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Godinho R, Nowacka A, Aur S, Regamey J, Ltaief Z, Rusca M, Hullin R, Liaudet L, Kirsch M, Yerly P. Safety of Levosimendan Infusion Before LVAD Implantation. A Retrospective Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.812] [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: 04/05/2023] Open
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Godinho R, Nowacka A, Aur S, Regamey J, Ltaief Z, Rusca M, Hullin R, Liaudet L, Kirsch M, Yerly P. Preoperative Levosimendan to Reduce Risk of Right Ventricular Failure after LVAD Surgery. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.848] [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: 04/05/2023] Open
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Mekoa Mbarga JR, Luczak C, Stettler R, Regamey J, Trana C, Gabus V. [Premature ventricular complexes: what to do?]. Rev Med Suisse 2023; 19:455-458. [PMID: 36883705 DOI: 10.53738/revmed.2023.19.817.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Premature ventricular complexes (PVCs) are frequently encountered arrhythmias in the general population. They can occur in the context of an underlying structural heart disease (SHD) of ischemic, hypertensive or inflammatory cause and therefore be a prognostic factor. Some PVCs can appear in the context of inherited arrhythmic syndromes while others are seen as idiopathic in the absence of an underlying heart condition and are considered benign. Those idiopathic PVCs often arise from the ventricular outflow tracts, mostly from the right ventricle outflow tract (RVOT). The PVCs burden even with no underlying SHD can be associated with PVC-induced cardiomyopathy which is a diagnosis of exclusion.
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Affiliation(s)
- Joëlle Régine Mekoa Mbarga
- Service de cardiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | | | | | - Julien Regamey
- Service de cardiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne.,Service de cardiologie, Hôpital Riviera-Chablais, 1847 Rennaz
| | - Catalina Trana
- Service de cardiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne.,Service de cardiologie, Hôpital Riviera-Chablais, 1847 Rennaz
| | - Vincent Gabus
- Service de cardiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne.,Service de cardiologie, Hôpital Riviera-Chablais, 1847 Rennaz
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Bourlond B, Cipriano A, Regamey J, Papadimitriou-Olivgeris M, Kamani C, Seidel D, Lamoth F, Muller O, Yerly P. Case report: Disseminated Scedosporium apiospermum infection with invasive right atrial mass in a heart transplant patient. Front Cardiovasc Med 2022; 9:1045353. [DOI: 10.3389/fcvm.2022.1045353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Scedosporium apiospermum associated endocarditis is extremely rare. We report a case of a disseminated S. apiospermum infection with an invasive right atrial mass in a 52-year-old male, 11 months after heart transplantation, referred to our institution for an endogenous endophthalmitis with a one-month history of diffuse myalgias and fatigue. The patient had been supported two times with extracorporeal membrane oxygenation (ECMO) during the first three postoperative months. The echocardiography on admission revealed a mass in the right atrium attached to a thickened lateral wall. The whole-body [18F]FDG PET/CT revealed systemic dissemination in the lungs, muscles, and subcutaneous tissue. Blood cultures were positive on day three for filamentous fungi later identified as S. apiospermum. The disease was refractory to a 3-week dual antifungal therapy with voriconazole and anidulafungin in addition to reduced immunosuppression, and palliative care was implemented.
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Hullin R, Tzimas G, Barras N, Abdurashidova T, Soborun N, Aur S, Regamey J, Hugelshofer S, Lu H, Crisinel V, Daux A, Vinet E, Mekoa‐Mbarga SJ, Kirsch M, Müller O, Hugli O, Monney P. Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode. ESC Heart Fail 2022; 9:3814-3824. [PMID: 35923106 PMCID: PMC9773654 DOI: 10.1002/ehf2.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The prognostic role of decongestion-related change of cardiac morphology and in particular right heart function has not been investigated comprehensively in AHF patients. METHODS AND RESULTS This prospective observational single-centre study included consecutive patients hospitalized for treatment of AHF with reduced, mildly-reduced or preserved left ventricular ejection fraction (LVEF). Comprehensive transthoracic echocardiography at admission and discharge assessed decongestion-related change of cardiac function and morphology. The combined endpoint of 1 year all-cause mortality and cardiovascular rehospitalization explored the prognostic importance of decongestion-related change. The 176 study participants were 83 years old [74-87] and 54% were men. Fifty one (29%) had rLVEF, 65 (37%) mrLVEF, and 60 (34%) pLVEF. The proportion of de novo or worsening chronic HF was not different between LVEF groups. HF aetiology and cardiovascular risk factors were equally distributed across all groups except for a higher BMI in the pLVEF group. Decongestion equally reduced body weight, heart rate, systolic and diastolic blood pressure, tricuspid regurgitation gradient, and inferior vena cava diameter across all groups (P < 0.004 for all). Decongestion-related increase in TAPSE independent of the LVEF was associated with improvement of right-ventricular-pulmonary artery coupling and a lower incidence of the combined outcome in the Cox proportional hazard risk analysis (unadjusted HR 0.50 95% CI 0.33-0.78, P = 0.002; adjusted HR 0.46 95% CI: 0.33-0.78, P = 0.001). CONCLUSIONS Decongestion-related increase in TAPSE and recovery of RV/pulmonary artery coupling was observed across all LVEF groups and associated with a risk reduction for the combined endpoint highlighting the important prognostic role of right heart recovery after an AHF episode.
