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Gall E, Pezel T, Lattuca B, Hamzi K, Puymirat E, Piliero N, Deney A, Fauvel C, Aboyans V, Schurtz G, Bouleti C, Fabre J, El Ouahidi A, Thuaire C, Millischer D, Noirclerc N, Delmas C, Roubille F, Dillinger JG, Henry P. Profile of patients hospitalized in intensive cardiac care units in France: ADDICT-ICCU registry. Arch Cardiovasc Dis 2024; 117:195-203. [PMID: 38418306 DOI: 10.1016/j.acvd.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Intensive cardiac care units (ICCU) were initially developed to monitor ventricular arrhythmias after myocardial infarction. In recent decades, ICCU have diversified their activities. AIM To determine the type of patients hospitalized in ICCU in France. METHODS We analysed the characteristics of patients enrolled in the ADDICT-ICCU registry (NCT05063097), a prospective study of consecutive patients admitted to ICCU in 39 centres throughout France from 7th-22nd April 2021. In-hospital major adverse events (MAE) (death, resuscitated cardiac arrest and cardiogenic shock) were recorded. RESULTS Among 1499 patients (median age 65 [interquartile range 54-74] years, 69.6% male, 21.7% diabetes mellitus, 64.7% current or previous smokers), 34.9% had a history of coronary artery disease, 11.7% atrial fibrillation and 5.2% cardiomyopathy. The most frequent reason for admission to ICCU was acute coronary syndromes (ACS; 51.5%), acute heart failure (AHF; 14.1%) and unexplained chest pain (6.8%). An invasive procedure was performed in 36.2%. "Advanced" ICCU therapies were required for 19.9% of patients (intravenous diuretics 18.4%, non-invasive ventilation 6.1%, inotropic drugs 2.3%). No invasive procedures or advanced therapies were required in 44.1%. Cardiac computed tomography or magnetic resonance imaging was carried out in 12.3% of patients. The median length of ICCU hospitalization was 2.0 (interquartile range 1.0-4.0) days. The mean rate of MAE was 4.5%, and was highest in patients with AHF (10.4%). CONCLUSIONS ACS remains the main cause of admissions to ICCU, with most having a low rate of in-hospital MAE. Most patients experience a brief stay in ICCU before being discharged home. AHF is associated with highest death rate and with higher resource consumption.
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Affiliation(s)
- Emmanuel Gall
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Théo Pezel
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Kenza Hamzi
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Etienne Puymirat
- Department of Cardiology, hôpital européen Georges-Pompidou (HEGP), Paris, France
| | - Nicolas Piliero
- Department of Cardiology, CHU de Grenoble-Alpes, Grenoble, France
| | - Antoine Deney
- Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Charles Fauvel
- Department of Cardiology, CHU de Rouen, University, UNIROUEN, U1096, 76000 Rouen, France
| | - Victor Aboyans
- Dupuytren University Hospital, Inserm 1094, Limoges, France
| | - Guillaume Schurtz
- Department of Cardiology, University Hospital of Lille, Lille, France
| | | | - Julien Fabre
- Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
| | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, 29609 Brest cedex, France
| | - Christophe Thuaire
- Department of Cardiology, centre hospitalier de Chartres, 28630 Le Coudray, France
| | - Damien Millischer
- Department of Cardiology, hôpital Montfermeil, 93370 Montfermeil, France
| | - Nathalie Noirclerc
- Department of Cardiology, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Department of Cardiology, INI-CRT, CHU de Montpellier, PhyMedExp, université de Montpellier, Inserm, CNRS, 3429 Montpellier, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Patrick Henry
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France.
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Piliero N, Salvat M, Finas M, Curioz F, Traclet J, Ahmad K, Bertoletti L, Vautrin E, Bouvaist H, Degano B. Upfront triple therapy with parenteral prostanoid as a bridge to balloon pulmonary angioplasty in severe chronic thromboembolic pulmonary hypertension. ERJ Open Res 2024; 10:00085-2024. [PMID: 38444667 PMCID: PMC10910263 DOI: 10.1183/23120541.00085-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024] Open
Abstract
In patients with very severe CTEPH eligible for BPA, it is possible to achieve major haemodynamic improvement with upfront triple PH therapy including epoprostenol and then to perform angioplasties https://bit.ly/3vZZvib.
