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R Roudaut

Publications and source records attributed to R Roudaut.

At least 19 recordsLinked to original sources
PubMed2006

[Identification of candidates for multisite pacing: results and presumed mechanisms of action after five years experience].

Biventricular resynchronisation is an additional therapeutic option in the management of refractory heart failure, with a functional and haemodynamic benefit as well as an improved morbidity and mortality. However, the rate of non-responsive patients has prompted a re-think about the presumed mechanisms of action for this procedure. This study aims to identify candidates more successfully. Based on five years experience in this centre, our work confirmed a medium and long term clinical benefit with multisite pacing. Nevertheless, there was evidence of a relative discordance between the functional benefit and the haemodynamic impact in terms of ejection fraction achieved with resynchronisation. While QRS narrowing appears to be a predictive factor for a successful procedure, the ECG alone is not sufficient to select 'unsynchronised' candidates. Statistical analysis reveals that before implantation the independent predictive factors to identify non-responsive patients include the presence of a complication of myocardial infarction and a low grade mitral leak. The limits of the ECG suggest a more mechanical than electrical approach to understanding the mechanisms of action for resynchronisation. Its effectiveness in cases of right bundle branch block confirm the hypothesis of left intra-ventricular conduction defects, not apparent on the surface ECG but accessible through new imaging techniques. Based on the hypothesis of delayed movement of the ventricular walls, the principle of resynchronisation aims to restore homogenous contraction. Echocardiography allows observation of electromechanical delay and opens new perspectives in the future for selecting patients for pacing. Ar

Cardiac Pacing, Artificial↗
PubMed2006

Heart failure with preserved systolic function: a diagnostic algorithm for a pragmatic definition.

Heart failure is a major health problem which often concerns the elderly. Prevalence of heart failure with preserved systolic function is increasing and varies from 40 to 50%. In the literature, and in the large epidemiological studies, it is commonly designed with the term of "diastolic heart failure", even if a precise analysis of diastolic function is not performed. A diagnostic algorithm is proposed in order to better define the concept of heart failure with preserved systolic function. It consists of seven steps from symptoms and clinical signs to the echocardiographic analysis of diastolic function, in order to confirm the definition of heart failure with preserved systolic function.

Algorithms↗
PubMed2006

[Thrombosis of valvular prostheses: the role of medical treatment].

Thromboses of valvular prostheses represent a rare but serious complication for mechanical valves, and are sometimes fatal. Obstructive thromboses present an immediate threat to life, while the more common, more insidious, non-obstructive thromboses are essentially manifested by thrombo-embolic events. These thromboses often occur at times of insufficient anticoagulation, especially during the first post-operative year and during treatment breaks for non-cardiac surgery, an increasingly common situation. The therapeutic management of an 'obstructive' thrombosis is above all surgical. However, fibrinolysis represents an effective alternative, although it does present a not insignificant risk of systemic embolism (in the order of 10 to 15%). The main indications for fibrinolysis are thromboses of right heart valves, and for left heart prostheses, patients in a very unstable haemodynamic state, remoteness from a cardiac surgery centre, any surgical contraindications, and cases where a large thrombus has been excluded by trans-oesophageal ultrasound. In cases of contraindications to both surgery and fibrinolysis, treatment with heparin might be proposed, but without any great hopes of completely unblocking the prosthesis. Treatment of a 'non-obstructive' thrombosis is primarily medical: optimising anticoagulation with intravenous heparin, or even the addition of aspirin. When the thrombus is large and mobile, surgery should be envisaged if medical treatment fails.

Algorithms↗
PubMed2006

[Exercise test in athletes].

