1
|
Sharobeem S, Boulmier D, Leurent G, Bedossa M, Leclercq C, Mabo P, Raphaël Pedro M, Tomasi J, Verhoye JP, Donal E, Sost G, Le Guellec M, Le Breton H, Auffret V. Prognostic impact of permanent pacemaker implantation after transcatheter aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.160] [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]
|
2
|
Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
Collapse
Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Jung W, Mondoly P, Leclercq C, Bordachar P, Pasquie J, Johansen J, Zaidi A, Keilegavlen H, Mansourati J, Nof E, Theis C, Roberts P, Stromberg K, Fagan D, Garweg C. Leadless pacemaker implant in patients requiring CIED extraction: outcomes based upon timing of extraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0615] [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
Previous results from global Micra Transcatheter Pacemaker clinical trials have demonstrated leadless pacing as a safe and attractive option for patients with prior cardiac implantable electronic device (CIED) infection and extraction. Whether outcomes differ based upon the timing of prior device extraction has not been studied.
Purpose
To describe characteristics and outcomes of patients undergoing CIED extraction during or prior to Micra implantation.
Methods
Patients who underwent CIED explant and Micra implantation were identified from the Micra Post-Approval Registry and Micra Acute Performance studies. Baseline characteristics were summarized. A Fine-Gray competing risk model was used to compare risk for major complication through 24 months.
Results
Of the 2739 patients included in the studies, 99 (3.6%) patients had CIED extraction the day of Micra implantation (same day) and 127 (4.6%) patients had CIED extraction within 30 days prior to Micra implantation (prior). Although infection was the primary reason for CIED extraction in both groups, a larger proportion of prior patients underwent extraction for this reason (87.4% vs. 42.4%). In contrast, more same day patients underwent CIED extraction for physician/elective reasons (16.2% vs. 3.1%). Same day patients prior device history included pacemaker (42 dual chamber and 30 single chamber), ICD (1 single chamber and 4 dual chamber), CRT (7 CRT-ICD and 13 CRT-P) while prior patients device history included pacemaker (29 single chamber, 80 dual chamber), ICD (3 dual chamber), CRT (5 CRT-ICD and 7 CRT-P). Overall, patients with extraction were aged 72.8±14.3 years, predominantly male (65.9%), and medical history was similar between groups, with the exception to CHF, which was higher for the same day group (18.2% vs 6.3%, P=0.021). The implant success rate was 98.0% for same day patients and 100% for prior patients. Median procedure duration was not significantly different between the groups (26.0 minutes and 25.0 minutes for same day and prior, respectively). Average follow-up duration was 16.5±13.8 months (range 0–53.4) for same day patients and 18.2±15.2 months (range 0–58.3) for subsequent patients. The rate of acute major complications (<30 days) was 5.1% for same day and 3.2% for prior. Through 24 months, the rate of major complications was 6.4% for same day and 6.0% for prior (HR: 1.19, 95% CI: 0.40 – 3.50, P=0.76, Figure). The rate of major complications related to infection was low and did not differ by group (1.01% vs. 1.57%, P=1.00)
Conclusion
The Micra leadless pacemaker was implanted with a high success rate following CIED extraction. Outcomes following CIED extraction appear similar, whether the extraction is performed during or prior to Micra implant.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. Risk of major complications
Collapse
Affiliation(s)
- W Jung
- Department of Cardiology, Academic Hospital Villingen, Villingen-Schwenningen, Germany
| | - P Mondoly
- University Hospital of Toulouse, Toulouse, France
| | - C Leclercq
- Hospital Pontchaillou of Rennes, Rennes, France
| | - P Bordachar
- University Hospital of Bordeaux, Bordeaux, France
| | - J.L Pasquie
- University of Montpellier, Montpellier, France
| | | | - A Zaidi
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - E Nof
- Sheba Medical Center, Tel Aviv, Israel
| | - C Theis
- Johannes Gutenberg University Mainz (JGU), Mainz, Germany
| | - P.R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - K Stromberg
- Medtronic, Mounds View, United States of America
| | - D.H Fagan
- Medtronic, Mounds View, United States of America
| | - C Garweg
- University Hospitals (UZ) Leuven, Leuven, Belgium
| |
Collapse
|
4
|
George S, Rizkallah M, Leviet D, Leclercq C, El Abiad R. Early vs late surgical treatment of radial instability of the thumb metacarpophalangeal joint. A retrospective cohort study. Hand Surg Rehabil 2021; 40:771-776. [PMID: 34455102 DOI: 10.1016/j.hansur.2021.08.008] [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] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/14/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
There is no clear evidence in the literature whether treating thumb radial collateral ligament (RCL) injury in the acute phase improves outcome. The purpose of the present study was to compare the clinical and radiological results of RCL repair in acute and chronic settings. Fourteen patients were included. Clinical range of motion (ROM) of the thumb, Kapandji score and radiological parameters were compared pre- and post-operatively to the contralateral uninjured thumb (control group) to evaluate the results of the surgical technique. Patients were then divided into two groups according to early versus late repair and outcomes were compared between the two groups and the control group. Preoperatively, mean spontaneous angle between first metacarpal (M1) and proximal phalanx (P1) (spontaneous M1P1 angle), ulnar stress M1P1 angle, ROM and Kapandji score differed significantly between injured and uninjured sides. Postoperatively these parameters for the injured side improved, reaching values similar to those on the uninjured side, especially with acute phase treatment; late treatment also tended to provide clinical improvement in ROM, Kapandji score and ulnar stress angle, but with significant improvement only for spontaneous deviation of the thumb. This study showed the late and immediate repair of the RCL of the thumb both gave good results, with slightly better outcome with acute phase repair. LEVEL OF EVIDENCE: Therapeutic, Level III.
Collapse
Affiliation(s)
- S George
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
| | - M Rizkallah
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
| | - D Leviet
- Hôpital de la Croix Rouge Henry Dunant, 95 Rue Michel Ange, 75016 Paris, France.
| | - C Leclercq
- Institut de la Main, Clinique Bizet, 21 Rue Georges Bizet, 75016 Paris, France.
| | - R El Abiad
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
| |
Collapse
|
5
|
Leclercq C, Hentz VR. Surgical restoration of the upper limb in cervical spinal cord injury patients. Hand Surg Rehabil 2021; 41S:S148-S152. [PMID: 34391954 DOI: 10.1016/j.hansur.2020.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/04/2020] [Accepted: 05/16/2020] [Indexed: 10/20/2022]
Abstract
Prior to the 1950s, relatively few patients who suffered a transection of the cervical spinal cord survived their injury. Improved medical care and better coordination have resulted in greater numbers of patients surviving and leaving the hospital. The pioneering work of individual surgeons during the 1960s and 1970s stimulated interest in surgical restoration of upper limb function in tetraplegic patients. Since the publication of Moberg's monograph in 1978, surgical improvement of the upper limbs is regarded as one of the options that should be offered to tetraplegic individuals to improve their function. Patients are classified according to the level of spinal cord injury and the residual motor function (international classification: groups 1 to 9). Surgical procedures are adapted to the motor level for each group of patients. Indications for these procedures are well standardized, the techniques are well mastered, and predictable results can be expected. New nerve transfer techniques have been developed in recent years; they are currently being evaluated.
