Archives of Cardiovascular Diseases最新文献

{"title":"Advanced myocardial deformation echocardiography for evaluation of the athlete's heart: Functional and mechanistic analysis","authors":"Eva Colne ,&nbsp;Nathalie Pace ,&nbsp;Antoine Fraix ,&nbsp;Félix Gauthier ,&nbsp;Christine Selton-Suty ,&nbsp;Bruno Chenuel ,&nbsp;Nicolas Sadoul ,&nbsp;Nicolas Girerd ,&nbsp;Zohra Lamiral ,&nbsp;Jérôme Felloni ,&nbsp;Karim Djaballah ,&nbsp;Laura Filippetti ,&nbsp;Olivier Huttin","doi":"10.1016/j.acvd.2024.05.121","DOIUrl":"10.1016/j.acvd.2024.05.121","url":null,"abstract":"<div><h3>Background</h3><div>Assessment of the athlete's heart is challenging because of a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The potential value of myocardial deformation remains controversial in identifying early cardiomyopathy.</div></div><div><h3>Aim</h3><div>To identify the echocardiographic phenotype of athletes using advanced two-dimensional speckle tracking imaging, and to define predictive factors of subtle left ventricular systolic dysfunction.</div></div><div><h3>Methods</h3><div>In total, 191 healthy male athletes who underwent a preparticipation medical evaluation at Nancy University Hospital between 2013 and 2020 were included. Clinical and echocardiographic data were compared with 161 healthy male subjects from the STANISLAS cohort. Borderline global longitudinal strain value was defined as<!--> <!-->&lt;<!--> <!-->17.5%.</div></div><div><h3>Results</h3><div>Athletes demonstrated lower left ventricular ejection fraction (57.9<!--> <!-->±<!--> <!-->5.3% vs. 62.6<!--> <!-->±<!--> <!-->6.4%; <em>P</em> <!-->&lt;<!--> <!-->0.01) and lower global longitudinal strain (17.5<!--> <!-->±<!--> <!-->2.2% vs. 21.1<!--> <!-->±<!--> <!-->2.1%; <em>P</em> <!-->&lt;<!--> <!-->0.01). No significant differences were found between athletes with and without a borderline global longitudinal strain value regarding clinical characteristics, structural echocardiographic features and exercise capacity. A borderline global longitudinal strain value was associated with a lower endocardial global longitudinal strain (18.8<!--> <!-->±<!--> <!-->1.2% vs. 22.7<!--> <!-->±<!--> <!-->1.9%; <em>P</em> <!-->=<!--> <!-->0.02), a lower epicardial global longitudinal strain (14.0<!--> <!-->±<!--> <!-->1.1% vs. 16.6<!--> <!-->±<!--> <!-->1.2%; <em>P</em> <!-->&lt;<!--> <!-->0.01) and a higher endocardial/epicardial global longitudinal strain ratio (1.36<!--> <!-->±<!--> <!-->0.07 vs. 1.32<!--> <!-->±<!--> <!-->0.06; <em>P</em> <!-->&lt;<!--> <!-->0.01). No significant difference was found regarding mechanical dispersion (<em>P</em> <!-->=<!--> <!-->0.46).</div></div><div><h3>Conclusions</h3><div>Borderline global longitudinal strain value in athletes does not appear to be related to structural remodelling, mechanical dispersion or exercise capacity. The athlete's heart is characterized by a specific myocardial deformation pattern with a more pronounced epicardial layer strain impairment.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997020","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":"Scientific statement from the French neurovascular and cardiac societies for improved detection of atrial fibrillation after ischaemic stroke and transient ischaemic attack","authors":"Nicolas Gaillard ,&nbsp;Jean-Claude Deharo ,&nbsp;Laurent Suissa ,&nbsp;Pascal Defaye ,&nbsp;Igor Sibon ,&nbsp;Christophe Leclercq ,&nbsp;Sonia Alamowitch ,&nbsp;Céline Guidoux ,&nbsp;Ariel Cohen ,&nbsp;French Neurovascular Society,&nbsp;French Society of Cardiology","doi":"10.1016/j.acvd.2024.06.002","DOIUrl":"10.1016/j.acvd.2024.06.002","url":null,"abstract":"<div><div>Atrial fibrillation (AF) is the primary cause of ischaemic stroke and transient ischaemic attack (TIA). AF is associated with a high risk of recurrence, which can be reduced using optimal prevention strategies, mainly anticoagulant therapy. The availability of effective prophylaxis justifies the need for a significant, coordinated and thorough transdisciplinary effort to screen for AF associated with stroke. A recent French national survey, initiated and supported by the Société française neurovasculaire (SFNV) and the Société française de cardiologie (SFC), revealed many shortcomings, such as the absence or inadequacy of telemetry equipment in more than half of stroke units, insufficient and highly variable access to monitoring tools, delays in performing screening tests, heterogeneous