Search PubMed⌕ Search

Biomedical subjects

J M Lablanche

Publications and source records attributed to J M Lablanche.

At least 145 records · Page 8Linked to original sources
PubMed1988

Left ventricular systolic and diastolic function during acute coronary artery balloon occlusion in humans.

Left ventricular function during percutaneous transluminal coronary angioplasty was studied in 16 patients undergoing the procedure. All measurements were performed before and during the first episode of balloon coronary occlusion. In 16 patients (Group A), data were recorded before and 30 or 50 s after balloon inflation, and in 8 of these patients (Group B) data were also recorded 15 min after the complete procedure. Left ventriculograms indicated a marked dyskinesia of the anterior and apical wall in all patients. After balloon inflation, there was a marked depression in stroke index and ejection fraction and an increase in left ventricular end-diastolic pressure and the time constants of relaxation in all patients. Simultaneous recording of left ventricular pressure (Millar micromanometer) during cineangiography permitted the assessment of myocardial and chamber stiffness. Although there was a strong tendency for both myocardial and chamber stiffness to increase after 30 to 50 s of occlusion, these increases were statistically insignificant. In Group B, a third set of angiographic and pressure measurements obtained 15 min after completion of the coronary angioplasty procedure indicated no residual left ventricular dysfunction, and in this respect, the results are of added clinical importance.

Angioplasty, Balloon↗
PubMed1988

[A new method of laser angioplasty by contact sapphire: preliminary results. Apropos of 20 cases].

We report our first 20 cases of peripheral laser angioplasty using an optic fibre with contact sapphire tip. The equipment included a teflon catheter on which was screwed a round sapphire 2.2 mm in diameter. A 600 microns optic fibre connected to a Nd-Yag laser instrument was introduced into the catheter and placed in contact with the sapphire. Twenty patients underwent recanalization of femoral or popliteal arteries occluded on a length of 5 to 45 cm. The sapphire-tipped catheter was introduced by the Seldinger technique up to the site of occlusion. The 15 watt laser emission was set at intervals of one second. Sixteen out of the 20 occluded arteries were recanalized. Among the 4 failures, 3 were due to perforation and 1 to intraparietal progression. Angioplasty was performed with laser alone in 3 cases and with laser completed by balloon catheter in 13 cases. The minimum diameter of the laser-induced channel was 2 mm and was significantly increased (3.8 mm) by complementary balloon dilatation. In the 3 patients who underwent laser angioplasty alone, no noticeable improvement in distal blood flow was demonstrated by doppler velocimetry, and reocclusion occurred either soon afterwards (n = 2) or later (n = 1). Midterm results were much better in patients who had had additional balloon dilatation: early (3rd day) or late (2 months) reocclusion took place in only 3 patients. In the remaining 10 patients, followed up for periods of 1 week to 18 months (mean: 6 months), clinical improvement and recanalization were maintained.

Angioplasty, Balloon↗
PubMed1988

[Reproducibility of the exercise test and coronary vasomotor tonus].

The effect of coronary vasomotor tone on exercise test reproducibility was evaluated in two groups of patients. All had an apparently stable angina, a positive first exercise test and at least one significant stenosis at coronary arteriography. Group A patients (n = 30) had a positive ergonovine test (dynamic stenosis) whereas this test was negative (fixed stenosis) in group B patients (n = 29). Patients of both groups underwent two exercise tests without treatment, each of these tests being performed on a different day of the same week, at the same time and according to Bruce's procedure. The reproducibility of angina was poor in group A patients: 6/15 (40 p. 100) as against 18/20 (90 p. 100) in group B patients (p less than 0.05). Moreover, the initially positive exercise test subsequently become negative in 6 of the group A patients and in none of the group B patients (p less than 0.05). The time elapsed before ischaemia appeared was globally increased to the same extent in both groups, but individual variations were more pronounced in group A: a more than 1 minute variation was noted in 63 p. 100 of group A patients and in 18 p. 100 of group B patients (p less than 0.01). Similarly, the double product of ischaemia (-1 mm) varied by more than 20 p. 100 in 37 p. 100 of group A patients and in 14 p. 100 of group B patients. In contrast, the maximum stress parameters were increased to the same degree in both groups, including the double product duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1988

[Congenital aneurysm of the coronary arteries. Apropos of 2 cases].

