Archives of Cardiovascular Diseases最新文献

{"title":"Identification of new phenotypes in type 2 diabetes with acute myocardial infarction: Toward a precision medicine?","authors":"A. Barbou ,&nbsp;S. Aho ,&nbsp;M. Boulin ,&nbsp;H. Adam ,&nbsp;J.M. Petit ,&nbsp;F. Chagué ,&nbsp;F. Bichat ,&nbsp;M. Zeller ,&nbsp;Y. Cottin","doi":"10.1016/j.acvd.2024.10.086","DOIUrl":"10.1016/j.acvd.2024.10.086","url":null,"abstract":"<div><h3>Introduction</h3><div>Type 2 diabetes mellitus (T2DM) is a highly heterogeneous entity, with multiple subgroups differing by clinic presentation, disease progression and risk of complications such as myocardial infarction (MI). A new T2DM phenotyping classification has been recently proposed to help to improve treatment tailoring and target early treatments.</div></div><div><h3>Objective</h3><div>We aimed to identify the prevalence and characteristics of the new T2DM phenotypes in patients with acute MI.</div></div><div><h3>Method</h3><div>All consecutive adults with a history T2DM hospitalized in a French Coronary Intensive Care Unit for an acute MI between February 1st, 2021 and January 31st, 2023 were included. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance). We stratified patients into five subgroups: 1/SAID<!--> <!-->=<!--> <!-->severe autoimmune diabetes; 2/SIDD<!--> <!-->=<!--> <!-->severe insulin-deficient diabetes; 3/SIRD<!--> <!-->=<!--> <!-->severe insulin-resistant diabetes; 4/MOD<!--> <!-->=<!--> <!-->mild obesity-related diabetes; and 5/MARD<!--> <!-->=<!--> <!-->mild age-related diabetes.</div></div><div><h3>Results</h3><div>Among the 266 patients included, characteristics according to diabetes phenotypes are summarized in <span><span>Table 1</span></span>.</div></div><div><h3>Conclusion</h3><div>Our prospective study showed that in real-world T2DM patients with acute MI, unclassical phenotypes, <em>i.e.</em> hyperinsulinaemic and insulinopaenic were common. Given the large discrepancies in characteristics, our findings suggest the relevance of the new substratification. However, its clinical utility and translation in tailored treatment strategies and prognosis remains to be determined.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S20-S21"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the understanding of coronary response to diabetes through comprehensive imaging evaluation","authors":"E. Belaid ,&nbsp;S. Fawaz ,&nbsp;R. Boulestreau ,&nbsp;Y. Pucheu ,&nbsp;C. Ducos ,&nbsp;J.-S. Liegey ,&nbsp;M. Darne ,&nbsp;V. Maury ,&nbsp;C. Labilloy ,&nbsp;R. Lembeye ,&nbsp;L. Hein ,&nbsp;D. Sadki ,&nbsp;R. Roland ,&nbsp;C. Bazin ,&nbsp;S. Sridi-Cheniti ,&nbsp;P. Coste ,&nbsp;K. Mohammedi ,&nbsp;H. Cochet ,&nbsp;M. Montaudon ,&nbsp;T. Couffinhal","doi":"10.1016/j.acvd.2024.10.088","DOIUrl":"10.1016/j.acvd.2024.10.088","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetes is one of the main risk factors for cardiovascular disease and is associated with a significant coronary atherosclerosis burden. However, recent studies have shown that among patients with diabetes a significant part do not develop coronary artery disease (CAD), even in long-standing diabetes.</div></div><div><h3>Objective</h3><div>We aimed to identify the determinants of the coronary and carotid atherosclerosis burden in a population of patients with diabetes and no history of CAD.</div></div><div><h3>Method</h3><div>All patients underwent a coronary computed tomography angiography (CCTA) with the measure of the coronary calcium score (CAC) and the quantification of the percent atheroma volume (PAV, dividing the coronary atheroma volume by the total coronary volume), alongside with a 3D carotid ultrasonography to quantify the carotid atheroma volume.</div></div><div><h3>Results</h3><div>Between March 2021 and March 2024, we included 138 patients (58.6 years in mean, 59% of men), 32% of whom had a CAC of zero. Mean CAC was 351.6 AU and 10% had a stenosis<!--> <!-->&gt;<!--> <!-->50%. The mean PAV was 8.3%. Twenty-five percent of the patients had carotid plaques, with a mean volume of 41.5 mm3. In the hole cohort, male gender (<em>p</em> <!-->=<!--> <!-->0.014) and duration of diabetes (<em>p</em> <!-->=<!--> <!-->0.017) were independently associated with PAV. In patients with a diabetes<!--> <!-->&lt;<!--> <!-->5 years, the presence of carotid plaques was the only independent determinant of CAC (<em>p</em> <!-->=<!--> <!