The particularities of exercise tests in athletes concern mainly the exertion protocols adapted to their increased physical capacities and the interpretation of ECG tracing which can sometimes be very special at rest and also misleading during exercise. In the great majority of cases, the test used is both cardiac and pulmonary, in order to assess the aerobic capacities, the maximal aerobic power, and the determination of ventilation thresholds (programming and follow-up of training...). More infrequently, the test is used to detect cardiovascular diseases, especially during a longitudinal follow-up of high-level athletes, or to exclude it in case of cardiovascular symptoms, atypical resting ECG or even in case of suspicion of disease (arrhythmia, cardiac chamber hypertrophy or dilation at echocardiography). In more aged sportsmen (athletes masters), exercise tests performed are usually required for screening coronary heart disease. In this case the test protocols should be more adapted for screening than for the assessment of sportive capacities.

Electrocardiography↗
PubMed2005

[Severity of aortic ring abscess complicated by cardiac conduction abnormalities].

OBJECTIVE: To determine clinical features, management and prognosis of cardiac conduction abnormalities (CCA) complicating abscessed endocarditis. METHODS: We have analysed clinical, microbiologic and echocardiographic datas, therapies and outcome of cardiac abscesses complicated by CCA in patient hospitalized between 1995 and 2001 in our centre. RESULTS: Above 35 cardiac abscesses, six men (mean age 62 years) had CCA complicating six aortic ring abscesses (4 on native valve and 2 on prosthetic valve) with four cases of interventricular septal involvement and fistulization. Severe heart failure is present four times, a septic cerebral embolization twice. Streptococcus and Staphylococcus prevail. Complete atrioventricular block (AVB) reveals endocarditis twice and complicates the evolution three times. Trifascicular block (first degree AVB, left anterior fascicular block and complete right bundle branch block) revealed recurrence of endocarditis. Two patients were treated medically: one died quickly (complete AVB pre-mortem), and the other one had favourable issue (paroxystic complete AVB). Four patients had surgery with temporary pacemaker in three cases (one died) then definitive pacemaker in two cases. At 26.5 month (7-50), the four survivors had no recurrence of endocarditis. CONCLUSION: Severe CCA are classical in aortic ring abscessed endocarditis and associated with increased mortality. Immediate transfert in a dentre with cardiac surgery is necessary. Definitive cardiac pacing can be performed early without leads infection.

Abscess↗
PubMed2005

Carotid intima-media thickness is slightly increased over time in HIV-1-infected patients.

OBJECTIVES: HIV-infected patients are at risk of atherosclerosis and cardiovascular diseases. In a 12-month follow-up study, we aimed to investigate changes in carotid intima-media thickness (IMT), a surrogate marker of atherosclerosis, and its determinants in HIV-1-infected patients. METHODS: Our multicentre prospective longitudinal cohort study included 346 HIV-infected patients, for each of whom two IMT measurements were taken by B-mode ultrasonography at baseline (M0) and 1 year later (M12). RESULTS: We observed a significant but moderate increase in the common carotid artery (CCA) median IMT, from 0.54 to 0.56 mm (P<10(-4)), i.e. an increase of 0.020 mm (95% confidence interval 0.012-0.029). There was a significant association between cross-sectional CCA IMT measures at M12 and conventional cardiovascular risk factors (higher CCA IMT with older age, P<10(-4); male gender, P=0.02; tobacco consumption, P=0.05), as well as higher CD4 cell count at M12 (>median 455 cells/microL, P=0.01). Only CD4 cell count at M0 was strongly and positively associated with the variation in IMT between M0 and M12 (P=4 x 10(-3)). IMT progression was +0.0020 mm for the lowest quartile of CD4 cell count distribution at M0, i.e. 3-253 cells/microL, +0.010 mm for 253-402 cells/microL, +0.043 mm for 402-590 cells/microL, and +0.028 mm for 590-2270 cells/microL. No association was found with type or duration of antiretroviral exposure. CONCLUSIONS: Conventional cardiovascular risk factors are major determinants of IMT evolution. The link between immunological status and carotid IMT requires further study.

Adult↗
PubMed2005

[Asynchronism and right ventricular pacing].

