Patients with cardiac implantable electronic devices are usually excluded from MRI examinations due to contraindication for MRI. The MRI-conditional pacemaker system may allow the benefits of MRI (system 1.5T) to be more accessible to pacemaker patients. A 62-year-old man was admitted with acute coronary syndrome and atrial fibrillation. A conventional angiography showed normal coronaries. A cardiac cardioversion revealed a significant sinus node dysfunction and a magnetic resonance imaging (MRI) compatible dual chamber system was implanted. At 6-week follow-up, a cardiac MRI revealed a typical anterior myocardial infarction with diagnostic quality images despite pacemaker. This is one of the first reports of cardiovascular MRI in a patient with MRI-conditional pacing system. (C) 2013 Elsevier Masson SAS. All rights reserved.
Background and aim. - Pulse wave analysis is a pivotal instrument to estimate central hemodynamic parameters. Applanation tonometry on radial and/or carotid arteries is usually used to detect pressure waveforms. Available commercial devices have been validated against invasive catheterism, showing a good agreement of harmonics pattern. In a previous investigation, we observed differences on radial second systolic peak (rSPB2) between two commonly used devices: SphygmoCor (AtCor, Australia) and PulsePen (Diatecne, Italy.). The aim of our study was to further quantify differences on radial and carotid signals from the two devices.Methods. - We measured radial and carotid pressure waveforms in 38 patients where systolic, diastolic blood pressure and heart rate presented minimal changes between measurements. Waveforms were digitally extracted for off-line analysis.Results. - Radial rSBP2, mean arterial pressure, form factor and augmentation index were different with SphygmoCor providing lower values. Carotid augmentation index and form factor were similar. However, carotid systolic pressure (cSBP) from PulsePen was higher that cSBP from SphygmoCor (2.7 +/- 4.4 mmHg, P < 0.001).Conclusion. - PulsePen and SphygmoCor sensors are not equivalent and provide different wave shapes. These differences on wave shape have important consequences on parameters computed from these waveforms with more discrepancy on radial derived parameters such as rSBP2 and mean arterial pressure than on carotid derived parameters. Further studies are required to compare invasive pressure parameters to indices derived from these two devices. (C) 2013 Published by Elsevier Masson SAS.
Objective. - Recent studies have shown a link between prolonged television viewing and cardiovascular (CV) morbidity and mortality. We aimed to estimate the relationship between television viewing and CV risk behaviors and in the adult population of the French West Indies.Patients and methods. - We used data from Consant, a cross-sectional study carried out in 2007 on a representative sample of the adult Guadeloupean population (1005 subjects aged 25-74 years selected by stratified random sampling and interviewed at home by trained investigators working in pairs).Results. - Among respondents who reported watching television for 2 hours or more per day, 46.5% stated practicing no leisure time physical activity, compared with 35.6% among those who reported watching television for less than 2 hours per day. Adjusting for age, sex, education, income, family status, and perceived CV benefits of physical activity, the odds ratio of physical inactivity was estimated at 1.75 (P < 10(-3)) among subjects who reported watching television for 2 hours or more per day, compared with other subjects. A similar relationship was observed when considering dieting to prevent weight gain.Conclusion. - In this representative sample of a French Caribbean population, a strong and very significant relationship was observed between prolonged television viewing and CV risk behaviors. Prolonged television viewing seems common to a lifestyle that is characterized by little physical activity and unhealthy eating habits. This may play a role in social inequalities observed in CV diseases. (C) 2013 Elsevier Masson SAS. All rights reserved.
Aim of the study. - The aim was to see if 40% of caloric restriction can improve in rats, the oxidative stress induced by a high fat diet on liver, heart and aorta, and have a positive impact on the lipoproteins-cholesterol contents.Methods. - Male Wistar rats (n=12) consumed at weaning obesegenic diet. The obese rats were divided into two groups (n=6) each consumed for 4 weeks a normocaloric diet (1,60 MJ) or a calorie restricted diet (40% of energy of the standard diet [0.96 MJ]). A control group (n=6) was fed a standard diet during the experiment.Results. - Caloric restriction decreased cholesterol and low-density lipoproteins-cholesterol, whereas the high-density lipoproteins-cholesterol was elevated. Levels of cholesterol in the aorta and heart were lowered in the group that consumed caloric restriction compared to normocaloric diet. The values of thiobarbituric acid reactive substances and hydroperoxides were lowered in the aorta and the heart. The caloric restriction compared to normocaloric diet increased positively the superoxide dismutase., catalase, glutathione peroxidase and glutathione reductase activities in the heart and those of catalase and superoxide dismutase in aorta.Conclusion. - In obese rats, caloric restriction may play a role in the antioxidant defense of cardiovascular system by reducing proatherogenic cholesterol and lipid peroxidation and increasing the antioxidant activity of some enzymes, which was in favor of reduction of cardiometabolic risk associated with obesity. (C) 2013 Elsevier Masson SAS. All rights reserved.
