References of "Pierard, L. A"
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See detailAcute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation
Ypenburg, C.; Lancellotti, Patrizio ULg; Tops, L. F. et al

in Journal of the American College of Cardiology (2007), 50(21), 2071-2077

Objectives The purpose of this study was to evaluate the relationship between dyssynchrony involving the mitral valve apparatus and the acute improvement in mitral regurgitation (MR) after cardiac ... [more ▼]

Objectives The purpose of this study was to evaluate the relationship between dyssynchrony involving the mitral valve apparatus and the acute improvement in mitral regurgitation (MR) after cardiac resynchronization therapy (CRT). The effect of interruption of CRT at 6 months' follow-up on dyssynchrony and MR was also evaluated. Background Mitral regurgitation may improve acutely after CRT, but the precise mechanism is not fully understood. Methods Out of 63 consecutive patients with baseline MR, 25 patients showed an acute reduction in MR severity immediately after CRT. This selected group of 25 patients (age 68 +/- 10 years, left ventricular ejection fraction 23 +/- 8%) was evaluated in the current study. Echocardiography including speckle tracking strain analysis was performed at baseline, after CRT initiation, and during interruption of CRT at 6 months' follow-up to study the relationship between clyssynchrony between the papillary muscles and severity of MR. Results According to the inclusion criteria, all patients showed an immediate improvement in MR after CRT (vena contracta width decreased from 0.54 +/- 0.15 cm to 0.39 +/- 0.13 cm; p < 0.001), accompanied by an improvement in mitral deformation indexes. Furthermore, dyssynchrony between the papillary muscles decreased from 169 69 ms to 25 +/- 26 ms (p < 0.001). Importantly, these beneficial effects were maintained at 6 months' followup, but acute loss of resynchronization (from 26 +/- 28 ms to 134 +/- 51 ms; p < 0.001) was observed after interruption of CRT, with an acute recurrence of MR and worsening in mitral deformation indexes. Conclusions Cardiac resynchronization therapy can acutely reduce MR in patients with clyssynchrony involving the papillary muscles; interruption of CRT at 6 months' follow-up, however, resulted in acute loss of resynchronization with recurrence of MR. [less ▲]

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See detailQuantitative analysis of semi-supine exercise echocardiography - influence of age on myocardial Doppler imaging indices
Petropoulou, E.; LANCELLOTTI, Patrizio ULg; Pierard, L. A.

in Acta Cardiologica (2006), 61(3), 271-277

Objectives - This study was performed to evaluate the feasibility of quantitative analysis of exercise echocardiography using pulsed wave Doppler myocardial imaging (DMI) and to examine the relation ... [more ▼]

Objectives - This study was performed to evaluate the feasibility of quantitative analysis of exercise echocardiography using pulsed wave Doppler myocardial imaging (DMI) and to examine the relation between age and DMI parameters at rest and during graded exercise in normal subjects. Methods and results - Seventy-two healthy volunteers were divided into three age groups (group 1, age :5 40 years, group 11, age 41 - 59 years and group 111, age : 60 years), and underwent a semisupine exercise echocardiogram. Peak systolic velocity (SV), time to peak SV (TPV), systolic velocity time integral (VTI) and peak diastolic velocities (V-E and V-A) were measured off-line. There was a heterogeneity in DMI parameters between different myocardial walls and a gradient was found between basal and mid segments. Both persisted during exercise. Group I had significantly higher TPV than groups II and III. Increase in workload was accompanied by an increase in velocities, while TPV decreased. Differences between groups persisted throughout exercise. Conclusions - Off-line measurements of DMI parameters are feasible during exercise. SV and E decline as age increases while A increases. SV already increases at low charge exercise and may serve as a quantitative marker for the detection of myocardial viability. Change of the absolute DMI velocity values during exercise may provide a better indicator of ischaemia or viability than the absolute values themselves. [less ▲]

