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Biomedical subjects

M Komajda

Publications and source records attributed to M Komajda.

At least 163 records · Page 9Linked to original sources
PubMed1986

[Exploration of left ventricular function in insulin-dependent diabetics (relation with retinopathy)].

Non invasive methods for the exploration of myocardial function permit the demonstration of preclinical diabetic cardiomyopathy. In this study, we have tried to define the relationship between the degree of diabetic retinopathy and the presence of myocardial dysfunction. We have recorded echocardiogram and phonomechanograms on thirty two insulin dependent diabetics (IDD) less than 50 years of age, without evidence of arteriosclerosis. All patients had a normal baseline electrocardiogram and a normal bicycle exercise test. These diabetics were assigned to three groups: I = no retinopathy (9 patients); II = minimum retinopathy (12 patients); III = marked retinopathy (11 patients). They were compared to ten non-diabetic control subjects of similar age (group 0). None of the parameters of systolic function was modified in the different groups of diabetics in comparison with the control group. We found, however, a very significant reduction of the maximum rate of enlargement of left ventricule and reduction of the maximum narrowing rate of the left ventricular posterior wall during the protodiastolic period in group III, v.s. group 0, I and II. Group III contained 3 patients with borderline hypertension and 5 patients with diabetic glomerulopathy. Our results indicate a diminution of myocardial compliance and relaxation in those IDD with marked retinopathy, but it raises the question of the role of borderline elevations of arterial pressure or hypertension during physical exercise, which are frequently found in diabetics with retinopathy in causing these abnormalities.

Adolescent↗
PubMed1985

[Efficacy and side effects of long-term treatment with amiodarone. Retrospective study. Apropos of 460 cases].

A retrospective study was conducted in a group of 460 patients in order to evaluate the effectiveness and frequency of side effects of amiodarone over a mean observation period of 2 years. The effectiveness was considered to be excellent or good in 71.5 p. cent of cases of ischaemic heart disease, in 84.8 p. cent of cases of supraventricular arrhythmia and in 92.3 p. cent of cases of ventricular arrhythmia. Side effects were observed in 32.8 p. cent of patients and treatment had to be suspended in 19.8 p. cent of cases. The most frequent side effects were photosensitisation (11.9%), thyroid disorders (5.6%) and bradycardia or sinus dysfunction (11.9%). Some of these side effects appear to be related to the cumulative dose received.

Adolescent↗
PubMed1985

[New cardiotonic agents].

The possibilities for therapy in the field of severe cardiac insufficiency have been extended in recent years by the introduction of novel agents endowed with a positive inotropic action. These substances may be arranged in two large classes: sympathomimetic agents and "non sympathomimetic--non digitalis-like" inotropic agents. The stimulant action of noradrenaline, adrenaline and isoproterenol on beta-adrenergic myocardial receptors has been clearly demonstrated but the usefulness of these medicines is limited by their positive chronotropic and arrhythmogenic actions. Dopamine and dobutamine have proved to be very useful in the treatment of patients in intensive care units. However, the exclusively intravenous route of administration limits their importance to the medium or long term. Several compounds, which are active by the oral route, have been the subject of therapeutic trials for the short or medium term. The problems posed by their use result, in the first place, from an insufficient understanding of their mechanism of action. Some of them (pirbuterol, salbutamol, terbutaline, penoterol) seem to act preferentially on B2 adrenergic receptors and the haemodynamic effect results, in part or predominantly, from the vasodilator action which they cause. On the other hand, other agents (prenalterol, ICI 108-87) show a relative selectivity for B1 adrenergic receptors. Ibopamine exerts its action on B1 receptors and dopaminergic receptors. A second problem concerns the hypothetical character of their long term therapeutic activity. A major problem in the use of several of these sympathomimetic agents in chronic treatment is the appearance of a desensitization of the beta receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Aminopyridines↗
PubMed1984

[Hemodynamic effects of ARL 115 in left ventricular insufficiency].

ARL 115 has vasodilator and positive inotropic properties which justify its use in heart failure. The effects of this drug were studied in 8 patients with advanced myocardial failure (7 cases of primary cardiomyopathy and 1 case of ischaemic cardiomyopathy) undergoing diagnostic cardiac catheterization, 15 minutes after angiocardiography. The cardiac output pressures were measured and the M mode electrocardiogram was recorded under basal conditions and following an infusion of 1 mg/kg of ARL 115 over 10 minutes. An improvement was observed in 7 cases, with an increase in the cardiac output and a decrease in the left ventricular diastolic pressure (p less than 0.05). There was no significant modification in the heart rate and there were no side effects. In one case, an abrupt fall in the diastolic pressure led to a decrease in the cardiac output. The arterial and venous vasodilator properties were demonstrated in every case, but a positive inotropic action (increase in the dp/dtmax and modification of the end-diastolic pressure: dimension ratio) was demonstrated in only two cases. The absence of positive inotropic action in the 6 other cases could be due to the advanced myocardial deterioration in these patients or to a delay in the positive inotropic effect in relation to the vasodilator effect.

Adult↗
PubMed1983

[Long-term treatment of chronic heart failure by an inhibitor of angiotensin converting enzyme].

