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Jammoul N, Dupasquier V, Akodad M, Meunier PA, Moulis L, Soltani S, Macia JC, Robert P, Schmutz L, Steinecker M, Piot C, Targosz F, Benkemoun H, Lattuca B, Roubille F, Cayla G, Leclercq F. Long-term follow-up of balloon-expandable valves according to the implantation strategy: insight from the DIRECTAVI trial. Am Heart J 2024; 270:13-22. [PMID: 38253304 DOI: 10.1016/j.ahj.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Safety and feasibility of transcatheter aortic valve replacement (TAVR) without balloon aortic valvuloplasty (BAV) using the SAPIEN 3 balloon-expandable device has been previously demonstrated. The impact on long-term valve hemodynamic performances and outcomes remains however unknown. We evaluate long-term clinical and hemodynamic results according to the implant strategy (direct TAVR vs BAV pre-TAVR) in patients included in the DIRECTAVI randomized trial (NCT02729519). METHODS Clinical and echocardiographic follow-up until January 2023 was performed for all patients included in the DIRECTAVI trial since 2016 (n = 228). The primary endpoint was incidence of moderate/severe hemodynamic valve deterioration (HVD), according to the Valve Academic Research defined Consortium-3 criteria (increase in mean gradient ≥10 mmHg resulting in a final mean gradient ≥20 mmHg, or new/worsening aortic regurgitation of 1 grade resulting in ≥ moderate aortic regurgitation). RESULTS Median follow-up was 3.8 (2.2-4.7) years. Mean age at follow-up was 87 ± 6.7 years. No difference in incidence of HVD in the direct implantation group compared to the BAV group was found (incidence of 1.97 per 100 person-years and 1.45 per 100 person-years, respectively, P = 0.6). Prevalence of predicted prothesis-patient mismatch was low (n = 13 [11.4%] in the direct TAVR group vs n = 15 [13.2%] in BAV group) and similar between both groups (P = .7). Major outcomes including death, stroke, hospitalization for heart failure and pacemaker implantation were similar between both groups, (P = .4, P = .7, P = .3, and P = .3 respectively). CONCLUSION Direct implantation of the balloon-expandable device in TAVR was not associated with an increased risk of moderate/severe HVD or major outcomes up to 6-year follow-up. These results guarantee wide use of direct balloon-expandable valve implantation, when feasible. CLINICAL TRIALS REGISTRATION NUMBER NCT05140317.
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Affiliation(s)
- Nidal Jammoul
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Valentin Dupasquier
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Massy, France
| | - Pierre-Alain Meunier
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Lionel Moulis
- Epidemiological and Clinical Research Unit, CHU Montpellier, Montpellier, France.
| | - Sonia Soltani
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Jean-Christophe Macia
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Pierre Robert
- Department of cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Laurent Schmutz
- Department of cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Matthieu Steinecker
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | | | | | | | - Benoît Lattuca
- Department of cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - François Roubille
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France; PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Guillaume Cayla
- Department of cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Florence Leclercq
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France.
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Huet F, Mariano-Goulart D, Aguilhon S, Delbaere Q, Lacampagne A, Fauconnier J, Leclercq F, Macia JC, Akodad M, Jammoul N, Prunier F, Mewton N, Angoulvant D, Lozza C, Soltani S, Rodier A, Grandemange S, Dupuy AM, Cristol JP, Amico M, Nagot N, Roubille F. Colchicine to prevent sympathetic denervation after acute myocardial infarction: the COLD-MI trial. Eur Heart J 2024; 45:725-727. [PMID: 38289979 DOI: 10.1093/eurheartj/ehae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/27/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Fabien Huet
- Department of Cardiology, Vannes Regional Hospital, 20 Bd Général Maurice Guillaudot, 56000 Vannes, France
- Department of Cardiology, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Denis Mariano-Goulart
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
- Department of Nuclear Medecine, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Sylvain Aguilhon
- Department of Cardiology, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Quentin Delbaere
- Department of Cardiology, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Alain Lacampagne
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Jérémy Fauconnier
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Florence Leclercq
- Department of Cardiology, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Jean-Christophe Macia
- Department of Cardiology, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Mariama Akodad
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
- Institut cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Ramsay Santé, 6 Av. du Noyer Lambert, 91300 Massy, France
| | - Nidal Jammoul
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Fabrice Prunier
- University Angers, UMR CNRS 6015, Inserm U1083, Unité MitoVasc, Team Carme, SFR ICAT, 2 rue Haute de Reculée, 49045 Angers cedex, France
- Department of Cardiology, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex, France
| | - Nathan Mewton
- Heart Failure Department, Clinical Investigation Center, INSERM 1060 & 1407, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 59 Bd Pinel, 69500 Bron, France
| | - Denis Angoulvant
- Cardiology Department and EA4245 Transplantation Immunologie Inflammation, CHRU de Tours & Université de Tours, Av. de la République, 37170 Chambray-lès-Tours, France
| | - Catherine Lozza
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Sonia Soltani
- Department of Cardiology, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Annabelle Rodier
- Department of Public Health, Clinical Research Unit, CHU Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Sylvie Grandemange
- Department of Public Health, Clinical Research Unit, CHU Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Anne-Marie Dupuy
- Department of Biochemistry, University Hospital of Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
- Department of Biochemistry, University Hospital of Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Mailis Amico
- Biostatistics and Research Unit, CHU Montpellier, Univ Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Nicolas Nagot
- Biostatistics and Research Unit, CHU Montpellier, Univ Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
- INI-CRCT (Investigation Network Initiative Cardiovascular and Rénal Clinical Trialist), CHRU de Nancy - Hôpitaux de Brabois, 4 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Hauguel-Moreau M, Guedeney P, Dauphin C, Auffret V, Marijon E, Aldebert P, Clerc JM, Beygui F, Elbaz M, Khalil WA, Da Costa A, Macia JC, Elhadad S, Cayla G, Brugier D, Silvain J, Hammoudi N, Duthoit G, Vicaut E, Montalescot G. Flecainide to prevent atrial arrhythmia after patent foramen ovale closure Rationale and design of the randomized AFLOAT study. Eur Heart J Cardiovasc Pharmacother 2024:pvad100. [PMID: 38216511 DOI: 10.1093/ehjcvp/pvad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Atrial arrhythmia is the most common complication of patent foramen ovale (PFO) closure. The real incidence of post-PFO closure atrial arrhytmia and whether this complication can be prevented is unknown. METHODS/DESIGN The Assessment of Flecainide to Lower the patent foramen Ovale closure risk of Atrial fibrillation or Tachycardia (AFLOAT) trial is a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide (150 mg per day in a single sustained-release dose) for 6 months (Group 1), Flecainide (150 mg per day in a single sustained-release dose) for 3 months (Group 2), or no additional treatment (standard of care) for 6 months (Group 3). The primary endpoint is the percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episode (≥30s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor. Whether 3 months of treatment is sufficient compared to 6 months will be analyzed as a secondary objective of the study. CONCLUSION AFLOAT is the first trial to test the hypothesis that a short treatment with oral Flecainide can prevent the new-onset of atrial arrhythmia after PFO closure. Clinical trial registration: NCT05213104 (clinicaltrials.gov).
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Affiliation(s)
- Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, INSERM U1018, CESP, ACTION Study Group, Department of Cardiology, Ambroise Paré Hospital (AP-HP), Boulogne, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Claire Dauphin
- Department of Cardiology and Cardiovascular Diseases, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Vincent Auffret
- University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | | | - Jean-Michel Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Farzin Beygui
- CHU de la Côte de Nacre, Département de Cardiologie, Caen, France
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Wissam Abi Khalil
- Institut Mitovasc, University of Angers, UMR CNRS 6015-INSERMU1083, Angers, France
| | - Antoine Da Costa
- Service de cardiologie, hôpital Nord, université Jean-Monnet, CHU de Saint-Étienne, Saint-Étienne, France
| | - Jean-Christophe Macia
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, Montpellier 5, France
| | - Simon Elhadad
- Service de Cardiologie, Centre hospitalier de Marne-la-Vallée, Jossigny, France
| | - Guillaume Cayla
- Cardiology department, Nimes university Hospital, Montpellier University, ACTION group, Nimes, France
| | - Delphine Brugier
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Duthoit
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hopital Lariboisière, (APHP), Université Paris-Diderot Paris 7, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Cardelli LS, Delbaere Q, Massin F, Granier M, Casella G, Barbato G, Dupasquier V, Macia JC, Leclercq F, Pasquie JL, Roubille F. Wearable Cardioverter Defibrillator Shortens the Lengths of Stay in Patients with Left Ventricular Dysfunction after Myocardial Infarction: A Single-Centre Real-World Experience. J Clin Med 2023; 12:4884. [PMID: 37568286 PMCID: PMC10419391 DOI: 10.3390/jcm12154884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The wearable cardioverter defibrillator (WCD) has been proven to be effective in preventing sudden cardiac death (SCD) in patients soon after acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤35%. The aim of this study was to assess whether a WCD may shorten the length of an initial hospital stay (total length, days in the intensive care unit (ICU) and in the acute cardiac care unit (ACCU)) among these patients. This was a single-centre, retrospective observational study of patients referred for the management of SCD risk post-AMI and LVEF ≤35%, in a tertiary care hospital. The clinical characteristics and length of index hospitalization of the group of patients discharged, with or without WCD, were compared. A propensity score analysis was performed, then weighted regression models were conducted. A total of 101 patients in the WCD group and 29 in the control group were enrolled in the analysis. In the weighted regression models, WCD significantly reduced the days spent in ACCU (p < 0.001). WCD patients had significantly fewer days spent in ACCU (5.5 ± 2.6 vs. 8.4 ± 12.8 days, p < 0.001) and shorter hospitalizations (10.2 ± 5.7 vs. 13.4 ± 17.6 days, p = 0.005), compared with the control group. It was concluded that the WCD appears to reduce the total length of hospitalization and lengths of stay in ACCU for patients post-AMI and with left ventricular dysfunction.
