E Aptecar

French Institute of Health and Medical Research, Lutetia Parisorum, Île-de-France, France

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Publications (69)325.56 Total impact

  • Journal des Maladies Vasculaires 03/2013; 38(2):107. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):107. · 0.24 Impact Factor
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    ABSTRACT: Until recently, the optimal work-up of patients with stable coronary artery disease (CAD) was based on non-invasive functional tests. Coronary CTA (CCTA) now challenges this standard work-up due to its efficacy to exclude significant coronary artery disease. Current indications for CCTA include symptomatic patients with intermediate pre-test probability of CAD with altered ECG (LBBB, repolarization abnormalities) rendering stress tests useless or patients unable to achieve sustained stress effort, and patients with indeterminate or uninterpretable results on ischemic work-up. A more agressive position is to consider CCTA as the cornerstone of patient management because the limitations and pitfalls of non-invasive techniques open the door to an alternative diagnostic imaging technique, either alone, or in combination with other Imaging techniques after reorganizing the sequence of imaging work-up. Without dismissing the dogma of initial détection of CAD along with prognostic stratification using functional tests, the recent availability of a minimally invasive anatomical test in the management of patients with stress angina, given the known limitations of traditional tests, changes the standard work-up algorithms. This suggests that the diagnostic work-up of patients with CAD is likely to be modified to increase the rôle of CCTA.
    Journal de Radiologie 06/2009; 90(5 Pt 1):553-9. · 0.57 Impact Factor
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    ABSTRACT: Until recently, the optimal work-up of patients with stable coronary artery disease (CAD) was based on non-invasive functional tests. Coronary CTA (CCTA) now challenges this standard work-up due to its efficacy to exclude significant coronary artery disease. Current indications for CCTA include symptomatic patients with intermediate pre-test probability of CAD with altered ECG (LBBB, repolarization abnormalities) rendering stress tests useless or patients unable to achieve sustained stress effort, and patients with indeterminate or uninterpretable results on ischemic work-up. A more agressive position is to consider CCTA as the cornerstone of patient management because the limitations and pitfalls of non-invasive techniques open the door to an alternative diagnostic imaging technique, either alone, or in combination with other Imaging techniques after reorganizing the sequence of imaging work-up. Without dismissing the dogma of initial détection of CAD along with prognostic stratification using functional tests, the recent availability of a minimally invasive anatomical test in the management of patients with stress angina, given the known limitations of traditional tests, changes the standard work-up algorithms. This suggests that the diagnostic work-up of patients with CAD is likely to be modified to increase the rôle of CCTA.
    Journal De Radiologie - J RADIOL. 01/2009; 90(5):553-559.
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    ABSTRACT: Objectifs pédagogiques Sensibliser le radiologue au rôle potentiel majeur du scanner coronaire dans un futur proche et aux enjeux pour la spécialité. Familiariser le radiologue aux contraintes techniques spécifiques du scanner pour l’étude du cœur. Expliquer en les démystifiant les connaissances cardiologiques cliniques indispensables légitimant le rôle du radiologue dans le domaine
    Journal de Radiologie 10/2006; 87(10):1157-1157. · 0.57 Impact Factor
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    ABSTRACT: Coronary vasomotor responses to sympathetic stimulation vary with endothelial-layer integrity or presence of atherosclerosis. Our study objective was to assess the effects of phenylephrine-induced alpha-adrenergic stimulation on coronary vasomotion in heart transplant recipients with and without graft atherosclerosis. Intracoronary phenylephrine (alpha(1)-selective agonist) was injected in 6 control subjects, 9 recipients with angiographically normal coronary arteries and 8 recipients with mild or moderate atherosclerosis. Coronary flow velocity was measured using a Doppler guide-wire. The diameters of 3 epicardial segments of the left coronary artery and coronary blood flow and resistance were assessed at baseline, after infusion of increasing acetylcholine doses (10(-7) and 10(-6) mol/liter) and after phenylephrine (150- to 200-microg bolus). Systemic and coronary hemodynamic parameters were measured immediately after acetylcholine and 1, 3, 5, 7, 10 and 15 minutes after phenylephrine. Phenylephrine induced similar significant increases in rate pressure product in the 3 groups. Acetylcholine induced epicardial vasodilation in controls and vasoconstriction in transplant recipients. Phenylephrine induced epicardial vasodilation in controls and in angiographically normal recipients; subsequent vasoconstriction occurred in this last group. In the recipients with angiographic abnormalities, sustained vasoconstriction occurred. At peak phenylephrine effect, coronary blood flow (CBF) increased significantly (p < 0.001 vs baseline) in all 3 groups. Coronary resistance decreased in the 3 groups but the decrease was smaller in the recipients with angiographic abnormalities (p < 0.05 vs controls). In heart transplant patients, graft atherosclerosis unmasks the direct coronary vasoconstricting effects of pharmacologic alpha-adrenergic stimulation.
