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V Gressin

Publications and source records attributed to V Gressin.

At least 19 recordsLinked to original sources
PubMed2006

Bosentan for the treatment of pulmonary arterial hypertension associated with congenital heart defects.

BACKGROUND: Bosentan is an effective first-line therapy in New York Heart Association (NYHA) III patients with idiopathic pulmonary arterial hypertension (PAH). Pre-clinical data support the rationale for the potential benefit of bosentan in PAH associated with congenital heart disease (CHD). MATERIALS AND METHODS: We performed a retrospective analysis of patients with PAH-associated CHD who were treated with bosentan on top of conventional therapy. Bosentan was started at 62.5 mg bid for 4 weeks, then titrated to 125 mg bid. New York Heart Association (NYHA) functional class, 6-min walking distance (6MWD), Borg dyspnoea index, arterial oxygen saturation and cardiopulmonary haemodynamic data (cardiac output, pulmonary blood flow and systemic and pulmonary vascular resistances) were collected at baseline and at follow up. RESULTS: Twenty-seven patients (23 females, mean 35 +/- 15 years) with NYHA class III-IV PAH-associated CHD (not repaired in 23 cases) were treated with bosentan for a mean 18.3 +/- 9.9 months. Bosentan improved 6MWD from 298 +/- 92 m at baseline to 355 +/- 82 m at 3 months (P = 0.0002) and to 364 +/- 92 m (P = 0.0001) at the last follow up (mean 15.2 +/- 9.7 months). At the last follow up, 13 patients had improved (= 1 NYHA class) and 14 remained stable. A favourable effect was observed in pulmonary blood flow and pulmonary vascular resistance for the 11 available patients. No change in pulse oximetry or liver enzyme elevation was reported. CONCLUSIONS: Bosentan improves exercise capacity, functional class and haemodynamics in most patients with PAH-associated CHD, without serious side-effects, suggesting bosentan may be an important treatment option for these patients.

Adolescent↗
PubMed2004

[Pulmonary arterial hypertension in systemic sclerosis: definition of a screening algorithm for early detection (the ItinérAIR-Sclérodermie Study)].

PURPOSE: Pulmonary arterial hypertension (PAH) is a severe complication of scleroderma. Its prevalence varies from 5% to 35% in the literature. A systematic yearly screening is recommended for early detection and management of PAH, but no precise algorithm is yet available. METHODS: From literature analysis as well as evaluation of medical needs and practices, a multidisciplinary board of experts proposed an algorithm for the screening of PAH in scleroderma. RESULTS: This algorithm is based on a precise Doppler echocardiography methodology for the purpose of screening scleroderma patients for PAH. Patients are considered as being at high or low risk of PAH depending on the maximal tricuspid regurgitation velocity. High-risk patients undergo right heart catheterization for confirmation of the diagnosis of PAH. A French multicenter transversal observational study ("ItinérAIR Sclérodermie") will be conducted in 21 hospital centers in France and involved 100 investigators organized as multidisciplinary networks. FUTURE PROSPECTS: Final results will provide confirmation that the screening algorithm is applicable in a real world setting, as well as a better knowledge of the prevalence of PAH in the various sub-groups of scleroderma patients, of the risk profile for PAH and of the value of DLCO as a predictive factor for PAH, and will support elaboration of precise screening guidelines.

Algorithms↗
PubMed2000

Comparative effects of bisoprolol and nitrendipine on exercise capacity in hypertensive patients with regular physical activity.

