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Levy D, Saura O, Lucenteforte M, Collado Lledó E, Demondion P, Hammoudi N, Assouline B, Petit M, Gautier M, Le Fevre L, Pineton de Chambrun M, Coutance G, Berg E, Chommeloux J, Schmidt M, Luyt CE, Lebreton G, Leprince P, Hekimian G, Combes A. Isoproterenol Improves Hemodynamics And Right Ventricle-Pulmonary Artery Coupling After Heart Transplantation. Am J Physiol Heart Circ Physiol 2024. [PMID: 38700470 DOI: 10.1152/ajpheart.00200.2024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/02/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Right ventricular failure (RVF) is a major cause of early mortality after heart transplantation (HT). Isoproterenol has chronotropic, inotropic, and vasodilatory properties which might improve right ventricle function in this setting. We aimed to investigate the hemodynamic effects of isoproterenol on patients with post-HT RVF. METHODS We conducted a one-year retrospective observational study including patients receiving isoproterenol and dobutamine for early RVF after HT. A comprehensive multiparametric hemodynamic evaluation was performed successively at three times: no isoproterenol, low doses: 0.025 µg/kg/min and high doses: 0.05 µg/kg/min (henceforth respectively called no-iso, low-iso and high-iso). RESULTS From June 2022 to June 2023, 25 patients, median [IQR25-75] age 54 [38-61] years, were included. Before isoproterenol introduction, all patients received dobutamine and 15 (60%) were on veno-arterial extracorporeal membrane oxygenation. Isoproterenol significantly increased heart rate from 84 [77-99] (no-iso) to 91 [88-106] (low-iso) and 102 [90-122] bpm (high-iso, p<0.001). Similarly, cardiac index raised from 2.3 [1.4-3.1] to 2.7 [1.8-3.4] and 3 [1.9-3.7] l/min/m2 (p<0.001) with concomitant increase of indexed stroke volume (28 [17-34] to 31 [20-34] and 33 [23-35] mL/m2, p<0.05). Effective pulmonary arterial elastance and pressures were not modified by isoproterenol. Pulmonary vascular resistance tended to decrease from 2.9 (1.4-3.6) WU to 2.3 (1.3-3.5) WU, p=0.06. Right ventricular ejection fraction/systolic PAP evaluating RV-PA coupling increased after isoproterenol from 0.8 to 0.9 and 1 %.mmHg-1 (p=0.001). CONCLUSIONS In post-HT RVF, isoproterenol exhibits chronotropic and inotropic effects, thereby improving RV-PA coupling and resulting in a clinically relevant increase in the cardiac index.
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Affiliation(s)
- David Levy
- Médecine intensive-Réanimation, Pitié-Salpêtrière Hospital, Paris, France
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Ederhy S, Cadranel J, Granger C, Hammoudi N. Investigation of endocarditis finds advanced lung adenocarcinoma: both resolve after tyrosine kinase inhibitor treatment. Lancet 2024; 403:860-861. [PMID: 38431352 DOI: 10.1016/s0140-6736(24)00042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/29/2023] [Accepted: 01/05/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Stéphane Ederhy
- Department of Cardiology, Saint-Antoine Hospital, AP-HP, Paris, France; Groupe de Recherche Clinique, Sorbonne Université, Paris, France; UNICO-GRECO Cardio-Oncology Program, Sorbonne Université, Paris, France.
| | - Jacques Cadranel
- Department of Pulmonology and Thoracic Oncology, Assistance Publique Hopitaux de Paris, Hopital Tenon, Paris, France; Groupe de Recherche Clinique 4 (GRC 4), Theranoscan, Paris, France
| | - Camille Granger
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France; Hôpital Pitié-Salpêtrière endocarditis team (AP-HP), Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France; Hôpital Pitié-Salpêtrière endocarditis team (AP-HP), Paris, France
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3
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Hauguel-Moreau M, Guedeney P, Dauphin C, Auffret V, Marijon E, Aldebert P, Clerc JM, Beygui F, Elbaz M, Khalil WA, Da Costa A, Macia JC, Elhadad S, Cayla G, Brugier D, Silvain J, Hammoudi N, Duthoit G, Vicaut E, Montalescot G. Flecainide to prevent atrial arrhythmia after patent foramen ovale closure Rationale and design of the randomized AFLOAT study. Eur Heart J Cardiovasc Pharmacother 2024:pvad100. [PMID: 38216511 DOI: 10.1093/ehjcvp/pvad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Atrial arrhythmia is the most common complication of patent foramen ovale (PFO) closure. The real incidence of post-PFO closure atrial arrhytmia and whether this complication can be prevented is unknown. METHODS/DESIGN The Assessment of Flecainide to Lower the patent foramen Ovale closure risk of Atrial fibrillation or Tachycardia (AFLOAT) trial is a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide (150 mg per day in a single sustained-release dose) for 6 months (Group 1), Flecainide (150 mg per day in a single sustained-release dose) for 3 months (Group 2), or no additional treatment (standard of care) for 6 months (Group 3). The primary endpoint is the percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episode (≥30s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor. Whether 3 months of treatment is sufficient compared to 6 months will be analyzed as a secondary objective of the study. CONCLUSION AFLOAT is the first trial to test the hypothesis that a short treatment with oral Flecainide can prevent the new-onset of atrial arrhythmia after PFO closure. Clinical trial registration: NCT05213104 (clinicaltrials.gov).
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Affiliation(s)
- Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, INSERM U1018, CESP, ACTION Study Group, Department of Cardiology, Ambroise Paré Hospital (AP-HP), Boulogne, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Claire Dauphin
- Department of Cardiology and Cardiovascular Diseases, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Vincent Auffret
- University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | | | - Jean-Michel Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Farzin Beygui
- CHU de la Côte de Nacre, Département de Cardiologie, Caen, France
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Wissam Abi Khalil
- Institut Mitovasc, University of Angers, UMR CNRS 6015-INSERMU1083, Angers, France
| | - Antoine Da Costa
- Service de cardiologie, hôpital Nord, université Jean-Monnet, CHU de Saint-Étienne, Saint-Étienne, France
| | - Jean-Christophe Macia
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, Montpellier 5, France
| | - Simon Elhadad
- Service de Cardiologie, Centre hospitalier de Marne-la-Vallée, Jossigny, France
| | - Guillaume Cayla
- Cardiology department, Nimes university Hospital, Montpellier University, ACTION group, Nimes, France
| | - Delphine Brugier
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Duthoit
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hopital Lariboisière, (APHP), Université Paris-Diderot Paris 7, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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4
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Guedeney P, Farjat-Pasos JI, Asslo G, Roule V, Beygui F, Hermida A, Gabrion P, Leborgne L, Houde C, Huang F, Lattuca B, Leclercq F, Mesnier J, Abtan J, Rouanet S, Hammoudi N, Collet JP, Zeitouni M, Silvain J, Montalescot G, Rodés-Cabau J. Impact of the antiplatelet strategy following patent foramen ovale percutaneous closure. Eur Heart J Cardiovasc Pharmacother 2023; 9:601-607. [PMID: 36963773 DOI: 10.1093/ehjcvp/pvad023] [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] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/26/2023]
Abstract
AIMS Temporary dual antiplatelet therapy (DAPT) is recommended following patent foramen ovale (PFO) percutaneous closure although its benefit, compared to single antiplatelet therapy (SAPT), has not been demonstrated in this setting. We aimed at assessing outcomes following PFO closure according to the antiplatelet strategy at discharge. METHODS AND RESULTS The ambispective AIR-FORCE cohort included consecutive patients from seven centres in France and Canada undergoing PFO closure and discharged without anticoagulation. Patients treated in French and Canadian centres were mostly discharged with DAPT and SAPT, respectively. The primary endpoint was the composite of death, stroke, transient ischaemic attack, peripheral embolism, myocardial infarction, or BARC type ≥2 bleeding with up to 5 years of follow-up. The impact of the antiplatelet strategy on outcomes was evaluated with a marginal Cox model (cluster analyses per country) with inverse probability weighting according to propensity score. A total of 1532 patients (42.2% female, median age: 49 [40-57] years) were included from 2001 to 2022, of whom 599 (39.1%) were discharged with SAPT and 933 (60.9%) with DAPT, for ≤3 months in 894/923 (96.9%) cases. After a median follow-up of 2.4 [1.1-4.4] years, a total of 58 events were observed. In the weighted analysis, the rate of the primary endpoint up to 5 years was 7.8% in the SAPT strategy and 7.3% in the DAPT strategy (weighted hazard ratio 1.04, 95% confidence interval 0.59-1.83). CONCLUSION The antiplatelet strategy following PFO closure did not seem to impact clinical outcomes, thus challenging the current recommendations of temporary DAPT.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | | | - Gabriel Asslo
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Vincent Roule
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Farzin Beygui
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Alexis Hermida
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Paul Gabrion
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Laurent Leborgne
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Christine Houde
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France
| | - Benoit Lattuca
- ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Jules Mesnier
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- FACT (French Alliance for Cardiovascular Clinical Trials), Université de Paris, INSERM U-1148, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Jérémie Abtan
- FACT (French Alliance for Cardiovascular Clinical Trials), Université de Paris, INSERM U-1148, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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5
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Reibel I, Hauguel-Moreau M, Guedeney P, Hage G, Hammoudi N, Duthoit G, Zeitouni M, Lattuca B, Kernéis M, Collet JP, Silvain J, Montalescot G. Comparison of three echo-guidance techniques in percutaneous patent foramen ovale closure for stroke prevention: Conventional transoesophageal, microprobe transoesophageal and intracardiac echocardiography. Arch Cardiovasc Dis 2023:S1875-2136(23)00171-7. [PMID: 37838576 DOI: 10.1016/j.acvd.2023.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/26/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent randomized trials have demonstrated a consistent reduction in recurrent stroke after percutaneous transcatheter patent foramen ovale closure versus medical therapy in patients with recent cryptogenic stroke. AIM To compare the safety and efficacy of intracardiac echocardiography-guided and microprobe transoesophageal echocardiography-guided patent foramen ovale closure under local anaesthesia with transoesophageal echocardiography-guided patent foramen ovale closure under general anaesthesia. METHODS This prospective observational single-centre study included 194 consecutive patients scheduled for patent foramen ovale closure for secondary prevention of stroke from February 2018 to December 2019. Patients were asked to choose between an intracardiac echocardiography-guided, microprobe transoesophageal echocardiography-guided or transoesophageal echocardiography-guided procedure. The primary endpoint was the rate of successful closure at 6 months, defined as correct positioning of the device without severe shunt on 6-month contrast echocardiography. RESULTS Successful closure was high and did not differ between groups: 97.8% (95% confidence interval 88.5-99.9%) in the intracardiac echocardiography-guided group versus 96.9% (95% confidence interval 83.8-99.9%) in the microprobe transoesophageal echocardiography-guided group and 99.1% (95% confidence interval 95.3-99.9%) in the transoesophageal echocardiography-guided group (P=0.63). Adverse events related to patent foramen ovale closure were low and did not differ between groups. CONCLUSION Our preliminary real-world experience suggests good efficacy and safety with intracardiac echocardiography and microprobe transoesophageal echocardiography guidance compared with conventional transoesophageal echocardiography guidance for percutaneous transcatheter patent foramen ovale closure in recurrent stroke prevention.
