Archives of Cardiovascular Diseases最新文献

{"title":"Toward a multidisciplinary approach: The increasing involvement of nurses in heart failure management","authors":"F. Zorès ,&nbsp;T. Damy ,&nbsp;A. Duchenne ,&nbsp;E. Huet ,&nbsp;C. Lecerf ,&nbsp;B. Lequeux ,&nbsp;E. Martin ,&nbsp;M. Moulin ,&nbsp;F. Mouquet ,&nbsp;B. Pedrono ,&nbsp;J. Redureau ,&nbsp;M. Salvat ,&nbsp;V. Thoré ,&nbsp;M. Villaceque ,&nbsp;E. Berthelot","doi":"10.1016/j.acvd.2024.10.044","DOIUrl":"10.1016/j.acvd.2024.10.044","url":null,"abstract":"<div><h3>Introduction</h3><div>The increasing prevalence of heart failure (HF), alongside the scarcity of medical time, necessitates the development of new practices and the promotion of task-sharing and skill-sharing. Over the past few years, new professions have emerged to facilitate the care of patients with HF: specialized nurses in heart failure management (ISPIC), advanced practice nurses (IPA), and telemonitoring nurses (ITS).</div></div><div><h3>Objective</h3><div>In spring 2023, the GICC (Groupe Insuffisance Cardiaque et Cardiomyopathies) distributed a questionnaire via email and social networks to better understand these new professions.</div></div><div><h3>Method</h3><div>196 usable questionnaires were collected, of which 106 (54%) had exhaustive responses. The majority of respondents were IPAs (59 (47%)), 45 (36%) were ISPICs, and 21 (17%) were ITSs. The average age was 44 years, similar across the three groups. Respondents had a median of 11 years of experience with CV pathologies, but IPAs had significantly less time working with cardiac patients than the other two groups.</div></div><div><h3>Results</h3><div>57% of IPAs, 81% of ISPICs, and 80% of ITSs have exclusive activity in cardiology (<em>P</em> <!-->=<!--> <!-->0.021). Outside of cardiology, the most frequently invested specialties are diabetology, geriatrics, and vascular medicine. 48% of the nurses exclusively work with HF patients.</div><div>Professional practice is mainly in public hospital structures (66%), with non-university hospital centers leading. Private practice is more common among IPAs than other professions (29% of IPAs vs. 5% for ISPICs and 0% for ITSs; <em>P</em> <!-->&lt;<!--> <!-->0.005).</div><div>Consultations for uptitration of medical therapy are conducted by 72% of IPAs and 55% of ISPICs. 94% of IPAs and 48% of ISPICs conduct clinical and biological follow-up consultations. A majority of nurses already perform or are in the process of implementing tools to coordinate patient care pathways. 70% of ISPICs participate in therapeutic patient education workshops, compared to only 37% of IPAs and 44% of ITSs (<em>P</em> <!-->=<!--> <!-->0.049). 100% of ITSs conduct telemonitoring, compared to only 46% of IPAs and 80% of ISPICs (<em>P</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>This initial study highlights the already effective involvement of specialized nurses in the care of HF patients, despite disparities in training and practice mode. It also highlights differences in roles with patients for each of these professions. Studies with larger populations will further refine this preliminary work.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S45"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150509","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":"The Healthcare Amyloidosis European Registry (HEAR): Study design and methods","authors":"P. Réant ,&nbsp;M. Kharoubi ,&nbsp;F. Delelis ,&nbsp;J. Jeanneteau ,&nbsp;C. Dagrenat ,&nbsp;F. Bauer ,&nbsp;J.C. Eicher ,&nbsp;A. Bisson ,&nbsp;A. Jobbé-Duval ,&nbsp;J. Inamo ,&nbsp;F. Roubille ,&nbsp;J.-P. Gueffet ,&nbsp;M.-F. Seronde ,&nbsp;N. Piriou ,&nbsp;A. Zaroui ,&nbsp;O. Lairez ,&nbsp;T. Damy","doi":"10.1016/j.acvd.2024.10.009","DOIUrl":"10.1016/j.acvd.2024.10.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac amyloidosis (CA) is a rare disease that can lead to poor quality of life, conduction disorders, arrhythmia, heart failure, and even death. Fortunately, specific treatments that can modify the natural history of the disease and the disease outcomes are now available. However, data on the prevailing patient management procedures and long-term outcomes of CA are scarce. In order to gather more information on the diagnosis and management of CA, we created the Healthcare Amyloidosis European Registry (HEAR).