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Affiliation(s)
- Roger Hullin
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Georgios Tzimas
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Nicolas Barras
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Tamila Abdurashidova
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Nisha Soborun
- Department of Cardiac Surgery, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Stefania Aur
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Julien Regamey
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Sarah Hugelshofer
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Henri Lu
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Vanessa Crisinel
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Aurelien Daux
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Elise Vinet
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | | | - Matthias Kirsch
- Department of Cardiac Surgery, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Olivier Müller
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Olivier Hugli
- Emergency DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Pierre Monney
- Department of Cardiology, Cardiovascular DepartmentLausanne University Hospital and University of LausanneLausanneSwitzerland
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Anouck Z, Tozzi P, Regamey J, Abdurashidova T, Meyer P, Lefol K, Pascual M, Yerly P, Aubert V, Aur S, Rancati V, Marcucci C, Rusca M, Rotman S, Pretre R, Kirsch M, Hullin R. Has the profile of heart transplantation recipients changed within the last three decades? Swiss Med Wkly 2022; 152:w30108. [PMID: 35072415 DOI: 10.4414/smw.2022.w30108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Heart transplantation remains the most durable treatment for patients with end-stage heart failure refractory to medical treatment. Central elements of the listing criteria for heart transplantation have remained largely unchanged in the last three decades whereas treatment of heart failure has significantly increased survival and reduced disease-related symptoms. It remains unknown whether the improvement of heart failure therapy changed the profile of heart transplantation candidates or affected post-transplant survival. METHODS The study investigated a total of 323 heart transplant recipients of the Lausanne University Hospital with 328 transplant operations between 1987 and 2018. Patients were separated into three groups on the basis of availability of heart failure therapy: period 1 (1987-1998; n = 115) when renin-angiotensin system blockade and diuretic treatment were available; period 2 (1999-2010; n = 106) marked by the addition of beta-blocker and mineralocorticoid receptor antagonist treatment in severe heart failure, and the establishment of cardiac defibrillator and resynchronisation therapy; period 3 (2011-2018; n = 107) characterised by the increasing use of ventricular assist devices for bridge to transplantation. RESULTS The patient characteristics age (all: 53.4 years), male sex (all: 79%) and body mass index (all: 24.5 kg/m2) did not differ between periods. History of arterial hypertension was less prevalent in period 2 (period 1 vs 2 vs 3: 44 vs 28 vs 43%, p = 0.04) whereas other cardiovascular risk factors were equally distributed. Left ventricular ejection fraction, VO2max, and pulmonary vascular resistance were not different between the three periods. The prevalence of ischaemic cardiomyopathy was higher in periods 1 and 3; dilated non-ischaemic cardiomyopathy was more frequent in period 2. Post-transplant 1-year survival was highest in period 3 (1 vs 2 vs 3: 87.2 ± 3.2% vs 70.8 ± 4.4% vs 93.0 ± 2.6%, p always ≤0.02), and the Kaplan-Meier estimates of survivors of the first year post-transplant were not different between the three periods. In descriptive analysis, early mortality was not associated with acknowledged pretransplant predictors of post-transplant mortality. CONCLUSION Availability of different medical heart failure treatments did not result in greatly different pretransplant characteristics of heart transplantation recipients across the three periods. This suggests that the maintained central criteria of listing for heart transplantation still identify end-stage heart failure patients with a similar profile. This finding can explain the unchanged overall mortality on condition of 1-year survival across the three periods, since pretransplant characteristics are relevant for long-term survival after heart transplantation.
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Affiliation(s)
- Zurbuchen Anouck
- Cardiology, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Cardiac surgery, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | - Julien Regamey
- Cardiology, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | - Tamila Abdurashidova
- Cardiology, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | - Philippe Meyer
- Cardiogy, Department of Medical Specialties, University Hospital Geneva, Switzerland
| | | | | | - Patrick Yerly
- Cardiology, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | | | - Stefania Aur
- Cardiology, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | - Valentina Rancati
- Anaesthesiology, Department of Abdominal Surgery and Anesthesiology, University Hospital Lausanne, University of Lausanne, Switzerland
| | - Carlo Marcucci
- Anaesthesiology, Department of Abdominal Surgery and Anesthesiology, University Hospital Lausanne, University of Lausanne, Switzerland
| | - Marco Rusca
- Department of Intensive Care, University Hospital Lausanne, University of Lausanne, Switzerland
| | - Sam Rotman
- Pathology, University Hospital Lausanne, University of Lausanne, Switzerland
| | - Rene Pretre
- Cardiac surgery, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | - Matthias Kirsch
- Cardiac surgery, Cardiovascular Department, University Hospital Lausanne, Switzerland
| | - Roger Hullin
- Cardiology, Cardiovascular Department, University Hospital Lausanne, Switzerland
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Yerly P, Rotman S, Regamey J, Aubert V, Aur S, Kirsch M, Hullin R, Pascual M. Complement blockade with eculizumab to treat acute symptomatic humoral rejection after heart transplantation. Xenotransplantation 2022; 29:e12726. [PMID: 35001433 PMCID: PMC9285545 DOI: 10.1111/xen.12726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
Antibody‐mediated rejection (AMR) is a major barrier preventing successful discordant organ xenotransplantation, but it also occurs in allotransplantation due to anti‐HLA antibodies. Symptomatic acute AMR is rare after heart allograft but carries a high risk of mortality, especially >1 year after transplant. As complement activation may play a major role in mediating tissue injury in acute AMR, drugs blocking the terminal complement cascade like eculizumab may be useful, particularly since “standards of care” like plasmapheresis are not based on strong evidence. Eculizumab was successfully used to treat early acute kidney AMR, a typical condition of “active AMR,” but showed mitigated results in late AMR, where “chronic active” lesions are more prevalent. Here, we report the case of a heart recipient who presented with acute heart failure due to late acute AMR with eight de novo donor‐specific anti‐HLA antibodies (DSA), and who fully recovered allograft function and completely cleared DSA following plasmapheresis‐free upfront eculizumab administration in addition to thymoglobulin, intravenous immunoglobulins (IVIG), and rituximab. Several clinical (acute onset, abrupt and severe loss of graft function), biological (sudden high‐level production of DSA), and pathological features (microvascular injury, C4d deposits) of this cardiac recipient are shared with early kidney AMR and may indicate a strong role of complement in the pathogenesis of acute graft injury that may respond to drugs like eculizumab. Terminal complement blockade should be further explored to treat acute AMR in recipients of heart allografts and possibly also in recipients of discordant xenografts in the future.
