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Evaristi MF, Caubère C, Harmancey R, Desmoulin F, Peacock WF, Berry M, Turkieh A, Barutaut M, Galinier M, Dambrin C, Polidori C, Miceli C, Chamontin B, Koukoui F, Roncalli J, Massabuau P, Smih F, Rouet P. Increased mean aliphatic lipid chain length in left ventricular hypertrophy secondary to arterial hypertension: A cross-sectional study. Medicine (Baltimore) 2016; 95:e4965. [PMID: 27861330 PMCID: PMC5120887 DOI: 10.1097/md.0000000000004965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
About 77.9 million (1 in 4) American adults have high blood pressure. High blood pressure is the primary cause of left ventricular hypertrophy (LVH), which represents a strong predictor of future heart failure and cardiovascular mortality. Previous studies have shown an altered metabolic profile in hypertensive patients with LVH. The goal of this study was to identify blood metabolomic LVH biomarkers by H NMR to provide novel diagnostic tools for rapid LVH detection in populations of hypertensive individuals. This cross-sectional study included 48 hypertensive patients with LVH matched with 48 hypertensive patients with normal LV size, and 24 healthy controls. Two-dimensional targeted M-mode echocardiography was performed to measure left ventricular mass index. Partial least squares discriminant analysis was used for the multivariate analysis of the H NMR spectral data. From the H NMR-based metabolomic profiling, signals coming from methylene (-CH2-) and methyl (-CH3) moieties of aliphatic chains from plasma lipids were identified as discriminant variables. The -CH2-/-CH3 ratio, an indicator of the mean length of the aliphatic lipid chains, was significantly higher (P < 0.001) in the LVH group than in the hypertensive group without LVH and controls. Receiver operating characteristic curve showed that a cutoff of 2.34 provided a 52.08% sensitivity and 85.42% specificity for discriminating LVH (AUC = 0.703, P-value < 0.001). We propose the -CH2-/-CH3 ratio from plasma aliphatic lipid chains as a biomarker for the diagnosis of left ventricular remodeling in hypertension.
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Affiliation(s)
- Maria Francesca Evaristi
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- University of Camerino, Camerino, Italy
| | - Céline Caubère
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Romain Harmancey
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson, MS
| | - Franck Desmoulin
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | | | - Matthieu Berry
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Annie Turkieh
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Manon Barutaut
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Michel Galinier
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Toulouse University Hospital, Toulouse
| | - Camille Dambrin
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Toulouse University Hospital, Toulouse
| | | | | | | | - François Koukoui
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | | | - Pierre Massabuau
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Toulouse University Hospital, Toulouse
| | - Fatima Smih
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Spartacus-Biomed, Clermont le Fort, France
| | - Philippe Rouet
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
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Maury P, Thomson E, Rollin A, Berry M, Cognet T, Duparc A, Mondoly P, Gautier M, Lairez O, Méjean S, Massabuau P, Cardin C, Combes S, Albenque JP, Combes N. Lack of Correlations between Electrophysiological and Anatomical-Mechanical Atrial Remodeling in Patients with Atrial Fibrillation. Pacing Clin Electrophysiol 2015; 38:617-24. [PMID: 25645067 DOI: 10.1111/pace.12598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/21/2014] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) progressively leads to electrical remodeling (ER) and anatomical-mechanical remodeling (AR), whose relationships in humans remain poorly known. METHODS ER and AR were compared in patients undergoing percutaneous radiofrequency (RF) ablation for AF. ER was defined by right and left appendage activation rates as a surrogate for atrial refractory periods. AR was approached by left atrial (LA) diameters and area and left atrial appendage (LAA) area and contractile function (mean emptying flow velocity) (LAAFV) before RF ablation. Mean duration between successive LAA contractions was considered as LAA mechanical rate. RESULTS Forty-one patients (31 men, age: 64 ± 9 years) with paroxysmal (27%), persistent (61%), or long-persistent AF (12%) were prospectively included (ejection fraction: 44 ± 16%). Parameters exploring AR were highly correlated to each other: LA area (28 ± 7 cm(2) ), LAA area (5.7 ± 2.25 cm(2) ), LA transverse (49 ± 7 mm), and anteroposterior diameter (59 ± 13 mm) or LAAFV (29 ± 13 cm/s; P < 0.05 for each comparison). Parameters exploring ER were also highly correlated: right atrial appendage (RAA; 181 ± 39 ms) and LAA (176 ± 33 ms) activation rates (P < 0.0001). There was no significant correlation between any ER and AR parameter. Only LAA mechanical rate (174 ± 36 ms) was correlated to LAA or RAA activations rates (P ≤ 0.01). CONCLUSION ER and AR are not mutually related, atrial activation rate being not correlated to LA or LAA size or function. Thus, the mechanisms leading to AF-induced atrial remodeling may differ for anatomical and electrophysiological aspects.
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Affiliation(s)
- Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
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3
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Caiani EG, Massabuau P, Weinert L, Vaïda P, Lang RM. Effects of 5 days of head-down bed rest, with and without short-arm centrifugation as countermeasure, on cardiac function in males (BR-AG1 study). J Appl Physiol (1985) 2014; 117:624-32. [DOI: 10.1152/japplphysiol.00122.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined cardiac remodeling and functional changes induced by 5 days of head-down (−6°) bed rest (HDBR) and the effectiveness of short-arm centrifugation (SAC) in preventing them in males. Twelve healthy men (mean age: 33 ± 7) were enrolled in a crossover design study (BR-AG1, European Space Agency), including one sedentary (CTRL) and two daily SAC countermeasures (SAC1, 30 min continuously; SAC2, 30 min intermittently) groups. Measurements included plasma and blood volume and left ventricular (LV) and atrial (LA) dimensions by transthoracic echocardiography (2- and 3-dimensional) and Doppler inflows. Results showed that 5 days of HDBR had a major impact on both the geometry and cardiac function in males. LV mass and volume decreased by 16 and 14%, respectively; LA volume was reduced by 36%; Doppler flow and tissue Doppler velocities were reduced during early filling by 18 and 12%, respectively; and aortic flow velocity time integral was decreased by 18% with a 3% shortening of LV ejection time. These modifications were presumably due to decreased physiological loading and dehydration, resulting in reduced plasma and blood volume. All these changes were fully reversed 3 days after termination of HDBR. Moreover, SAC was not able to counteract these changes, either when applied continuously or intermittently.
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Affiliation(s)
- E. G. Caiani
- Politecnico di Milano, Electronics, Information and Biomedical Engineering Department, Milano, Italy
| | - P. Massabuau
- University Hospital of Rangueil, Department of Cardiology, Toulouse, France
| | - L. Weinert
- University of Chicago, Noninvasive Cardiac Imaging Laboratory, Chicago, Illinois; and
| | - P. Vaïda
- Université de Bordeaux, Bordeaux, France
| | - R. M. Lang
- University of Chicago, Noninvasive Cardiac Imaging Laboratory, Chicago, Illinois; and
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Lairez O, Cognet T, Dercle L, Méjean S, Berry M, Bastié D, Richaud R, Gautier M, Fouilloux A, Galinier M, Carrié D, Massabuau P, Berry I. Prediction of all-cause mortality from gated-SPECT global myocardial wall thickening: comparison with ejection fraction and global longitudinal 2D-strain. J Nucl Cardiol 2014; 21:86-95. [PMID: 24170624 DOI: 10.1007/s12350-013-9813-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to assess the correlation between global wall thickening (GWT) obtained by gated-single photon emission computed tomography (SPECT) and echocardiographic measures [ejection fraction (EF), global longitudinal strain (GLS), and strain rate (GLSR)] and to compare their prognostic value for all-cause mortality. METHODS AND RESULTS Seventy-four patients with referral for dipyridamole myocardial perfusion SPECT were prospectively included and underwent transthoracic echocardiography to measure left ventricular EF, GLS, and GLSR. The strongest correlation with GWT was for EF (R = 0.63, P < .001), followed by GLSR (R = -0.57, P < .001) and GLS (R = -0.53, P < .001). There were ten deaths over a period of 14.6 ± 5.7 months. Using the multivariate Cox analysis, summed stress score (HR 1.108; P = .023), EF (HR 1.01, P = .031), GLS (HR 1.593, P = .001), and GWT (HR 0.898, P = .034) remained independent predictors of mortality. Mean survival rate evaluated by Kaplan-Meier analysis was longer in patients with GWT ≥ 24% (21.9 ± 0.6 months) than those with GWT < 24% (13.6 ± 2.7 months; P < .001). CONCLUSIONS GWT assessed is a highly sensitive tool to detect early myocardial systolic dysfunction and may bring additional prognostic information.
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Affiliation(s)
- Olivier Lairez
- Department of Nuclear Medicine, Toulouse University Hospital, 1, Avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France,
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Bounhoure JP, Galinier M, Roncalli J, Massabuau P. [Obesity and the prognosis of heart failure: the obesity paradox, myth or reality?]. Bull Acad Natl Med 2014; 198:61-70. [PMID: 26259287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Obesity has now reached epidemic proportions worldwide. Obesity is associated with numerous comorbidities, including hypertension, lipid disorders and type II diabetes, and is also a major cause of cardiovascular disease, coronary disease, heart failure, atrial fibrillation, and sudden death. Obesity is the main cause of heart failure in respectively 11% and 14% of cases in men and women. The Framingham study showed that, after correction for other risk factors, each point increase in the body mass index raises the risk of heart failure by 5% in men and 7% in women. Obesity increases the heart workload, causes left ventricular hypertrophy, and impairs both diastolic and systolic function. The most common form of heart failure is diastolic dysfunction, and heart failure in obese individuals is associated with preserved systolic function. Despite these comorbidities and the severity of heart failure, numerous studies have revealed an "obesity paradox" in which overweight and obese individuals with heart failure appear to have a better prognosis than non overweight subjects. This review summarizes the adverse cardiac effects of this nutritional disease, the results of some studies supporting the obesity paradox, the better survival rate of obese patients with heart failure. Potential explanations for these surprising data include the possibility that a number of obese patients may simply not have heart failure, as well as methodological bias, and protective effects of adipose tissue. Further studies of large populations are needed to determine how obesity may improve the prognosis of heart failure.
