199 results on '"Charles Guenancia"'
Search Results
2. Is COVID-19 Infection a Multiorganic Disease? Focus on Extrapulmonary Involvement of SARS-CoV-2
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Gauthier Duloquin, Thibaut Pommier, Marjolaine Georges, Maurice Giroud, Charles Guenancia, Yannick Béjot, Gabriel Laurent, and Claudio Rabec
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SARS-CoV-2 ,multiorganic ,COVID-19 infection ,Medicine - Abstract
First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endothelial cells, and cause haemostasis, CNS, and kidney and gastrointestinal tract abnormalities that can impact in the disease course and prognosis. In fact, COVID-19 may affect almost all the organs. Hence, SARS-CoV-2 is essentially a systemic infection that can present a large number of clinical manifestations, and it is variable in distribution and severity, which means it is potentially life-threatening. The goal of this comprehensive review paper in the series is to give an overview of non-pulmonary involvement in COVID-19, with a special focus on underlying pathophysiological mechanisms and clinical presentation.
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- 2024
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3. Incidence of atrial fibrillation in cryptogenic stroke with patent foramen ovale closure: protocol for the prospective, observational PFO-AF study
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Fiona Ecarnot, Nicolas Meneveau, Gilles Rioufol, Charles Guenancia, Romain Chopard, Marc Badoz, François Derimay, Guillaume Serzian, Matthieu Besutti, and Pierre Frey
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Medicine - Abstract
Introduction After closure of patent foramen ovale (PFO) due to stroke, atrial fibrillation (AF) occurs in up to one in five patients. However, data are sparse regarding the possible pre-existence of AF in these patients prior to PFO closure, and about recurrence of AF in the long term after the procedure. No prospective study to date has investigated these topics in patients with implanted cardiac monitor (ICM). The PFO-AF study (registered with ClinicalTrials.gov under the number NCT04926142) will investigate the incidence of AF occurring within 2 months after percutaneous closure of PFO in patients with prior stroke. AF will be identified using systematic ICM. Secondary objectives are to assess incidence and burden of AF in the 2 months prior to, and up to 2 years after PFO closure.Methods and analysis Prospective, multicentre, observational study including 250 patients with an indication for PFO closure after stroke, as decided by interdisciplinary meetings with cardiologists and neurologists. Patients will undergo implantation of a Reveal Linq device (Medtronic). Percutaneous PFO closure will be performed 2 months after device implantation. Follow-up will include consultation, ECG and reading of ICM data at 2, 12 and 24 months after PFO closure. The primary endpoint is occurrence of AF at 2 months, defined as an episode of AF or atrial tachycardia/flutter lasting at least 30 s, and recorded by the ICM and/or any AF or atrial tachycardia/flutter documented on ECG during the first 2 months of follow-up.Ethics and dissemination The study was approved by the Ethics Committee ‘Comité de Protection des Personnes (CPP) Sud-Méditerranéen III’ on 2 June 2021 and registered with ClinicalTrials.gov (NCT04926142). Findings will be presented in national and international congresses and peer-reviewed journals.Trial registration number NCT04926142.
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- 2023
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4. Using Artificial Intelligence to Analyse the Retinal Vascular Network: The Future of Cardiovascular Risk Assessment Based on Oculomics? A Narrative Review
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Louis Arnould, Fabrice Meriaudeau, Charles Guenancia, Clément Germanese, Cécile Delcourt, Ryo Kawasaki, Carol Y. Cheung, Catherine Creuzot-Garcher, and Andrzej Grzybowski
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Artificial intelligence ,Deep learning ,Retina ,Cardiovascular disease ,OCT-angiography ,Adaptive optics ,Ophthalmology ,RE1-994 - Abstract
Abstract The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple and noninvasive and can provide in vivo information of the microstructure and vascular health. For more than 10 years, different research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT angiography, adaptive optics, etc.) and to provide a description of the geometric characteristics of its arterial and venous components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called “oculomics” using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. Despite the large volume of associated research, the role of retinal biomarkers in the screening, monitoring, or prediction of systemic vascular disease remains uncertain. A PubMed search was conducted until August 2022 and yielded relevant peer-reviewed articles based on a set of inclusion criteria. This literature review is intended to summarize the state of the art in oculomics and cardiovascular disease research.
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- 2022
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5. Cardiovascular outcomes after cardiac resynchronization therapy in cardiac amyloidosis
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Kilian Fischer, Nicolas Lellouche, Thibaud Damy, Raphaël Martins, Nicolas Clementy, Arnaud Bisson, François Lesaffre, Madeline Espinosa, Rodrigue Garcia, Bruno Degand, Guillaume Serzian, François Jourda, Olivier Huttin, Jean‐Baptiste Guichard, Hervé Devilliers, Jean‐Christophe Eicher, Gabriel Laurent, and Charles Guenancia
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Cardiac amyloidosis ,Cardiac resynchronization therapy ,Heart failure ,Pacemaker ,Implantable cardioverter defibrillator ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims Cardiac resynchronization therapy (CRT) is highly effective in dilated cardiomyopathy (DCM) patients with impaired left ventricular ejection fraction (LVEF) and left bundle block branch. In cardiac amyloidosis (CA) patients, left ventricular dysfunction and conduction defects are common, but the potential of CRT to improve cardiac remodelling and survival in this particular setting remains undefined. We investigated cardiovascular outcomes in CA patients after CRT implantation in terms of CRT echocardiographic response and major cardiovascular events (MACEs). Methods and results Our retrospective study included 47 CA patients implanted with CRT devices from January 2012 to February 2020, in nine French university hospitals (77 ± 6 years old, baseline LVEF 30 ± 8%) compared with propensity‐matched (1:1 for age, LVEF at implantation, and CRT indication) DCM patients with a CRT device. CA patients had lower rates of CRT response (absolute delta LVEF ≥ 10%) compared with DCM patients (36% vs. 70%, P = 0.002). After multivariate Cox analysis, CA was independently associated with MACE (hospitalization for heart failure/cardiovascular death) [hazard ratio (HR) 3.73, 95% confidence interval (CI) 1.85–7.54, P
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- 2022
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6. A Retinal Oct-Angiography and Cardiovascular STAtus (RASTA) Dataset of Swept-Source Microvascular Imaging for Cardiovascular Risk Assessment
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Clément Germanèse, Fabrice Meriaudeau, Pétra Eid, Ramin Tadayoni, Dominique Ginhac, Atif Anwer, Steinberg Laure-Anne, Charles Guenancia, Catherine Creuzot-Garcher, Pierre-Henry Gabrielle, and Louis Arnould
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retina ,swept-source ,optical coherence tomography angiography ,cardiovascular risk ,CHA2DS2-VASc ,Bibliography. Library science. Information resources - Abstract
In the context of exponential demographic growth, the imbalance between human resources and public health problems impels us to envision other solutions to the difficulties faced in the diagnosis, prevention, and large-scale management of the most common diseases. Cardiovascular diseases represent the leading cause of morbidity and mortality worldwide. A large-scale screening program would make it possible to promptly identify patients with high cardiovascular risk in order to manage them adequately. Optical coherence tomography angiography (OCT-A), as a window into the state of the cardiovascular system, is a rapid, reliable, and reproducible imaging examination that enables the prompt identification of at-risk patients through the use of automated classification models. One challenge that limits the development of computer-aided diagnostic programs is the small number of open-source OCT-A acquisitions available. To facilitate the development of such models, we have assembled a set of images of the retinal microvascular system from 499 patients. It consists of 814 angiocubes as well as 2005 en face images. Angiocubes were captured with a swept-source OCT-A device of patients with varying overall cardiovascular risk. To the best of our knowledge, our dataset, Retinal oct-Angiography and cardiovascular STAtus (RASTA), is the only publicly available dataset comprising such a variety of images from healthy and at-risk patients. This dataset will enable the development of generalizable models for screening cardiovascular diseases from OCT-A retinal images.
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- 2023
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7. Asymptomatic left circumflex artery stenosis is associated with higher arrhythmia recurrence after persistent atrial fibrillation ablation
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Rodrigue Garcia, Mathilde Clouard, Fabian Plank, Bruno Degand, Séverine Philibert, Gabriel Laurent, Pierre Poupin, Saliman Sakhy, Matthieu Gras, Markus Stühlinger, Nándor Szegedi, Szilvia Herczeg, Judit Simon, Harry J. G. M. Crijns, Eloi Marijon, Luc Christiaens, and Charles Guenancia
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atrial fibrillation ,ablation ,electrophysiology ,coronary artery disease ,pathophysiology ,cardiac computed tomography (CCT) ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThe pathophysiology of persistent atrial fibrillation (AF) remains unclear. While several studies have demonstrated an association between myocardial infarction and atrial fibrillation, the role of stable coronary artery disease (CAD) is still unknown. As a result, we aimed to assess the association between CAD obstruction and AF recurrence after persistent AF ablation in patients with no history of CAD.Materials and methodsThis observational retrospective study included consecutive patients who underwent routine preprocedural cardiac computed tomography (CCT) before persistent AF ablation between September 2015 and June 2018 in 5 European University Hospitals. Exclusion criteria were CAD or coronary revascularization previously known or during follow-up. Obstructive CAD was defined as luminal stenosis ≥ 50%.ResultsAll in all, 496 patients (mean age 61.8 ± 10.0 years, 76.2% males) were included. CHA2DS2–VASc score was 0 or 1 in 225 (36.3%) patients. Obstructive CAD was present in 86 (17.4%) patients. During the follow-up (24 ± 19 months), 207 (41.7%) patients had AF recurrence. The recurrence rate was not different between patients with and without obstructive CAD (43.0% vs. 41.5%, respectively; P = 0.79). When considering the location of the stenosis, the recurrence rate was higher in the case of left circumflex obstruction: 56% vs. 32% at 2 years (log-rank P ≤ 0.01). After Cox multivariate analysis, circumflex artery obstruction (HR 2.32; 95% CI 1.36–3.98; P < 0.01) was independently associated with AF recurrence.ConclusionCircumflex artery obstruction detected with CCT was independently associated with 2-fold increase in the risk of AF recurrence after persistent AF ablation. Further research is necessary to evaluate this pathophysiological relationship.
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- 2022
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8. Multimodal Approach for the Prediction of Atrial Fibrillation Detected After Stroke: SAFAS Study
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Lucie Garnier, Gauthier Duloquin, Alexandre Meloux, Karim Benali, Audrey Sagnard, Mathilde Graber, Geoffrey Dogon, Romain Didier, Thibaut Pommier, Catherine Vergely, Yannick Béjot, and Charles Guenancia
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atrial fibrillation ,stroke ,atrial cardiopathy ,biomarkers ,Holter ,echocardiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundIntensive screening for atrial fibrillation (AF) has led to a better recognition of this cause in stroke patients. However, it is currently debated whether AF Detected After Stroke (AFDAS) has the same pathophysiology and embolic risk as prior-to-stroke AF. We thus aimed to systematically approach AFDAS using a multimodal approach combining clinical, imaging, biological and electrocardiographic markers.MethodsPatients without previously known AF admitted to the Dijon University Hospital (France) stroke unit for acute ischemic stroke were prospectively enrolled. The primary endpoint was the presence of AFDAS at 6 months, diagnosed through admission ECG, continuous electrocardiographic monitoring, long-term external Holter during the hospital stay, or implantable cardiac monitor if clinically indicated after discharge.ResultsOf the 240 included patients, 77 (32%) developed AFDAS. Compared with sinus rhythm patients, those developing AFDAS were older, more often women and less often active smokers. AFDAS patients had higher blood levels of NT-proBNP, osteoprotegerin, galectin-3, GDF-15 and ST2, as well as increased left atrial indexed volume and lower left ventricular ejection fraction. After multivariable analysis, galectin-3 ≧ 9 ng/ml [OR 3.10; 95% CI (1.03–9.254), p = 0.042], NT-proBNP ≧ 290 pg/ml [OR 3.950; 95% CI (1.754–8.892, p = 0.001], OPG ≥ 887 pg/ml [OR 2.338; 95% CI (1.015–5.620), p = 0.046) and LAVI ≥ 33.5 ml/m2 [OR 2.982; 95% CI (1.342–6.625), p = 0.007] were independently associated with AFDAS.ConclusionA multimodal approach combining imaging, electrocardiography and original biological markers resulted in good predictive models for AFDAS. These results also suggest that AFDAS is probably related to an underlying atrial cardiopathy.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03570060].
