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Bennani G, Atlas I, Zahri S, Haboub M, Drighil A, Habbal R. [Association of a myxoma of the left atrium and a mitral stenosis : About a case]. Ann Cardiol Angeiol (Paris) 2024; 73:101719. [PMID: 38266406 DOI: 10.1016/j.ancard.2023.101719] [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: 07/31/2023] [Revised: 10/28/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Atrial myxoma is a rare and benign clinical entity. It remains common in women and mainly affects the left atrium. Its clinical picture is polymorphic. We report the case of a 53-year-old woman who consulted for dyspnea with cardiac failure's picture. The diagnosis of myxoma of the left atrium was made on echocardiography which also objectified the existence of mitral stenosis. The patient underwent surgical excision and mitral valve replacement with good postoperative outcomes.
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Affiliation(s)
- G Bennani
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc.
| | - I Atlas
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - S Zahri
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - M Haboub
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - A Drighil
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - R Habbal
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
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2
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Allera H, Cohu M, Maley K, Crabot D, Karila-Cohen P, Strauss C, Lidove O, Cotto E. [Thoracic calcifications]. Rev Med Interne 2024; 45:176-177. [PMID: 37833151 DOI: 10.1016/j.revmed.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 10/15/2023]
Affiliation(s)
- H Allera
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - M Cohu
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - K Maley
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - D Crabot
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - P Karila-Cohen
- Service de radiologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - C Strauss
- Service de radiologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - O Lidove
- Service de médecine interne, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - E Cotto
- Service de gériatrie aiguë, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
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3
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Ruku DM, Mandias RJ, Pitoy FF. Relationship between sitting time and health status in patients with heart failure. Ann Cardiol Angeiol (Paris) 2024; 73:101673. [PMID: 37995449 DOI: 10.1016/j.ancard.2023.101673] [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: 07/30/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To describe self-reported sitting time (ST), and determine the factors associated with health status (HS) among patients with heart failure (HF). METHODS A cross-sectional study design was used in this study. Outcome measures included an international physical activity questionnaire and a self-report health status questionnaire. The data assessments were examined using the Pearson correlation coefficient, t-test, one-way ANOVA, and Hierarchical multiple regression. RESULT 180 respondents joined this study. The mean age was mean 59.92 (SD= 11.90) years old, and 60% were male. The mean score of HS was mean 9.43 (SD= 2.16). The HS had a significant correlation with age (r= .17, p< .05), Hemoglobin (r= -.46, p< .01), HF medications (r= .31, p< .01), length of diagnostic HF (r= .35, p< .01), and comorbidity (r= .25, p< .01), and the HS was associated with the NYHA Classification (F= 203.43, p< .001), and the ST (F= 73.97, p< .001). Four variables were significant predictors of HS such as comorbidity (β = .14), NYHA Class I (β= -2.22), ST 6 to 8 hours/day (β= 1.27), and ST > 8 hours/day (β= 3.03), and they were predicted 75.1% of the variance in HS. CONCLUSION High amounts of ST and high NYHA classifications were associated with decreased HS in patients with HF, Moreover, HS is independently associated with comorbidities status and length of diagnostic HF.
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Polyzos D, Patavoukas G, Lykoudis A, Mamaloukaki M, Lampropoulos K. [Régurgitation mitrale sévère due à la sarcoïdose cardiaque : une présentation clinique inhabituelle ; une étude de cas et des recherches antérieures]. Ann Cardiol Angeiol (Paris) 2024; 73:101675. [PMID: 37988891 DOI: 10.1016/j.ancard.2023.101675] [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: 07/07/2023] [Revised: 08/20/2023] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
Sarcoidosis is a granulomatous inflammatory disease that may involve multiple organ systems, including the heart. Cardiac manifestations are not rare and include atrial and ventricular arrhythmias, conduction abnormalities, congestive heart failure, valvular dysfunction, pericarditis, and sudden death. Although, cardiac sarcoidosis (CS) remains a diagnostic and therapeutic challenge. This article describes a case of a patient with a history of pulmonary sarcoidosis who presented with congestive heart failure, on the basis of severe mitral regurgitation secondary to cardiac infiltration and summarizes the published evidence regarding CS and mitral regurgitation.
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Affiliation(s)
- Dimitrios Polyzos
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece.
| | - Georgios Patavoukas
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Anastasios Lykoudis
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Maria Mamaloukaki
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
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Argacha JF. [Effects of air pollution on cardiovascular events in cardiac intensive care units]. Ann Cardiol Angeiol (Paris) 2023; 72:101663. [PMID: 37688973 DOI: 10.1016/j.ancard.2023.101663] [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: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023]
Abstract
Many environmental factors influence the occurrence of cardiovascular events. Among these, air pollution is certainly the most harmful, due to its dual composition and effects. Air pollution is both particulate and gaseous, and can vary in concentration and composition according to its source and type of emission. Moreover, clinical effects are not only observed at long-term but also at short-term, following rapid deterioration in air quality. Air pollution must therefore be seen both as a risk factor for atherosclerotic disease, and as a trigger for cardiovascular events. These acute effects are essentially mediated by an increased risk of acute coronary syndromes and heart failure. The effects of air pollution on admissions for ventricular arrhythmias and arterial hypertension are also possible. The cardiotoxicity of pollution is mainly mediated by sympatho-vagal imbalance, by the initiation and amplification of an oxidative, inflammatory and pro-aggregatory cascade, and by endothelial dysfunction and activation of metalloproteinases. Although now well established, the consequences of air pollution on acute cardiovascular events require further investigation. Environmental cardiology is an emerging discipline whose current vision still fails to integrate qualitative aspects, such as the oxidative potential of particulate matter, and the joint effects of multiple environmental exposures.
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Affiliation(s)
- J F Argacha
- Département de cardiologie, Universitair Ziekenhuis Brussel, VUB, Belgium.
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Millogo GRC, Thiam Tall A, Seghda TAA, Kambiré Y, Nongkouni E, Dabiré YE, Kagambéga LJ, Kologo JK, Yaméogo VN, Marcaggi X, Zabsonré P. [Contribution of the 6-minutes walking test and the plasma NT-proBNP at admission and discharge to the prognostic evaluation of patients with NYHA class II-III Heart Failure.]. Ann Cardiol Angeiol (Paris) 2023; 72:101639. [PMID: 37717311 DOI: 10.1016/j.ancard.2023.101639] [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: 08/01/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To study the 6MWT and NT-proBNP contribution to the prognosis evaluation of patients with NYHA class II-III heart failure in the Yalgado Ouédraogo Teaching Hospital. METHODS We carried out a nine months prospective observational cohort from the 1st February to the 31st October 2020. Patients with NYHA class II-III HF who consented to participate were included in the study. We identified two variables of interest: death and readmission. RESULTS We included 50 patients with congestive heart failure representing 37.3% of heart failure. The average follow up time of patients was 154.58 ± 74.8 days. Twelve patients (24%) were readmited and 11 passed away with five during hospitalisation. On admission, The average distance on the 6MWT (194.6 ± 85.5 m) on admission and average NT-proBNP (5812.1±4729.4 ng/L) measured on admission and before discharge wasn't significantly correlated to the risk of death and re-hospitalisation. The average distance on the 6MWT before discharge (306.2±84.6) was significantly correlated to an increase risk of death and re-hospitalisation. Patients with an increase in NT-proBNP superior to 30% from measurement on admission to the one before discharge had a high risk of re-hospitalisation and death compare to those with a decrease of more than 30% with a moderate to good correlation coefficient of 0.6 between the two. CONCLUSION 6MWT and NT-proBNP variations from admission to discharge have been necessary to evaluate the prognosis of patients with CHF.
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Affiliation(s)
- G R C Millogo
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
| | - A Thiam Tall
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - T A A Seghda
- Service de cardiologie centre hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | - Y Kambiré
- Service de cardiologie centre hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
| | - E Nongkouni
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Y E Dabiré
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - L J Kagambéga
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - J K Kologo
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - V N Yaméogo
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | - P Zabsonré
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Abassade P. [Home return Assistance Program for Chronic heart failure in-hospitalized patients (PRADO-IC) : Description, evaluations, perspectives]. Ann Cardiol Angeiol (Paris) 2023; 72:101630. [PMID: 37541169 DOI: 10.1016/j.ancard.2023.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Return to home after discharge for congestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations, the prognosis remains poor. Since 2013, the Caisse Nationale d'Assurance Maladie (CNAM) with the Société Française de Cardiologie (SFC) has set up a support program PRADO-IC (support program for returning home after hospitalization for heart failure). THE AIM OF THIS STUDY was to describe the program, to present epidemiologic data, and the evaluations by the CNAM, and by clinical studies, then to expose strengths limits and perspectives. RESULTS After the inclusion a CPAM advisor organize the outcome, the care of the outpatient is based on his general practitioner (GP) and a private nurse trained in CHF care during a three-months program. Between 2017 and 2019, 20 264 patients per year were hospitalized in Ile de France, 8.8% were included in PRADO-IC. The retrospective CNAM evaluations were positive: follow up criteria were improved and mortality rate at 6 months was lower (10.3% vs. 14.1%). However, clinical retrospective study of Troyes hospital (n = 89), and Paris Saint Joseph Hospital (n = 633), did not confirm these results: rate mortality and/or re-hospitalization were not different between patients and control. Several prospective studies are underway; results will be soon available. Limits of PRADO-IC are discussed like the lack of inclusion criteria, lack of geriatric evaluation, or the pivotal role based on GP, and the short term of duration. Strengths are its existence, national reach, multi-disciplinary approach, educational contents. Clinical studies showed that the PRADO-IC program concerned to the most severe patients. Despite this, the one-year mortality and the HF readmission rate are the same than out-program patients. CONCLUSION PRADO-IC is the one and the only national transition of care program for IC patients. First evaluations are positive but prospective evaluation studies are needed in order to limit methodologic bias.
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Affiliation(s)
- Philippe Abassade
- Service de Cardiologie, Groupe hospitalier Paris Saint Joseph, 185 rue Raymond Losserand 75014 Paris, France.
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Charbonnel C, Jagu A, Vannier C, De Cordoue M, Aroulanda MJ, Lozinguez O, Komajda M, Garcon P, Antakly-Hanon Y, Moeuf Y, Lesage JB, Mantes L, Midey C, Izabel M, Boukefoussa W, Manne J, Standish B, Duc P, Iliou MC, Cador R. [Introduction of treatments for heart failure and reduced ejection fraction under 50 % : In-hospital optimization using an algorithmic approach]. Ann Cardiol Angeiol (Paris) 2023; 72:101640. [PMID: 37677914 DOI: 10.1016/j.ancard.2023.101640] [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: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Recent international guidelines recommend rapid initiation and titration of basic treatments of heart failure but do not explain how to achieve this goal. Despite these recommendations, implementation of treatment in daily practice is poor. This may be partly explained by the profile of the patients (frailty, comorbidities), safety considerations and tolerability issues related to kydney function, low blood pressure or heart rate and hyperkalaemia. In this special article, we intended to help the physician, through an algorithmic approach, to quickly and safely introduce guideline-directed medical therapy in the field of heart failure with ejection fraction under 50%.
