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Landolff Q, Lefèvre T, Fajadet J, Sainsous J, Lhermusier T, Elhadad S, Tarragano F, Ranc S, Ghostine S, Cayla G, Marco F, Garot P, Maillard L, Motreff P, Delarche N, De Labriolle A, Pansieri M, Morelle JF, Cazaux P, Moulichon ME, Chopat P, Angoulvant D, Bataille V, Le Breton H, Koning R. Five-year clinical outcomes using the bioresorbable vascular scaffold: Insights from the FRANCE ABSORB registry. Arch Cardiovasc Dis 2022; 115:505-513. [PMID: 36123284 DOI: 10.1016/j.acvd.2022.05.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Randomized trials comparing the first-generation absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA, USA) with a drug-eluting stent showed a moderate but significant increase in the rate of 3-year major adverse cardiac events and scaffold thrombosis, followed by a decrease in adverse events after 3 years. AIM The objective of this study was to assess the 5-year outcomes of patients treated with at least one absorb BVS and included in the FRANCE ABSORB registry. METHODS All patients treated in France with an absorb BVS were prospectively included in a large nationwide multicentre registry. The primary efficacy outcome was the occurrence of 5-year major adverse cardiac events. Secondary efficacy outcomes were the rates of 5-year target vessel revascularization and definite/probable scaffold thrombosis. RESULTS Between September 2014 and April 2016, 2,070 patients were included in 86 centres (mean age 55±11 years; 80% men; 49% with acute coronary syndrome). The rates of 1-, 3- and 5-year major adverse cardiac events were 3.9%, 9.4% and 12.1%, respectively (including cardiac death in 2.5% and target vessel revascularization in 10.4%). By multivariable analysis, diabetes, oral anticoagulation, the use of multiple Absorb BVSs and the use of a 2.5mm diameter absorb BVS were associated with 5-year major adverse cardiac events. The rates of 1-, 3- and 5-year definite/probable scaffold thrombosis were 1.5%, 3.1% and 3.6%, respectively. By multivariable analysis, older age, diabetes, anticoagulation at discharge and the use of a 2.5mm diameter absorb BVS were associated with 5-year scaffold thrombosis. CONCLUSIONS Absorb BVS implantation was associated with low rates of 1-year major adverse cardiac events, which increased significantly at 3-year follow-up. There was a clear decrease in the rates of scaffold thrombosis and major adverse cardiac events after 3 years.
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Affiliation(s)
| | - Thierry Lefèvre
- Institut cardiovasculaire Paris Sud, Ramsay-Générale de Santé, hôpital privé Jacques-Cartier, 91300 Massy, France
| | | | | | | | - Simon Elhadad
- Centre hospitalier de Marne-la-Vallée, 77600 Jossigny, France
| | | | - Sylvain Ranc
- Centre hospitalier Saint-Joseph Saint-Luc, 69007 Lyon, France
| | - Saïd Ghostine
- Hôpital Marie-Lannelongue (groupe hospitalier Paris Saint-Joseph), 92350 Le Plessis-Robinson, France
| | | | | | - Philippe Garot
- Hôpital privé Claude-Galien, 91480 Quincy-sous-Sénart, France
| | | | | | | | | | | | | | - Pierre Cazaux
- Centre hospitalier de Bretagne Sud Site de Scorff, 56322 Lorient, France
| | | | - Patrick Chopat
- Centre hospitalier territorial, hôpital Gaston-Bourret, 98800 Nouméa, Nouvelle-Calédonie, France
| | | | - Vincent Bataille
- ADIMEP, université Paul-Sabatier, Toulouse III, 31400 Toulouse, France
| | | | - René Koning
- Clinique Saint-Hilaire, 76000 Rouen, France.
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Bonnet G, Panagides V, Becker M, Rivière N, Yvorel C, Deney A, Lattuca B, Duband B, Moussa K, Juenin L, Pamart T, Semaan C, Uhry S, Noirclerc N, Vincent F, Vignac M, Palermo V, Martin AS, Zeitouni M, Van Belle E, Tirouvanziam A, Manchuelle A, Chamandi C, Kerneis M, Boukantar M, Belle L, De Poli F, Angoulvant D, Meneveau N, Robin M, Pansieri M, Bonello L, Motreff P, Bouisset F, Isaaz K, Cetran L, Khalife K, Lesizza P, Adjedj J, Benamer H, Cayla G. ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in France. Arch Cardiovasc Dis 2021; 114:340-351. [PMID: 33926830 PMCID: PMC9056233 DOI: 10.1016/j.acvd.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/22/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.
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Affiliation(s)
- Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vassili Panagides
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Mathieu Becker
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | - Nicolas Rivière
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Cédric Yvorel
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Antoine Deney
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France
| | - Benoit Lattuca
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Benjamin Duband
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Karim Moussa
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Léa Juenin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Thibault Pamart
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Carl Semaan
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Sabrina Uhry
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | | | | | - Maxime Vignac
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vincenzo Palermo
- Cardiology Department, Marie Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - Anne Sophie Martin
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | | | | | | | - Chekrallah Chamandi
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris, INSERM U970, 75015 Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Madjid Boukantar
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Loïc Belle
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | - Fabien De Poli
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | - Denis Angoulvant
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Nicolas Meneveau
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Marie Robin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Michel Pansieri
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Pascal Motreff
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Frédéric Bouisset
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France; Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France
| | - Karl Isaaz
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Laura Cetran
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Khalifé Khalife
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | | | - Julien Adjedj
- Arnaud Tzanck Institute, 06700 Saint Laurent du Var, France
| | - Hakim Benamer
- Institut Jacques Cartier, Ramsay Générale de Santé, ICPS, 91300 Massy, France
| | - Guillaume Cayla
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France.
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Hernández-Enríquez M, Belle L, Madiot H, Pansieri M, Souteyrand G, de Poli F, Piot C, Boueri Z, Gerbaud E, Boiffard E, Benamer H, Lattuca B, Commeau P, Gervasoni R, Rangé G, Lhoest N, Marliere S, Abdellaoui M, Delarche N, Zemour G, Armengaud J, Carre M, Levesque S, Boudou N. Use and outcomes of the PK Papyrus covered stent in France: SOS PK Papyrus Registry. Catheter Cardiovasc Interv 2020; 98:874-881. [PMID: 33085150 DOI: 10.1002/ccd.29328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/08/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the rate of procedural success and long-term outcomes of the PK Papyrus (PKP) covered stent (CS). BACKGROUND CS are essential in the treatment of coronary artery perforation (CAP). They have also been used to treat coronary artery aneurysms. Limited evidence is available on clinical outcomes with the PKP. METHODS This was a multicenter, observational, retrospective, and prospective study. Consecutive patients undergoing intentional PKP implantation in 22 centers in France were included. The primary endpoint was the rate of procedural success. Secondary endpoints included rates of death, myocardial infarction (MI), target lesion revascularization (TLR), in-stent restenosis (ISR), and stent thrombosis (ST). RESULTS Data from 130 patients were analyzed (mean age 72.5 ± 10.5 years; 71% men). The main indication for PKP was CAP, in 84 patients (65%). Delivery success was achieved in 95% and procedural success in 91%. During the in-hospital stay, 15 patients died (12%) and 7 (5%) presented with ST. Data from 127 patients were available at 19.2 ± 12.8 month follow-up. Thirty-three patients died (26%), 15 (12%) had an MI and 21 (17%) presented with TLR. TLR was due to ISR in 12 patients (9%), 10 had definite ST (8%) and 1 patient for stent under-expansion. CONCLUSIONS The principal indication for PKP was CAP. PKP had high rates of delivery and procedural success. At long-term follow-up, there was a high rate of TLR, mainly due to ISR and ST. These results are consistent with previously reported data in these clinical settings.
