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Sanchez O, Roy PM, Gaboreau Y, Schmidt J, Moustafa F, Benmaziane A, Élias A, Espitia O, Sevestre MA, Couturaud F, Mahé I. [Translation into French and republication of: "Home treatment for patients with cancer-associated venous thromboembolism"]. Rev Med Interne 2024:S0248-8663(24)00096-1. [PMID: 38632029 DOI: 10.1016/j.revmed.2024.04.003] [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: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 04/19/2024]
Abstract
Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service. Nonetheless, there is a need for a VTE risk-stratification tool specifically addressing prognosis in patients with cancer. This may aid in the selection of low-risk patients with cancer and VTE who are suitable for outpatient treatment. Although several prognostic scores have been proposed, we suggest using a pragmatic clinical decision-making tool such as the Hestia criteria for selecting patients for home care in everyday clinical practice. Once patients have been discharged, it is mandatory to monitor patients regularly (we suggest after 3 days, 10 days, 1 month and 3 months, or more frequently if needed) with the involvement of a multidisciplinary team, so that appropriate and timely remedial action can be taken in case of warning signs of complications. If patients are selected carefully and monitored effectively, many patients who experience acute VTE can be cared for safely at home.
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Affiliation(s)
- Olivier Sanchez
- Service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Université Paris Cité, Inserm UMR S1140, Innovations thérapeutiques en hémostase, Paris, France; F-Crin INNOVTE network, Saint-Étienne, France.
| | - Pierre-Marie Roy
- Service de médecine d'urgence, CHU d'Angers, université d'Angers, UMR MitoVasc CNRS 6015-Inserm 1083, équipe Carme, Angers, France; F-Crin INNOVTE network, Saint-Étienne, France
| | - Yoann Gaboreau
- Département de médecine générale, faculté de médecine, Techniques de l'ingénierie médicale et de la complexité (Timc), université Grenoble Alpes, Grenoble, France
| | - Jeannot Schmidt
- Service d'urgence, CHU de Clermont-Ferrand, Lapsco-UMR UBP-CNRS 6024, université Clermont Auvergne, Clermont-Ferrand, France; F-Crin INNOVTE network, Saint-Étienne, France
| | - Farès Moustafa
- Inrae, UNH, département urgence, hôpital de Clermont-Ferrand, université Clermont Auvergne, Clermont-Ferrand, France; F-Crin INNOVTE network, Saint-Étienne, France
| | | | - Antoine Élias
- Département de cardiologie et de médecine vasculaire, délégation Recherche clinique et innovation, centre hospitalier intercommunal de Toulon La Seyne-sur-Mer, Toulon, France; F-Crin INNOVTE network, Saint-Étienne, France
| | - Olivier Espitia
- Service de médecine interne et vasculaire, Institut du thorax, Nantes université, CHU de Nantes, Inserm UMR 1087 - CNRS UMR 6291, Team III Vascular & pulmonary diseases, Nantes, France
| | - Marie-Antoinette Sevestre
- Service de médecine vasculaire, ÉA Chimère 7516, CHU d'Amiens-Picardie, Amiens, France; F-Crin INNOVTE network, Saint-Étienne, France
| | - Francis Couturaud
- Département de médecine interne, médecine vasculaire et pneumologie, CHU de Brest, Inserm U1304 - Getbo, université de Brest, Brest, France; F-Crin INNOVTE network, Saint-Étienne, France
| | - Isabelle Mahé
- Université Paris Cité, Inserm UMR S1140, Innovations thérapeutiques en hémostase, Paris, France; Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; F-Crin INNOVTE network, Saint-Étienne, France
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Gallou S, Agard C, Dumont A, Deshayes S, Boutemy J, Maigné G, Martin Silva N, Nguyen A, Philip R, Espitia O, Aouba A, de Boysson H. Evolution and outcomes of aortic dilations in giant cell arteritis. Eur J Intern Med 2024:S0953-6205(24)00146-8. [PMID: 38580542 DOI: 10.1016/j.ejim.2024.03.038] [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: 12/07/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES To identify factors associated with the progression of giant cell arteritis (GCA)-related or associated aortic dilations. METHODS In this retrospective study, 47 GCA patients with aortic dilation were longitudinally analyzed. Each patient underwent ≥2 imaging scans of the aorta during the follow-up. Three progression statuses of aortic dilations were distinguished: fast-progressive (FP) defined by a progression of the aortic diameter ≥5 mm/year or ≥1 cm/2 years, slow progressive (SP) by a progression of the aortic diameter >1 mm during the follow-up, and not progressive (NP) when aortic diameter remained stable. RESULTS Among the 47 patients with aortic dilation, the thoracic section was involved in 87 % of patients. Within a total follow-up of 89 [6-272] months, we identified 13 (28 %) patients with FP dilations, and 16 (34 %) and 18 (38 %) patients with SP and NP dilations, respectively. No differences regarding baseline characteristics, cardiovascular risk factors or treatments were observed among the 3 groups. However, FP patients more frequently showed atheromatous disease (p = 0.04), with a more frequent use of statins (p = 0.04) and antiplatelet agents (p = 0.02). Among the 27 (57 %) patients with aortitis, aortic dilation developed on an inflammatory segment in 23 (85 %). Among the FP patients who underwent aortic surgery with available histology (n = 3), all presented active vasculitis. CONCLUSION This study suggests that aortic inflammation, as well as atheromatous disease, might participate in the fast progression of aortic dilation in GCA.
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Affiliation(s)
- Sophie Gallou
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | | | - Alexandre Nguyen
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Rémi Philip
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France.
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Espitia O, Del Giudice C, Hartung O, Herquelot E, Schmidt A, Sapoval M, Sobocinski J. Editor's Choice -- Survival, Limb Salvage, and Management of Patients with Lower Limb Acute Ischaemia: A French National Retrospective Observational Study. Eur J Vasc Endovasc Surg 2024; 67:631-642. [PMID: 37926151 DOI: 10.1016/j.ejvs.2023.11.001] [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: 05/10/2022] [Revised: 09/22/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The aim was to describe the baseline characteristics of French patients referred with acute limb ischaemia (ALI), and their clinical management and outcome (death, amputation). METHODS This retrospective observational cohort study used the National Health Data System. All adults hospitalised for ALI who underwent revascularisation with an endovascular or open surgical approach between 1 January 2015 and 31 December 2020 were included and followed up until death or the end of the study (31 December 2021). A one year look back period was used to capture patients' medical history. The risks of death, and major and minor amputations were described using Kaplan-Meier and Aalen-Johansen estimators. A Cox model was used to report the adjusted association between groups and risk of death and Fine-Gray models for the risk of amputations considering the competing risk of death. RESULTS Overall, 51 390 patients (median age 70 years, 69% male) were included and had a median follow up of 2.7 years: 39 411 (76.7%) were treated with an open approach and 11 979 (23.3%) with a percutaneous endovascular approach. The preferred approach for the revascularisation varied between French regions. The one year overall survival was 78.0% and 85.2% in the surgery and endovascular groups, respectively. The surgery group had a higher risk of death (hazard ratio [HR] 1.17, 95% CI 1.12 - 1.21), a higher risk of major amputation (sub-distribution HR 1.20, 95% CI 1.10 - 1.30) and lower risk of minor amputation (sub-distribution HR 0.66, 95% CI 0.60 - 0.71) than the endovascular group. Diabetes and dialysis increased the risk of major amputation by 52% and 78%, respectively. Subsequent ALI was the third most common cause of hospital re-admission within one year. CONCLUSION ALI remains a condition at high risk of death and amputation. Individual risk factors and ALI severity need to be considered to choose between approaches. Continued prevention efforts, improved management, and access to the most suitable approach are necessary.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, F-44000 Nantes, France.
| | | | - Olivier Hartung
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire Nord, Marseille, France
| | | | | | - Marc Sapoval
- Radiologie interventionnelle, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jonathan Sobocinski
- Chirurgie vasculaire et endovasculaire, Centre Hospitalier Universitaire de Lille, Lille, France
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Chehem Daoud Chehem F, Espitia O, Agard C. Reply on « Commentary on giant cell arteritis associated with scalp, tongue or lip necrosis in a French study". Semin Arthritis Rheum 2024; 67:152427. [PMID: 38503021 DOI: 10.1016/j.semarthrit.2024.152427] [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: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Affiliation(s)
| | - Olivier Espitia
- L'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes F-44000, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of internal medicine, Nantes F-44000, France.
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Mekinian A, Noé L, Salvarani C, Dagna L, Espitia O, Biard L, Hernández-Rodríguez J, Tomelleri A, Baldissera E, Campochiaro C, Cacoub P, Fain O, Saadoun D. Effectiveness and safety of rituximab in Takayasu arteritis: a multicenter retrospective study. Joint Bone Spine 2024; 91:105658. [PMID: 37913918 DOI: 10.1016/j.jbspin.2023.105658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Arsène Mekinian
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, 75012 Paris, France; French Armenian research center, Erevan, Armenia.
| | - Lucie Noé
- Service de Biostatistique et Information Médicale (DMU PRISME), Inserm U1153 Team ECSTRRA, Université de Paris, AP-HP, Hôpital Saint Louis, Paris, France
| | - Carlo Salvarani
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, San Raffaele, Italy
| | - Olivier Espitia
- Department of internal and vascular medicine, Nantes Université, CHU de Nantes, 44000 Nantes, France
| | - Lucie Biard
- Service de Biostatistique et Information Médicale (DMU PRISME), Inserm U1153 Team ECSTRRA, Université de Paris, AP-HP, Hôpital Saint Louis, Paris, France
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases. Hospital Clínic of Barcelona. IDIBAPS, University of Barcelona, Vasculitis Research Unit, Barcelona, Spain
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, San Raffaele, Italy
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, San Raffaele, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, San Raffaele, Italy
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Pitié Salpetrière, 75013 Paris, France
| | - Olivier Fain
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, 75012 Paris, France; French Armenian research center, Erevan, Armenia
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Pitié Salpetrière, 75013 Paris, France
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Guédon AF, Collot R, Agard C, Raimbeau A, Bénichou A, Connault J, Mekinian A, Espitia O. Aortitis Increases Risk of Relapse and Vascular Events in Takayasu Arteritis. Mayo Clin Proc 2024; 99:504-507. [PMID: 38432753 DOI: 10.1016/j.mayocp.2023.11.017] [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: 09/24/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 03/05/2024]
Affiliation(s)
- Alexis F Guédon
- Service de Médecine Interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Romain Collot
- Department of Internal and Vascular Medicine, Nantes Université, CHU Nantes, Nantes, France
| | - Christian Agard
- Department of Internal and Vascular Medicine, Nantes Université, CHU Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal and Vascular Medicine, Nantes Université, CHU Nantes, Nantes, France
| | - Antoine Bénichou
- Department of Internal and Vascular Medicine, Nantes Université, CHU Nantes, Nantes, France
| | - Jérôme Connault
- Department of Internal and Vascular Medicine, Nantes Université, CHU Nantes, Nantes, France
| | - Arsène Mekinian
- Service de Médecine Interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, Nantes Université, CHU Nantes, Nantes, France.
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Chehem Daoud Chehem F, de Mornac D, Feuillet F, Liozon E, Samson M, Bonnotte B, de Boysson H, Guffroy A, Balquet MH, Ledoult E, Lavigne C, Trefond L, Smets P, Bodard Q, Fenot M, Richez C, Duffau P, Guillaud C, Espitia O, Agard C. Giant cell arteritis associated with scalp, tongue or lip necrosis: A French multicenter case control study. Semin Arthritis Rheum 2024; 64:152348. [PMID: 38091870 DOI: 10.1016/j.semarthrit.2023.152348] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/03/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Scalp, tongue and/or lip necrosis are rare complications of GCA. OBJECTIVES To describe characteristics and outcome of patients with giant cell arteritis (GCA) -related scalp, tongue and/or lip necrosis. METHODS A retrospective nationwide multicenter study included 20 GCA patients with scalp, tongue, and/or lip necrosis diagnosed between 1998 and 2021 and 80 GCA control patients matched for age, sex and management period. Logistic regression analyses were conducted to identify baseline characteristics associated with scalp, tongue and/or lip necrosis. RESULTS Compared to controls, patients with scalp, tongue and/or lip necrosis showed significantly more cranial manifestations (headache, p=0.045; scalp tenderness, p=0.006; jaw claudication, p=0.02). No differences were observed between both groups regarding the occurrence of visual symptoms or large vessel involvement. At diagnosis, GCA patients with necrosis more likely received IV methylprednisolone infusions and higher doses of oral prednisone. There were no differences regarding vascular complications during follow up. Compared to controls, survival was decreased in GCA patients with necrosis (p=0.003). In a multivariable logistic regression model, scalp tenderness [odds ratio (OR) 4.81(95 % CI: 1.57, 14.79), p = 0.006] and cognitive disorder [OR 6.42 (95 % CI: 1.01, 40.60), p=0.048] were identified as factors associated to scalp, tongue, and/or lip necrosis. CONCLUSION Our results suggest that scalp, tongue, and/or lip necrosis is associated to higher mortality in GCA patients. Scalp tenderness and cognitive disorder were significant factors associated to this very rare complication of GCA.
