Dynamic myocardial velocity changes between phases of the cardiac cycle.

The purpose of this study was 1. to define relationships between myocardial velocities according to phases and the range of dynamic phasic changes in controls using tissue Doppler echocardiography (TDE); 2. to compare the usefulness of dynamic changes vs.

New insights into septal anterior wall motion velocities at end-systole in normal and hypertrophied left ventricles.

Aims: It was two-fold (1) to define tissue Doppler echocardiographic characteristics of the end-systolic septal anterior motion: passive due to heart translation, or active motion free of translational effects, substantiated by a myocardial velocity gradient. (2) to specify the temporal features of this septal anterior motion on normal and hypertrophied left ventricles since it occurs while the posterior wall contracts during late ejection.

Methods And Results: Myocardial velocity gradient was calculated during the anterior motion in simultaneously colour M-mode imaged septal and posterior walls of 21 controls (49+/-12 years) and 17 patients (49+/-13 years) with left ventricle hypertrophy.

Myocardial time intervals preceding left ventricular filling in chronic coronary artery disease: value of a decreased septal ejection time.

The aim was to assess the capabilities of a two-segment myocardial recording to recognize patients with an underlying chronic ischemic process as a fast screening from controls, prior to the usual segment-to-segment tissue Doppler echocardiographic assessment of ischemia. Ischemia generates systolic and relaxation abnormalities. A flow Doppler index of global systolic and diastolic myocardial performance was recently drawn from time durations studied by coupling isovolumic relaxation (IR) to preejection (PEP)/ejection (ET) ratio (PEP/ET).

Treatment of heart failure with celiprolol, a cardioselective beta blocker with beta-2 agonist vasodilatory properties. The CELICARD Group.

Treatment with beta blockers results in improvement in functional status, and reduces mortality in patients with heart failure. A number of differences in the results noted could be due to additional properties of the specific beta blockers studied: absence of cardioselectivity, and existence of a vasodilator effect and of an associated antioxidant effect. We studied the effects of celiprolol, a cardioselective beta blocker with a stimulant effect on beta2 receptors.

[Diagnostic value of electrocardiography using dobutamine in coronary artery disease].

Objectives: Assess the sensitivity and specificity of electrocardiograms performed during dopamine perfusion to detect coronary artery stenosis.

Patients And Methods: One hundred three coronary artery disease patients with a coronarography were studied; 23 coronarographies were normal, 59 patients were taking a beta blocker. An exercise test was also performed in 54 cases.

Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium.

Objective: To evaluate the efficiency of the new technique colour Doppler tissue imaging (DTI) by studying the concordance between dobutamine DTI, standard grey scale echocardiography (SE), and rest-reinjection TI-201 tomography (TI) in dysfunctional myocardium.

Patients: 23 patients with chronic wall motion abnormalities and proven coronary artery disease (> 70% diameter stenosis of at least one major coronary artery at angiogram).

Methods: The contractile reserve and the resting perfusion characteristics of dysfunctional myocardial segments were assessed with low dose dobutamine SE and/or DTI (2.

Pre-ejectional left ventricular wall motions studied on conscious dogs using Doppler myocardial imaging: relationships with indices of left ventricular function.

Duration of the pre-ejection period is a sensitive index of myocardial function. Our purpose was to document normal pre-ejectional left ventricular (LV) wall motions at rest and under dobutamine using Doppler myocardial imaging (DMI), and to correlate posterior wall velocities with indices of LV systolic function. M-mode recordings of both walls were imaged on eight conscious dogs chronically instrumented.

[Contribution of doppler imaging of the myocardium to the study of cardiomyopathies].

Colour Doppler imaging (CDI) is a recent method of evaluation of cardiomyopathy based on intra-myocardial abnormalities. CDI provides quantitative assessment of myocardial wall motion both circumferential by studying the movements of the myocardium and longitudinal by studying the movements of the mitral annulus. The harmonious decrease in velocity between the endocardium and epicardium disappears in pathological conditions, showing disorganisation of wall motion within the myocardium.

Comparison of 2 myocardial velocity gradient assessment methods during dobutamine infusion with Doppler myocardial imaging.

Myocardial velocity gradient (MVG) has been shown to be the best quantitative parameter for the detection of ischemic myocardium during dobutamine infusion with the use of Doppler myocardial imaging. MVG has been previously assessed by velocity measurements across the thickness of the myocardium at the time of visually selected maximal color brightness (thickness-velocity plot method). We hypothesized that MVG could be assessed by velocity measurements throughout the cardiac cycle in the subendocardium parallel to the endocardial boundary to the left ventricular cavity and in the subepicardium parallel to the epicardial boundary (time-velocity plot method).

[Doppler tissue imaging of pre-ejection left ventricular wall dynamics in normal subjects].

Pre-ejectional left ventricular wall motion has been demonstrated clinically by angiography. Intramyocardial wall velocities generated by cardiac contraction may be measured by Doppler tissue imaging. The aim of this study was to detect pre-ejectional wall motion and to analyse its sequencer.

Right and left isovolumic ventricular relaxation time intervals compared in patients by means of a single-pulsed Doppler method.

Right and left isovolumic ventricular relaxation time intervals measurements were obtained as follows: from the peak R wave on the electrocardiogram to either the mitral or the tricuspid pulsed Doppler flow trace onset minus the R to end-ejection zero flow crossing of the subaortic (left side) or pulmonary (right side) D flow trace time interval. A ratio was calculated as a percent difference duration between both isovolumic ventricular relaxation time intervals. The aim was to compare isovolumic ventricular relaxation time interval values in 42 healthy controls and to study the changes induced by heart diseases in 27 patients with (1) controlled hypertension without left ventricular hypertrophy, (2) hypertrophic cardiomyopathy, and (3) Cor pulmonale.

