Publications (29)156.4 Total impact
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Article: Colchicine in acute pericarditis: a new standard?
Archives of cardiovascular diseases 08/2011; 104(8-9):425-7. · 0.66 Impact Factor -
Article: Syphilitic aortic regurgitation and ostial coronary occlusion.
Journal of the American College of Cardiology 06/2011; 57(24):e375. · 14.16 Impact Factor -
Article: Heart rate recovery identifies high risk heart failure patients with intermediate peak oxygen consumption values.
International journal of cardiology 03/2011; 149(2):284-5. · 7.08 Impact Factor -
Article: Nonsteroidal anti-inflammatory drug treatment for postoperative pericardial effusion: a multicenter randomized, double-blind trial.
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ABSTRACT: The incidence of asymptomatic pericardial effusion is high after cardiac surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in this setting, but no study has assessed their efficacy. To assess whether the NSAID diclofenac is effective in reducing postoperative pericardial effusion volume. Multicenter randomized, double-blind, placebo-controlled study. (Clinical trials.gov registration number: NCT00247052) 5 postoperative cardiac rehabilitation centers. 196 patients at high risk for tamponade because of moderate to large persistent pericardial effusion (grade 2, 3, or 4 on a scale of 0 to 4, as measured by echocardiography) more than 7 days after cardiac surgery. Random assignment at each site in blocks of 4 to diclofenac, 50 mg, or placebo twice daily for 14 days. The main end point was change in effusion grade after 14 days of treatment. Secondary end points included frequency of late cardiac tamponade. The initial mean pericardial effusion grade was 2.58 (SD, 0.73) for the placebo group and 2.75 (SD, 0.81) for the diclofenac group. The 2 groups showed similar mean decreases from baseline after treatment (-1.08 grades [SD, 1.20] for the placebo group vs. -1.36 (SD, 1.25) for the diclofenac group). The mean difference between groups was -0.28 grade (95% CI, -0.63 to 0.06 grade; P = 0.105). Eleven cases of late cardiac tamponade occurred in the placebo group and 9 in the diclofenac group (P = 0.64). These differences persisted after adjustment for grade of pericardial effusion at baseline, treatment site, and type of surgery. The sample was not large enough to find small beneficial effects of diclofenac or assess the cardiovascular tolerance of diclofenac. In patients with pericardial effusion after cardiac surgery, diclofenac neither reduced the size of the effusions nor prevented late cardiac tamponade. French Society of Cardiology.Annals of internal medicine 02/2010; 152(3):137-43. · 16.73 Impact Factor -
Article: Ventilatory efficiency and the selection of patients for heart transplantation.
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ABSTRACT: Ventilatory efficiency, assessed by the slope of minute ventilation (VE) versus carbon dioxide production (VCO(2)), is a powerful prognostic marker in patients with chronic heart failure. We hypothesized that VE/VCO(2) slope would be more accurate than the current listing criteria for heart transplantation (HTx) in identifying patients likely to derive a survival benefit from this intervention. A total of 663 patients with chronic heart failure who underwent cardiopulmonary exercise testing were tracked for cardiac mortality and HTx. Ve/Vco(2) slope was the strongest independent predictor of mortality. Using a VE/VCO(2) slope threshold instead of the current exercise criteria would classify 39 more subjects as being high risk (196 versus 157), correctly identifying 19 more patients who died during follow-up (57 versus 38) and 16 others who underwent transplantation (52 versus 36). Unlike the current listing criteria for HTx, VE/VCO(2) slope provided significant discrimination between the 3-year survival of high- and low-risk patients and posttransplant patients selected from the International Society for Heart and Lung Transplantation registry. Reanalysis of survival data using death or HTx as the end point showed similar results. VE/VCO(2) slope is more accurate than the current listing criteria for HTx in identifying patients likely to derive a survival benefit from HTx.Circulation Heart Failure 02/2010; 3(3):378-86. · 6.29 Impact Factor -
Article: Benefits of exercise training in chronic heart failure.
