Benoit Fremont - Academia.edu (original) (raw)
Papers by Benoit Fremont
Archives Des Maladies Du Coeur Et Des Vaisseaux, 2007
La manifestation la plus frequente de la maladie thromboembolique veineuse d'effort est la th... more La manifestation la plus frequente de la maladie thromboembolique veineuse d'effort est la thrombose veineuse des membres superieurs survenant dans des conditions particulieres et stereotypees, et parfois compliquee d'embolies pulmonaires. Quelques cas de thromboses veineuses des membres inferieurs sont decrits chez des sportifs. Certains arguments physiopathologiques (modifications rheologiques, lesions parietales et anomalies de la coagulation) laissent suggerer qu'il existe une relation entre la maladie thromboembolique veineuse et l'effort physique, mais le lien de causalite est parfois difficile a etablir. Nous rapportons trois observations d'embolies pulmonaires apparues au decours d'un effort prolonge de course a pied chez des marathoniens entraines. A notre connaissance, tres peu de cas similaires ont ete decrits. La possible responsabilite de ce type d'effort physique est discutee, de meme que celle de differents autres cofacteurs tels que les an...
Major ST-segment elevation hiding acute severe pancreatitis
Prognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism *
CHEST Journal, 2008
In the literature, echocardiographic assessment of the prognosis of acute pulmonary embolism is b... more In the literature, echocardiographic assessment of the prognosis of acute pulmonary embolism is based on analysis of right ventricle free-wall motion or on a composite index combining right ventricular dilatation, paradoxical septal wall motion, and pulmonary hypertension. The aim of this study was to determine the prognostic value of a single quantitative echocardiographic criterion, the right/left ventricular end-diastolic diameter (RV/LV) ratio. Registry data on 1,416 consecutive patients hospitalized for acute pulmonary embolism were used to study retrospectively a population of 950 patients who underwent echocardiographic assessment on hospital admission and for whom the RV/LV ratio was available. The hospital mortality rate for the series was 3.3%. Sensitivity and specificity of RV/LV ratio >or= 0.9 for predicting hospital mortality were 72% and 58%, respectively. Multivariate analysis showed the independent predictive factors for hospital mortality to be the following: systolic BP < 90 mm Hg (odds ratio [OR], 10.73; p < 0.0001), history of left heart failure (OR, 8.99; p < 0.0001), and RV/LV ratio >or= 0.9 (OR, 2.66; p = 0.01). In our retrospective series, an echocardiographic RV/LV ratio >or= 0.9 was shown to be an independent predictive factor for hospital mortality. This criterion may be of value in selecting cases of submassive pulmonary embolism with a poor prognosis that are liable to benefit from thrombolytic treatment.
Archives of Cardiovascular Diseases, 2008
Context. -Although thrombolysis (THL) and primary percutaneous coronary intervention (PPCI) are t... more Context. -Although thrombolysis (THL) and primary percutaneous coronary intervention (PPCI) are two validated options in reperfusion algorithms for ST-elevation myocardial infarction (STEMI), recent papers seems to show that PPCI could be the best therapeutic option irrespective of the time to treatment (TT) and of the cardiovascular risk profile of the patient. The impact of TT and age on reperfusion strategies requires elucidation. The aim of this study was to analyze the effect of time to treatment and age on the 1-year mortality of patients presenting with STEMI, for each reperfusion strategy. Materials and methods. -The study population consisted in 794 patients directly admitted to the cardiological intensive care unit for STEMI ≤ 12 hours. The relationship between TT and 1-year mortality was studied using logistic regression models. The models were implemented on the overall population and on 3 different age groups: [<65 years]; [≥65 and <75 years]; [≥ 75 years] for patients undergoing THL (n=299) and for patients undergoing PPCI (n = 495). There was no significant between-group difference in all-cause 1-year mortality for the patients [< 65 years] and those [≥ 65 and < 75 years]. In contrast, the 1-year mortality was significantly higher in the patients [≥ 75 years] undergoing THL (51.4 vs. 15.3%; p<0.001). The analysis of the curves of mortality suggests that 1-year mortality of patients with STEMI depend not only on reperfusion strategy but so on the time to treatment and on the age of the patients. * A. de Labriolle, Unités de soins intensifs cardiologiques, Centre hospitalier universitaire Trousseau, Effect of time to treatment and age on one year mortality in acute STEMI: difference between thrombolysis and primary percutaneous coronary intervention 49 Conclusion. -In STEMI, on a 1-year mortality criteria, PPCI is not always upper than THL, particularly for