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Biomedical subjects

C M Brandt

Publications and source records attributed to C M Brandt.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Hypertrophic cardiomyopathy with left ventricular dynamic obstruction syndrome in hypertensive adult patients].

Seven adult patients with old and severe arterial hypertension were found to have hypertrophic cardiomyopathy with left ventricular obstruction demonstrated by an isoproterenol test. Whenever feasible, confirmation that systolic obstruction of the left ventricular outflow tract was due to anterior systolic movement of the mitral valve was obtained. Echocardiography revealed a number of ultrasonic features (asymmetrical septal hypertrophy, small left ventricle and clear-cut reduction of the left ventricular outflow tract) which put these cases closer to the primary hypertrophic cardiopathy group than to the hypertensive cardiomyopathy group, with a similar history of hypertension. Detecting this group is facilitated by the use of vasoactive drugs in patients with these echocardiographic features. This is important since there is a risk of poor tolerance to vasodilators, notably nitrates, which may suddenly reveal the left ventricular dynamic obstruction syndrome. These patients are also exposed to paroxysmal atrial fibrillation.

Adult↗
PubMed1990

[Left ventricular diastolic function in hypertensive heart diseases. Comparison of results obtained by echocardiography and mechanocardiography].

Usefulness of computerized mechanocardiography and echocardiography in the bedside diagnosis of impaired left ventricular diastolic function is established in a study comparing 17 hypertensive cardiomyopathy patients and 17 hypertrophic obstructive patients to 20 control. The echocardiographic study involves the ratio A/E obtained from the diastolic motion of the mitral valve and max DD/dtN, the peak rate of maximal diastolic dimension change. Both measurements allow statistical differentiation between pathological conditions and the control. The mechanocardiographic evaluation of left ventricular diastolic function provides easily three different parameters of diastolic function: isovolumic relaxation by the interval B2 alpha-0 or by t-dr/dt and the ratio dr/dt/A2, left ventricular stiffness by the A/H ratio and TRR the time of rapid filling. The mechanocardiographic indices allow clear distinction between the control group and the hypertrophic conditions for all the measured parameters giving evidence for an increased isovolumic relaxation period with a reduced velocity of relaxation, an increase in left ventricular stiffness and in the case of the hypertrophic obstructive cardiomyopathy, a prolonged time of rapid filling.

Adult↗
PubMed1990

Mechanocardiographic evaluation of left ventricular diastolic function in hypertrophic cardiomyopathy and hypertensive cardiomyopathy.

Usefulness of computerized mechanocardiography and echocardiography in the diagnosis of impaired left ventricular diastolic function is shown in a study comparing 17 hypertrophic obstructive cardiomyopathy and 17 hypertensive cardiomyopathy patients to 20 normal subjects. Mechanocardiography allows the evaluation of three different parameters of diastolic function: isovolumic relaxation evaluated by S2a-O or better by t-dr/dt and dr/dt/A2 ratio, left ventricular compliance by the A/H ratio and time of rapid filling. All the parameters are impaired in both pathological populations. Isovolumic relaxation being more depressed in hypertensive cardiomyopathy and duration of rapid filling being prolonged especially in the hypertrophic obstructive cardiomyopathy patients. Although the differences are small indicating only trends computerized mechanocardiography gives some evidence for difference in the alteration of diastolic function in hypertrophic obstructive cardiomyopathy and hypertensive cardiomyopathy.

Cardiomyopathy, Hypertrophic↗
PubMed1987

[Hyperammonemia induced by propranolol in cirrhotic patients. Role of the kidney and influence of the severity of the cirrhosis].

