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Biomedical subjects

Y Taeymans

Publications and source records attributed to Y Taeymans.

53 records · Page 3Linked to original sources
PubMed1985

Factors associated with progression of coronary artery disease in patients with normal or minimally narrowed coronary arteries.

This study was performed to identify the subset of patients with normal or with minimal (49% or less) stenosis of the coronary vessels who may be prone to progressive coronary artery disease (CAD). Data were collected from 51 patients (19 men, 32 women, mean age 48 years) with normal coronary arteries (20 patients) or with minimal narrowing (31 patients) on a first angiogram, who underwent repeat catheterization 4 to 120 months later (mean 52) because of persistent chest pain. Three classic lifestyle-related risk factors (systemic hypertension, cigarette smoking status and hypercholesterolemia) were noted; the number of diseased segments on the first angiogram was counted according to a 15-segment coding system. Progression of CAD required the consensus of 3 observers on a 30% or greater decrease in luminal diameter. Progression was recorded in 16 of 31 patients with minimal CAD and in 3 of 20 patients with normal coronary arteries (p less than 0.01). By multivariate logistic regression, progression was predicted by (1) number of diseased segments (p = 0.001), (2) age (p less than 0.01), (3) smoking status (p less than 0.05) and (4) initial cholesterol level (p less than 0.05). Using the probability computed by the logistic model, we could separate the 51 patients in groups with low (0 of 18), medium (9 of 23) and high (10 of 10) risk of progression. Thus, patients with normal or minimally narrowed coronary arteries at angiography form a heterogeneous population including both normal or borderline subjects and patients with CAD at its early stage. The latter condition was associated with presence of risk factors and to the angiographic extent of the disease.

Adult↗
PubMed1985

Prognostic significance of progression of coronary artery disease.

Angiographically documented coronary artery disease (CAD) can progress. Although progression itself is frequently recognized in patients who have undergone repeat cardiac catheterization, its prognostic significance remains unclear. To evaluate the influence of progression on survival, 313 patients with CAD who underwent catheterization twice (39 +/- 25 months apart) were followed for 3 to 129 months (mean 41 +/- 30) after the second angiogram. At the time of the second angiogram, 21, 91, 113 and 88 patients had 0-, 1-, 2- and 3-vessel CAD, respectively. The mean ejection fraction (EF) of the group was 55 +/- 13%. Progression was noted in 139 patients (44%). Of the 313 patients, 33 died and 39 had acute myocardial infarction (AMI) during follow-up. Four-year survival was estimated at 94% and 83% in the nonprogression and progression groups, respectively. Progression was predictive of survival by (univariate) long-rank test (p less than 0.01), but only EF (p less than 0.001), number of diseased vessels (p less than 0.01) and percent stenosis in the left main coronary artery (p less than 0.05) were independently significant by (multivariate) Cox regression analysis. Four-year survival without AMI was 89% and 73% in the nonprogression and progression groups, respectively. Progression was related to survival without AMI (p less than 0.001) by log-rank test. Cox regression analysis provided 3 independent predictors of survival without AMI: number of diseased vessels (p less than 0.01), progression (p less than 0.01), relative risk = 2.28) and EF (p less than 0.01). Results were similar when analyzing only the 39 AMIs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Spontaneous regression of coronary artery obstructions: incidence in 313 consecutive repeat angiograms.

We studied the incidence of reversibility of coronary obstructions in a consecutive series of 313 patients with nonoperated coronary artery disease catheterized twice 3 to 118 (mean 38) months apart. Recanalization was observed in three patients and regression from an initial less than 100% obstruction in six patients. Progression in a different location occurred in six of the nine patients who demonstrated one recanalized or one regressive lesion. We conclude that true regression is an infrequent event in the natural history of medically treated patients with coronary artery disease; moreover, the pathophysiology and clinical relevance of angiographic regression remain poorly defined.

Angina Pectoris↗
PubMed1985

A randomized study comparing propranolol and diltiazem in the treatment of unstable angina.