Collapse
Affiliation(s)
- C Leclercq
- Institut de la Main, 22, rue Georges Bizet, 75116 Paris, France.
| | - V R Hentz
- Department of Plastic Surgery, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| |
Collapse
|
6
|
Coats AJS, Anker SD, Baumbach A, Alfieri O, von Bardeleben RS, Bauersachs J, Bax JJ, Boveda S, Čelutkienė J, Cleland JG, Dagres N, Deneke T, Farmakis D, Filippatos G, Hausleiter J, Hindricks G, Jankowska EA, Lainscak M, Leclercq C, Lund LH, McDonagh T, Mehra MR, Metra M, Mewton N, Mueller C, Mullens W, Muneretto C, Obadia JF, Ponikowski P, Praz F, Rudolph V, Ruschitzka F, Vahanian A, Windecker S, Zamorano JL, Edvardsen T, Heidbuchel H, Seferovic PM, Prendergast B. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur Heart J 2021; 42:1254-1269. [PMID: 33734354 PMCID: PMC8014526 DOI: 10.1093/eurheartj/ehab086] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/01/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023] Open
Abstract
Secondary (or functional) mitral regurgitation (SMR) occurs frequently in chronic heart failure (HF) with reduced left ventricular (LV) ejection fraction, resulting from LV remodelling that prevents coaptation of the valve leaflets. Secondary mitral regurgitation contributes to progression of the symptoms and signs of HF and confers worse prognosis. The management of HF patients with SMR is complex and requires timely referral to a multidisciplinary Heart Team. Optimization of pharmacological and device therapy according to guideline recommendations is crucial. Further management requires careful clinical and imaging assessment, addressing the anatomical and functional features of the mitral valve and left ventricle, overall HF status, and relevant comorbidities. Evidence concerning surgical correction of SMR is sparse and it is doubtful whether this approach improves prognosis. Transcatheter repair has emerged as a promising alternative, but the conflicting results of current randomized trials require careful interpretation. This collaborative position statement, developed by four key associations of the European Society of Cardiology-the Heart Failure Association (HFA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association of Cardiovascular Imaging (EACVI), and European Heart Rhythm Association (EHRA)-presents an updated practical approach to the evaluation and management of patients with HF and SMR based upon a Heart Team approach.
Collapse
Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology (CVK), Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany.,Charité Universitätsmedizin Berlin, Germany
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, and Yale University School of Medicine, New Haven, USA
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,State Research Institute Centre For Innovative Medicine, Vilnius, Lithuania
| | - John G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Deneke
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Germany
| | | | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Jörg Hausleiter
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Christoph Leclercq
- Université de Rennes I, CICIT 804, Rennes, CHU Pontchaillou, France, Rennes
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Mandeep R Mehra
- Brigham Women's Hospital Heart and Vascular Center and the Center of Advanced Heart Disease, Harvard Medical School, Boston, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Nathan Mewton
- Hôpital Cardio-Vasculaire Louis Pradel, Centre d'Investigation Clinique, Filière Insuffisance Cardiaqu, e, France, Lyon
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Frank Ruschitzka
- Cardiology Clinic, University Heart Center, University Hospital Zürich, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.,University Alcala, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | | | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, Westminster Bridge Road, London, UK
| |
Collapse
|
7
|
Galli E, Smiseth OA, Aalen JM, Larsen CK, Sade E, Le Rolle V, Hernandez A, Leclercq C, Duchenne J, Voigt JU, Donal E. Prognostic value of diastolic function assessment in patients undergoing cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.030] [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
Funding Acknowledgements
Type of funding sources: None.
Objective
The best modality to assess diastolic function in CRT-candidates is an object of debate and the relationship between diastolic function, CRT-response and survival are not
clearly understood.
Purpose of the study: to assess diastolic patterns in patients undergoing CRT according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging and to evaluate the prognostic value of diastolic dysfunction (DD) in CRT candidates.
Methods
193 patients (age: 67 ± 11 years, QRS width: 167 ± 21 ms) were included in this multicentre prospective study. Patients were stratified according to DD grades (grade I
to III). CRT-response was defined as a reduction of left ventricular (LV) end-systolic volume >15% at 6-month follow-up (FU). The primary endpoint was defined as a
composite of heart transplantation, LV assisted device implantation or all-cause death during FU.
Results
During FU, 132 (68%) patients were CRT-responders. CRT delivery was associated with diastolic function degradation in non-responders. Grade I DD was able to predict
CRT-response with a sensitivity, specificity and accuracy of 70%, 65%, and 63%, respectively. After a median period of 35 months, the primary endpoint occurred in 29
(15%) patients. Grade I DD was associated with a better outcome [HR 0.26 95% CI: (0.10-0.66)], independently from ischemic cardiomyopathy, LV dyssynchrony and CRT-response (Table 1). Non-responders with grade II or grade III DD had the worse prognosis (HR 4.36, 95%CI: 2.10-9.06) Figure 1.
Conclusions
Grade I DD is associated with LV remodelling after CRT and is an independent predictor of prognosis in CRT candidates.
Abstract Figure.
Collapse
Affiliation(s)
- E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - JM Aalen
- University of Oslo, Oslo, Norway
| | | | - E Sade
- Baskent University, Ankara, Turkey
| | | | | | - C Leclercq
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | | | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
| |
Collapse
|
8
|
Galli E, Bouali Y, Gallard A, Hubert A, Leclercq C, Donal E. Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.026] [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
Funding Acknowledgements
Type of funding sources: None.
Background
the non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs).
Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients.
Methods
79 patients with HFrEF (mean age: 66 ± 12 years; LV ejection fraction: 28 ± 9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan.
Results
Sacubitril/Valsartan significantly increased myocardial constructive work (CW) (1023 ± 449 vs 1424 ± 484 mmHg%, p < 0.0001) and myocardial work efficiency (WE) [87 (78-90) vs 90 (86-95), p < 0.0001]. During FU (2.6 ± 0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, global myocardial constructive work (CW) was the only predictor of MACEs [HR 0.99 (0.99-1.00), p = 0.05]. (Table 1). A CW < 910 mmHg (AUC = 0.81, p < 0.0001, Figure 1, left panel) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45-98.94), p = 0.002, log-rank test p < 0.0001] (Figure 2, Right panel).
Conclusions
in patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs.
Univariable analysis Multivariable analysis HR (95% CI) p-value HR (95% CI) p-value Age, per year 0.99 (0.95-1.04) 0.81 Ischemic cardiomyopathy 1.07 (0.36-3.21) 0.89 LVEDVi*, per ml/m2 1.01 (1.00-1.03) 0.03 LVESVi, per ml/m2 1.01 (1.00-1.03) 0.009 1.01 (0.99-1.02) 0.35 LVEF, per % 0.91 (0.85-0.98) 0.01 1.02 (0.93-1.12) 0.71 CW, per mmHg% 0.99 (0.99-1.00) 0.002 0.99 (0.99-1.00) 0.04 WE, per mmHg% 0.91 (0.86-0.96) 0.001 0.95 (0.88-1.02) 0.16 Predictors of MACEs at univariable and multivariable analysis Abstract Figure 1 A and B
Collapse
Affiliation(s)
- E Galli
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - Y Bouali
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - A Gallard
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - A Hubert
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - C Leclercq
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - E Donal
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| |
Collapse
|
9
|
Galli E, Le Rolle V, Smiseth OA, Duchenne J, Aalen JM, Larsen CK, Sade E, Hubert A, Anilkumar S, Penicka M, Linde C, Leclercq C, Hernandez A, Voigt JU, Donal E. Importance of systematic right ventricular assessment in cardiac resynchronization therapy candidates: a machine-learning approach. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.044] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Despite having all a systolic heart failure and broad QRS, patients proposed for cardiac resynchronization therapy (CRT) are highly heterogeneous and it remains extremely complicated to predict the impact of the device on left ventricular (LV) function and outcomes.
Objectives
We sought to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular (LV) remodeling and prognosis of CRT-candidates by the application of machine learning (ML) approaches.
Methods
193 patients with systolic heart failure undergoing CRT according to current recommendations were prospectively included in this multicentre study. We used a combination of the Boruta algorithm and random forest methods to identify features predicting both CRT volumetric response and prognosis (Figure 1). The model performance was tested by the area under the receiver operating curve (AUC). We also applied the K-medoid method to identify clusters of phenotypically-similar patients.
Results
From 28 clinical, electrocardiographic, and echocardiographic-derived variables, 16 features were predictive of CRT-response; 11 features were predictive of prognosis.
Among the predictors of CRT-response, 7 variables (44%) pertained to right ventricular (RV) size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with a very good prediction of both CRT response (AUC 0.81, 95% CI: 0.74-0.87) and outcomes (AUC 0.84, 95% CI: 0.75-0.93) (Figure 1, Supervised Machine Learning Panel). An unsupervised ML approach allowed the identifications of two phenogroups of patients who differed significantly in clinical and parameters, biventricular size and RV function. The two phenogroups had significant different prognosis (HR 4.70, 95% CI: 2.1-10.0, p < 0.0001; log –rank p < 0.0001; Figure 1, Unsupervised Machine Learning Panel).