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See detailEffect of dynamic left ventricular dyssynchrony on dynamic mitral regurgitation in patients with heart failure due to coronary artery disease
Lancellotti, Patrizio ULg; Stainier, P. Y.; Lebois, Florence ULg et al

in American Journal of Cardiology (2005), 96(9), 1304-1307

In patients with heart failure, exercise-induced increases in mitral regurgitation (MR), which convey a poor prognosis, are related to the dynamic distortion of mitral valve geometry. It was hypothesized ... [more ▼]

In patients with heart failure, exercise-induced increases in mitral regurgitation (MR), which convey a poor prognosis, are related to the dynamic distortion of mitral valve geometry. It was hypothesized that dynamic MR may also be related to intermittent changes in left ventricular synchronicity during exercise. (c) 2005 Elsevier Inc. All rights reserved. [less ▲]

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See detailDeterminants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction
Pierard, L. A.; Lancellotti, Patrizio ULg

in Heart (2005), 91(8), 1008-1012

OBJECTIVE: To determine whether persistent versus early or delayed T wave normalisation of negative T waves after acute myocardial infarction is determined by the myocardial state, the treatment strategy ... [more ▼]

OBJECTIVE: To determine whether persistent versus early or delayed T wave normalisation of negative T waves after acute myocardial infarction is determined by the myocardial state, the treatment strategy, or both. DESIGN: 127 consecutive patients with a first acute myocardial infarction and > or = 2 negative T waves on the 24-36 hour ECG were studied. They underwent dobutamine stress echocardiography and coronary angiography during the first week. ECG was recorded at hospital discharge and at a mean (SD) of 4 (1) months. SETTING: University hospital. RESULTS: T wave normalisation was observed in 88 patients (early at discharge in 19 and delayed at four months in 69). Early T wave normalisation was associated with sustained contractile reserve during dobutamine stress (13 of 19 (68%)), whereas delayed T wave normalisation was observed mainly in patients with an ischaemic response (49 of 69 (71%)). The persistence of negative T waves was associated with an ischaemic response (21 of 39 (54%)) or persistent akinesis (17 of 39 (44%)). Among patients with an ischaemic response to dobutamine, in-hospital elective angioplasty was an independent determinant of delayed T wave normalisation (39 of 49 v 4 of 21 patients with persistent negative T waves at four months, p < 0.0001). CONCLUSIONS: Early T wave normalisation is associated with dobutamine induced, sustained improvement indicating myocardial stunning. Delayed normalisation is observed mainly in patients with ischaemic myocardium who have undergone revascularisation. Persistent negative T waves correspond to either extensive necrosis or non-revascularised, jeopardised myocardium. [less ▲]

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See detailPredictors of rapid QRs widening in patients with coronary artery disease and left ventricular dysfunction
LANCELLOTTI, Patrizio ULg; Kulbertus, Henri ULg; Pierard, L. A.

in American Journal of Cardiology (2004), 93(11), 1410-1412

To assess the predictors of rapid QRS widening in patients with chronic ischemic left ventricular dysfunction, 82 patients who underwent greater than or equal to2 electrocardiograms and exercise Doppler ... [more ▼]

To assess the predictors of rapid QRS widening in patients with chronic ischemic left ventricular dysfunction, 82 patients who underwent greater than or equal to2 electrocardiograms and exercise Doppler echocardiography were studied. In a multivariate analysis, left ventricular end-diastolic Volume, a large increase in mitral regurgitant volume during exercise, and diabetes emerged as independent predictors of QRS widening. (C)2004 by Excerpta Medica, Inc. [less ▲]

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See detailL'oedeme aigu pulmonaire cardiogenique
Stainier, P. Y.; Lancellotti, Patrizio ULg; Smeets, V. et al

in Revue Médicale de Liège (2004), 59(4), 196-200

Acute cardiogenic pulmonary oedema frequently occurs in clinical practice, frequently in an old patient. It consists in acute respiratory distress related to rapid development of transsudative fluid ... [more ▼]