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Martin R, Lairez O, Boudou N, Méjean S, Lhermusier T, Dumonteil N, Berry M, Cognet T, Massabuau P, Elbaz M, Rousseau H, Galinier M, Carrié D. Relation between left ventricular outflow tract obstruction and left ventricular shape in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance imaging study. Arch Cardiovasc Dis 2013; 106:440-7. [DOI: 10.1016/j.acvd.2013.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/19/2013] [Accepted: 05/16/2013] [Indexed: 11/24/2022]
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Calviere L, Tall P, Massabuau P, Bonneville F, Larrue V. Migraine with aura and silent brain infarcts lack of mediation of patent foramen ovale. Eur J Neurol 2013; 20:1560-5. [DOI: 10.1111/ene.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 06/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L. Calviere
- Department of Vascular Neurology; University Hospital; Toulouse France
| | - P. Tall
- Department of Neuroradiology; University Hospital; Toulouse France
| | - P. Massabuau
- Department of Cardiology; University Hospital; Toulouse France
| | - F. Bonneville
- Department of Neuroradiology; University Hospital; Toulouse France
| | - V. Larrue
- Department of Vascular Neurology; University Hospital; Toulouse France
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Cognet T, Vervueren PL, Dercle L, Bastié D, Richaud R, Berry M, Marchal P, Gautier M, Fouilloux A, Galinier M, Carrié D, Massabuau P, Berry I, Lairez O. New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value. Cardiovasc Diabetol 2013; 12:84. [PMID: 23759020 PMCID: PMC3685519 DOI: 10.1186/1475-2840-12-84] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/28/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS Although dipyridamole is a widely used pharmacological stress agent, the direct effects on myocardium are not entirely known. Diabetic cardiomyopathy can be investigated by 2D-strain echocardiography. The aim of this study was to assess myocardial functional reserve after dipyridamole infusion using speckle-tracking echocardiography. METHODS Seventy-five patients referred for dipyridamole stress myocardial perfusion gated SPECT (MPGS) were examined by echocardiography to assess a new concept of longitudinal strain reserve (LSR) and longitudinal strain rate reserve (LSRR) respectively defined by the differences of global longitudinal strain (GLS) and longitudinal strain rate between peak stress after dipyridamole and rest. Twelve patients with myocardial ischemia were excluded on the basis of MPGS as gold standard. RESULTS Mean LSR was -2.28±2.19% and was more important in the 28 (44%) diabetic patients (-3.27±1.93%; p=0.001). After multivariate analyses, only diabetes improved LSR (p=0.011) after dipyridamole infusion and was not associated with glycaemic control (p=0.21), insulin therapy (p=0.46) or duration of the disease (p=0.80). Conversely, age (p=0.002) remained associated with a decrease in LSR. LSSR was also correlated to age (p=0.005). Patients with a LSR<0% have a better survival after 15 months (log-rank p=0.0012). CONCLUSION LSR explored by 2D speckle-tracking echocardiography after dipyridamole infusion is a simple and new concept that provides new insights into the impact of diabetes and age on the myocardium with a potential prognostic value.
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Affiliation(s)
- Thomas Cognet
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France.
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Desmoulin F, Galinier M, Trouillet C, Berry M, Delmas C, Turkieh A, Massabuau P, Taegtmeyer H, Smih F, Rouet P. Metabonomics analysis of plasma reveals the lactate to cholesterol ratio as an independent prognostic factor of short-term mortality in acute heart failure. PLoS One 2013; 8:e60737. [PMID: 23573279 PMCID: PMC3616116 DOI: 10.1371/journal.pone.0060737] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 03/01/2013] [Indexed: 11/23/2022] Open
Abstract
Objective Mortality in heart failure (AHF) remains high, especially during the first days of hospitalization. New prognostic biomarkers may help to optimize treatment. The aim of the study was to determine metabolites that have a high prognostic value. Methods We conducted a prospective study on a training cohort of AHF patients (n = 126) admitted in the cardiac intensive care unit and assessed survival at 30 days. Venous plasmas collected at admission were used for 1H NMR–based metabonomics analysis. Differences between plasma metabolite profiles allow determination of discriminating metabolites. A cohort of AHF patients was subsequently constituted (n = 74) to validate the findings. Results Lactate and cholesterol were the major discriminating metabolites predicting 30-day mortality. Mortality was increased in patients with high lactate and low total cholesterol concentrations at admission. Accuracies of lactate, cholesterol concentration and lactate to cholesterol (Lact/Chol) ratio to predict 30-day mortality were evaluated using ROC analysis. The Lact/Chol ratio provided the best accuracy with an AUC of 0.82 (P < 0.0001). The acute physiology and chronic health evaluation (APACHE) II scoring system provided an AUC of 0.76 for predicting 30-day mortality. APACHE II score, Cardiogenic shock (CS) state and Lact/Chol ratio ≥ 0.4 (cutoff value with 82% sensitivity and 64% specificity) were significant independent predictors of 30-day mortality with hazard ratios (HR) of 1.11, 4.77 and 3.59, respectively. In CS patients, the HR of 30-day mortality risk for plasma Lact/Chol ratio ≥ 0.4 was 3.26 compared to a Lact/Chol ratio of < 0.4 (P = 0.018). The predictive power of the Lact/Chol ratio for 30-day mortality outcome was confirmed with the independent validation cohort. Conclusion This study identifies the plasma Lact/Chol ratio as a useful objective and simple parameter to evaluate short term prognostic and could be integrated into quantitative guidance for decision making in heart failure care.
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Affiliation(s)
- Franck Desmoulin
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
| | - Michel Galinier
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Charlotte Trouillet
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Matthieu Berry
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Clément Delmas
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Annie Turkieh
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
| | - Pierre Massabuau
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Heinrich Taegtmeyer
- Division of Cardiology, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, Texas, United States of America
| | - Fatima Smih
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
| | - Philippe Rouet
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
- * E-mail:
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Dumonteil N, Marcheix B, Grunenwald E, Roncalli J, Massabuau P, Carrié D. Left Ventricular Embolization of an Aortic Balloon-Expandable Bioprosthesis. JACC Cardiovasc Interv 2013; 6:308-10. [DOI: 10.1016/j.jcin.2012.08.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 08/02/2012] [Indexed: 11/27/2022]
