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Summary Background Despite guidelines describing the optimal diagnostic and therapeutic procedures for patients with suspected cardiac implantable electronic device (CIED) infections, their management is often challenging. Aims To describe our diagnostic and therapeutic practices for suspected CIED infection, and to compare them with European Heart Rhythm Association (EHRA) guidelines. Methods Patients hospitalized in the tertiary care Nancy University Hospital for suspected CIED infection from 2014 to 2019 were included retrospectively. We applied the EHRA classification of CIED infection, and compared diagnostic and therapeutic management with the EHRA guidelines. Results Among 184 patients (mean age 72.3 ± 12.4 years), 137 had a proven infection of the lead (by transthoracic echocardiography/transoesophageal echocardiography, 18F-fluorodesoxyglucose positron emission tomography/computed tomography or positive culture of the lead) or an isolated pocket infection without proof of lead infection, and 47 had no proof of CIED infection. According to the EHRA classification, CIED infection was considered as definite in 145 patients and possible in 31 and was excluded in eight patients. Regarding recommended diagnostic procedures, blood cultures were performed in 90.8%, transthoracic echocardiography in 97.8%, transoesophageal echocardiography in 85.9%, 18F-fluorodesoxyglucose positron emission tomography/computed tomography in 50.5% and imaging for embolisms in 78.3% of the patients. Compared with therapeutic recommendations for the 145 cases of definite CIED infection, device removal was performed in 96 patients (66.2%) and antibiotic therapy was prescribed in 130 (89.7%), with a duration equal to or longer than that recommended in 105 (72.4%) of the patients. Conclusion This study underlines the difficulties in following theoretical guidelines in daily practice, where both technical and human considerations interfere with their strict appliance.

Summary Background Heart failure management guidelines have been published, but the degree of adherence to these guidelines remains unknown. Aims To study in 2015 healthcare utilization and causes of death for people previously identified with heart failure. Methods The national health data system was used to identify adult general scheme (86% of the French population) hospitalized for heart failure between 2011 and 2014 or with only a long-term chronic disease allowance for heart failure. The frequency and median (interquartile range) of at least one healthcare use among those still alive in 2015 was calculated. Results A total of 499,296 adults (1.4% of the population) were included, and 429,853 were alive in 2015; median age 79 (68–86) years. At least one utilization was observed for a general practitioner in 95% of patients (median 8 [interquartile range 5–13] consultations), a cardiologist in 42% (2 [1–3]), a nurse in 78% (16 [4–100]), a loop diuretic in 64% (11 [8–12] dispensations), an aldosterone antagonist in 21% (8 [5–11]), a thiazide in 15% (7 [4–11]), a renin-angiotensin system inhibitor in 68% (11 [8–13]), a beta-blocker in 65% (11 [7–13]), a beta-blocker plus a renin-angiotensin system inhibitor in 57%, and a beta-blocker plus a renin-angiotensin system inhibitor plus an aldosterone antagonist in 37%. Hospitalization for heart failure was present for 8% (1 [1,2]). Higher levels of healthcare utilization were observed in the presence of hospitalization for heart failure before 2015. Among the 13.9% of people who died in 2015, heart failure accounted for 8% of causes, cardiovascular disease accounted for 39%. Conclusions General practitioners and nurses are the main actors in the regular follow-up of patients with heart failure, whereas cardiologist consultations and dispensing of first-line treatments are insufficient with respect to guidelines.

Background Atrial fibrillation (AF) and heart failure (HF) often coexist and are closely intertwined, each condition worsening the other. The temporal relationships between these two disorders have not yet been fully explored. We assessed, on a nationwide scale, the prognosis of patients hospitalized with HF and AF, based on the timing of AF and HF development. Methods From the administrative database covering hospital care for the whole French population, we identified 1,349,638 patients diagnosed with both AF and HF between 2010 and 2018: 956,086 of these AF patients developed HF first (prevalent HF) and 393,552 developed HF after AF (incident HF). The outcome analysis (all-cause death, cardiovascular [CV] death, ischemic stroke or hospitalization for HF) was performed with follow-up starting at the time of last event between AF or HF in the whole cohort and in 427,848 propensity-score-matched patients (213,924 with incident HF and 213,924 with prevalent HF). Results During follow-up (mean follow-up 1.6±1.9 year), matched patients with prevalent HF had a higher risk of all-cause death (21.6 vs 19.2%/year), CV death (7.6 vs 6.5%/year) as well as non-cardiovascular death (13.9 vs 12.7%/year) than those with incident HF. The risk for ischemic stroke was lower in the prevalent HF group (1.2 vs 2.4%/year). Conclusion In patients hospitalized with both AF and HF, we identified two distinct clinical entities based on the chronological sequence of the two disorders. Patients in whom HF preceded AF (prevalent HF) had higher mortality and higher risk of rehospitalization for HF. Funding Acknowledgement Type of funding sources: None.

Background Despite guidelines describing the optimal diagnostic and therapeutic procedures of patients with suspected infection of cardiac implantable electronic device (CIED), the management of such patients is often challenging. Purpose The aim of this study was to describe our diagnostic and therapeutic practices for suspected CIED infection and to compare them to European Heart Rhythm Association (EHRA) guidelines. Methods Patients hospitalized in our tertiary care hospital for suspected CIED infection from 2014 to 2019 were retrospectively included. We applied the EHRA classification and compared diagnostic and therapeutic management to EHRA guidelines. Results Among 184 patients (mean age 72.3±12.4 years), 137 had a proven infection of the lead (either by TTE/TEE, by [18F]FDG PET/CT, or by positive culture of the lead) or an isolated pocket infection without proof of lead infection and 47 had no proof of infection of CIED. According to EHRA classification, CIED infection was considered as definite in 145 patients, possible in 31 and excluded in 8. Regarding recommended diagnostic procedures, blood cultures were performed in 90.8%, TTE in 97.8%, TEE in 85.9%, [18F]FDG PET/CT in 50.5% and imaging for embolisms in 78.3% of the patients. Compared to therapeutic recommendations for the 145 cases of definite CIED infection, device removal was performed in 96 patients (66.2%), antibiotic therapy was prescribed in 130 (89.7%), with a duration equal or superior to the one recommended in 105 (72.4%) of the patients. One-year survival rate was 66.3% and was better in patients with device removal than in patients without, both in the whole population (respectively 77.7% and 48.6%) and in the patients with definite CIED infection (80.0% vs 49.0%). After adjustement on age and Charlson's score, patients without device removal had a significantly higher risk of 1-year mortality (HR=3.40 [1.84–6.26], p=0.0001). Conclusion Suspicion of CIED infection are difficult situations. The use of theoretical classification helps to define the different types of cases and the resultant therapeutic approach. In daily practice, our study shows that the strict adherence to these guidelines is not always possible. This study shows a relatively good use of diagnostic procedures. However, theoretical advice for medical therapy and removal procedures are not always properly followed. To improve patients' prognosis, infected device removal must be systematically discussed in multidisciplinary endocarditis team, weighing the benefit-risk ratio of the strict appliance of the guidelines. Funding Acknowledgement Type of funding sources: None. Diagnostic comparisonTherapeutic comparison

Background Aortic stenosis (AS) is one of the most common forms of valvular heart disease. Our aim was to estimate the burden of AS in the hospital in France, describe patient characteristics, and evaluate the mortality rate and temporal trends. Methods and Results All patients hospitalized for AS in France between 2006 and 2016 were identified from the national hospital discharge database. Patients’ sociodemographic, medical, and surgical characteristics and temporal trends were described. All AS‐related deaths between 2000 and 2014 were identified using death certificates. In 2016, 26 071 patients were hospitalized for AS: 56.5% were men with an average age of 77 years. The all‐cause mortality rate at 1 year postindex stay was 11%. The rate of patients hospitalized for AS increased by 59% between 2006 and 2016, reaching 38.7/100 000 person‐years in 2016. This increase was most pronounced in patients aged >75 years. The number of transcatheter aortic valve implantations increased following their introduction in 2010. In 2016, 44% of patients were treated with aortic valve surgery during the index hospital stay or following year (mean age, 71.5 years), and 34% were treated with transcatheter aortic valve implantation (mean age, 83.0 years). In 2014, 6186 deaths caused by AS were identified in death certificates: 41.6% were men with an average age of 87 years. The age‐standardized mortality rate increased by 5% between 2000 and 2014, reaching 8.5/100 000 person‐years in 2014. Conclusions The rate of patients hospitalized for AS increased in recent years in line with the higher life expectancy and introduction of transcatheter aortic valve implantation. Mortality increased more moderately.

