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Fakih W, Mroueh A, Gong DS, Kikuchi S, Pieper MP, Kindo M, Mazzucottelli JP, Mommerot A, Kanso M, Ohlmann P, Morel O, Schini-Kerth V, Jesel L. Activated factor X stimulates atrial endothelial cells and tissues to promote remodeling responses through AT1R/NADPH oxidases/SGLT1/2. Cardiovasc Res 2024:cvae101. [PMID: 38742661 DOI: 10.1093/cvr/cvae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 05/16/2024] Open
Abstract
AIMS Atrial fibrillation (AF), the most common cardiac arrhythmia favoring ischemic stroke and heart failure involves left atrial remodeling, fibrosis and a complex interplay between cardiovascular risk factors. This study examined whether activated factor X (FXa) induces pro-remodeling and pro-fibrotic responses in atrial endothelial cells (AECs) and human atrial tissues and determined the underlying mechanisms. METHODS AND RESULTS AECs were from porcine hearts and human right atrial appendages (RAA) from patients undergoing heart surgery. Protein expression levels were assessed by Western blot and immunofluorescence staining, mRNA levels by RT-qPCR, formation of reactive oxygen species (ROS) and NO using fluorescent probes, thrombin and angiotensin II generation by specific assays, fibrosis by Sirius red staining and senescence by senescence-associated beta-galactosidase (SA-β-gal) activity.In AECs, FXa increased ROS formation, senescence (SA-β-gal activity, p53, p21), angiotensin II generation and the expression of pro-inflammatory (VCAM-1, MCP-1), pro-thrombotic (tissue factor), pro-fibrotic (TGF-β and collagen-1/3a) and pro-remodeling (MMP-2/9) markers whereas eNOS levels and NO formation were reduced. These effects were prevented by inhibitors of FXa but not thrombin, protease-activated receptors antagonists (PAR-1/2) and inhibitors of NADPH oxidases, ACE, AT1R, SGLT1/SGLT2. FXa also increased expression levels of ACE1, AT1R, SGLT1/2 proteins which was prevented by SGLT1/2 inhibitors. Human RAA showed tissue factor mRNA levels that correlated with markers of endothelial activation, pro-remodeling and pro-fibrotic responses and SGLT1/2 mRNA levels. They also showed protein expression levels of ACE1, AT1R, p22phox, SGLT1/2, and immunofluorescence signals of nitrotyrosine and SGLT1/2 colocalized with those of CD31. FXa increased oxidative stress levels which were prevented by inhibitors of the AT1R/NADPH oxidases/SGLT1/2 pathway. CONCLUSIONS FXa promotes oxidative stress triggering premature endothelial senescence and dysfunction associated with pro-thrombotic, pro-remodeling and pro-fibrotic responses in AECs and in human RAA involving the AT1R/NADPH oxidases/SGLT1/2 pro-oxidant pathway. Targeting this pathway may be of interest to prevent atrial remodeling and the progression of atrial fibrillation substrate.
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Affiliation(s)
- Walaa Fakih
- University of Strasbourg, UR 3074, Translational Cardiovascular Medicine, Biomedicine Research Center of Strasbourg, Strasbourg, France
| | - Ali Mroueh
- University of Strasbourg, UR 3074, Translational Cardiovascular Medicine, Biomedicine Research Center of Strasbourg, Strasbourg, France
| | - Dal-Seong Gong
- University of Strasbourg, UR 3074, Translational Cardiovascular Medicine, Biomedicine Research Center of Strasbourg, Strasbourg, France
| | - Shinnosuke Kikuchi
- University of Strasbourg, UR 3074, Translational Cardiovascular Medicine, Biomedicine Research Center of Strasbourg, Strasbourg, France
- Cardiology Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Michel Kindo
- Cardiology Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Arnaud Mommerot
- Cardiology Department, Strasbourg University Hospital, Strasbourg, France
| | - Mohamad Kanso
- Cardiology Department, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Cardiology Department, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- University of Strasbourg, UR 3074, Translational Cardiovascular Medicine, Biomedicine Research Center of Strasbourg, Strasbourg, France
- Cardiology Department, Strasbourg University Hospital, Strasbourg, France
| | - Valérie Schini-Kerth
- University of Strasbourg, UR 3074, Translational Cardiovascular Medicine, Biomedicine Research Center of Strasbourg, Strasbourg, France
| | - Laurence Jesel
- University of Strasbourg, UR 3074, Translational Cardiovascular Medicine, Biomedicine Research Center of Strasbourg, Strasbourg, France
- Cardiology Department, Strasbourg University Hospital, Strasbourg, France
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation. J Am Heart Assoc 2024; 13:e032777. [PMID: 38639357 DOI: 10.1161/jaha.123.032777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND A delayed and recurrent complete atrioventricular block (CAVB) is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Post-TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new-onset right bundle-branch block (RBBB) after TAVR on PPI remains unknown. METHODS AND RESULTS In total, 407 patients with aortic stenosis who underwent TAVR were included in this analysis. Intraprocedural CAVB was defined as CAVB that occurred during TAVR. A 12-lead ECG was evaluated at baseline, immediately after TAVR, on postoperative days 1 and 5, and according to the need to identify new-onset bundle-branch block (BBB) and CAVB after TAVR. Forty patients (9.8%) required PPI, 17 patients (4.2%) had persistent intraprocedural CAVB, and 23 (5.7%) had delayed or recurrent CAVB after TAVR. The rates of no new-onset BBB, new-onset left BBB, and new-onset RBBB were 65.1%, 26.8%, and 4.7%, respectively. Compared with patients without new-onset BBB and those with new-onset left BBB, the rate of PPI was higher in patients with new-onset RBBB (3.4% versus 5.6% versus 44.4%, P<0.0001). On post-TAVR evaluation in patients without persistent intraprocedural CAVB, the multivariate logistic regression analysis showed that new-onset RBBB was a statistically significant predictor of PPI compared with no new-onset BBB (odds ratio [OR], 18.0 [95% CI, 5.94-54.4]) in addition to the use of a self-expanding valve (OR, 2.97 [95% CI, 1.09-8.10]). CONCLUSIONS Patients with new-onset RBBB after TAVR are at high risk for PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yugo Minamimoto
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Kensuke Matsushita
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Tomoki Cho
- Cardiovascular Center Yokohama City University Medical Center Yokohama Japan
| | - Kengo Terasaka
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yohei Hanajima
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Hidefumi Nakahashi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Masaomi Gohbara
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yuichiro Kimura
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Shota Yasuda
- Cardiovascular Center Yokohama City University Medical Center Yokohama Japan
| | - Kozo Okada
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yasushi Matsuzawa
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Noriaki Iwahashi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Masami Kosuge
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Toshiaki Ebina
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Strasbourg France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Strasbourg France
| | - Keiji Uchida
- Cardiovascular Center Yokohama City University Medical Center Yokohama Japan
| | - Kiyoshi Hibi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
- Department of Cardiology Yokohama City University Graduate School of Medicine Yokohama Japan
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Chen B, Ngremmadji MA, Morel O. Editorial for "A Hybrid Model for Fetal Growth Restriction Assessment by Automatic Placental Radiomics on T2-Weighted MRI and Multi-Feature Fusion". J Magn Reson Imaging 2024. [PMID: 38708929 DOI: 10.1002/jmri.29418] [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] [Received: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Bailiang Chen
- CIC-IT 1433, CHRU Nancy, Vandœuvre-lès-Nancy, France
- INSERM U1254, IADI, Université de Lorraine, Nancy, France
| | | | - Olivier Morel
- INSERM U1254, IADI, Université de Lorraine, Nancy, France
- Obstetrics and Fetal Medicine Unit, CHRU of Nancy, Nancy, France
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Marzak H, Fitouchi S, Labani A, Hammann J, Ringele R, Kanso M, Cardi T, Schatz A, Ohlmann P, Morel O, Jesel L. Left atrial remodeling and voltage-guided ablation outcome in obese patients with persistent atrial fibrillation. Front Cardiovasc Med 2024; 11:1362903. [PMID: 38628316 PMCID: PMC11018888 DOI: 10.3389/fcvm.2024.1362903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background Obesity is a risk factor for atrial fibrillation (AF). Data regarding left atrial (LA) remodeling in obese patients are scarce. Whether obesity favors AF recurrence after catheter ablation (CA) is still controversial. We assessed the distribution of epicardial atrial fat on computed tomography (CT), LA bipolar voltage, low-voltage zone (LVZ) extent, and the outcome of voltage-guided ablation of persistent AF in obese and non-obese patients. Methods A total of 139 patients with persistent AF undergoing a first voltage-guided ablation were enrolled and divided into two groups: 74 were non-obese and 65 were obese. Epicardial adipose tissue (EAT) was assessed on a CT scanner. LA endocardial voltage maps were obtained using a 3D mapping system in sinus rhythm. LVZ was defined as a bipolar peak-to-peak voltage amplitude <0.5 mV. Results LA volume, voltage, and EAT amount were similar in the two groups. LVZ was less frequent in obese patients [12 (18.8%) vs. 26 (35.1%), p = 0.05], particularly on the anterior wall. The posterior and lateral EATs were correlated with posterior and lateral LVZ extent, respectively, in obese patients. After 36 months of follow-up, the AF-free survival rate was similar. Lateral EAT [odds ratio (OR) 1.21, 95% confidence interval (CI) 1-1.4, p = 0.04] and P-wave duration (OR 1.03, 95% CI 1-1.05, p = 0.03), but not body mass index (BMI), were predictors of AF recurrence after CA. Conclusion In obese patients, LVZ was less marked than in non-obese patients with similar LA volumes, voltage, and EAT amounts. In obese patients, posterior and lateral EATs were correlated with posterior and lateral LVZ extents. Obese patients had a similar and favorable 36-month outcome after AF ablation. BMI was not predictive of AF recurrence.
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Affiliation(s)
- Halim Marzak
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Simon Fitouchi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Aïssam Labani
- Department of Radiology, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Justine Hammann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Romain Ringele
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Mohamad Kanso
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Thomas Cardi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Alexandre Schatz
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
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Deniau B, Ricbourg A, Weiss E, Paugam-Burtz C, Bonnet MP, Goffinet F, Mignon A, Morel O, Le Guen M, Binczak M, Carbonnel M, Michelet D, Dahmani S, Pili-Floury S, Ducloy Bouthors AS, Mebazaa A, Gayat E. Association of severe postpartum hemorrhage and development of psychological disorders: Results from the prospective and multicentre HELP MOM study. Anaesth Crit Care Pain Med 2024; 43:101340. [PMID: 38128731 DOI: 10.1016/j.accpm.2023.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Post-partum hemorrhage (PPH) is the leading preventable cause of worldwide maternal morbidity and mortality. Risk factors for psychological disorders following PPH are currently unknown. HELP-MOM study aimed to determine the incidence and identify risk factors for psychological disorders following PPH. METHODS HELP-MOM study was a prospective, observational, national, and multicentre study including patients who experienced severe PPH requiring sulprostone. The primary endpoint was the occurrence of psychological disorders (anxiety and/or post-traumatic disorder and/or depression) following PPH, assessed at 1, 3, and 6 months after delivery using HADS, IES-R, and EPDS scales. RESULTS Between November 2014 and November 2016, 332 patients experienced a severe PPH and 236 (72%) answered self-questionnaires at 1, 3, and 6 months. A total of 161 (68%) patients declared a psychological disorder following severe PPH (146 (90.1%) were screened positive for anxiety, 96 (58.9%) were screened positive for post-traumatic stress disorder, and 94 (57.7%) were screened positive for post-partum depression). In multivariable analysis, the use of intra-uterine tamponnement balloon was associated with a lower risk to be screened positive for psychological disorder after severe PPH (OR = 0.33 [IC95% 0.15-0.69], p = 0.004, and after propensity score matching (OR=0.34 [IC95% 0.12-0.94], p = 0.04)). Low hemoglobin values during severe PPH management were associated with a higher risk of being screened positive for psychological disorders. Finally, we did not find differences in desire or pregnancy between patients without or with psychological disorders occurring in the year after severe PPH. DISCUSSION Severe PPH was associated with significant psychosocial morbidity including anxiety, post-traumatic disorder, and depression. This should engage a psychological follow-up. Large cohorts are urgently needed to confirm our results. REGISTRATION ClinicalTrials.gov under number NCT02118038.
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Affiliation(s)
- Benjamin Deniau
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France; Réseau INI-CRCT, France
| | - Aude Ricbourg
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Emmanuel Weiss
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Clichy, France
| | - Catherine Paugam-Burtz
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Clichy, France
| | - Marie-Pierre Bonnet
- Université de Paris Cité, Paris, France; Département d'Anesthésie Réanimation, Hôpital Armand Trousseau, DMU DREAM, APHP, Paris, France
| | - François Goffinet
- Université de Paris Cité, Paris, France; Maternité Cochin-Port Royal, APHP, Paris, France
| | - Alexandre Mignon
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Cochin-Port Royal, APHP, Paris, France; Maternité Cochin-Port Royal, APHP, Paris, France
| | - Olivier Morel
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire de Nancy, Nancy France
| | - Morgan Le Guen
- Université de Versailles Saint-Quentin, France; Département d'Anesthésie, Hôpital Foch, Suresnes, France
| | - Marie Binczak
- Service de Gynécologie et Obstétrique, Hôpital Foch, Suresnes, France
| | - Marie Carbonnel
- Service de Gynécologie et Obstétrique, Hôpital Foch, Suresnes, France
| | - Daphné Michelet
- Département d'Anesthésie et Réanimation, CHU de Reims, France; Université de Reins Champagne Ardenne, Reims, France
| | - Souhayl Dahmani
- Université de Paris Cité, Paris, France; Service d'Anesthésie, Hôpital Robert Debré, APHP, Paris, France; Service d'Anesthésie et Réanimation, Hôpital Robert Ballanger, Aulnay-sous-Bois, France
| | | | | | - Alexandre Mebazaa
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France; Réseau INI-CRCT, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France.