The effect of the intravenous injection of 0.1 mg/kg of propranolol on arterial ammonemia was studied in 30 patients with alcoholic cirrhosis comparatively with 10 healthy volunteers. Moreover, in 20 patients in the cirrhotic group (10 were Pugh's grade A or B and 10 others were grade C), left renal vein catheterization was performed to follow the changes in ammonemia and glutaminemia levels simultaneously with those occurring in arterial blood. After 30 min, arterial ammonemia was significantly increased in the controls (p less than 0.02) and in the cirrhotic patients (p less than 0.001). The renal venous ammonemia was also significantly increased in all of the cirrhotic patients (p less than 0.01). In the grade A and B patients, the increase in ammonemia was more marked in the renal vein as compared with that in arterial blood (p less than 0.001). In contrast, in the grade C patients, the increase in ammonemia did not differ significantly between the two sectors. The difference in ammonia concentration between arterial and renal venous blood increased significantly after 30 min in the grade A and B patients (p less than 0.001) whereas it was stable in the grade C patients. The changes of glutaminemia in arterial and renal venous blood were not significantly different in the two groups of cirrhotic patients. These data show that, in our experimental conditions, propranolol induces arterial hyperammonemia in cirrhotic patients and that the kidney could interfere with the mechanism of hyperammonemia, at least in grade A and B patients.

Ammonia↗
PubMed1986

[Use of structured lights in the evaluation of thoracic deformity bound with cardiac activity. Study of apical impulse using Moiré technics].

Chest deformation due to cardiac activity can be studied with the use of techniques based on Moiré principle. The shadow technique allows to obtain well contrasted fringes, whereas the technique of projected Moiré allows an easier taking of camera pictures. The fringes in this case, although less contrasted, allow to recognize level differences of the order of 0.17 mm with a network of 20 traits/mm in the present configuration of our material. The best criteria of registration have been set up after the study of 10 young subjects. In the presented case topographic measurements allowed a quantitative evaluation of the apical impulse. The telesystolic image after treatment allowed a tridimensional reconstruction of chest deformation.

Humans↗
PubMed1986

[Hypertrophic obstructive cardiomyopathy in elderly patients. Retrospective study of 23 cases].

This retrospective study was based on data obtained from 23 patients over 65 years old (72 +/- 1.04 years) with hypertrophic obstructive cardiomyopathy followed up for 3 years (37.2 +/- 5.4 months) in whom the diagnosis was established essentially on phonomechanographic and echocardiographic criteria under basal conditions or during pharmacodynamic stress testing when the initial examination was inconclusive. Under these conditions, diagnostic catheterisation was only required in 9 cases. The incidence of this disease seems to be substantially underestimated in this age group; clinical symptoms and ECG or chest X-ray changes are often attributed to other pathologies if these patients are not thoroughly investigated. In our experience, patients over 65 years represent 20 per cent of the total population of hypertrophic obstructive cardiomyopathy admitted to our Department during the 6 years' study period. Accurate diagnosis is important because of the therapeutic implications; digitalis and vasodilator therapy especially with nitrate derivatives are poorly tolerated by these patients. Betablockers and verapamil seem to be beneficial, judged on the decrease in the number of symptomatic patients when given these drugs. Only one of the 3 deaths observed in the 20 patients followed-up was attributed to cardiac causes, which seems to confirm the lower mortality rate in older patients with this condition.

Aged↗
PubMed1986

Evaluation of chest wall distortion related to cardiac activity by structured lights. A study of the apical impulse by the Moiré technique.

The use of structured lights and especially of the Moiré technique to evaluate chest wall distortion in front of the apical impulse allows a topographic study of the precordial movement in relation with cardiac activity. Shade Moiré technology offers the possibility to study a reduced area of the chest with a good enlargement effect and well contrasted fringes. Projected Moiré allows the study of an increased area of the chest (40 cm2) and provides less contrasted pictures with a reduced enlargement effect. Both techniques offer the possibility of automatic imaging. The study of a normal subject is realized with a topographic evaluation of the chest wall distortion on a endsystolic frame. 3D representation of the chest wall deformation is performed after image treatment on a endsystolic print.

Humans↗
PubMed1985

[Obstructive myocardiopathy in the elderly. A retrospective study of 18 cases].

From a retrospective study of 18 cases of obstructive cardiomyopathy in elderly people collected over a 5-year period, it appears that the incidence of the disease is probably underestimated. It seems to vary in severity, but only one-third of the patients present suggestive clinical symptoms associated with an obvious obstructive syndrome. The best diagnostic method is phonomechanography, which is easy to perform, systematically completed by a pharmaco-dynamic test. Hyperkinesia and disorders of cardiac compliance add useful specific data to the clinical picture. Echocardiography provides information on cardiac anatomy and on the obstructive mechanism. Left ventricular function tests are of particular interest in these old-age patients with cardiopathy. In our opinion, the two non-invasive methods are sufficient for a firm diagnosis, even when some criteria, notably ultrasonic, are lacking. Once the condition is diagnosed, the patient should be put on beta-blockers or calcium inhibitors, such as verapamil, which constitute an effective treatment.

