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Biomedical subjects

N Danchin

Publications and source records attributed to N Danchin.

At least 199 records · Page 11Linked to original sources
PubMed1993

Patient, lesion, and procedural variables as risk factors for luminal re-narrowing after successful coronary angioplasty: a quantitative analysis in 653 patients with 778 lesions. Multicenter European Research Trial with Cilazapril after Angioplasty to prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) Study Group.

Follow-up angiography at 6 months was obtained in 94% of the 693 patients (778 successfully dilated coronary lesions) enrolled in the Multicenter European Research trial with Cilazapril after Angioplasty to prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) trial--a double-blind, placebo-controlled trial--to study the effects of cilazapril 5 mg b.i.d. on restenosis [defined as the mean loss in minimal luminal diameter during follow-up, assessed by an interpolated edge detection technique (coronary angiography analysis system)] and long-term clinical outcome. No statistically significant difference could be detected between treatment and placebo groups with regard to clinical outcome or restenosis. The purpose of this ancillary study was to determine which, if any, patient, lesion, or procedural factors were predictive of restenosis. The identification of such factors could be helpful in the selection of lesions suitable for angioplasty and, if modifiable or controllable, potentially reduce restenosis. A stepwise multiple linear regression analysis was performed to identify independent predictors of restenosis. The following variables were retained in the model in order of significance: (a) relative gain (difference between the minimal luminal diameter pre- and post-percutaneous transluminal coronary angioplasty (PTCA), normalized for vessel size), (b) minimal luminal diameter post-PTCA, and (c) dilatation of another vessel than right coronary artery. The fit of the model was poor; where the predicted change in minimal luminal diameter was < 0.1 mm, 0.1-0.3 mm, > 0.3 mm, the corresponding percent correct classification was 30, 52, and 55%. The present study illustrates that the restenosis phenomenon cannot accurately be predicted by patient, lesion, and procedural variables.

Angioplasty, Balloon, Coronary↗
PubMed1993

[Outcome of Doppler parameters of left ventricular systolic function during atrial stimulation as a function of coronary disease].

The authors studied the effects of transoesophageal atrial pacing on Doppler parameters derived from flow in the left ventricular out flow tract (maximal velocity (V max), velocity-time integral (VTI), mean acceleration of aortic flow (Acc), acceleration force (AF) of the left ventricle). These parameters were recorded in patients with normal left ventricular wall motion at rest, with and without coronary disease. Eight patients had angiographically normal coronary arteries (Group 1) and 21 had coronary disease (Group 2) including 10 with an isolated stenosis of the left anterior descending artery (Group 2a) and 11 with multivessel disease (Group 2b). The heart rate was increased by increments of 20 beats per minute from 90 to 130 each minute. In coronary patients, atrial pacing resulted in a fall in V max from 0.99 +/- 0.15 to 0.90 +/- 0.12 m/s, p < 0.0005 and in AF from 23.1 +/- 6.3 to 19.6 +/- 4.8 Kdynes, p < 0.0005, whereas the Acc remained stable (13.51 +/- 3.27 and 13.53 +/- 2.47 m/s/s, NS). Conversely, V max (1.04 +/- 0.11 and 1.04 +/- 0.11, NS) and AF (25.2 +/- 5.7 and 26.3 +/- 6.7, NS) were unchanged in normal controls and the Acc improved from 13.87 +/- 3.61 to 17.04 +/- 3.49, (p < 0.05). The VTI fell significantly in both groups. The percentage variations of V max, Acc and AF were significantly different in coronary patients compared with normal controls. There were no differences between the two coronary subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Bacterial endocarditis occurring on native valves: identification of risk patients].