access to advanced or connected ambulatory monitoring techniques, and a lack of dedicated human resources. The present scientific document has been prepared on the initiative of the SFNV and the SFC with the aim of helping to address the current shortcomings and gaps, to promote efficient and cost-effective AF detection, and to improve and, where possible, homogenize the quality of practice in AF screening among stroke units and outpatient post-stroke care networks. The working group, composed of cardiologists and vascular neurologists who are experts in the field and are nominated by their peers, reviewed the literature to propose statements, which were discussed in successive cycles, and maintained, either by consensus or by vote, as appropriate. The text was then submitted to the SFNV and SFC board members for review. This scientific statement document argues for the widespread development of patient pathways to enable the most efficient AF screening after stroke. This assessment should be carried out by a multidisciplinary team, including expert cardiologists and vascular neurologists.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1875213624002870/pdfft?md5=71c313911484ddcab3c3fd63cc51412a&pid=1-s2.0-S1875213624002870-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological risk markers for major adverse events following transcatheter closure of ostium secundum atrial septal defects in 2253 children and adults","authors":"G. Albenque,&nbsp;E. Valdeolmillos,&nbsp;C. Foray,&nbsp;M. Jaber,&nbsp;F. Lecerf,&nbsp;E. Belli,&nbsp;C. Batteux,&nbsp;J. Petit,&nbsp;S. Hascoët","doi":"10.1016/j.acvd.2024.07.016","DOIUrl":"10.1016/j.acvd.2024.07.016","url":null,"abstract":"<div><h3>Introduction</h3><p>Since the 2000s, transcatheter closure has been the primary treatment for ostium secundum atrial septal defect (osASD) in children and adults.</p></div><div><h3>Objective</h3><p>This study aims to identify factors associated with short-term adverse outcomes following this procedure in a large cohort.</p></div><div><h3>Methods</h3><p>A prospective, single-center cohort study included 2,253 consecutive patients (median age 28<!--> <!-->years; children: <em>n</em> <!-->=<!--> <!-->865, 38.4%) who underwent transcatheter ASD closure with the Amplatzer Septal Occluder (ASO; Amplatzer™ Atrial Septal Occluder Device, Abbott, Chicago, USA) from May 1998 to December 2021. Peri-procedural data associated with major adverse events were investigated retrospectively.</p></div><div><h3>Results</h3><p>The mean ASD diameter, as measured by transthoracic echocardiography, was 18<!--> <!-->mm. About 8.9% of patients had an ASD size-to-body surface area (BSA) ratio of<!--> <!-->≥<!--> <!-->20<!--> <!-->mm/m². Deficient rims (&lt;<!--> <!-->5<!--> <!-->mm) were identified in 27.9% of patients, with retroaortic rim deficiency in 22.7% and inferior rim deficiency in 0.9%. The median ASO diameter was 24<!--> <!-->mm, with a procedural success rate of 98.2%. ASD/BSA<!--> <!-->≥<!--> <!-->20<!--> <!-->mm/m² was associated with procedural failure, while age and weight were not. Major peri-procedural adverse events occurred in 31 patients (1.4%), with 19 device embolizations and 2 cardiac erosions. No peri-procedural deaths were reported. Multivariate analysis showed that deficiency of the inferior vena cava rim and an ASD size/BS ratio<!--> <!-->≥<!--> <!-->20<!--> <!-->mm/m² were significantly associated with major adverse events (<em>P</em> <!-->=<!--> <!-->0.002 and <em>P</em> <!-->=<!--> <!-->0.035, respectively) (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>Transcatheter osASD closure using ASO is safe and effective in a large spectrum population with low rate of peri-procedural adverse events and favorable short-term outcomes. ASD size-to-body surface area ratio (≥<!--> <!-->20<!--> <!-->mm/m²) and inferior rim deficiency are key morphological risk markers for major adverse events following this procedure.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271048","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":"Transcatheter pulmonary valve implantation: Initial experience with self-expandable valve in patients with congenital heart diseases and comparison with balloon-expandable valve","authors":"Q. Rouau","doi":"10.1016/j.acvd.2024.07.027","DOIUrl":"10.1016/j.acvd.2024.07.027","url":null,"abstract":"<div><h3>Introduction/Background</h3><p>Self-expandable valves have emerged as an alternative option for transcatheter pulmonary valve replacement (TPVR) compared to balloon-expandable valves. However, their efficacy in patients with congenital heart diseases remains relatively unexplored.