Laurent Argaud

Hospices Civils de Lyon, Lyons, Rhône-Alpes, France

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Publications (79)265.59 Total impact

  • Réanimation 12/2014;
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    ABSTRACT: Opening of the mitochondrial permeability transition pore (mPTP) appears to be a pivotal event in myocardial ischemia-reperfusion (I/R) injury. Resuscitated cardiac arrest (CA) leads to the post-CA syndrome that encompasses, not only myocardial dysfunction, but also brain injury, failure of other organs (kidney, liver or lung), and systemic response to I/R. We aimed to determine whether cyclosporine A (CsA) might prevent multiple organ failure following CA through a ubiquitous mPTP inhibition in each distant vital organ. Anesthetized NZW rabbits were subjected to 15 minutes of CA and 120 minutes of reperfusion. At the onset of resuscitation the rabbits received CsA, its non-immunosuppressive derivative NIM811, or vehicle (controls). Survival, hemodynamics, brain damage, organ injuries and systemic I/R response were analyzed. Fresh mitochondria were isolated from the brain, heart, kidney, liver and lung to assess both oxidative phosphorylation and permeability transition. CsA-analogs significantly improved short-term survival and prevented multiple organ failure, including brain damage and myocardial dysfunction (p<0.05 vs controls). Susceptibility of mPTP opening was significantly increased in heart, brain, kidney, and liver mitochondria isolated from controls, while mitochondrial respiration was impaired (p<0.05 vs Sham). CsA-analogs prevented these mitochondrial dysfunctions (p<0.05 vs controls). These results suggest that CsA and NIM811 can prevent the post-CA syndrome through a ubiquitous mitochondrial protective effect at the level of each major distant organ.
    Journal of applied physiology (Bethesda, Md. : 1985). 09/2014;
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    ABSTRACT: Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays >24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.RESULTS: This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P<0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P<0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P<0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P<0.001).CONCLUSIONS: ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.
    Clinical journal of the American Society of Nephrology : CJASN. 05/2014;
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    ABSTRACT: Increasing evidence suggests that dysnatraemia at ICU admission may predict mortality. Little information is available, however, on the potential effect of dysnatraemia correction.Patients and Methods Observational multicentre cohort study in patients admitted between 2005 and 2012 to 18 French ICUs. Hyponatraemia and hypernatraemia were defined as serum sodium concentration < 135 and > 145 mmoL/L, respectively. We assessed the influence on day-28 mortality of dysnatraemia correction by day 3 and of the dysnatraemia correction rate. Of 7067 included patients, 1830 (25.9%) had hyponatraemia and 634 (9.0%) hypernatraemia at ICU admission (day 1). By day 3, hyponatraemia had been corrected in 1019 (1019/1830, 55.7%) and hypernatraemia in 393 (393/634, 62.0%) patients. After adjustment for confounders, persistent hyponatraemia or hypernatraemia on day 3 was independently associated with higher day-28 mortality (odds ratio [OR], 1.31; 95% confidence interval [95%CI], 1.06-1.61; and OR, 1.86; 95%CI, 1.37-2.54; respectively). Hyponatraemia corrected by day 3, hypernatraemia corrected by day 3, and ICU-acquired hyponatraemia were not associated with day-28 mortality. Median correction rate from days 1 to 3 was 2.58 mmoL/L per day (IQR, 0.67-4.55). Higher natraemia correction rate was associated with lower crude and adjusted day-28 mortality rates (OR per mmoL/L per day, 0.97; 95%CI, 0.94-1.00; p = 0.04; and OR per mmoL/L per day, 0.93; 95%CI, 0.90-0.97; p = 0.0003, respectively). Our results indicate that dysnatraemia correction is independently associated with survival, with the effect being greater with faster correction rates of up to 12 mmoL/L/day.
    Shock (Augusta, Ga.) 03/2014; · 2.87 Impact Factor
  • Revue des maladies respiratoires. 01/2014; 31(8):779-95.
