References of "Legrand, Victor"
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See detailRisque de restenose et d'evenements cardiaques apres angioplastie coronaire chez le patient diabetique: reduction par des approches pharmacologiques systemiques.
Nyssen, Anne-Sophie ULg; Legrand, Victor ULg; Scheen, André ULg

in Revue medicale de Liege (2009), 64(4), 192-8

Various systemic pharmacological approaches have been evaluated to reduce the risk of restenosis after coronary angioplasty, with or without stent, in the general population and in diabetic patients who ... [more ▼]

Various systemic pharmacological approaches have been evaluated to reduce the risk of restenosis after coronary angioplasty, with or without stent, in the general population and in diabetic patients who are at increased risk for such complication. The aim of the present paper is to describe the effects of the main pharmacological classes on the risk of restenosis, the need for new revascularisation procedures and the incidence of major clinical events (MACE: death, myocardial infarction, revascularisation). We will analyse the role of antiplatelet agents, omega-3 fatty acids, statins, anti-inflammatory compounds, immunomodulators, anti-oxidants, glitazones and, finally, classical antidiabetic drugs such as metformin and insulin. Whenever possible, we will focus our attention on the results obtained in the diabetic population. [less ▲]

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See detailA frozen heart.
DAVIN, Laurent ULg; Legrand, Victor ULg; Legrand, Delphine

in European heart journal (2009), 30(15), 1827

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See detailElevation des biomarqueurs cardiaques apres un effort physique intense.
DUGAUQUIER, Christophe ULg; Hanssen, M.; GACH, Olivier ULg et al

in Revue medicale de Liege (2009), 64(7-8), 370-2

We present the case of a patient who felt faint after a strenuous exercise. A coronary angiography was performed because of an elevated level of troponin, but it failed to demonstrat any significant ... [more ▼]

We present the case of a patient who felt faint after a strenuous exercise. A coronary angiography was performed because of an elevated level of troponin, but it failed to demonstrat any significant coronary stenosis. We discuss the effect of strenuous exercise on cardiac biomarkers. Most previous published studies involved young trained populations. The frequency of these abnormalities in older, less trained people is unknown. Moreover, the possible impact of these abnormalities on mid- or long-term outcome is a matter of debate. Seniors practising intensive sport activities should systematically be submitted to a cardiological evaluation. [less ▲]

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See detailAnticorps monoclonaux en cardiologie.
Legrand, Victor ULg

in Revue medicale de Liege (2009), 64(5-6), 310-2

Clinical efficacy of antiplatelet agents administration to reduce ischemic complications has supported the concept of atherothrombosis and plaque rupture. Specifically, administration of monoclonal ... [more ▼]

Clinical efficacy of antiplatelet agents administration to reduce ischemic complications has supported the concept of atherothrombosis and plaque rupture. Specifically, administration of monoclonal antibody against platelet membrane receptor glycoprotein IIb/IIa was shown to be highly effective whenever percutaneous intervention is performed in the setting of unstable coronary syndrome. The in-hospital use of glycoprotein IIb/IIIa is unanimously recommended in these situations. [less ▲]

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See detailL'image du mois. Traitement percutane d'une cardiomyopathie hypertrophique obstructive.
Moonen, Marie ULg; Legrand, Victor ULg; Lancellotti, Patrizio ULg et al

in Revue Médicale de Liège (2009), 64(10), 481-3

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See detailA large-scale multicentre study of patient skin doses in interventional cardiology: dose-area product action levels and dose reference levels.
Bogaert, E.; Bacher, K.; Lemmens, K. et al

in The British journal of radiology (2009), 82(976), 303-12

For 318 patients in 8 different Belgian hospitals, the entire skin-dose distribution was mapped using a grid of 70 thermoluminescence dosimeters per patient, allowing an accurate determination of the ... [more ▼]

