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Goehringer F, Lalloué B, Selton-Suty C, Alla F, Botelho-Nevers E, Chirouze C, Curlier E, El Hatimi S, Gagneux-Brunon A, le Moing V, Lim P, Piroth L, Strady C, Tribouilloy C, Virion JM, Agrinier N, Duval X, Hoen B. Compared Performance of the 2023 Duke-International Society for Cardiovascular Infectious Diseases, 2000 Modified Duke, and 2015 European Society of Cardiology Criteria for the Diagnosis of Infective Endocarditis in a French Multicenter Prospective Cohort. Clin Infect Dis 2024; 78:937-948. [PMID: 38330171 DOI: 10.1093/cid/ciae035] [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: 06/02/2023] [Revised: 09/03/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The 2023 Duke-International Society for Cardiovascular Diseases (ISCVID) criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. Using an open prospective multicenter cohort of patients treated for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 European Society of Cardiology (ESC) criteria. METHODS Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated with 95% confidence intervals. RESULTS Of the 1194 patients analyzed (mean age, 66.1 years; 71.2% males), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% (95% confidence interval [CI], 91.6-94.8), 95.0% (95% CI, 93.7-96.4), and 97.6% (95% CI, 96.6-98.6), respectively (P < .001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% (95% CI, 55.2-67.4), 60.5% (95% CI, 54.4-66.6), and 46.0% (95% CI, 39.8-52.2), respectively. In patients without CIED, sensitivity rates were 94.8% (95% CI, 93.2-96.4), 96.5% (95% CI, 95.1-97.8), and 97.7% (95% CI, 96.6-98.8); specificity rates were 59.0% (95% CI, 51.6-66.3), 56.6% (95% CI, 49.3-64.0), and 53.8% (95% CI, 46.3-61.2), respectively. CONCLUSIONS Overall, the 2023 Duke-ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity compared with older criteria. This decreased specificity was mainly attributable to patients with CIED.
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Affiliation(s)
- Francois Goehringer
- Service de maladies infectieuses et tropicales, CHRU de Nancy, Nancy, France
| | - Benoit Lalloué
- CHRU de Nancy, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | | | - François Alla
- INSERM, BPH, U1219, I-prev/PHARES, CIC 1401, Universite Bordeaux, Bordeaux, France
- Service de prévention, CHU de Bordeaux, Bordeaux, France
| | - Elisabeth Botelho-Nevers
- Service de maladies infectieuses, CHU de Saint-Etienne, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Team GIMAP, Université Jean Monnet, Université de Lyon, Inserm, U1111, CNRS, UMR530, Saint-Etienne, France
| | - Catherine Chirouze
- Chrono-environnement UMR6249, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Service de maladies infectieuses et tropicales, CHU Jean Minjoz, Besançon, France
| | - Elodie Curlier
- Service de maladies infectieuses, CHU de la Guadeloupe, Pointe-à-Pitre, France
| | | | - Amandine Gagneux-Brunon
- Service de maladies infectieuses, CHU de Saint-Etienne, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Team GIMAP, Université Jean Monnet, Université de Lyon, Inserm, U1111, CNRS, UMR530, Saint-Etienne, France
| | - Vincent le Moing
- Service de Maladies Infectieuses et Tropicales, CHU de Montpellier, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Pascal Lim
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, Créteil, France
| | - Lionel Piroth
- Service de maladies infectieuses, CHU de Dijon, Dijon, France
- CHU Dijon-Bourgogne, INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne, Dijon, France
| | | | | | - Jean-Marc Virion
- CHRU de Nancy, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Nelly Agrinier
- CHRU de Nancy, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Xavier Duval
- Inserm CIC 1425, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat Claude-Bernard, Paris, France
- Inserm UMR-1137 IAME, Paris, France
- UFR de Médecine-Bichat, Université Paris Cité, Paris, France
| | - Bruno Hoen
- Ecole de santé publique-UR 4360 Apemac, Université de Lorraine, Nancy, France
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Cherbi M, Bonnefoy E, Puymirat E, Lamblin N, Gerbaud E, Bonello L, Levy B, Lim P, Muller L, Merdji H, Range G, Ferrari E, Elbaz M, Khachab H, Bourenne J, Seronde MF, Florens N, Schurtz G, Labbé V, Harbaoui B, Vanzetto G, Combaret N, Marchandot B, Lattuca B, Leurent G, Faguer S, Roubille F, Delmas C. Cardiogenic shock and chronic kidney disease: Dangerous liaisons. Arch Cardiovasc Dis 2024; 117:255-265. [PMID: 38594150 DOI: 10.1016/j.acvd.2024.01.006] [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: 08/29/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs - the so-called "cardiorenal syndrome". Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce. METHODS FRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors. RESULTS CKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs. 63.9years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1month (36.6% vs. 23.2%; hazard ratio 1.39, 95% confidence interval 1.01-1.9; P=0.04) and 1year (62.8% vs. 40.5%, hazard ratio 1.39, 95% confidence interval 1.09-1.77; P<0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1month and 1year regardless of baseline CKD status. CONCLUSIONS Cardiogenic shock and CKD are frequent "cross-talking" conditions with limited therapeutic options, resulting in higher rates of death at 1month and 1year. RRT is a strong predictor of death, regardless of preexisting CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Department of Cardiology, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 5, avenue de Magellan, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, avenue du Haut-Lévêque, 33600 Pessac, France
| | - Laurent Bonello
- Aix-Marseille Université, 13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Assistance publique-Hôpitaux de Marseille, Hôpital Nord, 13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, 54500 Vandœuvre-Lès-Nancy, France
| | - Pascal Lim
- Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, 94010 Créteil, France
| | - Laura Muller
- Réanimation, Centre Hospitalier Broussais, 35400 Saint-Malo, France
| | - Hamid Merdji
- Medical Intensive Care Unit, Nouvel Hôpital Civil, CHU de Strasbourg, 67091 Strasbourg, France
| | - Grégoire Range
- Cardiology Department, Centre Hospitalier Louis-Pasteur, 28630 Chartres, France
| | - Emile Ferrari
- Cardiology Department, CHU de Nice, 06003 Nice, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix-en-Provence, avenue des Tamaris, 13616 Aix-en-Provence cedex 1, France
| | - Jeremy Bourenne
- Aix-Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, 13005 Marseille, France
| | | | - Nans Florens
- Nephrology Department, Strasbourg University Hospital, 67091 Strasbourg, France
| | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | - Vincent Labbé
- Medical Intensive Care Unit, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, Inserm U1044, INSA-15, 69229 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU de Clermont-Ferrand, CNRS, Université Clermont-Auvergne, 63003 Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médicochirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Guillaume Leurent
- Department of Cardiology, CHU de Rennes, Inserm, LTSI, UMR 1099, Université Rennes 1, 35000 Rennes, France
| | - Stanislas Faguer
- Department of Nephrology and Transplantation, French Intensive Care Renal Network, Inserm U1297 (Institute of Metabolic and Cardiovascular Diseases), University Hospital of Toulouse, 31059 Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, Inserm, CNRS, Cardiology Department, CHU de Montpellier, 34295 Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France.
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Manzo-Silberman S, Martin AC, Boissier F, Hauw-Berlemont C, Aissaoui N, Lamblin N, Roubille F, Bonnefoy E, Bonello L, Elbaz M, Schurtz G, Morel O, Leurent G, Levy B, Jouve B, Harbaoui B, Vanzetto G, Combaret N, Lattucca B, Champion S, Lim P, Bruel C, Schneider F, Seronde MF, Bataille V, Gerbaud E, Puymirat E, Delmas C. Sex disparities in cardiogenic shock: Insights from the FRENSHOCK registry. J Crit Care 2024; 82:154785. [PMID: 38493531 DOI: 10.1016/j.jcrc.2024.154785] [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: 10/17/2023] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial. OBJECTIVES The aim was to analyze the impact of sex on aetiology, management and prognosis of CS. METHODS The FRENSHOCK registry included all CS admitted in 49 French Intensive Care Units (ICU) and Intensive Cardiac Care Units (ICCU) between April and October 2016. RESULTS Among the 772 CS patients included, 220 were women (28.5%). Women were older, less smokers, with less history of ischemic cardiac disease (20.5% vs 33.6%) than men. At admission, women presented less cardiac arrest (5.5 vs 12.2%), less mottling (32.5 vs 41.4%) and higher LVEF (30 ± 14 vs 25 ± 13%). Women were more often managed via emergency department while men were directly admitted at ICU/ICCU. Ischemia was the most frequent trigger irrespective of sex (36.4% in women vs 38.2%) but women had less coronary angiogram and PCI (45.9% vs 54% and 24.1 vs 31.3%, respectively). We found no major difference in medication and organ support. Thirty-day mortality (26.4 vs 26.5%), transplant or permanent assist device were similar in both sexes. CONCLUSION Despite some more favorable parameters in initial presentation and no significant difference in medication and support, women shared similar poor prognosis than men. Further analysis is required to cover the lasting gap in knowledge regarding sex specificities to distinguish between differences and inequalities. NCT02703038.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France; Université de Paris, INSERM, Innovative Therapies in Haemostasis, 75006 Paris, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France; Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Bordeaux U1045, France; Université de Paris, 75006 Paris, France.
| | - Anne-Céline Martin
- Cardiology Department, AP HP, European Hospital Georges Pompidou, 75015, France
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire de Poitiers, INSERM CIC 1402 (IS-ALIVE group), Université de Poitiers, Member of FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Poitiers, France
| | - Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Université Paris Cité, Paris, France
| | - Nadia Aissaoui
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre - Université de Paris, Medical School, Paris, France
| | - Nicolas Lamblin
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - François Roubille
- PhyMedExp, Cardiology Department, University of Montpellier, INSERM U1046, CNRS UMR, 9214; INI-CRT, Montpellier, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | | | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France
| | - Guillaume Schurtz
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Guillaume Leurent
- Univ Rennes1, Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1009, F-35000 Rennes, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Bernard Jouve
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, Avenue des Tamaris, 13616, cedex 1, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gérald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benoit Lattucca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Sébastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150 Le Chesnay, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Cédric Bruel
- Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75674 Paris, France
| | - Francis Schneider
- Médecine intensive réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg et Unistra, Faculté de Médecine, Strasbourg, France
| | | | - Vincent Bataille
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Adimep : Association pour la Diffusion de la Médecine de Prévention, Toulouse, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Recherche Enseignement en Insuffisance cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU de Toulouse, France.
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4
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Matsushita K, Delmas C, Marchandot B, Roubille F, Lamblin N, Leurent G, Levy B, Elbaz M, Champion S, Lim P, Schneider F, Khachab H, Carmona A, Trimaille A, Bourenne J, Seronde M, Schurtz G, Harbaoui B, Vanzetto G, Biendel C, Labbe V, Combaret N, Mansourati J, Filippi E, Maizel J, Merdji H, Lattuca B, Gerbaud E, Bonnefoy E, Puymirat E, Bonello L, Morel O. Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry. J Am Heart Assoc 2024; 13:e030975. [PMID: 38390813 PMCID: PMC10944045 DOI: 10.1161/jaha.123.030975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline-directed heart failure (HF) medical therapy (GDMT) and one-year survival rate in patients who are post-CS. METHODS AND RESULTS FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in-hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P<0.001 and 29% versus 37%, P<0.001, respectively). In the overall cohort, the one-year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one-year all-cause mortality compared with non-triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19-0.80]; P=0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one-year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P<0.001). CONCLUSIONS In survivors of CS, the one-year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS.
