Publications by authors named "David Attias"

47 Publications

Reduced Rivaroxaban Dose Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure: ADRIFT a Randomized Pilot Study.

Circ Cardiovasc Interv 2020 Jul 17;13(7):e008481. Epub 2020 Jul 17.

Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.).

Background: Percutaneous left atrial appendage closure (LAAC) exposes to the risk of device thrombosis in patients with atrial fibrillation who frequently have a contraindication to full anticoagulation. Thereby, dual antiplatelet therapy (DAPT) is usually preferred. No randomized study has evaluated nonvitamin K antagonist oral anticoagulant after LAAC, and we decided to evaluate the efficacy and safety of reduced doses of rivaroxaban after LAAC.

Methods: ADRIFT (Assessment of Dual Antiplatelet Therapy Versus Rivaroxaban in Atrial Fibrillation Patients Treated With Left Atrial Appendage Closure) is a multicenter, phase IIb study, which randomized 105 patients after successful LAAC to either rivaroxaban 10 mg (R, n=37), rivaroxaban 15 mg (R, n=35), or DAPT with aspirin 75 mg and clopidogrel 75 mg (n=33). The primary end point was thrombin generation (prothrombin fragments 1+2) measured 2 to 4 hours after drug intake, 10 days after treatment initiation. Thrombin-antithrombin complex, D-dimers, rivaroxaban concentrations were also measured at 10 days and 3 months. Clinical end points were evaluated at 3-month follow-up.

Results: The primary end point was reduced with R (179 pmol/L [interquartile range (IQR), 129-273], <0.0001) and R (163 pmol/L [IQR, 112-231], <0.0001) as compared with DAPT (322 pmol/L [IQR, 218-528]). We observed no significant reduction of the primary end point between R and R while rivaroxaban concentrations increased significantly from 184 ng/mL (IQR, 127-290) with R to 274 ng/mL (IQR, 192-377) with R, <0.0001. Thrombin-antithrombin complex and D-dimers were numerically lower with both rivaroxaban doses than with DAPT. These findings were all confirmed at 3 months. The clinical end points were not different between groups. A device thrombosis was noted in 2 patients assigned to DAPT.

Conclusions: Thrombin generation measured after LAAC was lower in patients treated by reduced rivaroxaban doses than DAPT, supporting an alternative to the antithrombotic regimens currently used after LAAC and deserves further evaluation in larger studies. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03273322.
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http://dx.doi.org/10.1161/CIRCINTERVENTIONS.119.008481DOI Listing
July 2020

Comparison Between ESC and Duke Criteria for the Diagnosis of Prosthetic Valve Infective Endocarditis.

JACC Cardiovasc Imaging 2020 Dec 17;13(12):2605-2615. Epub 2020 Jun 17.

APHM, La Timone Hospital, Cardiology Department, Marseille, France; Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France. Electronic address:

Objectives: The primary objective was to assess the value of the European Society of Cardiology (ESC) criteria, including F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) in prosthetic valve infective endocarditis (PVE). Secondary objectives were: 1) to assess the reproducibility of F-FDG-PET/CT; 2) to compare its diagnostic value with that of echocardiography; and 3) to assess the diagnostic value of the presence of a diffuse splenic uptake BACKGROUND: F-FDG PET/CT has been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines, but the benefit of the ESC criteria has not been prospectively compared with the conventional Duke criteria.

Methods: Between 2014 and 2017, 175 patients with suspected PVE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable F-FDG PET/CT, 115 patients were evaluated, including 91 definite and 24 rejected IE, as defined by an expert consensus.

Results: Cardiac uptake by F-FDG PET/CT was observed in 67 of 91 patients with definite PVE and 6 with rejected IE (sensitivity 73.6% [95% confidence interval (CI): 63.3% to 82.3%], specificity 75% [95% CI: 53.3% to 90.2%]). The ESC 2015 classification increased the sensitivity of Duke criteria from 57.1% (95% CI: 46.3% to 67.5%) to 83.5% (95% CI: 74.3% to 90.5%) (p < 0.001), but decreased its specificity from 95.8% (95% CI: 78.9% to 99.9%) to 70.8% (95% CI: 48.9% to 87.4%). Intraobserver reproducibility of F-FDG PET/CT was good (kappa = 0.84) but interobserver reproducibility was less satisfactory (kappa = 0.63). A diffuse splenic uptake was observed in 24 (20.3%) patients, including 23 (25.3%) of definite PVE, and only 1 (4.2%) rejected PVE (p = 0.024).