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- 2022
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9. Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope?
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Amélie Gabet, Clémence Grave, Philippe Tuppin, Thomas Lesuffleur, Charles Guenancia, Viêt Nguyen-Thanh, Romain Guignard, Jacques Blacher, and Valérie Olié
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cardiovascular ,medication ,initiation ,cardiovascular risk ,COVID-19 pandemic ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ObjectivesThis study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population.MethodsFor each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017–2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists.ResultsIn 2020, IRR significantly decreased for initiations of antihypertensives (−11.1%[CI95%, −11.4%;−10.8%]), lipid-lowering drugs (−5.2%[CI95%, −5.5%;−4.8%]), oral anticoagulants in atrial fibrillation (−8.6%[CI95%, −9.1%;−8.0%]), and smoking cessation medications (−50.9%[CI95%, −51.1%;−50.7%]) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women.ConclusionThe COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.
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- 2022
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10. Retinal Vascular Density as A Novel Biomarker of Acute Renal Injury after Acute Coronary Syndrome
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Guillaume Alan, Charles Guenancia, Louis Arnould, Arthur Azemar, Stéphane Pitois, Maud Maza, Florence Bichat, Marianne Zeller, Pierre-Henri Gabrielle, Alain Marie Bron, Catherine Creuzot-Garcher, and Yves Cottin
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Medicine ,Science - Abstract
Abstract Iodinated contrast agent (ICA)-induced acute kidney injury (AKI) following acute coronary syndrome (ACS) is a frequent complication, which may lead to chronic kidney disease and increased mortality. Optical coherence tomography angiography (OCT-A) of the retina is new tool delivering a rapid and noninvasive assessment of systemic microvascularization, which is potentially involved in the occurrence of ICA-induced AKI. Between October 2016 and March 2017, 452 ACS patients were admitted to our cardiac intensive care unit. OCT-A was performed within 48 h after the ICA injection. Patients with a history of retinal disease were excluded. The patients included were divided into two groups depending on whether or not AKI occurred after injection of ICA, according to KDIGO criteria. Of the 216 patients included, 21 (10%) presented AKI. AKI was significantly associated with age, Mehran score, GRACE score, and NT-proBNP. AKI patients had significantly lower retinal vascular density (RVD)) and had more frequent low RVD (81% vs 45%, P = 0.002). Adding low RVD to the Mehran score and the NT-proBNP, or to the GRACE score and the NT-proBNP, significantly improved their predictive values, suggesting that systemic microvascular involvement remains incompletely addressed by either standard risk scores or factors known to be associated with ICA-induced AKI.
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- 2019
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11. Trends of Myocarditis and Endocarditis Cases before, during, and after the First Complete COVID-19-Related Lockdown in 2020 in France
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Thibaut Pommier, Eric Benzenine, Chloé Bernard, Anne-Sophie Mariet, Yannick Béjot, Maurice Giroud, Marie-Catherine Morgant, Eric Steinmetz, Charles Guenancia, Olivier Bouchot, and Catherine Quantin
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myocarditis ,endocarditis ,COVID-19 ,epidemiology ,Biology (General) ,QH301-705.5 - Abstract
Background. The impact of the COVID-19 pandemic on hospitalization for cardiac infections is not well known. We aimed to evaluate the nationwide trends in hospital stays for myocarditis and endocarditis cases before, during and after the nationwide lockdown for the COVID-19 pandemic in France. We then aimed to describe the proportion of myocarditis and endocarditis patients with and without COVID-19 and their clinical characteristics. Methods. Hospitalized cases of cardiac infection were extracted from the French National Discharge database, which collects the medical records of all patients discharged from all public and private hospitals in France. Age, sex, and available cardiovascular risk factors were compared between stays with and without COVID-19 during the lockdown. Results. The number of myocarditis cases was 11% higher in 2020, compared to the average of the three prior years. In 2020, 439 of 3727 cases of myocarditis were associated with COVID-19. For endocarditis, there was an increase in cases by 7% in 2020 versus prior years. For endocarditis, 3% (240 of 8128 cases) of patients with endocarditis had COVID-19. For myocarditis, older age, hypertension, diabetes, obesity, and atrial fibrillation were more frequent in patients with COVID-19 than in those without. For endocarditis, only hypertension was more frequent in patients with COVID-19 than in those without. Conclusion. Our study reports an increase in hospitalizations for both myocarditis and endocarditis in 2020, possibly related to the COVID-19 pandemic. Interestingly, the trends differ according to the COVID-19 status. Knowledge of the factors associating myocarditis or endocarditis and COVID-19 may improve the quality and the type of monitoring for people with COVID-19, the identification of patients at risk of cardiac infections, and the treatment of COVID-19 patients.
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- 2022
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12. Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer: French CANTO cohort study.
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Elisé G Kaboré, Charles Guenancia, Ines Vaz-Luis, Antonio Di Meglio, Barbara Pistilli, Charles Coutant, Paul Cottu, Anne Lesur, Thierry Petit, Florence Dalenc, Philippe Rouanet, Antoine Arnaud, Olivier Arsene, Mahmoud Ibrahim, Johanna Wassermann, Geneviève Boileau-Jolimoy, Anne-Laure Martin, Jérôme Lemonnier, Fabrice André, and Patrick Arveux
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Medicine - Abstract
BackgroundIn patients treated with cardiotoxic chemotherapies, the presence of cardiovascular risk factors and previous cardiac disease have been strongly correlated to the onset of cardiotoxicity. The influence of overweight and obesity as risk factors in the development of treatment-related cardiotoxicity in breast cancer (BC) was recently suggested. However, due to meta-analysis design, it was not possible to take into account associated cardiac risk factors or other classic risk factors for anthracycline (antineoplastic antibiotic) and trastuzumab (monoclonal antibody) cardiotoxicity.Methods and findingsUsing prospective data collected from 2012-2014 in the French national multicenter prospective CANTO (CANcer TOxicities) study of 26 French cancer centers, we aimed to examine the association of body mass index (BMI) and cardiotoxicity (defined as a reduction in left ventricular ejection fraction [LVEF] > 10 percentage points from baseline to LVEF < 50%). In total, 929 patients with stage I-III BC (mean age 52 ± 11 years, mean BMI 25.6 ± 5.1 kg/m2, 42% with 1 or more cardiovascular risk factors) treated with anthracycline (86% epirubicin, 7% doxorubicin) and/or trastuzumab (36%), with LVEF measurement at baseline and at least 1 assessment post-chemotherapy were eligible in this interim analysis. We analyzed associations between BMI and cardiotoxicity using multivariate logistic regression. At baseline, nearly 50% of the study population was overweight or obese. During a mean follow-up of 22 ± 2 months following treatment completion, cardiotoxicity occurred in 29 patients (3.2%). The obese group was more prone to cardiotoxicity than the normal-weight group (9/171 versus 8/466; p = 0.01). In multivariate analysis, obesity (odds ratio [OR] 3.02; 95% CI 1.10-8.25; p = 0.03) and administration of trastuzumab (OR 12.12; 95% CI 3.6-40.4; p < 0.001) were independently associated with cardiotoxicity. Selection bias and relatively short follow-up are potential limitations of this national multicenter observational cohort.ConclusionsIn BC patients, obesity appears to be associated with an important increase in risk-related cardiotoxicity (CANTO, ClinicalTrials.gov registry ID: NCT01993498).Trial registrationClinicalTrials.gov NCT01993498.
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- 2019
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13. Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy
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Nobila Valentin Yaméogo, André Koudnoaga Samadoulougou, Larissa Justine Kagambèga, Koudougou Jonas Kologo, Georges Rosario Christian Millogo, Anna Thiam, Charles Guenancia, and Patrice Zansonré
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Peripartum cardiomyopathy ,Subsequent pregnancy ,Prognosis ,Burkina Faso ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background The aim of this study was to describe maternal and fetal outcomes after pregnancy complicated by peripartum cardiomyopathy (PPCM). Methods We included women that had subsequent pregnancy (SSP) after PPCM and assessed maternal prognosis and pregnancy outcomes, in-hospital up to one week after discharge. Clinical and echocardiographic data were collected comparing alive and deceased women. Factors associated with pregnancy outcomes were assessed. Results Twenty-nine patients were included, with a mean age of 26.7 ± 4.6 years and a mean gravidity number of 2.3 ± 0.5 of. At the last medical control before subsequent pregnancy, there was no congestive heart failure, the mean left ventricular diastolic diameter (LVDD) was 53 ± 4 mm and the left ventricular ejection fraction (LVEF) was ≥50% in 13 cases (44.8%). Maternal outcomes were marked by 14 deaths (48.3%). Among the factors tested in univariate analysis, LVEF at admission had an excellent receiver-operating characteristic (ROC) curve to predict maternal mortality (AUC = 0.95; 95% CI 0.87–1, p
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- 2018
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14. Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort
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Charles Guenancia, Nefissa Hammache, Clémence Docq, Karim Benali, Darren Hooks, Mathieu Echivard, Nathalie Pace, Isabelle Magnin-Poull, Christian de Chillou, and Jean-Marc Sellal
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atrial fibrillation ,ablation ,laser ,radiofrequency ,paroxysmal ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Laser balloon (LB) has emerged as an interesting strategy for pulmonary vein isolation in paroxysmal atrial fibrillation (AF). A third-generation LB has recently been developed, allowing a continuous ablation set. We aimed to compare the results from our center’s experience with second and third-generation LBs to a cohort of matched patients who had undergone radiofrequency ablation (RFA) with contact-force catheters. This retrospective monocenter case-control study included our first 50 LB paroxysmal AF ablations (26 second and 24 third-generation LB) and 50 RFA controls, matched on age, sex and left atrial dilation. The two groups had similar baseline parameters. LB procedures were significantly shorter than RFA (129 (110–160) vs. 160 (119–198) min, p = 0.007). During AF ablation, two major complications occurred in each group. At the one-year follow-up, AF recurrence was diagnosed in 7 (14%) of the LB group vs. 14 (28%) of the RFA group (p = 0.14). Moreover, we observed that third-generation LB procedures were associated with shorter laser applications (22 (19–29) vs. 69 (55–76) min, p < 0.001) and procedural durations (111 (100–128) vs. 151.5 (128.5–167) min, p < 0.001) compared to second-generation LB procedures. In the context of the major increase in the number of AF ablations, LB demonstrated consistent results in terms of clinical success, complications and also reduced procedure durations compared to RFA.
