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Biomedical subjects

A Sacrez

Publications and source records attributed to A Sacrez.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Value of nuclear magnetic resonance in dilated cardiomyopathy. Approach to intraventricular hemodynamics].

The value of magnetic resonance imaging (MRI) with multiechoes spin-echo sequences was investigated in 22 patients with dilated cardiomyopathy (group I) and 25 normal subjects serving as controls (group II). The results of MRI in group I were compared with those of echocardiography and radionuclide ventriculography. Measurements of left ventricular dimensions at echography and MRI showed a tendency, with MRI, to overestimate wall thickness and underestimate ventricular diameter. Thus, for diastolic LV we had 63.8 +/- 10.5 mm with MRI vs 70.6 +/- 7.6 mm with echography, the corresponding figures for posterior wall thickness being 112 +/- 1.4 mm vs 9.9 +/- 1.1 mm respectively. These differences seem to be due to MRI introducing a partial volume effect dependent on the thickness of slices and of their orientation in relation to the cardiac axis. MRI evaluation of left ventricular function by calculation of myocardial fibre shortening fractions correlated poorly with the echocardiographic value of the same parameter and with the radionuclide ejection fraction (r = 0.58 and 0.575 respectively; p less than 0.05). For better quantification of the cardiac pump function, planimetry of the endocardial contour during diastole and systole is required. It would seem that the value of MRI resides in the possibility it offers to explore left intraventricular haemodynamics by studying the "flow signal" obtainable from multiechoes sequences at different moments of the cardiac cycle. During systole, we found a left intraventricular signal that was reinforced on even echoes and much more intense in cardiomyopathy patients (scores = 1.61 +/- 1.06) than in controls (score = 0.77 +/- 0.7; p less than 0.01). The intensity score for this signal correlated with the ejection fraction in group I subjects (r = 0.82).

Adult↗
PubMed1987

[Developmental profile of scintigraphic parameters within 3 weeks following primary myocardial infarction without any attempt at revascularization].

30 patients with a transmural primary myocardial infarction conventionally treated, are explored by myocardial scintigraphy using thallium 201, and calculation of a lesional score (L.S) and angio-scintigraphy on the first day (D1) and at three weeks (D21). The results of these examinations are compared to those of coronography at D21. Anterior necroses present a myocardial fixation defect and a dysfunction of the left ventricle which are more severe than in inferior necroses. Patients with a marked fixation defect (L.S 2) at D1, present a low ejection fraction (EF) becoming significantly worse at D21. Coronary permeability is accompanied by an appreciable improvement of the myocardial fixation from D1 to D21 and a stability of EF. On the contrary, if the occlusion persists, the fixation defect is stable and the EF decreases significantly. In this study, the coronary permeability appears to be associated to a perservation of the ischemic myocardium which may only be demonstrated by knowing the evolution of the various parameters during the first three weeks of the infarction.

Coronary Angiography↗
PubMed1986

Dilated cardiomyopathy and the level of alcohol consumption: a planned multicentre case-control study.

The association between clinical or environmental factors and dilated cardiomyopathy (DCM) has been assessed in a planned case-control study. Patients and controls were men aged between 20 and 65 years, matched for age, profession and geographic location. DCM was defined by strict radiologic and angiographic criteria excluding multiple-vessel coronary disease. Controls were recruited from the surgical centres after excluding diseases usually linked with alcohol or tobacco consumption. Univariate and multivariate analyses were used to ensure adequate techniques for matched pairs. The prevalence of diabetes and hypertension and the exposure to toxic substances, drugs and tobacco was identical in both groups. Alcohol consumption before the onset of first symptoms was higher in patients than in controls (101 vs 64 ml day-1, P less than 0.001); the excess of consumption concerns all kinds of alcoholic beverage (wine, beer, etc.). The relative risk (RR), estimated from the odds ratio, increased only among heavy drinkers (greater than or equal to 110 ml day-1; RR: 7.6, P less than 0.001) with an independent contribution of both wine (RR: 4.7, P less than 0.001) and other alcoholic beverages (RR: 4.1, P less than 0.01). In conclusion, alcohol is a strong risk factor for DCM, but the excess of risk is limited to heavy drinkers and is independent of the type of beverage.

