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Matsushita K, Marchandot B, Hess S, Kibler M, Sato C, Heger J, Truong D, Trimaille A, Sattler L, Grunebaum L, Reydel Dedieu A, Jesel L, Ohlmann P, Morel O. Primary hemostatic disorders drive early and late major bleedings of patients with atrial fibrillation after transcatheter aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.142] [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]
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2
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Trimaille A, Matsushita K, Marchandot B, Carmona A, Hess S, Kibler M, Heger J, Reydel A, Sattler L, Grunebaum L, Jesel L, Ohlmann P, Morel O. Baseline mean platelet volume is a strong predictor of major and life-threatening bleedings after transcatheter aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.144] [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]
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3
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Matsushita K, Marchandot B, Hess S, Kibler M, Sato C, Heger J, Truong DP, Trimaille A, Sattler L, Grunebaum L, Reydel A, Jesel L, Ohlmann P, Morel O. Primary hemostatic disorders drive early and late major bleedings of patients with atrial fibrillation after transcatheter aortic valve replacement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1631] [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
Introduction
Patients with atrial fibrillation (AF) are likely to have multiple co-morbidities and receive anticoagulants after TAVR, which lead to a poor prognosis including bleeding events. Closure time adenosine diphosphate (CT-ADP) is a primary hemostasis point-of-care test used as a surrogate marker of high molecular weight (HMW) multimers defect of Von Willebrand factor (VWF). Our prior studies suggest that prolongation of CT-ADP (>180 seconds) after TAVR is a major determinant of early and late major/life-threatening bleeding complications (MLBCs).
Purpose
To evaluate the impact of post-procedural CT-ADP >180sec on bleeding events in AF patients.
Methods
We included 878 patients from our prospective TAVR registry between 2010 and 2019. Bleeding complications were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization within 1-year after TAVR. Ongoing primary haemostasis disorder was defined by post-procedure CT-ADP >180sec. Primary endpoint was the occurrence of MLBCs during the first year and the second endpoint was 1-year MACCE.
Results
Patients with AF had a higher incidence of all-cause mortality (15% vs. 8%, p=0.002), MACCE (29% vs. 20%, p=0.002), and MLBCs (20% vs. 12%, p=0.001) within 1-year compared to non-AF patients. When the cohort was split into 4 subgroups according to AF and CT-ADP >180sec, patients with AF and CT-ADP >180sec had the highest risk of MLBCs (log-rank test; p<0.001) (Figure). Multivariate Cox regression analysis confirmed that the patients with AF and CT-ADP >180sec had 4.6-fold higher risk of MLBCs within 1 year compared to non-AF patients with CT-ADP ≤180sec (hazard ratio: 4.60; 95% confidence interval: 2.18 - 9.68; p<0.001).
Conclusion
Among TAVR patients, AF with post-procedural CT-ADP >180 sec was identified as a strong independent predictor of MLBCs at 1-year follow-up. Our study suggest that persistent primary haemostasis disorders contribute to a higher risk of bleeding events particularly in AF patients and may be considered for a tailored and risk-adjusted antithrombotic therapy after TAVR.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Matsushita received a grant from Edwards Lifesciences.
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Affiliation(s)
- K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - S Hess
- University Hospital of Strasbourg, Strasbourg, France
| | - M Kibler
- University Hospital of Strasbourg, Strasbourg, France
| | - C Sato
- University Hospital of Strasbourg, Strasbourg, France
| | - J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - D P Truong
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - L Sattler
- University Hospital of Strasbourg, Strasbourg, France
| | - L Grunebaum
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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4
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Carmona A, Marchandot B, Matsushita K, Curtiaud A, Elidrissi A, Trimaille A, Kibler M, Cardi T, Heger J, Hess S, Reydel A, Fafi-Kremer S, Schini-Kerth V, Jesel L, Ohlmann P, Morel O. Impact of Covid-19 infection in high-risk coronary patients. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC7803089 DOI: 10.1016/j.acvdsp.2020.10.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Background Methods Results Conclusions
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Matsushita K, Marchandot B, Kibler M, Sato C, Heger J, Peillex M, Trimaille A, Hess S, Grunebaum L, Ohana M, Reydel A, Jesel L, Ohlmann P, Morel O. P2Y12 inhibition by clopidogrel increases adverse clinical outcomes in patients undergoing transcatheter aortic valve replacement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1921] [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
Introduction
Current recommendations support short-term dual antiplatelet therapy (DAPT) for patients undergoing transcatheter aortic valve replacement (TAVR) despite no relevant study exploring the extent of platelet inhibition by clopidogrel.
