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Biomedical subjects

F Cherrier

Publications and source records attributed to F Cherrier.

At least 37 records · Page 2Linked to original sources
PubMed1995

Isolated myocardial bridges with angiographic milking of the left anterior descending coronary artery: a long-term follow-up study.

Among 7467 consecutive coronary angiograms performed during an 8-year period, 61 patients had a myocardial bridge of the left anterior descending coronary artery. The overall prevalence of myocardial bridges was 0.82% (from 0.41% to 1.16% per year). Among these patients, 26 had coronary artery disease, 4 had valvular heart disease, and 3 had cardiomyopathy. We studied the long-term outcome (11 +/- 3 years) of the other 28 patients with isolated milking at baseline. Two groups were constituted according to the percentage of systolic reduction of the left anterior descending coronary artery lumen: group A, < 50% (15 patients) and group B, > or = 50% (13 patients). During follow-up, 1 group A patient (cancer) and 2 group B patients (1 cancer and 1 suicide) died. Moreover, 1 group B patient was lost to follow-up. None of the patients sustained a myocardial infarction during follow-up. In group A patients, 71% felt very well or well and 50% had clinical symptoms; 64% took antianginal medications. In group B patients, 50% felt well and 70% had clinical symptoms; 50% took antianginal drugs. The long-term prognosis of isolated myocardial bridges of the left anterior descending coronary artery is good and is independent of the severity of systolic narrowing of internal lumen diameter.

Cardiac Catheterization↗
PubMed1995

[Transluminal coronary angioplasty in patients with left ventricular dysfunction; immediate and long term results].

Transluminal coronary angioplasty is increasingly performed in patients with left ventricular dysfunction. However, there is little data available concerning the outcome of these patients. The aim of this retrospective study was to assess the immediate and long-term results in 90 patients (76 men and 14 women) with left ventricular ejection fractions < or = 35% (average 29 +/- 5%) undergoing angioplasty between 1980 and December 1992. Eighty-seven patients (96%) had a history of infarction, 27 (30%) had already at least one episode of left ventricular failure and 34 (38%) had unstable angina at the time of angioplasty. The coronary disease was usually multi-vessel. A total of 118 lesions were dilated with a primary success rate of 77% (91/118): 86% (82/95) in non-occlusive stenoses and 39% (9/23) in complete obstructions. The total success rate per procedure was 72% (65/90) with a hospital mortality rate of 5.5% (5 cases). The mean follow-up period was 53 +/- 47 months. Twelve patients died during this period and two were lost to follow-up. The total and cardiovascular mortality at the end of the study was 19% (17/88). Eight of the 71 survivors underwent another revascularisation procedure (4 bypasses and 4 angioplasties); 21 (29%) have stable angina, 50 (71%) have no anginal pain and 61 (86%) have antianginal treatment. The probability of survival at one and four years was 81 +/- 4% and 79 +/- 5%, respectively. A multivariate analysis using the Cox model showed three independent prognostic factors for long-term mortality: triple coronary vessel disease, the best predictive factor, left ventricular ejection fraction and female gender.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Does recanalisation of chronic right coronary occlusion improve long-term quality of life and the return to work?].

Between 1985 and 1990, right coronary artery recanalisation was attempted in 60 consecutive patients. In order to evaluate the long-term benefits, 2 groups were compared: group A (27 patients: 26 men, 1 woman) with an initial success; 1 patient was lost to follow-up (3.7%); group B (33 patients, 31 men, 2 women) with an initial failure; no patients were lost to follow-up and 1 patient died after secondary coronary artery surgery. After a follow-up of at least 1 year, the patients assessed their health and compared it with their pre-angioplasty state with the aid of a questionnaire. Age, initial left ventricular ejection fraction, the percentage of multiple vessel disease and the number of patients at work before angioplasty were the same in the two groups. After a mean follow-up period of two and a half years, 7.6% of patients had undergone coronary bypass surgery in group A compared with 18.2% in group B (NS); 69% of patients in group A claimed to be improved compared with only 24% in group B (p = 0.07); a bi or triple anti-anginal therapy was used in 58% of patients in group B and 42% of patients in group A (NS); however, 59% of patients returned to work in group B compared with 44% in group A (NS). Initial successful recanalisation of chronic right coronary occlusion improves the quality of life at long-term but does not increase the chances of returning to work.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1995

Thallium-201 rest-reinjection and iodine-123-MIHA imaging of myocardial infarction: analysis of defect reversibility.

