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CANDELLIER A, Bohbot Y, Pasquet A, Diouf M, Vermes E, Goffin E, Gun M, Peugnet F, Hénaut L, Rusinaru D, Mentaverri R, Kamel S, Choukroun G, Vanoverschelde J, Tribouilloy C. WCN23-0900 CHRONIC KIDNEY DISEASE IS A KEY RISK FACTOR FOR AORTIC STENOSIS PROGRESSION. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.351] [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: 03/22/2023] Open
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2
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Dreyfus J, Komar M, Attias D, De Bonis M, Ruschitzka F, Popescu B, Laroche C, Tribouilloy C, Prokophiev A, Mizariene V, Bax J, Maggioni A, Vahanian A, Iung B. Tricuspid regurgitation: Frequency, management and outcome among patients with severe left-sided valvular heart disease in Europe. Insights from the ESC-EORP Valvular Heart Disease II survey. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.142] [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: 01/01/2023]
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3
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De Azevedo D, De Meester C, Hanet V, Altes A, Pouleur AC, Pasquet A, Gerber B, Marechaux S, Tribouilloy C, Vanoverschelde JL, Vancraeynest D. Prognostic implications of paradoxical low gradient severe aortic stenosis: a comprehensive analysis from a large multicentric registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1614] [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: 11/14/2022] Open
Abstract
Abstract
Background
Up to 40% of patients with severe aortic stenosis (SAS; indexed aortic valve area (AVAi) <0.6 cm2/m2) present with low transvalvular mean gradient (MG) despite a normal left ventricular ejection fraction (EF). There is intense debate about the prognostic significance of such entity, with some referring to it as an advanced form of the disease, others as an intermediate form between a moderate and a severe form.
Objectives
To compare outcome of patients with paradoxical low gradient SAS (PLG-SAS; i.e., mean gradient <40 mmHg and AVAi <0.6 cm2/m2) vs. moderate aortic stenosis (MAS; i.e. mean gradient <40 mmHg and AVAi >0.6 cm2/m2) and high gradient SAS (HG-SAS; i.e. mean gradient >40 mmHg and AVAi <0.6 cm2/m2).
Methods
2582 consecutive patients with aortic stenosis (PLG-SAS, n=933; MAS, n=876 and HG-SAS, n=773) and a preserved EF (>50%) from an international multicentric registry were studied. Five years mortality between groups was compared using Kaplan Meier analysis. Inverse probability weighting was used to adjust for clinical and imaging baseline characteristics. Additionally, to explore the impact of MG (<40 mmHg vs. >40 mmHg) in patients with AVAi <0.6 cm2/m2 (PLG-SAS vs. HG-SAS) and to explore the impact of AVAi (<0.6 cm2/m2 vs. >0.6 cm2/m2) in patients with MG <40 mmHg (PLG-SAS vs MAS) we performed 2 different propensity score analyses. Patients were censored at the time of surgery.
Results
Overall, during 23 [IQR,10–47] months of follow-up 1003 patients died and 770 patients underwent aortic valve replacement. IPW-adjusted natural history was significantly better in patients with MAS, intermediate for patients with PLG-SAS and worst in patients with HG-SAS (59 vs. 47 vs. 41%, p<0.001, see Figure 1A). Furthermore, at equal MG (448 pairs), survival was significantly better in patients with MAS compared with PLG-SAS (54% vs. 39% p<0.001, see Figure 1B) and at equal AVAi (377 pairs), survival was significantly better in patients with PLG-SAS compared with HG-SAS (43% vs. 32% p<0.001, see Figure 1C).
Conclusions
In this large multicentric cohort, survival of PLG-SAS patients was better than that of HG-SAS patients and worse than that of MAS patients. Furthermore, with a comparable mean gradient, the smaller the calculated AVAi, the worse the prognosis whereas with a comparable AVAi, the higher the mean gradient, the worse the prognosis. Taking together, these data demonstrate that PLG-SAS is an intermediate form in the disease continuum, HG-SAS being the most malignant form of AS.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds National de la Recherche Scientifique (F.R.S.–FNRS)
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Affiliation(s)
- D De Azevedo
- Cliniques Universitaires St Luc (UCL) , Bruxelles , Belgium
| | - C De Meester
- Cliniques Universitaires St Luc (UCL) , Bruxelles , Belgium
| | - V Hanet
- Cliniques Universitaires St Luc (UCL) , Bruxelles , Belgium
| | - A Altes
- Lille Catholic Institute Hospitals Group, Cardiology , Lomme , France
| | - A C Pouleur
- Cliniques Universitaires St Luc (UCL) , Bruxelles , Belgium
| | - A Pasquet
- Cliniques Universitaires St Luc (UCL) , Bruxelles , Belgium
| | - B Gerber
- Cliniques Universitaires St Luc (UCL) , Bruxelles , Belgium
| | - S Marechaux
- Lille Catholic Institute Hospitals Group, Cardiology , Lomme , France
| | - C Tribouilloy
- University Hospital of Amiens, Cardiology , Amiens , France
| | | | - D Vancraeynest
- Cliniques Universitaires St Luc (UCL) , Bruxelles , Belgium
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4
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Bohbot Y, Habib G, Stohr E, Chirouze C, Hernandez-Meneses M, Melissopoulou M, Scheggi V, Branco L, Olmos C, Reye G, Pazdernik M, Iung B, Sow R, Lancellotti P, Tribouilloy C. Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) regist. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1663] [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: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Congestive heart failure (CHF) is a strong prognostic factor in infective endocarditis (IE), but data are lacking regarding its current management and outcome in Europe.
Purpose
To evaluate the current management and survival of patients with left-sided IE complicated by CHF.
Methods
We used data of the ESC-EORP EURO-ENDO registry, which is a prospective multicentre observational study conducted between January 1, 2016 and March 31, 2018 in 156 centres in 40 countries. The primary endpoints were 30-day and one-year mortality.
Results
Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n=698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p≤0.019). Patients with CHF experienced higher 30-day and one-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (OR [95% CI]: 2.37 [1.73–3.24]; p<0.001) and one-year mortality (HR [95% CI]: 1.69 [1.40–2.05]; p<0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n=618 [88.5%] for each group, both p<0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson index, cerebrovascular accident, staphylococcus aureus IE, Streptococcal IE, uncontrolled infection, vegetation size >10mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR [95% CI]: 0.22 [0.12–0.38]; p<0.001) and in one-year mortality (HR [95% CI]: 0.29 [0.20–0.41]; p<0.001).
Conclusion
CHF is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and one-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular Int. (2011–2014) Amgen Cardiovascular (2009–2018),
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Affiliation(s)
- Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - G Habib
- Hospital La Timone of Marseille , Marseille , France
| | - E Stohr
- University hospital Bonn , Bonn , Germany
| | - C Chirouze
- University of Besançon , Besancon , France
| | | | | | - V Scheggi
- University of Florence , Florence , Italy
| | - L Branco
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre , Lisbon , Portugal
| | - C Olmos
- Hospital Clinico San Carlos , Madrid , Spain
| | - G Reye
- Instituto Medico de Alta Complejidad (IMAC) , Buenos Aires , Argentina
| | - M Pazdernik
- Charles University of Prague , Prague , Czechia
| | - B Iung
- Bichat APHP Site of Paris Nord University Hospital , Paris , France
| | - R Sow
- Hospital Center of Luxembourg , Luxembourg , Luxembourg
| | - P Lancellotti
- University Hospital of Liege (CHU) , Liege , Belgium
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5
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Lozano Torres J, Sambola A, Magne J, Olmos C, Ternacle J, Calvo F, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Cam Bekkers S, Chan KL, Iung B, Lancellotti P, Habib G. Risk calculator to predict 30-day mortality in left-sided infective endocarditis. The EURO-ENDO score. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1662] [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
Background/Introduction
Infective endocarditis (IE) is associated with high in-hospital mortality, despite improvements in therapeutic strategies. Nonetheless, there is no prospective risk model to estimate IE mortality.
Purpose
We sought to develop and validate a calculator to predict 30-day mortality risk regarding to perform surgery or medical treatment alone in left-sided IE.
Methods
This is a prospective, multicenter registry that included patients between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Patients with possible or definite left-sided IE were included in the analyses. Clinical, biological, microbiological and imaging data were collected. The primary end point was 30-day mortality in patients with left-sided IE. The risk calculator was based on multivariable Cox regression models. The accuracy of the logistic regression models was assessed by discrimination and calibration using C-statistic and Hosmer-Lemeshow test.
