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Panagides V, Cuervo G, Llopis J, Abdel-Wahab M, Mangner N, Habib G, Regueiro A, Mestres CA, Tornos P, Durand E, Selton-Suty C, Ihlemann N, Bruun N, Urena M, Cecchi E, Thiele H, Durante-Mangoni E, Pellegrini C, Eltchaninoff H, Athan E, Søndergaard L, Linke A, Tattevin P, Del Val D, Quintana E, Chu V, Rodés-Cabau J, Miro JM. Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement. Clin Infect Dis 2024; 78:179-187. [PMID: 37552784 DOI: 10.1093/cid/ciad464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Scarce data are available comparing infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study aimed to compare the clinical presentation, microbiological profile, management, and outcomes of IE after SAVR versus TAVR. METHODS Data were collected from the "Infectious Endocarditis after TAVR International" (enrollment from 2005 to 2020) and the "International Collaboration on Endocarditis" (enrollment from 2000 to 2012) registries. Only patients with an IE affecting the aortic valve prosthesis were included. A 1:1 paired matching approach was used to compare patients with TAVR and SAVR. RESULTS A total of 1688 patients were included. Of them, 602 (35.7%) had a surgical bioprosthesis (SB), 666 (39.5%) a mechanical prosthesis, 70 (4.2%) a homograft, and 350 (20.7%) a transcatheter heart valve. In the SAVR versus TAVR matched population, the rate of new moderate or severe aortic regurgitation was higher in the SB group (43.4% vs 13.5%; P < .001), and fewer vegetations were diagnosed in the SB group (62.5% vs 82%; P < .001). Patients with an SB had a higher rate of perivalvular extension (47.9% vs 27%; P < .001) and Staphylococcus aureus was less common in this group (13.4% vs 22%; P = .033). Despite a higher rate of surgery in patients with SB (44.4% vs 27.3%; P < .001), 1-year mortality was similar (SB: 46.5%; TAVR: 44.8%; log-rank P = .697). CONCLUSIONS Clinical presentation, type of causative microorganism, and treatment differed between patients with an IE located on SB compared with TAVR. Despite these differences, both groups exhibited high and similar mortality at 1-year follow-up.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Guillermo Cuervo
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology, and Statistics, University of Barcelona, Barcelona, Spain
| | | | - Norman Mangner
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Gilbert Habib
- Cardiology Department, Assistance Publique des Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Ander Regueiro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Pilar Tornos
- Department of Cardiology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Eric Durand
- Department of Cardiology, Normandie University, CHU Rouen, France
| | | | | | - Niels Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Marina Urena
- Cardiology Department, Bichat Hospital, Paris, France
| | - Enrico Cecchi
- Cardiology Department, Hospital Maria Vittoria, Turin, Italy
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | | | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Axel Linke
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eduard Quintana
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vivian Chu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Benseba J, Mercier J, Couture T, Faroux L, Bernatchez L, Côté M, Panagides V, Mesnier J, Mohammadi S, Dumont É, Kalavrouziotis D, Hadjadj S, Beaudoin J, DeLarochellière R, Rodés-Cabau J, Paradis JM. Fractional Flow Reserve to Assess Coronary Artery Disease in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: Long-Term Outcomes. Struct Heart 2023; 7:100179. [PMID: 37520135 PMCID: PMC10382974 DOI: 10.1016/j.shj.2023.100179] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/31/2023] [Accepted: 02/22/2023] [Indexed: 08/01/2023]
Abstract
Background The long-term outcomes of patients undergoing functional assessment of coronary lesions with fractional flow reserve (FFR) while awaiting transcatheter aortic valve implantation (TAVI) are unknown. Data on the safety of intracoronary adenosine use in this setting are scarce. The objectives of this study were to describe (1) the long-term outcomes based on the coronary artery disease (CAD) assessment strategy used and (2) the safety of intracoronary adenosine in patients with severe aortic stenosis (AS). Methods 1023 patients with severe AS awaiting TAVI were included. Patients were classified according to their CAD assessment strategy: angiography guided or FFR guided. Patients were further subdivided according to the decision to proceed with percutaneous coronary intervention (PCI): angiography-guided PCI (375/1023), angiography-guided no-PCI (549/1023), FFR-guided PCI (50/1023), and FFR-guided no-PCI (49/1023). Patients were followed up for the occurrence of major adverse cardiac and cerebrovascular events (MACCEs). Results At a mean follow-up of 33.7 months, we observed no significant differences in terms of major adverse cardiovascular and cerebrovascular events (MACCE) in the angiography-guided group (42.4%) compared with the FFR-guided group (37.4%) (p = 0.333). When comparing outcomes of the FFR-guided no-PCI group (32.7%) with the angiography-guided PCI group (46.4%), no significant difference was noted (p = 0.999). Following intracoronary adenosine, a single adverse event occurred. Conclusions In this population, intracoronary adenosine is safe and well tolerated. We found no significant benefit to an FFR-guided strategy compared with an angiography-guided strategy with respect to MACCEs. Although clinically compelling, avoiding the procedural risks of PCI by deferring the intervention in functionally insignificant lesions failed to show a statistically significant benefit.
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Affiliation(s)
- Juva Benseba
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Julien Mercier
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Thomas Couture
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Laurent Faroux
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Mélanie Côté
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Vassili Panagides
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Canada
| | - Éric Dumont
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Sandra Hadjadj
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
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Panagides V, Côté F, Khalifa A, Bernier F, Rodes-Cabau J, Bernier M. Percutaneous Lymphatic Drainage Through the Thoracic Duct: New Paths in Heart Failure. CJC Open 2023; 5:593-596. [PMID: 37496783 PMCID: PMC10366659 DOI: 10.1016/j.cjco.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/27/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Vassili Panagides
- Division of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Côté
- Division of Radiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Abubaker Khalifa
- Division of Cardiology, Joseph Brant Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Florence Bernier
- Division of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Division of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mathieu Bernier
- Division of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Mangner N, Panagides V, Del Val D, Abdel-Wahab M, Crusius L, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Gervais P, Côté M, Thiele H, Holzhey D, Linke A, Rodés-Cabau J. Incidence, Clinical Characteristics, and Impact of Absent Echocardiographic Signs in Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation. Clin Infect Dis 2023; 76:1003-1012. [PMID: 36331961 DOI: 10.1093/cid/ciac872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Echocardiography is the primary imaging modality for diagnosis of infective endocarditis (IE) in prosthetic valve endocarditis (PVE) including IE after transcatheter aortic valve implantation (TAVI). This study aimed to evaluate the characteristics and clinical outcomes of patients with absent compared with evident echocardiographic signs of TAVI-IE. METHODS Patients with definite TAVI-IE derived from the Infectious Endocarditis after TAVI International Registry were investigated comparing those with absent and evident echocardiographic signs of IE defined as vegetation, abscess, pseudo-aneurysm, intracardiac fistula, or valvular perforation or aneurysm. RESULTS Among 578 patients, 87 (15.1%) and 491 (84.9%) had absent (IE-neg) and evident (IE-pos) echocardiographic signs of IE, respectively. IE-neg were more often treated via a transfemoral access with a self-expanding device and had higher rates of peri-interventional complications (eg, stroke, major vascular complications) during the TAVI procedure (P < .05 for all). IE-neg had higher rates of IE caused by Staphylococcus aureus (33.7% vs 23.2%; P = .038) and enterococci (37.2% vs 23.8%; P = .009) but lower rates of coagulase-negative staphylococci (4.7% vs 20.0%, P = .001). IE-neg was associated with the same dismal prognosis for in-hospital mortality in a multivariate binary regression analysis (odds ratio: 1.51; 95% confidence interval [CI]: .55-4.12) as well as a for 1-year mortality in Cox regression analysis (hazard ratio: 1.10; 95% CI: .67-1.80). CONCLUSIONS Even with negative echocardiographic imaging, patients who have undergone TAVI and presenting with positive blood cultures and symptoms of infection are a high-risk patient group having a reasonable suspicion of IE and the need for an early treatment initiation.
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Affiliation(s)
- Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Lisa Crusius
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eric Durand
- Department of Cardiology, Normandie University, UNIROUEN, INSERM U1096, Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy
- Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR1099, Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Ontario, Canada
- Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Helene Eltchaninoff
- Department of Cardiology, Normandie University, UNIROUEN, INSERM U1096, Rouen, France
| | | | | | | | | | - Hervé Le Breton
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR1099, Rennes, France
| | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- Clínic Barcelona, Barcelona, Spain
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5
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Panagides V, Cheema AN, Urena M, Nombela-Franco L, Veiga-Fernandez G, Vilalta V, Regueiro A, Del Val D, Asmarats L, Del Trigo M, Serra V, Munoz-Garcia A, Rezaei E, Himbert D, Tirado-Conte G, de la Torre Hernandez JM, Fernandez-Nofrerias E, Cepas-Guillén PL, Alfonso F, Gutierrez-Alonso L, Oteo Domínguez JF, Belanech Y, Paradis JM, Mesnier J, Rodés-Cabau J. Optimal Degree of Balloon-Expandable Transcatheter Valve Oversizing in Patients With Borderline Aortic Annulus Measurements: Insights From a Multicenter Real-World Experience. Circ Cardiovasc Interv 2023; 16:e012554. [PMID: 36943930 DOI: 10.1161/circinterventions.122.012554] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The potential benefit of using larger or smaller transcatheter heart valves (THV) in patients with borderline aortic annulus measurement (BAM) remains uncertain. The objective of this study was to evaluate the clinical outcomes associated with the selection of larger or smaller THV in the context of BAM. METHODS This was a multicenter observational study including patients who underwent transcatheter aortic valve replacement with the SAPIEN 3 or SAPIEN 3 Ultra-valve systems (Edwards Lifesciences, Irvine, CA) from April 2014 to June 2021. BAM was defined according to the manufacturer sizing chart and included the following annulus areas: 314 to 346, 400 to 430, 500 to 546 mm2. A 1:1 propensity score matching was used to compare outcomes of patients with larger or smaller THV. RESULTS From a total of 2467 patients, BAM was identified in 852 patients (34.5%). A larger and smaller THV was selected in 338 (39.7%) and 514 patients (60.3%) patients, respectively. The choice of a larger THV was associated (before and after propensity matching) with a higher risk of new-onset left bundle branch block (HR, 2.25 [95% CI, 1.39-3.65; P=0.001) and permanent pacemaker implantation (HR, 1.86 [95% CI, 1.11-3.09]; P=0.016) without any impact on gradients or the risk of moderate or severe paravalvular regurgitation at discharge (HR, 0.78 [95% CI, 0.41-1.45]; P=0.427). The risk of periprocedural complications such as aortic rupture and tamponade was low (<1%) and similar between groups. CONCLUSIONS In patient with BAM, selecting a larger SAPIEN 3/Ultra THV increased the risk of conduction disturbances without any benefit on valve hemodynamics and clinical outcomes.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.P., J.-M.P., J.M., J.R.-C.)
| | - Asim N Cheema
- St. Michael's Hospital, Toronto, Ontario, Canada (A.N.C.)
- Southlake Regional Health Centre, Newmarket, Ontario, Canada (A.N.C., E.R.)
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria, Madrid, Spain (L.N.-F., G.T.-C.)
| | | | - Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., E.F.-N.)
| | | | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Spain (D.D.V., F.A.)
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.A., L.G.-A.)
| | - Maria Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain (M.d.T., J.F.O.D.)