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    ABSTRACT: The influenza H1N1 epidemics in 2009 led a substantial number of people to develop severe acute respiratory distress syndrome and refractory hypoxemia. In these patients, extracorporeal membrane oxygenation was used as rescue oxygenation therapy. Several randomized clinical trials and observational studies suggested that extracorporeal membrane oxygenation associated with protective mechanical ventilation could improve outcome, but its efficacy remains uncertain. Organized by the Société de Réanimation de Langue Française (SRLF) in conjunction with the Société Française d'Anesthésie et de Réanimation (SFAR), the Société de Pneumologie de Langue Française (SPLF), the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP), the Société Française de Perfusion (SOFRAPERF), the Société Française de Chirurgie Thoracique et Cardiovasculaire (SFCTV) et the Sociedad Española de Medecina Intensiva Critica y Unidades Coronarias (SEMICYUC), a Consensus Conference was held in December 2013 and a jury of 13 members wrote 65 recommendations to answer the five following questions regarding the place of extracorporeal life support for patients with acute respiratory distress syndrome: 1) What are the available techniques?; 2) Which patients could benefit from extracorporeal life support?; 3) How to perform extracorporeal life support?; 4) How and when to stop extracorporeal life support?; 5) Which organization should be recommended? To write the recommendations, evidence-based medicine (GRADE method), expert panel opinions, and shared decisions taken by all the thirteen members of the jury of the Consensus Conference were taken into account.
    Annals of intensive care. 01/2014; 4:15.
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    ABSTRACT: Pneumothorax is a frequent cause of admission in an emergency department. It can be due to a leakage of air from an air-filled lung cavitation into the pleural space. We report the unusual case of pneumothorax in a patient with a pulmonary cavitary infectious process mimicking tuberculosis. A 30-year-old asthmatic man, treated for several years with low-dose inhaled corticosteroids, presented a complete left tension pneumothorax and chronic necrotising pulmonary aspergillosis that mimicked initial pulmonary tuberculosis. Antifungal treatment by voriconazole was started and continued for 1 year, with a favourable outcome. This case highlights that chronic necrotising pulmonary aspergillosis is a diagnosis that should be considered in patients with a clinical presentation of pulmonary tuberculosis or in patients experiencing pneumothorax, especially in the context of corticosteroid treatment.
    BMJ case reports. 01/2014; 2014.
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    ABSTRACT: To describe and analyse factors associated with Clostridium difficile infection (CDI) severity in hospitalised medical intensive care unit patients. We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit (MICU) at a French university hospital. We include patients hospitalised between January 1, 2007 and December 31, 2011. Data on demographics characteristics, past medical history, CDI description was collected. Exposure to risk factors associated with CDI within 8 wk before CDI was recorded, including previous hospitalisation, nursing home residency, antibiotics, antisecretory drugs, and surgical procedures. All included cases had their first episode of CDI. The mean incidence rate was 12.94 cases/1000 admitted patients, and 14.93, 8.52, 13.24, 19.70, and 8.31 respectively per 1000 admitted patients annually from 2007 to 2011. Median age was 62.9 [interquartile range (IQR) 55.4-72.40] years, and 13 (32.5%) were women. Median length of MICU stay was 14.0 d (IQR 5.0-22.8). In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. The duration of diarrhoea was 13.0 (8.0-19.5) d. In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. Prior to CDI, 38 patients (95.0%) were exposed to antibiotics, and 12 (30%) received at least 4 antibiotics. Fluoroquinolones, 3(rd) generation cephalosporins, coamoxiclav and tazocillin were prescribed most frequently (65%, 55%, 40% and 37.5%, respectively). The majority of cases were hospital-acquired (n = 36, 90%), with 5 cases (13.9%) being MICU-acquired. Fifteen patients had severe CDI. The crude mortality rate within 30 d after diagnosis was 40% (n = 16), with 9 deaths (9 over 16; 56.3%) related to CDI. Of our 40 patients, 15 (37.5%) had severe CDI. Multivariate logistic regression showed that male gender [odds ratio (OR): 8.45; 95%CI: 1.06-67.16, P = 0.044], rising serum C-reactive protein levels (OR = 1.11; 95%CI: 1.02-1.21, P = 0.021), and previous exposure to fluoroquinolones (OR = 9.29; 95%CI: 1.16-74.284, P = 0.036) were independently associated with severe CDI. We report predictors of severe CDI not dependent on time of assessment. Such factors could help in the development of a quantitative score in ICU's patients.