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Affiliation(s)
- Nicolas Piliero
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Muriel Salvat
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Mathieu Finas
- Service de Radiologie, CHU Grenoble Alpes, Grenoble, France
| | - Florence Curioz
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Julie Traclet
- Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Hôpital Louis-Pradel, Université de Lyon, Lyon, France
| | - Kaïs Ahmad
- Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Hôpital Louis-Pradel, Université de Lyon, Lyon, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Équipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
| | - Estelle Vautrin
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- INSERM U1300, Laboratoire HP2, Université Grenoble Alpes, Grenoble, France
- Service de Pneumologie, CHU Grenoble Alpes, Grenoble, France
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Dillinger JG, Pezel T, Delmas C, Schurtz G, Trimaille A, Piliero N, Bouleti C, Lattuca B, Andrieu S, Fabre J, Rossanaly Vasram R, Dib JC, Aboyans V, Fauvel C, Roubille F, Gerbaud E, Boccara A, Puymirat E, Toupin S, Vicaut E, Henry P. Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study. EClinicalMedicine 2024; 67:102401. [PMID: 38261914 PMCID: PMC10796965 DOI: 10.1016/j.eclinm.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p < 0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO > 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively). Interpretation Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding Grant from Fondation Coeur & Recherche.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Théo Pezel
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000, Toulouse, France
| | | | | | | | | | | | | | - Julien Fabre
- University Hospital of Fort de France, Fort De France, Martinique
| | | | - Jean-Claude Dib
- Clinique Medico-Chirurgicale Ambroise Pare, Neuilly Sur Seine, France
| | | | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, 76000, Rouen, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295, Montpellier, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and, Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | | | - Etienne Puymirat
- Université Paris Cité, Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Solenn Toupin
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Eric Vicaut
- Unité de recherche clinique – Hopital Lariboisiere, Paris, France
| | - Patrick Henry
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
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Larsson CE, Cabassut V, Peretout P, Marliere S, Vautrin E, Piliero N, Salvat M, Riou L, Vanzetto G, Vilotitch A, Bosson JL, Barone-Rochette G. Assessment of the Objective Effect of Virtual Reality for Preoperative Anxiety in Interventional Cardiology. Am J Cardiol 2023; 205:207-213. [PMID: 37611412 DOI: 10.1016/j.amjcard.2023.07.130] [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: 03/29/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
The management of anxiety because of upcoming invasive coronary angiography (ICA) remains suboptimal. Previously published studies investigating the potential of virtual reality (VR) for the reduction of anxiety in ICA procedures used a subjective evaluation method. The purpose of this study was to determine whether the use of a VR program before ICA objectively decreases anxiety as assessed by the SD of normal to normal (SDNN). Lower SDNN is associated with worse anxiety. A total of 156 patients referred for ICA after a positive noninvasive test for coronary disease were included in the present randomized study. The interventional group benefited from the use of a VR mask in the transfer room before ICA, whereas the control group underwent the procedure as usual. In both groups, SDNN was measured before ICA. No statistical difference in SDNN was observed between the VR and control groups (45.5 ± 17.8 vs 50.6 ± 19.5, p = 0.12). The preoperative use of a VR mask for anxiolytic purposes in the setting of ICA did not result in a decrease in anxiety.
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Affiliation(s)
| | - Verane Cabassut
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France
| | - Pauline Peretout
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France
| | - Stéphanie Marliere
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France
| | - Estelle Vautrin
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France
| | - Nicolas Piliero
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France
| | - Muriel Salvat
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France
| | - Laurent Riou
- Univ. Grenoble Alpes, Institut national de la santé et de la recherche médicale (INSERM), CHU Grenoble Alpes, LRB, 38000 Grenoble, France
| | - Gerald Vanzetto
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, Institut national de la santé et de la recherche médicale (INSERM), CHU Grenoble Alpes, LRB, 38000 Grenoble, France; French Clinical Research Infrastructure Network, Paris, France
| | | | - Jean Luc Bosson
- TIMC Laboratory Centre national de la recherche scientifique (CNRS)-UMR 5525, University Grenoble Alpes, Grenoble, France; Public Health Department, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, Institut national de la santé et de la recherche médicale (INSERM), CHU Grenoble Alpes, LRB, 38000 Grenoble, France; French Clinical Research Infrastructure Network, Paris, France.
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Fard D, Noirclerc N, Bonnet G, Goralski M, Elbaz M, Deney A, Schurtz G, Docq C, Roubille F, Fauvel C, Bochaton T, Aboyans V, Boccara F, Puymirat E, Batisse A, Steg G, Vicaut E, Henry P. Prevalence and impact of recreational drug use in patients with acute cardiovascular events. Heart 2023; 109:1608-1616. [PMID: 37582633 DOI: 10.1136/heartjnl-2023-322520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/26/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE While recreational drug use is a risk factor for cardiovascular events, its exact prevalence and prognostic impact in patients admitted for these events are not established. We aimed to assess the prevalence of recreational drug use and its association with in-hospital major adverse events (MAEs) in patients admitted to intensive cardiac care units (ICCU). METHODS In the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, systematic screening for recreational drugs was performed by prospective urinary testing all patients admitted to ICCU in 39 French centres from 7 to 22 April 2021. The primary outcome was prevalence of recreational drug detection. In-hospital MAEs were defined by death, resuscitated cardiac arrest, or haemodynamic shock. RESULTS Of 1499 consecutive patients (63±15 years, 70% male), 161 (11%) had a positive test for recreational drugs (cannabis 9.1%, opioids 2.1%, cocaine 1.7%, amphetamines 0.7%, 3,4-methylenedioxymethamphetamine (MDMA) 0.6%). Only 57% of these patients declared recreational drug use. Patients who used recreational drugs exhibited a higher MAE rate than others (13% vs 3%, respectively, p<0.001). Recreational drugs were associated with a higher rate of in-hospital MAEs after adjustment for comorbidities (OR 8.84, 95% CI 4.68 to 16.7, p<0.001). After adjustment, cannabis, cocaine, and MDMA, assessed separately, were independently associated with in-hospital MAEs. Multiple drug detection was frequent (28% of positive patients) and associated with an even higher incidence of MAEs (OR 12.7, 95% CI 4.80 to 35.6, p<0.001). CONCLUSION The prevalence of recreational drug use in patients hospitalised in ICCU was 11%. Recreational drug detection was independently associated with worse in-hospital outcomes. CLINICAL TRIAL REGISTRATION NCT05063097.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, University Hospital of Rangueil, Toulouse, France
