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Biomedical subjects

N Danchin

Publications and source records attributed to N Danchin.

At least 217 records · Page 12Linked to original sources
PubMed1992

Alcohol consumption and biological markers for alcoholism in idiopathic dilated cardiomyopathy: a case-controlled study.

The aim of this study was to compare alcohol consumption and biological markers for alcoholism in a population of 23 men (57 +/- 8 years) admitted to hospital with idiopathic dilated cardiomyopathy (DCM), and a control group of 46 men (54 +/- 8 years) with coronary artery disease, matched for age. The DCM group had a higher daily alcohol consumption (82 g/day vs. 30 g/day, P < 0.0002). This difference was greater for the consumption of wine (63 g/day in the DCM group vs. 24 g/day in the control group, P < 0.002). Duration of regular daily alcohol consumption was longer in DCM patients (34 years vs. 22 years, P < 0.01) as well as duration of heavy alcohol consumption (> 60 g/day) (25 years vs. 10 years, P < 0.001). Among the biological markers, only the serum levels of immunoglobulin A were significantly increased in the DCM group (3.7 g/l vs. 2.7 g/l, P < 0.03). In this French population, alcohol is strongly linked to DCM. Biological markers appear to be poor predictors of alcohol intoxication in this so-called 'idiopathic' myocardial disease.

Alcohol Drinking↗
PubMed1992

[Coronary angioplasty after thrombolytic therapy].

Two strategic choices are available after thrombolytic therapy: an aggressive strategy with the objective of restoring blood flow in the coronary artery responsible for the infarction or a conservative strategy, In the aggressive strategy, there is some debate about the timing of coronary angiography: immediate coronary angiography with a view to angioplasty during the same procedure whenever technically feasible or only when the artery remains occluded after thrombolysis ("salvage" angioplasty); or deferred coronary angiography and angioplasty with the objective of preventing recurrence of ischaemia, performed during the hospital phase before the patient's discharge. Besides this aggressive strategy, some cardiologists prefer to adopt a conservative attitude which consists in only performing coronary angiography and eventual revascularisation when the patients develop ischaemia during follow-up either spontaneously or during stress testing. Several randomised clinical trials performed in recent years, (TAMI, TIMI 2A and 2B, European Study, SWIFT), have all shown that there was no significant difference in survival or global left ventricular function between patients managed "aggressively" and those managed "conservatively". However, these studies are open to criticism, especially in the light of recent data about associated medical therapy which reduces the incidence of complications, especially of reocclusion. This point should be emphasised as secondary studies on subgroups have shown that the benefits of the aggressive strategy were totally lost in patients who developed reocclusion but, conversely, the outcome was much better if the angioplasty was followed by long-term success.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1992

[Emergency coronary surgery after transluminal angioplasty. Immediate results and long-term outcome of 100 operations].

The increasing application of percutaneous transluminal coronary angioplasty (PTCA) requires evaluation of emergency coronary artery surgery for complications of this procedure. In a consecutive series of 2,576 angioplasties performed between April 1980 and January 1990, 100 patients (82 men and 18 women, average age 54 +/- 10 years, 3.9%) underwent emergency coronary artery surgery because of complications. The artery involved was the left anterior descending artery in 81% of cases. The causal lesion was a dissection and/or thrombus in 95% of cases; 85% of patients were referred for surgery with acute myocardial infarction. The average delay before surgery was 110 +/- 15 minutes (interval between coronary occlusion and starting cardiopulmonary bypass) and 155 coronary grafts were implanted (1.5 per patient). The hospital mortality was 19%; the infarction rate was 57%. The left ventricular ejection fraction decreased from 63 +/- 10% (preoperatively) to 52 +/- 9% (postoperatively), p less than 0.001. Hospital mortality was significantly related to three factors, old age, unstable angina before PTCA, and cardiogenic shock or the necessity for external cardiac massage. In the subgroup of patients developing cardiogenic shock (n = 7) or requiring external cardiac massage during transfer to the operating theatre (n = 16) the mortality was 44%. Among the 81 survivors, the global 7 year survival rate was 96% (Kaplan-Meier) with 3 cardiac deaths, 2 other patients developing myocardial infarction and 4 undergoing repeat angioplasty. After an average follow-up of 55 +/- 38 months, 80% of patients are asymptomatic, 34% have no antianginal drugs and 73% of those who were previously employed have returned to work.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1992

[Endocarditis caused by heart valve prosthesis. Apropos of 35 cases].

