E Aptecar

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

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Publications (75)373.96 Total impact

  • Journal des Maladies Vasculaires 03/2013; 38(2):107. DOI:10.1016/j.jmv.2012.12.077 · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):107. · 0.24 Impact Factor
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    ABSTRACT: Multislices Cardiac CT scan (MSCT) is a current non invasive coronary arteries imaging modality which is increasingly used. Radiation dose to which the patient is exposed remains a major problematic issue. Prospective Dose modulation protocol (DMP) allows marked dose reduction when correctly used.Aim and Methodsin order to figure out how DMP impacts Dose radiation to patient in daily life practice we prospectively studied 187 consecutive patients referred to our center for a 64 slices MSCT over a 2 months period. DMP was variabely used according to the operator's discretion wheather to modulate (1 to 3 EKG phases) or not based on patient's heart rate. Radiation measured by Dose length product (DLP), percent of modulation induced dose reduction, qualitative quality of the image (assessed by two blinded expert cardiologists) and signal on noise ratio were compared for each patient according to the DMP status.ResultsMSCTs were divided in modulated vs non modulated acquisition and the modulated group was divided in 4 groups according to the dose modulation protocol used : no DMP (n=24), DMP 1 phase (n=97), DMP 2 phases (n=51), DMP 3 (n=15) phases. All groups were comparable considering age, sex ratio and body mass index. Kilovolt and intensity were comparable between groups. DLP was signicantly lower in the modulated group compared to non modulated (734 □ 311 mGy.cm vs 1100 □ 371 mGy.cm, p<0.0001). Percent of dose reduction was only significantly higher for DMP 1 phase compared to other groups (-40 □ 7% DMP 1 vs -15 □ 6 DMP 2, -10 □ 3 DMP 3, 0 DMP 0; p<0.0001). Global image quality was significantly better in the modulated vs non modulated group (p=0.0016) and there was no quality difference between DMP 1 vs others. S/N ratio was not affected by the use or not of DMP.ConclusionDMP has a very positive impact in MSCT dose reduction with no deterioration of image quality. DMP allows the best dose reduction when modulation is conducted over 1 phase and should be used in that way.
    Archives of Cardiovascular Diseases Supplements 01/2010; 2(1):42. DOI:10.1016/S1878-6480(10)70130-0
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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 05/2009; 90(5):553-559. DOI:10.1016/S0221-0363(09)74021-1 · 0.57 Impact Factor
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    ABSTRACT: Destiné aux PCR, ce poster met à leur disposition un support pédagogique pour dispenser l’enseignement obligatoire de radioprotection aux personnels travaillant en zones.Des tableaux et des schémas simples illustrant les messages clés sont proposés.Points clésSelon le code du travail, la PCR doit dispenser au sein de son établissement un enseignement de radioprotection aux personnels porteurs du dosimètre passif en présence du médecin du travail et au moins tous les trois ans.L’exposé doit être court mais délivrer quelques messages et chiffres clés, il doit être vivant et devra être « mis au style » de l’orateur tout en laissant la place aux questions.
    Journal de Radiologie 10/2008; 89(10):1625. DOI:10.1016/S0221-0363(08)77103-8 · 0.57 Impact Factor
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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. DOI:10.1016/S0221-0363(06)86510-8 · 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. DOI:10.1016/j.healun.2006.03.001 · 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 05/2006; 67(5):711-20. DOI:10.1002/ccd.20679 · 2.40 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. DOI:10.1016/j.healun.2005.08.020 · 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):1440-1440. DOI:10.1016/S0221-0363(04)77437-5 · 0.57 Impact Factor
  • Journal de Radiologie 09/2004; 85(9):1263-1263. DOI:10.1016/S0221-0363(04)76856-0 · 0.57 Impact Factor