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Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Clément Delmas
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology DepartmentCHU de MontpellierMontpellierFrance
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Guillaume Leurent
- Department of CardiologyCHU Rennes, Inserm, LTSI‐UMR 1099RennesFrance
| | - Bruno Levy
- Réanimation Médicale BraboisCHRU NancyNancyFrance
| | - Meyer Elbaz
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRBAP‐HP, Hôpital Universitaire Henri‐Mondor, Service de CardiologieCréteilFrance
| | - Francis Schneider
- Médecine Intensive‐RéanimationHôpital de Hautepierre, Hôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of CardiologyCH d’Aix en ProvenceAix‐en‐ProvenceFrance
| | - Adrien Carmona
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Jeremy Bourenne
- Aix Marseille UniversitéService de Réanimation des Urgences, CHU La Timone 2MarseilleFrance
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Brahim Harbaoui
- Cardiology DepartmentHôpital Croix‐Rousse and Hôpital Lyon Sud, Hospices Civils de LyonLyonFrance
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA‐15LyonFrance
| | | | - Caroline Biendel
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Vincent Labbe
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico‐Universitaire APPROCHESAssistance Publique‐Hôpitaux de Paris (APHP), Sorbonne UniversitéParisFrance
| | - Nicolas Combaret
- Department of CardiologyHU Clermont‐Ferrand, CNRS, Université Clermont AuvergneClermont‐FerrandFrance
| | - Jacques Mansourati
- Department of CardiologyUniversity Hospital of Brest and University of Western BrittanyOrphyFrance
| | - Emmanuelle Filippi
- Department of CardiologyGeneral Hospital of Atlantic BrittanyVannesFrance
| | - Julien Maizel
- Intensive Care DepartmentCHU Amiens‐PicardieAmiensFrance
| | - Hamid Merdji
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
- Medical Intensive Care UnitNouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Benoit Lattuca
- Department of CardiologyNîmes University Hospital, Montpellier UniversityNîmesFrance
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional CardiologyHôpital Cardiologique du Haut Lévêque, Bordeaux Cardio‐Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier ArnozanPessacFrance
| | - Eric Bonnefoy
- Intensive Cardiac Care UnitLyon Brom University HospitalLyonFrance
| | - Etienne Puymirat
- Cardiology DepartmentEuropean Georges Pompidou HospitalParisFrance
| | - Laurent Bonello
- Department of Cardiology, Aix‐Marseille Université, Intensive Care Unit, Assistance Publique‐Hôpitaux de MarseilleHôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio)MarseilleFrance
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
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5
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Cherbi M, Bouisset F, Bonnefoy E, Lamblin N, Gerbaud E, Bonello L, Levy B, Lim P, Joffre J, Beuzelin M, Roland Y, Niquet L, Favory R, Khachab H, Harbaoui B, Vanzetto G, Combaret N, Marchandot B, Lattuca B, Leurent G, Lairez O, Puymirat E, Roubille F, Delmas C. Characteristics, management, and mid-term prognosis of older adults with cardiogenic shock admitted to intensive care units: Insights from the FRENSHOCK registry. Int J Cardiol 2024; 395:131578. [PMID: 37956759 DOI: 10.1016/j.ijcard.2023.131578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The incidence of heart failure and cardiogenic shock (CS) in older adults is continually increasing due to population aging. To date, prospective data detailing the specific characteristics, management and outcomes of CS in this population are scarce. METHODS FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. We studied 1-month and 1-year mortality among patients over 75-year-old, adjusted for independent predictors of 1-month and 1-year mortalities. RESULTS Out of 772 patients included, 236 (30.6%) were 75 years old or more (mean age 81.9 ± 4.7 years, 63.6% male). Compared to patients <75 years old, older adults had a higher prevalence of comorbidities including hypertension, dyslipidemia, chronic kidney disease, and history of heart disease. Older adults were characterized by a lower blood pressure, as well as higher creatinine and lower haemoglobin levels at presentation. Yet, they were less likely to be treated with norepinephrine, epinephrine, invasive ventilation, and renal replacement therapy. They showed a higher 1-month (aHR: 2.5 [1.86-3.35], p < 0.01) and 1-year mortality (aHR: 2.01 [1.58-2.56], p < 0.01). Analysis of both 1-month and 1-year mortality stratified by age quartiles showed a gradual relationship between aging and mortality in CS patients. CONCLUSION A third of patient with CS in critical care unit are older than 75 years and their risk of death at one month and one year is more than double compared to the younger ones. Further research is essential to identify best therapeutic strategy in this population. NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France
| | - Frédéric Bouisset
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 5 Avenue de Magellan, 33600 Pessac, France
| | - Laurent Bonello
- Aix-Marseille Université, Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), F-13385 Marseille, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France
| | | | | | - Yves Roland
- IHU HealthAge, Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Louis Niquet
- Intensive Care Unit, CH Intercommunal des Vallées de l'Ariège, France
| | - Raphael Favory
- Intensive Care Unit, Hôpital Roger Salengro, CHU de Lille, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Avenue des Tamaris, 13616, Aix-en-Provence cedex 1, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, F-35000 Rennes, France
| | - Olivier Lairez
- Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse 31059, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, Université de Paris, 75006 Paris, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France; REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France.
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6
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Merdji H, Gantzer J, Bonello L, Lamblin N, Roubille F, Levy B, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Curtiaud A, Kurtz JE, Combaret N, Marchandot B, Lattuca B, Biendel C, Leurent G, Bataille V, Gerbaud E, Puymirat E, Bonnefoy E, Aissaoui N, Delmas C. Characteristics, management, and outcomes of active cancer patients with cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2023; 12:682-692. [PMID: 37410588 DOI: 10.1093/ehjacc/zuad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
AIMS Characteristics, management, and outcomes of patients with active cancer admitted for cardiogenic shock remain largely unknown. This study aimed to address this issue and identify the determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all aetiologies. METHODS AND RESULTS FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October 2016. 'Active cancer' was defined as a malignancy diagnosed within the previous weeks with planned or ongoing anticancer therapy. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 51 (6.6%) had active cancer. Among them, the main cancer types were solid cancers (60.8%), and hematological malignancies (27.5%). Solid cancers were mainly urogenital (21.6%), gastrointestinal (15.7%), and lung cancer (9.8%). Medical history, clinical presentation, and baseline echocardiography were almost the same between groups. In-hospital management significantly differed: patients with cancers received more catecholamines or inotropes (norepinephrine 72% vs. 52%, P = 0.005 and norepinephrine-dobutamine combination 64.7% vs. 44.5%, P = 0.005), but had less mechanical circulatory support (5.9% vs. 19.5%, P = 0.016). They presented a similar 30-day mortality rate (29% vs. 26%) but a significantly higher mortality at 1-year (70.6% vs. 45.2%, P < 0.001). In multivariable analysis, active cancer was not associated with 30-day mortality but was significantly associated with 1-year mortality in 30-day survivors [HR 3.61 (1.29-10.11), P = 0.015]. CONCLUSION Active cancer patients accounted for almost 7% of all cases of cardiogenic shock. Early mortality was the same regardless of active cancer or not, whereas long-term mortality was significantly increased in patients with active cancer.
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Affiliation(s)
- Hamid Merdji
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg university hospital, Nouvel Hôpital Civil, Medical intensive care unit, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Laurent Bonello
- Aix-Marseille Université, F-13385 Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000, Lille, France
| | - François Roubille
- Cardiology Department, PhyMedExp, Université de Montpellier, INSERM, CNRS, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Sebastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150 Le Chesnay, France
| | - Pascal Lim
- Service de Cardiologie, Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, F-94010 Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, France, Avenue des Tamaris 13616 Aix-en-Provence cedex 1, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, Aix Marseille Université, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS UMR5220; INSERM U1044; INSA-15 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, 1 rue de la Marne, 35400 St Malo, France
| | - Anais Curtiaud
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg university hospital, Nouvel Hôpital Civil, Medical intensive care unit, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Université de Strasbourg, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, F-35000, Rennes, France
| | - Vincent Bataille
- Association pour la diffusion de la médecine de prévention (ADIMEP), Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604 Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600 Pessac, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015 Paris, France
- Université de Paris, 75006 Paris, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nadia Aissaoui
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clément Delmas
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- Recherche et Enseignement en Insuffisance Cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU Toulouse, Toulouse, France
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7
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Taylor S, D'Souza D, Moinuddin S, Gains J, Gaze MN, Gaunt T, Veiga C, Lim P. Pancreas: An Organ-at-Risk to Consider in Future Pediatric Abdominal Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:S135. [PMID: 37784347 DOI: 10.1016/j.ijrobp.2023.06.538] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Irradiation to the pancreas during pediatric radiotherapy is associated with secondary late effects, yet the pancreas is not typically considered an organ-at-risk (OAR) during radiotherapy planning. This audit investigated incidental pancreatic doses to estimate the relative risk (RR) of developing diabetes in later life. MATERIALS/METHODS Incidental pancreas doses were audited from 92 patients aged 2 to 19 historically treated with photons for craniospinal irradiation (CSI, N = 73) and for abdominal neuroblastoma (N = 19). Prescription doses ranged 21-36 Gy and 21-39 Gy (with boost to spine up to 50 Gy) for neuroblastoma and CSI patients, respectively. The pancreas was segmented on all planning CT scans following RTOG guidelines. Furthermore, the pancreas was split into its sub-volumes (head, body and tail) for abdominal cases only, since these scans were acquired with contrast enhancement. The RR of developing subsequent diabetes was estimated as a function of dose (D): RR = 1+0.65 × D × exp(-0.3 × D). Dose to the pancreas tail was used for neuroblastoma cases, whereas dose to the whole pancreas was used for CSI patients given that the pancreas could not be split in non-contrast scans. RESULTS The mean dose delivered to the whole pancreas was 15.4±7.5 Gy for all patients, 12.7±4.7 Gy for CSI patients and 25.9±7.4 Gy for abdominal patients. Pancreas V10Gy was 61.2% for all patients, 51.5% for CSI, and 98.6% for abdominal patients; V30Gy = 0% in all cases. These doses represented an estimated diabetes RR of 7.3±1.5, 6.6±1.3, and 8.7±0.6, respectively; RR>5 in 88%, 85% and 100% of all patients, CSI and abdominal patients audited, respectively. CONCLUSION Current incidental doses were associated with a diabetes RR>5 in all patients treated for abdominal neuroblastoma and the majority who received CSI. These findings suggest the pancreas should be routinely delineated and considered as an OAR in radiotherapy planning. This may help to identify higher risk patients and inform late-effect monitoring during survivorship. Further work in underway to assess if proton therapy could reduce the RR of diabetes particularly in abdominal cases. Improved availability of high-quality imaging during radiotherapy planning, such as contrast administration or planning MRI, is becoming more necessary to accurately delineate subsegments of the pancreas for improved RR estimations.
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Affiliation(s)
- S Taylor
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - D D'Souza
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - S Moinuddin
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - J Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - M N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Gaunt
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - C Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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8
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Gaffney J, Rieu R, France AK, Glynn AM, Brown K, Rooney C, Swan A, Kapacee Z, Brennan B, Dyker K, Noble D, Dixon L, Houghton F, Mandeville HC, Brennan SM, Gains J, Lim P, Thomson DD, McPartlin A, Pan S. Evaluation of Radiotherapy Dose and Survival Outcomes for Teenagers, and Young Adults with Nasopharyngeal Carcinoma in UK and Ireland. Int J Radiat Oncol Biol Phys 2023; 117:e582. [PMID: 37785767 DOI: 10.1016/j.ijrobp.2023.06.1924] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Nasopharyngeal carcinoma (NPC) follows a bimodal distribution with a smaller incidence peak in teenagers and young adults (TYAs). In TYAs, an over-whelming proportion are associated with Epstein-Barr virus (EBV). We have evaluated the variation in TYA NPC practice patterns across the UK and Ireland, along with survival outcomes. MATERIALS/METHODS We performed a multicenter, observational cohort study, of patients aged 13-25 years, with histologically confirmed NPC, treated between the years 2002-2022. An initial expression of interest was sent to selected centers treating H&N patients in the UK and Ireland. For analysis, patients were assessed based on total prescribed dose, with a cut off for low dose (LD) (≤61.2Gy) versus a high dose (HD)(>61.2Gy). RESULTS Ninety-five patients, from 9 centers, were eligible for inclusion. Patient demographics are shown in table1. At a median follow up of 45 months (IQR 23-111), 3-year overall survival (OS) was 98% (95% CI 93%-100%) with LD versus 91% (95% CI 83%-99%) with HD (Hazard ratio (HR) = 3.0; 95% CI 0.3-27, p = 0.3). 3-year progression free survival (PFS) was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6), and 5-year PFS was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6). Incidence of distant metastasis (DM) was 9.9%. 2 patients (6%) with T3-T4 tumors, treated with LD, had locoregional failure (LRF) compared to 1 patient (3%) treated with HD. CONCLUSION We have demonstrated excellent survival outcomes for the UK & Ireland TYA NPC patients. As the majority of cases in this age group have EBV+ NPC, with survival similar between LD and HD protocols, we propose that pediatric protocols, with lower radiotherapy doses should be considered for all TYA NPC, with the aim of reducing late effects. Additional analysis to better understand the impact of heterogeneity between both groups, including choice of protocol, induction and adjuvant treatment will follow this study. Prospective evaluation, as part of an international collaboration, is required to optimize the management strategy for this rare cohort of patients.
