Carbamazepine and pacing threshold.
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Carbamazepine↗
Biomedical subjects
R Luccioni
Publications and source records attributed to R Luccioni.
Effects of angiotensin-converting enzyme inhibition with perindopril on hemodynamics, arterial structure, and wall rheology in the hindquarters of atherosclerotic mini-pigs.
The effects of ACE inhibition with perindopril on the atherosclerosis-induced impairment of arterial flow were investigated via histopathologic studies, hemodynamics, and vascular rheology of hindlimb arteries in 7 adult Pitman-Moore mini-pigs (7 months of age) fed for 4 months with an atherogenic diet and perindopril (at the daily oral dose of 4 mg, which induced a continuous 70% inhibition of serum ACE activity), versus 7 atherogenic and 7 control animals. Major fibroproliferative fatty lesions with medial intimalization were observed in the abdominal aorta. Atherosclerosis impaired the function of both capacitance and resistance hindlimb arteries. In atherogenic mini-pigs, blood pressure (BP) increased significantly due to increased hindlimb peripheral resistance (HPR) and aortic input impedance, although aortic blood flow was not affected. Altered aortic wall rheology revealed that the stiffness of the aorta was markedly increased due to increased wall tension and reduced viscoelasticity, the viscous component being reduced in the arterial wall. Perindopril significantly opposed these alterations by reducing BP, HPR and input impedance and by returning parietal stiffness to control values by increasing aortic compliance. Angiotensin converting enzyme (ACE) inhibition significantly prevented the development of atherosclerosis in the abdominal aorta by decreasing the cross-sectional area of lesions and the presence of lipid-laden cells, as well as by preventing alteration and fragmentation of elastic laminae. In conclusion, ACE inhibition with perindopril showed a significant preventive action on atherosclerosis-induced deleterious effects on vascular wall function and structure in mini-pig arteries.
Angiotensin-Converting Enzyme Inhibitors↗
Dose-effect relationship of rilmenidine after chronic administration.
The antihypertensive efficacy and acceptability of 3 doses of rilmenidine (0.5, 1 and 2 mg, once daily) and a placebo over a 4 week period have been compared in a randomised, double-blind, parallel-group trial in 60 mild to moderate hypertensive patients. Six patients dropped out: 4 in the 2 mg-group and one in the 1 mg-group because of adverse events, and one in the placebo group for personal reason. The blood pressure was significantly decreased after the 1 and 2 mg doses with the maximum antihypertensive effect already being obtained after 1 mg. A significant dose-effect relationship was shown for supine systolic blood pressure (P = 0.05) but not for the supine diastolic blood pressure. The most beneficial efficacy/acceptability ratio was achieved at the dose of 1 mg once daily, which demonstrated the maximum antihypertensive effect associated with a low incidence of adverse events.
Antihypertensive Agents↗
Diagnosis of prosthetic heart valve thrombosis. The respective values of transthoracic and transoesophageal Doppler echocardiography.
Early diagnosis of acute prosthetic thrombosis remains a challenge. In 20 patients with 23 thrombosed cardiac valves, we evaluated the respective value of transthoracic (TTE) and transoesophageal (TEE) Doppler echocardiography. According to the presence or absence of prosthetic obstruction by continuous-wave Doppler, prostheses were separated into two groups. Group 1 included nine thrombosed prostheses (8 mitral, 1 aortic) with severe obstruction. All patients presented with severe symptoms of heart failure. Transthoracic Doppler echocardiography allowed immediate diagnosis of prosthetic thrombosis, even in critically ill patients, showing (1) eccentric transprosthetic colour flow jets in all eight mitral prostheses, (2) severe obstruction on Doppler examination (mean gradient = 18 to 36 mmHg in eight mitral prostheses, and 69 mmHg in one aortic valve), and (3) direct echocardiographic evidence of thrombosis (i.e. thrombus or abnormal disc or leaflet motion) in four patients. All nine patients were immediately treated by surgery (n = 8) or fibrinolysis (n = 1) on the basis of TTE results only. TEE allowed better visualization of thrombus and restricted leaflet or disc motion, but had little influence on patient management. Group 2 included 14 thrombosed prostheses (10 mitral, 4 aortic) with mild or absent obstruction. In three patients with massive mitral prosthetic thrombosis, an associated minimal thrombosis of a prosthetic aortic valve was found at surgery, but was detected neither by TTE, nor by TEE. The 11 remaining patients with isolated partial mitral (n = 10) or aortic (n = 1) thrombosis. Clinical presentation was fever, cerebral embolism, or mild dyspnoea, but no heart failure. TTE was normal in all.(ABSTRACT TRUNCATED AT 250 WORDS)
Aortic Valve↗
[Prognostic value of thallium-201 myocardial scintigraphy in patients with hypertension, suspected of coronary disease].