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ABSTRACT: Exercise training performed in cardiac rehabilitation centres is an adjuvant therapy in chronic heart failure patients with left ventricular dysfunction; it decreases the deleterious consequences of chronic heart failure. Exercise training attenuates neurohormonal stimulation, the production of proinflammatory cytokines and natriuretic peptide overexpression. Trained patients showed a significant decrease in the peripheral organ injuries encountered in chronic heart failure, with a reduction in vascular resistance and improvements in endothelial dysfunction and the oxidative capacity of peripheral muscles, without a deleterious effect on left ventricular remodelling. Ultimately, exercise training leads to a notable improvement in ventilatory capacity. These beneficial effects are accompanied by improvements in symptoms at rest, exercise capacity and quality of life. Several training programmes are in current use: exercise training sessions always include endurance exercise performed either at a constant load intensity or with interval training, combining periods of exercise performed at high intensity with periods performed at low intensity. Most of the time, training programmes also include resistance training sessions, which improves large muscle strength. Exercise training programmes seem to have a favourable effect on prognosis, even if the results of Heart Failure: a Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) remain controversial, emphasizing the difficulty in monitoring observance and the importance of compliance with a long-term exercise training programme. Patients who do not improve their exercise capacity significantly after an exercise training programme have a poorer prognosis.Archives of cardiovascular diseases 10/2009; 102(10):721-30. · 0.66 Impact Factor -
Article: Absence of exercise capacity improvement after exercise training program: a strong prognostic factor in patients with chronic heart failure.
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ABSTRACT: Exercise training is established as adjuvant therapy for chronic heart failure, but the prognostic value of improvement in exercise capacity after exercise training has never been evaluated. In this prospective bicentric study, all chronic heart failure patients with left ventricular ejection fraction <45% who underwent an exercise training program in a cardiac rehabilitation center between January 2004 and September 2006 were consecutively included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (deltaPVo(2)) and in PVo(2) expressed as a percentage of predicted PVo(2) (delta%PPVo(2)) measured before and after the training program. We included 155 patients (54+/-12 years old, male 81%, left ventricular ejection fraction=29.5+/-7.1%). Patients underwent 20 (10-30) training sessions. PVo(2) and %PPVo(2) were significantly increased after the training program (14% and 13%, respectively, P<0.001 for both). After 16+/-6 months follow-up, 27 patients had a cardiac event (death [n=12], cardiac transplantation [n=5], hospitalization for acute heart failure [n=10]). Univariate analysis revealed that among 17 significant predictors of cardiac events, the 2 more powerful ones were level of B-type natriuretic peptide at baseline (P<0.0001) and improvement in exercise capacity as assessed by deltaPVo(2) and delta%PPVo(2) (P<0.0001). Multivariate analysis revealed B-type natriuretic peptide level and delta%PPVo(2) as only independent predictive factors of outcome (P=0.01). The risk ratio of cardiac events for nonresponse versus response to the training program (defined as median delta%PPVo(2)<6%) was 8.2 (P=0.0006). Among patients with chronic heart failure, the lack of improvement in exercise capacity after an exercise training program has strong prognostic value for adverse cardiac events independent of classical predictive factors such as left ventricular ejection fraction, New York Heart Association class, and B-type natriuretic peptide level.Circulation Heart Failure 11/2008; 1(4):220-6. · 6.29 Impact Factor -
Article: Transient worsening of renal function during hospitalization for acute heart failure alters outcome.
