1
|
Logeart D, Doublet M, Gouysse M, Damy T, Isnard R, Roubille F. Development and validation of algorithms to predict left ventricular ejection fraction class from healthcare claims data. ESC Heart Fail 2024; 11:1688-1697. [PMID: 38438250 PMCID: PMC11098626 DOI: 10.1002/ehf2.14725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS The use of large medical or healthcare claims databases is very useful for population-based studies on the burden of heart failure (HF). Clinical characteristics and management of HF patients differ according to categories of left ventricular ejection fraction (LVEF), but this information is often missing in such databases. We aimed to develop and validate algorithms to identify LVEF in healthcare databases where the information is lacking. METHODS AND RESULTS Algorithms were built by machine learning with a random forest approach. Algorithms were trained and reinforced using the French national claims database [Système National des Données de Santé (SNDS)] and a French HF registry. Variables were age, gender, and comorbidities, which could be identified by medico-administrative code-based proxies, Anatomical Therapeutic Chemical codes for drug delivery, International Classification of Diseases (Tenth Revision) coding for hospitalizations, and administrative codes for any other type of reimbursed care. The algorithms were validated by cross-validation and against a subset of the SNDS that includes LVEF information. The areas under the receiver operating characteristic curve were 0.84 for the algorithm identifying LVEF ≤ 40% and 0.79 for the algorithms identifying LVEF < 50% and ≥50%. For LVEF ≤ 40%, the reinforced algorithm identified 50% of patients in the validation dataset with a positive predictive value of 0.88 and a specificity of 0.96. The most important predictive variables were delivery of HF medication, sex, age, hospitalization, and testing for natriuretic peptides with different orders of positive or negative importance according to the LVEF category. CONCLUSIONS The algorithms identify reduced or preserved LVEF in HF patients within a nationwide healthcare claims database with high positive predictive value and low rates of false positives.
Collapse
Affiliation(s)
- Damien Logeart
- Department of Cardiology, Paris Cité University, AP-HP Hôpital Lariboisière, Inserm U942, 2 rue Ambroise Paré, Paris, France
| | | | | | - Thibaud Damy
- Department of Cardiology and French National Reference Centre for Cardiac Amyloidosis, Hôpitaux Universitaires Henri-Mondor AP-HP, IMRB, Inserm, Université Paris-Est Créteil, Créteil, France
| | | | - François Roubille
- Department of Cardiology, INI-CRT PhyMedExp Inserm CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| |
Collapse
|
2
|
Hulot JS, Janiak P, Boutinaud P, Boutouyrie P, Chézalviel-Guilbert F, Christophe JJ, Cohen A, Damy T, Djadi-Prat J, Firat H, Hervé PY, Isnard R, Jondeau G, Mousseaux E, Pernot M, Prot P, Tyl B, Soulat G, Logeart D. Rationale and design of the PACIFIC-PRESERVED (PhenomApping, ClassIFication and Innovation for Cardiac dysfunction in patients with heart failure and PRESERVED left ventricular ejection fraction) study. Arch Cardiovasc Dis 2024:S1875-2136(24)00057-3. [PMID: 38644067 DOI: 10.1016/j.acvd.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that is poorly defined, reflecting an incomplete understanding of its pathophysiology. AIM To redefine the phenotypic spectrum of HFpEF. METHODS The PACIFIC-PRESERVED study is a prospective multicentre cohort study designed to perform multidimensional deep phenotyping of patients diagnosed with HFpEF (left ventricular ejection fraction≥50%), patients with heart failure with reduced ejection fraction (left ventricular ejection fraction≤40%) and subjects without overt heart failure (3:2:1 ratio). The study proposes prospective investigations in patients during a 1-day hospital stay: physical examination; electrocardiogram; performance-based tests; blood samples; cardiac magnetic resonance imaging; transthoracic echocardiography (rest and low-level exercise); myocardial shear wave elastography; chest computed tomography; and non-invasive measurement of arterial stiffness. Dyspnoea, depression, general health and quality of life will be assessed by dedicated questionnaires. A biobank will be established. After the hospital stay, patients are asked to wear a connected garment (with digital sensors) to collect electrocardiography, pulmonary and activity variables in real-life conditions (for up to 14 days). Data will be centralized for machine-learning-based analyses, with the aim of reclassifying HFpEF into more distinct subgroups, improving understanding of the disease mechanisms and identifying new biological pathways and molecular targets. The study will also serve as a platform to enable the development of innovative technologies and strategies for the diagnosis and stratification of patients with HFpEF. CONCLUSIONS PACIFIC-PRESERVED is a prospective multicentre phenomapping study, using novel analytical techniques, which will provide a unique data resource to better define HFpEF and identify new clinically meaningful subgroups of patients.
Collapse
Affiliation(s)
- Jean-Sébastien Hulot
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; CIC1418 and DMU CARTE, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France.
| | | | | | - Pierre Boutouyrie
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; Pharmacology and DMU CARTE, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | | | | | - Ariel Cohen
- Cardiology, Hôpital Saint-Antoine, AP-HP, ICAN 1166, Sorbonne Université, 75012 Paris, France
| | - Thibaud Damy
- Cardiology, Hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Juliette Djadi-Prat
- Clinical Research Unit, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | | | | | - Richard Isnard
- Cardiology, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | | | - Elie Mousseaux
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; Cardiac Imaging Radiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, PSL University, CNRS FRE 2031, 75015 Paris, France
| | | | | | - Gilles Soulat
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; Cardiac Imaging Radiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Damien Logeart
- Cardiology, Hôpital Lariboisière, AP-HP, 75018 Paris, France
| |
Collapse
|
3
|
Logeart D. Heart failure with preserved ejection fraction: New challenges and new hopes. Presse Med 2024; 53:104185. [PMID: 37875242 DOI: 10.1016/j.lpm.2023.104185] [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: 08/10/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
Heart failure (HF) is a major public health problem affecting millions of adults worldwide. HF with preserved ejection fraction, i.e. > 50 %, (HFpEF) accounts for more than half of all HF cases, and its incidence and prevalence are increasing with the aging of the population and the growing prevalence of metabolic disorders such as obesity, diabetes and hypertension. Diagnosis of HFpEF requires a combination of numerous echocardiographic parameters and also results of natriuretic peptide assays, to which may be added the need for a stress test. HFpEF is characterized by complex, interrelated pathophysiological mechanisms, which must be understood. This complexity probably accounts for the lack of evidence-based medicine compared with HF with reduced EF. Nevertheless, significant progress has been made recently, with a high level of evidence obtained for the SGLT2 inhibitor class on the one hand, and promising data with new drugs targeting more specifically certain mechanisms such as obesity and inflammation on the other.
Collapse
Affiliation(s)
- Damien Logeart
- Université Paris Cité, Inserm U942, Assistance publique hôpitaux de Paris, Hôpital Lariboisière, Paris, France.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Berthelot E, Eliahou L, Jagu A, Damy T, Hanon O, Hulot JS, Meune C, Roig C, Roubille F, Sabouret P, Logeart D, Mewton N. [Natriuretic peptides in the diagnosis and monitoring of heart failure]. Rev Prat 2024; 74:185-193. [PMID: 38415425] [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] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
NATRIURETIC PEPTIDES IN THE DIAGNOSIS AND MONITORING OF CARDIAC FAILURE. Heart failure (HF) is a serious and common disease requiring a prompt diagnosis for appropriate management. Natriuretic peptides, such as BNP and NT-proBNP, play a crucial role in diagnosing HF due to their s pecificity and reproducibility. It is important to measuring natriuretic peptides, especially in cases of acute dyspnea, to differentiate cardiac causes from others. Specific thresholds are recommended, with high values strongly suggest HF, while normal levels rule out the diagnosis. Clinical characteristics, such as age, renal function, atrial fibrillation, obesity, and gender, influence natriuretic peptides levels and should be considered in interpretation. For diabetic, hypertensive, and obese patients, early screening for HF through natriuretic peptides measurement is crucial. Furthermore, these natriuretic peptides are useful for monitoring chronic heart failure patients. They assist in confirming decompensation, titrating treatment, evaluating treatment response, and establishing prognosis. However, it's essential to choose a single biomarker (BNP or NT-proBNP) to avoid confusion.
Collapse
Affiliation(s)
| | - Ludivine Eliahou
- Centre national de référence pour le syndrome de Marfan et les maladies apparentées, VASCERN HTAD European Reference Centre, AP-HP, hôpital Bichat-Claude-Bernard, Paris, France. Service de cardiologie, AP-HP, hôpital Bichat-Claude-Bernard, Paris, France
| | - Annabelle Jagu
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Thibaud Damy
- Service de cardiologie, Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU A-TVB, AP-HP CHU Henri-Mondor et université Paris-Est Créteil, France
| | - Olivier Hanon
- EA4468 université de Paris, service de gériatrie, hôpital Broca, AP-HP, Hôpitaux universitaires Paris Centre, France
| | | | - Christophe Meune
- Service de cardiologie, hôpital Avicenne, AP-HP, université de Paris, Paris, France
| | - Clemence Roig
- Service de cardiologie, Institut mutualiste Montsouris, Paris, France
| | - François Roubille
- INSERM U661, Montpellier, France. hôpital Arnaud-de-Villeneuve, université de Montpellier-1 et 2, Montpellier, France
| | - Pierre Sabouret
- Département de cardiologie médicale de l'Institut de cardiologie de Paris et Collège national des cardiologues français, hôpital La Pitié-Salpêtrière, université La Sorbonne, Paris, France
| | - Damien Logeart
- Service de cardiologie, AP-HP, hôpital Lariboisière, Paris, France, université de Paris, Paris, France
| | - Nathan Mewton
- Hôpital cardiovasculaire Louis-Pradel, centre d'investigation clinique INSERM 1407, service insuffisance cardiaque, Hospices civils de Lyon ; université Claude-Bernard Lyon-1, INSERM U1060 CarMeN, Lyon, France
| |
Collapse
|
6
|
Logeart D, Taille Y, Derumeaux G, Gellen B, Sirol M, Galinier M, Roubille F, Georges JL, Trochu JN, Launay JM, Vodovar N, Bauters C, Vicaut E, Mercadier JJ. Patterns of left ventricular remodeling post-myocardial infarction, determinants, and outcome. Clin Res Cardiol 2024:10.1007/s00392-023-02331-z. [PMID: 38261025 DOI: 10.1007/s00392-023-02331-z] [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: 07/16/2023] [Accepted: 10/20/2023] [Indexed: 01/24/2024]
Abstract
AIM Left ventricular remodeling (LVR) after myocardial infarction (MI) can lead to heart failure, arrhythmia, and death. We aim to describe adverse LVR patterns at 6 months post-MI and their relationships with subsequent outcomes and to determine baseline. METHODS AND RESULTS A multicenter cohort of 410 patients (median age 57 years, 87% male) with reperfused MI and at least 3 akinetic LV segments on admission was analyzed. All patients had transthoracic echocardiography performed 4 days and 6 months post-MI, and 214 also had cardiac magnetic resonance imaging performed on day 4. To predict LVR, machine learning methods were employed in order to handle many variables, some of which may have complex interactions. Six months post-MI, echocardiographic increases in LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were 14.1% [interquartile range 0.0, 32.0], 5.0% [- 14.0, 25.8], and 8.7% [0.0, 19.4], respectively. At 6 months, ≥ 15% or 20% increases in LVEDV were observed in 49% and 42% of patients, respectively, and 37% had an LVEF < 50%. The rate of death or new-onset HF at the end of 5-year follow-up was 8.8%. Baseline variables associated with adverse LVR were determined best by random forest analysis and included stroke volume, stroke work, necrosis size, LVEDV, LVEF, and LV afterload, the latter assessed by Ea or Ea/Ees. In contrast, baseline clinical and biological characteristics were poorly predictive of LVR. After adjustment for predictive baseline variables, LV dilation > 20% and 6-month LVEF < 50% were significantly associated with the risk of death and/or heart failure: hazard ratio (HR) 2.12 (95% confidence interval (CI) 1.05-4.43; p = 0.04) and HR 2.68 (95% CI 1.20-6.00; p = 0.016) respectively. CONCLUSION Despite early reperfusion and cardioprotective therapy, adverse LVR remains frequent after acute MI and is associated with a risk of death and HF. A machine learning approach identified and prioritized early variables that are associated with adverse LVR and which were mainly hemodynamic, combining LV volumes, estimates of systolic function, and afterload.
Collapse
Affiliation(s)
- Damien Logeart
- UMR-S 942 MASCOT, Université Paris Cité and Inserm, Paris, France.
- Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière-Fernand Widal, 75010, Paris, France.
- Université Paris Cité, Paris, France.
| | - Yoann Taille
- Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière-Fernand Widal, 75010, Paris, France
| | - Geneviève Derumeaux
- Assistance Publique Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
| | | | - Marc Sirol
- American Hospital, Neuilly-Sur-Seine, France
| | | | | | | | | | | | - Nicolas Vodovar
- UMR-S 942 MASCOT, Université Paris Cité and Inserm, Paris, France
| | | | - Eric Vicaut
- UMR-S 942 MASCOT, Université Paris Cité and Inserm, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière-Fernand Widal, 75010, Paris, France
- Université Paris Cité, Paris, France
| | | |
Collapse
|
7
|
Nougué H, Picard F, Cohen-Solal A, Logeart D, Launay JM, Vodovar N. Impact of sacubitril/valsartan on cardiac and systemic hypoxia in chronic heart failure. iScience 2024; 27:108520. [PMID: 38161412 PMCID: PMC10755360 DOI: 10.1016/j.isci.2023.108520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
In heart failure patients with reduced ejection fraction, Sacubitril/valsartan (S/V) increased proBNP T71 glycosylation, which is regulated negatively by hypoxia via miR-30a in vitro. Using a cohort of 73 HFrEF patients who were transitioned from standard HF medication to S/V, we found that the increase in proBNP T71 glycosylation after S/V was associated with a decrease in cardiac hypoxia. We further found that plasma levels of K709-acteylated HIF1α, HIF-regulated and HIF-independent biomarkers also evolved consistently with a decrease in hypoxia. We further confirmed that biomarker changes were related to hypoxia, in a rat model subjected to isobaric hypoxia. We measured them in rats subjected to isobaric hypoxia. Overall, these data strongly suggest that optimally treated HFrEF patients exhibited subclinical hypoxia that is improved by S/V. The data also posit proBNP T71 glycosylation as a biomarker of cardiac hypoxia.