Summary Background Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systeme national des donnees de sante; SNDS) can be used to compare these guidelines with real-life practice. Aims To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. Methods We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. Results Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). Conclusions Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.

Background: Our purpose was to describe the care pathway of patients hospitalized for acute heart failure (AHF) and investigate whether a management involving a cardiology department had an impact on in-hospital mortality. Methods: Between June 2014 and October 2018, we included patients hospitalized for AHF in 24 French hospitals. Characteristics of the episode, patient’s care pathway and outcomes were recorded on a specific assessment tool. The primary outcome was the association between patient care pathway and in-hospital mortality. The independent association between admission to a cardiology ward and in-hospital mortality was assessed through a multivariate regression model and propensity score matching. Results: A total of 3677 patients, mean age of 78, were included. The in-hospital mortality rate was 8% (n = 287) and was associated on multivariate regression with advanced age, presence of sepsis, of cardiogenic shock, high New York Heart Association (NYHA) score and increased plasma creatinine level on admission. High blood pressure and admission to a cardiology department appeared as protective factors. After propensity score matching, hospitalization in a cardiology department remained a protective factor of in-hospital mortality (OR = 0.61 [0.44–0.84], p = 0.002). Conclusion: A hospital course of care involving a cardiology department was associated with an increase in hospital survival in AHF patients. These finding may highlight the importance of collaboration between cardiologists and other in-hospitals specialties, such as emergency physicians, in order to find the best in-hospital pathway for patients with AHF.Clinical Trial NCT03903198. Keywords: Acute heart failure, Acute cardiac care, Outcome

Background Both pulmonary artery pressure (PAP) and right ventricular (RV) function have shown their value in the prognostic evaluation of patients with mitral valve prolapse (MVP). Echocardiography which allows simultaneous pressure estimation and volume measurement by 3D allows an approach of arterial (Ea) and ventricular elastance (Emx) and of right ventriculo-arterial coupling (RVAC), usually derived from pressure-volume loops, and could be of interest in the assessment of the RV-PA unit. Methods Thirty normal patients (group Nl, mean age 52.7 ± 15.9) and 75 patients with stable MVP (mean age 52.4 ± 15.4 (ns for age), 39 (group MVP1) with no or mild mitral regurgitation (MR) and 36 (group MVP2) with moderate to severe MR) underwent echocardiography including 3D RV acquisition. RV end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV) (mL) and ejection fraction (EF) (%) were obtained 3D echo (3DE) volumetric analysis (GE, EchoPac). mPAP was estimated from echo using Chemla’s formula (mPAP = 0.61 x sPAP + 2mmHg). Pulmonary artery effective elastance (Ea) was estimated as mPAP/SV (mmHg/mL), RV maximal end-systolic elastance (Emax) as mPAP/ESV (mmHg/mL), and RVAC as Ea/Emax. Ea, Emax and RVAC were compared between the 3 groups of patients using ANOVA. Results Mean LVEF was similar in the 3 groups. There was a significant differences in mPAP (Nl: 15.6 ± 3.0; MVP1: 16.3 ± 3.3; MVP2: 22.9 ± 11.1, p = 0.001). RVEDV (Nl: 81.3 ± 19.2; MVP1: 80.1 ± 22.0; MVP2: 96.1 ± 28.6, p = 0.09), RVEF (Nl: 50.4 ± 4.4; MVP1: 49.3 ± 5.5; MVP2: 46.6 ± 6.6, p = 0.02) and RVESV (Nl: 39.9 ± 9.8; MVP1: 40.8 ± 12.8; MVP2: 52.0 ± 19.5, p = 0.01) were significantly different among the 3 groups. There was a non significant trend toward progressive increase in Ea (Nl: 0.41 ± 0.12; MVP1: 0.45 ± 0.15; MVP2: 0.53 ± 0.30, p = 0.07) and E max (Nl: 0.42 ± 0.11; MVP1: 0.45 ± 0.17; MVP2: 0.53 ± 0.31, p = 0.11) among the 3 groups but RVAC was not significantly different (Nl: 0.99 ± 0.17; MVP1: 1.04 ± 0.22; MVP2: 1.05 ± 0.37, ns). Conclusion 3D echocardiography allows a complete analysis of the RV-PA unit and is able to reveal subtle changes in its equilibrium. Together with an increase in RV volumes and decrease in RVEF, our study reveals a progressive increase in arterial elastance in parallel with the severity of MR, compensated by an increase in ventricular elastance to maintain RV – PA coupling in those stable patients with MVP.

The analysis of right ventriculo-arterial coupling (RVAC) from pressure-volume loops is not routinely performed. RVAC may be approached by the combination of right heart catheterization (RHC) pressure data and cardiac magnetic resonance (CMR)-derived right ventricular (RV) volumetric data. RV pressure and volume measurements by Doppler and three-dimensional echocardiography (3DE) allows another way to approach RVAC.Ninety patients suspected of having pulmonary hypertension underwent RHC, 3DE, and CMR (RHC mean pulmonary artery pressure [mPAP] 37.9 ± 11.3 mm Hg; range, 15-66 mm Hg). Three-dimensional (3D) echocardiography was performed in 30 normal patients (echocardiographic mPAP 18.4 ± 3.1 mm Hg). Pulmonary artery (PA) effective elastance (Ea), RV maximal end-systolic elastance (Emax), and RVAC (PA Ea/RV Emax) were calculated from RHC combined with CMR and from 3DE using simplified formulas including mPAP, stroke volume, and end-systolic volume.Three-dimensional echocardiographic and RHC-CMR measures for PA Ea (3DE, 1.27 ± 0.94; RHC-CMR, 0.71 ± 0.52; r = 0.806, P .001), RV Emax (3DE, 0.72 ± 0.37; RHC-CMR, 0.38 ± 0.19; r = 0.798, P .001), and RVAC (3DE, 2.01 ± 1.28; RHC-CMR, 2.32 ± 1.77; r = 0.826, P .001) were well correlated despite a systematic overestimation of 3DE elastance parameters. Among the whole population, 3D echocardiographic PA Ea and 3D echocardiographic RVAC but not 3D echocardiographic RV Emax were significantly lower in patients with mPAP25 mm Hg (n = 41) than in others (n = 79). Among the 90 patients who underwent RHC, 3D echocardiographic PA Ea and 3D echocardiographic RVAC but not 3D echocardiographic RV Emax increased significantly with increasing levels of pulmonary vascular resistance.Three-dimensional echocardiography-derived PA Ea, RV Emax, and RVAC correlated well with the reference RHC-CMR measurements. Ea and RVAC but not Emax were significantly different between patients with different levels of afterload, suggesting failure of the right ventricle to maintain coupling in severe pulmonary hypertension.

OBJECTIVE The aim of our study was to evaluate the outcome of patients with severe aortic stenosis presenting with acute decompensated heart failure (ADHF) and planned for transcatheter aortic valve implantation (TAVI) and to study the variables influencing their prognosis. METHODS Our retrospective study included 801 patients planned for TAVI in our center. Seven hundred and fifty-six underwent TAVI and were categorized according to ADHF as the initial clinical presentation into two groups: ADHF group (n = 261) and no-ADHF group (n = 495). Pre as well as periprocedural outcomes and 1 year mortality were analyzed. RESULTS Among the patients planned for the TAVI procedure, 45 patients remained untreated: 35 patients died while waiting to undergo TAVI which represented 20% of all deaths in our study, ADHF was observed in 23 of 45 (51%) these untreated patients. The 1-year all-cause mortality rate was significantly higher in the ADHF group versus the no-ADHF group (27% vs. 15%, p

Summary Background The effectiveness of transitional care services for patients discharged from hospital after acute heart failure is challenging, especially in terms of reducing subsequent heart failure hospitalizations. The increased adoption of smartphone applications in society offers a new opportunity to interact with patients to avoid rehospitalization. Thus, electronic health (e-health) can enhance the impact of existing therapeutic education programmes. Aims To determine the prevalence of smartphone use among patients with chronic heart failure, and to assess the epidemiological characteristics and therapeutic management of these patients, with a broader aim of developing smartphone-based therapeutic education programmes for patients. Methods The French Observatoire francais de l’insuffisance cardiaque et du sel (OFICSel) registry was conducted in 2017 by 300 cardiologists, and included both inpatients and outpatients who had been hospitalized for heart failure at least once in the previous 5 years. Data collection included demographic and heart failure-related variables, which were provided by the cardiologist and by the patient via a questionnaire. Results Among the 2822 patients included, 2517 completed the questionnaire. Of this total, 907 patients (36%) were smartphone users. Compared with non-users, smartphone users were younger, were more frequently men, more frequently lived in cities, had a higher educational level and were more frequently professionally active. Smartphone users less frequently had diabetes, hypertension, atrial fibrillation or ischaemic cardiopathy. Only 22% of patients were actively participating in a therapeutic education programme. Conclusion Smartphones were used by more than one-third of patients with heart failure in France in 2017, underscoring the feasibility of developing a smartphone application to deliver therapeutic education to the population with chronic heart failure.

