Archives of Cardiovascular Diseases最新文献

{"title":"Assessment of non-inferiority of a hospital-at-home care pathway for patients with acute heart failure: FIL-EAS-ic","authors":"C. Birgy ,&nbsp;J. Candel ,&nbsp;L. Jaunay ,&nbsp;M. Le Caignec ,&nbsp;C. Patin ,&nbsp;L. Kesri-Tartière ,&nbsp;L. Chaibi ,&nbsp;P. Armangau ,&nbsp;L. Gonthier-Maurin ,&nbsp;A. Autret ,&nbsp;M. Harel ,&nbsp;M. Esteveny ,&nbsp;G. Quaino ,&nbsp;I. Lecardonnel ,&nbsp;F. Challal ,&nbsp;J.-M. Tartière","doi":"10.1016/j.acvd.2024.10.010","DOIUrl":"10.1016/j.acvd.2024.10.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute heart failure (AHF) is a common cause of hospitalization and is associated with high mortality rates, long hospital stays and high economic costs worldwide. Novel care pathways are increasingly being considered to address these burdens. FIL-EAS-ic a mixed French conventional hospitalization and hospital-at-home (HaH) care pathway, under the responsibility of a multidisciplinary HF hospital team managing the city-hospital transition has been designed to reduce the length of hospital stay without compromising HF outcomes for patients.</div></div><div><h3>Objective</h3><div>The primary objective of the study described in this protocol will be to evaluate the non-inferiority of the FIL-EAS-ic pathway compared to conventional hospitalization, in terms of all-cause death and unscheduled HF hospitalization at 6 months.</div></div><div><h3>Method</h3><div>A randomized, prospective, (<span><span>NCT04878263</span><svg><path></path></svg></span>) was conducted from June 2021 to June 2023, involving two groups of patients in a 1:2 ratio: (A) a control group following the conventional hospitalization pathway, and (B) the experimental group following the FIL-EAS-ic pathway and including HaH when possible.</div></div><div><h3>Results</h3><div>361 patients were included (454 planned) and intention-to-treat analysis was carried out on 349 patients. The population had the following well balanced characteristics: 78.9<!--> <!-->±<!--> <!-->11.7 years, female 43%, LVEF<!--> <!-->&gt;<!--> <!-->0.40 48%, with main reason for AHF hospitalization: congestive heart failure 57%, pulmonary edema 38%, right heart failure 3%, cardiogenic shock 5%. Analysis of the primary objective showed statistical non-inferiority (A) 33% vs. 25% (B), <em>P</em> <!-->&lt;<!--> <!-->0.001, without being able to demonstrate superiority (<em>P</em> Log-rank<!--> <!-->=<!--> <!-->0.151, HR 0.74 [0.49,1.12]) (<span><span>Fig. 1</span></span>). In group B, 67% were admitted to HaH, resulting in a lower in hospital length of stay of 8.9<!--> <!-->±<!--> <!-->5.5 days (A) vs 5.8<!--> <!-->±<!--> <!-->5.2 days (B), <em>P</em> <!-->&lt;<!--> <!-->0.001. Moreover, access to HF education was higher (39% vs 7%, <em>P</em> <!-->&lt;<!--> <!-->0.001), as was the rate of vaccination against pneumococcus (53% vs 20%, <em>P</em> <!-->&lt;<!--> <!-->0.001) and COVID (91% vs 83%, <em>P</em> <!-->=<!--> <!-->0.033), and the prescription of sacubitril-valsartan in HFREF (55% vs 23%, <em>P</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>FIL-EAS-ic shows, in a very elderly population, that an HF team management of patients hospitalized for AHF, including early HaH hospitalization, is similar to conventional care, with a much shorter length of stay, and a higher quality in terms of access to education, vaccines and treatment.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S26-S27"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151294","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":"Outpatient heart failure worsening in patients with cardiac transthyretin amyloidosis: Results from the Apollo-B trial","authors":"M. Fontana ,&nbsp;S.M. Maurer ,&nbsp;D.J. Gillmore ,&nbsp;S. Bender ,&nbsp;P.Y. Jay ,&nbsp;A. Bakdache ,&nbsp;S. Solomon","doi":"10.1016/j.acvd.2024.10.011","DOIUrl":"10.1016/j.acvd.2024.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospitalization is a significant clinical event in the progression of cardiac transthyretin (ATTR) amyloidosis, but not all patients (pts) who worsen become hospitalized. Outpatient oraldiuretic intensification or diuretic initiation (ODI) for heart failure (HF) has been shown to be prognostic of outcomes in pts with HFrEF or HFpEF</div></div><div><h3>Objective</h3><div>To assess the effect of patisiran on outpatient worsening of HF, characterized by ODI, and the prognostic utility of ODI in patients with ATTR-CM.