Center Cardiologique du Nord

Tours, France

Center Cardiologique du Nord

Tours, France
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Calvet D.,University of Paris Descartes | Calvet D.,Center Hospitalier Sainte Anne | Touze E.,University of Paris Descartes | Touze E.,Center Hospitalier Sainte Anne | And 6 more authors.
International Journal of Stroke | Year: 2014

Background: Aortic stiffness is an independent predictor of coronary events. Aims: We assessed the predictive value of aortic stiffness for ≥50% asymptomatic coronary artery disease in a stroke/transient ischemic attack population. Methods: We enrolled 300 consecutive patients aged 45-75 years with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary artery disease. Coronary artery disease was assessed with 64-section computed tomography coronary angiography and all patients had a detailed cervicocephalic arterial work-up. Aortic stiffness was determined from carotid-femoral pulse wave velocity with 9·6m/s as cutoff value. The predictive value of aortic stiffness was assessed by logistic regression and reclassification tables method after adjustment for the Framingham Risk Score and the presence of cervicocephalic stenosis, which were previously shown to be independent predictor of ≥50% asymptomatic coronary artery disease. Results: Among the 274 included patients who had computed tomography coronary angiography, 26% (95% CI, 21%-32%) had an increased stiffness (pulse wave velocity>9·6m/s) and 18% (14%-23%) had ≥50% asymptomatic coronary artery disease. Increased aortic stiffness was associated with the presence of ≥50% asymptomatic coronary artery disease, both in univariate (odds ratio=3·4 [1·8-6·4]) and multivariate analyses (odds ratio=2·3 [1·2-4·7]) after adjustment for Framingham Risk Score and presence of cervicocephalic stenosis. After carotid-femoral pulse wave velocity was added to the standard model including Framingham Risk Score and the presence of cervicocephalic stenosis, net reclassification improvement was 12·6% (P<0·005), integrated discrimination index was 2·51% (P=0·025), and model fit was improved (likelihood ratio=4·99, P=0·025). Conclusions: In stroke/transient ischemic attack patients, aortic pulse wave velocity improves the prediction of ≥50% asymptomatic coronary artery disease beyond classical risk factors. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Habib G.,Marseille University Hospital Center | Charron P.,University Pierre and Marie Curie | Eicher J.-C.,CHU Dijon | Giorgi R.,La Timone Hospital | And 7 more authors.
European Journal of Heart Failure | Year: 2011

Aims The clinical features, prognosis, and even definition of left ventricular non-compaction (LVNC) are still the subject of much debate. The aim of this registry was to describe the clinical, echocardiographic, and prognostic features of LVNC in France. The main endpoint was to assess clinical and echocardiographic predictors of adverse outcome, defined as death or heart transplantation. Methods and resultsBetween 2004 and 2006, 154 suspected cases of LNVC were identified from a nationwide survey in France. The diagnosis of LVNC was confirmed in 105 cases by echocardiographic evaluation in a core laboratory. Clinical and echocardiographic data for the 105 cases of LVNC are presented. Left ventricular non-compaction was first detected from heart failure symptoms in 45 patients, rhythm disorders in 12, and familial screening in 8. Left ventricular ejection fraction (LVEF) was <30 in 46 of patients, but ≥50 in 16. The latter had less symptoms of severe heart failure (11 vs. 54%, P = 0.001), but similar extension of the NC zone. During 2.33 ± 1.47 years of follow-up, several complications occurred, including severe heart failure in 33 patients, transplantation in 9, ventricular arrhythmia in 7, embolic events in 9, and death in 12. Factors associated with death or heart transplantation were NYHA 3 or 4 (HR = 6.69; P = 0.0007), high LV filling pressures (HR = 7.59; P = 0.001), LVEF (HR = 0.93; P = 0.006), and hospitalization for heart failure (HR = 13.55; P < 0.0001). Conclusion In this large reported series of LVNC, we observed that: (i) Left ventricular non-compaction was detected by familial screening in asymptomatic patients in 8% of cases. (ii) Left ventricular non-compaction was frequently over-diagnosed by echocardiography. (iii) Patients identified as LVNC presented with a high risk of severe complications, transplantation or death and needed close follow-up. © 2010 The Author.