-->0.016). In patients with long-standing diabetes (&gt;<!--> <!-->10 years), only male gender was independently associated with CAC (<em>p</em> <!-->=<!--> <!-->0.031). We found no correlation between the carotid atheroma volume and CAC or PAV.</div></div><div><h3>Conclusion</h3><div>Our study suggests that the male gender and the duration of diabetes are the two clinical determinants of CAD in patients with diabetes, and that the carotid ultrasound could be used to identify the patients with short-standing diabetes who are the most at risk to develop CAD through the detection of carotid plaques. More studies are needed to precise the role of the carotid atheroma volume in patients with diabetes and no CAD.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S21"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does audio-visual information influence the level of anxiety before invasive coronary procedures?","authors":"R. Kallel ,&nbsp;O. Haddar ,&nbsp;Y. Mallek ,&nbsp;E.M. Kharrat ,&nbsp;A. Battrawi ,&nbsp;A. Kchaw ,&nbsp;W. Abbes ,&nbsp;D. Hichem","doi":"10.1016/j.acvd.2024.10.081","DOIUrl":"10.1016/j.acvd.2024.10.081","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Anxiety before invasive coronary procedures may precipitate outcomes, so it is worth reducing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;We investigated the effect of audiovisual-based information, compared to structured verbal information, on the level of anxiety before invasive coronary artery procedures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;We conducted a prospective randomized and controlled study including patients scheduled for non-emergent coronary artery procedures. Patients were randomized to be informed by structured verbal information alone or with the help of an audio-visual explanation. The level of anxiety was evaluated before and after the information. We used the Visual Analogical Scale (VAS) and the State-Trait Anxiety Inventory (STAI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;145 patients were included, males in 81.4% of cases; the mean ages were 61.63 years (SD 11.95); and there was a stabilised acute coronary syndrome in 81.4% of cases. Patients were illiterate or had a low instructive level in 42.9% of cases. 65.5% of patients adhered to the national social insurance regimen. 22.6% of patients experimented with invasive coronary procedures, but only 23% were estimated to have been appropriately informed before the procedure. Patients were very anxious according to the STAI-Trait Score (46.34&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;6.15), with no significant difference between the two groups (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.068). The variation in the level of anxiety was a significant reduction in both groups. In the group of verbal structured information, the VAS was very significantly reduced (3.17&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.51 After &lt;em&gt;vs.&lt;/em&gt; 3.6&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.51 Before; &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001), and the STAI-State too (45.93&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;6.4 &lt;em&gt;vs.&lt;/em&gt; 46.28&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;6.7; &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001). In the group of audio-visual-based information, the anxiety was reduced very significantly according to the VAS (3.45&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.11 after &lt;em&gt;vs.&lt;/em&gt; 4.51&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.18; &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001) and to the STAI-State score (43.48&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;6.42 after &lt;em&gt;vs.&lt;/em&gt; 47.05&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;5.88; &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.008). We compared the variation of anxiety between the two groups, and we noticed a much more important reduction in the level of anxiety in the group of audio-visual information: VAS (−0.43&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.25 in the verbal information group &lt;em&gt;vs.&lt;/em&gt; −1.06&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;0.99 in the audiovisual group; &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) and the STAI-State (−0.35&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;5.09 in the verbal information group &lt;em&gt;vs.