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Affiliation(s)
- Marco Hernández-Enríquez
- Cardiology Department, Hospital Universitari General de Catalunya, Barcelona, Spain.,Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Loic Belle
- Cardiology Department, Hospital of Annecy, Annecy, France
| | - Hende Madiot
- Cardiology Department, Hospital of Annecy, Annecy, France
| | | | - Geraud Souteyrand
- Cardiology Department, University Hospital of Clermont Ferrand, Clermont-Ferrand, France
| | - Fabiel de Poli
- Cardiology Department, Hospital of Haguenau, Haguenau, France
| | - Christophe Piot
- Cardiology Department, Private Hospital of Millenaire, Montpellier, France
| | - Ziad Boueri
- Cardiology Department, Hospital of Bastia, Bastia, France
| | - Edouard Gerbaud
- Cardiology Department, University Hospital of Bordeaux, Burdeaux, France
| | - Emmanuel Boiffard
- Cardiology Department, Hospital of La Roche sur Yon, La Roche sur Yon, France
| | - Hakim Benamer
- Cardiology Department, ICPS Massy groupe Ramsay générale de santé, Aubervilliers, France
| | - Benoit Lattuca
- Cardiology Department, University Hospital of Nîmes, Nîmes, France
| | - Philippe Commeau
- Cardiology Department, Private Hospital of Clinique des Fleurs, Ollioule, France
| | - Richard Gervasoni
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Gregoire Rangé
- Cardiology Department, Hospital of Chartres, Chartres, France
| | - Nicolas Lhoest
- Cardiology Department, Private Hospital of L'Orangerie, Strasbourg, France
| | - Stéphanie Marliere
- Cardiology Department, University Hospital of Grenoble, Grenoble, France
| | - Mohamed Abdellaoui
- Cardiology Department, "Groupement Hospitalier Mutualiste" of Grenoble, Grenoble, France
| | | | - Gilles Zemour
- Cardiology Department, Hospital of Cannes, Cannes, France
| | | | - Max Carre
- Cardiology Department, Hospital of Auxerre, Auxerre, France
| | - Sebastien Levesque
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
| | - Nicolas Boudou
- Cardiology Department, Rangueil University Hospital, Toulouse, France
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4
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Aboukhoudir F, Quillot M, Rekik S, Pansieri M. [Dobutamine speckle tracking imaging for evaluation of microvascular dysfunction in a patient with exertion dyspnea]. Ann Cardiol Angeiol (Paris) 2020; 69:303-310. [PMID: 33039118 DOI: 10.1016/j.ancard.2020.09.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Microcirculatory dysfunction despite the absence of angiographically obvious significant coronary artery disease may potentially generate symptomatic myocardial ischemia; comprehensive assessment both noninvasive and invasive could prove to be of critical interest. We report the case of a 54-year old patient referred for an exertion dyspnea that proved to be caused by both micro and microvascular dysfunction. We present key elements for diagnosis, functional evaluation and management and demonstrate the potential role of speckle tracking imaging in that setting.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France; Avignon université EA4278 laboratoire de pharm écologie cardiovasculaire, Avignon, France.
| | - M Quillot
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier Nord-Franche comté, Belfort, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
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5
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Krackhardt MF, Waliszewski M, Pansieri M, Lozano F, Heang TM, Hudec M, Studencan M, Mauri J, Toušek P, Garcia B, Ahn T, Kocka V, Janek B, Sebagh L, Herberger D, Levy G, Tomulic V, Rischner J. TCT CONNECT-249 Real-World Dual Antiplatelet Therapy Following Polymer-free, Sirolimus-Eluting Stent Implantations to Treat Coronary Artery Disease. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.266] [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: 10/23/2022]
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Krackhardt F, Waliszewski M, Kočka V, Toušek P, Janek B, Hudec M, Lozano F, Roman KGS, Del Blanco BG, Mauri J, Heang TM, Ahn TH, Jeong MH, Herberger D, Tomulic V, Levy G, Sebagh L, Rischner J, Pansieri M. Real-World Dual Antiplatelet Therapy Following Polymer-Free Sirolimus-Eluting Stent Implantations to Treat Coronary Artery Disease. Cardiovasc Drugs Ther 2020; 34:335-344. [PMID: 32212061 PMCID: PMC8626401 DOI: 10.1007/s10557-020-06963-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives The objective of this post hoc analysis was to analyze real-world dual antiplatelet therapy (DAPT) regimens following polymer-free sirolimus-eluting stent (PF-SES) implantations in an unselected patient population. Methods Patient-level data from two all-comers observational studies (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled and analyzed in terms of their primary endpoint. During the data verification process, we observed substantial deviations from DAPT guideline recommendations. To illuminate this gap between clinical practice and guideline recommendations, we conducted a post hoc analysis of DAPT regimens and clinical event rates for which we defined the net adverse event rate (NACE) consisting of target lesion revascularization (TLR, primary endpoint of all-comers observational studies) all-cause death, myocardial infarction (MI), stent thrombosis (ST), and bleeding events. A logistic regression was utilized to determine predictors why ticagrelor was used in stable coronary artery disease (CAD) patients instead of the guideline-recommended clopidogrel. Results For stable CAD, the composite endpoint of clinical, bleeding, and stent thrombosis, i.e., NACE, between the clopidogrel and ticagrelor treatment groups was not different (5.4% vs. 5.1%, p = 0.745). Likewise, in the acute coronary syndrome (ACS) cohort, the NACE rates were not different between both DAPT strategies (9.2% vs. 9.3%, p = 0.927). There were also no differences in the accumulated rates for TLR, myocardial infarction ([MI], mortality, bleeding events, and stent thrombosis in elective and ACS patients. The main predictors for ticagrelor use in stable CAD patients were age < 65 years, smaller vessels, treatment of ostial and calcified lesions, and in-stent restenosis. Conclusion Within the framework of a post hoc analysis based on a real-world, large cohort study, there were no differences in the combined endpoint of major adverse cardiac events (MACE), bleeding and thrombotic events for clopidogrel and ticagrelor in stable CAD or ACS patients. Despite the recommendation for clopidogrel by the European Society of Cardiology (ESC), real-world ticagrelor use was observed in subgroups of stable CAD patients that ought to be explored in future trials.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany.
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | - Viktor Kočka
- University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- University Hospital Královské Vinohrady, Prague, Czech Republic
| | | | | | - Fernando Lozano
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Josepa Mauri
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Tae Hoon Ahn
- Gachon University Gil Medical Center, Incheon, South Korea
| | | | - Denny Herberger
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
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7
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Aboukhoudir F, Moussa K, Latu I, Gounane C, Cloarec N, Rekik S, Pansieri M. [Cardiac metastasis of a lung adenocarcinoma mimicking atrial myxoma]. Ann Cardiol Angeiol (Paris) 2020; 69:299-302. [PMID: 32829893 PMCID: PMC7440856 DOI: 10.1016/j.ancard.2020.07.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/21/2020] [Indexed: 12/03/2022]
Abstract
Les tumeurs cardiaques secondaires demeurent une pathologie sévère et assez rare et sont typiquement associées à un stade évolué de la tumeur primitive et, de fait, à un pronostic péjoratif. Les présentations cliniques sont variables et potentiellement déroutantes. Nous rapportons les cas d’une patiente de 76 ans chez laquelle la présentation échocardiographique évoquait, en premier lieu, un myxome de l’oreillette gauche, mais le diagnostic définitif était celui d’un envahissement par un adénocarcinome pulmonaire. Nous abordons le tableau clinique, le résumé de la littérature et la prise charge.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France; EA4278, laboratoire de Pharm, écologie cardiovasculaire, Avignon université, Avignon, France.
| | - K Moussa
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | - I Latu
- Service de pneumologie, centre hospitalier d'Avignon, Avignon, France
| | - C Gounane
- Service de pneumologie, centre hospitalier d'Avignon, Avignon, France
| | - N Cloarec
- Service d'onco-hématologie, centre hospitalier d'Avignon, Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier Nord Franche Comté, Belfort, France.
