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Chaix MA, Dore A, Mondésert B, Mongeon FP, Roy V, Desrosiers-Gagnon C, Guertin MC, White M, Ibrahim R, O’Meara E, Rouleau JL, Khairy P. Angiotensin receptor-neprilysin inhibitor vs. placebo in congenital systemic right ventricular heart failure: the PARACYS-RV trial. Eur Heart J 2024; 45:1481-1483. [PMID: 38445853 PMCID: PMC11032706 DOI: 10.1093/eurheartj/ehad890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Marie-A Chaix
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Annie Dore
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Véronique Roy
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Charles Desrosiers-Gagnon
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal H1T 1C8, QC, Canada
| | - Michel White
- Heart failure clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Réda Ibrahim
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Eileen O’Meara
- Heart failure clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Lucien Rouleau
- Heart failure clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
- Montreal Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal H1T 1C8, QC, Canada
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Roubille F, Bouabdallaoui N, Kouz S, Waters DD, Diaz R, Maggioni AP, Pinto FJ, Grégoire JC, Gamra H, Kiwan GS, Berry C, López-Sendón J, Koenig W, Delorme L, Elbaz M, Coste P, Provencher M, Bassevitch Z, Blondeau L, L'Allier PL, Guertin MC, Tardif JC. Low-Dose Colchicine in Patients With Type 2 Diabetes and Recent Myocardial Infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Diabetes Care 2024; 47:467-470. [PMID: 38181203 DOI: 10.2337/dc23-1825] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The cardiovascular benefits of low-dose colchicine have been demonstrated in patients with coronary disease. Its effects were evaluated in this prespecified analysis in patients with type 2 diabetes (T2D) from the Colchicine Cardiovascular Outcomes Trial (COLCOT). RESEARCH DESIGN AND METHODS COLCOT was a randomized, double-blinded trial of colchicine, 0.5 mg daily, versus placebo initiated within 30 days after a myocardial infarction. RESULTS There were 959 patients with T2D enrolled and monitored for a median of 22.6 months. A primary end point event occurred in 8.7% of patients in the colchicine group and in 13.1% in the placebo group (hazard ratio 0.65; 95% CI 0.44-0.96; P = 0.03). Nausea was reported in 2.7% and 0.8% in the study groups (P = 0.03), and pneumonia occurred in 2.4% and 0.4% (P = 0.008). CONCLUSIONS Among patients with T2D and a recent myocardial infarction, colchicine, 0.5 mg daily, leads to a large reduction of cardiovascular events. These results support the conduct of the COLCOT-T2D trial in primary prevention.
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Affiliation(s)
- François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Quebec, Canada
| | | | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Aldo P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Research Center, Heart Care Foundation, Florence, Italy
| | - Fausto J Pinto
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Jean C Grégoire
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, and National Health Service Greater Glasgow and Clyde, Glasgow, U.K
| | - José López-Sendón
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid, Spain
| | - Wolfgang Koenig
- Deutsches Herzzentrum Munchen, Technische Universitat Munchen, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - Meyer Elbaz
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Pierre Coste
- Hôpital Cardiologique, Université de Bordeaux, Bordeaux, France
| | - Mylène Provencher
- Montreal Health Innovations Coordinating Center, Montreal, Quebec, Canada
| | - Zohar Bassevitch
- Montreal Health Innovations Coordinating Center, Montreal, Quebec, Canada
| | - Lucie Blondeau
- Montreal Health Innovations Coordinating Center, Montreal, Quebec, Canada
| | | | | | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Camm AJ, Piccini JP, Alings M, Dorian P, Gosselin G, Guertin MC, Ip JE, Kowey PR, Mondésert B, Prins FJ, Roux JF, Stambler BS, van Eck JWM, Al Windy N, Thermil N, Shardonofsky S, Bharucha DB, Roy D. Multicenter, Phase 2, Randomized Controlled Study of the Efficacy and Safety of Etripamil Nasal Spray for the Acute Reduction of Rapid Ventricular Rate in Patients With Symptomatic Atrial Fibrillation (ReVeRA-201). Circ Arrhythm Electrophysiol 2023; 16:639-650. [PMID: 37950726 PMCID: PMC10734780 DOI: 10.1161/circep.123.012567] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Despite chronic therapies, atrial fibrillation (AF) leads to rapid ventricular rates (RVR) often requiring intravenous treatments. Etripamil is a fast-acting, calcium-channel blocker administered intranasally affecting the atrioventricular node within minutes. METHODS Reduction of Ventricular Rate in Patients with Atrial Fibrillation evaluated the efficacy and safety of etripamil for the reduction of ventricular rate (VR) in patients presenting urgently with AF-RVR (VR ≥110 beats per minute [bpm]), was randomized, double-blind, placebo-controlled, and conducted in Canada and the Netherlands. Patients presenting urgently with AF-RVR were randomized (1:1, etripamil nasal spray 70 mg: placebo nasal spray). The primary objective was to demonstrate the effectiveness of etripamil in reducing VR in AF-RVR within 60 minutes of treatment. Secondary objectives assessed achievement of VR <100 bpm, reduction by ≥10% and ≥20%, relief of symptoms and treatment effectiveness; adverse events; and additional measures to 360 minutes. RESULTS Sixty-nine patients were randomized, 56 dosed with etripamil (n=27) or placebo (n=29). The median age was 65 years; 39% were female patients; proportions of AF types were similar between groups. The difference of mean maximum reductions in VR over 60 minutes, etripamil versus placebo, adjusting for baseline VR, was -29.91 bpm (95% CI, -40.31 to -19.52; P<0.0001). VR reductions persisted up to 150 minutes. Significantly greater proportions of patients receiving etripamil achieved VR reductions <100 bpm (with longer median duration <100 bpm), or VR reduction by ≥10% or ≥20%, versus placebo. VR reduction ≥20% occurred in 66.7% of patients in the etripamil arm and no patients in placebo. Using the Treatment Satisfaction Questionnaire for Medication-9, there was significant improvement in satisfaction on symptom relief and treatment effectiveness with etripamil versus placebo. Serious adverse events were rare; 1 patient in the etripamil arm experienced transient severe bradycardia and syncope, assessed as due to hypervagotonia. CONCLUSIONS Intranasal etripamil 70 mg reduced VR and improved symptom relief and treatment satisfaction. These data support further development of self-administered etripamil for the treatment of AF-RVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04467905.
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Affiliation(s)
- A. John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George’s University of London, United Kingdom (A.J.C.)
| | - Jonathan P. Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (J.P.P.)
| | - Marco Alings
- Department of Cardiology, Amphie Hospital, Breda, the Netherlands (M.A.)
| | - Paul Dorian
- Division of Cardiology, Unity Health Toronto, Ontario, Canada (P.D.)
| | - Gilbert Gosselin
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
| | - Marie-Claude Guertin
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
| | - James E. Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital (J.E.I.)
| | - Peter R. Kowey
- Cardiology Division and Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA (P.R.K.)
| | - Blandine Mondésert
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
| | | | - Jean-Francois Roux
- Centre Hospitalier de l’Université de Sherbrooke, Québec, Canada (J.-F.R.)
| | | | - JWM van Eck
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (J.W.M.v.E.)
| | | | | | | | | | - Denis Roy
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
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Rivard L, Nault I, Krahn AD, Daneault B, Roux JF, Natarajan M, Healey JS, Quadros K, Sandhu RK, Kouz R, Greiss I, Leong-Sit P, Gourraud JB, Ben Ali W, Asgar A, Aguilar M, Bonan R, Cadrin-Tourigny J, Cartier R, Dorval JF, Dubuc M, Dürrleman N, Dyrda K, Guerra P, Ibrahim M, Ibrahim R, Macle L, Mondesert B, Moss E, Raymond-Paquin A, Roy D, Tadros R, Thibault B, Talajic M, Nozza A, Guertin MC, Khairy P. Rationale and Design of the Randomized Bayesian Multicenter COME-TAVI Trial in Patients With a New Onset Left Bundle Branch Block. CJC Open 2023; 5:611-618. [PMID: 37720184 PMCID: PMC10502429 DOI: 10.1016/j.cjco.2023.05.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/22/2023] [Indexed: 09/19/2023] Open
Abstract
Patients with new-onset left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) are at risk of developing delayed high-degree atrioventricular block. Management of new-onset LBBB post-TAVI remains controversial. In the Comparison of a Clinical Monitoring Strategy Versus Electrophysiology-Guided Algorithmic Approach in Patients With a New LBBB After TAVI (COME-TAVI) trial, consenting patients with new-onset LBBB that persists on day 2 after TAVI, meeting exclusion/inclusion criteria, are randomized to an electrophysiological study (EPS)-guided approach or 30-day electrocardiographic monitoring. In the EPS-guided approach, patients with a His to ventricle (HV) interval ≥ 65 ms undergo permanent pacemaker implantation. Patients randomized to noninvasive monitoring receive a wearable continuous electrocardiographic recording and transmitting device for 30 days. Follow-up will be performed at 3, 6, and 12 months. The primary endpoint is a composite outcome designed to capture net clinical benefit. The endpoint incorporates major consequences of both strategies in patients with new-onset LBBB after TAVI, as follows: (i) sudden cardiac death; (ii) syncope; (iii) atrioventricular conduction disorder requiring a pacemaker (for a class I or IIa indication); and (iv) complications related to the pacemaker or EPS. The trial incorporates a Bayesian design with a noninformative prior, outcome-adaptive randomization (initially 1:1), and 2 prespecified interim analyses once 25% and 50% of the anticipated number of primary endpoints are reached. The trial is event-driven, with an anticipated upper limit of 452 patients required to reach 77 primary outcome events over 12 months of follow-up. In summary, the aim of this Bayesian multicentre randomized trial is to compare 2 management strategies in patients with new-onset LBBB post-TAVI-an EPS-guided approach vs noninvasive 30-day monitoring. Trial registration number: NCT03303612.
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Affiliation(s)
- Lena Rivard
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Nault
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benoit Daneault
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Francois Roux
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Madhu Natarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Quadros
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Roopinder K. Sandhu
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Remi Kouz
- Department of Cardiology, Hopital Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Isabelle Greiss
- Department of Cardiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Peter Leong-Sit
- Department of Cardiology, Western University, London, Ontario, Canada
| | | | - Walid Ben Ali
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anita Asgar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raoul Bonan
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Dorval
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Dubuc
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Dürrleman
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Peter Guerra
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marina Ibrahim
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Reda Ibrahim
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Macle
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondesert
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuel Moss
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandre Raymond-Paquin
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Roy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mario Talajic
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Chaix MA, Dore A, Mondésert B, Mongeon FP, Roy V, Guertin MC, White M, Ibrahim R, O’Meara E, Rouleau JL, Khairy P. Design of the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor Versus Pl acebo in Patients With Congenital Systemic Right Ventricle Heart Failure (PARACYS-RV) Trial. CJC Open 2023; 5:537-544. [PMID: 37496786 PMCID: PMC10366661 DOI: 10.1016/j.cjco.2023.04.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/19/2023] [Indexed: 07/28/2023] Open
Abstract
The presence of a systemic right ventricle (sRV) with biventricular physiology (biV) is associated with increased patient morbidity and mortality. To date, no pharmacologic therapy for heart failure has been proven effective for patients with systolic dysfunction of the sRV-biV. We designed a randomized, double-blind, placebo-controlled crossover trial to compare sacubitril/valsartan treatment to placebo in adults (aged ≥ 18 years) with moderate-to-severe sRV-biV dysfunction and New York Heart Association functional class II to III symptoms. Two primary efficacy endpoints are assessed in the trial: exercise capacity (submaximal exercise duration) and neurohormonal activation (N-terminal prohormone brain natriuretic peptide). Secondary objectives include assessing a change in the Kansas City Cardiomyopathy Questionnaire score and evaluating the safety and tolerance of sacubitril/valsartan. A 6-week open run-in phase identifies the maximum tolerated dose of sacubitril/valsartan, up to 97 mg/103 mg twice daily. After a 2-week washout period, patients are randomized 1:1 to sacubitril/valsartan treatment vs placebo for a 24-week phase, followed by another 2-week washout period and subsequent crossover to the alternative treatment arm for an additional 24-week phase. Data to assess primary and secondary endpoints are collected at baseline and at the end of each phase. A total of 48 patients is required to provide > 80% power to detect a 30% difference in distance walked and in N-terminal prohormone brain natriuretic peptide levels with sacubitril/valsartan treatment vs placebo, each with a 2-sided P-value of 0.025. In summary, the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor vs Placebo in Patients With Congenital Systemic Right Ventricular Heart Failure Trial (PARACYS-RV) should determine the role of sacubitril/valsartan in treating heart failure in patients with sRV-biV and carries the potential to alter management of this patient population.
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Affiliation(s)
- Marie-A. Chaix
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Dore
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Véronique Roy
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre (MHICC), Montreal, Quebec, Canada
| | - Michel White
- Heart Failure Clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Réda Ibrahim
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Eileen O’Meara
- Heart Failure Clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Lucien Rouleau
- Heart Failure Clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Montreal Health Innovations Coordinating Centre (MHICC), Montreal, Quebec, Canada
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Ferron M, Merlet N, Mihalache-Avram T, Mecteau M, Brand G, Gillis MA, Shi Y, Nozza A, Cossette M, Guertin MC, Rhéaume E, Tardif JC. Adcy9 Gene Inactivation Improves Cardiac Function After Myocardial Infarction in Mice. Can J Cardiol 2023; 39:952-962. [PMID: 37054880 DOI: 10.1016/j.cjca.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Polymorphisms in the adenylate cyclase 9 (ADCY9) gene influence the benefits of the cholesteryl ester transfer protein (CETP) modulator dalcetrapib on cardiovascular events after acute coronary syndrome. We hypothesized that Adcy9 inactivation could improve cardiac function and remodelling following myocardial infarction (MI) in absence of CETP activity. METHODS Wild-type (WT) and Adcy9-inactivated (Adcy9Gt/Gt) male mice, transgenic or not for human CETP (tgCETP+/-), were subjected to MI by permanent left anterior descending coronary artery ligation and studied for 4 weeks. Left ventricular (LV) function was assessed by echocardiography at baseline, 1, and 4 weeks after MI. At sacrifice, blood, spleen and bone marrow cells were collected for flow cytometry analysis, and hearts were harvested for histologic analyses. RESULTS All mice developed LV hypertrophy, dilation, and systolic dysfunction, but Adcy9Gt/Gt mice exhibited reduced pathologic LV remodelling and better LV function compared with WT mice. There were no differences between tgCETP+/- and Adcy9Gt/Gt tgCETP+/- mice, which both exhibited intermediate responses. Histologic analyses showed smaller cardiomyocyte size, reduced infarct size, and preserved myocardial capillary density in the infarct border zone in Adcy9Gt/Gt vs WT mice. Count of bone marrow T cells and B cells were significantly increased in Adcy9Gt/Gt mice compared with the other genotypes. CONCLUSIONS Adcy9 inactivation reduced infarct size, pathologic remodelling, and cardiac dysfunction. These changes were accompanied by preserved myocardial capillary density and increased adaptive immune response. Most of the benefits of Adcy9 inactivation were only observed in the absence of CETP.
