Archives of Cardiovascular Diseases最新文献

{"title":"A clinician viewpoint on the 2024 European guidelines on the management of patients with atrial fibrillation","authors":"Laurent Fauchier , Jean Claude Deharo , Frederic Sacher , Ariel Cohen","doi":"10.1016/j.acvd.2024.12.003","DOIUrl":"10.1016/j.acvd.2024.12.003","url":null,"abstract":"","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 2","pages":"Pages 81-84"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873569","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":"Machine learning to detect recent recreational drug use in intensive cardiac care units.","authors":"Nathan El Bèze, Kenza Hamzi, Patrick Henry, Antonin Trimaille, Amine El Ouahidi, Cyril Zakine, Olivier Nallet, Clément Delmas, Victor Aboyans, Marc Goralski, Franck Albert, Eric Bonnefoy-Cudraz, Thomas Bochaton, Guillaume Schurtz, Pascal Lim, Antoine Lequipar, Trecy Gonçalves, Emmanuel Gall, Thibaut Pommier, Léo Lemarchand, Christophe Meune, Sonia Azzakani, Claire Bouleti, Jonas Amar, Jean-Guillaume Dillinger, P Gabriel Steg, Eric Vicaut, Solenn Toupin, Théo Pezel","doi":"10.1016/j.acvd.2024.12.010","DOIUrl":"https://doi.org/10.1016/j.acvd.2024.12.010","url":null,"abstract":"<p><strong>Background: </strong>Although recreational drug use is a strong risk factor for acute cardiovascular events, systematic testing is currently not performed in patients admitted to intensive cardiac care units, with a risk of underdetection. To address this issue, machine learning methods could assist in the detection of recreational drug use.</p><p><strong>Aims: </strong>To investigate the accuracy of a machine learning model using clinical, biological and echocardiographic data for detecting recreational drug use in patients admitted to intensive cardiac care units.</p><p><strong>Methods: </strong>From 07 to 22 April 2021, systematic screening for all traditional recreational drugs (cannabis, opioids, cocaine, amphetamines, 3,4-methylenedioxymethamphetamine) was performed by urinary testing in all consecutive patients admitted to intensive cardiac care units in 39 French centres. The primary outcome was recreational drug detection by urinary testing. The framework involved automated variable selection by eXtreme Gradient Boosting (XGBoost) and model building with multiple algorithms, using 31 centres as the derivation cohort and eight other centres as the validation cohort.</p><p><strong>Results: </strong>Among the 1499 patients undergoing urinary testing for drugs (mean age 63±15 years; 70% male), 161 (11%) tested positive (cannabis: 9.1%; opioids: 2.1%; cocaine: 1.7%; amphetamines: 0.7%; 3,4-methylenedioxymethamphetamine: 0.6%). Of these, only 57% had reported drug use. Using nine variables, the best machine learning model (random forest) showed good performance in the derivation cohort (area under the receiver operating characteristic curve=0.82) and in the validation cohort (area under the receiver operating characteristic curve=0.76).</p><p><strong>Conclusions: </strong>In a large intensive cardiac care unit cohort, a comprehensive machine learning model exhibited good performance in detecting recreational drug use, and provided valuable insights into the relationships between clinical variables and drug use through explainable machine learning techniques.</p>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384104","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":"Cyanosis period: A key factor influencing exercise cardiac performance after Fontan procedure.","authors":"Pauline David, Elena Panaioli, Laurence Iserin, Julie Karila-Cohen, Anne-Solène Chaussade, Sophie Malekzadeh-Milani, Fanny Bajolle, Damien Bonnet, Diala Khraiche, Antoine Legendre","doi":"10.1016/j.acvd.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.acvd.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>Most patients with Fontan circulation struggle to increase cardiac output during exercise, affecting aerobic capacity and quality of life.</p><p><strong>Aim: </strong>We sought to identify factors in the preFontan period and in management that influence their exercise cardiac performance.</p><p><strong>Methods: </strong>We retrospectively collected anatomical, clinical and pre- and postFontan invasive haemodynamic data, including ventricular filling pressure in 57 consecutive Fontan patients who underwent cardiopulmonary exercise testing. Exercise cardiac performance was assessed by peak cardiac index measurement using a thoracic bioelectrical impedance device.