Aim of the study. - To valorize fish by-products oil by investigating its effects on dyslipidemia, hyperglycemia, reverse cholesterol transport and paraoxonase-1 activity in obese rat.Methods. - Sixteen male Wistar rats were fed a high fat diet. At 400 +/- 10 g, obese rats were randomly divided into two groups: the first received 20% of sardine by-products oil and the second 20% of the edible portion oil. At d28, glycemia and serum lipids concentrations were estimated. High density lipoproteins (HDL2 and HDL3) were separated and their contents and composition in lipids and apolipoproteins were analyzed. Lecithin: cholesterol acyltransferase and paraoxonase-1 activities were assessed.Results. - In group which consumed sardine by-products oil, serum cholesterol and triacylglycerols were reduced (-8% and -36%, respectively). However, glycemia was similar. HDL3-phospholipids, HDL3-unesterified cholesterol and HDL3-apolipoproteins were decreased by 56%, 10% and 12%, respectively. Lecithin: cholesterol acyltransferase activity was increased by 35% and the content of HDL2-cholesteryl esters was elevated by 12%. Serum paraoxonase-1 activity was increased by 25%.Conclusion. - In obese rat, sardine by-products oil may have a protective effect against cardiovascular risk by improving the anti-atherogenic metabolic pathway of cholesterol and triacylglycerols. This anti-atherogenic action is particularly enhanced by the increase in paraoxonase-1 activity which protects lipoproteins from oxidation. (C) 2013 Elsevier Masson SAS. All rights reserved.
Objectives. - The authors have tried to assess the noise annoyance and its relation with the development of hypertension for the staff working at the civilian airport of Algiers. This population is constantly subject to aircraft noises. The noise, through creating stress, acts on the central nervous system and on the autonomic nervous system and is likely to cause hypertension by increasing peripheral resistance, total cholesterol, fatty acids, adrenaline, cortisol and blood glucose. A number of studies revealed that starting from 65 decibels, the noise causes hypertension for patients of more than 40 years following 5 years of exposure.Methods. - An analytical study was conducted in 2000, which made the comparison between two groups of men working at Air Algerie company. There were 91 officers belonging to air crew, whose number was estimated at that time at 547, and whose average age was 49 years, compared with 111 officers of the ground crew on a total of 1200 persons and whose average age was 56 years. All those officers have received work medical consultation. Patients with suspected hypertension were systematically oriented to cardiologist. Similarly, everyone has had a biological assessment, an ophthalmologic consultation and ENT consultation as well.Results. - Hypertension was found in 9.25% of the ground crew and in 16.63% of the air crew (P < 0.001). Hypertension is more common among air crew, subject to a more important noise nuisance, at a younger age and with less risk factors than the ground crew, who develops hypertension with similar prevalence to general population's but at a younger age. The air crew gives more importance to treatment due to the risk of losing their navigation license. The ENT examination was abnormal in 39% of the air crew versus 8% of the ground crew.Conclusion. - In the light of these results, the noise seems to really interfere in the development of hypertension in airport environment. It would be more interesting to identify the number of strokes and particularly acute coronary syndromes which are far from being rare in this population subject to this noise annoyance. Preventive measures are of course extremely important. (C) 2013 Elsevier Masson SAS. All rights reserved.
