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Biomedical subjects

J Piessens

Publications and source records attributed to J Piessens.

At least 55 records · Page 3Linked to original sources
PubMed1991

Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia.

The prevalence of esophageal chest pain was studied prospectively in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. A group of 248 consecutive patients without previously documented heart disease was admitted for elective diagnostic coronary angiography. The clinical history classified 185 patients as having anginal pain and the coronary angiogram was normal in 48 of them. In 37 of these 48 patients full esophageal testing was performed including 24-hr intraesophageal pH and pressure recordings with indication of chest pain episodes as well as a number of esophageal provocation tests, ie, acid perfusion, edrophonium stimulation, balloon distension, and ergonovine stimulation, all performed under continuous esophageal manometric and electrocardiographic monitoring. In 19 of these 37 patients, the familiar chest pain could be reproduced by esophageal provocative testing without ischemic ST-T segment alterations; six of these 19 patients had also a positive 24-hr pH and pressure recording. These data strongly suggest an esophageal origin of chest pain in half the patients with typical angina and a normal coronary angiogram.

Angina Pectoris↗
PubMed1991

Long-term prognosis of male patients with an isolated chronic occlusion of the left anterior descending coronary artery.

The purpose of this study was to determine the long-term prognosis of patients with an isolated total occlusion of the left anterior descending artery (LAD). A total of 173 male patients with a chronic LAD occlusion and less than 50% narrowing of the other coronary arteries (group I) was compared with a group of 177 male patients with only insignificant coronary artery disease and a normal left ventricular function (group II). Baseline characteristics of both groups were comparable except for the inclusion of 54 patients (31.2%) with moderately or markedly reduced left ventricular systolic function in group I. During an 8-year follow-up period there was a greater number of patients with cardiac events in group I when compared with group II: cardiac death 11.2% versus 0.6% (p less than 0.0001), myocardial infarction 12.7% versus 3.4% (p = 0.001), myocardial revascularization procedures 11.6% versus 3.4% (p = 0.04). Stepwise discriminant analysis showed that a reduced ejection fraction and a family history of coronary artery disease were the best predictors for these adverse cardiac events.

Belgium↗
PubMed1991

Percutaneous transluminal laserangioplasty with balloon centered direct argon laser light. Experience with 12 patients and a minimal follow-up of 6 months.

Laser angioplasty with direct argon laser light, combined with a special centering balloon (Lastac system) was performed in 12 patients with a single superficial femoral artery occlusion. The mean length of the occlusion was 5.4 +/- 2.15 cm with a mean duration of occlusion of 7.8 +/- 5.9 months. Initial angiographic success was obtained in 9/12 procedures. Reason of failure was perforation in 1 patient and impossibility to pass the stenosis due to calcifications in 2 patients. Early rethrombosis in 1 patient reduced the primary success rate to 8/12 procedures. Peripheral emboli occurred in 2 patients, both successfully treated by thrombolysis or surgery. Of the 8 recanalized arteries, all remained patent with a mean follow-up of 7.1 +/- 0.68 months. It remains to be determined on larger series whether the Lastac system offers substantial advantages over other, less expensive systems of laser angioplasty.

Aged↗
PubMed1991

The value of the intracoronary electrogram for the early detection of myocardial ischaemia during coronary angioplasty.

The clinical value of intracoronary electrography for the detection of myocardia ischaemia was assessed during coronary angioplasty and compared to a standard technique of surface ECG monitoring. In 73 patients undergoing single lesion angioplasty, an intracoronary electrogram and four representative surface ECG leads were obtained. During angioplasty of the left anterior descending artery leads, I, V3, V5, V6 were recorded. For the circumflex artery leads I, aVL, aVF, V6, and for the right coronary artery leads II, III, aVF, V6 were monitored. Eight patients were excluded due to transient intraventricular conduction disturbances during balloon inflation; 65 patients remained for further analysis. Out of a total of 154 balloon inflations (35 in the circumflex, 71 in the left anterior descending and 48 in the right coronary artery), the percentage that produced a greater than or equal to 1 mm ST segment elevation, the time to the appearance of a greater than or equal to 1 mm ST segment elevation and the maximal ST segment elevation were recorded. During inflations in the circumflex artery, the respective values of these three parameters were 20%, 22.6 +/- 11.5 s and 0.37 +/- 0.80 mm in V6, the most sensitive surface lead, versus 70% (P less than 0.001), 14.4 +/- 9.6 s (P less than 0.01) and 5.82 +/- 6.35 mm (P less than 0.0001) on the intracoronary electrogram.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1991

