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The pomegranate (Punica granatum L.) juice, peels, and kernels are rich in secondary metabolites responsible for some biological properties that are important in healthy eating. Among them, anthocyanins present in the arils and, therefore, in juices are pigments with antioxidant and anti-inflammatory activities. In the Algarve region (southern Portugal), a century old variety Assaria is largely cultivated, but there is lack of information about its chemical and biological characteristics. In the present work, a comparative study of the pomegranate juice was made, over three years (2017-2019), between this cultivar and three other well-known cultivars (Wonderful, Mollar de Elche, and Acco). The variables studied were pH, titratable acidity, formol number, total phenol content, total monomeric anthocyanins, and polymeric color. The in vitro biological activities of pomegranate juices studied were antioxidant through the capacity for scavenging ABTS and NO free radicals; and inhibitory activities on lipoxygenase and -glucosidase activities. Simultaneously, the biological activities of the main anthocyanins of pomegranate juice were also determined and compared with the juice samples. The results showed that Assaria had characteristics similar to Mollar de Elche, with lower amounts of total phenols (2.609 and 2.849 mg mL-1, respectively) and monomeric anthocyanins (104.785 and 82.047 mg L-1, respectively) and lower antioxidant and antiinflammatory activities than the other two cultivars. Wonderful had the highest amounts of those metabolites (7.072 and 594.944 mgL-1, respectively) and the best activities. 'The in vitro biological activities of individual anthocyanins were significantly higher than the juices. The juice activities of Wonderful cultivar were the closest to anthocyanin ones. The best activities of isolated anthocyanins lead to the hypothesis that those antagonistic effects can occur among the juices' constituents and decrease their activities. [ABSTRACT FROM AUTHOR]

Self-reported questionnaires are useful for estimating the health-related quality of life (HR-QoL), impact of interventions, and prognosis. To our knowledge, no HR-QoL questionnaire has been developed for cardiac amyloidosis (CA). This study aimed to validate Amylo-AFFECT-QOL questionnaire to assess HR-QoL and its prognostic value in CA. A self-reported questionnaire, "Amylo-AFFECT" had been designed and validated for CA symptoms evaluation and screening by physicians. It was adapted here to assess HR-QoL (Amylo-AFFECT-QOL) and its prognostic value in CA. To validate the theoretical model, internal consistency and convergent validity were assessed, particularly correlations between Amylo-AFFECT-QOL and the HR-QoL Minnesota Living Heart Failure (MLHF) questionnaire. Amylo-AFFECT-QOL was completed by 515 patients, 425 of whom (82.5%) had CA. Wild-type and hereditary transthyretin amyloidosis (ATTRwt and ATTRv) and immunoglobulin light-chain amyloidosis (AL) were diagnosed in 47.8%, 14.7%, and 18.8% of cases, respectively. The best HR-QoL evaluation was obtained with five dimensions: "Heart failure", "Vascular dysautonomia", "Neuropathy", "Ear, gastrointestinal and urinary dysautonomia" and "Skin or mucosal involvement". The global Amylo-AFFECT-QOL and MLHF scores showed significant positive correlations (rs = 0.72, P < 0.05). Patients with a final diagnosis of CA had a global Amylo-AFFECT-QOL score significantly higher than the control group composed by patients with other diagnoses (22.2 ± 13.6 vs. 16.2 ± 13.8, respectively; P -value < 0.01). According to the Amylo-AFFECT-QOL global results, ATTRv patients' QoL was more affected than AL patients' QoL or ATTRwt patients' QoL. Patients with a higher HR-QoL score had a greater risk of death or heart transplant after 1 year of follow-up (log-rank < 0.01). Amylo-AFFECT-QOL demonstrates good psychometric properties and is useful for quantifying HR-QoL and estimating CA prognosis. Its use may help to improve overall management of patients with CA. [ABSTRACT FROM AUTHOR]

