Eric Bonnefoy

Publications (26)261.19 Total impact

• Article: Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention.

  Charles Amanieu, Ingrid Sanchez, Simona Arion, Eric Bonnefoy, Didier Revel, Philippe Douek, Loic Boussel
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  ABSTRACT: OBJECTIVE: To evaluate the capabilities of delayed enhanced multidetector CT (DE-MDCT), performed immediately after percutaneous coronary intervention (PCI), in predicting myocardial microvascular obstruction (MVO) formation assessed by delayed enhanced MRI (DE-MRI). METHODS: Thirty-two patients presenting with a primary acute myocardial infarction, successfully recanalised by PCI, underwent a DE-MDCT immediately after PCI and a DE-MRI within 1 week. The left ventricle was split into 64 subsegments, rated as "healthy", "infarcted" or "MVO" on DE-MRI. Their mean density was measured on DE-MDCT and calculated relative to the patient's mean healthy myocardium density. Hypoenhanced DE-MDCT subsegments, termed "CT early MVO", were also recorded. Sensitivity and specificity of DE-MDCT for MRI-assessed "MVO" subsegments detection was calculated for mean CT relative density (threshold determined from a ROC analysis), "CT early MVO" and both. RESULTS: Mean CT relative density was higher in MRI-assessed "MVO" than in "infarcted" and "healthy" subsegments (1.82 ± 0.46, 1.43 ± 0.36 and 1.0 ± 0.13 respectively; P < 0.001) leading to a sensitivity and specificity of 94.3 % and 89.2 % for a cutoff of 1.36. Sensitivity and specificity were respectively 16.9 % and 99.8 % for "CT early MVO" and 95.3 % and 89.3 % when considering the two patterns. CONCLUSION: DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation. KEY POINTS : • Myocardial microvascular obstruction (MVO) is an important prognostic sequel following myocardial infarction. • MVO can be accurately predicted by multidector CT (MDCT). • Both hypo- and hyperenhanced myocardial areas can be analysed by MDCT. • MDCT may become a useful prognostic tool for acute MI outcome.
  European Radiology 05/2013; · 3.22 Impact Factor
• Source

  Available from: pierre-yves Courand

  Article: Arrhythmogenic effect of flecainide toxicity.

  Pierre-Yves Nd Courand, Franck Sibellas, Sylvain Ranc, Audrey Mullier, Gilbert Kirkorian, Eric Bonnefoy
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  ABSTRACT: Flecainide is a class 1C antiarrhythmic drug especially used for the management of supraventricular arrhythmia. In overdose cases, flecainide can induce life treating ventricular arrhythmias and cardiogenic shock. We report the case of a 72-year-old woman admitted to our intensive care unit for a regular monomorphic wide complex tachycardia (QRS duration 240 ms, right bundle branch block and superior axis morphology) without apparent P waves. Clinical examination showed slight left congestive heart failure signs without cardiogenic shock. An intravenous bolus of 10 mg adenosine 5'-triphosphate (ATP) was ineffective to stop the tachycardia. The diagnosis of ventricular tachycardia induced by flecainide overdose was considered. 500 mL of intravenous 84‰ sodium bicarbonate was administrated. The patient's QRS narrowed immediately and 12-lead ECG showed sinus rhythm. Blood samples confirmed the flecainide overdose and the clinical status progressively improved.
  Cardiology journal 01/2013; 20(2):203-5. · 1.31 Impact Factor
• Article: Pulseless electrical activity after myocardial infarction: not always a left ventricular free wall rupture.

  Didier Bresson, Nicolas Girerd, Anissa Bouali, Jean Turc, Eric Bonnefoy
  The American journal of emergency medicine 07/2012; · 1.54 Impact Factor
• Source

  Available from: pierre-yves Courand

  Article: Churg-Strauss syndrome presenting with acute myocarditis and cardiogenic shock.