Conclusions
Machine learning can reliably identify clinical and echocardiographic features associated with CRT-response and prognosis. The evaluation of both RV-size and function parameters has pivotal importance for the risk stratification of CRT-candidates and should be systematically assessed in patients undergoing CRT.
Abstract Figure 1
Collapse
Affiliation(s)
- E Galli
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - V Le Rolle
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | | | | | - JM Aalen
- University of Oslo, Oslo, Norway
| | | | - E Sade
- Baskent University, Ankara, Turkey
| | - A Hubert
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | | | | | - C Linde
- Karolinska Institute, Stockholm, Sweden
| | - C Leclercq
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - A Hernandez
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | | | - E Donal
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| |
Collapse
|
10
|
Galli E, Smiseth OA, Aalen JM, Larsen CK, Sade E, Hubert A, Anilkumar S, Penicka M, Linde C, Le Rolle V, Hernandez A, Leclercq C, Duchenne J, Voigt JU, Donal E. Prognostic utility of the assessment of diastolic function in patients undergoing cardiac resynchronization therapy. Int J Cardiol 2021; 331:144-151. [PMID: 33535079 DOI: 10.1016/j.ijcard.2021.01.046] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
Conflicting data exist about the relationship between cardiac resynchronization therapy (CRT) and diastolic function. Aims of the study are to assess diastolic patterns in patients undergoing CRT according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging and to evaluate the prognostic value of diastolic dysfunction (DD) in CRT candidates. METHODS AND RESULTS: One-hundred ninety-three patients (age: 67 ± 11 years, QRS width: 167 ± 21 ms) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III. CRT-response, defined as a reduction of left ventricular (LV) end-systolic volume > 15% at 6-month follow-up (FU), occurred in 132 (68%) patients. The primary endpoint was a composite of heart transplantation, LV assisted device implantation, or all-cause death during FU and occurred in 29 (15%) patients. CRT was associated with a degradation of DD in non-responders. At multivariable analysis corrected for clinical variables, QRS duration, mitral regurgitation, CRT-response and LV dyssynchrony, grade I DD was associated with a better outcome (HR 0.37, 95% CI: 0.14-0.96). Non-responders with grade II-III DD had the worse prognosis (HR 4.36, 95%CI: 2.10-9.06). CONCLUSIONS: The evaluation of DD in CRT candidates allows the prognostic stratification of patients, independently from CRT-response.
Collapse
Affiliation(s)
- E Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - O A Smiseth
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - J M Aalen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - C K Larsen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - E Sade
- Department of Cardiology, Baskent University Hospital, Ankara, Turkey
| | - A Hubert
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - S Anilkumar
- Non-Invasive Cardiac Laboratory, Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - V Le Rolle
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - A Hernandez
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - C Leclercq
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - J Duchenne
- Department of Cardiovascular Disease and Departement of Cardiovascular Science, KU, Leuven, Belgium
| | - J-U Voigt
- Department of Cardiovascular Disease and Departement of Cardiovascular Science, KU, Leuven, Belgium
| | - E Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France.
| |
Collapse
|
11
|
Bouali Y, Donal E, Laurin C, Gallard A, Hubert A, Bidaut A, Leclercq C, Galli E. Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.113] [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: 11/16/2022]
|
12
|
Galli E, Smiseth O, Aalen J, Larsen C, Sade E, Hubert A, Anilkumar S, Sirnes P, Penicka M, Linde C, Le Rolle V, Hernandez A, Leclercq C, Duchenne J, Voigt J, Donal E. Better diastolic function in CRT candidates is associated with improved survival after CRT implantation. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.092] [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: 10/22/2022]
|
13
|
Artus A, Guenancia C, Behar N, Leclercq C, Schatz A, Mansourati J, Garnier F. Success and complication rate of Tightrail mechanical percutaneous lead extraction: A multicentre French study. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.203] [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: 11/30/2022]
|
14
|
Galli E, Bouali Y, Laurin C, Gallard A, Hubert A, Bidaut A, Leclercq C, Donal E. Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0040] [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
The non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs).
Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients.
Methods
79 patients with HFrEF (mean age: 66±12 years; LV ejection fraction: 28±9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan.
Results
Sacubitril/Valsartan significantly increased global myocardial constructive work (CW) (1023±449 vs 1424±484 mmHg%, p<0.0001) and myocardial work efficiency (WE) [87 (78–90) vs 90 (86–95), p<0.0001]. During FU (2.6±0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, CW was the only predictor of MACEs (Table 1). A CW<910 mmHg (AUC=0.81, p<0.0001, Figure 1A) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45–98.94), p=0.002, log-rank test p<0.0001] (Figure 1 B).
Conclusions
In patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | - Y Bouali
- Hospital Pontchaillou of Rennes, Rennes, France
| | - C Laurin
- Hospital Pontchaillou of Rennes, Rennes, France
| | - A Gallard
- Hospital Pontchaillou of Rennes, Rennes, France
| | - A Hubert
- Hospital Pontchaillou of Rennes, Rennes, France
| | - A Bidaut
- Hospital Pontchaillou of Rennes, Rennes, France
| | - C Leclercq
- Hospital Pontchaillou of Rennes, Rennes, France
| | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
| |
Collapse
|
15
|
Galli E, Smiseth O, Aalen J, Duchenne J, Larsen C, Sade E, Hubert A, Anilkumar S, Penicka M, Hernandez A, Leclercq C, Voigt JU, Donal E. Better diastolic function in CRT candidates is associated with improved survival after CRT implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0041] [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
The relationship between diastolic dysfunction (DD) and outcome after CRT is debated.
Purpose
Purpose of this study was to evaluate the role of DD in predicting all-cause mortality in heart failure patients undergoing CRT.
Methods
One-hundred ninety-three patients (age: 67±11 years, QRS width: 167±21 ms, LVEF 28±8%) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging. A reduction of LV end-systolic volume >15% at 6-month follow-up (FU) identified CRT-responders and was observed in 132 (68%) patients.
Results
During a median 35 months FU, 29 (15%) patients died. Through multivariable analysis, coronary artery disease, NYHA functional class and grade I DD were shown to be independent predictors of prognosis (Table 1). Grade I DD was associated with a longer survival rate in both responders and non responders (Figure 1). Non responders with grade II-III DD had the worse outcome (HR 12.5 [3.56–44.04], p<0.0001).
Conclusions
Better diastolic function at baseline is associated with an improved survival after CRT implantation, independently of CRT-response.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - J Aalen
- University of Oslo, Oslo, Norway
| | | | - C Larsen
- University of Oslo, Oslo, Norway
| | - E Sade
- Baskent University, Ankara, Turkey
| | - A Hubert
- Hospital Pontchaillou of Rennes, Rennes, France
| | - S Anilkumar
- Hamad Medical Corporation Heart Hospital, Doha, Qatar
| | - M Penicka
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - A Hernandez
- Laboratory Signal Processing and Image, Rennes, France
| | - C Leclercq
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
| |
Collapse
|
16
|
Artus A, Guenancia C, Behar N, Leclercq C, Schatz A, Mansourati J, Garnier F. Success and complication rate of Tightrail mechanical percutaneous lead extraction: a multicenter French study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0833] [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
Our objective was to assess Philips TightRail™ rotating dilator sheath efficacy and safety for extraction of endocardial leads. No large scale multicenter data is available on this mechanical lead extraction device, now commonly used in France.
Methods and results
We conducted a retrospective, multicenter (from 4 French university hospitals) study. These centers that only perform mechanical lead extraction using this device were selected on the basis of the annual volume of procedures (>10 leads/year). All patients from January 2015 to January 2020 who underwent at least one extraction of an endocardial lead with using TightRail™ were included. All of the extracted leads were >12 months old and indications for extraction were based on ESC guidelines.
Overall, 395 leads were extracted using TightRail™ in 203 patients (mean age 70 years, 75% male sex).
