Publications by authors named "Arnaud Bisson"

52 Publications

Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: A nationwide cohort study.

Cancer 2021 Feb 25. Epub 2021 Feb 25.

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.

Background: The number of patients with atrial fibrillation (AF) and cancer is rapidly increasing in clinical practice. The impact of cancer on clinical outcomes in this patient population is unclear, as is the performance of the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol) and CHA DS -VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes Mellitus, Stroke or Transient Ischemic Attack, Vascular Disease, Age 65 to 74 Years, Sex Category) scores.

Methods: This was an observational, retrospective cohort study including 2,435,541 adults hospitalized with AF. The authors investigated the incidence rates (IRs) of all-cause and cardiovascular mortality, ischemic stroke, major bleeding, and intracranial hemorrhage (ICH) according to the presence of cancer and cancer types.

Results: Overall, 399,344 (16.4%) had cancer, with the most common cancers being metastatic, prostatic, colorectal, lung, breast, and bladder. During a mean follow-up of 2.0 years, cancer increased all-cause mortality (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.99-2.01). The IR of ischemic stroke was higher with pancreatic cancer (2.8%/y), uterine cancer (2.6%/y), and breast cancer (2.6%/y), whereas it was lower with liver/lung cancer (1.9%/y) and leukemia/myeloma (2.0%/y), in comparison with noncancer patients (2.4%/y). Cancer increased the risk of major bleeding (HR, 1.27; 95% CI, 1.26-1.28) and ICH (HR, 1.07; 95% CI, 1.05-1.10). Leukemia, liver cancer, myeloma, and metastatic cancers showed the highest IRs for major bleeding/ICH. Major bleeding and ICH rates progressively increased with the HAS-BLED score, which showed generally good predictivity with C indexes > 0.70 for all cancer types. The CHA DS -VASc score's predictivity was slightly lower in AF patients with cancer.

Conclusions: Cancer increased all-cause mortality, major bleeding, and ICH risk in AF patients. The association between cancer and ischemic stroke differed among cancer types, and in some types, the risk of bleeding seemed to exceed the thromboembolic risk.
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http://dx.doi.org/10.1002/cncr.33470DOI Listing
February 2021

Outcomes in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis.

Clin Res Cardiol 2021 Jan 28. Epub 2021 Jan 28.

Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Dijon, Dijon, France.

Background: In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with similar outcomes is a matter of debate.

Methods: We collected information for all patients with AMI seen in French hospitals between 2010 and 2019. Among 797,212 patients seen with STEMI or NSTEMI, 75,701 (9.5%) had history of AF, and 34,768 (4.4%) had new AF diagnosed between day 1 and day 30 after AMI.

Results: Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. During follow-up [mean (SD) 1.8 (2.4) years, median (interquartile range) 0.7 (0.1-3.1) years], 163,845 deaths and 30,672 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.17, 95% CI 1.16-1.19) and this was also the case for patients with new AF (adjusted HR 2.11, 2.07-2.15). Both history of AF and new AF were associated with a higher risk of ischemic stroke compared to patients with no AF: adjusted HR 1.19 (1.15-1.23) for history of AF, adjusted HR 1.78 (1.68-1.88) for new AF. New AF was associated with a higher risk of death and of ischemic stroke than history of AF: adjusted HR 1.74 (1.70-1.79) and 1.32 (1.23-1.42), respectively.

Conclusions: In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was independently associated with higher risks of death and ischemic stroke than those in patients with no AF or previously known AF.
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http://dx.doi.org/10.1007/s00392-021-01805-2DOI Listing
January 2021

Sex, age, type of diabetes and incidence of atrial fibrillation in patients with diabetes mellitus: a nationwide analysis.

Cardiovasc Diabetol 2021 Jan 22;20(1):24. Epub 2021 Jan 22.

Service de Cardiologie, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Hôpital Trousseau, 37044, Tours, France.

Background: There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age.

Methods: All patients aged ≥ 18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes).

Results: In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27-1.37) in women vs. 1.12(1.08-1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16-1.19) in women vs. 1.10(1.09-1.12) in men for type 2 diabetes.

Conclusion: Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.
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http://dx.doi.org/10.1186/s12933-021-01216-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821402PMC
January 2021

Impact of gender on relative rates of cardiovascular events in patients with diabetes.

Diabetes Metab 2021 Jan 14;47(5):101226. Epub 2021 Jan 14.

Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, EA4245 T2i, France.

Aim: To investigate whether diabetes confers higher relative risks of cardiovascular events in women compared with men using contemporary data and also whether such gender-differences are dependent on age.

