PubMed Health⌕ Search

Biomedical subjects

P Gosse

Publications and source records attributed to P Gosse.

At least 19 recordsLinked to original sources
PubMed1992

[Are non blood pressure effects of converting enzyme inhibitors important in arterial hypertension?].

Lowering blood pressure by medical treatment is not enough for correct prevention of the cardiovascular complications of high blood pressure. In this respect, we would like to emphasize the potential value of the non-antihypertensive effects of angiotensin-converting enzyme (ACE) inhibitors which may be summarized as follows. In the heart, ACE inhibitors significantly reduce left ventricular hypertrophy. They have no noticeable anti-ischaemic activity and are devoid of antiarrhythmic effects. On the kidneys, ACE inhibitors seem to have a protective effect, still to be determined, in certain cases of diabetes or renal impairment. ACE inhibitors have no deleterious metabolic effects. Other antihypertensive agents share the same properties. Long-term comparative trials are necessary to find out whether some of these drugs are more effective in this field than the others.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

[Relative value of attenuation and negativation of systolic pulmonary venous flow in severe mitral insufficiency. Transesophageal echocardiographic study].

The aim of this study was to analyse the velocity profile of the systolic fraction of the pulmonary venous flow (PVF) in mitral regurgitation (MR). Three velocity profiles were identified in left superior pulmonary vein. Inversion of the systolic fraction of the PVF was specific for angiographic grade 4 MR (specificity 97%, sensitivity 100%). On the other hand, a decrease in this wave is much less specific for mild MR and depends on severe factors such as left atrial pressure, size and ejection fraction and the lack of atrial systole (as in atrial fibrillation or atrioventricular block). Therefore, inversion of PVF has a good positive predictive value for severe MR, but the interpretation of attenuation of this wave should take into consideration not only the MR but also left atrial pressure and compliance.

Blood Flow Velocity↗
PubMed1992

Mechanical cardiac valve thrombosis. Is fibrinolysis justified?

BACKGROUND: Thrombosis is a serious complication of heart valve replacement, and management is often difficult. In recent years, thrombolytic therapy has been used as the primary technique by some investigators. METHODS AND RESULTS: Sixty-four consecutive patients presenting with 75 instances of prosthetic heart valve thrombosis (41 mitral, 33 aortic, one tricuspid) were treated with fibrinolytic agents. Obstructed prosthetic valves comprised 39 tilting disc and 36 bileaflet valves. The time interval between valve replacement and obstruction ranged from 15 days to 192 months (mean, 38 months). Fibrinolytic agents used were streptokinase (42 patients), urokinase (27 patients), or recombinant tissue-type plasminogen activator (six patients). Immediate results of fibrinolytic treatment were 1) full success after one or several consecutive fibrinolytic regimens in 55 cases (73%), 2) incomplete improvement in two cases, and 3) failure in 18 cases, leading to an emergency surgery in nine cases. Nine patients died (four strokes, four cardiac arrests, one hemorrhage). Only one severe hemorrhagic complication was observed, but 11 cases of embolism occurred during fibrinolytic treatment (14.6%) (four major cerebral embolisms with death). The immediate efficacy was better for thrombosed aortic prosthesis than with the mitral prosthesis (85% versus 63%). CONCLUSIONS: Fibrinolytic treatment appears to be an attractive nonsurgical alternative for prosthetic heart valve thrombosis, but because of the risk of cerebral embolism, its use should be reserved for tricuspid valve thrombosis or critically ill patients with mitral or aortic valve thrombosis. The use of a fibrinolytic agent in cases of small, nonobstructive paravalvular thrombosis demonstrated with transesophageal echocardiography needs further studies.

Aortic Valve↗
PubMed1992

[Comparative effects of angiotensin converting enzyme inhibitors and calcium inhibitors related to baseline ambulatory blood pressure. A French multicenter study].

OBJECTIVE: This multicenter study was aimed at determining whether the baseline ambulatory blood pressure (BP) level does influence the efficacy of angiotensin-converting enzyme inhibitors (CEI) and that of calcium antagonists (CA) to the same degree. METHODS: The BP recordings of 236 patients with mild to moderate hypertension were reviewed: these subjects previously entered clinical trials comprising a mean 2-week placebo period and a mean 6-week active treatment phase (CEI = 115, CA = 121). The 24-hour baseline ambulatory BP was considered as high when greater than 139/87 mmHg, according to Staessen's meta-analysis. RESULTS: In the patients with an high baseline ambulatory BP, CEI and CA have had roughly a similar effect (reduction in systolic = 9.5 +/- 7.8% vs 7.7 +/- 6.3%, NS; reduction in diastolic = 9.8 +/- 8.6% vs 8.3 +/- 5.8%, NS). Conversely, the patients with a baseline ambulatory BP level lower than or equal to 139/87 mmHg experienced a greater reduction in ambulatory BP with CEI than with CA (systolic = 7.9 +/- 7.0% vs 0.6 +/- 6.7%, p = 0.0001; diastolic: 5.0 +/- 7.4% vs 1.9 +/- 7.6%, p = 0.040). Finally, further analysis found the threshold of drug efficacy to be 120/80 and 135/85 mmHg in CEI and CA patients respectively. CONCLUSIONS: 1) CEI are more effective than CA in patients with a low ambulatory BP only. 2) The risk of a visceral hypoperfusion seems however to be limited, since CEI do not reduce diastolic ambulatory BP further, when its baseline level is lower than 80 mmHg.

