Early pronostic index and late exercise test compared in survivors from acute myocardial infarction
Chapelle, Jean-Paul ; ; et al
in European Heart Journal Supplements : Journal of the European Society of Cardiology (1987), 8(suppl.2), 11Detailed reference viewed: 11 (0 ULg)
Thrombolysis in anterior myocardial infarction: effect on regional viability studied with positon emission tomography
; ; Pierard, Luc et al
in Circulation (1987), 76(suppl.IV), 5Detailed reference viewed: 20 (1 ULg)
Incidence, clinical significance and prognosis of ventricular fibrillation in the early phase of myocardial infarction.
Dubois, Catherine ; ; et al
in European heart journal (1986), 7(11), 945-51
Of 1265 patients admitted to the CCU with the diagnosis of acute MI, 96 (7.6%) developed ventricular fibrillation within 72 hours following admission. Of these 96, 35 (36.5%) had secondary VF associated ... [more ▼]
Of 1265 patients admitted to the CCU with the diagnosis of acute MI, 96 (7.6%) developed ventricular fibrillation within 72 hours following admission. Of these 96, 35 (36.5%) had secondary VF associated with left ventricular failure; they had a high in-hospital mortality of 57.1%. The remaining 61 (63.5%) had primary VF, i.e. VF occurring in the absence of significant LV failure. Fourteen of these (23%) died in hospital: 9 due to PVF (3 during the first episode, 6 during a recurrence). This mortality figure was significantly higher (P less than 0.001) than the mortality of 10% seen among patients who did not experience VF. Primary VF showed a recurrence rate of 20%. Compared with the 1061 patients who left the hospital without primary VF, the 61 subjects with this rhythm disorder were older, had larger infarcts and more frequent complications, such as pericarditis, conduction abnormalities, frequent ventricular premature contractions and signs of right ventricular failure. These findings, in contrast with a widely held view, suggest that primary VF may carry a guarded prognosis. [less ▲]Detailed reference viewed: 21 (0 ULg)
Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion.
BERTHE, Christian ; Pierard, Luc ; et al
in The American journal of cardiology (1986), 58(13), 1167-72
The feasibility, safety and usefulness of 2-dimensional echocardiography (2-D echo) during dobutamine infusion for identifying patients with multivessel coronary artery disease (CAD) after acute ... [more ▼]
The feasibility, safety and usefulness of 2-dimensional echocardiography (2-D echo) during dobutamine infusion for identifying patients with multivessel coronary artery disease (CAD) after acute myocardial infarction (AMI) were evaluated in 30 patients 5 to 10 days after AMI. Patients underwent 2-D echo under basal conditions and during dobutamine infusion at each dose from 5 to a maximum of 40 micrograms/kg/min, limited multilead submaximal bicycle exercise testing and coronary and left ventricular angiography. Echocardiograms were analyzed independently by 2 observers. The test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during dobutamine infusion in vascular distributions other than the area of infarction identified during basal conditions. Exercise testing was considered positive when more than 1 mm of ST depression occurred 80 ms after the J point. Dobutamine stress testing was well tolerated; no complications and no significant arrhythmia were observed. Echocardiographic recordings were adequate in all patients during the entire test; the concordance in interpretation between the 2 observers was perfect for the prediction and location of ischemic segments during dobutamine infusion. In 15 of 17 patients without multivessel CAD, no asynergy was observed outside the infarct zone during dobutamine infusion (specificity 88%). In 11 of 13 patients with multivessel CAD, new wall motion abnormalities were identified in the segments corresponding to the arterial lesions diagnosed by angiography (sensitivity 85%).(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]Detailed reference viewed: 24 (1 ULg)
Correction d'une stenose pulmonaire congenitale par valvuloplastie transluminale percutanee.
Legrand, Victor ; ; et al
in Revue medicale de Liege (1986), 41(6), 199-204Detailed reference viewed: 13 (0 ULg)
Incidence and significance of pericardial effusion in acute myocardial infarction as determined by two-dimensional echocardiography
PIERARD, Luc ; Albert, Adelin ; et al
in Journal of the American College of Cardiology (1986), 8Detailed reference viewed: 8 (0 ULg)
Complementary role of thallium-201 scintigraphy to predischarge exercise electrocardiography for patients stratification after a first myocardial infarction.
