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T Laperche

Publications and source records attributed to T Laperche.

At least 19 recordsLinked to original sources
PubMed2005

[Pre-hospital management of acute coronary syndromes with ST elevation in the Ile-de-France Region: the E-MUST registry].

The E-MUST registry gathers patient data from the emergency ambulance service of the IIe-de-France for acute coronary syndromes with ST elevation seen within 24 hours from onset of symptoms. The parameters include the type of emergency phone call, details relative to the different phase of management, decisions of therapeutic strategy concerning pre-hospital thrombolysis or primary angioplasty and the different factors influencing these decisions. From January 2001 to June 2002, the mean delay from the onset of symptoms and the call-out of the emergency ambulance was 67.5 minutes for the 2584 patients studied. In this group, a pre-hospital decision for coronary revascularisation was taken in 84.3% of cases, pre-hospital thrombolyis started 33 minutes after arrival of the ambulance (32.7% of cases) and primary angioplasty carried out 81 minutes after that arrival (51.6% of cases). Decisions for revascularisation were less common in the elderly and those seen over 6 hours after the onset of symptoms. Pre-hospital management allows decisions concerning coronary reperfusion to be taken more often and earlier in patients with acute coronary syndromes.

Adult↗
PubMed2001

A randomized double-blind trial of intravenous trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction.

BACKGROUND: Despite high patency rates, primary angioplasty for myocardial infarction does not necessarily result in optimal myocardial reperfusion and limitation of infarct size. Experimentally, trimetazidine limits infarct size, decreases platelet aggregation, and reduces leukocyte influx into the infarct zone. To assess trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction a prospective, double-blind, placebo-controlled pilot trial was performed. METHODS: 94 patients with acute myocardial infarction were randomized to receive trimetazidine (40 mg bolus followed by 60 mg/day intravenously for 48 h) (n=44) or placebo (n=50), starting before recanalization of the infarct vessel by primary angioplasty. Patients underwent continuous ST-segment monitoring to assess return of ST-segment deviation to baseline and presence of ST-segment exacerbation at the time of vessel recanalization. Infarct size was measured enzymatically from serial myoglobin measurements. Left ventricular angiography was performed before treatment and repeated at day 14. RESULTS: Blinded ST segment analysis showed that despite higher initial ST deviation from baseline in the trimetazidine group (355 (32) vs. 278 (29) microV, P=0.07), there was an earlier and more marked return towards baseline within the first 6 h than in the placebo group (P=0.014) (change: 245 (30) vs. 156 (31) microV respectively, P=0.044). There was a trend towards less frequent exacerbation of ST deviation at the time of recanalization in the trimetazidine group (23.3 vs. 42.2%, P=0.11). There was no difference in left ventricular wall motion at day 14, or in enzymatic infarct size. There was no side effect from treatment. Clinical outcomes were similar between groups. CONCLUSION: Trimetazidine was safe and led to earlier resolution of ST-segment elevation in patients treated by primary angioplasty for acute myocardial infarction.

Adolescent↗
PubMed2001

[Rupture of a sinus of Valsalva aneurysm in the left atrium].

Ruptures of sinus of Valsalva aneurysms are a rare complication, and very few cases of rupture in the left atrium have been described. In this clinical case we report the case of a patient hospitalised with a scenario of cardiac insufficiency revealing a very large posterior sinus of Valsalva aneurysm, associated with a bicuspid aortic valve, and rupture in the left atrium. The diagnosis was by transthoracic and transoesophageal multiplan echocardiography, and the treatment surgical, with a good result.

Aged↗
PubMed1999

Elevated circulating cardiac troponin I in patients with cirrhosis.

It has been shown that certain patients with cirrhosis have asymptomatic cardiac abnormalities that have not yet been explained. Thus, cardiac troponin I, a specific marker of myocardial injury, has been measured in patients with cirrhosis without previous cardiac disease. Thirty-two consecutive patients (age 49 +/- 11) with cirrhosis and normal ECG were selected, 22 of which were alcoholic. Hemodynamic investigations were performed. Left ventricular function and mass were evaluated by echocardiography. Serum creatine kinase MB mass, myoglobin, and cardiac troponin I concentrations were measured. Cardiac troponin I concentrations were elevated in 10 patients (32%) (range 0.06-0.25 microg/L) whereas creatine kinase MB mass and myoglobin were normal in all patients. Abnormal troponin I values were not related to the severity of cirrhosis, to the degree of portal hypertension, or to other hemodynamic values. In contrast, elevated serum cardiac troponin I concentrations were related to a decreased stroke-volume index (P <. 05) and a decreased left ventricular mass (P <.05). These results show a high prevalence of slightly elevated serum cardiac troponin I in patients with cirrhosis, especially in those with alcoholic cirrhosis. Elevated troponin I is associated with subclinical left ventricular myocardial damage. These findings may be linked to a lack of left ventricular adaptation in certain patients with cirrhosis and alcoholic cardiomyopathy.