One hundred consecutive patients hospitalized in the coronary care unit for unstable angina, excluding patients with Prinzmetal's variant angina, were randomized within 24 hours of admission to treatment with diltiazem (50 patients) or propranolol (50 patients). Also excluded were patients with previous coronary artery bypass surgery and those receiving a beta-receptor blocking agent at the time of hospital admission. Left ventricular function and the extent of coronary artery disease were similar in the two groups. During the hospital stay, the number of chest pain episodes decreased from a mean (+/- SD) of 0.75 +/- 0.1 per patient per day to 0.26 +/- 0.07 (p less than 0.05) with diltiazem and 0.29 +/- 0.1 (p less than 0.05) with propranolol therapy. The circadian distribution of chest pain episodes was affected similarly. After 1 month, 14 of the patients treated with diltiazem were symptom-free compared with 13 treated with propranolol. At a mean follow-up time of 5.1 months (range 1 to 15), death had occurred in two patients in each group and myocardial infarction in five diltiazem- and four propranolol-treated patients (difference not significant). Coronary artery bypass surgery had been performed in 21 diltiazem- and 19 propranolol-treated patients (difference not significant). Only 15 patients were symptom-free, 9 treated with diltiazem and 6 with propranolol. This similar result observed with the two forms of treatment suggests that coronary artery spasm may not be the main factor involved in unstable angina when Prinzmetal's variant angina is excluded. It also suggests that diltiazem can be used as an alternative to the usual treatment with beta-receptor blocking drugs.

Aged↗
PubMed1984

Clinical and angiographic predictors of new total coronary occlusion in coronary artery disease: analysis of 313 nonoperated patients.

A new coronary artery occlusion was found in 98 of 313 consecutive patients (31%) with coronary artery disease treated medically who underwent catheterization twice, 39 +/- 25 months apart. Multivariate logistic regression displayed 8 independent predictors of new occlusion. Four were available at the time of the second angiogram: the interval between the 2 studies (p = 0.005), a decrease in ejection fraction (p less than 0.01), the appearance of bundle branch block (p less than 0.01), and an interim myocardial infarction (p less than 0.05). Four other predictors were found at the time of the first angiogram: 2 angiographic characteristics, 1 related to the severity (presence of an 80% or greater luminal diameter narrowing of an artery supplying a non-akinetic left ventricular segment [p less than 0.005]) and 1 to the extent (count of the lesions narrowed 75% or less in luminal diameter in a 15-segment coding system [p less than 0.05]) of coronary artery disease, and 2 risk factors: smoking status (p less than 0.05) and male sex (p less than 0.05). The 140 male smokers with at least 80% diameter stenosis or at least 4 segments with moderate (75% or less) stenosis were at a higher risk of occlusion than the 173 other patients after intervals of less than 2 years (13 of 53 vs 7 of 74, p less than 0.01), 2 to 4 years (23 of 40 vs 10 of 47, p less than 0.005) and more than 4 years (27 of 47 vs 18 of 54, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Improved gas chromatographic determination of diltiazem and deacetyldiltiazem in human plasma.

This study describes an improved, simple, and specific gas chromatographic method for the determination of diltiazem (I) and deacetyldiltiazem (II) in human plasma using loxapine (III) as an internal standard. After extraction at pH 7.5 with anhydrous ether-ethyl acetate (1:1), II was silylated with N-methyl-N-(trimethylsilyl)trifluoroacetamide. The gas chromatograph, equipped with an electron-capture detector, allowed measurements as low as 2 ng/mL for I and 3 ng/mL for II. Recoveries of III, I, and II were 95, 85, and 79%, respectively. There were no interferences with endogenous substances in plasma or with common cardiovascular drugs. This method was used to measure plasma concentrations of two patients who received 20 mg iv of I. The areas under the curve for these two patients were 275 and 273 ng.h/mL, respectively. The apparent volumes of distribution were 493.6 and 288.6 L, and the elimination half-lives were 4.70 and 2.73 h. No deacetyldiltiazem could be detected in the blood after the single-dose diltiazem administration.

Benzazepines↗
PubMed1984

High-performance liquid chromatographic determination of diltiazem and six of its metabolites in human urine.