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Bertholdt C, Morel O, Hossu G, Cherifi A, Beaumont M, Eszto ML. Evaluation of utero-placental vascularization using contrast-enhanced ultrasound: Early first trimester maternal perfusion of the intervillous space is confirmed. Placenta 2024; 148:53-58. [PMID: 38401206 DOI: 10.1016/j.placenta.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The objective was to confirm and semiquantify the maternal perfusion of the intervillous space between 8 and 13 + 6 gestational weeks (GW). METHODS We conducted a prospective, multicenter, and nonrandomized open study. Women undergoing voluntary termination of pregnancy at three different gestational ages (Group 8 GW: 8 to 8 + 6 GW, Group 11GW: 11 to 11 + 6 GW and Group 13GW: 13 to 13 + 6 GW) were included, with 14 subjects per group. Women presenting with a personal risk of preeclampsia and/or intrauterine growth restriction were excluded. Contrast-enhanced ultrasound (CEUS) was performed with an intravenous bolus administration of 2.4 mL of microbubbles. The region of interest (ROI) was the entire placenta. The perfusion curves and kinetic parameters, including wash-in perfusion index, peak enhancement and mean transit time, were calculated. RESULTS Of the 42 women initially included, interpretable perfusion curves could be obtained for 33. Regardless of the gestational age, contrast was observed in the entire placenta. No significant difference in perfusion parameters was observed between groups. There was an association between signal intensity and both maternal heart frequency and placental location. Signal intensity was decreased when the heart frequency increased (p < 0.05) and when the placenta was in a nonanterior position (p > 0.005). DISCUSSION We confirmed the presence of maternal perfusion of the intervillous space as early as 8 GW. No significant increase in perfusion parameters was observed between 8 and 13 + 6 GW. Our observations, in accordance with the previous experiment published by Roberts et al.1, strongly challenge the classic trophoblastic plug theory.
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Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - G Hossu
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France; CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - A Cherifi
- CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - M Beaumont
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France; CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - M L Eszto
- Obstetric Department, Metz-Thionville Regional Hospital Center, Mercy Hospital, 1 Allée du Château, 57085, Metz, Cedex 03, France
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Kayem G, Seco A, Vendittelli F, Crenn Hebert C, Dupont C, Branger B, Huissoud C, Fresson J, Winer N, Langer B, Rozenberg P, Morel O, Bonnet MP, Perrotin F, Azria E, Carbillon L, Chiesa C, Raynal P, Rudigoz RC, Patrier S, Beucher G, Dreyfus M, Sentilhes L, Deneux-Tharaux C. Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study. Sci Rep 2024; 14:6564. [PMID: 38503816 PMCID: PMC10951207 DOI: 10.1038/s41598-024-56964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or low-lying. The PACCRETA prospective population-based study took place in 12 regional perinatal networks from 2013 through 2015. All women with one or more prior cesareans and a placenta previa or low lying were included. Placenta accreta spectrum (PAS) was diagnosed at delivery according to standardized clinical and histological criteria. Of the 520,114 deliveries, 396 fulfilled inclusion criteria; 108 were classified with PAS at delivery. Combining the number of prior cesareans and the placental location yielded a rate ranging from 5% for one prior cesarean combined with a posterior low-lying placenta to 63% for three or more prior cesareans combined with placenta previa. The factors independently associated with PAS disorders were BMI ≥ 30, previous uterine surgery, previous postpartum hemorrhage, a higher number of prior cesareans, and a placenta previa. Finally, in this high-risk population, the rate of PAS disorders varies greatly, not only with the number of prior cesareans but also with the exact placental location and some of the women's individual characteristics. Risk stratification is thus possible in this population.
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Affiliation(s)
- Gilles Kayem
- Trousseau Hospital, APHP, Sorbonne University, Paris, France.
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France.
| | - Aurélien Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - Francoise Vendittelli
- Réseau de Santé en Périnatalité d'Auvergne, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Catherine Crenn Hebert
- APHP, Louis Mourier University Hospital, Colombes, France
- Réseau périnatal des Hauts de Seine, PERINAT92, 60 Rue du Général Leclerc, Issy-Les-Moulineaux, France
| | - Corinne Dupont
- University Claude Bernard Lyon 1, RESHAPE INSERM U1290, Univ. Lyon, 7425, Lyon, France
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Bernard Branger
- Réseau « Sécurité Naissance - Naître Ensemble » des Pays-de-la-Loire, Nantes, France
| | - Cyril Huissoud
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
- Maternité de la Croix Rousse, Lyon, France
| | - Jeanne Fresson
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
- CHRU Nancy, Réseau Périnatal Lorrain, Nancy, France
| | - Norbert Winer
- Service de Gynécologie Obstétrique HME Université de Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, 44000, Nantes, France
| | | | | | | | - Marie Pierre Bonnet
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
- Anesthesia and Critical Care Department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - Elie Azria
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
- Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Lionel Carbillon
- Réseau Périnatal NEF Naître dans l'Est Francilien, Paris 13 University, Villetaneuse, France
| | - Coralie Chiesa
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
| | - Pierre Raynal
- CH de Versailles, Site Andre Mignot, Versailles, France
| | - René Charles Rudigoz
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
- Maternité de la Croix Rousse, Lyon, France
| | | | - Gaël Beucher
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Avenue Côte de Nacre, Caen Cedex 9, France
| | - Michel Dreyfus
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Avenue Côte de Nacre, Caen Cedex 9, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Deneux-Tharaux
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
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8
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Manzo-Silberman S, Martin AC, Boissier F, Hauw-Berlemont C, Aissaoui N, Lamblin N, Roubille F, Bonnefoy E, Bonello L, Elbaz M, Schurtz G, Morel O, Leurent G, Levy B, Jouve B, Harbaoui B, Vanzetto G, Combaret N, Lattucca B, Champion S, Lim P, Bruel C, Schneider F, Seronde MF, Bataille V, Gerbaud E, Puymirat E, Delmas C. Sex disparities in cardiogenic shock: Insights from the FRENSHOCK registry. J Crit Care 2024; 82:154785. [PMID: 38493531 DOI: 10.1016/j.jcrc.2024.154785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial. OBJECTIVES The aim was to analyze the impact of sex on aetiology, management and prognosis of CS. METHODS The FRENSHOCK registry included all CS admitted in 49 French Intensive Care Units (ICU) and Intensive Cardiac Care Units (ICCU) between April and October 2016. RESULTS Among the 772 CS patients included, 220 were women (28.5%). Women were older, less smokers, with less history of ischemic cardiac disease (20.5% vs 33.6%) than men. At admission, women presented less cardiac arrest (5.5 vs 12.2%), less mottling (32.5 vs 41.4%) and higher LVEF (30 ± 14 vs 25 ± 13%). Women were more often managed via emergency department while men were directly admitted at ICU/ICCU. Ischemia was the most frequent trigger irrespective of sex (36.4% in women vs 38.2%) but women had less coronary angiogram and PCI (45.9% vs 54% and 24.1 vs 31.3%, respectively). We found no major difference in medication and organ support. Thirty-day mortality (26.4 vs 26.5%), transplant or permanent assist device were similar in both sexes. CONCLUSION Despite some more favorable parameters in initial presentation and no significant difference in medication and support, women shared similar poor prognosis than men. Further analysis is required to cover the lasting gap in knowledge regarding sex specificities to distinguish between differences and inequalities. NCT02703038.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France; Université de Paris, INSERM, Innovative Therapies in Haemostasis, 75006 Paris, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France; Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Bordeaux U1045, France; Université de Paris, 75006 Paris, France.
| | - Anne-Céline Martin
- Cardiology Department, AP HP, European Hospital Georges Pompidou, 75015, France
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire de Poitiers, INSERM CIC 1402 (IS-ALIVE group), Université de Poitiers, Member of FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Poitiers, France
| | - Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Université Paris Cité, Paris, France
| | - Nadia Aissaoui
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre - Université de Paris, Medical School, Paris, France
| | - Nicolas Lamblin
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - François Roubille
- PhyMedExp, Cardiology Department, University of Montpellier, INSERM U1046, CNRS UMR, 9214; INI-CRT, Montpellier, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | | | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France
| | - Guillaume Schurtz
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Guillaume Leurent
- Univ Rennes1, Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1009, F-35000 Rennes, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Bernard Jouve
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, Avenue des Tamaris, 13616, cedex 1, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gérald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benoit Lattucca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Sébastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150 Le Chesnay, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Cédric Bruel
- Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75674 Paris, France
| | - Francis Schneider
- Médecine intensive réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg et Unistra, Faculté de Médecine, Strasbourg, France
| | | | - Vincent Bataille
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Adimep : Association pour la Diffusion de la Médecine de Prévention, Toulouse, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Recherche Enseignement en Insuffisance cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU de Toulouse, France.
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9
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Matsushita K, Delmas C, Marchandot B, Roubille F, Lamblin N, Leurent G, Levy B, Elbaz M, Champion S, Lim P, Schneider F, Khachab H, Carmona A, Trimaille A, Bourenne J, Seronde M, Schurtz G, Harbaoui B, Vanzetto G, Biendel C, Labbe V, Combaret N, Mansourati J, Filippi E, Maizel J, Merdji H, Lattuca B, Gerbaud E, Bonnefoy E, Puymirat E, Bonello L, Morel O. Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry. J Am Heart Assoc 2024; 13:e030975. [PMID: 38390813 PMCID: PMC10944045 DOI: 10.1161/jaha.123.030975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline-directed heart failure (HF) medical therapy (GDMT) and one-year survival rate in patients who are post-CS. METHODS AND RESULTS FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in-hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P<0.001 and 29% versus 37%, P<0.001, respectively). In the overall cohort, the one-year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one-year all-cause mortality compared with non-triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19-0.80]; P=0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one-year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P<0.001). CONCLUSIONS In survivors of CS, the one-year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS.
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Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Clément Delmas
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology DepartmentCHU de MontpellierMontpellierFrance
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Guillaume Leurent
- Department of CardiologyCHU Rennes, Inserm, LTSI‐UMR 1099RennesFrance
| | - Bruno Levy
- Réanimation Médicale BraboisCHRU NancyNancyFrance
| | - Meyer Elbaz
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRBAP‐HP, Hôpital Universitaire Henri‐Mondor, Service de CardiologieCréteilFrance
| | - Francis Schneider
- Médecine Intensive‐RéanimationHôpital de Hautepierre, Hôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of CardiologyCH d’Aix en ProvenceAix‐en‐ProvenceFrance
| | - Adrien Carmona
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Jeremy Bourenne
- Aix Marseille UniversitéService de Réanimation des Urgences, CHU La Timone 2MarseilleFrance
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Brahim Harbaoui
- Cardiology DepartmentHôpital Croix‐Rousse and Hôpital Lyon Sud, Hospices Civils de LyonLyonFrance
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA‐15LyonFrance
| | | | - Caroline Biendel
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Vincent Labbe
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico‐Universitaire APPROCHESAssistance Publique‐Hôpitaux de Paris (APHP), Sorbonne UniversitéParisFrance
| | - Nicolas Combaret
- Department of CardiologyHU Clermont‐Ferrand, CNRS, Université Clermont AuvergneClermont‐FerrandFrance
| | - Jacques Mansourati
- Department of CardiologyUniversity Hospital of Brest and University of Western BrittanyOrphyFrance
| | - Emmanuelle Filippi
- Department of CardiologyGeneral Hospital of Atlantic BrittanyVannesFrance
| | - Julien Maizel
- Intensive Care DepartmentCHU Amiens‐PicardieAmiensFrance
| | - Hamid Merdji
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
- Medical Intensive Care UnitNouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Benoit Lattuca
- Department of CardiologyNîmes University Hospital, Montpellier UniversityNîmesFrance
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional CardiologyHôpital Cardiologique du Haut Lévêque, Bordeaux Cardio‐Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier ArnozanPessacFrance
| | - Eric Bonnefoy
- Intensive Cardiac Care UnitLyon Brom University HospitalLyonFrance
| | - Etienne Puymirat
- Cardiology DepartmentEuropean Georges Pompidou HospitalParisFrance
| | - Laurent Bonello
- Department of Cardiology, Aix‐Marseille Université, Intensive Care Unit, Assistance Publique‐Hôpitaux de MarseilleHôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio)MarseilleFrance
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
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10
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Trimaille A, Carmona A, Kikuchi S, Vu MC, Matsushita K, Marchandot B, Morel O. Association Between Prosthesis-Patient Mismatch and Valve Thrombosis: An Independent Link? Can J Cardiol 2024:S0828-282X(24)00191-0. [PMID: 38438013 DOI: 10.1016/j.cjca.2024.02.026] [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] [Received: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Affiliation(s)
- Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Adrien Carmona
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Shinnosuke Kikuchi
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Manh Cuong Vu
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Kensuke Matsushita
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Benjamin Marchandot
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.
