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P Gibelin

Publications and source records attributed to P Gibelin.

At least 19 recordsLinked to original sources
PubMed2003

Non-invasive blood pressure variability in chronic heart failure: characteristics and prognostic value.

BACKGROUND: Short-term variability of blood pressure can be used as an index of sympathetic vascular modulation and has been studied in patients with hypertension. AIM: The aim of this study was to characterise blood pressure variability (BPV) and its prognostic value in patients with congestive heart failure. METHODS AND RESULTS: 104 patients with congestive heart failure due to ischemia (n = 104) or idiopathic cardiomyopathy (n = 50) in New York Heart Association (NYHA) class II (n = 50), III (n = 71), IV (n = 33), and 40 healthy subjects were studied. The mean ejection fraction was 0.33 +/- 0.10. Continuous non-invasive BP recordings were obtained for 3,600 seconds with a photoplethysmographic finger device in patients and control subjects at rest. Patients with chronic heart failure (CHF) had significantly less pronounced BPV than control subjects. Diastolic blood pressure (DBP) variability was related to left ventricular ejection and to peak oxygen uptake. BPV was not different in patients with ischemic or idiopathic CHF. During the mean follow up (+/- SD) of 565 +/- 215 days, 44 patients died (28.6%). All deaths were cardiac related. Cox's univariate analysis identified the following factors to be predictors of death: peak oxygen uptake (p = 0.01), ejection fraction (p = 0.008), and among BPV parameters: total spectral amplitude (TA) for DBP (p = 0.002), very low frequencies over total amplitude (VLF/TA) for DBP (p = 0.005) and for mean blood pressure (MBP) (p = 0.03), and very low over high frequencies ratio (VLF/HF) for DBP (p = 0.002). Multivariate analysis showed that BPV predicted survival independently of EF or peak VO2. Kaplan-Meier survival curves revealed that VLF/TA < 55% for DBP, MBP and SBP are useful risk factors. One-year survival in patients with VLF/TA < 55% of DBP was 53% compared with 95% in those with VLF/TA > 55% (p = 0.005). CONCLUSIONS: Decreased BPV in patients with CHF is related to left ventricular dysfunction. Analysis of BPV can identify patients with CHF who have an increased risk of cardiac death.

Aged↗
PubMed2002

[Role of angiotensin-converting enzyme inhibitors in the treatment of heart failure in the 21st century].

The angiotensin converting enzyme (ACE) inhibitors have progressively stood out in a large population of heart failure patients as a gold-standard treatment, in relation with their beneficial effects on mortality and morbidity. In a recent meta-analysis published in the Lancet collecting 12,763 patients, Flather demonstrates global mortality decrease of 25% compared to placebo. This risk reduction not only concerns the mortality due to heart failure but also that due to myocardial infarction. The same goes for the morbidity. Thus, in international as well as European recommendations, ACE-inhibitors are indicated as a first lane treatment in heart failure due to systolic LV dysfunction. Nonetheless several questions remain unanswered. The ACE-inhibitors are under-utilised, not only they are under-prescribed (only 60% of heart failure patients benefit from them) but also when prescribed, the dosage (comparing to those used in clinical trials) is generally as low as the half expected. This under-utilisation seems to be related to the side effects as renal failure, hypotension or more often due to the concern of their occurrence especially in the elderly and in those with other concomitant morbidities. They are actually related in part to an under-estimation of the benefit/risk ratio. The ATLAS study suggests that high doses of ACE-inhibitors are associated with a deeper reduction of morbidity without significant differences compared to low doses concerning global mortality or side effects. However this study compared very high (extreme) doses to low ones and comparison between heavy- and mid-doses remains to be performed. After the HOPE study, new indications appear promising: heart failure with preserved systolic function; patients with risk factors without heart failure: risk reduction of subsequent heart failure and reduction of mortality. Tolerance of their association with beta-blocking agents. In conclusion, the optimisation of the ACE-inhibitors treatment goes through a wider prescription with higher doses, probably extended to new indications.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

An evaluation of symptom classification systems used for the assessment of patients with heart failure in France.