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Affiliation(s)
| | - Quentin Delbaere
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - François Massin
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Mathieu Granier
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, 40100 Bologna, Italy
| | - Gaetano Barbato
- Cardiology Department, Ospedale Maggiore, 40100 Bologna, Italy
| | - Valentin Dupasquier
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Jean-Christophe Macia
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Florence Leclercq
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Jean-Luc Pasquie
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - François Roubille
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
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Akodad M, Meunier PA, Padovani C, Cayla G, Zitouni W, Macia JC, Robert P, Steinecker M, Roubille F, Leclercq F. Identification of Low- versus High-Risk Acute Coronary Syndrome for a Selective ECG Monitoring Strategy. J Clin Med 2023; 12:4604. [PMID: 37510718 PMCID: PMC10380550 DOI: 10.3390/jcm12144604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND While admission of patients with acute coronary syndromes (ACS) in cardiology intensive care unit (CICU) is usual, in-hospital major outcomes in lower risk patients may be evaluated after early coronary angiography according to the European guidelines. METHODS Consecutive ACS patients were prospectively included after coronary angiography evaluation within 24 h and percutaneous coronary intervention (PCI), when required. Patients were classified as high- or low-risk according to hemodynamics, rhythmic state, ischemic and bleeding risks. Major in-hospital outcomes were assessed. RESULTS From January to June 2021, 277 patients were enrolled (62.8% with ST-segment elevation myocardial infarction (STEMI) (n = 174); 37.2% with non-NSTEMI (NSTEMI) (n = 103). PCI was required for 260 patients (93.9%). Seventy-four patients (26.7%) were classified as low-risk (n = 47 NSTEMI; n= 27 STEMI) and 203 patients (73.3%) as high-risk of events. All patients were monitored in CICU. While 38 patients (18.7%) from the high-risk group reached the primary endpoint, mainly related to rhythmic or conduction disorder (n = 24, 11.8%) or unstable hemodynamics (n = 17; 8.4%), only 1 patient (1.3%) in the low-risk group had one major outcome (no fatal bleeding); p < 0.01. The negative predictive value of our patient stratification for the absence of major in-hospital outcome was 100% (CI95%: 100-100%) for STEMI and 97.9% [CI95%: 93.2-100%] for NSTEMI patients. CONCLUSIONS Stratification of ACS patients after early coronary angiography and most of the time PCI, identify a population with very low risk of in-hospital events (1/4 of all ACS and 1/2 of NSTEMI) who may probably not require ECG monitoring and/or CICU admission. (NCT04378504).
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Affiliation(s)
- Mariama Akodad
- South Paris Cardiovascular Institute, Jacques Cartie Hospital, 91300 Massy, France
| | - Pierre-Alain Meunier
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Caroline Padovani
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nîmes, 30900 Nîmes, France
| | - Wassim Zitouni
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Jean-Christophe Macia
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Pierre Robert
- Department of Cardiology, University Hospital of Nîmes, 30900 Nîmes, France
| | - Matthieu Steinecker
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
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Leclercq F, Lorca L, Agullo A, Bouchdoug K, Macia JC, Delseny D, Roubille F, Gandet T, Lattuca B, Robert P, Schmutz L, Cayla G, Duflos C, Akodad M. Evolution of right ventricular dysfunction and tricuspid regurgitation after TAVI: A prospective study. Int J Cardiol 2022; 353:29-34. [DOI: 10.1016/j.ijcard.2022.01.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 11/05/2022]
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Akodad M, Aldhaheri E, Marin G, Roubille F, Macia JC, Gandet T, Delseny D, Schmutz L, Lattuca B, Robert P, Dubard A, Robert G, Targosz F, Maupas E, Albat B, Cayla G, Leclercq F. Transcatheter aortic valve replacement performed with selective telemetry monitoring: A prospective study. Int J Cardiol 2021; 330:158-163. [PMID: 33621627 DOI: 10.1016/j.ijcard.2021.02.028] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Telemetry monitoring (TM) with or without intensive care unit (ICU) admission is the standard of care after Transcatheter aortic valve replacement (TAVR). Regarding to improvements of the technique and procedural results, TM may be considered only in selected patients. We aimed to confirm feasibility and safety of selective TM in patients undergoing TAVR. METHODS We prospectively evaluated 449 consecutive patients undergoing TAVR. Patients were transferred to general cardiology ward (GCW) without TM after the procedure when stable clinical state, transfemoral access, no baseline right bundle branch block (RBBB), left ventricular ejection fraction (LVEF) > 40%, and no complication including any electrocardiogram (ECG) change within 1 h after the procedure ("low-risk" group). Others patients were considered for TM in ICU ("high-risk" group). The primary endpoint evaluated in-hospital major adverse events after unit admission according to VARC-2 criteria. RESULTS The mean age was 81.8 ± 7.5 years and mean EuroSCORE II was 7.5 ± 4.8%. In total, 116 patients (25.8%) were considered as "low-risk" patients and 163 patients (36.3%) were referred to GCW, including those with immediate pacemaker implantation. A total of 96 patients (21.3%) reached the primary endpoint including mainly conductive disorders (12.8%). No major adverse events, particularly no late severe conductive disorder, occurred in the "low-risk" group (negative predictive value of 100%). Baseline RBBB (p < 0.01), LVEF < 40% (p = 0.02) and "high-risk" group (p < 0.01) were predictive of outcomes. CONCLUSIONS Using rigorous periprocedural selection criteria, patients' admission in GCW without TM can be routinely and safely performed in 1/3 of patients after TAVR.
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Affiliation(s)
- Mariama Akodad
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France; PhyMedExp, Université de Montpellier, INSERM, CNRS, France, France
| | - Eissa Aldhaheri
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Gregory Marin
- Department of Medical Information, University Hospital of Montpellier, France
| | - François Roubille
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France; PhyMedExp, Université de Montpellier, INSERM, CNRS, France, France
| | - Jean-Christophe Macia
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Thomas Gandet
- Department of Cardiovascular Surgery, University Hospital of Montpellier, France
| | - Delphine Delseny
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Laurent Schmutz
- Department of Cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Benoit Lattuca
- Department of Cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Pierre Robert
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | | | | | | | | | - Bernard Albat
- Department of Cardiovascular Surgery, University Hospital of Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Florence Leclercq
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France.
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Akodad M, Roubille F, Marin G, Lattuca B, Macia JC, Delseny D, Gandet T, Robert P, Schmutz L, Piot C, Maupas E, Robert G, Targosz F, Albat B, Cayla G, Leclercq F. Myocardial Injury After Balloon Predilatation Versus Direct Transcatheter Aortic Valve Replacement: Insights From the DIRECTAVI Trial. J Am Heart Assoc 2020; 9:e018405. [PMID: 33297821 PMCID: PMC7955361 DOI: 10.1161/jaha.120.018405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Myocardial injury is associated with higher mortality after transcatheter aortic valve replacement (TAVR) and might be increased by prior balloon aortic valvuloplasty (BAV). We aimed to evaluate the impact of prior BAV versus direct prosthesis implantation on myocardial injury occurring after (TAVR) with balloon-expandable prostheses. Methods and Results The DIRECTAVI (Direct Transcatheter Aortic Valve Implantation) trial, an open-label randomized study, demonstrated noninferiority of TAVR without BAV (direct TAVR group) compared with systematic BAV (BAV group) with the Edwards SAPIEN 3 valve. High-sensitivity troponin was assessed before and the day after the procedure. Incidence of myocardial injury after the procedure (high-sensitivity troponin elevation >15× the upper reference limit [14 ng/L]) was the main end point. Impact of myocardial injury on 1-month adverse events (all-cause mortality, stroke, major bleeding, major vascular complications, transfusion, acute kidney injury, heart failure, pacemaker implantation, and aortic regurgitation) was evaluated. Preprocedure and postprocedure high-sensitivity troponin levels were available in 211 patients. The mean age of patients was 83 years (78-87 years), with 129 men (61.1%). Mean postprocedure high-sensitivity troponin was 124.9±81.4 ng/L in the direct TAVR group versus 170.4±127.7 ng/L in the BAV group (P=0.007). Myocardial injury occurred in 42 patients (19.9%), including 13 patients (12.2%) in the direct TAVR group and 29 (27.9%) in the BAV group (P=0.004). BAV increased by 2.8-fold (95% CI, 1.4-5.8) myocardial injury probability. Myocardial injury was associated with 1-month adverse events (P=0.03). Conclusions BAV increased the incidence and magnitude of myocardial injury after TAVR with new-generation balloon-expandable valves. Myocardial injury was associated with 1-month adverse events. These results argue in favor of direct SAPIEN 3 valve implantation. Registration URL: https://www.Clinicaltrials.gov; Unique identifier: NCT02729519.
