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Soulat-Dufour L, Ichou F, Ponnaiah M, Lang S, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Capderou E, Arnaud C, Le Goff W, Boccara F, Hatem SN, Cohen A. Left atrial strain: A memory of the severity of atrial myocardial stress in atrial fibrillation. Arch Cardiovasc Dis 2024; 117:134-142. [PMID: 38290892 DOI: 10.1016/j.acvd.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Left atrial (LA) strain is a simple marker of LA function. The aim of the study was to evaluate the determinants of atrial cardiomyopathy in AF. METHODS In this pilot study, we prospectively evaluated clinical, biological, metabolomic and echocardiographic parameters for 85 consecutive patients hospitalized for atrial fibrillation (AF) with restoration of sinus rhythm at 6 months. Eighty-one patients with an analysable LA strain at 6 months were divided into groups according to median reservoir strain:<23.3% (n=40) versus≥23.3% (n=41). RESULTS Compared to patients with the highest LA strain, patients with lowest LA strain had multiple differences at admission: clinical (older age; more frequent history of AF; more patterns of persistent AF); biological (higher fasting blood glucose levels, glycated haemoglobin, high-sensitivity C-reactive protein, and urea; lower glomerular filtration rate); metabolomic (higher levels of kynurenine, kynurenine/tryptophan, and urea/creatinine; lower levels of arginine and methionine/methionine sulfoxide); and echocardiographic (higher two-dimensional end-systolic LA volume [LAV] indexes; higher three-dimensional end-systolic and end-diastolic LAV and right atrial volume indexes; lower LA and right atrial emptying fractions and three-dimensional right ventricular ejection fraction) (all P<0.05). Area under the receiver operating characteristic curve to predict LA strain alteration at 6 months was highest for a combined score including clinical, biological, metabolomic and echocardiographic variables at admission (area under the receiver operating characteristic curve 0.871; P<0.0001). CONCLUSIONS LA reservoir strain could be a memory of initial atrial myocardial stress in AF. It can be predicted using a combination of clinical, biological, metabolomic and echocardiographic admission variables.
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Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France; Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Farid Ichou
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Maharajah Ponnaiah
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Sylvie Lang
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Stéphane Ederhy
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France; Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Saroumadi Adavane-Scheuble
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Marion Chauvet-Droit
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Elodie Capderou
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Camille Arnaud
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Wilfried Le Goff
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Franck Boccara
- Inserm 938, Faculté de Médecine Sorbonne Université Site Saint-Antoine, 75571 Paris, France
| | - Stéphane N Hatem
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France; Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France.
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Boccara F, Fonteille A, Chauvet-Droit M, Jansen C, Ederhy S, Vitrat V, Soulat-Dufour L, Tolsma V, Piet E, Adavane-Scheuble S, Belle L, Bouygues M, Valran A, Nhan P, Cohen A. Coronary artery calcium score in people living with HIV. Results from the French CAC study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
People living with HIV (PLWH) have a higher risk of CAD. Whether coronary artery calcification (CAC) score could better stratify the CV risk remains debated in this middle age population.
Purpose
We conducted the French CAC score study to compare the CAC score between PLHIV and HIV− subjects at intermediate risk.
Methods
689 subjects (257 PLHIV and 432 HIV−) were consecutively addressed for CV risk evaluation including CAC score assessment in 2 centers between 2013 and 2019. Subjects were included if they were 18 years'old or older, had no known cardiovascular disease and had a CAC score along with cardiometabolic assessment.
Results
The mean age of the cohort was 59.3 years ± 10.7 and predominantly male (54%). PLHIV were younger (55.8 years ± 9.1 vs 61.3±11.3, p<0.004), with a lower rate of diabetics (18% vs 26%, p=0.009) and lower levels of total cholesterol, LDLc, and HDLc (2.0 mmol/l vs, 2.2 mmol/l; 1.2 mmol/L vs 1.3 mmol/L; and 1.2 mmol/L vs 1.4 mol/L respectively, all p<0.001). The prevalence of hypertension, dyslipidemia and obesity was similar between PLHIV and the HIV− group (40%, 43% and 21%, respectively). No differences were observed in CV therapies prescribed including antihypertensive drugs and statins between PLHIV and the HIV− group (39% vs 37%, p=0.54 and 46% vs 39%, p=0.065). In contrast, PLHIV had higher rate of triglycerides (1.4 mmol/L vs 1.2 mmol/L, p=0.01), higher rate of active smoking (28% vs 14%, p<0.001), CRP level (4.0 mg/L vs 2.9 mg/L, p<0.001) along with higher black ethnicity representation (17% vs 5%;, p<0.001). 96% of PLHIV were under antiretroviral therapy at the time of enrollment with 88% who had been exposed to protease inhibitors. In subjects who had carotid and/or limb ultrasound evaluation (67% and 45% respectively in PLHIV and HIV), no increased rate of arterial stenosis >50% was found (13% vs 8%, p=0.16). Concerning, CV risk estimation using 10-year ASCVD and HEART scores, we observed that the median ASCVD score was similar between PLHIV and HIV− group (10.7% vs 9.8, p=0.15) but that PLHIV had a higher HEART score (3.0% vs 2.0%, p<0.001). The repartition between the ASCVD or HEART scores classes between the 2 groups was similar with 80% of the cohort classified as low or intermediate CV risk with the ASCVD score and 88% at intermediate or borderline CV risk with the HEART score. However, no statistically significant differences was found between the 2 groups regarding the prevalence of CAC = 0 (41% vs 44%, p=0.52) and the median CAC score (7.7 vs 8.2, p=0.81).
Conclusion
In this cohort of subjects at intermediate CV risk according to CV risk scores estimation (ASCVD or HEART scores), PLHIV had a similar prevalence of CAC = 0 and median CAC scores as compared to HIV− subjects despite a younger age (6 years). Longitudinal follow up will explore whether this similar CAC score evaluation will be translated into higher CV events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Boccara
- AP-HP - Hospital Saint Antoine , Paris , France
| | - A Fonteille
- Centre Hospitalier Annecy Genevois , Annecy , France
| | | | - C Jansen
- Centre Hospitalier Annecy Genevois , Annecy , France
| | - S Ederhy
- AP-HP - Hospital Saint Antoine , Paris , France
| | - V Vitrat
- Centre Hospitalier Annecy Genevois , Annecy , France
| | | | - V Tolsma
- Centre Hospitalier Annecy Genevois , Annecy , France
| | - E Piet
- Centre Hospitalier Annecy Genevois , Annecy , France
| | | | - L Belle
- Centre Hospitalier Annecy Genevois , Annecy , France
| | - M Bouygues
- Centre Hospitalier Annecy Genevois , Annecy , France
| | - A Valran
- Centre Hospitalier Annecy Genevois , Annecy , France
| | - P Nhan
- AP-HP - Hospital Saint Antoine , Paris , France
| | - A Cohen
- AP-HP - Hospital Saint Antoine , Paris , France
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Lang RM, Cameli M, Sade LE, Faletra FF, Fortuni F, Rossi A, Soulat-Dufour L. Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging 2022; 23:867-884. [PMID: 35079782 DOI: 10.1093/ehjci/jeac011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/15/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.
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Affiliation(s)
- Roberto M Lang
- Heart and Vascular Center, University of Chicago, 5758 S Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Leila E Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Cardiology, University of Baskent, Ankara, Turkey
| | | | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Zurich, Switzerland
| | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, Pr Ariel Cohen, Sorbonne Université, INSERM, Unité de recherche sur les maladies cardiovasculaires, le métabolisme et la nutrition, ICAN, Paris F-75013, France
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Robert R, Cottin Y, Potard V, Mary-Krause M, Lang S, Teiger E, Collet JP, Chauvet-Droit M, Ederhy S, Soulat-Dufour L, Ancedy Y, Adavane-Scheuble S, Nhan P, Steg PG, Funck-Brentano C, Costagliola D, Cohen A, Boccara F. Coronary Angiographic Features and Major Adverse Cardiac or Cerebrovascular Events in People Living With Human Immunodeficiency Virus Presenting With Acute Coronary Syndrome. Circ Cardiovasc Interv 2022; 15:e011945. [PMID: 35535605 DOI: 10.1161/circinterventions.122.011945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Affiliation(s)
- Raphael Robert
- Cardiology Department, University Hospital, PEC 2, Univ. Bourgogne Franche-Comté, Dijon, France (R.R., Y.C.)
| | - Yves Cottin
- Cardiology Department, University Hospital, PEC 2, Univ. Bourgogne Franche-Comté, Dijon, France (R.R., Y.C.)
| | - Valérie Potard
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France (V.P., M.M.-K., D.C.)
| | - Murielle Mary-Krause
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France (V.P., M.M.-K., D.C.)
| | - Sylvie Lang
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | - Emmanuel Teiger
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France (E.T.).,Inserm, CIC 1430 et U955 team 3, Henri Mondor University Hospital, Créteil, France (E.T.)
| | - Jean Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de cardiologie (AP-HP), Paris, France (J.P.C.)
| | - Marion Chauvet-Droit
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | - Stéphane Ederhy
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | - Laurie Soulat-Dufour
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | - Yann Ancedy
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | - Saroumadi Adavane-Scheuble
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | - Pascal Nhan
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | | | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology, France (C.F.-B.)
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France (V.P., M.M.-K., D.C.)
| | - Ariel Cohen
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.)
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Université, Paris, France (S.L., M.C.-D., S.E., L.S.-D., Y.A., S.A.-S., P.N., A.C., F.B.).,Sorbonne Université, GRC n°22, C2MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Paris, France (F.B.)
