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Domengé O, Fayol A, Ladouceur M, Wahbi K, Amar L, Carette C, Hagège A, Hulot JS. Trends in prevalence of major etiologies leading to heart failure in young patients: An integrative review. Trends Cardiovasc Med 2024; 34:80-88. [PMID: 36155830 DOI: 10.1016/j.tcm.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
The prevalence of Heart failure (HF) is increasing with the aging of the population but it is estimated that 10% of HF patients are younger than 50 years-old. HF development in this population is characterized with a fast-growing prevalence, and important disparities according to underlying etiologies or gender. These observations highlight the need to identify specific and preventable factors in these patients, a topic that is under-studied. Here we provide an overview of trends in prevalence of major etiologies leading to HF in young subjects, including genetic factors associated with cardiomyopathies, premature vascular dysfunction and related ischemia, metabolic stress, cardio-toxic responses to different agents, and myocarditis. We also highlight the increasing influence of major risk factors that are driving HF in younger patients, such as obesity, diabetes or arterial hypertension.
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Affiliation(s)
- Orianne Domengé
- Université de Paris, INSERM, PARCC, Paris F-75006, France; CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France
| | - Antoine Fayol
- Université de Paris, INSERM, PARCC, Paris F-75006, France; CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France
| | - Magalie Ladouceur
- Université de Paris, INSERM, PARCC, Paris F-75006, France; Adult Congenital Heart Disease Unit, Department of Cardiology, AP-HP, Hôpital Européen Georges Pompidou and Necker Hospital, Paris, France
| | - Karim Wahbi
- Cardiology Department, Centre de Référence de Pathologie Neuromusculaire, AP-HP, Hôpital Cochin, Paris, France
| | - Laurence Amar
- Université de Paris, INSERM, PARCC, Paris F-75006, France; Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris F-75015, France
| | - Claire Carette
- CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France; Service de nutrition, Centre Spécialisé Obésité, AP-HP, Hôpital Européen Georges-Pompidou, Paris F-75015, France
| | - Albert Hagège
- Department of Cardiology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris F-75015, France
| | - Jean-Sébastien Hulot
- Université de Paris, INSERM, PARCC, Paris F-75006, France; CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France.
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Lecoeur E, Domengé O, Fayol A, Jannot AS, Hulot JS. Epidemiology of heart failure in young adults: a French nationwide cohort study. Eur Heart J 2022; 44:383-392. [PMID: 36452998 PMCID: PMC9890267 DOI: 10.1093/eurheartj/ehac651] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 05/09/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS Heart failure (HF) in young adults is uncommon, and changes in its incidence and prognosis in recent years are poorly described. METHODS AND RESULTS The incidence and prognosis of HF in young adults (1850 years) were characterized using nationwide medico-administrative data from the French National Hospitalization Database (period 20132018). A total of 1,486 877 patients hospitalized for incident HF were identified, including 70 075 (4.7) patients aged 1850 years (estimated incidence of 0.44 for this age group). During the study period, the overall incidence of HF tended to decrease in the overall population but significantly increased by 0.041 in young adults (P 0.001). This increase was notably observed among young men (from 0.51 to 0.59, P 0.001), particularly those aged 3650 years. In these young men, ischaemic heart disease (IHD) was the most frequently reported cause of HF, whereas non-ischaemic HF was mainly observed in patients 35 years old. In contrast to non-ischaemic HF, the incidence of IHD increased over the study period, which suggests that IHD-related HF is progressively affecting younger patients. Concordantly, young HF patients presented with high rates of traditional IHD risk factors, including obesity, smoking, hypertension, dyslipidaemia, or diabetes. Lastly, the rates of re-hospitalization (for HF or for any cause) within two years after the first HF event and in-hospital mortality were high in all groups, indicating a poor-prognosis population. CONCLUSION Strategies for the prevention of HF risk factors should be strongly considered for patients under 50 years old.