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
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8
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Krackhardt F, Kočka V, Waliszewski M, Toušek P, Janek B, Trenčan M, Krajči P, Lozano F, Roman KGS, Otaegui I, del Blanco BG, del Olmo VV, Nofrerías EF, Wachowiak L, Heang TM, Ahn TH, Jeong MH, Jung BC, Han KR, Piot C, Sebagh L, Rischner J, Pansieri M, Leschke M. Unrestricted use of polymer-free sirolimus eluting stents in routine clinical practice. Medicine (Baltimore) 2020; 99:e19119. [PMID: 32080086 PMCID: PMC7034709 DOI: 10.1097/md.0000000000019119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Stent designs with ultrathin struts may further increase the procedural success of challenging lesion subsets. The objective of this study was to assess the safety and efficacy of ultrathin strut, polymer-free sirolimus eluting stent (PF-SES) implantations in a large scale, unselected patient population.Adult patients underwent percutaneous coronary interventions (PCI) with a thin-strut PF-SES. Data from two all-comers observational studies having the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled. The accumulated target lesion revascularization (TLR) rate at 9-12 months was the primary endpoint. All dual antiplatelet therapy strategies according to the applicable guidelines were permissible.In total, 7243 patients were prospectively enrolled for PCI with PF-SES in stable coronary artery disease or acute coronary syndrome (ACS). Major risk factors in the overall cohort were diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall population. The TLR rate in the overall cohort was 2.2% whereas definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with in-stent restenosis lesions, the major adverse cardiac events rate was 6.4% whereas the corresponding rate for isolated left main coronary artery (LMCA) disease was highest with 6.7% followed by patients with culprit lesions in vein bypasses (VB, 7.1%). The mortality rate in patients treated in VB lesions was highest with 5.4%, followed by the isolated LMCA subgroup (3.4%) and ACS (2.6%).PCI with PF-SES in an unselected patient population, is associated with low clinical event and ST rates. Furthermore, PF-SES angioplasty in niche indications demonstrated favorable safety and efficacy outcomes with high procedural success rates.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Viktor Kočka
- University Hospital Královské Vinohrady Prague, Czech Republic
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | - Petr Toušek
- University Hospital Královské Vinohrady Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | | - Lucie Wachowiak
- Medical Scientific Affairs, B.Braun France, Saint Cloud, France
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Krackhardt F, Waliszewski M, Wan Ahmad WA, Kočka V, Toušek P, Janek B, Trenčan M, Krajči P, Lozano F, Garcia-San Roman K, Otaegui Irurueta I, Garcia del Blanco B, Wachowiak L, Vilalta del Olmo V, Fernandez Nofrerías E, Ho Jeong M, Jung BC, Han KR, Piot C, Sebagh L, Rischner J, Pansieri M, Leschke M, Ahn TH. Polymer-free sirolimus-eluting stent use in Europe and Asia: Ethnic differences in demographics and clinical outcomes. PLoS One 2020; 15:e0226606. [PMID: 31929543 PMCID: PMC6957170 DOI: 10.1371/journal.pone.0226606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of this study was to assess regional and ethnic differences in an unselected patient population treated with polymer-free sirolimus-eluting stents (PF-SES) in Asia and Europe. METHODS Two all-comers observational studies based on the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were combined for data analysis to assure sufficient statistical power. The primary endpoint was the accumulated target lesion revascularization (TLR) rate at 9-12 months. RESULTS Of the total population of 7243 patients, 44.0% (3186) were recruited in the Mediterranean region and 32.0% (2317) in central Europe. The most prominent Asian region was South Korea (17.6%, 1274) followed by Malaysia (5.7%, 413). Major cardiovascular risk factors varied significantly across regions. The overall rates for accumulated TLR and MACE were low with 2.2% (140/6374) and 4.4% (279/6374), respectively. In ACS patients, there were no differences in terms of MACE, TLR, MI and accumulated mortality between the investigated regions. Moreover, dual antiplatelet therapy (DAPT) regimens were substantially longer in Asian countries even in patients with stable coronary artery disease as compared to those in Europe. CONCLUSIONS PF-SES angioplasty is associated with low clinical event rates in all regions. Further reductions in clinical event rates seem to be associated with longer DAPT regimens.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
- * E-mail:
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | | | - Viktor Kočka
- University Hospital Královské Vinohrady Prague, Czech Republic
| | - Petr Toušek
- University Hospital Královské Vinohrady Prague, Czech Republic
| | | | | | | | - Fernando Lozano
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Lucie Wachowiak
- Medical Scientific Affairs, B.Braun France, Saint-Cloud, France
| | | | | | | | | | - Kyu-Rock Han
- Kangdong Sacred Heart Hospital, Kangdong, South Korea
| | | | | | | | | | | | - Tae Hoon Ahn
- Gachon University Gil Medical Center, Incheon, South Korea
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Beurtheret S, Karam N, Resseguier N, Houel R, Modine T, Folliguet T, Chamandi C, Com O, Gelisse R, Bille J, Joly P, Barra N, Tavildari A, Commeau P, Armero S, Pankert M, Pansieri M, Siame S, Koning R, Laskar M, Le Dolley Y, Maudiere A, Villette B, Khanoyan P, Seitz J, Blanchard D, Spaulding C, Lefevre T, Van Belle E, Gilard M, Eltchaninoff H, Iung B, Verhoye JP, Abi-Akar R, Achouh P, Cuisset T, Leprince P, Marijon E, Le Breton H, Lafont A. Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 74:2728-2739. [DOI: 10.1016/j.jacc.2019.09.054] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 11/15/2022]
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11
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Aboukhoudir F, Faugier JP, Rica O, Moussa K, Ben Ali Z, Najjar A, Barthez O, Rekik S, Pansieri M. [Cocaine-induced acute myocarditis]. Ann Cardiol Angeiol (Paris) 2019; 68:367-370. [PMID: 31558269 DOI: 10.1016/j.ancard.2019.07.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
Cocaine is a potent sympathomimetic drug usually associated with cardiotoxicity, including ventricular arrhythmia, systemic hypertension and acute myocardial infarction. It constitutes the most frequent cause of drug-related death reported by medical examiners in the US, and these events are most often related to the cardiovascular manifestations of the drug. However; to the best of our knowledge; cocaine induced acute myocarditis has very rarely been reported. We describe the case of a 19 year-old male regular user of marijuana and cocaine who was admitted for a suspicion on an acute lateral-wall myocardial infarction and in whom the final diagnosis of acute cocaine myocarditis has been made. We report diagnosis modalities and evolution.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France; Laboratoire de pharm-écologie-cardiovasculaire, Avignon université, 84000 Avignon, France.
| | - J P Faugier
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
| | - O Rica
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
| | - K Moussa
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
| | - Z Ben Ali
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
| | - A Najjar
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
| | - O Barthez
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier nord Franche Comté, 90400 Trevanans, France.
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
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12
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Albert F, Pansieri M, Range G. [Interventional cardiology in non-university hospitals has become a major player for 40 years]. Ann Cardiol Angeiol (Paris) 2019; 68:283-284. [PMID: 31540703 DOI: 10.1016/j.ancard.2019.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- F Albert
- Service de cardiologie, centre hospitalier de Chartres, 4, rue Claude-Bernard, 28630 Le Coudray, France; Groupe cardiologie interventionnelle, Collège national des cardiologues des hôpitaux, 75012 Paris, France.
| | - M Pansieri
- Service de cardiologie, centre hospitalier Henri-Duffaut, 305, rue Raoul-Follereau, 84000 Avignon, France; Groupe cardiologie interventionnelle, Collège national des cardiologues des hôpitaux, 75012 Paris, France.
| | - G Range
- Service de cardiologie, centre hospitalier de Chartres, 4, rue Claude-Bernard, 28630 Le Coudray, France; Groupe cardiologie interventionnelle, Collège national des cardiologues des hôpitaux, 75012 Paris, France.