Aim. - The antihypertensive effect of renal denervation in hypertensive patients is partially explained by increased tubular natriuresis. To study the possible contribution of the kallikrein-kinin system (KKS) to this natriuretic effect in rats, we measured kallikrein activity (KA) and bradykinin concentrations (BK) in plasma and tissues.Methods. - To measure KA, we adapted and validated an enzymatic assay that cleaves para-nitroaniline (pNA) from the tripeptide H-D-Pro-Phe-Arg-pNA. The coefficients of variation (CV) within- and between-assays were less than 8% for plasma and tissue KA (plasma n=6 and 13; tissue n=4). Linear results for serially diluted samples confirmed the assay specificity. Tissue BK determinations were based on an established assay for plasma BK: tissue was homogenized and kinins extracted in ethanol, and BK was isolated by high-performance (HPLC) liquid chromatography and quantitated by radioimmunassay. Within- and between-assay CV for plasma BK were 18% (n = 8 and n=35, respectively) and for BK in various tissues less than 16% (n=5-8).Results. - In male Wistar rats (n=3), plasma BK was 8.2 +/- 6.6 fmol/naL (mean +/- SD), and tissue BK (fmol/g) in 14 tested organs varied between brain (14 +/- 3) and submaxillary gland (521 +/- 315). Six days after left-sided unilateral renal denervation, left renal tissue BK (89 +/- 9) was not different from right renal BK (75 +/- 23). Similarly, KA was comparable in the two kidneys (left 18.0 +/- 1.5, right 15.8 +/- 1.4 mu kat/g).Conclusion. - Any possible effect of unilateral renal denervation on the kidney's KKS would have to be bilateral. (C) 2013 Elsevier Masson SAS. All rights reserved.
Purpose. - Aortic stiffness is a functional and structural consequence of ageing and arteriosclerosis. Regional arterial stiffness can be easily evaluated using pOpmetre (R) (Axelife SAS, France). This new technique assesses the pulse wave transit time (TT) between the finger (TTf) and the toe (TTt). Based on height chart, regional pulse wave velocity (PWV) between the toe and the finger can be estimated (PWVtf). pOpscore (R) index is also calculated as the ratio between PWVtoe and PWVfinger and can be considered as a peripheral vascular stiffness index. The aim of the study was to evaluate the relationship between pOpmetre (R) indices and the presence of carotid plaques in a population with cardiovascular risk factors.Methods. - In 77 consecutive patients recruited for a vascular screening for atherosclerosis (46 men aged 54 +/- 2 years; 31 women aged 49 +/- 3 years; ns), the difference between Trt and TTf (called Dt-f), the regional pulse wave velocity between the toe and the finger (PWVtf = constant x height/Dt-f m/s) and pOpscore (R) were measured by pOpmetre (R). Presence of carotid plaques was assessed using ultrasound imaging. The local aortic stiffness (AoStiff) was evaluated by the Physioflow (R) system.Results. - No difference was found between patients with or without carotid plaques (n=25 versus 52) for Anlde-Brachial Pressure Index (ABPI: 1.15 +/- 0.04 versus 1.12 +/- 0.03), nor for diastolic or systolic blood pressure (87 +/- 3 versus 82 +/- 2; 137 +/- 3 versus 132 +/- 2 mmHg). The first group was older than the second (59 +/- 2 versus 49 +/- 2 years, P < 0.002) with a larger intimae media thickness (0.69 +/- 0.02 versus 0.63 +/- 0.01 mm, P < 0.004), a higher AoStiff (10.4 +/- 0.7 versus 8.2 +/- 0.5 m/s, P < 0.02), and PWVtf (14.3 +/- 1.0 versus 10.7 +/- 0.7 m/s, P < 0.004) and a shorter Dt-f (57.9 +/- 5.1 versus 73.5 +/- 3.5 ms, P < 0.01). PWVtf (r(2) = 0.49, P < 0.0001) and Dt-f (r(2) = 0.54, P < 0.0001) correlated with age. A significant difference in pOpscore (R) index was observed between both groups (1.51 +/- 0.3 versus 1.41 +/- 0.2, P < 0.006).Conclusion. - Our results show a significant arterial stiffness indices measured by pOpmetre (R) in patients with and without carotid plaques. (C) 2013 Elsevier Masson SAS. All rights reserved.
Aim of the study. - In the present work, the objective was to evaluate the influence of a dietary sodium restriction on cardiovascular morphology changes associated with insulin-resistance.Animals and protocol. - At 8 weeks of age, rats were fed for 12 weeks a 60%-fructose diet containing a regular sodium content (0.64%) or totally lacking in sodium chloride (<0.01%). A group of rats fed a wheat starch-based diet with regular sodium content served as control group.Results. - Elevated HOMA index and plasma insulin confirm the presence of insulin-resistance in fructose-fed rats. Concomitantly, an increase in cardiac mass and in cardiac collagen (Sirius red staining) was detected without obvious change in arterial pressure or cardiac aldosterone synthase mRNA expression. In addition, cross-sectional area of the carotid artery was higher in fructose-fed rats. Production of superoxide anion, equated with dihydroethidium (DBE) staining, was enhanced in cardiac tissue of rats with insulin-resistance. Withdrawal of sodium from the fructose diet prevented all the cardiovascular effects of fructose consumption, including DBE staining.Conclusion. - These results are in favor of the participation of oxidative stress normalization in the beneficial influence of dietary sodium deprivation on cardiovascular remodeling in this model of insulin-resistance in rats. (C) 2013 Elsevier Masson SAS. All rights reserved.
