Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy.

in European Heart Journal (2008), 29(6), 757-65

AIMS: The aim of the current study was to evaluate the relationship between the presence of left ventricular (LV) dyssynchrony at baseline and acute vs. late improvement in mitral regurgitation (MR) after ... [more ▼]

AIMS: The aim of the current study was to evaluate the relationship between the presence of left ventricular (LV) dyssynchrony at baseline and acute vs. late improvement in mitral regurgitation (MR) after cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Sixty eight patients consecutive (LV ejection fraction 23 +/- 8%) with at least moderate MR (>or=grade 2+) were included. Echocardiography was performed at baseline, 1 day after CRT initiation and at 6 months follow-up. Speckle tracking radial strain was used to assess LV dyssynchrony at baseline. The majority of patients improved in MR after CRT, with 43% improving immediately after CRT, and 20% improving late (after 6 months) after CRT. Early and late responders had similar extent of LV dyssynchrony (209 +/- 115 ms vs. 190 +/- 118 ms, P = NS); however, the site of latest activation in early responders was mostly inferior or posterior (adjacent to the posterior papillary muscle), whereas the lateral wall was the latest activated segment in late responders. CONCLUSION: Current data suggest that the presence of baseline LV dyssynchrony is related to improvement in MR after CRT. LV dyssynchrony involving the posterior papillary muscle may lead to an immediate reduction in MR, whereas LV dyssynchrony in the lateral wall resulted in late response to CRT. [less ▲]

Effects of surgery on ischaemic mitral regurgitation: a prospective multicentre registry (SIMRAM registry).

in European Journal of Echocardiography (2008), 9(1), 26-30

AIMS: Functional ischaemic mitral regurgitation (IMR) is common in patients with ischaemic left ventricular dysfunction undergoing coronary artery bypass surgery. Although the presence of IMR negatively ... [more ▼]

AIMS: Functional ischaemic mitral regurgitation (IMR) is common in patients with ischaemic left ventricular dysfunction undergoing coronary artery bypass surgery. Although the presence of IMR negatively affects prognosis, the additional benefit of valve repair is debated, particularly with mild IMR at rest. Exercise echocardiography may help identify a subset of patients at higher risk of cardiovascular events by revealing the dynamic component of IMR. METHODS: A large prospective, multicentre, non-randomized registry is designed to evaluate the effects of surgery on IMR at rest and on its dynamic component at exercise (z). SIMRAM will enrol approximately 550 patients with IMR in up to 17 centres with clinical and exercise follow-up for 1 year. Three sets of outcomes will be prospectively assessed and several hypotheses will be tested including determinants of adverse outcome and progressive left ventricular remodeling, efficacy of treatment and role of ischaemia on the dynamic consequences of IMR. Enrolment began in November 2006 and is expected to end by early 2008. [less ▲]

Le medicament du mois. L'aliskiren (Rasilez), inhibiteur direct de la renine.

in Revue Médicale de Liège (2008), 63(9), 564-9

Aliskiren (Rasilez) is the first oral renin inhibitor. Its present indication is essential hypertension, as monotherapy or in combination with other antihypertensive agents (diuretic, calcium antagonist ... [more ▼]

Aliskiren (Rasilez) is the first oral renin inhibitor. Its present indication is essential hypertension, as monotherapy or in combination with other antihypertensive agents (diuretic, calcium antagonist, ...). It may also be associated with an angiotensin converting enzyme inhibitor (or an AT1 angiotensin receptor antagonist) in order to benefit of a dual blockade of the renin-angiotensin-aldosterone system. The usual daily dose is 150 mg, to be increased up to 300 mg if necessary. New clinical trials are ongoing to validate this novel therapeutic approach in other indications such as congestive heart failure and diabetic nephropathy. [less ▲]

Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure

in European Heart Journal (2007), 28(5), 569-574

Aims Pulmonary hypertension, a marker of poor prognosis in heart failure, may develop or increase during exercise. We sought to examine the determinants of pulmonary hypertension at rest and during ... [more ▼]

