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Biomedical subjects

M Komajda

Publications and source records attributed to M Komajda.

At least 145 records · Page 8Linked to original sources
PubMed1990

[Analysis of predictive factors of mortality in dilated cardiomyopathy. A cooperative study by the Cardiomyopathy Working Group].

UNLABELLED: An analysis of factors predictive of mortality was undertaken in a group of 201 patients with dilated cardiomyopathy (163 men, 38 women; average age 46 +/- 11 years) using a multivariate analysis (Cox's model) of 51 clinical electrocardiographic, echocardiographic and haemodynamic parameters. The average follow-up period was 57.1 +/- 29.9 months. Fifty-six patients died and the probability of 5-year survival was 77 +/- 3 per cent. The best predictive factor of survival was determined by the combination of the following parameters: presenting symptom: pulmonary oedema, peripheral oedema, syncope; duration of symptoms before inclusion into the study; left ventricular end diastolic volume; left ventricular end diastolic dimension; systolic pulmonary artery pressure. A quantitative score "S" was calculated which enabled identification of 3 subgroups: A (S less than 4.5); B (4.5 less than S less than 6); C (S greater than 6). The probability of 5-year survival was 90 +/- 5 per cent in Group A, 84 +/- 4 per cent in Group B and 53 +/- 7 per cent in Group C. IN CONCLUSION: global survival was relatively long in this patient population with dilated cardiomyopathy at different stages of evolution; the combination of factors related to clinical severity, left ventricular dilatation, systolic pulmonary artery pressure and duration of symptoms allows identification of a subgroup of patients with a poor prognosis.

Adult↗
PubMed1990

[Mortality in cardiac insufficiency. Evaluation of prognosis, influence of treatments].

Chronic cardiac failure is associated with a high mortality from refractory cardiac failure or sudden death. Several factors (etiology, clinical severity, hemodynamic parameters, degree of left ventricular dilatation, biological parameters, conduction defects and arrhythmias) seem to have a predictive value for mortality in this condition. Univariable analysis does not take into account any interrelation between these parameters. Therefore multivariable analysis should be used to assess the independent predictive value of a given factor on mortality. Most published studies in the medical literature concern patients in severe cardiac failure. It is not clear whether the identified factors of poor prognosis can be extrapolated to mild cardiac failure. The influence of treatment on the clinical course of cardiac failure is not well understood: favorable effects of vasodilators, converting enzyme inhibitors, no or unfavorable effects of positive inotropic agents, unknown effects (diuretics, digitalis, betablockers). Only randomised, multicentre therapeutic trials in comparable groups of patients can provide information about the effects of medical treatment on the long-term prognosis of cardiac failure.

Arrhythmias, Cardiac↗
PubMed1990

[Role of arterial hypertension in the cardiac involvement of acromegaly].

Cardiac disease is common in acromegaly. Several mechanisms have been implicated: hypertension, coronary artery disease, valvular heart disease, endocrinopathies including "acromegalic cardiomyopathy". Fifteen consecutive patients with acromegaly, aged 48 +/- 13 years and treated for 4 +/- 5 years, underwent Doppler echocardiography. The patients had no cardiovascular symptoms: 6 had hypertension for 10 +/- 7 years and were compared with a group of 10 control subjects of the same age (48 +/- 17 years). The myocardial mass index (MMI) was higher in acromegaly (110 +/- 32 vs 82 +/- 12 g/m2, p = 0.02), left ventricular enddiastolic dimensions where comparable (48 +/- 7 vs 48 +/- 5 mm, NS) fractional shortening was slightly greater (0.37 +/- 0.04 vs 0.34 +/- 0.04, p = 0.07) as was velocity of shortening (NS) and the ratio of systolic time intervals (NS). The mitral EF slope was decreased (80 +/- 21 vs 101 +/- 30 ms; p less than 0.02); the ratio of the amplitudes of the E and A waves was a little decreased and the isovolumic relaxation phase was increased (92 +/- 13 vs 69 +/- 16 ms; p less than 0.01). Hypertensives (N = 6) had higher MMI (133 +/- 27 vs 94 +/- 24 g/m2, p = 0.02). Normotensive patients had larger isovolumic relaxation periods than control subjects (90 +/- 11 vs 69 +/- 16 ms, p less than 0.05). These results show that in the infraclinical phase, the heart in acromegaly is hypertrophied, not dilated. Hypertension plays a significant role in the development of this hypertrophy. Left ventricular systolic function is normal but diastolic function is impaired.