| | - Nicolas Piliero
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Claire Bouleti
- Cardiology, University of Poitiers, Clinical Investigation Center (CIC) INSERM 1402, Poitiers University Hospital, Poitiers, France
| | | | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, Brest, France
| | | | - Benoit Lattuca
- Cardiology, Centre Hospitalier Universitaire de Nîmes, Montpellier University, Nimes, France
| | | | - Damien Fard
- Intensive Cardiac Care Unit, Hopital Henri Mondor, Creteil, France
| | - Nathalie Noirclerc
- Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, Rhône-Alpes, France
| | - Guillaume Bonnet
- Assistance Publique Hopitaux de Marseille, Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, Provence-Alpes-Côte d'Azu, France
- Unité de Recherche Clinique, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | | | - Meyer Elbaz
- Intensive Cardiac Care Unit, University Hospital of Rangueil, Toulouse, France
| | - Antoine Deney
- University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
| | | | - Clemence Docq
- Department of Cardiology, University Hospital of Lille, Lille, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, Rouen, France
| | - Thomas Bochaton
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital and Inserm 1094, Limoges, France
| | - Franck Boccara
- Cardiology, Sorbonne Université, GRC n°22, C²MV, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine Service de Cardiologie, Paris, France
| | | | - Anne Batisse
- Centre d'évaluation et d'information sur la pharmacodépendence de Paris, GH Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | - Gabriel Steg
- Cardiology, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, and Institut Universitaire de France, PARIS, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | - Patrick Henry
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
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Morjane Y, Sebestyen A, Lejeune S, Salvat M, Piliero N, Martin C, Abaziou T, Chavanon O. [Constrictive pericarditis and disseminated nocardiosis]. Ann Cardiol Angeiol (Paris) 2023; 72:101584. [PMID: 36898929 DOI: 10.1016/j.ancard.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023]
Abstract
Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ, it occurs in immunocompromised hosts as well as individuals with no apparent predisposition. Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates a special management. This report describes the first case in Europe of a patient with chronic constrictive pericarditis from nocardia brasiliens, successfully treated with pericardiectomy and appropriate antibiotic therapy.
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Affiliation(s)
- Y Morjane
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France.
| | - A Sebestyen
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France
| | - S Lejeune
- Service de Maladies Infectieuses et Tropicales, CHU Grenoble-Alpes, La Tronche, France
| | - M Salvat
- Service de Cardiologie, CHU Grenoble-Alpes, La Tronche, France
| | - N Piliero
- Service de Cardiologie, CHU Grenoble-Alpes, La Tronche, France
| | - C Martin
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France
| | - T Abaziou
- Service d'Anesthésie-Réanimation, CHU Grenoble-Alpes, La Tronche, France
| | - O Chavanon
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France
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7
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Noirclerc N, Schurtz G, Roubille F, Fauvel C, Bochaton T, Aboyans V, Puymirat E, Vicaut E, Henry P. Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: The ADDICT-ICCU Trial. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.307] [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: 01/01/2023]
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Sermet R, Piliero N, Guillien A, Madoun S, Doutreleau S, Salvat M, Finas M, Thony F, Vautrin E, Bouvaist H, Degano B. Pulmonary arterial compliance and exercise capacity after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. ERJ Open Res 2022; 9:00590-2022. [PMID: 37009025 PMCID: PMC10052638 DOI: 10.1183/23120541.00590-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveTo determine whether changes in pulmonary vascular resistance (PVR) and changes in pulmonary artery compliance (PCa) are associated with changes in exercise capacity assessed either by changes in peak oxygen consumption (V̇O2) or by changes in 6-min walk distance (6MWD) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA).MethodsInvasive haemodynamic parameters, peak V̇O2and 6MWD were measured within 24 h, before and after BPA (interval, 3.1±2.4 months) in 34 CTEPH patients without significant cardiac and/or pulmonary comorbidities, of which 24 received at least one pulmonary hypertension-specific treatment. PCa was calculated according to the pulse pressure method: PCa=([SV/PP]/1.76+0.1), where SV is the stroke volume and PP is the pulse pressure. The resistance-compliance (RC)-time of the pulmonary circulation was calculated as the PVR and PCa product.ResultsAfter BPA, PVR decreased (562±234versus290±106 dyn.s.cm−5;p<0.001), PCa increased (0.90±0.36versus1.63±0.65 mL.mmHg−1; p<0.001) but RC-time did not change (0.325±0.069versus0.321±0.083 s; p=0.75). There were improvements in peak V̇O2(1.11±0.35versus1.30±0.33 L.min-1; p <0.001) and in 6MWD (393±119versus432±100 m; p <0.001). After adjustment for age, height, weight and gender, changes in exercise capacity, assessed either by peak V̇O2and 6MWD, were significantly associated with changes in PVR, but not with changes in PCa.ConclusionsContrary to what has been reported in CTEPH patients undergoing pulmonary endarterectomy, in CTEPH patients undergoing BPA, changes in exercise capacity was not associated with changes in pulmonary artery compliance.
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Fard D, Noirclerc N, Vicaut E, Henry P. Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: the ADDICT-ICCU Trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1482] [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
The prevalence and short-term cardiovascular consequences of illicit drug use in patients admitted to the intensive cardiac care unit (ICCU) for acute cardiovascular events are not well established.