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Affiliation(s)
| | | | | | | | | | | | - Yanfen Shi
- Montréal Heart Institute, Montréal, Québec, Canada
| | - Anna Nozza
- Montréal Health Innovations Coordinating Centre (MHICC), Montréal, Québec, Canada
| | - Mariève Cossette
- Montréal Health Innovations Coordinating Centre (MHICC), Montréal, Québec, Canada
| | - Marie-Claude Guertin
- Montréal Health Innovations Coordinating Centre (MHICC), Montréal, Québec, Canada
| | - Eric Rhéaume
- Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Claude Tardif
- Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
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7
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Rioux-Labrecque V, Cossette M, Rufiange M, Bilodeau D, Guertin MC, Tardif JC. Supplementation with a beta-glucan tablet has no effect on hyperlipidemia: a randomized, placebo-controlled clinical trial. Am J Clin Nutr 2023:S0002-9165(23)46841-4. [PMID: 37054888 DOI: 10.1016/j.ajcnut.2023.04.012] [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: 01/19/2023] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Clinical evidence has suggested that the oat soluble fiber β-glucan might have lipid-lowering effects. OBJECTIVE The present clinical trial was conducted to evaluate the efficacy and safety of high-medium molecular weight β-glucan on serum low-density lipoprotein cholesterol (LDL-C) and other lipid subfractions in subjects with hyperlipidemia. METHODS A randomized double-blind trial was performed to assess the efficacy and safety of β-glucan supplementation in reducing lipid levels. Subjects with LDL-C above 3.37 mmol/L when treated or not with a statin were randomly assigned to receive one of three daily doses of a tableted formulation of β-glucan (1.5, 3 or 6 grams) or placebo. The primary efficacy endpoint was the change from baseline to 12 weeks in LDL-C. Secondary endpoints of lipid sub-fractions and safety were also assessed. RESULTS A total of 263 subjects were enrolled; 66 subjects were assigned to each of the 3 β-glucan groups and 65 subjects to the placebo group. The mean change from baseline to 12 weeks in serum LDL-C was 0.08, 0.11 and -0.04 mmol/L in the three β-glucan groups (P=0.23, 0.18 and 0.72 vs. placebo group, respectively) and -0.10 mmol/L in the placebo group. The changes in total cholesterol, small LDL-C subclass particle concentration, non-high-density lipoprotein cholesterol, apolipoprotein B, very low-density lipoprotein cholesterol and high sensitivity C-reactive protein were also not significant in the β-glucan groups when compared to placebo. Gastrointestinal adverse events were reported in 23.4, 34.8 and 66.7% of patients in the β-glucan groups and in 36.9% of patients in the placebo group (P<0.0001 for the overall comparison across the four groups). CONCLUSIONS In subjects with LDL-C above 3.37 mmol/L, a tablet formulation of β-glucan was not effective in reducing LDL-C concentration or other lipid sub-fractions when compared to placebo. CLINICALTRIALS GOV IDENTIFIER NCT03857256.
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Affiliation(s)
| | - Marieve Cossette
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Marianne Rufiange
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | | | | | - Jean-Claude Tardif
- Faculté de médecine, Université de Montréal, Montreal, Canada; Montreal Heart Institute (MHI), Montreal, Canada.
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Yordanova M, Sideris L, Dubé P, Boileau JF, Lemieux J, Mihalcioiu C, Levesque S, Guertin MC, Patocskai E, Younan R, Robidoux A, Hassan S. Abstract P6-01-39: The impact of the 21-gene Recurrence Score® assay upon physician treatment recommendations in the neoadjuvant setting in lymph node-negative breast cancer patients in a multicenter prospective study in Quebec. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-01-39] [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] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Although the role of the 21-gene Breast Recurrence Score® assay is well established to predict response to adjuvant chemotherapy in the setting of node-negative hormone receptor (HR)-positive, HER2-negative breast cancers (BC), fewer studies have evaluated the assay in the neoadjuvant setting. Due to the correlation between a high Recurrence Score® (RS) result and pathological complete response (pCR), the Breast Recurrence Score assay has been used to aid in selecting between chemotherapy (CT) or endocrine therapy. We wanted to further understand the impact of the assay upon physician treatment recommendations and the use of chemotherapy in this patient cohort. Methods: We conducted a multicenter, prospective, observational study in patients with clinically node-negative HR-positive, HER2-negative BC with T2-T3 disease being considered for neoadjuvant therapy. Physicians were required to complete two questionnaires indicating treatment choice, including CT, endocrine therapy, or surgery, prior to and post availability of RS result. Patients were followed up for 6 months after commencement of neoadjuvant therapy. The primary objective was to evaluate the change in the physician’s recommendation for neoadjuvant CT prior to and post assay results. As a secondary objective, we also evaluated the impact of the RS result on physician’s expressed level of confidence. Results: A total of 70 patients were enrolled between April 2018 and November 2021 at five hospital centers, as part of the McPeak Sirois Group of Quebec. The median age of the cohort was 60 years (range, 30 to 79 years). 24.3 % (n=17) of the cohort consisted of patients aged < 50 years, and 75.7% (n=53) were ≥ to 50 years. 29.0% (n=20) of the patients had a RS < 16, 39.1% (n=27) had a RS between 16-25, and 31.9% (n=22) had a RS > 25. For the entire cohort, the RS result led to a net reduction in chemotherapy recommendation by 33.3% (OR (odds of having CT post-RS recommendation versus pre-RS recommendation) = 0.23 [95% CI: 0.12-0.44]; P< 0.0001), and 39.2% net reduction in the use of chemotherapy at 6-month follow-up (OR = 0.18 [95% CI: 0.09-0.35]; P< 0.0001). Furthermore, the RS result led to a 35.3% net reduction in physician recommendation of CT for patients < 50 years (OR = 0.19 [95% CI: 0.04-0.83]; P=0.027) and a 32.7% net reduction for patients ≥ 50 years (OR = 0.24 [95% CI: 0.11-0.50]; P=0.0001). For patients with a RS < 16, there was a reduction in CT recommendation by 75.0%, and by 44.4% for patients with a RS between 16 - 25 (OR = 0.15 [95% CI: 0.06-0.38]; P< 0.0001). Moreover, RS results led to an increase in confidence in physician treatment decisions for 59.4% of patients (OR = 12.53 [95% CI: 5.46-28.78]; P< 0.0001). Conclusion: We determined that the 21-gene Breast Recurrence Score assay altered neoadjuvant treatment decisions, leading to a reduction in the use of chemotherapy by about one-third, regardless of age. Additionally, the assay increased physician confidence in their treatment recommendation for about 60% of patients. This demonstrates the potential clinical utility of the assay to decrease the use of CT in the neoadjuvant setting amongst HR-positive, node-negative BC patients in Quebec.
Citation Format: Mariya Yordanova, Lucas Sideris, Pierre Dubé, Jean-Francois Boileau, Julie Lemieux, Catalin Mihalcioiu, Sylvie Levesque, Marie-Claude Guertin, Erica Patocskai, Rami Younan, André Robidoux, Saima Hassan. The impact of the 21-gene Recurrence Score® assay upon physician treatment recommendations in the neoadjuvant setting in lymph node-negative breast cancer patients in a multicenter prospective study in Quebec [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-39.
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Affiliation(s)
- Mariya Yordanova
- 1Université de Sherbrooke, Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Lucas Sideris
- 2Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Pierre Dubé
- 3Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Jean-Francois Boileau
- 4Jewish General Hospital Segal Cancer Centre, McGill University, Montréal, Quebec, Canada, Montréal, Quebec, Canada
| | - Julie Lemieux
- 5Oncologist - Centre des maladies du sein du CHU de Québec-Université Laval, Hôpital St-Sacrement, Québec, Quebec, Canada
| | | | - Sylvie Levesque
- 7Montreal Health Innovations Coordinating Center, Montréal, Quebec, Canada
| | | | - Erica Patocskai
- 9Centre hospitaler de l’Université de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Rami Younan
- 10Centre hospitalier de l’Université de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - André Robidoux
- 11Centre hospitaler de l’Université de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Saima Hassan
- 12Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
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Cyr S, Marcil MJ, Houchi C, Marin MF, Rosa C, Tardif JC, Guay S, Guertin MC, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study. BMC Psychiatry 2022; 22:809. [PMID: 36539718 PMCID: PMC9763813 DOI: 10.1186/s12888-022-04457-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later. METHODS We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points. RESULTS Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression. CONCLUSIONS Healthcare workers' occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important factors over time.
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Affiliation(s)
- Samuel Cyr
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Pharmacy, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Marie-Joelle Marcil
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada
| | - Cylia Houchi
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada
| | - Marie-France Marin
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada ,grid.38678.320000 0001 2181 0211Department of Psychology, UQAM, 100 Sherbrooke Street West, Montréal, Québec, H2X 3P2 Canada ,grid.414210.20000 0001 2321 7657Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada
| | - Camille Rosa
- Montreal Health Innovations Coordinating Centre, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada
| | - Jean-Claude Tardif
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Stéphane Guay
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada ,grid.414210.20000 0001 2321 7657Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada
| | - Christine Genest
- grid.414210.20000 0001 2321 7657Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada ,grid.14848.310000 0001 2292 3357Faculty of Nursing, Université de Montréal, Marguerite-d’Youville Pavilion, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, P.O. Box 8888, Downtown Branch, Montreal, Québec, H3C 3P8 Canada
| | - Patrick Lavoie
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Nursing, Université de Montréal, Marguerite-d’Youville Pavilion, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Mélanie Labrosse
- grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada ,grid.411418.90000 0001 2173 6322Department of Pediatrics, Division of Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Sainte-Catherine Road, Montreal, Québec, H3T 1C5 Canada
| | - Alain Vadeboncoeur
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Shaun Selcer
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Simon Ducharme
- grid.412078.80000 0001 2353 5268Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Québec, H4H 1R3 Canada ,grid.416102.00000 0004 0646 3639McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University St, Montreal, Québec, H3A 2B4 Canada
| | - Judith Brouillette
- Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8, Canada. .,Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7, Canada.
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Basmaji S, Samuel M, Shohoudi A, Hamilton RM, Aboulhosn J, Broberg CS, Chaix MA, Cohen S, Cook S, Dore A, Fernandes SM, Fortier A, Fournier A, Guertin MC, Kay J, Mondésert B, Mongeon FP, Opotowsky AR, Proietti A, Ting J, Zaidi A, Khairy P. Time in Therapeutic Range With Vitamin K Antagonists in Congenital Heart Disease: A Multicentre Study. Can J Cardiol 2022; 38:1751-1758. [PMID: 35964887 DOI: 10.1016/j.cjca.2022.08.004] [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] [Received: 01/14/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vitamin K antagonists (VKAs) are frequently prescribed to patients with congenital heart disease (CHD) for atrial arrhythmias or Fontan palliation, but there is a paucity of data regarding time spent in the therapeutic range (TTR). We sought to determine the TTR in patients with CHD and atrial arrhythmias or Fontan palliation prescribed VKAs and explore associations with thromboembolic and bleeding events. METHODS A multicentre North American cohort study was conducted on patients with CHD who received VKAs for sustained atrial arrhythmia or Fontan palliation. TTR was calculated using the Rosendaal linear interpolation method. Generalized estimating equations were used to explore factors associated with time outside the therapeutic range. RESULTS A total of 567 patients, aged 33 ± 17 years, 56% female, received VKAs for 11.5 ± 8.4 years for atrial arrhythmias (63.0%) or Fontan palliation (58.0%). CHD was simple, moderate, and complex in 10.8%, 20.3%, and 69.0%, respectively. Site investigators perceived good control over international normalized ratio (INR) levels in most patients (75.3%), with no or minor compliance or adherence issues (85.6%). The mean TTR was 41.9% (95% confidence interval [CI], 39.0%-44.8%). Forty-seven (8.3%) and 34 (6.0%) patients had thromboembolic and bleeding events, respectively. Thromboembolic events were associated with a higher proportion of time below the therapeutic range (31.3% vs 19.1%, P = 0.003) and bleeding complications with a higher proportion of time above the therapeutic range (32.5% vs 19.5%, P = 0.006). CONCLUSIONS Patients with CHD who receive VKAs spend < 42% of their time with INR levels in the therapeutic range, with repercussions regarding thromboembolic and bleeding complications.
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Affiliation(s)
- Samir Basmaji
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Azadeh Shohoudi
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Robert M Hamilton
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Marie-A Chaix
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Scott Cohen
- The Wisconsin Adult Congenital Heart (WAtCH) Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen Cook
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Annik Fortier
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Anne Fournier
- Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | | | - Joseph Kay
- University of Colorado Denver, Aurora, Colorado, USA
| | - Blandine Mondésert
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Alexander R Opotowsky
- Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Proietti
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jennifer Ting
- Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Ali Zaidi
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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Hassan S, Younan R, Patocskai E, Provencher L, Poirier B, Sideris L, Dubé P, Mihalcioiu C, Chabot-Blanchet M, Guertin MC, Boileau JF, Robidoux A. Impact of the 21-Gene Recurrence Score Assay on Treatment Decisions and Cost in Patients with Node-Positive Breast Cancer: A Multicenter Study in Quebec. Oncologist 2022; 27:822-831. [PMID: 35830543 PMCID: PMC9526502 DOI: 10.1093/oncolo/oyac123] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The 21-gene Breast Recurrence Score (RS) assay, "the assay", has led to a paradigm shift for patients with hormone receptor-positive, node-negative early breast cancer and is emerging as an important tool to assist physician-patient decisions in foregoing chemotherapy in node-positive patients. We wanted to better understand the impact of the RS assay in node-positive patients upon physician treatment decisions and treatment cost in Quebec, Canada. PATIENTS AND METHODS We conducted a multicenter, prospective observational trial for Estrogen/Progesterone Receptor (ER/PR)- positive, Human Epidermal Growth Factor Receptor 2 (HER2)-negative breast cancer patients with 1-3 positive lymph nodes. Physicians completed a questionnaire indicating treatment choice prior to and post availability of RS results. The primary endpoint was change in the physician's recommendation for chemotherapy prior to and post assay results. Secondary endpoints included change in physician's expressed level of confidence, and changes in estimated cost of recommended treatments prior to and post assay results. RESULTS For the entire cohort, physician recommendation for chemotherapy was reduced by an absolute 67.1% by knowledge of the RS assay result (P < .0001). Physician recommendation of chemotherapy was decreased by 75.9% for patients RS result <14 (P < .0001); and 67.5% for patients with RS result 14-25 (P < .0001). Changes in treatment recommendations were associated with an overall reduction in cost by 73.7% per patient, and after incorporating the cost of the RS test, a cost benefit of $823 CAN at 6-month follow-up. CONCLUSION Altogether, we established that the assay led to a two-third reduction in the use of chemotherapy, and was a cost-effective approach for hormone receptor-positive, node-positive breast cancer.
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Affiliation(s)
- Saima Hassan
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de CHUM (CRCHUM), Institut de Cancer de Montréal, Montreal, QC, Canada
| | - Rami Younan
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Erica Patocskai
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Louise Provencher
- McPeak Sirois Group, Montreal, QC, Canada
- Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, QC, Canada
| | - Brigitte Poirier
- McPeak Sirois Group, Montreal, QC, Canada
- Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, QC, Canada
| | - Luca Sideris
- McPeak Sirois Group, Montreal, QC, Canada
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada
| | - Pierre Dubé
- McPeak Sirois Group, Montreal, QC, Canada
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada
| | - Catalin Mihalcioiu
- McPeak Sirois Group, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Jean-François Boileau
- McPeak Sirois Group, Montreal, QC, Canada
- Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - André Robidoux
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de CHUM (CRCHUM), Institut de Cancer de Montréal, Montreal, QC, Canada
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12
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Rautureau Y, Berlatie M, Rivas D, Uy K, Blanchette A, Miquel G, Higgins MÈ, Mecteau M, Nault A, Villeneuve L, Lavoie V, Théberge-Julien G, Brand G, Lapointe L, Denis M, Rosa C, Fortier A, Blondeau L, Guertin MC, Dubé MP, Thorin É, Ledoux J, Rhainds D, Rhéaume É, Tardif JC. Adenylate cyclase type 9 antagonizes cAMP accumulation and regulates endothelial signaling involved in atheroprotection. Cardiovasc Res 2022; 119:450-464. [PMID: 35576489 DOI: 10.1093/cvr/cvac085] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The adenylate cyclase type 9 (ADCY9) gene appears to determine atherosclerotic outcomes in patients treated with dalcetrapib. In mice, we recently demonstrated that Adcy9 inactivation potentiates endothelial function and inhibits atherogenesis. The objective of this study was to characterize the contribution of ADCY9 to the regulation of endothelial signaling pathways involved in atherosclerosis. METHODS AND RESULTS We show that ADCY9 is expressed in the endothelium of mouse aorta and femoral arteries. We demonstrate that ADCY9 inactivation in cultured endothelial cells paradoxically increases cAMP accumulation in response to the adenylate cyclase activators forskolin and vasoactive intestinal peptide (VIP). Reciprocally, ADCY9 overexpression decreases cAMP production. Using mouse femoral artery arteriography, we show that Adcy9 inactivation potentiates VIP-induced endothelial-dependent vasodilation. Moreover, Adcy9 inactivation reduces mouse atheroma endothelial permeability in different vascular beds. ADCY9 overexpression reduces forskolin-induced phosphorylation of Ser157-vasodilator-stimulated phosphoprotein (VASP) and worsens thrombin-induced fall of RAP1 activity, both leading to increased endothelial permeability. ADCY9 inactivation in thrombin-stimulated human coronary artery endothelial cells results in cAMP accumulation, increases p-Ser157-VASP and inhibits endothelial permeability. MLC2 phosphorylation and actin stress fiber increases in response to thrombin were reduced by ADCY9 inactivation, suggesting actin cystoskeleton regulation. Finally, using the Miles assay, we demonstrate that Adcy9 regulates thrombin-induced endothelial permeability in vivo in normal and atherosclerotic animals. CONCLUSION Adcy9 is expressed in endothelial cells and regulates local cAMP and endothelial functions including permeability relevant to atherogenesis.
