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Biomedical subjects

A Cribier

Publications and source records attributed to A Cribier.

At least 163 records · Page 9Linked to original sources
PubMed1983

Coronary hemodynamic data in ischemic heart disease according to ischemic behavior during pacing.

In order to study the circulatory changes induced by maximal atrial pacing in coronary patients, coronary sinus blood flow (CBF) measured by continuous thermodilution, lactate extraction coefficient (K), arteriovenous difference in oxygen (AVO2 diff), and aortic blood pressure (BP) were measured at basal state and at maximal heart rate (HRmax) in 11 patients without coronary disease (group I) and in 28 patients with severe coronary lesions, divided into two groups according to the absence (group IIa) or the presence (group IIb) of chest pain and ST-segment depression at HRmax X K was inverted in group IIb (24 +/- 17% vs -23 +/- 39%, p less than 0.001), but remained unchanged in group I and group IIa. Despite similar HRmax, percent increase in CBF was significantly lower in group IIb (54 +/- 34%), than in group I (113 +/- 54%, p less than 0.01). This contrasts with the higher values of the product of heart rate times systolic blood pressure (HR X SBP) as well as of diastolic blood pressure (DBP) in group IIb. The decrease in coronary resistances was lower in group IIb than in group I (p less than 0.001), and also lower than in group IIa (p less than 0.05). The ratio MVO2 X CBF/systolic BP X HRmax was significantly lowered only in group IIb (p less than 0.001) confirming the imbalance between myocardial oxygen supply and oxygen demand. In coronary patients, myocardial ischemia induced by atrial pacing is related to an insufficient increase in CBF, well evidenced by continuous thermodilution.

Angina Pectoris↗
PubMed1983

Intracoronary thrombolysis in evolving myocardial infarction. Sequential angiographic analysis of left ventricular performance.

Since November 1979 left ventricular angiography and coronary arteriography have been performed in 80 patients with evolving acute myocardial infarction in order to attempt coronary recanalisation by local streptokinase infusion. The average delay between the onset of symptoms and streptokinase infusion was 3.6 hours. Thrombolysis was successful in 64% of cases. No serious complications related to the procedure were noted. Of the 12 patients in cardiogenic shock, recanalisation was achieved in only four, of whom two survived. To evaluate the left ventricular salvage resulting from early recanalisation the last 58 patients had a second left ventricular angiogram and further coronary arteriograms 21 +/- 10 days later and 16 patients had a third study three months later. From the left ventricular angiogram in the right anterior oblique projection the ejection fraction and two graphic variables of regional wall motion were computed quantifying the hypokinetic zone. Patients were divided into two groups, according to the patency of the infarct related artery at the second control: group 1 consisted of 28 patients with successful recanalisation confirmed, and group 2 of 30 patients in whom no recanalisation was achieved or secondary reocclusion had occurred. At the second study the ejection fraction was unchanged in group 1 but had significantly decreased in group 2. Regional wall motion improved in group 1 and worsened in group 2, more so in patients without recanalisation than in those in whom secondary reocclusion had occurred. The third study showed a further decrease in ejection fraction in group 2. A progressive decrease in percentage residual stenosis was observed in group 1. This sequential angiographic study confirms the partial myocardial salvage resulting from early coronary recanalisation during acute myocardial infarction.

Adult↗
PubMed1983

[Angina pectoris with normal coronary arteries: clinical, hemodynamic and metabolic study].