    World Journal of Gastroenterology 11/2013; 19(44):8034-41. · 2.55 Impact Factor
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    ABSTRACT: The Berlin definition for acute respiratory distress syndrome (ARDS) is a new proposal for changing the American-European consensus definition but has not been assessed prospectively as yet. In the present study, we aimed to determine (1) the prevalence and incidence of ARDS with both definitions, and (2) the initial characteristics of patients with ARDS and 28-day mortality with the Berlin definition. We performed a 6-month prospective observational study in the ten adult ICUs affiliated to the Public University Hospital in Lyon, France, from March to September 2012. Patients under invasive or noninvasive mechanical ventilation, with PaO2/FiO2 <300 mmHg regardless of the positive end-expiratory pressure (PEEP) level, and acute onset of new or increased bilateral infiltrates or opacities on chest X-ray were screened from ICU admission up to discharge. Patients with cardiogenic pulmonary edema were excluded. Patients were further classified into specific categories by using the American-European Consensus Conference and the Berlin definition criteria. The complete data set was measured at the time of inclusion. Patient outcome was measured at day 28 after inclusion. During the study period 3,504 patients were admitted and 278 fulfilled the American-European Consensus Conference criteria. Among them, 18 (6.5 %) did not comply with the Berlin criterion PEEP ≥ 5 cmH2O and 20 (7.2 %) had PaO2/FiO2 ratio ≤200 while on noninvasive ventilation. By using the Berlin definition in the remaining 240 patients (n = 42 mild, n = 123 moderate, n = 75 severe), the overall prevalence was 6.85 % and it was 1.20, 3.51, and 2.14 % for mild, moderate, and severe ARDS, respectively (P > 0.05 between the three groups). The incidence of ARDS amounted to 32 per 100,000 population per year, with values for mild, moderate, and severe ARDS of 5.6, 16.3, and 10 per 100,000 population per year, respectively (P < 0.05 between the three groups). The 28-day mortality was 35.0 %. It amounted to 30.9 % in mild, 27.9 % in moderate, and 49.3 % in severe categories (P < 0.01 between mild or moderate and severe, P = 0.70 between mild and moderate). In the Cox proportional hazard regression analysis ARDS stage was not significantly associated with patient death at day 28. The present study did not validate the Berlin definition of ARDS. Neither the stratification by severity nor the PaO2/FiO2 at study entry was independently associated with mortality.
    European Journal of Intensive Care Medicine 10/2013; · 5.17 Impact Factor
  • European Journal of Intensive Care Medicine 10/2013; · 5.17 Impact Factor
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    ABSTRACT: We examined the effects on infarct size and mitochondrial function of ischemic (Isch), cyclosporine A (CsA) and isoflurane (Iso) preconditioning and postconditioning in the in vivo rat model. Anesthetized open-chest rats underwent 30 min of ischemia followed by either 120 min (protocol 1: infarct size assessment) or 15 min of reperfusion (protocol 2: assessment of mitochondrial function). All treatments administered before the 30-min ischemia (Pre-Isch, Pre-CsA, Pre-Iso) significantly reduced infarct as compared to control. In contrast, only Post-Iso significantly reduced infarct size, while Post-Isch and Post-CsA had no significant protective effect. As for the postconditioning-like interventions, the mitochondrial calcium retention capacity significantly increased only in the Post-Iso group (+58 % vs control) after succinate activation. Only Post-Iso increased state 3 (+177 and +62 %, for G/M and succinate, respectively) when compared to control. Also, Post-Iso reduced the hydrogen peroxide (H2O2) production (-46 % vs control) after complex I activation. This study suggests that isoflurane, but not cyclosporine A, can prevent lethal reperfusion injury in this in vivo rat model. This might be related to the need for a combined effect on cyclophilin D and complex I during the first minutes of reperfusion.
