Search PubMed⌕ Search

Biomedical subjects

V Aboyans

Publications and source records attributed to V Aboyans.

At least 19 recordsLinked to original sources
PubMed2006

Type-2 diabetes and carotid stenosis: a proposal for a screening strategy in asymptomatic patients.

The objective of this prospective observational study was to establish the prevalence of carotid atherosclerosis in an asymptomatic diabetic population and to determine predictive factors for a screening optimization. A total of 300 consecutive type-2 diabetic subjects (166 males, 134 females) underwent a physical examination and duplex carotid scanning. Patients with a recent cerebrovascular event (< or = 6 weeks) or previous carotid surgery were excluded. The prevalence of carotid stenosis > or = 60% or occlusion was 4.7%; the prevalence of carotid atherosclerosis was 68.3%. Risk factors for stenosis > or = 60% or occlusion were the presence of diabetic retinopathy (OR: 3.62; 95% CI: 1.12-11.73), ankle-brachial index (ABI) <0.85 (OR: 3.94; 95% CI: 1.21-12.84) and a personal history of neurological disorders (OR: 4.54; 95% CI: 1.16-17.81). Being female was a protective factor (OR: 0.09; 95% CI: 0.01-0.78). The two factors in the analysis limited to the male population were an ABI < 0.85 (OR: 3.66; 95% CI: 1.04-12.84) and a personal history of coronary heart disease (OR: 3.34; 95% CI: 1.01-11.01). If male diabetics without either of these two factors are excluded, the negative predictive value for carotid stenosis is 96.6%. In conclusion, the prevalence of atherosclerotic carotid disease in diabetic patients is high. In these patients, the probability of finding >60% stenosis is highest among men with a history of coronary heart disease or an ABI <0.85.

Adult↗
PubMed2005

[Clinical and therapeutic specificities of myocardial infarction in patients with peripheral arterial disease: the USIC 2000 registry].

OBJECTIVE: Several studies underlined the worse prognosis of myocardial infarction (MI) among patients with peripheral arterial disease (PAD). We sought to describe the presentation and management modalities of a cohort of PAD patients presenting an acute MI, compared to those without PAD. MATERIALS AND METHODS: The USIC 2000 registry, a nationwide database on all patients admitted to a CCU for an acute MI < 48 hours in France in November 2000 was used for this study. RESULTS: Among the 2311 patients included, PAD was reported in 215 subjects (9.3%). In multivariate analysis, the following factors were positively related to the presence of PAD (P < or = 0.05): age >75 y (OR = 2.3), diabetes (OR = 2.0), hypertension (OR = 1.4), active smoking (OR = 4.6), renal failure (OR =3.1), and treatments with antiplatelets (OR = 3.9), anti-vitamin K (OR = 1.9), statins (OR = 1.7) and low molecular weight heparins (OR = 6.8). By introducing the data concerning the arrival in CCUs in the model, the following factors were also significantly more frequent among PAD patients: male sex (OR = 1.6), past history of coronary artery disease (OR = 2.2), left bundle branch block (OR = 1.8) and late management >6 hours (OR = 1.4). Conversely, ST-segment elevation was less frequent (OR = 0.7). When the CCU stay data were introduced in the model, a lower rate of coronary stenting (OR = 0.7) and betablockers use within 48 hours of admission (OR = 0.6) were noted. CONCLUSION: Beyond the presence of PAD per se, several particularities do exist, especially the coexistence of a high number of pejorative factors and an under-utilization of treatments presenting prognostic benefits.

Aged↗
PubMed2005

[A long-term follow-up quality evaluation of patients taking oral anticoagulant therapy].

OBJECTIVES: the aim of this study was to estimate the population under Vitamin-K antagonists (VKA) in the region of Limousin (France), and to assess the treatment quality and the level of knowledge of the patients. METHODS: a transversal study permitted to identify all the patients under VKA under the French general health care coverage. During 6 months, a cohort of 370 patients had been followed. Major data measured were: the number of INR, the duration within the therapeutic range, the duration in the hazardous zone (INR >4.5), the level of patients' education and the knowledge on the treatment's indication by biologists. Data were collected through the French general health care database as well as questionnaires sent to general practitioners, biologists and patients. RESULTS: one percent of the entire population was under VKA. The mean number of INR performed during 6 months was 6.6, and 36.5% of patients had less than one biological control monthly. The mean duration passed within the therapeutic range was at 54%. The hazardous zone was reached by 22% of the patients. The level of education of the patients was poor in one half of the patients. The indication of the treatment was known in 6% of patients' biologists. CONCLUSION: these results reflect the limits of application of recommendations. Facing to this evidence, it is necessary to optimize the management and follow-up of these treatments, especially through the development of public health charters with biologists, education with patients, or even anticoagulant clinics.