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- 2021
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15. More than 50% of Persistent Myocardial Scarring at One Year in 'Infarct-like' Acute Myocarditis Evaluated by CMR
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Thibaut Pommier, Thibault Leclercq, Charles Guenancia, Simon Tisserand, Céline Lairet, Max Carré, Alain Lalande, Florence Bichat, Maud Maza, Marianne Zeller, Alexandre Cochet, and Yves Cottin
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acute myocarditis ,cardiac magnetic resonance ,one year follow-up ,Medicine - Abstract
Background: Cardiac magnetic resonance (CMR) has emerged as a reference tool for the non-invasive diagnosis of myocarditis. However, its role in follow-up (FU) after the acute event is unclear. The objectives were to assess the evolution of CMR parameters between the acute phase of infarct-like myocarditis and 12 months thereafter and to identify the predictive factors of persistent myocardial scarring at one year. Methods: All patients with infarct-like acute myocarditis confirmed by CMR were included. CMR was performed within 8 days following symptom onset, at 3 months and at one year. One-year FU included ECG, a cardiac stress test, Holter recording, biological assessments, medical history and a quality-of-life questionnaire. Patients were classified according to the presence or absence of complete recovery at one year based on the CMR evaluation. Results: A total of 174 patients were included, and 147 patients had three CMR. At one year, 79 patients (54%) exhibited persistent myocardial scarring on CMR. A multivariate analysis showed that high peak troponin at the acute phase (OR: 3.0—95%CI: 1.16–7.96—p = 0.024) and the initial extent of late gadolinium enhancement (LGE) (OR: 1.1—95%CI: 1.03–1.19—p = 0.006) were independent predictors of persistent myocardial scarring. Moreover, patients with myocardial scarring on the FU CMR were more likely to have premature ventricular contractions during the cardiac stress test (25% versus 9%, p = 0.008). Conclusion: Less than 50% of patients with infarct-like acute myocarditis showed complete recovery at one year. Although major adverse cardiac events were rare, ventricular dysrhythmias at one year were more frequent in patients with persistent myocardial scarring.
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- 2021
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16. Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures
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Karim Benali, Julien Verain, Nefissa Hammache, Charles Guenancia, Darren Hooks, Isabelle Magnin-Poull, Marie Toussaint-Hacquard, Christian de Chillou, and Jean-Marc Sellal
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anticoagulation ,atrial fibrillation ,heparin ,activated clotting time ,direct oral anticoagulants ,vitamin K antagonist ,Medicine - Abstract
Background: Activated Clotting Time (ACT) guided heparinization is the gold standard for titrating unfractionated heparin (UFH) administration during atrial fibrillation (AF) ablation procedures. The current ACT target (300 s) is based on studies in patients receiving a vitamin K antagonist (VKA). Several studies have shown that in patients receiving Direct Oral Anticoagulants (DOACs), the correlation between ACT values and UFH delivered dose is weak. Objective: To assess the relationship between ACT and real heparin anticoagulant effect measured by anti-Xa activity in patients receiving different anticoagulant treatments. Methods: Patients referred for AF catheter ablation in our centre were prospectively included depending on their anticoagulant type. Results: 113 patients were included, receiving rivaroxaban (n = 30), apixaban (n = 30), dabigatran (n = 30), and VKA (n = 23). To meet target ACT, a higher UFH dose was required in DOAC than VKA patients (14,077.8 IU vs. 9565.2 IU, p < 0.001), leading to a longer time to achieve target ACT (46.5 min vs. 27.3 min, p = 0.001). The correlation of ACT and anti-Xa activity was tighter in the VKA group (Spearman correlation ρ = 0.53), compared to the DOAC group (ρ = 0.19). Despite lower ACT values in the DOAC group, this group demonstrated a higher mean anti-Xa activity compared to the VKA group (1.56 ± 0.39 vs. 1.14 ± 0.36; p = 0.002). Conclusion: Use of a conventional ACT threshold at 300 s during AF ablation procedures leads to a significant increase in UFH administration in patients treated with DOACs. This increase corresponds more likely to an overdosing than a real increase in UFH requirement.
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- 2021
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17. Left Atrial Remodeling and Brain Natriuretic Peptide Levels Variation after Left Atrial Appendage Occlusion
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Thibaut Pommier, Thibault Leclercq, Charles Guenancia, Carole Richard, Guillaume Porot, Gabriel Laurent, and Luc Lorgis
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left atrial appendage occlusion ,bleeding risk ,BNP ,atrial remodeling ,atrial fibrillation ,atrial cardiopathy ,Medicine - Abstract
Background: Few data are available about brain natriuretic peptide (BNP) variation and left atrial remodeling after the left atrial appendage occlusion (LAAO) technique. Methods: Prospective study included all consecutive patients successfully implanted with an LAAO device. Contrast-enhanced cardiac computed tomography (CT) was performed before and 6 weeks after the procedure with reverse left atrial remodeling defined by an increase in LA volume >10%, together with blood sampling obtained before, 48 h after device implantation and at the first visit after discharge (30–45 days) for BNP measurement. Results: Among the 43 patients implanted with a complete dataset, mean end-diastolic LA volume was 139 ± 64 mL and 141 ± 62 mL at baseline and during follow-up (45 ± 15 days), respectively, showing no statistical difference (p = 0.45). No thrombus was seen on the atrial side of the device. Peridevice leaks (defined as presence of dye in the LAA beyond the device) were observed in 17 patients (40%) but were trivial or mild. Reverse atrial remodeling (RAR) at 6 weeks was observed in six patients (14%). Despite no difference in BNP levels on admission, median BNP levels at 48 h were slightly increased in RAR patients when compared with controls. During FU, BNP levels were strictly identical in both groups. These results were not modified even when each RAR case was matched with two controls on age, LVEF, creatinine levels and ACE inhibitors treatment to avoid potential confounders. Conclusion: Our study showed that despite the fact that the LAAO technique can induce left atrial remodeling measured by a CT scan, it does not seem to impact BNP levels on the follow-up. The results need to be transposed to clinical outcomes of this expanding population in future studies.
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- 2021
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18. Incremental predictive value of mean platelet volume/platelet count ratio in in-hospital stroke after acute myocardial infarction
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Charles Guenancia, Olivier Hachet, Karim Stamboul, Yannick Béjot, Thibault Leclercq, Fabien Garnier, Nobila Valentin Yameogo, Emmanuel de Maistre, Yves Cottin, and Luc Lorgis
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acute myocardial infarction ,c-reactive protein ,platelets ,risk factor ,stroke ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Stroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. Though the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity could play an important role in the occurrence of stroke during AMI. We aimed to investigate the relationship between both mean platelet volume (MPV), a parameter of platelet function, and C-reactive protein (CRP) and the occurrence of in-hospital ischemic stroke (IHS) after AMI. Data were obtained from a French regional survey for AMI that included 5976 patients admitted to an intensive care unit (ICU) between 2001 and 2010. Patients were divided into two groups according to the occurrence of IHS. MPV, platelet count (PC), and CRP were routinely measured at admission to the ICU; 99 (1.6%) IHSs were recorded during hospitalization after admission for AMI. In multivariate analysis, IHS was independently associated with a history of stroke (OR: 1.99%, CI: 1.1–3.49, p = 0.01), impaired left ventricular ejection fraction 10 mg/l (OR: 2.19, 95% CI: 1.44–3.33, p < 0.001), and MPV/PC ratio (OR: 1.04, 95% CI: 1.01–1.08, p = 0.023). Compared with the first to fourth quintiles, the last quintile of the MPV/PC ratio was associated with higher rates of IHS on survival curve analysis (p = 0.014). At hospital admission, a high MPV/PC ratio and a high level of CRP might help to identify patients at increased risk of IHS. Moreover, these results provide new insights into the potential role played by increased inflammation and platelet reactivity in the occurrence of stroke after AMI.
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- 2017
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19. Programming of Cardiovascular Dysfunction by Postnatal Overfeeding in Rodents
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Marie Josse, Eve Rigal, Nathalie Rosenblatt-Velin, Luc Rochette, Marianne Zeller, Charles Guenancia, and Catherine Vergely
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perinatal programming ,postnatal overfeeding ,rodents ,heart ,arteries ,ischemia ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Nutritional environment in the perinatal period has a great influence on health and diseases in adulthood. In rodents, litter size reduction reproduces the effects of postnatal overnutrition in infants and reveals that postnatal overfeeding (PNOF) not only permanently increases body weight but also affects the cardiovascular function in the short- and long-term. In addition to increased adiposity, the metabolic status of PNOF rodents is altered, with increased plasma insulin and leptin levels, associated with resistance to these hormones, changed profiles and levels of circulating lipids. PNOF animals present elevated arterial blood pressure with altered vascular responsiveness to vasoactive substances. The hearts of overfed rodents exhibit hypertrophy and elevated collagen content. PNOF also induces a disturbance of cardiac mitochondrial respiration and produces an imbalance between oxidants and antioxidants. A modification of the expression of crucial genes and epigenetic alterations is reported in hearts of PNOF animals. In vivo, a decreased ventricular contractile function is observed during adulthood in PNOF hearts. All these alterations ultimately lead to an increased sensitivity to cardiac pathologic challenges such as ischemia-reperfusion injury. Nevertheless, caloric restriction and physical exercise were shown to improve PNOF-induced cardiac dysfunction and metabolic abnormalities, drawing a path to the potential therapeutic correction of early nutritional programming.
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- 2020
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20. New Perspective in Atrial Fibrillation
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Audrey Sagnard, Nefissa Hammache, Jean-Marc Sellal, and Charles Guenancia
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n/a ,Medicine - Abstract
Despite a large number of publications on this subject, the pathophysiological mechanisms involved in atrial fibrillation (AF) onset and recurrence are uncertain [...]
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- 2020
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21. Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction
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Audrey Sagnard, Charles Guenancia, Basile Mouhat, Maud Maza, Marie Fichot, Daniel Moreau, Fabien Garnier, Luc Lorgis, Yves Cottin, and Marianne Zeller
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acute myocardial infarction ,atrial fibrillation ,heart rate variability ,autonomic nervous system ,Medicine - Abstract
Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed by Holter-ECG Results: Among the 2040 included patients, 168 (8.2%) developed AF during AMI. Compared to the sinus-rhythm (SR) group, AF patients were older, had more frequent hypertension and lower left ventricular ejection fraction LVEF. On the Holter parameters, AF patients had higher pNN50 values (11% vs. 4%, p < 0.001) and median LH/HF ratio, a reflection of sympathovagal balance, was significantly lower in the AF group (0.88 vs 2.75 p < 0.001). The optimal LF/HF cut-off for AF prediction was 1.735. In multivariate analyses, low LF/HF Conclusion: Our study strongly suggests that new-onset AF in AMI mainly occurs in a dysregulated autonomic nervous system, as suggested by low LF/HF, and higher PNN50 and RMSSD values.
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- 2020
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22. High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis
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Laurent Rosier, Amir Zouaghi, Valentin Barré, Raphaël Martins, Vincent Probst, Eloi Marijon, Nicolas Sadoul, Samuel Chauveau, Antoine Da Costa, Marc Badoz, Michael Peyrol, Jérémie Barraud, Grégoire Massoullie, Romain Eschalier, Madeline Espinosa, François Lesaffre, Rodrigue Garcia, Bruno Degand, Antoine Noël, Jacques Mansourati, Fabrice Extramiana, Vincent Algalarrondo, Hervé Devilliers, Yves Cottin, Estelle Gandjbakhch, and Charles Guenancia
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myocarditis ,ventricular tachycardia ,ventricular fibrillation ,implantable cardioverter defibrillator ,Medicine - Abstract
Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan−Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.
