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1. Cardiac remodelling - Part 1: From cells and tissues to circulating biomarkers. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology

Author

Arantxa González, A. Mark Richards, Rudolf A. de Boer, Thomas Thum, Henrike Arfsten, Martin Hülsmann, Inês Falcao‐Pires, Javier Díez, Roger S.Y. Foo, Mark Y. Chan, Alberto Aimo, Chukwuemeka G. Anene‐Nzelu, Magdy Abdelhamid, Stamatis Adamopoulos, Stefan D. Anker, Yuri Belenkov, Tuvia Ben Gal, Alain Cohen‐Solal, Michael Böhm, Ovidiu Chioncel, Victoria Delgado, Michele Emdin, Ewa A. Jankowska, Finn Gustafsson, Loreena Hill, Tiny Jaarsma, James L. Januzzi, Pardeep S. Jhund, Yuri Lopatin, Lars H. Lund, Marco Metra, Davor Milicic, Brenda Moura, Christian Mueller, Wilfried Mullens, Julio Núñez, Massimo F. Piepoli, Amina Rakisheva, Arsen D. Ristić, Patrick Rossignol, Gianluigi Savarese, Carlo G. Tocchetti, Sophie Van Linthout, Maurizio Volterrani, Petar Seferovic, Giuseppe Rosano, Andrew J.S. Coats, Antoni Bayés‐Genís, Center for Applied Medical Research [Plamplona] (CIMA), Universidad de Navarra [Pamplona] (UNAV), Navarra Institute for Health Research / Instituto de Investigación Sanitaria de Navarra (IdiSNA), Universidad Pública de Navarra [Espagne] = Public University of Navarra (UPNA)-Universidad de Navarra [Pamplona] (UNAV)-Clínica Universidad de Navarra [Pamplona], Instituto de Salud Carlos III [Madrid] (ISC), Yong Loo Lin School of Medicine [Singapore], National University of Singapore (NUS), University of Otago [Dunedin, Nouvelle-Zélande], University Medical Center Groningen [Groningen] (UMCG), Hannover Medical School [Hannover] (MHH), Fraunhofer Institute for Toxicology and Experimental Medicine (Fraunhofer ITEM), Fraunhofer (Fraunhofer-Gesellschaft), Medizinische Universität Wien = Medical University of Vienna, German Center for Cardiovascular Research (DZHK), Berlin Institute of Health (BIH), Faculdade de Medicina da Universidade do Porto (FMUP), Universidade do Porto = University of Porto, Departments of Cardiology and Cardiac Surgery, and Nephrology, Clínica Universidad de Navarra, Clínica Universidad de Navarra [Pamplona], Scuola Universitaria Superiore Sant'Anna [Pisa] (SSSUP), Fondazione Toscana Gabriele Monasterio, Montreal Heart Institute - Institut de Cardiologie de Montréal, Cairo University - Faculty of Medicine, Onassis Cardiac Surgery Center [Athens] (OCSC), Charité Campus Virchow-Klinikum (CVK), Berlin-Brandenburg Center for Regenerative Medicine [Berlin, Germany] (BCRT), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Université d'État Lomonossov de Moscou = Lomonosov Moscow State University (MSU), Cardiology Department, Rabin Medical Center, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Saarland University Hospital (UKS), Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu' [Bucharest, Romania], Leiden University Medical Center (LUMC), Wrocław Medical University, Hôpital national = Rigshospitalet [Copenhagen, Denmark] (HNC), Queen's University [Belfast] (QUB), Linköping University (LIU), Massachusetts General Hospital [Boston], Baim Institute for Clinical Research Boston MA, British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), University of Glasgow-NHS Greater Glasgow and Clyde, Volgograd State Medical University [Russian Federation] (VSMU), Karolinska University Hospital [Stockholm], Karolinska Institutet [Stockholm], Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia [Brescia], Università degli Studi di Brescia = University of Brescia (UniBs), University of Zagreb, Cardiology Department, Porto Armed Forces Hospital, University Hospital Basel [Basel], Ziekenhuis Oost-Limburg (ZOL), Universitat de València (UV), Hospital Clínico Universitario de Valencia, Cardiology Division, Castelsangiovanni Hospital, Scientific Research Institute of Cardiology and Internal Medicine [Almaty, Kazakhstan], University Clinical Centre of Serbia, 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 ), University of Naples Federico II = Università degli studi di Napoli Federico II, IRCCS Ospedale San Raffaele [Milan, Italy], Serbian Academy of Sciences and Arts (SASA), University of Belgrade [Belgrade], St George’s University Hospitals, University of Warwick [Coventry], Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain] (GTPUH), Universitat Autònoma de Barcelona (UAB), This work was supported by grants from the Spanish Ministry of Science, Innovation and Universities Institute of Health Carlos III (ISCIII) (PI18/01469 and PI21/00946 to A.G., CB16/11/00403 to A.B.-G and CB16/11/00483 to J.D. projects co-funded by the European Regional Development Funds), the European Commission (H2020 CRUCIAL project 2019–848109-2 to A.G.), the European Research Council (ERC CoG 818715 to R.A.d.B., ERC-PoC Megfib to T.T.), the National Medical Research Council of Singapore (NMRC, NMRC/STaR/0022/2014 to A.M.R. and MOH-000280 to M.Y.C.), the Health Research Council of New Zealand (02/152, 08/070, 11/1070), National Heart Foundation of New Zealand, New Zealand Lotteries Grant Board, Foundation for Research, Science and Technology and the Christchurch Heart Institute Trust to A.M.R., the Netherlands Heart Foundation (2017-21, 2017-11, 2018-30, 2020B005) to R.A.d.B., the leDucq Foundation (Cure-PLaN) to R.A.d.B., the Deutsche Forschungsgemeinschaft (KFO311 and TRR267 to T.T., TTR 219 to M.B., and TRR 1470 to S.V.L.), the Karolinska Institutet, the Swedish Research Council (523–2014-2336), the Swedish Heart Lung Foundation (20150557, 20190310), and the Stockholm County Council (20170112, 20190525) to L.H.L., European Project, BOZEC, Erwan, H2020 CRUCIAL project 2019–848109-2 - INCOMING, and Universiteit Leiden