Conclusions: F-FDG PET/CT is a useful diagnostic tool in suspected PVE, and explains the greater sensitivity of ESC criteria than Duke criteria. However, F-FDG PET/CT also presents with important limitations concerning its feasibility, specificity, and reproducibility. Our study describes for the first time a new endocarditis criterion, that is, the presence of a diffuse splenic uptake on F-FDG PET/CT.
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http://dx.doi.org/10.1016/j.jcmg.2020.04.011DOI Listing
December 2020

Impact of COVID-19 lockdown on adherence to continuous positive airway pressure by obstructive sleep apnoea patients.

Eur Respir J 2020 07 30;56(1). Epub 2020 Jul 30.

Dept of Cardiovascular Medicine, Princess Grace Hospital, Monaco, Monaco

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http://dx.doi.org/10.1183/13993003.01607-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241111PMC
July 2020

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis.

Diagnostics (Basel) 2020 Mar 26;10(4). Epub 2020 Mar 26.

Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy.

Background: Transcatheter aortic valve replacement has proved its safety and effectiveness in intermediate- to high-risk and inoperable patients with severe aortic stenosis. However, despite current guideline recommendations, the use of transcatheter aortic valve replacement (TAVR) to treat severe aortic valve stenosis caused by degenerative leaflet thickening and calcification has not been widely adopted in low-risk patients. This reluctance among both cardiac surgeons and cardiologists could be due to concerns regarding clinical and subclinical valve thrombosis. Stent performance alongside increased aortic root and leaflet stresses in surgical bioprostheses has been correlated with complications such as thrombosis, migration and structural valve degeneration.

Materials And Methods: Self-expandable catheter-based aortic valve replacement (Medtronic, Minneapolis, MN, USA), which was received by patients who developed transcatheter heart valve thrombosis, was investigated using high-resolution biomodelling from computed tomography scanning. Calcific blocks were extracted from a 250 CT multi-slice image for precise three-dimensional geometry image reconstruction of the root and leaflets.

Results: Distortion of the stent was observed with incomplete cranial and caudal expansion of the device. The incomplete deployment of the stent was evident in the presence of uncrushed refractory bulky calcifications. This resulted in incomplete alignment of the device within the aortic root and potential dislodgment.

Conclusion: A Finite Element Analysis (FEA) investigation can anticipate the presence of calcified refractory blocks, the deformation of the prosthetic stent and the development of paravalvular orifice, and it may prevent subclinical and clinical TAVR thrombosis. Here we clearly demonstrate that using exact geometry from high-resolution CT scans in association with FEA allows detection of persistent bulky calcifications that may contribute to thrombus formation after TAVR procedure.
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http://dx.doi.org/10.3390/diagnostics10040183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235717PMC
March 2020

The Choice of Treatment in Ischemic Mitral Regurgitation With Reduced Left Ventricular Function.

Ann Thorac Surg 2019 12 22;108(6):1901-1912. Epub 2019 Aug 22.

Department of Surgery and Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.

Background: Ischemic mitral regurgitation is a condition characterized by mitral insufficiency secondary to an ischemic left ventricle. Primarily, the pathology is the result of perturbation of normal regional left ventricular geometry combined with adverse remodeling. We present a comprehensive review of contemporary surgical, medical, and percutaneous treatment options for ischemic mitral regurgitation, rigorously examined by current guidelines and literature.

Methods: We conducted a literature search of the PubMed database, Embase, and the Cochrane Library (through November 2018) for studies reporting perioperative or late mortality and echocardiographic outcomes after surgical and nonsurgical intervention for ischemic mitral regurgitation.

Results: Treatment of this condition is challenging and often requires a multimodality approach. These patients usually have multiple comorbidities that may preclude surgery as a viable option. A multidisciplinary team discussion is crucial in optimizing outcomes. There are several options for treatment and management of ischemic mitral regurgitation with differing benefits and risks. Guideline-directed medical therapy for heart failure is the treatment choice for moderate and severe ischemic mitral regurgitation, with consideration of coronary revascularization, mitral valve surgery, cardiac resynchronization therapy, or a combination of these, in appropriate candidates. The use of transcatheter mitral valve therapy is considered appropriate in high-risk patients with severe ischemic mitral regurgitation, heart failure, and reduced left ventricular ejection fraction, especially in those with hemodynamic instability.