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Affiliation(s)
- Patrick Yerly
- Service of Cardiology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Julien Regamey
- Service of Cardiology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Vincent Aubert
- Service of Immunology and Allergology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Stefania Aur
- Service of Cardiology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiac Surgery, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Roger Hullin
- Service of Cardiology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Manuel Pascual
- Center for Organ Transplantation, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
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Regamey J, Monney P, Yerly P, Favre L, Kirsch M, Tozzi P, Lamy O, Hullin R. Body composition and maximal exercise capacity after heart transplantation. ESC Heart Fail 2021; 9:122-132. [PMID: 34854252 PMCID: PMC8788057 DOI: 10.1002/ehf2.13642] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Maximal exercise capacity as measured by peak oxygen consumption (pVO2) in cardiopulmonary exercise testing (CPET) of heart transplant recipients (HTR) is limited to a 50–70% level of healthy age‐matched controls. This study investigated the relationship between body composition and pVO2 during the first decade post‐transplant. Methods and results Body composition was determined by dual‐energy X‐ray absorptiometry (DXA) and pVO2 by CPET in 48 HTR (n = 38 males; mean age 51 ± 12 years). A total of 95 assessments were acquired 1–9 years post‐transplant, and the results of four consecutive periods were compared [Period 1: 1–2 years (n = 25); 2: 3–4 years (n = 23); 3: 5–6 years (n = 23); 4: 7–9 years (n = 24)]. Linear regression analysis analysed the correlation between pVO2 and pairs of appendicular lean mass (ALM) and fat mass (FM). The relation between ALM and daily dose of calcineurin inhibitor (CNI) was explored using partial correlation controlling for age, gender, and height. pVO2 increased from 0.98 (0.34) to 1.35 (0.35) L/min (P < 0.01) between Periods 1 and 4 corresponding to 54.5–63.3% of predicted value. Peak heart rate (HR) raised from 115 ± 19 to 131 ± 23 b.p.m. (P = 0.05), and anaerobic threshold (AT = VO2 achieved at AT) increased from 0.57 (0.18) to 0.83 (0.35) L/min (P < 0.01) between Periods 1 and 3. Median FM normalized to height2 (FMI) always remained elevated (>8.8 kg/m2). ALM normalized to body mass index increased from 0.690 (0.188) to 0.848 (0.204) m2 (P = 0.02) between Periods 1 and 4, explaining 45% of the variance of pVO2 (R2 = 0.455; P < 0.001). Eighty‐one per cent of the variance of pVO2 (R2 = 0.817; P < 0.001) in multiple regression was explained by AT (β = 0.488), ALM (β = 0.396), peak HR (β = 0.366), and FMI (β = −0.181). ALM was negatively correlated with daily CNI dose (partial R = −0.258; P = 0.01). Conclusions After heart transplantation, the beneficial effect of peripheral skeletal muscle gain on pVO2 is opposed by increased FM. Our findings support lifestyle efforts to fight adiposity and CNI dose reduction in the chronic stable phase to favour positive adaptation of peripheral muscle mass.
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Affiliation(s)
- Julien Regamey
- Service de Cardiologie, Département Coeur-Vaisseaux, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Pierre Monney
- Service de Cardiologie, Département Coeur-Vaisseaux, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Patrick Yerly
- Service de Cardiologie, Département Coeur-Vaisseaux, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lucie Favre
- Service d'Endocrinologie, Diabétologie et Métabolisme, Département de Médecine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Matthias Kirsch
- Service de Chirurgie Cardiaque, Département Cœur-Vaisseaux, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Service de Chirurgie Cardiaque, Département Cœur-Vaisseaux, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Olivier Lamy
- Centre des Maladies osseuses, Département de l'Appareil Locomoteur, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Roger Hullin
- Service de Cardiologie, Département Coeur-Vaisseaux, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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Hullin R, Regamey J, Yerly P, Aur S, Abdurashidova T, Rancati V, Tozzi P, Kirsch M. Advanced heart failure: when and what to consider for left ventricular assist device implantation? Cardiovasc Med 2021. [DOI: 10.4414/cvm.2021.02169] [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: 12/03/2022] Open
Affiliation(s)
| | - Julien Regamey
- Cardiologie, Département Coeur-Vaisseaux; Centre Hospitalier Universitaire Vaudois; Université de Lausanne
| | - Patrick Yerly
- Cardiologie, Département Coeur-Vaisseaux; Centre Hospitalier Universitaire Vaudois; Université de Lausanne
| | - Stefania Aur
- Cardiologie, Département Coeur-Vaisseaux; Centre Hospitalier Universitaire Vaudois; Université de Lausanne
| | - Tamila Abdurashidova
- Cardiologie, Département Coeur-Vaisseaux; Centre Hospitalier Universitaire Vaudois; Université de Lausanne
| | - Valentina Rancati
- Département Anesthésiologie; Centre Hospitalier Universitaire Vaudois; Université de Lausanne
| | - Piergiorgio Tozzi
- Chirurgie Cardiaque, Département Coeur-Vaisseaux; Centre Hospitalier Universitaire Vaudois; Université de Lausanne
| | - Matthias Kirsch
- Chirurgie Cardiaque, Département Coeur-Vaisseaux; Centre Hospitalier Universitaire Vaudois; Université de Lausanne
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Nowacka A, Hullin R, Tozzi P, Barras N, Regamey J, Yerly P, Rosner L, Marcucci C, Rusca M, Liaudet L, Kirsch M. Short-term single-centre experience with the HeartMate 3 left ventricular assist device for advanced heart failure. Eur J Cardiothorac Surg 2021; 58:511-518. [PMID: 32236472 DOI: 10.1093/ejcts/ezaa075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/24/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objective of this study was to analyse clinical characteristics, survival and adverse events of patients with advanced heart failure supported using the Abbott HeartMate 3 left ventricular assist device (LVAD). METHODS We retrospectively reviewed 42 consecutive HeartMate 3 recipients implanted in our centre between 1 November 2015 and 31 October 2019. RESULTS Our series comprised 39 males, aged 56.7 ± 11.8 years. Eleven (26%) patients had preimplant INTERMACS clinical profiles of 1 or 2. The mean duration support was 14.0 ± 10.6 months (range 0.69-44 months). During follow-up, 4 (10%) patients died while on support, 13 (35%) patients received a heart transplant and 25 patients are still ongoing. Actuarial survival after LVAD implantation was 88.4 ± 5.5% and 84.4 ± 6.6% at 1 and 2 years, respectively. There were no cases of pump thrombosis or technical malfunction. Seven (17%) patients required post-implant temporary right ventricular support. Adverse events included bleeding requiring surgery in 13 (31%) patients, gastrointestinal bleeding in 6 (14%) patients, LVAD-specific infections in 19 (45%) patients and non-disabling ischaemic stroke in 5 (12%) patients. The incidence of ischaemic stroke was significantly higher in patients where the outflow graft was anastomosed to the descending aorta as compared to those where it was anastomosed to the ascending aorta (P < 0.003). CONCLUSIONS We have observed satisfactory survival rates using the HeartMate 3 LVAD for long-term mechanical circulatory support. The absence of technical failure, pump thrombosis, haemolysis or need for pump exchange during our 4-year experience confirms its technical reliability and improved haemocompatibility, but bleeding complications and infections remain a concern.