    Archiv für Kreislaufforschung 09/2013; 108(5):379. · 7.35 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 06/2013; · 3.41 Impact Factor
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    ABSTRACT: BACKGROUND: /st>Manual changeover of vasoactive drug infusion pumps (CVIP) frequently lead to haemodynamic instability. Some of the newest smart pumps allow automated CVIP. The aim of this study was to compare automated CVIP with manual 'Quick Change' relays. METHODS: /st>We performed a prospective, quasi-experimental study, in a university-affiliated intensive care unit (ICU). All adult patients receiving continuous i.v. infusion of vasoactive drugs were included. CVIP were successively performed manually (Phase 1) and automatically (Phase 2) during two 6-month periods. The primary endpoint was the frequency of haemodynamic incidents related to the relays, which were defined as variations of mean arterial pressure >15 mm Hg or heart rate >15 bpm. The secondary endpoints were the nursing time dedicated to relays and the number of interruptions in care because of CVIP. A multivariate mixed effects logistic regression was fitted for analytic analysis. RESULTS: /st>We studied 1329 relays (Phase 1: 681, Phase 2: 648) from 133 patients (Phase 1: 63, Phase 2: 70). Incidents related to CVIP decreased from 137 (20%) in Phase 1 to 73 (11%) in Phase 2 (P<0.001). Automated relays were independently associated with a 49% risk reduction of CVIP-induced incidents (adjusted OR=0.51, 95% confidence interval 0.34-0.77, P=0.001). Time dedicated to the relays and the number of interruptions in care to manage CVIP were also significantly reduced with automated relays vs manual relays (P=0.001). CONCLUSIONS: /st>These results demonstrate the benefits of automated CVIP using smart pumps in limiting the frequency of haemodynamic incidents related to relays and in reducing the nursing workload.
    BJA British Journal of Anaesthesia 06/2013; · 4.24 Impact Factor
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    ABSTRACT: We report an immunocompetent patient who had fatal encephalopathy after mild influenza. He rapidly died after unusual symptoms related to intracerebral thrombosis and hemorrhage. A brain biopsy specimen was positive for influenza A(H1N1)pdm09 virus RNA, but a lung biopsy specimen and cerebrospinal spinal fluid samples were negative.
    Emerging Infectious Diseases 06/2013; 19(6):1005-7. · 6.79 Impact Factor
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    ABSTRACT: INTRODUCTION: Acute exacerbations of chronic obstructive pulmonary disease (COPD) patients are major events in the history of this chronic respiratory disease. Their management in French emergency services is unknown, although national guidelines exist. METHODS: This is a descriptive audit study, over a 10 weeks period (12/01-22/03/2009), of the management of COPD exacerbations in the RESUVal (Réseau des Urgences de la Vallée du Rhône, France) network emergency departments. RESULTS: The enrollement of 16 emergency units allowed the analysis of 221 exacerbations of COPD. Measurement of respiratory rate and description of the sputum were mentioned in only 99 (45%) medical records. The rest of the initial assessment was generally satisfactory. Regarding the therapeutic management, 215 (97%) patients received oxygen, beta-2-agonist aerosols were administrated for 209 (95%) patients and anticholinergic aerosols were used for 176 (80%) patients. A systemic corticosteroid and antibiotics were respectively prescribed for 116 (52%) and 123 (56%) patients. Non-invasive ventilation (NIV) was used in only 59% of patients presenting a pH<7.35. CONCLUSIONS: These findings demonstrate that management of exacerbations of COPD could be improved through systematic patients' respiratory rate and sputum characteristics recording or NIV utilization reinforcement.
    Revue de Pneumologie Clinique 04/2013; · 0.20 Impact Factor
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    ABSTRACT: OBJECTIVE: The authors had for objective to describe patients with confirmed influenza A(H1N1)pdm09 admitted to an intensive care unit (ICU) in a university hospital and to identify risk factors correlated with the severity of the disease. DESIGN: A prospective study was conducted in an university hospital during the A(H1N1)pdm09 influenza pandemic. Severe laboratory confirmed cases (admitted to an ICU) were described and compared with non-severe confirmed cases (not admitted to an ICU). RESULTS: Sixty-nine patients were included; 36 (52%) were 15 to 44 years of age. Sixteen (23%) cases were defined as severe, ten of these (63%) concerned patients 45 to 64 years of age. The independent factors associated with severity were: a history of heart disease, obesity, and tobacco abuse. CONCLUSIONS: This work reinforces the need to identify and protect groups at risk of severe outcomes.
