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H Milon

Publications and source records attributed to H Milon.

At least 37 records · Page 2Linked to original sources
PubMed2000

Characteristics, management, and in-hospital mortality of acute myocardial infarction in the "real world" in France--data from a large unselected cohort of 2,519 consecutive patients in a French region.

OBJECTIVE: The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute MI) sought to determine characteristics, management, and in-hospital mortality of myocardial infarction (MI), regardless of age and hospital facilities, in the "real world" in a region in France. METHODS AND RESULTS: Data were prospectively collected in all patients with MI admitted in all hospitals in three departments in the Rh ne-Alpes region between September 1, 1993 and January 31, 1995. 2,519 patients (68% men; mean +/- SD: 68 +/- 14 years) were included. Time from onset of symptoms to admission was < 6 h in 56% of the patients (median: 4 h 30 min). MI was non-Q wave in 12%. Among Q wave MI, location was anterior in 44%. At admission, Killip class was > 1 in 33%. The overall rate of thrombolysis was 36%. It was significantly higher in men than in women, in younger patients than in older patients, in lower Killip classes, in Q wave MI, and when the delay before initial medical intervention was < 6 hours. After age-adjustment, there was no difference between men and women for thrombolysis rate (odds ratio women/men: 0.92; p = 0.10). During the first 5 days, Killip class worsened in 17%. In-hospital mortality rate was 14%. Multivariate analysis identified age, anterior location, presence of Q waves, and higher Killip classes as significant predictors of in-hospital mortality. CONCLUSIONS: This large unselected cohort revealed that among patients with MI in a French region, there was a high proportion of elderly patients, a low rate of thrombolysis, and a high in-hospital mortality.

Age of Onset↗
PubMed2000

[The best of arterial hypertension in 1999].

THE RELIEF OF THE RESULTS OF THE HOPE TRIAL WITH RESPECT TO THE INCIDENCE OF CEREBROVASCULAR EVENT UNDER ACE INHIBITOR THERAPY: In 1998, the CAPP trial had raised a serious concern about whether captopril therapy increased the risk of cerebrovascular accidents. When compared with betablocker therapy (+/- diuretics) in 11,000 hypertensives, there was a very worrying number of excess cerebrovascular accidents in the captopril group (+25%) (with no difference in the number of cerebrovascular accidents overall). There were several reasons which led to believe that the captopril was not the causal factor. But a doubt remained. In 1999, the results of the HOPE trial with ramipril, though not primarily for a hypertensive population, provided reassurance beyond the investigators' hopes concerning the value of ACE inhibitors in the prevention of vascular events, including cerebrovascular accidents. THE FRAMINGHAM EXPERIENCE OF LVH AND THE TREATMENT OF HYPERTENSION: The Framingham study reported unique data concerning the effects of antihypertensive therapy on LVH in 10,333 subjects of 45 to 74 years of age followed up for 40 years (1950-1989). As the incidence of antihypertensive therapy increased during the observation period, that of hypertension and LVH decreased in parallel. Although these data were retrospective, they are compatible with a causal relationship between the treatment and regression of LVH. This could explain up to 50% of the decrease in cardiovascular mortality observed in the United States during this period. The Framingham study so reposition, in an epidemiological context, the considerable benefits of antihypertensive therapy and of the regression of the associated LVH. THE SEVERITY OF THE WHO AND IHS RECOMMENDATIONS: Less than 130/85: this is the target value of the blood pressure in adults under antihypertensive therapy according to WHO and IHS. In patients with diabetes or renal failure with proteinuria > 1 g/j, the target is even lower. These recommendations incite physicians to beware of any laxness in the treatment of hypertension. The most recent epidemiological data from France indicates that only a minority of the hypertensive patients under treatment are well controlled and that this advice is probably not superfluous. Moreover, in the decision to treat hypertension (drug therapy or not), these recommendations underline the evaluation of the individual risk of the subject on the basis of associated risk factors, target organ complications and previous history of vascular events.

Adult↗
PubMed2000

[Hypertension].

Explore the source record for details and available documents.

Adult↗
PubMed2000

[Hypertension. New French recommendations].

The field of hypertensive medicine is constantly and rapidly changing, especially with regards to treatment. In view of its high incidence and its complications, it is a major public health concern. This explains the periodic publication of national or international recommendations with the object of informing practitioners of the latest publications in a form applicable to clinical medicine. In France, the "Agence Nationale d'Accréditation et d'Evaluation en Santé" (ANAES) has recently published its recommendations for the management of hypertension. The dominant issues are the recognition of validated electronic sphygmomanometers for measuring the blood pressure in the out-patient setting, the evaluation of individual cardiovascular risk for treatment choice, the value of non-pharmacological interventions, the tailoring of antihypertensive treatment and the abandon of the concept of equal benefit of comparable blood pressure lowering irrespective of the molecule used.