UNLABELLED: Rest SPECT imaging with [123I]-16-iodo-3-methylhexadecanoic acid (MIHA) frequently shows an increased level of uptake in areas with irreversible defects on exercise 201TI SPECT. Such mismatch patterns between flow (201TI) and metabolic (MIHA) tracers might correspond to areas with ischemic but viable myocardium misidentified by 201TI imaging. METHODS: Eighty-three patients with myocardial infarction underwent exercise SPECT 201TI with rest-reinjection and rest SPECT with MIHA. Defect areas on the exercise images were reversible on MIHA but not on 201TI reinjection images that were determined visually. The presence and extent of these areas were quantified from normalized uptake values for both tracers. RESULTS: In areas with irreversible 201TI reinjection defects, MIHA detected exercise defect reversibility in 59% of patients. In areas with irreversible 201TI reinjection defects, the extent of visually determined defect reversibility on MIHA scans was related to the quantified extent of areas with 201TI uptake > or = 50% of normal; the correlation, however, was weak. In 86% of patients, areas with > or = 50% 201TI uptake were larger than those that were reversible on MIHA. CONCLUSION: After myocardial infarction, rest SPECT with MIHA often enables visual detection of increased uptake in areas with irreversible 201TI reinjection defects.

Exercise Test↗
PubMed1995

Comparative effects of atenolol and clonidine on polygraphically recorded sleep in hypertensive men: a randomized, double-blind, crossover study.

The effects on sleep of atenolol and clonidine were compared in 8 hypertensive men (mean age 46.9 years, range 16-56 years) without prior history of sleep disturbances. Polygraphic sleep recordings were performed at baseline (NO) and after a single oral dose of atenolol (100 mg) or clonidine (0.15 mg) at 6:00 pm at a 48-hour interval in a double-blind randomized crossover protocol. Both medications lowered arterial pressure to a similar extent. The subjective quality of sleep was judged satisfactory after both medications, the number of patients reporting dreams decreased from 5 (NO) to 1 after each treatment night. Total sleep time decreased slightly but not significantly after atenolol (440 +/- 63 min vs 474 +/- 47 min at baseline). Sleep latency was not affected after atenolol but significantly decreased after clonidine (16.9 +/- 21.6 vs 28.6 +/- 16.6 at baseline, p < 0.02). Although rapid-eye movement (REM) sleep time decreased after atenolol (71 +/- 30 min vs 95 +/- 30 min at baseline, p < 0.05), the percentage of REM sleep was unchanged (22 +/- 7% vs 23 +/- 5%). In contrast, clonidine strikingly reduced both REM sleep time (54 +/- 28 min vs 95 +/- 30 min at baseline, p < 0.002) and percentage of REM sleep (14 +/- 6% vs 23 +/- 5%, p < 0.0005). Thus atenolol tends to decrease total sleep time but does not affect the normal architecture of sleep, clonidine has a marked hypnotic effect, similar to that of some sedative medications and significantly reduces REM sleep.

Adolescent↗
PubMed1995

[Is percutaneous transluminal coronary angioplasty in chronic total coronary occlusion justified? Long term results in a series of 201 patients].

Percutaneous transluminal coronary angioplasty of chronic total coronary occlusions has a low primary success rate and is associated with a high percentage of restenosis. The aim of this retrospective study was to assess the long-term benefits of these procedures. In a series of 201 patients with 203 chronic total occlusions, the technical success rate was 51%, the clinical success rate was 46% with 3% of major complications. The only factor associated with a favourable outcome was the presumed duration of the occlusion. The clinical follow-up period was established at 6 years. The result of the initial procedure was used to establish two groups of patients: group I, clinical success, and group II, clinical failure. Patients in group I had a probability of survival greater than that of those in group II (97 vs 92%; p < 0.05); survival without coronary bypass surgery was also significantly better (89 vs 74%; p < 0.003). On the other hand, the probability without angioplasty was less in group I (70 vs 77%; p < 0.01), the result of a high restenosis rate (48%). A Cox analysis identified clinical success of angioplasty as a good prognostic factor for survival. Moreover, the clinical status at long-term was significantly better in patients in group I. These results indicate that in patients with chronic total coronary occlusions, the success of angioplasty has a favourable effect on long-term outcome both in terms of survival and in quality of life. They must be interpreted in the light of the limitations inherent in a retrospective study and should be confirmed by prospective trials.

Aged↗
PubMed1994

Comparison of right ventricular systolic function in idiopathic dilated cardiomyopathy and healed anterior wall myocardial infarction associated with atherosclerotic coronary artery disease.