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Affiliation(s)
- Yohann Rautureau
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Daniel Rivas
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Kurunradeth Uy
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Alexandre Blanchette
- Department of Physiology and Pharmacology, Université de Montréal, Montreal, Canada
| | - Géraldine Miquel
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Mélanie Mecteau
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Audrey Nault
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Louis Villeneuve
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Véronique Lavoie
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Geneviève Brand
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Line Lapointe
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Maxime Denis
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Camille Rosa
- Montreal Health Innovations Coordinating Centre (MHICC), Montreal, Canada
| | - Annik Fortier
- Montreal Health Innovations Coordinating Centre (MHICC), Montreal, Canada
| | - Lucie Blondeau
- Montreal Health Innovations Coordinating Centre (MHICC), Montreal, Canada
| | | | - Marie-Pierre Dubé
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada.,Department of Medicine
| | - Éric Thorin
- Montreal Heart Institute, Université de Montréal, Montreal, Canada.,Department of Surgery of the Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Jonathan Ledoux
- Department of Physiology and Pharmacology, Université de Montréal, Montreal, Canada
| | - David Rhainds
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Éric Rhéaume
- Montreal Heart Institute, Université de Montréal, Montreal, Canada.,Department of Medicine
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Canada.,Department of Medicine
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13
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Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A, Bourfiss M, Fortier A, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, van der Heijden JF, Tandri H, Jongbloed JDH, Guertin MC, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2022; 43:e1-e9. [PMID: 35441664 PMCID: PMC9392651 DOI: 10.1093/eurheartj/ehac180] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 03/01/2019] [Indexed: 12/16/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized by ventricular arrhythmias (VAs) and sudden cardiac death (SCD). We aimed to develop a model for individualized prediction of incident VA/SCD in ARVC patients. METHODS AND RESULTS Five hundred and twenty-eight patients with a definite diagnosis and no history of sustained VAs/SCD at baseline, aged 38.2 ± 15.5 years, 44.7% male, were enrolled from five registries in North America and Europe. Over 4.83 (interquartile range 2.44-9.33) years of follow-up, 146 (27.7%) experienced sustained VA, defined as SCD, aborted SCD, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator (ICD) therapy. A prediction model estimating annual VA risk was developed using Cox regression with internal validation. Eight potential predictors were pre-specified: age, sex, cardiac syncope in the prior 6 months, non-sustained ventricular tachycardia, number of premature ventricular complexes in 24 h, number of leads with T-wave inversion, and right and left ventricular ejection fractions (LVEFs). All except LVEF were retained in the final model. The model accurately distinguished patients with and without events, with an optimism-corrected C-index of 0.77 [95% confidence interval (CI) 0.73-0.81] and minimal over-optimism [calibration slope of 0.93 (95% CI 0.92-0.95)]. By decision curve analysis, the clinical benefit of the model was superior to a current consensus-based ICD placement algorithm with a 20.3% reduction of ICD placements with the same proportion of protected patients (P < 0.001). CONCLUSION Using the largest cohort of patients with ARVC and no prior VA, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs (www.arvcrisk.com).
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Affiliation(s)
- Julia Cadrin-Tourigny
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Laurens P Bosman
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Øyvind H Lie
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Anneli Svensson
- Department of Cardiology, University Hosptial of Linköping, S-581 85 Linköping, Sweden
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands.,Faculty of Population Health Sciences, Institute of Cardiovascular Science, Institute of Health Informatics, University College London, 69-75 Chenies Mews, London, UK
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia 211 - 1033 Davie Street, Vancouver, BC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Stephen Chelko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Jane E Crosson
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, GD, Rotterdam, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - J Peter van Tintelen
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD Amsterdam, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University Hosptial, Lund, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Paul Khairy
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Richard N W Hauer
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Anneline S J M Te Riele
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
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14
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Coulis G, Londhe AD, Sagabala RS, Shi Y, Labbé DP, Bergeron A, Sahadevan P, Nawaito SA, Sahmi F, Josse M, Vinette V, Guertin MC, Karsenty G, Tremblay ML, Tardif JC, Allen BG, Boivin B. Protein tyrosine phosphatase 1B regulates miR-208b-argonaute 2 association and thyroid hormone responsiveness in cardiac hypertrophy. Sci Signal 2022; 15:eabn6875. [PMID: 35439023 DOI: 10.1126/scisignal.abn6875] [Citation(s) in RCA: 4] [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: 12/15/2022]
Abstract
Increased production of reactive oxygen species plays an essential role in the pathogenesis of several diseases, including cardiac hypertrophy. In our search to identify redox-sensitive targets that contribute to redox signaling, we found that protein tyrosine phosphatase 1B (PTP1B) was reversibly oxidized and inactivated in hearts undergoing hypertrophy. Cardiomyocyte-specific deletion of PTP1B in mice (PTP1B cKO mice) caused a hypertrophic phenotype that was exacerbated by pressure overload. Furthermore, we showed that argonaute 2 (AGO2), a key component of the RNA-induced silencing complex, was a substrate of PTP1B in cardiomyocytes and in the heart. Our results revealed that phosphorylation at Tyr393 and inactivation of AGO2 in PTP1B cKO mice prevented miR-208b-mediated repression of thyroid hormone receptor-associated protein 1 (THRAP1; also known as MED13) and contributed to thyroid hormone-mediated cardiac hypertrophy. In support of this conclusion, inhibiting the synthesis of triiodothyronine (T3) with propylthiouracil rescued pressure overload-induced hypertrophy and improved myocardial contractility and systolic function in PTP1B cKO mice. Together, our data illustrate that PTP1B activity is cardioprotective and that redox signaling is linked to thyroid hormone responsiveness and microRNA-mediated gene silencing in pathological hypertrophy.
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Affiliation(s)
- Gérald Coulis
- Department of Nanobioscience, College of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, NY 12203, USA.,Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | - Avinash D Londhe
- Department of Nanobioscience, College of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, NY 12203, USA
| | - R Sudheer Sagabala
- Department of Nanobioscience, College of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, NY 12203, USA
| | - Yanfen Shi
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | - David P Labbé
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC H3G 1Y6, Canada.,Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 1A3, Canada.,Department of Surgery, Division of Urology, McGill University, Montreal, QC H3G 1Y6, Canada
| | - Alexandre Bergeron
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Pramod Sahadevan
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Sherin A Nawaito
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Pharmacology and Physiology, Université de Montréal, Montréal, QC H3C 3J7, Canada.,Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Fatiha Sahmi
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | - Marie Josse
- Department of Nanobioscience, College of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, NY 12203, USA
| | - Valérie Vinette
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 1A3, Canada.,Department of Biochemistry, McGill University, Montreal, QC H3G 1Y6, Canada
| | | | - Gérard Karsenty
- Department of Genetics and Development, Columbia University, New York, NY 10032, USA
| | - Michel L Tremblay
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 1A3, Canada.,Department of Biochemistry, McGill University, Montreal, QC H3G 1Y6, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Bruce G Allen
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada.,Pharmacology and Physiology, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Benoit Boivin
- Department of Nanobioscience, College of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, NY 12203, USA.,Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
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15
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Marcil MJ, Cyr S, Marin MF, Rosa C, Tardif JC, Guay S, Guertin MC, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Hair cortisol change at COVID-19 pandemic onset predicts burnout among health personnel. Psychoneuroendocrinology 2022; 138:105645. [PMID: 35134663 PMCID: PMC8697418 DOI: 10.1016/j.psyneuen.2021.105645] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked. METHODS 467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors. RESULTS As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% (IQR = 3-59%, p < 0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model's predictability. CONCLUSION Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.
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Affiliation(s)
- Marie-Joëlle Marcil
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Samuel Cyr
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Pharmacy, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Marie-France Marin
- Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Department of Psychology, UQAM, 100 Sherbrooke Street West, Montréal, H2X 3P2 Québec, Canada,Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada
| | - Camille Rosa
- Montreal Health Innovations Coordinating Centre, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Stéphane Guay
- Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada
| | - Christine Genest
- Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada,Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Pavilion, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, P.O. Box 8888, Downtown Branch, Montréal, H3C 3P8 Québec, Canada
| | - Patrick Lavoie
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Pavilion, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Mélanie Labrosse
- Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Division of Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Sainte-Catherine Road, Montréal, H3T 1C5 Québec, Canada
| | - Alain Vadeboncoeur
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Shaun Selcer
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, H4H 1R3 Québec, Canada,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University St, Montréal, H3A 2B4 Québec, Canada
| | - Judith Brouillette
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada.
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16
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Vrinceanu T, Khairy P, Roy D, Payer M, Gagnon C, Kaushal N, Talajic M, Tardif JC, Nattel S, Black SE, Healey J, Lanthier S, Andrade J, Massoud F, Nault I, Guertin MC, Dorian P, Kouz S, Essebag V, Ellenbogen KA, Racine N, Nozza A, Bherer L, Rivard L. Pattern of Atrial Fibrillation and Cognitive Function in Young Patients With Atrial Fibrillation and Low CHADS 2 Score: Insights From the BRAIN-AF Trial. Circ Arrhythm Electrophysiol 2022; 15:e010462. [PMID: 35089051 DOI: 10.1161/circep.121.010462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tudor Vrinceanu
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada (T.V., M.P., C.G., L.B.)
| | - Paul Khairy
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Denis Roy
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Marie Payer
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada (T.V., M.P., C.G., L.B.)
| | - Christine Gagnon
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada (T.V., M.P., C.G., L.B.)
| | - Navin Kaushal
- Department of Health Sciences, School of Health and Human Sciences, Indiana University, Indianapolis (N.K.)
| | - Mario Talajic
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Jean-Claude Tardif
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Stanley Nattel
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.B.)
| | - Jeffrey Healey
- University of British Columbia, Vancouver, Canada (J.A.)
| | - Sylvain Lanthier
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada
| | | | - Fadi Massoud
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Canada (I.N.)
| | - Marie-Claude Guertin
- Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Paul Dorian
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Ontario, Canada (P.D.)
| | - Simon Kouz
- Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Vidal Essebag
- McGill University Health Centre, Hôpital du Sacré-Coeur de Montréal, Quebec, Canada (V.E.)
| | | | - Normand Racine
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Anna Nozza
- Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada
| | - Louis Bherer
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada (T.V., M.P., C.G., L.B.)
| | - Léna Rivard
- Department of Medicine (T.V., P.K., D.R., M.P., C.G., M.T., J.-C.T., S.N., S.L., F.M., N.R., L.B., L.R.), Université de Montréal, Quebec, Canada.,Research Centre, Montreal Heart Institute (T.V., M.P., C.G., J.-C.T., M.-C.G., S.K., A.N., L.B., L.R.), Université de Montréal, Quebec, Canada
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Tardif JC, Cossette M, Guertin MC, Bouabdallaoui N, Dubé MP, Boivin G. Predictive risk factors for hospitalization and response to colchicine in patients with COVID-19. Int J Infect Dis 2022; 116:387-390. [PMID: 35038601 PMCID: PMC8758567 DOI: 10.1016/j.ijid.2022.01.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE A predictive model for hospitalization due to COVID-19 or death was developed in the placebo group (N=2084) from a large clinical trial of colchicine in COVID-19 patients (N = 4159). RESULTS The seven variables retained in the predictive model were age, sex, body-mass index, history of respiratory disease, use of diabetes drugs, use of anticoagulants and use of oral steroids at the time of randomization. An optimal threshold value identified from the predictive model was used to classify high-risk patients (those with a predicted probability above the optimal threshold) and low-risk patients (those with a predicted probability below the optimal threshold). The number needed to treat to prevent one hospitalization or death with colchicine treatment decreased from 71 in the whole study population (N = 4159) to 29 in the high-risk subgroup (N=1692). CONCLUSION This model could serve to identify high-risk subjects who will particularly benefit from early colchicine therapy.
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Affiliation(s)
- Jean-Claude Tardif
- Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
| | - Mariève Cossette
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, QC, Canada
| | | | | | - Marie-Pierre Dubé
- Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
| | - Guy Boivin
- Research Center in Infectious Diseases, CHU de Québec and Université Laval, Quebec City, QC, Canada..
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Rivard L, Samuel M, Fortier A, Guertin MC, Khairy P, Roy D, Talajic M, Tardif JC. Effect of Perindopril on Atrial Fibrillation Recurrence and Burden: Results of the Canadian Trial of Atrial Fibrillation (CTAF)-2. CJC Open 2021; 3:1100-1107. [PMID: 34712936 PMCID: PMC8531231 DOI: 10.1016/j.cjco.2021.04.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Hypertension is a risk factor for the development and exacerbation of atrial fibrillation (AF). Angiotensin-converting enzyme inhibitors are a standard-of-care treatment option for patients with hypertension; however, there is conflicting evidence about their effects on AF recurrence. Therefore, our objective was to assess the efficacy of perindopril, compared with placebo, to reduce AF recurrence in patients with hypertension and AF. Methods In a multicenter, double-blind, placebo-controlled trial, patients with hypertension and symptomatic AF were randomly assigned (1:1) to perindopril or placebo based on a stratification factor of antiarrhythmic drug use. Patients with terminated AF were followed up from 30 days after randomization to 7 to 13 months. The primary endpoint was AF recurrence. Secondary endpoints included AF hospitalization, cardioversion, and blood pressure control. Recurrent events, AF burden, and safety endpoints were also investigated. Results A total of 315 patients were randomly assigned, and 301 patients were included in the modified intent-to-treat analysis (155 vs 146 patients in the perindopril and placebo groups, respectively). The mean follow-up was 336 ± 70 days, and 91.1% of patients were compliant to the treatment medication throughout the study. After adjustment for baseline antiarrhythmic drugs, there was no statistically significant difference in the hazards of AF recurrence (hazard ratio, 1.22; 95% confidence interval, 0.92-1.61), with similar blood pressure. The incidence of secondary endpoints and adverse events also did not differ between treatment arms. Conclusions Perindopril does not reduce recurrence or the number of AF episodes in patients with hypertension and AF.
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Affiliation(s)
- Lena Rivard
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Michelle Samuel
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul Khairy
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Roy
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mario Talajic
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- Corresponding author: Dr Jean-Claude Tardif, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada. Tel.: 514 376-3330; Fax: 514 376-1355.
