Archives des maladies du coeur et des vaisseaux最新文献

{"title":"[Combined surgery of acute type A aortic dissections by ascending aorta replacement and bare stent].","authors":"B Léobon,&nbsp;D Roux,&nbsp;S Saccani,&nbsp;Y Glock,&nbsp;G Fournial","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>Aim. After surgical treatment of type A aortic dissections a long segment of these aortas often remain dissected. Our goal was to analyse feasibility and first clinical and pathophysiological results of a combined treatment by ascending aorta replacement and stenting of the arch or descending aorta with Djumbodis(R) bare stents.</p><p><strong>Patients and methods: </strong>Twenty two cases from two centres were analyzed (Universitary Hospital of Parma and Rangueil Universitary Hospital of Toulouse).</p><p><strong>Results: </strong>All the stents have been implanted with short times of circulatory arrest. Average follow-up was 278 days (0-2005). There were two peroperative deaths (9.1%). One year cumulate survival rate was 72.7%. Postoperative complications were mainly respiratory and renal. We have shown a reduction in number of perfused false lumen for aortic arches, more often stented, than for descending aortas (p=0.0104), and for dissected and stented segments versus dissected unstented segments (p=0.0083).</p><p><strong>Conclusion: </strong>Our study demonstrates feasibility of this combined procedure and its positive effect on pathophysiologic evolution. Long term results have to be evaluated, but we think promising to extend this treatment to the whole dissected aorta.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"753-9"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[About new European recommendations on the care for valvulopathies].","authors":"G De Gévigney","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"775-81"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evaluation of the cost of complications of automatic implantable defibrillators].","authors":"A Tisseau,&nbsp;L Fauchier,&nbsp;P Poret,&nbsp;I Robin,&nbsp;P Cosnay,&nbsp;D Babuty","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The automatic implantable defibrillator (AID) has been shown to prevent sudden death but it frequently gives rise to complications. These complications seem to be costly but they do not figure in the economic assessments of AID. From 1989 to 2003, 202 patients (173 men, age 58 +/- 14 years) received consecutively 264 AID in the same centre of implantation. The authors studied the complications of these implantations. The medical indication was secondary (documented spontaneous ventricular tachycardia or fibrillation) in 145 patients (71.8%) and prophylactic in the remaining 57 patients (28.2%). During the 36 month (+/- 35) follow-up, 40.6% patients had an appropriate treatment: 50.3% in the secondary prevention group versus 15.8% in the prophylactic implantation group. The one year, 5 and 15 year survival rates were 99, 88 and 85% respectively. Eighty seven complications were observed resulting in a long term complication in 36.7% of patients. These complications were: inappropriate electric shock, n=24 (27.6%), fractured catheters, n=12 (13.6%), haematomas, n=12 (13.6%), loss of function of the AID, n=10 (11.4%), infection, n=6 (6.8%), pneumothorax, n=7 (8.0%), and others n=16 (18.4%). The cost of these complications was assessed in terms of hospital stay in intensive care (1010.40 euros per day) or in the general cardiology wards (546.70 euros per day). The complications resulted in 502 days of additional hospital stay (5.77 days per complication) with a total cost of 285 655.20 euros (3283.40 euros per complication). The most expensive complications in terms of hospital stay were: infections (24.5 days), fractured catheter (5.75 days), and postoperative haematoma (5.5 days). These results indicate a significant cost of complications which should be indicated in the economic evaluation of AID.