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1. Does layer-specific strain using speckle tracking echocardiography improve the assessment of left ventricular myocardial deformation? A review

Author

Laurie Soulat-Dufour, P Nhan, Franck Boccara, Yann Ancedy, Marion Chauvet-Droit, Ariel Cohen, Marie-Liesse Jean, Stéphane Ederhy, Saroumadi Adavane-Scheuble, Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, Heart Diseases, [SDV]Life Sciences [q-bio], Speckle tracking echocardiography, Strain (injury), Normal values, 030204 cardiovascular system & hematology, Ventricular Function, Left, Layer-specific strain, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Humans, Medicine, Circumferential strain, 030212 general & internal medicine, Échocardiographie, Observer Variation, Reproducibility, business.industry, Multilayer strain, Strain multicouches, Healthy subjects, Reproducibility of Results, General Medicine, Prognosis, medicine.disease, Myocardial Contraction, medicine.anatomical_structure, Echocardiography, Ventricle, Cardiology, Deformation (engineering), Cardiology and Cardiovascular Medicine, business
Abstract

International audience; An increasing number of studies of left ventricular myocardial deformation have been published. Layer-specific strain using speckle tracking echocardiography to evaluate left ventricular function is not recommended in clinical practice. However, evaluation of myocardial mechanics using longitudinal and circumferential layer-specific strain enables the detection of subclinical impairment of myocardial deformation in various diseases. Unfortunately, normal values for longitudinal and circumferential strain have not been clearly defined. In normal subjects, layer-specific strain decreases from the endocardial to the epicardial layer, and from the apex to the base of the left ventricle. Although various studies have tried to define normal values for each layer in healthy subjects, studies with more subjects are needed. This tool has good reproducibility in terms of intraobserver and interobserver variability, but, as with monolayer strain, it has poor intervendor variability. Efforts that aim for standardization between vendors will be required before widespread use of this technique can be advocated.

Published
2020
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2. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial

Author

Johanne Silvain, Benoit Lattuca, Farzin Beygui, Grégoire Rangé, Zuzana Motovska, Jean-Guillaume Dillinger, Ziad Boueri, Philippe Brunel, Thibault Lhermusier, Christophe Pouillot, Elisa Larrieu-Ardilouze, Franck Boccara, Jean-Noël Labeque, Paul Guedeney, Mohamad El Kasty, Mikael Laredo, Raphaëlle Dumaine, Grégory Ducrocq, Jean-Philippe Collet, Guillaume Cayla, Katrien Blanchart, Petr Kala, Eric Vicaut, Gilles Montalescot, Johanne SILVAIN, Jean-Philippe COLLET, Gilles MONTALESCOT, Mathieu KERNEIS, Nassim BRAIK, Olivier BARTHELEMY, Gérard HELFT, Claude LEFEUVRE, Rémi CHOUSSAT, Marie HAUGUEL, Michel ZEITOUNI, Thomas CUISSET, Jean-Louis BONNET, Pierre DEHARO, Benoit LATTUCA, Guillaume CAYLA, Luc CORNILLET, Bertrand LEDERMANN, Clément LONJON, Laurent SCHMUTZ, Grégoire RANGE, Franck ALBERT, Thibault DEMICHELI, Laurent ROUSSEL, Reda BENSAID, Christophe THUAIRE, Jean-Guillaume DILLINGER, Patrick HENRY, Stéphane MANZO-SILBERMAN, Georgios SIDERIS, Damien LOGEART, Vincent SPAGNOLI, Léa CACOUB, Christophe POUILLOT, Jean Richard VI-FANE, Jens GLASENAPP, Karim BOUGRINI, Nicolas COMBARET, Pascal MOTREFF, Géraud SOUTEYRAND, Aimé AMONCHOT, Thomas MOUYEN, Thibault LHERMUSIER, Didier CARRIE, Frédéric BOUISSET, Thomas CHOLLET, Francisco CAMPELO-PARADA, Nicolas DELARCHE, François SCHIELE, Mathieu BESUTTI, Marie HAUGUEL-MOREAU, Rami EL MAHMOUD, Christophe CAUSSIN, Mami ZOHEIR, Aurelie VEUGEOIS, Alain DIBIE, Olivier VARENNE, Fabien PICARD, Alexandre LAFONT, Julien ADJEDJ, Philippe DEGRELL, Farzin BEYGUI, Rémi SABATIER, Vincent ROULE, Mathieux BIGNON, Katrien BLANCHART, Pierre ARDOUIN, Adrien LEMAITRE, Clément BRIET, Ziad BOUERI, Pascal GOUBE, Pierre COSTE, Laura CETRAN, Jérôme CLERC, Hervé LE BRETON, Dominique BOULMIER, Vincent AUFFRET, Jean-Noël LABEQUE, Jean-Luc BONAS, Jean-Louis GEORGES, Bernard LIVAREK, Elodie BLICQ, Nicolas BARON, Géraldine GIBAULT-GENTY, Yves COTTIN, Isabelle LHUILLIER, Carole RICHARD, Luc LORGIS, Philippe BUFFET, Christian SPAULDING, Nicole KARAM, Etienne PUYMIRAT, Marco MENNUNI, Emmanuel POULIDAKIS, Lionel BONNEVIE, Franck BOCCARA, Marion CHAUVET, Laurie DUFOUR, Yann ANCEDY, Stéphane EDERHY, Arnaud ETIENNEY, Anne BELLEMAIN-APPAIX, Nathaniel BITTON, Laurent JACQ, Christophe SAINT-ETIENNE, Florence LECLERCQ, François ROUBILLE, Gilles RIOUFOL, François DERIMAY, Marc GORALSKI, Wael YAFI, Emmanuelle FILIPPI, Alain KERMARREC, Christophe LE RAY, Antoine MERLET, Aurelie LOIRAT, Philippe BRUNEL, Damien BRUNET, Jack RAVISY, Laurent MOCK, Guillaume MOLINS, Max CARRE, Erwan BRESSOLLETTE, Luc CHRISTIAENS, Elisa LARRIEU-ARDILOUZE, Romain CADOR CADOR, Eric VAN BELLE, Gilles LEMESLE, Cédric DELHAYE, Flavien VINCENT, Sina POROUCHANI, Hugues SPILLEMAEKER, Katy PETIT, Olivier RESSENCOURT, Vincent HUMEAU, François JOURDA, Marc-Antoine ARNOULD, Stephen CHASSAING, Karl ISAAZ, Laurent PAYOT, Jacques MONTSEGU, Benjamin FAURIE, Michel PANSIERI, Marc METGE, Karim MOUSSA, Mathieu PANKERT, Olivier MOREL, Sébastien HESS, Luc MAILLARD, Thibault MANIGOLD, Vincent LETOCART, Julien PLESSIS, Pauline BERTHOME, Mickael BONIN, François HUCHET, Emmanuel TEIGER, Romain GALLET, Gauthier MOUILLET, Madjid BOUKANTAR, Mohammed NEJJARI, David ATTIAS, Mathieu STEINECKER, Zuzana MOTOVSKA, Martin KOZEL, Zdenko STELMACH, Ota HLINOMAZ, Michal REZEK, Martin NOVAK, Jan SITAR, Jiri SEMENKA, Petr KALA, Otakar BOCEK, Roman ŠTIPAL, Martin POLOCZEK, Jan KANOVSKÝ, Petr JERABEK, Jiří KARASEK, Sylvie HRUSKOVA, Marian BRANNY, Jan MROZEK, Tomas GREZL, Leos PLEVA, Pavel KUKLA, Martin PORZER, Lesnik, Philippe, Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de cardiologie et de pathologie vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Louis Pasteur [Chartres], Charles University [Prague] (CU), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Bastia (G2HC), Service de Cardiologie [Hôpital privé Dijon Bourgogne], Hôpital privé Dijon Bourgogne, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Clinique Sainte Clotilde, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Le