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Affiliation(s)
- Anna Nowacka
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
| | - Roger Hullin
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
| | - Nicolas Barras
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Julien Regamey
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Patrick Yerly
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Lorenzo Rosner
- Department of Anaesthesiology, University Hospital, Lausanne, Switzerland
| | - Carlos Marcucci
- Department of Anaesthesiology, University Hospital, Lausanne, Switzerland
| | - Marco Rusca
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Lucas Liaudet
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
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Othenin-Girard A, Regamey J, Lamoth F, Horisberger A, Glampedakis E, Epiney JB, Kuntzer T, de Leval L, Carballares M, Hurni CA, Rusca M, Pantet O, Di Bernardo S, Oddo M, Comte D, Piquilloud L. Multisystem inflammatory syndrome with refractory cardiogenic shock due to acute myocarditis and mononeuritis multiplex after SARS-CoV-2 infection in an adult. Swiss Med Wkly 2020; 150:w20387. [PMID: 33181855 DOI: 10.4414/smw.2020.20387] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 22-year-old male with a typical history of pauci-symptomatic COVID-19 3 weeks earlier, confirmed by positive serology for SARS-CoV-2 (IgG), was admitted to the intensive care unit because of severe myocarditis with refractory cardiogenic shock that required extracorporeal life support. Due to a clinical presentation suggestive of Kawasaki-like disease with coronary aneurysm and severe systemic inflammation, intravenous immunoglobulins were administered in combination with tocilizumab. The initial clinical course was favourable with these treatments. However, the patient subsequently developed a severe mononeuritis multiplex leading to bilateral foot drop, which required intensive immunosuppressive therapy (corticosteroids, cyclophosphamide and rituximab). The clinical presentation meets the criteria for multisystem inflammatory syndrome associated with SARS-CoV-2, but includes very severe organ damages. Early recognition, a multidisciplinary approach and aggressive therapeutic intervention can lead to a favourable outcome.
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Affiliation(s)
- Alexandra Othenin-Girard
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / Anaesthesiology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Julien Regamey
- Cardiology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland / Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Alice Horisberger
- Immunology and Allergy Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jean-Benoit Epiney
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Thierry Kuntzer
- University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurence de Leval
- University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Maude Carballares
- Emergency Medicine Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Claire-Anne Hurni
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Rusca
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Pantet
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Stefano Di Bernardo
- University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Paediatric Cardiology Service, Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Mauro Oddo
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Denis Comte
- University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Immunology and Allergy Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Lise Piquilloud
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
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12
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Abdurashidova T, Monney P, Tzimas G, Soborun N, Regamey J, Daux A, Barras N, Kirsch M, Müller M, Hullin R. Non-severe aortic regurgitation increases short-term mortality in acute heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:3901-3909. [PMID: 33026164 PMCID: PMC7754983 DOI: 10.1002/ehf2.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/15/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
Aims Mild or moderate aortic regurgitation (AR) has only little effect on cardiovascular outcome in people with normal left ventricular ejection fraction (EF); therefore, it is not perceived as a major clinical problem. This study investigates whether mild or moderate AR is associated with increased short‐term mortality in patients hospitalized for treatment of acute heart failure (AHF) and whether mild or moderate AR impacts differently on short‐term mortality in AHF patients with reduced EF (AHFrEF), mid‐range EF (AHFmrEF), or preserved EF (AHFpEF). Methods and results This mono‐centric study included 505 consecutive adult patients hospitalized for de novo or worsening chronic HF not related to acute ischaemia or severe valvular pathology in the echocardiogram at index hospitalization. Cox regression analysis studied the impact of AR on all‐cause mortality (ACM) over the 150 days' study period. Mild or moderate AR was associated with increased ACM (HR 1.75 [95% CI: 1.1–2.7]; P = 0.009). The prevalence of mild or moderate AR in the study population was 42% and not significantly different between AHFpEF (n = 227), AHFmrEF (n = 86), and AHFrEF (n = 192) study participants (37.9% vs. 50.0% vs. 42.7%; P = 0.144). In AHFpEF patients, the age‐adjusted hazard for ACM was increased in patients with AR compared with patients without AR (HR 2.17 [95% CI: 1.1–4.2]; P = 0.002). The age‐adjusted hazard for ACM was increased by a trend in AHFmrEF with AR (HR 7.11, [95% CI: 0.9–57.8]; P = 0.067) and not different between the AHFrEF groups (HR 0.95 [95% CI: 0.5–1.8]; P = 0.875). Conclusions Mild or moderate AR increased ACM only in AHFpEF patients, highlighting a distinct clinical relevance.
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Affiliation(s)
- Tamila Abdurashidova
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Pierre Monney
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Georgios Tzimas
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Nisha Soborun
- Cardiac Surgery, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Julien Regamey
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Aurelien Daux
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Nicolas Barras
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Matthias Kirsch
- Cardiac Surgery, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Roger Hullin
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
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13
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Pitta Gros B, Regamey J, Rotman S, Monney P. Isolated Endomyocardial Fibrosis of the Right Ventricle. Can J Cardiol 2020; 36:1554.e13-1554.e14. [PMID: 32416319 DOI: 10.1016/j.cjca.2020.04.045] [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] [Received: 03/10/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Barbara Pitta Gros
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Julien Regamey
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland
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14
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Regamey J, Barras N, Rusca M, Hullin R. A role for the Reitan catheter pump for percutaneous cardiac circulatory support of patients presenting acute congestive heart failure with low output and renal dysfunction? Future Cardiol 2020; 16:159-164. [DOI: 10.2217/fca-2019-0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Outcomes in acute decompensated heart failure remain poor, in particular when patients present with impaired renal function. Recent results indicate that treatment of acute decompensated heart failure patients with the Reitan catheter pump not only increases cardiac index, but also improves renal function resulting in maintained increase of diuresis. These favorable effects were achieved without significant hemolysis, bleeding or vascular complications suggesting that Reitan catheter pump treatment has the potential to facilitate recovery from acute decompensated heart failure with low output and complicated by renal dysfunction.
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Affiliation(s)
- Julien Regamey
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nicolas Barras
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Marco Rusca
- Department of Intensive Care, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Roger Hullin
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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15
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Lindup M, van den Bogaart L, Golshayan D, Aubert JD, Vionnet J, Regamey J, Pascual M, Manuel O, Mombelli M. Real-life food-safety behavior and incidence of foodborne infections in solid organ transplant recipients. Am J Transplant 2020; 20:1424-1430. [PMID: 31765061 DOI: 10.1111/ajt.15725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/21/2019] [Revised: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 01/25/2023]
Abstract
Food-safety measures are recommended in solid organ transplant (SOT) recipients. However, the actual adherence of patients in a real-life setting and the impact on the incidence of foodborne infections remain largely unexplored. We performed a survey among SOT recipients followed at our institution, aiming to evaluate their food-safety behavior. We assessed the incidence of microbiologically proven foodborne infections by chart review. One hundred ninety-seven SOT recipients (kidney = 117, lung = 35, liver = 29, and heart = 16) participated in the survey. Overall, 17.7% of the participants observed all food-safety recommendations (22.0% avoided food at risk of contamination while 67.9% applied hygiene recommendations). Patients within the first year after transplantation (odds ratio [OR] 5.42; P = .001) and females (OR 4.67; P = .001) followed food-safety recommendations more closely. Although the majority of SOT recipients felt concerned and actively sought information on food safety (68%-70%), only 27% were able to recognize all risks of foodborne infection in hypothetical scenarios. Incidence of proven foodborne infections was 17.9% (95% confidence interval 9.9%-30.9%) 5 years after transplantation. Importantly, foodborne infections occurred exclusively among patients not following food-safety recommendations. In summary, most SOT recipients eat foods that make them at risk of foodborne infections. Our results indicate that there is room for improvement in patient education, particularly later after transplantation, and reinforce current food-safety recommendations.