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11
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Marchandot B, Faller E, Akladios C, Matsushita K, Bäck M, Jesel L, Schini-Kerth V, Morel O. Fostering Cardio-Endometriosis: A Call to Action for a Comprehensive Understanding of Cardiovascular Disease in Endometriosis. Eur J Prev Cardiol 2024:zwae087. [PMID: 38421615 DOI: 10.1093/eurjpc/zwae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/02/2024]
Abstract
Recently, a growing body of evidence has highlighted a concerning link between endometriosis and cardiovascular disease. Endometriosis, a chronic, inflammatory hormone-dependent condition affecting 5 to 10% of reproductive-aged women worldwide, has long been associated with reproductive and gynecological consequences. However, emerging research has suggested that it may also contribute to adverse cardiovascular outcomes. This paper aims to shed light on the importance of recognizing cardio-endometriosis as a new and developing sphere of research in the field of cardiology, thereby urging the medical community to address this pressing issue.
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Affiliation(s)
- Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Kensuke Matsushita
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Magnus Bäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Section of Translational Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Université de Lorraine, Institut National de la Sante et de la Recherche Medicale U1116, Nancy, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
| | - Valérie Schini-Kerth
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
- Hanoï Medical University, Vietnam
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12
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Ratio of left ventricular outflow tract area to aortic annulus area and complete atrioventricular block after transcatheter aortic valve replacement for aortic stenosis. Int J Cardiol 2024; 397:131608. [PMID: 38030042 DOI: 10.1016/j.ijcard.2023.131608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Mechanical compression of cardiac conduction system by transcatheter heart valves leads to complete atrioventricular block (CAVB) after transcatheter aortic valve replacement (TAVR). Bulging of ventricular septum in the left ventricular outflow tract (LVOT) may be associated with greater compression of conduction system, leading to irreversible CAVB. OBJECTIVE This study aimed to investigate the association of ventricular septal bulging with TAVR-related CAVB and permanent pacemaker implantation (PPI). METHODS Among 294 consecutive patients with severe aortic stenosis who underwent TAVR between July 2017 and February 2023, 271 were included in the analysis. As a quantitative evaluation of bulging of the ventricular septum, the ratio of LVOT area to aortic annulus area (L/A ratio) was measured at the systolic phase of computed tomography images. RESULTS TAVR-related CAVB occurred in 64 patients (23.6%). Twenty-eight patients (10.3%) required PPI. The optimal thresholds of L/A ratio for predicting TAVR-related CAVB and PPI were 1.0181 and 0.985, respectively. Patients with less than the cut-off values had higher rate of TAVR-related CAVB and PPI than those above (28.3% vs 13.1%, p = 0.0063; 14.7% vs 4.4%, p = 0.0077, respectively). A multivariate analysis showed that L/A ratio < 1.0181 was an independent predictor of TAVR-related CAVB (odds ratio [OR] 2.65, p = 0.011), in addition to prior right bundle branch block (OR 3.76, p = 0.0005), use of a self-expanding valve (OR 1.99, p = 0.030), and short membranous septum length (OR 0.96, p = 0.037). Only L/A ratio < 0.985 was independently associated with PPI (OR 3.70, p = 0.011). CONCLUSION Low L/A ratio is a predictor of TAVR-related CAVB and PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yugo Minamimoto
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kensuke Matsushita
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Terasaka
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Hanajima
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hidefumi Nakahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
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13
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Lattuca B, Mazeau C, Cayla G, Ducrocq G, Guedeney P, Laredo M, Dumaine R, El Kasty M, Kala P, Nejjari M, Hlinomaz O, Morel O, Varenne O, Leclercq F, Payot L, Spaulding C, Beygui F, Rangé G, Motovska Z, Portal JJ, Vicaut E, Collet JP, Montalescot G, Silvain J. Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome. JACC Cardiovasc Interv 2024; 17:359-370. [PMID: 38355265 DOI: 10.1016/j.jcin.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. OBJECTIVES The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. METHODS All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. RESULTS Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (Pinteraction = 0.47) nor the secondary endpoints. CONCLUSIONS In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.
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Affiliation(s)
- Benoit Lattuca
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Cedric Mazeau
- Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Guillaume Cayla
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Grégory Ducrocq
- Cardiology Department, Université de Paris, Hôpital Bichat, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation Centre, Villeneuve St Denis, France
| | - Mohamad El Kasty
- Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Marne-la-Vallée, France
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Paris, France
| | - Ota Hlinomaz
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve Hospital, Montpellier University, Montpellier, France
| | - Laurent Payot
- Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc, France
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Sudden Cardiac Death Expert Center, INSERM U 971, PARCC, Paris, France
| | - Farzin Beygui
- Cardiology Department, Caen University Hospital, ACTION Study Group, Caen, France
| | - Grégoire Rangé
- Cardiology Department, Chartres Hospital, Chartres, France
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jean-Jacques Portal
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), EA 4543, Université Paris 1 Panthéon-Sorbonne Paris, Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), EA 4543, Université Paris 1 Panthéon-Sorbonne Paris, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Agopiantz M, Dap M, Mougniotte G, Bertholdt C, Morel O. [Altruistic surrogacy in France: Context and perspectives]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00040-0. [PMID: 38340981 DOI: 10.1016/j.gofs.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/07/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Mikaël Agopiantz
- Service de médecine de la reproduction, CHRU de Nancy, université de Lorraine, 10, avenue Dr.-Heydenreich, 54000 Nancy, France.
| | - Matthieu Dap
- Service d'obstétrique, CHRU de Nancy, université de Lorraine, Nancy, France
| | - Guillaume Mougniotte
- Laboratoire de biologie de la reproduction, CHRU de Nancy, université de Lorraine, Nancy, France
| | - Charline Bertholdt
- Service d'obstétrique, CHRU de Nancy, université de Lorraine, Nancy, France
| | - Olivier Morel
- Service d'obstétrique, CHRU de Nancy, université de Lorraine, Nancy, France
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Best C, Hascoet JM, Jeanbert E, Morel O, Baumann C, Renard E. Impact of corticosteroid exposure on preterm labor in neonates eventually born at term. J Perinatol 2024; 44:195-202. [PMID: 38040875 DOI: 10.1038/s41372-023-01831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To evaluate the impact of antenatal corticosteroid therapy (ACS) on birth outcomes in term infants exposed during pregnancy. STUDY DESIGN Exposed newborns were compared with non-exposed controls in a 1 to 2 design. Multivariate analysis was used to assess the effect of ACS exposure on neonatal outcomes. RESULT 408 newborns were included (136 exposed to ACS, 272 non-exposed). Mean ± SD head circumference (HC) was 33.7 ± 1.4 vs 34.3 ± 1.6 cm, p = 0.001 in exposed vs controls; birth weight was 3.1 ± 0.4 vs 3.3 ± 0.4 kg, p = 0.0001; and birth height was 47.9 ± 2.1 vs. 49.1 ± 2.0 cm, p < 0.0001. Hypocalcemia (4.4 vs 0.7%, p = 0.019) and feeding difficulties (5.1 vs 1.5%, p = 0.047) were significantly more common in exposed newborns. Multivariate analysis for HC showed a significant independent association with ACS exposure (β = -0.5, p = 0.009). CONCLUSION Term newborns exposed to ACS have lower birth HC and higher risk of neonatal complications. CLINICAL TRIAL REGISTRATION NCT05640596.
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Affiliation(s)
- Céline Best
- Pediatric Endocrinology-Pediatric Department, Children's Hospital, University Hospital of Nancy, Vandœuvre-Les-Nancy, France
| | - Jean-Michel Hascoet
- Department of Neonatology, CHRU of Nancy; DevAH, Lorraine University, Vandœuvre-Les-Nancy, France
| | - Elodie Jeanbert
- DRCI, MPI Department, Methodology, Data Management and Statistics Unit, University Hospital of Nancy, Vandœuvre-Les-Nancy, France
| | - Olivier Morel
- Department of Gynecology and Obstetrics, Maternity Hospital CHRU of Nancy, Lorraine University, Vandœuvre-Les-Nancy, France
| | - Cédric Baumann
- DRCI, MPI Department, Methodology, Data Management and Statistics Unit, University Hospital of Nancy, Vandœuvre-Les-Nancy, France
| | - Emeline Renard
- Pediatric Endocrinology-Pediatric Department, Children's Hospital, University Hospital of Nancy, Vandœuvre-Les-Nancy, France.
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Marchandot B, Trimaille A, Morel O. 2024: Year one-from inception to mass disruption of artificial intelligence in cardiology. Eur Heart J Open 2024; 4:oeae002. [PMID: 38318500 PMCID: PMC10839633 DOI: 10.1093/ehjopen/oeae002] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg University, Strasbourg, France
| | - Antonin Trimaille
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg University, Strasbourg, France
- Hanoï Medical University, Vietnam
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17
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Mroueh A, Fakih W, Carmona A, Trimaille A, Matsushita K, Marchandot B, Qureshi AW, Gong DS, Auger C, Sattler L, Reydel A, Hess S, Oulehri W, Vollmer O, Lessinger JM, Meyer N, Pieper MP, Jesel L, Bäck M, Schini-Kerth V, Morel O. COVID-19 promotes endothelial dysfunction and thrombogenicity: role of proinflammatory cytokines/SGLT2 prooxidant pathway. J Thromb Haemost 2024; 22:286-299. [PMID: 37797691 DOI: 10.1016/j.jtha.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND COVID-19 is associated with an increased risk of cardiovascular complications. Although cytokines have a predominant role in endothelium damage, the precise molecular mechanisms are far from being elucidated. OBJECTIVES The present study hypothesized that inflammation in patients with COVID-19 contributes to endothelial dysfunction through redox-sensitive SGLT2 overexpression and investigated the protective effect of SGLT2 inhibition by empagliflozin. METHODS Human plasma samples were collected from patients with acute, subacute, and long COVID-19 (n = 100), patients with non-COVID-19 and cardiovascular risk factors (n = 50), and healthy volunteers (n = 25). Porcine coronary artery endothelial cells (ECs) were incubated with plasma (10%). Protein expression levels were determined using Western blot analyses and immunofluorescence staining, mRNA expression by quantitative reverse transcription-polymerase chain reaction, and the level of oxidative stress by dihydroethidium staining. Platelet adhesion, aggregation, and thrombin generation were determined. RESULTS Increased plasma levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α, monocyte chemoattractant protein-1, and soluble intercellular adhesion molecule-1 were observed in patients with COVID-19. Exposure of ECs to COVID-19 plasma with high cytokines levels induced redox-sensitive upregulation of SGLT2 expression via proinflammatory cytokines IL-1β, IL-6, and tumor necrosis factor-α which, in turn, fueled endothelial dysfunction, senescence, NF-κB activation, inflammation, platelet adhesion and aggregation, von Willebrand factor secretion, and thrombin generation. The stimulatory effect of COVID-19 plasma was blunted by neutralizing antibodies against proinflammatory cytokines and empagliflozin. CONCLUSION In patients with COVID-19, proinflammatory cytokines induced a redox-sensitive upregulation of SGLT2 expression in ECs, which in turn promoted endothelial injury, senescence, platelet adhesion, aggregation, and thrombin generation. SGLT2 inhibition with empagliflozin appeared as an attractive strategy to restore vascular homeostasis in COVID-19.
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Affiliation(s)
- Ali Mroueh
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Walaa Fakih
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Adrien Carmona
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Antonin Trimaille
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France; Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France. https://twitter.com/A_Trimaille
| | - Kensuke Matsushita
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France; Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Abdul Wahid Qureshi
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Dal-Seong Gong
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Cyril Auger
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Laurent Sattler
- Department Laboratory Haematology, Centre for Thrombosis and Haemostasis, Strasbourg University Hospital, Strasbourg, France
| | - Antje Reydel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Sébastien Hess
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Walid Oulehri
- Department of Critical Care, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Vollmer
- Department of Immunology and Internal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Jean-Marc Lessinger
- Biochemistry and Molecular Biology Laboratory, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Meyer
- Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France
| | | | - Laurence Jesel
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France; Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Magnus Bäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Section of Translational Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Institut National de la Sante et de la Recherche Medicale U1116, Université de Lorraine, Nancy, France
| | - Valérie Schini-Kerth
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France.
| | - Olivier Morel
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France; Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France; Department Laboratory Haematology, Centre for Thrombosis and Haemostasis, Strasbourg University Hospital, Strasbourg, France; Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam.
