Clinical significance of myocardial work parameters after acute myocardial infarction

Background

To date, there is little data regarding the clinical significance of myocardial work (MW) parameters after a stable period following acute myocardial infarction (AMI).

Purpose

To investigate the additional prognostic value of MW parameters following AMI.

Methods

Between 2018 and 2020, 244 patients admitted in cardiac intensive care unit of a university hospital for AMI were included. One-month following AMI, a comprehensive transthoracic echocardiography (TTE) was performed to assess parameters of myocardial function. Patients were then followed for major events (ME): cardiovascular death, heart failure and unplanned coronary revascularisation.

Results

At 1 month, half of the population was symptomatic (NYHA≥II), and medical therapy was almost optimized (ACEi/ARB in 95.5%, beta-blockers in 96.3%, DAPT in 94.7% and statins in 97.1%). After a median follow-up of 681 [IQR 538–840] days, ME occurred in 26 patients (10.7%). Patients presenting ME were older (65.5±14.2 vs. 58.1±12.1 years, P=0.005) with higher prevalence of hypertension (65.4 vs. 36.2%, P=0.004), more impaired LV function as assessed by left ventricular ejection fraction (LVEF) (P=0.07), global longitudinal strain (GLS) (P=0.03) or MW parameters (P=0.01 for global work efficiency (GWE)), and greater LV and LA dilations (P=0.06 for LVEDVi and P=0.03 for LAVi). After adjustment, GWE was the only TTE parameter independently associated with long-term occurrence of ME (P=0.02). A GWE value <91% was selected to identify patients at higher ME risk (HR 95% CI) = 2.94 (1.36–6.35), P=0.0041) (Figure 1 & 2).

Conclusion

Lower GWE at 1 month after AMI is independently associated with higher ME rates. A GWE <91% can improve the post-AMI patient risk stratification.

Funding Acknowledgement

Type of funding sources: None.

High on-treatment platelet reactivity with ticagrelor versus prasugrel: a systematic review and meta-analysis

BACKGROUND

Ticagrelor and prasugrel have shown superiority over clopidogrel. However, it remains unclear if one is superior to another regarding on-treatment platelet reactivity.

OBJECTIVES

To compare the impact of ticagrelor and prasugrel on high on-treatment platelet reactivity (HTPR).

METHODS

The PubMed and Cochrane databases were searched for eligible studies in December 2014. Studies were eligible if they compared ticagrelor and prasugrel regarding high on-treatment platelet reactivity (HTPR). Pooled estimates were calculated by using a random-effects model with 95% confidence intervals.

RESULTS

We included 14 studies and 1822 patients: 805 and 1017 in the ticagrelor and prasugrel groups, respectively. The rate of HTPR was significantly lower in the ticagrelor group: 1.5% vs. 9.8% (RR = 0.27 [0.14-0.50]). The pre-specified analysis focusing on randomized trials (n = 10) showed consistent results (RR = 0.27 [0.12-0.60]).

CONCLUSION

Our results suggest that ticagrelor allows a higher platelet reactivity inhibition as compared with prasugrel and leads to a further decrease in the rate of HTPR.

Experiment in planar geometry for shock ignition studies

The capacity to launch a strong shock wave in a compressed target in the presence of large preplasma has been investigated experimentally and numerically in a planar geometry. The experiment was performed on the LULI 2000 laser facility using one laser beam to compress the target and a second to launch the strong shock simulating the intensity spike in the shock ignition scheme. Thanks to a large set of diagnostics, it has been possible to compare accurately experimental results with 2D numerical simulations. A good agreement has been observed even if a more detailed study of the laser-plasma interaction for the spike is necessary in order to confirm that this scheme is a possible alternative for inertial confinement fusion.

Revisiting nonlocal electron-energy transport in inertial-fusion conditions

Correct modeling of the electron-energy transport is essential for inertial confinement fusion target design. Various transport models have been proposed in order to extend the validity of a hydrodynamical description into weakly collisional regimes, taking into account the nonlocality of the electron transport combined with the effects of self-generated magnetic fields. We have carried out new experiments designed to be highly sensitive to the modeling of the heat flow on the Ligne d'Intégration Laser facility, the prototype of the Laser Megajoule. We show that two-dimensional hydrodynamic simulations correctly reproduce the experimental results only if they include both the nonlocal transport and magnetic fields.