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Ferrari E, Sartre B, Labbaoui M, Heme N, Asarisi F, Redjimi N, Fourrier E, Squara F, Bun S, Berkane N, Breittmayer JP, Doyen D, Moceri P. Diuretics Versus Volume Expansion in the Initial Management of Acute Intermediate High-Risk Pulmonary Embolism. Lung 2022; 200:179-185. [PMID: 35381867 DOI: 10.1007/s00408-022-00530-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
AIMS The very early management of pulmonary embolism (PE), a part from antithrombotic treatment, has been little studied. Our aim was to compare the effects of diuretic therapy (DT) versus volume expansion (VE) in patients hospitalized for PE with RV dysfunction. METHODS AND RESULTS We conducted a randomized open-label multicentric study including patients with intermediate high-risk PE. Patients were randomized between diuretics or saline infusion. The primary endpoint was time to troponin (Tp) normalization. Secondary endpoints were time to normalization of B-type natriuretic peptide (BNP), changes in echocardiographic RV function parameters and treatment tolerance. Sixty patients presenting intermediate high-risk PE were randomized. Thirty received DT and 30 VE. We noted no changes in Tp kinetics between the two groups. In contrast, faster normalization of BNP was obtained in the DT group: 56 [28-120] vs 108 [48-144] h: p = 0.05, with a shorter time to 50%-decrease from peak value 36 [24-48] vs 54 [41-67] h, p = 0.003 and a higher rate of patients with a lower BNP concentration within the first 12 h (42% vs 12% p < 0.001). RV echocardiographic parameters were unchanged between the groups. One dose 40 mg furosemide was well-tolerated and not associated with any serious adverse events. CONCLUSION In the acute management of intermediate high-risk PE, initial therapy including diuretic treatment is well-tolerated and safe. Although changes in Tp kinetics and echocardiographic RV dysfunction parameters did not differ, normalization of BNP is achieved more quickly in the DT group. This finding, which need to be confirmed in trials with clinical end points, may reflects a rapid improvement in RV function using one dose 40 mg furosemide. TRIAL REGISTRY Clinical Trial Registration NCT02531581.
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Affiliation(s)
- Emile Ferrari
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France.
| | - Benjamin Sartre
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Mohamed Labbaoui
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Nathan Heme
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Florian Asarisi
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Nassim Redjimi
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Etienne Fourrier
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Fabien Squara
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Sithy Bun
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Nathalie Berkane
- Cardiology Department, Centre Hospitalier de Cannes, Cannes, France
| | - Jean Philippe Breittmayer
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Denis Doyen
- Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nice, Nice, France
- UR2CA, Université Côte d'Azur, Nice, France
| | - Pamela Moceri
- Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France
- UR2CA, Université Côte d'Azur, Nice, France
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Moceri P, Duchateau N, Sartre B, Baudouy D, Squara F, Sermesant M, Ferrari E. Value of 3D right ventricular function over 2D assessment in acute pulmonary embolism. Echocardiography 2021; 38:1694-1701. [PMID: 34672394 DOI: 10.1111/echo.15167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/17/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is a common life-threatening disease, with mortality related to right ventricular (RV) dysfunction. AIMS To investigate the value of 3D global and regional RV strain in patients with acute PE and at 1 month, as compared to a control population. METHODS AND RESULTS We conducted a longitudinal case-control prospective study, including 24 consecutive intermediate-risk PE patients. All patients underwent 2D and 3D transthoracic echocardiography within 12 hours of PE diagnosis and 1 month after hospital discharge. A control group was recruited, consisting of healthy volunteers matched on age and sex with PE patients. 3D RV echocardiographic sequences were analyzed by commercial RV-specific software and output meshes were post-processed to extract regional deformation. 3D echocardiographic 1-month follow-up was available in 18 patients. During acute PE, area strain was substantially altered in the RV free wall and within the trabecular septum. PE patients initially had RV dysfunction as assessed by 2D and 3D parameters. At follow-up, 2D parameters were restored compared to the control group, contrary to 3D RV area and circumferential strains. The McConnell's sign was identified in 83% of patients and was associated with reduced apical and global RV area strain. CONCLUSIONS Our 3D RV strain study demonstrates an incomplete recovery of 3D strain parameters 1 month after an episode of intermediate-risk acute PE despite restored 2D parameters. Further studies are required to assess the prognostic role and implications of this residual RV strain impairment after PE.