CHCB, Centre Hospitalier de la Côte Basque, Grand Hôpital de l'Est Francilien (GHEF), Centre de Réadaptation Cardiaque Les Grands Prés [Villeneuve Saint Denis] (CRCLGP), Service de cardiologie [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), University Hospital Brno, Masaryk University [Brno] (MUNI), Hopital Saint-Louis [AP-HP] (AP-HP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), ALPHEUS investigators: Johanne Silvain, Jean-Philippe Collet, Gilles Montalescot, Mathieu Kerneis, Nassim Braik, Olivier Barthelemy, Gérard Helft, Claude Lefeuvre, Rémi Choussat, Marie Hauguel, Michel Zeitouni, Thomas Cuisset, Jean-Louis Bonnet, Pierre Deharo, Benoit Lattuca, Guillaume Cayla, Luc Cornillet, Bertrand Ledermann, Clément Lonjon, Laurent Schmutz, Grégoire Range, Franck Albert, Thibault Demicheli, Laurent Roussel, Reda Bensaid, Christophe Thuaire, Jean-Guillaume Dillinger, Patrick Henry, Stéphane Manzo-Silberman, Georgios Sideris, Damien Logeart, Vincent Spagnoli, Léa Cacoub, Christophe Pouillot, Jean Richard Vi-Fane, Jens Glasenapp, Karim Bougrini, Nicolas Combaret, Pascal Motreff, Géraud Souteyrand, Aimé Amonchot, Thomas Mouyen, Thibault Lhermusier, Didier Carrie, Frédéric Bouisset, Thomas Chollet, Francisco Campelo-Parada, Nicolas Delarche, François Schiele, Mathieu Besutti, Marie Hauguel-Moreau, Rami El Mahmoud, Christophe Caussin, Mami Zoheir, Aurelie Veugeois, Alain Dibie, Olivier Varenne, Fabien Picard, Alexandre Lafont, Julien Adjedj, Philippe Degrell, Farzin Beygui, Rémi Sabatier, Vincent Roule, Mathieux Bignon, Katrien Blanchart, Pierre Ardouin, Adrien Lemaitre, Clément Briet, Ziad Boueri, Pascal Goube, Pierre Coste, Laura Cetran, Jérôme Clerc, Hervé LE Breton, Dominique Boulmier, Vincent Auffret, Jean-Noël Labeque, Jean-Luc Bonas, Jean-Louis Georges, Bernard Livarek, Elodie Blicq, Nicolas Baron, Géraldine Gibault-Genty, Yves Cottin, Isabelle Lhuillier, Carole Richard, Luc Lorgis, Philippe Buffet, Christian Spaulding, Nicole Karam, Etienne Puymirat, Marco Mennuni, Emmanuel Poulidakis, Lionel Bonnevie, Franck Boccara, Marion Chauvet, Laurie Dufour, Yann Ancedy, Stéphane Ederhy, Arnaud Etienney, Anne Bellemain-Appaix, Nathaniel Bitton, Laurent Jacq, Christophe Saint-Etienne, Florence Leclercq, François Roubille, Gilles Rioufol, François Derimay, Marc Goralski, Wael Yafi, Emmanuelle Filippi, Alain Kermarrec, Christophe LE Ray, Antoine Merlet, Aurelie Loirat, Philippe Brunel, Damien Brunet, Jack Ravisy, Laurent Mock, Guillaume Molins, Max Carre, Erwan Bressollette, Luc Christiaens, Elisa Larrieu-Ardilouze, Romain Cador Cador, Eric VAN Belle, Gilles Lemesle, Cédric Delhaye, Flavien Vincent, Sina Porouchani, Hugues Spillemaeker, Katy Petit, Olivier Ressencourt, Max Carre, Vincent Humeau, François Jourda, Marc-Antoine Arnould, Stephen Chassaing, Karl Isaaz, Laurent Payot, Jacques Montsegu, Benjamin Faurie, Michel Pansieri, Marc Metge, Karim Moussa, Mathieu Pankert, Olivier Morel, Sébastien Hess, Luc Maillard, Thibault Manigold, Vincent Letocart, Julien Plessis, Pauline Berthome, Mickael Bonin, François Huchet, Emmanuel Teiger, Romain Gallet, Gauthier Mouillet, Madjid Boukantar, Rami El Mahmoud, Mohammed Nejjari, David Attias, Léa Cacoub, Mathieu Steinecker, François Huchet, Zuzana Motovska, Martin Kozel, Zdenko Stelmach, Ota Hlinomaz, Michal Rezek, Martin Novak, Jan Sitar, Jiri Semenka, Petr Kala, Otakar Bocek, Roman Štipal, Martin Poloczek, Jan KanovskÝ, Petr Jerabek, Jiří Karasek, Sylvie Hruskova, Marian Branny, Jan Mrozek, Tomas Grezl, Leos Pleva, Pavel Kukla, Martin Porzer., Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Male, Ticagrelor, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, business.industry, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Clopidogrel, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Action study, Elective Surgical Procedures, Anesthesia, Conventional PCI, Purinergic P2Y Receptor Antagonists, Female, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract

International audience; Background: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI.Methods: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290.Findings: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070).Interpretation: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.Funding: ACTION Study Group and AstraZeneca.

Published
2020
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3. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome

Author

Franck Boccara, Murielle Mary‐Krause, Valérie Potard, Emmanuel Teiger, Sylvie Lang, Nadjib Hammoudi, Marion Chauvet, Stéphane Ederhy, Laurie Dufour‐Soulat, Yann Ancedy, Pascal Nhan, Saroumadi Adavane, Ph. Gabriel Steg, Christian Funck‐Brentano, Dominique Costagliola, Ariel Cohen, S. Weber, K. Wahbi, P. Beaufils, P. Henri, G. Sideris, D. Thomas, G. Montalescot, F. Beygui, C. Meuleman, S. Janower, F. Raoux, G. Dufaitre, N. Benyounes, P. L. Michel, B. Petillon, N. Hammoudi, P. Gueret, J. L. Dubois‐Rande, E. Teiger, P. Lim, M. Slama, P. Colin, C. Saudubray, O. Dubourg, O. Milleron, B. Gallet, F. Duclos, S. Godard, L. Fuchs, V. Dormagen, P. Lewy, S. Cattan, O. Nallet, G. Grollier, J. Shayne, J. E. Wolf, Y. Cottin, J. Machecourt, H. Bouvaist, G. Finet, B. De Breyne, J. N. Trochu, M. Baudouy, E. Ferrari, M. Benhamou, J. Allal, D. Coisne, H. Le Breton, M. Bedossa, J. Puel, M. Elbaz, L. Larifla, S. Matheron, R. Landman, G. Fremont, G. Spiridon, P. Blanche, J. P. Morini, D. Sicard, V. Zeller, D. Batisse, P. Clevenbergh, G. Cessot, E. Dohin, M. A. Valantin, S. Khelifa, P. M. Girard, F. Lallemand, B. Lefebvre, J. P. Laporte, J. L. Meynard, H. Bideault, O. Picard, M. C. Meyohas, P. Campa, J. Tredup, L. Fonquernie, G. Raguin, J. M. Molina, A. Furco, S. Gharakanian, J. P. Vincensini, J. B. Guiard‐Schmid, G. Pialoux, B. Cardon, A. S. Lascaux, F. Chaix, P. Lesprit, R. Fior, F. Boue, C. Dupont, C. Bellier, A. Blanc, T. Lambert, T. Touahri, G. Force, P. de Truchis, M. A. Compagnucci‐Seguenot, I. Cahitte, L. Roudière, M. E. Techer, P. Thelpin, D. Troisvallets, A. Lepretre, M. Echard, Y. Le Mercier, D. Houlbert, S. Dargere, C. Bazin, R. Verdon, B. De Goer, M. Duong, P. Chavanet, E. Gozlan, P. Leclercq, F. Brunel‐Dal Mas, J. Durant, P. Heudier, C. Brunet‐François, G. Le Moal, J. M. Chapplin, C. Arvieux, G. Chaumentin, B. Guerin, E. Bonnet, Y. Poinsignon, F. Boulard, I. De Lacroix, M. T. Goerger‐Sow, M. Kirstetter, M. Volstein, F. Laylavoix, X. Copin, C. Ceppi, Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, CIC Paris Est, Service de pharmacologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre d'investigation clinique Paris Est (CIC Paris-Est), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Service de Pharmacologie médicale [CHU Pitié-Salpêtrière]

Subjects
Male, Heart disease, [SDV]Life Sciences [q-bio], Human immunodeficiency virus (HIV), Aftercare, heart failure, HIV Infections, heart disease, 030204 cardiovascular system & hematology, medicine.disease_cause, Coronary artery disease, 0302 clinical medicine, prevention, Recurrence, Risk Factors, Cardiovascular Disease, Secondary Prevention, Medicine, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Original Research, Middle Aged, Prognosis, 3. Good health, Editorial, myocardial infarction, Anti-Retroviral Agents, Cardiovascular Diseases, Cardiology, Female, France, Cardiology and Cardiovascular Medicine, coronary artery disease, Adult, Acute coronary syndrome, medicine.medical_specialty, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, Humans, Acute Coronary Syndrome, business.industry, dyslipidemia, Coronary Care Units, Editorials, HIV, medicine.disease, HIV infection, Cerebrovascular Disorders, Heart Disease Risk Factors, Case-Control Studies, ST Elevation Myocardial Infarction, business, Dyslipidemia
Abstract

Background It is unclear whether HIV infection affects the long‐term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV‐uninfected (HIV−) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV− patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36‐month follow‐up. A total of 103 PLHIV and 195 HIV− patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow‐up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− patients (17.8% and 15.1%, P =0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67–3.82 [ P =0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32–30.21 [ P =0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P =0.01) and had smaller total cholesterol decreases (–22.3 versus –35.0 mg/dL; P =0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT00139958.

Published
2020
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4. Takotsubo-Like Syndrome in Cancer Patients Treated With Immune Checkpoint Inhibitors

Author

Yann Ancedy, Franck Thuny, Marion Escudier, Jennifer Cautela, Ariel Cohen, and Stéphane Ederhy

Subjects
Oncology, Takotsubo syndrome, medicine.medical_specialty, Acute coronary syndrome, Cardiotoxicity, Chemotherapy, business.industry, Immune checkpoint inhibitors, medicine.medical_treatment, fungi, food and beverages, Cancer, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, In patient, Cardiology and Cardiovascular Medicine, business
Abstract

Takotsubo syndrome (TTS) is defined as an acute, reversible, left ventricular (LV) systolic dysfunction that can mimic acute coronary syndrome. In patients with TTS, the prevalence of patients with a history of cancer can be as high as 29% [(1)][1]. Several drugs and particularly chemotherapy are

Published
2018
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5. Natural history of left atrial thrombus in atrial fibrillation patients

Author

Ariel Cohen, Yann Ancedy, Marion Chauvet, A Etienney, Magali Charbonnier, Saroumadi Adavane, Ciham El Asri, Franck Boccara, Stéphane Ederhy, Laurie Soulat Dufour, and Nabila Haddour

Subjects
medicine.medical_specialty, Rivaroxaban, business.industry, medicine.drug_class, Atrial fibrillation, Hematology, Vitamin K antagonist, medicine.disease, Dabigatran, medicine.anatomical_structure, Ventricle, Internal medicine, Heart failure, cardiovascular system, medicine, Cardiology, sense organs, cardiovascular diseases, Thrombus, skin and connective tissue diseases, business, Stroke, medicine.drug
Abstract