  Pierre-Yves Courand, Pierre Croisille, Chahéra Khouatra, Vincent Cottin, Gilbert Kirkorian, Eric Bonnefoy
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  ABSTRACT: Churg-Strauss syndrome (CSS) is a multisystem disorder characterised by asthma, prominent peripheral blood eosinophilia, and vasculitis signs. We report the case of a 22 year-old man admitted to the intensive care unit for acute myocarditis complicated with cardiogenic shock. Eosinophilia, history of asthma, lung infiltrates, paranasal sinusitis, glomerulonephritis, and abdominal pain suggested the diagnosis of CSS. Cardiac MRI confirmed cardiac involvement with a diffuse subendocardial delayed enhancement of the left ventricular wall, and a left ventricular ejection fraction (LVEF) of 30%. Acute myocarditis was confirmed with myocardial biopsy. The patient was successfully treated with systemic corticosteroids, intravenous cyclophosphamide, vasopressor inotropes, intra-aortic balloon pump and mechanical ventilation, and was discharged 21 days later. One year after diagnosis, the patient was asymptomatic. The eosinophilic cell count was normal. Follow-up MRI at one year showed LVEF of 40% with persistent delayed enhancement. Cardiac involvement by CSS requires immediate therapy with corticosteroids and cyclophosphamide, which may allow recovery of the cardiac function.
  Heart Lung &amp Circulation 09/2011; 21(3):178-81. · 1.20 Impact Factor
• Article: Preliminary experience with Impella Recover(®) LP5.0 in nine patients with cardiogenic shock: a new circulatory support system in the intensive cardiac care unit.

  Didier Bresson, Franck Sibellas, Fadi Farhat, Olivier Jegaden, Gilbert Kirkorian, Eric Bonnefoy
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  ABSTRACT: Cardiogenic shock is associated with high mortality. We report our experience with the short-term left ventricular axial pump Impella LP5.0 in nine patients with severe ischaemic heart failure. Six patients (group 1) presented with cardiogenic shock at the acute phase of an ST elevation myocardial infarction. Three patients (group 2) had severe ischaemic cardiomyopathy with temporary contra-indication to LVAD or transplantation. We measured haemodynamic and metabolic variables up to 96hours and recorded morbidity, mechanical pump failures, and mortality up to one year postimplantation. In all patients the Impella LP5.0 was safely placed through the right subclavian artery. Cardiac power output increased from 0.64 (0.07) W to 0.94 (0.44) W and 1.02 (0.30) W at 24 and 72hours, respectively. The Impella LP5.0 remained in place for 12 (7.2) days. In group 1, five patients were in INTERMACS Profile 3 at the time of pump insertion. Three could be weaned and survived. One patient in INTERMACS Profile 1 died of intractable heart failure within hours. In group 2, two of three patients underwent heart transplantation. Haemorrhage requiring transfusions was observed in four patients but only one case was directly related to the Impella LP5.0. Left ventricular assistance with the Impella LP5.0 appears to be well tolerated. It may be especially useful in patients with acute myocardial infarction complicated by cardiogenic shock who achieve INTERMACS Profile 3 with initial treatment.
  Archives of cardiovascular diseases 08/2011; 104(8-9):458-64. · 0.66 Impact Factor
• Article: The influence of time from symptom onset and reperfusion strategy on 1-year survival in ST-elevation myocardial infarction: a pooled analysis of an early fibrinolytic strategy versus primary percutaneous coronary intervention from CAPTIM and WEST.

  Cynthia M Westerhout, Eric Bonnefoy, Robert C Welsh, Philippe Gabriel Steg, Florent Boutitie, Paul W Armstrong
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  ABSTRACT: The CAPTIM trial suggested a survival benefit of prehospital fibrinolysis (FL) compared to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) with a presentation delay of <2 hours. We examined the relationship between reperfusion strategy and time from symptom onset on 1-year mortality in a combined analysis of 1,168 patients with STEMI. Individual patient data from CAPTIM (n = 840, 1997-2000) and the more recent WEST trial (n = 328, 2003-2005) were pooled. Median age was 58 years, 81% were men, and 41% had anterior myocardial infarction; 640 patients were randomized to FL versus 528 patients to PCI. Both arms received contemporary adjunctive medical therapy. Presentation delay (ie, symptom onset to randomization) was similar in FL and PCI patients (median 105 [72-158] vs 106 [74-162] minutes, P = .712). Rescue PCI after FL occurred in 26% and 27%, and 30-day PCI, in 70% and 71% in CAPTIM and WEST, respectively. Mortality was not different between FL and PCI (4.6% vs 6.5%, P = .263); however, the interaction between presentation delay and treatment was significant (P = .043). Benefit with FL was observed with time <2 hours (2.8% [FL] vs 6.9% [PCI], P = .021, hazard ratio [HR] 0.43, 95% CI 0.20-0.91), whereas beyond 2 hours, no treatment difference was observed (6.9% [FL] vs 6.0% [PCI], P = .529, HR 1.23, 95% CI 0.61-2.46). A strategy of early FL demonstrated a reduction in 1-year mortality compared to primary PCI in early presenters. Time from symptom onset should be a key consideration when selecting reperfusion therapy for STEMI.
  American heart journal 02/2011; 161(2):283-90. · 4.65 Impact Factor
• Article: Prehospital high-dose tirofiban in patients undergoing primary percutaneous intervention. The AGIR-2 study.