Sixty patients without organic heart disease presenting with chest pain suggestive of angina pectoris and angiographically normal coronary arteries underwent clinical, hemodynamic and metabolic investigation. The study of myocardial lactate metabolism during atrial pacing (168 +/- 14 bpm) allowed identification of two groups: --40 patients with a normal coefficient of lactate extraction (K greater than or equal to 9 per cent); --20 patients with a pathologically low coefficient of lactate extraction (K less than 9 per cent) reflecting myocardial ischemia. In the first group, chest pain was often atypical (75 per cent of cases). Hemodynamic investigation showed minor abnormalities of the left ventricle in 48 per cent of cases. The diagnosis of angina was rejected in these patients. In the second group, the majority of patients developed chest pain (85 per cent of cases) at the maximal heart rate with significant ST depression (80 per cent of cases). The chest pain was typical of angina pectoris in 50 per cent of cases. Hemodynamic and angiographic investigation of the left ventricle was completely normal in nearly all cases. Only these patients with clinical, electrocardiographic and metabolic signs of myocardial ischemia can be considered as having angina with normal coronary arteries. Although studies of myocardial lactate metabolism and other signs of myocardial ischemia distinguish clearly between these two groups of patients, the coronary hemodynamics were similar. Resting coronary flow, its increase for the same myocardial oxygen demands and coronary resistances were comparable in both groups, and not significantly different from the values obtained in a control group of patients without coronary artery disease or chest pain. These results confirm that about 30 per cent of patients investigated for chest pain suggestive of angina pectoris who have angiographically normal coronary arteries, develop signs of myocardial ischemia during atrial pacing. The physiopathological explanation remains unclear as coronary hemodynamics have been found to be normal.

Adult↗
PubMed1983

[Evaluation of functional myocardial recovery after emergency revascularization by intracoronary fibrinolysis in the acute infarct period].

An angiographic study was carried out to evaluate myocardial recovery in 50 patients who had undergone coronary angiography in the first six hours of myocardial infarction with the object of attempting emergency revascularisation by a selective intracoronary infusion of streptokinase. Left ventriculography performed before initial coronary arteriography and 2 to 10 weeks later was compared. The ejection fractions and two indices obtained by quantitative analysis of regional contractility, the surface (SHK) and extent (EHK) of the ischemic zones were calculated. The patients were divided into two groups according to results: Group I, 25 patients with patent arteries at the second control, and Group II, 25 patients not revascularised or with a reobstructed artery at the second angiographic control. In Group I, the ejection fraction remained stable (47 +/- 11 p. 100 to 48 = 10 p. 100 N.S.) but SHK (13 +/- 6 cm2 to 10 +/- 5 cm2, p less than 0,01) and EHK in percentage of ventricular circumference (48 +/- 12 p. 100 to 42 +/- 11 p. 100, p less than 0,05) fell significantly. In Group II, the ejection fraction fell (55 +/- 9 p. 100 to 44 +/- 11 p. 100, p less than 0,001) whilst SHK (7 +/- 4 cm2 to 11 +/- 5 cm2, p less than 0,001) and EHK (34 +/- 11 p. 100 to 43 +/- 14 p. 100, p less than 0,001) increased significantly. These results show that revascularisation may result in significant functional myocardial recovery and, consequently, that some ischemic myocardium can be salvaged in these patients.

Cardiac Catheterization↗
PubMed1982

Acute coronary occlusion during coronary angiography in two cases. Treatment by transluminal disobliteration.

Acute coronary obstruction occurred in two patients during coronary angiography. In one case the obstruction was in the left main coronary artery; in the other it was close to the origin of the left anterior descending artery. In both cases acute cardiac ischaemia ensued, with electromechanical dissociation and collapse, which was not reversible by resuscitation. Rapid disobliteration of the occluded coronary artery was done with a guide-wire pushed through the obstruction via the coronary catheter. The recanalisation was completed by an intracoronary perfusion of streptokinase in one case. In both cases recovery was rapid and spectacular. The occurrence of acute ischaemia during coronary angiography should suggest accidental coronary occlusion. If a thromboembolic origin is suspected, transluminal disobliteration should be attempted. It is simple and can reverse a dangerous condition.

Aged↗
PubMed1982

[Angiographic study of the ejection fraction by thirds of systole in coronary patients].