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13
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Aboukhoudir F, Rekik S, Pansieri M, Obert P. [Adipose epicardial tissue association with subclinical systolic dysfunction detected by longitudinal strain in diabetic patients with poor glycemic control]. Ann Cardiol Angeiol (Paris) 2018; 67:310-314. [PMID: 30314666 DOI: 10.1016/j.ancard.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of this study is to assess the association between epicardial adipose tissue (EAT) and infraclinical myocardial dysfunction detected by strain imaging in diabetic patients (T2DM) with poor glycemic control. METHODS 22 patients with T2DM and 22 healthy control subjects of similar age and sex were prospectively recruited. Echocardiographic parameters were investigated. RESULTS In comparison to controls, diabetic patients had significantly higher body mass index (27.7 vs. 24.6; P<0.01), waist perimeter (103 vs. 84; P<0.001) and usCRP level (5.4 vs. 1.5; P<0.01). On echocardiography; no differences were found in terms of ejection fraction or ventricular mass; however, patients with T2DM had significantly thicker EAT (8.7±0.7 vs. 3.0±1.0; P<0.001) and altered systolic longitudinal strain (-18.8±3.2 vs. 22.3±1.6; P<0.001). On multivariate analysis, EAT was identified as an independent contributor (β=0,46, P=0.001) to systolic longitudinal strain. CONCLUSION In patients with T2DM and poor glycemic control; EAT was associated with infraclinical systolic dysfunction evaluated by global longitudinal strain despite normal at rest ejection fraction and no coronary artery disease.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon université, 84000 Avignon, France.
| | - S Rekik
- Service de cardiologie, centre hospitalier nord franche comté, route de mulhouse, 90000 Belfort, France.
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - P Obert
- EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon université, 84000 Avignon, France
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14
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Krackhardt F, Waliszewski M, Rischner J, Piot C, Pansieri M, Ruiz-Poveda FL, Boxberger M, Noutsias M, Ríos XF, Kherad B. Nine-month clinical outcomes in patients with diabetes treated with polymer-free sirolimus-eluting stents and 6‑month vs. 12‑month dual-antiplatelet therapy (DAPT). Herz 2018; 44:433-439. [PMID: 29356832 DOI: 10.1007/s00059-017-4675-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetes mellitus is known to be associated with worse clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCI) with drug-eluting stents (DES). Defining the optimal duration of dual antiplatelet therapy (DAPT) after DES implantation is still under debate. The objective of this subgroup analysis of the all-comers ISAR 2000 registry was to assess the safety and efficacy of a short DAPT (<6 month) versus a longer DAPT (>6 month) in patients with diabetes electively treated with the polymer-free sirolimus-coated ultrathin strut drug-eluting stent (PF-SES). METHODS Patients who received the PF-SES were investigated in a multicenter all-comers observational study. The primary endpoint was the 9‑month target lesion revascularization (TLR) rate, whereas secondary endpoints included the 9‑month major adverse cardiac event (MACE) and procedural success rates. RESULTS In all, 167 patients were treated with DAPT for ≤6 months (S-DAPT group) and 350 patients underwent DAPT treatment for 12 months (L-DAPT group). There was no significant difference in the overall MACE rate (4.6% vs. 3.1%, p = 0.441), the 9‑month accumulated stent thrombosis rates (0.8% vs. 0.3%, p = 0.51), or the accumulated rate of bleeding complications (5.3% vs. 3.4%, p = 0.341). CONCLUSION PF-SES are safe and effective in daily clinical routine with low rates of TLR and MACE in patients with diabetes and stable disease. Our data suggest that extending the duration of DAPT beyond 6 months does not improve MACE or TLR at 9 months in patients with stable CAD (ClinicalTrials.gov Identifier NCT02629575).
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Affiliation(s)
- F Krackhardt
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Waliszewski
- Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany
| | - J Rischner
- Hôpital Albert Schweitzer Colmar, Colmar, France
| | - C Piot
- Clinique du Millénaire Montpellier, Montpellier, France
| | - M Pansieri
- Centre Hospitalier d'Avigon, Avignon, France
| | - F L Ruiz-Poveda
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - M Boxberger
- Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany
| | - M Noutsias
- Midgerman Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle, Germany
| | - X F Ríos
- Complexo Hospitalario Universitario de A Coruña, Coruña, Spain
| | - B Kherad
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
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15
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Aboukhoudir F, Boulet V, Rekik S, Pansieri M. [Lead-related infective endocarditis with massive vegetation causing severe functionnal tricuspid stenosis]. Ann Cardiol Angeiol (Paris) 2017; 66:326-329. [PMID: 29050737 DOI: 10.1016/j.ancard.2017.09.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Lead-related infective endocarditis with negative hemocultures constitutes a severe condition potentially associated with a pejorative prognosis. It may induce a functional tricuspid stenosis caused by an important obstructive vegetation. We report the case of an 82 year-old woman in whom the lead-related endocarditis produced massive vegetation causing a severe functional tricuspid stenosis. We describe the medical history, diagnosis and treatment.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France; EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon université, Avignon, France
| | - V Boulet
- Cabinet de cardiologie, Isle-sur-la-Sorgue, France
| | - S Rekik
- Service de cardiologie, centre hospitalier Nord-Franche-Comté, 100, route de Moval, 90400 Trevenans, France.
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
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16
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Aboukhoudir F, Barnay P, Miramont V, Pansieri M, Meille L, Rekik S. Delayed Formation of a Massive Atrial Hematoma After Coronary Intervention Manifesting With an Isolated Cough: Multimodality Imaging and Outcome. Can J Cardiol 2017; 33:1736.e5-1736.e7. [PMID: 29066330 DOI: 10.1016/j.cjca.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/20/2017] [Accepted: 08/04/2017] [Indexed: 11/28/2022] Open
Abstract
Coronary artery perforation is a relatively rare but potentially life-threatening complication of percutaneous coronary intervention because it could result in cardiac tamponade; exceptionally, distal coronary perforation could cause an acute formation of a mural hematoma, which could also prove lethal without adequate management. We report an exceptional case of a 76-year-old man in whom an important left atrial hematoma formed progressively over weeks after a planned percutaneous coronary intervention and manifested with an isolated cough. Diagnosis was made using multimodality imaging. A conservative strategy was adopted and produced a favourable outcome.
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Affiliation(s)
- Falah Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France; Avignon université, EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon, France
| | - Pierre Barnay
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | | | - Michel Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | | | - Sofiene Rekik
- Service de cardiologie, Hopital nord franche comté, Trévenans, France.
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17
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Krackhardt MF, Waliszewski M, Pons M, Verdun F, Pansieri M, Rios XF, Lozano F, Boxberger M, Kherad B. TCT-731 Nine-month clinical outcomes in patients with diabetes treated with polymer free sirolimus-eluting stents and dual-anti platelet therapy (DAPT) for 6 months versus DAPT for 12 months. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.966] [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: 10/18/2022]
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18
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Georges JL, Belle L, Etard C, Azowa JB, Albert F, Pansieri M, Monsegu J, Barbou F, Trouillet C, Leddet P, Livarek B, Marcaggi X, Hanssen M, Cattan S. Radiation Doses to Patients in Interventional Coronary Procedures-Estimation of Updated National Reference Levels by Dose Audit. Radiat Prot Dosimetry 2017; 175:17-25. [PMID: 27624893 DOI: 10.1093/rpd/ncw261] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
The objective of this study was to estimate the French national updated reference levels (RLs) for coronary angiography (CA) and percutaneous coronary intervention (PCI) by a dose audit from a large data set of unselected procedures and in standard-sized patients. Kerma-area product (PKA), air kerma at interventional point (Ka,r), fluoroscopy time (FT), and the number of registered frames (NFs) and runs (NRs) were collected from 51 229 CAs and 42 222 PCIs performed over a 12-month period at 61 French hospitals. RLs estimated by the 75th percentile in CAs and PCIs performed in unselected patients were 36 and 78 Gy.cm² for PKA, 498 and 1285 mGy for Ka,r, 6 and 15 min for FT, and 566 and 960 for NF, respectively. These values were consistent with the RLs calculated in standard-sized patients. The large difference in dose between sexes leads us to propose specific RLs in males and females. The results suggest a trend for a time-course reduction in RLs for interventional coronary procedures.