Subjects
Heart Failure, Tissue, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Biomarkers, Cells, Remodeling, Endothelial Cells, Humans, Ventricular Remodeling, Cardiology, Cardiology and Cardiovascular Medicine, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Abstract

International audience; Cardiac remodelling refers to changes in left ventricular structure and function over time, with a progressive deterioration that may lead to heart failure (HF) development (adverse remodelling) or vice versa a recovery (reverse remodelling) in response to HF treatment. Adverse remodelling predicts a worse outcome, whilst reverse remodelling predicts a better prognosis. The geometry, systolic and diastolic function and electric activity of the left ventricle are affected, as well as the left atrium and on the long term even right heart chambers. At a cellular and molecular level, remodelling involves all components of cardiac tissue: cardiomyocytes, fibroblasts, endothelial cells and leucocytes. The molecular, cellular and histological signatures of remodelling may differ according to the cause and severity of cardiac damage, and clearly to the global trend toward worsening or recovery. These processes cannot be routinely evaluated through endomyocardial biopsies, but may be reflected by circulating levels of several biomarkers. Different classes of biomarkers (e.g. proteins, non-coding RNAs, metabolites and/or epigenetic modifications) and several biomarkers of each class might inform on some aspects on HF development, progression and long-term outcomes, but most have failed to enter clinical practice. This may be due to the biological complexity of remodelling, so that no single biomarker could provide great insight on remodelling when assessed alone. Another possible reason is a still incomplete understanding of the role of biomarkers in the pathophysiology of cardiac remodelling. Such role will be investigated in the first part of this review paper on biomarkers of cardiac remodelling.

Published
2022

2. European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum: First Edition

Author

Ricard Navarro-Ripoll, Marc Vives, Steffen Rex, P. Matute, R. Peter Alston, Theofili Kousi, Simon J. Howell, Mona Momeni, Hossam El-Ashmawi, Fawzia Aboulfetouh, M. Granell, Aniruddha R. Janai, Gabor Erdoes, Caetano Nigro Neto, Alberto Hernandez Martinez, Sascha Treskatsch, Gianluca Paternoster, Theofani Antoniou, Anna Flo Forner, Kirstin Wilkinson, Giovanni Landoni, Joost M.A.A. van der Maaten, Joachim Erb, Philippe Gaudard, Philippe Burtin, E Schindler, Andrea Székely, Alain Vuylsteke, Laszlo L. Szegedi, Vera von Dossow, Jens Fassl, Chirojit Mukherjee, Mohamed R. El-Tahan, Fabio Guarracino, Dominique Bettex, Maria Benedetto, Dieter Van Beersel, Jan-Uwe Schreiber, Patrick Wouters, Dragana Unic-Stojanovic, Mansoura University [Egypt], University of Bern, University Medical Center Groningen [Groningen] (UMCG), University Hospital Southampton NHS Foundation Trust, Onassis Cardiac Surgery Center [Athens] (OCSC), Ruhr University Bochum (RUB), Instituto de Cardiologia Dante Pazzanese (IDPC), University Hospital Bonn, Semmelweis University [Budapest], University of Leipzig [Leipzig, Allemagne], University Department of Fundamental and Applied Medical Sciences and Clinical Department of Anesthesiology and Perioperative Medicine, Ghent, Belgium, Azienda Ospedaliera Universitaria Pisana, Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], University of Belgrade [Belgrade], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Hospital Clinic [Barcelona, Spain], Misr University for Science & Technology (MUST), Technische Universität Dresden = Dresden University of Technology (TU Dresden), University hospital of Zurich [Zurich], Sant'Orsola-Malpighi Hospital [Bologna, Italy], Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Royal Infirmary of Edinburgh, IRCCS San Raffaele Scientific Institute [Milan, Italie], University General Hospital of Valencia, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Charité Campus Benjamin Franklin, University Hospitals Leuven [Leuven], Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom., University of Leeds, Hospital Universitario de Bellvitge, University Hospital Basel [Basel], Hospital Dr Josep Trueta, Cairo University, Department of Anesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany., Hospital Clinico San Carlos, Hospital Clínico San Carlos, Cliniques Universitaires Saint-Luc [Bruxelles], Université Catholique de Louvain = Catholic University of Louvain (UCL), UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service d'anesthésiologie, El-Tahan, M. R., Erdoes, G., van der Maaten, J., Wilkinson, K., Kousi, T., Antoniou, T., von Dossow, V., Neto, C. N., Schindler, E., Szekely, A., Forner, A. F., Wouters, P. F., Guarracino, F., Burtin, P., Unic-Stojanovic, D., Schreiber, J. -U., Matute, P., Aboulfetouh, F., Navarro-Ripoll, R., Fassl, J., Bettex, D., Benedetto, M., Szegedi, L., Alston, R. P., Landoni, G., Granell, M., Gaudard, P., Treskatsch, S., Van Beersel, D., Vuylsteke, A., Howell, S., Janai, A. R., Martinez, A. H., Erb, J. M., Vives, M., El-Ashmawi, H., Rex, S., Mukherjee, C., Paternoster, G., Momeni, M., MUMC+: MA Anesthesiologie (9), and RS: MHeNs - R3 - Neuroscience