Methods: All patients discharged from French hospitals in 2013 with at least 5 years of follow-up and no history of major adverse cardiovascular events including heart failure (MACE-HF; heart failure, myocardial infarction, ischaemic stroke, cardiovascular death) were identified and categorized by diabetes status. Overall and age-stratified incidence rates, hazard ratios (HRs) and women-to-men ratios (WMRs) for MACE-HF leading to hospitalization were also calculated. Adjustments were then made for age and baseline characteristics according to cardiovascular risk factors and non-cardiovascular comorbidities.

Results: The study included 2,953,816 subjects, among whom 349,928 (11.9%) had diabetes. Of those with diabetes, the absolute rate of MACE-HF was higher in men than in women (96 vs 66 per 1000 person-years); corresponding absolute rates in men and women without diabetes were 44 vs 27 per 1000 person-years. Comparing those with and without diabetes, women had a higher unadjusted HR of MACE-HF (2.45, 95% CI: 2.42-2.47) than men (2.15, 95% CI: 2.14-2.17), with an adjusted WMR of 1.13 (95% CI: 1.12-1.15). HRs of MACE-HF related to diabetes were highest in women aged around 45 years and in the youngest men and decreased with advancing age in both these groups. However, HRs were higher in women of all ages > 40 years. After adjustment, this effect was more apparent for myocardial infarction (adjusted WMR: 1.43, 95% CI: 1.38-1.48) than for either ischaemic stroke (adjusted WMR: 1.10, 95% CI: 1.07-1.14) or heart failure (adjusted WMR: 1.13, 95% CI: 1.11-1.14).

Conclusion: Although men have higher absolute risks of cardiovascular complications, the relative risks of cardiovascular complications associated with diabetes are higher in women than in men.
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http://dx.doi.org/10.1016/j.diabet.2021.101226DOI Listing
January 2021

His bundle pacing implantable cardiac defibrillator with defibrillation lead placement in the middle cardiac vein: a case report.

Europace 2021 Apr;23(4):633

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.

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http://dx.doi.org/10.1093/europace/euaa296DOI Listing
April 2021

Acute pathophysiological myocardial changes following intra-cardiac electrical shocks using a proteomic approach in a sheep model.

Sci Rep 2020 11 20;10(1):20252. Epub 2020 Nov 20.

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.

Implantable cardioverter-defibrillators (ICD) are meant to fight life-threatening ventricular arrhythmias and reduce overall mortality. Ironically, life-saving shocks themselves have been shown to be independently associated with an increased mortality. We sought to identify myocardial changes at the protein level immediately after ICD electrical shocks using a proteomic approach. ICD were surgically implanted in 10 individuals of a healthy male sheep model: a control group (N = 5) without any shock delivery and a shock group (N = 5) with the delivery of 5 consecutive shocks at 41 J. Myocardial tissue samples were collected at the right-ventricle apex near to the lead coil and at the right ventricle basal free wall region. Global quantitative proteomics experiments on myocardial tissue samples were performed using mass spectrometry techniques. Proteome was significantly modified after electrical shock and several mechanisms were associated: protein, DNA and membrane damages due to extreme physical conditions induced by ICD-shock but also due to regulated cell death; metabolic remodeling; oxidative stress; calcium dysregulation; inflammation and fibrosis. These proteome modifications were seen in myocardium both "near" and "far" from electrical shock region. N-term acetylated troponin C was an interesting tissular biomarker, significantly decreased after electrical shock in the "far" region (AUC: 0.93). Our data support an acute shock-induced myocardial tissue injury which might be involved in acute paradoxical deleterious effects such as heart failure and ventricular arrhythmias.
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http://dx.doi.org/10.1038/s41598-020-77346-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679418PMC
November 2020

Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies: A French Nationwide Cohort Study.

Clin J Am Soc Nephrol 2020 Nov 15;15(11):1587-1594. Epub 2020 Oct 15.

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France.

Background And Objectives: The risk of major bleeding after percutaneous native kidney biopsy is usually considered low but remains poorly predictable. The aim of the study was to assess the risk of major bleeding and to build a preprocedure bleeding risk score.

Design, Setting, Participants, & Measurements: Our study was a retrospective cohort study in all 52,138 patients who had a percutaneous native kidney biopsy in France in the 2010-2018 period. Measurements included major bleeding (, blood transfusions, hemorrhage/hematoma, angiographic intervention, or nephrectomy) at day 8 after biopsy and risk of death at day 30. Exposures and outcomes were defined by diagnosis codes.