Collapse
Affiliation(s)
- Hélène Nougué
- Université de Paris and Inserm UMR-S 942, Paris, France
- Department of Anaesthesiology and Intensive Care, Saint Louis – Lariboisière – Fernand Vidal University Hospital, Paris, France
| | - François Picard
- Service d’insuffisance cardiaque, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Alain Cohen-Solal
- Université de Paris and Inserm UMR-S 942, Paris, France
- Department of Cardiology, Lariboisière Hospital, Paris, France
| | - Damien Logeart
- Université de Paris and Inserm UMR-S 942, Paris, France
- Department of Cardiology, Lariboisière Hospital, Paris, France
| | | | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Cohen-Solal A, Logeart D. Exercise hypoxaemia in heart failure with preserved ejection fraction. Eur J Heart Fail 2023; 25:1604-1605. [PMID: 37530210 DOI: 10.1002/ejhf.2989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/27/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Alain Cohen-Solal
- Paris Cite University, Paris, France
- INSERM Unit 942 'MASCOT', Paris, France
- Cardiology Department, Saint Louis-Lariboisiere University Hospital, Paris, France
| | - Damien Logeart
- Paris Cite University, Paris, France
- INSERM Unit 942 'MASCOT', Paris, France
- Cardiology Department, Saint Louis-Lariboisiere University Hospital, Paris, France
| |
Collapse
|
10
|
Nicol M, Vergaro G, Damy T, Kharoubi M, Baudet M, Canuti ES, Aimo A, Castiglione V, Emdin M, Royer B, Harel S, Cohen-Solal A, Arnulf B, Logeart D. Prognostic value of soluble ST2 in AL and TTR cardiac amyloidosis: a multicenter study. Front Cardiovasc Med 2023; 10:1179968. [PMID: 37600055 PMCID: PMC10433216 DOI: 10.3389/fcvm.2023.1179968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
Background Both light-chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis are types of cardiac amyloidosis (CA) that require accurate prognostic stratification to plan therapeutic strategies and follow-ups. Cardiac biomarkers, e.g., N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (Hs-cTnT), remain the cornerstone of the prognostic assessment. An increased level of soluble suppression of tumorigenesis-2 (sST2) is predictive of adverse events [all-cause death and heart failure (HF) hospitalizations] in patients with HF. This study aimed to evaluate the prognostic value of circulating sST2 levels in AL-CA and ATTR-CA. Methods We carried out a multicenter study including 133 patients with AL-CA and 152 patients with ATTR-CA. During an elective outpatient visit for the diagnosis of CA, Mayo Clinic staging [NT-proBNP, Hs-cTnT, differential of free light chains (DFLCs)] and sST2 were assessed for all AL patients. Gillmore staging [including estimated glomerular filtration rate (eGFR), NT-proBNP] and Grogan staging (including NT-proBNP and Hs-cTnT) were assessed for TTR-CA patients. Results The median age was 73 years [interquartile range (IQR) 61-81], and 53% were men. The endpoint was the composite of all-cause death or first HF-related hospitalization. The median follow-up was 20 months (IQR 3-34) in AL amyloidosis and 33 months (6-45) in TTR amyloidosis. The primary outcome occurred in 70 (53%) and 99 (65%) of AL and TTR patients, respectively. sST2 levels were higher in patients with AL-CA than in patients with ATTR-CA: 39 ng/L (26-80) vs. 32 ng/L (21-46), p < 0.001. In AL-CA, sST2 levels predicted the outcome regardless of the Mayo Clinic score (HR: 2.16, 95% CI: 1.17-3.99, p < 0.001). In TTR-CA, sST2 was not predictive of the outcome in multivariate models, including Gillmore staging and Grogan staging (HR: 1.17, CI: 95% 0.77-1.89, p = 0.55). Conclusion sST2 level is a relevant predictor of death and HF hospitalization in AL cardiac amyloidosis and adds prognostic stratification on top of NT-proBNP, Hs cTnT, and DFLC.
Collapse
Affiliation(s)
- Martin Nicol
- Cardiology Department Lariboisière Saint Louis Hospital, University of Paris, Paris, France
| | - Giuseppe Vergaro
- Cardiology Department, Scuola Superiore Sant’Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Thibaud Damy
- Referral Cardiac Amyloidosis Center and Cardiology Department, Mondor Hospital, IMRB U955 and Université Paris Est Créteil all at 94000Créteil, France
| | - Mounira Kharoubi
- Referral Cardiac Amyloidosis Center and Cardiology Department, Mondor Hospital, IMRB U955 and Université Paris Est Créteil all at 94000Créteil, France
| | - Mathilde Baudet
- Cardiology Department Lariboisière Saint Louis Hospital, University of Paris, Paris, France
| | | | - Alberto Aimo
- Cardiology Department, Scuola Superiore Sant’Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Vincenzo Castiglione
- Cardiology Department, Scuola Superiore Sant’Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Cardiology Department, Scuola Superiore Sant’Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Bruno Royer
- Immuno-Hematology Department, Saint Louis Hospital, University of Paris, Paris, France
| | - Stephanie Harel
- Immuno-Hematology Department, Saint Louis Hospital, University of Paris, Paris, France
| | - Alain Cohen-Solal
- Cardiology Department Lariboisière Saint Louis Hospital, University of Paris, Paris, France
| | - Bertrand Arnulf
- Immuno-Hematology Department, Saint Louis Hospital, University of Paris, Paris, France
| | - Damien Logeart
- Cardiology Department Lariboisière Saint Louis Hospital, University of Paris, Paris, France
| |
Collapse
|
11
|
Desroche LM, Mandry D, Ducrocq G, Durand-Zaleski I, Alfaiate T, Millischer D, Milleron O, Huttin O, Valla M, Belle L, Lavie-Badie Y, Farah B, Diakov C, Logeart D, Safar B, Burdet C, Jondeau G. Multicentre medicoeconomic evaluation of cardiac magnetic resonance imaging for predicting coronary artery disease in left ventricular dysfunction: The CAMAREC study design. Arch Cardiovasc Dis 2023; 116:366-372. [PMID: 37573160 DOI: 10.1016/j.acvd.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Cardiac magnetic resonance imaging may provide a non-invasive alternative to coronary angiography for differentiating between ischaemic and non-ischaemic cardiomyopathy in cases of unexplained reduced left ventricular ejection fraction. AIM The CAMAREC study aims to evaluate the diagnostic accuracy of cardiac magnetic resonance imaging in predicting significant coronary artery disease in patients with reduced left ventricular ejection fraction, using coronary angiography as the gold standard for comparison. METHODS CAMAREC is a prospective cohort study of 406 patients in 10 centres with newly diagnosed, unexplained left ventricular ejection fraction ≤ 45%. Cardiac magnetic resonance imaging and coronary angiography will be conducted within a 2-week interval, starting with cardiac magnetic resonance imaging; independent committees will review the results blindly. Primary outcome is sensitivity of detecting ischaemic scar on cardiac magnetic resonance imaging for predicting significant coronary artery disease on coronary angiography according to Felker's criteria. Secondary outcomes include specificity and positive and negative predictive values (with 95% confidence intervals) of cardiac magnetic resonance imaging for predicting significant coronary artery disease in patients with reduced left ventricular ejection fraction, kappa concordance coefficient between cardiac magnetic resonance imaging and coronary angiography for diagnosing the affected myocardial territory, and the impact of cardiac magnetic resonance imaging on revascularization decisions. Two ancillary studies will evaluate the incremental cost-effectiveness of using cardiac magnetic resonance imaging first versus coronary angiography first, and the sensitivity of pre- and postcontrast T1-mapping for predicting significant coronary artery disease in patients with reduced left ventricular ejection fraction. CONCLUSION Our study protocol is designed to rigorously evaluate cardiac magnetic resonance imaging as a non-invasive alternative to coronary angiography in patients with unexplained reduced left ventricular ejection fraction. The results will have significant implications for patient management, and may support growing evidence for the clinical utility of cardiac magnetic resonance imaging.
Collapse
Affiliation(s)
- Louis-Marie Desroche
- Cardiology Department, CHU de la Réunion, allée des Topazes, 97490 Saint-Denis, France.
| | - Damien Mandry
- Cardiology Department, CHU Nancy-Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - Gregory Ducrocq
- Cardiology Department, hôpital Bichat, AP-HP, 75018 Paris, France
| | | | - Toni Alfaiate
- Département d'épidémiologie, biostatistique et recherche clinique, hôpital Bichat, AP-HP, 75018 Paris, France
| | - Damien Millischer
- Cardiology Department, GHI de Montfermeil, 93370 Montfermeil, France
| | - Olivier Milleron
- Cardiology Department, hôpital Bichat, AP-HP, 75018 Paris, France
| | - Olivier Huttin
- Cardiology Department, CHU Nancy-Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - Mathieu Valla
- Cardiology Department, CHR de Metz, 57085 Metz, France
| | - Loic Belle
- Cardiology Department, CH Annecy, 74370 Epagny Metz-Tessy, France
| | | | - Bruno Farah
- Cardiology Department, clinique Pasteur, 31076 Toulouse, France
| | - Christelle Diakov
- Cardiology Department, institut mutualiste Montsouris, 75014 Paris, France
| | - Damien Logeart
- Cardiology Department, Lariboisière Hospital, AP-HP, 75010 Paris, France
| | - Benjamin Safar
- Cardiology Department, GHI de Montfermeil, 93370 Montfermeil, France
| | - Charles Burdet
- Département d'épidémiologie, biostatistique et recherche clinique, hôpital Bichat, AP-HP, 75018 Paris, France; Université Paris-Cité and université Sorbonne-Paris-Nord, Inserm, IAME, 75870 Paris, France
| | - Guillaume Jondeau
- Cardiology Department, hôpital Bichat, AP-HP, 75018 Paris, France; Service de cardiologie, université Paris-Cité, Inserm U1148 LVTS, 75018 Paris, France
| |
Collapse
|
12
|
Nougué H, Michel T, Picard F, Lassus J, Sadoune M, Laribi S, Cohen-Solal A, Logeart D, Launay JM, Vodovar N. Deconvolution of BNP and NT-proBNP Immunoreactivities by Mass Spectrometry in Heart Failure and Sacubitril/Valsartan Treatment. Clin Chem 2023; 69:350-362. [PMID: 36762414 DOI: 10.1093/clinchem/hvac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/13/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Elevated BNP and the N-terminal fragment of the proBNP (NT-proBNP) are hallmarks of heart failure (HF). Generally, both biomarkers parallel each other. In patients receiving sacubitril/valsartan, BNP remained stable while NT-proBNP decreased. As BNP and NT-proBNP assays have limited specificity due to cross-reactivity, we quantified by mass spectrometry (MS) the contributing molecular species. METHODS We included 356 healthy volunteers, 100 patients with acute dyspnoea (49 acute decompensated HF; 51 dyspnoea of non-cardiac origin), and 73 patients with chronic HF and reduced ejection fraction treated with sacubitril/valsartan. BNP and NT-proBNP immunoreactivities (BNPir and NT-proBNPir) were measured by immunoassays (Abbott ARCHITECT and Roche Diagnostics proBNPII) and proBNP-derived peptides and glycosylation at serine 44 by MS on plasma samples. RESULTS BNPir corresponded to the sum of proBNP1-108, BNP1-32, BNP3-32, and BNP5-32 (R2 = 0.9995), while NT-proBNPir corresponded to proBNP1-108 and NT-proBNP1-76 not glycosylated at serine 44 (R2 = 0.992). NT-proBNPir was better correlated (R2 = 0.9597) than BNPir (R2 = 0.7643) with proBNP signal peptide (a surrogate of proBNP production). In patients receiving sacubitril/valsartan, non-glycosylated NT-proBNP1-76 remained constant (P = 0.84) despite an increase in NT-proBNP1-76 and its glycosylation (P < 0.0001). ProBNP1-108 remained constant (P = 0.12) while its glycosylation increased (P < 0.0001), resulting in a decrease in non-glycosylated proBNP1-108 (P < 0.0001), and in NT-proBNPir. CONCLUSIONS Glycosylation interfered with NT-proBNPir measurement, explaining the discrepant evolution of these 2 biomarkers in patients receiving sacubitril/valsartan. Both BNPir and NT-proBNPir are surrogates of proBNP1-108 production, NT-proBNPir being more robust in the clinical contexts studied.
Collapse
Affiliation(s)
- Hélène Nougué
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Intensive Care, Saint-Louis and Lariboisière Hospital, Paris, France
| | | | | | - Johan Lassus
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Malha Sadoune
- Université Paris Cité and Inserm UMR-S 942, Paris, France
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Alain Cohen-Solal
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Cardiology, Lariboisière Hospital, Paris, France
| | - Damien Logeart
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Cardiology, Lariboisière Hospital, Paris, France
| | | | | |
Collapse
|
13
|
Masurkar N, Bouvet M, Logeart D, Jouve C, Dramé F, Claude O, Roux M, Delacroix C, Bergerot D, Mercadier JJ, Sirol M, Gellen B, Livrozet M, Fayol A, Robidel E, Trégouët DA, Marazzi G, Sassoon D, Valente M, Hulot JS. Novel Cardiokine GDF3 Predicts Adverse Fibrotic Remodeling After Myocardial Infarction. Circulation 2023; 147:498-511. [PMID: 36484260 DOI: 10.1161/circulationaha.121.056272] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myocardial infarction (MI) induces a repair response that ultimately generates a stable fibrotic scar. Although the scar prevents cardiac rupture, an excessive profibrotic response impairs optimal recovery by promoting the development of noncontractile fibrotic areas. The mechanisms that lead to cardiac fibrosis are diverse and incompletely characterized. We explored whether the expansion of cardiac fibroblasts after MI can be regulated through a paracrine action of cardiac stromal cells. METHODS We performed a bioinformatic secretome analysis of cardiac stromal PW1+ cells isolated from normal and post-MI mouse hearts to identify novel secreted proteins. Functional assays were used to screen secreted proteins that promote fibroblast proliferation. The expressions of candidates were subsequently analyzed in mouse and human hearts and plasmas. The relationship between levels of circulating protein candidates and adverse post-MI cardiac remodeling was examined in a cohort of 80 patients with a first ST-segment-elevation MI and serial cardiac magnetic resonance imaging evaluations. RESULTS Cardiac stromal PW1+ cells undergo a change in paracrine behavior after MI, and the conditioned media from these cells induced a significant increase in the proliferation of fibroblasts. We identified a total of 12 candidates as secreted proteins overexpressed by cardiac PW1+ cells after MI. Among these factors, GDF3 (growth differentiation factor 3), a member of the TGF-β (transforming growth factor-β) family, was markedly upregulated in the ischemic hearts. Conditioned media specifically enriched with GDF3 induced fibroblast proliferation at a high level by stimulation of activin-receptor-like kinases. In line with the secretory nature of this protein, we next found that GDF3 can be detected in mice and human plasma samples, with a significant increase in the days after MI. In humans, higher GDF3 circulating levels (measured in the plasma at day 4 after MI) were significantly associated with an increased risk of adverse remodeling 6 months after MI (adjusted odds ratio, 1.76 [1.03-3.00]; P=0.037), including lower left ventricular ejection fraction and a higher proportion of akinetic segments. CONCLUSIONS Our findings define a mechanism for the profibrotic action of cardiac stromal cells through secreted cardiokines, such as GDF3, a candidate marker of adverse fibrotic remodeling after MI. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01113268.
