Impact of balloon predilatation in patients with reduced versus preserved ejection fraction during transcatheter aortic valve implantation

Background

Although there is a trend toward direct transcatheter aortic valve implantation (TAVI), still balloon predilatation is necessary in some cases, especially in patients with severe calcification. However, predilatation including rapid ventricular pacing may have adverse outcomes, especially in patients with reduced ejection factor (EF).

Objective

To evaluate the impact of predilatation on in-hospital outcomes in patients with reduced versus preserved EF underwent TAVI.

Methods

This was a prospective observational study including 110 patients (72 patients with preserved EF (≥50%) and 38 patients with reduced EF (<50%)) who underwent TAVI. The two groups were compared regarding in-hospital outcomes.

Results

Predilatation was done routinely in all 110 patients. The mean age was significantly higher in patients with preserved EF (82.76  ±  5.74 vs. 80.13  ±  6.51 years; p = 0.03). The majority (51.4%) of patients with preserved EF were females but the majority (73.7%) of those with reduced EF were males ( P < 0.001). Predilatation showed no statistical difference regarding in-hospital mortality (2.6% vs. 1.4%; p  =  0.29), hemodynamic instability (5.3% vs. 0.0%; p = 0.11), stroke (0% vs. 1.4%; p = 0.67), conduction defects (13.2% vs. 19.4%; p = 0.29), permanent pacemaker implantation (7.9% vs. 5.5%; p = 0.45), paravalvular leakage (5.3% vs. 2.8%; p = 0.42), vascular complications (7.9% vs. 11.1%; p  =  0.43), and acute kidney injury (7.9% vs. 7%; p  =  0.4) in patients with reduced versus preserved EF, respectively.

Conclusion

When balloon predilatation is inevitable during TAVI it is safe in patients with reduced as well as preserved EF with no added risk of hemodynamic instability or other outcomes.

Comparative proteomic analysis of cardiac mitochondria-associated reticulum membranes in type 2 diabetes

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): INSERM U1060

Introduction

The prevalence of type 2 diabetes (T2D) is increasing worldwide with cardiovascular complications being a leading cause of T2D-related morbi-mortality, notably diabetic cardiomyopathy (DCM). The involvement of the mitochondria-associated reticular membranes (MAM) in diabetic cardiomyopathy starts to be demonstrated, notably for Ca²+ regulation of cellular processes. However, while the MAM protein composition was studied in several organs, none was conducted on cardiac MAM.

Objective

We aim to characterize the cardiac MAM proteome by an exhaustive mass spectrometry-based proteomics together with the effect of early T2D using two well-established obesogenic diabetic mouse models (high-fat high-sucrose diet, HFHSD, and leptin-deficient ob/ob).

Methods

12 weeks old ob/ob mice versus 16 weeks HFHSD-fed mice were characterized at the subcellular level. MAM were enriched by subcellular fractionation, then protein compostion was assessed by mass spectrometry. Uniprot and Panther softwares were used to study the MAM proteomes. At the cellular level, mitochondrial calcium transfer was assessed using a mitochondrial Ca²+ sensor, while contractile function was evaluated by studying cardiomyocyte Ca²+ transients and echocardiography.

Results

Compartmental analysis of MAMs showed an enrichment of proteins from mitochondria, reticulum, cytoskeleton and plasma membrane. On the functional level, molecular and biological annotations revealed that cardiac MAM presents mainly enzymes and transporters, associated to 4 main biological processes: cellular and metabolic processes, localization and cellular component organization. Both the cellular response to stress and the lipid metabolism processes were found upregulated in both diabetic cardiac MAM. While Ca²+ transport was downregulated in the HFHSD MAM, this process was upregulated in the ob/ob MAM. However, no change in the histamine-induced reticulum-mitochondria Ca²+ transfer was observed in the ob/ob cardiomyocytes. Contrary to the HFHSD mice, the ob/ob mice did not exhibit any cardiac hypertrophy, by echocardiography or electrophysiology. Echocardiography further revealed no diastolic dysfunction in the ob/ob mice but a mild strain rate reduction with preserved ejection fraction.

