486 research outputs found
Clinical trials update from the European society of cardiology congress in Munich, 2008: TIME-CHF, CARESS-in-AMI, TRITON-TIMI 38, EUROPA, AF-CHF, and ADVANCE
No full textJ. Horowitz, W. J. Remme and C. Torp-Pederse
Angiotensin-converting enzyme inhibition with perindopril in patients with prior myocardial infarction and/or revascularization: A subgroup analysis of the EUROPA trial
No full textBackground.— The European trial on Reduction Of cardiac events with perindopril in patients
with stable coronary Artery disease (EUROPA) demonstrated the benefits of perindopril with
respect to secondary prevention of cardiovascular risk in patients with stable coronary artery
disease.
Aims.— To describe the clinical effects of perindopril in a subpopulation of patients from
EUROPA with a history of myocardial infarction and/or revascularization.
Patients and methods.— Of the 12,218 patients in the EUROPA study, 10,962 had a history of
myocardial infarction and/or revascularization. In this EUROPA subpopulation, 7910 patients had
a history of myocardial infarction and 6709 had a history of revascularization. Patients were randomized to treatment with perindopril 8 mg/day or placebo. The primary endpoint was a
composite of cardiovascular mortality, myocardial infarction and resuscitated cardiac arrest.
Results.— After a mean follow-up of 4.2 years, treatment with perindopril 8 mg/day was associated
with a 22.4% reduction in the primary endpoint compared with placebo (p < 0.001) in
patients with a history of myocardial infarction. Patients with a history of myocardial revascularization
showed a 17.3% reduction in the primary endpoint with perindopril versus placebo
(p < 0.05). In the combined population of patients with a history of myocardial infarction and/or
revascularization, treatment with perindopril produced a 22.4% reduction in the primary endpoint
compared with placebo (p < 0.001).
Conclusions.— This study confirms the benefits of a high dose of angiotensin-converting enzyme
inhibitor for the secondary prevention of cardiovascular risk among patients with a history of
myocardial infarction and/or revascularization.
© 2008 Elsevier Masson SAS. All rights reserved
Effects of perindopril on long-term clinical outcome of patients with coronary artery disease and left ventricular function
No full textResults in patients with preserved LV function are consistent with those of the whole EUROPA study population and perindopril 8mg is beneficial in all patients with stable CAD
A Model-based Approach for Clinical Evaluation of Left Ventricular Deformation
No full textAssessment of left ventricular (LV) deformation is essential for clinical evaluation of LV function and cardiac images are frequently used to evaluate the LV motion and function. By combining the images with mathematical models more information may be extracted from the images. The work presented in this thesis has focused on using the finite element (FE) method to describe the LV and its deformation and combining this method with images of the heart to extract more information about the deformation.
We developed a method that estimated the LV deformation by manually tracking distinct anatomical landmarks (fiducial markers) through the cardiac cycle in 3 dimensional (3D) images of the heart. The motion of the nodal parameters of an FE mesh shaped to the geometry of the LV was fitted to the motion of the fiducial markers and thus provided a means to describe the motion. The sparsity of the fiducial markers made the fitting problem under-constrained so a parameter distribution model (PDM) of likely motions were constructed from a historical database of cases where FE meshes had been fitted to the motion of magnetic resonance (MR) tagged data. The estimated deformation from the fiducial marker fitting was filtered through the PDM and the resulting deformation corresponded well when compared to the deformation obtained from MR tagging in 13 normal subjects.
A method that decomposed the LV deformation into different deformation modes such as longitudinal shortening, wall thickening, and twisting was developed. The nodes of a subject’s LV FE mesh were displaced according to each deformation mode and the relative contribution of each mode to the total deformation measured by MR tagging was quantified by calculating a coefficient for each mode. A study that compared 13 young normal subjects with 13 older diabetes patients showed that the patients had a significantly lower degree of longitudinal shortening and wall thickening but a higher degree of longitudinal twist.
The LV deformation is influenced by cardiac disease via the material properties of the myocardium. We investigated the effects of the material parameter values on the LV deformation in a simulation study using an FE model of the LV. A description of the myocardial microstructure and a passive and active constitutive law was included in the model. The cardiac cycle was simulated from the beginning of diastasis through to the end of ejection by applying appropriate boundary conditions. The different deformation modes between end diastole and end systole were extracted and quantified for different sets of material parameters. We found that stiffer material properties particularly in the myocardial sheet direction impaired longitudinal shortening and wall thickening.
A sensitivity analysis was carried out to look at the various material parameters’ influence on LV wall strains during passive inflation. The analysis showed a high degree of coupling of the parameters in the constitutive law, which indicated an overparameterization of the law. A parameter estimation study revealed the same problem. Most of the parameters were set to constant values and only one parameter in each of the three microstructural directions were estimated during the passive inflation phase using synthetic strain data as measurements. This still gave good estimates of the stress-strain relationships in the fiber and sheet directions
Ace inhibition and endothelial function: The perfect study, sub study of the EUROPA trial: Main findings
No full textFindings support the notion that part of the beneficial effects of perindopril on cardiovascular mobidity and mortality in the EUROPA study may be explained by improvement in endothelial function
Effects of perindopril on long-term clinical outcome of patients with CAD and left ventricular function.