Summary Background Patient education programmes (PEP) are recommended for patients with heart failure but have not been specifically assessed in heart failure with preserved ejection fraction (HFpEF). Aim To assess the effectiveness of a structured PEP in reducing all-cause mortality in patients with HFpEF. Methods Patients with HFpEF were selected from the ODIN cohort, designed to assess PEP effectiveness in patients with HF whatever their ejection fraction, included from 2007 to 2010, and followed up until 2013. Baseline sociodemographic, clinical, biological and therapeutic characteristics were collected. At inclusion, patients were invited to participate in the PEP, which consisted of educational diagnosis, education sessions and final evaluation. Education focused on HF pathophysiology and medication, symptoms of worsening HF, dietary recommendations and management of exercise. Propensity score matching and Cox models were performed. Results Of 849 patients with HFpEF, 572 (67.4%) participated in the PEP and 277 (32.6%) did not. Patients who participated in the PEP were younger (67.0 ± 13.1 vs 76.1 ± 13.2 years; standardized difference [StDiff] = −54.6%), less often women (39.7% vs 48.4%; StDiff = −17.6%) and presented more often with hypercholesterolaemia (55.2% vs 35.2%; StDiff 41.2%), smoking (35.1% vs 28.7%; StDiff 13.8%), alcohol abuse (14.1% vs 8.9%; StDiff 16.5%) and ischaemic HF (38.7% vs 29.2%; StDiff 20.0%) than those who did not; they also presented with better clinical cardiovascular variables. After propensity score matching, baseline characteristics were balanced, except hypertension (postmatch StDiff 19.1%). The PEP was associated with lower all-cause mortality (pooled hazard ratio 0.70, 95% confidence interval 0.49–0.99; P = 0.042). This association remained significant after adjustment for hypertension (adjusted pooled hazard ratio 0.68, 95% confidence interval 0.48–0.97; P = 0.036). Conclusions In this investigation, a structured PEP was associated with lower all-cause mortality. Patient education might be considered an effective treatment in patients with HFpEF.

Background Atrial fibrillation and heart failure often coexist and are closely intertwined, each condition worsening the other. However, the temporal relationships between these two conditions have not yet been fully explored. We aimed to assess, on a national scale, the prognosis of patients hospitalised with HF and AF based on the timing of the onset of the two conditions. Methods All consecutive patients with both AF and HF admitted to hospital between 2010 and 2018 were included, i.e. 1,237,927. Patients were identified in the French administrative hospital discharge database. Results Overall, most patients developed HF before AF (n = 860,937; 69.5%). At follow-up (median [IQR]: 1.4 [0.2–3.7] years), patients with HF first had an increased risk of all-cause death (yearly incidence: 19.9% vs. 10.1%; [RR (95% CI)]: [1.98 (1.96–1.99)]; P Conclusion In this large study, we identified two distinct clinical entities based on the chronological sequence of AF and HF onset. Our results confirm that the prognosis for HF preceding AF was much worse than the opposite, but further studies are needed to investigate the thromboembolic results highlighted in this study.

AIM To investigate the survival benefit of bilateral internal mammary artery (BIMA) grafts in patients with left ventricular dysfunction. METHODS Between 1996 and 2009, we performed elective, isolated, primary, multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery (LIMA)-saphenous venous grafting (SVG). RESULTS The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups (7.8% vs 10.3%, P = 0.49). Early postoperative morbidity included myocardial infarction (4.2% vs 3.8%, P = 0.80), stroke (1.2% vs 3.8%, P = 0.14), and mediastinitis (5.3% vs 2.3%, P = 0.11). At 8-year follow-up, Kaplan-Meier-estimated survival (74.2% vs 58.9%, P = 0.02) and Kaplan-Meier-estimated event-free survival (all cause deaths, myocardial infarction, stroke, target vessel revascularization, heart failure) (61.7% and 41.1%, P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival (P = 0.40) and event-free survival (P = 0.13) in comparison with LIMA-SVG use. CONCLUSION Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.

Aims We aimed to analyse trends in annual incidence of hospitalized acute coronary syndrome (ACS) in France from 2004 to 2014. Methods and results Primary diagnosis of ACS and subtypes on admissions were selected in national and exhaustive French Hospitalization Database from 2004 to 2014. Age-standardized rates were computed using standardization on the census of the 2010 European population and mean annual percent changes were estimated by using Poisson regression model. In 2014, 113 407 patients, 36 480 women (32.2%) and 76 927 men (67.8%) were hospitalized for ACS. Among women, the proportion aged under 65 years was 25.2% (n = 9206) and there was 34.4% of STEMI, 18.2% of NSTEMI and 47.4% of UA. From 2004 to 2014, the rates of age-standardized admissions for ACS in women less than 65 years old increased by 6.3%.This rise in ACS was driven by significant increases in STEMI (+21.7%) and NSTEMI (+53.7%). The largest increase in STEMI mean annual percent change was observed among women aged 45–54 years old (+3.6%/per year). After 65 years of age, significant decreases in all ACS types were observed. Conclusion This nationwide study showed substantial rising trends in STEMI annual incidence, especially among younger women. This increase could be attributed to increase in smoking and obesity. Efforts to strengthen primary prevention of CVD in younger women is needed as the main risk factors are modifiable, and as there is a growing evidence of higher short-term mortality of CHD in women.

Background In 2006, the prevalence of mitral regurgitation has been estimated at 9.3% in the US population over 75 years of age. The main etiology of mitral regurgitation is degenerative with valve prolapses and ischaemic in developed countries. Purpose Estimate the annual incidence of patients hospitalized for non-rheumatic mitral regurgitation (nRMR) in France, and describe their characteristics and the temporal trends. Methods All patients hospitalized for nRMR management in France between 2006 and 2016 were identified using data from the national hospital discharge database (PMSI-MCO) integrated into the national health data system (SNDS). The index stay was defined as the first stay of the year in which the patient are hospitalized for valvular heart disease. Stays whose principal or related diagnosis was mitral valve insufficiency (ICD10-I340) or mitral valve prolapse (ICD10 - I341) were included in this study. Surgical valve procedures were identified from the French medical classification for clinical procedures. The socio-demographic, medical and surgical characteristics of patients and temporal trends from 2006 to 2016 were described. Results In 2016 5,864 patients were hospitalized for a nRMR, 32% of whom had associated ischemic heart disease and 12% had mitral prolapse, identifiable by the SNDS; 59% were male and the average age was 68 years. A total of 17.9% of these patients had a multivalvular heart disease. The case-fatality rate at 1 year of the index stay was 8.5%. The incidence of patients hospitalized for nRMR increased by 14% between 2006 and 2016, and was 9.1/100,000 PY. Moreover, in 2016, 73% of patients hospitalized for nRMR were operated in the year following the index hospital stay. Conclusion The incidence of patients hospitalized for nRMR increased in recent years. This upward trend is expected to continue with the current development of percutaneous mitral valve procedures.

