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R Luccioni

Publications and source records attributed to R Luccioni.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Quantification of mitral regurgitation by cine-MRI. Comparison with transesophageal echocardiography in 45 patients].

Cine-MRI demonstrates the presence of mitral regurgitation by a signal void. This study was undertaken to assess the value of this method for quantification of mitral regurgitation in a population not excluding either patients with mitral valve prostheses or those with atrial fibrillation. The subjects included had a mean age of 59 years and were referred for transoesophageal echocardiography, either for assessment of valvular heart disease (38 patients), or for detection of atrial thrombosis before external electrical cardioversion (7 patients). Eight patients had mitral valve prostheses and 19 were in atrial fibrillation. Cine-MRI was performed within 12 days of the transoesophageal echocardiography study with a 1.5 tesla magnet, using a sequence of gradient echo in 3 parallel planes in the 4 chamber view. The regurgitation was quantified by MRI from the extension of the signal void in the left atrium. The transoesophageal Doppler echocardiographic criteria were the width of the regurgitant jet at its origin, the intensity of the regurgitation signal recorded by continuous wave Doppler and the extension of the jet within the left atrium. The quantification by degrees 1 to 4 did not differ by more than 1 degree between the 2 techniques in 43 of the 45 patients. Out of 4 left atrial thrombus detected by transoesophageal echocardiography, only 1 was visible by MRI. The authors concluded that quantification of mitral regurgitation by cine-MRI provides similar results to those obtained by transoesophageal echocardiography and that the correlation remains valid in cases of atrial fibrillation. However, Doppler echocardiography provides further valuable information for the clinician.

Aged↗
PubMed1996

[Magnetic resonance angiography. Value for evaluating the patency of aortocoronary bypass].

OBJECTIVE: Assessment of coronary bypass patency with conventional angiography can be limited by difficulties in selective catheterism. The aim of this work was to determine whether ultrarapid sequences proposed for imaging coronary arteries could be used to evaluate bypass patency. METHODS: Twenty patients (mean age 66 +/- 7 years) with 42 aorto-coronary bypasses (32 venous and 10 mammary bypasses) underwent conventional angiography and magnetic resonance angiography within a 1 week interval. All patients were evaluated 1 to 15 years after bypass surgery. Magnetic resonance imaging (MRI) was performed in ventral supine position using a flexible surface coil. Breathhold electrocardiogram-synchronized sequences were acquired using a 1.5 T magnet, with TR = 156 ms, TE = 8 ms, slice thickness 5 mm, 126.256 matrix, and a 7 to 11 segmentation per cardiac cycle. At most, 24 transverse slices were acquired for each patient. RESULTS: Twenty-six patent bypasses were correctly identified with MRI. Three bypass were patent on angiography and appeared occluded on MRI (2 mammary and 1 venous bypass). Nine bypasses were classed as occluded with both techniques. MRI demonstrated patency in one bypass for which selective catheterism was not possible. The sensitivity of MRI for the diagnosis of patency in aorto-coronary bypasses was 89% with a 92% specificity. MRI did not identify 1 out of 4 bypass stenoses. CONCLUSION: We conclude that the ultrarapid breath-hold magnetic resonance sequences can be used to determine patency of aorto-coronary bypasses with good sensitivity and specificity. Our results would suggest however that this method is inadequate for the diagnosis of bypass stenosis.

Aged↗
PubMed1996

Therapeutic effects of nitric oxide-donor isosorbide dinitrate on atherosclerosis-induced alterations in hemodynamics and arterial viscoelasticity are independent of the wall elastic component.

Whether the arterial elastic structures are involved in the beneficial effects of long-term treatment with organic nitrates on atherosclerosis-induced changes in hemodynamics and arterial wall viscoelastic properties, are case for angiotensin-converting enzyme (ACE) inhibitors, is not known. In the present study, atherogenic (A) diet, and isosorbide dinitrate (ISDN) (I) (60 mg Risordan LP, daily dose) were given concomitantly for 4 months to adult Pitman-Moore minipigs (A + I animals, n = 8), which were compared with A (n = 8) or control (C, n = 8) animals. Blood flow was investigated by hemodynamics in the hindlimb arterial bed; and wall rheology, histomorphometry and elastin; and desmosine (DES) and isodesmosine (IDE) contents in the abdominal aorta. Atherosclerosis prominently impaired the function of capacitance and resistance arteries, altered blood pressure contours, increased aortic stiffness and wall tension, and reduced parietal viscoelasticity through viscous component blunting. The treatment with ISDN significantly improved aortic pulsatility, arteriolar opposition to blood flow, and blood pressure (BP) contours by restoring, at least in part, the wall viscoelastic properties. However, there was no significant change in the area of the pressure-diameter curve hysteresis between the three animal groups. In contrast, ISDN reduced neither the cross-sectional area of lesions nor the losses in wall elastin content and had no influence on lipid accumulations in vessels and in the blood. The present results demonstrate that the beneficial hemodynamic and wall viscoelastic effects elicited by ISDN in atherosclerotic minipigs are not accounted for by therapeutic properties of the nitric oxide (NO) donor against alterations of elastic structures, but by the viscoelastic properties in the arterial wall.