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- 2020
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23. Association between the retinal vascular network with Singapore 'I' Vessel Assessment (SIVA) software, cardiovascular history and risk factors in the elderly: The Montrachet study, population-based study.
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Louis Arnould, Christine Binquet, Charles Guenancia, Seydou Alassane, Ryo Kawasaki, Vincent Daien, Christophe Tzourio, Yumiko Kawasaki, Abderrahmane Bourredjem, Alain Bron, and Catherine Creuzot-Garcher
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Medicine ,Science - Abstract
To identify patterns summarizing the retinal vascular network in the elderly and to investigate the relationship of these vascular patterns with cardiovascular history.We conducted a population-based study, the Montrachet study (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases), in participants older than 75 years. The history of cardiovascular disease and a score-based estimation of their 10-year risk of cardiovascular mortality (Heart SCORE) were collected. Retinal vascular network analysis was performed by means of Singapore "I" Vessel Assessment (SIVA) software. Principal component analysis was used to condense the information contained in the high number of variables provided and to identify independent retinal vascular patterns.Overall, 1069 photographs (1069 participants) were reviewed with SIVA software. The mean age was 80.0 ± 3.8 years. We extracted three vascular patterns summarizing 41.3% of the vascular information. The most clinically relevant pattern, Sparse vascular network, accounted for 17.4% of the total variance. It corresponded to a lower density in the vascular network and higher variability in vessel width. Diabetic participants with hypoglycemic treatment had a sparser vascular network pattern than subjects without such treatment (odds ratio, [OR], 1.68; 95% CI, 1.04-2.72; P = 0.04). Participants with no history of cardiovascular disease who had a sparser vascular network were associated with a higher Heart SCORE (OR, 1.76; 95% CI, 1.08-2.25; P = 0.02).Three vascular patterns were identified. The Sparse vascular network pattern was associated with having a higher risk profile for cardiovascular mortality risk at 10 years.
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- 2018
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24. Relation between high levels of myeloperoxidase in the culprit artery and microvascular obstruction, infarct size and reverse remodeling in ST-elevation myocardial infarction.
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Karim Stamboul, Marianne Zeller, Luc Rochette, Yves Cottin, Alexandre Cochet, Thibault Leclercq, Guillaume Porot, Charles Guenancia, Marie Fichot, Nicolas Maillot, Catherine Vergely, and Luc Lorgis
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Medicine ,Science - Abstract
To better understand the role of myeloperoxidases (MPO) in microvascular obstruction (MO) phenomenon and infarct size (IS) using cardiac magnetic resonance (CMR) data in patients with acute myocardial infarction (AMI).40 consecutive patients classified according to the median level of MPO in the culprit artery. A CMR study was performed during the week following AMI and at 6 months, with late gadolinium enhancement sequences.Persistent MO was observed in the same proportion (50 vs. 65%, p = 0.728) between the low vs. high MPO group levels. However, the extent of the microvascular obstruction was significantly greater in the high-MPO group (6 (0-9) vs.16.5 (0-31), p = 0.027), together with a greater infarct size, and a trend towards a lower left ventricular ejection fraction (LVEF) (p = 0.054) at one week. CMR data at 6 months showed that reverse systolic remodeling was two fold more present in the low-MPO group (p = 0.058). Interestingly, the extent of MO (8.5 (6.5-31) vs. 4.1 (3-11.55), p = 0.042) and IS remained significantly greater (24.5 (9.75-35) vs. 7.5 (2.5-18.75), p = 0.022) in the high-MPO group. Moreover, MPO in the culprit artery appeared to correlate positively with MPO in non-culprit arteries and serum, and with troponin levels and peak CK.This patient-based study revealed in patients after AMI that high MPO levels in the culprit artery were associated with more severe microvascular obstruction and greater IS. These findings may provide new insights pathophysiology explanation for the adverse prognostic impact of MO.
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- 2017
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25. Increased Symmetric Dimethylarginine Level Is Associated with Worse Hospital Outcomes through Altered Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction.
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Julie Lorin, Jean-Claude Guilland, Karim Stamboul, Charles Guenancia, Yves Cottin, Luc Rochette, Catherine Vergely, and Marianne Zeller
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Medicine ,Science - Abstract
We aimed to investigate whether SDMA- symmetric dimethylarginine -the symmetrical stereoisomer of ADMA- might be a marker of left ventricular function in AMI.Asymmetric dimethylarginine (ADMA) has been implicated in the prognosis after acute myocardial infarction (AMI) and heart failure (HF).Cross sectional prospective study from 487 consecutive patients hospitalized 2, and death.Patients were analysed based on SDMA tertiles. Sex, diabetes, dyslipidemia, and prior MI were similar for all tertiles. In contrast, age and hypertension increased across the tertiles (p
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- 2017
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26. Atrial Fibrillation Is Associated with a Marker of Endothelial Function and Oxidative Stress in Patients with Acute Myocardial Infarction.
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Karim Stamboul, Julie Lorin, Luc Lorgis, Charles Guenancia, Jean-Claude Beer, Claude Touzery, Luc Rochette, Catherine Vergely, Yves Cottin, and Marianne Zeller
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Medicine ,Science - Abstract
Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI.273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) ≥48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample.The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients without AF (≈ 20 y). There was a trend towards higher ADMA levels in patients with symptomatic AF than in patients with silent AF or no AF (0.53 vs 0.49 and 0.49 μmol/L, respectively, p = 0.18,). After matching on age, we found that patients with symptomatic AF had a higher heart rate on admission and a higher rate of patients with LV dysfunction (28% vs. 3%, p = 0.025). Patients who developed symptomatic AF had a higher ADMA level than patients without AF (0.53 vs. 0.43 μmol/L; p = 0.001). Multivariate logistic regression analysis to estimate symptomatic AF occurrence showed that ADMA was independently associated with symptomatic AF (OR: 2.46 [1.21-5.00], p = 0.013) beyond history of AF, LVEF
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- 2015
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27. Incidence and Predictors of New-Onset Atrial Fibrillation in Septic Shock Patients in a Medical ICU: Data from 7-Day Holter ECG Monitoring.
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Charles Guenancia, Christine Binquet, Gabriel Laurent, Sandrine Vinault, Rémi Bruyère, Sébastien Prin, Arnaud Pavon, Pierre-Emmanuel Charles, and Jean-Pierre Quenot
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Medicine ,Science - Abstract
We investigated incidence, risk factors for new-onset atrial fibrillation (NAF), and prognostic impact during septic shock in medical Intensive Care Unit (ICU) patients.Prospective, observational study in a university hospital. Consecutive patients from 03/2011 to 05/2013 with septic shock were eligible. Exclusion criteria were age 30 seconds. Patient characteristics, infection criteria, cardiovascular parameters, severity of illness, support therapies were recorded.Among 66 patients, 29(44%) developed NAF; 10 (34%) would not have been diagnosed without Holter ECG monitoring. NAF patients were older, with more markers of heart failure (troponin and NT-pro-BNP), lower left ventricular ejection fraction (LVEF), longer QRS duration and more nonsustained supra ventricular arrhythmias (
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- 2015
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28. Growth differentiation factor-15 (GDF-15) levels are associated with cardiac and renal injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
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Abdelkader Kahli, Charles Guenancia, Marianne Zeller, Sandrine Grosjean, Karim Stamboul, Luc Rochette, Claude Girard, and Catherine Vergely
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Medicine ,Science - Abstract
Growth differentiation factor-15 (GDF-15) has been identified as a strong marker of cardiovascular disease; however, no data are available concerning the role of GDF-15 in the occurrence of organ dysfunction during coronary artery bypass grafting (CABG) associated with cardiopulmonary bypass (CPB).Five arterial blood samples were taken sequentially in 34 patients from anesthesia induction (IND) until 24 h after arrival at the intensive care unit (ICU). Plasma levels of GDF-15, follistatin-like 1 (FLST1), myeloperoxidases (MPO), hydroperoxides and plasma antioxidant status (PAS) were measured at each time-point. Markers of cardiac (cardiac-troponin I, cTnI) and renal dysfunction (neutrophil gelatinase-associated lipocalin, NGAL) and other classical biological factors and clinical data were measured.Plasma GDF-15 levels increased gradually during and after surgery, reaching nearly three times the IND levels in the ICU (3,075±284 ng/L vs. 1,061±90 ng/L, p3 were shown to have higher GDF-15 levels.During cardiac surgery associated with CPB, GDF-15 levels increased substantially and were associated with markers of cardiac injury and renal dysfunction.
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- 2014
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29. Postnatal overfeeding causes early shifts in gene expression in the heart and long-term alterations in cardiometabolic and oxidative parameters.
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Ahmed Habbout, Charles Guenancia, Julie Lorin, Eve Rigal, Céline Fassot, Luc Rochette, and Catherine Vergely
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Medicine ,Science - Abstract
BACKGROUND: Postnatal overfeeding (OF) in rodents induces a permanent moderate increase in body weight in adulthood. However, the repercussions of postnatal OF on cardiac gene expression, cardiac metabolism and nitro-oxidative stress are less well known. METHODOLOGY/PRINCIPAL FINDINGS: Immediately after birth, litters of C57BL/6 mice were either maintained at 10 (normal-fed group, NF), or reduced to 3 in order to induce OF. At weaning, mice of both groups received a standard diet. The cardiac gene expression profile was determined at weaning and cardiac metabolism and oxidative stress were assessed at 7 months. The cardiac expression of several genes, including members of the extracellular matrix and apelin pathway, was modified in juvenile OF mice. In adult mice, OF led to an increase in body weight (+30%) and to significant increases in plasma cholesterol, insulin and leptin levels. Myocardial oxidative stress, SOD and catalase activity and mRNA expression were increased in OF mice. In vivo, diastolic and systolic blood pressures were significantly higher and LV shortening and ejection fraction were decreased in OF mice. Ex vivo, after 30 min of ischemia, hearts isolated from OF mice showed lower functional recovery and larger infarct size (31% vs. 54%, p
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- 2013
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30. Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study
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Yannick Béjot, Romain Didier, Charles Guenancia, Gauthier Duloquin, Thibaut Pommier, Gabriel Laurent, Lucie Garnier, Alexandre Meloux, Audrey Sagnard, Mathilde Graber, Geoffrey Dogon, Karim Benali, and Catherine Vergely
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Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background Atrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS).Methods Stepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission.Results A total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p34 mL/m2, OR 2.35 (CI 1.09 to 5.06) p=0029).Conclusion AC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations.Trial registration number NCT03570060.