35 cases of prosthetic valve endocarditis are reported. The diagnostic is based on clinical, echocardiographic, bacteriological and anatomical aspects. Heart failure, neurologic complications, positive culture of prosthesis, Staphylococcus aureus infection and perivalvular abscess are factors of a bad prognosis. The current therapeutic trends associate antibiotic treatment and infected prosthetic valve replacement rather for hemodynamic indications than bacteriological factors. General prognosis has a mortality of 40 p. cent. Prophylaxis of infection, although simple is necessary.

Adult↗
PubMed1992

[Coronary transluminal angioplasty after 70 years of age. Multivariate analysis of parameters influencing immediate results and long-term prognosis].

Between January 1986 and July 1990, 186 patients over 70 years of age underwent 215 transluminal coronary angioplasties. The patients' characteristics were: 117 men and 69 women; mean age 75.5 +/- 4 years (70-89 years): left ventricular ejection fraction 62 +/- 12%: 40% had previous myocardial infarction; 48% had single vessel disease; 80% had severe angina (19% Class III and 61% Class IV) and 58% of dilated vessels had calcification. In all, 276 vessels (1.3 patient) were dilated: one vessel in 77%, 2 vessels in 18% and 3 or more in 5% of patients. The primary success rate defined as a reduction of the diameter of stenosis below 50% was 81% (174/215 procedures) (85%-215/253 stenosis--in dilatations and 65%-15/23 obstructions--in attempted disobliterations). There were 4 deaths (2.1%), 12 Q wave infarcts (5.5%) and 5 non Q wave infarcts (2.3%), 2 emergency bypass grafts procedures and no cerebrovascular accidents. A multivariate analysis identified two factors which reduced the primary success rate: coronary calcification (p less than 0.02) and a history of previous infarction (p less than 0.02). Three factors were associated with an increased risk of perioperative infarction: the female sex, age greater than 75 years (p less than 0.01) and previous infarction (p less than 0.03). The first 154 patients were followed up for 25 +/- 14 months (8-61 months) without any patients being lost to follow-up. In this period, 16 patients died (11 of cardiac causes), 2 had non-fatal infarction, 13 underwent secondary aortocoronary bypass surgery and 30 patients (20%) developed an angiographic restenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Evolution of myocardial ischemia and left ventricular function in patients with angina pectoris without myocardial infarction and total occlusion of the left anterior descending coronary artery and collaterals from other coronary arteries.

Repeated episodes of myocardial ischemia might lead to progressive impairment of left ventricular (LV) function. This radionuclide study assessed myocardial ischemia and LV function several years after documented coronary occlusion without myocardial infarction. Over 5 years, 24 consecutive patients, who underwent cardiac catheterization for angina pectoris without myocardial infarction, had isolated total occlusion of the left anterior descending coronary artery with well-developed collateral vessels. Five patients were successfully treated by coronary bypass grafting and 3 by coronary angioplasty. Among the 16 medically treated patients, 1 was lost to follow-up and 1 died (extracardiac death). The mean (+/- standard deviation) follow-up (14 patients) was 48 +/- 15 months. At follow-up, 8 patients still had clinical chest pain, 11 received antianginal therapy, 4 patients had no stress ischemia and the other 10 had greater than or equal to 1 sign of stress ischemia. All patients had a normal LV ejection fraction at rest (mean 60 +/- 3%; range 55 to 65%). Collateral circulation preserves LV function at the time of occlusion and, in some cases, prevents the development of myocardial ischemia; in patients with persisting myocardial ischemia after well-collateralized coronary occlusion, LV function is not impaired at long-term follow-up.