Torsades de pointes after intracoronary papaverine.

Coronary blood flow velocity and coronary flow reserve can be assessed in humans using a coronary Doppler catheter and the vasodilator papaverine. Although it is a safe, elegant and reproducible technique, serious complications can occur. Coronary flow reserve assessment in a 49-year-old man with a critical stenosis in the proximal part of the circumflex artery was complicated by a papaverine-induced ventricular arrhythmia. Several features of the present case report support papaverine-induced disturbances of the repolarization phase as the pathophysiological mechanism: a 'torsade de pointes' pattern of the tachycardia, the lengthening of the QT-interval, the appearance of a new U-wave and the presence of additional risk factors (hypokalaemia and alcalosis). Patients presenting additional risk factors for this complication should be excluded from coronary flow reserve assessment.

Angioplasty, Balloon, Coronary↗
PubMed1991

Hemodynamic changes after subselective intracoronary administration of nisoldipine in humans.

Hemodynamic changes after the subselective intracoronary administration of 50 micrograms of nisoldipine were analyzed in 24 nonstenotic coronary arteries using a randomized, placebo-controlled, double-blind protocol. The following hemodynamic parameters were studied: (a) epicardial coronary artery diameter, assessed by quantitative angiography; (b) coronary blood flow velocity, measured by an intracoronary Doppler probe; (c) coronary blood flow, calculated from the above parameters; (d) coronary flow velocity reserve, assessed after intracoronary administration of 10 mg of papaverine hydrochloride; and (e) heart rate and arterial blood pressure. Since 3 patients were excluded due to unreliable Doppler signals, a total of 21 patients was eligible for complete analysis (placebo: n = 9; nisoldipine: n = 12). In placebo-treated patients, all studied parameters proved to be very stable on repeat measurement and no significant changes were found. In nisoldipine-treated patients, a significant increase in epicardial diameter (+19%; p = 0.0001) and coronary blood flow (+47%; p = 0.003) was found. The coronary blood flow velocity transiently increased after nisoldipine, with a maximum (+80%) after 2 min and returning to baseline within 10 min. Finally, nisoldipine resulted in a significant decrease in the coronary flow velocity reserve by 20% (p = 0.001). All coronary hemodynamic effects were observed in the absence of changes in heart rate and arterial blood pressure. Therefore, the present data demonstrate that nisoldipine acts as a potent dilator of epicardial as well as resistance vessels in nonstenotic human coronary arteries.

Blood Pressure↗
PubMed1991

Outcome following coronary balloon angioplasty in young adults aged 35 years or less.

The natural history of symptomatic young patients with coronary artery disease is often far from benign. Follow-up studies of young patients who have undergone coronary bypass graft surgery show frequent recurrence of symptoms and need for reoperation. Prompted by these considerations, we reviewed the records of 23 consecutive patients aged less than or equal to 35 years with symptomatic coronary artery disease, who underwent coronary balloon angioplasty at our center between August, 1984 and November, 1989. Mean patient age was 32 (3) (mean [SD]) years. Acute myocardial infarction was the first symptom of coronary artery disease in 7 (30%) of the 23 patients. At the time of angioplasty, 17 (74%) patients, had functional Class 3 or 4 anginal symptoms. Eight (35%) had multivessel coronary artery disease (stenoses greater than or equal to 70% in two or more major coronary arteries). Overall, a total of 36 critical coronary lesions were identified in 32 vessels of the 23 patients (mean of 1.6 lesions and 1.4 diseased vessels per patient). At angioplasty, dilatation of 31 lesions in 27 vessels was attempted. Multilesion angioplasty was attempted in 7 (30%) patients. Successful dilatation was achieved in 29 of the 31 (94%) lesions, and 25 of the 27 (93%) vessels. Primary clinical success (successful dilatation of all attempted lesions without any complications) was achieved in 21 of 23 (91%) patients. Three of the 21 patients with successful initial angioplasty had repeat angioplasty for restenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Effects of a single oral administration of Epanolol on exercise tolerance in patients with stable effort angina pectoris.

