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Biomedical subjects

L Piérard

Publications and source records attributed to L Piérard.

At least 19 recordsLinked to original sources
PubMed2006

[Anemia and heart failure].

The prevalence of heart failure is increasing. Anemia is often present, particularly in severe cases. The Fick equation illustrates the relationship between anemia and heart failure. The concepts of cardiorenal syndrome and erythropoietin resistance are parts of the physiopathology. Anemia is associated with a bad prognosis in heart failure. Nevertheless, it is too early to know precisely whether anemia represents a simple marker of severity or if specific treatment, especially with erythropoietin, is useful in terms of morbidity and mortality. Current guidelines recommend the correction of secondary causes when anemia is present in a heart failure patient.

Anemia↗
PubMed2006

[Arrhythmogenic right ventricular dysplasia].

Arrhythmogenic right ventricular dysplasia is an unfrequent disease that associates ventricular tachycardia with left bundle branch block morphology and right ventricular fibro-fatty degeneration. The etiology, pathogenesis, criteria for diagnosis and treatment are discussed.

Arrhythmogenic Right Ventricular Dysplasia↗
PubMed2005

[Replacement of the descending aorta sparing the aortic valve: the David's operation].

We report the case of an ascending aortic aneurysm involving the aortic root, with a functionally competent bicuspid aortic valve, treated by the David's operation. This operation allows to fix the aortic root pathology, whilst preserving the native aortic valve. The technical aspects, surgical indications, and potential benefits of this operation are reviewed.

Adult↗
PubMed2005

[Inflammation and atherosclerosis: state of the art in 2004-2005].

Inflammation plays a pivotal role in atherosclerosis; being present in all steps of the pathology, from initiation to the progression of the lesions to the development of vulnerable plaques and clinical destabilisation. Therefore, systemic markers of inflammation have emerged to predict future cardiovascular events in patients initially admitted for unstable syndromes, but also in healthy subjects. These markers can identify high risk patients and they are used to adapt ideal treatment to the patient's profile. The implication of the inflammation process in the treatment strategies is described in the last part of the article.

Atherosclerosis↗
PubMed2004

[Syncope].

Syncope remains a clinical challenge. Accurate history taking, physical examination and EKG are mainstays of the diagnosis work up. The most important parameter for prognosis and requiring aggressive management is a structural heart disease. Patient without cardiopathy presenting multiple episodes may be candidate for tilt testing and loop EKG recorder.

Diagnosis, Differential↗
PubMed2004

[The Brugada syndrome].

The Brugada syndrome, a genetically transmitted disease according to an autosomal mode with a variable penetrance, is responsible for sudden death secondary to polymorphic ventricular tachycardia. The diagnosis is based on a typical electrocardiographical paturn that combines a right bundle branch block with ST elevation in the right precordial leads. In high risk patients, the automatic implantable defibrillator has the unique capability to protect against the occurrence of ventricular arrhythmias.

Death, Sudden↗
PubMed2003

Alteration of left ventriculo-arterial coupling and mechanical efficiency during acute myocardial ischemia.

AIM: Myocardial revascularisation being frequently performed during acute myocardial ischemia, in a hostile hemodynamic environment, we evaluated left ventriculo-arterial (VA) coupling, left ventricular (LV) mechanical efficiency, and the mechanical properties of the systemic vasculature during acute myocardial ischemia. METHODS: In 6 pigs, vascular properties [characteristic impedance (R(1)), peripheral resistance (R(2)), compliance (C), inductance (L), arterial elastance (E(a))] were estimated with a windkessel model. LV function was assessed by the slope (E(es)) of end-systolic pressure-volume relationship (ESPVR), and stroke work (SW) - end-diastolic volume (EDV) relation. Pressure-volume area (PVA) was referred to as myocardial oxygen consumption. VA coupling was defined as E(es)/E(a), and mechanical efficiency as SW/PVA. After baseline recordings, the left anterior descending coronary artery was ligated and hemodynamic measures obtained every 30 minutes for 3 hours. Data are expressed as mean (SEM). RESULTS: Coronary occlusion induced an ESPVR rightward shift, and decreased E(es) from 3.67 (0.33) to 1.92 (0.20) mmHg/ml and the slope of the SW - EDV relationship from 72.3 (3.4) to 40.4 (4.5) mmHg (p<0.001), while E(a) increased from 3.33 (0.56) to 4.65 (0.29) mmHg/ml (p<0.005). This was responsible for a dramatic alteration of VA coupling from 1.22 (0.11) to 0.44 (0.07), (p<0.001). While R2 increased from 1.72 (0.30) to 2.38 (0.16) mmHg x s x ml(-1) (p<0.05) and C decreased from 0.78 (0.16) to 0.46 (0.08) ml/mmHg (p<0.05), R(1) and L were unchanged. Coronary occlusion decreased SW from 4056 (223) to 2580 (122) mmHg.ml (p<0.001), while PVA and SW/PVA decreased from 5575 (514) to 4813 (317) mmHg x ml (NS), and from 0.76 (0.04) to 0.57 (0.03) (p<0.001), respectively. CONCLUSION: Acute myocardial ischemia severely altered left ventriculo-arterial coupling and LV mechanical efficiency. Impaired left VA coupling was due to a combination of augmented arterial elastance, secondary to early vasoconstriction later associated with decreased arterial compliance, and decreased LV contractility.