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Lang RM, Cameli M, Sade LE, Faletra FF, Fortuni F, Rossi A, Soulat-Dufour L. Corrigendum to: Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging 2022; 23:884. [PMID: 35511583 DOI: 10.1093/ehjci/jeac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Singulane CC, Slivnick JA, Addetia K, Asch F, Sarswat N, Soulat-Dufour L, Mor-Avi V, Lang RM. Prevalence of Right Atrial Impairment and Association with Outcomes in Cardiac Amyloidosis. J Am Soc Echocardiogr 2022; 35:829-835.e1. [DOI: 10.1016/j.echo.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
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Gabarre P, Ruiz P, Chenevier-Gobeaux C, Charpentier E, Soulat-Dufour L, Cohen A, Monnier-Cholley L, Chemali L, François H, Kerneis M, Lefèvre G, Boissan M. Inverted Takotsubo Syndrome With HELLP Syndrome: A Case Report. Front Cardiovasc Med 2022; 9:832098. [PMID: 35433851 PMCID: PMC9008274 DOI: 10.3389/fcvm.2022.832098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTakotsubo syndrome is an acute cardiac condition involving sudden, transient apical ballooning of the left ventricle of the heart that may be triggered by emotional stress and some non-cardiac conditions. Its diagnosis is based on clinical presentation, electrocardiogram, cardiac imaging and biomarkers.Case SummaryHere, we present a novel and original case report of a patient presenting very soon in the post-partum period with an unusual form of Takotsubo syndrome without clinical symptoms of cardiac disease and accompanied by HELLP syndrome. The overall dynamics of the changes in troponin I, troponin T and NT-proBNP levels after delivery were generally similar, but the amount of troponin I was much greater than that of troponin T and troponin I was already elevated before delivery. NT-proBNP levels peaked around the same time as the troponins and the peak concentration was within the same range as that of troponin I.DiscussionOur findings indicate that assaying circulating cardiac biomarkers, especially troponin I and NT-proBNP, may be a useful complement to non-invasive cardiac imaging including transthoracic echocardiography and cardiovascular magnetic resonance imaging, in the diagnosis of Takotsubo syndrome. They illustrate the importance of cardiac biomarkers in assisting diagnosis of this disease.
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Affiliation(s)
- Paul Gabarre
- AP-HP, Hôpital Tenon, Soins Intensifs Néphrologiques et Rein Aigu (SINRA), Paris, France
| | - Pablo Ruiz
- AP-HP, Hôpital Tenon, Laboratoire de Biochimie, Paris, France
| | - Camille Chenevier-Gobeaux
- AP-HP-Centre Université de Paris, Hôpital Cochin, Department of Automated Biological Diagnostic, Paris, France
| | - Etienne Charpentier
- AP-HP, Groupe Hospitalier Pitié Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique ICT, Institut de Cardiologie, Paris, France
| | - Laurie Soulat-Dufour
- AP-HP, Hôpital Saint-Antoine-Tenon, Service de Cardiologie, Paris, France
- Sorbonne Université, Inserm, Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition, ICAN, Paris, France
| | - Ariel Cohen
- AP-HP, Hôpital Saint-Antoine-Tenon, Service de Cardiologie, Paris, France
- Sorbonne Université, Inserm, Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition, ICAN, Paris, France
| | | | - Lotfi Chemali
- AP-HP, Hôpital Tenon, Laboratoire de Biochimie, Paris, France
| | - Hélène François
- AP-HP, Hôpital Tenon, Soins Intensifs Néphrologiques et Rein Aigu (SINRA), Paris, France
- Sorbonne Université, Inserm, UMR_S1155, Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Paris, France
| | | | - Mathieu Boissan
- AP-HP, Hôpital Tenon, Laboratoire de Biochimie, Paris, France
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, Paris, France
- *Correspondence: Mathieu Boissan
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Soulat-Dufour L, Lang S, Addetia K, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Jean ML, Nhan P, Ben Said R, Kamami I, Issaurat P, Capderou E, Arnaud C, Boccara F, Lang RM, Cohen A. Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol 2022; 79:951-961. [PMID: 35272799 DOI: 10.1016/j.jacc.2021.12.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [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: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac chamber remodeling in atrial fibrillation (AF) reflects the progression of cardiac rhythm and may affect functional regurgitation. OBJECTIVES The purpose of this study was to explore the 3-dimensional echocardiographic variables of cardiac cavity remodeling and the impact on functional regurgitation in patients with AF with/without sinus rhythm restoration at 12 months. METHODS A total of 117 consecutive patients hospitalized for AF were examined using serial 3-dimensional transthoracic echocardiography at admission, at 6 months, and at 12 months (337 examinations). RESULTS During follow-up, 47 patients with active restoration of sinus rhythm (SR) (through cardioversion and/or ablation) had a decrease in all atrial indexed volumes (Vi), end-systolic (ES) right ventricular (RV) Vi, an increase in end-diastolic (ED) left ventricular Vi, and an improvement in 4-chambers function (P < 0.05). Patients with absence/failure of restoration of SR (n = 39) had an increase in ED left atrial Vi and ED/ES RV Vi without modification of 4-chambers function, except for a decrease in left atrial emptying fraction (P < 0.05). Patients with spontaneous restoration of SR (n = 31) had no changes in Vi or function. The authors found an improvement vs baseline in severity of functional regurgitation in patients with active restoration of SR (tricuspid and mitral regurgitation) and in spontaneous restoration of SR (tricuspid regurgitation) (P < 0.05). In multivariable analysis, right atrial and/or left atrial reverse remodeling exclusively correlated with intervention (cardioversion and/or ablation) during 12-month follow-up. CONCLUSIONS Management of AF should focus on restoration of SR to induce anatomical (all atrial Vi, ES RV Vi) and/or functional (4 chambers) cardiac cavity reverse remodeling and reduce severity of functional regurgitation. (Thromboembolic and Bleeding Risk Stratification in Patients With Non-valvular Atrial Fibrillation [FASTRHAC]; NCT02741349).
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Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France. https://twitter.com/lsoulatdufour
| | - Sylvie Lang
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Karima Addetia
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Stephane Ederhy
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | - Marion Chauvet-Droit
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Marie-Liesse Jean
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pascal Nhan
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Rim Ben Said
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Iris Kamami
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pauline Issaurat
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Elodie Capderou
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Camille Arnaud
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Franck Boccara
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Sorbonne Université, GRC n°22, C(2)MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France.
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Karagodin I, Carvalho Singulane C, Descamps T, Woodward GM, Xie M, Tucay ES, Sarwar R, Vasquez-Ortiz ZY, Alizadehasl A, Monaghan MJ, Ordonez Salazar BA, Soulat-Dufour L, Mostafavi A, Moreo A, Citro R, Narang A, Wu C, Addetia K, Tude Rodrigues AC, Lang RM, Asch FM. Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-Up of The World Alliance Societies of Echocardiography (WASE-COVID) Study. J Am Soc Echocardiogr 2021; 35:295-304. [PMID: 34752928 PMCID: PMC8572036 DOI: 10.1016/j.echo.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/15/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Abstract
Background COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection. Methods Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyzable, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardiographic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function. Results For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not significantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a significant reduction of LVEF at follow-up (74.3% ± 3.1% vs 64.4% ± 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% ± 5.9% vs 49.3% ± 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<−18%) at baseline had a significant reduction of LVLS at follow-up (−21.6% ± 2.6% vs −20.3% ± 4.0%, P = .006), while patients with impaired LVLS at baseline had a significant improvement at follow-up (−14.5% ± 2.9% vs −16.7% ± 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>−20%) at baseline had significant improvement at follow-up (−15.2% ± 3.4% vs −17.4% ± 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 ± 0.7 cm vs 4.6 ± 0.6 cm, P = .019). Conclusions Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.
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Affiliation(s)
| | | | | | | | - Mingxing Xie
- Union Hospital, Tongji Medical College of HUST, Wuhan, P.R. of China
| | | | - Rizwan Sarwar
- Ultromics Ltd, Oxford, UK; Experimental Therapeutics, Radcliffe Department of Medicine, University of Oxford, UK
| | - Zuilma Y Vasquez-Ortiz
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran (INCMNSZ), Ciudad de Mexico, Mexico
| | - Azin Alizadehasl
- Rajaie Cardiovascular Medical and Research Center, Echocardiography Research Center, IUMS, Tehran, Iran
| | | | | | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, FR
| | - Atoosa Mostafavi
- Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Chun Wu
- Union Hospital, Tongji Medical College of HUST, Wuhan, P.R. of China
| | | | - Ana C Tude Rodrigues
- Radiology institute of the University of Sao Paulo Medical School, São Paulo, Brazil
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10
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Vandestienne M, Zhang Y, Santos-Zas I, Al-Rifai R, Joffre J, Giraud A, Laurans L, Esposito B, Pinet F, Bruneval P, Raffort J, Lareyre F, Vilar J, Boufenzer A, Guyonnet L, Guerin C, Clauser E, Silvestre JS, Lang S, Soulat-Dufour L, Tedgui A, Mallat Z, Taleb S, Boissonnas A, Derive M, Chinetti G, Ait-Oufella H. TREM-1 orchestrates angiotensin II-induced monocyte trafficking and promotes experimental abdominal aortic aneurysm. J Clin Invest 2021; 131:142468. [PMID: 33258804 DOI: 10.1172/jci142468] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 07/23/2020] [Accepted: 11/20/2020] [Indexed: 01/16/2023] Open
Abstract
The triggering receptor expressed on myeloid cells 1 (TREM-1) drives inflammatory responses in several cardiovascular diseases but its role in abdominal aortic aneurysm (AAA) remains unknown. Our objective was to explore the role of TREM-1 in a mouse model of angiotensin II-induced (AngII-induced) AAA. TREM-1 expression was detected in mouse aortic aneurysm and colocalized with macrophages. Trem1 gene deletion (Apoe-/-Trem1-/-), as well as TREM-1 pharmacological blockade with LR-12 peptide, limited both AAA development and severity. Trem1 gene deletion attenuated the inflammatory response in the aorta, with a reduction of Il1b, Tnfa, Mmp2, and Mmp9 mRNA expression, and led to a decreased macrophage content due to a reduction of Ly6Chi classical monocyte trafficking. Conversely, antibody-mediated TREM-1 stimulation exacerbated Ly6Chi monocyte aorta infiltration after AngII infusion through CD62L upregulation and promoted proinflammatory signature in the aorta, resulting in worsening AAA severity. AngII infusion stimulated TREM-1 expression and activation on Ly6Chi monocytes through AngII receptor type I (AT1R). In human AAA, TREM-1 was detected and TREM1 mRNA expression correlated with SELL mRNA expression. Finally, circulating levels of sTREM-1 were increased in patients with AAA when compared with patients without AAA. In conclusion, TREM-1 is involved in AAA pathophysiology and may represent a promising therapeutic target in humans.
