C Mounier-Vehier

Centre Hospitalier Régional Universitaire de Lille, Lille, Nord-Pas-de-Calais, France

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Publications (191)339.61 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnea (OSA) is the most common factor involved in uncontrolled blood pressure (BP). Management of OSA is part of cardiologist work. We have few data on BP control in a population of OSA followed by cardiologists. We evaluated the prevalence of effective BP control using ambulatory measurement in a population of patients followed in cardiology. Data from 69 OSA patients treated for more than 6 months by continuous positive airway pressure (CPAP) were collected prospectively from March 2012 until December 2012. These patients were divided into 2 groups according to the results of 24-h ambulatory BP monitoring (ABPM). Controlled BP was defined as a 24 h BP <130/80 mmHg. All patients were hypertensive. 44 patients (63 %) had uncontrolled hypertension (HTN). The onset of OSA (p = 0.01) and persistent daytime sleepiness appeared as predictors of uncontrolled BP. Systolic BP (SBP) during consultation and all the ABPM variables were higher in uncontrolled BP patients. Uncontrolled BP was associated with greater left ventricular mass (p = 0.02) and greater diameter of the ascending aorta (p = 0.04). Control of HTN should be evaluated in all OSA patients, using ABPM. The onset of OSA and high SBP during consultation are both factors associated with uncontrolled BP in this population. Repeating ABPM should be of interest for the follow up of these patients.
    High Blood Pressure & Cardiovascular Prevention 04/2015; DOI:10.1007/s40292-015-0088-1
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    ABSTRACT: Resistant hypertension is common, mainly idiopathic, but sometimes related to primary aldosteronism. Thus, most hypertension specialists recommend screening for primary aldosteronism. To optimize the selection of patients whose aldosterone-to-renin ratio (ARR) is elevated from simple clinical and biological characteristics. Data from consecutive patients referred between 1 June 2008 and 30 May 2009 were collected retrospectively from five French 'European excellence hypertension centres' institutional registers. Patients were included if they had at least one of: onset of hypertension before age 40 years, resistant hypertension, history of hypokalaemia, efficient treatment by spironolactone, and potassium supplementation. An ARR>32ng/L and aldosterone>160ng/L in patients treated without agents altering the renin-angiotensin system was considered as elevated. Bayesian network and stepwise logistic regression were used to predict an elevated ARR. Of 334 patients, 89 were excluded (31 for incomplete data, 32 for taking agents that alter the renin-angiotensin system and 26 for other reasons). Among 245 included patients, 110 had an elevated ARR. Sensitivity reached 100% or 63.3% using Bayesian network or logistic regression, respectively, and specificity reached 89.6% or 67.2%, respectively. The area under the receiver-operating-characteristic curve obtained with the Bayesian network was significantly higher than that obtained by stepwise regression (0.93±0.02 vs. 0.70±0.03; P<0.001). In hypertension centres, Bayesian network efficiently detected patients with an elevated ARR. An external validation study is required before use in primary clinical settings. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Archives of cardiovascular diseases 04/2015; DOI:10.1016/j.acvd.2014.09.011 · 1.66 Impact Factor
  • Journal des Maladies Vasculaires 03/2015; 40(2). DOI:10.1016/j.jmv.2014.12.079 · 0.24 Impact Factor
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    ABSTRACT: Based on theoretical evidence, intensity at the crossover point (COP) of substrate utilization could be considered as potential exercise intensity for metabolic syndrome (MetS). This study aimed to examine the effects of a training program at COP on exercise capacity parameters in women with MetS and to compare two metabolic indices (COP and the maximal fat oxidation rate point LIPOXmax®) with ventilatory threshold (VT). Nineteen women with MetS volunteered to perform a 12-week training program on cycle ergometer, with an intensity corresponding to COP. Pre- and post-training values of anthropometric and exercise capacity parameters were compared in order to determine the effects of exercise training. The pre-post training change of COP, LIPOXmax® and VT were also investigated. After training, anthropometric parameters were significantly modified, with a reduction of body mass (3.0 ± 3.0%, p<0.001), fat mass (3.3 ± 3.4%, p<0.001) and body mass index (3.2 ± 3.4%, p<0.001). Exercise capacity was improved after the training program, with significant increase of maximal power output (25.0 ± 18.4%, p<0.001) and maximal oxygen uptake (VO2max = 9.0 ± 11.2%, p<0.01). Lastly, when expressed in terms of power output, COP, LIPOXmax® and VT occurred at a similar exercise intensity but the occurrence of these three indices is different when expressed in terms of oxygen uptake, heart rate or rating of perceived exertion. This study highlights the effectiveness of 12-week training program at COP to improve physical fitness in women with MetS. The relationships between metabolic indices and VT in terms of power output highlight the determination of VT from a shorter maximal exercise as a useful method for the determination of metabolic indices in MetS.