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Affiliation(s)
- Pamela Moceri
- Université Côte d'Azur, Inria Epione team, Sophia Antipolis, France.,Centre Hospitalier Universitaire de Nice, Service de Cardiologie, Nice, France.,UR2CA, Université Côte d'Azur, Nice, France
| | - Nicolas Duchateau
- Creatis, CNRS UMR5220, INSERM U1206, Université Lyon 1, Lyon, France
| | - Benjamin Sartre
- Centre Hospitalier Universitaire de Nice, Service de Cardiologie, Nice, France
| | - Delphine Baudouy
- Centre Hospitalier Universitaire de Nice, Service de Cardiologie, Nice, France
| | - Fabien Squara
- Centre Hospitalier Universitaire de Nice, Service de Cardiologie, Nice, France
| | - Maxime Sermesant
- Université Côte d'Azur, Inria Epione team, Sophia Antipolis, France
| | - Emile Ferrari
- Centre Hospitalier Universitaire de Nice, Service de Cardiologie, Nice, France
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Azzolini M, Moceri P, Sartre B, Baudouy D, Labbaoui M, Doyen D, Ferrari E. Right atrial strain in acute pulmonary embolism. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ferrari E, Sartre B, Squara F, Contenti J, Occelli C, Lemoel F, Levraut J, Doyen D, Dellamonica J, Mondain V, Chirio D, Risso K, Cua E, Orban JC, Ichai C, Labbaoui M, Mossaz B, Moceri P, Appert-Flory A, Fischer F, Toulon P. High Prevalence of Acquired Thrombophilia Without Prognosis Value in Patients With Coronavirus Disease 2019. J Am Heart Assoc 2020; 9:e017773. [PMID: 32972320 PMCID: PMC7763401 DOI: 10.1161/jaha.120.017773] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent literature reports a strong thrombotic tendency in patients hospitalized for a coronavirus disease 2019 (COVID-19) infection. This characteristic is unusual and seems specific to COVID-19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia, which can then lead to thrombotic complications. We investigate for the presence of acquired thrombophilia, which could participate in this phenomenon, and report its prevalence. We also wonder if these thrombophilias participate in the bad prognosis of severe COVID-19 infections. Methods and Results In 89 consecutive patients hospitalized for COVID-19 infection, we found a 20% prevalence of PS (protein S) deficiency and a high (ie, 72%) prevalence of antiphospholipid antibodies: mainly lupus anticoagulant. The presence of PS deficiency or antiphospholipid antibodies was not linked with a prolonged activated partial thromboplastin time nor with D-dimer, fibrinogen, or CRP (C-reactive protein) concentrations. These coagulation abnormalities are also not linked with thrombotic clinical events occurring during hospitalization nor with mortality. Conclusions We assess a high prevalence of positive tests detecting thrombophilia in COVID-19 infections. However, in our series, these acquired thrombophilias are not correlated with the severity of the disease nor with the occurrence of thrombotic events. Albeit the strong thrombotic tendency in COVID-19 infections, the presence of frequent acquired thrombophilia may be part of the inflammation storm of COVID-19 and should not systematically modify our strategy on prophylactic anticoagulant treatment, which is already revised upwards in this pathological condition. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04335162.
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Affiliation(s)
- Emile Ferrari
- Department of Cardiology University Hospital of Nice France
| | | | - Fabien Squara
- Department of Cardiology University Hospital of Nice France
| | - Julie Contenti
- Department of Emergency University Hospital of Nice France
| | - Celine Occelli
- Department of Emergency University Hospital of Nice France
| | - Fabien Lemoel
- Department of Emergency University Hospital of Nice France
| | | | - Denis Doyen
- Department of Intensive Care 1 University Hospital of Nice France
| | - Jean Dellamonica
- Department of Intensive Care 1 University Hospital of Nice France
| | - Veronique Mondain
- Department of Infectious Diseases University Hospital of Nice France
| | - David Chirio
- Department of Infectious Diseases University Hospital of Nice France
| | - Karine Risso
- Department of Infectious Diseases University Hospital of Nice France
| | - Eric Cua
- Department of Infectious Diseases University Hospital of Nice France
| | | | - Carole Ichai
- Department of Intensive Care 2 University Hospital of Nice France
| | | | | | - Pamela Moceri
- Department of Cardiology University Hospital of Nice France
| | | | | | - Pierre Toulon
- Hematology Laboratory University Hospital of Nice France
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Bun SS, Taghji P, Courjon J, Squara F, Scarlatti D, Theodore G, Baudouy D, Sartre B, Labbaoui M, Dellamonica J, Doyen D, Marquette CH, Levraut J, Esnault V, Bun SS, Ferrari E. QT Interval Prolongation Under Hydroxychloroquine/Azithromycin Association for Inpatients With SARS-CoV-2 Lower Respiratory Tract Infection. Clin Pharmacol Ther 2020; 108:1090-1097. [PMID: 32588427 PMCID: PMC7361407 DOI: 10.1002/cpt.1968] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
Association between Hydroxychloroquine (HCQ) and Azithromycin (AZT) is under evaluation for patients with lower respiratory tract infection (LRTI) caused by the Severe Acute Respiratory Syndrome (SARS-CoV-2). Both drugs have a known torsadogenic potential, but sparse data are available concerning QT prolongation induced by this association. Our objective was to assess for COVID-19 LRTI variations of QT interval under HCQ/AZT in patients hospitalized, and to compare manual versus automated QT measurements. Before therapy initiation, a baseline 12 lead-ECG was electronically sent to our cardiology department for automated and manual QT analysis (Bazett and Fridericia's correction), repeated 2 days after initiation. According to our institutional protocol (Pasteur University Hospital), HCQ/AZT was initiated only if baseline QTc ≤ 480ms and potassium level> 4.0 mmol/L. From March 24th to April 20th 2020, 73 patients were included (mean age 62 ± 14 years, male 67%). Two patients out of 73 (2.7%) were not eligible for drug initiation (QTc ≥ 500 ms). Baseline average automated QTc was 415 ± 29 ms and lengthened to 438 ± 40 ms after 48 hours of combined therapy. The treatment had to be stopped because of significant QTc prolongation in two out of 71 patients (2.8%). No drug-induced life-threatening arrhythmia, nor death was observed. Automated QTc measurements revealed accurate in comparison with manual QTc measurements. In this specific population of inpatients with COVID-19 LRTI, HCQ/AZT could not be initiated or had to be interrupted in less than 6% of the cases.