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Martin R, Lairez O, Boudou N, Lhermuisier T, Dumonteil N, Chabbert V, Massabuau P, Rousseau H, Galinier M, Carrié D. 111: Relationship between left ventricular obstruction, left ventricular shape and mitral angle in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ojaghi-Haghighi Z, Mostafavi A, Moladoust H, Noohi F, Maleki M, Esmaeilzadeh M, Samiei N, Hosseini S, Jasaityte R, Teske A, Claus P, Verheyden B, Rademakers F, D'hooge J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Maniatakis P, Parthenakis F, Vardas P, Hilde JM, Skjoerten I, Humerfelt S, Hansteen V, Melsom M, Hisdal J, Steine K, Ippolito R, Gripari P, Muraru D, Esposito R, Kocabay G, Tamborini G, Galderisi M, Maffessanti F, Badano L, Pepi M, Yurdakul S, Oner F, Sahin T, Avci B, Tayyareci Y, Direskeneli H, Aytekin S, Filali T, Jedaida B, Lahidheb D, Gommidh M, Mahfoudhi H, Hajlaoui N, Dahmani R, Fehri W, Haouala H, Andova V, Georgievska-Ismail L, Srbinovska-Kostovska E, Gardinger Y, Joanna Hlebowicz J, Ola Bjorgell O, Magnus Dencker M, Liao MT, Tsai CT, Lin JL, Piestrzeniewicz K, Luczak K, Maciejewski M, Komorowski J, Jankiewicz-Wika J, Drozdz J, Ismail MF, Alasfar A, Elassal M, El-Sayed S, Ibraheim M, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Santos Furtado M, Nogueira K, Arruda A, Rodrigues AC, Carvalho F, Silva M, Cardoso A, Lira-Filho E, Pinheiro J, Andrade JL, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Taha N, Zagari D, Oteri A, Quattrone A, Boretti I, Carerj S, Obremska O, Boratynska B, Poczatek P, Zon Z, Magott M, Klinger K, Szenczi O, Szelid Z, Soos P, Bagyura Z, Edes E, Jozan P, Merkely B, Ahn J, Kim D, Jeon D, Kim I, Baeza Garzon F, Delgado M, Mesa D, Ruiz M, De Lezo JS, Pan M, Leon C, Castillo F, Morenate M, Toledano F, Zhong L, Lim E, Shanmugam N, Law S, Ong B, Katwadi K, Tan R, Chua Y, Liew R, Ding Z, Von Bibra H, Leclerque C, Schuster T, Schumm-Draeger PM, Bonios M, Kaladaridou A, Papadopoulou O, Tasoulis A, Pamboucas C, Ntalianis A, Nanas J, Toumanidis S, Silva D, Cortez-Dias N, Carrilho-Ferreira P, Placido R, Jorge C, Calisto C, Robalo Martins S, Carvalho De Sousa J, Pinto F, Nunes Diogo A, Przewlocka-Kosmala M, Orda A, Karolko B, Mysiak A, Kosmala W, Moral Torres S, Rodriguez-Palomares J, Pineda V, Gruosso D, Evangelista A, Garcia-Dorado D, Figueras J, Cambronero E, Corbi MJ, Valle A, Cordoba J, Llanos C, Fernandez M, Lopez I, Hidalgo V, Barambio M, Jimenez J, D'andrea A, Riegler L, Cocchia R, Russo M, Bossone E, Calabro R, Iniesta Manjavacas A, Valbuena Lopez S, Lopez Fernandez T, Garcia-Blas S, De Torres Alba F, De Diego JG, Ramirez Valdiris U, Mesa Garcia J, Moreno Yanguela M, Lopez-Sendon J, Logstrup B, Andersen H, Thuesen L, Christiansen E, Terp K, Klaaborg K, Poulsen S, Cacicedo A, Velasco S, Aguirre U, Onaindia J, Rodriguez I, Oria G, Subinas A, Zugazabeitia G, Romero A, Laraudogoitia Zaldumbide E, Weisz S, Magne J, Dulgheru R, Rosca M, Pierard L, Lancellotti P, Auffret V, Donal E, Bedossa M, Boulmier D, Laurent M, Verhoye J, Le Breton H, Van Hall S, Herbrand T, Ketterer U, Keymel S, Boering Y, Rassaf T, Meyer C, Zeus T, Kelm M, Balzer J, Floria M, Seldrum S, Mariciuc M, Laurence G, Buche M, Eucher P, Louagie Y, Jamart J, Marchandise B, Schroeder E, Venkatesh A, Sahlen A, Johnson J, Brodin L, Winter R, Shahgaldi K, Manouras A, Maffessanti F, Tamborini G, Fusini L, Gripari P, Muratori M, Alamanni F, Bartorelli A, Ferrari C, Caiani E, Pepi M, Yaroslavskaya E, Kuznetsov V, Pushkarev G, Krinochkin D, Zyrianov I, Ciobotaru C, Kobayashi Y, Yamamoto K, Kobayashi Y, Hirose E, Hirohata A, Ohe T, Jhund P, Cunningham T, Murday V, Findlay I, Sonecki P, Rangel I, Sousa C, Goncalves A, Correia A, Vigario A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Lovric D, Samardzic J, Milicic D, Reskovic V, Baricevic Z, Ivanac I, Separovic Hanzevacki J, Kim K, Song J, Jeong H, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Kang J, Iorio A, Pinamonti B, Bobbo M, Merlo M, Barbati G, Massa L, Faganello G, Di Lenarda A, Sinagra G, Heggemann F, Hamm K, Streitner F, Sueselbeck T, Papavassiliu T, Borggrefe M, Haghi D, Ferreira F, Galrinho A, Soares R, Branco L, Abreu J, Feliciano J, Papoila A, Alves M, Leal A, Ferreira R, Reynaud A, Donal E, Lund LH, Oger E, Drouet E, Hage C, Bauer F, Linde C, Daubert J, Schnell F, Donal E, Lentz P, Kervio G, Leurent G, Mabo P, Carre F, Rodrigues A, Roque M, Arruda A, Becker D, Barros S, Kay F, Emerick T, Pinheiro J, Sampaio-Barros P, Andrade J, Yamada S, Okada K, Iwano H, Nishino H, Nakabachi M, Yokoyama S, Kaga S, Mikami T, Tsutsui H, Mincu R, Magda S, Dumitrache Rujinski S, Constantinescu T, Mihaila S, Ciobanu A, Florescu M, Vinereanu D, Ashcheulova T, Kovalyova O, Ardeleanu E, Gurgus D, Gruici A, Suciu R, Ana I, Bergenzaun L, Ohlin H, Gudmundsson P, Willenheimer R, Chew M, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs S, Caiani E, Massabuau P, Weinert L, Lairez O, Berry M, Sotaquira M, Vaida P, Lang R, Khan I, Waterhouse D, Asegdom S, Alqaseer M, Foley D, Mcadam B, Colonna P, Michelotto E, Genco W, Rubino M, Pugliese S, Belfiore A, Sorino M, Trisorio Liuzzi M, Antonelli G, Palasciano G, Duszanska A, Skoczylas I, Streb W, Kukulski T, Polonski L, Kalarus Z, Fleig A, Seitz K, Secades S, Martin M, Corros C, Rodriguez M, De La Hera J, Garcia A, Velasco E, Fernandez E, Barriales V, Lambert J, Zwas DR, Hoss S, Leibowitz D, Beeri R, Lotan C, Gilon D, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Chrzanowski L, Lipiec P, Kasprzak J, Wita K, Mizia-Stec K, Wrobel W, Plonska-Gosciniak E, Goncalves A, Sousa C, Rangel I, Pinho T, Wang Y, Houle H, Madureira AJ, Macedo F, Zamorano J, Maciel MJ, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Calabro' R, Cadenas Chamorro R, Lopez T, Gomez J, Moreno M, Salinas P, Jimenez Rubio C, Valbuena S, Manjavacas A, De Torres F, Lopez-Sendon J, Vaugrenard T, Huttin O, Rouge A, Schwartz J, Zinzius P, Popovic B, Sellal J, Aliot E, Juilliere Y, Selton-Suty C, Looi J, Lee A, Hsiung M, Song W, Wong R, Underwood MJ, Fang F, Lin Q, Lam Y, Yu C, Vitarelli A, Nguyen B, Capotosto L, D-Alessandro G, D-Ascanio M, Rafique A, Gang E, Barilla F, Siegel R, Kydd A, Khan F, Watson W, Mccormick L, Virdee M, Dutka D, Ranjbar S, Karvandi M, Hassantash S, Grapsa J, Efthimiadis I, Pakrashi T, Dawson D, Punjabi P, Nihoyannopoulos P, Jasaityte R, D'hooge J, Rademakers F, Claus P, Henein M, Soderberg S, Tossavainen E, Henein M, Lindqvist P, Bellsham-Revell H, Bell A, Miller O, Simpson J, Altekin E, Kucuk M, Yanikoglu A, Karakas S, Er A, Ozel D, Ermis C, Demir I, Henein M, Soderberg S, Henein M, Lindqvist P, Bajraktari G, Di Salvo G, Baldini L, Del Gaizo F, Rea A, Pergola V, Caso P, Pacileo G, Fadel B, Calabro R, Russo M, Seo JS, Choi GN, Jin HY, Seol SH, Jang JS, Yang TH, Kim DK, Kim DS, Papadopoulou E, Kaladaridou A, Hatzidou S, Agrios J, Pamboukas C, Antoniou A, Toumanidis S, Gargiulo P, Dellegrottaglie S, Bruzzese D, Scala O, D'amore C, Ruggiero D, Marciano C, Vassallo E, Pirozzi E, Perrone Filardi P, Mor-Avi V, Kachenoura N, Lodato J, Port S, Chandra S, Freed B, Bhave N, Newby B, Lang R, Patel A, Dwivedi G, Alam M, Boczar K, Chow B, Staskiewicz G, Czekajska-Chehab E, Uhlig S, Tomaszewski A, Przegalinski J, Maciejewski R, Drop A, Di Giammarco G, Canosa C, Foschi M, Liberti G, Bedir M, Marinelli D, Masuyama S, Rabozzi R, Vijayan S, Miller H, Muthusamy R, Smith S, Gargani L, Pang P, Davis E, Schumacher A, Sicari R, Picano E, Mizia-Stec K, Chmiel A, Mizia M, Haberka M, Gieszczyk K, Sikora - Puz A, Lasota B, Trojnarska O, Grajek S, Gasior Z, Koumoulidis A, Vlasseros I, Tousoulis D, Katsi V, Avgeropoulou A, Divani M, Stefanadis C, Kallikazaros I. Poster session Thursday 6 December - AM: Other myocardial diseases. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Larrue V, Massabuau P. Patent foramen ovale and ischemic stroke. Minerva Med 2012; 103:199-207. [PMID: 22653100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patent foramen ovale (PFO) is a common finding in healthy subjects and has not been associated with increased risk of ischemic stroke in population-based cohort studies. Nevertheless, case-control studies have consistently shown an increased prevalence of PFO in cryptogenic stroke, suggesting that PFO might be a cause of stroke. The risk of stroke recurrence in patients with cryptogenic stroke and PFO is low under aspirin therapy but may be substantially higher in patients with an associated atrial septal aneurysm (ASA). The mechanisms of stroke associated with PFO or ASA are uncertain. Paradoxical embolism through the PFO is rarely documented. The optimal treatment for secondary prevention in patients with cryptogenic stroke and PFO is still uncertain and debated. A randomized controlled trial failed to demonstrate the superiority of transcatheter PFO closure over medical therapy. Whether anticoagulation is superior to aspirin should be tested in a randomized controlled trial.
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Affiliation(s)
- V Larrue
- Department of Neurology, University of Toulouse, Toulouse, France.