For 318 patients in 8 different Belgian hospitals, the entire skin-dose distribution was mapped using a grid of 70 thermoluminescence dosimeters per patient, allowing an accurate determination of the maximum skin dose (MSD). Dose-area product (DAP) values, exposure parameters and geometry, together with procedure, patient and cardiologist characteristics, were also registered. Procedures were divided into two groups: diagnostic procedures (coronary angiography) and therapeutic procedures (dilatation, stent, combined procedures (e.g. coronary angiography + dilatation + stent)). The mean value of the MSD was 0.310 Gy for diagnostic and 0.699 Gy for therapeutic procedures. The most critical projection for receiving the MSD is the LAO90 (left anterior oblique) geometry. In 3% of cases, the MSD exceeded the 2 Gy dose threshold for deterministic effects. Action levels in terms of DAP values as the basis for a strategy for follow-up of patients for deterministic radiation skin effects were derived from measured MSD and cumulative DAP values. Two DAP action levels are proposed. A first DAP action level of 125 Gy cm(2) corresponding to the dose threshold of 2 Gy would imply an optional radiopathological follow-up depending on the cardiologist's decision. A second DAP action level of 250 Gy cm(2) corresponding to the 3 Gy skin dose would imply a systematic follow-up. Dose reference levels - 71.3 Gy cm(2) for diagnostic and 106.0 Gy cm(2) for therapeutic procedures - were derived from the 75 percentile of the DAP distributions. As a conclusion, we propose that total DAP is registered in patient's record file, as it can serve to improve the follow-up of patients for radiation-induced skin injuries. [less ▲]

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See detailDrug-eluting stents: a study of international practice.
Austin, David; Oldroyd, Keith G.; Holmes, David R. Jr et al

in American heart journal (2009), 158(4), 576-84

OBJECTIVE: We aimed to analyze trends in drug-eluting stents (DES) use in four international health care and regulatory settings. BACKGROUND: Accounts suggest a differential approach to DES ... [more ▼]

OBJECTIVE: We aimed to analyze trends in drug-eluting stents (DES) use in four international health care and regulatory settings. BACKGROUND: Accounts suggest a differential approach to DES internationally and recent reductions in use following reports of late stent thrombosis. Current studies of clinical practice are limited in their scope. METHODS: Data were pooled from angioplasty registries in Alberta (Canada), Belgium, Mayo Clinic (Rochester, MN), and Scotland (UK) that have routinely recorded consecutive patients treated since 2003. Trend analysis was performed to examine variations in DES use over time and by clinical subgroup. RESULTS: A total of 178,504 lesions treated between January 2003 and September 2007 were included. In the Mayo Clinic Registry, rapid adoption to a peak of 91% DES use for all lesions by late 2004 was observed. In contrast, Alberta and Scotland showed delayed adoption with lower peak DES use, respectively, 56% and 58% of lesions by early 2006. Adoption of DES in Belgium was more gradual and peak use of 35% lower than other registries. Reductions in DES use were seen in all data sets during 2006, although this varied in absolute and relative terms and by clinical subgroup. CONCLUSION: Adoption and use of DES showed wide variation in four countries. The determinants of use are complex, and it is likely that nonclinical factors predominate. Recent reductions in use may be as a consequence of publicity and concerns regarding late stent thrombosis. The optimum application of DES in clinical practice is unclear and is reflected in the degree of international variation demonstrated. [less ▲]

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See detailTwo-year clinical, angiographic, and intravascular ultrasound follow-up of the XIENCE V everolimus-eluting stent in the treatment of patients with de novo native coronary artery lesions: the SPIRIT II trial.
Claessen, Bimmer E.; Beijk, Marcel A.; Legrand, Victor ULg et al

in Circulation. Cardiovascular interventions (2009), 2(4), 339-47

BACKGROUND: This article reports the 2-year clinical, angiographic, and intravascular ultrasound outcomes of the everolimus-eluting stent (EES) compared with the paclitaxel-eluting stent (PES) in the ... [more ▼]