Analysis of the large series of infective endocarditis reported in the medical literature allows identification of the principal poor prognostic factors. Of the clinical factors, the worst prognosis is observed in the most elderly patients, in those with persistence of the infections syndrome despite antibiotic therapy, those with cardiac failure or complications, principally arterial embolism (cerebral or peripheral). From the anatomical viewpoint, aortic valve endocarditis seems to carry a slightly worse prognosis than mitral valve endocarditis, but the extension of infection to the paravalvular region is the complication most likely to aggravate the condition. The infecting organism is also an important factor: non-streptococci, especially staphylococcal endocarditis, have a much worse prognosis. Finally, echocardiographic analysis of the vegetations allows identification of the cases with the highest risk of embolism: those with vegetations over 10 mm in size which appear very mobile. The appearance of signs of poor haemodynamic tolerance, the persistence of an infectious syndrome despite appropriate medical therapy and the detection of large, mobile vegetations by echocardiography should lead to early surgical referral: this attitude now provides good immediate and long-term results.

Age Factors↗
PubMed1993

[Immediate and long-term results of coronary transluminal angioplasty in patients under 35 years of age].

Over an eleven year period, 57 patients under 35 years of age underwent percutaneous transluminal coronary angioplasty (PTCA). The features of the study population were: 55 men and 2 women, average age 32 +/- 3 years; unstable angina in 30%, previous myocardial infarction in 53%, average left ventricular ejection fraction 59 +/- 12%, single vessel disease in 84%. A total of 63 vessels were dilated. The primary success rate was 81% (72% in the first 29 patients compared with 89% in the latter 28 patients, p = 0.1). The following complications were observed: peri-procedural infarction (4 cases), emergency coronary bypass surgery (4 cases), no fatalities. During follow-up (average 6 +/- 3 years), of the 43 patients who underwent control coronary angiography in the last 6 months, 14 (33%) had angiographic restenosis. The long-term outcome was marked by 5 coronary bypass operations (3 for restenosis, 1 after failure of PTCA and 1 for progression of the coronary disease), 8 PTCAs for a new lesion due to progression of the coronary disease, 2 deaths and 2 non-lethal infarctions. The 10 year survival was 96 +/- 3% and the survival rate without cardiac events (infarction, surgical revascularisation or repeat PTCA) was 62 +/- 10% at 10 years. Of the 54 survivors, 50 (92%) have no angina, and 44 (81%) continue to take antiischaemic drug therapy. Of the 50 patients who were in full employment, 37 (74%) have gone back to full-time working and 8 (16%) have taken part-time jobs. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Irreversible auriculo-ventricular block of viral origin].

Transitory disturbances of atrioventricular conduction are an usual feature of the acute phase of viral myocarditis. In contrast, the onset of complete heart block is rarer. The authors report a case of permanent heart block of progressive onset in a context of infectious mononucleosis in a 29-year-old male, requiring fitting with a permanent pacemaker. A long term follow-up visit confirmed the irreversible nature of the conduction disturbance.

Adult↗
PubMed1992

[Vasomotor disorders in the atherosclerotic coronary artery. Are there practical repercussions today?].

The 1980s have brought increasing evidence that coronary vasomotricity has a major role in the pathophysiology of stable angina pectoris. Specifically, it has been shown that mediators such as serotonin have opposite effects on normal and atherosclerotic coronary arteries, resulting in vasodilation and increased coronary blood flow in the former and vasoconstriction with decreased flow in the latter. Other studies have shown that, even in patients with stable angina, coronary vaso-constriction is likely to trigger clinical episodes of angina. In this regard, the adjunction of coronary vasodilator medications to medications reducing myocardial demand might prove useful in patients with stable angina.

Acetylcholine↗
PubMed1992

[Transluminal coronary angioplasty in patients over 75 years of age. Immediate and long-term results].

