Showing papers by "Pierre-Vladimir Ennezat published in 2010"

Echocardiography predictors and prognostic value of pulmonary artery systolic pressure in chronic organic mitral regurgitation

Abstract: Objective To evaluate the predictors of pulmonary artery systolic pressure (PASP) in organic mitral regurgitation (MR) and its prognostic value after surgery. Design Prospective observational study, conducted from 1998 to 2006. Setting Echocardiography and cardiac surgery departments, University Hospital. Patients Echocardiography was carried out in 256 patients (63±12 years, 170 male) with organic MR (degenerative aetiology: 91%) referred for surgery. Main outcome measures Echocardiography predictors of PASP. Postoperative end points were overall mortality and cardiovascular mortality. Results Baseline PASP was 45±14 mmHg, ranging from 25 to 105 mmHg. PASP was ≥50 mmHg in 82 patients (32%). Left atrial volume (p=0.003), mitral deceleration time (p Conclusions In organic MR, mitral deceleration time, mitral E/E′ and left atrial volume correlate with PASP. Pulmonary artery systolic pressure ≥50 mmHg is an independent predictor of overall and cardiovascular mortality after surgery in organic MR.

Elevated left atrial pressure estimated by Doppler echocardiography is a key determinant of mitral valve tenting in functional mitral regurgitation

Abstract: Background Functional mitral regurgitation (FMR) may occur in patients with reduced or preserved left ventricular ejection fraction (LVEF) and has been associated with excess valvular tenting only in patients with reduced LVEF. This study aimed at identifying the predictors of FMR and to determine whether or not they are different in patients with reduced versus preserved LVEF. Methods 190 consecutive patients free of congenital or primary valvular disease had a comprehensive echocardiographic assessment of LV remodelling and function, diastolic function and FMR severity. Results 112 patients had depressed LVEF ( Conclusions In both patients with preserved and reduced LVEF, mitral tenting that leads to FMR is mainly determined by both mitral tethering forces—that is, displacement of papillary muscles and by pushing forces—that is, increased left atrial pressure. This study underscores that LV preload is a key determinant of FMR.

Iconography : Insights into functional mitral regurgitation despite preserved LVEF

Abstract: MOTS CLES Insuffisance mitrale fonctionnelle ; Insuffisance cardiaque ; Pression atriale gauche ; A 65-year-old woman with a history of hypertension and diabetes was evaluated for progressive dyspnoea. Her blood pressure was 150/90mmHg. Examination revealed pulmonary crackles and leg oedema. The results of the electrocardiogram were normal. Echocardiography displayed a non-hypertrophied and non-dilated left ventricle (end-diastolic volume, 40mL/m2) with left ventricular ejection fraction at 55%. Neither segmental wall-motion abnormality nor asynchrony was found. The left atrium was enlarged (area, 30 cm2) with a moderate MR (effective regurgitant orifice area, 9mm2; regurgitant volume, 20mL) (Fig. 1, Supplementary data, Loop 1, left panel). The valvular and subvalvular mitral apparatus were normal, but with increased valvular tenting (Fig. 1, Supplementary data, Loop 2). Pulsed-wave Doppler showed a restrictive mitral-inflow pattern and an increased E/Ea ratio of 18 (Fig. 2, left panel). Transtricuspid gradient was 38mmHg. Loop diuretics improved the patient’s symptoms, while MR severity (Fig. 1, right panel), E/Ea ratio (Fig. 2, right panel) and mitral tenting (3.6—2.5 cm2) decreased, without changes in leaflet tethering and global longitudinal strain (−17%). Functional MR has been seldom studied in patients with preserved left ventricular geometry and function. Increased left atrial pressure that characterizes HFpEF may generate pushing forces upon the mitral valve leaflets, leading to tenting and MR. This Echo-doppler cardiaque further contributes to left atrial pressure augmentation, thereby creating a vicious circle (Fig. 3). This case underlines the importance of optimizing unloading medication in HFpEF patients, who are sometimes referred for severe functional MR. Cardiac surgery is likely to be harmful in these latter patients, who respond dramatically to diuretics and nitrates. Whether the decreased global longitudinal strain observed frequently in HFpEF contributes to MR merits further study.

Maladies cardiovasculaires: anomalies des canaux calciques

Abstract: La meilleure comprehension de la physiologie cardiaque liee aux mouvements et aux changements de concentration intracellulaire des ions Ca++ a permis de mieux comprendre les consequences des anomalies de fonctionnement des canaux calciques, « canalopathies » dans un grand nombre de pathologies cardiovasculaires acquises et congenitales. Ces connaissances devraient permettre de developper des outils therapeutiques ciblant des aspects specifiques de la physiopathologie de l’insuffisance cardiaque ou de la fibrillation auriculaire, des problemes importants de sante publique.

Functional decline in elderly patients presenting with acute coronary syndromes: Impact on midterm outcome Impact pronostique à moyen terme de la perte d'autonomie chez les sujets âgés hospitalisés pour un syndrome coronaire aigu

Abstract: Summary Background. — Elderly patients with an acute coronary syndrome (ACS) are less likely to be enrolled into randomized, controlled trials or receive guideline-recommended therapies, because of a higher burden of comorbidity, including functional decline. Aim. — To assess the prognostic value of functional decline in a prospective, observational cohort of elderly ACS patients. Methods. — ACS patients aged ≥ 70 years were enrolled. The ACS definition included STand non-ST-segment elevation myocardial infarction, and unstable angina pectoris. Clinical admission and laboratory data and echocardiographic variables were recorded. Functional