Giant left atrial thrombus in a transplanted heart.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
Pierre Ambrosi
Publications and source records attributed to Pierre Ambrosi.
Accuracy of tissue Doppler echocardiography in the diagnosis of new-onset congestive heart failure in patients with levels of B-type natriuretic peptide in the midrange and normal left ventricular ejection fraction.
BACKGROUND: Based on the hypothesis that it reflects left ventricular (LV) diastolic pressures, B-type natriuretic peptide (BNP) is largely utilized as first-line diagnostic complement in the emergency diagnosis of congestive heart failure (HF). The incremental diagnostic value of tissue Doppler echocardiography, a reliable noninvasive estimate of LV filling pressures, has been reported in patients with preserved LV ejection fraction and discrepancy between BNP levels and the clinical judgment, however, its clinical validity in such patients in the presence of BNP concentrations in the midrange, which may reflect intermediate, nondiagnostic levels of LV filling pressures, is unknown. METHODS: 34 patients without history of HF, presenting with acute dyspnea at rest, BNP levels of 100-400 pg/ml and normal LV ejection fraction were prospectively enrolled (17 with congestive HF and 17 with noncardiac cause). Tissue Doppler echocardiography was performed within 3 hours after admission. RESULTS: Unlike BNP (P = 0.78), Boston criteria (P = 0.0129), radiographic pulmonary edema (P = 0.0036) and average E/Ea ratio (P = 0.0032) were predictive of congestive HF by logistic regression analysis. In this clinical setting, radiographic pulmonary edema had a positive predictive value of 80% in the diagnosis of congestive HF. In patients without evidence of radiographic pulmonary edema, average E/Ea > 10 was a powerful predictor of congestive HF (area under the ROC curve of 0.886, P < 0.001, sensitivity 100% and specificity 78.6%). CONCLUSION: By better reflecting LV filling pressures, bedside tissue Doppler echocardiography accurately differentiates congestive HF from noncardiac cause in dyspneic patients with intermediate, nondiagnostic BNP levels and normal LV ejection fraction.
Aged↗
Comparative accuracy of color M-mode and tissue Doppler echocardiography in the emergency diagnosis of congestive heart failure in chronic hypertensive patients with normal left ventricular ejection fraction.
The accuracy of the tissue Doppler E/Ea and color M-mode Doppler E/Vp indexes in diagnosing congestive heart failure (HF) was investigated in 20 chronic hypertensive patients with acute dyspnea and normal left ventricular ejection fractions who met Vasan's criteria for definite diastolic HF, compared with 20 gender- and age-matched hypertensive patients with noncardiac cause of acute dyspnea. The E/Ea ratio appeared to be more reproducible (variability 4% to 9% vs 6 to 14%) and more precise (sensitivity 77.8%, specificity 100%, and accuracy 89.5% for the optimal cutoff of 11 vs sensitivity 73.7%, specificity 75%, and accuracy 74.3% for the optimal cutoff of 1.5) than the E/Vp ratio in this clinical setting.
Aged↗
B-type natriuretic peptide and tissue Doppler study findings in elderly patients hospitalized for acute diastolic heart failure.
The imbalance of Starling's forces was investigated in 25 elderly patients hospitalized for acute diastolic heart failure. Tissue Doppler evidence of elevated left ventricular filling pressures was present on admission in 17 patients with high B-type natriuretic peptide (BNP) levels. Serum proteins concentrations and colloid osmotic pressure, related to malnutrition and severe sepsis, were significantly less in the 8 patients without tissue Doppler evidence of elevated filling pressures, and a high level of BNP was consistent with paroxysmal elevation in filling pressures in this setting.
Acute Disease↗
Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study.