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain (V.S., Y.B.)
| | - Antonio Munoz-Garcia
- Hospital Regional Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Málaga, Spain (A.M.-G.)
| | - Effat Rezaei
- Southlake Regional Health Centre, Newmarket, Ontario, Canada (A.N.C., E.R.)
| | - Dominique Himbert
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria, Madrid, Spain (L.N.-F., G.T.-C.)
| | | | | | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Spain (D.D.V., F.A.)
| | - Lola Gutierrez-Alonso
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.A., L.G.-A.)
| | | | - Yassin Belanech
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain (V.S., Y.B.)
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.P., J.-M.P., J.M., J.R.-C.)
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.P., J.-M.P., J.M., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.P., J.-M.P., J.M., J.R.-C.)
- Clínic Barcelona, Spain (A.R., P.L.C.-G., J.R.-C.)
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Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J. Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:394-412. [PMID: 36697140 DOI: 10.1016/j.jacc.2022.11.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 06/06/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 01/25/2023]
Abstract
Infective endocarditis (IE) is a rare but serious complication following transcatheter aortic valve replacement (TAVR). Despite substantial improvements in the TAVR procedure (less invasive) and its expansion to younger and healthier patients, the incidence of IE after TAVR remains stable, with incidence rates similar to those reported after surgical aortic valve replacement. Although IE after TAVR is recognized as a subtype of prosthetic valve endocarditis, this condition represents a particularly challenging scenario given its unique clinical and microbiological profile, the high incidence of IE-related complications, the uncertain role of cardiac surgery, and the dismal prognosis in most patients with TAVR-IE. The number of TAVR procedures is expected to grow exponentially in the coming years, increasing the number of patients at risk of developing this life-threatening complication. Therefore, a detailed understanding of this disease and its complications will be essential to improve clinical outcomes.
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Affiliation(s)
- David Del Val
- Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, CIBERCV, Madrid, Spain; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-L'Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Clínic Barcelona, Barcelona, Spain.
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Panagides V, Cuervo G, Llopis J, Regueiro A, Mestres C, Tornos P, del Val D, Quintana E, Rodés-Cabau J, Miro J. ENDOCARDITIS INFECCIOSA TRAS LA IMPLANTACIÓN DE LA VÁLVULA AÓRTICA TRANSCATéTER VERSUS QUIRÚRGICA. Cirugía Cardiovascular 2023. [DOI: 10.1016/j.circv.2022.12.021] [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: 02/16/2023] Open
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8
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Vilalta V, Cediel G, Mohammadi S, López H, Kalavrouziotis D, Resta H, Dumont E, Voisine P, Philippon F, Escabia C, Borrellas A, Alperi A, Fernandez-Nofrerias E, Carrillo X, Panagides V, Bayes-Genis A, Rodés-Cabau J. New-onset persistent left bundle branch block following sutureless aortic valve replacement. Heart 2022; 109:143-150. [PMID: 35842233 DOI: 10.1136/heartjnl-2022-321191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the incidence, predictive factors and prognostic value of new-onset persistent left bundle branch block (NOP-LBBB) in patients undergoing sutureless surgical aortic valve replacement (SU-SAVR). METHODS A total of 329 consecutive patients without baseline conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent SU-SAVR with the Perceval valve (LivaNova Group, Saluggia, Italy) in two centres from 2013 to 2019 were included. Patients were on continuous ECG monitoring during hospitalisation and 12-lead ECG was performed after the procedure and at hospital discharge. NOP-LBBB was defined as a new postprocedural LBBB that persisted at hospital discharge. Baseline, procedural and follow-up clinical and echocardiography data were collected in a dedicated database. RESULTS New-onset LBBB was observed in 115 (34.9%) patients, and in 76 (23.1%) persisted at hospital discharge. There were no differences in baseline and procedural characteristics between patients with (n=76) and without (n=253) NOP-LBBB. After a median follow-up of 3.3 years (2.3-4.4 years), patients with NOP-LBBB had a higher incidence of PPI (14.5% vs 6.3%, p=0.016), but exhibited similar rates of all-cause mortality (19.4% vs 19.2%, p=0.428), cardiac mortality (8.1% vs 9.4%, p=0.805) and heart failure readmission (21.0% vs 23.2%, p=0.648), compared with the no/transient LBBB group. NOP-LBBB was associated with a decrease in left ventricular ejection fraction (LVEF) at 1-year follow-up (delta: -5.7 vs +0.2, p<0.001). CONCLUSIONS NOP-LBBB occurred in approximately a quarter of patients without prior conduction disturbances who underwent SU-SAVR and was associated with a threefold increased risk of PPI along with a negative impact on LVEF at follow-up.
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Affiliation(s)
- Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Germán Cediel
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Siamak Mohammadi
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Helena López
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Dimitri Kalavrouziotis
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Helena Resta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eric Dumont
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - François Philippon
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Claudia Escabia
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Andrea Borrellas
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alberto Alperi
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | | | - Xavier Carrillo
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vassili Panagides
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Rodés-Cabau
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
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9
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Weizman O, Duceau B, Trimaille A, Pommier T, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Sutter W, Mika D, Fauvel C, Pezel T, Waldmann V, Cohen A, Bonnet G. Machine learning-based scoring system to predict in-hospital outcomes in patients hospitalized with COVID-19. Arch Cardiovasc Dis 2022; 115:617-626. [PMID: 36376208 PMCID: PMC9595484 DOI: 10.1016/j.acvd.2022.08.003] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evolution of patients hospitalized with coronavirus disease 2019 (COVID-19) is still hard to predict, even after several months of dealing with the pandemic. AIMS To develop and validate a score to predict outcomes in patients hospitalized with COVID-19. METHODS All consecutive adults hospitalized for COVID-19 from February to April 2020 were included in a nationwide observational study. Primary composite outcome was transfer to an intensive care unit from an emergency department or conventional ward, or in-hospital death. A score that estimates the risk of experiencing the primary outcome was constructed from a derivation cohort using stacked LASSO (Least Absolute Shrinkage and Selection Operator), and was tested in a validation cohort. RESULTS Among 2873 patients analysed (57.9% men; 66.6±17.0 years), the primary outcome occurred in 838 (29.2%) patients: 551 (19.2%) were transferred to an intensive care unit; and 287 (10.0%) died in-hospital without transfer to an intensive care unit. Using stacked LASSO, we identified 11 variables independently associated with the primary outcome in multivariable analysis in the derivation cohort (n=2313), including demographics (sex), triage vitals (body temperature, dyspnoea, respiratory rate, fraction of inspired oxygen, blood oxygen saturation) and biological variables (pH, platelets, C-reactive protein, aspartate aminotransferase, estimated glomerular filtration rate). The Critical COVID-19 France (CCF) risk score was then developed, and displayed accurate calibration and discrimination in the derivation cohort, with C-statistics of 0.78 (95% confidence interval 0.75-0.80). The CCF risk score performed significantly better (i.e. higher C-statistics) than the usual critical care risk scores. CONCLUSIONS The CCF risk score was built using data collected routinely at hospital admission to predict outcomes in patients with COVID-19. This score holds promise to improve early triage of patients and allocation of healthcare resources.
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Affiliation(s)
- Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France,Université de Paris, PARCC, INSERM, 75015 Paris, France
| | | | - Antonin Trimaille
- Nouvel Hopital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, 80000 Amiens, France
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, 59800 Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | | | | | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | | | - Corentin Chaumont
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, 76000 Rouen, France
| | | | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Julie Pastier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Nacim Ezzouhairi
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Benjamin Perin
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP–HP, Université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier Régional de Orléans, 45100 Orléans, France
| | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, 76000 Rouen, France
| | - Théo Pezel
- Hôpital Lariboisière, AP–HP, Université de Paris, 75010 Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, 75015 Paris, France,Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Ariel Cohen
- Hôpital Saint-Antoine, 75012 Paris, France,Corresponding author. Hôpital Saint-Antoine, 184, Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France,Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
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10
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Silva I, Turgeon PY, Paradis JM, Beaudoin J, O’Connor K, Ternacle J, Alperi A, Panagides V, Mesnier J, Gravel C, Clavel MA, Dagenais F, Dumont E, Mohammadi S, Pibarot P, Bernier M, Rodés-Cabau J, Salaun E. Percutaneous Transcatheter Edge-to-Edge Mitral Valve Repair With MitraClip System in the Era of G4. Structural Heart 2022. [DOI: 10.1016/j.shj.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Nuche J, Panagides V, Nault I, Mesnier J, Paradis JM, de Larochellière R, Kalavrouziotis D, Dumont E, Mohammadi S, Philippon F, Rodés-Cabau J. Incidence and clinical impact of tachyarrhythmic events following transcatheter aortic valve replacement: A review. Heart Rhythm 2022; 19:1890-1898. [PMID: 35952981 DOI: 10.1016/j.hrthm.2022.07.028] [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: 05/03/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is well established for treating severe symptomatic aortic stenosis. Whereas broad information on the epidemiology, clinical implications, and management of bradyarrhythmias after TAVR is available, data about tachyarrhythmic events remain scarce. Despite the progressively lower risk profile of TAVR patients and the improvement in device characteristics and operator skills, approximately 10% of patients develop new-onset atrial fibrillation (NOAF) after TAVR. The proportion of patients in whom NOAF actually corresponds to previously undiagnosed silent atrial fibrillation (AF) has not been properly determined. The transapical approach, the need for pre- or post- balloon dilation, and the presence of periprocedural complications have been associated with a higher risk of NOAF. Older age, left atrial volume, or worse functional class are patient-derived risk factors shared with preprocedural AF. NOAF after TAVR has been associated with poorer survival and a higher incidence of cerebrovascular events. However, patient management differs markedly among different centers, especially with regard to anticoagulation in patients with short-duration AF episodes detected in the periprocedural setting and in cases of silent NOAF detected during continuous electrocardiographic (ECG) monitoring. Evidence about ventricular arrhythmias is even more scarce than for AF. Some case reports of sudden cardiac death after TAVR in patients with a pacemaker have identified ventricular tachycardia or ventricular fibrillation in device interrogation. TAVR has been shown to reduce the arrhythmic burden, but a significant proportion of patients (16%) present with complex premature ventricular complex arrhythmias within the year after TAVR. Whether these events are related to poorer outcomes is unknown. Continuous ECG monitoring after TAVR may help describe the frequency, risk factors, and prognostic implications of tachyarrhythmias in this population.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Isabelle Nault
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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12
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Guedeney P, Mesnier J, Michel M, Hauguel-Moreau M, Silvain J, Houde C, Alperi A, Panagides V, Collet JP, Wallet T, Rouanet S, Hammoudi N, Rodes-Cabau J, Montalescot G. Outcomes following patent foramen ovale percutaneous closure according to the delay from last ischemic event. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2132] [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
Randomized controlled trials evaluating patent foramen ovale (PFO) percutaneous closure only included patients with recent embolic event. We aimed to evaluate outcomes following percutaneous PFO closure outcomes according to the delay from the last embolic episode.
Methods
This international ambispective cohort included consecutive patients from two centers in France and Canada undergoing PFO percutaneous closure for secondary prevention of paradoxical embolic event. The primary endpoint was the composite of stroke or transient ischemic attack (TIA). Logistic regression model was used to evaluate determinants of late PFO closure procedures.