Soussan M.,University of Paris 13 | Guetz G.D.,University of Paris 13 | Barrau V.,Center Cardiologique du Nord | Aflalo-Hazan V.,University of Paris 13 | And 8 more authors.
European Radiology | Year: 2012

Objectives To assess the accuracy of FDG-PET/CT and MRwith diffusion-weighted imaging (MR-DWI) for diagnosing peritoneal carcinomatosis (PC) from gastrointestinal malignancies. Methods Thirty consecutive patients referred for staging of gastrointestinal malignancy underwent FDG-PET/CT and MR-DWI in this retrospective study. Extent of PC was characterised by dividing the peritoneal cavity into three sites in each patient: right and left supramesocolic areas and inframesocolic level (total 90 sites). Presence of PC was confirmed either by surgery (18/30) or by follow-up (12/30). Results PC was confirmed in 19 patients (19/30). At a total of 90 sites, 27 showed proven PC. On a patient-based analysis, sensitivity, specificity, PPV, NPV and accuracy were respectively 84%, 73%, 84%, 73% and 80% for PET/ CT and 84%, 82%, 89%, 75% and 83% for MR-DWI. On a site-based analysis, overall sensitivity and specificity of PET/ CT (63%, 90%) and MR-DWI (74%, 97%) were not statistically different (P00.27). In the supramesocolic area, MR-DWI detected more sites involved than PET/CT (7/9 vs. 4/9). The sensitivities of PET and MR were lower for subcentimetre tumour implants (42%, 50%). Interobserver agreement was very good for PET/CT and good for MR-DWIConclusions FDG-PET/CT and MR-DWI showed similar high accuracy in diagnosing PC. Both techniques underestimated the real extent of PC because of decreased sensitivity for subcentimetre lesions. Key Points ̇ FDG-PET/CT and MR-DWI showed similar high accuracy for diagnosing peritoneal carcinomatosis. ̇ In the supramesocolic area, MR-DWI could be more sensitive than PET/CT. ̇ Both techniques showed lower sensitivity for subcentimetre lesions. ̇ Interobserver agreement was very good for PET/CT and good for MR-DWI. © European Society of Radiology 2012.

Rodallec M.H.,Center Cardiologique du Nord | Ridereau-Zins C.,C.H.U
Radiographics | Year: 2011

Acute gastrointestinal (GI) bleeding remains an important cause of emergency hospital admissions, with substantial related morbidity and mortality. Bleeding may relate to the upper or lower GI tract, with the dividing anatomic landmark between these two regions being the ligament of Treitz. The widespread availability of endoscopic equipment has had an important effect on the rapid identification and treatment of the bleeding source. However, the choice of upper or lower GI endoscopy is largely dictated by the clinical presentation, which in many cases proves misleading. Furthermore, there remains a large group of patients with negative endoscopic results or failed endoscopy, in whom additional techniques are required to identify the source of GI bleeding. Multi detector computed tomography (CT) with its speed, resolution, multi planar techniques, and angiographic capabilities allows excellent visualization of both the small and large bowel. Multi phasic multi detector CT allows direct demonstration of bleeding into the bowel and is helpful in the acute setting for visualization of the bleeding source and its characterization. Thus, multi detector CT angiography provides a time-efficient method for directing and planning therapy for patients with acute GI bleeding. The additional information provided by multi detector CT angiography before attempts at therapeutic angiographic procedures leads to faster selective catheterization of bleeding vessels, thereby facilitating embolization. © RSNA, 2011.

Botto G.L.,SantAnna Hospital | Ricci R.P.,San Filippo Neri Hospital | Benezet J.M.,Hospital General Of Ciudad | Cosedis Nielsen J.,Aarhus University Hospital | And 8 more authors.
Heart Rhythm | Year: 2014