  Carlos El Khoury, Pierre-Yves Dubien, Catherine Mercier, Loic Belle, Guilaume Debaty, Olivier Capel, Thibault Perret, Dominique Savary, Patrice Serre, Eric Bonnefoy
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  ABSTRACT: Compared with administration in the catheterization laboratory, early treatment with glycoprotein IIb/IIIa inhibitors provides benefits to patients with ST-segment elevation myocardial infarction who undergo primary percutaneous intervention. Whether this benefit is maintained on top of a 600 mg loading dose of clopidogrel is unknown. In a multicentre, controlled, randomized study, 320 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention received a high-dose bolus of tirofiban given either in the ambulance (prehospital group) or in the catheterization laboratory. The primary endpoint was a TIMI flow grade 2-3 of the infarct-related vessel at initial angiography. Secondary endpoints included ST-segment resolution 1h after percutaneous coronary intervention and peak serum troponin I concentration. Tirofiban was administered 48 (95% confidence interval 21.4-75.0) min earlier in the prehospital group. At initial angiography, the combined incidence of TIMI 2-3 flow was 39.7% in the catheterization-laboratory group and 44.2% in the prehospital group (p=0.45). No difference was found on postpercutaneous intervention angiography or peak troponin concentration. Complete ST-segment resolution 60 min after the start of intervention was 55.4% in the catheterization-laboratory group and 52.6% in the prehospital group (p=0.32). Prehospital initiation of high-dose bolus tirofiban did not improve significantly initial TIMI 2 or 3 flow of the infarct-related artery or complete ST-segment resolution after coronary intervention compared with initiation of tirofiban in the catheterization laboratory (NCT00538317).
  Archives of cardiovascular diseases 05/2010; 103(5):285-92. · 0.66 Impact Factor
• Article: Effect of cyclosporine on left ventricular remodeling after reperfused myocardial infarction.

  Nathan Mewton, Pierre Croisille, Gerald Gahide, Gilles Rioufol, Eric Bonnefoy, Ingrid Sanchez, Thien Tri Cung, Catherine Sportouch, Denis Angoulvant, Gérard Finet, Xavier André-Fouët, Geneviève Derumeaux, Christophe Piot, Hélène Vernhet, Didier Revel, Michel Ovize
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  ABSTRACT: This study examined the effect of a single dose of cyclosporine administered at the time of reperfusion on left ventricular (LV) remodeling and function by cardiac magnetic resonance 5 days and 6 months after myocardial infarction. In a human study, administration of cyclosporine at the time of acute reperfusion was associated with a smaller infarct size. Twenty-eight patients of the original cyclosporine study had an acute (at 5 days) and a follow-up (at 6 months) cardiac magnetic resonance study to determine LV volumes, mass, ejection fraction, myocardial wall thickness in infarcted and remote noninfarcted myocardium, and infarct size. There was a persistent reduction in infarct size at 6 months in the cyclosporine group compared with the control group of patients (29 +/- 15 g vs. 38 +/- 14 g; p = 0.04). There was a significant reduction of LV end-systolic volume (and a trend for LV end-diastolic volume; p = 0.07) in the cyclosporine group compared with the control group, both at 5 days and 6 months after infarction. There was no significant difference between the 2 groups in either global LV mass or regional wall thickness of the remote noninfarcted myocardium at 5 days or 6 months. Attenuation of LV dilation and improvement of LV ejection fraction by cyclosporine at 6 months were correlated with infarct size reduction. Cyclosporine used at the moment of acute myocardial infarction reperfusion persistently reduces infarct size and does not have a detrimental effect on LV remodeling. These results are preliminary and must be supported by further studies. (Ciclosporin A and Acute Myocardial Infarction; NCT00403728).
  Journal of the American College of Cardiology 03/2010; 55(12):1200-5. · 14.16 Impact Factor
• Article: Giving the ischaemic heart a shot in the arm.