Conclusions: The role of mitral valve surgery and transcatheter mitral valve therapy continues to evolve.
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http://dx.doi.org/10.1016/j.athoracsur.2019.06.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424599PMC
December 2019

Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: An echocardiographic and computed tomography study.

Arch Cardiovasc Dis 2019 Oct 8;112(10):567-575. Epub 2019 Aug 8.

Echocardiography Laboratory, Heart Valve Centre, Cardiology and Radiology Departments, Faculté de médecine et de Maïeutique, GCS-groupement des hôpitaux de l'institut catholique Lillois, UCLille, 59000 Lille, France; Laboratoire UPJV, université de Picardie, 80025 Amiens, France. Electronic address:

Background: An increased acceleration time to ejection time (AT/ET) ratio is associated with increased mortality in patients with aortic stenosis (AS).

Aim: To identify the factors associated with an increased AT/ET ratio.

Methods: The relationships between the AT/ET ratio and clinical and Doppler echocardiographic variables of interest in the setting of AS were analysed retrospectively in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (LVEF). The computed tomography aortic valve calcium (CT-AVC) score was studied in a subgroup of 342 patients.

Results: In the univariate analysis, the AT/ET ratio was found to correlate with peak aortic jet velocity (r=0.57; P<0.0001), mean pressure gradient (r=0.60; P<0.0001), aortic valve area (r=-0.50; P<0.0001) and CT-AVC score (r=0.24; P<0.0001). The AT/ET ratio had good accuracy in predicting a peak aortic jet velocity≥4 m/s, a mean pressure gradient≥40mmHg and an aortic valve area≤1.0cm, with an optimal cut-off value of 0.34. Multivariable linear regression analysis showed that presence of AS-related symptoms, decreased LV stroke volume index, LVEF, absence of diabetes mellitus, systolic blood pressure, increased LV mass index, relative wall thickness and peak aortic jet velocity were independently associated with an increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC scoring, the CT-AVC score was independently associated with an increased AT/ET ratio (P<0.05).

Conclusions: The AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond the haemodynamic and anatomical severity of AS influence the AT/ET ratio, including LV geometry, function and systolic blood pressure. These findings should be considered when assessing the AT/ET ratio in patients with AS and preserved LVEF.
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http://dx.doi.org/10.1016/j.acvd.2019.06.004DOI Listing
October 2019

Diagnostic score of cardiac involvement in AL amyloidosis.

Eur Heart J Cardiovasc Imaging 2020 05;21(5):542-548

Cardiology Department, Hopital Lariboisiere, 2 rue Ambroise Paré, 75010 Paris, France.

Aims: Early diagnosis of cardiac involvement is a key issue in the management of AL amyloidosis. Our objective was to establish a diagnostic score of cardiac involvement in AL amyloidosis and to compare it with the current consensus criteria [i.e. left ventricular hypertrophy >12 mm and N-terminal pro b-type natriuretic peptide (NT-proBNP) >332 ng/L].

Methods And Results: We carried out a prospective and multicenter study on AL amyloidosis patients who underwent cardiac evaluation including clinical examination, electrocardiography (ECG), cardiac biomarkers, transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR). Cardiac involvement was based on CMR and/or endomyocardial biopsy. In a derivation cohort of 114 patients (82 with cardiac involvement), the highest diagnostic accuracy was observed with NT-proBNP and troponin blood levels, TTE-derived global longitudinal strain (LS), and apical to basal LS gradient. By using multivariate analysis, we established a diagnostic score including global LS ≥-17% (1 point), apical/(basal + median) LS ≥0.90 (1 point), and troponin T >35 ng/L (1 point). A score >1 was associated with sensitivity of 94% and specificity of 97%, an area under the curve of 0.98 [95% confidence interval (CI) 0.93-0.99] as well as a net reclassification index of 0.39 (95% CI 0.28-0.46) when compared with consensus criteria. In a validation cohort of 73 AL amyloidosis patients, the area under the receiver operating characteristic curve of the diagnostic score was 0.97 (95% CI 0.90-0.99).