Collapse
Affiliation(s)
- Nihar Masurkar
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Marion Bouvet
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Damien Logeart
- Hôpital Lariboisière (D.L., M.S.), Université de Paris, Cité' France
| | - Charlène Jouve
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Fatou Dramé
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Olivier Claude
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Maguelonne Roux
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardio Metabolism and Nutrition, France (M.R.)
| | - Clément Delacroix
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Damien Bergerot
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France (D.B., M.L., A.F., J.-S.H.)
| | - Jean-Jacques Mercadier
- Signalisation and Cardiovascular Pathophysiology - Univ. Paris-Sud, INSERM, Université Paris-Saclay, Châtenay-Malabry, France (J.-J.M.)
| | - Marc Sirol
- Hôpital Lariboisière (D.L., M.S.), Université de Paris, Cité' France
| | - Barnabas Gellen
- ELSAN, Polyclinique de Poitiers, Service de Cardiologie, France (B.G.)
| | - Marine Livrozet
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France (D.B., M.L., A.F., J.-S.H.)
| | - Antoine Fayol
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France (D.B., M.L., A.F., J.-S.H.)
| | - Estelle Robidel
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - David-Alexandre Trégouët
- INSERM UMR_S 1219, Bordeaux Population Health Research Center, University of Bordeaux, France (D.-A.T.)
| | - Giovanna Marazzi
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - David Sassoon
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Mariana Valente
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France
| | - Jean-Sébastien Hulot
- Paris Cardiovascular Research Center, INSERM (N.M., M.B., C.J., F.D., O.C., C.D., E.R., G.M., D.S., M.V., J.-S.H.), Université de Paris, Cité' France.,CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France (D.B., M.L., A.F., J.-S.H.)
| |
Collapse
|
14
|
Vergaro G, Castiglione V, Aimo A, Prontera C, Masotti S, Musetti V, Nicol M, Cohen Solal A, Logeart D, Georgiopoulos G, Chubuchny V, Giannoni A, Clerico A, Buda G, Patel KN, Razvi Y, Patel R, Wechalekar A, Lachmann H, Hawkins PN, Passino C, Gillmore J, Emdin M, Fontana M. N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T hold diagnostic value in cardiac amyloidosis. Eur J Heart Fail 2023; 25:335-346. [PMID: 36597836 DOI: 10.1002/ejhf.2769] [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: 08/23/2022] [Revised: 12/20/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023] Open
Abstract
AIMS Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. This study aimed to evaluate the diagnostic performance for CA of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT). METHODS AND RESULTS Patients with suspected CA (n = 1149) underwent a diagnostic work-up in three centres in Italy, France (n = 343, derivation cohort), and United Kingdom (n = 806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule-out/rule-in cut-offs, respectively. In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT-proBNP and hs-TnT. NT-proBNP 180 ng/L and hs-TnT 14 ng/L were selected as rule-out cut-offs, and hs-TnT 86 ng/L as rule-in cut-off. NT-proBNP <180 ng/L or hs-TnT <14 ng/L were found in 7% of patients, and ruled out CA without false negatives. In the validation cohort, 20% of patients (2% false negatives) had NT-proBNP <180 ng/L or hs-TnT <14 ng/L, and 10% showed both biomarkers below cut-offs (0.5% false negatives). These cut-offs refined CA prediction when added to echocardiographic scores in patients with a haematologic disease or an increased wall thickness. In the validation cohort, the 86 ng/L hs-TnT cut-off ruled in 20% of patients (2% false positives). NT-proBNP and hs-TnT cut-offs retained their rule-out and rule-in performance also in cohorts with CA prevalence of 20%, 10%, 5% and 1% derived from the original cohort through bootstrap analysis. CONCLUSIONS Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT-proBNP <180 ng/L and hs-TnT <14 ng/L reliably exclude the diagnosis, both in the overall population and subgroups referred for either AL-CA or cardiac (pseudo)hypertrophy.
Collapse
Affiliation(s)
- Giuseppe Vergaro
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Alberto Aimo
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | - Martin Nicol
- Cardiology Department, Hôpital Lariboisière, Paris, France
| | | | - Damien Logeart
- Cardiology Department, Hôpital Lariboisière, Paris, France
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Alberto Giannoni
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Aldo Clerico
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gabriele Buda
- Hematology Department, University of Pisa, Pisa, Italy
| | - Kiara N Patel
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Yousuf Razvi
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Rishi Patel
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Helen Lachmann
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Claudio Passino
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Julian Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Michele Emdin
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| |
Collapse
|
15
|
Logeart D, Damy T, Doublet M, Salvat M, Tribouilloy C, Bauer F, Eicher JC, Picard F, Roul G, Trochu JN, De Groote P, Bihry N, Berthelot E, Jondeau G, Seronde MF, Roubille F, Isnard R. Feasibility and accuracy of linking a heart failure registry to the national claims database using indirect identifiers. Arch Cardiovasc Dis 2023; 116:18-24. [PMID: 36549971 DOI: 10.1016/j.acvd.2022.11.002] [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: 09/05/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heart failure (HF) registries include rich data on patient inclusion characteristics, but follow-up information is often incomplete. Medicoadministrative databases may provide less clinical information than registries, e.g. on left ventricular ejection fraction (LVEF), but long-term data are exhaustive and reliable. The combination of the two types of database is therefore appealing, but the feasibility and accuracy of such linking are largely unexplored. AIMS To assess the feasibility and accuracy of linking an HF registry (FRESH; FREnch Survey on Heart Failure) with the French National Healthcare System database (SNDS). METHODS A probabilistic algorithm was developed to link and match patient data included in the FRESH HF registry with anonymized records from the SNDS, which include: hospitalizations and diagnostic codes; all care-related reimbursements by national health system; and deaths. Consistency was assessed between deaths recorded in the registry and in the SNDS. A comparison between the two databases was carried out on several identifiable clinical characteristics (history of HF hospitalization, diabetes, atrial fibrillation, chronic bronchopneumopathy, severe renal failure and stroke) and on events during 1-year follow-up after inclusion. RESULTS Of 2719 patients included in the FRESH registry (1049 during decompensation; 1670 during outpatient follow-up), 1885 could be matched with a high accuracy of 94.3% for deaths. Mortality curves were superimposable, including curves according to type of HF and LVEF. The rates of missing data in the FRESH registry were 2.3-8.4% for clinical characteristics and 17.5% for hospitalizations during follow-up. The discrepancy rate for clinical characteristics was 3-13%. Hospitalization rates were significantly higher in the SNDS than in the registry cohort. CONCLUSIONS The anonymous matching of an HF research cohort with a national health database is feasible, with a significant proportion of patients being accurately matched, and facilitates combination of clinical data and a reduced rate of losses to follow-up.
Collapse
Affiliation(s)
- Damien Logeart
- Paris Cité University, Hôpital Lariboisière, AP-HP, 75010 Paris, France.
| | - Thibaud Damy
- Hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | | | | | | | | | | | | | - Gérald Roul
- University Hospital Strasbourg, 67000 Strasbourg, France
| | | | | | - Nicolas Bihry
- Saint-Joseph and Saint-Luc Hospital, 69007 Lyon, France
| | | | | | | | | | | | | |
Collapse
|
16
|
Pasqualini M, Baudet M, Nicol M, Henry P, Biassette H, Logeart D. Impact of Sars COV2 infection on acute myocarditis: Observational study of patients admitted from 2019 to 2021. Archives of Cardiovascular Diseases. Supplements 2023. [PMCID: PMC9800775 DOI: 10.1016/j.acvdsp.2022.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction Cases of acute myocarditis related to SARS COV2 infection and/or vaccines have been described but characteristics and complications require further research. Objective To analyze myocarditis directly related to SARS COV 2 infection and to compare with myocarditis before Covid as well as myocarditis related to Covid vaccines. Method Using PMSI coding, we included all patients hospitalized for myocarditis in 2 centers between 2019 and 2021 and analyzed clinical characteristics and early outcomes. The diagnosis had to be established by ESC guidelines including cardiac MRI and/or endomyocardial biopsy. We compared myocarditis related to COVID-19 infection with 2019 myocarditis (before Covid) and to Covid vaccination. Patients developing cardiogenic shock were also analyzed. Results Acute myocarditis related to COVID were diagnosed in 21 in-patients who had Covid symptoms several weeks before admission (post-Covid) or during hospitalization (per-Covid). Characteristics are shown in Table 1. Cardiogenic shock was observed in 7 patients and was associated with higher inflammation and more frequent myocardial necrosis in biopsy. As compared with 54 patients hospitalized in 2019 (before COVID), SarsCov2 related were more severe with more inflammation but had similar outcome. Conclusion Acute myocarditis related to COVID-19 are associated with severe systemic inflammation and relatively frequent heart failure as compared to others myocarditis, but all patients recovered whatever the cause in this cohort.
Collapse
Affiliation(s)
- M.E. Pasqualini
- Cardiologie, AP–HP, hôpital Lariboisière, Paris,Corresponding author
| | - M. Baudet
- Cardiologie, AP–HP, hôpital Lariboisière, Paris
| | - M. Nicol
- Cardiologie, AP–HP, hôpital Lariboisière, Paris
| | - P. Henry
- Cardiologie, AP–HP, hôpital Lariboisière, Paris
| | - H. Biassette
- Anatomopathologie, AP–HP, hôpital Lariboisière, Paris
| | - D. Logeart
- Cardiologie, AP–HP, hôpital Lariboisière, Paris
| |
Collapse
|
17
|
Castiglione V, Aimo A, Prontera C, Masotti S, Musetti V, Nicol M, Cohen-solal A, Logeart D, Georgiopoulos G, Chubuchny V, Giannoni A, Clerico A, Buda G, Patel KN, Razvi Y, Patel R, Wechalekar A, Lachman H, Hawkins PN, Passino C, Gillmore J, Emdin M, Fontana M, Vergaro G. 490 NT-PROBNP AND HIGH-SENSITIVITY TROPONIN T HOLD DIAGNOSTIC VALUE IN CARDIAC AMYLOIDOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated.
Aim
To evaluate the diagnostic performance for CA of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT).
Methods
Patients with suspected CA (n=1,149) underwent a diagnostic work-up in 3 Centers in Italy, France (n=343, derivation cohort), and United Kingdom (n=806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule-out/rule-in cut-offs, respectively.
Results
In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT-proBNP and hs-TnT. NT-proBNP 180 ng/L and hs-TnT 14 ng/L were selected as rule-out cut-offs, and hs-TnT 86 ng/L as rule-in cut-off. NT-proBNP <180 ng/L or hs-TnT <14 ng/L were found in 7% of patients, ruled out without false negatives. In the validation cohort, 20% of patients (2% false negatives) had NT-proBNP <180 ng/L or hs-TnT <14 ng/L, and 10% showed both biomarkers below cut-offs (0.5% false negatives). These cut-offs refined CA prediction when added to echocardiographic scores in patients with a hematologic disease or an increased wall thickness. In the validation cohort, the 86 ng/L hs-TnT cut-off ruled in 20% of patients (2% false positives).
Conclusions
Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT-proBNP <180 ng/L and hs-TnT <14 ng/L reliably exclude the diagnosis (Figure), both in the overall population and subgroups referred for either AL-CA or cardiac (pseudo)hypertrophy.
Collapse
Affiliation(s)
- Vincenzo Castiglione
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Cardiology Division, University Of Pisa - Pisa - Italy
| | - Alberto Aimo
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | | | | | - Veronica Musetti
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Martin Nicol
- Hopital Lariboisiere, Cardiology Department - Paris - France
| | | | - Damien Logeart
- Hopital Lariboisiere, Cardiology Department - Paris - France
| | - Georgios Georgiopoulos
- School Of Biomedical Engineering And Imaging Sciences , King’s College - London - United Kingdom
- Department Of Clinical Therapeutics, National And Kapodistrian University Of Athens - Athens - Greece
| | | | - Alberto Giannoni
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Aldo Clerico
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Gabriele Buda
- Haematology Department, University Of Pisa - Pisa - Italy
| | - Kiara N Patel
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Yousuf Razvi
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Rishi Patel
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Helen Lachman
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Claudio Passino
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Julian Gillmore
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Michele Emdin
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Giuseppe Vergaro
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Pezel T, Venkatesh BA, Vasconcellos HDD, Kato Y, Post WS, Wu CO, Heckbert SR, Bluemke DA, Cohen-Solal A, Logeart D, Henry P, Lima JAC. Determinants of left atrioventricular coupling index: The Multi-Ethnic Study of Atherosclerosis (MESA). Arch Cardiovasc Dis 2022; 115:414-425. [PMID: 35906156 DOI: 10.1016/j.acvd.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have described a novel left atrioventricular coupling index (LACI), which had a better prognostic value in predicting cardiovascular events than individual left atrial (LA) or left ventricular (LV) variables. AIMS To identify determinants of LACI and its 10-year annual change (ΔLACI), measured by cardiac magnetic resonance (CMR), and to better understand the variables governing this left atrioventricular coupling. METHODS In the Multi-Ethnic Study of Atherosclerosis, 2112 study participants, free from 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 and ΔLACI. RESULTS In the 2112 participants (mean age 58.8±9.1 years; 46.6% male), after adjustment for all covariates, age was independently associated with 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 (1.0±1.1 vs 0.8±1.1%/year; P<0.001). Diabetes and higher body mass index (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]; extracellular volume: R2=0.08, slope=0.28 [P=0.035]) and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration (R2=0.10, slope=-1.11; P<0.001), but was not associated with interleukin 6 or high-sensitivity C-reactive protein. CONCLUSIONS Age, sex, ethnicity, diabetes and BMI were independent determinants of LACI. LACI was independently associated with myocardial fibrosis markers and NT-proBNP concentration.