</div></div><div><h3>Method</h3><div>This post hoc analysis of APOLLO-B (<span><span>NCT03997383</span><svg><path></path></svg></span>; comparing patisiran vs pbo in ATTR cardiomyopathy pts in a 12-month double-blind [DB] period followed by an open-label extension[OLE], in which all pts receive patisiran) assessed the effect of patisiran on ODI and a composite endpoint of all-cause mortality, cardiovascular (CV) events, and ODI by a win-ratio method.</div></div><div><h3>Results</h3><div>In APOLLO-B (combined DB and OLE with all remaining pts having reached Month 24 or later), for patisiran vs pbo (per initial treatment in DB), 61 (33.7%) vs 81 (45.5%) had outpatient ODI, 88 (48.6%) vs 93 (52.2%) had a CV event, and 19 (10.5%) vs 28 (15.7%) died. In Kaplan-Meier analysis, the probability of freedom from ODI was higher with patisiran vs pbo with separation of the two arms during the DB period (HR 0.694; 95% CI: 0.497–0.967) (<span><span>Fig. 1</span></span>). Patisiran was associated with a win ratio of 1.31 (95% CI: 0.97–1.75) on the composite endpoint, reflecting more favorable outcomes than pbo.</div></div><div><h3>Conclusion</h3><div>In APOLLO-B, worsening HF requiring ODI was significantly reduced by patisiran. Patisiran had a favorable effect on the combined risk of all-cause mortality, frequency of CV events, and ODI.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S27"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151302","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":"Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio as a predictor of outcome in acute heart failure","authors":"S. Antit,&nbsp;A. Mrabet,&nbsp;M. Fathi,&nbsp;R. Fekih,&nbsp;I. Boussabeh,&nbsp;L. Zakhama","doi":"10.1016/j.acvd.2024.10.038","DOIUrl":"10.1016/j.acvd.2024.10.038","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute heart failure (AHF) is a life-threatening condition that requires swift diagnosis and tailored management to enhance patient outcomes. In the pursuit of more precise prognostic indicators, Tricuspid Annular Plane Systolic Excursion (TAPSE) and Pulmonary Arterial Systolic Pressure (PASP) have emerged as potential significant advancements. The TAPSE/PASP ratio, a novel parameter, has recently gained attention as a promising predictor of outcomes in acute heart failure.</div></div><div><h3>Objective</h3><div>The present study aims to establish the predictive value of the TAPSE/PASP ratio in determining all-cause mortality and/or rehospitalization in patients dealing with AHF.</div></div><div><h3>Method</h3><div>This was a prospective, monocentric, observational study, conducted from December 2020 to December 2022 in the Cardiology Department of our hospital. We included patients hospitalized for a diagnosis of AHF. Echocardiographic evaluation was performed at the time of admission. RV functions were evaluated by calculating the following (TAPSE, PASP, TAPSE/PASP ratio).</div></div><div><h3>Results</h3><div>The study cohort included 152 consecutive patients. Mean follow up was 18<!--> <!-->±<!--> <!-->6 months. Mean age was 65 years, and the majority (70%) were men. Ischemic heart disease was the leading cause of heart failure, accounting for 50% of all cases. The mean left ventricular ejection fraction was 38%. During follow-up, 69 patients died or were hospitalized for AHF (45%), 29 patients died (19%)within an average period of 3.7 months and 57 patients were hospitalized for AHF (37%). The TAPSE/PASP ratio emerged as a significant independent predictor of clinical outcomes in AHF patients (HR<!--> <!-->=<!--> <!-->2.601;95% CI: 1.044–6.477; <em>P</em> <!-->=<!--> <!-->0.040). Furthermore, among the echocardiographic parameters assessed, the TAPSE/PASP ratio was the sole predictor of rehospitalization for AHF (HR<!--> <!-->=<!--> <!-->3.975; 95% CI: 1.386–11.401; <em>P</em> <!-->=<!--> <!-->0.010). It also independently predicted all-cause mortality in AHF, with an HR of 2.735(; 95% CI: 1.250–9.124; <em>P</em> <!-->=<!--> <!-->0.031). When evaluating its predictive accuracy, the TAPSE/PASP ratio with a cutoff value<!--> <!-->&lt;<!--> <!-->0.35<!--> <!