Results
A total of 1,179 patients (mean age 49±12.7 years; 44.4% female) underwent PFO closure from 2001 to 2021 (Figure 1). The median delay from last embolic event to procedure was 6.0 (3.4–11.2) months. Determinants of late PFO closure procedure were the center (France versus Canada) adjusted Odds Ratio (aOR) 1.65 95% confidence interval (CI) 1.25–2.19, year of procedure (≥2018 versus <2018) aOR 1.43 95% CI 1.08–1.90, female sex aOR 1.63 95% CI 1.28–2.07 and lower RoPE score aOR 1.10 95% CI 1.03–1.19. After a median follow-up of 2.61 (1.13–7.25) years, the incidence rate of first stroke or TIA did not differ between early and late PFO procedures with 0.51 versus 0.29 events per 100 patient-years, respectively, incidence rate ratio 1.74 95% CI 0.66–5.08, p=0.25 (Figure 2). In univariate analysis, late PFO percutaneous closure was not associated with the occurrence of stroke or TIA, with hazard ratio 0.54 95% CI 0.22–1.34 p=0.17.
Conclusion
This analysis provides indirect evidence that delay from last ischemic event does not impact outcomes following PFO percutaneous closure for secondary prevention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - J Mesnier
- Quebec Heart and Lung Institute , Quebec , Canada
| | - M Michel
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, Cardiology , Boulogne Billancourt , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - C Houde
- Hospital Affiliated with the University of Quebec , Quebec , Canada
| | - A Alperi
- Quebec Heart and Lung Institute , Quebec , Canada
| | - V Panagides
- Quebec Heart and Lung Institute , Quebec , Canada
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - T Wallet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | | | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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13
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Bonnet G, Panagides V, Vincent F, Faroux L, Corona S, Modine T, Metz D, Van Belle E, Pibarot P, Leroux L, Rodes-Cabau J, Ternacle J. Bioprosthetic valve fracture during valve-in-valve transcatheter aortic valve replacement: multicenter propensity matched analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2111] [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: 11/13/2022] Open
Abstract
Abstract
Background
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) can be completed by bioprosthetic valve fracture (BVF) to reduce final transvalvular gradients. The aim was to compare outcomes in ViV-TAVI patients with versus without BVF.
Methods
Consecutive patients undergoing ViV-TAVI procedure in four international centers were included, from 2010 to 2021. We used a 1:2 propensity score-matching method to compare postprocedural hemodynamic, complications, and long-term outcomes. Patients were matched for baseline characteristics, time since prior surgery, and characteristics of surgical bioprothesis (type and size).
Results
A total of 390 patients were analyzed, including 40 BVF. Propensity matching 1:2 yielded 38 patients in BVF group and 76 patients in no-BVF group. There was no difference in procedural complications rate and in-hospital deaths (5.1%) between the two groups. Post-procedural hemodynamic parameters significantly improved using BVF: aortic valve area (1.4 cm2 [IQR: 1.23 to 2.3] vs. 1.3 cm2 [IQR: 1.05 to 1.61], p=0.008), mean aortic gradient (12mmHg [IQR: 7.5 to 16.5] vs. 17mmHg [IQR: 11 to 22], p=0.008) and peak velocity (2.2m/s [IQR: 1.8 to 2.7] vs. 2.6m/s [IQR: 2.2 to 3.1], p=0.027). BVF had an additional benefit in the smallest surgical valve (≤21 mm). The use of BVF was independently associated with improved hemodynamic parameters. Overall survival in the matched cohort was 87.8±3.7% at 2-year follow-up, without difference between groups (87.5±6.9% in the BVF group vs. 88.4±4.2% in the no-BVF group, p=0.85).
Conclusion
Compared to ViV-TAVI alone, BVF was safe and improved immediate hemodynamic and long-term outcomes, especially in patients with small surgical aortic bioprosthesis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Bonnet
- Hospital Haut Leveque , Bordeaux , France
| | - V Panagides
- Quebec Heart and Lung Institute , Quebec , Canada
| | - F Vincent
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - L Faroux
- Hospital Robert Debre - University Hospital Centre of Reims , Reims , France
| | - S Corona
- Hospital Haut Leveque , Bordeaux , France
| | - T Modine
- Hospital Haut Leveque , Bordeaux , France
| | - D Metz
- Hospital Robert Debre - University Hospital Centre of Reims , Reims , France
| | - E Van Belle
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - P Pibarot
- Quebec Heart and Lung Institute , Quebec , Canada
| | - L Leroux
- Hospital Haut Leveque , Bordeaux , France
| | | | - J Ternacle
- Hospital Haut Leveque , Bordeaux , France
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14
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Farjat-Pasos JI, Nuche J, Mesnier J, Panagides V, Cloutier S, Houde C, Rodés-Cabau J. Transcatheter Patent Foramen Ovale Closure in Stroke Patients with Thrombophilia: Current Status and Future Perspectives. J Stroke 2022; 24:335-344. [PMID: 36221936 PMCID: PMC9561223 DOI: 10.5853/jos.2022.01697] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Transcatheter patent foramen ovale (PFO) closure is a safe and effective treatment for secondary prevention after a PFO-associated stroke as demonstrated in multiple large randomized clinical trials. However, these trials excluded a significant proportion of patients who could have benefited from percutaneous PFO closure due to coexisting potential confounders such as additional thromboembolic risk factors, namely thrombophilia. Since scarce and conflicting data existed on such patients, current clinical management guidelines on patients with PFO mainly recommended against PFO closure in patients with thrombophilia and failed to provide any recommendation on the type and duration of antithrombotic treatment after transcatheter PFO closure. In the past 2 years, there has been new evidence supporting transcatheter PFO closure as a clinically meaningful alternative (vs. medical treatment) in this high-risk group of patients, along with additional data supporting the important role of systematic screening for thrombophilia in PFO-associated cerebrovascular events. This review article provides an updated overview of the incidence, clinical characteristics and outcomes of PFO closure in patients with thrombophilia, also commenting on the most appropriate medical treatment after PFO closure and future perspectives in the field.
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Affiliation(s)
| | - Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Stephanie Cloutier
- Quebec University Hospital Center (Centre Hospitalier Universitaire de Québec), Quebec City, QC, Canada
| | - Christine Houde
- Quebec University Hospital Center (Centre Hospitalier Universitaire de Québec), Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
- Quebec University Hospital Center (Centre Hospitalier Universitaire de Québec), Quebec City, QC, Canada
- Correspondence: Josep Rodés-Cabau Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada Tel: +1-4186568711 E-mail:
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15
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Panagides V, Mesnier J, Nuche J, Delarochellière R, Paradis JM, Kalavrouziotis D, Dumont E, Mohammadi S, Rodes-Cabau J. From the Evolut Pro to the Evolut FX self-expanding transcatheter aortic valve replacement systems: current status and future perspectives. Expert Rev Med Devices 2022; 19:561-569. [PMID: 36005274 DOI: 10.1080/17434440.2022.2113386] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Since the initial experience with the CoreValve (Medtronic, Minneapolis, Minnesota), there have been continuous iterations of this valve system in order to improve procedural success and reduce periprocedural complications. The Evolut Pro, Pro+, and FX are the latest generations of this transcatheter heart valve (THV). AREAS COVERED This review paper aims to analyze the main characteristics and clinical evidence about the Evolut Pro THV and summarize the main iterations of the newer generation Evolut FX valve system. EXPERT OPINION The Evolut Pro system has been associated with good clinical outcomes and excellent valve hemodynamic performance including reduced rates of paravalvular leaks. Technical enhancements to improve valve positioning, orientation, and vascular access have been implemented in the newer generation Evolut FX system.
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Affiliation(s)
- Vassili Panagides
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jorge Nuche
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Robert Delarochellière
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Eric Dumont
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Siamak Mohammadi
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
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16
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Rodés-Cabau J, Ibrahim R, De Larochellière R, Ben Ali W, Paradis JM, Robichaud S, Dorval JF, Mohammadi S, Dumont E, Kalavrouziotis D, Mesnier J, Panagides V, Picard-Deland M, Lalancette S, Pelletier-Beaumont E. A pressure wire for rapid pacing, valve implantation and continuous haemodynamic monitoring during transcatheter aortic valve implantation procedures. EUROINTERVENTION 2022; 18:e345-e348. [PMID: 35588013 PMCID: PMC9980398 DOI: 10.4244/eij-d-22-00190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, QC G1V 4G5, Canada
| | | | | | | | | | | | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | - Jules Mesnier
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
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17
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Panagides V, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Eltchaninoff H, Sondergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Gervais P, Val DD, Linke A, Crusius L, Thiele H, Holzhey D, Rodés-Cabau J. Sex Differences in Infective Endocarditis After Transcatheter Aortic Valve Replacement. Can J Cardiol 2022; 38:1418-1425. [PMID: 35842172 DOI: 10.1016/j.cjca.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 07/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Outcomes after transcatheter aortic valve replacement (TAVR) and infectious diseases may vary according to sex. METHODS This multicenter study aimed to determine the sex differences in clinical characteristics, management, and outcomes of infective endocarditis (IE) after TAVR. A total of 579 patients (217 women, 37.5%) were included retrospectively from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. RESULTS Women were older (80±8 vs. 78±8 years, p=0.001) and exhibited a lower comorbidity burden. Clinical characteristics and microbiological profile were similar between men and women, but culture-negative IE was more frequent in women (9.9% vs. 4.3%, p=0.009). A high proportion of patients had a clinical indication for surgery (54.4% in both groups, p=0.99), but a surgical intervention was performed in a minority of patients (women: 15.2%, men: 20.3%, p=0.13). The mortality rate at index IE hospitalization was similar in both groups (women: 35.4%, men: 31.7%, p=0.373), but women exhibited a higher mortality rate at 2-year follow-up (63% vs. 52.1%, p=0.021). Female sex remained an independent risk factor for cumulative mortality in the multivariable analysis (HRadj: 1.28, 95% CI: 1.02-1.62, p=0.035). After adjustment for in-hospital events, surgery was not associated with better outcomes in women. CONCLUSIONS There were no significant sex-related differences in the clinical characteristics and management of IE after TAVR. However, female sex was associated with increased two-years mortality risk.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy; Ospedale San Raffaele, Milan, Italy
| | - Piotr Scislo
- Department of Cardiology, Medical University of Warsaw, Poland
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, Poland
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; Augustinum Klinik München, München, Germany
| | - Azeem Latib
- Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy; Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Panagides V, del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Brito FSD, Dato GMA, Rosato F, Ferreira MC, de Lima VC, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Breton HL, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation. Am J Cardiol 2022; 172:90-97. [PMID: 35387738 DOI: 10.1016/j.amjcard.2022.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/01/2022]
Abstract
Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation ≥2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p <0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p <0.001) and septic shock (adjusted p <0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation ≥2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up.
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Salaun E, Bernier M, Paradis JM, Champagne J, Silva Conde I, Beaudoin J, O’Connor K, Dognin N, Alperi A, Mesnier J, Panagides V, Lemyre M, Rodes-Cabau J, O’Hara G. Watchman 2.5 TM versus Watchman FLX TM device in atypical left atrial anatomies: old fashion never dies. Acta Cardiol 2022; 78:372-376. [PMID: 35634743 DOI: 10.1080/00015385.2022.2080346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Erwan Salaun
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Mathieu Bernier
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jean Champagne
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Iria Silva Conde
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Kim O’Connor
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Nicolas Dognin
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Vassili Panagides
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Maryse Lemyre
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Gilles O’Hara
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Abstract
PURPOSE OF REVIEW This review intends to give an up-to-date overview of the current state of evidence in the treatment of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR), focusing on percutaneous coronary interventions (PCI) pre-TAVR. RECENT FINDINGS The recently published ACTIVATION trial is the 1st randomized trial comparing coronary revascularization (PCI) versus medical treatment in patients with significant CAD undergoing TAVR. With the caveat of several major limitations of the trial, the results of this study raised the question about the appropriateness of the common practice to routinely revascularize coronary stenosis before TAVR. Aortic valve stenosis is the most common valvular heart disease among the elderly and it often co-occurs with CAD. TAVR is increasingly considered an alternative to surgical aortic valve replacement not only in the elderly population but also in younger and lower-risk patients. The impact of co-existing CAD on clinical outcomes as well as the optimal timing of PCI in TAVR candidates is still unclear and the subject of ongoing randomized trials. Meanwhile, it is common practice in many centers to routinely perform invasive coronary angiography and PCI for significant coronary disease as part of the TAVR workup. While computed tomography angiography has emerged as a possible alternative to the invasive coronary angiography in patients with low pre-test probability for CAD, the value of functional invasive assessment of coronary lesions in the pre-TAVR setting has still to be clarified. Also, there is an increasing interest in the clinical relevance and optimal management of the potentially challenging coronary access post-TAVR, requiring further research.