This study was undertaken to determine the prognostic value of exercise myocardial scintigraphy in hypertension patients suspected of coronary disease. One hundred and thirty six hypertension patients (mean age: 59) suspected of coronary disease were monitored for 46 months after thallium 201 exercise myocardial scintigraphy (tomographic mode). Prognostic factors analysed were clinical (typical nature of pain, exercise blood pressure), electrocardiographic (presence of repolarisation abnormalities in resting ECG), ergometric (electrically positive test) and scintigraphic (existence or not of transitory hypofixation). Events sought were: death of coronary origin, non-fatal myocardial infarction, aorto-coronary bypass and coronary angioplasty. One-way analysis showed that the existence of transitory hypofixation by scintigraphy, positive exercise electrocardiogram and typical angina pain enabled the prediction of coronary events. Thus 14 of 36 patients (39%) with transitory or combined hypofixation had a coronary event as against 7 of the 100 patients without transitory hypofixation. Only the existence of transitory hypofixation retained a prognostic value for coronary events by multivariate analysis (relative risk = 5.4, p = 0.001). It was also found that the prognosis was good when scintigraphy did not reveal transitory hypofixation while exercise testing was positive (2 coronary events/27 patients). It is concluded that, despite the possibility of "false positives", linked in particular to myocardial hypertrophy, myocardial scintigraphy offers better prediction of coronary events in hypertension patients that other clinical or electrocardiographic parameters.
Adult↗
[Inhibitors of angiotensin-converting enzyme and processus of intima proliferation in atherosclerosis].
The renin angiotensin system is a negative feed-back system of blood pressure control. A number of concordant experimental and clinical results indicate that the angiotensin family has a trophic effect on the vessel wall. These properties of the angiotensins favorise the proliferation of the cells which make up the vessel wall and also amplify the vascular dysfunction in the absence of the inhibitory regulations. Angiotensin converting enzyme inhibitors could be a valuable therapeutic method of counteracting these deleterious effects on the composition and function of the vessel wall.
Angiotensin-Converting Enzyme Inhibitors↗
[Coronary disease of transplanted heart. Physiopathology, prevention].
Coronary artery disease in cardiac transplant recipients is the main cause of mortality after the first postoperative year. This atheroma has unique anatomical features with widespread infiltration of the intima by inflammatory cells. The different physiopathological hypotheses are analysed. Immunological processes are probably responsible, suggesting chronic rejection. The cytomegalovirus could be an inductive mechanism. The classical vascular risk factors probably play a role but their action is not as clear as that of immunological and viral factors. Hyperlipidaemia is a causative mechanism and the predisposing role of steroid therapy is also recognised. From the practical point of view, correction of the classical risk factors is the only available therapeutic possibility at present.
Animals↗
[Diastolic function of the left ventricle in aortic valve stenosis. Doppler echocardiography].
Doppler echocardiographic parameters of LV diastolic function (isovolumic relaxation time, E wave velocity, ratio of E/A wave velocities, mitral valve pressure half time) were compared to catheter data in 35 patients (average age 67 years) with pure or dominant aortic stenosis (mean gradient: 65 +/- 30 mmHg). The isovolumic relaxation time was prolonged in most patients (m = 103 +/- 23 ms) and seemed uninfluenced by any haemodynamic parameter. There was a positive correlation between pressure half time and ejection fraction (r = 0.41, p = 0.02) and a negative correlation with pulmonary capillary pressure (r = -0.61, p < 0.01). The E and E/A ratio were negatively correlated with the ejection fraction (r = -0.41 and -0.52) and positively correlated with pulmonary capillary pressure (r = 0.46 and 0.62). The Doppler parameters were independant of the patients' age, severity of stenosis and degree of left ventricular hypertrophy. Patients with normal pulmonary capillary pressure (< 15 mmHg, N = 19) had abnormal diastolic filling with low E wave velocities (71 +/- 28 cm/s) and E/A ratios (0.9 +/- 0.6) and prolonged half pressure times (96 +/- 37 ms). Conversely, patients with high pulmonary capillary pressures (> 15 mmHg, N = 16) had normal or high E wave velocities (107 +/- 31 cm/s) and E/A ratios (1.5 +/- 0.6) and normal or shortened isovolumic relaxation times (62 +/- 22 ms).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Right intra-atrial extension of hydatid cyst mimicking cardiac thrombosis. Apropos of a case].
The authors describe an unusual case of hydatid cyst inserted in the inferior vena cava and extending into the right atrium. The transoesoesophageal echocardiographic appearances were similar to those of a thrombus: the tumour was very mobile, echogenic, polylobular with a cord-like pedicle in the inferior vena cava. The pathological examination revealed a ruptured hydatid cyst. The mass and its insertion were not visible on CT scan or cavography. Transoesophageal echocardiography would therefore seem to be a very useful diagnostic method for tumours arising in the inferior vena cava and extending into the right atrium.