Microbial fuel cells (MFCs) are a promising technology that generates electricity from several biodegradable substrates and wastes. The main drawback of these devices is the need of using a catalyst for the oxygen reduction reaction at the cathode, which makes the process relatively expensive. In this work, two low cost materials are tested as catalysts in MFCs. A novel iron complex based on the ligand n-phenyledenparaethoxy aniline has been synthesized and its performance as catalyst in single chamber MFCs containing ionic liquids has been compared with a commercial inorganic material such as Raney nickel. The results show that both materials are suitable for bioenergy production and wastewater treatment in the systems. Raney nickel cathodes allow MFCs to reach a maximum power output of 160 mW.m−3anode, while the iron complex offers lower values. Regarding the wastewater treatment capacity, MFCs working with Raney nickel-based cathodes reach higher values of chemical oxygen demand removal (76%) compared with the performance displayed by the cathodes based on Fe-complex (56%). [ABSTRACT FROM AUTHOR]

Mortality in severe AL cardiac amyloidosis is difficult to predict because biomarker values are too low. to identify additional predictive factors of mortality in this population. This prospective, observational, cohort study included existing and de novo patients with confirmed cardiac AL amyloidosis at the Henri-Mondor National Reference Centre to identify additional predictive mortality biomarkers in this population. Over 12 years, 233 confirmed AL cardiac amyloidosis patients were included, of which 133 were NYHA III-IV and 179 were Mayo 2004. Median overall survival was 8 months 95%CI [2–24] Independent predictors for mortality were identified: hsTnT, NT-ProBNP, cardiac output and conjugated bilirubin. We developed a novel prognostic model, Mondor Amyloidosis Cardiac Staging (MACS) using biomarkers at the following cut-off values: stage 1: hsTnT ≤ 107 ng/L and NT-ProBNP < 3867 ng/L (n = 77; 33%); stage 2: hsTnT ≤ 107 ng/L, NT-ProBNP > 3867 ng/L (n = 72; 30%). If troponin > 107 ng/L then CB is added; stage 3: CB ≤4 μmol/L, (n = 41; 17.5%); stage 4: CB > 4 μmol/L, (n = 43; 18.5%). At 1-year, 102 (44%) patients died and the median survival with MACS stage 1 was not reached, stage 2; 15.2 months (95%CI [11–18]); stage 3, 6.6 months (95% CI [1–13]). Among European stage II, 17.1%, n = 8 were MACS stage 3 and among European stage IIIb 21.4% (n = 23) were MACS stage 4 and notably, among European stage IIIb patients 42.2% (n = 29) were MACS stage 4 and 12.5% n = 9 were only MACS stage 2. The Mondor prognostic staging system improves prognostic staging for patients with severe cardiac amyloidosis. [ABSTRACT FROM AUTHOR]

This paper deals with a class of singular Kirchhoff problem involving a critical nonlinearity. The existence and multiplicity of solutions for this problem are obtained by the variational methods. [ABSTRACT FROM AUTHOR]

A genome-wide assessment of diversity is provided for wild Mediterranean brown trout Salmo trutta populations from headwater tributaries of the Orb River and from Atlantic and Mediterranean hatchery-reared strains that have been used for stocking. Double-digest restriction-site-associated DNA sequencing (dd- RADseq) was performed and the efficiency of de novo and reference-mapping approaches to obtain individual genotypes was compared. Large numbers of single nucleotide polymorphism ( SNP) markers with similar genome-wide distributions were discovered using both approaches (196 639 v. 121 016 SNPs, respectively), with c. 80% of the loci detected de novo being also found with reference mapping, using the Atlantic salmon Salmo salar genome as a reference. Lower mapping density but larger nucleotide diversity ( π) was generally observed near extremities of linkage groups, consistent with regions of residual tetrasomic inheritance observed in salmonids. Genome-wide diversity estimates revealed reduced polymorphism in hatchery strains ( π = 0·0040 and π = 0·0029 in Atlantic and Mediterranean strains, respectively) compared to wild populations ( π = 0·0049), a pattern that was congruent with allelic richness estimated from microsatellite markers. Finally, pronounced heterozygote deficiency was found in hatchery strains (Atlantic FIS = 0·18; Mediterranean FIS = 0·42), indicating that stocking practices may affect the genetic diversity in wild populations. These new genomic resources will provide important tools to define better conservation strategies in S. trutta. [ABSTRACT FROM AUTHOR]