The aim of this study was to evaluate the long-term effects of administering bisoprolol compared with nitrendipine on the duration of the exercise tolerated by male and female patients, aged 18-65 years, having mild to moderate hypertension and taking regular exercise. In this double-blind, randomized prospective study, 96 patients (85 men and 11 women, 48+/-10 years) formed two groups: 49 in the bisoprolol group, and 47 in the nitrendipine group. After a washout period of 14 days, either 10 mg of bisoprolol or 20 mg of nitrendipine was given daily over a treatment period of 12 weeks. During the treatment period, the stability of the physical training was monitored weekly by using a questionnaire. The results of two maximal triangular exercise tolerance tests (ETTs) on an ergometric bicycle performed at D0 under placebo and at D84 under active treatment were compared. No statistical difference was observed between both groups, concerning age, gender, morphologic characteristics, resting cardiovascular parameters, or physical training. Both groups maintained the same training level throughout the study. No significant differences between the groups were noted for duration of ETT [D0 892+/-284 s, D84, 919+/-267 s (NS) vs. D0 929+/-290 s, D84 904+/-324 s (NS)], or maximal work load [D0 190+/-49 W, D84 197+/-48 W (NS) vs. D0 198+/-49 W, D84 196+/-55 W (NS)]. On the other hand, both groups differed in maximal systolic blood pressure [D0 239+/-24 mm Hg, D84 215+/-22 mm Hg (p<0.001) vs. D0 237+/-24 mm Hg, D84 222+/-27 mm Hg (p<0.05)] (p = 0.05), and maximal pulse rate during exercise [141+/-18 vs. 163+/-17] (p<0.001), albeit not in maximal diastolic blood pressure [D0 113+/-13 mm Hg, D84 106+/-17 mm Hg (p<0.05) vs. D0 112+/-13 mm Hg, D84 104+/-15 mm Hg (p<0.05)]. The patient's own perception of the maximal effort (Borg scale) was not significantly different in either of the groups (placebo vs. treatment). Overall, in a population of hypertensive patients taking regular exercise, long-term treatment with bisoprolol produced no significant changes in the duration of peak effort, maximal workload, or the effort perceived by the patients themselves. The effects of regular exercise were comparable in both groups (bisoprolol or nitrendipine). Because previous studies have shown that dihydropyridines do not modify exercise performance in hypertensive patients, it may be concluded that the antihypertensive therapy with bisoprolol is well tolerated in a population of active hypertensive patients during dynamic exercise.

Adolescent↗
PubMed1995

[Effects of bisoprolol and ramipril on short-term variability of systolic blood pressure during mental stress test: spectrum analysis].

UNLABELLED: The mid frequency component (MFC = 66-128 mHz) of blood pressure is an index of sympathetic vascular control. To investigate the effect of bisoprolol (B) and ramipril (R) treatment (TT) on the short-term variability of systolic blood pressure (SBP) diastolic blood pressure (DPB) and heart rate (HR) reactivity during mental stress, we studied 54 mild essential untreated hypertensive patients (24 men, 45 +/- 9.6 years, BP > 160/90 mmHg after a 15-days placebo run-in period) who were randomly assigned to double blind treatment (B: 10 mg/day: n = 28 and R: 5 mg/day: n = 26). A Stroop Word Color Conflict Test (SWCCT) was performed before and after 2 months of treatment. Hemodynamic parameters (BP and HR) were measured by a non invasive device (Finapres 2300E, Ohmeda-Maurepas) and underwent spectral analysis (SBP: mmHg.Hz-1/2, HR: beats/min.Hz-1/2, Anapres 1.2, Notocord-Orgametrie Systems, Igny-Lille) at rest and during SWCCT. The sympathetic vascular activity was assessed by calculating the area of the mid-frequency component (MFC = 66-128 Hz). RESULTS: [table: see text] CONCLUSION: The absolute variations in sympathetic activity during SWCCT as demonstrated by analysis of MFC of SBP and HR is not affected by chronic ramipril treatment, whereas bisoprolol attenuates sympathetic reactivity during SWCCT.

Adult↗
PubMed1995

Non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity.