The use of the calcium antagonist diltiazem (I) is increasing, particularly in treating unstable angina. This study describes a simple and specific high-performance liquid chromatographic method for the determination of I and six of its metabolites in urine. Diltiazem and its conjugated and unconjugated metabolites were assayed in the urine of patients treated with a dose of 120 mg po of diltiazem tid. Sensitivity of the method was 100 ng/mL for I and the metabolites desacetyldiltiazem (II), N-desmethyldesacetyldiltiazem (IV), O-desmethyldesacetyldiltiazem (V), O-desmethyl-N-desmethyldesacetyldiltiazem (VII), N-oxide desacetyldiltiazem (III), and O-desmethyl-N-oxide desacetyldiltiazem (VI). In the urine of patients, the extent of conjugation of six metabolites was greater than 80%.

Benzazepines↗
PubMed1984

Is progression of coronary artery disease occurring at bouts or as a continuous process? Serial cineangiographic studies in 44 patients.

In order to assess if coronary artery disease progression occurs as a slow, continuous process or at bouts, the coronary angiograms of 44 patients catheterized three times were reviewed. A previously developed logistic model, taking into account time interval between the angiograms, age, occurrence of unstable angina, and extent score of coronary artery disease, was used to compute a probability of progression from the second to the third angiogram. Two groups of patients were considered: those with (n = 15) and those without (n = 29) progression from the first to the second angiogram (PROGRESSION 1-2). A simulation provided in each group the distribution of the expected number of patients with progression from the second to the third catheterization. In the group without PROGRESSION 1-2, the observed number of progressions from the second to the third angiogram was in agreement with the expected one. However, in the group with PROGRESSION 1-2, the progression from the second to the third angiogram was more frequent than expected (p = 0.068). These results suggest that, in many patients, coronary artery disease progression is continuous over several years.

Cineangiography↗
PubMed1984

Clinical and angiographic factors associated with progression of coronary artery disease.

To characterize the clinical and angiographic factors associated with progression of coronary atherosclerosis, 313 consecutive medically treated patients who had had two coronary arteriograms 3 to 119 months (mean 39 +/- 25) apart were studied. One hundred eighty-one patients underwent recatheterization for stable angina, 52 for unstable angina and 80 for various other reasons. In addition to the conventional angiographic features present at the first angiographic study (number of diseased vessels 1.5 +/- 0.8, ejection fraction 59 +/- 11%), an extent score was defined based on the number of coronary segments with 5 to 75% narrowings from a 15 segment coding system. Multivariate logistic regression identified four independent predictors of progression of coronary artery disease: the interval between studies (p less than 0.0001), unstable angina (p less than 0.0001), a high extent score (p = 0.0001) and young age (p = 0.0026). In a subset of 74 patients aged 50 years or younger with, at the time of the first evaluation, an extent score of 4 or more, the probability of progression between 2 and 4 years and after 4 years was, respectively, 80 and 90% compared with 50% for the other patients. Risk stratification for progression of coronary artery disease can thus be obtained.

Adult↗
PubMed1983

Unstable angina and progression of coronary atherosclerosis.

We studied the progression of atherosclerotic coronary lesions in 38 patients who had previously undergone angiography and were later hospitalized for an episode of unstable angina pectoris, and in 38 matched patients with stable angina who had also undergone prior catheterization. Patients with unstable angina and those with stable angina were similar in terms of age (mean, 49 and 50 years, respectively), number of risk factors (1.5 per patient in both groups), interval between studies (mean +/- S.D., 44 +/- 31 and 35 +/- 31 months, respectively), number of diseased vessels on the first angiogram (1.52 in both groups), and initial ejection fraction (65 and 63 per cent, respectively). Progression of coronary lesions was demonstrated in 29 of the 38 patients with unstable angina, as compared with 12 of the 38 with stable angina (P less than 0.0005). Progression to 70 per cent or more stenosis was recorded in 21 of the patients with unstable angina but in only 5 of those with stable angina (P less than 0.0005). Also more frequent in the patients with unstable angina were multifocal progression (11 vs. 2, P less than 0.01) and progression of the left main or preseptal left anterior descending artery or both (9 vs. 1, P less than 0.01). Thus, we have demonstrated by angiography that unstable angina is associated with progression in the extent and severity of coronary atherosclerosis.