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ABSTRACT: We studied prevalence, causes and consequences of worsening renal function (WRF) during hospitalization for acute heart failure (AHF). Patients admitted for AHF were enrolled. Patients with severe chronic renal failure, cardiogenic shock and contrast medium-induced nephropathy were excluded. WRF was defined as an increase of 25 mumol/l or more in serum creatinine relative to the admission level. Survivors were monitored for 6 months, focusing on deaths and first unscheduled readmissions for heart failure. Among the included 416 patients, WRF occurred in 152 cases (37%), 5+/-3 days after admission, and two-thirds of patients recovered their baseline renal function before discharge. Old age, diabetes, hypertension and acute coronary syndromes increased the risk of WRF. In-hospital furosemide doses as well as discharge treatment were similar in WRF and no-WRF patients. Serum creatinine elevation was the strongest independent determinant of a longer hospital stay (r=0.37, p=0.001). Adverse events occurred in 158 patients (38%) during follow-up, with 23 deaths and 135 readmissions. Cox analysis showed that WRF, transient or not, was an independent predictor of the risk of death or readmission (hazard ratio=1.74 [1.14-2.68], p=0.01). WRF is frequent after admission for AHF and, although transient, is associated with longer hospitalization and with a higher risk of death and readmission, irrespectively of baseline renal function.International journal of cardiology 08/2008; 127(2):228-32. · 7.08 Impact Factor -
Article: Thromboembolic events early after mitral valve repair: incidence and predictive factors.
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ABSTRACT: The incidence of thromboembolic events (TE) in the early period following mitral valve repair (MV repair) is poorly documented. The aim of this prospective study was to evaluate it, and to determine predictive factors. In this prospective multicenter non-randomized study, 350 consecutive patients were included after MV repair and monitored until post-operative day 44+/-6. 65.7% received Vitamin K antagonists (VKA), 18.8% aspirin (ASA), 5.4% ASA+VKA and 10% received no antithrombotic therapy (AT). All patients with AF received VKA or VKA+ASA. Twelve patients had a cerebral TE during follow-up:14.3% among untreated patients, 3.0% in the VKA group, and 0% in the ASA and in the ASA+VKA groups (p=0.03 for comparison no AT group versus the three other combined groups; p=NS for VKA versus ASA). In univariate analysis, only the absence of post-operative AT was related to the risk of TE (HR=6.7, CI 95%[2.1-21], p=0.0002). In a prespecified subgroup (n=185) of patients with sinus rhythm and without concomitant cardiac surgery (in which the choice of AT is not influenced by these associate conditions), only the absence of post-operative AT remained related to the risk of TE (HR=10.0, CI 95%[2.45-40], p=0.001). In the first six weeks following MV repair, the incidence of thromboembolic events is far from negligible (3.5%), even in patients with sinus rhythm. The main predictive factor for thromboembolic event determined in this study is the absence of an antithrombotic therapy.International journal of cardiology 06/2008; 126(1):45-52. · 7.08 Impact Factor -
Article: Noninvasively determined radial dP/dt is a predictor of mortality in patients with heart failure.
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ABSTRACT: The left ventricular (LV) developed pressure is a marker of contractility, associated with a poor prognosis during systolic heart failure. The maximal first derivative or slope of the radial pulse wave (Rad dP/dt) has been proposed as a marker of LV systolic function. This study sought to assess the prognostic value of the baseline dP/dt of the radial pulse in patients with heart failure. The Rad dP/dt was noninvasively measured by applanation tonometry, and its effect on mortality was analyzed by using multivariate Cox regression models. We studied 310 consecutive patients. Mean follow-up was 327 +/- 187 days, and 64 patients died or were transplanted during this period. Death or transplantation was associated with New York Heart Association class III or IV, low systolic or mean blood pressure, low LV ejection fraction, and low Rad dP/dt (634.6 +/- 373.3 vs 730.2 +/- 367.4 mm Hg/s for patients who survived without transplantation, P < .02). A Rad dP/dt <440 mm Hg/s was associated with death or transplantation before and after adjustment for confounding variables (OR [95% CI] 2.19 [1.33-3.58] and 2.88 [1.29-6.38], respectively, P < .01 for both). This relationship was independent of pulse pressure and no significant interaction was found between the Rad dP/dt and the pulse pressure. This study demonstrates, for the first time, that the Rad dP/dt, proposed as a noninvasive peripheral marker of LV systolic function, is an independent predictor of death or transplantation in patients with HF regardless of LV ejection fraction.American heart journal 04/2008; 155(4):758-63. · 4.65 Impact Factor -
Article: Can we use a low molecular weight heparin after mechanical prosthetic heart valve surgery?