Subjects
medicine.medical_specialty, Critical Care, [SDV]Life Sciences [q-bio], education, MEDLINE, Subspecialty, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Pediatric anesthesiology, Anesthesiology, Intensive care, Anesthesia, Cardiac Procedures, Medicine, Humans, Fellowships and Scholarships, 610 Medicine & health, Child, Curriculum, Cardiothoracic anesthesiology, business.industry, General surgery, 030208 emergency & critical care medicine, 3. Good health, Cardiac Anesthesia, Anesthesiology and Pain Medicine, Perioperative care, cardiovascular system, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; Pediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers.

Published
2021

3. COVID-19 vaccination in patients with heart failure: a position paper of the Heart Failure Association of the European Society of Cardiology

Author

Wilfried Mullens, Dimitrios Farmakis, Tuvia Ben Gal, Gerasimos Filippatos, Tiny Jaarsma, Robin Ray, Ekaterini Lambrinou, Gianluigi Savarese, Carlo G. Tocchetti, Alain Cohen-Solal, Yuri N. Belenkov, Maurizio Volterrani, Stamatis Adamopoulos, Arsen D. Ristić, Brenda Moura, Amina Rakisheva, Arantxa González, Michele Senni, Finn Gustafsson, Antoni Bayes-Genis, Thomas Thum, Ovidiu Chioncel, Marco Metra, Magdy Abdelhamid, Fadi Jouhra, Y M Lopatin, Lars Lund, Giuseppe M.C. Rosano, Sophie Van Linthout, Davor Miličić, Petar M. Seferovic, Piotr Ponikowski, Andrew J.S. Coats, Mitja Lainscak, Massimo F Piepoli, Michael Böhm, Loreena Hill, Stefan D. Anker, Ewa A. Jankowska, Rosano, G, Jankowska, E, Ray, R, Metra, M, Abdelhamid, M, Adamopoulos, S, Anker, S, Bayes-Genis, A, Belenkov, Y, Gal, T, Böhm, M, Chioncel, O, Cohen-Solal, A, Farmakis, D, Filippatos, G, González, A, Gustafsson, F, Hill, L, Jaarsma, T, Jouhra, F, Lainscak, M, Lambrinou, E, Lopatin, Y, Lund, L, Milicic, D, Moura, B, Mullens, W, Piepoli, M, Ponikowski, P, Rakisheva, A, Ristic, A, Savarese, G, Seferovic, P, Senni, M, Thum, T, Tocchetti, C, Van Linthout, S, Volterrani, M, Coats, A, IRCCS San Raffaele [Rome, Italy], Wrocław Medical University, University of London [London], St George’s University Hospitals, Università degli Studi di Brescia = University of Brescia (UniBs), Civic Hospital of Brescia, Cairo University, Onassis Cardiac Surgery Center [Athens] (OCSC), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Berlin Institute of Health (BIH), Université de Barcelonne, Instituto de Salud Carlos III [Madrid] (ISC), Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain] (GTPUH), Sechenov First Moscow State Medical University, Tel Aviv University (TAU), Universität des Saarlandes [Saarbrücken], University of Medicine and Pharmacy 'Carol Davila' Bucharest (UMPCD), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Cyprus [Nicosia] (UCY), National and Kapodistrian University of Athens (NKUA), Center for Applied Medical Research [Plamplona] (CIMA), Universidad de Navarra [Pamplona] (UNAV), University of Copenhagen = Københavns Universitet (UCPH), Queen's University [Belfast] (QUB), Linköping University (LIU), University of Ljubljana, Cyprus University of Technology, Volgograd State Medical University [Russian Federation] (VSMU), Karolinska University Hospital [Stockholm], University of Zagreb, Universidade do Porto = University of Porto, Hasselt University (UHasselt), Ziekenhuis Oost-Limburg (ZOL), Università degli studi di Parma = University of Parma (UNIPR), Al-Farabi Kazakh National University [Almaty] (KazNU), University of Belgrade [Belgrade], Serbian Academy of Sciences and Arts (SASA), Azienda Ospedaliera Ospedale Papa Giovanni XXIII [Bergamo, Italy], Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), Fraunhofer Institute for Toxicology and Experimental Medicine (Fraunhofer ITEM), Fraunhofer (Fraunhofer-Gesellschaft), University of Naples Federico II = Università degli studi di Napoli Federico II, German Center for Cardiovascular Research (DZHK), University of Warwick [Coventry], leboeuf, Christophe, Publica, Rosano, G., Jankowska, E. A., Ray, R., Metra, M., Abdelhamid, M., Adamopoulos, S., Anker, S. D., Bayes-Genis, A., Belenkov, Y., Gal, T. B., Bohm, M., Chioncel, O., Cohen-Solal, A., Farmakis, D., Filippatos, G., Gonzalez, A., Gustafsson, F., Hill, L., Jaarsma, T., Jouhra, F., Lainscak, M., Lambrinou, E., Lopatin, Y., Lund, L. H., Milicic, D., Moura, B., Mullens, W., Piepoli, M. F., Ponikowski, P., Rakisheva, A., Ristic, A., Savarese, G., Seferovic, P., Senni, M., Thum, T., Tocchetti, C. G., Van Linthout, S., Volterrani, M., and Coats, A. J. S.