-->mm/mmHg demonstrated a sensitivity of 65%, specificity of 70%, and an area under the receiver operating characteristic (ROC) curve of 0.701 for forecasting adverse outcomes.</div></div><div><h3>Conclusion</h3><div>The non-invasive TAPSE/PASP ratio is an independent predictor of mortality and/or rehospitalization in patients with AHF.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S41-S42"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149751","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":"Impact of high intensity and long duration exercise in genetic arrhythmogenic left ventricular cardiomyopathy","authors":"C. Jean ,&nbsp;B. Guyomarch ,&nbsp;S. Schmitt ,&nbsp;A. Thollet ,&nbsp;S. Clero ,&nbsp;A. Guedon ,&nbsp;A.-L. Laprerie ,&nbsp;N. Piriou","doi":"10.1016/j.acvd.2024.10.018","DOIUrl":"10.1016/j.acvd.2024.10.018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Arrhythmogenic left ventricular (LV) cardiomyopathy (ALVC) is a genetic disease associating extensive LV myocardial fibrosis with or without dysfunction and no or mild right ventricle (RV) involvement, at risk of life-threatening ventricular arrhythmias (VA). While high intensity (HI) and long duration (LD) exercise have been identified as risk factors of RV dysfunction and VA in arrhythmogenic RV cardiomyopathy including in asymptomatic genetic variant carriers, the impact of exercise on disease phenotype and risk is not known in ALVC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To study the relationship between practicing HI and LD exercise and the risk of developing an ALVC phenotype and its severity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;In a retrospective observational study, patients with a pathogenic variant in common &lt;em&gt;ALVC&lt;/em&gt; genes (&lt;em&gt;DSP&lt;/em&gt;, &lt;em&gt;FLNC&lt;/em&gt;, &lt;em&gt;DES&lt;/em&gt;, &lt;em&gt;RBM20&lt;/em&gt;), including asymptomatic carriers, were interviewed about their physical practice from age 7 to the time of genetic or disease diagnosis. HI and LD exercise were defined as having practiced at least 1 sport with an intensity&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;6 METs and&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;2.5&lt;!--&gt; &lt;!--&gt;hours/week respectively. We studied the association of HI and LD exercise practice with the risk of ALVC phenotype occurrence and its severity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;114 out of 128 eligible patients were included (85 (74.6%) with a &lt;em&gt;DSP&lt;/em&gt; variant, 22 &lt;em&gt;FLNC&lt;/em&gt; (19.3%), 6 &lt;em&gt;DES&lt;/em&gt; (5.3%), 1 &lt;em&gt;RBM20&lt;/em&gt; (0.9%)). 35 were probands (31%) and 79 relatives (69%) among 46 families. 31 (27%) had no ALVC phenotype at the time of genetic diagnosis. Mean age at diagnosis was 41&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;18. 62 (54%) patients were women. 97 (85%) had practiced at least one sport, among which 81 (83.5%) at HI and 79 (81.4%) of LD. There were no differences in HI and LD exercise practice between probands and relatives (74.3% vs 69.6%, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.6 and 74.3% vs 67.1%, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.4 respectively), as well as between patients with and patients without ALVC phenotype at the time of diagnosis (74.7% vs 61.3%, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.2 and 72.3% vs 61.3%, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.3 respectively). Phenotypic features at diagnosis did not differ between patients with and without HI and LD practice (&lt;span&gt;&lt;span&gt;Table 1&lt;/span&gt;&lt;/span&gt;). Multivariate analysis adjusted on age and gender showed that HI and LD exercise were not significantly associated with an increased risk of developing an ALVC phenotype (OR [95% CI] for HI and LD exercise were 2.15 [0.63; 7.27] (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.22) and 1.17 [0.35; 3.87] (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.79) respectively).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Practicing HI and LD exercise was not associated with an increased risk of developing an ALVC phenotype and its severity at the time of diagnosis in genetic ALVC variant carriers.