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3. Rapport 20-05 – La transplantation cardiaque chez l’adulte

Author

J.-N. Trochu, Iradj Gandjbakhch, Pascal Leprince, C. Welty, Michel Komajda, and R. Dorent

Subjects
03 medical and health sciences, 0302 clinical medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology
Abstract

Resume La transplantation cardiaque est le traitement de reference de l’insuffisance cardiaque terminale refractaire au traitement medical optimal, avec une mediane de vie post greffe de 12 ans. Pourtant, l’acces a la transplantation tend actuellement a diminuer et il existe une inadequation entre le nombre de receveurs et celui des donneurs. Ce rapport revoit les indications, les contre-indications de la transplantation cardiaque et les complications survenant lors du suivi. Les conditions d’une meilleure prise en charge de l’insuffisance cardiaque severe dans l’ensemble du territoire national et d’une optimisation de l’offre de transplantation cardiaque sont examinees et le recours aux greffons preleves chez des patients decedes apres un arret circulatoire est discute.

Published
2021
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4. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome

Author

Franck Boccara, Murielle Mary‐Krause, Valérie Potard, Emmanuel Teiger, Sylvie Lang, Nadjib Hammoudi, Marion Chauvet, Stéphane Ederhy, Laurie Dufour‐Soulat, Yann Ancedy, Pascal Nhan, Saroumadi Adavane, Ph. Gabriel Steg, Christian Funck‐Brentano, Dominique Costagliola, Ariel Cohen, S. Weber, K. Wahbi, P. Beaufils, P. Henri, G. Sideris, D. Thomas, G. Montalescot, F. Beygui, C. Meuleman, S. Janower, F. Raoux, G. Dufaitre, N. Benyounes, P. L. Michel, B. Petillon, N. Hammoudi, P. Gueret, J. L. Dubois‐Rande, E. Teiger, P. Lim, M. Slama, P. Colin, C. Saudubray, O. Dubourg, O. Milleron, B. Gallet, F. Duclos, S. Godard, L. Fuchs, V. Dormagen, P. Lewy, S. Cattan, O. Nallet, G. Grollier, J. Shayne, J. E. Wolf, Y. Cottin, J. Machecourt, H. Bouvaist, G. Finet, B. De Breyne, J. N. Trochu, M. Baudouy, E. Ferrari, M. Benhamou, J. Allal, D. Coisne, H. Le Breton, M. Bedossa, J. Puel, M. Elbaz, L. Larifla, S. Matheron, R. Landman, G. Fremont, G. Spiridon, P. Blanche, J. P. Morini, D. Sicard, V. Zeller, D. Batisse, P. Clevenbergh, G. Cessot, E. Dohin, M. A. Valantin, S. Khelifa, P. M. Girard, F. Lallemand, B. Lefebvre, J. P. Laporte, J. L. Meynard, H. Bideault, O. Picard, M. C. Meyohas, P. Campa, J. Tredup, L. Fonquernie, G. Raguin, J. M. Molina, A. Furco, S. Gharakanian, J. P. Vincensini, J. B. Guiard‐Schmid, G. Pialoux, B. Cardon, A. S. Lascaux, F. Chaix, P. Lesprit, R. Fior, F. Boue, C. Dupont, C. Bellier, A. Blanc, T. Lambert, T. Touahri, G. Force, P. de Truchis, M. A. Compagnucci‐Seguenot, I. Cahitte, L. Roudière, M. E. Techer, P. Thelpin, D. Troisvallets, A. Lepretre, M. Echard, Y. Le Mercier, D. Houlbert, S. Dargere, C. Bazin, R. Verdon, B. De Goer, M. Duong, P. Chavanet, E. Gozlan, P. Leclercq, F. Brunel‐Dal Mas, J. Durant, P. Heudier, C. Brunet‐François, G. Le Moal, J. M. Chapplin, C. Arvieux, G. Chaumentin, B. Guerin, E. Bonnet, Y. Poinsignon, F. Boulard, I. De Lacroix, M. T. Goerger‐Sow, M. Kirstetter, M. Volstein, F. Laylavoix, X. Copin, C. Ceppi, Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, CIC Paris Est, Service de pharmacologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre d'investigation clinique Paris Est (CIC Paris-Est), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Service de Pharmacologie médicale [CHU Pitié-Salpêtrière]

Subjects
Male, Heart disease, [SDV]Life Sciences [q-bio], Human immunodeficiency virus (HIV), Aftercare, heart failure, HIV Infections, heart disease, 030204 cardiovascular system & hematology, medicine.disease_cause, Coronary artery disease, 0302 clinical medicine, prevention, Recurrence, Risk Factors, Cardiovascular Disease, Secondary Prevention, Medicine, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Original Research, Middle Aged, Prognosis, 3. Good health, Editorial, myocardial infarction, Anti-Retroviral Agents, Cardiovascular Diseases, Cardiology, Female, France, Cardiology and Cardiovascular Medicine, coronary artery disease, Adult, Acute coronary syndrome, medicine.medical_specialty, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, Humans, Acute Coronary Syndrome, business.industry, dyslipidemia, Coronary Care Units, Editorials, HIV, medicine.disease, HIV infection, Cerebrovascular Disorders, Heart Disease Risk Factors, Case-Control Studies, ST Elevation Myocardial Infarction, business, Dyslipidemia
Abstract

Background It is unclear whether HIV infection affects the long‐term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV‐uninfected (HIV−) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV− patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36‐month follow‐up. A total of 103 PLHIV and 195 HIV− patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow‐up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− patients (17.8% and 15.1%, P =0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67–3.82 [ P =0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32–30.21 [ P =0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P =0.01) and had smaller total cholesterol decreases (–22.3 versus –35.0 mg/dL; P =0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT00139958.