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Affiliation(s)
- Lukas S Keller
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Vassili Panagides
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jules Mesnier
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jorge Nuche
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Josep Rodés-Cabau
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada.
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Rodés-Cabau J, Abbas A, Serra V, Vilalta V, Nombela-Franco L, Regueiro A, Al-Azizi KM, Iskander A, Conradi L, Forcillo J, Lilly S, Calabuig A, Fernandez-Nofrerias E, Mohammadi S, Panagides V, Pelletier-Beaumont E, Pibarot P. Balloon- Versus Self-Expanding Valve Systems for Treating Small Failed Surgical Aortic Bioprostheses: The LYTEN Trial. J Am Coll Cardiol 2022; 80:681-693. [PMID: 35597385 DOI: 10.1016/j.jacc.2022.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data comparing valve systems in the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) field has been obtained from retrospective studies. OBJECTIVES To compare the hemodynamic results between the balloon-expandable SAPIEN (3/ULTRA) (BEV) and self-expanding Evolut (R/PRO/PRO+) (SEV) valves in ViV-TAVR. METHODS Patients with a failed small (≤23 mm) surgical valve. were randomized to receive a BEV or a SEV. The primary endpoint was valve hemodynamics (maximal/mean residual gradients; severe prosthesis patient mismatch [PPM] or moderate-severe aortic regurgitation [AR]) at 30 days as evaluated by Doppler-echocardiography. RESULTS A total of 102 patients were randomized, and of these, 98 patients finally underwent a ViV-TAVR procedure (BEV: 46, SEV: 52). The procedure was successful in all cases, with no differences in clinical outcomes at 30 days between groups (no death or stroke events). Patients in the SEV group exhibited lower mean and maximal transvalvular gradient values (15±8 vs 23±8 mmHg, p˂0.001; 28±16 vs 40±13 mmHg, p ˂0.001), and a tendency towards a lower rate of severe PPM (44% vs. 64%, p=0.07). There were no cases of moderate-severe AR. 55 consecutive patients (SEV: 27, BEV: 28) underwent invasive valve hemodynamic evaluation during the procedure, with no differences in mean and peak transvalvular gradients between both groups (p=0.41 and p=0.70, respectively). CONCLUSIONS In patients with small failed aortic bioprostheses, ViV-TAVR with a SEV was associated with improved valve hemodynamics as evaluated by echocardiography. There were no differences between groups in intra-procedural invasive valve hemodynamics and 30-day clinical outcomes (NCT03520101).
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Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada.
| | - Amr Abbas
- Beaumont Hospital, Royal Oak, Michigan, USA
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | | - Scott Lilly
- OSU Heart and Vascular Research Organization, Richard M Ross Hospital, Columbus, Ohio, USA
| | | | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
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22
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Junquera L, Alperi A, Panagides V, Mesnier J, Paradis JM, DeLarochellière R, Mohammadi S, Dumont E, Kalavrouziotis D, Rodés-Cabau J. Late Access Site Complications Following Transfemoral Aortic Valve Implantation. Am J Cardiol 2022; 169:86-92. [PMID: 35105462 DOI: 10.1016/j.amjcard.2021.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Few data exist on late vascular complications (VCs) after transfemoral (TF) transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate the incidence and predictors of late access site VC after TF TAVI. A total of 128 patients (mean age: 80 ± 8 years, women: 52%) who underwent TF TAVI without major VC were included. A femoral US-Doppler evaluation was performed in all patients at a median of 5 (3 to 15) months after the procedure, and 76 patients (59.4%) also had a preprocedural ultrasound (US)-Doppler examination. The impact of baseline and procedural factors (including the use of simple 2 Proglides or complex additional Proglide or Angioseal device on top of the 2 Proglide technique, hemostasis techniques, and the use of balloon dilation for optimizing femoral hemostasis) were evaluated. The follow-up US-Doppler evaluation detected 2 asymptomatic VCs (1.6%), and 5 (3.9%) patients exhibited significant femoral stenosis (peak systolic velocity [PSV] ≥300 cm/s). Female gender (p <0.001) and smaller femoral diameter (p = 0.045) were associated with higher femoral PSV values. In those patients who underwent a pre-TAVI femoral US-Doppler, the median PSV values after TAVI were higher compared with those obtained pre-TAVI (p <0.001), but similar results were found for the contralateral femoral arteries. A complex hemostasis technique or the use of balloon optimization at the puncture site was not associated with any increase in PSV values. In conclusion, percutaneous femoral hemostasis after TAVI was associated with a low rate of late VC. The results were similar irrespective of the hemostasis technique and the use of balloon dilation at the puncture site, but women and a smaller femoral size were associated with increased PSV values. Further studies are needed to determine the optimal femoral hemostasis technique in TAVI procedures.
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Panagides V, Kalavrouziotis D, Dumont E, Delarochellière R, Paradis JM, Mesnier J, Mohammadi S, Rodés-Cabau J. Carotid ultrasound following Transcarotid Transcatheter aortic valve replacement. Int J Cardiol 2022; 358:12-16. [DOI: 10.1016/j.ijcard.2022.04.054] [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: 02/27/2022] [Revised: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 11/05/2022]
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Panagides V, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Gervais P, Del Val D, Linke A, Crusius L, Thiele H, Holzhey D, Rodés-Cabau J. Very early infective endocarditis after transcatheter aortic valve replacement. Clin Res Cardiol 2022; 111:1087-1097. [PMID: 35262756 DOI: 10.1007/s00392-022-01998-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/09/2021] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR). OBJECTIVE The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR. METHODS This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. RESULTS Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p < 0.001), stroke (p = 0.019), and sepsis (p < 0.001) after TAVR. Staphylococcus aureus was the main pathogen among VE-IE patients (35.2% vs. 22.7% in the D-IE group, p = 0.012), and 31.2% of Staphylococcus aureus infections in the VE-IE group were methicillin-resistant (vs. 14.3% in the D-IE group, p = 0.001). The second-most common germ was enterococci (34.1% vs. 24.4% in D-IE cases, p = 0.05). VE-IE was associated with very high in-hospital (44%) and 1-year (54%) mortality rates. Acute renal failure following TAVR (p = 0.001) and the presence of a non-enterococci pathogen (p < 0.001) were associated with an increased risk of death. CONCLUSION A significant proportion of IE episodes following TAVR occurs within a few weeks following the procedure and are associated with dismal outcomes. Some baseline and TAVR procedural factors were associated with VE-IE, and Staphylococcus aureus and enterococci were the main causative pathogens. These results may help to select the more appropriate antibiotic prophylaxis in TAVR procedures and guide the initial antibiotic therapy in those cases with a clinical suspicion of IE. Very early infective endocarditis after trans-catheter aortic valve replacement. VE-IE indicates very early infective endocarditis (≤30 days post TAVR). D-IE indicates delayed infective endocarditis.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eric Durand
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, 76000, Rouen, France
| | | | | | | | - Francesco Giannini
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
- Ospedale San Raffaele, Milan, Italy
| | - Piotr Scislo
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, 35000, Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada
- Southlake Hospital, Newmarket, ON, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Helene Eltchaninoff
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, 76000, Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany
- Augustinum Klinik München, München, Germany
| | - Azeem Latib
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
- Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, 35000, Rennes, France
| | | | - Philippe Gervais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
- Hospital Clínic Barcelona, Barcelona, Spain.
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Benseba J, Rodés-Cabau J, Beaudoin J, Hadjadj S, Kalavrouziotis D, Dumont E, Mohammadi S, Mesnier J, Panagides V, Cote M, Couture T, Mercier J, Faroux L, Bernatchez L, Robert D, Paradis JM. LONG TERM OUTCOMES FOLLOWING THE USE OF FRACTIONAL FLOW RESERVE TO ASSESS CORONARY ARTERY DISEASE IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01757-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Panagides V, Laine M, Mancini J, Delmas C, Gaubert M, Dabry T, Boufi M, Paganelli F, Lemesle G, Bonello L. Haemodynamic support during high-risk percutaneous coronary intervention. Arch Cardiovasc Dis 2022; 115:109-113. [PMID: 35115264 DOI: 10.1016/j.acvd.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Vassili Panagides
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Marc Laine
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Hôpital de la Timone, Aix-Marseille University, 13005, Marseille, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, 31400, Toulouse, France
| | - Melanie Gaubert
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Thibaut Dabry
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Mourad Boufi
- Service de chirurgie vasculaire, Hôpital Nord, AP-HM, 13015, Marseille, France
| | - Franck Paganelli
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Gilles Lemesle
- USIC et centre hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Laurent Bonello
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France.
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Panagides V, Kalavrouziotis D, Dumont E, Delarochellière R, Paradis JM, Mesnier J, Mohammadi S, Rodés-Cabau J. Cranial nerve injury during transcarotid transcatheter aortic valve replacement. Int J Cardiol 2022; 353:46-48. [PMID: 35114203 DOI: 10.1016/j.ijcard.2022.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND No data exist about cranial nerve injury (CNI) as a potential complication of transcarotid (TC) transcatheter valve replacement (TAVR). METHODS This monocentric study included 318 consecutive patients undergoing TC-TAVR from May 2015 to August 2021. RESULTS CNI occurred in 7 (2.2%) TAVR-TC patients. Five out of the 7 patients (71.4%) had an injury of the laryngeal branch of the vagus nerve, and 2 patients (28.6%) had an injury of the facial nerve. The majority of patients were male (85.7%), with high body mass index (35.6 (IQR: 30.1-37.3) kg/m2). The induced disabilities were clinically important especially for patients with dysphonia. CONCLUSIONS CNI is a potential complication of TC-TAVR likely avoidable by a meticulous surgical technique. Structural heart teams must be aware of this serious setback.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | | | - Jules Mesnier
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada.
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28
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Bouisset F, Deney A, Ferrières J, Panagides V, Becker M, Riviere N, Yvorel C, Commeau P, Adjedj J, Benamer H, Bonnet G, Cayla G. Mechanical complications in ST-elevation myocardial infarction: The impact of pre-hospital delay. Int J Cardiol 2021; 345:14-19. [PMID: 34699868 DOI: 10.1016/j.ijcard.2021.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/30/2021] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 02/02/2023]
Abstract
AIMS Mechanical complications (MC) (i.e., free wall rupture (FWR), papillary muscle rupture (PMR) and ventricular septal rupture (VSR)) are rare complications of ST- elevation acute myocardial infarction (STEMI). Incidence of MC according to pre-hospital delay remains unknown. We aimed to determine the rates of MC according to pre-hospital delay. METHODS Analysis was conducted on the MODIF registry data. Patients were allocated to four groups according to pre-hospital delay: 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h. RESULTS 6185 patients with complete data were analyzed. Mean age was 64.1 years old and 75.7% of patients were males. Eighty-three patients (1.34%) presented with MC: 44 (0.71%) experienced a FWR, 17 (0.27%) a PMR, and 22 (0.36%) a VSR. Global rates of MC were 0.82%, 1.43%, 1.24% and 5.07% in the four groups of pre-hospital delays - 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h - respectively (p < 0.001). In-hospital mortality rates were high: 44.2%, 47.1% and 54.6% for FWR, PMR and VSR, respectively. In multivariate analysis, factors independently related to the occurrence of MC were older age, female sex, simultaneous COVID-19 infection, absence of dyslipidemia, initial TIMI flow 0 or 1 in the culprit artery, 36 to 48 h-pre-hospital delay and absence of revascularization by percutaneous coronary intervention (PCI) with stent implantation. CONCLUSION The probability of MC in STEMI increases with pre-hospital delay. Mechanical complications of STEMI remain associated with a very poor prognosis.