Conclusion

Our data investigate the protein composition of the cardiac MAM and unravel the main alterations of the MAM proteome in ob/ob model versus our HFHSD results. Importantly, while being two models of early diabetic cardiomyopathy, the MAM proteome is altered differently, emphasizing on the complexity of diabetic animal models. Indeed, these ob/ob mice, recognized as a T2D and obese mouse model, do not recapitulate the main hallmarks of DCM, i.e. diastolic dysfunction and cardiac hypertrophy, contrary to the heart failure with preserved ejection fraction (HFpEF) observed in the HFHSD mice, yet the lipotoxicity in the ob/ob cardiomyocytes may contribute to the early systolic dysfunction.

Cerebrovascular accidents in patients supported with veno-arterial extra-corporeal membrane oxygenation- is duration of support important?

Purpose of study

Veno-Arterial Extra-corporeal Membrane Oxygenation (VA-ECMO) is indicated for refractory cardiac and/or respiratory failure. Adverse events remain considerable despite best practices. We specifically aimed to understand risk factors associated with cerebrovascular accidents (CVA) in patients who underwent VA-ECMO support.

Methods

We retrospectively assessed all VA-ECMO patients from 2007 to 2019 at our institution. We identified those who experienced a CVA while supported by VA-ECMO. Patients with the primary event (CVA) were matched to controls (no CVA) based on age and sex. Comparisons were made between groups using McNemar's, Mantel-Haenszel, and Wilcoxon Signed-Rank tests where appropriate.

Results

Of the 278 VA-ECMO patients in the registry, 32 patients who experienced a CVA were identified; 24 (8.6%) ischemic and 8 (2.9%) hemorrhagic. Median age was 59.5 years (inter-quartile range: 49–65 years) and 75% of patients were males. Hypertension, diabetes, CAD and CHF were common co-morbidities (Table 1). Cardiogenic shock was the most common indication for VA-ECMO support in both cohorts, 75% in cases and 71.9% in controls. Cannulation strategies were identified as central or peripheral. There was a significant association of duration of VA-ECMO support with incidence of CVA, with a p-value of 0.03. Regression analysis showed a trend of increased risk of CVA by 4% for each additional day on VA-ECMO, however, this was not statistically significant (Odds ratio: 1.04; confidence interval 1.00–1.08). Most common outcome was death followed by decannulation to recovery and bridge to LVAD.

Conclusion

Ischemic and hemorrhagic CVAs are not uncommon during VA-ECMO support. Our case control study shows an association of duration of VA-ECMO support with incidence of CVA. This underscores the importance of timely assessment and weaning or bridging of VA-ECMO patients to their next management step.

Funding Acknowledgement

Type of funding sources: None.

Evidence of West Nile virus circulation among humans in central northern Algeria

West Nile Virus (WNV) is the most widely distributed flavivirus worldwide. It is a mosquito-borne virus, and birds constitute its natural reservoir. Humans and equines are considered accidental hosts. Human WNV infections are usually asymptomatic or express as a mild febrile syndrome; however, in around 1% of cases they are responsible for more serious neurological diseases with a potentially lethal outcome. In the Mediterranean basin the virus circulation is regarded as endemic. Outbreaks of WNV meningoencephalitis are regularly notified, especially during summer and autumn seasons. In Algeria, although some surveys have reported WNV activity in the Sahara, to date few data are available about virus circulation in the northern part of the country. We conducted this study to detect possible WNV activity in this part of Algeria. For this purpose, in 2010 a total of 164 human sera were collected from native patients of the Algiers district and surrounding areas, then tested retrospectively for IgG anti-WNV by ELISA. Plaque reduction neutralization technique (PRNT) was used for result confirmation. In this cohort, 9.8% of the 164 collected sera returned positive for anti-WNV IgG; after confirmation by PRNT; 6.7% had specific neutralizing antibodies. No statistically significant difference was observed according to the sex or transfusion status of the patients. In conclusion, these data show for the first time serological evidence of WNV circulation in Algiers and its surrounding areas. They also highlight the need for implementing an integrated surveillance programme covering all aspects of WNV disease in order to better understand the circulation dynamics of WNV in this region. Other flaviviruses antigenically related to WNV should be investigated, given the evidence of serological cross-reaction, as specific IgG antibodies decrease after PRNT confirmation.