Published
2020
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6. Traitement de recours dans l’insuffisance cardiaque avancée

Author

J. C. Roussel, D. Guijarro, J.-N. Trochu, T. Lepoivre, J.P. Gueffet, S. Pattier, and M. Michel

Subjects
03 medical and health sciences, 0302 clinical medicine, Emergency Medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Emergency Nursing
Abstract

L’insuffisance cardiaque (IC) a fonction systolique alteree est une pathologie dont la mortalite reste elevee malgre les progres du traitement medicamenteux des dernieres decennies. Les patients connaissent generalement, au-dela de la periode diagnostique de la maladie, une stabilisation clinique de plusieurs annees. Une degradation de l’IC au cours du temps peut entrainer une limitation fonctionnelle importante, un retentissement systemique important (denutrition, insuffisance renale), particulierement en cas de congestion non maitrisee. Cet etat qualifie d’insuffisance cardiaque avancee (ICA) est souvent difficile a reconnaitre pour le clinicien, alors qu’il s’agit d’une periode charniere ou le projet therapeutique a plus long terme doit etre envisage precocement pour juger de l’eligibilite du patient a des soins lourds que sont la greffe cardiaque, l’implantation d’une assistance ventriculaire gauche. Le poids des comorbidites, le statut psychosocial et le retentissement de l’IC sur l’organisme conditionnent en effet les resultats de ces therapeutiques. Les episodes de decompensations aigues avec etats de choc cardiogenique et defaillance multiviscerale peuvent relever d’une prise en charge en reanimation vers un traitement invasif de la defaillance cardiaque par l’implantation de dispositif d’assistance mecanique et/ou une transplantation cardiaque en urgence. Apres un rappel de la definition de l’ICA, nous aborderons les indications de prise en charge en reanimation des patients en etat de choc cardiogenique, les therapeutiques de support que l’on propose en reanimation et nous discuterons des conditions de realisation des soins de long terme que sont la greffe cardiaque et l’assistance circulatoire.

Published
2015
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7. Perspectives actuelles concernant l’éducation thérapeutique et les réseaux. Réflexion à partir de l’expérience du réseau Respecticœur

Author

J.-N. Trochu and A.-L. Laprérie

Subjects
Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Internal Medicine, Cardiology and Cardiovascular Medicine
Abstract

Resume L’education therapeutique s’est developpee initialement dans les services hospitaliers. Cependant, afin de faire face au nombre croissant de malades chroniques et aux besoins en programmes d’education therapeutique de proximite, de nouveaux modes d’organisation doivent se mettre en place. Dans cet objectif, des programmes de prise en charge multidisciplinaires se sont developpes au debut des annees 2000. Ainsi, le reseau nantais Respecticœur, cree en 2004, a organise une prise en charge multidisciplinaire basee sur un programme educatif structure et sur la coordination des soins, dans le but de proposer a chaque patient atteint d’insuffisance cardiaque, un plan personnalise de sante. Sur la base d’une organisation souple, adaptee a chaque patient, et facile d’acces, de tels programmes ont demontre leur efficacite sur la qualite de vie, la reduction des re-hospitalisations et la survie. Dans le contexte des nouvelles directives destinees aux Agences regionales de sante (ARS) visant au developpement de l’education therapeutique en ambulatoire, nous discutons, dans cet article, les roles que peuvent assurer les reseaux de sante. Ces equipes ont su developper des competences educationnelles et organisationnelles specifiques, et nous suggerons fortement qu’elles soient sollicitees pour aider les professionnels de sante de proximite dans la mise en place de programmes educatifs au sein des maisons de sante pluridisciplinaires.

Published
2013
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8. Myocardites

Author

J-N, Trochu, N, Piriou, C, Toquet, C, Bressollette, F, Valleix, T, Le Tourneau, and J-P, Gueffet

Subjects
Radiography, Myocarditis, Molecular Diagnostic Techniques, Virus Diseases, Biopsy, Myocardium, Virology, Gastroenterology, Internal Medicine, Humans, Heart, Genome, Viral, Magnetic Resonance Imaging
Abstract

Myocarditis is an inflammatory disease of the myocardium associated with cardiac dysfunction. Etiologies of myocarditis are numerous - viral causes being the most frequent - as well as their clinical presentations which varies from isolated increase in cardiac enzymes during a viral pericarditis, fulminant myocarditis associated with cardiogenic shock to endomyocardial biopsy proven inflammation discovered during the etiologic diagnosis of a dilated cardiomyopathy. This article will discuss the importance of recognition of specific clinical scenarios of myocarditis and their echocardiographic presentations that are very useful for the etiologic diagnosis and to decide the medical strategy. Recent advances in the field of myocarditis concern improvement in understanding the pathophysiology, in the diagnostic approach with the use of noninvasive imaging (MRI) and molecular biology. However, specific treatment is still limited. Clinical trials with antiviral medications are not conclusive, and the medical strategies remain mainly based on the symptomatic treatment of heart failure.

Published
2012
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10. Abstracts

