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C Chauvel

Publications and source records attributed to C Chauvel.

At least 37 records · Page 2Linked to original sources
PubMed1997

Is dobutamine stress echocardiography useful for noninvasive differentiation of ischemic from idiopathic dilated cardiomyopathy?

Dobutamine stress echocardiography was performed in 56 consecutive patients, mean age: sixty-two +/- twelve years. Twenty-two patients had an idiopathic dilated cardiomyopathy (group 1) and 34 had angiographically proven ischemic dilated cardiomyopathy (group 2). Wall motion score index and left ventricular ejection fraction were determined at baseline, 5 micrograms/kg/min, peak, and ten minutes after stepwise dobutamine infusion. Worsening or no change in global wall motion score was observed in 9 group 2 patients (26%) and 1 group 1 patient (5%, P = .07). No significant difference was observed with regard to wall motion score index decrease between baseline and peak dose. Left ventricular ejection fraction increase during dobutamine infusion was comparable in both groups. Thus, an ischemic response was observed more often in the coronary artery disease group, yielding a good specificity and positive predictive value although sensitivity was low. However, left ventricular function improvement did not help to discriminate patients with or without significant CAD.

Aged↗
PubMed1997

[Clinical, echocardiographic and Doppler outcome in ischemic right ventricular dysfunction associated with inferior wall infarction].

Right ventricular involvement during inferior wall myocardial infarction does not seem to alter long-term clinical prognosis but its specific outcome has not been clearly studied. We have previously demonstrated that pulmonary regurgitant (PR) flow tracings doppler analysis allows the accurate diagnosis of RV involvement, especially when the pressure half-time of PR was < or = 150 ms and the ratio of the minimal velocity to the maximal velocity was < or = 0.5. We studied 40 patients with acute inferior wall myocardial infarction and with PR flow. Doppler echocardiography was obtained during the first day, before discharge (early control) and between 12 and 24 months follow-up (late control). Among 22 patients with RV involvement defined with PR-derived doppler parameters (RVIPR). 8 had right ventricular enlargement and/or wall motion abnormalities, observed in 6 cases at early control and in 4 at late control. Doppler analysis showed remnant RVIPR parameters in 9 patients at early control and 8 among these at late contorl, with no relation with pulmonary artery pressure or other echocardiographic parameters. No clinical, angiographic or therapeutic data predicted these distinct echocardiographic and doppler patterns and the long-term prognosis was not different. At late control, among 12 RVIPR patients which PR-derived doppler parameters were normal at early control, two patients had still RVIPR pattern at late control and described ischemic recurrence. PR flow doppler analysis is a useful tool for diagnosis and outcome evaluation of RV involvement and shows a remnant diastolic dysfunction in half of the patients with acute RV involvement.

Aged↗
PubMed1997

[Dobutamine stress echocardiography; a monocentric experience on 600 consecutive patients. Effect of age].

The increasing indications of dobutamine stress echo in the investigation of myocardial ischaemia, viability and evaluation of the prognosis of coronary artery disease has made this technique a tool of everyday clinical practice. The authors reviewed the results of 600 investigations in consecutive unselected including patients aged over 75. No significant difference was observed with respect to the causes of interruption of the test between patients aged less than 75 (521 patients) and those older than 75 (79 patients). Attaining the target theoretical maximal heart rate was the commonest reason for stopping the test (47 and 48% respectively). Ventricular arrhythmias were not more common (12 and 10% respectively). Twelve cases of ventricular tachycardia were observed, 8 of which were non-sustained; 9 led to interruption of the test. No cases of ventricular fibrillation were observed. A previous history of cardiac arrhythmias was not associated with a higher frequency of arrhythmia during the test (8% in those with a previous history, 4% in those patients without). Supraventricular arrhythmias were significantly more common in patients over 75 years of age (15 versus 8%, p = 0.046). Dobutamine stress echocardiography' is feasible in a population of unselected patients, including those over 75. Therefore, age does not represent a limitation to the extension of this investigation.

Adult↗
PubMed1996

Safety of dobutamine stress echocardiography. A 24 h Holter monitoring study.