    Medicine and science in sports and exercise 03/2015; DOI:10.1249/MSS.0000000000000674 · 4.46 Impact Factor
  • Journal des Maladies Vasculaires 03/2015; 40(2):129-130. DOI:10.1016/j.jmv.2014.12.048 · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 01/2015; 40(1). DOI:10.1016/j.jmv.2014.12.008 · 0.24 Impact Factor
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    ABSTRACT: Conflicting blood pressure-lowering effects of catheter-based renal artery denervation have been reported in patients with resistant hypertension. We compared the ambulatory blood pressure-lowering efficacy and safety of radiofrequency-based renal denervation added to a standardised stepped-care antihypertensive treatment (SSAHT) with the same SSAHT alone in patients with resistant hypertension. The Renal Denervation for Hypertension (DENERHTN) trial was a prospective, open-label randomised controlled trial with blinded endpoint evaluation in patients with resistant hypertension, done in 15 French tertiary care centres specialised in hypertension management. Eligible patients aged 18-75 years received indapamide 1·5 mg, ramipril 10 mg (or irbesartan 300 mg), and amlodipine 10 mg daily for 4 weeks to confirm treatment resistance by ambulatory blood pressure monitoring before randomisation. Patients were then randomly assigned (1:1) to receive either renal denervation plus an SSAHT regimen (renal denervation group) or the same SSAHT alone (control group). The randomisation sequence was generated by computer, and stratified by centres. For SSAHT, after randomisation, spironolactone 25 mg per day, bisoprolol 10 mg per day, prazosin 5 mg per day, and rilmenidine 1 mg per day were sequentially added from months two to five in both groups if home blood pressure was more than or equal to 135/85 mm Hg. The primary endpoint was the mean change in daytime systolic blood pressure from baseline to 6 months as assessed by ambulatory blood pressure monitoring. The primary endpoint was analysed blindly. The safety outcomes were the incidence of acute adverse events of the renal denervation procedure and the change in estimated glomerular filtration rate from baseline to 6 months. This trial is registered with ClinicalTrials.gov, number NCT01570777. Between May 22, 2012, and Oct 14, 2013, 1416 patients were screened for eligibility, 106 of those were randomly assigned to treatment (53 patients in each group, intention-to-treat population) and 101 analysed because of patients with missing endpoints (48 in the renal denervation group, 53 in the control group, modified intention-to-treat population). The mean change in daytime ambulatory systolic blood pressure at 6 months was -15·8 mm Hg (95% CI -19·7 to -11·9) in the renal denervation group and -9·9 mm Hg (-13·6 to -6·2) in the group receiving SSAHT alone, a baseline-adjusted difference of -5·9 mm Hg (-11·3 to -0·5; p=0·0329). The number of antihypertensive drugs and drug-adherence at 6 months were similar between the two groups. Three minor renal denervation-related adverse events were noted (lumbar pain in two patients and mild groin haematoma in one patient). A mild and similar decrease in estimated glomerular filtration rate from baseline to 6 months was observed in both groups. In patients with well defined resistant hypertension, renal denervation plus an SSAHT decreases ambulatory blood pressure more than the same SSAHT alone at 6 months. This additional blood pressure lowering effect may contribute to a reduction in cardiovascular morbidity if maintained in the long term after renal denervation. French Ministry of Health. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet 01/2015; DOI:10.1016/S0140-6736(14)61942-5 · 39.21 Impact Factor