A case-controlled study assessed right ventricular (RV) systolic function in 10 patients with idiopathic dilated cardiomyopathy (IDC) and in 10 with healed anterior wall myocardial infarction associated with atherosclerotic coronary artery disease (CAD). Each patient was matched for sex, left ventricular ejection fraction +/- 5% and pulmonary artery mean pressure +/- 5 mm Hg. All patients had sinus rhythm and a left ventricular ejection fraction < 45%. A new, well-validated thermodilution technique was used to assess RV ejection fraction and volumes. RV ejection fraction was lower in the IDC than in the CAD group (25 +/- 14% vs 36 +/- 11%; p < 0.02). Linear correlations between RV parameters and pulmonary artery pressure were significantly present in both groups. However, the slopes of the equations were not statistically different. In comparison with healed anterior wall myocardial infarction with CAD and for similar levels of left ventricular dysfunction, RV systolic function appeared to be more altered in IDC.

Cardiomyopathy, Dilated↗
PubMed1994

Effect on early acute occlusion rate of adjunctive antithrombotic treatment with intravenously administered dipyridamole during percutaneous transluminal coronary angioplasty.

This study compared the acute occlusion and complication rates within 24 hours of coronary angioplasty in three groups of patients. In group 1, 178 procedures were performed by one operator who administered 30 mg of dipyridamole intravenously over 1 hour, starting immediately before the procedure; in group 2, 200 procedures were performed by the same operator before he administered dipyridamole; and in group 3, 599 procedures were performed during the same time period in the same catheterization laboratory by two other operators who did not administer dipyridamole. All patients received an intravenous bolus of heparin and aspirin. Baseline variables were similar in the three groups. The acute closure rate was 2.8% in group 1, 7.5% in group 2, and 5.2% in group 3 (p < 0.05 between groups 1 and 2); acute thrombosis was observed in 0.6%, 3.5%, and 3% of patients, respectively, in the three groups (p < 0.05 between group 1 and both groups 2 and 3), and acute dissection was noted in 2.2%, 4%, and 2% of patients, respectively (p = not significant). The cumulative rate of acute complications (death, acute myocardial infarction, or emergency coronary bypass surgery) was lower in group 1 (1.7%) than in group 2 (5.5%, p < 0.05) and group 3 (3.5%, p = not significant). Therefore in this retrospective study, adjunctive antithrombotic treatment with intravenously administered dipyridamole resulted in lower acute thrombosis and complication rates during the 24-hour period after the procedure than when heparin and aspirin therapy were used alone.

Acute Disease↗
PubMed1994

Long-term follow-up after coronary angioplasty in patients younger than 40 years of age.

Over an 11-year period, the initial and late outcomes of percutaneous transluminal coronary angioplasty (PTCA) were studied in 140 consecutive patients younger than 40 years of age (mean, 34 +/- 3 years; range, 23 to 39 years; 132 men). Before the procedure, 28% of the patients had unstable angina, and 44% had a history of prior myocardial infarction. Mean left ventricular ejection fraction was 64% +/- 10%, and 75% of the patients had one-vessel disease. Primary success was 86% (77% for the first 70 patients vs 93% for the last 70, p < 0.02). Complications were nine periprocedural myocardial infarctions, eight emergency coronary surgical procedures, and no deaths. During follow-up (mean, 6 +/- 3 years; range, 1 to 12 years), 39 (28%) of the 104 patients who had repeat coronary angiography had angiographic restenosis (all < 6 months after PTCA). Late events were 13 elective coronary surgical procedures (11 for restenosis, one for failed PTCA, and one for progression of coronary artery disease), 13 PTCAs on a new site, five deaths, and four nonfatal myocardial infarctions. Ten-year survival was 96% +/- 1%, and 10-year event-free survival (without myocardial infarction, elective coronary surgery, or repeat PTCA) was 58% +/- 6%. Among survivors, 88% were free of angina, and 93% had returned to work. In patients younger than 40 years of age, PTCA yields excellent long-term survival, provided that the eventuality of repeat procedures during the first months is accepted. In addition, PTCA for progression on a new site is not unusual after several years.

Adult↗
PubMed1994

Serial evaluation of dilated cardiomyopathy with exercise thallium-201 tomography: correlation with the evolution of left ventricular parameters.