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Smih F, Desmoulin F, Berry M, Turkieh A, Harmancey R, Iacovoni J, Trouillet C, Delmas C, Pathak A, Lairez O, Koukoui F, Massabuau P, Ferrieres J, Galinier M, Rouet P. 103 White blood cell genes expressions provide a molecular signature for pre-heart failure. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Massabuau P, Dumonteil N, Berthoumieu P, Marcheix B, Duterque D, Fournial G, Carrié D. Left-to-Right Interventricular Shunt as a Late Complication of Transapical Aortic Valve Implantation. JACC Cardiovasc Interv 2011; 4:710-2. [PMID: 21700259 DOI: 10.1016/j.jcin.2010.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 11/26/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Pierre Massabuau
- Pôle Cardio-vasculaire et Métabolique, Centre Hospitalier Universitaire, Rangueil, Toulouse, France
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Abstract
OBJECTIVES We attempted to classify causes of ischemic stroke in young adults using a progressive diagnostic algorithm and the ASCO (atherosclerosis, small-vessel disease, cardiac source, other cause) classification system. METHODS Patients aged 16-54 years consecutively treated for acute ischemic stroke in a tertiary stroke unit were included in this retrospective analysis. Causes of stroke were classified using the ASCO system, which assigns a graded level of likelihood to each potential cause in individual patients. The initial etiologic workup included brain imaging, magnetic resonance or CT angiography of cerebral and cervical vessels, EKG, and routine blood studies. Patients without a definite cause of ischemic stroke after initial evaluation underwent transesophageal echocardiography. RESULTS We included 318 patients (195 men and 123 women); 131 patients were aged 16-44 years, and 187 were aged 45-54 years. A definite cause of stroke (ASCO grade 1) could be identified in 145 patients (45.5%). An uncertain cause of stroke (ASCO grade 2) was found in 59 (18.5%) further patients. Most (130 of 145) definite causes were identified by initial evaluation. The 2 major definite or uncertain causes of stroke were patent foramen ovale associated with atrial septal aneurysm (PFO-ASA) (20 of 131 [15.3%]) and dissection of the cervical or cerebral artery (19 of 131 [14.5%]) in patients aged 16-44 years and large-vessel atherosclerosis (37 of 187 [19.8%]) and PFO-ASA (23 of 187 [12.3%]) in patients aged 45-54 years. CONCLUSIONS Our findings suggest that PFO-ASA may be a major cause of ischemic stroke in young adults.
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Affiliation(s)
- V Larrue
- Service de Neurologie Vasculaire, Hopital Rangueil, CHU de Toulouse 31059, Toulouse, France.
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Rousseau H, Cosin O, Marcheix B, Chabbert V, Midulla M, Dambrin C, Cron C, Leobon B, Conil C, Massabuau P, Otal P, Joffre F. Endovascular treatment of thoracic dissection. Semin Intervent Radiol 2011; 24:167-79. [PMID: 21326794 DOI: 10.1055/s-2007-980041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Type A aortic dissection remains fatal if untreated. Although classical medical therapy for type B dissection is considered the therapy of choice in uncomplicated cases, the paradigm is changing as greater experience is accrued with endovascular treatments and technical advances improve the long-term outlook. Diagnosis is also becoming more sophisticated, allowing greater appreciation of the anatomy of dissections and improving the knowledge base as their natural history is assessed.
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Affiliation(s)
- H Rousseau
- Department of Radiology, Cardio-Vascular Surgery and Cardiology, Hôpital Rangueil, Toulouse, France
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Marchal P, Lairez O, Marachet MA, Massabuau P, Galinier M, Roncalli J. Invalidating headaches as a symptom of pulmonary embolism in a Dandy-Walker syndrome with ventriculoatrial shunt. Eur J Neurol 2011; 18:e102-3. [DOI: 10.1111/j.1468-1331.2011.03429.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Smih F, Desmoulin F, Berry M, Turkieh A, Harmancey R, Iacovoni J, Trouillet C, Delmas C, Pathak A, Lairez O, Koukoui F, Massabuau P, Ferrieres J, Galinier M, Rouet P. Blood signature of pre-heart failure: a microarrays study. PLoS One 2011; 6:e20414. [PMID: 21731613 PMCID: PMC3123284 DOI: 10.1371/journal.pone.0020414] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 05/02/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The preclinical stage of systolic heart failure (HF), known as asymptomatic left ventricular dysfunction (ALVD), is diagnosed only by echocardiography, frequent in the general population and leads to a high risk of developing severe HF. Large scale screening for ALVD is a difficult task and represents a major unmet clinical challenge that requires the determination of ALVD biomarkers. METHODOLOGY/PRINCIPAL FINDINGS 294 individuals were screened by echocardiography. We identified 9 ALVD cases out of 128 subjects with cardiovascular risk factors. White blood cell gene expression profiling was performed using pangenomic microarrays. Data were analyzed using principal component analysis (PCA) and Significant Analysis of Microarrays (SAM). To build an ALVD classifier model, we used the nearest centroid classification method (NCCM) with the ClaNC software package. Classification performance was determined using the leave-one-out cross-validation method. Blood transcriptome analysis provided a specific molecular signature for ALVD which defined a model based on 7 genes capable of discriminating ALVD cases. Analysis of an ALVD patients validation group demonstrated that these genes are accurate diagnostic predictors for ALVD with 87% accuracy and 100% precision. Furthermore, Receiver Operating Characteristic curves of expression levels confirmed that 6 out of 7 genes discriminate for left ventricular dysfunction classification. CONCLUSIONS/SIGNIFICANCE These targets could serve to enhance the ability to efficiently detect ALVD by general care practitioners to facilitate preemptive initiation of medical treatment preventing the development of HF.
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Affiliation(s)
- Fatima Smih
- INSERM/Universite Paul Sabatier UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France.
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Rumeau P, Fourcade J, Duparc A, Hébrard A, Mondoly P, Rollin A, Massabuau P, Detis N, Elbaz M, Carrié D, Galinier M, Delay M, Maury P. ST-segment changes after direct current external cardioversion for atrial fibrillation. Incidence, characteristics and predictive factors. Int J Cardiol 2011; 148:341-6. [DOI: 10.1016/j.ijcard.2009.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 10/17/2009] [Accepted: 11/29/2009] [Indexed: 11/17/2022]
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Dumonteil N, Tchetche D, Marcheix B, Bongard V, Monteil B, Berthoumieu P, Massabuau P, Soula P, Fajadet J, Carrié D. AS-039 Non-Randomised Comparison of 30-Day All-Cause Mortality after Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Implantation for the Treatment of Severe Aortic Stenosis in High-Risk Patients: A Two-Centre Study. Am J Cardiol 2011. [DOI: 10.1016/j.amjcard.2011.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dumonteil N, Tchetche D, Monteil B, Bongard V, Marcheix B, Berthoumieu P, Massabuau P, Soula P, Fajadet J, Carrié D. 165 Non-randomised comparison of 30-day safety and effectiveness of surgical aortic valve replacement and transcatheter aortic valve implantation for high risk patients with severe aortic stenosis. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rousseau H, Chabbert V, Maracher M, El Aassar O, Auriol J, Massabuau P, Moreno R. Response to ‘Magnetic Resonance Imaging for Aortic Dissection’. Eur J Vasc Endovasc Surg 2010. [DOI: 10.1016/j.ejvs.2010.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rumeau P, Maury P, Fourcade J, Duparc A, Massabuau P, Hebrard A, Mondoly P, Rollin A, Carrie D, Galinier M, Delay M. 205 ST segment changes after external cardioversion using direct current shock: incidence, characteristics and predeictive factors. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dumonteil N, Marcheix B, Berthoumieu P, Massabuau P, Dieye E, Decramer I, Fournial G, Carrié D. Transfemoral aortic valve implantation with pre-existent mechanical mitral prosthesis: evidence of feasibility. JACC Cardiovasc Interv 2009; 2:897-8. [PMID: 19778782 DOI: 10.1016/j.jcin.2009.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Nicolas Dumonteil
- Cardiology Department, Pôle CardioVasculaire et Métabolique, Rangueil University Hospital, Toulouse, France
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Bounhoure JP, Galinier M, Lairez O, Massabuau P, Doazan JP, Marco I, Assoun B, Fondard O. [Stress cardiomyopathy, a topical cardiac disorder]. Bull Acad Natl Med 2009; 193:895-907. [PMID: 20120280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Stress cardiomyopathy (Tako-Tsubo, Broken Heart syndrome, or apical ballooning syndrome) was recently recognized as a distinct clinical entity. The aims of this review are to define this acute and reversible cardiomyopathy and to list its major clinical, biological and angiographic features. We performed a Medline scan for all relevant case series. The studies thus identified suggest that the apical ballooning syndrome accounts for 2% of ST-elevation infarcts, mainly affects women, and occurs after major emotional or physical stress. Most patients present with chest pain and dyspnoea, cardiogenic shock and (or?) ventricular fibrillation. ST segment modifications and mildly elevated cardiac enzyme levels are reported in 81% of patients. Left ventricular dysfunction occurs in the absence of epicardial coronary artery obstruction and typically consists of a hyperkinetic basal region and an akinetic apical half of the ventricle. The in-hospital mortality rate is about 1.2%. Most patients recover fully after a few weeks. Norepinephrine concentrations are elevated in three-quarters of patients. This syndrome should be considered among the differential diagnoses in patients presenting with chest pain, and especially in post-menopausal women with a recent history of stress. In its broadest sense, this phenomenon may encompass a range of disorders, including left ventricular dysfunction following central nervous system injury. It should also be considered in women with acute coronary syndromes.
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Acar P, Massabuau P, Elbaz M. Real-time 3D transoesophageal echocardiography for guiding Amplatzer septal occluder device deployment in an adult patient with atrial septal defect. ACTA ACUST UNITED AC 2008; 9:822-3. [PMID: 18579488 DOI: 10.1093/ejechocard/jen178] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 32-year-old male with secundum atrial septal defect underwent percutaneous transcatheter occlusion. The procedure was performed under general anaesthesia and guided by real-time 3D transoesophageal echocardiography (TEE) (i.e. 33, matrix probe 2-7 MHz). The device delivery system was advanced through a femoral vein catheter and placed in the left upper pulmonary vein. A 3D left atrial view was instantaneously obtained. The size of the septal occluder was chosen according to the balloon catheter method. A 12 mm Amplatzer device was deployed under real-time 3D TEE without fluoroscopy. The 3D views depicted the progression of the left-side disc from the left atrial cavity towards the septum. Left and right atrial views demonstrated the perfect application of the device to the atrial septum. Keeping a steady traction on the delivery rod, the right-side disc of the device was then deployed on the right atrial side of the defect. A pushing and pulling of the delivery cable ensured that the device was in a secure and stable position. Absence of peri prosthetic residual shunt was assessed by 2D colour Doppler TEE before release. Transthoracic echocardiography performed the day after ensured the right position of the device. Real-time 3D TEE is a very recent technology allowing on-line guidance of atrial septal occluder device deployment; such imaging should increase delivery safety and decrease fluoroscopy time.