Author

O. Barthelemy, J. Silvain, D. Brieger, A. Bellemain-Appaix, G. Cayla, F. Beygui, R. Lancar, J. P. Collet, A. Mercadier, G. Montalescot, K. S. Cha, Y. H. Nam, J. H. Kim, S. Y. Park, T. H. Park, M. H. Kim, Y. D. Kim, H. C. Lee, M. S. Ahn, T. J. Hong, R. Blanco, F. Blanco, J. Szarfer, A. Garcia Escudero, G. Gigena, J. Gagliardi, A. Rodriguez, R. Sarmiento, S. Affatatto, M. Riccitelli, A. Petris, M. D. Datcu, C. Pop, M. Radoi, C. Arsenescu-Georgescu, I. Petrescu, L. Petrescu, L. Serban, E. Nechita, G. Tatu-Chitoiu, M. Dorobantu, I. Benedek, E. Craiu, C. Sinescu, D. D. Ionescu, C. Ginghina, B. Minescu, A. Izzo, P. Mantovani, L. Tomasi, L. Dall'oglio, S. Bonatti, R. Rosiello, M. Romano, F. Agostini, R. Zanini, Z. Y. Zhao, Y. J. Wu, J. J. Li, Y. J. Yany, H. Y. Qian, Y. D. Tang, A. T. Timoteo, A. Toste, A. Lousinha, R. Ramos, J. A. Oliveira, M. L. Ferreira, R. C. Ferreira, C. Cabades, J. L. Diez Gil, P. Aguar, D. Sanmiguel, A. Lopez-March, R. Marmol, L. Guerra, V. Girbes, J. Ferrando, A. Rincon De Arellano, L. Patricio, M. Blondal, T. Ainla, T. Marandi, J. Eha, M. M. Oliveira, M. N. Silva, P. S. Cunha, J. Feliciano, S. Silva, J. Kanovsky, P. Kala, J. Parenica, M. Poloczek, K. Prymusova, L. Kubkova, J. Spinar, D. Olinic, C. Homorodean, M. Ober, M. Olinic, C. Andrioaia, A. Condac, M. Masmoudi, B. Berdaoui, S. Labidi, C. Tapia Ballesteros, C. Hernandez Luis, M. G. Sandin, J. M. Vegas, R. Andion, N. Martinez, I. A. Gonzalez, M. Alvarado, I. J. Amat, J. A. San Roman, M. J. Garcia Gonzalez, E. Arroyo Ucar, C. Hernandez Garcia, M. Dorta Martin, F. Marrero Rodriguez, R. Dragu, M. Kapeliovich, H. Hammerman, D. Silva, N. Cortez-Dias, C. Jorge, J. Silva Marques, P. Carilho Ferreira, S. Robalo Martins, M. Almeida Ribeiro, C. Calisto, M. Fiuza, M. G. Lopes, P. Milicevic, M. Panic, I. Stankovic, D. Milicevic, T. Kalezic, S. Kafedzic, I. Ilic, M. Cerovic, B. Putnikovic, A. Neskovic, D. Rott, D. Leibowitz, Z. Monhart, J. Reissigova, H. Grunfeldova, P. Jansky, B. Valente, I. Villanueva Benito, I. Solla, E. Paredes, O. Diaz Castro, F. Calvo, J. A. Baz, A. Iniguez, A. Aleksova, R. Gerloni, R. Belfiore, C. Carriere, G. Barbati, E. Fabris, F. Possa, D. Nait, M. Milo, G. Sinagra, N. Marques, J. Mimoso, V. Gomes, R. M. Agra Bermejo, E. A. A. Emad Abu Assi, S. R. R. Sergio Raposeiras Roubin, P. C. G. Pilar Cabanas Grandio, C. P. G. Carlos Pena Gil, J. M. G. A. Jose Maria Garcia Acuna, J. R. G. J. Jose Ramon Gonzalez Juanatey, M. J. Daly, P. Scott, C. G. Owens, A. Tomlin, B. Smith, A. A. J. Adgey, L. R. Alvarez-Contreras, U. Juarez, A. Altamirano, A. Arias, A. Alvarez-San Gabriel, H. Gonzalez-Pacheco, C. Martinez-Sanchez, M. Rahnavardi, M. Keshtkar-Jahromi, H. Vakili, S. Gholamin, S. M. Razavi, T. Gilis-Januszewski, K.- P. Mellwig, M. Wiemer, J. Gilis-Januszewski, A. Peterschroeder, J. Koerfer, D. Horstkotte, M. Vrsalovic, B. Getaldic, N. Vrkic, H. Pintaric, S. Khan, B. Wasan, L. Moretti, P. Grossi, S. Silenzi, M. Testa, L. Candelori, L. N. Clementi, M. Forlini, L. Lando, M. L. Pezzuoli, P. Corradetti, G. Leurent, P. Y. Pennec, E. Filippi, B. Moquet, J. P. Hacot, P. Druelles, A. Rialan, G. Rouault, I. Coudert, H. Le Breton, S. Gevaert, F. Tromp, E. Vandecasteele, F. De Somer, Y. Van Belleghem, S. Bouchez, F. Martens, I. Herck, M. De Pauw, O. Ludka, M. Sepsi, R. Miklik, L. Dusek, D. Tomcikova, J. M. Garcia-Acuna, P. Aguiar-Souto, S. Raposeiras Roubin, R. Agra-Bermejo, M. Jacquet, E. Abu-Assi, J. R. Gonzalez-Juanatey, A. Ibatov, R. Labrova, R. Karlik, P. Lokaj, Q. She, S. B. Deng, S. H. Huang, L. J. Gu, J. I. A. N. Rong, Z. K. Wu, Y. Li, J. Zhang, L. Parascan, A. Campanile, L. Spinelli, G. Santulli, M. Ciccarelli, S. De Gennaro, E. Assante Di Panzillo, B. Trimarco, G. Iaccarino, E. Bobescu, G. Datcu, D. Dobreanu, B. Doka, J.- C. Charniot, C. Cosson, J. P. Albertini, R. Bittar, P. Giral, C. Cherfils, E. Guillerm, D. Bonnefont-Rousselot, A. Rusali, L. Cojocaru, I. Parepa, T. Koizumi, S. Iida, J. Sato, T. Kikutani, T. Muramatsu, S. Nishimura, N. Komiyama, W. P. Lee, B. B. Ong, K. Haralambos, D. Townsend, J. A. E. Rees, E. J. Williams, J. P. Halcox, I. Mcdowell, M. Damjanovic, G. Koracevic, D. Djordjevic-Radojkovic, M. Pavlovic, N. Krstic, S. Ciric-Zdravkovic, A. Stojkovic, Z. Perisic, S. Apostolovic, A. Faustino, L. Seca, S. Barra, F. Caetano, R. Providencia, J. Silva, P. Gomes, G. Costa, M. Costa, A. Leitao-Marques, A. L. Volkova, G. P. Arutyunov, N. A. Bylova, I. I. Dayter, Y. T. F. N. Jao, C. C. Fang, Y. Chen, C. L. Yu, S. P. Wang, J. Valencia, P. Perez-Berbel, J. M. Ruiz-Nodar, J. Pineda, P. Bordes, M. Quintanilla, V. Mainar, F. Sogorb, N. Santos, M. Serrao, H. Cafe, B. Silva, R. Oliveira, G. Caires, A. Drumond, J. Araujo, R. A. Providencia, P. L. Gomes, J. R. Pais, P. Mota, A. M. Leitao-Marques, S. Farhan, R. Jarai, I. Tentzeris, B. Vogel, M. K. Freynhofer, J. Wojta, K. Huber, M. Poli, P. Trambaiolo, F. Corsi, M. De Luca, M. Mustilli, V. Lukic, M. Simonetti, G. Ferraiuolo, M. Lettino, G. Casella, M. R. Conte, L. De Luca, G. Geraci, R. Ceravolo, A. Pani, G. Fradella, A. Schratter, H. Thiele, T. Klemm, K. Demmin, D. Lehmann, M. Mende, G. Schuler, U. Pittl, A. Chernova, S. U. Nikulina, T. Naruke, T. Inomata, T. Yanagisawa, E. Maekawa, T. Mizutani, H. Shinagawa, M. Nishii, I. Takeuchi, H. Takehana, T. Izumi, C. Paulo, J. Mascarenhas, M. Patacho, J. Pimenta, P. Bettencourt, S. Nardai, G. Y. Szabo, B. Berta, I. Edes, B. Merkely, J. Delgado Silva, R. Baptista, R. Faria, J. Trigo, P. Gago, G. Gheorghe, I. T. Nanea, A. Cristea, S. Almarichi, H. Martins, F. Saraiva, E. Jorge, P. L. Mendes, P. Monteiro, S. Costa, F. Franco, L. A. Providencia, T. Nanea, G. S. Gheorghe, S. Visan, N. Paun, R. Gaber, R. Delewi, R. Nijveldt, H. A. De Bruin, A. Hirsch, A. Van Der Laan, B. J. Bouma, J. P. G. Tijssen, A. C. Van Rossum, F. Zijlstra, J. J. Piek, H. Rus, M. Donea, C. Ciurea, G. Ifteni, G. Casolo, M. Chioccioli, M. Magnacca, J. Del Meglio, A. Comella, M. Baratto, J. Lera, L. Salvadori, C. Tessa, C. Vignali, Z. Keca, T. Momcilov Popin, G. Panic, R. White, F. Mateen, A. Weaver, Y. Agmon, E. Okisheva, D. Tsaregorodtsev, V. Sulimov, I. J. Amat Santos, C. Hernandez, C. Tapia, A. Campo, D. Fredman, L. Svensson, M. Rosenqvist, S. Tadel-Kocjancic, P. Radsel, R. Knafelj, V. Gorjup, M. Noc, E. Zima, Z. S. Jenei, E. Kovacs, I. Osztheimer, L. Molnar, A. Horvath, D. Becker, L. Geller, R. Maggi, T. Furukawa, V. Viscardi, M. Brignole, S. R. N. Leal, H. Dores, I. Rosario, J. Monge, M. J. Carvalho, I. Arroja, A. Leitao, C. Fonseca, A. Aleixo, A. Silva, S. Keuleers, P. Herijgers, M. C. Herregods, W. Budts, C. Dubois, B. Meuris, P. Verhamme, W. Flameng, F. Van De Werf, T. Adriaenssens, H. Badran, M. Elnoamany, T. Lolah, C. Olariu, C. Macarie, M. A. H. Mollik, A. I. Hassan, T. K. Paul, M. Z. Haque, R. Jahan, M. Rahmatullah, M. A. Khatun, M. T. Rahman, M. H. Chowdhury, J. Bustamante Munguira, E. Tamayo, I. Garcia-Cuenca, E. Bustamante, J. Gualis, M. L. Gomez-Martinez, S. Florez, J. I. 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Rodrigues, M. Goncalves, L. Simoes, and K. V. Borisov

