1
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Fenioux C, Abbar B, Boussouar S, Bretagne M, Power JR, Moslehi JJ, Gougis P, Amelin D, Dechartres A, Lehmann LH, Courand PY, Cautela J, Alexandre J, Procureur A, Rozes A, Leonard-Louis S, Qin J, Cheynier R, Charmeteau-De Muylder B, Redheuil A, Tubach F, Cadranel J, Milon A, Ederhy S, Similowski T, Johnson DB, Pizzo I, Catalan T, Benveniste O, Hayek SS, Allenbach Y, Rosenzwajg M, Dolladille C, Salem JE. Publisher Correction: Thymus alterations and susceptibility to immune checkpoint inhibitor myocarditis. Nat Med 2024; 30:910. [PMID: 38172633 DOI: 10.1038/s41591-023-02771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Charlotte Fenioux
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Henri Mondor Hospital, Department of Oncology, Créteil, France
| | - Baptiste Abbar
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Oncology, Paris, France
| | - Samia Boussouar
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Marie Bretagne
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - John R Power
- Department of Medecine, University of California, San Diego, San Diego, CA, USA
| | - Javid J Moslehi
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Paul Gougis
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Damien Amelin
- Sorbonne Université, INSERM, Association Institut de Myologie, Center of Research in Myology, UMRS 974, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Lorenz H Lehmann
- Department of Cardiology, University Hospital Heidelberg; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pierre-Yves Courand
- Fédération de Cardiologie, IMMUCARE, Hôpital de La Croix-Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon; Université de Lyon, CREATIS UMR INSERM U1044, INSA, Lyon, France
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Center for Cardiovascular and Nutrition Research, INSERM 1263, INRAE 1260, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Paris, France
| | - Joachim Alexandre
- CHU de Caen Normandie, Department of Pharmacology, Pharmacoepidemiology Unit; Normandie Université, UNICAEN, INSERM U1086 ANTICIPE Centre François Baclesse, Caen, France
| | - Adrien Procureur
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Antoine Rozes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Sarah Leonard-Louis
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Laboratoire de Neuropathologie, Paris, France
| | - Juan Qin
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Rémi Cheynier
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | | | - Alban Redheuil
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Jacques Cadranel
- Hôpitaux de Paris, Tenon Hospital, Department of Pulmonology and Thoracic Oncology and GRC Theranoscan Sorbonne University, Paris, France
| | - Audrey Milon
- Hôpitaux de Paris, Tenon Hospital, Department of Radiology, Paris, France
| | - Stéphane Ederhy
- Hôpitaux de Paris, Saint-Antoine Hospital, Department of Cardiology, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique'; Assistance Publique -Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 'Département R3S', Paris, France
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian Pizzo
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Toniemarie Catalan
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Benveniste
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Yves Allenbach
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Michelle Rosenzwajg
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Immunology, Paris, France
| | - Charles Dolladille
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France.
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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2
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Fenioux C, Abbar B, Boussouar S, Bretagne M, Power JR, Moslehi JJ, Gougis P, Amelin D, Dechartres A, Lehmann LH, Courand PY, Cautela J, Alexandre J, Procureur A, Rozes A, Leonard-Louis S, Qin J, Cheynier R, Charmeteau-De Muylder B, Redheuil A, Tubach F, Cadranel J, Milon A, Ederhy S, Similowski T, Johnson DB, Pizzo I, Catalan T, Benveniste O, Hayek SS, Allenbach Y, Rosenzwajg M, Dolladille C, Salem JE. Thymus alterations and susceptibility to immune checkpoint inhibitor myocarditis. Nat Med 2023; 29:3100-3110. [PMID: 37884625 DOI: 10.1038/s41591-023-02591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
Immune checkpoint inhibitors (ICI) have transformed the therapeutic landscape in oncology. However, ICI can induce uncommon life-threatening autoimmune T-cell-mediated myotoxicities, including myocarditis and myositis. The thymus plays a critical role in T cell maturation. Here we demonstrate that thymic alterations are associated with increased incidence and severity of ICI myotoxicities. First, using the international pharmacovigilance database VigiBase, the Assistance Publique Hôpitaux de Paris-Sorbonne University data warehouse (Paris, France) and a meta-analysis of clinical trials, we show that ICI treatment of thymic epithelial tumors (TET, and particularly thymoma) was more frequently associated with ICI myotoxicities than other ICI-treated cancers. Second, in an international ICI myocarditis registry, we established that myocarditis occurred earlier after ICI initiation in patients with TET (including active or prior history of TET) compared to other cancers and was more severe in terms of life-threatening arrythmias and concurrent myositis, leading to respiratory muscle failure and death. Lastly, we show that presence of anti-acetylcholine-receptor antibodies (a biological proxy of thymic-associated autoimmunity) was more prevalent in patients with ICI myocarditis than in ICI-treated control patients. Altogether, our results highlight that thymic alterations are associated with incidence and seriousness of ICI myotoxicities. Clinico-radio-biological workup evaluating the thymus may help in predicting ICI myotoxicities.
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Affiliation(s)
- Charlotte Fenioux
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Henri Mondor Hospital, Department of Oncology, Créteil, France
| | - Baptiste Abbar
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Oncology, Paris, France
| | - Samia Boussouar
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Marie Bretagne
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - John R Power
- Department of Medecine, University of California, San Diego, San Diego, CA, USA
| | - Javid J Moslehi
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Paul Gougis
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Damien Amelin
- Sorbonne Université, INSERM, Association Institut de Myologie, Center of Research in Myology, UMRS 974, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Lorenz H Lehmann
- Department of Cardiology, University Hospital Heidelberg; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pierre-Yves Courand
- Fédération de Cardiologie, IMMUCARE, Hôpital de La Croix-Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon; Université de Lyon, CREATIS UMR INSERM U1044, INSA, Lyon, France
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Center for Cardiovascular and Nutrition Research, INSERM 1263, INRAE 1260, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Paris, France
| | - Joachim Alexandre
- CHU de Caen Normandie, Department of Pharmacology, Pharmacoepidemiology Unit; Normandie Université, UNICAEN, INSERM U1086 ANTICIPE Centre François Baclesse, Caen, France
| | - Adrien Procureur
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Antoine Rozes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Sarah Leonard-Louis
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Laboratoire de Neuropathologie, Paris, France
| | - Juan Qin
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Rémi Cheynier
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | | | - Alban Redheuil
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Jacques Cadranel
- Hôpitaux de Paris, Tenon Hospital, Department of Pulmonology and Thoracic Oncology and GRC Theranoscan Sorbonne University, Paris, France
| | - Audrey Milon
- Hôpitaux de Paris, Tenon Hospital, Department of Radiology, Paris, France
| | - Stéphane Ederhy
- Hôpitaux de Paris, Saint-Antoine Hospital, Department of Cardiology, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique'; Assistance Publique -Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 'Département R3S', Paris, France
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian Pizzo
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Toniemarie Catalan
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Benveniste
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Yves Allenbach
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Michelle Rosenzwajg
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Immunology, Paris, France
| | - Charles Dolladille
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France.
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Fenioux C, Abbar B, Boussouar S, Bretagne M, Power JR, Moslehi JJ, Gougis P, Amelin D, Dechartres A, Lehmann LH, Courand PY, Cautela J, Alexandre J, Procureur A, Rozes A, Leonard-Louis S, Qin J, Cheynier R, Charmeteau-De Muylder B, Redheuil A, Tubach F, Cadranel J, Milon A, Ederhy S, Similowski T, Johnson DB, Pizzo I, Catalan T, Benveniste O, Hayek SS, Allenbach Y, Rosenzwajg M, Dolladille C, Salem JE. Author Correction: Thymus alterations and susceptibility to immune checkpoint inhibitor myocarditis. Nat Med 2023:10.1038/s41591-023-02690-0. [PMID: 38012317 DOI: 10.1038/s41591-023-02690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Charlotte Fenioux
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Henri Mondor Hospital, Department of Oncology, Créteil, France
| | - Baptiste Abbar
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Oncology, Paris, France
| | - Samia Boussouar
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Marie Bretagne
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - John R Power
- Department of Medecine, University of California, San Diego, San Diego, CA, USA
| | - Javid J Moslehi
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Paul Gougis
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Damien Amelin
- Sorbonne Université, INSERM, Association Institut de Myologie, Center of Research in Myology, UMRS 974, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Lorenz H Lehmann
- Department of Cardiology, University Hospital Heidelberg; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pierre-Yves Courand
- Fédération de Cardiologie, IMMUCARE, Hôpital de La Croix-Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon; Université de Lyon, CREATIS UMR INSERM U1044, INSA, Lyon, France
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Center for Cardiovascular and Nutrition Research, INSERM 1263, INRAE 1260, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Paris, France
| | - Joachim Alexandre
- CHU de Caen Normandie, Department of Pharmacology, Pharmacoepidemiology Unit; Normandie Université, UNICAEN, INSERM U1086 ANTICIPE Centre François Baclesse, Caen, France
| | - Adrien Procureur
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Antoine Rozes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Sarah Leonard-Louis
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Laboratoire de Neuropathologie, Paris, France
| | - Juan Qin
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Rémi Cheynier
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | | | - Alban Redheuil
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Jacques Cadranel
- Hôpitaux de Paris, Tenon Hospital, Department of Pulmonology and Thoracic Oncology and GRC Theranoscan Sorbonne University, Paris, France
| | - Audrey Milon
- Hôpitaux de Paris, Tenon Hospital, Department of Radiology, Paris, France
| | - Stéphane Ederhy
- Hôpitaux de Paris, Saint-Antoine Hospital, Department of Cardiology, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique'; Assistance Publique -Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 'Département R3S', Paris, France
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian Pizzo
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Toniemarie Catalan
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Benveniste
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Yves Allenbach
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Michelle Rosenzwajg
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Immunology, Paris, France
| | - Charles Dolladille
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France.
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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4
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Cautela J, Deharo F, Thuny F. Overcoming challenges of immune checkpoint inhibitor-induced myocarditis diagnosis. Arch Cardiovasc Dis 2023; 116:429-432. [PMID: 37596110 DOI: 10.1016/j.acvd.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Jennifer Cautela
- Department of Cardiology, North Hospital, Assistance publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Unit of Heart Failure and Valvular Heart Diseases, Aix-Marseille University, University Mediterranean Center of Cardio-Oncology,, Inserm 1263, Inrae 1260, Marseille, France.
| | - Francois Deharo
- Department of Cardiology, North Hospital, Assistance publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Unit of Heart Failure and Valvular Heart Diseases, Aix-Marseille University, University Mediterranean Center of Cardio-Oncology,, Inserm 1263, Inrae 1260, Marseille, France
| | - Franck Thuny
- Department of Cardiology, North Hospital, Assistance publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Unit of Heart Failure and Valvular Heart Diseases, Aix-Marseille University, University Mediterranean Center of Cardio-Oncology,, Inserm 1263, Inrae 1260, Marseille, France
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5
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Deharo F, Thuny F, Cadour F, Resseguier N, Meilhac A, Gaubert M, Dolladille C, Paganelli F, Alexandre J, Cautela J. Diagnostic Value of the International Society of Cardio-Oncology Definition for Suspected Immune Checkpoint Inhibitor-Associated Myocarditis. J Am Heart Assoc 2023; 12:e029211. [PMID: 37042287 PMCID: PMC10227269 DOI: 10.1161/jaha.122.029211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/16/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Francois Deharo
- Unit of Heart Failure and Valvular Heart Diseases, North Hospital, Assistance Publique–Hôpitaux de Marseille, Center for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260Department of Cardiology, Aix‐Marseille University, University Mediterranean Center of Cardio‐OncologyMarseilleFrance
| | - Franck Thuny
- La Timone Hospital, Assistance Publique–Hôpitaux de MarseilleRadiology Department, Aix‐Marseille UniversityMarseilleFrance
| | - Farah Cadour
- La Timone Hospital, Assistance Publique–Hôpitaux de MarseilleRadiology Department, Aix‐Marseille UniversityMarseilleFrance
| | - Noemie Resseguier
- CEReSS‐Health Service Research and Quality of Life Center, School of MedicineAix‐Marseille UniversityMarseilleFrance
| | - Alexandra Meilhac
- Unit of Heart Failure and Valvular Heart Diseases, North Hospital, Assistance Publique–Hôpitaux de Marseille, Center for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260Department of Cardiology, Aix‐Marseille University, University Mediterranean Center of Cardio‐OncologyMarseilleFrance
| | - Melanie Gaubert
- Unit of Heart Failure and Valvular Heart Diseases, North Hospital, Assistance Publique–Hôpitaux de Marseille, Center for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260Department of Cardiology, Aix‐Marseille University, University Mediterranean Center of Cardio‐OncologyMarseilleFrance
| | - Charles Dolladille
- Normandie University, UniCaen, Inserm 1086 ANTICIPECaenFrance
- Department of Pharmacology, CHU de Caen‐NormandiePICARO Cardio‐Oncology ProgramCaenFrance
| | - Franck Paganelli
- Unit of Heart Failure and Valvular Heart Diseases, North Hospital, Assistance Publique–Hôpitaux de Marseille, Center for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260Department of Cardiology, Aix‐Marseille University, University Mediterranean Center of Cardio‐OncologyMarseilleFrance
| | - Joachim Alexandre
- Normandie University, UniCaen, Inserm 1086 ANTICIPECaenFrance
- Department of Pharmacology, CHU de Caen‐NormandiePICARO Cardio‐Oncology ProgramCaenFrance
| | - Jennifer Cautela
- Unit of Heart Failure and Valvular Heart Diseases, North Hospital, Assistance Publique–Hôpitaux de Marseille, Center for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260Department of Cardiology, Aix‐Marseille University, University Mediterranean Center of Cardio‐OncologyMarseilleFrance
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6
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Boyer J, Deharo P, Angoulvant D, Ivanes F, Ferrara J, Vaillier A, Cautela J, Herbert J, Saint Etienne C, Cuisset T, Thuny F, Fauchier L. Cardiovascular outcomes in patients with cancer during a 5-year follow-up: Results from a French administrative database. Arch Cardiovasc Dis 2023; 116:88-97. [PMID: 36641244 DOI: 10.1016/j.acvd.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Limited data are available regarding the optimal management and prognosis of patients with cancer who develop an acute myocardial infarction. AIM The objective of this study was to analyse the characteristics and outcomes of patients according to cancer and myocardial infarction occurrence. METHODS Based on the French administrative hospital discharge database, the study collected information for all consecutive patients seen in French hospitals in 2013, excluding those with a history of myocardial infarction. The population was divided into two groups according to their history of cancer. We studied the following outcomes: all-cause and cardiovascular mortality; acute myocardial infarction; and ischaemic stroke. Data were collected after a 5-year follow-up. RESULTS Between 2013 and 2019, 3,381,472 patients were seen in French hospitals; among them, 3,323,757 had no history of myocardial infarction. Patients with a history of cancer (n=497,593) had higher incidences of all-cause mortality (17.82%/year vs 3.79%/year), cardiovascular mortality (1.61%/year vs 1.17%/year), myocardial infarction (0.82%/year vs 0.61%/year) and ischaemic stroke (0.91%/year vs 0.62%/year) compared with patients without cancer (n=2,826,164). After performing an adjusted competing-risk analysis, the cumulative incidence of acute myocardial infarction, cardiovascular death and ischaemic stroke incidence was found to be lower in patients with a history of cancer, whereas death of non-cardiac origin was more prevalent in patients with a history of cancer. CONCLUSIONS In this observational study, we have shown that patients with cancer have a higher incidence of all-cause mortality, cardiovascular mortality and myocardial infarction. However, multivariable analysis showed a lower cumulative incidence of these events.