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Affiliation(s)
- Philippe Acar
- Congenital Heart Unit, Rangueil Hospital, Toulouse, France.
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Force M, Massabuau P, Larrue V. Prevalence of atrial septal abnormalities in older patients with cryptogenic ischemic stroke or transient ischemic attack. Clin Neurol Neurosurg 2008; 110:779-83. [PMID: 18534743 DOI: 10.1016/j.clineuro.2008.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/18/2008] [Accepted: 04/20/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the association of atrial septal abnormalities--patent foramen ovale (PFO), atrial septal aneurysm (ASA), or the combination of both (PFO+ASA)--with cryptogenic stroke or transient ischemic attack (TIA) in older patients. METHODS We examined the prevalences of PFO, ASA, and PFO+ASA in 132 consecutive patients aged 55 years or more who underwent transesophageal echocardiography (TEE) for evaluation of ischemic stroke or TIA. We compared patients with cryptogenic stroke/TIA and those with stroke/TIA of known cause. RESULTS PFO+ASA was more common in patients with cryptogenic stroke/TIA than in patients with stroke/TIA of known cause (12/62 or 19% vs. 2/70 or 3%; adjusted odds ratio, 7.4; 95% CI, 1.4-38.2). Differences between groups for isolated PFO, and isolated ASA were not significant. The association of PFO+ASA with cryptogenic stroke/TIA was confirmed in the subgroup of patients aged 75 years or more (odds ratio, 15.0; 95% CI, 1.5-146.7). CONCLUSION This study indicates a significant association of PFO+ASA with cryptogenic stroke or TIA in older patients.
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Affiliation(s)
- M Force
- Department of Neurology, Hôpital Rangueil, University of Toulouse, Toulouse 31059, France
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Roncalli J, Smih F, Desmoulin F, Dumonteil N, Harmancey R, Hennig S, Perez L, Pathak A, Galinier M, Massabuau P, Malet-Martino M, Senard JM, Rouet P. NMR and cDNA array analysis prior to heart failure reveals an increase of unsaturated lipids, a glutamine/glutamate ratio decrease and a specific transcriptome adaptation in obese rat heart. J Mol Cell Cardiol 2007; 42:526-39. [PMID: 17222424 DOI: 10.1016/j.yjmcc.2006.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 10/13/2006] [Accepted: 11/08/2006] [Indexed: 01/19/2023]
Abstract
Obesity is a risk factor for heart failure through a set of hemodynamic and hormonal adaptations, but its contribution at the molecular level is not clearly known. Therefore, we investigated the kinetic cardiac transcriptome and metabolome in the Spontaneous Hypertensive Heart Failure (SHHF) rat. The SHHF rat is devoid of leptin signaling when homozygous for a mutation of the leptin receptor (ObR) gene. The ObR-/- SHHF rat is obese at 4 months of age and prone to heart failure after 14 months whereas its lean counterpart ObR-/+ is prone to heart failure after 16 months. We used a set of rat pangenomic high-density macroarrays to monitor left ventricle cardiac transcriptome regulation in 4- and 10-month-old, lean and obese animals. Comparative analysis of left ventricle of 4- and 10-month-old lean rat revealed 222 differentially expressed genes while 4- and 10-month-old obese rats showed 293 differentially expressed genes. (1)H NMR analysis of the metabolome of left ventricular extracts displayed a global decrease of metabolites, except for taurine, and lipid concentration. This may be attributed to gene expression regulation and likely increased extracellular mass. The glutamine to glutamate ratio was significantly lower in the obese group. The relative unsaturation of lipids increased in the obese heart; in particular, omega-3 lipid concentration was higher in the 10-month-old obese heart. Overall, several specific kinetic molecular patterns act as a prelude to heart failure in the leptin signaling deficient SHHF obese rat.
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Affiliation(s)
- J Roncalli
- Unite de recherches sur les obesités, INSERM UPS U586, Institut Louis-Bugnard, Université Paul-Sabatier, CHU Rangueil, BP 84225, 31432 Toulouse cedex 4, France
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Rousseau H, Marcheix B, Chabbert V, Dambrin C, Cron C, Leobon B, Conil C, Massabuau P, Otal P, Joffre F. [Endografts (or stent-grafts) and diseases of the descending thoracic aorta]. Arch Mal Coeur Vaiss 2006; 99:1215-1224. [PMID: 18942524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The endovascular treatment of aorta diseases with S-Graft is considered as an alternative to surgery, especially interesting in patients with severe comorbidities. Indeed, the mid-term morbidity and mortality are comparable to surgery in relatively large series, and S-Graft implantation appeared as a safe, less invasive and efficient treatment for different affections of the thoracic aorta. This article reviews technical aspects, indications and results of endovascular repairs of thoracic aorta lesions. We will also assess the advantages and limitations of S-Graft therapy.
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Affiliation(s)
- H Rousseau
- Services de radiologie, chirurgie cardiovasculaire et cardiologie, hôpital Rangueil, Toulouse.
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31
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Lamant M, Smih F, Harmancey R, Philip-Couderc P, Pathak A, Roncalli J, Galinier M, Collet X, Massabuau P, Senard JM, Rouet P. ApoO, a novel apolipoprotein, is an original glycoprotein up-regulated by diabetes in human heart. J Biol Chem 2006; 281:36289-302. [PMID: 16956892 DOI: 10.1074/jbc.m510861200] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Obesity is an independent risk factor for cardiac failure. Obesity promotes excessive deposition of fat in adipose and nonadipose tissues. Intramyocardial lipid overload is a relatively common finding in nonischemic heart failure, especially in obese and diabetic patients, and promotes lipoapoptosis that contributes to the alteration of cardiac function. Lipoprotein production has been proposed as a heart-protective mechanism through the unloading of surplus cellular lipids. We previously analyzed the heart transcriptome in a dog nutritional model of obesity, and we identified a new apolipoprotein, regulated by obesity in heart, which is the subject of this study. We detected this new protein in the following lipoproteins: high density lipoprotein, low density lipoprotein, and very low density lipoprotein. We designated it apolipoprotein O. Apolipoprotein O is a 198-amino acid protein that contains a 23-amino acidlong signal peptide. The apolipoprotein O gene is expressed in a set of human tissues. Confocal immunofluorescence microscopy colocalized apolipoprotein O and perilipins, a cellular marker of the lipid droplet. Chondroitinase ABC deglycosylation analysis or cell incubation with p-nitrophenyl-beta-d-xyloside indicated that apolipoprotein O belongs to the proteoglycan family. Naringenin or CP-346086 treatments indicated that apolipoprotein O secretion requires microsomal triglyceride transfer protein activity. Apolipoprotein O gene expression is up-regulated in the human diabetic heart. Apolipoprotein O promoted cholesterol efflux from macrophage cells. To our knowledge, apolipoprotein O is the first chondroitin sulfate chain containing apolipoprotein. Apolipoprotein O may be involved in myocardium-protective mechanisms against lipid accumulation, or it may have specific properties mediated by its unique glycosylation pattern.
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Affiliation(s)
- Matthieu Lamant
- Unité de Recherches sur les Obésités, INSERM UPS U586, Institut Louis Bugnard IFR31, CHU Rangueil, Batiment L3, BP 84225, 31432 Toulouse Cedex 4, France
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Marcheix B, Dambrin C, Bolduc JP, Arnaud C, Cron C, Hollington L, Mugniot A, Soula P, Bennaceur M, Chabbert V, Massabuau P, Otal P, Cérène A, Rousseau H. Midterm results of endovascular treatment of atherosclerotic aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg 2006; 132:1030-6. [PMID: 17059919 DOI: 10.1016/j.jtcvs.2006.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Revised: 06/24/2006] [Accepted: 07/07/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to determine the midterm results of endovascular repair of atherosclerotic aneurysms of the thoracic descending aorta by using second-generation, commercially available stent grafts. METHODS Between 1996 and 2005, 45 patients (mean age, 68 +/- 11 years) with aneurysms of the descending thoracic aorta underwent endovascular repair. Aortic dissections, penetrating ulcers, and traumatisms were excluded. The mean follow-up was 24.7 +/- 21.6 months (maximum, 6.7 years). RESULTS No patients died, and no conversion to surgical intervention was required during the procedures. Three (6.7%) patients died during the first month, and 6 (14.7%) died later on. The main complications were strokes (13.3%), vascular access complications (8.9%), aortic complications (6.6%), paraplegia (4.4%), and sudden deaths (4.4%). Nineteen (42%) primary endoleaks were encountered: 3 required reinterventions, 15 spontaneously thrombosed, and 1 patient died. Except for 2 sudden unexplained deaths, no aortic complications were observed after 1 month. Actuarial survival estimates at 1, 3, and 5 years were 87.6% +/- 5.3%, 76.9% +/- 7.4%, and 70.6% +/- 9.2%, respectively. Actuarial freedom from death related to the treated aortic disease was 94.3% +/- 4.0%, 94.3% +/- 4.0%, and 86.4% +/- 8.4% at 1, 3, and 5 years, respectively. Aspirin status of greater than 3 (P = .005), high aortic diameter (P = .007), and long covered lengths (P = .02) were determinant for mortality. Actuarial freedom from complication was 62.6% +/- 7.7%, 58.9% +/- 8.1%, and 58.9% +/- 8.1% at 1, 3, and 5 years, respectively. The location of the aneurysm (P = .05) and a high aortic diameter (P = .04) were both determinants for endoleaks. CONCLUSIONS Stent grafting of atherosclerotic aneurysm of the thoracic descending aorta is safe and effective. Further studies are mandatory to determine the most relevant indications and the long-term efficacy of such treatment.