BACKGROUND: The incidence of embolic events (EE) and death is still high in patients with infective endocarditis (IE), and data about predictors of these 2 major complications are conflicting. Moreover, the exact role of echocardiography in risk stratification is not well defined. METHODS AND RESULTS: In a multicenter prospective European study, including 384 consecutive patients (aged 57+/-17 years) with definite IE according to Duke University criteria, we tested clinical, microbiological, and echocardiographic data as potential predictors of EE and 1-year mortality. Transesophageal echocardiography was performed in all patients. Embolism occurred before or after IE diagnosis (total-EE) in 131 patients (34.1%) and after initiation of antibiotic therapy (new-EE) in 28 patients (7.3%). Staphylococcus aureus and Streptococcus bovis were independently associated with total-EE, whereas vegetation length >10 mm and severe vegetation mobility were predictors of new-EE, even after adjustment for S aureus and S bovis. One-year mortality was 20.6%. In multivariable analysis, independently of the other predictors of death (age, female sex, creatinine serum >2 mg/L, moderate or severe congestive heart failure, and S aureus) and comorbidity, vegetation length >15 mm was a predictor of 1-year mortality (adjusted relative risk=1.8; 95% CI, 1.10 to 2.82; P=0.02). CONCLUSIONS: In IE, vegetation length is a strong predictor of new-EE and mortality. In combination with clinical and microbiological findings, echocardiography may identify high-risk patients who will need a more aggressive therapeutic strategy.
Adult↗
Accuracy of tissue Doppler echocardiography in the emergency diagnosis of decompensated heart failure with preserved left ventricular systolic function: comparison with B-type natriuretic peptide measurement.
BACKGROUND: Tissue Doppler echocardiography provides a reliable noninvasive estimation of left ventricular (LV) filling pressures irrespective of LV ejection fraction. However, the diagnostic accuracy of E/Ea ratio has not been adequately determined in patients with suspected heart failure (HF) with preserved LV systolic function in the acute care setting. OBJECTIVE: To investigate the accuracy of E/Ea ratio in the emergency diagnosis of decompensated HF with preserved LV systolic function. METHODS: Seventy patients with a LV ejection fraction >or=45%, 32 with decompensated HF (77 +/- 12 years of age), and 38 with noncardiac cause of acute dyspnea (74 +/- 12) were enrolled. B-type natriuretic peptide (BNP) was measured on admission; lateral, septal and average E/Ea ratios were calculated within 24 hours. RESULTS: Using receiver-operating characteristic curves to evaluate diagnostic performance, BNP (AUC of 0.875, P < 0.0001) and E/Ea ratios (AUC of 0.90-0.92, P < 0.0001) provided similar accuracy for predicting decompensated HF. Optimal cutoffs were 146 pg/ml for BNP (sensitivity and specificity of 90.6% and 76.3%), 9.8 for lateral E/Ea (83.3% and 88.9%), 12.7 for septal E/Ea (76.7% and 91.4%), and 11.5 for average E/Ea ratio (80% and 94.3%). On multivariate logistic regression analysis, average E/Ea ratio yielded independent additional information to a model based on the clinical judgment and BNP level according to the standard cutoff of 100 pg/ml. CONCLUSIONS: Tissue Doppler echocardiography is accurate for predicting decompensated HF with preserved LV systolic function and may be used as a diagnostic complement to inconclusive BNP level in this setting.
Acute Disease↗
Usefulness of N-terminal-pro-brain natriuretic peptide levels in predicting survival in heart transplant recipients.
We evaluated the prognostic value of plasma N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) in 71 transplanted heart recipients during a 38 +/- 2 month follow-up. The negative predictive value of NT-pro-BNP levels </=800 pg/ml to predict death was 97% (95% confidence interval 92 to 100). Thus, NT-pro-BNP levels </=800 pg/ml predict a middle-term good survival in transplanted heart recipients.
Biomarkers↗
Circulating endothelial cell count as a diagnostic marker for non-ST-elevation acute coronary syndromes.
BACKGROUND: Shedding of endothelial cells from damaged endothelium into the blood occurs in a variety of vascular disorders. The purpose of this study was to evaluate the utility of circulating endothelial cell (CEC) count as a diagnostic marker of non-ST-elevation acute coronary syndromes (ACSs). METHODS AND RESULTS: CEC counts were determined immediately (H0), 4 hours (H4), and 8 hours (H8) after admission in 60 patients with documented non-ST-elevation ACS and 40 control patients with no evidence of coronary artery disease. A total of 32 patients in the ACS group had elevated CEC counts (>3 cells/mL) in relation to early admission and single-episode chest pain. Patients from the control group had normal CEC counts. The interval between the chest pain episode and elevation was significantly shorter for CEC than troponin I. No correlation was found between the 2 markers. Interestingly, a subgroup of ACS patients with initially normal troponin I levels had high CEC counts, thus allowing early diagnosis in 30% more cases. At H0, the mean area under the receiver operating characteristic curve was significantly higher with the CEC count than with the troponin I level. At H4 and H8, the combined use of CEC and troponin was significantly better as a marker of ACS than CEC alone or troponin I alone. CONCLUSIONS: This study demonstrates that CEC count can be used as an early, specific, independent diagnostic marker for non-ST-elevation ACS. A combined strategy using CEC count and troponin I level could provide an effective diagnostic tool.