Subjects
medicine.medical_specialty, COVID-19 Vaccines, medicine.medical_treatment, media_common.quotation_subject, Frail Elderly, Frailty syndrome, Cardiology, Heart failure, Disease, Medical and Health Sciences, SARS‐CoV‐2, [SDV.IMM.VAC] Life Sciences [q-bio]/Immunology/Vaccinology, SDG 3 - Good Health and Well-being, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, COVID‐19, Hygiene, medicine, Humans, Intensive care medicine, media_common, Aged, Heart transplantation, HFA position paper, business.industry, SARS-CoV-2, Social distance, Vaccination, COVID-19, Iron Deficiencies, medicine.disease, failure, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Heart Failure, Position paper, Position Paper, Clinical Medicine, [SDV.IMM.VAC]Life Sciences [q-bio]/Immunology/Vaccinology, Cardiology and Cardiovascular Medicine, business
Abstract

Patients with heart failure (HF) who contract SARS-CoV-2 infection are at a higher risk of cardiovascular and non-cardiovascular morbidity and mortality. Regardless of therapeutic attempts in COVID-19, vaccination remains the most promising global approach at present for controlling this disease. There are several concerns and misconceptions regarding the clinical indications, optimal mode of delivery, safety and efficacy of COVID-19 vaccines for patients with HF. This document provides guidance to all healthcare professionals regarding the implementation of a COVID-19 vaccination scheme in patients with HF. COVID-19 vaccination is indicated in all patients with HF, including those who are immunocompromised (e.g. after heart transplantation receiving immunosuppressive therapy) and with frailty syndrome. It is preferable to vaccinate against COVID-19 patients with HF in an optimal clinical state, which would include clinical stability, adequate hydration and nutrition, optimized treatment of HF and other comorbidities (including iron deficiency), but corrective measures should not be allowed to delay vaccination. Patients with HF who have been vaccinated against COVID-19 need to continue precautionary measures, including the use of facemasks, hand hygiene and social distancing. Knowledge on strategies preventing SARS-CoV-2 infection (including the COVID-19 vaccination) should be included in the comprehensive educational programmes delivered to patients with HF. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.]