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Affiliation(s)
- Mariama Akodad
- Department of Cardiology Montpellier University Hospital Montpellier France.,PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France
| | - François Roubille
- Department of Cardiology Montpellier University Hospital Montpellier France.,PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France
| | - Gregory Marin
- Department of Medical Information Montpellier University Hospital Montpellier France
| | - Benoit Lattuca
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | | | - Delphine Delseny
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Thomas Gandet
- Department of Cardiovascular Surgery University Hospital of Montpellier France
| | - Pierre Robert
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Laurent Schmutz
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | | | | | | | | | - Bernard Albat
- Department of Cardiovascular Surgery University Hospital of Montpellier France
| | - Guillaume Cayla
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | - Florence Leclercq
- Department of Cardiology Montpellier University Hospital Montpellier France
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Leclercq F, Lonjon C, Marin G, Akodad M, Roubille F, Macia JC, Cornillet L, Gervasoni R, Schmutz L, Ledermann B, Colson P, Cayla G, Lattuca B. Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest. Int J Cardiol 2020; 310:73-79. [PMID: 32295717 DOI: 10.1016/j.ijcard.2020.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/22/2020] [Accepted: 03/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Coronary angiography is the standard of care after Out-of-Hospital Cardiac Arrest (OHCA), but its benefit for patients without persistent ST-segment elevation (STE) remains controversial. METHODS All patients admitted for coronary angiography after a resuscitated OHCA were consecutively included in this prospective study. Three patient groups were defined according to post-resuscitation ECG: STE or new left bundle branch block (LBBB) (group 1); other ST/T repolarization disorders (group 2) and no repolarisation disorders (group 3). The proportion and predictive factors of an acute coronary lesion, defined by acute coronary occlusion or thrombotic lesion or lesion associated with flow impairment, were evaluated according to different groups as well as thirty-day mortality. RESULTS Among 129 consecutive patients: 62 (48.1%), 30 (23.3%) and 30 (23.3%) patients were included in groups 1, 2 and 3 respectively. An acute coronary lesion was observed in 43% (n = 55) of patients, mainly in group 1 (n = 44, 70.9%). Initial coronary TIMI 0/1 flow was more frequently observed in group 1 than in group 2 (n = 25, 40.3% vs n = 1, 3.3%) and never in group 3. Chest pain and STE or new LBBB were independently associated with an acute coronary lesion (adj. OR = 7.14 [1.85-25.00]; p = 0.004 and adj. OR = 11.10 [3.70-33.33]; p < 0.001 respectively). In absence of any repolarization disorders, acute coronary lesion or occlusion were excluded with negative predictive values of 93.3% and 100% respectively. The one-month survival rate was 38.8% and was better in patients among the group 1 compared to those from the 2 other groups (n = 28, 45.2% vs n = 21, 35%, respectively; p = 0.014). CONCLUSION Considering the high negative predictive value of post-resuscitation ECG to exclude acute coronary lesion and occlusion after OHCA, a delayed coronary angiography appears a reliable alternative for patients without repolarization disorders.
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Affiliation(s)
- Florence Leclercq
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Clément Lonjon
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France
| | - Grégory Marin
- Department of Epidemiology, Medical Statistics and Public Health, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Mariama Akodad
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - François Roubille
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Jean-Christophe Macia
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Luc Cornillet
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Richard Gervasoni
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Laurent Schmutz
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Bertrand Ledermann
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, Montpellier, France..
| | - Guillaume Cayla
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Benoit Lattuca
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
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Leclercq F, Robert P, Akodad M, Macia JC, Gandet T, Delseny D, Chettouh M, Schmutz L, Robert G, Levy G, Targosz F, Maupas E, Roubille F, Marin G, Nagot N, Albat B, Lattuca B, Cayla G. Prior Balloon Valvuloplasty Versus Direct Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:594-602. [DOI: 10.1016/j.jcin.2019.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 10/24/2022]
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Lefèvre T, Haude M, Neumann FJ, Stangl K, Skurk C, Slagboom T, Sabaté M, Goicolea J, Barragan P, Cook S, Macia JC, Windecker S. Comparison of a Novel Biodegradable Polymer Sirolimus-Eluting Stent With a Durable Polymer Everolimus-Eluting Stent: 5-Year Outcomes of the Randomized BIOFLOW-II Trial. JACC Cardiovasc Interv 2019; 11:995-1002. [PMID: 29798778 DOI: 10.1016/j.jcin.2018.04.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/12/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The authors aimed to compare long-term data of an ultrathin cobalt-chromium stent with passive silicon carbide coating and an active biodegradable polymer that releases sirolimus (O-SES) (Orsiro, BIOTRONIK, Bülach, Switzerland) with the durable polymer-based Xience Prime everolimus-eluting stent (X-EES) (Abbott Vascular, Santa Clara, California). BACKGROUND Biodegradable polymer stents have been developed aiming to overcome long-term detrimental effects of durable polymer stents, ultimately leaving a bare-metal stent in the vessel. METHODS This multicenter, assessor-blinded trial randomized 452 patients with 505 lesions to either O-SES or X-EES in a 2:1 fashion. Endpoints at 5 years were target lesion failure (TLF), its components, and stent thrombosis. RESULTS TLF occurred in 10.4% (n = 30) of O-SES patients versus 12.7% (n = 19) of X-EES patients (p = 0.473), overall stent thrombosis occurred in 0.7% (n = 2) versus 2.8% (n = 4) (p = 0.088), and definite stent thrombosis in 0% versus 0.7% (n = 1) (p = 0.341). Post hoc analysis was performed in diabetic patients (n = 128) and vessels ≤2.75 mm (n = 259). In diabetic patients, the O-SES group had numerically more target lesion revascularizations (13.5% vs. 4.5%; p = 0.138), but fewer cardiac deaths (1.3% vs. 6.9%; p = 0.089) and stent thrombosis (0% vs. 6.9%; p = 0.039). In small vessels, the O-SES group had a significantly lower 5-year mortality (3.7% vs. 11.3%; p = 0.022). CONCLUSIONS At 5 years, the biodegradable polymer O-SES demonstrated low TLF rates comparable to the durable polymer X-EES, confirming its long-term safety and performance. Particularly encouraging is the absence of definite stent thrombosis.
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Affiliation(s)
- Thierry Lefèvre
- Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France.
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus, Neuss, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Karl Stangl
- Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Ton Slagboom
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Manel Sabaté
- Department of Cardiology, Hospital Clínic, Thorax Institute, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Javier Goicolea
- Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain
| | - Paul Barragan
- Department of Cardiology, Polyclinique les Fleurs, Ollioules, France
| | - Stéphane Cook
- Department of Cardiology, Hospital and University Fribourg, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Robert P, Leclercq F, Lattuca B, Albat B, Maupas E, Robert G, Akodad M, Macia JC, Dubar A, Targosz F, Gandet T, Cayla G. P1843Transcatheter aortic valve implantation in patients with uninterrupted vitamin k antagonist. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0595] [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
Bridging of vitamin K antagonist (VKA) with heparin is usually not promoted during interventional or surgical procedures related to increased risk of bleeding and thrombotic events but this strategy has not been evaluated during TAVI.
Purpose
The aim of this study was to evaluate the rate of major bleeding and vascular complications after TAVI performed in patients with uninterrupted VKA.
Methods
From January 2016 to October 2017, consecutive patients who underwent TAVI with uninterrupted VKA (INR between 1.5 and 3.5) were prospectively included in a monocentric registry. TAVI were performed according to current guidelines and a 50UI/kg bolus of heparin was injected at the beginning of the procedure for all patients. Vascular and bleeding complications were assessed using the Valve Academic Research Consortium 2 (VARC2) and the Bleeding Academic Research Consortium (BARC) definitions at 30 day follow-up.
Results
A total of 88 patients were included with a median age of 84 years [81.8–87], 42% being female, the median STS score was 5.1 [4.1–7.5], the median CHADS2-VASc was 5.5 [5–6] and 60.2% had a chronic kidney failure. Median INR at time of implantation was at 2.1 [1.8–2.6]. VKA were used for atrial fibrillation (89.8%), mechanic mitral prosthesis (5.7%) or venous thromboembolic disease (4.5%). Trans femoral access was used in 88.6% of the patients. Major bleeding (BARC ≥3b) occurred in 5 patients (5,7%) and major vascular complications occurred in 7 patients (8%). Peripheral arterial disease (RR = 10.95; 95% CI: 1.63 to 73.75; p=0.014) and carotid access (RR=8.56; 95% CI: 1.19 to 61.51; p=0.033) were significantly associated with major bleeding. INR >2.5 was significantly associated with vascular complications (RR=7.14; 95% CI: 1.29 to 39.63; p=0.025). In multivariate analysis, Body mass index (OR=1.26; 95% CI: 1.02 to 1.57; p=0.032) and INR >2.5 (OR=18.91; 95% CI: 1.62 to 221.26; p=0.010) were independent factor significantly associated with vascular complications or major bleeding. Mortality rate at 30 days follow-up was 2.3%, there was no myocardial infarction and stroke rate was 4.5%.
Figure 1. Study flowchart
Conclusion
TAVI with uninterrupted VKA treatment seems to be feasible and safe with low risk of bleeding and vascular complications in this first single centre experience. Particular caution is advocated in low BMI patients and to keep INR<2.5.
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Affiliation(s)
- P Robert
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - B Lattuca
- University Hospital of Nimes, Nimes, France
| | - B Albat
- University Hospital Arnaud de Villeneuve, Cardiac Surgery, Montpellier, France
| | - E Maupas
- Franciscaines clinic, Nimes, France
| | - G Robert
- Saint-Pierre Clinic, Perpignan, France
| | - M Akodad
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - J C Macia
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - A Dubar
- Millénaire Clinic, Montpellier, France
| | - F Targosz
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - T Gandet
- University Hospital Arnaud de Villeneuve, Cardiac Surgery, Montpellier, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
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13
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Lattuca B, Meilhac A, Robert C, Vandenbergh D, Manna F, Nagot N, Chettouh M, Akodad M, Gandet T, Macia JC, Delseny D, Schmutz L, Albat B, Cayla G, Leclercq F. P1793Eight-year clinical outcome and valve durability after transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0545] [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
With the growing indications of transcatheter aortic valve implantation (TAVI) worldwide and among lower risk patients, valve durability has become a crucial issue.
Purpose
To assess mid and long-term evolution of different generations of percutaneous balloon-expandable prostheses, predictive factors of valve deterioration and its correlation with long-term mortality.
