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Mauger C, Gouin I, Guéret P, Gac FN, Baillerie A, Lefeuvre C, Boutruche B, Bayard S, Jaquinandi V, Jégo P, Mahé G. Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases. J Med Vasc 2020; 45:192-197. [PMID: 32571559 DOI: 10.1016/j.jdmv.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients. MATERIALS AND METHODS A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017. RESULTS In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22 unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.). CONCLUSION Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management.
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Affiliation(s)
- C Mauger
- Cardiology Department, Saint Malo Hospital, Saint Malo, France; Vascular Medicine unit, Rennes University Hospital, Rennes, France.
| | - I Gouin
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Rennes 1 University, Rennes, France
| | - P Guéret
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France
| | - F Nedelec Gac
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France
| | - A Baillerie
- Departement of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - C Lefeuvre
- Oncology Department, Saint-Grégoire private hospital, Saint-Grégoire, France
| | - B Boutruche
- Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - S Bayard
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Pediatric Department, University Hospital, Rennes, France
| | - V Jaquinandi
- Vascular Medicine unit, Rennes University Hospital, Rennes, France
| | - P Jégo
- UMR INSERM U1085, Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Rennes, France
| | - G Mahé
- Vascular Medicine unit, Rennes University Hospital, Rennes, France; INSERM CIC 14 14, Rennes, France.
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Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, Lemesle G, Motreff P, Popovic B, Khalife K, Labèque JN, Perret T, Le Ray C, Orion L, Jouve B, Blanchard D, Peycher P, Silvain J, Steg PG, Goldstein P, Guéret P, Belle L, Aissaoui N, Ferrières J, Schiele F, Danchin N. Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation 2017; 136:1908-1919. [PMID: 28844989 DOI: 10.1161/circulationaha.117.030798] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015. METHODS We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France. RESULTS From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention. CONCLUSIONS Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010.
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Affiliation(s)
- Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology; Université Paris-Descartes, Paris, France; INSERM U-970, France (E.P., N.A., N.D.)
| | - Tabassome Simon
- AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, France (T.S.)
| | | | - Yves Cottin
- Centre Hospitalier Universitaire du Bocage, Dijon, France (Y.C.)
| | - Meyer Elbaz
- Toulouse University Hospital, Department of Cardiology, France (M.E.)
| | - Pierre Coste
- Hôpital Cardiologique Haut Levêque, CHU de Bordeaux, Pessac, France (P.C.)
| | - Gilles Lemesle
- Lille Regional University Hospital, Department of Cardiology, France (G.L.)
| | - Pascal Motreff
- Department of Cardiology, University Hospital of Clermont-Ferrand, UMR 6284 Auvergne University, France (P.M.)
| | - Batric Popovic
- Département de cardiologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France (B.P.)
| | - Khalife Khalife
- Centre Hospitalier Régional de Metz-Thionville, Mets, France (K.K.)
| | | | - Thibaut Perret
- Department of cardiology, Centre Hospitalier St Joseph et St Luc, Lyon, France (T.P.)
| | | | - Laurent Orion
- Department of Cardiology, Centre Hospitalier de Vendée, La Roche-sur-Yon, France (L.O.)
| | - Bernard Jouve
- Hospital of Aix en Provence, Department of Cardiology, France (B.J.)
| | | | | | - Johanne Silvain
- Institut de Cardiologie, Centre Hospitalier Pitié-Salpêtrière, Paris, France (J.S.)
| | - Philippe Gabriel Steg
- AP-HP, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, France; INSERM U-698, 75018 Paris, France (P.G.S.)
| | - Patrick Goldstein
- Lille Regional University Hospital, Emergency Department, France (P. Goldstein)
| | - Pascal Guéret
- University Hospital Henri Mondor, Department of Cardiology, Créteil, France (P. Guéret)
| | - Loic Belle
- Department of Cardiology, Centre hospitalier Annecy Genevois, Epagny Metz-Tessy, France (L.B.)
| | - Nadia Aissaoui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology; Université Paris-Descartes, Paris, France; INSERM U-970, France (E.P., N.A., N.D.)
| | - Jean Ferrières
- Toulouse Rangueil University Hospital, Department of Cardiology; UMR1027, INSERM, France (J.F.)
| | - François Schiele
- University Hospital Jean Minjoz, Department of Cardiology, Besançon, France (F.S.)
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology; Université Paris-Descartes, Paris, France; INSERM U-970, France (E.P., N.A., N.D.).
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Aissaoui N, Puymirat E, Juilliere Y, Jourdain P, Blanchard D, Schiele F, Guéret P, Popovic B, Ferrieres J, Simon T, Danchin N. Fifteen-year trends in the management of cardiogenic shock and associated 1-year mortality in elderly patients with acute myocardial infarction: the FAST-MI programme. Eur J Heart Fail 2016; 18:1144-52. [DOI: 10.1002/ejhf.585] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 01/14/2023] Open
Affiliation(s)
- Nadia Aissaoui
- AP-HP, Hôpital Européen Georges Pompidou, Paris, France, and Université Paris-Descartes; Paris France
| | - Etienne Puymirat
- AP-HP, Hôpital Européen Georges Pompidou, Paris, France, and Université Paris-Descartes; Paris France
| | | | | | | | | | | | | | | | | | - Nicolas Danchin
- AP-HP, Hôpital Européen Georges Pompidou, Paris, France, and Université Paris-Descartes; Paris France
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Guéret P. [Non-invasive imaging tests for detecting coronary artery disease in symptomatic stable patients. Is diagnostic performance sufficient for guiding strategy?]. Bull Acad Natl Med 2015; 199:341-354. [PMID: 27476314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Several non-invasive imaging techniques are currently available for coronary artery disease detection in stable patients with chest pain: exercise electrocardiogram, myocardial scintigraphy, stress echocardiography, stress MRI, positron emission tomography and computed tomography coronary angiography. According to recent guidelines from the European Society of Cardiology, the diagnosis process shall be guided by the coronary risk of the patient. The first recommended step is to clinically assess the probability of coronary artery disease. Thereafter, the choice of technique will be driven by usual parameters such as availability, local expertise and the contraindications of each test. Although detection of coronary artery disease by non-invasive tests follows different pathophysiological pathways, diagnostic value appears comparable. Therefore, choice of a diagnostic test must also take into consideration other factors such as the risks and hazards of imaging techniques as well as cost-efficiency parameters.
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Brémont C, Lim P, Elbaz N, Damy T, Guéret P, Dubois-Randé JL, Wallick DW, Lellouche N. Cardiac resynchronization therapy plus coupled pacing improves acutely myocardial function in heart failure patients. Pacing Clin Electrophysiol 2014; 37:803-9. [PMID: 24467552 DOI: 10.1111/pace.12348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 10/25/2013] [Accepted: 11/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coupled pacing (CP), which consists of an additional beat delivered after ventricular refractory period, has been proposed to reduce ventricular rate and increase ventricular contractility. We hypothesized that CP may be added to cardiac resynchronization therapy (CRT) to improve CRT effect in heart failure (HF) patients. METHODS The study included 20 consecutive HF patients in sinus rhythm referred for CRT-defibrillator (CRT-D) implantation (baseline left ventricular ejection fraction [LVEF] 27 ± 6%, baseline QRS duration 149 ± 33 ms, age = 63 ± 11 years). CP associated with CRT (CRT + CP) was delivered during CRT-D implantation from the right and left ventricular leads simultaneously. Echocardiography data were collected at baseline, during CRT and CRT + CP to assess changes in LVEF, cardiac output (CO), longitudinal global strain assessed by speckle tracking, and LV dyssynchrony (opposing wall delay using tissue Doppler imaging). RESULTS Compared to the conventional CRT, heart rate (HR) markedly decreased during CRT + CP (79 ± 20 beats/min vs 51 ± 8 beats/min, P < 0.0001) and was associated with a significant increase in LVEF (30 ± 8% vs 35 ± 8%, P = 0.0002) and peak of longitudinal global strain (-6 ± 2% vs -8 ± 2%, P < 0.0001). Importantly, during CRT + CP, CO increased (3.8 ± 1.0 L/min vs 4.4 ± 1.4 L/min, P = 0.004) and cardiac synchronicity remained unchanged (38 ± 24 ms for CRT alone vs 27 ± 18 ms for CRT + CP, P = 0.1). CONCLUSION In sinus rhythm HF patients, acute CP application in addition to CRT decreases HR and contributes to myocardial contractility and CO improvement without deleterious impact on ventricular synchronicity.