Acute Disease↗
Prevalence of angiographic coronary artery disease in patients hospitalized for acute diastolic heart failure without clinical and electrocardiographic evidence of myocardial ischemia on admission.
The prevalence of coronary artery disease was investigated in 18 patients hospitalized for acute diastolic heart failure without clinical and electrocardiographic evidence of myocardial ischemia on admission. On the basis of coronary angiography, 7 patients had coronary artery disease and 4 had ischemic heart disease. In addition, besides uncontrolled hypertension and several systemic factors, silent myocardial ischemia potentially contributed to acute exacerbation of heart failure for at least 5 patients with coronary artery disease, according to either elevation in troponin I or segmental wall motion abnormalities.
Aged↗
[Hyponatremia in elderly patients treated with thiazide diuretics and incited to drink abundantly during the heat wave].
Explore the source record for details and available documents.
Aged↗
Potentials and limitations of color M-Mode and tissue Doppler indexes in identifying pseudonormal mitral filling pattern in patients with acute symptoms of heart failure and preserved left ventricular systolic function.
The aim of this study was to assess the accuracy of flow propagation velocity by color M-mode (Vp) and peak early diastolic mitral annulus velocity by tissue Doppler (Ea) in identifying pseudonormal mitral filling in 25 patients with acute symptoms of heart failure and preserved left ventricular systolic function compared with 25 gender- and age-matched healthy subjects. Although normal velocities for both Vp and Ea were found in 40% of patients, E/Vp and E/Ea ratios were able to differentiate pseudonormal from normal filling irrespective of values for Vp and Ea.
Aged↗
Hypoalbuminemia in elderly patients with acute diastolic heart failure.
OBJECTIVES: This study evaluated the relative contribution of serum colloid osmotic pressure (COP) lowering and pulmonary artery wedge pressure (PAWP) elevation in the pathogenesis of pulmonary edema in patients with systolic or isolated diastolic heart failure (DHF). BACKGROUND: The role of hypoalbuminemia and the resulting low COP have been shown in some patients with acute systolic heart failure (SHF). Colloid osmotic pressure and PAWP were determined in 100 patients with acute heart failure (HF) (56 with DHF and 44 with SHF; mean age, 78 +/- 12 years), in 35 patients with acute dyspnea from pulmonary origin, and in 15 normal controls. Pulmonary artery wedge pressure was estimated using transthoracic Doppler echocardiography. RESULTS: Colloid osmotic pressure was significantly lower in the DHF group (20.5 +/- 5 mm Hg) than in the SHF group (24.2 +/- 3.7 mm Hg, p < 0.001), pulmonary disease group (25.1 +/- 4.2 mm Hg, p < 0.001), or normal control group (24.7 +/- 3 mm Hg). Low COP resulted from hypoalbuminemia due to age, malnutrition, and sepsis. Pulmonary artery wedge pressure was significantly higher in patients with SHF (26 +/- 6.3 mm Hg) than in the patients with DHF (20.3 +/- 7 mm Hg, p < 0.001) and was significantly higher in the patients with DHF than in the patients with pulmonary disease (13 +/- 4.2 mm Hg, p < 0.001). The COP-PAWP gradient was similar in patients with SHF (-1.6 +/- 7.1 mm Hg) and patients with DHF (0.7 +/- 6 mm Hg). CONCLUSIONS: Frequent hypoalbuminemia resulting in low COP facilitates the onset of pulmonary edema in patients with DHF who usually have lower PAWP than patients with SHF.
Aged↗
Aminoterminal pro-brain natriuretic peptide and ventricular filling pressures in heart transplant recipients.
