1
|
Lee GA, Aktaa S, Baker E, Gale CP, Yaseen IF, Gulati G, Asteggiano R, Szmit S, Cohen-Solal A, Abdin A, Jurczak W, Garrido Lopez P, Sverdlov AL, Tocchetti CG, Barac A, Parrini I, Zamorano P, Iakobishvili Z, Pudil R, Badimon L, Kirby AM, Blaes AH, Farmakis D, Curigliano G, Stephens R, Lyon AR, Lopez-Fernandez T. European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment. Eur Heart J Qual Care Clin Outcomes 2022; 9:1-7. [PMID: 36316010 PMCID: PMC9745663 DOI: 10.1093/ehjqcco/qcac070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022]
Abstract
AIMS To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.
Collapse
Affiliation(s)
- G A Lee
- Division of Applied Technology for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - S Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Baker
- Division of Applied Technology for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Israa F Yaseen
- Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq
| | - G Gulati
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - R Asteggiano
- School of Medicine, Insubria University, Varese, Italy
- LARC (Laboratorio Analisi e Ricerca Clinica), C.so Venezia 10, Turin, Italy
| | - S Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Otwock, Poland
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - A Cohen-Solal
- Research Medical Unit INSERM U-942, University of Paris, Paris, France
- Cardiology Department, Hôpitaux de Paris, Hôpital Lariboisière 2 Rue Ambroise Paré, Paris, France
| | - A Abdin
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - W Jurczak
- MSC National Research Institute of Oncology, Garnarska 11, 31-115 Krakow, Poland
| | - P Garrido Lopez
- Jefe Servicio Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A L Sverdlov
- Newcastle Centre of Excellence in Cardio-Oncology, Calvary Mater Newcastle, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, NSW, Australia
| | - C G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center for Clinical and Translational Research (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - A Barac
- Cardio-oncology Program, MedStar Heart and Vascular Institute, Washington DC, USA
| | - I Parrini
- Department of Cardiology, Mauriziano Hospital, Turin, Italy
| | - P Zamorano
- University Hospital Ramon y Cajal, Madrid, Spain
| | - Z Iakobishvili
- Department of Community Cardiology, Clalit Health Services, Tel Aviv Jaffa, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - R Pudil
- University Hospital Hradec Králové, Sokolská 5005, Hradec Králové, Czech Republic
| | - L Badimon
- IIBSant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV, Barcelona, Spain
| | - A M Kirby
- Royal Marsden NHS Trust & Institute of Cancer Research, London, UK
| | - A H Blaes
- Division of Hematology/Oncology/Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - D Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- IRCCS, European Institute of Oncology, Milan, Italy
| | | | - A R Lyon
- National Heart and Lung Institute, Imperial College London, and Cardio-Oncology Service, Royal Brompton Hospital, London, UK
| | - T Lopez-Fernandez
- Cardiology department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| |
Collapse
|
2
|
Tsutsui H, Lam CSP, Zhang J, Godoy-Palomino A, Tziakas D, Cohen-Solal A, Freitas C, Patel MJ, Ezekowitz JA, Hernandez AF, Pieske B, O'Connor CM, Westerhout CM, Alemayehu W, Armstrong PW. Geographic variation in heart failure with reduced ejection fraction: insights from the VICTORIA trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Geographic differences and background therapy have not been explored in the global VICTORIA trial, which enrolled high-risk patients with recent worsening heart failure with reduced ejection fraction (HFrEF).
Methods and results
Among 5050 patients enrolled in 5 pre-specified geographic regions, 34% were from Eastern Europe, 18% Western Europe, 23% Asia Pacific, 14% Latin and South America, and 11% North America (Table 1). Patients from Western Europe were older, had more atrial fibrillation, and lower glomerular filtration rates. Patients from Eastern Europe had more coronary artery disease and exhibited more advanced symptoms (∼50% New York Heart Association [NYHA] class III), whereas those from Latin and South America were less symptomatic (∼70% NYHA class II). North American patients had the largest body mass index as well as more diabetes and hypertension. Levels of NT-proBNP at randomization and MAGGIC risk scores were highest in Western European patients. Evidence-based triple medication therapy was used most frequently in Latin and South America and less frequently in North America; conversely, cardiac resynchronization therapy and implantable cardioverter defibrillators were most frequently used in North America and least frequently in Latin and South America. The overall primary composite event rate (cardiovascular death or HF hospitalization) in the placebo arm was 36.6/100 person-years over a median of 10.8 months and after adjusting for the MAGGIC score. When examined by region, these event rates were nominally highest in North America and lowest in Western Europe.
Conclusion
Substantial regional differences exist in characteristics and treatments among patients in this global trial of patients with HFrEF and a recent worsening event. These findings demonstrate the continuing unmet needs and opportunities for enhancing care in HFrEF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): VICTORIA was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
Collapse
Affiliation(s)
- H Tsutsui
- Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - C S P Lam
- National Heart Centre Singapore, Duke-NUS , Singapore , Singapore
| | - J Zhang
- Fuwai Hospital Chinese Academy of Medical Sciences , Beijing , China
| | | | - D Tziakas
- Democritus University of Thrace , Alexandroupolis , Greece
| | | | | | - M J Patel
- Merck & Co., Inc. , Kenilworth , United States of America
| | - J A Ezekowitz
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine , Durham , United States of America
| | - B Pieske
- Charité - University Medicine Berlin , Berlin , Germany
| | - C M O'Connor
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - C M Westerhout
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - W Alemayehu
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - P W Armstrong
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| |
Collapse
|
3
|
Pezel T, Ambale Venkatesh B, De Vasconcellos H, Kato Y, Post WP, Wu C, Heckbert S, Bluemke D, Cohen-Solal A, Logeart D, Henry P, Lima J. Determinants of left atrioventricular coupling index: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Recent studies have described a novel left atrioventricular coupling index (LACI), which had a better prognostic value than individual left atrial (LA) or left ventricular (LV) parameters measured separately to predict cardiovascular events.
Purpose
To identify the determinants of the LACI and its 10-year annual change (ΔLACI), measured by cardiovascular magnetic resonance (CMR), and to better understand the parameters governing this left atrioventricular coupling.
Methods
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2,112 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (LACIBaseline, 2000–2002) and 10 years later (2010–2012). The LACI was defined as the ratio of LA to LV end-diastolic volumes. Linear regression analyses were performed to identify independent determinants of LACIBaseline or ΔLACI.
Results
In the 2,112 participants (58.8±9.1 years, 46.6% male), after adjustment for all covariates, age was independently associated with both LACIBaseline (R2=0.10, slope=0.16) and ΔLACI (R2=0.15, slope=0.008, both p<0.001). African Americans had the highest LACIBaseline value (18.0±7.7%). Although there was no difference in LACIBaseline between women and men (p=0.19), ΔLACI was higher in women than in men (1.0±1.1 vs. 0.8±1.0%/year, p<0.001). Diabetes and a higher BMI were independently associated with LACIBaseline (both p<0.001). LACIBaseline was independently associated with LV myocardial fibrosis markers (native T1: R2=0.11, slope = 0.09, p=0.038; and extra-cellular volume: R2=0.08, slope = 0.28, p=0.035) and NT-proBNP levels (R2=0.10, slope = −1.11, p<0.001) but was not associated with IL-6 or hsCRP.
Conclusions
Age, sex, ethnicity, diabetes, and BMI were independent determinants of LACI. LACI was independently associated with LV myocardial fibrosis markers and NT-proBNP levels.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- T Pezel
- Hospital Lariboisiere , Paris , France
| | - B Ambale Venkatesh
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - H De Vasconcellos
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - Y Kato
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - W P Post
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - C Wu
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - S Heckbert
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - D Bluemke
- University of Wisconsin-Madison , Madison , United States of America
| | | | - D Logeart
- Hospital Lariboisiere , Paris , France
| | - P Henry
- Hospital Lariboisiere , Paris , France
| | - J Lima
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| |
Collapse
|
4
|
Ezekowitz J, Zheng Y, Cohen-Solal A, Melenovsky V, Escobedo J, Butler J, Hernandez A, Lam C, O'Connor C, Pieske B, Ponikowski P, Voors A, McMullan C, Roessig L, Armstrong P. Hemoglobin, anemia, and clinical outcomes in vericiguat global study in subjects with heart failure with reduced ejection fraction (VICTORIA). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In the VICTORIA trial of patients with HFrEF after a worsening HF event, anemia occurred more often in patients treated with vericiguat (7.6%) compared with placebo (5.7%). We explored the association between vericiguat, baseline hemoglobin, and anemia and also whether hemoglobin was related to the benefit of vericiguat in HF.
Methods
Anemia was defined as a hemoglobin <13.0 g/dL in men and <12.0 g/dL in women (WHO anemia). Adverse events reported as new anemia were also evaluated (AE anemia). We evaluated the risk-adjusted relationship between baseline hemoglobin (as both quartiles and continuous variable), hematocrit, and hematinic indices with the primary outcome (composite of cardiovascular death or heart failure hospitalization). Time-updated hemoglobin relationship was also examined.
Results
Of 4812 patients with baseline hemoglobin data available, 1719 (35.7%) were WHO anemic; median hemoglobin was 13.4 g/dL (IQR 12.1 to 14.7 g/dL). In total, 1643 patients had WHO anemia at 16 weeks (of which 284 were new from baseline for vericiguat and 219 for placebo) and this occurred more often in the vericiguat group than the placebo group (P<.001). Subsequently, there was no further decline in hemoglobin over the 96 weeks of follow-up (Figure A). The ratio of hemoglobin/hematocrit remained constant and none of the hematinic indices including red cell density width, mean corpuscular volume, white blood cell or platelet counts changed over time. Overall, AE anemia occurred in 342 patients (7.1%) and was more frequent in those with a lower baseline hemoglobin (hemoglobin Q1: 184 [14.5%], Q2: 94 [7.9%], Q3: 40 [3.4%], Q4: 24 [2.1%]; p<.001). Whereas outcomes were associated, quartiles of baseline hemoglobin were not related to the treatment benefit of vericiguat (compared with placebo) for the primary outcome (Figure B). Additionally, analysis of the time-updated hemoglobin values revealed no association with the treatment effect of vericiguat (compared with placebo) on the primary outcome.