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Affiliation(s)
- J Gaffney
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Rieu
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A K France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
| | - A M Glynn
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - K Brown
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - C Rooney
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - Z Kapacee
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK, Manchester, United Kingdom
| | - K Dyker
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - D Noble
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - L Dixon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, Sheffield, United Kingdom
| | - F Houghton
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - H C Mandeville
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - S M Brennan
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - J Gains
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - D D Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - S Pan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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9
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Ahmad R, Cantwell J, Borrelli C, Lim P, D'Souza D, Gaze MN, Moinuddin S, Gains J, Veiga C. Development of Population-Based Pediatric Computational Phantoms for Radiotherapy Applications. Int J Radiat Oncol Biol Phys 2023; 117:e456. [PMID: 37785462 DOI: 10.1016/j.ijrobp.2023.06.1647] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Age-specific pediatric computational phantoms are used in radiotherapy (RT) for quality assurance and for reconstruction of historical RT doses (within others). Phantoms are typically developed from healthy patients and may not effectively represent those with cancer due to pathology and/or treatment effects. This study evaluated a set of population-based pediatric computational phantoms developed in-house in terms of anatomical plausibility. MATERIALS/METHODS Planning CTs and contours from historical craniospinal irradiation (CSI) patients (n = 74, median age 7y, range: 1-17y) were used to generate and evaluate a set of in-house age-specific population-based RT phantoms (RT-P). The RT-P were generated by combining a sub-set of clinical CTs and contours through groupwise deformable image registration, generating average models of CSI sub-populations (n = 74, median age 7y, range: 3-14y). Models were then compared against clinical data and two libraries of phantoms representing healthy populations: the International Commission on Radiological Protection (ICRP) pediatric reference computational phantoms (n = 8, median age 8y, range: 1-15y) and a variety of default 4D extended cardiac torso (XCAT) phantoms (n = 75, median age 9y, range: 1-18y). Variation between organ volumes for the different datasets was assessed through a linear fit of organ volume with age, reporting the slope (∑) of each fit [y-1]. Average difference between the volume datapoints and the linear fit for clinical data (Δ) [%] were also reported. This allowed for comparisons of the RT-P to clinical and reference data in terms of organ volumes across developmental stages. RESULTS The table shows 9 of the 19 investigated organs. The ∑ reported for RT-P models were of similar magnitude as the clinical data and other phantoms, effectively modelling changes with age. The greatest and least ∑ were reported from lungs and thyroid respectively, in agreement with expected relative sizes between organs. Larger values for Δ were likely due to differences in organ filling and segmentation strategy between datasets, limitations of RT-P methodology, and/or anatomical differences between healthy and cancer populations. CONCLUSION The RT-P models show promise in representing the RT cohort that may benefit from specialized anatomical phantoms. Further work is needed to address the limitations of the current methodology and its applicability to other RT cohorts.
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Affiliation(s)
- R Ahmad
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - J Cantwell
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - C Borrelli
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - D D'Souza
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - M N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S Moinuddin
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - J Gains
- Department of Radiotherapy, University College London Hospital, London, United Kingdom
| | - C Veiga
- Centre for Medical Image Computing, University College London, London, United Kingdom
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10
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Cholley B, Bojan M, Guillon B, Besnier E, Mattei M, Levy B, Ouattara A, Tafer N, Delmas C, Tonon D, Rozec B, Fellahi JL, Lim P, Labaste F, Roubille F, Caruba T, Mauriat P. Correction: Overview of the current use of levosimendan in France: a prospective observational cohort study. Ann Intensive Care 2023; 13:94. [PMID: 37770809 PMCID: PMC10539228 DOI: 10.1186/s13613-023-01193-y] [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] [Indexed: 09/30/2023] Open
Affiliation(s)
- Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, 75015, Paris, France.
- Université Paris Cité, INSERM, UMR_S 1140 "Innovations Thérapeutiques en Hémostase", 75006, Paris, France.
| | - Mirela Bojan
- Pôle Cardiopathies Congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 92350, Le Plessis-Robinson, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, 76000, Rouen, France
| | - Mathieu Mattei
- Department of Cardiology and Cardiac Surgery, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-les Nancy, France
| | - Bruno Levy
- CHRU Nancy, Critical Care, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-Les Nancy, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Nadir Tafer
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Clément Delmas
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - David Tonon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix-Marseille University, 13385, Marseille CEDEX 05, France
| | - Bertrand Rozec
- Department of Anaesthesiology and Critical Care, Institut du Thorax, Laennec Hospital, CHU de Nantes, and Nantes Université, CHU Nantes*, CNRS, INSERM, 44000, Nantes, France
| | - Jean-Luc Fellahi
- Department of Cardiothoracic Anaesthesiology and Critical Care, Louis Pradel University Hospital, Lyon, France
| | - Pascal Lim
- Cardiology department, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - François Labaste
- Department of Anaesthesiology and Critical Care Medicine, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Cardiology Department INI-CRT PhyMedExp INSERM, CNRS CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Philippe Mauriat
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
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11
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Merdji H, Bataille V, Curtiaud A, Bonello L, Roubille F, Levy B, Lim P, Schneider F, Khachab H, Dib JC, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Marchand S, Gebhard CE, Henry P, Combaret N, Marchandot B, Lattuca B, Biendel C, Leurent G, Gerbaud E, Puymirat E, Bonnefoy E, Meziani F, Delmas C. Mottling as a prognosis marker in cardiogenic shock. Ann Intensive Care 2023; 13:80. [PMID: 37672139 PMCID: PMC10482815 DOI: 10.1186/s13613-023-01175-0] [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: 04/20/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS Impact of skin mottling has been poorly studied in patients admitted for cardiogenic shock. This study aimed to address this issue and identify determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all etiologies. METHODS AND RESULTS FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October, 2016. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 660 had skin mottling assessed at admission (85.5%) with almost 39% of patients in cardiogenic shock presenting mottling. The need for invasive respiratory support was significantly higher in patients with mottling (50.2% vs. 30.1%, p < 0.001) and likewise for the need for renal replacement therapy (19.9% vs. 12.4%, p = 0.09). However, the need for mechanical circulatory support was similar in both groups. Patients with mottling at admission presented a higher length of stay (19 vs. 16 days, p = 0.033), a higher 30-day mortality rate (31% vs. 23.3%, p = 0.031), and also showed significantly higher mortality at 1-year (54% vs. 42%, p = 0.003). The subgroup of patients in whom mottling appeared during the first 24 h after admission had the worst prognosis at 30 days. CONCLUSION Skin mottling at admission in patients with cardiogenic shock was statistically associated with prolonged length of stay and poor outcomes. As a perfusion-targeted resuscitation parameter, mottling is a simple, clinical-based approach and may thus help to improve and guide immediate goal-directed therapy to improve cardiogenic shock patients' outcomes.
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Affiliation(s)
- Hamid Merdji
- Faculté de Médecine, Strasbourg University Hospital, Nouvel Hôpital Civil, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Vincent Bataille
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France
| | - Anais Curtiaud
- Faculté de Médecine, Strasbourg University Hospital, Nouvel Hôpital Civil, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Laurent Bonello
- Aix-Marseille Université, 13385, Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13385, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, 94010, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix-en-Provence, France
- Avenue des Tamaris, 13616, Aix-en-Provence cedex 1, France
| | | | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700, La Tronche, France
| | | | - Caroline Eva Gebhard
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Patrick Henry
- Department of Cardiology, AP-HP, Lariboisière University Hospital, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse Cedex, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, 35000, Rennes, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600, Pessac, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015, Paris, France
- Université de Paris, 75006, Paris, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Bron University Hospital, Lyon, France
| | - Ferhat Meziani
- Faculté de Médecine, Strasbourg University Hospital, Nouvel Hôpital Civil, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse Cedex, France.
- Recherche et Enseignement en Insuffisance Cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU Toulouse, Toulouse, France.
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12
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Cherbi M, Bonnefoy E, Lamblin N, Gerbaud E, Bonello L, Roubille F, Levy B, Champion S, Lim P, Schneider F, Elbaz M, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Combaret N, Labbe V, Marchandot B, Lattuca B, Biendel-Picquet C, Leurent G, Puymirat E, Maury P, Delmas C. One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry. Front Cardiovasc Med 2023; 10:1167738. [PMID: 37731529 PMCID: PMC10507701 DOI: 10.3389/fcvm.2023.1167738] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023] Open
Abstract
Background Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS. Methods FRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1-3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors. Results Among 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59-1.39), p = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41-1.88), p = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78-1.98), p = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05-10.5), p = 0.01]. Conclusion SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis. Clinical Trial Registration https://clinicaltrials.gov, identifier: NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Laurent Bonello
- Cardiology Department, Hopital Nord, AP-HM, Aix-Marseille Université, Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - François Roubille
- Cardiology Department, PhyMedExp, Université de Montpellier, INSERM, CNRS, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, Vandoeuvre-les Nancy, France
| | - Sebastien Champion
- Anesthesiology and Intensive Care Department, Clinique de Parly 2, Ramsay Générale de Santé, Le Chesnay, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- Cardiology Department, AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Cardiology Department, CH d'Aix-en-Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, AP-HM, Hôpital de La Timone, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS, UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Vincent Labbe
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon,Paris, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle D'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel-Picquet
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI—UMR 1099, Univ Rennes 1, Rennes, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
- Université de Paris, Paris, France
| | - Philippe Maury
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- REICATRA, Institut Saint Jacques, CHU de Toulouse, ToulouseFrance
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13
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Hugues B, Emsen B, Pina Vegas L, Lepeule R, Ternacle J, Huguet R, Decousser JW, Fiore A, Lim P, Itti E, Chevalier X, Abulizi M, Eymard F. PET/CT for osteoarticular septic grafts in endocarditis: A large monocentric cohort. Joint Bone Spine 2023; 90:105577. [PMID: 37076094 DOI: 10.1016/j.jbspin.2023.105577] [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: 01/30/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Benjamin Hugues
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Berivan Emsen
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Laura Pina Vegas
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Raphaël Lepeule
- AP-HP, Henri-Mondor Hospital, Department of Microbiology, 94000 Créteil, France
| | - Julien Ternacle
- CHU de Bordeaux, Haut-Lévêque Hospital, Department of Cardiology, 33600 Pessac, France
| | - Raphaëlle Huguet
- AP-HP, Henri-Mondor Hospital, Department of Cardiology, 94000 Créteil, France
| | | | - Antonio Fiore
- AP-HP, Henri-Mondor Hospital, Department of Thoracic Surgery, 94000 Créteil, France
| | - Pascal Lim
- AP-HP, Henri-Mondor Hospital, Department of Cardiology, 94000 Créteil, France
| | - Emmanuel Itti
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Xavier Chevalier
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Mukedaizi Abulizi
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Florent Eymard
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
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14
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Cholley B, Bojan M, Guillon B, Besnier E, Mattei M, Levy B, Ouattara A, Tafer N, Delmas C, Tonon D, Rozec B, Fellahi JL, Lim P, Labaste F, Roubille F, Caruba T, Mauriat P. Overview of the current use of levosimendan in France: a prospective observational cohort study. Ann Intensive Care 2023; 13:69. [PMID: 37552372 PMCID: PMC10409690 DOI: 10.1186/s13613-023-01164-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/11/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. METHOD The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. RESULTS The patients included (n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock (n = 250, 41.5%), decompensated heart failure (n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment (n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation (n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. CONCLUSIONS We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied.
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Affiliation(s)
- Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, 75015, Paris, France.