Purpose
The Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study was designed to assess prospectively the prevalence of illicit drugs use, and their association with the occurrence of in-hospital major adverse events (MAEs) in consecutive patients admitted to ICCUs for acute cardiovascular events.
Methods
From 7 to 22 April 2021, screening for illicit drug was performed by systematic urinary testing in a prospective study including all consecutive patients admitted to ICCU in 39 centres throughout France. The primary outcome was the prevalence of the illicit drugs detected. The secondary clinical outcome was in-hospital Major Adverse cardiac Events (MAEs) defined by death, resuscitated cardiac arrest or cardiogenic shock.
Results
Among 1,499 consecutive patients screened (age 63.3±14.9 years, 69.6% male), 161 (10.7%) had a positive test for illicit drugs (cannabis: 9.1%, opioids: 2.1%, cocaine: 1.7%, amphetamines: 0.7%, 3,4-methylenedioxymethamphetamine: 0.6%). Patients who used illicit drugs were young (33.0% at age <40 vs. 5.9% at age ≥60 years), and more frequently male (11.9% vs. 8.1%, p<0.001). Self-reported current use was 56.5% in patients with a positive test. After a median duration of hospitalisation of five days, there were 61 in-hospital MAEs (4.1%).
The detection of illicit drugs was associated with a higher rate of MAEs after adjustment for known predictors of severity (OR=8.84; 95% CI: 4.68–16.7, p<0.001) or after using a propensity score adjustment (OR=5.81; 95% CI: 4.14–8.14, p<0.001). After adjustment for age and sex, detection of cannabis or cocaine was significantly associated with MAEs (OR=3.53; 95% CI: 1.25–9.95, p<0.001; OR=5.12; 95% CI: 1.48–17.2, p=0.004 respectively). Multiple drug detection (28% of positive patients) was associated with a higher incidence of MAEs than single drug detection.
Conclusions
The prevalence of illicit drugs use in patients hospitalised in the ICCUs for acute cardiovascular events was 10.7% and was under-reported. Illicit drugs detection was independently associated with a higher occurrence of in-hospital MAEs.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fondation Coeur et Recherche
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | | | - A Trimaille
- University Hospital of Strasbourg , Strasbourg , France
| | - C Delmas
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - N Piliero
- University Hospital of Grenoble , Grenoble , France
| | - C Bouleti
- University of Poitiers , Poitiers , France
| | - T Pommier
- University Hospital of Dijon , Dijon , France
| | | | | | - B Lattuca
- University Hospital of Nimes , Nimes , France
| | | | - D Fard
- Henri-Mondor University Hospital , Créteil , France
| | - N Noirclerc
- Centre Hospitalier Annecy Genevois , Annecy , France
| | - E Vicaut
- Hôpital Fernand Widal, AP-HP, Unité de Recherche Clinique et Statistiques , Paris , France
| | - P Henry
- Hospital Lariboisiere, Cardiology , Paris , France
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10
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Piliero N, Guichard A, Bedague D, Sebestyen A, Saunier C, Bouvaist H. Percutaneous FlowTriever Retrieval/Aspiration System for Impending Paradoxical Embolism. JACC Cardiovasc Interv 2022; 15:1994-1995. [DOI: 10.1016/j.jcin.2022.07.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/26/2022] [Indexed: 10/14/2022]
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11
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Madoun S, Piliero N, Guillien A, Salvat M, Thony F, Finas M, Augier C, Bouvaist H, Degano B. Improved ventilatory efficiency to evidence haemodynamic improvement after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Respir J 2022; 60:13993003.00762-2022. [PMID: 35896210 DOI: 10.1183/13993003.00762-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Simon Madoun
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Nicolas Piliero
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Alicia Guillien
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Épidemiologie environnementale appliquée à la reproduction et à la santé respiratoire, INSERM, CNRS, Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France
| | - Muriel Salvat
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Frédéric Thony
- Pole Imagerie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Mathieu Finas
- Pole Imagerie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Caroline Augier
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France .,Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
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12
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Piliero N, Thony F, Guillien A, Rousseau J, Finas M, Vautrin E, Degano B, Bouvaist H. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: Evaluation of haemodynamic effects, complication rates and radiation exposure over time. Arch Cardiovasc Dis 2022; 115:295-304. [DOI: 10.1016/j.acvd.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/02/2022]
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13
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Blanquez-Nadal M, Piliero N, Guillien A, Salvat M, Thony F, Augier C, Bouvaist H, Degano B. Neural respiratory drive in chronic thromboembolic pulmonary hypertension: Effect of balloon pulmonary angioplasty. Respir Physiol Neurobiol 2022; 299:103857. [PMID: 35121103 DOI: 10.1016/j.resp.2022.103857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/19/2022] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
Excessive ventilation (V̇E) during exercise, ascribed to heightened neural ventilatory drive and/or to increased "wasted" ventilation, is a feature of chronic thromboembolic pulmonary hypertension (CTEPH). In selected CTEPH patients, balloon pulmonary angioplasty (BPA) allows near-normalization of resting haemodynamic parameters but does not allow excess exercise hyperventilation to normalize. Neural ventilatory drive can be estimated by studying how arterial PCO2 (PaCO2), end-tidal PCO2 (PETCO2), V̇E and CO2 output (V̇CO2) change across the exercise-to-recovery transition during a cardiopulmonary exercise test. Increased "wasted" ventilation can be quantified by the physiological dead space fraction of tidal volume (VD/VT) calculated with the Enghoff simplification of the Bohr equation. These measurements were made before and after BPA in 22 CTEPH patients without significant cardiac and/or pulmonary comorbidities. Our observations suggest that before BPA, excessive hyperventilation was secondary to both heightened neural ventilatory drive and increased "wasted" ventilation; after BPA, measurements made across the exercise-to-recovery transition suggest that heightened neural ventilatory drive was no longer present.