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Cardiology and Cardiovascular Medicine
Published
2010
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11. Ischémies digitales : présentation clinique, étiologies et suivi à long terme. Une cohorte de 323 patients

Author

P. Plissonneau, Marc-Antoine Pistorius, Bernard Planchon, K. Asehnoune, B. Maurel, J. Reignier, G. Gautier, C. N’Gohou, M. Aartifoni, Q. Didier, Y. Goueffic, Jérôme Connault, P. Pottier, J.-N. Trochu, A. Raimbeau, C. Durant, C. Agard, Olivier Espitia, and B. Rozec

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Objectif Les ischemies digitales (ID) sont une entite rare et heterogene auxquelles est cependant, confronte le medecin vasculaire ; l’ischemie du membre superieur est quarante fois moins frequente que celle des membres inferieurs. L’objectif de cette etude etait d’evaluer les etiologies, les traitements, les pronostics et l’evolution a long terme des ID dans la plus grande cohorte jamais rapportee. Malades et methodes Nous avons inclus les patients presentant des ischemies digitales, avec ou sans necrose, limitees ou non aux doigts sur la periode de janvier 2000 a decembre 2016 au sein du CHU de Nantes. Nous avons recueilli les donnees retrospectives portant sur l’etiologie, la recidive d’ID, les amputations digitales et la survie globale. Resultats Les ischemies digitales d’origine cardio-emboliques (IDCE) etaient l’etiologie principale avec 59 patients (18,3 %), suivie des patients atteints de sclerodermie systemique (SSc) avec 52 patients (16 %), les ID idiopathiques representaient 38 patients (11,7 %), les maladies de Buerger avec 30 patients (9,3 %), les causes iatrogeniques avec 30 patients (9,3 %) et les neoplasies avec 20 patients (6,2 %). Les patients avec une IDCE etaient significativement plus vieux et presentaient plus d’hypertension arterielle alors que les maladies de Buerger consommaient plus de tabac et de cannabis. Sur le plan clinique, les patients avec une IDCE avaient plus de pâleur des doigts et de douleur a la fois nociceptive et neuropathique alors que les SSc presentaient plus de necrose digitale. Le suivi a long terme a montre des recidives significativement plus frequentes dans le groupe SSc par rapport a tous les autres groupes (p Conclusion Dans cette etude, les etiologies principales d’ID etaient les cardiopathies emboligenes, la SSc et les ID idiopathiques. Cette etude montre une augmentation de l’etiologie iatrogenique en comparaison aux series d’ID precedentes. Les ID de la SSc sont associees a un mauvais pronostic local alors que les IDCE sont associees a un mauvais pronostic general. Les ID dans la SSc et la maladie de Buerger sont associees a plus de recidive.