Over a 4-year period, 120 transluminal coronary angioplasties were performed in 102 patients older than 75 years. There were 56 men and 46 women aged from 75 to 89 years (mean: 78 +/- 3 years) presenting with the following characteristics: left ventricular ejection fraction 60 +/- 11 percent; severe angina (class III or IV) 86 percent; history of myocardial infarction 43 percent; one-vessel lesion 39 percent; 66 percent of the arteries dilated were calcified. Altogether, 158 vessels (1.3 per procedure) were dilated: 1 vessel in 74 percent of the patients, 2 in 20 percent and 3 in 6 percent. The primary success rate was 80 percent per lesion (126/158 lesions) and 77 percent per procedure (92/120 procedures). This primary success rate was significantly higher when the stenosis dilated was not calcified (88 versus 75 percent, P < 0.05) and in cases with stenosis rather than complete occlusion (83 versus 53 percent, P < 0.01). Three patients died (3 percent) and 9 (7.5 percent) developed infarction with Q wave, but no emergency bypass was needed. The first 79 patients could be followed up for a mean period of 23 +/- 13 months (range: 8-61 months), and no patient was lost sight of. During that period, 11 patients died (including 7 of cardiac cause), 2 had a non-lethal infarction, 7 underwent distant aortocoronary bypass and 18 had a second angioplasty for restenosis. The long-term survival rate (Kaplan-Meier) was 83 +/- 6 percent at 4 years (90 percent when the angioplasty was successful and 73 percent when it failed; P < 0.02). Among the 65 survivors, 73 percent no longer had angina, 96 percent are in the New York Heart Association class I or II, and 92 percent are still on oral anti-angina therapy. Thus, transluminal coronary angioplasty can be performed in very old patients with good efficacy and an acceptable complication rate. The improvement obtained persists for a long time when the angioplasty is successful.

Aged↗
PubMed1992

[Angioplasty of coronary arteries in chronic coronary insufficiency].

During the past five years transluminal angioplasty of the coronary arteries has considerably developed due to the improvement of the technology. Beside one-vessel lesions, its indications have been extended to multiple vessel pathology, chronic obturation and lesions found in patients who had previously undergone aorto-coronary bypass, as well as in those who had unstable angina, or in the elderly. Despite the quality of the initial results and the relatively low accident rate, this method has raised numerous problems: (I) unintentional optimization of the results, (II) unexplained postangioplastic incidents, (III) high rate of early restenosis, (IV) encouraging long-term results but marked by numerous coronary "events", (V) increasing cost of the procedure, (VI) disappointing resumption of work and, above all, (VII) lack of good randomized trials to establish the exact indications of angioplasty in the treatment of chronic heart failure. The new techniques of cardiocirculatory assistance or excision of atheroma have only started to be evaluated.

Angioplasty, Balloon, Coronary↗
PubMed1992

Right ventricular overload and induced sustained ventricular tachycardia in operatively "repaired" tetralogy of Fallot.

The aim of the study was to evaluate the main predictors of the inducibility of sustained ventricular tachycardia (VT) in patients with repaired tetralogy of Fallot. Thirty-five patients (age 12 +/- 6 years) underwent right-sided cardiac catheterization, echocardiography, radionuclide angiography and ventricular stimulation; 10 had (group 1) and 25 had no (group 2) sustained VT. Group 1 patients were significantly older at the time of surgery and had longer follow-up periods (7 +/- 3 vs 4 +/- 4 years, p less than 0.02; and 12 +/- 4 vs 5 +/- 2 years, p less than 0.001, respectively). Right ventricular (RV) systolic pressure, end-systolic and end-diastolic normalized RV volumes were higher in group 1 (48 +/- 14 vs 38 +/- 11 mm Hg, p less than 0.05; 1.23 +/- 0.2 vs 0.86 +/- 0.17, p less than 0.001; and 2.35 +/- 0.37 vs 1.70 +/- 0.22, p less than 0.001, respectively). RV end-diastolic pressure, left ventricular and RV ejection fractions were similar in the 2 groups. A stepwise discriminant analysis was made to predict patients with inducible sustained VT (group 1): Time period from surgery to follow-up (p less than 0.001), normalized RV end-systolic volume (p less than 0.002) and RV systolic pressure (p = 0.01) were higher in group 1 and allowed classification of 90% of patients in group 1 and 96% in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Percutaneous transluminal coronary angioplasty in patients more than 75 years old: early and long-term results.