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Affiliation(s)
- Clément Charbonnel
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Annabelle Jagu
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Claire Vannier
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Maylis De Cordoue
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Olivier Lozinguez
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Michel Komajda
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Garcon
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yara Antakly-Hanon
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yoann Moeuf
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Lucie Mantes
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Charlotte Midey
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Mathilde Izabel
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Wahiba Boukefoussa
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Julien Manne
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Brigitte Standish
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Duc
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Romain Cador
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
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Zakaria AMZ, Mahamat-Azaki O, Mahamat YK, Ali AA, Nelson NL, Aboubakar AM, Soha AA, Lucien A, Temoua ND, Ibrahim TA. [Management of heart failure at the CHU the National Reference of Ndjamena/Chad]. Ann Cardiol Angeiol (Paris) 2023; 72:101633. [PMID: 37647694 DOI: 10.1016/j.ancard.2023.101633] [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: 01/28/2023] [Revised: 05/25/2023] [Accepted: 07/15/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Heart failure (HF) is a syndrome of diverse etiologies, and a real public health problem in both developed and developing countries. The aim of this study was to determine the clinical, etiological, therapeutic and evolutionary aspects of heart failure. MATERIALS AND METHODS This was a descriptive and analytical study carried out in the cardiology department of the national referral university hospital in N'Djamena (Chad). RESULTS Heart failure accounted for 30.84% of cardiovascular pathologies hospitalized in the cardiology department during the study period. The mean age of our patients was 52 ± 34 years, with extremes ranging from 18 to 87 years. Females predominated, accounting for 50.7% of cases, with a M/F sex-ratio of 0.97. Hypertensive heart disease (33.7%), valvular heart disease (16.6%) and ischemic heart disease (15.1%) were the most frequent etiologies. The drugs most frequently used were loop diuretics (97%), ACE inhibitors (96%) and beta-blockers (93.5%). The in-hospital mortality rate was 9% in our series.
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Affiliation(s)
| | - Oumar Mahamat-Azaki
- Service de Cardiologie du CHU de la Référence Nationale. BP : 130 Ndjamena, Tchad.
| | - Yaya Kichiné Mahamat
- Service de Cardiologie du CHU de la Référence Nationale. BP : 130 Ndjamena, Tchad.
| | - Adam Ahamat Ali
- Service de Médecine du CHU de la Renaissance. BP : 2029 Ndjamena, Tchad.
| | | | | | - Alsser Adam Soha
- Service de Cardiologie du CHU de la Référence Nationale. BP : 130 Ndjamena, Tchad.
| | - Allawaye Lucien
- Service de Cardiologie du CHU de la Référence Nationale. BP : 130 Ndjamena, Tchad.
| | - Naibe Dangwe Temoua
- Service de Cardiologie du CHU de la Référence Nationale. BP : 130 Ndjamena, Tchad.
| | - Toure Ali Ibrahim
- Service de Médecine interne et de Cardiologie du CHU de Lamorde. BP : 11146 Niamey, Niger.
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Lapostolle F, Petrovic T. [Prehospital ultrasound and cardiological emergencies]. Ann Cardiol Angeiol (Paris) 2022; 71:345-349. [PMID: 36273951 DOI: 10.1016/j.ancard.2022.09.007] [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: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Tomislav Petrovic
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France
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Abstract
Home hemodialysis (HHD) is closely associated with the development of in-center hemodialysis (HD), being introduced gradually as the survival of dialysis patients increased with the progress of technology and scientific research. It peaked fifty years ago and then gradually declined. Nowadays there is a revival of HHD highlighting the clinical and quality of life benefits attributed to it. The practice is already solid in several countries internationally and in France the trend is growing up. However, in-center HD remains largely majority and several obstacles to the development of HHD are reported. In this article we address in particular the complex clinical context (heart failure, central venous catheter) of situations that may arise in daily practice that may call into question a HHD project. © 2022 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.
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Georges JL, Gaulupeau V, Chanut A, Merceron A, Delaroche-Vernet S, Harboun M, Chayeb S, Sadeg O, Aribi EH, Galindo G, Sekour K, Bornand A, Romain D. [Management of congestive heart failure in the elderly after hospitalization for acute decompensation Interest of a dedicated territorial geriatric network ; the GERICCO-78 study]. Ann Cardiol Angeiol (Paris) 2022; 71:259-266. [PMID: 36041961 DOI: 10.1016/j.ancard.2022.08.002] [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: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
AIMS Heart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients. METHODS From 01/10/2019 to 01/10/2021, 237 patients aged > 75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge. RESULTS The mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction > 40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients. CONCLUSION This study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations.
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Affiliation(s)
- Jean-Louis Georges
- Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, 177 rue de Versailles, 78157, Le Chesnay-Rocquencourt, France.
| | - Violaine Gaulupeau
- Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, 177 rue de Versailles, 78157, Le Chesnay-Rocquencourt, France
| | - Anais Chanut
- Infirmière Coordinatrice, Cellule de coordination ville-hôpital, et réseau REPY, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | - Annick Merceron
- Infirmière Coordinatrice, Cellule de coordination ville-hôpital, et réseau REPY, Centre Hospitalier de Plaisir, Plaisir, France
| | - Sophie Delaroche-Vernet
- Infirmière Coordinatrice, Cellule de coordination ville-hôpital, et réseau REPY, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | - Marc Harboun
- Service de gériatrie aiguë et soins de suite gériatrique, Hôpital Privé de la Porte Verte, Versailles, France
| | - Samir Chayeb
- Service de Cardiologie, Centre Hospitalier de Rambouillet, Rambouillet, France
| | - Ouali Sadeg
- Service de gériatrie aiguë , Centre Hospitalier de Plaisir, Plaisir, France
| | - El Heddi Aribi
- Service de soins de suite gériatriques, Centre Hospitalier de Plaisir, Plaisir, France
| | - Géraldine Galindo
- Service de gériatrie aiguë, Centre Hospitalier de Rambouillet, Rambouillet, France
| | - Kaci Sekour
- Service de médecine et soins de suite gériatriques, Centre Hospitalier de la Mauldre, Jouars Pontchartrain, France
| | - Anne Bornand
- Service de gériatrie aiguë, Pôle de gériatrie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Delphine Romain
- Service de soins de suite gériatriques, Pôle de gériatrie, Centre Hospitalier de Versailles, Hôpital Richaud, Versailles, France
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13
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Bourakba N, Dacunka M, Marchais A, Chapoutot L, Barbe C, Hurtaud A, Sanchez S. [Factors associated with patient participation in early return to the home Heart Failure program : a case-control study at the Centre Hospitalier de Troyes in 2017-2018]. Ann Cardiol Angeiol (Paris) 2022; 71:276-282. [PMID: 36115722 DOI: 10.1016/j.ancard.2022.08.001] [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: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES In 2013, the French National Health Insurance set up a programme to help patients with heart failure to return home and stay there (PRADO). During a hospitalization for cardiac decompensation, the medical team decides on the inclusion of the patient in the programme based on eligibility criteria defined. The objective of this study was to identify the factors most associated with the inclusion of heart failure patients in the PRADO program. MATERIALS AND METHODS This was a monocentric retrospective analytical stratified case-control study. It focused on the analysis of patient records hospitalized for cardiac decompensation between 01/01/2017 and 31/12/2018 in the cardiology department of the Centre Hospitalier de Troyes. For each patient included in the PRADO Heart Failure programme, one or two controls, not included in the PRADO Heart Failure programme were matched. The matching was exact without discounting. It was performed on the following criteria: age in 10-year increments, sex, main diagnosis of the stay, major category of diagnosis of the stay and its type (medical or surgical), the severity score of the Homogeneous Group of Patients of the stay and the Charlson score. RESULTS A total of 40 patients included in PRADO Heart Failure were matched to 56 controls not included in PRADO Heart Failure. Patients with respiratory disease (3.77 [1.07 - 13.29]), as well as patients on renin-angiotensin system inhibitors (2.24 [1.61 - 5.31]) were more often included in the PRADO Heart Failure programme. The most frequent criteria for non-eligibility were the need to transfer the patient to a specialised institution and significant impairment of higher functions. CONCLUSION Respiratory comorbidity and renin-angiotensin system blocker treatment are the factors most associated with the inclusion of heart failure patients in the PRADO Heart Failure programme.
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Affiliation(s)
| | - Marianne Dacunka
- Pôle vasculaire, Service de cardiologie, Centre hospitalier de Troyes, Troyes, France
| | - Aurélie Marchais
- Pôle vasculaire, Service de cardiologie, Centre hospitalier de Troyes, Troyes, France
| | - Laurent Chapoutot
- Pôle vasculaire, Service de cardiologie, Centre hospitalier de Troyes, Troyes, France
| | - Coralie Barbe
- Comité Universitaire de Ressources pour la Recherche en Santé - CURRS, Université de Reims Champagne Ardennes, Reims, France
| | | | - Stéphane Sanchez
- Comité Universitaire de Ressources pour la Recherche en Santé - CURRS, Université de Reims Champagne Ardennes, Reims, France; Pôle Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, Troyes, France.
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14
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Yayehd K, Tcherou T, Pio M, Pessinaba S, Kaziga WD, Agbetiafa KZM, Baragou S, Damorou F, Belle L. [Évaluation de la qualité de vie et description des facteurs associés, chez les patients en insuffisance cardiaque chronique vivant dans un pays d'Afrique de l'Ouest à faible revenu]. Ann Cardiol Angeiol (Paris) 2022; 71:194-198. [PMID: 35940970 DOI: 10.1016/j.ancard.2022.03.001] [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: 12/17/2021] [Revised: 02/16/2022] [Accepted: 03/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the quality of life (QOL) and describe associated factors in patients with chronic heart failure (HF) living in a low-income population in West Africa. METHODS This is was a cross-sectional study conducted from January 2017 to June 2018, in the department of cardiology of the University Teaching Hospital (CHU-Campus) in Lomé (Togo). Enrolled patients had stable chronic HF and have been hospitalized in the past 6 months; QOL was assessed using the Minnesota Living with Heart Failure questionnaire (MLHFQ). RESULTS 171 patients were included (women = 40.9%, 33% unschooled, 75% without health insurance; 46.8% in NYHA class II). The prevalence of depression was 62%. The mean total score of MLHFQ was 37.2 ± 22.3. In univariate analysis, there was a positive correlation between the total score and the following factors: age (r= 0.33, p ˂0.0001), NYHA classes (r= 0.67, p ˂0.0001), number of rehospitalizations (r= 0.61, p ˂0.0001), number of comorbidities (r= 0.43, p ˂0.0001), and the depression score (r= 0.67, p ˂0.0001). After adjustments, positive correlation persisted with NYHA classes (p ˂0.0001), number of rehospitalizations (p= 0.02), and depression (p ˂0.0001). CONCLUSION The QOL of HF patients was moderately impaired and was comparable to values reported among high-income populations. Factors associated with poor quality of life were advanced NYHA classes, number of rehospitalizations, and depression.