Conclusions
Anemia was present at baseline in over one-third of patients in the VICTORIA trial and was generally mild. Lower hemoglobin was associated with greater frequency of clinical events. Although vericiguat modestly lowered hemoglobin by 16 weeks, this effect did not further progress nor influence the association of benefit of vericiguat.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck & Co., Inc. and Bayer
Collapse
Affiliation(s)
| | - Y Zheng
- University of Alberta, Edmonton, Canada
| | | | - V Melenovsky
- Institute for Clinical and Experimental Medicine-IKEM, Prague, Czechia
| | - J Escobedo
- Regional Hospital No. 1, Mexico City, Mexico
| | - J Butler
- The University of Mississippi Medical Center, Jackson, United States of America
| | - A.F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - C.S.P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore, Singapore
| | - C.M O'Connor
- Inova Heart and Vascular Institute, Falls Church, United States of America
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | - A.A Voors
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - C McMullan
- Merck & Co., Inc., Kenilworth, United States of America
| | | | | | | |
Collapse
|
5
|
Pezel T, Ambale Venkatesh B, Kato Y, De Vasconcellos H, Heckbert S, Wu C, Post W, Bluemke D, Cohen-Solal A, Henry P, Lima J. Left atrioventricular coupling index to predict incident heart failure: The Multi-Ethnic Study of Atherosclerosis (MESA). Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Castiglione V, Aimo A, Prontera C, Masotti S, Chubuchny V, Genovesi D, Barison A, Nicol M, Cohen-Solal A, Logeart D, Passino C, Emdin M, Vergaro G. High-sensitivity cardiac troponin T and NT-proBNP for ruling-in and ruling-out of cardiac amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac amyloidosis (CA) is caused by the extracellular deposition of misfolded proteins into insoluble amyloid fibrils, the 2 most common forms being transthyretin (ATTR) and immunoglobulin light chain (AL) amyloidosis. Chronic elevation of cardiac troponins and natriuretic peptides is common in CA and predicts worse outcome. The diagnostic yield of biomarkers of cardiac damage for CA has been less investigated.
Purpose
We aimed to evaluate the ruling-in/out values for the diagnosis of CA of high-sensitivity cardiac troponin T (hs-cTnT) and of N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP).
Methods
We studied 275 consecutive patients referred to two tertiary Centers in Italy (n=184) and France (n=91) with the clinical suspicion of CA due to the presence of a plasma cell dyscrasia or an unexplained left ventricular (pseudo)hypertrophy. CA was confirmed by the combination of suggestive features on imaging techniques (echocardiography, cardiac magnetic resonance, diphosphonate scintigraphy) and biopsy examination. All patients underwent a full baseline characterization including hs-cTnT and NT-proBNP. Biomarkers values corresponding to a negative likelihood ratio <0.1 or a positive likelihood ratio >10 were respectively chosen as rule-out and rule-in cut-offs for CA.
Results
CA was confirmed in 161 (59%) patients, who had either AL amyloidosis (n=96, 60%) or ATTR amyloidosis (n=65, 40%). At time of evaluation, 97 (35%) patients (34 CA vs. 63 controls, p=0.112) were hospitalized for decompensated heart failure. Patients with CA showed higher hs-cTnT (65 ng/L [44–122] vs. 31 [18–42], p<0.001) and NT-proBNP (4260 ng/L [2006–8911] vs. 1199 [468–3357], p<0.001) than those without CA. The area under the curve (AUC) values for hs-cTnT and NT-proBNP were 0.832 and 0.744 respectively (p=0.002 for the difference). The combination of the two biomarkers (AUC=0.836) improved discrimination over NT-proBNP (p=0.004), but not over hs-cTnT (p=0.423). A hs-cTnT value <15 ng/L (sensitivity=100%, negative predictive value=100%, true negatives=13, false negatives=0) and a NT-proBNP <550 ng/L (sensitivity=98%, negative predictive value=89%, true negatives=33, false negatives=4) were selected as rule-out cut-offs. A hs-cTnT level ≥80 ng/L (specificity=96%, positive predictive value=93%, true positives=71, false positives=5) was optimal for ruling in amyloidosis, while no rule-in cut-off could be selected for NT-proBNP. hs-cTnT values of either ≥80 or <15 ng/dL could effectively rule-in/out 89 (32%) patients.
Conclusions
Plasma hs-cTnT and NT-proBNP have diagnostic value in patients with suspected CA. Stand-alone hs-cTnT levels <15 or ≥80 ng/L may help to exclude or confirm the diagnosis of CA in up to one third of patients undergoing a diagnostic screening for the disease.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- V Castiglione
- University of Pisa, Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Pisa, Italy
| | - A Aimo
- University of Pisa, Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Pisa, Italy
| | - C Prontera
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Masotti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - V Chubuchny
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - D Genovesi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Barison
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Nicol
- Hospital Lariboisiere, Cardiology Department, Paris, France
| | - A Cohen-Solal
- Hospital Lariboisiere, Cardiology Department, Paris, France
| | - D Logeart
- Hospital Lariboisiere, Cardiology Department, Paris, France
| | - C Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| |
Collapse
|
7
|
Aimo A, Chubuchny V, Vergaro G, Fontana M, Nicol M, Cohen-Solal A, Castiglione V, Spini V, Giannoni A, Taddei C, Pasanisi E, Passino C, Emdin M. Two common echocardiographic variables to diagnose cardiac amyloidosis: the AMYLoidosis Index (AMYLI) score. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Early diagnosis of cardiac amyloidosis (CA) is warranted to initiate specific treatment and improve outcome. The amyloid light chain (AL) and inferior wall thickness (IWT) scores have been proposed to assess patients referred by hematologists or with unexplained left ventricular (LV) hypertrophy, respectively. These scores are composed of 4 or 5 variables, respectively, including strain data, and no decisional cut-offs were introduced.
Methods
Based on 2 variables common to the AL and IWT scores, we defined a simple score named AMYLoidosis Index (AMYLI) as the product of relative wall thickness (RWT) and E/e' ratio, and assessed its diagnostic performance. Optimal rule-out cut-offs were searched as those with negative likelihood ratio (LR−) <0.1.
Results
In the derivation cohort (n=251), CA was ultimately diagnosed in 111 patients (44%). The 2.22 score value was selected as rule-out cut-off (LR- 0.0). In the hematology subset, AL CA was finally diagnosed in 32 patients (48%), with 2.36 as rule-out cut-off (LR− 0.0). In the hypertrophy subset, ATTR CA was diagnosed in 79 patients (43%), with 2.22 as best rule-out cut-off (LR− 0.0). In the validation cohort (n=691), where more patients were diagnosed with CA (94% and 68% in the hematology and in the hypertrophy subsets, respectively), the 2.22 rule-out cut-off had a LR− = ∞ (as no patient scoring <2.22 had CA). In the hematology and hypertrophy subsets, the 2.36 and 2.22 cut-offs were effective for ruling-out CA, with both LR− = ∞ (as no patient scoring <2.36 or 2.22, respectively, had CA).
Conclusions
The AMYLI score (RWT* E/e') is simpler than those proposed and similarly accurate. A 2.22 cut-off value excludes CA diagnosis in patients undergoing a diagnostic screening for CA, while a <2.36 and a <2.22 value may be better considered in the subsets with either blood dyscrasia or unexplained hypertrophy, respectively.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy, Pisa, Italy
| | - V Chubuchny
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Fontana
- University College London, London, United Kingdom
| | - M Nicol
- Hospital Lariboisiere, Paris, France
| | | | - V Castiglione
- Scuola Superiore Sant'Anna, Pisa, Italy, Pisa, Italy
| | - V Spini
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Giannoni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - C Taddei
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - E Pasanisi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - C Passino
- Scuola Superiore Sant'Anna, Pisa, Italy, Pisa, Italy
| | - M Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy, Pisa, Italy
| |
Collapse
|
8
|
Pezel T, Sideris G, Dillinger JG, Logeart D, Manzo-Silberman S, Cohen-Solal A, Beauvais F, Laissy JP, Henry P. 101Characterization of the calcium component of vulnerable coronary plaque in patients with NSTEMI: prospective comparison between coronary CT and optical coherence tomography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute Coronary Syndrome (ACS) remains a leading cause of mortality worldwide with a high risk of recurrence. Apart culprit plaques, the presence of vulnerable plaques could be associated with the occurrence of future cardiac events and need to adapt treatments. Several studies have demonstrated a role for Coronary Computed Tomographic Angiography (CCTA) to predict the vulnerability of the plaque but with limited analysis of its calcium component. Recent works suggest a role for calcification in this vulnerability.
To our knowledge, no studies have been performed to assess if the study of the calcium component of plaques with CCTA can help to predict vulnerability in non-ST elevation myocardial infarction (NSTEMI).
Purpose
To assess if the CCTA study of the calcium component of plaques can help to predict plaque vulnerability defined by intracoronary OCT analysis in patients with non-ST elevation myocardial infarction (NSTEMI).
Methods
Monocentric prospective study of consecutive patients referred for NSTEMI with elevated high-sensitivity cardiac troponin I level (hs-TnI>50 ng/ml) from January to October 2018. CCTA was systematically performed before coronary angiography to assess the presence of CAD. When CCTA demonstrated significant lesions, coronary angiography was performed within 24 hours associated with systematic OCT study of three coronary arteries. Apart culprit plaques, vulnerable plaques were defined in OCT by a fibrous screed thickness <65 microns. Calcified plaques were analysed with CT and then classified into 3 groups: vulnerable culprit plaque (VCP), vulnerable non-culprit plaque (VNCP) and stable plaque (SP).