Legrand, Victor ; Albert, Adelin ; Rigo, Pierre et al
in European Heart Journal (1986), 7(8), 644-53726
The value of a predischarge exercise test combined with thallium-201 myocardial scintigraphy in detecting patients with severe multivessel disease (MVD) was studied in 58 consecutive patients discharged ... [more ▼]
The value of a predischarge exercise test combined with thallium-201 myocardial scintigraphy in detecting patients with severe multivessel disease (MVD) was studied in 58 consecutive patients discharged after a first acute myocardial infarction. Twelve electrocardiographic, clinical and scintigraphic variables were analysed. Angiography at one month revealed MVD (greater than 70% narrowing in vessels unrelated to infarction) in 26 patients (45%). ST segment depression of 1mm or greater, thallium defects in multiple vascular distributions (MVTL), and reversible thallium defects in a vascular distribution different from the infarct related vessel predicted patients at risk for MVD (predictive value respectively of 68%, 65% and 75%). The other variables were not significantly associated with the presence of MVD. Only ST segment depression and thallium defects in multiple vascular distributions emerged as independent predictors of MVD. Their combination yielded a 77% sensitivity and a 59% specificity for MVD. Combination of thallium imaging with the predischarge exercise ECG significantly improved the stratification provided by the exercise test alone (P less than 0.05). A positive thallium scan (MVTl defects) associated with a positive ECG (ST depression) carried a risk for MVD of 80% in the population studied. When both tests were negative, MVD was infrequent (risk 22%). Because improvement in the stratification of patients is not as clear as expected from studies performed at a later stage, it appears that exercise thallium scintigraphy at a submaximal level one or two weeks after infarction does not provide optimal information. Predischarge exercise thallium-201 scintigraphy, however, is superior to an exercise tolerance test alone in separating patients into those with high and low risk of MVD. [less ▲]Detailed reference viewed: 8 (0 ULg)
Serum creatine kinase isoenzyme MB concentration after endomyocardial biopsy.
Chapelle, Jean-Paul ; El Allaf, Dia ; et al
in Clinica Chimica Acta (1986), 157(1), 55-63
Serum total creatine kinase (CK), CK-MB and myoglobin (Mb) were serially determined in 17 patients who underwent endomyocardial biopsy. Mean total CK levels increased from 36 +/- 27 U/l 30 min before ... [more ▼]
Serum total creatine kinase (CK), CK-MB and myoglobin (Mb) were serially determined in 17 patients who underwent endomyocardial biopsy. Mean total CK levels increased from 36 +/- 27 U/l 30 min before biopsy to a maximum of 112 +/- 77 U/l 8 h following the procedure (p less than 0.05). Similarly, Mb concentrations rose from 57 +/- 55 micrograms/l to 119 +/- 57 micrograms/l 30 min after biopsy (p less than 0.05). Normalization of total CK and Mb levels occurred within 16 and 8 h, respectively. A new immunoenzymetric assay (IEMA) was used to measure the mass concentration of the CK-MB molecule. The initial CK-MB levels were 0.2 +/- 0.4 microgram/l; a small but significant elevation was recorded as early as 2 h after biopsy (1.6 +/- 1.5 micrograms/l, p less than 0.05). CK-MB returned to initial concentration 16 h after the beginning of the procedure. Comparison with the maximum CK-MB levels recorded in 16 myocardial infarction patients (258 +/- 172 micrograms/l, range 90-680 micrograms/l) indicated that the modest increase of CK-MB level detected after biopsy probably reflects a limited endomyocardium lesion at the sampling site, excluding any significant myocardial damage. Total CK and Mb, which showed more pronounced elevations than CK-MB, are likely to originate from other sources than the myocardium. [less ▲]Detailed reference viewed: 40 (4 ULg)
Contribution de la Chimie clinique au diagnostic et au pronostic et au pronostic de l'infarctus du myocarde
; Chapelle, Jean-Paul ; Kulbertus, Henri
Poster (1985, October 29)Detailed reference viewed: 15 (0 ULg)
Patterns of total CK, CK-MB and myoglobin release following endomyocardial biopsy
Chapelle, Jean-Paul ; El Allaf, Dia ; et al
Poster (1985, September)Detailed reference viewed: 15 (0 ULg)
Computerization and routine use of dynamic risk index for acute myocardial infarction patients
Albert, Adelin ; Chapelle, Jean-Paul ; El Allaf, Dia et al
Conference (1985, August)Detailed reference viewed: 11 (0 ULg)
Frequency and clinical significance of pericardial friction rubs in the acute phase of myocardial infarction.