Introduction. - Abnormal albuminuria (>= 30 mg/g) and low estimated glomerular filtration rate (eGFR <60 mL/min/1.73m(2)) not only are renal risk factors, but also cardiovascular and coronarian risk factors. Though, the relation between coronary risk and renal risk, and its interaction with insufficiently controlled brachial pressure (BP) is poorly described in the literature.Subjects and methods. - We realised a cross-sectional study on subjects 40 and older, having attended a medical exam in 11 IRSA centers between 2006 and 2010. Every subject filled a questionnaire, underwent biological analysis, and a clinical examination. eGFR and albuminuria were measured, and the 10-year risk of coronarian event was calculated (Laurier's equation)Results. - We analysed 118 314 subjects, amongst whom 96 400 had no personal cardiovascular history. Amongst those, 9.1% had a 10-year coronary risk over 10%. There was a continuous relationship between coronary risk and renal risk: subjects with a risk above 15% had a significative risk of pathological albuminuria (OR: 6.87 [5.58-8.44]), and of low eGFR (2.26 [1.82-2.78]) compared to those with a risk under 5%. There was a continuous relationship between BP and renal risk, with a significative risk of pathological albuminuria (OR = 7.75 [6.69-8.96]) and of low eGFR (OR: 1.33 [1.09-1.60]) in subjects with BP greater than or equal to 180/110 mmHg, compared to those with normal BRConclusion. - In the French population, 9.1% of subjects have a 10-year coronary risk above 10%. This risk is associated to abnormalities of the renal function. The relation between coronary risk and renal risk is continuous and dose-dependent, as is the relation between BP and renal risk. (C) 2013 Elsevier Masson SAS. All rights reserved.
Objective. - Determination of clinical and angiographic characteristics of myocardial infarctions related to sport.Methods. - Retrospective study of acute coronary syndromes with ST elevation related to sport treated with interventional cardiology from 2006 to 2013.Results. - Sixteen patients were included. They are mostly men (15/16), aged 24-65 years (over 35 years old in 13 cases) with few cardiovascular risk factors, most frequently heredity or smoking. Myocardial infarctions usually occur during the practice of sports (13/16), with serious rhythmic complications in three of the cases. On angiography, most patients have single vessel disease (12/16).Conclusion. - Myocardial infarction related to sports affects a male population aged over 35 years old with few cardiovascular risk factors, most often single vessel disease, making the preventative screening uneasy. Other studies investigating larger populations, assessing previous clinical events (symptoms, results of stress tests), evaluating the impact of competition and integrating sudden deaths would improve the screening and the treatment of sport-related myocardial infarctions. (C) 2013 Elsevier Masson SAS. All rights reserved.
The field of cardiovascular MRI has evolved rapidly over the past decade, feeding new applications across a broad spectrum of clinical and research areas. Advances in magnet hardware technology, and key developments such as segmented k-space acquisitions, advanced motion encoding techniques, ultra-rapid perfusion imaging and delayed myocardial enhancement imaging have all contributed to a revolution in how patients with ischernic and non-ischemic heart disease are diagnosed and treated. Actually, cardiac MRI is a widely accepted method as the "gold standard" for detection and characterization of many forms of cardiac diseases. The aim of this review is to present an overview of cardiac MRI technology, advances in clinical applications, and future directions. (C) 2013 Elsevier Masson SAS. All rights reserved.