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Affiliation(s)
- Jérémy Boyer
- Département de cardiologie, CHU Timone, 13005 Marseille, France
| | - Pierre Deharo
- Département de cardiologie, CHU Timone, 13005 Marseille, France; C2VN, Aix-Marseille université, Inserm, INRA, 13005 Marseille, France; Faculté de médecine, Aix-Marseille université, 13385 Marseille, France.
| | - Denis Angoulvant
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France; EA4245 Transplantation immunité inflammation, université de Tours, 37032 Tours, France
| | - Fabrice Ivanes
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France; EA4245 Transplantation immunité inflammation, université de Tours, 37032 Tours, France
| | - Jerome Ferrara
- Département de cardiologie, CHU Timone, 13005 Marseille, France
| | | | - Jennifer Cautela
- Faculté de médecine, Aix-Marseille université, 13385 Marseille, France; Département de cardiologie, CHU Nord, 13015 Marseille, France
| | - Julien Herbert
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, centre hospitalier universitaire et Faculté de médecine, EA7505, université de Tours, 37044 Tours, France
| | - Christophe Saint Etienne
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France
| | - Thomas Cuisset
- Département de cardiologie, CHU Timone, 13005 Marseille, France; C2VN, Aix-Marseille université, Inserm, INRA, 13005 Marseille, France; Faculté de médecine, Aix-Marseille université, 13385 Marseille, France
| | - Franck Thuny
- Faculté de médecine, Aix-Marseille université, 13385 Marseille, France; Département de cardiologie, CHU Nord, 13015 Marseille, France
| | - Laurent Fauchier
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France
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Pezel T, Dreyfus J, Mouhat B, Thébaut C, Audureau E, Bernard A, Badie YL, Bohbot Y, Fard D, Nguyen LS, Monteil C, Bière L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Bazire B, Fauvel C, Cautela J, Cambet T, Le Tourneau T, Donal E, Lafitte S, Magne J, Mansencal N, Coisne A, Aghezzaf S, Blanchard V, Meilhac A. Effectiveness of Simulation-Based Training on Transesophageal Echocardiography Learning. JAMA Cardiol 2023; 8:248-256. [PMID: 37070491 DOI: 10.1001/jamacardio.2022.5016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Trial RegistrationClinicalTrials.gov Identifier: NCT05564507
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Affiliation(s)
- Théo Pezel
- Université de Paris, Service de Cardiologie, Hôpital universitaire Lariboisière – APHP, Paris, France
- Centre de simulation de l’Université de Paris, Centre Ilumens, Université de Paris, Paris, France
- INSERM UMRS 942, Paris, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital, Besançon, France
| | - Clémence Thébaut
- Université de Limoges, Inserm U1094 IRD U270 EpiMaCT, chercheur en économie de la santé associé LEDA-Legos PSL Paris-Dauphine, Limoges, France
| | - Etienne Audureau
- Clinical Epidemiology and Ageing (CEPIA), IMRB U955, UPEC, CHU Henri Mondor, AP-HP, Creteil, France
| | - Anne Bernard
- Service de Cardiologie, CHRU de Tours, Tours, France
- EA4245, Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France
- Centre Régional d’Enseignement par la Simulation en Santé MEDISIM, Université de Tours, Tours, France
| | - Yoan Lavie Badie
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Health Simulation Center SimUSanté, Amiens University Hospital, Amiens, France
| | - Damien Fard
- Department of Cardiology, Cardiology Intensive Care Unit, Henri-Mondor University Hospital, AP-HP, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Lee S. Nguyen
- Research and Innovation, RICAP, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Cécile Monteil
- Centre de simulation de l’Université de Paris, Centre Ilumens, Université de Paris, Paris, France
| | - Loïc Bière
- All’Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, Angers, France
| | - Florent Le Ven
- Department of Cardiology, Brest University Hospital, CHRU de la Cavale Blanche, Brest, France
- Centre de simulation en santé-CESIM Brest, Brest, France
| | - Marjorie Canu
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | | | - Baptiste Mion
- Université de Paris, Service de Cardiologie, Hôpital universitaire Hôtel Dieu – APHP, Paris, France
| | - Baptiste Bazire
- Université de Paris, Service de Cardiologie, Hôpital universitaire Bichat – APHP, Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU CARNAVAL, Rouen, France
- Department of Cardiovascular medicine, Wexner Medical Center, The Ohio State University, Columbus
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Marseille, France
| | - Théo Cambet
- Explorations fonctionnelles cardiovasculaires, Louis Pradel Hospital, Hospices Civils de Lyon, BRON Cedex, France
| | - Thierry Le Tourneau
- L’institut du thorax, INSERM, CNRS, Simu de Nantes, Univ Nantes, CHU Nantes, Nantes, France
| | - Erwan Donal
- Cardiologie, CHU de Rennes, LTSI, Inserm 1099, Rennes, France
| | - Stéphane Lafitte
- UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Julien Magne
- Center of Epidemiology, biostatistics and methodology of research, Limoges, CHU Limoges, Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - OmegaHealth, Limoges, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Augustin Coisne
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France
- Centre de simulation en santé PRESAGE, Faculté de médecine, Université de Lille, Lille, France
- Cardiovascular Research Foundation, New York, New York
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8
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Thuny F, Bonaca MP, Cautela J. What Is the Evidence of the Diagnostic Criteria and Screening of Immune Checkpoint Inhibitor-Induced Myocarditis? JACC CardioOncol 2022; 4:624-628. [PMID: 36636431 PMCID: PMC9830188 DOI: 10.1016/j.jaccao.2022.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022] Open
Abstract
Myocarditis is a rare, but serious, complication of immune checkpoint inhibitor therapy. The diagnosis of immune checkpoint inhibitor–induced myocarditis is sometimes challenging because of clinical, biological, and imaging features. Diagnostic criteria have been proposed to help clinicians, but have never been validated to date. Some guidelines now recommend early detection by repeated troponin and ECG testing, but its role has not yet been clearly demonstrated.
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Key Words
- 2018-LL, 2018-Lake Louise
- ACS, acute coronary syndrome
- CMR, cardiac magnetic resonance
- ECG, electrocardiogram
- EMB, endomyocardial biopsy
- IC-OS, International Cardio-Oncology Society
- ICI, immune checkpoint inhibitor
- ICI-M, immune checkpoint inhibitor–induced myocarditis
- LGE, late gadolinium enhancement
- MACE, major cardiovascular events
- cTn, cardiac troponin
- diagnosis
- immunotherapy
- irAE, immune-related adverse event
- myocarditis
- screening
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Affiliation(s)
- Franck Thuny
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Department of Cardiology, Assistance Publique–Hôpitaux de Marseille, North Hospital, Marseille, France,Center for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Marseille, France,French Working Group of Cardio-Oncology, France,Address for correspondence: Prof Franck Thuny, University Mediterranean Center of Cardio-Oncology, North Hospital, Aix-Marseille University, Chemin des Bourrely, 13015 Marseille, France. @franckthuny@CautelaJennifer@MarcBonaca
| | - Marc P. Bonaca
- Colorado Prevention Centre, Clinical Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Department of Cardiology, Assistance Publique–Hôpitaux de Marseille, North Hospital, Marseille, France,Center for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Marseille, France,French Working Group of Cardio-Oncology, France
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9
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Nowatzke J, Guedeney P, Palaskas N, Lehmann L, Ederhy S, Zhu H, Cautela J, Francis S, Courand PY, Deswal A, Ewer SM, Aras M, Arangalage D, Ghafourian K, Fenioux C, Finke D, Peretto G, Zaha V, Itzhaki Ben Zadok O, Tajiri K, Akhter N, Levenson J, Baldassarre L, Power J, Huang S, Collet JP, Moslehi J, Salem JE. Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry. Eur J Cancer 2022; 177:197-205. [PMID: 36030143 PMCID: PMC10165738 DOI: 10.1016/j.ejca.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/04/2022] [Accepted: 07/15/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Immune checkpoint blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis. METHODS An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence of coronary artery disease (CAD) was defined as coronary artery stenosis >70% in patients undergoing coronary angiogram. RESULTS Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary angiography, CAD was present in 59/261 patients (22.6%). Coronary revascularization was performed during the index hospitalisation in 19/59 (32.2%) patients. Patients undergoing coronary revascularization less frequently received steroids administration within 24 h of admission compared to the other groups (p = 0.029). Myocarditis-related 90-day mortality was 9/17 (52.7%) in the revascularised cohort, compared to 5/31 (16.1%) in those not revascularized and 25/156 (16.0%) in those without CAD (p = 0.001). Immune-related adverse event-related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 6/31 (19.4%) in those not revascularized and 31/156 (19.9%) in no CAD groups (p = 0.007). All-cause 90-day mortality was 11/17 (64.7%) in the revascularized cohort, compared to 13/31 (41.9%) in no revascularization and 60/158 (38.0%) in no CAD groups (p = 0.10). After adjustment of age and sex, coronary revascularization remained associated with ICB-myocarditis-related death at 90 days (hazard ratio [HR] = 4.03, 95% confidence interval [CI] 1.84-8.84, p < 0.001) and was marginally associated with all-cause death (HR = 1.88, 95% CI, 0.98-3.61, p = 0.057). CONCLUSION CAD may exist concomitantly with ICB-myocarditis and may portend a poorer outcome when revascularization is performed. This is potentially mediated through delayed diagnosis and treatment or more severe presentation of ICB-myocarditis.
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Affiliation(s)
- Joseph Nowatzke
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul Guedeney
- Sorbonne Université, Department of Cardiology, INSERM UMRS_1166, Pitié Salpêtrière (AP-HP), Paris, France
| | - Nicholas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Lorenz Lehmann
- Department of Cardiology, University Hospital of Heidelberg, 69120, Heidelberg, Germany; Institute of Experimental Cardiology, University Hospital of Heidelberg, 69120, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Stephane Ederhy
- Department of Cardiology, UNICO Cardio-Oncology Program, INSERM U 856, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Han Zhu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer Cautela
- French Institute of Health and Medical Research 1263, National Institute of Agricultural Research, Centre for CardioVascular and Nutrition Research, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, University Mediterranean Centre of Cardio-Oncology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Sanjeev Francis
- Cardiovascular Disease Service Line, Maine Medical Center, Portland, ME, USA
| | - Pierre-Yves Courand
- Fédération de Cardiologie, Hôpital de La Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, France
| | - Anita Deswal
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Steven M Ewer
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Mandar Aras
- Division of Cardiology, University of California-San Francisco, San Francisco, CA, USA
| | - Dimitri Arangalage
- Department of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UMRS1148, INSERM, Paris, France; Université de Paris, Paris, France
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charlotte Fenioux
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, INSERM, 75013, Paris, France
| | - Daniel Finke
- Department of Cardiology, University Hospital of Heidelberg, 69120, Heidelberg, Germany; Institute of Experimental Cardiology, University Hospital of Heidelberg, 69120, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Vita-Salute University and San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Vlad Zaha
- Division of Cardiology, Department of Internal Medicine, Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Osnat Itzhaki Ben Zadok
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kazuko Tajiri
- Department of Cardiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Nausheen Akhter
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua Levenson
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - John Power
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, CA, USA
| | - Shi Huang
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Philippe Collet
- Sorbonne Université, Department of Cardiology, INSERM UMRS_1166, Pitié Salpêtrière (AP-HP), Paris, France
| | - Javid Moslehi
- Division of Cardiology, University of California-San Francisco, San Francisco, CA, USA.
| | - Joe-Elie Salem
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, INSERM, 75013, Paris, France.
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10
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Nowatzke J, Guedeney P, Palaskas N, Lehmann L, Ederhy S, Cautela J, Francis S, Courand PY, Aras M, Arangalage D, Fenioux C, Finke D, Huang S, Moslehi J, Salem JE. Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis – report from an international registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2562] [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
Purpose
Immune-checkpoint-blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis.
Methods
An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence of coronary artery disease (CAD) was defined as coronary artery stenosis >70% in patients undergoing coronary angiogram.
Results
Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary angiography, CAD was present in 59/261 (22.6%) (Table 1). Coronary revascularization was performed during the index hospitalization in 19/59 (32.2%) patients. Patients undergoing coronary revascularization less frequently received steroids administration within 24h of admission compared to the other groups (p=0.029). Myocarditis related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 5/31 (16.1%) in those not revascularized and 25/156 (16.0%) in those without CAD (p=0.001). irAE-related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 6/31 (19.4%) in those not revascularized and 31/156 (19.9%) in no CAD groups (p=0.007) (Figure 1). All-cause 90-day mortality was 11/17 (64.7%) in the revascularized cohort, compared to 13/31 (41.9%) in no revascularization and 60/158 (38.0%) in no CAD groups (p=0.10). After adjustment on age and sex, coronary revascularization remained associated with ICB-myocarditis-related death at 90 days (Hazard ratio [HR]=4.03, 95%confidence interval [CI] 1.84–8.84, p<0.001) and was marginally associated with all-cause death (HR=1.88, 95% CI 0.98–3.61, p=0.057).
Conclusion
CAD may exist concomitantly with ICB-myocarditis and portend a poorer outcome when revascularization is performed. This is potentially mediated thru delayed diagnosis and treatment or more severe presentation of ICB-myocarditis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Nowatzke
- Vanderbilt University Medical Center, Department of internal medicine , Nashville , United States of America
| | - P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - N Palaskas
- The University of Texas Medical School, Department of cardiology , Houston , United States of America
| | - L Lehmann
- University Hospital of Heidelberg, Department of cardiology , Heidelberg , Germany
| | - S Ederhy
- Hospital Saint-Antoine, Department of cardiology , Paris , France
| | - J Cautela
- Hospital Nord of Marseille, Department of cardiology , Marseille , France
| | - S Francis
- Maine Medical Center, Cardiovascular disease service line , Portland , United States of America
| | - P Y Courand
- Croix-Rousse Hospital - HCL, Fédération de cardiologie , Lyon , France
| | - M Aras
- University of California San Francisco, Division of cardiology , San Francisco , United States of America
| | - D Arangalage
- Bichat APHP Site of Paris Nord University Hospital, Department of cardiology , Paris , France
| | - C Fenioux
- Hospital Pitie-Salpetriere, Department of Pharmacology and Clinical Investigation Centre , Paris , France
| | - D Finke
- University Hospital of Heidelberg, Department of cardiology , Heidelberg , Germany
| | - S Huang
- Vanderbilt University Medical Center, Department of internal medicine , Nashville , United States of America
| | - J Moslehi
- University of California San Francisco, Division of cardiology , San Francisco , United States of America
| | - J E Salem
- Hospital Pitie-Salpetriere, Department of Pharmacology and Clinical Investigation Centre , Paris , France
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11
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Deharo F, Carvelli J, Cautela J, Garcia M, Sarles C, Maues de Paula A, Bourenne J, Gainnier M, Bichon A. Immune Checkpoint Inhibitor-Induced Myositis/Myocarditis with Myasthenia Gravis-like Misleading Presentation: A Case Series in Intensive Care Unit. J Clin Med 2022; 11:jcm11195611. [PMID: 36233479 PMCID: PMC9573481 DOI: 10.3390/jcm11195611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Immune checkpoint inhibitors (ICIs) are a major breakthrough in cancer treatment. Their increasingly frequent use leads to an uprising incidence of immune-related adverse events (irAEs). Among those, myocarditis is the most reported fatal cardiovascular irAE, frequently associated with ICI-related myositis. Case series: Here, we report three cases of ICI-induced myocarditis/myositis with an extremely severe myasthenia gravis-like (MG-like) presentation, highlighting the main challenges in irAEs management. These patients were over 60 years old and presented an ongoing melanoma, either locally advanced or metastatic, treated with ICI combinations. Shortly after the first or second ICI infusion, they were admitted in an intensive care unit (ICU) for grade 3 ICI-induced MG-like symptoms leading to acute respiratory failure (ARF) requiring invasive mechanical ventilation (IMV). The initial misdiagnosis was later corrected to severe ICI-induced seronegative myocarditis/myositis upon biological results and histopathology from muscular/endomyocardial biopsies. All of them received urgent high-dose corticosteroids pulses. The oldest patient died prematurely, but the two others received targeted therapies leading to complete recovery for one of them. Discussion: These cases highlight the four main challenges of irAEs, encompassing the lack of knowledge among physicians, the risk of misdiagnosis due to numerous and non-specific symptoms, the frequent overlapping forms of irAEs, and the extremely rare MG-like misleading presentation of myocarditis/myositis. The exact pathophysiology of irAEs remains unclear, although a major involvement of the lymphoid compartment (specifically T lymphocytes) was evidenced. Therapeutic management is based on urgent high-dose corticosteroids. For the severest forms of irAEs, case-by-case targeted immunosuppressive therapies should be urgently administered upon multidisciplinary meetings. Conclusion: These cases highlight the lack of knowledge of irAEs among physicians, aggravated by misleading overlapping forms, requiring specific management in trained units and multidisciplinary care. Severe MG-like presentation of irAEs constitutes an absolute therapeutic emergency with high-dose corticosteroids and targeted immunosuppressive therapy.