Purpose
To assess whether P2Y12 inhibition by clopidogrel as evaluated by vasodilator-stimulated phosphoprotein flow cytometry test (VASP-FCT) impacts 1-year clinical outcomes in patients undergoing TAVR.
Methods
Patients were included in a prospective registry between February 2010 and May 2019. VASP-FCT was assessed 24h after the procedure. Responder to clopidogrel was defined by a platelet reactivity index ≤50%.
Results
Of 640 patients who underwent TAVR with preprocedural clopidogrel therapy, we enrolled 491 patients for whom VASP data were available. Responders were identified in 22% (n=110) of patients and low responders were 78% (n=381) of patients. Low body mass index, active cancer, and clopidogrel on admission were found to be independent predictors of responder. Mean transaortic pressure gradient was lower in the responder group at 1-month post-TAVR (9.9±4.4 mmHg vs. 11.2±5.8 mmHg, p=0.03) but was similar at 1-year (11.5±6.2 mmHg vs. 11.9±7.4 mmHg, p=0.74). By multivariate Cox regression analysis, patients responding to clopidogrel (hazard ratio [HR]: 2.19; 95% confidence interval [CI]: 1.04 to 3.64; p=0.04), prior PCI (HR: 2.12; 95% CI: 1.07 to 4.37; p=0.03), and mean transaortic pressure gradient at baseline (HR: 0.07; 95% CI: 0.01 to 0.70; p=0.02) were identified as independent predictors of 1-year adverse clinical outcomes, including all-cause death, myocardial infarction, stroke, and heart failure hospitalization.
Conclusions
Appropriate P2Y12 inhibition by clopidogrel is a major determinant of adverse clinical events after TAVR. In sum, the present data challenges the need of DAPT as a standard therapy during TAVR.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - M Kibler
- University Hospital of Strasbourg, Strasbourg, France
| | - C Sato
- University Hospital of Strasbourg, Strasbourg, France
| | - J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - M Peillex
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - S Hess
- University Hospital of Strasbourg, Strasbourg, France
| | - L Grunebaum
- University Hospital of Strasbourg, Strasbourg, France
| | - M Ohana
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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Matsushita K, Marchandot B, Kibler M, Sato C, Heger J, Peillex M, Trimaille A, Hess S, Grunebaum L, Ohana M, Reydel A, Jesel L, Ohlmann P, Morel O. Predictive impact of PVL assessments on clinical outcomes in patients undergoing TAVR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2581] [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
Introduction
Paravalvular leakage (PVL) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality. In clinical practice, determining PVL severity after TAVR remains challenging and often requires multiparametric assessment.
Purpose
This study sought to evaluate the respective value of various modalities of PVL assessments, including transthoracic echocardiography (TTE), cine-angiography, aortic regurgitation index (ARI), and closure time with adenosine diphosphate (CT-ADP), in the prediction of adverse clinical outcomes.
Methods
We included 1044 patients from our prospective TAVR registry between February 2010 and May 2019. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization within 1-year. Established cutoff values of ARI (<25) and CT-ADP (>180 sec) were used to assess the presence of PVL after TAVR.
Results
Moderate to severe PVL occurred in 14.2% and 5.2% of patients as measured by TTE and angiography. The rate of patients with ARI <25 and CT-ADP >180 sec were 36.5% and 24.9%, respectively. Among the four modalities, PVL evaluated by angiography predicted poorer clinical outcomes (Log rank test; p=0.001), whereas TTE, ARI <25, and CT-ADP >180 sec were not associated with 1-year MACCE. By multivariate Cox regression analysis, moderate to severe PVL by angiography was an independent predictor of 1-year MACCE (hazard ratio: 1.96; 95% confidence interval: 1.22–3.00; p=0.007).