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Affiliation(s)
- Sok-Sithikun Bun
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Philippe Taghji
- Cardiology Department, Clinique la Casamance, Aubagne, France
| | - Johan Courjon
- Infectious Diseases Department, Archet University Hospital, Nice, France
| | - Fabien Squara
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Didier Scarlatti
- Cardiology Department, Pasteur University Hospital, Nice, France
| | | | - Delphine Baudouy
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Benjamin Sartre
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Mohamed Labbaoui
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Jean Dellamonica
- Medical Intensive Care Unit, Archet University Hospital, Nice, France
| | - Denis Doyen
- Medical Intensive Care Unit, Archet University Hospital, Nice, France
| | | | - Jacques Levraut
- Department of Emergency Medicine, Pasteur University Hospital, Nice, France
| | - Vincent Esnault
- Nephrology Department, Pasteur University Hospital, Nice, France
| | - Sok-Siya Bun
- Pharmacy Faculty, CNRS, IRD, IMBE, Aix Marseille University, Marseille, France.,Pharmacy Department, CHU Nord, APHM, Marseille, France
| | - Emile Ferrari
- Cardiology Department, Pasteur University Hospital, Nice, France
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Missana A, Azzolini-Jacquin M, David C, Baudouy D, Sartre B, Wehrlin C, Sermesant M, Ferrari E, Moceri P. Evaluation of right ventricular contractile reserve with exercise stress echocardiography. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Missana A, Azzolini Jacquin M, David C, Baudouy D, Sartre B, Sanfiorenzo C, Wehrlin C, Sermesant M, Ferrari E, Moceri P. P941 Evaluation of right ventricular contractile reserve with exercise stress echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls.
METHODS
We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary TVI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients.
RESULTS
Our patient group was composed by PAH patients, 61.5 ± 14.8 years; mean age of our control group was 29.33 ± 5.5 years. PAH patients achieved an exercise with a mean workload of 69.17 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (p = 0.17), whereas change in pulmonary TVI, pulmonary output and RV peak systolic strain was highly discriminant (respectively p = 0.03, p = 0.009 and p = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (p = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (p = 0.005, p= 0.0008, p = 0004).
CONCLUSION
Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve.
echocardiographic parameters PAH (n = 12) Healthy Controls (n = 12) p value sPAP at rest (mmHg) 40.91 ± 10.7 15.42 ± 4.1 <0.001 sPAP at peak (mmHg) 82.50 ± 21.7 42.50 ± 17.8 <0.001 TAPSE at rest/sPAP at rest (mm/mmHg) 0.62 ± 0.2 1.72 ± 0.6 <0.001 TAPSE at peak /sPAP at peak 0.36 ± 0.1 0.80 ± 0.2 <0.001 ΔStrain (%) 3.43 ± 3.1 8.08 ± 2.8 <0.001 Δ(peak Strain/sPAP) -0.17 ± 0.2 -0.77 ± 0.4 <0.001 Δpulmonary TVI (cm) 3.88 ± 4.0 7.46 ± 3.5 0.03 Δ(RVEF/sPAP) -0.34 ± 0.4 -2.06 ± 1.7 <0.001
Abstract P941 Figure. echography (rest/peak) PAH patient
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Affiliation(s)
- A Missana
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | | | - C David
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - D Baudouy
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - B Sartre
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - C Sanfiorenzo
- University Hospital Pasteur of Nice, pneumology, Nice, France
| | - C Wehrlin
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - M Sermesant
- Equipe Epione, INRIA, sophia antipolis, France
| | - E Ferrari
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - P Moceri
- University Hospital Pasteur of Nice, cardiology, Nice, France
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Missana A, Azzolini-Jacquin M, David C, Baudouy D, Sartre B, Sanfiorenzo C, Wehrlin C, Sermesant M, Ferrari E, Moceri P. Evaluation of right ventricular contractile reserve with exercise stress echocardiography. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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