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Morisson L, Laferrière-Langlois P, Carrier FM, Pagé G, Godbout C, Fortier LP, Ogez D, Létourneau G, Jarry S, Denault A, Fortier A, Guertin MC, Verdonck O, Richebé P. Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia). PLoS One 2021; 16:e0255852. [PMID: 34375362 PMCID: PMC8354438 DOI: 10.1371/journal.pone.0255852] [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] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The number of elderly patients undergoing major surgery is rapidly increasing. They are particularly at risk of developing postoperative neurocognitive disorders (NCD). Earlier studies suggested that processed electroencephalographic (EEG) monitors may reduce the incidence of postoperative NCD. However, none of these studies controlled for intraoperative nociception levels or personalized blood pressure targets. Their results remain unclear if the reduction in the incidence of postoperative NCD relates to avoidance of any electroencephalographic pattern suggesting excessive anesthesia depth. Objective The objective of this trial is to investigate–in patients ≥ 70 years old undergoing major non-cardiac surgery–the effect of EEG-guided anesthesia on postoperative NCD while controlling for intraoperative nociception, personalized blood pressure targets, and using detailed information provided by the EEG monitor (including burst suppression ratio, density spectral array, and raw EEG waveform). Material and methods This prospective, randomized, controlled trial will be conducted in a single Canadian university hospital. Patients ≥ 70 years old undergoing elective major non-cardiac surgery will be included in the trial. The administration of sevoflurane will be adjusted to maintain a BIS index value between 40 and 60, to keep a Suppression Ratio (SR) at 0%, to keep a direct EEG display without any suppression time and a spectrogram with most of the EEG wave frequency within the alpha, theta, and delta frequencies in the EEG-guided group. In the control group, sevoflurane will be administered to achieve an age-adjusted minimum alveolar concentration of [0.8–1.2]. In both groups, a nociception monitor will guide intraoperative opioid administration, individual blood pressure targets will be used, and cerebral oximetry used to tailor intraoperative hemodynamic management. The primary endpoint will be the incidence of NCD at postoperative day 1, as evaluated by the Montreal Cognitive Assessment (MoCA). Secondary endpoints will include the incidence of postoperative NCD at different time points and the evaluation of cognitive trajectories up to 90 days after surgery among EEG-guided and control groups. Study registration NCT04825847 on ClinicalTrials.gov.
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Affiliation(s)
- Louis Morisson
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Pascal Laferrière-Langlois
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
| | - François Martin Carrier
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Department of Anesthesiology and Department of Medicine, Critical Care Division, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Research Center of the CHUM (Centre Hospitalier de l’Université de Montréal), Université de Montréal, Montréal, Québec, Canada
| | - Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CHUM (Centre Hospitalier de l’Université de Montréal), Université de Montréal, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Cédric Godbout
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Louis-Philippe Fortier
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - David Ogez
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Létourneau
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Jarry
- Department of Anesthesiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - André Denault
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Department of Anesthesiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - Annik Fortier
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, Québec, Canada
| | - Marie-Claude Guertin
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, Québec, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- * E-mail:
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Sbeghen V, Verdonck O, McDevitt J, Zaphiratos V, Brulotte V, Loubert C, Tanoubi I, Drolet P, Belanger ME, Fortier LP, Godin N, Guertin MC, Fortier A, Richebé P. A randomized controlled trial comparing nociception level (NOL) index, blood pressure, and heart rate responses to direct laryngoscopy versus videolaryngoscopy for intubation: the NOLint project. Can J Anaesth 2021; 68:855-867. [PMID: 33709262 DOI: 10.1007/s12630-021-01936-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The effect of direct laryngoscopy using a Macintosh blade (MAC) vs GlideScope™ videolaryngoscopy using a Spectrum LoPro blade (GVL) on nociceptive stimulation has not been quantitatively studied. This study used the new nociception level (NOL) index to compare the nociceptive response induced by GVL or MAC during laryngoscopy with or without intubation. METHODS Patients underwent two laryngoscopies at four-minute intervals (L1, L2), one with GVL and the other with MAC (first randomization). A third laryngoscopy (L3) followed by tracheal intubation was performed four minutes after L2 (GVL or MAC, second randomization). Nociception was quantitatively assessed by NOL and standard hemodynamic parameters (heart rate [HR] and mean arterial pressure). For the crossover design, blade comparisons accounted for sequence and blade type. A possible carryover effect between laryngoscopies was assessed. RESULTS In the 50 patients randomized, there was no carryover effect from one laryngoscopy to the next for all analyzed parameters. Nociception level index peak values were higher with MAC than GVL. Analysis of ΔNOL showed a lower nociceptive response with GVL for L1+L2 combined. Mean peak NOL values were significantly higher after L3+intubation than after L1+L2, for both GVL and MAC groups. Analysis of ΔHR values did not show a significant difference between GVL and MAC for any laryngoscopy. CONCLUSION Laryngoscopy alone with GVL induces less nociception than with MAC. The NOL was more sensitive than HR at detecting nociceptive responses to MAC vs GVL. Additionally, and irrespective of which technique/blade was used, the combination of laryngoscopy + tracheal intubation produced a much greater nociceptive response than the laryngoscopy alone. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03277872); registered 29 August 2017.
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Affiliation(s)
- Virginie Sbeghen
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Jason McDevitt
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Valérie Zaphiratos
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Véronique Brulotte
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Christian Loubert
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Issam Tanoubi
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Pierre Drolet
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Marie-Eve Belanger
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Louis-Philippe Fortier
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Nadia Godin
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Marie-Claude Guertin
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, QC, Canada
| | - Annik Fortier
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, QC, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
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Tardif JC, Bouabdallaoui N, L'Allier PL, Gaudet D, Shah B, Pillinger MH, Lopez-Sendon J, da Luz P, Verret L, Audet S, Dupuis J, Denault A, Pelletier M, Tessier PA, Samson S, Fortin D, Tardif JD, Busseuil D, Goulet E, Lacoste C, Dubois A, Joshi AY, Waters DD, Hsue P, Lepor NE, Lesage F, Sainturet N, Roy-Clavel E, Bassevitch Z, Orfanos A, Stamatescu G, Grégoire JC, Busque L, Lavallée C, Hétu PO, Paquette JS, Deftereos SG, Levesque S, Cossette M, Nozza A, Chabot-Blanchet M, Dubé MP, Guertin MC, Boivin G. Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial. Lancet Respir Med 2021. [PMID: 34051877 DOI: 10.1101/2021.01.26.21250494] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence suggests a role for excessive inflammation in COVID-19 complications. Colchicine is an oral anti-inflammatory medication beneficial in gout, pericarditis, and coronary disease. We aimed to investigate the effect of colchicine on the composite of COVID-19-related death or hospital admission. METHODS The present study is a phase 3, randomised, double-blind, adaptive, placebo-controlled, multicentre trial. The study was done in Brazil, Canada, Greece, South Africa, Spain, and the USA, and was led by the Montreal Heart Institute. Patients with COVID-19 diagnosed by PCR testing or clinical criteria who were not being treated in hospital were eligible if they were at least 40 years old and had at least one high-risk characteristic. The randomisation list was computer-generated by an unmasked biostatistician, and masked randomisation was centralised and done electronically through an automated interactive web-response system. The allocation sequence was unstratified and used a 1:1 ratio with a blocking schema and block sizes of six. Patients were randomly assigned to receive orally administered colchicine (0·5 mg twice per day for 3 days and then once per day for 27 days thereafter) or matching placebo. The primary efficacy endpoint was the composite of death or hospital admission for COVID-19. Vital status at the end of the study was available for 97·9% of patients. The analyses were done according to the intention-to-treat principle. The COLCORONA trial is registered with ClinicalTrials.gov (NCT04322682) and is now closed to new participants. FINDINGS Trial enrolment began in March 23, 2020, and was completed in Dec 22, 2020. A total of 4488 patients (53·9% women; median age 54·0 years, IQR 47·0-61·0) were enrolled and 2235 patients were randomly assigned to colchicine and 2253 to placebo. The primary endpoint occurred in 104 (4·7%) of 2235 patients in the colchicine group and 131 (5·8%) of 2253 patients in the placebo group (odds ratio [OR] 0·79, 95·1% CI 0·61-1·03; p=0·081). Among the 4159 patients with PCR-confirmed COVID-19, the primary endpoint occurred in 96 (4·6%) of 2075 patients in the colchicine group and 126 (6·0%) of 2084 patients in the placebo group (OR 0·75, 0·57-0·99; p=0·042). Serious adverse events were reported in 108 (4·9%) of 2195 patients in the colchicine group and 139 (6·3%) of 2217 patients in the placebo group (p=0·051); pneumonia occurred in 63 (2·9%) of 2195 patients in the colchicine group and 92 (4·1%) of 2217 patients in the placebo group (p=0·021). Diarrhoea was reported in 300 (13·7%) of 2195 patients in the colchicine group and 161 (7·3%) of 2217 patients in the placebo group (p<0·0001). INTERPRETATION In community-treated patients including those without a mandatory diagnostic test, the effect of colchicine on COVID-19-related clinical events was not statistically significant. Among patients with PCR-confirmed COVID-19, colchicine led to a lower rate of the composite of death or hospital admission than placebo. Given the absence of orally administered therapies to prevent COVID-19 complications in community-treated patients and the benefit of colchicine in patients with PCR-proven COVID-19, this safe and inexpensive anti-inflammatory agent could be considered for use in those at risk of complications. Notwithstanding these considerations, replication in other studies of PCR-positive community-treated patients is recommended. FUNDING The Government of Quebec, the Bill & Melinda Gates Foundation, the National Heart, Lung, and Blood Institute of the US National Institutes of Health, the Montreal Heart Institute Foundation, the NYU Grossman School of Medicine, the Rudin Family Foundation, and philanthropist Sophie Desmarais.
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Affiliation(s)
| | | | | | - Daniel Gaudet
- Ecogene-21, Université de Montréal, Montreal, QC, Canada; Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Binita Shah
- New York University Grossman School of Medicine, New York, NY, USA
| | | | | | - Protasio da Luz
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Lucie Verret
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Sylvia Audet
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Jocelyn Dupuis
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - André Denault
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Martin Pelletier
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Philippe A Tessier
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Sarah Samson
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Denis Fortin
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | | | - David Busseuil
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Elisabeth Goulet
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Chantal Lacoste
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Anick Dubois
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | | | | | | | - Norman E Lepor
- Cedars-Sinai Heart Institute, Geffen School of Medicine-UCLA, Los Angeles, CA, USA
| | - Frédéric Lesage
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Nicolas Sainturet
- Montréal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Eve Roy-Clavel
- Montréal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Zohar Bassevitch
- Montréal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Andreas Orfanos
- Montréal Health Innovations Coordinating Center, Montreal, QC, Canada
| | | | - Jean C Grégoire
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Lambert Busque
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada
| | - Christian Lavallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada
| | | | | | - Spyridon G Deftereos
- Second Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sylvie Levesque
- Montréal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Mariève Cossette
- Montréal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Anna Nozza
- Montréal Health Innovations Coordinating Center, Montreal, QC, Canada
| | | | - Marie-Pierre Dubé
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | | | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
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22
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Dubé MP, Lemaçon A, Barhdadi A, Lemieux Perreault LP, Oussaïd E, Asselin G, Provost S, Sun M, Sandoval J, Legault MA, Mongrain I, Dubois A, Valois D, Dedelis E, Lousky J, Choi J, Goulet E, Savard C, Chicoine LM, Cossette M, Chabot-Blanchet M, Guertin MC, de Denus S, Bouabdallaoui N, Marchand R, Bassevitch Z, Nozza A, Gaudet D, L'Allier PL, Hussin J, Boivin G, Busseuil D, Tardif JC. Genetics of symptom remission in outpatients with COVID-19. Sci Rep 2021; 11:10847. [PMID: 34035401 PMCID: PMC8149390 DOI: 10.1038/s41598-021-90365-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/11/2021] [Indexed: 01/09/2023] Open
Abstract
We conducted a genome-wide association study of time to remission of COVID-19 symptoms in 1723 outpatients with at least one risk factor for disease severity from the COLCORONA clinical trial. We found a significant association at 5p13.3 (rs1173773; P = 4.94 × 10-8) near the natriuretic peptide receptor 3 gene (NPR3). By day 15 of the study, 44%, 54% and 59% of participants with 0, 1, or 2 copies of the effect allele respectively, had symptom remission. In 851 participants not treated with colchicine (placebo), there was a significant association at 9q33.1 (rs62575331; P = 2.95 × 10-8) in interaction with colchicine (P = 1.19 × 10-5) without impact on risk of hospitalisations, highlighting a possibly shared mechanistic pathway. By day 15 of the study, 46%, 62% and 64% of those with 0, 1, or 2 copies of the effect allele respectively, had symptom remission. The findings need to be replicated and could contribute to the biological understanding of COVID-19 symptom remission.
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Affiliation(s)
- Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada. .,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada. .,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.
| | - Audrey Lemaçon
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Amina Barhdadi
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Louis-Philippe Lemieux Perreault
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Essaïd Oussaïd
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Géraldine Asselin
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Sylvie Provost
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Maxine Sun
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Johanna Sandoval
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Marc-André Legault
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Ian Mongrain
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Anick Dubois
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Diane Valois
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Emma Dedelis
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Jennifer Lousky
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Julie Choi
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Elisabeth Goulet
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada
| | - Christiane Savard
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada
| | - Lea-Mei Chicoine
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada
| | - Mariève Cossette
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Montreal Health Innovations Coordinating Centre, Montreal, Canada
| | - Malorie Chabot-Blanchet
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Montreal Health Innovations Coordinating Centre, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Montreal Health Innovations Coordinating Centre, Montreal, Canada
| | - Simon de Denus
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | | | - Richard Marchand
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada
| | - Zohar Bassevitch
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Montreal Health Innovations Coordinating Centre, Montreal, Canada
| | - Anna Nozza
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Montreal Health Innovations Coordinating Centre, Montreal, Canada
| | - Daniel Gaudet
- Ecogene-21 and Department of Medicine, Université de Montréal, Chicoutimi, Canada
| | | | - Julie Hussin
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Guy Boivin
- Centre Hospitalier de l'Université Laval, Quebec City, Canada
| | - David Busseuil
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8, Canada. .,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.
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23
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Nachar W, Merlet N, Maafi F, Mihalache-Avram T, Mecteau M, Gélinas D, Shi Y, Brodeur M, Alem S, Blondeau L, Cossette M, Guertin MC, Rhainds D, Busseuil D, Rhéaume E, Tardif JC. ApoA-I mimetic does not improve left ventricular diastolic dysfunction in rabbits without aortic valve stenosis. Int J Cardiol 2021; 331:199-205. [PMID: 33421451 DOI: 10.1016/j.ijcard.2020.12.089] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We previously demonstrated that high-density lipoprotein (HDL) infusions may improve left ventricular diastolic dysfunction (LVDD) in an aortic valve stenosis (AVS) model. Whether the benefit was direct or mediated by the observed reduction in AVS severity is not clear. Here, we aimed to test the direct effect of an ApoA-I mimetic on LVDD in the absence of AVS. METHODS Rabbits were exposed to three different protocols to develop LVDD. First, rabbits were exposed to 0.5% cholesterol-rich diet for an average of 17 weeks. Second, rabbits were subjected to surgical ascending aortic constriction (AAC), to mimic the effect of fixed reduced aortic valve area, and studied after 10 weeks. The third model combined both cholesterol-enriched diet (for 12 weeks) and surgical AAC. The control group consisted of age-matched rabbits under normal diet. After development of LVDD, rabbits were randomized to receive infusions of saline or apoA-I mimetic (25 mg/kg) 3 times per week for 4 weeks. Detailed cardiac structure and function measurements were assessed at baseline and weekly during treatment period. Histological and molecular analyses were performed on LV samples. RESULTS In the three models, echocardiographic results showed development of LVDD over time, with preserved LV systolic and aortic valve functions versus controls. ApoA-I mimetic infusions did not significantly improve echocardiographic parameters nor molecular markers of cardiac inflammation, oxidative stress and fibrosis. CONCLUSION ApoA-I mimetic therapy did not directly improve LVDD. These results indicate that previously observed changes of LVDD were caused by AVS improvement induced by this treatment.
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Affiliation(s)
- Walid Nachar
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada; Department of medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal H3T 1J4, Canada
| | - Nolwenn Merlet
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - Foued Maafi
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada; Department of medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal H3T 1J4, Canada
| | | | - Mélanie Mecteau
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - Danielle Gélinas
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - Yanfen Shi
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - Mathieu Brodeur
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - Sonia Alem
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - Lucie Blondeau
- Montreal Health Innovations Coordinating Centre (MHICC), 4100 Molson Street, Montreal H1Y 3N1, Canada
| | - Mariève Cossette
- Montreal Health Innovations Coordinating Centre (MHICC), 4100 Molson Street, Montreal H1Y 3N1, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre (MHICC), 4100 Molson Street, Montreal H1Y 3N1, Canada
| | - David Rhainds
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - David Busseuil
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada
| | - Eric Rhéaume
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada; Department of medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal H3T 1J4, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal H1T 1C8, Canada; Department of medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal H3T 1J4, Canada.
