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Thierry C Gillebert

Publications and source records attributed to Thierry C Gillebert.

15 recordsLinked to original sources
PubMed2006

Risk factors for primary ventricular fibrillation during acute myocardial infarction: a systematic review and meta-analysis.

AIMS: To evaluate potential risk factors for primary ventricular fibrillation (PVF) during acute myocardial infarction (AMI) by a systematic review and meta-analyses. METHODS AND RESULTS: We searched PubMed for English articles on 'humans' published between 1964 and January 2006 using a validated combination of MESH terms. Twenty-one cohort studies describing 57 158 patients with AMI were analysed. Patients with validated PVF (n=2316) were characterized by an earlier admission (weighted mean difference -2.62 h), male gender [odds ratio (OR 1.27)], smoking (OR 1.26), absence of history of angina (OR for history of angina 0.84), lower heart rate at admission (weighted mean difference -4.02 b.p.m.), ST-segment elevation on admission ECG (OR 3.35), AV conduction block before PVF (OR 2.02), and lower serum potassium at admission (weighted mean difference -0.27 meq/L). Patients with validated PVF developed a larger enzymatic infarct size (standardized mean difference 0.74, P<0.00001). PVF was not associated with a history of myocardial infarction or hypertension. CONCLUSION: Patients who developed a validated PVF presented with characteristics of both abrupt coronary occlusion and early hospital admission. This review provides no evidence for risk factors for PVF other than ST-elevation and time from onset of symptoms. To find new risk factors, studies should compare validated PVF patients with non-PVF patients who have no signs of heart failure and comparable time delay between onset of symptoms and medical attendance.

Case-Control Studies↗
PubMed2006

Maximum oxygen uptake at peak exercise in elderly patients with coronary artery disease and preserved left ventricular function: the role of inflammation on top of tissue Doppler-derived systolic and diastolic function.

BACKGROUND: Several studies have shown that longitudinal systolic function and left ventricular filling pressures, as assessed with tissue Doppler imaging, predict exercise capacity. AIM: The aim of this study was to evaluate whether natriuretic peptides and inflammatory parameters can independently predict maximum oxygen uptake at peak exercise (VO2max) on top of tissue Doppler imaging-derived markers. METHODS: We evaluated 142 patients (age 70 +/- 6 years, 77% men) with known or suspected coronary artery disease and a preserved left ventricular ejection fraction (> or = 50%). All patients underwent bicycle spiroergometry, and N-terminal pro-B-type natriuretic peptide levels were determined. Cytokines (IL-6 and soluble tumor necrosis factor receptors 1 and 2) and high-sensitivity C-reactive protein were measured as inflammatory markers. Tissue Doppler imaging was applied to evaluate peak long axis systolic velocities (Sm) and early mitral annulus velocities (E'). Ratio of early transmitral flow (E) to E' was assessed as marker of left ventricular filling. Analysis of variance, comparing VO2max quartiles, was used to determine univariate predictors and linear regression to determine multivariate VO2max predictors. RESULTS: Average VO2max was 18.5 +/- 5.7 mL/kg per minute (range 6-36.6). Compared with the highest quartile, patients with low VO2max were more frequently women (P < .0001). N-terminal pro-B-type natriuretic peptide and cytokine levels were significantly higher in the lower VO2max categories. Longitudinal myocardial velocities increased, and E/E' decreased along with increasing VO2max. In multivariate linear regression analysis, VO2max was independently predicted by sex, glucose, Sm, E/E', and cytokine levels. CONCLUSION: Maximum oxygen uptake at peak exercise in patients with known or suspected coronary artery disease and preserved systolic function was independently predicted by inflammatory makers on top of tissue Doppler-derived systolic and diastolic function.

Aged↗
PubMed2006

Right sided infective endocarditis: tempus fugit!

We report a case of an intravenous drug user who already had a tricuspid bioprosthesis implanted after an infective endocarditis with massive tricuspid regurgitation one year ago. Now he presents with a large mass on the atrial side of the bioprosthesis that led to obstruction; hemocultures contained Enterococcus faecalis. After one-week therapy with antibiotics, aspirin and enoxaparin the mass untangled to a swinging structure and moderate to severe triscupid regurgitation developed; surgery appeared inevitable. After two weeks however the mass was gone, tricuspid insufficiency subsided and the patient became asymptomatic. This case illustrates the potential but controversial role of anticoagulation in the treatment of patients with infective endocarditis.

Anti-Infective Agents↗
PubMed2006

Diabetes and impaired fasting glucose as predictors of morbidity and mortality in male coronary artery disease patients with reduced left ventricular function.