- Université Paris Cité, INSERM, UMR_S 1140 "Innovations Thérapeutiques en Hémostase", 75006, Paris, France.
| | - Mirela Bojan
- Pôle Cardiopathies Congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 92350, Le Plessis-Robinson, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, 76000, Rouen, France
| | - Mathieu Mattei
- Department of Cardiology and Cardiac Surgery, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-les Nancy, France
| | - Bruno Levy
- CHRU Nancy, Critical Care, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-Les Nancy, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Nadir Tafer
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Clément Delmas
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - David Tonon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix-Marseille University, 13385, Marseille CEDEX 05, France
| | - Bertrand Rozec
- Department of Anaesthesiology and Critical Care, Institut du Thorax, Laennec Hospital, CHU de Nantes, and Nantes Université, CHU Nantes*, CNRS, INSERM, 44000, Nantes, France
| | - Jean-Luc Fellahi
- Department of Cardiothoracic Anaesthesiology and Critical Care, Louis Pradel University Hospital, Lyon, France
| | - Pascal Lim
- Cardiology department, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - François Labaste
- Department of Anaesthesiology and Critical Care Medicine, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Cardiology Department INI-CRT PhyMedExp INSERM, CNRS CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Philippe Mauriat
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
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15
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Karsenty C, Touafchia A, Ladouceur M, Roubille F, Bonnefoy E, Bonello L, Leurent G, Levy B, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Combaret N, Morel O, Lattuca B, Leborgne L, Fillippi E, Gerbaud E, Brusq C, Bongard V, Lamblin N, Puymirat E, Delmas C. Cardiogenic shock in adults with congenital heart disease: Insights from the FRENSHOCK registry. Arch Cardiovasc Dis 2023; 116:390-396. [PMID: 37598062 DOI: 10.1016/j.acvd.2023.06.008] [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: 04/12/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Data on cardiogenic shock in adults with congenital heart disease (ACHD) are scarce. AIM We sought to describe cardiogenic shock in ACHD patients in a nationwide cardiogenic shock registry. METHODS From the multicentric FRENSHOCK registry (772 patients with cardiogenic shock from 49 French centres between April and October 2016), ACHD patients were compared with adults without congenital heart disease (non-ACHD). The primary outcome was defined by all-cause mortality, chronic ventricular assist device or heart transplantation at 1year. RESULTS Out of the 772 patients, seven (0.9%) were ACHD, who were younger (median age: 56 vs. 67years), had fewer cardiovascular risk factors, such as hypertension (14.3% vs. 47.5%) and diabetes (14.3% vs. 28.3%), and no previous ischaemic cardiopathy (0 vs. 61.5%). Right heart catheterization (57.1% vs. 15.4%), pacemakers (28.6% vs. 4.6%) and implantable cardioverter-defibrillators (28.6% vs. 4.8%) were indicated more frequently in the management of ACHD patients compared with non-ACHD patients, whereas temporary mechanical circulatory support (0 vs. 18.7%) and invasive mechanical ventilation (14.3% vs. 38.1%) were less likely to be used in ACHD patients. At 1year, the primary outcome occurred in 85.7% (95% confidence interval: 42.1-99.6) ACHD patients and 52.3% (95% confidence interval: 48.7-55.9) non-ACHD patients. Although 1-year mortality was not significantly different between ACHD patients (42.9%) and non-ACHD patients (45.4%), ventricular assist devices and heart transplantation tended to be more frequent in the ACHD group. CONCLUSIONS Cardiogenic shock in ACHD patients is rare, accounting for only 0.9% of an unselected cardiogenic shock population. Despite being younger and having fewer co-morbidities, the prognosis of ACHD patients with cardiogenic shock remains severe, and is similar to that of other patients.
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Affiliation(s)
- Clément Karsenty
- Paediatric and Adult Congenital Cardiology Unit, CHU de Toulouse, 31300 Toulouse, France; Institut Des Maladies Métaboliques et Cardiovasculaires (I2MC), Inserm U1048, 31432 Toulouse, France.
| | - Anthony Touafchia
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France
| | - Magalie Ladouceur
- Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, Inserm, CNRS, 34295 Montpellier, France; Cardiology Department, CHU de Montpellier, 34295 Montpellier, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon University Hospital, 69622 Bron, France
| | - Laurent Bonello
- Aix-Marseille University, 13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Hôpital Nord, AP-HM, 13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13385 Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU de Rennes, 35000 Rennes, France; LTSI-UMR 1099, Inserm, University of Rennes 1, 35000 Rennes, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, 54511 Vandœuvre-les Nancy, France
| | | | - Pascal Lim
- Université Paris-Est Créteil, Inserm, IMRB, 94010 Créteil, France; Service de Cardiologie, Hôpital Universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, AP-HP, 75014 Paris, France; Medical School, Centre-Université de Paris, 75014 Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix-en-Provence, 13616 Aix-en-Provence, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, CHU de la Timone 2, Aix-Marseille Université, 13385 Marseille, France
| | | | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 69004 Lyon, France; University of Lyon, CREATIS UMR 5220, Inserm U1044, INSA-15, 69100 Lyon, France
| | - Gérald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | | | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie-Réanimation Chirurgicale-Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, 67091 Strasbourg, France
| | - Nicolas Combaret
- Department of Cardiology, CHU de Clermont-Ferrand, CNRS, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30900 Nîmes, France
| | | | | | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, 33600 Pessac, France
| | - Clara Brusq
- Unité de Soutien Méthodologique à la Recherche (USMR), Service d'Épidémiologie Clinique et Santé Publique, CHU de Toulouse, 31300 Toulouse, France
| | - Vanina Bongard
- Unité de Soutien Méthodologique à la Recherche (USMR), Service d'Épidémiologie Clinique et Santé Publique, CHU de Toulouse, 31300 Toulouse, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, Inserm U1167, University of Lille, 59000 Lille, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Clément Delmas
- Paediatric and Adult Congenital Cardiology Unit, CHU de Toulouse, 31300 Toulouse, France; Institut Des Maladies Métaboliques et Cardiovasculaires (I2MC), Inserm U1048, 31432 Toulouse, France; REICATRA, Institut Saint-Jacques, CHU de Toulouse, 31059 Toulouse, France
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16
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Gaze MN, Smeulders N, Ackwerh R, Allen C, Bal N, Boutros M, Cho A, Eminowicz G, Gill E, Fittall MW, Humphries PD, Lim P, Mushtaq I, Nguyen T, Peet C, Pendse D, Polhill S, Rees H, Sands G, Shankar A, Slater O, Sullivan T, Hoskin PJ. A National Referral Service for Paediatric Brachytherapy: An Evolving Practice and Outcomes Over 13 Years. Clin Oncol (R Coll Radiol) 2023; 35:237-244. [PMID: 36588012 DOI: 10.1016/j.clon.2022.12.008] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023]
Abstract
AIMS Most children requiring radiotherapy receive external beam treatment and few have tumours suitable for brachytherapy. No paediatric radiotherapy centre will treat enough patients from its own normal catchment population for expertise in brachytherapy to be developed and sustained. Following discussion and agreement in the national paediatric radiotherapy group, a service for paediatric brachytherapy in the UK has been developed. We report the process that has evolved over more than 10 years, with survival and functional outcome results. MATERIALS AND METHODS Since 2009, potential patients have been referred to the central paediatric oncology multidisciplinary team meeting, where imaging, pathology and treatment options are discussed. Since 2013, the National Soft Tissue Sarcoma Advisory Panel has also reviewed most patients, with the principal aim of advising on the most suitable primary tumour management for complex patients. Clinical assessment and examination under anaesthetic with biopsies may be undertaken to confirm the appropriateness of brachytherapy, either alone or following conservative surgery. Fractionated high dose rate brachytherapy was delivered to a computed tomography planned volume after implantation of catheters under ultrasound imaging guidance. Since 2019, follow-up has been in a dedicated multidisciplinary clinic. RESULTS From 2009 to 2021 inclusive, 35 patients (16 female, 19 male, aged 8 months to 17 years 6 months) have been treated. Histology was soft-tissue sarcoma in 33 patients and carcinoma in two. The treated site was pelvic in 31 patients and head and neck in four. With a median follow-up of 5 years, the local control and overall survival rates are 100%. Complications have been few, and functional outcome is good. CONCLUSION Brachytherapy is effective for selected paediatric patients, resulting in excellent tumour control and good functional results. It is feasible to deliver paediatric brachytherapy at a single centre within a national referral service.
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Affiliation(s)
- M N Gaze
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - N Smeulders
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Ackwerh
- University College London Hospitals NHS Foundation Trust, London, UK
| | - C Allen
- University College London Hospitals NHS Foundation Trust, London, UK
| | - N Bal
- University College London Hospitals NHS Foundation Trust, London, UK
| | - M Boutros
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Cho
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - G Eminowicz
- University College London Hospitals NHS Foundation Trust, London, UK
| | - E Gill
- University College London Hospitals NHS Foundation Trust, London, UK
| | - M W Fittall
- University College London Hospitals NHS Foundation Trust, London, UK
| | - P D Humphries
- University College London Hospitals NHS Foundation Trust, London, UK
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - I Mushtaq
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - T Nguyen
- University College London Hospitals NHS Foundation Trust, London, UK
| | - C Peet
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Pendse
- University College London Hospitals NHS Foundation Trust, London, UK
| | - S Polhill
- University College London Hospitals NHS Foundation Trust, London, UK
| | - H Rees
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - G Sands
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Shankar
- University College London Hospitals NHS Foundation Trust, London, UK
| | - O Slater
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - T Sullivan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - P J Hoskin
- University College London Hospitals NHS Foundation Trust, London, UK
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17
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Lim P, Sharifi J, Huguet R, Gallet R, Aouate D. Repetitive Use of Levosimendan in Severe Functional Tricuspid Regurgitation. Eur Heart J Acute Cardiovasc Care 2023; 12:336-337. [PMID: 36989396 DOI: 10.1093/ehjacc/zuad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Pascal Lim
- Cardiac Intensive Care Unit and Cardiology Department, AP-HP, Henri Mondor University Hospital, Creteil, France; UPEC, Institut Mondor de Recherche Biomédicale, U955 Inserm
| | - Julia Sharifi
- Cardiac Intensive Care Unit and Cardiology Department, AP-HP, Henri Mondor University Hospital, Creteil, France; UPEC, Institut Mondor de Recherche Biomédicale, U955 Inserm
| | - Raphaelle Huguet
- Cardiac Intensive Care Unit and Cardiology Department, AP-HP, Henri Mondor University Hospital, Creteil, France; UPEC, Institut Mondor de Recherche Biomédicale, U955 Inserm
| | - Romain Gallet
- Cardiac Intensive Care Unit and Cardiology Department, AP-HP, Henri Mondor University Hospital, Creteil, France; UPEC, Institut Mondor de Recherche Biomédicale, U955 Inserm
| | - David Aouate
- Cardiac Intensive Care Unit and Cardiology Department, AP-HP, Henri Mondor University Hospital, Creteil, France; UPEC, Institut Mondor de Recherche Biomédicale, U955 Inserm
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18
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Hamon D, Moulin T, Nicolas E, Labbé JP, Ternacle J, Huguet R, Lim P, Derumeaux G, Teiger E, Miller JM, Lellouche N. Usefulness of Doppler Transthoracic Echocardiography for the Diagnosis of Wide QRS Complex Tachycardia. J Am Soc Echocardiogr 2023:S0894-7317(23)00140-2. [PMID: 36931577 DOI: 10.1016/j.echo.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Affiliation(s)
- David Hamon
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France; University of Iowa Hospitals and Clinics (UIHC), Department of Cardiology, Carver college of Medicine, Iowa City, Iowa.