</p><p><strong>Results: </strong>The median age at Fontan procedure was 6.3 (interquartile range 2.8) years, and 43 patients had concomitant fenestration. Age at cardiopulmonary exercise testing was 14.7 (interquartile range 5.4) years. In multivariable models, peak cardiac index was influenced by cyanosis duration (B=-0.272; P<0.0001) and by the Norwood procedure (-1.977; P=0.002). Peak indexed stroke volume was influenced by cyanosis duration (B=-1.109; P=0.0002), whereas peak heart rate was influenced by preFontan peripheral oxygen saturation (B=0.602; P=0.009). Cyanosis duration≤6.9 years predicted a peak indexed stroke volume≥45mL/m² (area under the curve=0.747; P=0.001). Furthermore, peak indexed stroke volume and peak heart rate were correlated with postFontan ventricular filling pressure: r_p=-0.539 (P=0.012) and r_p=-0.552 (P=0.010), respectively. PostFontan ventricular filling pressure was correlated with bidirectional cavopulmonary shunt duration (r_s=0.498; P=0.023).</p><p><strong>Conclusions: </strong>Cyanosis duration and low preFontan peripheral oxygen saturation affect exercise cardiac performance after Fontan, partly through ventricular dysfunction. Early Fontan procedure and limited postFontan cyanosis could promote better long-term exercise cardiac performance.</p>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384009","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 of ventricular arrhythmias after implantable cardioverter-defibrillator implantation or replacement, and driving restriction consequences","authors":"Thomas Marc ,&nbsp;Karim Benali ,&nbsp;Pierre Groussin ,&nbsp;Redwane Rakza ,&nbsp;Joana Brito ,&nbsp;Nathalie Behar ,&nbsp;Philippe Mabo ,&nbsp;Dominique Pavin ,&nbsp;Christophe Leclercq ,&nbsp;Vincent Galand ,&nbsp;Raphaël P. Martins","doi":"10.1016/j.acvd.2024.10.005","DOIUrl":"10.1016/j.acvd.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Following implantation/replacement of an implantable cardioverter-defibrillator, patients are legally subjected to variable lengths of driving restrictions based on the indication (1 and 3 months after primary and secondary prevention, respectively; 1 week after device replacement).</div></div><div><h3>Aim</h3><div>To assess the incidence of ventricular arrhythmia during the theoretical driving restriction period in a large cohort of patients.</div></div><div><h3>Methods</h3><div>Patients who underwent implantable cardioverter-defibrillator implantation for primary or secondary prevention or device replacement between 2015 and 2021 were included retrospectively. The primary endpoint was the occurrence of ventricular arrhythmia during the theoretical driving restriction period, as defined by guidelines.</div></div><div><h3>Results</h3><div>A total of 914 patients were analysed, including 654 first implantations (438 and 216 for primary and secondary prevention, respectively) and 260 device replacements. The primary outcome occurred in 2/438 patients (0.004%) during the 1-month period following device implantation for primary prevention and in 25/216 patients (11.5%) during the 3-month period following device implantation for secondary prevention; it did not occur in the 1-week period following device replacement. The monthly calculated risk of harm remained below the accepted threshold of 0.005% for each group.</div></div><div><h3>Conclusions</h3><div>Primary prevention patients, such as those who have undergone device replacement, have a low risk of ventricular arrhythmia, which could lead to a reduction in their driving restriction period. Secondary prevention patients experienced a higher risk of recurrent ventricular arrhythmia, supporting the 3-month driving restriction period.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages 35-42"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693923","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":"The significance of residual inflammation in mortality risk stratification for Takotsubo syndrome: Evaluating CRP measurement alongside the InterTAK Prognostic Score","authors":"L. Faucher ,&nbsp;B. Marchandot ,&nbsp;M. Kensuke ,&nbsp;L. Jesel ,&nbsp;K. Roulot ,&nbsp;A. Granier ,&nbsp;A. Carmona ,&nbsp;S. Kikuchi ,&nbsp;S. Amissi ,&nbsp;A. Trimaille ,&nbsp;P. Ohlmann ,&nbsp;T. Tatarcheh ,&nbsp;V. Schini-Kerth ,&nbsp;O. Morel","doi":"10.1016/j.acvd.2024.10.019","DOIUrl":"10.1016/j.acvd.2024.10.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Initially described as a benign acute cardiomyopathy, Takotsubo syndrome (TTS) has been linked to elevated mortality rates during both the acute phase and long-term follow-up. Emerging evidence suggests that unresolved myocardial inflammation may contribute to this adverse prognosis.