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Biomedical subjects

R Slama

Publications and source records attributed to R Slama.

At least 73 records · Page 4Linked to original sources
PubMed1988

The influence of molsidomine on infarct size: an acute post-infarction pilot study with 303 patients.

In a multicenter, randomized and double-blind study, the efficiency of molsidomine on infarct size has been examined in 303 patients suffering from a first myocardial infarction and compared with a placebo. According to previous enzyme studies, and in order to detect a 20% reduction infarct size with conventional levels of risk, alpha = 0.05 and beta = 0.20, the recommended sample size was 264 patients. Thirty-three patients initially selected were excluded for protocol violation and, among the 270 patients definitively included, 133 were allocated to molsidomine and 137 to placebo, without any difference concerning age, delay of treatment, infarct location, and initial blood pressure. Test drugs were both initiated within the 6 first hours and administered orally at decreasing doses for 10 days: 16 mg on the first day, 12 mg on the second day, and 6 mg daily from the third to the tenth days. There was not a significant difference between the molsidomine and placebo groups regarding the enzyme evaluation of infarct size, neither for CK dosage (101.72 +/- 74.76 gram equivalents vs. 92.71 +/- 65.91 gram equivalents, NS) nor for its MB fraction (67.34 +/- 50.07 gram equivalents vs. 63.50 +/- 43.01 gram equivalents, NS). Moreover, changes in the Q- or R-wave sum during the 10 days of follow-up were strictly identical. However, in-hospital mortality was lower in the molsidomine group than in the placebo group (4.5% vs. 8.0%), but this reduction was not statistically significant. During the study, there were few side effects, mainly headaches, without withdrawal of the treatment.

Acute Disease↗
PubMed1988

Rate dependence of ventricular extrasystoles: computer identification and quantitative analysis.

A new computer program was designed to identify and quantify the rate dependence of arrhythmias using 24 hour Holter tape recordings. The program was used in 10 untreated apparently healthy patients with fixed, coupled, isolated monomorphic ventricular extrasystoles. The second cycles of two consecutive sinus cycles were grouped according to whether or not they were followed by a ventricular extrasystole. Each of these sinus cycles was further analysed by cycle length during successive one hour periods. From the number of cycles in each cycle length class, identification and quantification of an upper or lower limit, or both, of cycle length beyond which ventricular extrasystoles disappeared were possible. Upper and lower limits were observed in 10 and eight of the 10 patients respectively. An upper and a lower limit were identifiable (mean(SD) 9.3(5.1) and 8.4(5.8) times per recording respectively). Values of both types of limits varied throughout tape recording. A positive significant correlation was found between the values of upper and lower limits and the mean sinus cycle length during the corresponding hour in nine of the 10 and eight of the eight patients respectively. The type of relation observed suggests that heart rate directly alters limits or that heart rate and limits are under the same influence of the autonomic nervous system. It is concluded (a) that identification and quantification of the rate dependence of arrhythmias is possible using this computer program; and (b) that, in patients with ventricular extrasystoles and apparently normal hearts, upper and lower limits vary and are related to heart rate.

Adolescent↗
PubMed1988

[Kearns-Sayre syndrome: complete auriculoventricular block, torsade de pointes and ventricular fibrillation].

The authors present the case of a new case of Kearns-Sayre syndrome, with early manifestations (7 months) and dramatic cardiac course. They document the ultimate and often fatal stage of the cardiac disorders of this syndrome, which was usually related to an asystole due to a total atrio-ventricular block and represented in this case by a ventricular hyperexcitability (ventricular tachycardia--"torsade de pointes"--ventricular fibrillation) occurring on an atrio-ventricular block; only one previous, undocumented case was found in the literature. The literature is reviewed in order to analyze the nature and chronology of the heart disorders in the course of the disease, and stress the screening modalities and therapeutic indications (continuous heart stimulation).

Electrocardiography↗
PubMed1988

[Quantitative analysis of ventricular volumes by digital two-dimensional echocardiography].

