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J C Daubert

Publications and source records attributed to J C Daubert.

At least 19 recordsLinked to original sources
PubMed2006

[Valve replacement for aortic regurgitation associated with rheumatoid arthritis: a series of 5 cases].

Between 30 and 50% of patients with rheumatoid arthritis (RA) have cardiac involvement but only 2 to 10% have clinical manifestations. The authors report the results of a retrospective study of 5 cases of aortic regurgitation (AR) requiring valve replacement. There were 4 women and 1 man with an average age of 48.4 years. The average duration of the RA was 19.6 years. All patients had cardiac failure. Aortic valve replacement was performed in all cases, with bioprostheses in 4 out of 5 patients. The histopathological examination of the valves showed a rheumatoid nodule in 3 cases and non-specific lesions in one case. In the fifth patient, rheumatoid serology was positive in the pericardial effusion. The average interval between the onset of symptoms and cardiac surgery was 3.6 months (range 1 to 6 months) There were 3 deaths at 3 days, 20 months and 10 years, two patients survive after 12 and 14 years. The characteristic rapid progression of this form of AR, which may be life-threatening, should be emphasised.

Adult↗
PubMed2006

[Pilot study of a strategy combining coronary angioplasty with valvular and/or coronary surgery on the same day].

A strategy combining percutaneous coronary angioplasty followed by valvular and/or coronary surgery was recently proposed as an alternative to the classical surgical only approach. The aim of this study was to assess the feasibility and the results of such a combined strategy with the two procedures performed the same day. The population comprised 34 patients including 17 with valvular disease and revascularisable coronary lesions (15 symptomatic severe aortic stenoses and two acute mitral insufficiencies) plus 17 multitrunk coronary patients without valvular disease but with an indication for revascularisation. Angioplasty was performed several hours prior to surgery and a loading dose of 300mg clopidogrel was administered immediately postoperatively; all patients were on aspirin before the procedure. The average age was 67 +/- 11 years, NYHA class 2.3 +/- 0.7, angina 73%, LVEF 58 +/- 10%. Single coronary artery disease was present in 26%, two vessel disease in 35% and three vessel disease in 39%. The success rate for angioplasty plus stent was 98%. 60 stents were active. Bypasses were exclusively arterial (left or right internal mammary arteries). We observed 4 in-hospital deaths, one of which was due to an infarct and three due to extra-cardiac causes (1 non-cardiogenic acute respiratory distress syndrome, 1 respiratory tract infection and 1 pyelonephritis). Further surgery was necessary in 4 cases: for haemorrhage and one episode of digestive tract haemorrhage. There were no additional deaths, coronary events nor haemorrhage at the end of an average follow-up of 15 +/- 6 months. The results of this combined strategy are encouraging in this population and merit further evaluation in a prospective study.

Aged↗
PubMed2005

Baseline characteristics of patients recruited into the CARE-HF study.

BACKGROUND: Cardiac resynchronization therapy (CRT) is a promising new treatment for patients with heart failure and cardiac dyssynchrony. The CARE-HF study is a morbidity/mortality trial designed to provide conclusive evidence of the effects of CRT in patients with moderate to severe heart failure. METHODS: A description of the baseline characteristics of patients randomised in the CARE-HF trial. RESULTS: 813 Patients with predominantly NYHA class III (94%) heart failure were randomised in 82 centres. Their mean age was 65 (interquartile range [IQR] 59 to 72) years, 34% were aged >70 years and 27% were women. Thirty-eight percent of the patients had ischaemic heart disease. Mean heart rate was adequately controlled at 70 (IQR 60 to 78) bpm consistent with the use of beta-blockers. Supine systolic blood pressure was low at 117 (IQR 105 to 130) mm Hg. Eighty-eight percent of patients had a QRS > or =150 ms. Mean LV ejection fraction was 26% (IQR 22 to 29) and end-diastolic dimension was 7.2 (IQR 6.4 to 7.8) cm. Ninety-four percent of patients were receiving loop diuretics, 95% an ACE inhibitor or angiotensin receptor blocker (ARB), 72% a beta-blocker and 56% were taking spironolactone. CONCLUSIONS: The patients enrolled in CARE-HF had moderately severe heart failure and cardiac dysfunction with evidence of cardiac dyssynchrony. The population appears at high risk of events despite pharmacological therapy and therefore appropriate for a trial of CRT.

Aged↗
PubMed2005

[Cardiac arrest outside hospital: initial and subsequent cardiological management].

UNLABELLED: The prognosis of cardiac arrest outside hospital is directly related to the initial management. The aim of this work was to evaluate the characteristics of the initial and subsequent cardiological management of victims of cardiac arrest outside hospital with a retrospective analysis of data from the SAMU 35 (Emergency Medical Service, IIIe et Vilaine region) in the period April 1998 - April 2002. RESULTS: 533 non-traumatic cardiac arrests outside hospital were reported in 532 patients (average age 63 +/- 17, 73% male). The cardiac arrest occurred at home in 77% of cases. The initial cardiac rhythm documented was asystole in 63% of cases, ventricular fibrillation (VF) in 30% ventricular tachycardia (VT) in 1% and electromechanical dissociation in 6%. A cardiac aetiology was presumed in 294 (69%) of the 424 resuscitated patients. Among these, 22% (66/294) were admitted to coronary care units, 11% (31) left hospital alive, 8% (24) with no neurological sequelae. The survival rate for patients with cardiac arrest outside hospital in the presence of a witness and for whom the initial rhythm was VF or VT was 21%. The patient's age (<60 years)[OR: 1.05; CI 95%: 1.02-1.07; p < 0.001], rapid arrival of the SAMU (<10 min) [OR: 5.68; CI 95%: 1.42-22.7; p = 0.01] and resuscitation by the witness (OR: 8.26; CI 95%: 3.28-20.83; p < 0.001) were factors predictive of survival in a multivariate analysis. Coronary heart disease remains the principal cause of cardiac arrest in patients admitted to cardiology units (68%), with a recent coronary thrombosis shown in 40% of patients undergoing angiography (16/40). CONCLUSION: the prognosis of cardiac arrest outside hospital remains bleak, with a mortality of 90%. The survival rate is higher if the initial management is optimal, associated with bystander resuscitation and an immediate emergency service response allowing rapid defibrillation. Diagnosis and management of acute coronary syndrome in a cardiological setting must be integrated into the strategy.

