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Fauvel C, Dillinger JG, Bouleti C, Trimaille A, Tron C, Chaussade AS, Thuaire C, Delmas C, Boccara A, Roule V, Millischer D, Thevenet E, Meune C, Stevenard M, Charbonnel C, Ballesteros LM, Pommier T, El Ouahidi A, Swedsky F, Martinez D, Hauguel-Moreau M, Schurtz G, Coisne A, Dupasquier V, Bochaton T, Gerbaud E, Puymirat E, Henry P, Pezel T. TAPSE/sPAP prognostic value for In-Hospital Adverse Events in Patients Hospitalized for Acute Coronary Syndrome. Eur Heart J Cardiovasc Imaging 2024:jeae110. [PMID: 38650518 DOI: 10.1093/ehjci/jeae110] [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: 10/05/2023] [Revised: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Although several studies have shown that the right ventricular to pulmonary artery (RV-PA) coupling, assessed by the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) using echocardiography, is strongly associated with cardiovascular events, its prognostic value is not established in acute coronary syndrome (ACS). We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for ACS in a retrospective analysis from the prospective ADDICT-ICCU study. METHODS AND RESULTS 481 consecutive patients hospitalized in intensive cardiac care unit (mean age 65±13 years, 73% of male, 46% STEMI) for ACS (either ST-elevation [STEMI] or non-ST-elevation [NSTEMI] myocardial infarction) with TAPSE/sPAP available were included in this prospective French multicentric study (39 centers). The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock and occurred in 33 (7%) patients. ROC-curve analysis identified 0.55 mm/mmHg as the best TAPSE/sPAP cut-off to predict in-hospital MACEs. TAPSE/sPAP <0.55 was associated with in-hospital MACEs, even after adjustment with comorbidities (OR:19.1, 95%CI[7.78-54.8]), clinical severity including left ventricular ejection fraction (OR:14.4, 95%CI[5.70-41.7]) and propensity-matched population analysis (OR:22.8, 95%CI[7.83-97.2], all p<0.001). After adjustment, TAPSE/sPAP <0.55 showed the best improvement in model discrimination and reclassification above traditional prognosticators (C-statistic improvement: 0.16; global chi-square improvement: 52.8; LR-test p<0.001) with similar results for both STEMI and NSTEMI subgroups. CONCLUSION A low RV-PA coupling defined as TAPSE/sPAP ratio <0.55 was independently associated with in-hospital MACEs and provided incremental prognostic value over traditional prognosticators in patients hospitalized for ACS. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05063097.
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Affiliation(s)
- Charles Fauvel
- Cardiology department, FHU CARNAVAL, Rouen University Hospital, Rouen, France
- INSERM EnVI U1096, Rouen University Hospital, Rouen, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| | - Claire Bouleti
- University Hospital of Poitiers, Clinical Investigation Center (INSERM 1204), Cardiology Department, 86000 Poitiers, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Christophe Tron
- Cardiology department, FHU CARNAVAL, Rouen University Hospital, Rouen, France
| | | | - Christophe Thuaire
- Service de Cardiologie, Centre Hospitalier de Chartres, 28630 Le Coudray, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Albert Boccara
- Department of Cardiology Andre Gregoire Hospital 93100 Montreuil, France
| | - Vincent Roule
- Department of Cardiology, Caen University Hospital, Caen, France
| | | | - Eugénie Thevenet
- Department of Cardiology, University Hospital of Martinique, France
| | - Christophe Meune
- Department of Cardiology, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathilde Stevenard
- Service de cardiologie et médecine aéronautique, Hôpital d'Instruction des Armées Percy, 101 avenue Henri Barbusse, 92140 Clamart
| | | | | | - Thibaut Pommier
- Department of Cardiology, University Hospital, Dijon, France
| | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, 29609, Brest cedex, France
| | - Fédérico Swedsky
- Service de cardiologie, Hôpital Henri Duffaut, 84902 AVIGNON, France
| | - David Martinez
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Marie Hauguel-Moreau
- Service de Cardiologie, Hôpital Ambroise Pare, AP-HP, Boulogne Billancourt, France
| | | | - Augustin Coisne
- Department of Cardiology, University Hospital of Lille, France
| | | | - Thomas Bochaton
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, 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, 33076 Bordeaux, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| | - Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
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Bohbot Y, Pezel T, Demirkıran A, Androulakis E, Houshmand G, Szabo L, Manka R, Botezatu SB, Rodríguez-Palomares JF, Biering-Sørensen T, Podlesnikar T, Dweck MR. European Association of Cardiovascular Imaging (EACVI) survey on Cardiovascular Multimodality Imaging in Acute Myocarditis. Eur Heart J Cardiovasc Imaging 2024:jeae092. [PMID: 38568982 DOI: 10.1093/ehjci/jeae092] [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: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS To assess the current role of cardiac imaging in the diagnosis, management, and follow-up of patients with acute myocarditis (AM) through an European Association of Cardiovascular Imaging survey. METHODS AND RESULTS A total of 412 volunteers from 74 countries responded to the survey. Most participants worked in tertiary centres(56%). All participants had access to echocardiography, while 79% and 75% had access to cardiac computed tomography (CCTA) and cardiac magnetic resonance (CMR), respectively. Less than half(47%) had access to myocardial biopsy and only 5% used this test routinely. CMR was performed within 7 days of presentation in 73% of cases. Non-ischemic late gadolinium enhancement (LGE,88%) and high-signal intensity in T2-weighted images(74%) were the most used diagnostic criteria for AM. CCTA was preferred to coronary angiography by 47% of participants to exclude coronary artery disease. Systematic prescription of beta-blockers and ACEi was reported by 38% and 32% of participants. Around a quarter of participants declared considering LGE burden as a reason to treat. Most participants (90%) reported performing a follow-up echocardiogram, while 63% scheduled a follow-up CMR. The main reason for treatment discontinuation was improvement of left ventricular ejection fraction(89%), followed by LGE regression(60%). In two-thirds of participants the decision to resume high-intensity sport was influenced by residual LGE. CONCLUSION This survey confirms the high utilization of cardiac imaging in AM, but reveals major differences in how cardiac imaging is used and how the condition is managed between centres, underlining the need for recommendation statements in this topic.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Théo Pezel
- Université Paris Cité, Department of Cardiology, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010, Paris, France
- Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, 75010, Paris, France
- MIRACL.ai laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010, Paris, France
| | - Ahmet Demirkıran
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Cardiology, Kocaeli Sehir Medical Center, Kocaeli, Türkiye
| | - Emmanuel Androulakis
- St George's University London, UK
- Imaging Centre, Royal Brompton Hospital, Guy's St Thomas NHS Foundation Trust, London, UK
| | - Golnaz Houshmand
- Rajaie Cardiovascular, Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, EC1A 7BE, London, UK
- Semmelweis University, Budapest, Hungary
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Simona B Botezatu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - José F Rodríguez-Palomares
- Cardiovascular Imaging Unit. Cardiology Department. Hospital Universitari Vall Hebrón. Barcelona. Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte
- Steno Diabetes Center Copenhagen
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Slovenia
- Department of Cardiology, University Medical Centre Ljubljana, Slovenia
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University ot Edinburgh, United Kingdom. Chancellors Buidling, Little France Crescent, Edinburgh EH16 4SB
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Pezel T, Habert P. Can coronary CT angiography be used as the new gold-standard for quantifying coronary artery disease burden? Diagn Interv Imaging 2024; 105:127-128. [PMID: 38212228 DOI: 10.1016/j.diii.2024.01.001] [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: 12/31/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024]
Affiliation(s)
- Théo Pezel
- Université Paris Cité, Service de Radiologie, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, AP-HP, 75010, Paris, France; Université Paris Cité, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, AP-HP, 75010, Paris, France; Inserm MASCOT - UMRS 942, Hôpital Lariboisière, 75010, Paris, France
| | - Paul Habert
- Department of Radiology, Hôpital Nord, APHM, Aix Marseille Université, 13015 Marseille, France; Aix Marseille Univ, LIIE, 13005 Marseille, France.
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Sanguineti F, Garot P, Toupin S, Pezel T, Bohbot Y, Tawa C, Poupineau M, Boileve V, Landon V, Duhamel S, Garot J. Feasibility, safety and diagnostic yield of interventional cardiac magnetic resonance for routine right heart catheterization in adults. Arch Cardiovasc Dis 2024; 117:275-282. [PMID: 38472043 DOI: 10.1016/j.acvd.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Real-time cardiac magnetic resonance generates spatially and temporally resolved images of cardiac anatomy and function, without the need for contrast agent or X-ray exposure. Cardiac magnetic resonance-guided right heart catheterization (CMR-RHC) combines the benefits of cardiac magnetic resonance and invasive cardiac catheterization. The clinical adoption of CMR-RHC represents the first step towards the development of cardiac magnetic resonance-guided therapeutic procedures. AIM To describe the feasibility, safety and diagnostic yield of CMR-RHC in consecutive all-comer patients with clinical indications for right heart catheterization. METHODS From December 2018 to May 2021, 35 consecutive patients with prespecified indications for right heart catheterization were scheduled for CMR-RHC via the femoral route under local anaesthesia in a 1.5T cardiac magnetic resonance suite equipped for interventional cardiac magnetic resonance. The duration of various procedural components and safety data were recorded. Success rate (defined by the ability to record all prespecified haemodynamic measurements and imaging metrics), adverse events and patient/physician perprocedural comfort were assessed. RESULTS One patient withdrew his consent before the study, and scanner troubleshooting occurred in one case. Among the 33 remaining patients, prespecified cardiac magnetic resonance imaging metrics were obtained in all patients, whereas full CMR-RHC measurements were obtained in 30 patients (91%). A dedicated cardiac magnetic resonance-compatible wire was used in 25/33 procedures. CMR-RHC was completed in 29±16minutes, and the total duration of the procedure, including conventional cardiac magnetic resonance imaging, was 62±20minutes. There were no adverse events and no femoral haematomas. Procedural comfort was deemed good by the patients and operators for all procedures. CMR-RHC significantly impacted diagnosis or patient management in 28/33 patients (85%). CONCLUSIONS CMR-RHC seems to be a feasible and safe procedure that can be used in routine daily practice in consecutive adults with an impactful clinical yield.
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Affiliation(s)
- Francesca Sanguineti
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Philippe Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Solenn Toupin
- Siemens Healthineers, Scientific Partnership, 93210 Saint-Denis, France
| | - Théo Pezel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Yohann Bohbot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Chloé Tawa
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Mathieu Poupineau
- Hôpital Privé Claude Galien, Ramsay Santé, Institut Cardiovasculaire Paris Sud (ICPS), 91480 Quincy-sous-Sénart, France
| | - Victor Boileve
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Valentin Landon
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Suzanne Duhamel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Jérôme Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France.
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Fauvel C, Dillinger JG, Rossanaly Vasram R, Bouleti C, Logeart D, Roubille F, Meune C, Ohlmann P, Bonnefoy-Coudraz E, Albert F, Attou S, Boukhris M, Pommier T, Merat B, Noirclerc N, Bouali N, Aghezzaf S, Schurtz G, Mansencal N, Andrieu S, Henry P, Pezel T. In-hospital Prognostic Value of TAPSE/sPAP in Patients Hospitalized for Acute Heart Failure. Eur Heart J Cardiovasc Imaging 2024:jeae059. [PMID: 38428980 DOI: 10.1093/ehjci/jeae059] [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: 11/21/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
AIMS TAPSE/sPAP (tricuspid annular plane systolic excursion over systolic pulmonary artery pressure) assessed by echocardiography appears to be a good noninvasive approach for right ventricular to pulmonary artery coupling assessment. We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for acute heart failure (AHF). METHODS AND RESULTS 333 consecutive patients (mean age 68 ± 14 years, 70% of male, mean LVEF 44 ± 16%) hospitalized for AHF across 39 French cardiology department, with TAPSE/sPAP measured by echocardiography within the 24 first hours of hospitalization were included in this prospective study. The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock and occurred in 50 (15%) patients. Using receiver operating characteristics curves analysis, the best TAPSE/sPAP threshold for in-hospital MACEs was 0.40 mm/mmHg. TAPSE/sPAP <0.40 mm/mmHg was independently associated with in-hospital MACEs, even after adjustment with comorbidities (OR:3.75, 95%CI[1.87-7.93], p < 0.001), clinical severity (OR:2.80, 95%CI[1.36-5.95], p = 0.006). Using a 1:1 propensity-matched population, TAPSE/sPAP ratio <0.40 was associated with a higher rate of in-hospital MACEs (OR:2.98, 95%CI[1.53-6.12], p = 0.002). After adjustment, TAPSE/sPAP <0.40 showed the best improvement in model discrimination and reclassification above traditional prognostic factors (C-statistic improvement: 0.05; Chi-2 improvement: 14.4; LR-test p < 0.001). These results were consistent in an external validation cohort of 133 patients. CONCLUSION TAPSE/sPAP < 0.40 mm/mmHg assessed by an early echocardiography during an AHF episode is independently associated with in-hospital MACEs suggesting enhanced close monitoring and strengthened HF-specific care in these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05063097.