Dubois, Catherine ; ; et al
in European heart journal (1985), 6(9), 766-8
An early pericardial friction rub was noted in 23.4% of a population of 1264 consecutive patients admitted with acute myocardial infarction. The incidence of the rub did not vary with age, sex or past ... [more ▼]
An early pericardial friction rub was noted in 23.4% of a population of 1264 consecutive patients admitted with acute myocardial infarction. The incidence of the rub did not vary with age, sex or past cardiac history. The pericardial rub, however, was more often a complication of Q- than non-Q-wave infarcts (25.5% vs 10.5%, P greater than 0.001) and of anterior than inferior infarcts (35.3% vs 20.8%, P greater than 0.001). In comparing the 297 patients with a pericardial rub to the 967 others, we noted that the former group had a higher CK peak (1706 +/- 1110 UI l-1 vs 1189 +/- 1038 UI l-1, P greater than 0.001) and a higher incidence of Killip class greater than 1 (47.5% vs 33.2%, P greater than 0.001), atrial flutter or fibrillation (22.2% vs 9.3%, P greater than 0.001), second or third degree atrioventricular blocks (16.8% vs 9.4%, P greater than 0.001) and complete bundle branch block (14.5% vs 7.1%, P greater than 0.001). In spite of this, the development of a pericardial rub did not increase the in-hospital mortality (10.8% in patients with pericardial rub; 11.3% in those without). [less ▲]Detailed reference viewed: 19 (0 ULg)
Comparative haemodynamic effects of intravenous flecainide in patients with and without heart failure and with and without beta-blocker therapy.
Legrand, Victor ; ; et al
in European heart journal (1985), 6(8), 664-71
The haemodynamic effects of flecainide were compared in three different subsets of patients with documented coronary disease. Ten patients (A) had no heart failure, 5 patients were on beta blockers (B ... [more ▼]
The haemodynamic effects of flecainide were compared in three different subsets of patients with documented coronary disease. Ten patients (A) had no heart failure, 5 patients were on beta blockers (B) and 5 patients had overt heart failure (C). Flecainide was associated with negative inotropic effects that were relatively more pronounced in patients with left ventricular dysfunction: pulmonary wedge pressure increased by 27% in A, by 31% in B and by 42% in C; left ventricular stroke volume and stroke work decreased respectively by 10 and 12% in A, 21 and 19% in B, 26 and 28% in C. Ejection fraction decreased by 9% in A, 13% in B and 20% in C, in relation with an increase in end systolic volume (+9% in A, +10% in B and +5% in C). Absolute changes, however, were not significantly different from one group to another except for the increase of systemic vascular resistance which was more pronounced in C as compared with the other groups. The myocardial depression was also confirmed by the fall in dP/dt that was maximal at the end of injection; dP/dt remained depressed 15 min later despite some improvement. Flecainide thus exerts negative inotropic effects that are maximal at the end of infusion and may be of importance in patients with established left ventricular dysfunction. [less ▲]Detailed reference viewed: 10 (0 ULg)
Contribution de la chimie clinique au diagnostic et au pronostic de l'infarctus du myocarde.
; Chapelle, Jean-Paul ; Kulbertus, Henri
in Bulletin de l'Académie Nationale de Médecine (1985), 169(7), 1097-107Detailed reference viewed: 16 (1 ULg)
On the interpretation of serial laboratory measurements in acute myocardial infarction.