BACKGROUND: This article reports the 2-year clinical, angiographic, and intravascular ultrasound outcomes of the everolimus-eluting stent (EES) compared with the paclitaxel-eluting stent (PES) in the randomized SPIRIT II trial. METHODS AND RESULTS: This was a prospective, single-blind clinical trial in which a total of 300 patients with de novo native coronary artery lesions were randomized to either EES or PES in a 3:1 fashion. Clinical follow-up was planned at 2 years in all patients. A subset of 152 patients underwent serial angiographic and intravascular ultrasound analyses at 6 months and 2 years. After 2 years, target lesion failure (cardiac death, myocardial infarction, and ischemia-driven target lesion revascularization) rates were 6.6% and 11% in EES and PES, respectively (P=0.31). At 6 months, a significant reduction in angiographic in-stent late loss and percentage volume obstruction measured by intravascular ultrasound was observed in the EES group. However, at 2-year follow-up, a late increased intimal hyperplasia growth after implantation of an EES was observed. There were no significant differences between EES and PES for in-stent late loss (EES, 0.33+/-0.37 mm versus PES, 0.34+/-0.34 mm; P=0.84) and percentage volume obstruction (EES, 5.18+/-6.22% versus PES, 5.80+/-6.31%; P=0.65) at 2 years. The incidence of stent thrombosis was low and comparable in both groups (EES, 0.9%; PES, 1.4%). CONCLUSIONS: Although the previously reported angiographic and clinical superiority of the EES has vanished over time, this report confirms and extends the previously demonstrated noninferiority in terms of in-stent late loss of the EES when compared with the PES up to 2-year follow-up. There were no significant differences between EES and PES in clinical, angiographic and intravascular ultrasound outcomes at 2 years. [less ▲]

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See detailBelgian Society of Cardiology position paper on heart centres in Belgium.
Berkenboom, Guy; Budts, Werner; Claeys, Marc et al

in Acta Cardiologica (2009), 64(4), 537-9

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See detailPrévention de la resténose et des accidents cardiaques après angioplastie coronaire chez le diabétique
Nyssen, Astrid; Legrand, Victor ULg; Scheen, André ULg

in Revue Médicale de la Suisse Romande (2009), 5

Différentes approches pharmacologiques systémiques ont été testées pour réduire le risque de resténose et de complications après angioplastie coronaire, avec ou sans stent, objectif prioritaire dans la ... [more ▼]

Différentes approches pharmacologiques systémiques ont été testées pour réduire le risque de resténose et de complications après angioplastie coronaire, avec ou sans stent, objectif prioritaire dans la population diabétique où ce risque est significativement accru. Le but de cet article est de décrire les effets des principales classes médicamenteuses évaluées quant au risque de resténose, à la nécessité de recourir à de nouvelles procédures de revascularisation et à l’incidence des événements cardiaques majeurs (décès, infarctus non mortels et revascularisations). Nous analyserons le rôle des antiagrégants plaquettaires, des acides gras oméga 3, des statines, des anti-inflammatoires, des immunomodulateurs, des anti-oxydants et des inhibiteurs du système rénine-angiotensine. Dans toute la mesure du possible, nous centrerons notre atten tion sur les résultats obtenus dans la population diabétique. [less ▲]

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See detailRisque de restenose et d'evenements cardiaques apres angioplastie coronaire chez le patient diabetique: reduction par des approches pharmacologiques systemiques.
Legrand, Victor ULg; Scheen, André ULg; Nyssen, Astrid

in Revue Médicale de Liège (2009), 64(4), 192-8

Various systemic pharmacological approaches have been evaluated to reduce the risk of restenosis after coronary angioplasty, with or without stent, in the general population and in diabetic patients who ... [more ▼]

Various systemic pharmacological approaches have been evaluated to reduce the risk of restenosis after coronary angioplasty, with or without stent, in the general population and in diabetic patients who are at increased risk for such complication. The aim of the present paper is to describe the effects of the main pharmacological classes on the risk of restenosis, the need for new revascularisation procedures and the incidence of major clinical events (MACE: death, myocardial infarction, revascularisation). We will analyse the role of antiplatelet agents, omega-3 fatty acids, statins, anti-inflammatory compounds, immunomodulators, anti-oxidants, glitazones and, finally, classical antidiabetic drugs such as metformin and insulin. Whenever possible, we will focus our attention on the results obtained in the diabetic population. [less ▲]