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Affiliation(s)
| | - Tchaa Tcherou
- Centre hospitalier universitaire de Kara, Kara, Togo
| | - Machihude Pio
- Centre hospitalier universitaire de Kara, Kara, Togo
| | | | | | | | | | | | - Loic Belle
- Centre Hospitalier Annecy-Genevois, 74000 Annecy, France
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15
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Oghina S, Delbarre MA, Poullot E, Belhadj K, Fanen P, Damy T. [Cardiac amyloidosis: State of art in 2022]. Rev Med Interne 2022; 43:537-544. [PMID: 35870985 DOI: 10.1016/j.revmed.2022.04.036] [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: 01/19/2022] [Revised: 04/17/2022] [Accepted: 04/30/2022] [Indexed: 10/17/2022]
Abstract
The 3 main types of cardiac amyloidosis are linked to two protein precursors: AL amyloidosis secondary to free light chain deposits in the context of monoclonal gammopathy (mainly of undetermined significance or myeloma) and transthyretin amyloidosis (ATTR), comprising wild-type transthyretin amyloidosis (ATTRwt for wild type) and hereditary transthyretin amyloidosis (ATTRv for variant). These diseases are underdiagnosed and highly prevalent in common cardiac phenotypes in recent studies (heart failure with preserved ejection fraction, severe aortic stenosis, hypertrophic cardiomyopathy). Myocardial amyloid infiltration affects all cardiac structures and clinically promotes predominantly heart failure, conductive disorders and cardioembolic events. The search for extracardiac signs makes it possible to arouse diagnostic suspicion. Electrocardiogram, echocardiography and cardiac MRI can suspect cardiac amyloidosis. The diagnostic confirmation follows a simple algorithm including a systematic search for monoclonal gammapathy and a disphosphonate scintigraphy. Histological proof is necessary in case of AL or ATTR amyloidosis with concomitant monoclonal gammopathy in order to initiate specific treatment. Due to the late disease onset in ATTRv, genetic testing must be routine in all cases of ATTR. These diseases are no longer perceived as incurable since recent therapeutic innovations. A better knowledge of the disease is more than ever necessary.
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Affiliation(s)
- S Oghina
- Service de cardiologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France.
| | - M A Delbarre
- Service de cardiologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - E Poullot
- Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Service d'anatomo-pathologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - K Belhadj
- Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Service d'hématologie lymphoïde, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - P Fanen
- Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Service de génétique, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), FHU SENEC, 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - T Damy
- Service de cardiologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), FHU SENEC, 1, rue Gustave-Eiffel, 94010 Créteil, France
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16
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Huttin O, Girerd N. The e'VM algorithm: A new evidence-based echocardiographic approach to predicting heart failure. Arch Cardiovasc Dis 2022; 115:63-66. [PMID: 35115265 DOI: 10.1016/j.acvd.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Olivier Huttin
- Cardiology Department, ILCV, CHU Nancy, 54511 Vandœuvre-lès-Nancy, France.
| | - Nicolas Girerd
- Centre d'Investigation Clinique Plurithematique de Nancy, 54035 Nancy, France
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17
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Hammami R, Bahloul A, Charfeddine S, Gargouri R, Ellouze T, Abid L, Triki F, Kammoun S, Mrad IB, Amor HIH. [Maladies cardiaques et Ramadan : revue de la littérature]. Ann Cardiol Angeiol (Paris) 2022; 71:166-172. [PMID: 35039144 DOI: 10.1016/j.ancard.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/08/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022]
Abstract
We review the literature on the safety of fasting in cardiac patients. We examined the changes of blood pressure among hypertensive patients and the incidence of cardiac events during Ramadan in patients with coronary disease and heart failure. We also assess the modifications of INR levels in cardiac patients who take oral anticoagulant. We found that Ramadan fasting is safe in stable cardiac patients, even under several drugs. Fasting does not affect blood pressure. There is no difference in regards to cardiac event incidence between Ramadan and the non-fasting-months. The level of INR is slightly higher when fasting, it is thus recommended to monitor patients with high bleeding risk during Ramadan.
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Affiliation(s)
- Rania Hammami
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Amine Bahloul
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Selma Charfeddine
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Rania Gargouri
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Tarek Ellouze
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Leila Abid
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Faten Triki
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Samir Kammoun
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
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18
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Maeder MT, Rickli H, Brenner R, Scheler E, Buser M. [Therapy of Heart Failure with Reduced Ejection Fraction: What's New in the 2021 Guidelines?]. Praxis (Bern 1994) 2022; 111:445-456. [PMID: 35673837 DOI: 10.1024/1661-8157/a003876] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Therapy of Heart Failure with Reduced Ejection Fraction: What's New in the 2021 Guidelines? Abstract. The spectrum of treatment options for patients with heart failure with reduced ejection fraction (HFrEF) has substantially expanded over the last years. The 2021 guidelines of the European Society of Cardiology propose a new treatment algorithm for patients with HFrEF and define the role of the currently available drugs, interventions and devices in this context. The new standard is a basic therapy consisting of four drugs with different mechanisms of action for all patients with HFrEF: an angiotensin-converting enzyme inhibitor, a betablocker, a mineralocorticoid antagonist, and a sodium glucose co-transporter-2 inhibitor. Additional drugs and/or interventions/devices are indicated depending on the response to the four-drug basic therapy (which has to be up-titrated to the maximally tolerated doses) and the clinical phenotype. In the present article, we discuss the available drugs and devices, their role in the proposed HFrEF treatment algorithm and clinically relevant practical aspects.
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Affiliation(s)
- Micha T Maeder
- Klinik für Kardiologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - Hans Rickli
- Klinik für Kardiologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - Roman Brenner
- Klinik für Kardiologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - Eva Scheler
- Klinik für Kardiologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - Marc Buser
- Klinik für Kardiologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
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19
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Mueller M, Siegenthaler J, Fäh D, Schuetz P. [Nutrition in Case of Heart Failure]. Praxis (Bern 1994) 2022; 111:375-380. [PMID: 35611481 DOI: 10.1024/1661-8157/a003860] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nutrition in Case of Heart Failure Abstract. Despite the complexity of the subject, nutritional medicine has made important advances in recent years, especially regarding cardiovascular health and for patients with heart failure. There is quite good evidence on specific diets, such as the Mediterranean and plant-based diets, but also on individual micronutrients, such as intravenous iron supplementation of iron deficiency in heart failure. No precise quantities can yet be named when dealing with the recommended amount of salt in heart failure patients, but the intake of high amounts of salt (>12 g/day) should be avoided. Considering the risk of malnutrition in this vulnerable patient population, an individualized nutritional therapy is advisable for some patients. This requires targeted screening for malnutrition. Nutritional medicine research still lacks many answers to further questions regarding heart failure patients. More randomized controlled trials and their meta-analyses are therefore required. Studies available so far have - among other shortcomings - paid too little attention to differences in nutrition in the different types and stages of heart failure. Interdisciplinary collaboration between cardiologists, hospital internists, general practitioners and nutritional therapists is in any case crucial for optimal treatment of patients with heart failure.
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Affiliation(s)
- Marlena Mueller
- Abteilung Endokrinologie, Diabetologie und Metabolismus, Medizinischen Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Abteilung für Allgemeine- und Notfallmedizin, Medizinische Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
| | - Jolanda Siegenthaler
- Abteilung Endokrinologie, Diabetologie und Metabolismus, Medizinischen Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Abteilung für Allgemeine- und Notfallmedizin, Medizinische Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
| | - David Fäh
- Abteilung für Epidemiologie chronischer Krankheiten, Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich, Zürich, Schweiz
- Fachbereich Gesundheit - Ernährung und Diätetik, Berner Fachhochschule, Bern, Schweiz
| | - Philipp Schuetz
- Abteilung Endokrinologie, Diabetologie und Metabolismus, Medizinischen Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Abteilung für Allgemeine- und Notfallmedizin, Medizinische Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Medizinische Fakultät, Universitätsspital Basel, Basel, Schweiz
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20
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Aghezzaf S, Coisne A. Définition de l’ insuffisance cardiaque systolique : le point de vue du cardiologue. Rev Med Interne 2021; 42:753-755. [PMID: 34580000 DOI: 10.1016/j.revmed.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Affiliation(s)
- S Aghezzaf
- CHU Lille, Department of Clinical Physiology and Echocardiography-Heart Valve Center, Lille, France; University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France
| | - A Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography-Heart Valve Center, Lille, France; University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France.
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21
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Gtif I, Bouzid F, Charfeddine S, Abid L, Kharrat N. Heart failure disease: An African perspective. Arch Cardiovasc Dis 2021; 114:680-690. [PMID: 34563468 DOI: 10.1016/j.acvd.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.
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Affiliation(s)
- Imen Gtif
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia.
| | - Fériel Bouzid
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
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22
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Ihsen Z, Khadija M, Marwa C, Imtinen BM, Fethia BM, Sofien K, Sondos K. [Study of the factors contributing to poor quality of life in chronic heart failure with reduced ejection fraction]. Ann Cardiol Angeiol (Paris) 2021; 70:231-236. [PMID: 34517976 DOI: 10.1016/j.ancard.2021.07.004] [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: 08/18/2020] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. Since little is known about the QoL in Tunisian patients with heart failure (HF), the current study was performed to assess QoL in a sample of Tunisian patients hospitalized with HF and to identify factors related to QoL. METHODS In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Echocardiography was performed and patients with left ventricular ejection fraction of 45% or less were selected. QoL assessment was performed with a disease-specific instrument: the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in a sample of 100 selected patients. Relationships between health-related QoL and the studied variables were examined with bivariate correlations and binary logistic regression analysis. RESULTS In the total sample (n = 100), mean age was 62.7 years. The majority were male (77%), married (76%), with a mean of 2.5 comorbidities, and in a New York Heart Association (NYHA) functional class III to IV (61%). Mean LVEF was 36%. Half of the patients had poor QoL on the total MLHFQ scale (median = 41.5) as well as on its physical (median = 17.5) and emotional (median = 11.25) domains. In univariate analysis, the following variables were related to poor QoL with p < 0.005: not being employed, suffering from hypertension, renal failure, anemia, being under a low-salt diet, having no regular physical activity, having the physical symptoms of HF, higher NYHA class and longer QRS duration. In multiple regression analysis, the main independent predictors of poor QoL on the total scale were higher NYHA functional class and renal dysfunction,. The data provided no evidence of an association between LVEF and QoL. CONCLUSION This study has found that higher NHYA functional class and chronic kidney disease are risk factors for impaired QoL, independently of disease severity among patients with heart failure.