Off-pump Revascularization with Bilateral versus Single Mammary Arteries-A Propensity Score-Matched Analysis

BACKGROUND

Coronary artery bypass grafting is the first-line therapy for severe multivessel coronary artery disease. We aimed to investigate the clinical outcome in patients undergoing isolated off-pump surgery with the single or bilateral internal mammary artery (SIMA or BIMA) approach.

METHODS

We performed a propensity score-matched analysis in 1,852 consecutive patients, aged 50 to 70 years, who underwent myocardial revascularization at our institution between July 2009 and August 2016. Primary end point was the probability of survival.

RESULTS

Mean follow-up was 36.3 (range: 0.1-89.6) months. The probability of survival in the SIMA and BIMA groups was 98.6 and 99.0% at year 1, 92.0 and 92.5% at year 5, and 85.6 and 81.6% at year 7, respectively, with a hazard ratio (HR) of mortality for the BIMA group versus the SIMA group of 0.98 (95% confidence interval[CI]: 0.64-1.52; p = 0.94). There was evidence for interaction between diabetes and study group on mortality risk (HR = 2.59, 95% CI: 1.07-6.23; p = 0.034). Freedom from mediastinitis/wound infection was higher in the SIMA group than in the BIMA group (99.5 and 96.9%, respectively; HR of an event = 6.39, 95% CI: 2.88-14.18; p < 0.001). The corresponding values in the subgroups of diabetic patients were 98.6 and 90.9%, respectively (HR = 6.45, 95% CI: 2.24-18.58; p = 0.001). Mediastinitis/wound infection was associated with increased mortality risk (HR = 2.96, 95% CI: 1.29-6.78; p = 0.010).

CONCLUSION

Overall, our data indicate similar probability of survival up to a maximum follow-up of 7 years by off-pump surgery with the SIMA or BIMA approach. However, in diabetic patients, the clinical outcome indicates caution regarding the use of the BIMA approach.

Investigation of Clostridium botulinum in commercial poultry farms in France between 2011 and 2013

Between 2011 and 2013, 17 poultry botulism outbreaks were investigated in France. All cases were associated with Clostridium botulinum type C-D. Presence of C. botulinum was studied in seven areas: poultry house, changing room, ventilation system, surroundings, animal reservoirs, water, and feed. Swabs, litter, soil, darkling beetles, rodents and wild bird droppings, feed and water samples were collected. The presence of C. botulinum type C-D in the environment of affected flocks was detected in 39.5% of the 185 samples analysed by real-time polymerase chain reaction. C. botulinum type C-D was reported in each area. Four areas were more frequently contaminated, being found positive in more than one-half of farms: darkling beetles (9/11), poultry house (14/17), water (13/16) and surroundings (11/16). After cleaning and disinfection, the ventilation system and/or the soil (in the houses and the surroundings) returned positive results in four out of eight poultry farms. Consequently, darkling beetles, the drinking water, the ventilation system and the soil in the surroundings and the houses were identified as the main critical contaminated areas to consider in poultry farms to prevent recurrence of botulism outbreaks.

Seasonal variations and trends in weight and arm circumference of non-pregnant rural Senegalese women, 1990–1997

OBJECTIVE

To describe levels, monthly variations and trends in weight and arm circumference of non-pregnant lactating women living in the Sahel, characterized by one short yearly rainy season (July-October).

METHODS

A mixed unbalanced cross-sectional longitudinal observational study conducted at 3, 5, 7 and 10 months postpartum among 3869 women living in the Sine area in central Senegal who had brought their infants into dispensaries for immunization from January 1990 to February 1997, and 1-5 consecutive children per woman (26 106 visits).