Conclusions
Paravalvular leakage measured by angiography was evidenced as the most meaningful modality in the prediction of adverse clinical outcomes. Future multicenter studies are warranted to ensure these findings in the current TAVR era.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - M Kibler
- University Hospital of Strasbourg, Strasbourg, France
| | - C Sato
- University Hospital of Strasbourg, Strasbourg, France
| | - J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - M Peillex
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - S Hess
- University Hospital of Strasbourg, Strasbourg, France
| | - L Grunebaum
- University Hospital of Strasbourg, Strasbourg, France
| | - M Ohana
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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Carmona A, Marchandot B, Kibler M, Trimaille A, Heger J, Peillex M, Matsushita K, Ristorto J, Hoang V, Hess S, Jesel L, Ohlmann P, Morel O. Impact of incomplete coronary revascularization on late ischemic and bleeding events after transcatheter aortic-valve Replacement. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.160] [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: 10/25/2022]
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8
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Trimaille A, Marchandot B, Kibler M, Heger J, Peillex M, Carmona A, Matsushita K, Trinh A, Reydel A, Zeyons F, Petit-Eisenmann H, Jesel L, Ohlmann P, Morel O. Outcomes of patients with active cancer undergoing transcatheter aortic-valve replacement. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Jimenez C, Ohana M, Marchandot B, Kibler M, Carmona A, Peillex M, Heger J, Trimaille A, Matsushita K, Reydel A, Hess S, Jesel L, Ohlmann P, Morel O. Impact of anti-thrombotic regimen and platelet inhibition extent on leaflet thrombosis detected by cardiac MDCT after transcatheter aortic-valve replacement. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.162] [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: 10/25/2022]
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10
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Heger J, Trimaille A, Kibler M, Marchandot B, Peillex M, Carmona A, Matsushita K, Trinh A, Reydel A, Zeyons F, Petit-Eisenmann H, Jesel L, Ohlmann P, Morel O. Electrocardiographic strain pattern is a major determinant of rehospitalization for heart failure after Transcatheter Aortic-Valve Replacement. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.188] [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: 10/25/2022]
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11
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Drouelle E, De Poli F, Couppie P, Uhry S, Heyer H, Morel O, Ohlmann P, Hess S, Kibler M, Leddet P. [Common femoral artery bailout stenting with covered stent graft due to TAVR vascular complication: Clinical long term follow-up]. Ann Cardiol Angeiol (Paris) 2019; 68:316-324. [PMID: 31570157 DOI: 10.1016/j.ancard.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular complications are frequent in the context of transcatheter aortic valve replacement and may require the implantation of a covered stent graft in the common femforal artery. However, common femoral artery is considered to be at high risk of stent fracture or occlusion due to high mobility of the hip joint. PATIENTS AND METHODS We analyzed medical records of patients with transcatheter aortic valve replacement related vascular complications between 2015 and 2018, treated with commom femoral artery transluminal angioplasty or surgery. Vascular complications or suspect symptoms were followed up by phone calls. RESULTS Among 552 patients, 43 patients were included. Twelve (11.6 %) were managed by prolonged balloon inflation, 5 (11.6 %) by first line surgery and 26 (60.4 %) by the implantation of a covered stent graft. Among the latter group, the covered stent graft was efficient in 24 patients (92.3 %). The median follow-up was 430 days [3-1499]. The first-line surgery group had a higher risk of red blood cell transfusion and all causes mortality. At follow-up, no patient had suspicious symptoms of vascular covered stent complication. Four patients (9.3 %) had US-doppler or CT vascular imaging at follow-up, showing no evidence of stent fracture or occlusion. CONCLUSION In our study, the implantation of a covered stent graft in the common femoral artery was an efficient and safe strategy for the management of transcatheter aortic valve replacement related vascular complications.
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Affiliation(s)
- E Drouelle
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau.
| | - F De Poli
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - P Couppie
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - S Uhry
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - H Heyer
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - O Morel
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - P Ohlmann
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - S Hess
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - M Kibler
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - P Leddet
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
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12
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Park S, Belcastro E, Hasan H, Bruckert C, Marchandot B, Kibler M, Toti F, Auger C, Jesel L, Ohlmann P, Morel O, Schini-Kerth V. P6266Circulating microparticules of patients with coronary artery disease up-regulate the expression of sodium-glucose cotransporters 1 and 2 in coronary artery endothelial cells: role of angiotensin II. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0865] [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
Introduction
Circulating microparticles (MPs) from patients with coronary artery diseases (CAD) have been shown to promote endothelial senescence and dysfunction involving the pro-oxidant local angiotensin system. Sodium-glucose cotransporters (SGLTs)2 inhibitors decreased the risk of cardiovascular disease in patients with type 2 diabetes and this effect appears to be independent of glycemic control. Moreover, high glucose and H2O2 have been shown to cause a redox-sensitive upregulation of SGLT1 and 2 in coronary artery endothelial cells (ECs).