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Affiliation(s)
| | - Donatienne de Mornac
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France
| | - Fanny Feuillet
- Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Eric Liozon
- Internal Medicine Department, Limoges University Hospital, Limoges, France
| | - Maxime Samson
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Bernard Bonnotte
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Hubert de Boysson
- Internal Medicine Department, Caen University Hospital, Caen, France
| | - Aurélien Guffroy
- Internal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Emmanuel Ledoult
- Internal Medicine Department, Lille University Hospital, Lille, France
| | - Christian Lavigne
- Internal Medicine Department, Angers University Hospital, Angers, France
| | - Ludovic Trefond
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Perrine Smets
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Quentin Bodard
- Internal medicine and Infectious Diseases Department, Departmental Hospital Centre, Angoulême, France
| | - Marion Fenot
- Dermatology Department, Departmental Hospital Centre, La Roche Sur Yon, France
| | - Christophe Richez
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, and CHU of Bordeaux, Department of Rheumatology, F-33000 Bordeaux, France
| | - Pierre Duffau
- University Bordeaux, CHU Bordeaux, Department of internal medicine, Bordeaux, France
| | - Constance Guillaud
- Internal Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Olivier Espitia
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France; L'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, F-44000 Nantes, France
| | - Christian Agard
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France.
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Espitia O, Raimbeau A, Planquette B, Katsahian S, Sanchez O, Espinasse B, Bénichou A, Murris J. A systematic review and meta-analysis of the incidence of post-thrombotic syndrome, recurrent thromboembolism, and bleeding after upper extremity vein thrombosis. J Vasc Surg Venous Lymphat Disord 2024; 12:101688. [PMID: 37717788 DOI: 10.1016/j.jvsv.2023.09.002] [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] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Data on complications after upper extremity vein thrombosis (UEVT) are limited and heterogeneous. METHODS The aim of the present study was to evaluate the pooled proportions of venous thromboembolism (VTE) recurrence, bleeding, and post-thrombotic syndrome (PTS) in patients with UEVT. A systematic literature review was conducted of PubMed, Embase, and the Cochrane Library databases from January 2000 to April 2023 in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. All studies included patients with UEVT and were published in English. Meta-analyses of VTE recurrence, bleeding, and of PTS after UEVT were performed to compute pooled estimates and associated 95% confidence intervals (CIs). Subgroup analyses of cancer-associated UEVT and catheter-associated venous thrombosis were conducted. Patients with Paget-Schroetter syndrome or effort thrombosis were excluded. RESULTS A total of 55 studies with 15,694 patients were included. The pooled proportions for VTE recurrence, major bleeding, and PTS were 4.8% (95% CI, 3.8%-6.2%), 3.0% (95% CI, 2.2%-4.0%), and 23.8% (95% CI, 17.0%-32.3%), respectively. The pooled proportion of VTE recurrence was 2.7% (95% CI, 1.6%-4.6%) for patients treated with direct oral anticoagulants (DOACs), 1.7% (95% CI, 0.8%-3.7%) for patients treated with low-molecular-weight heparin (LMWH), and 4.4% (95% CI, 1.5%-11.8%) for vitamin K antagonists (VKAs; P = .36). The pooled proportion was 6.3% (95% CI, 4.3%-9.1%) for cancer patients compared with 3.1% (95% CI, 2.1%-4.6%) for patients without cancer (P = .01). The pooled proportion of major bleeding for patients treated with DOACs, LMWH, and VKAs, was 2.1% (95% CI, 0.9%-5.1%), 3.2% (95% CI, 1.4%-7.2%), and 3.4% (95% CI, 1.4%-8.4%), respectively (P = .72). The pooled proportion of PTS for patients treated with DOACs, LMWH, and VKAs was 11.8% (95% CI, 6.5%-20.6%), 27.9% (95% CI, 20.9%-36.2%), and 24.5% (95% CI, 17.6%-33.1%), respectively (P = .02). CONCLUSIONS The results from this study suggest that UEVT is associated with significant rates of PTS and VTE recurrence. Treatment with DOACs might be associated with lower PTS rates than treatment with other anticoagulants.
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Affiliation(s)
- Olivier Espitia
- Department of Vascular Medicine, Nantes Université, CHU Nantes, l'institut du Thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France; UNAV, Nantes Vascular Access Unit, Nantes Université, CHU Nantes, Nantes, France.
| | - Alizée Raimbeau
- Department of Vascular Medicine, Nantes Université, CHU Nantes, l'institut du Thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France; UNAV, Nantes Vascular Access Unit, Nantes Université, CHU Nantes, Nantes, France
| | - Benjamin Planquette
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Centre - Université Paris Cité, INSERM UMR S1140, Innovative Therapies in Hemostasis, Paris, France, F-CRIN INNOVTE, Université Paris Cité, St-Etienne, France
| | - Sandrine Katsahian
- INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, AP-HP, Hôpital Européen Georges Pompidou, Unité de Recherche Clinique, Service d'Informatique Médicale, Biostatistiques et Santé Publique, AP-HP Centre, Paris, France; Inserm, Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Paris, France; HeKA, Inria, Paris, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Centre - Université Paris Cité, INSERM UMR S1140, Innovative Therapies in Hemostasis, Paris, France, F-CRIN INNOVTE, Université Paris Cité, St-Etienne, France
| | | | - Antoine Bénichou
- Department of Vascular Medicine, Nantes Université, CHU Nantes, l'institut du Thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France; UNAV, Nantes Vascular Access Unit, Nantes Université, CHU Nantes, Nantes, France
| | - Juliette Murris
- Inserm, Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Paris, France; HeKA, Inria, Paris, France; RWE and Data, Pierre Fabre, Boulogne-Billancourt, France
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Bertoletti L, Girard P, Elias A, Espitia O, Schmidt J, Couturaud F, Mahé I, Sanchez O. Recurrent venous thromboembolism in anticoagulated cancer patients: Diagnosis and treatment. Arch Cardiovasc Dis 2024; 117:84-93. [PMID: 38065753 DOI: 10.1016/j.acvd.2023.11.006] [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: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Patients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drug-drug interactions) and cancer progression.
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Affiliation(s)
- Laurent Bertoletti
- Service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, INSERM, UMR1059, Équipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Philippe Girard
- Institut du thorax Curie-Montsouris, institut mutualiste Montsouris, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Antoine Elias
- Service de cardiologie et de médecine vasculaire, délégation recherche clinique et innovation, centre hospitalier intercommunal Toulon La Seyne-sur-Mer, Toulon, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Espitia
- Service de médecine interne et vasculaire, institut du thorax, Nantes université, CHU de Nantes, Inserm UMR 1087-CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Jeannot Schmidt
- Service d'urgence, CHU de Clermont-Ferrand, LAPSCO-UMR UBP-CNRS 6024, Université Clermont Auvergne, Clermont-Ferrand, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Francis Couturaud
- Département de médecine interne, médecine vasculaire et pneumologie, CHU de Brest, Inserm U1304-GETBO, université de Brest, Brest, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Isabelle Mahé
- Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de pneumologie et de soins intensifs, Hôpital européen Georges-Pompidou, AP-HP, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
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10
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Espitia O, Tissot A, Miossec A, Pistorius MA, Richard R, Raimbeau A, Bénichou A, Espinasse B, Guédon AF. Upper extremity venous thrombosis in hospitalized patients: A prospective epidemiological study. Thromb Res 2024; 233:174-180. [PMID: 38091816 DOI: 10.1016/j.thromres.2023.11.026] [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] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND The frequency of upper extremities vein thrombosis (UEVT) is rising with the increasing use of endovenous devices. These thromboses are particularly common among hospitalized patients. The epidemiology and risk factors for UEVT are poorly understood in a hospitalized population. OBJECTIVE To assess the prevalence of UEVT in hospitalized patients and study thrombosis risk factors according to their location. METHODS Prospective evaluation of patients hospitalized in a university hospital with clinical and Doppler ultrasound (DUS) assessment of the upper extremities. RESULTS Of the 400 patients included, 91(22.8 %) had UEVT including 8 (8.8 %) proximal thrombosis, 32 (35.2 %) arm venous thrombosis and 51 (56.0 %) forearm venous thrombosis; 7 (7.7 %) patients with UEVT had a concomitant symptomatic pulmonary embolism. In this population of hospitalized patients, 40 (10 %) had proximal or arm thrombosis and 51 (12.8 %) forearm thrombosis. All patients with UEVT had a venous catheter and 63 (69.2 %) of UEVT patients had therapeutic or prophylactic anticoagulation at the time of DUS evaluation. In multivariate analysis, peripheral intravenous catheter (PIVC) OR 3.71 [1.90; 7.91] (p < 0.001); MID line OR 3.58 [1.46; 8.91] (p = 0.005) and infection disease OR 2.21 [1.26; 4386] (p = 0.005) were associated with UEVT. Central venous catheter OR 66.24 [12.64; 587.03] was associated with proximal UEVT and MID line OR 12.61 [4.64; 35.77] (p < 0.001) with arm UEVT. Forearm UEVT were associated with PIVCOR 10.71[3.14; 67.37] (p = 0.001); infectious disease OR 2.87 [1.48; 5.60] (p = 0.002), iron infusion OR 3.11 [1.23; 7.47] and hospitalization for postpartum OR 4.37 [0.97; 18.06] (p = 0.04). CONCLUSION One in 5 hospitalized patients suffers from UEVT. Proximal venous thrombosis is uncommon. The presence of a catheter and hospitalization for infection are the factors most frequently associated with UEVT.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France; Nantes Université, l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, F-44000 Nantes, France.
| | - Audry Tissot
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France
| | - Annaïg Miossec
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France
| | - Marc-Antoine Pistorius
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France
| | - Rodica Richard
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France
| | - Alizée Raimbeau
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France
| | - Antoine Bénichou
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France
| | - Benjamin Espinasse
- GETBO INSERM 1304 & Department of Vascular Medicine, CHU Brest, F-29000 Brest, France
| | - Alexis F Guédon
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France
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11
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Sanchez O, Roy PM, Gaboreau Y, Schmidt J, Moustafa F, Benmaziane A, Elias A, Espitia O, Sevestre MA, Couturaud F, Mahé I. Home treatment for patients with cancer-associated venous thromboembolism. Arch Cardiovasc Dis 2024; 117:16-28. [PMID: 38092577 DOI: 10.1016/j.acvd.2023.11.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service. Nonetheless, there is a need for a VTE risk-stratification tool specifically addressing prognosis in patients with cancer. This may aid in the selection of low-risk patients with cancer and VTE who are suitable for outpatient treatment. Although several prognostic scores have been proposed, we suggest using a pragmatic clinical decision-making tool such as the Hestia criteria for selecting patients for home care in everyday clinical practice. Once patients have been discharged, it is mandatory to monitor patients regularly (we suggest after 3 days, 10 days, 1 month and 3 months, or more frequently if needed) with the involvement of a multidisciplinary team, so that appropriate and timely remedial action can be taken in case of warning signs of complications. If patients are selected carefully and monitored effectively, many patients who experience acute VTE can be cared for safely at home.