Animals↗
PubMed1996

[Value of echocardiography in the study of aortic valve homografts and autografts].

Although increasingly used, the echocardiographic parameters of aortic valve homografts and autografts have not been extensively investigated. The aim of this study was to assess the value of transthoracic (TTE) and transoesophageal (TOE) echocardiography in the preoperative assessment of these patients, especially with regards to prediction of homograft size and to describe the normal and pathological echocardiographic appearances of this type of prosthesis. Thirty-seven consecutive patients were studied. Before surgery, the diameter of the aortic ring (24.1 +/- 3 mm), correlated well with the value measured by the surgeon (24.4 +/- 2 mm; r = 0.9), but in 2 cases, this measurement was impossible and in 3 cases inaccurate, the difference between the 2 measurements being greater than 2 mm. It was possible to measure the aortic ring diameter in all cases by TOE. After surgery, TTE showed normal function of 33 of the 37 prosthetic valves with minimal or no obstruction (mean gradient 5.9 +/- 4 mmHg, aortic surface area = 2.8 +/- 0.5 cm2) with no significant difference between the homografts and autografts. Better visualisation of the homograft leaflets was possible by TOE and detected minimal central regurgition in 16 (84%) of the homografts examined, the persistence of an annular abscess in 2 patients and a minimal aorto-left atrial fistula in 1 patient. In conclusion. TTE coupled with Doppler examination is usually adequate for preoperative selection of the homografts and haemodynamic evaluation and follow-up of these patients. TOE should be performed preoperatively in patients with unsatisfactory TTE studies but is mainly useful for preoperative evaluation and postoperative follow-up of patients operated for aortic endocarditis with paravalvula abscess.

Adolescent↗
PubMed1996

[Lymphoma in the transplanted heart].

Lymphoma is a classical complication of cardiac transplantation. The authors report a case in which the disease affected the cardiac graft. There were few symptoms and a good response to treatment was obtained. The patient underwent cardiac transplantation at 48 years of age because of primary dilated cardiomyopathy. Four years later, she presented with general ill health and a left supraclavicular lymphadenopathy which led to the diagnosis of a tumour of the atria extending into the mediastinum. MRI was the investigation which gave the best images of tumour extension. As with most late lymphomas of transplanted patients, the proliferation was a monoclonal B type. A significant reduction of tumour size was observed during the 13 months follow-up with chemotherapy and there were no cardiac functional signs.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

[Abnormal origin of the left coronary artery from the pulmonary artery. Diagnostic contribution of ultrasonographic technique].

We report a case of abnormal origin of the left coronary artery from the pulmonary artery trunk. The original features of this case were its discovery in a young pregnant woman, the normality of basal left ventricular function and the electrocardiogram, the diagnosis by transoesophaegeal echocardiography, and the demonstration of severe myocardial ischaemia by stress echocardiography.

Adult↗
PubMed1996

[Course of ischemic risk in treated atheromatous hypertensive patients. The PRIHAM study (Prognosis of Ischemic Risk in Atheromatous Patients under Mediatensyl)].

Hypertension is one of the major cardiovascular risk factors. However it seldom occurs alone in a patient and the antihypertensive treatment should be taken into account when assessing global cardiovascular status. The PRIHAM study was an open study which enrolled 3,216 hypertensive atheromatous patients who already has had a clinical ischaemic accident. Patients were followed-up for 3 years. The lowering effect on cardiovascular risk, starting from the fifteenth month was confirmed to the end of 36-month study. The effect on blood pressure was observed from the third month. Stabilized blood pressure observed within the first year persisted throughout the three years without tachyphylaxis. It was effective on SBP (-14.4%) and on DBP (-15%) while maintaining a stable heart rate both in the supine position or immediately upon standing or after 3 minutes in the standing position. Tolerance was globally judged as good or very good by the investigating practitioners and the patients expressed an improvement in their feeling of well-being. In conclusion, from the level of effectiveness obtained and the low incidence of adverse effects, urapidil appears well adapted and easy to manage in a population with a particularly high cardiovascular risk.