Conclusion: Combining T troponin blood levels and two echo-derived strain parameters leads to very high accuracy for diagnosing cardiac involvement in AL amyloid patients.
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http://dx.doi.org/10.1093/ehjci/jez180DOI Listing
May 2020

Finite element analysis applied to the transcatheter mitral valve therapy: Studying the present, imagining the future.

J Thorac Cardiovasc Surg 2019 04;157(4):e149-e151

Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway.

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http://dx.doi.org/10.1016/j.jtcvs.2018.08.112DOI Listing
April 2019

Relationship between nocturia and mortality: are we missing the forest for the trees?

Prostate Cancer Prostatic Dis 2019 03 28;22(1):3-4. Epub 2018 Nov 28.

Department of Cardiology, Clinique Pasteur, Toulouse, France.

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http://dx.doi.org/10.1038/s41391-018-0115-0DOI Listing
March 2019

Obstructive sleep apnea syndrome should always be screened in patients complaining of nocturia.

World J Urol 2019 12 22;37(12):2801-2802. Epub 2018 Oct 22.

Department of Cardiology, Clinique Pasteur, Toulouse, France.

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http://dx.doi.org/10.1007/s00345-018-2534-xDOI Listing
December 2019

Mitral endocarditis: A new management framework.

J Thorac Cardiovasc Surg 2018 10 13;156(4):1486-1495.e4. Epub 2018 Apr 13.

Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.jtcvs.2018.03.159DOI Listing
October 2018

How to treat severe symptomatic structural valve deterioration of aortic surgical bioprosthesis: transcatheter valve-in-valve implantation or redo valve surgery?

Eur J Cardiothorac Surg 2018 12;54(6):977-985

Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.

The optimal management of aortic surgical bioprosthesis presenting with severe symptomatic structural valve deterioration is currently a matter of debate. Over the past 20 years, the number of implanted bioprostheses worldwide has been rapidly increasing at the expense of mechanical prostheses. A large proportion of patients, however, will require intervention for bioprosthesis structural valve deterioration. Current options for older patients who often have severe comorbidities include either transcatheter valve-in-valve (TVIV) implantation or redo valve surgery. The emergence of TVIV implantation, which is perceived to be less invasive than redo valve surgery, offers an effective alternative to surgery for these patients with proven safety and efficacy in high-risk patient groups including elderly and frail patients. A potential caveat to this strategy is that results of long-term follow-up after TVIV implantation are limited. Redo surgery is sometimes preferable, especially for young patients with a smaller-sized aortic bioprosthesis. With the emergence of TVIV implantation and the long experience of redo valve surgery, we currently have 2 complementary treatment modalities, allowing a tailor-made and patient-orientated intervention. In the heart team, the decision-making should be based on several factors including type of bioprosthesis failure, age, comorbidities, operative risk, anatomical factors, anticipated risks and benefits of each alternative, patient's choice and local experience. The aim of this review is to provide a framework for individualized optimal treatment strategies in patients with failed aortic surgical bioprosthesis.
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http://dx.doi.org/10.1093/ejcts/ezy204DOI Listing
December 2018

Fingermarks in blood: Mechanical models and the color of ridges.

Forensic Sci Int 2018 May 14;286:141-147. Epub 2018 Mar 14.

Division of Identification and Forensic Science, Israel Police, 1 Haim Bar Lev Rd., Jerusalem, 91906, Israel. Electronic address:

This article treats fingermarks in blood on non-porous surfaces and addresses the question of "which came first": the fingermark or the blood. Three mechanical models were systematically examined: (1) A blood-contaminated finger pressed against a clean surface; (2) blood contaminates a latent print that had been placed on a clean surface; (3) A clean finger pressed against a blood-contaminated surface. The questions of reliability and limits of all three models were discussed. The relevancy of the approach to "which came first", based solely on the color of ridges was questioned. The first mechanical model most simulated a real situation, when previously cleaned, a blood contaminated finger touched a clean Formica or glass surface with pressure of 100-500g. Concerning the second model, it was observed that in the case of a greasy latent print, placed on an inclined surface and contaminated with appropriate amount of blood, the color of ridges were normally darker than the color of its valleys. As for the third model, it was concluded that it works only in about 25% of cases. While investigating this model, two phenomena were observed: ridge color inversion and valley color inversion. In conclusion the color of ridges can not be the only and ultimate indicator to the question of "which came first", the fingermark or the blood stain.
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http://dx.doi.org/10.1016/j.forsciint.2018.03.008DOI Listing
May 2018

Benfluorex-induced severe primary tricuspid and mitral regurgitation requiring a double-valve replacement.