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    ABSTRACT: The present study examined the effects of a training program at a special exercise intensity—the crossover point of substrate utilization (COP)—on the metabolic abnormalities and cardiovascular risk factors in obese women with metabolic syndrome (MetS). Eighteen postmenopausal obese women with MetS (age, 54.8 ± 8.4 years; height, 160 ± 6 cm) followed a 12-week training program consisting of three 45-minute sessions/wk on a cycle ergometer. The intensity imposed during the training sessions corresponded to COP. Before and after the training program, anthropometric, biological, and blood pressure data were collected and compared. After the training program, body mass (88.4 ± 12.3 kg vs. 85.7 ± 11.1 kg), fat mass (43.2 ± 4.8% vs. 41.8 ± 4.8% body mass), body mass index (34.3 ± 3.9 kg/m2 vs. 33.2 ± 3.6 kg/m2), and waist circumference (105 ± 10 cm vs. 100 ± 9 cm) were significantly lower (p < 0.01). Moreover, fasting plasma glucose was significantly lower after the training program (114 ± 20 mg/dL vs. 107 ± 15 mg/dL; p = 0.02) and the quantitative insulin-sensitivity check index was significantly higher (0.58 ± 0.08 vs. 0.61 ± 0.05; p = 0.05). A significant reduction in systolic blood pressure was also observed (141 ± 15 mmHg vs. 129 ± 11 mmHg; p = 0.02). After the program, the number of patients with fasting plasma hyperglycemia and arterial hypertension was significantly decreased by 54.4% and 44.4%, respectively, and the number of patients with MetS was nonsignificantly reduced by 22.2% (p = 0.10). The present study shows that a training program at COP is an efficient means to treat MetS.
    Journal of exercise science and fitness (JESF) 11/2014; 12(2). DOI:10.1016/j.jesf.2014.09.002 · 0.53 Impact Factor
  • Journal des Maladies Vasculaires 10/2014; 39(5):341. DOI:10.1016/j.jmv.2014.07.070 · 0.24 Impact Factor
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    ABSTRACT: Cardiovascular (CV) diseases are the primary cause of death of women. Since they kill 10 times more than breast cancer, preventive measures should be implemented. According to U.S. recommendations, a woman is either at "CV risk" or at "optimal health status" if she has no risk factors and a perfectly healthy lifestyle. Some risk factors are more deleterious to women (smoking, diabetes, stress, depression, atrial fibrillation); or specific to women (preeclampsia, gestational diabetes, contraception, menopause, headaches). The lifestyle plays a key role for them. The blood pressure measurement is the most frequent opportunity to detect women at risk. CV tests should be performed to all symptomatic women and for those over the age of 45 who want to start practicing sport. The cardiologist can play a key role to improve women's CV health by integrating their hormonal risks. Women can also be a powerful medium of prevention by adopting a healthy lifestyle. From those recommendations concerning women's CV health, there is a great opportunity to initiate a health path for women at high cardiovascular risk. The objectives of the specific path "heart, arteries and women" of University hospital of Lille will be to improve professional practice, awareness of women, educate public authorities and within a few years reduce the epidemic of CVD of French women.
    Annales de cardiologie et d'angeiologie 06/2014; DOI:10.1016/j.ancard.2014.05.001 · 0.30 Impact Factor
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    ABSTRACT: Cardiovascular (CV) diseases are the primary cause of death of women. Since they kill 10 times more than breast cancer, preventive measures should be implemented. According to U.S. recommendations, a woman is either at “CV risk” or at “optimal health status” if she has no risk factors and a perfectly healthy lifestyle. Some risk factors are more deleterious to women (smoking, diabetes, stress, depression, atrial fibrillation); or specific to women (preeclampsia, gestational diabetes, contraception, menopause, headaches). The lifestyle plays a key role for them. The blood pressure measurement is the most frequent opportunity to detect women at risk. CV tests should be performed to all symptomatic women and for those over the age of 45 swho want to start practicing sport. The cardiologist can play a key role to improve women's CV health by integrating their hormonal risks. Women can also be a powerful medium of prevention by adopting a healthy lifestyle. From those recommendations concerning women's CV health, there is a great opportunity to initiate a health path for women at high cardiovascular risk. The objectives of the specific path “heart, arteries and women” of University hospital of Lille will be to improve professional practice, awareness of women, educate public authorities and within a few years reduce the epidemic of CVD of French women.