    The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 09/2006; 25(8):912-20. · 5.61 Impact Factor
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    ABSTRACT: To compare in terms of efficacy and safety the transulnar to the transradial approach for coronary angiography and angioplasty. Background: Opposite to the transradial approach, which is now widely used in catheterization laboratories worldwide, the ulnar artery approach is rarely used for cardiac catheterization. Diagnostic coronarography, followed or not by angioplasty, was performed by transulnar or transradial approach, chosen at random. A positive (normal) direct or reverse Allen's test was required before tempting the radial or the ulnar approach, respectively. MACE were recorded till 1-month follow-up. Doppler ultrasound assessment of the forearm vessels was scheduled for all the angioplastied patients. Successful access was obtained in 93.1% of patients in the ulnar group (n = 216), and in 95.5% of patients in the radial group (n = 215), P = NS. One hundred and three and 105 angioplasty procedures were performed in 94 and 95 patients in ulnar and radial group, with success in 95.2% and 96.2% of procedures in ulnar and radial group, respectively (P = NS). Freedom from MACE at 1-month follow-up was observed in 93 patients in both groups (97.8% for ulnar group and 95.8% for radial group), P = NS. Asymptomatic access site artery occlusion occurred in 5.7% of patients after transulnar and in 4.7% of patients after transradial angioplasty. A big forearm hematoma, and a little A-V fistula were observed, each in one patient, in the ulnar group. The transulnar approach for diagnostic and therapeutic coronary interventions is a safe and effective alternative to the transradial approach, as both techniques share a high success rate and an extremely low incidence of entry site complications. The transulnar approach has the potential to spare injury to the radial artery in anticipation of its use as a coronary bypass conduit.
    Catheterization and Cardiovascular Interventions 06/2006; 67(5):711-20. · 2.51 Impact Factor
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    ABSTRACT: The aim of the present study was to assess the effects of selective B1-receptor stimulation with des-Arg9-bradykinin on coronary vasomotion in transplanted and non-transplanted patients. Bradykinin B1-receptors have been identified on endothelial and smooth muscle cells in human coronary arteries in vitro; however, their physiologic role in the coronary circulation is unknown. Twelve heart transplant patients were compared with 10 control subjects at 3.2 +/- 2.2 months after surgery. Coronary flow velocity was measured using guide-wire Doppler. The diameter of 3 epicardial segments of the left coronary artery and coronary blood flow were assessed at baseline, immediately after infusions of increasing doses of des-arginine(Arg9)-bradykinin at estimated coronary blood concentrations of 5.4 x 10(-9), 5.4 x 10(-8), 5.4 x 10(-7) and 1.6 x 10(-6) mol/liter, and of acetylcholine at 10(-8), 10(-7) and 10(-6) mol/liter). Des-Arg9-bradykinin induced a similar decrease in all measured epicardial diameters in both groups and no change in coronary blood flow. Vasoconstriction was significant only at the 2 highest concentrations: -6 +/- 9% (p < 0.01) and -7 +/- 11% (p < 0.01) in control subjects, and -8 +/- 8% (p < 0.001) and -9 +/- 11% (p < 0.001) in heart transplant patients. Acetylcholine induced significant epicardial vasodilation in control subjects and vasoconstriction in transplant patients. The presence of allograft rejection did not modify the responses to des-Arg9-bradykinin with regard to both conductance and resistance vessels. Kinin B1-receptors exist and can be stimulated in humans. The vasoconstrictive action on epicardial coronary arteries of des-Arg(9)-bradykinin in humans argues for a predominant action of B1-receptor stimulation at the level of smooth muscle cells.
    The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 02/2006; 25(2):187-194. · 5.61 Impact Factor