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Affiliation(s)
- Emmanuel Lecoeur
- Department of Medical Informatics and Public Health, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Orianne Domengé
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France,CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Antoine Fayol
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France,CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Anne-Sophie Jannot
- Department of Medical Informatics and Public Health, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
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Fayol A, Wack M, Livrozet M, Carves JB, Domengé O, Vermersch E, Mirabel M, Karras A, Le Guen J, Blanchard A, Azizi M, Amar L, Bories MC, Mousseaux E, Carette C, Puymirat E, Hagège A, Jannot AS, Hulot JS. Aetiological classification and prognosis in patients with heart failure with preserved ejection fraction. ESC Heart Fail 2021; 9:519-530. [PMID: 34841727 PMCID: PMC8788026 DOI: 10.1002/ehf2.13717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/29/2021] [Accepted: 10/31/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various causes that may influence prognosis. METHODS AND RESULTS We extracted the electronic medical records for 2180 consecutive patients hospitalized between 2016 and 2019 for decompensated heart failure. Using a text mining algorithm looking for a left ventricular ejection fraction ≥50% and plasma brain natriuretic peptide level >100 pg/mL, we identified 928 HFpEF patients. We screened for a prevailing cause of HFpEF according to European guidelines and found that 418 (45.0%) patients had secondary HFpEF due to either myocardial (n = 125, 13.5%) or loading condition abnormalities (n = 293, 31.5%), while the remaining 510 (55.0%) patients had idiopathic HFpEF. We assessed the association between the causes of HFpEF and survival collected up to 31 December 2020 using Cox proportional hazards analysis. Even though patients with idiopathic HFpEF were older, frequently female, and had frequent co-morbidities and a higher crude mortality rate compared with secondary HFpEF patients, their prognosis was similar after adjustment for age and sex. Unsupervised clustering analysis revealed three main phenogroups with different distribution of idiopathic vs. secondary HFpEF. The phenogroup with the highest proportion of idiopathic HFpEF (69%) had (i) an excess rate of non-cardiac co-morbidities including chronic obstructive pulmonary disease (31%) or obesity (41%) and (ii) a better prognosis compared with the two other phenogroups enriched with secondary HFpEF. CONCLUSIONS Aetiological classification provides clinical and prognostic information and may be useful to better decipher the clinical heterogeneity of HFpEF.
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Affiliation(s)
- Antoine Fayol
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Maxime Wack
- Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, Paris, France.,Departement d'Informatique Hospitalière, DMU PRIME, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Marine Livrozet
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Jean-Baptiste Carves
- CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | | | - Eva Vermersch
- Université de Paris, INSERM, PARCC, Paris, F-75006, France
| | | | - Alexandre Karras
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Nephrology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Julien Le Guen
- Department of Geriatry, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Anne Blanchard
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Michel Azizi
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Hypertension Department and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Laurence Amar
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Hypertension Department and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Marie-Cécile Bories
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Cardiology and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, F-75015, France
| | - Elie Mousseaux
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Claire Carette
- CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France.,Department of Nutrition, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Etienne Puymirat
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Cardiology and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, F-75015, France
| | - Albert Hagège
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Cardiology and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, F-75015, France
| | - Anne-Sophie Jannot
- Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, Paris, France.,Departement d'Informatique Hospitalière, DMU PRIME, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Jean-Sébastien Hulot
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
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Domengé O, Ragot H, Deloux R, Crépet A, Revet G, Boitard SE, Simon A, Mougenot N, David L, Delair T, Montembault A, Agbulut O. Efficacy of epicardial implantation of acellular chitosan hydrogels in ischemic and nonischemic heart failure: impact of the acetylation degree of chitosan. Acta Biomater 2021; 119:125-139. [PMID: 33161185 DOI: 10.1016/j.actbio.2020.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022]
Abstract
This work explores the epicardial implantation of acellular chitosan hydrogels in two murine models of cardiomyopathy, focusing on their potential to restore the functional capacity of the heart. Different chitosan hydrogels were generated using polymers of four degrees of acetylation, ranging from 2.5% to 38%, because the degree of acetylation affects their degradation and biological activity. The hydrogels were adjusted to a 3% final polymer concentration. After complete macromolecular characterization of the chitosans and study of the mechanical properties of the resulting hydrogels, they were sutured onto the surface of the myocardium, first in rat after four-weeks of coronary ligation (n=58) then in mice with cardiomyopathy induced by a cardiac-specific invalidation of serum response factor (n=20). The implantation of the hydrogels was associated with a reversion of cardiac function loss with maximal effects for the acetylation degree of 24%. The extent of fibrosis, the cardiomyocyte length-to-width ratio, as well as the genes involved in fibrosis and stress were repressed after implantation. Our study demonstrated the beneficial effects of chitosan hydrogels, particularly with polymers of high degrees of acetylation, on cardiac remodeling in two cardiomyopathy models. Our findings indicate they have great potential as a reliable therapeutic approach to heart failure.
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