Methods
All consecutive patients undergoing TAVI for severe aortic stenosis with balloon-expandable prosthesis between 2009 and 2014 and with a minimum follow-up of one-year were included in this monocentric prospective study. All echocardiograms were reviewed by two independent experts. Clinical events were defined according to the Valve Academic Research Consortium criteria. Valve deterioration was defined according to the 2017 EAPCI-ESC-EACTS international consensus statement at the longest follow-up.
Results
A total of 160 patients were included with a median follow-up of 3.4 years [1.5–4.9] and a maximum of 8 years. Patients were mostly implanted with the first generation Sapien XT valve (n=138, 86.2%). Median age was 85 [79–86] years, with 42.5% of women and a median logistic Euro-SCORE of 14.2% [10.6–23.2]. Immediately after TAVI, mean aortic gradient decreased dramatically from 51±12mmHg to 9±2.6mmHg (p<0.0001) and remained overall stable with a mean gradient of 12±1mmHg at 8 years. Valve deterioration occurred in 5.6% (n=9) of patients, of which 3.7% (n=6) with severe deterioration. Moderate or severe peri-prosthetic aortic regurgitation was observed in 2.5% (n=4) of patients. The eight-year survival rate was 12.9%. During follow-up, hospitalization for acute heart failure was required for 23.7% (n=38) of patients, a myocardial infarction or a stroke occurred respectively among 1.9% (n=3) and 5% (n=8) of patients. After multivariate analysis, size or generation of valves were not independent predictive factors of valve deterioration.
Evolution of mean aortic gradient
Conclusions
After a maximal 8-year follow-up, valve deterioration after balloon-expandable TAVI is very low. In this high-risk population, TAVI seems to be a safe and durable alternative to surgery in severe aortic stenosis regardless of prosthesis generation.
Acknowledgement/Funding
Edwards Lifesciences
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Affiliation(s)
- B Lattuca
- University Hospital of Nimes, Nimes, France
| | - A Meilhac
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - C Robert
- University Hospital of Nimes, Nimes, France
| | - D Vandenbergh
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - F Manna
- University Hospital of Montpellier, Montpellier, France
| | - N Nagot
- University Hospital of Montpellier, Montpellier, France
| | - M Chettouh
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - M Akodad
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - T Gandet
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - J C Macia
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - D Delseny
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - L Schmutz
- University Hospital of Nimes, Nimes, France
| | - B Albat
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Montpellier, France
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Akodad M, Meilhac A, Lefèvre T, Cayla G, Lattuca B, Autissier C, Duflos C, Gandet T, Macia JC, Delseny D, Roubille F, Maupas E, Schmutz L, Piot C, Targosz F, Robert G, Rivalland F, Albat B, Chevalier B, Leclercq F. Hemodynamic Performances and Clinical Outcomes in Patients Undergoing Valve-in-Valve Versus Native Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:90-97. [PMID: 31076081 DOI: 10.1016/j.amjcard.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) emerged has a less invasive treatment than surgery for patients with degenerated bioprosthesis. However, few data are currently available regarding results of ViV versus TAVI in native aortic valve. We aimed to compare hemodynamic performances and 1-year outcomes between patients who underwent ViV procedure and patients who underwent non-ViV TAVI. This bicentric study included all patients who underwent aortic ViV procedure for surgical bioprosthetic aortic failure between 2013 and 2017. All patients who underwent TAVI were included in the analysis during the same period. ViV and non-ViV patients were matched with 1:2 ratio according to size, type of TAVI device, age (±5 years), sex, and STS score. Primary end point was hemodynamic performance including mean aortic gradient and aortic regurgitation at 1-year follow-up. A total of 132 patients were included, 49 in the ViV group and 83 in the non-ViV group. Mean age was 82.8 ± 5.9 years, 55.3% were female. Mean STS score was 5.2% ± 3.1%. Self-expandable valves were implanted in 78.8% of patients. At 1-year follow-up, aortic mean gradient was significantly higher in ViV group (18.1 ± 9.4 mm Hg vs 11.4 ± 5.4 mm Hg; p < 0.0001) and 17 (38.6%) patients had a mean aortic gradient ≥20 mm Hg vs 6 (7.8%) in the non-ViV group (p = 0.0001). Aortic regurgitation > grade 2 were similar in both groups (p = 0.71). In the ViV group, new pacemaker implantation was less frequent (p = 0.01) and coronary occlusions occurred only in ViV group (n = 2 [4.1%]). At 1-year follow-up, 3 patients (2.3%) died from cardiac cause, 1 (2.1%) in the ViV group vs 2 (2.4%) in the non-ViV group (p = 0.9). There was no stroke. In conclusion, compared with TAVI in native aortic stenosis, ViV appears as a safe and feasible strategy in patients with impaired bioprosthesis. As 1-year hemodynamic performances seem better in native TAVI procedure, long-term follow-up should be assessed to determinate the impact of residual stenosis on outcomes and durability.
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Schaaf M, Huet F, Akodad M, Gorce-Dupuy AM, Adda J, Macia JC, Delseny D, Leclercq F, Cristol JP, Marin G, Mewton N, Roubille F. Which high-sensitivity troponin variable best characterizes infarct size and microvascular obstruction? Arch Cardiovasc Dis 2019; 112:334-342. [DOI: 10.1016/j.acvd.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
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Roubille F, Sultan A, Huet F, Leclercq F, Macia JC, Gervasoni R, Delseny D, Akodad M, Roubille C. Is hypertriglyceridemia atherogenic? Presse Med 2018; 47:757-763. [PMID: 30262206 DOI: 10.1016/j.lpm.2018.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Received: 05/22/2018] [Revised: 08/09/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022] Open
Abstract
ASCVD reduction is based on LDL reduction, especially by statins. Highly elevated TG could be harmful, especially because of the risk of pancreatitis. Elevation of TG is mainly due to metabolic disorders and diabetes, alcohol intake and overweight. Genetic factors have been clearly identified in the most severe cases. TG have been generally considered as bystanders for cardiovascular diseases (CVD). Both biological and basic research provide strong data suggesting that TG-rich lipoproteins could be involved in the pathophysiology of CVD. Recent epidemiological and genetics studies strongly corroborate the causal role of TG in CVD. This paves the way for new approaches in the management of patients both for primary and secondary prevention.
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Affiliation(s)
- François Roubille
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Université de Montpellier, PhyMedExp, Inserm, CNRS, 34000 Montpellier, France.
| | - Ariane Sultan
- Université de Montpellier, PhyMedExp, Inserm, CNRS, 34000 Montpellier, France; Montpellier University Hospital, Department of Endocrinology-Diabetes-Nutrition, 34295 Montpellier cedex 5, France
| | - Fabien Huet
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Université de Montpellier, PhyMedExp, Inserm, CNRS, 34000 Montpellier, France
| | - Florence Leclercq
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Université de Montpellier, PhyMedExp, Inserm, CNRS, 34000 Montpellier, France
| | - Jean-Christophe Macia
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Richard Gervasoni
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Delphine Delseny
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Mariama Akodad
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Université de Montpellier, PhyMedExp, Inserm, CNRS, 34000 Montpellier, France
| | - Camille Roubille
- Université de Montpellier, PhyMedExp, Inserm, CNRS, 34000 Montpellier, France
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Lattuca B, Belardi D, Demattei C, Schmutz L, Cornillet L, Ledermann B, Macia JC, Iemmi A, Gervasoni R, Roubille F, Cung TT, Robert P, Messner-Pellenc P, Leclercq F, Cayla G. Safety of Percutaneous Coronary Intervention Without P2Y12 Inhibitor Pretreatment From a Cohort of Unselected Patients. J Invasive Cardiol 2018; 30:348-354. [PMID: 30012889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Recent studies have challenged systematic pretreatment with a P2Y12 inhibitor before percutaneous coronary intervention (PCI) in elective and non-ST segment elevation myocardial infarction (NSTEMI) patients. The aim of this study was to assess outcomes after performing PCI immediately after coronary angiography with an exclusive "on-the-table" P2Y12 inhibitor loading dose, by evaluating ischemic and bleeding complications in unselected patients. METHODS Consecutive patients admitted for elective PCI or NSTEMI were included in this two-center, prospective, observational study, and received a P2Y12 inhibitor after coronary angiography when PCI was decided. The primary composite endpoint was first occurrence of cardiovascular death, myocardial infarction, stroke, urgent revascularization, or use of bail-out glycoprotein IIb/IIIa inhibitors at 30 days after PCI. Stent thrombosis and bleeding criteria (Bleeding Academic Research Consortium [BARC]) were evaluated. RESULTS Among 299 included patients, a total of 188 were admitted for elective PCI and 111 for NSTEMI. The incidence of the primary endpoint was 8.5% (95% confidence interval [CI], 5.7-12.4). No definite stent thrombosis occurred. Three independent predictive factors were associated with the primary endpoint: NSTEMI setting (odds ratio [OR], 5.61; 95% CI, 1.75-17.98), thrombotic coronary lesion (OR, 4.26; 95% CI, 1.45-12.54), and longer procedure duration (OR, 1.06; 95% CI, 1.03-1.09). Clinically relevant bleedings (BARC 2, 3, or 5) occurred in 5.4% of patients. CONCLUSIONS In an unselected population admitted for elective PCI or NSTEMI in real-world clinical practice, administration of a P2Y12 inhibitor only after coronary angiography is associated with a low rate of ischemic and bleeding events at 30 days.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guillaume Cayla
- Cardiology Department, Nîmes University Hospital, Place Pr Debré, 30029 Nîmes, Cedex, France.