    Annales de cardiologie et d'angeiologie 01/2014; · 0.30 Impact Factor
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    ABSTRACT: Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France. This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64±11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP]≥140 and/or diastolic BP≥90mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire. Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90mmHg. Significant factors associated with TI were older age (Z=2.35, P<0.05) and sleep apnea syndrome (χ(2)=8.33, P<0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ(2)=4.28, 0.1>P>0.05) and the number of consultations (Z=1.92, 0.1>P>0.05) exhibited a significant trend to be associated with TI. Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.
    Journal des Maladies Vasculaires 10/2013; DOI:10.1016/j.jmv.2013.09.001 · 0.24 Impact Factor
  • C. Mounier-Vehier
    Archives des Maladies du Coeur et des Vaisseaux - Pratique 10/2013; 2013(221):7–8. DOI:10.1016/S1261-694X(13)70516-9
  • Archives des Maladies du Coeur et des Vaisseaux - Pratique 10/2013; 2013(221):28–32. DOI:10.1016/S1261-694X(13)70520-0
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    ABSTRACT: HTA Vasc offers an approved educational program for hypertensive patients at high cardiovascular risk (CVR). METHOD: A telephone survey (December 2011-July 2012) evaluated the benefits of different workshops "my treatment", "my blood pressure" and "my nutrition", more than 6 months after the end of the program. The follow-up data (TS) were compared to inclusion data (T0) and to final data (TF) in 73 hypertensive patients. RESULTS: The follow-up period was 6 to 31 months. The number of hypertensive controlled patients [blood pressure (BP)<140/90mmHg] increased from 55.4% to 75.4% (P=0.0158) in TF, which remained over time. The practice of physical activity increased from 47.9% (T0) to 79.5% (TS) (P=0.001). The follow-up period of 18 months or more was associated with a tendency to weight gain (P=0.0059) and with a decline in physical activity [89.7% (<18 months) to 67.5% (≥18 months) (P=0.0198)]. The practice of self-measurement BP increased from 41.1% (T0) to 71.2% (TS) (P<0.0001); knowledge of the "rule of three" increased from 6.8% (T0) to 74% (TS) (P<0.0001). CONCLUSION: An educational support contributes to a better long-term BP control. The motivation for lifestyle rules decreases with time. The implementation of a structured motivational follow-up could maintain the lifestyle motivation at these CVR patients.
    Annales de cardiologie et d'angeiologie 04/2013; 62(3). DOI:10.1016/j.ancard.2013.04.004 · 0.30 Impact Factor
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    ABSTRACT: Mid-term and long-term mortality after aortic dissection remain high and due to unknown factors. To determine predicting factors at the acute phase associated with mid- and long-term all-cause mortality, patients with type B aortic dissection including intramural hematoma, treated in one referral university center in an area with a population of 4 million, were analyzed over a period of 12 years (from 1996 to 2008). Based on the total population, 77 patients discharged after type B aortic dissection (including 11 intramural hematoma) were recorded as treated with either medical treatment alone (n = 41) or with additional endovascular therapy (n = 36). The mean follow-up period was 50.8 months, with a survival rate of 78 % (17 deaths). Patient history, symptoms, medical treatment, biological parameters, imaging, and intervention during acute phase (more than 150 parameters) were analyzed to identify any relationship with complications and death. Kaplan-Meier survival curve and Cox proportional hazards analyses identified independent predictors of follow-up mortality from any cause. Factors influencing mortality (P < 0.05) were a low systolic blood pressure (SBP) at admission, a thrombocytopenia in the acute period, chronic bronchitis, diameter of ascending aorta, and renin-angiotensin system inhibitor intake. Independent predictors of mortality were chronic bronchitis (P = 0.0022, hazard ratio (HR) 17.5), early thrombocytopenia (P = 0.042, HR 3.5), and admission SBP <120 mmHg (P = 0.0048, HR 7.928). Treated (medical ± endovascular) type B aortic dissection held a worse long-term prognosis, which can be correlated with predicting factors, especially in-hospital thrombocytopenia, and should require closer follow-up.