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Affiliation(s)
- Zairi Ihsen
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040.
| | - Mzoughi Khadija
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Chouaieb Marwa
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Ben Mrad Imtinen
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Ben Moussa Fethia
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Kamoun Sofien
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040.
| | - Kraiem Sondos
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
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23
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Nganou-Gnindjio CN, Tankeu A, Assomo Ndemba P, Chatue Ngassi MN, Kingue S. [Niveau d'activité physique et déconditionnement des patients insuffisants cardiaques suivis dans deux hôpitaux de la ville de Yaoundé : étude observationnelle au Cameroun]. Ann Cardiol Angeiol (Paris) 2021; 70:199-202. [PMID: 34517971 DOI: 10.1016/j.ancard.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the basic physical condition of chronic heart failure's Cameroonian patients. PATIENTS AND METHODS We carried out a cross-sectional study from February to June 2020 at the Yaoundé Central and General Hospitals, including all consenting adults with stage I or II chronic heart failure of the New York Heart Association without sign of decompensation and received in outpatient consultation. Socio-demographic data and the level of physical activity assessed according to the International Questionnaire on PhysicalActivity were recorded. Quality of Life was evaluated using the "Minnesota Living with Heart Failure Questionnaire". Associated factors were analysed using the Chi-square test, the strength of association expressed by the odds ratio, and its 95% confidence interval. The significance level was 0.05. RESULTS We recruited 102 participants, including 60 women with a median age of 64 [56,68]. Daily physical activity was moderate in 54% of participants and low in 45%, with no significant difference between the sexes (p = 0.3). About 39.2% of patients had an altered physical condition, and the most effective associated factors were obesity (p = 0.01), low daily physical activity (p = 0.002) and non-compliance to the treatment (p = 0.03). The mean Quality of Life score was low (36.7 ± 22.4), and the deterioration in physical condition harmed it (p < 0.001). CONCLUSION More than a third of the study population had a poor physical condition, which negatively affected their Quality of Life. Therefore, we can suggest that prescribing appropriate physical activity should be an integral part of heart failure management in our context.
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Benson B, Theret P, Tonini F, Marang A, Sergent F, Gondry J, Foulon A. [Peripartum cardiomyopathy: A review of the literature]. ACTA ACUST UNITED AC 2021; 50:266-271. [PMID: 34481099 DOI: 10.1016/j.gofs.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left ventricular systolic dysfunction appearing towards the end of pregnancy or in the months following delivery with a non-specific clinic presentation. Through reviewing previous research, our critical literature review wishes to bring a concise and objective summarize for a better understanding of physiopathology, evocative symptoms and knowing of factors influencing prognosis in order to standardize peripartum management. The treatment remains mainly symptomatic but other promising treatments are still in development. In conclusion, early detection and treatment allow a better cardiac function recovery reducing cardiac transplantation.
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Affiliation(s)
- B Benson
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - P Theret
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Service de gynécologie-obstétrique, centre hospitalier de Saint-Quentin, 1, avenue Michel-de-l'Hospital, BP 608, 02321 Saint-Quentin, France
| | - F Tonini
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - A Marang
- Service de cardiologie, centre hospitalier régional universitaire Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - F Sergent
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - J Gondry
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France.
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Sabouret P, Attias D, Beauvais C, Berthelot E, Bouleti C, Gibault Genty G, Galat A, Hanon O, Hulot JS, Isnard R, Jourdain P, Lamblin N, Lebreton G, Lellouche N, Logeart D, Meune C, Pezel T, Damy T. Diagnosis and management of heart failure from hospital admission to discharge: A practical expert guidance. Ann Cardiol Angeiol (Paris) 2021; 71:41-52. [PMID: 34274113 DOI: 10.1016/j.ancard.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) has high event rates, mortality, and is challenging to manage in clinical practice. Clinical management is complicated by complex therapeutic strategies in a population with a high prevalence of comorbidity and general frailty. In the last four years, an abundance of research has become available to support multidisciplinary management of heart failure from within the hospital through to discharge and primary care as well as supporting diagnosis and comorbidity management. Within the hospital setting, recent evidence supports sacubitril-valsartan combination in frail, deteriorating or de novo patients with LVEF≤40%. Furthermore, new strategies such as SGLT2 inhibitors and vericiguat provide further benefit for patients with decompensating HF. Studies with tafamidis report major clinical benefits specifically for patients with ATTR cardiac amyloidosis, a remaining underdiagnosed and undertreated disease. New evidence for medical interventions supports his bundle pacing to reduce QRS width and improve haemodynamics as well as ICD defibrillation for non-ischemic cardiomyopathy. The Mitraclip reduces hospitalisations and mortality in patients with symptomatic, secondary mitral regurgitation and ablation reduces mortality and hospitalisations in patients with paroxysmal and persistent atrial fibrillation. In end-stage HF, the 2018 French Heart Allocation policy should improve access to heart transplants for stable, ambulatory patients and, mechanical circulatory support should be considered to avoid deteriorating on the waiting list. In the community, new evidence supports that improving discharge education, treatment and patient support improves outcomes. The authors believe that this review fills the gap between the guidelines and clinical practice and provides practical recommendations to improve HF management.
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Affiliation(s)
- P Sabouret
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - D Attias
- Cardiology department, Centre Cardiologique du Nord, Saint-Denis, France
| | - C Beauvais
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - E Berthelot
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - C Bouleti
- Cardiology department, Poitiers University Hospital, CIC INSERM 1402, Poitiers, France
| | - G Gibault Genty
- Cardiology department, André Mignot Hospital, Le Chesnay, France
| | - A Galat
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - O Hanon
- Geriatrics Department, Hospital Broca, Paris Descartes University, Paris, France
| | - J S Hulot
- Pharmacology Department, Georges-Pompidou European Hospital, INSERM, PARCC, CIC1418 Paris-Descartes University, Paris, France
| | - R Isnard
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - P Jourdain
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - N Lamblin
- Cardiology Department, University Hospital, Lille, France
| | - G Lebreton
- Heart Institute, Cardiac Surgery department, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - N Lellouche
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - D Logeart
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - C Meune
- Department of Cardiology, Avicenne Hospital, Paris 13 University, Bobigny, France
| | - T Pezel
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - T Damy
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France.
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Nganou-Gnindjio CN, Awah Epoupa RA, Wafeu Sadeu G, Tchapmi Njeunje DP, Endomba Angong FT, Menanga AP. Seasonal variation of decompensated heart failure admissions and mortality rates in sub-Saharan Africa, Cameroon. Ann Cardiol Angeiol (Paris) 2021; 70:148-152. [PMID: 33962785 DOI: 10.1016/j.ancard.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Epidemiological data of heart failure (HF) decompensation from the northern hemisphere suggests higher rates during winter. OBJECTIVES We aimed to explore the seasonal variation in decompensated HF admission and mortality rates in a country with equatorial climate. METHODS We conducted a retrospective cross-sectional study by chart review of the admission, discharge registries and patient files from 2016 to 2018 in the cardiology unit of the Yaoundé Central Hospital, Cameroon. Data was collected on HF morbidity and mortality from the registers and patients' files. Corresponding seasonal climatic data was obtained from the meteorology office of the Cameroonian ministry of transports. Analysis of variance and Chi-square test were respectively used to compare the continuous and categorical data between across seasons. Correlation between continuous data was assess with the Spearman correlation. RESULTS Decompensated HF accounted for 636 (36.2%) out 1755 cardiology unit admission and an 18% lethality rate. Decompensated HF admission, mortality and lethality rates were respectively 38.2%, 6.7% and 17.9% higher during the long rainy season (all P values>0.05). We observed a borderline-to-significant inverse linear continuous correlation between monthly temperatures and admission rate (r=-0.301; P=0.070), lethality rate (r=-0.361; P=0.030) and mortality rate (r=-0.385; P=0.020). There was no significant difference of the distribution of precipitating factors between seasons. CONCLUSION Although statistically insignificant, decompensated HF admissions and mortality increase in rainy season where the temperature is lower in an equatorial climate.
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Affiliation(s)
- C N Nganou-Gnindjio
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; Cardiology department, Yaoundé Central Hospital, Yaoundé, Cameroon.
| | - R A Awah Epoupa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Wafeu Sadeu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - D P Tchapmi Njeunje
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - F T Endomba Angong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - A P Menanga
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; Internal medicine department, Yaoundé General Hospital, Yaoundé, Cameroon
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Roncalli J, Roubille F, Lamblin N, Girerd N, Mouquet F, Chapet N, Roubille C, Berthelot E, Galois K, Battistella P, Jondeau G, Tartiere JM, Aguilhon S, Gueffet JP, Salvat M, Damy T, Galinier M; Heart Failure Group of the French Society of Cardiology. Coronavirus disease vaccination in heart failure: No time to waste. Arch Cardiovasc Dis 2021; 114:434-8. [PMID: 34099378 DOI: 10.1016/j.acvd.2021.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
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Rossignol P. [Recurrent hyperkalaemia management and use of renin-angiotensin-aldosterone system inhibitors: Analysis of French data from the PROKALE multinational European study]. Nephrol Ther 2021; 17:422-427. [PMID: 33994135 DOI: 10.1016/j.nephro.2021.01.004] [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: 10/23/2020] [Revised: 11/30/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Recurrent hyperkalaemia may result in underutilisation of renin-angiotensin-aldosterone system inhibitors. We report an analysis of French data from the PROKALE retrospective study, which assessed the management of recurrent hyperkalaemia in five European countries. PATIENTS AND METHODS A retrospective chart review including patients not on dialysis with two or more hyperkalaemia episodes≥5.5 mEq/L documented within a 12-month observation period was performed. RESULTS In France, 115 physicians (57 nephrologists et 58 cardiologists) participated in the study and 295 patients were studied in this analysis. Mean age was 68 years; 212 patients (71.9%) had chronic kidney disease, 108 (36.6%) had chronic heart failure and 102 (34.6%) had diabetes mellitus. The mean number of documented hyperkalaemic episodes was 2.3. A total of 90 hospitalizations occurred during the observation period, of which 24 (26.7%) were directly related to a hyperkalaemic episode. At the time of the first documented hyperkalaemic episode, measures used for the management of hyperkalaemia included loop diuretics (144 patients [48.8%]), sodium/calcium polystyrene sulphonate (135 patients [45.8%]), a low-potassium diet (31 patients [10.5%]) and sodium bicarbonate (31 patients [10.5%]). Between the two consecutive hyperkalaemic episodes documented, the proportion of patients on renin-angiotensin-aldosterone system inhibitors treatment decreased from 42.4% to 34.6%. CONCLUSION Renin-angiotensin-aldosterone system inhibitors treatment interruptions were observed in the setting of recurrent hyperkalaemic episodes. Recurrent hyperkalaemia is a major cause of hospitalizations. More effective strategies for the prevention of recurrent hyperkalaemia are needed.