We studied the hemodynamic, echocardiographic, phonomechanographic and hormonal changes during acute (25 mg) and chronic (6 months--75 to 225 mg/day) treatment of 10 patients with congestive cardiac failure due to cardiomyopathy with dilatation with SQ 14 225 (Captopril). The following changes were observed after the single dose: an increase in cardiac output (p less than 0,001), in stroke volume (p less than 0,01), a reduction in heart rate (p less than 0,01), in peripheral resistance (p less than 0,001) and pulmonary capillary pressure (p less than 0,001). There were no significant changes in end systolic or end diastolic left ventricular internal diameter. Plasma renin activity increased (p less than 0,001); there was a concurrent fall in serum aldosterone (NS): the plasma concentration of converting enzyme decreased (p less than 0,001). There was a correlation between the increase in peripheral resistance under basal conditions and the basal plasma renin activity (R = 0,72, p less than 0,02). The decrease in peripheral resistance after captopril also correlated with basal plasma renin activity (R = 0,89, p less than 0,01). After six months continuous therapy, the hemodynamic effect was sustained and was accompanied by a significant symptomatic improvement. Left ventricular internal end systolic and end diastolic diameters decreased (p less than 0,01 and p less than 0,01 respectively). The pre-ejectional period decreased (p less than 0,05). Serum aldosterone fell significantly (p less than 0,001) as did plasma renin activity (p less than 0,01); the serum level of converting enzyme remained low with respect to its initial value. These results show that captopril may be useful in severe cardiac failure without tolerance during long-term administration. No renal or hematological toxicity was observed in this group of patients.

Adult↗
PubMed1983

[Mitral systolic anterior motion and left ventricular function in obstructive cardiomyopathy].

The term hypertrophic cardiomyopathy with obstruction encompasses a wide range of clinico-pathological conditions. The mildest forms have localised septal hypertrophy and obstruction only during pharmacodynamic stimulation. The more severe forms have major wall hypertrophy and are obstructive under basal conditions. Mitral systolic anterior motion (SAM) recorded at echocardiography is generally attributed to obstruction. However, the construction of this image by subvalvular structures and the relationship between the obstruction and anatomical deformation led us to study left ventricular haemodynamics with respect to the presence or absence of SAM under basal conditions. Thirty one cases of hypertrophic obstructive cardiomyopathy were divided into 2 groups: -- Group 1 without basal SAM (11 cases); -- Group 2 with SAM under basal conditions (20 cases). Under basal conditions there was no significant difference in LVEDP or ventricular volume between the two groups. An intraventricular pressure gradient was commoner in Group 2 (65% compared to 27%) as was mitral incompetence (53% compared to 27% in the 30 patients undergoing selective left ventriculography). Left ventriculography in the right anterior oblique plane distinguished two types of LV deformation: systolic biloculation of the chamber and systolic apical obliteration. The second form was mainly observed in Group 2. The effect of isoproterenol on LVEDP was studied in 9 cases in Group 1 and 13 cases in Group 2: LVEDP decreased from 14 +/- 6 mmHg to 8 +/- 6 mmHg in Group 1, and increased from 14.5 +/- 6 to 23.5 +/- 6.5 mmHg in Group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

Long-term treatment of congestive heart failure with captopril.

1 The efficacy of the converting-enzyme inhibitor captopril in the management of severe congestive heart failure was assessed in 14 patients over 360-885 days by clinical evaluation, M-mode echocardiography, systolic time intervals, plasma renin activity, and plasma aldosterone. 2 As compared with baseline values, a significant reduction was observed in heart rate, mean arterial pressure, left ventricular end-diastolic and end-systolic diameters, left ventricular pre-ejection period, tension time index, body weight, and plasma aldosterone. Significant increases in left ventricular ejection time and fractional circumferential shortening (p less than 0.01) were also observed. 3 The functional and haemodynamic benefit provided by captopril was therefore sustained during long-term therapy without severe untoward effects or attenuation.

Adult↗
PubMed1981

[Angiographic morphological study of the left ventricle in obstructive cardiomyopathy. Comparison with haemodynamic data (author's transl)].

The right anterior oblique ventriculographs of 20 patients with obstructive cardiomyopathy were reviewed, and the images obtained during systole were divided into three groups: (1) bilocular left ventricular cavity with midventricular stenosis; (2) obliteration of the ventricle reduced to its infra-sigmoidal portion, with atrophy or even amputation of the apical portion; and (3) subnormal image. Haemodynamically, the most common abnormality (5/8 patients) in group 1 was the presence of a gradient in the basal state. In group 2, this gradient was only found in 2/8 patients, but the left ventricular telediastolic pressure was much higher in the basal state or after stimulation than in group 1. Haemodynamic changes were moderate in group 3. The abnormalities in left ventricular telediastolic pressure in this type of cardiomyopathy are interpreted as reflecting disorders in compliance which would then be maximal in group 2. This study is part of an attempt to classify the various characteristics of the left ventricle with the view of identifying some forms amenable to surgical treatment.

Adult↗
PubMed1981

[Long-term treatment of severe cardiac failure with captopril (author's transl)].

Nine patients with primary, non-obstructive myocardiopathy were treated during 6 months with captopril in daily doses of 75 to 225 mg. Early signs of haemodynamic improvement included significant increase in cardiac output (p Less Than 0.01) and stroke volume (p Less Than 0.01) and significant decrease in peripheral resistance (p Less Than 0.001) and pulmonary wedge pressure (p Less Than 0.001). These effects were sustained throughout treatment and were accompanied with noticeable improvement in the patients' functional status. Echocardiographic studies showed a reduction in the telesystolic (p Less Than 0.01) and telediastolic (p Less Than 0.05) diameters of the left ventricle after 6 months's treatment. The preejection period, calculated from phonomecanograms, was also significantly reduced. Plasma renin activity initially rose (p Less Than 0.01), then fell below pre-treatment values (p Less Than 0.02). Plasma aldosterone levels decreased (p Less Than 0.05), together with angiotensin-converting enzyme levels (p Less Than 0.05). Basal plasma renin activity correlated with both basal peripheral resistance (r = 0.72; p Less Than 0.02) and fall in peripheral resistance (r = 0.89; p Less Than 0.01). There was no tachyphylaxis nor evidence of blood, kidney or liver toxicity.

Adult↗