    Médecine et Maladies Infectieuses 02/2013; · 0.75 Impact Factor
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    ABSTRACT: AIM: Regular increasing of health-care expense brought about the development of medical implication in prescription control and the will to give more responsibility to prescribers. Emergency departments account for a large part of hospital expenses. This study was carried out to evaluate cost awareness among French emergency physicians. METHODS: A questionnaire was sent to 160 physicians (junior and senior grade) working at the emergency department of 12 hospitals in the Lyon region (France). Every participant had to estimate the true hospital costs of a selection of drugs, blood products, laboratory tests and imaging modalities. RESULTS: One hundred and seven questionnaires (68%) were returned and analysed: 48 filled in by juniors (45%), 59 by seniors (55%). Only 26 physicians accurately estimated costs within 50% of the true cost. Response errors were underestimations averaging 4695±226euros, i.e. -59±3% of the total sum (7899euros). Drug prescriptions were significantly (P<0.001) the most underestimated (-74±3%), when compared to both imaging modalities (-23±5%) or blood products prescriptions (-37±6%). High-cost drugs (>1000euros) were the most overestimated pharmaceuticals (-82±2%). Laboratory tests were rather overestimated (+12±8%). Junior grade physicians underestimated more costs than senior physicians (P=0.04). DISCUSSION: Physicians had a poor understanding of prescription costs at the emergencies, especially regarding high-cost drugs. Much progress is required to integrate the cost-containment problem in daily prescriptions at the emergency department.
    La Presse Médicale 02/2013; · 0.87 Impact Factor
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    ABSTRACT: Author contributions: Khanafer N contributed to the concep-tion, data acquisition, analysis and interpretation, drafting of manuscript and final approval; Touré A actively participated in the conception, data acquisition, analysis and interpretation, revising and final approval of the manuscript; Chambrier C, Ar-gaud L and Cour M partook in the interpretation, revising and final approval of the manuscript; Reverdy ME performed the microbiological tests; Vanhems P was involved in the conception, interpretation, revising and final approval of the manuscript. Abstract AIM: To describe and analyse factors associated with
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    ABSTRACT: INTRODUCTION: The preventive impact of hospital-acquired infection (HAI) surveillance is difficult to assess. Our objective was to investigate the effect of HAI surveillance disruption on ventilator-associated pneumonia (VAP) incidence. METHODS: A quasi-experimental study with intervention group and control group was conducted between 1st January 2004 and 31st December 2010 in two intensive care units (ICUs) of a university hospital that participated in a national HAI surveillance network. Surveillance was interrupted during the year 2007 in unit A (intervention group) and was continuous in unit B (control group). Period 1 (pre-test period) comprised patients hospitalized during 2004-2006, and period 2 (post-test period) involved patients hospitalized during 2008-2010. Patients hospitalized [greater than or equal to]48 hours and intubated during their stay were included. Multivariate Poisson regression was fitted to ascertain the influence of surveillance disruption. RESULTS: 2,771 patients, accounting for 19,848 intubation-days at risk, were studied in total; 307 had VAP. The VAP attack rate increased in unit A from 7.8% during period 1 to 17.1% during period 2 (P<0.001); in unit B, it was 7.2% and 11.2% for the 2 periods respectively (P=0.17). Adjusted VAP incidence rose in unit A after surveillance disruption (incidence rate ratio=2.17, 95% confidence interval 1.05-4.47, P=0.036), independently of VAP trend; no change was observed in unit B. All-cause mortality and length of stay increased (P=0.028 and P=0.038, respectively) in unit A between periods 1 and 2. In unit B, no change in mortality was observed (P=0.22), while length of stay decreased between periods 1 and 2 (P=0.002). CONCLUSIONS: VAP incidence, length of stay, and all-cause mortality rose after HAI surveillance disruption in ICU, which suggests a specific effect of HAI surveillance on VAP prevention and reinforces the role of data feedback and counselling as a mechanism to facilitate performance improvement.
    Critical care (London, England) 08/2012; 16(4):R161. · 4.72 Impact Factor
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    ABSTRACT: This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI). Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans. Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release. The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 ± 7 g/m(2) vs. 21 ± 14 g/m(2); p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 ± 16 g/m(2) vs. 34 ± 18 g/m(2); p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk. This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.
    Journal of the American College of Cardiology 06/2012; 59(24):2175-81. · 14.09 Impact Factor

Publication Stats

1k Citations
265.59 Total Impact Points


  • 2006–2014
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2003–2014
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2013
    • University of Lyon
      Lyons, Rhône-Alpes, France
  • 2010
    • Szpital Uniwersytecki nr 1 im. A. Jurasza w Bydgoszczy
      Bromberg, Kujawsko-Pomorskie, Poland
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2008–2009
    • CHU de Lyon - Hôpital Gériatrique Antoine Charial 
      Lyons, Rhône-Alpes, France
  • 2003–2008
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 2004
    • Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2000
    • CHU de Lyon - Hôpital Cardio-vasculaire et Pneumologique Louis Pradel
      Lyons, Rhône-Alpes, France