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Magne, Julien

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Magne
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Julien
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Faculté de médecine, Université Laval
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Voici les éléments 1 - 10 sur 34
  • Publication
    Restreint
    Prognostic importance of brain natriuretic peptide and left ventricular longitudinal function in asymptomatic degenerative mitral regurgitation
    (BMJ, 2012-02-18) O'Connor, Kim; Fleury, Charles; Piérard, Luc A.; Mahjoub, Haïfa; Magne, Julien; Pibarot, Philippe; Lancellotti, Patrizio
    OBJECTIVES: To identify the determinants and the impact on outcome of brain natriuretic peptide (BNP) in asymptomatic patients with degenerative mitral regurgitation (MR). METHOD: Comprehensive transthoracic echocardiography including two-dimensional speckle tracking quantification was performed in 135 consecutive asymptomatic patients (60±14 years, 56% men) with moderate to severe degenerative MR and preserved left ventricular (LV) function. Blood samples were collected at the time of the echocardiography and plasma BNP levels were measured. MAIN OUTCOME MEASURES: BNP level and cardiac events. RESULTS: BNP was correlated with age, indexed LV end-systolic diameter, indexed left atrium (LA) volume, estimated LV filling pressure with E/Ea ratio, systolic pulmonary arterial pressure and global longitudinal strain (GLS). In multiple regression analysis, indexed LA volume (p=0.008), mitral deceleration time (p=0.003) and GLS (p<0.0001) were independently associated with BNP. During follow-up (mean=23±19 months), 54 events occurred resulting in 4-year event-free survival of 50±6%. There was a graded relationship between the increase in BNP (ie, according to quartile) and reduced event-free survival (p<0.0001). In Cox multivariable analysis, indexed LA volume (HR=1.04, p=0.003), GLS (HR=1.14, p=0.007) and 3rd and 4th quartiles of BNP (HR=8.5, p=0.002 and HR=8.8, p=0.002) were independent determinants of event-free survival. CONCLUSION: In asymptomatic degenerative MR, LV longitudinal function and LA volume are the main determinants of BNP release. BNP is a powerful independent predictor of cardiac events. Measurement of plasma BNP may help to improve risk stratification and management of asymptomatic patients with degenerative MR.
  • Publication
    Accès libre
    Postoperative atrial fibrillation predicts long-term survival after aortic-valve surgery but not after mitral-valve surgery : a retrospective study.
    (BMJ Publishing, 2011-10-27) Magne, Julien; Voisine, Pierre; Girerd, Nicolas; Pibarot, Philippe; Dagenais, François; Mathieu, Patrick
    Background: Postoperative atrial fibrillation (POAF) has been reported to be associated with reduced long-term survival after isolated coronary artery bypass grafting surgery. The objective of this study was to determine the impact of POAF on long-term survival after valvular surgery. Methods: The authors retrospectively analysed the preoperative and operative data of 2986 consecutive patients with no preoperative history of atrial fibrillation undergoing first valvular surgery (aortic-valve replacement (AVR), mitral valve replacement or mitral valve repair (MVR/MVRp) with or without coronary artery bypass grafting surgery) in their institution between 1995 and 2008 (median follow-up 5.31 years, range 0.1-15.0). The authors investigated the impact of POAF on survival using multivariable Cox regression. Results: Patients with POAF were older, and were more likely to have hypertension or renal failure when compared with patients without POAF. The 12-year survival in patients with POAF was 45.7±2.8% versus 61.4±2.1% in patients without POAF (p<0.001). On a multivariable analysis, when adjusting for age and other potential confounding factors, POAF tended to be associated with lower long-term survival (HR for all-cause death (HR)=1.17, 95% CI 1.00 to 1.38, p=0.051). The authors also analysed this association separately in patients with AVR and those with MVR/MVRp. In the multivariable analysis, POAF was a significant predictor of higher long-term mortality in patients with AVR (HR=1.22, CI 1.02 to 1.45, p=0.03) but not in patients with MVR/MVRp (HR=0.87, CI 0.58 to 1.29, p=0.48). Conclusions: POAF is significantly associated with long-term mortality following AVR but not after MVR/MVRp. The underlying factors involved in the pathogenesis of POAF after MVR/MVRp may partially account for the lack of association between POAF and survival in these patients.
  • Publication
    Restreint
    Moderate patient–prosthesis mismatch can impact on mortality after aortic valve replacement
    (BMJ, 2009-03-15) Magne, Julien; Girerd, Nicolas; Pibarot, Philippe; Dumesnil, Jean G.