| | - Thibaut Moulin
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France
| | - Eroan Nicolas
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France
| | - Jean-Philippe Labbé
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France; Saint Camille Hospital, Department of Cardiology, Bry sur Marne, France
| | - Julien Ternacle
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France
| | - Raphaelle Huguet
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France
| | - Pascal Lim
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France
| | - Geneviève Derumeaux
- AP-HP, University Hospital Henri Mondor, Department of Physiology, FHU SENEC, Creteil, France
| | - Emmanuel Teiger
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France
| | - John M Miller
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicolas Lellouche
- AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France
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19
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Dreyfus J, Bohbot Y, Coisne A, Lavie-Badie Y, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, Mbaki Y, Eyharts D, Sénage T, Modine T, Nicol M, Doguet F, Le Tourneau T, Tribouilloy C, Donal E, Tomasi J, Habib G, Selton-Suty C, Radu C, Lim P, Raffoul R, Iung B, Obadia JF, Audureau E, Messika-Zeitoun D. Predictive value of the TRI-SCORE for in-hospital mortality after redo isolated tricuspid valve surgery. Heart 2023; 109:951-958. [PMID: 36828623 DOI: 10.1136/heartjnl-2022-322167] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES The TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores. METHODS Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated. RESULTS We identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure. CONCLUSION Redo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Yohann Bohbot
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Augustin Coisne
- Department of Echocardiography and Cardiovascular Explorations, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Yoan Lavie-Badie
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Michele Flagiello
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | - Baptiste Bazire
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | | | - Florence Viau
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | - Elisabeth Riant
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France.,Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Yannick Mbaki
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Damien Eyharts
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Thomas Sénage
- Cardiac Surgery Department, University Hospital Centre Nantes, Nantes, France
| | - Thomas Modine
- Cardiac Surgery Department, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Martin Nicol
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Fabien Doguet
- Cardiac Surgery Department, University Hospital Centre Rouen, Rouen, France
| | | | - Christophe Tribouilloy
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Erwan Donal
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Jacques Tomasi
- Cardiac Surgery Department, University Hospital Centre Rennes, Rennes, France
| | - Gilbert Habib
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | | | - Costin Radu
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Pascal Lim
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Richard Raffoul
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | | | - David Messika-Zeitoun
- Cardiology Department, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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20
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Cherbi M, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Aissaoui N, Combaret N, Tomasevic D, Marchandot B, Lattuca B, Henry P, Gerbaud E, Bonnefoy E, Puymirat E, Maury P, Delmas C. One-year outcomes in cardiogenic shock triggered by ventricular arrhythmia: An analysis of the FRENSHOCK multicenter prospective registry. Front Cardiovasc Med 2023; 10:1092904. [PMID: 36776263 PMCID: PMC9909601 DOI: 10.3389/fcvm.2023.1092904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Background Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers remains unclear. The aim of this study was to evaluate 1-year outcomes [mortality, heart transplantation, ventricular assist devices (VAD)] between VA-triggered and non-VA-triggered CS. Methods FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. One to three triggers can be identified in the registry (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance). Baseline characteristics, management and 1-year outcomes were analyzed according to the VA-trigger in the CS population. Results Within 769 CS patients included, 94 were VA-triggered (12.2%) and were compared to others. At 1 year, although there was no mortality difference [42.6 vs. 45.3%, HR 0.94 (0.67-1.30), p = 0.7], VA-triggered CS resulted in more heart transplantations and VAD (17 vs. 9%, p = 0.02). Into VA-triggered CS group, though there was no 1-year mortality difference between ischemic and non-ischemic cardiomyopathies [42.5 vs. 42.6%, HR 0.97 (0.52-1.81), p = 0.92], non-ischemic cardiomyopathy led to more heart transplantations and VAD (25.9 vs. 5%, p = 0.02). Conclusion VA-triggered CS did not show higher mortality compared to other triggers but resulted in more heart transplantation and VAD at 1 year, especially in non-ischemic cardiomyopathy, suggesting the need for earlier evaluation by advanced heart failure specialized team for a possible indication of mechanical circulatory support or heart transplantation. Clinical trial registration https://clinicaltrials.gov, identifier NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Bonello
- Aix-Marseille Université, Marseille, France,Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Nancy, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | | | - Pascal Lim
- Université Paris Est-Créteil, INSERM, IMRB, Créteil, France,AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre–Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d’Aix-en-Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Aix-Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France,Department of Cardiology, University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, Grenoble, France
| | - Charlotte Quentin
- Service de Réanimation Polyvalente, Centre Hospitalier Broussais, 1 Rue de la Marne, Saint-Malo, France
| | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie–Réanimation Chirurgicale–Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l’Hôpital, Strasbourg, France
| | - Nadia Aissaoui
- Intensive Cardiac Care Unit, Department of Cardiology, CH d’Aix-en-Provence, Aix-en-Provence, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Patrick Henry
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Department of Cardiology, Paris, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France,Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France,Université de Paris, Paris, France
| | - Philippe Maury
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France,REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France,*Correspondence: Clément Delmas, ,
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21
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Gaze M, Smeulders N, Sands G, Sullivan T, Bal N, Gill E, Peet C, Slater O, Rees H, Nguyen T, Humphries P, Pendse D, Allen C, Polhill S, Ackwerh R, Lim P, Eminowicz G, Hoskin P. Establishment of a UK national referral service for paediatric brachytherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Teiger E, Nejjari M, Lim P, Ruf T, Blanke P, Schäfer U, Treede H, Gallet R, Dreyfus J. First-in-human implantation of the Topaz transcatheter tricuspid valve replacement system. EUROINTERVENTION 2022; 18:862-864. [PMID: 35971661 PMCID: PMC9724900 DOI: 10.4244/eij-d-22-00277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/23/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Emmanuel Teiger
- Cardiology Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Pascal Lim
- Cardiology Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Tobias Ruf
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Johannes Gutenberg Universität, Mainz, Germany
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
| | - Ulrich Schäfer
- Department of Internal Medicine, Marienkrankenhaus, Hamburg, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, University Hospital Mainz, Mainz, Germany
| | - Romain Gallet
- Cardiology Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
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Pritchard A, Altas M, Tinker A, Kong I, Goddard K, Lim P, Hamilton S. Long-Term Toxicities of Adolescent and Young Adult Survivors of Cervix Cancer Who Underwent Radiation Therapy: A Cross-Sectional Analysis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1704] [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: 10/31/2022]
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Suhail D, Smith O, Lim P, Chintapatla S. P-066 ABDOMINAL WALL RECONSTRUCTION FOLLOWING FULL THICKNESS BILATERAL RUPTURE OF THE RECTUS ABDOMINIS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.164] [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: 11/14/2022]
Abstract
Abstract
Introduction
Rupture of the rectus abdominis is rare injury with no consensus on management. Previous reported cases have been due to exercise-related injuries and blunt abdominal trauma. We report the case of a 20-year-old male trainee paratrooper who presented with severe lower abdominal pain that occurred during military training. MRI revealed full-thickness bilateral rupture of the rectus abdominis. Abdominal wall reconstruction involved bilateral rectus muscle repair and placement of a biosynthetic mesh in the retrorectus plane. Postoperatively, our patient could walk pain-free at 3 weeks, jog pain-free at 10 weeks, and run up to 2 miles at 25 weeks.
Methods
Pubmed, Medline and Embase were searched to identify relevant studies using the MeSH terms, “rectus abdominis” and “rupture”, as well as their free text counterparts and synonyms. Texts were restricted to publications in English and publications after the year 2000. The search resulted in 391 articles. Manual cross-referencing was performed, limiting the included articles to 8 for review.
Results
6 out of the 8 selected articles discussed management using conservative means, while only 2 cases were managed surgically. Interestingly, no other exercise-related cases in the literature were managed surgically. Instead, all exercise related cases were managed conservatively, while only cases of traumatic aetiology were managed surgically. Among both surgically and conservatively treated patients, none suffered any treatment related complications, and all patients returned to normal levels of activity.
Conclusion
Full-thickness, bilateral rupture of the rectus abdominis can occur during exercise. Surgical and conservative treatment yield similar results.
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Affiliation(s)
- D Suhail
- Plastic Surgery, York Teaching Hospital , York , United Kingdom
| | - O Smith
- Plastic Surgery, York Teaching Hospital , York , United Kingdom
| | - P Lim
- Plastic Surgery, York Teaching Hospital , York , United Kingdom
| | - S Chintapatla
- General Surgery, York Teaching Hospital , York , United Kingdom
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Lim P, Le Maistre M, Campanini LB, De Roux Q, Mongardon N, Landon V, Bouguerra H, Aouate D, Woerther PL, Vincent F, Galy A, Tacher V, Galien S, Ennezat PV, Fiore A, Folliguet T, Huguet R, Mekontso-Dessap A, Iung B, Lepeule R. Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis. J Clin Med 2022; 11:jcm11195523. [PMID: 36233404 PMCID: PMC9573652 DOI: 10.3390/jcm11195523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose: Post-operative vasoplegic syndrome is a dreaded complication in infective endocarditis (IE). Methods and Results: This retrospective study included 166 consecutive patients referred to cardiac surgery for non-shocked IE. Post-operative vasoplegic syndrome was defined as a persistent hypotension (mean blood pressure < 65 mmHg) refractory to fluid loading and cardiac output restoration. Cardiac surgery was performed 7 (5−12) days after the beginning of antibiotic treatment, 4 (1−9) days after negative blood culture and in 72.3% patients with adapted anti-biotherapy. Timing of cardiac surgery was based on ESC guidelines and operating room availability. Most patients required valve replacement (80%) and cardiopulmonary bypass (CPB) duration was 106 (95−184) min. Multivalvular surgery was performed in 43 patients, 32 had tricuspid valve surgery. Post-operative vasoplegic syndrome was reported in 53/166 patients (31.9%, 95% confidence interval of 24.8−39.0%) of the whole population; only 15.1% (n = 8) of vasoplegic patients had a post-operative documented infection (6 positive blood cultures) and no difference was reported between vasoplegic and non-vasoplegic patients for valve culture and the timing of cardiac surgery. Of the 23 (13.8%) in hospital-deaths, 87.0% (n = 20) occurred in the vasoplegic group and the main causes of death were multiorgan failure (n = 17) and neurological complications (n = 3). Variables independently associated with vasoplegic syndrome were CPB duration (1.82 (1.16−2.88) per tertile) and NTproBNP level (2.11 (1.35−3.30) per tertile). Conclusions: Post-operative vasoplegic syndrome is frequent and is the main cause of death after IE cardiac surgery. Our data suggested that the mechanism of vasoplegic syndrome was more related to inflammatory cardiovascular injury rather than the consequence of ongoing bacteremia.
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Affiliation(s)
- Pascal Lim
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
- Correspondence:
| | - Margaux Le Maistre
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Lucas Benoudiba Campanini
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Quentin De Roux
- Service d’anesthésie-Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Nicolas Mongardon
- Service d’anesthésie-Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Valentin Landon
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Hassina Bouguerra
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - David Aouate
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Paul-Louis Woerther
- Laboratoire de Bactériologie et Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Fihman Vincent
- Laboratoire de Bactériologie et Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Adrien Galy
- Unité Transversale de Traitement des Infections, DMU PDTI, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Vania Tacher
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Sébastien Galien
- Service de Maladies Infectieuses et Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Pierre-Vladimir Ennezat
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Antonio Fiore
- Service de Chirurgie Cardiaque, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Thierry Folliguet
- Service de Chirurgie Cardiaque, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Raphaelle Huguet
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive Réanimation, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Bernard Iung
- Service de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Bichat et Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75018 Paris, France
| | - Raphael Lepeule
- Unité Transversale de Traitement des Infections, DMU PDTI, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
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Moore K, Oza A, Colombo N, Oaknin A, Scambia G, Lorusso D, Banerjee S, Murphy C, Konner J, Lim P, Prasad-Hayes M, Monk B, Wang J, Birrer M, Vergote I. 532P Analyses of patient-reported outcomes (PROs) with mirvetuximab soravtansine (MIRV) versus standard chemotherapy in the randomized phase III FORWARD I study in ovarian cancer (GOG 3011). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.660] [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: 11/01/2022] Open
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Lee-A-Ping K, Chintapatla S, Chitsabesan P, Lim P, MacLeod T. 602 Using Plastic Surgery Techniques in Abdominal Wall Surgery. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.141] [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: 11/05/2022]
Abstract
Abstract
Complex Abdominal Wall Hernias (CAWH) present a huge challenge to surgeons and patients often requiring Abdominal Wall Reconstruction (AWR). AWR aims to restore abdominal wall anatomy, improve function, and reduce the risk of future herniation. Plastic surgery techniques can be used including primary closure, skin grafts, flaps, tissue expansion and small bite, small stitch technique. Below are two cases where some of these techniques were utilised.
Case 1
LC is a 65 y/o female with CAWH. Her gastric band became infected requiring a laparotomy for perforation of gastroesophageal junction. She subsequently had primary open repair of abdominal hernia using Permacol. It became infected requiring 5 debridements and application of a VAC device. Her hernia was a Ventral Hernia Working Group (VHWG) grade 3 at 10cm×16cm. Her CAWH was repaired using a Rives-Stoppa technique and a Surgimend mesh. The epigastric component of her wound was closed using a superiorly based local rhomboid flap and a Prevena VAC dressing.
Case 2
KH is a 37 y/o female with a para-ileal conduit skin granuloma that was painful and refractory to other treatments such as silver nitrate and steroid topical treatments. She had excision of the area of granulation and her wound was closed using a local advancement flap taking account of previous scars raised and a prevena VAC dressing.