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Affiliation(s)
- Mathilde Blanquez-Nadal
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - Nicolas Piliero
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Alicia Guillien
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Épidemiologie environnementale appliquée à la reproduction et à la santé respiratoire, INSERM, CNRS, Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), U1209, Grenoble, France
| | - Muriel Salvat
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Frédéric Thony
- Pole Imagerie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Caroline Augier
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France; Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France.
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14
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Canu M, Khouri C, Marliere S, Vautrin E, Piliero N, Ormezzano O, Bertrand B, Bouvaist H, Riou L, Djaileb L, Charlon C, Vanzetto G, Roustit M, Barone-Rochette G. Prognostic significance of severe coronary microvascular dysfunction post-PCI in patients with STEMI: A systematic review and meta-analysis. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.019] [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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15
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Blanquez-Nadal M, Piliero N, Guillien A, Doutreleau S, Salvat M, Thony F, Pison C, Augier C, Bouvaist H, Aguilaniu B, Degano B. Exercise hyperventilation and pulmonary gas exchange in chronic thromboembolic pulmonary hypertension: Effects of balloon pulmonary angioplasty. J Heart Lung Transplant 2021; 41:70-79. [PMID: 34742646 DOI: 10.1016/j.healun.2021.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/25/2021] [Accepted: 09/14/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Excessive ventilation (V̇E) and abnormal gas exchange during exercise are features of chronic thromboembolic pulmonary hypertension (CTEPH). In selected CTEPH patients, balloon pulmonary angioplasty (BPA) improves symptoms and exercise capacity. How BPA affects exercise hyperventilation and gas exchange is poorly understood. METHODS In this longitudinal observational study, symptom-limited cardiopulmonary exercise tests and carbon monoxide lung diffusion (DLCO) were performed before and after BPA (interval, mean (SD): 3.1 (2.4) months) in 36 CTEPH patients without significant cardiac and/or pulmonary comorbidities. RESULTS Peak work rate improved by 20% after BPA whilst V̇E at peak did not change despite improved ventilatory efficiency (lower V̇E with respect to CO2 output [V̇CO2]). At the highest identical work rate pre- and post-BPA (75 (30) watts), V̇E and alveolar-arterial oxygen gradient (P(Ai-a)O2) decreased by 17% and 19% after BPA, respectively. The physiological dead space fraction of tidal volume (VD/VT), calculated from measurements of arterial and mixed expired CO2, decreased by 20%. In the meantime, DLCO did not change. The best correlates of P(Ai-a)O2 measured at peak exercise were physiological VD/VT before BPA and DLCO after BPA. CONCLUSIONS Ventilatory efficiency, physiological VD/VT, and pulmonary gas exchange improved after BPA. The fact that DLCO did not change suggests that the pulmonary capillary blood volume and probably the true alveolar dead space were unaffected by BPA. The correlation between DLCO measured before BPA and P(Ai-a)O2 measured after BPA suggests that DLCO may provide an easily accessible marker to predict the response to BPA in terms of pulmonary gas exchange.
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Affiliation(s)
- Mathilde Blanquez-Nadal
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - Nicolas Piliero
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Alicia Guillien
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Épidemiologie environnementale appliquée à la reproduction et à la santé respiratoire, INSERM, CNRS, Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France
| | - Stéphane Doutreleau
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France; Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Muriel Salvat
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Frédéric Thony
- Pole Imagerie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - Caroline Augier
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bernard Aguilaniu
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France; Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France.
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16
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Piliero N, Bedague D, Fournel E, Saunier C, Bouvaist H. The Atrial Flow Regulator: A Novel Device for Left Ventricular Unloading in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support? Chest 2021; 160:e165-e167. [PMID: 34366037 DOI: 10.1016/j.chest.2021.03.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 10/20/2022] Open
Abstract
Severe pulmonary edema, secondary to left ventricular afterload increment, is a common problem occurring in patients receiving venoarterial extracorporeal membrane oxygenation. No consensus is currently available for its management, but several devices/procedures have been described, including an Impella device (Abiomed), balloon atrial septostomy, intraaortic balloon counterpulsation, or an additional venous cannula, as possible adjuncts. We report the feasibility and efficacy of the atrial flow regulator device (Occlutech) for left ventricular unloading in a 58-year-old patient receiving extracorporeal membrane oxygenation. However, the benefits of this device relative to simple balloon atrial septostomy need to be further investigated.