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"736-44"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endovascular treatment of aortic isthmus ruptures: medium term results].","authors":"S Rubin,&nbsp;A Bayle,&nbsp;O Pages,&nbsp;F Bonnet,&nbsp;A Poncet,&nbsp;B Caplan,&nbsp;E Durand,&nbsp;C Marcus,&nbsp;B Baehrel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>Despite an improvement in the surgical management of aortic isthmus ruptures, the observed morbidity and mortality rates remain high. The use of aortic endoprostheses could improve these results, but there are not yet many medium term studies on ruptures of the isthmus. Between January 2000 and December 2005, we treated endovascularly 9 patients (7 males and 2 females) presenting with a rupture of the aortic isthmus, acute in 8 of them and chronic in one case. The average age was 46 years. All of the patients presented with significant traumatic co-morbidity. Ten endoprostheses were used in these 9 patients, and no immediate conversion was necessary. Complete excision of the lesions lasted on average 112 +/- 27 min and there were no per-operative deaths. Hospital mortality was 22% (2 patients: multiple organ failure on day 3, and a CVA on day 10). The mean length of hospital stay was 16 +/- 20 days. The mean follow up of the 7 surviving patients was 38 +/- 17 months. No complications relating to the endoprostheses were reported. In all of the patients an almost complete disappearance of lesions on CT scan was noted: by 6 months for the acute ruptures and at 1 year for the chronic rupture.</p><p><strong>Conclusion: </strong>the medium term results of endovascular treatment of isthmus ruptures are good.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"766-70"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A familial form of conduction defects associated with a PRKAG2 gene mutation].","authors":"G Pochmalicki,&nbsp;M Genest,&nbsp;P Richard,&nbsp;M Komajda,&nbsp;P Charron","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Conduction defects are usually secondary to elective aging of the conduction pathways. However, some familial and genetic forms are now being described. Here we report a particular electrocardiographic pattern in four members of the same family over three generations, naturally leading to the suspicion of a hereditary origin. The ECG appearance is very specific and includes conduction defects (RBBB and occasionally left anterior hemiblock), short PR interval, pseudo appearance of atrial hypertrophy, and occasionally sinus dysfunction or supraventricular extrasystole. Gene analysis identified a R302Q mutation of the gamma2 subunit producing AMP protein kinase, coded by the gene PRKAG2. This is a wrong sense mutation present in the heterozygous state in each of those displaying the ECG anomalies, and is transmitted in an autosomal dominant fashion. The clinical picture here appears to constitute a clinical entity distinct from those previously described as being associated with mutations of the PRKAG2 gene, without any left ventricular hypertrophy or Wolff-Parkinson-White syndrome.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"760-5"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficacy of candesartan cilexetil in hypertensive patients with or without diabetes].","authors":"R El Féghali,&nbsp;S Nisse-Durgeat,&nbsp;R Asmar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of an ARB, candesartan cilexetil (CC), on blood pressure (BP) from 5 double-blind, randomised, studies in hypertensive patients.</p><p><strong>Methods: </strong>Similar design was used in the 5 selected studies. Following 2-4 weeks run-in period with placebo, patients were randomised to receive the double-blind treatment. BP were assessed at inclusion, after 4-6 weeks and at the end (8-12 weeks). Depending on the BP response, dosage of CC 8 mg was doubled at the follow-up visit if BP >or=140/90 mmHg.</p><p><strong>Results: </strong>702 patients were randomised in CC group of whom 22% (153) were diabetic. Mean BP was 160 +/- 13/94 +/- 10/65 +/- 14 mmHg for SBP/DBP/PP at inclusion and were significantly reduced to 141 +/- 15/83 +/- 10/58 +/- 13 mmHg (p<0.001) after 8-12 weeks. The results according to the diabetes status are presented in the table below: [table: see text]</p><p><strong>Conclusion: </strong>Results of this meta analysis analysis performed on individual data show that CC reduces significantly BP in hypertensive population with a significant decrease in the diabetic patients.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 8","pages":"679-82"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27041042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Recommendations of the French National Health Authority for management of high blood pressure in clinical practice].","authors":"L Bordier,&nbsp;F Baigts,&nbsp;H Mayaudon,&nbsp;O Dupuy,&nbsp;J-P Le Berre,&nbsp;C Garcia,&nbsp;B Bauduceau","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>The new recommendations of the French national authority for health (or Haute Autorité de Santé: HAS) concerning management of high blood pressure (HBP) deserve to be compared with real clinical practices in a large population.