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Affiliation(s)
- Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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Cohen A, Selton-Suty C, Danchin N. A tribute to Yves Juillière, MD, PhD (1957 to 2021). Arch Cardiovasc Dis 2021. [PMID: 33972175 DOI: 10.1016/j.acvd.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ariel Cohen
- Saint-Antoine and Tenon Hospitals, AP-HP, INSERM UMRS-ICAN 1166 Sorbonne Université and French society of cardiology 2020-2022 President, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
| | - Christine Selton-Suty
- Department of cardiology, Centre hospitalier régional universitaire de Nancy, 54511 Vandœuvre-Lès-Nancy, France
| | - Nicolas Danchin
- Department of cardiology, Hôpital européen Georges-Pompidou, Paris, France
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Rusnak J, Behnes M, Reiser L, Schupp T, Bollow A, Reichelt T, Borggrefe M, Ellguth D, Engelke N, El-Battrawy I, Ansari U, Barre M, Weidner K, Müller J, Barth C, Meininghaus DG, Akin M, Bertsch T, Taton G, Akin I. Atrial fibrillation increases the risk of recurrent ventricular tachyarrhythmias in implantable cardioverter defibrillator recipients. Arch Cardiovasc Dis 2021; 114:443-454. [PMID: 33967015 DOI: 10.1016/j.acvd.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/26/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients according to atrial fibrillation is limited. OBJECTIVE To assess the prognostic impact of atrial fibrillation on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator recipients. METHODS A large retrospective registry was used, including all ICD recipients with episodes of ventricular tachycardia or fibrillation from 2002 to 2016. Patients with atrial fibrillation were compared to those without atrial fibrillation. The primary endpoint was first recurrence of ventricular tachyarrhythmias at 5 years. Secondary endpoints comprised recurrences of ICD-related therapies, first cardiac rehospitalization and all-cause mortality at 5 years. Cox regression, Kaplan-Meier and propensity score-matching analyses were applied. RESULTS A total of 592 consecutive ICD recipients were included (33% with atrial fibrillation). Atrial fibrillation was associated with reduced freedom from recurrent ventricular tachyarrhythmias (42% vs. 50%, log-rank P=0.004; hazard ratio 1.445, 95% confidence interval 1.124-1.858), mainly attributable to recurrent ventricular fibrillation in secondary-preventive ICD recipients. Accordingly, atrial fibrillation was associated with reduced freedom from first appropriate ICD therapies (31% vs. 42%, log-rank P=0.001; hazard ratio 1.598, 95% confidence interval 1.206-2.118). Notably, the primary endpoint of freedom from first episode of recurrent ventricular tachyarrhythmias was still reduced in those with atrial fibrillation compared to those without atrial fibrillation after propensity score matching. Regarding secondary endpoints, patients with atrial fibrillation still showed a trend towards reduced freedom from appropriate ICD therapies. CONCLUSIONS Atrial fibrillation was associated with increased rates of recurrent ventricular tachyarrhythmias and appropriate device therapies in ICD recipients with ventricular tachyarrhythmias.
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Affiliation(s)
- Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Max Barre
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Julian Müller
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christian Barth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | | | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Abstract
Since 2015, 10 randomized clinical trials assessed the cardiovascular safety of SGLT2 inhibitors, and then assessed the potential renal and cardiovascular benefits of these drugs (EMPAREG Outcome, CANVAS, DECLARE, DAPA-HF, CREDENCE, EMPEROR-reduced, VERTIS, DAPA-CKD, SCORED, SOLOIST-WHF) in over 88,000 patients. The results of EMPAREG Outcome showed major renal and cardiovascular protection but they were unexpected. The other trials regarding the effects of dapagliflozin, canagliflozin, empagliflozin and more recently sotagliflozin have confirmed most of these results and extended them to other populations. There is no scientific doubt that these drugs confer a marked renal protection in patients already treated with renin angiotensin system blockers (reduction of the risk of end-stage renal disease: -35 to 40%) et reduce the risk of hospitalization for heart failure (-30 to 35%), especially in patients with heart failure with reduced ejection fraction. The benefit/risk profile is highly favorable but minor (genital candidosis, urinary tract infections, euglycemic acido-ketosis) and serious (Fournier gangrene) side effects must not be forgotten. Renal protection is twice the effect of renin angiotensin system blockers, and is maintained in patients already treated with them, in patients with GFR 25mL/min/1.73m2 and over, regardless of whether they have type 2 diabetes mellitus or not (of note, patients with type 1 diabetes mellitus, polycystic kidney disease, lupus and vasculitis were excluded in these studies). Reduction of the incidence of heart failure is similar to that observed with sacubitril/valsartan, and is maintained in patients already treated with sacubitril/valsartan. SGLT2 inhibitors have now defined a new standard of care, and it will be necessary to explore the proper use of the new mineralocorticoid receptor antagonist finerenone that demonstrated significant renal and cardiovascular protection in mostly SGLT2 inhibitors-untreated diabetic patients with chronic kidney disease (or even some GLP-1 agonists). A new era for our patients.
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Affiliation(s)
- Jean-Michel Halimi
- Service de néphrologie-HTA, dialyses et transplantation rénale, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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Theron A, Lavagna F, Gaubert G, Resseguier N, Porto A, Ferrara J, Jaussaud N, Morera P, Cuisset T, Deharo P, Collart F. Prosthesis-patient mismatch is an independent predictor of congestive heart failure after transcatheter aortic valve replacement. Arch Cardiovasc Dis 2021; 114:504-514. [PMID: 33509746 DOI: 10.1016/j.acvd.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/28/2020] [Revised: 07/15/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the effect of prosthesis-patient mismatch (PPM) on outcomes after transcatheter aortic valve replacement. We reported previously an increased risk of PPM with the SAPIEN 3 transcatheter heart valve (S3-THV). AIMS To investigate the association of PPM with 1-year outcomes in patients with severe aortic stenosis (AS) implanted with S3-THV. METHODS Moderate PPM was defined by an indexed effective orifice area (iEOA)≤0.85cm2/m2, and severe PPM by an iEOA<0.65cm2/m2. Inclusion criteria were severe symptomatic AS and implantation with S3-THV. The primary endpoint was hospitalization for congestive heart failure (CHF) at 1 year; the secondary endpoint was all-cause mortality. RESULTS A total of 208 consecutive patients were included between 2016 and 2018. Male sex was prevalent (53.8%), mean age was 81.9±6.2 years, mean EuroSCORE II was 4.35±3.37, mean LVEF was 57.9±13%. Moderate and severe PPM were observed in 69 (33.2%) and 10 (4.8%) patients. Patients with PPM were younger (80.4±7 vs 82.8±5.41 years; P=0.006), had a larger BSA (1.84±0.19 vs 1.77±0.19 m2; P=0.01), a lower iEOA (0.73±0.08 vs 1.11±0.22 cm2/m2; P<0.001) and a higher mean gradient (14±4.6 vs 11.9±3.9mmHg; P<0.001). CHF occurred in 16.5% vs 7% (P=0.03). By multivariable analysis, PPM was independently associated with CHF (hazard ratio [HR] 3.17, 95% confidence interval [CI] 1.17 to 8.55; P=0.032), especially in patients with mitral regurgitation≥2/4 (HR>100, 95%CI>100 to>1000; P<0.01). PPM did not correlate with all-cause mortality (HR 0.90, 95%CI 0.22 to 3.03; P=0.86). CONCLUSIONS PPM after S3-THV implantation is strongly associated with CHF at 1 year, but is not correlated with overall mortality.
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Affiliation(s)
- Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Flora Lavagna
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | | | | | - Alizée Porto
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Jerome Ferrara
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Pierre Morera
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Thomas Cuisset
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Pierre Deharo
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France; C2VN, Inserm, Inra, Aix-Marseille University, 13005 Marseille, France; Faculty of Medicine, Aix-Marseille University, 13385 Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
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Hanon O, Belmin J, Benetos A, Chassagne P, De Decker L, Jeandel C, Krolak-Salmon P, Nourhashemi F, Paccalin M. Consensus of experts from the French Society of Geriatrics and Gerontology on the management of heart failure in very old subjects. Arch Cardiovasc Dis 2021; 114:246-259. [PMID: 33455889 DOI: 10.1016/j.acvd.2020.12.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Abstract
The prevalence of heart failure increases with age. In France, the 1-year mortality rate is 35% in subjects aged 80-89 years with heart failure, and 50% after the age of 90 years. In octogenarians, heart failure is associated with high rates of cardiovascular and non-cardiovascular events, and is one of the main causes of hospitalization and disability. The prevalence of frailty increases in elderly subjects with heart failure, and the co-occurrence of heart failure and frailty increases the risk of mortality in patients with heart failure. In the elderly, the presence of frailty must be evaluated using a comprehensive geriatric assessment to manage geriatric syndromes, such as cognitive disorders, malnutrition, falls, depression, polypharmacy, disability and social isolation. The objective of heart failure therapy in octogenarians is to reduce symptoms, mortality and hospitalizations, but also to improve quality of life. In the absence of specific studies involving very old subjects, most recommendations are extrapolated from evidence-based data from younger populations. Overall, the epidemiological studies in patients with heart failure aged>80 years highlight the underprescription of recommended drugs. This underprescription may be related to comorbidity, a fear of side-effects and the lack of specific recommendations for drug prescription in heart failure with preserved ejection fraction, which is common in this very old population. The benefit/risk ratio related to heart failure treatment and comorbidity should be carefully weighed and reassessed on a regular basis. Consideration of disease prognosis according to factors that predict mortality can help to better define the care plan and promote palliative and supportive care when needed.