Cardiomyopathies↗
[Value and limits of the tilt-test in the etiological diagnosis of transient malaise].
This study was undertaken to assess the usefulness of the head-up tilt test in the diagnosis of vasovagal syncope and to evaluate the indications of this investigation. The test consists in a 30 minute period in the horizontal decubitus position followed by a 60 degrees head-up tilt position for 30 minutes. In the 26 subjects in whom the diagnosis of repeated vasovagal syncope had been made on the basis of typical prodromic symptoms after exclusion of all other causes, the test induced a vasodepressive or vagal reaction in 10 cases (38%) 20 +/- 4 minutes after tilting. In 8 patients in whom the test was performed within 48 hours of their syncopal episode, a similar malaise was induced in 7 cases. Twenty patients with repeated malaise without loss of consciousness had no symptoms during the test which was also negative in 10 normal control subjects. In a group of 27 subjects with unexplained syncope after clinical and paraclinical investigations, the test was accompanied by a malaise on five occasions (19%). Using this protocol, the tilt test had good specificity but moderate sensitivity in the diagnosis of vasovagal syncope. Its sensitivity increased when performed within 48 hours of syncope. It is of no value in the diagnosis of recurrent malaise without loss of consciousness.
Blood Pressure↗
[Development of echocardiographic and Doppler parameters after orthotopic cardiac transplantation, except during rejection periods].
The aim of this study was to evaluate spontaneous changes of Doppler and echocardiographic parameters of cardiac transplants in the absence of rejection. Based on 258 recordings representing the follow up of 30 patients after orthotopic cardiac transplantation in the absence of histological signs of rejection on biopsy within 24 hours, we tried to define: the evolution of these parameters from the first postoperative week to after the 30th month (average 12 months); the Doppler echocardiographic values of "normal" transplants: the values observed one year after surgery were compared with a control group age-matched to the donors.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Changes in personality and hypertension. The "athymhormic" syndrome].
In 3 hypertensive patients, aged 57 to 66, profound behavioral and personality changes occurred rather abruptly, characterized by total loss of spontaneous activity and initiative, apathetic behavior, passivity, lack of drive and motivation, loss of interest for any of previous occupations and hobbies, and total flatness of affect. Neurological examination was normal or only showed mild extra-pyramidal signs. Neuropsychological evaluation was only remarkable for mild intellectual impairment suggestive of frontal lobe dysfunction. None of the 3 patients fulfilled criteria for dementia or severe depression. This neurobehavioral syndrome has been coined "athymhormic syndrome" (Habib & Poncet, 1988), a term emphasizing the specific defect in drive ("horme") and affect ("thumos"). Electrical and clinical heart examination was unremarkable. Blood pressure was always found within normal limits during hospitalization, including 24-hour monitoring in one case. However, all patients were known as hypertensive in the past, with repeated bouts of high blood pressure (up to 270 mmHg systolic in one case). X-ray CT-scan was usually normal or showed non-specific white matter changes (so-called "leukoaraiosis"). In all 3 cases, a brain MRI scan showed multiple small infarcts mainly involving deep subcortical structures (caudate nuclei and/or adjacent periventricular white matter) of both hemispheres, consistent with the definition of lacunes.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Alpha-1 inhibition. Clinical studies of the efficacy and tolerability of Alpress LP in mild to moderate essential hypertension].
Alpress LP allows a continuous flow of prazosin, thanks to its new galenic form. This implies a better efficacy and less side-effects in the treatment of hypertension. Besides, prazosin being known for its favourable effect on hypercholesterolemia, Alpress LP was studied in this respect. In each of the three studies detailed thereafter, concerning hypertensive patients, proof was made of the efficacy and the good tolerance of Alpress LP, as compared to reference therapeutics given in hypercholesterolemia.
Antihypertensive Agents↗
[The value of lysinopril in cardiac insufficiency].
Owing to its original pharmacokinetic profile, lisinopril can be taken once a day, independently of meals, providing a 24-hour inhibition of the angiotensin-converting enzyme. Lisinopril is a potent angiotensin-converting enzyme inhibitor. Administered in doses of 2.5 to 20 mg per day, it improves the functional and haemodynamic state of patients whose congestive heart failure is refractory to the digitalis-diuretic treatment. The drug is well tolerated, and no severe side-effects have been reported. Lisinopril seems to be at least as effective as captopril in congestive heart failure, and it has over the latter the advantage of a once a day dosage therapy.
Angiotensin-Converting Enzyme Inhibitors↗
French multicenter trial of anistreplase versus heparin in acute myocardial infarction.