Discussion
CAWH requiring AWR is a complex operation benefiting from plastic surgical specialists. Plastic surgical techniques can help with closure of the abdominal wall and reduce complication rates including wound infections and incisional hernia.
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Affiliation(s)
- K Lee-A-Ping
- York and Scarborough Teaching Hospitals NHS Foundation Trust , York , United Kingdom
| | - S Chintapatla
- York and Scarborough Teaching Hospitals NHS Foundation Trust , York , United Kingdom
| | - P Chitsabesan
- York and Scarborough Teaching Hospitals NHS Foundation Trust , York , United Kingdom
| | - P Lim
- York and Scarborough Teaching Hospitals NHS Foundation Trust , York , United Kingdom
| | - T MacLeod
- York and Scarborough Teaching Hospitals NHS Foundation Trust , York , United Kingdom
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Veiga C, Cantwell J, Ahmad R, Lim P, D'Souza D, Gaze M, Moinuddin S, Gains J. PO-1789 Quantitative evaluation of whole-body spatial normalisation in paediatric patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Silva I, Szmul A, Cantwell J, Lim P, D’Souza D, Moinuddin S, Alves V, Gains J, Veiga C. PO-1616 Evaluation of deep learning-based OAR segmentation in paediatric radiotherapy settings. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Szmul A, Taylor S, Lim P, Cantwell J, D’Souza D, Moinuddin S, Gaze M, Gains J, Veiga C. OC-0773 CBCT-to-CT synthesis using weakly-paired cycle-consistent generative adversarial networks. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02679-2] [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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Taylor S, Lim P, Cantwell J, D’Souza D, Moinuddin S, Ching-Chang Y, Gaze M, Gains J, Veiga C. OC-0786 Surface imaging to track inter-fractional anatomical variation in paediatric abdominal radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02692-5] [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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Delmas C, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Danchin N, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Aissaoui N, Combaret N, Manzo-Silberman S, Tomasevic D, Marchandot B, Lattuca B, Henry P, Gerbaud E, Bonnefoy E, Puymirat E. Baseline characteristics, management, and predictors of early mortality in cardiogenic shock: insights from the FRENSHOCK registry. ESC Heart Fail 2021; 9:408-419. [PMID: 34973047 PMCID: PMC8788015 DOI: 10.1002/ehf2.13734] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Aims Published data on cardiogenic shock (CS) are scarce and are mostly focused on small registries of selected populations. The aim of this study was to examine the current CS picture and define the independent correlates of 30 day mortality in a large non‐selected cohort. Methods and results FRENSHOCK is a prospective multicentre observational survey conducted in metropolitan French intensive care units and intensive cardiac care units between April and October 2016. There were 772 patients enrolled (mean age 65.7 ± 14.9 years; 71.5% male). Of these patients, 280 (36.3%) had ischaemic CS. Organ replacement therapies (respiratory support, circulatory support or renal replacement therapy) were used in 58.3% of patients. Mortality at 30 days was 26.0% in the overall population (16.7% to 48.0% depending on the main cause and first place of admission). Multivariate analysis showed that six independent factors were associated with a higher 30 day mortality: age [per year, odds ratio (OR) 1.06, 95% confidence interval (CI): 1.04–1.08], diuretics (OR 1.74, 95% CI: 1.05–2.88), circulatory support (OR 1.92, 95% CI: 1.12–3.29), left ventricular ejection fraction <30% (OR 2.15, 95% CI: 1.40–3.29), norepinephrine (OR 2.55, 95% CI: 1.69–3.84), and renal replacement therapy (OR 2.72, 95% CI: 1.65–4‐49). Conclusions Non‐ischaemic CS accounted for more than 60% of all cases of CS. CS is still associated with significant but variable short‐term mortality according to the cause and first place of admission, despite frequent use of haemodynamic support, and organ replacement therapies.
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Affiliation(s)
- Clement Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, Toulouse, 31059, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Bonello
- Aix-Marseille Université; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, Nancy, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, Toulouse, 31059, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Aix Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France, University of Lyon, CREATIS UMR5220; INSERM U1044; INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, Grenoble, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, Saint-Malo, France
| | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie-Réanimation chirurgicale-Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l'Hôpital, Strasbourg, France
| | - Nadia Aissaoui
- Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Patrick Henry
- Department of Cardiology, Université de Paris, Hôpital Lariboisière, AP-HP, Paris, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
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Dixit Y, Hitchman S, Hicks T, Lim P, Wong C, Holibar L, Gordon K, Loeffen M, Farouk M, Craigie C, Reis M. Non-invasive spectroscopic and imaging systems for prediction of beef quality in a meat processing pilot plant. Meat Sci 2021; 181:108410. [DOI: 10.1016/j.meatsci.2020.108410] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
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Urban R, Wong J, Lim P, Zhang S, Spadinger I, Olson R, Bachand F, Ho C, Tinker A, Lovedeep G, Hamilton S. Cervical Cancer Patient Reported Gastrointestinal Outcomes: Intensity/Volumetric Modulated vs. 3D Conformal Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lim P, Delmas C, Sanchez O, Meneveau N, Rosario R, Bouvaist H, Bernard A, Mansourati J, Couturaud F, Sebbane M, Coste P, Rohel G, Tardy B, Biendel C, Lairez O, Ivanes F, Gallet R, Dubois-Rande JL, Fard D, Chatelier G, Simon T, Paul M, Natella PA, Layese R, Bastuji-Garin S. Diuretic vs. placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trial. Eur Heart J Acute Cardiovasc Care 2021; 11:2-9. [PMID: 34632490 DOI: 10.1093/ehjacc/zuab082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/01/2021] [Indexed: 11/12/2022]
Abstract
AIMS The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we randomly assigned normotensive patients with intermediate-risk PE to receive either a single 80 mg bolus of furosemide or a placebo. METHODS AND RESULTS Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all sPESI items. Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac arrest, mechanical ventilation, or need of catecholamine. A total of 276 patients underwent randomization; 135 were assigned to receive the diuretic, and 141 to receive the placebo. The primary outcome occurred in 68/132 patients (51.5%) in the diuretic and in 49/132 (37.1%) in the placebo group (relative risk = 1.30, 95% confidence interval 1.04-1.61; P = 0.021). Major adverse outcome at 48 h occurred in 1 (0.8%) patients in the diuretic group and 4 patients (2.9%) in the placebo group (P = 0.19). Increase in serum creatinine level was greater in diuretic than placebo group [+4 µM/L (-2; 14) vs. -1 µM/L (-11; 6), P < 0.001]. CONCLUSION In normotensive patients with intermediate-risk PE, a single bolus of furosemide improved the primary efficacy outcome at 24 h and maintained stable renal function. In the furosemide group, urine output increased, without a demonstrable improvement in heart rate, systolic blood pressure, or arterial oxygenation.ClinicalTrials.gov identifier NCT02268903.
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Affiliation(s)
- Pascal Lim
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | | | - Olivier Sanchez
- Université de Paris, Paris, France.,Division of Respiratory and Intensive Care, AP-HP, Hôpital Europèen Georges Pompidou, Paris, France.,INSERM UMR-S 1140, Innovative Therapies in Haemostasis, Paris, France
| | - Nicolas Meneveau
- Cardiology Department, Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Roger Rosario
- Cardiology Department, Hôpital Saint-Joseph, Marseille, France
| | | | - Anne Bernard
- Cardiology Department, CHU, Tours, France and EA4245, Université de Tours, France
| | - Jacques Mansourati
- Respiratory Department, CHRU de la Cavale Blanche, Brest, France and University Hospital of Brest and UBO (Université de Bretagne Occidentale)
| | - Francis Couturaud
- Respiratory Department, CHRU de la Cavale Blanche, Brest, France and University Hospital of Brest and UBO (Université de Bretagne Occidentale)
| | | | - Pierre Coste
- Cardiology Department, Bordeaux University Hospital, France
| | - Gwenole Rohel
- Cardiology Department, Military Hospital of Clermont Tonnerre, Brest, France
| | - Bernard Tardy
- Emergency Department, CHU Saint Etienne, Saint Pirest en Jarez, France
| | | | | | - Fabrice Ivanes
- Cardiology Department, CHU, Tours, France and EA4245, Université de Tours, France
| | - Romain Gallet
- Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Emergency Department, CHRU Lapeyronie, Montpellier, France
| | - Jean-Luc Dubois-Rande
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Damien Fard
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Gilles Chatelier
- Clinical Research Department, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Tabassome Simon
- Cinical Pharmacology, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Muriel Paul
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,AP-HP Hôpitaux Universitaires Henri-Mondor, Clinical Pharmacology, Créteil F-94010, France
| | - Pierre-André Natella
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Public Health, AP-HP Hôpitaux Universitaires Henri-Mondor, Creteil F-94010, France
| | - Richard Layese
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France
| | - Sylvie Bastuji-Garin
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Public Health, AP-HP Hôpitaux Universitaires Henri-Mondor, Creteil F-94010, France
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36
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Lim P, Damola A, Apakama I. 688 Cancellation Rate of Prostate Template Biopsy: Are There Any Merits to Implementing Pre-Operative Bowel Preparations? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1090] [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: 11/14/2022]
Abstract
Abstract
Introduction
The aim of this quality improvement project was to analyse the cancellation rates of the template biopsy done at the George Eliot Hospital. The focus was mainly on those due to poor bowel prep whereby manual evacuations have failed. Locally we have sometimes noted the failure rate of transperineal prostate biopsy as a result of the poor quality of the ultrasound due to inadequately evacuated rectum. Unfortunately, there are very limited studies which have looked into this issue hence the significance of this problem is not universally acknowledged.
Method
Retrospective review of all the template biopsies that were planned from April 2019 to April 2020 using the operation notes and local theatre management software.
Results
There was a total of 105 planned template biopsies from April 2019 to April 2020. 72 cases were attempted and within this, 7 of these cases required manual evacuations in which 3 resulted in abandonment of procedure. There were 33 cases which were cancelled due various other reasons.
Conclusions
The results showed that the failure rates due to poor bowel prep were not significant (4%). Based on these findings we have decided not to proceed with the implementation of pre-operative bowel prep with phosphate enema as we felt that the potential benefits were not enough for it be initiated as a routine practice. We aim to address the other reasons identified for cancellations.