Published
2018
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12. Éducation et prise en charge multidisciplinaire dans l'insuffisance cardiaque chronique

Author

A.L. Laprérie, E. Gravoueille, Catherine Greffier, L. Le Helias, P. Herbouiller, H. Lambert, H. Guibert-Heriteau, O. Stora, V. Hossler, C. Mariaux, G. Lacaze, and J.-N. Trochu

Subjects
medicine.medical_specialty, Chronic congestive heart failure, business.industry, Multidisciplinary approach, Internal medicine, medicine, Cardiology, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published
2007
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13. Importance de l'éducation thérapeutique dans la prise en charge multidisciplinaire de l'insuffisance cardiaque

Author

P. Jourdain, J.-N. Trochu, and Yves Juillière

Subjects
Gynecology, medicine.medical_specialty, business.industry, medicine, Therapeutic education, Cardiology and Cardiovascular Medicine, business, Multidisciplinary team
Abstract

Resume L'insuffisance cardiaque est une maladie severe grevee d'une morbimortalite encore trop lourde. L'interet pour une prise en charge multidisciplinaire des patients insuffisants cardiaques prend actuellement un essor afin d'ameliorer la prescription du traitement medical et de permettre une meilleure qualite de vie. Les preuves d'une reduction de morbimortalite existent et plusieurs modeles de prise en charge ont ete evalues. Le point fondamental unissant ces differents modeles reside dans le role majeur de l'education therapeutique. La formation des personnels concernes (medicaux et paramedicaux) a cette technique est necessaire. Des outils d'education therapeutique ont ete crees a cote de moyens d'information complementaires. L'ensemble de ces elements œuvre pour permettre qu'une nouvelle forme d'approche de l'insuffisance cardiaque se mette en place en France.

Published
2006
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14. Y a-t-il une place pour les statines dans le traitement de l'insuffisance cardiaque ?

Author

J.-N Trochu

Subjects
Gynecology, medicine.medical_specialty, business.industry, medicine, Energy metabolism, Cardiology and Cardiovascular Medicine, business
Abstract

Resume Au-dela de leurs proprietes hypocholesterolemiantes, les inhibiteurs de l'HMG–CoA reductase (ou statines) ont de multiples effets dans le systeme cardiovasculaire. Communement regroupees sous le terme « proprietes pleiotropes », ces proprietes correspondent a plusieurs mecanismes d'action qui pourraient justifier l'utilisation des statines dans le traitement medical de l'insuffisance cardiaque congestive. Sans reprendre les effets benefiques des statines sur les differents processus physiopathologiques impliques dans les syndromes ischemiques, l'objectif de cette revue de la litterature est de discuter ces nouvelles voies therapeutiques et en particulier les actions des statines sur l'endothelium vasculaire, en insistant sur le metabolisme energetique myocardique et renal, l'inflammation, la thrombose, le stress oxydatif, le remodelage ventriculaire et l'hypertrophie, et la fonction renale.

Published
2004
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15. Les problématiques et les apports de l'évaluation d'un réseau de santé

Author

H. Guibert, A.L. Laprérie, C. Mariaux, O. Stora, P. Lombrail, E. Gravoueille, V. Hossler, H. Lambert, J. Antras-Ferry, J.-N. Trochu, and G. Lacaze

Subjects
business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities, Pilotage
Abstract

Resume Les reseaux de sante correspondent a une forme d'organisation horizontale et souple qui consiste a prendre en charge des problemes de sante complexes et de long terme. Ils reposent sur l'echange et la coordination des differents acteurs de la prise en charge des patients dont la cle de voute est la circulation de l'information medicale. Un des defis de l'evaluation des reseaux de sante est d'apporter la preuve de la plus-value de l'organisation en reseau par rapport a la prise en charge classique axee sur la pathologie. L'evaluation du fonctionnement d'un reseau, legalement requise mais non epaulee par des specialistes de l'evaluation, permet de s'assurer de l'existence d'un reel pilotage, de mesurer l'implication des professionnels de sante et l'impact du reseau sur les pratiques professionnelles. En outre, l'evaluation accompagne le developpement des reseaux dans une dynamique d'amelioration continue et offre l'opportunite au coordinateur de se doter d'un outil de controle de gestion, c'est-a-dire d'un outil d'information et d'aide a la decision dans la perspective de l'amelioration de la qualite de la prise en charge des patients. Cependant, l'absence de formation a la gestion et a la communication des coordinateurs medicaux rend le pilotage des reseaux delicat. Les reseaux ne peuvent donc pas faire l'economie d'une bonne assise gestionnaire et administrative. De meme, ils doivent se doter d'un systeme d'information de qualite, utile au pilotage, adapte a leur mode de coordination et qui facilitera le travail d'evaluation demande par les tutelles.

Published
2006
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16. [Nebivolol: the first vasodilatory beta-blocker with a beta3-adrenergic agonist activity]

Author

C, Gauthier and J N, Trochu

Subjects
Cardiovascular Diseases, Ethanolamines, Vasodilator Agents, Animals, Humans, Adrenergic beta-3 Receptor Agonists, Benzopyrans, Adrenergic beta-1 Receptor Antagonists, Nebivolol
Abstract

Several studies suggest that the beta(3)-adrenergic stimulation could be a new therapeutic target for the treatment of cardiovascular diseases. The vascular effects induced by beta(3)-adrenergic stimulation are able to decrease the left ventricular strain allowing to reduce after-load. In addition, the increased coronary blood flow due to vasorelaxation increases the myocardial oxygene delivery. The hypothesis about the beneficial role of beta(3)-adrenoceptors is supported by recent data about a beta-blocker of third generation, nebivolol, currently used in the treatment of heart failure and hypertension. The present review presents the beta(3)-adrenoceptors characteristics as well as its involvement in the cardiovascular effects of nebivolol.