Aims Pulmonary hypertension, a marker of poor prognosis in heart failure, may develop or increase during exercise. We sought to examine the determinants of pulmonary hypertension at rest and during exercise in heart failure patients. Methods and results Forty-six patients with left ventricular (W) dysfunction (ejection fraction: 30 +/- 6%) underwent a semi-recumbent, incremental bicycle exercise Doppler echocardiography. LV systolic and diastolic function, pulmonary artery systolic pressure (PASP), functional mitral regurgitation (MR), and left atrial volume were quantified at rest and during exercise. Wide changes in PASP at exercise were unrelated to PASP at rest (r = 0.12). Independent predictors of PASP at rest were left atrial. volume (P = 0.006), E-wave velocity (P = 0.02), mitral tenting area (P = 0.005), and mitral effective regurgitant orifice (ERO) (P=0.02). The incidence of dyspnoea was similar in patients with and without moderately severe pulmonary hypertension at baseline. At peak exercise, LV ejection fraction (P = 0.03) and mitral ERO (P = 0.008) were independently associated with PASR Patients with a larger exercise increase in PASP (> 60 mmHg) interrupted frequently exercise for dyspnoea (70 vs. 27%; P = 0.04). A larger rise in mitral regurgitant volume during exercise emerged as the single determinant of exercise-induced increases in PASP. Conclusion In patients with HF, left atrial. volume, mitral deformation, and mitral regurgitant orifice correlated with pulmonary pressure at rest, whereas dynamic MR and limited contractile reserve correlated with pulmonary pressure at exercise. The magnitude of pulmonary pressure during exercise in these patients mainly depends on dynamic MR. [less ▲]

L'insuffisance mitrale ischemique.

in Archives des Maladies du Coeur et des Vaisseaux (2007), 100(12), 1056-62

Mitral regurgitation (MR) is a serious complication of coronary heart disease. The functional form is the most frequent, often presenting with a dynamic character. The presence, and in particular the ... [more ▼]

Mitral regurgitation (MR) is a serious complication of coronary heart disease. The functional form is the most frequent, often presenting with a dynamic character. The presence, and in particular the severity of MR and its dynamic character have a major impact on the medium and long term prognosis. The mechanisms responsible for MR are complex and occur in a state of disequilibrium between traction forces and closing forces, for which the significance is partly affected by the presence of asynchrony in left ventricular contraction. The therapeutic management of these patients is difficult. In cases of proven asynchrony, implantation of a biventricular pacemaker is justified. A mitral surgical procedure may be envisaged in cases of severe MR where bypass surgery is planned. In cases of moderate MR at rest, an evaluation of its dynamic character on effort can assist with the decision to undertake combined surgery. Mitral regurgitation (MR) is a common and serious complication of ischemic heart disease. Three general forms are distinguished: MR related to acute rupture of the mitral pillar, ischemic MR and functional MR. [less ▲]

Beriberi

in Revue Médicale de Liège (2007), 62(7-8), 523-530

We discuss here the case of a 49 years old man who is admitted in the emergency department in acute heart failure. He suffers of severe alcoholism and malnutrition. This heart failure is a high-output ... [more ▼]

We discuss here the case of a 49 years old man who is admitted in the emergency department in acute heart failure. He suffers of severe alcoholism and malnutrition. This heart failure is a high-output heart failure. The diagnosis is beriberi, a disease caused by a deficiency of thiamine (vitamin B1). The treatment is intravenous administration of thiamine. Clinical response is spectacular with normalization of the clinical setting within a few hours. [less ▲]

Dynamics of spontaneous ventricular fibrillation in acutely ischemic pigs

in Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology (2006), 8 (supplement 1)

Le cas clinique du mois. Remplacement de l'aorte ascendante et conservation de la valve aortique: operation de David

in Revue Médicale de Liège (2005), 60(3), 141-3

We report the case of an ascending aortic aneurysm involving the aortic root, with a functionally competent bicuspid aortic valve, treated by the David's operation. This operation allows to fix the aortic ... [more ▼]