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    ABSTRACT: While the transradial approach is now a well-established alternative to the conventional femoral approach for cardiac catheterization, the ulnar artery is rarely used. The objective of this prospective study was to evaluate the feasibility and safety of transulnar catheterization for routine diagnostic and therapeutic coronary interventions. Among 210 consecutive patients referred for diagnostic coronary angiography and or angioplasty and screened for appropriateness of the ulnar approach, 172 (172 of 210, 82%) underwent attempted ulnar artery catheterization, which was successful in 158 (158 of 172, 91%). The 173 procedures successfully performed via the ulnar approach included 122 diagnostic coronary angiographies, 38 coronary angiographies followed by angioplasty, and 13 elective angioplasties. Access site complications consisted of one case each of silent ulnar artery thrombosis, pseudoaneurysm, and hematoma due to ulnar artery wall rupture during an unsuccessful catheterization attempt. No cardiac or systemic complications were recorded. The transulnar approach appears feasible and safe for routine coronary diagnostic and therapeutic interventions.
    The Journal of invasive cardiology 07/2005; 17(6):312-7. · 0.82 Impact Factor
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    ABSTRACT: Background: Fractional flow reserve (FFR) is correlated with angiographic and intravascular ultrasound assessments of stent placement. Post-stenting FFR has been described as a good predictor of clinical events after 6 months. Objective: To evaluate the feasibility and clinical impact of targeting an FFR > 0.95 via incremental in-stent inflation pressures. Methods: In this multicenter prospective study, 100 consecutive patients underwent FFR measurement at baseline, after balloon predilatation, and after stenting with 4-atm inflation pressure increments from 8 to 20 atmospheres. Inflations were stopped when FFR increased above 0.95 and angiographic stenosis was less than 20%. Results: FFR > 0.95 was achieved in 81% of cases; this FFR target was reached at 8 atm in 47% of patients, 12 atm in 16 %, 16 atm in 15%, and 20 atm in 3%. Fifty percent of patients with adequate angiographic result had an FFR less than 0.95 and needed further higher inflations. FFR was correlated with residual stenosis when the total procedure was evaluated, and this correlation persisted when in-stent inflations alone were considered. Final FFR was significantly correlated with anginal status after 6 months.Conclusions: Angiography guided PCI does not allow optimization of FFR. Since optimal post stenting FFR is correlated to better anginal status at 6-months, this suggests that FFR guided PCI is required to achieve optimal functional results of PCI.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 05/2005; 1(1):85-92. · 3.76 Impact Factor
  • Journal de Radiologie 09/2004; 85(9):1169-1169. · 0.57 Impact Factor
  • Journal de Radiologie 09/2004; 85(9):1440-1440. · 0.57 Impact Factor
  • Journal de Radiologie 09/2004; 85(9):1441-1441. · 0.57 Impact Factor
  • Journal of the American College of Cardiology 03/2004; 43(5). · 15.34 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2004; 43(5).
  • Journal De Radiologie - J RADIOL. 01/2004; 85(9):1263-1263.
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    ABSTRACT: Acute arterial thrombo-embolic pathology constitutes a common pathology in the elderly population, principally in cases of cardiac arrhythmia. Out study allowed analysis of the results of percutaneous manual thrombo-aspiration as a primary procedure in a series of 25 patients (average age: 73.3 +/- 11.3 years) presenting with a picture of acute femoro-popliteal ischaemia, of supposed cardiac origin. Most of the patients had an arrhythmia with atrial fibrillation (68%), and 88% had grade II ischaemia. The site of proximal occlusion most frequently found was the popliteal axis (22 patients). Thrombo-aspiration was performed in all cases via the common femoral route homo-lateral with the ischaemia, by anterograde approach, after having obtained a diagnostic angiograph of the opposite side. The procedure, with an average duration of 39 minutes, allowed restoration of good quality flow in at least 2 axes subjacent to the occlusion in 23 patients (92%). Besides two failures, two complications (8%) were counted (one Scarpa haematoma and one early re-thrombosis). This good result was sustained long term, with 94% of patients reviewed on average 3 years after the procedure remaining asymptomatic. Manual thrombo-aspiration thus constitutes a technique of choice in the framework of the management of acute infra-inguinal emboli due to its angiographic and functional results on the one hand, and its low morbidity on the other, in a population particularly exposed to the risk of spontaneous and post-operative vascular complications.
    Archives des maladies du coeur et des vaisseaux 01/2003; 95(12):1173-80. · 0.40 Impact Factor