Published
2010

17. Soluble interleukin 2 receptor (Tac chain) is not a reliable marker in kidney transplant recipient monitoring

Author

Yannick Jacques, J. N. Trochu, Denis M, Magali Giral, B. Le Mauff, J. P. Soulillou, and J. L. Auget

Subjects
Graft Rejection, Interleukin 2, Nephrology, medicine.medical_specialty, T-Lymphocytes, Renal function, Kidney, Lymphocyte Activation, Nephrotoxicity, chemistry.chemical_compound, Antigen, Internal medicine, medicine, Humans, Kidney transplantation, Transplantation, Creatinine, business.industry, Receptors, Interleukin-2, Prognosis, medicine.disease, Kidney Transplantation, medicine.anatomical_structure, Endocrinology, Solubility, chemistry, Cytomegalovirus Infections, Immunology, Cyclosporine, business, Biomarkers, medicine.drug
Abstract

T lymphocyte expansion is triggered through interaction of interleukin 2 (IL-2) with its high-affinity receptor (IL-2R). This molecule is a heterodimer comprising an antigen-inducible component, the Tac chain (P55). Activation of T lymphocytes also generates a soluble form of this P55 called S-IL-2R. S-IL-2R is elevated in many T-cell-related pathologies (leukemia, autoimmunity, etc.). In graft recipients, rejection is a result of T-cell activation by graft antigens and therefore might induce a release of S-IL-2R in the circulation; this parameter is now said to be a good indicator of rejection. We have performed a study in renal graft recipients in order to assess the usefulness of circulating S-IL-2R particularly to discriminate the origin of renal failure in cases of rejection or of cyclosporin-A (CsA)-induced nephrotoxicity. We demonstrated that there are no differences between isolated values in the clinical groups at the time of diagnosis. Variations in S-IL-2R are increased compared to steady-state periods during rejection and cytomegalovirus infections, although not in CsA toxicity episodes. However, at the individual level there are too many false-positive and false-negative results, making this parameter no more meaningful than serum creatinine levels alone or even in association (as tested in logistic discriminant analysis). In addition, it seems that the variations in S-IL-2R are partly related to renal function itself, as suggested by the correlation between S-IL-2R levels and serum creatinine levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1992
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19. [Genetic aspects of valvulopathies]

Author

F, Kyndt, S, Le Scouarnec, P, Jaafar, J-P, Gueffet, A, Legendre, J-N, Trochu, V, Jousseaume, A, Chaventré, J-J, Schott, H, Le Marec, and V, Probst

Subjects
Chromosomes, Human, X, Contractile Proteins, Filamins, Microfilament Proteins, Mutation, Heart Valve Diseases, Humans, Pedigree
Abstract

Valvular dystrophies due to myxoid degeneration are common and potentially serious cardiac pathologies. They constitute a heterogeneous group of which the most usual is idiopathic mitral valvular prolapse (Barlow's disease). The majority of mitral valvular prolapses are sporadic, but there are several familial forms. Transmission is usually autosomal dominant with incomplete penetrance and variable expression. The first chromosomal location to be identified was on the 16p11-13 chromosome. Since then, two other loci have been identified on the 11p15.4 and 13q31-32 chromosomes. Our team has recently identified the first gene responsible for myxoid valvulopathy linked to the X chromosome, from a large family of 318 members. This is the gene that codes for filamin A, which is a cytoskeleton protein. The frequency of mutations in this gene is still unknown, but out of 7 families in which transmission was compatible with X-linked transmission, mutations were discovered in 4 of the families. Thanks to a genetic epidemiological approach, we have also demonstrated that there are familial forms of aortic stenosis, which are probably common. Identification of the genes implicated in these common forms of valvular pathology is important, as it will allow a better understanding of the pathophysiology of these valvular disorders and could lead to better therapeutic management in the future.

Published
2008

21. [Importance of therapeutic education in the multidisciplinary management of heart failure]

Author

Y, Juillière, J N, Trochu, and P, Jourdain

Subjects
Heart Failure, Physician-Patient Relations, Patient Education as Topic, Delivery of Health Care, Integrated, Quality of Life, Humans, France
Abstract

Heart failure is a severe disease with high morbidity and mortality rates. The interest for multidisciplinary heart failure patient management is increasing in order to improve prescription of medical therapies and to allow a better quality of life. Proofs of reduction in morbi-mortality exist and some models of management have been assessed. The most important point remains the major role of therapeutic education. Training of health care professionals is needed. Tools for therapeutic education have been created and can be associated with complementary informative means. All these elements allow that a new approach of heart failure takes in place in France.

Published
2006

22. [Therapeutic education for cardiac failure patients: the I-care programme]

Author

Y, Juillière, P, Jourdain, J, Roncalli, J N, Trochu, E, Gravoueille, H, Guibert, H, Lambert, S, Neau, L, Spinazze, N, Tallec, C, Bachèlerie, F, Beauvais, C, Ertzinger, and G, Jondeau

Subjects
Heart Failure, Physician-Patient Relations, Patient Education as Topic, Activities of Daily Living, Humans, France, Program Development, Exercise, Life Style, Diet
Abstract

Therapeutic education is becoming increasingly important in the management of chronic diseases including cardiac failure. The I-CARE programme consists of an evaluation of the role of therapeutic education in France, creating standardised tools and setting up training sessions for therapeutic education in the context of cardiac failure. Approximately two thirds of the French centres contacted perform therapeutic education with their available means. The lack of personnel, space, and training tools represent obstacles to the development of therapeutic education. The tools developed in the programme fall into 5 areas: diagnosis education, understanding the illness, diet, physical activity/daily life, and treatment. Training sessions were organised for the teams, consisting of at least one cardiologist and nurse. The I-CARE programme should allow the expansion of therapeutic education for cardiac failure and improve the multidisciplinary management of this disease which increasingly affects often elderly subjects.

Published
2005

23. [Pulmonary hypertension and cardiac transplantation]

Author

J N, Trochu

Subjects
Postoperative Care, Cardiopulmonary Bypass, Risk Factors, Hypertension, Pulmonary, Ventricular Dysfunction, Right, Heart Transplantation, Humans, Prognosis, Patient Care Planning
Abstract

Evaluation of pulmonary hypertension in chronic cardiac failure before cardiac transplantation is one of the major objectives of the pre-transplantation investigations. The risk of right ventricular failure, a poor short-term prognostic factor, is correlated with the level of pulmonary arteriolar resistance. Based on recent physiopathological data concerning the pulmonary circulation, advances on postoperative care and cardiopulmonary bypass techniques, this article aims to present the modern conception of evaluation of pulmonary hypertension, its reversibility in patients who are candidates for cardiac transplantation, and its treatment after the transplantation.