Prognostic value of bisoprolol-induced hemodynamic effects in heart failure during the Cardiac Insufficiency BIsoprolol Study (CIBIS).

Background: To further evaluate the mechanism of beta-blocker-induced benefits in heart failure, the relationships between bisoprolol-induced hemodynamic effects and survival were studied during the Cardiac Insufficiency BIsoprolol Study (CIBIS).

Methods And Results: In 557 patients studied, bisoprolol significantly reduced heart rate (-16.3+/-15.

Preejectional left ventricular wall motion in normal subjects using Doppler tissue imaging and correlation with ejection fraction.

Relations have been demonstrated between the preejection period (PEP) and indexes of left ventricular (LV) systolic function. Doppler tissue M-mode imaging has the capability to measure wall velocities and to display as colored strips within the walls velocity reversals representing changes in direction of wall motion. To document LV preejectional wall motions, this procedure was performed on 16 normal subjects with a twofold purpose: to measure septal and posterior preejectional intramyocardial velocities and durations and to correlate preejectional parameters with LV ejection fraction (LVEF).

[Comparative effects of captopril and atenolol on lipid metabolism in hypertensive hypercholesterolemic patients treated with pravastatin. A multicenter controlled trial].

Objectives: A randomized double-blind trial was conducted in hypertensive subjects with hypercholesterolemia treated with pravastatin in order to compare the effects of captopril and atenolol on lipid metabolism.

Methods: After a pre-inclusion period, 147 eligible subjects (64 men and 83 women, age range 32-74 years) were randomized into two groups and given, in a double-blind trial, either captopril (50 mg/d) or atenolol (50 mg/d) for 6 months. The controlled trial was followed by an open trial in 120 subjects for 6 more months.

[Drug therapy of heart failure. What choice in 1996?].

The mortality of heart failure remains high despite recent therapeutic progress. The objectives of treatment are to relieve symptoms, but also to improve survival. The secondary objectives are extension of the duration of effort, improvement of the ejection fraction, reduction of arrhythmias and neuroendocrine disturbances, although these criteria are not strictly related to the primary objectives.

[Prognostic factors of prosthetic valve endocarditis. Apropos of 122 cases].

The prognostic factors of 122 patients suffering from prosthetic valve endocarditis between 1978 and 1992 were studied by univariate and multivariate analysis. The principal causative organisms were Staphylococcus aureus (33%), streptococci (20%), coagular-negative staphylococci (12%), enterococci (10%) and gram-negative bacilli (9%). The 4 month survival rate was 66% (42 deaths).

Colour doppler valvar and subvalvar flow diameter imaging versus echo score in mitral stenosis: comparison with type of surgery.

Objective: To compare the value of echo score with that of Doppler subvalvar flow broadening in deciding the type of mitral stenosis surgery.

Patients: 30 patients, mean age 47 years, with severe stenosis undergoing surgery were divided into two groups according to type of surgery: open heart commissurotomy (group 1, n = 12), or prosthesis (group 2, n = 18). A control group of 10 patients with prosthesis served as reference, representing mild stenosis without subvalvar connection.

[Prognostic value of exercise gamma-angiography in coronary insufficiency].

The predictive value for cardiac events in stable coronary artery disease was analysed with resting and exercise radionuclide angiography and conventional exercise stress testing under medical therapy. The population comprised 93 men and 12 women, followed up for 1 to 8 years (mean 51 months). The patients were divided into two groups.

Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision.

We carried out univariate and multivariate analysis of outcome among 122 patients with prosthetic valve endocarditis (PVE) admitted to our ICU between 1978 and 1992. The predominant pathogens were Staphylococcus aureus (33%), streptococci (20%), coagulase-negative staphylococci (12%), enterococci (10%), and Gram-negative bacilli (9%). At 4 months, overall survival was 66% (42 deaths).

Nicorandil safety in the long-term treatment of coronary heart disease.

The results of an open prospective study that evaluated the long-term clinical safety of nicorandil are presented. This study included 199 patients with severe chronic stable angina treated over a 1-year period. The most often reported adverse event was headache, which was responsible for most of the study withdrawals due to clinical intolerance (9.

[Infectious endocarditis: the right time for surgery].

Valve repair is often required to maintain haemodynamic performance in patients with infectious endocarditis. Localizations on the aortic valve are frequent and lead to rapid, often severe, deterioration, especially when the valve ring and the septum are also infected. Conduction disorders and rupture of the abscess into the heart cavities are formal indications for surgery.

[Diuretics, potassium depletion and ventricular hyperexcitability].

This prospective randomized study involved 28 patients with moderate essential hypertension who for one year, took either hydrochlorothiazide [Esidrex (E) 25-50 mg per day] or a combination of altizide 15 mg--aldactone 25 mg [Aldactazine (A) 1 or 2 tablets per day] without potassium supplements. Blood pressure, plasma potassium, exchangeable potassium, ventricular premature contractions measured by Holter and plasma magnesium were monitored. Blood pressure was brought to normal in both treatment groups (p < 0.

[Outcome of prognostic factors of infectious endocarditis over a 16 year period. Apropos of 471 cases].

Four hundred and seventy one cases of infective endocarditis (IE) were reviewed: 338 native valve IE and 133 prosthetic valve IE (42 early and 91 late IE). Two periods were compared: 1973-1980 (250 cases) and 1981-1988 (221 cases). There was a decrease in native valve IE (78% to 64%) and an increase in late prosthetic valve IE (13% to 27%), little change with respect to age, causal cardiac disease, delay in diagnosis (except in native valve IE, 39 to 29 days), or frequency of complications, especially cardiac (50% and 51%).