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Biomedical subjects

J Loiret

Publications and source records attributed to J Loiret.

At least 19 recordsLinked to original sources
PubMed2004

[Prediction of intolerance to beta blocker therapy in chronic heart failure patients using BNP].

Beta-blocker therapy is actually recommended as first line therapy for systolic heart failure. However, beta-blocker have a low prescription rate comparatively to ACEI. Beta-blocker potential side effects as bradycardia, hypotension and especially acute decompensation could explain this under prescription. Clinical data could easily identify high-risk patients for hypotension or bradycardia but not high-risk patients for induced decompensation linked to beta-blocker therapy. BNP could identify these patients with a high sensitivity. Patients with BNP above 1000 pg/ml had a 40% risk of acute decompensation after introduction or increase of beta-blocker therapy. As a conclusion, clinicians must be very cautious for introducing or increasing Carvedilol therapy in patients with high BNP levels.

Adrenergic beta-Antagonists↗
PubMed2003

[Brain natriuretic peptide, heart failure and elderly patients].

Natriuretic Peptides like BNP or NT Pro BNP are diagnostic and prognostic makers largely used in clinical practice. Ageing may increase these peptides, especially in case of comorbidities like renal failure or hypertension and require adjustment for age. Diagnostic value of natriuretic peptides seems however preserved in elderly people.

Adult↗
PubMed2003

Bedside B-type natriuretic peptide and functional capacity in chronic heart failure.

OBJECTIVES: To determine if B-type natriuretic peptide (BNP) measurement could be useful in determination of functional capacity in patients suffering from chronic heart failure. BACKGROUND: Evaluating functional capacity is a crucial factor in the follow-up of patients with chronic heart failure. There are numerous methods for measuring functional capacity and their relative merits remain under discussion. Clinical classifications are very subjective and other methods are difficult to use in clinical practice. METHODS: We evaluated functional capacity in 151 consecutive patients using the 6-min walk test. All patients were clinically classified using the New York Heart Association (NYHA) classification. We measured BNP plasma levels using a bedside BNP test. RESULTS: Six minute walk test performance decreased through NYHA classes 1 to 4 (469+/-87, 411+/-82, 325+/-83 and 196+/-63 m, respectively, P<0.01) and BNP levels increased through NYHA classes 1 to 4 (26.3+/-7.2, 73+/-13, 401+/-74 and 924+/-84 pg/ml, respectively, P<0.001). There was a significant correlation between 6-min walk test performance and BNP plasma levels (R=0.69 P<0.001) and a weaker correlation between BNP and left ventricular ejection fraction (R=0.45 P<0.04). In some patients there was a mismatch between NYHA classification and 6-min walk test performance. In all cases BNP could correct the clinical estimation of functional capacity. When we divided the patients into three sub-groups within each NYHA class, we showed that using BNP could better define functional capacity in patients suffering from chronic heart failure in NYHA classes I to III. CONCLUSION: The measurement of BNP levels thus usefully supplements the clinical examination. The existence of bedside BNP testing methods facilitates its use in routine clinical practice. It also permits easier follow-up of patients with chronic heart failure.

Adolescent↗
PubMed2003

[Utility of BNP measurement in the emergency room in patients with suspected unstable angina with a normal ECG].

Unstable angina is a serious condition, difficult to diagnose in the emergency room. Clinical, electrocardiographic and biological signs (increased troponine) are not sensitive. The authors set out to assess whether measuring B natiuretic peptide in the emergency room was more sensitive for identifying symptomatic coronary lesions. One hundred and twenty patients admitted to the emergency room for chest pain compatible with the diagnosis of unstable angina and a normal ECG were included in this prospective study. All patients underwent coronary angiography during their hospital admission. The sensitivities of troponine at a threshold of 0.4 ng/ml and of brain natiuretic peptide (BNP) at a threshold of 10 pg/ml in this population were 66% and 92% respectively. The use of troponine and BNP together provided better results than troponine and BNP alone for the identification of patients with chest pain with significant coronary lesions.

Angina, Unstable↗
PubMed2003

[Educating patients about heart failure in community hospitals: it is possible...].

Prognosis for heart failure is linked to patient's compliance. Compliance is also dependent from patient education about his disease and treatment. Therapeutic education could be done in a community hospital but needs a lot of time. However, therapeutic education for heart failure patients becomes more and more essential in clinical practice and improves patient knowledge and implication and hospitalization duration.

Aged↗
PubMed2003

[Clinical research in community hospitals in France].

Medical research is an important part of medical art. From Hippocratis to hypothesis ... resume research processes. Medical trials could be done or managed by community hospitals but it implies several collaborations with university structures. Even it is sometimes difficult to do, improvement of medical science and patient management through publications and communications are the ultimate goal of such trials....