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Affiliation(s)
- Olivier Sanchez
- Service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Pierre-Marie Roy
- Service de médecine d'urgences, CHU Angers, Université d'Angers, UMR MitoVasc CNRS 6015 - Inserm 1083, équipe CARME, Angers, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Yoann Gaboreau
- Département de médecine générale, faculté de médicine, techniques de l'ingénierie médicale et de la complexité (TIMC), université Grenoble-Alpes, Grenoble, France
| | - Jeannot Schmidt
- Service d'urgence, CHU de Clermont-Ferrand, LAPSCO-UMR UBP-CNRS 6024, Université Clermont Auvergne, Clermont-Ferrand, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Farès Moustafa
- Inrae, UNH, département urgence, hôpital de Clermont Ferrand, université Clermont Auvergne, Clermont-Ferrand, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | | | - Antoine Elias
- Département de cardiologie et de médecine vasculaire, délégation recherche clinique et innovation, centre hospitalier intercommunal Toulon La Seyne-sur-Mer, Toulon, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Espitia
- Service de médecine interne et vasculaire, institut du thorax, Nantes université, CHU de Nantes, Inserm UMR 1087 -CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Marie-Antoinette Sevestre
- Service de médecine vasculaire, EA Chimère 7516 CHU d'Amiens-Picardie, Amiens, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Francis Couturaud
- Département de médecine interne, médecine vasculaire et pneumologie, CHU de Brest, Inserm U1304 -GETBO, université de Brest, Brest, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Isabelle Mahé
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; F-CRIN INNOVTE network, Saint-Etienne, France
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12
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Elias A, Debourdeau P, Espitia O, Sevestre MA, Girard P, Mahé I, Sanchez O. Central venous catheter associated upper extremity deep vein thrombosis in cancer patients: Diagnosis and therapeutic management. Arch Cardiovasc Dis 2024; 117:72-83. [PMID: 38065755 DOI: 10.1016/j.acvd.2023.11.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Catheter-related thrombosis (CRT) is a relatively frequent and potentially fatal complication arising in patients with cancer who require a central catheter placement for intravenous treatment. In everyday practice, CRT remains a challenge for management; despite its frequency and its negative clinical impact, few data are available concerning diagnosis and treatment of CRT. In particular, no diagnostic studies or clinical trials have been published that included exclusively patients with cancer and a central venous catheter (CVC). For this reason, many questions regarding optimal management of CRT remain unanswered. Due to the paucity of high-grade evidence regarding CRT in cancer patients, guidelines are derived from upper extremity DVT studies for diagnosis, and from those for lower limb DVT for treatment. This article addresses the issues of diagnosis and management of CRT through a review of the available literature and makes a number of proposals based on the available evidence. In symptomatic patients, venous ultrasound is the most appropriate choice for first-line diagnostic imaging of CRT because it is noninvasive, and its diagnostic performance is high (which is not the case in asymptomatic patients). In the absence of direct comparative clinical trials, we suggest treating patients with CRT with a therapeutic dose of either a LMWH or a direct oral factor Xa inhibitor, with or without a loading dose. These anticoagulants should be given for a total of at least three months, including at least one month after catheter removal following initiation of therapy.
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Affiliation(s)
- Antoine Elias
- Département de Cardiologie et de Médecine Vasculaire, Délégation Recherche Clinique et Innovation, Centre Hospitalier Intercommunal Toulon La Seyne-sur-Mer, Toulon, France; F-CRIN INNOVTE network, Saint-Étienne, France.
| | - Philippe Debourdeau
- Équipe Mobile Territoriale Soins Palliatifs, Hôpital Joseph-Imbert d'Arles, Arles, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Olivier Espitia
- Service de Médecine Interne et Vasculaire, Nantes Université, CHU de Nantes, Institut du thorax, Inserm UMR 1087, CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France
| | - Marie-Antoinette Sevestre
- Service de Médecine Vasculaire, EA Chimère 7516, CHU Amiens, 80054, Amiens, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Isabelle Mahé
- Service de Médecine Interne, Hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Olivier Sanchez
- Service de Pneumologie et de Soins Intensifs, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Étienne, France
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13
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le Sève JD, Guédon AF, Bordenave S, Agard C, Connault J, Pistorius MA, Quéreux G, Espitia O. Risk Factors of Venous Thromboembolic Disease in Cancer Patients Treated with Immune Checkpoint Inhibitor. Thromb Haemost 2023; 123:1049-1056. [PMID: 37257835 DOI: 10.1055/s-0043-1769609] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionized the management of cancers. The risk factors and pathophysiological mechanisms of venous thromboembolic events (VTEs) of this new therapeutic class are still to be specified. METHODS The included patients had to have cancer and should be treated with ICI. Data analyzed included demographic data, biological data, and immune-related adverse events (IRAEs). We studied the prevalence of VTEs and the factors associated with VTEs. RESULTS Of 374 patients on ICI, over a median follow-up period of 15.2 months, the number of VTE was 50 (13.4%). The majority of patients were treated for metastatic melanoma or nonsmall cell lung cancer. There was no difference in prevalence or survival between cancer types. Patients with combined therapy composed of nivolumab and ipilimumab had higher 1-year cumulative VTE occurrence (29.3% [95% confidence interval [CI]: 9.7; 44.6]) than patients with pembrolizumab (14.9%, [95%CI: 2.5; 25.8], p = 0.03) or nivolumab (9.1%, [95% CI: 5.0; 12.9], p < 0.01). The presence of IRAE was associated with a higher risk of VTE occurrence compared with patients without any IRAE (1-year VTE cumulative incidence: 17.42% [95% CI: 9.5; 24.65] vs. 9.46% [95% CI: 5.18; 13.55], p = 0.04). There was a higher risk of VTE in patients treated with the combination of nivolumab and ipilimumab (adjusted subdistribution hazard ratio [SHR]: 3.71 [95% CI: 1.74; 7.90], p < 0.001) and in patients with IRAE (adjusted SHR: 2.14 [95% CI: 1.22; 3.75], p < 0.01). CONCLUSION The prevalence of VTE was 14.2% under ICIs. IRAE and combine treatment of nivolumab and ipilimumab were associated with VTE. The pathophysiological mechanisms are multiple and complex with a possible link to aberrant activation of the immune system.
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Affiliation(s)
- Julien Denis le Sève
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | - Alexis F Guédon
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | - Stéphanie Bordenave
- Nantes Université, CHU Nantes, Department of Thoracic Oncology, Nantes, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | - Jérôme Connault
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | - Marc-Antoine Pistorius
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | - Gaelle Quéreux
- Nantes Université, CHU Nantes, Department of Dermatology, Nantes, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
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14
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Espitia O, Bruneval P, Assaraf M, Pouchot J, Liozon E, de Boysson H, Gaudric J, Chiche L, Achouh P, Roussel JC, Miranda S, Mirault T, Boussouar S, Redheuil A, Serfaty JM, Bénichou A, Agard C, Guédon AF, Cacoub P, Paraf F, Fouret PJ, Toquet C, Biard L, Saadoun D. Long-Term Outcome and Prognosis of Noninfectious Thoracic Aortitis. J Am Coll Cardiol 2023; 82:1053-1064. [PMID: 37673506 DOI: 10.1016/j.jacc.2023.06.031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known. OBJECTIVES The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis. METHODS This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis. RESULTS Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died. CONCLUSIONS This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France.
| | - Patrick Bruneval
- Department of cardiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Morgane Assaraf
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jacques Pouchot
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Liozon
- Department of Internal Medicine, CHU Limoges, France
| | | | - Julien Gaudric
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Paul Achouh
- Department of Cardiothoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Christian Roussel
- Department of Cardiothoracic Surgery, Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | | | - Tristan Mirault
- Université Paris Cité, Department of Vascular Medicine, Hôpital Européen Georges Pompidou, APHP, INSERM U970 PARCC, Paris, France
| | - Samia Boussouar
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Alban Redheuil
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Jean-Michel Serfaty
- Nantes Université, CHU Nantes, Department of Cardiovascular Imaging, Nantes, France
| | - Antoine Bénichou
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Alexis F Guédon
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Patrice Cacoub
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Pierre-Jean Fouret
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Service d'anatomopathologie, UPMC-Paris VI, Paris, France
| | - Claire Toquet
- Nantes Université, CHU Nantes, Department of Pathology, Nantes, France
| | - Lucie Biard
- APHP Department of Biostatistics and Medical Information, Saint-Louis Hospital, Paris, France; ECSTRRA Team, CRESS UMR 1153, INSERM, Paris Cité University, Paris, France
| | - David Saadoun
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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15
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Guilhem A, Dupuis-Girod S, Espitia O, Rivière S, Seguier J, Kerjouan M, Lavigne C, Maillard H, Magro P, Alric L, Lipsker D, Parrot A, Leguy V, Vanlemmens C, Guibaud L, Vikkula M, Eyries M, Valette PJ, Giraud S. Seven cases of hereditary haemorrhagic telangiectasia-like hepatic vascular abnormalities associated with EPHB4 pathogenic variants. J Med Genet 2023; 60:905-909. [PMID: 36813543 DOI: 10.1136/jmg-2022-109107] [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] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND EPHB4 loss of function is associated with type 2 capillary malformation-arteriovenous malformation syndrome, an autosomal dominant vascular disorder. The phenotype partially overlaps with hereditary haemorrhagic telangiectasia (HHT) due to epistaxis, telangiectases and cerebral arteriovenous malformations, but a similar liver involvement has never been described. METHODS Members of the French HHT network reported their cases of EPHB4 mutation identified after an initial suspicion of HHT. Clinical, radiological and genetic characteristics were analysed. RESULTS Among 21 patients with EPHB4, 15 had a liver imaging, including 7 with HHT-like abnormalities (2 female patients and 5 male patients, ages 43-69 years). Atypical epistaxis and telangiectases were noted in two cases each. They were significantly older than the eight patients with normal imaging (median: 51 vs 20 years, p<0.0006).The main hepatic artery was dilated in all the cases (diameter: 8-11 mm). Six patients had hepatic telangiectases. All kind of shunts were described (arteriosystemic: five patients, arterioportal: two patients, portosystemic: three patients). The overall liver appearance was considered as typical of HHT in six cases.Six EPHB4 variants were classified as pathogenic and one as likely pathogenic, with no specific hot spot. CONCLUSION EPHB4 loss-of-function variants can be associated with HHT-like hepatic abnormalities and should be tested for atypical HHT presentations.
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Affiliation(s)
- Alexandre Guilhem
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
| | - Sophie Dupuis-Girod
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
- Laboratory Biology of Cancer and Infection, CEA de Grenoble, Grenoble, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Sophie Rivière
- Médecine Interne et Maladies Multi-Organiques, CHU Montpellier, Montpellier, France
| | - Julie Seguier
- Département de Médecine Interne, Hôpital de la Timone, Marseille, France
| | | | | | - Hélène Maillard
- Service de Médecine Interne et Immunologie Clinique, CHU Lille, Lille, France
| | - Pascal Magro
- Service de Pneumologie, Hôpital Bretonneau, Tours, France
| | - Laurent Alric
- Médecine Interne, Département des Maladies Digestives, CHU Toulouse, Toulouse, France
| | - Dan Lipsker
- Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Vanessa Leguy
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - Claire Vanlemmens
- Service Hépatologie et soins intensifs digestifs, CHU Besancon, Besancon, France
| | - Laurent Guibaud
- Service d'Imagerie Médicale Pédiatrique et Foetale, CHU Lyon, Lyon, France
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Bruxelles, Belgium
| | - Melanie Eyries
- Genetics, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Paris, France
| | | | - Sophie Giraud
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
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Núñez Fernández MJ, Padín Paz EM, Vázquez Temprano N, Nieto Rodríguez JA, Marchena Yglesias PJ, Imbalzano E, Montenegro AC, Fernández Jiménez B, Rivera A, Espitia O, Monreal M. Risk for recurrence of symptomatic upper-extremity deep vein thrombosis in patients without cancer: Analysis of three RIETE cohorts. Vasc Med 2023; 28:324-330. [PMID: 37272085 DOI: 10.1177/1358863x231175185] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied. METHODS We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT. RESULTS As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98-10.6). CONCLUSIONS Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation.
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Affiliation(s)
- Manuel J Núñez Fernández
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Emilio M Padín Paz
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Nuria Vázquez Temprano
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - José A Nieto Rodríguez
- Department of Internal Medicine, Hospital General Virgen de la Luz, Cuenca, Castilla-La Mancha, Spain
| | - Pablo J Marchena Yglesias
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, A.O.U Policlinico 'G. Martino', Messina, Italy
| | - Ana Cristina Montenegro
- Department of Vascular Medicine, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Alberto Rivera
- Department of Internal Medicine, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Olivier Espitia
- Centre Hospitalier Universitaire de Nantes, Service de Médecine Interne, Nantes, Pays de la Loire, France
| | - Manuel Monreal
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Renaud A, Jirka A, Durant C, Connault J, Espitia O, Takoudju C, Agard C. [Gastrointestinal tract involvement in systemic sclerosis]. Rev Med Interne 2023; 44:410-422. [PMID: 37270380 DOI: 10.1016/j.revmed.2023.05.003] [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] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
Gastrointestinal tract involvement in systemic sclerosis concerns more than 90% of patients but is of heterogeneous clinical expression. It can involve the entire intestinal tract and be responsible for multifactorial malnutrition, which is frequent in this disease. It is a major source of deterioration in the quality of life and can even be life-threatening. Management is complex and multidisciplinary, ranging from simple hygienic and dietary measures, to specialized endoscopic or surgical interventional procedures, also including medical treatments, particularly proton pump inhibitors and prokinetics, with potential side effects. Ongoing research for new diagnostic and therapeutic tools promises to improve the management and prognosis of these patients.