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Affiliation(s)
- Jean-Louis Georges
- Service de Cardiologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France
- Collège National des Cardiologues des Hôpitaux, Paris, France
| | - Loic Belle
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier d'Annecy-Genevois, Annecy, France
| | - Cécile Etard
- Institut de Radioprotection et de Sureté Nucléaire, PRP-HOM/SER, BP17, 92262 Fontenay-aux-Roses, France
| | - Jean-Baptiste Azowa
- Service de Cardiologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France
| | - Franck Albert
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Hôpital Louis Pasteur, Chartres, France
| | - Michel Pansieri
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier d'Avignon, Avignon, France
| | - Jacques Monsegu
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Franck Barbou
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Hôpital d'instruction des Armées du Val de Grâce, Paris, France
| | - Charlotte Trouillet
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Groupe Hospitalier de la Rochelle-Ré-Aunis, La Rochelle, France
| | - Pierre Leddet
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier de Haguenau, Haguenau, France
| | - Bernard Livarek
- Service de Cardiologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France
- Collège National des Cardiologues des Hôpitaux, Paris, France
| | - Xavier Marcaggi
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier Jacques Lacarin, Vichy, France
| | - Michel Hanssen
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier de Haguenau, Haguenau, France
| | - Simon Cattan
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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Georges JL, Belle L, Meunier L, Dechery T, Khalifé K, Pecheux M, Elhaddad S, Amabile N, Pansieri M, Ballout J, Marchand X, Rouault G, Leddet P, Nugue O, Lucke N, Cattan S. Radial versus femoral access for coronary angiography and intervention is associated with lower patient radiation exposure in high-radial-volume centres: Insights from the RAY’ACT-1 study. Arch Cardiovasc Dis 2017; 110:179-187. [DOI: 10.1016/j.acvd.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/19/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
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20
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Amabile N, Trouillet C, Meneveau N, Tissot CM, Belle L, Combaret N, Range G, Pansieri M, Delaunay R, Levesque S, Lhermusier T, Derimay F, Motreff P, Caussin C, Souteyrand G. Mechanical abnormalities associated with first- and second-generation drug-eluting stent thrombosis analyzed by optical coherence tomography in the national PESTO French registry. Int J Cardiol 2016; 227:161-165. [PMID: 27863292 DOI: 10.1016/j.ijcard.2016.11.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 07/28/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES DES thrombosis may be triggered by different mechanisms that are difficult to identify by angiography alone. This work aimed to investigate and compare the characteristics of stent thrombosis (ST) between 1st- and 2nd-generation drug-eluting stents (DES) among a large cohort of patients explored by optical coherence tomography (OCT). METHODS AND RESULTS The PESTO study was a prospective national registry involving 29 French catheterization facilities. Patients with acute coronary syndromes were prospectively screened for presence of definite ST and analyzed by OCT after culprit lesion deocclusion. The analysis involved 71 subjects including 34 patients with 1st-generation DES (DES1G) and 35 patients with 2nd-generation DES (DES2G). Most patients (80%) presented with very late stent thrombosis. The median time between initial PCI and ST was longer in DES1G than DES2G patients (3.8 [2.6-6.5] years vs. 1.1 [0.04-2.3] years, p<0.0001). OCT identified an underlying morphological abnormality in 96% of the cases. Significant malapposition was the main abnormality observed either in DES1G (26%) or DES2G patients (35%). Ruptured neoatherosclerotic lesions were more frequently observed with DES1G than with DES2G (26% vs. 3%, p=0.008). There was no significant difference in percentage of malapposed struts and uncovered struts between groups. CONCLUSIONS In this registry, DES thrombosis mainly occurred ≥1year after initial PCI. OCT identified a mechanical abnormality in the vast majority of the cases. Similar causes were observed between DES1G and DES2G, but neoatherosclerotic lesions were more common in DES1G.
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Affiliation(s)
- Nicolas Amabile
- Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
| | | | | | - Claire Marie Tissot
- Cardiology Department, CHU Henri Mondor-Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Loic Belle
- Cardiology Department, CH Annecy, Annecy, France
| | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Grégoire Range
- Cardiology Department, CH Albert Schweitzer, Chartres, France
| | | | | | | | | | | | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
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21
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Aboukhoudir F, Rekik B, Rica O, Aboukhoudir I, Pansieri M, Rekik S. [Massive intraatrial mass?]. Ann Cardiol Angeiol (Paris) 2016; 65:359-362. [PMID: 27697300 DOI: 10.1016/j.ancard.2016.09.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/04/2016] [Indexed: 06/06/2023]
Abstract
Posterior mediastinal hematoma in a rare and potentially lethal disease and is frequently consecutive to a traumatism. We report the original case of a 88-year-old male admitted to our department for lipothymia and syncope related to a severe compression of the left atrium by an important mediastinal hematoma mimicking in transthoracic echocardiography an obstructive intraatrial mass.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharm-écologie cardiovasculaire, université, 84000 Avignon, France
| | - B Rekik
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - O Rica
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, hôpital de Belfort, centre hospitalier Nord-Franche-Comté, 14, rue de Mulhouse, 90000 Belfort, France.
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22
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Aboukhoudir F, Aboukhoudir I, Rica O, Khennine B, Pansieri M, Rekik S. [Atypical form of cor triatrium in a 59-year-old man]. Ann Cardiol Angeiol (Paris) 2016; 65:355-358. [PMID: 27692749 DOI: 10.1016/j.ancard.2016.09.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Cor triatrium is a rare congenital heart disease typically diagnosed amongst very young patients. Delayed diagnosis in the elderly is much more unusual. We report the case of a 59-year-old male with unremarkable medical history in whom we have discovered, on an echocardiography performed for an exploration of transient ischemic accident with atrial fibrillation, a particular form of an isolated cor triatrium dextrum investigated with multimodality imaging.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharmécologie cardiovasculaire, Avignon université, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - O Rica
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - B Khennine
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier Nord-Franche-Comté, 14, rue de Mulhouse, 90000 Belfort, France.
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23
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Andrieu S, Jouve B, Pansieri M. [Optimization of the management of acute heart failure. New concept of fast-track]. Ann Cardiol Angeiol (Paris) 2016; 65:330-333. [PMID: 27692752 DOI: 10.1016/j.ancard.2016.09.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
The acute heart failure generates a very important number of hospitalizations for a high cost. A recent reflection on optimizing its management is ongoing, based on the fastest management in the emergency department, with a distinction between which patient should remain and who returns at home, and under what conditions, allowing to limit the number of hospitalizations. It will require a reorganization of emergency department and updating of decision algorithms and new guidelines of care.
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Affiliation(s)
- S Andrieu
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France.
| | - B Jouve
- Service de cardiologie, centre hospitalier du pays d'Aix, 13616 Aix-en-Provence, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
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24
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Georges JL, Belle L, Azowa JB, Albert F, Pansieri M, Monsegu J, Cattan S. 0254: Updated reference levels for radiation doses to patients undergoing coronary angiography and coronary percutaneous interventions: the RAY’ACT2 study. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30012-x] [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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25
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Aboukhoudir F, Aboukhoudir I, Pansieri M, Rekik S. [Dobutamine-related coronary spasm among patients with false positive dobutamine stress echocardiography: Prevalence and predictors]. Ann Cardiol Angeiol (Paris) 2015; 64:313-317. [PMID: 26499214 DOI: 10.1016/j.ancard.2015.09.027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Dobutamine stress echocardiography (DSE) is being consistently used as an exercise-independent stress modality aimed at the detection of coronary artery disease (CAD) and the evaluation of myocardial ischemia. It may though occasionally induce coronary vasospasm. In this study, we aimed to evaluate the prevalence and predictors of dobutamine-related coronary spasm in patients without known CAD and false positive DSE (positive DSE but no significant coronary lesions on angiogram). METHODS Three thousand nine hundred and fifty-two patients referred to our echocardiography laboratory for DSE between January 2010 and May 2012 were prospectively investigated. Those with positive DSE underwent coronary angiograms with systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients with spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were enrolled and compared with those with positive DSE but no coronary lesions nor spontaneous or induced spasm ("true" false positive DSE). RESULTS Twenty-nine patients with DSE-related vasospasm (19.4% of positive DES without known CAD) were compared with 56 patients with no lesions and no spasm ("true" false positive DSE). They were more frequently smokers (72.4% vs 37.5%; P=0.003); they had more frequently dyslipidemia (79.3% vs 43%; P=0.001); they also had a larger ischemic area at peak DSE (3.4 segments vs 2.7 segments; P=0.05). On multivariate analysis, dyslipidemia (HR=10.7; 95% CI=[2.7-42.1]; P=0.001) and active smoking (HR=6.1; 95% CI=[1.7-21.1]; P=0.004) were found to be independent predictors of spasm-related DSE rather than "true" false positive DSE. CONCLUSION DSE-related coronary spasm is present in a significant proportion of patients with erroneously labelled "false" positive DSE and should systematically be ruled out. Dyslipidemia and active smoking were independent predictors of spasm rather than "true" false positive DSE.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharm écologie cardiovasculaire, Avignon université, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier Nord - Franche-Comté, 14, rue de Mulhouse, 90000 Belfort, France.