Adult↗
PubMed1999

Fluid therapy directly interferes with immunoassay for cardiac troponin I.

OBJECTIVE: To investigate interference in cardiac troponin I (cTNI) immunoassay induced by some widely used loading fluids. SETTING: A biochemistry unit of a university hospital. MEASUREMENTS AND RESULTS: Human serum with a cTNI concentration of 0.32 microg/l was diluted at 10, 20, 40, and 80% with saline serum (SS), Plasmion (P) (a modified fluid gelatin), hydroxyethyl starch (HES), and 20% human albumin (Alb). Serum with a cTNI concentration of 1.29 microg/l was diluted at 20, 40, 60, and 80%. Four samples with increasing cTNI concentrations (from 0 to 8.14 microg/l) were diluted at 80% with the four fluids. Differences (delta-C) between expected concentrations resulting from the dilutional effect and those measured with the Access cTNI immunoassay were expressed in microg/l. Statistical analysis was performed using a nonparametric test. No false positivity was observed. At a low cTNI concentration (0.32 microg/l), interference was observed with SS and HES at 40 and 80% dilution and with P and Alb at 80%. When cTNI was 1.29 microg/l, interference was observed with each fluid at a dilution of 20% and increased with the increase in dilution. The highest interference was observed with HES, the lowest with P. When the dilution was at 80% for increasing concentrations of cTNI, the higher the initial cTNI was the higher the interference appeared, mostly with SS and HES. CONCLUSIONS: SS, P, Alb, and HES interfere in this cTNI immunoassay. This interference is higher with SS and HES and is higher when the percentage of hemodilution or real cTNI concentration increases.

Fluid Therapy↗
PubMed1998

Efficacy of streptokinase, but not tissue-type plasminogen activator, in achieving 90-minute patency after thrombolysis for acute myocardial infarction decreases with time to treatment. PERM Study Group. Prospective Evaluation of Reperfusion Markers.

OBJECTIVES: We sought to examine the relation between time to treatment and 90-min patency rates in patients receiving intravenous streptokinase (SK) or accelerated tissue-type plasminogen activator (t-PA). BACKGROUND: Early patency of the infarct-related artery is a major determinant of survival after thrombolysis for acute myocardial infarction. Some data suggest that time to treatment may influence the efficacy of nonfibrin-specific thrombolytic agents in restoring early patency of the infarct-related vessel. METHODS: We performed a retrospective analysis of a cohort of 481 patients receiving thrombolytic therapy for acute myocardial infarction <6 h after pain onset, all of whom underwent 90-min coronary angiography. Patency of the infarct-related artery was graded by two observers who had no knowledge of the treatment received or the time between pain and therapy. RESULTS: There was no difference in baseline clinical or angiographic characteristics according to the timing or nature of treatment. Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3 patency rate after SK correlated negatively with the time between onset of pain and thrombolysis (r = 0.8, p = 0.05), whereas the 90-min patency rate after t-PA appeared stable as a function of time to treatment. When patients were categorized as having received treatment <3 or > or = 3 h after pain onset, the patency rate was similar with t-PA, but significantly higher when SK was administered early rather than late, regardless of whether TIMI flow grades 2 and 3 were pooled (86.9% vs. 59.4%, p = 0.0001) or TIMI flow grade 3 alone was considered to indicate patency (81.7% vs. 53.6%, p = 0.0001). Multivariate logistic regression analysis showed a negative effect of time to treatment on the patency probability for SK (p = 0.0001) but not for t-PA. CONCLUSIONS: The efficacy of streptokinase but not t-PA in restoring early coronary patency after intravenous thrombolysis is markedly lower when patients are treated later after onset of pain.

Coronary Angiography↗
PubMed1998

Limitations of radionuclide angiographic assessment of left ventricular systolic function before lung transplantation.