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Affiliation(s)
- A Renaud
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - A Jirka
- Service d'hépato-gastro-entérologie, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - C Durant
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Connault
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - O Espitia
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - C Takoudju
- Service d'hépato-gastro-entérologie, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - C Agard
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Mekinian A, Biard L, Lorenzo D, Novikov PI, Salvarani C, Espitia O, Sciascia S, Michaud M, Lambert M, Hernández-Rodríguez J, Schleinitz N, Awisat A, Puechal X, Aouba A, Munoz Pons H, Smitienko I, Gaultier JB, Edwige LM, Benhamou Y, Perlat A, Jego P, Goulenok T, Sacre K, Lioger B, Hassold N, Broner J, Dufrost V, Sené T, Seguier J, Maurier F, Berthier S, Belot A, Frikha F, Denis G, Audemard-Verger A, Koné-Paut I, Humbert S, Woaye-Hune P, Tomelleri A, Baldissera EM, Kuwana M, Logullo A, Mukuchyan V, Dellal A, Gaches F, Zeminsky P, Galli E, Alvarado M, Boiardi L, Francesco M, Vautier M, Corrado C, Moiseev S, Vieira M, Cacoub P, Fain O, Saadoun D. Intravenous versus subcutaneous tocilizumab in Takayasu arteritis: multicentre retrospective study. RMD Open 2023; 9:e002830. [PMID: 37321669 DOI: 10.1136/rmdopen-2022-002830] [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: 10/30/2022] [Accepted: 02/02/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES In this large multicentre study, we compared the effectiveness and safety of tocilizumab intravenous versus subcutaneous (SC) in 109 Takayasu arteritis (TAK) patients. METHODS We conducted a retrospective multicentre study in referral centres from France, Italy, Spain, Armenia, Israel, Japan, Tunisia and Russia regarding biological-targeted therapies in TAK, since January 2017 to September 2019. RESULTS A total of 109 TAK patients received at least 3 months tocilizumab therapy and were included in this study. Among them, 91 and 18 patients received intravenous and SC tocilizumab, respectively. A complete response (NIH <2 with less than 7.5 mg/day of prednisone) at 6 months was evidenced in 69% of TAK patients, of whom 57 (70%) and 11 (69%) patients were on intravenous and SC tocilizumab, respectively (p=0.95). The factors associated with complete response to tocilizumab at 6 months in multivariate analysis, only age <30 years (OR 2.85, 95% CI 1.14 to 7.12; p=0.027) and time between TAK diagnosis and tocilizumab initiation (OR 1.18, 95% CI 1.02 to 1.36; p=0.034). During the median follow-up of 30.1 months (0.4; 105.8) and 10.8 (0.1; 46.4) (p<0.0001) in patients who received tocilizumab in intravenous and SC forms, respectively, the risk of relapse was significantly higher in TAK patients on SC tocilizumab (HR=2.55, 95% CI 1.08 to 6.02; p=0.033). The overall cumulative incidence of relapse at 12 months in TAK patients was at 13.7% (95% CI 7.6% to 21.5%), with 10.3% (95% CI 4.8% to 18.4%) for those on intravenous tocilizumab vs 30.9% (95% CI 10.5% to 54.2%) for patients receiving SC tocilizumab. Adverse events occurred in 14 (15%) patients on intravenous route and in 2 (11%) on SC tocilizumab. CONCLUSION In this study, we confirm that tocilizumab is effective in TAK, with complete remission being achieving by 70% of disease-modifying antirheumatic drugs-refractory TAK patients at 6 months.
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Affiliation(s)
- Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France, French Armenian research center, Erevan, Armenia
| | - Lucie Biard
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Dagna Lorenzo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pavel I Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Carlo Salvarani
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Olivier Espitia
- Department of internal and vascular medicine, Nantes Université, CHU Nantes, F-44000 Nantes, France
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Martin Michaud
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Marc Lambert
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, Lille, France
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Abid Awisat
- Rheumatology Unit, Bnei Zion Hospital, Haifa, Israel
| | - Xavier Puechal
- Université Paris Descartes, Paris, France ; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, 27 rue du Faubourg Saint-Jacques, Paris, France
| | - Achille Aouba
- Département de médecine interne, CHU Caen, Caen, France
| | - Helene Munoz Pons
- Département de médecine interne, CHU Saint Etienne, Saint-Etienne, France
| | - Ilya Smitienko
- Rheumatology Department, Medical Center K-31, Moscow, Russian Federation
| | - Jean Baptiste Gaultier
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier universitaire de St Etienne, Saint Etienne, France
| | - Le Mouel Edwige
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Ygal Benhamou
- Service de médecine interne, Université Rouen, CHU de Rouen, Rouen, France
| | - Antoinette Perlat
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Patrick Jego
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France
| | | | - Nolan Hassold
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay, Paris, France
| | | | - Virginie Dufrost
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Nancy, France
| | - Thomas Sené
- Service de médecine interne, Rothschild, Paris, France
| | - Julie Seguier
- Département de médecine interne, CHU de La Timone, Marseille, France
| | - Francois Maurier
- Service de Médecine Interne et Immunologie Clinique Groupe Hospitalier UNEOS, Vantoux, France
| | - Sabine Berthier
- Service de médecine interne et immunologie clinique, Université Dijon, Hôpital Dijon, Dijon, France
| | - Alexandre Belot
- Service de pédiatrie et immunologie clinique, Université Lyon, Hôpital Lyon, Lyon, France
| | - Faten Frikha
- Service de Médecine interne CHU Hédi Chaker, Route El Ain 3029 Sfax -Faculté de Médecine de Sfax, Sfax, Tunisia
| | - Guillaume Denis
- Service de médecine et d'hématologie, Hopital Rochefort, Rochefort, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, University of Tours, Tours, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay, Paris, France
| | - Sebastien Humbert
- Service de médecine interne et immunologie clinique, Hôpital Besancon, Besancon, France
| | | | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Marina Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Alberto Logullo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Ospedale Piemonte, Messina, Italy
| | - Vahan Mukuchyan
- Department of Internal Medicine and Rheumatology, Nairi hospital, Erevan, Armenia
| | - Azeddine Dellal
- Service de rhumatologie, Hôpital Montfermeil, GHI Le Raincy Montfermeil, Montfermeil, France
| | - Francis Gaches
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Pierre Zeminsky
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Nancy, France
| | - Elena Galli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Moya Alvarado
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Boiardi
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Muratore Francesco
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Mathieu Vautier
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Campochiaro Corrado
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Matheus Vieira
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
| | - Patrice Cacoub
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France, French Armenian research center, Erevan, Armenia
| | - David Saadoun
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
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Lapébie FX, Bura-Rivière A, Espitia O, Bongard V, Ciammaichella MM, Martínez JG, Sigüenza P, Giménez JC, Bertoletti L, Monreal M. Predictors of recurrence of cancer-associated venous thromboembolism after discontinuation of anticoagulant therapy: a multicenter cohort study. J Thromb Haemost 2023:S1538-7836(23)00325-2. [PMID: 37068594 DOI: 10.1016/j.jtha.2023.04.010] [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] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Data on recurrence after the end of anticoagulant for a first cancer-associated venous thromboembolism (VTE) are scarce. OBJECTIVES Our aim was to assess predictors of VTE recurrence during a one-year follow-up. PATIENTS/METHODS It is an analysis of RIETE, an international, multicenter, prospective cohort study of patients diagnosed with VTE. Patients had to have an active cancer at the time of VTE and have withdrawn, anticoagulation after 3 months full treatment. Analyses were performed using Fine and Gray models with death as a competing risk, and a multiple imputation of missing data by chained equations. RESULTS Among 14,318 patients with cancer-associated VTE, 3,414 had received a time-limited anticoagulation of at least 3 months. The cumulative incidence function for recurrent VTE was 10.2% (95%CI, 9.1-11.5) at 1-year. Chronic kidney disease (subhazard ratio [sHR] 0.99 for 1 mL/min increase of glomerular filtration rate, 95%CI, 0.99-1.00), cancer of lung, brain, stomach, oesophagus, liver or ovary (sHR 3.56, 95%CI, 1.07-11.80, compared with cancer of oropharynx, larynx or melanoma), cancer of pancreas, biliary tract or unknown origin (sHR 6.86, 95%CI, 1.89-24.85), inferior vena cava filter (sHR 3.16, 95%CI, 1.75-5.71), post-thrombotic syndrome (sHR 2.09, 95%CI, 1.06-4.15), and residual pulmonary thrombotic obstruction (sHR 2.58, 95%CI, 1.38-4.82) were predictive of recurrence. Surgery during the 2 months before VTE was predictive of the absence of recurrence (sHR 0.60, 95%CI, 0.40-0.92). CONCLUSION One year after anticoagulant cessation for a cancer-associated VTE, about 10% of patients experienced a recurrence. Discontinuing anticoagulant therapy seems safe mainly in surgery-associated VTE.
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Affiliation(s)
- François-Xavier Lapébie
- Department of Vascular Medicine, Toulouse University Hospital, Toulouse, France; UMR 1295 INSERM, CERPOP, Toulouse III - Paul Sabatier University, Toulouse, France.
| | - Alessandra Bura-Rivière
- Department of Vascular Medicine, Toulouse University Hospital, Toulouse, France; UMR 1031 INSERM, StromaLab, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Olivier Espitia
- Department of Internal Medicine and Vascular Medicine, Nantes University Hospital, Nantes, France
| | - Vanina Bongard
- UMR 1295 INSERM, CERPOP, Toulouse III - Paul Sabatier University, Toulouse, France; Department of Epidemiology, Toulouse University Hospital, Toulouse, France; Federation of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - José González Martínez
- Department of Internal Medicine, Hospital Universitari Sant Joan de Déu, Fundació Althaia, Manresa, Barcelona, Spain
| | - Patricia Sigüenza
- Department of Internal Medicine, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Joaquín Castro Giménez
- Department of Internal Medicine, Hospital Santa Bárbara, Puertollano, Ciudad Real, Spain
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, Saint-Etienne University Hospital, Saint-Etienne, France; CIC 1408 INSERM, Saint-Etienne University Hospital, Saint-Etienne, France; UMR 1059 INSERM, SAINBIOSE, Jean Monnet University, Saint-Etienne, France
| | - Manuel Monreal
- Department of Internal Medicine, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain
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20
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Genin V, Alexandra JF, de Boysson H, Sailler L, Samson M, Granel B, Sacre K, Quéméneur T, Rousselin C, Urbanski G, Magnant J, Devauchelle-Pensec V, Queyrel-Moranne V, Martin M, Héron E, Daumas A, de Pinho QG, Jamet B, Serfaty JM, Agard C, Espitia O. Prognostic factors in giant cell arteritis associated aortitis with PET/CT and CT angiography at diagnosis. Semin Arthritis Rheum 2023; 59:152172. [PMID: 36801668 DOI: 10.1016/j.semarthrit.2023.152172] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Prognosis data on giant-cell arteritis (GCA)-associated aortitis are scarce and heterogeneous. The aim of this study was to compare the relapses of patients with GCA-associated aortitis according to the presence of aortitis on CT-angiography (CTA) and/or on FDG-PET/CT. METHODS This multicenter study included GCA patients with aortitis at diagnosis; each case underwent both CTA and FDG-PET/CT at diagnosis. A centralized review of image was performed and identified patients with both CTA and FDG-PET/CT positive for aortitis (Ao-CTA+/PET+); patients with positive FDG-PET/CT but negative CTA for aortitis (Ao-CTA-/PET+), and patients solely positive on CTA. RESULTS Eighty-two patients were included with 62 (77%) of female sex. Mean age was 67±8 years; 64 patients (78%) were in the Ao-CTA+/PET+ group; 17 (22%) in the Ao-CTA-/PET+ group and 1 had aortitis only on CTA. Overall, 51 (62%) patients had at least one relapse during follow-up: 45/64 (70%) in the Ao-CTA+/PET+ group and 5/17 (29%) in the Ao-CTA-/PET+ group (log rank, p = 0.019). In multivariate analysis, aortitis on CTA (Hazard Ratio 2.90, p = 0.03) was associated with an increased risk of relapse. CONCLUSION Positivity of both CTA and FDG-PET/CT for GCA-related aortitis was associated with an increased risk of relapse. Aortic wall thickening on CTA was a risk factor of relapse compared with isolated aortic wall FDG uptake.