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26
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Aboukhoudir F, Aboukhoudir I, Pansieri M, Khennine B, Hirsch JL, Rekik S. [Partial anomalous pulmonary venous return in a 64-year-old woman]. Ann Cardiol Angeiol (Paris) 2015; 64:394-398. [PMID: 26482625 DOI: 10.1016/j.ancard.2015.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Partial anomalous pulmonary venous return (PAPVR) represents 3 % of the congenital cardiopathies. Diagnosis in adults is challenging as clinical symptomatology is non-specific and echocardiographic signs are discrete and misleading potentially confusing with idiopathic pulmonary hypertension. We report the case of a 64-year-old woman in whom we diagnosed PAPVR associated with sinus venosus atrial septal defect. We describe medical history, clinical signs, investigations and postoperative evolution.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon université, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - B Khennine
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - J L Hirsch
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier de Belfort, 14, rue de Mulhouse, 90000 Belfort, France.
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27
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Aboukhoudir F, Rekik S, Aboukhoudir I, Pansieri M. 0026: Uselessness of high-sensitivity cardiac troponins to improve diagnostic accuracy of dobutamine stress echocardiography in high-risk diabetic patients. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71539-9] [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: 11/16/2022]
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28
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Aboukhoudir F, Rekik S, Hirsch JL, Aboukhoudir I, Pansieri M. [Large aneurysm of the left sinus of Valsalva in a 54-year-old man successfully treated with surgery]. Ann Cardiol Angeiol (Paris) 2014; 63:376-80. [PMID: 24972985 DOI: 10.1016/j.ancard.2014.05.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/25/2014] [Indexed: 11/19/2022]
Abstract
Sinus of Valsalva aneurysms are very rare and are often asymptomatic. Clinical manifestations depend on associated complications, most commonly rupture or dissection. We describe the case of a 54-year-old male presenting with exercise-related angina and dyspnea and in whom we found a large unruptured aneurysm of the left sinus of Valsalva. On angiography, he also had a severe stenosis of the left artery descending and the diagonal. He underwent a successful surgical intervention with bypass and closure of the aneurysm.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, Avignon université, laboratoire de pharm écologie cardiovasculaire, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier d'Antibes, 06600 Antibes, France.
| | - J-L Hirsch
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
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29
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Aboukhoudir F, Rekik S, Latil Plat F, Aboukhoudir I, Kadem M, Benamo E, Pansieri M. [Uselessness of high-sensitivity cardiac troponins to improve diagnostic accuracy of dobutamine stress echocardiography in high-risk diabetic patients]. Ann Cardiol Angeiol (Paris) 2014; 63:307-11. [PMID: 24972986 DOI: 10.1016/j.ancard.2014.05.015] [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: 05/01/2014] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIM Dobutamine stress echocardiography (DSE) is a well-established noninvasive stress modality for the detection and evaluation of coronary artery disease in diabetic patients. High-sensitivity cardiac troponin T recently emerged as a highly sensitive dosage for the detection of ischemia. The aim of the study was to examine whether high-sensitivity cardiac troponin T may improve the diagnostic accuracy of silent ischemia by DSE in high-risk diabetic patients. METHODS AND RESULTS Twenty-one patients with long-standing (>10years) and/or complicated type II DM but no established CAD were included. In addition to DSE, venous blood samples for measurement of hs-cTnT were collected prior to DSE, 6hours and 24hours after the test. Troponins were deemed positive if>1.5 upper limit for normality. Patients with positive troponins underwent coronary angiography or CT scan regardless of the result of DSE. Among the 21 patients, 7 had positive troponins measured 6hours after stress, (mean peak troponin=44.5). DSE were negative in all of them. Mean age was 64years significantly higher than patients with negative troponins. No differences were noted between the groups in terms of epidemiological, clinical or echocardiographic characteristics. Patients with positive cardiac troponins were evaluated for the presence of coronary lesions but none of them had significant disease. After an 18-month mean follow-up, no adverse cardiac events were noted in either group. CONCLUSION In high-risk diabetic patients, the measurement of hs-cTnT during DSE does not improve the sensitivity at least in those with negative DSE tests.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France; Laboratoire de Pharm écologie cardiovasculaire, université d'Avignon, EA4278, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier d'Antibes, 107, route de Nice, 06600 Antibes, France.
| | - F Latil Plat
- Service endocrinologie, centre hospitalier d'Avignon, 305, rue Raoul Follereau, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
| | - M Kadem
- Service endocrinologie, centre hospitalier d'Avignon, 305, rue Raoul Follereau, 84000 Avignon, France
| | - E Benamo
- Service endocrinologie, centre hospitalier d'Avignon, 305, rue Raoul Follereau, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France
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Aboukhoudir F, Rekik S, Salloum N, Hirsch JL, Aboukhoudir I, Khennine B, Pansieri M. [Totally asymptomatic coronary left main artery critical stenosis: when non-invasive tests are falsely reassuring]. Ann Cardiol Angeiol (Paris) 2013; 62:342-346. [PMID: 24054445 DOI: 10.1016/j.ancard.2013.08.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/13/2013] [Indexed: 06/02/2023]
Abstract
Left main coronary artery severe stenosis is frequently very symptomatic and is considered as a classical contraindication for non-invasive ischemia testing. When performed, those tests usually yield a large area of ischemia associated with a rich symptomatology. We report the case of a 69-year-old completely asymptomatic man in whom both treadmill effort testing and dobutamine stress echocardiography were falsely reassuring as they eliminated significant ischemia despite the presence of a critical stenosis of distal left main artery ultimately confirmed by angiography. Dobutamine 2D strain performed afterwards was pathological and could have corrected the initially reassuring diagnosis.