  Michel Ovize, Eric Bonnefoy
  The Lancet 02/2010; 375(9716):699-700. · 38.28 Impact Factor
• Article: Comparison of visual scoring and quantitative planimetry methods for estimation of global infarct size on delayed enhanced cardiac MRI and validation with myocardial enzymes.

  Nathan Mewton, Didier Revel, Eric Bonnefoy, Michel Ovize, Pierre Croisille
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  ABSTRACT: Although delayed enhanced CMR has become a reference method for infarct size quantification, there is no ideal method to quantify total infarct size in a routine clinical practice. In a prospective study we compared the performance and post-processing time of a global visual scoring method to standard quantitative planimetry and we compared both methods to the peak values of myocardial biomarkers. This study had local ethics committee approval; all patients gave written informed consent. One hundred and three patients admitted with reperfused AMI to our intensive care unit had a complete CMR study with gadolinium-contrast injection 4±2 days after admission. A global visual score was defined on a 17-segment model and compared with the quantitative planimetric evaluation of hyperenhancement. The peak values of serum Troponin I (TnI) and creatine kinase (CK) release were measured in each patient. The mean percentage of total left ventricular myocardium with hyperenhancement determined by the quantitative planimetry method was (20.1±14.6) with a range of 1-68%. There was an excellent correlation between quantitative planimetry and visual global scoring for the hyperenhancement extent's measurement (r=0.94; y=1.093x+0.87; SEE=1.2; P<0.001) The Bland-Altman plot showed a good concordance between the two approaches (mean of the differences=1.9% with a standard deviation of 4.7). Mean post-processing time for quantitative planimetry was significantly longer than visual scoring post-processing time (23.7±5.7min vs 5.0±1.1min respectively, P<0.001). Correlation between peak CK and quantitative planimetry was r=0.82 (P<0.001) and r=0.83 (P<0.001) with visual global scoring. Correlation between peak Troponin I and quantitative planimetry was r=0.86 (P<0.001) and r=0.85 (P<0.001) with visual global scoring. A visual approach based on a 17-segment model allows a rapid and accurate assessment of the myocardial global delayed enhancement. This scoring method could be used on a daily practice and useful for the management strategy of post-MI patients.
  European journal of radiology 12/2009; 78(1):87-92. · 2.65 Impact Factor
• Article: Impact of stroke on therapeutic decision making in infective endocarditis.

  Laurent Derex, Eric Bonnefoy, François Delahaye
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  ABSTRACT: The diagnosis of infective endocarditis (IE) must be made as soon as possible to initiate antimicrobial therapy and identify patients at high risk for complications who may be best managed by early surgery. Cerebral complications make the timing of cardiac surgery difficult. The safety of cardiopulmonary bypass (CPB) surgery in stroke patients remains controversial. Stroke complicates the outcome of left-sided IE in 20-40% of cases and is associated with poor outcome. The risk of stroke in IE falls rapidly after the initiation of effective antimicrobial therapy. The risk of embolization is highest during the first week of therapy, and in patients with mobile vegetations or vegetations >10 mm in diameter occurring on the anterior mitral leaflet. Indications for valvular surgery are significant congestive heart failure or valvular regurgitation, myocardial abscess, persistent bacteremia and large-size vegetations with high risk of embolism. Decisions regarding surgical intervention in patients with IE should be individualized. In the absence of large prospective studies, optimal timing of surgery is still discussed when stroke complicates IE. A multidisciplinary assessment of the situation, involving cardiologists, cardiac surgeons, infectiologists and neurologists, is recommended. Estimating the risk of recurrence after a first embolic event and careful evaluation of the indication for valve replacement are essential steps in making the therapeutic decision. Surgery should be delayed if possible in the event of large cerebral infarction or ICH in order to prevent neurological deterioration. It has been suggested that valve replacement should be considered within the first 72 h if the patients with brain infarction have severe heart failure, otherwise after 4 weeks. Early surgery appears safe in patients presenting transient ischemic attacks or "silent" cerebral embolism.
  Journal of Neurology 10/2009; 257(3):315-21. · 3.47 Impact Factor
• Article: Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up.