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Affiliation(s)
- Victor Genin
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, F-44000 Nantes, France
| | | | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Laurent Sailler
- Department of Internal Medicine, University Hospital of Toulouse, Toulouse, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital, Dijon, France
| | - Brigitte Granel
- Department of Internal Medicine, University Hospital of Marseille, Marseille, France
| | - Karim Sacre
- Department of Internal Medicine, Bichat Hospital, Paris, France
| | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, Hospital of Valenciennes, Valenciennes, France
| | - Clémentine Rousselin
- Department of Nephrology and Internal Medicine, Hospital of Valenciennes, Valenciennes, France
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Julie Magnant
- Department of Internal Medicine, CHRU Tours, Tours, France
| | | | | | - Mickaël Martin
- Department of Internal Medicine and Infectious Diseases, CHU Poitiers, Poitiers, France
| | - Emmanuel Héron
- Department of Internal Medicine, Hospital Quinze-Vingts, Internal Medicine, Paris, France
| | - Aurélie Daumas
- Department of Internal Medicine, University Hospital of Marseille, Marseille, France
| | | | - Bastien Jamet
- Nantes Université, CHU Nantes, Department of nuclear medicine, F-44000 Nantes, France
| | - Jean-Michel Serfaty
- Nantes Université, CHU Nantes, Department of cardiovascular imaging, F-44000 Nantes, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, F-44000 Nantes, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, F-44000 Nantes, France.
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Espitia O, Douane F, Hersant J, Abbadie F, Sobocinski J, Heautot JF, Miossec A, Lapébie FX, Hartung O. Predictive Factors of Stent Patency in Iliofemoral Venous Diseases in a Multicentre Cohort Study. Eur J Vasc Endovasc Surg 2023; 65:564-572. [PMID: 36642400 DOI: 10.1016/j.ejvs.2023.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/08/2022] [Revised: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study assessed primary stent patency predictive factors in three groups of patients with history of lower limb (LL) vein thrombosis: non-thrombotic iliac vein lesion (NIVL), acute deep vein thrombosis (aDVT), and post-thrombotic syndrome (PTS). METHODS Consecutive patients from January 2014 to December 2020 with history of LL vein stenting from seven hospitals were included. All patients received an iliac or common femoral venous stent and had at least a six month follow up available with stent imaging. Anticoagulant and antiplatelet therapy strategies employed after venous stenting are reported and compared between groups. RESULTS This study included 377 patients: 134 NIVL, 55 aDVT, and 188 PTS. Primary patency was statistically significantly higher in the NIVL group (99.3%) compared with the PTS group (68.6%) (p < .001) and the aDVT group (83.6%) (p = .002). PTS patients received a statistically significantly greater number of stents (p < .001) and had more stents below the inguinal ligament (p < .001). Median follow up was 28.8 months (IQR 16, 47). Discontinuation of antiplatelet therapy at the last assessment was 83.6% for NIVL, 100% for aDVT, and 95.7% for the PTS group (p < .001). Discontinuation of anticoagulation therapy at the last assessment was 93.2% for NIVL, 25.0% for aDVT, and 70.3% for the PTS group (p < .001). The only predictor of worse primary patency in the aDVT group was long term anticoagulation before stenting. CONCLUSION Patients with NIVL have better primary patency after venous stenting than patients with venous thrombotic disorders. Long term anticoagulation before stenting was the only factor associated with poorer primary patency in patients with aDVT.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France.
| | - Frédéric Douane
- Nantes Université, CHU Nantes, Department of Radiology, Nantes, France
| | | | | | | | | | - Annaïg Miossec
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
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F Guédon A, Bourgade R, Elhannani M, Toquet C, Espitia O, Fain O, Mekinian A. [Takayasu's arteritis]. Rev Prat 2023; 73:400-405. [PMID: 37289153] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
TAKAYASU'S ARTERITIS. Takayasu's arteritis is an inflammatory panarteritis of the large vessels, preferentially affecting the aorta, its main branches, and the pulmonary arteries. Its incidence is estimated at 1.11 cases per million person-years, with a female predominance. The disease is classically characterized by the succession of two phases: a pre-occlusive inflammatory phase that may go unnoticed and an occlusive phase characterized by ischemic vascular symptoms because of parietal arterial lesions such as stenosis, occlusion or aneurysm. The diagnosis is based on clinical, biological and morphological findings. When available, pathological examination reveals a predominantly medial-adventitial, segmental and focal granulomatous panarteritis. Treatment consists of administering corticosteroid therapy and often immunosuppressants, or even biotherapies, managing cardiovascular risk factors, and managing vascular complications.
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Affiliation(s)
- Alexis F Guédon
- Sorbonne université, service de médecine interne, et Inflammation- Immunopathology Biotherapy Department (DMU 3iD), hôpital Saint-Antoine, AP-HP, Paris, France
| | - Raphaël Bourgade
- Service d'anatomie et cytologie pathologiques, CHU de Nantes, Nantes, France
| | - Mounia Elhannani
- Service d'anatomie et cytologie pathologiques, CHU de Nantes, Nantes, France
| | - Claire Toquet
- Service d'anatomie et cytologie pathologiques, CHU de Nantes, Nantes, France. Institut du thorax, UMR 1087, CNRS, université de Nantes, CHU de Nantes, Nantes, France
| | - Olivier Espitia
- Service de médecine interne et médecine vasculaire, CHU de Nantes, Nantes, France
| | - Olivier Fain
- Sorbonne université, service de médecine interne, et Inflammation- Immunopathology Biotherapy Department (DMU 3iD), hôpital Saint-Antoine, AP-HP, Paris, France
| | - Arsène Mekinian
- Sorbonne université, service de médecine interne, et Inflammation- Immunopathology Biotherapy Department (DMU 3iD), hôpital Saint-Antoine, AP-HP, Paris, France
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Parreau S, Espitia O, Bold MS, Frota Lima LM, Lades G, Bois M, Assaraf M, Saadoun D, Koster MJ, Ly KH, Weyand CM, Warrington KJ, Liozon E. Relationship between histopathological features of non-infectious aortitis and the results of pre-operative 18F-FDG-PET/CT: a retrospective study of 16 patients. Clin Exp Rheumatol 2023; 41:916-921. [PMID: 36762741 DOI: 10.55563/clinexprheumatol/5mevq4] [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: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To describe the characteristics of 18F-fluorodeoxyglucose positron-emission tomography/computed-tomography (18FDG-PET/CT) findings before surgery in patients with active, histologically confirmed aortitis, and to correlate the degree of arterial wall inflammation with PETVAS score. METHODS This was a multiple-centre retrospective study including cases with histologically proven active, non-infectious aortitis who had a 18FDG-PET/CT performed within one year before surgery for aneurysm repair. PETVAS score was determined by radiologists blinded to the pathology findings. Cardiovascular pathologists reviewed aortic tissue samples and graded the degree of inflammation in the vessel wall. RESULTS Sixteen patients were included (8 giant cell arteritis, 4 clinically isolated aortitis, 2 Takayasu's arteritis, 1 relapsing polychondritis, and 1 rheumatoid arthritis). In 5/16 (31%) patients, 18FDG-PET/CT did not detect the presence of aortic inflammation; two of whom were being treated with glucocorticoids at the time of procedure. Ascending thoracic and abdominal aorta had the highest FDG uptake among the affected territories. Patients without active aortitis on 18FDG-PET/CT were significantly older (p=0.027), had a lower PETVAS score (p=0.007), and had a lower degree of adventitial inflammation (p=0.035). In contrast, there was no difference between 18FDG-PET/CT active and inactive aortitis patients as regards the timing between PET/CT and surgery, serum CRP level (during 18FDG-PET/CT) and, FDG uptake per study site. CONCLUSIONS In histologically proved aortitis, 18FDG-PET/CT before surgery did not detect vascular inflammation in 31% patients, and PETVAS score correlated with the degree of adventitial histopathologic inflammation.
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Affiliation(s)
- Simon Parreau
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA, and Department of Internal Medicine, Dupuytren Hospital, Limoges, France.
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | - Michael S Bold
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Guillaume Lades
- Department of Nuclear Medicine, Dupuytren Hospital, Limoges, France
| | - Mélanie Bois
- Department of Pathology, Mayo Clinic, Rochester, MN, USA
| | - Morgane Assaraf
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - David Saadoun
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | | | - Kim-Heang Ly
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France
| | | | | | - Eric Liozon
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France
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Suleiman M, Costedoat-Chalumeau N, Le Guern V, Morel N, Amoura Z, Espitia O, Martis N, Jeandel P, Audia S, Cormarmond C, Sève P, Sene D, Gerfaud-Valentin M, Goutte J, Lavigne C, Thomas G, Bourgarit A, Roblot P, Puyade M, Martin M. Syndrome des antiphospholipides et atteinte surrénalienne : étude cas-témoin nationale multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.060] [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: 12/12/2022]
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Parreau S, Espitia O, Bold M, Frota Lima L, Lades G, Bois M, Assaraf M, Saadoun D, Koster M, Ly K, Weyand C, Warrington K, Liozon E. Aortites prouvées histologiquement et 18F-FDG-PET/CT réalisée avant chirurgie. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.115] [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: 12/12/2022]
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Espitia O, Robin O, Hersant J, Roncato C, Théry A, Vibet MA, Gautier G, Raimbeau A, Lapébie FX. Inter and intra-observer agreement of arterial wall contrast-enhanced ultrasonography in giant cell arteritis. Front Med (Lausanne) 2022; 9:1042366. [DOI: 10.3389/fmed.2022.1042366] [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: 09/12/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
ObjectiveThe aim of this study was to analyze inter- and intra-observer agreement for contrast-enhanced ultrasonography (CEUS) for monitoring disease activity in Giant Cell Arteritis (GCA) in the wall of axillary arteries, and common carotid arteries.MethodsGiant cell arteritis patients have CEUS of axillary arteries and common carotid. These images were rated by seven vascular medicine physicians from four hospitals who were experienced in duplex ultrasonography of GCA patients. Two weeks later, observers again rated the same images. GCA patients were recruited in from December 2019 to February 2021. An analysis of the contrast of the ultrasound images with a gradation in three classes (grade 0, 1, and 2) was performed. Grade 0 corresponds to no contrast, grade 1 to moderate wall contrast and grade 2 to intense contrast. A new analysis in 2 classes: positive or negative wall contrast; was then performed on new series of images.ResultsSixty arterial segments were evaluated in 30 patients. For the three-class scale, intra-rater agreement was substantial: κ 0.70; inter-rater agreement was fair: κ from 0.22 to 0.27. Thirty-four videos had a wall thickness of less than 2 mm and 26 videos had a wall thickness greater than 2 mm. For walls with a thickness lower than 2 mm: intra-rater agreement was substantial: κ 0.69; inter-rater agreement was fair: κ 0.35. For walls with a thickness of 2 mm or more: intra-rater agreement was substantial: κ 0.53; inter-rater agreement was fair: κ 0.25. For analysis of parietal contrast uptake in two classes: inter-rater agreement was fair to moderate: κ from 0.35 to 0.41; and for walls with a thickness of 2 mm or more: inter-rater agreement was fair to substantial κ from 0.22 to 0.63.ConclusionThe visual analysis of contrast uptake in the wall of the axillary and common carotid arteries showed good intra-rater agreement in GCA patients. The inter-rater agreement was low, especially when contrast was analyzed in three classes. The inter-rater agreement for the analysis in two classes was also low. The inter-rater agreement was higher in two-class analysis for walls of 2 mm thickness or more.
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Masson C, An Nguyen TT, Dufrost V, Audrain M, Hémont C, Agard C, Artifoni M, Connault J, Fouassier M, Hamidou M, Guedon AF, Wahl D, Zuily S, Espitia O. Antiphospholipid syndrome in patients over 65 years: A comparative study of clinical and biological features and thrombotic relapses. Lupus 2022; 31:1816-1823. [PMID: 36177950 DOI: 10.1177/09612033221130975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the study was to describe clinical and biological characteristics and thrombotic relapses of patients diagnosed with antiphospholipid syndrome (APS) after the age of 65 years, in comparison with patients diagnosed with APS before 65. METHODS This retrospective multicenter study was performed to 2005 from 2017 and included patients diagnosed with APS after the age of 65 years, in accordance with Sydney criteria. We compared these patients with APS patients diagnosed before the age of 65 years, and with control thrombotic patients older than 65 years. RESULTS Fifty-eight APS patients over the age of 65 years were compared to 127 APS patients aged less than 65 and to 58 controls. In elderly APS versus younger APS, there was a male predominance (58.6% vs 36.2% p = .001); myocardial infarction and lower limb deep vein thrombosis (LLDVT) were more frequent in elderly, respectively, 12.1% versus 1.6% (p = .005), and 44.8% versus 29.9% (p = .048). Anticardiolipin antibody (aCL) IgM was more frequently found in old patients compared to younger patients (33.9% vs 18.1%, p = .02), contrary to lupus anticoagulant (LAC) (52.8% vs 66.9%, p = .02). Older patients were more often diagnosed with single positive APS (82.8% vs 59.8% p = .002). The thrombotic relapse free survival was lower in elderly APS patients (p = .044) compared to younger APS. Elderly APS patients had more recurrent arterial and venous thrombosis (p = .03) and had poorer overall survival (p = .004) than elderly controls. CONCLUSION In this study, APS was different in patients aged more than 65 years, with a male predominance and more myocardial infarctions and LLDVT at diagnosis. Single antiphopholipid positivity and aCL IgM were more frequent in older patients. Older patient with APS had more thrombotic recurrence during follow-up. Compared to elderly controls, elderly APS patients had more thrombosis recurrences and poorer survival.