Results: Major bleeding occurred in 2765 of 52,138 (5%) patients (blood transfusions: 5%; angiographic intervention: 0.4%; and nephrectomy: 0.1%). Nineteen diagnoses were associated with major bleeding. A bleeding risk score was calculated (Charlson index [2-4: +1; 5 and 6: +2; >6: +3]; frailty index [1.5-4.4: +1; 4.5-9.5: +2; >9.5: +3]; women: +1; dyslipidemia: -1; obesity: -1; anemia: +8; thrombocytopenia: +2; cancer: +2; abnormal kidney function: +4; glomerular disease: -1; vascular kidney disease: -1; diabetic kidney disease: -1; autoimmune disease: +2; vasculitis: +5; hematologic disease: +2; thrombotic microangiopathy: +4; amyloidosis: -2; other kidney diagnosis: -1) + a constant of 5. The risk of bleeding went from 0.4% (lowest score group =0-4 points) to 33% (highest score group ≥35 points). Major bleeding was an independent risk of death (500 of 52,138 deaths: bleeding: 81 of 2765 [3%]; no bleeding: 419 of 49,373 [0.9%]; odds ratio, 1.95; 95% confidence interval, 1.50 to 2.54; <0.001).

Conclusions: The risk of major bleeding after percutaneous native kidney biopsy may be higher than generally thought and is associated with a twofold higher risk of death. It varies widely but can be estimated with a score useful for shared decision making and procedure choice.
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http://dx.doi.org/10.2215/CJN.14721219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646233PMC
November 2020

To the Editor-Fear does not avoid the danger!

Heart Rhythm 2021 Jan 19;18(1):161. Epub 2020 Aug 19.

Cardiology Department, University Hospital of Tours, Tours, France.

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http://dx.doi.org/10.1016/j.hrthm.2020.07.039DOI Listing
January 2021

Transcatheter Valve-in-Valve Aortic Valve Replacement as an Alternative to Surgical Re-Replacement.

J Am Coll Cardiol 2020 08;76(5):489-499

Service de Cardiologie, Centre Hospitalier Trousseau, Tours, France.

Background: Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) and redo surgical aortic valve replacement (SAVR) represent the 2 treatments for aortic bioprosthesis failure. Clinical comparison of both therapies remains limited by the number of patients analyzed.

Objectives: The purpose of this study was to analyze the outcomes of VIV TAVR versus redo SAVR at a nationwide level in France.

Methods: Based on the French administrative hospital-discharge database, the study collected information for patients treated for aortic bioprosthesis failure with isolated VIV TAVR or redo SAVR between 2010 and 2019. Propensity score matching was used for the analysis of outcomes.

Results: A total of 4,327 patients were found in the database. After matching on baseline characteristics, 717 patients were analyzed in each arm. At 30 days, VIV TAVR was associated with lower rates of the composite of all-cause mortality, all-cause stroke, myocardial infarction, and major or life-threatening bleeding (odds ratio: 0.62; 95% confidence interval: 0.44 to 0.88; p = 0.03). During follow-up (median 516 days), the combined endpoint of cardiovascular death, all-cause stroke, myocardial infarction, or rehospitalization for heart failure was not different between the 2 groups (odds ratio: 1.18; 95% confidence interval: 0.99 to 1.41; p = 0.26). Rehospitalization for heart failure and pacemaker implantation were more frequently reported in the VIV TAVR group. A time-dependent interaction between all-cause and cardiovascular mortality following VIV TAVR was reported (p-interaction <0.05).

Conclusions: VIV TAVR was observed to be associated with better short-term outcomes than redo SAVR. Major cardiovascular outcomes were not different between the 2 treatments during long-term follow-up.
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http://dx.doi.org/10.1016/j.jacc.2020.06.010DOI Listing
August 2020

Futility Risk Model for Predicting Outcome After Transcatheter Aortic Valve Implantation.

Am J Cardiol 2020 09 7;130:100-107. Epub 2020 Jun 7.

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France.

Risk-benefit assessment for transcatheter aortic valve implantation (TAVI) is still a matter of debate. We aimed to identify patients with a bad outcome within 1 year after TAVI, and to develop a Futile TAVI Simple score (FTS). Based on the administrative hospital-discharge database, all consecutive patients treated with percutaneous TAVI in France between 2010 and 2018 were included. A prediction model was derived and validated for 1-year all-cause death after TAVI (considered as futility) by using split-sample validation: 20,443 patients were included in the analysis (mean age 83 ± 7 years). 7,039 deaths were recorded (yearly incidence rate 15.5%), among which 3,702 (53%) occurred in first year after TAVI procedure. In the derivation cohort (n = 10,221), the final logistic regression model included male sex, history of hospital stay with heart failure, history of pulmonary oedema, atrial fibrillation, previous stroke, vascular disease, renal disease, liver disease, pulmonary disease, anaemia, history of cancer, metastasis, depression and denutrition. The area under the curve (AUC) for the FTS was 0.674 (95%CI 0.660 to 0.687) in the derivation cohort and 0.651 (95%CI 0.637 to 0.665) in the validation cohort (n = 10,222). The Hosmer-Lemeshow test had a p-value of 0.87 suggesting an accurate calibration. The FTS score outperformed EuroSCORE II, Charlson comorbidity index and frailty index for identifying futility. Based on FTS score, 7% of these patients were categorized at high risk with a 1-year mortality at 43%. In conclusion, the FTS score, established from a large nationwide cohort of patients treated with TAVI, may provide a relevant tool for optimizing healthcare decision.
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http://dx.doi.org/10.1016/j.amjcard.2020.05.043DOI Listing
September 2020