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Affiliation(s)
- P Lim
- George Eliot Hospital, Nuneaton, United Kingdom
| | - A Damola
- George Eliot Hospital, Nuneaton, United Kingdom
| | - I Apakama
- George Eliot Hospital, Nuneaton, United Kingdom
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Jamme M, Oliver L, Ternacle J, Lepeule R, Moussafeur A, Haymann JP, San S, Fiore A, Mongardon N, Daudon M, Lim P, Letavernier E. Amoxicillin crystalluria is associated with acute kidney injury in patients treated for acute infective endocarditis. Nephrol Dial Transplant 2021; 36:1955-1958. [PMID: 33848352 DOI: 10.1093/ndt/gfab074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/21/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthieu Jamme
- Urgence Néphrologique et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
- Centre de Recherche en Epidémiologie et Santé des Populations, Equipe "Epidemiologie Clinique", INSERM U1018, Université Paris Saclay, Villejuif, France
| | - Leopold Oliver
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Julien Ternacle
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Raphael Lepeule
- Unité SOS Endocardite, Equipe Mobile D'infectiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Amina Moussafeur
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Jean-Philippe Haymann
- Explorations Fonctionnelles Rénales, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM, Paris, France
| | - Sovannarith San
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Antonio Fiore
- Unité SOS Endocardite, Service de Chirurgie Cardiaque, Hôpital Henri Mondor, APHP, Créteil, France
| | - Nicolas Mongardon
- Unité SOS Endocardite, Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, APHP, Créteil, France
| | - Michel Daudon
- Explorations Fonctionnelles Rénales, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM, Paris, France
| | - Pascal Lim
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Emmanuel Letavernier
- Explorations Fonctionnelles Rénales, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM, Paris, France
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38
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Siméon S, Galy A, Woerther P, Fihman V, Gallien S, Deux J, Gomart C, Huguet R, Lim P, Lepeule R. Existe-t-il encore des endocardites infectieuses non documentées microbiologiquement ? Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Moulin T, Landes R, Ouazana V, Abehsira G, Lim P, Huguet R, Damy T, Teiger E, Lellouche N, Hamon D. Severe Heart Failure Associated With Tachycardia-Induced Cardiomyopathy Due to Incessant Atrioventricular Re-Entrant Tachycardia. JACC Case Rep 2021; 3:479-483. [PMID: 34317562 PMCID: PMC8311047 DOI: 10.1016/j.jaccas.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
Short RP interval atrioventricular re-entrant tachycardias do not typically present as an incessant form. We present 2 cases of incessant atrioventricular re-entrant tachycardias leading to tachycardia-induced cardiomyopathy with severe heart failure presentation in middle-aged adults. Both underwent accessory pathway ablation and recovered normal left ventricle function before hospital discharge. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Thibaut Moulin
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Rosanna Landes
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Victoria Ouazana
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Guillaume Abehsira
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Pascal Lim
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Raphaelle Huguet
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Thibaud Damy
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Emmanuel Teiger
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - Nicolas Lellouche
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | - David Hamon
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France
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40
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Koutsoukis A, Nahory L, Deguillard C, Juguet W, Nguyen A, Fard D, Folliguet T, Fiore A, Bergoend E, Gallet R, Mouillet G, Derumeaux G, Vincent F, Teiger E, Lim P, Ternacle J. Timing of aortic valve replacement in high-gradient severe aortic stenosis: impact of left ventricular ejection fraction. Acta Cardiol 2021; 76:517-524. [PMID: 33283639 DOI: 10.1080/00015385.2020.1851495] [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: 10/22/2022]
Abstract
BACKGROUND Patients with high-gradient (HG) severe aortic stenosis (AS) and left ventricular (LV) dysfunction are at high risk of death. The optimal timing for aortic valve replacement (AVR) is not defined by guidelines. The objective was to define the optimal timing to perform isolated AVR in patients with HG-AS and severe LV dysfunction. METHODS We retrospectively included 233 consecutive patients admitted for severe HG-AS (aortic valve area <1cm2 and mean gradient ≥40mmHg). Severe LV dysfunction was defined by LV ejection fraction ≤35% (LVEF). All-cause mortality while waiting for AVR and after the intervention (30 days) was compared in patients with (n = 28) and without (n = 205) LVEF ≤35%. RESULTS Patients with HG-AS and severe LV dysfunction had a higher risk profile than those with LVEF >35%. AVR was performed in 93% (218/233) of patients, 41% by surgery (SAVR) and 53% by transcatheter (TAVR). TAVR was the preferred method to treat HG-AS patients with LVEF ≤35%. All-cause mortality while waiting for AVR was higher in patients with severe LV dysfunction (22% vs. 2.0%, p < 0.001) and occurred within a shorter time (12 [8-26] days vs. 63 [58-152] days, p = 0.010) compared to those with LVEF >35%. All death in HG-AS patients with a severe LV dysfunction occurred within the first month. Postoperative mortality was low (1.3%), irrespective of LVEF. CONCLUSIONS AVR should be performed promptly after Heart Team decision in patients with HG severe AS and LVEF ≤35% because of a very high and premature risk of death while waiting for intervention.
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Affiliation(s)
- Athanasios Koutsoukis
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Louis Nahory
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Camille Deguillard
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - William Juguet
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Annabelle Nguyen
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Damien Fard
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Thierry Folliguet
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Cardiac Surgery Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Antonio Fiore
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Cardiac Surgery Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Eric Bergoend
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Cardiac Surgery Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Romain Gallet
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Gauthier Mouillet
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Genevieve Derumeaux
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Physiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Flavien Vincent
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
- Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Emmanuel Teiger
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Pascal Lim
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Julien Ternacle
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
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41
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Royer G, Roisin L, Demontant V, Lo S, Coutte L, Lim P, Pawlotsky JM, Jacquier H, Lepeule R, Rodriguez C, Woerther PL. Microdiversity of Enterococcus faecalis isolates in cases of infective endocarditis: selection of non-synonymous mutations and large deletions is associated with phenotypic modifications. Emerg Microbes Infect 2021; 10:929-938. [PMID: 33913790 PMCID: PMC8158287 DOI: 10.1080/22221751.2021.1924865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Context: Today, infective endocarditis (IE) caused by Enterococcus faecalis represents 10% of all IE and is marked by its difficult management and the frequency of relapses. Although the precise reasons for that remain to be elucidated, the evolution of the culprit strain under selective pressure through microdiversification could be, at least in part, involved. Material and methods: To further study the in situ genetic microdiversity and its possible phenotypic manifestations in E. faecalis IE, we sequenced and compared multiple isolates from the valves, blood culture and joint fluid of five patients who underwent valvular surgery. Growth rate and early biofilm production of selected isolates were also compared. Results: By sequencing a total of 58 E. faecalis genomes, we detected a considerable genomic microdiversity, not only among strains from different anatomical origins, but also between isolates from the same studied cardiac valves. Interestingly, deletions of thousands of bases including the well-known virulence factors ebpA/B/C, and srtC, as well as other large prophage sequences containing genes coding for proteins implicated in platelet binding (PlbA and PlbB) were evidenced. The study of mutations helped unveil common patterns in genes related to the cell cycle as well as central metabolism, suggesting an evolutionary convergence in these isolates. As expected, such modifications were associated with a significant impact on the in-vitro phenotypic heterogeneity, growth, and early biofilm production. Conclusion: Genome modifications associated with phenotypic variations may allow bacterial adaptation to both antibiotic and immune selective pressures, and thus promote relapses.
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Affiliation(s)
- G Royer
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,LABGeM, Génomique Métabolique, Genoscope, Institut François Jacob, CEA, CNRS, Univ Evry, Université Paris-Saclay, Evry, France
| | - L Roisin
- EA 7380, Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC Anses, Créteil, France
| | - V Demontant
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - S Lo
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - L Coutte
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - P Lim
- Department of Cardiovascular Medicine and SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - J M Pawlotsky
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - H Jacquier
- Bacteriology Unit, Lariboisière Hospital, APHP, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - R Lepeule
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - C Rodriguez
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - P L Woerther
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,EA 7380, Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC Anses, Créteil, France
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42
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Chevance V, Pigneur F, Lim P, Deux JF. Granulomatous abcess on a migrated pacemaker probe. Eur Heart J 2021; 42:4773. [PMID: 34000005 DOI: 10.1093/eurheartj/ehab231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Virgile Chevance
- APHP, CHU Henri Mondor, Service d'imagerie médicale, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - Fréderic Pigneur
- APHP, CHU Henri Mondor, Service d'imagerie médicale, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - Pascal Lim
- APHP, CHU Henri Mondor, Service de cardiologie, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - Jean-François Deux
- APHP, CHU Henri Mondor, Service d'imagerie médicale, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Créteil, France
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43
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Carteaux G, Pons M, Morin F, Tuffet S, Lesimple A, Badat B, Haudebourg AF, Perier F, Deplante Y, Guillaud C, Schlemmer F, Fois E, Mongardon N, Khellaf M, Jaffal K, Deguillard C, Grimbert P, Huguet R, Razazi K, de Prost N, Templier F, Beloncle F, Mercat A, Brochard L, Audard V, Lim P, Richard JC, Savary D, Mekontso Dessap A. Continuous positive airway pressure for respiratory support during COVID-19 pandemic: a frugal approach from bench to bedside. Ann Intensive Care 2021; 11:38. [PMID: 33655452 PMCID: PMC7924341 DOI: 10.1186/s13613-021-00828-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/18/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We describe a frugal approach (focusing on needs, performance, and costs) to manage a massive influx of COVID-19 patients with acute hypoxemic respiratory failure (AHRF) using the Boussignac valve protected by a filter ("Filter Frugal CPAP", FF-CPAP) in and out the ICU. METHODS (1) A bench study measured the impact of two filters with different mechanical properties on CPAP performances, and pressures were also measured in patients. (2) Non-ICU healthcare staff working in COVID-19 intermediate care units were trained with a video tutorial posted on a massive open online course. (3) A clinical study assessed the feasibility and safety of using FF-CPAP to maintain oxygenation and manage patients out of the ICU during a massive outbreak. RESULTS Bench assessments showed that adding a filter did not affect the effective pressure delivered to the patient. The resistive load induced by the filter variably increased the simulated patient's work of breathing (6-34%) needed to sustain the tidal volume, depending on the filter's resistance, respiratory mechanics and basal inspiratory effort. In patients, FF-CPAP achieved pressures similar to those obtained on the bench. The massive training tool provided precious information on the use of Boussignac FF-CPAP on COVID-19 patients. Then 85 COVID-19 patients with ICU admission criteria over a 1-month period were studied upon FF-CPAP initiation for AHRF. FF-CPAP significantly decreased respiratory rate and increased SpO2. Thirty-six (43%) patients presented with respiratory indications for intubation prior to FF-CPAP initiation, and 13 (36%) of them improved without intubation. Overall, 31 patients (36%) improved with FF-CPAP alone and 17 patients (20%) did not require ICU admission. Patients with a respiratory rate > 32 breaths/min upon FF-CPAP initiation had a higher cumulative probability of intubation (p < 0.001 by log-rank test). CONCLUSION Adding a filter to the Boussignac valve does not affect the delivered pressure but may variably increase the resistive load depending on the filter used. Clinical assessment suggests that FF-CPAP is a frugal solution to provide a ventilatory support and improve oxygenation to numerous patients suffering from AHRF in the context of a massive outbreak.
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Affiliation(s)
- Guillaume Carteaux
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France. .,Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France. .,INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France.
| | - Manuella Pons
- Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - François Morin
- Département de Médecine d'Urgence, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Samuel Tuffet
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - Arnaud Lesimple
- CNRS, INSERM 1083, MITOVASC, Université d'Angers, Angers, France.,Laboratoire Med2Lab ALMS, Antony, France
| | | | - Anne-Fleur Haudebourg
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - François Perier
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - Yvon Deplante
- Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France
| | - Constance Guillaud
- Département d'Aval des Urgences, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France
| | - Frédéric Schlemmer
- INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France.,Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Unité de Pneumologie, 94010, Créteil, France
| | - Elena Fois
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Unité des Maladies Génétiques du Globule Rouge, 94010, Créteil, France
| | - Nicolas Mongardon
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service d'Anesthésie-Réanimation Chirurgicale, 94010, Créteil, France
| | - Mehdi Khellaf
- Emergency Department, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France
| | - Karim Jaffal
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service d'immunologie Clinique Et Maladies Infectieuses, 94010, Créteil, France
| | - Camille Deguillard
- Department of Cardiovascular Medicine, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France
| | - Philippe Grimbert
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », 94010, Créteil, France
| | - Raphaëlle Huguet
- Department of Cardiovascular Medicine, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France
| | - Keyvan Razazi
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - François Templier
- Département de Médecine d'Urgence, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - François Beloncle
- CNRS, INSERM 1083, MITOVASC, Université d'Angers, Angers, France.,Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Vent' Lab, Université d'Angers, Angers, France
| | - Alain Mercat
- CNRS, INSERM 1083, MITOVASC, Université d'Angers, Angers, France.,Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Vent' Lab, Université d'Angers, Angers, France
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Vincent Audard
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », 94010, Créteil, France.,Université Paris Est-Créteil, INSERM, IMRB, Equipe 21, 94010, Créteil, France
| | - Pascal Lim
- INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France.,Department of Cardiovascular Medicine, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France
| | - Jean-Christophe Richard
- Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Vent' Lab, Université d'Angers, Angers, France.,INSERM, UMR 1066, Créteil, France
| | - Dominique Savary
- Département de Médecine d'Urgence, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France.,IRSET (Institut de Recherche en Santé, environnement et travail)-UMR_S 1085, 49000, Angers, France
| | - Armand Mekontso Dessap
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
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Koutsoukis A, Delmas C, Roubille F, Bonello L, Schurtz G, Manzo-Silberman S, Puymirat E, Elbaz M, Bouisset F, Meunier PA, Huet F, Paganelli F, Laine M, Lemesle G, Lamblin N, Henry P, Tea V, Gallet R, Teiger E, Huguet R, Fard D, Lim P. Acute Coronary Syndrome in the Era of SARS-CoV-2 Infection: A Registry of the French Group of Acute Cardiac Care. CJC Open 2021; 3:311-317. [PMID: 33200121 PMCID: PMC7657607 DOI: 10.1016/j.cjco.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/01/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In this study, we aimed to report clinical characteristics and outcomes of patients with and without SARS-CoV-2 infection who were referred for acute coronary syndrome (ACS) during the peak of the pandemic in France. METHODS We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south, and north of France), all performing primary percutaneous coronary intervention. RESULTS The study included 237 patients (67 ± 14 years old; 69% male), 116 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2-associated ACS was 11% (n = 26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen > 6 L/min). Patients were comparable regarding medical history and risk factors, except a higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs 25.6%; P = 0.003). In SARS-CoV-2 patients, cardiac arrest on admission was more frequent (26.9% vs 6.6%; P < 0.001). The presence of significant coronary artery disease and culprit artery occlusion in SARS-CoV-2 patients respectively, was 92% and 69.4% for those with STEMI, and 50% and 15.5% for those with NSTEMI. Percutaneous coronary intervention was performed in the same percentage of STEMI (84.6%) and NSTEMI (84.8%) patients, regardless of SARS-CoV-2 infection, but no-reflow (19.2% vs 3.3%; P < 0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared with noninfected patients (26.9% vs 6.2%; P < 0.001). CONCLUSIONS In this registry, ACS in SARS-CoV-2 patients presented with high a percentage of cardiac arrest on admission, high incidence of no-reflow, and high in-hospital mortality.