Albert, Adelin ; ; CHAPELLE, Jean-Paul et al
in Clinical Chemistry (1984), 30(1), 69-76
Serial laboratory determinations are now routinely performed on patients admitted to intensive-care units. Adequate interpretation of such cumulative information for clinical decision-making purposes is a ... [more ▼]
Serial laboratory determinations are now routinely performed on patients admitted to intensive-care units. Adequate interpretation of such cumulative information for clinical decision-making purposes is a challenging problem. We describe a statistical method for predicting--sequentially as the data become available--the patient's outcome, death or survival. Thus, the method goes beyond previously reported techniques that base such prediction on only a single multivariate observation. The method has been applied to daily measurements of serum urea and lactate dehydrogenase, performed during one week on patients hospitalized in the coronary-care unit with acute myocardial infarction. Two baseline variables were also included in the dynamic risk index so derived: the age of the patient and the number of previous myocardial infarctions recorded on admission. We also discuss the problems of selecting the most-predictive laboratory tests and of determining for each test the amount of past data needed to achieve satisfactory prediction. We distinguish between global evaluation of the dynamic risk index obtained (in terms of specificity and sensitivity) and individual interpretation (in terms of posterior/prior probability ratio) of a given risk score for a particular patient. The approach described may contribute to more effective use of results of repeated laboratory tests on critically ill patients. [less ▲]Detailed reference viewed: 8 (1 ULg)
Hemodynamic effects of intravenous diltiazem with impaired left ventricular function.
; Legrand, Victor ; et al
in The American journal of cardiology (1984), 54(7), 733-7
The acute hemodynamic effects of intravenous diltiazem were studied in 8 patients with coronary artery disease, left ventricular (LV) failure (New York Heart Association functional class III), a rest ... [more ▼]
The acute hemodynamic effects of intravenous diltiazem were studied in 8 patients with coronary artery disease, left ventricular (LV) failure (New York Heart Association functional class III), a rest ejection fraction (EF) less than 40% or a cardiac index less than 2.4 liters/min/m2. Hemodynamic measurements and LV angiograms were performed at rest before and after the administration of diltiazem, 0.5 mg/kg, administered at a speed of 5 mg/min. Diltiazem treatment induced a decrease in heart rate from 68 +/- 12 to 55 +/- 9 beats/min (p less than 0.001). Mean aortic pressure decreased from 94 +/- 14 to 81 +/- 15 mmHg (p less than 0.05). Thus, the pressure-rate product significantly decreased under the influence of the drug, from 8,791 +/- 2,465 to 6,342 +/- 1,808 beats mm Hg/min, (p less than 0.001). Diltiazem induced no significant change of LV end-diastolic pressure, pulmonary wedge pressure, cardiac index and LV stroke work index. Systemic vascular resistance decreased (p less than 0.01), whereas pulmonary vascular resistance showed no change. End-systolic volume diminished (p less than 0.02), which accounts for the increase of stroke volume and ejection fraction (p less than 0.001). Disorders of regional contractility were not aggravated by diltiazem, and even improved in individual cases. Thus, intravenous diltiazem may be used safely in patients with heart failure. However, in view of the marked bradycardic effects seen in some cases, heart rate should be carefully monitored. [less ▲]Detailed reference viewed: 13 (0 ULg)
Haemodynamic effects of intravenous diltiazem at rest and exercise in patients with coronary artery disease.
Legrand, Victor ; ; et al
in European heart journal (1984), 5(6), 456-63
The acute effects of intravenous diltiazem on exercise performance were studied in 10 patients with coronary artery disease. Haemodynamic measurements were made at rest and during exercise before and ... [more ▼]
The acute effects of intravenous diltiazem on exercise performance were studied in 10 patients with coronary artery disease. Haemodynamic measurements were made at rest and during exercise before and after 0.5 mg kg-1 of diltiazem. Diltiazem prolonged the duration of exercise (+2.85 min, P less than 0.001) and delayed the onset of ischaemic ST depression or angina in all patients. The highest tolerated heart rate and pressure rate product were increased in all but one patient after diltiazem. At rest diltiazem decreased mean arterial pressure (-10.8%, P less than 0.005), systemic vascular resistance (SVR) (-11.8%, P less than 0.05) and left ventricular stroke work index (SWI) (-14.1%, P less than 0.005). During exercise under diltiazem therapy, at the level achieved before the drug, the pulmonary capillary wedge pressure (-30%, P less than 0.005) and the SVR (-13.6%, P less than 0.02) were lowered, the SWI (+13%, P less than 0.01) was increased; at the end of exercise only the SVR (-14%, P less than 0.05) was reduced. Two patients experienced angina on lying down and one had orthostatic hypotension after exercise with diltiazem. This study indicates that intravenous diltiazem is a potentially useful agent for the treatment of angina by reducing myocardial oxygen demand at rest and by improving left ventricular performances on exercise. [less ▲]Detailed reference viewed: 8 (0 ULg)
Continuous risk assessment using serial data in patients with myocardial infarction
Albert, Adelin ; Chapelle, Jean-Paul ; et al
Poster (1983, September)Detailed reference viewed: 10 (0 ULg)
Right ventricular myocardial infarction diagnosed by 99 m technetium pyrophosphate scintigraphy: clinical course and follow-up.