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Akodad M, Lattuca B, Agullo A, Macia JC, Gandet T, Marin G, Iemmi A, Vernhet H, Schmutz L, Nagot N, Albat B, Cayla G, Leclercq F. Prognostic Impact of Calcium Score after Transcatheter Aortic Valve Implantation Performed With New Generation Prosthesis. Am J Cardiol 2018; 121:1225-1230. [PMID: 29706182 DOI: 10.1016/j.amjcard.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/12/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
Calcium score (CS) is a well-known prognostic factor after transcatheter aortic valve implantation (TAVI) performed with first generation prosthesis but few data are available concerning new generation valves. The aim of this study was to evaluate if CS remains a prognostic factor after Sapien 3 and Evolut R valves implantation. Agatston CS was evaluated on multislice computed tomography before TAVI in 346 patients implanted with Sapien XT (n = 61), CoreValve (n = 57) devices, (group 1, n = 118), and with new generation Sapien 3 (n = 147), Evolut R (n = 81) prosthesis, (group 2, n = 228). Major adverse cardiovascular events and aortic regurgitation (AR) were evaluated at 1 month. The 2 groups were similar at baseline except for logistic Euroscore (20.1% in group 1 vs 15.0 % in group 2; p = 0.001), chronic renal failure (44.1% vs 37.2% respectively, p = 0.007) and preprocedural CS (4,092 ± 2,176 vs 3,682 ± 2,109 respectively, p = 0.022). In group 1, 28 patients (23.7%) had adverse clinical events vs 21 (9.2%) in group 2 (p <0.01). In multivariate analysis, a higher CS was predictive of adverse events in group 1 (5,785 ± 3,285 vs 3,565 ± 1,331 p <0.0001) but not in group 2 (p = 0.28). A higher CS was associated with AR in group 1 (6,234 ± 2711 vs 3,429 ± 1,505; p <0.001) and in patients implanted with an Evolut R device from group 2 (4,085 ± 3,645 vs 2,551 ± 1,356; p = 0.01). In conclusion, CS appears as an important prognostic factor of major events after TAVI with first generation valves but not with new generation devices. CS remains associated with AR only with new generation self-expandable Evolut R devices.
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Robert P, Macia JC, Albat B, Lattuca B, Labour J, Akodad M, Gandet T, Schmutz L, Delseny D, Maupas E, Piot C, Targosz F, Robert G, Cayla G, Leclercq F. PRIOR BALLOON VALVULOPLASTY VERSUS DIRECT TRANSCATHETER AORTIC VALVE IMPLANTATION (DIRECTAVI): PRELIMINARY FINDINGS ON THE FIRST 128 RANDOMIZED PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31677-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Leclercq F, Robert P, Labour J, Lattuca B, Akodad M, Macia JC, Gervasoni R, Roubille F, Gandet T, Schmutz L, Nogue E, Nagot N, Albat B, Cayla G. Prior balloon valvuloplasty versus DIRECT transcatheter Aortic Valve Implantation (DIRECTAVI): study protocol for a randomized controlled trial. Trials 2017; 18:303. [PMID: 28676065 PMCID: PMC5496363 DOI: 10.1186/s13063-017-2036-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
Background Balloon predilatation of the aortic valve has been regarded as an essential step during the transcatheter aortic valve implantation (TAVI) procedure. However, recent evidence has suggested that aortic valvuloplasty may cause complications and that high success rates may be obtained without prior dilatation of the valve. We hypothesize that TAVI performed without predilatation of the aortic valve and using new-generation balloon-expandable transcatheter heart valves is associated with a better net clinical benefit than TAVI performed with predilatation. Methods/design The transcatheter aortic valve implantation without prior balloon dilatation (DIRECTAVI) trial is a randomized controlled open label trial that includes 240 patients randomized to TAVI performed with prior balloon valvuloplasty (control arm) or direct implantation of the valve (test arm). All patients with an indication for TAVI will be included excepting those requiring transapical access. The trial tests the hypothesis that the strategy of direct implantation of the new-generation balloon-expandable SAPIEN 3 valve is noninferior to current medical practice using predilatation of the valve. The primary endpoint assessing efficacy and safety of the procedure consists of immediate procedural success and secondary endpoints include complications at 30-day follow-up (VARC-2 criteria). A subgroup analysis evaluates neurological ischemic events with cerebral MRI imaging (25 patients in each strategy group) performed before and between 1 and 3 days after the procedure. Discussion This prospective randomized study is designed to assess the efficacy and safety of TAVI performed without prior dilatation of the aortic valve using new-generation balloon-expandable transcatheter heart valves. We aim to provide robust evidence of the advantages of this strategy to allow the interventional cardiologist to use it in everyday practice. Trial registration ClinicalTrials.gov identifier: NCT02729519. Registered on 15 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2036-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France. .,Department of Cardiology, Arnaud de Villeneuve Hospital, University of Montpellier, Avenue du doyen Giraud, 34295, Montpellier cedex 5, France.
| | - Pierre Robert
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Jessica Labour
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Benoit Lattuca
- Department of Cardiology, University Hospital of Nimes, Nimes, France
| | - Mariama Akodad
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | | | - Richard Gervasoni
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Francois Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Thomas Gandet
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Laurent Schmutz
- Department of Cardiology, University Hospital of Nimes, Nimes, France
| | - Erika Nogue
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Nagot
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Bernard Albat
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, Nimes, France
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Akodad M, Lattuca B, Nagot N, Georgescu V, Buisson M, Cristol JP, Leclercq F, Macia JC, Gervasoni R, Cung TT, Cade S, Cransac F, Labour J, Dupuy AM, Roubille F. COLIN trial: Value of colchicine in the treatment of patients with acute myocardial infarction and inflammatory response. Arch Cardiovasc Dis 2017; 110:395-402. [PMID: 28065445 DOI: 10.1016/j.acvd.2016.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 10/13/2016] [Accepted: 10/17/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Inflammation is involved during acute myocardial infarction, and could be an interesting target to prevent ischaemia-reperfusion injuries. Colchicine, known for its pleiotropic anti-inflammatory effects, could decrease systemic inflammation in this context. AIMS To evaluate the impact of colchicine on inflammation in patients admitted for ST-segment elevation myocardial infarction (STEMI). METHODS All patients admitted for STEMI with one of the main coronary arteries occluded, and successfully treated with percutaneous coronary intervention, were included consecutively. Patients were randomized to receive either 1mg colchicine once daily for 1 month plus optimal medical treatment or optimal medical treatment only. C-reactive protein (CRP) was assessed at admission and daily until hospital discharge. The primary endpoint was CRP peak value during the index hospitalization. RESULTS Forty-four patients were included: 23 were treated with colchicine; 21 received conventional treatment only. At baseline, both groups were well balanced regarding age, sex, risk factors, thrombolysis in myocardial infarction flow and reperfusion delay. The culprit artery was more often the left anterior descending artery in the colchicine group (P=0.07), reflecting a more severe group. There was no significant difference in mean CRP peak value between the colchicine and control groups (29.03mg/L vs 21.86mg/L, respectively; P=0.36), even after adjustment for type of culprit artery (26.99 vs 24.99mg/L, respectively; P=0.79). CONCLUSION In our study, the effect of colchicine on inflammation in the context of STEMI could not be demonstrated. Further larger studies may clarify the impact of colchicine in acute myocardial infarction.
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Affiliation(s)
- Mariama Akodad
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Benoît Lattuca
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Nicolas Nagot
- UFR de médecine, medical information department, université Montpellier 1, CHU de Montpellier, 34295 Montpellier, France
| | - Vera Georgescu
- UFR de médecine, medical information department, université Montpellier 1, CHU de Montpellier, 34295 Montpellier, France
| | - Mathilde Buisson
- UFR de médecine, medical information department, université Montpellier 1, CHU de Montpellier, 34295 Montpellier, France
| | - Jean-Paul Cristol
- UFR de médecine, department of biochemistry, université Montpellier 1, CHU de Montpellier, 34295 Montpellier, France; PhyMedExp, Inserm U1046, CNRS UMR 9214, university of Montpellier, 34295 Montpellier, France
| | - Florence Leclercq
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Jean-Christophe Macia
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Richard Gervasoni
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Thien-Tri Cung
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Stéphane Cade
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Frédéric Cransac
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Jessica Labour
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France
| | - Anne-Marie Dupuy
- UFR de médecine, department of biochemistry, université Montpellier 1, CHU de Montpellier, 34295 Montpellier, France
| | - François Roubille
- UFR de médecine, cardiology department, hôpital Arnaud-de-Villeneuve, université Montpellier 1, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France; PhyMedExp, Inserm U1046, CNRS UMR 9214, university of Montpellier, 34295 Montpellier, France.
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22
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Leclercq F, Iemmi A, Lattuca B, Macia JC, Gervasoni R, Roubille F, Gandet T, Schmutz L, Akodad M, Agullo A, Verges M, Nogue E, Marin G, Nagot N, Rivalland F, Durrleman N, Robert G, Delseny D, Albat B, Cayla G. Feasibility and Safety of Transcatheter Aortic Valve Implantation Performed Without Intensive Care Unit Admission. Am J Cardiol 2016; 118:99-106. [PMID: 27184173 DOI: 10.1016/j.amjcard.2016.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/18/2022]
Abstract
Admission to the intensive care unit (ICU) is a standard of care after transcatheter aortic valve implantation (TAVI); however, the improvement of the procedure and the need to minimize the unnecessary use of medical resources call into question this strategy. We evaluated prospectively 177 consecutive patients who underwent TAVI. Low-risk patients, admitted to conventional cardiology units, had stable clinical state, transfemoral access, no right bundle branch block, permanent pacing with a self-expandable valve, and no complication occurring during the procedure. High-risk patients included all the others transferred to ICU. In-hospital events were the primary end point (Valve Academic Research Consortium 2 criteria). The mean age of patients was 83.5 ± 6.5 years, and the mean logistic EuroSCORE was 14.6 ± 9.7%. The balloon-expandable SAPIEN 3 valve was mainly used (n = 148; 83.6%), mostly with transfemoral access (n = 167; 94.4%). Among the 61 patients (34.5%) included in the low-risk group, only 1 (1.6%) had a minor complication (negative predictive value 98.4%, 95% confidence interval [CI] 0.91 to 0.99). Conversely, 31 patients (26.7%) from the high-risk group had clinical events (positive predictive value 26.7%, 95% CI 0.19 to 0.35), mainly conductive disorders requiring pacemaker (n = 26; 14.7%). In multivariate analysis, right bundle branch block (odds ratio [OR] 14.1, 95% CI 3.5 to 56.3), use of the self-expandable valve without a pacemaker (OR 5.5, 95% CI 2 to 16.3), vitamin K antagonist treatment (OR 3.8, 95% CI 1.1 to 12.6), and female gender (OR 2.6, 95% CI 1.003 to 6.9) were preprocedural predictive factors of adverse events. In conclusion, our results suggested that TAVI can be performed safely without ICU admission in selected patients. This strategy may optimize efficiency and cost-effectiveness of procedures.