  • Publication
    Restreint
    Ischemic mitral regurgitation : a complex multifaceted disease
    (S. Karger, 2009-03-01) Sénéchal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.
    Ischemic mitral regurgitation (MR) is a complex multifactorial disease that involves global and regional left ventricular remodeling as well as dysfunction and distortion of the components of the mitral valve including the chordae, annulus and leaflets. This is a frequent (13–59%) complication of myocardial infarction, which is associated with a poor prognosis. The suboptimal results obtained with the most commonly used surgical strategy, that is, restrictive annuloplasty combined with coronary artery bypass graft, emphasize the need to develop alternative or concomitant surgical techniques that directly target the causal mechanisms of the disease. A comprehensive assessment of mitral valve configuration and left ventricular geometry and function prior to surgery as well as an accurate quantification of MR severity at rest and during exercise may help improve patient risk stratification and better individualize the surgical strategy based on the patient’s specific characteristics. The purpose of this review is to summarize the current state of knowledge with regard to the definition, prevalence, mechanisms, outcome and treatment of ischemic MR.
  • Publication
    Restreint
    Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis
    (American College of Cardiology, 2008-04-22) Sénéchal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François; Mathieu, Patrick
    Objectives : The purpose of this study was to evaluate mitral valve hemodynamic performance and functional capacity in patients with ischemic mitral regurgitation (MR) who underwent restrictive mitral valve annuloplasty (MVA). Background : Restrictive MVA combined with coronary artery bypass graft is the conventional approach for the surgical management of patients with ischemic MR. We hypothesized that the restriction of the mitral annulus could cause an obstruction to antegrade mitral flow that may affect the patient's functional capacity. Methods : A dobutamine stress echocardiography (DSE) and a 6-min walk test (6MWT) were performed in 24 patients with ischemic MR 13 ± 3 months after restrictive MVA and coronary artery bypass graft and in 20 control patients with coronary artery disease matched for age, gender, and left ventricular ejection fraction. Results : None of the 24 MVA patients had significant MR after operation. Compared with control patients, MVA patients had significantly (p < 0.001) higher resting and stress peak gradients (rest: 13 ± 4 mm Hg vs. 4 ± 1 mm Hg; DSE: 19 ± 6 mm Hg vs. 6 ± 3 mm Hg) and systolic pulmonary arterial pressures (PAP) (rest: 42 ± 13 mm Hg vs. 27 ± 8 mm Hg; DSE: 58 ± 12 mm Hg vs. 38 ± 11 mm Hg) and lower (p = 0.01) 6MWT distance (358 ± 95 m vs. 433 ± 61 m). The resting peak mitral gradient correlated with systolic PAP (r = -0.67; p = 0.001) and 6MWT distance (r = -0.78; p < 0.0001) in the MVA group. Conclusions : The results suggest that performing a restrictive MVA in patients with ischemic MR may create a functional mitral stenosis. This hemodynamic sequel is associated with higher PAP and a worse functional capacity
  • Publication
    Restreint
    Recommendations for the imaging assessment of prosthetic heart valves : a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging.
    (Oxford University Press, 2016-05-03) Lancellotti, Patrizio; Magne, Julien; Chambers, John; Thor, Edvardsen; Delgado, Victoria; Dulgheru, Raluca; Pepi, Mauro; Cosyns, Bernard; Dweck, Mark R.; Garbi, Madalina; Nieman, Koen; Rosenhek, Raphael; Lowenstein, Jorge; Campos Vieira, Marcelo Luiz; Rabischoffsky, Arnaldo; Vyhmeiste, Rodrigo Hernández; Zhou, Xiao; Zhang, Yun; Zamorano, José L. (José Luis); Habib, Gilbert
    Prosthetic heart valve (PHV) dysfunction is rare but potentially life-threatening. Although often challenging, establishing the exact cause of PHV dysfunction is essential to determine the appropriate treatment strategy. In clinical practice, a comprehensive approach that integrates several parameters of valve morphology and function assessed with 2D/3D transthoracic and transoesophageal echocardiography is a key to appropriately detect and quantitate PHV dysfunction. Cinefluoroscopy, multidetector computed tomography, cardiac magnetic resonance imaging, and to a lesser extent, nuclear imaging are complementary tools for the diagnosis and management of PHV complications. The present document provides recommendations for the use of multimodality imaging in the assessment of PHVs.
  • 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 pg.ml -1 vs. -61 ± 959 pg.ml -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
    Restreint
    Continued global left ventricular remodeling is not the sole mechanism responsible for the late recurrence of ischemic mitral regurgitation after restrictive annuloplasty
    (Elsevier, 2009-11-01) Sénéchal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.