Indications for lead removal included cardiac device infection in 172 (85%) cases, lead malfunction in the 25 (12%) cases, vein thrombosis in 3 (1.5%) cases and 3 for other indications (1,5%). The extracted devices were pacemaker in 134 (66%) cases, implantable cardioverter-defibrillator (ICD) in 69 (44%) cases. The mean time from implantation was 124 months. Complete procedural success with TightRail™ system alone was achieved in 180 (89.1%) patients (352 leads) and overall clinical success was 93% (367 leads). Fifteen right sided leads were completely removed with the help of femoral snare. Ten (5%) patients had at least one major perioperative complication: 3 cardiac tamponades, 1 haemothorax, 1 stroke, 5 vascular breaches requiring surgical intervention. No in-hospital death was observed.
Conclusion
Our large scale retrospective study in 4 high-volume mechanical lead extraction centers shows that TightRail™ is highly effective for chronically implanted lead extraction. The safety profile appears similar to the rate recently described with power sheaths.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Artus
- University Hospital of Dijon, Cardiology, Dijon, France
| | | | - N Behar
- Hospital Pontchaillou of Rennes, Cardiology, Rennes, France
| | - C Leclercq
- Hospital Pontchaillou of Rennes, Cardiology, Rennes, France
| | - A Schatz
- University Hospital of Strasbourg, Cardiology, Strasbourg, France
| | - J Mansourati
- University Hospital of Brest, Cardiology, Brest, France
| | - F Garnier
- University Hospital of Dijon, Cardiology, Dijon, France
| |
Collapse
|
17
|
Gallard A, Donal E, Le Rolle V, Hubert A, Bidaut A, Leclercq C, Galli E, Hernandez A. 539 Optimized multiparametric analysis of cardiac dyssynchrony: machine learning and prediction of response to cardiac resynchronization therapy based of the apical 4-chamber view. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.273] [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
Aims. We hypothesized that a multiparametric evaluation, based on the combination of electrocardiographic and echocardiographic parameters, could enhance the appraisal of the likelihood of reverse remodeling and prognosis of favorable clinical evolution after cardiac resynchronization therapy (CRT). Also, we sought to test the respective value of automatically extracted parameters from left ventricular (LV) strain curves recorded in apical 4-chamber view as compared to the other echocardiographic views.
Methods and results;
This is a machine learning study based on a dataset of 161 patients who were treated by CRT according to current ESC-guidelines. The longitudinal strain curves of the 6 LV-segments of the left ventricle were plot for the three different apical views. Several features as times or integrals were extracted as previously published. These features were classified by importance using the out-of-bag method(fig1). Half of the most important features come from the 4-chamber view and a third from the 2-chamber view. The correlation between the most important features was studied to determine the relationship between them. Almost all the features from the 2-chamber and apical long-axis views are correlated with others and generally with one acquired from the 4-chamber view.
Conclusion
The high number of important features indicate the relevance of the 4-chamber as unique view for applying machine learning approaches on strain curves. Optimizing selection of patients for CRT should be possible just on the dataset coming from one apical 4-chamber view.
Abstract 539 Figure. fig1
Collapse
Affiliation(s)
- A Gallard
- Laboratory Signal Processing and Image, Rennes, France
| | - E Donal
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - V Le Rolle
- Laboratory Signal Processing and Image, Rennes, France
| | - A Hubert
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - A Bidaut
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - C Leclercq
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - E Galli
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - A Hernandez
- Laboratory Signal Processing and Image, Rennes, France
| |
Collapse
|
18
|
Galli E, Aalen J, Duchenne J, Larsen C, Hubert A, Saade E, Le Rolle V, Leclercq C, Smiseth O, Voigt JU, Donal E. 557 Left ventricular diastolic function is a predictor of volumetric response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.287] [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
Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aims of the study are: 1) to assess diastolic patterns in patients undergoing CRT; 2) to evaluate the role of DF in predicting CRT-response.
Methods
193 patients (age: 67 ± 11 ms, QRS width: 167 ± 21 ms, LVEF 28 ± 8%) were prospectively included in this multicentric study. 2D-standard echocardiography was performed before CRT and at 6-month follow-up (FU). DF was assessed according to recommendations from grade I to III. In case of data in the "grey zone", DF was defined as "indeterminate". A reduction of left ventricular (LV) end-systolic volume >15% at FU identified CRT-responders (CRT-R).
Results
At 6-month FU, 132 patients (68%) were CRT-R. Figure 1 shows DF parameters in the overall population, CRT-R, and CRT-non responders (CRT-NR) before and after CRT. At multivariable analysis, grade I diastolic dysfunction at baseline was a significant independent predictor of CRT response (OR 3.02, p = 0.001) (Table 1). The addition of grade I diastolic dysfunction to a model including clinical (sex, NYHA class, ischemic cardiomyopathy) and echocardiographic parameters (LV size), significantly increase the model power for the prediction of CRT-response (χ2: 29 vs 44, p = 0.001).
Conclusions
Before CRT, DF parameters are significantly altered in CRT-NR with respect to CRT-R. Moreover, CRT-NR experience a significant deterioration of DF after CRT. In our population, grade I diastolic function at baseline was a significant independent predictor of positive response to CRT.
Table 1 Univariable analysis Multivariable analysis Age 1.01 (0.99-1.05) 0.25 Males 0.36 (0.17-0.76) 0.008 0.57 (0.22-1.47) 0.25 CAD 0.21 (0.11-0.40) <0.001 0.31 (0.15-0.65) 0.002 NYHA 0.52 (0.31-0.88) 0.01 0.57 (0.22-1.47) 0.25 QRS 1.01 (0.99-1.02) 0.44 LVEDV 0.99 (0.99-1.00) 0.003 0.98 (0.97-1.01) 0.18 LVESV 0.99 (0.98-0.99) 0.005 1.01 (0.99-1.03) 0.28 LVEF 1.00 (0.97-1.05) 0.63 Grade I DD 4.13 (2.16-7.91) <0.0001 3.02 (1.26-7.23) 0.001 Grade II DD 0.57 (0.40-0.80) 0.001 0.87 (0.35-2.19) 0.79 Grade III DD 0.76 (0.58-1.02) 0.06
Abstract 557 Figure.
Collapse
Affiliation(s)
- E Galli
- University Hospital of Rennes, Rennes, France
| | - J Aalen
- University of Oslo, Oslo, Norway
| | | | - C Larsen
- University of Oslo, Oslo, Norway
| | - A Hubert
- University Hospital of Rennes, Rennes, France
| | - E Saade
- Baskent University, Ankara, Turkey
| | - V Le Rolle
- University Hospital of Rennes, Rennes, France
| | - C Leclercq
- University Hospital of Rennes, Rennes, France
| | | | | | - E Donal
- University Hospital of Rennes, Rennes, France
| |
Collapse
|
19
|
Hubert A, Galli E, Leurent G, Corbineau H, Leclercq C, Donal E. 424 Left ventricular function after correction of a proportionate mitral regurgitation: impact of the clipping approach. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.238] [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
Aims : Secondary mitral regurgitation (MR) is associated with poor outcome in systolic heart failure (HF-)patients. Percutaneous edge-to-edge mitral valve repair (PMVR) recently failed to prove any beneficial effect over optimal medical treatment (OMT). Nevertheless, little is known about the effect of PMVR on LV performance and mechanics in HF-patients with severe secondary MR.
Method and results
Thirty-seven patients with severe secondary MR treated by PMVR were included and compared (according to indices of LV myocardial function) to nineteen patients with treated by OMT. Both groups were clinically comparable. At 6-month follow-up, only LV constructive work improve significantly in both groups (977 vs 1101 mmHg.%, p =0,003, 967 vs 1110 mmHg.%, p = 0,002 for PMVR and OMT groups, respectively) whereas left ventricular (LV) end-systolic volume index, LV ejection fraction and global longitudinal strain were not different. Compared to MITRA-FR and COAPT studies, our population had a proportionate MR (blue point in Figure 1, panel A). Figure 1-panel B demonstrate that only five patients of PMVR group had disproportionate MR (red points). Interestingly, these patients hadn’t any major event during 6 months FU.
Conclusion
Echocardiographic characteristics at 6-month follow-up are not different when compare PMVR and OMT for HF- patients with a severe proportionate secondary MR.