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Affiliation(s)
- Nicolas Piliero
- Service Hospitalier Universitaire de Cardiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
| | - Damien Bedague
- Service Hospitalier Universitaire de Réanimation Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Emmanuelle Fournel
- Service Hospitalier Universitaire de Réanimation Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Carole Saunier
- Service Hospitalier Universitaire de Cardiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Service Hospitalier Universitaire de Cardiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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17
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Noirclerc N, Marliere S, Bakhti A, Mangin L, Cassar E, Vautrin E, Piliero N, Ormezzano O, Bouvaist H, Riou L, Vanzetto G, Belle L, Barone-Rochette G. Impact of a micro-net mesh technology covering stent on coronary microvascular dysfunction in patients with high thrombus burden. Catheter Cardiovasc Interv 2021; 99:397-404. [PMID: 34057279 DOI: 10.1002/ccd.29782] [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: 12/24/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Highly thrombotic coronary lesions continue to be a serious and clinically significant problem that is not effectively and completely addressed by current technology. OBJECTIVES We aimed to investigate whether a micro-net mesh (MNM) technology covering stent could preserve the index of microcirculatory resistance (IMR) after percutaneous coronary intervention (PCI) in patients with high thrombus burden. METHODS AND RESULTS Fifty-two patients with non-ST elevation myocardial infarction or ST Elevation Myocardial Infarction and high thrombus burden (TIMI thrombus grade ≥ 3) were randomized into two groups, PCI with a MNM covering stent (MNM group, n = 25) and PCI with any commercially available stent (DES group, n = 27). As the primary endpoint, IMR was measured immediately after PCI using a pressure-temperature sensor-tipped coronary wire. The secondary endpoint was left ventricular ejection fraction (LVEF) at 6 months of follow-up. The IMR in the MNM group was significantly lower in comparison to the DES group (33.2 [21.3, 48.9] vs. 57.2 [39.9, 98.0], p = 0.005). No significant differences were observed in baseline LVEF (54.5 ± 10.2% vs. 53.1 ± 6.87%, p = .57), while LVEF was significantly improved at follow-up in the MNM group (61.1 ± 7.1% vs. 53.9 ± 6.35%, p = .0001). CONCLUSION MNM technology significantly improved coronary microvascular dysfunction after PCI in patient with acute coronary syndrome and appears as a useful technological option for thrombus management.
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Affiliation(s)
| | | | - Akader Bakhti
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Lionel Mangin
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Emmanuel Cassar
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Estelle Vautrin
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Nicolas Piliero
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Olivier Ormezzano
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France
| | - Helene Bouvaist
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Laurent Riou
- University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France
| | - Gerald Vanzetto
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France.,French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France
| | - Loic Belle
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France.,French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France
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18
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Deschamps E, Piliero N, Bouvaist H, Porcu P, Ennezat PV. An Exceedingly Rare Case of Concomitant Quadricuspid Aortic Valve and Atrial Myxoma. JACC Case Rep 2021; 3:267-268. [PMID: 34317514 PMCID: PMC8310983 DOI: 10.1016/j.jaccas.2020.11.011] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022]
Abstract
We present an exceptional case of a quadricuspid aortic valve associated with a left atrial myxoma. Both are rare conditions, and this association has not been reported yet. These conditions can be silent but may lead to several complications. This case highlights importance of a careful echocardiographic evaluation for early management. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Elodie Deschamps
- Department of Cardiology, University Hospital of Grenoble, Grenoble, France
- Address for correspondence: Dr. Elodie Deschamps, Department of Cardiology, University Hospital of Grenoble, CS 10217, Grenoble Cedex 09, 38043, France.
| | - Nicolas Piliero
- Department of Cardiology, University Hospital of Grenoble, Grenoble, France
| | - Hélène Bouvaist
- Department of Cardiology, University Hospital of Grenoble, Grenoble, France
| | - Paolo Porcu
- Department of Cardiovascular Surgery, University Hospital of Grenoble, Grenoble, France
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19
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Yanaka K, Guillien A, Soumagne T, Benet J, Piliero N, Picard F, Pison C, Sitbon O, Bouvaist H, Degano B. Transition from intravenous epoprostenol to selexipag in pulmonary arterial hypertension: a word of caution. Eur Respir J 2020; 55:13993003.02418-2019. [PMID: 32108046 DOI: 10.1183/13993003.02418-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/16/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Kenichi Yanaka
- Dept of Cardiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Alicia Guillien
- Environmental Epidemiology applied to Reproduction and Respiratory Health, INSERM, CNRS, University Grenoble Alpes, Institute for Advanced Biosciences (IAB), U1209 Joint Research Center, Grenoble, France
| | - Thibaud Soumagne
- Dept of Intensive Care Medicine, University Hospital, Besançon, France
| | - Justin Benet
- Dept of Respiratory Medicine, University Hospital of Grenoble Alpes, Grenoble, France
| | - Nicolas Piliero
- Dept of Cardiology, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Christophe Pison
- Dept of Respiratory Medicine, University Hospital of Grenoble Alpes, Grenoble, France
| | - Olivier Sitbon
- University Paris-Saclay, Le Kremlin-Bicêtre, France.,Dept of Respiratory Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France.,INSERM, UMR_S999, Le Plessis-Robinson, France
| | - Hélène Bouvaist
- Dept of Cardiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Bruno Degano