Results
Of 1478 patients with chest pain, 257 (17%) had NSTEMI with high level of hs-TnI. From this 257 NSTEMI patients, 44 (17%) were without known CAD and among these, 33 (75%) had received coronary angiography with 29 (66% - mean age 59±13 years, 73% men) having coronary anatomy compatible with OCT assessment. A total of 123 calcified plaques were identified. Among them, OCT allowed to identify 77 (63%) SP and 47 calcified vulnerable plaques; 28 (23%) VNCP and 19 (15%) VCP. After CCTA analysis of the calcium component, predictive factors of plaque vulnerability were identified: longer calcification length (p<0.001), larger calcification volume (p<0.001), lower calcium mass (p=0.003), higher single plaque Agatston score (p<0.001), lower sphericity index (p=0.001), more spotty calcifications (p=0.001), as well as more intimal position in the wall (p<0.001). No significant differences were observed comparing VNCP and VCP (Figure).
OCT and “Virtual Histology” CT
Conclusion
CCTA study of the calcium component of plaque allows to identify predictors of plaque vulnerability defined by OCT in patients with NSTEMI.
Collapse
Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology and Radiology, Paris, France
| | - G Sideris
- Hospital Lariboisiere, Cardiology, Paris, France
| | | | - D Logeart
- Hospital Lariboisiere, Cardiology, Paris, France
| | | | | | - F Beauvais
- Hospital Lariboisiere, Cardiology, Paris, France
| | - J P Laissy
- Hospital Lariboisiere, Radiology, Paris, France
| | - P Henry
- Hospital Lariboisiere, Cardiology, Paris, France
| |
Collapse
|
9
|
Akiyama E, Cinotti R, Arrigo M, Lassus J, Miro O, Celutkiene J, Cohen-Solal A, Maggioni AP, Mueller C, Parenica J, Spinar J, Sato N, Tamura K, Kimura K, Mebazaa A. P6354Decreased beneficial effects of oral heart failure medications in patients with acute decompensated heart failure and hyperglycemia: results from an international observational cohort. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyperglycemia is common, regardless of diabetes mellitus (DM), and is associated with increased mortality in patients with acute heart failure (AHF). Current oral heart failure (HF) medications improve the outcome in patients with AHF. However, the relationships between HF medications, admission glucose levels, and prognosis in AHF patients remained unknown.
Purpose
This study sought to investigate the effect of oral HF medications on relationships between hyperglycemia at admission and 1-year all-cause mortality in patients with AHF.
Methods
From the GREAT (Global Research on Acute Conditions Team) registry, 13840 patients presenting with AHF whose admission glucose levels were available were included and followed up for 1-year all-cause mortality. Hyperglycemia was defined as a glucose levels of ≥7 mmol/L for patients without history of DM and ≥10 mmol/L for those with history of DM. Patients with hypoglycemia (defined as a glucose levels of ≤4 mmol/L, n=193, 1.4%) were excluded in this analysis.
Results
There were 6418 (%) patients with hyperglycemia and 7229 (%) patients with normoglycemia. One-year mortality was higher in patients with hyperglycemia than those with normoglycemia (1911 [30%] and 1821 [25%], respectively). Even after adjustment, the risk for 1-year mortality was significantly higher in hyperglycemia (HR 1.14, 95%-CI 1.04–1.26, P=0.008) compared with normoglycemia. Detrimental effects of hyperglycemia on 1-year mortality were more severe in de novo AHF patients than in patients with history of HF (p for interaction 0.004). Oral HF medications (beta blockers and/or angiotensin converting enzyme inhibitors/angiotensin receptor blockers) at discharge were effective in AHF patients with normoglycemia regardless of history of HF. Oral HF medications at discharge are very effective in de novo AHF patients with hyperglycemia and less effective in acute decompensated HF patients with hyperglycemia (Figure).
HF medications and 1-year mortality
Conclusions
Hyperglycemia at admission is associated with increased risk for 1-year mortality. Current oral HF medications are effective in most of subgroups, though they were less effective in patients with acute decompensated HF and hyperglycemia. These patients might need more aggressive therapies to improve outcomes.
Acknowledgement/Funding
This work was supported by a research fellowship from Japan Heart Foundation (E.A.)
Collapse
Affiliation(s)
- E Akiyama
- Yokohama City University Medical Center, Yokohama, Japan
| | | | - M Arrigo
- University Hospital Zurich, Zurich, Switzerland
| | - J Lassus
- Helsinki University Central Hospital, Helsinki, Finland
| | - O Miro
- University of Barcelona, Barcelona, Spain
| | | | | | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
| | | | - J Spinar
- Masaryk University, Brno, Czechia
| | - N Sato
- Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - K Tamura
- Yokohama City University, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | | |
Collapse
|
10
|
Akiyama E, Cinotti R, Cohen-Solal A, Lassus J, Miro O, Maggioni AP, Mueller C, Parenica J, Park JJ, Spinar J, Zhang Y, Tamura K, Kimura K, Gayat E, Mebazaa A. P3436The J-curve relationship between admission glucose level and 1-year mortality in patients with acute heart failure: results from an international observational cohort. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - R Cinotti
- University Hospital of Nantes, Nantes, France
| | | | - J Lassus
- Helsinki University Central Hospital, Helsinki, Finland
| | - O Miro
- University of Barcelona, Barcelona, Spain
| | - A P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
| | - J Parenica
- Masaryk University, Brno, Czech Republic
| | - J J Park
- Seoul National University Hospital, Seoul, Korea Republic of
| | - J Spinar
- Masaryk University, Brno, Czech Republic
| | - Y Zhang
- Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China People's Republic of
| | - K Tamura
- Yokohama City University, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - E Gayat
- Hospital Lariboisiere, Paris, France
| | - A Mebazaa
- Hospital Lariboisiere, Paris, France
| | | |
Collapse
|
11
|
Berry M, Galinier M, Delmas C, Fournier P, Desmoulin F, Turkieh A, Mischak H, Mullen W, Barutaut M, Eurlings L, Brunner La Rocca H, Butler J, Roncalli J, Evaristi M, Cohen-Solal A, Escamilla R, Ferrieres J, Koukoui F, Smih F, Rouet P. Discovery and validation of a new biomarker for heart failure diagnostic. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Motiejunaite J, Akiyama E, Cohen-Solal A, Maggioni A, Mueller C, Choi D, Parenica J, Lassus J, Kajimoto K, Sato N, Miro O, Peacock W, Gayat E, Mebazaa A. P1491Gender related differences in long-term outcomes of acute heart failure patients from different geographic regions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Motiejunaite
- Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Department of Anesthesiology and Critical Care, Paris, France
| | | | | | | | - C. Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel and Department of Cardiology, Basel, Switzerland
| | - D.J. Choi
- Seoul National University Hospital, Cardiovascular Center and Department of Internal Medicine, Seoul, Korea Republic of
| | - J. Parenica
- University Hospital Brno, Department of Cardiology, Brno, Czech Republic
| | - J. Lassus
- Helsinki University Central Hospital, Division of Cardiology, Heart and Lung Center, Helsinki, Finland
| | - K. Kajimoto
- Sekikawa Hospital, Division of Cardiology, Tokyo, Japan
| | - N. Sato
- Nippon Medical School, Musashi-Kosugi Hospital, Division of Cardiology and Intensive Care Unit, Kawasaki, Japan
| | - O. Miro
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - W.F. Peacock
- Cleveland Clinic Foundation, Emergency Medicine Institute, Cleveland, United States of America
| | - E. Gayat
- Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Department of Anesthesiology and Critical Care, Paris, France
| | - A. Mebazaa
- Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Department of Anesthesiology and Critical Care, Paris, France
| | | |
Collapse
|
13
|
Boulogne M, Sadoune M, Launay JM, Baudet M, Cohen-Solal A, Logeart D. Inflammation versus mechanical stretch biomarkers over time in acutely decompensated heart failure with reduced ejection fraction. Int J Cardiol 2016; 226:53-59. [PMID: 27788390 DOI: 10.1016/j.ijcard.2016.10.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/09/2016] [Accepted: 10/14/2016] [Indexed: 12/16/2022]
Abstract
Heart failure can be associated with inflammation but it is unclear if inflammation is directly related to hemodynamic worsening or is an independent pathway. Our aim was to investigate inflammation and mechanical stress using serial measurements of biomarkers in acute and chronic heart failure with reduced ejection fraction (AHF and CHF). METHOD The following biomarkers were measured on admission, at discharge and one month after discharge: B-type natriuretic peptide (BNP), high-sensitivity C-Reactive protein (hsCRP), Tumour Necrosis Factor alpha (TNFα), interleukin 6 (IL6), myeloperoxidase (MPO), suppression of tumorigenicity 2 (ST2), mid-regional pro-adrenomedullin (MR-proADM), galectin 3 (Gal3), Growth differentiating factor 15 (GDF15) and procalcitonin (PCT). RESULTS In control CHF group (n=20, 69±11y, NYHA 1-2), most biomarker levels were low and stable over time. In AHF (n=55, 71±14y), BNP, ST2 and GDF15 levels were highly increased on admission and then decreased rapidly with clinical improvement; BNP, ST2 and GDF15 levels were statistically correlated (r=0.64, 0.46 and 0.39; p<0.001 for both). Both hsCRP, MPO, TNFα and Gal3 levels were increased in most AHF patients (70, 56, 83 and 98% respectively) with poor change over time. HsCRP, MPO and TNFα levels were correlated. IL6, MR-proADM and PCT levels were slightly increased, without change over time. Highest quartiles of BNP and ST2 were associated with death or readmission at one year (HR 2.33 [95CI 1.13-4.80] and 2.42 [1.27-4.60]). CONCLUSION AHF is associated with systemic inflammation. This inflammatory response continued up to one month after discharge despite normalisation of mechanical stress-related markers.