Main echocardiographic characteristics PMVR OMT Inclusion 6-month p Inclusion 6-month p NYHA 2.6 ± 0.6* 1.8 ± 0.7* <0.0001 2.3 ± 0.5* 2.2 ± 0.4* 0.43 LVESVi(ml.m-2) 76 ± 36 75 ± 35 0.6 94 ± 32 90 ± 31 0.35 LVEF (%) 33 ± 6 33 ± 13 0.78 30 ± 8 31 ± 8 0.53 GLS (%) -9.8 ± 4 -9.9 ± 3.9 0.84 -10.0 ± 4 -10.3 ± 3.3 0.62 MR grade 3.4 ± 0.5 1.3 ± 1.0* <0.0001 3.5 ± 0.5 2.8 ± 1.1* 0.007 Global work index (mmHg.%) 831 ± 370 933 ± 406 0.07 875 ± 314 939 ± 304 0.14 Constructive work (mmHg.%) 977 ± 366 1101 ± 404 0.003 967 ± 290 1110 ± 349 0.002 *symbols denote p < 0.05 between both groups
Abstract 424 Figure.
Collapse
Affiliation(s)
- A Hubert
- University Hospital of Rennes, Rennes, France
| | - E Galli
- University Hospital of Rennes, Rennes, France
| | - G Leurent
- University Hospital of Rennes, Rennes, France
| | - H Corbineau
- University Hospital of Rennes, Rennes, France
| | - C Leclercq
- University Hospital of Rennes, Rennes, France
| | - E Donal
- University Hospital of Rennes, Rennes, France
| |
Collapse
|
20
|
Aalen J, Donal E, Larsen CK, Duchenne J, Cvijic M, Leclercq C, Bogaert J, Hopp E, Fjeld JG, Penicka M, Linde C, Kongsgaard E, Galli E, Voigt JU, Smiseth OA. 561 Targeting septal work and viability identifies responders to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.291] [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
Funding Acknowledgements
The study was supported by Center for Cardiological Innovation.
Introduction
Septal dysfunction is the dominant mechanism of left ventricular (LV) failure in left bundle branch block (LBBB). We hypothesize that, provided septum is viable, septal function can recover and hence LV function improve after cardiac resynchronization therapy (CRT).
Purpose
To determine if combined assessment of septal function and viability identifies responders to CRT.
Methods
In a prospective multicenter study of 200 unselected patients referred for CRT, we measured myocardial strain by speckle-tracking echocardiography and regional work by pressure-strain analysis before and 7 ± 1 months after CRT. Viability was assessed by late gadolinium enhancement cardiac magnetic resonance imaging (n = 123). CRT response was defined as ≥15% reduction in LV end-systolic volume.
Results
Before CRT, septal work was 258 ± 463 and LV lateral wall work 1469 ± 674 mmHg·% (p < 0.0001). In CRT responders, septal work was restored to 1243 ± 495 mmHg·%, whereas non-responders showed less marked improvement (p < 0.0001). The figure illustrates a typical CRT responder with negative septal work and a large difference between work in the LV lateral wall and septum (panel A). There was no septal scar (panel B) and, after 6 months with CRT, septal work was recovered (panel C). Pressure-strain loops illustrate that CRT converted inefficient septal contractions with substantial negative (wasted) work to positive work throughout systole. For the entire study population, the difference between work in the LV lateral wall and septum predicted CRT response with area under the curve (AUC) 0.75 (95% CI: 0.68-0.83) and was feasible in 98% of patients. Furthermore, septal scar predicted non-response to CRT with AUC 0.76 (95% CI: 0.65-0.86). Combining work difference and septal viability improved AUC for CRT response to 0.85 (95% CI: 0.76-0.94) (figure panel D). The AUC was similar for QRS 120-150 and >150 ms.
Conclusions
The proposed combined approach with assessment of septal work and viability identified CRT responders with high precision.
Abstract 561 Figure.
Collapse
Affiliation(s)
- J Aalen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E Donal
- University Hospital of Rennes, Rennes, France
| | - C K Larsen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | | | | | - C Leclercq
- University Hospital of Rennes, Rennes, France
| | | | - E Hopp
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - J G Fjeld
- Oslo University Hospital, Cardiology, Oslo, Norway
| | | | - C Linde
- Karolinska University Hospital, Stockholm, Sweden
| | - E Kongsgaard
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - E Galli
- University Hospital of Rennes, Rennes, France
| | | | - O A Smiseth
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
21
|
Galand V, Ghoshhajra BG, Szymonifka J, Das S, Orencole M, Leclercq C, Truong QA, Singh JP. P5684Left ventricular wall thickness measured with computed tomography stratifies the response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0626] [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
Cardiac resynchronization therapy (CRT) has provided benefit in selected heart failure (HF) patients. Unfortunately, up to 30% of device recipients do not benefit clinically from CRT. Left ventricular (LV) wall geometry analyzed using computed tomography (CT) has not been evaluated in the response to CRT. The objective of this study was to examine the association of LV wall thickness (WT) and the ability for reverse LV remodeling after CRT in non ischemic cardiomyopathy (NICM) patients.
Methods
In this prospective study, a total 54 patients (33 NICM) scheduled for CRT, underwent pre procedural CT. Reduced LV WT was defined as WT≤6mm and was quantified as a percentage of total LV area. End points were 6-month clinical and echocardiographic response to CRT (NYHA functional class, LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVEDV)) and 2-year major adverse cardiac events (MACE). Of note, positive reduction was defined as in reduction LVESV and LVEDV by ≥15% and ≥10% respectively and ≥5% absolute increase in LVEF.
Results
The 33 NICM enrolled patients were divided in 3 groups according to the percentage of LV WT<6mm area: ≤20% (low LV WT area); 20–50% (moderate LV WT area) and ≥50% (high LV WT area). At 6 months, 78%, 67% and 25% of the patients experienced NYHA class improvement by ≥1 in the ≤20%, 20–50% and ≥50% group respectively. Furthermore, majority of patients in the ≤20% and 20–50% groups (92% and 75% respectively) had a significant improvement of their global assessment compared to only 38% in the ≥50% group. Additionally, low LV WT area group presented a significant LVEF, LVEDV and LVESV positive response rate (92%, 69% and 85% respectively). Patients included in the moderate and high groups exhibited gradually lower LVEF, LVEDV and LVESV positive response rate (42% and 50%; 67% and 50%; 75% and 50%, respectively). Notably, patients with the least LV WT (i.e ≥50% group) experienced significantly lower 2-years MACE survival free probability than other groups.
Left ventriculat segmentation
Conclusion
LV WT evaluated using CT could help to stratify the response to CRT in NICM patients.
Collapse
Affiliation(s)
- V Galand
- Hospital Pontchaillou of Rennes, service de maladie cardio-vasculaire, Rennes, France
| | - B G Ghoshhajra
- Massachusetts General Hospital, Boston, United States of America
| | - J Szymonifka
- Mount Sinai Medical Center, Department of Public Health, Division of Biostatistics, New York University, New York, New York, New York, United States of America
| | - S Das
- Massachusetts General Hospital, Boston, United States of America
| | - M Orencole
- Massachusetts General Hospital, Boston, United States of America
| | - C Leclercq
- Hospital Pontchaillou of Rennes, service de maladie cardio-vasculaire, Rennes, France
| | - Q A Truong
- Weill Cornell Medical College, Department of Radiology and Cardiology, Weill Cornell Medicine, New York, New York,, New York, United States of America
| | - J P Singh
- Massachusetts General Hospital, Boston, United States of America
| |
Collapse
|
22
|
Galand V, Ghoshhajra B, Szymonifka J, Das S, Orencole M, Leclercq C, Truong QA, Singh JP. P3804Left ventricular wall thickness measured with computed tomography predicts mitral regurgitation improvement in patients implanted with cardiac resynchronization therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0649] [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
Secondary mitral regurgitation (MR) is common in heart failure (HF) patients and results in progressive left ventricular (LV) dilatation, papillary muscle (PM) displacement and mitral valve leaflet tethering. In selected HF patients, cardiac resynchronization therapy (CRT) has been proved to reduce MR by LV reverse remodeling, resynchronization of PM insertion site contraction and reduction in MV tenting area and inter PM distance. However, data regarding the impact of LV wall thickness (WT) on MR improvement are scarce.