&lt;/em&gt; −3.57&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;7.16 in the audiovisual group; &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.002).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Both verbal and audio-visual-based information reduced the level of anxiety before invasive coronary procedu","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S18"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulant levels in patients admitted for an acute myocardial infarction and treated with non-vitamin K antagonist oral anticoagulants","authors":"P. Savard ,&nbsp;E. De Maistre ,&nbsp;M. Maza ,&nbsp;F. Chagué ,&nbsp;F. Bichat ,&nbsp;M. Boulin ,&nbsp;M. Zeller ,&nbsp;Y. Cottin","doi":"10.1016/j.acvd.2024.10.080","DOIUrl":"10.1016/j.acvd.2024.10.080","url":null,"abstract":"<div><h3>Introduction</h3><div>A significant rate of patients admitted for acute myocardial infarction (MI) are under chronic treatment with non-vitamin K antagonist oral anticoagulants (NOACs). Their initial anticoagulant management should be limited to an unfractionated heparin bolus during percutaneous coronary angiography (PCI), according to the new ESC guidelines. However, level of anticoagulants through standard laboratory tests or specific dosages could provide important information to adapt anticoagulation therapy and limit the early bleeding risk.</div></div><div><h3>Objective</h3><div>We aimed to investigate the levels of NOACs in patients admitted for an acute MI.</div></div><div><h3>Method</h3><div>Between February 1st, 2021 and January 31st, 2023, all consecutive adults admitted in coronary care unit for an acute MI and chronically treated with NOACs were prospectively included. Blood sampling was made on admission for anticoagulant assessment. NOAC concentrations (expressed in ng/mL) were measured using Liquid anti-Xa (Stago, Asnières sur Seine, France) for rivaroxaban and apixaban, and ECA-2 (Stago, Asnières sur Seine, France) for dabigatran, with specific set-up tests, according to the manufacturer's recommendations. Calibrations were performed using rivaroxaban, apixaban, dabigatran plasma calibrators (Stago, Asnières sur Seine, France). Patients were divided into 3 ranges according to levels of NOAC (Group 1:<!--> <!-->&lt;<!--> <!-->50 ng/mL, Group 2: 50–100 ng/mL, Group 3:<!--> <!-->&gt;<!--> <!-->100 ng/mL) taking account the haemostatic threshold of 50 ng/mL for surgery (except neurosurgery) or use of antidote and the through concentration of 100 ng/mL observed before next dose of twice-daily treatments.</div></div><div><h3>Results</h3><div>Rate of MI patients under chronic NOAC was 8,5% (<em>n</em> <!-->=<!--> <!-->155). Their median (IQR) anticoagulant concentration was at 98 (51–179) ng/mL and the time from the last dose of NOACs was 495 (240–660) min. The main indication for chronic NOAC was atrial fibrillation. Among the 155 patients, 39 (25%), were in group 1, 42 (27%) in group 2 and 74 (48%) in group 3. Baseline characteristics were similar for the 3 groups (<span><span>Table 1</span></span>), including age, risk factors, type of NOAC and rate of PCI. However, there was a trend toward a higher rate of ST segment elevation MI in patients with elevated levels of anticoagulant.</div></div><div><h3>Conclusion</h3><div>Our prospective pilot study suggests that the dosage of NOACs could be a relevant guiding tool for anticoagulant strategy in patients with acute MI. However, its clinical utility and prognosis value remains to be determined in larger prospective multicentric studies.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S17-S18"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving prognostic accuracy in ischemic cardiomyopathy: the “CMR-LGE score”","authors":"A. Unger ,&nbsp;J. Amar ,&nbsp;J. Garot ,&nbsp;T. Hovasse ,&nbsp;P. Garot ,&nbsp;S. Champagne ,&nbsp;T. Unterseeh ,&nbsp;S. Duhamel ,&nbsp;J. Florence ,&nbsp;J.-G. Dillinger ,&nbsp;P. Henry ,&nbsp;V. Bousson ,&nbsp;F. Sanguineti ,&nbsp;S. Toupin ,&nbsp;T. Pezel","doi":"10.1016/j.acvd.2024.10.054","DOIUrl":"10.1016/j.acvd.2024.10.054","url":null,"abstract":"<div><h3>Introduction</h3><div>Several studies have shown the impact of cardiovascular magnetic resonance (CMR) imaging findings notably late gadolinium enhancement (LGE) to stratify the risk in ischemic cardiomyopathy (ICM) but an easy interpretable score to guide clinical practice is lacking.