Results
Among 3116 patients included, 2171 patients presented left-sided IE and 257 patients (11.8%) died during the first 30 days of IE diagnosis. After multivariable Logistic regression analysis, eleven variables were associated with 30-days mortality and were included in the calculator: previous cardiac surgery, previous stroke/TIA, creatinine >2 mg/dL, S. aureus infection, embolic events on admission, heart failure or cardiogenic shock, vegetation size >14 mm, presence of abscess, severe regurgitation, double left-sided IE and no left valve surgery. There was an excellent correlation between the predicted 30-days mortality in both models with or without performing left valve surgery (area under the receiver operator curve: 0.798 and 0.758, respectively). Moreover, calibration by Hosmer-Lemeshow were 0.085 and 0.09, respectively).
Conclusion(s)
Our risk score in patients with left-sided IE provides an accurate individualized estimation of 30-day mortality according to perform or not perform left-valve surgery. It allows medical professionals to determine whether submitting patients to surgery or not, and thus improve their prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Sambola
- Hospital Universitari Vall d?Hebron , Barcelona , Spain
| | - J Magne
- Dupuytren University Hospital Centre Limoges, Cardiologie , Limoges , France
| | - C Olmos
- Hospital Clinico San Carlos , Madrid , Spain
| | - J Ternacle
- University Hospital Henri Mondor , Creteil , France
| | - F Calvo
- Hospital do Meixoeiro, Cardiología , Vigo , Spain
| | | | | | | | - S W Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S Cam Bekkers
- Maastricht University Medical Centre (MUMC) , Maastricht , The Netherlands
| | - K L Chan
- University of Ottawa, Heart Institute , Ontario , Canada
| | - B Iung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | - P Lancellotti
- University Hospital of Liege (CHU), GIGA Cardiovascular Sciences , Liege , Belgium
| | - G Habib
- Hospital La Timone of Marseille , Marseille , France
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Bohbot Y, Garot J, Hovasse T, Unterseeh T, Di Lena C, Boukefoussa W, Tawa C, Renard C, Limouzineau I, Duhamel S, Garot P, Tribouilloy C, Sanguineti F. Clinical and cardiovascular magnetic resonance predictors of early and long-term clinical outcome in acute myocarditis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.183] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
The natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are debated.
Purpose
We sought to assess the impact of various cardiac magnetic resonance (CMR) parameters on early and long-term prognosis in a population of patients with AM.
Methods
In a two-centre longitudinal study, we included consecutive patients with diagnosis of AM based on CMR and without haemodynamic compromise. The primary endpoint was the occurrence of an event in the acute phase (≤15 days). Secondary endpoints were the occurrence of major adverse cardiac events (MACE) and recurrence of AM during follow-up.
Results
Three hundred and eighty-eight patients were included (mean age 38.5 years, 77.3% male, mean ejection fraction [EF]:56%) of which 82% (317) presented with chest pain. CMR was performed 4±2 days after index presentation. Overall, 38 patients (9.8%) had an event at the acute phase, 41 (10.6%) presented at least one MACE during follow-up (median 7.5 years, 6.6–8.9) and 30 (7.7%) experienced a recurrence of AM. By multivariate analysis, the independent predictors of initial complications were absence of chest pain (OR [95% CI] = 0.35 [0.15–0.82]), presence of syncope/pre-syncope (OR [95% CI] = 3.56 [1.26–10.02]), lower EF (OR [95% CI] = 0.94 [0.91–0.98] per %), myocardial extent of late gadolinium enhancement (LGE) (OR [95% CI] = 1.05 [1.002–1.100] per %) and absence of edema (OR [95% CI] = 0.44 [0.19–0.97]). Only age (HR [95% CI] = 1.021 [1.001–1.041] per year) and an initial alteration of EF (HR [95% CI] = 0.94 [0.91–0.97] per %) were associated with MACE during follow-up. Factors independently associated with AM recurrence were myocarditis prior to the index episodes (HR [95% CI] = 5.74 [1.72–19.22]) and viral syndrome at the index episode (HR [95% CI] = 4.21 [1.91–9.28]).
Conclusion
In routine consecutive hemodynamically stable patients with diagnosis of AM based on CMR, absence of edema, reduced EF, and extent of LGE were associated with early adverse outcome. Only age and EF were associated with long-term events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - C Di Lena
- University Hospital of Amiens , Amiens , France
| | | | - C Tawa
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - C Renard
- University Hospital of Amiens , Amiens , France
| | | | - S Duhamel
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | | | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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7
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Dreyfus J, Komar M, Attias D, De Bonnis M, Ruschitzka F, Popescu BA, Laroche C, Tribouilloy C, Prokophiev AB, Mizariene V, Bax JJ, Maggioni AP, Vahanian A, Iung B. Tricuspid regurgitation: frequency, management and outcome among patients with severe left-sided valvular heart disease in Europe. Insights from the ESC-EORP valvular heart disease II survey. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1530] [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: 11/14/2022] Open
Abstract
Abstract
Background
Tricuspid regurgitation (TR) is frequent among patients with severe left-sided valvular heart disease (LS-VHD).
Objectives
This study sought to assess TR frequency, management and outcome in this population.
Methods
Among 6883 patients with severe LS-VHD or previous valvular intervention in the EURObservational Research Programme prospective VHD II survey, we analyzed frequency and grade of TR according to LS-VHD, and 6-month survival according to TR grade. Among 2081 patients who underwent an intervention for severe LS-VHD, we analyzed frequency and outcome of concomitant TV intervention, and concordance between Class I indications for concomitant TV surgery (patients with severe TR) and real-practice decision-making.
Results
Moderate to severe TR was very frequent among patients with severe mitral VHD (≥30%), especially in patients with secondary mitral regurgitation (46%), and rare among patients with aortic VHD (<5%). Higher TR grade was associated with a poorer 6-month survival (P<0.001). Rates of concomitant tricuspid valve (TV) intervention at the time of left-sided heart valve surgery were high at the time of mitral valve surgery (more than 40%). Concomitant TV intervention at the time of left-sided heart valve surgery (LS-HVS) was not associated with an increase in-hospital mortality (P=0.93). Concordance between Class I indications for concomitant TV surgery at the time of LS-HVS according to guidelines and real-practice decision-making was very good (88% overall).
Conclusion
TR was frequent in patients with mitral VHD and was associated with a poorer outcome as TR grade increased. Compliance to guidelines for Class I indications for concomitant TV surgery at the time of LS-HVS was very good. With the trend toward more transcatheter treatment for left-sided VHD, there is a critical need for safe and efficient tricuspid valve transcatheter treatment for patients with concomitant TR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Dreyfus
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | - M Komar
- Jagiellonian University , Krakow , Poland
| | - D Attias
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | | | - F Ruschitzka
- University Hospital Zurich , Zurich , Switzerland
| | - B A Popescu
- Emergency Institute for Cardiovascular Diseases , Bucarest , Romania
| | - C Laroche
- European Society of Cardiology , Sophia-Antipolis , France
| | | | - A B Prokophiev
- National Medical Research Center , Novosibirsk , Russian Federation
| | - V Mizariene
- Hospital of Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - J J Bax
- Leiden University Medical Center , Leiden , The Netherlands
| | - A P Maggioni
- European Society of Cardiology , Sophia-Antipolis , France
| | - A Vahanian
- University Paris Diderot , Paris , France
| | - B Iung
- AP-HP-Bichat Hospital-Cardiology Department , Paris , France
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8
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Dreyfus J, Bohbot Y, Coisne A, Lavie-Badie Y, Riant E, Modine T, Le Tourneau T, Tribouilloy C, Donal E, Habib G, Selton-Suty C, Iung B, Obadia JF, Audureau E, Messika-Zeitoun D. Redo isolated tricuspid valve surgery: prediction of in-hospital mortality using the TRI-SCORE. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1600] [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
Background
Redo isolated tricuspid valve surgery (ITVS) is rarely performed. The TRI-SCORE reliably predicts in-hospital mortality after ITVS on native valve but has not been tested in the setting of redo interventions.
Purpose
We aimed to compare the predictive value of the TRI-SCORE to other surgical risk scores for redo ITVS.
Methods
Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centers between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and the TRI-SCORE, Logistic EuroSCORE, EuroSCORE II and STS were calculated.
Results
We identified 70 patients who underwent a redo ITVS (mean age 54±15 years, 63% female). Prior intervention was a repair in 51% and a replacement in 49%. A tricuspid valve replacement was performed in all patients. In-hospital mortality was 10%. The TRI-SCORE was the only risk score associated with in-hospital mortality (p=0.01). Area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than with logistic EuroSCORE (0.58), EuroSCORE II (0.61) or STS (0.59). The table presents the observed and predicted values of in-hospital mortality according to TRI-SCORE categories.