Hereditary (ATTRv) and senile (ATTRwt) transthyretin amyloidosis are severe and fatal systemic diseases, characterised by amyloid fibrillar accumulation principally in the heart or peripheral nerves (or both). Since 2012, tafamidis is used in France to treat patients with ATTRv with neuropathy (alone or with cardiomyopathy). Recently, the Phase III ATTRACT trial showed that tafamidis decreased the relative risk of mortality in ATTR amyloidosis with cardiomyopathy. The aims of this study were to assess the clinical characteristics of ATTR amyloidosis in a real-life population in comparison to the population included in the ATTRACT trial and to assess the impact of tafamidis on major cardiovascular outcome-free (MCO-free) survival time without cardiac decompensation, heart transplant, or death. From June 2008 to November 2018, 648 patients with ATTR amyloidosis (423 ATTRwt and 225 ATTRv) consecutively referred to the French Referral Center for cardiac amyloidosis were included. 467 (72%) patients matched the inclusion criteria of the ATTRACT study. For the 631 patients with cardiomyopathy, median MCO-free survival time increased with tafamidis treatment (N = 98): 1565 (1010–2400) days vs. 771 (686–895) days without treatment (log-rank P < 0.001). This beneficial effect was confirmed after considering confounding factors (age at inclusion, Nt-proBNP and amyloidosis type) with a propensity score based on (hazard ratio: 0.546, P = 0.0132). In a large cohort of ATTRwt and ATTRv patients, representative of the inclusion criteria of the ATTRACT trial, the present results confirm the positive impact of tafamidis treatment on preventing the occurrence of cardiovascular outcome in a real-life population. [ABSTRACT FROM AUTHOR]

The prevalence of small-fiber neuropathy (SFN) is high in patients with hereditary transthyretin amyloidosis (ATTRv) but remains unknown in transthyretin wild-type cardiac amyloidosis (ATTRwt-CA). To determine the prevalence of SFN in patients with ATTRwt-CA using Sudoscan®, a non-invasive method used to provide evidence of SFN in clinical practice and based on measurement of electrochemical skin conductance at the hands (hESC) and feet (fESC). A series of 62 non-diabetic patients with ATTRwt-CA was prospectively included over 2 years and compared to healthy elderly subjects, matched on age, gender and body mass index. The presence of SFN was defined as hESC < 60 μS and/or fESC < 70 μS and conductances were analyzed according to clinical, biological, and echocardiographic data. Mean hESC and fESC were significantly lower in patients with ATTRwt-CA than in elderly controls: 61.5 vs. 70.0 μS (P = 0.006) and 68.3 vs. 76.9 μS respectively (P < 0.0001). Prevalence of hESC < 60 μS and fESC < 70 μS was higher in patients with ATTRwt-CA than in controls: 33.9% versus 16.7% and 48.4% versus 19.9%, P < 0.05. Univariate analysis showed that fESC, NT-proBNP, creatinine plasma levels, and echocardiographic global longitudinal strain were associated with decompensated cardiac failure and death. Multivariate analysis revealed that fESC was an independent prognostic factor and Kaplan-Meier estimator evidenced a larger occurrence of cardiac decompensation and death in patients with fESC < 70 μS, P = 0.046. A reduced fESC was observed in almost 50% of patients with ATTRwt-CA and was associated with a worse prognosis. Sudoscan® could be used easily to screen ATTRwt-CA patients for the presence of SFN and identify patients at higher risk of outcome. [ABSTRACT FROM AUTHOR]