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12
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Bruzzese L, Cautela J, Rebaoui Z, Tran TT, Joseph C, Thuny F, Lalevée N. Immunotherapy-related cardiovascular toxicity: Development of a preclinical murine model of acute myocarditis. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2022.04.074] [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: 10/17/2022]
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13
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Abstract
OPINION STATEMENT Vascular events have become an important issue in the overall management of cancer patients. They usually result from a combination of (i) direct or indirect toxicity of anticancer treatments, (ii) a higher prevalence of cardiovascular risk factors in cancer patients, and (iii) prolonged exposure to treatments due to an increasing patient survival rate. In addition to conventional chemotherapies and radiotherapy, targeted therapies and immunotherapies have been developed which improve the prognosis of cancer patients but sometimes at the cost of vascular toxicity, which can lead to systemic or pulmonary hypertension and arterial/venous thromboembolic events. Endothelial dysfunction, a procoagulant state and metabolic disorders are the three main pathophysiological patterns leading to cancer treatment-related vascular toxicity. This issue is challenging because serious vascular adverse events can necessitate cancer treatment being put on hold or stopped, which could compromise patient survival. In addition to increasing the risk of thrombotic adverse events, cancer therapies may lead to an increased risk of bleeding, especially in treatments with vascular endothelial growth factor inhibitors. Therefore, we can define vasculo-oncology as a part of the cardio-oncology specialty; its aims are to predict, prevent, screen, and treat vascular toxicity related to cancer treatments. While the level of evidence is low regarding the management of vascular toxicity during cancer therapy, cardiologists and specialists in vascular diseases should closely collaborate with oncologists and hematologists to determine the optimal strategy for each patient.
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Affiliation(s)
- Alexandra Meilhac
- Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Inserm 1263, Inrae 1260, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Jennifer Cautela
- Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Inserm 1263, Inrae 1260, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Franck Thuny
- Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Inserm 1263, Inrae 1260, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France.
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14
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Cadour F, Cautela J, Rapacchi S, Varoquaux A, Habert P, Arnaud F, Jacquier A, Meilhac A, Paganelli F, Lalevée N, Scemama U, Thuny F. Cardiac MRI Features and Prognostic Value in Immune Checkpoint Inhibitor-induced Myocarditis. Radiology 2022; 303:512-521. [PMID: 35230185 DOI: 10.1148/radiol.211765] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Cardiac MRI features are not well-defined in immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M), a severe complication of ICI therapy in patients with cancer. Purpose To analyze the cardiac MRI features of ICI-M and to explore their prognostic value in major adverse cardiovascular events (MACE). Materials and Methods In this retrospective study from May 2017 to January 2020, cardiac MRI findings (including late gadolinium enhancement [LGE], T1 and T2 mapping, and extracellular volume fraction [ECV] z scores) of patients with ICI-M were compared with those of patients with cancer scheduled to receive ICI therapy (pre-ICI group) and patients with viral myocarditis. As a secondary objective, the potential value of cardiac MRI for predicting MACE in patients with ICI-M by using Cox proportional hazards models was explored. Results Thirty-three patients with ICI-M (mean age ± standard deviation, 68 years ± 14; 23 men) were compared with 21 patients scheduled to receive to ICI therapy (mean age, 65 years ± 14; 14 men) and 85 patients with viral myocarditis (mean age, 32 years ± 13; 67 men). Compared with the pre-ICI group, patients with ICI-M showed higher global native T1, ECV, and T2 z scores (0.03 ± 0.85 vs 1.79 ± 1.93 [P < .001]; 1.34 ± 0.57 vs 2.59 ± 1.97 [P = .03]; and -0.76 ± 1.41 vs 0.88 ± 1.96 [P = .002], respectively), and LGE was more frequently observed (27 of 33 patients [82%] vs two of 21 [10%]; P < .001). LGE was less frequent in patients with ICI-M than those with viral myocarditis (27 of 33 patients [82%] vs 85 of 85 [100%]; P < .001) but was more likely to involve the septal segments (16 of 33 patients [48%] vs 25 of 85 [29%]; P < .001) and midwall layer (11 of 33 patients [33%] vs two of 85 [2%]; P < .001). Septal LGE was the only cardiac MRI predictor of MACE at 1 year even after adjustment for peak troponin (adjusted hazard ratio, 2.7 [95% CI: 1.1, 6.7]; P = .03). Conclusion Cardiac MRI features of immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) seem to differ from those in patients scheduled to receive ICIs and patients with viral myocarditis. Septal late gadolinium enhancement might be a predictor of major cardiovascular events in patients with ICI-M. Clinical trial registration no. NCT03313544 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Edelman and Pursnani in this issue.
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Affiliation(s)
- Farah Cadour
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Jennifer Cautela
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Stanislas Rapacchi
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Arthur Varoquaux
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Paul Habert
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - François Arnaud
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Alexis Jacquier
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Alexandra Meilhac
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Franck Paganelli
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Nathalie Lalevée
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Ugo Scemama
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
| | - Franck Thuny
- From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.)
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15
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Pezel T, Bernard A, Lavie-Badie Y, Dreyfus J, Bohbot Y, Fard D, Nguyen L, Biere L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Fauvel C, Ternacle J, Cautela J, Le Tourneau T, Donal E, Lafitte S, Mansencal N, Coisne A. SIMULATOR study: Multicentre randomized study to assess the impact of SIMULation-bAsed Training on transoesophageal echocardiOgraphy leaRning for cardiology residents. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Power JR, Alexandre J, Choudhary A, Ozbay B, Hayek S, Asnani A, Tamura Y, Aras M, Cautela J, Thuny F, Gilstrap L, Arangalage D, Ewer S, Huang S, Deswal A, Palaskas NL, Finke D, Lehman L, Ederhy S, Moslehi J, Salem JE. Electrocardiographic Manifestations of Immune Checkpoint Inhibitor Myocarditis. Circulation 2021; 144:1521-1523. [PMID: 34723640 DOI: 10.1161/circulationaha.121.055816] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John R Power
- University of California San Diego Health (J.R.P.)
| | | | | | - Benay Ozbay
- Basaksehir Cam and Sakura State Hospital, Istanbul, Turkey (B.O.)
| | - Salim Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (S. Hayek)
| | - Aarti Asnani
- Beth Israel Deaconess Medical Center, Boston, MA (A.C., A.A.)
| | - Yuichi Tamura
- International University of Health and Welfare Mita Hospital, Tokyo, Japan (Y.T.)
| | - Mandar Aras
- University of California, San Francisco (M.A.)
| | - Jennifer Cautela
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France (J.C., F.T.)
| | - Franck Thuny
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France (J.C., F.T.)
| | | | | | - Steven Ewer
- University of Wisconsin Hospital, Madison (S. Ewer)
| | - Shi Huang
- Vanderbilt University Medical Center, Nashville, TN (S. Huang, J.M.)
| | - Anita Deswal
- University of Texas MD Anderson Cancer Center, Houston (A.D., N.L.P.)
| | | | - Daniel Finke
- University of Heidelberg, Germany (D.F., L.L.).,Assistance Publique-Hôpitaux de Paris, University of Paris, France (D.F.)
| | | | - Stephane Ederhy
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France (S. Ederhy, J.-E.S.)
| | - Javid Moslehi
- Vanderbilt University Medical Center, Nashville, TN (S. Huang, J.M.)
| | - Joe-Elie Salem
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France (S. Ederhy, J.-E.S.)
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17
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Rique A, Cautela J, Thuny F, Michel G, Ovaert C, El Louali F. Physical activity reduces longitudinal strain alteration in children treated by anthracyclins. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.06.041] [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: 10/20/2022]
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18
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Lehmann LH, Cautela J, Palaskas N, Baik AH, Meijers WC, Allenbach Y, Alexandre J, Rassaf T, Müller OJ, Aras M, Asnani AH, Deswal A, Laufer-Perl M, Thuny F, Kerneis M, Hayek SS, Ederhy S, Salem JE, Moslehi JJ. Clinical Strategy for the Diagnosis and Treatment of Immune Checkpoint Inhibitor-Associated Myocarditis: A Narrative Review. JAMA Cardiol 2021; 6:1329-1337. [PMID: 34232253 DOI: 10.1001/jamacardio.2021.2241] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 12/19/2022]
Abstract
Importance In the last decade, immune checkpoint inhibitors (ICIs) have been approved for the treatment of many cancer types. Immune checkpoint inhibitor-associated myocarditis has emerged as a significant and potentially fatal adverse effect. Recognizing, diagnosing, and treating ICI-associated myocarditis poses new challenges for the practicing clinician. Here, the current literature on ICI-associated myocarditis is reviewed. Observations Clinical presentation and cardiac pathological findings are highly variable in patients with ICI-associated myocarditis. Although endomyocardial biopsy is the criterion standard diagnostic test, a combination of clinical suspicion, cardiac biomarkers (specifically troponin), and cardiac imaging, in addition to biopsy, is often needed to support the diagnosis. Importantly, the combination of a cytotoxic T-lymphocyte-associated protein 4 inhibitor with a programmed cell death protein 1 or programmed death-ligand 1 inhibitor increases the risk of developing ICI-associated myocarditis. Conclusion and Relevance This review aims to provide a standardized diagnostic and therapeutic approach for patients with suspected ICI-associated myocarditis. A complete history of recent cancer treatments and physical examination in combination with cardiac biomarkers, cardiac imaging, and endomyocardial biopsy represent a pragmatic diagnostic approach for most cases of ICI-associated myocarditis. The addition of novel biomarkers or imaging modalities is an area of active research and should be evaluated in larger cohorts.
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Affiliation(s)
- Lorenz H Lehmann
- Department of Cardiology, Angiology, and Pneumology, Cardio-Oncology Unit, Heidelberg University Hospital, Heidelberg, Germany.,German Centre for Cardiovascular Research, partner site Heidelberg/Mannheim, Heidelberg, Germany.,German Cancer Research Centre, Heidelberg, Germany
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Center for Cardiovascular and Nutrition Research, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, France.,Groupe Méditerranéen de Cardio-Oncologie, Marseille, France.,Oncosafety Network of the Early Phases Cancer Trials Center, Marseille, France
| | - Nicolas Palaskas
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Alan H Baik
- Department of Medicine, Division of Cardiology, University of California, San Francisco
| | - Wouter C Meijers
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS974, Paris, France
| | - Joachim Alexandre
- Department of Pharmacology, Normandie University, University of Caen Normandy, PICARO Cardio-oncology Program, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, Caen, France
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver J Müller
- Department of Internal Medicine III, University of Kiel, Kiel, Germany.,German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Mandar Aras
- Department of Medicine, Division of Cardiology, University of California, San Francisco
| | - Aarti H Asnani
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anita Deswal
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Thuny
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Center for Cardiovascular and Nutrition Research, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, France.,Groupe Méditerranéen de Cardio-Oncologie, Marseille, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, Institut National de la Santé et de la Recherche Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor
| | - Stéphane Ederhy
- Hôpitaux Universitaires Paris-Est, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Service de Cardiologie, Unico, Unité de Cardio-Oncologie, Groupe de Recherche Clinique en Cardio-Oncologie, Université Pierre et Marie Curie, Paris, France
| | - Joe-Elie Salem
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pharmacology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, UNICO-GRECO Cardio-Oncology Program, Pitié-Salpêtrière Hospital, Paris, France
| | - Javid J Moslehi
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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19
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Pezel T, Bernard A, Lavie Badie Y, Dreyfus J, Audureau E, Bohbot Y, Fard D, Hubert A, Nguyen LS, Monteil C, Bière L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Mouhat B, Bazire B, Fauvel C, Ternacle J, Cautela J, Cambet T, Le Tourneau T, Donal E, Lafitte S, Mansencal N, Coisne A. Rational and Design of the SIMULATOR Study: A Multicentre Randomized Study to Assess the Impact of SIMULation-bAsed Training on Transoesophageal echocardiOgraphy leaRning for Cardiology Residents. Front Cardiovasc Med 2021; 8:661355. [PMID: 34109225 PMCID: PMC8180582 DOI: 10.3389/fcvm.2021.661355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies. To assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology. Materials and Methods: Nationwide prospective randomized multicenter study involving 43 centers throughout France allowing for the inclusion of >70% of all French cardiology residents. All cardiology residents naive from TEE will be included. Randomization with stratification by center will allocate residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator in addition. Results: All residents will undergo both a theoretical test (0-100 points) and a practical test on a TEE simulator (0-100 points) before and 3 months after the training. Satisfaction will be assessed by a 5-points Likert scale. The primary outcomes will be to compare the scores in the final theoretical and practical tests between the two groups, 3 months after the completion of the training. Conclusion: Data regarding simulation-based learning in TEE are limited to non-randomized or single-center studies. The randomized multicenter SIMULATOR study will assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology, and whether such an educational program should be proposed in first line for TEE teaching.