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Affiliation(s)
- Camille Brémont
- APHP, Cardiovascular Department and INSERM U955, Henri Mondor University Hospital, Creteil, France
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Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, Khalife K, Goldstein P, Cattan S, Vaur L, Cambou JP, Ferrières J, Danchin N. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA 2012; 308:998-1006. [PMID: 22928184 DOI: 10.1001/2012.jama.11348] [Citation(s) in RCA: 345] [Impact Index Per Article: 28.8] [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] [Indexed: 01/15/2023]
Abstract
CONTEXT The contemporary decline in mortality reported in patients with ST-segment elevation myocardial infarction (STEMI) has been attributed mainly to improved use of reperfusion therapy. OBJECTIVE To determine potential factors-beyond reperfusion therapy-associated with improved survival in patients with STEMI over a 15-year period. DESIGN, SETTING, AND PATIENTS Four 1-month French nationwide registries, conducted 5 years apart (between 1995, 2000, 2005, 2010), including a total of 6707 STEMI patients admitted to intensive care or coronary care units. MAIN OUTCOME MEASURES Changes over time in crude 30-day mortality, and mortality standardized to the 2010 population characteristics. RESULTS Mean (SD) age decreased from 66.2 (14.0) to 63.3 (14.5) years, with a concomitant decline in history of cardiovascular events and comorbidities. The proportion of younger patients increased, particularly in women younger than 60 years (from 11.8% to 25.5%), in whom prevalence of current smoking (37.3% to 73.1%) and obesity (17.6% to 27.1%) increased. Time from symptom onset to hospital admission decreased, with a shorter time from onset to first call, and broader use of mobile intensive care units. Reperfusion therapy increased from 49.4% to 74.7%, driven by primary percutaneous coronary intervention (11.9% to 60.8%). Early use of recommended medications increased, particularly low-molecular-weight heparins and statins. Crude 30-day mortality decreased from 13.7% (95% CI, 12.0-15.4) to 4.4% (95% CI, 3.5-5.4), whereas standardized mortality decreased from 11.3% (95% CI, 9.5-13.2) to 4.4% (95% CI, 3.5-5.4). Multivariable analysis showed a consistent reduction in mortality from 1995 to 2010 after controlling for clinical characteristics in addition to the initial population risk score and use of reperfusion therapy, with odds mortality ratios of 0.39 (95%, 0.29-0.53, P <.001) in 2010 compared with 1995. CONCLUSION In France, the overall rate of cardiovascular mortality among patients with STEMI decreased from 1995 to 2010, accompanied by an increase in the proportion of women younger than 60 years with STEMI, changes in other population characteristics, and greater use of reperfusion therapy and recommended medications.
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Affiliation(s)
- Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université Paris-Descartes, and INSERM U-970, Paris, France
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Hayat D, Kloeckner M, Nahum J, Ecochard-Dugelay E, Dubois-Randé JL, Jean-François D, Guéret P, Lim P. Comparison of real-time three-dimensional speckle tracking to magnetic resonance imaging in patients with coronary heart disease. Am J Cardiol 2012; 109:180-6. [PMID: 22019208 DOI: 10.1016/j.amjcard.2011.08.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [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: 05/18/2011] [Revised: 08/21/2011] [Accepted: 08/21/2011] [Indexed: 11/29/2022]
Abstract
This study compared strain values from 2-dimensional (2D) and real-time 3-dimensional (3D) speckle tracking with hyperenhancement transmural extent by magnetic resonance imaging (MRI). The study included 18 control subjects (mean age 51 ± 10 years) and 25 patients (20 men, mean age 62 ± 16 years) with ischemic left ventricular (LV) dysfunction (mean LV ejection fraction 41 ± 9%) referred for viability assessment using MRI. Longitudinal, radial, and circumferential strain values were computed using 2D speckle tracking. From analysis of 3D speckle tracking, conventional strain markers (longitudinal, radial, and circumferential) and 2 new 3D strain indexes (area and 3D strains) were obtained from apical view 3D datasets. A hyperenhancement transmural extent segment (16-segment model) was defined as delayed contrast enhancement >50%. Overall, 661 of 688 segments (96%) were analyzable by MRI and 3D speckle tracking. All 3D strain components in hyperenhancement transmural extent segments (n = 154) were lower than in nontransmural necrosis (n = 219) and control (n = 288) segments. Longitudinal strain by 3D, but not by 2D, differentiated nontransmural segments with scar <25%. All 3D global strain indexes correlated with LV ejection fraction (r(2) = 0.67 to 0.26, p <0.05 for all comparisons), whereas only area, longitudinal, and circumferential 3D strains correlated with global scar extent. The best reproducibility was provided by 3D longitudinal (6%) and area (8%) strains. In conclusion, longitudinal and area strains by 3D speckle tracking provide an accurate and reproducible measurement of myocardial deformation that correlate with infarct size in patients with ischemic LV dysfunction.
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Affiliation(s)
- Delphine Hayat
- Department of Cardiology, APHP, Henri Mondor University Hospital, Institut National de la Sante et de la recherche Medicale U, Créteil, France
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Brémont C, Macron L, Hayat D, Bensaid A, Dubois-Randé JL, Guéret P, Lim P. 135 Assessment of left ventricular function by real-time three-dimensional speckle tracking echocardiography compared to magnetic resonance imaging. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70531-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Brémont C, Bensaid A, Alonso H, Zaghden O, Olezac AS, Nahum J, Dubois-Randé JL, Guéret P, Lim P. 133 LV dyssynchrony is superior to peak strain for differentiating physiologic from pathologic left ventricular hypertrophy: a 2D and 3D speckle tracking analysis. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70529-3] [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: 11/29/2022]
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Gellen B, Lesault PF, Canoui-Poitrine F, Lim P, Guéret P, Teiger E, Dubois-Randé JL, Hittinger L, Damy T. 163 Diagnostic value of Doppler transthoracic echocardiography in the estimation of left ventricular filling pressure in patients with severe symptomatic systolic heart failure. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70559-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brémont C, Lellouche N, Elbaz N, Jorrot P, Bars C, Guéret P, Dubois-Randé JL, Lim P. 229 Cardiac resynchronization therapy plus coupled pacing improves myocardial function in heart failure patients. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70625-0] [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: 10/14/2022]
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Guéret P. [Role of non-invasive cardiovascular imaging techniques in the evaluation of coronary artery disease]. Bull Acad Natl Med 2011; 195:1069-1089. [PMID: 22375371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Several cardiovascular imaging techniques have seen major technical improvements in recent years. Visualization of coronary arteries--so important for diagnosis and patient management--is routinely performed by coronarography, but new, less invasive techniques such as computed tomography are now available. Evaluation of myocardial function, which may be impaired in case of myocardial hypoperfusion, can now be achieved non invasively by means of echocardiography or scintigraphy. New imaging techniques, and MRI in particular, can provide useful complementary information. Knowledge of the respective advantages and limitations of these techniques is crucial if physicians are to use them appropriately in their daily practice, thereby avoiding redundant or useless tests and improving patient management.