UNLABELLED: In patients with congenital heart block (CHB), dual-chamber pacing restores physiological heart rate and atrio-ventricular synchronization. However, patients with narrow QRS junctional escape rhythm may be deleteriously affected by long-term, permanent, apical ventricular pacing. We assessed the impact of apical ventricular pacing on echocardiographic ventricular dyssynchrony and hemodynamic parameters. METHODS: Fourteen CHB adults (23 +/- years, 58% male), with a DDD transvenous pacemaker and a junctional escape rhythm (QRS<120 ms) before implantation, were studied. Echocardiography coupled with tissue Doppler imaging (TDI) and Strain rate was performed in spontaneous rhythm (VVI mode 30/mn) and during atrio-synchronized ventricular pacing. RESULTS: The heart rate (43 +/- 09 vs 68 +/- 07: p<0.01), cardiac output (2.9 +/- 0.7 vs 3.7 +/- 0.6 L/min) and left ventricular filling time (325 +/- 38 vs 412 +/- 51 ms; p<0.01) were significantly less in the escape spontaneous rhythm compared with atrio-ventricular synchronized apical pacing. However, interventricular dyssynchrony (28 +/- 12 vs 59 +/- 25 ms, p<0.05), intra-left ventricular dyssynchrony (36 +/- 11 vs 57 +/- 29 ms; p<0.05), extent of left ventricular myocardium displaying delayed longitudinal contraction (26 +/- 10 vs 39 +/- 17%: p<0.05) were significantly less in the escape rhythm compared with paced rhythm. CONCLUSION: Once implanted with a DDD pacemaker, CHB patients present with increased cardiac output secondary to the restoration of physiological heart rate and improved diastolic function. However, the apical site is not optimal, as it creates detrimental ventricular dyssynchrony in patients with previous nearly physiological ventricular activation. Alternative pacing sites should be investigated.

Adult↗
PubMed2005

[Echocardiography and biventricular resynchronisation].

Biventricular resynchronisation has been recently shown to be an effective therapeutic option in patients with refractory dilated cardiomyopathy. Based on the finding of ventricular asynchrony, the aim of the method is to restore uniform contraction of the ventricular walls. However, the initial electrocardiographic criteria for selection of patients were only associated with a 70% rate of response. Consequently, it became necessary to refocus this method in patients with true ventricular asynchrony. Echocardiography is one of the non-invasive techniques which provides morphological and functional analysis of the myocardium with a high degree of accessibility. The multiplication of tools for echocardiographic quantification has been very valuable from a theoretical point of view for assessing ventricular asynchrony. In practice, techniques such as Doppler tissue imaging are being validated, but already offer the possibility of a multi-directional approach to this pathology. The diagnosis of asynchrony is based on a range of echocardiographic findings which not only improve the selection of patients but also optimise the programming of multisite stimulation.

Cardiac Pacing, Artificial↗
PubMed2005

[Diagnosis difficulty in occult constrictive pericarditis].

We report the case of a 42 years woman known to have a cardiac heart failure attributed to restrictive cardiomyopathy for want of any other plausible diagnosis. Evolution and repeted investigations finally permitted to rectify the diagnosis by revealing a constrictive pericarditis, remained occult 9 years during. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Diagnosis of constrictive pericarditis is based on associated signs sometimes too poor to go straight to thoracotomy. We discuss the mean to approach more precisely this uncommon pattern named occult constrictive pericarditis.

Adult↗
PubMed2005

[Myocardial perfusion and contrast echocardiography. Application to acute coronary syndrome].

After mastering epicardial revascularisation, the therapeutic management of acute coronary syndrome has progressively turned towards the preservation of the capillary microcirculation. In this respect, contrast echocardiography provides all the answers to the main questions which arise, and is available within a timeframe and place compatible with the management of such patients. The techniques for microbubble detection, quantification tools, and contrast agents are well optimised for routine use both for initial diagnosis as well as monitoring the therapeutic effectiveness. It is only the administrative authorisation which is currently lacking treatment.

Angina, Unstable↗
PubMed2004

["Optigo" hand-held echocardiography in post-surgery of coronary artery bypass graft].