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Affiliation(s)
- Athanasios Koutsoukis
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Laurent Bonello
- Aix-Marseille Univ, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille France, Centre for CardioVascular and Nutrition research (C2VN), INSERM a263, INRA a260, Marseille, France
| | - Guillaume Schurtz
- Intensive Care Unit, Institut Coeur Poumon, Centre Hospitalier de Lille, Lille, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Lariboisière hospital, Assistance Publique - Hôpitaux de Paris, Paris University, INSERM UMRS i42, Paris, France
| | - Etienne Puymirat
- AP-HP, Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris France, Université de Paris, Paris, France
| | - Meyer Elbaz
- Cardiology department, Rangueil University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Cardiology department, Rangueil University Hospital, Toulouse, France
| | - Pierre-Alain Meunier
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Fabien Huet
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Franck Paganelli
- Aix-Marseille Univ, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille France, Centre for CardioVascular and Nutrition research (C2VN), INSERM a263, INRA a260, Marseille, France
| | - Marc Laine
- Aix-Marseille Univ, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille France, Centre for CardioVascular and Nutrition research (C2VN), INSERM a263, INRA a260, Marseille, France
| | - Gilles Lemesle
- Intensive Care Unit, Institut Coeur Poumon, Centre Hospitalier de Lille, Lille, France
| | - Nicolas Lamblin
- Intensive Care Unit, Institut Coeur Poumon, Centre Hospitalier de Lille, Lille, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière hospital, Assistance Publique - Hôpitaux de Paris, Paris University, INSERM UMRS i42, Paris, France
| | - Victoria Tea
- AP-HP, Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris France, Université de Paris, Paris, France
| | - Romain Gallet
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Emmanuel Teiger
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Raphaëlle Huguet
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Damien Fard
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
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45
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Smith O, MacLeod T, Lim P, Chitsabesan P, Chintapatla S. A structured pathway for developing your complex abdominal hernia service: our York pathway. Hernia 2021; 25:267-275. [PMID: 33599900 PMCID: PMC7890783 DOI: 10.1007/s10029-020-02354-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors' knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. METHODS A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. RESULTS We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. CONCLUSION A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.
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Affiliation(s)
- O Smith
- York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - T MacLeod
- Department of Plastic Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - P Lim
- Department of Plastic Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - P Chitsabesan
- York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - S Chintapatla
- York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK.
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46
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Guillet H, Gallet R, Pham V, D'Humières T, Huguet R, Lim P, Michel M, Khellaf M. Clinical spectrum of ischaemic arterial diseases associated with COVID-19: a series of four illustrative cases. Eur Heart J Case Rep 2020; 5:ytaa488. [PMID: 33542975 PMCID: PMC7799310 DOI: 10.1093/ehjcr/ytaa488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 11/07/2020] [Indexed: 12/13/2022]
Abstract
Background Severe coronavirus-induced disease 2019 (COVID-19) leads to acute respiratory distress syndrome with an increased risk of venous thrombo-embolic events. To a much lesser extent, arterial thrombo-embolic events have also been reported in this setting. Case summary Here, we describe four different cases of COVID-19 infection with ischaemic arterial events, such as a myocardial infarction with high thrombus load, ischaemic stroke on spontaneous thrombosis of the aortic valve, floating thrombus with mesenteric, splenic and renal infarction, and acute limb ischaemia. Discussion Cardiovascular risk factors such as hypertension, obesity, and diabetes are comorbidities most frequently found in patients with a severe COVID-19 infection and are associated with a higher death rate. Our goal is to provide an overview of the clinical spectrum of ischaemic arterial events that may either reveal or complicate COVID-19. Several suspected pathophysiological mechanisms could explain the association between cardiovascular events and COVID-19 (role of systemic inflammatory response syndrome, endothelial dysfunction, activation of coagulation cascade leading to a hypercoagulability state, virus-induced secondary antiphospholipid syndrome). We need additional studies of larger size, to estimate the incidence of these arterial events and to assess the efficacy of anticoagulation therapy.
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Affiliation(s)
- Henri Guillet
- Université Paris-Est Créteil, Faculté de médecine, 8 Rue du Général Sarrail, 94000 Créteil, France.,Département d'Aval des Urgences, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.,Service de Médecine interne, Unité des maladies génétiques du globule rouge, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Romain Gallet
- Université Paris-Est Créteil, Faculté de médecine, 8 Rue du Général Sarrail, 94000 Créteil, France.,Service de cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Vincent Pham
- Service de cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Thomas D'Humières
- Université Paris-Est Créteil, Faculté de médecine, 8 Rue du Général Sarrail, 94000 Créteil, France.,Service de physiologie exploration fonctionnelles, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Raphaelle Huguet
- Université Paris-Est Créteil, Faculté de médecine, 8 Rue du Général Sarrail, 94000 Créteil, France.,Service de cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Pascal Lim
- Université Paris-Est Créteil, Faculté de médecine, 8 Rue du Général Sarrail, 94000 Créteil, France.,Service de cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Marc Michel
- Université Paris-Est Créteil, Faculté de médecine, 8 Rue du Général Sarrail, 94000 Créteil, France.,Service de médecine interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Mehdi Khellaf
- Université Paris-Est Créteil, Faculté de médecine, 8 Rue du Général Sarrail, 94000 Créteil, France.,Département d'Aval des Urgences, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.,Service d'accueil des urgences, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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47
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Sifaoui I, Oliver L, Tacher V, Fiore A, Lepeule R, Moussafeur A, Huguet R, Teiger E, Audureau E, Derbel H, Luciani A, Kobeiter H, Lim P, Ternacle J, Deux JF. Diagnostic Performance of Transesophageal Echocardiography and Cardiac Computed Tomography in Infective Endocarditis. J Am Soc Echocardiogr 2020; 33:1442-1453. [PMID: 32981789 DOI: 10.1016/j.echo.2020.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
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Fard D, Huguet R, Koutsoukis A, Deguillard C, Tuffreau AS, Deux JF, Lim P, Teiger E. [SARS-COV-2 myocarditis. An update]. Ann Cardiol Angeiol (Paris) 2020; 69:349-354. [PMID: 33069383 PMCID: PMC7543970 DOI: 10.1016/j.ancard.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of the SARS-CoV-2 virus responsible for the COVID-19 disease has given rise to a new disease whose boundaries are still to be discovered. While the first data suggested a purely respiratory infection, the most recent publications highlight a large pleomorphism of the disease, responsible for multiple organ damage, of which cardiac injury seems to be the most represented. This cardiac injury can present as acute myocarditis. Our aim was to discuss the pathophysiological rationale underlying the existence of SARS-CoV-2 myocarditis and to analyze the literature data regarding the diagnosis and treatment of this particular entity.
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Affiliation(s)
- D Fard
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service de cardiologie, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France.
| | - R Huguet
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service de cardiologie, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - A Koutsoukis
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service de cardiologie, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - C Deguillard
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service de cardiologie, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - A-S Tuffreau
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service de cardiologie, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - J-F Deux
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service d'imagerie médicale, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - P Lim
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service de cardiologie, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - E Teiger
- Inserm U955, Institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France; Service de cardiologie, hôpital universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
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49
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Hamon D, Courty B, Leenhardt A, Lim P, Elbaz N, Rouffiac S, Varlet E, Algalarrondo V, Messali A, Audureau E, Extramiana F, Lellouche N. Predictive value of premature atrial complex characteristics in pulmonary vein isolation for patients with paroxysmal atrial fibrillation. Arch Cardiovasc Dis 2020; 114:122-131. [PMID: 33153949 DOI: 10.1016/j.acvd.2020.09.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Premature atrial complexes from pulmonary veins are the main triggers for atrial fibrillation in the early stages. Thus, pulmonary vein isolation is the cornerstone of catheter ablation for paroxysmal atrial fibrillation. However, the success rate remains perfectible. AIM To assess whether premature atrial complex characteristics before catheter ablation can predict pulmonary vein isolation success in paroxysmal atrial fibrillation. METHODS We investigated consecutive patients who underwent catheter ablation for paroxysmal atrial fibrillation from January 2013 to April 2017 in two French centres. Patients were included if they were treated with pulmonary vein isolation alone, and had 24-hour Holter electrocardiogram data before catheter ablation available and a follow-up of≥6 months. Catheter ablation success was defined as freedom from any sustained atrial arrhythmia recurrence after a 3-month blanking period following catheter ablation. RESULTS One hundred and three patients were included; all had an acute successful pulmonary vein isolation procedure, and 34 (33%) had atrial arrhythmia recurrences during a mean follow-up of 30±15 months (group 1). Patients in group 1 presented a longer history of atrial fibrillation (71.9±65.8 vs. 42.9±48.4 months; P=0.008) compared with those who were "free from arrhythmia" (group 2). Importantly, the daily number of premature atrial complexes before catheter ablation was significantly lower in group 1 (498±1413 vs. 1493±3366 in group 2; P=0.028). A daily premature atrial complex cut-off number of<670 predicted recurrences after pulmonary vein isolation (41.1% vs. 13.3%; sensitivity 88.2%; specificity 37.7%; area under the curve 0.635; P=0.017), and was the only independent predictive criterion in the multivariable analysis (4-fold increased risk). CONCLUSION Preprocedural premature atrial complex analysis on 24-hour Holter electrocardiogram in paroxysmal atrial fibrillation may improve patient selection for pulmonary vein isolation.
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Affiliation(s)
- David Hamon
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Baptiste Courty
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Antoine Leenhardt
- Department of Cardiology, University Hospital Bichat, AP-HP, 75018 Paris, France
| | - Pascal Lim
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Nathalie Elbaz
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Segolene Rouffiac
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Emilie Varlet
- Department of Cardiology, University Hospital Bichat, AP-HP, 75018 Paris, France
| | - Vincent Algalarrondo
- Department of Cardiology, University Hospital Bichat, AP-HP, 75018 Paris, France
| | - Anne Messali
- Department of Cardiology, University Hospital Bichat, AP-HP, 75018 Paris, France
| | - Etienne Audureau
- Department of Public Health, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Fabrice Extramiana
- Department of Cardiology, University Hospital Bichat, AP-HP, 75018 Paris, France
| | - Nicolas Lellouche
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France.
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Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, Kiwan GS, Blondeau L, Orfanos A, Ibrahim R, Grégoire JC, Dubé MP, Samuel M, Morel O, Lim P, Bertrand OF, Kouz S, Guertin MC, L’Allier PL, Roubille F. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J 2020; 41:4092-4099. [PMID: 32860034 PMCID: PMC7700755 DOI: 10.1093/eurheartj/ehaa659] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. METHODS AND RESULTS In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05). CONCLUSION Patients benefit from early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION COLCOT ClinicalTrials.gov number, NCT02551094.
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | | | - Fausto J Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Colin Berry
- University of Glasgow and NHS Glasgow Clinical Research Facility, Glasgow, UK
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Lucie Blondeau
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Andreas Orfanos
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Pascal Lim
- Department of Cardiology, AP-HP, Hôpital Universitaire Henri-Mondor and INSERM U955, Université Paris-Est Créteil, Créteil, France
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Canada
| | | | - Philippe L L’Allier
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
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