Atrial fibrillation is associated with left atrial (LA) and left atrial appendage (LAA) thrombus (LAT) formation which leads to thromboembolic events with significant morbidity and mortality. Wirchow's triad described three pathophysiological mechanisms required for thrombus formation associating: abnormal changes in flow by stasis in LA, abnormal changes in vessel walls and abnormal changes in blood contituents. Transesophageal echocardiography (TEE) is the main tool for LAT detection. Cardiac computed tomography could be a non invasive alternative to detect LAT. Predictive factors of LAA thrombus are: clinical: age, blood hypertension, diabetes mellitus, medical history of stroke, myocardial ischemia, heart failure, CHASD2, CHA2DS2-Vasc, overweight; biological: BNP, D-dimer, hyperuricemia; echocardiography: LA dilatation, left ventricle dysfunction, impaired LAA function assessed by TEE. LAA thrombus prevalence ranges from 1.5% to 2% in patients undergoing efficient anticoagulation. Rate of resolution of LAT after four weeks in patients treated with vitamin K antagonist is 80%. Direct oral anticoagulant demonstrated efficiency in treatment for LAT, however these data are extracted from observational retrospective studies and case report. Two prospective studies which are not published aimed to assess efficiency and tolerance of rivaroxaban and dabigatran for LAT resolution.

Published
2016
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6. Stratégie de dépistage précoce de la toxicité cardiaque secondaire aux anthracyclines et thérapies moléculaires ciblées

Author

Antoine Hollebecque, Marion Chauvet, Jean-Charles Soria, A Etienney, Laurie Soulat-Dufour, Franck Boccara, Ariel Cohen, Agathe Potier, Saroumadi Adavane-Scheuble, Stéphane Ederhy, and Yann Ancedy

Subjects
Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Cardiomyopathy, macromolecular substances, 030204 cardiovascular system & hematology, Malignancy, Asymptomatic, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Chemotherapy, Ejection fraction, biology, business.industry, Hematology, General Medicine, medicine.disease, Troponin, medicine.anatomical_structure, Oncology, Ventricle, Heart failure, Cardiology, biology.protein, medicine.symptom, business
Abstract

Anthracyclines and molecular targeted agents have improved prognosis of patients undergoing chemotherapeutics for malignancy. However, the use of these therapies is limited because of risk of cardiac toxicity. The severity of the cardiomyopathy can range from an asymptomatic left ventricular (LV) dysfunction to a severe congestive heart failure. Cardiomyopathy can be reversible or irreversible according to the type of chemotherapy, modality of administration and patient's characteristics. Several studies aimed to early detection and the evaluation of tools to characterize patients at risk to develop cardiac side effects in order to prevent severe LV dysfunction. According to this literature, it is recommended that initial assessment and follow-up of patients undergoing these chemotherapies be performed using troponin dosage, assessment of left ventricle ejection fraction and evaluation of LV myocardial deformation assessing LV global longitudinal strain.

Published
2016
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7. Foreign body causing superficial venous thrombosis and subsequent pulmonary embolism: a case report

Author

Franck Boccara, Marion Lebon, Ariel Cohen, and Yann Ancedy

Subjects
medicine.medical_specialty, Femoral vein, Case Reports, 030204 cardiovascular system & hematology, Chest pain, 03 medical and health sciences, 0302 clinical medicine, Case report, Medicine, Superficial thrombophlebitis, 030212 general & internal medicine, Groin, business.industry, Pulmonary embolism, medicine.disease, Thrombosis, Surgery, Venous thrombosis, Foreign body, Superficial venous thrombosis, medicine.anatomical_structure, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Background Superficial venous thrombosis (SVT) is common, but often perceived to be a non-serious condition. This pathology should not be overlooked as it can lead to complications that may require anticoagulation. We present a case of SVT complicated by pulmonary embolism (PE) revealing an unexpected cause Case summary A 41-year-old woman was admitted to the emergency department for chest pain and intense sudden pain of the left groin, revealing an extended great saphenous SVT associated with a PE. Further investigation showed that the thrombosis was caused by a sewing needle located between the superficial femoral artery and the femoral vein. Successful extraction was performed in a vascular surgery unit. Discussion Superficial venous thrombosis can be associated with deep venous thrombosis and PE, and can be caused by local inflammation, direct compression, and foreign bodies. These aetiologies should be investigated if no evident cause to SVT is found.

Published
2018

8. Antithrombotic management in patients with atrial fibrillation undergoing coronary stent implantation: What is the impact of guideline adherence?