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Affiliation(s)
- Charles Fauvel
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000, Rouen, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| | - Reza Rossanaly Vasram
- Department of Cardiology, Felix-Guyon University Hospital, Saint-Denis-de-la-Réunion, France
| | - Claire Bouleti
- University Hospital of Poitiers, Clinical Investigation Center (INSERM 1204), Cardiology Department, 86000 Poitiers, France
| | - Damien Logeart
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| | | | - Christophe Meune
- Department of Cardiology, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrick Ohlmann
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Eric Bonnefoy-Coudraz
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Franck Albert
- Service de Cardiologie, Centre Hospitalier de Chartres, 28360 Le Coudray, France
| | - Sabir Attou
- Department of Cardiology, Caen University Hospital, 14000 Caen, France
| | - Marouane Boukhris
- Department of Cardiology, Limoges University Hospital, Limoges, France
| | - Thibaut Pommier
- Department of Cardiology, Dijon University Hospital, Dijon, France
| | - Benoit Merat
- Service de cardiologie et médecine aéronautique, Hôpital d'Instruction des Armées Percy, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Nathalie Noirclerc
- Service de Cardiologie, Centre hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370 Epagny Metz-Tessy
| | - Nabil Bouali
- Service de Cardiologie, Centre hospitalier de Saintonge, 11, boulevard Ambroise-Paré, 17100 Saintes, France
| | - Samy Aghezzaf
- Department of Cardiology, University Hospital of Lille, France
| | | | - Nicolas Mansencal
- Service de Cardiologie, Boulogne Billancourt, Hôpital Ambroise Pare, University Hospital Center
| | - Stéphane Andrieu
- Service de Cardiologie, Hôpital Henri Duffaut, 84902, Avignon, France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| | - Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
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Gall E, Pezel T, Lattuca B, Hamzi K, Puymirat E, Piliero N, Deney A, Fauvel C, Aboyans V, Schurtz G, Bouleti C, Fabre J, El Ouahidi A, Thuaire C, Millischer D, Noirclerc N, Delmas C, Roubille F, Dillinger JG, Henry P. Profile of patients hospitalized in intensive cardiac care units in France: ADDICT-ICCU registry. Arch Cardiovasc Dis 2024; 117:195-203. [PMID: 38418306 DOI: 10.1016/j.acvd.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Intensive cardiac care units (ICCU) were initially developed to monitor ventricular arrhythmias after myocardial infarction. In recent decades, ICCU have diversified their activities. AIM To determine the type of patients hospitalized in ICCU in France. METHODS We analysed the characteristics of patients enrolled in the ADDICT-ICCU registry (NCT05063097), a prospective study of consecutive patients admitted to ICCU in 39 centres throughout France from 7th-22nd April 2021. In-hospital major adverse events (MAE) (death, resuscitated cardiac arrest and cardiogenic shock) were recorded. RESULTS Among 1499 patients (median age 65 [interquartile range 54-74] years, 69.6% male, 21.7% diabetes mellitus, 64.7% current or previous smokers), 34.9% had a history of coronary artery disease, 11.7% atrial fibrillation and 5.2% cardiomyopathy. The most frequent reason for admission to ICCU was acute coronary syndromes (ACS; 51.5%), acute heart failure (AHF; 14.1%) and unexplained chest pain (6.8%). An invasive procedure was performed in 36.2%. "Advanced" ICCU therapies were required for 19.9% of patients (intravenous diuretics 18.4%, non-invasive ventilation 6.1%, inotropic drugs 2.3%). No invasive procedures or advanced therapies were required in 44.1%. Cardiac computed tomography or magnetic resonance imaging was carried out in 12.3% of patients. The median length of ICCU hospitalization was 2.0 (interquartile range 1.0-4.0) days. The mean rate of MAE was 4.5%, and was highest in patients with AHF (10.4%). CONCLUSIONS ACS remains the main cause of admissions to ICCU, with most having a low rate of in-hospital MAE. Most patients experience a brief stay in ICCU before being discharged home. AHF is associated with highest death rate and with higher resource consumption.
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Affiliation(s)
- Emmanuel Gall
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Théo Pezel
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Kenza Hamzi
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Etienne Puymirat
- Department of Cardiology, hôpital européen Georges-Pompidou (HEGP), Paris, France
| | - Nicolas Piliero
- Department of Cardiology, CHU de Grenoble-Alpes, Grenoble, France
| | - Antoine Deney
- Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Charles Fauvel
- Department of Cardiology, CHU de Rouen, University, UNIROUEN, U1096, 76000 Rouen, France
| | - Victor Aboyans
- Dupuytren University Hospital, Inserm 1094, Limoges, France
| | - Guillaume Schurtz
- Department of Cardiology, University Hospital of Lille, Lille, France
| | | | - Julien Fabre
- Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
| | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, 29609 Brest cedex, France
| | - Christophe Thuaire
- Department of Cardiology, centre hospitalier de Chartres, 28630 Le Coudray, France
| | - Damien Millischer
- Department of Cardiology, hôpital Montfermeil, 93370 Montfermeil, France
| | - Nathalie Noirclerc
- Department of Cardiology, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Department of Cardiology, INI-CRT, CHU de Montpellier, PhyMedExp, université de Montpellier, Inserm, CNRS, 3429 Montpellier, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Patrick Henry
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France.
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Fauvel C, Dillinger JG, Bochaton T, Mansencal N, Noirclerc N, Schurtz G, Pommier T, Laissac Q, Henry P, Pezel T. Prevalence and Prognostic Impact of Drug Use in Patients Hospitalized for Acute Heart Failure. JACC Heart Fail 2024:S2213-1779(24)00038-6. [PMID: 38363274 DOI: 10.1016/j.jchf.2023.12.010] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Charles Fauvel
- Normandie University, CHU Rouen, Rouen, France. https://twitter.com/CharlesFauvel
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Bochaton
- Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Nicolas Mansencal
- Hôpital Ambroise Pare, University Hospital Center, Boulogne Billancourt, France
| | | | | | | | | | - Patrick Henry
- Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Théo Pezel
- Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Pezel T, Toupin S, Hovasse T, Champagne S, Unterseeh T, Chitiboi T, Sharma P, Sanguineti F, Garot P, Garot J. A fully automated stress regional strain score as a prognostic marker of cardiovascular events in patients with normal CMR. Front Cardiovasc Med 2024; 10:1334553. [PMID: 38259308 PMCID: PMC10800929 DOI: 10.3389/fcvm.2023.1334553] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Théo Pezel
- Department of Cardiology, University Hospital of Lariboisiere, Université Paris-Cité, (Assistance Publique des Hôpitaux de Paris, AP-HP), Paris, France
- Inserm MASCOT-UMRS 942, Department of Data Science, University Hospital of Lariboisiere, Paris, France
- Department of Radiology, University Hospital of Lariboisiere, Université Paris-Cité, (Assistance Publique des Hôpitaux de Paris, AP-HP), Paris, France
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
- MIRACL.ai laboratory, Multimodality Imaging for Research and Analysis Core Laboratory-Artificial Intelligence, Department of Data Science, Machine Learning and Artificial Intelligence in Health, University Hospital of Lariboisiere (AP-HP), Paris, France
| | - Solenn Toupin
- Siemens Healthcare France, Scientific Partnerships, Saint-Denis, France
| | - Thomas Hovasse
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Teodora Chitiboi
- Siemens Healthcare GmbH, Department of CMR, Hamburg, Deutschland
| | - Puneet Sharma
- Digital Technologies and Innovation, Siemens Healthineers, Princeton, NJ, United States
| | - Francesca Sanguineti
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Philippe Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Jérôme Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
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Dillinger JG, Pezel T, Delmas C, Schurtz G, Trimaille A, Piliero N, Bouleti C, Lattuca B, Andrieu S, Fabre J, Rossanaly Vasram R, Dib JC, Aboyans V, Fauvel C, Roubille F, Gerbaud E, Boccara A, Puymirat E, Toupin S, Vicaut E, Henry P. Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study. EClinicalMedicine 2024; 67:102401. [PMID: 38261914 PMCID: PMC10796965 DOI: 10.1016/j.eclinm.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p < 0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO > 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively). Interpretation Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding Grant from Fondation Coeur & Recherche.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Théo Pezel
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000, Toulouse, France
| | | | | | | | | | | | | | - Julien Fabre
- University Hospital of Fort de France, Fort De France, Martinique
| | | | - Jean-Claude Dib
- Clinique Medico-Chirurgicale Ambroise Pare, Neuilly Sur Seine, France
| | | | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, 76000, Rouen, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295, Montpellier, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and, Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | | | - Etienne Puymirat
- Université Paris Cité, Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Solenn Toupin
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Eric Vicaut
- Unité de recherche clinique – Hopital Lariboisiere, Paris, France
| | - Patrick Henry
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
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Moscatelli S, Leo I, Bianco F, Surkova E, Pezel T, Donald NA, Triumbari EKA, Bassareo PP, Pradhan A, Cimini A, Perrone MA. The Role of Multimodality Imaging in Patients with Congenital Heart Disease and Infective Endocarditis. Diagnostics (Basel) 2023; 13:3638. [PMID: 38132222 PMCID: PMC10742664 DOI: 10.3390/diagnostics13243638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Infective endocarditis (IE) represents an important medical challenge, particularly in patients with congenital heart diseases (CHD). Its early and accurate diagnosis is crucial for effective management to improve patient outcomes. Multimodality imaging is emerging as a powerful tool in the diagnosis and management of IE in CHD patients, offering a comprehensive and integrated approach that enhances diagnostic accuracy and guides therapeutic strategies. This review illustrates the utilities of each single multimodality imaging, including transthoracic and transoesophageal echocardiography, cardiac computed tomography (CCT), cardiovascular magnetic resonance imaging (CMR), and nuclear imaging modalities, in the diagnosis of IE in CHD patients. These imaging techniques provide crucial information about valvular and intracardiac structures, vegetation size and location, abscess formation, and associated complications, helping clinicians make timely and informed decisions. However, each one does have limitations that influence its applicability.
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Affiliation(s)
- Sara Moscatelli
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Children NHS Foundation Trust, London WC1N 3JH, UK; (S.M.); (N.A.D.)
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy;
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guys’ and St Thomas’ NHS Trust, London SW3 5NP, UK
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Elena Surkova
- Department of Echocardiography, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 5NP, UK;
| | - Théo Pezel
- Département de Cardiologie, Université Paris-Cité, Hôpital Universitaire de Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Inserm UMRS 942, 75010 Paris, France;
| | - Natasha Alexandra Donald
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Children NHS Foundation Trust, London WC1N 3JH, UK; (S.M.); (N.A.D.)
| | | | - Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Mater Misericordiae University Hospital, Children’s Health Ireland Crumlin, D07 R2WY Dublin, Ireland;
| | - Akshyaya Pradhan
- Department of Cardiology, King George’s Medical University, Lucknow 226003, India;
| | - Andrea Cimini
- Nuclear Medicine Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy
| | - Marco Alfonso Perrone
- Division of Cardiology and CardioLab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
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11
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Pezel T, Dillinger JG, Toupin S, Mirailles R, Logeart D, Cohen-Solal A, Unger A, Canuti ES, Beauvais F, Lafont A, Gonçalves T, Lequipar A, Gall E, Boutigny A, Ah-Sing T, Hamzi L, Lima JAC, Bousson V, Henry P. Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death. Diagn Interv Imaging 2023; 104:594-604. [PMID: 37353467 DOI: 10.1016/j.diii.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE The purpose of this study was to investigate the prognostic value of left atrioventricular coupling index (LACI) assessed by cardiac computed tomography (CT), to predict cardiovascular death in consecutive patients referred for cardiac CT with coronary analysis. MATERIALS AND METHODS Between 2010 and 2020, we conducted a single-centre study with all consecutive patients without known cardiovascular disease referred for cardiac CT. LACI was defined as the ratio of left atrial to left ventricle end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association between LACI and primary outcome after adjustment for traditional risk factors and cardiac CT angiography findings. RESULTS In 1,444 patients (mean age, 70 ± 12 [standard deviation] years; 43% men), 67 (4.3%) patients experienced cardiovascular death after a median follow-up of 6.8 (Q1, Q3: 5.9, 9.1) years. After adjustment, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI: 1.05-1.09] per 1% increment; P < 0.001), and all-cause death (adjusted HR, 1.05 [95% CI: 1.03-1.07] per 1% increment; P <0.001). After adjustment, a LACI ≥ 25% showed the best improvement in model discrimination and reclassification for predicting cardiovascular death above traditional risk factors and cardiac CT findings (C-statistic improvement: 0.27; Nnet reclassification improvement = 0.826; Integrative discrimination index =0.209, all P < 0.001; likelihood-ratio-test, P < 0.001). CONCLUSION LACI measured by cardiac CT is independently associated with cardiovascular death and all-cause death in patients without known cardiovascular disease referred for cardiac CT, with an incremental prognostic value over traditional risk factors and cardiac CT findings.
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Affiliation(s)
- Théo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France.