Heart (British Cardiac Society) 03/2008; 94(2):131-2. · 4.22 Impact Factor -
Article: Determination of exercise training level in coronary artery disease patients on beta blockers.
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ABSTRACT: To compare the intensity of three exercise training regimens. During a cardiac rehabilitation program coronary artery disease (CAD) patients should be trained at an intensity as close as possible to the ventilatory threshold (VT) level. The precise way to obtain this intensity of training during the sessions, however, remains unclear. In stable beta-blocked CAD patients, heart rate (HR) and workload (WL) at the VT were determined from a cardiopulmonary exercise test. The 3 following days, each patient performed (in a randomized order) one bicycle training session per day at an intensity determined by (i) HR at VT, (ii) WL at VT, (iii) patient's feelings (14 on the Borg scale). HR, WL, systolic blood pressure, oxygen consumption (VO2) and the respiratory exchange ratio were monitored during each session, to compare the intensity of each regimen. Twenty patients, 57+/-10 years old were included. VO2, WL, HR and systolic blood pressure were significantly higher in the sessions driven by feelings and WL, than in the HR-driven sessions. As respiratory exchange ratio remained less than 1, we can assume that there was no important and deleterious participation of anaerobic metabolism. Classical training HR prescription could lead to undertrain CAD patients, although a training session prescription driven by the feelings or by the WL observed at VT allows the patients to train at a higher--but still aerobic--intensity.European Journal of Cardiovascular Prevention and Rehabilitation 03/2008; 15(1):67-72. · 2.63 Impact Factor -
Article: Non-invasive radial pulse wave assessment for the evaluation of left ventricular systolic performance in heart failure.
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ABSTRACT: Left ventricular (LV) developed pressure (dP/dt) is a classical index of myocardial contractility related to prognosis during heart failure. We sought to assess the reproducibility and feasibility of use of the maximal first derivative of the radial pulse, Rad dP/dt, as a peripheral criterion of ventricular contractility in patients with heart failure. We assessed 50 consecutive, patients with heart failure using aplanation tonometry to record the radial pulse wave and calculate Rad dP/dt. Echocardiography, Doppler flow and tissue Doppler imaging were used to record classical parameters of LV function: LV ejection fraction (LVEF), Tei index, dP/dt on mitral regurgitation (MR dP/dt) and peak systolic velocity (S'). Total systemic vascular resistance (TSVR) was calculated by use of the Doppler calculated cardiac output. Preload was assessed by the E/Ea ratio. Feasibility was tested in an ongoing prospective mortality study (n=310). The Bland and Altman representation of repeated measurements of the Rad dP/dt showed good agreement. Feasibility was greater than 99% for a successful assessment on the right arm during the first attempt. The Rad dP/dt correlated with the LVEF, S' or Tei index as usual parameters of impaired contractility but not preload (E/Ea) or afterload (TSVR) parameters. MR dP/dt and Rad dP/dt were closely related (r=0.75, p<0.001). The ability of the arterial dP/dt to characterize LVEF was not modified by adjustment for arterial viscoelastic properties. The maximal dP/dt of the radial pulse appears to be a valuable and reproducible peripheral criterion of LV systolic performance.European Journal of Heart Failure 06/2007; 9(5):477-83. · 4.90 Impact Factor -
Article: Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism.