</div></div><div><h3>Objective</h3><div>To determine the CMR parameters most predictive of mortality in a cohort of ICM patients with reduced left ventricular ejection fraction (LVEF) less than 50%. Then, we will develop a readily interpretable score based on these CMR parameters.</div></div><div><h3>Method</h3><div>Between 2008 and 2022, consecutive patients with ICM, LVEF<!--> <!-->&lt;<!--> <!-->50% and presence of ischemic-LGE on CMR, were recruited by two independent centers. The primary outcome was all-cause death. The first center (i.e. the derivation cohort, ICPS Hospital, <em>n</em> <!-->=<!--> <!-->2900) was used for variable selection and score development, and the second center (i.e. the validation cohort, Lariboisiere Hospital, <em>n</em> <!-->=<!--> <!-->691) was used to evaluate the performance of the score. Clinical variables (17) and CMR variables (15) were initially assessed. Feature selection was performed using Random Survival Forest (RSF). Using the selected variables, our CMR-LGE score was derived from beta coefficients of the Cox regression. Performance evaluation was conducted using Harrel's C index compared with known prognostic factors associated with poor outcomes in ICM. Prognostic score categories were defined using survival tree analysis in the derivation cohort.</div></div><div><h3>Results</h3><div>Among the 3591 patients included (mean age 65 years; 75% male; mean LVEF 44%), 549 (15%) died over a median follow-up of 9 years. Feature selection with RSF highlighted that the most important variables to predict death were LGE variables: the LGE extent, its location (septal and anterior) and the transmurality of ischemic-LGE as well as the extent of additional midwall-LGE. Following these findings, we developed the CMR-LGE score using Cox regression coefficients (<span><span>Fig. 1</span></span>A). Harrel's C index of CMR-LGE score outperformed known prognostic factors, including LVEF (0.88 vs 0.69). Finally, based on our CMR-LGE score, we identified a low-risk population (score ≤ 5) and a high-risk population (score ≥ 9), validated using survival curves in the validation cohort (<span><span>Fig. 1</span></span>B).</div></div><div><h3>Conclusion</h3><div>Using RSF, we identified that the 5 most important CMR variables to predict mortality in ICM were all LGE features. Our CMR-LGE score showed excellent performance to stratify patient risk compared to traditional prognostic factors including LVEF.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S50"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of lung ultrasound in acute heart failure","authors":"M. Jabeur,&nbsp;H. Slim,&nbsp;R. Gargouri,&nbsp;A. Bahloul,&nbsp;S. Charfeddine,&nbsp;T. Ellouze,&nbsp;F. Triki,&nbsp;L. Abid","doi":"10.1016/j.acvd.2024.10.045","DOIUrl":"10.1016/j.acvd.2024.10.045","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical congestion rather than low cardiac output, is the most frequent cause in patients hospitalized for heart failure and accounts for high rates of death. Persisting symptoms and signs of congestion at discharge or amongst out-patients are strong predictors of an adverse outcome. Lung ultrasound (LUS) has emerged as a simple, non-invasive and semi-quantitative tool for the detection and the assessment of pulmonary congestion.</div></div><div><h3>Objective</h3><div>Assess the prognostic importance of pulmonary congestion detected with LUS on short-term adverse events and to describe the dynamic changes of LUS findings.</div></div><div><h3>Method</h3><div>In a bi-centric prospective observational study, we included consecutive patients hospitalized for acute heart failure. Each patient underwent a thorough clinical examination, a biological evaluation, a chest X-ray, LUS and echocardiography. The operators performing LUS were blinded to clinical data and examined 8 thoracic zones .The main clinical outcomes were a composite of urgent visit, HF hospitalization for acute decompensation of HF or cardiac death.</div></div><div><h3>Results</h3><div>A total of 116 individuals were included (median, 69 years of age; 53% men; mean ejection fraction 40%) The mean number of B-lines at discharge was 6.6<!--> <!-->±<!--> <!-->3.3. During a mean follow-up of 6 months, we detected 72 events: 52 patients were admitted due to severe HF symptoms and 20 patients died from cardiac cause. By multivariate analysis,<!