Aged↗
PubMed1991

Comparative effects of oral molsidomine and nifedipine on methylergometrine-induced coronary artery spasm.

Twelve consecutive patients (10 men and 2 women, mean +/- standard deviation age 49 +/- 9 years) with chest pain, angiographically normal coronary arteries and coronary artery spasm documented by methylergometrine testing received a single oral dose of molsidomine (4 mg) or nifedipine (10 mg) in a randomized, double-blind, crossover fashion at a 24-hour interval. Coronary artery spasm was documented during coronary angiography in 6 patients (left anterior descending artery, 3; right coronary artery, 2; left circumflex, 1). In the remaining 6 patients, coronary artery spasm was documented by a positive methylergometrine test performed at the bedside, which provoked ST-segment elevation in the inferior (n = 3), anterior (n = 1) or lateral (n = 2) leads. Ninety minutes after administration of the study medication, methylergometrine testing was performed at the bedside, using incremental doses of up to 0.4 mg of methylergometrine. After molsidomine, 10 patients (83%) had a negative and 2 had a positive test; after nifedipine, 9 patients (75%) had a negative and 3 a positive test. Only 1 patient had a methylergometrine test that remained positive after either molsidomine or nifedipine. Therefore, molsidomine appears as effective as nifedipine in suppressing methylergometrine-induced coronary artery spasm in patients with variant angina. In addition, patients not responding to 1 of the study medications may respond to the other.

Coronary Angiography↗
PubMed1991

Proximal rupture and intracoronary entrapment of a rotating device during low-speed rotational coronary angioplasty.

While attempting to recanalize a right coronary artery obstruction by using a low-speed rotating catheter (Rotacs), proximal rupture of the catheter body occurred with entrapment of the blunt tip in the obstruction. To retrieve the device, it was necessary to severe the guiding catheter and the flexible tube of the Rotacs. At low-speed rotation the flexible segment of the catheter was then pulled back.

Angioplasty, Balloon↗
PubMed1991

Differential effects on right ventricular function of transient right, left anterior descending and left circumflex coronary occlusions during percutaneous transluminal coronary angioplasty.

Right ventricular function was studied by means of a thermodilution catheter before, during and after percutaneous transluminal angioplasty of the proximal right (group 1, n = 8), left anterior descending (group 2, n = 8) or left circumflex (group 3, n = 8) coronary artery. All patients had evidence of myocardial ischemia, with single-vessel disease affecting the proximal segment of one of the three major coronary arteries; no patient had had a previous myocardial infarction and all had normal cardiac function at baseline study. Cardiac index decreased during balloon inflation. Mean pulmonary artery pressure was unaffected in group 1 but increased in group 2 (from 19 +/- 5 to 31 +/- 11 mm Hg, p less than 0.01) and in group 3 (from 19 +/- 2 to 22 +/- 5 mm Hg, p less than 0.05). Right ventricular ejection fraction decreased from 62 +/- 9% to 52 +/- 10% (p less than 0.01) in group 1 and from 64 +/- 7% to 44 +/- 10% (p less than 0.005) in group 2, and returned to normal within 2 min after balloon deflation in both groups. In group 3, right ventricular ejection fraction was unchanged during balloon inflation (58 +/- 5% at baseline, 58 +/- 9% at 60 s, p = NS). Therefore, brief occlusion of the proximal segments of the left anterior descending or right coronary artery results in marked alteration of right ventricular performance that is probably caused by right ventricular free wall ischemia in the right coronary group and by the concomitant effects of septal ischemia and increased right ventricular afterload in the left anterior descending artery group.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1991

Prevention of restenosis after percutaneous transluminal coronary angioplasty with thromboxane A2-receptor blockade. A randomized, double-blind, placebo-controlled trial. Coronary Artery Restenosis Prevention on Repeated Thromboxane-Antagonism Study (CARPORT).