INTRODUCTION: After all the advances in electronic miniaturization, first hand-held echocardiographs have finally appeared in echocardiographic laboratories. However, questions still remain about their usefulness in our everyday practice and also about their good diagnosis accuracy. Since some of them do not offer modes such as pulsed or continuous wave Doppler, nor M-mode, they cannot compete with conventional devices. However, they do offer advantages such as their long autonomy, the good quality of their image as well as the one obtained with colour-Doppler mode, in addition obviously to the fact that they can be carried around very easily. OBJECTIVES: To better define their possible uses, we assessed capabilities of one of them, the Optigo (Philips Ultrasound) to analyse patients who had undergone coronary artery bypass surgery. METHOD: Fifty patients have been included in this study few days after the surgery. Each of the patients had two echocardiographic examinations, one with a conventional device and one with the Optigo. Two separated and blinded observers for a subsequent and side-by-side criteria comparison performed the two echocardiograms. RESULTS: Hand-held echocardiography had a good diagnosis accuracy varying from 85% to 95% depending on the analysed criteria. It was more specifically good in the analysis of global or regional left heart function and of the right cavities as well as detecting the existence of pericardial effusion. CONCLUSION: Hand-held echocardiographic device demonstrated high accuracy in assessing patients with recent coronary bypass surgery especially regarding cardiac function and pericardial effusion diagnosis.

Coronary Artery Bypass↗
PubMed2004

[Prosthetic valve thrombosis in pregnancy. A single-center study of 12 cases].

Pregnancy in women with mechanical prosthetic heart valves carried an increased risk of thromboembolic complications due to changes in haemostasis. Prosthetic valve thrombosis is a serious complication resulting in high mortality. Ten patients from 20 to 38 years of age had 12 thromboses of mechanical heart prostheses during pregnancy. The prosthesis was mitral in 8 cases and aortic in 4 cases. The prosthesis was a ball valve in 1 case, a tilting disc in 3 cases and bi-leaflet in 8 cases. Initial emergency treatment was surgical in 3 cases and medical in 9 cases (thrombolysis in 7 cases and simple heparin therapy in 2 cases). Secondary surgery was carried out in one patient after failure of heparin therapy. There was one death in the surgical group (4 cases, 25%) and 30% foetal mortality in the surviving women. In the thrombolysis group (7 cases), two women died (28%) after failure of treatment. Both patients had mitral valve prostheses and were in cardiogenic shock. Three women, of the other 5 thrombolysed cases, were able to complete their pregnancies and had healthy babies with no foetal mortality. No per-thrombolytic embolic complications were observed. However, there was one severe bleeding complication which was successfully managed by surgical drainage. Finally, a global success rate of 75% (9 out of 12 patients) and a mortality of 30% (3 maternal deaths in the 10 patients--all with mitral valve protheses) were observed irrespective of the therapeutic protocol used. Thrombosis is the most life-threatening complication for women with prosthetic heart valve during pregnancy. Emergency surgery for valve replacement or thrombectomy is the commonest treatment. Trombolysis is classically limited by the risk of haemorrhagic and thromboembolic complications reported in the literature. In this study, thrombolysis was effective in the 71% of cases with a low risk of haemorrhagic complications.

Adult↗
PubMed2003

[Cardiac manifestations of amyloidosis by deposits of transthyretin and apolipoprotein A1. Report of 3 families].

Amyloidosis is characterised by extracellular deposits of a heterogenous protein. Compared with secondary forms, hereditary amyloidosis due to genetic mutations is rare. The authors report the cardiac manifestations in a French family of 5 sisters and 1 brother, three of whom presented with amyloidosis with deposits of transthyretin and apolipoprotein A1 due to a new genetic mutation.

Adult↗
PubMed2003

[Contrast echocardiography: from experimental validation to practice].

After a long wait, contrast echocardiography is at last becoming a reality. The experimental validation step has been passed with success and the first clinical results bring confirmation. The second generation contrast agents which are arriving on the market, and the spread of enhancement techniques such as Real-Time mode allow perfect visualisation of microbubbles within the left ventricular cavity, but equally at the level of the myocardial crown, thus targeting two direct applications in echocardiography: the first, indisputably, concerns the improvement in the detection of the endocardium in all the situations where it is insufficient, and in particular during stress echography; the second, more ambitious, confronts the study of myocardial perfusion, with a yet to be defined place in clinical practice.