  Eric Bonnefoy, Philippe Gabriel Steg, Florent Boutitie, Pierre-Yves Dubien, Frédéric Lapostolle, Jérome Roncalli, Frederic Dissait, Gérald Vanzetto, Alain Leizorowicz, Gilbert Kirkorian, C Mercier, E P McFadden, P Touboul
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  ABSTRACT: The CAPTIM (Comparison of primary Angioplasty and Pre-hospital fibrinolysis In acute Myocardial infarction) study found no evidence that a strategy of primary angioplasty was superior in terms of 30-day outcomes to a strategy of pre-hospital fibrinolysis with transfer to an interventional facility in patients managed early at the acute phase of an acute myocardial infarction. The present analysis was designed to compare both strategies at 5 years. The CAPTIM study included 840 patients managed in a pre-hospital setting within 6 h of an acute ST-segment elevation myocardial infarction. Patients were randomized to either a primary angioplasty (n = 421) or a pre-hospital fibrinolysis (rt-PA) with immediate transfer to a centre with interventional facilities (n = 419). Long-term follow-up was obtained in blinded fashion from 795 patients (94.6%). Using an intent-to-treat analysis, all-cause mortality at 5 years was 9.7% in the pre-hospital fibrinolysis group when compared with 12.6% in the primary angioplasty group [HR 0.75 (95% CI, 0.50-1.14); P = 0.18]. For patients included within 2 h, 5 year mortality was 5.8% in the pre-hospital fibrinolysis group when compared with 11.1% in the primary angioplasty group [HR 0.50 (95% CI, 0.25-0.97); P = 0.04], whereas it was, respectively, 14.5 and 14.4% in patients included after 2 h [HR 1.02, (95% CI 0.59-1.75), P = 0.92]. The 5-year follow-up is consistent with the 30-day outcomes of the trial, showing similar mortality for primary percutaneous coronary intervention and a policy of pre-hospital lysis followed by transfer to an interventional center. In addition, for patients treated within 2 h of symptom onset, 5-year mortality was lower with pre-hospital lysis.
  European Heart Journal 06/2009; 30(13):1598-606. · 10.48 Impact Factor
• Article: Increased levels of endothelial microparticles CD144 (VE-Cadherin) positives in type 2 diabetic patients with coronary noncalcified plaques evaluated by multidetector computed tomography (MDCT).

  Sophie Bernard, Romaric Loffroy, André Sérusclat, Loïc Boussel, Eric Bonnefoy, Chantal Thévenon, Muriel Rabilloud, Didier Revel, Philippe Moulin, Philippe Douek
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  ABSTRACT: The combination of both morphological and cellular markers of subclinical atherosclerosis, in addition to conventional risk factors, may help to improve cardiovascular prevention in type 2 diabetic patients. The aim of our cross-sectional study was to evidence a putative increase in endothelial (EMP) or platelet (PMP) microparticles, in type 2 diabetic patients with coronary noncalcified plaques detected by multidetector CT (MDCT). Microparticles and coronary MDCT were assessed in 56 type 2 diabetic patients with different cardiovascular risk levels. Both EMP (r=0.35, p=0.022) and PMP (rho=0.34, p=0.022) were correlated with hsCRP. EMP were elevated in patients with acute coronary syndromes (p=0.034). EMP count was significantly higher in the presence of noncalcified diseased segments (p=0.01). By contrast, there was no association between hsCRP and noncalcified atheroma. This increase in EMP in noncalcified diseased segment carriers remained borderline significant after adjustment for coronary heart disease and hsCRP. Conversely, there was no association of PMP count with noncalcified diseased segments and no difference in PMP count between patients with and without acute coronary syndrome. No significant association between either EMP and PMP counts and mixed or calcified diseased segments was observed. We report for the first time an association between plasma EMP-CD144+ and coronary noncalcified plaques assessed by MDCT in a population of type 2 diabetic patients. EMP might be used as a surrogate marker of unstable plaques, and might help to improve cardiovascular prediction in diabetic patients with intermediate risk.
  Atherosclerosis 09/2008; 203(2):429-35. · 3.79 Impact Factor
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  Available from: suc.org.uy

  Article: Effect of cyclosporine on reperfusion injury in acute myocardial infarction.