&lt;/div&gt;&lt;","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S31"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149780","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":"Heart failure therapeutic units: Prognostic impact","authors":"O. Ferchichi ,&nbsp;O. Zidi ,&nbsp;L. Mariem ,&nbsp;A.A. Mohamed ,&nbsp;I. Imen ,&nbsp;A. Souha ,&nbsp;W. Souissi ,&nbsp;M. Rahma ,&nbsp;S. Aouni ,&nbsp;A. Sabra ,&nbsp;A. Ben Halima ,&nbsp;E. Bennour ,&nbsp;I. Kammoun","doi":"10.1016/j.acvd.2024.10.042","DOIUrl":"10.1016/j.acvd.2024.10.042","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) continues to be a prevalent condition with high morbidity and mortality despite numerous therapeutic advances. Thus, we created a Heart Failure Therapeutic Unit (HFTU) to optimize medical treatment promptly.</div></div><div><h3>Objective</h3><div>Primary objective: to study the impact of the HFTU on reducing cardiovascular mortality and heart failure rehospitalizations at 1 year. Secondary objectives: to study the impact of the HFTU on treatment dose optimization and patient therapeutic adherence.</div></div><div><h3>Method</h3><div>We conducted a prospective, longitudinal, and single-center study at our cardiology department, with a follow-up period of 1 year. We included 159 patients with chronic HF (108 were included in the HFTU group and 51 in the control group). Patients included in the HFTU group received more frequent follow-up, early initiation of medical treatment with rapid progression to optimal doses, and transition to second-line treatments if there was no improvement and if indicated. The control group received standard care.</div></div><div><h3>Results</h3><div>The average age was 62.5<!--> <!-->±<!--> <!-->11.7 years, with a male predominance (80.5%), and a high prevalence of diabetes (44%); ischemic cardiomyopathy was the dominant etiology (57.9%), with a mean left ventricular ejection fraction (LVEF) of 31.6<!--> <!-->±<!--> <!-->8%. The most common inclusion criterion in the HFTU group was the absence of optimal medical treatment (97.2%). We observed a significant reduction in cardiovascular mortality and HF rehospitalizations at 1 year, as well as a significant decrease in HF rehospitalizations at 1 year in the UTIC group compared to the control group (15.7% vs 41.2%; <em>P</em> <!-->&lt;<!--> <!-->0.001; 11.1% vs 35.3%; <em>P</em> <!-->&lt;<!--> <!-->0.001 respectively), regardless of age, gender, and comorbidities (<em>P</em> <!-->&lt;<!--> <!-->0.001). Acquisition of optimal medical treatment (<em>P</em> <!-->&lt;<!--> <!-->0.001) and therapeutic adherence (<em>P</em> <!-->=<!--> <!-->0.015) were more frequent in the HFTU group. We noted an improvement in dyspnea (<em>P</em> <!-->=<!--> <!-->0.003), in LVEF (from<!--> <!-->≤<!--> <!-->40% to<!--> <!-->&gt;<!--> <!-->40%) (<em>P</em> <!-->&lt;<!--> <!-->0.001) and in heart rate control (HR<!--> <!-->&lt;<!--> <!-->70 bpm) (<em>P</em> <!-->&lt;<!--> <!-->0.001) in the HFTU group compared to the control group.</div></div><div><h3>Conclusion</h3><div>HFTU was associated with a significant reduction in the combined endpoint of cardiovascular mortality and heart failure rehospitalizations, as well as a decrease in heart failure rehospitalizations. Additionally, it was associated with more therapeutic optimization and adherence, and an improvement in symptoms, LVEF, and heart rate control.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S44"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150456","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 Body Mass Index and Waist Circumference in Patients With Chronic Heart Failure: Algerian experience","authors":"I. Bouaguel ,&nbsp;A. Trichine","doi":"10.1016/j.acvd.2024.10.049","DOIUrl":"10.1016/j.acvd.2024.10.049","url":null,"abstract":"<div><h3>Introduction</h3><div>To analyze the association between higher body mass index and waist circumference, and the prognostic values of both indicators in total and cardiac mortality in patients with chronic heart failure.</div></div><div><h3>Objective</h3><div>To analyze the association between higher body mass index and waist circumference, and the prognostic values of both indicators in total and cardiac mortality in patients with chronic heart failure.</div></div><div><h3>Method</h3><div>The study included 1954 patients who were followed up for 4 years in military hospitals of Algeria. Obesity was classified as a body mass index<!