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Affiliation(s)
- Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
| | - Anais Iemmi
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Benoit Lattuca
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | | | - Richard Gervasoni
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Francois Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Thomas Gandet
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Laurent Schmutz
- Department of Cardiology, University Hospital of Nîmes, Nîmes, France
| | - Mariama Akodad
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Audrey Agullo
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Marine Verges
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Erika Nogue
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Gregory Marin
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Nagot
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | | | | | - Gabriel Robert
- Department of Cardiology, Clinique St Pierre, Perpignan, France
| | | | - Bernard Albat
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nîmes, Nîmes, France
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Agullo A, Dauzat M, Schuster I, Cayla G, Boge G, Vacter T, Akodad M, Berous M, Macia JC, Leclercq F. 0503: Asymptomatic carotid stenosis in patient with acute coronary syndrome: who should be screened? Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30234-8] [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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24
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Iemmi A, Dupuy AM, Kuster N, Cristol JP, Roubille F, Macia JC, Lattuca B, Akodad M, Belardi D, Leclercq F. 0291: Incremental value of copeptin with high sensitivity cardiac T troponin for exclusion of severe coronary stenosis in patients with preexisting coronary artery disease. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30321-4] [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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Leclercq F, Akodad M, Macia JC, Gandet T, Lattuca B, Schmutz L, Gervasoni R, Nogue E, Nagot N, Levy G, Maupas E, Robert G, Targosz F, Vernhet H, Cayla G, Albat B. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access. Am J Cardiol 2015; 116:1399-404. [PMID: 26414600 DOI: 10.1016/j.amjcard.2015.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 12/20/2022]
Abstract
Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n = 26, 6.6%; and n = 67, 17.2%, respectively) was not related to major or minor VC (p = 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p = 0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p = 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients.
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Ben Bouallègue F, Roubille F, Lattuca B, Cung TT, Macia JC, Gervasoni R, Leclercq F, Mariano-Goulart D. SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements. J Nucl Med 2015; 56:1712-7. [DOI: 10.2967/jnumed.114.143164] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022] Open
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Laugaudin G, Kuster N, Petiton A, Leclercq F, Gervasoni R, Macia JC, Cung TT, Dupuy AM, Solecki K, Lattuca B, Cade S, Cransac F, Cristol JP, Roubille F. Kinetics of high-sensitivity cardiac troponin T and I differ in patients with ST-segment elevation myocardial infarction treated by primary coronary intervention. Eur Heart J Acute Cardiovasc Care 2015; 5:354-63. [PMID: 25943557 DOI: 10.1177/2048872615585518] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/12/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE Cardiac biomarkers including troponins are the cornerstone of the biological definition of acute myocardial infarction. New high-sensitivity cardiac assays determining troponin T (hs-cTnT) as well as I ((hs-cTnI) from Abbott and s-cTnI from Siemens) raise concerns because of their unclear kinetics following the peak. AIMS This study aims to compare kinetics of creatine kinases, hs-cTnT, hs-cTnI and s-cTnI in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention. METHODS We prospectively studied 106 consecutive patients admitted in our institution for STEMI and treated by percutaneous coronary intervention. We evaluated for all the patients simultaneously kinetics of creatine kinases, hs-cTnT (Roche) and two different cTnIs (hs-cTnI from Abbott and s-cTnI from Siemens). Modelling of kinetics was realized using mixed effects with cubic splines. RESULTS Kinetics of markers showed a first peak at 10.7h (8.0-12.0) for creatine kinases, 11.8h (10.4-13.3) for hs-cTnT (Roche); 11.8h (10.7-11.8) for hs-cTnI from Abbott and 10.2h (8.7-11.6) for s-cTnI from Siemens, respectively. This peak was followed by a nearly log linear decrease for hs-cTnI/s-cTnI and creatine kinases in contrast to hs-cTnT, which appeared with a biphasic shape curve marked by a second peak at 76.9h (69.5-82.8). The analysis of the decrease in percentage of the peak value at 77h showed that hs-cTnT follows a twice lower decrease than other markers. CONCLUSION Kinetics of hs-cTnT, hs-cTnI and s-cTnI differ significantly with a linear decrease regarding both cTnI assays contrasting with a biphasic shape curve for hs-cTnT. This is of importance for clinical management of patients in routine settings especially in follow-up after STEMI including the suspicion of reinfarction.
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Affiliation(s)
- Guillaume Laugaudin
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | - Nils Kuster
- Biochemistry, Montpellier University Hospital, France
| | - Amael Petiton
- Biochemistry, Montpellier University Hospital, France
| | - Florence Leclercq
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | - Richard Gervasoni
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | | | - Thien-Tri Cung
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | | | - Kamila Solecki
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | - Benoit Lattuca
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | - Stéphane Cade
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | - Frédéric Cransac
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France
| | - Jean-Paul Cristol
- Biochemistry, Montpellier University Hospital, France PhyMedExp, University of Montpellier, France
| | - François Roubille
- Cardiology Department, Montpellier University Hospital, CHU-Montpellier, France PhyMedExp, University of Montpellier, France
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Trivedi KR, Aldebert P, Riberi A, Mancini J, Levy G, Macia JC, Quilicci J, Habib G, Fraisse A. Sequential management of post-myocardial infarction ventricular septal defects. Arch Cardiovasc Dis 2015; 108:321-30. [DOI: 10.1016/j.acvd.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/23/2014] [Accepted: 01/12/2015] [Indexed: 01/20/2023]
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El Bouazzaoui R, Thomann S, Massin F, Cransac F, Tri Cung T, Macia JC, Pasquié JL, Davy JM. 0406: Anticoagulation therapy is frequent in patients with silent AF detected in cardiac devices memory, despite an absence of current guidelines: a monocentric registry. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71690-3] [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: 10/24/2022]
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Lattuca B, Leclercq F, Leroy S, Schmutz L, Macia JC, Fabbro-Peray P, Cornillet L, Ledermann B, Messner-Pellenc P, Cayla G. 0098: One year incidence and clinical impact of bleeding outcomes in STEMI patients treated by prasugrel or clopidogrel in real life: the BLEED-MI study. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71500-4] [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: 10/24/2022]
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Solecki K, Dupuy AM, Kuster N, Leclercq F, Gervasoni R, Macia JC, Cung TT, Lattuca B, Cransac F, Cade S, Pasquié JL, Cristol JP, Roubille F. Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction. ACTA ACUST UNITED AC 2015; 53:707-14. [DOI: 10.1515/cclm-2014-0475] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/13/2014] [Indexed: 11/15/2022]
Abstract
AbstractCardiac biomarkers are the cornerstone of the biological definition of acute myocardial infarction (AMI). The key role of troponins in diagnosis of AMI is well established. Moreover, kinetics of troponin I (cTnI) and creatine kinase (CK) after AMI are correlated to the prognosis. New technical assessment like high-sensitivity cardiac troponin T (hs-cTnT) raises concerns because of its unclear kinetic following the peak. This study aims to compare kinetics of cTnI and hs-cTnT to CK in patients with large AMI successfully treated by percutaneous coronary intervention (PCI).We prospectively studied 62 patients with anterior AMI successfully reperfused with primary angioplasty. We evaluated two consecutive groups: the first one regularly assessed by both CK and cTnI methods and the second group by CK and hs-cTnT. Modeling of kinetics was realized using mixed effects with cubic splines.Kinetics of markers showed a peak at 7.9 h for CK, at 10.9 h (6.9–12.75) for cTnI and at 12 h for hs-cTnT. This peak was followed by a nearly log linear decrease for cTnI and CK by contrast to hs-cTnT which appeared with a biphasic shape curve marked by a second peak at 82 h. There was no significant difference between the decrease of cTnI and CK (p=0.63). CK fell by 79.5% (76.1–99.9) vs. cTnI by 86.8% (76.6–92.7). In the hs-cTnT group there was a significant difference in the decrease by 26.5% (9–42.9) when compared with CK that fell by 79.5% (64.3–90.7).Kinetic of hs-cTnT and not cTnI differs from CK. The role of hs-cTnT in prognosis has to be investigated.