Published
2004

24. [Bradykinin and ventricular function]

Author

J N, Trochu

Subjects
Ventricular Remodeling, Angiotensin II, Myocardial Ischemia, Humans, Ventricular Function, Blood Pressure, Bradykinin
Abstract

Kinins are vasodilator peptides implicated in many physiological and physiopathological processes such as blood pressure regulation and that of the coronary circulation and inflammatory reactions. Kinins play an essential role in ventricular function as they counteract the effects of angiotensin II during myocardial ischaemia, ventricular remodelling and severe cardiac failure, emphasising the value of treatment favouring local endogenic production of bradykinin such as ACE inhibitors, neutral endopeptidase inhibitors and antagonists of AT1 receptors of angiotensin II.

Published
2002

25. [Surgery in heart failure (without transplantation)]

Author

O, Baron, O, al Habash, J N, Trochu, M, Treilhaud, M, Burban, J B, Bouhour, and D, Duveau

Subjects
Ventricular Remodeling, Cardiac Output, Low, Heart Transplantation, Humans, Assisted Circulation, Coronary Artery Bypass, Heart Valves, Patient Care Planning, Echocardiography, Stress, Tomography, Emission-Computed
Abstract

Cardiac transplant remains the treatment of reference for end-stage cardiac insufficiency. The very great disparity between the number of grafts available and the number of patients eligible to be included on the transplant list drives some of them to contemplate a surgical alternative in order to improve their clinical condition and to delay as much as possible the date of transplant. The objective is to treat surgically one or several of the lesions causing the cardiac insufficiency. It could be valvular surgery, coronary surgery or a combination of both, ventricular remodelling or cardiomyoplasty. It is coronary revascularisation surgery which gives the most spectacular results on condition that it is aimed at the myocardial zones for which viability has been demonstrated by stress echocardiography or a PET scan.

Published
2002

26. [Cure of superacute eosinophilic myocarditis treated by temporary circulatory assistance]

Author

J N, Trochu, O, Baron, M, Burban, C, Sagan, J C, Chevallier, A, Tirouvanziam, M, Treilhaud, J F, Godin, D, Duveau, and J B, Bouhour

Subjects
Adult, Myocarditis, Ventricular Dysfunction, Left, Treatment Outcome, Echocardiography, Biopsy, Myocardium, Shock, Cardiogenic, Humans, Female, Steroids, Assisted Circulation
Abstract

The authors report the case of a 31 year old woman, admitted as an emergency for acute myopericarditis, in cardiogenic shock. Echocardiography showed severe left ventricular dysfunction associated with concentric biventricular hypertrophy with increased echogenicity of the myocardial walls. Poor response to treatment with intravenous inotropic drugs led to referral for biventricular circulatory assistance with a Biomedicus pump, which was withdrawn on the 9th day after recovery of normal left ventricular function. Myocardial biopsies showed massive interstitial inflammation with a predominance of eosinophilic cells suggesting a hypersensitivity reaction. Steroid therapy was prescribed when the results of biopsy were known and stopped after 6 months. This case emphasises the value of echocardiography and myocardial biopsy in diagnosis and treatment of acute myocarditis with cardiogenic shock.

Published
2002

27. [Cardiomyopathies. Symptoms, prognosis, treatment]

Author

J N, Trochu, J M, Langlard, and H, Le Marec

Subjects
Diagnosis, Differential, Electrocardiography, Ventricular Dysfunction, Left, Echocardiography, Cardiovascular Surgical Procedures, Humans, Cardiomyopathies, Coronary Angiography, Magnetic Resonance Imaging
Published
2001

28. [Recurrent syncope and Chiari malformation]

Author

B, Guillon, J N, Trochu, S, Olindo, H, Desal, S, Martin, D, Ménégalli, and J R, Fève

Subjects
Male, Recurrence, Humans, Female, Budd-Chiari Syndrome, Middle Aged, Syncope
Abstract

Downward herniation of the cerebellar tonsils through the foramen magnum (Chiari I malformation) is usually revealed by head and neck pain, often associated with brain-stem or spinal cord disturbances. Syncopes are rarely reported and may be difficult to link to their cause when they occur alone. We report two cases with brief and repetitive syncopes revealing a Chiari I malformation. These manifestations may be attributed to transient compression of brain stem or vascular structures at the craniocervical junction, triggered by intracranial pressure increase, as they disappear after posterior fossa decompression.

Published
2001

29. [Late cerebrovascular complications of cardiac transplantation]

Author

B, Guillon, S, Wiertlewski, J N, Trochu, H, Desal, M, Treilhaud, J L, Michaud, J B, Bouhour, and J R, Fève

Subjects
Male, Stroke, Brain, Heart Transplantation, Humans, Female, Middle Aged, Tomography, X-Ray Computed, Magnetic Resonance Imaging, Medical Records, Aged, Retrospective Studies
Abstract

The occurrence of stroke after the post-operative period of cardiac transplantation is a rare event, and the role of the cardiac transplant in these patients, who often have various vascular risk factors, is unclear. We reviewed the clinical records of 303 consecutive patients with orthotopic cardiac transplantation performed from March 1985 to December 1996 and selected those who developed a stroke over the first 2 months postoperatively, in order to evaluate the frequency and the mechanisms of late cerebrovascular complications. Four patients had presented cerebral infarct and two intracranial hemorrhage. The overall risk of late cerebrovascular complications was 2.6p.100 at 5 years. Ischemic stroke was related to cardiac embolus in one patient, lacunar infarction in another, and was of undetermined etiology in two cases. In addition to vascular risk factors prior to transplantation and the development of intracardiac thrombus, immunosuppressive therapy, the surgical procedure and cardiac rejection may play a role in the occurrence of stroke in such patients.

