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Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown.To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event.This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up.The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed.This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.

International audience; Background: Coronary angiography (CA) is usually performed in patients with reduced left ventricular ejection fraction (LVEF) to search ischemic cardiomyopathy. Our aim was to examine the agreement between CA and cardiovascular magnetic resonance (CMR) imaging among a cohort of patients with unexplained reduced LVEF, and estimate what would have been the consequences of using CMR imaging as the first-line examination.Methods: Three hundred five patients with unexplained reduced LVEF of ≤45% who underwent both CA and CMR imaging were retrospectively registered. Patients were classified as CMR+ or CMR- according to presence or absence of myocardial ischemic scar, and classified CA+ or CA- according to presence or absence of significant coronary artery disease.Results: CMR+ (n = 89) included all 54 CA+ patients, except 2 with distal coronary artery disease in whom no revascularization was proposed. Among the 247 CA- patients, 15% were CMR+. CMR imaging had 96% sensitivity, 85% specificity, 99% negative predictive value, and 58% positive predictive value for detecting CA+ patients. Revascularization was performed in 6.5% of the patients (all CMR+). Performing CA only for CMR+ patients would have decreased the number of CAs by 71%.Conclusions: In reduced LVEF, performing CA only in CMR+ patients may significantly decrease the number of unnecessary CAs performed, without missing any patients requiring revascularization.

Aims: We sought to evaluate the impact of permanent pacemaker (PPM) implantation on two-year mortality and one-year left ventricular ejection fraction recovery (δLVEFR=one-year LVEF-baseline LVEF) after transcatheter aortic valve implantation (TAVI). Methods and results: We pooled patient-level data from four European institutions with significant TAVI volume. Outcomes were compared between patients without PPM (no-PPM), patients with PPM prior to TAVI (old-PPM) and patients with PPM implanted after TAVI (new-PPM). Out of 1,062 patients included in the pooled data set, 783 (73.7%) were in the no-PPM group, 164 (15.4%) in the new-PPM group and 115 (10.8%) in the old-PPM group. All-cause and cardiovascular mortality at two years were similar for patients with no-PPM and new-PPM (adjusted HR 1.11, 95% CI: 0.74-1.67; p=0.62; and adjusted HR 1.16, 95% CI: 0.68-1.98; p=0.59). Conversely, old-PPM was associated with increased risk of both all-cause and cardiovascular mortality vs. no-PPM. By multivariable analysis new-PPM did not affect LVEFR, while oldPPM did. We observed a multiplicative interaction, between new-PPM and post-procedural aortic regurgitation =1+ on two-year mortality and one-year LVEFR, with increased risk of death and impaired LVEFR in patients with new-PPM and post-procedural aortic regurgitation (PPAR) ≥1+ (both pinteraction

Introduction Sur des modeles animaux d’hibernation, lorsque la FEVG est significativement diminuee, on retrouve systematiquement des plages de necrose histologique. Notre hypothese est qu’une zone de necrose est toujours visible sur l’IRM en cas de FEVG ≤ 45 % si l’origine est ischemique. Une etude pilote retrospective semble confirmer cette affirmation, et CAMAREC va tester cette hypothese de facon prospective. Objectif Le PHRC-National CAMAREC a pour objectif d’evaluer la performance diagnostique de l’IRM cardiaque dans la recherche d’une cause ischemique a une dysfonction systolique sans cause evidente. Methode Nous allons inclure 406 patients avec decouverte recente d’une FEVG ≤ 45 % sans cause evidente, pendant 2 ans dans 9 centres francais (1re inclusion datee de mai 2018). Chez tous les patients, une IRM cardiaque puis une coronarographie seront pratiquees, et seront relues par des comites de relecture independants en aveugle. Une premiere etude ancillaire medicoeconomique s’attachera a comparer les couts de 2 strategies : une dans laquelle la coronarographie n’est realisee que si de la necrose est observee a l’IRM, l’autre dans laquelle la coronarographie est pratiquee chez tous les patients. Une seconde etude ancillaire evaluera l’interet du T1-mapping dans cette population. Resultats Le resultat principal est l’evaluation de la sensibilite de l’IRM cardiaque pour predire une coronaropathie expliquant une dysfonction VG systolique recente. L’etude medicoeconomique evaluera les economies d’une strategie dans laquelle la coronarographie n’est pas realisee systematiquement. Conclusions Si la capacite de l’IRM cardiaque a eliminer une cause ischemique en cas de dysfonction systolique se confirme, la nouvelle strategie proposant une coronarographie uniquement en cas de necrose vue sur l’IRM pourra etre proposee en pratique courante.

Objectives We sought to evaluate the impact of mixed aortic stenosis (MAS) on postprocedural aortic regurgitation (PPAR) and clinical outcomes after transcatheter aortic valve implantation (TAVI). Background The impact of MAS of TAVI outcomes is unknown. Methods and Results Data from a multicenter registry were retrospectively analysed. Outcomes were compared between patients with pure aortic stenosis (PAS; associated AR

A 64-year-old man with no significant medical history presented to the emergency department with severe acute heart failure. Initial management was based on oxygen therapy, diuretics, and nitroglycerin. Twenty-four hours after admission, the patient developed aphasia and left arm weakness. Brain MRI showed multiple strokes (Figure A) compatible with cardiac emboli. Echocardiography showed dilated cardiomyopathy with severe left ventricular (LV) dysfunction (ejection …