patients < 65 years treated within the first two hours after symptoms onset. TT and age affects the results of the reperfusion strategies and must be still incorporated in the reperfusion algorithms of STEMI. © 2008 Published by Elsevier Masson SAS. Résumé Contexte. -Bien que le délai de traitement soit le paramètre majeur des algorithmes de revascularisation dans les STEMI, son rôle pourrait dépendre du type de revascularisation et du profil de risque cardio vasculaire et plus particulièrement de l'âge des patients. Son impact dans les stratégies de revascularisation nécessite d'être clarifié. Le but de notre travail était d'analyser par classe d'âge, pour chaque stratégie de revascularisation, l'effet du délai de traitement sur la mortalité à un an des patients avec STEMI. Matériels et méthodes. -La population de l'étude était constituée de 794 patients admis directement en USIC pour un STEMI ≤ 12 heures. La relation entre le délai de traitement et la mortalité à un an a été étudiée par des modèles de régression logistique. Ces modèles ont été réalisés dans la population générale et dans les 3 sous groupes d'âge différent: [< 65 ans] ; [≥ 65 et < 75 ans] ; [≥ 75 ans] pour les patients traités par thrombolyse (n = 299) et pour les patients traités par angioplastie primaire (n=495). La mortalité à un an toute cause n'était pas significativement différente entre le deux groupes de traitement pour les patients [< 65 ans] et pour ceux du groupe [≥ 65 et < 75 ans]. En revanche, la mortalité à un an était significativement plus importante dans le groupe de patients [≥ 75 ans] traités par thrombolyse (51,4 % versus 15,3 %; p <0.001). L'analyse des courbes de décès en fonction du délai de traitement montre que l'effet du délai de traitement sur la mortalité à un an dépends de la stratégie de revascularisation et de l'âge des patients. Conclusion. -Nos résultats suggèrent que le délai de traitement affecte la mortalité de façon variable selon la stratégie de revascularisation utilisée et l'âge des patients traités. Ainsi, l'âge devrait faire partie des algorithmes en phase aigue de STEMI.
Major ST-segment elevation hiding acute severe pancreatitis
The American Journal of Emergency Medicine, 2010
Ultrasound in Medicine & Biology, 2009
The degree of carotid stenosis (%ST) remains the most frequently used parameter for identifying p... more The degree of carotid stenosis (%ST) remains the most frequently used parameter for identifying patients with high risk of stroke but the relationship between %ST and the occurrence of stroke remains controversial. The objectives of this study were to check (1) the relationship between the %ST and the plaque volume index (PVI) as measured by echography and Doppler, (2) the relationship between the intima media thickness (IMT), a vessel wall remodeling index and the PVI an atheromatous growth index. For each of the 128 patients, (165 carotid stenosis), we measured the % ST (section or diameter), the max stenosis velocity (V max ), the PVI and the common carotid IMT. The %ST (section) ranged from 10% to 93% (mean 66 ± 18), V max from 0.3 m/s to 3 m/s (mean 1.2 ± 0.8), PVI from 0.61 cm 3 to 1.17 cm 3 (mean 0.41 ± 0.21) and the IMT from 0.08 cm up to 0.31 cm (mean 0.12 ± 0.03). There was no significant correlation between either PVI and %ST (section or diameter), PVI and minimal stenosis section area (S1) or between PVI and V max . There was no significant correlation between IMT and both %ST area and PVI. PVI was significantly correlated with the whole artery section area (S2) and the plaque length (L). The %ST (section or diameter) was significantly correlated with S1 but not with S2. The absence of correlation between the PVI and the %ST confirm that these two parameters describe two different processes of the atheromatous development. (
Archives Des Maladies Du Coeur Et Des Vaisseaux, 2007
La manifestation la plus frequente de la maladie thromboembolique veineuse d'effort est la th... more La manifestation la plus frequente de la maladie thromboembolique veineuse d'effort est la thrombose veineuse des membres superieurs survenant dans des conditions particulieres et stereotypees, et parfois compliquee d'embolies pulmonaires. Quelques cas de thromboses veineuses des membres inferieurs sont decrits chez des sportifs. Certains arguments physiopathologiques (modifications rheologiques, lesions parietales et anomalies de la coagulation) laissent suggerer qu'il existe une relation entre la maladie thromboembolique veineuse et l'effort physique, mais le lien de causalite est parfois difficile a etablir. Nous rapportons trois observations d'embolies pulmonaires apparues au decours d'un effort prolonge de course a pied chez des marathoniens entraines. A notre connaissance, tres peu de cas similaires ont ete decrits. La possible responsabilite de ce type d'effort physique est discutee, de meme que celle de differents autres cofacteurs tels que les an...