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18
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Matsushita K, Trimaille A, Marchandot B, Ohlmann P, Morel O. Extensive Impairment of the Hemostatic System Increases Bleeding Events: The Potential of CT-ADP. JACC Cardiovasc Interv 2023; 16:2933. [PMID: 38092501 DOI: 10.1016/j.jcin.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
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Matta A, Kanso M, Kibler M, Carmona A, Trimaille A, Levai L, Greciano S, Plastaras P, Rischner J, Depoli F, Ledet P, Kindo M, Hoang M, Morel O, Ohlmann P. Long-Term Survival Outcomes After Transcatheter Aortic Valve Replacement: A Real-World Experience of a Large Tertiary Center. Am J Cardiol 2023; 207:229-236. [PMID: 37769567 DOI: 10.1016/j.amjcard.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 10/03/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) becomes the leading therapeutic choice for severe aortic stenosis. There is a growing body of knowledge on long-term survival outcomes, but available data from real-world observational studies are scarce. An observational cohort study was conducted on 705 consecutive patients who underwent TAVR at Strasbourg University Hospital between February 2010 and June 2017. We observed the living status (dead or alive) for each study participants by March 2023. The primary end point was to evaluate the all-cause mortality rate beyond 5 years after TAVR, compare the survival outcomes according to valve type, and identify predictors of mortality. Of the 705 study participants, 91.8% of the TAVR procedures were performed through the common femoral artery and 60.6% were treated with a balloon-expandable valve. Over a mean study period of 5.4 ± 3 years, the all-cause mortality rate was 45.8%. No difference in survival outcomes according to valve type was observed (p = 0.449). All-cause mortality rate was associated with age ≥90 years (hazard ratio [HR] 1.625, 1.109 to 2.380, p = 0.013), female gender (HR 0.228, 0.176 to 0.294, p <0.001), diabetes mellitus (HR 1.356, 1.070 to 1.719, p = 0.012), post-TAVR stroke (HR = 2.867, 1.690 to 4.865, p <0.001), and post-TAVR acute kidney injury (HR 1.977, 1.445 to 2.703, p <0.001). In conclusion, the present real-world large tertiary center experience showed that more than half of patients who underwent TAVR are alive beyond 5 years from procedure's date. All-cause mortality is mainly determined by advanced age and co-morbid conditions, and valve type has no advantage on the survival outcomes.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Mohamad Kanso
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Marion Kibler
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Adrien Carmona
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Antonin Trimaille
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Laszlo Levai
- Department of Cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Stephane Greciano
- Department of Cardiology, Civilian Hospitals of Colmar, Colmar, France
| | | | - Jérome Rischner
- Department of Cardiology, Schweitzer's hospital, Colmar, France
| | - Fabien Depoli
- Department of Cardiology, Hospital of Haguenau, Haguenau, France
| | - Pierre Ledet
- Department of Cardiology, Hospital of Haguenau, Haguenau, France
| | - Michel Kindo
- Department of Cardiac Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Minh Hoang
- Department of Cardiac Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France.
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Vallet Y, Baldit A, Bertholdt C, Rahouadj R, Morel O, Laurent C. Characterization of the skin-to-bone mechanical interaction on porcine scalp: A combined experimental and computational approach. J Mech Behav Biomed Mater 2023; 147:106139. [PMID: 37757616 DOI: 10.1016/j.jmbbm.2023.106139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/03/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
Fasciae are soft tissues permitting a large but finite sliding between organs, but also between skin and its underlying elements. The contribution of fasciae has been seldomly reported in the literature, and is usually neglected or overly simplified within simulations. In the present contribution, we propose to use peeling tests in order to quantify the skin-to-bone interaction associated with a simple computational approach based on a geometrical modeling of the skin-to-bone interface. To this aim, a new experimental set up combined with a computational model to characterize the skin-to-bone interaction were proposed. The current work is devoted to the porcine scalp complex since it constitutes a common mechanical surrogate for the human scalp complex. The ad hoc computational approach and peeling set up were firstly evaluated on a validation material, before being used to characterize the skin-to-bone interaction within 6 porcine specimens harvested from the scalp. Our experimental setup allowed to measure the peeling response of porcine scalp, showing a three-regimes response including a plateau force. The computational approach satisfyingly reproduced the peeling response based uniquely on experimental-based parameters and on a discrete modeling of skin-to-bone interface. The presented methodology is a first attempt to propose a computationally efficient geometrically based model able to take into account the skin-to-bone interaction up to failure and corroborated by experimental data, and may be largely extended to the modeling of soft interactions between biological human tissues in the future.
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Affiliation(s)
- Y Vallet
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France.
| | - A Baldit
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500, Vandoeuvre-lès-nancy, France
| | - R Rahouadj
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500, Vandoeuvre-lès-nancy, France
| | - C Laurent
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
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Rozenberg P, Sentilhes L, Goffinet F, Vayssiere C, Senat MV, Haddad B, Morel O, Garabedian C, Vivanti A, Perrotin F, Kayem G, Azria E, Raynal P, Verspyck E, Sananes N, Gallot D, Bretelle F, Seco A, Winer N, Deneux-Tharaux C. Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial. Am J Obstet Gynecol 2023; 229:542.e1-542.e14. [PMID: 37209893 DOI: 10.1016/j.ajog.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Many questions remain about the appropriate use of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that early use of intrauterine balloon tamponade might be beneficial. OBJECTIVE This study aimed to compare the effect of intrauterine balloon tamponade used in combination with second-line uterotonics vs intrauterine balloon tamponade used after the failure of second-line uterotonic treatment on the rate of severe postpartum hemorrhage in women with postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. STUDY DESIGN This multicenter, randomized, controlled, parallel-group, nonblinded trial was conducted at 18 hospitals and enrolled 403 women who had just given birth vaginally at 35 to 42 weeks of gestation. The inclusion criteria were a postpartum hemorrhage refractory to first-line uterotonics (oxytocin) and requiring a second-line uterotonic treatment with sulprostone (E1 prostaglandin). In the study group, the sulprostone infusion was combined with intrauterine tamponade by an ebb balloon performed within 15 minutes of randomization. In the control group, the sulprostone infusion was started alone within 15 minutes of randomization, and if bleeding persisted 30 minutes after the start of sulprostone infusion, intrauterine tamponade using the ebb balloon was performed. In both groups, if the bleeding persisted 30 minutes after the insertion of the balloon, an emergency radiological or surgical invasive procedure was performed. The primary outcome was the proportion of women who either received ≥3 units of packed red blood cells or had a calculated peripartum blood loss of >1000 mL. The prespecified secondary outcomes were the proportions of women who had a calculated blood loss of ≥1500 mL, any transfusion, an invasive procedure and women who were transferred to the intensive care unit. The analysis of the primary outcome with the triangular test was performed sequentially throughout the trial period. RESULTS At the eighth interim analysis, the independent data monitoring committee concluded that the incidence of the primary outcome did not differ between the 2 groups and stopped inclusions. After 11 women were excluded because they met an exclusion criterion or withdrew their consent, 199 and 193 women remained in the study and control groups, respectively, for the intention-to-treat analysis. The women's baseline characteristics were similar in both groups. Peripartum hematocrit level change, which was needed for the calculation of the primary outcome, was missing for 4 women in the study group and 2 women in the control group. The primary outcome occurred in 131 of 195 women (67.2%) in the study group and 142 of 191 women (74.3%) in the control group (risk ratio, 0.90; 95% confidence interval, 0.79-1.03). The groups did not differ substantially for rates of calculated peripartum blood loss pf ≥1500 mL, any transfusion, invasive procedure, and admission to an intensive care unit. Endometritis occurred in 5 women (2.7%) in the study group and none in the control group (P=.06). CONCLUSION The early use of intrauterine balloon tamponade did not reduce the incidence of severe postpartum hemorrhage compared with its use after the failure of second-line uterotonic treatment and before recourse to invasive procedures.
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Affiliation(s)
- Patrick Rozenberg
- Department of Obstetrics and Gynecology, American Hospital of Paris, Neuilly-sur-Seine, France; Université Paris-Saclay, UVSQ, Inserm, Equipe U1018, Epidémiologie clinique, CESP, Montigny-le-Bretonneux, France.
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - François Goffinet
- Department of Obstetrics and Gynecology, Hôpital Cochin-Port Royal, AP-HP, Paris, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Hôpital Paule de Viguier, CHU, Toulouse, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre, France
| | - Bassam Haddad
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Créteil, Créteil, France
| | - Olivier Morel
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Charles Garabedian
- Department of Obstetrics and Gynecology, Hôpital Jeanne de Flandre, Lille, France
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, Hôpital Antoine-Béclère AP-HP, Clamart, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Hôpital Bretonneau, Tours, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Hôpital Armand Trousseau AP-HP, Paris, France
| | - Elie Azria
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Paris, France
| | - Pierre Raynal
- Department of Obstetrics and Gynecology, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Nicolas Sananes
- Department of Obstetrics and Gynecology, Centre Médico-Chirurgical et Obstétrical, Schiltigheim, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand Site Estaing, Clermont Ferrand, France
| | - Florence Bretelle
- Department of Obstetrics and Gynecology, Hôpital Nord, Marseille, France
| | - Aurélien Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Hôpital Mère-Enfant, Nantes, France; NUN INRAE UMR 1280, PhAN Nantes University, Nantes, France
| | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, Université de Paris Cité, CRESS, INSERM, INRA, Paris, France
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Trimaille A, Marchandot B, Morel O. Modulation of inflammatory response after myocardial infarction: one explanation for the cardiovascular benefit of empagliflozin in the EMMY trial? Eur Heart J 2023; 44:3929-3930. [PMID: 37350191 DOI: 10.1093/eurheartj/ehad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Affiliation(s)
- Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, Grand-Est, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 1 Rue Eugene Boeckel, 67000 Strasbourg, Grand-Est, France
| | - Benjamin Marchandot
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, Grand-Est, France
| | - Olivier Morel
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, Grand-Est, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 1 Rue Eugene Boeckel, 67000 Strasbourg, Grand-Est, France
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Eber J, Blondet C, Le Fevre C, Chambrelant I, Hubele F, Morel O, Antoni D, Noel G. Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review. Front Oncol 2023; 13:1240889. [PMID: 37876964 PMCID: PMC10591197 DOI: 10.3389/fonc.2023.1240889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Radiotherapy has significantly improved cancer survival rates, but it also comes with certain unavoidable complications. Breast and thoracic irradiation, for instance, can unintentionally expose the heart to radiation, leading to damage at the cellular level within the myocardial structures. Detecting and monitoring radiation-induced heart disease early on is crucial, and several radionuclide imaging techniques have shown promise in this regard. Method In this 10-year review, we aimed to identify nuclear medicine imaging modalities that can effectively detect early cardiotoxicity following radiation therapy. Through a systematic search on PubMed, we selected nineteen relevant studies based on predefined criteria. Results The data suggest that incidental irradiation of the heart during breast or thoracic radiotherapy can cause early metabolic and perfusion changes. Nuclear imaging plays a prominent role in detecting these subclinical effects, which could potentially serve as predictors of late cardiac complications. Discussion However, further studies with larger populations, longer follow-up periods, and specific heart dosimetric data are needed to better understand the relationship between early detection of cardiac abnormalities and radiation-induced heart disease.
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Affiliation(s)
- Jordan Eber
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Cyrille Blondet
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Nuclear Medicine, Strasbourg, France
| | - Clara Le Fevre
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Isabelle Chambrelant
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Fabrice Hubele
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Nuclear Medicine, Strasbourg, France
| | - Olivier Morel
- Nouvel Hôpital Civil, Department of Cardiology, Strasbourg, France
| | - Delphine Antoni
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Georges Noel
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
- Strasbourg University, Institut Centre national de la recherche scientifique (CNRS), Institut Pluridisciplinaire Hubert Curien (IPHC) UMR 7178, Centre Paul Strauss, UNICANCER, Strasbourg, France
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Vallet Y, Lefebvre J, Laurent C, Rahouadj R, Morel O, Bertholdt C. A preliminary quantification of the clinical gesture during vacuum assisted delivery on a training dummy. Clin Biomech (Bristol, Avon) 2023; 109:106093. [PMID: 37734119 DOI: 10.1016/j.clinbiomech.2023.106093] [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: 02/02/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The vacuum assisted delivery represents, in France, the most used operative vaginal delivery technique. The purpose was to provide a preliminar quantification of the operator's hand kinematics while performing a vacuum assisted delivery. METHODS A group of 21 participants composed of 12 trainees and 9 obstetricians were recorded performing a vacuum assisted delivery on a training dummy, the matching fetal presentation was a left occiput anterior position. FINDINGS The mean movement was composed of a first phase corresponding to a descendant pull, followed by an ascendant finish of the gesture. No significative difference were found between the trainees and the obstetricians' mean gesture. INTERPRETATION This is the first quantification of the clinical gesture associated with the vacuum assisted delivery.