Collapse
Affiliation(s)
- Theo Pezel
- Division of Cardiology, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Cardiology, Lariboisière Hospital, AP-HP, INSERM UMRS 942, University of Paris, 75010 Paris, France
| | - Bharath Ambale Venkatesh
- Division of Cardiology, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Henrique Doria De Vasconcellos
- Division of Cardiology, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Yoko Kato
- Division of Cardiology, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Colin O Wu
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, AP-HP, INSERM UMRS 942, University of Paris, 75010 Paris, France
| | - Damien Logeart
- Department of Cardiology, Lariboisière Hospital, AP-HP, INSERM UMRS 942, University of Paris, 75010 Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière Hospital, AP-HP, INSERM UMRS 942, University of Paris, 75010 Paris, France
| | - João A C Lima
- Division of Cardiology, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| |
Collapse
|
20
|
Vodovar N, Cohen-Solal A, Logeart D. Could Neprilysin Be Already Inhibited by BNP in the LIFE Trial? JAMA Cardiol 2022; 7:656-657. [PMID: 35507360 DOI: 10.1001/jamacardio.2022.0784] [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: 11/14/2022]
Affiliation(s)
| | - Alain Cohen-Solal
- Department of Cardiology, Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Logeart
- Department of Cardiology, Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
21
|
Michel T, Nougué H, Cartailler J, Lefèvre G, Sadoune M, Picard F, Cohen-Solal A, Logeart D, Launay JM, Vodovar N. proANP Metabolism Provides New Insights Into Sacubitril/Valsartan Mode of Action. Circ Res 2022; 130:e44-e57. [PMID: 35485239 DOI: 10.1161/circresaha.122.320882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sacubitril/valsartan (S/V) treatment is associated with clinical benefits in patients with heart failure with reduced ejection fraction (HFrEF), but its mode of action remains elusive, although it involves the increase of ANP (atrial natriuretic peptide). METHODS AND RESULTS Using a cohort of 73 HFrEF patients treated with S/V and controls, we deciphered the proteolytic cascade that converts proANP into 4 vasoactive peptides, including ANP, which exert vasodilatory actions. We found that proANP processing is sequential and involved meprin B, ECE (endothelin-converting enzyme) 1, and ANPEP (aminopeptidase N). This processing is limited in HFrEF patients when compared with controls via the downregulation of proANP production, corin, and meprin B activities by miR-425 and miR1-3p, resulting in limited production of proANP-derived bioactive peptides. S/V restored or compensated proANP processing by downregulating miR-425 and miR1-3p beyond levels observed in controls, hence increasing levels of proANP-derived bioactive peptides and vasodilation. In contrast, S/V directly and indirectly partially inhibited ECE1 and ANPEP. Consequently, ECE1 partial inhibition resulted in a lower-than-expected increase in ET1 (endothelin 1), tilting the vasoactive balance toward vasodilation, possibly explaining the hypotensive action of S/V. Finally, we show that proANP glycosylation interferes with the midregional proANP assay-a clinical surrogate for proANP production, preventing any pathophysiological interpretation of the results. Finally, the analysis of S/V dose escalation with respect to baseline treatments suggests S/V-specific effects. CONCLUSIONS These findings offer mechanistic evidence to the natriuretic peptide-defective state in HFrEF, which is improved by S/V. These data also strongly suggest that S/V increases plasma ANP by multiple mechanisms that involve the indirect regulation of 2 microRNAs, besides its protection from NEP (neprilysin) cleavage. Altogether, these data provide new insights on HFrEF pathophysiology and the mode of action of S/V.
Collapse
Affiliation(s)
- Thibault Michel
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.)
| | - Hélène Nougué
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.).,Department of Anaesthesiology and Intensive Care Unit, Hôpital Lariboisière, Paris, France (H.N., J.C.)
| | - Jérôme Cartailler
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.).,Department of Anaesthesiology and Intensive Care Unit, Hôpital Lariboisière, Paris, France (H.N., J.C.)
| | - Guillaume Lefèvre
- AP-HP, Hôpital Tenon, Biochemistry Department, Sorbonne Université, Paris, France (G.L.)
| | - Malha Sadoune
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.)
| | - François Picard
- Heart Failure Unit, Haut-Lévêque Hospital, Pessac, France (F.P.)
| | - Alain Cohen-Solal
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.).,Department of Cardiology, Lariboisière Hospital, Paris, France (A.C.-S., D.L.)
| | - Damien Logeart
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.).,Department of Cardiology, Lariboisière Hospital, Paris, France (A.C.-S., D.L.)
| | - Jean-Marie Launay
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.)
| | - Nicolas Vodovar
- Inserm UMR-S 942, Université Paris Cité, France (T.M., H.N., J.C., M.S., A.C.-S., D.L., J.-M.L., N.V.)
| |
Collapse
|
22
|
Pezel T, Sideris G, Dillinger JG, Logeart D, Manzo-Silberman S, Cohen-Solal A, Beauvais F, Devasenapathy N, Laissy JP, Henry P. Coronary Computed Tomography Angiography Analysis of Calcium Content to Identify Non-culprit Vulnerable Plaques in Patients With Acute Coronary Syndrome. Front Cardiovasc Med 2022; 9:876730. [PMID: 35498013 PMCID: PMC9051337 DOI: 10.3389/fcvm.2022.876730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/15/2022] [Accepted: 03/22/2022] [Indexed: 12/26/2022] Open
Abstract
Background Aside from the culprit plaque, the presence of vulnerable plaques in patients with acute coronary syndrome (ACS) may be associated with future cardiac events. A link between calcification and plaque rupture has been previously described. Aim To assess whether analysis of the calcium component of coronary plaques using CT angiography, coronary computed tomographic angiography (CCTA) can help to detect additional vulnerable plaques in patients with non-ST elevation myocardial infarction (NSTEMI). Materials And Methods Cross sectional study of consecutive patients referred for NSTEMI from 30 July to 30 August 2018 with CCTA performed before coronary angiography with systematic optical coherence tomography (OCT) analysis of all coronary arteries within 24 h of clinical onset of NSTEMI. Three types of plaques were defined: culprit plaques defined by angiography (vulnerable culprit plaques–VCP) – plaques with a fibrous cap thickness < 65 microns or thrombus in OCT (vulnerable non-culprit plaque–VNCP) – plaques with a fibrous cap thickness ≥ 65 microns in OCT (stable plaque–SP). Results A total of 134 calcified plaques were identified in 29 patients (73% male, 59 ± 14 years) with 29(22%) VCP, 28(21%) VNCP and 77(57%) SP. Using CCTA analysis of the calcium component, factors associated with vulnerable plaques were longer calcification length, larger calcification volume, lower calcium mass, higher Agatston score plaque-specific (ASp), presence of spotty calcifications and an intimal position in the wall. In multivariate analysis, ASp, calcification length and spotty calcifications were independently associated to vulnerable plaques. There was no difference between VCP and VNCP. Conclusions CCTA analysis of calcium component of the plaque could help to identify additional vulnerable plaques in NSTEMI patients.
Collapse
Affiliation(s)
- Théo Pezel
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
- Department of Radiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
- *Correspondence: Théo Pezel,
| | - Georgios Sideris
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Damien Logeart
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Alain Cohen-Solal
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Florence Beauvais
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | | | - Jean-Pierre Laissy
- Department of Radiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
- Patrick Henry,
| |
Collapse
|
23
|
Desroche LM, Moussi TS, Ducrocq G, Mandry D, Zaleski I, Millischer D, Milleron O, Huttin O, Valla M, Belle L, Lavie-Badie Y, Farah B, Diakov C, Logeart D, Vasram RR, Safar B, Travers JY, Darmon A, Alfaiate T, Burdet C, Jondeau G. UNEXPLAINED LEFT VENTRICULAR DYSFUNCTION: HOW IS CORONARY ANGIOGRAPHY USEFUL TODAY? J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
24
|
Pezel T, Ambale Venkatesh B, De Vasconcellos H, Kato Y, Post W, Wu C, Heckbert S, Bluemke D, Logeart D, Henry P, Lima J. Determinants of left atrioventricular coupling index as a prognostic marker of cardiovascular events from the multi-ethnic atherosclerosis study (MESA). Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.329] [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
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Recent studies have emphasized the incremental prognostic value of a novel left atrioventricular coupling index (LACI) and its 10-year annual change (ΔLACI) to predict cardiovascular events. However, no study has investigated the potential determinants of this index.
PURPOSE
To identify the determinants of LACI and ΔLACI, measured by cardiovascular magnetic resonance (CMR), and to better understand the parameters governing this left atrioventricular coupling in the Multi-Ethnic Study of Atherosclerosis (MESA).
METHODS
In the MESA, 2,112 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (LACIBaseline, Exam 1, 2000–2002) and 10 years later (Exam 5, 2010–2012). The LACI was defined as the ratio of left atrium to left ventricular (LV) end-diastolic volumes. Multivariable linear regression analyses were performed, adjusting for traditional risk factors and LV structure, to identify independent determinants of LACIBaseline or ΔLACI.
RESULTS
In the 2,112 participants (mean age 58.8 ± 9.1 years and 46.6% male), after adjustment for all covariates, age was independently associated with both LACIBaseline (R2 = 0.10) and ΔLACI (R2 = 0.15, both p < 0.001). 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). African Americans had the highest LACIBaseline value (18.0 ± 7.7%) while Chinese Americans had the lowest (13.8 ± 6.4%, p < 0.001). Diabetes and a higher body mass index were independently associated with LACIBaseline (coefficients B: 1.75 and 0.24, respectively, both p < 0.001). LACIBaseline was independently associated with LV myocardial fibrosis markers (native T1: R2 = 0.11, p = 0.038; and extra-cellular volume [ECV]: R2 = 0.08, p = 0.035) and NT-proBNP levels (R2 = 0.10, p < 0.001) but was not associated with inflammation biomarkers.
CONCLUSIONS
In a multi-ethnic population, age, sex, ethnicity, diabetes, and a higher body mass index were independent determinants of LACI. LACI was independently associated with LV myocardial fibrosis markers and NT-proBNP levels but not associated with inflammation biomarkers.
ClinicalTrials.gov Identifier: NCT00005487 Abstract Figure. Relationship between LACI and Age Abstract Figure. Relationship between LACI and Gender
Collapse
Affiliation(s)
- T Pezel
- The Johns Hopkins Hospital, Cardiology , Baltimore, United States of America
| | - 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 Post
- The Johns Hopkins Hospital, Cardiology , Baltimore, United States of America
| | - C Wu
- National Heart Lung and Blood Institute, Bethesda, United States of America
| | - S Heckbert
- University of Washington Medical Center, Seattle, United States of America
| | - D Bluemke
- University of Wisconsin-Madison, Madison, United States of America
| | - D Logeart
- Hospital Lariboisiere, Cardiology , Paris, France
| | - P Henry
- Hospital Lariboisiere, Cardiology , Paris, France
| | - J Lima
- The Johns Hopkins Hospital, Cardiology , Baltimore, United States of America
| |
Collapse
|
25
|
Nicol M, Siguret V, Vergaro G, Aimo A, Emdin M, Dillinger JG, Baudet M, Cohen‐Solal A, Villesuzanne C, Harel S, Royer B, Arnulf B, Logeart D. Thromboembolism and bleeding in systemic amyloidosis: a review. ESC Heart Fail 2022; 9:11-20. [PMID: 34784656 PMCID: PMC8787981 DOI: 10.1002/ehf2.13701] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/18/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
The assessment of both thromboembolic and haemorrhagic risks and their management in systemic amyloidosis have been poorly emphasized so far. This narrative review summarizes main evidence from literature with clinical perspective. The rate of thromboembolic events is as high as 5-10% amyloidosis patients, at least in patients with cardiac involvement, with deleterious impact on prognosis. The most known pro-thrombotic factors are heart failure, atrial fibrillation, and atrial myopathy. Atrial fibrillation could occur in 20% to 75% of systemic amyloidosis patients. Cardiac thrombi are frequently observed in patients, particularly in immunoglobulin light chains (AL) amyloidosis, up to 30%, and it is advised to look for them systematically before cardioversion. In AL amyloidosis, nephrotic syndrome and the use of immunomodulatory drugs also favour thrombosis. On the other hand, the bleeding risk increases because of frequent amyloid digestive involvement as well as factor X deficiency, renal failure, and increased risk of dysautonomia-related fall.