Over 4 yr, 102 consecutive patients more than 75 yr old (56 men, 46 women; mean age 78 +/- 3 years, range: 76-89 years) underwent 120 percutaneous transluminal coronary angioplasty procedures. At baseline, 86% had severe anginal symptoms (Canadian class III or IV), 43% had a history of prior myocardial infarction; 61% had multivessel coronary artery disease, and mean left ventricular ejection fraction was 60 +/- 11%. Calcifications were observed on 66% of the dilated arteries. A total of 158 vessels (1.3 vessel per procedure) were attempted: 1 vessel in 89 procedures (74%), 2 vessels in 24 (20%) and 3 vessels in 7 (6%). The primary success rate was 80% per lesion (126/158) and 77% per procedure (92/120). Complications included 3 deaths (3%), 9 Q-wave infarctions (7.5%) and there was no emergency coronary bypass surgery. The primary success rate was significantly related to the absence of coronary calcifications on the dilated segment (88% versus 75%, p < 0.05) and to the initial patency of the dilated artery (subtotal stenosis: 83% versus total occlusion: 53%, p < 0.05). Follow-up data were obtained in the 79 consecutive patients with a duration of follow-up exceeding 8 months. The mean duration of follow-up was 23 +/- 13 months (range 8 to 61 months). No patient was lost to follow-up; 11 patients died (cardiac causes: 7), 2 had a non-fatal infarction, 7 had aortocoronary bypass surgery and 18 had repeat percutaneous transluminal coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Therapeutic dissection after successful coronary balloon angioplasty: no influence on restenosis or on clinical outcome in 693 patients. The MERCATOR Study Group (Multicenter European Research Trial with Cilazapril after Angioplasty to prevent Transluminal Coronary Obstruction and Restenosis).

OBJECTIVES: The objective of this study was to examine the relation between an angiographically visible coronary dissection immediately after successful coronary balloon angioplasty and a subsequent restenosis and long-term clinical outcome. BACKGROUND: The study population comprised all 693 patients who participated in the MERCATOR trial (randomized, double-blind, placebo-controlled restenosis prevention trial of cilazapril, 5 mg two times a day). METHODS: Cineangiographic films were processed and analyzed at a central angiographic core laboratory, without knowledge of clinical data, with use of an automated interpolated edge detection technique. Dissection was judged according to the National Heart, Lung, and Blood Institute classification. Angiographic follow-up was obtained in 94% of patients with 778 lesions. Two approaches were used to assess the restenosis phenomenon: 1) categoric, using the traditional cutoff criterion of greater than 50% diameter stenosis at follow-up, and 2) continuous, defined as absolute change in minimal lumen diameter (mm) between the postcoronary angioplasty and follow-up, adjusted for the vessel size (relative loss). Clinical outcome was ranked according to the most serious adverse clinical event per patient during the 6-month follow-up period, ranging from death, nonfatal myocardial infarction, coronary revascularization and recurrent angina requiring medical therapy to none of these. RESULTS: Dissection was present in 247 (32%) of the 778 dilated lesions. The restenosis rate was 29% in lesions with and 30% in lesions without dissection (relative risk 0.97; 95% confidence interval 0.77 to 1.23). The relative loss in both groups was 0.10 (mean difference 0; 95% confidence interval -0.03 to 0.03). Clinical outcome ranged from death in 4 patients (0.9%) without dissection and 1 patient (0.4%) with dissection; nonfatal myocardial infarction in 4 (0.9%) without and 8 (3.2%) with dissection; coronary revascularization in 73 (16.6%) without and 32 (12.7%) with dissection; recurrent angina requiring medical therapy in 88 (20%) without and 47 (18.7%) with dissection to no serious adverse event in 272 (61.7%) without and 114 (65.1%) with dissection. CONCLUSIONS: These data indicate that a successfully dilated coronary lesion with an angiographically visible dissection is no more likely to develop restenosis, and is not associated with a worse clinical outcome, at 6-month follow-up than is a dilated lesion without visible dissection on the post-balloon angioplasty angiogram.

