1
|
Grave C, Gabet A, Cinaud A, Iliou MC, Tuppin P, Blacher J, Olié V. Cardiac rehabilitation after an acute coronary syndrome in France: Latest estimates and temporal trends 2009–2021. An overall improvement but persistent regional and sex disparities. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.239] [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]
|
2
|
Constantin V, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Deharo J, Defaye P, Montalescot G, Fauchier L, Mansourati J. Does left atrial appendage morphology have any impact on the results of percutaneous closure? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Transcatheter left atrial appendage (LAA) occlusion is an alternative treatment in patients with atrial fibrillation (AF), high CHADSVASC Score and a contra-indication to anticoagulants. This retrospective cohort study aims to evaluate the impact of LLA morphology on procedure outcomes.
Methods
Patients from eight French centers who underwent left atrial appendage occlusion from February 2012 to January 2017 were included in this retrospective cohort study. LLA morphology was described by preoperative cardiac computed tomography (CT). Clinical data and Transoesophageal echocardiography (TEE) or CT results were collected during follow-up.
Results
Among 469 included patients, LAA morphologies were described in 215 cases 45.8%), 150 patients (70%) were implanted with Watchman devices, 57 (26%) with Amplatzer devices and 8 procedures (4%) failed. LAA Morphology was Chicken Wing (34%), Windsock (45%), cauliflower (18%) and 3% had another morphology including Cactus.
There was no difference in patient characteristics between the different morphology groups. Mean follow-up was 9.6±11 months, during which 190 patients underwent LAA imaging (TEE in 171 and CT in 19 patients). There was no significant difference in the failure rate (p=0.72), duration of the procedure (p=0.065), peri-device leak (p=0.83) device-related thrombus (p=0.96) and the occurrence of stroke (p=1) during follow-up.
Conclusion
LLA morphology did not influence complication occurrence after occlusion in this cohort.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
| | - A Cinaud
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - F Brigadeau
- CHRU De Lille - Institut Coeur-Poumons, Lille, France
| | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - B Pierre
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - J.C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| | - G Montalescot
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - L Fauchier
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - J Mansourati
- University Hospital of Brest and Université de Bretagne Occidentale, Cardioloy and ORPHY (EA4324), Brest, France
| |
Collapse
|
3
|
Fauchier L, Bisson A, Cinaud A, Brigadeau F, Lepillier A, Jacon P, Gras D, Klug D, Guedeney P, Pierre B, Mansourati J, Piot O, Montalescot G, Deharo JC, Defaye P. P999Major adverse events with percutaneous left atrial appendage closure in patients with atrial fibrillation in real life setting. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0592] [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
Transcatheter left atrial appendage (LAA) closure is an alternative strategy for stroke prevention in atrial fibrillation (AF) patients with an inacceptable risk of bleeding with oral anticoagulation (OAC). A better characterization of major adverse clinical events after LAA closure in daily practice is still needed.
Methods
We analysed data from all AF patients treated with Watchman or Amplatzer LAA closure according to European guidelines in 8 French cardiology departments. Antithrombotic management was decided for each patient on an individual basis. A Cox regression model was used for multivariable analysis of major adverse events. Yearly rate of ischemic stroke during follow-up was calculated and compared to that expected for a same risk score population. Yearly rate of bleeding was extrapolated from that reported with the HASBLED score.
Results
A total of 469 consecutive AF patients (299 males, 74.9±8.9 years old, mean CHA2DS2-VASc score 4.5±1.4, HASBLED score 3.7±1.0) received LAA closure from March 2012 to January 2017. There were 272 Watchman devices (58%) and 197 ACP devices (42%) implanted. At discharge, 36% received a single anti platelet therapy (APT), 23% received dual APT, 29% received OAC and no APT, 5% received OAC plus APT and 8% received no antithrombotic therapy. Mean follow up was 11.4 months (median 7, interquartile 3–22 months) during which 70 major adverse events (19 ischemic strokes, 18 major haemorrhages and 33 deaths) were recorded in 69 patients. The annual rate of ischemic stroke was 3.96%, which translates into a 13% relative risk reduction (95% CI −59 to 52%) as compared with the calculated stroke rate for similar CHA2DS2-VASc score after adjustment for exposure to APT and OAC. The annual rate of major bleeding in the study was 3.75%, which corresponds to a 48% relative risk reduction (95% CI 9 to 70%) as compared with the rate that would have been expected based on a comparable HAS-BLED score. Yearly rate of mortality was 7.4% (2.5 to 3 fold higher than in previous randomized trials) and the rate of non-cardiovascular death was 82%. None of the baseline characteristics was predictive of major adverse events, neither in univariate nor in multivariable analysis, which highlights the difficulty in identifying a risk of unfavourable outcome with simple tools.