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Raphael Mirailles
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Damien Logeart
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alain Cohen-Solal
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Unger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Department of Cardiology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 1070 Brussels, Belgium
| | - Elena Sofia Canuti
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Florence Beauvais
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Lafont
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Trecy Gonçalves
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Boutigny
- Université Paris Cité, Service des Explorations Fonctionnelles, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Tania Ah-Sing
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Lounis Hamzi
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287-0409, USA
| | - Valérie Bousson
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Fard D, Noirclerc N, Bonnet G, Goralski M, Elbaz M, Deney A, Schurtz G, Docq C, Roubille F, Fauvel C, Bochaton T, Aboyans V, Boccara F, Puymirat E, Batisse A, Steg G, Vicaut E, Henry P. Prevalence and impact of recreational drug use in patients with acute cardiovascular events. Heart 2023; 109:1608-1616. [PMID: 37582633 DOI: 10.1136/heartjnl-2023-322520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/26/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE While recreational drug use is a risk factor for cardiovascular events, its exact prevalence and prognostic impact in patients admitted for these events are not established. We aimed to assess the prevalence of recreational drug use and its association with in-hospital major adverse events (MAEs) in patients admitted to intensive cardiac care units (ICCU). METHODS In the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, systematic screening for recreational drugs was performed by prospective urinary testing all patients admitted to ICCU in 39 French centres from 7 to 22 April 2021. The primary outcome was prevalence of recreational drug detection. In-hospital MAEs were defined by death, resuscitated cardiac arrest, or haemodynamic shock. RESULTS Of 1499 consecutive patients (63±15 years, 70% male), 161 (11%) had a positive test for recreational drugs (cannabis 9.1%, opioids 2.1%, cocaine 1.7%, amphetamines 0.7%, 3,4-methylenedioxymethamphetamine (MDMA) 0.6%). Only 57% of these patients declared recreational drug use. Patients who used recreational drugs exhibited a higher MAE rate than others (13% vs 3%, respectively, p<0.001). Recreational drugs were associated with a higher rate of in-hospital MAEs after adjustment for comorbidities (OR 8.84, 95% CI 4.68 to 16.7, p<0.001). After adjustment, cannabis, cocaine, and MDMA, assessed separately, were independently associated with in-hospital MAEs. Multiple drug detection was frequent (28% of positive patients) and associated with an even higher incidence of MAEs (OR 12.7, 95% CI 4.80 to 35.6, p<0.001). CONCLUSION The prevalence of recreational drug use in patients hospitalised in ICCU was 11%. Recreational drug detection was independently associated with worse in-hospital outcomes. CLINICAL TRIAL REGISTRATION NCT05063097.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, University Hospital of Rangueil, Toulouse, France
| | - Nicolas Piliero
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Claire Bouleti
- Cardiology, University of Poitiers, Clinical Investigation Center (CIC) INSERM 1402, Poitiers University Hospital, Poitiers, France
| | | | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, Brest, France
| | | | - Benoit Lattuca
- Cardiology, Centre Hospitalier Universitaire de Nîmes, Montpellier University, Nimes, France
| | | | - Damien Fard
- Intensive Cardiac Care Unit, Hopital Henri Mondor, Creteil, France
| | - Nathalie Noirclerc
- Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, Rhône-Alpes, France
| | - Guillaume Bonnet
- Assistance Publique Hopitaux de Marseille, Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, Provence-Alpes-Côte d'Azu, France
- Unité de Recherche Clinique, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | | | - Meyer Elbaz
- Intensive Cardiac Care Unit, University Hospital of Rangueil, Toulouse, France
| | - Antoine Deney
- University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
| | | | - Clemence Docq
- Department of Cardiology, University Hospital of Lille, Lille, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, Rouen, France
| | - Thomas Bochaton
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital and Inserm 1094, Limoges, France
| | - Franck Boccara
- Cardiology, Sorbonne Université, GRC n°22, C²MV, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine Service de Cardiologie, Paris, France
| | | | - Anne Batisse
- Centre d'évaluation et d'information sur la pharmacodépendence de Paris, GH Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | - Gabriel Steg
- Cardiology, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, and Institut Universitaire de France, PARIS, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | - Patrick Henry
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
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13
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Pezel T, Garot P, Toupin S, Sanguineti F, Hovasse T, Unterseeh T, Champagne S, Morisset S, Chitiboi T, Jacob AJ, Sharma P, Venkatesh BA, Lima JAC, Garot J. AI-Based Fully Automated Left Atrioventricular Coupling Index as a Prognostic Marker in Patients Undergoing Stress CMR. JACC Cardiovasc Imaging 2023; 16:1288-1302. [PMID: 37052568 DOI: 10.1016/j.jcmg.2023.02.015] [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: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. Its prognostic value is not established in patients with cardiovascular disease. OBJECTIVES This study sought to determine in patients undergoing stress cardiac magnetic resonance (CMR) whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF. METHODS Between 2016 and 2018, the authors conducted a longitudinal study including all consecutive patients with abnormal (inducible ischemia or late gadolinium enhancement) vasodilator stress CMR. Control subjects with normal stress CMR were selected using propensity score matching. LACI was defined as the ratio of left atrial to left ventricular end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death. Cox regression was used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors. RESULTS In 2,134 patients (65 ± 12 years, 77% men, 1:1 matched patients [1,067 with normal and 1,067 with abnormal CMR]), LACI was positively associated with the primary outcome (median follow-up: 5.2 years [IQR: 4.8-5.5 years]) before and after adjustment for risk factors in the overall propensity-matched population (adjusted HR: 1.18 [95% CI: 1.13-1.24]), in patients with abnormal CMR (adjusted HR per 0.1% increment: 1.22 [95% CI: 1.14-1.30]), and in patients with normal CMR (adjusted HR per 0.1% increment: 1.12 [95% CI: 1.05-1.20]) (all P < 0.001). After adjustment, a higher LACI of ≥25% showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-index improvement: 0.16; net reclassification improvement = 0.388; integrative discrimination index = 0.153, all P < 0.001; likelihood ratio test P < 0.001). CONCLUSIONS LACI is independently associated with hospitalization for HF and cardiovascular death in patients undergoing stress CMR, with an incremental prognostic value over traditional risk factors including inducible ischemia and late gadolinium enhancement.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Solenn Toupin
- Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Morisset
- Independent Biostatistician, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Athira J Jacob
- Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Puneet Sharma
- Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Bharath Ambale Venkatesh
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
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Duhamel S, Pezel T, Garot J. Functional imaging after the "ISCHEMIA" trial. Arch Cardiovasc Dis 2023:S1875-2136(23)00166-3. [PMID: 37743129 DOI: 10.1016/j.acvd.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023]
Abstract
Previous randomized trials have shown a lack of benefits from the addition of revascularization to optimal medical therapy versus optimal medical therapy alone in patients with stable ischaemic heart disease at relatively low risk (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]), and in diabetic patients with stable ischaemic heart disease (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetics [BARI 2D]). More recently, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) randomized clinical trial showed similar results in patients with moderate-severe ischaemia on functional testing (imaging or stress electrocardiogram) and at least one significant (> 50%) coronary stenosis in a major epicardial coronary artery on coronarography computed coronary angiography. Although the ISCHEMIA trial adds pivotal knowledge regarding the management of and decision-making in stable patients, this study has prompted a great debate about the role of functional imaging for diagnosis, risk stratification and therapeutic decision-making. The objectives of this review are to summarize the results of the ISCHEMIA trial, to underline its limitations and to warn care providers about potential misinterpretation of this trial.
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Affiliation(s)
- Suzanne Duhamel
- Cardiovascular Magnetic Resonance Laboratory, institut cardiovasculaire Paris Sud, hôpital privé Jacques-Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Théo Pezel
- Service de cardiologie, hôpital Lariboisière, AP-HP, université Paris cité, Inserm UMRS 942, 75010 Paris, France
| | - Jérôme Garot
- Cardiovascular Magnetic Resonance Laboratory, institut cardiovasculaire Paris Sud, hôpital privé Jacques-Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France.
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15
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Yoon SS, Fischer C, Amsel D, Monzon M, Toupin S, Pezel T, Garot J, Wetzl J, Maier A, Giese D. Fully automated AI-based cardiac motion parameter extraction - application to mitral and tricuspid valves on long-axis cine MR images. Eur J Radiol 2023; 166:110978. [PMID: 37517314 DOI: 10.1016/j.ejrad.2023.110978] [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: 01/23/2023] [Revised: 05/07/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE In cardiac MRI, valve motion parameters can be useful for the diagnosis of cardiac dysfunction. In this study, a fully automated AI-based valve tracking system was developed and evaluated on 2- or 4-chamber view cine series on a large cardiac MR dataset. Automatically derived motion parameters include atrioventricular plane displacement (AVPD), velocities (AVPV), mitral or tricuspid annular plane systolic excursion (MAPSE, TAPSE), or longitudinal shortening (LS). METHOD Two sequential neural networks with an intermediate processing step are applied to localize the target and track the landmarks throughout the cardiac cycle. Initially, a localisation network is used to perform heatmap regression of the target landmarks, such as mitral, tricuspid valve annulus as well as apex points. Then, a registration network is applied to track these landmarks using deformation fields. Based on these outputs, motion parameters were derived. RESULTS The accuracy of the system resulted in deviations of 1.44 ± 1.32 mm, 1.51 ± 1.46 cm/s, 2.21 ± 1.81 mm, 2.40 ± 1.97 mm, 2.50 ± 2.06 mm for AVPD, AVPV, MAPSE, TAPSE and LS, respectively. Application on a large patient database (N = 5289) revealed a mean MAPSE and LS of 9.5 ± 3.0 mm and 15.9 ± 3.9 % on 2-chamber and 4-chamber views, respectively. A mean TAPSE and LS of 13.4 ± 4.7 mm and 21.4 ± 6.9 % was measured. CONCLUSION The results demonstrate the versatility of the proposed system for automatic extraction of various valve-related motion parameters.
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Affiliation(s)
- Seung Su Yoon
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany.
| | - Carola Fischer
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany; Technische Universität Berlin, Germany
| | - Daniel Amsel
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maria Monzon
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France; Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Jens Wetzl
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | - Andreas Maier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Giese
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
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Pezel T, Garot P, Toupin S, Hovasse T, Sanguineti F, Champagne S, Morisset S, Chitiboi T, Jacob AJ, Sharma P, Unterseeh T, Garot J. Prognostic impact of artificial intelligence-based fully automated global circumferential strain in patients undergoing stress CMR. Eur Heart J Cardiovasc Imaging 2023; 24:1269-1279. [PMID: 37159403 DOI: 10.1093/ehjci/jead100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
AIMS To determine whether fully automated artificial intelligence-based global circumferential strain (GCS) assessed during vasodilator stress cardiovascular (CV) magnetic resonance (CMR) can provide incremental prognostic value. METHODS AND RESULTS Between 2016 and 2018, a longitudinal study included all consecutive patients with abnormal stress CMR defined by the presence of inducible ischaemia and/or late gadolinium enhancement. Control subjects with normal stress CMR were selected using a propensity score-matching. Stress-GCS was assessed using a fully automatic machine-learning algorithm based on featured-tracking imaging from short-axis cine images. The primary outcome was the occurrence of major adverse clinical events (MACE) defined as CV mortality or nonfatal myocardial infarction. Cox regressions evaluated the association between stress-GCS and the primary outcome after adjustment for traditional prognosticators. In 2152 patients [66 ± 12 years, 77% men, 1:1 matched patients (1076 with normal and 1076 with abnormal CMR)], stress-GCS was associated with MACE [median follow-up 5.2 (4.8-5.5) years] after adjustment for risk factors in the propensity-matched population [adjusted hazard ratio (HR), 1.12 (95% CI, 1.06-1.18)], and patients with normal CMR [adjusted HR, 1.35 (95% CI, 1.19-1.53), both P < 0.001], but not in patients with abnormal CMR (P = 0.058). In patients with normal CMR, an increased stress-GCS showed the best improvement in model discrimination and reclassification above traditional and stress CMR findings (C-statistic improvement: 0.14; NRI = 0.430; IDI = 0.089, all P < 0.001; LR-test P < 0.001). CONCLUSION Stress-GCS is not a predictor of MACE in patients with ischaemia, but has an incremental prognostic value in those with a normal CMR although the absolute event rate remains low.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière-APHP, Inserm UMRS 942, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, Scientific partnerships, 93200 Saint-Denis, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Stéphane Morisset
- Independent Biostatistician, Université de Paris Cité, Pérouges, France
| | - Teodora Chitiboi
- Siemens Healthineers, Biomedical Engineering, Lindenplatz 2, Germany
| | - Athira J Jacob
- Siemens Healthineers, Digital Technologies and Innovation, 755 College Road East, Princeton NJ 08540, USA
| | - Puneet Sharma
- Siemens Healthineers, Digital Technologies and Innovation, 755 College Road East, Princeton NJ 08540, USA
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
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Silva TQAC, Pezel T, Jerosch-Herold M, Coelho-Filho OR. The Role and Advantages of Cardiac Magnetic Resonance in the Diagnosis of Myocardial Ischemia. J Thorac Imaging 2023; 38:235-246. [PMID: 36917509 DOI: 10.1097/rti.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Ischemic heart disease continues to be the leading cause of death and disability worldwide. For the diagnosis of ischemic heart disease, some form of cardiac stress test involving exercise or pharmacological stimulation continues to play an important role, despite advances within modalities like computer tomography for the noninvasive detection and characterization of epicardial coronary lesions. Among noninvasive stress imaging tests, cardiac magnetic resonance (CMR) combines several capabilities that are highly relevant for the diagnosis of ischemic heart disease: assessment of wall motion abnormalities, myocardial perfusion imaging, and depiction of replacement and interstitial fibrosis markers by late gadolinium enhancement techniques and T1 mapping. On top of these qualities, CMR is also well tolerated and safe in most clinical scenarios, including in the presence of cardiovascular implantable devices, while in the presence of renal disease, gadolinium-based contrast should only be used according to guidelines. CMR also offers outstanding viability assessment and prognostication of cardiovascular events. The last 2019 European Society of Cardiology guidelines for chronic coronary syndromes has positioned stress CMR as a class I noninvasive imaging technique for the diagnosis of coronary artery disease in symptomatic patients. In the present review, we present the current state-of-the-art assessment of myocardial ischemia by stress perfusion CMR, highlighting its advantages and current shortcomings. We discuss the safety, clinical, and cost-effectiveness aspects of gadolinium-based CMR-perfusion imaging for ischemic heart disease assessment.