We report the case of an ascending aortic aneurysm involving the aortic root, with a functionally competent bicuspid aortic valve, treated by the David's operation. This operation allows to fix the aortic root pathology, whilst preserving the native aortic valve. The technical aspects, surgical indications, and potential benefits of this operation are reviewed. [less ▲]

Effects of dobutamine on left ventriculoarterial coupling and mechanical efficiency in acutely ischemic pigs

in Journal of Cardiovascular Pharmacology (2005), 45(2), 144-152

This study investigated the effects of dobutamine on left ventriculoarterial (VA) coupling and mechanical efficiency in acutely ischemic pigs. Experiments were performed in 12 pigs in which vascular ... [more ▼]

This study investigated the effects of dobutamine on left ventriculoarterial (VA) coupling and mechanical efficiency in acutely ischemic pigs. Experiments were performed in 12 pigs in which vascular properties, including peripheral resistance (R-2), compliance (C), and arterial elastance (E-a), were estimated with a windkessel model, and left ventricular (LV) function by the slope (E-es) of the end-systolic pressure-volume relationship (ESPVR) and stroke work (SW). VA coupling was defined as E-es/E-a, and mechanical efficiency as SW/pressure-volume area (PVA). In all animals, the left anterior descending coronary artery was ligated after basal measures. The animals were then randomly divided into 2 groups: group CTRL (n = 6) was followed for 180 minutes without other intervention, whereas group DOBU (n = 6) was infused with dobutamine (5 mug(.)kg(-1.)min(-1)) starting after T60 measures. Coronary occlusion induced a rightward shift of ESPVR and a decrease in E-es from 3.67 +/- 0.33 to 1.92 +/- 0.20 mm Hg(.)mL(-1), while E-a changed from 3.33 +/- 0.56 to 4.65 +/- 0.29 mm Hg(.)mL(-1), R-2 from 1.72 +/- 0.30 to 2.38 +/- 0.16 mm Hg(.)s(.)mL(-1), and C from 0.78 +/- 0.16 to 0.46 +/- 0.08 mL(.)mm Hg-1. This altered VA coupling from 1.22 +/- 0.11 to 0.44 +/- 0.07. SW decreased from 4056 +/- 223 to 2372 +/- 122 mm Hg(.)mL, and PVA and SW/PVA decreased from 5575 +/- 514 to 4830 +/- 3.17 mm Hg(.)mL, and from 0.76 +/- 0.04 to 0.49 +/- 0.03, respectively. In group DOBU, dobutamine restored E-es and the position of ESPVR to baseline values, while E-a decreased to 3.39 +/- 0.34 mm Hg(.)mL(-1) because of an R-2 decrease to 1.60 +/- 0.24 mm Hg(.)s(.)mL(-1). VA coupling was restored. SW and PVA increased to 3833 +/- 180 mm Hg(.)mL and to 7498 +/- 442 mm Hg(.)mL, respectively, while SW/PVA was unchanged. In ischemic pigs, dobutamine restored VA coupling through an increase in LV contractility and decrease in arterial elastance as a result of peripheral vasodilatation. However, myocardial oxygen consumption was increased, and mechanical efficiency impaired. [less ▲]

Le coenzyme Q10: biochimie, physiopathologie de sa carence et interet potentiel d'une augmentation de ses apports.

in Revue Médicale de Liège (2005), 60(1), 45-51

After a brief reminding of the synthesis and function of coenzyme Q10, this article tries to summarise the current state of knowledge about the consequences of its deficiency and about the potential ... [more ▼]

After a brief reminding of the synthesis and function of coenzyme Q10, this article tries to summarise the current state of knowledge about the consequences of its deficiency and about the potential benefits of an increased intake of this coenzyme. We then describe the arguments in favour of such an increase in cardiac diseases and in Parkinson's disease. [less ▲]