Acute cardiogenic pulmonary oedema frequently occurs in clinical practice, frequently in an old patient. It consists in acute respiratory distress related to rapid development of transsudative fluid within the lung interstitium and alveolar accumulation. It requires rapid assessment and therapy to prevent progression to respiratory failure and cardiovascular collapse. The pathogenesis and identification of the underlying disease process are essential for optimal medical approach. The aetiology is multiple. [less ▲]

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See detailElectrocardiographic changes during dobutamine stress testing in patients with recent myocardial infarction: relation with residual infarct artery stenosis and contractile recovery
Lancellotti, Patrizio ULg; Mipinda, J. B.; Pierard, L. A.

in Acta Cardiologica (2004), 59(1), 11-16

OBJECTIVE: The identification of viable but jeopardized myocardium after acute myocardial infarction (AMI) is of great importance for selecting patients who could benefit from a revascularization ... [more ▼]

OBJECTIVE: The identification of viable but jeopardized myocardium after acute myocardial infarction (AMI) is of great importance for selecting patients who could benefit from a revascularization procedure. The aim of the study was to determine the accuracy of the dobutamine stress electrocardiogram (ECG) 1) for detecting significant stenosis of the infarct-related artery and 2) for predicting the occurrence of contractile recovery. METHODS AND RESULTS: Ninety-four patients underwent dobutamine stress ECG and quantitative angiography within the first week after AMI. A follow-up resting echocardiogram was obtained in all patients at 1 month. Significant stenosis of the infarct-related artery was detected in 76 patients and functional recovery occurred in 56 patients. Dobutamine stress induced ST-segment elevation in 44 patients, ST-segment depression in 17 and T-wave normalization in 34. Increase in QT dispersion and dobutamine ST elevation were more sensitive than chest pain and ST-segment depression (79% and 53% vs. 24% and 17%, respectively; p<0.05) for detecting significant infarct-related artery stenosis. Four independent variables were selected for predicting contractile recovery: > or = 20 ms increase in QT dispersion from baseline to low-dose dobutamine (p = 0.00016), dobutamine-induced ST-segment elevation (p = 0.0009), elective angioplasty of the infarct-related artery (p = 0.001) and T-wave normalization (p = 0.005). CONCLUSIONS: The analysis of predischarge dobutamine stress ECG is useful for predicting residual stenosis of the infarct-related artery and contractile recovery in the affected area. QT dispersion changes during the test are the most accurate parameter. [less ▲]

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See detailDeterminants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction
Lancellotti, Patrizio ULg; Lebrun, F.; Pierard, L. A.

in Journal of the American College of Cardiology (2003), 42(11), 1921-1928

OBJECTIVES: We sought to examine the determinants of exercise-induced changes in ischemic mitral regurgitation (MR) in patients with left ventricular (LV) dysfunction. BACKGROUND: In the post-myocardial ... [more ▼]

OBJECTIVES: We sought to examine the determinants of exercise-induced changes in ischemic mitral regurgitation (MR) in patients with left ventricular (LV) dysfunction. BACKGROUND: In the post-myocardial infarction (MI) phase, ischemic MR contributes to worsening of symptoms and of LV dysfunction. METHODS: In this study, 70 patients in the chronic, post-MI phase, with LV ejection fraction <45% and at least mild MR, underwent semi-supine exercise Doppler echocardiography. The effective regurgitant orifice (ERO) of MR was quantified at rest and during exercise. Exercise-induced changes in ERO were compared with changes in mitral deformation and in local and global LV remodeling. RESULTS: The wide range of exercise-induced ERO changes that were observed was unrelated to the degree of MR at rest (r = 0.20). Effective regurgitant orifice changes correlated best with changes in mitral deformation (i.e., differences in systolic mitral tenting area, systolic annular area, and coaptation height) (p < 0.0001). Posterior displacement of the papillary muscles was associated with larger changes in the ERO in both infarct groups. In patients with inferior MI, a decrease in the ERO was related to improvement in wall motion (r = 0.68). The independent predictors of ERO changes during exercise were changes in systolic annular area for all infarct categories, in tenting area and wall motion score in the global population and those with inferior infarction, and in apical displacement of mitral leaflets for patients with anterior MI. CONCLUSIONS: The degree of MR at rest is unrelated to exercise-induced changes in EROs, which are related to those in local LV remodeling and in mitral deformation but not those in global LV function. [less ▲]