Two cases of aneurysm of the coronary arteries were diagnosed by coronary angiography in the course of a myocardial infarction. The first aneurysm was located at the level of the left coronary trunk in a 32 year-old woman; it was complicated with a massive anterior infarction which led to a heart transplant in the following months. The second aneurysm was located on the right coronary artery in an 18 year-old man; the inferior infarction was rudimentary and the subsequent course was quite favorable. Congenital aneurysm of the coronary arteries is a rare anomaly, often localized on the left coronary trunk and almost always diagnosed in young patients following myocardial infarction.

Adolescent↗
PubMed1987

Enhanced efficacy of computerized exercise test by multivariate analysis for the diagnosis of coronary artery disease. A study of 558 men without previous myocardial infarction.

Multivariate analysis has been proposed to enhance diagnostic accuracy of the exercise test in coronary artery disease. To quantify the improvement given by multivariate analysis in comparison with ST segment depression alone during exercise test, 558 men without previous myocardial infarction were studied retrospectively. All the patients underwent a symptom-limited Bruce protocol with computer-averaged recordings in V5, aVF, V2. Coronary angiography was performed within the following 90 days. Prevalence of coronary artery disease (diameter narrowing of 50% or greater) was 0.56. Among 12 clinical and exercise parameters studied by stepwise multivariate analysis, five were found to reach the maximal accuracy: (1) exercise duration, (2) history of typical angina, (3) typical angina during the test, (4) age, (5) maximal heart rate. In comparison with ST depression, multivariate analysis significantly improves accuracy (74.6 vs. 66.8%, P less than 0.01) by increasing sensitivity (0.68 vs. 0.59, P less than 0.05) without affecting specificity (0.83 vs. 0.76, NS). Thus, in a group of men without infarction and a low prevalence of coronary artery disease, multivariate analysis with five easily collected variables is more accurate than ST segment depression alone during exercise. In addition, ST depression did not appear as discriminant as exercise duration for diagnostic purposes. This finding emphasises the importance of performing a symptom-limited exercise test.

Adult↗
PubMed1987

Percutaneous transluminal coronary angioplasty in patients with spasm superimposed on atherosclerotic narrowing.

Of 552 patients undergoing percutaneous transluminal coronary angioplasty 102 had coronary artery spasm superimposed on atherosclerotic narrowing. Coronary angioplasty was successful in 97 (95%). The patients were discharged on a regimen of nifedipine (40-60 mg/day). Seventy six patients were symptom free 6-8 months after the procedure. Restenosis was detected in 35% of patients. Coronary artery spasm was provoked in 38 (44%) of the 87 patients who underwent an ergometrine maleate test. Twenty seven of the 34 patients with restenosis had a provocation test and coronary artery spasm was superimposed on restenosis in 22 (81.5%). Coronary angioplasty is feasible in patients with coronary artery spasm superimposed on atherosclerotic narrowing but the rate of restenosis is high and coronary artery spasm could have a role in the pathogenesis of restenosis.

Angioplasty, Balloon↗
PubMed1987

[Probability of coronary lesions evaluated by the discriminant analysis of clinical and ergometric parameters].