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24
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Samuel M, Tardif JC, Bouabdallaoui N, Khairy P, Dubé MP, Blondeau L, Guertin MC. Colchicine for Secondary Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Can J Cardiol 2021; 37:776-785. [DOI: 10.1016/j.cjca.2020.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
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25
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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26
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Dubé MP, Legault MA, Lemaçon A, Lemieux Perreault LP, Fouodjio R, Waters DD, Kouz S, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, Kiwan GS, Asselin G, Provost S, Barhdadi A, Sun M, Cossette M, Blondeau L, Mongrain I, Dubois A, Rhainds D, Bouabdallaoui N, Samuel M, de Denus S, L'Allier PL, Guertin MC, Roubille F, Tardif JC. Pharmacogenomics of the Efficacy and Safety of Colchicine in COLCOT. Circ Genom Precis Med 2021; 14:e003183. [PMID: 33560138 PMCID: PMC8284376 DOI: 10.1161/circgen.120.003183] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The randomized, placebo-controlled COLCOT (Colchicine Cardiovascular Outcomes Trial) has shown the benefits of colchicine 0.5 mg daily to lower the rate of ischemic cardiovascular events in patients with a recent myocardial infarction. Here, we conducted a post hoc pharmacogenomic study of COLCOT with the aim to identify genetic predictors of the efficacy and safety of treatment with colchicine. Methods: There were 1522 participants of European ancestry from the COLCOT trial available for the pharmacogenomic study of COLCOT trial. The pharmacogenomic study’s primary cardiovascular end point was defined as for the main trial, as time to first occurrence of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina requiring coronary revascularization. The safety end point was time to the first report of gastrointestinal events. Patients’ DNA was genotyped using the Illumina Global Screening array followed by imputation. We performed a genome-wide association study in colchicine-treated patients. Results: None of the genetic variants passed the genome-wide association study significance threshold for the primary cardiovascular end point conducted in 702 patients in the colchicine arm who were compliant to medication. The genome-wide association study for gastrointestinal events was conducted in all 767 patients in the colchicine arm and found 2 significant association signals, one with lead variant rs6916345 (hazard ratio, 1.89 [95% CI, 1.52–2.35], P=7.41×10−9) in a locus which colocalizes with Crohn disease, and one with lead variant rs74795203 (hazard ratio, 2.51 [95% CI, 1.82–3.47]; P=2.70×10−8), an intronic variant in gene SEPHS1. The interaction terms between the genetic variants and treatment with colchicine versus placebo were significant. Conclusions: We found 2 genomic regions associated with gastrointestinal events in patients treated with colchicine. Those findings will benefit from replication to confirm that some patients may have genetic predispositions to lower tolerability of treatment with colchicine.
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Affiliation(s)
- Marie-Pierre Dubé
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada.,Department of Medicine (M.-P.D., A.L., M.S., N.B., M.S., J.-C.T.), Université de Montréal, Canada
| | - Marc-André Legault
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada.,Departments of Biochemistry and Molecular Medicine, Faculty of Medicine (M.-A.L.), Université de Montréal, Canada
| | - Audrey Lemaçon
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada.,Department of Medicine (M.-P.D., A.L., M.S., N.B., M.S., J.-C.T.), Université de Montréal, Canada
| | - Louis-Philippe Lemieux Perreault
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada
| | - René Fouodjio
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Canada (S.K.)
| | - Fausto J Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Portugal (F.J.P.)
| | - Aldo P Maggioni
- Maria Cecilia Hospital, GVM Care and Research, Italy (A.P.M.)
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina (R.D.)
| | - Colin Berry
- University of Glasgow, NHS Glasgow Clinical Research Facility, United Kingsom (C.B.)
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K.).,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (W.K.).,Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
| | | | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.)
| | | | - Géraldine Asselin
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada
| | - Sylvie Provost
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada
| | - Amina Barhdadi
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada
| | - Maxine Sun
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada.,Department of Medicine (M.-P.D., A.L., M.S., N.B., M.S., J.-C.T.), Université de Montréal, Canada
| | - Mariève Cossette
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Montreal Health Innovation Coordinating Centre, Canada (M.C., L.B., M.-C.G.)
| | - Lucie Blondeau
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Montreal Health Innovation Coordinating Centre, Canada (M.C., L.B., M.-C.G.)
| | - Ian Mongrain
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada
| | - Anick Dubois
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada
| | - David Rhainds
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada
| | - Nadia Bouabdallaoui
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Department of Medicine (M.-P.D., A.L., M.S., N.B., M.S., J.-C.T.), Université de Montréal, Canada
| | - Michelle Samuel
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Department of Medicine (M.-P.D., A.L., M.S., N.B., M.S., J.-C.T.), Université de Montréal, Canada
| | - Simon de Denus
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., I.M., A.D., S.d.D.), Université de Montréal, Canada.,Université de Montréal, Faculty of Pharmacy, Canada (S.d.D.)
| | - Philippe L L'Allier
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada
| | - Marie-Claude Guertin
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Montreal Health Innovation Coordinating Centre, Canada (M.C., L.B., M.-C.G.)
| | - François Roubille
- PhyMedExp (Physiologie et Médecine Expérimentale du Coeur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, France (F.R.)
| | - Jean-Claude Tardif
- Montreal Heart Institute (M.-P.D., M.-A.L., A.L., L.-P.L.P., R.F., G.A., S.P., A.B., M.S., M.C., L.B., I.M., A.D., D.R., N.B., M.S., S.d.D., P.L.L., M.-C.G., J.-C.T.), Université de Montréal, Canada.,Department of Medicine (M.-P.D., A.L., M.S., N.B., M.S., J.-C.T.), Université de Montréal, Canada
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27
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Cyr S, Marcil MJ, Marin MF, Tardif JC, Guay S, Guertin MC, Rosa C, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Factors Associated With Burnout, Post-traumatic Stress and Anxio-Depressive Symptoms in Healthcare Workers 3 Months Into the COVID-19 Pandemic: An Observational Study. Front Psychiatry 2021; 12:668278. [PMID: 34305675 PMCID: PMC8295587 DOI: 10.3389/fpsyt.2021.668278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: This study examined how best to identify modifiable protective and risk factors for burnout in healthcare workers in the face of the COVID-19 pandemic. Individual, occupational, organizational and social factors were investigated. The study also assessed the impact of these factors on post-traumatic stress disorder (PTSD), anxiety, and depression. Methods: Healthcare workers in the Quebec (Canada) healthcare system were recruited between May 21 to June 5, 2020. Participants answered an electronic survey 3 months after the COVID-19 epidemic outbreak began in Canada. Using the Maslach Burnout Inventory, PTSD Checklist for DSM-5, and Hospital Anxiety and Depression Scale, we studied the prevalence of burnout, PTSD, anxiety and depression in this cohort. Multivariable logistic or linear regression models including resilience, social and organizational support, workload and access to mental health help, simulation techniques and protective personal equipment (PPE) as well as perception of PPE security were conducted for each outcome. Results: In mid-June 2020, 467 participants completed the survey. We found that half (51.8%) of the respondents experienced burnout characterized by emotional exhaustion and/or depersonalization at least once a week. In total, 158 healthcare workers (35.6%) displayed severe symptoms of at least one of the mental health disorders (24.3% PTSD, 23.3% anxiety, 10.6% depression). Resilience (OR = 0.69, 95% CI: [0.55-0.87]; p = 0.002) and perceived organizational support (OR = 0.75, 95% CI: [0.61-0.93]; p = 0.009) were significantly associated with burnout and other outcomes. Social support satisfaction, perception of PPE security, work type and environment, mental health antecedents and reassignment were associated with PTSD and/or anxiety and/or depression, but not burnout. Conclusion: Future studies should address primarily resilience and perceived organizational support to promote mental health and prevent burnout, PTSD, anxiety and depression.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Marie-Joelle Marcil
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Marie-France Marin
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Research Center, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
| | - Jean-Claude Tardif
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Guay
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada.,Centre D'étude sur le Trauma, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | | | - Camille Rosa
- Montreal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Christine Genest
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, Montreal, QC, Canada
| | - Patrick Lavoie
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Mélanie Labrosse
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, QC, Canada
| | - Alain Vadeboncoeur
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Shaun Selcer
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
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28
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Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, Kiwan GS, Blondeau L, Orfanos A, Ibrahim R, Grégoire JC, Dubé MP, Samuel M, Morel O, Lim P, Bertrand OF, Kouz S, Guertin MC, L’Allier PL, Roubille F. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J 2020; 41:4092-4099. [PMID: 32860034 PMCID: PMC7700755 DOI: 10.1093/eurheartj/ehaa659] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. METHODS AND RESULTS In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05). CONCLUSION Patients benefit from early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION COLCOT ClinicalTrials.gov number, NCT02551094.
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | | | - Fausto J Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Colin Berry
- University of Glasgow and NHS Glasgow Clinical Research Facility, Glasgow, UK
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Lucie Blondeau
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Andreas Orfanos
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Pascal Lim
- Department of Cardiology, AP-HP, Hôpital Universitaire Henri-Mondor and INSERM U955, Université Paris-Est Créteil, Créteil, France
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Canada
| | | | - Philippe L L’Allier
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
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29
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Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A, Bourfiss M, Fortier A, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, van der Heijden JF, Tandri H, Jongbloed JDH, Guertin MC, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2020; 40:1850-1858. [PMID: 30915475 PMCID: PMC6568197 DOI: 10.1093/eurheartj/ehz103] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 03/01/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Julia Cadrin-Tourigny
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Laurens P Bosman
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Øyvind H Lie
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Anneli Svensson
- Department of Cardiology, University Hosptial of Linköping, S-581 85 Linköping, Sweden
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands.,Faculty of Population Health Sciences, Institute of Cardiovascular Science, Institute of Health Informatics, University College London, 69-75 Chenies Mews, London, UK
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia 211 - 1033 Davie Street, Vancouver, BC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Stephen Chelko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Jane E Crosson
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, GD, Rotterdam, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - J Peter van Tintelen
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD Amsterdam, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University Hosptial, Lund, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Paul Khairy
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Richard N W Hauer
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Anneline S J M Te Riele
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
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30
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Samuel M, Tardif JC, Khairy P, Roubille F, Waters DD, Grégoire JC, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Ostadal P, Lopez-Sendon J, Gamra H, Kiwan GS, Dubé MP, Provencher M, Orfanos A, Blondeau L, Kouz S, L'Allier PL, Ibrahim R, Bouabdallaoui N, Mitchell D, Guertin MC, Lelorier J. Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J Qual Care Clin Outcomes 2020; 7:486-495. [PMID: 32407460 PMCID: PMC8445085 DOI: 10.1093/ehjqcco/qcaa045] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022]
Abstract
Aims In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine (0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy. Methods and results A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy. Conclusion Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.
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Affiliation(s)
- Michelle Samuel
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - François Roubille
- Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Cardiology Department, CHU Arnaud de Villeneuve, 371, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France
| | - David D Waters
- San Francisco General Hospital, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Jean C Grégoire
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Fausto J Pinto
- Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Aldo P Maggioni
- ANMCO Research Center, Via La Marmora 34, 50121 Firenze, Italy
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Paraguay 160, 2000, Rosario, Argentina
| | - Colin Berry
- University of Glasgow and NHS Glasgow Clinical Research Facility, 126 University Pl, University of Glasgow, Glasgow, G12 8TA, Scotland, UK
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Lazarettstr. 36, D-80636 Munchen, Germany
| | - Petr Ostadal
- Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 150 00 Prague, Czech Republic
| | - Jose Lopez-Sendon
- H La Paz, IdiPaz, UAM, Ciber-CV Madrid, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Habib Gamra
- Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia
| | - Ghassan S Kiwan
- Bellevue Medical Center, Qanater Zubayda- Mansouriyeh, Mansourieh, Metn District, Beirut, Lebanon
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Mylène Provencher
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Andreas Orfanos
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Lucie Blondeau
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, 1000 Sainte-Anne Blvd Saint-Charles-Borromée, Quebec J6E 6J2, Canada
| | - Philippe L L'Allier
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Nadia Bouabdallaoui
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Dominic Mitchell
- Logimetrix Inc., 3600 Rhodes Drive Windsor, Ontario N8W 5A4, Canada
| | - Marie-Claude Guertin
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Jacques Lelorier
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St Denis St Montreal, Quebec H2X 0A9, Canada
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Tardif JC, Dubé MP, Pfeffer MA, Waters DD, Koenig W, Maggioni AP, McMurray JJV, Mooser V, White HD, Heinonen T, Black DM, Guertin MC. Study design of Dal-GenE, a pharmacogenetic trial targeting reduction of cardiovascular events with dalcetrapib. Am Heart J 2020; 222:157-165. [PMID: 32087417 DOI: 10.1016/j.ahj.2020.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/15/2020] [Indexed: 11/16/2022]
Abstract
The objectives of precision medicine are to better match patient characteristics with the therapeutic intervention to optimize the chances of beneficial actions while reducing the exposure to unneeded adverse drug experiences. In a retrospective genome-wide association study of the overall neutral placebo-controlled dal-Outcomes trial, the effect of the cholesteryl ester transfer protein (CETP) modulator dalcetrapib on the composite of cardiovascular death, myocardial infarction or stroke was found to be influenced by a polymorphism in the adenylate cyclase type 9 (ADCY9) gene. Whereas patients with the AA genotype at position rs1967309 experienced fewer cardiovascular events with dalcetrapib, those with the GG genotype had an increased rate and the heterozygous AG genotype exhibited no difference from placebo. Measurements of cholesterol efflux and C-reactive protein (CRP) offered directionally supportive genotype-specific findings. In a separate, smaller, placebo-controlled trial, regression of ultrasonography-determined carotid intimal-medial thickness was only observed in dalcetrapib-treated patients with the AA genotype. Collectively, these observations led to the hypothesis that the cardiovascular effects of dalcetrapib may be pharmacogenetically determined, with a favorable benefit-risk ratio only for patients with this specific genotype. We describe below the design of dal-GenE, a precision medicine, placebo-controlled clinical outcome trial of dalcetrapib in patients with a recent acute myocardial infarction with the unique feature of selecting only those with the AA genotype at rs1967309 in the ADCY9 gene.
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Affiliation(s)
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Université de Montréal, Montreal, Canada; University of Montreal Beaulieu-Saucier Pharmacogenomics Center
| | - Marc A Pfeffer
- the Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Vincent Mooser
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Harvey D White
- Green Lane Cardiovascular Unit, Auckland City Hospital, University of Auckland, New Zealand
| | | | - Donald M Black
- DalCor Pharmaceuticals, Montreal, Canada and Sarasota, Florida
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32
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Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, Pinto FJ, Ibrahim R, Gamra H, Kiwan GS, Berry C, López-Sendón J, Ostadal P, Koenig W, Angoulvant D, Grégoire JC, Lavoie MA, Dubé MP, Rhainds D, Provencher M, Blondeau L, Orfanos A, L'Allier PL, Guertin MC, Roubille F. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med 2019; 381:2497-2505. [PMID: 31733140 DOI: 10.1056/nejmoa1912388] [Citation(s) in RCA: 1486] [Impact Index Per Article: 297.2] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Experimental and clinical evidence supports the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis. METHODS We performed a randomized, double-blind trial involving patients recruited within 30 days after a myocardial infarction. The patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily) or placebo. The primary efficacy end point was a composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization. The components of the primary end point and safety were also assessed. RESULTS A total of 4745 patients were enrolled; 2366 patients were assigned to the colchicine group, and 2379 to the placebo group. Patients were followed for a median of 22.6 months. The primary end point occurred in 5.5% of the patients in the colchicine group, as compared with 7.1% of those in the placebo group (hazard ratio, 0.77; 95% confidence interval [CI], 0.61 to 0.96; P = 0.02). The hazard ratios were 0.84 (95% CI, 0.46 to 1.52) for death from cardiovascular causes, 0.83 (95% CI, 0.25 to 2.73) for resuscitated cardiac arrest, 0.91 (95% CI, 0.68 to 1.21) for myocardial infarction, 0.26 (95% CI, 0.10 to 0.70) for stroke, and 0.50 (95% CI, 0.31 to 0.81) for urgent hospitalization for angina leading to coronary revascularization. Diarrhea was reported in 9.7% of the patients in the colchicine group and in 8.9% of those in the placebo group (P = 0.35). Pneumonia was reported as a serious adverse event in 0.9% of the patients in the colchicine group and in 0.4% of those in the placebo group (P = 0.03). CONCLUSIONS Among patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo. (Funded by the Government of Quebec and others; COLCOT ClinicalTrials.gov number, NCT02551094.).