Methods
In this prospective study, a total 54 patients scheduled for CRT, underwent pre procedural CT. Reduced LV WT was defined as WT<6mm and was quantified as a percentage of total LV area. LV was segmented in 17 segments to assess the number of LV segments with reduced WT. End point was 6-month echocardiographic MR improvement by ≥1 class. For this analysis, we focused on patient with mild (class 2) to severe (class 4) MR.
Results
Among the 54 patients, 38 (70.4%) had mild to severe MR at baseline and a total of 16 (42.1%) experienced MR improvement by ≥1 class at 6 months. there was no difference regarding the co-morbidities, electrocardiogram and echocardiographic parameters between patients with or without MR improvement. However, patients without MR improvement had significant higher NT-pro BNP level at baseline. Interestingly, patients without MR improvement had larger LVWT <6mm area (41.541.5±19.4 vs. 22.4±16.1%, p=0.003) associated with higher number of papillary muscle (PM) inserted in reduced LV WT area. In multivariate analysis, an area ≥25% of LVWT<6mm including at least 1 PM insertion was the only predictor of no MR improvement at 6 months (HR 18.4 (1.25–271.75), p=0.034). Lastly, patients with MR improvement had significant lower rate of basal segments with reduced WT, especially in the lateral location. Of note, patients with MR improvement exhibited fewer rate of postero-lateral WT <6mm segments.
Left ventriculat segmentation
Conclusion
LV WT evaluated using CT is a strong predictor of no MR improvement in HF patients with mild to severe MR and who scheduled for CRT implantation.
Collapse
Affiliation(s)
- V Galand
- Hospital Pontchaillou of Rennes, service de maladie cardio-vasculaire, Rennes, France
| | - B Ghoshhajra
- Massachusetts General Hospital, Boston, United States of America
| | - J Szymonifka
- Mount Sinai Medical Center, Department of Public Health, Division of Biostatistics, New York University, New York, New York, New York, United States of America
| | - S Das
- Massachusetts General Hospital, Boston, United States of America
| | - M Orencole
- Massachusetts General Hospital, Boston, United States of America
| | - C Leclercq
- Hospital Pontchaillou of Rennes, service de maladie cardio-vasculaire, Rennes, France
| | - Q A Truong
- Weill Cornell Medical College, Department of Radiology and Cardiology, Weill Cornell Medicine, New York, New York,, New York, United States of America
| | - J P Singh
- Massachusetts General Hospital, Boston, United States of America
| |
Collapse
|
23
|
Marijon E, Garcia R, Gras D, Sadoul N, Guedon-Moreau L, Leclercq C, Extramiana F, Lellouche N, Defaye P, Combes N. 2404The use of wearable cardioverter defibrillator in France. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0157] [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
The wearable cardioverter defibrillator (WCD) has been shown to be useful during transient periods of high sudden cardiac death risk, and the issue of compliance recently pointed out. This Registry was designed to provide real-world data on WCD use in France, in terms of compliance, potential adverse events, as well as efficacy.
Methods and results
Multicenter evaluation (WEARIT FRANCE Registry) was conducted in France between January 2017 and March 2018. Overall, 1,157 patients were analyzed: 950 with ischemic heart disease (82%, including 647 patients after myocardial infarction), 119 after ICD explant (10%), and 88 pre-transplant (8%). The median age was 61 years; the median ejection fraction was 25%. Median WCD wear time was 62 days, with median daily use of 23.4 hours. Less than 1% of patients did not wear WCD at least 4 hours per day. During follow-up, a total of 42 sustained ventricular tachyarrhythmias (VT/VF) occurred in 36 patients, of whom 50% (n=18) received appropriate WCD shocks, giving an incidence of appropriate therapy of 1.56%. The rate of all VT/VF episodes were 3.1% among patients with ischemic cardiomyopathy (n=29/950) versus 3.4% for the others (n=7/207). Of the ischemic patients wearing beyond 30 days (N=784), 5 received appropriate therapy of VT/VF episodes. Overall shock survival was 100%. At the end of the WCD period, 586 patients (51%) were implanted with an implantable cardioverter defibrillator. Eight patients (0.69%) received inappropriate WCD shocks. Regarding the apparent very low proportion of women considered for WCD therapy, we aimed to appreciate in which extent
Conclusions
In this multicenter nationwide WCD evaluation, 3.1% of patients presented with sustained VT/VF with 47% of those patients developing VT/VF after 30 days. The incidence of inappropriate therapy was low. The compliance to WCD in this real life evaluation was very high. These data suggest that the WCD, when worn appropriately, may be helpful in the arsenal to protect high-risk patients against SCD, especially in case of transient risk situations.
Acknowledgement/Funding
Zoll
Collapse
Affiliation(s)
- E Marijon
- University Paris-Descartes, Paris, France
| | - R Garcia
- University Hospital of Poitiers, Poitiers, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | - N Sadoul
- Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
| | | | - C Leclercq
- University Hospital of Rennes, Rennes, France
| | | | | | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| | - N Combes
- Clinic Pasteur, Toulouse, France
| |
Collapse
|
24
|
Rouge J, Burtin P, Leclercq C, Berthezene R, Bigeon J, Charpentier C. Perioperative LV strain (AVGGLS) alteration and predictive value for long term occurence of MACE. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Leclercq C, Rouge J, Burtin P, Roussiaux A, Ducrocq N, Halchini C. Left ventricular strain variations in cardiac surgery; The role of the type of surgery. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
26
|
Galli E, Hubert A, Hernandez A, Le Rolle V, Mabo P, Leclercq C, Dona E. Myocardial constructive work is additive to volumetric response to CRT in the prediction of cardiac mortality after CRT implantation. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.100] [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: 10/27/2022]
|
27
|
Galli E, Hubert A, Hernandez A, Le Rolle V, Mabo P, Leclercq C, Donal E. Myocardial constructive work is a predictor of long-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.060] [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]
|
28
|
Sottiaux A, Didi S, Baltieri V, Monseux A, Leclercq C, Vanache D, Tomsej M. 13 Influence of statistical noise and noise reduction filter on gamma analysis for VMAT plan calculated with PRIMO. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.095] [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: 10/27/2022] Open
|
29
|
Sottiaux A, Rodriguez M, Baltieri V, Monseux A, Leclercq C, Vanache D, Tomsej M. 32 Automatization of clinical VMAT plan verification with PRIMO. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.114] [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: 10/27/2022] Open
|
30
|
Aubignat M, Canaple S, Lamy C, Arnoux A, Leclercq C, Godefroy O. Hypersensibilité d’origine génétique aux traitements anti-vitamine K. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.177] [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: 10/27/2022]
|
31
|
Sottiaux A, Baltieri V, Monseux A, Leclercq C, Vanache D, Peiffer F, Debelle J, Tomsej M. 35 Monte Carlo dose calculation of VMAT clinical treatment plans for Novalis TrueBeam STx linac using PRIMO. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.048] [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: 10/27/2022] Open
|
32
|
Sottiaux A, Latorre A, Sempau J, Baltieri V, Leclercq C, Monseux A, Vanache D, Tomsej M. 31 EPID response modeling with Monte Carlo for Novalis TrueBeam STx. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.113] [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: 10/27/2022] Open
|
33
|
Galli E, Hubert A, Le Rolle V, Hernandez A, Smiseth O, Mabo P, Leclercq C, Donal E. P6470Myocardial constructive work is a predictor of long-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6470] [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)
- E Galli
- University Hospital of Rennes, Cardiology, Rennes, France
| | - A Hubert
- University Hospital of Rennes, Cardiology, Rennes, France
| | - V Le Rolle
- University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099, Rennes, France
| | - A Hernandez
- University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099, Rennes, France
| | | | - P Mabo
- University Hospital of Rennes, Cardiology, Rennes, France
| | - C Leclercq
- University Hospital of Rennes, Cardiology, Rennes, France
| | - E Donal
- University Hospital of Rennes, Cardiology, Rennes, France