We tested the hypothesis that, in heart transplant recipients, plasma aminoterminal pro-brain natriuretic peptide (NT-proBNP) dosage is useful for diagnosis of high ventricular loading pressures in the absence of systolic dysfunction. We studied 60 consecutive transplanted heart recipients without systolic dysfunction at 1 to 16 years after transplantation. We found that, in these patients with frequent high ventricular filling pressures, plasma NT-proBNP was highly correlated with creatininemia and not correlated with ventricular loading pressures. These results do not support the hypothesis that NT-proBNP is useful for diagnosis of isolated diastolic dysfunction in transplanted heart recipients.
Adult↗
Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings.
Explore the source record for details and available documents.
Aged↗
[Critical review of the publication of a clinical trial].
THE MAIN OBJECTIVES OF THE CRITICAL REVIEW OF THE PUBLICATION OF A CLINICAL TRIAL: Are to underline the biases that may influence the validity and credibility of the results and to assess the quantity of the effect observed and the potential clinical impact. FOUR PRELIMINARY ELEMENTS: Should be taken into account: publication in a journal with a reading committee, notoriousness of the author, the interest declared by the authors and the approval of an ethics committee. EXAMINATION OF THE REPORT ITSELF: Concerns the study objectives, clearly defined and integrated within the logics of a scientific context and suggesting concrete applications. A good quality demonstrative trial is prospective, controlled, randomized, and carried out double blind. The patients included are clearly characterized in order to know to what type of patient the research results can subsequently be applied. The principle end-point, whenever possible, is of clinical significance. The choice of the comparative arm is pertinent. The required number of patients has been calculated. The author has agreed to respect Good Clinical Practice and the statistical analyses are appropriate. THE RESULTS: Presented clearly, must indicate the patients in whom the values observed have been calculated. The confidence intervals are provided. The principle analysis, in intent to treat, includes the principle end-point. The significance threshold is 5%. The extent of the difference between the results of the groups is detailed and of clinical significance. Any causal imputation is documented. The results of eventual sub-group analyses are only provided for information. THE DISCUSSION: Concerns the scope of the results, their internal and external coherence with already validated data. The conclusion, factual, evokes the eventual therapeutic benefits of the research conducted. With regard to the latter, readers will be interested in the application of the results obtained to their own patients.
Advisory Committees↗
Post-Traumatic Pseudoaneurysm of the Left Sinus of Valsalva Revealed by an Acute Coronary Compression: An Echocardiographic Case Report.
A 69-year-old woman presented with chest pain and electrocardiographic evidence of subacute anterior ischaemia. Transthoracic and transesophageal echocardiography allowed correct diagnosis of a posttraumatic pseudoaneurysm of the left sinus of Valsalva. The large pseudoaneurysm caused compression of the left main coronary artery and was successfully treated by aortic root replacement, left main coronary artery ligation, and arterial bypass.
Journal Article↗
[The statins: new properties]].
The comparison of major statin trials with trials using either cholestyramine or ileal bypass has suggested that the reduction in coronary heart disease events for those patients receiving statin therapy largely result from their low density lipoprotein (LDL)-cholesterol lowering action. LDL-cholesterol lowering has several physiological consequences, including plaque stabilisation with a decrease in the inflammatory process, slowing of plaque progression, and improvement of endothelial function, as evidenced by the measurement of endothelial-dependent vasorelaxation in response to hyperhaemia or acetylcholine infusion. Statins lower C-reactive protein without any consistent effect on the other inflammation acute phase proteins. The cause and consequences of this effect are still debated. In order to explain why some statins can prevent coronary events within a few months, a direct effect of this therapy on thrombosis has also been advocated; however, the evaluation of statin antithrombotic effects in humans has produced conflicting results. By inhibiting L-mevalonic acid synthesis, statins also prevent the farnelysation of small-GTP binding proteins such as Rho and Ras. In vitro, and in animal models, the inhibition of Rho with statins results in a decrease in endothelial nitric oxide production, an inhibition of leucocyte adhesion on endothelium, decrease in PPAR alpha activation and high density lipoprotein (HDL) production by the hepatocyte, decrease in Ca2+ stores in vascular smooth cells, and a stimulation of vascular smooth muscle cell apoptosis. However, most of these effects were obtained with high statin concentrations. Further evidence is needed before a full assessment of the clinical importance of isoprenylation blockage with therapeutic concentrations of statins in humans can be made.
Animals↗