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Affiliation(s)
- Iphigénie Reibel
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie Hauguel-Moreau
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Paul Guedeney
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Georges Hage
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Nadjib Hammoudi
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Guillaume Duthoit
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Michel Zeitouni
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Benoit Lattuca
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Mathieu Kernéis
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Jean-Philippe Collet
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Johanne Silvain
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Gilles Montalescot
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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6
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Hammoudi N, Lehmann-Che J, Lambert J, Amoyel M, Maggiori L, Salfati D, Tran Minh ML, Baudry C, Asesio N, Poirot B, Lourenco N, Corte H, Allez M, Aparicio T, Gornet JM. Prognosis and molecular characteristics of IBD-associated colorectal cancer: Experience from a French tertiary-care center. Dig Liver Dis 2023; 55:1280-1287. [PMID: 36872200 DOI: 10.1016/j.dld.2023.02.011] [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: 11/07/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Little is known about the prognosis of colorectal cancer associated with inflammatory bowel disease (CRC-IBD) in a real-world cohort in France. METHODS We conducted a retrospective observational study including all patients presenting CRC-IBD in a French tertiary center. RESULTS Among 6510 patients, the rate of CRC was 0.8% with a median delay of 19.5 years after IBD diagnosis (median age 46 years, ulcerative colitis 59%, initially localized tumor 69%). There was a previous exposure to immunosuppressants (IS) in 57% and anti-TNF in 29% of the cases. A RAS mutation was observed in only 13% of metastatic patients. OS of the whole cohort was 45 months. OS and PFS of synchronous metastatic patients was 20.4 months and 8.5 months respectively. Among the patients with localized tumor those previously exposed to IS had a better PFS (39 months vs 23 months; p = 0.05) and OS (74 vs 44 months; p = 0.03). The IBD relapse rate was 4%. No unexpected chemotherapy side-effect was observed CONCLUSIONS: OS of CRC-IBD is poor in metastatic patients although IBD is not associated with under-exposure or increased toxicity to chemotherapy. Previous IS exposure may be associated with a better prognosis.
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Affiliation(s)
- N Hammoudi
- Université de Paris, INSERM U1160, EMiLy, Institut de Recherche Saint-Louis, Paris, France; Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - J Lehmann-Che
- Department of molecular oncology, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - J Lambert
- Department of biostatistics, Hôpital Saint-Louis, APHP, Paris University, Paris, France. Hôpital Saint-Louis, Paris - France
| | - M Amoyel
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - L Maggiori
- Department of digestive surgery, Hôpital Saint-Louis, APHP, Université Paris Cité, Paris, France
| | - D Salfati
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - M L Tran Minh
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - C Baudry
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - N Asesio
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - B Poirot
- Department of molecular oncology, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - N Lourenco
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - H Corte
- Department of digestive surgery, Hôpital Saint-Louis, APHP, Université Paris Cité, Paris, France
| | - M Allez
- Université de Paris, INSERM U1160, EMiLy, Institut de Recherche Saint-Louis, Paris, France; Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - T Aparicio
- Université de Paris, INSERM U1160, EMiLy, Institut de Recherche Saint-Louis, Paris, France; Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France
| | - J M Gornet
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis / Lariboisière, Paris, France.
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7
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Tchan BGO, Ngazoa-Kakou S, Aka N, Apia NKB, Hammoudi N, Drancourt M, Saad J. PPE Barcoding Identifies Biclonal Mycobacterium ulcerans Buruli Ulcer, Côte d'Ivoire. Microbiol Spectr 2023; 11:e0034223. [PMID: 37222600 PMCID: PMC10269924 DOI: 10.1128/spectrum.00342-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
Mycobacterium ulcerans, an environmental opportunistic pathogen, causes necrotic cutaneous and subcutaneous lesions, named Buruli ulcers, in tropical countries. PCR-derived tests used to detect M. ulcerans in environmental and clinical samples do not allow one-shot detection, identification, and typing of M. ulcerans among closely related Mycobacterium marinum complex mycobacteria. We established a 385-member M. marinum/M. ulcerans complex whole-genome sequence database by assembling and annotating 341 M. marinum/M. ulcerans complex genomes and added 44 M. marinum/M. ulcerans complex whole-genome sequences already deposited in the NCBI database. Pangenome, core genome, and single-nucleotide polymorphism (SNP) distance-based comparisons sorted the 385 strains into 10 M. ulcerans taxa and 13 M. marinum taxa, correlating with the geographic origin of strains. Aligning conserved genes identified one PPE (proline-proline-glutamate) gene sequence to be species and intraspecies specific, thereby genotyping the 23 M. marinum/M. ulcerans complex taxa. PCR sequencing of the PPE gene correctly genotyped nine M. marinum/M. ulcerans complex isolates among one M. marinum taxon and three M. ulcerans taxa in the African taxon (T2.4). Further, successful PPE gene PCR sequencing in 15/21 (71.4%) swabs collected from suspected Buruli ulcer lesions in Côte d'Ivoire exhibited positive M. ulcerans IS2404 real-time PCR and identified the M. ulcerans T2.4.1 genotype in eight swabs and M. ulcerans T2.4.1/T2.4.2 mixed genotypes in seven swabs. PPE gene sequencing could be used as a proxy for whole-genome sequencing for the one-shot detection, identification, and typing of clinical M. ulcerans strains, offering an unprecedented tool for identifying M. ulcerans mixed infections. IMPORTANCE We describe a new targeted sequencing approach that characterizes the PPE gene to disclose the simultaneous presence of different variants of a single pathogenic microorganism. This approach has direct implications on the understanding of pathogen diversity and natural history and potential therapeutic implications when dealing with obligate and opportunistic pathogens, such as Mycobacterium ulcerans presented here as a prototype.
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Affiliation(s)
- B. G. O. Tchan
- IRD, MEPHI, IHU Méditerranée Infection, Aix-Marseille-Université, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | - S. Ngazoa-Kakou
- Plateforme de Biologie Moléculaire, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - N. Aka
- Unité des Mycobactéries Tuberculeuses et Atypiques, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - N. K. B. Apia
- Plateforme de Biologie Moléculaire, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - N. Hammoudi
- IRD, MEPHI, IHU Méditerranée Infection, Aix-Marseille-Université, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | - M. Drancourt
- IRD, MEPHI, IHU Méditerranée Infection, Aix-Marseille-Université, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | - J. Saad
- IRD, MEPHI, IHU Méditerranée Infection, Aix-Marseille-Université, Marseille, France
- IHU Méditerranée Infection, Marseille, France
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8
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Zeitouni M, Morlon Q, Silvain J, Procopi N, Guedeney P, Rouanet S, Kerneis M, Hatem S, Hammoudi N, Le Feuvre C, Helft G, Collet JP, Lebreton G, Varnous S, Leprince P, Montalescot G. Implication of the new definition of pulmonary hypertension in patients evaluated for heart transplantation. Int J Cardiol 2023:S0167-5273(23)00602-2. [PMID: 37119941 DOI: 10.1016/j.ijcard.2023.04.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The 2018 World Symposium on Pulmonary Hypertension (WSPH) changed the definition of pulmonary hypertension (PH) with a new threshold of mean pulmonary artery pressure (mPAP) above 20 mmHg. OBJECTIVE To evaluate the profile and prognosis of patients with chronic heart failure (HF) considered for heart transplantation with the new definition of PH. METHODS Patients with chronic HF considered for heart transplantation were classified as mPAP≤20mmHg, mPAP 20-25 mmHg, and mPAP≥25mmHg. Using a multivariate Cox model, we compared the mortality of patients with mPAP20-25mmHg, and mPAP≥25mmHg versus those with mPAP≤20mmHg. RESULTS Of 693 patients with chronic HF considered for heart transplantation, 12.7%, 77.5% and 9.8% were classified as mPAP20-25mmHg, mPAP≥ 25mmHg and mPAP≤20mmHg. Patients of mPAP ≥ 25mmHg and mPAP 20-25 mmHg categories were older than mPAP ≤ 20 mmHg (56 versus 55 and 52 year-old, p = 0.02) with more frequent co-morbidities. Within 2.8 years, the mPAP20-25mmHg category displayed a higher risk of mortality compared with those of the mPAP≤20mmHg category (aHR 2.75, 95% CI 1.27-5.97, p = 0.01). Overall, the new PH definition using a threshold of mPAP >20 mmHg was associated with a higher risk of death (adj HR 2.71, 95% CI 1.26-5.80) than the previous definition (mPAP >25 mmHg, aHR: 1.35 95% CI 1.00-1.83, p = 0.05). CONCLUSIONS One out of 8 patients with severe HF are reclassified as having PH following the 2018 WSPH. Patients with mPAP20-25 evaluated for heart transplantation displayed significant co-morbidities and high mortality rates.
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Affiliation(s)
- Michel Zeitouni
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France; Sorbonne Université (UPMC), INSERM UMRS 1166, Chirugie Cardiaque, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Quentin Morlon
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Niki Procopi
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | | | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | | | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Claude Le Feuvre
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Gerard Helft
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, Institute of Cardiometabolism and Nutrition. Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | | | - Pascal Leprince
- Sorbonne Université, Institute of Cardiometabolism and Nutrition. Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
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9
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Hammoudi N, Lionnet F. Heart failure in SCA: still challenging. Blood 2023; 141:1248-1249. [PMID: 36929440 DOI: 10.1182/blood.2022019136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Affiliation(s)
- Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, and Hôpital Pitié-Salpêtrière
| | - François Lionnet
- Sorbonne Université, ACTION Study Group, and Hôpital Pitié-Salpêtrière
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10
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Levy D, Desnos C, Lebreton G, Théry G, Pineton de Chambrun M, Leprince P, Hammoudi N, Schmidt M, Combes A, Hékimian G. Early Reversal of Right Ventricular Dysfunction after Venovenous Extracorporeal Membrane Oxygenation in Patients with COVID-19 Pneumonia. Am J Respir Crit Care Med 2023; 207:784-787. [PMID: 36459095 PMCID: PMC10037471 DOI: 10.1164/rccm.202208-1486le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- David Levy
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Cyrielle Desnos
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Chirurgie Cardiaque et thoracique, Institut de Cardiologie, and
| | - Guillaume Théry
- Service de Médecine Intensive-Réanimation
- Service de Médecine Intensive-Réanimation, Hôpital Universitaire de Reims, Reims, France; and
| | - Marc Pineton de Chambrun
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
- Service de Médecine Interne 2, Centre de référence Lupus Systémique, SAPL et Autres Maladies Auto-immunes et Systémiques Rares, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Leprince
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Chirurgie Cardiaque et thoracique, Institut de Cardiologie, and
| | - Nadjib Hammoudi
- ACTION Study Group, INSERM UMR_S 1166 and Hôpital Pitié-Salpêtrière (AP-HP), Boulevard de l'hôpital, Sorbonne Université, Paris, France
| | - Matthieu Schmidt
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Guillaume Hékimian
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
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11
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Salem JE, Bretagne M, Abbar B, Leonard-Louis S, Ederhy S, Redheuil A, Boussouar S, Nguyen LS, Procureur A, Stein F, Fenioux C, Devos P, Gougis P, Dres M, Demoule A, Psimaras D, Lenglet T, Maisonobe T, Pineton DE Chambrun M, Hekimian G, Straus C, Gonzalez-Bermejo J, Klatzmann D, Rigolet A, Guillaume-Jugnot P, Champtiaux N, Benveniste O, Weiss N, Saheb S, Rouvier P, Plu I, Gandjbakhch E, Kerneis M, Hammoudi N, Zahr N, Llontop C, Morelot-Panzini C, Lehmann L, Qin J, Moslehi JJ, Rosenzwajg M, Similowski T, Allenbach Y. Abatacept/Ruxolitinib and Screening for Concomitant Respiratory Muscle Failure to Mitigate Fatality of Immune-Checkpoint Inhibitor Myocarditis. Cancer Discov 2023; 13:1100-1115. [PMID: 36815259 DOI: 10.1158/2159-8290.cd-22-1180] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Immune-checkpoint-inhibitor (ICI)-associated myotoxicity involves the heart (myocarditis) and skeletal muscles (myositis), which frequently occur concurrently and is highly fatal. We report the results of a strategy that included identification of individuals with severe ICI-myocarditis by also screening for and managing concomitant respiratory muscle involvement with mechanical ventilation, as well as treatment with CTLA4-fusion protein abatacept and the Janus-kinase inhibitor ruxolitinib. Forty cases with definite ICI-myocarditis were included with pathological confirmation of concomitant myositis in the majority of patients. In the first 10 patients, using recommended guidelines, myotoxicity-related fatality occurred in 60%, consistent with historical controls. In the subsequent 30 cases, we instituted systematic screening for respiratory muscle involvement coupled with active ventilation and treatment using ruxolitinib and abatacept. Abatacept dose was adjusted using CD86-receptor occupancy on circulating monocytes. Myotoxicity-related fatality rate was 3.4%(1/30) in these 30 patients vs.60% in 1st quartile(p<0.0001). These clinical results are hypothesis-generating and need further evaluation.