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the incremental prognostic utility of C-reactive protein (CRP) in conjunction with the InterTAK Prognosis score for stratifying long-term mortality in TTS.</div></div><div><h3>Method</h3><div>A retrospective analysis was conducted on data from a multicenter registry encompassing 307 patients diagnosed with Takotsubo syndrome (TTS) between 2008 and 2020. Patients were stratified into quartiles based on the InterTAK Prognosis score. The discriminatory potential of C-reactive protein (CRP) in predicting long-term mortality was assessed. The primary endpoint was defined as all-cause mortality within 1 year.</div></div><div><h3>Results</h3><div>Stepwise increase of CRP at discharge that corresponds to INTERTAK quartiles was observed: 9.5<!--> <!-->mg/L (25th percentile) in the first quartile, 15.8<!--> <!-->mg/L (median) in the second quartile, 25.3<!--> <!-->mg/L (75th percentile) in the third quartile, and 41.2<!--> <!-->mg/L (maximum) in the fourth quartile. Receiver operating characteristic curves (ROC) analysis revealed that CRP value at discharge was predictive of one-year mortality (area under the curve [AUC]<!--> <!-->=<!--> <!-->0.81; 95% confidence interval [CI]<!--> <!-->=<!--> <!-->0.68–0.90) with an optimal threshold set at 33<!--> <!-->mg/L (Sensitivity: 65%; Specificity: 87%). When considering the InterTAK score, the incorporation of CRP at discharge with a cut-off of 33<!--> <!-->mg/L exhibited a significant enhancement in the prediction of one-year mortality in “intermediate” risk (25% vs. 1%; <em>P</em> <!-->=<!--> <!-->0.008) or “very high” risk (40% vs. 10%; <em>P</em> <!-->=<!--> <!-->0.02) patients. Receiver operating characteristic (ROC) curves indicated a tendency for the area under the curve (AUC) to increase when considering the CRP value at discharge (AUC 0.85 vs. 0.79, <em>P</em> <!-->=<!--> <!-->0.06). While the improvement in AUC did not attain statistical significance, discrimination improved from “acceptable” (AUC [0.7–0.8]) for the original InterTAK Prognosis score to “excellent” (AUC [0.8–0.9]) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>In Takotsubo syndrome, the persistence of inflammatory burden at hospital discharge emerged as an independent predictor of one-year mortality, augmenting the predictive capacity of the conventional INTERTAK Prognosis score.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S32"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149778","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":"Pregnancy associated spontaneous coronary artery dissection: A multicenter case series study","authors":"S. Boudiche ,&nbsp;F. Boudiche El Ayech ,&nbsp;M. Saadi ,&nbsp;S. Haboubi ,&nbsp;Y. Khelil ,&nbsp;M. Chedly ,&nbsp;S. Charfeddine ,&nbsp;A. Noamen ,&nbsp;L. Abid ,&nbsp;L. Bezdah ,&nbsp;W. Fehri ,&nbsp;M.S. Mourali","doi":"10.1016/j.acvd.2024.10.075","DOIUrl":"10.1016/j.acvd.2024.10.075","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnancy-associated (P-) spontaneous coronary artery dissection (SCAD) is a rare and underdiagnosed but a potentially lethal complication of pregnancy.</div></div><div><h3>Objective</h3><div>The aim of this study was to describe a case series with a highlight on management strategies and outcomes of 6 P-SCAD women.</div></div><div><h3>Method</h3><div>A retrospective analysis of data of six patients of P-SCAD managed in four tertiary care centers from January 2011 to June 2023 was done. Clinical, angiographic, therapeutic, and follow-up data were analyzed.</div></div><div><h3>Results</h3><div>All patients presented in the postpartum period, majority with severe initial clinical presentation: persistent and non-persistent ST segment elevation myocardial infarction were noted in 4 and 2 patients (of which 1 transient ST elevation myocardial infarction) respectively. Hemodynamic instability was reported in 3 patients: 2 cardiogenic shocks and 1 acute pulmonary oedema. Left main coronary artery (LMCA) and left anterior descending coronary artery were involved in 5 and 4 patients respectively. 5 out of 6 patients had multivessel dissections. All patients had angiographic type 1 SCAD angiographic pattern. 2 patients needed immediate primary (<em>n</em> <!-->=<!--> <!-->1) or rescue (<em>n</em> <!-->=<!--> <!-->1) percutaneous coronary intervention (PCI) with angiographic success. Conservative therapy was initially attempted in 4 patients with unfavorable evolution: dissection persistence (<em>n</em> <!-->=<!--> <!-->2) and extension (<em>n</em> <!-->=<!--> <!-->2). Dissection extension was associated with worsening clinical presentations with recurrent angina (<em>n</em> <!-->=<!--> <!-->1) and cardiogenic shock (<em>n</em> <!-->=<!--> <!