</p><p><strong>Material and methods: </strong>[corrected] EPIMIL is a prospective epidemiological study designed to assess the prevalence of the metabolic syndrome and the risk factors in a 2045 French male military personnel coming from Paris area. The different recommendations of the HAS have been applied to these subjects, and the aim of this work is to compare these theoretical objectives to what is done in real practice.</p><p><strong>Results: </strong>Among these 2045 subjects aged of mean 38,6 +/- 8,8 years, 78 (4%) are known and treated for HPB. Although half of them present more than two associated risk factors, the means of systolic blood pressure and diastolic blood pressure stay at high levels. The blood pressure (BP) targets established at 140/90 mmHg are only reached by 33 patients (42%). Among the 1967 subjects considered to have normal BP, the BP considered as optimal (120/80 mmHg) is only found in 695 subjects (35.3%) and 428 (21.7%) do present ignored or neglected HBP, in spite of the presence of important associated risk factors. Then, the cardiovascular risk stratification into levels, as recommended by the HAS, shows that for these subjects considered to have normal BP, risk is finally low for 6%, moderate for 12%, and high for 3.5%.</p><p><strong>Comments: </strong>In a selected and in theory regularly followed population, the recommendations of the HAS are insufficiently applied, as well for detection or treatment of HBP. Then, information of both medical personnel and also the interested parties should be necessary, in order to see these recommendations applied in real practice.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 8","pages":"605-8"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27041713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ten-year incidence of high blood pressure in the general population: influence of clinical parameters, and implication for screening strategies].","authors":"M Tourdjman,&nbsp;D Jacobi,&nbsp;P Petit,&nbsp;S Vol,&nbsp;J Tichet,&nbsp;J-M Halimi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>International guidelines recommend to modulate the periodicity of hypertension screening according to the initial level of blood pressure (BP). The aim of our study was to evaluate other factors that could be useful to optimise the screening for hypertension.</p><p><strong>Methods: </strong>9777 normotensive volunteers (4151 men, 5626 women) aged 16 to 68, studied at a 10 year interval during systematic health check ups (standardised questionnaire, clinical examination, biological tests) were included. We determined the 10-year incidence of high BP (systolic BP >or=140 mmHg and/or diastolic BP >or=90 mmHg and/or anti-hypertensive treatment). The role of potential risk factors for hypertension was assessed.</p><p><strong>Results: </strong>The 10 year incidence of high BP was 19.9%. It was associated with the initial level of BP (OR=2.02 and 1.81 per +10 mmHg of systolic and diastolic BP, respectively, p<0.0001). Initial age and BMI were strongly associated with the incidence of a high BP (OR=1.88 / + 10 years and 1.18 / + 1 kg/m2, p<0.0001) after adjustment for the initial systolic BP. In men, a low reported physical activity level, alcohol consumption, and current smoking were independent risk factors (Table1). [table: see text]</p><p><strong>Conclusion: </strong>These results suggest that the recommendations for the screening of hypertension should not be based solely on the initial level of BP.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 8","pages":"615-9"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27041715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Relationship of white matter lesions on brain computed tomography and cognitive function in elderly subjects with mild cognitive impairment].","authors":"E Duron,&nbsp;A Alami,&nbsp;R Pequignot,&nbsp;P Bert,&nbsp;A-S Rigaud,&nbsp;O Hanon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>White matter lesions (WML) are frequently disclosed on elderly people computed tomography (CT) brain scan.</p><p><strong>Objective: </strong>To evaluate the relationship between WML and cognitive functions of patients suffering from Mild Cognitive Impairment (MCI).</p><p><strong>Methods: </strong>We studied the association between WML on CT brain scan and cognitive functions in 136 consecutive elderly subjects attending a geriatric outpatient clinic, suffering from MCI. The global cognitive assessment was based on Mini Mental State Examination (MMSE), a validated comprehensive battery of neuropsychological tests, the Cognitive Efficiency Profile (CEP), a CT brain scan and a complete biological screening. WML on CT brain scan was evaluated by a blinded investigator.