Major ST-segment elevation hiding acute severe pancreatitis
Prognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism *
CHEST Journal, 2008
In the literature, echocardiographic assessment of the prognosis of acute pulmonary embolism is b... more In the literature, echocardiographic assessment of the prognosis of acute pulmonary embolism is based on analysis of right ventricle free-wall motion or on a composite index combining right ventricular dilatation, paradoxical septal wall motion, and pulmonary hypertension. The aim of this study was to determine the prognostic value of a single quantitative echocardiographic criterion, the right/left ventricular end-diastolic diameter (RV/LV) ratio. Registry data on 1,416 consecutive patients hospitalized for acute pulmonary embolism were used to study retrospectively a population of 950 patients who underwent echocardiographic assessment on hospital admission and for whom the RV/LV ratio was available. The hospital mortality rate for the series was 3.3%. Sensitivity and specificity of RV/LV ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 0.9 for predicting hospital mortality were 72% and 58%, respectively. Multivariate analysis showed the independent predictive factors for hospital mortality to be the following: systolic BP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 90 mm Hg (odds ratio [OR], 10.73; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), history of left heart failure (OR, 8.99; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and RV/LV ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 0.9 (OR, 2.66; p = 0.01). In our retrospective series, an echocardiographic RV/LV ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 0.9 was shown to be an independent predictive factor for hospital mortality. This criterion may be of value in selecting cases of submassive pulmonary embolism with a poor prognosis that are liable to benefit from thrombolytic treatment.
Archives of Cardiovascular Diseases, 2008
Context. -Although thrombolysis (THL) and primary percutaneous coronary intervention (PPCI) are t... more Context. -Although thrombolysis (THL) and primary percutaneous coronary intervention (PPCI) are two validated options in reperfusion algorithms for ST-elevation myocardial infarction (STEMI), recent papers seems to show that PPCI could be the best therapeutic option irrespective of the time to treatment (TT) and of the cardiovascular risk profile of the patient. The impact of TT and age on reperfusion strategies requires elucidation. The aim of this study was to analyze the effect of time to treatment and age on the 1-year mortality of patients presenting with STEMI, for each reperfusion strategy. Materials and methods. -The study population consisted in 794 patients directly admitted to the cardiological intensive care unit for STEMI ≤ 12 hours. The relationship between TT and 1-year mortality was studied using logistic regression models. The models were implemented on the overall population and on 3 different age groups: [<65 years]; [≥65 and <75 years]; [≥ 75 years] for patients undergoing THL (n=299) and for patients undergoing PPCI (n = 495). There was no significant between-group difference in all-cause 1-year mortality for the patients [< 65 years] and those [≥ 65 and < 75 years]. In contrast, the 1-year mortality was significantly higher in the patients [≥ 75 years] undergoing THL (51.4 vs. 15.3%; p<0.001). The analysis of the curves of mortality suggests that 1-year mortality of patients with STEMI depend not only on reperfusion strategy but so on the time to treatment and on the age of the patients. * A. de Labriolle, Unités de soins intensifs cardiologiques, Centre hospitalier universitaire Trousseau, Effect of time to treatment and age on one year mortality in acute STEMI: difference between thrombolysis and primary percutaneous coronary intervention 49 Conclusion. -In