  Christophe Piot, Pierre Croisille, Patrick Staat, Hélène Thibault, Gilles Rioufol, Nathan Mewton, Rachid Elbelghiti, Thien Tri Cung, Eric Bonnefoy, Denis Angoulvant, [......], Franck Raczka, Catherine Sportouch, Gerald Gahide, Gérard Finet, Xavier André-Fouët, Didier Revel, Gilbert Kirkorian, Jean-Pierre Monassier, Geneviève Derumeaux, Michel Ovize
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  ABSTRACT: Experimental evidence suggests that cyclosporine, which inhibits the opening of mitochondrial permeability-transition pores, attenuates lethal myocardial injury that occurs at the time of reperfusion. In this pilot trial, we sought to determine whether the administration of cyclosporine at the time of percutaneous coronary intervention (PCI) would limit the size of the infarct during acute myocardial infarction. We randomly assigned 58 patients who presented with acute ST-elevation myocardial infarction to receive either an intravenous bolus of 2.5 mg of cyclosporine per kilogram of body weight (cyclosporine group) or normal saline (control group) immediately before undergoing PCI. Infarct size was assessed in all patients by measuring the release of creatine kinase and troponin I and in a subgroup of 27 patients by performing magnetic resonance imaging (MRI) on day 5 after infarction. The cyclosporine and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before PCI. The release of creatine kinase was significantly reduced in the cyclosporine group as compared with the control group (P=0.04). The release of troponin I was not significantly reduced (P=0.15). On day 5, the absolute mass of the area of hyperenhancement (i.e., infarcted tissue) on MRI was significantly reduced in the cyclosporine group as compared with the control group, with a median of 37 g (interquartile range, 21 to 51) versus 46 g (interquartile range, 20 to 65; P=0.04). No adverse effects of cyclosporine administration were detected. In our small, pilot trial, administration of cyclosporine at the time of reperfusion was associated with a smaller infarct by some measures than that seen with placebo. These data are preliminary and require confirmation in a larger clinical trial.
  New England Journal of Medicine 08/2008; 359(5):473-81. · 53.30 Impact Factor
• Article: Assessment of acute myocardial infarction using MDCT after percutaneous coronary intervention: comparison with MRI.

  Loïc Boussel, Michael Ribagnac, Eric Bonnefoy, Patrick Staat, Brett M Elicker, Didier Revel, Philippe Douek
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  ABSTRACT: Imaging to determine myocardial infarct size is difficult in the emergency setting because the current gold standards, MRI and nuclear medicine techniques, are difficult to perform in unstable patients. Delayed enhanced MDCT has recently been proposed as a technique to study contrast uptake in infarcted myocardium. In this study, we compared the extent of acute myocardial infarction as measured by delayed enhanced MDCT performed immediately after percutaneous coronary intervention (PCI) without an additional iodine injection with that measured by delayed gadolinium-enhanced MRI. Nineteen consecutive patients presenting with primary acute myocardial infarction underwent delayed enhanced MDCT immediately after coronary angioplasty and underwent delayed enhanced MRI within 8 days of angioplasty. Only patients with a thrombolysis in myocardial infarction (TIMI) score of 0 or 1 of the culprit coronary artery before endovascular angioplasty and TIMI score of 2 or 3 after angioplasty were selected. Comparison of delayed enhanced MDCT and delayed enhanced MRI was performed by three observers and focused on identifying the involved segments and determining the transmural extent of enhancement and infarct size. The mean signal intensity was significantly higher in the involved territory than in healthy myocardium: 197 +/- 81 H versus 71 +/- 20 H, respectively (p < 0.0001). We found significant agreement between delayed enhanced MDCT and delayed enhanced MRI for the number of involved segments, transmural extent of enhancement, and infarct size (r(2) = 0.74, 0.76, and 0.67, respectively; p < 0.0001) with good interobserver reproducibility (kappa = 0.8). The results of our study show that delayed enhanced MDCT allows accurate visualization of early myocardial contrast uptake compared with delayed enhanced MRI and does not require an additional contrast injection after PCI.
  American Journal of Roentgenology 08/2008; 191(2):441-7. · 2.78 Impact Factor
• Article: The right axillary artery approach for the Impella Recover LP 5.0 microaxial pump.