Adult↗
PubMed1995

[Pharmaco-epidemiologic evaluation of rilmenidine in 18,235 hypertensive patients].

OBJECTIVES: Assess the effects of rilmenidine in routine clinical practice. METHODS: 18,235 patients with high blood pressure--mean age 61.2 years, arterial systolic pressure in supine position (SSP) over arterial diastolic pressure in supine position (SDP) at day 0: 174.58 +/- 0.12/101.51 +/- 0.06 mmHg--were followed by 2,072 general physicians. Treatment was initiated with a daily dose of 1 mg rilmenidine which was adapted as needed at different times in the study. At inclusion, diastolic pressure was between 90 and 115 mmHg in 84.5% of the patients; 1,126 patients had severe hypertension (SDP > or = 115 mmHg); 16,496 of these patients (81.5%) were followed for one year. RESULTS: Mean fall in blood pressure between day 0 and month 12 was -28.7/-19.3 mmHg in the overall study population and -27.4/-18.9 mmHg in patients treated with 1 mg/day. Mean fall in blood pressure was comparable in the 8 risk populations identified. The percentage of patients who achieved normalized blood pressure status was 96.2% (SDP < or = 90 mmHg); 59.1% with a 1 mg daily dose, 23.7% with 2 mg/day, 11.6% with two-drug treatment and 1.8% with three-drug treatment. Acceptability, taking into account all possible imputabilities (more than 35,000 coprescriptions) and associated diseases, the incidence of undesirable side effects never exceeded 5.6% of the overall study population (5.2% in single-drug treatment, 8.3% in two- or three-drug treatment) and only 3.6% of the patients withdrew from the study due to an undesirable effect whether imputable to the treatment or not. There was little change in heart rate (mean--3 beats per minute between day 0 and month 12); variations observed depended on the rate at study onset. Laboratory tests (blood glucose, cholesterol, triglycerides, potassium, creatinine, uric acid) were not changed in any of the population groups. CONCLUSIONS: This pharmaco-epidemiologic study showed that the benefit/acceptability ratio for rilmenidine is quite satisfactory and confirms the contribution of rilmenidine as first line treatment for hypertension.

Adult↗
PubMed1995

Standard orthotopic heart transplantation versus total orthotopic heart transplantation. A transesophageal echocardiography study of the incidence of left atrial thrombosis.

BACKGROUND: After standard orthotopic heart transplantation (Sd HT), the enlarged resultant atria may promote atrial thrombosis. The purpose of this study was to compare the incidence of spontaneous echo contrast and left atrial thrombosis after Sd HT and total orthotopic (Tot HT) heart transplantation. METHODS AND RESULTS: Transesophageal echocardiography (TEE) was performed in 75 patients with Sd HT and in 20 patients with Tot HT. Despite the use of antiplatelet therapy, an acute arterial embolism occurred in 11 (15%) of the 75 patients with Sd HT but in none of the 20 Tot HT patients. All patients were in sinus rhythm. Left ventricular ejection fraction was similar in Sd HT and Tot HT patients. Left atrial diameter was smaller in Tot HT patients than in Sd HT patients (41 +/- 4 versus 58 +/- 6 mm, P < .001). In Sd HT patients, spontaneous echo contrast was present in 43 patients (57%) and was associated with left atrial thrombus in 20 patients (on the left atrial appendage in 12 patients, on the posterior wall in 6, and on the suture in 2). No thrombus was detected by transthoracic echocardiography; all thrombi were detected by TEE. On the other hand, no left atrial thrombus was observed in Tot HT patients, and only 1 patient had spontaneous echo contrast. Of the 11 Sd HT patients who experienced an arterial embolism, 5 had both spontaneous echo contrast and left atrial thrombus and 5 had only spontaneous echo contrast. CONCLUSIONS: This study demonstrates a high rate of left atrial thrombus after Sd HT and emphasizes the role of TEE in the follow-up of these patients. The therapeutic implications are the need for a preventive anticoagulant therapy in the high-risk population receiving Sd HT diagnosed with TEE and the consideration of Tot HT as a better surgical approach as far as thrombotic complications are concerned.