STEMI, on a 1-year mortality criteria, PPCI is not always upper than THL, particularly for patients < 65 years treated within the first two hours after symptoms onset. TT and age affects the results of the reperfusion strategies and must be still incorporated in the reperfusion algorithms of STEMI. © 2008 Published by Elsevier Masson SAS. Résumé Contexte. -Bien que le délai de traitement soit le paramètre majeur des algorithmes de revascularisation dans les STEMI, son rôle pourrait dépendre du type de revascularisation et du profil de risque cardio vasculaire et plus particulièrement de l'âge des patients. Son impact dans les stratégies de revascularisation nécessite d'être clarifié. Le but de notre travail était d'analyser par classe d'âge, pour chaque stratégie de revascularisation, l'effet du délai de traitement sur la mortalité à un an des patients avec STEMI. Matériels et méthodes. -La population de l'étude était constituée de 794 patients admis directement en USIC pour un STEMI ≤ 12 heures. La relation entre le délai de traitement et la mortalité à un an a été étudiée par des modèles de régression logistique. Ces modèles ont été réalisés dans la population générale et dans les 3 sous groupes d'âge différent: [< 65 ans] ; [≥ 65 et < 75 ans] ; [≥ 75 ans] pour les patients traités par thrombolyse (n = 299) et pour les patients traités par angioplastie primaire (n=495). La mortalité à un an toute cause n'était pas significativement différente entre le deux groupes de traitement pour les patients [< 65 ans] et pour ceux du groupe [≥ 65 et < 75 ans]. En revanche, la mortalité à un an était significativement plus importante dans le groupe de patients [≥ 75 ans] traités par thrombolyse (51,4 % versus 15,3 %; p <0.001). L'analyse des courbes de décès en fonction du délai de traitement montre que l'effet du délai de traitement sur la mortalité à un an dépends de la stratégie de revascularisation et de l'âge des patients. Conclusion. -Nos résultats suggèrent que le délai de traitement affecte la mortalité de façon variable selon la stratégie de revascularisation utilisée et l'âge des patients traités. Ainsi, l'âge devrait faire partie des algorithmes en phase aigue de STEMI.
Major ST-segment elevation hiding acute severe pancreatitis
The American Journal of Emergency Medicine, 2010
Ultrasound in Medicine & Biology, 2009
The degree of carotid stenosis (%ST) remains the most frequently used parameter for identifying p... more The degree of carotid stenosis (%ST) remains the most frequently used parameter for identifying patients with high risk of stroke but the relationship between %ST and the occurrence of stroke remains controversial. The objectives of this study were to check (1) the relationship between the %ST and the plaque volume index (PVI) as measured by echography and Doppler, (2) the relationship between the intima media thickness (IMT), a vessel wall remodeling index and the PVI an atheromatous growth index. For each of the 128 patients, (165 carotid stenosis), we measured the % ST (section or diameter), the max stenosis velocity (V max ), the PVI and the common carotid IMT. The %ST (section) ranged from 10% to 93% (mean 66 ± 18), V max from 0.3 m/s to 3 m/s (mean 1.2 ± 0.8), PVI from 0.61 cm 3 to 1.17 cm 3 (mean 0.41 ± 0.21) and the IMT from 0.08 cm up to 0.31 cm (mean 0.12 ± 0.03). There was no significant correlation between either PVI and %ST (section or diameter), PVI and minimal stenosis section area (S1) or between PVI and V max . There was no significant correlation between IMT and both %ST area and PVI. PVI was significantly correlated with the whole artery section area (S2) and the plaque length (L). The %ST (section or diameter) was significantly correlated with S1 but not with S2. The absence of correlation between the PVI and the %ST confirm that these two parameters describe two different processes of the atheromatous development. (