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See detailPrognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction
Lancellotti, Patrizio ULg; Troisfontaines, P.; Toussaint, A. C. et al

in Circulation (2003), 108(14), 1713-1717

Background-In the post-myocardial infarction phase, mortality risk is related to the severity of mitral regurgitation (MR). Ischemic MR is a dynamic condition that can be studied during exercise. Whether ... [more ▼]

Background-In the post-myocardial infarction phase, mortality risk is related to the severity of mitral regurgitation (MR). Ischemic MR is a dynamic condition that can be studied during exercise. Whether the assessment of exercise-induced changes in the degree of MR provides prognostic information is unknown. Methods and Results-Ninety-eight consecutive patients with chronic ischemic left ventricular dysfunction and at least mild MR who prospectively underwent quantitative measurement of the regurgitant volume and the effective regurgitant orifice (ERO) of MR at rest and during semisupine exercise test were followed up for 19+/-8 months. The 16 patients who underwent surgery were censored at the time of operation. Of the 82 patients who were medically treated, 9 (11%) died. No clinical data demonstrated a distinction between survivors and nonsurvivors. By multivariate Cox regression analysis, independent predictors of cardiac death were an increase in ERO by greater than or equal to13 mm(2) (P=0.0045) during exercise, an ERO >20 mm(2) at rest (P=0.01), and a shorter mitral deceleration time (P=0.044). Half of the patients with exercise-induced significant increases in MR who died had moderate MR at rest. In contrast, none of the 14 patients with a decrease in MR at exercise displayed cardiac death. Conclusions-In patients with ischemic MR and left ventricular dysfunction, quantitative assessment of exercise-induced changes in the degree of MR provides independent prognostic information. Significant exercise-induced increases in MR unmask patients at high risk of poor outcome. [less ▲]

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See detailDetection and clinical usefulness of a biphasic response during exercise echocardiography early after myocardial infarction
Lancellotti, Patrizio ULg; Hoffer, E. P.; Pierard, L. A.

in Journal of the American College of Cardiology (2003), 41(7), 1142-1147

OBJECTIVES The aim of this study was to determine the accuracy of exercise echocardiography (EE) for detecting infarct-related artery (IRA) stenosis and predicting functional recovery early after acute ... [more ▼]

OBJECTIVES The aim of this study was to determine the accuracy of exercise echocardiography (EE) for detecting infarct-related artery (IRA) stenosis and predicting functional recovery early after acute myocardial infarction (AMI). BACKGROUND Dobutamine stress echocardiography is widely used for identifying jeopardized myocardium. The clinical usefulness of a biphasic response detected during EE has never been investigated. METHODS A total of 114 consecutive patients with a first AMI and greater than or equal to2 dyssynergic segments in the infarct-related territory underwent semi-supine continuous EE 6 +/- 2 days after AMI. Quantitative coronary angiography was performed in all patients after EE. A follow-up echocardiogram was obtained one month later. RESULTS Ninety-seven patients had significant (greater than or equal to50%) IRA stenosis, and 26 had multivessel disease. Residual ischemia was identified in 77 patients (biphasic response in 62 and worsening response in 15). The sensitivity and specificity of ischemia during EE for predicting IRA stenosis were 75% and 76%, respectively. The sensitivity of a biphasic response was higher than the sensitivity of a worsening response (61% vs. 14%, p < 0.0001). Wall motion abnormalities induced in other vascular territories were specific (97%) and moderately sensitive (62%) for the detection of multivessel disease. Functional recovery was observed in 75 patients. Two independent variables predicted contractile recovery: contractile reserve during EE (p < 0.0001) and elective angioplasty of the IRA (p = 0.002). A biphasic response, but not sustained improvement, predicted reversible dysfunction (73% vs. 9%, p < 0.0001). CONCLUSIONS A biphasic response can be detected during exercise. Exercise echocardiography is an accurate tool for detecting IRA stenosis and predicting functional improvement early after AMI. [less ▲]