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31. Rapid ventricular tachycardia in patients with tetralogy of Fallot and implantable cardioverter-defibrillator: Insights from the DAI-T4F nationwide registry
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Mikael Laredo, Guillaume Duthoit, Frédéric Sacher, Frédéric Anselme, Caroline Audinet, Francis Bessière, Pierre Bordachar, Abdeslam Bouzeman, Serge Boveda, Sok Sithikun Bun, Morgane Chassignolle, Gaël Clerici, Antoine Da Costa, Maxime de Guillebon, Pascal Defaye, Nathalie Elbaz, Romain Eschalier, Fabrice Extramiana, Laurent Fauchier, Alexis Hermida, Estelle Gandjbakhch, Rodrigue Garcia, Jean-Baptiste Gourraud, Charles Guenancia, Benoit Guy-Moyat, Didier Irles, Laurence Iserin, François Jourda, Linda Koutbi, Fabien Labombarda, Magalie Ladouceur, Philippe Lagrange, Nicolas Lellouche, Jacques Mansourati, Christelle Marquié, Raphael Martins, Grégoire Massoulié, Amel Mathiron, Philippe Maury, Anne Messali, Antoine Milhem, Pierre Mondoly, Cédric Nguyen, Sandro Ninni, Jean Luc Pasquié, Bertrand Pierre, Penelope Pujadas, Jean-Marc Sellal, Jean-Benoit Thambo, Camille Walton, Pierre Winum, Cyril Zakine, Alexandre Zhao, Xavier Jouven, Nicolas Combes, Eloi Marijon, Victor Waldmann, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Institut de rythmologie et modélisation cardiaque [Pessac] (IHU Liryc), 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], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)
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Sudden cardiac death ,Rapid ventricular tachycardia ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Physiology (medical) ,Tetralogy of Fallot ,Ventricular arrhythmia ,Adult congenital heart disease ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Cardiology and Cardiovascular Medicine ,Implantable cardioverter-defibrillator - Abstract
In repaired tetralogy of Fallot (TOF), little is known about characteristics of patients with rapid ventricular tachycardia (VT). Also, whether patients with a first episode of nonrapid VT may subsequently develop rapid VT or ventricular fibrillation (VF) has not been addressed.The objectives of this study were to compare patients with rapid VT/VF with those with nonrapid VT and to assess the evolution of VT cycle lengths (VTCLs) overtime.Data were analyzed from a nationwide registry including all patients with TOF and implantable cardioverter-defibrillator (ICD) since 2000. Patients with ≥1 VT episode with VTCL ≤250 ms (240 beats/min) formed the rapid VT/VF group.Of 144 patients (mean age 42.0 ± 12.7 years; 104 [72%] men), 61 (42%) had at least 1 VT/VF episode, including 28 patients with rapid VT/VF (46%), during a median follow-up of 6.3 years (interquartile range 2.2-10.3 years). Compared with patients in the nonrapid VT group, those in the rapid VT/VF group were significantly younger at ICD implantation (35.2 ± 12.6 years vs 41.5 ± 11.2 years; P = .04), had more frequently a history of cardiac arrest (8 [29%] vs 2 [6%]; P = .02), less frequently a history of atrial arrhythmia (11 [42%] vs 22 [69%]; P = .004), and higher right ventricular ejection fraction (43.3% ± 10.3% vs 36.6% ± 11.2%; P = .04). The median VTCL of VT/VF episodes was 325 ms (interquartile range 235-429 ms). None of the patients with a first documented nonrapid VT episode had rapid VT/VF during follow-up.Patients with TOF and rapid VT/VF had distinct clinical characteristics. The relatively low variation of VTCL over time suggests a room for catheter ablation without a backup ICD in selected patients with well-tolerated VT.Clinicaltrials.gov identifier: NCT03837574.
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- 2023
32. Cardiac Stereotactic Radiation Therapy for Refractory Ventricular Arrhythmias in Patients With Left Ventricular Assist Device
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Karim Benali, Kristin Higgins, Magali Quivrin, Igor Bessieres, John A. Wight, Divya Gupta, Raphael Martins, Anand D. Shah, Charles Guenancia, and Michael S. Lloyd
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- 2023
33. Incremental value of the combined brain-cardiac CT protocol on prediction of atrial fibrillation after stroke
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Alexandra Braillon, Angélique Bernard, Thibault Leclercq, Gauthier Duloquin, Thibaut Pommier, Karim Benali, Pierre-Olivier Comby, Romaric Loffroy, Marco Midulla, Frédéric Ricolfi, Yannick Béjot, and Charles Guenancia
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Original Research Articles ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Atrial fibrillation (AF) is one of the most common causes of ischemic stroke. It is essential to target patients at highest risk of AF detected after stroke (AFDAS), who should benefit from a prolonged rhythm screening strategy. Cardiac-CT angiography (CCTA) was added to the stroke protocol used in our institution in 2018. We sought to assess, for AFDAS, the predictive value of atrial cardiopathy markers by a CCTA performed on admission for acute ischemic stroke. Patients and Methods: From November 2018 to October 2019, consecutive stroke patients with no history of AF were included. Let atrial volume (LAV), epicardial adipose tissue (EAT) attenuation and volume, and LAA characteristics were measured on CCTA. The primary endpoint was the presence of AFDAS at follow-up, diagnosed by continuous electrocardiographic monitoring, long-term external Holter monitoring during hospital stay, or implantable cardiac monitor (ICM). Results: Sixty of the 247 included patients developed AFDAS. Multivariable analysis shows independent predictors of AFDAS: age >80 years (HR 2.46; 95%CI (1.23–4.92), p = 0.011), indexed LAV >45 mL/m2 (HR 2.58; 95%CI (1.19–5.62), p = 0.017), EAT attenuation > −85HU (HR 2.16; 95%CI (1.13–4.15), p = 0.021) and LAA thrombus (HR 2.50; 95%CI (1.06–5.93), p = 0.037). Added consecutively to AFDAS prediction AS5F score (combining age and NIHSS >5), these markers had an incrementally better predictive value compared with the global Chi2 of the initial model ( p = 0.001, 0.035, and 0.015 respectively). Discussion and conclusion: Adding CCTA to the acute stroke protocol to assess markers of atrial cardiopathy associated with AFDAS may help to better stratify the AF screening strategy, including the use of an ICM.
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- 2022
34. How to use pace mapping for ventricular tachycardia ablation in postinfarct patients
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Charles Guenancia, Gregory Supple, Jean‐Marc Sellal, Isabelle Magnin‐Poull, Karim Benali, Nefissa Hammache, Mathieu Echivard, Francis Marchlinski, and Christian de Chillou
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Electrocardiography ,Heart Rate ,Physiology (medical) ,Catheter Ablation ,Tachycardia, Ventricular ,Humans ,Cardiology and Cardiovascular Medicine ,Endocardium - Abstract
We aim to describe the technical aspects of pace mapping (PM), as well as the two typical patterns of pacing correlation maps during ventricular tachycardia (VT) ablation. The first main pattern is focal, with a gradual and eccentric decrease of the QRS correlation from the area with the best PM correlation. This focal pattern may be associated with two clinical situations: (1) with some endocardial points showing a good correlation compared to VT morphology: true endocardial exit of VT or endocardial breakthrough of either an intramural or an epicardial circuit; (2) without any endocardial points showing a good correlation compared to VT morphology: the VT may originate from the other ventricle, but the presence of an intramural or an epicardial circuit should be considered in patients with a structural heart disease. The second pattern is the presence of PM points exhibiting a good correlation close to other PM points showing a poor correlation compared to VT morphology: this abrupt change in paced QRS morphology over a short distance indicates divergence of activation wavefronts between these sites and suggests the presence of a slow conduction channel: the VT isthmus.
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- 2022
35. Machine Learning–Based Phenogrouping in Mitral Valve Prolapse Identifies Profiles Associated With Myocardial Fibrosis and Cardiovascular Events
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Olivier Huttin, Nicolas Girerd, Antoine Jobbe-Duval, Anne-Laure Constant Dit Beaufils, Thomas Senage, Laura Filippetti, Caroline Cueff, Kevin Duarte, Antoine Fraix, Nicolas Piriou, Damien Mandry, Nathalie Pace, Solena Le Scouarnec, Romain Capoulade, Matthieu Echivard, Jean Marc Sellal, Marie Marrec, Marine Beaumont, Gabriella Hossu, Jean-Noel Trochu, Nicolas Sadoul, Pierre-Yves Marie, Charles Guenancia, Jean-Jacques Schott, Jean-Christian Roussel, Jean-Michel Serfaty, Christine Selton-Suty, Thierry Le Tourneau, Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre d'investigation clinique (CIC) de Nantes -CIC Plurithématique (CIC 0004 - Nantes), Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - équipe Thorax - CHU Nantes (CIC - thorax), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Fondation Cœur et Recherche (TLT, 2013, Paris, France), French Ministry of Health 'PHRC-I 2012' (TLT, API12/N/019, Paris, France). T Le Tourneau was supported by an INSERM Translational Research Grant (2012-2016, Paris, France). The STAMP study (OH, CSS) was supported by a grant from the French Ministry of Health (APJ 2015, n°: 2016-A00954-47). Pr Girerd is supported by the French National Research Agency Fighting Heart Failure (ANR-15-RHU-0004), by the French PIA project Lorraine Université d’Excellence GEENAGE (ANR-15-IDEX-04-LUE) programs, and the Contrat de Plan Etat Région Lorraine and FEDER IT2MP, ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-IDEX-0004,LUE,Isite LUE(2015), and European Project
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[SDV]Life Sciences [q-bio] ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
International audience; Background: Structural changes and myocardial fibrosis quantification by cardiac imaging have become increasingly important to predict cardiovascular events in patients with mitral valve prolapse (MVP). In this setting, it is likely that an unsupervised approach using machine learning may improve their risk assessment.Objectives: This study used machine learning to improve the risk assessment of patients with MVP by identifying echocardiographic phenotypes and their respective association with myocardial fibrosis and prognosis.Methods: Clusters were constructed using echocardiographic variables in a bicentric cohort of patients with MVP (n = 429 patients, 54 ± 15 years) and subsequently investigated for their association with myocardial fibrosis (assessed by cardiac magnetic resonance) and cardiovascular outcomes.Results: Mitral regurgitation (MR) was severe in 195 (45%) patients. Four clusters were identified: cluster 1 comprised no remodeling with mainly mild MR, cluster 2 was a transitional cluster, cluster 3 included significant left ventricular (LV) and left atrial (LA) remodeling with severe MR, and cluster 4 included remodeling with a drop in LV systolic strain. Clusters 3 and 4 featured more myocardial fibrosis than clusters 1 and 2 (P < 0.0001) and were associated with higher rates of cardiovascular events. Cluster analysis significantly improved diagnostic accuracy over conventional analysis. The decision tree identified the severity of MR along with LV systolic strain 42 mL/m2 as the 3 most relevant variables to correctly classify participants into 1 of the echocardiographic profiles.Conclusions: Clustering enabled the identification of 4 clusters with distinct echocardiographic LV and LA remodeling profiles associated with myocardial fibrosis and clinical outcomes. Our findings suggest that a simple algorithm based on only 3 key variables (severity of MR, LV systolic strain, and indexed LA volume) may help risk stratification and decision making in patients with MVP. (Genetic and Phenotypic Characteristics of Mitral Valve Prolapse; NCT03884426 and Myocardial Characterization of Arrhythmogenic Mitral Valve Prolapse [MVP STAMP]; NCT02879825).