  Thomas Sassard, Aurelien Scalabre, Eric Bonnefoy, Ingrid Sanchez, Fadi Farhat, Olivier Jegaden
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  ABSTRACT: As a ventricular unloading catheter, the Impella Recover LP 5.0 (Abiomed, Danvers, MA) is appropriate for temporary circulatory assistance in severe left ventricular dysfunction. We describe a new implantation approach to the right axillary artery with the aims of avoiding vascular problems due to atherosclerosis of the peripheral arteries and improving patient mobility and rehabilitation during mechanical support.
  The Annals of thoracic surgery 05/2008; 85(4):1468-70. · 3.74 Impact Factor
• Article: Long-term benefit of postconditioning.

  Hélène Thibault, Christophe Piot, Patrick Staat, Laurence Bontemps, Catherine Sportouch, Gilles Rioufol, Thien Tri Cung, Eric Bonnefoy, Denis Angoulvant, Jean-François Aupetit, Gérard Finet, Xavier André-Fouët, Jean Christophe Macia, Franck Raczka, Rolland Rossi, Rolland Itti, Gilbert Kirkorian, Geneviève Derumeaux, Michel Ovize
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  ABSTRACT: We previously demonstrated that ischemic postconditioning decreases creatine kinase release, a surrogate marker for infarct size, in patients with acute myocardial infarction. Our objective was to determine whether ischemic postconditioning could afford (1) a persistent infarct size limitation and (2) an improved recovery of myocardial contractile function several months after infarction. Patients presenting within 6 hours of the onset of chest pain, with suspicion for a first ST-segment-elevation myocardial infarction, and for whom the clinical decision was made to treat with percutaneous coronary intervention, were eligible for enrollment. After reperfusion by direct stenting, 38 patients were randomly assigned to a control (no intervention; n=21) or postconditioned group (repeated inflation and deflation of the angioplasty balloon; n=17). Infarct size was assessed both by cardiac enzyme release during early reperfusion and by 201thallium single photon emission computed tomography at 6 months after acute myocardial infarction. At 1 year, global and regional contractile function was evaluated by echocardiography. At 6 months after acute myocardial infarction, single photon emission computed tomography rest-redistribution index (a surrogate for infarct size) averaged 11.8+/-10.3% versus 19.5+/-13.3% in the postconditioned versus control group (P=0.04), in agreement with the significant reduction in creatine kinase and troponin I release observed in the postconditioned versus control group (-40% and -47%, respectively). At 1 year, the postconditioned group exhibited a 7% increase in left ventricular ejection fraction compared with control (P=0.04). Postconditioning affords persistent infarct size reduction and improves long-term functional recovery in patients with acute myocardial infarction.
  Circulation 03/2008; 117(8):1037-44. · 14.74 Impact Factor
• Article: Postconditioning the human heart.

  Patrick Staat, Gilles Rioufol, Christophe Piot, Yves Cottin, Thien Tri Cung, Isabelle L'Huillier, Jean-François Aupetit, Eric Bonnefoy, Gérard Finet, Xavier André-Fouët, Michel Ovize
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  ABSTRACT: In animal models, brief periods of ischemia performed just at the time of reperfusion can reduce infarct size, a phenomenon called postconditioning. In this prospective, randomized, controlled, multicenter study, we investigated whether postconditioning may protect the human heart during coronary angioplasty for acute myocardial infarction. Thirty patients, submitted to coronary angioplasty for ongoing acute myocardial infarction, contributed to the study. Patients were randomly assigned to either a control or a postconditioning group. After reperfusion by direct stenting, control subjects underwent no further intervention, whereas postconditioning was performed within 1 minute of reflow by 4 episodes of 1-minute inflation and 1-minute deflation of the angioplasty balloon. Infarct size was assessed by measuring total creatine kinase release over 72 hours. Area at risk and collateral blood flow were estimated on left ventricular and coronary angiograms. No adverse events occurred in the postconditioning group. Determinants of infarct size, including ischemia time, size of the area at risk, and collateral flow, were comparable between the 2 groups. Area under the curve of creatine kinase release was significantly reduced in the postconditioning compared with the control group, averaging 208 984+/-26 576 compared with 326,095+/-48,779 (arbitrary units) in control subjects, ie, a 36% reduction in infarct size. Blush grade, a marker of myocardial reperfusion, was significantly increased in postconditioned compared with control subjects: 2.44+/-0.17 versus 1.95+/-0.27, respectively (P<0.05). This study suggests that postconditioning by coronary angioplasty protects the human heart during acute myocardial infarction.
  Circulation 10/2005; 112(14):2143-8. · 14.74 Impact Factor
• Article: Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial.