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Affiliation(s)
- Théo Pezel
- University of Paris, Department of Cardiology, Lariboisiere Hospital—APHP, Paris, France
- INSERM UMRS 942, Paris, France
- Ilumens Healthcare Simulation Department, Paris University, Paris, France
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Anne Bernard
- Service de Cardiologie, CHRU de Tours, Toulouse, France
- EA4245, Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France
- Centre Régional d'Enseignement par la Simulation en Santé, Faculté de Médecine de Tours, Tours, France
| | - Yoan Lavie Badie
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Etienne Audureau
- Clinical Epidemiology and Ageing (CEPIA), IMRB U955, UPEC, Creteil, France
- CHU Henri Mondor, AP-HP, Creteil, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Health Simulation Center SimUSanté®, Amiens University Hospital, Amiens, France
| | - Damien Fard
- Department of Cardiology, Cardiology Intensive Care Unit, Henri-Mondor University Hospital, AP-HP, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | | | - Lee S. Nguyen
- Research and Innovation, RICAP, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Cécile Monteil
- Ilumens Healthcare Simulation Department, Paris University, Paris, France
| | - Loïc Bière
- Department of Cardiology, Angers University Hospital, Angers, France
| | - Florent Le Ven
- Department of Cardiology, Brest University Hospital, CHRU de la Cavale Blanche, Brest, France
| | - Marjorie Canu
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | | | - Baptiste Mion
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital, Besançon, France
| | - Baptiste Bazire
- University of Paris, Department of Cardiology, Bichat Hospital—APHP, Paris, France
| | - Charles Fauvel
- Department of Cardiology, CHU Rouen, FHU REMOD-VHF, Rouen, France
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique—Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Marseille, France
| | - Théo Cambet
- Explorations fonctionnelles cardiovasculaires, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Thierry Le Tourneau
- Inserm UMR1087, Institut du thorax, Université de Nantes, CHU de Nantes, Nantes, France
| | - Erwan Donal
- Cardiologie, CHU de Rennes, LTSI, Rennes, France
| | - Stéphane Lafitte
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Augustin Coisne
- Department of Cardiovascular Explorations and Echocardiography—Heart Valve Clinic, CHU Lille, Lille, France
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
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Orimoloye O, Power JR, Nowatzke J, Hughes AM, Lehmann L, Cautela J, Aras M, Weppler A, Narezkina A, Peretto G, Pela M, Crusz SM, Asnani A, Salem JE, Deswal A, Palaskas N, Moslehi J. ECHOCARDIOGRAPHIC FEATURES OF IMMUNE CHECKPOINT INHIBITOR ASSOCIATED MYOCARDITIS AND THEIR ASSOCIATION WITH ADVERSE OUTCOMES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04690-8] [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: 11/15/2022]
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21
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Dolladille C, Ederhy S, Sassier M, Cautela J, Thuny F, Cohen AA, Fedrizzi S, Chrétien B, Da-Silva A, Plane AF, Legallois D, Milliez PU, Lelong-Boulouard V, Alexandre J. Immune Checkpoint Inhibitor Rechallenge After Immune-Related Adverse Events in Patients With Cancer. JAMA Oncol 2021; 6:865-871. [PMID: 32297899 DOI: 10.1001/jamaoncol.2020.0726] [Citation(s) in RCA: 264] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Limited information is available on the safety of a rechallenge with an immune checkpoint inhibitor (ICI) after an immune-related adverse event (irAE). Objective To identify the recurrence rate of the same irAE that prompted discontinuation of ICI therapy after an ICI rechallenge in patients with cancer and to identify the clinical features associated with such recurrences. Design, Setting, and Participants This observational, cross-sectional, pharmacovigilance cohort study examined individual case safety reports from the World Health Organization database VigiBase, which contains case reports from more than 130 countries. Case reports were extracted from database inception (1967) to September 1, 2019. All consecutive ICI cases with at least 1 associated irAE were included. Main Outcomes and Measures The primary outcome was the rate of recurrence of the initial irAE after an ICI rechallenge. Secondary outcomes included the factors associated with the recurrence after a rechallenge among informative rechallenges, the recurrence rate according to the ICI regimen (anti-programmed cell death 1 or anti-programmed cell death ligand 1 monotherapy, anti-cytotoxic T-lymphocyte antigen-4 monotherapy, or combination therapy), and the rate of occurrence of a different irAE after a rechallenge. Results A total of 24 079 irAE cases associated with at least 1 ICI were identified. Among the irAEs, 452 of 6123 irAEs associated with ICI rechallenges (7.4%) were informative rechallenges. One hundred thirty recurrences (28.8%; 95% CI, 24.8-33.1) of the initial irAE were observed. In a rechallenge, colitis (reporting odds ratio [OR], 1.77; 95% CI, 1.14-2.75; P = .01), hepatitis (reporting OR, 3.38; 95% CI, 1.31-8.74; P = .01), and pneumonitis (reporting OR, 2.26; 95% CI, 1.18-4.32; P = .01) were associated with a higher recurrence rate, whereas adrenal events were associated with a lower recurrence rate (reporting OR, 0.33; 95% CI, 0.13-0.86; P = .03) compared with other irAEs. Conclusions and Relevance This cohort study found a 28.8% recurrence rate of the same irAE associated with the discontinuation of ICI therapy after a rechallenge with the same ICI. Resuming ICI therapy could be considered for select patients, with appropriate monitoring and use of standard treatment algorithms to identify and treat toxic effects.
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Affiliation(s)
- Charles Dolladille
- Normandie University, University of Caen Normandy, Centre Hospitalier Universitaire (CHU) de Caen Normandie, PICARO Cardio-oncology Program, Department of Pharmacology, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, Caen, France
| | - Stéphane Ederhy
- Hôpitaux Universitaires Paris-Est, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Service de Cardiologie, Unico, Unité de Cardio-Oncologie APHP.6, GRC Groupe de Recherche Clinique en Cardio Oncologie, Inserm 856, Université Pierre et Marie Curie, Paris, France
| | - Marion Sassier
- CHU de Caen Normandie, Department of Pharmacology, Caen, France
| | - Jennifer Cautela
- Aix-Marseille Mediterranean University, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Cardio-Oncology Center, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France.,Centre de Recherche Cardiovasculaire et Nutrition, Inserm 1263, Inra, Marseille, France.,Groupe Méditerranéen de Cardio-Oncologie, Marseille, France.,Oncosafety Network of the Early Phases Cancer Trials Center, Marseille, France
| | - Franck Thuny
- Aix-Marseille Mediterranean University, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Cardio-Oncology Center, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France.,Centre de Recherche Cardiovasculaire et Nutrition, Inserm 1263, Inra, Marseille, France.,Groupe Méditerranéen de Cardio-Oncologie, Marseille, France.,Oncosafety Network of the Early Phases Cancer Trials Center, Marseille, France
| | - Ariel A Cohen
- Hôpitaux Universitaires Paris-Est, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Service de Cardiologie, Unico, Unité de Cardio-Oncologie APHP.6, GRC Groupe de Recherche Clinique en Cardio Oncologie, Inserm 856, Université Pierre et Marie Curie, Paris, France
| | - Sophie Fedrizzi
- CHU de Caen Normandie, Department of Pharmacology, Caen, France
| | - Basile Chrétien
- CHU de Caen Normandie, Department of Pharmacology, Caen, France
| | - Angélique Da-Silva
- CHU de Caen Normandie, Department of Pharmacology, Caen, France.,Centre Francois Baclesse Centre de Lutte Contre le Cancer (Cancer Centre), Caen, France
| | - Anne-Flore Plane
- CHU de Caen Normandie, PICARO Cardio-oncology Program, Department of Cardiology, Caen, France
| | - Damien Legallois
- Normandie University, UNICAEN, CHU de Caen Normandie, PICARO Cardio-oncology Program, Department of Cardiology, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, Caen, France
| | - Paul U Milliez
- Normandie University, UNICAEN, CHU de Caen Normandie, PICARO Cardio-oncology Program, Department of Cardiology, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, Caen, France
| | | | - Joachim Alexandre
- Normandie University, University of Caen Normandy, Centre Hospitalier Universitaire (CHU) de Caen Normandie, PICARO Cardio-oncology Program, Department of Pharmacology, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, Caen, France
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Thuny F, Alexandre J, Salem JE, Mirabel M, Dolladille C, Cohen-Solal A, Cohen A, Ederhy S, Cautela J. Management of Immune Checkpoint Inhibitor-Induced Myocarditis: The French Working Group's Plea for a Pragmatic Approach. JACC CardioOncol 2021; 3:157-161. [PMID: 34396318 PMCID: PMC8352226 DOI: 10.1016/j.jaccao.2020.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Franck Thuny
- French Institute of Health and Medical Research 1263, National Institute of Agricultural Research, Centre for CardioVascular and Nutrition Research, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, University Mediterranean Centre of Cardio-Oncology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Mediterranean Group of Cardio-Oncology, Marseille, France
- Address for correspondence: Dr. Franck Thuny, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, North Hospital, Aix-Marseille University, Chemin des Bourrely, 13015 Marseille, France. @franckthuny@CautelaJennifer@unico_greco
| | - Joachim Alexandre
- PICARO Cardio-oncology Program, Department of Pharmacology, Department of Cardiology, Caen Hospital, Medical School, University of Caen Normandy, Caen, France
| | - Joe-Elie Salem
- UNICO-GRECO Cardio-Oncology Program, Centre d’Investigation Clinique Paris-Est, Department of Pharmacology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Mariana Mirabel
- Unit of Cardio-Oncology and Prevention, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Charles Dolladille
- PICARO Cardio-oncology Program, Department of Pharmacology, Department of Cardiology, Caen Hospital, Medical School, University of Caen Normandy, Caen, France
| | - Alain Cohen-Solal
- UMR-S 942, Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Ariel Cohen
- French Institute of Health and Medical Research 856, UNICO-GRECO Cardio-Oncology Program, Department of Cardiology, Saint-Antoine Hospital and Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Stéphane Ederhy
- French Institute of Health and Medical Research 856, UNICO-GRECO Cardio-Oncology Program, Department of Cardiology, Saint-Antoine Hospital and Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jennifer Cautela
- French Institute of Health and Medical Research 1263, National Institute of Agricultural Research, Centre for CardioVascular and Nutrition Research, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, University Mediterranean Centre of Cardio-Oncology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Mediterranean Group of Cardio-Oncology, Marseille, France
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Cautela J, Zeriouh S, Gaubert M, Bonello L, Laine M, Peyrol M, Paganelli F, Lalevee N, Barlesi F, Thuny F. Intensified immunosuppressive therapy in patients with immune checkpoint inhibitor-induced myocarditis. J Immunother Cancer 2020; 8:jitc-2020-001887. [PMID: 33298621 PMCID: PMC7725077 DOI: 10.1136/jitc-2020-001887] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background Myocarditis is a rare but life-threatening adverse event of cancer treatments with immune checkpoint inhibitors (ICIs). Recent guidelines recommend the use of high doses of corticosteroids as a first-line treatment, followed by intensified immunosuppressive therapy (IIST) in the case of unfavorable evolution. However, this strategy is empirical, and no studies have specifically addressed this issue. Therefore, we aimed to investigate and compare the clinical course, management and outcome of ICI-induced myocarditis patients requiring or not requiring IIST. Methods This case–control study included all patients consecutively admitted to The Mediterranean University Center of Cardio-Oncology (Aix-Marseille University, France) for the diagnosis of ICI-induced myocarditis according to Bonaca’s criteria and treated with or without IIST. In addition, we searched PubMed and included patients from previously published case reports treated with IIST in the analysis. The clinical, biological, imaging, treatment, all-cause death and cardiovascular death data of patients who required IIST were compared with those of patients who did not. Results A total of 60 patients (69±12 years) were included (36 were treated with IIST and 24 were not). Patients requiring IIST were more likely to have received a combination of ICIs (39% vs 8%, p=0.01), and developed the first symptoms/signs of myocarditis earlier after the onset of ICI therapy (median, 18 days vs 60 days, p=0.002). They had a significantly higher prevalence of sustained ventricular arrhythmia, complete atrioventricular block, cardiogenic shock and troponin elevation. Moreover, they were more likely to have other immune-related adverse events simultaneously (p<0.0001), especially myositis (p=0.0002) and myasthenia gravis (p=0.009). Patients who required IIST were more likely to die from any cause (50% vs 21%, p=0.02). Among them, patients who received infliximab were more likely to die from cardiovascular causes (OR, 12.0; 95% CI 2.1 to 67.1; p=0.005). Conclusion The need for IIST was more common in patients who developed myocarditis very early after the start of ICI therapy, as well as when hemodynamic/electrical instability or neuromuscular adverse events occurred. Treatment with infliximab might be associated with an increased risk of cardiovascular death.
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Affiliation(s)
- Jennifer Cautela
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France.,Mediterranean Group of Cardio-oncology (gMEDICO), Aix-Marseille-University, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Sarah Zeriouh
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Melanie Gaubert
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Bonello
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Marc Laine
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Michael Peyrol
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Franck Paganelli
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Nathalie Lalevee
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France.,Technological Advances for Genomics and Clinics (TAGC), UMR/INSERM 1090, Aix-Marseille-University, Marseille, France
| | - Fabrice Barlesi
- Mediterranean Group of Cardio-oncology (gMEDICO), Aix-Marseille-University, Marseille, Provence-Alpes-Côte d'Azur, France.,Gustave Roussy, Drug Development Department (DITEP), Paris-Saclay University, Villejuif, France
| | - Franck Thuny
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France .,Mediterranean Group of Cardio-oncology (gMEDICO), Aix-Marseille-University, Marseille, Provence-Alpes-Côte d'Azur, France
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Dolladille C, Ederhy S, Allouche S, Dupas Q, Gervais R, Madelaine J, Sassier M, Plane AF, Comoz F, Cohen AA, Thuny FR, Cautela J, Alexandre J. Late cardiac adverse events in patients with cancer treated with immune checkpoint inhibitors. J Immunother Cancer 2020; 8:jitc-2019-000261. [PMID: 31988143 PMCID: PMC7057417 DOI: 10.1136/jitc-2019-000261] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background Immune checkpoint inhibitor (ICI)-associated early cardiac adverse events (CAEs), mostly acute and fulminant myocarditis, have been well characterized and mainly occur during the first 90 days after ICI therapy initiation. ICI-associated late CAEs (occurring after the first 90 days of treatment) have not yet been described. Methods First, we compared characteristics of a cohort involving early (defined as a CAE time to onset (TTO) of <90 days after ICI therapy initiation) and late (defined as a CAE TTO of ≥90 days after ICI therapy initiation) ICI-associated CAE consecutive cases who were referred to three French cardio-oncology units. Second, ICI-associated CAE cases were searched in VigiBase, the WHO global individual case safety report database, and early and late ICI-associated CAEs were compared. Results In the cohort study, compared with early CAE cases (n=19, median TTO of 14 days), late ICI-associated CAE cases (n=19, median TTO of 304 days) exhibited significantly more left ventricular systolic dysfunction (LVSD) and heart failure (HF) and less frequent supraventricular arrhythmias. In VigiBase, compared with early cases (n=437, 73.3%, median TTO 21 days), the late ICI-associated CAE reports (n=159, 26.7%, median TTO 178 days) had significantly more frequent HF (21.1% vs 31.4%, respectively, p=0.01). Early and late ICI-associated CAE cases had similarly high mortality rates (40.0% vs 44.4% in the cohort and 30.0% vs 27.0% in VigiBase, respectively). Conclusions Late CAEs could occur with ICI therapy and were mainly revealed to be HF with LVSD. Trial registration numbers NCT03678337, NCT03882580, and NCT03492528.
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Affiliation(s)
- Charles Dolladille
- CHU de Caen, PICARO Cardio-oncology Program, Department of Pharmacology, CHU de Caen, Caen, France .,CHU de Caen, Department of Cardiology, CHU de Caen, Caen F-14000, France
| | - Stephane Ederhy
- Department of Cardiology, Cardio-oncology Unit, Cardio-oncology Research G, INSERM U 856, Thrombose, Athérothrombose et Pharmacologie Appliquée, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Stéphane Allouche
- EA4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-reperfusion Myocardique, Université de Caen Normandie, Caen, Normandie, France
| | - Querntin Dupas
- EA4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-reperfusion Myocardique, Université de Caen Normandie, Caen, Normandie, France
| | - Radj Gervais
- Onco-pneumology, Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | | | - Marion Sassier
- CHU de Caen, PICARO Cardio-oncology Program, Department of Pharmacology, CHU de Caen, Caen, France
| | - Anne-Flore Plane
- CHU de Caen, Department of Cardiology, CHU de Caen, Caen F-14000, France
| | | | - Ariel Aron Cohen
- Department of Cardiology, Cardio-oncology Unit, Cardio-oncology Research G, INSERM U 856, Thrombose, Athérothrombose et Pharmacologie Appliquée, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Franck Roland Thuny
- Mediterranean University Cardio-oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, APHM, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Jennifer Cautela
- Mediterranean University Cardio-oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, APHM, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Joachim Alexandre
- CHU de Caen, PICARO Cardio-oncology Program, Department of Pharmacology, CHU de Caen, Caen, France.,EA4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-reperfusion Myocardique, Université de Caen Normandie, Caen, Normandie, France
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Power J, Meijers W, Fenioux C, Tamura Y, Asnani A, Alexandre J, Cautela J, Aras M, Lehmann L, Perl M, Narezkina A, Gilstrap L, Ederhy S, Moslehi J, Salem J. Predictors of steroid-refractory immune checkpoint inhibitor associated myocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Immune checkpoint inhibitor (ICI)-associated myocarditis has a high mortality rate of approximately 50%. Clinical decompensation often occurs despite first-line treatment with corticosteroids. Factors associated with steroid failure are currently unknown.
Purpose
To identify predictors of steroid failure in patients with ICI-associated myocarditis.
Methods
We developed a web-based registry to collect and study 157 cases with clinical manifestations of ICI-associated myocarditis across 16 countries. Steroid failure was defined as patients who were escalated to immunomodulators after ≥1mg/kg daily dose of prednisone or had in-hospital death due to myocarditis despite ≥1mg/kg daily dose of prednisone. Steroid response was defined as all other patients treated with steroids without escalation to immunomodulators and without death due to myocarditis. A multivariate logistic model accounting for age and sex was used to predict association with steroid failure.