OBJECTIVES: To evaluate the prognostic value of impaired fasting glucose and diabetes mellitus in male patients with coronary artery disease and poor left ventricular function. METHODS AND RESULTS: From a prospective database on patients referred for gated myocardial perfusion imaging between 1998 and 2002 all male patients with a history of coronary artery disease and poor left ventricular function were selected. Poor function was defined as left ventricular ejection fraction < or = 40%. Subjects were classified as non-diabetics with fasting blood glucose levels < 110 mg/dL, non-diabetics with impaired fasting glucose (fasting blood glucose between 110 and 125 mg/dL) and diabetics. Median follow-up was 2.7years. End points were all-cause mortality, cardiac death and hospitalization for heart failure. One hundred and sixty patients were selected (age 65 +/- 9 years and left ventricular ejection fraction 29 +/- 8%). In univariate analysis atrial fibrillation, NYHA class, glycaemia and diabetes mellitus discriminated between survivors and non-survivors. In Cox multivariate regression analysis for all-cause mortality only NYHA class and diabetes mellitus remained significant. Kaplan Meier analysis showed that diabetics had the worst survival and non-diabetics with glucose < 110 mg/dL had the best survival. Non-diabetics with impaired fasting glucose had intermediate survival. Analysis for cardiac death/hospitalization for heart failure showed similar results. CONCLUSION: In male patients with coronary artery disease and impaired left ventricular function diabetes mellitus and fasting glucose are strongly predictive of poor outcome. Diabetics have the worst prognosis but non-diabetics with impaired fasting glucose also are at higher risk compared to nondiabetics with low fasting blood glucose.

Aged↗
PubMed2006

Transient stress-induced cardiomyopathy with an "inverted takotsubo" contractile pattern.

We describe a patient who had transient cardiomyopathy with akinesia of the basal portions of the left ventricle and hyperkinesia of the apex triggered by alcoholic pancreatitis. This case seems to confirm recent publications suggesting a new or variant clinical entity with a clinical presentation similar to that of Takotsubo cardiomyopathy but with an Inverse left ventricular contractile pattern ("Inverted Takotsubo"). This entity could provide clues to the underlying pathophysiology of these syndromes of acute heart injury.

Adult↗
PubMed2005

Primary impairment of left ventricular function in Marfan syndrome.

BACKGROUND: Cardiovascular involvement in Marfan syndrome is mainly characterized by progressive dilatation of the proximal aorta. Whether left ventricular dysfunction is present in these patients is not clear at present. OBJECTIVES: Assess left ventricular function in patients with Marfan syndrome, free of significant valvular heart disease, using a combination of MRI and Tissue Doppler imaging (TDI). METHODS AND RESULTS: A total of 26 Marfan patients (mean age=32.0+/-10.9, 12 men) without significant valvular heart disease, and 26 age- and sex-matched controls were studied. Left ventricular volumes and ejection fraction were measured with magnetic resonance imaging. Systolic and diastolic function parameters were assessed using conventional echocardiography and TDI. When compared to controls, Marfan patients showed impairment of left ventricular contractile function as expressed by a reduced ejection fraction (53.5+/-9.0% vs. 59.6+/-6.7%, p=0.009), an increased end-systolic volume (36.0+/-9.5 vs. 29.5+/-6.7 ml/m(2), p=0.007), and reduced peak systolic velocities at the basal septal and lateral myocardial wall (5.2+/-1.4 vs. 6.4+/-1.3 cm/s, p=0.003 and 6.0+/-2.2 vs. 7.5+/-2.3 cm/s, p=0.03, respectively). Diastolic function was impaired with an increased deceleration time of the E wave (171+/-41 ms vs. 141+/-36 ms, p=0.006). Peak early diastolic velocity at the mitral valve annulus was significantly lower (9.6+/-2.4 cm/s vs. 11.9+/-3.3 cm/s, p=0.006). CONCLUSION: These data provide evidence for mild, but significant impairment of left ventricular systolic and diastolic function in Marfan patients, not related to valvular heart disease.

Adult↗
PubMed2005

Relationship between QRS duration, left ventricular volumes and prevalence of nonviability in patients with coronary artery disease and severe left ventricular dysfunction.

BACKGROUND: Patients with coronary artery disease (CAD), a QRS duration >or=120 ms and left ventricular ejection fraction (LVEF) or=120 ms was present in 91 patients (69%). Although there were no differences in LVEF, patients with longer QRS durations had significant larger end-diastolic and end-systolic volumes (p<0.01). Substantial nonviable tissue in the inferior or lateral wall was present in 29% of patients with a QRS duration >or=120 ms versus 7% of those with a QRS duration <120 ms (p<0.01). CONCLUSIONS: An increased QRS duration is associated with more advanced remodeling in patients with CAD and poor LV function. Almost one third of these patients with a prolonged QRS duration have no viable tissue in the inferolateral wall, an area that is usually stimulated with CRT.