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Roubille F, Micheau A, Combes S, Thibaut S, Souteyrand G, Cayla G, Bonello L, Lesavre N, Sportouch-Dukhan C, Klein F, Berboucha S, Cade S, Cung TT, Raczka F, Macia JC, Gervasoni R, Cransac F, Leclercq F, Barrère-Lemaire S, Paganelli F, Mottref P, Vernhet Kovacsik H, Ovize M, Piot C. Intracoronary administration of darbepoetin-alpha at onset of reperfusion in acute myocardial infarction: Results of the randomized Intra-Co-EpoMI trial. Arch Cardiovasc Dis 2013; 106:135-45. [DOI: 10.1016/j.acvd.2012.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 11/13/2012] [Accepted: 12/04/2012] [Indexed: 01/29/2023]
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Lattuca B, Khoueiry Z, Leclercq F, Macia JC, Piot C, Sportouch-Dukhan C, Cransac F, Pasquie JL, Davy JM, Roubille F. 090: Could heart rate predict duration of hospitalizations for patients admitted for acute pericarditis? Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71020-6] [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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Mariano-Goulart D, Jacquet JM, Molinari N, Bourdon A, Benkiran M, Sainmont M, Cornillet L, Macia JC, Reynes J, Ben Bouallègue F. Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT? Eur J Nucl Med Mol Imaging 2012; 40:271-9. [DOI: 10.1007/s00259-012-2262-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
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Khoueiry Z, Roubille C, Nagot N, Lattuca B, Piot C, Leclercq F, Delseny D, Busseuil D, Gervasoni R, Davy JM, Pasquié JL, Cransac F, Sportouch-Dukhan C, Macia JC, Cung TT, Massin F, Cade S, Cristol JP, Barrère-Lemaire S, Roubille F. Could heart rate play a role in pericardial inflammation? Med Hypotheses 2012; 79:512-5. [PMID: 22858356 DOI: 10.1016/j.mehy.2012.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/04/2012] [Accepted: 07/08/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED PURPOSE AND MEDICAL HYPOTHESIS: Rest is usually recommended in acute pericarditis, as it could help to lower heart rate (HR) and contribute to limit "mechanical inflammation". Whether HR on admission could be correlated and perhaps participate to inflammation has not been reported. METHODS Between March 2007 and February 2010, we conducted a retrospective study on all patients admitted to our center for acute pericarditis. Diagnosis criteria included two of the following ones: typical chest pain, friction rub, pericardial effusion on cardiac echography, or typical electrocardiogram (ECG) findings. Primary endpoint was biology: CRP on admission, on days 1, 2, 3, and especially peak. RESULTS We included 73 patients. Median age was 38 years (interquartiles 28-51) and median hospitalization duration was 2.0 days (1.5-3.0). Median heart rate was 88.0 beats per minute (bpm) on admission (interquartiles 76.0-100.0) and 72.0 on discharge (65.0-80.0). Heart rate on admission was significantly correlated with CRP peak (p<0.001), independently of temperature on admission, hospitalization duration and age. Recurrences occurred within 1 month in 32% of patients. Heart rate on hospital discharge was correlated with recurrence, independently of age. CONCLUSION In acute pericarditis, heart rate on admission is independently correlated with CRP levels and heart rate on discharge seems to be independently correlated to recurrence. This could suggest a link between heart rate and pericardial inflammation.
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Affiliation(s)
- Ziad Khoueiry
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
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Abstract
Objective: To review the literature for information regarding pharmacokinetic interactions between antiretrovirals and antihypertensive agents, evaluate the clinical significance of these interactions, and analyze the effect of antihypertensive drugs on the metabolic complications frequently observed in HIV-infected patients to emphasize the advantages and inconveniences of every class of antihypertensive drugs in association with antiretrovirals. Data Sources: A literature search was conducted via PubMed and MEDLINE (1950-November 2011) using the search terms drug interactions, cytochrome P450, names of antiretrovirals, names of commonly prescribed antihypertensive drugs, pharmacokinetics, and metabolic complications. Reference citations from relevant publications, manufacturers’ product information, and www.HIV-druginteracttons.org were also reviewed. Study Selection And Data Extractions: All articles with an English abstract identified through the data search were examined. Of these, pharmacologic reviews, studies, and case reports were evaluated. Data Synthesis: Antihypertensive drugs interact with several antiretroviral drugs, non nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (Pls) in particular. Pharmacokinetic interactions are less expected with diuretics, jî-blockers excreted by the kidney, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) other than losartan and irbesartan. Calcium channel blockers (CCBs) are metabolized by CYP3A4, with the potential for interaction with NNRTIs and Pls. Because CCBs do not adversely affect glucose or lipid metabolism or renal function, they may be preferred in patients with such complications. ACE inhibitors and ARBs may exert favorable effects on glucose homeostasis. In addition, they may significantly reduce protein excretion and further slow the progression of renal disease. Conclusions: The choice of antihypertensive drugs in HIV-infected patients is complex and must take into account the metabolic pathways of antiretroviral drugs and antihypertensive drugs with the potential of pharmacokinetic interactions, as well as the effect of antihypertensive drugs on some biological parameters.
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Affiliation(s)
- Hélène Peyriere
- Medical Pharmacology and Toxicology Department, UMI233 TransVIHMI, University Hospital of Montpellier, Montpellier, France
| | - Céline Eiden
- Medical Pharmacology and Toxicology Department, University Hospital of Montpellier
| | | | - Jacques Reynes
- Infectious Diseases Department, UMI233 TransVIHMI, University Hospital of Montpellier
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Cayla G, Collet JP, Silvain J, Schmutz L, Ledermann B, Macia JC, Gervasoni R, Cornillet L, Leclercq F, Messner-Pellenc P. 075 Identification of patients at risk for premature discontinuation of oral antiplatelet therapy after elective percutaneous coronary intervention. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70077-5] [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: 11/29/2022]
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Roubille F, Samri A, Cornillet L, Sportouch-Dukhan C, Davy JM, Raczka F, Gervasoni R, Pasquie JL, Cung TT, Piot C, Macia JC, Cransac F, Leclercq F. Routinely-feasible multiple biomarkers score to predict prognosis after revascularized STEMI. Eur J Intern Med 2010; 21:131-6. [PMID: 20206886 DOI: 10.1016/j.ejim.2009.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 11/22/2009] [Accepted: 11/25/2009] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We assessed the long-term prognostic value of an easy-to-do multiple cardiac biomarkers score after a revascularized acute myocardial infarction (MI) in order to evaluate a multimarker approach to risk stratification, based on routine biomarkers. MATERIAL AND METHODS Blood samples from 138 patients hospitalized with acute myocardial infarction and successfully treated by primary coronary intervention (with TIMI 3 flow) were subsequently tested for creatinin level at admittance and then BNP, hsCRP, troponin I from Day 0 to day 7. The primary endpoint was a clinical evaluation comprising: new hospitalization for cardiac reasons, acute coronary events (acute coronary syndrome), and death. RESULTS During the median follow-up period of 11.01 months [9.44-12.59], 47 events were recorded. All the following markers were able to predict events: creatinemia on admission (p=0.0057), CRP on day 3 (p, troponin I on day 1 (p<0.001), BNP (p<0.0001) and biological multimarker score (p<0.0001). Clinical events were predicted with a hazard ratio (HR) of respectively 3.30 [2.88-12.30] in BNP Q4 as compared to the three lower quartiles (Q1-3), and 3.15 [2.75-21.00] for the Multimarker approach. The multimarker score was not significantly better than BNP on day 1 alone (p=0.77), troponin on day 1 alone (p=0.43), creatininemia on admission (p=0.19) or CRPhs on day 3 alone (p=0.054). Nevertheless, the Multimarker approach leads to the selection of a smaller, hence more manageable, high-risk population (13% versus 25%). CONCLUSION Among 138 subjects admitted for acute MI, and all successfully revascularized, a routinely multimarker approach with BNP, hsCRP, creatininemia, troponin I, is feasible. BNP is the most powerful marker, and this multimarker approach renders additional prognostic information helping to identify patients with high-risk to clinical events.
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Affiliation(s)
- F Roubille
- CHU Arnaud de Villeneuve, Cardiology Department, 371 avenue du doyen Gaston GIRAUD, 34295 Montpellier, France.
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Machado S, Roubille F, Gahide G, Vernhet-Kovacsik H, Cornillet L, Cung TT, Sportouch-Dukhan C, Raczka F, Pasquié JL, Gervasoni R, Macia JC, Cransac F, Davy JM, Piot C, Leclercq F. Can troponin elevation predict worse prognosis in patients with acute pericarditis? Ann Cardiol Angeiol (Paris) 2010; 59:1-7. [PMID: 19963205 DOI: 10.1016/j.ancard.2009.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 07/15/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Myopericarditis are common in clinical practice: up to 15% of acute pericarditis have a significant myocardial involvement as assessed by biological markers. This prospective, bicentric study is aimed at describing a myopericarditis population, the clinical and MRI follow-up, and search for prognosis markers. PATIENTS AND METHODS Between May 2005 and September 2007, 103 patients hospitalised for acute pericarditis were prospectively enrolled. Physical examination, ECG, echocardiography, biological screening and cardiac MRI, in case of myopericarditis defined as acute pericarditis with troponin I elevation, were performed. Between December 2007 and July 2008, patients were contacted for new clinical and MRI evaluation. RESULTS Among the initial population of 103 patients admitted for acute pericarditis, 14 myopericarditis and 38 pericarditis were included. Compared with pericarditis, the myopericarditis group was associated with the following features: younger age (34.9 years [95% CI 28.3-41.2]; p=0.01), ST-segment elevation (nine patients between 14; p=0.03), higher troponin I (7.3 microg/L [95% CI 4.4-10.2]; p<10(-4)) and lower systemic inflammation (CRP peak 38.1mg/L [95% CI 7-69.2]; p=0.01). In the case of myopericarditis, infectious etiologies were predominant (12 patients among 14; p=0.002) and patients stayed longer in hospital (5.8 days [95% CI 4.7-6.8]; p=0.01). Follow-up showed no difference in terms of functional status (p=0.3) and global complications (p=0.9) between paired myopericarditis and pericarditis. Nevertheless, cardiac mortality was higher for myopericarditis (p=0.04). MRI follow-up showed myocardial sequelae without clinical impact. CONCLUSION Myopericarditis significantly distinguished from pericarditis. Three years follow-up showed no difference in terms of global complications but a higher cardiac mortality for myopericarditis. MRI myocardial lesions did not develop into symptomatic sequelae.