Published
2021

4. Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece

Author

Ioulia Karageorgou, Nektarios Kogerakis, Emmanouil Angelakis, George Stavridis, Andreas Mentis, Stavroula Labropoulou, Sophia Hatzianastasiou, Institut Pasteur Hellénique, Réseau International des Instituts Pasteur (RIIP), Onassis Cardiac Surgery Center [Athens] (OCSC), and Aix Marseille Université (AMU)

Subjects
Microbiology (medical), Aortic valve, Epidemiology, genotype, [SDV]Life Sciences [q-bio], 030231 tropical medicine, lcsh:Medicine, Q fever, Serology, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Genotype, Research Letter, Medicine, Endocarditis, Animals, Humans, In patient, lcsh:RC109-216, 030212 general & internal medicine, bacteria, multispacer sequence typing, MST, biology, Greece, business.industry, lcsh:R, Endocarditis, Bacterial, Coxiella burnetii, biology.organism_classification, medicine.disease, bacterial infections and mycoses, Virology, 3. Good health, Q fever endocarditis, Infectious Diseases, medicine.anatomical_structure, endocarditis, Cattle, Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece, business, acute Q fever endocarditis
Abstract

International audience; Underdiagnosis of Coxiella burnetii infections in Greece is possible because of lack of awareness by physicians, and most suspected cases are in patients with no bovine contact. We found serologic evidence of C. burnetii infection throughout Greece and identified a new C. burnetii genotype in the aortic valve of a patient with Q fever endocarditis.

Published
2020

5. Vasopressor Therapy in Cardiac Surgery-An Experts' Consensus Statement

Author

Erich Kilger, Uwe Schirmer, Johann Knotzer, Marit Habicher, Stephan Kettner, Andrea Székely, Lidia Lysenko, Helene Häberle, Michael Sander, Matthias Heringlake, Luca Salvi, Sascha Treskatsch, Ludhmila Abrahão Hajjar, Gianluca Paternoster, Fabio Guarracino, Jean Luc Fellahi, Amalia Rompola, Phillipe Gaudard, Perikles Giannakopoulos, Heinrich Groesdonk, University of Pisa - Università di Pisa, Justus-Liebig-University [Gießen, Germany], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Semmelweis University [Budapest], Hospital Clinico San Carlos, Hospital Clínico San Carlos, IRCCS Istituto Nazionale dei Tumori [Milano], Wroclaw Medical University [Wrocław, Pologne], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Evangelismos Athens General Hospital, Ludwig Maximilians University of Munich, Onassis Cardiac Surgery Center [Athens] (OCSC), University of Tübingen, Ruhr University Bochum (RUB), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Hospital das Clinicas, University of Sao Paulo School of Medicine, and Helios Hospital

Subjects
Vasopressin, medicine.medical_specialty, Consensus, Vasopressins, [SDV]Life Sciences [q-bio], Hemodynamics, 030204 cardiovascular system & hematology, Norepinephrine (medication), 03 medical and health sciences, Norepinephrine, 0302 clinical medicine, 030202 anesthesiology, Medicine, Humans, Vasoconstrictor Agents, Cardiac Surgical Procedures, ComputingMilieux_MISCELLANEOUS, business.industry, Shock, medicine.disease, Pulmonary hypertension, 3. Good health, Cardiac surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Distributive shock, Anesthesia, Shock (circulatory), Vascular resistance, medicine.symptom, Cardiology and Cardiovascular Medicine, business, hormones, hormone substitutes, and hormone antagonists, medicine.drug
Abstract

Hemodynamic conditions with reduced systemic vascular resistance commonly are observed in patients undergoing cardiac surgery and may range from moderate reductions in vascular tone, as a side effect of general anesthetics, to a profound vasodilatory syndrome, often referred to as vasoplegic shock. Therapy with vasopressors is an important pillar in the treatment of these conditions. There is limited guidance on the appropriate choice of vasopressors to restore and optimize systemic vascular tone in patients undergoing cardiac surgery. A panel of experts in the field convened to develop statements and evidence-based recommendations on clinically relevant questions on the use of vasopressors in cardiac surgical patients, using a critical appraisal of the literature following the GRADE system and a modified Delphi process. The authors unanimously and strongly recommend the use of norepinephrine and/or vasopressin for restoration and maintenance of systemic perfusion pressure in cardiac surgical patients; despite that, the authors cannot recommend either of these drugs with respect to the risk of ischemic complications. The authors unanimously and strongly recommend against using dopamine for treating post-cardiac surgery vasoplegic shock and against using methylene blue for purposes other than a rescue therapy. The authors unanimously and weakly recommend that clinicians consider early addition of a second vasopressor (norepinephrine or vasopressin) if adequate vascular tone cannot be restored by a monotherapy with either norepinephrine or vasopressin and to consider using vasopressin as a first-line vasopressor or to add vasopressin to norepinephrine in cardiac surgical patients with pulmonary hypertension or right-sided heart dysfunction.