Introduction Differences in baseline characteristics and anatomy between female and male patients with aortic-valve stenosis may influence outcomes after TAVI. Female gender has been linked to increased risk of periprocedural adverse events which contrasts with paradoxically more favorable long-term outcomes. Purpose To compare perioperative outcomes and 1-year mortality after TAVI in women versus men. Methods Our retrospective monocentric study included 652 consecutive patients (343 women, 52.6%) with severe, symptomatic aortic stenosis who underwent TAVI from January 2010 to July 2017. Results Women were likely to be older with lower rate of known coronaropathy, peripheral arteriopathy and past cardiac surgery. The 30-day mortality was not significantly different between women (7.3%) and men (7.4%) group, P = 0.940. During the postoperative course, VARC-2 major vascular complications (15.7% in women group versus 14.2% in men group, P = 0.592) and major bleeding composite criteria (BARC type 3b, 3c and 5) (17.5% versus 17.2%, P = 0.909) did not significantly differ between two groups. The incidence of 1-year all-cause mortality was 16.3% (n = 56) in women and 23.9% (n = 74) in men group, P = 0.015. After multivariate analysis, the only independent predictors of 1-year mortality were acute heart failure at admission (adjusted HR 1.83, 95% CI [1.23 to 2.72], P = 0.003) and femoral access (adjusted HR 0.48, 95% CI [0.32 to 0.70], P Conclusions The 1-year all-cause mortality was lower in women than men after TAVI, with similar perioperative outcomes. After multivariate analysis, initial acute heart failure and femoral access were independent predictors of 1-year mortality but not gender.

Aims Alhough cardiogenic shock (CS) after acute myocardial infarction (AMI) is more common in elderly patients, information on the epidemiology of these patients is scarce. This study aimed to assess the trends in prevalence, characteristics, management, and outcomes of elderly patients admitted with CS complicating AMI between 1995 and 2010, using data from the FAST-MI programme. Methods and results We analysed the incidence and 1-year mortality of CS in four nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive AMI patients over 1-month periods. Among the 10 610 patients, 3389 were aged ≥75 years, of whom 9.9% developed CS. The prevalence of CS decreased in elderly patients from 11.6% in 1995 to 6.7% in 2010 (P = 0.02). Over the 15-year period, the characteristics of elderly patients with CS changed, with more diabetes, hypertension, and hypercholesterolaemia. The use of PCI increased markedly in elderly patients with and without CS, reaching 51% and 59%, respectively, in 2010. In addition, medical therapy also evolved, with more patients receiving antithrombotic agents, beta-blockers, and statins. Over time, 1-year mortality decreased by 32% among elderly patients with CS but remained high (59% in 2010). ST-segmet elevation myocardial infarction and previous AMI were independent correlates of increased 1-year death, while study period was associated with decreased mortality (2010 vs, 1995: hazard ratio 0.40, 95% confidence interval 0.27–0.61, P < 0.001), along with early use of PCI. Conclusion Cardiogenic shock in elderly patients with AMI remains a major clinical concern. However, 1-year mortality declined in these patients, a decrease potentially mediated by broader use of PCI and the improvement of global patient management.

Summary Background Right ventricular (RV) dysfunction is an important predictor of impaired prognosis in idiopathic dilated cardiomyopathy. Aims To determine the prognostic role of RV dysfunction, independent of left ventricular (LV) dysfunction. Methods A total of 136 consecutive patients (73% men; mean age 59.0 ± 13.2 years) with idiopathic dilated cardiomyopathy (LV ejection fraction ≤ 45%) were enrolled retrospectively. Thirty-four patients (25%, group 1) presented with RV dysfunction, defined as tricuspid annular plane systolic excursion (TAPSE) ≤ 15 mm; 102 patients (group 2) had preserved RV function. Results Mean LV ejection fraction was 27.5 ± 8.7%. Mean TAPSE was 18.6 ± 5.4 mm (15–21.8 mm). Multivariable predictors of RV dysfunction were LV outflow tract time-velocity integral (odds ratio 0.8, 95% confidence interval [CI] 0.7–0.9; P = 0.003) and E-wave deceleration time ≤ 145 ms (odds ratio 4.1, 95% CI 1.3–12.8; P = 0.017). Major adverse cardiac event-free survival rates at 1 and 2 years were 64% and 55%, respectively, in group 1 and 87% and 79%, respectively, in group 2 ( P = 0.002). Both by multivariable analysis and after stratification using a propensity score, RV dysfunction emerged as an independent predictor for major adverse cardiac events (hazard ratio 3.2, 95% CI 1.3–7.6; P = 0.009), along with right atrium area and age. Conclusion In idiopathic dilated cardiomyopathy, RV dysfunction with TAPSE ≤ 15 mm offers additional prognostic information, independent of the extent of LV dysfunction.

Background Atrial flutter-related tachycardiomyopathy (AFL-TCM) is a rare and treatable cause of heart failure. Little is known about its epidemiology and long-term prognosis. Our aims are to determine the prevalence, predictors and outcomes of AFL-TCM. Methods A total of 1269 patients were referred for radiofrequency ablation of AFL between January 1996 and September 2014; 184 had reduced left ventricular ejection fraction (LVEF

Aims A shorter time delay between onset of symptoms and first call for medical attention would be expected in patients with a history of ischemic heart disease (IHD). We aimed to determine whether time to first call for an ST-elevation myocardial infarction (STEMI) differed between patients with or without history of coronary artery disease from the French registry of acute ST-elevation or non-ST-elevation myocardial infarction (FAST-MI) 2010 registry. Methods FAST-MI 2010 is a nationwide French registry that included 4169 patients with acute myocardial infarction (AMI, 2193 STEMI) at the end of 2010 in 213 centers. Factors correlated with time to first call were assessed, with a specific emphasis on previous history of IHD (IHD+; n = 402), compared with patients without history of IHD (IHD−; n = 1791). Results Time from onset to first call was 222 ± 420 min (median time 68 min) in IHD+ patients versus 240 ± 4423 min (median time 75 min) in IHD− patients (P = 0.28). In multivariate analysis, only a few factors were significantly related to a shorter time from onset to first call (≤75min); time of onset during the day (7:00 a.m. to 11:00 p.m.), upper socioeconomic class, anterior MI, cardiac arrest as the initial symptom, whereas history of IHD was not associated with a shorter time delay (odds ratio 0.86; 95% confidence interval 0.70–1.05). Similar results were found between patients with previous AMI and IHD− patients. Conclusion Patients with a history of IHD do not call earlier than IHD-naive patients when they are confronted with symptoms of AMI. Cardiologists should spend more time educating their coronary patients to recognize symptoms of AMI. Conclusion Clinicaltrials.gov identifier: NCT01237418

Background To reduce readmissions for heart failure (HF) among HF patients, most at-risk individuals could be targeted to benefit from adapted interventions. A better understanding of HF readmission predictors could help clinicians and regulators identify patients most at-risk. Purpose Our objective was to study predictors of HF readmission available in administrative data, taking into account the competing mortality risk. In particular, we focused on distinguishing HF severity from overall health-state severity, in order to identify HF readmission risk-groups. Methods In a nationwide cohort of patients aged 65 years or older, surviving an index hospitalization for HF in 2015 (n = 70 657), we estimated subdistribution hazard ratios (sdHRs) of HF readmission and cause-specific hazard ratios (csHRs) for HF readmission and for death without HF readmission, over a 1-year follow-up period. We then computed cumulative incidences and daily rates of HF readmission for specific risk-groups. Results In total, 31.8% of patients were readmitted at least once for HF, among which 27.2% (8.6% of study cohort) were readmitted 30 days after discharge. 17.6% of patients died without any HF readmission. HF severity and overall health-state severity were the strongest HF readmission predictors (sdHRs 2.66 [95% CI: 2.52–2.81] and 1.37 [1.30–1.45] respectively, when comparing extreme categories). HF severity and length of index stay were more strongly associated with the rate (csHRs) of HF readmissions, whereas overall health-state severity and age were more strongly associated with the competing rate of death without HF readmission. Risk-groups defined upon HF severity and overall health-state severity had approximately 40% of separation in HF readmission proportion (21.9% versus 60.4%). Conclusions Considering overall morbidity burden and taking into account the competing mortality risk permits segmenting patients into HF readmission risk-groups.