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Affiliation(s)
- Marie Vandestienne
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Yujiao Zhang
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Icia Santos-Zas
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Rida Al-Rifai
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Jeremie Joffre
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Andreas Giraud
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Ludivine Laurans
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Bruno Esposito
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | | | - Patrick Bruneval
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France.,Department of Anatomopathology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Juliette Raffort
- Université Côte d'Azur, Centre Hospitalo-Universitaire (CHU), INSERM, C3M, Nice, France
| | - Fabien Lareyre
- Université Côte d'Azur, Centre Hospitalo-Universitaire (CHU), INSERM, C3M, Nice, France
| | - Jose Vilar
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | | | - Lea Guyonnet
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Institut Curie, Cytometry Platform F-75006, Paris, France.,Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Coralie Guerin
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Institut Curie, Cytometry Platform F-75006, Paris, France.,Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Eric Clauser
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | | | - Sylvie Lang
- Cardiology Department, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Laurie Soulat-Dufour
- Cardiology Department, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Alain Tedgui
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Ziad Mallat
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France.,Department of Medicine, Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Soraya Taleb
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Alexandre Boissonnas
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses Cimi-Paris, Paris, France
| | | | - Giulia Chinetti
- Université Côte d'Azur, Centre Hospitalo-Universitaire (CHU), INSERM, C3M, Nice, France
| | - Hafid Ait-Oufella
- Université de Paris, Inserm U970, Paris-Cardiovascular Research Center, Paris, France.,Medical Intensive Care Unit, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
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11
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Cohen A, Donal E, Delgado V, Pepi M, Tsang T, Gerber B, Soulat-Dufour L, Habib G, Lancellotti P, Evangelista A, Cujec B, Fine N, Andrade MJ, Sprynger M, Dweck M, Edvardsen T, Popescu BA. EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:e24-e57. [PMID: 33709114 DOI: 10.1093/ehjci/jeab008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
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Affiliation(s)
- Ariel Cohen
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20141, Milan, Italy
| | - Teresa Tsang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvainAv Hippocrate 10/2803, B-1200 Brussels, Belgium
| | - Laurie Soulat-Dufour
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Arturo Evangelista
- Servei de Cardiologia. Hospital Universitari Vall d'Hebron-VHIR. CIBER-CV. Pº Vall d'Hebron 119. 08035. Barcelona. Spain
| | - Bibiana Cujec
- Division of Cardiology, University of Alberta, 2C2.50 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, Alberta, Canada T6G 2B7
| | - Nowell Fine
- University of Calgary, Libin Cardiovascular Institute, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Maria Joao Andrade
- Maria Joao Andrade Cardiology Department, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos 2790-134 Carnaxide, Portugal
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Marc Dweck
- British Heart Foundation, Centre for Cardiovascular Science, Edinburgh and Edinburgh Imaging Facility QMRI, University of Edinburgh, United Kingdom
| | - Thor Edvardsen
- Faculty of medicine, Oslo University, Oslo, Norway and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila', Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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12
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Soulat-Dufour L, Lang S, Ederhy S, Adavane-Scheuble S, Chauvet Droit M, Nhan P, Jean M, Kamami I, Arnaud C, Capderou E, Issaurat P, Ben Said R, Boccara F, Cohen A. Three dimensional right cardiac cavities remodeling and functional tricuspid regurgitation at one year follow up in patients with atrial fibrillation. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Karagodin I, Carvalho Singulane C, Woodward GM, Xie M, Tucay ES, Tude Rodrigues AC, Vasquez-Ortiz ZY, Alizadehasl A, Monaghan MJ, Ordonez Salazar BA, Soulat-Dufour L, Mostafavi A, Moreo A, Citro R, Narang A, Wu C, Descamps T, Addetia K, Lang RM, Asch FM. Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study. J Am Soc Echocardiogr 2021; 34:819-830. [PMID: 34023454 PMCID: PMC8137346 DOI: 10.1016/j.echo.2021.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 02/24/2021] [Revised: 05/01/2021] [Accepted: 05/01/2021] [Indexed: 12/14/2022]
Abstract
Background The novel severe acute respiratory syndrome coronavirus-2 virus, which has led to the global coronavirus disease-2019 (COVID-19) pandemic is known to adversely affect the cardiovascular system through multiple mechanisms. In this international, multicenter study conducted by the World Alliance Societies of Echocardiography, we aim to determine the clinical and echocardiographic phenotype of acute cardiac disease in COVID-19 patients, to explore phenotypic differences in different geographic regions across the world, and to identify parameters associated with in-hospital mortality. Methods We studied 870 patients with acute COVID-19 infection from 13 medical centers in four world regions (Asia, Europe, United States, Latin America) who had undergone transthoracic echocardiograms. Clinical and laboratory data were collected, including patient outcomes. Anonymized echocardiograms were analyzed with automated, machine learning–derived algorithms to calculate left ventricular (LV) volumes, ejection fraction, and LV longitudinal strain (LS). Right-sided echocardiographic parameters that were measured included right ventricular (RV) LS, RV free-wall strain (FWS), and RV basal diameter. Multivariate regression analysis was performed to identify clinical and echocardiographic parameters associated with in-hospital mortality. Results Significant regional differences were noted in terms of patient comorbidities, severity of illness, clinical biomarkers, and LV and RV echocardiographic metrics. Overall in-hospital mortality was 21.6%. Parameters associated with mortality in a multivariate analysis were age (odds ratio [OR] = 1.12 [1.05, 1.22], P = .003), previous lung disease (OR = 7.32 [1.56, 42.2], P = .015), LVLS (OR = 1.18 [1.05, 1.36], P = .012), lactic dehydrogenase (OR = 6.17 [1.74, 28.7], P = .009), and RVFWS (OR = 1.14 [1.04, 1.26], P = .007). Conclusions Left ventricular dysfunction is noted in approximately 20% and RV dysfunction in approximately 30% of patients with acute COVID-19 illness and portend a poor prognosis. Age at presentation, previous lung disease, lactic dehydrogenase, LVLS, and RVFWS were independently associated with in-hospital mortality. Regional differences in cardiac phenotype highlight the significant differences in patient acuity as well as echocardiographic utilization in different parts of the world.
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Affiliation(s)
| | | | | | - Mingxing Xie
- Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, P.R. of China
| | | | - Ana C Tude Rodrigues
- Radiology institute of the University of Sao Paulo Medical School, São Paulo, Brazil
| | - Zuilma Y Vasquez-Ortiz
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran (INCMNSZ), Ciudad de Mexico, Mexico
| | - Azin Alizadehasl
- Rajaie Cardiovascular Medical and Research Center, Echocardiography Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Bayardo A Ordonez Salazar
- Centro Medico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Ciudad de Mexico, Mexico
| | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, FR
| | - Atoosa Mostafavi
- Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Chun Wu
- Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, P.R. of China
| | | | | | | | - Federico M Asch
- MedStar Health Research Institute, Washington District of Columbia.
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14
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Soulat-Dufour L, Fauvel C, Weizman O, Barbe T, Pezel T, Mika D, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Duceau B, Sutter W, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Trimaille A, Bonnet G, Canu M, Coisne A, Cohen A. Prognostic value of right ventricular dilatation in patients with COVID-19: a multicentre study. Eur Heart J Cardiovasc Imaging 2021; 23:569-577. [PMID: 34008835 PMCID: PMC8600376 DOI: 10.1093/ehjci/jeab067] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/23/2020] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Aims Although cardiac involvement has prognostic significance in coronavirus disease 2019 (COVID-19) and is associated with severe forms, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19. Methods and results Consecutive patients with COVID-19 admitted to 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Among 2878 patients, 445 (15%) underwent TTE. Most of these had cardiovascular risk factors, a history of cardiovascular disease, and were on cardiovascular treatments. Dilatation and dysfunction were observed in, respectively, 12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV). Primary composite outcome occurred in 44% (n = 196) of patients [9% (n = 42) for death without ICU transfer and 35% (n = 154) for admission to ICU]. RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex [hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.09 − 2.25; P = 0.02], higher body mass index (HR 1.10, 95% CI 1.02 − 1.18; P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 − 0.86; P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 − 2.64; P = 0.03) remained independently associated with the primary outcome. Conclusion Echocardiographic evaluation of RV dilatation could be useful for assessing risk of severe COVID-19 developing in hospitalized patients.
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Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, F76000 Rouen, France
| | - Orianne Weizman
- Department of Cardiology, Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France.,Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Thomas Barbe
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, F76000 Rouen, France
| | - Théo Pezel
- Department of Cardiology, Lariboisiere Hospital, APHP, University of Paris, 75010 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Joffrey Cellier
- Department of Cardiology, Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Department of Cardiology, Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Vassili Panagides
- Department of Cardiology, Aix-Marseille Université, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Wassima Marsou
- Department of Cardiology, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Antoine Deney
- Departement of Cardiology, Rangueil University Hospital, Toulouse, France" et "Institute of Cardiovascular and Metabolic Diseases, National Institute of Health and Medical Research (INSERM), UMR-1048 Toulouse, France
| | - Sabir Attou
- Department of Cardiology, Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Department of Cardiology, Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | - Sophie Ribeyrolles
- Department of Cardiology, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Pascale Chemaly
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, 91300 Massy, France
| | - Clement Karsenty
- Paediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse University, France
| | - Gauthier Giordano
- Department of Cardiology, Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Alexandre Gautier
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, 91300 Massy, France
| | | | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Corentin Chaumont
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, F76000 Rouen, France
| | - Pierre Guilleminot
- Department of Cardiology, Centre Hospitalier Universitaire de Dijon, 21079 Dijon, France
| | - Audrey Sagnard
- Department of Cardiology, Centre Hospitalier Universitaire de Dijon, 21079 Dijon, France
| | - Julie Pastier
- Paediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse University, France
| | - Antonin Trimaille
- Department of Cardiology, Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France.,Department of Cardiology, Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Marjorie Canu
- Department of Cardiology, University Hospital, CHU Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography-Heart Valve Center. University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, France
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15
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Ederhy S, Salem JE, Dercle L, Hasan AS, Chauvet-Droit M, Nhan P, Ammari S, Pinna B, Redheuil A, Boussouar S, Champiat S, Soulat-Dufour L, Cohen A. Role of Cardiac Imaging in the Diagnosis of Immune Checkpoints Inhibitors Related Myocarditis. Front Oncol 2021; 11:640985. [PMID: 34055610 PMCID: PMC8158154 DOI: 10.3389/fonc.2021.640985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) have constituted a paradigm shift in the management of patients with cancer. Their administration is associated with a new spectrum of immune-related toxicities that can affect any organ. In patients treated with ICI, cardiovascular toxicities, particularly myocarditis, occur with a low incidence (<1%) but with a high fatality rate (30-50%). ICI-related myocarditis has been attributed to an immune infiltration, comprising of T-cells that are positive for CD3+, CD4+, CD8+, and macrophages that are positive for CD68. The diagnosis remains challenging and is made based on clinical syndrome, an electrocardiogram (ECG), biomarker data, and imaging criteria. In most clinical scenarios, endomyocardial biopsy plays a pivotal role in diagnosis, while cardiac magnetic resonance imaging (cMRI) has limitations that should be acknowledged. In this review, we discuss the role of medical imaging in optimizing the management of ICI related myocarditis, including diagnosis, prognostication, and treatment decisions.