Collapse
Affiliation(s)
- M Boulogne
- AP-HP Lariboisiere Hospital, Department of cardiology, Paris, France
| | - M Sadoune
- INSERM U942, Lariboisiere Hospital, Paris, France
| | - J M Launay
- INSERM U942, Lariboisiere Hospital, Paris, France; AP-HP Lariboisiere Hospital, Department of biochemistry, Paris, France
| | - M Baudet
- AP-HP Lariboisiere Hospital, Department of cardiology, Paris, France
| | - A Cohen-Solal
- AP-HP Lariboisiere Hospital, Department of cardiology, Paris, France; INSERM U942, Lariboisiere Hospital, Paris, France; University Paris Diderot, Paris, France
| | - D Logeart
- AP-HP Lariboisiere Hospital, Department of cardiology, Paris, France; INSERM U942, Lariboisiere Hospital, Paris, France; University Paris Diderot, Paris, France.
| |
Collapse
|
14
|
Giannuzzi P, Mezzani A, Saner H, Björnstad H, Fioretti P, Mendes M, Cohen-Solal A, Dugmore L, Hambrecht R, Hellemans I, McGee H, Perk J, Vanhees L, Veress G. Physical activity for primary and secondary prevention. Position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. ACTA ACUST UNITED AC 2016; 10:319-27. [PMID: 14663293 DOI: 10.1097/01.hjr.0000086303.28200.50] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is now clear scientific evidence linking regular aerobic physical activity to a significant cardiovascular risk reduction, and a sedentary lifestyle is currently considered one of the five major risk factors for cardiovascular disease. In the European Union, available data seem to indicate that less than 50% of the citizens are involved in regular aerobic leisure-time and/or occupational physical activity, and that the observed increasing prevalence of obesity is associated with a sedentary lifestyle. It seems reasonable therefore to provide institutions, health services, and individuals with information able to implement effective strategies for the adoption of a physically active lifestyle and for helping people to effectively incorporate physical activity into their daily life both in the primary and the secondary prevention settings. This paper summarizes the available scientific evidence dealing with the relationship between physical activity and cardiovascular health in primary and secondary prevention, and focuses on the preventive effects of aerobic physical activity, whose health benefits have been extensively documented.
Collapse
Affiliation(s)
- P Giannuzzi
- 'Salvatore Maugeri' Foundation, Institute for Clinical Care and Research, Veruno, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Bucciarelli V, Avenatti E, Rosner SJ, Cherneva ZHCH, Li H, Surkova EA, Degiovanni A, Ortiz Garrido A, Mihaila S, Tamulenaite E, Amorouayeche FZ, Kolesnyk MY, Garcia Campos A, Savcioglu AS, Filipiak D, Kuusisto JK, Torbas O, Kupczynska K, Tountas X, Ionin VA, Cescau A, Altin C, Ferreiro Quero C, Lowery C, Najih H, Valuckiene Z, Onciul S, Yang LT, Baricevic Z, Ghulam Ali S, Bianco F, Izzicupo P, Ghinassi B, Di Baldassarre A, Gallina S, Milazzo V, Milan A, Patel A, Kuvin J, Pandian N, Orban M, Nadjiri J, Lesevic H, Hadamitzky M, Sonne C, Kuneva ZK, Vasilev DV, Yuan L, Xie MX, Jin XY, Muraru D, Grapsa J, Donal E, Lancellotti P, Habib G, Badano LP, Buffa MC, De Vecchi F, Prenna E, Boggio E, Marino P, De La Chica J, Cuenca Peiro V, Picazo Angelin B, Conejo Munoz L, Narbona I, Anderica JR, De Mora M, Zabala Arguelles JI, Velcea A, Matei L, Andronic A, Calin S, Rimbas R, Muraru D, Badano LP, Vinereanu D, Ovsianas J, Valuckiene Z, Jurkevicius R, Latreche S, Benkhedda S, Dzyak GV, Riznyk YY, Kovalyova OV, Velasco-Alonso E, Colunga-Blanco S, Martin-Fernandez M, Corros-Vicente C, Rodriguez-Suarez ML, Leon-Aguero V, De La Hera Galarza JM, Safak O, Nazli C, Akyildiz Akcay F, Yakar Tuluce S, Kahya Eren N, Ozdemir E, Kocabas U, Kasprzak JD, Lipiec P, Jarvinen VM, Sinisalo JP, Sirenko YU, Radchenko G, Rekovets O, Kushnir S, Michalski BW, Miskowiec D, Kasprzak JD, Wdowiak-Okrojek K, Wejner-Mik P, Lipiec P, Beldekos D, Protogerou A, Gournizakis A, Panopoulos S, Theodosis-Georgilas A, Fousas S, Sfikakis P, Soboleva AV, Listopad OV, Nifontov SE, Polyakova EA, Belyaeva OD, Baranova EI, Shlyachto EV, Baudet M, Cohen-Solal A, Logeart D, Sakallioglu O, Aydin E, Yilmaz M, Sade LE, Muderrisoglu H, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Sanchez Fernandez J, Duran Jimenez E, Morenate Navio C, Romero M, Pan M, Suarez De Lezo J, Frenneaux MP, Parasuraman SK, Rudd AE, Srinivasan J, Elbaghdadi D, Laarej A, Allouch M, Azzouzi L, Habbal R, Ovsianas J, Mizariene V, Ablonskyte-Dudoniene R, Jurkevicius R, Cucchini U, Miglioranza MH, Dorobantu M, Iliceto S, Badano LP, Muraru D, Tsai WC, Cikes M, Ljubas Macek J, Skoric B, Skorak I, Jurin H, Samardzic J, Gasparovic H, Milicic D, Separovic Hanzevacki J, Fusini L, Tamborini G, Gripari P, Muratori M, Celeste F, Carminati MC, Alamanni F, Pepi M. HIT Poster session 2P486The effect of short term aerobic exercise and ACE polymorphism on cardiovascular remodeling in healthy sedentary postmenopausal womenP487Are there predictors of malignant progression of aortic stenosis severity?P488Quantitative und semiquantitative parameters in the classification of aortic insufficiency: a 3D-echocardiography and magnet resonance imaging studyP489Vascular indicies surrogate markers for left ventricular dysfunctionP490Left ventricular systolic strain data does not require indexation to cavity size in mitral valve diseasesP491Impact of EACVI grant programme on career progression of grant winnersP492Early predictor of atrial fibrillation recurrence after electrical cardioversion: diastolic parameters come firstP493Echocardiographic diagnosis of arrhythmias in the fetusP4943D echocardiography is a fast-learning and a more reliable method compared with 2D echocardiography for the assessment of left ventricular volumes and ejection fraction in patients with heart failureP495Right ventricular mechanics in functional ischemic mitral regurgitation in acute inferior myocardial infarctionP496Added value of two dimentional strain in assessement of left ventricular systolic function in rheumatic mitral stenosis patients with normal ejection fractionP497Left ventricular myocardial deformation in arterial hypertension with different types of glucose metabolism disordersP498Epicardial to pericardial adipose tissue ratio: predicting myocardial ischemia in patients referred for exercise stress echocardiographyP499Echocardiographic evaluation of the patients with asd after percutaneous closureP500Screening for carotid artery stenosis with the use of pocket-size imaging device equipped with linear probeP501LAD correlates poorly with LAVIP502Predictors associated with the diastolic dysfunction formation in patients with moderate hypertensionP503Assessment of left atrial function by speckle tracking analysis in transthoracic echocardiography for predicting the presence of left atrial appendage thrombus in patients with atrial fibrillationP504can echocardiography detect subclinical myocardial damage in the layers of myocardial wall? (The first study in a large population with known inflammatory disease)P505Epicardial fat thickness and galectin 3 in patients with atrial fibrillation and metabolic syndromeP506Left ventricular reverse remodeling in heart failure: a new obesity paradox?P507Epicardial adipose tissue and carotid intima media thickness in hemodialysis patients; single center experienceP508Echocardiographic parameters of mitral valve remodeling associated with poor clinical outcome in high risk patients with functional mitral regurgitation after Mitraclip implantationP509Prevalence of valve disease in a community population over the age of 60P510Discordance between mitral valve area and mean transmitral pressure gradient in mitral stenosis: Is mean gradient marker of the severity or parameter of tolerance in severe mitral stenosis?P511Ischemic mitral regurgitation is associated with impaired radial and circumferential myocardial deformation in acute inferoposterior myocardial infarctionP512The importance of early left atrial functional changes in predicting long term left ventricular remodeling in patients surviving a ST elevation myocardial infarctionP513Remodeling of myocardial deformation after mitral valve surgeryP514Global longitudinal peak systolic strain is reduced shortly after heart transplantationP515Detailed transthoracic and transesophageal echocardiographic analysis of mitral leaflets in patient undergoing mitral valve repair. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Assous B, Baudet M, Bihry N, Moubarak G, Cohen-Solal A, Logeart D. 42 Prevalence and determinants of atrial dyssynchrony in heart failure patients. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
17
|
Laribi S, Aouba A, Resche-Rigon M, Johansen H, Eb M, Peacock FW, Masip J, Ezekowitz JA, Cohen-Solal A, Jougla E, Plaisance P, Mebazaa A. Trends in death attributed to myocardial infarction, heart failure and pulmonary embolism in Europe and Canada over the last decade. QJM 2014; 107:813-20. [PMID: 24729266 DOI: 10.1093/qjmed/hcu083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Worldwide, cardiovascular diseases and cancer account for ∼40% of deaths. Certain reports have shown a progressive decrease in mortality. Our main objective was to assess mortality trends related to myocardial infarction (MI), heart failure (HF) and pulmonary embolism (PE). METHODS MI, HF and PE were studied as cause of death based on the analysis of death certificates in Canada (C), England and Wales (E), France (F) and Sweden (S). We also used a multiple cause approach. Age-standardized death rates (SDR) were calculated. RESULTS The SDR for MI, HF or PE as the underlying cause of death, all decreased during the last decade. The decrease in SDR secondary to MI exceeded that for HF or PE. Concerning multiple cause of death, a greater decrease was also found for MI, compared with HF or PE. CONCLUSIONS We confirm the beneficial trends in SDR with MI, HF or PE both as underlying or multiple causes in the studied countries. For HF and PE, multiple cause approach seems more accurate to describe the burden of these two pathologies. Our study also suggests that more efforts should be dedicated to HF and PE in order to achieve similar trends than in MI.