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See detailRapport benefice/risque des endoprotheses coronaires pharmaco-actives. 2ème partie : analyse dans la population diabétique
Nyssen, Astrid ULg; Legrand, Victor ULg; Scheen, André ULg

in Revue Médicale de Liège (2008), 63(11), 654-661

The diabetic patient is at high risk of coronary heart disease. He/she can benefit of revascularisation procedures, even if he/she is exposed to a higher incidence of complications after a coronary artery ... [more ▼]

The diabetic patient is at high risk of coronary heart disease. He/she can benefit of revascularisation procedures, even if he/she is exposed to a higher incidence of complications after a coronary artery bypass graft or a percutaneous transluminal coronary angioplasty. The use of drug-eluting stents — paclitaxel (PES) or sirolimus (SES) — dramatically reduces the risk of restenosis as compared to bare-metal stents; nevertheless, the rate of restenosis remains almost double in diabetic patients compared to that observed in non-diabetic subjects. However, the risk of (very) late thrombosis is higher with drug-eluting stents than with bare-metal stents, in the diabetic population as in the non-diabetic population. Altogether, among diabetic patients, the incidence of major cardiovascular events is significantly reduced with drug-eluting stents. This global clinical benefit essentially results from a diminution of revascularisation procedures rather than from a reduction of myocardial infarcts or cardiovascular deaths. Comparison between SES and PES gives discordant results. Indeed, while the loss of intra-stent lumen is more important with PES than with SES, PES are associated with a lower rate of major cardiovascular events than SES. Efficacious antiplatelet therapy in the long run is mandatory in all diabetic patients treated with drug-eluting stents [less ▲]

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See detailMultivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial.
Daemen, Joost; Kuck, Karl Heinz; Macaya, Carlos et al

in Journal of the American College of Cardiology (2008), 52(24), 1957-67

OBJECTIVES: The purpose of this study was to assess the 3-year outcome of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES) in ... [more ▼]

OBJECTIVES: The purpose of this study was to assess the 3-year outcome of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES) in patients who had multivessel coronary artery disease with and without diabetes mellitus. BACKGROUND: The optimal method of revascularization in diabetic patients remains in dispute. METHODS: The ARTS-II (Arterial Revascularization Therapies Study-Part II) trial is a single-arm study (n = 607) that included 159 diabetic patients treated with SES whose 3-year clinical outcome was compared with that of the historical diabetic and nondiabetic arms of the randomized ARTS-I trial (n = 1,205, including 96 diabetic patients in the CABG arm and 112 in the PCI arm). RESULTS: At 3 years, among nondiabetic patients, the incidence of the primary composite of death, CVA, myocardial infarction (MI), and repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]), was significantly lower in ARTS-II than in ARTS-I PCI (adjusted odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.26 to 0.64) and similar to ARTS-I CABG. The ARTS-II patients were at significantly lower risk for death, CVA, and MI as compared with both the ARTS-I PCI (adjusted OR: 0.55; 95% CI: 0.34 to 0.91) and ARTS-I CABG patients (adjusted OR: 0.56; 95% CI: 0.35 to 0.92). Among diabetic patients, the incidence of MACCE in ARTS-II was similar to that of both PCI and CABG in ARTS-I. Conversely, the incidence of death, CVA, and MI was significantly lower in ARTS-II than in ARTS-I PCI (adjusted OR: 0.67; 95% CI: 0.27 to 1.65) and was similar to that of ARTS-I CABG. CONCLUSIONS: At 3 years, PCI using SES for patients with multivessel coronary artery disease seems to be safer and more efficacious than PCI using bare-metal stents, irrespective of the diabetic status of the patient. Hence, PCI using SES appears to be a valuable alternative to CABG for both diabetic and nondiabetic patients. [less ▲]

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See detailClassification of coronary artery bifurcation lesions and treatments: time for a consensus!
Louvard, Yves; Thomas, Martyn; Dzavik, Vladimir et al

in Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2008), 71(2), 175-83

BACKGROUND: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display ... [more ▼]