Adult↗
PubMed1992

[Effects of verapamil and nifedipine on blood pressure during rest and exertion and on left ventricular hypertrophy].

UNLABELLED: The effects of 6 months treatment with nifedipine 20 mg SR (N) or verapamil 240 mg SR (V) on rest and exercise BP and left ventricular mass (LVM) and function were evaluated in 31 essential hypertensive patients (mean age: 54, 19 males, 12 females), never treated with calcium antagonist. After a 15 days placebo run in, BP was measured at rest and during a maximal bicycle exercise test (stages: 30 watts, 3 min). 2D guided M mode echocardiography and pulsed Doppler allowed assessment of left ventricular mass (Devereux's formula) and function (fractional shortening FS, peak early (E) and late (A) velocities of LV filling). Patients were randomised to N (n = 18) or V (n = 13) and reassessed 6 months later. All echo-Doppler recordings were read blindly by 2 observers. RESULTS: rest BP was similarly reduced in both groups (V: 148 +/- 12/88 +/- 5 vs 162 +/- 10/101 +/- 7; N: 148 +/- 15/90 +/- 7 vs 170 +/- 14/101 +/- 8), as well as exercise maximal BP (V: 224 +/- 32/93 +/- 11 vs 243 +/- 21/104 +/- 11; N: 206 +/- 27/90 +/- 10 vs 231 +/- 17/97 +/- 8). The duration of exercise was significantly increased with V (15 +/- 5 min vs 12 +/- 4, p < 0.05) and insignificantly decreased with N (11 +/- 2 vs 12 +/- 3). Left ventricular mass was higher in V group at entry and was significantly more reduced with V (250 g +/- 74 vs 302 g +/- 92, p < 0.01) than with N (225 g +/- 54 vs 234 g +/- 69).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Diagnosis of abnormal intra-atrial echoes. Contribution of transesophageal echocardiography].

The aim of this study was to evaluate the results of transesophageal echocardiography in the diagnosis of abnormal intraatrial echoes detected by transthoracic echocardiography. Patients with active endocarditis, mitral stenosis, and valve prostheses were excluded. The 47 patients (28 women and 19 men) were classified into 4 groups according to the results of transesophageal echocardiography. Group I: normal (7 cases), "phantom echos"; Group II: anatomical variants (9 cases), Chiari apparatus, muscular spur; Group III: pseudo-tumours (7 cases); retro-atrial haematoma, mitral valve prolapse, interatrial septal aneurysm; Group IV: cardiac masses (24 cases). This group comprises: typical myxomas (10 cases), typical thrombi (2 cases), localised atypical masses, relatively immobile and non-prolapsing: 5 myxomas, 1 metastasis, 2 thrombi. The results of this study suggest that transesophageal echocardiography is very useful in diagnosing suspected abnormal intraatrial echos observed on conventional transthoracic examination. However, the nature of the mass may remain obscure.

Adult↗
PubMed1992

[Coronary disease and peripheral arterial disease: contribution of echo-Doppler in the study of the arteries of the neck and lower limbs before the age of 60. Apropos of 76 cases].

Echo-duplex exploration of heart and inferior limbs arteries is performed in 76 patients less than 60 years old, with angiographically established coronary heart disease. Peripheral vascular lesions are found in 15 cases (20%), they are more frequent in patients with tritrunkular coronary disease (35%) than in those with one (16%) or two-vessel lesions (10%). Mean encephalic circulatory resistance index is higher in patients with tritrunkular lesions (p less than 0.03). Vascular echo-duplex should be performed in case of coronary disease in order to avoid catheterism complications and to purpose combined surgical procedure (coronary bypass and carotid endarterectomy).

Adult↗
PubMed1991

[Transesophageal echocardiography: a new view of the heart].