How to estimate the potential clinical benefit associated with left atrial appendage closure?

Europace 2020 11;22(11):1755

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, 37044 Tours, France.

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http://dx.doi.org/10.1093/europace/euaa153DOI Listing
November 2020

Mortality and cardiac resynchronization therapy with or without defibrillation in primary prevention.

Europace 2020 08;22(8):1224-1233

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France.

Aims: Cardiac resynchronization therapy with (CRTD) or without (CRTP) defibrillator is recommended in selected patient with systolic chronic heart failure and wide QRS. There is no guideline firmly indicating choice between CRTP and CRTD in primary prevention, particularly in older patients.

Methods And Results: Based on the French administrative hospital-discharge database, information was collected from 2010 to 2017 for all patients implanted with CRTP or CRTD in primary prevention. Outcome analyses were undertaken in the total study population and in propensity-matched samples. During follow-up (913 days, SD 841, median 701, IQR 151-1493), 45 697 patients were analysed (CRTP 19 266 and CRTD 26 431). Incidence rate (%patient/year) of all-cause mortality was higher in CRTP patients (11.6%) than in CRTD patients (6.8%) [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.63-1.76, P < 0.001]. After propensity-matched analyses, mortality of patients over 75 years old with non-ischaemic cardiomyopathy (NICM) was not different with CRTP and CRTD (HR 0.93, 95% CI 0.80-1.09, P = 0.39). The CRTP patients under 75 years old with NICM had a higher mortality than CRTD patients (HR 1.22, 95% CI 1.03-1.45, P = 0.02). Mortality rate was also higher with CRTP than with CRTD irrespectively of age in patients with ischaemic cardiomyopathy (ICM) (<75 years old: HR 1.22, 95% CI 1.08-1.37, P = 0.01; ≥75 years old: HR 1.13, 95% CI 1.04-1.22, P = 0.003).

Conclusion: In this real-life study, CRTD was associated with a significantly lower all-cause mortality than CRTP in patients with ICM and in patients with NICM under 75 years old. Patients over 75 years old with NICM did not have lower mortality with primary prevention CRTD implantation.
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http://dx.doi.org/10.1093/europace/euaa096DOI Listing
August 2020

Response by Deharo et al to Letter Regarding Article, "Impact of Sapien 3 Balloon-Expandable Versus Evolut R Self-Expandable Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis: Data From a Nationwide Analysis".

Circulation 2020 Jun 15;141(24):e912-e913. Epub 2020 Jun 15.

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France (A.B., C.S.E., L.F.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.047271DOI Listing
June 2020

Valve-in-valve transcatheter aortic valve implantation after failed surgically implanted aortic bioprosthesis versus native transcatheter aortic valve implantation for aortic stenosis: Data from a nationwide analysis.

Arch Cardiovasc Dis 2021 Jan 10;114(1):41-50. Epub 2020 Jun 10.

Service de cardiologie, CHU Trousseau, 37044 Tours, France; EA7505, université de Tours, 37044 Tours, France.

Background: Valve-in-valve transcatheter aortic valve implantation (TAVI) has emerged as a treatment for aortic bioprosthesis failure in case of prohibitive risk for redo surgery. However, clinical evaluation of valve-in-valve TAVI remains limited by the number of patients analysed.

Aim: To evaluate outcomes of valve-in-valve TAVI compared with native aortic valve TAVI at a nationwide level in France.

Methods: Based on the French administrative hospital discharge database, the study collected information for all consecutive patients treated with TAVI for aortic stenosis or with isolated valve-in-valve TAVI for aortic bioprosthesis failure between 2010 and 2019. Propensity score matching was used for the analysis of outcomes.