Contrast Media↗
PubMed2003

[Unusual cause of myocardial infarction].

The authors report the case of a woman with an acute myocardial infarction in whom coronary angiography performed a few hours earlier was completely normal. Transoesophageal echocardiography showed two thrombi in the left atrial appendage confirming the thromboembolic mechanism of this infarct.

Aged↗
PubMed2002

[Study of variations in preload on the new echocardiography parameters of diastolic function in health subjects].

The standard Doppler indices of transmitral filling are changed by variations in preload, relaxation and left ventricular compliance. Recent work in the literature suggests that the new parameters of diastolic function [mitral flux propagation speed in colour TM. (Vp) and tissue Doppler mitral ring velocities (Ea)] are independent of loading conditions. The objective of this work was to study the effect of modifications in the preload on Vp and Ea in normal subjects. Therefore, we have studied various Doppler echocardiographic measurements performed at rest, during a Trendelenberg manoeuvre at 60 degrees, and after sublingual administration of trinitrate in 25 healthy young (2 +/- 8 years) male volunteers. The end diastolic volume increased from 126 +/- 25 ml in the resting state to 145 +/- 24 ml during the Trendelenberg (p = 0.009) then decreased after trinitrate to 121 +/- 28 ml. The peak of the E wave increased from 88 +/- 12 cm/s in the resting state to 90 +/- 15 cm/s during the Trendelenberg and decreased to 70 +/- 11 cm/s after trinitrate (p < 0.0001). The peak Ea annular velocities of the septal and lateral walls were 22 +/- 4 cm/s and 15 +/- 1.6 cm/s in the resting state, without variation during the Trendelenberg (22 +/- 5 cm/s and 15 +/- 2 cm/s) but with a significant reduction after trinitrate to 19 +/- 5 cm/s and 13 +/- 2 cm/s (p = 0.02 and p = 0.002). In contrast, no significant variation was noted in Vp (60 +/- 14 cm/s in the resting state, 62 +/- 12 cm/s during the Trendelenberg and 59 +/- 14 cm/s after trinitrate). We conclude that Vp is not significantly affected by preload whereas Ea is not independent of the loading conditions.

Adult↗
PubMed2002

[Fibrinolysis and thrombosis of mechanical valvular prosthesis: risk stratification by transesophageal echocardiography].

The place of fibrinolysis in the treatment of mechanical valvular prostheses is still much discussed. The aim of this work is to define the role of transoesophageal echocardiography in risk stratification. This monocentric study draws on 49 cases of thrombolysis preceded by transoesophageal echocardiography (average age 62.1 years, 37 mitral, 11 aortic, 1 tricuspid, 1 mitro-tricuspid). There were 41 obstructive thromboses (OT) and 8 non-obstructive thromboses (NOT). Clinical events and the effectiveness of fibrinolysis were studied as a function of the obstructive or non-obstructive character of the thrombosis and the size of the thrombus < 10 mm (n = 33) or > or = 10 mm (n = 16). Complete success was observed in 34 patients (69.4%). Follow up revealed 2 early cerebral haemorrhages (4.1%) of which one was in the NOT group, and six systemic emboli (12.2%) of which one was in the NOT group. There was a relationship between the size of the thrombus and embolus at the limit of significance in favour of an increased risk of embolus for a voluminous thrombus. Furthermore, the mobility of the thrombi went in hand with an increased rate of systemic emboli (p < 0.01). The rate of failure of fibrinolysis and/or complications correlated with the size of thrombus (complete success in 88% of the < 10 mm thrombus group, versus 35% in the > or = 10 mm; p < 0.01). This work underlines the significance of trans-oesophageal echocardiography in the therapeutic choice for valvular prosthesis thrombosis and suggests that the existence of a voluminous thrombus especially if mobile is a contra-indication for fibrinolysis.

Adult↗