Acromegaly↗
PubMed1990

[Long-term effects of indapamide in left ventricular hypertrophy in patients with hypertension].

Left ventricular hypertrophy is a major and independent cardiovascular risk factor in hypertension. The effects of a diuretic, indapamide, on the regression of left ventricular hypertrophy were studied in a group of 9 patients with mild hypertension treated in an open therapeutic trial over a 12 month period. At the end of the trial, the left ventricular mass index decreased significantly from 172 +/- 11 to 147 +/- 11 g/m2 (p less than 0.001). Therefore, in contrast to the other diuretics which have been studied, indapamide seems able to induce regression of the left ventricular hypertrophy complicating hypertension.

Adult↗
PubMed1989

Right heart failure due to an inter-atrial shunt after percutaneous mitral balloon dilatation.

Percutaneous mitral valve dilatation was performed in a 61-year-old female patient with severe mitral valve stenosis. The valve could be dilated, but a moderate left to right atrial shunt was present after the procedure. Although the mitral valve area had increased from 1 cm2 to 1.7 cm2, the patient presented 1 week later with right heart failure, explained by right heart volume overload resulting from the persistent shunt. Clinical status quickly improved with diuretics. Although this evolution has not been previously reported, it may be expected in older patients with decreased compliance of pulmonary arteries and right heart chambers.

Cardiac Volume↗
PubMed1989

[Value and limitations of new cardiotonic agents].

New cardiotonic agents are an original approach in the treatment of severe heart failure. They can be classified into two groups: --beta-adrenergic agonists which stimulate beta-adrenergic receptors and, therefore, increase cyclic AMP production and intracellular calcium concentration; --phosphodiesterase inhibitors which block the cyclic AMP intracellular degradation pathway. Rapid tachyphylaxis may occur with beta-adrenergic agonists through a down-regulation phenomenon and, therefore, limits the value of this group to short-term treatment. Several different biochemical compounds are under evaluation in the second group. Short-term effects appear beneficial but cardiac side-effects may occur. The value and indications of these drugs in long-term treatment of chronic congestive heart failure remain to be determined.

Cardiotonic Agents↗
PubMed1988

[First-line treatment of cardiac insufficiency: digitalis glycosides, diuretics, vasodilator agents or new cardiotonic agents?].

The advent of vasodilator therapy and new cardiotonic agents has modified the medical treatment of heart failure. First-line treatment is no longer standard; its choice must take into account a number of individual factors such as patient's age, causative cardiopathy, severity of the disease, response to treatment, contra-indications and side-effects of drugs. The aim is to obtain an improvement not only in the patient's comfort but also in long-term prognosis. The prescription of digitalis compounds to heart failure patients with sinus rhythm has been questioned. Alternatives to the conventional therapeutic approach based on cardiac glycosides and diuretics are now available. They include the use at an early stage of vasodilator therapy, and notably angiotensin-converting enzyme inhibitors, in the hope of avoiding gradual reduction of cardiac performance.

Cardiotonic Agents↗
PubMed1988

Detection of myocarditis during the first year after discovery of a dilated cardiomyopathy by endomyocardial biopsy and gallium-67 myocardial scintigraphy: prospective multicentre French study of 91 patients.

The purpose of this study was to assess the frequency of inflammatory lesions in the myocardium of subjects with dilated cardiomyopathy and to determine if there was any correlation between the results of two methods of evaluation, one (endomyocardial biopsy) invasive and the other (gallium-67 scintigraphy) noninvasive. Of 115 subjects recruited in seven centres, 91 met the inclusion criteria (left ventricular dilatation greater than or equal to 100 ml m-2 and ejection fraction less than 55% with normal coronary arteriography) and had endomyocardial biopsy (mean five specimens) and Ga-67 myocardial scintigraphy after several days. Scanning was considered doubtful 19 times and positive 13 times. The histologic count of mononuclear cells in the myocardial interstitium in 20 fields was greater than 5 cells field-1 in only four cases. No correlation was found between the two methods. Subjectivity in the choice of the criterion of positivity of Ga-67 scintigraphy and difficulties in identifying lymphocytes upon pathological examination were the major problems encountered. Despite limitations, both techniques suggest that cellular infiltrates are minimal and quite infrequent in dilated cardiomyopathy.

Adolescent↗
PubMed1988

[Atrial natriuretic factor, catecholamines and the renin-angiotensin system in cardiac insufficiency. Relation to hemodynamic parameters].