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Affiliation(s)
- Y Vallet
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France.
| | - J Lefebvre
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France
| | - C Laurent
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - R Rahouadj
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Verrecchia-Ramos E, Morel O, Ginet M, Retif P, Ben Mahmoud S. Clinical validation of an AI-based automatic quantification tool for lung lobes in SPECT/CT. EJNMMI Phys 2023; 10:57. [PMID: 37733103 PMCID: PMC10513978 DOI: 10.1186/s40658-023-00578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Lung lobar ventilation and perfusion (V/Q) quantification is generally obtained by generating planar scintigraphy images and then imposing three equally sized regions of interest on the data of each lung. This method is fast but not as accurate as SPECT/CT imaging, which provides three-dimensional data and therefore allows more precise lobar quantification. However, the manual delineation of each lobe is time-consuming, which makes SPECT/CT incompatible with the clinical workflow for V/Q estimation. An alternative may be to use artificial intelligence-based auto-segmentation tools such as AutoLung3D (Siemens Healthineers, Knoxville, USA), which automatically delineate the lung lobes on the CT data acquired with the SPECT data. The present study assessed the clinical validity of this approach relative to planar scintigraphy and manual quantification in SPECT/CT. METHODS The Autolung3D software was tested on the retrospective SPECT/CT data of 43 patients who underwent V/Q scintigraphy with 99mTc-macroaggregated albumin and 99mTc-labeled aerosol. It was compared to planar scintigraphy and SPECT/CT using the manual quantification method in terms of relative lobar V/Q quantification values and interobserver variability. RESULTS The three methods provided similar V/Q estimates for the left lung lobes and total lungs. However, compared to the manual SPECT/CT method, planar scintigraphy yielded significantly higher estimates for the middle right lobe and significantly lower estimates for the superior and inferior right lobes. The estimates of the manual and automated SPECT/CT methods were similar. However, the post-processing time in the automated method was approximately 5 min compared to 2 h for the manual method. Moreover, the automated method associated with a drastic reduction in interobserver variability: Its maximal relative standard deviation was only 5%, compared to 23% for planar scintigraphy and 19% for the manual SPECT/CT method. CONCLUSIONS This study validated the AutoLung3D software for general clinical use since it rapidly provides accurate lobar quantification in V/Q scans with markedly less interobserver variability than planar scintigraphy or the manual SPECT/CT method.
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Affiliation(s)
- Emilie Verrecchia-Ramos
- Department of Medical Physics, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France.
| | - Olivier Morel
- Department of Nuclear Medicine, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Merwan Ginet
- Department of Nuclear Medicine, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Paul Retif
- Department of Medical Physics, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
- CNRS, CRAN, Université de Lorraine, 54000, Nancy, France
| | - Sinan Ben Mahmoud
- Department of Nuclear Medicine, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
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Trimaille A, Matsushita K, Marchandot B, Carmona A, Hess S, Reydel A, Faucher L, Granier A, Mai TA, Diop B, Ohlmann P, Jesel L, Morel O. Outcomes of patients with active cancer undergoing transcatheter aortic valve replacement. Arch Cardiovasc Dis 2023:S1875-2136(23)00165-1. [PMID: 37758593 DOI: 10.1016/j.acvd.2023.08.001] [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: 05/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Cardiovascular disease and cancer are the two leading causes of mortality worldwide, and their association presents a therapeutic challenge. Current data regarding the prognosis of active cancer in patients undergoing transcatheter aortic valve replacement are conflicting. AIM To determine the impact and prognosis of active cancer in transcatheter aortic valve replacement. METHODS All consecutive patients with severe aortic stenosis treated by transcatheter aortic valve replacement between February 2010 and May 2019 were enrolled in a prospective study. The cohort was divided according to the presence or absence of active cancer at baseline. The primary endpoint was all-cause mortality 1 year after the procedure. RESULTS A total of 1,125 patients were enrolled: 1,037 (92.2%) without and 88 (7.8%) with active cancer. The most frequent cancers were haematological (36.4%), breast (14.8%) and prostate (14.8%), with 79.5% of patients receiving curative treatment and 17.0% receiving palliative treatment. The 1-year mortality rate was higher in patients with active cancer (27.3% vs. 13.9%; P<0.01), mainly driven by non-cardiovascular causes. An increased cardiovascular mortality rate at 2 years was seen in patients with active cancer (27.5% vs. 15.0%; P=0.03) compared with a similar rate at 1-year follow-up. Active cancer was a strong predictor of 1-year all-cause mortality (hazard ratio 2.46, 95% confidence interval 1.19-4.68; P=0.02). Major/life-threatening bleeding events at 1 year were more frequent in patients with active cancer (P=0.02). CONCLUSIONS Among patients who undergo transcatheter aortic valve replacement, 1-year all-cause mortality is higher in those with active cancer. We also observed a trend towards increased long-term bleeding events in case of active cancer.
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Affiliation(s)
- Antonin Trimaille
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Adrien Carmona
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Sebastien Hess
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Antje Reydel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Loic Faucher
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Amandine Granier
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Trung Anh Mai
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Bamba Diop
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France.
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Pillot R, Hossu G, Cherifi A, Guillez K, Morel O, Beaumont M, Fijean AL, Bertholdt C. Contribution of contrast-enhanced ultrasound in the diagnosis of adnexal torsion (AGATA): protocol for a prospective comparative study. BMJ Open 2023; 13:e073301. [PMID: 37620263 PMCID: PMC10450051 DOI: 10.1136/bmjopen-2023-073301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Adnexal torsion is a surgical emergency and its prognosis depends on the time elapsed prior to treatment. The diagnosis relies on pelvic ultrasound in which sensitivity remains low and may lead to misdiagnosis.The primary objective is to evaluate the diagnostic performance of contrast-enhanced ultrasound for the diagnosis of adnexal torsion in women with suspected adnexal torsion. The secondary objectives are: (1) to describe the perfusion parameters of the ovaries by contrast-enhanced ultrasound, (2) to compare diagnostic performance of contrast ultrasound with bidimensional (2D) Doppler for the detection of adnexal torsion, (3) to describe the perfusion parameters of the ovarian as a function of the degree of adnexal torsion, (4) to compare perfusion parameters before and after ovarian detorsion and (5) to describe perfusion parameters of the ovarian by using MicroVascular Flow technique. METHODS AND ANALYSIS This is a monocentric, prospective comparative, non-randomised, open and interventional study. We hypothesise to include 30 women: 20 positive cases compared with 10 control cases. Women are informed and recruited in the emergency ward, over a period of 36 months.The primary endpoint is the signal intensity measurement to assess sensitivity, specificity, positive and negative predictive values of contrast-enhanced ultrasound for detection of adnexal torsion in women with suspected adnexal torsion. The presence or absence of adnexal torsion is confirmed during the surgical intervention. ETHICS AND DISSEMINATION The study was approved by the French Ethics Committee, the CPP (Comité de Protection des Personnes) OUEST I on 3 July 2020 with reference number 2020T1-16. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry (NCT04522219); EudraCT registry (2020-000993-27).
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Affiliation(s)
- Rémi Pillot
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
| | - Gabriela Hossu
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
- CIC-Innovation Technologique, CHRU Nancy, Vandoeuvre-lès-Nancy, Lorraine, France
| | - Aboubaker Cherifi
- CIC-Innovation Technologique, CHRU Nancy, Vandoeuvre-lès-Nancy, Lorraine, France
| | - Kévin Guillez
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
| | - Olivier Morel
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
| | - Marine Beaumont
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
- CIC-Innovation Technologique, CHRU Nancy, Vandoeuvre-lès-Nancy, Lorraine, France
| | - Anne-Laure Fijean
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
| | - Charline Bertholdt
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
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Marzak H, Ringele R, Matsushita K, Marchandot B, Fitouchi S, Cardi T, Kanso M, Schatz A, Hammann J, Ohlmann P, Morel O, Jesel L. Impact of gender on left atrial low-voltage zones in patients with persistent atrial fibrillation: results of a voltage-guided ablation. Front Cardiovasc Med 2023; 10:1229345. [PMID: 37692044 PMCID: PMC10484507 DOI: 10.3389/fcvm.2023.1229345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
Background Gender-related differences have been reported in atrial fibrotic remodeling and prognosis of atrial fibrillation (AF) patients after ablation. We assessed in persistent AF the regional distribution of left atrial (LA) bipolar voltage and the extent of low-voltage zones (LVZ) according to gender as well as the results of a voltage-guided substrate ablation. Methods Consecutive patients who underwent a voltage-guided AF ablation were enrolled. LA endocardial voltage maps were obtained using a 3D electro-anatomical mapping system in sinus rhythm. LVZ was defined as <0.5 mV. Results A total of 115 patients were enrolled (74 men, 41 women). The LA bipolar voltage amplitude was twice lower in the whole LA (p < 0.01) and in each atrial region in women compared with men, whereas the LA indexed volume was similar. LVZ were found in 56.1% of women and 16.2% of men (p < 0.01). LVZ were also more extensive in women (p = 0.01), especially in the anterior LA. Atrial voltage alteration occurred earlier in women than in men. In a multivariate analysis, the female sex (OR 12.99; 95% CI, 3.23-51.63, p = 0.0001) and LA indexed volume (OR 1.09; 95% CI, 1.04-1.16, p = 0.001) were predictive of LVZ. Atrial arrhythmia-free survival was similar in men and women 36 months after a single ablation procedure. Conclusion The study reports a strong relationship between the female gender and atrial substrate remodeling. The female gender was significantly associated with higher incidence, earlier occurrence, and greater extent of LVZ compared with men. Despite the female-specific characteristics in atrial remodeling, LVZ-guided ablation may improve the AF ablation outcome in women.
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Affiliation(s)
- Halim Marzak
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Romain Ringele
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- Regenerative Nanomedicine, Faculty of Pharmacy, UMR 1260 INSERM (French National Institute of Health and Medical Research), University of Strasbourg, Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Simon Fitouchi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Thomas Cardi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Mohamad Kanso
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Alexandre Schatz
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Justine Hammann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- Regenerative Nanomedicine, Faculty of Pharmacy, UMR 1260 INSERM (French National Institute of Health and Medical Research), University of Strasbourg, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- Regenerative Nanomedicine, Faculty of Pharmacy, UMR 1260 INSERM (French National Institute of Health and Medical Research), University of Strasbourg, Strasbourg, France
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Faucher L, Marchandot B, Carmona A, Ohana M, Trimaille A, Morel O. Bioprosthetic valve thrombosis after transcatheter aortic valve replacement and pulmonary embolism due to heparin-induced thrombocytopenia: a case report. Front Cardiovasc Med 2023; 10:1164432. [PMID: 37614940 PMCID: PMC10442482 DOI: 10.3389/fcvm.2023.1164432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
Background Bioprosthetic valve thrombosis is a complication of transcatheter aortic valve replacement (TAVR). It is believed to be platelet independent, mainly driven by contact phase activation, and more likely to be targeted by oral anticoagulant (OAC). Case summary We report case of an 86-year-old man with history of TAVR, who presented an early TAVR aortic valve thrombosis occurring in the context of heparin-induced thrombocytopenia (HIT) and pulmonary embolism. The patient rapidly recovered and was discharged 17 days after readmission. OAC by Coumadin was administered for 3 months. Chest tomography after 3 months showed the disappearance of the hypoattenuated leaflet thickening. Discussion Although HIT has been fully described and is known for being a prothrombotic disorder, this is the first case report of aortic valve thrombosis after TAVR due to HIT. HIT is rare but possibly lethal. Diagnosis is based on pre-test probability evaluation with the 4T clinical score and confirmation with laboratory evidence of anti-PF4/heparin complexes and positivity of a functional test. Management of HIT is based on heparin discontinuation, and treatment of thrombotic complication with direct anti-IIa inhibitor or anti-Xa inhibitor. According to our knowledge, this case represents the first report of bioprosthetic valve thrombosis after TAVR due to HIT.
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Karsenty C, Touafchia A, Ladouceur M, Roubille F, Bonnefoy E, Bonello L, Leurent G, Levy B, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Combaret N, Morel O, Lattuca B, Leborgne L, Fillippi E, Gerbaud E, Brusq C, Bongard V, Lamblin N, Puymirat E, Delmas C. Cardiogenic shock in adults with congenital heart disease: Insights from the FRENSHOCK registry. Arch Cardiovasc Dis 2023; 116:390-396. [PMID: 37598062 DOI: 10.1016/j.acvd.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Data on cardiogenic shock in adults with congenital heart disease (ACHD) are scarce. AIM We sought to describe cardiogenic shock in ACHD patients in a nationwide cardiogenic shock registry. METHODS From the multicentric FRENSHOCK registry (772 patients with cardiogenic shock from 49 French centres between April and October 2016), ACHD patients were compared with adults without congenital heart disease (non-ACHD). The primary outcome was defined by all-cause mortality, chronic ventricular assist device or heart transplantation at 1year. RESULTS Out of the 772 patients, seven (0.9%) were ACHD, who were younger (median age: 56 vs. 67years), had fewer cardiovascular risk factors, such as hypertension (14.3% vs. 47.5%) and diabetes (14.3% vs. 28.3%), and no previous ischaemic cardiopathy (0 vs. 61.5%). Right heart catheterization (57.1% vs. 15.4%), pacemakers (28.6% vs. 4.6%) and implantable cardioverter-defibrillators (28.6% vs. 4.8%) were indicated more frequently in the management of ACHD patients compared with non-ACHD patients, whereas temporary mechanical circulatory support (0 vs. 18.7%) and invasive mechanical ventilation (14.3% vs. 38.1%) were less likely to be used in ACHD patients. At 1year, the primary outcome occurred in 85.7% (95% confidence interval: 42.1-99.6) ACHD patients and 52.3% (95% confidence interval: 48.7-55.9) non-ACHD patients. Although 1-year mortality was not significantly different between ACHD patients (42.9%) and non-ACHD patients (45.4%), ventricular assist devices and heart transplantation tended to be more frequent in the ACHD group. CONCLUSIONS Cardiogenic shock in ACHD patients is rare, accounting for only 0.9% of an unselected cardiogenic shock population. Despite being younger and having fewer co-morbidities, the prognosis of ACHD patients with cardiogenic shock remains severe, and is similar to that of other patients.
