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Dubois, Michelle

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Université Laval
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  • Publication
    Accès libre
    Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy
    (BioMed Central, 2009-08-20) Dubois, Michelle; Sénéchal, Mario; Magne, Julien; Champagne, Jean; Philippon, François; Pibarot, Philippe; Dumesnil, Jean G.; O'Hara, Gilles
    Background: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF). However, = 30% of patients have no significant clinical or echocardiographic improvement following CRT. Reverse remodeling after CRT correlates with improved clinical outcomes. We hypothesized that in NT-pro BNP monitoring is accurate to identify responders following CRT. Methods: 42 consecutive patients (mean age 66 ± 12 years, male 68%) with HF undergoing CRT were prospectively enrolled. Responders at follow-up were defined by echocardiography (decrease in LV end systolic volume = 15%). Echocardiography and NT-pro BNP measurement were performed at baseline and repeated 3 to 6 month after CRT. Results: There was no significant difference between responders (n = 29, 69%) and non-responders (n = 13, 31%) regarding baseline NT-pro BNP level. Responders had significantly higher decrease in NT-pro BNP levels during follow-up than non-responders (absolute: -1428 ± 1333 -1 vs. -61 ± 959 -1 , p = 0.002; relative: -45 ± 28% vs. 2 ± 28%, p < 0.0001). A decrease of = 15% in NT-pro BNP 3–6 months after CRT identifies echocardiographic responders with a sensitivity of 90% and a specificity of 77%. Conclusion: NT-pro BNP monitoring can accurately identify echocardiographic responders after CRT.
  • Publication
    Direction of persistent ischemic mitral jet after restrictive valve annuloplasty: implications for interpretation of perioperative echocardiography
    (Elsevier, 2007-10-01) Dubois, Michelle; Magne, Julien; Sénéchal, Mario; Charbonneau, Éric; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François.
    BACKGROUND: Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty (MVA) and is associated with a poor prognosis. It was hypothesized that the anterior displacement of the posterior aspect of the annulus caused by annuloplasty could induce a change in the direction of MR jet. METHODS: The echocardiograms of 21 patients who underwent restrictive MVA for ischemic MR and who had detectable postoperative MR were analyzed before and early after surgery to evaluate the direction of MR jet. RESULTS: The MR jet direction was posterior in 15 patients (72%) and central or anterior in six patients (28%) before the operation, compared with four patients (20%) and 17 patients (80%), respectively, after MVA (P<0.001). Overall, the jet direction was modified in 16 of 21 7patients (76%) following MVA. Among the subset of 11 patients with clinically significant persistent MR (vena contracta width greater than 3 mm), the MR jet direction changed in nine patients (82%) compared with their preoperative evaluation. Importantly, the initial clinical interpretation, based on a subjective evaluation, had classified MR severity as nonsignificant in six of 11 patients (55%), likely due to the eccentricity of the jet and its change in direction. CONCLUSION: The direction of the persistent MR jet early after annuloplasty is often different from that of preoperative MR jet and may lead to significant misinterpretation of the postoperative echocardiogram