BACKGROUND: Dobutamine-atropine stress echocardiography is an efficient method in the evaluation of patients with coronary artery disease. However, because high-dose dobutamine is potentially arrhythmogenic, the safety of this stress modality has been questioned. METHODS: We performed a 24 h Holter monitoring, before and immediately after this test, in 73 consecutive patients (60 men and 13 women), mean age 60 +/- 12 years. Twenty-eight patients had had a recent myocardial infarction, 25 had stable chronic angina, 10 chronic ischaemic cardiomyopathy and 10 idiopathic dilated cardiomyopathy. Dobutamine was progressively increased (5-40 micrograms.kg-1.min-1) and atropine was injected in 30 patients. Arrhythmias and ST-segment deviation before and after the stress test were evaluated. RESULTS: The mean peak dobutamine dose was 32 +/- 11 micrograms.kg-1.min-1. The heart rate at rest and at peak dose was, respectively, 69 +/- 16 and 110 +/- 28 beats.min-1. Side effects during the injection of dobutamine were mainly ventricular (n = 14) or atrial (n = 4) premature contractions. Three patients had non-sustained ventricular tachycardia and five had hypotension during the test. No sustained episode of supraventricular or ventricular tachycardia was observed during the study. Non-sustained supraventricular and ventricular tachycardias were detected in 8 and 21 patients before and in 11 and 16 patients after dobutamine stress echocardiography (P = ns). Asymptomatic ST-segment deviation was observed in two patients before and four after dobutamine stress echocardiography. An increase in total ischaemic time (20 vs 102 mn) was observed after the test, but only five patients had ST modifications. A separate analysis of patients with and without beta-blocker did not alter these results. In addition, when the occurrence of significant arrhythmias was stratified according to a left ventricular ejection fraction threshold of 45%, we observed no difference in frequency and severity of cardiac arrhythmias. CONCLUSION: This study demonstrates that dobutamine stress echocardiography does not significantly increase arrhythmia during the following 24 h. Further studies are required to evaluate the influence of the test on ST-segment modification during the same period.

Aged↗
PubMed1995

Hemodynamic criteria for diagnosis of right ventricular ischemia associated with inferior wall left ventricular acute myocardial infarction.

To test the diagnostic value of different hemodynamic indexes for the diagnosis of acute right ventricular (RV) ischemic dysfunction, we studied 2 groups of consecutive patients admitted for an acute left ventricular inferior wall myocardial infarction: 51 patients with (group 1) and 32 patients without (group 2) RV ischemia as determined by coronary angiography. In both groups, we analyzed by right-sided cardiac catheterization right-sided heart pressures, pulmonary capillary wedge pressure, and cardiac index. We also calculated pressure ratios (mean right atrial pressure or RV end-diastolic over pulmonary capillary wedge pressures), pulmonary vascular resistance, and RV stroke work index. We found significant differences (p < 0.01) between the 2 groups when comparing mean right atrial pressure, RV end-diastolic pressure, ratio of these 2 pressures over pulmonary capillary wedge pressure, RV stroke work index, and right atrial and RV pressure waveforms. The best combined sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were found for the right atrial M or W waveform pattern, isolated or combined with a disproportionate elevation of RV end-diastolic over pulmonary capillary wedge pressures (respectively, 92%, 94%, 90%, 87%, and 89%). Volume loading was performed in 27 patients (18 with and 9 without RV ischemia). Right heart pressures and RV stroke work index increased significantly and similarly in both groups. Cardiac index increased significantly only in patients without RV ischemia (p = 0.02). However, volume loading did not significantly modify the diagnostic value of the different hemodynamic criteria studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Relations between Doppler tracings of pulmonary regurgitation and invasive hemodynamics in acute right ventricular infarction complicating inferior wall left ventricular infarction.