Adult↗
PubMed1995

Assessment of aortic regurgitation severity by magnetic resonance imaging of the thoracic aorta.

A new method of assessing the severity of aortic regurgitation severity by magnetic resonance imaging has been developed. Two groups were studied: 20 controls (age = 58 +/- 19 years) without valvular aortic disease, and 24 patients (age = 62 +/- 13 years) with chronic aortic insufficiency evaluated by magnetic resonance and aortic root cineangiography within 1 week of each other. A magnetic resonance sequence (TR = 35 ms/TE = 12 ms/flip angle = 20 degrees/magnet = 1.5 T) was acquired in a plane containing the thoracic aorta. A transverse saturation band 30 mm wide was positioned 30-40 mm above the aortic valve. Aortic insufficiency was graded; the importance of end-diastolic retrograde movement in the saturation band in the descending aorta was noted. Magnetic resonance was also compared to Doppler echocardiography in 20 patients. In the controls, we found that retrograde blood flow was absent (18/20) or mild (2/20). In contrast, the presence of marked retrograde movement in a saturation band across the thoracic aorta was always associated with severe aortic regurgitation (angiographic grade III or IV). This rapid method (imaging time less than 20 min) can be applied in most patients with aortic regurgitation and is likely to be helpful when echocardiography is not possible or gives inconclusive results.

Adult↗
PubMed1995

[Course of ischemic risk in treated atheromatous hypertensive patients. The PRIHAM study].

Hypertension is one of the major cardiovascular risk factors. However seldom occurs alone in a patient and the antihypertensive treatment should be taken into account when assessing global cardiovascular status. The PRIHAM study was an open study which enrolled 3,216 hypertensive atheromatous patients who already has had a clinical ischaemic accident. Patients were followed-up for 3 years. The lowering effect on cardiovascular risk, starting from the fifteenth month was confirmed to the end of 36-month study. The effect on blood pressure was observed from the third month. Stabilized blood pressure observed within the first year persisted throughout the three years without tachyphylaxis. It was effective on SBP (-14.4%) and on DBP (-15%) while maintaining a stable heart rate both in the supine position or immediately upon standing or after 3 minutes in the standing position. Amongst diabetic and dyslipidemic patients, an absence of deleterious metabolic effects was noticed, parallel with the effectiveness. Tolerance was globally judged as good or very good by the investigating practitioners and the patients expressed an improvement in their feeling of well-being. In conclusion, from the level of effectiveness obtained and the low incidence of adverse effects, urapidil appears well adapted and easy to manage in a population with a particularly high cardiovascular risk.

Adult↗
PubMed1995

An equivalence study of the safety and efficacy of a fixed-dose combination of perindopril with indapamide versus fixed-dose combinations of captopril with hydrochlorothiazide and enalapril with hydrochlorothiazide in the treatment of hypertension.

OBJECTIVE: The aim of this multicenter, randomly allocated, double-blind, parallel-group study was to evaluate the equivalence of three fixed-dose combination drugs in mild to moderate hypertension: perindopril + indapamide (4 + 1.25 mg), captopril + hydrochlorothiazide (50 + 25 mg) and enalapril + hydrochlorothiazide (20 + 12.5 mg). PATIENTS AND METHODS: After a single-blind, 4-week, placebo run-in phase, 527 patients (mean +/- SD age 54.5 +/- 1.2 years) with a supine diastolic blood pressure of 101.2-101.7 mmHg were randomly assigned to one of the three treatments for 8 weeks. The main evaluation criteria were diastolic blood pressure and serum potassium concentration. Equivalence was assessed on an intention-to-treat basis, using Schuirmann's method, which involves performing two one-tailed statistical tests on the data. Thirty-five patients were withdrawn from the study but there were no differences between groups in the reasons for withdrawal. RESULTS: Diastolic blood pressure decreased by between 13.1 and 14.2 mmHg in the three groups. The 90% confidence intervals for the differences between perindopril + indapamide and the other treatments were -1.1, +1.7 mmHg for captopril + hydrochlorothiazide and -0.4, +2.6 mmHg for enalapril + hydrochlorothiazide. Schuirmann's test was highly statistically significant (P<0.001 for perindopril + indapamide versus captopril + hydrochlorothiazide; P<0.002 for perindopril + indapamide versus enalapril + hydrochlorothiazide), so that the two one-sided hypotheses that the treatments were not equivalent were rejected at the nominal level of alpha = 0.05. Similarly, the safety of the treatments was equivalent in terms of serum potassium. The 90% confidence intervals of the differences between perindopril + indapamide and the other treatments were -8.7, -1.6% for captopril + hydrochlorothiazide (P = 0.004) and -1.5, +2.7% for enalapril + hydrochlorothiazide (P<0.001). CONCLUSIONS: We conclude that the safety and efficacy of perindopril + indapamide, captopril + hydrochlorothiazide and enalapril + hydrochlorothiazide were equivalent after 8 weeks of treatment in patients with mild to moderate hypertension.