Angioplasty, Balloon, Coronary↗
PubMed1992

[Relationship between right ventricular ejection fraction and pulmonary pressure in man].

This clinical study analysed the changes in right ventricular ejection fraction induced by changes in right ventricular afterload using a new thermodilution catheter linked to a rapid response computer which allowed instantaneous measurements of the right ventricular ejection fraction. The first group comprised 16 patients referred for coronary angioplasty with single vessel disease (isolated proximal stenosis of one of the two main branches of the left coronary artery) and a normal left ventricular ejection fraction (> or = 55%) and mean pulmonary artery pressure of < 25 mmHg: right ventricular ejection fraction and mean pulmonary artery pressure were measured under basal conditions and after 60 seconds' coronary occlusion with the balloon catheter in order to assess the effects of the reactional increase in afterload on the right ventricular ejection fraction. The second group comprised 11 patients with dilated primary cardiomyopathy with decreased left ventricular ejection fraction (< 50%) and mean pulmonary artery pressure > or = 25 mmHg: the right ventricular ejection fraction and mean pulmonary artery pressure were measured under basal conditions and after intravenous trinitrin (performed to evaluate the pulmonary reaction to vasodilators) in order to analyse the effects of the reduction of afterload on right ventricular ejection fraction. Negative linear correlations were observed between the right ventricular ejection fraction and mean pulmonary artery pressure under basal conditions (r = -0.72; p < 0.005) and between the right ventricular ejection fraction and mean pulmonary artery pressure after changing the conditions of afterload (r = -0.82; p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Measurement of right ventricular dP/dt. A simultaneous/comparative hemodynamic and Doppler echocardiographic study].

Right ventricular systolic function is difficult to assess by Doppler echocardiography. We studied 14 patients with tricuspid regurgitation on Doppler echocardiographic examination with the object of determining an index of right ventricular contractility based on the continuous Doppler signal of the regurgitant jet. The rate of increase in right ventricular pressure was calculated between 2 points, V1 and V2, situated on the ascending limb of the velocity profile of the tricuspid regurgitation and compared with the dP/dt max measured simultaneously at right heart catheterisation. The different values of V1 and V2 were: 0 and 1 m/s, 0 and 2 m/s, 0.5 and 1.5 m/s, 1 and 2 m/s and 0.5 and 2 m/s. An excellent correlation was observed between the catheter dP/dt max and the rate of increase in pressure measured by Doppler between 0 and 2 m/s (r = 0.93; p = 0.0001) and between 0.5 and 2 m/s (r = 0.93; p = 0.0001). The correlation was not as close between 0 and 1 m/s (r = 0.69; p = 0.048) and there was no correlation with the measurements between 0.5 and 1.5 m/s and between 1 and 2 m/s. Doppler echocardiography could therefore be used for non-invasive assessment of right ventricular systolic function in clinical practice.

Blood Pressure↗
PubMed1992

[Indications for coronarography and coronary angioplasty during the 1st week after myocardial infarction].

There is little data available on the precise indications of coronary angiography and myocardial revascularisation during the first week after myocardial infarction. Mechanical complications (subacute rupture, ventricular septal defect, ruptured mitral chordae), usually require emergency surgery: when the patient's haemodynamic status permits, preoperative coronary angiography is desirable. Recurrent ischaemia may be treated by urgent coronary angiography--dilatation; nevertheless, the results of this type of procedure are associated with high mortality and morbidity and it would seem better practice to start with repeat intravenous thrombolytic therapy: coronary angiography can then be performed in a less acute situation with a view to angioplasty. Finally, in most cases of uncomplicated infarctions, functional investigations such as exercise stress testing coupled with radioisotopic methods, may be usefully performed before coronary angiography to demonstrate any residual ischaemia justifying a myocardial revascularisation procedure: under these conditions, it seems more realistic to envisage coronary angiography 8 to 10 days after the initial coronary event.

Angioplasty, Balloon, Coronary↗