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Wang LZ, Oehmichen B, Pariente B, Mohamedi N, Cheng C, Detriche G, Galloula A, Lilo Le Louet A, Messas E, Amar L, Goudot G, Mirault T. Fluoroquinolone Use Preceding Visceral Artery Dissection: A Case Series. Angiology 2023:33197231207945. [PMID: 37855079 DOI: 10.1177/00033197231207945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Fluoroquinolones (FQ), commonly prescribed antibiotics, may trigger aortic and carotid dissections. We report three successive cases of visceral artery dissection: one patient with celiac trunk dissection and two with dissection of the superior mesenteric artery. These events occurred up to 4 months after 7 to 14 days of FQ treatment (2 cases of ofloxacin, 1 of norfloxacin). There was no other apparent cause of dissection. These dissections were isolated, apart from a minimal aortic dissection separate from the visceral arterial dissection in one case. A case series cannot certify the relationship between dissection and FQ, but it can be hypothesized. The association between fluoroquinolone use and higher occurrence of aneurysm and dissection remains discussed in aortic syndrome. The potential link between FQ and visceral artery dissection is even less described but should be reported in the absence of previous cases in the literature. The pathophysiological theory is the induction of overexpression of some matrix metalloproteinases and a decrease of their inhibitors, provoking a dysregulation in collagen synthesis and degradation of the extracellular matrix.
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Affiliation(s)
- Louise Z Wang
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Boris Oehmichen
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Benjamin Pariente
- Hypertension Center, Georges Pompidou European Hospital, APHP, Paris, France
| | - Nassim Mohamedi
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Charles Cheng
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Grégoire Detriche
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Alexandre Galloula
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Agnès Lilo Le Louet
- Pharmacovigilance Center, Georges Pompidou European Hospital, APHP, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
- Université Paris Cité, INSERM U970 PARCC, Paris, France
| | - Laurence Amar
- Hypertension Center, Georges Pompidou European Hospital, APHP, Paris, France
- Université Paris Cité, INSERM U970 PARCC, Paris, France
| | - Guillaume Goudot
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
- Université Paris Cité, INSERM U970 PARCC, Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
- Université Paris Cité, INSERM U970 PARCC, Paris, France
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Wang L, Oehmichen B, Pariente B, Mohamedi N, Cheng C, Détriché G, Galloula A, Khider L, Lillo Le Louet A, Messas E, Amar L, Goudot G, Mirault T. Fluoroquinolone use preceding medium-size artery dissection: A case series. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.217] [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: 12/31/2022]
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Mazzella JM, Oehmichen B, Billon C, Nicolas S, Lahlou-Laforet K, Frank M, Jeunemaitre X, Mirault T. Celiprolol to prevent arterial events in patients with vascular Ehlers-Danlos and neither symptomatic nor silent arterial event. A retrospective cohort study from the French national reference center. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1941] [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
Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited connective tissue disorder, leading to mainly arterial complications, caused by COL3A1 pathogenic variations. Ong et al. (Lancet 2010) showed that the introduction of celiprolol significantly reduced arterial events in a predominantly symptomatic population on arterial level. We reported the benefit of full dose of Celiprolol in longitudinal study to prevent arterial events in Frank et al. (JACC 2019). To our knowledge, there is no data regarding the benefit of celiprolol in patients without any arterial event.
Purpose
The aim of this study was to assess the occurrence of arterial events during follow-up in vEDS patients without arterial event.
Methods
All patients – probands and relatives – with a pathogenic variation in COL3A1 diagnosed at the Referral Centre for Rare Vascular Diseases since 2001 and at least one arterial tree assessment were included. We then focused on vEDS patients without any arterial event. We retrospectively analyzed the duration of follow-up, the occurrence of arterial events during follow-up, and the introduction and dose of celiprolol, especially at the time of occurrence of an arterial event.
Results
Among the 230 patients included, 144 (63%) had at least one symptomatic arterial event, 44 (19%) had only silent arterial event and 67 (29%) had no arterial event at the first arterial tree assessment event. Patients with no arterial event were significantly younger at this visit compared with the two other groups with a median age of 23 vs. 38 and 39 years (silent and symptomatic) (p<0.05). Patients with no arterial event were more frequently relatives (73%) than probands (27%) (p<10–3). Celiprolol was introduced in 48 (72%) of the 67 patients with no arterial event after positive genetic diagnosis disclosure or during one of the outpatient visit. During follow-up, 22 patients had a first arterial event at a median age of 29 years: 16 (33%) were receiving celiprolol and 6 (32%) were not. But the median follow-up duration was 4 years for the 48 treated patients vs. 2 years for the 19 untreated patients (p=0.03).
Conclusions
Genetic testing of the relatives of probands with vEDS remains of utmost importance as one quarter presented with symptomatic arterial event and one fifth had silent arterial event at initial arterial tree assessment. For patients with no arterial event, those without celiprolol have a similar incidence of arterial events than those with celiprolol, however their follow-up duration was twice shorter suggesting a higher incidence rate or arterial event in the absence of celiprolol.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J M Mazzella
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
| | - B Oehmichen
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
| | - C Billon
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
| | - S Nicolas
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
| | - K Lahlou-Laforet
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
| | - M Frank
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
| | - X Jeunemaitre
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
| | - T Mirault
- Université Paris Cité, hôpital européen Georges-Pompidou APHP, INSERM U970, National reference center for Rare Vascular Diseases , Paris , France
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