It has been suggested that multivariate analysis can be used to improve the diagnostic value of the conventional exercise tests. In order to evaluate the usefulness of this method in clinical practice, we have conducted a retrospective study of 558 male subjects without history of infarction who had undergone an exercise test and, less than 90 days later, a coronary arteriography. All exercise tests were performed according to Bruce's procedure and with an equipment which provided continuous averaging of ST segment values on V5, V2 and VF leads. The prevalence of significant coronary lesions (more than 50% luminal narrowing) was 56%. The values of 12 clinical and electrocardiographic parameters at rest and during exercise were subjected to a step-by-step multivariate analysis. Compared with the quantitative analysis of ST alone, the multivariate analysis increased the sensitivity (68% vs 59%, p less than 0.05) and specificity (83% vs 76%, NS) of the tests and the percentage of well-classified subjects (74.6% vs 66.8%, p less than 0.01). The best combination was obtained with the first 5 parameters of the final classification, viz.: (i) duration of exercise; (ii) clinical history of angina; (iii) anginal pain during exercise; (iv) age, and (v) maximum heart rate. The validity of the method was demonstrated on a recent series of 200 consecutive patients where the prevalence of coronary lesions was 58%. The discriminant function score enabled 74% of these patients to be correctly classified and improved the sensitivity of their exercise test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Provocative test in recent myocardial infarction.

Coronary artery spasm has become a frequently recognized cause of angina. Since spontaneous spasm is a rare occurrence, a number of provocative tests have been proposed. We will not discuss the different criteria of various tests, but having compared them, it seems to us that the ergometrine is the most sensitive, the most reproducible and the easiest to perform. Thus we will discuss only the ergometrine test.

Angina Pectoris↗
PubMed1986

Dilated cardiomyopathy and the level of alcohol consumption: a planned multicentre case-control study.

The association between clinical or environmental factors and dilated cardiomyopathy (DCM) has been assessed in a planned case-control study. Patients and controls were men aged between 20 and 65 years, matched for age, profession and geographic location. DCM was defined by strict radiologic and angiographic criteria excluding multiple-vessel coronary disease. Controls were recruited from the surgical centres after excluding diseases usually linked with alcohol or tobacco consumption. Univariate and multivariate analyses were used to ensure adequate techniques for matched pairs. The prevalence of diabetes and hypertension and the exposure to toxic substances, drugs and tobacco was identical in both groups. Alcohol consumption before the onset of first symptoms was higher in patients than in controls (101 vs 64 ml day-1, P less than 0.001); the excess of consumption concerns all kinds of alcoholic beverage (wine, beer, etc.). The relative risk (RR), estimated from the odds ratio, increased only among heavy drinkers (greater than or equal to 110 ml day-1; RR: 7.6, P less than 0.001) with an independent contribution of both wine (RR: 4.7, P less than 0.001) and other alcoholic beverages (RR: 4.1, P less than 0.01). In conclusion, alcohol is a strong risk factor for DCM, but the excess of risk is limited to heavy drinkers and is independent of the type of beverage.

Adult↗
PubMed1986

[Transluminal coronary angioplasty: immediate and short-term results. Apropos of 302 dilated vessels].

This study reports the experience of the Cardiac Hospital of Lille up to the 1st October 1984. Two hundred and sixty-nine patients with a mean age of 51 years underwent transluminal coronary angioplasty for one or more stenotic lesions. Three hundred and two vessels were dilated. The left anterior descending artery was dilated in 72.5% of cases, the right coronary in 17.6% and the left circumflex in 8.6% of cases. The immediate results may be summarised as follows: it was possible to cross the stenosis to be treated in 91.4% of cases; the primary success rate (a gain of more than 20% without complications) was 83%. The narrowing was significantly decreased from 72 +/- 7% to 25 +/- 17%, the average gain in lumen size was 53 +/- 16%. The emergency coronary artery bypass surgery rate was 4.3%, and 3.6% of all the patients developed myocardial infarction. Sixty four per cent of patients had negative maximal exercise stress tests on discharge from hospital. The patients who had positive tests had improved exercise tolerance compared to the stress test performed before angioplasty. Angiographic control at 6 months was performed in about half the patients and showed coronary stenosis in 27%. Sixty eight per cent of the patients were totally asymptomatic.

Adult↗
PubMed1986

[Comparative study of short and medium-term results of angioplasty and bypass in severe or unstable angina pectoris caused by isolated stenosis of the anterior interventricular branch].