    Heart and Vessels 04/2013; 29(2). DOI:10.1007/s00380-013-0354-x · 2.11 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):131. DOI:10.1016/j.jmv.2012.12.039 · 0.24 Impact Factor
  • T Caudrelier, P Delsart, G Claisse, C Mounier-Vehier
    Journal des Maladies Vasculaires 03/2013; 38(2):140. DOI:10.1016/j.jmv.2012.12.062 · 0.24 Impact Factor
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    ABSTRACT: Background Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France. Method This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64 ± 11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP] ≥ 140 and/or diastolic BP ≥ 90 mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire. Results Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90 mmHg. Significant factors associated with TI were older age (Z = 2.35, P < 0.05) and sleep apnea syndrome (χ2 = 8.33, P < 0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ2 = 4.28, 0.1 >P > 0.05) and the number of consultations (Z = 1.92, 0.1 > P > 0.05) exhibited a significant trend to be associated with TI. Conclusions Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.
    Journal des Maladies Vasculaires 01/2013; DOI:10.1016/j.jmv.2011.12.081 · 0.24 Impact Factor
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    ABSTRACT: Biological diagnostic criteria for diagnosing aldosterone-producing adenoma (APA) are not well-established. The aim of the study was to establish the best biological predictors of APA. A prospective register was implemented in 17 secondary or tertiary hypertension centres. The inclusion criterion was one of the following: onset of hypertension before 40 years of age; history of hypokalaemia; drug-resistant hypertension (resistant to three drugs); or spironolactone efficiency on BP. Among the 338 collected cases, 192 patients had two aldosterone-to-renin ratio (ARR) determinations (after 1hour supine and at least 1hour upright) on the same occasion. Twenty-five patients (8.2%) had biological hyperaldosteronism and an adrenal adenoma identified by computed tomography. APA was histologically confirmed in all 12 patients who underwent surgery. Histologically proven APAs were used as the 'gold standard' in receiver operating characteristic (ROC) curve analysis. ARRs were computed with a minimum renin value set at 5ng/L to avoid misclassification of so-called 'low-renin hypertension'. To predict an APA, the ARR area under the ROC curve was 0.93. A supine ARR cut-off value of 32ng/ng provided the highest sum of sensitivity (92%) plus specificity (92%). On the basis of an ARR≥32ng/ng in the supine and/or upright position, sensitivity reached 100%. The proposed cut-off value of 32ng/ng for ARR (minimum renin value set at 5ng/L) in one of two determinations had 100% sensitivity and 72% specificity with 20% positive and 100% negative predictive values for diagnosing APA.
    Archives of cardiovascular diseases 12/2012; 105(12):623-30. DOI:10.1016/j.acvd.2012.07.006 · 1.66 Impact Factor

Publication Stats

802 Citations
339.61 Total Impact Points

Institutions

  • 1998–2015
    • Centre Hospitalier Régional Universitaire de Lille
      • Department of Cardio Vascular Surgery
      Lille, Nord-Pas-de-Calais, France
  • 1999–2014
    • CHRU de Strasbourg
      • Pôle Gynécologie-obstétrique
      Strasburg, Alsace, France
  • 2009–2011
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
  • 2003–2010
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2000
    • Centre Hospitalier Intercommunal Fréjus Saint-Raphael
      Saint-Raphaël, Provence-Alpes-Côte d'Azur, France