A single oral dosage of 100, 200 or 300 mg Epanolol or placebo was administered in a randomized double-blind, cross-over fashion to 12 patients with stable effort angina. Symptom limited bicycle ergometer tests were performed before and 2 and 8 hours after each drug administration. Spontaneous diurnal and day to day differences in exercise tolerance and related analyzed variables were not present; 48 hours after drug intake a carry-over effect of the previous Epanolol administration could not be demonstrated. At each dose level of Epanolol, 2 hours after drug intake, heart rate and rate pressure product at peak exercise fell while exercise duration rose significantly. After 8 hours these effects were less marked. No significant differences between the 3 dose levels were found. In the pooled data of the 3 Epanolol doses, systolic blood pressure at peak exercise and maximal ischemic ST segment depression during exercise were also significantly reduced after 2 hours, while total performed external work rose. The percentage increase in heart rate during exercise after Epanolol administration was similar to the control tests at lower exercise levels but was less marked during the later stages of the test. Heart rate after Epanolol intake was percentage wise more reduced at higher exercise levels. Plasma levels of Epanolol were lower 8 hours after drug administration than after 2 hours. There was no correlation between plasma levels of Epanolol and the observed changes of any of the exercise variables 2 hours after drug intake.

Administration, Oral↗
PubMed1991

Changes in human coronary flow reserve after administration of intracoronary diltiazem.

Epicardial coronary artery diameter (ECAD), coronary blood flow velocity (CBFV), and coronary flow velocity reserve (CFVR) were analyzed at baseline and after a 500 micrograms i.c. bolus of diltiazem in nonstenotic coronary arteries of awake humans. Furthermore, patients (n = 25) were first randomized to pretreatment either with placebo (n = 12) or isosorbide dinitrate (0.5 micrograms/kg/min infusion) (n = 13). Diltiazem resulted in a significant increase in epicardial diameter (+10%; p = 0.001) and in coronary blood flow (CBF) (+30%; p = 0.0001). Whereas basal CBFV only slightly increased (+7%; NS), there was a significant fall in CFVR (-11%; p = 0.001). The increase in coronary diameter and CBF after administration of i.c. diltiazem was comparable in placebo- and nitrate-pretreated patients. The decrease in CFVR, however, was restricted to the placebo-pretreated patients (-21%; p = 0.0004). Apparently, diltiazem attenuated the CFVR but only in the absence of nitrates. Thus, diltiazem i.c. appears to enhance myocardial oxygen supply without deleterious effects on the distal coronary perfusion pressure.

Blood Flow Velocity↗
PubMed1991

Silent ischaemia: an update on current concepts.

Angina pectoris is the cardinal symptom of coronary heart disease and is a symptom with which physicians are very familiar. The clinical diagnosis of ischaemic heart disease is often based largely on a history of typical chest or arm pain, and the major therapeutic endeavour in such patients is directed towards abolition or amelioration of angina. Indeed physicians have, at least up until recently, been confident in assuming that angina is a reliable marker of ongoing ischaemia and that success of medical or surgical treatment of coronary heart disease can be accurately gauged according to improvement or disappearance of anginal symptoms (Cohn & Braunwald, 1988). However, the results of a number of important clinical studies, reported over that last 10 to 15 years, appear to challenge these traditional medical assumptions. In many patients with coronary heart disease, acute episodes of myocardial ischaemia are frequently unaccompanied by angina, often referred to as "silent myocardial ischaemia" (Epstein et al., 1988; Fox, 1988; Cohn, 1985; Maseri, 1985). It has to be pointed out that not all painless ischaemic episodes are truly silent. Instead of experiencing pain during some episodes of acute myocardial ischaemia, patients may, on occasion, instead report symptoms such as dyspnoea or palpitations (these symptoms being known as "anginal equivalents") (Cohn & Braunwald, 1988). Nevertheless, the great majority of painless ischaemic episodes are, truly silent and not accompanied by "anginal equivalents", which has led to the trend in the recent literature to regard the terms "silent" and "painless" myocardial ischaemia as synonymous.