Collapse
Affiliation(s)
- Martin Nicol
- Cardiology departmentLariboisière Hospital, APHP2 rue Ambroise ParéParisFrance
- Université de ParisParisFrance
| | - Virginie Siguret
- Université de ParisParisFrance
- INSERM UMR‐S‐1140 University of ParisParisFrance
- Laboratory of HematologyLariboisière Hospital, APHPParisFrance
| | - Giuseppe Vergaro
- Division of Cardiology and Cardiovascular MedicineFondazione Toscana Gabriele MonasterioPisaItaly
| | - Alberto Aimo
- Division of Cardiology and Cardiovascular MedicineFondazione Toscana Gabriele MonasterioPisaItaly
| | - Michele Emdin
- Division of Cardiology and Cardiovascular MedicineFondazione Toscana Gabriele MonasterioPisaItaly
| | - Jean Guillaume Dillinger
- Cardiology departmentLariboisière Hospital, APHP2 rue Ambroise ParéParisFrance
- Université de ParisParisFrance
| | - Mathilde Baudet
- Cardiology departmentLariboisière Hospital, APHP2 rue Ambroise ParéParisFrance
| | - Alain Cohen‐Solal
- Cardiology departmentLariboisière Hospital, APHP2 rue Ambroise ParéParisFrance
- Université de ParisParisFrance
| | | | - Stephanie Harel
- Immuno‐hematology DepartmentSaint Louis Hospital, APHPParisFrance
| | - Bruno Royer
- Immuno‐hematology DepartmentSaint Louis Hospital, APHPParisFrance
| | - Bertrand Arnulf
- Université de ParisParisFrance
- Immuno‐hematology DepartmentSaint Louis Hospital, APHPParisFrance
| | - Damien Logeart
- Cardiology departmentLariboisière Hospital, APHP2 rue Ambroise ParéParisFrance
- Université de ParisParisFrance
| |
Collapse
|
26
|
Pezel T, Venkatesh B, Heckbert S, Yoko K, De Vasconcellos H, Wu C, Post W, Bluemke D, Logeart D, Henry P, Lima J. Change in left atrioventricular coupling index to predict hard cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
27
|
Logeart D, Berthelot E, Bihry N, Eschalier R, Salvat M, Garcon P, Eicher JC, Cohen A, Tartiere JM, Samadi A, Donal E, deGroote P, Mewton N, Mansencal N, Raphael P, Ghanem N, Seronde MF, Chavelas C, Rosamel Y, Beauvais F, Kevorkian JP, Diallo A, Vicaut E, Isnard R. Early and short-term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD-HF). Eur J Heart Fail 2021; 24:219-226. [PMID: 34628697 DOI: 10.1002/ejhf.2357] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/06/2021] [Revised: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Hospitalization for acute heart failure (HF) is followed by a vulnerable time with increased risk of readmission or death, thus requiring particular attention after discharge. In this study, we examined the impact of intensive, early follow-up among patients at high readmission risk at discharge after treatment for acute HF. METHODS AND RESULTS Hospitalized acute HF patients were included with at least one of the following: previous acute HF < 6 months, systolic blood pressure ≤ 110 mmHg, creatininaemia ≥ 180 µmol/L, or B-type natriuretic peptide ≥ 350 pg/mL or N-terminal pro B-type natriuretic peptide ≥ 2200 pg/mL. Patients were randomized to either optimized care and education with serial consultations with HF specialist and dietician during the first 2-3 weeks, or to standard post-discharge care according to guidelines. The primary endpoint was all-cause death or first unplanned hospitalization during 6-month follow-up. Among 482 randomized patients (median age 77 and median left ventricular ejection fraction 35%), 224 were hospitalized or died. In the intensive group, loop diuretics (46%), beta-blockers (49%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (39%) and mineralocorticoid receptor antagonists (47%) were titrated. No difference was observed between groups for the primary endpoint (hazard ratio 0.97; 95% confidence interval 0.74-1.26), nor for mortality at 6 or 12 months or unplanned HF rehospitalization. Additionally, no difference between groups according to age, previous HF and left ventricular ejection fraction was found. CONCLUSIONS In high-risk HF, intensive follow-up early post-discharge did not improve outcomes. This vulnerable post-discharge time requires further studies to clarify useful transitional care services.
Collapse
Affiliation(s)
- Damien Logeart
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | | | | | | | | | | | | | - Ariel Cohen
- Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Nicolas Mansencal
- Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | - Yann Rosamel
- Hôpital Sud-Francilien, Corbeil-Essonnes, France
| | - Florence Beauvais
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Abdourahmane Diallo
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Vicaut
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Richard Isnard
- Hôpital Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
28
|
Sabouret P, Attias D, Beauvais C, Berthelot E, Bouleti C, Gibault Genty G, Galat A, Hanon O, Hulot JS, Isnard R, Jourdain P, Lamblin N, Lebreton G, Lellouche N, Logeart D, Meune C, Pezel T, Damy T. Diagnosis and management of heart failure from hospital admission to discharge: A practical expert guidance. Ann Cardiol Angeiol (Paris) 2021; 71:41-52. [PMID: 34274113 DOI: 10.1016/j.ancard.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) has high event rates, mortality, and is challenging to manage in clinical practice. Clinical management is complicated by complex therapeutic strategies in a population with a high prevalence of comorbidity and general frailty. In the last four years, an abundance of research has become available to support multidisciplinary management of heart failure from within the hospital through to discharge and primary care as well as supporting diagnosis and comorbidity management. Within the hospital setting, recent evidence supports sacubitril-valsartan combination in frail, deteriorating or de novo patients with LVEF≤40%. Furthermore, new strategies such as SGLT2 inhibitors and vericiguat provide further benefit for patients with decompensating HF. Studies with tafamidis report major clinical benefits specifically for patients with ATTR cardiac amyloidosis, a remaining underdiagnosed and undertreated disease. New evidence for medical interventions supports his bundle pacing to reduce QRS width and improve haemodynamics as well as ICD defibrillation for non-ischemic cardiomyopathy. The Mitraclip reduces hospitalisations and mortality in patients with symptomatic, secondary mitral regurgitation and ablation reduces mortality and hospitalisations in patients with paroxysmal and persistent atrial fibrillation. In end-stage HF, the 2018 French Heart Allocation policy should improve access to heart transplants for stable, ambulatory patients and, mechanical circulatory support should be considered to avoid deteriorating on the waiting list. In the community, new evidence supports that improving discharge education, treatment and patient support improves outcomes. The authors believe that this review fills the gap between the guidelines and clinical practice and provides practical recommendations to improve HF management.
Collapse
Affiliation(s)
- P Sabouret
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - D Attias
- Cardiology department, Centre Cardiologique du Nord, Saint-Denis, France
| | - C Beauvais
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - E Berthelot
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - C Bouleti
- Cardiology department, Poitiers University Hospital, CIC INSERM 1402, Poitiers, France
| | - G Gibault Genty
- Cardiology department, André Mignot Hospital, Le Chesnay, France
| | - A Galat
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - O Hanon
- Geriatrics Department, Hospital Broca, Paris Descartes University, Paris, France
| | - J S Hulot
- Pharmacology Department, Georges-Pompidou European Hospital, INSERM, PARCC, CIC1418 Paris-Descartes University, Paris, France
| | - R Isnard
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - P Jourdain
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - N Lamblin
- Cardiology Department, University Hospital, Lille, France
| | - G Lebreton
- Heart Institute, Cardiac Surgery department, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - N Lellouche
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - D Logeart
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - C Meune
- Department of Cardiology, Avicenne Hospital, Paris 13 University, Bobigny, France
| | - T Pezel
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - T Damy
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France.
| |
Collapse
|
29
|
Nicol M, Baudet M, Brun S, Harel S, Royer B, Vignon M, Lairez O, Lavergne D, Jaccard A, Attias D, Macron L, Gayat E, Cohen-Solal A, Arnulf B, Logeart D. Diagnostic score of cardiac involvement in AL amyloidosis. Eur Heart J Cardiovasc Imaging 2021; 21:542-548. [PMID: 31292624 DOI: 10.1093/ehjci/jez180] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 02/17/2019] [Revised: 05/25/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS Early diagnosis of cardiac involvement is a key issue in the management of AL amyloidosis. Our objective was to establish a diagnostic score of cardiac involvement in AL amyloidosis and to compare it with the current consensus criteria [i.e. left ventricular hypertrophy >12 mm and N-terminal pro b-type natriuretic peptide (NT-proBNP) >332 ng/L]. METHODS AND RESULTS We carried out a prospective and multicenter study on AL amyloidosis patients who underwent cardiac evaluation including clinical examination, electrocardiography (ECG), cardiac biomarkers, transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR). Cardiac involvement was based on CMR and/or endomyocardial biopsy. In a derivation cohort of 114 patients (82 with cardiac involvement), the highest diagnostic accuracy was observed with NT-proBNP and troponin blood levels, TTE-derived global longitudinal strain (LS), and apical to basal LS gradient. By using multivariate analysis, we established a diagnostic score including global LS ≥-17% (1 point), apical/(basal + median) LS ≥0.90 (1 point), and troponin T >35 ng/L (1 point). A score >1 was associated with sensitivity of 94% and specificity of 97%, an area under the curve of 0.98 [95% confidence interval (CI) 0.93-0.99] as well as a net reclassification index of 0.39 (95% CI 0.28-0.46) when compared with consensus criteria. In a validation cohort of 73 AL amyloidosis patients, the area under the receiver operating characteristic curve of the diagnostic score was 0.97 (95% CI 0.90-0.99). CONCLUSION Combining T troponin blood levels and two echo-derived strain parameters leads to very high accuracy for diagnosing cardiac involvement in AL amyloid patients.
Collapse
Affiliation(s)
- Martin Nicol
- Cardiology Department, Hopital Lariboisiere, 2 rue Ambroise Paré, 75010 Paris, France
| | - Mathilde Baudet
- Cardiology Department, Hopital Lariboisiere, 2 rue Ambroise Paré, 75010 Paris, France
| | - Stephanie Brun
- Cardiology Department, Hopital Rangueil, 2 rue Viguerie, 31300 Toulouse, France
| | - Stephanie Harel
- Immuno-Hematology Department, Hopital Saint Louis, 2 avenue Claude Vellefaux, 75010 Paris, France
| | - Bruno Royer
- Immuno-Hematology Department, Hopital Saint Louis, 2 avenue Claude Vellefaux, 75010 Paris, France
| | - Marguerite Vignon
- Hematology Department, Hopital Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Olivier Lairez
- Cardiology Department, Hopital Rangueil, 2 rue Viguerie, 31300 Toulouse, France
| | - David Lavergne
- Hematology Department, Hopital Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Arnaud Jaccard
- Hematology Department, Hopital Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - David Attias
- Cardiology Department, Centre cardiologique du Nord, 32 rue des Moulins Gémeaux, 93200 Saint Denis, France
| | - Laurent Macron
- Cardiology Department, Centre cardiologique du Nord, 32 rue des Moulins Gémeaux, 93200 Saint Denis, France
| | - Etienne Gayat
- Anesthesiology Department, Hopital Lariboisiere, 2 rue Ambroise Paré, 75010 Paris, France.,Université de Paris, 10 avenue de Verdun, 75010 Paris, France
| | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, 2 rue Ambroise Paré, 75010 Paris, France.,Université de Paris, 10 avenue de Verdun, 75010 Paris, France
| | - Bertrand Arnulf
- Cardiology Department, Hopital Rangueil, 2 rue Viguerie, 31300 Toulouse, France.,Université de Paris, 10 avenue de Verdun, 75010 Paris, France
| | - Damien Logeart
- Cardiology Department, Hopital Lariboisiere, 2 rue Ambroise Paré, 75010 Paris, France.,Université de Paris, 10 avenue de Verdun, 75010 Paris, France
| |
Collapse
|
30
|
Hulot JS, Trochu JN, Donal E, Galinier M, Logeart D, De Groote P, Juillière Y. Vericiguat for the treatment of heart failure: mechanism of action and pharmacological properties compared with other emerging therapeutic options. Expert Opin Pharmacother 2021; 22:1847-1855. [PMID: 34074190 DOI: 10.1080/14656566.2021.1937121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The significant morbidity and mortality in patients with heart failure (HF), notably in the most advanced forms of the disease, justify the need for novel therapeutic options. In the last year, the soluble guanylate cyclase (sGC) stimulator, vericiguat, has drawn the attention of the medical community following the report of reduced clinical outcomes in patients with worsening chronic HF (WCHF). AREAS COVERED The authors review the available data on the mechanism of action of vericiguat (cyclic guanosine monophosphate (cGMP) pathway), its clinical development program, its role in HF management, and its future positioning in the therapeutic recommendations. EXPERT OPINION cGMP deficiency has deleterious effects on the heart and contributes to the progression of HF. Different molecules, including nitric oxide (NO) donors, phosphodiesterase inhibitors, and natriuretic peptides analogues, target the NO-sCG-cGMP pathway but have yielded conflicting results in HF patients. Vericiguat acts as a sGC stimulator thus targeting the NO-sGC-cGMP pathway by a different mechanism that complements the current pharmacotherapy for HF. Vericiguat has shown an additional statistical add-on therapy efficacy by reducing morbi-mortality in patients with WCHF. A better evaluation of HF severity might be an important determinant to guide the use of vericiguat among the available therapies.
Collapse
Affiliation(s)
- Jean-Sébastien Hulot
- Université de Paris, INSERM, PARCC, Paris, France.,CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jean-Noël Trochu
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du Thorax, Nantes, France
| | - Erwan Donal
- LTSI INSERM U1099, Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, Université Rennes, Rennes, France
| | - Michel Galinier
- Department of Cardiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Damien Logeart
- Department of Cardiology, Lariboisière Hospital, Paris, France.,Université de Paris, Paris, France
| | - Pascal De Groote
- CHU Lille, Service de Cardiologie, France.,INSERM U1167, Institut Pasteur de Lille, Lille, France
| | - Yves Juillière
- Centre Hospitalier Universitaire de Nancy Brabois, Vandoeuvre Lès Nancy, France
| |
Collapse
|
31
|
Pezel T, Dillinger JG, Bonnet G, Vidal Trecan T, Asselin A, Sideris G, Logeart D, Manzo-Silberman S, Gautier JF, Riveline JP, Henry P. Cardiac troponin I and BNP for predicting zero Agatston score in patients with diabetes mellitus. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.231] [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
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Coronary artery calcifications (CAC) scoring assessed by the Agatston score has shown an excellent prognostic value in large studies, particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis, especially in diabetic patients. However, the link between hs-cTnI/BNP and the Agatston score has not been investigated in this population.
PURPOSE
The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston score in patients with diabetes mellitus in addition to usual risk factors.
METHODS
Between 2015 and 2019, CAC score was prospectively performed in consecutive patients with diabetes mellitus with high cardiovascular risk. Patients with symptoms or known coronary artery disease were excluded. Within 24h from CT exam, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston score was evaluated using univariate and multivariate binomial models. 77 variables have been used to build the model. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi-squared test of independence.