Conclusion
The TRI-SCORE accurately predicted in-hospital mortality after redo isolated tricuspid valve surgery and may guide the clinical decision-making process especially as transcatheter therapies are emerging.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Dreyfus
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | - Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - A Coisne
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - E Riant
- University Hospital Henri Mondor , Creteil , France
| | - T Modine
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | | | | | - E Donal
- Hospital Pontchaillou of Rennes , Rennes , France
| | - G Habib
- Aix-Marseille University , Marseille , France
| | | | - B Iung
- AP-HP-Bichat Hospital-Cardiology Department , Paris , France
| | - J F Obadia
- Hospital Louis Pradel of Bron , Lyon , France
| | - E Audureau
- University Hospital Henri Mondor , Creteil , France
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9
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Altes A, Levy F, Iacuzio L, Dumortier H, Toledano M, Tartar J, Tribouilloy C, Marechaux S. Comparison of mitral regurgitant volume assessment between proximal flow convergence and volumetric methods in patients with significant primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.192] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Discrepancies have been observed between transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (MRI) severity grading in primary mitral regurgitation (MR).
Purpose. To compare mitral regurgitant volume (RV) obtained by the proximal flow convergence method (PISA) method by TTE and by volumetric methods (TTE and MRI), and study the relationship between LV size and RV obtained by either the PISA or volumetric methods.
Methods and results. 188 patients from 2 heart valve clinics with at least moderate-to-severe primary MR due to prolapse in sinus rhythm who underwent evaluation with TTE and MRI were included. RV was estimated by either PISA or volumetric methods (Left ventricular [LV] stroke volume minus systolic aortic outflow volume)) by either MRI (MRI-RV) or TTE (TTE-RV)). PISA-RV and either MRI-RV or TTE-RV weakly correlated (r = 0.29 and 0.30,p < 0.001). On multivariable analysis, LV end-diastolic volume (LVEDV) and bileaflet prolapse independently correlated with the magnitude of the difference between PISA and volumetric methods. While PISA-RV and LVEDV were unrelated, MRI-RV and TTE-RV strongly correlated with LVEDV (r = 0.66 and 0.68,p < 0.001). In contrast, LVEDV and regurgitant fraction (RF = RV/LVEDV) either with TTE or MRI were poorly related (r = 0.17,p = 0.02 and r = 0.12,p = 0.10).
Conclusion. RV estimated by the PISA and volumetric methods are not comparable. The expected proportional relationship between volumetric RV and LV size, which is not observed with PISA-RV suggests the inaccuracy of PISA-RV. Given that RV by volumetric methods depends on LV size, determination of a unique RV threshold for severe MR is challenging. Calculation of RF may overcome this limitation. Abstract Figure. RV assessed by PISA or volumetric method Abstract Figure. Illustrative example
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Affiliation(s)
- A Altes
- Lille Catholic University, Lille, France
| | - F Levy
- Cardio-Thoracic Center of Monaco, Monaco, Monaco
| | - L Iacuzio
- Cardio-Thoracic Center of Monaco, Monaco, Monaco
| | | | - M Toledano
- Lille Catholic University, Lille, France
| | - J Tartar
- Lille Catholic University, Lille, France
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10
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Essayagh B, Benfari G, Antoine C, Grigioni F, Le Tourneau T, Roussel JC, Ajmone N, Van Wijngaarden A, Delgado V, Bax J, Tribouilloy C, Hochstadt A, Topilsky Y, Michelena H, Enriquez-Sarano M. The MIDA quantitative international registry: prognostic implications of moderately elevated pulmonary artery pressure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Pulmonary hypertension is a frequent complication of severe degenerative mitral regurgitation (DMR) associated with major outcome implications. However, whether pulmonary hypertension is linked with worse outcome in less that severe MR is uncertain and even more unsubstantiated is the link of elevated systolic pulmonary artery pressure (sPAP) < 50mmHg with clinical presentation and outcome.
Purpose
To assess the outcome implication of sPAP elevation, even moderate, among mitral regurgitation severity subgroups.
Methods
The MIDA-Quantitative (MIDA-Q) unprecedented registries included 7373 consecutive patients (age 64 ± 17 years, 45% women, follow-up 5.5 ± 3.4 years) with isolated DMR diagnosed at tertiary (European/North-American/Middle East) centers in which systolic pulmonary artery pressure (sPAP) was measured prospectively at baseline. Long-term survival overall, under medical management and post-mitral surgery was analyzed.
Results
Elevated pulmonary pressure (sPAP >50mmHg) was observed in 1371 patients (19%, mean 63 ± 13mmHg) and moderate increase in pulmonary pressure (35< sPAP < 50mmHg) in 1874 patients (25%, mean 41 ± 14mmHg), with no/mild MR in 4067 (50%), moderate in 2073 (25%), and severe or above in 2047 (25%), mean ERO 0.24 ± 24cm2, RVol 37 ± 35mL and posterior leaflet prolapse in 34%. sPAP severe but also moderate both strongly and independently linked to more severe clinical presentation, with more dyspnea, more AFib, and impaired renal function (P ≤ 0.0001). <SPAP< >By sPAP categories, 35 < sPAP< 50mmHg (vs. 35mmHg) was independently associated with worse outcome under medical management adjusted-HR 1.62[1.40-1/87], with considerable excess-mortality for sPAP > 50mmHg (vs. <35mmHg) adjusted-HR 2.54[2.17-2.96], all P < 0.0001. As continuous variable, sPAP was associated with worse outcome adjusted-HR 1.25[1.21-1.29], P < 0.0001 per 10mmHg-increase. Mitral valve surgery (performed in 2378 patients, 32%) improved outcome without alleviating completely higher mortality associated with sPAP > 50mmHg (P < 0.0001).
Conclusion
In this very large international cohort of patients with DMR of all range and prospective sPAP grading, higher sPAP is associated at diagnosis with more severe clinical presentation. Long term, sPAP > 50mmHg but also 35-50mmHg is independently of all confounders, associated with worse mortality. Thus careful assessment and consideration for mitral surgery/transcatheter therapy is warranted even in patients with sPAP <50mmHg.</SPAP< > Abstract Figure. Survival stratified by sPAP Categories Abstract Figure. Postop survival by sPAP Categories
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Affiliation(s)
- B Essayagh
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - F Grigioni
- Campus Bio-Medico University Of Rome, Division of Cardiovascular Diseases, Rome, Italy
| | - T Le Tourneau
- University Hospital of Nantes, Department of Cardiology, Nantes, France
| | - JC Roussel
- University Hospital of Nantes, Department of Cardiothoracic Surgery, Nantes, France
| | - N Ajmone
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - A Van Wijngaarden
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - J Bax
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - C Tribouilloy
- University Hospital of Amiens, Division of Cardiovascular Diseases, Amiens, France
| | - A Hochstadt
- Tel Aviv University, Division of Cardiovascular Diseases, Tel Aviv, Israel
| | - Y Topilsky
- Tel Aviv University, Division of Cardiovascular Diseases, Tel Aviv, Israel
| | - H Michelena
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - M Enriquez-Sarano
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
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11
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Tribouilloy C, Bohbot Y, Kubala M, Ruschitzka F, Popescu B, Wendler O, Laroche C, Bartha E, Ince H, Simajova I, Vahanian A, Iung B. Characteristics, management and outcomes of patients with multiple native valvular heart disease: A substudy of the EURObservational research programme valvular heart disease II survey. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.131] [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: 11/24/2022]
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12
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Dhayni K, Chabry Y, Hénaut L, Ouled-Haddou H, Avondo C, Tribouilloy C, Caus T, Zibara K, Kamel S, Bennis Y. IL-8 promotes the calcification of human aortic valve interstitial cells, which is prevented through antagonizing CXCR1 and CXCR2 receptors. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.233] [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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13
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Essayagh B, Benfari B, Antoine C, Grigioni F, Le Tourneau T, Roussel J, Bax J, Delgado V, Ajmone N, Van Wijngaarden A, Tribouilloy C, Hochstadt A, Topilsky Y, Michelena H, Enriquez-Sarano M. The MIDA quantitative mortality risk score: Prognostic model in floppy mitral valves. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.126] [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: 12/01/2022]
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14
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Levy F, Iacuzio L, Marechaux S, Tribouilloy C, Eker A. Influence of prolapse volume in myxomatous mitral valve prolapse. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.097] [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: 10/19/2022]
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15
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Boukefoussa W, Di Lena C, Limouzineau I, Jarry G, Leborgne L, Renard C, Tribouilloy C, Bohbot Y. Impact of late gadolinium enhancement localization on outcomes in acute myocarditis. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.078] [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: 10/19/2022]
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16
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Delbarre M, Girardon F, Blanc-Durand P, Hubaut M, Roquette L, Hachulla E, Semah F, Huglo D, Marchal E, El Esper I, Kharoubi M, Tribouilloy C, Lamblin N, Duhaut P, Itti E, Schmidt J, Damy T. Détection automatique des amyloses cardiaques en scintigraphie osseuse à l’aide du machine learning. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.314] [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: 10/19/2022]
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17
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Delbarre M, Zaroui A, Annabi M, Galat A, Duhaut P, Schmidt J, Tribouilloy C, Pibarot P, Damy T. Amylose cardiaque sénile et rétrécissement aortique: l’œuf et la poule. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.315] [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: 10/19/2022]
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18
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Dhayni K, Chabry Y, Henaut L, Ouled-Haddou H, Avondo C, Tribouilloy C, Caus T, Zibara K, Kamel S, Bennis Y. IL-8 promotes the calcification of human aortic valve interstitial cells, which is prevented through antagonizing CXCR1 and CXCR2 receptors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Inflammation is a key feature of calcific aortic valve stenosis (CAVS) against which there is currently no pharmacological treatment.