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Affiliation(s)
- Thiago Quinaglia A C Silva
- Discipline of Cardiology, Faculty of Medical Science-State University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Théo Pezel
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cardiology, University of Paris, CHU Lariboisière, Inserm, UMRS 942, Paris, France
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program and Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Otávio R Coelho-Filho
- Discipline of Cardiology, Faculty of Medical Science-State University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
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Pezel T, Unterseeh T, Hovasse T, Sanguineti F, Garot P, Champagne S, Toupin S, Ah-Sing T, Faradji A, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Safety and incremental prognostic value of stress cardiovascular magnetic resonance in patients with known chronic kidney disease. J Cardiovasc Magn Reson 2023; 25:29. [PMID: 37308923 PMCID: PMC10259036 DOI: 10.1186/s12968-023-00939-8] [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: 11/26/2022] [Accepted: 05/15/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the main cause of mortality in patients with chronic kidney disease (CKD). Although several studies have demonstrated the consistently high prognostic value of stress cardiovascular magnetic resonance (CMR), its prognostic value in patients with CKD is not well established. We aimed to assess the safety and the incremental prognostic value of vasodilator stress perfusion CMR in consecutive symptomatic patients with known CKD. METHODS Between 2008 and 2021, we conducted a retrospective dual center study with all consecutive symptomatic patients with known stage 3 CKD, defined by estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/1.73 m2, referred for vasodilator stress CMR. All patients with eGFR < 30 ml/min/1.73 m2 (n = 62) were excluded due the risk of nephrogenic systemic fibrosis. All patients were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent nonfatal myocardial infarction (MI). Cox regression analysis was used to determine the prognostic value of stress CMR parameters. RESULTS Of 825 patients with known CKD (71.4 ± 8.8 years, 70% men), 769 (93%) completed the CMR protocol. Follow-up was available in 702 (91%) (median follow-up 6.4 (4.0-8.2) years). Stress CMR was well tolerated without occurrence of death or severe adverse event related to the injection of gadolinium or cases of nephrogenic systemic fibrosis. The presence of inducible ischemia was associated with the occurrence of MACE (hazard ratio [HR] 12.50; 95% confidence interval [CI] 7.50-20.8; p < 0.001). In multivariable analysis, ischemia and late gadolinium enhancement were independent predictors of MACE (HR 15.5; 95% CI 7.72 to 30.9; and HR 4.67 [95% CI 2.83-7.68]; respectively, both p < 0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI = 0.477; IDI = 0.049). CONCLUSIONS In patients with known stage 3 CKD, stress CMR is safe and its findings have an incremental prognostic value to predict MACE over traditional risk factors.
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Affiliation(s)
- Théo Pezel
- Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière-APHP, Inserm UMRS 942, 75010, Paris, France
- CMR Department-ICPS, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
- Université de Paris Cité, Service de Radiologie, Hôpital Lariboisière-APHP, 75010, Paris, France
| | - Thierry Unterseeh
- CMR Department-ICPS, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Thomas Hovasse
- CMR Department-ICPS, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Francesca Sanguineti
- CMR Department-ICPS, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Philippe Garot
- CMR Department-ICPS, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Stéphane Champagne
- CMR Department-ICPS, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200, Saint-Denis, France
| | - Tania Ah-Sing
- Université de Paris Cité, Service de Radiologie, Hôpital Lariboisière-APHP, 75010, Paris, France
| | - Alyssa Faradji
- Université de Paris Cité, Service de Radiologie, Hôpital Lariboisière-APHP, 75010, Paris, France
| | - Martin Nicol
- Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière-APHP, Inserm UMRS 942, 75010, Paris, France
- Université de Paris Cité, Service de Radiologie, Hôpital Lariboisière-APHP, 75010, Paris, France
| | - Lounis Hamzi
- Université de Paris Cité, Service de Radiologie, Hôpital Lariboisière-APHP, 75010, Paris, France
| | - Jean Guillaume Dillinger
- Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière-APHP, Inserm UMRS 942, 75010, Paris, France
| | - Patrick Henry
- Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière-APHP, Inserm UMRS 942, 75010, Paris, France
| | - Valérie Bousson
- Université de Paris Cité, Service de Radiologie, Hôpital Lariboisière-APHP, 75010, Paris, France
| | - Jérôme Garot
- CMR Department-ICPS, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
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Pezel T, Coisne A. What other than simulation for the future of echocardiography training? Arch Cardiovasc Dis 2023; 116:298-299. [PMID: 37268492 DOI: 10.1016/j.acvd.2023.05.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Théo Pezel
- Service de cardiologie, hôpital universitaire Lariboisière - AP-HP, université Paris-Cité, 75010 Paris, France; Centre de simulation de l'université Paris-Cité, centre Ilumens, université de Paris, 75006 Paris, France; Inserm UMRS 942, cardiovascular MArkers in Stressed COndiTions (MASCOT), 75010 Paris, France; French Commission of Simulation Teaching (commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France.
| | - Augustin Coisne
- French Commission of Simulation Teaching (commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Lille, Inserm, CHU de Lille, institut Pasteur de Lille, U1011- EGID, 59000 Lille, France; Centre de simulation en santé PRESAGE, faculté de médecine, université de Lille, 59045 Lille, France
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Maisons V, Hamzaoui M, Hanoy M, Pezel T, Guerrot D, Nezam D. Syndrome cardio-rénal : quoi de neuf en 2023 ? Nephrol Ther 2023; 19:121-138. [PMID: 37098707 DOI: 10.1684/ndt.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Cardiac and renal pathologies lead to a high morbidity and mortality rate. The cardio-renal syndrome is characterized by the coexistence of renal and cardiac dysfunction and represents a polymorphic situation that is often complex to understand. This is a common occurrence that constitutes a real public health problem. In this review article, we propose to review the current state of knowledge on this syndrome by focusing on the main physiopathological, epidemiological, clinical and therapeutic aspects.
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Pezel T, Coisne A, Michalski B, Soliman H, Ajmone N, Nijveldt R, Stankovic I, Donal E, van der Maaten J, Papadopoulos C, Edvardsen T, Muraru D, Petersen SE, Cosyns B, Bäck M, Bertrand PB, Haugaa KH, Keenan N, Donal E, Cosyns B. EACVI SIMULATOR-online study: evaluation of transoesophageal echocardiography knowledge and skills of young cardiologists. Eur Heart J Cardiovasc Imaging 2023; 24:285-292. [PMID: 36151868 DOI: 10.1093/ehjci/jeac195] [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: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess the level of transesophageal echocardiography (TOE) knowledge and skills of young cardiologists. METHODS AND RESULTS A European Association of Cardiovascular Imaging (EACVI) online study using the first fully virtual simulation-based software was conducted in two periods (9-12 December 2021 and 10-13 April 2022). All young cardiologists eligible to participate (<40 years) across the world were invited to participate. After a short survey, each participant completed two tests: a theoretical test to assess TOE knowledge and a practical test using an online TOE simulator to investigate TOE skills. Among 716 young cardiologists from 81 countries, the mean theoretical test score was 56.8 ± 20.9 points, and the mean practical test score was 47.4 ± 7.2 points (/100 points max each), including 18.4 ± 8.7 points for the acquisition test score and 29.0 ± 6.7 points for the anatomy test score (/50 points max each). Acquisition test scores were higher for four-chamber (2.3 ± 1.5 points), two-chamber (2.2 ± 1.4 points) and three-chamber views (2.3 ± 1.4 points) than for other views (all P < 0.001). Prior participation to a TOE simulation-based training session, a higher number of TOE exams performed per week, and EACVI certification for TOE were independently associated with a higher global score (all P < 0.001). CONCLUSION Online evaluation of young cardiologists around the world showed a relatively low level of TOE skills and knowledge. Prior participation to a TOE simulation-based training session, a higher number of TOE exams performed per week, and the EACVI certification for TOE were independently associated with a higher global score.
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Affiliation(s)
- Théo Pezel
- Université de Paris Cité, Service de Cardiologie, Hôpital universitaire Lariboisière - APHP, 2 rue Ambroise Paré, 75010 Paris, France.,Centre de simulation de l'Université de Paris Cité, Centre Ilumens, Université de Paris Cité, 20 rue du Département 75018 Paris, France.,INSERM UMRS 942, 2 rue Ambroise Pare, 75010 Paris, France
| | - Augustin Coisne
- Université. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, 1 Place de Verdun, 59000 Lille, France.,Centre de simulation en santé PRESAGE, Faculté de médecine, Université de Lille, 1 Place de Verdun, 59000 Lille, France
| | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, al. Tadeusza Kosciuszki 4, 90-419 Lodz, Poland
| | - Hatem Soliman
- Department of Anaesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Hill End Road, Harefield UB69 6JH, UK
| | - Nina Ajmone
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, University of Belgrade, Faculty of Medicine, Vukova 9, 11080 Belgrade, Serbia
| | - Erwan Donal
- Université RENNES-1, Service de Cardiologie, Centre hospitalo-universitaire (CHU), 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Joost van der Maaten
- Department of Anesthesiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Constantinos Papadopoulos
- Department of Cardiology, Korgialenio-Benakio Red Cross Hospital, Athanasakis 11, Athens 11526, Greece
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, MI, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University, Mile End Road, Bethnal Green, London E1 4NS, UK.,William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Bernard Cosyns
- Cardiology, Centrum voor hart en vaatziekten (CHVZ), Universitair Ziekenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), 101 laarbeeklaan, 1090 Brussels, Belgium
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Fauvel C, Bonnet G, Mullens W, Giraldo CIS, Mežnar AZ, Barasa A, Tokmakova M, Shchendrygina A, Costa FM, Mapelli M, Zemrak F, Tops LF, Jakus N, Sultan A, Bahouth F, Hadjseyd CE, Salvat M, Anselmino M, Messroghli D, Weberndörfer V, Giverts I, Bochaton T, Courand PY, Berthelot E, Legallois D, Beauvais F, Bauer F, Lamblin N, Damy T, Girerd N, Sebbag L, Pezel T, Cohen-Solal A, Rosano G, Roubille F, Mewton N. Sequencing and titrating approach of therapy in heart failure with reduced ejection fraction following the 2021 European Society of Cardiology guidelines: an international cardiology survey. Eur J Heart Fail 2023; 25:213-222. [PMID: 36404398 DOI: 10.1002/ejhf.2743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
AIMS In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists. METHODS AND RESULTS An independent academic web-based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1 year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32-47] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was ≤40% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors first (74%), beta-blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium-glucose cotransporter 2 inhibitors (53%) fourth. Eighty-four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers. CONCLUSION In a broad international cardiology community, the 'historical approach' to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices.