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- 2023
36. Cardiovascular outcomes after cardiac resynchronization therapy in cardiac amyloidosis
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Jean-Baptiste Guichard, Kilian Fischer, Nicolas Lellouche, Hervé Devilliers, Rodrigue Garcia, Raphaël P. Martins, Arnaud Bisson, Guillaume Serzian, Madeline Espinosa, Nicolas Clementy, Olivier Huttin, François Jourda, Thibaud Damy, François Lesaffre, Charles Guenancia, Bruno Degand, Jean-Christophe Eicher, and Gabriel Laurent
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medicine.medical_specialty ,genetic structures ,medicine.medical_treatment ,Population ,Cardiac resynchronization therapy ,Heart failure ,Cardiac amyloidosis ,Ventricular Function, Left ,Internal medicine ,Implantable cardioverter defibrillator ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,Ejection fraction ,business.industry ,Hazard ratio ,Dilated cardiomyopathy ,Stroke Volume ,Original Articles ,Amyloidosis ,medicine.disease ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,Pacemaker ,Treatment Outcome ,RC666-701 ,Cardiology ,cardiovascular system ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,therapeutics ,circulatory and respiratory physiology - Abstract
Aims Cardiac resynchronization therapy (CRT) is highly effective in dilated cardiomyopathy (DCM) patients with impaired left ventricular ejection fraction (LVEF) and left bundle block branch. In cardiac amyloidosis (CA) patients, left ventricular dysfunction and conduction defects are common, but the potential of CRT to improve cardiac remodelling and survival in this particular setting remains undefined. We investigated cardiovascular outcomes in CA patients after CRT implantation in terms of CRT echocardiographic response and major cardiovascular events (MACEs). Methods and results Our retrospective study included 47 CA patients implanted with CRT devices from January 2012 to February 2020, in nine French university hospitals (77 ± 6 years old, baseline LVEF 30 ± 8%) compared with propensity‐matched (1:1 for age, LVEF at implantation, and CRT indication) DCM patients with a CRT device. CA patients had lower rates of CRT response (absolute delta LVEF ≥ 10%) compared with DCM patients (36% vs. 70%, P = 0.002). After multivariate Cox analysis, CA was independently associated with MACE (hospitalization for heart failure/cardiovascular death) [hazard ratio (HR) 3.73, 95% confidence interval (CI) 1.85–7.54, P
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- 2022
37. Does size matter? Focus on the impact of reducing litter size in mice on cardio-metabolic risk and cardiac sensitivity to in vivo ischemia in adulthood
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Eve Rigal, Marie Josse, Geoffrey Dogon, Luc Rochette, Charles Guenancia, and Catherine Vergely-Vandriesse
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Cardiology and Cardiovascular Medicine - Published
- 2023
38. Prevalence and Determinants of PVCs Originating From the Mitral Apparatus in Patients With MVP
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Charles Guenancia, Nathalie Pace, Gabriela Hossu, Christine Selton-Suty, Damien Mandry, Marine Beaumont, Thierry Le Tourneau, Christian de Chillou, Jean-Marc Sellal, and Olivier Huttin
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Prevalence ,Humans ,Mitral Valve Insufficiency ,Ventricular Premature Complexes - Published
- 2022
39. Nationwide initiation of cardiovascular risk treatments during the COVID-19 pandemic in France: Women on a slippery slope?
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Amélie Gabet, Clémence Grave, Philippe Tuppin, Thomas Lesuffleur, Charles Guenancia, Viêt Nguyen-Thanh, Romain Guignard, Jacques Blacher, and Valérie Olié
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Cardiology and Cardiovascular Medicine - Abstract
ObjectivesThis study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population.MethodsFor each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017–2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists.ResultsIn 2020, IRR significantly decreased for initiations of antihypertensives (−11.1%[CI95%, −11.4%;−10.8%]), lipid-lowering drugs (−5.2%[CI95%, −5.5%;−4.8%]), oral anticoagulants in atrial fibrillation (−8.6%[CI95%, −9.1%;−8.0%]), and smoking cessation medications (−50.9%[CI95%, −51.1%;−50.7%]) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women.ConclusionThe COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.
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- 2023
40. Safety and efficacy of left atrial appendage occlusion with the <scp>ACP</scp> or Watchman device guided by intracardiac echocardiography from the left atrium
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Audrey Sagnard, Thibaut Pommier, G. Porot, Marie Fichot, Clemence Salignon-Vernay, Charles Guenancia, Luc Lorgis, Carole Richard, and Gabriel Laurent
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Cardiac Catheterization ,medicine.medical_specialty ,Intracardiac echocardiography ,medicine.medical_treatment ,Clinical Investigations ,Left atrium ,Left atrial appendage occlusion ,percutaneous occlusion ,Cohort Studies ,Atrial Fibrillation ,medicine ,Humans ,Atrial Appendage ,Local anesthesia ,Thrombus ,Ultrasonography, Interventional ,business.industry ,ICE ,Amplatzer cardiac plug ,General Medicine ,medicine.disease ,Surgery ,Catheter ,Treatment Outcome ,medicine.anatomical_structure ,Embolism ,left appendage ,local anesthesia ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Echocardiography, Transesophageal - Abstract
Background There is a paucity of randomized data regarding the safety and efficacy of the use of intracardiac echocardiography (ICE) from the left atrium (LA) to guide left atrial appendage occlusion (LAAO) procedures under local anesthesia using either of the available devices. Hypothesis The aim of this study was to compare the efficacy and safety of ICE from the LA with transesophageal echocardiography (TEE) for guidance during transcatheter LAAO procedures. Methods Single‐center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Watchman device. Procedures were guided by ICE from the LA with local anesthesia (n = 175) or TEE under general anesthesia (n = 49). Efficacy outcomes were procedural success and peri‐device leaks 6 weeks after LAAO. The safety outcome was a composite of procedure‐related complications. Results Procedural success was similar between groups: 100% in the TEE‐guided group, and 98% in the ICE‐guided group. Procedure‐related complications such as death, embolism, migration, or major vascular complications occurred similarly between groups (p = 0.590). The rate and degree of peri‐device leaks or presence of a thrombus on the device did not differ between groups on follow‐up CT. Turnover time in the catheter laboratory and use of contrast agent were reduced with ICE. Conclusions ICE in the left atrium to guide LAAO procedures appears to be as effective and safe as TEE. There was no increase in procedure‐related complications, whatever the device used. ICE resulted in similar procedural success while decreasing procedure time and requiring only local anesthesia.
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- 2021
41. Mechanism of ventricular tachycardia in a patient with double‐outlet left ventricle
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Christian de Chillou, Charles Guenancia, Karim Benali, and Nefissa Hammache
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Surgical repair ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Ventricular tachycardia ,medicine.disease ,Ablation ,medicine.anatomical_structure ,Ventricle ,Physiology (medical) ,Internal medicine ,Double outlet left ventricle ,cardiovascular system ,Cardiology ,medicine ,Tricuspid annulus ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Pace mapping - Abstract
We report the case of ventricular tachycardia (VT) ablation procedure in a patient with history of surgically repaired double-outlet left ventricle. The electrophysiology procedure revealed a re-entry pattern between the right-ventricle to main-pulmonary-artery conduit and the tricuspid annulus. The re-entrant mechanism was most likely promoted by a fibrous remodeling of this area, related to the surgical repair. This case is the first to describe a re-entry mechanism between fixed anatomical barriers in a repaired right ventricle of a double-outlet left ventricle. A pace mapping technique was used to highlight the VT isthmus.
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- 2021
42. Letter by Benali et al Regarding Article, 'Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial'
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Karim Benali, Charles Guenancia, Raphaël P. Martins, Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), and CHU Pontchaillou [Rennes]
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Physiology (medical) ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine - Abstract
International audience
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- 2022
43. MP-453092-9 PROGNOSTIC SIGNIFICANCE OF SUSTAINED VENTRICULAR ARRHYTHMIAS OCCURRING UNDER WEARABLE CARDIOVERTER DEFIBRILLATOR PROTECTION IN POST-INFARCT PATIENTS WITH A LEFT VENTRICULAR DYSFUNCTION
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Mathieu ECHIVARD, Jean-Marc Sellal, Chloé Ziliox, Eloi Marijon, Pierre BORDACHAR, christelle marquie, Clemence Docq, Romain Eschalier, Baptiste Maille, JEAN-CLAUDE DEHARO, Dominique Babuty, estelle gandjbakhch, Antoine Da Costa, Olivier Piot, Damien Minois, JEAN BAPTISTE GOURRAUD, PIERRE MONDOLY, Philippe Maury, SERGE BOVEDA, Jean-Luc Pasquie, Raphael Martins, Christophe Leclercq, Charles Guenancia, Gabriel LAURENT, Mathieu Becker, JULIEN BERTRAND, Philippe Chevalier, Vladimir Manenti, MACIEJ KUBALA, PASCAL DEFAYE, Peggy Jacon, Antoine Desbiolles, Marc Badoz, Laurence Jesel, Nicolas Lellouche, Paul Milliez, Paul Ollitrault, Samir Fareh, Matthieu Bercker, Jacques Mansourati, Benoit Guy Moyat, Nicolas Luconi, Jean-Pierre Chabert, null pierre winum, Frederic Anselme, Antoine Leenhardt, Fabrice Extramiana, Camille Delahaye, François Jourda, Olivier Bizeau, Mathieu Nasarre, ARNAUD OLIVIER, Stéphane Fromentin, THIBAULT VILLEMIN, Olivier Levavasseur, Néfissa Hammache, Isabelle Magnin, Hugues Blangy, Nicolas Sadoul, Kévin Duarte, Nicolas Girerd, and Christian de Chillou
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
44. Risk Prediction Models for Cardiotoxicity of Chemotherapy Among Patients With Breast Cancer
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Elisé G. Kaboré, Conor Macdonald, Ahmed Kaboré, Romain Didier, Patrick Arveux, Nicolas Meda, Marie-Christine Boutron-Ruault, and Charles Guenancia
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General Medicine - Abstract
ImportanceCardiotoxicity is a serious adverse effect that can occur in women undergoing treatment for breast cancer. Identifying patients who will develop cardiotoxicity remains challenging.ObjectiveTo identify, describe, and evaluate all prognostic models developed to predict cardiotoxicity following treatment in women with breast cancer.Evidence ReviewThis systematic review searched the Medline, Embase, and Cochrane databases up to September 22, 2021, to include studies developing or validating a prediction model for cardiotoxicity in women with breast cancer. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess both the risk of bias and the applicability of the prediction modeling studies. Transparency reporting was assessed with the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) tool.FindingsAfter screening 590 publications, we identified 7 prognostic model studies for this review. Six were model development studies and 1 was an external validation study. Outcomes included occurrence of cardiac dysfunction (echocardiographic parameters), heart failure, and composite clinical outcomes. Model discrimination, measured by the area under receiver operating curves or C statistic, ranged from 0.70 (95% IC, 0.62-0.77) to 0.87 (95% IC, 0.77-0.96). The most common predictors identified in final prediction models included age, baseline left ventricular ejection fraction, hypertension, and diabetes. Four of the developed models were deemed to be at high risk of bias due to analysis concerns, particularly for sample size, handling of missing data, and not presenting appropriate performance statistics. None of the included studies examined the clinical utility of the developed model. All studies met more than 80% of the items in TRIPOD checklist.Conclusions and RelevanceIn this systematic review of the 6 predictive models identified, only 1 had undergone external validation. Most of the studies were assessed as being at high overall risk of bias. Application of the reporting guidelines may help future research and improve the reproducibility and applicability of prediction models for cardiotoxicity following breast cancer treatment.