BACKGROUND: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display methodological flaws and other shortcomings such as inaccurate designation of lesions, heterogeneity, and inadequate description of techniques implemented. METHODS: The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques in various anatomical and clinical settings. RESULTS: A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification of the techniques (MADS: Main, Across, Distal, Side) is based on the manner in which the first stent has been implanted. A visual presentation of PCI techniques and devices used should allow the development of a software describing quickly and accurately the procedure performed. CONCLUSION: The EBC proposes a new classification of bifurcation lesions and their treatments to permit accurate comparisons of well described techniques in homogeneous lesion groups. [less ▲]

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See detailAntiagregants: doit-on les arreter avant un acte invasif?
Maeyns, K.; Legrand, Victor ULg; Pierard, Luc ULg et al

in Revue Médicale de Liège (2008), 63(3), 136-40

Antiplatelet therapy is the leading therapy for the primary and secondary prevention for the atherosclerotic arterial disease. The practical question of withdraw alavoiding or continuation of oral ... [more ▼]

Antiplatelet therapy is the leading therapy for the primary and secondary prevention for the atherosclerotic arterial disease. The practical question of withdraw alavoiding or continuation of oral antiplatelet agents accurs currently before any invasive procedure. It is important to compare the relative thrombotic vs hemorrhagic risk. For most interventions, it is recommended to continue antiplatelet therapy. It is particularly important in patients who benefited from drug-eluting stents where the thrombotic risk is major. [less ▲]

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See detailL'image du mois. Les valvules cardiaques en tomodensitometrie multidetecteur et echo 3D.
Davin, Laurent ULg; Bruyere, Pierre-Julien ULg; Gach, Olivier ULg et al

in Revue Médicale de Liège (2008), 63(10), 577-8

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See detailRapport benefice/risque des endoprotheses coronaires pharmaco-actives. 1ere partie: analyse dans la population generale.
Nyssen, Astrid ULg; Legrand, Victor ULg; Scheen, André ULg

in Revue Médicale de Liège (2008), 63(9), 542-8

Coronary drug-eluting stents (DES) are increasingly used in interventional cardiology. Stents coated with pharmacological substances such as sirolimus or paclitaxel, capable of reducing endothelial ... [more ▼]

Coronary drug-eluting stents (DES) are increasingly used in interventional cardiology. Stents coated with pharmacological substances such as sirolimus or paclitaxel, capable of reducing endothelial proliferation, have been proposed to replace bare-metal stents (BMS) in order to reduce the risk of restenosis. The survey of the literature confirms a major and significant reduction in the risk of restenosis with both sirolimus and paclitaxel DES as compared to BMS in the global population. This effect leads to a diminished requirement for new revascularisation procedures. However, such DES may increase the risk of very late stent thrombosis, presumably due to a defect of endothelialisation, which requires long-term effective antiplatelet therapy. The impact on major clinical coronary events shows no significant difference in mortality between DES and BMS. However, the incidence of myocardial infarct may be, slightly but significantly, reduced with sirolimus DES. In a next paper, the same analysis will be specifically performed in the diabetic population, which is well known to be at high risk of coronary heart disease, but is also expected to particularly benefit from DES. [less ▲]

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See detailEndoprotheses coronaires pharmaco-actives chez les patients diabetiques.
Nyssen, Astrid; Legrand, Victor ULg; Scheen, André ULg

in Revue Médicale Suisse (2008), 4(168), 1806-10

In diabetic patients, the use of drug-eluting stents (paclitaxel-PES or sirolimus-SES) reduces the risk of restenosis as compared to bare-metal stents. However, the risk of (very) late thrombosis is ... [more ▼]

In diabetic patients, the use of drug-eluting stents (paclitaxel-PES or sirolimus-SES) reduces the risk of restenosis as compared to bare-metal stents. However, the risk of (very) late thrombosis is higher with drug-eluting stents than with bare-metal stents. All together, the incidence of major cardiovascular events is reduced with drug-eluting stents, mainly resulting from a diminution of revascularisation procedures rather than from a reduction in myocardial infarcts or cardiovascular deaths. Attempts to compare SES and PES gave discordant results in both randomised trials and registries. Efficacious antiplatelet therapy in the long run is mandatory in all diabetic patients treated with drug-eluting stents. [less ▲]

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