--> <!-->&gt;<!--> <!-->30 and overweight as a body mass index of 25.0–29.9. Central obesity was defined as waist circumference<!--> <!-->&gt;<!--> <!-->88<!--> <!-->cm for women and<!--> <!-->&gt;<!--> <!-->102<!--> <!-->cm for men. Independent predictors of total and cardiac mortality were assessed in a multivariate Cox model adjusted for confounding variables.</div></div><div><h3>Results</h3><div>Obesity was present in 38% of patients, overweight in 46%, and central obesity in 63%. Body mass index and waist circumference were independent predictors of lower total mortality: hazard ratio<!--> <!-->=<!--> <!-->0.84 (<em>P</em> <!-->&lt;<!--> <!-->.001) and hazard ratio<!--> <!-->=<!--> <!-->0.97 (<em>P</em> <!-->=<!--> <!-->.01), respectively, and lower cardiac death (body mass index, hazard ratio<!--> <!-->=<!--> <!-->0.84, <em>P</em> <!-->&lt;<!--> <!-->.001; waist circumference, hazard ratio<!--> <!-->=<!--> <!-->0.97, <em>P</em> <!-->=<!--> <!-->.01). The interaction between body mass index and waist circumference (hazard ratio<!--> <!-->=<!--> <!-->1.001, <em>P</em> <!-->&lt;<!--> <!-->.01) showed that the protective effect of body mass index was lost in patients with a waist circumference<!--> <!-->&gt;<!--> <!-->120<!--> <!-->cm.</div></div><div><h3>Conclusion</h3><div>Mortality was significantly lower in patients with a high body mass index and waist circumference. The results also showed that this protection was lost when these indicators over a certain limit.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S47"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150461","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":"Epidemiological and clinical insights into heart failure among the elderly: Implications for management","authors":"M. Belhakim,&nbsp;L. Laklalech,&nbsp;Z. Asmae,&nbsp;M. Bouziane,&nbsp;M. Haboub,&nbsp;S. Arous,&nbsp;G. Bennouna,&nbsp;A. Drighil,&nbsp;R. Habbal","doi":"10.1016/j.acvd.2024.10.047","DOIUrl":"10.1016/j.acvd.2024.10.047","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) presents a significant healthcare challenge in the elderly population.</div></div><div><h3>Objective</h3><div>This study aimed to describe the epidemiological, clinical, and therapeutic profile of elderly individuals with HF within our hospital structure.</div></div><div><h3>Method</h3><div>A transversal retrospective study conducted over an 18 year period (2006–2023) included all patients aged over 65 with HF, followed up in the therapeutic unit for heart failure in the cardiology department of our university hospital. Data were collected using Excel.</div></div><div><h3>Results</h3><div>Among the 3990 patients monitored for HF, 1902 were aged over 65 years (47.6%), predominantly men (64.3%), with a mean age of 75.4 yo (66–104). Prevalent cardiovascular risk factors included hypertension (37.2%), diabetes mellitus (30%), dyslipidemia (10%), and tobacco use (31.6%). Notable comorbidities included stroke (17%), chronic obstructive pulmonary disease (1.72%), and end-stage chronic kidney disease (10.3%). Ischemic heart disease (74.8%), dilated cardiomyopathy (11.4%), and valvular heart disease (4.3%) were the principal etiologies of HF. Dyspnea predominated, mainly categorized as New York Heart Association (NYHA) stage II. Atrial fibrillation was present in 11.3% of patients. The distribution of HF types included HFrEF (62.2%), HFpEF (11.9%), and HFmrEF (25.9%). Adherence to pharmacotherapy varied, with most patients adhering to beta-blockers (83.5%), angiotensin-converting enzyme inhibitors (ACE-I) (93.6%), and furosemide (86.2%). The hospitalization rate for acute decompensated HF was 49.2%, with an overall mortality rate of 11.2%.</div></div><div><h3>Conclusion</h3><div>In conclusion, this study outlines HF characteristics in elderly patients, emphasizing high prevalence of risk factors and comorbidities, predominant ischemic etiology, and challenges in management despite pharmacotherapy adherence. Integration of multidisciplinary approaches and tailored interventions may enhance outcomes in this vulnerable population.