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Affiliation(s)
- Charles Fauvel
- CHU ROUEN, Department of Cardiology, FHU Carnaval, Rouen University Hospital, Rouen, France
- Internal Medicine Department, Cardiovascular Medicine Section, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Unité Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Pessac, France
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Hasselt University, Hasselt, Belgium
| | | | | | - Anders Barasa
- Department of Cardiology, Glostrup Hospital, Copenhagen, Denmark
| | - Mariya Tokmakova
- Cardiology Department, UMHAT 'Sv. Georgi' EAD Plovdi, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Anastasia Shchendrygina
- Cardiology Department, Department of Hospital Therapy No.2, Sechenov University, Moscow, Russia
| | | | - Massimo Mapelli
- Heart Failure Unit, Centro Cardiologico Monzino IRCCs, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Filip Zemrak
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Jakus
- Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Arian Sultan
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Köln, Germany
| | - Fadel Bahouth
- Cardiology Department, Bnai Zion Hospital, Haifa, Israel
| | - Chahr-Eddine Hadjseyd
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | | | - Matteo Anselmino
- Città della Salute e della Scienza di Torino, Hospital Department of Medical Sciences, University of Turin, Turin, Italy
| | - Daniel Messroghli
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Vanessa Weberndörfer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, The Netherlands
| | - Ilya Giverts
- Cardiopulmonary Exercise Core Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Bochaton
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - Pierre Yves Courand
- Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon
- France; Université de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1, France
| | | | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, Caen, France
| | - Florence Beauvais
- Inserm UMRS 942, Department of Cardiology, University of Paris, Paris, France
| | - Fabrice Bauer
- Service de Chirurgie Cardiaque, Clinique d'Insuffisance Cardiaque Avancée, Centre de Compétence en Hypertension Pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France
| | - Nicolas Lamblin
- Université de Lille, Service de Cardiologie, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Thibaud Damy
- Réseau Cardiogen, Department of Cardiology, Centre Français de Référence de l'Amylose Cardiaque (CRAC), CHU d'Henri-Mondor, Créteil, France
| | - Nicolas Girerd
- Centre d'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Laurent Sebbag
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - Théo Pezel
- Inserm UMRS 942, Department of Cardiology, University of Paris, Paris, France
| | - Alain Cohen-Solal
- Inserm UMRS 942, Department of Cardiology, University of Paris, Paris, France
| | - Giuseppe Rosano
- Department of Cardiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, Montpellier, France
| | - Nathan Mewton
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
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Lim D, Varadarajan V, Quinaglia T, Pezel T, Wu C, Noda C, Heckbert S, Bluemke D, Ambale-Venkatesh B, Lima J. Change in minimum indexed left atrial volume predicts incident heart failure: the multi-ethnic study of atherosclerosis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Purpose
Longitudinal change in the left atrium prior to the onset of heart failure has not been as well studied as left atrial (LA) dysfunction in pre-existing heart failure. This study used cardiac magnetic resonance (CMR) imaging to investigate the relationship between longitudinal change in LA volume and function and incident heart failure (HF), in a multi-ethnic population free of known cardiovascular disease at baseline.
Methods and Results
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2470 participants (60±9 years, 47% males), free at baseline of clinically recognized cardiovascular disease, had LA volume, emptying fractions and peak longitudinal strain assessed with Multimodality Tissue Tracking (MTT; version 6.0 Toshiba, Japan) on CMR imaging at baseline (2000-02) and at follow-up 9.4±0.6 years later. Seventy three (3%) participants subsequently developed incident HF 7.1±2.1 years after the follow-up CMR exam. In cox regression models, an annualized change in all LA parameters were significantly associated with an increased risk of incident HF. An annual increase of 1ml/m2 in minimum indexed LA volumes (∆LAVimin) was most strongly associated with the risk of incident HF (Hazard Ratio(HR)=1.85, 95% confidence interval(CI) [1.49-2.29], P<0.001) and improved model reclassification and discrimination in predicting incident HF (c-statistic=0.80, 95%CI [0.75-0.86]; NRI=0.13, P=0.04; IDI=0.04, P=0.01; x2=6.52, P=0.69) adjusting for known risk factors (age, gender, systolic blood pressure, anti-hypertensive medication use, smoking status, diabetes mellitus, total cholesterol, previous atrial fibrillation) and baseline LA parameters.
Conclusion
In this multi-ethnic population free of clinical cardiovascular disease at baseline, ∆LAVimin was most strongly associated with, and incrementally predictive of incident HF, after adjusting for known risk factors and baseline LA measures.
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Affiliation(s)
- D Lim
- The Johns Hopkins Hospital , Baltimore , United States of America
| | - V Varadarajan
- The Johns Hopkins Hospital , Baltimore , United States of America
| | - T Quinaglia
- The Johns Hopkins Hospital , Baltimore , United States of America
| | - T Pezel
- The Johns Hopkins Hospital , Baltimore , United States of America
| | - C Wu
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - C Noda
- The Johns Hopkins Hospital , Baltimore , United States of America
| | - S Heckbert
- University of Washington , Seattle , United States of America
| | - D Bluemke
- University of Wisconsin-Madison , Madison , United States of America
| | | | - J Lima
- The Johns Hopkins Hospital , Baltimore , United States of America
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24
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Said MA, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Garot P, Bousson V, Garot J. Safety, feasibility, and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. Eur Heart J Cardiovasc Imaging 2023; 24:202-211. [PMID: 36214336 DOI: 10.1093/ehjci/jeac202] [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: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To assess the safety, feasibility, and prognostic value of stress cardiovascular magnetic resonance (CMR) in patients with pacemaker (PM). METHODS AND RESULTS Between 2008 and 2021, we conducted a bi-centre longitudinal study with all consecutive patients with MR-conditional PM referred for vasodilator stress CMR at 1.5 T in the Institut Cardiovasculaire Paris Sud and Lariboisiere University Hospital. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction. Cox regression analyses were performed to determine the prognostic value of CMR parameters. The quality of CMR was rated by two observers blinded to clinical details. Of 304 patients who completed the CMR protocol, 273 patients (70% male, mean age 71 ± 9 years) completed the follow-up (median [interquartile range], 7.1 [5.4-7.5] years). Among those, 32 experienced a MACE (11.7%). Stress CMR was well tolerated with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.9% of segments. Ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.71 [95% CI: 4.60-28.2]; and HR: 5.62 [95% CI: 2.02-16.21], both P < 0.001). After adjustment for traditional risk factors, ischaemia and LGE were independent predictors of MACE (HR: 5.08 [95% CI: 2.58-14.0]; and HR: 2.28 [95% CI: 2.05-3.76]; both P < 0.001). CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.
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Affiliation(s)
- Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Lacotte
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Jérôme Horvilleur
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Mina Ait Said
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Fiorella Salerno
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Laurent Fiorina
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Vladimir Manenti
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Amir Zouaghi
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris, Service de Cardiologie, Department of Cardiology and Electrophysiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Alyssa Faradji
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Martin Nicol
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Tania Ah-Sing
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Valérie Bousson
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
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25
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Pezel T, Dreyfus J, Mouhat B, Thébaut C, Audureau E, Bernard A, Badie YL, Bohbot Y, Fard D, Nguyen LS, Monteil C, Bière L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Bazire B, Fauvel C, Cautela J, Cambet T, Le Tourneau T, Donal E, Lafitte S, Magne J, Mansencal N, Coisne A, Aghezzaf S, Blanchard V, Meilhac A. Effectiveness of Simulation-Based Training on Transesophageal Echocardiography Learning. JAMA Cardiol 2023; 8:248-256. [PMID: 37070491 DOI: 10.1001/jamacardio.2022.5016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Trial RegistrationClinicalTrials.gov Identifier: NCT05564507
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Affiliation(s)
- Théo Pezel
- Université de Paris, Service de Cardiologie, Hôpital universitaire Lariboisière – APHP, Paris, France
- Centre de simulation de l’Université de Paris, Centre Ilumens, Université de Paris, Paris, France
- INSERM UMRS 942, Paris, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital, Besançon, France
| | - Clémence Thébaut
- Université de Limoges, Inserm U1094 IRD U270 EpiMaCT, chercheur en économie de la santé associé LEDA-Legos PSL Paris-Dauphine, Limoges, France
| | - Etienne Audureau
- Clinical Epidemiology and Ageing (CEPIA), IMRB U955, UPEC, CHU Henri Mondor, AP-HP, Creteil, France
| | - Anne Bernard
- Service de Cardiologie, CHRU de Tours, Tours, France
- EA4245, Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France
- Centre Régional d’Enseignement par la Simulation en Santé MEDISIM, Université de Tours, Tours, France
| | - Yoan Lavie Badie
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Health Simulation Center SimUSanté, Amiens University Hospital, Amiens, France
| | - Damien Fard
- Department of Cardiology, Cardiology Intensive Care Unit, Henri-Mondor University Hospital, AP-HP, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Lee S. Nguyen
- Research and Innovation, RICAP, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Cécile Monteil
- Centre de simulation de l’Université de Paris, Centre Ilumens, Université de Paris, Paris, France
| | - Loïc Bière
- All’Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, Angers, France
| | - Florent Le Ven
- Department of Cardiology, Brest University Hospital, CHRU de la Cavale Blanche, Brest, France
- Centre de simulation en santé-CESIM Brest, Brest, France
| | - Marjorie Canu
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | | | - Baptiste Mion
- Université de Paris, Service de Cardiologie, Hôpital universitaire Hôtel Dieu – APHP, Paris, France
| | - Baptiste Bazire
- Université de Paris, Service de Cardiologie, Hôpital universitaire Bichat – APHP, Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU CARNAVAL, Rouen, France
- Department of Cardiovascular medicine, Wexner Medical Center, The Ohio State University, Columbus
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Marseille, France
| | - Théo Cambet
- Explorations fonctionnelles cardiovasculaires, Louis Pradel Hospital, Hospices Civils de Lyon, BRON Cedex, France
| | - Thierry Le Tourneau
- L’institut du thorax, INSERM, CNRS, Simu de Nantes, Univ Nantes, CHU Nantes, Nantes, France
| | - Erwan Donal
- Cardiologie, CHU de Rennes, LTSI, Inserm 1099, Rennes, France
| | - Stéphane Lafitte
- UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Julien Magne
- Center of Epidemiology, biostatistics and methodology of research, Limoges, CHU Limoges, Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - OmegaHealth, Limoges, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Augustin Coisne
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France
- Centre de simulation en santé PRESAGE, Faculté de médecine, Université de Lille, Lille, France
- Cardiovascular Research Foundation, New York, New York
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Toupin S, Pezel T, Hovasse T, Sanguineti F, Champagne S, Unterseeh T, Chitiboi T, Jacob A, Borgohain I, Sharma P, Garot P, Garot J. Incremental prognostic value of fully-automatic LVEF by stress CMR using machine learning. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Toupin S, Pezel T, Garot P, Sanguineti F, Kinnel M, Unterseeh T, Champagne S, Hovasse T, Garot J. Prognostic value of unrecognized myocardial infarction and silent ischemia detected by stress CMR in asymptomatic patients with prior cryptogenic ischemic stroke. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Noirclerc N, Schurtz G, Roubille F, Fauvel C, Bochaton T, Aboyans V, Puymirat E, Vicaut E, Henry P. Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: The ADDICT-ICCU Trial. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Pezel T, Hovasse T, Garot P, Sanguineti F, Champagne S, Unterseeh T, Toupin S, Ah-Sing T, Faradji A, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Incremental prognostic value of stress CMR for cardiovascular risk stratification in patients with known chronic kidney disease. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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30
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Gall E, Pezel T, Lattuca B, Puymirat E, Hauguel-Moreau M, Gretzinger A, Trimaille A, Léquipar A, Fauvel C, Charbonnel C, Zakine C, Bedossa M, Aboyans V, Deney A, Schurtz G, Bouleti C, Rossanaly Vasram R, Bochaton T, Dillinger JG, Henry P. Description of intensive cardiac care units (ICCU) in France in 2021: Insight from ADDICT-ICCU registry. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Ait Said M, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Bousson V, Garot P, Garot J. Safety, feasibility and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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32
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Pezel T, Hovasse T, Toupin S, Sanguineti F, Garot P, Champagne S, Chitiboi T, Jacob A, Borgohain I, Sharma P, Unterseeh T, Garot J. Additional prognostic value of fully automatic global longitudinal strain using machine learning. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Weizman O, Duceau B, Trimaille A, Pommier T, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Sutter W, Mika D, Fauvel C, Pezel T, Waldmann V, Cohen A, Bonnet G. Machine learning-based scoring system to predict in-hospital outcomes in patients hospitalized with COVID-19. Arch Cardiovasc Dis 2022; 115:617-626. [PMID: 36376208 PMCID: PMC9595484 DOI: 10.1016/j.acvd.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evolution of patients hospitalized with coronavirus disease 2019 (COVID-19) is still hard to predict, even after several months of dealing with the pandemic. AIMS To develop and validate a score to predict outcomes in patients hospitalized with COVID-19. METHODS All consecutive adults hospitalized for COVID-19 from February to April 2020 were included in a nationwide observational study. Primary composite outcome was transfer to an intensive care unit from an emergency department or conventional ward, or in-hospital death. A score that estimates the risk of experiencing the primary outcome was constructed from a derivation cohort using stacked LASSO (Least Absolute Shrinkage and Selection Operator), and was tested in a validation cohort. RESULTS Among 2873 patients analysed (57.9% men; 66.6±17.0 years), the primary outcome occurred in 838 (29.2%) patients: 551 (19.2%) were transferred to an intensive care unit; and 287 (10.0%) died in-hospital without transfer to an intensive care unit. Using stacked LASSO, we identified 11 variables independently associated with the primary outcome in multivariable analysis in the derivation cohort (n=2313), including demographics (sex), triage vitals (body temperature, dyspnoea, respiratory rate, fraction of inspired oxygen, blood oxygen saturation) and biological variables (pH, platelets, C-reactive protein, aspartate aminotransferase, estimated glomerular filtration rate). The Critical COVID-19 France (CCF) risk score was then developed, and displayed accurate calibration and discrimination in the derivation cohort, with C-statistics of 0.78 (95% confidence interval 0.75-0.80). The CCF risk score performed significantly better (i.e. higher C-statistics) than the usual critical care risk scores. CONCLUSIONS The CCF risk score was built using data collected routinely at hospital admission to predict outcomes in patients with COVID-19. This score holds promise to improve early triage of patients and allocation of healthcare resources.