  Eric Bonnefoy, Philippe Gabriel Steg, Sylvie Chabaud, Pierre-Yves Dubien, Frédéric Lapostolle, Frédéric Boudet, Jean-Michel Lacroute, Frederic Dissait, Gérald Vanzetto, Alain Leizorowicz, Paul Touboul
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  ABSTRACT: The CAPTIM study randomized patients managed within 6 h of acute ST-segment elevation myocardial infarction to primary angioplasty or prehospital fibrinolysis (rt-PA), with immediate transfer to a centre with interventional facilities. It found a similar incidence of the primary endpoint of death, recurrent MI, or stroke at 30 days with both strategies. We report here the outcome in the diabetic subgroup. The relationship of diabetic status (diabetics, n=103, non-diabetics, n=731) and treatment strategy with the occurrence of the primary endpoint and of death was analysed. Compared with non-diabetics, diabetics had a higher baseline risk profile, a higher rate of the primary endpoint (14.6 vs. 5.6%; P=0.002), and a high rate of mortality (8.7 vs. 3.1%; P=0.01) at 30 days. The incidence of the primary endpoint tended to be higher in diabetics randomized to prehospital fibrinolysis compared with those randomized to primary angioplasty [21.7 vs. 8.8% (10/46 vs. 5/57); RR: 2.47 (0.91-6.74); P=0.09]. This difference was driven by the higher mortality in the fibrinolysis group [13.0 vs. 5.3% (6/46 vs. 3/57); RR: 2.47 (0.7-9.4); P=0.29]. For non-diabetics, no such trend was observed. Compared with non-diabetics, diabetics had a much higher rate of rescue angioplasty (41.4 vs. 23.5%; P=0.01) and a higher mortality after rescue angioplasty [17.4 vs. 0% (4/23 vs. 0/90); P=0.001]. These results suggest that diabetic patients presenting within 6 h of an acute myocardial infarction may derive particular benefit from a strategy of primary angioplasty. However, the small number of diabetic patients in this subgroup analysis does not allow a final conclusion and a specifically designed study is warranted.
  European Heart Journal 10/2005; 26(17):1712-8. · 10.48 Impact Factor
• Article: 150 microgram intracoronary adenosine bolus for accurate fractional flow reserve assessment of angiographically intermediate coronary stenosis.

  Gilles Rioufol, Jean-Raymond Caignault, Gérard Finet, Patrick Staat, Eric Bonnefoy, Guy de Gévigney, Roland Rossi, Xavier André-Fouët
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  ABSTRACT: Aims: Fractional flow reserve measurement is based upon achieving maximum hyperemia. A 40 microg intracoronary (IC) adenosine bolus sometimes seems insufficient, and we therefore sought to assess the possible role of 100-150 microg boli in routine.Methods and results: 108 intermediate (49+/-16%) stenoses were consecutively studied with 6F catheters. A history of myocardial infarction in the territory of the explored artery or myocardial hypertrophy were the exclusion criteria. Mean FFR was 0.82+/-0.12 with a 40 microg adenosine bolus and decreased to 0.80+/-0.12 and 0.80+/-13 respectively with 100microg and 150 microg boli (P<0.001 vs 40microg in both cases; 100 vs 150 microg, NS). The 40 microg bolus failed to diagnose 8 out of 30 (27%) significant stenoses (i.e., final FFR <0.75). The large boli led to 12 (11%) transient asymptomatic and spontaneously resolving AV blocks without other side-effects.Conclusion: FFR underestimated a quarter of intermediate stenoses with the currently used 40microg IC adenosine bolus. A large bolus up to 150 microg appears to be accurate and safe for routine FFR measurement.
  EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 08/2005; 1(2):204-7. · 3.29 Impact Factor