- Dept of Respiratory Medicine, University Hospital of Grenoble Alpes, Grenoble, France .,HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
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20
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Piliero N, Jankowski A, Thony F, Degano B, Bouvaist H. Just because it walks like a duck, quacks like a duck, doesn't mean it can't be a goose! Thorax 2020; 75:357-358. [PMID: 31974107 DOI: 10.1136/thoraxjnl-2019-214198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Nicolas Piliero
- Department of Cardiology, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Adrien Jankowski
- Department of Radiology, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Frédéric Thony
- Department of Radiology, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Department of Pneumology, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Department of Cardiology, University Hospital Centre Grenoble Alpes, Grenoble, France
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Barone-Rochette G, Zoreka F, Djaileb L, Piliero N, Calizzano A, Quesada JL, Broisat A, Riou L, Machecourt J, Fagret D, Vanzetto G, Ghezzi C. Diagnostic value of stress thallium-201/rest technetium-99m-sestamibi sequential dual isotope high-speed myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis. J Nucl Cardiol 2019; 26:1269-1279. [PMID: 29380286 DOI: 10.1007/s12350-018-1189-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 01/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to determine the diagnostic accuracy of stress thallium-201/rest technetium-99m-sestamibi sequential dual-isotope high-speed myocardial perfusion imaging (DI-HS-MPI) against invasively determined fractional flow reserve (FFR). METHODS Fifty-four consecutive patients prospectively underwent DI-HS-MPI before invasive coronary angiography. Perfusion was scored visually by summed stress score on a patient and coronary territory basis. Significant coronary artery disease (CAD) was defined by the presence of ≥ 90% stenosis/occlusion or fractional flow reserve ≤ 0.80 for coronary stenosis ≥ 50%. RESULTS FFR was measured in 69 of 162 coronary vessels, with 1.28 ± 0.56 vessels assessed/patient. Sensitivity, specificity, and diagnostic accuracy of MPI for the detection of significant CAD were 92.8%, 69.2%, and 81.4%, on a patient basis, and 83.7%, 90.4%, and 88.8% by coronary territory. CONCLUSIONS DI-HS-MPI accurately detects functionally significant CAD as defined by using FFR.
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Affiliation(s)
- Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble Alpes, France.
- INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble Alpes, France.
- French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France.
| | - Feras Zoreka
- Department of Cardiology, University Hospital, Grenoble Alpes, France
| | - Loïc Djaileb
- Department of Nuclear medicine, University Hospital, Grenoble Alpes, France
| | - Nicolas Piliero
- Department of Cardiology, University Hospital, Grenoble Alpes, France
| | - Alex Calizzano
- Department of Nuclear medicine, University Hospital, Grenoble Alpes, France
| | - Jean Louis Quesada
- Center of Clinical Investigations, Grenoble Alpes University Hospital, Grenoble, France
| | - Alexis Broisat
- INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble Alpes, France
| | - Laurent Riou
- INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble Alpes, France
| | | | - Daniel Fagret
- INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble Alpes, France
- Department of Nuclear medicine, University Hospital, Grenoble Alpes, France
| | - Gerald Vanzetto
- Department of Cardiology, University Hospital, Grenoble Alpes, France
- INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble Alpes, France
- French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France
| | - Catherine Ghezzi
- INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble Alpes, France
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22
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Dumas L, Piliero N, Montemagno C, Ahmadi M, Bacot S, Pascal P, Riou L, Fagret D, Barone-Rochette G, Broisat A, Ghezzi C. Evaluation of anti-atherogenic effects of P2Y12 receptor antagonists in Apolipoprotein E-deficient mice. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.02.007] [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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23
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Djaïleb L, Riou L, Piliero N, Carabelli A, Vautrin E, Broisat A, Leenhardt J, Machecourt J, Fagret D, Vanzetto G, Barone-Rochette G, Ghezzi C. SPECT myocardial ischemia in the absence of obstructive CAD: Contribution of the invasive assessment of microvascular dysfunction. J Nucl Cardiol 2018; 25:1017-1022. [PMID: 29209950 DOI: 10.1007/s12350-017-1135-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/02/2017] [Indexed: 11/28/2022]
Abstract
Coronary microvascular dysfunction has recently emerged as a major independent prognostic factor and can be invasively assessed by coronary flow reserve (CFR) and the index of microvascular resistance (IMR). The incremental prognostic value of myocardial ischemia from SPECT myocardial perfusion imaging (MPI) over clinical characteristics, cardiac risk factors, and stress test data for the prediction of hard cardiac events (myocardial infarction and cardiac death) has been well demonstrated over the last two decades regardless of the absence or presence of epicardial CAD. Recently developed semi-conductor, cardiac-dedicated cameras allow for decreased acquisition times and systematic procubitus and decubitus acquisitions thereby limiting the occurrence of false positives historically attributable to artefactual motion, attenuation, and digestive artifacts. It is therefore likely that pathophysiological causes rather than acquisition artifacts might underlie SPECT perfusion abnormalities. Here, we report four representative examples of patients presenting with ischemia in the setting of no obstructive CAD and normal fractional flow reserve together with elevated IMR and low CFR. The results indicate that ischemia from SPECT MPI could result from microvascular dysfunction in patients without obstructive CAD and should be considered as a prognostic factor for hard cardiac events.
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Affiliation(s)
- Loïc Djaïleb
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France.