Background Several studies have shown that unnecessary right ventricular pacing has detrimental effects. Objective To evaluate whether minimization of ventricular pacing as compared with standard dual-chamber pacing (DDD) improves clinical outcomes in patients referred for pacemaker or implantable cardioverter-defibrillator (ICD) replacement. Methods In an international single-blind, multicenter, randomized controlled trial, we compared DDD with managed ventricular pacing (MVP), a pacing mode developed to minimize ventricular pacing by promoting intrinsic atrioventricular conduction. We included patients referred for device replacement with >40% ventricular pacing, no cardiac resynchronization therapy upgrade indication, no permanent atrial fibrillation (AF), and no permanent complete atrioventricular block. Follow-up was for 2 years. The primary end point was cardiovascular hospitalization. The intention-to-treat analysis was performed by using Kaplan-Meier method and the log-rank test. Results We randomized 605 patients (556 referred for pacemaker and 49 referred for ICD replacement; mean age 75 ± 11 years; 365 [60%] men, at 7.7 ± 3.3 years from first device implantation) to MVP (n = 299) or DDD (n = 306). We found no significant differences in the primary end point cardiovascular hospitalization (MVP: 16.3% vs DDD: 14.5%; P =.72) and the secondary end point persistent AF (MVP: 15.4% vs DDD: 11.2%; P =.08), permanent AF (MVP: 4.1% vs DDD: 3.1%; P =.44), and composite of death and cardiovascular hospitalization (MVP: 23.9% vs DDD: 20.2%; P =.48). MVP reduced right ventricular pacing (median 5% vs 86%; Wilcoxon, P <.0001) as compared with DDD. Conclusions In patients referred for pacemaker and ICD replacement with clinically well-tolerated long-term exposure to >40% ventricular pacing in the ventricle, a strategy to minimize ventricular pacing is not superior to standard DDD in reducing incidence of cardiovascular hospitalizations. © 2014 Heart Rhythm Society.

Calvet D.,University of Paris Descartes | Touze E.,University of Paris Descartes | Varenne O.,Assistance Publique Hopitaux de Paris | Sablayrolles J.-L.,Center Cardiologique du Nord | And 2 more authors.
Circulation | Year: 2010

BACKGROUND-: Coronary artery disease (CAD) is a significant cause of morbidity and mortality in stroke patients. Some patients with asymptomatic CAD might benefit from specific prevention, but the prevalence of asymptomatic CAD is not well known. We assessed the prevalence of ≥50% asymptomatic CAD in patients with ischemic stroke or transient ischemic attack and whether the prevalence is related to traditional vascular risk factors and cervicocephalic atherosclerosis. METHODS AND RESULTS-: From January 2006 to February 2009, consecutive patients between 45 and 75 years of age with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack and no prior history of CAD were enrolled in the study. All patients had a 64-section computed tomography coronary angiography and a detailed cervicocephalic arterial workup. Risk factors were assessed individually and through the Framingham Risk Score. Among 300 patients included in the study, 274 had computed tomography coronary angiography. The prevalence of ≥50% asymptomatic CAD was 18% (95% confidence interval [CI], 14 to 23; n=50). Asymptomatic CAD was independently associated with traditional risk factors assessed individually and through the Framingham Risk Score (odds ratio [OR], 2.6; 95% CI, 1.0 to 7.6 for a 10-year risk of coronary heart disease of 10% to 19%; and OR, 7.3; 95% CI, 2.8 to 19.1 for a 10 year-risk of coronary heart disease ≥20%), the presence of at least 1 ≥50% cervicocephalic artery stenosis (OR, 4.0; 95% CI, 1.4 to 11.2), excessive alcohol consumption (OR, 3.1; 95% CI 1.3 to 7.3), and ankle brachial index <0.9 (OR, 2.2; 95% CI, 0.9 to 5.2). The prevalence of ≥50% asymptomatic CAD was also related to the extent of cervicocephalic atherosclerosis. CONCLUSIONS-: About one fifth of patients with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack have ≥50% asymptomatic CAD. In addition to vascular risk factors, the presence of ≥50% cervicocephalic artery stenosis is strongly related to ≥50% asymptomatic CAD.

Pessis E.,Center Cardiologique du Nord | Pessis E.,University of Paris Descartes | Campagna R.,Imagerie de lOrangerie | Campagna R.,University of Paris Descartes | And 7 more authors.
Radiographics | Year: 2012

With arthroplasty being increasingly used to relieve joint pain, imaging of patients with metal implants can represent a significant part of the clinical work load in the radiologist's daily practice. Computed tomography (CT) plays an important role in the postoperative evaluation of patients who are suspected of having metal prosthesis-related problems such as aseptic loosening, bone resorption or osteolysis, infection, dislocation, metal hardware failure, or periprosthetic bone fracture. Despite advances in detector technology and computer software, artifacts from metal implants can seriously degrade the quality of CT images, sometimes to the point of making them diagnostically unusable. Several factors may help reduce the number and severity of artifacts at multidetector CT, including decreasing the detector collimation and pitch, increasing the kilovolt peak and tube charge, and using appropriate reconstruction algorithms and section thickness. More recently, dual-energy CT has been proposed as a means of reducing beam-hardening artifacts. The use of dual-energy CT scanners allows the synthesis of virtual monochromatic spectral (VMS) images. Monochromatic images depict how the imaged object would look if the x-ray source produced x-ray photons at only a single energy level. For this reason, VMS imaging is expected to provide improved image quality by reducing beam-hardening artifacts. © RSNA, 2013.