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Olezac AS, Bensaid A, Nahum J, Teiger E, Dubois-Randé JL, Guéret P, Lim P. 091 Left ventricular dyssynchrony and exercise capacity in patients with hypertrophic cardiomyopathy. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70093-3] [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: 11/26/2022]
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Bensaid A, Gallet R, Fougeres E, Lim P, Nahum J, Macron L, Troussier X, Deux JF, Teiger E, Guéret P, Dubois-Randé JL, Monin JL. 120 Superiority of CT scan over transthoracic echocardiography in predicting aortic regurgitation after TAVI. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70122-7] [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: 10/18/2022]
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Hayat D, Kloeckner M, Nahum J, Dussault C, Deux JF, Dubois Rande JL, Guéret P, Lim P. 122 3D Speckle tracking for characterizing transmurality of myocardial necrosis. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70124-0] [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: 10/18/2022]
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Deswarte G, Kirsch M, Roussel JC, Lesault PF, Vermes E, Duveau D, Guéret P, Randé JLD, Loisance D, Hittinger L, Trochu JN, Damy T. 073 Right Ventricle Contractile Reserve as a Pre-operative Tool for Assessing RV failure after Continuous Flow LVAD Implantation. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Macron L, Bensaid A, Nahum J, Mitchell-Heggs L, Deal L, Deux JF, Lim P, Guéret P. 138 Single or Multibeat Modality for 3D Echocardiography LV Volumes Assessment. Comparison study with MRI. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70140-3] [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: 10/19/2022]
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Monin JL, Monchi M, Lancellotti P, Lim P, Weiss E, Piérard L, Guéret P. 166 A risk score for predicting outcome in asymptomatic aortic stenosis. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70168-3] [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: 10/19/2022]
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Mitchell-Heggs L, Deal L, Bensaïd A, Nahum J, Dubois-Randé JL, Guéret P, Lelouche N, Lim P. 232 Atrial fibrillation ablation monitored by minimally invasive echocardiography using AcuNaV probe. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bensaid A, Macron L, Nahum J, Mitchell-Heggs L, Teiger E, Guéret P, Dubois-Randé JL, Lim P. 118 Myocardial function by longitudinal global strain correlates to exercise capacity in patients with Hypertrophic Cardiomyopathy. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mansencal N, Tissier R, Deux JF, Ghaleh B, Couvreur N, Rienzo M, Guéret P, Rahmouni A, Berdeaux A, Garot J. Relation of the ischaemic substrate to left ventricular remodelling by cardiac magnetic resonance at 1.5 T in rabbits. Eur Radiol 2009; 20:1214-20. [PMID: 19936756 DOI: 10.1007/s00330-009-1660-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 09/14/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Contrast-enhanced cardiac magnetic resonance (CMR) for infarct sizing has been validated in large animals, but studies and follow-up are restricted. We sought to (1) validate CMR for assessment of myocardial area at risk (MAR) and infarct size (IS) in a rabbit model of reperfused myocardial infarction (MI); (2) analyse the relation between ischaemic substrates and subsequent left ventricular (LV) remodelling. METHODS Experimental reperfused acute MI was induced in 16 rabbits. Ten animals underwent cross-registered cine and contrast-enhanced CMR and histopathology at day 3 for assessment of MAR and IS (group 1). The remaining six rabbits underwent serial CMR for the study of LV remodelling (group 2). RESULTS In group 1, mean IS was 12.7 +/- 6.4% and 12.7 +/- 6.9% of total LV myocardial mass on CMR (late-enhancement technique) and histopathology (P = 0.52; r = 0.93). No significant difference occurred between CMR and histopathology for the calculation of MAR and IS/MAR ratio (P = 0.18 and P = 0.17), whereas correlations were strong (r = 0.92 and r = 0.95). In group 2, mean LV end-diastolic, end-systolic volumes and LV mass were significantly increased at 3 weeks compared with measurements at day 3 (P < 0.01). Significant correlations between initial IS and the increase in LV end-diastolic volume (r = 0.66) and the increase in LV mass (r = 0.48) were observed, as well as correlations between initial MAR and the increase in LV end-diastolic volume (r = 0.70) and the increase in LV mass (r = 0.37). CONCLUSIONS Comprehensive CMR provides accurate assessment of IS and MAR in reperfused rabbit MI. Infarct size is closely related to LV remodelling. Through the infarct size/MAR ratio, this approach has great potential for assessing interventions aimed at cardioprotection.
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Affiliation(s)
- Nicolas Mansencal
- INSERM U841, IMRB, Faculté de médecine, Université Paris 12 et Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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Tribouilloy C, Lévy F, Rusinaru D, Guéret P, Petit-Eisenmann H, Baleynaud S, Jobic Y, Adams C, Lelong B, Pasquet A, Chauvel C, Metz D, Quéré JP, Monin JL. Outcome after aortic valve replacement for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol 2009; 53:1865-73. [PMID: 19442886 DOI: 10.1016/j.jacc.2009.02.026] [Citation(s) in RCA: 251] [Impact Index Per Article: 16.7] [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: 11/18/2008] [Revised: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study investigated whether aortic valve replacement (AVR) is associated with improved survival in patients with severe low-flow/low-gradient aortic stenosis (LF/LGAS) without contractile reserve (CR) on dobutamine stress echocardiography (DSE). BACKGROUND Patients with LF/LGAS without CR have a high mortality rate with conservative therapy. The benefit of AVR in this subset of patients remains controversial. METHODS Eighty-one consecutive patients with symptomatic calcified LF/LGAS (valve area <or=1 cm(2), left ventricular ejection fraction <or=40%, mean pressure gradient [MPG] <or=40 mm Hg) without CR on DSE were enrolled. Absence of CR was defined as the absence of increase in stroke volume of >or=20% compared with the baseline value. Multivariable analysis and propensity scores were used to compare survival according to whether or not AVR was performed (n = 55). RESULTS Five-year survival was higher in AVR patients compared with medically managed patients (54 +/- 7% vs. 13 +/- 7%, p = 0.001) despite a high operative mortality of 22% (n = 12). An AVR was independently associated with lower 5-year mortality (adjusted hazard ratio from 0.16 to 5.21 varying with time [95% confidence interval: 0.12-3.16 to 0.21-8.50], p = 0.00026). In 42 propensity-matched patients, 5-year survival was markedly improved by AVR (65 +/- 11% vs. 11 +/- 7%, p = 0.019). Associated bypass surgery (p = 0.007) and MPG <or=20 mm Hg (p = 0.035) were independently predictive of operative mortality. Late survival after AVR (excluding operative death) was 69 +/- 8% at 5 years. CONCLUSIONS In patients with LF/LGAS without CR on DSE, AVR is associated with better outcome compared with medical management. Surgery should not be withheld from this subset of patients solely on the basis of lack of CR on DSE.
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Affiliation(s)
- Christophe Tribouilloy
- Department of Cardiology, INSERM, ERI-12, Amiens and University Hospital Amiens, Amiens, France.
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Lim P, Pasquet A, Gerber B, D'Hondt AM, Vancraeynest D, Guéret P, Vanoverschelde JLJ. Is Postsystolic Shortening a Marker of Viability in Chronic Left Ventricular Ischemic Dysfunction? Comparison with Late Enhancement Contrast Magnetic Resonance Imaging. J Am Soc Echocardiogr 2008; 21:452-7. [DOI: 10.1016/j.echo.2007.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Indexed: 10/22/2022]
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Garot J, Clément S, Deux JF, Roiron C, Paziaud J, Monin JL, Jourdan G, Rahmouni A, Guéret P. [Evaluation of left ventricular function: echocardiography, MRI or CT?]. Arch Mal Coeur Vaiss 2007; 100:1042-1047. [PMID: 18223520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The objective of this article is to clarify the advantages and limits of echocardiography, MRI, and CT for the determination of left ventricular (LV) function, emphasising the importance of evaluating global ventricular function. MRI is the reference technique, owing to its precision, reproducibility, and innocuous nature. However, echography is performed much more frequently because it is more widely available and easier to carry out. It is our reference technique in everyday practice. More recently, synchronised multi-slice tomodensitometry has provided dynamic reconstructed images of the left ventricle throughout the cardiac cycle, offering a succession of short axis views covering the entire volume of the ventricle. These acquisitions, in addition to non-invasive coronary angiography, allow the LV ejection fraction to be determined. With MRI, study of the LV function does not require any contrast medium to be injected and makes use of effective semi-automatic segmentation programs.