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Affiliation(s)
- Colombe Masson
- Department of Internal and Vascular Medicine, 26922CHU de Nantes, France
| | - Thi T An Nguyen
- 26907INSERM UMR-S1140 Innovations Thérapeutiques en Hémostase, Paris, France
| | | | - Marie Audrain
- Department of Immunology, 26922CHU de Nantes, France
| | | | - Christian Agard
- Department of Internal and Vascular Medicine, 26922CHU de Nantes, France.,Nantes Université
| | - Mathieu Artifoni
- Department of Internal and Vascular Medicine, 26922CHU de Nantes, France
| | - Jérôme Connault
- Department of Internal and Vascular Medicine, 26922CHU de Nantes, France
| | | | - Mohamed Hamidou
- Department of Internal and Vascular Medicine, 26922CHU de Nantes, France
| | - Alexis F Guedon
- Department of Internal and Vascular Medicine, 26922CHU de Nantes, France
| | - Denis Wahl
- Department of Vascular Medicine, 26920CHRU de Nancy, France
| | - Stéphane Zuily
- Department of Vascular Medicine, 26920CHRU de Nancy, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, 26922CHU de Nantes, France.,Nantes Université
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Le TTT, Martinent G, Dupuis-Girod S, Parrot A, Contis A, Riviere S, Chinet T, Grobost V, Espitia O, Dussardier-Gilbert B, Alric L, Armengol G, Maillard H, Leguy-Seguin V, Leroy S, Rondeau-Lutz M, Lavigne C, Mohamed S, Chaussavoine L, Magro P, Seguier J, Kerjouan M, Fourdrinoy S. Development and validation of a quality of life measurement scale specific to hereditary hemorrhagic telangiectasia: the QoL-HHT. Orphanet J Rare Dis 2022; 17:281. [PMID: 35854330 PMCID: PMC9295423 DOI: 10.1186/s13023-022-02426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) disease is a rare genetic disorder with symptoms and complications that can significantly affect patients’ daily lives. To date, no scale has been validated to assess the specific symptoms of this disease on the quality of life (QOL) of HHT patients. This makes it difficult for clinicians to accurately measure the quality of life of patients with HHT. The present study aims to develop and validate a QOL measurement tool specific to HHT disease: the QOL questionnaire in HHT (QoL-HHT). Methods A quantitative, non-interventional, multi-center study involving HHT patients in twenty French HHT expert centers was conducted. A calibration sample of 415 HHT patients and a validation sample of 228 HHT patients voluntarily participated in the study. Data were analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Exploratory Structural Equation Modeling (ESEM) analyses, reliability analyses, and correlational analyses. Results The EFA, CFA and ESEM results allowed us to provide evidence of the factorial structure of a questionnaire composed of 24 items measuring 6 domains of QOL: Physical limitations, social relationships, concern about bleeding, relationship with the medical profession, experience of symptoms, and concern about the evolution of the disease. Cronbach’s alpha coefficients (> 0.70) demonstrated reliable internal consistency of all the QoL-HHT scores (dimensions). The results of the test–retest provided further evidence of the reliability of the QOL-HHT scores over time. Correlational analyses provided evidence for the convergent validity of the QoL-HHT scores. Conclusions We developed a simple and quick self-assessment tool to measure quality of life specific to HHT disease. This study demonstrated reliability and validity of our QoL-HHT scores. It is a very promising tool to evaluate the impact of HHT disease on all aspects of the quality of life of HHT patients in order to offer them individualized medico-psycho-social support. Trial registration: ClinicalTrials, NCT03695874. Registered 04 October 2018, https://www.clinicaltrials.gov/ct2/show/NCT03695874 Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02426-2.
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Affiliation(s)
- Thi Thao Truc Le
- Laboratoire de Psychologie sur les Dynamiques Relationnelles et Processus Identitaires (EA 7458), Université de Bourgogne-Franche-Comté, 3 Allée des Stades Universitaires, 21000, Dijon, France
| | - Guillaume Martinent
- Laboratoire sur les Vulnérabilités et l'Innovation dans le Sport (EA 7428), Université de Lyon, Université Claude Bernard Lyon 1, 27-29 bd du 11 Novembre 1918, 69622, Villeurbanne, France
| | - Sophie Dupuis-Girod
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France
| | - Antoine Parrot
- Service de pneumologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 rue de Chine, 75790, Paris Cedex 20, France
| | - Anne Contis
- Service de médecine interne, Hôpital Saint André, 1 rue Jean Burguet, 33000, Bordeaux, France
| | - Sophie Riviere
- Service de médecine interne, CHU de Montpellier Hôpital St Eloi, Avenue A. Fliche, 34295, Montpellier Cedex 5, France
| | - Thierry Chinet
- Consultation Maladie de Rendu-Osler, CHU Ambroise Paré, 9 av Charles de Gaulle, 92104, Boulogne Billancourt, France
| | - Vincent Grobost
- Service de médecine interne, CHU Estaing, 1 rue Lucie et Raymond Aubrac, 63100, Clermont-Ferrand, France
| | - Olivier Espitia
- Service de médecine interne - médecine vasculaire, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Laurent Alric
- Service de médecine interne, CHU Rangueil, 1 av du Pr Jean Poulhès, 31059, Toulouse Cedex 9, France
| | - Guillaume Armengol
- Service de médecine interne, CHU de Rouen Ch. Nicolle, , 1 rue de Germont, 76031, Rouen Cedex, France
| | - Hélène Maillard
- Service de médecine interne, Hôpital Huriez, 1 rue Michel Polonovski, 59037, LILLE Cedex, France
| | - Vanessa Leguy-Seguin
- Service de médecine interne, Hôpital Le Bocage, 2 Bd Maréchal de Lattre de Tassigny, BP 77908, 21079, Dijon Cedex, France
| | - Sylvie Leroy
- Service de pneumologie, CHU de Nice, 30 av de la Voie Romaine, 06002, Nice Cedex, France
| | - Murielle Rondeau-Lutz
- Service de médecine interne, CHU de Strasbourg Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Christian Lavigne
- Service de médecine interne, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex 09, France
| | - Shirine Mohamed
- Service de médecine interne, CHU de Nancy, Hôpital Brabois, Rue du Morvan, 54511, Vandoeuvre Les Nancy, France
| | - Laurent Chaussavoine
- Service de médecine vasculaire, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Pascal Magro
- Service de pneumologie, CHRU de Tours Hôpital Bretonneau, 2 bd Tonnellé, 37044, Tours Cedex 9, France
| | - Julie Seguier
- Service de médecine interne, Hôpital de La Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France
| | - Mallorie Kerjouan
- Service de pneumologie, CHU de Rennes Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 09, France
| | - Sylvie Fourdrinoy
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France.
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Crosnier C, Dufrost V, Audrain M, Hemont C, Agard C, Connault J, Artifoni M, Fouassier M, Hamidou M, Guédon A, Zuily S, Espitia O. Syndrome des antiphospholipides après 65 ans : étude comparative rétrospective des caractéristiques clinicobiologiques et des récidives thrombotiques. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.275] [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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Maillet F, Abitbol V, Allain J, Pérard L, Espitia O, Riviere E, Durel C, Guilpain P, Mouthon L, Cohen P, Melki I, De Moreuil C, Limal N, Mekinian A, Costedoat-Chalumeau N, Morel N, Harlé J, Raffray L, Boutemy J, Terrier B. Association entre vascularites des gros vaisseaux et maladies inflammatoires chroniques de l’intestin : description d’une cohorte rétrospective multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Génin V, Agard C, De Boysson H, Rousselin C, Alexandra J, Martin M, SamsoN M, Sailler L, Urbanski G, Granel B, Espitia O. Impact pronostique de l’épaississement pariétal aortique associé ou non à l’hypermétabolisme pariétal dans l’aortite associée à l’artérite à cellules géantes. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.325] [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: 11/30/2022]
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Gautier G, Douane F, David A, Perret C, Pistorius MA, Goueffic Y, Connault J, Artifoni M, Durant C, Ploton G, Raimbeau A, Bergere G, Robin O, Maurel B, Espitia O. Pharmaco-mechanical catheter-directed thrombolysis versus recanalization and stenting for post thrombotic syndrome after lower limb deep vein thrombosis: a comparative study. Quant Imaging Med Surg 2022; 12:1664-1673. [DOI: 10.21037/qims-21-572] [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] [Received: 05/29/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022]
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Herquelot E, Giudice CD, Espitia O, Hartung O, Sapoval M, Sobocinski J, Schmidt A. Utilisation des modèles à risques concurrents sur les données du Système national des données de santé (SNDS) : application pour l’étude du risque d'amputations dans l'ischémie aiguë des membres inférieurs. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Espitia O. [Catheter thrombosis and upper extremity thrombosis in oncology]. Rev Prat 2022; 72:277-280. [PMID: 35638951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Olivier Espitia
- "Service de médecine interne et vasculaire, Nantes université, CHU Nantes, France"
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Abstract
Background Behçet’s disease (BD) is a rare form of systemic vasculitis that affects small to large vessels. It is characterized by mucocutaneous, pulmonary, cardiovascular, gastrointestinal, and neurological manifestations. Large vessel involvement may occur in a third of cases. Veins are usually more affected than arteries. Furthermore aneurysms are the most frequent arterial complication. Case presentation A 41-year-old man presented with multiple arterial aneurysms. He had previous medical history of a right popliteal aneurysm treated with a reversed femoro-popliteal venous bypass, long-term steroids and immunosuppressive treatment. On admission, diagnostic computed tomography angiography revealed multiple aneurysms, including an 87 mm aneurysm of the femoro-popliteal bypass and an abdominal aortic and left common iliac artery aneurysm. He received an intensification of medical treatment with methylprednisolone and infliximab intravenous infusion. Aorto iliac artery aneurysms were treated by infrarenal bifurcated stent graft implantation. The aneurysm of the venous femoro-popliteal bypass was treated by explantation and prosthetic repair. One month later, he presented with acute right limb ischemia related to occlusion of the right limb of the stent graft despite anticoagulation which was treated by mechanical thrombectomy. Conclusions Vascular BD can worsen the vascular outcome after surgery. Except in an urgent context, BD must be controlled before surgery. This case report illustrates the importance of combined medical and surgical management, with first BD activity control with corticosteroids and immunosuppressive treatment, then surgical or endovascular treatment.
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Affiliation(s)
- Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | | | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
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Renaud A, Pautre R, Morla O, Achille A, Durant C, Espitia O, Frampas E, Agard C. Thoracic lymphadenopathies in diffuse systemic sclerosis: an observational study on 48 patients using computed tomography. BMC Pulm Med 2022; 22:44. [PMID: 35078448 PMCID: PMC8788097 DOI: 10.1186/s12890-022-01837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Thoracic multidetector computed tomography (MDCT) is essential for the detection of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). Thoracic MDCT assessment can reveal the presence of thoracic lymphadenopathies (LAP) whose signification remains uncertain. The purpose of the study was to describe the characteristics and to assess the significance of thoracic LAP in patients with diffuse SSc.
Methods
We conducted a monocentric observational study on adult patients with diffuse SSc, and collected general patient and first thoracic MDCT characteristics, PET-CT and outcome data. Comparisons were made between patients with and without thoracic LAP.
Results
Forty-eight patients were included. There were 30 patients (62.5%) with an ILD and 23 (48%) with at least one thoracic LAP on the first MDCT assessment. Median number per patient of thoracic LAP was 3 [1–8], with a mean size of 11.7 ± 1.7 mm, mainly located in right para-tracheal area (22.8% of the total number of LAP), right hilar area (20.3%), left hilar area (6.5%), and sub-carinal area (15.2%). PET-CT showed lymph node hypermetabolism in 11/15 patients (73.3%) with mean SUVmax at 4 ± 1.3. There were significantly more males (p = 0.002) and more patients exposed to silica (p = 0.001) in patients with thoracic LAP. ILD was significantly more extended according to Goh score (p = 0.03), and using semi-quantitative score for mixed ground-glass reticulation (p = 0.01) and global abnormalities (p = 0.03) in patients with thoracic LAP and ILD. Thirteen patients (27.1%) died during follow-up without significant difference according to the presence or not of thoracic LAP (p = 0.15). There was also no significant difference concerning immunosuppressive treatment initiation (p = 0.17).
Conclusions
Thoracic LAP are common in diffuse SSc and are generally multiple, not bulky, moderately hypermetabolic, and located at the base of the mediastinum lymph node chains. Their presence correlates with the extent of ILD. In absence of ILD, thoracic LAP presence seems to be often explained by silica exposure.