Plasma concentrations of atrial natriuretic factor (ANF), catecholamines (adrenaline, noradrenaline, dopamine) and aldosterone, and plasma renin activity (PRA) were measured in a group of 20 patients with moderate to medium heart failure (NYHA class II 7 patients, class III 13 patients), 24 hours after treatment was discontinued. Compared with a control group, plasma concentrations of ANF (p less than 0.01), noradrenaline (p less than 0.05), aldosterone (p less than 0.01) and PRA (p less than 0.01) were significantly increased. There was a significant difference between class II patients and class III patients in plasma ANF (p less than 0.01) and noradrenaline (p less than 0.02) concentrations, but not in PRA and aldosterone levels. A significant correlation was observed between plasma ANF concentration and left ventricular end-diastolic pressure (r = 0.68, p less than 0.001), pulmonary arterial pressure (r = 0.59, p less than 0.01), pulmonary capillary pressure (r = 0.51, p less than 0.02), cardiac index (r = 0.46, p less than 0.05) and left ventricular end-diastolic volume (r = 0.50, p less than 0.05). However, ANF concentration was not correlated with mean right atrial pressure. Plasma adrenaline concentration correlated with systemic arterial resistance (r = 0.80, p less than 0.001), pulmonary arterial pressure (r = 0.57, p less than 0.02), mean pulmonary capillary pressure (r = 0.62, p less than 0.001), cardiac index (r = 0.53, p less than 0.05) and left ventricular end-diastolic pressure (r = 0.58, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

RO 13-6438 in congestive heart failure: dose-response relationship after 3 single doses.

The dose-response for the new cardiotonic agent RO13-6438 was studied in 6 patients with grade III or IV congestive heart failure. Oral doses of 10, 20, or 30 mg of RO 13-6438 were administered on 3 consecutive days in accordance with a double-blind, randomized cross-over pattern. Hemodynamic changes, which were dose-dependent, included an increase in cardiac index combined with decreases in pulmonary capillary wedge pressure and systemic and pulmonary arterial pressures. Heart rate remained unchanged. The area under the plasma RO 13-6438 concentration time curve and the peak plasma concentration were dose-related. At each measurement, the log concentration of RO 13-6438 correlated with the percent changes in both cardiac index and capillary wedge pressure recorded at that time.

Administration, Oral↗
PubMed1987

[HLA A-B and DR in dilated myocardiopathies].

HLA A, B typing was performed in 90 patients (90 men, 10 women), and HLA DR typing in 49 patients with dilated cardiomyopathy in order to test the hypothesis that a particular genetic background may influence the immune response in that disease. No significant difference in phenotype frequency of the HLA A and B antigens was observed between patients and control population. In contrast, the HLA DR4 antigen was significantly more frequent among patients (40.8% vs 23.8%, p corrected less than 0.001). The results suggest that genetic factors play a role in the pathogenesis of dilated cardiomyopathy, and that since DR4 is frequently associated with auto-immune manifestations, a modified immune response is possible in dilated cardiomyopathy.

Adolescent↗
PubMed1986

Dilated cardiomyopathy and the level of alcohol consumption: a planned multicentre case-control study.

The association between clinical or environmental factors and dilated cardiomyopathy (DCM) has been assessed in a planned case-control study. Patients and controls were men aged between 20 and 65 years, matched for age, profession and geographic location. DCM was defined by strict radiologic and angiographic criteria excluding multiple-vessel coronary disease. Controls were recruited from the surgical centres after excluding diseases usually linked with alcohol or tobacco consumption. Univariate and multivariate analyses were used to ensure adequate techniques for matched pairs. The prevalence of diabetes and hypertension and the exposure to toxic substances, drugs and tobacco was identical in both groups. Alcohol consumption before the onset of first symptoms was higher in patients than in controls (101 vs 64 ml day-1, P less than 0.001); the excess of consumption concerns all kinds of alcoholic beverage (wine, beer, etc.). The relative risk (RR), estimated from the odds ratio, increased only among heavy drinkers (greater than or equal to 110 ml day-1; RR: 7.6, P less than 0.001) with an independent contribution of both wine (RR: 4.7, P less than 0.001) and other alcoholic beverages (RR: 4.1, P less than 0.01). In conclusion, alcohol is a strong risk factor for DCM, but the excess of risk is limited to heavy drinkers and is independent of the type of beverage.

Adult↗
PubMed1986

Left coronary artery aneurysm and anteroseptal acute myocardial infarction following blunt chest trauma.