| |
Collapse
|
34
|
Galli E, Hubert A, Le Rolle V, Hernandez A, Smiseth O, Leclercq C, Donal E. P893Myocardial constructive work is additive to left ventricular dyssynchrony and volumetric response to CRT in the prediction of overall mortality after CRT implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p893] [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)
- E Galli
- University Hospital of Rennes, Cardiology, Rennes, France
| | - A Hubert
- University Hospital of Rennes, Cardiology, Rennes, France
| | - V Le Rolle
- University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099, Rennes, France
| | - A Hernandez
- University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099, Rennes, France
| | | | - C Leclercq
- University Hospital of Rennes, Cardiology, Rennes, France
| | - E Donal
- University Hospital of Rennes, Cardiology, Rennes, France
| |
Collapse
|
35
|
Galli E, Hubert A, Le Rolle V, Hernandez A, Smiseth O, Mabo P, Leclercq C, Donal E. 4915Myocardial constructive work is additive to volumetric response to cardiac resynchronization therapy in the prediction of mortality after CRT implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4915] [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)
- E Galli
- University Hospital of Rennes, Cardiology, Rennes, France
| | - A Hubert
- University Hospital of Rennes, Cardiology, Rennes, France
| | - V Le Rolle
- University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099, Rennes, France
| | - A Hernandez
- INSERM, Laboratoire du traitement du Signal et de l'Image, RENNES, France
| | | | - P Mabo
- University Hospital of Rennes, Cardiology, Rennes, France
| | - C Leclercq
- University Hospital of Rennes, Cardiology, Rennes, France
| | - E Donal
- University Hospital of Rennes, Cardiology, Rennes, France
| |
Collapse
|
36
|
Leclercq C, Lercher P, Lunati M, Rordorf R, Landolina M, Pappone C, Mangual J, Mcspadden L, Badie N, Singh J. P1140Influence of Etiology, QRS duration, and Baseline Systolic Function on Long-term CRT Response Rate with Multipoint Pacing: A Multicenter Experience. Europace 2018. [DOI: 10.1093/europace/euy015.626] [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: 11/13/2022] Open
Affiliation(s)
- C Leclercq
- University Hospital of Rennes, Rennes, France
| | - P Lercher
- Medical University of Graz, Graz, Austria
| | - M Lunati
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - R Rordorf
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | | | - C Pappone
- IRCCS, Policlinico San Donato, San Donato Milanese, Italy
| | - J Mangual
- Abbott, Sylmar, California, United States of America
| | - L Mcspadden
- Abbott, Sylmar, California, United States of America
| | - N Badie
- Abbott, Sylmar, California, United States of America
| | - J Singh
- Harvard Medical School, Boston, United States of America
| |
Collapse
|
37
|
Polin B, Auffret V, Martins R, Pavin D, Daubert JC, Mabo P, Leclercq C, Behar N. P1235A stepwise strategy using TightRailTM Rotating Mechanical Dilator Sheath is safe and effective for transvenous lead extraction. Europace 2018. [DOI: 10.1093/europace/euy015.716] [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: 11/12/2022] Open
Affiliation(s)
- B Polin
- University Hospital of Rennes, Rennes, France
| | - V Auffret
- University Hospital of Rennes, Rennes, France
| | - R Martins
- University Hospital of Rennes, Rennes, France
| | - D Pavin
- University Hospital of Rennes, Rennes, France
| | - J C Daubert
- University Hospital of Rennes, Rennes, France
| | - P Mabo
- University Hospital of Rennes, Rennes, France
| | - C Leclercq
- University Hospital of Rennes, Rennes, France
| | - N Behar
- University Hospital of Rennes, Rennes, France
| |
Collapse
|
38
|
Hubert A, Galli E, Samset E, Leclercq C, Donal E. Percutaneous mitral valve repair in secondary mitral regurgitation improves cardiac work. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.337] [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]
|
39
|
Gras M, Leclercq C. Spasticity and hyperselective neurectomy in the upper limb. Hand Surgery and Rehabilitation 2017; 36:391-401. [DOI: 10.1016/j.hansur.2017.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/15/2017] [Accepted: 06/13/2017] [Indexed: 10/18/2022]
|
40
|
Claridge S, Sebag F, Behar J, Porter B, Jackson T, Sieniewicz B, Gould J, Webb J, Chen Z, O'Neill M, Gill J, Leclercq C, Rinaldi C. 96Cost effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators at the time of generator change. Europace 2017. [DOI: 10.1093/europace/eux283.091] [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: 11/12/2022] Open
|
41
|
Hubert A, Galli E, Samset E, Leclercq C, Donal E. P2404Percutaneous mitral valve repair in secondary mitral regurgitation improves cardiac work. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2404] [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
|
42
|
Vitel E, Galli E, Corbineau H, Bouzille G, Leclercq C, Donal E. P3540Prognostic role of exercise tricuspid annular plane systolic excursion in pauci-symptomatic patients with severe primary mitral regurgitation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3540] [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
|
43
|
Flechon PC, Blangy H, Girerd N, Duva-Pentiah A, Marquie C, Klug D, Leclercq C, Defaye P, Boveda S, Piot O, Sadoul N. 3876Cardioverter-defibrillators in hypertrophic cardiomyopathy: a French multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3876] [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: 11/15/2022] Open
|
44
|
Hubert A, Galli E, Samset E, Leclercq C, Donal E. P2408Impact of mitral regurgitation correction (mitraclip vs surgical repair) on left ventricular myocardial performance according to baseline left ventricular ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2408] [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
|
45
|
Prinzen FW, Engels EB, Rordorf R, Lercher P, Lunati M, Landolina M, Badie N, Qu F, Ryu K, Singh JP, Leclercq C. P449Vectorcardiography illustrates enhanced electrical synchronization by multiPoint pacing. Europace 2017. [DOI: 10.1093/ehjci/eux141.172] [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: 11/13/2022] Open
|
46
|
Ben Abdelouahab F, Ziyad M, Leclercq C, Millet JM, Olier R, Volta JC. Étude physicochimique de phases phosphates de vanadium dopées par le cobalt et le fer. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp/1995921320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
47
|
Bohbot Y, Rusinaru D, Salaun E, Donal E, Casalta A, Galli E, Szymanski C, Leclercq C, Habib G, Tribouilloy C. Determinants of left atrial volume index in patients with aortic stenosis. A multicentre pilot study. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30537-2] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
48
|
von Goetz N, Pirow R, Hart A, Bradley E, Poças F, Arcella D, Lillegard ITL, Simoneau C, van Engelen J, Husoy T, Theobald A, Leclercq C. Including non-dietary sources into an exposure assessment of the European Food Safety Authority: The challenge of multi-sector chemicals such as Bisphenol A. Regul Toxicol Pharmacol 2017; 85:70-78. [PMID: 28185845 DOI: 10.1016/j.yrtph.2017.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/10/2016] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
Abstract
In the most recent risk assessment for Bisphenol A for the first time a multi-route aggregate exposure assessment was conducted by the European Food Safety Authority. This assessment includes exposure via dietary sources, and also contributions of the most important non-dietary sources. Both average and high aggregate exposure were calculated by source-to-dose modeling (forward calculation) for different age groups and compared with estimates based on urinary biomonitoring data (backward calculation). The aggregate exposure estimates obtained by forward and backward modeling are in the same order of magnitude, with forward modeling yielding higher estimates associated with larger uncertainty. Yet, only forward modeling can indicate the relative contribution of different sources. Dietary exposure, especially via canned food, appears to be the most important exposure source and, based on the central aggregate exposure estimates, contributes around 90% to internal exposure to total (conjugated plus unconjugated) BPA. Dermal exposure via thermal paper and to a lesser extent via cosmetic products may contribute around 10% for some age groups. The uncertainty around these estimates is considerable, but since after dermal absorption a first-pass metabolism of BPA by conjugation is lacking, dermal sources may be of equal or even higher toxicological relevance than dietary sources.