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Affiliation(s)
- Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France,Université de Paris, PARCC, INSERM, 75015 Paris, France
| | | | - Antonin Trimaille
- Nouvel Hopital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, 80000 Amiens, France
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, 59800 Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | | | | | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | | | - Corentin Chaumont
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, 76000 Rouen, France
| | | | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Julie Pastier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Nacim Ezzouhairi
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Benjamin Perin
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP–HP, Université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier Régional de Orléans, 45100 Orléans, France
| | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, 76000 Rouen, France
| | - Théo Pezel
- Hôpital Lariboisière, AP–HP, Université de Paris, 75010 Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, 75015 Paris, France,Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Ariel Cohen
- Hôpital Saint-Antoine, 75012 Paris, France,Corresponding author. Hôpital Saint-Antoine, 184, Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France,Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
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Pezel T, Bonnet G, Kinnel M, Asselin A, Hovasse T, Unterseeh T, Champagne S, Sanguineti F, Toupin S, Garot P, Garot J. Clustering of patients with inconclusive non-invasive stress testing referred for vasodilator stress cardiovascular magnetic resonance. Arch Cardiovasc Dis 2022; 115:627-636. [PMID: 36376207 DOI: 10.1016/j.acvd.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inconclusive non-invasive stress testing is associated with impaired outcome. This population is very heterogeneous, and its characteristics are not well depicted by conventional methods. AIMS To identify patient subgroups by phenotypic unsupervised clustering, integrating clinical and cardiovascular magnetic resonance data to unveil pathophysiological differences between subgroups of patients with inconclusive stress tests. METHODS Between 2008 and 2020, consecutive patients with a first inconclusive non-invasive stress test referred for stress cardiovascular magnetic resonance were followed for the occurrence of major adverse cardiovascular events (defined as cardiovascular death or myocardial infarction). A cluster analysis was performed on clinical and cardiovascular magnetic resonance variables. RESULTS Of 1402 patients (67% male; mean age 70±11years) who completed the follow-up (median 6.5years, interquartile range 5.6-7.5years), 197 experienced major adverse cardiovascular events (14.1%). Three distinct phenogroups were identified based upon unsupervised hierarchical clustering of principal components: phenogroup 1=history of percutaneous coronary intervention with viable myocardial infarction and preserved left ventricular ejection fraction; phenogroup 2=atrial fibrillation with preserved left ventricular ejection fraction; and phenogroup 3=coronary artery bypass graft with non-viable myocardial scar and reduced left ventricular ejection fraction. Using survival analysis, the occurrence of major adverse cardiovascular events (P=0.007), cardiovascular mortality (P=0.002) and all-cause mortality (P<0.001) differed among the three phenogroups. Phenogroup 3 presented the worse prognosis. In each phenogroup, ischaemia was associated with major adverse cardiovascular events (phenogroup 1: hazard ratio 2.79, 95% confidence interval 1.61-4.84; phenogroup 2: hazard ratio 2.59, 95% confidence interval 1.69-3.97; phenogroup 3: hazard ratio 3.16, 95% confidence interval 1.82-5.49; all P<0.001). CONCLUSIONS Cluster analysis of clinical and cardiovascular magnetic resonance variables identified three phenogroups of patients with inconclusive stress testing, with distinct prognostic profiles.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; Department of Cardiology, Lariboisière Hospital, AP-HP, Inserm UMRS 942, University of Paris, 75010 Paris, France
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Marine Kinnel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | | | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Solenn Toupin
- Scientific Partnerships Division, Siemens Healthcare France, 93200 Saint-Denis, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France.
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Laissy JP, Pezel T, Herbin C, Corino C, Bendriss A. Contrast-enhanced cine MR sequences in the assessment of myocardial hyperemia in acute myocarditis: can they help? A feasibility study. Heart Vessels 2022; 38:662-670. [PMID: 36436026 DOI: 10.1007/s00380-022-02207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/16/2022] [Indexed: 11/28/2022]
Abstract
The study was designed to assess the accuracy of contrast-enhanced balanced steady-state free precession (cine-SSFP) CMR imaging sequences to exhibit myocardial hyperemia in acute myocarditis, which has for a long time been investigated in some centers using early gadolinium enhancement (EGE) sequence. Contrast-enhanced cine-SSFP (CESSFP) sequences were compared to precontrast cine-SSFP sequences to calculate the early cine-contrast enhancement in 36 consecutive patients with acute myocarditis and 36 controls matched for age and gender. Four-chamber views images were obtained in each subject before and after gadolinium injection. Absolute and relative left ventricular myocardial enhancement of the overall myocardium, then separately of the lateral wall and interventricular septum was analyzed in telediastole. Myocarditis patients displayed higher cine-SSFP absolute enhancement than controls (overall left ventricular myocardium 2.38 ± 0.33 vs 1.84 ± 0.31; lateral wall 2.45 ± 0.35 vs 1.83 ± 0.32; and septum 2.26 ± 0.29 vs 1.82 ± 0.29, p < 0.0001 for all). Less significant differences were observed for the relative enhancement (p < 0.05 for all). Using ROC curves, the optimal threshold value of absolute enhancement to diagnose acute myocarditis was 2.05 (sensitivity: 86%; specificity: 81%). Given the simplicity of use, contrast-enhanced cine-SSFP sequences should be used as an additional diagnostic tool to detect hyperemia in acute myocarditis patients.
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Affiliation(s)
- Jean-Pierre Laissy
- Departments of Radiology, Hôpital Bichat AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex 18, France.
- Departments of Radiology, Hôpital Lariboisière APHP, 2 Rue Ambroise Paré, 75010, Paris, France.
- INSERM U1148, University de Paris, Paris, France.
- DHU FIRE, University de Paris, Paris, France.
| | - Théo Pezel
- Departments of Radiology, Hôpital Lariboisière APHP, 2 Rue Ambroise Paré, 75010, Paris, France
- Departments of Cardiology, Hôpital Lariboisière APHP, University de Paris, Paris, France
| | - Christine Herbin
- Departments of Radiology, Hôpital Lariboisière APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Clémentine Corino
- Departments of Radiology, Hôpital Lariboisière APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Ahmed Bendriss
- Departments of Radiology, Hôpital Bichat AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex 18, France
- INSERM U1148, University de Paris, Paris, France
- DHU FIRE, University de Paris, Paris, France
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Pezel T, Michos ED, Varadarajan V, Shabani M, Venkatesh BA, Vaidya D, Kato Y, De Vasconcellos HD, Heckbert SR, Wu CO, Post WS, Bluemke DA, Allison MA, Henry P, Lima JAC. Prognostic value of a left atrioventricular coupling index in pre- and post-menopausal women from the Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2022; 9:1066849. [DOI: 10.3389/fcvm.2022.1066849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BackgroundSex hormones associated with both the left atrial (LA) and left ventricular (LV) structures in women, but the association of menopause status with left atrioventricular coupling is not established.AimTo assess the prognostic value of a left atrioventricular coupling index (LACI) in peri-menopausal women without a history of cardiovascular disease (CVD).Materials and methodsIn all women participating in MESA study with baseline cardiovascular MRI, the LACI was measured as the ratio of the LA end-diastolic volume to the LV end-diastolic volume. Cox models were used to assess the association between the LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), coronary heart disease (CHD) death, and hard CVD.ResultsAmong the 2,087 women participants (61 ± 10 years), 485 cardiovascular events occurred (mean follow-up: 13.2 ± 3.3 years). A higher LACI was independently associated with AF (HR 1.70; 95%CI [1.51–1.90]), HF (HR 1.62; [1.33–1.97]), CHD death (HR 1.36; [1.10–1.68]), and hard CVD (HR 1.30; [1.13–1.51], all p < 0.001). Adjusted models with the LACI showed significant improvement in model discrimination and reclassification when compared to traditional models to predict: incident AF (C-statistic: 0.82 vs. 0.79; NRI = 0.325; IDI = 0.036), HF (C-statistic: 0.84 vs. 0.81; NRI = 0.571; IDI = 0.023), CHD death (C-statistic: 0.87 vs. 0.85; NRI = 0.506; IDI = 0.012), hard CVD (C-statistic: 0.78 vs. 0.76; NRI = 0.229; IDI = 0.012). The prognostic value of the LACI had a better discrimination and reclassification than individual LA or LV parameters.ConclusionIn a multi-ethnic population of pre- and post-menopausal women, the LACI is an independent predictor of HF, AF, CHD death, and hard CVD.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT00005487].
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Pezel T, Sanguineti F, Garot P, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, Faradji A, Ah-Sing T, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Machine-Learning Score Using Stress CMR for Death Prediction in Patients With Suspected or Known CAD. JACC Cardiovasc Imaging 2022; 15:1900-1913. [PMID: 35842360 DOI: 10.1016/j.jcmg.2022.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In patients with suspected or known coronary artery disease, traditional prognostic risk assessment is based on a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables. OBJECTIVES This study sought to investigate the feasibility and accuracy of ML using stress cardiac magnetic resonance (CMR) and clinical data to predict 10-year all-cause mortality in patients with suspected or known coronary artery disease, and compared its performance with existing clinical or CMR scores. METHODS Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 (IQR: 5.0-8.0) years included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. ML involved automated feature selection by random survival forest, model building with a multiple fractional polynomial algorithm, and 5 repetitions of 10-fold stratified cross-validation. The primary outcome was all-cause death based on the electronic National Death Registry. The external validation cohort of the ML score was performed in another center. RESULTS Of 31,752 consecutive patients (mean age: 63.7 ± 12.1 years, and 65.7% male), 2,679 (8.4%) died with 206,453 patient-years of follow-up. The ML score (ranging from 0 to 10 points) exhibited a higher area under the curve compared with Clinical and Stress Cardiac Magnetic Resonance score, European Systematic Coronary Risk Estimation score, QRISK3 score, Framingham Risk Score, and stress CMR data alone for prediction of 10-year all-cause mortality (ML score: 0.76 vs Clinical and Stress Cardiac Magnetic Resonance score: 0.68, European Systematic Coronary Risk Estimation score: 0.66, QRISK3 score: 0.64, Framingham Risk Score: 0.63, extent of inducible ischemia: 0.66, extent of late gadolinium enhancement: 0.65; all P < 0.001). The ML score also exhibited a good area under the curve in the external cohort (0.75). CONCLUSIONS The ML score including clinical and stress CMR data exhibited a higher prognostic value to predict 10-year death compared with all traditional clinical or CMR scores.
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Affiliation(s)
- Théo Pezel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Francesca Sanguineti
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Philippe Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Solenn Toupin
- Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France
| | | | - Thomas Hovasse
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Alyssa Faradji
- Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Tania Ah-Sing
- Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Martin Nicol
- Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Lounis Hamzi
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jean Guillaume Dillinger
- Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Patrick Henry
- Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Valérie Bousson
- Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jérôme Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
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Lim D, Varadarajan V, Quinaglia T, Pezel T, Wu C, Noda C, Heckbert S, Bluemke D, Ambale-Venkatesh B, Lima J. Change in left atrial function and volume predicts heart failure with preserved and reduced ejection fraction: the multi-ethnic study of atherosclerosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
This study used cardiac magnetic resonance (CMR) imaging to investigate the relationship between longitudinal change in left atrial (LA) function and incident heart failure (HF), in a multi-ethnic population free of known cardiovascular disease at baseline.
Methods and results
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2470 participants (60±9 years, 47% males), free at baseline of clinically recognized cardiovascular disease, had LA volume and function assessed with CMR imaging at baseline (2000–02) and 9.4±0.6 years later. Seventy three (3%) participants developed incident HF over 7.1±2.1 years; of these, 39 participants had preserved ejection fraction (HFpEF) and 34 participants had reduced ejection fraction (HFrEF). An annual decrease of 1-SD unit in peak LA strain (ΔLASmax) was most strongly associated with the risk of HFpEF (subdistribution HR=2.56, 95% confidence interval (CI) [1.34–4.90], P=0.004) and improved model reclassification and discrimination in predicting HFpEF (c-statistic=0.84, 95% CI [0.79–0.90]; NRI=0.34, P=0.01; IDI=0.02, P=0.02; x2=4.25, P=0.89) adjusting for event-specific risk factors and baseline LA parameters. An annual decrease of 1ml/m2 of pre-atrial LA volume index (ΔLAVipreA) was most strongly associated with the risk of HFrEF (subdistribution HR=1.88, 95% CI [1.44–2.45], P<0.001) and improved model reclassification and discrimination in predicting HFrEF (c-statistic=0.81, 95% CI (0.72–0.90); NRI=0.31, P=0.03; IDI=0.01, P=0.50; x2=15.4, P=0.08), adjusting for event-specific risk factors and baseline LA measures (Table 1).
Conclusion
In this multi-ethnic population free of clinical cardiovascular disease at baseline, ΔLASmax and ΔLAVipreA were associated with, and incrementally predictive of HFpEF and HFrEF respectively, after adjusting for event-specific risk factors and baseline LA measures.