Animals↗
PubMed2003

[Rapid analysis of circulating cardiac natriuretic peptides. A new contribution to the diagnosis, regular treatment and prognosis of cardiovascular diseases].

Only about half of the diagnoses of heart failure are correct. The limitations of clinical judgment and complementary investigations are described in this article. Recently, BNP was found to be a good biological marker of ventricular dysfunction. Rapid and reliable BNP measurement is now available and the clinical value of this peptide was examined in many studies. The role of BNP in the diagnosis and management of heart failure will be increasing.

Atrial Natriuretic Factor↗
PubMed2002

[Clinical study of the month. Effects of valsartan in chronic heart failure: the VAL-HeFT study].

Current guidelines recommend drugs which reduce neurohormonal activation as standard therapy for heart failure: angiotensin converting-enzyme (ACE) inhibitors, beta-blockers and spironolactone. The Valsartan Heart Failure Trial (Val-HeFT) tested the efficacy of the angiotensin-receptor blocker valsartan in addition to prescribed therapy. A total of 5010 patients with heart failure of NYHA class II, III or IV were randomly assigned to receive 160 mg of valsartan or placebo twice daily. Further angiotensin antagonism by valsartan did not improve survival but was beneficial in terms of morbidity and mortality, because of reduced rate of hospitalization, significant improvements in NYHA class, ejection fraction, signs and symptoms of heart failure, and quality of life. Valsartan had highly favourable effects in patients not receiving ACE inhibitors but an adverse effect in patients receiving both ACE inhibitors and beta-blockers. The effects of adding valsartan are depending on the importance of previous neurohormonal inhibition.

Adrenergic beta-Antagonists↗
PubMed2002

[Clinical case of the month. Type A aortic dissection after valve replacement].

The risk for aortic dissection or further dilation of the ascending aorta exists after aortic valve replacement. We present a case of acute aortic dissection following replacement of the aortic valve. The management and treatment of dilated ascending aorta associated with aortic valve disease are reviewed and discussed.

Acute Disease↗
PubMed2001

[Cardiovascular rehabilitation].

In industrialized countries, coronary artery disease is the leading cause of mortality. Cardiovascular rehabilitation is one of the most important components of secondary prevention and is mainly prescribed after acute myocardial infarction or coronary artery revascularization. The aims of rehabilitation are not only the improvement of functional capacity but also the correction of risk factors and assistance to social and professional reintegration. There are numerous indications, including not only patients with coronary artery disease but also patients with heart failure and those who underwent cardiac surgery or heart transplantation. Cardiac rehabilitation consists in 3 successive stages. The first is performed during hospital stay. The two others take place in an approved center of multidisciplinary cardiac rehabilitation. The intensity of exercise is determined for each individual patient from the results of stress testing. The beneficial effects are well established: reduction in morbidity and mortality, improvement of quality of life and of pulmonary, cardiac, muscular and metabolic parameters. Its efficacy is only maximal when patients continue performing exercise regularly.

Coronary Disease↗
PubMed2001

[Echocardiography in athletes].

Sporting activities and athletic training induce not only physiologic, but also morphologic changes. Dynamic training is associated with an enlarged left ventricle and a small increase in wall thickness. Athletes who perform predominantly static or isometric exercise have increased wall thickness with normal left ventricular internal diameter. Systolic and diastolic function are normal. Echocardiography is the method of choice to identify and follow the athlete's heart and to distinguish between physiologic and pathologic hypertrophy.

Adult↗
PubMed2000

Stenosis of a mechanical mitral prosthetic valve in a patient with systemic lupus erythematosus.

