[Intravenous labetalol in normotensive coronary patients. Effects on hemodynamics and myocardial metabolism]

The haemodynamic and myocardial metabolic effects of intravenous Labetalol were studied in 7 normotensive coronary patients with at least one significant stenosis on the left anterior descending artery. The study consisted of 5 successive observation periods: basal (I); during atrial pacing at the theoretical maximal heart rate or when anginal pain occurred (II); return to basal conditions (III); 20 minutes after an injection of 1.5 mg/kg of Labetalol over 3 minutes into the pulmonary artery (IV); during repeat atrial pacing at the rate achieved during phase II (V). There was no significant difference between phases I and III except for a slightly faster heart rate in phase III. The effects of Labetalol were assessed by comparing the results during phases III and IV between phases II and V and by analysing the variations between phases I, II, IV and V. In comparison with basal conditions (phase III), Labetalol (phase IV) induced a slight decrease in cardiac output (p less than 0.05), a decrease in aortic pressure and systemic arterial resistances (p less than 0.01) and of the double product. Coronary sinus flow did not change but myocardial oxygen consumption fell by an average of 11% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute hemodynamic and coronary effects of captopril in chronic cardiac failure]

The acute effects of captopril on haemodynamics, coronary flow and myocardial metabolism were studied in 12 patients with chronic severe cardiac failure (primary cardiomyopathy: 10 cases; ischaemic: 2 cases) in functional Classes III or IV of the NYHA. All patients were male and their average age was 51.3 +/- 14.1 years (range 27 to 68 years). Measurements were carried out under basal conditions and 90 minutes after a single dose of 50 mg (5 cases) or 100 mg (7 cases) of captopril. Captopril administration leads to an increase in cardiac index from 2.05 +/- 0.32 to 2.34 +/- 0.35 l/min/m2 (p less than 0.05) and a greater increase in systolic index from 23.9 +/- 6.7 to 29.8 +/- 6.9 ml/syst/m2 (p less than 0.01), because the heart rate decreased slightly (p less than 0.05). These changes were the result of a decrease in afterload: mean aortic pressure fell from 85 +/- 11.8 to 68 +/- 19.6 mmHg (p less than 0.01) and systemic arterial resistance fell from 2 886 +/- 745 to 2 010 +/- 610 dynes/cm-5/sec/m-2 (p less than 0.01). Captopril also led to a fall in venous tone, i.e. pre-load: left ventricular end diastolic pressure fell from 26.9 +/- 6.1 to 20.8 +/- 6.6 mmHg: p less than 0.01. There was no change in contractility as shown by the absence of variation of the V.max (0.92 +/- 0.18 under basal conditions, and 0.90 +/- 0.15 after 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

[Return to work following myocardial infarction. Medical and socio-professional factors]

The aim of this study was to assess the influence of medical and socioprofessional factors on return to work after myocardial infarction. The authors studied a continuous series of 174 patients with an average age of 51.3 years, all of whom were active before their illness. The average follow-up period was 33 months. One hundred and thirty of the patients (75%) returned to work. The only clinical factors predictive of not returning to work were older age short exercise time and fall in blood pressure on exercise. On the other hand, nearly all socioprofessional factors, social class, type of occupation, size of company, length of employment in their company, physical stresses related to their occupation, were related to return to work. The average time before returning to work was 5.5 +/- 1 month. Though certain immediate criteria of severity of infarction such as previous myocardial infarction or anterior wall infarction were related to a more delayed return to work. The cardiac status evaluated by complementary investigations (left ventricular ejection fraction, exercise testing and Holter monitoring) was not related to the time before return to work. Of the socioprofessional factors, only difficulties related to the patients' work (modification or change of job) were associated with a more delayed return to work. Forty-four patients (33.8%) returned to work after a change in working hours (28 patients), the tasks involved (20 patients) or position (7 patients). Only the lower socioprofessional classes, independent workers and extremes of age could benefit from these measures.

[Remote results of ostial coronaritis surgically treated]

This study comprises 15 patients operated for syphilitic coronary ostial stenosis by Dubost's team between 1959 and 1975. Three operative deaths (20%) were observed. Three other late deaths occured, but only one of his coronary pathology. Of the nine survivors, seven have been reviewed and five have undergone control coronary angiography. The long term results of the 9 survivors, reviewed from 3 1/2 to 11 years after operation, illustrate the difficulties of disobliteration of the right coronary ostium, the necessity of changing the aortic valve systematically when incompetent and the maintenance of the good results obtained by this surgery.

Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics

BACKGROUND

During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical.

METHODS

We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations.

RESULTS

Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, P < 0.001 and OR 1.4, 95% CI 0.8-2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, P = 0.30 and OR 1.1, 95% CI 0.6-1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, P = 0.079 and OR 0.75, 95% CI 0.3-2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively).

CONCLUSIONS

We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.

[Prognosis and risk evaluation of postoperative coronary patients (PERISCOP). Methodology and study population characteristics]

The aim of the PERISCOP study was to evaluate the predictive value of cardiological investigations performed after recent coronary bypass surgery with regards to cardiac event and mortality at one year. The treatment of lipid abnormalities was also analysed. This first article describes the methodology and patient characteristics at inclusion. This prospective national multicenter trial included 2065 patients (86% men) with an average age of 63.1 +/- 9.9 years. The number of diseased vessels was 2.6 +/- 0.6. Preoperative left ventricular function was normal (ejection fraction 60 +/- 13%). Revascularisation was complete in 73% of cases (22% of arterial grafts). The cardiological investigations were performed at Day 20 +/- 10 after surgery. The duration of exercise on stress testing was 429 +/- 170 seconds. It was positive or doubtful in 9% of cases. Ventricular arrhythmias were observed in 6.5% of cases. The blood pressure response was abnormal in 6% of cases. Holter monitoring showed a median number of ventricular extrasystoles over 24 hours of 44. Three per cent of patients had one episode of ventricular tachycardia and 7% had ischaemic episodes. The echocardiographic index of segmental contractility was on average 1.75 (ejection fraction: 52.6%). The lipid analysis performed at one month, under lipid therapy in 34% of cases, showed a total cholesterol level at 1.91 +/- 0.10 g/l, an LDL-cholesterol of 1.27 +/- 0.08 g/l. The therapeutic target (LDL-cholesterol < 1 g/l) was attained in 46% of cases with treatment and in 18% of cases without treatment.

[Cardiac rehabilitation in the Ile-de-France region. Current organization and suggestions for reorganization]

The Ile-de-France Regional Hospital Agency wished to complete the Regional Health Organisation Plan for Cardiology from 1999-2004 with a specific report on cardiac rehabilitation. A working group was set up and, after 8 meetings, its conclusions were submitted. They were adopted after presentation to the regional technical committee for cardiology. The requirements for cardiac rehabilitation were defined according to acknowledged indications in the medical literature: about 18,000 patients per year are candidates for cardiac rehabilitation in the Ile de France region. The existing equipment (1999-2000) was reviewed: 435 hospital beds allowing treatment of 5,780 patients per year; 45 day hospital places (only 20 of which were operational in 2000), in addition to a large fee for act activity allowing a total ambulatory management of a further 1,265 patients per year. The following proposals were made: more uniform distribution of hospital beds in the region; develop ambulatory rehabilitation especially on a day hospital basis; create a third possibility of rehabilitation associating home exercise rehabilitation and a program of education, prevention, reinsertion, psychotherapy within a network of extra-hospital care.