To test the hypothesis that flow characteristics from pulmonary regurgitation (PR) can predict right ventricular (RV) involvement in patients with inferior wall acute myocardial infarction, we prospectively recorded continuous-wave Doppler tracings and right-sided cardiac hemodynamics in 48 consecutive patients with inferior wall acute myocardial infarction and PR. Right heart hemodynamics enabled the identification of 29 patients with (group 1) and 19 without (group 2) RV involvement. In patients with RV involvement, the pulmonary regurgitant flow pattern was characterized by a rapid rise in flow velocity to a peak level followed by an abrupt deceleration in mid-diastole, whereas in patients without RV involvement, the deceleration in mid-diastole was gradual. The pressure half-time of PR (PHTPR) and the lowest mid-diastolic to peak early diastolic velocity ratio were significantly lower in group 1 than in group 2 (91 +/- 31 vs 214 +/- 57 ms [p < 0.001], 0.35 +/- 0.08 vs 0.59 +/- 0.13 [p < 0.001], respectively). The best diagnostic accuracy (95%) was obtained with cut-off values of PHTPR < or = 150 ms and the lowest mid-diastolic to peak early diastolic velocity ratio < or = 0.5: sensitivity 100%, specificity 89%, positive predictive value 94%, and negative predictive value 100%. Using multiple logistic regression analysis, we found that PHTPR was the strongest predictor of RV involvement. Thus, these parameters, derived from pulmonary regurgitant tracings, are useful in the noninvasive bedside diagnosis of RV infarction.

Aged↗
PubMed1995

[Segmental myocarditis in Churg-Strauss syndrome. Review of the literature apropos of a case].

We describe a 25-year old man in whom segmental myocarditis and pericarditis was diagnosed using two-dimensional echocardiography. Churg-Strauss syndrome was suspected in the presence of asthma and evidence of hypereosinophilia. Early therapy with oral prednisone led to resolution of pericarditis but septal hypokinesia was still present after 4 years. The pathophysiology of segmental myocarditis in the Churg Strauss syndrome is discussed.

Adult↗
PubMed1995

Radioisotopic pacemaker: long-term clinical results.

In order to prolong the service life of the generator, the isotopic pacemakers, powered by Pu238, have been developed and implanted since 1970. We report the follow-up of 325 patients (mean age 39 +/- 18 years) implanted with an isotopic pulse generator (Medtronic 9000/9090) between April 1970 and July 1982. The mean follow-up was 12 years (range 6 days to 18.5 years). The generator was highly reliable; the mean value of pacing rate between implantation and last follow-up decreased significantly but no more than 1 beat/min (72.7 vs 71.8 beats/min; P < 0.001) and the pulse width did not change significantly. The actuarial survival of the device was 97% at 18.5 years. During the follow-up period, 122 reoperations were performed in 85 patients: 88 explanations of the entire pacing system and 34 modifications of the lead system. Lead dysfunction accounted for 68% of the 122 reoperations, generator failure for 6%, and miscellaneous reasons for 26%. However, 72% of patients remain free of intervention during the follow-up period and 61 patients (20%) died during this period. Most deaths (52%) were of nonsudden cardiovascular origin, 17% were related to cancer, and 13% to sudden death. After 5, 10, and 18.5 years, 94%, 89%, and 73% of the patients were alive, respectively. No side effect could be attributed to the radioisotope. We conclude that this isotopic pacemaker demonstrated its reliability for long-term cardiac pacing.

Actuarial Analysis↗
PubMed1995

[Morphological study by transesophageal echocardiography and clinical aspects of ruptured chordae tendineae in the elderly].

Ruptured mitral chordae tendinae is a classical complication of myxomatous mitral valves or Barlow's syndrome. This complication is controversial in non-myxomatous mitral valve. Of 91 consecutive patients with mitral valve prolapse examined over an 18 months period by transthoracic and transesophageal echocardiography, 42 (18 women and 24 men) with an average age of 76 +/- 8 years (60-93 years) had ruptured mitral chordae tendinae. The thickness of the anterior mitral leaflet measured at the distal third of the valve by transesophageal echocardiography enabled the identification of two groups of patients; group I: > 3 mm (24 patients), average 4.8 +/- 0.8 mm and group II: < or = 3 mm (18 patients), average 2.6 +/- 0.3 mm. The diameter of the mitral ring and left atrium, the length of the anterior mitral leaflet, the left ventricular end diastolic dimensions and fractional shortening, were measured by transthoracic 2D echocardiography (mitral ring) and M mode (other parameters). Ruptured chordae were detected in only 13 cases (31%) by transthoracic echocardiography; 38% were asymptomatic and a chance finding at transesophageal echocardiography. No significant difference was observed between the two groups with respect to age, gender presence of hypertension, dimensions of the cardiac chambers, fractional shortening or localisation of the prolapse related to the ruptured chordae. Fifty-eight per cent of patients in group I were in NYHA functional classes 3-4 as compared to 16% in group II (p < 0.02). The size of the left atrium was significantly greater in group I, 51 +/- 8 mm vs 38 +/- 7 mm (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