Adolescent↗
PubMed1994

Thallium perfusion and myocardial hypertrophy in transplanted heart recipients with normal or near-normal coronary arteriograms.

In patients with hypertrophic cardiomyopathy or systemic hypertension, exercise thallium perfusion defects have been observed but without significant angiographic stenoses. Hypertension and myocardial hypertrophy are common in transplanted heart recipients, and the aim of this study was to determine if exercise thallium scintigraphy false-positives are frequent in transplanted heart recipients. Thirty-four transplanted heart recipients were evaluated by exercise thallium single emission computed tomography and subsequently had a normal or near normal coronary arteriogram. At the time of the exercise, the patients (28 men and six women) had a mean age of 48.9 +/- 12 years and 29 had been previously treated for systemic hypertension. The mean duration between transplantation and the exercise test was 31.6 +/- 13 months. In all patients left ventricular mass was obtained by echocardiography within 3 months of thallium 201 SPECT and was > or = 130 g.m-2 in nine males and > or = 110 g.m-2 in four females. M-mode septal + posterior end-diastolic thickness was > 23 mm in 14 patients, all of whom had been previously treated for systemic hypertension. These patients were older and endured a longer period during which the heart was kept cold but ischaemic before being grafted ('cold ischaemia') but a shorter exercise duration than patients without left ventricular hypertrophy. During exercise testing, 26 of 34 patients achieved at least 80% of their maximal predicted heart rate and two developed significant ECG changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Hyperhomocysteinaemia in heart transplant recipients.

The aim of this study was to determine the prevalence of hyperhomocysteinaemia in cardiac transplant recipients. Three groups of subjects were studied: 27 heart transplant recipients, 14 to 63 months (mean = 36.5) after transplantation; 10 patients with moderate chronic renal insufficiency without clinical evidence of vascular disease; 17 apparently healthy individuals. Twenty-five out of 27 transplanted patients had a coronaroangiography within 6 months of homocysteine measurement. Plasma homocysteine was measured both while the subject was fasting (t0) and 6 h after administration of 0.1 g.kg-1 of methionine (t6). Hyperhomocysteinaemia was present in 14/27 fasting transplanted patients and after methionine loading. Mean plasma levels of homocysteine at t0 were higher (P = 0.03) in transplanted heart recipients (15.4 +/- 7 mumol.l-1) than in the renal patients (9.9 +/- 5 mumol.l-1) despite similar mean plasma creatinin. In eight transplanted patients with angiographic coronary abnormalities of the cardiac graft, homocysteinaemia was at t0 17.1 +/- 9 mumol.l-1 and at t6 47.8 +/- 25 mumol.l-1. In 17 transplanted patients with angiographically normal coronary arteries, plasma homocysteine levels were at t0, 13.2 +/- 4 mumol.l-1 and at t6, 46.8 +/- 25 mumol.l-1. We conclude that hyperhomocysteinaemia is common in transplanted heart recipients, and partly related to renal insufficiency. No correlation was found between hyperhomocysteinaemia and angiographic evidence of coronary atherosclerosis of the graft, but the population of the study was possibly too small to establish this correlation.

Aged↗
PubMed1994

[Favorable outcome of severe right cardiac insufficiency after bipulmonary transplantation].

The authors report a long term success of bipulmonary transplantation in a 15 year old girl with cystic fibrosis and respiratory failure complicated by severe right heart failure. The operation did not cause any particular problems. After transplantation, the clinical signs of right ventricular failure and echocardiographic right ventricular dilatation regressed in less than one week. The right ventricular hypertrophy also regressed. Echocardiography shows no abnormality after 5 years' follow-up.

Adolescent↗