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Affiliation(s)
- J Garot
- Fédération de cardiologie et département d'imagerie médicale, CHU Henri-Mondor, Faculté de médecine-université Paris 12, Créteil.
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25
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Lim P, Collet JP, Moutereau S, Guigui N, Mitchell-Heggs L, Loric S, Bernard M, Benhamed S, Montalescot G, Randé JLD, Guéret P. Fetuin-A Is an Independent Predictor of Death after ST-Elevation Myocardial Infarction. Clin Chem 2007; 53:1835-40. [PMID: 17702860 DOI: 10.1373/clinchem.2006.084947] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: Fetuin-A inhibits inflammation and has a protective effect against myocardial ischemia. Its deficiency has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. We investigated the association between plasma fetuin-A and clinical outcome after ST-elevation acute myocardial infarction (STEMI).
Methods: We measured fetuin-A in 284 consecutive patients with STEMI and correlated these data with the occurrence of death at 6 months (n = 25). We also measured fetuin-A in a control group and chose the 95th percentile as the cutoff to define abnormality.
Results: Patient mean (SD) age was 60 (14) years, and creatinine clearance was 83 (31) mL/min; 82% were men. Mean (SD) plasma fetuin-A concentrations at admission [188 (69) mg/L, P = 0.01] and at day 3 [163 (57) mg/L, P <0.0001] were lower in patients than in controls [219 (39) mg/L; 95th percentile 140 mg/L]. Fetuin-A <140 mg/L was observed in 20% of patients at admission vs 40% at day 3 (P <0.001). Fetuin-A concentrations did not correlate with peak cardiac troponin values but did correlate inversely with C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (NT-proBNP). Fetuin-A <140 mg/L at admission (OR = 3.3, P = 0.03) and at day 3 (OR = 6.3, P = 0.002) was an independent correlate of death at 6 months, irrespective of NT-proBNP, CRP, or Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score. Conversely, fetuin-A ≥140 mg/L was associated with an excellent survival rate [negative predictive value (NPV) = 97% overall], even in high-risk populations with CADILLAC risk score ≥6 (NPV = 90% in patients).
Conclusions: Fetuin-A is an important predictor of death at 6 months in STEMI patients independent of NT-proBNP, CRP, and CADILLAC risk score.
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Affiliation(s)
- Pascal Lim
- Department of Cardiology, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.
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Abstract
AIMS To assess whether response to cardiac resynchronization therapy (CRT) is related to myocardial viability in the paced left ventricular (LV) region, evaluated by contractile reserve (CR). Non-response to CRT may partly be due to inefficient pacing by the LV lead located in a fibrotic area. METHODS AND RESULTS Nineteen patients (64 +/- 13 years, 14 men, 9 ischaemic) with severe heart failure (EF = 27 +/- 8%, QRS = 154 +/- 25 ms) were included in the week after device implantation. Stroke volume (SV) and LV dyssynchrony (by Tissue Doppler Imaging) were successively assessed with CRT on and CRT off. Afterwards, CRT device was maintained off during dobutamine infusion to assess CR in the LV-pacing region. LV end-systolic volume (ESV) was assessed after 6 months to quantify reverse remodelling. CR in the paced LV region (n = 10, 5/9 ischaemic and 5/10 non-ischaemic) was correlated to a reduction in LV dyssynchrony under CRT (120 +/- 76 vs. 78 +/- 64 ms, P = 0.02). Conversely, LV dyssynchrony was unchanged (161 +/- 100 vs. 163 +/- 80 ms) without CR. In desynchronized patients (>65 ms, n = 15), increase in SV under CRT and changes in ESV at 6 months were +22 and -18%, respectively, when CR was present and 0% and +9%, respectively, when absent. CONCLUSION Acute haemodynamic response and reverse remodelling under CRT require viability in the target region of LV lead.
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Affiliation(s)
- Pascal Lim
- Department of Cardiology, APHP, Henri Mondor Hospital, 51 Av du Marechal de Lattre de Tassigny, 94000, Creteil, France.
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27
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Guéret P. [Coronary CT scan: the best indications at present]. Arch Mal Coeur Vaiss 2007; 100:253-5. [PMID: 17542427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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28
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Steg PG, Cambou JP, Goldstein P, Durand E, Sauval P, Kadri Z, Blanchard D, Lablanche JM, Guéret P, Cottin Y, Juliard JM, Hanania G, Vaur L, Danchin N. Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry. Heart 2006; 92:1378-83. [PMID: 16914481 PMCID: PMC1861049 DOI: 10.1136/hrt.2006.101972] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To study the impact on outcomes of direct admission versus emergency room (ER) admission in patients with ST-segment elevation myocardial infarction (STEMI) DESIGN: Nationwide observational registry of STEMI patients SETTING 369 intensive care units in France. INTERVENTIONS Patients were categorised on the basis of the initial management pathway (direct transfer to the coronary care unit or catheterisation laboratory versus transfer via the ER). MAIN OUTCOME MEASURES Delays between symptom onset, admission and reperfusion therapy. Mortality at five days and one year. RESULTS Of 1204 patients enrolled, 66.9% were admitted direct and 33.1% via the ER. Bypassing the ER was associated with more frequent use of reperfusion (61.7% v 53.1%; p = 0.001) and shorter delays between symptom onset and admission (244 (interquartile range 158) v 292 (172) min; p < 0.001), thrombolysis (204 (150) v 258 (240) min; p < 0.01), hospital thrombolysis (228 (156) v 256 (227) min, p = 0.22), and primary percutaneous coronary intervention (294 (246) v 402 (312) min; p < 0.005). Five day mortality rates were lower in patients who bypassed the ER (4.9% v 8.6%; p = 0.01), regardless of the use and type of reperfusion therapy. After adjusting for the simplified Thrombolysis in Myocardial Infarction (TIMI) risk score, admission via the ER was an independent predictor of five day mortality (odds ratio 1.67, 95% confidence interval 1.01 to 2.75). CONCLUSIONS In this observational analysis, bypassing the ER was associated with more frequent and earlier use of reperfusion therapy, and with an apparent survival benefit compared with admission via the ER.
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Affiliation(s)
- P G Steg
- Department of Cardiology, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Guéret P. [Financial report from 11th November 2004 to 31th October 2005 of the French Society of Cardiology]. Arch Mal Coeur Vaiss 2006; 99:641-2. [PMID: 16878729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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30
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Mulazzi I, Amar J, Cambou J, Hanania G, Guéret P, Vaur L, Blanchard D, Lablanche JM, Boutalbi Y, Genès N, Danchin N. High risk hypertensives: pre-hospital management of acute myocardial infarction--results from the French nationwide registry USIC 2000. Ann Cardiol Angeiol (Paris) 2006; 55:6-10. [PMID: 16457029 DOI: 10.1016/j.ancard.2005.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the use of mobile coronary care units (MCU) in hypertensive patients previously treated for cardiovascular diseases in comparison with those with no history of cardiovascular disease and to estimate the influence of the use of MCU on cardiovascular outcome in this population. PATIENTS We used a nationwide prospective registry of all patients admitted for AMI in French intensive care units in 2000. Patients without history of hypertension or patients admitted with pulmonary oedema or cardiogenic shock were excluded. Men (N = 514) and women (N = 291) were analysed separately. RESULTS The proportion of patients with history of myocardial infarction, peripheral artery disease and stroke was not significantly higher in subjects who used physician-staffed MCU as compared with patients with no history of myocardial infarction, peripheral artery disease or stroke. In each sex, revascularization (pre hospital fibrinolysis, in hospital fibrinolysis or coronary angioplasty) were more frequent in patients who used MCU. Also, one year cardiovascular mortality was lower in men who used MCU. CONCLUSION Known high risk hypertensive patients did not use physician-staffed MCU more than subjects free of such condition. Education of hypertensive patients at risk during routine visits is required to increase of the use of physician-staffed MCU in case of symptoms suggestive of AMI.