Adult↗
PubMed2004

[Systolic pressure, a powerful marker of the risk of obliterating artery disease of the lower limbs].

A MARKER OF PERIPHERAL ARTERIAL DISEASE: The measurement of the ankle/arm index (AAI) is a simple, rapid and inexpensive means for the assessment of distal lower limb perfusion. Its decrease reveals an alteration in the patient's arterial status. Consecutively, AAI is an excellent marker of peripheral arterial disease, well before the onset of functional consequences. A TRIPLE MARKER: Beyond the diagnosis of peripheral arterial disease, AAI provides other interests: it is not only a tool for the functional assessment of lower limb perfusion, but also a marker of local and general atherosclerosis, as well as cardiovascular events.

Arterial Occlusive Diseases↗
PubMed2004

[Non-invasive explorations in arteriopathy of the lower limbs].

FOR THE DIAGNOSIS OF AN ARTERIOPATHY: The approach is basically clinical, and vascular explorations are represented by the measurement of ankle blood pressure and calculation of the pressure index, a simple test that should systematically complete the examination. THE SEARCH FOR LOCAL LESIONS OF POTENTIALLY POOR PROGNOSIS: These are principally aneurysm and stenosis of the derivation routes that should be searched for using a Doppler in order to localise them and, completed by measurement of ankle blood pressure, specify the upstream impact and the ultrasound-Doppler analysis of certain selected areas. BEFORE REVASCULARISATION: The arteriography, examination of reference until recently, has certain limits that explain its more restricted use and the widened use of ultrasound-Doppler explorations, combined with magnetic resonance imaging and scanning.

Angiography↗
PubMed2004

A new approach for the screening of carotid lesions: a 'fast-track' method with the use of new generation hand-held ultrasound devices.

OBJECTIVES: We assessed the usefulness of fast-track neck sonography with a new-generation hand-held ultrasound scanner in the detection of > or =60% carotid stenosis. DESIGN: Patients with a past history of atherosclerotic disease or presence of risk factors were enrolled. All had fast-track carotid screening with a hand-held ultrasound scanner. METHODS: Initial assessment was performed with our quick imaging protocol. A second examiner performed a conventional complete carotid duplex as gold-standard. RESULTS: We enrolled 197 consecutive patients with a mean age of 67 years (range 35-94). A carotid stenosis >60% was detected in 13 cases (6%). The sensitivity, specificity, positive and negative predictive value of fast-track sonography was 100%, 64%, 17% and 100%, respectively. Concomitant power Doppler imaging during the fast-track method did not improve accuracy. CONCLUSIONS: The use of a fast-track method with a hand-held ultrasound device can reduce the number of unnecessary carotid Duplex and enhance the screening efficiency without missing significant carotid stenoses.

Adult↗
PubMed2004

[Ankle-brachial index: an essential component for the screening, diagnosis and management of peripheral arterial disease].

The measurement of the ankle-brachial index (ABI) or the ankle/arm ratio provides a simple, rapid and cheap method for the evaluation of the distal perfusion of lower limbs. A decreased value underlines an altered arterial state. Thus, ABI is an excellent marker of peripheral arterial disease, even prior to the occurrence of functional symptoms. Beyond the diagnosis of peripheral arterial disease, ABI is nowadays known as a marker of atherosclerosis and a cardiovascular marker. Hence, ABI appears not only as a tool in the functional assessment of lower limbs perfusion, but also a local and general marker of atherosclerosis and cardiovascular events. The aim of this paper is to update data on the usefulness of ABI through a general review, and to present open issues. After a focus on the methodology of ABI measurement, the diagnostic value of ABI will be presented in this paper.

Arteriosclerosis Obliterans↗
PubMed2004

[Ankle-brachial index: a marker of atherosclerosis and cardiovascular prognosis].