Background In 2006, the prevalence of aortic stenosis (AS) has been estimated at 2.8% in the US population over 75 years of age. The main etiology of AS is age-related degeneration. The management of this pathology evolved in recent years with the development of transcatheter aortic-valve implantation (TAVI). Purpose Estimate the annual incidence of patients hospitalized for non-rheumatic aortic stenosis (nRAS) in France, and describe their characteristics, their care, and the temporal trends. Methods All patients hospitalized for nRAS management in France between 2006 and 2016 were identified using data from the national health data system (SNDS). The index stay was defined as the first stay of the year in which the patients are hospitalized for valvular heart disease. Stays whose principal or related diagnosis was nRAS were included in this study (ICD10 I350-I352). Surgical or percutaneous aortic-valve procedures were identified from the French medical classification for clinical procedures. The socio-demographic, medical and surgical characteristics of patients and temporal trends from 2006 to 2016 were described. Results In 2016 25,149 patients were hospitalized for a nRAS, 57% of whom were male and the average age was 77 years. 11% of these patients had a multivalvular heart disease. The case-fatality rate at 1 year of the index stay was 11%. The incidence of patients hospitalized for nRAS increased by 67% between 2006 and 2016, and was 37.4/100,000 PY in 2016. The increase was most pronounced in patients over 75 years. The number of TAVI increased since their introduction in 2010. Thus, in 2016, 45% of patients are operated by thoracotomy in the year following the index hospital stay, and 35% by TAVI. Conclusion The incidence of patients hospitalized for nRAS increased in recent years in line with the increase in life expectancy and the development of TAVI which allows a wider range of aortic-valve implantation indications and thus more patients to be managed.

Introduction Recommendations for heart failure (HF) outpatient follow-up have been published. The SNDS offers the opportunity to confront them to real-life, including geographical disparities. Moreover, estimation variation has to be explored when population excludes institutionalized patients (IP) that have specific healthcare use and refund: rehabilitation (SSR), psychiatric hospitalization (psy), skilled nursing home (EHPAD) which is not usually done. Purpose To study outpatient healthcare use variations in France after hospitalization for HF, using SNDS data. Methods The first stay for HF (> 0 days) in 2015 of patients over 18 y.o. covered by the general scheme (RG/SLM 88% of population) was considered. Healthcare use 30 days after was compared with (RG/SLM) or without IP (RG/SLM eIP). Regional outpatient care use rates were standardized by age and sex. Results Among 104 984 alive patients 30 days after HF hospitalization (RG/SLM, female 52%, mean age 79 y.o.), 16% stayed in SSR, 9% in cardiologic SSR, 12% in EHPAD, 0.2% in psy and 75% returning home and not institutionalized (RG/SLM eIP; n = 70367). Among all RG/SLM patients vs RG/SLM eIP (mean age 79 y.o. vs. 78 y.o.), a cardiologist was seen at least once in 30 days post hospitalization 20% vs. 21% (median delay 14 days IQR 7-23 vs. 16 IQR 9-24), a general practitioner 69% vs. 78% (8 IQR 3-16 vs. 7 IQR 3-15), a nurse 58% vs. 69% (3 IQR 1-9 vs. 2 IQR 1-7). ACE inhibitors were reimbursed at least once for 34% vs. 39%, ARBs 14% vs. 17%, and diuretics 69% vs. 77%. Among RG/SLM eIP patients, departmental disparities were high: cardiologist (3% to 46%), GP (59% to 93%), nurse visit (49% to 82%). Lower rates for GP were found in the center of France but with higher rates for nurse visits. Conclusions We recommend using RG/SLM eIP when studying outpatient healthcare use in the SNDS. Low visit rates and high delays regarding the recommendations point out the need of a multidisciplinary community health care in France.

Acute myocarditis (AM) refers to a series of heterogeneous clinical manifestations, ranging from asymptomatic course, heart failure, arrhythmia, to cardiogenic shock. Low-risk patients according to conventional criteria remain the most common form, and 80% of patients are discharged from hospital

International audience; Background: Appropriate information about the benefits and risks of invasive procedures is crucial, but limited data is available in this field. The aim of this study was to evaluate the incremental value of a short video about coronary angiography compared with standard information, in terms of patient understanding, satisfaction and anxiety. Methods: This prospective multicenter study included patients admitted for scheduled coronary angiography, who were randomized to receive either standard information or video information by watching a three-dimensional educational video. After information was delivered, patients were asked to complete a dedicated 16-point information questionnaire, as well as satisfaction and anxiety scales. Results: From 21 September to 4 October 2015, 821 consecutive patients were randomized to receive either standard information (n = 415) or standard information with an added educational video (n = 406). The information score was higher in the video information group than in the standard group (11.8 +/- 2.8 vs 9.5 +/- 3.1; P \textless .001). This result was consistent across age and education level subgroups. Self-reported satisfaction was also higher in the video information group (8.4 +/- 1.9 vs. 7.7 +/- 2.3; P \textless .001), while anxiety level did not differ between groups. The variables associated with a higher information score were the use of the educational video, younger age, higher level of education, previous follow-up by a cardiologist, prior information about coronary angiography and previous coronary angiography. Conclusions: In comparison with standard information, viewing a dedicated educational video improved patients' understanding and satisfaction before scheduled coronary angiography. These results are in favor of widespread use of this incremental information tool. (C) 2018 Elsevier Inc. All rights reserved.

Background— Coronary artery embolism (CE) is recognized as an important nonatherosclerotic cause of ST-segment–elevation myocardial infarction. The objective was to describe clinical characteristics and long-term outcomes and to identify risks factors of CE in a large consecutive series of ST-segment–elevation myocardial infarction patients. Methods and Results— We studied 1232 consecutive patients who presented with de novo ST-segment–elevation myocardial infarction. CE was diagnosed based on criteria encompassing clinical, angiographic, and diagnostic imaging findings. A total of 53 patients were identified in the CE group including 12 (22.6%) patients with multisites CE and 9 patients with other extracoronary localization. Compared with the non-CE group, age and coronary risks factors were not significantly different in the CE group except for smoking ( P =0.03) and body mass index ( P P P P Conclusions— Etiopathogenesis of ST-segment–elevation myocardial infarction secondary to CE is diverse ranging from cardiac to systemic disease, and patient long-term survival is worse than expected according to the baseline cardiovascular risk.

Introduction Pulmonary artery pressure (PAP) and right ventricular (RV) function have shown their value in the prognostic evaluation of patients with mitral valve prolapse (MVP). Echocardiography, including pressure estimation and volume measurement by 3D, allows an approach of right ventriculo-arterial coupling (RVAC) and assessment of the RV-PA unit. Method Thirty healthy controls patients and 53 patients with MVP (34 in group MVP1 with no or mild mitral regurgitation (MR) and 19 in group MVP2) with moderate to severe MR underwent echocardiography including 3D RV acquisition. RV end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV) (mL) and ejection fraction (EF) (%) were obtained 3D echo (3DE) volumetric analysis (GE, EchoPac). mPAP was estimated from echo using Chemla's formula (mPAP = 0.61 × sPAP + 2 mmHg). Pulmonary artery effective elastance (Ea) was estimated as mPAP/SV (mmHg/mL), RV maximal end-systolic elastance (Emax) as mPAP/ESV (mmHg/mL), and RVAC as Ea/Emax. Ea, Emax and RVAC were compared between the 3 groups of patients unsing ANOVA. Results Mean LVEF, TAPSE, mPAP were similar in the 3 groups. RVEDV (Nl: 81.3 ± 19.2; MVP1: 81.5 ± 23.1; MVP2: 92.7 ± 26.4, ns) and RVEF (Nl: 50.4 ± 4.4; MVP1: 49.2 ± 5.6; MVP2: 47.1 ± 5.5, ns) were similar in the 3 groups but not RVESV (Nl: 39.9 ± 9.8; MVP1: 41.6 ± 13.4; MVP2: 49.2 ± 15.7, P = 0.05). Ea (Nl: 0.41 ± 0.12; MVP1: 0.45 ± 0.16; MVP2: 0.48 ± 0.30, ns) and E max (Nl: 0.42 ± 0.11; MVP1: 0.45 ± 0.18; MVP2: 0.43 ± 0.25, ns) were not significantly different but RVAC was significantly different (Nl: 0.99 ± 0.17; MVP1: 1.06 ± 0.23; MVP2: 1.15 ± 0.25, P = 0.04). Conclusion 3D echocardiography is able to reveal subtle changes in RV-PA unit equilibrium. Together with an increase in RV end-systolic volume, our study reveals a progressive alteration in RVAC in parallel with the severity of MR in patients with MVP as compared to normal patients.