--> <!-->≥<!--> <!-->3 B-lines Bilaterally (11.024 HR, 95% CI 5.542–21.926, <em>P</em> <!-->&lt;<!--> <!-->0.001) was retained as a predictor for the risk of the combined endpoint at 180-day follow-up. The number of B-lines significantly decreased from 31.9<!--> <!-->±<!--> <!-->12.7 when patients were admitted at the hospital to 6.6<!--> <!-->±<!--> <!-->3.1 when discharged from it (<em>P</em> <!-->=<!--> <!-->0).</div></div><div><h3>Conclusion</h3><div>A simplified 8-Zone LUS method is useful to assess severity and monitor the resolution of lung congestion. Patients with persistent pulmonary congestion at discharge assessed by LUS have worse prognosis.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S45"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-year follow-up of myocardial revascularization after anatomical and functional screening for myocardial ischemia: Insights from the “Nancy Ischemia Registry”","authors":"Z. Chati ,&nbsp;S. Tissier ,&nbsp;C. Balaj ,&nbsp;M. Lafitte ,&nbsp;N. Benzaghou ,&nbsp;M. Amor ,&nbsp;J. Emoine ,&nbsp;M. Angioi ,&nbsp;C.-H. Maigrat ,&nbsp;G. Farah ,&nbsp;K. Belhadj ,&nbsp;J. Schwartz ,&nbsp;A. Olivier ,&nbsp;C. Breton ,&nbsp;J.-P. Simon","doi":"10.1016/j.acvd.2024.10.063","DOIUrl":"10.1016/j.acvd.2024.10.063","url":null,"abstract":"<div><h3>Introduction</h3><div>Myocardial revascularization after screening for myocardial ischemia is one of the main Major Adverse Cardiovascular Events (MACE) observed. Careful monitoring of patients could play an important role.</div></div><div><h3>Objective</h3><div>Systematic monitoring of patients after a myocardial revascularization procedure is known from randomized clinical trials. A real follow-up outside of this context is not really known. In a real world, Nancy Ischemia Registry aims to prospectively study the consequences of screening for myocardial ischemia on subsequent myocardial revascularization.</div></div><div><h3>Method</h3><div>After prospectively including 2977 patients as part of screening for myocardial ischemia by anatomical (Coronary Calcium-Scores, CT-Coronary Angiograms) and functional imaging (Stress Echo, Stress CMR) between May 2021 and the end of December 2022, we observed the occurrence of a myocardial revascularization procedure in these patients. After a positive screening for myocardial ischemia, a coronary angiography was performed. A first myocardial revascularization procedure was decided if the patient presented at least one significant coronary lesion (≥<!--> <!-->70% or FFR<!--> <!-->≤<!--> <!-->0.80).</div></div><div><h3>Results</h3><div>In 2,375 patients, screening did not reveal significant myocardial ischemia (ISCHEMIA<!--> <!-->−). We noted 602 examinations (20% of all examinations) with suspicion of myocardial ischemia (ISCHEMIA<!--> <!-->+). 324 patients (11% of all examinations) (REAVASC<!--> <!-->+) benefited from a first myocardial revascularization in the following weeks. All patients in the three groups had usual follow-up. At the end of 2023, in the ISCHEMIA<!--> <!-->−<!--> <!-->group, we had recorded two cases of myocardial revascularization. In the ISCHEMIA<!--> <!-->+<!--> <!-->group, 97 new revascularization interventions were recorded. However, at least one other myocardial revascularization procedure was observed in 73 patients in the REVASC<!--> <!-->+<!--> <!-->group.</div></div><div><h3>Conclusion</h3><div>Far from the context of randomized clinical trials, non-systematic, but regular, monitoring of patients with suspected myocardial ischemia and/or revascularization shows the interest of anatomical and functional imaging to probably avoid a more significant evolution of MACE and allows for better stratification of patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S9"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the prevalence of coronary artery disease in patients managed for supraventricular tachycardia with elevated troponinemia","authors":"A. Said Ibrahim ,&nbsp;B. Lattuca","doi":"10.1016/j.acvd.2024.10.067","DOIUrl":"10.1016/j.acvd.2024.10.067","url":null,"abstract":"<div><h3>Introduction</h3><div>Supraventricular tachycardia (SVT) are frequently associated with elevation of blood troponin, but its clinical significance to determine possible coronary artery disease remains unclear. The aim of this study was to assess the prevalence of significant coronary artery disease (CAD) in patients admitted for SVT with troponin elevation.