Disclaimer
The views expressed in this abstract are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Heart, Lung and Blood InstituteNational Center for Advancing Translational Sciences
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Affiliation(s)
- D Lim
- Johns Hopkins University of Baltimore , Baltimore , United States of America
| | - V Varadarajan
- Johns Hopkins University of Baltimore , Baltimore , United States of America
| | - T Quinaglia
- Johns Hopkins University of Baltimore , Baltimore , United States of America
| | - T Pezel
- Johns Hopkins University of Baltimore , Baltimore , United States of America
| | - C Wu
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - C Noda
- Johns Hopkins University of Baltimore , Baltimore , United States of America
| | - S Heckbert
- University of Washington , Seattle , United States of America
| | - D Bluemke
- University of Wisconsin-Madison , Madison , United States of America
| | - B Ambale-Venkatesh
- Johns Hopkins University of Baltimore , Baltimore , United States of America
| | - J Lima
- Johns Hopkins University of Baltimore , Baltimore , United States of America
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Pezel T, Sanguineti F, Garot P, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, Ah-Sing T, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Machine-learning score using stress CMR for death prediction in patients with suspected or known CAD. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In patients with suspected or known coronary artery disease (CAD), traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables.
Purpose
To investigate the feasibility and accuracy of ML using stress CMR and clinical data to predict 10-year all-cause mortality in patients with suspected or known CAD, and compared its performance to existing clinical or CMR scores.
Methods
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0–8.0) included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. Machine learning involved automated feature selection by random survival forest, model building with a multiple fractional polynomial algorithm, and 5 repetitions of 10-fold stratified cross-validation. The primary outcome was all-cause death based on the electronic National Death Registry. The external validation cohort of the ML score was performed in another center.
Results
Of 31,752 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2,679 (8.4%) died with 206,453 patient-years of follow-up. ML score (ranging 0 to 10 points) exhibited a higher area-under-the-curve compared with C-CMR-10-score, ESC-score, QRISK3-score, FRS and stress CMR data alone for prediction of 10-year all-cause mortality (ML: 0.76 vs. C-CMR-10-score: 0.68, ESC-score: 0.66, QRISK3-score: 0.64, FRS: 0.63, extent of inducible ischemia: 0.66, extent of LGE: 0.65, all p<0.001). The ML score exhibited also a good area-under-the-curve in the external cohort (AUC: 0.75).
Conclusions
The ML score including clinical and stress CMR data exhibited a higher prognostic value to predict 10-year death compared with all traditional clinical or CMR scores.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Toupin
- Siemens Healthcare France, MRI Department , Saint Denis , France
| | - S Morisset
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Ah-Sing
- Hospital Lariboisiere, Radiology , Paris , France
| | - M Nicol
- Hospital Lariboisiere, Cardiology , Paris , France
| | - L Hamzi
- Hospital Lariboisiere, Radiology , Paris , France
| | | | - P Henry
- Hospital Lariboisiere, Cardiology , Paris , France
| | - V Bousson
- Hospital Lariboisiere, Radiology , Paris , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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40
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Pezel T, Hovasse T, Lefevre T, Sanguineti F, Champagne S, Benamer H, Neylon A, Toupin S, Garot P, Chevalier B, Garot J. Incremental prognostic value of stress CMR in symptomatic patients with coronary stenosis on CCTA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Noninvasive functional imaging is often performed in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA). However, the prognostic value of stress cardiovascular magnetic resonance (CMR) is unknown in patients with coronary stenosis of unknown significance on CCTA.
Purpose
To assess the prognostic value of stress CMR in symptomatic patients with obstructive CAD of unknown significance on CCTA.
Methods
Between 2008–2020, consecutive symptomatic patients without known CAD referred for CCTA were screened. Patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) were further referred for stress CMR and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction.
Results
Of 2,210 patients who completed CMR, 2,038 (46.5% male, mean age 69.8±12.2 years) completed follow-up (median 6.8 [IQR 5.9–9.2] years); 281 experienced a MACE (13.8%). Inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with MACE (HR: 4.51, [95% CI: 3.55–5.74]; and HR: 3.32, [95% CI: 2.55–4.32], respectively; p<0.001). In multivariable Cox regression, number of segments with >70% stenosis, with noncalcified plaques and number of vessels with obstructive CAD were prognosticators (p<0.001). The presence of inducible ischemia and LGE were independent predictors of MACE (HR: 3.97, [95% CI: 3.43–5.13]; HR: 2.30, [95% CI: 1.52–3.33]; p<0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA (C-statistic improvement: 0.04; NRI=0.421; IDI=0.047).
Conclusions
In symptomatic patients with obstructive CAD of unknown significance on CCTA, stress CMR had incremental prognostic value to predict MACE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Lefevre
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - H Benamer
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - A Neylon
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Toupin
- Siemens Healthcare France, MRI Department , Saint Denis , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - B Chevalier
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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41
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Pezel T, Bluemke D, Wu C, Lima J, Ambale Venkatesh B. Regional strain score as prognostic marker of cardiovascular events. from the Multi-Ethnic Study of Atherosclerosis (MESA). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function, particularly using the regional Ecc or layer-specific strain.
Purpose
To investigate the prognostic value of a regional strain score (RSS) for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline.
Methods
In Multi-Ethnic Study of Atherosclerosis (MESA), 1,506 study participants (63.3±9.4 years, 54.6% men) underwent tagged magnetic resonance imaging for left ventricular circumferential strain (Ecc) analysis. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0–2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three RSS: Endo-, Mid-, and Epi-RSS, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-RSS was the sum of these three RSS. Cox proportional models were used to evaluate the association between RSS and cardiovascular outcomes.
Results
After a median [IQR] follow-up of 15.9 [12.9–16.6] years, 122 hard CHD and 91 HF were observed. After adjustment, Mid-, Epi-, and Intramyocardial-RSS values <50% were independently associated with HF (HR 1.43; 95% CI [1.08–2.87], p=0.004; HR 1.80; 95% CI [1.12–3.07], p<0.001; and HR 2.01; 95% CI [1.19–3.20], p<0.001). After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-RSS <50% were also independently associated with hard CHD (HR 1.31; 95% CI [1.03–1.51], p=0.04; HR 1.79; 95% CI [1.26–2.57], p<0.001; HR 2.03; 95% CI [1.45–3.40], p<0.001; and HR 2.28; 95% CI [1.51–3.53], p<0.001).
Conclusion
Layer-specific regional Ecc, assessed by RSS, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any cardiovascular disease at baseline.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - D Bluemke
- University of Wisconsin-Madison , Madison , United States of America
| | - C Wu
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - J Lima
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - B Ambale Venkatesh
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
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Pezel T, Dreyfus J, Mouhat B, Thebaut C, Audureau E, Bernard A, Lavie Badie Y, Bohbot Y, Fard D, Biere L, Le Ven F, Fauvel C, Donal E, Mansencal N, Coisne A. Efficacy of simulation-based training on transoesophageal echocardiography learning in a multicentre randomised controlled trial: SIMULATOR study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence on the impact of simulation-based training in transesophageal echocardiography (TEE) is scarce.
Purpose
We aimed to assess the efficacy of simulation-based versus traditional teaching on TEE knowledge and skills for cardiology residents.
Methods
Between November 2020 and November 2021, all consecutive cardiology residents inexperienced from TEE were randomised (1:1, n=324) through 42 French University Centers into two groups with or without simulation support (either a simulation group or a traditional group). The coprimary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the feelings of residents were also assessed. An economic analysis was also performed.
Results
While the theoretical and practical test scores were similar between the two groups before the training (respectively P=0.80 and P=0.51), the residents in the simulation group displayed higher theoretical test and practical test scores after the training than those in the traditional group (respectively 47.2±15.6% vs. 38.3±19.8%, P<0.0001 and 74.5±17.7% vs. 59.0±25.1%, P<0.0001). Subgroups analyses showed that the efficacy of the simulation training was even greater when performed at the beginning of residency (P<0.0001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group (respectively 8.3±1.4 min vs. 9.4±1.2 min, P<0.0001). Finally, residents' feelings were better in the simulation group than in the traditional group across all components (P<0.0001). Compared to the traditional group, the average additional cost per resident of the simulation program was respectively €1,785, €942 or €662 for 20, 40 and 60 residents.
Conclusion
Simulation-based teaching on TEE showed a significant improvement in knowledge, skills, and feelings of cardiology residents as well as a reduction in the duration to complete the examination.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere , Paris , France
| | - J Dreyfus
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | - B Mouhat
- University of Besançon , Besancon , France
| | - C Thebaut
- University Hospital of Limoges , Limoges , France
| | - E Audureau
- Henri-Mondor University Hospital, Unité de Recherche Clinique et Statistiques , Créteil , France
| | - A Bernard
- University of Tours - Faculty of Medicine , Tours , France
| | - Y Lavie Badie
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - D Fard
- Henri-Mondor University Hospital, Unité de Recherche Clinique et Statistiques , Créteil , France
| | - L Biere
- University Hospital of Angers , Angers , France
| | - F Le Ven
- University Hospital of Brest , Brest , France
| | - C Fauvel
- University Hospital of Rouen , Rouen , France
| | - E Donal
- Hospital Pontchaillou of Rennes , Rennes , France
| | - N Mansencal
- Ambroise Pare Universitary Hospital, Cardiology , Paris , France
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Pezel T, Ambale Venkatesh B, De Vasconcellos H, Kato Y, Post WP, Wu C, Heckbert S, Bluemke D, Cohen-Solal A, Logeart D, Henry P, Lima J. Determinants of left atrioventricular coupling index: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Recent studies have described a novel left atrioventricular coupling index (LACI), which had a better prognostic value than individual left atrial (LA) or left ventricular (LV) parameters measured separately to predict cardiovascular events.
Purpose
To identify the determinants of the LACI and its 10-year annual change (ΔLACI), measured by cardiovascular magnetic resonance (CMR), and to better understand the parameters governing this left atrioventricular coupling.
Methods
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2,112 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (LACIBaseline, 2000–2002) and 10 years later (2010–2012). The LACI was defined as the ratio of LA to LV end-diastolic volumes. Linear regression analyses were performed to identify independent determinants of LACIBaseline or ΔLACI.
Results
In the 2,112 participants (58.8±9.1 years, 46.6% male), after adjustment for all covariates, age was independently associated with both LACIBaseline (R2=0.10, slope=0.16) and ΔLACI (R2=0.15, slope=0.008, both p<0.001). African Americans had the highest LACIBaseline value (18.0±7.7%). Although there was no difference in LACIBaseline between women and men (p=0.19), ΔLACI was higher in women than in men (1.0±1.1 vs. 0.8±1.0%/year, p<0.001). Diabetes and a higher BMI were independently associated with LACIBaseline (both p<0.001). LACIBaseline was independently associated with LV myocardial fibrosis markers (native T1: R2=0.11, slope = 0.09, p=0.038; and extra-cellular volume: R2=0.08, slope = 0.28, p=0.035) and NT-proBNP levels (R2=0.10, slope = −1.11, p<0.001) but was not associated with IL-6 or hsCRP.
Conclusions
Age, sex, ethnicity, diabetes, and BMI were independent determinants of LACI. LACI was independently associated with LV myocardial fibrosis markers and NT-proBNP levels.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere , Paris , France
| | - B Ambale Venkatesh
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - H De Vasconcellos
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - Y Kato
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - W P Post
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - C Wu
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - S Heckbert
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - D Bluemke
- University of Wisconsin-Madison , Madison , United States of America
| | | | - D Logeart
- Hospital Lariboisiere , Paris , France
| | - P Henry
- Hospital Lariboisiere , Paris , France
| | - J Lima
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
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44
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Pezel T, Toupin S, Sanguineti F, Kinnel M, Hovasse T, Unterseeh T, Champagne S, Garot P, Garot J. Incremental prognostic value of stress CMR for cardiovascular risk stratification after a cryptogenic ischemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
One-third of ischemic strokes are “cryptogenic” without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest of CAD screening in patients with cryptogenic stroke is still debated.
Purpose
The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.
Methods
Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.
Results
Of 542 patients (55.2% male, mean age 71.4±8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18% and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE (hazard ratio, HR: 8.43 [95% CI: 5.11–13.9]; HR: 7.87 [95% CI: 4.80–12.9]; respectively, p<0.001). In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE (HR: 8.08 [95% CI: 4.21–15.5]; HR: 6.65 [95% CI: 3.49–12.7]; respectively, p<0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.428; IDI=0.048).
Conclusions
In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - S Toupin
- Siemens Healthcare France, MRI Department , Saint Denis , France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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45
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Fard D, Noirclerc N, Vicaut E, Henry P. Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: the ADDICT-ICCU Trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prevalence and short-term cardiovascular consequences of illicit drug use in patients admitted to the intensive cardiac care unit (ICCU) for acute cardiovascular events are not well established.
Purpose
The Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study was designed to assess prospectively the prevalence of illicit drugs use, and their association with the occurrence of in-hospital major adverse events (MAEs) in consecutive patients admitted to ICCUs for acute cardiovascular events.
Methods
From 7 to 22 April 2021, screening for illicit drug was performed by systematic urinary testing in a prospective study including all consecutive patients admitted to ICCU in 39 centres throughout France. The primary outcome was the prevalence of the illicit drugs detected. The secondary clinical outcome was in-hospital Major Adverse cardiac Events (MAEs) defined by death, resuscitated cardiac arrest or cardiogenic shock.