Arterial hypertension is the largest single contributor to global mortality, and is poorly controlled in approximately 50% of patients despite lifestyle and pharmacologic interventions. Randomized clinical trials have demonstrated that catheter-based renal sympathetic denervation reduces blood pressure (BP) in patients with resistant hypertension. We sought to evaluate the efficacy of this novel therapy in "Real World" clinical practice. Consecutive patients with treatment-resistant primary hypertension, as defined as home BP > 160 mmHg despite treatment with >= 3 antihypertensive drugs, were selected for denervation following renal artery screening. Ambulatory and home BP monitoring was performed in all patients prior to and following percutaneous renal sympathetic denervation. In total, 35 patients were selected for catheter-based renal sympathetic denervation. The mean age was 63.6 +/- 11.7 years, 37.1% were women, 37.1% were diabetic, and 11.4% had renal impairment (GFR <45 mL/min). The basal BP (home or ambulatory) was 179.1 +/- 20.75/99.66 +/- 19.76 mmHg, despite an average of 4.91 +/- 0.98 medications per patient. Successful bilateral sympathetic denervation was performed in 33/35 patients (1 renal artery stenosis on angiography [not ablated], 1 patient with renal artery spasm [unilateral denervation]), with an average 5.9 +/- 1.6 ablations per renal artery. No procedural complications occurred. At 6 months, blood pressure was 15.5 +/- 22.37/87.76 +/- 13.97 mmHg (P < 0.01). At 2 years follow-up, systolic blood pressure (ABPM or Home BP) was 143.8 +/- 15.30 mmHg (P < 0.0001) and diastolic 83.42 +/- 12.80 mmHg (P=0.0004). There were no adverse events during follow-up, and no deterioration in renal function was observed. Catheter-based renal denervation is safe and efficacious treatment, which results in significant reductions in blood pressure in patients with treatment-resistant hypertension, stable at 2 years follow-up. These results are applicable to real-world patient populations. (C) 2013 Elsevier Masson SAS. All rights reserved.
The European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) have recently updated guidelines for management of ST-elevation myocardial infarction (STEMI). The aim of this study is to compare the both recommendations. (C) 2013 Elsevier Masson SAS. All rights reserved.
Among the wide spectrum of congenital abnormalities of coronary arteries, a single coronary artery is often confused with an ectopic coronary artery connected with the contralateral coronary artery. Both abnormalities are characterized by a single coronary ostium, but they differ by the lack or not of an initial ectopic course. The prognosis of anomalous connections of coronary arteries depends mainly on the type of the initial course in relation to other cardiac structures. Therefore, the distinction between a single coronary artery and an ectopic coronary artery connected with the contralateral artery is of importance.
Coronary anomalies are a rare entity. The gold standard remains the coronary angiogram. However, the identification of the origin and the course of aberrant coronary arteries using angiography may be difficult. We report two cases regarding two patients who underwent coronary angiography in order to evaluate coronary heart disease. In the first case, angiography has shown a left anterior descending artery (LAD) originating from the right anterior sinus. A multidetector CT scan (MDCT) showed an inter-aortopulmonary course of the LAD. In the second case, selective catheterization of the right coronary artery could not be done. A MDCT scan was performed. An abnormal origin of the right coronary artery was detected. It originates from the left sinus with a separate ostium of the left main coronary artery. This artery had an inter-aortopulmonary course. The 64 MDCT scan can be useful as a complementary tool for the diagnosis of coronary artery anomalies. Detection of the inter-aortopulmonary course is essential, since this situation will require surgical treatment to avoid sudden cardiac death. (C) 2012 Elsevier Masson SAS. All rights reserved.
Preeclampsia is a pregnancy disorder being a leading cause of maternal and fetal mortality and morbidity. It is a complex multisystem disease characterized by hypertension and proteinuria. In preeclampsia the placenta releases factors into the maternal circulation which cause a systemic endothelial dysfunction. Here, we review data demonstrating the central role played by the endothelium in the development of the maternal syndrome of preeclampsia We present also original data showing how circulating factors present in the plasma of preeclamptic women can alter the transcriptome of endothelial cells. The expression of genes involved in essential functions such as vasoregulation, oxidative stress, apoptosis and cell proliferation show differential expression when endothelial cells are exposed to preeclamptic or normal pregnancy plasma. We conclude by discussing the growing evidences that the alterations of the endothelium during preeclampsia are linked to an increased risk of cardiovascular diseases latter on life. Therefore, a better understanding of the modifications undergone by the endothelial cells during preeclampsia is essential to develop new therapeutic approaches to both, manage preeclampsia and to prevent the long-term sequelae of the disease on women cardiovascular system. (C) 2013 Elsevier Masson SAS. All rights reserved.
Introduction. - Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization.Methods. - To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4 years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain = diRect chain (Call the emergency number specialist mobile emergency unit Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain = Long chain.Results. - On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26 hours (+/-3.12), 6.17 hours (+/-4.82) in the Long chain group. There is a significant difference between the two groups of 1.9 hours (P <0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit.Conclusion. - These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion. (C) 2013 Elsevier Masson SAS. All rights reserved.