Aim
Therefore, this study examined whether angiotensin II (Ang II, a potent NADPH oxidase-dependent inducer of oxidative stress) and CAD MPs stimulate SGLT1 and 2 expression in ECs, and assessed their role in the induction of endothelial dysfunction.
Methods
ECs were isolated from porcine coronary arteries. The protein expression level was assessed by Western blot analysis and immunocytochemical staining, oxidative stress using dihydroethidium staining, and senescence by senescence-associated beta-galactosidase activity (SA-beta-gal activity). Circulating CAD MPs were collected from blood samples of patients (61–79 year) with established cardiovascular disease.
Results
Control ECs expressed low levels of SGLT1 and SGLT2 proteins. Exposure of ECs to Ang II caused a time- and concentration-dependent increase in the protein level of SGLT1 and SGLT2 with a significant increase observed at concentrations as low as 10 nM. Exposure of ECs to CAD MPs (10 nM PhtdSer eq) from 3/5 patients increased the SGLT1 and SGLT2 protein level. An increased SGLT1 and SGLT2 immunofluorescence signal was also observed in response to Ang II and H2O2. Ang II increased the level of oxidative stress, SA-beta-gal activity, senescence markers (p53, p21 and p16), VCAM-1, MCP-1, tissue factor (TF) and the local angiotensin system (ACE, AT1R), and down-regulated that of eNOS. CAD MPs from 4/5 patients decreased eNOS level and from 5/5 patients increased VCAM-1 level. All the Ang II-induced effects were prevented by the dual SGLT1/2 inhibitor LX-4211 and the selective SGLT2 inhibitor, empagliflozin.
Conclusions
The present findings indicate that CAD MPs and Ang II upregulate the expression of SGLT1 and SGLT2 protein levels in ECs, and that they promote endothelial dysfunction. They further suggest that inhibition of SGLT1 and/or SGLT2 might be an attractive strategy to protect the arterial wall and, hence, the development of cardiovascular diseases.
Acknowledgement/Funding
Unrestricted research grant from Boehringer Ingelheim Pharma GmbH & Co. KG
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Affiliation(s)
- S Park
- University of Strasbourg, INSERM UMR 1260, Regenerative Nanomedicine, Strasbourg, France
| | - E Belcastro
- University of Strasbourg, INSERM UMR 1260, Regenerative Nanomedicine, Strasbourg, France
| | - H Hasan
- University of Strasbourg, INSERM UMR 1260, Regenerative Nanomedicine, Strasbourg, France
| | - C Bruckert
- University of Strasbourg, INSERM UMR 1260, Regenerative Nanomedicine, Strasbourg, France
| | - B Marchandot
- University Hospital Strasbourg, Cardiology, Strasbourg, France
| | - M Kibler
- University Hospital Strasbourg, Cardiology, Strasbourg, France
| | - F Toti
- University of Strasbourg, INSERM UMR 1260, Regenerative Nanomedicine, Strasbourg, France
| | - C Auger
- University of Strasbourg, INSERM UMR 1260, Regenerative Nanomedicine, Strasbourg, France
| | - L Jesel
- University Hospital Strasbourg, Cardiology, Strasbourg, France
| | - P Ohlmann
- University Hospital Strasbourg, Cardiology, Strasbourg, France
| | - O Morel
- University Hospital Strasbourg, Cardiology, Strasbourg, France
| | - V Schini-Kerth
- University of Strasbourg, INSERM UMR 1260, Regenerative Nanomedicine, Strasbourg, France
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13
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Heger J, Marchandot B, Kibler M, Peillex M, Trimaille A, Carmona A, Matsushita K, Trinh A, Reydel A, Zeyons F, Petit-Eisenmann H, Jesel L, Ohlmann P, Morel O. P6485Incremental prognostic value of electrocardiographic strain after transcatheter aortic valve replacement for aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1075] [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
Electrocardiographic (ECG) strain pattern has recently been associated with increased adverse outcome in aortic stenosis (AS) and after surgical aortic valve replacement (AVR). However, the relation linking ECG strain and cardiovascular MACE in patients with transcatheter aortic valve replacement (TAVR) has not been yet described.