Many systems have been proposed to assess the degree of functional impairment in patients with chronic heart failure in order to be able to draw comparisons between patients and assess the development of the disease in the same patient. The NYHA classification is subjective and insufficiently reproducible and has no real predictive value with respect to the exertion test. The Canadian classification does not contribute much in terms of validation. The Feinstein and Duke University classifications are too complex, not very easy to use and have never been validated. The scale of activity proposed by Goldman gives details on functional impairment by using examples from daily activities, selected for their variety and grouped according to the energy that they require. This classification is highly reproducible and is concordant with the exertion test (duration of the exertion test, VO2 max). However, it is not suitable for France. The examples are not precise enough: in addition, they do not eliminate contradictions that can make the patient impossible to classify. We propose a scale of activity specifically designed for use in France. It is reproducible and the VO2 peaks are highly concordant. Lastly, the questions the patient is asked are progressive, thus avoiding contradictory answers. This classification could prove to be useful in everyday life and also for multi-center studies in French-speaking countries.

Activities of Daily Living↗
PubMed1999

Seasonal variation in chronic heart failure hospitalizations and mortality in France.

BACKGROUND: Circannual variation in blood pressure and in the incidence of acute myocardial infarction is well known but has not been investigated in chronic heart failure. This report describes and compares the seasonal variation of chronic heart failure hospitalizations and mortality in the French population. METHODS AND RESULTS: All deaths that occurred among French adults over the period 1992 to 1996 (n=138 602) and all discharges by adults in French public hospitals for chronic heart failure over the period 1995 to 1997 (n=324 013) were examined retrospectively. First, chronic heart failure deaths in France occurred with a striking annual periodicity and peaked in winter (December through January), both in the overall population and in subgroups defined by age (>44 years old) and sex. The distribution of cumulative monthly deaths differed by nearly 35%, ranging from a peak of 20% above average in January to 15% below average in August (Roger's test: P<0.001). Second, hospitalizations for chronic heart failure in French public hospitals followed a similar seasonal pattern (P<0.001), with a winter-spring predominance (+7% to +10% from December through April). Third, for persons >/=85 years old, excess hospitalizations occurred earlier in the year, with marked synchronized peaks in January for both mortality and hospitalizations (P<0.001). CONCLUSIONS: Clear seasonal variations in adult chronic heart failure hospitalizations and deaths were identified. The considerable economic impact on health care services warrants further epidemiological investigations and a more comprehensive approach to disease management.

Adolescent↗
PubMed1999

Familial dilated cardiomyopathy: clinical features in French families.

UNLABELLED: The aims of the study were to analyze the clinical features, the penetrance and the mode of inheritance of 13 French families with dilated cardiomyopathy using diagnostic criteria recently established by a European collaboration. METHODS: Screening consisted of physical examination, ECG and Echo of all the probands first degree relatives (n = 118). Using major Echo criteria [ejection fraction (EF) < 45% or FS < 25% and left ventricular diameter (LVD) > 117% of the predictive value], or combined minor Echo/ECG criteria, relatives were classified as affected, unknown or healthy. RESULTS: (1) Adult affected relatives (n = 31) were identified with major Echo criteria in 74% of cases, and with combined minor Echo/ECG criteria in 26% of cases. (2) In the unknown relatives (n = 21), the most common abnormality was an isolated left ventricular dilation (67%). (3) Mode of inheritance was autosomal dominant (AD) in 11 families and possibly autosomal recessive in two. (4) In AD families, the penetrance was incomplete in adults (72%), age-related (O.R.: 1.3 per 10 years; 95% CI 1.03-1.56) and sex-related [greater in men (87%) than in women (61%), actuarial survival curve: P<0.002]. (5) Mortality related to end stage heart failure was 2.2 times as high as mortality related to sudden death (11% vs. 5%). CONCLUSIONS: (1) In the absence of a specific phenotype of FDC, the characterization of relatives appears more accurate when minor criteria were added. (2) Since high mortality (16%) and incomplete penetrance frequently give rise to small nuclei of clinically affected and alive relatives per family, the accurate model of penetrance that we proposed might be helpful in the future to enhance the statistical power of linkage analysis in this disease.

Adult↗
PubMed1999

Fasting, postprandial, and post-methionine-load homocysteinaemia and methylenetetrahydrofolate reductase polymorphism in vascular disease.