Purpose
To verify the hypothesis that interleukin-8 (IL-8), a pro-inflammatory factor involved in arterial calcifications, also promotes the calcification of human aortic valve interstitial cells (hVICs).
Methods
Primary hVICs were isolated from healthy pieces of aortic valves harvested from patients undergoing surgical valve replacement. They were cultured in a pro-calcifying condition (Pi-3.8mM) with or without IL-8 (5 to 50 pg/ml) for up to 21 days. Calcification was analysed by alizarin red staining and calcium content was measured with the o-cresolphthalein complexone method. The viability of hVICs was verified by the MTT assay. The expression of osteogenic (BMP2, OPN, osterix and ALP) and myofibrotic (alpha-SMA, collagen-1, collagen-3 and elastin) markers as well as that of metalloproteases (MMP-2, -9 and -12) was analysed by RT-qPCR. The expression of IL-8 receptors, CXCR-1 and CXCR-2 was evaluated by Western blot and flow cytometry, and the effects of IL-8 were tested in the presence or absence of SCH527123, an antagonist of CXCR-1 and CXCR-2. Finally, the expression of CXCR-1 and -2 and elastin was analysed by immunohistochemistry in the calcified and non-calcified areas of human aortic valve samples. All of these experiments were carried out from valves of at least 5 different donors and a P<0.05 was considered statistically significant.
Results
IL-8 (15 pg/mL) caused a significant ∼2-fold increase in the calcification of hVICs in the Pi condition, compared to the Pi-only condition, without modulation of cell viability. In the presence of Pi, IL-8 exposure significantly stimulated the expression of the transcripts of elastin and MMP-12, an elastase, and reduced that of OPN, a well-known inhibitor of calcification. The effects of IL-8 on hVICs calcification and on the expression of MMP-12, elastin and OPN transcripts were significantly prevented by the addition of SCH527123. In addition, the expression of CXCR-1 and -2 was confirmed in histological samples of human aortic valves. This expression was more pronounced in calcified areas compared to non-calcified areas and co-localized with degraded elastin.
Conclusion
IL-8 promoted the calcification of hVICs in culture. This effect was significantly prevented by antagonizing CXCR-1 and CXCR-2 IL-8 receptors, which we showed for the first time to be expressed by human VICs and aortic valves of patients with CAVS. Further studies are underway to clarify the cellular mechanisms involved.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Fédération Hospitalo-Universitaire REMOD-VHF
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Affiliation(s)
- K Dhayni
- UPJV Amiens, MP3CV Laboratory. UPJV UR 7517, Amiens, France
| | - Y Chabry
- University Hospital of Amiens, Department of cardiac surgery, Amiens, France
| | - L Henaut
- UPJV Amiens, MP3CV Laboratory. UPJV UR 7517, Amiens, France
| | - H Ouled-Haddou
- UPJV Amiens, HEMATIM Laboratory, UPJV UR 4666, Amiens, France
| | - C Avondo
- UPJV Amiens, MP3CV Laboratory. UPJV UR 7517, Amiens, France
| | - C Tribouilloy
- University Hospital of Amiens, Department of Cardiology, Amiens, France
| | - T Caus
- University Hospital of Amiens, Department of cardiac surgery, Amiens, France
| | - K Zibara
- Lebanese University, Department of Biology, Faculty of Sciences, Beirut, Lebanon
| | - S Kamel
- UPJV Amiens, MP3CV Laboratory. UPJV UR 7517, Amiens, France
| | - Y Bennis
- UPJV Amiens, MP3CV Laboratory. UPJV UR 7517, Amiens, France
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19
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Essayagh B, Benfari G, Antoine C, Grigioni F, Le Tourneau T, Roussel JC, Bax J, Delgado V, Ajmone N, Van Wijngaarden A, Tribouilloy C, Hochstadt A, Topilsky Y, Michelena H, Enriquez-Sarano M. The MIDA quantitative mortality risk score: prognostic model in floppy mitral valves. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1699] [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: 11/14/2022] Open
Abstract
Abstract
Background
The Mitral Regurgitation International Database (MIDA) score is a validated tool for Degenerative Mitral Regurgitation (DMR) management, being able to position a given patient within a continuous spectrum of short and long term mortality. However, whether this score may be applicable and incremental in the entire span of Floppy Mitral Valves (FMV), regardless of DMR severity, remains unsubstantiated.
Methods
The MIDA-Quantitative (MIDA-Q) unprecedented registries include 8187 consecutive patients (age 64±17 years, 45% women, follow-up 5.5±3.4 years) with isolated degenerative mitral valve disease diagnosed at tertiary (European/ North-American/ Middle Eastern) centers in whom DMR severity used both integrative and quantitative grading. The MIDA-Q Score ranged from 0 to 15 depending on accumulating risk factors. Long-term survival overall, under medical management and post-mitral surgery was analysed.
Results
By quantitative grading, MR was no/trivial in 1938 (24%), mild in 1423 (17%), moderate in 2027 (25%) and severe in 2799 (34%), with ERO 0.24±24cm2, RVol 37±35mL, and posterior leaflet prolapse in 49%. MIDA-Q Scores stratified in 8 categories were 0 (score 0, n=851), 1 (score 1–2, n=1301), 2 (score 3–4, n=2043), 3 (score 5–6, n=1581), 4 (score 7–8, n=1273), 5 (score 9–10, n=718), 6 (score 11–12, n=331) and 7 (score 13–15, n=89). In the whole MIDA-Q population (n=8187 patients), 5-year survival under medical management with Scores categories 0–1, 2–4, and 5–7 was 96±1%, 73±1%, and 61±3% respectively (P<0.0001). Five-year mortality ranged from 3% with MIDA Q-score 0 to 95% with MIDA Q-score 13–15 (P<0.0001). After mitral surgery, 1-year mortality with Scores categories 0–1, 2–4, and 5–7 was 0%, 1%, and 6% respectively and 5-year post-operative survival was 99±1%, 94±1%, and 82±2% (all P<0.0001). In models including age, sex and all guideline-provided prognostic markers, the EuroScoreII and the MIDA Score without DMR severity, the MIDA-Q Score provided incremental prognostic information (P<0.001).
Conclusion
This unheard international cohort of patients with FMV and prospective mitral severity quantitative grading, enables for the first time the calculation of a MIDA-Q Score, highly determinant of survival after diagnosis of FMV with any degree of DMR, that may be very useful for mitral valve prolapse management.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Mayo Fundation Figure 1
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Affiliation(s)
- B Essayagh
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - F Grigioni
- Campus Bio-Medico University of Rome, Department of Cardiology, Rome, Italy
| | - T Le Tourneau
- University Hospital of Nantes, Department of Cardiology, Nantes, France
| | - J C Roussel
- University Hospital of Nantes, Department of Cardiothoracic Surgery, Nantes, France
| | - J Bax
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - N Ajmone
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - A Van Wijngaarden
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - C Tribouilloy
- University Hospital of Amiens, Department of Cardiology, Amiens, France
| | - A Hochstadt
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - Y Topilsky
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - H Michelena
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - M Enriquez-Sarano
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
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20
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Sambola A, Lozano Torres J, Olmos C, Ternacle J, Calvo-Iglesias FE, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Arregle F, Lung B, Lancellotti P, Habib G. Predictors of mortality in patients with left-side infective endocarditis, the ESC-EORP EURO-ENDO registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1716] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Infective endocarditis (IE) is associated with high in-hospital mortality, ranging from 16% to 25%, despite improvement in diagnostic and therapeutic strategies, mainly due to complications and heterogeneity of the disease. Baseline risk stratification is essential, in order to focus an aggressive management toward high-risk patients.