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    ABSTRACT: Comparer les performances diagnostiques du scanner 16 barrettes à celles de la coronarographie dans les syndromes coronariens aigus sans sus décalage persistant de ST (angor instable).Matériels et méthodesVingt patients coronarographiés en urgence pour angor instable de novo ont bénéficié avant revascularisation coronaire de la lésion responsable, essentiellement par angioplastie, d’un scanner des artères coronaires, dans les 12 heures ayant suivi la coronarographie. L’interprétation du scanner a été réalisée conjointement par 2 investigateurs en aveugle des résultats de la coronarographie. Seize segments coronaires par patient ont été analysés en terme de visualisation, aspect des lésions, évaluation de sténose et comparés à l’angiographie.RésultatsL’âge moyen était de 60 ans. La fréquence cardiaque moyenne était de 70/mn (50-96). Deux cent cinquante deux des 320 segments étaient interprétables par le scanner (78 %). Trente segments présentaient une sténose jugée significative parmi lesquelles 18 ont été retenues comme la lésion cible sur des considérations électrocardiographiques. Sur les 18 lésions responsables, 13 étaient calcifiées et 5 considérées comme des plaques molles. Comparée à la coronarographie, la sensibilité du scanner dans la détection de la lésion cible était de 90 %. Aucune complication n’a été à déplorer.Conclusion Le scanner 16 barrettes réalisé dans le cadre de l’angor instable est efficace pour détecter la lésion coronaire en cause et pourrait représenter une alternative technique dans l’évaluation des douleurs thoraciques.
    Journal de Radiologie 09/2004; 85(9):1441-1442. DOI:10.1016/S0221-0363(04)77442-9 · 0.57 Impact Factor
  • Journal de Radiologie 09/2004; 85(9):1441-1441. DOI:10.1016/S0221-0363(04)77441-7 · 0.57 Impact Factor
  • Journal de Radiologie 09/2004; 85(9):1169-1169. DOI:10.1016/S0221-0363(04)76528-2 · 0.57 Impact Factor
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    ABSTRACT: Evaluation de la performance diagnostique du scanner 16 barrettes dans une population de patients à coronaires normales.Matériels et méthodesUn scanner des artères coronaires a été realisé chez 25 patients à coronaires angiographiquement saines. Les images scanner étaient analysées en aveugle de la coronarographie en terme de qualité globale, d’interpréation des différents segments des 3 artères coronaires, de capacité à conclure à la normalité du réseau coronaire.RésultatsLa fréquence cardiaque moyenne était de 67 /mn et l’index de surface corporelle (ISC) de 27+/-5. La reconstruction complète était respectivement de 100 %, 100 %, 92 %, 80 % sur le tronc commun (TC), l’interventriculaire antérieure (IVA), la circonflexe (CX), la coronaire droite (CD). Dans ces conditions, le tronc commun était interprétable dans 100 % des cas, l’IVA dans 92 %, la CX dans 95 % et la CD dans 100 %. La totalité du réseau coronaire était reconstruite de manière satisfaisante dans 79 % des cas (19 /25) et dans cette situation interprétable comme normal dans 89 % (17/19). En analyse univariée la présence de calcifications était corrélée au caractére non interprétable de la lumière artérielle (p = 0,04), un ISC élevé était un critère prédictif négatif d’interprétation de la CD (p = 0,04) et de mauvaise qualité globale de l’examen (p = 0,03). Comparée à la coronarographie et après exclusion des patients avec calcifications, la valeur prédictive négative (VPN) pour l’interprétation globale de l’arbre coronaire était de 98 %.Conclusion En l’absence de calcifications, le scanner multibarrette apparaît comme une méthode non invasive de choix de l’évaluation des artères coronaires de sujets à faible risque de maladie coronaire.
    Journal de Radiologie 09/2004; 85(9):1441. DOI:10.1016/S0221-0363(04)77440-5 · 0.57 Impact Factor
  • Journal of the American College of Cardiology 03/2004; 43(5). DOI:10.1016/S0735-1097(04)91327-7 · 15.34 Impact Factor
  • Journal of the American College of Cardiology 03/2004; 43(5). DOI:10.1016/S0735-1097(04)90125-8 · 15.34 Impact Factor

Publication Stats

991 Citations
373.96 Total Impact Points

Institutions

  • 1989–2006
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1996–2001
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      • Service de Cardiologie 2
      Créteil, Île-de-France, France
  • 1999
    • Saint Louis University
      • Department of Internal Medicine
      Saint Louis, MI, United States
  • 1995
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France