[Prevalence of renal artery stenosis in patients undergoing cardiac catheterization: when should abdominal aortography be performed? Results in 467 patients]. / Prévalence des sténoses des artères rénales dépistées au cours de coronarographies diagnostiques: dans quels cas doit-on réaliser une aortographie abdominale? A propos de 467 patients.

PURPOSE: To define a subgroup of patients at increased risk of renal artery stenosis (RAS) in a population of patients undergoing cardiac catheterization. MATERIALS AND METHODS: A total of 467 patients (mean age of 64 Years +/-11) underwent cardiac catheterization and aortography Results were evaluated to detect correlations between the presence or absence of RAS and clinical and biological parameters. RESULTS: A total of 42 (9%) patients had a renal artery stenosis. Univariate analysis defined parameters correlated with the presence of RAS: systolic blood pressure (p=0.03), pulse pressure (p=0.005), age (p<0.0001), creatinine clearance (p<0.0001), 2-vessel (p=0.028) and 3-vessel (p=0.037) coronary artery diseases. Multivariate analysis showed that the presence of RAS correlated to creatinine clearance (p=0.02) and 2-vessel coronary artery disease. A creatinine clearance between 30 and 60 ml/min and multi-vessel coronary artery disease defined a subgroup at increased risk of RAS with sensitivity, specificity, positive and negative predictive values of: 47.6, 90.1, 32.3 and 94.6%. The prevalence of renal artery stenosis was 5.2% when both parameters were absent. CONCLUSION: Patients with mild renal insufficiency and multi-vessel coronary artery disease defined a subgroup of patients at increased risk of RAS (32.5%) that may benefit from abdominal aortography performed at the time of cardiac catheterization.

Effects of endurance training on the cardiovascular system and water compartments in elderly subjects.

The effects of endurance training on the water compartments and the cardiovascular system were determined in 10 elderly subjects [age 62 +/- 2 yr, pretraining maximal oxygen consumption (VO2 max)/kg = 25 +/- 2 ml . min-1 . kg-1 body wt]. They trained on a cycloergometer 3 times/wk for 16 wk (50-80% VO2 max, then 80-85% VO2 max). They were checked at 8 wk, 16 wk, and 4 mo after detraining. Training improved VO2 max (+16%) and induced plasma volume expansion (+11%). No change in total body water, extracellular fluid, interstitial and intracellular fluid volumes, fat-free mass, and body weight was detected in this small sample with training. Body fat mass decreased (-2.1 +/- 2.2 kg). Echocardiography at rest showed increased fractional shortening and ejection fraction and decreased left ventricular end-systolic dimension (P < 0.05). Blood volume expansion correlates with cardiac contractility and has an impact on cardiac function. These improvements are precarious, however, and are completely lost after 4 mo of detraining, when elderly subjects lose the constraints and the social stimulation of the imposed protocol.