Background Left atrial (LA) dysfunction (LAD) and thrombi have been described in systemic light chain (AL) cardiac amyloidosis (CA). The causes and consequences of these alterations are unclear. Purpose To (1) demonstrate that LA 2D-strain echocardiography (2D-SE) is useful to analyze LAD; (2) explore causes, consequences and association of this dysfunction with thromboembolic events (TE) in the three major types of CA. Methods and results Seventy-six patients with CA and in sinus-rhythm were included. 21 had AL, 42 hereditary transthyretin (m-TTR) and 13 wild-type (wt-TTR) CA. History of TE was recorded at baseline. Global and regional LA longitudinal strain (LS) were measured using 2D-SE. Peak atrial LS (PALS-4C) was negatively correlated to NT-proBNP ( r = −0.6, P < 0.0001) and to LA end-diastolic volume ( r = −0.48, P < 0.0001). LA volume was higher and PALS-4C more altered in wt-TTR compared to the other groups. The 19 patients with a history of TE had a significantly lower PALS-4C compared to those without ( P = 0.003). Multivariate analysis identified PALS-4C as the only LA echocardiographic independent factor of mortality with an optimal cutoff-value of 9.5% (AUC 0.75, 95% CI 0.60–0.89). When including all the variables, NT-proBNP became the only independent marker of prognosis. Conclusions Atrial function estimated by 2D-SE is useful to identify patients at risk of death and might be helpful to select those that may benefit from preventive anticoagulant treatment. [ABSTRACT FROM AUTHOR]

Introduction Cardiac amyloidosis (CA) is a severe disease, often lethal. Little is known about cause of death during the natural course of CA. Identification of cause of death during CA is of particular interest to design clinical trials and identify therapeutic targets in this pathology. We aimed to describe mode of death in CA patients during long-term follow-up, according to the type of amyloidosis. Material and methods All patients consecutively referred to the French referral center for light-chain (AL), transthyretin hereditary (hTTR) or wild-type (WT-TTR) CA were consecutively included between 2010 and 2016 were included. Mode of death was centrally adjudicated by two blinded clinical committees, using multiple sources, and classified as cardiovascular (including worsening heart failure, sudden death, stroke) or non-cardiovascular (1). Results From the 565 patients included, 187 patients had AL amyloidosis, 220 had hTTR and 158 had WT-TTR amyloidosis. One hundred thirty-nine patients (25%) died during a follow-up of 864 patients-years, with median follow-up in survivors 14.6 months (IQR 3.7–33.9). One-year survival was 67% in AL patients, 92% in hTTR patients and 89% in WT-TTR patients (logrank < 0.0001). Among 139 deaths during follow-up, 86 (62%) resulted from cardiovascular causes, mainly worsening heart failure (58/86, 67%) and sudden death (20/86, 23%). Thirty-four deaths were from non-cardiovascular causes (24%), mostly from infection (27/34, 79%). Discussion and Conclusions Mortality is high during natural course of cardiac amyloidosis, significantly different according to CA type. Main causes of death were cardiovascular (mostly worsening heart failure and sudden death), opening room for optimal prevention and management. [ABSTRACT FROM AUTHOR]