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- 2023
45. Multimodal approach for the prediction of atrial fibrillation detected after stroke: SAFAS study
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Lucie Garnier, Gauthier Duloquin, Alexandre Meloux, Karim Benali, Audrey Sagnard, Mathilde Graber, Geoffrey Dogon, Romain Didier, Thibaut Pommier, Catherine Vergely, Yannick Béjot, and Charles Guenancia
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Cardiology and Cardiovascular Medicine - Abstract
BackgroundIntensive screening for atrial fibrillation (AF) has led to a better recognition of this cause in stroke patients. However, it is currently debated whether AF Detected After Stroke (AFDAS) has the same pathophysiology and embolic risk as prior-to-stroke AF. We thus aimed to systematically approach AFDAS using a multimodal approach combining clinical, imaging, biological and electrocardiographic markers.MethodsPatients without previously known AF admitted to the Dijon University Hospital (France) stroke unit for acute ischemic stroke were prospectively enrolled. The primary endpoint was the presence of AFDAS at 6 months, diagnosed through admission ECG, continuous electrocardiographic monitoring, long-term external Holter during the hospital stay, or implantable cardiac monitor if clinically indicated after discharge.ResultsOf the 240 included patients, 77 (32%) developed AFDAS. Compared with sinus rhythm patients, those developing AFDAS were older, more often women and less often active smokers. AFDAS patients had higher blood levels of NT-proBNP, osteoprotegerin, galectin-3, GDF-15 and ST2, as well as increased left atrial indexed volume and lower left ventricular ejection fraction. After multivariable analysis, galectin-3 ≧ 9 ng/ml [OR 3.10; 95% CI (1.03–9.254), p = 0.042], NT-proBNP ≧ 290 pg/ml [OR 3.950; 95% CI (1.754–8.892, p = 0.001], OPG ≥ 887 pg/ml [OR 2.338; 95% CI (1.015–5.620), p = 0.046) and LAVI ≥ 33.5 ml/m2 [OR 2.982; 95% CI (1.342–6.625), p = 0.007] were independently associated with AFDAS.ConclusionA multimodal approach combining imaging, electrocardiography and original biological markers resulted in good predictive models for AFDAS. These results also suggest that AFDAS is probably related to an underlying atrial cardiopathy.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03570060].
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- 2023
46. High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol
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Pierre-Olivier Comby, Gauthier Duloquin, Angélique Bernard, Charles Guenancia, Thibault Leclercq, Frédéric Ricolfi, and Yannick Béjot
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medicine.medical_specialty ,Computed tomography ,Brain Ischemia ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Thrombus ,Stroke ,Cardiac imaging ,Retrospective Studies ,Acute stroke ,High rate ,medicine.diagnostic_test ,business.industry ,Thrombosis ,Atrial fibrillation ,medicine.disease ,Neurology ,Cardiac thrombus ,Cardiology ,Female ,Tomography, X-Ray Computed ,business ,Echocardiography, Transesophageal - Abstract
Background Detection of left atrial appendage thrombus (LAAt) in acute stroke patients can be improved by cardiac computed tomography using prospective electrocardiogram-gated volume acquisition, which was added to the acute stroke computed tomography protocol in our institution in 2018. Aims To evaluate the factors and clinical management associated with LAAt in patients with acute ischemic stroke. Methods We retrospectively included 324 consecutive patients with ischemic stroke from November 2018 to October 2019. Clinical data and post-stroke management were compared in LAAt and no-LAAt patients. Results Thirty-five patients (10.8%; 95%CI 7.4–14.2) had LAAt and 289 had no-LAAt. LAAt patients were significantly older (82 ± 12 vs. 74 ± 14 yo for no-LAAt, p = 0.002), predominantly female (71% vs. 45%, p = 0.004), and were more likely to have previous atrial fibrillation (63% vs. 15%, p 86 ml (odds ratio 5.33; 95%CI 1.70–16.69, p = 0.004) were independently associated with LAAt. More than a third of LAAt patients (37%) received acute heparin therapy compared to 13% of no-LAAt patients (p Conclusions Cardiac computed tomography for left atrial appendage thrombus evaluation in routine acute stroke imaging protocol could be beneficial for decision-making with regard to the initiation of early anticoagulation.
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- 2020
47. Long-Term Follow-Up of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator
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Victor Waldmann, Abdeslam Bouzeman, Guillaume Duthoit, Linda Koutbi, Francis Bessiere, Fabien Labombarda, Christelle Marquié, Jean Baptiste Gourraud, Pierre Mondoly, Jean Marc Sellal, Pierre Bordachar, Alexis Hermida, Frédéric Anselme, Anouk Asselin, Caroline Audinet, Yvette Bernard, Serge Boveda, Paul Bru, Sok Sithikun Bun, Gael Clerici, Antoine Da Costa, Maxime de Guillebon, Pascal Defaye, Nathalie Elbaz, Romain Eschalier, Rodrigue Garcia, Charles Guenancia, Benoit Guy-Moyat, Franck Halimi, Didier Irles, Laurence Iserin, François Jourda, Magalie Ladouceur, Philippe Lagrange, Mikael Laredo, Jacques Mansourati, Grégoire Massoulié, Amel Mathiron, Philippe Maury, Anne Messali, Kumar Narayanan, Cédric Nguyen, Sandro Ninni, Marie-Cécile Perier, Bertrand Pierre, Penelope Pujadas, Frédéric Sacher, Pascal Sagnol, Ardalan Sharifzadehgan, Camille Walton, Pierre Winum, Cyril Zakine, Laurent Fauchier, Raphael Martins, Jean Luc Pasquié, Jean Benoit Thambo, Xavier Jouven, Nicolas Combes, Eloi Marijon, Fabien Squara, Guillaume Theodore, Didier Scarlatti, Jérome Hourdain, Jean-Claude Deharo, Pierre Ollitrault, Paul Milliez, Laure Champ-Rigot, Hugues Bader, Cécile Duplantier, Antoine Milhem, Audrey Sagnard, Géraldine Bertaux, Gabriel Laurent, Marc Badoz, Agustin Bortone, Guillaume Laborie, Anne Rollin, Quentin Voglimacci Stephanopoli, Franck Mandel, Alexandre Duparc, Guillaume Domain, Jean-Paul Albenque, Christèle Cardin, Stéphane Combes, Nikita Tanese, Karim Hasni, Christophe Leclercq, Vincent Galand, Dominique Pavin, Philippe Mabo, Nathalie Behar, Nicolas Clementy, Christophe Loose, Akli Otmani, Sandrine Venier, Adrien Carabelli, Peggy Jacon, Mouna Ben Kilani, Jean Bapstist Guichard, Cécile Romeyer-Bouchard, Laurianne Le Gloan, Vincent Probst, Luc Freysz, Hugues Blangy, Christian De Chillou, Nicolas Sadoul, Pierre Khattar, Charlotte Potelle, Frederic Jean, Paul Puie, Ziad Khoueiry, Philippe Chevallier, Arnaud Dulac, Sylvie Di Filippo, Kevin Gardey, Pierre Frey, Chrystelle Akret, Antoine Dompnier, Carole Maupain, Xavier Waintraub, Françoise Hidden-Lucet, Thomas Chastre, Estelle Gandjbakhch, Nicolas Badenco, Fabrice Extramiana, Antoine Leenhardt, Amir Zouaghi, Vincent Algalarrondo, Denis Amet, Emilie Varlet, Tej Chalbia, Séverine Philibert, Jacky Ollitrault, Thomas Lavergne, Pierre Baudinaud, Adrian Mirolo, Arnaud Savouré, Bénédicte Godin, Cathy Bertrand, Pierre Fiorello, Nicolas Johnson, Pierre-Marc Lallemand, Alexis Herminda, Jean-Sylvain Hermida, Bruno Degand, Rim El Bouazzaou, Stéphane Mourot, Samuel Goussot, Gaël Jauvert, Arnaud Lazarus, Caroline Grimard, Christine Alonso, Alexandre Zhao, Olivier Thomas, Bruno Cauchemez, Ghassan Moubarak, Nicolas Lellouche, David Hamon, Bogdan Enache, Gabriel Lactu, Françoise Wiart, Olivier Geoffroy, Damien Poindron, Alice Maltret, Cristine Raimondo, Damien Bonnet, Sébastien Hascoët, Nicolas Derval, Michel Haïssaguerre, Mélèze Hocini, and Clinical sciences
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Adult ,Male ,medicine.medical_specialty ,Long term follow up ,Cyanotic congenital heart disease ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Sudden death ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Defibrillators, Implantable/trends ,Registries ,030212 general & internal medicine ,Tetralogy of Fallot ,business.industry ,medicine.disease ,Implantable cardioverter-defibrillator ,Tetralogy of Fallot/epidemiology ,Defibrillators, Implantable ,3. Good health ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce. Methods: A Nationwide French Registry including all patients with tetralogy of Fallot with an ICD was initiated in 2010 by the French Institute of Health and Medical Research. The primary time to event end point was the time from ICD implantation to first appropriate ICD therapy. Secondary outcomes included ICD-related complications, heart transplantation, and death. Clinical events were centrally adjudicated by a blinded committee. Results: A total of 165 patients (mean age, 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (interquartile range) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least 1 appropriate ICD therapy. The annual incidence of the primary outcome was 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively; P =0.03). Overall, 71 (43.0%) patients presented with at least 1 ICD complication, including inappropriate shocks in 42 (25.5%) patients and lead dysfunction in 36 (21.8%) patients. Among 61 (37.0%) patients in primary prevention, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with, respectively, 0, 1, 2, or ≥3 guidelines-recommended risk factors. QRS fragmentation was the only independent predictor of appropriate ICD therapies (hazard ratio, 3.47 [95% CI, 1.19–10.11]), and its integration in a model with current criteria increased the 5-year time-dependent area under the curve from 0.68 to 0.81 ( P =0.006). Patients with congestive heart failure or reduced left ventricular ejection fraction had a higher risk of nonarrhythmic death or heart transplantation (hazard ratio, 11.01 [95% CI, 2.96–40.95]). Conclusions: Patients with tetralogy of Fallot and an ICD experience high rates of appropriate therapies, including those implanted in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria including QRS fragmentation might improve risk stratification. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03837574.