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Affiliation(s)
- Frederic Bouisset
- Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Toulouse, France; Department of Epidemiology INSERM UMR 1027, Toulouse, France.
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Toulouse, France
| | - Jean Ferrières
- Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Toulouse, France; Department of Epidemiology INSERM UMR 1027, Toulouse, France
| | - Vassili Panagides
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Mathieu Becker
- CHR Metz -Thionville, Metz Hopital de Mercy, Metz, France
| | - Nicolas Riviere
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | | | - Julien Adjedj
- Institute Arnaud Tzanck, Saint Laurent du Var, France
| | - Hakim Benamer
- Institut Jacques Cartier, Ramsay Générale de Santé, ICPS, Massy, France
| | - Guillaume Bonnet
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Guillaume Cayla
- Cardiology Department, Nimes University Hospital, Montpellier University, Nimes, France
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29
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Panagides V, Mohammadi S, Rodés-Cabau J, Paradis JM. "Ménage à Trois": Use of 2 Supplemental Buddy Wires During TAVI. CJC Open 2021; 3:1403-1405. [PMID: 34901812 PMCID: PMC8640649 DOI: 10.1016/j.cjco.2021.06.016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/03/2022] Open
Abstract
We herein present clinical images illustrating a transcatheter aortic valve implantation within an extremely calcified aortic valve, which posed considerable difficulty in crossing the aortic annulus. To gain maximum support, we used 2 buddy wires to allow a balloon predilation and then a successful crossing of the transcatheter heart valve. This technique provides additional support for those performing this procedure and may be included in the armamentarium of transcatheter aortic valve specialists.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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30
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Panagides V, Del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Correia de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement. Clin Infect Dis 2021; 75:638-646. [PMID: 34894124 DOI: 10.1093/cid/ciab1004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. METHODS This multicenter study included a total of 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm or fistula confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings. RESULTS A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs. 15.2% in patients without PEE, p<0.001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality risk were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj<0.05 for all). CONCLUSION PEE occurred in about one fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany.,Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada.,Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañon, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, USA.,Mount Sinai Hospital, New York, NY, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy.,University Hospital Galway, Galway, Ireland
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany.,St.-Johannes Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy.,Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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31
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Trimaille A, Ribeyrolles S, Fauvel C, Chaumont C, Weizman O, Pommier T, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Chemaly P, Karsenty C, Giordano G, Gautier A, Guilleminot P, Sagnard A, Pastier J, Duceau B, Sutter W, Waldmann V, Pezel T, Mika D, Cohen A, Bonnet G. Cardiovascular Characteristics and Outcomes of Young Patients with COVID-19. J Cardiovasc Dev Dis 2021; 8:jcdd8120165. [PMID: 34940520 PMCID: PMC8704739 DOI: 10.3390/jcdd8120165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/14/2021] [Accepted: 11/21/2021] [Indexed: 01/10/2023] Open
Abstract
Although 18–45-year-old (y-o) patients represent a significant proportion of patients hospitalized for COVID-19, data concerning the young population remain scarce. The Critical COVID France (CCF) study was an observational study including consecutive patients hospitalized for COVID-19 in 24 centers between 26 February and 20 April 2020. The primary composite outcome included transfer to the intensive care unit (ICU) or in-hospital death. Secondary outcomes were cardiovascular (CV) complications. Among 2868 patients, 321 (11.2%) patients were in the 18–45-y-o range. In comparison with older patients, young patients were more likely to have class 2 obesity and less likely to have hypertension, diabetes and dyslipidemia. The primary outcome occurred less frequently in 18–45-y-o patients in comparison with patients > 45 years old (y/o) (16.8% vs. 30.7%, p < 0.001). The 18–45-y-o patients presented with pericarditis (2.2% vs. 0.5%, p = 0.003) and myocarditis (2.5% vs. 0.6%, p = 0.002) more frequently than patients >45 y/o. Acute heart failure occurred less frequently in 18–45-y-o patients (0.9% vs. 7.2%, p < 0.001), while thrombotic complications were similar in young and older patients. Whereas both transfer to the ICU and in-hospital death occurred less frequently in young patients, COVID-19 seemed to have a particular CV impact in this population.
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Affiliation(s)
- Antonin Trimaille
- Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France;
| | | | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, 76000 Rouen, France; (C.F.); (C.C.)
| | - Corentin Chaumont
- Centre Hospitalier Universitaire de Rouen, 76000 Rouen, France; (C.F.); (C.C.)
| | - Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Lès-Nancy, France; (O.W.); (G.G.)
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Joffrey Cellier
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France; (J.C.); (W.S.); (V.W.)
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, 80000 Amiens, France;
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France;
| | - Wassima Marsou
- Faculté de Médecine et de Maïeutique, GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Université Catholique de Lille, 59800 Lille, France;
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France; (A.D.); (C.K.)
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France;
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France;
| | - Pascale Chemaly
- Institut Cardiovasculaire Paris Sud, Massy, 91300 Paris, France; (P.C.); (A.G.)
| | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France; (A.D.); (C.K.)
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Lès-Nancy, France; (O.W.); (G.G.)
| | - Alexandre Gautier
- Institut Cardiovasculaire Paris Sud, Massy, 91300 Paris, France; (P.C.); (A.G.)
| | - Pierre Guilleminot
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Julie Pastier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Baptiste Duceau
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
| | - Willy Sutter
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France; (J.C.); (W.S.); (V.W.)
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
| | - Victor Waldmann
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France; (J.C.); (W.S.); (V.W.)
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
| | - Théo Pezel
- Hôpital Lariboisière, APHP, Université de Paris, 75010 Paris, France;
| | - Delphine Mika
- Signaling and Cardiovascular Pathophysiology, Inserm, UMR-S 1180, Université Paris-Saclay, Chatenay-Malabry, 92296 Paris, France;
| | - Ariel Cohen
- Hôpital Saint Antoine, 75012 Paris, France
- Correspondence:
| | - Guillaume Bonnet
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
- Unité Médico-Chirurgicale de Valvulopathies et Cardiomyopathies, Université de Bordeaux, Hopital Cardiologique Haut-Lévêque, 33600 Pessac, France
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32
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Mesnier J, Alperi A, Panagides V, Bédard E, Salaun E, Philippon F, Rodés-Cabau J. Transcatheter tricuspid valve interventions: Current devices and associated evidence. Prog Cardiovasc Dis 2021; 69:89-100. [PMID: 34801577 DOI: 10.1016/j.pcad.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
Tricuspid regurgitation (TR) is a common finding in patients with chronic cardiopathy, and often a marker of an advanced disease. Being silent or with symptoms intertwined with the primitive left heart disease, TR has often been neglected, leading to the late referral of patients with advanced right-heart failure. Hence, isolated tricuspid surgery has been associated with high morbidity and mortality rates, the worse of all valve interventions, and medical management has been limited to symptomatic treatment. In this context, percutaneous therapies for severe TR have gained traction, addressing the unmet therapeutic gap for a less invasive disease-modifying management. The aim of this review is to provide an updated overview on transcatheter tricuspid valve interventions, focusing on devices' characteristics, associated evidence, and future perspectives.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic Barcelona, Barcelona, Spain.
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Alperi A, Mesnier J, Panagides V, Rodés-Cabau J. Device profile of the SAPIEN 3 transcatheter heart valve in low-risk patients with aortic stenosis: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:815-821. [PMID: 34404298 DOI: 10.1080/17434440.2021.1969915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has become a treatment of reference for patients with symptomatic severe aortic stenosis, and the balloon-expandable SAPIEN 3 and SAPIEN 3 Ultra transcatheter heart valve systems are two of the most broadly used worldwide. Lately, TAVR has progressively expanded toward the treatment of low-risk patients. AREAS COVERED In this review we aimed to describe the main characteristics of the SAPIEN 3 valve, and to delineate the main clinical findings regarding the safety and efficacy associated with this THV system in low-risk patients undergoing TAVR. EXPERT OPINION The approval of THV systems for use in low-risk patients has been a significant step forward in expanding current TAVR indications. Along with procedural refinement and growing operator experience, device iterations implemented in new-generation THV systems have played a vital role in the successful spread of TAVR. The availability of SAPIEN 3 represented an inflection point, as it allows for a predictable positioning and safer navigability while dramatically decreasing the rate of residual paravalvular leakage compared to previous balloon-expandable systems. However, some unresolved issues remain like the relatively high rates of conduction disturbances and the uncertainty about valve performance in the long-term. Future studies are warranted.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Abstract
Introduction: Over the past decade, the number of transcatheter aortic valve replacement (TAVR) procedures has increased exponentially. Despite major improvements in both device and successes, the rate of hospital readmission after TAVR remains high, with heart failure (HF) decompensation being one of the most important causes.Areas covered: This review provides an overview of the current status of HF following TAVR, including details about its incidence, clinical impact, contributing factors, and current and future treatment perspectives.Expert opinion: HF decompensation has been identified as the most common cause of rehospitalization following TAVR, and it has been associated with a negative prognosis. Multiple preexisting factors including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary artery disease, and atrial fibrillation have been associated with an increased risk of HF events. Also, multiple post-procedural factors like the occurrence of significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances have also contributed to increase this risk . Thus, reducing HF events in TAVR recipients would require a multifactorial and multidisciplinary effort including the optimization of the medical treatment and close follow-up and treatment of residual or concomitant valvular disease and conduction disturbance issues. Future studies in this challenging group of patients are warranted.
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Affiliation(s)
- Vassili Panagides
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mathieu Bernier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Panagides V, Vincent F, Weizman O, Jonveaux M, Trimaille A, Pommier T, Cellier J, Geneste L, Marsou W, Deney A, Attou S, Delmotte T, Fauvel C, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Karsenty C, Duceau B, Sutter W, Mika D, Pezel T, Waldmann V, Ternacle J, Cohen A, Bonnet G. History of heart failure in patients with coronavirus disease 2019: Insights from a French registry. Arch Cardiovasc Dis 2021; 114:415-425. [PMID: 34099379 PMCID: PMC8141712 DOI: 10.1016/j.acvd.2021.04.003] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cardiovascular comorbidities seem to be strongly associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19), data regarding patients with preexisting heart failure are limited. AIMS To investigate the incidence, characteristics and clinical outcomes of patients with COVID-19 with a history of heart failure with preserved or reduced ejection fraction. METHODS We performed an observational multicentre study including all patients hospitalized for COVID-19 across 24 centres in France from 26 February to 20 April 2020. The primary endpoint was a composite of in-hospital death or need for orotracheal intubation. RESULTS Overall, 2809 patients (mean age 66.4±16.9years) were included. Three hundred and seventeen patients (11.2%) had a history of heart failure; among them, 49.2% had heart failure with reduced ejection fraction and 50.8% had heart failure with preserved ejection fraction. COVID-19 severity at admission, defined by a quick sequential organ failure assessment score>1, was similar in patients with versus without a history of heart failure. Before and after adjustment for age, male sex, cardiovascular comorbidities and quick sequential organ failure assessment score, history of heart failure was associated with the primary endpoint (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.90; P=0.02). This result seemed to be mainly driven by a history of heart failure with preserved ejection fraction (HR: 1.61, 95% CI: 1.13-2.27; P=0.01) rather than heart failure with reduced ejection fraction (HR: 1.19, 95% CI: 0.79-1.81; P=0.41). CONCLUSIONS History of heart failure in patients with COVID-19 was associated with a higher risk of in-hospital death or orotracheal intubation. These findings suggest that patients with a history of heart failure, particularly heart failure with preserved ejection fraction, should be considered at high risk of clinical deterioration.