Author

Laurent Fauchier, Coralie Lecoq, Yann Ancedy, Fabrice Ivanes, Christophe Saint Etienne, Dominique Babuty, Gregory Y.H. Lip, Denis Angoulvant, Thrombose, atherothrombose et pharmacologie appliquée, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de Cardiologie A (TOURS - Cardiologie A), Cellules Dendritiques, Immunomodulation et Greffes, Université de Tours (UT), University of Liverpool, Aalborg University [Denmark] (AAU), and Éducation Éthique Santé EA 7505 (EES)

Subjects
Male, Acute coronary syndrome, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, [SHS]Humanities and Social Sciences, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Risk Factors, Internal medicine, Atrial Fibrillation, Coronary stent, Antithrombotic, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, business.industry, Anticoagulants, Percutaneous coronary intervention, Stent, Thrombosis, Guideline, Prognosis, medicine.disease, Drug-eluting stent, Conventional PCI, Cardiology, Female, Stents, Guideline Adherence, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) and stenting require triple antithrombotic therapy according to current ESC guidelines. The purpose of this study was to assess guideline implementation and predictive factors of the prognosis related to ESC guideline adherence.We enrolled consecutive AF patients referred for PCI with stent from 2011 to 2014. Among 371 patients (72% male; mean age 76 ± 11) followed up for 505 ± 372 days (median 391, interquartile range 550 days), 118 (45%) undergoing elective coronary stenting and 41 (31%) among those with acute coronary syndrome were guideline adherent. Oral anticoagulation (OAC) before hospitalization was the only factor independently associated with guideline adherence (OR, 0.45; 95% CI 0.26-0.77; p=0.003). OAC underuse and antiplatelet therapy (APT) underuse were independently associated with increased risks of death (OR 5.55; 95% CI 2.42-13.47; p0.0001 and OR 5.56; 95% CI, 2.17-14.65; p=0.0004, respectively) and major adverse cardiac events (MACE) (OR 4.18; 95% CI 2.05-8.79; p0.0001 and OR 4.81; 95% CI, 2.09-11.18; p=0.0002, respectively).Guidelines for antithrombotic therapy in patients with AF who undergo PCI and stent implantation are still poorly followed in clinical practice. OAC and APT underuse were both associated with an increased risk of death and MACE in this population.

Published
2016
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9. AORTIC VALVULAR DISEASE IN FAMILIAL HYPERCHOLESTEROLEMIA ADULT PATIENTS RECEIVING LDL APHERESIS

Author

Stéphane Ederhy, P Nhan, Samir Saheb, Franck Boccara, Antonio Gallo, Yann Ancedy, Saroumadi Adavane-Scheuble, Ariel Cohen, Eric Bruckert, Laurie Soulat-Dufour, and Marion Chauvet-Droit

Subjects
medicine.medical_specialty, Adult patients, LDL apheresis, business.industry, Internal medicine, medicine, Cardiology, Familial hypercholesterolemia, Cardiology and Cardiovascular Medicine, medicine.disease, business, Aortic valvular disease
Published
2020
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10. Clinical Features, Management, and Outcomes of Immune Checkpoint Inhibitor-Related Cardiotoxicity

Author

Ugo Scemama, Jean-Jacques Grob, Jennifer Cautela, Marc Laine, Michael Peyrol, Alexis Jacquier, Marion Escudier, Franck Paganelli, Fabrice Barlesi, Johan Pinto, Jeremie Barraud, Ariel Cohen, Franck Thuny, N. Malissen, Laurent Bonello, Yann Ancedy, Nathalie Lalevée, Stéphane Ederhy, Sandrine Monestier, Morgane Orabona, Aix Marseille Université (AMU), Hôpital Nord [CHU - APHM], Département de dermatologie [CHU de Montpellier], Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Thrombose, atherothrombose et pharmacologie appliquée, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Timone [CHU - APHM] (TIMONE), Département de dermatologie, CHU Marseille, CHU Marseille, Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Technologies avancées pour le génôme et la clinique (TAGC), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie de l'Endothelium, Vascular research center of Marseille (VRCM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Service de Cardiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Oncologie multidisciplinaire et innovations thérapeutiques [Hôpital Nord - APHM], Aix Marseille Université (AMU)- Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM]

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Databases, Factual, Heart Diseases, Cardiology, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030204 cardiovascular system & hematology, Risk Assessment, Young Adult, 03 medical and health sciences, Antineoplastic Agents, Immunological, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Informed consent, Allergy and Immunology, Neoplasms, Physiology (medical), medicine, Humans, Intensive care medicine, Adverse effect, Aged, Retrospective Studies, Aged, 80 and over, Cardiotoxicity, business.industry, Medical record, Incidence (epidemiology), Cancer, Middle Aged, Institutional review board, medicine.disease, 3. Good health, Clinical trial, 030220 oncology & carcinogenesis, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Immune checkpoint inhibitors (ICIs) represent a major advance in the treatment of cancer. Although clinical trials reported a low incidence of immune-related cardiovascular adverse events,1 the number of published life-threatening cases of cardiotoxicity is increasing.2 In this descriptive observational analysis, we aimed to describe the clinical manifestations, management, and outcomes of patients who developed ICI-related cardiotoxicity. The medical records of patients with a clinical suspicion of ICI-related cardiotoxicity were reviewed from the databases of 2 cardio-oncology units between March 2015 and April 2017. The patients are managed according to similar protocols. Because no specific follow-up had previously been established for patients receiving ICIs during the study period, the oncologists referred patients receiving ICIs only on the basis of their clinical suspicion of cardiovascular events. These patients had a standardized evaluation including clinical consultation, ECG, transthoracic echocardiography, and measurement of brain natriuretic peptide and troponin I serum levels. The management of cardiotoxicity was left to the physician’s discretion. The study was approved by our institutional review board, and informed consent has been obtained from the subjects. To create a pooled analysis, we also searched PubMed for English articles reporting cases of ICI-related cardiotoxicity until April 2017. We selected …