Published
2020

6. Echocardiographic reference ranges for normal left atrial function parameters results from the EACVI NORRE study

Author

Tadafumi, Sugimoto, Sébastien, Robinet, Raluca, Dulgheru, Anne, Bernard, Federica, Ilardi, Laura, Contu, Karima, Addetia, Luis, Caballero, George, Kacharava, George D, Athanassopoulos, Daniele, Barone, Monica, Baroni, Nuno, Cardim, Andreas, Hagendorff, Krasimira, Hristova, Teresa, Lopez, Gonzalo, de la Morena, Bogdan A, Popescu, Martin, Penicka, Tolga, Ozyigit, Jose David, Rodrigo Carbonero, Nico, van de Veire, Ralph Stephan, Von Bardeleben, Dragos, Vinereanu, Jose Luis, Zamorano, Yun Yun, Go, Stella, Marchetta, Alain, Nchimi, Monica, Rosca, Andreea, Calin, Marie, Moonen, Sara, Cimino, Julien, Magne, Bernard, Cosyns, Elena, Galli, Erwan, Donal, Gilbert, Habib, Roberta, Esposito, Maurizio, Galderisi, Luigi P, Badano, Roberto M, Lang, Patrizio, Lancellotti, Centre Hospitalier Universitaire de Liège (CHU-Liège), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hospital Univeristario Virgen de la Arrixaca, Onassis Cardiac Surgery Center [Athens] (OCSC), Universität Leipzig [Leipzig], Universidad de Alcalá - University of Alcalá (UAH), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Timone [CHU - APHM] (TIMONE), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Hospital Clínico Universitario Virgen de la Arrixaca = University Hospital Virgen de la Arrixaca [Murcia], Universität Leipzig, CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinical sciences, Cardio-vascular diseases, Cardiology, Sugimoto, T, Robinet, S, Dulgheru, R, Bernard, A, Ilardi, F, Contu, L, Addetia, K, Caballero, L, Kacharava, G, Athanassopoulos, G, Barone, D, Baroni, M, Cardim, N, Hagendorff, A, Hristova, K, Lopez, T, De La Morena, G, Popescu, B, Penicka, M, Ozyigit, T, Rodrigo Carbonero, J, Van De Veire, N, Von Bardeleben, R, Vinereanu, D, Zamorano, J, Go, Y, Marchetta, S, Nchimi, A, Rosca, M, Calin, A, Moonen, M, Cimino, S, Magne, J, Cosyns, B, Galli, E, Donal, E, Habib, G, Esposito, R, Galderisi, M, Badano, L, Lang, R, Lancellotti, P, Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Sugimoto, Tadafumi, Robinet, Sébastien, Dulgheru, Raluca, Bernard, Anne, Ilardi, Federica, Contu, Laura, Addetia, Karima, Caballero, Lui, Kacharava, George, Athanassopoulos, George D, Barone, Daniele, Baroni, Monica, Cardim, Nuno, Hagendorff, Andrea, Hristova, Krasimira, Lopez, Teresa, de la Morena, Gonzalo, Popescu, Bogdan A, Penicka, Martin, Ozyigit, Tolga, Rodrigo Carbonero, Jose David, van de Veire, Nico, Von Bardeleben, Ralph Stephan, Vinereanu, Drago, Zamorano, Jose Lui, Go, Yun Yun, Marchetta, Stella, Nchimi, Alain, Rosca, Monica, Calin, Andreea, Moonen, Marie, Cimino, Sara, Magne, Julien, Cosyns, Bernard, Galli, Elena, Donal, Erwan, Habib, Gilbert, Esposito, Roberta, Galderisi, Maurizio, Badano, Luigi P, Lang, Roberto M, and Lancellotti, Patrizio

Subjects
Male, deformation imaging, Pump function, Echocardiography, Three-Dimensional, Sex Factor, 030204 cardiovascular system & hematology, Cohort Studies, 0302 clinical medicine, Left atrial, Reference Values, Healthy volunteers, Image Processing, Computer-Assisted, Age Factor, adult echocardiography, left atrial function, reference values, 030212 general & internal medicine, Multivariate Analysi, Observer Variation, Healthy subjects, Age Factors, General Medicine, Middle Aged, Reference Standards, Healthy Volunteer, Healthy Volunteers, Homogeneous, Radiology Nuclear Medicine and imaging, Echocardiography, Cardiology, Linear Model, Atrial Function, Left, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, Human, Adult, medicine.medical_specialty, Statistics, Nonparametric, 03 medical and health sciences, Sex Factors, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Heart Atria, Left atrial function, business.industry, reference value, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Reference values, Multivariate Analysis, Linear Models, Reference Standard, Parameter, Cohort Studie, Large group, business
Abstract

International audience; Aims - To obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender. Methods and results - A total of 371 (median age 45 years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS. Conclusion - The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.