-->1) mandating subsequent emergent PCI and coronary artery bypass grafting in the 2 patients respectively. Intra-aortic balloon pump (IABP) was inserted in 2 patients. In-hospital death occurred in 2 out of 6 patients.</div></div><div><h3>Conclusion</h3><div>P-SCAD women had severe clinical presentations. LMCA and multivessel involvement were often observed. Conservative strategy was attempted when it was possible with unfavorable angiographic outcome. Consequently, in-hospital mortality rate was as high as 33%.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S15"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150107","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":"One-year prognostic value of right ventricular to pulmonary arterial coupling among patients hospitalized for acute coronary syndrome: Insights from the ADDICT-ICCU study","authors":"C. Nogarede ,&nbsp;N. El Beze ,&nbsp;G. Schurtz ,&nbsp;J.C. Dib ,&nbsp;C. Delmas ,&nbsp;C. Bouleti ,&nbsp;V. Roule ,&nbsp;A. Boccara ,&nbsp;A. Trimaille ,&nbsp;F. Boccara ,&nbsp;S. Toupin ,&nbsp;J.-G. Dillinger ,&nbsp;P. Henry ,&nbsp;T. Pezel ,&nbsp;C. Fauvel","doi":"10.1016/j.acvd.2024.10.062","DOIUrl":"10.1016/j.acvd.2024.10.062","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP) assessed by echocardiography is a good non-invasive approach for right ventricular to pulmonary artery (RV-PA) coupling assessment. Although the prognostic value of this ratio is well known in many cardiovascular diseases, its prognostic value in acute coronary syndrome (ACS) is not established.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To assess one-year prognostic value of TAPSE/sPAP among patients hospitalised for ACS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;In the prospective multicentric ADDICT-ICCU study, all consecutive patients hospitalized for ACS over two weeks in April 2021 at 39 centres across France were included. The TAPSE/sPAP ratio was measured using the first echocardiography performed within the first 24 hours of hospitalisation. The primary composite outcome was one-year major adverse cardiovascular event (MACE) including: all-cause death or urgent hospitalisation for acute cardiovascular reason (acute heart failure, urgent myocardial revascularisation). C-tree analysis was used to find the optimal TAPSE/sPAP cut-off to predict the primary outcome.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among the 772 ACS patients (age 64&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;12 years, 74% males) included, 113 (15%) experienced 1-year MACE. The best cut-off for TAPSE/sPAP to predict 1-year MACE was 0.67 mm/mmHg. Patients with TAPSE/Spap&lt;!--&gt; &lt;!--&gt;≤&lt;!--&gt; &lt;!--&gt;0.67 mm/mmHg were more likely older (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001), with previous atrial fibrillation (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001), a higher length of hospitalization in ICCU (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001), a higher NTproBNP (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.001) and a worse LVEF value (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). At one-year, all-cause death occurred in 27 (24%) patients with TAPSE/sPAP&lt;!--&gt; &lt;!--&gt;≤&lt;!--&gt; &lt;!--&gt;0.67, compared to 7 (6%) with TAPSE/Spap&lt;!--&gt; &lt;!--&gt;&gt;&lt;!--&gt; &lt;!--&gt;0.67 (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001), and 32 (28%) patients with TAPSE/sPAP&lt;!--&gt; &lt;!--&gt;≤&lt;!--&gt; &lt;!--&gt;0.67 were hospitalised for acute cardiovascular reason against 20 (18%) with TAPSE/sPAP&lt;!--&gt; &lt;!--&gt;&gt;&lt;!--&gt; &lt;!--&gt;0.67 (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.006). After adjustment for all traditional prognosticators, grouped in models, TAPSE/sPAP&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.67 mm/mmHg remained independently associated with the primary outcome: model 1 (comorbidities): HR 2.82, 95% CI [2.92–4.38], &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001, model 2 (echocardiography): HR&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2.38, 95% CI [1,40–4,03], &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). &lt;span&gt;&lt;span&gt;Fig. 1&lt;/span&gt;&lt;/span&gt; shows that patients with TAPSE/sPAP ≤0.67 mm/mmHg had worse event-free survival for the primary outcome: HR&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2.92, 95% CI [1.98–4.29], &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;TAPSE/sPAP was independently associated with 1-year MACE in patients hospitalised f","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S8-S9"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150432","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":"Optimization of the treatment of Heart Failure with Reduced Ejection Fraction following the updated European Society of Cardiology guidelines","authors":"B. El Boussaadani ,&nbsp;S. Mayoussi ,&nbsp;H. Bendoudouch ,&nbsp;L. Hara ,&nbsp;A. Ech-Chenbouli ,&nbsp;Z. Raissouni","doi":"10.1016/j.acvd.2024.10.041","DOIUrl":"10.1016/j.acvd.2024.10.