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Affiliation(s)
| | - Marie Bretagne
- Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | | | | | | | | | | | - Lee S Nguyen
- Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly-sur-Seine, France
| | | | | | | | | | | | | | | | - Dimitri Psimaras
- Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France, Paris, France
| | | | | | | | | | - Christian Straus
- Sorbonne Université, INSERM, UMRS1158, AP-HP, Hôpital Pitié-Salpêtrière, PARIS, France
| | | | - David Klatzmann
- UPMC Univ Paris 06, UMR 7211, Immunology-Immunopathology-Immunotherapy, Paris, France
| | | | | | | | | | | | | | | | | | | | | | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | | | | | | | | | - Juan Qin
- University of California, San Francisco, San Fransisco, CA, United States
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12
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Wallet T, Al Mohani A, Waintraub X, Berman E, Mertens E, Bouziri N, Allali Y, Helft G, Lefeuvre C, Isnard R, Montalescot G, Hammoudi N. Exercise-induced ventricular arrythmia in patients with mitral valve prolapse. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Hascoët S, Smolka G, Brochet E, Bouisset F, Leurent G, Thambo JB, Combes N, Bauer F, Nejjari M, Pilliere R, Dauphin C, Bonnet G, Ketelers R, Dumonteil N, Ciobotaru V, Gallet R, Hammoudi N, Spaulding C, Champagnac D, Gérardin B. Predictors of clinical success after transcatheter paravalvular leak closure: An international prospective multicenter registry. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Elegamandji B, Alamowitch S, Crozier S, Sabben C, Deltour S, Obadia M, Benyounes N, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular Arrhythmia Following Patent Foramen Ovale Percutaneous Closure. JACC Cardiovasc Interv 2022; 15:2315-2322. [PMID: 36008269 DOI: 10.1016/j.jcin.2022.07.044] [Citation(s) in RCA: 18] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patient-reported symptomatic episodes, so the true incidence and timing of AF after PFO closure remain unknown. OBJECTIVES The aim of this study was to prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure on the basis of loop recorder monitoring. METHODS Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 at a single center by means of implantable loop recorder monitoring in patients considered at higher risk for AF (age ≥ 55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder monitoring in other patients. The primary endpoint was the incidence of AF, atrial flutter, or supraventricular tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed using a stepwise logistic regression model. RESULTS A total of 225 patients were included. The primary endpoint occurred in 47 patients (20.9%), including 13 (9.9%) and 24 (28.9%) among patients monitored with external loop recorders and implantable loop recorders, respectively. Overall, the median delay from procedure to arrhythmia was 14.0 days (IQR: 6.5-19.0 days), and one-half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted OR: 1.67 per 10-year increase; 95% CI: 1.18-2.36), device left disc diameter ≥25 mm (adjusted OR: 2.67; 95% CI: 1.19-5.98) and male sex (adjusted OR: 4.78; 95% CI: 1.96-11.66). CONCLUSIONS Using loop recorder monitoring for ≥28 days, supraventricular arrhythmia was diagnosed in 1 in 5 patients, with a median delay of 14 days, suggesting that this postprocedural event has so far been underestimated.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Marie Hauguel-Moreau
- INSERM U-1018, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Thomas Wallet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Benjamin Elegamandji
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Sonia Alamowitch
- Sorbonne Université, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Sophie Crozier
- Sorbonne Université, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Candice Sabben
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Sandrine Deltour
- Neurology Department, Raymond-Poincaré Hospital (AP-HP), Garches, France
| | - Michaël Obadia
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Nadia Benyounes
- Cardiology Department, Rothschild Foundation Hospital, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France.
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15
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Guedeney P, Mesnier J, Michel M, Hauguel-Moreau M, Silvain J, Houde C, Alperi A, Panagides V, Collet JP, Wallet T, Rouanet S, Hammoudi N, Rodes-Cabau J, Montalescot G. Outcomes following patent foramen ovale percutaneous closure according to the delay from last ischemic event. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Randomized controlled trials evaluating patent foramen ovale (PFO) percutaneous closure only included patients with recent embolic event. We aimed to evaluate outcomes following percutaneous PFO closure outcomes according to the delay from the last embolic episode.
Methods
This international ambispective cohort included consecutive patients from two centers in France and Canada undergoing PFO percutaneous closure for secondary prevention of paradoxical embolic event. The primary endpoint was the composite of stroke or transient ischemic attack (TIA). Logistic regression model was used to evaluate determinants of late PFO closure procedures.
Results
A total of 1,179 patients (mean age 49±12.7 years; 44.4% female) underwent PFO closure from 2001 to 2021 (Figure 1). The median delay from last embolic event to procedure was 6.0 (3.4–11.2) months. Determinants of late PFO closure procedure were the center (France versus Canada) adjusted Odds Ratio (aOR) 1.65 95% confidence interval (CI) 1.25–2.19, year of procedure (≥2018 versus <2018) aOR 1.43 95% CI 1.08–1.90, female sex aOR 1.63 95% CI 1.28–2.07 and lower RoPE score aOR 1.10 95% CI 1.03–1.19. After a median follow-up of 2.61 (1.13–7.25) years, the incidence rate of first stroke or TIA did not differ between early and late PFO procedures with 0.51 versus 0.29 events per 100 patient-years, respectively, incidence rate ratio 1.74 95% CI 0.66–5.08, p=0.25 (Figure 2). In univariate analysis, late PFO percutaneous closure was not associated with the occurrence of stroke or TIA, with hazard ratio 0.54 95% CI 0.22–1.34 p=0.17.
Conclusion
This analysis provides indirect evidence that delay from last ischemic event does not impact outcomes following PFO percutaneous closure for secondary prevention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - J Mesnier
- Quebec Heart and Lung Institute , Quebec , Canada
| | - M Michel
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, Cardiology , Boulogne Billancourt , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - C Houde
- Hospital Affiliated with the University of Quebec , Quebec , Canada
| | - A Alperi
- Quebec Heart and Lung Institute , Quebec , Canada
| | - V Panagides
- Quebec Heart and Lung Institute , Quebec , Canada
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - T Wallet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | | | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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16
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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Alamowitch S, Sabben C, Deltour S, Benyounes N, Obadia M, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patients-reported symptomatic episodes, thus true incidence and timing of AF after PFO closure remain unknown.
Objective
To prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure based on loop recorder monitoring.
Methods
Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 in our center by mean of implantable loop recorder (ILR) monitoring in patients considered at higher risk of AF (age ≥55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder (ELR) monitoring in other patients. The primary endpoint was the incidence of AF, flutter, or atrial tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed with stepwise logistic regression model.
Results
A total of 225 patients were included. The primary endpoint occurred in 47/225 (20.9%) patients, including n=13 (9.9%) and n=24 (28.9%) among ELR- and ILR-monitored patients, respectively. Among ILR-monitored patients, median follow-up was 428 (211–752) days, and four more cases of supraventricular arrhythmia were diagnosed beyond 28 days (Figure 1). Overall, median delay from procedure to arrhythmia was 14.0 (6.5–19.0) days and half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.18–2.36, per 10-year increase), device left disc diameter ≥25mm (aOR: 2.67, 95% CI: 1.19–5.98) and male sex (aOR: 4.78, 95% CI: 1.96–11.66) (Figure 2).
Conclusion
Using prolonged loop recorder monitoring, supraventricular arrhythmia was diagnosed in one patient out of five with a median delay of 14 days suggesting that this post-procedural event has been so far, underestimated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Laredo
- Hospital Pitie-Salpetriere , Paris , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, cardiology , Boulogne Billancourt , France
| | - T Wallet
- Hospital Pitie-Salpetriere , Paris , France
| | | | - C Sabben
- Fondation Rothschild, Neurology , Paris , France
| | - S Deltour
- Hopital Raymond Poincare, Neurology , Garches , France
| | - N Benyounes
- Fondation Rothschild, Cardiology , Paris , France
| | - M Obadia
- Fondation Rothschild, Neurology , Paris , France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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Hascoët S, Smolka G, Blanchard D, Kloëckner M, Brochet E, Bouisset F, Leurent G, Thambo JB, Combes N, Dumonteil N, Bauer F, Nejjari M, Pillière R, Dauphin C, Bonnet G, Ciobotaru V, Kételers R, Gallet R, Hammoudi N, Mangin L, Bouvaist H, Spaulding C, Aminian A, Kilic T, Popovic B, Armero S, Champagnac D, Gérardin B. Predictors of Clinical Success After Transcatheter Paravalvular Leak Closure: An International Prospective Multicenter Registry. Circ Cardiovasc Interv 2022; 15:e012193. [PMID: 36256693 DOI: 10.1161/circinterventions.122.012193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter closure of a symptomatic prosthetic paravalvular leak (PVL) is feasible, but there is presently no conclusive evidence to show consistent efficacy. We aimed to identify predictors of clinical success after transcatheter PVL closure. METHODS Consecutive patients referred to 24 European centers for transcatheter PVL closure in 2017 to 2019 were included in a prospective registry (Fermeture de Fuite ParaProthétique, FFPP). Clinical success was absence of any of the following within 1 month: re-admission for heart failure, blood transfusion, open-heart valvular surgery, and death. RESULTS We included 216 symptomatic patients, who underwent 238 percutaneous PVL closure procedures on the mitral (64.3%), aortic (34.0%), or tricuspid (1.7%) valve. Symptoms were heart failure, hemolytic anemia, or both in 48.9%, 7.8%, and 43.3% of patients, respectively. One, 2, and 3 leaks were treated during the same procedure in 69.6%, 26.6%, and 3.8% of patients, respectively. The PVL was pinpoint or involved 1/8 or 1/4 of the valve circumference in 18.6%, 52.4%, and 28.1% of cases, respectively. The most frequently used devices were the Vascular Plug 3, Ventricular Septal Defect Occluder, Vascular Plug 2, and Paravalvular Leak Device (45.0%, 16.6%, 14.2%, and 13.6% of cases, respectively). Successful device(s) implantation with leak reduction to ≤grade 2 was obtained in 85.0% of mitral and 91.4% of aortic procedures, respectively (P=0.164); with major periprocedural adverse event rates of 3.3% and 1.2%, respectively (P=0.371); and clinical success rates of 70.3% and 88.0%, respectively (P=0.004). By multivariate analysis, technical failure, mechanical valve, and hemolytic anemia were independently associated with absence of clinical success (odds ratios [95% CIs], 7.7 [2.0-25.0]; P=0.002; 3.6 [1.1-11.1]; P=0.036; and 3.7 [1.2-11.9]; P=0.025; respectively). CONCLUSIONS Transcatheter PVL closure is efficient and safe in symptomatic patients but is associated with a lower clinical success rate in patients with hemolysis and/or a mechanical valve. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT05089136.