Trial Registration: NA.
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Quéneau A, Pistorius MA, Connault J, Raimbeau A, Gautier G, Bergère G, Artifoni M, Durant C, Bénichou A, Hersant J, Espitia O. Case–Control Study on Exercise-Induced Vasculitis in Hikers. Angiology 2022; 73:643-648. [DOI: 10.1177/00033197211065792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to identify clinical factors associated with exercise-induced vasculitis (EIV). This study included EIV cases and controls matched for age. Cases included were all members of a hiking club and participated in extended hiking trips. Exercise-induced vasculitis was diagnosed based on clinical signs occurring only after prolonged walks. Chronic venous disease was defined using the Clinical Etiological Anatomical Pathophysiologic classification. This study included 162 hikers: 32 EIV cases and 130 matched controls. Mean age at EIV diagnosis was 47.1 years and 24 (75.0%) of EIV cases were women. Chronic venous disease was present in 19 (57.6%) of EIV cases vs 39 (30.0%) in controls ( P = .001); those with EIV had significantly more saphenous vein insufficiency and C3 venous insufficiency than controls, 85.0 vs 52.6% and 8 (25.0%) vs 13 (10.0%) ( P = .02), respectively. For EIV cases, mean walking distance per hike was significantly higher than for controls ( P = .002). Exercise-induced vasculitis symptoms were typical with rash and/or purpura on the leg in warm conditions. Lesions spontaneously disappear in <10 days. In this study, EIV cases had more chronic venous disease and longer mean walking distances than controls.
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Affiliation(s)
- Alexandre Quéneau
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | | | - Jérôme Connault
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Giovanni Gautier
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Guillaume Bergère
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Cécile Durant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Antoine Bénichou
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
- Nantes Université, Nantes, France
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Rosa V, Chaar CIO, Espitia O, Otalora S, López-Jiménez L, Ruiz-Sada P, Verhamme P, Muñoz-Torrero JFS, Marchena PJ, Monreal M. A RIETE registry analysis of patients with upper extremity deep vein thrombosis and thoracic outlet syndrome. Thromb Res 2022; 213:65-70. [DOI: 10.1016/j.thromres.2021.12.030] [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] [Received: 09/10/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
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Ferfar Y, Morinet S, Espitia O, Agard C, Vautier M, Comarmond C, Desbois AC, Domont F, Resche-Rigon M, Cacoub P, Biard L, Saadoun D. Spectrum and Outcome of Noninfectious Aortitis. J Rheumatol 2021; 48:1583-1588. [PMID: 34210830 DOI: 10.3899/jrheum.201274] [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] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the spectrum and long-term outcome of patients with noninfectious aortitis. METHODS We performed a retrospective multicenter study of 353 patients (median age at diagnosis was 62 [IQR 46-71] yrs and 242 [68.6%] patients were women) with noninfectious aortitis. Factors associated with vascular complications were assessed in multivariate analysis. RESULTS We included 136 patients with giant cell arteritis (GCA), 96 with Takayasu arteritis (TA), 73 with clinically isolated aortitis (CIA), and 48 with aortitis secondary to inflammatory diseases (including Behçet disease, relapsing polychondritis, IgG4-related disease, Cogan syndrome, ankylosing spondylitis). After a median follow-up of 52 months, vascular complications were observed in 32.3%, revascularizations in 30% of patients, and death in 7.6%. The 5-year cumulative incidence of vascular complications was 58% (95% CI 41-71), 20% (95% CI 13-29), and 19% (95% CI 11-28) in CIA, GCA, and TA, respectively. In multivariate analysis, male sex (HR 2.10, 95% CI 1.45-3.05, P < 0.0001) and CIA (HR 1.76, 95% CI 1.11-2.81, P = 0.02) were independently associated with vascular complications. CONCLUSION Noninfectious aortitis accounts for significant morbidity and mortality. CIA seems to carry the highest rate of vascular complications.
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Affiliation(s)
- Yasmina Ferfar
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Sarah Morinet
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Olivier Espitia
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Christian Agard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Mathieu Vautier
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Cloé Comarmond
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Anne Claire Desbois
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Fanny Domont
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Matthieu Resche-Rigon
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Patrice Cacoub
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Lucie Biard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
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de Mornac D, Agard C, Hardouin JB, Hamidou M, Connault J, Masseau A, Espitia-Thibault A, Artifoni M, Ngohou C, Perrin F, Graveleau J, Durant C, Pottier P, Néel A, Espitia O. Risk factors for symptomatic vascular events in giant cell arteritis: a study of 254 patients with large-vessel imaging at diagnosis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211006967. [PMID: 34249150 PMCID: PMC8239952 DOI: 10.1177/1759720x211006967] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Aims To identify factors associated with vascular events in patients with giant cell arteritis (GCA). Methods We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Symptomatic vascular events were defined as the occurrence of any aortic event (aortic dissection or symptomatic aortic aneurysm), stroke, myocardial infarction, limb or mesenteric ischemia and de novo lower limbs arteritis stage 3 or 4. Patients with symptomatic vascular event (VE+) and without were compared, and risk factors were identified in a multivariable analysis. Results Thirty-nine (15.4%) of the 254 included patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were more frequent in VE+ patients (p < 0.05), as an abnormal computed tomography (CT)-scan at diagnosis (p = 0.04), aortitis (p = 0.01), particularly of the descending thoracic aorta (p = 0.03) and atheroma (p = 0.03). Deaths were more frequent in the VE+ group (37.1 versus 10.3%, p = 0.0003). In multivariable analysis, aortic surgery [hazard ratio (HR): 10.46 (1.41-77.80), p = 0.02], stroke [HR: 22.32 (3.69-135.05), p < 0.001], upper limb ischemia [HR: 20.27 (2.05-200.12), p = 0.01], lower limb ischemia [HR: 76.57 (2.89-2027.69), p = 0.009], aortic atheroma [HR: 3.06 (1.06-8.82), p = 0.04] and aortitis of the descending thoracic aorta on CT-scan at diagnosis [HR: 4.64 (1.56-13.75), p = 0.006] were independent predictive factors of a vascular event. Conclusion In this study on GCA cases with large vessels imaging at diagnosis, aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event. Plain language summary Risk factors for symptomatic vascular events in giant cell arteritisThis study was performed to identify the risk factors for developing symptomatic vascular event during giant cell arteritis (GCA) because these are poorly known.We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis.Patients with symptomatic vascular event (VE+) and without (VE-) were compared, and risk factors were identified in a multivariable analysis.Thirty-nine patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months.Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were significantly more frequent in VE+ patients, as an abnormal CT-scan at diagnosis, aortitis, particularly of the descending thoracic aorta and atheroma. Deaths were more frequent in the VE+ group.Among 254 GCA patients, 39 experienced at least one vascular event during follow-up.Aortic surgery, stroke, upper and lower limb ischemia were vascular event risk factors.Aortic atheroma and descending thoracic aorta aortitis on CT-scan were vascular event risk factors.This study on GCA cases with large vessels imaging at diagnosis, showed that aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event.
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Affiliation(s)
| | | | | | | | | | - Agathe Masseau
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | | | | | - Chan Ngohou
- Department of Medical Information, Nantes University Hospital, Nantes, France
| | - François Perrin
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Julie Graveleau
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Cécile Durant
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - Pierre Pottier
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - Antoine Néel
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, Nantes, 44093, France
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Mekinian A, Biard L, Dagna L, Jégo P, Salvarani C, Sergey M, Espitia O, Sciascia S, Hernan P, Cacoub P, Fain O, Saadoun D. OP0068 EFFICACY AND SAFETY OF TNF-Α ANTAGONISTS AND TOCILIZUMAB IN TAKAYASU ARTERITIS: MULTICENTER WORLDWIDE RETROSPECTIVE STUDY OF 209 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2843] [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] [Indexed: 11/03/2022]
Abstract
Background:In this large worldwide TAK registry, we report 209 patients treated with TNF-α antagonists and tocilizumab aiming to compare their safety and efficacy, and determine the predictive factors of treatment response and relapse.Objectives:To assess safety and efficacy of TNF-α antagonists and tocilizumab in patients with Takayasu arteritis (TAK).Methods:We conducted a retrospective multicenter study in referral centers from France, Italy, Spain, Israel, Japan, Tunisia and Russia about biological-targeted therapies in TAK during the period from January 2017 to September 2019 for the data collection.Results:Two-hundred nine patients with TAK [median age of 29 years [7-62], and 186 (89%) females] were included. They received either TNF-α antagonists [n=132 (63%) with 172 lines; infliximab (n=109), adalimumab (n=45), golimumab (n=8), certolizumab (n=6) and etanercept (n=5)], or tocilizumab [n=77 (37%) with 121 lines; intravenous and subcutaneous in 95 and 26 cases, respectively]. A complete response at 6 months was evidenced in 101/152 (66%) on TNF-α antagonists and 75/107 (70%) on tocilizumab, respectively. Age ≥ 30 years [OR= 2.09 [1.09; 3.99]] was associated with complete response, whereas vascular signs [0.26 [0.1;0.65]], baseline prednisone ≥ 20 mg/day [0.51 [0.28;0.93]] were negatively associated with the complete response to TNF-α antagonists or tocilizumab. During a median follow-up of 36 months, 103 relapses were noted. Supra-aortic branches and thoracic aorta involvements [HR 2.44 (1.06;5.65) and 3.66 (1.18;11.4), respectively], and systemic signs at baseline [HR 2.01 (1.30;3.11)] were significantly associated with relapse. The cumulative incidence of treatment discontinuation and relapse were similar in TNFα antagonists and tocilizumab. Fifty-eight (20%) adverse effects occurred on biological-targeted therapies of whom 37 (21%) and 21 (17%), (p=0.4) on TNF-α antagonists and tocilizumab, respectivelyConclusion:This large multicenter study shows high efficacy of biological-targeted treatments in refractory TAK. Efficacy, relapse and drug retention rate were equivalent with TNF-α antagonists and tocilizumab.Disclosure of Interests:None declared
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Briane A, Jamet B, Espitia O, Jaafar P, Durant C, Mugniot A, Néel A, Hamidou M, Agard C. Rechute valvulaire cardiaque d’une granulomatose avec polyangéite. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.180] [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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Panhaleux M, Espitia O, Terrier B, Manson G, Maria A, Humbert S, Godbert B, Perrin J, Achille A, Arrondeau J, Kostine M, Fallet V, Pugnet G, Chaigne B, Champiat S, Lambotte O, Michot J, Forestier A. Étude SCLERONCO-1 : Étude de tolérance et de pharmacovigilance des Immune Checkpoint Inhibiteurs chez les patients ayant une SCLERodermie systémique préexistante en ONCOlogie. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.238] [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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Raimbeau A, Pistorius MA, Goueffic Y, Connault J, Plissonneau-Duquene P, Maurel B, Reignier J, Asehnoune K, Artifoni M, Didier Q, Gautier G, Trochu JN, Rozec B, N’Gohou C, Durant C, Pottier P, Denis Le Sève J, Brebion N, Agard C, Espitia O. Digital ischaemia aetiologies and mid-term follow-up: A cohort study of 323 patients. Medicine (Baltimore) 2021; 100:e25659. [PMID: 34011027 PMCID: PMC8136985 DOI: 10.1097/md.0000000000025659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/05/2021] [Indexed: 12/30/2022] Open
Abstract
Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively.Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups (P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients (P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) (P = .02) and the TAO group (n = 7) (P = .03) than in DICE (n = 2).This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.
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Affiliation(s)
| | | | - Yann Goueffic
- Department of Vascular Surgery, University Hospital of Nantes
| | | | | | - Blandine Maurel
- Department of Vascular Surgery, University Hospital of Nantes
| | | | | | | | | | | | | | | | - Chan N’Gohou
- Department of Medical Data Processing, University Hospital of Nantes
| | | | | | | | - Nicolas Brebion
- Department of Vascular Medicine, Hospital of La Roche sur Yon, France
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de Boysson H, Le Besnerais M, Blaison F, Daumas A, Jarrot PA, Perrin F, Tieulié N, Maria A, Duffau P, Gombert B, Samson M, Espitia O, Lambert M, Mékinian A, Aouba A. Assessment of the efficacy and safety of tocilizumab in patients over 80 years old with giant cell arteritis. Arthritis Res Ther 2021; 23:143. [PMID: 34011407 PMCID: PMC8132404 DOI: 10.1186/s13075-021-02529-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the efficacy and tolerance of tocilizumab (TCZ) in giant cell arteritis (GCA) patients over 80. Method GCA patients over 80 years old from the French Study Group for Large Vessel Vasculitis register who received TCZ were analyzed. Results Twenty-one GCA patients (median age 84 [81–90] years old, including nine over 85) received TCZ for the following nonexclusive reasons: glucocorticoid (GC)-sparing effect in 14, relapsing disease in 8, disease severity in 4, and/or failure of another immunosuppressant in 4. TCZ was introduced with GCs at diagnosis in 6 patients and at 8 [3–37] months after GC initiation in 15 others. After a median delay of 8 [2–21] months post-TCZ introduction, 14 (67%) patients were able to definitively stop GCs, including 6 who were GC-dependent before TCZ. At the last follow-up (median 20 [3–48] months), 11 (52%) patients had definitively stopped TCZ, and 2 additional patients had stopped but relapsed and resumed TCZ. Seven (33%) patients experienced 11 adverse events: hypercholesterolemia in 4 patients; infections, i.e., pyelonephritis, bronchitis, and fatal septic shock associated with mesenteric infarction following planned surgery (GCs were stopped for 1 year and TCZ infusions for 2 months), respectively, in 3 patients; moderate thrombocytopenia and moderate neutropenia in 2 patients; and a 5-fold increase in transaminase levels in another that improved after TCZ dose reduction. Conclusion TCZ remains a valuable GC-sparing option in the oldest GCA patients with an interesting risk-benefit ratio. Mild-to-moderate adverse events were observed in one-third of patients.