Introduction Les amyloses cardiaques sont fréquemment associées à des processus emboliques mais la fréquence, les facteurs de risque et le devenir des patients présentant un infarctus rénal (IR) dans ce contexte n’ont jamais été étudiés. Patients/matériels et méthodes Entre octobre 2015 et février 2018, 156 scintigraphies rénales au 99mTc-DMSA ont été réalisées dans notre institution. Nous avons analysé rétrospectivement les 87 patients ayant un diagnostic d’amylose confirmé. Résultats Parmi les 87 patients (âge médian 76 ans, 76 % d’hommes), 24 présentaient une amylose AL (aAL) (27,5 %), 24 une amylose héréditaire à transthyrétine mutée (aTTRM) (27,5 %), et 39 une amylose sénile à TTR sauvage (aTTRS) (45 %). Les patients avec une aTTRS étaient significativement plus âgés, avaient une pression artérielle systolique plus élevée et recevaient plus fréquemment un traitement anticoagulant pour une ACFA. Les taux de NT-proBNP et la protéinurie basale étaient plus élevés et l’albuminémie plus basse dans le groupe avec une aAL. Toutes les autres données étaient identiques. Dix-huit patients avaient un infarctus rénal (IR) (21 %) sans différence significative entre les 3 groupes. En comparant les 18 patients avec un IR aux 69 patients sans IR, aucune des caractéristiques démographiques, cliniques, biologiques, thérapeutiques et écho-cardiographiques de base était différente entre les deux groupes exceptée le taux de protéinurie (p = 0,032). Le délai médian entre le diagnostic d’amylose et la réalisation de la scintigraphie était identique dans les 2 groupes. Au moment de la scintigraphie, les données classiquement associées à la survenue d’un IR n’étaient pas différentes entre les deux groupes. Cependant, les patients avec IR avaient une insuffisance rénale aiguë (IRA) plus fréquente (p = 0,003) et plus sévère (p = 0,001). Après un délai médian de suivi de 159 jours (identique dans les deux groupes), la survie des patients entre les 2 groupes n’était pas différente mais plus de patients du groupe avec IR présentaient une augmentation de plus de 50 % de la créatininémie au dernier suivi par rapport à sa valeur initiale (p = 0,022), ainsi qu’un risque accru de mise en dialyse ou de transplantation rénale (p = 0,045). Une IRA au moment de la scintigraphie était associée à une augmentation du risque d’IR (47 % vs 15 %, p = 0,003). Conclusion Cette étude suggère que 21 % des patients atteints d’amylose cardiaque ont un IR qui peut justifier d’un traitement anticoagulant pour prévenir des récidives emboliques. Un IR doit être recherché en cas de survenue d’une IRA chez un patient avec une amylose du fait de son impact thérapeutique et pronostique. [ABSTRACT FROM AUTHOR]

Objective A decreased longitudinal strain in basal segments with a base-to-apex gradient has been described inpatients with cardiac amyloidosis (CA). Aim of the study was to investigate the left ventricular (LV) regional distribution of early-phase 99mTc-hydroxymethylene diphosphonate (HMDP) uptake inpatients with transthyretin-related cardiac amyloidosis (TTR-CA). Methods All patients underwent a whole-body planar 99mTc-HMDP scintigraphy acquired at 10 min postinjection (early-phase) followed by a thorax SPECT/CT. The relative segmental uptake % was investigated on AHA 17-segment model and 3-segment model (basal, mid-cavity, apical). Results Sixty-one TTR-CA patients were included of whom; 29 were wild-type (wt-TTR-CA) and 32 had hereditary TTR-CA (m-TTR-CA). Early myocardial 99mTc-HMDP uptake occurred in all TTR-CA. In all patients, segmental analysis of the LV myocardial distribution of 99mTc-HMDP uptake showed an increased median uptake (interquartile range) in basal/mid-cavity segments compared to the lowest median uptake of apical segments (respectively 79 [72–86] vs. 72 [64–81]; P < 10 −6 ). This pattern was similar in wt-TTR-CA group (78 [70–84] vs. 70 [61–81]; P < 10 −6 ), in m-TTR-CA group (80 [74–86] vs. 73 [66–82]; P < 10 −7 ) and remains constant independently of the TTR mutation's subtype with P ranging 10–5 to 0.03. Conclusions Early-phase myocardial scintigraphy identified regional distribution of 99mTc-HMDP uptake characterized by a base-to-apex gradient, corroborating echocardiographic and cardiac magnetic resonance findings. This relative “apical sparing” pattern was similar across TTR-CA and TTR mutations’ subtypes. [ABSTRACT FROM AUTHOR]