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Affiliation(s)
- Stéphane Ederhy
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
| | - Joe-Elie Salem
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM CIC-1901, AP-HP.Sorbonne, Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
- Unité INSERM UMRS-ICAN 1166, Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, Sorbonne Universités, Paris, France
- Division of Medicine and Pharmacology, Cardio-oncology program, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laurent Dercle
- Department of Radiology, New York Presbyterian, Columbia University Irving Medical Center, New York, NY, United States
| | - Abrar Saqif Hasan
- Department of Internal Medicine, Montefiore/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Marion Chauvet-Droit
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Pascal Nhan
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Samy Ammari
- Radiology Department, Gustave Roussy Cancer Campus, Villejuif, France
- BIOMAPS, UMR1281, INSERM.CEA.CNRS, Université Paris-Saclay, Paris, France
| | - Bruno Pinna
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
| | - Alban Redheuil
- LIB Biomedical Imaging Laboratory INSERM, CNRS, ICT Cardiothoracic Imaging Unit & Radiology Department, ICAN Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, Paris, France
| | - Samia Boussouar
- LIB Biomedical Imaging Laboratory INSERM, CNRS, ICT Cardiothoracic Imaging Unit & Radiology Department, ICAN Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, Paris, France
| | - Stephane Champiat
- Drug Development Department (DITEP), Institut Gustave Roussy, Villejuif, France
| | - Laurie Soulat-Dufour
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Ariel Cohen
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
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Ederhy S, Benhamou-Tarallo I, Chauvet-Droit M, Nhan P, Cohen R, Pinna B, Cholet C, Fenioux C, Champiat S, Salem JE, Soulat-Dufour L, Cohen AA. Cardiotoxicity Related to Immune Checkpoint Inhibitors. Curr Treat Options Cardio Med 2021. [DOI: 10.1007/s11936-020-00878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Soulat-Dufour L, Addetia K, Miyoshi T, Citro R, Daimon M, Fajardo PG, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Diehl M, Schreckenberg M, Mor-Avi V, Asch FM, Lang RM. Normal Values of Right Atrial Size and Function According to Age, Sex, and Ethnicity: Results of the World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr 2020; 34:286-300. [PMID: 33212183 DOI: 10.1016/j.echo.2020.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 09/23/2020] [Revised: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The World Alliance Societies of Echocardiography study is a multicenter, international, prospective, cross-sectional study whose aims were to evaluate healthy adult individuals to establish age- and sex-normative values of echocardiographic parameters and to determine whether differences exist among people from different countries and of different ethnicities. The present report focuses on two-dimensional (2D) and three-dimensional (3D) right atrial (RA) size and function. METHODS Transthoracic 2D and 3D echocardiographic images were obtained in 2,008 healthy adult individuals evenly distributed among subgroups according to sex (1,033 men, 975 women) and age 18 to 40 years (n = 854), 41 to 65 years (n = 653), and >65 years (n = 501). For ethnicity, 34.9% were white, 41.6% Asian, and 9.7% black. Images were analyzed in a core laboratory according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. RA measurements included 2D dimensions, 2D and 3D RA volumes (RAVs) indexed to body surface area (BSA), emptying fraction (EmF), and global longitudinal strain, including total/reservoir, passive/conduit, and active/contractile phases. Differences among age and sex categories and among countries were also examined. RESULTS RAVs were larger in men (even after BSA indexing), while 3D total EmF and global longitudinal strain magnitudes were higher in women. For both sexes, there were no significant age-related differences in 2D RAV measurements, but 3D RAV values differed minimally with age, remaining significant after BSA indexing. RA total EmF and reservoir strain and passive EmF and conduit strain magnitude were lower in older groups for both sexes. Interestingly, whereas RA active EmF increased with age, contractile strain magnitude decreased. Considerable geographic variations were identified: Asians of both sexes had significantly lower BSA than non-Asians, and their 2D and 3D end-systolic RAVs were significantly smaller even after BSA indexing. Of note, 2D end-systolic RAVs in this group were considerably lower than normal values provided in the current guidelines. CONCLUSIONS There is significant sex, age, and geographic variability in normal RA size and function parameters. Current guideline-recommended normal ranges for RA size and function parameters should be adjusted geographically on the basis of the results of this study.
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Affiliation(s)
| | | | - Tatsuya Miyoshi
- MedStar Health Research Institute, Washington, District of Columbia
| | | | | | | | | | | | | | - Denisa Muraru
- University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | | | - Seung Woo Park
- Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Yun Zhang
- Qilu Hospital of Shandong University, Jinan, China
| | - Markus Diehl
- TOMTEC Imaging Systems, Unterschleissheim, Germany
| | | | | | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
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Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Scheuble A, Boccara F, Addetia K, Lang R, Cohen A. Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed.
Purpose
Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus.
Methods
We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M.
Results
At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p<0.001 for 2D ED TA diameter; ρ=0.34, p<0.005 for 3D ES RA Vi; ρ=0.33, p<0.005 for 3D ED RV Vi; ρ=0.29, p<0.005 for 3D ES RV Vi).
Conclusion
Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted.
TR Evolution
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | | | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - M Jean
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - A Scheuble
- Centre Cardiologique du Nord, Saint Denis, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936, Paris, France
| | - K Addetia
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - R Lang
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
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Philabout P, Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Boccara F, Addetia K, Lang R, Cohen A. Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome.
Purpose
To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6).
Methods
In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7)
Results
In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure).
Conclusion
Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm.
Evolution of strain between M0 and M6
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Philabout
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | | | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - M Jean
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936, Paris, France
| | - K Addetia
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - R Lang
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
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Soulat-Dufour L, Lang S, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean ML, Ben Said R, Issaurat P, Boccara F, Cohen A. Left ventricular ejection fraction: An additional risk marker in COVID-19. Arch Cardiovasc Dis 2020; 113:760-762. [PMID: 33187875 PMCID: PMC7571962 DOI: 10.1016/j.acvd.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Laurie Soulat-Dufour
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France; Inserm UMRS-ICAN 1166, "Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition", 75013 Paris, France
| | - Sylvie Lang
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France
| | - Stephane Ederhy
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France; Inserm UMRS-ICAN 1166, "Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition", 75013 Paris, France
| | - Saroumadi Adavane-Scheuble
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France
| | - Marion Chauvet-Droit
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France
| | - Pascal Nhan
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France
| | - Marie-Liesse Jean
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France
| | - Rim Ben Said
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France
| | - Pauline Issaurat
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France
| | - Franck Boccara
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France; Inserm, UMR S 938, Centre de Recherche Saint-Antoine, 75012 Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, Sorbonne-Universités, 75012 Paris, France; Inserm UMRS-ICAN 1166, "Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition", 75013 Paris, France.
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Karagodin I, Addetia K, Singh A, Dow A, Rivera L, DeCara JM, Soulat-Dufour L, Yamat M, Kruse E, Shah AP, Mor-Avi V, Lang RM. Improved Delineation of Cardiac Pathology Using a Novel Three-Dimensional Echocardiographic Tissue Transparency Tool. J Am Soc Echocardiogr 2020; 33:1316-1323. [PMID: 32972777 DOI: 10.1016/j.echo.2020.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Accurate visualization of cardiac valves and lesions by three-dimensional (3D) echocardiography is integral for optimal guidance of structural procedures and appropriate selection of closure devices. A new 3D rendering tool known as transillumination (TI), which integrates a virtual light source into the data set, was recently reported to effectively enhance depth perception and orifice definition. We hypothesized that adding the ability to adjust transparency to this tool would result in improved visualization and delineation of anatomy and pathology and improved localization of regurgitant jets compared with TI without transparency and standard 3D rendering. METHODS We prospectively studied 30 patients with a spectrum of structural heart disease who underwent 3D transesophageal imaging (EPIQ system, Philips) with standard acquisition and TI with and without the transparency feature. Six experienced cardiologists and sonographers were shown randomized images of all three display types in a blinded fashion. Each image was scored independently by all experts using a Likert scale from 1 to 5, while assessing each of the following aspects: (1) ability to recognize anatomy, (2) ability to identify pathology, including regurgitant jet origin, (3) depth perception, and (4) quality of border delineation. RESULTS TI images with transparency were successfully obtained in all cases. All experts perceived an incremental value of the transparency mode, compared with TI without transparency and standard 3D rendering, in terms of ability to recognize anatomy (respective scores: 4.5 ± 1.1 vs 4.1 ± 1.1 vs 3.6 ± 1.1, P < .05), ability to identify pathology (4.1 ± 1.1 vs 3.9 ± 1.2 vs 3.3 ± 1, P < .05), depth perception (4.6 ± 0.7 vs 4.1 ± 0.8 vs 3.2 ± 1.0, P < .05), and border delineation (4.6 ± 0.8 vs 4.1 ± 1.0 vs 3.1 ± 1.1, P < .05). CONCLUSIONS The addition of the transparency mode to TI rendering significantly improves the diagnostic and clinical utility of 3D echocardiography and has the potential to markedly enhance echocardiographic guidance of cardiac structural interventions.
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Affiliation(s)
- Ilya Karagodin
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Karima Addetia
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Amita Singh
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | | | - Jeanne M DeCara
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Laurie Soulat-Dufour
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois; Sorbonne University, APHP, Paris, France
| | - Megan Yamat
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Eric Kruse
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Atman P Shah
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Victor Mor-Avi
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
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Ancedy Y, Ederhy S, Jean ML, Nhan P, Soulat-Dufour L, Adavane-Scheuble S, Chauvet-Droit M, Boccara F, Cohen A. Does layer-specific strain using speckle tracking echocardiography improve the assessment of left ventricular myocardial deformation? A review. Arch Cardiovasc Dis 2020; 113:721-735. [PMID: 32891564 DOI: 10.1016/j.acvd.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
An increasing number of studies of left ventricular myocardial deformation have been published. Layer-specific strain using speckle tracking echocardiography to evaluate left ventricular function is not recommended in clinical practice. However, evaluation of myocardial mechanics using longitudinal and circumferential layer-specific strain enables the detection of subclinical impairment of myocardial deformation in various diseases. Unfortunately, normal values for longitudinal and circumferential strain have not been clearly defined. In normal subjects, layer-specific strain decreases from the endocardial to the epicardial layer, and from the apex to the base of the left ventricle. Although various studies have tried to define normal values for each layer in healthy subjects, studies with more subjects are needed. This tool has good reproducibility in terms of intraobserver and interobserver variability, but, as with monolayer strain, it has poor intervendor variability. Efforts that aim for standardization between vendors will be required before widespread use of this technique can be advocated.