Collapse
Affiliation(s)
- S Laribi
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
| | - A Aouba
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - M Resche-Rigon
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - H Johansen
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - M Eb
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - F W Peacock
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - J Masip
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - J A Ezekowitz
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - A Cohen-Solal
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
| | - E Jougla
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - P Plaisance
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
| | - A Mebazaa
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
| |
Collapse
|
18
|
Goretti E, Seronde MF, Vausort M, Gayat E, Thum T, Cohen-Solal A, Wagner DR, Mebazaa A, Devaux Y. P70Circulating microRNAs and outcome in patients with acute heart failure. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Nikolaou M, Parissis J, Yilmaz MB, Seronde MF, Kivikko M, Laribi S, Paugam-Burtz C, Cai D, Pohjanjousi P, Laterre PF, Deye N, Poder P, Cohen-Solal A, Mebazaa A. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 2012; 34:742-9. [DOI: 10.1093/eurheartj/ehs332] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
20
|
Berthelot E, Berthelot-Garcias E, Voicu S, de Menthon M, Logeart D, Mahr A, Nataf P, Fabre A, Sirol M, Cohen-Solal A. Unusual pseudotumoral right atrial involvement in Listeria monocytogenes septicemia. Circulation 2012; 126:e66-8. [PMID: 22869861 DOI: 10.1161/circulationaha.112.096347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Berthelot
- Hôpital Lariboisière, Service de Cardiologie, 10, rue Ambroise Paré, 75010 Paris, France.
| | - E Berthelot-Garcias
- Hôpital Lariboisière, Service de Cardiologie, 10, rue Ambroise Paré, 75010 Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ambrosio G, Flather MD, Böhm M, Coats AJ, Tavazzi L, Van Veldhuisen DJ, Conti MG, Spinucci G, Mascagni F, Murrone A, Cohen-Solal A. β-blockade with nebivolol for prevention of acute ischaemic events in elderly patients with heart failure. Cardiovasc Ther Prev 2011. [DOI: 10.15829/1728-8800-2011-4-69-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. This subanalysis of the Study of the Effects of Nebivolol Intervention on Outcomes and Hospitalisation in Seniors with Heart Failure (SENIORS) investigates whether treatment with nebivolol, a β-blocker with nitric oxide-releasing properties, can provide additional benefits besides its effects on heart failure (HF), by reducing cardiac ischaemic events in patients with HF of ischaemic aetiology. Material and methods. A double-blind, randomised, placebo-controlled, multicentre trial of nebivolol in 2128 elderly patients. For this analysis, data were extracted for 2128 elderly (≥70 years) HF patients in whom coronary artery disease (CAD) was the underlying aetiology (68,2 %; 717 placebo-treated patients and 735 assigned to nebivolol). The main endpoint was the composite of cardiac ischaemic events at 2 year follow-up: death/hospitalisation for myocardial infarction, unstable angina or sudden death, as originally identified in the case report form. Results. At follow-up, nebivolol treatment was associated with a one-third reduction in the risk of ischaemic events, the composite endpoint occurring in 15,9 % of placebo and 10,7 % of nebivolol-treated patients (HR 0,68; 95 % CI 0,51 to 0,90; p=0,008). This effect was independent of age, gender and ejection fraction. No difference in this composite endpoint was observed in the subgroup of patients of non-ischaemic aetiology. Conclusion. Nebivolol was effective in reducing cardiac ischaemic events in patients with HF of ischaemic aetiology. The prevention of ischaemic events can be an additional beneficial effect of β-blockade in HF patients with underlying CAD.
Collapse
Affiliation(s)
- G. Ambrosio
- Division of Cardiology, University of Perugia School of Medicine
| | - M. D. Flather
- Clinical Trials and Investigation Unit, Royal Brompton and Harefield NHS Trust
| | - M. Böhm
- Klinik für Innere Medizin III, Universität des Saarlandes
| | | | - L. Tavazzi
- Department of Cardiology, IRCCS Policlinico San Matteo
| | - D. J. Van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen
| | - M. G. Conti
- Division of Cardiology, University of Perugia School of Medicine
| | - G. Spinucci
- Division of Cardiology, University of Perugia School of Medicine
| | - F. Mascagni
- Data Management & Biometry Unit, CAST and TRIAL
| | - A. Murrone
- Division of Cardiology, University of Perugia School of Medicine
| | - A. Cohen-Solal
- INSERM U942; Faculté Paris 7 Paris Diderot; Hopital Lariboisiere
| |
Collapse
|
22
|
Segouin C, Leenhardt A, Dozol A, Duteil C, Barbier V, Cohen-Solal A. Comment identifier et valoriser un transfert d’activité ? Application à une activité de cardiologie. Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
23
|
Ambrosio G, Flather MD, Bohm M, Cohen-Solal A, Murrone A, Mascagni F, Spinucci G, Conti MG, van Veldhuisen DJ, Tavazzi L, Coats AJS. -blockade with nebivolol for prevention of acute ischaemic events in elderly patients with heart failure. Heart 2010; 97:209-14. [DOI: 10.1136/hrt.2010.207365] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
24
|
Etchepareborde S, Heimann M, Cohen-Solal A, Hamaide A. Use of tamoxifen in a German shepherd dog with sclerosing encapsulating peritonitis. J Small Anim Pract 2010; 51:649-53. [DOI: 10.1111/j.1748-5827.2010.00998.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
25
|
Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K. Corrigendum to: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) [Eur Heart J 2008;29:2388-2442]. Eur Heart J 2010. [DOI: 10.1093/eurheartj/ehq027] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Mesirca P, Torrente A, Marger L, Fort A, Cohen-Solal A, Leoni AL, Striessnig J, Nargeot J, Mangoni ME. J020 A functional role for Cav1.3 channels in muscarinic regulation of heart rate (HR) and automaticity in pacemaker cells: experimental results. Arch Cardiovasc Dis 2009. [DOI: 10.1016/s1875-2136(09)72395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
|
28
|
Komajda M, Amouyel P, Johnson N, Bergougnoux L, Laperche T, de Groote P, Jaillon P, Cohen-Solal A. [Treating heart failure with carvedilol in private practice (initiating treatment and follow-up at one year. The KEOPS study]. Arch Mal Coeur Vaiss 2007; 100:818-826. [PMID: 18033011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIMS This study aimed at describing usual conditions of carvedilol use in heart failure (HF) patients. METHODS KEOPS was a one-year, multi-centre, prospective pharmaco-epidemiological study in carvedilol treated HF patients recruited by private cardiologists. RESULTS Two thousand nine patients (mean age: 68) with heart failure were included by 401 cardiologists. 64% of patients were in class II of NYHA and 27% in class III, 87% of patients presented stable heart failure for at least four weeks. Contraindication to beta blocking was observed in 24% of patients, mean left ventricular fraction of ejection was 39% and only 39% of patients had mean left ventricular fraction of ejection<35%. Co-medications included a diuretic agent, ACE inhibitor or ARB in 68% of cases. Eighty three percent of patients had a titration of carvedilol (median duration=1 20 days). Thirty percent reached the recommended maximal dose. The dose of carvedilol at the titration's visit for all the patients (patient in stop included) was on average 30.5 +/- 22.1 mg/day with a median on 25 [confidence interval: 23-27] During the year of follow-up, 10% of patients have stopped the treatment (3% of patients having reached the maximum recommended dose of carvedilol versus 13% for the others), for cardiovascular reasons in 50% of patients (aggravation of heart failure: 28%, symptomatic arterial hypotension: 9%, symptomatic bradycardia: 5%). Finally, symptomatology of patients has improved during the study (59% of patients in class mild to severe at inclusion, versus 36% at the end of the observation), especially for the 30% of patients followed at one year and having reached the maximum recommended dose of carvedilol. Only in univariate analysis, patients with an inclusion high weight (>85 kg) were likely less to reach recommended maximal dose (37.2 versus 8.7%, p-value<0.0001), the patients with systolic heart failure had more chance than the patients with diastolic heart failure to reach the recommended maximal dose (31 versus 17.4%, p-value=0.006), in the same way, the lack of auricular supported more the reach of recommended maximal dose (31.2 versus 24.1%, p-value=0.018) CONCLUSION KEOPS study suggests an improvement of usual conditions of carvedilol compared to the last investigation but the persistence of prescription outside medical authorization and less dosage of this product compared with clinical studies.