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Affiliation(s)
- Matti Lindup
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lorena van den Bogaart
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Déla Golshayan
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John-David Aubert
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Vionnet
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Gastroenterology and Hepatology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Regamey
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manuel Pascual
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matteo Mombelli
- Transplantation Center, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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16
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Meier D, Fournier S, Barras N, Regamey J, Rosset S, Pavon AG, Kamani CH, Deliniere A, Domenichini G, Graf D, Hullin R, Pascale P, Girod G, Eeckhout É, Schwitter J, Prior JO, Pruvot É, Bouchardy J, Monney P, Muller O, Rutz T. [Cardiology]. Rev Med Suisse 2020; 16:16-22. [PMID: 31961076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2019, the guidelines on the new entity « chronic coronary syndrome » have been published. They influence importantly the work-up and treatment of patients with stable coronary artery disease. We will also report on publications showing the benefit of percutaneous aortic valve implantation (TAVI) in patients with aortic stenosis and low risk surgical risk. With regard to infectious endocarditis, we elucidate the importance of the vegetation's size for predicting mortality and the prognostic value of the positron emission tomography in predicting septic embolism. We highlight the spectacular results of the DAPA-HF study in patients with heart failure and review publications showing the important role of the detection of myocardial fibrosis and scar by cardiac MRI for risk stratification of sudden cardiac death.
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Affiliation(s)
- David Meier
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Stéphane Fournier
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Nicolas Barras
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Julien Regamey
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Sabina Rosset
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Anna-Giulia Pavon
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Christel H Kamani
- Service de médecine nucléaire et d'imagerie moléculaire, Département de radiologie médicale, CHUV et Université de Lausanne, 1011 Lausanne
| | - Antoine Deliniere
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Giulia Domenichini
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Denis Graf
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Roger Hullin
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Patrizio Pascale
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Grégoire Girod
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Éric Eeckhout
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Juerg Schwitter
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
- Centre de résonance magnétique cardiaque, CHUV, 1011 Lausanne
| | - John O Prior
- Service de médecine nucléaire et d'imagerie moléculaire, Département de radiologie médicale, CHUV et Université de Lausanne, 1011 Lausanne
| | - Étienne Pruvot
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Judith Bouchardy
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Pierre Monney
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Olivier Muller
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
| | - Tobias Rutz
- Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne
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17
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Pagnoni M, Regamey J, Adjedj J, Rogati G, Muller O, Tozzi P. Case report - coronary vasospasm in transplanted heart: a puzzling phenomenon. BMC Cardiovasc Disord 2019; 19:305. [PMID: 31856732 PMCID: PMC6924038 DOI: 10.1186/s12872-019-01280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Coronary artery spasm (CAS) is an underdiagnosed disease especially in heart transplant patients, and in those patients the etiology and pathophysiology remain largely unknown, although it has been associated with cardiac allograft vasculopathy or graft rejection. Case presentation We report the case of a heart-transplant patient whose cardiac graft experienced two coronary vasospasms: the first before transplantation, and the other at one-month of a postoperative course complicated by primary graft failure. Conclusion Our case illustrates that a transplanted heart predisposed with coronary vasospasm may suffer from early relapse in the recipient despite of complete post-surgical autonomic denervation. Exacerbated endothelial dysfunction of the donor heart after transplant, with the addition of systemic factors in the recipient may be involved in the genesis of this puzzling phenomenon.
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18
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van Heeswijk RB, Bastiaansen JAM, Iglesias JF, Degrauwe S, Rotman S, Barras JL, Regamey J, Lauriers N, Tozzi P, Yerly J, Ginami G, Stuber M, Hullin R. Quantification of myocardial interstitial fibrosis and extracellular volume for the detection of cardiac allograft vasculopathy. Int J Cardiovasc Imaging 2019; 36:533-542. [DOI: 10.1007/s10554-019-01733-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/09/2019] [Indexed: 01/06/2023]
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19
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Monney P, Barras N, Tzimas G, Abdurashidova T, Regamey J, Yerly P, Hugli O, Hullin R. P788Discharge echocardiographic parameters of RV and LV function but not of changes in cardiac unloading are related to 12-month prognosis during hospitalization for acute decompensated heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Introduction
Acute decompensated heart failure (ADHF) is associated with a high mortality and rehospitalization rate. The aim of this study was to assess whether echocardiographic markers of systolic and diastolic function, and their changes under treatment during hospitalization for ADHF, would predict 12-months mortality.
Methods
Adult patients admitted to our emergency department for ADHF between June 2015 and January 2018 were included if a complete transthoracic echocardiography (TTE) could be obtained within 12 hours of admission. TTE was repeated upon discharge. Baseline clinical and echocardiographic characteristics were collected on admission and at discharge, and outcome at 12 months was obtained by telephone interview. All parameters are given as median [interquartile range].
Results
A total of 221 patients were identified but 45 excluded because of in-hospital death (n=8), early transfer to another hospital (n=31) or refusal to perform discharge TTE (n=6), leaving 176 patients for final analysis. Age was 83 [74–87] years, 95 (54%) were men and 89 (51%) were in sinus rhythm. Baseline TTE was performed within 6.6h [4.1–11.9] of admission and median duration of hospital stay was 13 days [9–19]. Admission ejection fraction (EF) was 45% [37–54] (29% HFrEF, 37% HFmrEF, 34% HFpEF). Between admission and discharge, significant changes were observed for global longitudinal LV strain (−10.3 [−7.2 to 15.1] to −11.8% [−8.1 to 15.0], p=0.017), mitral E velocity (100 [80–124] to 96 cm/s [74–117], p=0.001), E/e' ratio (16 [12–20] to 15 [11–19], p=0.003, RV basal diameter (41 [36–45] to 41mm [34–44], p=0.007), tricuspid regurgitation gradient (41 [34–52] to 35 mmHg [28–44], p=0.0001 and vena cava diameter (22 [19–26] to 19 mm [15–23],. Deaths occurred in 35 (20%) at 12 months follow-up. In our multivariable model, none of the changes in TTE parameters was predictive of mortality. Age (OR 1.09, p0.01), LVEF (OR 0.95, p0.02) and TAPSE (OR 0.86, p0.01) measured at discharge, but not LV or RV strain, were identified as independent predictors of 12-months mortality (see figure).