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Affiliation(s)
- Vassili Panagides
- Aix-Marseille Université, Intensive Care Unit, Hôpital Nord, AP-HM, 13015 Marseille, France
| | - Flavien Vincent
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, INSERM U1011, Institut Pasteur de Lille, EGID, Université de Lille, 59800 Lille, France
| | - Orianne Weizman
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-les-Nancy, France; Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Melchior Jonveaux
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, 59800 Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | - Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Nacim Ezzouhairi
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Benjamin Perin
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-les-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP-HP, Université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier Annecy Genevois, 74370 Épagny-Metz-Tessy, France
| | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Baptiste Duceau
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Willy Sutter
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Delphine Mika
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Châtenay-Malabry, France
| | - Théo Pezel
- Hôpital Lariboisière, AP-HP, University of Paris, 75010 Paris, France
| | - Victor Waldmann
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Julien Ternacle
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Québec G1V 4G5, Canada
| | | | - Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, 75015 Paris, France; University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
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Weizman O, Mika D, Cellier J, Geneste L, Trimaille A, Pommier T, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Duceau B, Sutter W, Fauvel C, Pezel T, Bonnet G, Cohen A, Waldmann V. Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: A multicentre cohort study. Arch Cardiovasc Dis 2021; 114:394-406. [PMID: 34154954 PMCID: PMC8139232 DOI: 10.1016/j.acvd.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 01/10/2023]
Abstract
Background Although women account for up to half of patients hospitalized for coronavirus disease 2019 (COVID-19), no specific data have been reported in this population. Aims To assess the burden and impact of cardiovascular comorbidities in women with COVID-19. Methods All consecutive patients hospitalized for COVID-19 across 24 hospitals from 26 February to 20 April 2020 were included. The primary composite outcome was transfer to an intensive care unit or in-hospital death. Results Among 2878 patients, 1212 (42.1%) were women. Women were older (68.3 ± 18.0 vs. 65.4 ± 16.0 years; P < 0.001), but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8%) experienced the primary outcome, including 161 (13.3%) transfers to an intensive care unit and 115 (9.5%) deaths without transfer to intensive care unit. The rate of in-hospital death or transfer to an intensive care unit was lower in women versus men (crude hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.53–0.72). Age (adjusted HR: 1.05 per 5-year increase, 95% CI: 1.01–1.10), body mass index (adjusted HR: 1.06 per 2-unit increase, 95% CI: 1.02–1.10), chronic kidney disease (adjusted HR: 1.57, 95% CI: 1.11–2.22) and heart failure (adjusted HR: 1.52, 95% CI: 1.04–2.22) were independently associated with the primary outcome in women. Elevated B-type natriuretic peptide/N-terminal prohormone of B-type natriuretic peptide (adjusted HR: 2.41, 95% CI: 1.70–3.44) and troponin (adjusted HR: 2.00, 95% CI: 1.39–2.88) concentrations at admission were also associated with the primary outcome, even in women free of previous coronary artery disease or heart failure. Conclusions Although female sex was associated with a lower risk of transfer to an intensive care unit or in-hospital death, COVID-19 remained associated with considerable morbimortality in women, especially in those with cardiovascular diseases.
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Affiliation(s)
- Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Les-Nancy, France; Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Châtenay-Malabry, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | | | | | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Les-Nancy, France
| | | | | | | | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Julie Pastier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | | | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Théo Pezel
- Hôpital Lariboisiere, AP-HP, University of Paris, 75010 Paris, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France; University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Ariel Cohen
- Hôpital Saint-Antoine, AP-HP, 75012 Paris, France.
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, 75015 Paris, France; Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, 75015 Paris, France
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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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Bonnet G, Panagides V, Becker M, Rivière N, Yvorel C, Deney A, Lattuca B, Duband B, Moussa K, Juenin L, Pamart T, Semaan C, Uhry S, Noirclerc N, Vincent F, Vignac M, Palermo V, Martin AS, Zeitouni M, Van Belle E, Tirouvanziam A, Manchuelle A, Chamandi C, Kerneis M, Boukantar M, Belle L, De Poli F, Angoulvant D, Meneveau N, Robin M, Pansieri M, Bonello L, Motreff P, Bouisset F, Isaaz K, Cetran L, Khalife K, Lesizza P, Adjedj J, Benamer H, Cayla G. ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in France. Arch Cardiovasc Dis 2021; 114:340-351. [PMID: 33926830 PMCID: PMC9056233 DOI: 10.1016/j.acvd.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.
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Affiliation(s)
- Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vassili Panagides
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Mathieu Becker
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | - Nicolas Rivière
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Cédric Yvorel
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Antoine Deney
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France
| | - Benoit Lattuca
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Benjamin Duband
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Karim Moussa
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Léa Juenin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Thibault Pamart
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Carl Semaan
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Sabrina Uhry
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | | | | | - Maxime Vignac
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vincenzo Palermo
- Cardiology Department, Marie Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - Anne Sophie Martin
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | | | | | | | - Chekrallah Chamandi
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris, INSERM U970, 75015 Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Madjid Boukantar
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Loïc Belle
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | - Fabien De Poli
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | - Denis Angoulvant
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Nicolas Meneveau
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Marie Robin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Michel Pansieri
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Pascal Motreff
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Frédéric Bouisset
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France; Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France
| | - Karl Isaaz
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Laura Cetran
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Khalifé Khalife
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | | | - Julien Adjedj
- Arnaud Tzanck Institute, 06700 Saint Laurent du Var, France
| | - Hakim Benamer
- Institut Jacques Cartier, Ramsay Générale de Santé, ICPS, 91300 Massy, France
| | - Guillaume Cayla
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France.
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Chocron R, Duceau B, Gendron N, Ezzouhairi N, Khider L, Trimaille A, Goudot G, Weizman O, Alsac JM, Pommier T, Bory O, Cellier J, Philippe A, Geneste L, Ben Abdallah I, Panagides V, El Batti S, Marsou W, Juvin P, Deney A, Messas E, Attou S, Planquette B, Mika D, Gaussem P, Fauvel C, Diehl JL, Pezel T, Mirault T, Sutter W, Sanchez O, Bonnet G, Cohen A, Smadja DM. D-dimer at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicenter cohort study. Arch Cardiovasc Dis 2021; 114:381-393. [PMID: 33846096 PMCID: PMC7942155 DOI: 10.1016/j.acvd.2021.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high concentrations of D-dimer, and increased frequency of venous thromboembolism. Aim To explore the association between D-dimer at admission and in-hospital mortality in patients hospitalised for COVID-19, with or without symptomatic venous thromboembolism. Methods From 26 February to 20 April 2020, D-dimer concentration at admission and outcomes (in-hospital mortality and venous thromboembolism) of patients hospitalised for COVID-19 in medical wards were retrospectively analysed in a multicenter study in 24 French hospitals. Results Among 2878 patients enrolled in the study, 1154 (40.1%) patients had D-dimer measurement at admission. Receiver operating characteristic curve analysis identified a D-dimer concentration > 1128 ng/mL as the best cut-off value for in-hospital mortality (area under the curve 64.9%, 95% confidence interval [CI] 60–69), with a sensitivity of 71.1% (95% CI 62–78) and a specificity of 55.6% (95% CI 52–58), which did not differ in the subgroup of patients with venous thromboembolism during hospitalisation. Among 545 (47.2%) patients with D-dimer concentration > 1128 ng/mL at admission, 86 (15.8%) deaths occurred during hospitalisation. After adjustment, in Cox proportional hazards and logistic regression models, D-dimer concentration > 1128 ng/mL at admission was also associated with a worse prognosis, with an odds ratio of 3.07 (95% CI 2.05–4.69; P < 0.001) and an adjusted hazard ratio of 2.11 (95% CI 1.31–3.4; P < 0.01). Conclusions D-dimer concentration > 1128 ng/mL is a relevant predictive factor for in-hospital mortality in patients hospitalised for COVID-19 in a medical ward, regardless of the occurrence of venous thromboembolism during hospitalisation.
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Affiliation(s)
- Richard Chocron
- Université de Paris, PARCC, INSERM; Emergency department, Georges-Pompidou European hospital, AP-HP, 75015 Paris, France.
| | | | - Nicolas Gendron
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Nacim Ezzouhairi
- Université de médecine de Bordeaux, Centre hospitalier universitaire de Bordeaux, 33076 Bordeaux, France
| | - Lina Khider
- Université de Paris, Vascular medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Antonin Trimaille
- Nouvel hôpital civil, Centre hospitalier régional universitaire de Strasbourg, 67000 Strasbourg, France
| | - Guillaume Goudot
- Université de Paris, Vascular medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Orianne Weizman
- Centre hospitalier régional universitaire de Nancy, 54511 Vandœuvre-Les-Nancy, France
| | - Jean Marc Alsac
- Université de Paris, Innovative therapies in haemostasis, INSERM; Vascular surgery department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | | | - Olivier Bory
- Université de Paris, Emergency department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Joffrey Cellier
- Georges-Pompidou European Hospital, AP-HP, Université de Paris, 75015 Paris, France
| | - Aurélien Philippe
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Laura Geneste
- Centre hospitalier universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Iannis Ben Abdallah
- Université de Paris, Innovative therapies in haemostasis, INSERM; Vascular surgery department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Vassili Panagides
- Centre hospitalier universitaire de Marseille, 13005 Marseille, France
| | - Salma El Batti
- Université de Paris, Innovative therapies in haemostasis, INSERM; Vascular surgery department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Wassima Marsou
- Centre hospitalier universitaire de Lille, Université catholique de Lille, 59000 Lille, France
| | - Philippe Juvin
- Université de Paris, Emergency department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Antoine Deney
- Centre hospitalier universitaire de Toulouse, 31400 Toulouse, France
| | - Emmanuel Messas
- Université de Paris, PARCC, INSERM; Vascular medicine department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Sabir Attou
- Centre hospitalier universitaire de Caen-Normandie, 14000 Caen, France
| | - Benjamin Planquette
- Université de Paris, Innovative therapies in haemostasis, INSERM; Respiratory medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European hospital, AH-HP, 75015 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Pascale Gaussem
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Charles Fauvel
- Rouen university hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Jean-Luc Diehl
- Université de Paris, Innovative therapies in haemostasis, INSERM; Intensive care medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Theo Pezel
- Lariboisière hospital, AP-HP, Université de Paris, 75010 Paris, France
| | - Tristan Mirault
- Université de Paris, PARCC, INSERM; Vascular medicine department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Olivier Sanchez
- Université de Paris, Innovative therapies in haemostasis, INSERM; Respiratory medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European hospital, AH-HP, 75015 Paris, France
| | | | - Ariel Cohen
- Department of cardiology, Saint-Antoine hospital, AP-HP, 75012 Paris, France
| | - David M Smadja
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
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Bonnet G, Weizman O, Trimaille A, Pommier T, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Chaumont C, Guilleminot P, Sagnard A, Pastiero J, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Duceau B, Sutter W, Mika D, Fauvel C, Pezel T, Waldmann V, Cohen A. Characteristics and outcomes of patients hospitalized for COVID-19 in France: The Critical COVID-19 France (CCF) study. Arch Cardiovasc Dis 2021; 114:352-363. [PMID: 34154953 PMCID: PMC7923854 DOI: 10.1016/j.acvd.2021.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to a public health crisis. Only limited data are available on the characteristics and outcomes of patients hospitalized for COVID-19 in France. Aims To investigate the characteristics, cardiovascular complications and outcomes of patients hospitalized for COVID-19 in France. Methods The Critical COVID-19 France (CCF) study is a French nationwide study including all consecutive adults with a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection hospitalized in 24 centres between 26 February and 20 April 2020. Patients admitted directly to intensive care were excluded. Clinical, biological and imaging parameters were systematically collected at hospital admission. The primary outcome was in-hospital death. Results Of 2878 patients included (mean ± SD age 66.6 ± 17.0 years, 57.8% men), 360 (12.5%) died in the hospital setting, of which 7 (20.7%) were transferred to intensive care before death. The majority of patients had at least one (72.6%) or two (41.6%) cardiovascular risk factors, mostly hypertension (50.8%), obesity (30.3%), dyslipidaemia (28.0%) and diabetes (23.7%). In multivariable analysis, older age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03 − 1.06; P < 0.001), male sex (HR 1.69, 95% CI 1.11 − 2.57; P = 0.01), diabetes (HR 1.72, 95% CI 1.12 − 2.63; P = 0.01), chronic kidney failure (HR 1.57, 95% CI 1.02 − 2.41; P = 0.04), elevated troponin (HR 1.66, 95% CI 1.11 − 2.49; P = 0.01), elevated B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide (HR 1.69, 95% CI 1.0004 − 2.86; P = 0.049) and quick Sequential Organ Failure Assessment score ≥ 2 (HR 1.71, 95% CI 1.12 − 2.60; P = 0.01) were independently associated with in-hospital death. Conclusions In this large nationwide cohort of patients hospitalized for COVID-19 in France, cardiovascular comorbidities and risk factors were associated with a substantial morbi-mortality burden.