Published
2017
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11. 0554 : Right ventricle 2D strain derived from speckle tracking imaging might help to identify patients with pulmonary embolism at low risk

Author

Franck Boccara, Yann Ancedy, Laurie Soulat-Dufour, Ariel Cohen, Marion Chauvet, Sylvie Lang, Stéphane Ederhy, A Etienney, and Saroumadi Adavane-Scheuble

Subjects
medicine.medical_specialty, biology, Receiver operating characteristic, medicine.diagnostic_test, business.industry, Scintigraphy, medicine.disease, Brain natriuretic peptide, Troponin, Pulmonary embolism, Surgery, medicine.anatomical_structure, Ventricle, Internal medicine, Troponin I, medicine, biology.protein, Cardiology, business, Cardiology and Cardiovascular Medicine, Perfusion
Abstract

Background We sought to investigate whether right ventricular deformation parameters as assessed with two-dimensional (2D) speckle tracking imaging (STI) could help in identifying patients at low risk according to the ESC guidelines. Methods From February 2015 to September 2015 all consecutive patients with a PE confirmed by thoracic computed tomography scan or by ventilation/ perfusion scintigraphy were included in the study. 2D Echocardiography was performed at admission. STI Longitudinal strain for the RV free wall and septal wall. We defined as intermediate-to-high risk PE patients with RV systolic dysfunction on echocardiography (defined as RV/LV ratio>0.9) and/or troponin I >0.04 μg/L and/or brain natriuretic peptide >100 pg/mL. When none of these criteria were present, patients were considered at low risk. Results Fifty-eight patients (mean age 66.1 ± 18.5 years, 55% male) were prospectively included. None of these patients exhibit hemodynamic instability. Twenty-three patients (40%) showed a RV/LV ratio > 0.9, 25 patients (43%) an elevated BNP levels (mean: 454±494 pg/mL) and 17 patients (29%) an elevated troponin levels (mean: 0.36±0.46 μg/L). According to the ESC guidelines, 14 patients (24%) were classified at low risk PE, and 44 (76%) at intermediate-to-high risk. Global 2D RV strain differed significantly between the 2 groups (23.0% vs. 19.3%, p=0.0035), as did RV strain of the free wall (26.9% vs. 21.1%, p=0.0038). However, 2D RV strain of the septal wall did not differ significantly in the 2 groups (20.0% vs. 18.5%, p=0.12). ROC curves were determined to evaluate the ability of RV strain parameters derived from STI to identify low risk patients. The best performance was obtained with global 2D RV strain and a cut off value of 23.0%. Conclusion Global longitudinal 2D strain is significantly reduced in patients with intermediate-to-high risk PE compared with low risk PE. A cut off value of 23% allowed to identify PE patients at low risk. Download : Download full-size image Figure . Comparative receiver operative character The author hereby declares no conflict of interest

Published
2016
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12. Initial bi atrial three-dimensional echocardiographic evaluation in non-valvular atrial fibrillation according to rhythm outcome at six month follow-up

Author

Magali Charbonnier, A. Beraud, Laurie Soulat-Dufour, Stéphane Ederhy, F. Boccara, N. Hammoudi, Ariel Cohen, Marion Chauvet, Sylvie Lang, Saroumadi Adavane-Scheuble, P Nhan, and Yann Ancedy

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Non valvular atrial fibrillation, Atrial fibrillation, medicine.disease, Cardioversion, Electrical cardioversion, Rhythm, Left atrial, Internal medicine, Cardiology, Medicine, Sinus rhythm, Cardiology and Cardiovascular Medicine, business, Month follow up
Abstract

Background Two-dimensional left atrial (LA) size is an independent echocardiographic predictor of atrial fibrillation (AF) occurrence and recurrence. Purpose Our study aimed to evaluate LA and right atrial (RA) three-dimensional (3D) volumes at admission (M0) in patients with AF to define atrial remodeling according to rhythm outcome at 6 month follow-up (M6). Methods 3D RA and LA parameters were assessed at M0 in patients admitted for AF: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and indexed minimum volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF) and atrial expansion index (3D RAEI, 3D LAEI). Results Forty-eight consecutive patients hospitalized for AF were prospectively included. Two groups were individualized according to rhythm outcome: successful cardio version (SuccCV) in 35(72.9%) patients including either spontaneous (n = 10) or electrical cardioversion (n = 25) (AF at M0 and sinus rhythm (SR) at M6); failure or contra indication to cardioversion (FailCV) in 13(27.1%) patients (AF at M0 and AF at M6). 3D echocardiographic evaluation from 41 patients at M0 found: – significantly upper Min 3D RA Voli, Min 3D LA Voli in group FailCV in comparison with SuccCV; – significantly lower 3D RAEF, 3D RAEI, 3D LAEF, 3D LAEI in group FailCV in comparison with SuccCV; – no significant differences regarding Max 3D RA Voli, Max 3D LA Voli between groups FailCV and SuccCV ( Table 1 ). Conclusion 3D atrial echocardiographic parameters could be useful to predict initial atrial remodelling in patients admitted for AF.