Aged↗
PubMed1985

Mechanocardiography in evaluation of left ventricular function. Relevance of combined study of apex cardiogram and systolic time intervals in diagnosis of cardiomyopathies.

The study of left ventricular performance by means of systolic time intervals, especially represented by the PEP/LVET ratio and indices drawn from the first derivative of the apex cardiogram, makes possible a good approach to the functional anomalies of patients suffering from hypokinetic cardiomyopathies or hyperkinetic conditions of obstructive or unobstructive hypertrophic cardiomyopathies and of patients with hyperthyroid conditions. In hypokinetic states, the sensitivity and the specificity of the PEP/LVET ratio proved to be good, as was the case for indices taken from the first derivative of the apex cardiogram. However, the sensitivity and the specificity of the cardiogram were much better in the detection and evaluation of hyperkinetic conditions, hypertrophic cardiopathies or hyperthyroiditis. By providing the elements required for analysis of isometric contraction through indices drawn from the first derivative of the apex cardiogram and from the ejection phase, through the PEP/LVET ratio, and by adding exploitation of the diastolic phase, in particular through the A/H ratio exploring diastolic compliance, mechanocardiograms allow an all-round, quasi-physiopathological approach to disorders of left ventricular function during cardiomyopathies.

Adolescent↗
PubMed1985

[Left intraventricular thrombosis. From diagnosis to treatment].

Left ventricular thrombi are the source of much concern in numerous conditions affecting the ventricles. Refinement in echocardiographic and isotopic techniques is enabling earlier diagnosis and a more rational approach to therapy. These thrombi occur very frequently, and are most often asymptomatic (more than 2 to 3 times out of 4), and their natural course is not well known. Recent studies have dealt with acute ischemic cardiopathies, but these should not obscure the fact that thrombi occur with similar frequency in chronic conditions, in particular, hypokinetic cardiomyopathies. Three recent cases emphasize this, demonstrate the frequency of these thrombi, and help illustrate available diagnostic methods and a practical approach to this condition. These recent developments only confirm the importance of effective anticoagulation in all patients at risk and the necessity of optimal treatment with inotropic agents which do not suppress thrombus formation, but appear to prevent their complications.

Aged↗
PubMed1984

[Phonomechanographic evaluation of left ventricular function in hyperthyroid states].

Hyperthyroidism is associated with a hyperkinetic syndrome, the mechanisms of which are not fully understood but which include an increase in heart rate, a reduction in systemic arterial resistance and a debatable increase in myocardial contractility. The limitations of radioimmunological assay of the hormonal mediators underline the diagnostic value of an atraumatic method of quantifying left ventricular systolic function. In view of the variable sensitivity of phonomechanographic and echocardiographic indices with respect to changes in heart rate, pre- and after load, we studied apex cardiographic indices during the phase of isovolumetric contraction. Fifty-eight patients with hyperthyroidism but without patent cardiovascular disease were divided into two subgroups: Grave's disease: 38 cases, and toxic adenoma: 22 cases. The results of the measurements of systolic time intervals and the calculation of "indices of contractility" obtained from the apex cardiogram and its first derivative, were compared with those of 36 young, normal subjects. The results show that: the pre-ejection period of the study population was much shorter than normal (65,7 ms +/- 2,5 vs 84,6 ms +/- 3,4; p less than 0,001); this was clearly related to the chronotropic factor (p less than 0,05). The pre-ejection/ejection period ratio did not differentiate hyperthyroid from normal subjects (0,265 vs 0,283, p greater than 0,20), except in Graves' disease (0,249, p less than 0,02). On the other hand, measurements made from the apex cardiogram showed significant differences in both types of hyperthyroidism. (Formula: see text). In conclusion, phonomechanography may be used to quantify the increase in left ventricular function in hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Evaluation of left ventricular function and regional kinetics following myocardial infarction. Comparative study of angiocardiography, echography and radionuclide angiography].