Purpose
We sought to assess the association between surgery and 30-day mortality rate as related to vegetation size.
Methods
The ESC-EORP EURO-ENDO registry is a prospective multicentre observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Multivariable logistic regression analysis was performed to assess variables associated with 30-day mortality. Besides, univariable analysis was performed to assess best vegetation size cut-off related to 30-day mortality.
Results
Among 2171 patients with left-side IE, 257 patients (11.8%) died during the first 30 days of IE diagnosis. Patient characteristics and univariable analysis are summarized in TABLE 1. Cut-off value for best vegetation size related to 30-day mortality was vegetation length >14mm, with a HR =2.00 (95% CI 1.59–2.51, p<0.0001) and a Harrell's Concordance of 0.58. After multivariable logistic regression analysis, factors associated with 30-day mortality risk were: vegetation size >14mm (OR =2.68, 95% CI [1.96–3.67], p<0.0001), previous stroke or transient ischemic attack (TIA) (OR =1.60, 95% CI [1.07–2.40], p=0.0235), creatinine >2mg/dL (OR =2.45, 95% CI [1.73–3.47], p<0.0001), presence of embolic events (OR =2.64, 95% CI [1.86–3.74], p<0.0001), hemorrhagic stroke (OR=3.71, 95% CI [1.80–7.64], p=0.0004), presence of heart failure or cardiogenic shock (OR =3.50, 95% CI [2.57–4.77], p<0.0001) and no cardiac surgery during the event (OR =4.07, 95% CI [2.93–5.67], p<0.0001). The C-statistic of the logistic model to predict 30-day mortality was 0.795.
Conclusion
Left-side infective endocarditis had a high 30-day mortality rate (11.8%). Presence of a large vegetation size (>14mm), embolic events, hemorrhagic stroke, renal failure, presence of heart failure or cardiogenic shock were associated with an increase in 30-day mortality. Performing cardiac surgery had a protective effect.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC-EORP EURO-ENDO project from the ESC society
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Affiliation(s)
- A Sambola
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - J Lozano Torres
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Ternacle
- Henri Mondor University Hospital Chenevier APHP, Creteil, France
| | | | | | | | | | - S W Park
- Asan Medical Center, Seoul, Korea (Republic of)
| | - S Bekkers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K L Chan
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - F Arregle
- APHM La Timone Hospital, Marseille, France
| | - B Lung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | | | - G Habib
- APHM La Timone Hospital, Marseille, France
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21
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Sambola A, Lozano Torres J, Olmos C, Ternacle J, Calvo-Iglesias FE, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Arregle F, Lung B, Lancellotti P, Habib G. Predictors of mortality in patients with right-side and cardiac device-related infective endocarditis, the esc-eorp euro-endo registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1717] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Mortality in right-sided infective endocarditis (RSIE) and cardiac device-related IE (CDRIE) rates have increased mainly due derived complications and heterogeneity of the disease. A better understanding of associated risk factors to mortality in these entities are required in order to develop an efficient therapy.
Purpose
The aim of this study was to assess 30-day mortality rate and variables associated in RSIE and CDRIE.
Methods
The ESC-EORP EURO-ENDO registry is a prospective multicenter observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Univariable analysis was performed to assess variables associated with 30-day mortality.
Results
Among 269 patients with RSIE, 24 patients (9.8%) died during the first 30-day of IE diagnosis. Cut-off value for best vegetation size related to 30-day mortality was vegetation length >19mm, with a HR = 2.88 (95% CI 1.26–6.58, p=0.01) and a Harrell's Concordance of 0.632. Factors associated with 30-days mortality by univariable analysis were: vegetation size >19mm (OR = 2.99, 95% CI [1.31–6.84], p=0.009), previous stroke or transient ischemic attack (OR = 5.10, 95% CI [1.19–21.88], p=0.029), HIV infection (OR = 3.52, 95% CI [1.03–12.10], p=0.046), chronic renal failure (OR = 2.66, 95% CI [1.06–6.71], p=0.038), congestive heart failure at admission (OR = 2.34, 95% CI [1.00–5.47], p=0.050) and severe regurgitation (OR = 3.77, 95% CI [1.56–9.09], p=0.003).
On the other side, among the 227 patients with CDRIE, 24 patients (8.8%) died during the first 30-day of IE diagnosis. Factors associated with an increase in 30-day mortality by univariate analysis were: age per 10 years (OR = 1.49, 95% CI [1.02–2.18], p=0.039), heart failure history (OR = 3.88, 95% CI [1.39–10.80], p=0.009), congestive heart failure on admission (OR = 5.80, 95% CI [2.31–14.55], p<0.001) and cardiogenic shock on admission (OR = 13.37, 95% CI [3.75–47.64], p<0.001). An increase in left ventricular ejection fraction (LVEF) per 10% was a protective factor (OR = 0.66, 95% CI [0.49–0.90], p=0.008).
Conclusions
Patients with RSIE and CDRIE had a not negligible 30-day mortality rate (9.8% and 8.8%, respectively). Factors associated with RSIE and CDRIE mortality are different; while in the right side location, the mortality was related with vegetation size and comorbidities, in the case of CDRIE, the mortality was mainly associated to the presence of heart failure.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Euro-Endo registry by European Society of Cardiology
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Affiliation(s)
- A Sambola
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - J Lozano Torres
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Ternacle
- University Hospital Henri Mondor, Creteil, France
| | | | | | | | | | - S W Park
- Asan Medical Center, Seoul, Korea (Republic of)
| | - S Bekkers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K L Chan
- Asan Medical Center, Seoul, Korea (Republic of)
| | - F Arregle
- APHM La Timone Hospital, Marseille, France
| | - B Lung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | | | - G Habib
- APHM La Timone Hospital, Marseille, France
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22
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Altes A, Thellier N, Bohbot Y, Ringle A, Levy F, Castel A, Delelis F, Mailliet A, Tribouilloy C, Marechaux S. Clinical significance of the ratio of acceleration time to ejection time in severe aortic stenosis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.024] [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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23
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Bohbot Y, Rusinaru D, Kubala M, Diouf M, Altes A, Pasquet A, Marechaux S, Vanoverschelde J, Tribouilloy C. Myocardial Contraction fraction for risk stratification in low-gradient aortic stenosis with preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.021] [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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24
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Riolet C, Menet A, Mailliet A, Binda C, Altes A, Appert L, Castel A, Delelis F, Viart G, Guyomar Y, Legoffic C, Decroocq M, Ennezat P, Graux P, Tribouilloy C, Marechaux S. Clinical Significance of Global Wasted Work in patients receiving Cardiac Resynchronization Therapy for Heart Failure. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.048] [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: 11/25/2022]
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25
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Altes A, Thellier N, Rusinaru D, Marsou W, Bohbot Y, Chadha G, Leman B, Paquet P, Ennezat P, Tribouilloy C, Maréchaux S. Clinical significance of dimensionless index in patients with low-gradient severe aortic stenosis and preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.037] [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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Bohbot Y, Rusinaru D, Belkhir K, Altes A, Levy F, Marechaux S, Sarano M, Tribouilloy C. Impact of sex on management and survival in aortic stenosis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.157] [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: 11/25/2022]
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Bohbot Y, Candellier A, Rusinaru D, Altes A, Pasquet A, Marechaux S, Vanoverschelde J, Tribouilloy C. Severe aortic stenosis and chronic kidney disease: Outcomes and impact of aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.163] [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: 10/22/2022]
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Dreyfus J, Flagiello M, Bazire B, Viau F, Riant E, Mbaki Mampuya Y, Bohbot Y, Nicol M, Doguet F, Nguyen V, Coisne A, Le Tourneau T, Lavie-Badie Y, Tribouilloy C, Donal E, Habib G, Selton-Suty C, Iung B, Obadia J, Messika-Zeitoun D. Isolated tricuspid valve surgery–impact of etiology and clinical presentation on outcomes. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.165] [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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Bohbot Y, Rusinaru D, Belkhir K, Altes A, Delpierre Q, Serbout S, Levy F, Marechaux S, Sarano M, Tribouilloy C. Impact of sex on management and survival in aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1899] [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: 11/15/2022] Open
Abstract
Abstract
Background
Increasing attention has been paid to differences between the sexes in recent studies, but only a few have focused on such differences in aortic stenosis (AS).