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Affiliation(s)
- Guillaume Bonnet
- Université de Paris, PARCC, inserm, 75015 Paris, France; Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Orianne Weizman
- Université de Paris, PARCC, inserm, 75015 Paris, France; Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Antonin Trimaille
- Nouvel hopital Civil, Centre Hospitalier régional universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Lariboisiere hospital, AP-HP, university of Paris, 75010 Paris, France; Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Antoine Deney
- Centre Hospitalier universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier universitaire de Reims, 51100 Reims, France
| | | | | | - Clément Karsenty
- Centre Hospitalier universitaire de Toulouse, 31400 Toulouse, France
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | | | | | | | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Julie Pastiero
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Nacim Ezzouhairi
- Centre Hospitalier universitaire de Bordeaux, 33076 Bordeaux, France
| | - Benjamin Perin
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP-HP, université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier régional de Orléans, 45100 Orléans, France
| | - Baptiste Duceau
- Université de Paris, PARCC, inserm, 75015 Paris, France; Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Willy Sutter
- Université de Paris, PARCC, inserm, 75015 Paris, France; Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Théo Pezel
- Lariboisiere hospital, AP-HP, university of Paris, 75010 Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, inserm, 75015 Paris, France; Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Ariel Cohen
- Hôpital Saint-Antoine, Saint-Antoine and Tenon hospitals, AP-HP, Inserm UMRS-ICAN 1166 Sorbonne-Université, French Society of Cardiology 2020-2022, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
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41
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Chavarot N, Gueguen J, Bonnet G, Jdidou M, Trimaille A, Burger C, Amrouche L, Weizman O, Pommier T, Aubert O, Celier J, Sberro-Soussan R, Geneste L, Panagides V, Delahousse M, Marsou W, Aguilar C, Deney A, Zuber J, Fauvel C, Legendre C, Mika D, Pezel T, Anglicheau D, Sutter W, Zaidan M, Snanoudj R, Cohen A, Scemla A. COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities. Am J Transplant 2021; 21:1285-1294. [PMID: 33252201 PMCID: PMC7753406 DOI: 10.1111/ajt.16416] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 08/05/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/25/2023]
Abstract
Higher rates of severe COVID-19 have been reported in kidney transplant recipients (KTRs) compared to nontransplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score-matching method to compare survival and severe disease-free survival (defined as death and/or need for intensive care unit [ICU]) incidence in hospitalized KTRs and nontransplant control patients between February 26 and May 22, 2020. Patients were matched for risk factors of severe COVID-19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease, and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3-73.1) in three French transplant centers. After a median follow-up of 13 days (7-30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow-up of 8.5 days (2-14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched nontransplant patients with respective 30-day survival of 62.9% and 71% (p = .38) and severe disease-free 30-day survival of 50.6% and 47.5% (p = .91). These findings suggest that severity of COVID-19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression.
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Affiliation(s)
- Nathalie Chavarot
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France,Correspondence Nathalie Chavarot
| | - Juliette Gueguen
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Guillaume Bonnet
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Mariam Jdidou
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Carole Burger
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Lucile Amrouche
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-Les-Nancy, France
| | | | - Olivier Aubert
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Joffrey Celier
- Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, Amiens, France
| | | | - Michel Delahousse
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Claire Aguilar
- Université de Paris, Paris, France,Départment de maladies infectieuses et tropicales, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Julien Zuber
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, Rouen, France
| | - Christophe Legendre
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, Chatenay-Malabry, France
| | - Theo Pezel
- Hôpital Lariboisière, APHP, University of Paris, Paris, France
| | - Dany Anglicheau
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Willy Sutter
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Mohamad Zaidan
- Département de Néphrologie et transplantation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Renaud Snanoudj
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Ariel Cohen
- Université de Paris, Paris, France,Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Scemla
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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Chocron R, Galand V, Cellier J, Gendron N, Pommier T, Bory O, Khider L, Trimaille A, Goudot G, Weizman O, Alsac JM, Geneste L, Schmeltz A, Panagides V, Philippe A, Marsou W, Ben Abdallah I, Deney A, El Batti S, Attou S, Juvin P, Delmotte T, Messas E, Pezel T, Planquette B, Duceau B, Gaussem P, Sutter W, Sanchez O, Waldman V, Diehl JL, Mirault T, Bonnet G, Cohen A, Smadja DM. Anticoagulation Before Hospitalization Is a Potential Protective Factor for COVID-19: Insight From a French Multicenter Cohort Study. J Am Heart Assoc 2021; 10:e018624. [PMID: 33550816 PMCID: PMC8174166 DOI: 10.1161/jaha.120.018624] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID‐19) is a respiratory disease associated with thrombotic outcomes with coagulation and endothelial disorders. Based on that, several anticoagulation guidelines have been proposed. We aimed to determine whether anticoagulation therapy modifies the risk of developing severe COVID‐19. Methods and Results Patients with COVID‐19 initially admitted in medical wards of 24 French hospitals were included prospectively from February 26 to April 20, 2020. We used a Poisson regression model, Cox proportional hazard model, and matched propensity score to assess the effect of anticoagulation on outcomes (intensive care unit admission or in‐hospital mortality). The study enrolled 2878 patients with COVID‐19, among whom 382 (13.2%) were treated with oral anticoagulation therapy before hospitalization. After adjustment, anticoagulation therapy before hospitalization was associated with a better prognosis with an adjusted hazard ratio of 0.70 (95% CI, 0.55–0.88). Analyses performed using propensity score matching confirmed that anticoagulation therapy before hospitalization was associated with a better prognosis, with an adjusted hazard ratio of 0.43 (95% CI, 0.29–0.63) for intensive care unit admission and adjusted hazard ratio of 0.76 (95% CI, 0.61–0.98) for composite criteria intensive care unit admission or death. In contrast, therapeutic or prophylactic low‐ or high‐dose anticoagulation started during hospitalization were not associated with any of the outcomes. Conclusions Anticoagulation therapy used before hospitalization in medical wards was associated with a better prognosis in contrast with anticoagulation initiated during hospitalization. Anticoagulation therapy introduced in early disease could better prevent COVID‐19–associated coagulopathy and endotheliopathy, and lead to a better prognosis.
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Affiliation(s)
- Richard Chocron
- PARCC INSERM Université de Paris France.,Emergency Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | | | - Joffrey Cellier
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | | | - Olivier Bory
- PARCC INSERM Université de Paris France.,Emergency Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Lina Khider
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | - Antonin Trimaille
- Nouvel Hôpital CivilCentre Hospitalier Régional Universitaire de Strasbourg Strasbourg France
| | - Guillaume Goudot
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | - Orianne Weizman
- PARCC INSERM Université de Paris France.,Cardiology Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Jean Marc Alsac
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Vascular Surgery Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Laura Geneste
- Centre Hospitalier Universitaire d'Amiens-Picardie Amiens France
| | - Armand Schmeltz
- Emergency Department AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | | | - Aurélien Philippe
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Wassima Marsou
- Centre Hospitalier Universitaire de LilleUniversité Catholique de Lille France
| | - Iannis Ben Abdallah
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Vascular Surgery Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Salma El Batti
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Vascular Surgery Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie Caen France
| | - Philippe Juvin
- Emergency Department AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | | | - Emmanuel Messas
- PARCC INSERM Université de Paris France.,Vascular Medicine Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Théo Pezel
- Lariboisiere Hospital AP-HP University of Paris France
| | - Benjamin Planquette
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Baptiste Duceau
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Pascale Gaussem
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Willy Sutter
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Olivier Sanchez
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Victor Waldman
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Jean-Luc Diehl
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Intensive Care Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Tristan Mirault
- PARCC INSERM Université de Paris France.,Vascular Medicine Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Guillaume Bonnet
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Ariel Cohen
- Service de Cardiologie Unité de Cardio-Oncologie AP-HP.6 Groupe de Recherche Clinique en Cardio Oncologie Inserm 856 Hôpitaux Universitaires Paris-Est Assistance Publique-Hôpitaux de ParisHôpital Saint AntoineUniversité Pierre et Marie Curie Paris France
| | - David M Smadja
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
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Panagides V, Vase H, Shah SP, Basir MB, Mancini J, Kamran H, Batra S, Laine M, Eiskjær H, Christensen S, Karami M, Paganelli F, Henriques JPS, Bonello L. Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience. J Clin Med 2021; 10:jcm10020339. [PMID: 33477532 PMCID: PMC7831079 DOI: 10.3390/jcm10020339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/20/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. METHODS We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. RESULTS Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). CONCLUSIONS In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.
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Affiliation(s)
- Vassili Panagides
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Sachin P. Shah
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA;
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Aix-Marseille University, INSERM, IRD, APHM, UMR1252, SESSTIM, Hôpital de la Timone, 13005 Marseille, France;
| | - Hayaan Kamran
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Supria Batra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Marc Laine
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Steffen Christensen
- Department of Intensive Care Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Mina Karami
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Franck Paganelli
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Jose P. S. Henriques
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
- Correspondence: ; Tel.: +33-4-9196-7487
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Weizman O, Mika D, Geneste L, Cellier J, Trimaille A, Pommier T, Panagides V, Chaumont C, Karsenty C, Duceau B, Sutter W, Fauvel C, Pezel T, Bonnet G, Cohen A, Waldmann V. Cardiovascular Comorbidities and Covid-19 in Women. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC8719934 DOI: 10.1016/j.acvdsp.2020.10.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population. Purpose Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19. Methods We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death. Results Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1). Conclusions Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases.