Adult↗
PubMed1986

[Spatial ventricular gradient studied by computerized vectorcardiography. Normal and pathological values. Interpretation and clinical evaluation].

The ventricular gradient is a reflection of uneven ventricular repolarisation. Until recently is was only appreciated in the frontal plane of the classical electrocardiogramme and expressed as the sum of the vectors representing the surfaces under the QRS complex and T wave. We used computerised vectorcardiography to obtain a more exact evaluation of the size and spatial orientation of the vector gradient. The spatial vector gradient was calculated in a control group and in a number of pathological conditions. The reference values were established in 70 normal subjects with a mean age of 36 +/- 21 years: 0.092 +/- 0.016 m V.s for amplitude: 38.4 degrees +/- 6.1 for thesite and 21.6 degrees +/- 8.7 for the azimuth. The size and spatial orientation of the ventricular gradient can be used to define normal limits and to distinguish subgroups by using the values of the site and azimuth. The spatial ventricular gradient is a new approach to defining the limits of normality in poorly understood abnormalities of ventricular repolarisation. It may also be useful in the comprehension of certain forms of cardiac arrhythmia related to desynchronisation of ventricular repolarisation.

Adolescent↗
PubMed1986

[Nuclear magnetic resonance in the diagnosis of aortic diseases].

The diagnostic value of nuclear magnetic resonance imaging was assessed in a number of aortic pathologies: aneurysms of the thoracic and abdominal aorta, sinus of Valsalva aneurysms and dissection of the aorta. The imager was equipped with a resistor magnet providing a field of 0.15 Tesla. An electrocardiographic gating system was perfected. The images obtained were very satisfactory as they provided three dimensional morphological information and a qualitative assessment of blood flow. Further studies are now required with comparison with other invasive and non-invasive diagnostic methods to determine the clinical role of NMR imaging and to evaluate the diagnostic sensitivity and specificity of this new technique.

Aortic Dissection↗
PubMed1986

[Ultra-sensitive TSH levels: an aid in the screening for amiodarone-induced thyroid dysfunction].

Amiodarone modifies thyroid hormone secretion and hypothyroidism occurs in some cases. The latter diagnosis is often difficult and is of particular importance in these patients as it may have serious consequences for the heart. Early diagnosis is therefore essential but difficult because of the induced hyperthyroxinemia with maintenance of euthyroidism and a hypotriiodothyronemia. The diagnostic performance of an ultrasensitive method of measuring TSH (TSH-U), capable of distinguishing hyper and euthyroidism were compared with standard thyroid function tests and TSH stimulation with TRH in 50 patients treated with amiodarone. Only 6 of the 14 patients with hyperthyroxinaemia had TSH-U values in the hyperthyroid range: only one of these patients had an increased triiodothyronine. In 2 cases the THS-U was low but the T4L was normal. In 4 patients, increased TSH-U allowed diagnosis of latent or patent hypothyroidism. There was a close correlation between results of the TRH stimulation test and those of the TSH-U in all cases. This test may therefore be used as an initial screening test for thyroid dysfunction in patients on amiodarone and is simple, reliable and relatively cheap to perform. It makes it unnecessary to measure all thyroid hormonal parameters and the TRH test simultaneously.

Amiodarone↗
PubMed1986

[Nuclear magnetic resonance. Our preliminary experience on the normal heart and in various cardiopathies].

Nuclear magnetic resonance imaging (NMRI) is applied in our department to the study of the normal heart and in aortic, pericardial and myocardial pathologies: aortic aneurysms, hypertrophic cardiomyopathies, myocardial infarction, pericarditis and congenital cardiopathies. The apparatus used consists of a resistive magnet which provides a field of 0.15 Tesla. Synchronisation with the electrocardiogram leads to improvement of the cardiac signals. The documents obtained are promising to the extent that information concerning cardiac structure is provided in three planes (frontal, sagittal and horizontal) and is complementary to that provided by echocardiography, isotopic techniques and contrast angiography. The future potential of the method is considerable, particularly in the area of tissue characterisation.