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S46-S47"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150511","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":"Feasibility, efficacity and safety of a fast up-titration program of heart failure treatments in real-life practice","authors":"L. Blasi ,&nbsp;P. Fournier ,&nbsp;M. Galinier ,&nbsp;J. Roncalli ,&nbsp;C. Delmas ,&nbsp;R. Itier","doi":"10.1016/j.acvd.2024.10.015","DOIUrl":"10.1016/j.acvd.2024.10.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Guideline-directed medical therapy (GDMT) of chronic heart failure (HF) associates four drugs: Beta-Blockers (BB), Angiotensin Receptor-Neprilysin Inhibitor (ARNi), Mineralocorticoid Receptor Antagonists (MRA) and Sodium-Glucose co-Transporter 2 (SGLT2) inhibitors. Their initiation and implementation should begin quickly from the diagnostic, but therapeutic inertia leads to higher mortality and hospitalisation rates.</div></div><div><h3>Objective</h3><div>To evaluate the feasibility, efficacity and safety of an intensive and fast up-titration program of GDMT at three months, limiting factors to GDMT up-titration and factors associated with poor outcomes in this population.</div></div><div><h3>Method</h3><div>We retrospectively included all patients participating to our up-titration program from January 2021 to September 2022. Patients were followed every 2 weeks by consultation (on-site or teleconsultation). We collected clinic-biological, echocardiographic data and GDMT doses at the enrolment, at the end of the up-titration, and three months later.</div></div><div><h3>Results</h3><div>222 patients were enrolled. The mean titration duration was 10 weeks (±<!--> <!-->57 days). The proportion of patients with full dose of ARNi was 1.4% at day one and 44.6% at three months, 4.5% then 32.7% for MRA, and 5% then 15.4% for BB. 90% of the population was treated with SGLT2 inhibitor at 3 months (<span><span>Fig. 1</span></span>). Consecutively, the proportion of patients with loop diuretics decreased from 70.7% to 42.9%. In the meantime, we observed a significant improvement of the dyspnoea (from 85.4% to 45.7% of patient in class II of the NYHA and from 10.8% to 51.1% of patients in class I), the LVEF (from 30.8% to 45.2%) and a decline of the NT-proBNP (from 1322 to 484<!--> <!-->pg/ml). Associated adverse events were hypotension (15.3%), acute renal impairment (14.9%) and hyperkalaemia (6.8%) without difference between on-site and teleconsultation groups. Limiting factors to up-titration of ARNi and MRA were advanced age, low eGFR and high value of the NT-proBNP (&gt;<!--> <!-->1000<!--> <!-->pg/ml). 6 patients died during the study (2.7%) and 16 were readmitted in hospital for HF (7.2%). Persistent treatment with loop diuretics at the end of the up-titration was identified as a poor prognostic, whereas prescription of ARNi was identified as a protective factor.</div></div><div><h3>Conclusion</h3><div>A fast up-titration program is feasible, efficient and safe in real-life practice. Combination of on-site and teleconsultation seems appropriate and should be proposed to fight therapeutic inertia without increasing adverse events.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S29-S30"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150704","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":"Gender disparities in outcomes following percutaneous coronary intervention for unprotected left main coronary artery disease","authors":"A. Ghrab,&nbsp;S. Charfeddine,&nbsp;M. Derwich,&nbsp;R. Gargouri,&nbsp;A. Bahloul,&nbsp;T. Ellouze,&nbsp;M. Jabeur,&nbsp;F. Triki,&nbsp;L. Abid","doi":"10.1016/j.acvd.2024.10.071","DOIUrl":"10.1016/j.acvd.2024.10.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Understanding the nuanced disparities in clinical outcomes between male and female patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (CAD) is pivotal in refining patient care and treatment protocols.</div></div><div><h3>Objective</h3><div>To determine the sex-specific outcomes in left main PCI.</div></div><div><h3>Method</h3><div>We analysed data from 213 patients (48 females; 165 males) with unprotected left main CAD who underwent PCI between January 2012 and January 2023 in our catheterization lab. The primary endpoint was a composite of all-cause mortality, myocardial infarction, or stroke.