Aged↗
PubMed2005

Prevalence of mechanical dyssynchrony in patients with heart failure and preserved left ventricular function (a report from the Belgian Multicenter Registry on dyssynchrony).

The present study evaluated the prevalence of mechanical inter- and intraventricular dyssynchrony in patients with heart failure and preserved left ventricular (LV) ejection fraction (LVEF). We studied 138 patients with heart failure (age 67+/-11 years; 76% men); 60 patients had preserved LVEF (>40%). Using conventional Doppler echocardiography, an interventricular mechanical delay>or=40 ms was defined as interventricular dyssynchrony. Using pulse-wave tissue Doppler imaging, the time from the beginning of the QRS complex to onset of systolic motion was measured in 4 basal LV segments. A dispersion of >or=60 ms was defined as intraventricular dyssynchrony. The prevalence of inter- and intraventricular dyssynchrony was lower in patients with preserved LVEF than in those with reduced LVEF (17% vs 41%, p<0.01 for interventricular dyssynchrony, 18% vs 36%, p<0.01 for intraventricular dyssynchrony). However, patients with preserved LVEF and a QRS width>or=120 ms had higher values for the parameters for inter- and intraventricular dyssynchrony than patients with a QRS width<120 ms (interventricular mechanical delay 33+/-20 vs 20+/-16 ms, p<0.05; tissue Doppler imaging dispersion 42+/-26 vs 33+/-22 ms, p<0.05). In patients with a QRS width>or=120 ms, the prevalence of inter- and intraventricular dyssynchrony was comparable for patients with preserved and reduced LVEF (42% vs 55%, p=NS for interventricular dyssynchrony and 45% vs 46%, p=NS for intraventricular dyssynchrony). In conclusion, the prevalence of inter- and intraventricular dyssynchrony was low (17% and 18%, respectively) in patients with heart failure and preserved LVEF. However, in the presence of a QRS width of >or=120 ms, this prevalence increased to almost 50%, comparable to that for patients with heart failure and reduced LVEF and a QRS width of >or=120 ms.

Aged↗
PubMed2005

Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E') and the ratio of transmitral early peak velocity to E' (E/E').

The ratio of the transmitral early peak velocity (E) evaluated by conventional Doppler imaging over early diastolic mitral annulus velocity (E') evaluated by tissue Doppler imaging has been proposed as a noninvasive marker for left ventricular filling pressure. We evaluated 174 normal patients and 86 patients with hypertension and LV hypertrophy to assess the effects of age, gender, and left ventricular hypertrophy on E' and E/E'. Age appeared to be the strongest determinant of E' and E/E', suggesting that in normal patients and in those with left ventricular hypertrophy, age-dependent cut-off values should be considered.

Adult↗
PubMed2005

Global and regional parameters of dyssynchrony in ischemic and nonischemic cardiomyopathy.

In this study, color tissue Doppler imaging was used to assess global and regional mechanical dyssynchrony in patients with ischemic cardiomyopathy and those with idiopathic dilated cardiomyopathy. Potential differences in the area of latest mechanical activation could have practical implications regarding lead positioning and the success rate of biventricular pacemaker implantation.

Aged↗
PubMed2004

Functional analysis of the common carotid artery: relative distension differences over the vessel wall measured in vivo.

OBJECTIVES: Absolute (DeltaD) and relative (DeltaD/D) arterial diameter distension, parameters related to the elasticity of the vessel, can be measured in superficial arteries using ultrasound-based vessel "wall tracking" techniques. Currently available systems (e.g. the Wall Track System; WTS) measure the displacement of the media-adventitia transition (outer wall). We hypothesize that, given volume incompressibility of the vessel wall, DeltaD and DeltaD/D measured at the outer wall, significantly underestimate vessel distension at the lumen-intima interface (inner wall). METHODS: We measured DeltaD and DeltaD/D at both the inner and outer wall of the common carotid artery in 39 subjects (aged 18-83 years) using a new prototype "wall tracking" system based on the Vivid-7 scanner (GE Vingmed Ultrasound, Horten, Norway). In addition, DeltaD and DeltaD/D were also measured using WTS. RESULTS: As anticipated, tracking the inner wall yielded lower diastolic diameters than when tracking the outer wall (Ddia = 5.70 +/- 0.80 and 6.91+/- 0.98 mm, respectively, P < 0.0001). DeltaD (0.54+/- 0.16 versus 0.49 +/- 0.16 mm; P < 0.0001) and DeltaD/D (0.096+/- 0.030 versus 0.071+/- 0.026, P < 0.0001) were indeed larger at the inner than at the outer wall. For WTS, Ddia, DeltaD and DeltaD/D were 7.04 +/- 1.02 mm, 0.45 +/- 0.14 mm and 0.066 +/- 0.022, respectively. CONCLUSIONS: On average, DeltaD and DeltaD/D are 10 and 25% higher on the inner than on the outer wall, respectively. Follow-up studies in larger cohort trials are mandatory to assess whether tracking the inner wall yields arterial function parameters with a higher cardiovascular prognostic potential.