Collapse
Affiliation(s)
- M Komajda
- Service de cardiologie, université Pierre et Marie Curie; hôpital de la Pitié-Salpêtrière, Paris. michel.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Peltier M, Houpe D, Cohen-Solal A, Béguin M, Levy F, Tribouilloy C. Treatment practices in heart failure with preserved left ventricular ejection fraction: A prospective observational study. Int J Cardiol 2007; 118:363-9. [PMID: 17049391 DOI: 10.1016/j.ijcard.2006.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 07/13/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current guidelines for treatment of patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) are empirical. One of the objectives of the ETICS study was to evaluate medical treatment at discharge and after 1 year in patients hospitalised for a first episode of HF in 2000. We report the results concerning treatment of patients with preserved LVEF at discharge and at 1 year. METHODS Two hundred and sixty three consecutive patients (75+/-10 years, 47 males) with LVEF >50% hospitalised for a first episode of HF were prospectively included. Mean LVEF was 63+/-8%. The main aetiology was hypertension (61%) followed by ischaemic heart disease (29%). Atrial fibrillation and diabetes were present in 34% and 27% of cases, respectively. Medical treatment records were complete at discharge and at 1 year after discharge. RESULTS At discharge, as at 1 year after discharge, diuretics were the drugs most commonly prescribed (81% and 78%), followed by ACE inhibitors (49% and 46%), amiodarone (32% and 28%), beta-blockers (27% and 29%), nitrates (28% and 27%), calcium channel blockers (27% and 26%), spironolactone (21% and 25%), cardiac glycosides (19% and 24%), and angiotensin II receptor antagonists (4% and 6%). Once prescribed at hospital discharge, drug prescription rates and daily doses did not change significantly over time. Age did not influence drug prescription rates at discharge or at 1 year, except for the spironolactone prescription rate, which decreased at 1 year in patients > or =75 years of age. At discharge, ACE inhibitor and beta-blocker daily doses were lower in older patients, while, at 1 year, no differences in daily doses of these drugs were observed between patients above and below the age of 75 years. CONCLUSION Loops diuretics are largely prescribed in HF with preserved LVEF, followed by ACE inhibitors. Future large multicentre trials are required to define the background standard treatment in addition to treatment of aetiological factors.
Collapse
Affiliation(s)
- M Peltier
- INSERM, ERI 12, South Hospital, Amiens, France
| | | | | | | | | | | |
Collapse
|
30
|
Cohen-Solal A, Logeart D. [Diabetes and heart failure, a fatal association]. Arch Mal Coeur Vaiss 2007; 100:535-46. [PMID: 17893636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The prevalence of heart failure and diabetes are both increasing: 25 to 30% of patients with heart failure suffer from diabetes, and the latter aggravates heart failure. The presence of macro- or micro-angiopathy, cardiac neuropathy or renal failure worsens the clinical pattern and disturbs treatment strategies. Doppler-echocardiography and the dosage of BNP can probably help to detect and consequently to treat prematurely heart failure in the diabetic patient. The usual treatments in heart failure have similar or lower efficacy in the diabetic patient, and treatment intolerance is frequent. Treatments used for diabetes can be handled with difficulty in case of heart failure (metformin, glitazones). In the future, it is therefore extremely important: 1--to prevent the occurrence of diabetes in patients with glucose intolerance; 2--in diabetic patients, to prematurely detect cardiac dysfunction and optimally control diabetes, in order to avoid its occurrence; 3--and finally, in diabetic patients with heart failure, to optimize the medical treatment, in order that these patients have similar benefits compared to non-diabetic patients with heart failure. The ACE-inhibitors and angiotensin-2 antagonists seem to have an important role. Treatments breaking the glycation bridges, as well as statins, appear as interesting therapeutic options. Finally, the exact role of myocardial revascularization, either by angioplasty or surgery, might probably be important.
Collapse
Affiliation(s)
- A Cohen-Solal
- Département de Cardiologie, hôpital Lariboisière, 2 rue Ambroise-Paré, 75010 Paris
| | | |
Collapse
|
31
|
Tabet JY, Meurin P, Ben Driss A, Logeart D, Héliès-Toussaint C, Tartière JM, Cohen-Solal A, Grynberg A, Bourdel-Marchasson I. [Heart failure and cachexia]. Arch Mal Coeur Vaiss 2006; 99:1203-1209. [PMID: 18942522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cachexia is related to a malnutrition state related to hypercatabolism. Initially described in cancer, it is also related to several chronic diseases including heart failure. Defined by an unintentional weight loss exceeding 7.5% of body mass during more than 6 months, it is presented by the association of nutritional deficiencies, digestive and/or urinary losses as well as metabolic abnormalities causing fat and lean mass loss and is associated to a poor prognosis. The pathophysiology of cachexia and heart failure presented some similarities associating especially neuro-hormonal activation, a cortisol/DHEA ratio imbalance, as well as pro-inflammatory cytokines activation. Currently the treatment of cachexia is mainly preventive, based on ACE-inhibitors and beta-blockers therapy and physical reconditioning. The benefits of hormonal and nutritional substitutes remains to be evidenced.
Collapse
Affiliation(s)
- J Y Tabet
- Centre de réadaption cardiaque des Grands Près 27, rue Sainte-Christine, Villeneuve-Saint-Denis.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Tabet JY, Meurin P, Ben Driss A, Weber H, Renaud N, Cohen-Solal A. [Exercise training in cardiac patients: usefulness of the cardiopulmonary exercise test]. Ann Cardiol Angeiol (Paris) 2006; 55:178-86. [PMID: 16922166 DOI: 10.1016/j.ancard.2006.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Exercise training is currently including in the treatment of coronary arterial disease patients, in patients with left ventricular dysfunction as well as in patients who underwent cardiac transplantation or cardiac surgery. However methods of prescribing exercise-training programs are difficult to determine and must be adapted for each patient Exercise test with gas analysis through the determination of anaerobic threshold may help to understand the physiopathological mechanism related to exercise limitation in these patients. Exercise test may help to precise exercise intensity during cardiac rehabilitation and may assess the benefits on exercise tolerance.
Collapse
Affiliation(s)
- J Y Tabet
- Service de cardiologie, centre de réadaptation cardiovasculaire de la Brie, 27, rue Sainte-Christine, 77174 Villeneuve-Saint-Denis, France.
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
We report the case of a man admitted for massive pulmonary embolism. Transthoracic echocardiography showed a serpentine thrombus in the right atrium across the foramen oval. Because of an acute worsening of the circulatory insufficiency, an intravenous thrombolysis was prescribed and the patient recovered progressively. An early control echocardiography showed the disappearing of the intracardiac thrombus and no evidence of abnormality of interatrial septum. While there was no evidence of venous thrombosis in legs, a renal cancer was diagnosed by echography. Silent stroke were highlighted at the scanner. This clinical case leads to discuss the origin of thrombus (in situ formation or thrombus migration) as well as the treatment (heparinotherapy, thrombolysis, surgical embolectomy, definitive closure of the foramen oval).
Collapse
Affiliation(s)
- F Tournoux
- Département de cardiologie, hôpital Beaujon, 100, boulevard du General-Leclerc, 92118 Clichy, France.
| | | | | |
Collapse
|
34
|
Ennezat PV, Gal B, Kouakam C, Marquie C, LeTourneau T, Klug D, Lacroix D, Logeart D, Cohen-Solal A, Dennetière S, Van Belle E, Deklunder G, Asseman P, de Groote P, Kacet S, LeJemtel TH. Cardiac resynchronisation therapy reduces functional mitral regurgitation during dynamic exercise in patients with chronic heart failure: an acute echocardiographic study. Heart 2005; 92:1091-5. [PMID: 16387811 PMCID: PMC1861095 DOI: 10.1136/hrt.2005.071654] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To assess non-invasively the acute effects of cardiac resynchronisation therapy (CRT) on functional mitral regurgitation (MR) at rest and during dynamic exercise. METHODS 21 patients with left ventricular (LV) systolic dysfunction and functional MR at rest, treated with CRT, were studied. Each patient performed a symptom-limited maximal exercise with continuous two dimensional Doppler echocardiography twice. The first exercise was performed with CRT; the second exercise was performed without CRT. Mitral regurgitant flow volume (RV), effective regurgitant orifice area (ERO) and LV dP/dt were measured at rest and at peak exercise. RESULTS CRT mildly reduced resting mitral ERO (mean 8 (SEM 2) v 11 (2) mm(2) without CRT, p = 0.02) and RV (13 (3) v 18 (3) ml without CRT, p = 0.03). CRT attenuated the spontaneous increase in mitral ERO and RV during exercise (1 (1) v 9 (2) mm(2), p = 0.004 and 1 (1) v 8 (2) ml, p = 0.004, respectively). CRT also significantly increased exercise-induced changes in LV dP/dt (140 (46) v 479 (112) mm Hg/s, p < 0.001). CONCLUSION Attenuation of functional MR, induced by an increase in LV contractility during dynamic exercise, may contribute to the beneficial clinical outcome of CRT in patients with chronic heart failure and LV asynchrony.
Collapse
|
35
|
Tartière JM, Logeart D, Safar ME, Cohen-Solal A. Interaction between pulse wave velocity, augmentation index, pulse pressure and left ventricular function in chronic heart failure. J Hum Hypertens 2005; 20:213-9. [PMID: 16355121 DOI: 10.1038/sj.jhh.1001965] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pulse wave velocity (PWV), the carotid augmentation index (AIx), and pulse pressure (PP) may be prognostic factors in heart failure, but the possible influence of the ejection fraction (EF) and other simple haemodynamic variables on them has not been investigated in this setting. Noninvasive methods were used to measure carotid-radial (CR), carotid-femoral (CF) PWV and AIx, and brachial PP, in 135 consecutive patients with stable symptomatic chronic heart failure. The patients were divided into two groups, with preserved (>or=40%) or reduced (<40%) EF. CF-PWV, AIx and PP were lower in the decreased EF group (8.85+/-2.77 versus 10.60+/-2.75 m/s, P<0.001; 121+/-21 versus 132+/-24, P=0.009 and 41+/-19 versus 67+/-17 mmHg, P<0.001), but CR-PWV values were similar regardless of the EF status. These results were not modified after adjustment for age and sex. Multiple regression analysis showed that AIx and PP were systematically related to time domain parameters (heart rate or ejection duration) and EF, whatever the group. CF-PWV was weakly related to time domain values and unrelated to mean blood pressure (BP) or EF in the preserved EF group, whereas it was related to both mean BP and EF in the low EF group. In conclusion, whatever the EF level, PP and AIx were strongly modulated in the time domain, by pressure and by the EF level. The same relationships were found with CF-PWV, but only in the reduced EF group. Whether CF-PWV is the best prognostic factor in patients with 'diastolic' heart failure must be confirmed in a prospective study.