</p></div><div><h3>Objective</h3><p>This study aims to compare the characteristics and outcomes of patients who underwent TPVR with self-expandable valves versus balloon-expandable valves.</p></div><div><h3>Methods</h3><p>A prospective single-center analysis was conducted, encompassing all consecutive patients (<em>n</em> <!-->=<!--> <!-->89) who underwent TPVR using either balloon-expandable valves (Sapien 3 valves, <em>n</em> <!-->=<!--> <!-->63, 70%) or self-expandable valves (Venus-P, <em>n</em> <!-->=<!--> <!-->26, 30%) between January 2022 and February 2024. Patient characteristics, procedural data, and short-term outcomes were compared. Electrophysiological studies were performed in all patients with tetralogy of Fallot (ToF) prior to the procedure.</p></div><div><h3>Results</h3><p>The median age of patients was 34<!--> <!-->years for Sapien 3 (11 children, youngest: 8<!--> <!-->years) and 46<!--> <!-->years for Venus-P (one child aged 15<!--> <!-->years), <em>P</em> <!-->=<!--> <!-->0.014. Tetralogy of Fallot (ToF) was the primary diagnosis in 49 cases (55%, 32 with Sapien 3 and 17 with Venus-P valve, <em>P</em> <!-->=<!--> <!-->0.041). Native or patched right ventricular outflow tracts were identified in 100% and 54% of patients with Venus-P and Sapien 3 valves, respectively, <em>P</em> <!-->&lt;<!--> <!-->0.001.</p><p>Valve implantation was successful in all patients. Major adverse events occurred in 4.5% of cases (3.8% in Sapien 3 vs. 4.7% in Venus P-valve group, <em>P</em> <!-->=<!--> <!-->0.66). Ventricular ectopy necessitating medical therapy was more frequent in the Venus-P group (19% vs. 0%, <em>P</em> <!-->=<!--> <!-->0.002) including one case of sustained asymptomatic ventricular tachycardia, managed with amiodarone therapy. No peri-procedural deaths were reported.</p></div><div><h3>Conclusion</h3><p>Self-expandable valves demonstrate efficacy for TPVR in patients with large native or patched right ventricular outflow tracts, accompanied by a low rate of major adverse events. However, an increased incidence of ventricular arrhythmias was noted compared to balloon-expandable valves, indicating the importance of long-term follow-up data to better understand outcomes.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271053","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":"Clinical and paraclinical evolution of term and near term neonates with persistent pulmonary hypertension, treated with treprostinil and/or epoprostenol, hospitalized in NICU","authors":"C. Mazepa ,&nbsp;S. Mur ,&nbsp;G. Gascoin ,&nbsp;L. Storme ,&nbsp;N. Joram ,&nbsp;C. Viard ,&nbsp;Y. Dulac ,&nbsp;M. Butin ,&nbsp;S. Breinig","doi":"10.1016/j.acvd.2024.07.013","DOIUrl":"10.1016/j.acvd.2024.07.013","url":null,"abstract":"<div><h3>Introduction</h3><p>Persistent pulmonary hypertension of the newborn (PPHN) is a serious disease that occurs in 1.9 per 1000 live births. Epoprostenol and treprostinil, witch are prostacyclin analogues, are used by some care teams in the treatment of PPHN, in absence of established proof of their efficacy in this indication.</p></div><div><h3>Objective</h3><p>The main objective of this retrospective multicenter study was to evaluate clinical and paraclinical evolution of newborns treated with treprostinil and/or epoprostenol during neonatal period.</p></div><div><h3>Methods</h3><p>Inclusion of neonates<!--> <!-->≥<!--> <!-->34<!--> <!-->SA and aged<!--> <!-->≤<!--> <!-->28<!--> <!-->days, with clinical signs and<!--> <!-->≥<!--> <!-->1 ultrasound sign of pulmonary hypertension, treated with treprostinil and/or epoprostenol between 01/01/17 and 31/12/22 in 4 French teaching hospitals. Data collected included clinical, biological and ultrasound parameters.</p></div><div><h3>Results</h3><p>Seventy patients were included, with a mean age of 39<!--> <!-->SA<!--> <!-->+<!--> <!-->2.5<!--> <!--> days and a mean birth weight of 3200<!--> <!-->g, including 40 congenital diaphragmatic hernia (57%). On arrival in NICU over 90% of newborns had iso or supra-systemic pulmonary hypertension. The introduction of prostacyclin analogues appears to have a beneficial effect on the pre- and post-ductal saturation differential as well as on the echocardiographic evolution of pulmonary hypertension. The temporality of evolution of pulmonary hypertension seems to depend on the underlying etiology due to the different pathophysiological mechanisms. Moreover, our study shows that epoprostenol and treprostinil can be used in neonates suffering from iNO refractory PPHN without significant adverse effects.