Eighty-four patients aged less than 71 years with less than 4-hour duration acute myocardial infarction (AMI) were randomized in a multicenter study to 30 U anistreplase or heparin (single injection of 6500 IU followed by 1000 IU/hr). Early reperfusion was assessed from ECG changes (50% of sum ST decrease 2 hours postdosing) and the CK release profile (CK peak less than 16 hours after onset of symptoms, CK slope greater than 10%/hr). Reperfusion rates in patients meeting at least two criteria of reperfusion were 62.5% on anistreplase versus 27.5% on heparin. On delayed angiogram (13.7 +/- 3.4 days), patency rates were 66% with anistreplase versus 47% (NS) with heparin in 76 patients. Global LVF was similar in both groups. With anistreplase, the mean lowest fibrinogen level was 0.43 +/- 0.55 g/l, plasminogen was 20 +/- 9%, and the highest F.D.P. was 1447 +/- 548 micrograms/ml. All values recovered by hour 48. In-hospital and 1-year follow-up mortality was 7.2% (three patients) with anistreplase versus 10.2% (four patients) with heparin. Bleeding occurred in 9.7% and 5.1% of the patients (NS), respectively. No intracranial hemorrhage occurred. Thus, with combined clinical criteria or reperfusion, anistreplase is twice as efficient as heparin, has a good tolerance, and is easy to use as a single injection.
Anistreplase↗
Efficacy and tolerance of sustained-release diltiazem 300 mg and a diuretic in the elderly.
A randomized, double-blind, parallel study has been performed to compare the antihypertensive action and clinical and biological tolerance of monotherapy with two different substances: sustained-release diltiazem 300 mg and a diuretic combining 25 mg of hydrochlorothiazide and 50 mg of triamterene (HCT-T). Antihypertensive treatment was suspended at least 15 days before initiation of a placebo period that lasted 14 days and allowed confirmation of persisting hypertension. Eighty-five patients who were at least 65 years old were included in the study: 42 in the group treated with sustained-release diltiazem 300 mg and 43 in the group treated with a diuretic. All of them presented with mild to moderate arterial hypertension, characterized by supine diastolic blood pressures (supine DBP) of 95-115 mm Hg. Duration of treatment was 3 months. After 1 and 3 months, efficacy and tolerance of the antihypertensive treatment were evaluated. On day 30, a significant decrease (p less than 0.0001) in the main parameter, i.e., supine DBP, as well as other parameters such as standing diastolic blood pressure (standing DBP), supine systolic blood pressure (supine SBP), and standing systolic blood pressure (standing SBP) was observed. Blood pressure was reduced by 18, 16, 28, and 26 mm Hg, respectively, in the sustained-release diltiazem 300 mg group and by 13, 12, 21, and 18 mm Hg, respectively, in the diuretic group. Moreover, on day 90, blood pressure values were maintained in the diuretic-treated group, whereas an additional significant reduction in supine DBP (p less than 0.002) was noted in the sustained-release diltiazem 300 mg-treated group (-4.8 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Application of ultrasono-micrometric technic to study vasomotility].
An experimental model of simultaneous recording of pressure and flow (instantaneous and mean values) and of the vascular diameter (by ultrasonomicrometry) at the entry of a clearly limited territory of the systemic circulation has been developed in the animal together with a programme of data aquisition and analysis. This programme allows quantification of the different viscoelastic properties of the vessel wall which characterise arterial flow in the arteries of distribution (capacitance vessels) and irrigation (resistance vessels). The model was applied to the study of the pharmacological effects of two antianginal agents, a nitrate derivative (ND) administered acutely by slow intravenous infusion at a dose of 25 micrograms/Kg/mn over 20 minutes (total dose: 500 micrograms/Kg) and a substitute sydronimous substance (SYD) administered in the same manner at a dose of 15 g/Kg/mn over 20 minutes (total dose: 300 micrograms/Kg). The hypotensive effects obtained were comparable and significant (p less than 0.001) in both cases. The ND led to a fall in mean blood pressure of 9.7 +/- 1.3% and SYD of 10.0 +/- 2.1%. However, SYD led to an increase in aortic blood flow (11.7 +/- 3.6%, p less than 0.01) whilst the ND had no significant effect on this parameter (+ 6.07 +/- 5.7%). As a result, there was a much greater decrease of peripheral resistances after administration of SYD (-22.8 +/- 3.1%) than with the ND (-12.7 +/- 4.2%). This difference was also observed when the input impedence of the vascular bed was studied (-31.2 +/- 6.9% after SYD and -12.0 +/- 2.5% after the ND).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Reversible dementia syndrome due to chronic bromide poisoning caused by drugs].
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Bromine↗