Purpose
We sought to evaluate the differences between genders in AS outcomes and management.
Methods
We included 2429 patients (51.5% men; 49.5% women) with severe AS. Median follow-up was 42.0 (21–78) months.
Results
Women were older (p<0.001), more often symptomatic (p=0.007), and presented with smaller aortic valve area (p<0.001), and greater ejection fraction (p<0.001) than men. Despite that women have a longer life expectancy than men in the general population, estimated five-year survival of patients with severe AS was lower for women compared to men (62±2% versus 69±1% respectively, p<0.001). The 5-year survival was lower compared to expected survival, especially for women (62±2% vs. 71% for women and 69±1% vs. 71% for men). The cumulative 5-years incidence of AVR was 79±2% for men, and only 70±2% for women (p<0.001) and, being male was independently predictive of AVR (OR: 1.49 [1.18–1.97]; p=0.011). After propensity matching, when both genders were comparable in terms of characteristics and management (AVR), women, as expected due to their higher life expectancy than men, had better 5-year survival than men (69±2% vs. 62±2%; p=0.023).
Conclusion
Women with severe AS present at a more advance stage of the disease, at older ages with more symptoms, and incur higher mortality than men. This excess mortality is related to a combination of late diagnosis and a less frequent and later referral for AVR than in men. This justifies appropriate measures to improve the situation and to ensure that both sexes receive equivalent care.
Figure 1. (A) Survival curves. (B) Surgery incidence.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Bohbot
- University Hospital of Amiens, Amiens, France
| | - D Rusinaru
- University Hospital of Amiens, Amiens, France
| | - K Belkhir
- University Hospital of Amiens, Amiens, France
| | - A Altes
- Lille Catholic University, Lille, France
| | - Q Delpierre
- University Hospital of Amiens, Amiens, France
| | - S Serbout
- University Hospital of Amiens, Amiens, France
| | - F Levy
- Cardio-Thoracic Center of Monaco, Monaco, Monaco
| | - S Marechaux
- University Hospital of Amiens, Amiens, France
| | - M Sarano
- Mayo Clinic, Rochester, United States of America
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Grave C, Tribouilloy C, Juillière Y, Tuppin P, Weill A, Olié V. Nationwide incidence of patients hospitalized for a mitral regurgitation: Patient characteristics and temporal trends in France 2006–2016. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.177] [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: 11/17/2022]
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31
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Bohbot Y, Cheng C, Fay F, Elmkies F, Gugeinheim AL, Tribouilloy C. P1762 Natural history and outcome of adults with bicuspid aortic valve: a middle-aged french cohort of 541 patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1120] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
none
Background
No data are available regarding the natural history and outcomes of middle-aged European patients with bicuspid aortic valve(BAV), as the only 2 large studies were conducted on the other side of the Atlantic.
Purpose
To determine the frequency of cardiovascular events and to assess the survival relative to that of the general population(GP) in a large population of adults diagnosed with BAV according to the presence or the absence of a surgical indication at baseline.
Methods
Between 2005 and 2017, 350 patients without surgical indication (mean age 53, 71% men) and 191 patients with surgical indication (mean age 59, 71% men) at baseline were included. Median follow-up was 80 months.
Results
In the medical group, 34 deaths(9.7%) were recorded(10 cardiovascular). The 10-years survival rate was 88 ± 2% with a relative survival compared to the age-and-sex matched population of 98.8%. Nine patients(2.6%) were diagnosed with infective endocarditis (IE) and no aortic dissection occurred. Aortic valve and/or ascending aorta surgery was performed in 102 patients(29%) during follow-up. In the surgical group, 12 deaths(6.3%) were recorded(5 cardiovascular). The 10-years survival rate was 90 ± 3% with a relative survival compared to the matched population of 99.2%. Five patients(2.6%) were diagnosed with IE and no aortic dissection occurred.
Conclusion
Middle-aged adults with BAV have a high likelihood of surgery but a survival comparable to the GP. The rate of IE is low and no aortic dissection occurred in our study.
Abstract P1762 Figure. a) survival curves B) surgery incidence
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Affiliation(s)
- Y Bohbot
- University Hospital of Amiens, Amiens, France
| | - C Cheng
- University Hospital of Amiens, Amiens, France
| | - F Fay
- University Hospital of Amiens, Amiens, France
| | - F Elmkies
- University Hospital of Amiens, Amiens, France
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Altes A, Sochala M, Attias D, Dreyfus J, Bohbot Y, Toledano M, Macron L, Renard C, Chadha G, Truffier A, Guerbaai R, Ennezat P, Graux P, Tribouilloy C, Maréchaux S. Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: An echocardiographic and computed tomography study. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.139] [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: 11/27/2022]
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33
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Grave C, Tribouilloy C, Juillière Y, Tuppin P, Weill A, Olié V. Nationwide incidence of patients hospitalized for a valvular heart disease according to etiology: Patient characteristics and temporal trends in France 2006–2016. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.178] [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: 10/25/2022]
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34
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Altes A, Ringlé A, Bohbot Y, Bouchot O, Appert L, Guerbaai R, Gun M, Ennezat P, Tribouilloy C, Marechaux S. Prognostic interest of energy loss index in patients with low gradient severe aortic stenosis and preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Grave C, Tribouilloy C, Juillière Y, Tuppin P, Weill A, Olié V. Nationwide incidence of patients hospitalized for an aortic stenosis: Patient characteristics and temporal trends in France 2006–2016. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.156] [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: 10/25/2022]
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36
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Carbone A, Mouhat B, Philip M, Gouriet F, Cammilleri S, Tessonnier L, Casalta J, Riberi A, Bohbot Y, Santelli F, Tribouilloy C, Habib G. Spondylitis: A frequent and severe complication of infective endocarditis. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.174] [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: 10/25/2022]
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37
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Bohbot Y, Chadha G, Delabre J, Landemaine T, Beyls C, Tribouilloy C. Characteristics and prognosis of patients with significant tricuspid regurgitation. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.196] [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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38
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Chadha G, Bohbot Y, Rusinaru D, Marechaux S, Tribouilloy C. Outcome of normal-flow low-gradient “severe” aortic stenosis with preserved left ventricular ejection fraction: A propensity matched study. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.181] [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: 11/25/2022]
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39
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Carbone A, Mouhat B, Lieu A, Santelli F, Bohbot Y, Tessonnier L, D'Andrea A, Cammilleri S, Gouriet F, Camoin L, Casalta JP, Riberi A, Philip M, Tribouilloy C, Habib G. P3666Spondylitis: a frequent and severe complication of infective endocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Abstract
Abstract
Background
Spondylodiscitis (SP) is a rare, but severe complication of infective endocarditis (IE). The incidence, clinical features and prognosis of SP in IE are unknown.
Purpose
The primary objective of our study was to assess the incidence, epidemiology, clinical presentation, prognosis, and therapeutic implications of SP in patient with IE. The secondary objectives were to assess factors associated with occurrence of spondylitis and to assess the value of imaging techniques.
Methods
In a French bi-center prospective study of patients who presented in our endocarditis reference centers with a diagnosis of definite IE from 1990 to 2018 (n=1755), 150 (8.5%) presented with SP. Clinical, epidemiological, microbiological, and prognostic variables were prospectively recorded and compared between patients with (n=150) and without (n=1605) SP.
Results
Patients with SP were older (mean age 69.7±18 vs 66.2±14; p=0.004), had more arterial hypertension (48% vs 34,5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without SP. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L3-L4. Neurological symptoms were observed in 59% of patients. Enterococci et Gallolyticus streptococci were more frequent (24% vs 12% and 24% vs 11%; p<0,001, respectively) in the SP group. Observed sensitivities of full spine contrast-enhanced MRI and CT were 95% and 89%, respectively. PET/CT had a great power to differentiate infective to degenerative vertebral processes, and to find embolic foci with a sensitivity of 90%. Clinical outcome did not differ between patients with or without SP, including similar in-hospital mortality (16% vs 13,5%, p=0.38).