</p></div><div><h3>Conclusion</h3><p>We report few adverse effects of epoprostenol and treprostinil in neonates treated for in iNO refractory PPHN. However, the heterogeneity of practices between centers requires further studies to establish recommendations for the use of these molecules in severe neonatal pulmonary hypertension.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271095","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":"Pulmonary artery growth in Fontan: What is the most effective strategy?","authors":"N. Derridj,&nbsp;M. Hily,&nbsp;L. Houyel,&nbsp;S. Malekzadeh-Milani,&nbsp;D. Bonnet","doi":"10.1016/j.acvd.2024.07.035","DOIUrl":"10.1016/j.acvd.2024.07.035","url":null,"abstract":"<div><h3>Introduction</h3><p>The best strategy to achieve optimal growth of pulmonary artery branches (PAs) in functionally univentricular heart (FUH) between partial cavopulmonary connection (PCPC) and total cavopulmonary connection (TCPC) is still controversial, especially the preservation of anterograde pulmonary blood flow (APBF).</p></div><div><h3>Objective</h3><p>To model the growth of PA in FUH between PCPC and TCPC and to assess whether APBF promotes this growth. Then to determine whether the maintenance of an APBF is associated with higher morbidity and mortality.</p></div><div><h3>Methods</h3><p>We retrospectively included all patients with FUH who underwent cardiac catheterization before PCPC and TCPC between 2004 and 2021. A linear regression model was used to model PA growth. We compared mortality and morbidity outcomes between the APBF group and no APBF group using the Kaplan–Meier method.</p></div><div><h3>Results</h3><p>In total, 118 children with FUH with a median follow-up of 8.8<!--> <!-->years were included, 49 (41.5%) had maintained APBF. PA branch growth can be considered continuous and linear over time [fractional polynomials (<em>P</em> <!-->=<!--> <!-->0.2)], estimated at β<!--> <!-->=<!--> <!-->8.5 [0.7–16.2] mm²/year. In multivariate analysis, maintaining an APBF was the only factor associated with increased PA branch growth [β<!--> <!-->=<!--> <!-->55.9 (21.8; 90) mm² (<em>P</em> <!-->=<!--> <!-->0.01)], regardless of TCPC timing (<span><span>Fig. 1</span></span>). Before PCPC, there was no difference in mean pulmonary artery pressure (mPAP) between groups with and without APBF. Between PCPC and TCPC, there was no significant increase in mPAP [13.2 (12–16) vs. 14.1 (12.4–15.8), <em>P</em> <!-->=<!--> <!-->0.3] or transpulmonary pressure gradient [7.2 (5.2–9.3) vs. 6.9 (4.6–9.1), <em>P</em> <!-->=<!--> <!-->0.6] in the APBF group. There was no difference in survival at 6<!--> <!-->years after TCPC between the group with APBF [87.6, 95% CI (65.6%–95.9%)] and the group without APBF [82.3 95% CI (67.8–90.6)]. No difference was also found when comparing morbidity characteristics between the two groups, such as length of hospital stay after TCPC (<em>P</em> <!-->=<!--> <!-->0.7), chylothorax (<em>P</em> <!-->=<!--> <!-->0.81), hemodynamic contraindications to fenestration closure (<em>P</em> <!-->=<!--> <!-->0.9), failing Fontan rate (<em>P</em> <!-->=<!--> <!-->0.38).</p></div><div><h3>Conclusion</h3><p>PAs growth between PCPC and TCPC is significant and can be considered linear over time. By maintaining APBF, growth potential can be achieved much more quickly and without additional risk of morbidity or mortality.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271310","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":"Deaths and major cardiovascular events in patients with lymphoma: Analysis from a French nationwide hospitalization database","authors":"","doi":"10.1016/j.acvd.2024.05.117","DOIUrl":"10.1016/j.acvd.2024.05.117","url":null,"abstract":"<div><h3>Background</h3><div>There are few data assessing the risk of death and cardiovascular events in patients with lymphoma.</div></div><div><h3>Aim</h3><div>Using a nationwide hospitalization database, we aimed to address cardiovascular outcomes in patients with lymphoma.