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    ABSTRACT: To evaluate early changes in myocardial microcirculation after balloon or stent coronary angioplasty, we studied 57 patients undergoing coronary angioplasty with a Doppler-tipped guidewire, with (n = 26) or without stenting. Postprocedural quantitative coronary angiography and coronary flow velocity were measured after 10 min and 24 hr. As compared to stenting, no stenting was associated with a higher postprocedural stenosis rate (21% +/- 13% vs. 12% +/- 10%; P < 0.05), smaller coronary velocity reserve (CVR; 2.2 +/- 0.4 vs. 2.5 +/- 0.7; P = 0.04), and smaller relative CVR (0.8 +/- 0.2 vs. 1.1 +/- 0.3; P = 0.001). At 24 hr, CVR and relative CVR in the unstented group increased to the level in the stented group, mainly because of a decrease in basal average peak velocity (APV). Overall, there was a significant negative linear relation between CVR and APV variations during the 24-hr period. In the subgroups with persistent abnormalities, CVR variation was closely related to the basal APV/reference APV ratio. In conclusion, coronary reserve normalization can occur within 24 hr after coronary angioplasty and is closely dependent on postangioplasty APV. Myocardial distal resistances should be considered when interpreting postangioplasty CVR.
    Catheterization and Cardiovascular Interventions 10/2002; 57(2):191-8. · 2.51 Impact Factor
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    ABSTRACT: Mean arterial pressure (MAP) is estimated at the brachial artery level by adding a fraction of pulse pressure (form factor; =0.33) to diastolic pressure. We tested the hypothesis that a fixed form factor can also be used at the aortic root level. We recorded systolic aortic pressure (SAP) and diastolic aortic pressure (DAP), and we calculated aortic pulse pressure (PP) and the time-averaged MAP in the aorta of resting adults (n=73; age 43+/-14 years). Wave reflection was quantified using the augmentation index. The aortic form factor (range 0.35-0.53) decreased with age, MAP, PP and augmentation index (each P<0.001). The mean form factor value (0.45) gave a reasonable estimation of MAP (MAP=DAP+0.45PP; bias=0+/-2 mmHg), and the bias increased with MAP (P<0.001). An alternative formula (MAP=DAP+PP/3+5 mmHg) gave a more precise estimation (bias=0+/-1 mmHg), and the bias was not related to MAP. This latter formula was consistent with the previously reported mean pulse wave amplification of 15 mmHg, and with unchanged MAP and diastolic pressure from aorta to periphery. Multiple linear regression showed that 99% of the variability of MAP was explained by the combined influence of DAP and SAP, thus confirming major pressure redundancy. Results were obtained irrespective of whether the marked differences in heart period and extent of wave reflection between subjects were taken into account. In conclusion, the aortic form factor was strongly influenced by age, aortic pressure and wave reflection. An empirical formula (MAP=DAP+PP/3+5 mmHg) that is consistent with mechanical principles in the arterial system gave a more precise estimate of MAP in the aorta of resting humans. Only two distinct pressure-powered functions were carried out in the (SAP, DAP, MAP, PP) four-pressure set.
    Clinical Science 07/2002; 103(1):7-13. · 5.63 Impact Factor
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    ABSTRACT: In this study we compare the incidence of cardiac rejection and long-term survival after combined heart and kidney transplantation (HK) and single heart transplantation (H). Combined HK transplantation is a surgical option for patients with irreversible cardiac and renal failure. However, long-term results of combined HK transplantation on immunologic events and patient survival remain unknown. Between 1988 and 1997, 12 consecutive patients underwent combined HK transplantation (HK group) at a single institution. A control group (H group) of 24 single heart transplant recipients operated on within the same period was matched for age, pre-operative pulmonary vascular resistance, hepatic insufficiency and gender mismatch. Recipients and donors were ABO compatible without HLA antigen matching. All patients received immediate triple immunosuppression that included cyclosporine. Because of early renal dysfunction, cyclosporine was switched to anti-thymocyte globulin in 5 patients from the HK group and in 1 patient from the H group (p = 0.01). Actuarial freedom from heart rejection at 6 months and at 1 year following transplantation averaged 90 +/- 9% and 70 +/- 14% in the HK group, and 65 +/- 10% and 49 +/- 11% in the H group, respectively (p = 0.023). Actuarial survival at 1, 5 and 12 years was not significantly different between groups, at 66%, 55% and 28% in the HK group, and 66%, 44% and 32% in the H group, respectively (p = 0.66). The incidence of cardiac rejection was significantly lower. Long-term survival in the HK group was similar to that in the H group. Putative mechanisms of decreased cardiac rejection in the HK group include allogeneic stimulation, donor-derived dendritic cells and induction by anti-thymocyte globulins. The need for long-term immunosuppression may be reduced after combined heart and kidney transplantation.
    The Journal of Heart and Lung Transplantation 11/2001; 20(10):1084-91. · 5.61 Impact Factor

Publication Stats

877 Citations
325.56 Total Impact Points

Institutions

  • 1989–2006
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1999
    • Saint Louis University
      • Department of Internal Medicine
      Saint Louis, MI, United States
  • 1991–1999
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      • Service de Cardiologie 2
      Créteil, Ile-de-France, France