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Affiliation(s)
- Olivier Hanon
- Service de gériatrie, hôpital Broca, AP-HP, 75013 Paris, France; EA 4468, gérontopôle d'Île-de-France, université de Paris, 75013 Paris, France.
| | - Joël Belmin
- Service de gériatrie, hôpital Charles-Foix, 94200 Ivry-sur-Seine, France; Faculté de médecine, Sorbonne université, 75103 Paris, France
| | - Athanase Benetos
- Service de médecine interne gériatrique, CHRU plurithématiques-Nancy, 54035 Nancy, France; UMR_S 1116, Inserm, université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Philippe Chassagne
- Service de médecine interne gériatrique, CHU de Rouen, 76000 Rouen, France
| | - Laure De Decker
- Service de gérontologie clinique, CHU de Nantes, 44093 Nantes, France
| | - Claude Jeandel
- Centre Antonin-Balmès, CHU de Montpellier, 34090 Montpellier, France
| | - Pierre Krolak-Salmon
- Institut du vieillissement, hôpital des Charpennes, hospices civils de Lyon, 69002 Lyon, France; Inserm 1048, université de Lyon, 69675 Bron, France
| | - Fati Nourhashemi
- Gérontopôle, CHU de Toulouse, 31059 Toulouse, France; Inserm 1027, 31000 Toulouse, France
| | - Marc Paccalin
- Pôle de Gériatrie, CHU La Milétrie, 86021 Poitiers, France; CIC 1402, Inserm, centre hospitalier universitaire de Poitiers, université de Poitiers, 86000 Poitiers, France
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Riolet C, Menet A, Verdun S, Altes A, Appert L, Guyomar Y, Delelis F, Ennezat PV, Guerbaai RA, Graux P, Tribouilloy C, Marechaux S. Clinical and prognostic implications of phenomapping in patients with heart failure receiving cardiac resynchronization therapy. Arch Cardiovasc Dis 2021; 114:197-210. [PMID: 33431324 DOI: 10.1016/j.acvd.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite having an indication for cardiac resynchronization therapy according to current guidelines, patients with heart failure with reduced ejection fraction who receive cardiac resynchronization therapy do not consistently derive benefit from it. AIM To determine whether unsupervised clustering analysis (phenomapping) can identify distinct phenogroups of patients with differential outcomes among cardiac resynchronization therapy recipients from routine clinical practice. METHODS We used unsupervised hierarchical cluster analysis of phenotypic data after data reduction (55 clinical, biological and echocardiographic variables) to define new phenogroups among 328 patients with heart failure with reduced ejection fraction from routine clinical practice enrolled before cardiac resynchronization therapy. Clinical outcomes and cardiac resynchronization therapy response rate were studied according to phenogroups. RESULTS Although all patients met the recommended criteria for cardiac resynchronization therapy implantation, phenomapping analysis classified study participants into four phenogroups that differed distinctively in clinical, biological, electrocardiographic and echocardiographic characteristics and outcomes. Patients from phenogroups 1 and 2 had the most improved outcome in terms of mortality, associated with cardiac resynchronization therapy response rates of 81% and 78%, respectively. In contrast, patients from phenogroups 3 and 4 had cardiac resynchronization therapy response rates of 39% and 59%, respectively, and the worst outcome, with a considerably increased risk of mortality compared with patients from phenogroup 1 (hazard ratio 3.23, 95% confidence interval 1.9-5.5 and hazard ratio 2.49, 95% confidence interval 1.38-4.50, respectively). CONCLUSIONS Among patients with heart failure with reduced ejection fraction with an indication for cardiac resynchronization therapy from routine clinical practice, phenomapping identifies subgroups of patients with differential clinical, biological and echocardiographic features strongly linked to divergent outcomes and responses to cardiac resynchronization therapy. This approach may help to identify patients who will derive most benefit from cardiac resynchronization therapy in "individualized" clinical practice.
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Affiliation(s)
- Clémence Riolet
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Aymeric Menet
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Stéphane Verdun
- Biostatistics Department-Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, 59160 Lille, France
| | - Alexandre Altes
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Ludovic Appert
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Yves Guyomar
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - François Delelis
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | | | - Raphaelle A Guerbaai
- Department of Public Health (DPH), Faculty of Medicine, Basel University, 4056 Basel, Switzerland
| | - Pierre Graux
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Christophe Tribouilloy
- Amiens University Hospital, 80080 Amiens, France; Laboratory MP3CV-EA 7517, University Centre for Health Research, Picardy University, 80000 Amiens, France
| | - Sylvestre Marechaux
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France; Laboratory MP3CV-EA 7517, University Centre for Health Research, Picardy University, 80000 Amiens, France.
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Lambert V, Ladarre D, Fortas F, Durand P, Hervé P, Gonzales E, Guérin F, Savale L, McLin VA, Ackermann O, Franchi-Abella S. Cardiovascular disorders in patients with congenital portosystemic shunts: 23 years of experience in a tertiary referral centre. Arch Cardiovasc Dis 2020; 114:221-231. [PMID: 33281106 DOI: 10.1016/j.acvd.2020.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/11/2020] [Revised: 08/16/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Congenital portosystemic shunts are rare vascular malformations that may have an impact on the heart-lung system. Associated congenital and/or acquired heart diseases are poorly reported. AIMS To analyse cardiovascular disorders within a large congenital portosystemic shunt population, and develop a diagnostic strategy. METHODS Among the 168 consecutive fetuses and children referred for congenital portosystemic shunt (1996-2019), patients presenting with at least one cardiovascular disorder, including congenital heart disease, heart failure, portopulmonary hypertension and/or hepatopulmonary syndrome, were reviewed retrospectively. Cardiovascular disorders were detected using echocardiography and one or more of the following: right-sided heart catheterization; contrast-enhanced transthoracic echocardiography; or lung perfusion radionuclide scan. RESULTS Overall, 46/168 patients with a congenital portosystemic shunt (27.4%) had one or more clinically significant cardiovascular disorders. Congenital heart disease was present in 28 patients, including six with left heterotaxy. Heart failure was present in six fetuses and 21 neonates (eight without congenital heart disease, and 13 with congenital heart disease). In neonates without congenital heart disease, heart function recovered by the age of 3years. Portopulmonary hypertension was identified in 11 patients (mean age at diagnosis: 9years); it was fatal in one patient, and remained stable in five of six patients after congenital portosystemic shunt closure. In six patients, hepatopulmonary syndrome presented as hypoxia (mean age at diagnosis: 5.3years), which reversed after congenital portosystemic shunt closure. CONCLUSIONS Evaluation and monitoring of the cardiopulmonary status of patients with a congenital portosystemic shunt is mandatory to detect and prevent cardiovascular complications. Furthermore, congenital portosystemic shunts must be sought in patients with unexplained cardiovascular disorders, especially when malformations are present.
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Affiliation(s)
- Virginie Lambert
- Paediatric and Congenital Cardiology, Department of Cardiology, Institut Mutualiste Montsouris, 75014 Paris, France; Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France.
| | - Delphine Ladarre
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France
| | - Feriel Fortas
- Department of Paediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Philippe Durand
- Department of Paediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Pierre Hervé
- Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; INSERM UMR-S 1193, Paris-Saclay, 91400 Orsay, France
| | - Florent Guérin
- Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; Department of Paediatric Surgery, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; INSERM UMR-999, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - Valérie A McLin
- Swiss Paediatric Liver Center, Department of Paediatrics, Gynecology and Obstetrics, European Reference Network RARE-LIVER, University Hospitals Geneva and University of Geneva Medical School, 1205 Geneva, Switzerland
| | - Oanez Ackermann
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France
| | - Stéphanie Franchi-Abella
- Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; BioMaps-UMR 8081, University Paris-Saclay, 91400 Orsay, France
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Maquet J, Bories E, Nogier MB, Beck C, Aizel G, Toledano A, Faguer S, Paricaud K, Pugnet G, Moulis G, Astudillo L, Sailler L. [TAFRO syndrome and cutaneous necrotizing vasculitis]. Rev Med Interne 2021; 42:134-9. [PMID: 33218790 DOI: 10.1016/j.revmed.2020.10.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/02/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION TAFRO syndrome is a systemic inflammatory syndrome in the spectrum of Castleman's disease, associating thrombocytopenia, anasarca, fever, renal failure and/or reticulin myelofibrosis and organomegaly. Its association with necrotizing cutaneous vasculitis has not yet been reported. CASE REPORT A 69-year-old woman presented with weight loss, fever, anasarca, organomegaly, lymphadenopathy, anuria and extensive necrotic livedo occurring after acute diarrhea. Biology showed anemia, thrombocytopenia, renal failure, hypergammaglobulinemia, a circulating B-lymphocyte clone, hypoparathyroidism and autoimmune hypothyroidism. The skin biopsy showed small vessel vasculitis with fibrinoid necrosis. Methylprednisolone infusions associated with tocilizumab were ineffective and the patient became anuric. Rituximab and plasma exchanges associated to corticosteroids allowed remission for 2 months. Combination of rituximab, cyclophosphamide and dexamethasone resulted in a prolonged remission. CONCLUSION We report here the first case of severe cutaneous necrotizing vasculitis in a patient suffering from TAFRO syndrome. The possible resistance to tocilizumab should be known.
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Battault S, Renguet E, Van Steenbergen A, Horman S, Beauloye C, Bertrand L. Myocardial glucotoxicity: Mechanisms and potential therapeutic targets. Arch Cardiovasc Dis 2020; 113:736-748. [PMID: 33189592 DOI: 10.1016/j.acvd.2020.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/13/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022]
Abstract
Besides coronary artery disease, which remains the main cause of heart failure in patients with diabetes, factors independent of coronary artery disease are involved in the development of heart failure in the onset of what is called diabetic cardiomyopathy. Among them, hyperglycaemia - a hallmark of type 2 diabetes - has both acute and chronic deleterious effects on myocardial function, and clearly participates in the establishment of diabetic cardiomyopathy. In the present review, we summarize the cellular and tissular events that occur in a heart exposed to hyperglycaemia, and depict the complex molecular mechanisms proposed to be involved in glucotoxicity. Finally, from a more translational perspective, different therapeutic strategies targeting hyperglycaemia-mediated molecular mechanisms will be detailed.
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Affiliation(s)
- Sylvain Battault
- Pole of cardiovascular research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, B-1200 Brussels, Belgium
| | - Edith Renguet
- Pole of cardiovascular research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, B-1200 Brussels, Belgium
| | - Anne Van Steenbergen
- Pole of cardiovascular research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, B-1200 Brussels, Belgium
| | - Sandrine Horman
- Pole of cardiovascular research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, B-1200 Brussels, Belgium
| | - Christophe Beauloye
- Pole of cardiovascular research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, B-1200 Brussels, Belgium; Division of cardiology, Cliniques Universitaires Saint-Luc, B-1200 Brussels, Belgium.
| | - Luc Bertrand
- Pole of cardiovascular research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, B-1200 Brussels, Belgium; WELBIO, B-1300 Wavre, Belgium.
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Arques S, Chelaifa H, Allari JB, Gelisse R, Roux E. [Does hypoalbuminemia contribute to the worsening of heart failure?]. Ann Cardiol Angeiol (Paris) 2020; 69:294-298. [PMID: 32800317 DOI: 10.1016/j.ancard.2020.07.009] [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: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hypoalbuminemia has now emerged as a powerful prognosticator in heart failure regardless of age, clinical presentation, left ventricular ejection fraction and usual prognostic markers. Growing evidence is that this prognostic value persists after adjusting for causative factors for hypoalbuminemia such as malnutrition, inflammation and liver dysfunction. OBJECTIVE To address the prognostic relevance of hypoalbuminemia in frail elderly patients with well-characterized cardiogenic pulmonary edema at high risk for adverse outcome, beyond causative factors for low serum albumin levels. Serum albumin was measured after clinical stabilization to avoid hypervolemia. RESULTS In all, 67 patients with a mean age of 86 years were included. Hospital mortality was 30%. Patients who died and who survived were similar in age, ejection fraction, BNP concentration, serum creatinine, serum hemoglobin, total bilirubin and prealbumin. Patients who died had lower serum albumin levels (P<0.001), higher blood urea nitrogen (P=0.03) and higher C-reactive protein (P=0.02). In multivariate analysis, serum albumin was the sole independent predictor of hospital death (P<0.01), after adjusting for malnutrition (prealbumin P=ns), inflammation (C-reactive protein P=ns) and liver dysfunction (total bilirubin P=ns). CONCLUSION Serum albumin is a powerful prognosticator in frail elderly patients with acute cardiogenic pulmonary edema even after adjusting for main causative factors. These results suggest that hypoalbuminemia may contribute to the worsening of heart failure given the physiological properties of serum albumin that includes antioxidant activity and plasma colloid osmotic pressure action. Further studies are critically needed to address the relevance of prevention and correction of hypoalbuminemia in heart failure.