The purpose of this prospective study was to correlate (1) the initial findings of exercise thallium-201 tomography with the evolution of left ventricular parameters at long term follow-up in patients with dilated cardiomyopathy and (2) the changes of exercise thallium-201 tomography repeated 1 year later. We studied 19 men with dilated cardiomyopathy and normal coronary angiogram. Two patients died and three patients had heart transplantation during follow-up. The other 14 patients were assessed at baseline and 1-year follow-up. Thallium-201 tomograms were divided into 20 segments for each patient. Two groups were defined according to the evolution of left ventricular ejection fraction: group 1 (n = 7) had unchanged or decreased ejection fraction at follow-up (24 +/- 11% at baseline versus 22 +/- 11% at follow-up, ns) and group 2 (n = 7) had improved ejection fraction at follow-up (25 +/- 9% at baseline versus 49 +/- 8% at follow-up, P < 0.03). The number of total abnormal segments at stress were not statistically different at baseline between groups 1 and 2, and in group 1 between baseline and follow-up. Group 2 at follow-up had a reduced number of total abnormal segments (P < 0.03). The percentage of reversibility was similar in both groups at baseline and follow-up. On exercise thallium-201 tomography, neither the presence nor the reversibility of stress myocardial perfusion abnormalities can predict improvement of left ventricular ejection fraction in dilated cardiomyopathy. However, regression of dilated cardiomyopathy is accompanied by a reduction of stress myocardial perfusion abnormalities.

Adult↗
PubMed1994

[Cardiopulmonary exercise evaluation: value and influence of the use of a ramp protocol versus triangular protocol].

The aim of the study was to evaluate a ramp bicycle ergometer exercise protocol consisting of a very small but rapid increase in load (2 watts/12 seconds) for direct measurement of the VO2 max. Eighteen sedentary healthy subjects were in Group I (16 men, mean age 29 +/- 6 years) and 10 men with chronic stable cardiac failure in Group II (mean age: 51 +/- 16 years). All subjects performed two exercise tests within a period of 8 days, one with a ramp protocol (protocol R) and the other with a standard triangular exercise protocol (protocol T) of 30 watts/3 minutes for Group I and 20 watts/2 minutes for Group II. All procedures were performed until the subjects were exhausted. Direct measurement of VO2 max was performed by rapid response analysers enabling a cycle to cycle study. The parameters were measured and compared by a paired Student t test at each stage of the test: at rest, at submaximal exercise (third level), at anaerobic threshold and at maximal exercise. There was no significant difference between VO2 max and VO2 at the threshold of ventilation between the two populations. An increase in carbon dioxide production at different stages was observed with the ramp protocol. Furthermore, the highest maximal respiratory quotient and anaerobic threshold appeared earlier in Group II with the ramp protocol. Therefore, with respect to the standard triangular protocol, the ramp protocol provides comparable VO2 values. Its potential value, reported in the literature, is a better correlation between the observed and theoretical VO2 values. However, an increase in CO2 production should be underlined, probably related to greater recruitment of anaerobic metabolism in the absence of a steady state. This may be the reason for attaining the anaerobic threshold earlier.

Adolescent↗
PubMed1994

[Influence of the severity of coronary stenosis on the course of left ventricular function in case of subsequent coronary occlusion. Longitudinal coronarographic study].

In order to evaluate the consequences concerning left ventricular function of the spontaneous occlusion of coronary stenoses, the authors studied the clinical and angiographic characteristics of 30 consecutive patients (25 men, 5 women, mean age: 54) undergoing successive coronary arteriograms showing progression to complete occlusion of the anterior interventricular or right coronary between the two investigations. Two groups of patients were identified: Group I (n = 19) with occlusion of a previously moderate (< or = 50%) stenosis; Group II (n = 11) with occlusion of an initially tight stenosis (> 50%). At the time of the first angiogram, left ventricular ejection fraction (LVEF) was 60 +/- 13% in Group I and 58 +/- 9% in Group II (NS). Times between the two investigations were similar in the two groups (58 +/- 43 months and 54 +/- 57 months, NS). Between the two coronary arteriograms, 7 patients of Group I sustained an infarction as against 3 in Group II (NS). Impairment of LVEF developed in 16 patients of Group I (84%) as against 5 of Group II (45%) (p < 0.005). Global LVEF varied on average by -10.4 +/- 13.3% (p < 0.005) in Group I and -0.1 +/- 9.5% (NS) in Group II. This difference in variation in LVEF between the two groups was significant (p < 0.04). Spontaneous occlusion of moderate coronary stenoses results in certain cases in greater impairment of left ventricular function than the occlusion of tight stenoses. The development of a collateral circulation probably plays a protective role in the second group.