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Affiliation(s)
- Clément Karsenty
- Paediatric and Adult Congenital Cardiology Unit, CHU de Toulouse, 31300 Toulouse, France; Institut Des Maladies Métaboliques et Cardiovasculaires (I2MC), Inserm U1048, 31432 Toulouse, France.
| | - Anthony Touafchia
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France
| | - Magalie Ladouceur
- Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, Inserm, CNRS, 34295 Montpellier, France; Cardiology Department, CHU de Montpellier, 34295 Montpellier, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon University Hospital, 69622 Bron, France
| | - Laurent Bonello
- Aix-Marseille University, 13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Hôpital Nord, AP-HM, 13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13385 Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU de Rennes, 35000 Rennes, France; LTSI-UMR 1099, Inserm, University of Rennes 1, 35000 Rennes, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, 54511 Vandœuvre-les Nancy, France
| | | | - Pascal Lim
- Université Paris-Est Créteil, Inserm, IMRB, 94010 Créteil, France; Service de Cardiologie, Hôpital Universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, AP-HP, 75014 Paris, France; Medical School, Centre-Université de Paris, 75014 Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix-en-Provence, 13616 Aix-en-Provence, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, CHU de la Timone 2, Aix-Marseille Université, 13385 Marseille, France
| | | | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 69004 Lyon, France; University of Lyon, CREATIS UMR 5220, Inserm U1044, INSA-15, 69100 Lyon, France
| | - Gérald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | | | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie-Réanimation Chirurgicale-Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, 67091 Strasbourg, France
| | - Nicolas Combaret
- Department of Cardiology, CHU de Clermont-Ferrand, CNRS, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30900 Nîmes, France
| | | | | | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, 33600 Pessac, France
| | - Clara Brusq
- Unité de Soutien Méthodologique à la Recherche (USMR), Service d'Épidémiologie Clinique et Santé Publique, CHU de Toulouse, 31300 Toulouse, France
| | - Vanina Bongard
- Unité de Soutien Méthodologique à la Recherche (USMR), Service d'Épidémiologie Clinique et Santé Publique, CHU de Toulouse, 31300 Toulouse, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, Inserm U1167, University of Lille, 59000 Lille, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Clément Delmas
- Paediatric and Adult Congenital Cardiology Unit, CHU de Toulouse, 31300 Toulouse, France; Institut Des Maladies Métaboliques et Cardiovasculaires (I2MC), Inserm U1048, 31432 Toulouse, France; REICATRA, Institut Saint-Jacques, CHU de Toulouse, 31059 Toulouse, France
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Dap M, Chavatte-Palmer P, Morel O, Bertholdt C. Comments on "Prenatal interventions for fetal growth restriction in animal models: A systematic review". Placenta 2023; 139:212. [PMID: 37473551 DOI: 10.1016/j.placenta.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Matthieu Dap
- Obstetric and Fetal Medicine Unit, Centre Hospitalier Régional Universitaire of Nancy, Nancy, France; Department of Foetopathology and Placental Pathology, Centre Hospitalier Régional Universitaire of Nancy, Nancy, France; INSERM U1254, IADI, Vandoeuvre-lès-Nancy, France.
| | | | - Olivier Morel
- Obstetric and Fetal Medicine Unit, Centre Hospitalier Régional Universitaire of Nancy, Nancy, France; INSERM U1254, IADI, Vandoeuvre-lès-Nancy, France
| | - Charline Bertholdt
- Obstetric and Fetal Medicine Unit, Centre Hospitalier Régional Universitaire of Nancy, Nancy, France; INSERM U1254, IADI, Vandoeuvre-lès-Nancy, France
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Matsushita K, Marchandot B, Trimaille A, Hmadeh S, Kibler M, Heger J, Carmona A, Hess S, Reydel A, Jesel L, Ohlmann P, Schini-Kerth V, Morel O. Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch. ESC Heart Fail 2023. [PMID: 37430483 PMCID: PMC10375170 DOI: 10.1002/ehf2.14435] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/26/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis in elderly and comorbid population. Significant improvement in heart function has been observed in patients undergoing TAVI, but numerous patients are readmitted to hospital for heart failure (HF). Moreover, repeat HF hospitalization is strongly associated with an adverse prognosis and increases the financial burden of health care. Although studies have identified pre-existing and post-procedural factors that contribute to HF hospitalization after TAVI, there is a paucity of data regarding optimal post-procedural pharmacological treatments. This review aims to provide an overview of the current understanding of mechanisms, determinants, and potential treatments of HF following TAVI. We first review the pathophysiology of left ventricular (LV) remodelling, coronary microcirculation disorder, and endothelial dysfunction in patients with aortic stenosis and then examine the impact of TAVI on these conditions. We then present evidence of various factors and complications that may interplay with LV remodelling and contribute to HF events after TAVI. Next, we describe the triggers and predictors of early and late HF rehospitalizations following TAVI. Lastly, we discuss the potential of conventional pharmacological treatments, including renin-angiotensin blockers, beta-blockers, and diuretics in TAVI patients. The paper explores the potential of newer drugs, including sodium-glucose co-transporter 2 inhibitors, anti-inflammatory drugs, and ion supplementation. Comprehensive knowledge in this field may aid in recognizing successful existing therapies, developing effective new treatments, and establishing dedicated patient care strategies during follow-up after TAVI.
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Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Sandy Hmadeh
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Marion Kibler
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Joe Heger
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Adrien Carmona
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Sebastien Hess
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Antje Reydel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Laurence Jesel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Valerie Schini-Kerth
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
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Wilmé V, Harscoat S, Séverac F, Carmona A, Le Borgne P, Bilbault P, Morel O, Kepka S. Occurrence of Severe Arrhythmias in Patients with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS): A Retrospective Study. J Clin Med 2023; 12:jcm12103456. [PMID: 37240561 DOI: 10.3390/jcm12103456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Non-ST elevation acute coronary syndrome (NSTE-ACS) is one of the most frequent manifestations of coronary artery disease. The occurrence of serious heart rhythm disorders (SHRDs) in NSTE-ACS is not well documented. However, continuous heart rhythm monitoring is recommended during the initial management of NSTE-ACS. The targeted monitoring of patients at greater risk for SHRDs could facilitate patients' care in emergency departments (EDs) where the flow of patients is continuously increasing. METHODS This retrospective single-center study included 480 patients from emergency and cardiology departments within the Strasbourg University Hospital between 1 January 2019 and 31 December 2020. The objective was to estimate the frequency of the occurrence of SHRDs among patients with NSTE-ACS. The secondary objective was to highlight the factors associated with a higher risk of SHRDs. RESULTS The proportion of SHRDs during the first 48 h of hospital care was 2.3% (CI95%: 1.2-4.1%, n = 11). Two time periods were considered: before coronary angiography (1.0%), and during, or after coronary angiography (1.3%). In the first group, two patients required immediate treatment (0.4% of the patients) and no death occurred. In the univariate analysis, the variables significantly associated with SHRDs were age, anticoagulant medication, a decrease in glomerular filtration rate, plasmatic hemoglobin, and left ventricle ejection fraction (LVEF), and an increase in plasmatic troponin, BNP, and CRP levels. In the multivariable analysis, plasmatic hemoglobin > 12 g/dL seemed to be a protective factor for SHRDs. CONCLUSIONS In this study, SHRDs were rare and, most often, spontaneously resolved. These data challenge the relevance of systematic rhythm monitoring during the initial management of patients with NSTE-ACS.
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Affiliation(s)
- Valérie Wilmé
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Sébastien Harscoat
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - François Séverac
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Adrien Carmona
- Interventional Cardiology Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Olivier Morel
- Interventional Cardiology Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- ICube, UMR 7357 CNRS, 67400 Illkirch-Graffenstaden, France
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Marchandot B, Trimaille A, Morel O. Letter regarding the article 'Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes'. Eur J Heart Fail 2023; 25:771. [PMID: 36823783 DOI: 10.1002/ejhf.2812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Antonin Trimaille
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
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Matsushita K, Marchandot B, Kibler M, Carmona A, Phi TD, Heger J, Trimaille A, Hess S, Sattler L, Ohana M, Reydel AC, Jesel-Morel L, Ohlmann P, Morel O. Combination of primary hemostatic disorders and atrial fibrillation increases bleeding events following transcatheter aortic valve replacement. TH Open 2023; 7:e117-e127. [PMID: 37180426 PMCID: PMC10174752 DOI: 10.1055/a-2068-5783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Abstract
Background Patients with atrial fibrillation (AF) are likely to have a poor prognosis including bleedings following transcatheter aortic valve replacement (TAVR). Closure time of adenosine diphosphate (CT-ADP) is a primary hemostasis point-of-care test and is a predictor of bleeding events following TAVR. We aimed to evaluate the impact of ongoing primary hemostatic disorders on bleeding events in TAVR patients with AF.
Methods We enrolled 878 patients from our prospective registry. The primary endpoint was VARC-2 major/life-threatening bleeding complications (MLBCs) at 1-year after TAVR and secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1-year, defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization. Ongoing primary hemostatic disorder was defined by a post-procedural CT-ADP>180sec.
Results Patients with AF had a higher incidence of MLBCs (20% vs. 12%, p=0.002), MACCE (29% vs. 20%, p=0.002), and all-cause mortality (15% vs. 8%, p=0.002) within 1-year compared to non-AF patients. When the cohort was split into 4 subgroups according to AF and CT-ADP>180sec, patients with AF and CT-ADP>180sec had the highest risk of MLBCs and MACCE. Multivariate Cox regression analysis confirmed that the patients with AF and CT-ADP>180sec had 3.9-fold higher risk of MLBCs, whereas those patients were no longer associated with MACCE after the adjustment.
Conclusions In TAVR patients, AF with post-procedural CT-ADP>180 sec was strongly associated with MLBCs following TAVR. Our study suggests that persistent primary haemostatic disorders contribute to a higher risk of bleeding events particularly in AF patients.
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Affiliation(s)
- Kensuke Matsushita
- Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
| | - Benjamin Marchandot
- Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Marion Kibler
- Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
| | - Adrien Carmona
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | | | - Joe Heger
- Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
| | - Antonin Trimaille
- Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
| | - Sebastien Hess
- Cardiology, Université de Strasbourg, Strasbourg, France
| | - Laurent Sattler
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | | | | | - Laurence Jesel-Morel
- Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Centre Hospitalo Universitaire de Strasbourg, Strasbourg, France
| | - Patrick Ohlmann
- Cardiology department Hautepierre, Fédération de Cardiologie, Strasbourg, France
| | - Olivier Morel
- Cardiology, Hôpiaux Universitaires de Strasbourg, Strasbourg, France
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Ambroise Grandjean G, Le Gall L, Bourguignon L, Collin A, Hossu G, Morel O. Is accuracy of estimated fetal weight improved by better image quality scores? Int J Gynaecol Obstet 2023; 161:289-297. [PMID: 36117460 DOI: 10.1002/ijgo.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess in a group of ultrasound operators of various levels of experience the predictive value of systematic quality scoring to assess estimated fetal weight (EFW) validity. METHODS Screenshots, sonographer experience, and neonate birth weight were collected for 131 ultrasound examinations in the 7 days before birth. The difference (EFW error) between projected birth weight (EFW + [30 g × interval in days to birth]) and actual birth weight was then assessed (absolute value). Three senior sonographers rated all the screenshots (International Society of Ultrasound in Obstetrics and Gynecology 16-point score for image quality) and interobserver reproducibility was assessed concomitantly. The impact of the score on EFW accuracy was then assessed (univariate analysis). Receiver operating characteristic curves allowed us to assess the score's positive predictive value (PPV) for accurate EFW. RESULTS Mean birth weight was 2998 ± 954 g and mean EFW error was 8.6% ± 7.1%. Both the sonographer's experience and score significantly impacted the EFW error (P < 0.05). The PPVs of systematic image scores for identifying an EFW error greater than 10% and greater than 15% were appropriate for clinical use (areas under the curve 0.61 and 0.70, respectively). Score reproducibility was modest. CONCLUSION Low image scores and limited ultrasound expertise are associated with an increased risk of inaccurate EFW.