</div></div><div><h3>Objective</h3><div>The aim of this study was to assess the prevalence of significant coronary artery disease (CAD) in patients admitted for SVT with troponin elevation.</div></div><div><h3>Method</h3><div>This bicentric observational historical-prospective study, conducted at the Montpellier and Nîmes university hospital centers, included patients with SVT and anormal troponin and for whom coronary angiography was performed within one-month follow-up. The primary endpoint was the presence of significant CAD (CAD+) defined by coronary lesion more than 70% or 50% in case of positive FFR or more than 50% for the left main. The predictive value of troponin in favor of significant CAD was assessed using multivariate analysis. Procedural, hospital and clinical complications were assessed up to 6 months.</div></div><div><h3>Results</h3><div>The study included 131 patients. Of these, 57 patients were in the CAD+ group while 74 patients did not have significant CAD (CAD−). Patients with significant CAD had higher mean troponin levels than those in the CAD− group (495.56 ng/L <em>vs.</em> 167.54 ng/L). Among CAD+ patients, only 3 had an unstable coronary lesion with a peak troponin levels systematically above 1000 ng/L.</div><div>Predictive factors for significant CAD were troponin above 232, repolarization disorders on electrocardiogram, male gender and previous CAD before hospitalization. Significantly more complications were observed in patients with significant CAD (26.32% <em>vs.</em> 8.11%; <em>p</em> <!-->=<!--> <!-->0.005). At 6-month follow-up, there was no difference in term of hospitalization for cardiac cause in the two groups (27.0% and 31.6% in CAD− and CAD+ groups respectively, <em>p</em> <!-->=<!--> <!-->0.598) with only one stroke and one myocardial infarction in the CAD+ group.</div></div><div><h3>Conclusion</h3><div>In patients admitted for SVT, a significant coronary artery disease was more frequently observed in case of increased troponin with a higher predictive value of troponin above 232. An individualized approach, including patient history, chest pain and repolarization changes, is nevertheless necessary, particularly in cases of moderately elevated troponin levels.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S11"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"4 cavities myocardial strain: A useful tool to refine the early risk score of death in acute pulmonary embolism","authors":"L. Soulat-Dufour ,&nbsp;I. Evain ,&nbsp;S. Lang ,&nbsp;S. Ederhy ,&nbsp;S. Adavane-Scheuble ,&nbsp;M. Chauvet-Droit ,&nbsp;C. Arnaud ,&nbsp;L. Benoudiba Campanini ,&nbsp;P. Fagnen ,&nbsp;P.-A. Lebos ,&nbsp;M. Gerard ,&nbsp;F. Boccara ,&nbsp;A. Cohen","doi":"10.1016/j.acvd.2024.10.099","DOIUrl":"10.1016/j.acvd.2024.10.099","url":null,"abstract":"<div><h3>Introduction</h3><div>In acute pulmonary embolism (PE), the early risk of death is currently evaluated based on European Society of Cardiology (ESC) risk score, including two-dimensional echocardiographic derived-parameters: right ventricular (RV) dimension, function and hemodynamics.</div></div><div><h3>Objective</h3><div>We hypothesized that additional parameters including the 4 cavities myocardial strain analysis could also be of interest in the stratification of early risk of death in PE.</div></div><div><h3>Method</h3><div>We retrospectively analyzed 477 patients hospitalized for acute EP. Patients were divided into 2 groups according to the early (in-hospital or at 30 day) risk of death as stated in the 2019 ESC Guidelines: group 1, with low or intermediate-low risk of death (<em>n</em> <!-->=<!--> <!-->302) and group 2, with intermediate-high or high risk of death (<em>n</em> <!-->=<!--> <!-->175). We determined usual 2D echocardiographic parameters used to define RV dysfunction in the ESC risk score: RV dilatation, pulmonary arterial pressure, TAPSE, S’, RV Fractionnal Area Change (FAC), end diastolic left ventricle (LV) diameter, right atrial (RA) area. In addition, we evaluated LV, left atrial (LA), RA and RV strain using transthoracic echocardiography (TTE) obtained at admission.</div></div><div><h3>Results</h3><div>Patients with intermediate-high or high risk of death were older, had more often a familial history of PE, stroke, and cognitive impairment (<em>P</em> <!