No full textResults in patients with preserved LV function are consistent with those of the whole EUROPA study population and perindopril 8mg is beneficial in all patients with stable CAD
A Model-based Approach for Clinical Evaluation of Left Ventricular Deformation
No full textAssessment of left ventricular (LV) deformation is essential for clinical evaluation of LV function and cardiac images are frequently used to evaluate the LV motion and function. By combining the images with mathematical models more information may be extracted from the images. The work presented in this thesis has focused on using the finite element (FE) method to describe the LV and its deformation and combining this method with images of the heart to extract more information about the deformation. We developed a method that estimated the LV deformation by manually tracking distinct anatomical landmarks (fiducial markers) through the cardiac cycle in 3 dimensional (3D) images of the heart. The motion of the nodal parameters of an FE mesh shaped to the geometry of the LV was fitted to the motion of the fiducial markers and thus provided a means to describe the motion. The sparsity of the fiducial markers made the fitting problem under-constrained so a parameter distribution model (PDM) of likely motions were constructed from a historical database of cases where FE meshes had been fitted to the motion of magnetic resonance (MR) tagged data. The estimated deformation from the fiducial marker fitting was filtered through the PDM and the resulting deformation corresponded well when compared to the deformation obtained from MR tagging in 13 normal subjects. A method that decomposed the LV deformation into different deformation modes such as longitudinal shortening, wall thickening, and twisting was developed. The nodes of a subject’s LV FE mesh were displaced according to each deformation mode and the relative contribution of each mode to the total deformation measured by MR tagging was quantified by calculating a coefficient for each mode. A study that compared 13 young normal subjects with 13 older diabetes patients showed that the patients had a significantly lower degree of longitudinal shortening and wall thickening but a higher degree of longitudinal twist. The LV deformation is influenced by cardiac disease via the material properties of the myocardium. We investigated the effects of the material parameter values on the LV deformation in a simulation study using an FE model of the LV. A description of the myocardial microstructure and a passive and active constitutive law was included in the model. The cardiac cycle was simulated from the beginning of diastasis through to the end of ejection by applying appropriate boundary conditions. The different deformation modes between end diastole and end systole were extracted and quantified for different sets of material parameters. We found that stiffer material properties particularly in the myocardial sheet direction impaired longitudinal shortening and wall thickening. A sensitivity analysis was carried out to look at the various material parameters’ influence on LV wall strains during passive inflation. The analysis showed a high degree of coupling of the parameters in the constitutive law, which indicated an overparameterization of the law. A parameter estimation study revealed the same problem. Most of the parameters were set to constant values and only one parameter in each of the three microstructural directions were estimated during the passive inflation phase using synthetic strain data as measurements. This still gave good estimates of the stress-strain relationships in the fiber and sheet directions.Papers I and II reprinted with kind permission of Elsevier, ScienceDirec
ACE inhibition and endothelial function in t he Europa Trial: The main findings from the PERFECT Study.
No full textEffects of perindopril on long-term clinical outcome of patients with coronary artery disease and preserved left ventricular function
No full textBACKGROUND: The EUROPA trial has demonstrated that an ACE inhibitor perindopril, was able to significantly decrease the risk of major cardiac events in patients with stable coronary heart disease without apparent heart failure. AIM: To assess the long-term clinical outcome of patients with stable coronary heart disease and preserved left ventricular function (left ventricular ejection fraction (LVEF> or =40%). METHODS: A retrospective evaluation of LVEF was performed in the EUROPA study population. Among the 12,218 patients of EUROPA, we identified 7096 (58%) patients who had LVEF measurement before randomization. The measurements were obtained mainly by echocardiography in 5214 cases (73%) or by angiography in 1470 cases (21%). Two groups of patients were studied: 6878 (97 %) patients with LVEF> or =40% (3429 received 8 mg of perindopril and 3449 received a placebo) and 218 patients (3%) with a LVEF or =40%), there was a significant relative risk reduction of 16% of the primary endpoint (a composite of cardiovascular death, non-fatal myocardial infarction and resuscitated cardiac arrest) in the group treated with perindopril (8.3%) in comparison to the group treated with placebo (9.8%): Hazard ratio (HR)=0.84 [95% CI: 0.72-0.99] p=0.033). Similar results were obtained for the first secondary endpoint (total mortality, non-fatal myocardial infarction, hospital admission for unstable angina and cardiac arrest with successful resuscitation): HR=0.85 [95% CI: 0.76-0.96] p=0.008, for cardiovascular mortality and non-fatal MI: HR=0.84 [95% CI: 0.72-0.99] p=0.036. Similar benefits were observed in patients with an LVEF> or =40% and a history of previous myocardial infarction and in patients with an LVEF<40%. CONCLUSIONS: LVEF was documented in 58% of the EUROPA study population and only 3% had an impaired LV function, confirming that EUROPA patients did not have asymptomatic LV dysfunction. Results in patients with preserved LV function are consistent with those of the whole EUROPA study population and perindopril 8 mg is beneficial in the broad spectrum of patients with stable coronary artery disease without evidence of heart failure
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