The parameters of myocardial function in the initial phase of ventricular ejection are theoretically more sensitive than the indices calculated over the total systolic ejection period. The object of this study was to evaluate whether the calculation of the ejection fraction by thirds of systole, giving a separate assessment of left ventricular performance at the beginning, the middle and end of ejection, could reliably detect minor changes in ventricular function unrecognised by the usual holosystolic indices. Seventy left ventricular angiograms were analysed in 20 normal subjects (Group I) and 50 patients with coronary artery disease whose ventricular function estimated by the usual parameters was either decreased (Group II, 20 patients) or normal (Group III, 30 patients). In Group I, the ejection fraction in the first third of systole (FE1/3) was much higher than the ejection fraction in the second third (FE2/3). On the other hand, in Groups II and III, all patients had a FE1/3 lower than the FE2/3 (specificity: 100 p. 100). In these two groups, the reduction of FE1/3 and the increase of FE2/3 were very significant compared to Groupe I (p less than 0,001). The ejection fraction of the lest third was identical in the 3 groups. This abnormal distribution of ejection was detected in all coronary patients and was the only alteration of ventricular performance in each of the 30 patients in Group III. In this group, this abnormality was detected equally in patients with triple vessel disease (Subgroup III a, 20 patients) and in patients with isolated left anterior descending disease (Subgroup III b, 10 patients) illustrating the high sensitivity of this index for the detection of a minor abnormality of myocardial function.

Adolescent↗
PubMed1982

[Immediate and long-term effects of prazosin on hemodynamics in chronic cardiac insufficiency].

Prazosine was studied in the treatment of chronic heart failure in 17 patients. The immediate effects were a reduction in pulmonary capillary pressure (22,9+/-8,8 mmHg to 15,5+/-7,4 mmHg, p less than 0,001), mean pulmonary artery pressure (34,2+/-10,6 mmHg to 23,8+/-9,2 mmHg, p less than 0,001), an increase in cardiac index (2,13+/-0,5 to 2,70+/-0,68 l/mn/m2 p less than 0,01), a reduction in mean systolic blood pressure (95,6+/-12,9 to 80,8+/-10,6 mmHg, p less than 0,001) and systemic resistance (1983+/-464 to 1 370+/-406 dynes.sec.cm-5). Heart rate did not change significantly. The long-term effects were assessed after 2 months continuous treatment in 14 patients. There was a clear-cut symptomatic improvement in the patients. This was without doubt related to the increase in cardiac output (+24 p. 100) which persisted at long term. On the other hand, the preload rose to its pre-treatment levels as did the blood pressure. This study confirms the value of Prazosine in the long-term treatment of chronic cardiac failure.

Adult↗
PubMed1981

Hemodynamic and angiographic evaluation of aortic regurgitation 8 and 27 months after aortic valve replacement.

Eighteen patients with chronic aortic insufficiency were evaluated hemodynamically and angiographically 8 months after aortic valve replacement. Both the pulmonary artery diastolic pressure and the left ventricular end-diastolic volume decreased significantly (p less than 0.001), but the mean ejection fraction and the cardiac output remained identically lowered, though some individual cases showed improvement. The relative reduction in end-diastolic volume correlated only with the preoperative ejection (p less than 0.05) and regurgitation fractions (p less than 0.02). In the 10 patients whose left ventricular volume remained high or ejection fraction low, a second evaluation was performed 27 months after surgery. The left ventricular end-diastolic volume was significantly lowered (from 151 to 120 ml/m2, p less than 0.05) back to normal in five cases. The systolic and diastolic ventricular shape returned to normal. Cardiac index and ejection fraction were unchanged. These results show a marked improvement a few months after aortic valve replacement, with a further improvement several months later, as shown mainly by the decrease of left ventricular end-diastolic volume and the return to normal of left ventricular cavity shape. However, in most cases, the ejection fraction remained at its preoperative valve, suggesting that surgery should be performed early, before myocardial deterioration appears.

Adolescent↗
PubMed1980

[Diclofurime, a new major hypotensive agent. Clinical study in 24 patients (author's transl)].