Survival according to LVEF and TAPSE
Conclusion
Several changes in TTE parameters were observed during hospitalization for ADHF, reflecting effective cardiac unloading with diuretic treatment. However, none of these changes appears to have prognostic significance. LVEF and TAPSE at discharge were identified as the only independent echocardiographic predictors of 12-months mortality, in addition to age.
Acknowledgement/Funding
Swiss Heart Foundation
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Affiliation(s)
- P Monney
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - N Barras
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - G Tzimas
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - T Abdurashidova
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - J Regamey
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Yerly
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - O Hugli
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - R Hullin
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
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20
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Regamey J, Adjedj J, Rotman S, Hullin R. Intimal lesions detected by optical coherence tomography herald intraluminal progression of cardiac allograft vasculopathy associated with humoral rejection. Eur Heart J 2019; 40:1739. [PMID: 30753431 DOI: 10.1093/eurheartj/ehz050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julien Regamey
- Service de cardiologie, Département cœur-vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Rue du Bugnon 46, Lausanne, Switzerland
| | - Julien Adjedj
- Service de cardiologie, Département cœur-vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Rue du Bugnon 46, Lausanne, Switzerland
| | - Sam Rotman
- Service de pathologie clinique, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Rue du Bugnon 25, CH-1011 Lausanne, Switzerland
| | - Roger Hullin
- Service de cardiologie, Département cœur-vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Rue du Bugnon 46, Lausanne, Switzerland
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21
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Hullin R, Métrich M, Sarre A, Basquin D, Maillard M, Regamey J, Martin D. Diverging effects of enalapril or eplerenone in primary prevention against doxorubicin-induced cardiotoxicity. Cardiovasc Res 2019; 114:272-281. [PMID: 29016737 DOI: 10.1093/cvr/cvx162] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/10/2017] [Indexed: 12/12/2022] Open
Abstract
Aims Clinical studies suggest beneficial effects of renin-angiotensin system blockade for prevention of left ventricular (LV) dysfunction after chemotherapy. However, the efficacy of this strategy as primary prevention has been poorly studied. This study aimed at identifying the pathophysiological mechanisms by which mineralocorticoid receptor antagonism (MRA) or angiotensin converting enzyme inhibition (ACEi) provide protection against doxorubicin-induced cardiotoxicity (DIC) in mouse models of acute and chronic toxicity. Methods and results Acute DIC was induced by a single injection of Dox at 15 mg/kg and chronic DIC applied 5 injections of Dox at 4 mg/kg/week. MRA was achieved using eplerenone or cardiomyocyte-specific ablation of the MR gene in transgenic mice and ACEi using enalapril. Drugs were provided with the first dose of Dox and applied until the end of the study. In both model of DIC, Dox induced cardiac atrophy with decreased LV volume, reduced cardiomyocyte cell size, and cardiac dysfunction. In the acute model, neither MRA nor ACEi protected against these manifestations of DIC. In the chronic model, concomitant treatment with eplerenone did not protect against DIC and drastically increased plasma aldosterone levels and cardiac levels of angiotensin II type 1 receptor and of connective tissue growth factor (CTGF), as observed in acute DIC. Enalapril treatment in the chronic model, however, protected against cardiac dysfunction and cardiomyocyte atrophy and was associated with increased activation of the PI3K/AKT/mTOR pathway along with normal levels of CTGF. Conclusion Enalapril and eplerenone disparately impact on cellular signalling in DIC. Eplerenone, on top of Dox treatment was not protective and associated with increased levels of plasma aldosterone and of cardiac CTGF. In contrast, we show that primary prevention with enalapril preserves LV morphology and function in a clinically relevant model of chronic DIC, with increased stimulation of the PI3K/AKT/mTOR axis and normal CTGF levels suggesting potential therapeutic implications.
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Affiliation(s)
- Roger Hullin
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital (CHUV) Lausanne, Switzerland
| | - Mélanie Métrich
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital (CHUV) Lausanne, Switzerland
| | - Alexandre Sarre
- Cardiovascular Assessment Facility, University of Lausanne, Lausanne, Switzerland
| | - Denis Basquin
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital (CHUV) Lausanne, Switzerland
| | - Marc Maillard
- Service of Nephrology, Medicine Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julien Regamey
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital (CHUV) Lausanne, Switzerland
| | - David Martin
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital (CHUV) Lausanne, Switzerland
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22
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Aittigrine S, Tozzi P, Hullin R, Yerly P, Regamey J, Rösner L, Rusca M, Kirsch M, Suter M, Mantziari S. Laparoscopic sleeve gastrectomy for class III obesity in a patient with a left ventricular assist device (LVAD) Heartmate III. Surg Obes Relat Dis 2019; 15:1420-1421. [PMID: 31253506 DOI: 10.1016/j.soard.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Souhila Aittigrine
- Department of Cardiovascular Surgery , Lausanne University Hospital CHUV, Switzerland.