Adolescent↗
PubMed2005

[Use of the six-minute walk test in cardiology].

The symptom-limited exercise test is nowadays the gold standard to assess the exercise tolerance and the effects of different treatments in patients with chronic heart failure (CHF). A simpler alternative to this test is the 6-minute walk test. The 6-minute walk test is easy to realize and well-tolerated. Moreover, it is reliable just after one familiarization practice and requires standardization. Indeed, its conduction, which is submitted to some security precautions, can be altered by variation factors. The distance walked during the 6 minutes was the only parameter studied during the test. This parameter could allow judging the CHF severity and prognostic. The analyse of cardiorespiratory parameters has shown that the 6-minute walk test relative intensity is near to the peak individual values. Moreover, the cardiac and ventilatory adaptation of patient during this test depends to his own functional capacity. Lastly, the 6-minute walk test is a submaximal constant-load exercise, which should be performed in complement to the symptom-limited exercise test in cardiac patients.

Exercise Test↗
PubMed2005

[Factor VIII hyperactivity: an arterio-venous thrombogenic factor. Case report].

Thrombosis is the principal mechanism in vascular pathology, whether cerebral, coronary or peripheral. During the initial stages of infarction, coagulation contributes to vascular occlusion, the haemostatic factors playing a determining role in the development of atherothrombotic lesions. An increase in a coagulation protein, besides any lowering of anticoagulation protein levels, is a risk factor for thrombosis. Among these pro-coagulant factors, the pro-thrombogenic action of factor VIII has without doubt been studied the least. We report the case of a 62 year old patient with a personal and family history of many previous thrombotic episodes, both arterial and venous, in whom factor VIII hyperactivity was discovered after a myocardial infarction. This case underlines the association of the factor VIII complex with thrombosis, and its clinical repercussions, especially the incidence of coronary pathology.

Coronary Thrombosis↗
PubMed2004

[Value of the association of D-dimer measurement and the evaluation of clinical probability in a non-invasive diagnostic strategy of pulmonary embolism].

New diagnostic tools in suspected pulmonary embolism complete the classical diagnostic strategy of pulmonary scintigraphy and pulmonary angiography to limit the indications of these two invasive investigations. In a prospective series of 204 consecutive patients with suspected pulmonary embolism the association of D-dimer measurement and clinical probability was assessed for the exclusion of the diagnosis of pulmonary embolism. The D-DI Liatest is a new generation, unitary, rapid and quantitative latex test with a comparative diagnostic performance to that of the reference ELISA test, and well adapted to emergency situations.The clinical probability was assessed by a quantitative score based on past history, clinical symptoms and signs. The positive diagnosis of pulmonary embolism was made by spiral CT scanner and/or pulmonary angiography, associated with Duplex ultrasonography of the leg veins in nondiagnostic results. The prevalence of pulmonary embolism was 42.6% and the absence of anticoagulation in patients considered not to have pulmonary embolism was associated with a thrombo-embolic incidence of 0.9% at 3 months. Fifty-six patients had D-dimer concentrations equal or inferior to the threshold of 500 microg/L; the sensitivity was 99% and the specificity 47% with a negative predictive value of 98% to 100% in cases with a low clinical probability. D-dimer measurement is reliable and has a high cost-benefit value in ambulatory patients with suspected of pulmonary embolism and is even more valuable when the clinical probability of this diagnosis is low.

Female↗
PubMed2004

[The role of cardiac pacing in the treatment of atrial arrhythmias].

The role of cardiac pacing in the treatment of atrial arrhythmias can be analysed from the angle of prevention or treatment in a strategy of rhythm control or heart rate control. From the heart rate control viewpoint, "ablate and place" is a validated method, especially in terms of mortality based on the results of large registers, in cases of uncontrolled ventricular rhythms causing symptoms or left ventricular dysfunction. In a strategy of rhythm control, the theoretical bases of prevention of atrial fibrillation (AF) by atrial pacing are convincing but the clinical results of different prospective clinical trials, though encouraging, do not provide formal proof of the efficacy of preventive pacing. Permanent 100% atrial pacing remains the objective which has led to the development of many algorithms evaluated in the ADOPT, AF Therapy, PIPAF, ATTEST...trials, with contradictory results. The choice of atrial pacing site seems to be a determining factor for the success of the method with better results seemingly with the high or low septal positions. The results of the OASES trial support this hypothesis but they were not confirmed by the ASPECT trial. An interesting observation was made in the PIPAF and a new Danish trial on the deleterious effects of ventricular capture when not required which is the rule in patients paced for brady-tachycardia syndromes. As for the role of anti-tachycardia pacing, the technique remains to be validated. Perhaps, the association of different techniques evaluated--the site of pacing, the prevention algorithms, respect of the ventricular rhythms, reduction by anti-tachycardia stimulation--will provide multifunction devices capable of best managing atrial arrhythmias which do not require "curative" therapy, and in particular, endocavitary ablation. In practice, it is generally when faced with brady-tachycardia syndromes that the question of the preventive role of pacing is raised. The problem is to choose the site of stimulation and the most appropriate pacing device in the light of current knowledge.

Algorithms↗