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Affiliation(s)
- Sébastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | | | - David Blanchard
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | - Martin Kloëckner
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | - Eric Brochet
- Hôpital Bichat AP-HP, Hôpital Bichat-Paris, Paris, France (E.B.)
| | - Frederic Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Hôpital Rangueil, CHU Toulouse, Toulouse, France (F.B.)
| | - Guillaume Leurent
- Department of cardiology, Université Rennes, Inserm, LTSI - UMR1099, CHU Rennes, Rennes, France (G.L.)
| | | | | | | | | | | | - Rémy Pillière
- Clinique Ambroise Paré-25-27 boulevard Victor Hugo, France (R.P.)
| | - Claire Dauphin
- Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France (C.D.)
| | - Guillaume Bonnet
- CHU Timone, Assistance Publique des Hôpitaux de Marseille, France (G.B.)
| | | | | | | | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, and Hôpital Pitié-Salpêtrière AP-HP, Boulevard de l'Hôpital, Paris, France (N.H.)
| | - Lionel Mangin
- Hôpital d'Annecy, 1 avenue de l'Hôpital, France (L.M.)
| | - Hélène Bouvaist
- CHU Grenoble, avenue du Maquis du Grésivaudan, France (H.B.)
| | | | | | - Teoman Kilic
- Kocaeli University School of Medicine, Cardiology Department, Umuttepe, Yerteskesi, Kocaeli, Turkey (T.K.)
| | - Batric Popovic
- Lorraine University, CHRU Nancy, Cardiology department, Nancy, France (B.P.)
| | | | | | - Benoît Gérardin
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
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18
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Escolà-Vergé L, Rello P, Declerck C, Dubée V, Rouleau F, Duval X, Habib G, Lavie-Badie Y, Martin-Blondel G, Porte L, Bouiller K, Goehringer F, Selton-Suty C, Lamas CDC, Nacinovich F, Issa N, Richaud C, Hammoudi N, Barranco FJ, Almirante B, Tattevin P, Fernández-Hidalgo N. Infective endocarditis in pregnant women without intravenous drug use: a multicentre retrospective case series. J Antimicrob Chemother 2022; 77:2701-2705. [PMID: 35962570 DOI: 10.1093/jac/dkac258] [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] [Received: 04/04/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To describe the clinical features and outcomes of infective endocarditis (IE) in pregnant women who do not inject drugs. METHODS A multinational retrospective study was performed at 14 hospitals. All definite IE episodes between January 2000 and April 2021 were included. The main outcomes were maternal mortality and pregnancy-related complications. RESULTS Twenty-five episodes of IE were included. Median age at IE diagnosis was 33.2 years (IQR 28.3-36.6) and median gestational age was 30 weeks (IQR 16-32). Thirteen (52%) patients had no previously known heart disease. Sixteen (64%) were native IE, 7 (28%) prosthetic and 2 (8%) cardiac implantable electronic device IE. The most common aetiologies were streptococci (n = 10, 40%), staphylococci (n = 5, 20%), HACEK group (n = 3, 12%) and Enterococcus faecalis (n = 3, 12%). Twenty (80%) patients presented at least one IE complication; the most common were heart failure (n = 13, 52%) and symptomatic embolism other than stroke (n = 4, 16%). Twenty-one (84%) patients had surgery indication and surgery was performed when indicated in 19 (90%). There was one maternal death and 16 (64%) patients presented pregnancy-related complications (11 patients ≥1 complication): 3 pregnancy losses, 9 urgent Caesarean sections, 2 emergency Caesarean sections, 1 fetal death, and 11 preterm births. Two patients presented a relapse during a median follow-up of 3.1 years (IQR 0.6-7.4). CONCLUSIONS Strict medical surveillance of pregnant women with IE is required and must involve a multidisciplinary team including obstetricians and neonatologists. Furthermore, the potential risk of IE during pregnancy should never be underestimated in women with previously known underlying heart disease.
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Affiliation(s)
- Laura Escolà-Vergé
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Rello
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Charles Declerck
- Infectious Diseases Department, Angers University Hospital, Angers, France
| | - Vincent Dubée
- Infectious Diseases Department, Angers University Hospital, Angers, France
| | - Fréderic Rouleau
- Department of Cardiology, Angers University Hospital, Angers, France
| | - Xavier Duval
- Infectious Diseases, CIC Inserm 1425, IAME, Bichat Hospital, APHP, Paris Cité University, Paris, France
| | - Gilbert Habib
- Cardiology Department, La Timone Hospital, Aix Marseille University, IRD, APHM, Marseille, France
| | - Yoan Lavie-Badie
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | | | - Lydie Porte
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | | | | | | | - Cristiane da Cruz Lamas
- Infectious Diseases, Instituto Nacional de Cardiologia. Unigranrio. Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Francisco Nacinovich
- Infectious Diseases, Instituto Cardiovascular Buenos Aires, Buenos Aires, Argentina
| | - Nahema Issa
- Infectious Diseases and ICU, Groupe Saint-André Hospital, University Hospital, Bordeaux, France
| | - Clémence Richaud
- Internal Medecine, Institut Mutualiste Montsouris, Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Francisco José Barranco
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pierre Tattevin
- Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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19
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Salem JE, Hammoudi N, Pinna B, Ederhy S, Lamazière A, Fenioux C, Redheuil A, Salem P, Ribet C, Hamwy O, Marcelin AG, Burrel S, Funck-Brentano C, Montalescot G, Lacorte JM, Gandjbakhch E, Benveniste O, Saadoun D, Allenbach Y, Boussouar S, Prifti E, Cacoub P. Echocardiography and renin-aldosterone interplay as predictors of death in COVID-19. Arch Cardiovasc Dis 2022; 115:96-105. [PMID: 35148974 PMCID: PMC8809659 DOI: 10.1016/j.acvd.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022]
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20
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Hammoudi N, Ceccaldi A, Haymann JP, Guedeney P, Nicolas-Jilwan F, Zeitouni M, Montalescot G, Lionnet F, Isnard R, Hatem SN. Altered cardiac reserve is a determinant of exercise intolerance in sickle cell anaemia patients. Eur J Clin Invest 2022; 52:e13664. [PMID: 34390499 DOI: 10.1111/eci.13664] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/18/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The underlying mechanisms of exercise intolerance in sickle cell anaemia (SCA) patients are complex and not yet completely understood. While latent heart failure at rest could be unmasked upon exercise, most previous studies assessed cardiac function at rest. We aimed to investigate exercise cardiovascular reserve as a potential contributor to exercise intolerance in adult SCA patients. METHODS In this observational prospective study, we compared prospectively 60 SCA patients (median age 31 years, 60% women) to 20 matched controls. All subjects underwent symptom-limited combined exercise echocardiography and oxygen uptake (VO2 ) measurements. Differences between arterial and venous oxygen content (C(a-v)O2 ) were calculated. Cardiac reserve was defined as the absolute change in cardiac index (Ci) from baseline to peak exercise. RESULTS Compared to controls, SCA patients demonstrated severe exercise intolerance (median peakVO2 , 34.3 vs. 19.7 ml/min/kg, respectively, p < .0001). SCA patients displayed heterogeneously increased Ci from rest to peak exercise (median +5.8, range 2.6 to 10.6 L/min/m²) which correlated with peakVO2 (r = 0.71, p < .0001). In contrast, the C(a-v)O2 exercise reserve was homogenously reduced and did not correlate with peakVO2 (r = 0.18, p = .16). While haemoglobin level and C(a-v)O2 were similar in SCA subgroups, SCA patients in the lower VO2 tertile had chronotropic incompetence and left ventricular diastolic dysfunction (left atrial peak longitudinal strain was reduced, and both E/e' ratio and left atrial volume index were increased) and were characterized by a reduced cardiac reserve, +5.0[4.2-5.5] compared to +6.7[5.5-7.8] L/min/m² for the rest of the patient cohort, p < .0001. CONCLUSIONS Altered cardiac reserve due to chronotropic incompetence and left ventricular diastolic dysfunction seems to be an important determinant of exercise intolerance in adult SCA patients.
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Affiliation(s)
- Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Alexandre Ceccaldi
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Jean-Philippe Haymann
- Département de physiologie et de néphrologie (AP-HP), Centre Hospitalier Universitaire Tenon, Sorbonne Université, INSERM UPMC 1155, Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Fadila Nicolas-Jilwan
- Département de physiologie et de néphrologie (AP-HP), Centre Hospitalier Universitaire Tenon, Sorbonne Université, INSERM UPMC 1155, Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - François Lionnet
- Service de médecine interne, Centre de référence de la drépanocytose (AP-HP), Centre Hospitalier Universitaire Tenon, Sorbonne Université, Paris, France
| | - Richard Isnard
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Stéphane N Hatem
- Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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21
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Roger C, Lionnet F, Mattioni S, Livrozet M, Steichen O, Letavernier E, Hammoudi N, Avellino V, Haymann J. Risk factors for CKD stage II onset in a prospective cohort of homozygous sickle cell adults. Am J Hematol 2021; 96:1147-1155. [PMID: 34111308 DOI: 10.1002/ajh.26264] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
Prevalence of renal impairment is increasing with aging in sickle cell anemia (SCA) patients, and is responsible for a high morbidity and mortality. However, sickle cell nephropathy's natural course remains mostly unknown. We conducted a prospective observational cohort study aimed to identify risk factors for CKD stage II in a cohort of SCA patients. Baseline clinical and biological parameters were collected. Renal parameters were updated at each visit. Risk factors were analyzed using the Cox model. Five-hundred and thirty-five SCA patients were included with a median follow-up of 5.33 (IQR:2.10-8.13) years. Median age was 22 (IQR:19-30) years old. Glomerular hyperfiltration was detected in 299 (55.9%) patients, microalbuminuria and macroalbuminuria in 180 (34%) and 67 (12.7%) patients respectively. During follow up, CKD stage II onset was detected in 39 patients (7.3%). Risk factors for CKD stage II after adjustment on baseline eGFR and age were macroalbuminuria HR: 3.89 [95% CI: 1.61;9.43], diastolic blood pressure (DBP) above 70 mm Hg HR: 2.02 [1.02-3.971], LDH (for 100 IU/L increase) HR: 1.28 [1.12;1.48] and tricuspid regurgitation velocity >2.5 m/sec HR: 2.89 [1.20-6.99]. Multivariate analysis also found age as a strong independent risk factor with HR: (per year increase) 1.13 [1.09;1.16] and a 13.3-fold increase above 30 years (p < 0.001). Our results show a high incidence of CKD stage II with aging, with a strong significant risk increase after 30-years-old, and pinpoint baseline DBP, macroalbuminuria and increased LDH as independent risk factors raising the issue of optimal blood pressure targets for SCA patients.