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Affiliation(s)
- Yann Ancedy
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Stephane Ederhy
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Marie-Liesse Jean
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Pascal Nhan
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Laurie Soulat-Dufour
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Saroumadi Adavane-Scheuble
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Marion Chauvet-Droit
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Franck Boccara
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France.
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Soulat-Dufour L, Cohen A, Singh A, DeCara JM, Mor-Avi V, Ward P, Kruse E, Upadhyay GA, Aziz Z, Beaser AD, Broman M, Tung R, Lang S, Lang R, Addetia K. CHAMBER REMODELING AFTER SUCCESSFUL CARDIOVERSION FOR ATRIAL FIBRILLATION AND IMPACT ON TRICUSPID REGURGITATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ancedy Y, Gallo A, Ederhy S, Adavane-Scheuble S, Soulat-Dufour L, Nhan P, Chauvet-Droit M, Saheb S, Bruckert E, Cohen A, Boccara F. AORTIC VALVULAR DISEASE IN FAMILIAL HYPERCHOLESTEROLEMIA ADULT PATIENTS RECEIVING LDL APHERESIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ancedy Y, Moussaoui A, Lapidus N, Ederhy S, Adavane-Scheuble S, Soulat-Dufour L, Nhan P, Boccara F, Cohen A. NORMAL VALUES OF LEFT VENTRICULAR LONGITUDINAL AND CIRCUMFERENTIAL LAYER SPECIFIC STRAIN A META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chalard C, Soulat-Dufour L, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Ben Said R, Boccara F, Cohen A. P350 Right atrial remodelling in atrial fibrillation using three dimensional transthoracic echocardiography and strain imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Evaluation of right atrial cavities and right atrial (RA) remodelling in atrial fibrillation (AF) has been poorly studied.
Purpose
The aim of this study was to evaluate in AF, the role of three-dimensional (3D) transthoracic echocardiography (TTE) and strain to refine the evaluation of the RA according to evolution of cardiac rhythm ad mid-term follow-up.
Methods
A complete 2D and 3D TTE was performed in patient hospitalized for AF. In addition to the usual parameters, RA parameters were specifically assessed: 3D RA end-systolic (ES) and end-diastolic (ED) volume, RA ejection fraction (EF) and the global longitudinal strain (GLS) of the RA. A complete clinical evaluation and electrocardiogram were performed at admission (M0) and 6 months after inclusion (M6) to determine the cardiac rhythm at follow-up.
Results
34 consecutive patients hospitalized for AF were analysed. At M0, there was no significant difference between 2D RA ES volume and the 3D RA ES volume. Three groups of patients were individualized according to cardiac rhythm at M0 and M6: AF at M0 and AF at M6 (AF-AF), AF at M0 and sinus rhythm (SR) at M6 (AF-SR), SR at M0 (spontaneous reduction before the admission ECG) and SR at M6 (SR-SR). At M0 echocardiography, in the AF-AF group and AF-SR in comparison with SR-SR group were as follow: the 3D RA ED volume was significantly higher (respectively 21.6 (18.2-26.6) and 26.9 (19.4-36.8) versus 11.3 (6.9-16.6) mL/m2 ; p = 0.0025), the 3D RAEF was significantly lower (42.2 (35.1-44.7) and 34.5 (24.1-38.6) versus 57.6 (53.4-62.2)%; p = 0.0105) and the RA GLS was also significantly lower (7.6 (6.5-10.5) and 9.1 (5.8-11.2) versus 26.6 (22.0-35.0)%; p = 0.0001) (Figure 1).
Conclusion
3D ultrasound and strain could be useful tools for evaluating the anatomical and functional RA remodelling in AF, to be further validated in a larger ongoing study.
Abstract P350 Figure 1
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Affiliation(s)
- C Chalard
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166 , Paris, France
| | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166 , Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936 , Paris, France
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166 , Paris, France
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Nhan P, Ederhy S, Soulat-Dufour L, Ancedy Y, Chauvet-Droit M, Adavane-Scheublé S, Ben Said R, Lajus M, Boccara F, Cohen A. [Cardiovascular imaging in heart failure]. Presse Med 2019; 48:1406-1415. [PMID: 31761606 DOI: 10.1016/j.lpm.2019.09.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/02/2019] [Accepted: 09/30/2019] [Indexed: 01/15/2023] Open
Abstract
Transthoracic echocardiography remains the first-line cardiac imaging for diagnosis, management and screening of heart failure, whatever its phenotype (heart failure with reduced, mid-range and preserved ejection fraction). It allows anatomic characterization, systolic and diastolic functions of left and right ventricles assessment, intracardiac hemodynamic evaluation and for the assessment of valve disease. Myocardial deformation imaging (strain) is indicated in patients with heart failure for the assessment of systolic ventricles function and the diagnosis of specific heart diseases. Strain is indicated for the screening of preclinical myocardial dysfunction in patients at risk or exposed to cardiotoxic treatment. Altered global longitudinal strain is associated with a poor prognosis in heart failure. Cardiac magnetic resonance is recommended for the assessment of myocardial structure and function in subjects with poor acoustic window and patients with complex congenital heart diseases, in order to distinguish between ischemic and non-ischemic myocardial damage in patients with dilated cardiopathy and to characterize myocardial tissue in case of suspected specific heart disease.
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Affiliation(s)
- Pascal Nhan
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Stéphane Ederhy
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Laurie Soulat-Dufour
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Yann Ancedy
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Marion Chauvet-Droit
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Saroumadi Adavane-Scheublé
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Rim Ben Said
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Mathieu Lajus
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Franck Boccara
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Ariel Cohen
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de cardiologie, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France.
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Boccara F, Lang S, Ederhy S, Soulat-Dufour L, Adavane-Scheuble S, Ancedy Y, Chauvet M, Nhan P, Meynard JL, Valantin MA, Slama L, Pialoux G, Katlama C, Girard PM, Cohen A. P5338Atherosclerotic cardiovascular events in people living with Human Immunodeficiency Virus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
People living with Human Immunodeficiency Virus (PLWHIV) under antiretrovirals have an increased risk of atherosclerotic cardiovascular disease (ASCVD) events. The risk factors associated with ASCVD events in this high risk population are various including traditional vascular risk factors and specific HIV-related factors. However their respective influence is questionable.
Purpose
Our aim was to determine the incidence of ASCVD events in a large cohort of PLWHIV and to identify the risk factors associated.
Methods
We conducted a longitudinal observational cohort study of asymptomatic PLWHIV at high risk of ASCVD addressed to our preventive cardiovascular unit for non-invasive cardiovascular evaluation. The first ASCVD event was censored and included CV death, acute coronary syndromes, coronary and peripheral revascularizations (PCI or CABG or endarterectomy or limb procedures) and ischemic strokes.
Results
From January 2003 to December 2014, 763 consecutive asymptomatic PLWHIV were enrolled (mean age of 51.3±8.3 years, 87% men, 90% were free of known coronary artery disease, mean Left ventricular ejection fraction 60%). At baseline, traditional CV risk factors were as follow: 54% had dyslipidemia, 43% hypertension, 35% were active smokers, 22% had family history of CAD and 11% were diabetics. Statins were prescribed in 38% of the cohort, aspirin in 14%, clopidogrel in 14% betablockers in 14%, RAS blockers in 32%, Calcium channel blockers in 8%. At baseline, median duration of HIV seropositivity was 19.8 years (14.0–23.6), 94% were under ARV predominantly protease inhibitors (68%). Median CD4 cell count was 545/mm3 (404–745) and 92% had undetectable HIV viral load. During a median follow up of 5.8 years (3.7–8.7), 58 (7.3%) subjects had a first ASCVD event (incidence of 12.70 [9.78–16.51] per 1000 persons-years) including 5 cardiovascular deaths, 14 ACS, 20 coronary revascularizations, 13 peripheral vascular procedures and 6 strokes) with a median time of occurrence of 3.1 years (1.5–5.1). CV death (first and second ASCVD events) occurred in 8 patients (22%) after CV death related to malignancies (33%) but before deaths related to unexplained causes (21%), infectious disease (13%), liver disease (8%) and suicides (3%). Coronary events including coronary death, MI, and coronary revascularization occurred in 39 patients (5.2%); Incidence of 8.28 [6.00–11.43] per 1000 persons-years. Conventional multivariate Cox model shows that age and tobacco were the independent risk factors associated with ACSVD events [Hazard ratio (HR) 1.04, 95% CI 0.99–1.09, p=0.05 and HR 2.17, 95% CI 1.07–4.38, p=0.03].
Conclusion
Traditional vascular risk factors (age and active smoking) are associated with the occurrence of ASCVD events predominantly coronary artery disease in our observational cohort of asymptomatic PLWIHV at high risk for ASCVD. Cardiovascular prevention including tobacco cease action is mandatory in the aging HIV population.
