6 research outputs found

    Etude de la réserve coronaire par doppler transthoracique haute fréquence

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    PARIS6-Bibl.PitiĂ©-SalpĂȘtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

    Prévention des resténoses intra

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    La pose de stents est devenue la principale technique d’angioplastie coronaire percutanĂ©e en France, comme dans les autres pays occidentaux. La principale limite de cette technique est la survenue de restĂ©noses au site d’implantation du stent. Les techniques mĂ©dicamenteuses de prĂ©vention, inefficaces dans l’ensemble, souffrent autant d’une mĂ©connaissance de la physiopathologie des restĂ©noses intrastent que d’une inadĂ©quation entre des traitements systĂ©miques et un phĂ©nomĂšne biologique Ă©minemment focal. Des traitement locaux prenant en compte ces donnĂ©es physiopathologiques sont donc en cours d’évaluation chez l’homme. Les premiers rĂ©sultats cliniques des stents imprĂ©gnĂ©s actifs, qui permettent de dĂ©livrer localement de fortes concentrations de substances antiprolifĂ©rantes (sirolimus, paclitaxel
), sont trĂšs prometteurs et suggĂšrent que ces nouveaux stents devraient probablement rĂ©volutionner la pratique de la cardiologie interventionnelle. Quant Ă  la thĂ©rapie gĂ©nique, son application au problĂšme des restĂ©noses nĂ©cessite une simplification et une amĂ©lioration de l’efficacitĂ© des techniques de transfert gĂ©nique

    Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight

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    International audienceBackground: Atrial remodelling has been poorly investigated in atrial fibrillation (AF), and few studies have focused on biatrial remodelling.Aim: To evaluate right atrial (RA) and left atrial (LA) remodelling in AF using global atrial reservoir strain and three-dimensional (3D) atrial volumes, according to rhythm outcome at mid-term follow-up.Methods: Two-dimensional and 3D transthoracic echocardiography (TTE) were performed within 24hours after admission (M0) and at 6-month follow-up (M6) in patients admitted for AF. RA and LA variables were assessed: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF); atrial expansion index (3D RAEI, 3D LAEI); and global RA and LA reservoir strain.Results: Forty-eight consecutive patients were included prospectively. Three groups were identified depending on rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) in 25 (52.1%) patients; AF at M0 and AF at M6 (AF-AF) in 13 (27.1%) patients; and SR at M0 (spontaneous cardioversion before first TTE) and SR at M6 (SR-SR) in 10 (20.8%) patients. Between M0 and M6 in the AF-SR group, we found: significant decreases in Max 3D RA Voli (P=0.020), Min 3D RA Voli (P=0.0008), Max 3D LA Voli (P=0.001) and Min 3D LA Voli (P=0.0021); significant increases in 3D RAEF (P=0.037) and 3D RAEI (P=0.034); no significant differences in 3D LAEF and 3D LAEI; and significant increases in global RA and LA reservoir strain (both P<0.0001). There was no significant difference with regard to these variables in the AF-AF and SR-SR groups.Conclusion: 3D volume and strain analyses were useful in the evaluation of RA and LA reverse remodelling in successfully cardioverted patients with AF

    Patterns of use and potential impact of early beta-blocker therapy in non-ST-elevation myocardial infarction with and without heart failure: the Global Registry of Acute Coronary Events

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    BACKGROUND: Early beta-blocker (BB) therapy improves outcomes in ST-segment elevation myocardial infarction; however, limited data are available on its early use and its impact in non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: We evaluated data from 7106 patients with NSTEMI, without contraindications to BBs, enrolled in the Global Registry of Acute Coronary Events between April 1999 and September 2004. Baseline characteristics, management, and outcomes were analyzed according to the use of oral (+/-intravenous) BB within 24 hours of presentation. Multivariable analysis was conducted adjusting for comorbidities using the Global Registry of Acute Coronary Events risk model (c statistic 0.83). RESULTS: Beta-blocker therapy was initiated within the first 24 hours in 76% of patients with NSTEMI (79% with Killip class I vs 62% with class II/III; P \u3c .001). Failure to initiate BBs within the first 24 hours was associated with lower rates of subsequent BB therapy (P \u3c .001) and other evidence-based therapies. Early BB therapy was correlated with lower hospital mortality for NSTEMI patients (OR 0.58, 95% CI 0.42-0.81) and for those with Killip class II/III (OR 0.39, 95% CI 0.23-0.68) with a trend toward lower mortality in the Killip class I group (OR 0.77, 95% CI 0.49-1.21). At 6 months postdischarge, early BB use was associated with lower mortality in NSTEMI patients (OR 0.75, 95% CI 0.56-0.997) with a trend toward lower mortality in patients with Killip class I or II/III. CONCLUSIONS: Many eligible patients do not receive early BB therapy. Treatment with early BBs may have a beneficial impact on hospital and 6-month mortality in all patients, including those presenting with heart failure

    Temporal Trends in Transcatheter Aortic Valve Replacement in France

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