The purpose of this study was to assess the usefulness of digital enhancement of two-dimensional echocardiographic images by cardiac cycle-synchronized summation and digital manipulation of the resulting images. We developed a system which provides for: (1) real-time storage of end-diastolic and end-systolic cardiac cycle images irrespective of rhythm variations; (2) exclusion from summation of end-diastolic and end-systolic images altered by respiratory movements or transducer displacements; (3) performance on the resulting images of various mathematical operations (3*3 convolutions, colour scale-guided manipulation of grey shades); (4) performance of complex mathematical calculations from the extracted edges including, in particular, reconstruction of ventricular volumes by Simpson's crossed method from a transverse and an apical section or from two apical sections. This method was used to collect echocardiographic images from 32 patients who had undergone left ventricular quantitative angiography during the same week. Qualitatively, digital enhancement of two-dimensional echocardiographic images undoubtedly facilitated the identification of endocardial edges and reduced image noise, notably in patients whose ventricular edges were virtually unrecognizable by any other method. Moreover, summation improved correlations with angiography and reduced the variability of quantitative ventricular volume assessment. Finally, the ease and rapidity with which this "real-time" system can be used enables quantitative analysis of left ventricular function to be routinely carried out.

Adult↗
PubMed1988

[Characteristics and prognosis of ventricular arrhythmia in arrhythmogenic right ventricular dysplasia].

The authors report their findings in 47 cases of ventricular arrhythmias due to arrhythmogenic dysplasia. The 47 patients were selected on the presence of ventricular tachycardia or fibrillation associated with dysplasia affecting selectively (44/47) or predominantly (3/47) the right ventricle at angiography. In this series males were predominant (38/47, 81 p. 100), familial incidence was high (13/47, 28 p. 100) and ECG abnormalities were constant. Most of the dysrhythmias (40/47) consisted of sustained ventricular tachycardia (VT) with left bundle branch block pattern (96 p. 100), occurring at the rate of 1.6 per patient on average and seldom with extreme axial deviation, as seen in post-infarction VT or VT associated with cardiomyopathy. The QRS complex was slightly prolonged (151 +/- 28 ms) and of high amplitude (2.5 +/- 1 mV on a VR, a VL and a VF leads), these values being intermediate between those of mild VT bursts and those of post-infarction or cardiomyopathy-related VT. The tachycardia was easily tippered by EP study, Intercritical Holter recordings showed frequent ventricular extrasystoles in the vast majority of cases; these were usually polymorphous and grouped into short bursts in one-half of the patients. On an 8.3 +/- 7 years' follow-up starting with the first attack of VT, it was found that only during the initial phase the spontaneous onset of VT was mediated by the adrenergic system (triggered by sports). Only 3 patients died during the follow-up period: one of ventricular fibrillation, 2 of right heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Dynamic coronary fibrinolysis evaluation in patients with myocardial infarction and unstable angina by specific plasma fibrin degradation product determination.

It has been shown that myocardial infarction (MI) is caused by thrombotic occlusion of a coronary artery. A thrombotic process is also involved in the flow obstruction associated with peripheral embolization in unstable angina (UA). In UA, a local fibrinolytic process should occur, but biological evidence has never been reported. Therefore, we measured sequential changes in plasma fibrin degradation products (FDP) in patients with stable and unstable angina pectoris without MI and compared the levels to those in patients with MI. FDP determination was carried out by ELISA using a D neo monoclonal antibody allowing low amounts of FDP to be reliably and precisely detected. Our results show an early increase in FDP in UA indicating a thrombolytic process. In patients who presented only one episode of chest pain, a prompt decrease of FDP was noted whereas in patients with recurrent chest pain, the levels of FDP remained high. On the contrary, during the first 3 days of uncomplicated MI, FDP levels were not significantly different from those of normal control suggesting an absence of clot dissolution. This study underlines the important function of fibrinolysis in the spontaneous evolution of acute coronary syndrome.

Angina Pectoris↗
PubMed1987

Alpha-myosin heavy chain isoform and atrial size in patients with various types of mitral valve dysfunction: a quantitative study.

The cardiac myosin phenotype, an important determinant of myocardial contractility, is modified by chronic increases in hemodynamic load. To quantify the proportion of atrial alpha-myosin heavy chain in various types of left atrial overload and to assess the possible relation between this proportion and atrial size, 34 patients were studied, 4 with Wolff-Parkinson-White syndrome, 29 with various types of mitral valve dysfunction and 1 with an atrial septal defect. Four normal autopsy hearts were also studied. The proportion of alpha-myosin heavy chain among total (alpha plus beta) myosin heavy chains was determined in each atrial sample, using an enzyme-linked immunosorbent assay. The size of the left atrium was assessed by one- and two-dimensional echocardiography. Alpha-myosin heavy chain was the main isoform present in the normal atria (85.5 +/- 9% of total myosin heavy chains). Patients with pure tight mitral stenosis (n = 9), mitral stenosis plus mild regurgitation (n = 8) and severe mitral regurgitation (n = 8), who had a higher indexed left atrial transverse diameter than those with Wolff-Parkinson-White syndrome (33 +/- 6, 39 +/- 10 and 46 +/- 5 versus 19.5 +/- 2 mm/m2, p less than 0.01, p less than 0.001 and p less than 0.001, respectively), also demonstrated a much smaller percent of alpha-myosin heavy chain content (28 +/- 20, 23.5 +/- 13 and 12 +/- 10 versus 58 +/- 18%, p less than 0.01, p less than 0.01 and p less than 0.001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Clinical use of automatic implantable defibrillators.