Results
Compared to steroid responsive cases, steroid failure was more likely to result in fulminant myocarditis (56.7% vs 19.6%, OR=5.37 [2.62–10.98] p<0.001) and all-cause in-hospital mortality (49.1% vs 12.9%, OR=6.50 [2.86–14.73] p<0.001) with shorter time from presentation to death (27.5 vs 43.0 days HR: 2.56 [1.45–4.50] p=0.001). When adjusting for age and sex, cases were more likely to be steroid-refractory if they were female (46.7% vs 30.1%, OR=2.77 [1.31–5.85] p=0.007), higher body mass index (27.2 vs 22.0, OR=1.09 [1.01–1.18] p=0.012), had higher intake creatine kinase (2800.5 vs 528.0 U/L, OR=1.48 [1.14–1.90] p=0.003) had higher intake troponin T (1.40 vs 0.25 ng/mL OR=1.63 [1.00–2.64] p=0.049), or had one or more concomitant non-cardiac immune-related adverse event (90.0% vs 74.2%, OR=3.10 [1.14–8.25] p<0.026). The only immune-related adverse events independently associated with steroid failure in myocarditis were myasthenia gravis-like syndrome (26.7% vs 8.2%, OR=3.84 [1.47–10.10] p=0.006) and myositis (45.0% vs 24.7%, OR=2.38 [1.16–4.92] p=0.018). Steroid failure was not significantly associated with cardiovascular or autoimmune history but was associated with a history of thymoma (12.0% vs 2.6%, OR=18.86 [0.10–356.7] p=0.05)
Conclusion(s)
Features such as female sex, high body mass index, and pre-existing thymoma as well as findings of elevated cardiac biomarkers and other non-cardiac immune-related adverse events – particularly myositis and myasthenia gravis-like syndrome – may represent a steroid-refractory phenotype of ICI-associated myocarditis. These results suggest that a multidisciplinary approach to diagnosing concomitant non-cardiac immune related adverse events is key to risk-stratifying ICI-associated myocarditis.
Forrest Plot
Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): National Institutes of Health
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Affiliation(s)
- J Power
- Vanderbilt University Medical Center, Nashville, United States of America
| | - W Meijers
- Vanderbilt University Medical Center, Nashville, United States of America
| | | | - Y Tamura
- International University of Health and Welfare, Narita, Japan
| | - A Asnani
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, United States of America
| | | | - J Cautela
- Hospital Nord of Marseille, Marseille, France
| | - M Aras
- University of California San Francisco, San Francisco, United States of America
| | - L Lehmann
- University of Heidelberg, Heidelberg, Germany
| | - M Perl
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Narezkina
- University of California San Diego, San Diego, United States of America
| | - L Gilstrap
- Dartmouth-Hitchcock Health, Lebanon, United States of America
| | - S Ederhy
- Sorbonne University, Paris, France
| | - J Moslehi
- Vanderbilt University Medical Center, Nashville, United States of America
| | - J Salem
- Sorbonne University, Paris, France
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26
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Capron T, Cautela J, Scemama U, Miola C, Bartoli A, Theron A, Pinto J, Porto A, Collart F, Lepidi H, Bernard M, Guye M, Thuny F, Avierinos JF, Jacquier A. Cardiac magnetic resonance assessment of left ventricular dilatation in chronic severe left-sided regurgitations: comparison with standard echocardiography. Diagn Interv Imaging 2020; 101:657-665. [DOI: 10.1016/j.diii.2020.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/05/2020] [Accepted: 04/18/2020] [Indexed: 12/19/2022]
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27
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Alexandre J, Cautela J, Ederhy S, Damaj GL, Salem JE, Barlesi F, Farnault L, Charbonnier A, Mirabel M, Champiat S, Cohen-Solal A, Cohen A, Dolladille C, Thuny F. Cardiovascular Toxicity Related to Cancer Treatment: A Pragmatic Approach to the American and European Cardio-Oncology Guidelines. J Am Heart Assoc 2020; 9:e018403. [PMID: 32893704 PMCID: PMC7727003 DOI: 10.1161/jaha.120.018403] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The considerable progress made in the field of cancer treatment has led to a dramatic improvement in the prognosis of patients with cancer. However, toxicities resulting from these treatments represent a cost that can be harmful to short- and long-term outcomes. Adverse events affecting the cardiovascular system are one of the greatest challenges in the overall management of patients with cancer, as they can compromise the success of the optimal treatment against the tumor. Such adverse events are associated not only with older chemotherapy drugs such as anthracyclines but also with many targeted therapies and immunotherapies. Recognizing this concern, several American and European governing societies in oncology and cardiology have published guidelines on the cardiovascular monitoring of patients receiving potentially cardiotoxic cancer therapies, as well as on the management of cardiovascular toxicities. However, the low level of evidence supporting these guidelines has led to numerous discrepancies, leaving clinicians without a consensus strategy to apply. A cardio-oncology expert panel from the French Working Group of Cardio-Oncology has undertaken an ambitious effort to analyze and harmonize the most recent American and European guidelines to propose roadmaps and decision algorithms that would be easy for clinicians to use in their daily practice. In this statement, the experts addressed the cardiovascular monitoring strategies for the cancer drugs associated with the highest risk of cardiovascular toxicities, as well as the management of such toxicities.
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Affiliation(s)
- Joachim Alexandre
- PICARO Cardio-Oncology Program Department of Pharmacology Department of Cardiology Caen Hospital Medical School Caen-Normandy University Caen France
| | - Jennifer Cautela
- Unit of Heart Failure and Valvular Heart Diseases Department of Cardiology Nord Hospital Center for CardioVascular and Nutrition Research (C2VN) University Mediterranean Center of Cardio-Oncology (MEDI-CO Center) Assistance Publique - Hôpitaux de MarseilleAix-Marseille University Marseille France.,Mediterranean Group of Cardio-Oncology (gMEDICO) Marseille France
| | - Stéphane Ederhy
- UNICO-GRECO Cardio-Oncology Program Department of Cardiology Saint-Antoine Hospital Tenon Hospital Inserm 856 Assistance Publique - Hôpitaux de ParisSorbonne University Paris France
| | - Ghandi Laurent Damaj
- Department of Hematology Caen Hospital Medical School Caen-Normandy University Caen France
| | - Joe-Elie Salem
- UNICO-GRECO Cardio-Oncology Program Department of Pharmacology Centre d'Investigation Clinique Paris-Est Pitié-Salpêtrière Hospital Assistance Publique - Hôpitaux de ParisSorbonne University Paris France
| | - Fabrice Barlesi
- Drug Development Department (DITEP) Gustave RoussyParis-Saclay University Villejuif France
| | - Laure Farnault
- Departement of Hematology Conception HospitalAssistance Publique - Hôpitaux de MarseilleAix-Marseille University Marseille France
| | - Aude Charbonnier
- Departement of Hematology Paoli-Calmettes Cancer InstituteAix-Marseille University Marseille France
| | - Mariana Mirabel
- Unit of Cardio-Oncology and Prevention European Georges Pompidou HospitalAssistance Publique - Hôpitaux de ParisSorbonne University Paris France
| | - Stéphane Champiat
- Drug Development Department (DITEP) Gustave RoussyParis-Saclay University Villejuif France
| | - Alain Cohen-Solal
- Department of Cardiology Lariboisière Hospital UMR-S 942 Assistance Publique - Hôpitaux de ParisParis University Paris France
| | - Ariel Cohen
- UNICO-GRECO Cardio-Oncology Program Department of Cardiology Saint-Antoine Hospital Tenon Hospital Inserm 856 Assistance Publique - Hôpitaux de ParisSorbonne University Paris France
| | - Charles Dolladille
- PICARO Cardio-Oncology Program Department of Pharmacology Department of Cardiology Caen Hospital Medical School Caen-Normandy University Caen France
| | - Franck Thuny
- Unit of Heart Failure and Valvular Heart Diseases Department of Cardiology Nord Hospital Center for CardioVascular and Nutrition Research (C2VN) University Mediterranean Center of Cardio-Oncology (MEDI-CO Center) Assistance Publique - Hôpitaux de MarseilleAix-Marseille University Marseille France.,Mediterranean Group of Cardio-Oncology (gMEDICO) Marseille France
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28
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Tartiere JM, Cohen-Solal A, Roubille F, Girerd N, Cautela J. All rise! Orthostatic hypotension in heart failure: reply. Eur J Heart Fail 2020; 22:1742. [PMID: 32500590 DOI: 10.1002/ejhf.1927] [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] [Received: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Alain Cohen-Solal
- CUMR-S 942 MASCOT, Paris University, Cardiology Department, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, Montpellier, France
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116, Faculté de Médecine, Vandoeuvre les Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.,Cardiology Department, Institut Lorrain du Cœur et des Vaisseaux, CHRU Nancy, Nancy, France
| | - Jennifer Cautela
- Department of Cardiology, Heart Failure and Valvular Heart Diseases Unit, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
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29
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Cautela J, Tartiere JM, Cohen-Solal A, Bellemain-Appaix A, Theron A, Tibi T, Januzzi JL, Roubille F, Girerd N. Management of low blood pressure in ambulatory heart failure with reduced ejection fraction patients. Eur J Heart Fail 2020; 22:1357-1365. [PMID: 32353213 PMCID: PMC7540603 DOI: 10.1002/ejhf.1835] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
Low blood pressure is common in patients with heart failure and reduced ejection fraction (HFrEF). While spontaneous hypotension predicts risk in HFrEF, there is only limited evidence regarding the relationship between hypotension observed during heart failure (HF) drug titration and outcome. Nevertheless, hypotension (especially orthostatic hypotension) is an important factor limiting the titration of HFrEF treatments in routine practice. In patients with signs of shock and/or severe congestion, hospitalization is advised. However, in the very frequent cases of non‐severe and asymptomatic hypotension observed while taking drugs with a class I indication in HFrEF, European and US guidelines recommend maintaining the same drug dosage. In instances of symptomatic or severe persistent hypotension (systolic blood pressure < 90 mmHg), it is recommended to first decrease blood pressure reducing drugs not indicated in HFrEF as well as the loop diuretic dose in the absence of associated signs of congestion. Unless the management of hypotension appears urgent, a HF specialist should then be sought rather than stopping or decreasing drugs with a class I indication in HFrEF. If symptoms or severe hypotension persist, no recommendations exist. Our HF group reviewed available evidence and proposes certain steps to follow in such situations in order to improve the pharmacological management of these patients.
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Affiliation(s)
- Jennifer Cautela
- Heart Failure and Valvular Heart Diseases Unit, Department of Cardiology, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | | | - Alain Cohen-Solal
- CUMR-S 942 MASCOT, Paris University, Cardiology Department, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Alexis Theron
- Cardio-Thoracic Surgery Department, Hôpital de la Timone, Marseille, France
| | - Thierry Tibi
- Cardiology Department, Centre Hospitalier de Cannes, Cannes, France
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Harvard Medical School, Boston, MA, USA
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Nicolas Girerd
- Faculté de Médecine, Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116, Vandoeuvre les Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.,Cardiology Department, Institut Lorrain du Cœur et des Vaisseaux, CHRU Nancy, Nancy, France
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30
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Alexandre J, Salem JE, Moslehi J, Sassier M, Ropert C, Cautela J, Thuny F, Ederhy S, Cohen A, Damaj G, Vilque JP, Plane AF, Legallois D, Champ-Rigot L, Milliez P, Funck-Brentano C, Dolladille C. Identification of anticancer drugs associated with atrial fibrillation: analysis of the WHO pharmacovigilance database. Eur Heart J Cardiovasc Pharmacother 2020; 7:312-320. [PMID: 32353110 DOI: 10.1093/ehjcvp/pvaa037] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/05/2020] [Accepted: 04/22/2020] [Indexed: 02/04/2023]
Abstract
AIMS The explosion of novel anticancer therapies has meant emergence of cardiotoxicity signals including atrial fibrillation (AF). Reliable data concerning the liability of anticancer drugs in inducing AF are scarce. Using the World Health Organization individual case safety report database, VigiBase®, we aimed to determine the association between anticancer drugs and AF. METHODS AND RESULTS A disproportionality analysis evaluating the multivariable-adjusted reporting odds ratios for AF with their 99.97% confidence intervals was performed for 176 U.S. Food and Drug Administration (FDA)- or European Medicines Agency (EMA)-labelled anticancer drugs in VigiBase®, followed by a descriptive analysis of AF cases for the anticancer drugs identified in VigiBase®. ClinicalTrial registration number: NCT03530215. A total of 11 757 AF cases associated with at least one anticancer drug were identified in VigiBase® of which 95.8% were deemed serious. Nineteen anticancer drugs were significantly associated with AF of which 14 (74%) are used in haematologic malignancies and 9 (45%) represented new AF associations not previously confirmed in literature including immunomodulating agents (lenalidomide, pomalidomide), several kinase inhibitors (nilotinib, ponatinib, midostaurin), antimetabolites (azacytidine, clofarabine), docetaxel (taxane), and obinutuzumab, an anti-CD20 monoclonal antibody. CONCLUSION Although cancer malignancy itself may generate AF, we identified 19 anticancer drugs significantly associated with a significant increase in AF over-reporting. This pharmacovigilance study provides evidence that anticancer drugs themselves could represent independent risk factors for AF development. Dedicated prospective clinical trials are now required to confirm these 19 associations. This list of suspected anticancer drugs should be known by physicians when confronted to AF in cancer patients, particularly in case of haematologic malignancies.
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Affiliation(s)
- Joachim Alexandre
- PICARO Cardio-oncology Program, Department of Pharmacology, Normandie University, UNICAEN, CHU de Caen Normandie, EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, F-14000 Caen, France
| | - Joe-Elie Salem
- Department of Pharmacology, AP-HP, Pitié-Salpêtrière Hospital, CIC-1421, INSERM, UMR ICAN 1166, Sorbonne Université, APHP.6 Cardio-oncology Program, F-75013 Paris, France.,Department of Medicine, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, TN 37240, USA
| | - Javid Moslehi
- Department of Medicine, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, TN 37240, USA
| | - Marion Sassier
- Department of Pharmacology, CHU de Caen Normandie, PICARO Cardio-oncology Program, F-14000 Caen, France
| | - Camille Ropert
- Department of Cardiology, CHU de Caen Normandie, F-14000 Caen, France
| | - Jennifer Cautela
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center, Hôpital Nord, Marseille 13915, France.,Centre de Recherche Cardiovasculaire et Nutrition, Inserm 1263, Inra, Marseille 13915, France.,Groupe Méditerranéen de Cardio-Oncologie, Marseille 13915, France.,Oncosafety Network of the Early Phases Cancer Trials Center, Marseille 13915, France
| | - Franck Thuny
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center, Hôpital Nord, Marseille 13915, France.,Centre de Recherche Cardiovasculaire et Nutrition, Inserm 1263, Inra, Marseille 13915, France.,Groupe Méditerranéen de Cardio-Oncologie, Marseille 13915, France.,Oncosafety Network of the Early Phases Cancer Trials Center, Marseille 13915, France
| | - Stéphane Ederhy
- Hôpitaux Universitaires Paris-Est, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Service de cardiologie, Unico, Unité de cardio-oncologie APHP.6, GRC Groupe de recherche clinique en cardio oncologie, Inserm 856, Université Pierre et Marie Curie, Paris, France
| | - Ariel Cohen
- Hôpitaux Universitaires Paris-Est, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Service de cardiologie, Unico, Unité de cardio-oncologie APHP.6, GRC Groupe de recherche clinique en cardio oncologie, Inserm 856, Université Pierre et Marie Curie, Paris, France
| | - Ghandi Damaj
- Department of Hematology, CHU de Caen Normandie, F-14000 Caen, France
| | | | - Anne-Flore Plane
- Department of Cardiology, CHU de Caen Normandie, F-14000 Caen, France
| | - Damien Legallois
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, F-14000 Caen, France
| | - Laure Champ-Rigot
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, F-14000 Caen, France
| | - Paul Milliez
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, F-14000 Caen, France
| | - Christian Funck-Brentano
- Department of Medicine, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, TN 37240, USA
| | - Charles Dolladille
- PICARO Cardio-oncology Program, Department of Pharmacology, Normandie University, UNICAEN, CHU de Caen Normandie, EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, F-14000 Caen, France
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31
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Cautela J, Rouby F, Salem JE, Alexandre J, Scemama U, Dolladille C, Cohen A, Paganelli F, Ederhy S, Thuny F. Acute Coronary Syndrome With Immune Checkpoint Inhibitors: A Proof-of-Concept Case and Pharmacovigilance Analysis of a Life-Threatening Adverse Event. Can J Cardiol 2019; 36:476-481. [PMID: 32144037 DOI: 10.1016/j.cjca.2019.11.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/28/2019] [Accepted: 11/30/2019] [Indexed: 12/20/2022] Open
Abstract
Isolated cases of acute coronary syndrome (ACS) associated with immune checkpoint inhibitors (ICIs) have been described without the establishment of a formal cause-and-effect relationship between treatment and adverse event. We reported a case of ACS after the first administration of an ICI and with a fatal recurrence in another coronary area immediately after readministration. According to guidelines, causality was considered to be certain. Subsequently, we queried the French pharmacovigilance database and found 4 cases of ACS with coronary artery thrombosis. Causality was probable in those patients. These data suggest that ACS may be another life-threatening cardiac adverse event occurring with ICI exposure.