Hyperhomocysteinaemia is an independent risk factor for cardiovascular disease. The C677T mutation of the methylenetetrahydrofolate reductase (MTHFR) is a common genetic cause of increased homocysteine (HCY) levels. Post-methionine-load HCY concentrations allow identification of certain cases of hyperhomocysteinaemia not demonstrated by fasting levels. This study investigated the relationship between MTHFR polymorphism and (1) fasting HCY levels (77 patients); (2) post-methionine HCY levels (54 patients); and (3) postprandial HCY concentrations (36 patients) in cardiovascular disease. As expected, mean fasting HCY value was higher in the +/+ patients. Moreover, patients who were homozygous for the mutation exhibited significantly increased mean post-methionine-load HCY; in contrast, literature results are conflicting. Mean postprandial HCY, which is not known to be increased in controls, was also increased in the (+/+) patients, although the difference did not reach statistical significance, probably owing to the small size of the sample. MTFHR polymorphism is known to be aggravated by a drop in circulating folate. Additional risk factors may be more prevalent in patients with cardiovascular disease.

Adolescent↗
PubMed1999

[Evaluation of a specific French scale of activity in chronic heart failure. A national multicenter study. Group for Cardiac Insufficiency and Cardiomyopathy of the French Society of Cardiology].

Many systems have been proposed to evaluate the functional incapacity caused by chronic cardiac failure. The classification of the New York Heart Association (NYHA) is the best known. It is subjective, poorly reproducible and has a poor predictive value on effort. The authors propose a Specific French Scale of Activity with the object of a more accurate functional evaluation of cardiac failure, easier to use by the doctor and more specific to French patients and their life styles. A French multicentre study was set up in hospital departments by the French Society of Cardiology working group on Cardiomyopathy and Cardiac Failure to assess this new classification with respect to the NYHA classification and peak VO2 (Weber's classification). Eight centres participated in the study. A total of 124 patients with chronic cardiac failure and a mean age of 61 years (102 men) were included. Cardiac failure was due to ischaemic heart disease in 72 cases, hypertension in 10 cases, dilated cardiomyopathy in 40 cases and aortic regurgitation in 2 cases. Eighty-two patients underwent a double evaluation using the French Scale: 40 patients by 2 physicians and 42 patients by a physician and a nurse. Good reproducibility was found between the assessment by the 2 physicians in 35 cases (87%) and between the physician and nurse in 30 cases (71%). When compared with peak VO2, the classification was concordant in 47% of cases using the NYHA and in 61% of cases using the French Scale, with variation of one class in 40% of cases with the NYHA and 35% of cases with the French Scale. These results show good reproducibility and correspondence of classification with the exercise test which was better using the French Scale than the NYHA classification.

Aged↗
PubMed1998

[Transformation of left bundle branch block into simulated bundle branch block after ablation of the right bundle in a patient with branch-to-branch reentry ventricular tachycardia].

Masquerading bundle branch block associates left bundle branch block in the standard lead and right bundle branch block in the precordial leads. Mr R., 67 year old, was referred for investigation of syncope. He had a history of idiopathic dilated cardiomyopathy (normal coronary arteries; EF: 14%, CI: 2.2 l/min/m2 at later investigations). The ECG showed LBBB with left axis deviation, a PR interval at the upper limits of normal and ventricular premature beats. During observation, he had another syncopal episode and the ECG showed wide complex tachycardia (160 bpm) reduced by external cardioversion. Electrophysiological investigations showed inducible VT due to bundle branch reentry. The HV interval in sinus rhythm was 80 ms. Radiofrequency ablation of the right bundle led to first degree AVB with masquerading bundle branch block with an increased HV interval of 120 ms. The usual facility of ablation of the right bundle branch block is an argument in favour of the hypothesis whereby masquerading bundle branch block is a variety of RBBB with severe conduction defects of the two branches.

Aged↗
PubMed1998

[Aspirin, oral anticoagulants, and heart failure].

The incidence of thromboembolic complications in patients with cardiac failure is low. The predisposing factors are principally the presence of a left ventricular mural thrombus, atrial fibrillation, a low ejection fraction and a low peak VO2. The risk of cerebral haemorrhage in a patient with cardiac failure treated with oral anticoagulants is about the same as the risk of thromboembolism. Therefore, anticoagulant therapy for patients with cardiac failure is controversial in the absence of a prospective large scale clinical trial demonstrating its benefits. In the meantime, a prudent approach with risk stratification to determine which patients would benefit the most from oral anticoagulation is advised.