This article is the second part of a general review on ankle-brachial index (ABI). After stressing on the interest of ABI for the diagnosis, screening and follow-up of peripheral arterial disease, this second part focuses on the usefulness of ABI in the evaluation of cardiovascular prognosis. Many large scale epidemiological studies evidenced the predictive abilities of ABI in general population or in high-risk subgroups, such as diabetics. A low ABI corresponds to a risk excess of total and cardiovascular mortality, cardiac events and stroke. The interest of ABI in this issue overpasses the simple increased probability of presence of concomitant atherosclerotic lesions in a patient with peripheral arterial disease. Beyond the primary prevention, a low ABI in patients with coronary artery disease appears to be of poorer prognosis. In the future, according to the results of ongoing studies, it is possible that ABI measurement and the detection of any abnormal result would be followed by a more aggressive therapeutic management.

Ankle↗
PubMed2003

Epidemiology of venous insufficiency in an occupational population.

AIM: A cross sectional study of the prevalence and risk factors of chronic venous insufficiency (CVI) in a South European occupational population was performed. METHODS: Over a 7-month period a questionnaire (CVI symptoms, general data and life style habits) was administrated to 1604 consecutive females (73.3%) and 586 consecutive males (26.7%). An oriented clinical examination was then performed. Subjects were classified into 4 groups: asymptomatic, light, moderate and severe CVI. Univariate and multivariate analysis were used. RESULTS: Mean age 38.8+/-11.6 years (range 15-65). The prevalence of CVI all classes confounded was 51.4% (62.3% in women and 21.8% in men); the prevalence of moderate and severe CVI was 10.4% (12.1% in female and 6.3% in male). Age (Odds Ratio (OR): 1.93, 95% confidence interval (CI): 1.55-3.53), female sex (OR: 2.34, 95% CI: 1.62-2.30), obesity (kg/m(2)) (OR:1.11, 95% CI: 1.07-1.15) and familial history of CVI (OR: 2.80, 95% CI: 2.02-3.89) were risks factors of moderate and severe CVI. The comparison extended to the whole group of CVI added other risk factors: history of leg injury, pregnancy; a sitting posture at work. Unexpectedly smoking had a protective effect but only in the female group for the last one. CONCLUSION: CVI is an important medical problem concern in this population. Some of the risk factors like obesity and standing position at work may benefit from preventive measures.

Adolescent↗
PubMed2003

Carotid intima-media thickness as predictor of secondary events after coronary angioplasty.

AIM: Subjects with symptomatic or asymptomatic peripheral arterial or cerebro-vascular disease have an increased risk of death or cardiovascular event. The aim of this study was to determine whether intima-media thickening of the common carotid artery and/or a low ankle brachial index (ABI) are related with an increased risk of cardio-vascular event after percutaneous coronary angioplasty (PTCA). METHODS: One hundred and thirteen consecutive, patients (88 males, 25 females, mean age: 62 years) undergoing PTCA were included. Intima media thickness (IMT) of the common carotid artery and ABI were measured within the 2 days following the PTCA. Subjects were followed up for 10.2 +/- 4 months. The end-point was a composite criterion associating death, non fatal acute myocardial infarction, recurrence or worsening of angina pectoris, hospitalisation for heart failure, new positive exercise stress testing. RESULTS: In the follow-up study a common carotid IMT >0.7 mm was a predictor of event (p=0.03) in the univariate analysis. The other risk factors were unstable angina (p=0.001) and PTCA on the left descending coronary artery (p<0.05). We did not find any relation between the end-point and ABI or presence of atheroma on the common femoral artery. In the logistic regression analysis unstable angina was associated with a 3.14 fold increased risk (IC 95%: 1.51-6.4, p=0.002), subjects without HMG-CoA inhibitors drugs at the inclusion had also an increased risk of 2.5 (IC 95%:1.09-5.75, p=0.02). CONCLUSION: This study suggest that CCA-IMT is associated with an increased risk of cardiac events after PTCA. The measurement of subclinical disease could be useful for identifying high-risk patients.

Aged↗
PubMed2002

[Validation of a French translation of the Edinburgh claudication questionnaire among general practitioners' patients].