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Affiliation(s)
- I Mulazzi
- SAMU 31, CHU de Purpan, TSA 40031, 31059 Toulouse 09, France
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Simon T, Mary-Krause M, Cambou JP, Hanania G, Guéret P, Lablanche JM, Blanchard D, Genès N, Danchin N. Impact of age and gender on in-hospital and late mortality after acute myocardial infarction: increased early risk in younger women: results from the French nation-wide USIC registries. Eur Heart J 2006; 27:1282-8. [PMID: 16401671 DOI: 10.1093/eurheartj/ehi719] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [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] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine whether sex differences of in-hospital and after-discharge mortality differ according to the age. METHODS AND RESULTS Data of 4347 consecutive patients hospitalized within 48 h of the onset of acute myocardial infarction (AMI) were analysed. Patients were classified according to median age (68 years): Group 1 (G1) (308 women, 30-67 years), G2 (1878 men, 30-67 years), G3 (860 women, 68-89 years), and G4 (1301 men, 68-89 years). In both age groups, women were older, had more frequent co-morbidities, lower rate of reperfusion therapy, and received less anti-platelet agents, beta-blockers, and statins than men. The overall 1-year mortality was higher in women (25% vs. 16% in men, P<0.0001). After adjustment, in-hospital mortality was higher only for the women in the younger age group. (G1 vs. G2: OR=2.2, 95%CI=1.3-3.8; G3 vs. G4: OR=1.1, 95%CI=the risk of death, after hospital discharge, was no longer related to gender in any age group. CONCLUSION The higher 1-year mortality following AMI in women is explained by the higher risk of death in young women during the first days of hospitalization. Further investigations are crucial to determine the cause in order to improve the chance of survival in younger women.
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Affiliation(s)
- Tabassome Simon
- Department of Pharmacology, Saint-Antoine, Pierre et Marie Curie University, 27 Rue Chaligny, 75012 AP-HP, and Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France.
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Kadri Z, Danchin N, Vaur L, Cottin Y, Guéret P, Zeller M, Lablanche JM, Blanchard D, Hanania G, Genès N, Cambou JP. Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study. Heart 2005; 92:910-5. [PMID: 16339808 PMCID: PMC1860714 DOI: 10.1136/hrt.2005.073791] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [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] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To analyse the short and long term prognostic significance of admission glycaemia in a large registry of non-diabetic patients with acute myocardial infarction. METHODS Assessment of short and long term prognostic significance of admission blood glucose in a consecutive population of 1604 non-diabetic patients admitted to intensive care units in France in November 2000 for a recent (<or= 48 hours) myocardial infarction. RESULTS In-hospital mortality, compared with that of patients with admission glycaemia below the median value of 6.88 mmol/l (3.7%), rose gradually with each of the three upper sextiles of glycaemia: 6.5%, 12.5% and 15.2%. Conversely, one year survival decreased from 92.5% to 88%, 83% and 75% (p < 0.001). Admission glycaemia remained an independent predictor of in-hospital and one year mortality after multivariate analyses accounting for potential confounders. Increased admission glycaemia also was a predictor of poor outcome in all clinical subsets studied: patients without heart failure on admission, younger and older patients, patients with or without reperfusion therapy, and patients with or without ST segment elevation. CONCLUSION In non-diabetic patients, raised admission blood glucose is a strong and independent predictor of both in-hospital and long term mortality.
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Affiliation(s)
- Z Kadri
- Hôpital Européen Georges Pompidou, Paris, France
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Chaib A, Henegariu V, Danchin N, Guéret P, Lablanche JM, Genès N, Blanchard D, Vaur L, Clerson P, Hanania G, Cambou JP. [Combination therapy at hospital discharge in the USIC 2000 survey]. Ann Cardiol Angeiol (Paris) 2005; 54 Suppl 1:S24-9. [PMID: 16411648] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
UNLABELLED We tried to determine the prognostic impact of triple (antiplatelet agents, statins and beta-blockers) and quadruple (the same+ACE inhibitors) combination therapy at hospital discharge after acute myocardial infarction. The USIC 2000 survey is nationwide registry of consecutive patients admitted to intensive care units for acute myocardial infarction in November 2000 in France. Of the 2119 patients discharged alive, 1095 (52%) were prescribed a combination of antiplatelet agents, beta-blockers and statins (triple therapy), including 567 (27%) with a similar combination plus ACE inhibitors (quadruple therapy). One-year survival was 97% in patients receiving triple combination therapy versus 88% in those who received either no, one or two of these medications (p < 0.0001). After multivariate adjustment, the odds ratio for one-year mortality in patients with triple combination therapy was 0.49 (95% confidence interval: 0.32-0.75). Quadruple combination therapy had no additional predictive value in the entire population. In patients with ejection fraction < or = 35%, however, beta-blockers and ACE inhibitors were independent predictors of survival, and combination therapy had no additional prognostic value. CONCLUSIONS compared with the prescription of any single class of secondary prevention medications, combination therapy offers additional protection in patients with acute myocardial infarction.
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Affiliation(s)
- Aurès Chaib
- Hôpital européen Georges-Pompidou, Paris, France
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Danchin N, Cambou JP, Hanania G, Kadri Z, Genès N, Lablanche JM, Blanchard D, Vaur L, Clerson P, Guéret P. Impact of combined secondary prevention therapy after myocardial infarction: data from a nationwide French registry. Am Heart J 2005; 150:1147-53. [PMID: 16338251 DOI: 10.1016/j.ahj.2005.01.058] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [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: 11/04/2004] [Accepted: 01/18/2005] [Indexed: 01/13/2023]
Abstract
BACKGROUND Several classes of medications improve survival in patients with coronary artery disease. Whether these medications, as used in the real world, have additive efficacy remains speculative. OBJECTIVES To assess whether patients discharged on combined secondary prevention medications after acute myocardial infarction (AMI) have improved 1-year survival, compared with the action of any single class of medications. DESIGN AND SETTING Nationwide registry of consecutive patients admitted to intensive care units for AMI in November 2000 in France. Multivariate Cox regression analysis, including a propensity score for the prescription of combined therapy, was used. RESULTS Of the 2119 patients discharged alive, 1095 (52%) were prescribed a combination of antiplatelet agents, beta-blockers, and statins (triple therapy), of whom 567 (27%) also received angiotensin-converting enzyme inhibitors (quadruple therapy) and 528 (25%) did not. One-year survival was 97% in patients receiving triple combination therapy versus 88% in those who received either none, 1, or 2 of these medications (P < .0001). After multivariate adjustment including the propensity score, the hazard ratio for 1-year mortality in patients with triple combination therapy was 0.52 (95% CI 0.33-0.81). In patients with ejection fraction < or = 35%, beta-blockers and angiotensin-converting enzyme inhibitors were independent predictors of survival, and combination therapy had no additional prognostic value. CONCLUSIONS Compared with the prescription of any single class of secondary prevention medications, combination therapy offers additional protection in patients with AMI.
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Guéret P, Lim P, Abitbol E, Monin JL. [Echocardiography and mechanical complications of recent myocardial infarction]. Arch Mal Coeur Vaiss 2005; 98:1101-10. [PMID: 16379106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The constantly advancing technology of echocardiography and its widespread usage in the intensive care unit has made it a routine examination in patients with acute myocardial infarction. It has become the reference method for diagnosis and monitoring of certain complications such as pericardial effusion, intra-ventricular thrombosis, ventricular aneurysm and mitral regurgitation. The echocardiographic description of these complications dates back to the 1980s during which prospective studies accurately described the principal abnormalities. These descriptions have not been much improved upon with the advent of new technology. On the other hand, the frequency of these complications assessed in an era when reperfusion by thrombolysis or primary angioplasty was much less common than today, has considerably decreased.