We implanted the automatic implantable defibrillator model B (AID-B) in 11 patients (pts). Seven pts had coronary disease with sustained VT, and/or VF. Two had syncopal VT due to primary cardiomyopathy, and two pts had syncopal torsades de pointes (Tdp) without cardiac disease (1 long QT syndrome). These arrhythmias occurred despite antiarrhythmic drugs or beta blockers. Four pts had implanted: an epicardial patch by thoracotomy, an intra-atrial string electrode by the jugular vein, then AID-B by abdominal route. In 7 pts, subcostal approach was used, for implanting simultaneously 2 epicardial patches and the AID-B itself. During the operation, VT, Tdp and/or VF were induced in all pts by 50 Hz alternating current. The defibrillation threshold (DT) between atrial catheter and epicardial patch was less than 15 J in 4 pts, and greater than 25 J in two, requiring a larger patch in 1, and replacement of atrial electrode by another patch in the 2nd pt to obtain a DT less than 20 J. In the 6 pts implanted with 2 patches, DT was always less than 25 J. In 3 pts, DT was markedly higher for VF (25 J) than for VT (less than 15 J). One pt died from pulmonary embolism, another died after 3 years, before replacement of a failing battery, and a third died from progressive congestive heart failure, 6 months later. Eight pts are alive with a follow-up greater than 6 months. Local aseptic reactions obliged a removal of the implant in 2 pts operated by bifocal approach, and none when the subcostal route was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Value of beta blockers in the treatment of recurrent ventricular tachycardia in cardiac insufficiency].

Beta-blockers were used to treat 20 patients (mean age 55 +/- 12 years) presenting with severe ventricular arrhythmia on chronic heart failure (NYHA stages II to IV; mean ejection fraction 29.7 +/- 7.8%) due to coronary disease (18 cases) or to cardiomyopathy (2 cases). Ventricular tachycardia sustained (7.6 +/- 6.3 attacks/patient) in 19 patients, unsustained in 18, monomorphous in 8 and polymorphous in 12, had been present for 12.4 +/- 18 months. In all but one hitherto untreated patient, the condition had failed to respond to amiodarone combined with a type Ia (19 patients) and type Ic (16 patients) antiarrhythmic drug. Short-term results were: 17 successes, 2 failures and 1 death due to cardiogenic shock. Fifteen patients were followed up for 14 +/- 6.7 months. Thirteen of them benefited from smaller doses of a formerly ineffective treatment; there was one failure, and one patient in whom the attacks of tachycardia, but not the numerous and polymorphous extrasystoles, were controlled by the beta-blockers suddenly died at night. The actuarial mortality rate was 11.4% as against an expected figure of 30% in such a high risk group. Although no significant changes in ejection fraction were observed, heart failure became worse in 8 patients, but it was compensated by diuretics and/or vasodilators. The effects of beta-blockers in resistant ventricular arrhythmia on heart failure suggest that an adrenergic factor is involved in the mechanism of arrhythmia. Provided treatment is progressive and its haemodynamic consequences carefully monitored, beta-blockade is well tolerated. Its effectiveness on severe arrhythmia and on mortality rate seems to confirm that it prevents sudden death by an anti-arrhythmic mechanism.

Adrenergic beta-Antagonists↗
PubMed1987

[Coronary angioplasty 1987].

Percutaneous transluminal coronary angioplasty (PTCA) is currently a common technique in the treatment of coronary artery disease, since the first dilatation was performed with success by A. Gruentzig (1977). If clinical indication is reserved to symptomatic angina pectoris, angiographic indications have been enlarged on account of progress in techniques and technology. Immediate success is good, about 90% with a low rate of mortality (1%), sometimes despite an emergency surgical revascularization. Restenosis is frequent, about 30% a few months after PTCA, with necessity of a new PTCA in almost half the cases. Long-term follow-up is satisfactory, about two third patients are asymptomatic. Immediate efficacy of this simple technique, and good results on a long-term follow-up, are explications of the increase in the number of PTCA during the last ten years.