Conclusions
We describe the largest ever reported series of patients with spondylodiscitis complicating IE. Spondylodiscitis is a more frequent complication of IE than previously reported (8.5% of IE), is observed in older hypertensive patients with Enterococcal or Streptococcus gallolyticus IE and has a similar prognosis than other forms of IE. Since SP is associated with prolonged antibiotic therapy and may need specific surgical therapy, multimodality imaging including MRI, CT, and PET/CT should be used for early diagnosis of this IE complication.
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Affiliation(s)
- A Carbone
- La Timone Hospital, Marseille, France
| | - B Mouhat
- La Timone Hospital, Marseille, France
| | - A Lieu
- University Hospital of Amiens, Amiens, France
| | - F Santelli
- Vincenzo Monaldi Hospital, Naples, Italy
| | - Y Bohbot
- University Hospital of Amiens, Amiens, France
| | | | - A D'Andrea
- Vincenzo Monaldi Hospital, Naples, Italy
| | | | - F Gouriet
- La Timone Hospital, Marseille, France
| | - L Camoin
- La Timone Hospital, Marseille, France
| | | | - A Riberi
- La Timone Hospital, Marseille, France
| | - M Philip
- La Timone Hospital, Marseille, France
| | | | - G Habib
- La Timone Hospital, Marseille, France
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40
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Altes A, Sochala M, Attias D, Dreyfus J, Toledano M, Macron L, Renard C, Truffier A, Guerbaai RA, Ennezat PV, Graux P, Tribouilloy C, Marechaux S. P3696Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: an echocardiographic and computed tomography study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0550] [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
Background
Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS).
Purpose
To identify the determinants associated with increased AT/ET.
Methods
The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were studied in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (EF), with Computed Tomography – Aortic Valve Calcium (CT-AVC) score studied in a subgroup of 342 patients.
Results
In univariate analysis, AT/ET ratio did correlate with aortic peak velocity (Vmax, r=0.57, p<0.0001), mean pressure gradient (MPG, r=0.60, p<0.0001), aortic valve area (AVA, r=−0.50, p<0.0001) and CT-AVC score (r=0.24, p<0.0001). An AT/ET ratio had a good accuracy to predict an aortic peak velocity ≥4 m/s, a MPG≥40 mmHg, or an AVA≤1.0 cm2, with an optimal cut-off value of 0.34. By multivariate linear regression analysis, presence of AS-related symptoms, decreased LV stroke volume index, LVEF, systolic blood pressure (SBP), absence of diabetes mellitus, and increased LV mass index, relative wall thickness, and Vmax were independently associated with increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC, CT-AVC score was independently associated with increased AT/ET ratio (P<0.05).
Conclusion
AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond hemodynamic and anatomic severity of AS influence AT/ET ratio including LV geometry, function and SBP. These findings should be considered when assessing AT/ET in patients with AS and preserved LVEF.
Acknowledgement/Funding
Local funding
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Affiliation(s)
- A Altes
- Lille Catholic University, Lille, France
| | - M Sochala
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - D Attias
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - J Dreyfus
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - M Toledano
- Lille Catholic University, Lille, France
| | - L Macron
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | | | - A Truffier
- Lille Catholic University, Lille, France
| | | | - P V Ennezat
- University Hospital of Grenoble, Grenoble, France
| | - P Graux
- Lille Catholic University, Lille, France
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41
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Logeart D, Isnard R, Damy T, Salvat M, Eicher JC, Roubille F, Tribouilloy C, Bauer F, Picard F, Trochu JN, Roul G. P1658Pharmacological treatment of patients with HFrEF: is it really optimized in case of CRT and/or ICD implantation? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0416] [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
Background
Cardiac resynchronization (CRT) as well as implantable cardiac defibrillator (ICD) in primary prevention should be considered in patients with heart failure and reduced ejection fraction (HFrEF) only when pharmacological treatment has been optimized.
Purpose
we sought to analyze pharmacological treatments according to the presence or not of CRT-P, CRT-D or ICD in real life HFrEF patients by using a multicenter survey.
Methods
the survey (NCT01956539) was carried out between 2015 and 2018 in 32 hospitals and included 2735 patients with HF who gave their consent during consultation or hospitalization. In this study, we analyzed only outpatients with chronic HFrEF treated for more than 6 months.
Results
among 1061 patients studied, 138 had CRT-P or CRT-D and 215 had ICD for primary prevention. The main clinical characteristics were: age 65±13 years, ischemic heart disease in, NYHA classes 1, 2, 3 and 4 in 15%, 52%, 23% and 10% cases respectively, systolic blood pressure 115mmHg [IQR 104–129], heart rate 70bpm [IQR 60–80], eGFR 64ml/min/1.73m2 [IQR 46–83]and LVEF was 30% [IQR 24–34]. The table shows the rate of use of evidence-based drugs and the dose for ACEi/ARB and betablockers, according to the presence of ICD or CRT.
HFrEF CRT-P or D ICD (primary prevention) n=1061 n=138 n=215 Loop diuretics 78.2% 79.7% 74.9% ACEi or ARB 65.2% 75.4% 67.3% Sacubitril/valsartan 5.9% 8.5% 9.5% Betablockers 72.3% 83.9% 76.8% Mineralocorticoid antagonists 45.7% 63.6% 60.2% ACEi/ARB mean % maxi dose 77 81 83 Beta-blockers mean % maxi dose 74 63 79
Conclusion
these results suggest that pharmacological treatment remains poorly optimized in a number of patients with HFrEF who received ICD or CRT
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Affiliation(s)
- D Logeart
- AP-HP - Hospital Lariboisiere, Department of cardiology, Paris, France
| | - R Isnard
- Hospital Pitie-Salpetriere, Paris, France
| | - T Damy
- University Hospital Henri Mondor, Creteil, France
| | - M Salvat
- University Hospital of Grenoble, Grenoble, France
| | - J C Eicher
- University Hospital Center, Dijon, France
| | - F Roubille
- University Hospital of Montpellier, Montpellier, France
| | | | - F Bauer
- University Hospital of Rouen, Rouen, France
| | - F Picard
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - J N Trochu
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - G Roul
- University Hospital of Strasbourg, Strasbourg, France
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Mary A, Issa H, Boullier A, Henaut L, Avondo C, Brazier M, Mentaverri R, Tribouilloy C, Messika-Zeitoun D, Kamel S. P905Association of ionized serum magnesium with progression of aortic valve calcification. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0501] [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
Background
Calcific aortic valve disease (CAVD) is the most common heart valve disease among adults. It is a progressive disease whose final step leads to severe aortic stenosis (AS). Pharmacotherapeutic strategies aimed to limit the progression of valve leaflet calcification could be beneficial to slow-down the CAVD progression and to preserve left ventricular function. Several recent clinical studies demonstrated that lower serum magnesium (Mg) level is associated with vascular calcification. Whether serum magnesium is a determinant of aortic calcific stenosis progression remains unkwown.
Methods
In an ongoing prospective cohort of AS patients (COFRASA/GENERAC) we studied the association between serum Mg with the aortic valve calcification prevalence and progression. Serum Mg was measured at baseline in both its ionized (iMg) and total (tMg) forms. AS stenosis severity was evaluated at baseline and yearly thereafter using mean pressure gradient (MPG), the aortic valve area indexed to body surface (AVAi) assessed by echocardiography and the degree of aortic valve calcification (AVC) assessed by computed tomography. Annual progression was calculated as: (final measurement − baseline measurement)/follow-up duration.
Results
We enrolled 356 patients (73.1±10 years, 73% men), the mean follow-up duration was 2.5±2 years. There was a highly significant correlation between iMg and t Mg concentrations values (r=0.85, p<0.0001). Approximately 37% and 25% of patients have respectively iMg values ≤0.45 mmol/L (normal range 0.45–0.60 mmol/L) and t Mg ≤0.80 mmol/L (normal range 0.80–0.95 mmol/L). At baseline, lower i Mg and t Mg were significantly associated with sex, diabètes, lower heamoglobin and hypertension but not with AVC neither with MPG or AVAi. After mean follow-up of 2.5±2 years, the annual mean Log AVC progression was significantly greater (p=0.01) in patients with values of iMg ≤0.45 mmol/L (2,04±0.73) as compared to patients with iMg >0,45 mmol/L (1.78±0.94). Annual Mean MGP and AVAi also progressed greater in patients with low iMg but without reaching a significant level. Similar association was not found with tMg. In multivariate analysis, iMg remained significantly associated with the progression of AVC (odds ratio per 0.1 mmol/L increment [95% confidence interval] = 0.36 [0.15–0.83]; p=0.015) independently of age, tMg, glucose, type 2 diabetes, Tobacco use, baseline AVC, MPG and AVAi.