Conclusions
AF patients treated with LAA closure may have a lower risk of stroke and bleeding events compared to their theoretical risk. However, our findings indicate that a high rate of major adverse events is observed in these patients during follow-up. This questions the suggested cost-effectiveness of the procedure (with models based on previous trials) for a real-life perspective. A better identification of patients with a relevant benefit of LAA closure is needed among those with long-term anticoagulation contraindication, both for an optimal management of each patient on an individual basis and for a global perspective with limited healthcare resources.
Collapse
Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | - D Klug
- Hospital of Lille, Lille, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - B Pierre
- University Hospital of Grenoble, Grenoble, France
| | | | - O Piot
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| |
Collapse
|
4
|
Boccara F, Tan BK, Chalouni M, Salmon Ceron D, Cinaud A, Esterle L, Gilbert C, Bani-Sadr F, Dabis F, Sogni P, Wittkop L. P5341Predictive factors of atherosclerotic cardiovascular diseases events in HIV-HVC co-infected patients: results from hepavih ANRS co13 cohort. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0309] [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
Introduction
Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events.
Purpose
Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence.
Methods
The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models.
Results
A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not.
Cumulative incidence of CV events
Conclusion
HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk.
Acknowledgement/Funding
Agence Natoinale de Recherche sur le SIDA et les Hépatites virales
Collapse
Affiliation(s)
- F Boccara
- AP-HP - Hospital Saint Antoine, Paris, France
| | - B K Tan
- Hospital Cochin, Internal Medicine, Paris, France
| | - M Chalouni
- University of Bordeaux, ISPED, Bordeaux, France
| | - D Salmon Ceron
- Hospital Hotel-Dieu, Infectious Diseases Federation, Paris, France
| | - A Cinaud
- Hospital Hotel-Dieu, Cardiology, Paris, France
| | - L Esterle
- University of Bordeaux, ISPED, Bordeaux, France
| | - C Gilbert
- University of Bordeaux, ISPED, Bordeaux, France
| | - F Bani-Sadr
- University of Bordeaux, ISPED, Bordeaux, France
| | - F Dabis
- University of Bordeaux, ISPED, Bordeaux, France
| | - P Sogni
- Hospital Cochin, Hepatology, Paris, France
| | - L Wittkop
- Hospital Cochin, Hepatology, Paris, France
| |
Collapse
|
5
|
Fauchier L, Cinaud A, Brigadeau F, Guedeney P, Jacon P, Mansourati J, Deharo JC, Franceschi F, Pierre B, Klug D, Lepillier A, Piot O, Gras D, Montalescot G, Defaye P. P4809Possible benefits of left atrial appendage closure for stroke prevention in patients with atrial fibrillation in real life setting. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - F Franceschi
- Hospital La Timone of Marseille, Marseille, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Klug
- Cardiology Hospital of Lille, Lille, France
| | - A Lepillier
- Centre Cardiologique du Nord, Saint Denis, France
| | - O Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| |
Collapse
|
6
|
Cinaud A, Mewton N, Ivanes F, Fauchier L, Angoulvant D, Bejan-Angoulvant T. Cyclosporine A to reduce myocardial reperfusion injury: A systematic review and meta-analysis of randomized controlled trials. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Fauchier L, Cinaud A, Lepillier A, Brigadeau F, Jacon P, Pierre B, Paziaud O, Franceschi F, Mansourati J, Klug D, Piot O, Gras D, Montalescot G, Deharo JC, Defaye P. 201Left atrial appendage closure for stroke prevention in patients with atrial fibrillation: the difficult task of estimating the possible benefit in real life setting. Europace 2018. [DOI: 10.1093/europace/euy015.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Lepillier
- Centre Cardiologique du Nord, Saint Denis, France
| | | | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - O Paziaud
- Centre Cardiologique du Nord, Saint Denis, France
| | - F Franceschi
- Hospital La Timone of Marseille, Marseille, France
| | | | - D Klug
- Cardiology Hospital of Lille, Lille, France
| | - O Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| |
Collapse
|
8
|
Fauchier L, Cinaud A, Brigadeau F, Pierre B, Lepillier A, Paziaud O, Fatemi M, Jacon P, Abbey S, Franceschi F, Klug D, Mansourati J, Deharo J, Gras D, Defaye P. P4562Predictors of cardiovascular events in patients with atrial fibrillation after left atrial appendage closure for stroke prevention in a multicenter analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
Fauchier L, Cinaud A, Brigadeau F, Pierre B, Lepillier A, Paziaud O, Fatemi M, Jacon P, Abbey S, Franceschi F, Klug D, Mansourati J, Deharo J, Gras D, Defaye P. 5718Incidence, predictors and prognosis of thrombus formation on device in patients with atrial fibrillation after left atrial appendage occlusion for stroke prevention in a multicenter analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|