Acute Pulmonary Embolism Decreases Adenosine Plasma Levels in Anesthetized Pigs

Adenosine plays a role in pulmonary arterial (PA) resistance due to its vasodilator properties. However, the behavior of adenosine plasma levels (APLs) during pulmonary embolism remains unknown. We investigated the effects of gradual pulmonary embolism on right ventricular (RV) contractility and PA coupling and on APLs in an piglet experimental model of RV failure. PA distal resistance by pressure-flow relationships and pulmonary vascular impedance were measured. RV contractility was determined by the end-systolic pressure-volume relationship (Ees), PA effective elastance by the end-diastolic to end-systolic relationship (Ea), and RV-PA coupling efficiency by the Ees/Ea ratio. APLs were measured before and during gradual pulmonary embolization. PA embolism increased PA resistance and elastance, increased Ea from 1.08 ± 0.15 to 5.62 ± 0.32 mmHg/mL, decreased Ees from 1.82 ± 0.10 to 1.20 ± 0.23 mmHg/mL, and decreased Ees/Ea from 1.69 ± 0.15 to 0.21 ± 0.07. APLs decreased from 2.7 ± 0.26 to 1.3 ± 0.12 μM in the systemic bed and from 4.03 ± 0.63 to 2.51 ± 0.58 μM in the pulmonary bed during embolism procedure. Pulmonary embolism worsens PA hemodynamics and RV-PA coupling. APLs were reduced, both in the systemic and in the pulmonary bed, leading then to pulmonary vasoconstriction

Bilan global des maladies chroniques (enquête d'évaluation de la pratique des médecins généralistes du Languedoc-Roussillon)

Les maladies chroniques sont des affections de longue durée. Responsables de 63% des décès, elles sont la première cause de mortalité dans le monde et de perte des années de vie en bonne santé dans la population adulte normalement active. Plusieurs maladies chroniques coexistent fréquemment chez un même patient alors que les recommandations ne sont généralement pas adaptées aux situations polypathologiques Le CHRU de Montpellier et le département de médecine générale mettent en place un travail visant à valider un bilan global des co-morbidités chez les patients présentant une maladie chronique. Un questionnaire, évaluant la prise en charge des maladies chroniques et l'intérêt de la mise en place d'un bilan global, a été adressé à 1221 médecins généralistes libéraux du Languedoc-Roussillon. Cette thèse montre que les médecins interrogés ne suivent pas totalement, les recommandations émises par l'HAS concernant le suivi de trois pathologies index cardiopathie ischémique, BPCO et diabète de type 2. On peut penser que cette absence d'observance vient de recommandations trop larges, ne tenant pas compte des diversités cliniques. Les prises en charges sont donc individualisées. On relève un avis favorable sur l'impact de la mise en place d'un bilan global des maladies chroniques et sur le choix des examens proposés. De plus des critères de sélection déterminant la population cible de ce bilan sont évoqués. Cette attitude favorable semble essentielle et de bonne augure pour la suite du développement de ce bilan, lequel permettra de mieux cibler les besoins réelsMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Étude des caractéristiques des patients diabétiques de type 2 en échec secondaire des antidiabétiques oraux, selon leur réponse glycémique à l'éxénatide

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Shifting from a Rheumatologic Point of View toward Patient-centered Care in Rheumatoid Arthritis with an Integrated Management of Comorbidities

International audienc

Evaluation des déterminants des atteintes d'organes cibles dans la maladie vasculaire hypertensive