Atherosclerotic disease of the aortic arch and the risk of ischemic stroke.

BACKGROUND: Atherosclerotic disease of the aortic arch has been suspected to be a potential source of cerebral emboli. We conducted a study to quantify the risk of ischemic stroke associated with atherosclerotic disease of the aortic arch. METHODS: Using transesophageal echocardiography, we performed a prospective case-control study of the frequency and thickness of atherosclerotic plaques in the ascending aorta and proximal arch in 250 consecutive patients admitted to the hospital with ischemic stroke and 250 consecutive controls, all over the age of 60 years. RESULTS: Atherosclerotic plaques > or = mm in thickness were found in 14.4 percent of the patients but in only 2 percent of the controls. After adjustment for atherosclerotic risk factors, the odds ratio for ischemic stroke among patients with such plaques was 9.1 (95 percent confidence interval, 3.3 to 25.2; P < 0.001). Among the 78 patients who had brain infarcts with no obvious cause, 28.2 percent had plaques > or = 4 mm in thickness, as compared with 8.1 percent of the 172 patients who had infarcts whose possible or likely causes were known (odds ratio, 4.7; 95 percent confidence interval, 2.2 to 10.1; P < 0.001). Plaques of > or = 4 mm in the aortic arch were not associated with the presence of atrial fibrillation or stenosis of the extracranial internal carotid artery. In contrast, plaques that were 1 to 3.9 mm thick were frequently associated with carotid stenosis of > or = 70 percent. CONCLUSIONS: These results indicate a strong, independent association between atherosclerotic disease of the aortic arch and the risk of ischemic stroke. The association was particularly strong with thick plaques. Atherosclerotic disease of the aortic arch should be regarded as a risk factor for ischemic stroke and as a possible source of cerebral emboli.

Aged↗
PubMed1994

[Value of transesophageal echocardiography in the cardiovascular assessment of an ischemic cerebral accident of suspected embolic origin].

Transoesophageal echocardiography (TOE) is a new modality of cardiac investigation allowing examination of cardiac structures and anomalies previously inaccessible to ultrasound. TOE is performed under local anaesthesia after fasting the subject for more than 4 hours and after premedication when the patient is admitted to hospital. In the assessment of an ischaemic cerebral vascular accident, TOE may reveal potential sources of emboli such as intracavitary thrombi and tumours (left atrium and left atrial appendage), atherosclerosis of the aortic arch, vegetations. Certain indirect causes may also be more clearly identified: aneurysm of the interatrial septum, patent foramen ovale for which the causal relationship is more difficult to establish. Intra-atrial blood stasis ("spontaneous echo contrast") is perfectly analysed in the form of intra-atrial "smoke" observed in the presence of atrial dilatation, particularly in the presence of atrial fibrillation and mitral valve obstruction (mitral stenosis, valve prosthesis). The indication for TOE in this context is currently under evaluation, particularly in young patients. It is routinely indicated in patients with known heart disease when peripheral embolism is suspected, looking for intracavitary thrombosis, generally not seen on transthoracic echocardiography.

Adult↗
PubMed1993

[Incidental finding of an isolated thrombus in the left atrium in a young woman with sinus rhythm 5 years after cerebral ischemic accident].

The authors report the case of a 40 year old woman who had an ischemic stroke. The initial investigation including a complete blood clotting analysis, failed to demonstrate the cause. Five years later, the investigations were completed systematically by transesophageal echocardiography which demonstrated an isolated thrombus localised in the left atrial appendage though the localisation heart was in sinus rhythm and morphologically normal. This case illustrates in the diagnostic yield of transesophageal echocardiography in the investigation of systemic embolism in young patients who have had a cerebral ischemic event of unknown cause, even in the absence of predisposing cardiac cause.