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Affiliation(s)
- F Boccara
- AP-HP - Hospital Saint Antoine, Paris, France
| | - S Lang
- AP-HP - Hospital Saint Antoine, Paris, France
| | - S Ederhy
- AP-HP - Hospital Saint Antoine, Paris, France
| | | | | | - Y Ancedy
- AP-HP - Hospital Saint Antoine, Paris, France
| | - M Chauvet
- AP-HP - Hospital Saint Antoine, Paris, France
| | - P Nhan
- AP-HP - Hospital Saint Antoine, Paris, France
| | - J L Meynard
- AP-HP - Hospital Saint Antoine, Paris, France
| | - M A Valantin
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - L Slama
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - G Pialoux
- Hospital Tenon, Infectious Diseases Department, Paris, France
| | - C Katlama
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - P M Girard
- AP-HP - Hospital Saint Antoine, Paris, France
| | - A Cohen
- AP-HP - Hospital Saint Antoine, Paris, France
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Soulat-Dufour L, Lang S, Ederhy S, Ancedy Y, Beraud AS, Adavane-Scheuble S, Chauvet-Droit M, Hammoudi N, Scheuble A, Nhan P, Charbonnier M, Boccara F, Cohen A. Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight. Arch Cardiovasc Dis 2019; 112:585-593. [PMID: 31540880 DOI: 10.1016/j.acvd.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/05/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial remodelling has been poorly investigated in atrial fibrillation (AF), and few studies have focused on biatrial remodelling. AIM To evaluate right atrial (RA) and left atrial (LA) remodelling in AF using global atrial reservoir strain and three-dimensional (3D) atrial volumes, according to rhythm outcome at mid-term follow-up. METHODS Two-dimensional and 3D transthoracic echocardiography (TTE) were performed within 24hours after admission (M0) and at 6-month follow-up (M6) in patients admitted for AF. RA and LA variables were assessed: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF); atrial expansion index (3D RAEI, 3D LAEI); and global RA and LA reservoir strain. RESULTS Forty-eight consecutive patients were included prospectively. Three groups were identified depending on rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) in 25 (52.1%) patients; AF at M0 and AF at M6 (AF-AF) in 13 (27.1%) patients; and SR at M0 (spontaneous cardioversion before first TTE) and SR at M6 (SR-SR) in 10 (20.8%) patients. Between M0 and M6 in the AF-SR group, we found: significant decreases in Max 3D RA Voli (P=0.020), Min 3D RA Voli (P=0.0008), Max 3D LA Voli (P=0.001) and Min 3D LA Voli (P=0.0021); significant increases in 3D RAEF (P=0.037) and 3D RAEI (P=0.034); no significant differences in 3D LAEF and 3D LAEI; and significant increases in global RA and LA reservoir strain (both P<0.0001). There was no significant difference with regard to these variables in the AF-AF and SR-SR groups. CONCLUSION 3D volume and strain analyses were useful in the evaluation of RA and LA reverse remodelling in successfully cardioverted patients with AF.
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Affiliation(s)
- Laurie Soulat-Dufour
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France
| | - Sylvie Lang
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Stephane Ederhy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Yann Ancedy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | | | - Saroumadi Adavane-Scheuble
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Marion Chauvet-Droit
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Nadjib Hammoudi
- Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France; Service de cardiologie, Sorbonne universités, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | | | - Pascal Nhan
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Magali Charbonnier
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Franck Boccara
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Inserm, UMR S 938, centre de recherche Saint-Antoine, 75012 Paris, France
| | - Ariel Cohen
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France.
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Coisne A, Dreyfus J, Bohbot Y, Pelletier V, Collette E, Cescau A, Cariou E, Alexandrino C, Coulibaly S, Seemann A, Karsenty C, Theron A, Caspar T, Soulat-Dufour L, Ternacle J. Transoesophageal echocardiography current practice in France: A multicentre study. Arch Cardiovasc Dis 2018; 111:730-738. [PMID: 30539734 DOI: 10.1016/j.acvd.2018.03.014] [Citation(s) in RCA: 4] [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: 12/16/2017] [Revised: 01/29/2018] [Accepted: 03/20/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few data are available on the application of transoesophageal echocardiography (TOE) recommendations in daily practice. AIMS To evaluate TOE practice based on echocardiography societies' guidelines, and to determine complication rates and factors associated with patient feelings. METHODS Between April and June 2017, we prospectively included all consecutive patients referred to 14 French hospitals for a transoesophageal echocardiogram (TOE). A survey was taken just after the examination, which included questions about pre-procedural anxiety, and any pain, unpleasant feeling or breathing difficulties experienced during the examination. RESULTS Overall, 1718 TOEs were performed, mainly for stroke evaluation. A standardized operating procedure checklist was completed in half of the patients before the examination. TOE was unpleasant for 62.4% of patients, but was stopped for agitation or intolerance in 3.5 and 1.4% of cases, respectively. We observed one severe complication (pulmonary oedema). The mean TOE duration was short (9.2±4.6minutes), but was longer with residents than with more experienced physicians (11±4.7 vs. 8.8±4.7minutes for junior physicians [P=0.0027]; vs. 8.9±4.8minutes for senior physicians [P=0.0013]; and vs. 7.5±4.1minutes for associate professors/professors [P<0.0001]). The visual analogue scale (VAS) score after TOE was good (8.3±1.7 out of 10), and was better in patients with general anaesthesia (GA) than in those without GA (9.3±0.9 vs. 8.1±1.7; P<0.0001). In patients without GA, the VAS score was similar with and without local anaesthesia (8.1±1.7 vs. 8.2±1.6; P=0.19). After multivariable adjustment, absence of anxiety before TOE and greater operator experience were consistently associated with a higher VAS score. CONCLUSIONS TOE is safe, with a low rate of complications and few stops for intolerance. A shorter TOE duration and better patient feelings were observed for experienced operators, highlighting the importance of the learning curve, and paving the way for teaching on a TOE simulator.
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Affiliation(s)
- Augustin Coisne
- Department of clinical physiology and echocardiography, Heart Valve Clinic, Institut Cœur-Poumon, CHU de Lille, 59000 Lille, France.
| | - Julien Dreyfus
- Department of cardiology, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Yohann Bohbot
- Department of cardiology, Amiens University Hospital, 80054 Amiens, France
| | - Vincent Pelletier
- Department of cardiology, SOS Endocardites, Henri-Mondor Hospital, 94010 Creteil, France
| | | | - Arthur Cescau
- Department of cardiology and radiology, Lariboisière Hospital, 75010 Paris, France
| | - Eve Cariou
- Department of cardiology, CHU de Toulouse, 31059 Toulouse, France
| | | | | | - Aurélien Seemann
- NCT+ Saint Gatient Alliance, Institut Cardiologique Saint-Gatien, 37000 Tours, France
| | - Clément Karsenty
- Department of cardiology, European Hospital Georges-Pompidou, 75015 Paris, France
| | - Alexis Theron
- Department of cardiac surgery, La Timone Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Thibault Caspar
- Nouvel Hôpital Civil, Strasbourg University Hospital, 67091 Strasbourg, France
| | | | - Julien Ternacle
- Department of cardiology, SOS Endocardites, Henri-Mondor Hospital, 94010 Creteil, France
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Ederhy S, Ancedy Y, Soulat-Dufour L, Chauvet-Droit M, Cohen A. [Is cancer a factor or a marker of cardiovascular risk in women?]. Presse Med 2018; 47:780-783. [PMID: 30293849 DOI: 10.1016/j.lpm.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases and cancers are the 2 main causes of mortality in industrialized countries. Cancer and cardiovascular disease share molecular and pathophysiological mechanisms involved in both cardiovascular disease and cancer development. Some prescribed therapies for primary or secondary prevention of cardiovascular disease (statin, aspirin) may have effects on the cancer plan. Physical activity would be particularly beneficial in reducing the risk of colorectal cancer, breast and endometrial cancer in women. The control of risk factors is associated with a reduction in the incidence of cancers.
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Affiliation(s)
- Stéphane Ederhy
- AP-HP, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, Paris-Sorbonne, service de cardiologie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Yann Ancedy
- AP-HP, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, Paris-Sorbonne, service de cardiologie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Laurie Soulat-Dufour
- AP-HP, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, Paris-Sorbonne, service de cardiologie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Marion Chauvet-Droit
- AP-HP, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, Paris-Sorbonne, service de cardiologie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Ariel Cohen
- AP-HP, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, Paris-Sorbonne, service de cardiologie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France.
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Ancedy Y, Berthelot E, Lang S, Ederhy S, Boyer-Chatenet L, Di Angelantonio E, Soulat-Dufour L, Etienney A, Adavane-Scheublé S, Boccara F, Cohen A. Is von Willebrand factor associated with stroke and death at mid-term in patients with non-valvular atrial fibrillation? Arch Cardiovasc Dis 2018; 111:357-369. [PMID: 29685722 DOI: 10.1016/j.acvd.2017.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/07/2017] [Accepted: 08/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart failure and atrial fibrillation share common mechanisms that may contribute to hypercoagulability and thrombotic risk. Elevated von Willebrand factor (vWF) concentration has been associated with increased risk of thromboembolism and cardiovascular events. AIM To investigate whether increased vWF plasma concentration predicts occurrence of a composite endpoint (all-cause death and stroke) in patients with non-valvular atrial fibrillation (NVAF). METHODS We prospectively studied 122 patients (mean age 70±14years; 46% men) hospitalized with NVAF, and followed over a median (interquartile range) of 5.4 (2.3-9.0)years. Cox proportional models were used to estimate the association of vWF concentration with time to stroke and death. RESULTS Forty-three patients (35%) had at least a stroke or died during the 5-year follow-up. Kaplan-Meier curves using vWF plasma concentration tertiles (≤191IU/dL;>191 to≤295IU/dL;>295IU/dL) showed that vWF plasma concentrations discriminated groups of patients with higher cardiovascular event rates (log-rank P=0.01). In the multivariable analysis, higher vWF concentrations (middle tertile hazard ratio [HR] 4.59, 95% confidence interval [CI] 1.55-13.50 [P=0.006]; upper tertile HR 4.10, 95% CI 1.43-11.75 [P=0.009]), age≥75years (HR 5.02, 95% CI 1.53-16.49; P=0.008), heart failure (HR 2.05, 1.01-4.19; P=0.048), C-reactive protein, log2 per unit increase (HR 1.29, 95% CI 1.04-1.61; P=0.021), no warfarin at discharge (HR 4.96, 95% CI 2.02-12.20; P<0.0001) and no aspirin at discharge (HR 4.41, 95% CI 1.71-11.97; P=0.002) were independently associated with an increased risk of stroke and all-cause death, whereas female sex was a protective factor (HR 0.35, 0.16-0.78; P=0.01). CONCLUSIONS High vWF plasma concentrations may discriminate patients with NVAF at greater risk of stroke or all-cause death.
