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Bertaina G, Rouchon B, Huon B, Guillot N, Robillard C, Noel B, Nadra M, Tribouilloy C, Marijon E, Jouven X, Mirabel M. Natural history of borderline rheumatic heart disease in New Caledonia: A prospective cohort study. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30003-4] [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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Bertaina G, Rouchon B, Huon B, Guillot N, Robillard C, Noel B, Nadra M, Tribouilloy C, Marijon E, Jouven X, Mirabel M. Natural history of borderline rheumatic heart disease in New Caledonia: a prospective cohort study. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mirabel M, Tafflet M, Noël B, Parks T, Axler O, Robert J, Nadra M, Phelippeau G, Descloux E, Cazorla C, Missotte I, Gervolino S, Barguil Y, Rouchon B, Laumond S, Jubeau T, Braunstein C, Empana JP, Marijon E, Jouven X. Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific. Heart 2015; 101:1901-6. [PMID: 26537732 PMCID: PMC4680122 DOI: 10.1136/heartjnl-2015-308237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/02/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Rheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. We aimed at assessing outcomes and influencing factors in the contemporary era. METHODS Hospital-based cohort in a high-income island nation where RHD remains endemic and the population is captive. All patients admitted with newly diagnosed RHD according to World Heart Federation echocardiographic criteria were enrolled (2005-2013). The incidence of major cardiovascular events (MACEs) including heart failure, peripheral embolism, stroke, heart valve intervention and cardiovascular death was calculated, and their determinants identified. RESULTS Of the 396 patients, 43.9% were male with median age 18 years (IQR 10-40)). 127 (32.1%) patients presented with mild, 131 (33.1%) with moderate and 138 (34.8%) with severe heart valve disease. 205 (51.8%) had features of acute rheumatic fever. 106 (26.8%) presented with at least one MACE. Among the remaining 290 patients, after a median follow-up period of 4.08 (95% CI 1.84 to 6.84) years, 7 patients (2.4%) died and 62 (21.4%) had a first MACE. The annual incidence of first MACE and of heart failure were 59.05‰ (95% CI 44.35 to 73.75) and 29.06‰ (95% CI 19.29 to 38.82), respectively. The severity of RHD at diagnosis (moderate vs mild HR 3.39 (0.95 to 12.12); severe vs mild RHD HR 10.81 (3.11 to 37.62), p<0.001) and ongoing secondary prophylaxis at follow-up (HR 0.27 (0.12 to 0.63), p=0.01) were the two most influential factors associated with MACE. CONCLUSIONS Newly diagnosed RHD is associated with poor outcomes, mainly in patients with moderate or severe valve disease and no secondary prophylaxis.
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Affiliation(s)
- Mariana Mirabel
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Muriel Tafflet
- INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Baptiste Noël
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | | | - Olivier Axler
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Jacques Robert
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Marie Nadra
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Gwendolyne Phelippeau
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Elodie Descloux
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Cécile Cazorla
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Isabelle Missotte
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Shirley Gervolino
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Yann Barguil
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Bernard Rouchon
- Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Sylvie Laumond
- Direction des Affaires Sanitaires et Sociales, Nouméa, New Caledonia
| | - Thierry Jubeau
- Département des Evacuations Sanitaires, Contrôle Médical Unifié, CAFAT, Nouméa, New Caledonia
| | - Corinne Braunstein
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Jean-Philippe Empana
- INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Xavier Jouven
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Mirabel M, André R, Barsoum Mikhaïl P, Colboc H, Lacassin F, Noël B, Robert J, Nadra M, Braunstein C, Gervolino S, Marijon E, Iung B, Jouven X. Infective endocarditis in the Pacific: clinical characteristics, treatment and long-term outcomes. Open Heart 2015; 2:e000183. [PMID: 25973211 PMCID: PMC4422921 DOI: 10.1136/openhrt-2014-000183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/13/2014] [Accepted: 12/11/2014] [Indexed: 01/23/2023] Open
Abstract