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- 2020
48. Vascular density with optical coherence tomography angiography and systemic biomarkers in low and high cardiovascular risk patients
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Florence Bichat, Marc-Antoine Hannappe, Catherine Vergely, Alexandre Meloux, Christine Binquet, Louis Arnould, Charles Guenancia, Yves Cottin, B. Mouhat, Catherine Creuzot-Garcher, Marianne Zeller, Julien, Sabine, Nature Publishing Group, Service d'Ophtalmologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon] (PEC2), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Cardiologie [CHU de Dijon], Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), and Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Male ,lcsh:Medicine ,030204 cardiovascular system & hematology ,law.invention ,chemistry.chemical_compound ,0302 clinical medicine ,law ,Risk Factors ,Macula Lutea ,lcsh:Science ,Multidisciplinary ,Angiography ,Middle Aged ,Intensive care unit ,3. Good health ,medicine.anatomical_structure ,[SDV.MHEP.OS] Life Sciences [q-bio]/Human health and pathology/Sensory Organs ,Cardiology ,Female ,Anatomy ,Tomography, Optical Coherence ,medicine.medical_specialty ,Acute coronary syndrome ,Growth Differentiation Factor 15 ,Article ,Angiopoietin-2 ,Transforming Growth Factor beta1 ,03 medical and health sciences ,Osteoprotegerin ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,medicine ,Humans ,Acute Coronary Syndrome ,[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs ,Aged ,Retina ,business.industry ,Length density ,lcsh:R ,Retinal Vessels ,Retinal ,Optical coherence tomography angiography ,medicine.disease ,Interleukin-1 Receptor-Like 1 Protein ,chemistry ,030221 ophthalmology & optometry ,lcsh:Q ,sense organs ,business ,Biomarkers ,Blood sampling - Abstract
International audience; We aimed to compare retinal vascular density in optical coherence tomography Angiography (oct-A) between patients hospitalized for acute coronary syndrome (AcS) and control patients and to investigate correlation with angiogenesis biomarkers. patients hospitalized for an acute coronary syndrome (AcS) in the intensive care Unit were included in the "high cardiovascular risk" group while patients without cardiovascular risk presenting in the ophthalmology department were included as "control". Both groups had blood sampling and OCT-A imaging. Retina microvascularization density in the superficial capillary plexus was measured on 3 × 3 mm angiograms centered on the macula. Angiopoietin-2, TGF-β1, osteoprotegerin, GDF-15 and ST-2 were explored with ELISA or multiplex method. Overall, 62 eyes of ACS patients and 42 eyes of controls were included. ACS patients had significantly lower inner vessel length density than control patients (p = 0.004). A ROC curve found that an inner vessel length density threshold below 20.05 mm −1 was moderately associated with AcS. Significant correlation was found between serum levels of angiopoietin-2 and osteoprotegerin, and retinal microvascularization in OCT-A (R = − 0.293, p = 0.003; R = − 0.310, p = 0.001). Lower inner vessel length density measured with oct-A was associated with AcS event and was also correlated with higher concentrations of angiopoietin-2 and osteoprotegerin. In spite of the improvements in diagnosis and treatment of cardiovascular diseases (CVD), aging of population and urbanization make CVD one of the world's major disease burdens 1,2. Indeed, CVD remain a main cause of premature deaths and disability worldwide, with an estimated 16.7 million deaths in 2010, and projections show an overwhelming 23.3 million by 2030 3. Cardiovascular risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus lead to systemic inflammation, vascular and cardiac oxidative stress, which contribute to coronary dysfunction and microvascular impairment 4. Thus, coronary macro and microvascular alterations are closely associated and together contribute to the pathophysiology of myocardial ischemia 5. The assessment of myocardial microvascularization is then of major interest in order to estimate the risk of acute coronary events; however, only invasive procedures, using intra vascular contrast agents, are currently available 6 .
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- 2020
49. EASI™ 12‑lead ECG with a handheld computer refines cardiovascular diagnosis in general practice
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Anne-Gaëlle Pollet, Charles Guenancia, Rodrigue Garcia, Guillaume Viart, Daphnée Dubois, Marc-antoine Bourgois, François Chapelet, Thibault Loyez, Benoit Dautriche, Yves Guyomar, Pierre Graux, Sylvestre Maréchaux, and Aymeric Menet
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Electrocardiography ,Heart Diseases ,Computers, Handheld ,Humans ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Family Practice - Abstract
Electrocardiogram (ECG) is used to a small extent in general medicine, because of general practitioner (GP) apprehension about interpretation and time consumption.This study tested the hypothesis that user-friendly EASI ECG improves GP diagnosis of cardiovascular symptoms.Patients over 18 years with recent cardiovascular symptoms or auscultation rhythm abnormalities were included in this prospective, multicentric study (10 practices, 17 GPs). ECG recordings were made with Cardiosecur® (4‑lead ECG connected to a handheld computer for EASI™ processing). Besides clinical data, diagnosis/patient referral were noted before and after ECG and interpretation. GP diagnosis and ECG interpretation were compared with a reference diagnosis made by ECG specialist.There were 338 patients; 66% had cardiovascular risk factors. ECGs were performed for chest pain (41%), auscultation rhythm abnormalities (33%) or palpitations (19%). Average time to perform ECG was 4.7 ± 2.1 min, with possible home recordings. Compared with standard ECG, improvement provided by Cardiosecur® was scored 9/10 (range 7-10) by GPs. GPs correctly interpreted ECG normality/abnormality in 77% of patients. Diagnosis was correctly changed for 14% of patients thanks to the ECG, and wrongly changed for 2%. One new appropriate final diagnosis was achieved for 9 ECG recordings (p 0.001). Diagnostic certainty increased 1.9 ± 2.1/10 (p 0.001). ECG brought about changes in GP decision making: referral or treatment changed for 82 patients (24%) and complementary test for 69 patients (20%).The EASI™ algorithm coupled with a handheld computer facilitates ECG recordings in the primary care setting, providing improved diagnosis.
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- 2022
50. Sex Differences in Outcomes of Tetralogy of Fallot Patients With Implantable Cardioverter-Defibrillators
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Victor Waldmann, Abdeslam Bouzeman, Guillaume Duthoit, Linda Koutbi, Francis Bessière, Fabien Labombarda, Christelle Marquié, Jean-Baptiste Gourraud, Pierre Mondoly, Jean Marc Sellal, Pierre Bordachar, Alexis Hermida, Alain Al Arnaout, Frédéric Anselme, Caroline Audinet, Yvette Bernard, Serge Boveda, Sok Sithikun Bun, Morgane Chassignolle, Gaël Clerici, Antoine Da Costa, Maxime de Guillebon, Pascal Defaye, Nathalie Elbaz, Romain Eschalier, Rodrigue Garcia, Charles Guenancia, Benoit Guy-Moyat, Franck Halimi, Didier Irles, Laurence Iserin, François Jourda, Magalie Ladouceur, Philippe Lagrange, Mikael Laredo, Jacques Mansourati, Grégoire Massoulié, Amel Mathiron, Philippe Maury, Anne Messali, Kumar Narayanan, Cédric Nguyen, Sandro Ninni, Marie-Cécile Perier, Bertrand Pierre, Penelope Pujadas, Frédéric Sacher, Pascal Sagnol, Ardalan Sharifzadehgan, Camille Walton, Pierre Winum, Cyril Zakine, Laurent Fauchier, Raphaël Martins, Jean-Luc Pasquié, Jean-Benoit Thambo, Xavier Jouven, Nicolas Combes, Eloi Marijon, Chrystelle Akret, Jean-Paul Albenque, Vincent Algalarrondo, Christine Alonso, Denis Amet, Frédéric Ansselme, Anouk Asselin, Nicolas Badenco, Hugues Bader, Marc Badoz, Pierre Baudinaud, Nathalie Behar, Mouna Ben Kilani, Géraldine Bertaux, Cathy Bertrand, Francis Bessiere, Hughes Blangy, Damien Bonnet, Pierre Bordchar, Paul Bru, Adrien Carabelli, Christèle Cardin, Bruno Cauchemez, Tej Chalbia, Laure Champ-Rigot, Thomas Chastre, Philippe Chevallier, Nicolas Clementy, Stéphane Combes, Christian De Chillou, Maxime De Guillebon, Bruno Degand, Jean-Claude Deharo, Nicolas Derval, Sylvie Di Filippo, Guillaume Domain, Antoine Dompnier, Arnaud Dulac, Alexandre Duparc, D Cécile Duplantier, Rim El Bouazzaoui, Bogdan Enache, Fabrice Extramiana, Pierre Fiorello, Pierre Frey, Luc Freysz, Vincent Galand, Estelle Gandjbakhch, Kevin Gardey, Olivier Geoffroy, Bénédicte Godin, Samuel Goussot, Caroline Grimard, Jean-Baptiste Guichard, Michel Haissaguerre, David Hamon, Sébastien Hascoet, Karim Hasni, Jean-Sylvain Hermida, Françoise Hidden-Lucet, Mélèze Hocini, Jérome Hourdain, Peggy Jacon, Gaël Jauvert, Frédéric Jean, Nicolas Johnson, Pierre Khattar, Ziad Khoueiry, Rita Koutbi, Guillaume Laborie, Gabriel Lactu, Pierre-Marc Lallemand, Gabriel Laurent, Thomas Lavergne, Arnaud Lazarus, Laurianne Le Gloan, Christophe Leclercq, Antoine Leenhardt, Nicolas Lellouche, Christophe Loose, Philippe Mabo, Alice Maltret, Franck Mandel, Christelle Marquie, Carole Maupain, Antoine Milhelm, Paul Milliez, Adrian Mirolo, Ghassan Moubarak, Stéphane Mourot, Jacky Ollitrault, Pierre Ollitrault, Akli Otmani, Jean-Luc Pasquie, Dominique Pavin, Séverinne Philibert, Damien Poindron, Charlotte Potelle, Vincent Probst, Paul Puie, Anne Rollin, Cécile Romeyer-Bouchard, Nicolas Sadoul, Audrey Sagnard, Arnaud Savoure, Didier Scarlatti, Fabien Squara, Nikita Tanese, Jean Benoit Thambo, Olivier Thomas, Emie Varlet, Sandrine Venier, Quentin Voglimacci Stephanopoli, Xavier Waintraub, Françoise Wiart, Alexandre Zhao, Amir Zouaghi, Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Clinique Pasteur, Clinique Pasteur [Toulouse], and This work was supported by the French Institute of Health and Medical Research, Fédération Française de Cardiologie, and Société Française de Cardiologie. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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Male ,Adult ,Heart Defects, Congenital ,Sex Characteristics ,sudden death ,Middle Aged ,congenital heart disease ,Defibrillators, Implantable ,Cohort Studies ,implantable cardioverter-defibrillator ,Death, Sudden, Cardiac ,Tetralogy of Fallot ,sex ,Humans ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Female ,women ,ventricular arrhythmia - Abstract
International audience; Background: Women with congenital heart disease at high risk for sudden cardiac death have been poorly studied thus far.Objectives: The aim of this study was to assess sex-related differences in patients with tetralogy of Fallot (TOF) and implantable cardioverter-defibrillators (ICDs).Methods: Data were analyzed from the DAI-T4F (French National Registry of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator) cohort study, which has prospectively enrolled all patients with TOF with ICDs in France since 2010. Clinical events were centrally adjudicated by a blinded committee.Results: A total of 165 patients (mean age 42.2 ± 13.3 years) were enrolled from 40 centers, including 49 women (29.7%). Among the 9,692 patients with TOF recorded in the national database, the proportion of women with ICDs was estimated to be 1.1% (95% CI: 0.8%-1.5%) vs 2.2% (95% CI: 1.8%-2.6%) in men (P < 0.001). The clinical profiles of patients at implantation, including the number of risk factors for ventricular arrhythmias, were similar between women and men. During a median follow-up period of 6.8 years (IQR: 2.5-11.4 years), 78 patients (47.3%) received at least 1 appropriate ICD therapy, without significant difference in annual incidences between women (12.1%) and men (9.9%) (HR: 1.22; 95% CI: 0.76-1.97; P = 0.40). The risk for overall ICD-related complications was similar in women and men (HR: 1.33; 95% CI: 0.81-2.19; P = 0.30), with 24 women (49.0%) experiencing at least 1 complication.Conclusions: Our findings suggest that women with TOF at high risk for sudden cardiac death have similar benefit/risk balance from ICD therapy compared with men. Whether ICD therapy is equally offered to at-risk women vs men warrants further evaluation in TOF as well as in other congenital heart disease populations. (French National Registry of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator [DAI-T4F]; NCT03837574)
- Published
- 2022
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