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Affiliation(s)
- Gaëlle Ambroise Grandjean
- Département d'Obstétrique, CHRU Nancy, Nancy, France.,Inserm, IADI, Université de Lorraine, Nancy, France.,Département Universitaire de Maïeutique, Université de Lorraine, Nancy, France
| | - Laura Le Gall
- Département d'Obstétrique, CHRU Nancy, Nancy, France
| | | | | | | | - Olivier Morel
- Département d'Obstétrique, CHRU Nancy, Nancy, France.,Inserm, IADI, Université de Lorraine, Nancy, France
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Dion L, Sousa C, Legendre G, Nyangoh-Timoh K, Le Lous M, Morel O, Lavoue V, Descamps P. Assessment of the self-confidence of obstetrics & gynecology fellows to perform a postpartum hemostasis hysterectomy. J Gynecol Obstet Hum Reprod 2023; 52:102548. [PMID: 36781074 DOI: 10.1016/j.jogoh.2023.102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Hemostasis Hysterectomy (HH) is a last resort surgical procedure performed in situations of uncontrolled post-partum hemorrhage in maternity wards. The chances of being confronted with this situation are scarce during residency, and the situation is not well suited for teaching. Nevertheless, every obstetrician-gynecologist can be confronted with this stressful situation, and should therefore possess the surgical competence required, regardless of his routine practice. The aim of the present study is to evaluate clinical exposure and self-awareness concerning HH amongst obstetrics and gynecology residents and fellows. MATERIEL AND METHODS We performed a survey amongst French obstetrics and gynecology fellows. An anonymous survey was sent by email between December 1, 2020 to July 1, 2021. RESULTS Half of the interrogated fellows had practiced (as operator) an HH during residency with a senior and only 22,6% in post-residency. During the last year of residency 70% of them had performed less than 10 scheduled hysterectomies as primary operator. The laparoscopic approach was the most frequently practiced. Very few hysterectomies were performed as primary operator. Fellows with a surgical or mixed activity (both gynecological surgery and obstetrical activity in current practice) felt significantly more capable of performing HH compared to those with exclusive obstetrical or reproductive medicine activity; respectively 60% vs 36%, p = 0.008; Odds Ratio: 2.629 (95% CI 1.2214; 5.8094). CONCLUSION The number of scheduled hysterectomies or HH performed as primary operator is very low during residency or fellowship. It remains largely inferior to the number deemed necessary in previous publications about the learning curve for scheduled hysterectomy, which varies from 18 to 80 interventions. Nowadays, the increasing number of residents, added to the decrease of hemostasis hysterectomies through better management of post-partum hemorrhage, pushes towards the development of specific training, such as "damage control simulation".
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Affiliation(s)
- Ludivine Dion
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France.
| | - Carla Sousa
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France
| | | | | | - Maëla Le Lous
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France
| | - Olivier Morel
- Nancy University Hospital, Department of Obstetrics, France
| | - Vincent Lavoue
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France
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Verrecchia-Ramos E, Morel O, Beauchat V, Denet S, Djibo Sidikou A, Ginet M, Pfletschinger E, Teodor L, Trombowsky M, Verdier J, Vère C, Retif P, Mahmoud SB. Personalization of 99mTc-sestamibi activity in SPECT/CT myocardial perfusion imaging with the cardiofocal SmartZoom® collimator. EJNMMI Phys 2023; 10:23. [PMID: 36959483 PMCID: PMC10036680 DOI: 10.1186/s40658-023-00545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Patient radioprotection in myocardial perfusion imaging (MPI)-SPECT is important but difficult to optimize. The aim of this study was to adjust injected activity according to patient size-weight or BMI-by using a cardiofocal collimator camera. METHODS The correlation equation between size and observed counts in image was determined in patients who underwent stress Tc-99m-sestamibi MPI-SPECT/CT with a cardiofocal collimator-equipped conventional Anger SPECT/CT system. Image quality analyses by seven nuclear physicians were conducted to determine the minimum patient size-independent observed count threshold that yielded sufficient image quality for perfusion-defect diagnosis. These data generated an equation that can be used to calculate personalized activity for patients according to their size. RESULTS Analysis of consecutive patients (n = 294) showed that weight correlated with observed counts better than body mass index. The correlation equation was used to generate the equation that expressed the relationship between observed counts, patient weight, and injected activity. Image quality analysis with 50 images yielded an observed count threshold of 22,000 counts. Using this threshold means that the injected activity in patients with < 100 kg would be reduced (e.g., by 67% in 45-kg patients). Patients who are heavier than 100 kg would also benefit from the use of the threshold because although the injected activity would be higher (up to 78% for 150-kg patients), good image quality would be obtained. CONCLUSIONS This study provided a method for determining the optimal injected activity according to patient weight without compromising the image quality of conventional Anger SPECT/CT systems equipped with a cardiofocal collimator. Personalized injected activities for each patient weight ranging from 45 to 150 kg were generated, to standardize the resulting image quality independently of patient attenuation. This approach improves patient/staff radioprotection because it reduces the injected activity for < 100-kg patients (the majority of patients).
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Affiliation(s)
- Emilie Verrecchia-Ramos
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France.
| | - Olivier Morel
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Valérie Beauchat
- CHR Metz-Thionville, Department of Nuclear Medicine, Bel-Air Hospital, 1, Rue du Friscaty, 57100, Thionville, France
| | - Sylvie Denet
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Abdourahamane Djibo Sidikou
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Merwan Ginet
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Estelle Pfletschinger
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Luminita Teodor
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Maud Trombowsky
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Jeany Verdier
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Christelle Vère
- CHR Metz-Thionville, Department of Nuclear Medicine, Bel-Air Hospital, 1, Rue du Friscaty, 57100, Thionville, France
| | - Paul Retif
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
- Université de Lorraine, CNRS, CRAN, 54000, Nancy, France
| | - Sinan Ben Mahmoud
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
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Matsushita K, Morel O, Ohlmann P. Contemporary issues and lifetime management in patients underwent transcatheter aortic valve replacement. Cardiovasc Interv Ther 2023:10.1007/s12928-023-00924-z. [PMID: 36943655 DOI: 10.1007/s12928-023-00924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
Latest clinical trials have indicated favorable outcomes following transcatheter aortic valve replacement (TAVR) in low surgical risk patients with severe aortic stenosis. However, there are unanswered questions particularly in younger patients with longer life expectancy. While current evidence are limited to short duration of clinical follow-up, there are certain factors which may impair patients clinical outcomes and quality-of-life at long-term. Contemporary issues in the current TAVR era include prosthesis-patient mismatch, heart failure hospitalization, subclinical thrombosis, future coronary access, and valve durability. In this review, the authors review available evidence and discuss each remaining issues and theoretical treatment strategies in lifetime management of TAVR patients.
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Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091, Strasbourg, France.
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France.
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091, Strasbourg, France
- UMR1260 INSERM, Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091, Strasbourg, France
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Marchandot B, Matsushita K, Carmona A, Trimaille A, Morel O. ChatGPT: the next frontier in academic writing for cardiologists or a pandora's box of ethical dilemmas. Eur Heart J Open 2023; 3:oead007. [PMID: 36915398 PMCID: PMC10006694 DOI: 10.1093/ehjopen/oead007] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/02/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France.,UMR 1260, INSERM (French National Institute of Health and Medical Research), Regenerative Nanomedicine, FMTS, 1 rue Eugene Boeckel, Strasbourg 67000, France
| | - Adrien Carmona
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Antonin Trimaille
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France.,UMR 1260, INSERM (French National Institute of Health and Medical Research), Regenerative Nanomedicine, FMTS, 1 rue Eugene Boeckel, Strasbourg 67000, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France.,UMR 1260, INSERM (French National Institute of Health and Medical Research), Regenerative Nanomedicine, FMTS, 1 rue Eugene Boeckel, Strasbourg 67000, France
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Ambroise Grandjean G, Oster J, Dap M, Morel O, Hossu G. Artificial intelligence and fetal ultrasound biometry: Challenges and perspectives. Diagn Interv Imaging 2023; 104:200-201. [PMID: 36801095 DOI: 10.1016/j.diii.2023.01.008] [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] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Gaelle Ambroise Grandjean
- INSERM U1254, IADI, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France; Department of Obstetrics, CHRU Nancy, 54000 Nancy, France; Midwifery Department, Université de Lorraine, 54000 Nancy, France.
| | - Julien Oster
- INSERM U1254, IADI, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France; CIC-IT, CHRU Nancy, Université de Lorraine, 54000 Nancy, France
| | - Matthieu Dap
- INSERM U1254, IADI, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France; Department of Obstetrics, CHRU Nancy, 54000 Nancy, France
| | - Olivier Morel
- INSERM U1254, IADI, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France; Department of Obstetrics, CHRU Nancy, 54000 Nancy, France
| | - Gabriela Hossu
- INSERM U1254, IADI, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France; CIC-IT, CHRU Nancy, Université de Lorraine, 54000 Nancy, France
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Delhomme C, Urena M, Zouaghi O, Campelo-Parada F, Ohlmann P, Rioufol G, Van Belle E, Pinaud F, Meneveau N, Staat P, Morel O, Derimay F, Vincent F, Rouleau F, Brochet E, Chong-Nguyen C, Himbert D. Transcatheter aortic valve implantation using the SAPIEN 3 valve to treat aortic regurgitation: The French multicentre S3AR study. Arch Cardiovasc Dis 2023; 116:98-105. [PMID: 36707263 DOI: 10.1016/j.acvd.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and safety to treat patients with pure aortic regurgitation. AIMS We sought to evaluate the results of transcatheter aortic valve implantation using the balloon-expandable SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) in patients with pure aortic regurgitation on native non-calcified valves. METHODS We conducted a retrospective and prospective French multicentre observational study. We included all patients with symptomatic severe pure aortic regurgitation on native non-calcified valves, contraindicated to or at high risk for surgical valve replacement, who underwent transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve. RESULTS A total of 37 patients (male sex, 73%) with a median age of 81years (interquartile range 69-85years) were screened using transthoracic echocardiography and computed tomography and were included at eight French centres. At baseline, 83.8% of patients (n=31) had dyspnoea New York Heart Association class≥III. The device success rate was 94.6% (n=35). At 30days, the all-cause mortality rate was 8.1% (n=3) and valve migration occurred in 10.8% of cases (n=4). Dyspnoea New York Heart Association class≤II was seen in 86.5% of patients (n=32), and all survivors had aortic regurgitation grade≤1. At 1-year follow-up, all-cause mortality was 16.2% (n=6), 89.7% (n=26/29) of survivors were in New York Heart Association class≤II and all had aortic regurgitation grade≤2. CONCLUSION Transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve seems promising to treat selected high-risk patients with pure aortic regurgitation on non-calcified native valves, contraindicated to surgical aortic valve replacement.
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Affiliation(s)
- Clémence Delhomme
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France.
| | - Marina Urena
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
| | | | | | | | - Gilles Rioufol
- Hôpital Cardiologique et Pneumologique Louis-Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Cœur Poumon, Cardiology, CHU Lille, 59000 Lille, France
| | - Frédéric Pinaud
- Service Médico-Chirurgical de Valvulopathies, University Hospital Angers, 49100 Angers, France
| | | | - Patrick Staat
- Medipôle Lyon-Villeurbanne, 69100 Villeurbanne, France
| | - Olivier Morel
- Strasbourg University Hospital, 67000 Strasbourg, France
| | - François Derimay
- Hôpital Cardiologique et Pneumologique Louis-Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Flavien Vincent
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Cœur Poumon, Cardiology, CHU Lille, 59000 Lille, France
| | - Frédéric Rouleau
- Service Médico-Chirurgical de Valvulopathies, University Hospital Angers, 49100 Angers, France
| | - Eric Brochet
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
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Dap M, Morel O, Bertholdt C. Letter to the editor: Is there still an indication for episiotomy? Results from a French national database analysis. Int J Gynaecol Obstet 2023; 160:716-717. [PMID: 36403204 DOI: 10.1002/ijgo.14564] [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] [Received: 09/12/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Matthieu Dap
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.,Department of Foetopathology and Placental Pathology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.,INSERM U1254, IADI, Vandoeuvre-lès-Nancy, France
| | - Olivier Morel
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.,INSERM U1254, IADI, Vandoeuvre-lès-Nancy, France
| | - Charline Bertholdt
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.,INSERM U1254, IADI, Vandoeuvre-lès-Nancy, France
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Dap M, Allouche D, Gauchotte E, Bertholdt C, Morel O. Perinatal outcomes of severe, isolated intrauterine growth restriction before 25 weeks' gestation: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2023; 52:102514. [PMID: 36436808 DOI: 10.1016/j.jogoh.2022.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the perinatal outcome associated with severe and isolated intrauterine growth restriction (IUGR) diagnosed before 25 weeks and to describe factors related to fetal death. METHODS This retrospective study included singleton pregnancies with an estimated fetal weight (EFW) ≤ 3rd centile between 21 + 0 and 24 + 6 weeks' gestation referred between 2013 and 2020. All fetuses with morphological or chromosomal abnormalities were excluded. We constituted three groups based on perinatal outcomes to highlight poor prognostic factors: live birth, fetal death and termination of pregnancies (TOP). RESULTS We included 98 pregnancies with an overall survival rate of 61.2% (60/98). There were 63.2% (62/98) live births, 24.5% (24/98) TOP, and 12.2% (12/98) fetal death. Of the live births, 27.4% (17/62) of fetuses were born before 32 weeks, and two died in the neonatal period (2/62; 3.2%). The fetal death rate was higher with the presence of an EFW below the first percentile (83.3% of fetal death Vs 33.8% of live births; p = 0.002), Doppler abnormalities (83.3% of fetal death Vs 6.4% of live births; p<0.001), and oligoamnios (41.9% of fetal death Vs 11.3% of live births; p = 0.05). CONCLUSION Severe growth restriction detected before 25 weeks was associated with poor perinatal outcomes. There were more often EFW <1st percentile, abnormal Doppler and oligoamnios in cases of fetal death compared to live births.