Anti-Inflammatory Agents↗
PubMed1998

[Prognostic value of study of heart rate variability in chronic cardiac insufficiency].

Analysis of heart rate variability is an attractive, non-invasive method for studying the cardiac response to stimulation by the autonomic nervous system which is decreased in chronic cardiac failure. The prognostic value of heart rate variability in cardiac failure has been the subject of recent research. The 24-hour standard deviation is the commonest parameter with an independent predictive value for mortality. However, its threshold value is variable according to the different studies. The percentage of successive RR intervals varying by more than 50 ms is a sign of parasympathetic activity and is not found to be an independent prognostic factor by all workers. The results of values of low frequency on spectral analysis are contradictory. Finally, the Poincaré graphic method showing an abnormal graph is one of the only predictive factors of sudden death. Blood pressure variability will probably complete the analysis of heart rate variability as a prognostic factor of chronic heart failure.

Cardiac Output, Low↗
PubMed1997

[Blood levels of homocysteine in patients under 55 years of age with acute coronary insufficiency].

OBJECTIVES: High blood levels of homocysteine have been recently described as a risk factor for thromboembolic events and early development of atherosclerosis. The aim of this work was to study homocysteine blood levels in patients under 55 years of age with acute coronary artery disease. PATIENTS AND METHODS: The study included 110 patients (98 men, 12 women) with poorly controlled angina pectoris (n = 35) or in the acute phase of myocardial infarction (n = 65). Homocysteine was assayed by liquid chromatography in all patients on the day of the acute episode and 24 hours later. Homocysteine levels were also determined in 40 controls under 55 years of age with no history of coronary artery disease. RESULTS: Blood level of homocysteine was 10.6 +/- 6.2 mumol/l in the patients and 7.7 +/- 2.5 mumol/l in the controls (p < 0.01). The difference was greater in the 30-40 year age rang with 14.4 +/- 2 mumol/l in patients versus 6.4 +/- 1.5 mumol/l in controls (p < 0.001). The assays were reproducible at 24 hours (difference less than 10%). The levels were significantly higher in patients with several diseased arteries than those with single-artery disease. The difference between patients and controls was especially remarkable for non-smokers and those with high cholesterol levels. CONCLUSION: Hyperhomocysteinemia would be a factor favoring early development of coronary atherosclerosis.

Acute Disease↗
PubMed1997

Detection of embolic signals using Doppler ultrasound: a new approach to cardiac embolism.

Cerebral embolism from cardiac, aortic or carotid cause can be detected by Doppler examination of carotid arteries or transcranial Doppler with long-duration recordings. The signals detected called HITS (high intensity transient signals), which have been described in vitro and in vivo, have specific physical characteristics. This novel technique is considered promising in establishing the relationship between the discovery of embolic heart disease and its clinical neurological manifestations. In the evaluation of a stroke, the detection of HITS could provide evidence in support of an embolic cause. The areas of application of this new technique are many: screening for asymptomatic embolism in patients with an embolic cardiac disorder, and effects of antiplatelet and anticoagulant medications or surgical treatments.

Cardiovascular Diseases↗
PubMed1996

[Complete regression of cardiac non-Hodgkin's lymphoma after 23 months with chemotherapy].

The authors report the case of a non-Hodgkin malignant lymphoma (NHL) of the heart presenting with syncope. The diagnosis of a cardiac tumours was made by echocardiography. Myocardial biopsy enabled diagnosis of a highly malignant NHL in a patient with a history of low grade NHL. Chemotherapy with CNOP (Cyclophosphamide, Novantrone, Oncovin, Prednisone) induced total regression of the tumour. The patient is in total remission 23 months later. The authors emphasise the value of echocardiography in the diagnosis and follow-up of this pathology. The case is also noteworthy because of the unusual transformation of a low grade to a high grade cardiac NHL.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[Anticoagulant treatment and dilated cardiomyopathy].