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See detailSignificance of Dobutamine-Induced Changes in Qt Dispersion Early after Acute Myocardial Infarction
LANCELLOTTI, Patrizio ULg; Bilge, A. R.; Mipinda, J. B. et al

in American Journal of Cardiology (2001), 88(9), 939-43

This study sought to examine the effects of graded dobutamine infusion on QT dispersion early after acute myocardial infarction (AMI) and to investigate the relation of dobutamine-induced changes in QT ... [more ▼]

This study sought to examine the effects of graded dobutamine infusion on QT dispersion early after acute myocardial infarction (AMI) and to investigate the relation of dobutamine-induced changes in QT dispersion to wall motion responses. Seventy-eight patients with a first AMI underwent dobutamine-atropine stress echocardiography 5 +/- 2 days after admission. Contractile reserve was identified in 45 patients and ischemic myocardium in 40. Sixteen patients had persistent akinesia. The best cut-off value of QT dispersion on the baseline electrocardiogram for predicting myocardial viability was 65 ms (sensitivity and specificity of 68%). Dobutamine infusion increased QT dispersion only in patients with viable myocardium (61 +/- 18 to 83 +/- 19 ms, p = 0.003) and/or ischemia (72 +/- 16 to 112 +/- 25 ms, p < 0.0001). No change was observed in patients with persistent akinesia (84 +/- 10 to 87 +/- 15 ms, p = NS). QT dispersion increased by 22 +/- 12 ms with administration of low-dose dobutamine in patients who had viable myocardium and by 47 +/- 21 ms with administration of low- to high-dose dobutamine in patients with ischemic myocardium. An increase in QT dispersion of > or = 20 ms from at rest to low-dose dobutamine infusion was associated with myocardial viability with a sensitivity of 78% and a specificity of 79%, whereas an increase in QT dispersion of > or = 10 ms from low- to high-dose dobutamine infusion predicted ischemic myocardium with a sensitivity of 85% and a specificity of 82%. In conclusion, (1) low QT dispersion on the baseline electrocardiogram is determined by the presence of viable myocardium, (2) a dobutamine-induced increase in QT dispersion is associated with viable and jeopardized myocardium, and (3) unchanged QT dispersion during dobutamine stress is a simple marker of extensive necrosis. [less ▲]

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See detailAcute St-Segment Elevation in Neisseria Meningitis
Gach, Olivier ULg; LANCELLOTTI, Patrizio ULg; Pierard, L. A.

in Acta Cardiologica (2001), 56(5), 327-9

Meningitis due to Neisseria meningitidis occurred in a young man. On admission, he was in septic shock and the electrocardiogram revealed convex upwards ST-segment elevation in inferior and lateral leads ... [more ▼]

Meningitis due to Neisseria meningitidis occurred in a young man. On admission, he was in septic shock and the electrocardiogram revealed convex upwards ST-segment elevation in inferior and lateral leads. Rapid and complete normalisation of the ECG was observed and the patient had a favourable evolution with intensive therapy.The mechanisms of the ECG abnormalities in this disease are unclear. In this patient, ST-segment elevation was probably related to severe transmural ischaemia or prolonged coronary artery spasm as suggested by increase and decrease of cardiac enzymes and transient echocardiographic wall motion abnormalities without pericarditis. However, myocarditis could not be completely ruled out. [less ▲]

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