AIM: The objective of this study was to evaluate the relationship between non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity in hypertensive patients. SUBJECTS AND METHODS: Ambulatory blood pressure measurements (15-min intervals for 24 h) and continuous blood pressure measurements (Finapres, 20 min at rest after a 10-min resting period) were performed in 123 untreated hypertensives (resting diastolic blood pressure > or = 90 mmHg; 80 males, 43 females; mean +/- SD age 49 +/- 12 years, range 19-73). Fourier series were used to model 24-h blood pressure profiles (four harmonics). Ambulatory blood pressure variability was assessed by determination of the residuals in each 24-h blood pressure profile (measured minus predicted pressures). Resting blood pressure variability was defined as the SD of the mean Finapres value. Baroreflex sensitivity was evaluated by automatic detection of blood pressure and pulse interval sequences of > or = 3 beats when systolic blood pressure and pulse interval sequences changed in the same direction (increase or decrease: 1 mmHg for systolic blood pressure and 4 ms for RR interval), and was assessed as the slope of the regression line for each sequence. RESULTS: Ambulatory systolic blood pressure variability increased with age (r = 0.28*) and systolic pressure (r = 0.44**). Baroreflex sensitivity (increasing systolic pressure/pulse interval) decreased significantly with age (r = -0.48**) and systolic pressure (r = -0.23**), and was significantly related to increased ambulatory blood pressure variability (r = -0.33**). In a multivariate stepwise analysis the relationship between ambulatory blood pressure variability and baroreflex sensitivity (increasing systolic pressure/pulse interval) was statistically independent of age and systolic pressure (R = 0.55, P<0.001); this relationship was not observed with the corresponding decreasing sequence. CONCLUSIONS: This study shows that in uncomplicated hypertension, ambulatory blood pressure variability is related to baroreflex sensitivity independently of the blood pressure level. This finding has prognostic implications for this non-invasive measurement, which needs to be confirmed by large longitudinal studies.

Adult↗
PubMed1993

Is arrhythmogenicity related to the speed of reperfusion during thrombolysis for myocardial infarction?

The objective of this study was to relate the number of ventricular arrhythmias (VA) to the normalization time of the ST segment during thrombolysis for acute myocardial infarction. The 24 h Holter recordings, begun on start of intravenous thrombolytic therapy, and the 12-lead electrocardiograms of 41 patients with a patent infarct-related artery according to coronary angiography were analysed. The mean time from onset of chest pain to angiography was 30.5 +/- 3.1 h, < or = 24 h in 59%. The normalization time of the ST segment, assessed by the time of decrease of ST segment elevation from start of Holter recording to normal or steady state was < or = 60 min in 13 patients (group 1), 60 to 180 min in 15 patients (group 2) and > 180 min in 13 patients (group 3). The incidence of VA was similar in all groups, except for ventricular tachycardias (VT) > 15 beats (group 1:69%, group 2:13%, group 3:15%, P = 0.002). The frequency of accelerated idioventricular rhythms (AIVR), early AIVR (< or = 6 h) and of VT was significantly higher in group 1 than in group 3 with a 8-, 30- and 6-fold increase, respectively (back transformed mean). We conclude that the number of VAs is related to the normalization time of the ST segment during reperfusion. This may suggest that faster reflow is more arrhythmogenic.

Cardiac Complexes, Premature↗
PubMed1993

[Is sudden reperfusion more arrhythmogenic during thrombolysis for myocardial infarction?].

The object of this study was to analyse ventricular arrhythmias occurring during intravenous thrombolysis for acute myocardial infarction with respect to ST segment changes on 24 hour Holter ECG monitoring initiated at the same time as thrombolytic therapy and on repeated 12 lead electrocardiogrammes. Forty-one patients in whom the infarct-related artery was patent at coronary angiography carried out 30.5 +/- 3.1 hours (< or = 24 hours in 59% of cases) after the onset of chest pain were included. The time to normalisation of the ST segment was defined as the interval between maximum ST elevation to a steady state and helped identify rapid (< or = 60 minutes, n = 13) from intermediate (60-180 minutes, n = 15) and slow (> 180 minutes, n = 13) reperfusion. The incidence of ventricular arrhythmias was the same in all three groups, except for prolonged ventricular tachycardias (> 15 complexes): 69%, 13% and 15% respectively (p = 0.002). The number of arrhythmias was greater when the ST segment changes were rapid than when they were intermediate or slow. This was true for ventricular extrasystoles (p < 0.05), accelerated idioventricular rhythms (p < 0.05), early (< or = 6 hours from onset of thrombolysis) accelerated idioventricular rhythms (p < 0.01) and ventricular tachycardias (p < 0.05). Therefore, the number of ventricular arrhythmias seems to be related to the speed of ST segment change, suggesting that more sudden reperfusion is more arrhythmogenic.