Objectives
The aim of our study was to determine the impact and incremental value of ECG Strain pattern in predicting adverse outcome after TAVR.
Methods
585 patients with severe AS (mean age: 83±7 male 39.8%) were enrolled from November 2012 to May 2018. ECG strain pattern was defined as ≥1 mm concave down-sloping ST-segment depression and asymmetrical T-wave inversion in the lateral leads. Patients with baseline left bundle branch block (LBBB), right bundle branch block (RBBB) or ventricular paced rhythm were excluded. All patients underwent transthoracic echocardiography (TTE) before TAVR and at 30 days follow up. The primary endpoints of the study were the overall all-cause mortality after TAVR, rehospitalization for Hearth failure (HF), myocardial infarction and stroke.
Results
178 (30.4%) patients were excluded from analyses owing to the presence of either LBBB (n=103) or RBBB (n=75). Among the 407 remaining patients, 106 had ECG strain pattern (26.04%). Patients with ECG strain were significantly younger (81.6±8 years vs 83.5±6.8 years; p=0.022), had lower BMI (23±4.5 kg.m2 vs 27.9±6.8 kg.m2; p=0.02) more severe AS (mean gradient 52.3±15.2 mmHg vs 47.9±11.8 mmHg; p=0.003), significant lower LVEF (51.8±15% vs 58.4±10.7%; p<0.001). Left ventricular hypertrophy (LVH) was more frequent in patients with ECG Strain (indexed left ventricular mass (135.9±33.4 g.m2 vs 123.6±31.9 g.m2; p=0.002)). Death from any cause (22 (20.8%) vs 61 (20.3%); p=0.508) did not differ significantly between groups. Major adverse cardiovascular events (MACE) including death, stroke and heart failure at 1 month showed similar incidence (7 (6.6%) vs 17 (5.6%), p=0.439). Rehospitalization for hearth failure (HF) was significantly higher (33 (31.1%) vs 33 (11%); p<0.001) in patients with ECG strain pattern. In univariate model, ECG Strain was a strong predictor of rehospitalization for HF (HR 2.621 95% CI (1.607–4.277), p=0.001), independently of LVH assessed either by ECG criteria (HR 1.181 95% CI (0.698–1.997; p=0.536) or TTE (HR 1.557 95% (CI 0.701–3.458; p=0.277). ECG Strain remained associated with a higher risk of rehospitalization for hearth failure in multivariate analyses (HR 2.747 95% (CI 1.614- 4.674); p<0.001)
Conclusion
In patients with AS eligible for TAVR, ECG Strain Pattern is frequent and associated with an increased risk of post interventional heart failure regardless of preoperative LVH. ECG Strain pattern represents an easy, objective, reliable and low-cost tool to identify patients who may benefit from an extend and intensified post-interventional follow-up.