</div></div><div><h3>Objective</h3><div>The registry's primary objective is to describe the demographic, clinical, biological and imaging characteristics of patients with CA. The secondary objectives are to (i) describe the different types of CA and their progression, (ii) describe the prevailing disease management procedures and any changes in these procedures, (iii) evaluate tools and quality of life questionnaires, (iv) describe the prognosis for patients with CA; (v) describe the management of CA by cardiologists, and (vi) assess hospital admissions and treatments and any changes in these factors. The HEAR will give us an opportunity to share good practice and to evaluate and optimize the quality of care for patients with CA.</div></div><div><h3>Method</h3><div>The HEAR is non-intervention, longitudinal, multicentre registry initiated in France, but which has been designed with a view to extension to other European countries. It includes prospective, retroprospective and retrospective cohorts of patients referred for suspected CA or with a confirmed diagnosis of CA.</div></div><div><h3>Results</h3><div>Since July 2021, 34 hospitals across France have joined the HEAR project. We expect to include 6500 patients in the HEAR between January 2021 and December 2027. At baseline, we use an electronic case report form to collect data on demographics, clinical, biological and imaging variables, the management of CA by cardiologists, specific treatments, quality of life, and diagnostic data. Lastly, we intend to collect in-hospital data on outcomes (deaths, cause of death, and hospital readmissions) annually.</div></div><div><h3>Conclusion</h3><div>The HEAR is the first nationally representative, internationally extendable registry dedicated to suspected and confirmed cases of CA. It will provide crucial information on the prevailing aetiologies, prevalences, and CA management practices.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S26"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151301","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":"Diagnostic value of Left Atrial Strain and NT-ProBNP in the Diagnosis of HFpEF","authors":"G. Ben Hassen,&nbsp;S. Antit,&nbsp;M.K. Bahri,&nbsp;R. Fekih,&nbsp;S. Romdhane,&nbsp;I. Mtiri,&nbsp;E. Boussabeh,&nbsp;L. Zakhama","doi":"10.1016/j.acvd.2024.10.033","DOIUrl":"10.1016/j.acvd.2024.10.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure with preserved ejection fraction (HFpEF) poses diagnostic challenges due to its heterogeneous presentation.</div></div><div><h3>Objective</h3><div>This prospective study aimed to assess the utility of left atrial (LA) strain measured by echocardiography and NT-ProBNP levels in diagnosing HFpEF.</div></div><div><h3>Method</h3><div>We enrolled 110 consecutive participants who underwent comprehensive echocardiography, including assessment of left atrial strain using speckle tracking. NT-ProBNP levels were measured concurrently. A continuous diagnostic score for HFpEF was calculated based on the European Society of Cardiology's HFA-PEFF diagnostic algorithm.</div></div><div><h3>Results</h3><div>Mean age was 61.8<!--> <!-->±<!--> <!-->11.5 years; 57.3% female. Hypertension and Diabetes were the most common cardiovascular risk factor (90% and 60% respectively). In the study population, 44 patients (40%) had a confirmed diagnosis of HFpEF according to the HFA-PEFF score, after evaluation at rest and on exertion. The median PALS was 26%<!--> <!-->±<!--> <!-->7.6. Exploration objected a median N-terminal pro-BNP (NT-pro-BNP) of 95<!--> <!-->pg/mL [52–247]. A Value of NT Pro-BNP<!--> <!-->&gt;<!--> <!-->125<!--> <!-->pn/mL was found in 42% patients. LA strain reservoir was significatively correlated with NT Pro-BNP (<em>P</em> <!-->=<!--> <!-->0.049, <em>r</em> <!-->=<!--> <!-->−0.14).</div></div><div><h3>Conclusion</h3><div>Assessment of LA strain using speckle tracking echocardiography, alongside NT-ProBNP levels, shows promise in diagnosing HFpEF. These non-invasive measures offer valuable insights into cardiac dysfunction and may aid in early detection and management of HFpEF.