OBJECTIVES: Intermittent claudication is one of the clinical symptoms of peripheral arterial disease (PAD). The presence of PAD is a high risk marker of cardiac events and stroke. The PAD screening can be enhanced by the use of questionnaires. The Edinburgh Questionnaire presents in its English version better diagnostic performances compared to the Rose (WHO) Questionnaire. The aim of this study is to precise the performances of the French version of the Edinburgh Questionnaire among a population consulting general practitioners. METHODS: Four centers instructed 10 general practitioners each to the measurement of ankle pressure with a Doppler stethoscope. The physicians administrated the Questionnaire to 10 consecutive consultants in a same day, and measured the pressure on posterior tibial, dorsalis pedis and humeral arteries. With a second questionnaire they collected data concerning age, weight, height, and the presence of major risk factors. The same protocol was repeated a second day on new patients. The diagnosis of PAD was based on an ankle-arm index lower than 0.85 for at least on limb. RESULTS: The population studied consisted of 727 subjects (351 females and 376 males). The mean age was at 58.3 +/- 16.1 years (ranging from 18 to 83.3 years). The sensitivity of the Questionnaire is at 47% (95% CI: 32.3-61.7%), the specificity at 98.8% (95% CI: 97.5-99.4%), the positive and negative predictive values are respectively at 73.3% (95% CI: 54.1-87.7%) and 94.8% (95% CI: 94.7-97.6%). Among this population of general practitioners consultants, the prevalence of a low ankle-arm index under 0.85 is at 6.7%. DISCUSSION: The French version of the Edinburgh Questionnaire maintains the very good specificity of the English version. The lower sensitivity could be explained by the choice of the gold standard, namely the ankle-arm index which includes asymptomatic patients with authentic PAD. The use of this Questionnaire can be recommended for the screening of this disease as well as in epidemiological studies.

Adolescent↗
PubMed2002

Variability of ankle-arm index in general population according to its mode of calculation.

BACKGROUND: Ankle-arm index (AAI) is commonly used in epidemiological studies on peripheral arterial disease but its mode of calculation varies throughout the literature. We aimed to study the variance of the different measurements required to calculate the AAI according to different formulas, in order to find out the best way of AAI calculation, based on its lesser variability. METHODS: A sample of 222 subjects from the general population was prospectively studied. Ten persons were excluded because of the presence of intermittent claudication or due to a lack of a Doppler posterior tibial artery (PT) signal. The systolic pressures of both arms, the dorsalis pedis arteries (DP) and the PT were finally measured in 212 healthy persons (mean age 49.9, range 18-101). RESULTS: Methods using the lowest ankle artery pressure were excluded, as an absent pedal pulse may not be abnormal. The mode using the lowest variance was the choice of the highest pressure between PT and DP of each leg divided by the mean of the systolic pressures of both arms. CONCLUSIONS: We recommend this mode of AAI calculation in epidemiological studies. As the variances of the measurements used are the lowest, it would be easier thereafter to determine normal ranges and cutoff points.

Adolescent↗
PubMed2000

[Heat therapy in chronic venous insufficiency of the legs].

Water cures have long been advocated for venous and lymphatic disorders. Spa therapy combines hydrotherapy, physical therapy and education. Immersion increases central blood volume, diuresis and natriuresis. These effects are independent of the mineral characteristics of the water. Hydrotherapy is viewed as a complementary treatment of venous and lymphatic insufficiency whatever its stage of development; but this has not been formally proved.

Balneology↗
PubMed2000

Is the morning peak of acute myocardial infarction's onset due to sleep-related breathing disorders? A prospective study.

Many studies have shown that the risk of experiencing a myocardial infarction (MI) is increased during the first hours of the morning. Sleep apnea syndrome (SAS) is associated with an enhanced adrenergic activity, prolonged a few hours after awakening. We aimed at assessing whether sleep breathing disorders could be a culprit for the morning excess rate of MI. We studied 40 middle-aged men admitted for an acute MI. An overnight polysomnographic study was performed 37.4 +/- 9.4 days after the MI. The prevalence of SAS was high (30%). The prevalence of SAS was significantly higher in patients with the MI onset during the morning. The circadian pattern was significantly different in patients with or without SAS: those with SAS presented an important peak of MI onset during the period between 06.00 and 11.59 h. None of them had their MI during the period between 24.00 and 05.59 h. This different nyctohemeral pattern underlines the potential role of sleep breathing disorders as a trigger of MI.