Coronary Disease↗
PubMed1991

Coronary balloon angioplasty: a technique that is here to stay.

In this article, developments in the technique of percutaneous transluminal coronary angioplasty (PTCA) since its introduction in 1977 as well as current trends and likely future directions of the technique are outlined. Over the last 6 or 7 years, there has been a dramatic widening of the applications PTCA to include patients with complex anatomic lesions and adverse clinical features. Despite the large percentage of such difficult cases currently presenting for PTCA, an initial success rate in excess of 90% is achieved. Increased operator experience and continuing refinements in angioplasty technology are important factors in this continuing success of PTCA. Early restenosis remains the major drawback of the technique; this complication is usually treated by repeat PTCA. Available information indicates that the long-term outcome of patients after successful PTCA is excellent, with a low incidence of late restenosis and progression of disease. The relative efficacy of PTCA and coronary bypass surgery in patients with multivessel disease is, at present, uncertain.

Angioplasty, Balloon, Coronary↗
PubMed1991

Mechanisms of painless myocardial ischaemia.

The mechanisms responsible for the frequent absence of pain during episodes of acute myocardial ischaemia are poorly understood. The severity and duration of ischaemia are inadequate predictors of painless ischaemia, and thus it appears likely that important additional mechanisms must be involved. One such mechanism that may be operating in some patients is a generally deficient perception of painful stimuli. Destruction of afferent nerve fibres subserving cardiac nociception is a relevant consideration in some patients with diabetes mellitus and silent ischaemia. Psychological factors may also, in some patients, be important in modulating the ischaemic stimulus. The role of endorphins in the perception of cardiac ischaemic pain is uncertain. It is unlikely that the mechanisms responsible for painless myocardial ischaemia vary from patient to patient and even within the same patient from week to week or from day to day.

Chest Pain↗
PubMed1990

Ambulatory 24 hour intraoesophageal pH and pressure recordings v provocation tests in the diagnosis of chest pain of oesophageal origin.

Fifty patients with non-cardiac chest pain underwent 24 hour intraoesophageal pH and pressure recording and provocation tests to determine the relative value of both techniques in establishing the oesophageal origin of the chest pain. Twenty six patients (52%) had at least one positive provocation test: the acid perfusion test was positive related in 18 patients (36%), the edrophonium test in 16 patients (32%), the vasopressin test in five patients (10%), and the balloon distension test (performed in only 20 patients) in one (5%). The 24 hour pH and pressure recording correlated spontaneous chest pain attacks with abnormal motility or gastro-oesophageal reflux in 19 patients (38%). Fourteen of these patients also had at least one positive provocation test. Therefore, 24 hour pH and pressure recordings are only slightly better than a set of provocation tests in identifying the oesophagus as the cause of chest pain (10% diagnostic gain). In the case of oesophageal chest pain, however, 24 hour recording appeared to be the only way to identify the nature of the underlying oesophageal abnormality that caused the spontaneous pain attacks--for example, gastro-oesophageal reflux, motility disorders, or irritability of the oesophagus.

Adult↗
PubMed1990

Percutaneous transluminal valvuloplasty of calcific aortic stenosis in elderly patients. Role of noninvasive evaluation by Doppler echocardiography.