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ABSTRACT: To evaluate the usefulness of B-type natriuretic peptide and troponin I measurements in predicting right ventricular dysfunction (RVD) in non-massive pulmonary embolism. Prospective observational study. University-affiliated emergency unit, cardiology and pneumology departments. Sixty-seven patients admitted because of acute pulmonary embolism, without shock on admission, completed the study. Blood samples and echocardiography were obtained on admission for subsequent and independent assessment of B-type natriuretic peptide (BNP) and troponin I levels as well as RVD. Echocardiographic RVD was diagnosed in 36 patients and was severe in 13 on admission. BNP and troponin I levels were higher in patients with RVD than in those with no RVD [62 (27-105) vs. 431 (289-556) pg/ml for BNP, p<0.001; 0.01 (0-0.09) vs. 0.16 (0.03-0.32) microg/l for troponin I, p=0.005]. The area under the receiving operating characteristic curve (AUC) for diagnosing RVD was 0.93 for BNP and 0.72 for troponin I. The troponin I level increased further when RVD was severe, compared with moderate, and the AUC was 0.91 for identifying severe RVD. Diagnoses of RVD and severe RVD were ruled out by BNP<or=100 pg/ml (30% of patients) and troponin I 0.10 microg/l (58% of patients), respectively. In-hospital death or circulatory failure occurred in nine patients; all had echographic RVD and level of BNP >100 pg/ml and troponin I >0.10 microg/l. In hemodynamically stable pulmonary embolism, BNP/troponin I measurement is helpful on admission, especially for ruling out RVD, i.e. patients with in-hospital high-risk.Intensive Care Medicine 03/2007; 33(2):286-92. · 5.40 Impact Factor -
Article: Role of B-type natriuretic peptide and echocardiographic indices in predicting the development of acute heart failure following beta-blocker uptitration in chronic heart failure patients with left ventricular systolic dysfunction.
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ABSTRACT: We evaluated the role of clinical, BNP and echocardiographic left ventricular (LV) indices in predicting the development of acute heart failure (HF) following beta-blocker initiation and uptitration in 50 stable CHF patients with LVEF < 40% and creatininemia < 250 micromol/l. Use of NYHA class alone predicted the development of acute HF decompensation in only 56% and the absence of this event in 93% of patients. Use of echocardiographic indices (systolic PAP < 40 mmHg or E/A ratio < 1.4 or EDT > 145 ms) predicted the absence of acute HF decompensation in 100% of patients. Use of NYHA > 3 combined with BNP > 398 pg/ml or with echocardiographic indices (i.e. systolic PAP > 40 mmHg or E/A > 1.4 or EDT < 145 ms) predicted the development of acute HF decompensation in 100% of patients. In conclusion use of BNP and echocardiographic LV filling pressure indices in combination with NYHA class may predict beta-blocker tolerance more accurately than clinical indices alone in patients with LV systolic dysfunction (LVEF < 40%).International journal of cardiology 02/2007; 115(2):257-8. · 7.08 Impact Factor -
Article: [Do you know INR can be measured with a finger-stick device?].
La Presse Médicale 01/2007; 35(12 Pt 1):1785-6. · 0.67 Impact Factor -
Chapter: Cardiopulmonary Exercise Testing in Chronic Heart Failure
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ABSTRACT: Cardiopulmonary exercise testing (CPX) is being increasingly used in patients with chronic heart failure (CHF) for diagnostic and prognostic purposes. It provides major insights regarding the degree of functional impairment, the prognosis, and the effect of treatment. Despite the availability of simple and rapid gas analyzers, the general belief is that the procedure is complex, which is not the case. Peak oxygen uptake (peak VO2) is generally the only variable used to evaluate exercise capacity and prognosis. However, CPX provides a lot of information besides peak VO2.12/2006: pages 99-109; -
Article: Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation.
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ABSTRACT: Cardiac rehabilitation is widely recognized as a medical management procedure that reduces mortality, but the cardiovascular safety of exercise training has not been clearly established. Published data are retrospective or outdated, as patient management has substantially progressed in recent years. The aim of this prospective registry was to determine the current complication rate during exercise performed in the course of cardiac rehabilitation. This study was conducted by the Functional Evaluation and Cardiac Rehabilitation Working Group of the French Society of Cardiology. During a 1-year period, 65 cardiac rehabilitation centers reported that serious events had occurred during or 1 hour after an exercise stress test or a training session. Severe cardiovascular events were validated by a scientific committee. A total of 25,420 patients (78% men; mean age, 61.3 years) were included in the study. Initial indications for cardiac rehabilitation were post-cardiac surgery (coronary bypass, 34.3%; valvular surgery, 18.4%); recent percutaneous coronary intervention (21.6%); and other coronary (13.2%) and noncoronary (12.5%) conditions. The study population underwent 42,419 exercise stress tests and 743,471 patient-hours of exercise training. Twenty severe cardiac events were reported: 5 were related to exercise testing and 15 were related to exercise training. The event rate was 1 per 8484 exercise stress tests and 1 per 49,565 patient-hours of exercise training; the cardiac arrest rate was 1.3 per million patient-hours of exercise. Neither fatal complications nor emergency defibrillations were reported. The frequency of major cardiovascular complications during supervised exercise training in France is quite low.Archives of Internal Medicine 12/2006; 166(21):2329-34. · 11.46 Impact Factor -
Article: Prognostic value of cardiopulmonary exercise variables in chronic heart failure patients with or without beta-blocker therapy.