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) is a prevalent global health issue Guideline-directed medical therapy (GDMT) has been pivotal in managing HF with reduced ejection fraction (HFrEF), emphasizing the use of four key drug classes.</div></div><div><h3>Objective</h3><div>Our main objective was to query the Moroccan cardiology community about the sequencing approach of heart failure medications and general compatibility with current guidelines.</div></div><div><h3>Method</h3><div>Our study is a large-sample survey study is based on questionnaire form previously used in an international survey on heart failure, published in 2022. The form was distributed via e-mail to Moroccan cardiologists. This questionnaire was translated into French to meet the specific requirements of our study and facilitate the collection of information.</div><div>Three predefined subgroup analyses were systematically performed: sex (male vs female), age (&lt;30, 30–50, and &gt;50 years), and practitioner type (residents in cardiology vs cardiology specialists).</div></div><div><h3>Results</h3><div>63 cardiologists practicing in northern Morocco responded to the survey. 65% of the participants considered LVEF<!--> <!-->≤<!--> <!-->40% was the threshold to define HFrEF. The majority of participants (76.19%) would initiate HFrEF medical treatment with an ARNi instead of ACEi/ARB. 39.62% responded that adding another class of HFrEF medications is more important than increasing the dose of those already started. The “classic approach” of sequencing appears to be the most common, starting with ACEi or ARNi first (41%). Concerning the order of introduction of medications for heart failure, the “classic approach” appears to be the most common, starting with ACEi or ARNi first (41%), BB second (37%), and MRA third (45%) (<span><span>Fig. 1</span></span>). Nearly all participants believed it was feasible to initiate all four classes of heart failure medications during the first hospitalization. Beta-blockers were considered the most effective heart failure medication by 43% of participants followed by ARNIs (30%), but no practitioner aged<!--> <!-->&gt;<!--> <!-->50 considered that betablockers are the most effective medication. 65% of participants were hesitant to introduce mineralocorticoid receptor antagonists (MRA) when glomerular filtration rate (GFR) is<!--> <!-->&lt;<!--> <!-->30<!--> <!-->ml/min.</div></div><div><h3>Conclusion</h3><div>Our results show that our practice needs more adherence to recent guidelines on the medical management of HFrEF, but young practitioners seem to join this journey compared to older generations, which would help advance in the management of our heart failure patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S43-S44"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150455","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":"Unique nature of sickle sell diastolic cardiomyopathy: A tailored echocardiographic definition to refine prognostic stratification in young adults","authors":"T. Simon ,&nbsp;T. D’Humières ,&nbsp;S. Laurent ,&nbsp;G. De Luna ,&nbsp;S. Iles ,&nbsp;P. Bartolucci ,&nbsp;G. Derumeaux","doi":"10.1016/j.acvd.2024.10.040","DOIUrl":"10.1016/j.acvd.2024.10.040","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiovascular complications are the leading cause of mortality in sickle cell anemia (SCA) patients. While cardiac diastolic dysfunction (DD) is a well-documented mechanism contributing to heightened morbidity and mortality, the unique hemodynamic conditions inherent to SCA pose challenges to the application of standard diastolic evaluation methods.</div></div><div><h3>Objective</h3><div>To date, there remains an absence of a suitable echocardiographic definition for early DD in SCA, which could significantly improve risk stratification and management strategies.