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Affiliation(s)
- P Guéret
- Fédération de cardiologie, hôpital Henri Mondor, Tassigny, Créteil
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36
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Danchin N, Kadri Z, Cambou JP, Hanania G, Humbert R, Clerson P, Vaur L, Guéret P, Blanchard D, Genès N, Lablanche JM. [Management of patients admitted for acute myocardial infarction in France from 1995 to 2000: time to admission dependent improvement in outcome]. Arch Mal Coeur Vaiss 2005; 98:1149-54. [PMID: 16379113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The in-hospital management and short- and long-term outcomes was assessed in 2 registries of consecutive patients admitted for acute myocardial infarction, 5 years apart, in France. The 2000 cohort was younger and with a less frequent history of cardiac diseases, but was more often diabetic and with anterior infarcts. Time to admission was actually longer in 2000 than in 1995 (median 5.25 hours vs 4.00 hours). Overall, reperfusion therapy was used in 43% of the patients in both registries. However, the use of reperfusion therapy increased from 1995 to 2000 in patients admitted within 6 hours of symptom onset (64 vs 58%), with an increasing use of primary angioplasty (from 12 to 30%). Five-day mortality significantly improved from 7.7 to 6.1% (p < 0.03) and one-year survival was also less in the most recent period (85 vs 81%, p < 0.01). Multivariate analyses showed that the period of inclusion (2000 vs 1995) was an independent predictor of both short- and long-term mortality in patients admitted within 6 hours of symptom onset. Thus, in the real world setting, a continued decline in one-year mortality was observed in patients admitted to intensive care units for recent acute myocardial infarction, especially for patients admitted early. This goes along with a shift in reperfusion therapy towards a broader use of primary angioplasty, and with an increased use of the early prescription of recognised secondary prevention medications.
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Affiliation(s)
- N Danchin
- Cardiologie, Hôpital européen Georges Pompidou , Leblanc, Paris.
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Dahlöf B, Gosse P, Guéret P, Dubourg O, de Simone G, Schmieder R, Karpov Y, García-Puig J, Matos L, De Leeuw PW, Degaute JP, Magometschnigg D. Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study. J Hypertens 2005; 23:2063-70. [PMID: 16208150 DOI: 10.1097/01.hjh.0000187253.35245.dc] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Few data are available comparing the effects of monotherapy and combination therapy on target organ damage. The PICXEL study compared the efficacy of a strategy based on first-line combination with perindopril/indapamide versus monotherapy with enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients. METHODS In this 1-year multicentre randomized double-blind study, patients received an increasing dosage of perindopril/indapamide (n = 284) or enalapril (n = 272). Changes in blood pressure and echocardiographic measures of LVH were assessed from baseline to the end of treatment. Reading of the echocardiograms was central and blinded for therapy, patient and sequence. RESULTS Systolic and diastolic blood pressure decreased significantly more in the perindopril/indapamide than in the enalapril group (P < 0.0001 and P = 0.003). The left ventricular mass index decreased by 13.6 +/- 23.9 g/m(2) (mean +/- SD) with perindopril/indapamide (P < 0.0001) and 3.9 +/- 23.9 g/m(2) with enalapril (P < 0.005); these decreases were significantly different (P < 0.0001). The left ventricular internal diameter, posterior and interventricular septal wall thickness decreased significantly with perindopril/indapamide (P < or = 0.0001); the interventricular septal wall thickness decreased significantly with enalapril (P < 0.001). Both treatments were well tolerated. CONCLUSION A strategy based on first-line combination with perindopril/indapamide achieved better blood pressure decrease with a significantly greater degree of LVH reduction than a strategy based on monotherapy with enalapril in hypertensive patients with LVH.
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38
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Attias D, Abitbol E, Russel S, Paziaud J, Lim P, Roiron C, Monin JL, Guéret P, Garot J. Thrombus serpentin récidivant des cavités cardiaques droites. Presse Med 2005; 34:1337. [PMID: 16269999 DOI: 10.1016/s0755-4982(05)84183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- D Attias
- Fédération de cardiologie, Hôpital Henri Mondor, AP-HP, Créteil (94)
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39
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Aboyans V, Cambou JP, Hanania G, Cantet C, Ferrières J, Guéret P, Blanchard D, Lablanche JM, Lacroix P, Boutalbi Y, Danchin N. [Clinical and therapeutic specificities of myocardial infarction in patients with peripheral arterial disease: the USIC 2000 registry]. Ann Cardiol Angeiol (Paris) 2005; 54:241-9. [PMID: 16237913 DOI: 10.1016/j.ancard.2005.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Several studies underlined the worse prognosis of myocardial infarction (MI) among patients with peripheral arterial disease (PAD). We sought to describe the presentation and management modalities of a cohort of PAD patients presenting an acute MI, compared to those without PAD. MATERIALS AND METHODS The USIC 2000 registry, a nationwide database on all patients admitted to a CCU for an acute MI < 48 hours in France in November 2000 was used for this study. RESULTS Among the 2311 patients included, PAD was reported in 215 subjects (9.3%). In multivariate analysis, the following factors were positively related to the presence of PAD (P < or = 0.05): age >75 y (OR = 2.3), diabetes (OR = 2.0), hypertension (OR = 1.4), active smoking (OR = 4.6), renal failure (OR =3.1), and treatments with antiplatelets (OR = 3.9), anti-vitamin K (OR = 1.9), statins (OR = 1.7) and low molecular weight heparins (OR = 6.8). By introducing the data concerning the arrival in CCUs in the model, the following factors were also significantly more frequent among PAD patients: male sex (OR = 1.6), past history of coronary artery disease (OR = 2.2), left bundle branch block (OR = 1.8) and late management >6 hours (OR = 1.4). Conversely, ST-segment elevation was less frequent (OR = 0.7). When the CCU stay data were introduced in the model, a lower rate of coronary stenting (OR = 0.7) and betablockers use within 48 hours of admission (OR = 0.6) were noted. CONCLUSION Beyond the presence of PAD per se, several particularities do exist, especially the coexistence of a high number of pejorative factors and an under-utilization of treatments presenting prognostic benefits.
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Affiliation(s)
- V Aboyans
- U558 Inserm, 31, allée Jules-Guesde, 31037 Toulouse cedex, France.
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40
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Lellouche N, Berthier R, Mekontso-Dessap A, Braconnier F, Monin JL, Duval AM, Dubois-Randé JL, Guéret P, Garot J. Usefulness of plasma B-type natriuretic peptide in predicting recurrence of atrial fibrillation one year after external cardioversion. Am J Cardiol 2005; 95:1380-2. [PMID: 15904651 DOI: 10.1016/j.amjcard.2005.01.090] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 11/29/2004] [Revised: 01/27/2005] [Accepted: 01/26/2005] [Indexed: 11/19/2022]
Abstract
After successful external cardioversion, the rate of recurrence of atrial fibrillation remains high. The hypothesis that plasma B-type natriuretic peptide could predict the recurrence of atrial fibrillation at 1 year was tested. Plasma B-type natriuretic peptide was measured in 66 consecutive asymptomatic patients who underwent external cardioversion for atrial fibrillation. Twelve-lead electrocardiograms were obtained at 1 year. Sinus rhythm was maintained in 55% of patients. The independent predictors of the recurrence of atrial fibrillation at 1 year were a history of atrial fibrillation, plasma B-type natriuretic peptide, and the energy delivered for conversion. In patients without symptoms of heart failure, plasma B-type natriuretic peptide is an independent predictor of the recurrence of atrial fibrillation.