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S39"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149747","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 initial intravenous diuretic dose in Acute heart failure","authors":"H. Bendoudouch ,&nbsp;B. El Boussaadani ,&nbsp;L. Hara ,&nbsp;A. Ech-Chenbouli ,&nbsp;Z. Raissouni","doi":"10.1016/j.acvd.2024.10.046","DOIUrl":"10.1016/j.acvd.2024.10.046","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute heart failure is a frequent motive for emergency admissions. Intravenous loop diuretics remain the cornerstone of its management, yet its optimal initial dose remains controversial</div></div><div><h3>Objective</h3><div>Comparison of initial furosemide dose between ER practicians and both guidelines &amp; cardiology specialists, analysis of clinical improvement in the 3 categories, analysis of lack of clinical improvement in the 3 categories in relation with creatinine serum levels</div></div><div><h3>Method</h3><div>The present study included 300 patients from the Emergency Room. Anthropometric &amp; clinical elements were noted, as well as heart risk factors &amp; anterior therapeutics. Patients were divided into two groups depending on their oral diuretic intake. They were further classified into three IV bolus categories: Optimal, More &amp; Less, following guidelines. Clinical elements including diuresis and congestion physical signs were noted after 24<!--> <!-->h.</div></div><div><h3>Results</h3><div>In our study, 36.3% of our patients are on diuretic regimen, whereas 63.7% never received diuretics. Globally, emergency practicians indicated initial doses similar to the cardiologist assessment 36.7% of the, whereas it was different 63.7% of the time, mostly higher doses (36%). After dividing patients by their anterior diuretic intake, we found that emergency practicians tend to give higher doses to diuretic free patients (47.4%), whereas they mostly don’t increase diuretic doses for patients who are already on diuretics (18.2%), with sometimes even lower boluses (36.4%). Patients in the Optimal category had 81.8% adequate mean diuresis after 24<!--> <!-->h, as well as 85% clinical congestion improvement. Patients in the Less category had 60% adequate diuresis, and only 40% clinical improvement, with some worsening cases (8%). Patients in the More category had 81.8% adequate diuresis, as well as 85% clinical improvement. Patients in the More category had 76,9% adequate mean diuresis after 24<!--> <!-->h, less than in the Optimal category, and only 80% clinical congestion improvement (<span><span>Fig. 1</span></span>). Through analysis by Logistic Regression, we found that the unimprovement of congestion in the Low category isn’t related to creatinine serum levels. We also found that patients who didn’t improve with Optimal category doses didn’t have higher creatinine serum levels.</div></div><div><h3>Conclusion</h3><div>Our study shows that guidelines-based initial diuretic doses are effective on congestion improvement after 24<!--> <!-->h, and consequently should be followed by all medical practicians.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S46"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150515","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":"ATTR Cardiomyopathy in early and late onset ATTRV30M","authors":"A. Perault ,&nbsp;A. Echaniz-Laguna ,&nbsp;A. Monfort ,&nbsp;R. Chequer ,&nbsp;J. Inamo ,&nbsp;F. Rouzet ,&nbsp;M. Slama ,&nbsp;V. Algalarrondo","doi":"10.1016/j.acvd.2024.10.016","DOIUrl":"10.1016/j.acvd.2024.10.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Hereditary transthyretin amyloidosis (ATTRv) arising from the <em>TTR</em> gene V30M variant (ATTRV30M) manifests in two distinct phenotypes: early-onset (before age 50 years) with polyneuropathy and late-onset (after age 50 years) with a mixed phenotype, encompassing neurological and cardiac manifestations (ATTR-CM). Comparative studies examining ATTR-CM in early and late ATTRV30M have typically involved patients post-diagnosis, with early-onset individuals being younger.