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Affiliation(s)
- Jean-Claude Tardif
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Simon Kouz
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - David D Waters
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Olivier F Bertrand
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Rafael Diaz
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Aldo P Maggioni
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Fausto J Pinto
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Reda Ibrahim
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Habib Gamra
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Ghassan S Kiwan
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Colin Berry
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - José López-Sendón
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Petr Ostadal
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Wolfgang Koenig
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Denis Angoulvant
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Jean C Grégoire
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Marc-André Lavoie
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Marie-Pierre Dubé
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - David Rhainds
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Mylène Provencher
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Lucie Blondeau
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Andreas Orfanos
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Philippe L L'Allier
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - Marie-Claude Guertin
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
| | - François Roubille
- From the Montreal Heart Institute (J.-C.T., R.I., J.C.G., M.-A.L., M.-P.D., D.R., P.L.L.) and the Montreal Health Innovations Coordinating Center (M.P., L.B., A.O., M.-C.G.), Montreal, Centre Hospitalier Régional de Lanaudière, Joliette (S.K.), and Institut de Cardiologie et Pneumologie de Québec, Quebec City (O.F.B.) - all in Canada; San Francisco General Hospital, San Francisco (D.D.W.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (F.J.P.); Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.); Bellevue Medical Center, Beirut, Lebanon (G.S.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, and NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (C.B.); Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación La Paz, Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid (J.L.-S.); Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic (P.O.); Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours (D.A.), and PhyMedExp (Physiologie et Médecine Expérimentale du Cœur et des Muscles), Université de Montpellier, INSERM, Centre National de la Recherche Scientifique, Cardiology Department, CHU de Montpellier, Montpellier (F.R.) - all in France
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Azzalini L, Chabot-Blanchet M, Southern DA, Nozza A, Wilton SB, Graham MM, Gravel GM, Bluteau JP, Rouleau JL, Guertin MC, Jolicoeur EM. A disease-specific comorbidity index for predicting mortality in patients admitted to hospital with a cardiac condition. CMAJ 2019; 191:E299-E307. [PMID: 30885968 DOI: 10.1503/cmaj.181186] [Citation(s) in RCA: 10] [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] [Accepted: 02/05/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Comorbidity indexes derived from administrative databases are essential tools of research in global health. We sought to develop and validate a novel cardiac-specific comorbidity index, and to compare its accuracy with the generic Charlson-Deyo and Elixhauser comorbidity indexes. METHODS We derived the cardiac-specific comorbidity index from consecutive patients who were admitted to hospital at a tertiary-care cardiology hospital in Quebec. We used logistic regression analysis and incorporated age, sex and 22 clinically relevant comorbidities to build the index. We compared the cardiac-specific comorbidity index with refitted Charlson-Deyo and Elixhauser comorbidity indexes using the C-statistic and net reclassification improvement to predict in-hospital death, and the Akaike information criterion to predict length of stay. We validated our findings externally in an independent cohort obtained from a provincial registry of coronary disease in Alberta. RESULTS The novel cardiac-specific comorbidity index outperformed the refitted generic Charlson-Deyo and Elixhauser comorbidity indexes for predicting in-hospital mortality in the derivation population (n = 10 137): C-statistic 0.95 (95% confidence interval [CI] 0.94-0.9) v. 0.81 (95% CI 0.77-0.84) and 0.86 (95% CI 0.82-0.89), respectively. In the validation population (n = 17 877), the cardiac-specific comorbidity index was similarly better: C-statistic 0.92 (95% CI 0.89-0.94) v. 0.76 (95% CI 0.71-0.81) and 0.82 (95% CI 0.78-0.86), respectively, and also numerically outperformed the Charlson-Deyo and Elixhauser comorbidity indexes for predicting 1-year mortality (C-statistic 0.78 [95% CI 0.76-0.80] v. 0.75 [95% CI 0.73-0.77] and 0.77 [95% CI 0.75-0.79], respectively). Similarly, the cardiac-specific comorbidity index showed better fit for the prediction of length of stay. The net reclassification improvement using the cardiac-specific comorbidity index for the prediction of death was 0.290 compared with the Charlson-Deyo comorbidity index and 0.192 compared with the Elixhauser comorbidity index. INTERPRETATION The cardiac-specific comorbidity index predicted in-hospital and 1-year death and length of stay in cardiovascular populations better than existing generic models. This novel index may be useful for research of cardiology outcomes performed with large administrative databases.
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Affiliation(s)
- Lorenzo Azzalini
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Malorie Chabot-Blanchet
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Danielle A Southern
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Anna Nozza
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Stephen B Wilton
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Michelle M Graham
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Guillaume Marquis Gravel
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Jean-Pierre Bluteau
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Jean-Lucien Rouleau
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - Marie-Claude Guertin
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
| | - E Marc Jolicoeur
- Department of Medicine (Azzalini, Marquis Gravel, Rouleau, Jolicoeur), Montreal Heart Institute, Université de Montréal; Montreal Health Innovations Coordinating Center (Chabot-Blanchet, Guertin); Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal (Bluteau), Montréal, Que.; O'Brien Institute for Public Health (Southern), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Community Health Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (Graham), Edmonton, Alta.; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department (Azzalini), San Raffaele Scientific Institute, Milan, Italy
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Rautureau Y, Deschambault V, Higgins MÈ, Rivas D, Mecteau M, Geoffroy P, Miquel G, Uy K, Sanchez R, Lavoie V, Brand G, Nault A, Williams PM, Suarez ML, Merlet N, Lapointe L, Duquette N, Gillis MA, Samami S, Mayer G, Pouliot P, Raignault A, Maafi F, Brodeur MR, Levesque S, Guertin MC, Dubé MP, Thorin É, Rhainds D, Rhéaume É, Tardif JC. ADCY9 (Adenylate Cyclase Type 9) Inactivation Protects From Atherosclerosis Only in the Absence of CETP (Cholesteryl Ester Transfer Protein). Circulation 2019; 138:1677-1692. [PMID: 29674325 DOI: 10.1161/circulationaha.117.031134] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pharmacogenomic studies have shown that ADCY9 genotype determines the effects of the CETP (cholesteryl ester transfer protein) inhibitor dalcetrapib on cardiovascular events and atherosclerosis imaging. The underlying mechanisms responsible for the interactions between ADCY9 and CETP activity have not yet been determined. METHODS Adcy9-inactivated ( Adcy9Gt/Gt) and wild-type (WT) mice, that were or not transgenic for the CETP gene (CETPtg Adcy9Gt/Gt and CETPtg Adcy9WT), were submitted to an atherogenic protocol (injection of an AAV8 [adeno-associated virus serotype 8] expressing a PCSK9 [proprotein convertase subtilisin/kexin type 9] gain-of-function variant and 0.75% cholesterol diet for 16 weeks). Atherosclerosis, vasorelaxation, telemetry, and adipose tissue magnetic resonance imaging were evaluated. RESULTS Adcy9Gt/Gt mice had a 65% reduction in aortic atherosclerosis compared to WT ( P<0.01). CD68 (cluster of differentiation 68)-positive macrophage accumulation and proliferation in plaques were reduced in Adcy9Gt/Gt mice compared to WT animals ( P<0.05 for both). Femoral artery endothelial-dependent vasorelaxation was improved in Adcy9Gt/Gt mice (versus WT, P<0.01). Selective pharmacological blockade showed that the nitric oxide, cyclooxygenase, and endothelial-dependent hyperpolarization pathways were all responsible for the improvement of vasodilatation in Adcy9Gt/Gt ( P<0.01 for all). Aortic endothelium from Adcy9Gt/Gt mice allowed significantly less adhesion of splenocytes compared to WT ( P<0.05). Adcy9Gt/Gt mice gained more weight than WT with the atherogenic diet; this was associated with an increase in whole body adipose tissue volume ( P<0.01 for both). Feed efficiency was increased in Adcy9Gt/Gt compared to WT mice ( P<0.01), which was accompanied by prolonged cardiac RR interval ( P<0.05) and improved nocturnal heart rate variability ( P=0.0572). Adcy9 inactivation-induced effects on atherosclerosis, endothelial function, weight gain, adipose tissue volume, and feed efficiency were lost in CETPtg Adcy9Gt/Gt mice ( P>0.05 versus CETPtg Adcy9WT). CONCLUSIONS Adcy9 inactivation protects against atherosclerosis, but only in the absence of CETP activity. This atheroprotection may be explained by decreased macrophage accumulation and proliferation in the arterial wall, and improved endothelial function and autonomic tone.
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Affiliation(s)
- Yohann Rautureau
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Vanessa Deschambault
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Marie-Ève Higgins
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Daniel Rivas
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Mélanie Mecteau
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Pascale Geoffroy
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Géraldine Miquel
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Kurunradeth Uy
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Rocio Sanchez
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Véronique Lavoie
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Geneviève Brand
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Audrey Nault
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Pierre-Marc Williams
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Maria Laura Suarez
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Nolwenn Merlet
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Line Lapointe
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Natacha Duquette
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Marc-Antoine Gillis
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Samaneh Samami
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Gaétan Mayer
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.).,Faculty of Pharmacy (G. Mayer), Université de Montréal, Canada
| | | | - Adeline Raignault
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Foued Maafi
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Mathieu R Brodeur
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Sylvie Levesque
- Montreal Health Innovations Coordinating Centre, Montreal, Canada (S.L., M-C.G.)
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre, Montreal, Canada (S.L., M-C.G.)
| | - Marie-Pierre Dubé
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada (M-P.D.)
| | - Éric Thorin
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.).,Departments of Surgery (E.T.), Université de Montréal, Canada
| | - David Rhainds
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.)
| | - Éric Rhéaume
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.).,Medicine (E.R., J-C-.T.) of the Faculty of Medicine, Université de Montréal, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Canada (Y.R., V.D., M-E.H., D.R., M.M., P.G., G.Miquel, K.U., R.S., V.L., G.B., A.N., P-M.W., M.L.S., N.M., L.L., N.D., M-A.G., S.S., G.Mayer, A.R., F.M., M.R.B., E.T., D.R., E.R., J-C.T.).,Medicine (E.R., J-C-.T.) of the Faculty of Medicine, Université de Montréal, Canada
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35
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Roy DC, Lachance S, Cohen S, Delisle JS, Kiss T, Sauvageau G, Busque L, Ahmad I, Bernard L, Bambace N, Boumédine RS, Guertin MC, Rezvani K, Mielke S, Perreault C, Roy J. Allodepleted T-cell immunotherapy after haploidentical haematopoietic stem cell transplantation without severe acute graft-versus-host disease (GVHD) in the absence of GVHD prophylaxis. Br J Haematol 2019; 186:754-766. [PMID: 31135970 PMCID: PMC6771482 DOI: 10.1111/bjh.15970] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 01/29/2019] [Accepted: 03/12/2019] [Indexed: 01/04/2023]
Abstract
Graft‐versus‐host disease (GVHD) is a major cause of transplant‐related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and presents a challenge in haploidentical HSCT. GVHD may be prevented by ex vivo graft T‐cell depletion or in vivo depletion of proliferating lymphocytes. However, both approaches pose significant risks, particularly infections and relapse, compromising survival. A photodepletion strategy to eliminate alloreactive T cells from mismatched donor lymphocyte infusions (enabling administration without immunosuppression), was used to develop ATIR101, an adjunctive therapy for use after haploidentical HSCT. In this phase I dose‐finding study, 19 adults (median age: 54 years) with high‐risk haematological malignancies were treated with T‐cell‐depleted human leucocyte antigen‐haploidentical myeloablative HSCT followed by ATIR101 at doses of 1 × 104–5 × 106 CD3+ cells/kg (median 31 days post‐transplant). No patient received post‐transplant immunosuppression or developed grade III/IV acute GVHD, demonstrating the feasibility of ATIR101 infusion for evaluation in two subsequent phase 2 studies. Additionally, we report long‐term follow ‐up of patients treated with ATIR101 in this study. At 1 year, all 9 patients receiving doses of 0·3–2 × 106 CD3+ cells/kg ATIR101 remained free of serious infections and after more than 8 years, TRM was 0%, relapse‐related mortality was 33% and overall survival was 67% in these patients.
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Affiliation(s)
- Denis Claude Roy
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Sylvie Lachance
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Sandra Cohen
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Jean-Sébastien Delisle
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Thomas Kiss
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Guy Sauvageau
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Lambert Busque
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Imran Ahmad
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Lea Bernard
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Nadia Bambace
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Radia S Boumédine
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada
| | - Marie-Claude Guertin
- Department of Biostatistics, Montreal Health Innovations Coordinating Center, Montreal, Canada
| | - Katayoun Rezvani
- Department of Stem Cell Transplant and Cellular Therapy, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Stephan Mielke
- Department of Internal Medicine II, Center of Allogeneic Stem Cell Transplantation, Wuerzburg University Medical Center, University of Wuerzburg, Wuerzburg, Germany.,Department of Laboratory Medicine, CAST, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Claude Perreault
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Jean Roy
- Division of Hematology-Oncology/Stem Cell Transplantation, Hôpital Maisonneuve-Rosemont Research Center, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
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36
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Long V, Guertin MC, Dyrda K, Benrimoh D, Brouillette J. Descriptive Study of Anxiety and Posttraumatic Stress Disorders in Cardiovascular Disease Patients: From Referral to Cardiopsychiatric Diagnoses. Psychother Psychosom 2019; 87:370-371. [PMID: 30078016 DOI: 10.1159/000491581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/26/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Valérie Long
- Research Centre, Montreal Heart Institute and Université de Montréal, Montreal, Québec, Canada
| | | | - Katia Dyrda
- Research Centre, Montreal Heart Institute and Université de Montréal, Montreal, Québec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Judith Brouillette
- Research Centre, Montreal Heart Institute and Université de Montréal, Montreal, Québec, .,Department of Psychiatry and Addiction, Université de Montréal, Montreal, Québec,
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37
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Korol S, White M, O'Meara E, Tournoux F, Racine N, Ducharme A, Rouleau JL, Liszkowski M, Mansour A, Jutras M, Guertin MC, Bernier M, Lavoie J, Leclair G, Neagoe PE, Chaar D, Sirois MG, de Denus S. A comparison of the effects of selective and non-selective mineralocorticoid antagonism on glucose homeostasis of heart failure patients with glucose intolerance or type II diabetes: A randomized controlled double-blind trial. Am Heart J 2018; 204:190-195. [PMID: 30097164 DOI: 10.1016/j.ahj.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/26/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022]
Abstract
Mineralocorticoid receptor antagonists (MRAs) decrease morbidity and mortality in patients with heart failure (HF). However, spironolactone, a non-selective MRA, has been shown to exert a harmful effect on glucose homeostasis. The objective of this multicenter, randomized, controlled, double-blind trial was to compare the effects of spironolactone to those of the selective MRA eplerenone on glucose homeostasis among 62 HF patients with glucose intolerance or type II diabetes. Trial registration number:NCT01586442.