Background Therapeutic education (TE) and follow-up in heart failure (HF) patients are mandatory. This could be eased by new technologies, particularly with smartphone use. There is no data about the characteristics of the patients using a smartphone in this population. Purpose Evaluate the prevalence and the epidemiological characteristics of HF patients with smartphone in a large sample of HF patients. Methods The OFICsel observatory include 180 French HF centers. Out and in-patients hospitalized for acute HF during the last five years were included in the study. Data collection included a Physician and Patient questionnaires including clinical, echocardiographical, biological and treatment characteristics. Patients recorded their own sociodemographic data. Results From March to June 2017, a total of 2517 patients completed the questionnaire. Of these patients, 907 (36%) patients had a smartphone, 1553 (59%) had an Internet connection and 1454 (58%) had an e-mail address. When comparing with patients who didn’t have a smartphone, patients who had a smartphone were younger (59.5 vs. 71.6 years old P Conclusion HF Patients using a smartphone represented 1/3 of our population, were younger, more likely to have a urban way of life, and with a higher level of education. This highlights the type of patients who would benefit from an educational program supported by a HF smartphone's application.

Background Face-to-face Patient's Education Programs (PEP) have been widely developed in France to improve treatment and diet restriction regimens (DRR) observance in Heart Failure (HF). Internet or Smartphone's Application Used (ISAU) may improve communication and education therefore data are lacking concerning the use of these technics in this Elderly population. Purpose Determine prevalence of ISAU, DRR and PEP prescription and their observance in HF. Methods OFICSel observatory included out and in HF patients hospitalized for HF at least one time for the last five years (whatever their LVEF). Data were obtained from a physician and patient questionnaires. Results Of the 2822 patients included in 2017, 2517 completed the questions regarding the use of new technologies of whom 1553(59%) had an Internet Connection (IC), 1454(58%) an e-mail address and 907(36%) were Smartphone's Application Used (SAU). Prescription of salt, sugar, lipid and fluid DRR in the overall cohort were respectively of 79.3%, 40.0%, 49,6% and 26.2%. Only 33.5% reported having being invited to PEP of whom only 66.2% did. The every day life compliances of these DRR were respectively for salt, sugar, lipid and fluid of: 44.2%, 45.4%, 33.1% and 41.8%. 20.4% of the overall population weighed every day. When comparing with patients who didn’t have ISAU, patients who had ISAU were younger (63 vs. 73 years old for IC and 60 vs. 72 years old for SAU, P Conclusion Restriction diet regimens are frequently prescribed in HF therefore their observance is low. Usage of internet is large in HF patients suggesting that developing new HF education tools through dedicated website or smartphone application might be useful in HF population.

Aims The objectives of this study were to describe annual trends in patients hospitalized for heart failure (HF) and HF-associated mortality rates in France between 2000 and 2012. Methods and results Hospital discharge data were extracted from the French National Hospitalization Database (PMSI). Mortality data were obtained from the French National Mortality Database. HF events constituting the underlying or associated cause of death were selected. Rates were age standardized using the 2010 European census population as the standard population. Time trends were tested using a Poisson regression model. In 2012, the overall age-standardized rate of patients hospitalized for HF was 246.2 per 100 000 inhabitants. The age-standardized rate of HF-associated mortality was 113.8 per 100 000 inhabitants in 2010. Hospitalized patient rates remained steady between 2002 and 2012, whereas mortality decreased by 3.3% annually from 2000 to 2010. Trends in hospitalized patients and mortality differed significantly between men and women, particularly among the 45- to 55- and 65- to 74-year-old age groups, with a smaller decrease observed in women. Conclusion Among men, a slight decrease in patients hospitalized for HF and a substantial reduction in mortality were observed. Among women, only a large decrease in HF mortality was observed. HF remains one of the leading causes of death and hospitalization in France, particularly in the elderly.

Introduction Left ventricular (LV) systolic dysfunction is the most frequent initial presentation of patient with LV noncompaction (NC). Our objectives were to evaluate myocardial contraction properties in patients with LVNC and the relationship of non-compacted segments with the degree of global and regional systolic deformation. Methods We included 50 LVNC with an echocardiography and speckle imaging calculation of peak longitudinal strain (PLS). Each of the 16 LV myocardial segments was defined as NC (ratio NC/compacted layer > 2), borderline (NC/C 0–2) and compacted (NC/C = 0). Basal, median and apical strain values were calculated as the average of segmental strain values. For comparison a group of 50 patients with dilated cardiomyopathy (DCM) underwent the same measurements. Results There was no statistical difference between the 2 groups for any conventional LV systolic parameters. A characteristic deformation pattern was observed in LVNC with higher strain values in the LV apical segments (− 12.8 ± 5.9 vs − 10.7 ± 5.7) and an apical–basal ratio (1.52 ± 0.73 vs 1.12 ± 0.42; p, Highlights • We observed a base–apex gradient with relatively preserved deformation values in the apical region in LVNC. • We find lower regional deformation values in compacted segments. • We illustrate the role of deformation echocardiography to evaluate the degree and extent of LV segmental dysfunction. • We define a new tool to help classification of patient with similar dilated cardiomyopathy phenotype. • We confirmed the concept that LVNC is a phenotypic marker of an underlying diffuse cardiomyopathy.

With great interest, we have read the article by Christiansen et al1 describing Danish age-specific trends in heart failure incidence and mortality. However, the authors do not mention the results of a French nationwide study carried out on exhaustive databases of hospitalization. In this study, age-specific trends analyses between 2000 and 2012, including inpatients …

Aims Little data on very long-term survival and associated prognostic factors in heart failure (HF) are available. The aim was to describe 15-year survival and to identify the baseline prognostic factors associated with mortality in a community-based sample of patients hospitalized for systolic HF. Methods Vital status was collected 15years after inclusion of 352 patients hospitalized for systolic HF born in France from the prospective cohort EPICAL. The prognostic value of baseline socioeconomic, clinical and biological characteristics on 15-year mortality was assessed using Cox models. Results The mean (±SD) age was 63.9 (±10.8)years, 76% of the patients were male, median left ventricular ejection fraction (LVEF) was 23% IR [18–27]. Overall, the mean (±SD) follow-up was 1826 (±111)days. A total of 290 (82.4%) deaths and 22 heart transplantations occurred during the follow-up. The 15-year survival rate was 13.2% (95% CI [9.0–16.3]), i.e. 4.7 times lower than the one observed in the general population. Baseline characteristics associated with 15-year mortality were: age older than 65years (HR=1.48, CI 95% [1.15–1.90]), diabetes mellitus (1.31 [1.00–1.72]), chronic kidney disease (1.73 [1.23–2.43]), serious comorbidity (1.29 [1.02–1.64]), time from first HF diagnosis exceeding 1year at inclusion (1.68 [1.26–2.24]), HF hospitalization during the previous 12months (1.36 [1.04–1.78]), heart rate higher than 110 beats per minute (1.87 [1.26–2.76]), LVEF % (0.88 per quartile increase [0.80–1.98]), and serum sodium below 130mmol/L (3.14 [1.76–5.61]. Conclusions Only 13% of patients hospitalized for HF survived at 15years. The usual mid-term prognostic factors are also predictive of very long-term survival.

SummaryBackgroundChronic heart failure (CHF) is a frequent severe disease. Disease-management programmes, which contain a therapeutic patient education component, will play a central role in improving delivery of care and reducing mortality and hospitalizations for CHF.AimsIn order to have an up-to-date overview of medical treatment of CHF in France implemented by hospital and clinic cardiologists especially interested in CHF and therapeutic patient education, we described the prescription of cardiovascular drugs in the large ODIN cohort of CHF patients, according to age and type of CHF.MethodsFrom 2007 to 2010 (median follow-up 27.2 months), CHF patients were prospectively enrolled in a multicentre ‘real-world’ French cohort by centres previously trained in therapeutic patient education. Patients were grouped according to age (

Background Abdominal aortic aneurysms (AAA) are serious disease with a high fatality rate but recent epidemiologic data in France are lacking. Purpose Our objective was to estimate, in France, the hospitalization, in hospital mortality and mortality rates due to AAA and to analyze their trends over time. Methods Hospitalization data were extracted from the hospital discharge summaries in the national database between 2002 and 2013. The analysis covered all patients hospitalized for AAA as a principal diagnosis. During the same period, all death certificates mentioning AAA as an initial cause of death were included in the study. Crude and standardized rates were calculated according to age and sex. Poisson regression was used to analyze the average annual percent change. Results In 2013, there were 8 853 patients hospitalized for AAA in France (7 986 unruptured and 867 ruptured). Between 2002 and 2013, the rate of patients hospitalized for unruptured AAA decreased slightly in men (−5.0%) but increased in women (+5.2%). By contrast, the rate of patients hospitalized for ruptured AAA has decreased by more than 20% in men and women. The proportion of endovascular treatment of unruptured AAA rose from less than 10% in 2005 to 35% in women and 40% in men in 2013. In 2013, 939 deaths from AAA were recorded. Mortality for this disease declined significantly from 2002 to 2013 in men and women. Conclusion The unfavorable epidemiological trends in women and important evolution of the management of AAA call for an epidemiological surveillance of this disease.