- Nuclear Medicine Department, Grenoble-Alpes University Hospital (CHUGA), Avenue Maquis du Grésivaudan, 38700, Grenoble, France.
| | - Laurent Riou
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Grenoble-Alpes University, Grenoble, France
| | - Nicolas Piliero
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Cardiology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Adrien Carabelli
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Cardiology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Estelle Vautrin
- Nuclear Medicine Department, Grenoble-Alpes University Hospital (CHUGA), Avenue Maquis du Grésivaudan, 38700, Grenoble, France
- Cardiology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alexis Broisat
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Grenoble-Alpes University, Grenoble, France
| | - Julien Leenhardt
- Nuclear Medicine Department, Grenoble-Alpes University Hospital (CHUGA), Avenue Maquis du Grésivaudan, 38700, Grenoble, France
| | - Jacques Machecourt
- Cardiology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Daniel Fagret
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Nuclear Medicine Department, Grenoble-Alpes University Hospital (CHUGA), Avenue Maquis du Grésivaudan, 38700, Grenoble, France
| | - Gerald Vanzetto
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Cardiology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Gilles Barone-Rochette
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Cardiology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Catherine Ghezzi
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble-Alpes University, Grenoble, France
- Grenoble-Alpes University, Grenoble, France
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Bouvaist H, Piliero N, Thony F, Jondot M, Pison C. Angioplastie pulmonaire percutanée pour l’hypertension pulmonaire thromboembolique chronique (HTP-TEC) chez 53 patients consécutifs. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.054] [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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25
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Casset C, Jankowski A, Bertrand B, Saunier C, Piliero N, Rodiere M, Ferretti G, Quesada JL, Broisat A, Riou L, Fagret D, Ghezzi C, Vanzetto G, Barone-Rochette G. Evaluation of Imaging Strategy to Optimize and Improve Outcome of Transcatheter Aortic Valvular Implantation. Am J Cardiol 2017; 120:1633-1638. [PMID: 28864319 DOI: 10.1016/j.amjcard.2017.07.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/08/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
Cardiac computed tomography (CT) provides additional information with ultrasound in the transcatheter heart valve (THV) size selection. However, the influence of these incremental data on outcomes has not been evaluated in a randomized study. A single-center prospective, randomized, and open study was performed. Patients referred for transfemoral transcatheter aortic valve implantation with a balloon-expandable endoprothesis were included. THV size selection was performed using either transthoracic and transesophageal echocardiography data (control group) or ultrasound and CT results (CT group). The primary composite end point included the occurrence of stroke, major vascular complications, and moderate or severe paravalvular aortic regurgitation (PAR) at 1 year. Fifty patients (n = 25 in the control and CT groups) were enrolled. The primary composite end point occurred in 40% and 8% of patients from the control and CT groups, respectively (p = 0.008). The Kaplan-Meier analysis revealed a pejorative association with not performing the CT (p = 0.007). A decrease in the occurrence of PAR was observed in the CT group compared with the control group (PAR 28% vs 4%, p = 0.04; major vascular complications 12% vs 4%, p = 0.6; all-cause death 16% vs. 4%, p = 0.34; no stroke). In conclusion, the use of cardiac CT in addition to ultrasound data in THV size selection reduced the long-term occurrence of cardiovascular events.
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Piliero N, Guerbaai RA, Ennezat PV, Bouvaist H. Percutaneous tricuspid valve-in-ring implantation in a systemic sclerosis patient with pulmonary arterial -hypertension. Acta Cardiol 2017; 72:218-219. [PMID: 28597786 DOI: 10.1080/00015385.2017.1291192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicolas Piliero
- Department of Cardiology, University Hospital, Grenoble, France
| | | | | | - Hélène Bouvaist
- Department of Cardiology, University Hospital, Grenoble, France
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27
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Carron PL, Piliero N, Heitz M, Kribs M, Rodière M, Jousse P, Gunther-Calvino S, Thony F. Delayed renal dysfunction and flash pulmonary edema post endovascular abdominal aneurysm repair. Hemodial Int 2015; 20:E5-7. [PMID: 26486547 DOI: 10.1111/hdi.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After endovascular aortic repair (EVAR), the deterioration in long-term renal function is probably multifactorial. Preoperative renal failure is an independent risk factor. Postoperative renal dysfunction can be associated with inadvertent renal artery occlusion, renal artery complications as stenosis, plaque dislodgement, or dissection. Ischemic nephropathy can accelerate hypertension and circulatory congestion. We report a case of coverage of the renal arteries symptomatic with flash pulmonary edema and renal failure 15 months after EVAR, suggesting a delayed endograft migration. The patient had complete resolution of symptoms and renal function after renal artery stenting with placement between endograft and aneurysm to the left renal artery.
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Affiliation(s)
- Pierre-Louis Carron
- Service de Néphrologie, Dialyse et Transplantation, Centre Hospitalier Universitaire, Grenoble, France
| | - Nicolas Piliero
- Service de Néphrologie, Dialyse et Transplantation, Centre Hospitalier Universitaire, Grenoble, France
| | - Morgane Heitz
- Service de Néphrologie, Dialyse et Transplantation, Centre Hospitalier Universitaire, Grenoble, France
| | - Marc Kribs
- Service de Néphrologie, Hémodialyse, Centre Hospitalier, Haguenau, France
| | - Mathieu Rodière
- Clinique de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire, Grenoble, France
| | - Patrick Jousse
- Clinique de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire, Grenoble, France
| | - Silvia Gunther-Calvino
- Service de Néphrologie, Dialyse et Transplantation, Centre Hospitalier Universitaire, Grenoble, France
| | - Frédéric Thony
- Clinique de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire, Grenoble, France
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