| | - Piergiogio Tozzi
- Department of Cardiovascular Surgery , Lausanne University Hospital CHUV, Switzerland; Faculty of Biology and Medicine, Lausanne University, UNIL, Switzerland
| | - Roger Hullin
- Faculty of Biology and Medicine, Lausanne University, UNIL, Switzerland; Department of Cardiology, Lausanne University Hospital CHUV, Switzerland
| | - Patrick Yerly
- Department of Cardiology, Lausanne University Hospital CHUV, Switzerland
| | - Julien Regamey
- Department of Cardiology, Lausanne University Hospital CHUV, Switzerland
| | - Lorenzo Rösner
- Department of Anesthesiology, Lausanne University Hospital CHUV, Switzerland
| | - Marco Rusca
- Adult Intensive Care Unit, Lausanne University Hospital CHUV, Switzerland
| | - Mathias Kirsch
- Department of Cardiovascular Surgery , Lausanne University Hospital CHUV, Switzerland; Faculty of Biology and Medicine, Lausanne University, UNIL, Switzerland
| | - Michel Suter
- Faculty of Biology and Medicine, Lausanne University, UNIL, Switzerland; Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
| | - Styliani Mantziari
- Faculty of Biology and Medicine, Lausanne University, UNIL, Switzerland; Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
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Hullin R, Barras N, Abdurashidova T, Monney P, Regamey J. Red cell distribution width and prognosis in acute heart failure: ready for prime time! Intern Emerg Med 2019; 14:195-197. [PMID: 30547345 DOI: 10.1007/s11739-018-1995-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Roger Hullin
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, BU44_07_2208, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
| | - Nicolas Barras
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, BU44_07_2208, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Tamila Abdurashidova
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, BU44_07_2208, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Pierre Monney
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, BU44_07_2208, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Julien Regamey
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, BU44_07_2208, Rue du Bugnon 44, 1011, Lausanne, Switzerland
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Antiochos P, Barras N, Regamey J, Bisch L, Le Bloa M, Hullin R, Monney P, Schwitter J, Pascale P, Pruvot É, Eeckhout É, Muller O, Fournier S. [The year in cardiology : 2018]. Rev Med Suisse 2019; 15:27-30. [PMID: 30629363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This review article provides a broad overview of the novelties in cardiology in 2018. Advances in interventional cardiology and cardiovascular prevention, heart failure, electrophysiology and non-invasive cardiovascular imaging have provided important new insights in the pathophysiology, diagnosis and treatment of ischemic and valvular heart disease, heart failure, rhythm disorders and cardiomyopathies. This article provides an overview of the most relevant articles published in 2018.
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25
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Regamey J, Kirsch M, Tozzi P, Barras N, Marcucci C, Liaudet L, Hullin R, Yerly P. [Therapeutic options in advanced heart failure : place of durable left ventricular assist device (LVAD)]. Rev Med Suisse 2018; 14:1070-1077. [PMID: 29797852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite the benefit of the drugs acting on neuro-humoral activation and cardiac resynchronization therapy, some patients will end in a severe refractory form of heart failure: advanced heart failure. The only therapeutic options with a positive impact on mortality and quality of life are heart transplantation and permanent left ventricular assist device (LVAD). The significant technological improvements of the past 20 years lead to a reduction of the complications associated with these devices, which now allow their use not only during the waiting period preceding heart transplantation (bridge to transplant), but also as a durable therapeutic option (destination therapy).
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Affiliation(s)
| | | | | | | | | | - Lucas Liaudet
- Service de médecine intensive adulte, CHUV, 1011 Lausanne
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26
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Yerly P, Adjedj J, Fournier S, Hullin R, Kirsch M, Masci PG, Monney P, Müller O, Regamey J, Schwitter J, Vogt P. [Cardiology update 2017]. Rev Med Suisse 2018; 14:705-711. [PMID: 29589658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As usual, numerous papers published in 2017 contributed to optimize the management of patients in all clinical cardiologic fields. It is of course impossible to summarize them all in such an article. Subjects and papers were thus selected if they were thought to be particularly important for non-cardiologist physicians, especially general practitioners. The authors would also like to take the opportunity of this article to honor the memory of Pr Daniel Wagner who unfortunately passed away after less than six months at the head of our Cardiology Department. He was well recognized for his generosity as well as his clinical and scientific competence. This article is dedicated to him.
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d'Ersu E, Ribi C, Monney P, Vincenti G, Schwitter J, Rotman S, Hullin R, Regamey J. Churg-Strauss syndrome with cardiac involvement: case illustration and contribution of CMR in the diagnosis and clinical follow-up. Int J Cardiol 2018; 258:321-324. [PMID: 29459042 DOI: 10.1016/j.ijcard.2018.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/21/2017] [Accepted: 02/02/2018] [Indexed: 01/07/2023]
Abstract
This report summarises three cases of Churg-Strauss syndrome (CSS) illustrating the diagnostic challenges associated with the cardiac manifestation of this disease. Here, we illustrate the role of cardiac magnetic resonance (CMR) for diagnosis and follow-up of CSS with a focus on new non-contrast T2-weighted imaging sequences for quantification of myocardial scar tissue and quantitative T2 mapping techniques, which allow the detection of myocardial edema.
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Affiliation(s)
- E d'Ersu
- Service de cardiologie, Centre Hospitalier Universitaire Vaudois, Switzerland. Eleanor.d'
| | - C Ribi
- Service d'immunologie et allergie, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - P Monney
- Service de cardiologie, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - G Vincenti
- Service de cardiologie, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - J Schwitter
- Service de cardiologie, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - S Rotman
- Service de pathologie clinique, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - R Hullin
- Service de cardiologie, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - J Regamey
- Service de cardiologie, Centre Hospitalier Universitaire Vaudois, Switzerland
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Schmidhauser M, Regamey J, Pilon N, Pascual M, Rotman S, Banfi C, Prêtre R, Meyer P, Antonietti JP, Hullin R. The impact of multidisciplinary care on early morbidity and mortality after heart transplantation. Interact Cardiovasc Thorac Surg 2017; 25:384-390. [DOI: 10.1093/icvts/ivx151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
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Gabus V, Tran VN, Regamey J, Pascale P, Monney P, Hullin R, Vogt P. [Cardiology update in 2016]. Rev Med Suisse 2017; 13:27-32. [PMID: 28703531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In 2016 the European Society of Cardiology (ESC) published new guidelines. These documents update the knowledge in various fields such as atrial fibrillation, heart failure, cardiovascular prevention and dyslipidemia. Of course it is impossible to summarize these guidelines in detail. Nevertheless, we decided to highlight the major modifications, and to emphasize some key points that are especially useful for the primary care physician.