RESULTS
A total of 844 patients with diabetes were enrolled (61 ± 7 years, 57% men, mean diabetes duration 18 years). In this population, 294 (35%) had a zero Agatston score, 253 (30%) an Agatston score from 1 to 100, 161 (19%) from 101 to 400, and 136 (16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston score (respectively OR, 2.63 [95% CI, 1.51-5.01]; p < 0.001 and OR, 1.09 [95% CI, 1.01-1.22]; p = 0.03). In multivariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston score (respectively OR, 2.38 [95% CI, 1.51-4.76]; p = 0.009 and OR, 1.18 [95% CI, 1.07-1.32]; p = 0.001). Among the 77 variables, the multivariate model including age, gender, smoking, dyslipidaemia, duration of the diabetes, arterial hypertension, presence of diabetic neuropathy, hs-cTnI and BNP concentrations, significantly discriminated the zero Agatston score (AUC = 0.81; p < 0.001). The most discriminant threshold was ≤ 3ng/l for hs-cTnI and <17ng/l for BNP. In nested models, both hs-cTnI and BNP brought information to this multivariate model to predict a zero Agatston score (respectively p = 0.003 and p < 0.001 to the Chi-squared test). Moreover, removing hs-cTnI and BNP from the model results in a significant reduction in model performance (AUC = 0.79; p = 0.004).
CONCLUSIONS
Cardiac biomarkers hs-cTnI and BNP are associated with a zero Agatston score, which is correlated with a very low risk of cardiovascular events in asymptomatic patients with diabetes mellitus.
Abstract Figure. ROC curve to predict zero Agatston score
Collapse
Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Paris, France
| | - JG Dillinger
- Hospital Lariboisiere, Department of Cardiology , Paris, France
| | - G Bonnet
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | | | - A Asselin
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - G Sideris
- Hospital Lariboisiere, Department of Cardiology , Paris, France
| | - D Logeart
- Hospital Lariboisiere, Department of Cardiology , Paris, France
| | | | | | | | - P Henry
- Hospital Lariboisiere, Department of Cardiology , Paris, France
| |
Collapse
|
32
|
Nicol M, Deney A, Lairez O, Vergaro G, Emdin M, Inamo J, Montfort A, Damy T, Harel S, Royer B, Baudet M, Cohen Solal A, Arnulf B, Logeart D. Prognostic value of cardio-pulmonary exercise testing in cardiac amyloidosis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Pezel T, Mika D, Logeart D, Cohen-Solal A, Beauvais F, Henry P, Laissy JP, Moubarak G. Characterization of non-response to cardiac resynchronization therapy by post-procedural computed tomography. Pacing Clin Electrophysiol 2020; 44:135-144. [PMID: 33283875 DOI: 10.1111/pace.14134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Causes of non-response to cardiac resynchronization therapy (CRT) include mechanical dyssynchrony, myocardial scar, and suboptimal left ventricular (LV) lead location. We aimed to assess the utility of Late Iodine Enhancement Computed Tomography (LIE-CT) with image subtraction in characterizing CRT non-response. METHODS CRT response was defined as a decrease in LV end-systolic volume > 15% at 6 months. LIE-CT was performed after 6 months, and analyzed global and segmental dyssynchrony, myocardial scar, coronary venous anatomy, and position of LV lead relative to scar and segment of latest mechanical contraction. RESULTS We evaluated 29 patients (age 71 ± 12 years; 72% men) including 18 (62%) responders. All metrics evaluating residual dyssynchrony such as wall motion index and wall thickness index were worse in non-responders. There was no difference in presence and extent of scar between responders and non-responders. However, in non-responders, the LV lead was more often over an akinetic/dyskinetic area (72% vs. 22%, p = .007), a fibrotic area (64% vs. 8%, p = .0007), an area with myocardial thickness < 6 mm (82% vs. 22%, p = .002), and less often concordant with the region of maximal wall thickness (9% vs. 72%, p = .001). Among the 11 non-responders, eight had at least another coronary venous branch visualized by CT, including three (27%) coursing over a potentially interesting myocardial area (free of scar, with normal wall motion, and with a myocardial thickness ≥6 mm). CONCLUSION LIE-CT with image subtraction allows a comprehensive characterization of patients after CRT and may provide clues for management of non-responders.
Collapse
Affiliation(s)
- Théo Pezel
- Department of Cardiology, Lariboisière Hospital, APHP, Paris, France.,Department of Radiology, Lariboisière Hospital, APHP, Paris, France
| | - Delphine Mika
- University of Paris-Sud 11, INSERM UMR-S 1180, Chatenay-Malabry, France
| | - Damien Logeart
- Department of Cardiology, Lariboisière Hospital, APHP, Paris, France
| | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, APHP, Paris, France
| | - Florence Beauvais
- Department of Cardiology, Lariboisière Hospital, APHP, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière Hospital, APHP, Paris, France
| | | | - Ghassan Moubarak
- Department of Cardiology, Lariboisière Hospital, APHP, Paris, France.,Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| |
Collapse
|
34
|
Castiglione V, Aimo A, Prontera C, Masotti S, Chubuchny V, Genovesi D, Barison A, Nicol M, Cohen-Solal A, Logeart D, Passino C, Emdin M, Vergaro G. High-sensitivity cardiac troponin T and NT-proBNP for ruling-in and ruling-out of cardiac amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2112] [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
Background
Cardiac amyloidosis (CA) is caused by the extracellular deposition of misfolded proteins into insoluble amyloid fibrils, the 2 most common forms being transthyretin (ATTR) and immunoglobulin light chain (AL) amyloidosis. Chronic elevation of cardiac troponins and natriuretic peptides is common in CA and predicts worse outcome. The diagnostic yield of biomarkers of cardiac damage for CA has been less investigated.
Purpose
We aimed to evaluate the ruling-in/out values for the diagnosis of CA of high-sensitivity cardiac troponin T (hs-cTnT) and of N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP).
Methods
We studied 275 consecutive patients referred to two tertiary Centers in Italy (n=184) and France (n=91) with the clinical suspicion of CA due to the presence of a plasma cell dyscrasia or an unexplained left ventricular (pseudo)hypertrophy. CA was confirmed by the combination of suggestive features on imaging techniques (echocardiography, cardiac magnetic resonance, diphosphonate scintigraphy) and biopsy examination. All patients underwent a full baseline characterization including hs-cTnT and NT-proBNP. Biomarkers values corresponding to a negative likelihood ratio <0.1 or a positive likelihood ratio >10 were respectively chosen as rule-out and rule-in cut-offs for CA.
Results
CA was confirmed in 161 (59%) patients, who had either AL amyloidosis (n=96, 60%) or ATTR amyloidosis (n=65, 40%). At time of evaluation, 97 (35%) patients (34 CA vs. 63 controls, p=0.112) were hospitalized for decompensated heart failure. Patients with CA showed higher hs-cTnT (65 ng/L [44–122] vs. 31 [18–42], p<0.001) and NT-proBNP (4260 ng/L [2006–8911] vs. 1199 [468–3357], p<0.001) than those without CA. The area under the curve (AUC) values for hs-cTnT and NT-proBNP were 0.832 and 0.744 respectively (p=0.002 for the difference). The combination of the two biomarkers (AUC=0.836) improved discrimination over NT-proBNP (p=0.004), but not over hs-cTnT (p=0.423). A hs-cTnT value <15 ng/L (sensitivity=100%, negative predictive value=100%, true negatives=13, false negatives=0) and a NT-proBNP <550 ng/L (sensitivity=98%, negative predictive value=89%, true negatives=33, false negatives=4) were selected as rule-out cut-offs. A hs-cTnT level ≥80 ng/L (specificity=96%, positive predictive value=93%, true positives=71, false positives=5) was optimal for ruling in amyloidosis, while no rule-in cut-off could be selected for NT-proBNP. hs-cTnT values of either ≥80 or <15 ng/dL could effectively rule-in/out 89 (32%) patients.
Conclusions
Plasma hs-cTnT and NT-proBNP have diagnostic value in patients with suspected CA. Stand-alone hs-cTnT levels <15 or ≥80 ng/L may help to exclude or confirm the diagnosis of CA in up to one third of patients undergoing a diagnostic screening for the disease.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- V Castiglione
- University of Pisa, Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Pisa, Italy
| | - A Aimo
- University of Pisa, Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Pisa, Italy
| | - C Prontera
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Masotti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - V Chubuchny
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - D Genovesi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Barison
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Nicol
- Hospital Lariboisiere, Cardiology Department, Paris, France
| | - A Cohen-Solal
- Hospital Lariboisiere, Cardiology Department, Paris, France
| | - D Logeart
- Hospital Lariboisiere, Cardiology Department, Paris, France
| | - C Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| |
Collapse
|
35
|
Pezel T, Dillinger J, Bonnet G, Vidal Trecan T, Asselin A, Sideris G, Logeart D, Manzo-Silberman S, Gautier J, Riveline J, Henry P. Cardiac troponin I and BNP for predicting zero Agatston score in patients with diabetes mellitus. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2901] [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
Coronary artery calcifications (CAC) scoring assessed by the Agatston score has shown an excellent prognostic value in large studies, particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis, especially in diabetic patients. However, the link between hs-cTnI/BNP and the Agatston score has not been investigated in this population.
Purpose
The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston score in patients with diabetes mellitus in addition to usual risk factors.
Material
Between 2015 and 2019, CAC score was prospectively performed in consecutive patients with diabetes mellitus with high cardiovascular risk. Patients with symptoms or known coronary artery disease were excluded. Within 24h from CT exam, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston score was evaluated using univariate and multivariate binomial models. 77 variables have been used to build the model. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi-squared test of independence.
Results
A total of 844 patients with diabetes were enrolled (61±7 years, 57% men, mean diabetes duration 18 years). In this population, 294 (35%) had a zero Agatston score, 253 (30%) an Agatston score from 1 to 100, 161 (19%) from 101 to 400, and 136 (16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston score (respectively OR, 2.63 [95% CI, 1.51–5.01]; p<0.001 and OR, 1.09 [95% CI, 1.01–1.22]; p=0.03). In multivariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston score (respectively OR, 2.38 [95% CI, 1.51–4.76]; p=0.009 and OR, 1.18 [95% CI, 1.07–1.32]; p=0.001). Among the 77 variables, the multivariate model including age, gender, smoking, dyslipidaemia, duration of the diabetes, arterial hypertension, presence of diabetic neuropathy, hs-cTnI and BNP concentrations, significantly discriminated the zero Agatston score (AUC = 0.81; p<0.001). The most discriminant threshold was ≤3ng/l for hs-cTnI and <17ng/l for BNP. In nested models, both hs-cTnI and BNP brought information to this multivariate model to predict a zero Agatston score (respectively p=0.003 and p<0.001 to the Chi-squared test). Moreover, removing hs-cTnI and BNP from the model results in a significant reduction in model performance (AUC = 0.79; p=0.004).
Conclusions
Cardiac biomarkers hs-cTnI and BNP are associated with a zero Agatston score, which is correlated with a very low risk of cardiovascular events in asymptomatic patients with diabetes mellitus.
ROC curve to predict zero Agatston score
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Department of Cardiology, Paris, France
| | - J.G Dillinger
- Hospital Lariboisiere, Department of Cardiology, Paris, France
| | - G Bonnet
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - T Vidal Trecan
- Hospital Lariboisiere, Universitary center for the study of diabetes and its complications, Paris, France
| | - A Asselin
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - G Sideris
- Hospital Lariboisiere, Department of Cardiology, Paris, France
| | - D Logeart
- Hospital Lariboisiere, Department of Cardiology, Paris, France
| | | | - J.F Gautier
- Hospital Lariboisiere, Universitary center for the study of diabetes and its complications, Paris, France
| | - J.P Riveline
- Hospital Lariboisiere, Universitary center for the study of diabetes and its complications, Paris, France
| | - P Henry
- Hospital Lariboisiere, Department of Cardiology, Paris, France
| |
Collapse
|
36
|
Nicol M, Cacoub L, Baudet M, Nahmani Y, Cacoub P, Cohen-Solal A, Henry P, Adle-Biassette H, Logeart D. Delayed acute myocarditis and COVID-19-related multisystem inflammatory syndrome. ESC Heart Fail 2020; 7:4371-4376. [PMID: 33107217 PMCID: PMC7755006 DOI: 10.1002/ehf2.13047] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022] Open
Abstract
Precise descriptions of coronavirus disease 2019 (COVID‐19)‐related cardiac damage as well as underlying mechanisms are scarce. We describe clinical presentation and diagnostic workup of acute myocarditis in a patient who had developed COVID‐19 syndrome 1 month earlier. A healthy 40‐year‐old man suffered from typical COVID‐19 symptoms. Four weeks later, he was admitted because of fever and tonsillitis. Blood tests showed major inflammation. Thoracic computed tomography was normal, and RT–PCR for SARS‐CoV‐2 on nasopharyngeal swab was negative. Because of haemodynamic worsening with both an increase in cardiac troponin and B‐type natriuretic peptide levels and normal electrocardiogram, acute myocarditis was suspected. Cardiac echographic examination showed left ventricular ejection fraction at 45%. Exhaustive diagnostic workup included RT–PCR and serologies for infectious agents and autoimmune blood tests as well as cardiac magnetic resonance imaging and endomyocardial biopsies. Cardiac magnetic resonance with T2 mapping sequences showed evidence of myocardial inflammation and focal lateral subepicardial late gadolinium enhancement. Pathological analysis exhibited interstitial oedema, small foci of necrosis, and infiltrates composed of plasmocytes, T‐lymphocytes, and mainly CD163+ macrophages. These findings led to the diagnosis of acute lympho‐plasmo‐histiocytic myocarditis. There was no evidence of viral RNA within myocardium. The only positive viral serology was for SARS‐CoV‐2. The patient and his cardiac function recovered in the next few days without use of anti‐inflammatory or antiviral drugs. This case highlights that systemic inflammation associated with acute myocarditis can be delayed up to 1 month after initial SARS‐CoV‐2 infection and can be resolved spontaneously.