Aorta↗
PubMed1986

[Septal subaortic hypertrophy. Apropos of 23 cases].

Septal subaortic enlargement is seen by two-dimensional echography and involves localized hypertrophy of the basal part of the interventricular septum, the thickness of which is greater than or equal to 13 mm. The present study relates to 23 septal subaortic enlargements. Means thickness of the enlargement was 17.0 mm and the longitudinal parasternal length was 22.1 mm. SAM was noted in 2 cases and mesosytolic closure of the sigmoid sinuses in one case. Left ventricular volume was much reduced in one third of cases, especially when enlargement was great. Compliance disorders were marked in one third of cases. Only the longest and thickest enlargements caused obstruction, which was noted in 18% of cases. Enlargement was most often associated with valvular (56% of cases) or hypertensive (48 P of cases) pathologies. No specific clinical, radiologic or electrical signs were noted; anomalies were due to pathology associated with the enlargements. A stable trend was generally seen in subaortic hypertrophy after a mean period of 33 months. Nevertheless, moderate increases in hypertrophy were seen in 20% of cases. In the great majority of cases, enlargement did not correspond to obstructive hypertrophic cardiomyopathy according to Goodwin's criteria, and etiology remains uncertain due to lack of histological data.

Adult↗
PubMed1986

[Carotid sinus syndrome of mixed cardioinhibitory and vasodepressive form. Value of sequential atrioventricular stimulation].

The authors report an observation of cardioinhibitory and vasodepressive carotid sinus syndrome. The vasodepressive response was analyzed by electrophysiological exploration with determination of changes in arterial pressure. This pressure is increased automatically by the "pacemaker effect of a ventricular corrective response. The pressure drop can be limited by sequential stimulation. A review is given of the results and methods of cardiac stimulation in sinocarotid hypersensitivity.

Aged↗
PubMed1985

[Beta-blockers in the acute phase of myocardial infarction. Echographic study].

The purpose of this study was to evaluate the ability of beta blocker therapy in decreasing the amount of necrosis during a first transmural myocardial infarction (as evidenced by a local and overall kinetic study using two-dimensional ultrasonography). Twenty patients were randomly placed into 2 groups. Ten patients received 15 mg of metoprolol intravenously followed by 200 mg daily of the drug orally. The results indicated that beta blockers are well tolerated clinically and hemodynamically, and that they significantly reduced the amount of necrosis (p less than 0.05 in anterior myocardial infarctions).

Clinical Trials as Topic↗
PubMed1985

[Course and prognosis of apparently primary congestive cardiomyopathies in chronic alcoholic patients].

The authors analyse a series of 36 chronic alcoholic patients with primary congestive cardiomyopathy. The clinical course of these cases was analysed in order to define the prognostic factors. All of the patients were male with a mean age of 47 years. 55 per cent of cases presented a functional deterioration. The 5 year mortality was 50 per cent. The high incidence of sudden death (38 per cent of deaths) was probably related to ventricular arrhythmias. The other deaths were due to end-stage heart failure. The survival did not differ significantly from that of primary congestive cardiomyopathy in non-alcoholic patients. It depends, above all, on the left ventricular function and is influenced by the initial value for the ejection fraction. Alcoholic withdrawal was found to be a beneficial prognostic factor when it was early, but it became ineffective in cases with major alteration in the left ventricular function. Ultrasound and radioisotope studies demonstrated the development of segmental kinetic disorders and intracavitary thrombi in the left ventricle. These lesions have a pejorative prognostic significance. The initial systolic diameter of the left auricle seems to have a prognostic value as it reflects the degree of activity of the disease.