To evaluate the influence of increased right ventricular afterload on radionuclide assessment of the left ventricular ejection fraction (LVEF), we compared the preoperative and postoperative value of isotopic LVEF in 11 patients who underwent lung transplantation and had a preoperative LVEF value below 55% (normal value: 68 +/- 8%). The underlying disease conditions were obstructive lung disease (n = 7) and pulmonary fibrosis (n = 4). The transplantation procedure was unilateral in 10 patients and bilateral in one. The mean value of isotopic LVEF prior to transplantation was 51 +/- 3% (range: 49% to 55%). At 42 +/- 13 mo postoperatively, isotopic LVEF increased significantly, to 65 +/- 10% (p = 0.001), suggesting that intrinsic left ventricular systolic function was in fact normal in these patients. We hypothesize that the low preoperative isotopic LEVF was not related to intrinsic dysfunction of the left ventricle, but rather to right ventricular pressure overload, leading to bulging of the interventricular septum into the left ventricle and to subsequent geometric distortion of the left ventricle. We conclude that isotopic LVEF may underestimate intrinsic left-ventricular systolic function in patients with severe chronic lung disease. Candidates for lung transplantation should not be rejected on the basis of a low isotopic LVEF, provided echocardiographic examination does show apparently normal left ventricular contraction.

Adult↗
PubMed1997

Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie.

BACKGROUND: Atherosclerotic lesions of the aortic arch are potential sources of arterial embolism. Mobile thrombi in the aortic arch in young patients without diffuse atherosclerosis have been reported recently, but such cases remain exceptional. We describe a series of young patients with unexplained arterial embolism in whom transesophageal echocardiography detected mobile aortic arch thromboses. METHODS AND RESULTS: Transesophageal echocardiography files collected between 1991 and 1995 in French academic cardiology centers were reviewed to identify patients who fulfilled the following criteria: (1) an arterial embolic event in the preceding weeks; (2) a mobile pedunculated aortic arch thrombosis, defined as an echogenic mass protruding into the lumen of the aorta and inserted on the aortic arch; and (3) absence of obvious diffuse aortic atherosclerosis or of aortic debris on transesophageal echocardiography. Twenty-three cases were identified from 27 855 examinations. Thromboses were located on the horizontal aorta (n = 4), near the ostium of the left subclavian artery (n = 5), or on the concavity of the posterior segment of the aortic arch (in the isthmus) (n = 14). The insertion site was a small atherosclerotic plaque in 21 patients. The remaining aortic wall always appeared normal or mildly atherosclerotic. The mean age of the patients was 45 +/- 8.4 years (range, 26 to 61 years). All patients were treated with intravenous heparin after the diagnosis of aortic arch thrombosis, and surgical removal of the thrombosis was performed in 10 patients in whom histological examination confirmed an atherosclerotic process at the site of insertion of the thrombosis. The prognosis was mainly influenced by embolic events. CONCLUSIONS: Thromboses of the aortic arch appear to be a variant form of aortic atherosclerotic disease associated with arterial embolism in young patients.

Adult↗
PubMed1997

Early behavior of biochemical markers in patients with thrombolysis in myocardial infarction grade 2 flow in the infarct artery as opposed to other flow grades after intravenous thrombolysis for acute myocardial infarction. PERM Study Group. Prospective Evaluation of Reperfusion Markers.

BACKGROUND: Biochemical markers have been suggested for the noninvasive diagnosis of reperfusion early after thrombolysis. Their ability to discriminate between Thrombolysis in Myocardial Infarction (TIMI) 2 and 3 flow grades remains unknown. METHODS: In 97 patients with myocardial infarction < or =6 hours, myoglobin, troponin T, MBCK, and MMCK isoforms were measured before thrombolysis and after 90 minutes. A 90-minute coronary angiography ascertained the potency status of the infarct-related artery in all patients according to the TIMI grade flow (group A: TIMI 0-1 (n = 35), group B: TIMI 2 (n = 17), and group C: TIMI 3 (n = 45). For each marker the absolute rate of increase and the relative increase 90 minutes after thrombolysis were studied. RESULTS: Both absolute values and absolute rates of increase at 90 minutes of myoglobin were higher in group B than in groups A and C (p < 0.05, not significant for other markers). Relative increases were consistently higher in group C than in other groups with statistical significance for myoglobin in the subset of patients treated for >3 hours. CONCLUSION: Diagnostic indexes based on relative increases tend to discriminate between patients with TIMI 2 and 3 flow, and the best performance is obtained when the relative increase of myoglobin at 90 minutes is used in patients treated later than 3 hours after onset of symptoms.

Aged↗
PubMed1997

The stentless Bravo 300 aortic porcine xenograft: supra-annular versus annular implantation.