Introduction Amyloidosis is a disease caused by infiltration of tissues by an amyloid protein. The most frequent cardiac amyloidosis is light chain (AL) amyloidosis, hereditary transthyretin (TTR-h) and wild transthyretin (w-TTR). Objective Describe baseline clinical, biological, echocardiographic characteristics and prognostic of patients referred for cardiac amyloidosis in the Amyloidosis expert center. Methods From 2010 to July 2016, all patients referred to the expert center of our Hospital for suspected cardiac amyloidosis were included. Baseline demographic, clinical, laboratory and ultrasound characteristics were recorded and patients were followed-up for major events including death, cardiac transplantation and left ventricular assistance implant. Results Of the 942 patients referred for suspicion of CA, 502 had confirmed CA of whom162 had AL amyloidosis, 203 h-TTR and 141 w-TTR. CA were men in 60%, the median age was 69 years w-TTR amyloidosis were older (83 [79; 87], P < 0.001) and more men (86%, P < 0.001) than the two other types of CA. NYHA III-IV dyspnea was more frequent in AL amyloidosis (60%) and w-TTR (54%, P < 0.001) compared to h-TTR. Creatinine, NTproBNP and troponin were higher in AL amyloidosis and w-TTR ( P < 0.001) than in h-TTR. w-TTR amyloidosis had thicker Interventricular septum thicker, lower LVEF, higher global strain E/A and E/Ea ratios than the two other types of CA ( P < 0.001). During follow-up, 137 major events occurred. Median follow-up was 22 (8–36) months. The survival was 59% for AL amyloidosis, 79% for w-TTR, 81% for h-TTR versus 88% for patients without amyloidosis ( P < 0.001). In multivariate analysis, only NYHA class III-IV, hyponatremia, elevation of creatinine, troponin and NTproBNP were independent prognostic factors ( P < 0.001). Conclusion Cardiac amyloidosis is more frequent than initially thought and has poor prognosis. The challenge is to achieve earlier diagnosis to improve prognosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction L’amylose AA n’est classiquement pas associée à une atteinte cardiaque à la différence des amyloses immunoglobulinique et à transthyrétine. Une atteinte cardiaque n’est habituellement pas responsable de mortalité au cours de l’amylose AA. Aucune étude de dépistage systématique de l’atteinte cardiaque au cours de l’amylose AA n’a été réalisée depuis les 10 dernières années et notamment depuis que de nouveaux moyens de diagnostic de l’amylose non invasifs ont été développés comme l’imagerie par résonance magnétique (IRM) cardiaque et la scintigraphie osseuse. L’objectif de cette étude était de déterminer si l’amylose AA était ou non associée à une atteinte cardiaque avec les moyens modernes d’étude de l’amylose cardiaque. Patients et méthodes Trente-huit patients consécutifs avec amylose AA prouvée au plan histologique ont été inclus à partir du centre national français de référence de l’amylose AA et du réseau amylose de l’hôpital Mondor entre 2012 et 2017. Ils ont tous bénéficié d’une étude systématique cardiaque dans un seul centre cardiologique à l’hôpital Mondor avec un examen physique, un dosage des biomarqueurs cardiaques, une échographie cardiaque trans-thoracique (ETT), une IRM cardiaque et une scintigraphie osseuse. Résultats Parmi les 38 patients avec amylose AA, il s’agissait de 19 hommes et de 19 femmes d’âge médian 58,6 ans (allant de 51 à 78 ans). Les pathologies ayant abouti à la formation de l’amylose AA étaient variées : maladie autoinflammatoire génétique, essentiellement fièvre méditerranéenne familiale ( n = 12), maladie inflammatoire dont polyarthrite rhumatoïde, spondyloarthrite, rhumatisme psoriasique ( n = 8), infections chroniques, dont tuberculose et dilatation des bronches ( n = 7), origine indéterminée à ce jour ( n = 6) et obésité ( n = 5). Onze patients étaient dialysés des suites de l’amylose et 3 étaient transplantés rénaux. À l’inclusion, 78 % des patients avaient une dyspnée de stade I ou II et tous étaient en rythme sinusal. Sur le plan biologique, la troponinémie médiane était de 19 ng/L, et le NT-proBNP de 382 ng/L. la CRP à l’inclusion était en médiane de 3 mg/L (allant de 0,6 à 19). Sur l’ETT, la fraction d’éjection du ventricule gauche médiane était de 61 %, l’épaisseur du septum interventriculaire de 9 mm, et le strain longitudinal global de −18 %. Sur l’IRM, un seul patient avait un réhaussement tardif après injection de gadolinium. Aucun patient ne présentait de fixation myocardique du traceur à la scintigraphie osseuse mais 3 fixations extracardiaques notamment thyroïdienne ( n = 2), hépatique ( n = 1). Sept patients sont décédés en cours d’étude, tous étaient dialysés et avaient un ou plusieurs facteur(s) de risque cardiovasculaire. Conclusion Cette étude confirme avec les moyens modernes d’exploration de l’amylose cardiaque que le cœur n’est pas une cible de l’amylose AA ni une cause spécifique de mortalité a priori dans cette variété d’amylose. En effet, aucun des 38 patients ne présentait de critère classique d’amylose cardiaque. Une localisation spécifique périvasculaire reste possible et doit être étudiée dans le futur. [ABSTRACT FROM AUTHOR]