Collapse
Affiliation(s)
- Martin Nicol
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France
| | - Lea Cacoub
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France
| | - Mathilde Baudet
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France
| | - Yoram Nahmani
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France
| | - Patrice Cacoub
- Internal Medicine Department, APHP, Pitie-Salpetriere Hospital, Paris, France
| | - Alain Cohen-Solal
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France.,Université de Paris, Paris, France
| | - Patrick Henry
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France.,Université de Paris, Paris, France
| | - Homa Adle-Biassette
- Pathology Laboratory, APHP, Lariboisiere Hospital, Paris, France.,Université de Paris, Paris, France
| | - Damien Logeart
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France.,Université de Paris, Paris, France
| |
Collapse
|
37
|
Nicol M, Deney A, Lairez O, Vergaro G, Emdin M, Carecci A, Inamo J, Montfort A, Neviere R, Damy T, Harel S, Royer B, Baudet M, Cohen-Solal A, Arnulf B, Logeart D. Prognostic value of cardiopulmonary exercise testing in cardiac amyloidosis. Eur J Heart Fail 2020; 23:231-239. [PMID: 33006180 DOI: 10.1002/ejhf.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 05/09/2020] [Revised: 08/20/2020] [Accepted: 09/26/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS In amyloid patients, cardiac involvement dramatically worsens functional capacity and prognosis. We sought to study how the cardiopulmonary exercise test (CPET) could help in functional assessment and risk stratification of patients with cardiac amyloidosis (CA). METHODS AND RESULTS We carried out a multicentre study including patients with light chain (AL) or transthyretin (TTR) CA. All patients underwent exhaustive examination including CPET and follow-up. The primary prognostic endpoint was the occurrence of death or heart failure hospitalization. Overall, 150 patients were included (91 AL and 59 TTR CA). Median age, systolic blood pressure, N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin T were 70 (64-78) years, 121 [interquartile range (IQR) 109-139] mmHg, 2806 (IQR 1218-4638) ng/L and 64 (IQR 33-120) ng/L, respectively. New York Heart Association classes were I-II in 64%. Median peak oxygen consumption (VO2 ) and circulatory power were low at 13.0 (10.0-16.9) mL/kg/min and 1730 (1318-2614) mmHg/mL/min, respectively. The minute ventilation/carbon dioxide production slope was increased to 37 (IQR 33-45). A total of 77 patients (51%) had chronotropic insufficiency. After a median follow-up of 20 months, there were 37 deaths and 44 heart failure hospitalizations. At multivariate Cox analysis, peak VO2 ≤13 mL/kg/min [hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.6-4.8], circulatory power ≤1730 mmHg/mL/min (HR 2.4, 95% CI 1.2-4.6) and NT-proBNP ≥1800 ng/L (HR 2.2, 95% CI 1.1-4.3) were found to be associated with the primary outcome. No events occurred in patients with both peak VO2 >13 mL/kg/min and NT-proBNP <1800 ng/L, while the association of VO2 ≤13 mL/kg/min with NT-proBNP ≥1800 ng/L identified a very high-risk subgroup. CONCLUSION In CA, CPET is helpful in assessing functional capacity, circulatory and chronotropic responses as well as the prognosis of patients along with cardiac biomarkers.
Collapse
Affiliation(s)
- Martin Nicol
- Lariboisiere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Antoine Deney
- Rangueil Hospital, University Hospital of Toulouse, Toulouse, France
| | - Olivier Lairez
- Rangueil Hospital, University Hospital of Toulouse, Toulouse, France
| | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana 'Gabriele Monasterio', Pisa, Italy
| | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana 'Gabriele Monasterio', Pisa, Italy
| | | | - Jocelyn Inamo
- University Hospital of Fort de France, Fort De France, France
| | - Astrid Montfort
- University Hospital of Fort de France, Fort De France, France
| | - Remi Neviere
- University Hospital of Fort de France, Fort De France, France
| | - Thibaud Damy
- Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Stephanie Harel
- Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Royer
- Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathilde Baudet
- Lariboisiere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Cohen-Solal
- Lariboisiere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Bertrand Arnulf
- University of Paris, Paris, France.,Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Logeart
- Lariboisiere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| |
Collapse
|
38
|
Duflos C, Troude P, Strainchamps D, Ségouin C, Logeart D, Mercier G. Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission. Sci Rep 2020; 10:10644. [PMID: 32606326 PMCID: PMC7327074 DOI: 10.1038/s41598-020-66788-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
In patients with heart failure, some organizational and modifiable factors could be prognostic factors. We aimed to assess the association between the in-hospital care pathways during hospitalization for acute heart failure and the risk of readmission. This retrospective study included all elderly patients who were hospitalized for acute heart failure at the Universitary Hospital Lariboisière (Paris) during 2013. We collected the wards attended, length of stay, admission and discharge types, diagnostic procedures, and heart failure discharge treatment. The clinical factors were the specific medical conditions, left ventricular ejection fraction, type of heart failure syndrome, sex, smoking status, and age. Consistent groups of in-hospital care pathways were built using an ascending hierarchical clustering method based on a primary components analysis. The association between the groups and the risk of readmission at 1 month and 1 year (for heart failure or for any cause) were measured via a count data model that was adjusted for clinical factors. This study included 223 patients. Associations between the in-hospital care pathway and the 1 year-readmission status were studied in 207 patients. Five consistent groups were defined: 3 described expected in-hospital care pathways in intensive care units, cardiology and gerontology wards, 1 described deceased patients, and 1 described chaotic pathways. The chaotic pathway strongly increased the risk (p = 0.0054) of 1 year readmission for acute heart failure. The chaotic in-hospital care pathway, occurring in specialized wards, was associated with the risk of readmission. This could promote specific quality improvement actions in these wards. Follow-up research projects should aim to describe the processes causing the generation of chaotic pathways and their consequences.
Collapse
Affiliation(s)
- Claire Duflos
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France.
- PhyMedExp, U1046, INSERM, Montpellier, France.
| | - Pénélope Troude
- Public Health Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - David Strainchamps
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France
| | - Christophe Ségouin
- Public Health Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - Damien Logeart
- Cardiology Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - Grégoire Mercier
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France
- CEPEL, University of Montpellier, Montpellier, France
| |
Collapse
|
39
|
Berthelot E, Mas R, Damy T, Hanon O, Jondeau G, Logeart D, Rouquette A, Assayag P, Jourdain P. NTproBNP and BNP level in acute heart failure patients aged 75 or older are higher than in non-cardiac dyspnoea. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Paven E, Ghalem N, Mercadier JJ, Sirol M, Launay J, Vodovar N, Logeart D. Natriuretic peptides metabolism in left ventricular remodeling after myocardial infarction. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
41
|
Pezel T, Sideris G, Dillinger JG, Logeart D, Manzo-Silberman S, Cohen Solal A, Beauvais F, Laissy JP, Henry P. Characterization of the calcium component of vulnerable coronary plaque in patients with NSTEMI: Prospective comparison between coronary CT and optical coherence tomography. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.008] [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]
|
42
|
Affiliation(s)
- Alain Cohen-Solal
- Department of Cardiology, UMR-S942, University of Paris, Lariboisiere Hospital, AP-HP, 2 rue ambroise pare, 75010 Paris, France
| | - Damien Logeart
- Department of Cardiology, UMR-S942, University of Paris, Lariboisiere Hospital, AP-HP, 2 rue ambroise pare, 75010 Paris, France
| |
Collapse
|
43
|
Nicol M, Baudet M, Cescau A, Harel S, Royer B, Sarda-Mantel L, Cohen-Solal A, Arnulf B, Logeart D. Prognostic Value of Iodine-123-Metaiodobenzylguanidine Scintigraphy in Light-Chain Amyloidosis. Circ Cardiovasc Imaging 2019; 12:e009465. [DOI: 10.1161/circimaging.119.009465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/16/2022]
Affiliation(s)
- Martin Nicol
- Assistance Publique Hopitaux de Paris, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France (M.N., A.C., M.B., A. C.-S., D.L
| | - Mathilde Baudet
- Assistance Publique Hopitaux de Paris, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France (M.N., A.C., M.B., A. C.-S., D.L
| | - Arthur Cescau
- Assistance Publique Hopitaux de Paris, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France (M.N., A.C., M.B., A. C.-S., D.L
| | | | | | - Laure Sarda-Mantel
- in Haematology Department, L.S.-M
- in Nuclear Medicine Department). Université de Paris, Paris, France (L.S.-M., A.C.-S., B.A., D.L.)
| | - Alain Cohen-Solal
- Assistance Publique Hopitaux de Paris, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France (M.N., A.C., M.B., A. C.-S., D.L
- in Nuclear Medicine Department). Université de Paris, Paris, France (L.S.-M., A.C.-S., B.A., D.L.)
- Inserm U942, Paris, France (A.C.-S., D.L.)
| | - Bertrand Arnulf
- in Cardiology Department, S.H., B.R., B.A
- in Nuclear Medicine Department). Université de Paris, Paris, France (L.S.-M., A.C.-S., B.A., D.L.)
| | - Damien Logeart
- Assistance Publique Hopitaux de Paris, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France (M.N., A.C., M.B., A. C.-S., D.L
- in Nuclear Medicine Department). Université de Paris, Paris, France (L.S.-M., A.C.-S., B.A., D.L.)
- Inserm U942, Paris, France (A.C.-S., D.L.)
| |
Collapse
|
44
|
Patin C, Vidal Trecan T, Dillinger JG, Paven E, Cohen Solal A, Logeart D, Riveline JP, Gautier JF, Henry P. P2489What are the main determinants of an increase in bnp level in asymptomatic diabetic patients without known cardiac disease? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Diabetes mellitus is associated with a high risk of heart failure. The predictors of futures heart failure events in diabetic patients are not clearly understood. BNP measurement can be used as a surrogate endpoint for the diagnosis of heart failure. We investigated the determinants of an increase in BNP level in a large cohort of asymptomatic diabetic patients without known cardiac disease
Methods
This prospective study included consecutive stable diabetic (type 1 or 2) patients coming for yearly check-up between March 2015 and July 2018 in the university center for the study of diabetes and its complications. Patients with an history of cardiac disease (coronary artery disease, atrial fibrillation, cardiomyopathy, previous heart failure ...) were excluded. All patients had a complete clinical exam, blood pressure measurement (3 consecutive times – mean of 2 lasts measurements), ECG, and blood sample including HbA1C, risk factors assessment, renal function (CKD-EPI) and BNP measurement. Data are presented as mean±SD or median - Spearman's rank and multivariate regression were used for analysis.
Results
3743 patients (mean age 57±14 y.o. – 57% male – 78% / 18% / 4% of type 2, type 1 or other type of diabetes respectively – Mean duration of diabetes 17 [1–63] y. – 44% treated with insulin) were studied. Mean±SD / median [min-max] BNP level was 25±39 / 12 [4–737] ng/L. BNP was <20 / 21–35 / 36–50 / 51–100 / 101–400 / >400 ng/L in 69 / 15 / 6 / 7 / 3 / 0.1% of the population respectively. The parameters most correlated with BNP level in type 1 and type 2 diabetes were age, duration of diabetes, renal function, HbA1C, and pulsed pressure. For multivariate analysis, renal function was removed of the model as it was highly correlated with age (r=−0.68). Multivariate analysis demonstrated that in type 1 diabetes, high BNP level was linked to age (p<0.001), pulsed pressure (p<0.001), duration of diabetes (p=0.003) and HbA1C (p=0.02). In type 2 diabetes, high BNP level was linked to age (p<0.0001), pulsed pressure (p<0.0001), duration of diabetes (p=0.005) but not HbA1C (p=0.09). Interestingly the type of treatment (mainly insulin treatment) was not independently related to an increase in BNP level.
Conclusion
Age, pulsed pressure and duration of diabetes are the main determinants of an increased level of BNP in asymptomatic diabetic patients without any history of cardiac disease. This result could help to select a population who could benefit to a more extensive follow up concerning heart failure.
Collapse
Affiliation(s)
- C Patin
- AP-HP - Hospital Lariboisiere, Paris, France
| | | | | | - E Paven
- AP-HP - Hospital Lariboisiere, Paris, France
| | | | - D Logeart
- AP-HP - Hospital Lariboisiere, Paris, France
| | | | - J F Gautier
- AP-HP - Hospital Lariboisiere, Paris, France
| | - P Henry
- AP-HP - Hospital Lariboisiere, Paris, France
| |
Collapse
|
45
|
Logeart D, Isnard R, Damy T, Salvat M, Eicher JC, Roubille F, Tribouilloy C, Bauer F, Picard F, Trochu JN, Roul G. P1658Pharmacological treatment of patients with HFrEF: is it really optimized in case of CRT and/or ICD implantation? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0416] [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
Cardiac resynchronization (CRT) as well as implantable cardiac defibrillator (ICD) in primary prevention should be considered in patients with heart failure and reduced ejection fraction (HFrEF) only when pharmacological treatment has been optimized.
Purpose
we sought to analyze pharmacological treatments according to the presence or not of CRT-P, CRT-D or ICD in real life HFrEF patients by using a multicenter survey.
Methods
the survey (NCT01956539) was carried out between 2015 and 2018 in 32 hospitals and included 2735 patients with HF who gave their consent during consultation or hospitalization. In this study, we analyzed only outpatients with chronic HFrEF treated for more than 6 months.
Results
among 1061 patients studied, 138 had CRT-P or CRT-D and 215 had ICD for primary prevention. The main clinical characteristics were: age 65±13 years, ischemic heart disease in, NYHA classes 1, 2, 3 and 4 in 15%, 52%, 23% and 10% cases respectively, systolic blood pressure 115mmHg [IQR 104–129], heart rate 70bpm [IQR 60–80], eGFR 64ml/min/1.73m2 [IQR 46–83]and LVEF was 30% [IQR 24–34]. The table shows the rate of use of evidence-based drugs and the dose for ACEi/ARB and betablockers, according to the presence of ICD or CRT.