Results: A total of 44,218 patients were found in the database. After matching on baseline characteristics, 2749 patients were analysed in each arm. At 30 days, no significant differences were observed regarding the occurrence of major clinical events (composite of cardiovascular mortality, all-cause stroke, myocardial infarction, major or life-threatening bleeding and conversion to open heart surgery) (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.68-1.01; P=0.32). During follow-up (mean 516 days), the combined endpoint of cardiovascular death, all-cause stroke or rehospitalization for heart failure was not different between the valve-in-valve TAVI and native TAVI groups (RR 1.03, 95% CI 0.94-1.13; P=1.00).

Conclusion: We observed that valve-in-valve TAVI was associated with good short- and long-term outcomes. No significant differences were observed compared with native valve TAVI regarding clinical follow-up.
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http://dx.doi.org/10.1016/j.acvd.2020.04.005DOI Listing
January 2021

Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions.

Stroke 2020 06 11;51(6):1674-1681. Epub 2020 May 11.

From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France.

Background and Purpose- Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated sinus node disease (SND) is unclear. We compared the incidence of IS in patients with SND, patients with AF, and in a control population with other cardiac diseases (disease of the circulatory system using the ). Methods- This French longitudinal cohort study was based on the national database covering hospital care for the entire population from 2008 to 2015. Results- Of 1 692 157 patients included in the cohort, 100 366 had isolated SND, 1 564 270 had isolated AF, and 27 521 had AF associated with SND. Incidence of IS during follow-up was higher in isolated patients with AF than in AF associated with SND (yearly rate 2.22% versus 2.06%) and in isolated patients with AF than in isolated patients with SND (yearly rate 2.22% versus 1.59%). The incidence of IS was lower in a control population with other cardiac conditions (n=479 108) compared with SND and patients with AF (0.96%/y, 1.59%/y, and 2.22%/y, respectively). After 1:1 propensity score matching, SND was associated with lower incidence of IS compared to AF (hazard ratio, 0.77 [95% CI, 0.73-0.82]) but higher incidence of IS compared to control population (hazard ratio, 1.27 [95%CI, 1.19-1.35]). Conclusions- Patients with SND had a lower risk of thromboembolic events than patients with AF but a higher risk than a control population with other cardiac diseases. Randomized clinical trial in a selected SND population, with, for example, a high CHADS-VASc score, would be required to determine the value of IS prevention by anticoagulation.
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http://dx.doi.org/10.1161/STROKEAHA.120.029048DOI Listing
June 2020

Pacemaker Implantation After Balloon- or Self-Expandable Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis.

J Am Heart Assoc 2020 05 2;9(9):e015896. Epub 2020 May 2.

Service de Cardiologie Centre Hospitalier Universitaire Trousseau et Faculté de Médecine EA7505 Université de Tours France.

Background The incidence of conduction abnormalities requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with early and later generation prostheses remains debated. Methods and Results Based on the administrative hospital-discharge database, we collected information for all patients treated with TAVR between 2010 and 2019 in France. We compared the incidence of PPI after TAVR according to the type and generation of valve implanted. A total of 49 201 patients with aortic stenosis treated with TAVR using the balloon-expandable (BE) Edwards SAPIEN valve (early Sapien XT and latest Sapien 3) or the self-expanding (SE) Medtronic CoreValve (early CoreValve and latest Evolut R) were found in the database. Mean (SD) follow-up was 1.2 (1.5 years) (median [interquartile range] 0.6 [0.1-2.0] years). PPI after the procedure was reported in 13 289 patients, among whom 11 010 (22.4%) had implantation during the first 30 days. In multivariable analysis, using early BE TAVR as reference, adjusted odds ratio (95% CI) for PPI during the first 30 days was 0.88 (0.81-0.95) for latest BE TAVR, 1.40 (1.27-1.55) for early SE TAVR, and 1.17 (1.07-1.27) for latest SE TAVR. Compared with early BE TAVR, the adjusted hazard ratio for PPI during the whole follow-up was 1.01 (0.95-1.08) for latest BE TAVR, 1.30 (1.21-1.40) for early SE TAVR, and 1.25 (1.18-1.34) for latest SE TAVR. Conclusions In patients with aortic stenosis treated with TAVR, our systematic analysis at a nationwide level found higher rates of PPI than previously reported. BE technology was independently associated with lower incidence rates of PPI both at the acute and chronic phases than SE technology. Recent generations of TAVR were not independently associated with different rates of PPI than early generations during the overall follow-up.
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http://dx.doi.org/10.1161/JAHA.120.015896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428568PMC
May 2020

Incident Comorbidities, Aging and the Risk of Stroke in 608,108 Patients with Atrial Fibrillation: A Nationwide Analysis.

J Clin Med 2020 Apr 24;9(4). Epub 2020 Apr 24.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK.