Background Early after heart transplantation, patients require close medical follow up and exercise training.The objective of the study was to assess the usefulness of an inpatients Cardiac Rehabilitation center (inCRC) in these two settings. Methods 100 consecutive patients (age:47.2±13.2, men:79%) referred to our inCRC less than 3 months after heart transplantation were included. Acute events (AE) occurring during the inCRC stay and exercise training modality and results were assessed. Results Patients were hospitalized in the inCRC 33.8±21.3 days after the transplantation, for a 25.9±11.2 days duration on average. During this period, AE occurred in 49% (n=49) of the patients: 24 graft rejection, 19 infections requiring IV antibiotherapy, and 6 other AE. Most of these events were managed by the inCRC but 22 patients were temporarily referred to the transplantation center because of too severe AE (infection: n=11, tamponade: n=1, acute rejection requiring plasmapheresis: n=3, other: n=7). Seventeen patients (17%) were colonized by a multiresistant bacterium. Finally, due to all these event, 23% (n=23) of the patients underwent only 5 exercise training sessions or less. The exercise capacity improvement after completion of a classical exercise training program (n=13±5 sessions) is given in the table below for the 77 other patients (77%). Conclusion Early after heart transplantation an inCRC can be useful to (i) safely treat subacute complications under the guidance of the referent transplantation center and (ii) perform an exercise training program. Abstract 0012 - Table Post-op day 33±21 (before rehabilitation) Post-op day 60±22 (after rehabilitation) P Peak VO2 (ml/kg/min) 12.7±3.2 17.2±4.0 < 0.001 Ventilatory Threshold (ml/kg/min) 9.9±2.5 12.2±3.7 < 0.001 Maximal Workload (Watts) 60±17 82±23 < 0.01 Resting Heart Rate (bpm) 91±14 89±13 0.6 Maximal Heart Rate (bpm) 107±16 115±18 < 0.001 [ABSTRACT FROM AUTHOR]