</div></div><div><h3>Method</h3><div>To delineate the uniqueness of diastolic function parameters in SCA and propose an adapted echocardiographic definition of early SCA diastolic cardiomyopathy, we leveraged data from the French multicentric cohort Etendard alongside a matched subgroup from the Copenhagen City Heart Study (CCHS) cohort as control. Our investigation focused on early left ventricular (LV) diastolic impairment parameters, including e’ lateral wave (e’lat), E/e’ ratio, and indexed left atrial volume (LAVi), integrating hemodynamic data and 12-year prognostic outcomes. We then identified a young subgroup within Etendard cohort among which age exerted no impact on diastolic function parameters, facilitating the formulation of an adapted definition for early DD.</div></div><div><h3>Results</h3><div>SCA patients from the Etendard cohort (<em>n</em> <!-->=<!--> <!-->379) exhibited significantly and early impaired diastolic function parameters compared to the matched CCHS subgroup (<em>n</em> <!-->=<!--> <!-->672). Among younger SCA patients (<em>n</em> <!-->=<!--> <!-->252, age<!--> <!-->≤<!--> <!-->38 years), e’lat emerged as the sole independent diastolic parameter associated with prognosis (<em>P</em> <!-->=<!--> <!-->0.01), with an optimal cutoff of 11<!--> <!-->cm/s selected for prognostic stratification and further definition as DD (Se<!--> <!-->=<!--> <!-->89%, Sp<!--> <!-->=<!--> <!-->50%, AUC<!--> <!-->=<!--> <!-->0.66, 95% CI<!--> <!-->=<!--> <!-->[0.52; 0.81], <em>P</em> <!-->=<!--> <!-->0.01). Strikingly, young SCA patients with DD exhibited a fourfold higher 12-year mortality rate (16% vs. 4%, <em>P</em> <!-->&lt;<!--> <!-->0.001) (<span><span>Fig. 1</span></span>). Additionally, e’lat correlated with 6-minute walk test, NT pro-BNP levels, diastolic blood pressure, and lactate dehydrogenase levels. A three-year follow-up revealed a decline in 6MWT distance among the DD group and a trend toward higher tricuspid regurgitation velocity (TRV).</div></div><div><h3>Conclusion</h3><div>In young SCA patients, diastolic function evaluation requires dedicated definition. Lateral e’ wave demonstrates associations with key indicators of cardiac impairment, hemolysis, and systemic vasculopathy, with a value below 11<!--> <!-->cm/s dramatically increasing 12-year mortality.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S42-S43"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150458","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 hypertension in heart failure with preserved ejection fraction: Impact on mortality and hospitalization risk in PHHF registry","authors":"E. Berthelot ,&nbsp;C. Fauvel ,&nbsp;T. Damy ,&nbsp;F. Bauer ,&nbsp;J.-N. Trochu ,&nbsp;F. Picard ,&nbsp;N. Lamblin","doi":"10.1016/j.acvd.2024.10.053","DOIUrl":"10.1016/j.acvd.2024.10.053","url":null,"abstract":"<div><h3>Introduction</h3><div>The 2022 ESC/ERS guidelines changed the definition of post-capillary pulmonary hypertension (pcPH) in heart failure (HF) by lowering the level of mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). Yet, the echocardiographic profile of HF with preserved ejection fraction (PEF) patients according to their mPAP and RVP is not known.</div></div><div><h3>Objective</h3><div>To investigate the profile of HFPEF patients according to their mPAP and RVP.</div></div><div><h3>Method</h3><div>Stable HF patients with the need for right heart catheterization were enrolled from 2010 to 2018 and prospectively followed-up in this multicenter study. All patients had a right heart catheterization and an echocardiography within the 24<!--> <!-->hours. PcPH was characterized by a pulmonary wedge pressure exceeding 20<!--> <!-->mm Hg and mean mPAP greater than 20<!--> <!-->mm Hg, from an isolated state when PVR was less than 2 Wood units (WU, IpcPH) to a combined form when PVR exceeded 2 WU (CpcPH).</div></div><div><h3>Results</h3><div>280 patients with HFpEF were included, with an average age of 71 years, 65% female, and 35% male. 31% of patients were hypertensive, and 39% were diabetic. Three groups were formed: patients without PH, patients with PH and resistances<!--> <!-->&lt;<!--> <!-->2 UW (IPC PH), and patients with PH and resistances<!--> <!-->&gt;<!--> <!-->2 UW (CPC PH). 13 patients (5%) did not have pulmonary hypertension, 72% had IPC PH, and 23% had CPC PH. Patients without PH had an all-cause mortality risk of 7.7% compared to 22% and 24% in the other two groups, respectively. Regarding death, there was no significant difference between the IPC PH and CPC PH groups. Regarding hospitalization, there was a 7.7% risk of hospitalization in the HFpEF group without PH versus 19% and 20% in the other two groups, respectively.</div></div><div><h3>Conclusion</h3><div>pEF patients with PH, CpcPH patients had worse right ventricular function despite similar remodeling when compared to IpcPH patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S49-S50"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150513","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}