Left ventricular function and regional wall motion were studied three weeks after a myocardial infarction in 25 patients who had undergone L.V. monoplane cineangiography. The patients were studied by echocardiography (TM and 2D) and radionuclide angiography. Evaluation of global ejection fraction provides evidence of a close correlation between left ventricular angiography and radionuclide examination (r= 0.79). Measurement of ejection fraction by echocardiography (TM) remains clearly correlated with the same evaluation by angiography (r = 0.68). The correlations are markedly increased in the patients without significant wall motion defects (r = 0.87 for radionuclide angiography and r = 0.82 for echographic measurement). Sensitivity in the detection of L.V. aneurysms is excellent with our method of radionuclide examination (12/13) and can be compared with angiography (12/13). Two-dimensional echocardiography performed on a routine basis is less sensitive than radionuclide angiography in this diagnosis (4/13).

Angiocardiography↗
PubMed1984

[Semi-automatic acquisition and processing of mechanocardiograms].

Like echocardiography and radio-isotope techniques, mechanocardiography has a special place in the evaluation of left ventricular function in heart disease. This recognized technique can be easily performed by clinicians or pharmacologists or in aerospace medicine. A programme has been developed from micro-processor material (HP 9845 S - SP 9835 - HP 6940 B multi-programmer) already in use in the department. After sampling at 700 Hz and quantification, this programme can reproduce a complete mechanocardiographic tracing consisting of ECG, phonocardiogram, carotidogram and apexogram . The first derivative of the apex cardiogram is calculated numerically and visualized. The characteristic events of the systolic phase of the apex cardiogram are then checked manually or semi-automatically by the operator. After confirmation, the calculations are performed and are edited with the tracings. This system eliminates the need for a recorder, as the tracings can be stored on cassette or diskette and recalled later for statistical analysis. These programmes make the interpretation of the mechanocardiographic tracings considerably simpler and faster.

Heart Function Tests↗
PubMed1983

[Cardiac sarcoidosis. Mechanisms of valvular dysfunctions].

The sudden onset of massive tricuspid insufficiency in a patient with ocular and pulmonary sarcoïdosis diagnosed fifteen years earlier exemplifies the possible occurrence of sarcoid heart disease, an entity often misdiagnosed or overlooked. After excluding pericardial effusion and rhythm disturbances we point out the specific characteristics of endomyocardial involvement and discuss the mechanisms of valvular dysfunction. In this particular localization, the possibly deleterious effect of steroid therapy is mentioned.

Cardiomyopathies↗
PubMed1983

[Phonomechanography: a premature requiem].

The value of phonomechanographic recordings has been contested in recent years. This seems to be the result of the upsurge in other non-invasive methods of investigating cardiac diseases and left ventricular function such as those based on ultrasound, pulsed Doppler or radioisotopes. Far from opposing these techniques, phonocardiography has benefited from their comparison and association which have validated the systolic time and amplitude indices previously used empirically. This validation justifies maintaining and developing phonomechanographic recordings. Whilst recognising their limits, five of their main advantages are emphasised. As a true extension of our senses and complementary to the human ear phonomechanography is, foremost, the continuation of clinical examination and an unique and ideal instrument for teaching cardiac auscultation. By confirming and explaining the nature of an auscultatory abnormality, recording the morphology and timing of the arterial and venous pulses and of the apex beat, phonomechanography participates in the positive and etiological diagnosis of various conditions and even provides a semiquantitative assessment in some diseases. Left ventricular function may be assessed by measuring the systolic time intervals and by quantifying the systolic apical impulse. This appreciation based on the period of isovolumic contraction is complementary to echocardiographic assessments of LV function which are calculated during the ejection period. Only by combining the various non-invasive methods can the weakness and practical limitations of each particular method be avoided. Finally, as the reliability of systolic time and amplitude indices have been validated, the relative ease of their determination and their economic advantages must be emphasised.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1983

[Valvular or muscular cause of heart sounds?].

During the last twenty years, the genesis of the high frequency heart sounds could be outlined in the opposition between "valvular" and "muscular" theories challengers. The latter argued with haemodynamic results and the former with echographic results. The improving investigation methods permitted recently the understanding of valvular closure and authorize conciliation. A valvulo-muscular theory is suggested on the basis of non invasive methods: sound and external pulses recordings, and echography.

Echocardiography↗