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Affiliation(s)
- Camille Roger
- Service de Néphrologie – CHRU de Lille Université de Lille Lille France
| | - Francois Lionnet
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Sarah Mattioni
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Marine Livrozet
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
| | - Olivier Steichen
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
| | - Nadjib Hammoudi
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology Institute of Cardiology (AP‐HP), Hôpital Pitié‐Salpêtrière, Boulevard de l'hôpital Paris France
| | - Virginie Avellino
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Jean‐Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
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22
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Mertens E, Hekimian G, Leprince P, Elegamandji B, Redheuil A, Bouziri N, Isnard R, Montalescot G, Hammoudi N. Prosthesis choice for surgical treatment of left-sided native valve infective endocarditis: Determinants and impact on outcomes. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Wallet T, Lionnet F, Guedeney P, Haymann J, Bouziri N, Sy V, Steichen O, Isnard R, Montalescot G, Hammoudi N. Prevalence and factors associated with dyspnea in adult patients with Hemoglobin SC disease: a study of 221 cases. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Moreau J, Hammoudi N, Marthey L, Trang-Poisson C, Nachury M, Altwegg R, Grimaud JC, Orempuller S, Hébuterne X, Aubourg A, Baudry C, Seksik P, Roblin X, Nahon S, Savoye G, Mesnard B, Stefanescu C, Simon M, Coffin B, Fumery M, Carbonnel F, Peyrin-Biroulet L, Desseaux K, Allez M. Impact of an Education Programme on IBD Patients' Skills: Results of a Randomised Controlled Multicentre Study [ECIPE]. J Crohns Colitis 2021; 15:432-440. [PMID: 32969469 DOI: 10.1093/ecco-jcc/jjaa195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Better patient knowledge on inflammatory bowel disease [IBD] could improve outcome and quality of life. The aim of this study was to assess if an education programme improves IBD patients' skills as regards their disease. METHODS The GETAID group conducted a prospective multicentre randomised controlled study. IBD patients were included at diagnosis, or after a significant event in the disease course. Patients were randomised between 'educated' or control groups for 6 months. Education was performed by trained health care professionals. A psycho-pedagogic score [ECIPE] was evaluated by a 'blinded' physician at baseline and after 6 and 12 months [M6 and M12]. The primary endpoint was the increase of ECIPE score at M6 of more than 20%. RESULTS A total of 263 patients were included in 19 centres (male:40%; median age:30.8; Crohn's disease [CD]:73%). Of these, 133 patients were randomised into the educated group and 130 into the control group. The median relative increase in ECIPE score at M6 was higher in the educated group as compared with the control group (16.7% [0-42.1%] vs 7% [0-18.8%], respectively, p = 0.0008). The primary endpoint was met in 46% vs 24% of the patients in the educated and control groups, respectively [p = 0.0003]. A total of 92 patients met the primary endpoint. In multivariate analysis, predictors of an increase of at least 20% of the ECIPE score were randomisation in the educated group (odds ratio [OR] = 2.59) and no previous surgery [OR = 1.92]. CONCLUSIONS These findings support the set-up of education programmes in centres involved in the management of IBD patients.
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Affiliation(s)
- J Moreau
- Gastroenterology Department, Hôpital Rangueil, Toulouse, France
| | - N Hammoudi
- Gastroenterology Department, APHP, Hôpital Saint-Louis, INSERM UMRS 1160, Université Paris Diderot, Sorbonne Paris-Cité University, Paris, France
| | - L Marthey
- Gastroenterology Department, Hôpital du Kremlin-Bicetre, Kremlin Bicetre, France
| | | | - M Nachury
- CHU Lille, Maladies de l'appareil digestif, Lille, France
| | - R Altwegg
- Gastroenterology Department, Hôpital St-Eloi, Montpellier, France
| | - J C Grimaud
- Gastroenterology Department, Hôpital Nord, Marseille, France
| | - S Orempuller
- Gastroenterology Department, Hôpital Rangueil, Toulouse, France
| | - X Hébuterne
- Gastroenterology Department, Hôpital Archet, Nice, France
| | - A Aubourg
- Gastroenterology Department, Hôpital Trousseau, Tours, France
| | - C Baudry
- Gastroenterology Department, APHP, Hôpital Saint-Louis, INSERM UMRS 1160, Université Paris Diderot, Sorbonne Paris-Cité University, Paris, France
| | - P Seksik
- Department of Gastroenterology, Centre de recherche Saint-Antoine, Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - X Roblin
- Gastroenterology Department, Hôpital de St-Etienne, St-Etienne, France
| | - S Nahon
- Gastroenterology Department, Hôpital de Montfermeil, Montfermeil, France
| | - G Savoye
- Gastroenterology Department, Hôpital Charles Nicolle, Rouen, France
| | - B Mesnard
- Gastroenterology Department, Hôpital Dron, Tourcoing, France
| | - C Stefanescu
- Gastroenterology Department, Hôpital Beaujon, Clichy, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Monsouris, Paris, France
| | - B Coffin
- Gastroenterology Department, Hôpital Louis Mourier, Colombes, France
| | - M Fumery
- Gastroenterology Department, Hôpital Nord, Amiens, France
| | - F Carbonnel
- Gastroenterology Department, Hôpital du Kremlin-Bicetre, Kremlin Bicetre, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - K Desseaux
- SBIM, Hôpital Saint-Louis, Paris, France
| | - M Allez
- Gastroenterology Department, APHP, Hôpital Saint-Louis, INSERM UMRS 1160, Université Paris Diderot, Sorbonne Paris-Cité University, Paris, France
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Mertens E, Bouziri N, Guedeney P, Duthoit G, Redheuil A, Ceccaldi A, Chicheportiche T, Isnard R, Silvain J, Montalescot G, Hammoudi N. Impact of left atrial appendage closure on left atrial hemodynamics. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Benchabi Y, Belguedj R, Rhouati A, Hammoudi N. Prognosis of myocardial infarction in young women. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Lattuca B, Bouziri N, Kerneis M, Portal JJ, Zhou J, Hauguel-Moreau M, Mameri A, Zeitouni M, Guedeney P, Hammoudi N, Isnard R, Pousset F, Collet JP, Vicaut E, Montalescot G, Silvain J. Antithrombotic Therapy for Patients With Left Ventricular Mural Thrombus. J Am Coll Cardiol 2020; 75:1676-1685. [PMID: 32273033 DOI: 10.1016/j.jacc.2020.01.057] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [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: 06/28/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contemporary data are lacking regarding the prognosis and management of left ventricular thrombus (LVT). OBJECTIVES The purpose of this study was to quantify the effect of anticoagulation therapy on LVT evolution using sequential imaging and to determine the impact of LVT regression on the incidence of thromboembolism, bleeding, and mortality. METHODS From January 2011 to January 2018, a comprehensive computerized search of LVT was conducted using 90,065 consecutive echocardiogram reports. Only patients with a confirmed LVT were included after imaging review by 2 independent experts. Major adverse cardiovascular events (MACE), which included death, stroke, myocardial infarction, or acute peripheral artery emboli, were determined as well as major bleeding events (BARC ≥3) and all-cause mortality rates. RESULTS There were 159 patients with a confirmed LVT. Patients were treated with vitamin K antagonists (48.4%), parenteral heparins (27.7%), and direct oral anticoagulants (22.6%). Antiplatelet therapy was used in 67.9% of the population. A reduction of the LVT area from baseline was observed in 121 patients (76.1%), and total LVT regression occurred in 99 patients (62.3%) within a median time of 103 days (interquartile range: 32 to 392 days). The independent correlates of LVT regression were a nonischemic cardiomyopathy (hazard ratio [HR]: 2.74; 95% confidence interval [CI]: 1.43 to 5.26; p = 0.002) and a smaller baseline thrombus area (HR: 0.66; 95% CI: 0.45 to 0.96; p = 0.031). The frequency of MACE was 37.1%; mortality 18.9%; stroke 13.3%; and major bleeding 13.2% during a median follow-up of 632 days (interquartile range: 187 to 1,126 days). MACE occurred in 35.4% and 40.0% of patients with total LVT regression and those with persistent LVT (p = 0.203). A reduced risk of mortality was observed among patients with total LVT regression (HR: 0.48; 95% CI: 0.23 to 0.98; p = 0.039), whereas an increased major bleeding risk was observed among patients with persistent LVT (9.1% vs. 12%; HR 0.34; 95% CI: 0.14 to 0.82; p = 0.011). A left ventricular ejection fraction ≥35% (HR: 0.46; 95% CI: 0.23 to 0.93; p = 0.029) and anticoagulation therapy >3 months (HR: 0.42; 95% CI: 0.20 to 0.88; p = 0.021) were independently associated with less MACE. CONCLUSIONS The presence of LVT was associated with a very high risk of MACE and mortality. Total LVT regression, obtained with different anticoagulant regimens, was associated with reduced mortality.
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Affiliation(s)
- Benoit Lattuca
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Nesrine Bouziri
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Jean-Jacques Portal
- Unité de Recherche Clinique, Lariboisière Hospital (AP-HP), ACTION Study Group, Paris, France
| | - Jiannong Zhou
- Information system department, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Marie Hauguel-Moreau
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Amel Mameri
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Richard Isnard
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Françoise Pousset
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Lariboisière Hospital (AP-HP), ACTION Study Group, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France. https://twitter.com/docjohanne
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28
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Mertens E, Bouziri N, Guedeney P, Duthoit G, Redheuil A, Ceccaldi A, Chicheportiche T, Isnard R, Silvain J, Montalescot G, Hammoudi N. Impact of left atrial appendage closure on left atrial hemodynamics: a prospective single center study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Percutaneous left atrial (LA) appendage closure is increasingly used to prevent strokes in patients with atrial fibrillation (AF). While LA appendage plays a key role in LA physiology, data regarding the impact of LA appendage occlusion on LA hemodynamics are lacking. The alteration of LA compliance by LA appendage occlusion may represent a clinical issue in AF patients which are at high risk of heart failure.
Purpose
To describe the impact of LA appendage occlusion on LA hemodynamics.
Material and methods
From july 2015 to january 2020, all patients undergoing LA occlusion procedure at Pitié-Salpêtrière Hospital (Paris, France) in whom LA pressure curves were recorded, before and immediately after device implantation, were included. The LA mean pressure was measured at baseline and after LA appendage occlusion during the same procedure. Abnormal LA mean pressure was defined as >15mmHg. We also recorded cardiovascular death and hospitalization for congestive heart failure at longest follow-up.
Results
We enrolled 85 patients (78±8 years, 46 men), the CHA2DS2-VASc score was 5±1 and the HAS-BLED score was 4±1. The mean LA volume index was 51±15mL/m2, the left ventricular ejection fraction was 60±7%. The LA mean pressure increased significatively after LA appendage closure from 12.6±3.9mmHg to 15.5±5.2mmHg (p<0.0001, Figure). The prevalence of abnormal LA pressure was 20% (17/85) at baseline and 45% (38/85) after LA appendage closure (p=0.005). Post procedural LA pressure elevation was not related to procedure duration nor to fluid expansion volume.
During a median follow-up of 364 [124–726] days, 3 (3.5%) patients died from a cardiovascular cause. Hospitalization for heart failure occurred in 6 (16%) of the 38 patients with abnormal postprocedural LA pressure, whereas no congestive episode was observed in the rest of the study population (p=0.006).
Conclusion
Catheter-based LA appendage occlusion induces an acute alteration of LA hemodynamics. Post procedural abnormal LA pressure may be linked to heart failure episodes in some patients. Further studies are warranted to investigate heart failure as a potential late complication of LA appendage closure.
Variations of mean LA pressure
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Mertens
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - N Bouziri
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - P Guedeney
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - G Duthoit
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - A Redheuil
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - A Ceccaldi
- Pitie Salpetriere APHP University Hospital, Paris, France
| | | | - R Isnard
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - J Silvain
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - G Montalescot
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - N Hammoudi
- Pitie Salpetriere APHP University Hospital, Paris, France
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29
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Guedeney P, Silvain J, Hauguel-Moreau M, Sabben C, Deltour S, Zeitouni M, Reibel I, Ferrante A, Alamowitch S, Gandjbackch E, Hidden Lucet F, Hammoudi N, Montalescot G. Incidence and delay of atrial tachycardia after patent foramen ovale closure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the large randomized trials evaluating patent foramen ovale (PFO) closure vs. medical treatment in secondary prevention of stroke, the incidence of atrial fibrillation has been reported more frequently with PFO closure (2.9–6.6%) than with medical treatment (0.4–1.9%). These episodes were clinically reported and may not reflect the real incidence detected by prolonged ECG recording.
Purpose
To evaluate the incidence and timing of supraventricular tachycardia (SVT) after percutaneous PFO closure.
