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Bauters C, Dubois E, Porouchani S, Saloux E, Fertin M, de Groote P, Lamblin N, Pinet F. Long-term prognostic impact of left ventricular remodeling after a first myocardial infarction in modern clinical practice. PLoS One 2017; 12:e0188884. [PMID: 29176897 PMCID: PMC5703528 DOI: 10.1371/journal.pone.0188884] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/14/2017] [Indexed: 11/19/2022] Open
Abstract
Background The association of left ventricular remodeling (LVR) after myocardial infarction (MI) with the subsequent risk of heart failure (HF) and death has not been studied in patients receiving optimal secondary prevention. Methods and results We performed a long-term clinical follow-up of patients included in 2 prospective multicentric studies on LVR after first anterior MI. At 1-year echocardiography, LVR (≥20% increase in end-diastolic volume from baseline to 1 year) occurred in 67/215 (31%) patients in cohort 1 and in 87/226 (38%) patients in cohort 2. The prescription rate of secondary prevention medications was very high (ß-blockers at 1 year: 90% and 95% for cohorts 1 and 2, respectively; angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE-I/ARB) at 1 year: 93% and 97% for cohorts 1 and 2, respectively). Median clinical follow-up after LVR assessment was 11.0 years in cohort 1 and 7.8 years in cohort 2. In both cohorts, LVR patients had a progressive increase in the risk of cardiovascular death or hospitalization for HF (p = 0.0007 in cohort 1 and 0.009 in cohort 2) with unadjusted hazard ratios of 2.52 [1.45–4.36] and 2.52 [1.23–5.17], respectively. Similar results were obtained when cardiovascular death was considered as an isolated endpoint. After adjustement on baseline characteristics including ejection fraction, the association with the composite endpoint was unchanged. Conclusion In a context of a modern therapeutic management with a large prescription of evidence-based medications, LVR remains independently associated with HF and cardiovascular death at long-term follow-up after MI.
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Affiliation(s)
- Christophe Bauters
- University of Lille, Inserm U1167, Institut Pasteur, University Hospital of Lille, Lille, France
- * E-mail:
| | - Emilie Dubois
- University of Lille, Inserm U1167, Institut Pasteur, Lille, France
| | | | - Eric Saloux
- University of Caen, EA 4650, University Hospital of Caen, Caen, France
| | | | - Pascal de Groote
- University of Lille, Inserm U1167, Institut Pasteur, University Hospital of Lille, Lille, France
| | - Nicolas Lamblin
- University of Lille, Inserm U1167, Institut Pasteur, University Hospital of Lille, Lille, France
| | - Florence Pinet
- University of Lille, Inserm U1167, Institut Pasteur, Lille, France
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Ferreira JP, Machu JL, Girerd N, Jaisser F, Thum T, Butler J, González A, Diez J, Heymans S, McDonald K, Gyöngyösi M, Firat H, Rossignol P, Pizard A, Zannad F. Rationale of the FIBROTARGETS study designed to identify novel biomarkers of myocardial fibrosis. ESC Heart Fail 2017; 5:139-148. [PMID: 28988439 PMCID: PMC5793978 DOI: 10.1002/ehf2.12218] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/21/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
Aims Myocardial fibrosis alters the cardiac architecture favouring the development of cardiac dysfunction, including arrhythmias and heart failure. Reducing myocardial fibrosis may improve outcomes through the targeted diagnosis and treatment of emerging fibrotic pathways. The European‐Commission‐funded ‘FIBROTARGETS’ is a multinational academic and industrial consortium with the main aims of (i) characterizing novel key mechanistic pathways involved in the metabolism of fibrillary collagen that may serve as biotargets, (ii) evaluating the potential anti‐fibrotic properties of novel or repurposed molecules interfering with the newly identified biotargets, and (iii) characterizing bioprofiles based on distinct mechanistic phenotypes involving the aforementioned biotargets. These pathways will be explored by performing a systematic and collaborative search for mechanisms and targets of myocardial fibrosis. These mechanisms will then be translated into individualized diagnostic tools and specific therapeutic pharmacological options for heart failure. Methods and results The FIBROTARGETS consortium has merged data from 12 patient cohorts in a common database available to individual consortium partners. The database consists of >12 000 patients with a large spectrum of cardiovascular clinical phenotypes. It integrates community‐based population cohorts, cardiovascular risk cohorts, and heart failure cohorts. Conclusions The FIBROTARGETS biomarker programme is aimed at exploring fibrotic pathways allowing the bioprofiling of patients into specific ‘fibrotic’ phenotypes and identifying new therapeutic targets that will potentially enable the development of novel and tailored anti‐fibrotic therapies for heart failure.
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Affiliation(s)
- João Pedro Ferreira
- Centre d'Investigation Clinique 1433 Module Plurithématique, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Hopitaux de Brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500, Vandœuvre-lès-Nancy, France.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean-Loup Machu
- Centre d'Investigation Clinique 1433 Module Plurithématique, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Hopitaux de Brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
| | - Nicolas Girerd
- Centre d'Investigation Clinique 1433 Module Plurithématique, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Hopitaux de Brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
| | - Frederic Jaisser
- Centre de Recherche des Cordeliers, Inserm U1138, Université Pierre et Marie Curie, Paris, France
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hanover, Germany.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, NY, USA
| | - Arantxa González
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain.,Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - Javier Diez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain.,Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - Stephane Heymans
- Center for Heart Failure Research, Cardiovascular Research Institute Maastricht (CARIM), University Hospital Maastricht, Maastricht, The Netherlands
| | | | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Patrick Rossignol
- Centre d'Investigation Clinique 1433 Module Plurithématique, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Hopitaux de Brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
| | - Anne Pizard
- Centre d'Investigation Clinique 1433 Module Plurithématique, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Hopitaux de Brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
| | - Faiez Zannad
- Centre d'Investigation Clinique 1433 Module Plurithématique, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Hopitaux de Brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
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Ilic I, Stankovic I, Vidakovic R, Jovanovic V, Vlahovic Stipac A, Putnikovic B, Neskovic AN. Relationship of ischemic times and left atrial volume and function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2015; 31:709-16. [PMID: 25648258 DOI: 10.1007/s10554-015-0603-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/27/2015] [Indexed: 01/06/2023]
Abstract
Little is known about the impact of duration of ischemia on left atrial (LA) volumes and function during acute phase of myocardial infarction. We investigated the relationship of ischemic times, echocardiographic indices of diastolic function and LA volumes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). A total of 433 consecutive STEMI patients underwent echocardiographic examination within 48 h of primary PCI, including the measurement of LA volumes and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e'). Time intervals from onset of chest pain to hospital admission and reperfusion were collected and magnitude of Troponin I release was used to assess infarct size. Patients with LA volume index (LAVI) ≥28 ml/m(2) had longer total ischemic time (410 ± 347 vs. 303 ± 314 min, p = 0.007) and higher E/e' ratio (15 ± 5 vs. 10 ± 3, p < 0.001) than those with LAVI <28 ml/m(2), while the indices of LA function were similar between the study groups (p > 0.05, for all). Significant correlation was found between E/e' and LA volumes at all stages of LA filling and contraction (r = 0.363-0.434; p < 0.001, for all) while total ischemic time along with E/e' and restrictive filling pattern remained independent predictor of LA enlargement. Increased LA volume is associated with longer ischemic times and may be a sensitive marker of increased left ventricular filling pressures in STEMI patients treated with primary PCI.
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Affiliation(s)
- Ivan Ilic
- Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, 11080, Belgrade, Serbia,
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