Introduction Data on clinical characteristics and outcomes of infective endocarditis (IE) in the Pacific are scarce. Methods Retrospective hospital-based study in New Caledonia, a high-income country, on patients aged over 18 years with definite IE according to the modified Duke criteria (2005–2010). Results 51 patients were included: 31 (60.8%) men; median age of 52.4 years (IQR 33.0–70.0). Left-sided IE accounted for 47 (92.2%) patients: native valve IE in 34 (66.7%) and prosthetic valve IE in 13 (25.5%). The main underlying heart disease included: rheumatic valve disease in 19 (37.3%), degenerative heart valve disease in 12 (23.5%) and congenital heart disease in 6 (11.8%). Significant comorbidities (Charlson's score >3) were observed in 20 (38.7%) patients. Infection was community acquired in 43 (84.3%) patients. Leading pathogens included Staphylococcus aureus in 16 (31.4%) and Streptococcus spp in 15 (29.4%) patients. Complications were noted in 33 patients (64.7%) and 24 (47.1%) were admitted to the intensive care unit. Cardiac surgery was eventually performed in 22 of 40 (55.0%) patients with a theoretical indication. None underwent emergent cardiac surgery (ie, first 24 h); 2 (3.9%) were operated within 7 days; and 20 (39.2%) beyond 7 days. 11 (21.6%) patients died in hospital and 21 (42.9%) were dead after a median follow-up of 28.8 months (IQR 4.6–51.2). Two (3.9%) were lost to follow-up. Conclusions In New Caledonia, IE afflicts relatively young patients with rheumatic heart disease, and carries high complication and mortality rates. Access to heart surgery remains relatively limited in this remote archipelago.
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Affiliation(s)
- Mariana Mirabel
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou , Paris , France
| | - Romain André
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France
| | - Paul Barsoum Mikhaïl
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Hester Colboc
- Department of Internal Medicine and Infectious Disease , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Flore Lacassin
- Department of Internal Medicine and Infectious Disease , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Baptiste Noël
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Jacques Robert
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Marie Nadra
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Corinne Braunstein
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Shirley Gervolino
- Department of Bioinformatics , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Eloi Marijon
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou , Paris , France
| | - Bernard Iung
- Cardiology Department , Hôpital Bichat and Paris Diderot University , Paris , France
| | - Xavier Jouven
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou , Paris , France
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Baguet JP, Nadra M, Barone-Rochette G, Ormezzano O, Pierre H, Pépin JL. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manag 2009; 5:1063-73. [PMID: 20057899 PMCID: PMC2801630 DOI: 10.2147/vhrm.s8300] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Indexed: 01/19/2023] Open
Abstract
Obstructive sleep apnea (OSA) is associated with high cardiovascular morbidity and mortality. Recent studies have shown that it is associated with atherosclerosis and left ventricular dysfunction markers. The aim of this study was to assess the cardiovascular effects of OSA depending on its severity, in patients without clinically diagnosed cardiovascular disease. One hundred thirty newly diagnosed, nondiabetic OSA patients (mean age 49 +/- 10 years), without vasoactive treatment were included. They underwent clinical and ambulatory blood pressure measurements, echocardiography, carotid ultrasound examination, and a carotid-femoral pulse wave velocity (PWV) measurement. Seventy-five percent of the subjects were hypertensive according to the clinical or ambulatory measurement. More patients with the most severe forms (respiratory disturbance index >37/hour) had a nondipper profile (52% vs 34%; P = 0.025) and their left ventricular mass was higher (40 +/- 7 vs 36 +/- 8 g/m, p = 0.014). This last parameter was independently and inversely associated with mean nocturnal oxygen saturation (P = 0.004). PWV and carotid intima-media thickness did not differ between one OSA severity group to another, but the prevalence of carotid hypertrophy was higher when mean SaO(2) was below 93.5% (29.5 vs 16%; P = 0.05). Our study shows that in OSA patients without clinically diagnosed cardiovascular disease, there is a significant left ventricular and arterial effect, which is even more marked when OSA is severe.
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