Maillet J.-M.,Center Cardiologique du Nord | Sableyrolles J.-L.,Center Cardiologique du Nord | Guyon P.,Center Cardiologique du Nord | Bonnet N.,Center Cardiologique du Nord
Interactive Cardiovascular and Thoracic Surgery | Year: 2014

Transcatheter valve implantation (TAVI) is becoming a routine procedure to treat severe symptomatic aortic stenosis. It is associated with complications different from those of conventional aortic valve surgery. We describe an 80-year old man who developed an apical left ventricular (LV) false aneurysm 3 months after transapical TAVI (TA-TAVI) complicated postoperatively by a surgical site infection (SSI). Three months earlier, an Edwards Sapien bioprosthesis no. 29 had been successfully inserted transapically because of severe comorbidities and a very large aortic annulus. His postoperative course was complicated by acute respiratory failure, gastrointestinal bleeding and a surgical site infection of the thoracic incision; Escherichia coli and Klebsiella pneumonia were isolated. After surgical debridement drainage and prolonged antibiotic therapy, the wound healed correctly. His emergency chest computed tomography upon readmission for the acute onset of a beating tumefaction at the TA-TAVI site showed a false aneurysm of the LV apex. The apex was closed directly during emergency surgery. The postoperative course was uneventful. Surgical site infection after TA-TAVI, its frequency, treatment and potential role as an underlying cause of this severe complication are discussed. © 2013 The Author.

Campagna R.,University of Paris Descartes | Pessis E.,University of Paris Descartes | Pessis E.,Center Cardiologique du Nord | Biau D.J.,University of Paris Descartes | And 6 more authors.
Radiology | Year: 2012

Purpose: To evaluate whether knee extensor mechanism features are associated with superolateral Hoffa fat pad edema at magnetic resonance imaging. Materials and Methods: Institutional review board approval and written consent from all patients were obtained. Patients with superolateral Hoffa fat pad edema (n = 30) and a control group without edema of the fat pad (n = 60) were evaluated prospectively with magnetic resonance (MR) imaging. Demographic data and extensor mechanism features were compared, including trochlear depth, lateral trochlear inclination, patellar tilt angle, patellar height ratio, distance between patellar ligament and lateral trochlear facet, distance from the tibial tubercle to the trochlear groove, patellar facet asymmetry, and patellar ligament abnormalities. Results: The following variables were associated with superolateral Hoffa fat pad edema in the multivariable models: patellar height ratio (P = .023), shortest distance between patellar ligament and lateral trochlear facet (P < .001), and distance from the tibial tubercle to the trochlear groove (P = .046). Of all demographic and degenerative variables, only age was significantly associated, with younger patients more likely to have superolateral Hoffa fat pad edema (P < .009). Conclusion: A high-riding patella, a short distance between the patellar ligament and the lateral trochlear facet, and an increased distance from the tibial tubercle to the trochlear groove are associated with superolateral Hoffa fat pad edema at MR imaging. These results are suggestive of impingement between the lateral femoral condyle and the posterior aspect of the patellar ligament in these patients. © RSNA, 2012.

Viglietti D.,University Paris Diderot | Sverzut J.-M.,Center Cardiologique du Nord | Peraldi M.-N.,University Paris Diderot
Nephrology Dialysis Transplantation | Year: 2012

We report here a case with secondary polycythaemia, monoclonal gammopathy of undetermined significance and renal lymphangiectasis revealed by renal failure. Renal failure was probably linked to renal compression by fluid collections. Renal lymphangiectasis is a rare but has already been described in the literature. In addition, its association with a monoclonal paraprotein and polycythaemia seems to be a new clinical entity recently reported in only one patient. © 2011 The Author.

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