Methods
Prolonged cardiac monitoring was proposed to patients undergoing PFO closure at the tertiary center of Pitié Salpétrière Hospital, Paris. According to the estimated risk of SVT, two different approaches were used to monitor cardiac rhythm. A 3-year permanent recording using REVEAL™ XT or LINQ was proposed to high risk patients (age >45 years, multiple CV risk factors, prior palpitations or supraventricular ectopic activity during Holter monitoring prior to the intervention). A 4-week, 15-lead ECG continuous recording using the patch-free, wire-free, wearable Cardioskin™ system was proposed to lower risk patients. Endpoints of interest were the occurrence of SVT episodes (>30 seconds) and unplanned medical consultation or hospitalization for this reason
Results
From October 2018 to January 2020, a total of 64 patients underwent prolonged ECG monitoring including 32 (50.0%) and 32 (50.0%) patients with Cardioskin™ and REVEAL™ systems, respectively. A SVT was recorded in 11 (17.4%) patients, including atrial fibrillation (AF) in 6 (9.5%) patients. The median delay of SVT occurrence was 33.0 (14.0–39) days after the procedure (Figure 1) and 18 (10.8–34.8) days for the 6 patients with AF. Unplanned hospitalization or emergency medical visit for symptomatic SVT occurred in 5 (45.5%) patients. Antiarrhythmic medication and oral anticoagulation were initiated in 10 (90.1%) and 7 (63.6%) of the 11 patients, respectively, and SVT recurrences were recorded in 5 (45.5%) patients. No stroke was reported in any of the 11 patients during follow-up. There were no significant differences with respect to baseline and procedural characteristics among patients with or without SVT during follow-up.
Conclusion
Atrial tachycardia is frequent (17.4%) after PFO closure and long-term continuous ECG recording suggests that the incidence is higher than the clinical episodes reported in the randomized trials. This arrhythmic complication of PFO closure seems limited to the first 4 months following the procedure. Larger studies need now to confirm our findings.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
| | | | - C Sabben
- Fondation Rothschild, neurology, Paris, France
| | - S Deltour
- Hospital Pitie-Salpetriere, Paris, France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Paris, France
| | - I Reibel
- Hospital Pitie-Salpetriere, Paris, France
| | - A Ferrante
- Hospital Pitie-Salpetriere, Paris, France
| | - S Alamowitch
- Hospital Saint-Antoine, Service de Neurologie et d'Urgences Neurovasculaires,, Paris, France
| | | | | | - N Hammoudi
- Hospital Pitie-Salpetriere, Paris, France
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30
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Boccara F, Mary-Krause M, Potard V, Teiger E, Lang S, Hammoudi N, Chauvet M, Ederhy S, Dufour-Soulat L, Ancedy Y, Nhan P, Adavane S, Steg PG, Funck-Brentano C, Costagliola D, Cohen A. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome. J Am Heart Assoc 2020; 9:e017578. [PMID: 32844734 PMCID: PMC7660787 DOI: 10.1161/jaha.119.017578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background It is unclear whether HIV infection affects the long-term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV-uninfected (HIV-) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV- patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36-month follow-up. A total of 103 PLHIV and 195 HIV- patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow-up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- patients (17.8% and 15.1%, P=0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67-3.82 [P=0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32-30.21 [P=0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P=0.01) and had smaller total cholesterol decreases (-22.3 versus -35.0 mg/dL; P=0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00139958.
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Affiliation(s)
- Franck Boccara
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France.,National Institute of Health and Medical Research INSERM UMR_S 938 Sorbonne Université Paris France
| | - Murielle Mary-Krause
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Valérie Potard
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Emmanuel Teiger
- Interventional Cardiology Unit Henri Mondor University Hospital Assistance Publique Hôpitaux de Paris Créteil France.,Inserm CIC 1430 et U955 Team 3 Henri Mondor University Hospital Créteil France
| | - Sylvie Lang
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Nadjib Hammoudi
- Inserm UMRS 1166 Institute of Cardiometabolism and Nutrition (ICAN) ACTION Study Group and Institute of Cardiology (AP-HP) Hôpital Pitié-Salpêtrière Sorbonne Université Paris France
| | - Marion Chauvet
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Stéphane Ederhy
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Laurie Dufour-Soulat
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Yann Ancedy
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Pascal Nhan
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Saroumadi Adavane
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Ph Gabriel Steg
- Département Hospitalo-Universitaire (DHU) Fibrose Inflammation Remodelage (FIRE) INSERM U-1148 University Paris Diderot Assistance Publique - Hôpitaux de Paris (AP-HP) Paris France
| | - Christian Funck-Brentano
- Department of Pharmacology INSERM CIC Paris-Est, AP-HP ICAN Pitié-Salpêtrière Hospital Sorbonne Université Paris France
| | - Dominique Costagliola
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Ariel Cohen
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
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31
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Duthoit G, Silvain J, Marijon E, Ducrocq G, Lepillier A, Frere C, Dimby SF, Popovic B, Lellouche N, Martin-Toutain I, Spaulding C, Brochet E, Attias D, Mansourati J, Lorgis L, Klug D, Zannad N, Hauguel-Moreau M, Braik N, Deltour S, Ceccaldi A, Wang H, Hammoudi N, Brugier D, Vicaut E, Juliard JM, Montalescot G. Reduced Rivaroxaban Dose Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure. Circ Cardiovasc Interv 2020; 13:e008481. [DOI: 10.1161/circinterventions.119.008481] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background:
Percutaneous left atrial appendage closure (LAAC) exposes to the risk of device thrombosis in patients with atrial fibrillation who frequently have a contraindication to full anticoagulation. Thereby, dual antiplatelet therapy (DAPT) is usually preferred. No randomized study has evaluated nonvitamin K antagonist oral anticoagulant after LAAC, and we decided to evaluate the efficacy and safety of reduced doses of rivaroxaban after LAAC.
Methods:
ADRIFT (Assessment of Dual Antiplatelet Therapy Versus Rivaroxaban in Atrial Fibrillation Patients Treated With Left Atrial Appendage Closure) is a multicenter, phase IIb study, which randomized 105 patients after successful LAAC to either rivaroxaban 10 mg (R
10
, n=37), rivaroxaban 15 mg (R
15
, n=35), or DAPT with aspirin 75 mg and clopidogrel 75 mg (n=33). The primary end point was thrombin generation (prothrombin fragments 1+2) measured 2 to 4 hours after drug intake, 10 days after treatment initiation. Thrombin-antithrombin complex, D-dimers, rivaroxaban concentrations were also measured at 10 days and 3 months. Clinical end points were evaluated at 3-month follow-up.
Results:
The primary end point was reduced with R
10
(179 pmol/L [interquartile range (IQR), 129–273],
P
<0.0001) and R
15
(163 pmol/L [IQR, 112–231],
P
<0.0001) as compared with DAPT (322 pmol/L [IQR, 218–528]). We observed no significant reduction of the primary end point between R
10
and R
15
while rivaroxaban concentrations increased significantly from 184 ng/mL (IQR, 127–290) with R
10
to 274 ng/mL (IQR, 192–377) with R
15
,
P
<0.0001. Thrombin-antithrombin complex and D-dimers were numerically lower with both rivaroxaban doses than with DAPT. These findings were all confirmed at 3 months. The clinical end points were not different between groups. A device thrombosis was noted in 2 patients assigned to DAPT.
Conclusions:
Thrombin generation measured after LAAC was lower in patients treated by reduced rivaroxaban doses than DAPT, supporting an alternative to the antithrombotic regimens currently used after LAAC and deserves further evaluation in larger studies.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03273322.
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Affiliation(s)
- Guillaume Duthoit
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Eloi Marijon
- European Georges Pompidou Hospital, APHP; Paris Descartes University, INSERM U 970, France (E.M., C.S.)
| | - Grégory Ducrocq
- Département de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (A.L., D.A.)
| | - Corinne Frere
- Sorbonne Université, Department of Haematology Biologic, APHP Pitié-Salpêtrière Hospital; INSERM UMRS 1166, Institute of Cardiometabolism And Nutrition, Paris, France (C.F., I.M.-T.)
| | - Solohaja-Faniaha Dimby
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, France (S.-F.D., E.V.)
| | - Batric Popovic
- Université de Lorraine, Département de Cardiologie, Centre Hospitalier Universitaire Brabois, Nancy, France (B.P.)
| | - Nicolas Lellouche
- Département de Cardiologie, CHU Henri Mondor, Créteil, France (N.L.)
| | - Isabelle Martin-Toutain
- Sorbonne Université, Department of Haematology Biologic, APHP Pitié-Salpêtrière Hospital; INSERM UMRS 1166, Institute of Cardiometabolism And Nutrition, Paris, France (C.F., I.M.-T.)
| | - Christian Spaulding
- European Georges Pompidou Hospital, APHP; Paris Descartes University, INSERM U 970, France (E.M., C.S.)
| | - Eric Brochet
- Département de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)
| | - David Attias
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (A.L., D.A.)
| | - Jacques Mansourati
- Département de Cardiologie, CHRU Brest, Université de Bretagne Occidentale, EA 4324 (J.M.)
| | - Luc Lorgis
- Department of Cardiology, Laboratory of Cerebro-Vascular Pathophysiology and epidemiology (PEC2) EA 7460, University of Burgundy, Dijon, France (L.L.)
| | - Didier Klug
- Univ. Lille CHU Lille, F-59000 Lille, France (D.K.)
| | - Noura Zannad
- Département de Cardiologie, CHR Metz-Thionville, France (N.Z.)
| | - Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, Department of Cardiology, Ambroise Paré Hospital (AP-HP), INSERM U-1018, Boulogne, France (M.H.-M.)
| | - Nassim Braik
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Sandrine Deltour
- Sorbonne Université, Urgences Cerebro-Vasculaires Pitié-Salpêtrière Hospital (AP-HP), INSERM UMR U-942, Paris, France (S.D.)
| | - Alexandre Ceccaldi
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Hui Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China (H.W.)
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Delphine Brugier
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, France (S.-F.D., E.V.)
| | - Jean-Michel Juliard
- Département de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
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Lattuca B, Bouziri N, Kerneis M, Portal J, Zhou J, Hauguel-Moreau M, Mameri A, Zeitouni M, Guedeney P, Hammoudi N, Isnard R, Pousset F, Collet J, Vicaut E, Montalescot G, Silvain J. Antithrombotic therapy and cardiovascular events in patients with left ventricular thrombus. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Procopi N, Zeitouni M, Kerneis M, Hammoudi N, Berman E, Barthélémy O, Choussat R, Guedeney P, Braik N, Silvain J, Le Feuvre C, Helft G. Comparison of long-term outcomes between men and women after percutaneous coronary intervention. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hascoët S, Smolka G, Champagnac D, Brochet E, Bauer F, Pilliere R, Lavie-Badie Y, Nejjari M, Leurent G, Spaulding C, Combes N, Mangin L, Hammoudi N, Dauphin C, Aminian A, Ciobotaru V, Bouvaist H, Iriart X, Armero S, Gerardin B. Mitral and aortic paravalvular leaks closure: Insights from the prospective international multicenter FFPP cohort study. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zeitouni M, Procopi N, Kerneis M, Hammoudi N, Berman E, Barthelemy O, Choussat R, Guedeney P, Braik N, Silvain J, Le Feuvre C, Helft G. Long-term mortality and factors of poor outcomes in patients undergoing percutanenous coronary intervention. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yahia Cherif M, Mezereg S, Khedouci K, Hammoudi N. Wellens syndrome: Prospective study of 40 observations. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zeitouni M, Procopi N, Kerneis M, Hammoudi N, Berman E, Barthelemy O, Choussat R, Guedeney P, Braik N, Silvain J, Le Feuvre C, Helft G. P5534Causes and predictors of short, intermediate and long-term mortality in patients after PCI. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Causes of death after percutaneous coronary intervention (PCI) along multiple time-periods are poorly described.