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Affiliation(s)
- Bertrand Marcheix
- Department of Thoracic and Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
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Abadir S, Aggoun Y, Elbaz M, Massabuau P, Carrié D, Fauvel JM, Puel J, Acar P. [Percutaneous closure of three septal defects by two Amplatz occluders implanted during the same procedure]. Arch Mal Coeur Vaiss 2006; 99:835-8. [PMID: 17067105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Multiple atrial septal defects can be closed by interventional catheterisation. The procedure requires an accurate morphological evaluation: number of defects, distance from their edges to the main cardiac structures, resistance of the septum. The authors report the case of a 63 year old woman presenting with cardiac failure in whom 3 atrial septal defects were diagnosed. All 3 defects were successfully closed by the implantation of two Amplatz devices. Control echocardiography at 6 months showed the occluders in a normal position with no residual shunt and the patient was asymptomatic.
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Affiliation(s)
- S Abadir
- Cardiologie pédiatrique, Hôpital des Enfants, BP 3119, Toulouse
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Roncalli J, Delord JP, Galinier M, Massabuau P, Lescure M, Fauvel JM, Azria D. Bevacizumab in metastatic colorectal cancer: a left intracardiac thrombotic event. Ann Oncol 2006; 17:1177-8. [PMID: 16524976 DOI: 10.1093/annonc/mdl025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abdel-Massih T, Dulac Y, Taktak A, Aggoun Y, Massabuau P, Elbaz M, Carrié D, Acar P. Assessment of atrial septal defect size with 3D-transesophageal echocardiography: comparison with balloon method. Echocardiography 2005; 22:121-7. [PMID: 15693777 DOI: 10.1111/j.0742-2822.2005.03153.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcatheter closure of atrial septal defect (ASD) is an alternative approach to surgery in selected patients. Balloon stretched diameter (BSD) is considered as the standard way of measuring ASD size. Three-dimensional transesophageal echocardiography (3D-TEE) provides views of the ASD allowing its measurement and identifying its spatial relation with neighboring structures. Our aim was to compare the BSD and 3D-TEE methods to measure the ASD size before transcatheter closure. METHODS AND RESULTS Seventy-six consecutive patients were enrolled for ASD device closure. Three-dimensional transesophageal echocardiography and balloon sizing were adequately performed in 70 patients before the defect closure. The mean maximal diameter measured by 3D-TEE was 20 +/- 15 mm (range 10-28) while the mean BSD was 22 +/- 4.8 mm (range 9-31). When comparing the 3D-TEE and transcatheter measurements, there was a good correlation between the two methods (y = 3.15 + 0.77x; r = 0.8). The defect as viewed by 3D-TEE was unique in 54 patients and multiple in 16 patients. In patients with a single defect, the correlation between the two methods was high (y = 1.74 + 0.84x; r = 0.85) while patients with multiple ASDs, the correlation was poor (y = 12.4 + 0.4x; r = 0.45). Transcatheter closure was performed successfully in 86%. The mean size of the Amplatzer device was 23 +/- 4.8 mm (range 4-32). The reference to choose the size of the device was the BSD in single defects and the 3D-TEE maximal diameter in multiple defects. CONCLUSION Three-dimensional transesophageal echocardiography and transcatheter methods are two complementary techniques for the success of transcatheter ASDs closure.
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Affiliation(s)
- Tony Abdel-Massih
- Unité de cardiologie pédiatrique, Hôpital des Enfants, Toulouse, France
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36
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Pathak A, Curnier D, Fourcade J, Roncalli J, Stein PK, Hermant P, Bousquet M, Massabuau P, Sénard JM, Montastruc JL, Galinier M. QT dynamicity: a prognostic factor for sudden cardiac death in chronic heart failure. Eur J Heart Fail 2005; 7:269-75. [PMID: 15701477 DOI: 10.1016/j.ejheart.2004.10.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Revised: 09/27/2004] [Accepted: 10/20/2004] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death in patients with chronic heart failure (CHF). METHODS We prospectively included 175 CHF patients in sinus rhythm. QT dynamicity was evaluated by analyzing 24-h Holter recordings. The linear regression slope of QT interval measured to the apex and to the end of T wave plotted against RR intervals was calculated using a dedicated Holter algorithm. RESULTS Mean follow-up was 29.9+/-17.9 months. There were 48 deaths, of which 21 were sudden. The actuarial 3-year mortality rates were 38.4% for overall mortality and 14.1% for sudden death. Of all the parameters, an increased QTe/RR slope (>0.28) was the strongest independent predictor of sudden death (relative risk 3.47, 95% confidence interval 1.43-8.40, p=0.006). CONCLUSION Increased 24-h QTe dynamicity is independently predictive of sudden death among patients with heart failure. This simple parameter may help to stratify risk and select patients who may benefit from antiarrhythmic prophylaxis.
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Affiliation(s)
- Atul Pathak
- Club d'Etude du Système Nerveux Autonome et INSERM U586, Laboratoire de Pharmacologie médicale et clinique, Faculté de Médecine, 37 allés Jules Guesde, 31073 Toulouse Cedex, France.
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Roncalli J, Leobon B, Massabuau P, Galinier M, Parini A, Pathak A, Bourin P, Hagege AA, Menasche P, Fournial G, Fauvel JM. [Cardiac cellular therapy: from cells to the first clinical uses]. Arch Mal Coeur Vaiss 2005; 98:637-48. [PMID: 16007818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Despite the improvement in revascularisation techniques, coronary artery disease remains the principal aetiology of cardiac failure in developed countries. The therapeutic management of cardiac failure has been improved over recent years, yet cardiac failure is still associated with significant morbidity and mortality. As cardiac transplantation lacks donors, techniques that allow myocardial regeneration represent an attractive alternative. To date, several types of cells are under study and are suitable for implantation into infarcted myocardium (myoblasts, medullary stem cells...). Following good preclinical study results, the first human cell therapy trials, using the intramyocardial route, have begun, in the course of aorto-coronary bypass surgery in patients with chronic ischaemic cardiopathy and little altered left ventricular function, and then in those with ventricular dysfunction. Different modes of administration of these cell therapy products are under study and could be envisaged in clinical situations such as just after infarction in order to improve ventricular remodelling with an intracoronary injection technique. As for every new treatment, there are numerous problems to resolve, from understanding the relevant mechanisms of cellular transplantation, to the secondary effects that it could entail. Nevertheless, cardiac cellular transplantation is expanding rapidly and with the evolution of techniques it allows a glimpse of a new field of treatment for cardiac failure.
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Affiliation(s)
- J Roncalli
- INSERM U586 et Fédération des services de cardiologie des hôpitaux de Toulouse.
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Massabuau P. [Echocardiography and the painful aorta]. Arch Mal Coeur Vaiss 2005; 98 Spec No 3:35-9. [PMID: 16007831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The acute painful aortic syndrome is a clinical enity observed in four conditions: dissection, intramural haematoma, penetrating atheromatous ulcer and aneurysm. The diagnosis is based on three imaging techniques: echocardiography, CT scan and magnetic resonance imaging. They have displaced angiography which is incomplete and even dangerous in some cases. Their sensitivity and specificity are comparable in terms of diagnosis. However, each has a specificity. Transthoracic and transoesophageal echocardiography are useful in the diagnosis, the quantification and analysis of the mechanism of aortic regurgitation which may complicate dissection. CT scan visualises the collateral arteries, investigates the physiopathological mechanisms of poor perfusion syndromes and detects parietal fissuration. Magnetic resonance imaging is better adapted to the study of stable forms. In conclusion, transoesophageal echocardiography is a rapid and reliable diagnostic method, it can be used as the investigation of first intention and is essential in patient management. The use of other imaging modes is only required in some cases. The choice, guided by the clinical history, depends on its aptitude to complete the missing or partial data of transoesophageal echocardiography.
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Affiliation(s)
- P Massabuau
- Service de cardiologie A, CHU Toulouse, Hôpital Rangueil, Toulouse
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Rousseau H, Dambrin C, Marcheix B, Richeux L, Mazerolles M, Cron C, Watkinson A, Mugniot A, Soula P, Chabbert V, Canevet G, Roux D, Massabuau P, Meites G, Tran Van T, Otal P. Acute traumatic aortic rupture: A comparison of surgical and stent-graft repair. J Thorac Cardiovasc Surg 2005; 129:1050-5. [PMID: 15867779 DOI: 10.1016/j.jtcvs.2004.12.023] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. METHODS A total of 76 patients (14-76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5-257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. RESULTS In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13-90 months). No major complication was observed in group 3. CONCLUSIONS In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.
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MESH Headings
- Accidents, Traffic
- Acute Disease
- Analysis of Variance
- Angiography, Digital Subtraction
- Angioplasty, Balloon/adverse effects
- Angioplasty, Balloon/instrumentation
- Angioplasty, Balloon/methods
- Angioplasty, Balloon/mortality
- Aorta, Thoracic/injuries
- Aortic Rupture/diagnosis
- Aortic Rupture/etiology
- Aortic Rupture/therapy
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/methods
- Blood Vessel Prosthesis Implantation/mortality
- Echocardiography, Transesophageal
- Female
- Follow-Up Studies
- Humans
- Injury Severity Score
- Male
- Patient Selection
- Retrospective Studies
- Stents/adverse effects
- Thoracotomy/adverse effects
- Thoracotomy/instrumentation
- Thoracotomy/methods
- Thoracotomy/mortality
- Time Factors
- Tomography, Spiral Computed
- Treatment Outcome
- Wounds, Nonpenetrating/complications
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Affiliation(s)
- H Rousseau
- Department of Radiology, University Hospital Rangueil, 01 av. J Poulhes, 31403 Toulouse, France.