After a suicide attempt (fall from the ninth floor) a 28-year-old man presented with a blunt chest trauma. Electrocardiographic and enzymatic changes were characteristic of an acute anteroseptal myocardial infarction. A thallium myocardial scan showed decreased uptake of thallium over the septal area. Coronary angiography performed 6 weeks after the injury demonstrated aneurysmal dilatation of the left anterior descending artery which was patent, intramyocardial haemorrhage in the septum, and septal akinesia. The other left and right coronary arteries were normal. The patient remained asymptomatic 8 months later under medical treatment.

Adult↗
PubMed1986

Long-term experience with tertatolol in hypertension.

The long-term antihypertensive activity and acceptability of a new beta-blocking agent tertatolol (T) (5 mg once daily) was assessed in a 12-month (M0-M12) open study, in 110 out-patients (64 men, 46 women, mean age 53.5 +/- 1.0 years), presenting with stable placebo-resistant hypertension (HT) (95 less than or equal to diastolic blood pressure less than 130 mm Hg on 3 occasions during a 1-month placebo run-in period). To obtain normalization of blood pressure (BP), treatment was adapted as from M3, adding a combined thiazide- and potassium sparing-diuretic (D) and, if necessary, the vasodilator dihydralazine (V). At M12, 93.6% of patients were controlled (supine diastolic BP less than 95 mm Hg) among whom 72.7% under T monotherapy, 16.4% under double therapy (T + D) and 4.5% under triple therapy (T + D + V). Overall variations of BP were 26.4 mm Hg for SBP (from 171.7 +/- 1.6 to 145.3 +/- 1.3 mm Hg; p less than 0.01) and 19.9 mm Hg for DBP (from 105.6 +/- 0.7 to 85.7 +/- 0.6 mm Hg; p less than 0.01). Under T monotherapy, reduction in diastolic BP occurred early (15.0 mm Hg at M1) and was sustained thereafter (19.5 mm Hg at M12); HT control was comparable in the 40- to 60- and greater than 60-year-old age groups (respectively 67.6% and 74.1%) and higher in the less than 40-year-old group (100%). It also rose from 61.2% when initial diastolic BP was greater than 105 mm Hg to 82.0% when it was less than or equal to 105 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1986

[Treatment of torsade des pointes by intravenous magnesium].

A 72 year old woman was admitted with decompensation of a hypertensive cardiopathy and treated with diuretics. She developed recurrent syncopal torsades de pointes during the 24th hour which were reduced by a bolus intravenous injection of 3 g of magnesium sulphate (Mg SO4). There was a recurrence 30 minutes later which regressed after a second injection of 3 g of Mg SO4. A continuous intravenous infusion of 18 g/day of Mg SO4 prevented further recurrences of the arrhythmia. Biochemical analysis showed intra and extracellular magnesium deficiency at the time of the torsades de pointes but the intracellular potassium was normal. The QT interval was prolonged but this parameter did not change after the bolus of Mg SO4. It returned to normal progressively afterwards. The clinical course was uncomplicated with no recurrences. Metabolic correction was obtained in 3 days. This observation raises the question of the mechanisms relating diuretic therapy, magnesium and torsades de pointes.

Aged↗
PubMed1986

[Coronary stenosis after radiotherapy. Clinical study of 5 cases and review of the literature].

Coronary artery stenosis is one of the possible complications of radiotherapy to the mediastinum. Although less frequent than pericardial disease, anatomopathological studies have shown it not to be uncommon. Five cases with different clinical presentations are reported and the 30 previously described cases are reviewed. Radiotherapy was performed for Hodgkin's disease in 70% of cases and for carcinoma of the breast in 10% of cases. The average delay before onset of the symptoms was 4 years but in some cases delays of up to 10 years were observed. The most common presentation was an inaugural myocardial infarction (50 to 60% of cases). In other cases, angina of effort or typical spastic angina was observed. The coronary lesions were mainly proximal single artery stenosis affecting especially the left anterior descending artery. The typical histological appearances of the stenosis were intimal and sometimes adventicial fibrosis, occasionally associated with medial hyaline sclerosis. However, atherosclerotic lesions were also commonly present. This observation raises the question of the role of irradiation in the development of precocious atherosclerosis by coronary endothelial damage. This hypothesis is supported by the results of experimental studies and by the fact that several autopsy reports showed that the atheroma only developed in the irradiated zone. In addition, although the most demonstrative cases are those of young patients of 30 to 35 years of age, the responsibility of radiotherapy in the development or coronary pathology of older patients cannot be excluded, especially when none of the classical coronary risk factors are present.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