Published
2018

7. Short leukocyte telomere length precedes clinical expression of atherosclerosis: The blood-and-muscle model

Author

Benetos, Athanase, Toupance, Simon, Gautier, Sylvie, Labat, Carlos, Kimura, Masayuki, Rossi, Pascal M, Settembre, Nicla, Hubert, Jacques, Frimat, Luc, Bertrand, Baptiste, Boufi, Mourad, Flecher, Xavier, Sadoul, Nicolas, Eschwège, Pascal, Kessler, Michèle, Tzanetakou, Irene, Doulamis, Ilias, Konstantopoulos, Panagiotis, Tzani, Aspasia, Korou, Marilina, Gkogkos, Anastasios, Perreas, Konstantinos, Menenakos, Evangelos, Samanidis, Georgios, Vasiloglou-Gkanis, Michail, Kark, Jeremy, Malikov, Sergueï, Verhulst, Simon, Aviv, Abraham, Verhulst lab, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Gériatrie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Néphrologie [CHRU Nancy], Center of Human Development and Aging, New Jersey Medical School, Rutgers New Jersey Medical School (NJMS), Rutgers University System (Rutgers)-Rutgers University System (Rutgers), Médecine Interne [Hôpital Saint-Joseph - Marseille], Aix Marseille Université (AMU)-Hôpital Saint-Joseph [Marseille], Service de Cardiologie [CHRU Nancy], Service de Chirurgie Cardio-vasculaire [CHRU Nancy], Service d'Urologie [CHRU Nancy], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Vascular research center of Marseille (VRCM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Service de Chirurgie Vasculaire (SCV-AP-MM Marseille), Hôpital Nord AP‐MM Marseille, France (AP‐MM Marseille), Chirurgie orthopédique et traumatologie [Hôpital Sainte-Marguerite - APHM], Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud )-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), National and Kapodistrian University of Athens (NKUA), European University of Cyprus, Onassis Cardiac Surgery Center [Athens] (OCSC), Hippokration General Hospital, 'IASO' General Hospital of Athens, Hadassah School of Public Health and Community Medicine, The Hebrew University of Jerusalem (HUJ), Groningen Institute for Evolutionary Life Sciences [Groningen] (GELIFES), University of Groningen [Groningen], French National Research Agency (ANR), Translationnelle: N°ID RCB: 2014-A00298-39: 2014-2017, NIH grants R01HD071180, R01HL116446,R01HL13840, ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), DE CARVALHO, Philippe, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud )

Subjects
DYNAMICS, RISK, telomere, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, leukocytes, muscle, [SDV]Life Sciences [q-bio], aging, ASSOCIATION, DISEASE, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, SYNCHRONY, [SDV] Life Sciences [q-bio], AGE, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, biopsy, RATES, atherosclerosis, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; RATIONALE:Short telomere length (TL) in leukocytes is associated with atherosclerotic cardiovascular disease (ASCVD). It is unknown whether this relationship stems from having inherently short leukocyte TL (LTL) at birth or a faster LTL attrition thereafter. LTL represents TL in the highly proliferative hematopoietic system, whereas TL in skeletal muscle represents a minimally replicative tissue.OBJECTIVE:We measured LTL and muscle TL (MTL) in the same individuals with a view to obtain comparative metrics for lifelong LTL attrition and learn about the temporal association of LTL with ASCVD.METHODS AND RESULTS:Our Discovery Cohort comprised 259 individuals aged 63±14 years (mean±SD), undergoing surgery with (n=131) or without (n=128) clinical manifestation of ASCVD. In all subjects, MTL adjusted for muscle biopsy site (MTLA) was longer than LTL and the LTL-MTLA gap similarly widened with age in ASCVD patients and controls. Age- and sex-adjusted LTL (P=0.005), but not MTLA (P=0.90), was shorter in patients with ASCVD than controls. The TL gap between leukocytes and muscle (LTL-MTLA) was wider (P=0.0003), and the TL ratio between leukocytes and muscle (LTL/MTLA) was smaller (P=0.0001) in ASCVD than in controls. Findings were replicated in a cohort comprising 143 individuals.CONCLUSIONS:This first study to apply the blood-and-muscle TL model shows more pronounced LTL attrition in ASCVD patients than controls. The difference in LTL attrition was not associated with age during adulthood suggesting that increased attrition in early life is more likely to be a major explanation of the shorter LTL in ASCVD patients.CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT02176941.© 2017 The Authors.

Published
2018

8. Correction of human phospholamban R14del mutation associated with cardiomyopathy using targeted nucleases and combination therapy

Author

Alexandros Katoulis, Ronald A. Li, Fotis Kolokathis, Roger J. Hajjar, Evangelia G. Kranias, Chi Wing Kong, Francesca Stillitano, Folkert W. Asselbergs, Dimitrios Tsiapras, Johannes M.I.H. Gho, Despina Sanoudou, Joseph C. Wu, Jean-Sébastien Hulot, Aryan Vink, Mathieu Nonnenmacher, Delaine K. Ceholski, Jens Hansen, Ioannis Karakikes, Lihuan Ren, Christos Tzimas, Dimitrios Th. Kremastinos, Vittavat Termglinchan, Ninette Cohen, Stephanie N. Rushing, Icahn School of Medicine at Mount Sinai [New York] (MSSM), Stanford School of Medicine [Stanford], Stanford Medicine, Stanford University-Stanford University, Biomedical Research Foundation of the Academy of Athens, National and Kapodistrian University of Athens (NKUA), LKS Faculty of Medicine (HKU Med), The University of Hong Kong (HKU), University Medical Center [Utrecht], Onassis Cardiac Surgery Center [Athens] (OCSC), ICIN - Netherlands Heart Institute, University College of London [London] (UCL), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), University of Cincinnati (UC), HAL UPMC, Gestionnaire, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)