Circadian Rhythm↗
PubMed2000

[French translation and validation of the Edinburgh Questionnaire for the diagnosis of intermittent claudication].

Obliterative arterial disease of the lower limbs is diagnosed by simple, reproducible, sensitive and non-invasive methods. One of these, a questionnaire for the diagnosis on intermittent limping, is a method of choice. Until recent years, the only validated questionnaire was the one proposed by the World Health Organisation. This was criticised a lot, especially for its lack of sensitivity. Recently, a Scottish group proposed an improvement in the diagnostic performance of this questionnaire by carrying out several changes. This new version, called the Edinburgh Questionnaire, has promising diagnostic qualities. The authors present a French version of this questionnaire. This French translation was validated in 105 patients referred for diagnosis of obliterative lower limb arterial disease. A sensitivity of 86.5%, a specificity of 95.6%, a positive predictive value of 91.4% and a negative predictive value of 92.9% of this French version are comparable to the results obtained with the English version. Therefore, the authors suggest using this questionnaire in epidemiological and public health studies in France.

Aged↗
PubMed2000

[Long-term survival of elderly amputated vascular patients].

The object of this study was to assess the 10 year outcome of patients over 70 years of age who underwent amputation for vascular diseases. The secondary objective was to determine the prognostic risk factors. One hundred and four consecutive patients having undergone a leg (16 cases) or through-thigh amputation (88 cases) were reviewed. The average age at the time of surgery was 80.7 years (+/- 6.5 years, range 70-98 years). At the time of the enquiry, there were 4 survivors (operated on average 107.7 months previously +/- 14.6 months). The survival rates at one, six, twelve months and two years were 74.1%, 48.1%, 38.5% and 27% respectively. The mean survival time was 19.2 months with a median of 6 months. Univariate analysis showed the following criteria to be statistically correlated with a poor prognosis: female gender (p = 0.008), previous psychiatric disease (p = 0.007), cachexia (p = 0.004), age of 80 or over (p = 0.025), absence of diabetes (p = 0.025). Multivariate analysis showed that men had a lower risk of death (RR: 0.591--95% CI: 0.394-0.888--p = 0.011). The comparison of subjects who died during the first year with the survivors, showed a deleterious effect of proximal amputations (p = 0.032) and absence of diabetes (p = 0.021). These results confirm the very mediocre prognosis of elderly amputated vascular patients during the first postoperative year. Thereafter, the outlook is not as bad. Female gender would seem to be a poor prognostic factor whereas the presence of diabetes could identify a subgroup with a better outlook.

Aged↗
PubMed1999

Sleep apnoea syndrome and the extent of atherosclerotic lesions in middle-aged men with myocardial infarction.

BACKGROUND: To determine whether extended atherosclerotic lesions are correlated to the presence of sleep breathing disorders. METHODS EXPERIMENTAL DESIGN: A prospective clinical study. SETTING: A tertiary regional referral center. PATIENTS: 40 male patients < or =65 years consecutively admitted to the cardiac care unit for an acute myocardial infarction with serous creatinine phosphokinase (CPK) > or =350 IU/l and a CPK-MB fraction > or =10%. Exclusion criteria were: cardiac surgery on emergency, stroke, major neurological and/or psychiatric disturbances, alcohol consumption >50 g/day, toxicomania, clinical or biological hypothyroidism, clinical acromegaly and chronic obstructive pulmonary disease. MEASURES: Duplex ultrasonography was performed on carotid arteries, femoral arteries and their bifurcations. An overnight polysomnography was performed after hospital discharge. Patients with an apnoea index >5/hour or apnoea-hypopnea index >10/hour of sleep are considered to have sleep apnoea syndrome (SAS). Patients with additive peripheral atherosclerotic lesions are compared to patients with normal carotid and femoral arteries, regarding to standard cardiovascular risk factors and apnoeas or hypopnoeas during sleep. RESULTS: Duplex revealed in 18 patients carotid and/or femoral atherosclerotic lesions. The prevalence of SAS in patients with at least one peripheral arterial lesion was significantly higher (61% vs 18%, p<0.01). A nearly significant difference was also noted in patients with carotid lesions alone compared to those with normal carotid arteries (57% vs 27%, p=0.06). CONCLUSIONS: These results suggest a possible link between sleep breathing disorders and the pathogenesis of atherosclerotic lesions.

Aged↗