A young woman with systemic lupus erythematosus (SLE) developed progressive heart failure several years after mitral valve replacement with a Björk-Shiley prosthesis for treating mitral stenosis due to Libman-Sacks endocarditis. She was admitted to the hospital with pulmonary oedema. Transoesophageal echocardiography revealed stenosis of the mitral prosthesis, which was covered by fibrous tissue. Replacement of the prosthesis was done but the patient died from cerebral haemorrhage three days later. Although three cases of prosthetic valve dysfunction in SLE have been documented so far, this is to our knowledge the first report of a SLE recurrence on a tilting disc mechanical valve.

Adult↗
PubMed2000

[How I investigate ... thoracic artery dissection].

Thoracic aortic dissection constitutes an acute pathology that requires a rapid, accurate and reliable diagnosis. The authors describe and illustrate the advantages and limitations of imaging modalities used in this pathology.

Aortic Dissection↗
PubMed2000

[Diagnosis and treatment of heart failure].

The incidence of heart failure is consistently progressing among our population; it now represents a major problem of public health and is extremely costly for our health system. Over recent years, several well controlled studies have been devoted to heart failure. They allow to propose guidelines which fulfill all the requirements of Evidence-Based Medicine. These recommendations, however, are not always easy to apply in the individual patient. Guidelines for the sometimes difficult diagnosis of heart failure will be reviewed. On the basis of the results of large controlled clinical trials, we shall envisage the comprehensive treatment of a heart failure patient taking into account the functional class as well as some individual characteristics (age, presence of hypertension, atrial fibrillation, renal insufficiency). The different pharmacologic agents which have demonstrated efficacy will be reviewed and the strategies to avoid the potential pitfalls of their simultaneous use will be indicated. The key role of the general practitioner in the surveillance and titration of heart failure therapy will be emphasized.

Adrenergic beta-Antagonists↗
PubMed1999

NC100100, a new echo contrast agent for the assessment of myocardial perfusion--safety and comparison with technetium-99m sestamibi single-photon emission computed tomography in a randomized multicenter study.

BACKGROUND AND HYPOTHESIS: Myocardial contrast echocardiography using second-generation agents has been proposed to study myocardial perfusion. A placebo-controlled, multicenter trial was conducted to evaluate the safety, optimal dose, and imaging mode for NC100100, a novel intravenous second-generation echo contrast agent, and to compare this technique with technetium-99m sestamibi (MIBI) single-photon emission computed tomography (SPECT). METHODS: In a placebo-controlled, multicenter trial, 203 patients with myocardial infarction > 5 days and < 1 year previously underwent rest SPECT and MCE. Fundamental and harmonic imaging modes combined with continuous and electrocardiogram-- (ECG) triggered intermittent imaging were used. Six dose groups (0.030, 0.100, and 0.300 microliter particles/kg body weight for fundamental imaging; and 0.006, 0.030, and 0.150 microliter particles/kg body weight for harmonic imaging) were tested. A saline group was also included. Safety was followed for 72 h after contrast injection. Myocardial perfusion by MCE was compared with myocardial rest perfusion imaging using MIBI as a tracer. RESULTS: NC100100 was well tolerated. No serious adverse events or deaths occurred. No clinically relevant changes in vital signs, laboratory parameters, and ECG recordings were noted. There was no significant difference between adverse events in the NC100100 (25.7%) and in the placebo group (17.9%, p = 0.3). Intermittent harmonic imaging using the intermediate dose was superior to all other modalities, allowing the assessment of perfusion in 76% of all segments. Eighty segments (96%) with normal perfusion by SPECT imaging also showed myocardial perfusion with MCE. However, a substantial percentage of segments (61-80%) with perfusion defects by SPECT imaging also showed opacification by MCE. This resulted in an overall agreement of 66-81% and a high specificity (80-96%), but in low sensitivity (20-39%) of MCE for the detection of perfusion defects. CONCLUSION: NC100100 is safe in patients with myocardial infarction. Intermittent harmonic imaging with a dose of 0.03 microliter particles/kg body weight can be proposed as the best imaging protocol. Myocardial contrast echocardiography with NC 100100 provides perfusion information in approximately 76% of segments and results in myocardial opacification in the vast majority of segments with normal perfusion as assessed by SPECT. Although the discrepancies between MCE and SPECT with regard to the definition of perfusion defects requires further investigation, MCE with NC 100100 is a promising technique for the noninvasive assessment of myocardial perfusion.

Aged↗