The aim of the study was to compare the supra-annular and intra-annular implantation techniques by evaluating the differences in early haemodynamic outcome (gradients, effective orifice area, regurgitation). Since August 1991, 200 stentless Bravo model 300 valves have been implanted. Patients were divided into three groups of consecutive cases: group 1 (n = 50) represents exclusively intra-annular implantation; group 2 (n = 50) is a transitional period: and group 3 (n = 100) comprises only patients with supra-annular implantation. Significant differences were found (P<0.001) in low postoperative gradients (mean < or = 10 mmHg): 24% in group 1, 42% in group 2, and 95% in group 3. Comparing groups 1 and 3, gradients were lower and effective orifice area was augmented in all valve sizes in group 3. Trivial central regurgitation was present in groups 1-3 (6%, 12% and 0% respectively). Peripheral regurgitation was trivial in 6%, 8% and 0% and mild to moderate in 4%, 2% and 0% (P<0.001).

Animals↗
PubMed1997

Comparison of the long-term prognostic value of peak exercise oxygen pulse and peak oxygen uptake in patients with chronic heart failure.

OBJECTIVE: To evaluate the ratio of peak oxygen consumption to peak heart rate (peak oxygen pulse) as a predictor of long term prognosis in chronic heart failure. PATIENTS AND SETTING: 178 consecutive heart failure patients recruited to the cardiology department of a tertiary referral centre between 1986 and 1993. DESIGN: Bicycle ergometry with measurement of respiratory exchange. Mean (SD) follow up was 32 (25) months. RESULTS: Patients who died had a lower peak oxygen consumption (16.0 (5.5) v 18.0 (5.5) ml/min/kg, p = 0.05), lower indexed peak oxygen consumption (52 (14) v 60 (16)%, p = 0.006) but similar peak oxygen pulse (8.4 (2.6) v 8.4 (3.0) ml/beat, NS). The following variables were associated with a good long term prognosis: New York Heart Association class II, non-ischaemic heart failure, peak oxygen consumption > or = 17 ml/min/kg, indexed peak oxygen consumption > 63%. Peak oxygen pulse did not have predictive value. Only indexed peak oxygen consumption remained an independent predictor of survival in multivariate analysis. CONCLUSIONS: Peak oxygen pulse has lower prognostic value than peak oxygen consumption, especially when the latter is indexed to predicted values.

Exercise↗
PubMed1997

[Prognostic significance of early raised cardiac troponine I in unstable angina. Contribution to the identification of a high-risk sub-group].

The authors compared the clinical and angiographic characteristics of 44 patients with unstable angina according to cardiac Troponine I concentrations (TnIc) during early blood sampling and then tried to determine a threshold value to predic the occurrence of cardiac events during the hospital period and after 12 months. Tnlc, creatinine-kinase (CK), CK-MB activity and CK-MB mass were sampled over 48 hours. Forty-five per cent of patients had TnIc > or = 0.1 microgram/L; CK-MB activity and CK-MB mass were detected in 16 and 32% of patients. Age, gender, classification and recurrence of angina, previous cardiac history, risk factors, coronary angiographic appearances were comparable in patients with and without raised TnIc. No major cardiac events occurred during the hospital period in either group. The number of angioplasties and coronary bypass procedures was also comparable. At one year, the incidence of myocardial infarction (N = 4) and death (N = 5) was significantly different in patients with raised Tnlc (33% versus 0% in patients without increased TnIc). However, betablocker therapy was less prescribed in the group with the poorest outcomes and left ventricular dysfunction was also significantly more common in this group. Early elevation of Tnlc could contribute to the identification of a high risk subgroup of patients with unstable angina.

Aged↗
PubMed1996

Serial assessment of cardiopulmonary exercise capacity after cardiomyoplasty for either ischemic or idiopathic dilated cardiomyopathy.

Cardiomyoplasty is a surgical procedure aimed at assisting the left ventricle during ejection. We describe the long-term effects of cardiomyoplasty on peak exercise capacity, with serial assessments for up to 3 years after operation. Sixteen patients (12 in New York Heart Association class III and 4 in class IV) were enrolled. The mean left ventricular ejection fraction was 18 +/- 8%. Bicycle exercise tests with respiratory gas analysis were performed preoperatively and 6, 12, 18, 24, and 36 months after operation. Mean follow-up was 12 +/- 5 months (range 6 to 24). At 6 months, peak oxygen consumption and the ventilatory threshold were unchanged (from 17.8 +/- 5.8 to 15.8 +/- 5.3 ml/min/kg, and from 12.1 +/- 2.7 to 11.4 +/- 3.4 ml/min/kg, respectively). Ventilation at 50 W, viewed as an index of polypnea at submaximal exercise, was also unchanged. Serial assessment of exercise capacity thereafter showed no changes. However, ejection fraction tended to increase from 18 +/- 8% to 21 +/- 9% (p=0.08) and 14 patients reported an improvement in their functional status, resulting in a significant change in New York Heart Association functional class (3.3 +/- 0.5 to 2.2 +/- 0.4 at 6 months and 2.4 +/- 0.4 at the last visit, p <0.005) and improvement in quality-of-life scores. Thus, cardiomyoplasty does not appear to increase peak exercise capacity in the long term, despite an improvement in the left ventricular ejection fraction. Symptoms and quality of life, however, appear to improve. This may be related in part to an insufficient number of assisted systoles during exercise, persistent deconditioning, or changes in pulmonary mechanics.