Eur J Cardiothorac Surg 2018 07;54(1):195

Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France.

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http://dx.doi.org/10.1093/ejcts/ezy032DOI Listing
July 2018

Impact of Pre-Existing Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures.

JACC Cardiovasc Interv 2018 01;11(2):133-141

University of Washington, Seattle, Washington.

Objectives: The aim of this study was to determine whether the association of small label size of the surgical valve with increased mortality after transcatheter valve-in-valve (ViV) implantation is, at least in part, related to pre-existing prosthesis-patient mismatch (PPM) (i.e., a bioprosthesis that is too small in relation to body size).

Background: Transcatheter ViV implantation is an alternative for the treatment of patients with degenerated bioprostheses. Small label size of the surgical valve has been associated with increased mortality after ViV implantation.

Methods: Data from 1,168 patients included in the VIVID (Valve-in-Valve International Data) registry were analyzed. Pre-existing PPM of the surgical valve was determined using a reference value of effective orifice area for each given model and size of implanted prosthetic valve indexed for body surface area. Severe PPM was defined according to the criteria proposed by the Valve Academic Research Consortium 2: indexed effective orifice area <0.65 cm/m if body mass index is <30 kg/m and <0.6 cm/m if BMI is ≥30 kg/m. The primary study endpoint was 1-year mortality.

Results: Among the 1,168 patients included in the registry, 89 (7.6%) had pre-existing severe PPM. Patients with severe PPM had higher 30-day (10.3%, p = 0.01) and 1-year (unadjusted: 28.6%, p < 0.001; adjusted: 19.3%, p = 0.03) mortality rates compared with patients with no severe PPM (4.3%, 11.9%, and 10.9%, respectively). After adjusting for surgical valve label size, Society of Thoracic Surgeons score, renal failure, diabetes, and stentless surgical valves, presence of pre-existing severe PPM was associated with increased risk for 1-year mortality (odds ratio: 1.88; 95% confidence interval: 1.07 to 3.28; p = 0.03). Patients with severe PPM also more frequently harbored high post-procedural gradients (mean gradient ≥20 mm Hg).

Conclusions: Pre-existing PPM of the failed surgical valve is strongly and independently associated with increased risk for mortality following ViV implantation.
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http://dx.doi.org/10.1016/j.jcin.2017.08.039DOI Listing
January 2018

Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification.

JACC Cardiovasc Interv 2017 10;10(19):1932-1942

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.

Objectives: The aim of this study was to examine 1-year outcomes of transseptal balloon-expandable transcatheter heart valve implantation in failed mitral bioprosthesis, ring annuloplasty, and mitral annular calcification (MAC).

Background: Immediate outcomes following transseptal mitral valve implantation in failed bioprostheses are favorable, but data on subsequent outcomes are lacking.

Methods: Percutaneous transseptal implantation of balloon-expandable transcatheter heart valves was performed in 87 patients with degenerated mitral bioprostheses (valve in valve [VIV]) (n = 60), previous ring annuloplasty (valve in ring) (n = 15), and severe MAC (valve in MAC) (n = 12).

Results: The mean Society of Thoracic Surgeons risk score was 13 ± 8%, and the mean age was 75 ± 11 years. Acute procedural success was achieved in 78 of 87 patients (90%) in the overall group and 58 of 60 (97%) in the VIV group, with a success rate of 20 of 27 (74%) in the valve in ring/valve in MAC group. Thirty-day survival free of death and cardiovascular surgery was 95% (95% confidence interval [CI]: 92% to 97%) in the VIV subgroup and 78% (95% CI: 70% to 86%) in the valve in ring/valve in MAC group (p = 0.008). One-year survival free of death and cardiovascular surgery was 86% (95% CI: 81% to 91%) in the VIV group compared with 68% (95% CI: 58% to 78%) (p = 0.008). At 1 year, 36 of 40 patients (90%) had New York Heart Association functional class I or II symptoms, no patients had more than mild residual mitral prosthetic or periprosthetic regurgitation, and the mean transvalvular gradient was 7 ± 3 mm Hg.