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Affiliation(s)
- J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - M Kibler
- University Hospital of Strasbourg, Strasbourg, France
| | - M Peillex
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - A Carmona
- University Hospital of Strasbourg, Strasbourg, France
| | - K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trinh
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - F Zeyons
- University Hospital of Strasbourg, Strasbourg, France
| | | | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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Kibler M, Marchandot B, Messas N, Vincent F, Hoang V, Crimizade U, Jesel L, Susen S, Ohlmann P, Van Belle E, Morel O. Impact of primary hemostasis disorders on late (>30 days) major/life-threatening bleedings after TAVR. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.156] [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]
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Kibler M, Marchandot B, Nathan N, Vincent F, Grunebaum L, Crimizade U, Kindo M, Hoang MT, Petit-Eisenmann H, Jesel L, Susen S, Van Belle E, Ohlmann P, Morel O. 4283Impact of primary hemostasis disorders on late (>30 days) major/life-threatening bleedings after TAVR. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4283] [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: 11/14/2022] Open
Affiliation(s)
- M Kibler
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - N Nathan
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - F Vincent
- Cardiology Hospital of Lille, Lille, France
| | - L Grunebaum
- University Hospital of Strasbourg, Department of haemostasis, Strasbourg, France
| | - U Crimizade
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - M Kindo
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - M T Hoang
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - H Petit-Eisenmann
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | | | | | - P Ohlmann
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
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Affiliation(s)
- W. R. Cook
- Department of Clinical Sciences Cummings School of Veterinary Medicine Tufts University North Grafton Massachusetts USA
| | - M. Kibler
- Department of Mathematics and Computer Science Washington College Chestertown Maryland USA
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Kibler M, Marchandot B, Messas N, Caspar T, Grunebaum L, Crimizade U, Trinh A, Petit-Eisenmann H, Zeyons F, Von Hunolstein J, Kindo M, Hoang T, Jesel L, Ohlmann P, Morel O. Impact of CT-ADP point-of-care assay on 30-day paravalvular aortic regurgitation and bleeding events following transcatheter aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Marchandot B, Ohlmann P, Jesel L, Kibler M, Messas N, Crimizade U, Trinh A, Petit-Eisenmann H, Morel O, Caspar T. P5234Incremental value of resting 2D and 3D speckle-tracking echocardiography compared to exercise ECG testing to identify coronary artery disease in intermediate risk patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
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19
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Kibler M, Bächmann K. New derivatization method for carboxylic acids in aqueous solution for analysis by capillary electrophoresis and laser-induced fluorescence detection. J Chromatogr A 1999. [DOI: 10.1016/s0021-9673(99)00012-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mainka A, Ebert P, Kibler M, Prokop T, Tenberken B, Bächmann K. Development of new methods for the analysis of carboxylic acids and carbonyl compounds in size classified raindrops by CE for application in modelling atmospheric processes. Chromatographia 1997. [DOI: 10.1007/bf02505555] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tenberken B, Ebert P, Hartmann M, Kibler M, Mainka A, Prokop T, Röder A, Bächmann K. Analysis of single raindrops in the nl range by capillary electrophoresis. J Chromatogr A 1996. [DOI: 10.1016/0021-9673(96)00202-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Sztucki J, Daoud M, Kibler M. Intensity of two-photon absorption transitions for Ni2+ in MgO. Phys Rev B Condens Matter 1992; 45:2023-2028. [PMID: 10001714 DOI: 10.1103/physrevb.45.2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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27
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Gâcon JC, Marcerou JF, Bouazaoui M, Jacquier B, Kibler M. Two-photon transition intensities for Sm2+ in BaClF. Phys Rev B Condens Matter 1989; 40:2070-2075. [PMID: 9992082 DOI: 10.1103/physrevb.40.2070] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Grenet G, Jugnet Y, Duc TM, Kibler M. On the interpretation of 3dNions photoemission spectra. I. A comparative study for the valence band of FeO, CoO, and NiO. J Chem Phys 1981. [DOI: 10.1063/1.441376] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wytrychowski M, Czerchawski L, Morawska Z, Kibler M. [Unsuccessful heparin treatment of intravascular dissemination coagulation in infants with E. coli septicemia]. Pol Tyg Lek 1979; 34:1755-7. [PMID: 390515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Grenet G, Jugnet Y, Minh Duc T, Kibler M. On the photoemission spectra of CoO: Crystal-field analyses of the valence band structure. Chem Phys Lett 1979. [DOI: 10.1016/0009-2614(79)80426-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Grenet G, Kibler M, Linarès C, Louat A, Gaume F. Ligand field parameters for europium(III) in gadolinium, yttrium, and letetium orthovanadates. Chem Phys Lett 1977. [DOI: 10.1016/0009-2614(77)85376-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kibler M. [The sick hospital]. Folia Clin Int (Barc) 1967; 17:618-20. [PMID: 5619324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Poncet P, Kibler M, Laforgue A, Laforgue-Kantzer D. Un aspect théorique de processus électrochimiques. Electrochim Acta 1966. [DOI: 10.1016/0013-4686(66)80090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kibler M. [Conservative treatment of arthrosis deformans of the hip joint]. Hippokrates 1966; 37:57-61. [PMID: 5913585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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