Objective
To describe causes and predictors of short-term, intermediate-term, and long-term mortality after PCI.
Methods
Consecutive men and women admitted for PCI from 2008 to 2011 were prospectively included and followed-up in this cohort study. A dedicated follow-up by independent reviewers was performed to collect the outcomes and adjudicate the causes of death. A log-rank analysis was used to compare the occurrence of cardiovascular and non-cardiovascular death at 30 days, one year and up to 8 years. Last detailed cardiovascular and vital status were collected in January 2019.
Results
A total of 3524 patients including 2720 men (77.2%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2). The rate of complete follow-up was 97.6%. All-cause death occurred for 30.3% (n=1070) of patients in the cohort, in a median time of 2.5 years after PCI, with a rate of 5.3 deaths per 100 patient-years. Overall, mortality was mostly related to cardiovascular causes than non-cardiovascular causes (17.7% versus 12.6%, log-rank <0.001) (Figure). This trend was strong within 30 days (4.7% vs. 0.3%, p<0.0001) and the first year after PCI (3.1% vs. 2.2 p=0.01), but became non-significant beyond one year (9.9% vs. 10.2%, P=0.67). Of note, cancer was the major cause of non-cardiovascular death (5.6%; 1 per 100 patient-years). Diabetes (adHR = 1.48 95% [1.29–1.71], p<0.001), active smoking (adHR = 1.37, 95% [1.16–1.62]) and chronic kidney disease (adHR = 1.97, 95% [2.55–3.45], p<0.001) were the strongest risk factors for all-cause death.
Survival after PCI
Conclusions
In this long-term cohort study, cardiovascular death was more frequent than non-cardiovascular death in patients treated with PCI in the short and intermediate-term but not beyond one year. Cancer accounted for one fifth of the overall mortality.
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Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - N Procopi
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - E Berman
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - R Choussat
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - N Braik
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - C Le Feuvre
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - G Helft
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
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Lattuca B, Bouziri N, Portal JJ, Zhou J, Zeitouni M, Kerneis M, Guedeney P, Legrand L, Hammoudi N, Isnard R, Pousset F, Collet JP, Vicaut E, Montalescot G, Silvain J. P6454Antithrombotic therapy and cardiovascular events in patients with left ventricular thrombus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left Ventricular Thrombus (LVT) is associated with a high risk of thromboembolic complications such as stroke. Contemporary data are lacking on the management, prognosis and treatment of LVT, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs).
Purpose
To study the time and predictive factors associated with thrombus regression on treatment and its association with survival, embolic and bleeding complications.
Methods
From January 2011 to January 2018, a computerized case sensitive search of LVT was performed on 90 065 consecutive echocardiogram reports. All patients with a confirmed LVT were included in this analysis after imaging review by two independent experts. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. Major adverse cardiac events (MACE), defined as the composite of death, ischemic stroke or transient ischemic attack (TIA), myocardial infarction (MI) or embolic peripheral artery occlusion were analyzed as well as major bleeding events (BARC ≥3) and the predictive factors and impact of LVT regression.
Results
We identified 174 patients with a suspected LVT of whom 159 had confirmed LVT on two different cardiac imaging exams. Ischemic cardiomyopathy was the main cause of LVT (n=125, 78.6%) including 56 (35.2%) patients with an acute ST segment elevation MI. The mean left ventricular ejection fraction was 31.9±12.5% with predominant (98.1%) apical location of the LVT.
Anticoagulation therapy was achieved with vitamin K antagonists, NOACs and parenteral heparins in 48.7%, 22.8% and 27.8% of patients, respectively. Concomitant antiplatelet therapy was prescribed in 67.9% of patients. Total LVT regression was reached in two third of patients (62.3%, n=99) within a median time of 103 [32–392] days. Independent predictors of total LVT regression were an ischemic cardiomyopathy (HR: 0.36 [0.19–0.70], p=0.002), a larger baseline thrombus area (HR=0.66 [0.45–0.96], p<0.031) and a prolonged anticoagulation therapy over 3 months (HR=0.11 [0.05–0.22], p<0.0001).
During a median follow-up of 632 [187–1126] days, MACE occurred in 59 (37.1%) patients with a 18.9% rate of mortality and 13.2% of major bleeding. Patients with a total LVT regression had a non-significant lower rate of MACE as compared with patients without total LVT regression (35.4% vs. 40.0%; HR=0.71 [0.42–1.21]; p=0.20), and a significant lower rate of mortality (15.2% vs. 25.0%; HR=0.48 [0.23–0.98]; p=0.039).
Occurence of mortality (A) and MACE (B)
Conclusions
The prognosis of LVT remains severe with a high risk of major cardiovascular event and mortality. Total LVT regression, mostly reached in 3 months, can be obtained with both vitamin K antagonists and NOACs and is associated with a better prognosis.
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Affiliation(s)
- B Lattuca
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - N Bouziri
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J J Portal
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital (APHP), Paris, France
| | - J Zhou
- Information system department, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - M Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - M Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - P Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - L Legrand
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - N Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - R Isnard
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - F Pousset
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J P Collet
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - E Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital (APHP), Paris, France
| | - G Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
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Nahmani Y, Hammoudi N, Huang F, Bouziri N, Pousset F, Maupain C, Charron P, Isnard R. P886Exercise left ventricular outflow track obstruction in hypertrophic cardiomyopathy: peak exercise or post-exercise pressure gradients? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM), associated with poor prognosis and requiring specific management in symptomatic patients. Furthermore, new drugs targeting LVOTO are under investigation. Exercise echocardiography is the more relevant test to unmask latent obstruction in patients with HCM and to link obstruction to symptoms during physical activity. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery.
Objective
We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM.
Methods
We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position.
Results
121 patients with HCM were included (age 49±16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66±7%, max LV wall thickness 19±5 mm, 69% receiving betablockers). Exercise was performed until exhaustion at a mean workload of 118±58 Watts. Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17±18, 39±43 and 55±60 mmHg, p<0,0001). More than half of the patients (52%) had a gradient ≥30 mmHg at least in one phase, but a maximal gradient ≥50 mmHg (threshold for invasive treatment in symptomatic patients) was observed in only 7% of the population at rest, 25% at peak exercise and 37% at recovery (p<0.001). Finally, a maximal gradient ≥50 mmHg was recorded only during immediate recovery (69±25 mmHg) and not during exercise in 16 patients (13%). None of them experienced post-exercise syncope.
Conclusion
The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.
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Affiliation(s)
- Y Nahmani
- Hospital Center Andre Gregoire, Montreuil, France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie,, Paris, France
| | - F Huang
- Hospital Pitie-Salpetriere, Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie,, Paris, France
| | - N Bouziri
- Hospital Pitie-Salpetriere, Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie,, Paris, France
| | - F Pousset
- Hospital Pitie-Salpetriere, Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie,, Paris, France
| | - C Maupain
- Hospital Pitie-Salpetriere, Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie,, Paris, France
| | - P Charron
- Hospital Pitie-Salpetriere, Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie,, Paris, France
| | - R Isnard
- Hospital Pitie-Salpetriere, Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie,, Paris, France
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Procopi N, Zeitouni M, Kerneis M, Hammoudi N, Berman E, Barthelemy O, Choussat R, Guedeney P, Braik N, Silvain J, Le Feuvre C, Helft G. P1523Comparative long-term outcomes among men and women after percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Comparative long-term outcomes among women and men treated with percutaneous intervention (PCI) are unknown.
Objective
To describe and compare mortality and predictors of poor outcomes among men and women who underwent PCI.
Methods
Consecutive men and women admitted for PCI between 2008 and 2011 were prospectively included and followed-up in this cohort study. Major adverse cardiovascular and cerebrovascular events (MACCE) and causes of death were collected through consultations, calls and death certificate. The primary endpoint was all-cause mortality according to gender. Secondary endpoints were cardiovascular death, non-cardiovascular death and MACCEs. Last detailed cardiovascular and vital status were collected in January 2019.
Results
A total of 3524 patients including 2720 men (77.1%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2). The follow-up rate was 97.6%. Women were older at baseline (70±13.1 vs. 64.6±12), smoked less often (18.9% vs. 30.4%) but suffered more frequently of hypertension (67.9% vs. 58.1%) and chronic kidney disease (42.6% vs. 22.7%). All-cause death occurred for 30.3% (n=1070) and MACCE for 40.9% (n=1443) of patients in the cohort. In unadjusted analyses, women had a higher risk of all-cause mortality (35% vs 29%, HR = 1.25, 95% CI [1.09–1.43], p=0.0015) and cardiovascular mortality (61% vs. 57%, HR = 1.31, 95% CI [1.10–1.56]) but there was no difference on occurrence of MACCE (HR = 1.079, 95% CI = [0.9271–1.221]). After adjustments for baseline cardiovascular risk factors, presentation and severity of coronary disease, women and men shared a similar risk of mortality along time (adHR = 0.90, 95% CI [0.77–1.05]).
Survival curves in women vs. men
Conclusions
In this long-term follow-up, women had a higher risk of all-cause and cardiovascular mortality after PCI in unadjusted analyses. However, gender was not independently associated with mortality after adjustment for cardiovascular risk factors.
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Affiliation(s)
- N Procopi
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - E Berman
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - R Choussat
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - N Braik
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - C Le Feuvre
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Helft
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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Guedeney P, Hauguel-Moreau M, Hage G, Sabben C, Deltour S, Hammoudi N, Molho A, Mesnier J, Alamowitch S, Silvain J, Montalescot G. P3733Long term follow-up after percutaneous closure of patent foramen ovale for secondary prevention of stroke. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recent randomized trials have demonstrated the superiority of percutaneous patent foramen ovale (PFO) closure for the secondary prevention of stroke compared to antithrombotic therapy. However, real-world data on long-term outcomes after percutaneous PFO closure are scarce.
Purpose
To describe real-world long-term outcomes following PFO percutaneous closure and the impact of the use of intracardiac echocardiography under local anesthesia for the procedure
Methods
All consecutive patients undergoing PFO closure in a single high-volume tertiary center from January 2006 to December 2018, for secondary prevention of stroke, transient ischemic attack (TIA) or any other paradoxical arterial embolism were prospectively studied. A systematic contrast transthoracic echocardiography (TTE) was performed 3 months after closure. Clinical endpoints of interest were the occurrence of death, stroke or transient ischemic attack, as defined in previous randomized trials.
Results
Of the 242 closure procedures performed, a total of 208 (86.3%) were performed in secondary prevention of stroke, TIA or paradoxical arterial embolism (mean age 49.8±12.7 years; 62.0% male). An atrial septal aneurysm and a large shunt were present in 137 (66.8%) and 172 (84.7%) patients, respectively. General anesthesia associated with transesophageal echocardiography was initially used in all patients with a temporal trend towards the use of local anesthesia associated with either intracardiac echocardiography (Viewflex catheter, Abbott) in 23 more cases or micro transesophageal probe in 7 cases, without periprocedural complications. Discharge medication comprised of dual antiplatelet therapy, oral anticoagulation and single antiplatelet therapy in 80.7%, 16.8% and 2.5% of the patients, respectively. Contrast TTE with Valsalva maneuver was performed at a mean delay of 3.2±0.7 months after intervention and found no or minimal residual shunt in 87.0% of patients. Clinical follow-up was available up to 12.8 years (mean 2.1±3.0 years). A total of 3 patients died from cancer or unknown cause while stroke and TIA occurred in 2 and 1 patients, respectively. Event rate for death was 0.69 events per 100 patients-years. The event rates for stroke, TIA and stroke or TIA were 0.46, 0.23 and 0.70 events per 100 patients-year of observation, respectively, which compare favorably with reported outcomes following percutaneous closure in randomized clinical trials (Figure).