The prevalence of intracardiac thrombi in patients with dilated cardiomyopathy is very variable from one study to another, but is generally high: 20 to 25% for interatrial thrombi and 50% for intraventricular thrombi. There is also a high incidence of left atrial spontaneous contrast (30-40%). Left atrial thrombosis or spontaneous contrast is more common in atrial fibrillation, when the LA diameter is increased with low velocity intra-left atrial blood flow on Doppler examination and when there are disturbances of haemorrheological factors (increased fibrinogen levels and plasma viscosity). Ventricular thrombi are more common when the fractional shortening is decreased (< 11% = 80% of thrombi). The frequency of embolism is controversial. It varies between 1.4 and 12 events per 100 patients per year. The risk of complications is higher in patients with intracavitary thrombosis. The number of cerebral haemorrhagic complications in patients on long-term oral anticoagulants is far from negligible. Large prospective multicenter trials should be instituted, as for atrial fibrillation to evaluate systematic anticoagulation with respect to the risks. In the meantime, it would seem to be prudent to prescribe oral anticoagulants to all patients with dilated cardiomyopathy with an intracardiac thrombus and/or atrial fibrillation, and to perform echocardiography regularly when left ventricular function is very poor.

Anticoagulants↗
PubMed1994

[Transesophageal echocardiography in the etiological evaluation of ischemic cerebral vascular accidents. Value in young subjects].

OBJECTIVES: We conducted this study to evaluate the role of transoesophageal echocardiography in the aetiologic diagnosis of ischaemic cerebral vascular events in young subjects. METHODS: Over a 16-month period, 70 consecutive patients under 55 (mean age 49 years; range 32-55; 34 females, 36 males) underwent transoesophageal echocardiography as part of a complete work-up after a recent (< 1 month) cerebral event considered to be ischaemic in nature. Exclusion criteria were age over 55, vascular stenosis or ulcerated plaque, embologenic heart disease and valve prosthesis. 24-h Holter recordings were also obtained in all patients. RESULTS: The cerebral event was temporary in 11 subjects and permanent in the other 59. The ischaemic nature of the event was confirmed in all patients with computed tomography or magnetic resonance imagery. All patients were in sinus rhythm at examination and supraventricular paroxysmal arrhythmia was observed in 7 during the Holter recordings. The transoesophageal echocardiography was normal in 37 patients (52%) and pathologic in 33 (48%). The source of the embolus was identified in 4 cases (6%) and the probable cause of the cerebral event was found in 29 (42%). Among the abnormal structures observed were permeable oval foramens, inter-atrial septum aneurysms and plaques on the ascending aorta. CONCLUSIONS: In our selected population of patients under 55 years of age, transoesophageal echocardiography detected the certain or probable source of the ischaemic cerebral event in 48% of the cases, a diagnostic yield better than most other methods. Nevertheless, there is no known therapeutic response to several of the potential sources of embolus observed.

Adult↗
PubMed1994

[Heart rate variability in chronic cardiac failure insufficiency. Effect of severity and etiology].

The variability of the heart rate is a sign of the activation of the autonomic nervous system. This parameter was studied in 21 control subjects and 72 patients with chronic cardiac failure (20 stage II, 37 stage III and 15 stage IV of the NYHA) due to ischaemic heart disease in 48 cases and idiopathic in 24 cases. Spectral and non-spectral analysis of the variability of the heart rate recorded during 24 hour Holter monitoring was performed with the Marquette Electronics 8000 software. Plasma noradrenaline was measured in whole blood by HPLC. The left ventricular ejection fraction was measured by echocardiography. There was a superior to 40% decrease in non-spectral and over 50% decrease in spectral parameters in patients with cardiac failure. This was more pronounced when the cardiac failure was in an advanced stage. The decrease in sinus rhythm variability was proportional to the functional class (SDANN stage II: 96 +/- 34 ms; stage III: 63 +/- 34 ms; stage IV: 54 +/- 33 ms). Moreover, the non-spectral parameters were correlated to the ejection fraction and plasma noradrenaline levels (p < 0.01). In addition, with the same NYHA stage, plasma noradrenaline concentration, ejection fraction and heart rate, the SDNN and the pNN50 were over 50% lower in idiopathic cardiomyopathy than in ischaemic cardiomyopathy. In conclusion, the variability of the heart rate is reduced in chronic cardiac failure in relation with the severity and aetiology of the underlying disease.

Aged↗