</div></div><div><h3>Results</h3><div>Median follow-up duration was 2.16 years. Although women tended to be older and had higher rates of diabetes mellitus and hypertension, these distinctions were not statistically significant. Men more frequently presented with left main bifurcation lesions and extensive CAD. Baseline findings revealed that wall motion abnormalities were more prevalent in men compared to women (68.3% <em>vs.</em> 50%, respectively; <em>p</em> <!-->=<!--> <!-->0.020). Notably, the presence of wall motion abnormalities emerged as a significant predictor of adverse outcomes, including total mortality (19.2% <em>vs.</em> 5.4%; <em>p</em> <!-->=<!--> <!-->0.007) and cardiac death (16.2% <em>vs.</em> 2.7%; <em>p</em> <!-->=<!--> <!-->0.003). However, the primary endpoint did not exhibit a statistically significant difference between genders (20.8% <em>vs.</em> 24.8%, respectively; <em>p</em> <!-->=<!--> <!-->0.569). Similarly, the requirement for target lesion revascularization was comparable in both groups (7.9% <em>vs.</em> 12.5%, respectively; <em>p</em> <!-->=<!--> <!-->0.566).</div></div><div><h3>Conclusion</h3><div>Despite variations in clinical and lesion characteristics, female and male patients demonstrated similar long-term outcomes post-PCI for left main CAD.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S13"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150839","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":"Impact of anomalous aortic origin of a coronary artery on coronary angiography: A retrospective analysis","authors":"A. Brochier ,&nbsp;S. Zayed ,&nbsp;J. Corré ,&nbsp;C. Ferdynus ,&nbsp;L.-M. Desroche","doi":"10.1016/j.acvd.2024.10.073","DOIUrl":"10.1016/j.acvd.2024.10.073","url":null,"abstract":"<div><h3>Introduction</h3><div>Anomalous aortic origins of coronary arteries (AAOCA) are not uncommon and are often a challenge for coronary angiography (CA) operators. A detailed evaluation of the effect of AAOCA on CA may help to target the good levers to improve AAOCA catheterisation.</div></div><div><h3>Objective</h3><div>The objective of this study is to evaluate the impact of AAOCA on the quality of CA catheterisations, as well as the associated costs in terms of time, radiation and contrast injection.</div></div><div><h3>Method</h3><div>We conducted a retrospective analysis at Félix Guyon University Hospital on Réunion Island, reviewing 23,625 CA cases from May 2011 to December 2022. We identified 96 cases of AAOCA, each matched with a control based on examination type, year, operator, sex, and age. The primary endpoint was the rate of optimal catheterization defined according the position of the distal part of the catheter downstream of the coronary ostium, resting on the coronary artery. Secondary measures included catheterization failure rates, optimal image quality rates, procedural time, radiation exposure, and contrast media use. Qualitative variables were independently evaluated by three experienced operators.</div></div><div><h3>Results</h3><div>The study found that the optimal catheterization rate for AAOCA patients was significantly lower compared with controls (27.8% <em>vs.</em> 90.6%, <em>p</em> <!-->&lt;<!--> <!-->0.001). Secondary results highlighted a catheterization failure rate of 7.2% for AAOCA versus 0% for control patients (<em>p</em> <!-->&lt;<!--> <!-->0.001). The AAOCA cases showed inferior image quality, longer procedural times (31.5<!--> <!-->±<!--> <!-->18.2 min <em>vs.</em> 30.9<!--> <!-->±<!--> <!-->20.5 min, <em>p</em> <!-->&lt;<!--> <!-->0.001), increased fluoroscopy time (11.5<!--> <!-->±<!--> <!-->7.8 min <em>vs.</em> 6.9<!--> <!-->±<!--> <!-->5.0 min, <em>p</em> <!-->&lt;<!--> <!-->0.001), increased radiation dose (320.5<!--> <!-->±<!--> <!-->357.3 <em>vs.</em> 189.9<!--> <!-->±<!--> <!-->182.6 mGy·cm², <em>p</em> <!-->&lt;<!--> <!-->0.001), and higher contrast used (99.6<!--> <!-->±<!--> <!-->62.7 ml <em>vs.</em> 61.2<!--> <!-->±<!--> <!-->54.4 ml, <em>p</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>The presence of AAOCA resulted in a significant reduction in the quality of the catheterisation procedure, despite an increase in the cost of time, radiation and contrast. These findings suggest that a standardised protocol may be beneficial in improving the quality of CA catheterisation in cases of AAOCA.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S14"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150841","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}