Antihypertensive Agents↗
PubMed2000

[White coat hypertension].

White coat hypertension and the white coat effect are common clinical problems. Although they have similar names, they do not correspond to strictly identical entities. The white coat effect is an increase in blood pressure induced by the physician. It may be observed for all degrees of mean blood pressure and it is usually assessed by the difference between conventional and ambulatory blood pressure values. White coat hypertension is a qualitative status associating clinical hypertension and "normotension" outside the physician's office. In practice, the application of these definitions presents many difficulties. The usual methods of evaluating the white coat effect are a poor marker of the true effect as measured by continuous blood pressure monitoring. White coat hypertension has many definitions, both with respect to the threshold of clinical hypertension and to that of ambulatory normotension. Any attempt at evaluating the prognosis of these two conditions are faced with these considerations. However, the cardiovascular consequences which result appear to be mild and, usually, do not justify drug therapy. Their principal implications are above all diagnostic as they may lead to the erroneous assumption of severe or drug-resistant hypertension.

Antihypertensive Agents↗
PubMed1999

Influence of a rapid change of left ventricular dimensions on the echocardiographic measurement of left ventricular mass by the Penn convention.

OBJECTIVE: The purpose of this study was to test the robustness of the measurement of left ventricle mass (LVM), using Devereux's formula, in the presence of a rapid change in left ventricular volume induced by nitroglycerin. DESIGN: Forty-eight healthy volunteers with excellent echocardiographic recordings were included. The intrapatient variability of LVM measurement was assessed by two consecutive echocardiograms. The intraobserver reproducibility was assessed by the rereading of 19 echocardiograms by the same observer. The effects of nitroglycerin were compared with those of a placebo in a double-blind random manner on, the left ventricular internal dimension in diastole (LVIDd), the interventricular septum thickness, the posterior wall thickness and the LVM. RESULTS: It was shown that both the intrapatient and the intraobserver reproducibility were high. Nitroglycerin induced a significant decrease in LVIDd compared with placebo (-0.21 +/- 0.24 versus 0.01 +/- 0.21 cm, respectively, P < 0.01) and a non-significant increase in wall thickness. These variations were negatively correlated with each other (r= -0.58, P< 0.01). Despite the change of ventricular dimensions, the variation of LVM induced by nitroglycerin was not significantly different from that induced by placebo (2.0 +/- 16.0 versus 4.7 +/- 17.0 g, respectively, not significant) and close to the intrapatient variability. CONCLUSION: This experiment failed to demonstrate any influence of a rapid variation of ventricle size on the calculation of LVM with the Penn convention and strongly supports the robustness of the method in vivo.

Adult↗
PubMed1999

[Fractal analysis and arterial hypertension].

Fractal analysis is a new tool allowing to study the complexity of cardiovascular variability. This approach may be useful for investigating regulatory mechanisms. In fractal terms, homeostasis required an optimal organisation of complexity (beta coefficient close to 1): conversely, some pathological situations have proven to be associated with an altered organisation of fractals (beta coefficient different from 1). Our study aimed at determining if hypertension was associated with an alteration of the fractal component of blood pressure (BP) or heart rate (HR) variability. Eighty-eight subjects referred for high BP entered the study. BP was measured in ambulatory conditions by an automatic device during 24 hours (ABP). BP and HR were then recorded beat-to-beat by a Finapres and an ECG during 30 minutes at rest. The beta coefficient was obtained by coarse-graining spectral analysis from the BP and RR interval time series. This method has proven its interest for breaking down cardiovascular variability into an harmonic component and a non harmonic one, this latter containing fractal elements. Spontaneous baroreflex sensitivity was assessed by the method of sequences. The percentage of fractals contained in BP and RR signals remained relatively stable despite the increasing severity of hypertension. A significant but loose correlation was found between the beta coefficient of RR and ABP (r = 0.23, p = 0.053 with systolic ABP; r = 0.25, p = 0.03 with diastolic ABP). No correlation could be disclosed between ABP and the beta coefficient of BP. The beta coefficient of RR was significantly correlated with the spontaneous baroreflex sensitivity (-0.59, p < 0.0001). It is concluded that it is rather the complexity of HR signal than that of BP which is altered during hypertension. This may suggest that some regulatory processes are lost or less efficient. The correlation reported between the baroreflex gain and the beta coefficient of RR interval may reflect, in fact, an alteration of the parasympathetic drive. Globally, these results emphasise the importance of HR and probably cardiac output in the pathophysiology of high BP.