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Affiliation(s)
- Jennifer Cautela
- University Mediterranean Centre of Cardio-Oncology, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, and Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France; Groupe Méditerranéen de Cardio-Oncologie, Marseille, France; Centre for Cardiovascular and Nutrition Research, Aix-Marseille University, INSERM 1263, INRA 1260, Marseille, France
| | - Franck Rouby
- Department of Clinical Pharmacology and Pharmacovigilance, Regional Pharmacovigilance Centre of Marseille Provence Corse, Marseille, France
| | - Joe-Elie Salem
- UNICO-GRECO Cardio-Oncology Program, Sorbonne Université, INSERM, CIC Paris-Est, AP-HP, and Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
| | - Joachim Alexandre
- PICARO Cardio-Oncology Program, Department of Pharmacology, CHU de Caen, Caen, France; Department of Cardiology, CHU de Caen, Caen, France; Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, Medical School, Université de Caen Normandie, EA 4650, Caen, France
| | - Ugo Scemama
- Department of Imaging, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Charles Dolladille
- PICARO Cardio-Oncology Program, Department of Pharmacology, CHU de Caen, Caen, France; Department of Cardiology, CHU de Caen, Caen, France; Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, Medical School, Université de Caen Normandie, EA 4650, Caen, France
| | - Ariel Cohen
- Sorbonne Université, Hôpitaux Universitaires Est Parisien, Hôpital Saint Antoine, and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, INSERM 856, Paris, France
| | - Franck Paganelli
- University Mediterranean Centre of Cardio-Oncology, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, and Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France; Centre for Cardiovascular and Nutrition Research, Aix-Marseille University, INSERM 1263, INRA 1260, Marseille, France
| | - Stéphane Ederhy
- Sorbonne Université, Hôpitaux Universitaires Est Parisien, Hôpital Saint Antoine, and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, INSERM 856, Paris, France
| | - Franck Thuny
- University Mediterranean Centre of Cardio-Oncology, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, and Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France; Groupe Méditerranéen de Cardio-Oncologie, Marseille, France; Centre for Cardiovascular and Nutrition Research, Aix-Marseille University, INSERM 1263, INRA 1260, Marseille, France.
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32
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Cautela J, Thuny F. [Valvular heart disease]. Rev Prat 2019; 69:e291-e305. [PMID: 32237637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jennifer Cautela
- Unité Nord insuffisance cardiaque et valvulopathies, Aix-Marseille Université, Assistance publique-Hôpitaux de Marseille, hôpital Nord, 13015 Marseille, France
| | - Franck Thuny
- Unité Nord insuffisance cardiaque et valvulopathies, Aix-Marseille Université, Assistance publique-Hôpitaux de Marseille, hôpital Nord, 13015 Marseille, France
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33
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Courand PY, Bouali A, Harbaoui B, Cautela J, Thuny F, Lantelme P. [Myocarditis: Uncommon but severe toxicity of immune checkpoint inhibitors]. Bull Cancer 2019; 106:1050-1056. [PMID: 31627906 DOI: 10.1016/j.bulcan.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/15/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
Traditional cancer therapies, such as treatment with anthracyclines and chest radiation, are known to induce cardiovascular complications. Currently, the increase of cancer therapies will involve new mechanisms such as cancer immunotherapies, also called immune checkpoint inhibitors (PD-1, PD-L1 and CTLA-4 inhibitors). These treatments have shown long-term remissions in subgroup of cancers, including melanomas, non-small-cell lung cancer, urothelial carcinoma, renal cell carcinoma, squamous cell carcinoma of the head and neck and colorectal cancer. Although these treatments will change the natural course of these cancers, they may sometimes induce cardiovascular complications, which has been reported as about 1 % in the literature. Currently, the physicians must keep in mind one uncommon but severe cardiac complication: auto-immune myocarditis. The clinical presentation may include various symptoms like chest pain, heart failure or rhythm disorders. In this situation, a baseline cardiologic check-up before starting cancer immunotherapy may be very helpful. Cardiac biomarkers (troponin and brain natriuretic peptide) and 12-lead resting electrocardiogram must be promptly performed when myocarditis is suspected. A cardiologist's opinion must be requested in emergency to discuss both a transthoracic echocardiography and the appropriate treatment (stopping immunotherapy, adding immunosuppressive treatment such as corticoids) and the monitoring in an intensive care unit. Cardiac MRI and endomyocardial biopsies may help to approach the final diagnosis. In this situation, other cancer therapies may be discussed.
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Affiliation(s)
- Pierre-Yves Courand
- Hôpital de la Croix-Rousse et Hôpital Lyon Sud, hospices civils de Lyon, Cardiology Department, 69004, Lyon, France; Université de Lyon, université Claude-Bernard Lyon 1, hospices civils de Lyon, CREATIS ; CNRS UMR5220, INSA-Lyon, IMMUCARE, Inserm U1044, 69004, Lyon, France.
| | - Anissa Bouali
- Hôpital de la Croix-Rousse et Hôpital Lyon Sud, hospices civils de Lyon, Cardiology Department, 69004, Lyon, France; Université de Lyon, université Claude-Bernard Lyon 1, hospices civils de Lyon, CREATIS ; CNRS UMR5220, INSA-Lyon, IMMUCARE, Inserm U1044, 69004, Lyon, France
| | - Brahim Harbaoui
- Hôpital de la Croix-Rousse et Hôpital Lyon Sud, hospices civils de Lyon, Cardiology Department, 69004, Lyon, France; Université de Lyon, université Claude-Bernard Lyon 1, hospices civils de Lyon, CREATIS ; CNRS UMR5220, INSA-Lyon, IMMUCARE, Inserm U1044, 69004, Lyon, France
| | - Jennifer Cautela
- Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, centre méditerranéen hospitalo-universitaire de cardiologie oncologique - Medi-CO Center, hôpital Nord, Marseille, unité Nord insuffisance cardiaque et valvulopathies, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Franck Thuny
- Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, centre méditerranéen hospitalo-universitaire de cardiologie oncologique - Medi-CO Center, hôpital Nord, Marseille, unité Nord insuffisance cardiaque et valvulopathies, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Pierre Lantelme
- Hôpital de la Croix-Rousse et Hôpital Lyon Sud, hospices civils de Lyon, Cardiology Department, 69004, Lyon, France; Université de Lyon, université Claude-Bernard Lyon 1, hospices civils de Lyon, CREATIS ; CNRS UMR5220, INSA-Lyon, IMMUCARE, Inserm U1044, 69004, Lyon, France
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Venton G, Turcanu M, Colle J, Thuny F, Chebrek S, Farnault L, Mercier C, Ivanov V, Fanciullino R, Suchon P, Jarrot PA, Aissi K, Roche P, Cautela J, Arcani R, Costello R. Pulmonary hypertension in patients with myeloproliferative neoplasms: A large cohort of 183 patients. Eur J Intern Med 2019; 68:71-75. [PMID: 31421946 DOI: 10.1016/j.ejim.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic myeloproliferative neoplasms (MPN) are recognized as a cause of pulmonary hypertension (pH). We ought to describe the prevalence and characteristics of PH in a cohort of MPN who were screened using transthoracic echocardiography (TTE). METHODS One hundred eighty-three newly diagnosed consecutive MPN patients were prospectively evaluated using TTE to detect PH. RESULTS Two patients were diagnosed with chronic eosinophilic leukemia, two patients had post-essential thrombocythemia (ET) myelofibrosis (MF), two patients had post-polycythemia vera (PV) MF, 11 patients had primary myelofibrosis (PMF), 28 patients had chronic myeloid leukemia (CML), 51 patients had PV, and 87 patients had ET. TTE was used to determine PH, and PH was suspected in 16 of 183 patients as follows: four with PV, seven with ET, two with PMF, and three with CML. Two patients with ET were excluded because of global cardiac failure. Three patients underwent right heart catheterization to confirm PH. The 14 (7.7%) patients with PH had no cardiac or lung disease that directly involved MPN in PH development. CONCLUSION In this large cohort of 183 MPN patients, TTE was used to diagnose PH, and 14 patients (7.7%) developed PH. This prevalence was lower than expected based on previously reported data, but it remains higher than in the general population.
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Affiliation(s)
- Geoffroy Venton
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; Aix-Marseille University, INSERM, UMR1090 TAGC, Marseille F_13288, France
| | - Mihai Turcanu
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; General Medicine Department, Aix-Marseille University, France
| | - Julien Colle
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; Aix-Marseille University, INSERM, UMR1090 TAGC, Marseille F_13288, France
| | - Franck Thuny
- Aix-Marseille University, Assistance Publique - Hopitaux de Marseille, Mediterranean University Cardio-Oncology Center, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France; Aix-Marseille University, Inserm, Inra, Centre for Cardio-Vascular and Nutrition research (C2VN), Marseille, France
| | - Safia Chebrek
- Hematology Department, Hospital of Avignon, Marseille, France
| | - Laure Farnault
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - Cédric Mercier
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; UMR-911 INSERM, Toxicokinetics and Pharmacokinetics Laboratory, Pharmacological Faculty, Marseille, France
| | - Vadim Ivanov
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - Raphaëlle Fanciullino
- SMARTc Unit, Pharmacokinetics Laboratory, UMR_911 CRO2 AMU, Marseille, France; Pharmacy Unit, La Conception, University Hospital of Marseille, APHM, Marseille, France
| | - Pierre Suchon
- Hematology Laboratory, La Timone, University Hospital of Marseille, France; UMR 1062 NORT, INSERM, Marseille, France
| | - Pierre-André Jarrot
- Internal Medicine and Clinic Immunology Department, La Conception, University Hospital of Marseille, France; Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM _S1263, Aix-Marseille University, France
| | - Karim Aissi
- Internal Medicine Department, North Hospital, University Hospital of Marseille, France
| | - Pauline Roche
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - Jennifer Cautela
- Aix-Marseille University, Assistance Publique - Hopitaux de Marseille, Mediterranean University Cardio-Oncology Center, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France; Aix-Marseille University, Inserm, Inra, Centre for Cardio-Vascular and Nutrition research (C2VN), Marseille, France
| | - Robin Arcani
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France.
| | - Regis Costello
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; Aix-Marseille University, INSERM, UMR1090 TAGC, Marseille F_13288, France
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Deplano V, Boufi M, Gariboldi V, Loundou AD, D'Journo XB, Cautela J, Djemli A, Alimi YS. Mechanical characterisation of human ascending aorta dissection. J Biomech 2019; 94:138-146. [PMID: 31400813 DOI: 10.1016/j.jbiomech.2019.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/10/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
Mechanical characteristics of both the healthy ascending aorta and acute type A aortic dissection were investigated using in vitro biaxial tensile tests, in vivo measurements via transoesophageal echocardiography and histological characterisations. This combination of analysis at tissular, structural and microstructural levels highlighted the following: (i) a linear mechanical response for the dissected intimomedial flap and, conversely, nonlinear behaviour for both healthy and dissected ascending aorta; all showed anisotropy; (ii) a stiffer mechanical response in the longitudinal than in the circumferential direction for the healthy ascending aorta, consistent with the histological quantification of collagen and elastin fibre density; (iii) a link between dissection and ascending aorta stiffening, as revealed by biaxial tensile tests. This result was corroborated by in vivo measurements with stiffness index, β, and Peterson modulus, Ep, higher for patients with dissection than for control patients. It was consistent with histological analysis on dissected samples showing elastin fibre dislocations, reduced elastin density and increased collagen density. To our knowledge, this is the first study to report biaxial tensile tests on the dissected intimomedial flap and in vivo stiffness measurements of acute type A dissection in humans.
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Affiliation(s)
- Valérie Deplano
- Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France.
| | - Mourad Boufi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France; Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France
| | - Vlad Gariboldi
- Aix Marseille Univ, APHM, Timone Hospital, Department of Cardiac Surgery, Marseille, France
| | - Anderson D Loundou
- Aix Marseille Univ, SPMC EA3279, Department of Public Health, Marseille, France
| | - Xavier Benoit D'Journo
- Aix Marseille Univ, APHM, North Hospital, Department of Thoracic Surgery, Marseille, France
| | - Jennifer Cautela
- Aix Marseille Univ, APHM, North Hospital, Department of Cardiology, Marseille, France
| | - Amina Djemli
- Aix Marseille Univ, APHM, North Hospital, Department of Pathology, Marseille, France
| | - Yves S Alimi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France
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Baptiste F, Cautela J, Ancedy Y, Resseguier N, Aurran T, Farnault L, Escudier M, Ammar C, Gaubert M, Dolladille C, Barraud J, Peyrol M, Cohen A, Paganelli F, Alexandre J, Ederhy S, Thuny F. High incidence of atrial fibrillation in patients treated with ibrutinib. Open Heart 2019; 6:e001049. [PMID: 31168393 PMCID: PMC6519413 DOI: 10.1136/openhrt-2019-001049] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/02/2019] [Accepted: 04/14/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Atrial fibrillation (AF) is one of the most common side effects of ibrutinib, a drug that has dramatically improved the prognosis of chronic B-cell malignancies such as chronic lymphocytic leukaemia (CLL). The true incidence of ibrutinib-related AF (IRAF) is not well known and its therapeutic management poses unique challenges especially due to the inherent risk of bleeding. We aimed to determine the incidence and predictors of IRAF, and to analyse its management and outcome. Methods A standardised monitoring was applied at two cardio-oncology clinics in consecutive patients referred before and during ibrutinib therapy. The primary endpoint was the incidence of IRAF. The excess of AF incidence with ibrutinib was studied by comparing the incidence of IRAF with the expected incidence of AF in general population and in patients with CLL not exposed to ibrutinib. Results 53 patients were included. The incidence of IRAF was 38% at 2 years and the risk was 15-fold higher than the AF risk in both the general population and patients with CLL not exposed to ibrutinib (p<0.0001). The majority of cases occurred in asymptomatic patients within the first 6 months. Left atrial volume index ≥40 mL/m2 at treatment initiation identified patients at high risk of developing IRAF. No major bleeding events occurred in patients on ibrutinib, although the majority of patients with IRAF were treated with anticoagulants. Conclusions This cardio-oncology study showed that the risk of IRAF was much higher than previously reported. The majority of cases occurred in asymptomatic patients justifying close monitoring.