Adult↗
PubMed1985

[Clinical value of thallium-201 myocardial scintigraphy with dipyridamole performed before and after aortocoronary bypass].

In addition to preoperative coronary angiography, 63 patients undergoing coronary bypass surgery also had myocardial scintigraphy with dipyridamole 1 to 2 days before surgery, resting scintigraphy 10 after bypass and a repeat scintigraphy with dipyridamole 3 to 6 months later. The myocardium was divided into 5 segments. In each segment the perfusion was classified as: normal, presence of a reversible defect (redistribution), presence of a permanent defect (no redistribution). A comparison of pre-and postoperative scintigraphies led to the following conclusions. Three to six months after bypass, improved perfusion was observed in 65.6% os ischaemic segments, showing that surgery was very effective. On the other hand, the immediate postoperative control (10 days) only showed improved perfusion in 42.5% of the ischaemic segments: this interval was too short to appreciate the benefits of coronary bypass. There was a good correlation between the scintigraphic improvement after surgery and the reversibility of the zones of hypofixation of Thallium before surgery. When the defect was reversible, 80% of the revascularised segments were improved. Fifty-eight per cent of non-reversible defects before surgery were unchanged by the revascularisation procedure. However, the absence of redistribution during preoperative scintigraphy was not synonymous with definitive myocardial lesions and does not represent a contra-indication to coronary bypass surgery; in fact, improved perfusion was observed in 42% of these constant defects. The quality of recovery depends on the condition of the muscle: only segments with normal motion can be improved. Degradation of the clinical condition of patients was always related to aggravation(lack of improvement in 1 case) of scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1984

[The spatial vectorcardiogram loop. Estimation of its planarity by the calculation of a distortion coefficient. Trial of clinical evaluation].

Automatic techniques for interpreting the electrical activity of the heart are based more and more on vectorcardiographic parameters, especially information provided by the spatial vectorcardiographic loop. This data has been shown to be a useful complement to classical electrocardiography. The aim of this study was to define a method of calculation of the planes of the vectorcardiographic loops of depolarisation and repolarisation, and to calculate a coefficient of left-sidedness obtained by the sum of squares of the distances between the points on the loop in the plane. This value is then normalised with respect to the size of the loop. Normal values of this coefficient were first defined in a healthy reference population of 70 subjects: the values are expressed in (MV/10)2 or in mm2, and are 0,28 +/- 0,05 for the QRS and 0,0026 +/- 0,0008 for the ST-T. The coefficient was then calculated in different pathological groups, the diagnosis of which had been formally confirmed: ventricular hypertrophy, valvular heart disease, conduction defects, coronary artery disease. The highest values (four times normal) were obtained in right ventricular hypertrophy, right bundle branch block and infarction associated with conduction defects. The discriminative value of the coefficient of left-sidedness is discussed with the aim of distinguishing the normal from the pathological.

Adult↗
PubMed1984

[Echography in the surveillance of myocardial infarction during the acute phase].

An attempt is made to determine feasibility and capabilities of two-dimensional echocardiography (2DE) during acute myocardial infarction (AMI). Seventy-four consecutive patients with AMI (22 anterior, 29 inferior, 4 lateral, 5 non-transmural) underwent 2DE; in sixty cases, suitable examination was available. Regional wall motion abnormalities were studied by 2 methods, i.e. qualitative in all patients and quantitative in 32 patients. Akinesis or dyskinesis occurred in 57 cases (21/22 in anterior, 4/4 in lateral, 29/29 in inferior, 3/5 in non-transmural AMI) and was observed very early (within the first 24 hours after onset of chest pain). Intraventricular clots were observed in 8 patients (in 7 patients during anterior or lateral AMI) without peripheral embolization. In conclusion, 2DE is a suitable method for evaluation of AMI, especially in early thrombi detection and qualitative wall motion analysis. Evolution of quantitative wall excursion is still under investigation but will be highly attractive, more easily repeatable at the bedside and cheaper than nuclear angiography.

Adult↗