Baroreflex↗
PubMed1998

White coat effect and reactivity to stress: cardiovascular and autonomic nervous system responses.

The aim of this study was to elucidate further the precise nature of the so-called "white coat" (WC) effect. We enrolled 88 hypertensive (46 men, 42 women) and 18 normotensive (4 men, 14 women) subjects in whom beat-to-beat blood pressure (BP) and heart rate (HR) were measured with a Finapres device at rest (R period) and during conventional BP measurement (WC period). The WC effect was defined as WC period minus R period values of Finapres systolic BP. Using the same method, we also measured the BP and HR variations induced by mental stress (MS period) and by assuming the standing position (S period). Variability was estimated in the frequency domain for BP (BPV) and HR (HRV) and gave indices of the autonomic nervous system. Pulse wave velocity was taken as an index of arterial distensibility. In hypertensive subjects, the WC effect was significantly and positively correlated with the BP response to stress (0.51, P<.0001) and standing (0.63, P<.0001). An increased BPV was observed in the low-frequency band (0 to 0.150 Hz) during WC, MS, and S periods. In normotensive subjects, the WC effect was very slight and not correlated with the responses to stress and standing. In this group, the WC period was not accompanied with an increased BPV, unlike the stress and standing periods. HRV was similar in normotensives and in hypertensives: decreased, unchanged, and increased during MS, S, and WC periods, respectively. The PWV was significantly increased in the hypertensives relative to the normotensives, even in the quartile of those with the lowest BP (on average similar to that of the normotensives). This work shows that the WC effect is associated with an enhanced BP response to standing and mental stress; these three situations are characterized by an increased BPV in the low frequencies, suggesting a similar modification of the sympathovagal balance. The WC effect may entail an increased risk because it is associated with impaired arterial distensibility.

Adult↗
PubMed1997

Ad libitum intake of a high-carbohydrate or high-fat diet in young men: effects on nutrient balances.

The effect of diet composition [high-carbohydrate, low-fat (HC) and high-fat, low-carbohydrate (HF) diets] on macronutrient intakes and nutrient balances was investigated in young men of normal body weight. Eleven subjects were studied on two occasions for 48 h in a whole-body indirect calorimeter in a crossover design. Subjects selected their meals from a list containing a large variety of common food, which had a food quotient > 0.85 for the HC diet and < 0.85 for the HF diet. The average ad libitum intake was 14.41 +/- 0.85 MJ/d (67%, 18%, and 15% of energy as carbohydrate, fat, and protein, respectively) with the HC diet and 18.25 +/- 0.90 MJ/d (26%, 61%, and 13% of energy as carbohydrate, fat, and protein, respectively) with the HF diet. Total energy expenditure was not significantly influenced by diet composition: 10.46 +/- 0.27 and 10.97 +/- 0.22 MJ/d for the HC and HF diets, respectively. During the 2 test days, cumulative carbohydrate storage was 418 +/- 72 and 205 +/- 47 g, and fat balance was 29 +/- 17 and 291 +/- 29 g with the HC and HF diets, respectively. Only the HF diet induced a significantly positive fat balance. These results emphasize the important role of the dietary fat content in body fat storage.

Adult↗
PubMed1997

Risk stratification after myocardial infarction. A reappraisal in the era of thrombolysis. The Groupe d'Etude du Pronostic de l'Infarctus du Myocarde (GREPI)

OBJECTIVES: The present study was performed to evaluate whether the modalities of risk stratification after myocardial infarction were still operative in the thrombolytic era. BACKGROUND: Prediction of fatal events in the aftermath of myocardial infarction relies on tests which aim to assess myocardial function, residual ischaemia and propensity for ventricular arrhythmias. Recent data on improved myocardial infarction prognosis have led to the view that risk stratification needs to be updated. METHODS: In this multicentre, prospective study, 471 acute myocardial infarction patients, 45% of whom were given thrombolytic therapy, were enrolled from the 10th day and underwent all or part of the following tests exercise test, radionuclide ventriculography (resting and exertional ejection fraction). Holter monitoring, signal-averaged electrocardiography and programmed electrical stimulation. Univariate and multivariate analyses were performed to identify predictors of mortality. RESULTS: One year and long-term (mean follow-up 31.4 months) mortality rates were 5.5% and 8.4%, respectively. Prediction of mortality was assessed and the role of the following variables was thus determined: age over 56 years (P = 0.01), previous coronary attacks (P < 0.001), history of heart failure (P < 0.001), early heart failure after myocardial infarction (P = 0.017), maximum workload of lest than 120 W at exercise test (P = 0.014), ineligibility to perform exercise (P = 0.002), depressed left ventricular ejection fraction (P = 0.013), late potentials as identified using 50 Hz high pass filtering (P = 0.012), mean night-time cycle length of less than 750 ms (P < 0.001), standard deviation of day time RR intervals of less than 100 ms (P = 0.04), the last two measures reflecting heart rate variability. In this population, neither ventricular ectopic activity nor inducibility of sustained monomorphic ventricular tachycardia at electrophysiological study carried any prognostic significance. Multivariate analyses showed that decreased heart rate variability, presence of late potentials and low ejection fraction (< 30%) made an independent contribution to the survival models. CONCLUSION: In the current context of management of acute coronary patients, the basis for risk stratification after myocardial infarction remain roughly unchanged.