L'objectif principal de cette thèse est de préciser les déterminants des atteintes précliniques d'organes cibles dans l'hypertension artérielle sur une cohorte de près de 1500 individus normotendus et hypertendus, n'ayant jamais reçu de traitement antihypertenseur. L'hémodynamique rénale a été évaluée par mesure du débit de filtration gloméculaire (DFG) et du flux plasmatique rénal (FPR) par clairance isotopique. La morphologie et la fonction du ventricule gauche (VG) ont été étudiées par échocardiographie. Une première analyse transversale a permis de montrer le caractère étroitement lié des lésions cardiaques et rénales : les sujets hypertendus avec une hypertrophie ou un remodelage concentrique du VG avaient une décroissance plus rapide du DFG avec l'âge. Chez les normotendus, il a été observé une relation directe entre le niveau de la pression artérielle (PA) et le DFG ainsi que la masse VG. Le suivi longitudinal d'une partie de la cohorte a confirmé le rôle prépondérant de la PA sur la progression de l'hypertrophie VG et la décroissance de la fonction rénale. L'analyse des différentes composantes de la PA a montré que la pression pulsée était le déterminant le plus puissant de la baisse du DFG et du FPR chez les sujets hypertendus en cours de traitement. L'évaluation de la fonction des gros troncs artériels dans un sous-groupe de sujets normotendus a suggéré, en analyse trransversale, que la réflexion d'onde pouvait moduler la pression intra-glomulaire, comme en témoigne son influence sur la fraction de filtration et l'albuminurie. Un suivi de la cohorte sur un plus long terme devrait permettre de confirmer cette interaction entre microcirculation rénale et macrocirculationThe main objective in this work is to identify the determinants of preclinical target organ damages in hypertension in a cohort of 1500 nevertreated normotensive and hypertensive subjects. Renal hemodynamic was evaluated by measurement of glomerular filtration rate (GFR) and renal plasma flow (RPF) using isotopic techniques. Left ventricle (LV) morphology and function were studied by echocardiography. In a cross-sectional analysis, it was found that the age associated decline in GFR was steeper in hypertensive subjects with LV concentric hypertrophy or remodeling, showing the link between cardiac and renal damages. In normotensives, blood pressure (BP), despite its low range, was directly related with GFR and LV mass. The follow-up of a group of untreated subjects confirmed that BP was the main determinant for LV mass progression and decline in renal function. When considering the different components of BP, it was shown that pulse pressure was the most powerful correlate of decline in GFR and RPF in hypertensive subjects during treatment. Study of large arterial function in normotensive subjects suggested in a cross-sectional analysis that wave reflection but not arterial stiffness could modulate intraglomerular pressure as reflection magnitude was directly related to filtration fraction and albuminuria. Long-term follow-up is necessary is order to confirm this interaction between the renal microcirculation and the macrocirculationMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Non invasive evaluation of end systolic left ventricular elastance according to pressure-volume curve modeling during ejection in arterial hypertension

International audienceObjective: End systolic left ventricular (LV) elastance (Ees) has been previouslycalculated and validated invasively using LV pressure-volume (P-V) loop. Noninvasive studies have been proposed, but clinical application remains complex.The aim of the present study was to 1) estimate Ees according to modeling ofLV P-V curve during ejection (“Ejection PV Curve’’ method) and validate ourmethod with existing published LV P-V loop data; 2) test clinical applicability todetect non invasively a difference in Ees between normotensive and hypertensivesubjects.Design and method: Based on P-V curve and a linear relationship between LV elastanceand time during ejection, we used a non linear least square method to fi t the systolicpressure curve. We then computed slope and intercept of time varying elastance,and calculated Ees as LV elastance at the end of ejection. As a validation, 22 P-V loopsobtained from previous invasive studies were digitized and analyzed with our method.To test clinical applicability, P-V curve was obtained from 33 hypertensive and 32normotensive subjects, using carotid tonometry and real time 3D echocardiography.Results: A good univariate relationship (r2 = 0.92, p < 0.005) and a good limit ofagreement were found between previous invasive calculation of Ees and our newproposed “Ejection P-V Curve’’ method. In addition, the clinical reproductibilityof our method was similar to that of another non invasive method proposed byChen et al. In hypertensive patients, the increase in arterial elastance (Ea) wascompensated by an increase in Ees without change in Ea/Ees (see Figure).Conclusions: Ees can be estimated non invasively from modeling of P-V curve duringejection. This approach was found to be reproducible and sensitive enough to detect anexpected difference in LV contractility in hypertensive patients. Due to its non invasivenature, this methodology may have clinical implications in various disease states

Non invasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension

International audienceEnd-systolic left ventricular (LV) elastance (Ees) has been previously calculated and validated invasively using LV pressure-volume (P-V) loops. Noninvasive methods have been proposed, but clinical application remains complex. The aims of the present study were to 1) estimate Ees according to modeling of the LV P-V curve during ejection (“ejection P-V curve” method) and validate our method with existing published LV P-V loop data and 2) test the clinical applicability of noninvasively detecting a difference in Ees between normotensive and hypertensive subjects. On the basis of the ejection P-V curve and a linear relationship between elastance and time during ejection, we used a nonlinear least-squares method to fit the pressure waveform. We then computed the slope and intercept of time-varying elastance as well as the volume intercept (V0). As a validation, 22 P-V loops obtained from previous invasive studies were digitized and analyzed using the ejection P-V curve method. To test clinical applicability, ejection P-V curves were obtained from 33 hypertensive subjects and 32 normotensive subjects with carotid tonometry and real-time three-dimensional echocardiography during the same procedure. A good univariate relationship (r2 = 0.92, P < 0.005) and good limits of agreement were found between the invasive calculation of Ees and our new proposed ejection P-V curve method. In hypertensive patients, an increase in arterial elastance (Ea) was compensated by a parallel increase in Ees without change in Ea/Ees. In addition, the clinical reproducibility of our method was similar to that of another noninvasive method. In conclusion, Ees and V0 can be estimated noninvasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected increase in LV contractility in hypertensive patients. Because of its noninvasive nature, this methodology may have clinical implications in various disease states

Pulmonary vascular effects of dobutamine in experimental pulmonary hypertension

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Effects of sildenafil on hypoxic pulmonary vascular function in dogs

SCOPUS: ar.jinfo:eu-repo/semantics/publishe