Background: We hypothesized that the change in stroke risk profile between baseline and follow-up may be a better predictor of ischemic stroke than the baseline stroke risk determination using the CHADS-VASc score ((congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/transient ischemic attack/thromboembolism (doubled), vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque), age 65-75 years, sex category (female))).

Methods: We collected information for all patients treated with atrial fibrillation (AF) in French hospitals between 2010 and 2019. We studied 608,108 patients with AF who did not have risk factors of the CHADS-VASc score (except for age and sex). The predictive accuracies of baseline and follow-up CHADS-VASc scores, as well as the 'Delta CHADS-VASc' (i.e., change/difference between the baseline and follow-up CHADS-VASc scores) for prediction of ischemic stroke were studied.

Results: The mean CHADS-VASc score at baseline was 1.7, and increased to 2.4 during follow-up of 2.2 ± 2.4 years, (median (interquartile range: IQR) 1.2 (0.1-3.8) years), resulting in a mean Delta CHADS-VASc score of 0.7. Among 20,082 patients suffering ischemic stroke during follow-up, 67.1% had a Delta CHADS-VASc score ≥1 while they were only 40.4% in patients without ischemic stroke. The follow-up CHADS-VASc score and Delta CHADS-VASc score were predictors of ischemic stroke (C-index 0.670, 95% confidence interval (CI) 0.666-0.673 and 0.637, 95%CI 0.633-0.640) and they performed better than baseline CHADS-VASc score (C-index 0.612, 95%CI 0.608-0.615, < 0.0001).

Conclusions: Stroke risk was non-static, and many AF patients had ≥1 new stroke risk factor(s) before ischemic stroke occurred. The follow-up CHADS-VASc score and its change (i.e., 'Delta CHADS-VASc') were better predictors of ischemic stroke than relying on the baseline CHADS-VASc score.
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http://dx.doi.org/10.3390/jcm9041234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230460PMC
April 2020

Prognosis of Type 2 Myocardial Infarction Patients Implanted With a Prophylactic Defibrillator (from the Very-High-Rate Registry).

Am J Cardiol 2020 04 7;125(7):1001-1005. Epub 2020 Jan 7.

Cardiology Department, Trousseau Hospital, University of Tours, Tours, France. Electronic address:

An implantable cardioverter defibrillator (ICD) is recommended in primary prevention patients with a coronary artery disease (CAD) and reduced left ventricular ejection fraction. Benefits of ICD in CAD unrelated to coronary thrombosis are unknown. We sought to compare the prognosis of patients with CAD implanted with a prophylactic ICD according to the type of myocardial infarction (MI). Patients from the Very-High-Rate registry implanted with a prophylactic ICD for CAD between 2006 and 2016 were retrospectively included. Cardiac resynchronization therapy patients were excluded. Patients with type 2 MI were matched (1:4) with patients with type 1 MI using propensity score. The following events were collected: death, hospitalization for heart failure, cardiac transplantation, and appropriated therapies on ventricular arrhythmia (≥220 beats/min). Among 571 consecutive ischemic patients, 65 type 2 MI patients were matched to 260 type 1. After a mean follow up of 55 ± 36 months, 63 patients (24%) died in type 1 group, 18 (28%) in type 2 group (p = 0.19). Survival rate from appropriate therapies on high-rate ventricular arrhythmias was significantly lower in type 2 group (p = 0.04). In conclusion, patients implanted with a prophylactic ICD for severe CAD, whether type 1 or type 2 MI, have similar outcomes.
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http://dx.doi.org/10.1016/j.amjcard.2019.12.053DOI Listing
April 2020

Outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a nationwide analysis.

EuroIntervention 2020 Apr;15(17):1489-1496

Cardiologie, CHU-Timone, Marseille, France.

Aims: The aim of this study was to describe the midterm outcomes in nonagenarians undergoing transcatheter aortic valve implantation (TAVI).

Methods And Results: Based on the French administrative hospital discharge database, the study collected information for all consecutive patients with aortic stenosis (AS), and specifically those treated with TAVI between 2010 and 2018. Cox regression was used for the analysis of predictors of events. We compared patients according to their age. Within the studied period, 71,095 patients older than 90 years with AS were identified. After matching on baseline characteristics, TAVI was associated with lower rates of a combined outcome of all-cause death, rehospitalisation for heart failure and stroke (relative risk [RR] 0.58, p<0.001) in comparison with matched nonagenarians with AS treated medically. During follow-up (median 161 days, interquartile range 13-625), the combined outcome occurred more frequently in nonagenarians (RR 1.22, p<0.01) who had a TAVI than in younger patients undergoing this procedure. All-cause death was reported in 17.6% versus 14.5% of nonagenarians, rehospitalisation for heart failure in 21.3% versus 18.2%, and stroke in 3.7% versus 2.9% (p<0.01 for all parameters). We identified the Charlson comorbidity index, heart failure, atrial fibrillation, stroke, vascular disease, cognitive impairment and denutrition as independent predictors of adverse outcomes in nonagenarians undergoing TAVI.