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Affiliation(s)
- Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France. .,Normandy University, Unicaen, Caen, France.
| | | | - Félix Blaison
- Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Aurélie Daumas
- Department of Internal Medical and Clinical Immunology, Conception University Hospital, Marseille, France
| | - Pierre-André Jarrot
- Department of Internal Medical and Clinical Immunology, Conception University Hospital, Marseille, France
| | - François Perrin
- Department of Internal Medicine, Saint-Nazaire Hospital, Saint-Nazaire, France
| | - Nathalie Tieulié
- Department of Rheumatology, Nice University Hospital, Nice, France
| | - Alexandre Maria
- Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
| | - Pierre Duffau
- Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Bruno Gombert
- Department of Rheumatology, La Rochelle Hospital, La Rochelle, France
| | - Maxime Samson
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Olivier Espitia
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Marc Lambert
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Arsène Mékinian
- Department of Internal Medicine, Saint-Antoine Hospital, Paris, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France.,Normandy University, Unicaen, Caen, France
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de Mornac D, Espitia O, Néel A, Connault J, Masseau A, Espitia-Thibault A, Artifoni M, Achille A, Wahbi A, Lacou M, Durant C, Pottier P, Perrin F, Graveleau J, Hamidou M, Hardouin JB, Agard C. Large-vessel involvement is predictive of multiple relapses in giant cell arteritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211009029. [PMID: 34046092 PMCID: PMC8135215 DOI: 10.1177/1759720x211009029] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/21/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Giant cell arteritis (GCA) is the most common systemic vasculitis. Relapses are frequent. The aim of this study was to identify relapse risk factors in patients with GCA with complete large-vessel imaging at diagnosis. Methods: Patients with GCA followed in our institution between April 1998 and April 2018 were included retrospectively. We included only patients who had undergone large vascular imaging investigations at diagnosis by computed tomography (CT)-scan and/or positron emission tomography (PET)-scan and/or angio-magnetic resonance imaging (MRI). Clinical, biological, and radiological data were collected. Relapse was defined as the reappearance of GCA symptoms, with concomitant increase in inflammatory markers, requiring treatment adjustment. Relapsing patients (R) and non-relapsing patients (NR) were compared. Relapse and multiple relapses (>2) risk factors were identified in multivariable Cox analyses. Results: This study included 254 patients (73.2% women), with a median age of 72 years at diagnosis and a median follow up of 32.5 months. At diagnosis, 160 patients (63%) had an inflammatory large-vessel involvement on imaging, 46.1% (117 patients) relapsed at least once, and 21.3% (54 patients) had multiple relapses. The median delay of first relapse after diagnosis was 9 months. The second relapse delay was 21.5 months. NR patients had more stroke at diagnosis than R (p = 0.03) and the brachiocephalic trunk was involved more frequently on CT-scan (p = 0.046), as carotids (p = 0.02) in R patients. Multivariate Cox model identified male gender [hazard ratio (HR): 0.51, confidence interval (CI) (0.27–0.96), p = 0.04] as a relapse protective factor, and peripheral musculoskeletal manifestations [HR: 1.74 (1.03–2.94), p = 0.004] as a relapse risk factor. Peripheral musculoskeletal manifestations [HR: 2.78 (1.23–6.28), p = 0.014], negative temporal artery biopsy [HR: 2.29 (1.18–4.45), p = 0.015], large-vessel involvement like upper limb ischemia [HR: 8.84 (2.48–31.56), p = 0.001] and inflammation of arm arteries on CT-scan [HR: 2.39 (1.02–5.58), p = 0.04] at diagnosis were risk factors of multiple relapses. Conclusion: Male gender was a protective factor for GCA relapse and peripheral musculoskeletal manifestations appeared as a relapsing risk factor. Moreover, this study identified a particular clinical phenotype of multi-relapsing patients with GCA, characterized by peripheral musculoskeletal manifestations, negative temporal artery biopsy, and large-vessel involvement with upper limb ischemia or inflammation of arm arteries. Plain language Summary At giant cell arteritis diagnosis, large-vessel inflammatory involvement is predictive of multiple relapses
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Affiliation(s)
| | - Olivier Espitia
- Department of Internal Medicine, CHU Nantes, 1 Place Alexis Ricordeau, Nantes, 44093, France
| | - Antoine Néel
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Jérôme Connault
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Agathe Masseau
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Mathieu Artifoni
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Aurélie Achille
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Anaïs Wahbi
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Mathieu Lacou
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Cécile Durant
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Pierre Pottier
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - François Perrin
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Julie Graveleau
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
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Ploton G, Brebion N, Guyomarch B, Pistorius MA, Connault J, Hersant J, Raimbeau A, Bergère G, Artifoni M, Durant C, Gautier G, Dumont R, Kubina JM, Toquet C, Espitia O. Predictive factors of venous recanalization in upper-extremity vein thrombosis. PLoS One 2021; 16:e0251269. [PMID: 33983979 PMCID: PMC8118536 DOI: 10.1371/journal.pone.0251269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/22/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Upper extremity venous thrombosis (UEVT) represents about 10% of venous thrombo-embolic disease. This is mainly explained by the increasing use of central venous line, for oncologic or nutritional care. The factors associated with venous recanalization are not known. OBJECTIVE The aim of this study was to investigate prognosis factor associated with venous recanalization after UEVT. METHODS This study included patients with UEVT diagnosed with duplex ultra-sonography (DUS) from January 2015 to December 2017 with DUS evaluations during follow-up. A multivariate Cox proportional-hazards-model analysis was performed to identify predictive factors of UEVT complete recanalization. RESULTS This study included 494 UEVT, 304 proximal UEVT and 190 distal UEVT. The median age was 58 years, 39.5% were women. Clinical context was: hematological malignancy (40.7%), solid cancer (14.2%), infectious or inflammatory context (49.9%) and presence of venous catheters or pacemaker leads in 86.4%. The rate of recanalization without sequelae of UEVT was 38%. For all UEVT, in multivariate analysis, factors associated with complete vein recanalization were: thrombosis associated with central venous catheter (CVC) (HR:2.40, [1.45;3.95], p<0.001), UEVT limited to a venous segment (HR:1.94, [1.26;3.00], p = 0.003), occlusive thrombosis (HR:0.48 [0.34;0.67], p<0.0001), the presence of a PICC Line (HR:2.29, [1.48;3.52], p<0.001), a thrombosis of deep and distal topography (HR:1.70, [1.10;2.63], p = 0.02) or superficial thrombosis of the forearm (HR:2.79, [1.52;5.12], p<0.001). For deep and proximal UEVT, non-occlusive UEVT (HR:2.23, [1.49;3.33], p<0.0001), thrombosis associated with CVC (HR:1.58, [1.01;2.47], p = 0.04) and infectious or inflammatory context (HR:1.63, [1.10;2.41], p = 0.01) were factors associated with complete vein recanalization. CONCLUSION In this study, factors associated with UEVT recanalization were UEVT limited to a venous segment, thrombosis associated with CVC, a thrombosis of deep and distal thrombosis topography and superficial thrombosis of the forearm. Occlusive thrombosis was associated with the absence of UEVT recanalization.
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Affiliation(s)
- Gaëtan Ploton
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
| | - Nicolas Brebion
- Department of Vascular Medicine, CHD La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Béatrice Guyomarch
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Marc-Antoine Pistorius
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Jérôme Connault
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Jeanne Hersant
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Guillaume Bergère
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Cécile Durant
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Giovanni Gautier
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Romain Dumont
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
- Department of Anesthesia and Critical Care, CHU de Nantes, Nantes, France
| | - Jean-Manuel Kubina
- Department of Vascular Medicine, CHD La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Claire Toquet
- Department of Pathology, CHU de Nantes, Nantes, France
- Université de Nantes, CHU de Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
- Université de Nantes, CHU de Nantes, Nantes, France
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48
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Hervé H, Toquet C, Ploton G, Connault J, Gautier G, Raimbeau A, Bergère G, Hersant J, Durant C, Artifoni M, Brebion N, Kubina JM, Pistorius MA, Espitia O. Prevalence of post-thrombotic syndrome in a cohort of upper extremity vein thrombosis. J Vasc Surg Venous Lymphat Disord 2021; 10:111-117.e3. [PMID: 33894342 DOI: 10.1016/j.jvsv.2021.04.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Post-thrombotic syndrome (PTS) is one of the main complications that occurs after venous thrombosis. There are few data on the proportion of patients that will develop upper extremity PTS (UE-PTS) after upper extremity venous thrombosis (UEVT). The main objective of the study was to assess the prevalence of PTS in a UEVT cohort and to identify predictive factors of UE-PTS. METHODS This study included patients with a history of proximal or arm UEVT, diagnosed on duplex ultrasound examination, between January 1, 2015, and December 31, 2017, in a university hospital. After UEVT, each patient was evaluated by a prospective standardized recording of clinical manifestations and duplex ultrasound examination in case of upper limb symptoms. UE-PTS was defined as a modified Villalta score of 4 or higher. RESULTS Ninety-two patients were included; 68 (73.9%) had deep vein thrombosis (DVT) and 24 (19.2%) arm superficial vein thrombosis. Thirteen patients had PTS (14.1%), 12 (17.6%) in the DVT group and 1 (4.2%) in the superficial vein thrombosis group. There was a history of DVT in 92.3% of the cases of PTS. PTS was more frequent in patients with strokes with limb movement reduction (P = .01). On multivariate Cox analysis, a history of stroke (hazard ratio, 5.4; 95% confidence interval, 1.46-20.22; P = .01) was predictive of UE-PTS. CONCLUSIONS UE-PTS occurred in 14.1% of cases after UEVT. Stroke with a decrease in limb movement was a predictor of developing PTS. Diagnostic criteria should be established for UE-PTS and prospective studies are needed to improve the description and management of UE-PTS.
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Affiliation(s)
- Henri Hervé
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; Department of Vascular Medicine, CHD Vendée, La Roche sur Yon, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | | | - Gaëtan Ploton
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Jérôme Connault
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Giovanni Gautier
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Guillaume Bergère
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Cécile Durant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Nicolas Brebion
- Department of Vascular Medicine, CHD Vendée, La Roche sur Yon, France
| | | | - Marc-Antoine Pistorius
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France.
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49
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Espitia O, Agard C. Scalp Necrosis in Giant Cell Arteritis. Mayo Clin Proc 2021; 96:987-988. [PMID: 33814093 DOI: 10.1016/j.mayocp.2020.11.025] [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: 11/04/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Olivier Espitia
- Department of Internal Medicine, CHU Nantes, Nantes, France.
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50
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Bergère G, Toquet C, Hoffmann C, Bressollette L, Raimbeau A, Durant C, Artifoni M, Gautier G, Hersant J, Connault J, Pistorius MA, Espitia O. Effect of cannabis consumption on characteristics and evolution of thromboangitis obliterans. VASA 2021; 50:301-305. [PMID: 33739143 DOI: 10.1024/0301-1526/a000948] [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: 11/19/2022]
Abstract
Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa's criteria, were included in a retrospective bicentric study between the 1st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.
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Affiliation(s)
- Guillaume Bergère
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | | | - Clément Hoffmann
- Department of vascular medicine, EA 3878 GETBO, CHU de Brest, France
| | - Luc Bressollette
- Department of vascular medicine, EA 3878 GETBO, CHU de Brest, France
| | - Alizée Raimbeau
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Cécile Durant
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Mathieu Artifoni
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Giovanni Gautier
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Jeanne Hersant
- Department of internal and vascular medicine, CHU de Nantes, France
| | - Jérôme Connault
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Marc-Antoine Pistorius
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Olivier Espitia
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
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