HFrEF CRT-P or D ICD (primary prevention) n=1061 n=138 n=215 Loop diuretics 78.2% 79.7% 74.9% ACEi or ARB 65.2% 75.4% 67.3% Sacubitril/valsartan 5.9% 8.5% 9.5% Betablockers 72.3% 83.9% 76.8% Mineralocorticoid antagonists 45.7% 63.6% 60.2% ACEi/ARB mean % maxi dose 77 81 83 Beta-blockers mean % maxi dose 74 63 79
Conclusion
these results suggest that pharmacological treatment remains poorly optimized in a number of patients with HFrEF who received ICD or CRT
Collapse
Affiliation(s)
- D Logeart
- AP-HP - Hospital Lariboisiere, Department of cardiology, Paris, France
| | - R Isnard
- Hospital Pitie-Salpetriere, Paris, France
| | - T Damy
- University Hospital Henri Mondor, Creteil, France
| | - M Salvat
- University Hospital of Grenoble, Grenoble, France
| | - J C Eicher
- University Hospital Center, Dijon, France
| | - F Roubille
- University Hospital of Montpellier, Montpellier, France
| | | | - F Bauer
- University Hospital of Rouen, Rouen, France
| | - F Picard
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - J N Trochu
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - G Roul
- University Hospital of Strasbourg, Strasbourg, France
| |
Collapse
|
46
|
Nicol M, Cescau A, Baudet M, Harel S, Royer B, Sarda L, Cohen Solal A, Arnulf B, Logeart D. P2733Prognostic value of cardiac dysautonomia in AL amyloidosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1050] [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
Introduction
Cardiac involvement is the major prognostic factor in patients with light chain amyloidosis (AL). Cardiac dysautonomia can occur early in amyloidosis and can be assess by Iodine-123-metaiodobenzylguanidine (123I-MIBG) scintigraphy. Its prognostic value has been shown in TTR amyloidosis but is unknown in AL amyloidosis. We aimed to evaluate the prognosis impact of cardiac dysautonomia in patients with AL amyloidosis.
Methods
We carried out a prospective study in consecutive patients with biopsy-proven AL amyloidosis. All patients underwent clinical examination, EKG, echocardiography, cardiac MRI and biological tests. The 2012 Mayo clinic prognostic classification was calculated by using blood levels of NT-proBNP, cardiac T troponin and the differential of free light chains as recommended. The sympathetic cardiac innervation was assessed by using 123I-MIBGscintigraphy and measurement of the heart-to-mediastinum uptake ratio (late H/M) in the anterior view of the chest. A cardiac denervation was defined by late H/M <1.8 4h after injection of 3 MBq/kg of 123I-MIBG. The primary end-point was all-cause mortality during follow-up.
Results
Fifty consecutive patients with AL amyloidosis were included. The median age was 68 years old [58–73]. By using both echocardiography and MRI, cardiac involvement was diagnosed in 33 patients (66%) and thirteen of these patients were NYHA class III or IV. By using Mayo clinic classification, patients were I, II, III and IV classes in 9 (18%), 14 (28%), 16 (32%) and 11 (22%) cases respectively. According to echocardiographic data, the median wall thickness of left ventricle was 13 mm [12–15]. The late H/M was 1.51 [1.33–1.67]. Cardiac denervation was found in 44 patients (88%). The 6 patients (12%) with a normal late H/M had no cardiac amyloidosis involvement.
During a median follow-up of 24 months, 9 patients (18%) died. The area under the ROC curve of late H/M for predicting death was 0.74 (CI 95% 0.58–0.86). According to this curve, the best threshold was 1.44 and 7 of the 9 patients who died had late H/M ≤1.44. The figure shows the 2 year-survival according to late H/M. Late H/M ≤1.44 predicted all-cause death irrespective of the Mayo clinic classification: HR 8.0 (CI 95% 2.1–63) after adjustment on the Mayo clinic score (p=0.005). In addition, unplanned hospitalization for heart failure occurred in 8 patients with late H/M ≤1.44 versus 3 patients with late H/M >1.44 (p=0.03).
Survival according to late H/M
Conclusion
Late H/M ≤1.44 is predictive of adverse outcomes in patients with AL amyloidosis, independently of the Mayo Clinic prognostic classification.
Collapse
Affiliation(s)
- M Nicol
- Hospital Lariboisiere, Paris, France
| | - A Cescau
- Hospital Lariboisiere, Paris, France
| | - M Baudet
- Hospital Lariboisiere, Paris, France
| | - S Harel
- Hopital Saint-Louis, Paris, France
| | - B Royer
- Hopital Saint-Louis, Paris, France
| | - L Sarda
- Hospital Lariboisiere, Paris, France
| | | | - B Arnulf
- Hopital Saint-Louis, Paris, France
| | - D Logeart
- Hospital Lariboisiere, Paris, France
| |
Collapse
|
47
|
Vodovar N, Saadi M, Paven E, Sadoune M, Mercadier JJ, Launay JM, Logeart D. P5444Plasma Indoleamine 2,3-dioxygenase is highly predictive of cardiac remodeling after myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Acute myocardial infarction (MI) is associated with a strong inflammatory response resulting from the cardiac insult. On the other hand, such an inflammation may lead and/or worsen adverse left ventricular (LV) remodeling after MI. Among the markers of inflammation is Indoleamine 2,3-dioxygenase (IDO), which production is induced upon inflammation. IDO catalyzes the transformation of tryptophane into kynurenine.
Purpose
We tested plasma IDO activity as a predictor of LV remodeling post-MI.
Methods
The PREGICA cohort recruited prospectively patients who were admitted because of first acute myocardial infarction. Blood samples were collected on admission, at day 4 and at day 6. Echocardiography and cardiac MRI were obtained at day 4 and at 6 months. To be included, the number of akinetic LV wall segments had to be ≥3 on 17 at day 4. IDO activity was the ratio between kynurenine and tryptophane measured by high pressure liquid chromatography coupled with fluorimetric detection. Remodelers were identified as patients with a variation of end-diastolic left ventricular volume (EDLVV) between day 4 and 6 months post-MI >20%.
Results
Among the 292 patients studied (mean age 57y, mean necrosis size 26% on MRI), the median increase in EDLVV was 16.7% and 137 (47%) were classified as remodelers. On admission as well as at day 4, IDO activity was significantly higher in remodelers (8.2±4.2% vs 5.3±2.5% and 8.7±5.7% vs 5.6±4.4%, p<0.001) and remained higher at 6 months post-MI. IDO activity at day 4 was highly predictive of LV remodeling (Figure): AUC = 87% [95% CI 83–91%]; IDO threshold of 5.8% resulted in specificity = 81%, sensitivity = 89%, negative predictive value = 89%, positive predictive value = 80%. In contrast, blood levels of NTproBNP, ST2, Galectin 3 or CRP at day 4 were poorly predictive. In multivariate analysis including other predictive variables at day4 (primary angioplasty, EDLVV, LVEF, necrosis size), increase in IDO activity was significantly associated with LV remodeling (OR 1.21 [95% CI 1.11–1.33].
Conclusions
IDO activity appears as a promising biomarker for the prediction of LV remodeling after MI. Its specific role in postMI remodeling pathways requires further investigation.
Acknowledgement/Funding
PHRC national
Collapse
Affiliation(s)
| | - M Saadi
- AP-HP - Hospital Lariboisiere, Department of Cardiology, Paris, France
| | - E Paven
- AP-HP - Hospital Lariboisiere, Department of Cardiology, Paris, France
| | | | | | | | - D Logeart
- AP-HP - Hospital Lariboisiere, Department of Cardiology, Paris, France
| |
Collapse
|
48
|
Pezel T, Sideris G, Dillinger JG, Logeart D, Manzo-Silberman S, Cohen-Solal A, Beauvais F, Laissy JP, Henry P. 101Characterization of the calcium component of vulnerable coronary plaque in patients with NSTEMI: prospective comparison between coronary CT and optical coherence tomography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0029] [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
Acute Coronary Syndrome (ACS) remains a leading cause of mortality worldwide with a high risk of recurrence. Apart culprit plaques, the presence of vulnerable plaques could be associated with the occurrence of future cardiac events and need to adapt treatments. Several studies have demonstrated a role for Coronary Computed Tomographic Angiography (CCTA) to predict the vulnerability of the plaque but with limited analysis of its calcium component. Recent works suggest a role for calcification in this vulnerability.
To our knowledge, no studies have been performed to assess if the study of the calcium component of plaques with CCTA can help to predict vulnerability in non-ST elevation myocardial infarction (NSTEMI).
Purpose
To assess if the CCTA study of the calcium component of plaques can help to predict plaque vulnerability defined by intracoronary OCT analysis in patients with non-ST elevation myocardial infarction (NSTEMI).
Methods
Monocentric prospective study of consecutive patients referred for NSTEMI with elevated high-sensitivity cardiac troponin I level (hs-TnI>50 ng/ml) from January to October 2018. CCTA was systematically performed before coronary angiography to assess the presence of CAD. When CCTA demonstrated significant lesions, coronary angiography was performed within 24 hours associated with systematic OCT study of three coronary arteries. Apart culprit plaques, vulnerable plaques were defined in OCT by a fibrous screed thickness <65 microns. Calcified plaques were analysed with CT and then classified into 3 groups: vulnerable culprit plaque (VCP), vulnerable non-culprit plaque (VNCP) and stable plaque (SP).
Results
Of 1478 patients with chest pain, 257 (17%) had NSTEMI with high level of hs-TnI. From this 257 NSTEMI patients, 44 (17%) were without known CAD and among these, 33 (75%) had received coronary angiography with 29 (66% - mean age 59±13 years, 73% men) having coronary anatomy compatible with OCT assessment. A total of 123 calcified plaques were identified. Among them, OCT allowed to identify 77 (63%) SP and 47 calcified vulnerable plaques; 28 (23%) VNCP and 19 (15%) VCP. After CCTA analysis of the calcium component, predictive factors of plaque vulnerability were identified: longer calcification length (p<0.001), larger calcification volume (p<0.001), lower calcium mass (p=0.003), higher single plaque Agatston score (p<0.001), lower sphericity index (p=0.001), more spotty calcifications (p=0.001), as well as more intimal position in the wall (p<0.001). No significant differences were observed comparing VNCP and VCP (Figure).
OCT and “Virtual Histology” CT
Conclusion
CCTA study of the calcium component of plaque allows to identify predictors of plaque vulnerability defined by OCT in patients with NSTEMI.
Collapse
Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology and Radiology, Paris, France
| | - G Sideris
- Hospital Lariboisiere, Cardiology, Paris, France
| | | | - D Logeart
- Hospital Lariboisiere, Cardiology, Paris, France
| | | | | | - F Beauvais
- Hospital Lariboisiere, Cardiology, Paris, France
| | - J P Laissy
- Hospital Lariboisiere, Radiology, Paris, France
| | - P Henry
- Hospital Lariboisiere, Cardiology, Paris, France
| |
Collapse
|
49
|
Logeart D, Paven E, Damy T, Isnard R, Salvat M, Eicher JC, Roubille F, Tribouilloy C, Bauer F, Piccard F, Trochu JN. 132Imaging criteria for the diagnosis of heart failure with midrange and preserved LVEF in the real life. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0048] [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
According to last ESC guidelines, the diagnosis of heart failure with midrange and preserved left ventricular ejection fraction (HFmrEF-HF and HFpEF) requires at least one of the following imaging criteria: LV hypertrophy with LVMI >115g/m2 in men and 95g/m2 in women, left atria dilation with LAVI >34ml/m2, TDI e' wave average <9cm/s and E/e' average ≥13.
Purpose
We analyzed the prevalence of these imaging criteria in real life patients who are labeled HFmrEF or HFpEF by using a multicenter survey on HF.
Methods
Our survey (NCT01956539) was carried out in 32 hospitals between 2015 and 2018 and included 2735 HF patients who gave their consent during consultation or hospitalization. The diagnosis of HF was left to the discretion of investigators. Besides clinical and biological data, echocardiographic data (<1 month before or <3 months after inclusion) was collected in an electronic database. No echographic variable except the LVEF was mandatory to be included.
Results
Among the 523 and 765 HF patients who were labeled respectively as HFmrEF-HF and HFpEF, the 4 echographic variables required for the diagnosis of HFmrEF or HFpEF were obtained in 512 patients. The median age was 74y [IQR 62–82], HF was de novo in 28%, AF in 34%, median NTproBNP was 1563 pg/mL [IQR 500–4372]. At least one of the 4 diagnostic criteria was present in all patients but 2, and patients had 2, 3 or 4 criteria in 43%, 37% and 1% of cases. The table shows only little differences between HFmrEF and HFpEF or de novo HF regarding the rate of each diagnostic criteria. There was no difference regarding the date of inclusion, i.e. before or after the last ESC guidelines.
Table 1 All HF patients De novo HF HFpEF HFmrEF mrEF or pEF (n=143) (n=293) (n=219) LVMI >115g/m2 (men) or 95g/m2 (women) 69.6% 64.3% 68.6% 70.2% LAVI >34ml/m2 74.2% 73.3% 80.4% 68.9% e' average <9cm/s 64.1% 55.3% 55.9% 76.1% E/e' average ≥13 35.4% 38.6% 37.3% 32.8%
Conclusion
The diagnosis of HFpEF or mrEF may be difficult and requires comprehensive echocardiography including all diagnostic variables because each single diagnostic criteria are present in only 33 to 80% cases.
Collapse
Affiliation(s)
- D Logeart
- AP-HP - Hospital Lariboisiere, Department of cardiology, Paris, France
| | - E Paven
- AP-HP - Hospital Lariboisiere, Department of cardiology, Paris, France
| | - T Damy
- University Hospital Henri Mondor, Creteil, France
| | - R Isnard
- Hospital Pitie-Salpetriere, Paris, France
| | - M Salvat
- University Hospital of Grenoble, Grenoble, France
| | - J C Eicher
- University Hospital of Dijon, Dijon, France
| | - F Roubille
- University Hospital of Montpellier, Montpellier, France
| | | | - F Bauer
- University Hospital of Rouen, Rouen, France
| | - F Piccard
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - J N Trochu
- Research unit of l'Institut du thorax, Nantes, France
| |
Collapse
|
50
|
Vodovar N, Nougué H, Launay JM, Solal AC, Logeart D. Response to editorial expression of concern. Lancet Diabetes Endocrinol 2019; 7:510-511. [PMID: 31227249 DOI: 10.1016/s2213-8587(19)30199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Nicolas Vodovar
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S 942, Paris, France.
| | - Hélène Nougué
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S 942, Paris, France; Department of Anaesthesiology and Intensive Care, Lariboisière Hospital, Paris, France
| | - Jean-Marie Launay
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S 942, Paris, France; Centre for Biological Resources BB-0033-00064, Lariboisière Hospital, Paris, France
| | - Alain Cohen Solal
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S 942, Paris, France; Department of Cardiology, Lariboisière Hospital, Paris, France; Université Paris Diderot-Sorbonne Paris Cité, Paris, France
| | - Damien Logeart
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S 942, Paris, France; Department of Cardiology, Lariboisière Hospital, Paris, France; Université Paris Diderot-Sorbonne Paris Cité, Paris, France
| |
Collapse
|