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Affiliation(s)
- Nicolas Lellouche
- Fédération de Cardiologie, Hôpital de Jour, Henri Mondor University Hospital, Créteil, France
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41
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Danchin N, Charpentier G, Ledru F, Vaur L, Guéret P, Hanania G, Blanchard D, Lablanche JM, Genès N, Cambou JP. Role of previous treatment with sulfonylureas in diabetic patients with acute myocardial infarction: results from a nationwide French registry. Diabetes Metab Res Rev 2005; 21:143-9. [PMID: 15386810 DOI: 10.1002/dmrr.498] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND The cardiovascular effects of sulfonylureas (SU) in diabetic patients are controversial and it has been suggested that diabetic patients with acute myocardial infarction while on SU were at increased risk. OBJECTIVES To assess the in-hospital outcome of patients with acute myocardial infarction according to the use of SU at the time of the acute episode. METHODS Of 443 intensive care units in France, 369 (83%) prospectively collected all cases of infarction admitted within 48 h of symptom onset in November 2000. RESULTS Among the 2320 patients included in the registry, 487 (21%) had diabetes, of whom 215 (44%) were on SU. Patients on SU were older and had a more frequent history of hyperlipidemia than those not receiving SU. Type and location of infarction were similar in the two groups, and there was no difference in Killip class on admission. In-hospital mortality was lower in patients on SU (10.2%) than in those without SU (16.9%) (p = 0.035). There was a trend toward less frequent ventricular fibrillation (2.3% vs 5.9%, p = 0.052). In two models of multivariate analyses, SU therapy was associated with decreased in-hospital mortality (model 1: relative risk: 0.44, p = 0.012; model 2: relative risk: 0.37, p = 0.020). CONCLUSIONS In this nationwide registry reflecting real-world practice, the use of sulfonylureas in diabetic patients was not associated with increased in-hospital mortality.
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42
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Ferrières J, Cambou JP, Guéret P, Boutalbi Y, Lablanche JM, Hanania G, Genès N, Cantet C, Danchin N. Effect of early initiation of statins on survival in patients with acute myocardial infarction (the USIC 2000 Registry). Am J Cardiol 2005; 95:486-9. [PMID: 15695134 DOI: 10.1016/j.amjcard.2004.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 07/21/2004] [Revised: 10/11/2004] [Accepted: 10/11/2004] [Indexed: 11/26/2022]
Abstract
We evaluated the association of statin initiation within 48 hours of admission for an acute myocardial infarction with a 1-year prognosis on a nationwide scale. Patients who received a statin within 48 hours of admission but not before hospitalization had an improved prognosis (hazard ratio 0.57, 95% confidence interval 0.38 to 0.86, p <0.007) after adjustment for covariates and propensity score.
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Affiliation(s)
- Jean Ferrières
- Department of Epidemiology, INSERM U558, Toulouse, France.
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43
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Joffre F, Guéret P. [Collaboration between radiologists and cardiologists]. Arch Mal Coeur Vaiss 2005; 98:165-6. [PMID: 15787311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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44
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Hanania G, Cambou JP, Guéret P, Vaur L, Blanchard D, Lablanche JM, Boutalbi Y, Humbert R, Clerson P, Genès N, Danchin N. Management and in-hospital outcome of patients with acute myocardial infarction admitted to intensive care units at the turn of the century: results from the French nationwide USIC 2000 registry. Heart 2004; 90:1404-10. [PMID: 15547013 PMCID: PMC1768566 DOI: 10.1136/hrt.2003.025460] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [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] [Accepted: 12/18/2003] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess actual practices and in-hospital outcome of patients with acute myocardial infarction on a nationwide scale. METHODS Of 443 intensive care units in France, 369 (83%) prospectively collected data on all cases of infarction (within < 48 hours of symptom onset) in November 2000. RESULTS 2320 patients (median age 68 years, 73% men) were included, of whom 83% had ST segment elevation infarction (STEMI). Patients without STEMI were older and had a more frequent history of cardiovascular disease. Median time to admission was 5.0 hours for patients with and 6.5 hours for those without STEMI. Reperfusion therapy was used for 53% of patients with STEMI (thrombolysis 28%, primary angioplasty 25%). In-hospital mortality was 8.7% (5.5% of patients without and 9.3% of those with STEMI). Multivariate analysis found that age, Killip class, lower blood pressure, higher heart rate on admission, anterior location of infarct, STEMI, diabetes mellitus, previous stroke, and no current smoking independently predicted in-hospital mortality. At hospital discharge, 95% received antiplatelet agents, 75% received beta blockers, and over 60% received statins. Angiotensin converting enzyme inhibitors were prescribed for 40% of the patients without and 52% of those with ST elevation. CONCLUSIONS This nationwide registry, including all types of centres irrespective of their size and experience, shows continued improvement in patient care and outcomes. Time from symptom onset to admission, however, has not improved in recent years and reperfusion therapy is used for just over 50% of patients with STEMI, with an increasing use of primary angioplasty.
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45
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Danchin N, Blanchard D, Steg PG, Sauval P, Hanania G, Goldstein P, Cambou JP, Guéret P, Vaur L, Boutalbi Y, Genès N, Lablanche JM. Impact of Prehospital Thrombolysis for Acute Myocardial Infarction on 1-Year Outcome. Circulation 2004; 110:1909-15. [PMID: 15451803 DOI: 10.1161/01.cir.0000143144.82338.36] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [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] [Indexed: 11/16/2022]
Abstract
Background—
Limited data are available on the impact of prehospital thrombolysis (PHT) in the “real-world” setting.
Methods and Results—
Of 443 intensive care units in France, 369 (83%) prospectively collected all cases of infarction (≤48 hours of symptom onset) in November 2000; 1922 patients (median age, 67 years; 73% men) with ST-segment–elevation infarction were included, of whom 180 (9%) received intravenous thrombolysis before hospital admission (PHT). Patients with PHT were younger than those with in-hospital thrombolysis, primary percutaneous interventions, or no reperfusion therapy. Median time from symptom onset to hospital admission was 3.6 hours for PHT, 3.5 hours for in-hospital lysis, 3.2 hours for primary percutaneous interventions, and 12 hours for no reperfusion therapy. In-hospital death was 3.3% for PHT, 8.0% for in-hospital lysis, 6.7% for primary percutaneous interventions, and 12.2% for no reperfusion therapy. One-year survival was 94%, 89%, 89%, and 79%, respectively. In a multivariate analysis of predictors of 1-year survival, PHT was associated with a 0.49 relative risk of death (95% CI, 0.24 to 1.00;
P
=0.05). When the analysis was limited to patients receiving reperfusion therapy, the relative risk of death for PHT was 0.52 (95% CI, 0.25 to 1.08;
P
=0.08). In patients with PHT admitted in ≤3.5 hours, in-hospital mortality was 0% and 1-year survival was 99%.
Conclusions—
The 1-year outcome of patients treated with PHT compares favorably with that of patients treated with other modes of reperfusion therapy; this favorable trend persists after multivariate adjustment. Patients with PHT admitted very early have a very high 1-year survival rate.
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Affiliation(s)
- Nicolas Danchin
- Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France.
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Abstract
OBJECTIVES In addition to the interest of mixing the sequence of echo-exam in a central blinded review, we studied the effect that might result from group-analysis of all echocardiograms simultaneously for each patient, with their sequence kept blind. A priori, this method of reading has the potential of decreasing measurement variability. METHODS We included 630 echocardiograms from 210 hypertensive patients participating in a randomized clinical trial comparing two antihypertensive agents for regression of left ventricular (LV) hypertrophy. Three echocardiograms per patient [selection (4 weeks before; W-4), at inclusion (week 0; W0), and the end of treatment (week 52; W52)], were read twice, according to two methods, blind to centre, patient numbers and sequence of visits: (1) examination of individual serial echocardiograms, (2) examination of all-patient mixed echocardiograms. The first method was expected to increase the power of treatment comparison by reducing variability of measurements of left ventricular mass (LVM). RESULTS Pooling echocardiograms of all patients reduces variability of LVM change under treatment: absolute LVM (W52 - W0) standard deviation was reduced by 22%. Nevertheless, despite a good between-methods agreement for LVM values at each visit (intra-class coefficient of correlation from 0.88 to 0.92), LVM change under treatment was reduced even more, by 41%. Thus, the slight decrease of variability induced by gathering the echocardiograms is associated with an even greater reduction of LVM change. CONCLUSIONS According to these findings, the 'full-blind' methodology for a central blinded review in clinical trials appears to produce the maximum power of the study with the lowest sample size.