BACKGROUND: GR32191B is a novel thromboxane A2-receptor antagonist with potent antiagregational and antivasoconstrictive properties. We have conducted a randomized, double-blind placebo-controlled trial to study its usefulness in restenosis prevention. METHODS AND RESULTS: Patients received either GR32191B (80 mg orally before angioplasty and 80 mg/day orally for 6 months) or 250 mg i.v. aspirin before angioplasty and placebo for 6 months. Coronary angiograms before angioplasty, after angioplasty, and at 6-month follow-up were quantitatively analyzed. Angioplasty was attempted in 697 patients. For efficacy analysis, quantitative angiography at follow-up was available in 522 compliant patients (261 in each group). Baseline clinical and angiographic parameters did not differ between the two treatment groups. The mean difference in coronary diameter between postangioplasty and follow-up angiogram (primary end point) was -0.31 +/- 0.54 mm in the control group and -0.31 +/- 0.55 mm in the GR32191B group. Clinical events during 6-month follow-up, analyzed on intention-to-treat basis, were ranked according to the highest category on a scale ranging from death (control, six; GR32191B, four) to nonfatal infarction (control, 22; GR32191B, 18), bypass grafting (control, 19; GR32191B, 22) and repeat angioplasty (control, 52; GR32191B, 48). No significant difference in ranking was detected. Six months after angioplasty, 75% of patients in the GR32191B group and 72% of patients in the control group were symptom free. CONCLUSIONS: Long-term thromboxane A2-receptor blockade with GR32191B does not prevent restenosis and does not favorably influence the clinical course after angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Rotacs: a device used in coronary and peripheral arterial recanalization].

The authors report their preliminary results with the Rotacs system in the reopening of chronic coronary artery occlusion by low-speed rotational angioplasty. This system improves the percentage of coronary recanalisation in cases where it is impossible to pass the guide wire alone. It seems to be an effective, low-cost complementary tool for the treatment of this type of lesion.

Angioplasty, Balloon↗
PubMed1991

Early and long-term outcome after emergency coronary artery bypass surgery after failed coronary angioplasty.

From April 1980 to January 1990, among 2,576 percutaneous transluminal coronary angioplasty (PTCA) procedures, 100 patients (82 men and 18 women; mean age, 54 +/- 10 years [3.9%]) underwent emergency coronary artery bypass graft surgery. Before PTCA 56 had unstable angina, 34 had prior myocardial infarction, and 60 had single-vessel coronary artery disease. The mean time period from the onset of ischemia to surgical reperfusion was 147 +/- 16 minutes; 155 grafts were placed (1.5 grafts per patient). In-hospital mortality was 19%; operative mortality was significantly related to older age (59 +/- 9 versus 53 +/- 10 years, p less than 0.05), presence of unstable angina (74% versus 53%, p less than 0.05), and development of cardiogenic shock or necessity of cardiac massage before surgery (53% versus 16%, p less than 0.0001). In addition, 57 patients developed a Q wave myocardial infarction. For hospital survivors, overall survival at 7 years was 94% (Kaplan-Meier method), with three cardiac deaths during follow-up; two additional patients had late myocardial infarction, and four had late PTCA. At a mean follow-up of 55 +/- 38 months, 78% of the patients had no chest pain, and 80% reported no dyspnea. All patients received antiplatelet agents or oral anticoagulants; 34% had no antianginal medications. Among the 40 previously employed patients, 73% resumed work after surgery. All patients with cardiogenic shock or cardiac massage who survived the initial hospital period were alive at follow-up. After an initial critical period, the long-term clinical outcome of patients with emergency coronary bypass surgery after failed PTCA is satisfactory.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Food habits in primary dilated cardiomyopathy].