Diclofurine is a new ketone-oxime derivative with potent peripheral vasodilating properties. Its hypotensive effects were studied in 24 patients suffering from severe hypertension resistant to combinations of most hypotensive drugs. In 22 patients who received diclofurime alone the blood pressure decreased from mean values of 194 +/- 1/118 +/- 3 to 166 +/- 4/97 +/- 3 mmHg after the weeks of treatment and remined at simular levels on further examinations. Most remarkably, the fall in BP was accompanied by a decrease of 15 beats/minute in supine heart rate. The mean daily dosage of diclofurime was 518 mg, the drug being taken in three divided doses. In 7 cases where diclofurime was combined with acebutolol either from the start or (in 5 cases) after an initial period of monotherapy, the efficacy of the treatment was enhanced by the beta-blocking agent. Out of 24 patients studied only one failed to respond. The new drug was generally well tolerated. Diclofurime appears to be one of the most active and best tolerated drugs for long-term oral treatment of arterial hypertension.

Acebutolol↗
PubMed1980

Large multiple coronary artery aneurysm in adult patients: a report on three patients and a review of the literature.

Three cases of large multiple coronary aneurysms, situated on both right and left coronary arteries, were seen in three middle-aged adult patients. These patients were hospitalized for myocardial infarction in two cases and for angina pectoris in the third case. On the coronary angiogram, the coronary lesions were quite unusual as there were multiple voluminous aneurysms on both coronary arteries without evidence of atherosclerotic lesions of the remainder of the coronary tree. These lesions did not seem to be congenital or atherosclerotic, and it was postulated that these lesions might have been the sequelae of a mucocutaneous lymph node syndrome although no previous history of this condition could be found in these three patients.

Adult↗
PubMed1980

Variations in height of jugular "a" wave in relation to heart rate in normal subjects and in patients with atrial septal defect.

Analysis of jugular tracings in seven normal subjects in sinus rhythm whose heart rate varied spontaneously from one moment to another during expiratory apnoea, showed that a pronounced variation occurred in the size of the "a" waves in relation to that of the "v" waves and in accordance with the corresponding RR interval. In the 53 measurements which were carried out, the "a/v" ratio had a mean value of 0.9 for a heart rate above 87, 1.4 for a heart rate between 87 and 68, and 1.1 for a heart rate less than 68. The variations in the size of the "a" waves in relation to heart rate are explained by the place of atrial systole during the different phases of ventricular filling. This variation in the height of the "a" wave has also been found in patients with an atrial septal defect for heart rates between 62 and 86, and this could lead to misdiagnosis, either dismissing the diagnosis of atrial septal defect when the heart rate is around these values, or suspecting it wrongly when the heart rate is either slower or faster. When examining jugular tracings, one should therefore be cautious about interpreting the size of the "a" wave which should be evaluated as a function of heart rate.

Adolescent↗
PubMed1980

Quantitative angiographic evaluation in left ventricular aneurysm.

A new method was used for the quantitative analysis of left ventricular angiography in 22 patients with an anterior aneurysm. The line of demarcation between the aneurysm (A) and the remaining myocardium (RM) was determined accurately by looking at a sudden change in the percentage of shortening of two contiguous half-axes, the left ventricular cavity being divided by 19 parallel and equidistant axes. The total volume of the left ventricle, the volume of the A and that of the RM were calculated using a method derived from Chapman's method. Total ejection fraction, ejection fraction and VCF of the RM were also calculated. A comparison was made between patients with heart failure (Group I) and those without (Group II). In Group I, the A was much larger (P less than 0.01) but volume, ejection fraction and VCF of the RM, were not significantly different, indicating that the surgical resection should give a favorable result. The validity of this method of quantitative analysis was confirmed by a comparison of the calculated preoperative remaining left ventricular volume with the volume of the postoperative cavity in 8 patients. These measurements lead to a better evaluation of patients with ventricular aneurysm in view of selection for surgery.

Adult↗