Conclusion
In a prospective cohort of asymptomatic patients with a wide range of AS severity, low serum ionized Mg but not low total Mg was independently associated with AVC progression.
Acknowledgement/Funding
ANR -RHU-STOPAS
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Affiliation(s)
- A Mary
- UPJV Amiens CHU Amiens, Amiens, France
| | - H Issa
- UPJV Amiens CHU Amiens, Amiens, France
| | | | - L Henaut
- UPJV Amiens CHU Amiens, Amiens, France
| | - C Avondo
- UPJV Amiens CHU Amiens, Amiens, France
| | - M Brazier
- UPJV Amiens CHU Amiens, Amiens, France
| | | | | | | | - S Kamel
- UPJV Amiens CHU Amiens, Amiens, France
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Altes A, Ringle Griguer A, Bohbot Y, Bouchot O, Delelis F, Castel AL, Guerbaai RA, Ennezat PV, Graux P, Tribouilloy C, Marechaux S. P908Prognostic value of energy loss index in patients with low gradient severe aortic stenosis and preserved ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0504] [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
Background
Assessment of pressure recovery adjusted indexed aortic valve area (AVAi) – energy loss index (ELI) – has been shown of prognostic interest for patients with asymptomatic and/or mild aortic stenosis (AS), but limited data are available in the setting of low gradient aortic stenosis (LG-AS).
Purpose
We hypothesized that among these patients with LG-AS, reclassification of AS severity as moderate by ELI may help to identify a subgroup of patients with moderate AS.
Methods
379 patients with low gradient severe AS (defined by AVAi ≤0.6 cm2/m2 and mean aortic pressure gradient (MPG) <40 mmHg) and preserved left ventricular ejection fraction (LVEF ≥50%) were prospectively included. Reclassification as moderate AS by ELI was defined as AVAi ≤0.6 cm2 /m2 but an ELI >0.6 cm2/m2. Clinical and echocardiographic features of patients reclassified by ELI were studied. Clinical outcomes were all-cause and cardiac mortality.
Results
148 patients (39%) were reclassified as moderate AS by ELI. By multivariable logistic regression analysis, patients being reclassified as moderate AS by ELI were associated with increased stroke volume index (SVi), absence of documented coronary artery disease and decreased body surface area, left indexed ventricular mass (all p<0.05). During a median follow-up of 34 months (30–38 months), 119 patients died, 52 of them from cardiac causes. Three-year survival free from all-cause or cardiac death were 76±4%, 96±2% for patients with moderate AS by ELI and 71±3%, 84±3% for patients with severe AS by ELI (p=0.178 and p=0.013, respectively). After adjustment for variables of prognostic interest including aortic valve replacement as a time-dependent covariable, there was a significant reduction of risk of cardiac mortality in patients with moderate AS by ELI (adjusted HR 0.44 [95% CI, 0.23–0.85]; p=0.014) but not for all-cause mortality (adjusted HR 0.85 [95% CI, 0.58–1.25]; p=0.403)
Conclusion
In patients with low gradient “severe” AS and preserved ejection fraction, calculation of ELI permits to reclassify almost 40% of patients as having moderate AS. Patients reclassified as moderate AS by ELI had a reduction of risk of cardiac mortality during follow-up but not for all-cause mortality. Calculation of ELI may be useful for decision making in AS patients with discordant grading and preserved ejection fraction.
Acknowledgement/Funding
Local funding
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Affiliation(s)
- A Altes
- Lille Catholic University, Lille, France
| | | | | | - O Bouchot
- University Hospital of Grenoble, Grenoble, France
| | - F Delelis
- Lille Catholic University, Lille, France
| | - A L Castel
- Lille Catholic University, Lille, France
| | | | - P V Ennezat
- University Hospital of Grenoble, Grenoble, France
| | - P Graux
- Lille Catholic University, Lille, France
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Logeart D, Paven E, Damy T, Isnard R, Salvat M, Eicher JC, Roubille F, Tribouilloy C, Bauer F, Piccard F, Trochu JN. 132Imaging criteria for the diagnosis of heart failure with midrange and preserved LVEF in the real life. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0048] [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
Background
According to last ESC guidelines, the diagnosis of heart failure with midrange and preserved left ventricular ejection fraction (HFmrEF-HF and HFpEF) requires at least one of the following imaging criteria: LV hypertrophy with LVMI >115g/m2 in men and 95g/m2 in women, left atria dilation with LAVI >34ml/m2, TDI e' wave average <9cm/s and E/e' average ≥13.
Purpose
We analyzed the prevalence of these imaging criteria in real life patients who are labeled HFmrEF or HFpEF by using a multicenter survey on HF.
Methods
Our survey (NCT01956539) was carried out in 32 hospitals between 2015 and 2018 and included 2735 HF patients who gave their consent during consultation or hospitalization. The diagnosis of HF was left to the discretion of investigators. Besides clinical and biological data, echocardiographic data (<1 month before or <3 months after inclusion) was collected in an electronic database. No echographic variable except the LVEF was mandatory to be included.
Results
Among the 523 and 765 HF patients who were labeled respectively as HFmrEF-HF and HFpEF, the 4 echographic variables required for the diagnosis of HFmrEF or HFpEF were obtained in 512 patients. The median age was 74y [IQR 62–82], HF was de novo in 28%, AF in 34%, median NTproBNP was 1563 pg/mL [IQR 500–4372]. At least one of the 4 diagnostic criteria was present in all patients but 2, and patients had 2, 3 or 4 criteria in 43%, 37% and 1% of cases. The table shows only little differences between HFmrEF and HFpEF or de novo HF regarding the rate of each diagnostic criteria. There was no difference regarding the date of inclusion, i.e. before or after the last ESC guidelines.
Table 1 All HF patients De novo HF HFpEF HFmrEF mrEF or pEF (n=143) (n=293) (n=219) LVMI >115g/m2 (men) or 95g/m2 (women) 69.6% 64.3% 68.6% 70.2% LAVI >34ml/m2 74.2% 73.3% 80.4% 68.9% e' average <9cm/s 64.1% 55.3% 55.9% 76.1% E/e' average ≥13 35.4% 38.6% 37.3% 32.8%
Conclusion
The diagnosis of HFpEF or mrEF may be difficult and requires comprehensive echocardiography including all diagnostic variables because each single diagnostic criteria are present in only 33 to 80% cases.
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Affiliation(s)
- D Logeart
- AP-HP - Hospital Lariboisiere, Department of cardiology, Paris, France
| | - E Paven
- AP-HP - Hospital Lariboisiere, Department of cardiology, Paris, France
| | - T Damy
- University Hospital Henri Mondor, Creteil, France
| | - R Isnard
- Hospital Pitie-Salpetriere, Paris, France
| | - M Salvat
- University Hospital of Grenoble, Grenoble, France
| | - J C Eicher
- University Hospital of Dijon, Dijon, France
| | - F Roubille
- University Hospital of Montpellier, Montpellier, France
| | | | - F Bauer
- University Hospital of Rouen, Rouen, France
| | - F Piccard
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - J N Trochu
- Research unit of l'Institut du thorax, Nantes, France
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Rusinaru D, Bohbot Y, Rietzschel E, De Buyzere M, Buiciuc O, Maréchaux S, Gilebert T, Tribouilloy C. Normalized stroke volume in severe aortic stenosis with preserved ejection fraction: Reference values and outcome implications. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.015] [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: 10/26/2022]
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Bohbot Y, Chadha G, Delabre J, Landemaine T, Beyls C, Tribouilloy C. Characteristics and prognosis of patients with significant tricuspid regurgitation. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.017] [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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Altes A, Ringle A, Bohbot Y, Bouchot O, Le Goffic C, Appert L, Guerbaai R, Ennezat P, Tribouilloy C, Maréchaux S. Prognostic significance of energy loss index in patients with low gradient severe aortic stenosis and preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.018] [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: 10/26/2022]
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Chadha G, Bohbot Y, Rusinaru D, Maréchaux S, Tribouilloy C. Outcome of normal flow low gradient “severe” aortic stenosis with preserved left ventricular ejection fraction: A propensity matched study. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.012] [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: 11/15/2022]
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Delesalle G, Bohbot Y, Tribouilloy C. Characteristics, prognosis of moderate aortic stenosis. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.02.153] [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: 10/27/2022]
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Grave C, Tribouilloy C, Juilliere Y, Tuppin P, Weill A, Olié V. Incidence des patients hospitalisés pour valvulopathie en France : caractéristiques des patients et évolution 2006–2016. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.088] [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: 10/27/2022] Open
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