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Affiliation(s)
- S Arques
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
| | - H Chelaifa
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France
| | - J B Allari
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France
| | - R Gelisse
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France
| | - E Roux
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France
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Moini C, Lefoulon A, Rahim D, Yassine M, Poindron D, Amara W. [ICD and left ventricular assist device interference: Case report]. Ann Cardiol Angeiol (Paris) 2020; 69:332-334. [PMID: 33067008 DOI: 10.1016/j.ancard.2020.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
Left ventricular assist devices are used for severe chronic heart failure management. Many of these patients have an implantable cardioverter defibrillator (ICD). However electromagnetic interferences are possible between the 2 devices. We report here a case of an interference in a 77 years-old patient. This was associated with an impossibility to communicate with the ICD. We discuss how to manage this situation.
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Affiliation(s)
- C Moini
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France; Service de cardiologie, GHSIF, groupe hospitalier Sud Île-de-France, Melun, France
| | - A Lefoulon
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France; Service de cardiologie, GHSIF, groupe hospitalier Sud Île-de-France, Melun, France
| | - D Rahim
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France
| | - M Yassine
- Service de cardiologie, GHSIF, groupe hospitalier Sud Île-de-France, Melun, France
| | - D Poindron
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France
| | - W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, GHT Grand Paris Nord Est, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
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Abstract
Cardiovascular disease is the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory conditions and oxidative stress are at the forefront of the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin has many physiological properties, including in particular antioxidant, anti-inflammatory, anticoagulant and anti-platelet aggregation activity. It also plays an essential role in the exchange of fluids across the capillary membrane. Hypoalbuminemia is a powerful prognostic marker in the general population as well as in many disease states. In the more specific context of cardiovascular disease, low serum albumin is independently associated with the development of various deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation, stroke and venous thromboembolism. Low serum albumin has also emerged as a potent prognostic parameter in patients with cardiovascular disease regardless of usual prognostic markers. Remarkably, its potent prognostic value persists after adjusting for causative confounders such as malnutrition and inflammation. This prognostic value probably refers primarily to the syndrome of malnutrition-inflammation and the severity of comorbidities. Nevertheless, several recent meta-analyses strongly support the hypothesis that hypoalbuminemia may act as an unrecognized, potentially modifiable risk factor contributing to the emergence and progression of cardiovascular disease, primarily by exacerbating oxidative stress, inflammation and platelet aggregation, and by favouring peripheral congestion and pulmonary edema. Currently, it is unknown whether prevention and correction of low serum albumin offers a benefit to patients with or at risk for cardiovascular disease, and further studies are critically needed in this setting.
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Affiliation(s)
- S Arques
- Service de Cardiologie, Centre hospitalier Edmond Garcin, Avenue des Soeurs Gastine, 13400 Aubagne, France.
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Berger C, Prieur C, Bochaton T, Berthiller J, Luyt CE, Bonnefoy-Cudraz E. Patients with acute heart failure treated with the CARRESS-HF diuretic protocol in association with canrenoate potassium: Tolerance of high doses of canrenoate potassium. Arch Cardiovasc Dis 2020; 113:679-689. [PMID: 32948466 DOI: 10.1016/j.acvd.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 03/13/2020] [Accepted: 05/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Oral mineralocorticoid receptor antagonists have failed to prove their efficacy for decongestion and potassium homeostasis in acute heart failure. Intravenous mineralocorticoid receptor antagonists have yet to be studied. AIM The aim of this study was to confirm the safety of high-dose potassium canrenoate in association with classic diuretics in acute heart failure. METHODS This retrospective single-centre study included consecutive patients who were hospitalized with acute heart failure between 2013 and 2018. One hundred patients with overload treated with the standardized diuretic protocol from the CARRESS-HF trial were included. There were no exclusion criteria relating to creatinine or kalaemia at the time of admission. Two groups were constituted on the basis of potassium canrenoate posology: a low-dose group (<300mg/day) and a high-dose group (≥300mg/day); the groups were similar in terms of baseline characteristics. RESULTS Mean daily potassium canrenoate doses were 198mg/day (range 100-280mg/day) in the low-dose group and 360mg/day (range 300-600mg/day) in the high-dose group. There was no significant difference between the high-dose and low-dose groups in terms of mortality, dialysis, renal function, hyperkalaemia, haemorrhage, sepsis or confusion. CONCLUSIONS Potassium canrenoate at high doses can be used safely in association with standard diuretics in acute heart failure, even in patients with altered renal function. A prospective study is required to evaluate the efficacy of high-dose potassium canrenoate in preventing hypokalaemia and improving decongestion.
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Affiliation(s)
- Clothilde Berger
- Unité de soins intensifs cardiologiques, Hôpital cardio-vasculaire Louis Pradel, groupement hospitalier Est, Hospices civils de Lyon, 28, avenue du Doyen-Lépine, 69677 Bron, France.
| | - Cyril Prieur
- Unité de soins intensifs cardiologiques, Hôpital cardio-vasculaire Louis Pradel, groupement hospitalier Est, Hospices civils de Lyon, 28, avenue du Doyen-Lépine, 69677 Bron, France
| | - Thomas Bochaton
- Unité de soins intensifs cardiologiques, Hôpital cardio-vasculaire Louis Pradel, groupement hospitalier Est, Hospices civils de Lyon, 28, avenue du Doyen-Lépine, 69677 Bron, France
| | - Julien Berthiller
- Service de Recherche et d'Épidémiologie Clinique, Pôle de santé publique des Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Charles-Edouard Luyt
- Réanimation médicale, Institut de cardiologie, Hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Eric Bonnefoy-Cudraz
- Unité de soins intensifs cardiologiques, Hôpital cardio-vasculaire Louis Pradel, groupement hospitalier Est, Hospices civils de Lyon, 28, avenue du Doyen-Lépine, 69677 Bron, France
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Kichura AB, Duderija E, Vidic A, Hoerner RM, Bhandari V, Byrne LE, Patel KK, Chibnall JT, Hauptman PJ. Does a brief functional assessment in the emergency department predict outcomes of patients admitted with heart failure? The FASTER-HF study. Arch Cardiovasc Dis 2020; 113:766-771. [PMID: 32943373 DOI: 10.1016/j.acvd.2020.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/28/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evaluation of patients with acute decompensated heart failure includes symptom review, biomarker measurement and comorbidity assessment. Early objective evaluation of functional status is generally not performed. AIM To investigate whether a simple low-impact functional assessment and measurement of sarcopenia would be safe, feasible and predictive of hospital length of stay and all-cause 30-day hospital readmission. METHODS We administered 3-minute bicycle ergometry and hand grip strength tests at admission and discharge to patients for whom a decision to admit for heart failure management was made in the emergency department. Associations were examined between test results and length of stay and 30-day readmission. Exclusion criteria included acute coronary syndrome, hypoxia, end-stage renal disease, dementia/delirium and inability to sit at bedside. The Kansas City Cardiomyopathy Questionnaire-12, the Patient Health Questionnaire-2 and the visual analogue scale for dyspnoea were administered at admission, the visual analogue scale at discharge and the Kansas City Cardiomyopathy Questionnaire-12 at 30 days. RESULTS Fifty patients were enrolled: 58% were female; the mean age was 66.2±12.5 years; 24% had heart failure with preserved ejection fraction. Bicycle ergometry variables did not correlate with outcomes. Change in handgrip strength correlated with readmission, but not after adjustment (rpartial=0.14; P=0.35). Total diuretic dose correlated with length of stay; only discharge visual analogue scale and baseline lung disease had significant adjusted correlations with readmission. CONCLUSIONS Functional assessment in the emergency department of patients admitted for heart failure did not predict outcomes. However, the prognostic value of these assessments for decision-making about disposition (admission or discharge) may still be warranted.
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Affiliation(s)
- Andrew B Kichura
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Eldin Duderija
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Andrija Vidic
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Robert M Hoerner
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Vindeep Bhandari
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Laurie E Byrne
- Department of Surgery-Emergency Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Keval K Patel
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - John T Chibnall
- Department of Psychiatry & Behavioural Neuroscience, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Paul J Hauptman
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA.
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Lévy BI, Fauvel JP. Renin-angiotensin system blockers and severe acute respiratory syndrome coronavirus 2. Arch Cardiovasc Dis 2020; 113:572-578. [PMID: 32863157 PMCID: PMC7430243 DOI: 10.1016/j.acvd.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2, which is responsible for the current coronavirus disease 2019 pandemic, uses angiotensin-converting enzyme 2 as a gateway into host cells. In this review, we summarise the biology of this enzyme, which plays a key role in cardiovascular homeostasis. Blockers of the renin–angiotensin system modify the expression and activity of angiotensin-converting enzyme 2 in different ways. The effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the expression and enzyme activity of angiotensin-converting enzyme 2 are reviewed, and the consequences of these treatments for the severity of coronavirus disease 2019 infection are discussed.
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Affiliation(s)
- Bernard I Lévy
- Inserm UMR970 (PARCC) and Hôpital Lariboisière, 75010 Paris, France.
| | - Jean-Pierre Fauvel
- Service de Néphrologie, UMR 5558, Université Claude Bernard Lyon 1, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 69437 Lyon, France
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Mewton N, Girerd N, Boffa JJ, Courivaud C, Isnard R, Juillard L, Lamblin N, Legrand M, Logeart D, Mariat C, Meune E, Sabouret P, Sebbag L, Rossignol P. Practical management of worsening renal function in outpatients with heart failure and reduced ejection fraction: Statement from a panel of multidisciplinary experts and the Heart Failure Working Group of the French Society of Cardiology. Arch Cardiovasc Dis 2020; 113:660-70. [PMID: 32660835 DOI: 10.1016/j.acvd.2020.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/08/2023]
Abstract
Renal function is often affected in patients with chronic heart failure with reduced ejection fraction (HFrEF). The complex interplay between heart and renal dysfunction makes renal function and potassium monitoring mandatory. Renin-angiotensin-aldosterone system (RAAS) blockers are a life-saving treatment for patients with HFrEF, regardless of worsening renal function. Uptitration to the maximum-tolerated dose should be a constant goal. This simple fact is all too often forgotten (only 30% of patients with heart failure receive the target dosage of RAAS blockers), and the RAAS blocker effect on renal function is sometimes misunderstood. RAAS blockers are not nephrotoxic drugs as they only have a functional effect on renal function. In many routine clinical cases, RAAS blockers are withheld or stopped because of this misunderstanding, combined with suboptimal assessment of the clinical situation and underestimation of the life-saving effect of RAAS blockers despite worsening renal function. In this expert panel, which includes heart failure specialists, geriatricians and nephrologists, we propose therapeutic management algorithms for worsening renal function for physicians in charge of outpatients with chronic heart failure. Firstly, the essential variables to take into consideration before changing treatment are the presence of concomitant disorders that could alter renal function status (e.g. infection, diarrhoea, hyperthermia), congestion/dehydration status, blood pressure and intake of nephrotoxic drugs. Secondly, physicians are invited to adapt medication according to four clinical scenarios (patient with congestion, dehydration, hypotension or hyperkalaemia). Close biological monitoring after treatment modification is mandatory. We believe that this practical clinically minded management algorithm can help to optimize HFrEF treatment in routine clinical practice.