</div></div><div><h3>Methods</h3><div>From 01 January to 31 December 2013, 3,381,472 adults were hospitalized in French hospitals; 22,544 of these patients had a lymphoma. The outcome analysis (all-cause or cardiovascular death, myocardial infarction, ischaemic stroke, bleedings, new-onset heart failure and new-onset atrial fibrillation) was performed over a 5-year follow-up period. Each patient with lymphoma was matched with a patient without a lymphoma or other cancer (1:1). A competing risk analysis was also performed.</div></div><div><h3>Results</h3><div>After adjustment on all risk factors, cardiovascular and non-cardiovascular co-morbidities, the subdistribution hazard ratios for all-cause death, major bleeding, intracranial bleeding, new-onset heart failure and new-onset atrial fibrillation were higher in patients with lymphoma; conversely, the subdistribution hazard ratios for cardiovascular death, myocardial infarction and ischaemic stroke were lower in patients with lymphoma. In the matched analysis, the risk of all-cause death (subdistribution hazard ratio 1.936, 95% confidence interval 1.881–1.992) and major bleeding (subdistribution hazard ratio 1.117, 95% confidence interval 1.049–1.188) remained higher in patients with lymphoma.</div></div><div><h3>Conclusion</h3><div>In this large nationwide cohort study, patients with lymphoma had a higher incidence of all-cause death and major bleeding.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408346","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":"Outcomes of postoperative mediastinitis in children","authors":"S. Bernheim,&nbsp;S. Chikkhi,&nbsp;I. Foufa,&nbsp;A. Haydar,&nbsp;P. Parize,&nbsp;D. Bonnet,&nbsp;O. Raisky","doi":"10.1016/j.acvd.2024.07.046","DOIUrl":"10.1016/j.acvd.2024.07.046","url":null,"abstract":"<div><h3>Introduction</h3><p>Mediastinitis is a severe complication of heart surgery well described in the adult population. However very few studies focused on the description of mediastinitis and its outcomes in pediatric patients.</p></div><div><h3>Objective</h3><p>To describe the clinical features and outcomes of postoperative mediastinitis in children and identify risk factors for mortality.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed all children with mediastinitis over a period of 10 years (2013–2023). Mediastinitis was defined by a purulent discharge of the mediastinum requiring surgery or organisms cultured from discharge of the mediastinal area.</p></div><div><h3>Results</h3><p>The incidence of mediastinitis was 0.74% (57 cases). Median age at surgery was 12 days with 67% patients younger than 3 months old. Sixty percent had delayed sternal closure. Median delay between surgery and diagnosis was 8 days (range: 2–39). The most frequent germs were <em>Staphylococcus</em> (46%), gram negative bacteria (35%) and fungi (9%). All patients had surgical debridement: 46 (81%) in the operating room and 11 (19%) in the ICU. Median duration of antibiotic therapy was 44 days. Median duration of stay was 21 days (range: 10–113) in the ICU and 35 days (range: 11–188) until hospital discharge. Outcomes in the ICU included a median of 8 days of assisted ventilation. Nine patients needed veno-arterial ECMO. Mortality rate was 27% with 12 out of 15 deaths occurring in the ICU. Mortality risk factors were surgical revision in the ICU compared to the operating room (OR 4.9; CI95% 1.3 to 19.9), delayed sternal closure superior to 3 days (OR: 5.0; 95% CI: 1.3 to 16.5) and fungal mediastinitis (OR: 14.9; 95% CI: 2.0 to 185.4).</p></div><div><h3>Conclusion</h3><p>Mediastinitis leads to high mortality and morbidity in children. Mortality risk factors are: surgical revision in the ICU, prolonged delayed sternal closure and fungus infection. Patients with prolonged delayed sternal closure should be regularly screened for fungal colonization to prevent fungal mediastinitis.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271172","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":"Cardiac MRI characteristics and prognostic value in pediatric myocarditis","authors":"A. Moktadir,&nbsp;E. Daire,&nbsp;C. Renard,&nbsp;S. Dirani,&nbsp;M. Selegny","doi":"10.1016/j.acvd.2024.07.049","DOIUrl":"10.1016/j.acvd.2024.07.049","url":null,"abstract":"<div><h3>Introduction</h3><p>Acute myocarditis (AM) is a rare disease of the heart muscle. Diagnosis involves a combination of clinical, biological and radiological findings. Cardiac MRI is a highly effective diagnostic tool. Recent studies in both pediatric and adult patients have shown a connection between the location of fibrosis (scarring) detected on MRI and subsequent health issues. Patients with AM are at risk of developing dilated cardiomyopathy and major cardiovascular events.