Biomedical Research↗
PubMed2002

[Heart failure clinics. Concept, organization, results].

Chronic heart failure is linked to high rate of death and hospitalization. Some studies have highlighted the beneficial effect of heart failure clinics on morbidity and mortality. We have developed this type of structure at CHR Dubos since 3 years and we have recently created an heart failure clinic (10 beds). It's based on a concept including an experienced medical and nurse team, patient's and patient's family education and evaluation of the structure.

Aged↗
PubMed2002

Myocardial contractile reserve under low doses of dobutamine and improvement of left ventricular ejection fraction with treatment by carvedilol.

To examine the ability of myocardial contractile reserve (MCR) assessment to predict the improvement of left ventricular ejection fraction with treatment by carvedilol, a prospective study was undertaken in 85 patients with chronic heart failure and left ventricular ejection fraction < 45%. Low dose dobutamine echocardiography (DSE), a 6-min walk test and measured brain natriuretic peptide (BNP) were assessed in all the patients. Patients were separated into two groups. Group A were patients without any myocardial reserve and group B patients with a myocardial contractile reserve defined as an increment of more than 20% of the resting left ventricular ejection fraction during dobutamine infusion. The two groups differed for percentage of ischemic cardiomyopathy (67.8 in group A vs. 29.7% in group B P = 0.028), 6-min walk test performance (respectively, 343 vs. 415 meters P < 0.05) and BNP plasma levels (respectively, 184.5 vs. 70.1 P < 0.02) but not for left ventricular ejection fraction or NYHA class. During DSE, MCR and heart rate variation was higher in group B than in group A. At the end of the follow up, LVEF increased and NYHA class decreased in group B but not in group A. In multivariate analysis the existence of MCR could predict the improvement of LVEF with treatment by carvedilol. In our study, studying MCR could help to predict patients who will improve their LVEF with carvedilol prior to the administration of the treatment.

Adrenergic beta-Antagonists↗
PubMed2002

Short-term effects of sinus rhythm restoration in patients with lone atrial fibrillation: a hormonal study.

It is well known that atrial fibrillation can lead to heart failure, and is attributed to rapid ventricular rate (tachycardia-induced cardiomyopathy). Some recent studies suggest the possible existence of an intrinsic left-ventricular factor related to atrial fibrillation, irrespective of other elements. In order to demonstrate the implication of this factor, we measured B-type Natriuretic Peptide, known as a functional marker of left-ventricular dysfunction, in 40 consecutive patients with chronic non-valvular atrial fibrillation, with low ventricular rate and absence of clinical heart failure or echocardiographic left-ventricular dysfunction. In all patients, Brain Natriuretic Peptide (BNP) plasma level was high and dramatically decreased 24 h after external electrical cardioversion (61.4 pg/ml before cardioversion, 23.5 pg/ml 1 day after cardioversion, P<0.002). Our study demonstrates that atrial fibrillation, in absence of high ventricular rate, induces an asymptomatic cardiac alteration that is not detectable by echocardiography.

Atrial Fibrillation↗
PubMed2002

[Stress ultrasonography under low doses of dobutamine, contractile reserve and dilated cardiomyopathy].

The demonstration of a myocardial contractile reserve with low dose dobutamine is an emerging imaging technique in patients with dilated cardiomyopathy. This contractile reserve is correlated with a better prognosis and enables identification of subgroups of patients who could increase their left ventricular ejection fractions under carvedilol. A review of the published literature shows that the method does not expose patients to major risk, providing patients are selected and carefully monitored during the procedure. Complementary studies of larger numbers of patients are required to confirm its value as a prognostic and therapeutic marker in patients with dilated cardiomyopathy.

Adrenergic beta-Agonists↗
PubMed2002

[Anaphylactic shock and myocytic necrosis after treatment with Artotec].

Treatment with non-steroid anti-inflammatory drugs associated with a prostaglandin analogue is common, but the potential cardiovascular effects are largely unknown. The authors report a case of myocardial necrosis and anaphylactic shock due to treatment with diclofenac and misoprostol. The reintroduction of the treatment in hospital led to the recurrence of the initial cutaneous and cardiac symptoms in this patient.

Aged↗
PubMed2001

[Brain natriuretic peptide and heart failure].

Brain natiuretic peptide (BNP) is a hormone secreted specifically by the left ventricular myocytes. Its concentration is correlated with the severity of symptomatic or asymptomatic left ventricular dysfunction. The measurement of BNP has several applications from the screening of populations to the monitoring of the effects of treatment and the evaluation of the prognosis of cardiac failure. The emergence of new methods of rapid measurement will enable its usage as a routine investigation in the near future. Large scale clinical trials are, however, required to confirm the hopes raised by this new marker of left ventricular dysfunction.