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Bonnet G, Panagides V, Palermo V, Gautier A, Pommier T, Weizman O, Noirclerc N, Adjedj J, Commeau P, Benamer H, Cayla G. Myocardial infarction rates overview during COVID-19 pandemic In France: Results of the MODIF registry. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC8719936 DOI: 10.1016/j.acvdsp.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The emergence of Coronavirus disease 2019 (COVID-19) has evolved into a global pandemic. Systems of care have been reorganized worldwide in an effort to preserve hospital bed capacity. In France, from March 17 to May 11 2020, government imposed a complete lockdown on the whole population. Only urgent cardiac procedures have been ensured such as ST-elevation myocardial infarction (STEMI) revascularization. Some previously published studies suggest a reduction of admission for STEMI in many countries. Nevertheless, strong evidences and data across different French regions that have been affected variously by the outbreak are still lacking. Purpose We aimed to describe the incidence rates and characteristics of patients presenting with STEMI in order to evaluate the impact of the COVID-19 outbreak on STEMI care in France covering the lockdown period compared to same period one year ago. Methods We performed a retrospective multicenter registry across 60 French interventional cardiology centers including all consecutive STEMI patients referred for urgent revascularization in the heart catheterization laboratory between two periods: March 1st to May 31th 2020 compared with March 1st to May 31th 2019. Comprehensive data, including clinical, biological, COVID status and angiographic variables including time taken for care were recorded at admission. The primary outcome was a composite of invasive mechanical ventilation support or in-hospital death. The secondary outcome was the occurrence of myocardial infarction related complications during hospitalization. Enrollement is not complete at the time of the abstract submission. Conclusion This data collection between two periods with and without COVID19 will gave insights for a complete descriptive cartography of STEMI patients among different French regions which have been variously impacted by the outbreak.
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Laine M, Panagides V, Frère C, Cuisset T, Gouarne C, Jouve B, Lemesle G, Paganelli F, Alessi MC, Mancini J, Bonello L. On-Ticagrelor Platelet Reactivity and Clinical Outcome in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. Thromb Haemost 2020; 121:923-930. [PMID: 33260230 DOI: 10.1055/a-1326-5110] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A strong association between on-thienopyridine platelet reactivity (PR) and the risk of both thrombotic and bleeding events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) has been demonstrated. However, no study has analyzed the relationship between on-ticagrelor PR and clinical outcome in this clinical setting. OBJECTIVES We aimed to investigate the relationship between on-ticagrelor PR, assessed by the vasodilator-stimulated phosphoprotein (VASP) index, and clinical outcome in patients with ACS undergoing PCI. METHODS We performed a prospective, multicenter, observational study of patients undergoing PCI for ACS. PR was measured using the VASP index following ticagrelor loading dose. The primary study endpoint was the rate of Bleeding Academic Research Consortium (BARC) type ≥2 at 1 year. The key secondary endpoint was the rate of major adverse cardiovascular events (MACE) defined as the composite of cardiovascular death, myocardial infarction, stroke, and urgent revascularization. RESULTS We included 570 ACS patients, among whom 33.9% had ST-elevation myocardial infarction. BARC type ≥2 bleeding occurred in 10.9% and MACE in 13.8%. PR was not associated with BARC ≥2 or with MACE (p = 0.12 and p = 0.56, respectively). No relationship between PR and outcomes was observed, neither when PR was analyzed quantitatively nor when it was analyzed qualitatively (low on-treatment PR [LTPR] vs. no LTPR). CONCLUSION On-ticagrelor PR measured by the VASP was not associated with bleeding or thrombotic events in ACS patients undergoing PCI. PR measured by the VASP should not be used as a surrogate endpoint in studies on ticagrelor.
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Affiliation(s)
- Marc Laine
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Vassili Panagides
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Corinne Frère
- Institute of Cardiometabolism And Nutrition, INSERM UMRS_1166, GRC 27 GRECO, Sorbonne Université, Paris, France.,Department of Haematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gouarne
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.,Department of Haematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Bernard Jouve
- Department of Cardiology, Hospital of Aix-en-Provence, F-13100 Aix-en-Provence, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France.,Faculté de Médecine de l'Université de Lille, Lille, France.,INSERM UMR 1011, Institut Pasteur de Lille, Lille, France.,FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Franck Paganelli
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Marie-Christine Alessi
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, Marseille, France
| | - Julien Mancini
- Assistance Publique-Hôpitaux de Marseille, INSERM, IRD, SESSTIM, CHU Timone, Department of Public Health (BIOSTIC), Aix Marseille Université, Marseille, France
| | - Laurent Bonello
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
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Laine M, Panagides V, Frère C, Cuisset T, Gouarne C, Jouve B, Thuny F, Paganelli F, Alessi MC, Mancini J, Bonello L. Platelet reactivity inhibition following ticagrelor loading dose in patients undergoing percutaneous coronary intervention for acute coronary syndrome. J Thromb Haemost 2019; 17:2188-2195. [PMID: 31351022 DOI: 10.1111/jth.14592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/23/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Ticagrelor induces more potent platelet reactivity (PR) inhibition with reduced interindividual variability compared to clopidogrel. Although on-clopidogrel PR was shown to correlate with ischemia and bleeding events, no study has investigated the relationship between on-ticagrelor PR and outcome. OBJECTIVES We aimed to evaluate the relationship between on-ticagrelor PR, assessed by the vasodilator-stimulated phosphoprotein index (VASP), and thrombotic and bleeding events in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI). METHODS We performed a prospective, multicenter observational study on patients treated with PCI for ACS. The VASP index was used to assess PR after ticagrelor loading dose (LD). The primary endpoint was the link between major adverse cardiovascular events (MACE) and PR. RESULTS Among the 530 patients with ACS included, 183 (34.5%) were admitted for ST elevation myocardial infarction. We observed high potency and limited interindividual variability after the ticagrelor LD (VASP 19.1% ± 16.6%). At 1 month, 21 (3.8%) MACE and 29 (5.5%) bleedings ≥ 2 according to the Bleedings Academic Research Consortium (BARC) scale were recorded. Neither MACE nor bleeding was associated with PR (P = .34 and P = .78, respectively). However, there was a strong association between PR and the occurrence of definite acute stent thrombosis (P = .03). Platelet reactivity was the only factor associated with acute definite stent thrombosis. CONCLUSION In patients receiving a ticagrelor LD while undergoing PCI for ACS, PR using the VASP did not predict MACE or bleeding, but it was significantly associated with the occurrence of definite acute stent thrombosis.
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Affiliation(s)
- Marc Laine
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Vassili Panagides
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Corinne Frère
- Department of Haematology, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gouarne
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Bernard Jouve
- Department of Cardiology, Hospital of Aix-en-Provence, Aix-en-Provence, France
| | - Franck Thuny
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Franck Paganelli
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Marie-Christine Alessi
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, Marseille, France
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Aix-Marseille University, Hôpital de la Timone, Marseille, France
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
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Panagides V, Frere C, Cuisset T, Gouarne C, Thuny F, Paganelli F, Alessi MC, Mancini J, Bonello L. TCT-415 Platelet Reactivity Inhibition Following Ticagrelor Loading Dose in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.505] [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: 10/25/2022]
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49
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Panagides V, Laine M, Paganelli F, Bonello L. An Unusual Acute Coronary Syndrome Due to a Septic Embolism: A Case Presentation and Review of Revascularization Strategies. J Invasive Cardiol 2019; 31:E148-E153. [PMID: 31158811] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Treatment of acute coronary syndromes secondary to septic coronary valvular embolism in endocarditis patients remains unclear. Several revascularization strategies have been described, including thromboaspiration, stent implantation, balloon angioplasty, and surgical intervention. We herein present an illustration of an atypical case of an acute coronary syndrome related to a coronary bifurcation occlusion due to a septic embolism in a patient presenting with infective endocarditis. We also summarized previous similar cases and their management.
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Affiliation(s)
- Vassili Panagides
- Hôpital Universitaire Nord, Chemin des Bourrely, 13015 Marseille France.
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50
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Laine M, Lemesle G, Dabry T, Panagides V, Peyrol M, Paganelli F, Bonello L. Bivalirudin during percutaneous coronary intervention in acute coronary syndromes. Expert Opin Pharmacother 2018; 20:295-304. [PMID: 30513232 DOI: 10.1080/14656566.2018.1551361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Anticoagulant therapy is critical to prevent ischemic recurrences and complications in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Unfractionated heparin (UFH), an injectable anticoagulant has several limitations: lack of predictability of its biological efficacy, platelets activation, heparin-induced thrombopenia and bleedings. Bivalirudin, a synthetic direct thrombin inhibitor has biological properties that promised better clinical outcome in ACS patients undergoing PCI. AREAS COVERED The present review aimed to summarize two decades of randomized clinical trials that compared bivalirudin to UFH in ACS patients treated with PCI. Early trials highlighted a reduction of bleedings with bivalirudin compared to UFH in combination with glycoprotein inhibitors (GPI). Recent studies questioned this reduction given that GPI are less and less used during PCI. Further, trials raised concerns about the risk of stent thrombosis in patients treated with bivalirudin. In light of this data, bivalirudin has been downgraded in international guidelines and appears as a second line anticoagulant agent after UFH. EXPERT OPINION The highly questioned reduction of bleedings under bivalirudin and the potential risk of stent thrombosis are unwarranted. Based on clinical trials, UFH has no equivalent in terms of anticoagulation in ACS patients undergoing PCI.
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Affiliation(s)
- Marc Laine
- a Department of Cardiology , Intensive care unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord , Marseille , France.,b Mediterranean Association for Research and Studies in Cardiology (MARS Cardio) , Marseille , France.,c Centre for CardioVascular and Nutrition research (C2VN) , Marseille , France
| | - Gilles Lemesle
- d Faculté de Médecine de l'Université de Lille, USIC et Centre Hémodynamique, Institut Cœur et Poumon , CHRU de Lille , Lille , France
| | - Thibaut Dabry
- a Department of Cardiology , Intensive care unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord , Marseille , France.,b Mediterranean Association for Research and Studies in Cardiology (MARS Cardio) , Marseille , France.,c Centre for CardioVascular and Nutrition research (C2VN) , Marseille , France
| | - Vassili Panagides
- a Department of Cardiology , Intensive care unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord , Marseille , France.,b Mediterranean Association for Research and Studies in Cardiology (MARS Cardio) , Marseille , France.,c Centre for CardioVascular and Nutrition research (C2VN) , Marseille , France
| | - Michael Peyrol
- a Department of Cardiology , Intensive care unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord , Marseille , France.,b Mediterranean Association for Research and Studies in Cardiology (MARS Cardio) , Marseille , France.,c Centre for CardioVascular and Nutrition research (C2VN) , Marseille , France
| | - Franck Paganelli
- a Department of Cardiology , Intensive care unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord , Marseille , France.,b Mediterranean Association for Research and Studies in Cardiology (MARS Cardio) , Marseille , France.,c Centre for CardioVascular and Nutrition research (C2VN) , Marseille , France
| | - Laurent Bonello
- a Department of Cardiology , Intensive care unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord , Marseille , France.,b Mediterranean Association for Research and Studies in Cardiology (MARS Cardio) , Marseille , France.,c Centre for CardioVascular and Nutrition research (C2VN) , Marseille , France
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