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Affiliation(s)
- F Aboukhoudir
- Hôpital d'Avignon, centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84902 Avignon cedex 9, France
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31
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Laine M, Frère C, Toesca R, Berbis J, Barnay P, Pansieri M, Michelet P, Bessereau J, Camilleri E, Ronsin O, Helal O, Paganelli F, Dignat-George F, Bonello L. Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome. A pharmacodynamic randomised study. Thromb Haemost 2013; 111:273-8. [PMID: 24154787 DOI: 10.1160/th13-05-0384] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 05/13/2013] [Accepted: 09/23/2013] [Indexed: 01/10/2023]
Abstract
Optimal P2Y12 receptor blockade is critical to prevent ischaemic recurrence in patients undergoing percutaneous coronary intervention (PCI). We aimed to compare the level of platelet reactivity (PR) inhibition achieved by prasugrel and ticagrelor loading dose (LD) in diabetic acute coronary syndrome (ACS) patients undergoing PCI. We performed a single-center prospective open-label randomised trial. Patients with diabetes mellitus undergoing PCI for an ACS were randomised to receive prasugrel 60 mg or ticagrelor 180 mg. The primary endpoint of the study was the level of platelet reactivity (PR) assessed between 6 and 18 hours post-LD using the VASP index. We randomised 100 diabetic patients undergoing PCI for an ACS. No difference was observed in baseline characteristics between the two groups. In particular, the rate of patient receiving insulin therapy was identical (25 vs 28.6%; p =0.7). Ticagrelor achieved a significantly lower PR compared to prasugrel loading dose (17.3 ± 14.2 vs 27.7 ± 23.3%; p=0.009). In addition the rate of high on-treatment platelet reactivity, defined by a VASP ≥50%, tend to be lower in the ticagrelor group although the difference did not reach statistical significance (6 vs 16%; p=0.2). The rate of low on treatment PR was identical (60 vs 54%; p=0.8). The present study demonstrates that ticagrelor LD is superior to prasugrel LD to reduce PR in ACS patients with diabetes mellitus. Whether the higher potency of ticagrelor could translate into a clinical benefit should be investigated.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Laurent Bonello
- Laurent Bonello, MD, PhD, Department of cardiology, Hôpital universitaire nord, Chemin des bourrely, 13015 Marseille, France, Tel.: +33 491 968 858, Fax: +33 491 968 979, E-mail:
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Pansieri M, Barnay P, Larderet E, Krebs G, Aboukhoudir F, Andrieu S, Cheggour S, Faugier JP, Metge M, Hirsch JL. [Renal denervation for resistant hypertension without general anesthesia: advantage of a MEOPA morphine protocol. Preliminary experience]. Ann Cardiol Angeiol (Paris) 2013; 62:283-6. [PMID: 24060464 DOI: 10.1016/j.ancard.2013.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/27/2022]
Abstract
UNLABELLED Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA<5), in three cases intense (EVA>5) pain leading to increasing doses of morphin, (total dose of 0.25mg/kg in two cases, 0.17mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17mg/kg in group 1, 0.11mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. CONCLUSION regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.
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Affiliation(s)
- M Pansieri
- Service de cardiologie, centre hospitalier, 305, rue Raoul-Follereau, 84902 Avignon cedex 9, France.
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Laine M, Toesca R, Berbis J, Frere C, Barnay P, Pansieri M, Peyre JP, Michelet P, Bessereau J, Camilleri E, Helaf O, Camaleonte M, Paganelli F, Dignat-George F, Bonello L. Platelet reactivity evaluated with the VASP assay following ticagrelor loading dose in acute coronary syndrome patients undergoing percutaneous coronary intervention. Thromb Res 2013; 132:e15-8. [DOI: 10.1016/j.thromres.2013.04.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/27/2013] [Accepted: 04/29/2013] [Indexed: 11/29/2022]
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Aboukhoudir F, Pansieri M, Rekik S. Chronic calcific constrictive pericarditis complicating Churg-Strauss syndrome: first reported case. Thorac Cardiovasc Surg 2013; 62:631-3. [PMID: 23344748 DOI: 10.1055/s-0032-1331579] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Churg-Strauss syndrome is a necrotizing systemic vasculitis characterized by extravascular granulomas and eosinophilic infiltrates of small vessels. Although cardiac complications are considered to be relatively common, no case of constrictive calcified pericarditis has ever been previously described in this setting. In this report, we present the case of a 46-year-old man with Churg-Strauss syndrome, in whom we were able to document the development of symptomatic calcific constrictive pericarditis during a 10-year period despite long-term corticosteroid therapy.
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Affiliation(s)
| | - Michel Pansieri
- Department of Cardiology, Avignon Hospital Center, Avignon, France
| | - Sofiene Rekik
- Department of Cardiology, Avignon Hospital Center, Avignon, France
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Bonello L, Laine M, Mancini J, Pansieri M, Maillard L, Rossi P, Collet F, Jouve B, Wittenberg O, Lemesles G, Paganelli F, Dignt-George F, Camoin-Jau L, Michelet P. 039: Platelet reactivity predicts both ischemic and bleeding events at one year follow-up in acute coronary syndome patients receiving prasugrel. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)70969-8] [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: 10/25/2022]
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36
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Bonello L, Mancini J, Pansieri M, Maillard L, Rossi P, Collet F, Jouve B, Wittenberg O, Laine M, Michelet P, Bessereau J, Lemesle G, Dignat-George F, Paganelli F, Camoin-Jau L. Relationship between post-treatment platelet reactivity and ischemic and bleeding events at 1-year follow-up in patients receiving prasugrel. J Thromb Haemost 2012; 10:1999-2005. [PMID: 22863374 DOI: 10.1111/j.1538-7836.2012.04875.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-treatment platelet reactivity (PR) is associated with ischemic and bleeding events in patients receiving P2Y12 receptor antagonists. OBJECTIVES We aimed to study the relationship between post-treatment PR after a 60-mg loading dose (LD) of prasugrel and 1-year thrombotic and bleeding events. METHOD Patients were prospectively included in this multicenter study if they had a successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and received prasugrel. The platelet reactivity index (PRI) was measured using the Vasodilator-Stimulated Phosphoprotein index (VASP) after a prasugrel LD. Endpoints included the rate of thrombotic events and bleeding events at 1 year. RESULTS Among the 301 patients enrolled, 9 (3%) were lost to follow-up at 1 year. The rates of thrombotic and bleeding events at 1 year were of 7.5% and 6.8%, respectively. Receiver-operating curve (ROC) analysis demonstrated an optimal cut-off value of 53.5% of PRI to predict thrombotic events at 1 year. Using this cut-off value we observed that patients exhibiting high on-treatment platelet reactivity (HTPR) had a higher rate of thrombotic events (22.4% vs. 2.9%; P < 0.001). In parallel the optimal cut-off value of PRI to predict bleeding was 16%. Patients with a PRI ≤ 16% had a higher rate of bleeding events compared with those with a PRI > 16% (15.6% vs. 3.3%; P < 0.001). In multivariate analysis, the PRI predicted both thrombotic and bleeding events (OR: 1.44, 95% confidence interval [CI]: 1.2-1.72; P < 0.001 and OR: 0.75, 95% CI: 0.59-0.96; P = 0.024 [respectively, per 10% increase]). CONCLUSION Platelet reactivity measurement after a prasugrel LD predicts both ischemic and bleeding events at 1 year follow-up for ACS patients undergoing PCI.
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Affiliation(s)
- L Bonello
- Département de Cardiologie, Hôpital universitaire nord, Aix-Marseille Univ., France.
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Cattan S, Hanssen M, Dibie A, Fellinger F, Monsegu J, Dellinger A, Belle L, Georges JL, Marcaggi X, Khalife K, Charbonnel C, Steinbach M, Pesenti Rossi D, Pesenti Possi D, Ferrier N, Livarek B, Hirsch JL, Albert F, Pansieri M, Amara W, Taeib J, Georger F, Jourdain P, Ross M, Horeman H, Dujardin JJ, Monassier JP, Hanania G. [The white book of the National College of Hospital Cardiologists (NCHC) -- to respond to a public health issue]. Ann Cardiol Angeiol (Paris) 2012; 61:307-10. [PMID: 23062604 DOI: 10.1016/j.ancard.2012.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/05/2012] [Indexed: 11/26/2022]
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Bonello L, Pansieri M, Mancini J, Bonello R, Maillard L, Barnay P, Rossi P, Ait-Mokhtar O, Jouve B, Collet F, Peyre JP, Wittenberg O, de Labriolle A, Camilleri E, Cheneau E, Cabassome E, Dignat-George F, Camoin-Jau L, Paganelli F. High on-treatment platelet reactivity after prasugrel loading dose and cardiovascular events after percutaneous coronary intervention in acute coronary syndromes. J Am Coll Cardiol 2011; 58:467-73. [PMID: 21777742 DOI: 10.1016/j.jacc.2011.04.017] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [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: 12/20/2010] [Revised: 04/14/2011] [Accepted: 04/19/2011] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between platelet reactivity (PR) after a loading dose (LD) of prasugrel and thrombotic events. BACKGROUND Post-treatment PR has been shown to be strongly associated with the occurrence of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in the clopidogrel era. Prasugrel is a new P2Y(12)-adenosine diphosphate receptor with a higher potency on PR. METHODS A prospective multicenter study included patients who underwent successful PCI for acute coronary syndromes and received prasugrel therapy. Vasodilator-stimulated phosphoprotein (VASP) index was measured after the prasugrel LD. High on-treatment PR was defined as a VASP index ≥50%. MACE included cardiovascular death, myocardial infarction, and definite stent thrombosis at 1 month. RESULTS Three hundred one patients were enrolled. The mean VASP index after 60 mg of prasugrel was 34.3 ± 23.1%. High on-treatment PR was observed in 76 patients (25.2%). Patients experiencing thrombotic events after PCI had significantly higher VASP indexes compared with those free of events (64.4 ± 14.4% vs. 33.4 ± 22.7%; range: 51% to 64% and 5% to 47.6%, respectively; p = 0.001). Kaplan-Meier analysis comparing good responders and patients with high on-treatment PR demonstrated a significantly higher rate of MACE in patients with suboptimal PR inhibition (log-rank p < 0.001). Receiver-operating characteristic curve analysis found a cutoff value of 53.5% of the VASP index to predict thrombotic events at 1 month (r = 0.86, p < 0.001). Patients with minor or major Thrombolysis In Myocardial Infarction unrelated to coronary artery bypass grafting bleeding and those without had similar VASP indexes (30 ± 17.8% vs. 34.3 ± 23%, p = 0.70). CONCLUSIONS Despite the use of prasugrel, a significant number of patients undergoing PCI in the setting of acute coronary syndromes do not achieve optimal PR inhibition. Such patients have a higher risk for MACE after PCI.