Conclusions: Among nonagenarians with AS, patients treated with TAVI had a lower risk of cardiovascular events than matched patients treated medically. The patients undergoing a TAVI at this age were often highly selected; the procedure was associated with acceptable long-term outcomes.
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http://dx.doi.org/10.4244/EIJ-D-19-00647DOI Listing
April 2020

Impact of Sapien 3 Balloon-Expandable Versus Evolut R Self-Expandable Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis: Data From a Nationwide Analysis.

Circulation 2020 01 16;141(4):260-268. Epub 2019 Nov 16.

Service d'information médicale, d'épidémiologie et d'économie de la santé, Unité d'épidémiologie hospitalière régionale (J.H., T.L., L.G.-G.), France.

Background: Two competing transcatheter aortic valve replacement (TAVR) technologies are currently available. Head-to-head comparisons of the relative performances of these 2 devices have been published. However, long-term clinical outcome evaluation remains limited by the number of patients analyzed, in particular, for recent-generation devices.

Methods: Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with a TAVR device commercialized in France between 2014 and 2018. Propensity score matching was used for the analysis of outcomes during follow-up. The objective of this study was to analyze the outcomes of TAVR according to Sapien 3 balloon-expandable (BE) versus Evolut R self-expanding TAVR technology at a nationwide level in France.

Results: A total of 31 113 patients treated with either Sapien 3 BE or Evolut R self-expanding TAVR were found in the database. After matching on baseline characteristics, 20 918 patients were analyzed (10 459 in each group with BE or self-expanding valves). During follow-up (mean [SD], 358 [384]; median [interquartile range], 232 [10-599] days), BE TAVR was associated with a lower yearly incidence of all-cause death (relative risk, 0.88; corrected =0.005), cardiovascular death (relative risk, 0.82; corrected =0.002), and rehospitalization for heart failure (relative risk, 0.84; corrected <0.0001). BE TAVR was also associated with lower rates of pacemaker implantation after the procedure (relative risk, 0.72; corrected <0.0001).

Conclusions: On the basis of the largest cohort available, we observed that Sapien 3 BE valves were associated with lower rates of all-cause death, cardiovascular death, rehospitalization for heart failure, and pacemaker implantation after a TAVR procedure.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.119.043971DOI Listing
January 2020

How to upgrade a leadless pacemaker to cardiac resynchronization therapy.

J Cardiovasc Electrophysiol 2019 11 25;30(11):2578-2581. Epub 2019 Sep 25.

Cardiology Department, Trousseau Hospital, University of Tours, Tours, France.

Introduction: We sought to develop an efficient method to upgrade pacing-induced cardiomyopathy (PICM) patients from a leadless pacemaker (LPM) to cardiac resynchronization therapy.

Methods And Results: Three consecutive patients with chronic atrial fibrillation, implanted with an LPM, with permanent right ventricular pacing, and who developed left ventricular systolic dysfunction due to PICM, were included. A conventional biventricular pacemaker with two different coronary sinus leads, one used for left lateral ventricular pacing, one for early right ventricular sensing, was implanted. It was then synchronized with the LPM working as the right ventricular pacing lead to provide biventricular pacing. The upgrading technique was feasible in all cases, without any perioperative complication. All patients had an improved clinical status during follow-up.

Conclusion: This new upgrading technique allows efficient cardiac resynchronization therapy in LPM patients while preventing tricuspid valve crossing and providing an increased battery longevity.
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http://dx.doi.org/10.1111/jce.14169DOI Listing
November 2019

Multisite pacing via a quadripolar lead for cardiac resynchronization therapy.

J Interv Card Electrophysiol 2019 Oct 18;56(1):117-125. Epub 2019 Jul 18.

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.

Cardiac resynchronization therapy is challenging. Up to 40% of patients are non-responder. Multisite pacing via a quadripolar lead, also called multipoint/multipole pacing (MPP), is a debated alternative. In this review, we summarize evidence in the literature, tips and pitfalls related to MPP programming, and the different algorithms of MPP in different manufacturers.
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http://dx.doi.org/10.1007/s10840-019-00592-1DOI Listing
October 2019

C HEST Score and Prediction of Incident Atrial Fibrillation in Poststroke Patients: A French Nationwide Study.

J Am Heart Assoc 2019 07 25;8(13):e012546. Epub 2019 Jun 25.