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Affiliation(s)
- Sandra Korol
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Michel White
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Eileen O'Meara
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - François Tournoux
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Normand Racine
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anique Ducharme
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Lucien Rouleau
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mark Liszkowski
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Asmaa Mansour
- Montreal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Martin Jutras
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | | | | | - Joël Lavoie
- Montreal Heart Institute, Montreal, QC, Canada
| | - Grégoire Leclair
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | | | - Diana Chaar
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Martin G Sirois
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Simon de Denus
- Montreal Heart Institute, Montreal, QC, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
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38
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Gebhard C, Rhainds D, He G, Rodés-Cabau J, Lavi S, Spence JD, Title L, Kouz S, L'Allier PL, Grégoire J, Ibrahim R, Cossette M, Guertin MC, Beanlands R, Rhéaume E, Tardif JC. Elevated level of lecithin:cholesterol acyltransferase (LCAT) is associated with reduced coronary atheroma burden. Atherosclerosis 2018; 276:131-139. [DOI: 10.1016/j.atherosclerosis.2018.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/10/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
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39
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Rautureau Y, Deschambault V, Higgins MÈ, Rivas D, Mecteau M, Geoffroy P, Miquel G, Uy K, Sanchez R, Nault A, Williams PM, Suarez ML, Brand G, Lapointe L, Duquette N, Gillis MA, Samami S, Mayer G, Pouliot P, Raignault A, Maafi F, Brodeur M, Lévesque S, Guertin MC, Dubé MP, Thorin É, Rhainds D, Rhéaume É, Tardif JC. Abstract 624: Interactions Between Adenylate Cyclase Type 9 (ADCY9) and Cholesteryl Ester Transfer Protein (CETP) in Atherosclerosis. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.624] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pharmacogenomic studies have shown that
ADCY9
genotype determines the effects of the cholesteryl ester transfer protein (CETP) inhibitor dalcetrapib on cardiovascular events, atherosclerosis imaging and body weight variation. The underlying mechanisms responsible for the interactions between ADCY9 and CETP have not yet been determined.
Adcy9
-inactivated (
Adcy9
Gt/Gt
) and wild-type (WT) mice, that were or not transgenic for the CETP gene (CETP
Gt
and CETP
WT
), were submitted to an atherogenic protocol (injection of an AAV8 expressing a PCSK9 gain-of-function variant and 0.75% cholesterol diet for 16 weeks). Atherosclerosis, cell adhesion, vasorelaxation, telemetry and adipose tissue MRI were evaluated.
Adcy9
Gt/Gt
mice had a 65% reduction in aortic atherosclerosis compared to WT (
P
<0.01). CD68-positive macrophage accumulation and proliferation in plaques were reduced in
Adcy9
Gt/Gt
mice compared to WT animals (
P
<0.05 for both).
Adcy9
inactivation did not change counts of blood monocytes and their subsets. Splenocytes showed reduced adhesion to native aortic endothelium from
Adcy9
Gt/Gt
mice (
P
<0.05 vs WT). Femoral artery endothelial-dependent vasorelaxation was improved in
Adcy9
Gt/Gt
mice (versus WT,
P
<0.01). Selective pharmacological blockade showed that the nitric oxide, cyclooxygenase and endothelial-dependent hyperpolarization pathways all contributed to the improvement of vasodilatation in
Adcy9
Gt/Gt
versus WT (
P
<0.01 for all).
Adcy9
Gt/Gt
mice gained more weight than WT with the atherogenic diet, and this was associated with an increase in whole body adipose tissue volume (
P
<0.05 for both). Feed efficiency was increased in
Adcy9
Gt/Gt
compared to WT mice (
P
<0.05), which was accompanied by improved nocturnal heart rate variability (
P
=0.0572) and prolonged cardiac RR interval (
P
<0.05).
Adcy9
inactivation-induced effects on atherosclerosis, endothelium-dependent vasodilation, weight gain and feed efficiency were lost in CETP
Gt
mice (
P
>0.05 vs CETP
WT
).
Adcy9
inactivation protects against atherosclerosis, but only in the absence of CETP activity. This atheroprotection may be explained by decreased macrophage accumulation and proliferation in the arterial wall, improved endothelial function and autonomic tone.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sylvie Lévesque
- Montreal Health Innovations Coordinating Cntr, Montreal, Canada
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40
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de Denus S, Dubé MP, Fouodjio R, Huynh T, LeBlanc MH, Lepage S, Sheppard R, Giannetti N, Lavoie J, Mansour A, Provost S, Normand V, Mongrain I, Langlois M, O'Meara E, Ducharme A, Racine N, Guertin MC, Turgeon J, Phillips MS, Rouleau JL, Tardif JC, White M. A prospective study of the impact of AGTR1 A1166C on the effects of candesartan in patients with heart failure. Pharmacogenomics 2018; 19:599-612. [PMID: 29701105 DOI: 10.2217/pgs-2018-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM To evaluate the impact of AGTR1 A1166C (rs5186) on the response to candesartan in patients with heart failure. MATERIALS & METHODS Prospective, multicentre, open-label study. We studied 299 symptomatic patients with heart failure presenting a left ventricular ejection fraction ≤40%. RESULTS Reductions in the primary end points of natriuretic peptides were not significantly associated with AGTR1 A1166C. Nevertheless, carrying the 1166C allele was associated with a greater compensatory increase in renin activity (p = 0.037) after 16 weeks of treatment with candesartan and a more modest effect on aldosterone concentrations (p = 0.022). CONCLUSION AGTR1 1166C carriers may experience a greater long-term compensatory renin-angiotensin-aldosterone system activation following treatment with candesartan. Whether these associations ultimately influence clinical outcomes requires investigation. Clinicaltrials.gov : NCT00400582.
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Affiliation(s)
- Simon de Denus
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Marie-Pierre Dubé
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - René Fouodjio
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada
| | - Thao Huynh
- McGill Health University, McGill University, Montreal, Canada
| | - Marie-Hélène LeBlanc
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Serge Lepage
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | | | - Nadia Giannetti
- Royal-Victoria Hospital, McGill University, Montreal, Canada
| | - Joël Lavoie
- Research Center, Montreal Heart Institute, Montreal, Canada
| | - Asmaa Mansour
- Montreal Health Innovations Coordinating Center, a division of the Montreal Heart Institute, Montreal Canada
| | - Sylvie Provost
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada
| | - Valérie Normand
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada
| | - Ian Mongrain
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada
| | - Mathieu Langlois
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada
| | - Eileen O'Meara
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Anique Ducharme
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Normand Racine
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, a division of the Montreal Heart Institute, Montreal Canada
| | - Jacques Turgeon
- CRCHUM, Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Jean-Lucien Rouleau
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Jean-Claude Tardif
- Research Center, Montreal Heart Institute, Montreal, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Michel White
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
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Cournoyer A, Notebaert É, de Montigny L, Ross D, Cossette S, Londei-Leduc L, Iseppon M, Lamarche Y, Sokoloff C, Potter BJ, Vadeboncoeur A, Larose D, Morris J, Daoust R, Chauny JM, Piette É, Paquet J, Cavayas YA, de Champlain F, Segal E, Albert M, Guertin MC, Denault A. Impact of the direct transfer to percutaneous coronary intervention-capable hospitals on survival to hospital discharge for patients with out-of-hospital cardiac arrest. Resuscitation 2018; 125:28-33. [DOI: 10.1016/j.resuscitation.2018.01.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
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42
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Lévy S, Guertin MC, Khatibi A, Mezer A, Martinu K, Chen JI, Stikov N, Rainville P, Cohen-Adad J. Test-retest reliability of myelin imaging in the human spinal cord: Measurement errors versus region- and aging-induced variations. PLoS One 2018; 13:e0189944. [PMID: 29293550 PMCID: PMC5749716 DOI: 10.1371/journal.pone.0189944] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/05/2017] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To implement a statistical framework for assessing the precision of several quantitative MRI metrics sensitive to myelin in the human spinal cord: T1, Magnetization Transfer Ratio (MTR), saturation imposed by an off-resonance pulse (MTsat) and Macromolecular Tissue Volume (MTV). METHODS Thirty-three healthy subjects within two age groups (young, elderly) were scanned at 3T. Among them, 16 underwent the protocol twice to assess repeatability. Statistical reliability indexes such as the Minimal Detectable Change (MDC) were compared across metrics quantified within different cervical levels and white matter (WM) sub-regions. The differences between pathways and age groups were quantified and interpreted in context of the test-retest repeatability of the measurements. RESULTS The MDC was respectively 105.7ms, 2.77%, 0.37% and 4.08% for T1, MTR, MTsat and MTV when quantified over all WM, while the standard-deviation across subjects was 70.5ms, 1.34%, 0.20% and 2.44%. Even though particular WM regions did exhibit significant differences, these differences were on the same order as test-retest errors. No significant difference was found between age groups for all metrics. CONCLUSION While T1-based metrics (T1 and MTV) exhibited better reliability than MT-based measurements (MTR and MTsat), the observed differences between subjects or WM regions were comparable to (and often smaller than) the MDC. This makes it difficult to determine if observed changes are due to variations in myelin content, or simply due to measurement error. Measurement error remains a challenge in spinal cord myelin imaging, but this study provides statistical guidelines to standardize the field and make it possible to conduct large-scale multi-center studies.
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Affiliation(s)
- Simon Lévy
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Montreal, QC, Canada
| | - Ali Khatibi
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Psychology Department, Bilkent University, Ankara, Turkey
- Interdisciplinary program in Neuroscience, Bilkent University, Ankara, Turkey
- National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Aviv Mezer
- The Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kristina Martinu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Jen-I Chen
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
| | - Pierre Rainville
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
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Cossette S, Côté J, Rouleau G, Robitaille M, Heppell S, Mailhot T, Fontaine G, Cournoyer C, Gagnon MP, Gallani MC, Tanguay JF, Dupuis J, Nigam A, Guertin MC. A Web-Based Tailored Intervention to Support Illness Management in Patients With an Acute Coronary Syndrome: Pilot Study. JMIR Cardio 2017; 1:e4. [PMID: 31758758 PMCID: PMC6834220 DOI: 10.2196/cardio.7342] [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: 01/17/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, to foster participation in a cardiac rehabilitation (CR) program, and to optimize recovery. Web-based tailored interventions have the potential to provide individualized information and counseling to optimize patient's illness management after hospital discharge. OBJECTIVE We aimed to assess the feasibility and acceptability of a Web-based tailored intervention (TAVIE@COEUR) designed to improve illness management in patients hospitalized for an ACS. Illness management outcomes were operationalized by self-care, medication adherence, anxiety management, cardiac risk factors reduction, and enrollment in a CR program. METHODS This posttest pilot study was conducted with one group (N=30) of patients hospitalized for an ACS on the coronary care unit of a tertiary cardiology center. TAVIE@COEUR comprises three Web-based sessions, with a duration ranging from 10 to 45 min and is structured around an algorithm to allow the tailoring of the intervention to different pathways according to patients' responses to questions. TAVIE@COEUR includes 90 pages, 85 videos, and 47 PDF documents divided across session 1 (S1), session 2 (S2), and session 3 (S3). These sessions concern self-care and self-observation skills related to medication-taking (S1), emotional control and problem-solving skills (S2), and social skills and interacting with health professionals (S3). Throughout the videos, a virtual nurse (providing the intervention virtually) guides the participants in the acquisition of self-care skills. Patients completed S1 of TAVIE@COEUR before hospital discharge and were asked to complete S2 and S3 within 2 weeks after discharge. Feasibility indicators were extracted from the TAVIE@COEUR system. Data regarding acceptability (satisfaction and appreciation of the platform) and preliminary effect (self-care, medication adherence, anxiety management, risk factor reduction, and CR enrollment) were assessed through questionnaires at 1 month following discharge. Preliminary effect was assessed by comparing baseline and 1-month illness management variables. RESULTS Of the 30 participants, 20 completed S1, 10 completed S2, and 5 completed S3. Good acceptability scores were observed for ease of navigation (mean=3.58, standard deviation [SD]=0.70; scale=0-4), ease of understanding (mean=3.46, SD=0.63; scale=0-4), and applicability (mean=3.55, SD=0.74; scale=0-4). The lowest acceptability scores were observed for information tailoring (mean=2.93, SD=0.68; scale=0-4) and individual relevance (mean=2.56, SD=0.96; scale=0-4). With regard to preliminary effect, we observed an overall self-care at 1 month following discharge score higher than at baseline (mean at 1 month=54.07, SD=3.99 vs mean at baseline=49.09, SD=6.92; scale-0-60). CONCLUSIONS Although participants reported general satisfaction and appreciation of TAVIE@COEUR, acceptability and feasibility results show the need for further development of the Web-based intervention to enhance its tailoring before undertaking a full-fledged randomized controlled trial. This may be accomplished by optimizing the adaptability of TAVIE@COEUR to patients' knowledge, needs, interests, individual capabilities, and emotional and cognitive responses during session completion.
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Affiliation(s)
- Sylvie Cossette
- Montreal Heart Institute Research Center, Montréal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montréal, QC, Canada
| | - José Côté
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Research Chair in Innovative Nursing Practices, Montréal, QC, Canada
| | - Geneviève Rouleau
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Research Chair in Innovative Nursing Practices, Montréal, QC, Canada.,Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | | | - Sonia Heppell
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada.,Montreal Heart Institute, Montreal, QC, Canada
| | - Tanya Mailhot
- Montreal Heart Institute Research Center, Montréal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montréal, QC, Canada
| | - Guillaume Fontaine
- Montreal Heart Institute Research Center, Montréal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montréal, QC, Canada
| | | | | | | | - Jean-Francois Tanguay
- Montreal Heart Institute Research Center, Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Jocelyn Dupuis
- Montreal Heart Institute Research Center, Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Anil Nigam
- Montreal Heart Institute Research Center, Montréal, QC, Canada
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Tardif JC, Fikry S, Girard G, Discenza T, Fortier A, Cefali EA, Guertin MC. Abstract 542: Effects of 1-Methylnicotinamide on Inflammatory and Lipid Biomarkers. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.542] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
1-methylnicotinamide, a nicotinic acid metabolite, is TRIA-662’s active component. As part of a pilot study, we assessed TRIA-662’s effects on inflammatory biomarkers and blood lipids.
Methods:
Patients aged 18-80 years with mean serum triglycerides (TG) 2.26-5.65 mmol/L, low-density lipoprotein-cholesterol levels not needing drug therapy, and stable diet and exercise regimens were randomized to TRIA-662 or placebo (PBO, 3:1) up-titrating to 6 g daily orally for 14 weeks. Outcomes were treatment compliance and changes from baseline in inflammatory biomarkers and blood lipids.
Results:
The 71 randomized patients were 54±12 years old, 54% were male, 48% were obese, 37% had hypertension, 25% dyslipidemia, and 7% diabetes. Treatment compliance and study completion (95% CI) were reached in 87.1% (79.3, 95.0%) and 87.3% (79.6, 95.1%) of patients overall, respectively. Adjusted geometric mean percent change (95% CI) from baseline in high-sensitivity C-reactive protein was -15.66% (-28.40, -0.66%) with TRIA-662 (p=0.0419 vs baseline) and 1.21% (-13.95, 19.05%) with PBO. The between-group difference of -16.67% (-33.59%, 4.57%) in favor of TRIA-662 did not reach significance (p=0.1130). The effect of TRIA-662 on tumor necrosis factor (TNF) alpha was influenced by the baseline value: For a baseline TNF value of 3.30 pg/mL (third quartile), the adjusted mean change (95% CI) was -0.65 (-0.92, -0.38) pg/mL, corresponding to a 20% decrease, with TRIA-662 and 0.31 (-0.32, 0.95) pg/ml, corresponding to a 9% increase with PBO, with a between-group difference of -0.97 (-1.65, -0.29) pg/mL (p=0.0076). The adjusted mean changes from baseline in adiponectin were 0.55 μg/mL (0.23, 0.86 μg/mL) corresponding to a 6% increase for TRIA-662 and -0.06 μg/mL (-0.53, 0.42 μg/mL) corresponding to a 0.7% decrease for PBO (p=0.0391 between groups). Geometric mean TG value at baseline was 3.36 mmol/L. The adjusted geometric mean percent change (95% CI) in TG was -9.01% (-15.91%, -1.54%) for TRIA-662 and -2.09% (-13.03, 10.24%) for PBO (p=0.3088 between groups). Baseline HDL-C was 1.01 ± 0.28 mmol/L, and the difference in change over time was not significant between groups (p=0.8242).