Published
2000

30. Beta 3-adrenoceptor stimulation induces vasorelaxation mediated essentially by endothelium-derived nitric oxide in rat thoracic aorta

Author

J N, Trochu, V, Leblais, Y, Rautureau, F, Bévérelli, H, Le Marec, A, Berdeaux, and C, Gauthier

Subjects
Male, omega-N-Methylarginine, Dose-Response Relationship, Drug, Tetrahydronaphthalenes, Adrenergic beta-Antagonists, Isoproterenol, Aorta, Thoracic, Adrenergic beta-Agonists, In Vitro Techniques, Nitric Oxide, Rats, Propanolamines, Vasodilation, Nadolol, Phenylephrine, Vasoconstriction, Receptors, Adrenergic, beta-3, Receptors, Adrenergic, beta, Papers, Animals, Endothelium, Vascular, Nitric Oxide Synthase, Rats, Wistar, Cyclic GMP
Abstract

1. The relaxant effects of isoprenaline may result from activation of another beta-adrenoceptor subtype in addition to beta1 and beta2. This study evaluated the role of a third beta-adrenoceptor subtype, beta3, in beta-adrenoceptor-induced relaxation of rat thoracic aorta by isoprenaline. 2. Isoprenaline produced a concentration-dependent relaxation of phenylephrine pre-contracted rings of the thoracic aorta (pD2=7.46+/-0.15; Emax=85.9+/-3.4%), which was partially attenuated by endothelium removal (Emax=66.5+/-6.3%) and administration of the nitric oxide (NO) synthase inhibitor, L-NG-monomethyl arginine (L-NMMA) (Emax=61.3+/-7.9%). 3. In the presence of nadolol, a beta1- and beta2-adrenoceptor antagonist, isoprenaline-induced relaxation persisted (Emax=55.6+/-5.3%), but occurred at higher concentrations (pD2=6.71+/-0.10) than in the absence of nadolol and lasted longer. 4. Similar relaxant effects were obtained with two beta3-adrenoceptor agonists: SR 58611 (a preferential beta3-adrenoceptor agonist), and CGP 12177 (a partial beta3-adrenoceptor with beta1- and beta2-adrenoceptor antagonistic properties). SR 58611 caused concentration-dependent relaxation (pD2=5.24+/-0.07; Emax=59.5+/-3.7%), which was not modified by pre-treatment with nadolol but antagonized by SR 59230A, a beta3-adrenoceptor antagonist. The relaxation induced by SR 58611 was associated with a 1.7 fold increase in tissue cyclic GMP content. 5 Both relaxation and the cyclic GMP increase induced by SR 58611 were greatly reduced by endothelium removal and in the presence of L-NMMA. 6 We conclude that in the rat thoracic aorta, beta3-adrenoceptors are mainly located on endothelial cells, and act in conjuction with beta1- and beta2-adrenoceptors to mediate relaxation through activation of an NO synthase pathway and subsequent increase in cyclic GMP levels.

Published
1999

33. [Recent advances in cardiac pacing]

Author

J F, Godin, J N, Trochu, and J C, Chevallier

Subjects
Pacemaker, Artificial, Cardiac Pacing, Artificial, Humans, Arrhythmias, Cardiac
Abstract

Over recent years, the increasing complexity of pacemakers has discouraged many cardiologists who considered that their role in the surveillance of patients with pacemakers had become minimal. Fortunately, times have changed, as this sophistication, which has how reached maturity, simplifies the cardiologist's task and should renew this interest in pacemaking. For example, improvement of electronic circuits now allows simpler pacing modes (e.g. single electrode VDD mode) and the development of automation of the main pacing parameters: automatic adjustment of the discharge current, the A-V period, protection algorithms against tachycardia due to electronic re-entry and atrial arrhythmias, automatic mode switching. Finally, the incorporation of large capacity memory functions allows the apparatus to act like an implantable "mini Holter" monitor.

Published
1996

34. [Detection of residual myocardial ischemia by Thallium-201 myocardial scintigraphy after myocardial infarction. Apropos of 53 patients treated with thrombolytic agents during the acute phase and with coronary transluminal angioplasty]

Author

J, Hélias, J R, Hazard, R, Grossetête, J C, Chevallier, D, Crochet, J N, Trochu, and J F, Godin

Subjects
Adult, Male, Myocardial Infarction, Myocardial Ischemia, Middle Aged, Coronary Angiography, Thallium Radioisotopes, Exercise Test, Humans, Female, Thrombolytic Therapy, Prospective Studies, Angioplasty, Balloon, Coronary, Radionuclide Imaging
Abstract

The prognosis of silent ischemia after myocardial infarction is similar to that of post-infarction angina. In order to detect this condition two stress myocardial scintigraphies were performed: three weeks after hospital admission for myocardial infarction treated by thrombolytic therapy without any complications or recurrence of chest pain; one month later, after percutaneous transluminal coronary angioplasty on the infarct-related artery in 24 patients or after medical therapy alone when this procedure was not possible (29 patients). Silent ischemia, initially present in two thirds of patients, was less frequently observed in the patients undergoing angioplasty (p0.05). In the remaining one third of patients with no silent ischemia, myocardial scintigraphy was unchanged at the follow-up procedure whether or not angioplasty had been performed. These results show that silent ischemia is commonly observed during stress myocardial scintigraphy after acute myocardial infarction treated by thrombolysis, but that this condition can be significantly reduced by coronary angioplasty. When no silent ischemia is observed, coronary angiography and angioplasty do not seem to be indicated.

Published
1993

36. 374 Multicenter randomised trial of a multidisciplinary intervention program in heart failure patients in French medical practice

Author

A.L. Laprérie, J.B. Bouhour, S. Baleynaud, G. Mialet, L. Campion, C. Thomas, J.-N. Trochu, and H. Lambert

Subjects
medicine.medical_specialty, Intervention program, Multidisciplinary approach, business.industry, Heart failure, Physical therapy, medicine, Medical practice, Cluster randomised controlled trial, Cardiology and Cardiovascular Medicine, medicine.disease, business
Published
2003
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