</p><p><strong>Results: </strong>In this population, 75 +/- 8 years of age, (women 60%, and hypertension 54%), 33% of subjects had WML on CT brain scan. Patients with WML were significantly older (OR=1.27; IC 95%=1.04 - 1.22), had more frequently a past history of hypertension (OR=2.71; IC 95%=1.06 - 6.96) and more frequently lacunae associated with WML (OR=4.48; IC 95%=1.18 - 16.99). Subjects with WML had significantly poorer cognitive functions than those without WML (CEP score/100=62.33 +/- 13.58 versus 71.87 +/- 14.19, p<0.01 and MMSE score/30=27.02 +/- 2.34 versus 27.97 +/- 1.89, p<0.01)</p><p><strong>Conclusion: </strong>Our results showed a relationship between WML on CT brain scan and the depth of cognitive dysfunction among MCI patients. Further long term prospective studies have to be performed to determinate if WML are involved in transitions between MCI and Alzheimer' s disease.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 8","pages":"654-9"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27040604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Functional dissociation between apelin receptor signaling and endocytosis: implications for the effects of apelin on arterial blood pressure].","authors":"X. Iturrioz, S. El Messari, N. de Mota, C. Fassot, R. Alvear-Perez, B. Maigret, C. Llorens-Cortes","doi":"10.1097/01.HJH.0000298976.36334.9B","DOIUrl":"https://doi.org/10.1097/01.HJH.0000298976.36334.9B","url":null,"abstract":"Apelin is a peptide involved in the regulation of body fluid homeostasis and cardiovascular functions, that was recently isolated as the endogenous ligand for the human orphan APJ receptor, a G protein-coupled receptor which shares 31% amino-acid sequence identity with the angiotensin II type 1 receptor. The predominant molecular forms of apelin naturally occuring in vivo are apelin 36, apelin 17 (K17F) and the pyroglutamyl form of apelin 13 (pE13F). We investigated the structure-activity relationships of apelin at the rat apelin receptor, tagged at its C-terminal end with enhanced green fluorescent protein and stably expressed in CHO cells. We compared the abilities of N- and C-terminal deleted fragments of K17F (KFRRQRPRLSHKGPMPF) to bind with high affinity to the apelin receptor, to inhibit cAMP production and to induce apelin receptor internalization. The first five N-terminal and the last two C-terminal amino acids of K17F were not essential for apelin binding or cAMP response. In contrast, deletion of the arginine in position 6 drastically decreased binding and cAMP response. The full-length sequence of K17F was the most potent inducer of apelin receptor internalization because successive N-terminal amino-acid deletions progressively reduced internalization and the removal of a single amino acid, the phenylalanine in position 17 at the C-terminus of K17F abolished this process. Thus, K16P binds with high affinity to the apelin receptor and strongly inhibits cAMP production, but does not induce apelin receptor endocytosis. These data indicate that apelin receptor signaling (coupling to Gi) and endocytosis are functionally dissociated, possibly reflecting the existence of several conformational states of this receptor, stabilized by the binding of different apelin fragments to the receptor. We then investigated the consequences for biological activity of this functional dissociation by evaluating the effects of various apelin fragments, injected iv, on arterial blood pressure in normotensive Wistar Kyoto rats. We showed that apelin fragments, that did not induce receptor internalization in vitro but kept their ability to activate receptor coupling to Gi, did not decrease arterial blood pressure. Our data showed that hypotensive actions of apelin peptides correlate with the ability of those ligands to internalize. Thus, the depressor response of apelin may be controlled by apelin receptor endocytosis, which is probably required for initiation of a second wave of signal transduction. The development of biaised agonists of the apelin receptor capable of promoting only one specific signal transduction pathway may therefore offer new therapeutic avenues for the treatment of cardiovascular disorders.","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"38 1","pages":"704-8"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78061848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}