</div></div><div><h3>Objective</h3><div>This study aimed to compare ATTR-CM in early and late ATTRV30M at similar ages.</div></div><div><h3>Method</h3><div>Medical records of 370 ATTRV30M patients were analysed (median follow-up: 3.6 years), data were analysed by 10-year age groups. Confirmed ATTR-CM was defined by a positive DPD scan (Perugini score<!--> <!-->≥<!--> <!-->2), OR positive biopsy with unexplained interventricular septum<!--> <!-->&gt;<!--> <!-->12<!--> <!-->mm, CMR suggestive of cardiac amyloidosis or Perugini 1). Suspected ATTRv-CM was defined in case of cardiac abnormalities that did not meet the confirmed ATTRv-CM criteria.</div></div><div><h3>Results</h3><div>Among V30M carriers, 138 had early-onset polyneuropathy, 113 late-onset polyneuropathy, and 119 were asymptomatic carriers. ATTR-CM was confirmed in 16.7% of early-onset, 75.2% of late-onset, and 3.9% of asymptomatic carriers. ATTR-CM frequency increased with age. In a given age group, ATTR-CM degree was identical in early and late-onset groups (<span><span>Fig. 1</span></span>). Conversely, asymptomatic carriers showed lower ATTR-CM frequency (<em>P</em> <!-->=<!--> <!-->0.001 in the 50–59<!--> <!-->yo age group, <em>P</em> <!-->&lt;<!--> <!-->0.001 in the 60–69<!--> <!-->yo age group). Late-onset patients had significantly higher life expectancy than early-onset patients (83<!--> <!-->yo vs. 62<!--> <!-->yo, respectively; <em>P</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>In a comparable age group, ATTR-CM extent is consistent in early and late-onset ATTRV30M. ATTR-CM penetrance rises with age, and both early and late-onset ATTRV30M exhibit a mixed phenotype. Neurological manifestations precede ATTR-CM onset.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S30"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150708","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":"Drug-induced spontaneous coronary artery dissection: Analysis of the WHO pharmacovigilance database","authors":"P. Gautier ,&nbsp;C. Khouri ,&nbsp;M. Galinier ,&nbsp;M. Elbaz ,&nbsp;F. Montastruc","doi":"10.1016/j.acvd.2024.10.066","DOIUrl":"10.1016/j.acvd.2024.10.066","url":null,"abstract":"<div><h3>Introduction</h3><div>Spontaneous coronary artery dissection (SCAD) causes approximately 1% of myocardial infarctions, but accounts for about 35% of the myocardial infarctions in women under 50 years old. Several risk factors of SCAD have been identified, including drugs such as hormonal therapies and 5HT1 agonists (triptans), but we could hypothesize that the spectrum of drug-induced SCAD is broader.</div></div><div><h3>Objective</h3><div>To assess whether other drugs are associated with SCAD, using the WHO global individual case safety reports database, Vigibase®.</div></div><div><h3>Method</h3><div>We performed a disproportionality analysis on a case non-case design. We used Vigibase®, the World Health Organization (WHO) global database, and we selected all reports until December 31, 2021, with age<!--> <!-->&gt;<!--> <!-->18 years and with age and sex known. We conducted analysis on each drug of the database with at least 3 reports of SCAD. We also conducted analysis on ATC4 drug classes related to each of these drugs of interest. We conducted a sensitivity analysis by restricting to cases reported from physicians and pharmacists.</div></div><div><h3>Results</h3><div>We found 212 reports of SCAD mostly from United States (138 cases, 65.1%) and from women (178 cases, 84.0%) aged 18 to 44 (93 cases, 43.9%). 6 drugs showed significant signal of reporting in the main analysis that remained significant after sensitivity analysis: Cabergoline (ROR 215.2, 95% CI 101.2–457.6), Sumatriptan (ROR 55.7, 95% CI 32.4–95.7), Rofecoxib (ROR 11.5, 95% CI 5.4–24.4), Sunitinib (ROR 11.2, 95% CI 4.2–30.1), Celecoxib (ROR 6.8, 95% CI 2.8–16.5) and Fingolimod (ROR 5.81, 95% CI 2.2–15.63). 