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Affiliation(s)
- Florian Baptiste
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Jennifer Cautela
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Yan Ancedy
- Université Pierre et Marie Curie, Paris, France
| | - Noémie Resseguier
- Biostatistic and Public Healt Department, Hopital de la Timone, Marseille, France
| | - Thérèse Aurran
- Department of Haematology, Institut Paoli-Calmettes, Marseille, France
| | - Laure Farnault
- Department of Haematology, Aix-Marseille I University, Marseille, France
| | - Marion Escudier
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Chloé Ammar
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Mélanie Gaubert
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Charles Dolladille
- PICARO Cardio-oncology Program, Department of Pharmacology, CHRU de Caen, Caen, France
| | - Jeremie Barraud
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Michael Peyrol
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Ariel Cohen
- Université Pierre et Marie Curie, Paris, France
| | - Franck Paganelli
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
| | - Joachim Alexandre
- PICARO Cardio-oncology Program, Department of Pharmacology, CHRU de Caen, Caen, France
| | | | - Franck Thuny
- Department of Cardiology, Unit of Heart Failure and Valvular Heart Diseases, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Hôpital Nord, Aix-Marseille I University, Marseille, France
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Escudier M, Cautela J, Malissen N, Ancedy Y, Orabona M, Pinto J, Monestier S, Grob JJ, Scemama U, Jacquier A, Lalevee N, Barraud J, Peyrol M, Laine M, Bonello L, Paganelli F, Cohen A, Barlesi F, Ederhy S, Thuny F. Clinical Features, Management, and Outcomes of Immune Checkpoint Inhibitor-Related Cardiotoxicity. Circulation 2019; 136:2085-2087. [PMID: 29158217 DOI: 10.1161/circulationaha.117.030571] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Marion Escudier
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France (M.E., J.C., M.O., J.P., F.T.)
| | - Jennifer Cautela
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France (M.E., J.C., M.O., J.P., F.T.).,Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Oncosaftey Network of the Early Phases Cancer Trials Center (CLIP), Marseille, France (J.C., F.B., F.T.)
| | - Nausicaa Malissen
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Department of Dermatology, Hôpital Timone, Marseille, France (N.M. S.M., J.J.G.)
| | - Yann Ancedy
- Hôpitaux Universitaires Paris-Est, Hôpital Saint Antoine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Unité mixte de recherche, INSERM 856, Université Pierre et Marie Curie (Paris VI), France (Y.A., A.C., S.E.)
| | - Morgane Orabona
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France (M.E., J.C., M.O., J.P., F.T.)
| | - Johan Pinto
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France (M.E., J.C., M.O., J.P., F.T.)
| | - Sandrine Monestier
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Department of Dermatology, Hôpital Timone, Marseille, France (N.M. S.M., J.J.G.)
| | - Jean-Jacques Grob
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Department of Dermatology, Hôpital Timone, Marseille, France (N.M. S.M., J.J.G.)
| | - Ugo Scemama
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Department of Radiology and Cardiovascular Imaging, Hopital Nord, Marseille, France (U.S., A.J.)
| | - Alexis Jacquier
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Department of Radiology and Cardiovascular Imaging, Hopital Nord, Marseille, France (U.S., A.J.)
| | - Nathalie Lalevee
- Aix-Marseille University, Technological Advances for Genomics and Clinics (TAGC), Unité mixte de recherche/INSERM 1090, Marseille, France (N.L.)
| | - Jeremie Barraud
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.)
| | - Michael Peyrol
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.)
| | - Marc Laine
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.)
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Aix-Marseille University, Unité mixte de recherche, INSERM 1076, Marseille, France (L.B., F.P.)
| | - Franck Paganelli
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Aix-Marseille University, Unité mixte de recherche, INSERM 1076, Marseille, France (L.B., F.P.)
| | - Ariel Cohen
- Hôpitaux Universitaires Paris-Est, Hôpital Saint Antoine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Unité mixte de recherche, INSERM 856, Université Pierre et Marie Curie (Paris VI), France (Y.A., A.C., S.E.)
| | - Fabrice Barlesi
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, Marseille, France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.).,Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Oncosaftey Network of the Early Phases Cancer Trials Center (CLIP), Marseille, France (J.C., F.B., F.T.).,Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Department, Hôpital Nord, Marseille, France (F.B.)
| | - Stephane Ederhy
- Hôpitaux Universitaires Paris-Est, Hôpital Saint Antoine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Unité mixte de recherche, INSERM 856, Université Pierre et Marie Curie (Paris VI), France (Y.A., A.C., S.E.)
| | - Franck Thuny
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France (M.E., J.C., M.O., J.P., J.B., M.P., M.L., L.B., F.P., F.T.) .,Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France (M.E., J.C., M.O., J.P., F.T.).,Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Oncosaftey Network of the Early Phases Cancer Trials Center (CLIP), Marseille, France (J.C., F.B., F.T.)
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Marlinge M, Coulange M, Fitzpatrick RC, Delacroix R, Gabarre A, Lainé N, Cautela J, Louge P, Boussuges A, Rostain J, Guieu R, Joulia FC. Physiological stress markers during breath-hold diving and SCUBA diving. Physiol Rep 2019; 7:e14033. [PMID: 30912280 PMCID: PMC6434169 DOI: 10.14814/phy2.14033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/13/2018] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 12/22/2022] Open
Abstract
This study investigated the sources of physiological stress in diving by comparing SCUBA dives (stressors: hydrostatic pressure, cold, and hyperoxia), apneic dives (hydrostatic pressure, cold, physical activity, hypoxia), and dry static apnea (hypoxia only). We hypothesized that despite the hypoxia induces by a long static apnea, it would be less stressful than SCUBA dive or apneic dives since the latter combined high pressure, physical activity, and cold exposure. Blood samples were collected from 12SCUBA and 12 apnea divers before and after dives. On a different occasion, samples were collected from the apneic group before and after a maximal static dry apnea. We measured changes in levels of the stress hormones cortisol and copeptin in each situation. To identify localized effects of the stress, we measured levels of the cardiac injury markers troponin (cTnI) and brain natriuretic peptide (BNP), the muscular stress markers myoglobin and lactate), and the hypoxemia marker ischemia-modified albumin (IMA). Copeptin, cortisol, and IMA levels increased for the apneic dive and the static dry apnea, whereas they decreased for the SCUBA dive. Troponin, BNP, and myoglobin levels increased for the apneic dive, but were unchanged for the SCUBA dive and the static dry apnea. We conclude that hypoxia induced by apnea is the dominant trigger for the release of stress hormones and cardiac injury markers, whereas cold or and hyperbaric exposures play a minor role. These results indicate that subjects should be screened carefully for pre-existing cardiac diseases before undertaking significant apneic maneuvers.
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Affiliation(s)
- Marion Marlinge
- C2VNINSERMINRAAix‐Marseille Université (AMU)MarseilleFrance
- APHM: Assistance Publique des Hopitaux de MarseilleMarseilleFrance
| | - Mathieu Coulange
- C2VNINSERMINRAAix‐Marseille Université (AMU)MarseilleFrance
- Department of Hyperbaric MedicineSainte Marguerite University HospitalMarseilleFrance
| | | | - Romain Delacroix
- C2VNINSERMINRAAix‐Marseille Université (AMU)MarseilleFrance
- APHM: Assistance Publique des Hopitaux de MarseilleMarseilleFrance
- Laboratory of BiochemistryTimone University HospitalMarseilleFrance
| | - Alexie Gabarre
- C2VNINSERMINRAAix‐Marseille Université (AMU)MarseilleFrance
- APHM: Assistance Publique des Hopitaux de MarseilleMarseilleFrance
- Laboratory of BiochemistryTimone University HospitalMarseilleFrance
| | - Nicolas Lainé
- APHM: Assistance Publique des Hopitaux de MarseilleMarseilleFrance
- Department of Hyperbaric MedicineSainte Marguerite University HospitalMarseilleFrance
| | | | - Pierre Louge
- Department of CardiologyNorth HospitalMarseilleFrance
| | - Alain Boussuges
- C2VNINSERMINRAAix‐Marseille Université (AMU)MarseilleFrance
- HIA Saint AnneToulonFrance
| | | | - Régis Guieu
- C2VNINSERMINRAAix‐Marseille Université (AMU)MarseilleFrance
- APHM: Assistance Publique des Hopitaux de MarseilleMarseilleFrance
| | - Fabrice C. Joulia
- C2VNINSERMINRAAix‐Marseille Université (AMU)MarseilleFrance
- UFR STAPS Université de ToulonLa GardeFrance
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Laine M, Dabry T, Combaret N, Motreff P, Puymirat E, Paganelli F, Thuny F, Cautela J, Peyrol M, Mancini J, Lemesle G, Bonello L. OCT Analysis of Very Early Strut Coverage of the Synergy Stent in Non-ST Segment Elevation Acute Coronary Syndrome Patients. J Invasive Cardiol 2019; 31:10-14. [PMID: 30418164] [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: 06/09/2023]
Abstract
OBJECTIVES Early endothelialization of drug-eluting stent (DES) is a major challenge to reduce the risk of stent thrombosis and the duration of dual-antiplatelet therapy (DAPT) in high bleeding-risk patients. The aim of the present study is to evaluate very early strut coverage with optical coherence tomography (OCT) of the Synergy stent (Boston Scientific) at 1 month in non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients. METHODS This substudy of the EARLY trial prospectively included NSTE-ACS patients treated with the Synergy DES. OCT analysis of the Synergy stent was performed during a staged PCI of additional lesions at 1 month. The primary endpoint was the percentage of covered struts assessed with OCT at 1 month. RESULTS Twenty-four patients were included, with a mean stent length of 35.9 ± 10.1 mm per patient. The rate of covered struts was 78.5% out of 3839 struts analyzed. Nineteen patients (79.2%) had at least 70% of their struts covered. The average neointimal thickness was 0.0508 ± 0.016 mm. CONCLUSIONS In NSTE-ACS patients undergoing culprit percutaneous coronary intervention with the Synergy stent, the rate of covered struts at 1 month was 78.5%. This rapid coverage is in line with the results of clinical trials demonstrating the safety of short-duration DAPT in selected patients who are at high bleeding risk and treated with new-generation DES options.
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Affiliation(s)
- Marc Laine
- Service de Cardiologie, Hôpital Nord Chemin des Bourrely, 13015, Marseille, France.
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Cautela J, Lattanzi V, Månsson LK, Galantini L, Crassous JJ. Sphere-Tubule Superstructures through Supramolecular and Supracolloidal Assembly Pathways. Small 2018; 14:e1803215. [PMID: 30371004 DOI: 10.1002/smll.201803215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/14/2018] [Indexed: 05/21/2023]
Abstract
While colloids have been widely employed as models for atoms and molecules, the current study proposes to extend their use as building blocks for supracolloidal frameworks. Hereby, the self-assembly between highly anisotropic supramolecular microtubules and soft spherical fluorescent microgels is explored using confocal laser scanning microscopy. The influence of the particle size and charge with respect to the catanionic tubule composition, which consists of two oppositely charged bile salt derivatives, is investigated. Under certain conditions, microgel particles are found to specifically interact with the extremities of the tubular aggregates and hierarchically self-assemble into various superstructures varying from virus-like assemblies to supracolloidal networks. The reported approach is envisioned to open new self-assembly routes toward ordered hybrid superstructures where the spherical colloids act as responsive linkers of tubular structures.
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Affiliation(s)
- J Cautela
- Department of Chemistry, Sapienza University of Rome, I-00185, Rome, Italy
| | - V Lattanzi
- Department of Chemistry, Sapienza University of Rome, I-00185, Rome, Italy
| | - L K Månsson
- Physical Chemistry, Department of Chemistry, Lund University, SE-22100, Lund, Sweden
| | - L Galantini
- Department of Chemistry, Sapienza University of Rome, I-00185, Rome, Italy
| | - J J Crassous
- Physical Chemistry, Department of Chemistry, Lund University, SE-22100, Lund, Sweden
- Institute of Physical Chemistry, RWTH Aachen University, DE-52074, Aachen, Germany
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Gaubert M, Resseguier N, Thuny F, Paganelli F, Cautela J, Pinto J, Ammar C, Laine M, Bonello L. Doppler echocardiography for assessment of systemic vascular resistances in cardiogenic shock patients. Eur Heart J Acute Cardiovasc Care 2018; 9:102-107. [PMID: 30124051 DOI: 10.1177/2048872618795514] [Citation(s) in RCA: 5] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Impaired vascular tone plays an important role in cardiogenic shock. Doppler echocardiography provides a non-invasive estimation of systemic vascular resistance. The aim of the present study was to compare Doppler echocardiography with the transpulmonary thermodilution method for the assessment of systemic vascular resistance in patients with cardiogenic shock. METHODS This prospective monocentric comparison study was conducted in a single cardiology intensive care unit (Hopital Nord, Marseille, France). We assessed the systemic vascular resistance index by both echocardiography and transpulmonary thermodilution in 28 patients admitted for cardiogenic shock, on admission and after the introduction of an inotrope or vasopressor treatment. RESULTS A total of 35 paired echocardiographic and transpulmonary thermodilution estimations of the systemic vascular resistance index were compared. Echocardiography values ranged from 1309 to 3526 dynes.s.m2/cm5 and transpulmonary thermodilution values ranged from 1320 to 3901 dynes.s.m2/cm5. A statistically significant correlation was found between echocardiography and transpulmonary thermodilution (r=0.86, 95% confidence interval (CI) 0.74, 0.93; P<0.0001). The intraclass correlation coefficient was 0.84 (95% CI 0.72, 0.92). The mean bias was -111.95 dynes.s.m2/cm5 (95% CI -230.06, 6.16). Limits of agreement were -785.86, 561.96. CONCLUSIONS Doppler echocardiography constitutes an accurate non-invasive alternative to transpulmonary thermodilution to provide an estimation of systemic vascular resistance in patients with cardiogenic shock.
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Affiliation(s)
- Mélanie Gaubert
- Intensive Care Unit, Aix-Marseille University, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
| | - Noémie Resseguier
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, France
| | - Franck Thuny
- Unit of Heart Failure and Valvular Heart Diseases, Aix-Marseille University, France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
| | - Franck Paganelli
- Intensive Care Unit, Aix-Marseille University, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
| | - Jennifer Cautela
- Unit of Heart Failure and Valvular Heart Diseases, Aix-Marseille University, France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
| | - Johan Pinto
- Unit of Heart Failure and Valvular Heart Diseases, Aix-Marseille University, France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
| | - Chloé Ammar
- Unit of Heart Failure and Valvular Heart Diseases, Aix-Marseille University, France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
| | - Marc Laine
- Intensive Care Unit, Aix-Marseille University, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
| | - Laurent Bonello
- Intensive Care Unit, Aix-Marseille University, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, France
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Ederhy S, Cautela J, Ancedy Y, Escudier M, Thuny F, Cohen A. Takotsubo-Like Syndrome in Cancer Patients Treated With Immune Checkpoint Inhibitors. JACC Cardiovasc Imaging 2018; 11:1187-1190. [DOI: 10.1016/j.jcmg.2017.11.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/26/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
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Gaubert M, Marlinge M, Alessandrini M, Laine M, Bonello L, Fromonot J, Cautela J, Thuny F, Barraud J, Mottola G, Rossi P, Fenouillet E, Ruf J, Guieu R, Paganelli F. Uric acid levels are associated with endothelial dysfunction and severity of coronary atherosclerosis during a first episode of acute coronary syndrome. Purinergic Signal 2018. [PMID: 29626320 DOI: 10.1007/s11302-018-96q4-9] [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] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
The role of serum uric acid in coronary artery disease has been extensively investigated. It was suggested that serum uric acid level (SUA) is an independent predictor of endothelial dysfunction and related to coronary artery lesions. However, the relationship between SUA and severity of coronary atherosclerosis evaluated via endothelial dysfunction using peripheral arterial tone (PAT) and the reactive hyperhemia index (RHI) has not been investigated during a first episode of acute coronary syndrome (ACS). The aim of our study was to address this point. We prospectively enrolled 80 patients with a first episode of ACS in a single-center observational study. All patients underwent coronary angiography, evaluation of endothelial function via the RHI, and SUA measurement. The severity of the coronary artery lesion was assessed angiographically, and patients were classified in three groups based on the extent of disease and Gensini and SYNTAX scores. Endothelial function was considered abnormal if RHI < 1.67. We identified a linear correlation between SUA and RHI (R2 = 0.66 P < 0.001). In multivariable analyses, SUA remained associated with RHI, even after adjustment for traditional cardiovascular risk factors and renal function. SUA was associated with severity of coronary artery disease. SUA is associated with severity of coronary atherosclerosis in patients with asymptomatic hyperuricemia. This inexpensive, readily measured biological parameter may be useful to monitor ACS patients.