Conclusions: One-year outcomes following successful transseptal balloon-expandable transcatheter heart valve implantation in high-risk patients with degenerated mitral bioprostheses are excellent, characterized by durable symptom relief and prosthesis function. Although mitral valve in ring and valve in MAC have higher operative morbidity and mortality, 1-year outcomes after an initially successful procedure are favorable in carefully selected patients.
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http://dx.doi.org/10.1016/j.jcin.2017.08.014DOI Listing
October 2017

Prognostic value of one millisievert exercise myocardial perfusion imaging in patients without known coronary artery disease.

J Nucl Cardiol 2018 02 9;25(1):120-130. Epub 2016 Aug 9.

Nuclear Cardiology, Centre Cardiologique du Nord (CCN), Paris, France.

The aim of this study was to assess the prognostic value of normal ultra-low-dose exercise MPI with a CZT camera.

Methods: 1901 consecutive patients without known CAD referred for exercise MPI with 1.8 MBq/kg (0.05 mCi) of Tc99m sestamibi or tetrofosmin and a CZT camera were included prospectively. Patients with an abnormal scan requiring an additional resting image (230) or a submaximal exercise test (271) were excluded. The 1400 remaining patients were followed for 39 months. The primary end-point was cardiac events (cardiac death, nonfatal myocardial infarction, and revascularization). The secondary end-point was noncardiac death.

Results: The mean injected activity was 145 ± 37 MBq (3.9 ± 1 mCi), the mean acquisition duration was 10 ± 0.7 minutes, and the mean effective dose was 0.91 ± 0.13 mSv. 1288 patients (92%) achieved full follow-up. We observed 22 cardiac events and 16 noncardiac deaths. The annualized rates were equivalent to 0.55% for cardiac events and 0.37% for noncardiac mortality.

Conclusions: Normal ultra-low-dose exercise MPI with a CZT camera has a high negative predictive value. The effective dose was less than 1 mSv, and the study thus allays concerns about radiation burden.
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http://dx.doi.org/10.1007/s12350-016-0601-5DOI Listing
February 2018

First-in-man full percutaneous transfemoral valve-in-valve implantations using Edwards SAPIEN 3 prostheses to treat a patient with degenerated mitral and aortic bioprostheses.

Interact Cardiovasc Thorac Surg 2016 09 30;23(3):508-10. Epub 2016 May 30.

Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France

We report the case of a 64-year old man presenting with pulmonary oedema due to the degeneration of mitral and aortic bioprostheses. Baseline transthoracic and 3D transoesophageal echocardiography showed severe stenotic degeneration of the mitral bioprosthesis (Carpentier-Edwards bioprosthesis n°31), severe intraprosthetic aortic regurgitation (Perimount bioprosthesis n°27), left ventricular dilatation, decreased left ventricular ejection fraction at 50% and pulmonary hypertension. Because of severe comorbidities, the patient was denied redo surgery by the Heart Team (logistic EuroSCORE 2: 23, 85%). Transcatheter transfemoral mitral valve-in-valve implantation was first performed using a 29-mm SAPIEN 3 valve. Two weeks later, aortic valve-in-valve implantation was performed with the same approach using a 26-mm SAPIEN 3 valve. Four months later, the patient remained asymptomatic with good haemodynamic results for both prostheses. This case report illustrates that valve-in-valve implantations using a full percutaneous transfemoral approach may be a valuable alternative to conventional surgery in high-risk patients presenting with concomitant mitral and aortic bioprosthesis dysfunction.
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http://dx.doi.org/10.1093/icvts/ivw161DOI Listing
September 2016

Use of AFIS for linking scenes of crime.

Forensic Sci Int 2016 May 12;262:e25-7. Epub 2016 Mar 12.

Fingerprint Identification and AFIS Laboratory, Division of Identification and Forensic Science (DIFS), Israel Police, National Headquarters, Jerusalem, Israel.