Introduction Severe degenerative mitral stenosis (DMS) is a known predictor of mortality in patients with symptomatic aortic stenosis (AS) considered for transcatheter aortic valve replacement (TAVR) but little data exist regarding mild to moderate DMS. We assessed the association of DMS with mitral annulus calcification (MAC) and evaluated the association of non-severe DMS and MAC with morbidity and mortality in patients with severe AS undergoing TAVR. Method In a retrospective cohort of 346 patients with isolated severe AS undergoing TAVR, we evaluated the association of different DMS severities (based on transmitral mean pressure gradient (TMPG, mmHg)) and MAC severity with all-cause mortality and cardiovascular (CV) hospitalization/death. Severe DMS (TMPG > 10 mmHg) was excluded from the analysis. Results Non-severe DMS (TMPG > 2 mmHg) was present in 42% of patients (n = 147) and moderate to severe MAC in 46% (n = 131). Patients with TMPG > 2 mmHg were predominantly female (66.7% vs. 41.7%, P 2 mmHg) and MAC (moderate to severe) were found to be independent predictors of mortality (HR = 1.17 [1.02–1.35], P = 0.0245 and HR = 2.01 [1.18–3.44], P = 0.01 respectively). Conclusion Non-severe DMS is frequently associated with MAC in patients with severe AS undergoing TAVR. In the challenging context of DMS and MAC in patients undergoing TAVR, TMPG > 2 mmHg appears as an independent prognostic factor that discriminates high-risk patients.

Background Outcome of acute heart failure (AHF) patients according to the final destination after emergency department (ED) has been poorly studied with contradictory results. Purpose To compare long-term outcomes after an episode of acute heart failure (AHF) in patients according to their destinations after ED. Methods OFICA (Observatoire Francais de l’Insuffisance Cardiaque Aigue) is a French snapshot registry of all patients with ongoing hospitalization for AHF in a nationwide and representative sample of 170 French hospitals. One thousand six hundreds and fifty-seven patients were included the 12th of March, 2009. Various data were collected including the final destination after ED and patients were followed-up for death as primary outcome. Hazard ratios were calculated for patients admitted in geriatric departments and other wards then compared with those hospitalized in cardiology. P Results Mean age was 76,0 ± 13,2 y with a sex-ratio close to 1. Overall, the small number of AHF patients referred from the ED to a cardiology ward was 19% with more frequently HF REF. Besides, AHF patients admitted in geriatric unit were older (p Conclusion While patients have similar 1-year outcomes irrespective of the destination after ED care for an AHF episode, those initially admitted in geriatrics present worse 5-year outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.

Stroke associated with left cardiac catheterization is a devastating complication, and its incidence has not changed over the decades. We investigated the incidence, in-hospital outcomes and the modifiable and non-modifiable risk factors for periprocedural ischemic stroke.Our retrospective cohort study included all patients experiencing periprocedural ischemic stroke among the 24,500 patients who underwent left cardiac catheterization between January 2003 and October 2010. The case group was compared with a group of control patients randomly selected among those who underwent the procedure during this period.Ischemic cerebrovascular events attested by brain imaging occurred in 37 patients (0.15% of procedures), transient ischemic attack occurred in 9 cases, and persistent neurological deficit occurred in 28 cases. Patients who developed strokes were more likely to be older and were more often female with a greater prevalence of comorbidities. Emergency and longer procedures were more frequent in patients in the case group who had more coronary complications. A multivariate analysis identified diabetes mellitus (adjusted odds ratio (OR) 4.2; 95% CI 1.8-9.9; P.001), chronic renal dysfunction (OR 2.4; 95% CI 1.1-5.4; P.001), known cerebrovascular disease (OR 5.1; 95% CI 2.3-11.5; P.001), emergency procedure (OR 3.1; 95% CI 1.4-9.2; P.01) and recent congestive heart failure (OR 6.1; 95% CI 2.9-13; P.001) as independent predictors for stroke. The independent modifiable predictive factors were represented by left ventricular angiography (OR 7.5; 95% CI 2.7-21; P.001), and low operator volume (OR 3.1; 95% CI 1.3-7.4; P.01).Limiting the performance of left cardiac catheterization to high volume operators and avoiding unnecessary left ventricular angiography may reduce periprocedural ischemic stroke.

International audience; BACKGROUND:Identification of transmural extent and degree of non-viability after ST-segment elevation myocardial infarction (STEMI) is clinically important. The objective of the present study was to assess the regional mechanics and temporal deformation patterns using speckle tracking echocardiography (STE) in acute and later phases of STEMI to predict myocardial damage in these patients.METHODS AND RESULTS:Ninety-eight patients with first STEMI underwent both echocardiography and cardiac magnetic resonance imaging in acute phase and at 6 months follow-up with 2D STE-derived measurements of peak longitudinal strain (PLS), Pre-STretch index (PST) and post-systolic deformation index (PSI). For each segment, late gadolinium enhancement (LGE) was defined as transmural (LGE >66 %) or non-transmural (

As we do each year, the French Cardiology community, with our colleagues from Francophone countries, Europe, North America, and Africa, at our sides, meet at the Palais des Congrès for the annual event of our specialization, the 26th European Days of the French Society of Cardiology.We hope that this year, as for the precedent editions, diagnostic innovations and cardiovascular pathology therapeutics will be thoroughly represented throughout the meeting in the main sessions including more than thirty joint sessions with allied national societies, news flashes, updates of the leading clinical trials, practical workshops, original oral communications and commented poster presentations. This year, the timeline has been slightly modified, we will be starting at 8:30 a.m. on Thursday and Friday, leaving more free time at lunch (12 to 2 p.m.) and thus increasing the possibilities for the activities organized at this time. The program will be available online, in advance, on the dedicated smartphone application as of August and will be regularly updated.We will have the great fortune, at this edition, to attend presentations from numerous highly esteemed orators. Eugene Braunwald will be the honored speaker for one of the two American lectures dedicated to the future of cardiology. He has made significant contributions to our field through his scientific leadership and his exceptional pedagogy. Mariell Jessup will honor us by giving the second American lecture on her theme of excellence, heart failure. Patrick Serruys will be the European lecture orator and will address bioabsorbable stents. John Eikelboom, Patrizio Lancellotti, Roberto Lang and numerous other colleagues from neighboring countries, alongside the recognized French lecturers, will enlighten this year’s European Days with their insight in their fields of expertise. The traditional Laënnec lecture provides the occasion for a leader Alain Carpentier, MD, PhD, this year to share, from his own perspective, his experience in the advancements of the practice of our art.The theme of the European Days of the French Society of Cardiology 2016, « E-Cardiology » responds, at least we hope it does, to the increasing foregrounded necessity to orient and tailor our daily clinical practice, through the integration of connection technology and devices, providing us with continuous and precious information on the vital signs of our patients. Alongside remote detection of cardiac arrhythmias and implantable device malfunctioning, there are numerous uses for these technologies today. Other domains of cardiovascular pathologies are equally concerned by this technology such as therapeutic education of patients. The village will be dedicated to this theme, with practical case sessions and meetings with experts, overseen by Jean Ferrières. Learning through simulation will also be addressed through the experiences of various French centers.The organizing and scientific committees of the European Days of the French Society of Cardiology have based the organization this year’s program on the most recent clinical and therapeutic advances across the numerous domains of cardiovascular pathologies and on the constantly updated consensus guidelines emanating from the European Society of Cardiology. Beyond the programmed communications, we wish to draw your attention to the commented posters that have been selected and awarded prizes by a jury, which will be orally presented on Saturday, just before the session in which prizes and scholarships will be awarded by the French Society of Cardiology.A program dedicated to our youngest colleagues, Cardiologists in training, has been planned, addressing these various themes presented on a joint basis between our young colleagues, who have already gained experience, and their seniors. In partnership with the industry, and under the supervision of the Independent Validation Committee, the symposia and lunch-debates will address medication and intervention advances and perspectives. This program will be completed by the very practical information provided at the “training center”, proposing a convivial environment enabling more candid exchanges about the most recent diagnostic material (cardiovascular imagery in particular) and therapeutics (both medications and devices), underlining their increasingly important place in the therapeutic arsenal.Among the events of 2016, the exceptional lecture will be given by Jean-Christophe Rufin, a man of letters, neurologist, “doctor of the world”, French Ambassador, and academic, Goncourt Prize, who will honor us with his participation in our European Days by sharing his knowledge and cultivating our understanding. The 26th European Days of the French Society of Cardiology aim to refresh and to continue expanding upon the success of prior editions, which have united more than 8,000 participants, as the attendance and implication have since been proven.The organization of the 26th European Days of the French Society of Cardiology is each year both a challenge (going faster in order to stay at the pace of the news) and a gamble (always doing a little bit better), and may be attributed to the aid of our organization and scientific committees, to the team at the Maison du Cœur, and to the implication of the EUROPA Society Organization. All are to be thanked for this very special effort, which requires a full year of work in order to make these European Days, the success that each prior year has known.Enjoy the congress!