Cardiomyopathy, Dilated↗
PubMed1996

Tricuspid autograft for mitral-valve repair.

BACKGROUND: Transferring the posterior leaflet of the patient's own tricuspid valve with its subvalvular apparatus to the mitral valve is a new technique that allows a conservative approach to mitral-valve repair. The technique is based on the knowledge that the tricuspid valve can be remodelled from tricuspid to bicuspid, with a very low risk of significant dysfunction. METHODS: We describe six patients (age range 20-70 years) with mitral insufficiency in whom we have used the technique. FINDINGS: All patients survived the operation and were in sinus rhythm. Transoesophageal echocardiography before discharge showed trivial or no regurgitation at the site of mitral repair. Before operation, all patients were in New York Heart Association class III-IV; at follow-up after 6-13 months all patients were in class I-II. INTERPRETATION: Compared with using segments of mitral homografts in similar situations, the intraoperative availability of the tricuspid's viable natural chordae and valvular leaflet means that there are no immunological disadvantages to the procedure. With this new operation, the patient is his own tissue bank.

Adult↗
PubMed1996

[Mitral valve repair by transfer of the posterior tricuspid leaflet and its chordae].

Mitral valve repair was performed in six patients by transferring the posterior tricuspid leaflet with its sub-valvular apparatus onto the mitral valve. This new technique considers the tricuspid valve as the patients own tissue bank where the posterior leaflet and eventually the adjacent part of the anterior leaflet is used as a "donor" valve, based on the knowledge that the right atrio-ventricular valve can be efficiently repaired with a very low risk of significant dysfunction. The mitral repair consists of incorporating the tricuspid autograft by securing the tricuspid papillary muscle to the mitral papillary muscle and by suturing the leaflet tissue where required. A mitral annuloplasty ring reinforces the repair. The tricuspid valve is subsequently repaired by annular plication and leaflet suture. A tricuspid ring is necessary to maintain efficient remodeling. The six patients ages ranged from 20 to 70 years. A etiology, was rheumatic in the first case and degenerative in the following. In three cases, sterilised endocarditis was responsible for ruptured chordae and leaflet destruction. The mitral insufficiency was located in a commissural area in 4 cases, and was due to a widespread posterior prolapse in 2. Post-operative control transesophageal echocardiography confirmed the excellent results of the repair and proved that, in selected cases, the tricuspid leaflet inserted onto the mitral apparatus is very efficient in correcting mitral insufficiency, without causing significant tricuspid impairment. With a 3 to 7 month follow-up, the results are stable.

Adult↗
PubMed1996

Effects of aging on left ventricular-arterial coupling in man: assessment by means of arterial effective and left ventricular elastances.

The ejection fraction (EF) is a load-dependent index of the systolic function of the left ventricle (LV), which depends on the 'functional' coupling of the LV with the arterial system, evaluated by the ratio between arterial effective elastance (Ea) to end-systolic left ventricular elastance. The spectrum of changes in LV and the arterial system during aging has not been studied by means of coupled analysis of elastances. Twenty-five normotensive healthy subjects aged from 22 to 68 years underwent hemodynamic and angiographic studies. The functional properties of the arterial system were evaluated in terms of Ea (end-systolic pressure/stroke volume), and the systolic function of the LV was approximated by the end-systolic pressure to end-systolic volume ratio (Elv). The result is that Ea increased linearly with age. Elv increased less than Ea. The positive relationship between Ea/Elv and age was close to statistical significance (r = 0.39, p = 0.07), suggesting that left ventricular-arterial coupling changes little with aging. Analysis of the relationship between EF and end-systolic stress showed that several points were situated at the lower part of the relationship in elderly subjects, suggesting a decrease in the intrinsic contractility of left ventricular muscle in some cases. Aging is characterized by a simultaneous increase in arterial system elastance and the systolic performance of the left ventricular pump, thereby preserving the transfer function of the arterial system as a whole. However, some aged subjects may depart from this rule, probably because of variability in the capacity to produce myocardial hypertrophy and/or altered inotropy of the muscle.

Adult↗