Results
Among 1,499 consecutive patients screened (age 63.3±14.9 years, 69.6% male), 161 (10.7%) had a positive test for illicit drugs (cannabis: 9.1%, opioids: 2.1%, cocaine: 1.7%, amphetamines: 0.7%, 3,4-methylenedioxymethamphetamine: 0.6%). Patients who used illicit drugs were young (33.0% at age <40 vs. 5.9% at age ≥60 years), and more frequently male (11.9% vs. 8.1%, p<0.001). Self-reported current use was 56.5% in patients with a positive test. After a median duration of hospitalisation of five days, there were 61 in-hospital MAEs (4.1%).
The detection of illicit drugs was associated with a higher rate of MAEs after adjustment for known predictors of severity (OR=8.84; 95% CI: 4.68–16.7, p<0.001) or after using a propensity score adjustment (OR=5.81; 95% CI: 4.14–8.14, p<0.001). After adjustment for age and sex, detection of cannabis or cocaine was significantly associated with MAEs (OR=3.53; 95% CI: 1.25–9.95, p<0.001; OR=5.12; 95% CI: 1.48–17.2, p=0.004 respectively). Multiple drug detection (28% of positive patients) was associated with a higher incidence of MAEs than single drug detection.
Conclusions
The prevalence of illicit drugs use in patients hospitalised in the ICCUs for acute cardiovascular events was 10.7% and was under-reported. Illicit drugs detection was independently associated with a higher occurrence of in-hospital MAEs.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fondation Coeur et Recherche
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | | | - A Trimaille
- University Hospital of Strasbourg , Strasbourg , France
| | - C Delmas
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - N Piliero
- University Hospital of Grenoble , Grenoble , France
| | - C Bouleti
- University of Poitiers , Poitiers , France
| | - T Pommier
- University Hospital of Dijon , Dijon , France
| | | | | | - B Lattuca
- University Hospital of Nimes , Nimes , France
| | | | - D Fard
- Henri-Mondor University Hospital , Créteil , France
| | - N Noirclerc
- Centre Hospitalier Annecy Genevois , Annecy , France
| | - E Vicaut
- Hôpital Fernand Widal, AP-HP, Unité de Recherche Clinique et Statistiques , Paris , France
| | - P Henry
- Hospital Lariboisiere, Cardiology , Paris , France
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Pezel T, Michos ED, Varadarajan V, Shabani M, Ambale Venkatesh B, Vaidya D, Kato Y, De Vasconcellos H, Heckbert S, Wu C, Post W, Bluemke D, Allison MA, Lima J. Prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women. from the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Endogenous sex hormones associated with both the left atrial (LA) and left ventricular (LV) structures in peri-menopausal women, but the association of menopause status with left atrioventricular coupling is not well established.
Purpose
To assess the prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women without a history of cardiovascular disease (CVD) at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA).
Methods
In women participating in the MESA study, the LACI was measured as the ratio of the left atrial (LA) end-diastolic volume to the left ventricular (LV) end-diastolic volume using cardiovascular magnetic resonance (CMR). Cox proportional hazard models were used to assess the association between the LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), and hard CVD defined by myocardial infarction, resuscitated cardiac arrest, stroke, or coronary heart disease death.
Results
Among the 2,087 women participants (61±10 years), 485 cardiovascular events were observed during the mean follow-up period of 13.2±3.3 years. A higher LACI was independently associated with AF (HR 1.70; 95% CI [1.51–1.90]), HF (HR 1.62; [1.33–1.97]), and hard CVD (HR 1.30; [1.13–1.51], all p<0.001). Adjusted models with the LACI showed significant improvement in model discrimination and reclassification when compared to currently used standard models used to predict the incidence of AF (C-statistic=0.82 vs. 0.79; NRI=0.325; IDI=0.036), HF (C-statistic=0.84 vs. 0.81; NRI=0.571; IDI=0.023), hard CVD (C-statistic=0.78 vs. 0.76; NRI=0.229; IDI=0.012).
Conclusion
In a multi-ethnic population of pre- and post-menopausal women, the LACI is an independent predictor of HF, AF, and hard CVD. In both pre- and post-menopausal women, the LACI has an incremental prognostic value for predicting cardiovascular events over traditional risk factors and sex hormone levels.
ClinicalTrials: gov Identifier: NCT00005487
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - E D Michos
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - V Varadarajan
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - M Shabani
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - B Ambale Venkatesh
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - D Vaidya
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - Y Kato
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - H De Vasconcellos
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - S Heckbert
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - C Wu
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - W Post
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - D Bluemke
- University of Wisconsin-Madison , Madison , United States of America
| | - M A Allison
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
| | - J Lima
- The Johns Hopkins Hospital, Cardiology , Baltimore , United States of America
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47
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Toupin S, Pezel T, Sanguineti F, Kinnel M, Hovasse T, Unterseeh T, Champagne S, Garot P, Garot J. Additional prognostic value of stress cardiovascular magnetic resonance for cardiovascular risk stratification after a cryptogenic ischemic stroke. Front Cardiovasc Med 2022; 9:956950. [PMID: 36186993 PMCID: PMC9515378 DOI: 10.3389/fcvm.2022.956950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background One-third of ischemic strokes are “cryptogenic” without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest in CAD screening in patients with cryptogenic stroke is still debated. Aim The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke. Materials and methods Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACEs), defined by cardiovascular death or non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia. Results Of 542 patients (55.2% male, mean age 71.4 ± 8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18 and 17% of patients, respectively. Using Kaplan–Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE [hazard ratio, HR: 8.43 (95% CI: 5.11–13.9); HR: 7.87 (95% CI: 4.80–12.9), respectively, p < 0.001]. In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE [HR: 8.08 (95% CI: 4.21–15.5); HR: 6.65 (95% CI: 3.49–12.7), respectively, p < 0.001]. After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI = 0.428; IDI = 0.048). Conclusion In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.
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Affiliation(s)
| | - Théo Pezel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
- Department of Cardiology, Lariboisiere Hospital–APHP, Inserm UMRS 942, University of Paris, Paris, France
| | - Francesca Sanguineti
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Marine Kinnel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Philippe Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Jérôme Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
- *Correspondence: Jérôme Garot,
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Dillinger JG, Pezel T, Fauvel C, Delmas C, Schurtz G, Trimaille A, Gerbaud E, Roule V, Dib JC, Boccara A, Millischer D, Thuaire C, Fabre J, Levasseur T, Boukertouta T, Darmon A, Azencot R, Merat B, Haugel-Moreau M, Grentzinger A, Charbonnel C, Zakine C, Bedossa M, Lattuca B, Roubille F, Aboyans V, Puymirat E, Cohen A, Vicaut E, Henry P. Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology. Arch Cardiovasc Dis 2022; 115:514-520. [PMID: 36154799 DOI: 10.1016/j.acvd.2022.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown. AIM To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event. METHODS This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up. RESULTS The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed. CONCLUSIONS This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France
| | - Théo Pezel
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, 76000 Rouen, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000 Toulouse, France
| | - Guillaume Schurtz
- Department of Cardiology, University Hospital of Lille, 59000 Lille, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac Cedex, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33000 Bordeaux, France
| | - Vincent Roule
- Department of Cardiology, Caen University Hospital, 14000 Caen, France
| | - Jean-Claude Dib
- Département de Cardiologie, Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - Albert Boccara
- Department of Cardiology, Andre Gregoire Hospital, 93100 Montreuil, France
| | - Damien Millischer
- Service de Cardiologie, Hôpital Montfermeil, 93370 Montfermeil, France
| | - Christophe Thuaire
- Service de Cardiologie, Centre Hospitalier de Chartres, 28630 Le Coudray, France
| | - Julien Fabre
- Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
| | - Thomas Levasseur
- Service de Cardiologie, Centre Hospitalier de Fréjus/Saint-Raphaël, 83600 Fréjus, France
| | | | - Arthur Darmon
- Department of Cardiology, Hôpital Bichat, AP-HP, Université de Paris Cité, 75018 Paris, France
| | - Ruben Azencot
- Service de Cardiologie, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Benoit Merat
- Service de Cardiologie et Médecine Aéronautique, Hôpital d'Instruction des Armées Percy, 92140 Clamart, France
| | - Marie Haugel-Moreau
- Service de Cardiologie, Hôpital Ambroise Paré, AP-HP, 92012 Boulogne-Billancourt, France
| | - Alain Grentzinger
- Service de Cardiologie, Centre Hospitalier de Saintonge, 17100 Saintes, France
| | | | - Cyril Zakine
- Clinique Saint Gatien Alliance (NCT+), 37540 Saint-Cyr-sur-Loire, France
| | - Marc Bedossa
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 35000 Rennes, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - François Roubille
- Department of Cardiology, CHU de Montpellier, 34000 Montpellier, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital; and Inserm U1094 & IRD U270, Limoges University, 87000 Limoges, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), AP-HP, 75015 Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, AP-HP, 75010 Paris, France
| | - Patrick Henry
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France.
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Pezel T, Garot P, Unterseeh T, Hovasse T, Sanguineti F, Toupin S, Morisset S, Champagne S, Garot J. Clinical yield of serial follow-up by stress CMR in high cardiovascular risk patients. Front Cardiovasc Med 2022; 9:995752. [PMID: 36105533 PMCID: PMC9465505 DOI: 10.3389/fcvm.2022.995752] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
- Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière—APHP, Inserm UMRS 942, Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Solenn Toupin
- Siemens Healthcare France Saint-Denis, Bavaria, France
| | | | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
- *Correspondence: Jérôme Garot
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50
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Yoon S, Fischer C, Toupin S, Pezel T, Garot J, Wetzl J, Maier A, Giese D. Fully automatic AI-based valve motion parameter extraction on long axis CINE images - application on N=11000 patient datasets. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Research support from Siemens Healthineers GmbH.
Background
Mitral valve (MV) motion parameters, assessable using CMR [1, 2], have been shown to help the diagnosis of cardiac dysfunction. To extract valve motion parameters, we propose a fully automatic AI-based prototype system that tracks annulus and apex landmarks by the registration network on time-resolved two- and four-chamber CMR cine views. Parameters such as displacements, velocities, mitral annular plane systolic excursion (MAPSE), or longitudinal shortening (LS) are automatically extracted and evaluated on a large CMR dataset (N=11000).
Methods
The system consists of two sequential neural networks with a processing step in between (Fig. 1a) [3]. Initially, a 2D UNet is applied to localize both MV annulus insertion points as well as the apex. Based on these points, the image processing step consists of rotating, cropping, and interpolating the images, allowing a standardized image impression for both long axis views. Finally, the registration network (VoxelMorph framework [4]) is applied to the processed series and tracks the MV annulus insertion points and apex over the cardiac cycle by the deformation fields obtained by the network. The system was trained on (N=166) multivendor, multi-field strength, ground-truth annotated datasets [5].
A total of 11000 datasets, acquired on a 1.5T scanner (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) from January 2016 to September 2017 [6], were used for parameter extraction. 200 of these datasets were additionally annotated semi-automatically for the performance evaluation of the system.
Five motion parameters were automatically derived by the system that are defined as follows (Fig. 1b): (1) The atrioventricular plane displacement (AVPD) as the distance of the plane spanned by the MV annulus points relative to the first frame, (2) the atrioventricular plane velocity (AVPV) as the discrete temporal derivate of the AVPD, (3) the diameter of the annulus as the maximum distance between the MV annulus points, (4) the lateral/inferior and septal/superior MAPSE, as the maximum MV points’ excursion, and (5) the LS as the percentage size difference of the distance between the mid valvular point and the apex point at end-systole and end-diastole.
Results
The accuracy of the system resulted in deviations on the annotated dataset of 1.02 ± 0.87 mm, 0.01 ± 0.02 mm/s, 1.54 ± 1.21 mm, 2.30 ± 1.35 mm, 2.1 ± 1.8 mm for AVPD, AVPV, diameter, MAPSE, and LS respectively. Initial statistics on all datasets (Fig. 2) revealed a mean lateral/inferior, septal/superior MAPSE and LS of 8.7 ± 2.7 mm, 10.5 ± 3.2 mm and 16.3 ± 4.2 % for two-chamber and 9.6 ± 2.6 mm, 8.7 ± 2.6 mm and 15.5 ± 3.9 % for four-chamber views, respectively.
Conclusions
The results demonstrate the versatility of the proposed system for automatic extraction of various MV motion parameters. The proposed system enables automatic extraction of clinically relevant parameters and can improve the automation of MV-based analyses. System overview & Parameter of interestsAnalysis of the extracted parameters
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Affiliation(s)
- S Yoon
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Pattern Recognition Lab , Erlangen , Germany
| | - C Fischer
- Technische Universität , Berlin , Germany
| | - S Toupin
- Siemens Healthcare France , Saint-Denis , France
| | - T Pezel
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Wetzl
- Siemens Healthcare GmbH, Magnetic Resonance , Erlangen , Germany
| | - A Maier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Pattern Recognition Lab , Erlangen , Germany
| | - D Giese
- Siemens Healthcare GmbH, Magnetic Resonance , Erlangen , Germany
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