Adult↗
PubMed1983

Calcium antagonists. Clinical use in the treatment of angina.

Angina pectoris results from an imbalance between the oxygen supply and the oxygen needs of the myocardium. While the classic form of angina is usually caused by demands exceeding supply, a primary and transient decrease in coronary blood flow is more and more often recognised as an aetiological factor of myocardial ischaemia. Calcium antagonists, although new in cardiovascular therapeutics, are already recognised as the treatment of choice for some forms of angina and as useful therapeutic adjuncts in others. Few contraindications to their use exist. They are potent vasodilators and they can prevent the occurrence of coronary artery spasm responsible for the Prinzmetal's variant form of angina. They can also reduce coronary artery tone, which if high, can compromise flow through a narrowed coronary artery. Nifedipine, diltiazem and verapamil can also influence the various determinants of myocardial oxygen consumption to reduce myocardial oxygen needs. Their effects on heart rate, blood pressure and on the inotropic state of the left ventricle is, in vivo, the balance between their direct effects on the vascular wall and myocardial muscular cells and their indirect effects represented by the reflex physiological responses. Significant variations in these effects exist between the 3 calcium antagonists such that treatment can be individualised to a particular patient's needs. Precautions with their use as well as most of their side effects can be understood from a knowledge of their direct and indirect properties. Other pharmacological effects of these drugs include a regional redistribution of coronary blood flow, cardioprotection, delay in cell death and possibly in the progression of atherosclerosis. The clinical significance of these properties remains to be investigated.

Angina Pectoris↗
PubMed1982

Evaluation of mitral stenosis by the study of the left ventricular diastolic phase.

The left ventricular relaxation period has been studied by digitized monodimensional echocardiography in 14 patients with symptomatic pure mitral stenosis and in 11 normal subjects. The maximal relaxation rate and the maximal circumferential relaxation rate differed significantly in both groups (p less than 0.001) with a marked reduction in the patients with mitral stenosis; it was, however, not possible to trace a significant correlation between mitral valve area and the indices of diastolic phase, excepted a slightly significant one for the mean relaxation rate (r = 0.7). In spite of the fact that these results show a delayed left ventricular filling in mitral stenosis, the correlation with the mitral valve area was poor and suggests that it is not satisfactory to estimate the left ventricular filling only by the variation of the ventricular transverse diameter, and that a more accurate evaluation of the mitral valve area should include, in addition to the measurement of the ventricular relaxation rate, at least an indirect estimation of the transmitral pressure gradient, for instance by Doppler echocardiography of the transmitral flow.

Diastole↗
PubMedDate not supplied

Recurrent pulmonary embolism: importance, diagnosis, management and prevention.

Pulmonary emboli, even small, cause irreparable lung damage. Recurrent pulmonary emboli further increase the amount of non functional lung tissue and may result in incapacitating respiratory disease or death. It is therefore mandatory that the disease be correctly diagnosed and adequately treated. As prevention is better than cure, every patient presenting with clinical signs of deep venous thrombosis (DVT) should be correctly explored. The site and size of thrombosis must be visualized preferably with contrast venography with imaging of the veins of the limbs, iliac veins and vena cava. Risk factors such as obesity, immobilization etc. must be taken into account. Underlying disease such as heart disease and venous insufficiency must be treated. Malignancy must be looked for as in a recent series of patients with primary DVT which were studied, 15% presented with an up till then unknown malignant disease. In patients presenting with recurrent DVT this percentage rose to 20%. When a patient presents with DVT of the femoro-iliac vena cava axis, aggressive treatment must be adopted. Fibrinolysis or if this is contra-indicated, thrombectomy will be used. A vena cava filter may be necessary and longterm anticoagulation is mandatory. The same rationale is applicable in cases of pulmonary embolus whether it is a primary event or a recurrence.

Angiography↗