[Clinical and angiographic results of delayed revascularization by angioplasty or bypass after intravenous thrombolysis in myocardial infarction]. / Résultats cliniques et angiographiques de la revascularisation différée par angioplastie ou pontage après thrombolyse intraveineuse dans l'infarctus myocardique.

Between 1988 and 1990, 150 patients treated for an infarction by intravenous thrombolysis underwent coronary arteriography. Sixty seven were managed by revascularisation by angioplasty (n = 49) or bypass (n = 18) more than 48 hours after thrombolysis. In this delayed revascularisation group, the time before initial fibrinolysis was 114 +/- 55 minutes. The artery responsible for the infarction was patent in 88 per cent of cases at 12 +/- 9 days, with ejection fraction being 56 +/- 12 per cent. Indications for revascularisation were: recurrence of angina, Thallium stress test showing redistribution (n = 9), diffuse lesions (n = 11) or tight (greater than 75 per cent) proximal stenosis without vessel wall sequelae (n = 10). Comparison of the bypass and angioplasty groups showed a lower ejection fraction in the former than the latter (47% VS 58%, p less than 0.01), more frequent three-vessel disease (50% VS 6%, p less than 0.01) and more frequent revascularisation of the anterior interventricular (100% VS 37%, p less than 0.01). There were 2 deaths and 5 recurrences of infarction at one year. Follow-up arteriography was performed between at 2 and 6 months in 72% of the patients: 16 had restenosis after angioplasty and 4 occlusion of the graft after bypass. A second revascularisation procedure was necessary 15 times (14 angioplasties, 1 bypass). The outcome after bypass or angioplasty was favourable in 90% of cases in this group of patients exposed to a recurrence of infarction.

Hysteresis of the venous pressure-volume relationship in the forearm of borderline hypertensive subjects.

1. The forearm venous pressure-volume relationship was studied in 14 young men with borderline hypertension and in 16 control subjects of the same age and sex. Strain-gauge plethysmography was used to evaluate volume changes after slow increases and decreases in distention, in order to estimate the amplitude of the hysteresis curve. 2. Compared with normotensive control subjects, subjects with borderline hypertension had significantly higher values of blood pressure, heart rate and forearm blood flow. 3. Baseline forearm venous tone was slightly, but not significantly, increased in borderline hypertensive subjects (21.35 +/- 6.53 versus 18.75 +/- 5.95 mmHg ml-1 100 ml-1) and was significantly enhanced after a cold pressor test. The increase was no higher in the borderline hypertensive subjects than in the normotensive control subjects. 4. The area of the hysteresis curve was significantly decreased (7.58 +/- 3.58 versus 10.34 +/- 5.67 arbitrary units; P = 0.0092) as was the extent of isotonic relaxation (creep) (0.28 +/- 0.11 versus 0.39 +/- 0.22 ml/100 ml; P = 0.0098) in borderline hypertensive subjects compared with control subjects. Both parameters were unaffected by the cold pressor test. 5. The study suggests that the viscous component of the venous wall is altered in young patients with borderline hypertension, indicating intrinsic changes in vascular segments which are not exposed to increased intraluminal pressure.

[Doppler evaluation of blood flow of the lower limb]. / Evaluation du débit sanguin de membre inférieur par méthode doppler.

UNLABELLED: Regional blood flow measurement in the limbs (BFLL) is of special interest in order to evaluate the consequences of hypertension. The purpose of this study is to assess the interest of the Doppler ultrasound method in the BFLL measurement among normotensive or borderline hypertensives young male adults. BFLL reproducibility was evaluated among 23 healthy subjects aged 21 +/- 2 y, height 177 +/- 8 cm, weight 75 +/- 13 kg at day one (D1) and three day later (D3). Measurements were made basically after 20 minutes lying at rest and after cold pressor test (CPT). BFLL estimation depends on common femoral artery diameter (FAD) echographic measurement at the thigh root and on velocity time interval (VTI) calculation with pulsed wave doppler using controlled incident angle and sample volume. The following parameters were measured: mean arterial pressure (MAP) using Dinamap, heart rate (HR), FAD, common femoral artery cross sectorial area (A), VTI and peripheral arteriolar resistances (PAR). Basic and CPT results at D1 and D3 were compared using paired "t" test. RESULTS: [table: see text] Comparisons between basic state and CPT demonstrate a significant decrease of VTI and BFLL, a significant increase of PAR. D remained unchanged. Doppler ultrasound method is easy to use. Systolic femoral volume measurement is relatively insensitive to small transducer positioning variations so that the method reproducibility is satisfactory.

[Venous tone of the limbs. Methods and comparison of 2 areas]. / Tonus veineux de membre. Méthodologie et comparaison de deux territoires.

The limb venous tone, index of local venous compliance, was studied with mercury strain gauge plethysmography on 28 male normal subjects (40 +/- 17 years, +/- SD) simultaneously on upper and lower limbs. Measurements were done after 20 mn rest in supine position. Venous tone (VT) equals the slope of the pressure-volume curve established by simultaneous recording of the forearm and calf relative volumes for successive steps of pressure lower than or equal to 30 mmHg. Limb venous capacitance was expressed by means of the maximal limb relative volume (V30) reached for a pressure of 30 mmHg applied through cuffs in standardized conditions. The upper limb venous tone was greater than the lower limb venous tone: 24.3 +/- 8.2 mmHg/ml/100 vs 17.5 +/- 7.9 mmHg/ml/100, p = 0.001. V30 was greater in lower limb than in upper limb: 1.5 +/- 0.5 ml/100 vs 1.1 +/- 0.4 ml/100, p = 0.001. In conclusion, it appears that upper and lower limbs venous distensibility and capacitance are different. They are greater in the lower limb in baseline conditions. Thus simultaneous studies of both these limb venous systems seems important for physiological experiments because of their baseline differences.

Treatment for one year with perindopril: effect on cardiac mass and arterial compliance in essential hypertension.

Blood pressure, forearm arterial haemodynamics and echocardiographic parameters were studied in patients with sustained essential hypertension before and after administration of the angiotensin converting enzyme (ACE) inhibitor perindopril for 1 year. Perindopril significantly reduced blood pressure and at the same time increased brachial artery blood flow, diameter and compliance. As part of the haemodynamic investigation, a 5-min period of wrist occlusion was performed. Blood flow velocity decreased significantly to the same extent with perindopril and with placebo, but the corresponding reductions in arterial diameter were smaller with perindopril than with placebo, indicating that the increase in diameter following perindopril could not be explained solely on the basis of a flow-dependent dilation. After 3 months, treatment was stopped for 4 weeks. Blood pressure and forearm arterial haemodynamics returned towards baseline values. However, cardiac mass, which was significantly decreased after perindopril administration, remained decreased 4 weeks after cessation of treatment. In seven responder patients, perindopril was continued as sole therapy for 8 months. Arterial compliance remained elevated and cardiac mass diminished. The study showed that the arterial changes caused by perindopril involved a drug-related relaxation of arterial smooth muscle and that there was a differential response in cardiac and arterial changes following long-term treatment.