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Affiliation(s)
- Yann Ancedy
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Emmanuelle Berthelot
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Sylvie Lang
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Stéphane Ederhy
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Louise Boyer-Chatenet
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Emanuele Di Angelantonio
- Department of Public Health & Primary Care, Strangeways Research Laboratory, CB1 8RN Cambridge, UK
| | - Laurie Soulat-Dufour
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Arnaud Etienney
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Saroumadi Adavane-Scheublé
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France
| | - Franck Boccara
- Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France; Department of Public Health & Primary Care, Strangeways Research Laboratory, CB1 8RN Cambridge, UK; Centre de Recherche Saint-Antoine, Inserm, UMR S 938, 75012 Paris, France
| | - Ariel Cohen
- Service de cardiologie, hôpital Saint-Antoine, hôpitaux de l'Est parisien, AP-HP, 75012 Paris cedex 12, France; Université Pierre-et-Marie-Curie (UPMC), Sorbonne universités, 75005 Paris, France; Centre de Recherche Saint-Antoine, Inserm, UMR S 938, 75012 Paris, France; Inserm, U856, « Thrombose, Athérothrombose et Pharmacologie Appliquée », 75012 Paris, France.
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Lang S, Soulat-Dufour L, El Asri C, Boyer-Chatenet L, Ederhy S, Van der Vynckt C, Haddour N, Adavane S, Boccara F, Cohen A. SHOULD WE REFINE THE DEFINITION OF VALVULAR ATRIAL FIBRILLATION BASED ON ECHOCARDIOGRAPHIC CRITERIA? A SINGLE CENTER COHORT STUDY WITH MID-TERM FOLLOW-UP. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Etienney A, Ederhy S, Lang S, Soulat-Dufour L, Adavane-Scheuble S, Ancedy Y, Chauvet M, Boccara F, Cohen A. 0554 : Right ventricle 2D strain derived from speckle tracking imaging might help to identify patients with pulmonary embolism at low risk. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bodez D, Lang S, Meuleman C, Boyer-Châtenet L, Nguyen XL, Soulat-Dufour L, Boccara F, Fleury B, Cohen A. Left ventricular diastolic dysfunction in obstructive sleep apnoea syndrome by an echocardiographic standardized approach: An observational study. Arch Cardiovasc Dis 2015; 108:480-90. [PMID: 26068195 DOI: 10.1016/j.acvd.2015.03.006] [Citation(s) in RCA: 12] [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: 01/27/2015] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association between obstructive sleep apnoea syndrome (OSAS), left ventricular (LV) diastolic dysfunction and LV geometry remains controversial because of coexisting disorders. AIMS To evaluate LV diastolic dysfunction and its independent predictors in a real-life cohort of OSAS patients, by a standardized approach. METHODS We consecutively included 188 OSAS patients after an overnight polysomnography to undergo clinical evaluation, ambulatory blood pressure measurement and complete echocardiography, combining M-mode, two-dimensional Doppler and tissue Doppler imaging modes. Correlations between OSAS severity and clinical and echocardiographical variables were assessed, and logistic regression models were used to identify possible determining factors of LV diastolic dysfunction. RESULTS Most patients were hypertensive (n=148, 78.7%) and already receiving treatment by continuous positive airway pressure (n=158, 84.5%). The prevalence of LV hypertrophy, defined by LV mass index (LVMi) normalized by height (2.7), was 12.4%, with a significant correlation with hypertension (P=0.004). The apnoea-hypopnoea index was correlated with body mass index (P<0.0001), 24-hour systolic blood pressure (P=0.01) and LVMi normalized by height (2.7) (P=0.03). Diastolic function assessed by a global approach was impaired for 70 patients (37.2%) and none of the OSAS severity variables was a determining factor after multivariable analysis with adjustment for age and sex. CONCLUSION Diastolic dysfunction assessed by a standardized approach is common in OSAS and should be routinely evaluated; it is independently predicted by none of the respiratory severity variables.
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Affiliation(s)
- Diane Bodez
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Sylvie Lang
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Catherine Meuleman
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Louise Boyer-Châtenet
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Xuan-Lan Nguyen
- Centre d'évaluation et traitements des troubles du sommeil, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Laurie Soulat-Dufour
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Franck Boccara
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Bernard Fleury
- Centre d'évaluation et traitements des troubles du sommeil, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Ariel Cohen
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France.
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Poulizac C, Soulat-Dufour L, Lang S, Hermand C, El Asri C, Adavane S, Ederhy S, Boccara F, Pateron D, Cohen A. 33 Diagnostic accuracy of cardiovascular screening using pocket-size ultrasound in patients with dyspnea in the emergency setting. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Soulat-Dufour L, Lang S, Rousseau AP, Poulizac C, Hermand C, El Asri C, Boyer-Chatenet L, Adavane S, Ederhy S, Boccara F, Pateron D, Cohen A. 30 Pocket-size ultrasound does not alter the diagnosis of the cardiologist in patients admitted for chest pain in a cardiac unit. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Adavane S, Lang S, Ederhy S, Soulat-Dufour L, Boyer-Chatenet L, Van Der Vynckt C, Haddour N, Boccara F, Cohen A. 0579: CHA2DS2-VASc score is a predictor of stroke and death in patients with atrial flutter. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Benyounes N, Lang S, Soulat-Dufour L, Obadia M, Gout O, Chevalier G, Cohen A. Can global longitudinal strain predict reduced left ventricular ejection fraction in daily echocardiographic practice? Arch Cardiovasc Dis 2014; 108:50-6. [PMID: 25530159 DOI: 10.1016/j.acvd.2014.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 05/12/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) is the most commonly used method for measuring left ventricular ejection fraction (LVEF), but its reproducibility remains a matter of controversy. Speckle tracking echocardiography assesses myocardial deformation and left ventricular systolic function by measuring global longitudinal strain (GLS), which is more reproducible, but is not used routinely in hospital practice. AIM To investigate the feasibility of on-line two-dimensional GLS in predicting LVEF during routine echocardiographic practice. METHODS The analysis involved 507 unselected consecutive patients undergoing TTE between August 2012 and November 2013. Echocardiograms were performed by a single sonographer. Echogenicity was noted as good, moderate or poor. Simple linear regression was used to assess the relationship between LVEF and GLS, overall and according to quality of echogenicity. Receiver operating curve (ROC) analysis was used to identify the threshold GLS that predicts LVEF≤40%. RESULTS Mean LVEF was 64±11% and GLS was -18.0±4.0%. A reasonable correlation was found between LVEF and GLS (r=-0.53; P<0.001), which was improved when echogenicity was good (r=-0.60; P<0.001). GLS explained 28.1% of the variation in LVEF, and for one unit decrease in GLS, a 1.45 unit increase in LVEF was expected. Correlations between LVEF and GLS were -0.51 for patients in sinus rhythm (n=490) and -0.86 in atrial fibrillation (n=17). Based on ROC analysis, the area under the curve was 0.97 for GLS≥-14%, allowing detection of LVEF≤40% with a sensitivity of 95% and specificity of 86%. CONCLUSION Two-dimensional GLS is easy to obtain and accurately detects LVEF≤40% in unselected patients. GLS may be especially helpful when a suboptimal acoustic window makes LVEF measurement by Simpson's biplane method difficult and in atrial fibrillation patients with low heart rate variability.
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Affiliation(s)
| | - Sylvie Lang
- Department of Cardiology, Saint-Antoine Hospital, Paris, France
| | | | - Michaël Obadia
- Department of Neurology, Fondation A. de Rothschild, Paris, France
| | - Olivier Gout
- Department of Neurology, Fondation A. de Rothschild, Paris, France
| | | | - Ariel Cohen
- Department of Cardiology, Saint-Antoine Hospital, Paris, France