Adolescent↗
PubMed2003

Doppler estimation of filling pressures in a patient with hypertrophic cardiomyopathy.

A case of hypertrophic cardiomyopathy is presented with a restrictive mitral filling pattern but predominant systolic pulmonary vein flow velocities. A stepwise Doppler work-up including color M-mode, Doppler tissue imaging of the mitral annulus velocity and loading manipulations could clarify the underlying hemodynamic mechanisms. The Doppler data were correlated with invasive measurements.

Adult↗
PubMed2003

Beat-to-beat modulation of right and left ventricular positive dP/dt by afterload. Implications for the evaluation of inotropy.

OBJECTIVES: The rate of pressure rise (dP/dtmax) has mainly been studied in the left ventricle (LV), where it was demonstrated to be highly dependent of preload, but independent of afterload. Load dependence of right ventricular (RV) dP/dtmax is assumed to be similar to (LV)dP/dtmax, although this issue has not yet been investigated in detail. In the current study, we evaluated acute afterload dependence of dP/dtmax in both ventricles in rats. METHODS AND RESULTS: Adult Wistar rats (n = 8) were instrumented to record RV and LV pressures and septal-free wall diameters. RV and LV afterload elevations were performed by beat-to-beat graded constrictions of the pulmonary trunk or aortic root, respectively. Control cycles and low, moderate and high (isovolumetric) afterload levels were analysed. In both ventricles, afterload modulation of dP/dt was assessed by dP/dtmax normalized for end-diastolic dimensions (dP/dtmax/EDD) and by peak and mean accelerations of pressure rise. RV afterload elevation increased dP/dtmax, dP/dtmax/EDD, peak and mean acceleration of RV pressure rise, without changing the time from end-diastole to dP/dtmax. LV afterload elevations did not significantly change the corresponding left-sided parameters. CONCLUSIONS: In this study we demonstrated that, in contrast to the left ventricle, right ventricular dP/dtmax and dP/dtmax/EDD relation are significantly afterload sensitive. This should be taken into account for its application in the haemodynamic evaluation of cardiac function in experimental and clinical settings.

Animals↗
PubMedDate not supplied

Incremental prognostic value of combined perfusion and function assessment during myocardial gated SPECT in patients aged 75 years or older.

BACKGROUND: Perfusion and functional data obtained during gated single photon emission computed tomography (SPECT) have proven prognostic value in the middle-aged patient population. The aim of this study was to investigate whether perfusion and functional cardiac gated SPECT data have prognostic value in patients aged 75 years or older. METHODS AND RESULTS: We studied clinical and gated SPECT predictors of cardiac and all-cause death in 294 patients aged 75 years or older with known or suspected coronary artery disease who were referred for tetrofosmin cardiac gated SPECT imaging. Summed perfusion scores were calculated in a 17-segment model by use of commercially available software (4D-MSPECT). Left ventricular functional data were calculated by use of QGS gated SPECT software. The median age of the study population was 78 years (range, 75-91 years). There were 160 men (54%) and 134 women (46%). During a median follow-up of 25.9 months (range, 1.8-36 months), 47 patients (16%) died (27 cardiac deaths). In a multivariate Cox proportional hazards regression analysis, the summed rest score (chi2 gain = 8.0, P = .009), transient ischemic dilatation index (chi2 gain = 6.3, P = .012), and resting left ventricular ejection fraction (chi2 gain = 7.0, P = .030) were independent predictors of all-cause death. The summed rest score (chi2 gain = 8.2, P = .004) and resting end-systolic volume (chi2 gain = 13.7, P = .005) were independent predictors of cardiac death. CONCLUSIONS: This study showed that gated SPECT left ventricular functional data assessed during myocardial gated SPECT provide independent and incremental information above clinical and perfusion SPECT data for the prediction of cardiac and all-cause death in patients aged 75 years or older referred for myocardial SPECT imaging.

Aged↗