Angioplasty, Balloon↗
PubMed1987

[Aortic valvuloplasties: treatment of calcified aortic stenosis in elderly subjects].

Since September 1985, transluminal balloon catheter aortic valvuloplasty has been developed in France (Cribier and al.) and all around the world. Indications are still limited, in almost all catheterization laboratories, to elderly patients, with Monckeberg's disease, and with a very high operative risk. Immediately after aortic valvuloplasty, there is a moderate but a significant increase in valve area, without serious complications. Subjective improvement is often spectacular during few months after the valvuloplasty. In long-term evolution, there is sometimes a symptomatic restenosis which require a new valvuloplasty. So, if percutaneous valvuloplasty is efficacy in aortic stenosis in the elderly, long-term evaluation of this new technique is necessary.

Aged↗
PubMed1987

[Long-term clinical results of the implantable automatic defibrillator].

Between October 1982 and May 1986, 12 patients were implanted with an automatic defibrillator AID-B; 7 had coronary artery disease, 2 had dilated cardiomyopathies and 3 had torsades de pointe with or without long QT intervals. Five patients had a thoracic approach with a left ventricular patch and implantation of a right atrial endocavitary electrode. Thereafter a subcostal approach was used with 2 patch electrodes. Two of the first 5 patients rejected the device, but this complication was not observed in the remaining 7 cases. The threshold of defibrillation was greater than 25 joules in 1 case out of 5 with a patch and endocavitary electrode. This threshold was less than 25 joules in all patients with 2 patch electrodes. The AID-B was triggered in less than 20 seconds. One patient died of pulmonary embolism 8 days after implantation; 2 others had a temporary aggravation of their arrhythmias. There were no cases of inappropriate activation of the AID-B device during follow up: 5 patients had no arrhythmia or defibrillation. The 6 others had 2 to 35 defibrillations with documented arrhythmias before or after defibrillation. One patient suffered a sudden death after exhaustion of the device which had functioned on two occasions but had not been replaced for economic reasons. The technique of implantation has been simplified, so limiting local complications. This device is reliable and represents an effective palliative treatment of sudden death due to ventricular arrhythmias.

Adult↗
PubMed1987

[Surgery of Wolff-Parkinson-White: value of the epicardial approach. Apropos of 28 surgically treated cases].

The authors report their experience of 28 cases of the Wolff-Parkinson-White (WPW) syndrome treated by surgery. Four patients had multiple accessory pathways; of the 32 bundles of Kent detected, 16 were in the postero-septal region. Surgery, performed under cardio-pulmonary bypass after epicardial mapping, consisted in atrioventricular disconnection using no special physical agent. With the exception of 2 cases, the left lateral accessory pathways were operated using a classical left intraatrial approach whereas in the right lateral and septal forms the main procedure of dissection of the right atrioventricular groove was carried out by an epicardial approach. There was one operative death due to haemodynamic and haemorrhagic problems in a top class athlete with two bundles of Kent, the interruption of which required two consecutive bypass procedures. In the 27 survivors, 29 of the 30 accessory pathways were successfully interrupted (96 p. 100). The only failure occurred in a patient with two bundles of Kent. On the other hand, in 2 patients, complete atrioventricular block was successfully obtained by surgical section of the His bundle during the same procedure in one case, and by postoperative catheter ablation in the other case in which surgery had failed. There were no cases of accidental permanent atrioventricular block. The results in this series confirm the value of surgery in the treatment of the WPW syndrome, especially in the septal forms which are reputed to be the most difficult but in which the approach is greatly simplified by the initial dissection of the tricuspid ring by an epicardial approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Computer analysis of ambulatory electrocardiograms. Electrophysiological value of the Holter method].

Ambulatory electrocardiography (Holter method) is a technique which is well adapted to the recording of arrhythmias occurring during normal everyday activities. This data is assessed by conventional computer techniques with the object of quantifying the phenomena recorded. However, data processing should not be limited to these as more comprehensive methods of analysis are now available. An attack of arrhythmia is in fact never a chance happening. If one studies the context and the sequence of cardiac cycles leading up to the arrhythmia, the close relationship between arrhythmias and the autonomic nervous system becomes apparent with important therapeutic implications.

Arrhythmias, Cardiac↗