RationaleThough cardiogenic shock (CS) after AMI is more common in the elderly, information on its prevalence, determinants and prognostic factors in the aged is scarce.MethodsWe analysed incidence and 1-year mortality of CS in 4 nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive STEMI and NSTEMI patients over one-month periods.ResultsAmong the 10,610 patients, 3,389 were aged≥75 years, of whom 9.9% developed CS.Incidence of CS decreased from 11.6% in 1995 to 6.7% in 2010, P=0.02. Use of PCI≤3 days from admission increased for both patients with and without CS (11% to 48% and 5% to 55%, respectively), as did statin use (1% to 70% and 4% to 82%, respectively). Occurrence of atrial and ventricular fibrillation decreased in patients without CS (22% to 9%, and 3.6% to 1.5%, respectively, P

International audience; The acknowledgment of tricuspid regurgitation (TR) as a stand-alone and progressive entity, worsening the prognosis of patients whatever its aetiology, has led to renewed interest in the tricuspid-right ventricular complex. The tricuspid valve (TV) is a complex, dynamic and changing structure. As the TV is not easy to analyse, three-dimensional imaging, cardiac magnetic resonance imaging and computed tomography scans may add to two-dimensional transthoracic and transoesophageal echocardiographic data in the analysis of TR. Not only the severity of TR, but also its mechanisms, the mode of leaflet coaptation, the degree of tricuspid annulus enlargement and tenting, and the haemodynamic consequences for right atrial and right ventricular morphology and function have to be taken into account. TR is functional and is a satellite of left-sided heart disease and/or elevated pulmonary artery pressure most of the time; a particular form is characterized by TR worsening after left-sided valve surgery, which has been shown to impair patient prognosis. A better description of TV anatomy and function by multimodality imaging should help with the appropriate selection of patients who will benefit from either surgical TV repair/replacement or a percutaneous procedure for TR, especially among patients who are to undergo or have undergone primary left-sided valvular surgery.

Comme chaque année, la communauté cardiologique française, aux côtés de ses collègues des pays francophones du Maghreb, d’Afrique sub-saharienne et du Moyen-Orient, ainsi que d’Europe et d’Amérique du Nord, se donne rendez-vous à Paris, au Palais des Congrès, pour l’événement annuel dans notre spécialité, les 26es Journées Européennes de la Société Française de Cardiologie.Nous espérons que comme pour les éditions précédentes, l’innovation diagnostique et thérapeutique en pathologie cardiovasculaire sera au rendez-vous au travers des points forts habituels avec des séances à thème dont plus de trente sessions communes avec des sociétés savantes alliées, actualités sur les grands essais cliniques, ateliers pratiques, flashes d’actualité, communications originales orales ou affichées et commentées. Les horaires ont été un peu modifiés, dès 8h30 les jeudis et vendredis, avec une plage libre plus large à l’heure du déjeuner (12h-14h), octroyant donc une disponibilité accrue pour les activités organisées dans cette tranche horaire. Le programme sera mis en ligne de façon anticipée sur l’application smartphone dédiée, dès le mois d’août et mis à jour régulièrement.Nous aurons la chance lors de cette édition d’assister à des conférences de prestige. Eugène Braunwald sera en effet l’invité exceptionnel pour l’une des deux conférences américaines consacrée à l’avenir de notre spécialité. Il a marqué notre spécialité de son autorité scientifique et par ses qualités pédagogiques hors du commun.Mariell Jessup nous fera l’honneur de donner la 2ème conférence américaine autour de son thème de prédilection, l’insuffisance cardiaque. Patrick Serruys sera l’orateur de la conférence européenne et parlera des stents biorésorbables. John Eikelboom, Patrizio Lancellotti, Roberto Lang et tant d’autres collègues venant de pays voisins éclaireront ces journées de leur expertise dans leur domaine d’intérêt, au côté de conférenciers français connus. La conférence Laënnec traditionnelle donnera l’occasion au Pr Alain Carpentier de mettre en perspective son expérience avec les avancées de l’exercice de notre art.Le thème des Journées Européennes de la Société Française de Cardiologie 2016, « Cardiologie connectée » répondra, du moins nous l’espérons, à l’exigence de plus en plus mise en avant, de déterminer et d’orienter la démarche clinique au quotidien, au travers de ces outils connectés qui permettent de disposer en continu, d’informations précieuses sur les constantes vitales de nos patients. A côté de la détection à distance des arythmies cardiaques ou des dysfonctionnements des dispositifs implantables, les applications sont aujourd’hui multiples. D’autres domaines de la pathologie cardiovasculaire seront également concernés tels l’éducation thérapeutique du patient. Le village sera donc consacré à la cardiologie connectée, au travers de séances de cas pratiques et de rencontres avec les experts, sous la responsabilité de Jean Ferrières. L’enseignement par simulation sera également abordé, au travers des expériences de différents centres français.Les comités d’organisation et scientifique des Journées Européennes de la Société Française de Cardiologie ont œuvré cette année pour préparer un programme basé sur les dernières avancées cliniques et thérapeutiques dans les différents domaines de la pathologie cardiovasculaire et sur les recommandations consensuelles mises à jour régulièrement, chaque année, émanant de l’European Society of Cardiology. Nous avons souhaité mettre en avant, outre les communications libres ou affichées, les posters commentés sélectionnés et primés par un jury, qui seront présentés oralement samedi, juste avant la séance de remise des prix et bourses de la Société Française de Cardiologie. Un parcours dédié à nos plus jeunes collègues (cardiologues en formation) a été planifié, en déclinant les différents thèmes présentés de façon paritaire par nos collègues jeunes mais déjà expérimentés au côté de leurs maîtres. En partenariat avec l’industrie, et sous le contrôle du Comité indépendant de validation, les symposia et déjeuners-débats traiteront des avancées et des perspectives médicamenteuses et interventionnelles. Cette démarche sera complétée par des informations très pratiques apportées lors des « training centers » qui permettent de présenter dans un cadre convivial, avec des échanges non formels, les matériels les plus récents à visée tant diagnostique (imagerie cardiovasculaire en particulier), que thérapeutique (dispositifs), soulignant leur place croissante dans l’arsenal thérapeutique, ainsi que des innovations pharmacologiques.Parmi les évènements 2016, la conférence exceptionnelle sera assurée par Jean-Christophe Rufin, homme de lettres, neurologue, médecin du monde, ambassadeur de France, Académicien, Prix Goncourt, qui nous fera l’honneur de participer à nos journées, en nous instruisant et en nous éclairant.Les 26es Journées Européennes de la Société Française de Cardiologie ont donc l’ambition de renouveler et d’élargir le succès des éditions précédentes, qui ont réuni plus de 8 000 participants, dont l’assiduité et l’implication ne sont plus à prouver.L’organisation des 26es Journées Européennes de la Société Française de Cardiologie est chaque année un défi (faire plus vite pour être au plus près de l’actualité) et un pari (faire encore et toujours un peu mieux), relevés grâce à l’aide des comités d’organisation et scientifique, de l’ensemble du personnel de la Maison du Cœur et de l’implication de la société EUROPA Organisation. Tous sont à remercier pour cet effort particulier, qui demande une année de travail pour faire de ces journées, le succès que chaque édition précédente a rencontré.Bon congrès à tous !