Subjects
Cardiomyopathy, General Physics and Astronomy, 030204 cardiovascular system & hematology, ARRHYTHMOGENIC CARDIOMYOPATHY, CARDIOMYOCYTES, DISEASE, 0302 clinical medicine, Myocytes, Cardiac, Induced pluripotent stem cell, Sequence Deletion, 0303 health sciences, Transcription activator-like effector nuclease, Multidisciplinary, Deoxyribonucleases, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, HYPERTROPHIC CARDIOMYOPATHY, Targeted Gene Repair, DIRECTED DIFFERENTIATION, Gene Transfer Techniques, Phenotype, 3. Good health, Phospholamban, Female, Cardiomyopathies, PLURIPOTENT STEM-CELLS, ADENOASSOCIATED VIRUS VECTORS, Adult, endocrine system, Induced Pluripotent Stem Cells, LONG-QT SYNDROME, Biology, General Biochemistry, Genetics and Molecular Biology, Article, Adenoviridae, 03 medical and health sciences, Directed differentiation, medicine, Humans, Gene, 030304 developmental biology, Calcium-Binding Proteins, General Chemistry, IN-VITRO, medicine.disease, DILATED CARDIOMYOPATHY, Molecular biology, Cancer research, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

A number of genetic mutations is associated with cardiomyopathies. A mutation in the coding region of the phospholamban (PLN) gene (R14del) is identified in families with hereditary heart failure. Heterozygous patients exhibit left ventricular dilation and ventricular arrhythmias. Here we generate induced pluripotent stem cells (iPSCs) from a patient harbouring the PLN R14del mutation and differentiate them into cardiomyocytes (iPSC-CMs). We find that the PLN R14del mutation induces Ca2+ handling abnormalities, electrical instability, abnormal cytoplasmic distribution of PLN protein and increases expression of molecular markers of cardiac hypertrophy in iPSC-CMs. Gene correction using transcription activator-like effector nucleases (TALENs) ameliorates the R14del-associated disease phenotypes in iPSC-CMs. In addition, we show that knocking down the endogenous PLN and simultaneously expressing a codon-optimized PLN gene reverses the disease phenotype in vitro. Our findings offer novel strategies for targeting the pathogenic mutations associated with cardiomyopathies., Phospholamban (PLN) is a regulator of heart contractility. Here the authors show that cardiomyocytes derived from induced pluripotent stem cells of a cardiomyopathy patient with mutant PLN exhibit functional defects consistent with the disease, and that this mutation can be functionally corrected by genome editing and gene therapy.

Published
2015

9. CARDIAC MAGNETIC RESONANCE IN TRANSFUSION DEPENDENT THALASSAEMIA: ASSESSMENT OF IRON LOAD AND RELATION TO LEFT VENTRICULAR EJECTION FRACTION

Author

Chouliaras, Giorgos L, Kattamis, Antonis, Berdoukas, Vasilios Antonios, Gotsis, Efstathios, Mavrogeni, Sophie, Ladis, Vassilios, 1st Dept, of Paediatrics, Thalassaemia Unit, Encephalos-Euromedica Laboratories, Cardiology Department, and Onassis Cardiac Surgery Center [Athens] (OCSC)

Subjects
cardiovascular system, Medicine, cardiovascular diseases, circulatory and respiratory physiology
Abstract

International audience; Cardiac Magnetic Resonance (CMR) has replaced all other surrogate measurements in the determination of transfusional cardiac iron overload in patients with thalassaemia major. We aimed to determine the diagnostic value of CMR T2* with respect to cardiac dysfunction (CD) as determined by CMR-derived left ventricular ejection fraction (LVEF). Cardiac T2* values and LVEF measured by CMR were recorded in 303 patients with thalassaemia major, at the time of their first CMR. T2* was correlated with LVEF (regression coefficient: 0.57, p 8ms and ≤14 ms and reduced to 9.1% in patients with T2* between 14-20 ms. As the probability of CD is progressively, and not suddenly, reduced with increasing values of T2*, CMR has a limited diagnostic value for cardiac dysfunction (ROC Analysis, AUC = 0.68). Patients with cardiac T2* ≤ 8 ms require careful and intensive management. This risk decreases with increasing values of T2* but even in mildly loaded patients the probability of impaired LVEF is not negligible.

Published
2010

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