Arrhythmias, Cardiac↗
PubMed1993

[Evaluation of the antihypertensive efficacy of lisinopril and captopril associated with hydrochlorothiazide by ambulatory measurement of arterial pressure].

The objective of this study was to evaluate the efficacy, particularly in terms of the 24-hour cover, and the safety of lisinopril 20 mg + hydrochlorothiazide 12.5 mg 5L/HCTZ) and captopril 50 mg + hydrochlorothiazide 25 mg (C/HCTZ) in patients with essential HT requiring two-agent therapy. Twenty patients with a diastolic blood pressure (DBP) between 95 and 120 mmHg after 2 weeks of placebo were randomised to receive, under double-blind conditions, either L/HCTZ or C/HCTZ as a single daily dose for 4 weeks. Clinical examination, laboratory tests and 24-hour ambulatory blood pressure monitoring (ABPM) were performed at the end of the placebo and active treatment periods. L/HCTZ and C/HCTZ significantly lowered SBP and DBP on occasional recordings and on ABPM. The mean fall in blood pressure on ABPM (SBP, DBP, mean of 24-hour recording, diurnal and nocturnal) at 4 weeks was greater with L/HCTZ than with C/HCTZ. Both treatments were effective for 24 hours and did not alter the circadian cycle. The clinical and laboratory safety was good. The blood pressure figures obtained by ABPM were lower than on occasional recordings, emphasising the value of this technique in the evaluation of a patient's poor response to antihypertensive treatment.

Adult↗
PubMed1993

[Reperfusion arrhythmia].

Reperfusion arrhythmias were described from the first trials of intracoronary thrombolysis for myocardial infarction. The prevalence of ventricular fibrillation during intravenous thrombolysis is low (< 7%) and comparable to that observed with classical treatment. Holter recording shows that ventricular tachycardia and accelerated idioventricular rhythms occur in over 80% of cases. These arrhythmias are generally well tolerated and do not require specific therapy. A bradycardia-hypotension syndrome is observed in about a quarter of reperfused patients, nearly always in inferior wall infarction. It normally resolves spontaneously or after atropine or vascular filling. Reperfusion is associated with a clearcut increase in the number of episodes of arrhythmia. Some arrhythmias such as sustained ventricular tachycardia, early accelerated idioventricular rhythms (occurring in the first 6 hours) or the bradycardia-hypotension syndrome may be considered as non-invasive criteria of reperfusion. More severe ischemia and sudden reperfusion favour the arrhythmogenicity of reperfusion in the animal. Recent data suggest that this may be the case in the clinical context. In some uncontrolled studies, lidocaine, betablockers and aspirin did not affect the prevalence of the arrhythmias. Preliminary trials indicate that flunarizine and captopril may reduce the incidence of reperfusion arrhythmias in man. Ventricular arrhythmias and myocardial stunning could be the result of sa single phenomenon (the extent of the ischemic lesions or reperfusion lesions). Studies currently under way should clarify the relationship between the incidence of arrhythmias, the severity of stunning and myocardial recovery. Protocols evaluating therapeutic interventions on the reperfusate should include Holter monitoring.

Animals↗
PubMed1993

[Evolution of the ST segment in myocardial reperfusion].