Legrand, Victor ; Rigo, Pierre ; et al
in European heart journal (1983), 4(1), 9-19
Out of 178 consecutive patients with acute inferior wall myocardial infarction submitted to technetium-99 m pyrophosphate scintigraphy, 49 (27.5%) were found to have concomitant right ventricular ... [more ▼]
Out of 178 consecutive patients with acute inferior wall myocardial infarction submitted to technetium-99 m pyrophosphate scintigraphy, 49 (27.5%) were found to have concomitant right ventricular infarction. Gated blood pool scans showed right ventricular abnormalities in 21 out of 26 patients who were submitted to this investigation (right ventricular asynergy: 16 cases; right ventricular dilatation: eight cases; decreased right ventricular ejection fraction: 16 cases). Complications were common in the acute stage. Shock was noted in 19 cases (eight related to bradycardia, three related to relative hypovolaemia and eight instances of true cardiogenic shock). Atrial fibrillation (seven patients), ventricular fibrillation (eight patients) and severe atrioventricular conduction disorders (13 patients) were also frequent. In spite of this, the in-hospital mortality was low: three deaths occurred (6.1%), one from heart failure, two others from posterior septal rupture. All patients were followed up for one year or more. Six additional deaths were noted (three from left cardiac failure, two from recurrent anterior wall infarction and one from massive pulmonary embolism). Clinical assessment, haemodynamic measurements and gated blood pool scans showed significant improvement of right ventricular function with return to normal in those cases with small right ventricular infarcts as judged from technetium-99 m pyrophosphate scintigraphy. In spite of the complications seen in the initial period, patients with a right ventricular infarction have a good overall prognosis and the long-term outcome, primarily determined by the left-sided lesions, is often favourable. [less ▲]Detailed reference viewed: 8 (0 ULg)
Hemodynamic effects of a new antiarrhythmic agent, flecainide (R-818), in coronary heart disease.
Legrand, Victor ; ; et al
in The American journal of cardiology (1983), 51(3), 422-6
The hemodynamic effects of flecainide acetate, a new class I antiarrhythmic agent, were studied in 10 patients with coronary heart disease. The drug was injected intravenously at a dose of 2 mg/kg over 30 ... [more ▼]
The hemodynamic effects of flecainide acetate, a new class I antiarrhythmic agent, were studied in 10 patients with coronary heart disease. The drug was injected intravenously at a dose of 2 mg/kg over 30 minutes. The mean drug plasma level achieved was 394 ng/ml (range 329 to 470). The heart rate did not change, but a significant increase (p less than 0.001) in P-R (+17%), QRS (+15%), and Q-T (+7%) duration occurred after drug administration. Negative inotropic effects also were observed and consisted of an increase (p less than 0.01) in pulmonary wedge pressure (+27%) and a decrease (p less than 0.01) in stroke index (-10%), left ventricular stroke work index (-12%), and left ventricular ejection rate (-11%). No significant change in mean aortic pressure or systemic and pulmonary vascular resistance occurred. Left ventriculography performed after drug infusion revealed a significant increase (p less than 0.01) in systolic volume (+9%) and a decrease in ejection fraction (-9%) and mean velocity of circumferential fiber shortening (Vcf) (-13%). A progressive and significant decrease of dP/dt was observed during drug infusion, but 15 minutes after the injection, dP/dt had returned to near basal values. Thus, flecainide acetate has slight, but significant negative inotropic effects, particularly conspicuous during drug infusion. The drug should be administered with caution in patients with poorly compensated heart. [less ▲]Detailed reference viewed: 30 (0 ULg)