Collapse
Affiliation(s)
- J-M Tartière
- Department of Cardiology, Beaujon Hospital, Clichy, France.
| | | | | | | |
Collapse
|
36
|
Houpe D, Peltier M, Cohen-Solal A, Béguin M, Lévy F, Slama M, Chapelain K, Tribouilloy C. Heart failure due to left ventricular systolic dysfunction: Treatment at discharge from hospital and at one year. Int J Cardiol 2005; 103:286-92. [PMID: 16098391 DOI: 10.1016/j.ijcard.2004.08.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 07/03/2004] [Accepted: 08/07/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND The treatment of heart failure (HF) due to left ventricular systolic dysfunction has been defined in recent guidelines, but these guidelines are not always applied in routine clinical practice. One of the objectives of the ETICS study was to evaluate medical treatment at discharge and after 1 year in patients hospitalised for a first episode of congestive HF due to left ventricular systolic dysfunction in 2000. METHODS One hundred and seventy nine patients (63% males, mean age of 69+/-13 years) with an ejection fraction < or = 40% were prospectively included. The main aetiology was ischaemic heart disease (44%). RESULTS The drugs prescribed at discharge and at one year, respectively, were loop diuretics in 95% and 91% of cases, angiotensin-converting enzyme (ACE) inhibitors in 82% and 75%, spironolactone in 35% and 37%, beta-blockers in 25% and 41%, digitalis glycosides in 34% and 30% of cases, and nitrates in 20% and 16% of cases. ACE inhibitors were prescribed at discharge and at 1 year at dosages reaching 64+/-29% and 72+/-30% of the recommended doses, respectively, and beta-blockers were prescribed at 26+/-16% and 35+/-25% of recommended doses, respectively. CONCLUSION Diuretics and ACE inhibitors are largely prescribed in HF due to left ventricular systolic dysfunction, followed by spironolactone. Beta-blockers are still underused both in terms of the rate of patients receiving them and the daily doses. These results highlight the value of continuing to widely circulate official practice guidelines in order to improve the management of HF due to left ventricular systolic dysfunction.
Collapse
Affiliation(s)
- D Houpe
- Department of Cardiology, South Hospital, Amiens, France
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Tournoux F, Bouvier E, Alonso C, Sebbah J, Logeart D, Cohen-Solal A. 972 Assessment of cardiac resynchronisation therapy by exercise Doppler-echocardiography in heart failure. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.229-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- F. Tournoux
- Beaujon Hospital, Paris VII University, Cardiology, Clichy, France
| | - E. Bouvier
- Beaujon Hospital, Paris VII University, Cardiology, Clichy, France
| | - C. Alonso
- Beaujon Hospital, Paris VII University, Cardiology, Clichy, France
| | - J. Sebbah
- Beaujon Hospital, Paris VII University, Cardiology, Clichy, France
| | - D. Logeart
- Beaujon Hospital, Paris VII University, Cardiology, Clichy, France
| | | |
Collapse
|
38
|
Mebazaa A, Cohen-Solal A, Kleber F, Nieminen M, Packer M, Pocock S, Poder P, Sarapohja T, Kivikko M. Study design of a mortality trial with intravenous levosimendan - the SURVIVE study - in patients with acutely decompensated heart failure. J Card Fail 2004. [DOI: 10.1016/j.cardfail.2004.06.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
39
|
|
40
|
Beauvais F, Logeart D, Tartière JM, Bouvier E, Cohen-Solal A. [Left heart failure and coronary artery disease in COPD]. Rev Mal Respir 2003; 20:S39-44. [PMID: 15143309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- F Beauvais
- Service de Cardiologie, Hôpital Beaujon, Clichy
| | | | | | | | | |
Collapse
|
41
|
Giannuzzi P, Saner H, Björnstad H, Fioretti P, Mendes M, Cohen-Solal A, Dugmore L, Hambrecht R, Hellemans I, McGee H, Perk J, Vanhees L, Veress G. Secondary prevention through cardiac rehabilitation: position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. Eur Heart J 2003; 24:1273-8. [PMID: 12831822 DOI: 10.1016/s0195-668x(03)00198-2] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this statement is to provide specific recommendations in regard to evaluation and intervention in each of the core components of cardiac rehabilitation (CR) to assist CR staff in the design and development of their programmes; the statement should also assist health care providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of such programmes. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, at national or at individual centre level, need to consider where and how structured programmes of CR can be delivered to the large constituency of patients now considered eligible for CR.
Collapse
Affiliation(s)
- P Giannuzzi
- Salvatore Maugeri Foundation, Institute for Clinical Care and Research (IRCCS), Scientific Institute of Veruno Via per Revislate 13, 28010 (NO), Verona, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Komajda M, Follath F, Swedberg K, Cleland J, Aguilar JC, Cohen-Solal A, Dietz R, Gavazzi A, Van Gilst WH, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, Widimsky J, Freemantle N, Eastaugh J, Mason J. The EuroHeart Failure Survey programme--a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 2003; 24:464-74. [PMID: 12633547 DOI: 10.1016/s0195-668x(02)00700-5] [Citation(s) in RCA: 511] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND National surveys suggest that treatment of heart failure in daily practice differs from guidelines and is characterized by underuse of recommended medications. Accordingly, the Euro Heart Failure Survey was conducted to ascertain how patients hospitalized for heart failure are managed in Europe and if national variations occur in the treatment of this condition. METHODS The survey screened discharge summaries of 11304 patients over a 6-week period in 115 hospitals from 24 countries belonging to the ESC to study their medical treatment. RESULTS Diuretics (mainly loop diuretics) were prescribed in 86.9% followed by ACE inhibitors (61.8%), beta-blockers (36.9%), cardiac glycosides (35.7%), nitrates (32.1%), calcium channel blockers (21.2%) and spironolactone (20.5%). 44.6% of the population used four or more different drugs. Only 17.2% were under the combination of diuretic, ACE inhibitors and beta-blockers. Important local variations were found in the rate of prescription of ACE inhibitors and particularly beta-blockers. Daily dosage of ACE inhibitors and particularly of beta-blockers was on average below the recommended target dose. Modelling-analysis of the prescription of treatments indicated that the aetiology of heart failure, age, co-morbid factors and type of hospital ward influenced the rate of prescription. Age <70 years, male gender and ischaemic aetiology were associated with an increased odds ratio for receiving an ACE inhibitor. Prescription of ACE inhibitors was also greater in diabetic patients and in patients with low ejection fraction (<40%) and lower in patients with renal dysfunction. The odds ratio for receiving a beta-blocker was reduced in patients >70 years, in patients with respiratory disease and increased in cardiology wards, in ischaemic heart failure and in male subjects. Prescription of cardiac glycosides was significantly increased in patients with supraventricular tachycardia/atrial fibrillation. Finally, the rate of prescription of antithrombotic agents was increased in the presence of supraventricular arrhythmia, ischaemic heart disease, male subjects but was decreased in patients over 70. CONCLUSION Our results suggest that the prescription of recommended medications including ACE inhibitors and beta-blockers remains limited and that the daily dosage remains low, particularly for beta-blockers. The survey also identifies several important factors including age, gender, type of hospital ward, co morbid factors which influence the prescription of heart failure medication at discharge.
Collapse
|
43
|
Cleland JGF, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J. The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003; 24:442-63. [PMID: 12633546 DOI: 10.1016/s0195-668x(02)00823-0] [Citation(s) in RCA: 880] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The European Society of Cardiology (ESC) has published guidelines for the investigation of patients with suspected heart failure and, if the diagnosis is proven, their subsequent management. Hospitalisation provides a key point of care at which time diagnosis and treatment may be refined to improve outcome for a group of patients with a high morbidity and mortality. However, little international data exists to describe the features and management of such patients. Accordingly, the EuroHeart Failure survey was conducted to ascertain if appropriate tests were being performed with which to confirm or refute a diagnosis of heart failure and how this influenced subsequent management. METHODS The survey screened consecutive deaths and discharges during 2000-2001 predominantly from medical wards over a 6-week period in 115 hospitals from 24 countries belonging to the ESC, to identify patients with known or suspected heart failure. RESULTS A total of 46788 deaths and discharges were screened from which 11327 (24%) patients were enrolled with suspected or confirmed heart failure. Forty-seven percent of those enrolled were women. Fifty-one percent of women and 30% of men were aged >75 years. Eighty-three percent of patients had a diagnosis of heart failure made on or prior to the index admission. Heart failure was the principal reason for admission in 40%. The great majority of patients (>90%) had had an ECG, chest X-ray, haemoglobin and electrolytes measured as recommended in ESC guidelines, but only 66% had ever had an echocardiogram. Left ventricular ejection fraction had been measured in 57% of men and 41% of women, usually by echocardiography (84%) and was <40% in 51% of men but only in 28% of women. Forty-five percent of women and 22% of men were reported to have normal left ventricular systolic function by qualitative echocardiographic assessment. A substantial proportion of patients had alternative explanations for heart failure other than left ventricular systolic or diastolic dysfunction, including valve disease. Within 12 weeks of discharge, 24% of patients had been readmitted. A total of 1408 of 10434 (13.5%) patients died between admission and 12 weeks follow-up. CONCLUSIONS Known or suspected heart failure comprises a large proportion of admissions to medical wards and such patients are at high risk of early readmission and death. Many of the basic investigations recommended by the ESC were usually carried out, although it is not clear whether this was by design or part of a general routine for all patients being admitted regardless of diagnosis. The investigation most specific for patients with suspected heart failure (echocardiography) was performed less frequently, suggesting that the diagnosis of heart failure is still relatively neglected. Most men but a minority of women who underwent investigation of cardiac function had evidence of moderate or severe left ventricular dysfunction, the main target of current advances in the treatment of heart failure. Considerable diagnostic uncertainty remains for many patients with suspected heart failure, even after echocardiography, which must be resolved in order to target existing and new therapies and services effectively.