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Affiliation(s)
- S Machado
- Département de cardiologie, CHU Arnaud-de-Villeneuve, 371 avenue du Doyen-Gaston-Giraud, Montpellier, France
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Affiliation(s)
- Jérôme Adda
- Cardiology Department, Chu Arnaud de Villeneuve, Montpellier, France
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Abstract
We report a case of methicillin-resistant Staphylococcus aureus endocarditis treated by vancomycin and cotrimoxazole switched to oral linezolid alone with a complete resolution of the vegetation. Two months after discontinuation of treatment, the patient presented a relapse confirmed by pulsed-field gel electrophoresis involving the same linezolid-susceptible strain and rapidly died.
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Affiliation(s)
- Philippe Corne
- Department of Intensive Care Medicine, Gui de Chauliac Hospital, Montpellier, France.
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Roubille F, Cayla G, Gahide G, Mourad G, Macia JC. Acute myocarditis and Tumor Necrosis Factor Receptor-Associated Periodic (TRAP) syndrome: first case described and discussion. Eur J Intern Med 2009; 20:e25-6. [PMID: 19327590 DOI: 10.1016/j.ejim.2008.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 06/27/2008] [Accepted: 07/22/2008] [Indexed: 11/30/2022]
Affiliation(s)
- F Roubille
- CHU Montpellier, Département de Cardiologie, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Gahide G, Roubille F, Macia JC, Garrigue V, Vernhet H. Myocardial involvement in fibrinogen A-alpha chain amyloidosis. Eur J Intern Med 2008; 19:e54-6. [PMID: 19013365 DOI: 10.1016/j.ejim.2008.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 02/07/2008] [Indexed: 11/18/2022]
Affiliation(s)
- G Gahide
- Service de radiologie, Hopital A de Villeneuve, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.
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Roubille F, Gahide G, Granier M, Cornillet L, Vernhet-Kovacsik H, Moore-Morris T, Macia JC, Piot C. Likely tuberculous myocarditis mimicking an acute coronary syndrome. Intern Med 2008; 47:1699-701. [PMID: 18827419 DOI: 10.2169/internalmedicine.47.1062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute systemic infections may involve the heart, mostly represented by myocarditis and pericarditis. We report the case of a likely myopericarditis in an adult, leading to the diagnosis of tuberculosis infection. The clinical presentation was an acute coronary syndrome with elevated troponin Ic. An alternative diagnosis of myopericarditis was considered. Chest X-ray depicted a miliary pattern and a CT-scan demonstrated bilateral micronodules with a "tree-in-bud" pattern associated with parenchymal consolidations in the apical segment of the left upper lobe, suggesting infectious bronchiolitis. As the direct microscopic examination of the bronchial expectoration revealed the presence of Koch's bacterium, a diagnosis of a tuberculous myocarditis was likely. The clinical, electrocardiographic and CT-scan findings are shown; cardiac effects associated with tuberculosis are discussed.
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Affiliation(s)
- François Roubille
- Cardiology Department, CHU Arnaud de Villeneuve, Montpellier, France.
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45
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Pasquié JL, Massin F, Macia JC, Gervasoni R, Bortone A, Cayla G, Grolleau R, Leclercq F. Long-term follow-up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure. Pacing Clin Electrophysiol 2007; 30 Suppl 1:S31-3. [PMID: 17302712 DOI: 10.1111/j.1540-8159.2007.00599.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Besides standard left ventricular (LV) stimulation via the coronary sinus, a transseptal approach allows left ventricular endocardial stimulation. We report our long-term observations with biventricular stimulation, using a strictly endocardial system for patients presenting with severe congestive heart failure. METHODS Six patients with nonischemic cardiomyopathy (mean age = 60 +/- 9.6 years, women) in New York Heart Association (NYHA) functional class III (n = 5) or IV, despite optimal drug therapy, and a mean LV ejection fraction of 24 +/- 3%, underwent implantation of biventricular stimulation systems between April 1998 and March 1999. All presented with left bundle branch block and an increased LV end-diastolic diameter (mean = 66 +/- 5 mm). In all patients, a bipolar pacing lead was implanted in the lateral LV wall using a direct transseptal approach. After implantation, all patients received oral anticoagulation. RESULTS QRS duration decreased from 184 +/- 22 ms to 108 +/- 11 ms. NYHA functional class decreased to II in all patients within 1 month. Over a 85 +/- 5 month follow-up, two patients underwent cardiac transplantation, 2 and 4 years after device implantation, respectively; two patients died of end-stage heart failure 4 years after system implantation; and two patients were alive in functional class II. One patient, who experienced syncope due to fast ventricular, underwent implantation of an ICD. One transient ischemic attack occurred in a patient whose anticoagulation was temporarily interrupted. CONCLUSIONS Long-term endocardial biventricular stimulation via a transseptal approach was safe and effective in this small population. This approach needs to be further compared with conventional epicardial pacing via the coronary sinus.
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Affiliation(s)
- J L Pasquié
- Clinique des Maladies du Coeur et des Vaisseaux, Hôpital Arnaud de Villeneuve, Centre Hospitalo-Universitaire de Montpellier, France.
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Bortone A, Macia JC, Leclercq F, Pasquié JL. Monomorphic Ventricular Tachycardia Induced by Cardiac Resynchronization Therapy in Patient with Severe Nonischemic Dilated Cardiomyopathy. Pacing and Clinical Electrophysiology 2006; 29:327-30. [PMID: 16606403 DOI: 10.1111/j.1540-8159.2006.00342.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a patient with severe nonischemic dilated cardiomyopathy in whom cardiac resynchronization therapy (CRT) was the source of incessant, drug-resistant, monomorphic ventricular tachycardia (VT). VT recurrences were only resolutive with inactivation of CRT and reactivation of CRT reproduced VT occurrence. The possible pathophysiology of the VT and the potential ventricular proarrhythmic risk related to CRT are discussed. This report points out clearly that CRT can induce ventricular arrhythmias and suggests the need for CRT systematically associated with a defibrillation system.
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Affiliation(s)
- Agustín Bortone
- Service de Cardiologie A, Hôpital Arnaud de Villeneuve, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.
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Pasquié JL, Macia JC, Leclercq F, Grolleau R. [Ventricular tachycardia due to branch to branch re-entry]. Arch Mal Coeur Vaiss 2005; 98 Spec No 5:15-20. [PMID: 16433238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Ventricular tachycardia due to branch to branch re-entry constitutes a rare clinical entity. This circuit is remarkable by the fact that it is made up of the branches or hemi-branches of the bundle of His bifurcation. They occur under specific conditions, with a combination of left ventricular dilatation and atrioventricular or intraventricular conduction defects. They are also very often found in Steinert's disease. A positive diagnosis can sometimes be difficult and relies on a variety of factors. Recording of the His potential shows His activity preceding each ventriculogram, and variations in spontaneous cycles between 2 ventriculograms preceded by variations between the 2 His potentials. Atrial capture without modification of the QRS is possible, but fusion excludes the diagnosis. Drug therapy is only slightly effective, and the best treatment is ablation of the right branch of the bundle of His, which stops the tachycardia definitively.
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Affiliation(s)
- J L Pasquié
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 34295 Montpellier 5.
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48
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Cayla G, Macia JC, Pasquié JL. Infective pseudoaneurysm of a ruptured sinus of Valsalva as an unusual cause of myocardial infarction by compression of the right coronary artery. Heart 2005; 92:831. [PMID: 16698835 PMCID: PMC1860654 DOI: 10.1136/hrt.2005.074740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grolleau R, Pasquié JL, Macia JC, Leclercq F. [The electrocardiogram of atrioventricular blocks]. Arch Mal Coeur Vaiss 2004; 97 Spec No 4:35-46. [PMID: 15714888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Atrioventricular block (AVB) is defined as delay or absence of transmission of one or more atrial excitations to the ventricle. Physiological functional block protects the ventricle against very rapid atrial rhythms. Organic blocks may be transient, due to an acute regressive condition, or chronic, in which case they fall into two groups--permanent blocks or paroxysmal and generally rate-dependant blocks. The blocks are classified in three categories according to whether the atrial activation is delayed, conducted intermittently or not at all. The site of AVB may be determined by His bundle recordings but it may also be deduced from the surface ECG recording. Fundamental studies have questioned the reality of Rosenbaum's phase 3 and 4 blocks and suggest abnormalities of excitability in pathological zones.
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Affiliation(s)
- R Grolleau
- Service de cardiologie A, hôpital Arnaud de Villeneuve, Montpellier
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Bortone A, Corne P, Macia JC, Landreau L, Moulaire V, Leclercq F, Jonquet O. [Right atrial thrombus--a complication of central venous catheters]. Arch Mal Coeur Vaiss 2004; 97:693-6. [PMID: 15283045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We describe the development, in three days, of a pediculate mass hanging on the right atrial lateral wall in a 39-year-old woman with a subclavian venous catheterization. She was a current smoker and alcoholic but without drug addict. The hypothesis of a non valvular right atrial infective endocarditis was considered at first, but subsequent events directed the diagnosis towards a thrombus, which was resorbed by heparin. We discuss the incidence, the complications, the treatment and the differential diagnosis of thrombus caused by a central venous catheter. The prevention of right atrial thrombus caused by a central venous catheter depends on the position of the central venous catheter tip, either in the superior vena cava or at the superior vena cava-right atrium junction. A more distal position is a frequent source of thrombotic and embolic complications.
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Affiliation(s)
- A Bortone
- Service de cardiologie A, hôpital Arnaud de Villeneuve, Montpellier
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