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Galinier M, Pathak A, Roncalli J, Massabuau P. [Obesity and cardiac failure]. Arch Mal Coeur Vaiss 2005; 98:39-45. [PMID: 15724418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Obesity alone is the cause of 11% of cases of cardiac failure in men and 14% of cases in women in the United States. The frequency of obesity continues to rise in our country, 41% of our compatriots being obese or overweight. It is expected that obesity will become an important cause of cardiac failure in the coming years. The Framingham study showed that, after correction for other risk factors, for every point increase in body mass index, the increase in risk of developing cardiac failure was 5% in men and 7% in women. There are three physiopathological mechanisms to explain the adverse effects of obesity on left ventricular function: an increase in ventricular preload secondary to increased plasma volume induced by the high fatty mass; an increase in left ventricular afterload due to the common association of hypertension generated by activation of the sympathetic nervous system by hyperinsulinism; and systolic and diastolic dysfunction due to changes in the myocardial genome and coronary artery disease induced by risk factors of atherosclerosis aggravated by obesity. The adipocyte also secretes a number of hormones which act directly or indirectly on the myocardium: angiotensin II, leptin, resistin, adrenomedulin, cytokines. These haemodynamic and hormonal changes profoundly modify the genetic expression of the myocardium in obesity, favourising hypertrophy of the myocyte and the development of interstitial fibrosis. Whether it be eccentric in the absence of hypertension or concentric when hypertension is associated with obesity, left ventricular hypertrophy, although normalising left ventricular wall stress, has adverse consequences causing abnormal relaxation and decreased left ventricular compliance. Therefore, in obese patients, two forms of cardiac failure may be observed. The more common is due to diastolic dysfunction, obesity being one of the principal causes of cardiac failure with preserved systolic function. Cardiac failure due to systolic dysfunction is less common and may be observed in cases with inappropriate left ventricular hypertrophy which does not normalise abnormal left ventricular wall stress leading to cardiomyopathy, and in cases with associated coronary artery disease. Whatever the underlying mechanism, the diagnosis of cardiac failure is made more difficult by obesity. From the prognostic point of view, in the global population of patients with cardiac failure, obesity improves survival because it counteracts the adverse effect of cachexia; however, obesity increases the risk of sudden death. In fact, obesity is associated with dynamic change in QT interval. In cases of cardiac failure secondary to obesity-related cardiomyopathy, loss of weight leads to an improved functional status and a reduction of left ventricular remodelling and an increase of the ejection fraction.
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Affiliation(s)
- M Galinier
- Fédération des services de cardiologie des hôpitaux de Toulouse, Unité INSERM U 317, CHU Rangueil.
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Philip-Couderc P, Pathak A, Smih F, Dambrin C, Harmancey R, Buys S, Galinier M, Massabuau P, Roncalli J, Senard JM, Rouet P. Uncomplicated human obesity is associated with a specific cardiac transcriptome: involvement of the Wnt pathway. FASEB J 2004; 18:1539-40. [PMID: 15289443 DOI: 10.1096/fj.03-1242fje] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A dramatic increase in obesity prevalence and cardiovascular morbidity is expected for the coming years. However, with relevance to the heart, little is known about the specific contribution of obesity on associated morbidity. Consequently, global analysis of gene regulations in human heart was undertaken to monitor molecular regulations related to obesity or to obesity-related hypertension. Transcriptome analysis using cDNA arrays was performed in right appendage biopsies from obese patients (n=5), from patients with arterial hypertension with (n=5) or without obesity (n=5), and from 5 leans. All biopsies came from patients that had cardiac surgery and coronary bypass. Statistical analysis of the data revealed 2686 differentially expressed genes out of 11,500 when compared with lean tissues. Differential expression was verified by real-time PCR in 84% of 50 randomly chosen genes. Among genes encountered, 397 were specifically regulated in obese, 1,299 in non-obese hypertensive, and 355 in obese hypertensive patients, respectively, whereas an additional set of 153 genes was differentially expressed in all these situations. Ontology analysis, hierarchical clustering, and molecular pathway analysis indicated that the heart molecular picture of obesity differs clearly from that observed for obesity-related hypertension or arterial hypertension. Clearly, the Wnt pathway known to be involved in cardiac hypertrophy mechanisms, showed opposite regulation in obese heart compared with hypertensive heart and potentially prevented the development of cardiac remodeling in obese patients. All over, this work shows that uncomplicated obesity has a strong impact on cardiac gene expression, which could be considered as precursor signs for future cardiac disease and also demonstrates that obesity-related hypertension generates a heart-molecular-distinct phenotype that cannot be predicted by a simple sum of the impact of obesity and arterial hypertension on gene expression.
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Affiliation(s)
- Pierre Philip-Couderc
- Unité de recherches sur les obésités, Institut National de la Santé et de la Recherche Médicale (Inserm U586), Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
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Philip-Couderc P, Smih F, Hall JE, Pathak A, Roncalli J, Harmancey R, Massabuau P, Galinier M, Verwaerde P, Senard JM, Rouet P. Kinetic analysis of cardiac transcriptome regulation during chronic high-fat diet in dogs. Physiol Genomics 2004; 19:32-40. [PMID: 15226482 DOI: 10.1152/physiolgenomics.00001.2004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In the present study, we investigated, using custom dog cDNA arrays, the time course of transcriptional changes in the left ventricle of dogs fed a normal diet or a high-fat diet (HFD) for 9-24 wk. Array hybridizations were performed with complex probes representing mRNAs expressed in left ventricles from obese hypertensive and lean control dogs. We identified 63 differentially expressed genes, and expression of 17 of 20 randomly chosen genes was confirmed by real-time PCR. Transcripts were categorized into groups involved in metabolism, cell signaling, tissue remodeling, ionic regulation, cell proliferation, and protein synthesis. Hierarchical clustering indicated that the pattern of coregulated genes depends on duration of the HFD, suggesting that HFD-induced obesity hypertension is associated with continuous cardiac transcriptome adaptation despite stability of both body weight and blood pressure. GenMAPP analysis of the data pointed out the crucial importance of the ventricle TGF-beta pathway. Our results suggest that this system may be involved in molecular remodeling during HFD and in changes observed in the transcription profile, reflecting functional and morphological abnormalities that arise during prolonged HFD. These results also suggest some novel regulatory pathways for cardiac adaptation to obesity.
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Affiliation(s)
- Pierre Philip-Couderc
- Unité de Recherches sur les Obésités, Institut National de la Santé et de la Recherche Médicale U586, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
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Richeux L, Dambrin C, Marcheix B, Chabbert V, Meites G, Mazerolles M, Mugniot A, Massabuau P, Rousseau H. Vers une nouvelle prise en charge des ruptures traumatiques aiguës de l’isthme aortique. ACTA ACUST UNITED AC 2004; 85:101-6. [PMID: 15094623 DOI: 10.1016/s0221-0363(04)97555-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and safety of endovascular repair in acute traumatic aortic rupture on the basis of our experience with 16 patients. MATERIALS AND METHODS From January 1996 to December 2001,16 patients, with a mean age 36 years, underwent repair of traumatic rupture of the aorta with the use of stent-grafts. All patients presented with coexisting injuries and 9 of 16 patients were hemodynamically unstable because of other injury. After a delay ranging from 9 to 245 days (mean 78 days), aortic stent-grafting was performed by a multidisciplinary team. All patients had regular follow-up with spiral CT and transesophageal echocardiogram. RESULTS Stent-graft placement was successful in all patients with exclusion of false aneurysm. The duration of the procedure was about 120 min and mechanical respiratory assistance could be removed immediately in 80% of patients. Mean stay in the intensive care unit was 24 hours. One complication was noted: compression of the left main stem bronchus successfully treated with endoprosthesis. Maximum follow-up was 7 years. CONCLUSION Endovascular stent-graft repair is a valuable technique and is emerging as an alternative technique for treating thoracic aortic injury in patients in whom coexisting injury increases the surgical risk.
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Affiliation(s)
- L Richeux
- CHU de Rangueil, avenue JeanPoulhès, 31403 Toulouse.