6 drug classes showed significant signal of reporting in the main analysis that remained significant after sensitivity analysis: 5HT1 agonists (ROR 67.3, 95% CI 43.6–103.7), centrally acting sympathomimetics (ROR 55.5, 95% CI 37.5–82.2), dopamine agonists (ROR 25.3, 95% CI 14.1–45.3), Coxibs (ROR 6.7, 95% CI 2.7–12.3), sphingosine-1-phosphate receptor modulators (ROR 5.48, 95% CI 2.0–14.7) and progestogens (ROR 2.8, 95% CI 1.4–5.7) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>While such pharmacovigilance study has some limitations such as reporting bias and unmeasured confounding, this study generates new hypotheses about drugs potentially inducing SCAD. Further studies are needed to validate these results, such as observational studies with self-controlled designs.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S10-S11"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151187","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 impact of the initial coronary microvascular disease and microvascular obstruction using Angio-IMR in ACS patients","authors":"P. Guiraud-Chaumeil ,&nbsp;J.-G. Dillinger ,&nbsp;S. Toupin ,&nbsp;A. Trimaille ,&nbsp;C. Bouleti ,&nbsp;C. Delmas ,&nbsp;B. Lattuca ,&nbsp;E. Gall ,&nbsp;A. Clément ,&nbsp;A. Lafont ,&nbsp;M. Singh ,&nbsp;A. Léquipar ,&nbsp;J. Castillo Tovar ,&nbsp;J.H. Reiber ,&nbsp;P. Henry ,&nbsp;T. Pezel","doi":"10.1016/j.acvd.2024.10.093","DOIUrl":"10.1016/j.acvd.2024.10.093","url":null,"abstract":"<div><h3>Introduction</h3><div>Microvascular dysfunction, particularly microvascular obstruction (MVO), is an important prognostic predictor in acute coronary syndrome (ACS) patients. The index of microvascular resistance (IMR) has emerged for early MVO evaluation during invasive coronary angiography. However, its invasiveness limits routine use. Although angiography-derived IMR (angio-IMR) offers a non-invasive alternative with a good correlation with invasive IMR, its prognostic impact as microvascular disease marker in ACS patients is not well established.</div></div><div><h3>Objective</h3><div>We aimed to evaluate the prognostic impact of non-invasive angio-IMR measurement in both the culprit vessel, as marker of the MVO, and the non-culprit vessels, as marker of the baseline level of microvascular disease, in a consecutive cohort of patients with ACS from the multicentre Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study.</div></div><div><h3>Method</h3><div>The ADDICT-ICCU study is a multicenter cohort study assessing all patients hospitalized for ACS in ICCU. This ancillary study included only patients with angio-IMR measurements available post-PCI from 11 centers in France. Patients with distal culprit lesions, a history of coronary artery bypass graft, or unsuccessful revascularization of total occlusions were excluded. Angiographic analysis, performed post-PCI, and angio-IMR measurements were obtained through advanced post-processing software (<span><span>Fig. 1</span></span>). The primary outcome was in-hospital major adverse events including all-cause mortality, cardiogenic shock and resuscitated cardiac arrest. Secondary outcome was a composite of 1-year major adverse clinical events including cardiovascular mortality, recurrent myocardial infarction, and stroke.</div></div><div><h3>Results</h3><div>Of 108 consecutive patients (age 63<!--> <!-->±<!--> <!-->12 years, 72% male), 4 experienced the primary endpoint (2.8% all-cause mortality, 0.9% cardiogenic shock). Four patients experienced the secondary endpoint (2.8% died, 0.9% myocardial infarction). We found no difference regarding primary (odd-ratio: 1.00, 95% CI [0.95–1.03], <em>p</em> <!-->=<!--> <!-->0.80) or secondary (hazard-ratio: 1.02, 95% CI [1.00–1.05], <em>p</em> <!-->=<!--> <!-->0.07) outcomes. The average post-PCI angio-IMR values were 48<!--> <!-->±<!--> <!-->30 U in the culprit artery and 38<!--> <!-->±<!--> <!-->14 U in non-culprit arteries. The QFR value in the culprit artery was not significantly associated with the primary outcome.</div></div><div><h3>Conclusion</h3><div>Among 108 ACS patients, angio-IMR was not associated with prognosis. Others study with a dedicated designed protocol are necessary to assess the impact of angio-IMR on outcomes in ACS patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S23-S24"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of 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}