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Affiliation(s)
- Laurent Bonello
- Département de Cardiologie, Hôpital Universitaire Nord, Faculté de Médecine, Chemin des Bourrely, Marseille, France.
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Aboukhoudir F, Rekik S, Andrieu S, Cheggour S, Pansieri M, Barnay P, Metge M, Faugier JP, Unal C, Schouvey S, Gonzalez S, Hirsch JL. 129 Dobutamine stress echocardiography and coronary artery spasm: a missed link. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70131-2] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rekik S, Aboukhoudir F, Andrieu S, Pansieri M, Hirsch JL. Impressive ST-segment elevation during dobutamine stress echocardiography in a patient with normal coronary arteries: dobutamine-induced vasospasm? J Electrocardiol 2009; 42:414-9. [DOI: 10.1016/j.jelectrocard.2009.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Indexed: 11/30/2022]
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Aboukhoudir F, Rekik S, Andrieu S, Cheggour S, Pansieri M, Metge M, Barnay P, Faugier JP, Schouvey S, Quaino G, Unal C, Gonzalez S, Hirsch JL. Coronary artery spasm and dobutamine stress echocardiography. Eur J Echocardiogr 2009; 10:556-61. [PMID: 19202147 DOI: 10.1093/ejechocard/jep004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The aim of this article was to assess whether abnormal dobutamine stress echocardiography (DSE) can be due to a dobutamine-induced coronary spasm in patients with angiographically documented vasospastic coronary arteries. METHODS AND RESULTS Between January 2004 and April 2008, we prospectively evaluated all patients with known or suspected coronary artery disease (CAD) referred to the echocardiography laboratory for dobutamine stress tests (6061 examinations). Those with abnormal DSE underwent coronary angiogram with a systematic methylergometrine intracoronary injection in the case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test, but no significant stenoses, were ultimately included in this study. About 581 patients had abnormal DSE, among them only 20 (3.4%) fulfilled the inclusion criteria. There were 15 males and 5 females, and mean age was 64.35 years (range 52-85); 8 patients had a known history of CAD and all of them had at least two established cardiovascular risk factors. The culprit vessel was the left anterior descending artery in 10 cases (50%), right coronary artery in 8 cases (40%), and left circumflex in 2 cases (10%). There was a systematic correspondence between the culprit arteries and dobutamine-induced wall motion abnormality territories. No complications occurred during examination or during the provocation test. All the patients were discharged with a calcium channel blocker and were doing well after 13 months of mean follow-up. CONCLUSION Coronary artery spasm can be induced at DSE, but is a rare finding; it could, though, be clinically relevant as it may partly explain some erroneously labelled 'false-positive' examinations. Methylergometrine provocation test is a safe and advisable approach in such situations.
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Jouve B, Collet F, Silvestri M, Moyal C, Pansieri M, Bille J, Bremondy M, Rossi P, Gérard R. [Coronary angioplasty in patients aged 70 and over. Immediate results and later outcome]. Arch Mal Coeur Vaiss 1990; 83:1501-6. [PMID: 2122826] [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: 12/30/2022]
Abstract
One hundred and ninety one consecutive patients over 70 years of age (127 men and 64 women, average age 75.6 years) underwent percutaneous transluminal coronary angioplasty (PTCA) between January 1986 and February 1989. One hundred and sixty patients had severe angina (20 Class III and 140 Class IV), 72 patients had previous myocardial infarction, 36 of which were recent (less than 1 month), and 6 patients had previously undergone coronary bypass surgery. The coronary lesions affected one vessel in 67 patients and more than one vessel in 124 patients. The left ventricular ejection fraction was less than 50% in 15 patients. Angioplasty was attempted on 245 lesions (228 stenoses and 17 occlusions): 1 lesion in 141 patients, 2 lesions in 46 patients, 3 lesions in 4 patients, with a primary success rate of 81% in stenotic and 41% in occluded arteries. There were 9 deaths (4.7%) 6 of which occurred in patients with multivessel disease and unstable angina; there were 6 Q-wave infarctions (3.1%), 8 non Q-wave infarctions (4.2%) and 3 emergency coronary bypass operations (1.6%). The first 123 patients of this series were followed up for an average of 18.8 months (7 to 37 months). Follow-up of the 100 patients successfully dilated (4 lost to follow-up) showed that 55 remained improved (53 asymptomatic), 25 had recurrent angina after the initial improvement due to restenosis in 19, progression of coronary athero-sclerosis in 3, restenosis and an evolution of coronary atherosclerosis in 1 and a lesion which had been neglected in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Jouve
- Hôpital cardiovasculaire Jules Cantini, Marseille
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Lauribe P, Benzenou J, Pietri P, Vaillant A, el Kouby A, Comet B, Pansieri M, Bremondy M, Nazet J, Malmejac C. [Successful cardiac transplantation after 38 days of circulatory assistance with a heterotopic artificial heart]. Arch Mal Coeur Vaiss 1990; 83:109-12. [PMID: 2106298] [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: 12/30/2022]
Abstract
The survival of a patient with irreversible cardiac failure on the cardiac transplantation waiting list was assured for 38 days by circulatory assistance with heterotopic Pierce Donachy prosthetic ventricles and followed by successful cardiac transplantation. This method of circulatory assistance is relatively simple to install from the technical point of view and provides a satisfactory haemodynamic result whilst waiting for a compatible donor organ. Several complications, some of them serious, were observed. Some were related to the patient's poor preoperative condition: acute renal failure, disorders of coagulation. These regressed slowly when the patient's haemodynamic status improved. On the other hand, septic problems and local haemorrhage were inherent to this technique. These are the commonest complications reported by other authors. Although the mortality rate during the period of circulatory assistance may appear to be high, this technique remains a valuable method of survival for selected patients and does not affect the chances of success of ulterior cardiac transplantation.
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Affiliation(s)
- P Lauribe
- Service de chirurgie cardio-thoracique, centre Jules-Cantini, Marseille
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Nelson JR, Darriet M, Pansieri M, Bucco P, Vergnes P. [Antenatal diagnosis of 2 cases of intra-abdominal solitary cyst]. Arch Fr Pediatr 1987; 44:373-5. [PMID: 3304184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
On the occasion of 2 cases, torsion of an ovarian cyst and volvulus of a cystic intestinal duplication, the authors emphasize the usual benignity of fetal intra-abdominal solitary cystic pictures, among which the most frequent are the ovarian cysts. Antenatal diagnosis allows for detection of complications, especially torsions and for early neonatal management always leading to surgical treatment.
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