RESULTS

Mean weight was 55.7 kg (s.d.: 7.1), but it varied by 2.5-3.9 kg each year, from high means during the dry season (March-May) to low means at the end of the rainy season (September-November). The prevalence of underweight, overweight and obesity (body mass index (BMI)<18.5, 25-29.9 and >30 kg/m(2), respectively) was 7.6% (95% confidence interval: 7.3, 7.9), 6.4% (6.1, 6.7) and 0.4% (0.3, 0.4), but varied strongly by season (P<0.0001 for all). Unlike weight, mean arm increased during the early rains, a peak season of agricultural work (+0.10 cm/month (s.d.: 0.6) from June to August vs -0.35 kg/month (s.d.: 1.1) for weight). BMI and arm circumference were positively associated with age (mean: 20.8 vs 22.2 kg/m(2) and 25.3 vs 27.4 cm, at 20-24 and 40-49 years, respectively, P<0.0001 for both).

CONCLUSIONS

Season was a major determinant of the anthropometric status of rural African women. Negative energy balance reduced body weight from the onset of agricultural labour, while arm circumference increased during early rains, probably due to high physical activity.

[An incomplete form of pachydermoperiostosis. Diagnosis of finger clubbing]

INTRODUCTION

The finger clubbing is most of the time associated with cardiovascular and pulmonary diseases. Pachydermoperiostosis also known as osteodermopathic syndrome, an hereditary disorder, is a rare cause of finger clubbing which might be difficult to diagnose in an incomplete form.

EXEGESIS

We report a 36 years old black man presenting over many years polyarthralgias, broadening of fingers and clubbing of the fingers and toes extremities. This was mentioned on other family members. The physical examination was otherwise unremarkable. There were no skin thickening, no psoriasis-like and cardio-pulmonary disease features. These following exams were normal; Hemogram, fibrinogen, C reactive protein, rheumatoïd factor, serum calcium and phosphorus, thyroid hormones, growth hormone, chest X-ray, gastroduodenoscopy, electrocardiogram. The skeletal X-ray documented a widespread bone formation, a sacro-iliac osteosclerosis and interosseous ossifications betwen tibias and fibulas.

CONCLUSION

Pachydermoperiostosis diagnosis was set up on 3 out of the 4 Borochowitz criteria. The absence of pachyderma defines this incomplete form. The osteoarticular manifestations lead mainly to differential diagnosis with the secondary hypertrophic osteoarthropathy and chronic inflammatory rheumatisms. The underlying pathogenic mechanism of this disease remains still unclear.

[Occupational asthma in a Senegalese car sprayer. Diagnostic and medico-legal problems]

The industrial development policy adopted by African countries since their independence has contrasted with the relative rarity of occupational asthma in workers exposed to different situations and substances known to generate occupational asthma. Asthma occurring in a Senegalese car sprayer had persisted for twenty years before the its work-related nature was recognized. This observation demonstrates the need for: 1. Education to make health care personnel, as well as workers and employers, more aware of the clinical aspects of asthma. Educational programs should include diagnostic and preventive measures for respiratory occupational diseases including occupational asthma. 2. A registration system for occupational diseases so the occupational nature of diseases can acquire legal recognition. 3. Cooperative efforts between general practitioners, occupational physicians, physiologists and lung specialists in order to create reference laboratories where tests can be performed to confirm the diagnosis of occupational asthma, a disease which has not yet been included on the list of occupational diseases.

[Hyperthyroidism and diabetes mellitus: analysis of 10 African cases]

This retrospective study of 10 patients with hyperthyroidisma and diabetes mellitus concerned 8 women and 2 men, aged from 15 to 77 years. The two disease developed at the same time in 8 cases. Diabetes mellitus occurred first in 2 cases. Common signs were loss of weight. Hyperthyroidism led to tachycardia at more than 100 bpm. Diarrhea was observed simultaneously in 2 cases and muscular weakness in 5. Goiter was found in 10 cases with a diffuse aspect. Graves' disease was diagnosed with exophthalmia in 9 cases and affected both eyes in 8. Elevated levels of thyroid hormones confirmed diagnosis in 8 cases. Diabetes was insulin-dependent in 3 cases and non-insulin dependent in the 7 others. IDDM patients (2 female and 1 male) were aged 15, 17 and 38. Keto acidosis was the first symptom in all cases. NIDDM patients (6 female and 1 male) were aged between 37 and 77.