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ABSTRACT: The prognostic value of exercise-derived variables in the prediction of mortality in patients with chronic heart failure treated by beta blockers continues to be debated. A total of 402 patients with chronic heart failure, including 255 treated with beta blockers, were included and followed for 26 +/- 20 months after the exercise test. On univariate analysis, and in contrast to peak exercise oxygen consumption, the prognostic value of the minute ventilation/carbon dioxide production slope was increased in patients receiving beta-blocker therapy. On multivariate analysis, no independent prognostic variable emerged in patients not on beta-blocker therapy. However, the model that included the circulatory power (peak oxygen uptake x systolic blood pressure), in addition to age, New York Heart Association class, and left ventricular ejection fraction, was the best 1 for patients on beta-blocker therapy. In conclusion, in patients with chronic heart failure, the circulatory power is the exercise variable with the greatest independent prognostic value, compared with the peak exercise oxygen consumption and minute ventilation/carbon dioxide production slope.The American Journal of Cardiology 09/2006; 98(4):500-3. · 3.37 Impact Factor -
Article: Determination of exercise training heart rate in patients on beta-blockers after myocardial infarction.
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ABSTRACT: In patients with coronary artery disease, the target intensity-level of exercise training is usually based on a training heart rate that aims to be close to the upper level of metabolic aerobic exercise. We intended to evaluate whether a training heart rate calculated with the Karvonen formula after a conventional exercise test is comparable with the heart rate at the anaerobic threshold in patients after myocardial infarction treated with beta-blockers and if not to propose a new formula. In this multicenter prospective study, 115 consecutive beta-blocked patients recovering from myocardial infarction performed a cardiopulmonary exercise test to determine the anaerobic threshold. The training heart rate determined by the Karvonen formula was compared with the heart rate at the anaerobic threshold in a derivation sample (n=58) and a validation sample (n=57) of patients. The Karvonen training heart rate was significantly lower than the heart rate at the anaerobic threshold (91+/-5 versus 102+/-17 bpm, P<0.0001) in the first sample of patients and this difference was clinically relevant in 40% of patients. Thus, a 'modified Karvonen training heart rate', equal to 0.8xx(maximum heart rate-resting heart rate)+resting heart rate, was calculated by linear regression in the derivation sample and prospectively assessed in the validation sample. The modified Karvonen training heart rate was closer to the heart rate at the anaerobic threshold than the Karvonen training heart rate, and the difference between the modified Karvonen training heart rate and the heart rate at the anaerobic threshold was clinically relevant in only 5% of patients. The Karvonen formula underestimates the heart rate at the anaerobic threshold in beta-blocked patients, which may lead to undertraining of patients with coronary artery disease; we propose another formula more adapted to these patients.European Journal of Cardiovascular Prevention and Rehabilitation 08/2006; 13(4):538-43. · 2.63 Impact Factor
Top co-authors
Top Journals
Institutions
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2005–2011
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Centre de Réadaptation Cardiaque, Les Grands Prés
Serris, Ile-de-France, France
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2010
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Hospital Santa Cruz
- Cardiology
São Paulo, Estado de Sao Paulo, Brazil
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2006–2008
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Assistance Publique – Hôpitaux de Paris
- Département de Cardiologie
Paris, Ile-de-France, France
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2007
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Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
Boulogne-Billancourt, Ile-de-France, France
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