</p></div><div><h3>Objective</h3><p>Our objective is to investigate whether the location of fibrosis lesions found on cardiac MRI differs between children with and without cardiac dysfunction.</p></div><div><h3>Methods</h3><p>This retrospective study was conducted at Amiens University Hospital. The study included children diagnosed with AM who underwent both an initial cardiac MRI and a follow-up MRI. We recorded the number of segments showing edema and late enhancement (scarring) on the MRI images. Additionally, we assessed cardiac function and collected all relevant clinical and biological data.</p></div><div><h3>Results</h3><p>A total of 31 children with AM, with an average age of 12<!--> <!-->years, were included in the study. Most of the children exhibited typical involvement of the left ventricle in the inferolateral region. We found no association between the typical MRI localization and initial cardiac dysfunction (OR<!--> <!-->=<!--> <!-->0.25 [0.04, 1.24], <em>P</em> <!-->=<!--> <!-->0.091). However, patients with extensive edema experienced a decrease in subsequent MRI sequelae (scarring) by 0.69 [0.42, 0.97] per additional affected segment (<em>P</em> <!-->=<!--> <!-->0.029). Furthermore, children with more than 2 affected segments had longer hospital stays (OR<!--> <!-->=<!--> <!-->4.8 [1.03; 26.09], <em>P</em> <!-->=<!--> <!-->0.045) (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>The presence of initial edema appears to have a protective effect against subsequent MRI sequelae (scarring). Further studies are necessary to identify a specific subgroup of patients who are at a higher risk of developing dilated cardiomyopathy or major cardiovascular events.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271175","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":"Acute myocarditis according to age: Presentation, management, and early outcomes","authors":"C. Karsenty ,&nbsp;P. Vignaud-Marighetto ,&nbsp;C. Brusq ,&nbsp;P. Moceri ,&nbsp;P. Lim ,&nbsp;C. Ovaert ,&nbsp;S. Di Filippo ,&nbsp;C. Delmas","doi":"10.1016/j.acvd.2024.07.006","DOIUrl":"10.1016/j.acvd.2024.07.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Acute myocarditis (AM) is a rare but severe disease affecting patients of all age. Large multicentric data comparing children and adults are lacking.</p></div><div><h3>Objective</h3><p>We aimed to elucidate differences in presentation, management, and outcomes of AM across age groups.</p></div><div><h3>Methods</h3><p>A comprehensive French national cohort study, encompassing 53 pediatric and adult units from March 2020 to November 2021, was analysed. Baseline characteristics and evolution, management and in-hospital complications were collected. Major cardiovascular events (MACE) within 30 days included all-cause death, cardiogenic shock, cardiac arrest, ventricular arrhythmias, or complete AV block.</p></div><div><h3>Results</h3><p>We included 745 AM patients (328 children and 417 adults), mainly male (73.4%) with a median age of 19.8 years [IQR: 12.5–30.9]. Multisystem inflammatory syndrome (MIS) was more prevalent among pediatric cases (69.8%), whereas infectious aetiology dominated in adults (13.4 vs. 52.4%). Children exhibited a more severe clinical presentation, with increased risk of heart failure (15.9 vs. 7.2%) and cardiogenic shock (14.4 vs. 6.9%), requiring higher use of inotropes (25.0 vs. 9.4%), vasopressors (12.0 vs. 6.2%), and ventilatory support (12.5 vs. 7.7%). Cardiac treatments such as beta-blockers (33.4 vs. 84.4%) or ACE/ARB (37.3 vs. 63.1%) were less often used in children whereas corticosteroids (68.3 vs. 14.3%) and immunomodulators (65.1 vs. 4.5%) were more often used. MACE occurrence was substantial but not significantly different between children and adults (18.1 vs. 13.4%). Extra-cardiac manifestations at admission were significant predictors of MACE (aOR: 2.40 [1.43–4.38]), regardless of multisystem inflammatory syndrome (MIS) status.</p></div><div><h3>Conclusion</h3><p>AM exhibits variations in presentation, aetiologies, and management, but shares a comparable 30-day prognosis in children and adults.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271235","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}