Adult↗
PubMed1997

[Late discovery of inferior vena cava draining into the left atrium after surgical closure of atrial septal defect].

Drainage of the inferior vena cava into the left atrium during surgery for closure of an atrial septal defect is a rare complication. More common in low situated defects, it was more frequent when this type of surgery was performed without cardiopulmonary bypass. This diagnosis was made in a 45 year old woman with cyanosis operated 28 years previously. The right-to-left shunt was demonstrated by the hyperoxia test and confirmed by perfusion pulmonary scintigraphy and contrast echocardiography but only when the contrast was injected in the inferior vena cava territory, and by angiography. The surgeon confirmed the abnormality, closed the interatrial septum and reconnected the inferior vena cava to the right atrium.

Cyanosis↗
PubMed1997

[Reactivity of "white coat" type is associated with reactivity to mental stress].

This study was aimed to compare the white coat effect and the response to a mental stress. 29 subjects, referred for high blood pressure (BP) were included. Systolic BP (SBP) was recorded beat-to-beat with a Finapres device during 3 periods of at least 5 minutes: 1) rest (alone, in lying position); 2) white coat (5 measurements of BP with a standard mercury sphygmomanometer by the same physician); 3) mental stress (version for computer of the Stroop Word Color Conflict Test). A Coarse-graining spectral analysis was performed to compute the power in the low frequency band (PLF: 0-0.150 Hz) and in the high frequency band (PHF: 0.150-0.500 Hz). SBP was 142 +/- 3.7 during the rest period and increased significantly during the white coat (156.7 +/- 3.9 mmHg) and the mental stress (190.7 +/- 4.8 mmHg) periods. These rises of SBP levels were associated with a rise of PLF, significant only during mental stress (11.3 +/- 1.4, 15.7 +/- 3.7, 17.2 +/- 2.4 mmHg2/Hz, during rest, white coat and mental stress periods, respectively). Moreover, a significant correlation (r = 0.76; p < 0.0001) was found between the white coat effect (PAS "white coat"-PAS "rest") and the response to stress (PAS "stress"-PAS "rest"). This work shows that white coat effect is not a specific response but may rather represent an increased reactivity to stress. As it is associated with an increased power in the LF band like the response to stress, this white coat effect may involve an activation of the sympathetic system.

Blood Pressure↗
PubMed1997

[Risk assessment of hypertension: from population to individual].

Epidemiological studies have contributed to our understanding of several aspects of hypertension which could not have been remarked upon by clinical medicine alone: 1) the continuous nature of the relationship between the level of hypertension and cardiovascular risk has shown that the clinical definition by criteria based on numbers is arbitrary and should be adjusted according to the context and therapeutic management; 2) the risk of high blood pressure is strongly dependent on the presence or absence of other risk factors (smoking, diabetes, serum lipids, left ventricular hypertrophy), a factor which is not sufficiently taken into account in clinical practice; 3) assessment of the absolute risk of an individual on the basis of the respective roles of the principal risk factors is a useful guide to treatment. Moreover, population studies have shown that mild increases in blood pressure, associated with a long individual risk, are responsible for a large number of cardiovascular events because of the many people affected. Preventive action on the whole population is necessary in addition to individual therapeutic intervention in the clinical setting.

Cardiovascular Diseases↗
PubMed1996

Primary melanoma of the heart: case report of an association with coronary stenosis.

A 63-year-old man presented with unstable angina. The coronary angiogram revealed a proximal left anterior descending artery (LAD) stenosis and an irregularity on the anterior wall of the left ventricle. Intraoperatively, a malignant melanoma, independent of the coronary stenosis, was identified and resected, and an internal mammary graft was inserted. No primary tumor was found. The patient is alive 18 months after operation, with a normal magnetic resonance imaging (MRI), which seems to be the technique of choice for following-up heart melanomas.

Coronary Disease↗