Collapse
Affiliation(s)
- J G F Cleland
- Department of Cardiology, University of Hull, Castle Hill Hospital, Castle Road, Kingston upon Hull HU16 5JQ UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Cleland JGF, Cohen-Solal A, Aguilar JC, Dietz R, Eastaugh J, Follath F, Freemantle N, Gavazzi A, van Gilst WH, Hobbs FDR, Korewicki J, Madeira HC, Preda I, Swedberg K, Widimsky J. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet 2002; 360:1631-9. [PMID: 12457785 DOI: 10.1016/s0140-6736(02)11601-1] [Citation(s) in RCA: 380] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Heart failure is a prevalent condition that is generally treated in primary care. The aim of this study was to assess how primary-care physicians think that heart failure should be managed, how they implement their knowledge, and whether differences exist in practice between countries. METHODS The survey was undertaken in 15 countries that had membership of the European Society of Cardiology (ESC) between Sept 1, 1999, and May 31, 2000. Primary-care physicians' knowledge and perceptions about the management of heart failure were assessed with a perception survey and how a representative sample of patients was managed with an actual practice survey. FINDINGS 1363 physicians provided data for 11062 patients, of whom 54% were older than 70 years and 45% were women. 82% of patients had had an echocardiogram but only 51% of these showed left ventricular systolic dysfunction. Ischaemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, and major valve disease were all common. Physicians gave roughly equal priority to improvement of symptoms and prognosis. Most were aware of the benefits of ACE inhibitors and beta blockers. 60% of patients were prescribed ACE inhibitors, 34% beta blockers but only 20% received these drugs in combination. Doses given were about 50% of targets suggested in the ESC guidelines. If systolic dysfunction was documented, ACE inhibitors were more likely and beta blockers less likely to be prescribed than when there was no evidence of systolic dysfunction. INTERPRETATION Results from this survey suggest that most patients with heart failure are appropriately investigated, although this finding might be as a result of high rates of hospital admissions. However, treatment seems to be less than optimum, and there are substantial variations in practice between countries. The inconsistencies between physicians' knowledge and the treatment that they deliver suggests that improved organisation of care for heart failure is required.
Collapse
Affiliation(s)
- J G F Cleland
- Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Cohen-Solal A, Tabet JY, Logeart D, Bourgoin P, Tokmakova M, Dahan M. A non-invasively determined surrogate of cardiac power ('circulatory power') at peak exercise is a powerful prognostic factor in chronic heart failure. Eur Heart J 2002; 23:806-14. [PMID: 12009721 DOI: 10.1053/euhj.2001.2966] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study was designed to assess the prognostic value of a new variable derived from a cardiopulmonary exercise test, the circulatory power, a surrogate of cardiac power, at peak exercise, in patients with chronic heart failure. BACKGROUND Peak exercise cardiac power and stroke work are invasive parameters with recently proven prognostic value. It is unclear whether these variables have better prognostic value than peak oxygen uptake (VO(2)). METHODS The study population comprised 175 patients with chronic heart failure (ejection fraction <45%) who underwent a cardiopulmonary exercise test. Circulatory power and circulatory stroke work were defined as the product of systolic arterial pressure and VO(2) and oxygen pulse, respectively. Prognostic value was assessed by survival curves (Kaplan-Meier method) and uni- and multivariate Cox analyses. RESULTS With a mean follow-up of 25+/-10 months, ejection fraction, heart rate, systolic arterial pressure, peak VO(2), VCO(2), the anaerobic threshold, minute ventilation, the ventilatory equivalents of oxygen and carbon dioxide, the half times of VO(2) and VCO(2) recoveries, and the circulatory stroke work and power predicted outcome. Multivariate analysis demonstrated that the peak circulatory power (chi-square=19.9, P<0.001) (but not peak circulatory stroke work) was the only variable predictive of prognosis. CONCLUSION The prognostic value of cardiopulmonary exercise tests in heart failure patients can be improved by assessing a new variable, the circulatory power - a surrogate of cardiac power - at peak exercise.
Collapse
Affiliation(s)
- A Cohen-Solal
- Service de Cardiologie, Hôpital Beaujon, 92100 Clichy, 92110, France
| | | | | | | | | | | |
Collapse
|
46
|
Cohen-Solal A. [Precautions for use and contraindications of thiazolidinediones. A cardiologist opinion]. Ann Endocrinol (Paris) 2002; 63:1S51-5. [PMID: 12037510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The European marketing authorization ( product licence ) for thiazolidinediones (rosiglitazone and pioglitazone) contraindicate their use in type 2 diabetic patients with cardiac failure or history of cardiac failure. A warning and special precautions for use apply to fluid retention and cardiac failure. The main experimental and clinical data currently available are reviewed. Guidance are given to prescribing physician for the initiation of thiazolidinediones in type 2 diabetic patients and for management of these patients, particularly those at risk for cardiac failure. The cardiologist advice (and possibly diagnosis by echocardiography) is recommended when clinical doubts exist.
Collapse
Affiliation(s)
- A Cohen-Solal
- Service de Cardiologie, Hôpital Beaujon, F - 92110 Clichy, France
| |
Collapse
|
47
|
Cohen-Solal A. [Management of heart failure by general practitioners in France. Results of the study IMPROVEMENT of heart failure (IMPROVEMENT-HF)]. Arch Mal Coeur Vaiss 2002; 95 Spec 4:11-5. [PMID: 11933549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The IMPROVEMENT-HF programme (Improvement PROgramme on evaluation and management of Heart Failure) aimed to improve the management of patients with heart failure by general practitioners in France and in Europe. This programme had two aspects: diagnostic and therapeutic. In France, the programme had been carried out by the collaboration of 27 cardiologists and 217 general practitioners who collected the charts of 1200 patients. Among French doctors, the level of knowledge of the NYHA classification and the concept of diastolic dysfunction is poor. A majority of them request EKG and echocardiography for patients with heart failure. As expected, ACE-inhibitors are frequently prescribed, however, dosages remain low. It appears that the collaboration with cardiologists is close. In this study, some differences appear on the management between France and other countries.
Collapse
Affiliation(s)
- A Cohen-Solal
- Service de cardiologie, hôpital Beaujon, 100, bd du Général Leclerc, 92110 Clichy.
| |
Collapse
|
48
|
Jullien G, Fraboulet JY, Poncelet P, Avierinos C, Sebaoun A, Gallois H, Cohen-Solal A. [Registry of cardiac insufficiency in cardiology]. Arch Mal Coeur Vaiss 2001; 94:1351-6. [PMID: 11828919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
The epidemiological data on cardiac insufficiency in cardiology are very scarce. Therefore, with its members the National College of French Cardiologists has conducted a survey in order to evaluate the clinical, biological and therapeutic characteristics of cardiac insufficiency patients, and thus the possible seasonal variations, and to compare them to the current recommendations and to the data from a previous survey with the same methodology performed in 1994. During each season of the year 622 cardiologists recruited the first 5 cardiac insufficiency patients who had been stable for at least three months. 8618 observations were analysed. The results showed 68% are male with an average age of 70 years, with an ischaemic aetiology in 47% of cases, hypertensive in 23%, and in NYHA stage II or III in 94% of cases. The left ventricular ejection fractions are < 30% in 22% of cases, between 30 and 50% in 62% of cases, and > or = 50% in 16% of cases (20% in those over 78 years). Medical treatment includes diuretics in 78% of cases, with 28% of patients on spironolactone, angiotensin converting enzyme inhibitors (ACE inhibitors) in 82% of cases, betablockers in 29% of cases; ACE inhibitors and betablockers are clearly prescribed more often than during the previous 1994 survey but at doses often lower than the recommendations. Lastly, there are no seasonal variations in prescriptions.
Collapse
Affiliation(s)
- G Jullien
- CNCF Marseille, 4, avenue de Delphes, 13006 Marseille
| | | | | | | | | | | | | |
Collapse
|
49
|
Ennezat PV, Logeart D, Lachmann J, LeJemtel TH, Cohen-Solal A. [Functional mitral insufficiency: a neglected vascular lesion?]. Arch Mal Coeur Vaiss 2001; 94:1173-9. [PMID: 11794985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Functional mitral regurgitation is usually neglected during the course of dilated cardiomyopathies. However, functional mitral regurgitation is a sensitive marker of decreased survival. Recent development of treatments such as new surgical approach, permanent biventricular pacing and beta-blockade therapy lead to assess and treat more specifically the accompanying functional mitral regurgitation in congestive heart failure.
Collapse
Affiliation(s)
- P V Ennezat
- Service de cardiologie, hôpital Beaujon, 100, bd Général-Leclerc, 92110 Clichy, France
| | | | | | | | | |
Collapse
|
50
|
Abstract
Congestive heart failure in the elderly differs from the one in the younger. The ageing of the cardiovascular system makes the organism weaker. When a myocardial infarction or an other cardiovascular disease happens, the occurrence of congestive heart failure is precipitated. The symptoms which are often misleading and the polypathologies make the assumption of relationship difficult between a symptom like dyspnea and congestive heart failure. Further examinations are limited because of the reduced physical performances in the elderly (stress test) or because of an increased risk of side-effects (coronary angiogram). The echocardiography has a central role in the exploration of congestive heart failure. The medical treatment has the same principles than in the younger but with cautions especially regarding the renal insufficiency and the multiple treatments that an elderly patient has.
Collapse
Affiliation(s)
- P Duc
- Service de cardiologie, hôpital Bichat-Claude Bernard, 46, rue Henri-Huchard, 75877 Paris, France.
| | | | | | | |
Collapse
|