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Imamura T. Severity of cardiovascular diseases during the COVID-19 pandemic: A letter in response to "One train may hide another: Acute cardiovascular diseases could be neglected because of the COVID-19 pandemic." by Huet et al. Arch Cardiovasc Dis 2020; 113:485. [PMID: 32620445 PMCID: PMC7301083 DOI: 10.1016/j.acvd.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Teruhiko Imamura
- Second Department of Medicine, University of Toyama, 2630 Sugitani, 930-0194 Toyama, Japan.
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46
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Huet F, Prieur C, Schurtz G, Gerbaud E, Manzo-Silberman S, Vanzetto G, Elbaz M, Tea V, Mercier G, Lattuca B, Duflos C, Roubille F. Acute cardiovascular diseases may be less likely to be considered because of the COVID-19 pandemic-our duty is first to alert, then to analyse more deeply: Response to a letter entitled "Severity of cardiovascular diseases during the COVID-19 pandemic" from T. Imamura. Arch Cardiovasc Dis 2020; 113:486-487. [PMID: 32616390 PMCID: PMC7301107 DOI: 10.1016/j.acvd.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Fabien Huet
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France
| | - Cyril Prieur
- Department of Cardiology, Hôpital Cardiologique Louis-Pradel, 69500 Bron, France
| | - Guillaume Schurtz
- Department of Cardiology, Institut Coeur Poumons, Hôpital Cardiologique, 59000 Lille, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, 33600 Pessac, France
| | | | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Meyer Elbaz
- Department of Cardiology, Hôpital Rangueil, 31400 Toulouse, France
| | - Victoria Tea
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Grégoire Mercier
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Medico-Economic Research Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - Benoît Lattuca
- Department of Cardiology, CHU de Nîmes, 30029 Nîmes, France
| | - Claire Duflos
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Clinical Research and Epidemiology Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France.
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47
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Feldman SF, Lesuffleur T, Olié V, Gastaldi-Ménager C, Juillière Y, Tuppin P. Outpatient healthcare utilization 30 days before and after hospitalization for heart failure in France: Contribution of the national healthcare database (Systèmenationaldesdonnéesdesanté). Arch Cardiovasc Dis 2020; 113:401-419. [PMID: 32473996 DOI: 10.1016/j.acvd.2019.11.011] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/22/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systèmenationaldesdonnéesdesanté; SNDS) can be used to compare these guidelines with real-life practice. AIMS To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. METHODS We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. RESULTS Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). CONCLUSIONS Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.
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Affiliation(s)
- Sarah F Feldman
- Caisse nationale de l'assurance maladie (CNAM), 75986 Paris, France
| | | | - Valérie Olié
- Santé publique France, 94410 Saint-Maurice, France
| | | | - Yves Juillière
- Cardiologie, Institut Lorrain du cœur et des vaisseaux Louis-Mathieu, 54500 Vandœuvre-lès-Nancy, France
| | - Philippe Tuppin
- Caisse nationale de l'assurance maladie (CNAM), 75986 Paris, France.
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Jean G, Deleaval P, Chazot C. [Natriuretic peptides in dialysis: From theory to clinical practice]. Nephrol Ther 2020; 17:1-11. [PMID: 32409292 DOI: 10.1016/j.nephro.2019.08.003] [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: 07/23/2019] [Accepted: 08/25/2019] [Indexed: 10/24/2022]
Abstract
Cardiologists and emergency-wards physicians are used to check natriuretic peptides serum level, mainly B-type natriuretic peptide and N-terminal pro-Brain natriuretic peptide for acute cardiac failure diagnosis. Due to their accumulation in chronic kidney disease and their elimination by dialysis, natriuretic peptides sampling remains debatable in chronic kidney disease patients. In dialysis patients, high natriuretic peptides values are associated with mortality, left ventricular hypertrophy and cardiac failure. However, a single value cannot provide a reliable diagnosis. Our clinical practice is as follows: First, we prefer B-type natriuretic peptide to N-terminal pro-Brain natriuretic peptide because of its shorter half-life, with less impact of renal function and dialysis, making its interpretation easier in case of advanced chronic kidney disease or in dialysis patients; second, we define a reference value of B-type natriuretic peptide at dry weight from serial measurements; third, the B-type natriuretic peptide changes are interpreted according to extracellular fluid and cardiac status, but also from the arteriovenous fistula blood flow. In stable dialysis patients, B-type natriuretic peptide is sampled monthly and weekly in unstable patients. We illustrate our experience using clinical cases of overhydration, new cardiac disease onset, hypovolemia and arteriovenous fistula with high blood flow. Longitudinal follow-up of B-type natriuretic peptide is an important advance in dialysis patients in order to detect and treat extracellular fluid variations and cardiac disease status early, both important factors associated with hard outcomes.
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Affiliation(s)
- Guillaume Jean
- Service de néphrologie et dialyse, NephroCare Tassin-Charcot, 7, avenue du Maréchal-Foch, 69110 Sainte-Foy-les-Lyon, France.
| | - Patrik Deleaval
- Service de néphrologie et dialyse, NephroCare Tassin-Charcot, 7, avenue du Maréchal-Foch, 69110 Sainte-Foy-les-Lyon, France
| | - Charles Chazot
- Service de néphrologie et dialyse, NephroCare Tassin-Charcot, 7, avenue du Maréchal-Foch, 69110 Sainte-Foy-les-Lyon, France
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Huet F, Prieur C, Schurtz G, Gerbaud E, Manzo-Silberman S, Vanzetto G, Elbaz M, Tea V, Mercier G, Lattuca B, Duflos C, Roubille F. One train may hide another: Acute cardiovascular diseases could be neglected because of the COVID-19 pandemic. Arch Cardiovasc Dis 2020; 113:303-307. [PMID: 32362433 PMCID: PMC7186196 DOI: 10.1016/j.acvd.2020.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 03/28/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/23/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is likely to have significant implications for the cardiovascular care of patients. In most countries, containment has already started (on 17 March 2020 in France), and self-quarantine and social distancing are reducing viral contamination and saving lives. However, these considerations may only be the tip of the iceberg; most resources are dedicated to the struggle against COVID-19, and this unprecedented situation may compromise the management of patients admitted with cardiovascular conditions. Aim We aimed to assess the effect of COVID-19 containment measures on cardiovascular admissions in France. Methods We asked nine major cardiology centres to give us an overview of admissions to their nine intensive cardiac care units for acute myocardial infarction or acute heart failure, before and after containment measures. Results Before containment (02–16 March 2020), the nine participating intensive cardiac care units admitted 4.8 ± 1.6 patients per day, versus 2.6 ± 1.5 after containment (17–22 March 2020) (rank-sum test P = 0.0006). Conclusions We confirm here, for the first time, a dramatic drop in the number of cardiovascular admissions after the establishment of containment. Many hypotheses might explain this phenomenon, but we feel it is time raise the alarm about the risk for patients presenting with acute cardiovascular disease, who may suffer from lack of attention, leading to severe consequences (an increase in the number of ambulatory myocardial infarctions, mechanical complications of myocardial infarction leading to an increase in the number of cardiac arrests, unexplained deaths, heart failure, etc.). Similar consequences can be feared for all acute situations, beyond the cardiovascular disease setting.
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Affiliation(s)
- Fabien Huet
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier, France
| | - Cyril Prieur
- Department of Cardiology, Hôpital Cardiologique Louis Pradel, 69500 Bron, France
| | - Guillaume Schurtz
- Department of Cardiology, Institut Coeur Poumons, Hôpital Cardiologique, 59000 Lille, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, 33600 Pessac, France
| | | | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Meyer Elbaz
- Department of Cardiology, Hôpital Rangueil, 31400 Toulouse, France
| | - Victoria Tea
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Grégoire Mercier
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Medico-Economic Research Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - Benoît Lattuca
- Department of Cardiology, CHU de Nimes, 30029 Nimes, France
| | - Claire Duflos
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Clinical Research and Epidemiology Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier, France.
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50
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Adoubi KA, Soya E, Bamba KD, Koffi F, N'Cho-Mottoh MP, Diby F, Gnaba A, Konin C. [Burden of comorbidities in heart failure patients hospitalized at the Abidjan Heart Institute]. Ann Cardiol Angeiol (Paris) 2020; 69:74-80. [PMID: 32223908 DOI: 10.1016/j.ancard.2020.03.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of our work was to appreciate the importance of comorbidities of heart failure individually and globally in patients hospitalized at the Cardiology Institute of Abidjan. PATIENTS AND METHODS This was a prospective cohort study of adult heart failure patients hospitalized from January to December 2015, and followed up over 12 months. Co-morbidities were analysed through their prevalence, their relationship with the etiologies, and their impact on the prognosis. RESULTS Three hundred and two patients (mean age: 55.5±16.9 years, 61.6 % male) were recruited. High blood pressure, anaemia and kidney dysfunction were the most common co-morbidities (48 %, 43.7 % and 41.3 % respectively). There was an average of 3.4±1.8 comorbidities per patient with an increase in the number of comorbidities with age (P<0.05) and a more frequent association with hypertensive and ischemic heart disease (P<0.001). During the one-year follow-up, 96 patients died. Apart from hepatic dysfunction (RR=1.97, 95 % CI [1,19-3.25], P=0.008, a high score of Charlson index appeared as a risk factor of death as much in univariate analysis (RR=4.15 95 % CI [2.32-7.41], P<0.001), as in multivariate analysis according to the Cox model (RR=2.48. 95 % CI [1.08-5.09], P=0.03) confirmed by Kaplan Meier curves (P<0.001). CONCLUSION Comorbidities are common in our heart failure patients and significantly affect their prognosis.
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Affiliation(s)
- K A Adoubi
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire; Université de Bouaké, Bouaké, Cote d'Ivoire.
| | - E Soya
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - K D Bamba
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - F Koffi
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | | | - F Diby
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - A Gnaba
- Université de Bouaké, Bouaké, Cote d'Ivoire
| | - C Konin
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
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