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Métrich M, Mehmeti F, Feliciano H, Martin D, Regamey J, Tozzi P, Meyer P, Hullin R. Adrenergic Receptor Polymorphism and Maximal Exercise Capacity after Orthotopic Heart Transplantation. PLoS One 2016; 11:e0163475. [PMID: 27669015 PMCID: PMC5036840 DOI: 10.1371/journal.pone.0163475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Maximal exercise capacity after heart transplantion (HTx) is reduced to the 50–70% level of healthy controls when assessed by cardiopulmonary exercise testing (CPET) despite of normal left ventricular function of the donor heart. This study investigates the role of donor heart β1 and β2- adrenergic receptor (AR) polymorphisms for maximal exercise capacity after orthotopic HTx. Methods CPET measured peak VO2 as outcome parameter for maximal exercise in HTx recipients ≥9 months and ≤4 years post-transplant (n = 41; mean peak VO2: 57±15% of predicted value). Donor hearts were genotyped for polymorphisms of the β1-AR (Ser49Gly, Arg389Gly) and the β2-AR (Arg16Gly, Gln27Glu). Circumferential shortening of the left ventricle was measured using magnetic resonance based CSPAMM tagging. Results Peak VO2 was higher in donor hearts expressing the β1-Ser49Ser alleles when compared with β1-Gly49 carriers (60±15% vs. 47±10% of the predicted value; p = 0.015), and by trend in cardiac allografts with the β1-AR Gly389Gly vs. β1-Arg389 (61±15% vs. 54±14%, p = 0.093). Peak VO2 was highest for the haplotype Ser49Ser-Gly389, and decreased progressively for Ser49Ser-Arg389Arg > 49Gly-389Gly > 49Gly-Arg389Arg (adjusted R2 = 0.56, p = 0.003). Peak VO2 was not different for the tested β2-AR polymorphisms. Independent predictors of peak VO2 (adjusted R2 = 0.55) were β1-AR Ser49Gly SNP (p = 0.005), heart rate increase (p = 0.016), and peak systolic blood pressure (p = 0.031). Left ventricular (LV) motion kinetics as measured by cardiac MRI CSPAMM tagging at rest was not different between carriers and non-carriers of the β1-AR Gly49allele. Conclusion Similar LV cardiac motion kinetics at rest in donor hearts carrying either β1-AR Gly49 or β1-Ser49Ser variant suggests exercise-induced desensitization and down-regulation of the β1-AR Gly49 variant as relevant pathomechanism for reduced peak VO2 in β1-AR Gly49 carriers.
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Affiliation(s)
- Mélanie Métrich
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Fortesa Mehmeti
- Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Helene Feliciano
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - David Martin
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Julien Regamey
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Cardiac Surgery, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Philippe Meyer
- Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Roger Hullin
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- * E-mail:
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Sotiropoulos K, Yerly P, Monney P, Garnier A, Regamey J, Hugli O, Martin D, Metrich M, Antonietti JP, Hullin R. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction. ESC Heart Fail 2016; 3:198-204. [PMID: 27818784 PMCID: PMC5074265 DOI: 10.1002/ehf2.12091] [Citation(s) in RCA: 48] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 11/30/2015] [Accepted: 02/16/2016] [Indexed: 12/30/2022] Open
Abstract
Background Elevated red blood cell distribution width (RDW) is a valid predictor of outcome in acute heart failure (AHF). It is unknown whether elevated RDW remains predictive in AHF patients with either preserved left ventricular ejection fraction (LVEF) ≥50% or reduced LVEF (<50%). Methods and results Prospective local registry including 402 consecutive hospitalized AHF patients without acute coronary syndrome or need of intensive care. The primary outcome was all‐cause mortality (ACM) at 1 year after admission. Demographic and clinical data derive from admission, echocardiographic examinations (n = 269; 67%) from hospitalization. The Cox proportional hazard model including all patients (P < 0.001) was adjusted for age, gender, and RDW quartiles. Independent predictors of 1‐year ACM were cardiogenic shock (HR 2.86; CI: 1.3–6.4), male sex (HR 1.9; CI: 1.2–2.9), high RDW quartile (HR 1.66; CI: 1.02–2.8), chronic HF (HR 1.61; CI: 1.05–2.5), valvular heart disease (HR 1.61; CI: 1.09–2.4), increased diastolic blood pressure (HR 1.02 per mmHg; CI: 1.01–1.03), increasing age (HR 1.04 by year; CI: 1.02–1.07), platelet count (HR 1.002 per G/l; CI: 1.0–1.004), systolic blood pressure (HR 0.99 per mmHg; CI: 0.98–0.99), and weight (HR 0.98 per kg; CI: 0.97–0.99). A total of 114 patients (28.4%) died within the first year; ACM of all patients increased with quartiles of rising RDW (χ2 18; P < 0.001). ACM was not different between RDW quartiles of patients with reduced LVEF (n = 153; χ2 6.6; P = 0.084). In AHF with LVEF ≥50% the probability of ACM increased with rising RDW (n = 116; χ2 9.9; P = 0.0195). Conclusions High RDW is associated with increased ACM in AHF patients with preserved but not with reduced LVEF in this study population.
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Affiliation(s)
- Konstantinos Sotiropoulos
- Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - Patrick Yerly
- Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - Pierre Monney
- Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - Antoine Garnier
- Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - Julien Regamey
- Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - Olivier Hugli
- Service des Urgences Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - David Martin
- Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - Melanie Metrich
- Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
| | - Jean-Philippe Antonietti
- Institute of Psychology, Bâtiment Géopolis, Quartier UNIL-Dorigny University of Lausanne Lausanne Switzerland
| | - Roger Hullin
- Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland
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Pascale P, Regamey J, Iglesias JF, Gabus V, Clair M, Yerly P, Hullin R, Müller O, Eeckhout É, Vogt P. [Cardiology update in 2015]. Rev Med Suisse 2016; 12:17-22. [PMID: 26946696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present review provides a selected choice of clinical trials and therapeutic advances in the field of cardiology in 2015. A new treatment option in heart failure will become available this year in Switzerland. In interventional cardiology, new trials have been published on the duration of dual antiplatelet therapy, the new stents with bioresorbable scaffold and the long-term results of TAVR in patients who are not surgical candidates or at high surgical risk. RegardingAF the BRIDGE trial provides new evidences to guide the management of patients during warfarin interruption for surgery. Recent publications are changing the paradigm of AF treatment by showing a major impact of the management of cardiometabolic risk factors. Finally, refined criteria for ECG interpretation in athletes have been recently proposed to reduce the burden of false-positive screening.
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Uhlmann M, Burnard J, Cosma Rochat M, Gabus V, Micheloud VG, Gobin N, Laurent JC, Marino L, Méan M, Merz L, Regamey J, Stadelmann R. [Highlights of hospital-based internal medicine in 2010: chief residents' perspective]. Rev Med Suisse 2011; 7:296-302. [PMID: 21381273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.
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Abstract
This article reports the case of a 31 years old man who suffered from an acute pulmonary oedema after laryngospasma following extubation. This pathology, better known by anesthesiologists than internists, results primarly from a rapid rise in negative intrapleural pressure. It is not associated with previous cardio-pulmonary illness and has a begnin course with resolution within 48 hours with oxygen and positive end expiratory pressure support.
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Affiliation(s)
- J Regamey
- Département de médecine interne, CHUV, Lausanne.
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Gobat Y, Prader A, Regamey J. Au sujet de l’action du cytochrome C sur I’adénocarcinome du sein (tumeur greffée) chez la souris. Oncology 2009. [DOI: 10.1159/000223558] [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: 11/19/2022]
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