This retrospective non-randomized study deals with 146 patients subjected to revascularization procedures for severe or instable angina pectoris due to isolated stenosis of proximal or middle anterior interventricular artery, without myocardial infarction in the anamnesis. The patients were divided into two comparable groups: group A (74 patients) treated by an aorto-coronary bypass saphenous vein graft; group B (63 patients) subjected to transluminal coronary angioplasty. None of them presented an associated cardiopathy. The patients were controlled after 10.4 months (group A) and 9.1 months (group B); a physical stress-testing was performed according to the same protocol in the two groups, and control coronarography in group B. The evolution was characterized by one death in each group and a more frequent incidence of infarction (6.7%) in group A than in group B (2.7%, p = NS). The symptomatology in both groups was comparable: 12.1% in group A and 9.1% in group B was free of symptoms. Also the stress-testing yielded similar results: a negative and maximal in 43.6% in group A and 56.4% in group B. When positive at the control (in 27% of group A and 36% of group B) the threshold of appearance of ischemia was delayed only in group B. Thus even if the functional results are comparable in the two groups, the risk of infarction is less after angioplasty, in return, however, for 23% of recurrent stenoses.

Adult↗
PubMed1986

[Coronary vasomotor activity in man. Description of a method of quantification and normal values].

The role of vasomotor tone is important in coronary pathology but it has not yet been quantified. The aim of this study was to evaluate the normal maximal variation of diameter between vasoconstriction and vasodilation or the coronary vasomotor capacity: greater diameter-smallest diameter/smallest diameter %. This was performed by two successive pharmacological tests, ergometrine and isosorbide dinitrate (ISDN), the doses of which and modes of administration were defined in a group of 70 patients: Contrast medium: no variations were observed after 5 opacifications at a least 2 minute intervals in 6 patients. Ergometrine test: a single 0.4 mg dose (6 patients) gave a maximal response equal to that obtained with progressive increments 0.1, 0.2, 0.3, 0.4 mg (9 patients). Two opacifications at 3 and 5 minutes were adequate to assess the vasoconstriction with an underestimation of less than 3% compared with a 10 minute control. ISDN test: 3 mg was the maximal haemodynamically well tolerated dose in the majority of patients. This dose gave the same response whether administered by intracoronary (18 patients) or intravenous injection (10 patients). Maximal vasodilatation was obtained after 2 to 4 minutes. A single coronary opacification 2 minutes after injection of ISDN underestimated the vasomotor capacity by 9.3% compared to that calculated after 5 opacifications performed over a 10 minute period. We propose the following protocol: intravenous injection of 0.4 mg of ergometrine with 2 opacifications of the coronary arteries after 3 and 5 minutes respectively. This followed by intravenous or intracoronary injection of 3 mg of ISDN followed by opacification 2 minutes later.(ABSTRACT TRUNCATED AT 250 WORDS)

Constriction, Pathologic↗
PubMed1986

[Value of the computerized analysis of ST segment depression during exercise without myocardial infarction. Apropos of 807 cases].

The diagnostic value of ST segment changes on exercise were reassessed by computerised analysis in 807 patients without myocardial infarction who underwent coronary angiography. All the stress tests were carried out according to Bruce's protocol with a system of continuous averaging of the ST segment in V5, V2 and VF. An abnormal response was defined by the association of the following three criteria: 1) ST depression less than or equal to 1 mm, 2) the algebraic sum of the depression + ST slope less than or equal to -1, 3) changes occurring during exercise or the first minute of recovery. A significant coronary lesion was defined as at least 50 per cent narrowing of the vessel lumen. In the study population the prevalence of lesions was 55 per cent in men and 18 per cent in women. The sensitivity of exercise stress testing was 69 per cent but the specificity was only 65 per cent. The positive predictive value was 70 per cent in men, 29 per cent in women; the negative predictive value was 90 per cent in women compared with 62 per cent in men. The predictive values depended on the interpretation of the amplitude, morphology and topography of the ST depression. The low sensitivity and specificity were independent of the coronary angiographic criteria and not related to the bias usually encountered in the correlation between stress testing and coronary angiography. These results show that the quantitative analysis of ST changes during computerised stress testing is not sufficiently accurate in itself to detect atherosclerotic coronary artery disease.

Computers↗