    Background: Recurrence of ischemic mitral regurgitation (MR) late after mitral valve annuloplasty (MVA) is generally believed to be due to continued left ventricular (LV) remodeling. The aim of this study was to determine if other mechanisms could be involved in MR recurrence. Methods and Results: Preoperative (10 ± 11 days), early postoperative (6 ± 4 days), and late postoperative (1.5 ± 0.6 years) transthoracic echocardiograms of 26 patients (68 ± 7 years, 23 male [88%]) who underwent restrictive MVA and coronary artery bypass graft surgery were reviewed. Mitral valve geometry and MR severity were assessed using anterior leaflet and posterior leaflet angles and the anterior leaflet concavity area, defined as the area enclosed between the AL and a line connecting the tip of the leaflet and its basal insertion at the annulus. Recurrent MR (vena contracta > 3 mm) was observed in 10 patients (38.5%). Among the 10 patients with recurrent MR, 5 had significant late postoperative increase in LV end-systolic (preoperative: 66 ± 27 mL; early postoperative: 61 ± 11 mL; late postoperative: 89 ± 30 mL, P = .04) and end-diastolic (preoperative: 122 ± 39 mL; early postoperative: 108 ± 22 mL; late postoperative: 139 ± 39 mL, P = .04) volumes and PL angle (early postoperative: 65 ± 12 degrees; late postoperative: 77 ± 8 degrees, P = .04), suggesting that recurrent MR is related to continued adverse LV remodeling and ensuing worsening of leaflet tethering. However, in the remaining 5 patients with recurrent MR, there was no significant change in LV end-systolic and end-diastolic volumes, but there was a significant increase in anterior leaflet concavity area (early postoperative: 6 ± 11 mm2; late postoperative: 50 ± 3 mm2, P = .012). Conclusion: Although recurrent MR is often associated with continued adverse LV remodeling after restrictive MVA, this mechanism fails to explain all recurrences. In the absence of LV dilatation, recurrent MR might be explained by localized LV remodeling in the vicinity of papillary muscles resulting in increased AL tethering at the bending point.
  • Publication
    Restreint
    Multimodality imaging strategies for the assessment of aortic stenosis : viewpoint of the heart valve clinic international database (HAVEC) group.
    (Lippincott Williams & Wilkins, 2016-02-01) Dulgheru, Raluca; Magne, Julien; Bernard, Anne; Sengupta, Partho; Pibarot, Philippe; Piérard, Luc A.; Rosenhek, Raphael; Donal, Erwan; Fattouch, Khalil; Cosyns, Bernard; Vannan, Mani A.; Gillam, Linda D.; Lancellotti, Patrizio
    Aortic stenosis is the most frequent valvular heart disease. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and status of left ventricular systolic function. Surgical aortic valve replacement or transcatheter aortic valve implantation is the sole effective therapy in symptomatic patients with severe aortic stenosis, whereas the management of asymptomatic patients remains controversial and is mainly based on individual risk stratification. Imaging is fundamental for the initial diagnostic work-up, follow-up, and selection of the optimal timing and type of intervention. The present review provides specific recommendations for utilization of multimodality imaging to optimize risk stratification and therapeutic decision-making processes in aortic stenosis.
  • Publication
    Accès libre
    Pulmonary hypertension in valvular disease : a comprehensive review on pathophysiology to therapy from the HAVEC Group.
    (Elsevier, 2015-01-12) Magne, Julien; Pibarot, Philippe; Sengupta, Partho; Donal, Erwan; Rosenhek, Raphael; Lancellotti, Patrizio
    Pulmonary hypertension (PH) is a classic pathophysiological consequence of left-sided valvular heart disease (VHD). However, as opposed to other forms of PH, there are relatively few published data on the prevalence, impact on outcome, and management of PH with VHD. The objective of this paper is to present a systematic review of PH in patients with VHD. PH is found in 15% to 60% of patients with VHD and is more frequent among symptomatic patients. PH is associated with higher risk of cardiac events under conservative management, during valve replacement or repair procedures, and even following successful corrective procedures. In addition to its usefulness in assessing the presence and severity of VHD, Doppler echocardiography is a key tool in diagnosis of PH and assessment of its repercussion on right ventricular function. Assessment of pulmonary arterial pressure during exercise stress echocardiography may provide additional prognostic information beyond resting evaluation. Cardiac magnetic resonance is also useful for assessing right ventricular geometry and function, which provide additional prognostic information in patients with VHD and PH.