Intracoronary thrombolysis showed the chronological order of clinical electric and biological changes following the reestablishment of coronary flow. These changes make up the reperfusion syndrome; ST segment changes are part of this syndrome. They occur in practically all cases at the moment of reperfusion. The ST elevation may regress more or less rapidly or, on the contrary, increase transiently to a greater or lesser degree. When associated with other criteria of reperfusion-enzyme changes, arrhythmias, ST changes contribute to the indirect diagnosis of reestablishment of coronary flow. Rapid decrease in ST segment elevation is usually associated with a good myocardial outcome. The prognostic significance of transient increases in ST elevation--so called "reperfusion ischaemia"--is not fully understood, in particular its relationship to myocardial reperfusion injury. The myocardial prognosis after reperfusion may be the "biological" sum of cellular lesions due to ischaemia and reperfusion.

Arrhythmias, Cardiac↗
PubMed1993

[Reperfusion-induced arrhythmia and oxidative stress].

Although recognized and reproduced in numerous animal models, reperfusion arrhythmias were not studied extensively in humans until the advent of methods of coronary reperfusion during the acute phase of myocardial infarction. Usually of ventricular origin, these arrhythmias are polymorphic and constitute imperfect but useful markers of coronary reperfusion. Their electrophysiologic mechanisms are complex and their molecular mechanisms unelucidated. Predisposing conditions are the duration and severity of the ischemia, biochemical modifications such as heterogeneous uptake of extracellular potassium, magnesium deficit, intracellular calcium overload and release of arrhythmogenic lipid metabolites or prostaglandins. The autonomic nervous system also plays a part by an increase in the number and response of alpha-adrenoceptors. Furthermore, experimental studies provide theoretical and pharmacologic arguments for the participation of free oxygen radicals (superoxide anion (02.-, hydroxyl radical OH.) in reperfusion arrhythmias in the animal. By its complexity, human myocardial infarction differs markedly from the animal models studied; it probably involves, apart from the free oxygen radicals, multiple thrombotic, humoral and nervous factors whose respective role in the production of reperfusion arrhythmias remains to be established. Some enlightenment should be obtained by analysis of rhythmic events during proposed controlled studies using anti-free radical agents to prevent these post-myocardial infarct acute events.

Arrhythmias, Cardiac↗
PubMed1992

Holter recording of ventricular arrhythmias during intravenous thrombolysis for acute myocardial infarction.

Ventricular arrhythmias during thrombolysis for acute myocardial infarction and their relation to coronary artery patency were examined. Twenty-four-hour Holter monitoring was begun 3.1 +/- 0.2 hours after onset of pain in 40 patients (age 54 +/- 1.6 years; anterior infarction 42.5%) treated with streptokinase (42.5%) or recombinant tissue-type plasminogen activator (57.5%) (delay from pain 3.3 +/- 0.2 hours). A Marquette 8000 computer was used for Holter analysis. The infarct-related artery was considered as patent (72.5%) or non-patent (27.5%) according to coronary angiography (delay from pain 26.7 +/- 2.5 hours; 60% less than 24 hours). Ventricular arrhythmias were present in all patients. Tolerance was good (1 cardioversion for ventricular fibrillation). The incidence of accelerated idioventricular rhythm was not different between patients with a patent and nonpatent artery (90 vs 82%), nor for ventricular tachycardia (VT) (83 vs 73%). Coronary artery patency was associated with a 14-, 13- and 32-fold increase of ventricular premature complexes, VT and accelerated idioventricular rhythms, respectively. The increased incidence of sustained VT (patent 38%; nonpatent 0%; p less than 0.05) and early (before the first 6 hours) accelerated idioventricular rhythm (patent 76%; nonpatent 18%; p less than 0.01) associated with artery patency suggests that these arrhythmias may be noninvasive diagnostic criteria for reperfusion (sensitivity 38 vs 76%, and specificity 100 vs 82%). A positive correlation was found between the frequency of ventricular premature complexes and VT, and peak creatine kinase.

Arrhythmias, Cardiac↗
PubMed1992

[Holter monitoring of ventricular arrhythmia during the 24 first hours of myocardial infarction treated with intravenous thrombolysis].