Transoesophageal echocardiography is a simple technique which is now the object of a growing and well-deserved interest, due to the wealth of information it provides. This examination does not supersede the conventional transthoracic echocardiography, but it completes it by supplying more accurate data, especially in difficult clinical cases, such as mitral valve pathology, cardiac valve prostheses, intracardiac thrombosis, aortic dissection and septal abnormalities.

Echocardiography↗
PubMed1991

[Left ventricular diastolic function. Doppler-echocardiography study].

During the last few years the use of the noninvasive doppler-echocardiography method to study left ventricular relaxation and filling has aroused considerable interest owing to its excellent feasibility. However, it is now known that the filling flow rate may vary according to several parameters including filling conditions, heart rate, patient's age, site of measurement and medication, so that the curves obtained must be interpreted with extreme caution. Apart from this, doppler-echocardiography is invaluable not only to distinguish between physiological and pathological left ventricular hypertrophy, but also to detect heart transplant rejection.

Echocardiography, Doppler↗
PubMed1991

Effects of perindopril on left ventricular hypertrophy, coronary blood flow, and mechanical properties of cardiac muscle in renovascular hypertensive rats.

We studied the effects of perindopril on left ventricular hypertrophy, systemic and coronary hemodynamics, and mechanical cardiac performance in renovascular hypertensive rats (Goldblatt, two-kidneys, one-clip). Systemic and coronary hemodynamics, before and after carbochrome infusion, were assessed by radioactive microspheres injection via an atrial catheter in conscious rats. Mechanical performance was measured on isolated papillary muscle from the same animal. Twelve treated hypertensive rats were compared with 10 nontreated hypertensive rats and nine sham-operated normotensive rats of the same age. Perindopril treatment induced a complete control of blood pressure (mean blood pressure from 156 +/- 22 mm Hg in the untreated group to 100 +/- 24 mm Hg in the treated group (P less than .01), compared to 106 +/- 18 mm Hg in the sham group). This was associated with a nearly complete regression of left ventricular hypertrophy (left ventricular mass/body weight 2.26 +/- 0.38 mg/g in the treated group v 3.1 +/- 0.6 in the untreated group [P less than .01], compared to 2 +/- 0.25 mg/g in the sham group [p = NS]). Minimal left ventricular coronary resistances after carbochrome were slightly higher in the hypertensive group compared both to sham and treated group. A reversal of impaired myocardial mechanical parameters towards control values was observed, except for some parameters of relaxation. We conclude that perindopril allows in this model a complete control of blood pressure, and a regression of left ventricular hypertrophy with normalization of coronary hemodynamics and contractile function.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

[Morphological and functional characteristics of the heart in untreated hypertension].

UNLABELLED: To better define the different forms of hypertensive heart disease, we performed 2D guided M mode echo recording of the left ventricle (LV) and Doppler assessment of LV filling in 118 newly recognised (less than 1 year) and untreated hypertensive patients (mean age +/- SD: 49 +/- 10 years, 80 males, 38 females). All recordings were read "blindly". 86 patients underwent also 24 hours BP monitoring during daily routine. MAIN RESULTS: 1) The relative wall thickness (h/r) shows a normal distribution: mean = 0.39; SD = 0.08; 1st quartile = 0.33; 3rd = 0.43; 2) The septal/posterior wall ratio (ST/PWT) shows also a normal distribution: mean = 1.14; SD = 0.24; 1st quartile = 1; 3rd = 1.3; 3) Among patients with LVH (Devereux's criteria, n = 65) the 6 patients with h/r less than or equal to 0.33 are significantly different from the 18 patients with h/r greater than or equal to 0.43 for age (44 +/- 8 vs 51 +/- 10; p less than 0.03), casual (146 +/- 7 vs 166 +/- 13 mmHg; p less than 0.05) and ambulatory SBP (135 +/- 19 vs 146 +/- 16 mmHg; p less than 0.05), peak systolic stress (280 +/- 15 vs 187 +/- 31 Dynes/cm2; p less than 0.001) and E/A ratio (1.17 +/- 0.01 vs 0.94 +/- 0.27; p less than 0.05) but not for ponderal excess. 4) Patients with asymmetric LVH(ST/PWT greater than 1.3 in 22; greater than 1.5 in 10) are significantly different from patients with symmetric LVH for age (54 +/- 10 vs 47 +/- 10; p less than 0.03), diastolic diameter (51 +/- 5 vs 53 +/- 5 mm; p less than 0.02), ST (13.2 +/- 2.9 vs 10 +/- 1.9 mm; p less than 0.001) and PWT (8.9 +/- 1.5 vs 9.7 +/- 1.5 mm; p less than 0.02) but not for BP fractional shortening and LV filling. CONCLUSION: eccentric LVH may be found in young hypertensive patients with normal systolic function and LV filling despite high parietal stress; asymmetric LVH is more frequent in older patients in which LVH seems to develop rather on the septum than on free wall, independently of BP and without consequences on LV function.