Collapse
Affiliation(s)
- N von Goetz
- Swiss Federal Institute of Technology (ETH) Zurich, CH-8093 Zurich, Switzerland.
| | - R Pirow
- Federal Institute for Risk Assessment (BfR), D-10589 Berlin, Germany.
| | - A Hart
- Fera Science Ltd (FERA), York, YO41 1LZ, United Kingdom.
| | - E Bradley
- Fera Science Ltd (FERA), York, YO41 1LZ, United Kingdom.
| | - F Poças
- Faculty of Biotechnology - Universidade Católica Portuguesa, P-Porto, Portugal.
| | - D Arcella
- European Food Safety Authority (EFSA), I-43126 Parma, Italy.
| | - I T L Lillegard
- Norwegian Scientific Committee for Food Safety, N-0403 Oslo, Norway.
| | - C Simoneau
- European Commission Joint Research Centre, I-21020 Ispra, Italy.
| | - J van Engelen
- National Institute for Public Health and the Environment (RIVM), NL-3720 Bilthoven, The Netherlands.
| | - T Husoy
- Norwegian Institute of Public Health, N-0403 Oslo, Norway.
| | - A Theobald
- European Food Safety Authority (EFSA), I-43126 Parma, Italy.
| | - C Leclercq
- Council for Agricultural Research and Analysis of Agricultural Economics Analysis, Center for Research on Food and Nutrition, I-00178 Rome, Italy.
| |
Collapse
|
49
|
Polin B, Behar N, Auffret V, Pavin D, Mabo P, Leclercq C, Daubert J, Martins R. Clinical predictors of challenging atrioventricular node ablation for rate control in patients with atrial fibrillation. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30271-9] [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: 11/16/2022]
|
50
|
El-Dosouky I, Polte CL, Okubo T, Gonzalez Gomez A, Liu B, Generati G, Drakopoulou M, Olmos C, Trifunovic D, Ilhao Moreira R, Ilhao Moreira R, Morgan HP, Bosseau C, Romano G, Argiolas A, Kuperstein R, Koyuncu A, Sahara E, Spinelli L, Yaneva-Sirakova T, Ben Said R, Nowakowska MA, Ruivo C, Neves Pestana G, Wiligorska N, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Mahara K, Yamamoto H, Shitan H, Abe K, Terada M, Saito M, Nagatomo Y, Takanashi S, Del Val D, Monteagudo JM, Fernandez-Golfin C, Hinojar R, Garcia A, Marco A, Casas E, Jimenez-Nacher JJ, Zamorano JL, Baig S, Hayer M, Edwards N, Steeds R, Bandera F, Alfonzetti E, Guazzi M, Toutouzas K, Stathogiannis K, Michelongona A, Latsios G, Synetos A, Lazaros G, Brili S, Tsiamis E, Tousoulis D, Islas F, Ferrera C, Sanchez-Enrique C, Freitas-Ferraz A, Mahia P, Marcos-Alberca P, Tirado G, Perez De Isla L, Vilacosta I, Marinkovic J, Obrenovic- Kircanski B, Ivanovic B, Kalimanovska-Ostric D, Stevanovic G, Petrovic M, Boricic-Kostic M, Petrovic O, Tutos V, Petrovic I, Petrovic J, Draganic G, Stepanovic J, Vujisic-Tesic B, Coutinho Cruz M, Moura Branco L, Galrinho A, Coutinho Miranda L, Almeida Morais L, Modas Daniel P, Rodrigues I, Fragata J, Cruz Ferreira R, Coutinho Cruz M, Moura Branco L, Galrinho A, Timoteo AT, Viveiros Monteiro S, Aguiar Rosa S, Rodrigues I, Fragata J, Cruz Ferreira R, Nana M, Constantin C, Tarando F, Galli E, Rousseau C, Hubert A, Leclercq C, Donal E, Vitale G, Agnese V, Mina' C, Magro S, Falletta C, Di Gesaro G, Bellavia D, Clemenza F, Elena Reffo ER, Ornella Milanesi OM, Klempfner R, Ben-Zekry S, Maor E, Raanani E, Ofek E, Freimark D, Arad M, Oflar E, Ciftci S, Ungan I, Caglar FM, Ocal L, Kilicgedik A, Toprak C, Kahveci G, Atmadikoesoemah C, Kasim M, Pellegrino T, Pisani A, Giudice CA, Riccio E, Imbriaco M, Cuocolo A, Trimarco B, Tarnovska-Kadreva R, Traykov L, Vassilev D, Vladimirova L, Shumkova M, Gruev I, Zairi I, Mzoughi K, Ben Moussa F, Kammoun S, Fennira S, Kraiem S, Chrzanowski L, Frynas-Jonczyk K, Wdowiak-Okrojek K, Wejner-Mik P, Lipiec P, Krakowska M, Potemski P, Plonska-Gosciniak E, Kasprzak JD, Marques N, Domingues K, Lourenco C, Santos R, Gomes C, Abreu L, Reis L, Moz M, Azevedo O, Tavares-Silva M, Sousa C, Pinto R, Ribeiro V, Vasconcelos M, Bernardo-Almeida P, Macedo F, Maciel MJ, Wiligorska D, Talarowska P, Segiet A, Mozenska O, Kosior DA. P1088Match and mismatch between opening area and resistance in mild and moderate rheumatic mitral stenosisP1089When should cardiovascular magnetic resonance imaging be considered in patients with chronic aortic or mitral regurgitation?P1090Echocardiographic characteristics of aortic valve fenestration with aortic regurgitation for aortic valve repairP1091Aortic regurgitation assessment by 3D transesophageal echocardiography vena contracta area: usefulness and comparison with 2D methods.P1092Characterising cardiomyopathy in mitral regurgitation due to barlow disease: role of CMRP1093Compensatory peripheral increase in artero-venous o2 difference to severe functional mitral regurgitation in heart failureP1094Prognostic impact of concomitant atrioventricular valve regurgitation in patients undergoing transcatheter aortic valve implantationP1095Morphological characterization of vegetations by real-time three-dimensional transesophageal echocardiography in infective endocarditis: prognostic impactP1096Relation between causative pathogen and echocardiographic findings in patients with infective endocarditis: is there an association and is it clinically relevant?P1097Aortic and mitral valve infective endocarditis: different clinical and echocardiographic features and peculiar complication ratesP1098Vegetation size relevance and impact on prognosis in patients with infective endocarditisP1099Causes of death on the valvular heart disease surveillance list- a 5 year auditP1100Left ventricular non-compaction and idiopathic dilated cardiomyopathy: the significant diagnostic value of longitudinal strainP1101The role of echocardiography in the management of diuretics withdrawal in patients with chronic heart failure and severely reduced ejection fraction: a prospective cohort studyP1102Outcomes in paediatric new onset left ventricle dysfunction and dilatation: differences between post-myocarditis and DCMP1103De novo mitral regurgitation as a cause of heart failure exacerbation in hypertrophic cardiomyopathyP1104Correlation of conventional and new echocardiograhic parameters with sudden cardiac death risk score in patients with hypertrophic cardiomyopathyP1105Inverse correlation between myocardial fibrosis and left ventricular function in rheumatic mitral stenosis: a preliminary study with cardiac magnetic resonanceP1106Left ventricular diastolic dysfunction and cardiac sympathetic derangement in patients with Anderson-Fabry disease: a 2D speckle tracking echocardiography and cardiac 123I-MIBG studyP1107Left ventricular hypertrophy and mild cognitive impairment as markers for target organ damage in hypertensive patients with multiple risk factorsP1108Subclinical left ventricular dysfunction in asymptomatic type 1 diabetic childrenP1109Minimal differences shown by echocardiography and NT-proBNP level distinguishing cardiotoxic effect related to breast cancer therapy in patients with or without HER2 expression.P1110Speed of recovery of left ventricular function is not related to the prognosis of takotsubo cardiomyopathy - a portuguese multicenter studyP1111Myocardial dysfunction in Takotsubo cardiomyopathy - more than meets the eye?P1112Obstructive sleep apnea and echocardiographic parameters. Eur Heart J Cardiovasc Imaging 2016; 17:ii227-ii234. [DOI: 10.1093/ehjci/jew262.001] [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
|