Animals↗
PubMed2001

[Citalopram and Torsades de Pointes. A case report].

Inhibitors of serotonin uptake are drugs prescribed without recognised cardiovascular risk. The authors report a case of torsades de pointes following Citalopram ingestion. In this patient, the proof of reintroduction in a hospital environment resulted in prolongation of the QT interval. Screening of patients for acquired or congenital long QT intervals is therefore necessary before starting treatment with Citalopram.

Antidepressive Agents, Second-Generation↗
PubMed2000

[Optimal myocardial revascularization by coronary bypass and complementary angioplasty. Study of 100 patients].

One hundred patients underwent early coronary angiography (average 20.5 days) after coronary bypass surgery between 1994 and 1996. The indications in clinically asymptomatic patients were: study of double mammary grafts, non respect of the preoperative plan (grafts not available, technical difficulties), and/or postoperative ECG changes. 12.1% of internal mammary grafts and 18.2% of the saphenous vein grafts were considered to be non-fractional: due to occlusion in 3 and 11.9%, due to poor implantation site (persistence of a distal stenosis): 3 and 0.8% respectively. After investigations to detect ischaemia in the region concerned or persistence of a critical lesion on a non-revascularised main artery, 26 complementary angioplasties were performed: 3 on internal mammary grafts, 4 on saphenous vein grafts and 19 on the native vessels. Surgery alone resulted in complete revascularisation in 70% and its association with cardiological interventional techniques increased the value to 85%. The association of coronary bypass surgery and transluminal angioplasty may therefore result in optimal revascularisation. This should reduce the morbidity rate, the number of hospital admissions (recurrent ischaemia and reoperation) and improve survival. However, the exact modalities of this combined revascularisation remain to be defined.

Adult↗
PubMed1997

[Isolated left ventricular muscular diverticulum in an adult. Value of non-invasive examinations].

The authors report a case of ventriculum in a 45 year old women investigated for chest pain. This was a congenital muscular left ventricular diverticulum confirmed by a complete imaging series including echocardiography, magnetic resonance imaging, angio-scintigraphy and conventional angiography. This diverticulum was unusual due to the fact that there was no associated congenital disease and that it was discovered in an adult. The authors review the literature and discuss the value of non-invasive imaging procedures.

Angiocardiography↗
PubMed1997

[Management of myocardial infarction in patients over 75 years of age compared to patients under 75 years of age. Apropos of 594 consecutive cases admitted between 1991 and 1994].

This study analyses the patients consecutively admitted for myocardial infarction between January 1991 and December 1994. The study population consisted of 594 patients divided into two groups: 446 patients under the age of 75 years and 178 patients over the age of 75 years. The sex-ratio showed a male predominance (84%) before 75 years, and a female predominance (57%) after 75 years. A history of angina was more frequent in elderly patients (45% vs 30%, p < 0.001), who were admitted later (22.5% vs 46.6% before the 6th hour, p < 0.001). Thrombolysis was administered in 49.6% of subjects under the age of 75 years and in 17.3% of elderly patients. The course was uneventful in 56.7% of subjects under the age of 75 years and in 28.2% of elderly patients. Mortality was 6-fold higher in this group (22% vs 3.7%, p < 0.01). The cause of death was usually heart failure with a 10-fold higher frequency of cardiogenic shock (13.5% vs 1.4%, p < 0.001). Coronary angiography was performed in 81.4% of subjects under the age of 75 years and in 30% of the elderly patients. Multi-vessel lesions were more frequent in elderly subjects (78.4% vs 47.5%, p < 0.01). Revascularization by angioplasty or bypass graft was performed with a similar frequency (50%) in the two groups of patients investigated by coronary angiography. The mortality of myocardial infarction was high in the elderly, usually due to heart failure, and partly explained by the severity of the coronary lesions; in contrast, elderly patients were less frequently submitted to active management (thrombolysis-coronary angiography), while recent data of the literature argue in favour of primary angiography in these patients.

Aged↗
PubMed1992

[Recurrent syncope during deglutition. An uncommon form of sinusal dysfunction].

The authors report the case of a 69 year old man with a 16 year history of syncope occurring only while swallowing liquids. Two episodes were observed during a hospital admission to the intensive care unit for unstable angina and allowed documentation of prolonged sinus arrest (7 sec) causing syncope. In the light of this case and a review of the literature, the physiopathological role of deglutition in the genesis of cardiac conduction defects and arrhythmias is discussed and the new classification of sinus node dysfunction proposed by Bashour in 1985 is recalled.

Aged↗