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44
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Bounhoure JP, Massabuau P, Galinier M, Jordan C, Laurent JP, Marco J. [Heart failure with preserved left ventricular function: clinical, echocardiographic, and clinical course features. Prognostic factors]. Bull Acad Natl Med 2003; 186:1003-13; discussion 1013-4. [PMID: 12587339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Heart failure is clinically associated with inadequate myocardial contraction, a significant reduction of left ventricular systolic function and ejection fraction and a cardiac enlargement. Some studies have reported that patients with symptomatic heart failure may have an impaired left ventricular filling with a normal or preserved left ventricular systolic function and an ejection fraction > 45%. These patients have a "diastolic heart failure" often neglected or misdiagnosed. The aims of our study is to describe clinical, echocardiographic and hemodynamic characteristics of 64 patients hospitalized for symptomatic heart failure, to determine possible variables with prognosis relevance, and for evaluating the severity of this diastolic left ventricular dysfunction. All patients were assessed by physical and radiographic examination, 12 leads electrocardiogram, and usual laboratory tests. The internal diameter of left atrium and left ventricular end diastolic and tele-systolic diameter were measured following the recommendations of the American Society of Echocardiography, Ejection fraction was determined following Simpson's method. Left ventricular filling patterns were evaluated by pulsed Doppler mitral or venous pulmonary flow. The following parameters were assessed: maximum velocity of E and A waves, E/A ratio, E wave deceleration time and isovolumic relaxation time. The patients were studied following Appleton's classification. 45 patients were submitted to left heart catheterization and coronary angiography. All subjects were routinely followed by cardiologic examinations and the mean follow up is 18 +/- 4, 5 months. 29 women (45.3%) and 35 men with a mean age of 72.5 +/- 3.2 years were included in this study. Left ventricular ejection fraction was in mean 48.5 +/- 4.2%. 65% of patients had ischemic cardiomyopathy with severe coronary stenosis > 50%, often associated with hypertension. 52% of patients had hypertensive heart disease and 38% were diabetics. 34 patients were re-hospitalized for recurrent heart failure despite medical treatment with diuretics, ACE inhibitors (90% of patients), beta-blockers, (37%) or nitrates (36%). 24 patients have been treated by coronary angioplasty. In hospital mortality was 6.2% and during the follow up at 18 months the mortality reaches 18.7%. The factors of poor prognosis are age > 75 years, left ventricular restrictive pattern at doppler diastolic trans mitral flow evaluation, (p < 0.001), history of myocardial infarction, and renal insufficiency defined by creatinemia > 150 micromoles (p = 0.002). In conclusion heart failure with preserved left systolic ventricular function is frequent in women with hypertensive heart disease. The prognosis at mean term is better that prognosis of patients with systolic dysfunction but despite medical treatment there is a high morbidity with numerous re hospitalizations. Restrictive left ventricular filling pattern is significantly related to the occurrence of events and mortality.
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Affiliation(s)
- Jean-Paul Bounhoure
- Clinique Pasteur, Université Paul Sabatier-Faculté de Médecine Toulouse-Rangueuil-31403 Toulouse
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45
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Affiliation(s)
- H Rousseau
- University Hospital of Rangueil, Central Radiology, Toulouse, France
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46
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Galinier M, Pathak A, Baixas C, Alhabaj S, Fallouh V, Roncali J, Schmutz L, Massabuau P, Fauvel JM, Bounhoure JP. [Effects of bradykinin in the cardiovascular effects of angiotensin-converting enzyme inhibitors]. Arch Mal Coeur Vaiss 2002; 95 Spec 4:37-40. [PMID: 11933554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The role of bradykinin in the cardiovascular effects of angiotensin converting enzyme inhibitors remains difficult to establish. On their haemodynamic effects, bradykinin acts during their acute administration, participating in their vasodilatation action, while during their chronic administration they act slightly or not at all. On their trophic effects, the action of the tissue kallikrein-kinin system, suggested by the results of animal experimentation, is yet to be demonstrated in man. For their effects on cardiovascular morbidity and mortality the role of bradykinin remains under discussion. Nevertheless, besides ACE inhibitors, the other therapeutic agents which increase the levels of bradykinin, such as neutral endopeptidase inhibitors, have a significant field of development in the course of cardiovascular pathologies.
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Affiliation(s)
- M Galinier
- Fédération des services de cardiologie des hôpitaux, CHU de Rangueil, Toulouse 31403.
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47
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Viguier A, Pavy le Traon A, Massabuau P, Valton L, Larrue V. Asymptomatic cerebral embolic signals in patients with acute cerebral ischaemia and severe aortic arch atherosclerosis. J Neurol 2001; 248:768-71. [PMID: 11596781 DOI: 10.1007/s004150170092] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Severe aortic arch atheroma (AAA) is a strong risk factor for ischaemic stroke, but it is unclear whether AAA is a source of cerebral emboli or simply a marker of cerebral atherosclerosis. The purpose of this study was to find out the prevalence of asymptomatic cerebral embolic signals (ES) in patients with acute cerebral ischaemia, AAA and no other potential source of cerebral embolism. Forty patients with anterior circulation ischaemic stroke or transient ischaemic attack (TIA) were prospectively studied using transesophageal echocardiography (TEE) and transcranial Doppler (TCD) scanning within seven days of symptom onset. Patients with a cardiac source of embolism or carotid stenosis > 50% were excluded. ES were detected in 14.3% (2/14) of patients with AAA > or = 4 mm and in no patients with AAA < 4 mm or no AAA (p=0.14). The findings suggest that ES may be associated with severe AAA but their prevalence is low in this setting.
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Affiliation(s)
- A Viguier
- Department of Neurology, Hopital Rangueil, Toulouse, France
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48
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Galinier M, Pathak A, Fourcade J, Aloun JS, Massabuau P, Curnier D, Boveda S, Baixas C, Fauvel JM, Senard JM. [Left ventricular hypertrophy and sinus variability in arterial hypertension]. Arch Mal Coeur Vaiss 2001; 94:790-4. [PMID: 11575205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Previous studies of heart rate variability (HRV) in systemic hypertension have yielded conflicting results. We sought to assess the alterations of HRV in hypertensive patients with or without left ventricular hypertrophy (LVH). METHODS 195 hypertensive patients in sinus rhythm, mean age 53 +/- 11 years, without diabetes mellitus, nor symptomatic coronary disease or systolic dysfunction, were prospectively enrolled. Echocardiographic examination allowed their subdivision in 3 groups: normal geometry (112), concentric remodeling (43) and LVH (40). Time and frequency domain measures of HRV were obtained from 24 h Holter ECG recordings in all patients as in 40 control subjects. RESULTS In comparison with control subjects, the 3 hypertensive groups presented a significant decrease of SDNN and total frequency power both indexes of global HRV; a significant decrease of pNN50 and high frequency power, indexes of HRV reflecting parasympathetic tone, and a significant decrease of SDANN and low frequency power, indexes reflecting sympathetic modulation of HRV. Comparisons among the three hypertensive groups showed that patients with LVH had significantly (p < 0.05) lower low frequency power (5.5 +/- 1.0 Ln m2) than patients with left ventricular normal geometry (5.9 +/- 0.8 Ln m2) or concentric remodeling (5.9 +/- 0.9 Ln m2). CONCLUSION Assessment of HRV in hypertensive patients shows a constant decrease of parasympathetic indexes and a more markedly reduction of sympathetic parameters in presence of LVH.
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Affiliation(s)
- M Galinier
- Fédération des services de cardiologie, centre hospitalo-universitaire de Rangueil, Toulouse
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Boveda S, Galinier M, Pathak A, Fourcade J, Dongay B, Benchendikh D, Massabuau P, Fauvel JM, Senard JM, Bounhoure JP. Prognostic value of heart rate variability in time domain analysis in congestive heart failure. J Interv Card Electrophysiol 2001; 5:181-7. [PMID: 11342756 DOI: 10.1023/a:1011485609838] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS Analysis of heart rate variability is a noninvasive tool that allows to study autonomic control of the heart. Several studies have shown disturbed heart rate variability in patients with chronic heart failure (CHF). We sought to assess the prognostic value of time domain measures of heart rate variability in CHF. METHODS AND RESULTS We prospectively enrolled 190 patients with CHF in sinus rhythm, mean age 61+/-12 years, 109 (57.4 %) in NYHA class II and 81 (42.6 %) in class III or IV, mean cardiothoracic ratio 57.6+/-6.4 % and mean left ventricular ejection fraction 28.2+/-8.8 %, 85 (45 %) with ischemic and 105 (55 %) with idiopathic dilated cardiomyopathy. Time domain measures of heart rate variability were obtained from 24 h Holter ECG recordings. During follow-up (22+/-18 months), 55 patients died. In multivariate analysis, independent predictors for all-cause mortality were: ischemic heart disease, cardiothoracic ratio > or =60 % and standard deviation of all normal RR intervals <67 ms (RR=2.5, 95 % CI 1.5--4.2). CONCLUSIONS Depressed heart rate variability has independent prognostic value in patients with CHF.
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Affiliation(s)
- S Boveda
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.
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50
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Galinier M, Pathak A, Fourcade J, Androdias C, Curnier D, Varnous S, Boveda S, Massabuau P, Fauvel M, Senard JM, Bounhoure JP. Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. Eur Heart J 2000; 21:475-82. [PMID: 10681488 DOI: 10.1053/euhj.1999.1875] [Citation(s) in RCA: 177] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Identification of patients with chronic heart failure at risk for sudden death remains difficult. We sought to assess the prognostic value for all-cause and sudden death of time and frequency domain measures of heart rate variability in chronic heart failure. METHODS AND RESULTS We prospectively enrolled 190 patients with chronic heart failure in sinus rhythm, mean age 61+/-12 years, 109 (57.4%) in NYHA class II and 81 (42.6%) in classes III or IV, mean cardiothoracic ratio 57.6+/-6.4% and mean left ventricular ejection fraction 28.2+/-8.8%, 85 (45%) with ischaemic and 105 (55%) with idiopathic dilated cardiomyopathy. Time and frequency domain measures of heart rate variability were obtained from 24 h Holter ECG recordings, spectral measures were averaged for calculation of daytime (1000h-1900h) and night-time (2300h-0600h) values. During follow-up (22+/-18 months), 55 patients died, 21 of them suddenly and two presented with a syncopal spontaneous sustained ventricular tachycardia. In multivariate analysis, independent predictors for all-cause mortality were: ischaemic heart disease, cardiothoracic ratio > or =60% and standard deviation of all normal RR intervals <67 ms (RR = 2.5, 95% CI 1.5-4.2). Independent predictors of sudden death were: ischaemic heart disease and daytime low frequency power <3.3 ln (ms(2)) (RR = 2.8, 95% CI 1.2-8.6). CONCLUSION Depressed heart rate variability has independent prognostic value in patients with chronic heart failure; spectral analysis identifies an increased risk for sudden death in these patients.
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Affiliation(s)
- M Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
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