In this prospective study the nutritional profiles of 21 consecutive male hospital in-patients with primary dilated cardiomyopathy were evaluated in order to determine whether these profiles differed from those foodstuff consumed during on week and recording of the daily consumption of alcoholic beverages during the year preceding hospitalisation. The duration of dangerous alcohol consumption (more than 60 g/day) was also recorded. In these 21 patients the mean calorie intake was 3,600 kcal/day, including 500 kcal/day provided by alcohol. The mean nutrient intakes were: proteins 90 g/day, fats 100 g/day and carbohydrates 300 g/day. The daily alcohol consumption exceeded 20 years. Compared with the control population, the patients with primary dilated cardiomyopathy had a diet that was not lacking in calories but showed insufficient fat intake. Alcohol consumption was unquestionably excessive and constituted a major risk factor for this particular disease.

Adult↗
PubMed1990

[Current results of coronary transluminal angioplasty].

During the last few years, coronary angioplasty has been widely performed with excellent immediate results. The primary success rate now ranges from 85 to 97 per cent, with a mortality rate of 0.1 to 2.5 per cent, a 1 to 3 per cent rate of infarction and an 0.5 to 3 per cent of emergency bypass operation. However, disorders of repolarization and chest pain may be observed during the days which follow the angioplasty. The reasons for these manifestations are not always obvious, and the explanation provided by early exercise tests is not sufficiently accurate. In the short term, restenosis is the major problem, as it occurs almost invariably in 30 per cent of the cases, irrespective of the preventive method used. The long term results are very encouraging, and most patients remain symptom-free. This, of course, cannot be said of those cases where angioplasty fails: the long term survival is about the same as in the successful cases but coronary events are much more frequent. the socio-economic impact of coronary angioplasty is not easy to evaluate owing to the ever increasing cost of the procedure events are much more frequent. The socio-economic impact of coronary angioplasty is not easy to evaluate owing to the ever increasing cost of the procedure and to the extension of its indications. As regards the latter, the most important point is to decide whether subjects with multiple vessel lesions should be treated by angioplasty or undergo an aorto-coronary bypass; this problem can not be solved for the moment, but several multicentre randomized studies are in progress in search of an answer.

Angioplasty, Balloon, Coronary↗
PubMed1990

Role of previous angina pectoris and collateral flow to preserve left ventricular function in the presence or absence of myocardial infarction in isolated total occlusion of the left anterior descending coronary artery.

The aim of this study was to determine whether previous angina pectoris and collateral circulation influenced myocardial function after isolated coronary occlusion. In 58 consecutive patients, coronary angiography showed a complete isolated occlusion of the left anterior descending coronary artery; 43 patients (74%) had previous myocardial infarction. Duration of previous angina pectoris was defined as the time from the first ischemic symptom to the date of myocardial infarction or of coronary angiography in the absence of myocardial infarction. Left ventricular ejection fraction was measured on the 30 degrees right anterior oblique projection of the left ventricular angiogram. Collateral circulation was graded as follows: none or filling limited to side branches (group 1) and partial or complete filling of the epicardial arterial segment (group 2). Group 2 (40 patients) had higher ejection fraction (57 vs 38%; p less than 0.0001) and longer duration of previous angina pectoris (11 vs 0.1 months; p less than 0.002) than group 1 (18 patients). A longer duration of previous angina pectoris probably allows collateral development before coronary occlusion in 1-vessel coronary artery disease, thereby limiting myocardial damage.

Angina Pectoris↗
PubMed1990

Abstention from alcohol in dilated cardiomyopathy: complete regression of the clinical disease but persistence of myocardial perfusion defects on exercise thallium-201 tomography.

This case report describes a 43-year-old man with dilated cardiomyopathy reversed by abstention from alcohol over 1 year but with persistence of previous myocardial perfusion defects on exercise thallium-201 tomography. This suggests that despite the near normalization of left ventricular function, a permanent myocardial disease seems to persist.

Adult↗