Adult↗
PubMed1991

[Left ventricular hypertrophy and ambulatory blood pressure].

The relationship between ambulatory blood pressure and degree of left ventricular hypertrophy is analysed with a triple objective: to assess the value of ambulatory blood pressure recording; the observation of better correlations between left ventricular mass (LVM) and systolic BP with ambulatory rather than clinical recordings is one of the most convincing arguments in favour of the prognostic value of this technique; to guide analysis of ambulatory blood pressure recordings. These recordings provide a large number of measurements over a period of variable duration. The selection of the frequency of measurement, the duration of the recording and the periods of recording (at work, during the day or night), of the criteria of interpretation (average, variability, distribution of values) is partially arbitrary. The possibility of predicting the degree of LVH from these results is one of the only rational approaches while awaiting validation with respect to long-term outcome. In the author's experience, the average of the systolic blood pressure values during the period of activity is the parameter which is most closely related to LVM in untreated hypertensive patients; to improve our understanding of the relationship between the blood pressure, LVM and left ventricular function. There is evidence that the LVH of hypertensive patients has a multifactorial basis. The use of only occasional blood pressure measurements in clinical studies may have increased the apparent importance of one or another factor related to the degree of LVH. The precise influence of these factors, independent of their possible relationship to the blood pressure, should now be reevaluated with respect to ambulatory blood pressure recordings.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1991

[Effect of sotalol on left ventricular mass and function in the hypertensive patient].

The effects of 6 months treatment with Sotalol on the blood pressure, left ventricular mass and function, were studied in patients with essential hypertension and left ventricular hypertrophy. Thirty-three patients (18 men and 15 women aged 53 +/- 11 years) were included initially and 26 were reviewed after 6 months of treatment. The left ventricular mass and function were evaluated by Doppler echocardiography and all recordings were interpreted "blind" at the end of the study by two operators. Treatment led to a significant reduction of the blood pressure (152 +/- 12/94 +/- 11 versus 166 +/- 18/100 +/- 9 mmHg) and of the heart rate (60 +/- 10 versus 76 +/- 12 beats per minute). The left ventricular mass index decreased by 8% (p less than 0.001) due to reduction in wall thickness. Resting left ventricular systolic function was unchanged. Left ventricular filling patterns improved with an increase in the E/A ratio which was reduced at the beginning of the trial.

Adult↗
PubMed1991

[Left ventricular remodeling in hypertension. Physiopathology].

The usual concept of ventricular hypertrophy is simple and logical: increased systolic wall stress induces a hypertrophic reaction which is 1) symmetrical affecting all ventricular walls harmoniously, 2) concentric, developing at the expense of cavity size, increasing the thickness to radius ratio, and, 3) appropriate allowing normalisation of wall stress. This hypertrophy appears initially to be useful as it contributes to the maintenance of systolic function in the face of increasing load. However, it is accompanied by abnormalities of ventricular filling, of coronary circulation and myocardial excitability which may have undesirable consequences on the prognosis. In fact this simplistic and didactic view is inadequate for describing the complexity of left ventricular remodeling in hypertension. This is apparent at three levels at least: the stimuli responsible; if increased wall stress is a necessary and sometimes in itself enough to induce hypertrophy, other mechanisms may effect the degree and nature of this reaction; the protein, cellular and tissular expression; this is particularly true with respect to the connective (collagen) tissue which seems to develop in response to distinct stimuli and which could have an important influence on the functional properties of the myocardium; the morphological expression; this is the only parameter which can be analysed directly by the clinician by echocardiography. This investigation enables assessment of the frequency of eccentric and asymmetric forms of hypertrophy, the significance of which remains unclear.

Cardiomegaly↗
PubMed1991

[Complementary transthoracic and transesophageal echo-doppler in the diagnosis of rupture of the sinus of Valsalva in right heart. Apropos of 4 cases].

Aneurysms of the sinus of Valsalva are rare and usually present with rupture communicating with the right heart cavities. Echocardiography is a powerful diagnostic tool in ruptured sinus of Valsalva aneurysms, especially the Color Doppler mode which shows abnormal, continuous flow as a mosaic of colour extending from the aortic root to the right heart cavities. The four case reports describe rupture of the right sinus of Valsalva aneurysm into the right atrium (2 cases) and the right ventricle (2 cases). Transesophageal echocardiography was performed in two cases and provided valuable information by confirming the site of rupture and the length of the diverticulum. The results illustrate the accuracy of Doppler echocardiographic techniques by the transthoracic and transoesophageal approaches in the diagnosis of ruptured sinus of Valsalva aneurysms.

Adolescent↗