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Affiliation(s)
- Matthieu Dap
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France; Department of fetopathology and placental pathology, CHRU of Nancy, Nancy, France; Inserm, Diagnostic and Interventional Adaptive Imaging, University of Lorraine, Nancy, France.
| | - Dan Allouche
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France
| | - Emilie Gauchotte
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France
| | - Charline Bertholdt
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France; Inserm, Diagnostic and Interventional Adaptive Imaging, University of Lorraine, Nancy, France
| | - Olivier Morel
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France; Inserm, Diagnostic and Interventional Adaptive Imaging, University of Lorraine, Nancy, France
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Matsushita K, Trimaille A, Marchandot B, Ohlmann P, Morel O. Oral Anticoagulant Dose Adjustment After TAVR: The Role of Closure Time With Adenosine Diphosphate. JACC Cardiovasc Interv 2022; 15:2575. [PMID: 36543454 DOI: 10.1016/j.jcin.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022]
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Trimaille A, Hmadeh S, Matsushita K, Marchandot B, Kauffenstein G, Morel O. Aortic stenosis and the hemostatic system. Cardiovasc Res 2022:6942101. [DOI: 10.1093/cvr/cvac192] [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] [Received: 07/19/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Aortic stenosis (AS) affects more than 10% of the population over 80 years of age and constitutes a major risk factor for heart failure, thromboembolic stroke, and death. A better understanding of the disease, including its interaction with the hemostatic system, is a prerequisite to develop prophylactic treatments. AS pathogenesis is a dynamic process involving endothelial dysfunction, inflammation, fibrosis, and calcification. Several studies support the interplay between the components of the hemostatic system such as platelets, the coagulation system, von Willebrand factor, and extracellular microparticles at each pathophysiological stage of AS. Previous reports have evidenced persistent biological activity of the native valve after transcatheter aortic valve replacement (TAVR) and the subsequent development of microthrombosis that may impact the function of the newly implanted valve. Here, we review the current evidence on the interplay between AS and prothrombotic activity, and we emphasize the clinical consequences of these interactions after aortic valve replacement.
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Affiliation(s)
- Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital , Strasbourg , France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS , Strasbourg , France
| | - Sandy Hmadeh
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS , Strasbourg , France
| | - Kensuke Matsushita
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital , Strasbourg , France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS , Strasbourg , France
| | - Benjamin Marchandot
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital , Strasbourg , France
| | - Gilles Kauffenstein
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS , Strasbourg , France
| | - Olivier Morel
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital , Strasbourg , France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS , Strasbourg , France
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Dap M, Harter H, Lambert L, Perdriolle-Galet E, Bonnet C, Morel O. Genetic studies in isolated bilateral clubfoot detected by prenatal ultrasound. J Matern Fetal Neonatal Med 2022; 35:10384-10387. [PMID: 36167341 DOI: 10.1080/14767058.2022.2128654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the contribution of genetic investigations in case of isolated bilateral clubfoot detected by routine prenatal ultrasound. Pathogenic Copy Number Variations is about 3.9% in fetuses with isolated clubfoot (uni- or bilateral). We hypothesize that this rate could be higher in a homogenous group of fetuses with bilateral clubfoot. METHODS This retrospective single-center study included all women referred to our fetal-medicine center between 2013 and 2020 after ultrasound detection of isolated bilateral clubfoot. Genetic counseling was offered in which the woman was offered an amniocentesis for CMA and targeted investigation for Prader-Willi Syndrome (PWS), Steinert's disease and Spinal Muscular Atrophy (SMA). RESULTS 34 women were referred, 18 of them consented to undergo genetic studies by amniocentesis (18/34; 52.9%). Pathogenic copy number variations (CNVs) were found in 2/18 (11.1%) of cases. One of these CNVs was directly linked to the clubfoot pathology (a deletion in 5q31.1 containing PITX1 gene). Four fetuses (4/18, 22.2%) had variants of unknown significance (VUS). No PWS, SMA or Steinert's disease was found. No case diagnosed with isolated clubfoot prenatally had additional anomalies postnatally. CONCLUSIONS In the case of bilateral isolated clubfoot detected at the antenatal ultrasound, invasive prenatal testing should be offered, and if accepted, a CMA should be done, as pathogenic variations were observed in up to 11.1% of women who got amniocentesis. The findings of this study do not support the systematic recommendation of molecular studies for PWS, SMA, Steinert's disease.
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Affiliation(s)
- Matthieu Dap
- Obstetrics and Fetal medicine Unit, CHRU of Nancy, Nancy, France.,Department of Fetopathology and Placental Pathology, CHRU of Nancy, Nancy, France
| | - Hélène Harter
- Obstetrics and Fetal medicine Unit, CHRU of Nancy, Nancy, France
| | | | | | - Céline Bonnet
- Department of Genetics, CHRU de Nancy, Vandoeuvre-lès-Nancy, Nancy, France
| | - Olivier Morel
- Obstetrics and Fetal medicine Unit, CHRU of Nancy, Nancy, France.,INSERM, Diagnostic and Interventional Adaptive Imaging, University of Lorraine, Nancy, France
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Donadono V, Ambroise Grandjean G, Stegen ML, Collin A, Bertholdt C, Casagrandi D, Morel O, Napolitano R. Training in Obstetric Ultrasound Biometry: Results from a Multicenter Reproducibility Study. J Ultrasound Med 2022; 41:2819-2825. [PMID: 35302655 DOI: 10.1002/jum.15969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To assess the intra- and interobserver reproducibility of fetal biometry measurements obtained by trainee (junior) and experienced sonographers (senior) in the contest of two training programs in obstetric ultrasound. METHODS This was a prospective study on 192 women recruited ensuring an even distribution throughout gestation (18-41 weeks), at University College London Hospital (UCLH), England (87 cases), and at Maternité Regionale Universitaire de Nancy (MRUN), France (105 cases). The training took place in two training centers with experience in ultrasound training and subspecialist training in fetal medicine. Measurements for head circumference (HC), abdominal circumference (AC), and femur length (FL) were obtained twice by junior and senior sonographers, blind to their own and each other's measurements. Differences between and within sonographers were expressed in millimeters and as a percentage of fetal dimensions. Reproducibility was assessed using Bland-Altman plots. RESULTS Reproducibility was overall high with 95% confidence intervals (CI) within <6% for intraobserver and <8% for interobserver reproducibility. Intraobserver reproducibility was lower within junior than within senior sonographers' measurements for HC (95% CI: <4% versus <3%) and FL (95% CI: <6% and < 5%). Intraobserver reproducibility was similar between the two centers/training programs (AC 95% CI: <6%). Cumulative interobserver reproducibility in both centers was similar to the reproducibility within a single site (95% CI: <5%, <8%, and <7% for HC, AC, and FL, respectively). CONCLUSIONS Reproducibility of fetal biometry measurement was high in centers with structured training programs regardless of sonographers' experience. Reproducibility was higher in sonographers who completed the training.
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Affiliation(s)
- Vera Donadono
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, England
| | - Gaëlle Ambroise Grandjean
- Inserm, IADI, Université de Lorraine, Nancy, France
- Midwifery Department, Université de Lorraine, Nancy, France
- Obstetrics Department, CHRU Nancy, Nancy, France
| | - Marie-Louise Stegen
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, England
| | | | - Charline Bertholdt
- Inserm, IADI, Université de Lorraine, Nancy, France
- Obstetrics Department, CHRU Nancy, Nancy, France
| | - Davide Casagrandi
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, England
- Elizabeth Garrett Anderson Wing, Institute for Women's Health, University College London, London, England
| | - Olivier Morel
- Inserm, IADI, Université de Lorraine, Nancy, France
- Obstetrics Department, CHRU Nancy, Nancy, France
| | - Raffaele Napolitano
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, England
- Elizabeth Garrett Anderson Wing, Institute for Women's Health, University College London, London, England
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Vallet Y, Laurent C, Bertholdt C, Rahouadj R, Morel O. Analysis of suction-based gripping strategies in wildlife towards future evolutions of the obstetrical suction cup. Bioinspir Biomim 2022; 17:061003. [PMID: 36206746 DOI: 10.1088/1748-3190/ac9878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
The design of obstetrical suction cups used for vacuum assisted delivery has not substantially evolved through history despite of its inherent limitations. The associated challenges concern both the decrease of risk of soft tissue damage and failure of instrumental delivery due to detachment of the cup. The present study firstly details some of the suction-based strategies that have been developed in wildlife in order to create and maintain an adhesive contact with potentially rough and uneven substratum in dry or wet environments. Such strategies have permitted the emergence of bioinspired suction-based devices in the fields of robotics or biomedical patches that are briefly reviewed. The objective is then to extend the observations of such suction-based strategies toward the development of innovative medical suction cups. We firstly conclude that the overall design, shape and materials of the suction cups could be largely improved. We also highlight that the addition of a patterned surface combined with a viscous fluid at the interface between the suction cup and scalp could significantly limit the detachment rate and the differential pressure required to exert a traction force. In the future, the development of a computational model including a detailed description of scalp properties should allow to experiment various designs of bioinspired suction cups.
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Affiliation(s)
- Y Vallet
- CNRS UMR 7239 LEM3-Université de Lorraine, Nancy, France
| | - C Laurent
- CNRS UMR 7239 LEM3-Université de Lorraine, Nancy, France
| | - C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France
- IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - R Rahouadj
- CNRS UMR 7239 LEM3-Université de Lorraine, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France
- IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Kerth S, Petry A, Kracun D, Morel O, Schini-Kerth VB, Goerlach A. Sympathetic nervous system hyperactivity-induced oxidative stress promoting endothelial dysfunction is dependent on the NADPH oxidases/SGLT2 crosstalk: potential role in cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyperactivity of the sympathetic nervous system (SNS) promotes cardiac dysfunction, that can contribute to heart failure and even cardiogenic shock. Endothelial dysfunction associated with increased formation of reactive oxygen species (ROS) has been suggested to promote cardiac dysfunction and heart failure. Our previous results showed that SGLT2 and ROS derived from endothelial NADPH oxidases contribute to cardiac dysfunction.
Purpose
Therefore, this study examined whether cardiogenic shock and hyperactivation of the SNS involve NADPH oxidases and SGLT2 in the development of endothelial dysfunction using in vitro and in vivo approaches.
Methods
Peripheral blood from patients with cardiogenic shock and healthy controls was drawn by vein puncture into tubes containing sodium citrate. Cultured human microvascular endothelial cells (HMEC-1) were stimulated with either 100 nM of the β-adrenergic agonist isoproterenol or with heparinized (10 U/ml) patient plasma. Male wild-type mice and mice lacking the NADPH oxidase subunit p22phox in the endothelium (p22phox ecKO, 11-week-old) were treated with isoproterenol (100 mg/kg) for five consecutive days and sacrificed at day 14. ROS levels were assessed by dihydroethidium fluorescence, and the expression levels of target genes and proteins by RT-qPCR and Western blot, respectively. siRNA approaches were used to down-regulate the NADPH oxidase subunit p22phox or SGLT2.
Results
Exposure of HMEC-1 to either plasma from patients suffering from cardiogenic shock or isoproterenol stimulated the formation of ROS. ROS levels were reduced by N-acetylcysteine (an antioxidant) and silencing of p22phox, by empagliflozin (a selective SGLT2 inhibitor) and silencing of SGLT2 as well as by metoprolol (a beta1 adrenergic receptor antagonist) and ICI-118,551 (a beta2 adrenergic receptor antagonist). Cardiogenic shock patient plasma and isoproterenol upregulated the NADPH oxidase subunits p22phox and Nox4 as well as SGLT2. These responses were prevented by silencing of either p22phox or SGLT2, and by empagliflozin. In addition to improved cardiac function and blunted SGLT2 expression, p22phox ecKO mice were protected against isoproterenol-induced endothelial dysfunction and senescence, characterized by upregulation of eNOS, nitrotyrosine, VCAM-1 and p16 in the left ventricle.
Conclusion
SNS hyperactivity and cardiogenic shock-derived patient plasma cause a feed forward loop between NADPH oxidases and SGLT2, promoting pro-oxidant responses and endothelial dysfunction via activation of both beta1 and beta2 adrenergic receptors. The NADPH oxidase/SGLT2 crosstalk also contributes to SNS hyperactivity-induced senescence, cardiac and endothelial dysfunction. Thus, the endothelial NADPH oxidases/SGLT2 crosstalk appears to have a major role in cardiac diseases associated with SNS hyperactivity such as cardiogenic shock.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Deutsches Herzzentrum München
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Affiliation(s)
- S Kerth
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - A Petry
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - D Kracun
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - O Morel
- University of Strasbourg, UMR 1260, Regenerative Nanomedicine, Faculté de Pharmacie , Strasbourg , France
| | - V B Schini-Kerth
- University of Strasbourg, UMR 1260, Regenerative Nanomedicine, Faculté de Pharmacie , Strasbourg , France
| | - A Goerlach
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
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