3 Service de Cardiologie Centre Hospitalier Universitaire et Faculté de Médecine EA7505 Université de Tours France.

Background The CHEST score (coronary artery disease or chronic obstructive pulmonary disease [1 point each]; hypertension [1 point]; elderly [age ≥75 years, 2 points]; systolic heart failure [2 points]; thyroid disease [hyperthyroidism, 1 point]) was initially proposed for predicting incident atrial fibrillation (AF) in the general population. Its performance in poststroke patients remains to be established, especially because patients at high risk for incident AF should be targeted for more comprehensive screening. This study aimed to evaluate this newly established incident AF prediction risk score in a post-ischemic stroke population. Methods and Results Validation was based on a hospital-based nationwide cohort with 240 459 French post-ischemic stroke patients. Kaplan-Meier curves for incident rate of AF depict differences between varying risk categories. Discrimination of the CHEST score was evaluated using the C index, the net reclassification index, integrated discriminatory improvement, and decision curve analysis. During 7.9±11.5 months of follow-up, 14 095 patients developed incident AF. The incidence of AF increased from 23.5 per 1000 patient-years in patients with a CHEST score of 0 to 196.8 per 1000 patient-years in patients with a CHEST score ≥6. Kaplan-Meier curves showed a clear difference among different risk strata (log-rank P<0.0001). The CHEST score had good discrimination with a C index of 0.734 (95% CI, 0.732-0.736), which was better than the Framingham risk score and the CHADS-VASc score (congestive heart failure, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled], vascular disease, age 65 to 74 years, and female sex) ( P<0.0001, respectively). The CHEST score was also superior to the Framingham risk score and the CHADS-VASc score as shown by the net reclassification index, integrated discriminatory improvement ( P<0.0001, respectively) and decision curve analysis. Conclusions The CHEST score performed well in discriminating the individual risk of developing incident AF in a white European population hospitalized with previous ischemic stroke. This simple score may potentially be used as a risk stratification tool for decision making in relation to a screening strategy for AF in post-ischemic stroke patients.
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http://dx.doi.org/10.1161/JAHA.119.012546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662366PMC
July 2019

End-of-service management of leadless cardiac pacemakers: a case report.

Europace 2019 Aug;21(8):1245

Department of Cardiology, Trousseau Hospital, University of Tours, Tours, France.

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http://dx.doi.org/10.1093/europace/euz054DOI Listing
August 2019

Stroke and Thromboembolism in Patients With Atrial Fibrillation and Mitral Regurgitation.

Circ Arrhythm Electrophysiol 2019 03;12(3):e006990

Department of Cardiology, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Tours, France (A. Bisson, A. Bernard, A. Bodin, N.C., D.B., L.F.).

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http://dx.doi.org/10.1161/CIRCEP.118.006990DOI Listing
March 2019

Wearable Cardioverter–Defibrillator after Myocardial Infarction.

N Engl J Med 2019 02;380(6):600

Centre Hospitalier Universitaire Trousseau, Tours, France

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http://dx.doi.org/10.1056/NEJMc1816889DOI Listing
February 2019

Distal-to-proximal delay for ablation of premature ventricular contractions.

J Cardiovasc Electrophysiol 2019 02 27;30(2):205-211. Epub 2018 Dec 27.

Cardiology Department, University of Tours, Tours, France.

Introduction: Ablation of premature ventricular contractions (PVCs) has emerged as a safe and effective treatment in patients experiencing a high PVCs burden. Mapping of PVCs origin may sometimes be challenging. We sought to evaluate the accuracy of a new electrophysiological criterion, the distal-to-proximal (DP) delay, at localizing the optimal site for ablation of ventricular ectopic foci.

Methods And Results: Consecutive patients with ablation attempts of symptomatic PVCs were included. Prematurity and DP delay-that is, the time duration between the onset of ablation catheter distal bipolar electrogram and the onset of proximal bipolar electrogram-were measured at successful and unsuccessful ablation sites by three blinded experienced electrophysiologists. Mean DP delay at effective ablation sites (N = 30) was significantly higher than at ineffective sites ( N = 55) (23 ± 9 vs 11 ± 8 milliseconds; P < 0.0001). DP delay had good-to-excellent interrater reliability. A DP delay greater than or equal to 15 milliseconds had the highest accuracy at predicting a successful ablation site (sensitivity 0.97, the area under receiver operating characteristic curve 0.87; P < 0.0001).

Conclusion: DP delay is an additional, simple, and effective electrophysiological parameter to accurately localize PVCs foci.
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http://dx.doi.org/10.1111/jce.13807DOI Listing
February 2019