Adult↗
PubMed1991

Ultrasonographic posttreatment follow-up of breast cancer patients.

Clinical, radiographic (mammograms), and ultrasonographic data were compared retrospectively for 171 patients to evaluate the utility of ultrasound for the follow-up of breast cancer patients treated medically or by conservative surgery. When used to follow patients treated medically by induction or exclusive chemotherapy, ultrasonography accurately quantified tumor and nodal regression. After conservative surgery, sonograms are ideal to diagnose (and sometimes to treat) early complications such as hematoma, lymphocele, and abscess. Ultrasonography was more sensitive than mammography for the detection of late complications and benign lesions, but was insufficient for the detection of recurrent disease (95.5% sensitivity for radiography vs 90% for ultrasonography). After radical surgery and breast reconstruction, ultrasonography is the only procedure required for follow-up of patients with breast implants because it can determine the size and penetration of cutaneous recurrences. The fact that 30% of patients treated by lumpectomy and irradiation ultimately develop malignant or benign abnormalities justifies systematic ultrasonography for the follow-up of treated breast cancers. All sonographically demonstrable abnormalities warrant ultrasound-guided puncture biopsy.

Breast↗
PubMed1991

[Value of mammography in the diagnosis of breast masses in adolescents].

Breast masses in teenagers are uncommon; in most cases, the palpation of a mass by the patient herself leads to physical and radiological examination. According to the age of the patient, radiographic exams should be limited, and mammography in particular, should not necessarily be performed. Ultrasonography using a high frequency transducer is very useful when associated with physical examination, and gives an accurate diagnosis in most cases. A large isolated mass detected in a healthy young girl is usually benign (adenofibroma). Multiple small masses suggest a malignancy (metastases or hemopathy), especially if the subject has been previously treated for such a disease. Primary breast carcinoma is exceptional.

Adolescent↗
PubMed1991

[Color Doppler in breast tumor pathology].

Colour Doppler findings in a series of 63 cases of breast tumours and 19 cases of lymph node enlargements are reported. Colour Doppler signals of abnormal flow are found in 68.5 percent of the cancers, in 42.8 percent of metastatic lymph nodes and in 10 percent of benign lesions. There was bidirectional flow in 80 percent of all the cases. In cases of malignant tumours, the signal was correlated with the size and location of the lesions most often found peripherally. Presently, this technique appears to be of little value in determining whether a primary malignant tumour of the breast is malignant or benign. It does appear to be useful, first to follow-up cancers during initial chemotherapy (partial regression of the signal and of tumour volume) and secondly, in the diagnosis of metastatic lymph nodes with a specificity of 100 percent in our series. Colour Doppler is on the contrary difficult to interprete after conservative treatment of breast cancer because of post-radiotherapy tissue remodelling.

Breast Neoplasms↗
PubMed1991

[Ultrasonographic surveillance of treated breast cancer].

Clinical, radiographic (mammograms) and ultrasonographic data were compared retrospectively for 171 patients to evaluate the utility of ultrasound for the follow-up of breast cancer patients treated medically or by conservative surgery. When used to follow-up patients treated medically by induction or exclusive chemotherapy, ultrasonography accurately quantified tumor and nodal regression. After conservative surgery, sonograms are an ideal means to diagnose (and sometimes to treat) early complications (hematoma, lymphocele, abscess). Ultrasonography was more sensitive than mammography for the detection of recurrent disease (95.5% sensitivity for radiography versus 90% for ultrasonography). After radical surgery and breast reconstruction, ultrasonography is the only procedure required to follow-up of patients with breast implants, because it can determine the size and penetration of cutaneous recurrences. The fact that 30% of patients treated by lumpectomy and irradiation ultimately develop malignant or benign abnormalities justifies systematic ultrasonography for the follow-up of treated breast cancers. All sonographically demonstrable abnormalities warrant ultrasound-guided puncture biopsy.

Breast Neoplasms↗