The aim of this study was to assess ventricular arrhythmias after intravenous thrombolysis for acute myocardial infarction and to determine their relationship with coronary artery patency. A 24 hour Holter recording was started 3.1 +/- 0.2 hours after the onset of pain in 40 patients (age 54 +/- 1.6 years, 42.5% anterior infarcts) treated by streptokinase (42.5%) or tissue plasminogen activator (57.5%) within 3.3 +/- 0.2 hours of the beginning of symptoms. The arrhythmias were analysed on a Marquette 8000 computer. Coronary angiography was systematic and was performed 26.7 +/- 2.5 hours (within 4 hours in 60% of patients) after the onset of pain to define coronary artery patency (TIMI 2 and 3: 72.5%) or occlusion (TIMI 0 or 1: 27.5%). Ventricular arrhythmias were common and generally well tolerated (one defibrillation for ventricular fibrillation). Accelerated idioventricular rhythms and ventricular tachycardias were equally prevalent in patients with patent arteries (90% and 83%) as with occluded arteries (82% and 73%). The prevalence of sustained ventricular tachycardias (> 15 complexes) and of early accelerated idioventricular rhythms (< or = 6 hours) was significantly higher in patients with patent coronary arteries: 38% versus 0% (p < 0.05) and 76% versus 18% (p < 0.01). These arrhythmias may be considered to be non-invasive markers of early coronary reperfusion, with a sensitivity of 38 and 76% and a specificity of 100 and 82%. Coronary patency was associated with higher numbers of ventricular extrasystoles, ventricular tachycardias and accelerated idioventricular rhythms by a factor of 14, 13 and 32 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Myocardial reperfusion syndrome].

Myocardial reperfusion is associated with a number of clinical, electrocardiographic (arrhythmias, conduction defects, ST segment changes), haemodynamic and biological events. The commonest arrhythmias are ventricular extra-systoles, rapid ventricular tachycardias, and accelerated idio-ventricular rhythms. Reperfusion bradycardias are less common. When the arrhythmia is related to ischaemia it usually regresses when perfusion is restored. Reperfusion of the inferior wall of the left ventricle is often associated with sinus bradycardia and hypotension. The ST segment changes may evolve in two different ways: progressive regression or accentuation of ST elevation. When the responsible artery is recanalized, there is an immediate rise in plasma enzyme and myoglobin concentrations. The peak CPK concentration is usually observed after the 12th hours. The diagnostic value of the reperfusion syndrome lies in the interpretation of rapid ventricular tachycardias, accelerated idio-ventricular rhythms, ST segment changes and immediate rise in plasma CPK levels. The clinical risks of the reperfusion syndrome are low, practically never rhythmic and only exceptionally haemodynamic.

Arrhythmias, Cardiac↗
PubMed1987

[Impact and significance of early rhythm disorders after fibrinolytic treatment of myocardial infarction].

The study concerns 31 cases of parenteral fibrinolysis performed at the acute stage of myocardial infarction in 30 patients (mean age: 51.9 years), treated less than 4 hours and 15 minutes after the onset of pain. The treatment with streptokinase (80.65%), BRL 26 921 (12.90%) and urokinase (6.45%) was undertaken within a mean time of 3 hours and 17 minutes +/- 53 min. Revascularization defined by the disappearing of pain, the sudden flattening of ST with presence of Q wave, was obtained in 71 p. cent of patients before the 6th hour. The study of the CK curve shows that the enzymatic peak is reached earlier in these patients (13 hours 23 vs 19 h 42). Severe arrhythmias are rare (VF: 0%, transient AVB III: 3.2%). VAIRs were only observed in patients revascularized at an early stage (p 0.02) and in 54.5 p. cent of them. It seems to concern the largest M.Is, treated and revascularized later, regardless of the artery concerned. The syndrome bradycardia-hypotension (Bezold-Jarisch reflex) is only found in patients revascularized at an early stage (22.7 p. cent). Late VES (RR' RR-200 ms or fusion) are more frequent in patients revascularized at an early stage. These three benign rhythm disorders which do not usually require treatment, seem to be good success criteria of fibrinolysis but cannot be considered as predictive indications of myocardial protection.

Adult↗