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Domingos J, Augustine D, Leeson P, Noble J, Doan HL, Boubrit L, Cheikh-Khalifa R, Laveau F, Djebbar M, Pousset F, Isnard R, Hammoudi N, Lisi M, Cameli M, Di Tommaso C, Curci V, Reccia R, Maccherini M, Henein MY, Mondillo S, Leitman M, Vered Z, Rashid H, Yalcin MU, Gurses KM, Kocyigit D, Evranos B, Yorgun H, Sahiner L, Kaya B, Aytemir K, Ozer N, Bertella E, Petulla' M, Baggiano A, Mushtaq S, Russo E, Gripari P, Innocenti E, Andreini D, Tondo C, Pontone G, Necas J, Kovalova S, Hristova K, Shiue I, Bogdanva V, Teixido Tura G, Sanchez V, Rodriguez-Palomares J, Gutierrez L, Gonzalez-Alujas T, Garcia-Dorado D, Forteza A, Evangelista A, Timoteo AT, Aguiar Rosa S, Cruz Ferreira R, Campbell R, Carrick D, Mccombe C, Tzemos N, Berry C, Sonecki P, Noda M, Setoguchi M, Ikenouchi T, Nakamura T, Yamamoto Y, Murakami T, Katou Y, Usui M, Ichikawa K, Isobe M, Kwon B, Roh J, Kim H, Ihm S, Barron AJ, Francis D, Mayet J, Wensel R, Kosiuk J, Dinov B, Bollmann A, Hindricks G, Breithardt O, Rio P, Moura Branco L, Galrinho A, Cacela D, Pinto Teixeira P, Afonso Nogueira M, Pereira-Da-Silva T, Abreu J, Teresa Timoteo A, Cruz Ferreira R, Pavlyukova E, Tereshenkova E, Karpov R, Piatkowski R, Kochanowski J, Opolski G, Barbier P, Mirea O, Guglielmo M, Savioli G, Cefalu C, Pudil R, Horakova L, Rozloznik M, Balestra C, Rimbas R, Enescu O, Calin S, Vinereanu D, Karsenty C, Hascoet S, Hadeed K, Semet F, Dulac Y, Alacoque X, Leobon B, Acar P, Dharma S, Sukmawan R, Soesanto A, Vebiona K, Firdaus I, Danny S, Driessen MMP, Sieswerda G, Post M, Snijder R, Van Dijk A, Leiner T, Meijboom F, Chrysohoou C, Tsitsinakis G, Tsiachris D, Aggelis A, Herouvim E, Vogiatzis I, Pitsavos C, Koulouris G, Stefanadis C, Erdei T, Edwards J, Braim D, Yousef Z, Fraser A, Avenatti E, Magnino C, Omede' P, Presutti D, Moretti C, Iannaccone A, Ravera A, Gaita F, Milan A, Veglio F, Barbier P, Scali M, Simioniuc A, Guglielmo M, Savioli G, Cefalu C, Mirea O, Fusini L, Dini F, Okura H, Murata E, Kataoka T, Zaroui A, Ben Halima M, Mourali M, Mechmeche R, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Otaegui I, Garcia Del Blanco B, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Godinho AR, Correia A, Rangel I, Rocha A, Rodrigues J, Araujo V, Almeida P, Macedo F, Maciel M, Rekik B, Mghaieth F, Aloui H, Boudiche S, Jomaa M, Ayari J, Tabebi N, Farhati A, Mourali S, Dekleva M, Markovic-Nikolic N, Zivkovic M, Stankovic A, Boljevic D, Korac N, Beleslin B, Arandjelovic A, Ostojic M, Galli E, Guirette Y, Auffret V, Daudin M, Fournet M, Mabo P, Donal E, Chin CWL, Luo E, Hwan J, White A, Newby D, Dweck M, Carstensen HG, Larsen LH, Hassager C, Kofoed KF, Jensen JS, Mogelvang R, Kowalczyk M, Debska M, Kolesnik A, Dangel J, Kawalec W, Migliore R, Adaniya M, Barranco M, Miramont G, Gonzalez S, Tamagusuku H, Davidsen ES, Kuiper KKJ, Matre K, Gerdts E, Igual Munoz B, Maceira Gonzalez A, Erdociain Perales M, Estornell Erill J, Valera Martinez F, Miro Palau V, Piquer Gil M, Sepulveda Sanchez P, Cervera Zamora A, Montero Argudo A, Placido R, Silva Marques J, Magalhaes A, Guimaraes T, Nobre E Menezes M, Goncalves S, Ramalho A, Robalo Martins S, Almeida A, Nunes Diogo A, Abid L, Ben Kahla S, Charfeddine S, Abid D, Kammoun S, Tounsi A, Abid L, Abid D, Charfeddine S, Hammami R, Triki F, Akrout M, Mallek S, Hentati M, Kammoun S, Sirbu CF, Berrebi A, Huber A, Folliguet T, Yang LT, Shih J, Liu Y, Li Y, Tsai L, Luo C, Tsai W, Babukov R, Bartosh F, Bazilev V, Muraru D, Cavalli G, Addetia K, Miglioranza M, Veronesi F, Mihaila S, Tadic M, Cucchini U, Badano L, Lang R, Miyazaki S, Slavich M, Miyazaki T, Figini F, Lativ A, Chieffo A, Montrfano M, Alfieri O, Colombo A, Agricola E, Liu D, Hu K, Herrmann S, Stoerk S, Kramer B, Ertl G, Bijnens B, Weidemann F, Brand M, Butz T, Tzikas S, Van Bracht M, Roeing J, Wennemann R, Christ M, Grett M, Trappe HJ, Scherzer S, Geroldinger A, Krenn L, Roth C, Gangl C, Maurer G, Rosenhek R, Neunteufl T, Binder T, Bergler-Klein J, Martins E, Pinho T, Leite S, Azevedo O, Belo A, Campelo M, Amorim S, Rocha-Goncalves F, Goncalves L, Silva-Cardoso J, Ahn H, Kim K, Jeon H, Youn H, Haland T, Saberniak J, Leren I, Edvardsen T, Haugaa K, Ziolkowska L, Boruc A, Kowalczyk M, Turska-Kmiec A, Zubrzycka M, Kawalec W, Monivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J, Rodriguez Gonzalez E, Rivero Arribas B, Castro Urda V, Dominguez Rodriguez F, Mitroi C, Gracia Lunar I, Fernadez Lozano I, Palecek T, Masek M, Kuchynka P, Fikrle M, Spicka I, Rysava R, Linhart A, Saberniak J, Hasselberg N, Leren I, Haland T, Borgquist R, Platonov P, Edvardsen T, Haugaa K, Ancona R, Comenale Pinto S, Caso P, Coopola M, Arenga F, Rapisarda O, D'onofrio A, Sellitto V, Calabro R, Rosca M, Popescu B, Calin A, Mateescu A, Beladan C, Jalba M, Rusu E, Zilisteanu D, Ginghina C, Pressman G, Cepeda-Valery B, Romero-Corral A, Moldovan R, Saenz A, Orban M, Samuel S, Fijalkowski M, Fijalkowska M, Gilis-Siek N, Blaut K, Galaska R, Sworczak K, Gruchala M, Fijalkowski M, Nowak R, Gilis-Siek N, Fijalkowska M, Galaska R, Gruchala M, Ikonomidis I, Triantafyllidi H, Trivilou P, Tzortzis S, Papadopoulos C, Pavlidis G, Paraskevaidis I, Lekakis J, Kaymaz C, Aktemur T, Poci N, Ozturk S, Akbal O, Yilmaz F, Tokgoz Demircan H, Kirca N, Tanboga I, Ozdemir N, Greiner S, Jud A, Aurich M, Hess A, Hilbel T, Hardt S, Katus H, D'ascenzi F, Cameli M, Alvino F, Lisi M, Focardi M, Solari M, Bonifazi M, Mondillo S, Konopka M, Krol W, Klusiewicz A, Burkhard K, Chwalbinska J, Pokrywka A, Dluzniewski M, Braksator W, King GJ, Coen K, Gannon S, Fahy N, Kindler H, Clarke J, Iliuta L, Rac-Albu M, Placido R, Robalo Martins S, Guimaraes T, Nobre E Menezes M, Cortez-Dias N, Francisco A, Silva G, Goncalves S, Almeida A, Nunes Diogo A, Kyu K, Kong W, Songco G, Galupo M, Castro M, Shin Hnin W, Ronald Lee C, Poh K, Milazzo V, Di Stefano C, Tosello F, Leone D, Ravera A, Sabia L, Sobrero G, Maule S, Veglio F, Milan A, Jamiel AM, Ahmed AM, Farah I, Al-Mallah MH, Petroni R, Magnano R, Bencivenga S, Di Mauro M, Petroni S, Altorio S, Romano S, Penco M, Kumor M, Lipczynska M, Klisiewicz A, Wojcik A, Konka M, Kozuch K, Szymanski P, Hoffman P, Rimbas R, Rimbas M, Enescu O, Mihaila S, Calin S, Vinereanu D, Donal E, Reynaud A, Lund L, Persson H, Hage C, Oger E, Linde C, Daubert J, Maria Oliveira Lima M, Costa H, Gomes Da Silva M, Noman Alencar M, Carmo Pereira Nunes M, Costa Rocha M, Abid L, Charfeddine S, Ben Kahla S, Abid D, Siala A, Hentati M, Kammoun S, Kovalova S, Necas J, Ozawa K, Funabashi N, Takaoka H, Kobayashi Y, Matsumura Y, Wada M, Hirakawa D, Yasuoka Y, Morimoto N, Takeuchi H, Kitaoka H, Sugiura T, Lakkas L, Naka K, Ntounousi E, Gkirdis I, Koutlas V, Bechlioulis A, Pappas K, Katsouras C, Siamopoulos K, Michalis L, Naka K, Evangelou D, Kalaitzidis R, Bechlioulis A, Lakkas L, Gkirdis I, Tzeltzes G, Nakas G, Katsouras C, Michalis L, Generati G, Bandera F, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Zagatina A, Zhuravskaya N, Al-Mallah M, Alsaileek A, Qureshi W, Karsenty C, Hascoet S, Peyre M, Hadeed K, Alacoque X, Amadieu R, Leobon B, Dulac Y, Acar P, Yamanaka Y, Sotomi Y, Iwakura K, Inoue K, Toyoshima Y, Tanaka K, Oka T, Tanaka N, Orihara Y, Fujii K, Soulat-Dufour L, Lang S, Boyer-Chatenet L, Van Der Vynckt C, Ederhy S, Adavane S, Haddour N, Boccara F, Cohen A, Huitema M, Boerman S, Vorselaars V, Grutters J, Post M, Gopal AS, Saha S, Toole R, Kiotsekoglou A, Cao J, Reichek N, Meyer CG, Altiok E, Al Ateah G, Lehrke M, Becker M, Lotfi S, Autschbach R, Marx N, Hoffmann R, Frick M, Nemes A, Sepp R, Kalapos A, Domsik P, Forster T, Caro Codon J, Blazquez Bermejo Z, Lopez Fernandez T, Valbuena Lopez SC, Iniesta Manjavacas AM, De Torres Alba F, Dominguez Melcon F, Pena Conde L, Moreno Yanguela M, Lopez-Sendon JL, Nemes A, Lengyel C, Domsik P, Kalapos A, Orosz A, Varkonyi T, Forster T, Rendon J, Saldarriaga CI, Duarte N, Nemes A, Domsik P, Kalapos A, Forster T, Nemes A, Domsik P, Kalapos A, Sepp R, Foldeak D, Borbenyi Z, Forster T, Hamdy A, Fereig H, Nabih M, Abdel-Aziz A, Ali A, Broyd C, Wielandts JY, De Buck S, Michielsen K, Louw R, Garweg C, Nuyts J, Ector J, Maes F, Heidbuchel H, Gillis K, Bala G, Tierens S, Cosyns B, Maurovich-Horvat P, Horvath T, Jermendy A, Celeng C, Panajotu A, Bartykowszki A, Karolyi M, Tarnoki A, Jermendy G, Merkely B. Poster session 2: Thursday 4 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ederhy S, Soulat-Dufour L, Ileana E, Mir O, Haddour N, Boccara F, Soria JC, Cohen A. Apport de l’imagerie dans l’évaluation des masses et métastases cardiaques. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lang S, Ederhy S, Boyer-Chatenet L, Haddour N, Soulat-Dufour L, Fleury G, Baudin B, Raffi H, Boccara F, Cohen A. Copeptin levels are associated with cardiovascular events in patients with non valvular atrial fibrillation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ederhy S, Lang S, Haddour N, Boyer-Châtenet L, Soulat-Dufour L, Adavane S, Fleury G, der Vynckt CV, Charbonnier M, Asri CE, Boccara F, Cohen A. Questions pratiques dans le traitement de la fibrillation atriale. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)70889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Van Der Vynckt C, Joffre J, Lang S, Ederhy S, Arangalage D, Haddour N, Soulat-Dufour L, Adavane S, Boccara F, Cohen A. Echocardiographic predictors of cardiovascular events in a population of subjects aged over 65years: Preliminary results. Arch Cardiovasc Dis 2013. [DOI: 10.1016/j.acvd.2013.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Soulat-Dufour L, Haddour N, Lang S, Ederhy S, Boccara F, Cohen A. Place de l’imagerie chez le patient à risque cardiovasculaire intermédiaire. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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