Conclusion:
TRIA-662 favourably affected inflammatory biomarkers in this pilot study.
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Affiliation(s)
| | - Sameh Fikry
- Sameh Fikry Medicine Professional Corp, Waterloo, Canada
| | | | - Tania Discenza
- Montreal Health Innovations Coordinating Cntr, Montreal, Canada
| | - Annik Fortier
- Montreal Health Innovations Coordinating Cntr, Montreal, Canada
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Bissonnette R, Harel F, Krueger JG, Guertin MC, Chabot-Blanchet M, Gonzalez J, Maari C, Delorme I, Lynde CW, Tardif JC. TNF-α Antagonist and Vascular Inflammation in Patients with Psoriasis Vulgaris: A Randomized Placebo-Controlled Study. J Invest Dermatol 2017; 137:1638-1645. [PMID: 28286061 DOI: 10.1016/j.jid.2017.02.977] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/13/2023]
Abstract
Vascular inflammation is increased in patients with psoriasis. This randomized, double-blind, multicenter study evaluated the effects of tumor necrosis factor-α antagonist adalimumab on vascular inflammation in patients with psoriasis. A total of 107 patients were randomized (1:1) to receive adalimumab for 52 weeks or placebo for 16 weeks followed by adalimumab for 52 weeks. Vascular inflammation was assessed with positron emission tomography-computed tomography. There were no differences in the change from baseline in vessel wall target-to-background ratio (TBR) from the ascending aorta (primary endpoint) (adalimumab: TBR = 0.002, 95% confidence interval [CI] = -0.048 to 0.053; placebo: TBR = -0.002, 95% CI = -0.053 to 0.049; P = 0.916) and the carotids (adalimumab: TBR = 0.031, 95% CI = -0.005 to 0.066; placebo: TBR = 0.018, 95% CI = -0.019 to 0.055; P = 0.629) at week 16 between adalimumab and placebo. After 52 weeks of treatment with adalimumab there was no significant change from start of treatment in TBR from the ascending aorta (TBR = -0.006, 95% CI = -0.049 to 0.038; P = 0.796), but there was an increase in TBR in carotids (TBR = 0.027, 95% CI = 0.000 to 0.054; P = 0.046). This study showed no difference over 16 weeks in vascular inflammation in patients treated with a tumor necrosis factor-α antagonist or placebo and a modest increase in vascular inflammation in carotids after 52 weeks of treatment with adalimumab.
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Affiliation(s)
| | - François Harel
- Montreal Heart Institute Research Center, Université de Montréal, Montreal, Quebec, Canada
| | - James G Krueger
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York, USA
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada
| | | | - Juana Gonzalez
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York, USA
| | | | - Isabelle Delorme
- Dr Isabelle Delorme, Incorporated, Drummondville, Quebec, Canada
| | | | - Jean-Claude Tardif
- Montreal Heart Institute Research Center, Université de Montréal, Montreal, Quebec, Canada
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Harel F, Langleben D, Provencher S, Fournier A, Finnerty V, Nguyen QT, Letourneau M, Levac X, Abikhzer G, Guimond J, Mansour A, Guertin MC, Dupuis J. Molecular imaging of the human pulmonary vascular endothelium in pulmonary hypertension: a phase II safety and proof of principle trial. Eur J Nucl Med Mol Imaging 2017; 44:1136-1144. [PMID: 28236024 PMCID: PMC5434971 DOI: 10.1007/s00259-017-3655-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/13/2016] [Accepted: 02/09/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE The adrenomedullin receptor is densely expressed in the pulmonary vascular endothelium. PulmoBind, an adrenomedullin receptor ligand, was developed for molecular diagnosis of pulmonary vascular disease. We evaluated the safety of PulmoBind SPECT imaging and its capacity to detect pulmonary vascular disease associated with pulmonary hypertension (PH) in a human phase II study. METHODS Thirty patients with pulmonary arterial hypertension (PAH, n = 23) or chronic thromboembolic PH (CTEPH, n = 7) in WHO functional class II (n = 26) or III (n = 4) were compared to 15 healthy controls. Lung SPECT was performed after injection of 15 mCi 99mTc-PulmoBind in supine position. Qualitative and semi-quantitative analyses of lung uptake were performed. Reproducibility of repeated testing was evaluated in controls after 1 month. RESULTS PulmoBind injection was well tolerated without any serious adverse event. Imaging was markedly abnormal in PH with ∼50% of subjects showing moderate to severe heterogeneity of moderate to severe extent. The abnormalities were unevenly distributed between the right and left lungs as well as within each lung. Segmental defects compatible with pulmonary embolism were present in 7/7 subjects with CTEPH and in 2/23 subjects with PAH. There were no segmental defects in controls. The PulmoBind activity distribution index, a parameter indicative of heterogeneity, was elevated in PH (65% ± 28%) vs. controls (41% ± 13%, p = 0.0003). In the only subject with vasodilator-responsive idiopathic PAH, PulmoBind lung SPECT was completely normal. Repeated testing 1 month later in healthy controls was well tolerated and showed no significant variability of PulmoBind distribution. CONCLUSIONS In this phase II study, molecular SPECT imaging of the pulmonary vascular endothelium using 99mTc-PulmoBind was safe. PulmoBind showed potential to detect both pulmonary embolism and abnormalities indicative of pulmonary vascular disease in PAH. Phase III studies with this novel tracer and direct comparisons to lung perfusion agents such as labeled macro-aggregates of albumin are needed. CLINICAL TRIAL ClinicalTrials.gov, NCT02216279.
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Affiliation(s)
- François Harel
- Research Center, Montreal Heart Institute, 5000, Belanger Street, Montreal, QC, H1T 1C8, Canada.,Department of Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
| | - David Langleben
- Lady Davis Institute and Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Steve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | | | - Vincent Finnerty
- Research Center, Montreal Heart Institute, 5000, Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Quang T Nguyen
- Research Center, Montreal Heart Institute, 5000, Belanger Street, Montreal, QC, H1T 1C8, Canada
| | | | - Xavier Levac
- Research Center, Montreal Heart Institute, 5000, Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Gad Abikhzer
- Lady Davis Institute and Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Jean Guimond
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Asmaa Mansour
- Montreal Health Innovation Coordination Center, Montréal, QC, Canada
| | | | - Jocelyn Dupuis
- Research Center, Montreal Heart Institute, 5000, Belanger Street, Montreal, QC, H1T 1C8, Canada. .,Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
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Gebhard C, Rhéaume E, Berry C, Brand G, Kernaleguen AE, Théberge-Julien G, Alam MA, Lee CYW, Boileau L, Chabot-Blanchet M, Guertin MC, Lavoie MA, Grégoire J, Ibrahim R, L'Allier P, Tardif JC. Beneficial Effects of Reconstituted High-Density Lipoprotein (rHDL) on Circulating CD34+ Cells in Patients after an Acute Coronary Syndrome. PLoS One 2017; 12:e0168448. [PMID: 28060837 PMCID: PMC5218493 DOI: 10.1371/journal.pone.0168448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 12/01/2016] [Indexed: 12/16/2022] Open
Abstract
Background High-density lipoproteins (HDL) favorably affect endothelial progenitor cells (EPC). Circulating progenitor cell level and function are impaired in patients with acute coronary syndrome (ACS). This study investigates the short-term effects of reconstituted HDL (rHDL) on circulating progenitor cells in patients with ACS. Methods and Findings The study population consisted of 33 patients with recent ACS: 20 patients from the ERASE trial (randomized to receive 4 weekly intravenous infusions of CSL-111 40 mg/kg or placebo) and 13 additional patients recruited as controls using the same enrolment criteria. Blood was collected from 16 rHDL (CSL-111)-treated patients and 17 controls at baseline and at 6–7 weeks (i.e. 2–3 weeks after the fourth infusion of CSL-111 in ERASE). CD34+ and CD34+/kinase insert domain receptor (KDR+) progenitor cell counts were analyzed by flow cytometry. We found preserved CD34+ cell counts in CSL-111-treated subjects at follow-up (change of 1.6%), while the number of CD34+ cells was reduced (-32.9%) in controls (p = 0.017 between groups). The level of circulating SDF-1 (stromal cell-derived factor-1), a chemokine involved in progenitor cell recruitment, increased significantly (change of 21.5%) in controls, while it remained unchanged in CSL-111-treated patients (p = 0.031 between groups). In vitro exposure to CSL-111 of early EPC isolated from healthy volunteers significantly increased CD34+ cells, reduced early EPC apoptosis and enhanced their migration capacity towards SDF-1. Conclusions The relative increase in circulating CD34+ cells and the low SDF-1 levels observed following rHDL infusions in ACS patients point towards a role of rHDL in cardiovascular repair mechanisms.
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Affiliation(s)
- Catherine Gebhard
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Eric Rhéaume
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Colin Berry
- Montreal Heart Institute, Montreal, Quebec, Canada
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | - Laurianne Boileau
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | | | | | - Marc-André Lavoie
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Jean Grégoire
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Réda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Philippe L'Allier
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
- * E-mail:
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Asgar AW, Khairy P, Guertin MC, Cournoyer D, Ducharme A, Bonan R, Basmadjian A, Tardif JC, Cohen DJ. Clinical outcomes and economic impact of transcatheter mitral leaflet repair in heart failure patients. J Med Econ 2017; 20:82-90. [PMID: 27552378 DOI: 10.1080/13696998.2016.1227828] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) is a common valvular heart disorder requiring intervention once it becomes severe. Transcatheter mitral repair with the MitraClip device is a safe and effective therapy for selected patients denied surgery. The authors sought to evaluate the clinical outcomes and economic impact of this therapy compared to medical management in heart-failure patients with symptomatic mitral regurgitation. METHODS AND RESULTS The study was comprised of two phases; an observational study of patients with heart failure and mitral regurgitation treated with either medical therapy or the MitraClip, and an economic model. Results of the observational study were used to estimate parameters for the decision model, which estimated costs, and benefits in a hypothetical cohort of patients with heart failure and moderate-to-severe mitral regurgitation treated with either standard medical therapy or MitraClip. The cohort of patients treated with the MitraClip was propensity matched to a population of heart failure patients, and their outcomes compared. At a mean follow-up of 22 months, all-cause mortality was 21% in the MitraClip cohort and 42% in the medical management cohort (p = .007). The decision model demonstrated that MitraClip increased life expectancy from 1.87-3.60 years and quality-adjusted life years (QALY) from 1.13-2.76 years. The incremental cost was $52,500 Canadian dollars, corresponding to an incremental cost-effectiveness ratio (ICER) of $32,300.00 per QALY gained. Results were sensitive to the survival benefit. CONCLUSION In heart failure patients with symptomatic moderate-severe mitral regurgitation, therapy with the MitraClip is associated with superior survival and is cost-effective compared to medical therapy.
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Affiliation(s)
- Anita W Asgar
- a Department of Cardiology , Montreal Heart Institute , Montreal , Canada
| | - Paul Khairy
- a Department of Cardiology , Montreal Heart Institute , Montreal , Canada
| | | | - Daniel Cournoyer
- b Montreal Heart Institute Coordinating Centre , Montreal , Canada
| | - Anique Ducharme
- a Department of Cardiology , Montreal Heart Institute , Montreal , Canada
| | - Raoul Bonan
- a Department of Cardiology , Montreal Heart Institute , Montreal , Canada
| | - Arsene Basmadjian
- a Department of Cardiology , Montreal Heart Institute , Montreal , Canada
| | - Jean-Claude Tardif
- a Department of Cardiology , Montreal Heart Institute , Montreal , Canada
| | - David J Cohen
- c Department of Cardiology , Saint Luke's Mid America Heart Institute , Kansas City , MO , USA
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Stähli BE, Gebhard C, Duchatelle V, Cournoyer D, Petroni T, Tanguay JF, Robb S, Mann J, Guertin MC, Wright RS, L L'Allier P, Tardif JC. Effects of the P-Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention According to Timing of Infusion: Insights From the SELECT-ACS Trial. J Am Heart Assoc 2016; 5:JAHA.116.004255. [PMID: 27852589 PMCID: PMC5210344 DOI: 10.1161/jaha.116.004255] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The Effects of the P‐Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention for Non‐ST‐Segment Elevation Myocardial Infarction (SELECT‐ACS) trial suggested beneficial effects of inclacumab, a monoclonal antibody directed against P‐selectin, on periprocedural myocardial damage. This study evaluated the effect of inclacumab on myocardial damage according to varying time intervals between study drug infusion and percutaneous coronary intervention (PCI). Methods and Results Patients (n=544) enrolled in the SELECT‐ACS trial and randomized to receive 1 infusion of placebo or inclacumab (5 or 20 mg/kg, administered between 1 and 24 hours before PCI) were divided according to the time interval between study drug infusion and PCI. The primary end point was the change in troponin I from baseline at 16 and 24 hours after PCI. In patients receiving inclacumab 20 mg/kg with a short (less than median) time interval between infusion and PCI, placebo‐adjusted geometric mean percent changes in troponin I, creatine kinase–myocardial band, and peak troponin I at 24 hours were −45.6% (P=0.005), −30.7% (P=0.01), and −37.3% (P=0.02), respectively. No significant changes were observed in patients with a long (greater than median) time interval between infusion and PCI. Placebo‐adjusted geometric mean percent changes in troponin I and creatine kinase–myocardial band were −43.5% (P=0.02) and −26.0% (P=0.07), respectively, when inclacumab 20 mg/kg was administered between 1 and 3 hours before PCI, whereas the drug had no effect with longer intervals. Conclusions Inclacumab 20 mg/kg significantly reduces myocardial damage after PCI in patients with non–ST‐segment elevation myocardial infarction, and benefits are larger when the infusion is administered <3 hours before PCI. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01327183.
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Affiliation(s)
- Barbara E Stähli
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | | | - Daniel Cournoyer
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Thibaut Petroni
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
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Campeau L, Lespérance J, Bilodeau L, Fortier A, Guertin MC, Knatterud GL. Effect of Cholesterol Lowering and Cardiovascular Risk Factors on the Progression of Aortoiliac Arteriosclerosis: A Quantitative Cineangiography Study. Angiology 2016; 56:191-9. [PMID: 15793608 DOI: 10.1177/000331970505600209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The post-Coronary Artery Bypass Graft (Post-CABG) trial has shown that aggressive compared to moderate lowering of low-density lipoprotein cholesterol (LDL-C) delayed the progression of obstructive disease in aortocoronary saphenous vein grafts and in the left main coronary artery. Patients had been allocated to high- and low-dose lovastatin therapy for a 4-5 year period. The present study evaluated the effect of LDL-C lowering and the role of cardiovascular risk factors on the progression of arteriosclerosis in the distal abdominal aorta and common iliac arteries. From one of the participating centers of the post-CABG trial, 145 patients who had adequate imaging of the aortoiliac arteries at baseline and follow-up were included. Angiographic outcomes, presumed to reflect progression of arteriosclerosis and obtained from lumen diameter (LD) measurements using quantitative cineangiography, were as follows: significant decrease of the minimum lumen diameter (LD) and increase of the maximum LD, percent lumen stenosis, and percent lumen dilatation. These outcomes were not significantly less frequent in patients randomly allocated to aggressive compared to moderate LDL-C lowering. Of 9 cardiovascular risk factors, only 2 were significantly related to progression of aortoiliac arteriosclerosis. Current smoking predicted both percent lumen stenosis increase and, to a lesser degree, percent lumen dilatation increase (p=0.010 and p=0.055, respectively). Abnormally high body mass index (BMI ≥25 kg/m2) correlated with percent lumen dilatation increase (p=0.006). Aggressive compared to moderate LDL-C lowering did not prevent or delay the progression of aortoiliac arteriosclerosis. Smoking predicted both lumen narrowing and dilatation presumably caused by arteriosclerosis. Abnormally high BMI, reflecting overweight or obesity, was strongly associated with vessel dilatation.
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