Background: In aortic stenosis, it is not known which between longitudinal, radial and circumferential contraction is influenced by loading conditions or remodelling. To test our hypothesis and to understand left ventricular function recovery, we investigated patients at early, i.e. 7 days (contractility enhancement load-dependant) and at late follow-up, i.e. 3 months (contractility enhancement remodelling-dependant) after transcutaneous aortic valve implantation (TAVI). Methods and Results: Twenty-three subjects (AS: valve orifice < or =0.7cm2; 14 female; mean age, 84+/-6 years) were studied. All subjects of the study had conventional 2D-Doppler echocardiography and speckle tracking analysis (GE HealthCare). Speckle tracking was sampled in short-axis view for radial and circumferential strain and in apical 4, 3 and 2-chamber view for averaged longitudinal strain. Measurements were performed before, 7 days and 3 months after TAVI. Mean pressure gradient decreased from 41±20mmHg to 10±3mmHg (p<0.001) while aortic valve area increased from 0.6±0.1 to 1.7±0.2cm2 (p<0.001) after implantation. Biplane Simpson EF was 50±10 %, 51±13 and 58±11 % at baseline, 7-day and 3-month follow-up (p=0.01), respectively. Improvement of circumferential strain found 7 days after TAVI is sustained at 3 months. Radial strain increased shortly after TAVI, then decreased at 3 months and was compensated by improvement of longitudinal strain (see figure). Conclusion: In patients with aortic stenosis, radial contraction is load dependant, circumferential contraction is both load- and remodelling-dependant, whereas longitudinal contraction is remodeling-dependant . Display Omitted [Copyright &y& Elsevier]

The COVID-19 pandemic has deeply affected organ transplant activity across the world. During the first and second epidemic waves, the Agence de la biomedecine in agreement with the French scientific societies has pursued the heart transplant program where transplant's capacity was ensured. This study aimed to examine the impact of COVID-19 on new listings, waitlist outcomes and transplant activity in France. All patients newly registered on the national waiting list for heart transplantation between January and September 2018-2020 were included in the study (n=1 311). The number of new listings and transplants per million population (pmp) in 2018-2019 period and in 2020 COVID era were compared. Cumulative incidence of transplantation and waitlist mortality estimated with the competing risk analysis with transplantation and death or delisting for medical condition as the competing events were compared between the study periods. In 2020 compared with the 2018-2019 period, the total number of patients newly registered on the waiting list declined 11%, from 6.8 to 5.9 pmp and the number of transplants performed decreased 22%, from 4.6 to 3.5 pmp. While 3-month cumulative incidence of transplantation (Figure 1) decreased from 51% [47-54] to 45% [40-50], a non-significant increase in cumulative incidence of death or delisting for medical condition (9% [7-11] versus 12% [9-15]) (Figure 2) was observed. In 2020 COVID era, the waitlist and transplant access significantly declined in France without significant change in waitlist mortality. [ABSTRACT FROM AUTHOR]

Heart transplant recipients with SARS-CoV-2 infection are at high risk of poor outcomes. Given the high waitlist mortality in heart transplant candidates, the Agence de la biomedecine after discussion with the French scientific societies decided to pursue the transplant program where transplant's capacity was ensured. This study aimed to assess the impact of COVID-19 on heart recipient mortality in France. All heart recipients with SARS-CoV-2 infection reported in the French national registry CRISTAL between February 1st and September 30th 2020 were included in the study (n=86). Patient characteristics were extracted from CRISTAL. Cumulative number of cases by month since February (Figure 1) and case fatality rate (CFR) were calculated. Mortality rates from February to September in the whole 2019 and 2020 recipient cohorts were compared. Survival curves were estimated using Kaplan-Meier method and compared using the log-rank test. Of the 86 patients included (median age (IQR) 59 years (46-67), 69% male gender, median time from transplantation 6.9 years (3.0-15.2)) 77% required hospitalization including 39% in ICU. Twenty patients died (CFR: 23%). No difference in 3-month survival was observed between 2020 and 2019 recipient cohorts (98.8% [98.5%-99.1%] versus 99.0% [98.7%-99.2%], respectively) (Figure 2). While COVID-19 was associated with high fatality rate in heart transplant recipients, we could not identify an excess mortality in 2020 heart recipient cohort. These findings suggest that continuing heart transplant activity during the COVID-19 pandemic was a reasonable option. [ABSTRACT FROM AUTHOR]

Abstract: □ [Copyright &y& Elsevier]