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Affiliation(s)
| | - Marion Marlinge
- Laboratory of Biochemistry, Hopital Timone, Marseille, France
- UMR MD2, Aix-Marseille University, Marseille, France
| | - Marine Alessandrini
- EA 3279 Public Health, Chronic Disease and Quality of Life-Research Unit, Aix-Marseille University, Marseille, France
| | - Marc Laine
- Department of Cardiology, Hopital Nord, Marseille, France
| | | | - Julien Fromonot
- Laboratory of Biochemistry, Hopital Timone, Marseille, France
- UMR MD2, Aix-Marseille University, Marseille, France
| | | | - Franck Thuny
- Department of Cardiology, Hopital Nord, Marseille, France
| | | | - Giovanna Mottola
- Laboratory of Biochemistry, Hopital Timone, Marseille, France
- UMR MD2, Aix-Marseille University, Marseille, France
| | - Pascal Rossi
- UMR MD2, Aix-Marseille University, Marseille, France
| | - Emmanuel Fenouillet
- UMR MD2, Aix-Marseille University, Marseille, France
- Institut des Sciences Biologiques, CNRS, Paris, France
| | - Jean Ruf
- UMR MD2, Aix-Marseille University, Marseille, France
| | - Régis Guieu
- Laboratory of Biochemistry, Hopital Timone, Marseille, France.
- UMR MD2, Aix-Marseille University, Marseille, France.
- Faculté de Médecine Nord, Boulevard P. Dramard, F-13015, Marseille, France.
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Gaubert M, Marlinge M, Alessandrini M, Laine M, Bonello L, Fromonot J, Cautela J, Thuny F, Barraud J, Mottola G, Rossi P, Fenouillet E, Ruf J, Guieu R, Paganelli F. Uric acid levels are associated with endothelial dysfunction and severity of coronary atherosclerosis during a first episode of acute coronary syndrome. Purinergic Signal 2018; 14:191-199. [PMID: 29626320 DOI: 10.1007/s11302-018-9604-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/06/2018] [Indexed: 12/13/2022] Open
Abstract
The role of serum uric acid in coronary artery disease has been extensively investigated. It was suggested that serum uric acid level (SUA) is an independent predictor of endothelial dysfunction and related to coronary artery lesions. However, the relationship between SUA and severity of coronary atherosclerosis evaluated via endothelial dysfunction using peripheral arterial tone (PAT) and the reactive hyperhemia index (RHI) has not been investigated during a first episode of acute coronary syndrome (ACS). The aim of our study was to address this point. We prospectively enrolled 80 patients with a first episode of ACS in a single-center observational study. All patients underwent coronary angiography, evaluation of endothelial function via the RHI, and SUA measurement. The severity of the coronary artery lesion was assessed angiographically, and patients were classified in three groups based on the extent of disease and Gensini and SYNTAX scores. Endothelial function was considered abnormal if RHI < 1.67. We identified a linear correlation between SUA and RHI (R2 = 0.66 P < 0.001). In multivariable analyses, SUA remained associated with RHI, even after adjustment for traditional cardiovascular risk factors and renal function. SUA was associated with severity of coronary artery disease. SUA is associated with severity of coronary atherosclerosis in patients with asymptomatic hyperuricemia. This inexpensive, readily measured biological parameter may be useful to monitor ACS patients.
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Affiliation(s)
| | - Marion Marlinge
- Laboratory of Biochemistry, Hopital Timone, Marseille, France.,UMR MD2, Aix-Marseille University, Marseille, France
| | - Marine Alessandrini
- EA 3279 Public Health, Chronic Disease and Quality of Life-Research Unit, Aix-Marseille University, Marseille, France
| | - Marc Laine
- Department of Cardiology, Hopital Nord, Marseille, France
| | | | - Julien Fromonot
- Laboratory of Biochemistry, Hopital Timone, Marseille, France.,UMR MD2, Aix-Marseille University, Marseille, France
| | | | - Franck Thuny
- Department of Cardiology, Hopital Nord, Marseille, France
| | | | - Giovanna Mottola
- Laboratory of Biochemistry, Hopital Timone, Marseille, France.,UMR MD2, Aix-Marseille University, Marseille, France
| | - Pascal Rossi
- UMR MD2, Aix-Marseille University, Marseille, France
| | - Emmanuel Fenouillet
- UMR MD2, Aix-Marseille University, Marseille, France.,Institut des Sciences Biologiques, CNRS, Paris, France
| | - Jean Ruf
- UMR MD2, Aix-Marseille University, Marseille, France
| | - Régis Guieu
- Laboratory of Biochemistry, Hopital Timone, Marseille, France. .,UMR MD2, Aix-Marseille University, Marseille, France. .,Faculté de Médecine Nord, Boulevard P. Dramard, F-13015, Marseille, France.
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Thuny F, Cautela J. [How to organise cardiovascular management of cancer patients?]. Rev Prat 2018; 68:332-335. [PMID: 30869302] [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: 06/09/2023]
Abstract
How to organise cardiovascular management of cancer patients? Advances in cancer therapy have reduced cancer mortality. However, these results are sometimes achieved at the cost of cardiovascular adverse events that may limit the overall benefit of treatment. Cardio-oncology is a recent discipline that aims to prevent, screen and manage cardiovascular diseases associated with or secondary to cancer treatment without compromising its effectiveness. These goals must therefore be integrated into the patient care program at the time of cancer diagnosis. Therefore, a cardiovascular toxicity risk assessment should be conducted prior treatment to identify patients candidate for closer monitoring. In parallel with their oncologic follow-up, these high-risk patients should receive cardiovascular follow-up that should not be restricted to a solely measurement of the left ventricular ejection fraction. Indeed, toxicities can be multiple, so the assessment must be comprehensive and should include at least clinical examination, ECG, cardiac imaging, and sometimes biomarkers. In the case of cardiovascular events, this organisation will enable an earlier and coordinated management with oncologists, which will result in an improvement of the patients' overall prognosis.
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Affiliation(s)
- Franck Thuny
- Aix-Marseille université, Assistance publique-Hôpitaux de Marseille, unité Nord insuffisance cardiaque et valvulopathies, centre méditerranéen hospitalo-universitaire de cardiologie oncologique - Medi-CO Center, hôpital Nord, Marseille, France
| | - Jennifer Cautela
- Aix-Marseille université, Assistance publique-Hôpitaux de Marseille, unité Nord insuffisance cardiaque et valvulopathies, centre méditerranéen hospitalo-universitaire de cardiologie oncologique - Medi-CO Center, hôpital Nord, Marseille, France
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Thuny F, Trevisan L, Cautela J. Response to the letter: The high burden of coronary artery disease in heart failure with preserved ejection fraction. Arch Cardiovasc Dis 2018; 111:227. [DOI: 10.1016/j.acvd.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
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Trevisan L, Cautela J, Resseguier N, Laine M, Arques S, Pinto J, Orabona M, Barraud J, Peyrol M, Paganelli F, Bonello L, Thuny F. Prevalence and characteristics of coronary artery disease in heart failure with preserved and mid-range ejection fractions: A systematic angiography approach. Arch Cardiovasc Dis 2017; 111:109-118. [PMID: 29031580 DOI: 10.1016/j.acvd.2017.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/02/2017] [Accepted: 05/02/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Guidelines recommend careful screening and treatment of coronary artery disease (CAD) in heart failure with preserved or mid-range ejection fraction (HFpEF/HFmEF). AIM We aimed to determine the prevalence and characteristics of CAD using a prospective systematic coronary angiography approach. METHODS A systematic coronary angiography protocol was applied in consecutive patients admitted for HFpEF/HFmEF during a 6-month period in a single centre. History of CAD and results of angiography, including revascularization, were reported. RESULTS Of the 164 patients with HFpEF/HFmEF who were included, an angiography assessment was applied in 108 (66%) (median age: 79 years [interquartile range: 70-85 years]; 54% were women). In our analysis, 64% (95% confidence interval [CI] 55-73%) of patients had a significant coronary stenosis corresponding to a global CAD prevalence of 80% (95% CI 73-88%). The prevalence of CAD was similar for HFpEF and HFmEF. The left main coronary artery presented a significant stenosis in 6.5% of cases and 39% of patients had a two- or three-vessel disease. The rate of significant coronary stenosis was non-significantly higher in patients with a history of CAD. Patients with HFpEF/HFmEF with and without CAD did not differ in clinically meaningful ways, in terms of symptoms or laboratory and echocardiography results. This strategy led to complete revascularization in 36% of patients with significant stenosis and in 23% of all patients with HFpEF/HFmEF. CONCLUSIONS Our study differs from others in that we used a systematic angiography approach. The results suggest a much higher prevalence of CAD in HFpEF/HFmEF than previously reported and should encourage clinicians to aggressively identify this co-morbidity.
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Affiliation(s)
- Lory Trevisan
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Jennifer Cautela
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Noemie Resseguier
- Department of Public Health, Research Unit EA 3279, Aix-Marseille University, 13005 Marseille, France
| | - Marc Laine
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Stephane Arques
- Department of Cardiology, hôpital Aubagne, 13400 Aubagne, France
| | - Johan Pinto
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Morgane Orabona
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Jeremie Barraud
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Michael Peyrol
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Franck Paganelli
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; Inserm, UMRS 1076, Aix-Marseille University, 13005 Marseille, France
| | - Laurent Bonello
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; Inserm, UMRS 1076, Aix-Marseille University, 13005 Marseille, France
| | - Franck Thuny
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France.
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Barraud J, Pinon P, Laine M, Cautela J, Orabona M, Koutbi L, Pinto J, Thuny F, Franceschi F, Paganelli F, Bonello L, Peyrol M. Ventricular Arrhythmia Occurrence and Compliance in Patients Treated With the Wearable Cardioverter Defibrillator Following Percutaneous Coronary Intervention. Heart Lung Circ 2017; 27:984-988. [PMID: 28969980 DOI: 10.1016/j.hlc.2017.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 07/26/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is a life-saving therapy in patients with high risk of arrhythmic death. We aimed to evaluate ventricular arrhythmia (VA) occurrence rate and compliance with the WCD during the first 90 days following myocardial revascularisation with percutaneous coronary intervention (PCI) in patients with left ventricular ejection fraction (LVEF) <30%. METHODS From September 2015 to November 2016, clinical characteristics, WCD recordings and compliance data of the aforementioned subset of patients were prospectively collected. RESULTS Twenty-four patients (men=20, 80%) were included in this analysis. Mean age was 56±10 years and mean LVEF at enrolment was 26.6±4.3%. During a mean wearing period of 3.0±1.3 months, two episodes of VA occurred in two patients (8.3%): one successfully treated with WCD shock and one with spontaneous termination. The mean and median daily use of the WCD was 21.5hours and 23.5hours a day, respectively. Eighteen patients (75%) wore the WCD more than 22hours a day. CONCLUSIONS The rate of VA, during the WCD period use after myocardial revascularisation with PCI, was high in our study. Otherwise it underlined that patient compliance is critical during the WCD period use. Remote monitoring and patient education are keys to achieve good compliance.
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Affiliation(s)
- Jérémie Barraud
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Pauline Pinon
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Marc Laine
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Jennifer Cautela
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Morgane Orabona
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Linda Koutbi
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Hôpital Timone, Marseille, France
| | - Johan Pinto
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Franck Thuny
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Frederic Franceschi
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Hôpital Timone, Marseille, France
| | - Franck Paganelli
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Michaël Peyrol
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France.
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49
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Vairo D, Bruzzese L, Marlinge M, Fuster L, Adjriou N, Kipson N, Brunet P, Cautela J, Jammes Y, Mottola G, Burtey S, Ruf J, Guieu R, Fenouillet E. Towards Addressing the Body Electrolyte Environment via Sweat Analysis:Pilocarpine Iontophoresis Supports Assessment of Plasma Potassium Concentration. Sci Rep 2017; 7:11801. [PMID: 28924220 PMCID: PMC5603548 DOI: 10.1038/s41598-017-12211-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022] Open
Abstract
Electrolyte concentration in sweat depends on environmental context and physical condition but also on the pathophysiological status. Sweat analyzers may be therefore the future way for biological survey although how sweat electrolyte composition can reflect plasma composition remains unclear. We recruited 10 healthy subjects and 6 patients to have a broad range of plasma electrolyte concentrations (chloride, potassium and sodium) and pH. These variables were compared to those found in sweat produced following cycling exercise or pilocarpine iontophoresis, a condition compatible with operating a wearable device. We found no correlation between plasma and sweat parameters when exercise-induced sweat was analyzed, and we could identify a correlation only between plasma and sweat potassium concentration (R = 0.78, p < 0.01) when sweat was induced using pilocarpine iontophoresis. We tested measurement repeatability in sweat at 24hr-interval for 3 days in 4 subjects and found a great intra-individual variability regarding all parameters in exercise-induced sweat whereas similar electrolyte levels were measured in pilocarpine-induced sweat. Thus, electrolyte concentration in sweat sampled following physical activity does not reflect concentration in plasma while pilocarpine iontophoresis appears to be promising to reproducibly address sweat electrolytes, and to make an indirect evaluation of plasma potassium concentration in chronic kidney disease and arrhythmia.
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Affiliation(s)
- Donato Vairo
- UMR MD2, Aix Marseille University, Marseille, France
| | | | - Marion Marlinge
- Laboratory of Biochemistry, Timone Hospital, Marseille, France
| | - Lea Fuster
- Laboratory of Biochemistry, Timone Hospital, Marseille, France
| | - Nabil Adjriou
- UMR MD2, Aix Marseille University, Marseille, France
| | | | - Philippe Brunet
- Department of Dialysis, Conception Hospital, Marseille, France.,INSERM, U 1076, Marseille, France
| | | | - Yves Jammes
- UMR MD2, Aix Marseille University, Marseille, France
| | | | - Stephane Burtey
- Department of Dialysis, Conception Hospital, Marseille, France.,INSERM, U 1076, Marseille, France
| | - Jean Ruf
- UMR MD2, Aix Marseille University, Marseille, France.,INSERM, Paris, France
| | - Regis Guieu
- UMR MD2, Aix Marseille University, Marseille, France. .,Laboratory of Biochemistry, Timone Hospital, Marseille, France.
| | - Emmanuel Fenouillet
- UMR MD2, Aix Marseille University, Marseille, France.,CNRS, Institut des Sciences Biologiques, Paris, France
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50
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Affiliation(s)
- Jennifer Cautela
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Mediterranean University Cardio-Oncology Center, Aix-Marseille Univ, Hôpital NORD, Assistance Publique-Hôpitaux de Marseille, Marseille, France2Oncosafety Network of the Early Phases Cancer Trials Center, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, Marseille, France3Groupe Méditerranéen de Cardio-Oncologie, Marseille, France4Mediterranean Association for Research and Studies in Cardiology, Marseille, France
| | - Nathalie Lalevee
- Technological Advances for Genomics and Clinics, Aix-Marseille Univ, UMR/INSERM 1090, Marseille, France
| | - Franck Thuny
- Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Mediterranean University Cardio-Oncology Center, Aix-Marseille Univ, Hôpital NORD, Assistance Publique-Hôpitaux de Marseille, Marseille, France2Oncosafety Network of the Early Phases Cancer Trials Center, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, Marseille, France3Groupe Méditerranéen de Cardio-Oncologie, Marseille, France4Mediterranean Association for Research and Studies in Cardiology, Marseille, France
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