Adult↗
PubMed1994

[Systemic embolism and aortic atheroma. Contribution of transesophageal echography. Apropos of a case of systemic embolism caused by cholesterol crystals].

Systemic embolisms involving cholesterol crystals sometimes occur following vascular catheterization and may be responsible for a variety of clinical signs. The authors report a case in which the etiological diagnosis included a transesophageal echography (TEE) which revealed atheromatous plaques on the thoracic aorta which were probably responsible for the projections. It is possible that episodes of embolism, either fibrinocruoric or due to the release of cholesterol crystals, arising from the thoracic aorta, have hitherto been underestimated by imaging methods such as scans and angiographs. Further studies with TEE may make it possible to estimate the extent of this disorder.

Aged↗
PubMed1993

[Complications of coronary angioplasty].

Transluminal coronary angioplasty has become the most frequently used reperfusion technique. However, its value is limited not only by restenosis but also by a stable proportion (4 to 7 percent) of acute occlusion of the dilated vessels during or immediately after the procedure and its direct consequences (myocardial infarction, death, emergency coronary bypass). The literature on acute complications of coronary angioplasty is reviewed and shows that despite advances in equipment the acute occlusion rate of the dilated vessel has remained stable, due to the considerable widening of the initial indications for angioplasty. The authors try to determine the risk factors for acute occlusion, the preventive measures that can be taken to reduce this risk and the possible treatment available to cardiologists to deal with the acute occlusion when it occurs.

Acute Disease↗
PubMed1993

Results of percutaneous transluminal coronary angioplasty of either the left anterior descending or left circumflex coronary artery in patients with chronic total occlusion of the right coronary artery.

The acute and long-term results of percutaneous transluminal coronary angioplasty (PTCA) of the left coronary artery in 106 patients (group 1) with chronic occlusion of the right coronary artery were compared with those of 106 patients matched for sex (92 male) and age (56 +/- 10 years) undergoing left PTCA with a normal right coronary artery (group 2). Before the procedure, group 1 had more unstable angina (42 vs 29%; p < 0.05), more frequent prior myocardial infarction (80 vs 25%; p < 0.001), and a lower left ventricular ejection fraction (56 +/- 10% vs 65 +/- 11%; p < 0.005). Acute results were not different in the 2 groups with respect to primary success (group 1: 93%; and group 2: 89%) and complications (group 1: 2 with emergency coronary surgery, and 4 with periprocedural myocardial infarction and no death; and group 2: 1 with emergency coronary surgery, 1 death, and 3 with periprocedural myocardial infarction). At 6 months, 79 patients in group 1 and 71 patients in group 2 had reangiography; the rate of restenosis was 35% in group 1 and 42% in group 2. In both groups, left ventricular ejection fraction increased significantly in patients without restenosis (58 +/- 12% vs 63 +/- 10%, p < 0.001 [n = 44] in group 1; and 66 +/- 9% vs 70 +/- 10%, p < 0.001 [n = 29] in group 2). In group 1, improvement was significant only for patients without collaterals to the occluded right coronary artery (59 +/- 10% vs 66 +/- 7%; p < 0.003 [n = 24]).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1993

Usefulness of exercise SPECT-thallium to detect asymptomatic restenosis in patients who had angina before coronary angioplasty.

The usefulness of exercise single photon emission computed tomography (SPECT)-thallium for detecting asymptomatic restenosis was assessed prospectively in 62 patients with angina before angioplasty, who underwent < or = 6-month re-angiography and exercise SPECT-thallium imaging. Among patients with restenosis, nine had recurrence of angina but eight did not. These two subgroups had equivalent percentages of restenosis (71 +/- 16% vs 64 +/- 16%, NS) and extent of reversible thallium defects (2.8 +/- 1.7 vs 4.1 +/- 2.6, NS), and both subgroups had poorer hemodynamic responses to exercise compared with patients without restenosis (maximal) rate-pressure product [X 100], 258 +/- 54 and 239 +/- 33 vs 302 +/- 61; p < 0.05 and p < 0.01, respectively). Exercise testing detected fewer patients with restenosis compared to exercise SPECT-thallium imaging, especially among asymptomatic patients (25% vs 100%, p < 0.005). Asymptomatic restenosis occurs frequently, induces an amount of stress ischemia equivalent to that of symptomatic restenosis, and is efficiently detected by exercise SPECT-thallium with rest-reinjection but not by exercise testing.

Aged↗