-->&lt;<!--> <!-->0.05). Patients with intermediate-high or high risk of death had larger RV and RA, more severe RV and LV dysfunction and higher systolic pulmonary arterial pressure. Myocardial strain analyses demonstrated that patients with intermediate-high or high risk of death had significantly lower LV and RV strain, lower LA reservoir, conduit and contractile strain, lower RA reservoir and conduit strain (<em>P</em> <!-->&lt;<!--> <!-->0.05). Multivariate logistic regression analysis (excluding usual 2D echocardiographic parameters used to define RV dysfunction in the ESC risk score) found that RV free wall strain and RA conduit strain could in addition significantly predict the intermediate-high or high-risk group of death (<span><span>Table 1</span></span>).</div></div><div><h3>Conclusion</h3><div>RV and RA strain analysis are potentially interesting new tools in addition to conventional echocardiographic parameters to assess right cavities dysfunction and could contribute to predict short-term outcome in PE.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S55"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and predictors for pacemaker implantation in transthyretin cardiac amyloidosis","authors":"S. Istratoaie,&nbsp;C. Bourg,&nbsp;L. Guillaume,&nbsp;L. Marion,&nbsp;V. Barre,&nbsp;D. Fargeaud,&nbsp;E. Donal","doi":"10.1016/j.acvd.2024.10.012","DOIUrl":"10.1016/j.acvd.2024.10.012","url":null,"abstract":"<div><h3>Introduction</h3><div>The occurrence rate and factors influencing pacemaker (PM) implantation among patients with transthyretin cardiac amyloidosis (ATTR) have not been extensively investigated.</div></div><div><h3>Objective</h3><div>Our objective was to analyze the patterns of permanent PM implantation and to identify predictors for future PM placement in ATTR patients.</div></div><div><h3>Method</h3><div>We enrolled consecutive patients diagnosed with ATTR at referral center between 2016 and 2022. Clinical, laboratory and echocardiographic data were analysed. The primary outcome of the study was PM implantation. Patients with pre-existing PM (<em>n</em> <!-->=<!--> <!-->31) at the time of ATTR diagnosis were excluded.</div></div><div><h3>Results</h3><div>The study population included 160 patients, 88% male, median age 82 (76.85) years. During a median follow-up of 33 months, 37 (23.1%) patients underwent PM implantation. The indications for PM implantation were: 7 patients had a third-degree atrioventricular (AV) block (18.9%), 4 patients had a second-degree type 2 AV block (10.8%); 8 patients (16.2%) had advanced conduction impairment (trifascicular block or syncope with bifascicular block); 8 patients had an indication for cardiac resynchronisation therapy (21.6%); 6 patients (16.2%) with atrial fibrillation (AF) intolerant to rate control therapy underwent atrioventricular node ablation in addition to the PM implantation and 4 patients had AF with symptomatic low heart rate (10.8%). ECG demonstrated a more prolonged PR interval (200 (180–238) vs 180 (160–204) ms, <em>P</em> <!-->=<!--> <!-->0.007) and increased QRS duration (130 (100–150) vs 100 (95–120) ms, <em>P</em> <!-->&lt;<!--> <!-->0.001) with higher rate of both left and right bundle branch block (<em>P</em> <!-->=<!--> <!-->0.004) in patients requiring PM implantation. The echocardiogram showed a more dilated left atrium with a higher stiffness index and an increased interventricular septum (IVS) thickness. Patients that underwent PM implantation had a worse left ventricular (LV) systolic as measured by LV ejection fraction and global longitudinal strain and a more impaired right ventricular (RV) function with a lower TAPSE and RV free wall strain than patients that were not stimulated. At multivariable analysis, IVS thickness (HR<!--> <!-->=<!--> <!-->1.27, <em>P</em> <!-->=<!--> <!-->0.001) and first-degree AV block (HR<!--> <!-->=<!--> <!-->3.6, <em>P</em> <!-->=<!--> <!-->0.006) were independently associated with PM implantation.</div></div><div><h3>Conclusion</h3><div>In our cohort of patients with ATTR, conduction system disease was the main indication for PM implantation. The presence of first-degree atrioventricular block and increased IVS thickness were independent factors associated with PM implantation.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S27-S28"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}