Published
2019
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13. 0018 : Antithrombotic management in patients with atrial fibrillation undergoing stent implantation: An assessment of the ESC guidelines adherence

Author

Fabrice Ivanes, Laurent Fauchier, Anne Bernard, Yann Ancedy, Christophe Saint Etienne, Dominique Babuty, and Denis Angoulvant

Subjects
medicine.medical_specialty, Acute coronary syndrome, education.field_of_study, business.industry, medicine.medical_treatment, Population, Percutaneous coronary intervention, Atrial fibrillation, medicine.disease, Internal medicine, Heart failure, Conventional PCI, Antithrombotic, medicine, Cardiology, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, education, Stroke
Abstract

Background Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) and stenting initially require triple antithrombotic therapy according to the current ESC 2010 guidelines. The purpose of this study was to assess guidelines adherence and detect predictive factors of the prognosis linked to ESC guidelines adherence and clinical characteristics of this population. Methods AF patients referred for PCI with stenting were enrolled since the year 2011 to 2013. Prescription and chronology of the antithrombotic treatment (AT), occurrence of bleeding, myocardial ischemia, stroke and death were obtained by screening hospitalization reports and phone call with standardized questions during follow-up. Results Among 259 AF patients with PCI and stenting (age 76±10 years; CHA2DS2-VASc score 4.3 ± 1.7), 40% had acute coronary syndrome and 60% had elective PCI. During 633 ± 352 days follow-up, 53/156 (34%) of those admitted for elective PCI were guidelines adherent, whilst they were 10/49 (20%) for non ST elevation myocardial infarction (NSTEMI) and 8/54 (15%) for STEMI. Permanent AF (OR, 0.45; 95%CI 0.23-0.89; p=0.02), history of valvular heart disease (OR 0.51; 95%CI 0.26-0.98; p=0.04), heart failure (OR 0.49; 95%CI 0.25-0.94; p=0.03) and use of OAC before hospitalization (OR 0.48; 95%CI 0.24-0.96; p=0.04) were associated with guidelines adherence. OAC and APT underuse were associated with an increased risk of death (OR 3.73; 95%CI 1.47-10.10, p=0.005 and OR 7.35, 95%CI 2.27-26.68, p=0.0009 respectively) whereas APT overtreatment was associated with a significant lower rate of death (OR 0.23, 95% CI 0.08-0.59, p=0.002). Conclusion Guidelines for antithrombotic therapy in patients with AF who undergo PCI and stent implantation are still poorly followed in clinical practice. OAC underused was associated with an increased risk of death in this population.

Published
2015
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14. An atypical intracardiac mass in a 61-year-old man

Author

Eric Delannoy, Laurent Fauchier, Bruno Garcia, Yann Ancedy, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Thrombose, atherothrombose et pharmacologie appliquée, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Service de Cardiologie B, Éducation Éthique Santé EA 7505 (EES), and Université de Tours (UT)

Subjects
Male, medicine.medical_specialty, Echocardiography, Three-Dimensional, urologic and male genital diseases, New york heart association, Intracardiac injection, [SHS]Humanities and Social Sciences, Heart Neoplasms, Renal cell carcinoma, Internal medicine, medicine, Humans, Neoplasm Invasiveness, Coronary Artery Bypass, Carcinoma, Renal Cell, ComputingMilieux_MISCELLANEOUS, Echocardiography, Four-Dimensional, Heart Valve Prosthesis Implantation, Bundle branch block, Interventional cardiology, business.industry, Coronary Stenosis, Middle Aged, medicine.disease, Kidney Neoplasms, Treatment Outcome, Heart failure, Cardiology, Tricuspid Valve, Radiology, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Right axis deviation, Venous thromboembolism
Abstract

A 61-year-old man was referred to our cardiology department after a RV mass was discovered. He had recent history of renal cell carcinoma (RCC) diagnosed during workup of haematuria. He experienced dyspnoea New York Heart Association functional class (NYHA) II without other symptoms of heart failure. ECG showed right block bundle branch and right axis deviation. Chest X-ray was normal. Thoracoabdominal CT performed during evaluation of RCC found an intracardiac mass within the RV (figure 1A). Two, three and four-dimensional echocardiography performed before …

Published
2014
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