Between October 1986 and January 1989, 57 attempts of percutaneous transluminal valvuloplasty were made in 51 elderly patients, mean age 76.7 +/- 6.2 years, with symptomatic aortic stenosis; this included 3 failures and 6 repeat valvuloplasties. The procedure resulted in a significant immediate decrease of the peak-to-peak transaortic pressure gradient from 94.6 +/- 26.5 to 42.6 +/- 17.9 mm Hg (p less than 0.002) and an increase of the surface of the aortic valve from 0.4 +/- 0.1 to 0.6 +/- 0.2 cm2 (p less than 0.001). Cardiac output remained unchanged: 3.8 +/- 0.9 vs 3.8 +/- 0.8 lit/min. Complications included local vascular injury requiring surgical repair in 7 patients, cerebral events in 3 patients and disruption of the aortic annulus, the aortic wall and the pulmonary artery each in 1 patient, and resulted in 4 in-hospital deaths (8%). Follow-up data were available for all patients for a mean duration of 12.7 +/- 5.4 months. Fifteen patients (30%) died on average 9.0 +/- 4.9 months after discharge. Recurrence of symptoms and early restenosis were documented in the majority of the patients. Restenosis was successfully treated by repeat valvuloplasty in 4 and by valve replacement in 4 patients. Doppler echocardiography predicted the severity of the aortic stenosis before valvuloplasty and was very useful to assess follow-up results. Because of the limited hemodynamic results, the numerous procedural complications and the development of early restenosis balloon valvuloplasty of aortic stenosis should be restricted to selected symptomatic elderly patients.

Aged↗
PubMed1989

Effect of intravenous diltiazem on myocardial ischemia occurring during percutaneous transluminal coronary angioplasty.

To investigate the antiischemic efficacy of intravenously administered diltiazem, 42 patients were randomly allocated to receive placebo or active treatment before 1-vessel percutaneous transluminal coronary angioplasty (PTCA). The development of myocardial ischemia was studied using subjective (pain) and objective (electrocardiography) parameters. Pretreatment with intravenous diltiazem resulted in a significantly delayed onset of ischemic pain and ST-segment elevation; these variables also returned to baseline earlier after balloon deflation. Thus, intravenous diltiazem prevents or delays the onset of myocardial ischemia during repetitive transient coronary occlusions; improvement of the myocardial blood flow distal to the coronary occlusion or impedance of calcium entry into the ischemic cell are considered as possible mechanisms. Because PTCA is increasingly used in patients with poor left ventricular function and more extensive disease, and because recent evidence suggests that better PTCA results could be obtained by the use of longer inflation times, the addition of diltiazem to the classic armamentarium could be beneficial.

Angina Pectoris↗
PubMed1989

Fatal aortic rupture: an unusual complication of percutaneous balloon valvuloplasty for acquired valvular aortic stenosis.

A case report complicated by a perforation of the ascending aorta during percutaneous balloon valvuloplasty for acquired aortic stenosis in a bicuspid aortic valve is presented. The clinical and pathological findings are discussed. It is suggested that in patients with hard calcified valve cusps and calcifications of the aortic annulus balloon sizes exceeding the aortic diameter should be avoided.

Aged↗
PubMed1988

Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis.

A consecutive series of 192 patients (121 men and 71 women, mean age 59 years, range 28 to 82) with isolated, severe valvular aortic stenosis was with isolated, severe valvular aortic stenosis was analyzed retrospectively to determine the relation of angina pectoris and coronary risk factors to angiographically significant coronary artery disease (CAD). Significant CAD (diameter reduction greater than or equal to 50%) was found in 47 patients (24%). Angina was present in 83% of them, but it was also found in 61% of the non-CAD patients. This symptom had as a result a low positive predictive value (31%). Of the patients without angina (n = 65) 12% had significant CAD. The negative predictive value of angina alone was thus 88%. By using multivariate logistic regression, a risk score could be calculated based on angina, age and sex, which increased the negative predictive value to 95%. It was concluded that coronary arteriography can only be omitted in severe aortic valvular stenosis, when patients have no angina and when they are less than 40 years of age for men and less than 50 years for women. For all other cases, coronary arteriography should be recommended.

Adult↗