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Affiliation(s)
- Philippe Gosse
- Service de Cardiologie -- Hypertension Artérielle, Groupe Hospitalier Saint André, Bordeaux, France.
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47
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Palud L, Laurent M, Guéret P, Meunier C, Garin E, Benoît PO, Belléguic C, Bernard du Haut Cilly F, Almange C, Daubert JC. [Value of the association of D-dimer measurement and the evaluation of clinical probability in a non-invasive diagnostic strategy of pulmonary embolism]. Arch Mal Coeur Vaiss 2004; 97:93-9. [PMID: 15032407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
New diagnostic tools in suspected pulmonary embolism complete the classical diagnostic strategy of pulmonary scintigraphy and pulmonary angiography to limit the indications of these two invasive investigations. In a prospective series of 204 consecutive patients with suspected pulmonary embolism the association of D-dimer measurement and clinical probability was assessed for the exclusion of the diagnosis of pulmonary embolism. The D-DI Liatest is a new generation, unitary, rapid and quantitative latex test with a comparative diagnostic performance to that of the reference ELISA test, and well adapted to emergency situations.The clinical probability was assessed by a quantitative score based on past history, clinical symptoms and signs. The positive diagnosis of pulmonary embolism was made by spiral CT scanner and/or pulmonary angiography, associated with Duplex ultrasonography of the leg veins in nondiagnostic results. The prevalence of pulmonary embolism was 42.6% and the absence of anticoagulation in patients considered not to have pulmonary embolism was associated with a thrombo-embolic incidence of 0.9% at 3 months. Fifty-six patients had D-dimer concentrations equal or inferior to the threshold of 500 microg/L; the sensitivity was 99% and the specificity 47% with a negative predictive value of 98% to 100% in cases with a low clinical probability. D-dimer measurement is reliable and has a high cost-benefit value in ambulatory patients with suspected of pulmonary embolism and is even more valuable when the clinical probability of this diagnosis is low.
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Affiliation(s)
- L Palud
- Département de cardiologie et maladies vasculaires, CHU Pontchaillou, Rennes
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48
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Cambou JP, Danchin N, Boutalbi Y, Hanania G, Humbert R, Clerson P, Vaur L, Guéret P, Blanchard D, Genès N, Lablanche JM. Évolution de la prise en charge et du pronostic de l'infarctus du myocarde en France entre 1995 et 2000 : résultats des études USIK 1995 et USIC 2000Evolution of the management and outcomes of patients admitted for acute myocardial infarction in France from 1995 to 2000: data from the USIK 1995 and USIC 2000 nationwide registries. Ann Cardiol Angeiol (Paris) 2004; 53:12-7. [PMID: 15038522 DOI: 10.1016/s0003-3928(03)00201-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We assessed the in-hospital management and short- and long-term outcomes of two series of patients admitted for acute myocardial infarction, 5 years apart, in France. The most recent cohort was younger and with a less frequent history of cardiac diseases, but was more often diabetic and with anterior infarcts. Five-day mortality significantly improved from 7.7% to 6.1% (P < 0.03) and 1-year survival was also less in the most recent period (15% versus 19%, P < 0.01). Multivariate analyses showed that the period of inclusion (2000 versus 1995) was an independent predictor of both short- and long-term mortality. In analyses restricted to the patients who were alive by day 5, initial treatment with statins was associated with a 38% decrease in the risk of death at 1 year. Likewise, in patients with left ventricular ejection fraction < or = 35%, the early prescription of ACE inhibitors was associated with a 41% reduction in the risk of 1-year mortality. Thus, in the real world setting, a continued decline in 1-year mortality is observed in patients admitted to intensive care units for recent acute myocardial infarction. This goes along with a shift in reperfusion therapy towards a broader use of coronary angioplasty and with an increased use of the early prescription of recognised secondary prevention medications.
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Affiliation(s)
- J P Cambou
- Service de cardiologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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49
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Monin JL, Guéret P. [Calcified aortic stenosis with left ventricular dysfunction and low transvalvular gradients. Must one reject surgery in certain cases?]. Arch Mal Coeur Vaiss 2003; 96:864-70. [PMID: 14571640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The natural history of severe aortic stenosis (aortic valve area < 1 cm2 or < 0.6 cm2/m2) with left ventricular systolic dysfunction and low transvalvular gradients (mean gradient < 40 mmHg) is mediocre in the short term and the operative risk is high. Dobutamine echocardiography provides a reliable evaluation of the aortic obstacle by diagnosing the rare cases of relative aortic stenosis in which the valve surface area has been underestimated because of a low cardiac output (aortic surface area > 1.2 cm2 with a mean gradient < 30 mmHg with dobutamine): in this case, the limited available data suggests that medical therapy with strict follow-up of its efficacy is the best management. The other use of dobutamine echocardiography is to assess left ventricular contractile reserve, defined as a increase > or = 20% in stroke volume under dobutamine. Cases with a contractile reserve have an operative risk of 5 to 10% and the medium-term benefits of valve replacement have been demonstrated. In the absence of contractile reserve, the operative risk is much grater, 30 to 60%, and also depends on other parameters such as the mean basal transaortic pressure gradient (risk five times greater in cases with a mean gradient < 20 mmHg), the need for coronary bypass surgery and associated co-morbid conditions. The surgical contraindications are in fact relatively few and concern patients with several risk factors: absence of contractile reserve itself is not a definitive surgical contraindication.
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Affiliation(s)
- J L Monin
- Fédération de cardiologie, CHU Henri Mondor, AP-HP, 51, avenue de Lattre de Tassigny, 94 010 Créteil.
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50
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Monin JL, Quéré JP, Monchi M, Petit H, Baleynaud S, Chauvel C, Pop C, Ohlmann P, Lelguen C, Dehant P, Tribouilloy C, Guéret P. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation 2003; 108:319-24. [PMID: 12835219 DOI: 10.1161/01.cir.0000079171.43055.46] [Citation(s) in RCA: 465] [Impact Index Per Article: 22.1] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prognostic value of dobutamine stress hemodynamic data in the setting of low-gradient aortic stenosis has been addressed in small, single-center studies. Larger studies are needed to define the criteria for selecting the patients who will benefit from valve replacement. METHODS AND RESULTS Six centers prospectively enrolled 136 patients with aortic stenosis (96 men; median age, 72 years [range, 65 to 77 years]; median aortic valve area, 0.7 cm2 [range, 0.6 to 0.8]; mean transaortic gradient, 29 mm Hg [range, 23 to 34 mm Hg]; cardiac index, 2.11 L x min(-1) x m(-2) [range, 1.75 to 2.55 L x min(-1) x m(-2)]). Left ventricular contractile reserve on the dobutamine stress Doppler study was present in 92 patients (group I) and absent in 44 patients (group II). Operative mortality was 5% (3 of 64 patients) in group I compared with 32% (10 of 31 patients) in group II (P=0.0002). Predictors for operative mortality were the lack of contractile reserve (odds ratio, 10.9; 95% confidence interval [CI], 2.6 to 43.4; P=0.001) and a mean transaortic gradient < or =20 mm Hg (odds ratio, 4.7; 95% CI, 1.1 to 21.0; P=0.04). Predictors for long-term survival were valve replacement (hazard ratio, 0.30; 95% CI, 0.17 to 0.53; P=0.001) and left ventricular contractile reserve (hazard ratio, 0.40; 95% CI, 0.23 to 0.69; P=0.001). CONCLUSIONS In the setting of low-gradient aortic stenosis, surgery seems beneficial for most of the patients with left ventricular contractile reserve. In contrast, the postoperative outcome of patients without reserve is compromised by a high operative mortality. Thus, dobutamine stress Doppler hemodynamics may be factored into the risk-benefit analysis for each patient.
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Affiliation(s)
- Jean-Luc Monin
- Department of Cardiology, Henri Mondor Hospital, 51 Avenue De Lattre de Tassigny, 94010 Créteil, France.
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