Conclusion
In an experienced center, percutaneous PFO closure appears to be a safe procedure providing adequate protection against recurrent strokes over a long follow-up.
Acknowledgement/Funding
ACTION study group
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | | | - G Hage
- Hospital Pitie-Salpetriere, Paris, France
| | - C Sabben
- Fondation Rothschild, neurology, Paris, France
| | - S Deltour
- Hospital Pitie-Salpetriere, Urgences Cérébro-Vasculaires, Paris, France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Paris, France
| | - A Molho
- Hospital Pitie-Salpetriere, Paris, France
| | - J Mesnier
- Hospital Pitie-Salpetriere, Paris, France
| | - S Alamowitch
- Hospital Saint-Antoine, Service de Neurologie et d'Urgences Neurovasculaires,, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
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Soulat-Dufour L, Lang S, Ederhy S, Ancedy Y, Beraud AS, Adavane-Scheuble S, Chauvet-Droit M, Hammoudi N, Scheuble A, Nhan P, Charbonnier M, Boccara F, Cohen A. Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight. Arch Cardiovasc Dis 2019; 112:585-593. [PMID: 31540880 DOI: 10.1016/j.acvd.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/05/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial remodelling has been poorly investigated in atrial fibrillation (AF), and few studies have focused on biatrial remodelling. AIM To evaluate right atrial (RA) and left atrial (LA) remodelling in AF using global atrial reservoir strain and three-dimensional (3D) atrial volumes, according to rhythm outcome at mid-term follow-up. METHODS Two-dimensional and 3D transthoracic echocardiography (TTE) were performed within 24hours after admission (M0) and at 6-month follow-up (M6) in patients admitted for AF. RA and LA variables were assessed: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF); atrial expansion index (3D RAEI, 3D LAEI); and global RA and LA reservoir strain. RESULTS Forty-eight consecutive patients were included prospectively. Three groups were identified depending on rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) in 25 (52.1%) patients; AF at M0 and AF at M6 (AF-AF) in 13 (27.1%) patients; and SR at M0 (spontaneous cardioversion before first TTE) and SR at M6 (SR-SR) in 10 (20.8%) patients. Between M0 and M6 in the AF-SR group, we found: significant decreases in Max 3D RA Voli (P=0.020), Min 3D RA Voli (P=0.0008), Max 3D LA Voli (P=0.001) and Min 3D LA Voli (P=0.0021); significant increases in 3D RAEF (P=0.037) and 3D RAEI (P=0.034); no significant differences in 3D LAEF and 3D LAEI; and significant increases in global RA and LA reservoir strain (both P<0.0001). There was no significant difference with regard to these variables in the AF-AF and SR-SR groups. CONCLUSION 3D volume and strain analyses were useful in the evaluation of RA and LA reverse remodelling in successfully cardioverted patients with AF.
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Affiliation(s)
- Laurie Soulat-Dufour
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France
| | - Sylvie Lang
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Stephane Ederhy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Yann Ancedy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | | | - Saroumadi Adavane-Scheuble
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Marion Chauvet-Droit
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Nadjib Hammoudi
- Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France; Service de cardiologie, Sorbonne universités, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | | | - Pascal Nhan
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Magali Charbonnier
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Franck Boccara
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Inserm, UMR S 938, centre de recherche Saint-Antoine, 75012 Paris, France
| | - Ariel Cohen
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France.
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Roger C, Lionnet F, Kyheng M, Mattioni S, Livrozet M, Steichen O, Letavernier E, Hammoudi N, Duhamel A, Haymann J. Facteurs prédictifs de dégradation de la fonction rénale dans une population de patients drépanocytaires homozygotes adultes. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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44
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Hammoudi N, Hennequin C, Vercellino L, Costantini A, Valverde A, Cattan P, Quéro L. Early metabolic response to chemoradiotherapy by interim FDG PET/CT is associated with better overall survival and histological response in esophageal cancers. Dig Liver Dis 2019; 51:887-893. [PMID: 30630738 DOI: 10.1016/j.dld.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 08/08/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early assessment of response to neoadjuvant chemoradiotherapy (CRT) is crucial in determining the most suitable treatment strategy in locally advanced oesophageal cancer (LAEC). AIMS We evaluated the impact of early metabolic response during CRT on overall survival (OS) and histological response. METHODS Patients with biopsy-proven oesophageal carcinoma underwent FDG PET/CT with evaluation of the standardized uptake value (SUV) before any treatment and during CRT after 20 Gy. RESULTS 116 patients (Male: 66.4%, Median age: 63; squamous cell carcinomas (SCC): 70%) met inclusion criteria. Median OS was 21.7 months. There was a significant positive correlation between interim metabolic response and OS. In multivariate analysis, only metabolic response using the 50% cut-off value remained significantly associated with OS (IC95% = 0.28-0.73; p = 0.001). In this statistical analysis, surgery (p = 0.007) and T stage (p = 0.023) were also correlated with OS. There was a significant correlation between early metabolic response and local recurrence (Chi-squared test p = 0.0001). CONCLUSIONS Early metabolic response using FDG PET/CT is associated with better OS, disease-free survival, local control and pathological response in patients treated by CRT for LAEC.
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Affiliation(s)
- N Hammoudi
- Department of Radiation Oncology, Saint Louis Hospital, Paris, France
| | - C Hennequin
- Department of Radiation Oncology, Saint Louis Hospital, Paris, France
| | - L Vercellino
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
| | - A Costantini
- Department of Radiation Oncology, Saint Louis Hospital, Paris, France
| | - A Valverde
- Department of Surgery, Croix St Simon Hospital, Paris, France
| | - P Cattan
- Department of Surgery, Saint Louis Hospital, Paris, France
| | - L Quéro
- Department of Radiation Oncology, Saint Louis Hospital, Paris, France.
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Hammoudi N, Lionnet F, Redheuil A, Montalescot G. Cardiovascular manifestations of sickle cell disease. Eur Heart J 2019; 41:1365-1373. [DOI: 10.1093/eurheartj/ehz217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Sickle cell disease (SCD) is the most frequent genetic haemoglobinopathy worldwide. Early childhood mortality has dramatically decreased in high-income countries, and most patients now survive beyond the 5th decade. However, in the aging SCD population, the morbidity related to chronic organ damage, especially kidney and heart, has become a major concern. While pulmonary hypertension has attracted most attention, it appears that this condition is frequently linked to left heart failure (HF). Accordingly, SCD-associated cardiomyopathy is emerging as a major cause of reduced quality of life and early mortality in these patients. The diagnosis of this particular phenotype of high-output HF is challenging. Exercise intolerance and dyspnoea in SCD patients are linked to multiple causes including chronic anaemia. Moreover, echocardiographic features are unusual and can be misinterpreted. The classical diagnosis algorithm for HF is generally not suitable in SCD patients, and HF is poorly recognized and mostly diagnosed at a late congestive stage in routine practice. Such patients need to be identified at an earlier stage of myocardial dysfunction via improved phenotyping. This constitutes the first step towards further investigations in SCD needed to improve the prognosis and the quality of life. This article provides an updated review of the recent advances in the pathophysiology and diagnosis, and in addition, perspectives of new therapeutic approaches in SCD-related cardiac manifestations.
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Affiliation(s)
- Nadjib Hammoudi
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
| | - François Lionnet
- Sorbonne Université, Department of Internal Medicine, centre de référence de la drépanocytose (AP-HP), Centre Hospitalier Universitaire Tenon, rue de la Chine, 75020 Paris, France
| | - Alban Redheuil
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology (DICVRIT), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Sorbonne Université, Inserm, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Institute of Cardiometabolism and Nutrition (ICAN), Institute of Cardiology (AP-HP), Paris F-75013, France
| | - Gilles Montalescot
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
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Hascoët S, Smolka G, Bagate F, Hadeed K, Lavie-Badie Y, Bouvaist H, Dauphin C, Bauer F, Nejjari M, Mangin L, Bonnet G, Ciobotaru V, Leurent G, Hammoudi N, Aminian A, Karsenty C, Armero S, Champagnac D, Ternacle J, Isorni M. Multimodality imaging guidance for percutaneous paravalvular leak closure: Insights from the multicenter FFPP register. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Sy V, Mameri A, Laveau F, Barthelemy O, Ceccaldi A, Huang F, Helft G, Lefeuvre C, Montalescot G, Isnard R, Hammoudi N. The relative expansion of the left atrium over the left ventricle to detect early-stage heart failure with preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Epaillard N, Troussier I, Bourdais R, Hammoudi N, Huguet F, Bachet JB, Vaillant JC, Thierry A, Gligorov J, Ozsahin M, Spano JP, Simon JM, Maingon P, Blais E. Faut-il adapter la chimioradiothérapie néoadjuvante des cancers de l’œsophage à l’histologie ? Analyse des essais de phase III. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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49
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Lattuca B, Sy V, Nguyen LS, Bernard M, Zeitouni M, Overtchouk P, Yan Y, Hammoudi N, Ceccaldi A, Collet JP, Kerneis M, Diallo A, Montalescot G, Silvain J. Copeptin as a prognostic biomarker in acute myocardial infarction. Int J Cardiol 2018; 274:337-341. [PMID: 30217427 DOI: 10.1016/j.ijcard.2018.09.022] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Copeptin - the C-terminal section of vasopressin precursor - is a novel biomarker, that has been shown to be a useful prognostic factor in heart failure, ischemic stroke and in acute myocardial infarction (MI) but with restricted population and follow-up in ST-segment elevation MI (STEMI) setting. We evaluated in this study the hypothesis that copeptin measured on admission is an independent predictor of one-year all-cause mortality after a STEMI. METHODS Copeptin was measured immediately on arrival in the catheterization laboratory in a cohort of unselected STEMI patients and was compared to the peak of cardiac troponin I as a prognosis marker. One-year follow-up was performed. RESULTS We included 401 STEMI patients (77% of men, mean age 64 ± 14 years) treated by primary percutaneous coronary intervention. Copeptin on admission was significantly higher in patients who died during the one-year follow-up than in survivors (154.8 pmol/L; IQR [63.9-304.8] vs 30.3 pmol/L; IQR [10.8-93.5]); p < 0.0001). There was an increase in mortality at one year from the lowest to the highest quartile of copeptin. After Cox regression analysis, copeptin was an independent predictor of death at one year (adjHR 3.1, 95% CI [1.5-6.2], p = 0.001). When compared to the peak value of cardiac troponin I, copeptin measured on admission had a better prognostic value to predict one-year mortality (AUC of 0.74 vs 0.60, p = 0.022). CONCLUSION Copeptin measured on admission is a reliable and independent prognostic biomarker of one-year mortality in acute myocardial infarction patients.
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Affiliation(s)
- Benoit Lattuca
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France.
| | - Vuthy Sy
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Lee S Nguyen
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Maguy Bernard
- Sorbonne University - Paris 06 (UPMC), Biochemistry Department, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France.
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Pavel Overtchouk
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Yan Yan
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Alexandre Ceccaldi
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Abdourahmane Diallo
- ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisiere University Hospital, Paris, France.
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
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Helft G, Steg PG, Georges JL, Cherifi S, Hage G, Zeitouni M, Hammoudi N, Diallo A, Berman E, Silvain J, Metzger JPH, Le Feuvre C. 6132The OPTIDUAL trial: long term follow-up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Helft
- Institut de Cardiologie, Paris, France
| | | | | | - S Cherifi
- Institut de Cardiologie, Paris, France
| | - G Hage
- Institut de Cardiologie, Paris, France
| | | | | | - A Diallo
- Hospital Lariboisiere, URC Lariboisiere, Paris, France
| | - E Berman
- Institut de Cardiologie, Paris, France
| | - J Silvain
- Institut de Cardiologie, Paris, France
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