Forensic intelligence can provide critical information in criminal investigations - the linkage of crime scenes. The Automatic Fingerprint Identification System (AFIS) is an example of a technological improvement that has advanced the entire forensic identification field to strive for new goals and achievements. In one example using AFIS, a series of burglaries into private apartments enabled a fingerprint examiner to search latent prints from different burglary scenes against an unsolved latent print database. Latent finger and palm prints coming from the same source were associated with over than 20 cases. Then, by forensic intelligence and profile analysis the offender's behavior could be anticipated. He was caught, identified, and arrested. It is recommended to perform an AFIS search of LT/UL prints against current crimes automatically as part of laboratory protocol and not by an examiner's discretion. This approach may link different crime scenes.
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http://dx.doi.org/10.1016/j.forsciint.2016.03.003DOI Listing
May 2016

Aortic stenosis and transthyretin cardiac amyloidosis: the chicken or the egg?

Eur Heart J 2016 Dec 22;37(47):3525-3531. Epub 2016 Feb 22.

UPEC, Créteil F-94000, France

Background: Aortic stenosis (AS) and transthyretin cardiac amyloidosis (TTR-CA) are both frequent in elderly. The combination of these two diseases has never been investigated.

Aims: To describe patients with concomitant AS and TTR-CA.

Methods: Six cardiologic French centres identified retrospectively cases of patients with severe or moderate AS associated with TTR-CA hospitalized during the last 6 years.

Results: Sixteen patients were included. Mean ± SD age was 79 ± 6 years, 81% were men. Sixty per cent were NYHA III-IV, 31% had carpal tunnel syndrome, and 56% had atrial fibrillation. Median (Q1;Q4) NT-proBNP was 4382 (2425;4730) pg/mL and 91% had elevated cardiac troponin level. Eighty-eight per cent had severe AS (n = 14/16), of whom 86% (n = 12) had low-gradient AS. Mean ± SD interventricular septum thickness was 18 ± 4 mm. Mean left ventricular ejection fraction and global LS were 50 ± 13% and -7 ± 4%, respectively. Diagnosis of TTR-CA was histologically proven in 38%, and was based on strong cardiac uptake of the tracer at biphosphonate scintigraphy in the rest. Eighty-one per cent had wild-type TTR-CA (n = 13), one had mutated Val122I and 19% did not had genetic test (n = 3). Valve replacement was surgical in 63% and via transcatheter in 13%. Median follow-up in survivors was 33 (16;65) months. Mortality was of 44% (n = 7) during the whole follow-up period.

Conclusions: Combination of AS and TTR-CA may occur in elderly patients particularly those with a low-flow low-gradient AS pattern and carries bad prognosis. Diagnosis of TTR-CA in AS is relevant to discuss specific treatment and management.
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http://dx.doi.org/10.1093/eurheartj/ehw033DOI Listing
December 2016

Comparison of 2-Dimensional, 3-Dimensional, and Surgical Measurements of the Tricuspid Annulus Size: Clinical Implications.

Circ Cardiovasc Imaging 2015 Jul;8(7):e003241

From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).

Background: Associated tricuspid annuloplasty is recommended during left-heart valve surgery when the tricuspid annulus (TA) is dilated but methodology for the measurement of TA size and thresholds for TA enlargement are not clearly defined.

Methods And Results: Measurement of the TA diameter (TAD) was prospectively performed using 2-dimensional transthoracic echocardiography (2D-TTE) in 282 patients in 4 different views (parasternal long axis, parasternal short axis, apical 4-chamber [A4C], and subcostal). TAD was also measured using 3D-transesophageal echocardiography in 183 patients (long axis), peroperatively in 120 patients who underwent a tricuspid valve surgery and using TTE (A4C) in 66 healthy volunteers. TAD was significantly different between the 4 2D-TTE views (3.85±0.58, 3.87±0.61, 4.02±0.69, and 3.92±0.65 cm, respectively; P<0.0001) but differences were small and the A4C was the most feasible (76%, 65%, 92%, and 73%, respectively; P<0.0001) and offered the highest reproducibility. TAD measured in A4C view was smaller than when measured by 3D-transesophageal echocardiography (3.90±0.63 versus 4.33±0.62 cm; P<0.0001) but correlation was excellent (r=0.84; P<0.0001) with a systematic 4-mm underestimation. In contrast, 2D-TTE measurements were significantly smaller and only modestly correlated to surgical measurements (4.11±0.61 versus 4.37±0.75 cm; P<0.0001; r=0.57; P<0.0001) which were poorly reproducible. In healthy volunteers, we suggested 42 mm or 23 mm/m(2) as pathological values for the TAD in A4C.

Conclusions: Measurements of the TAD using 2D-TTE in A4C were highly feasible and reproducible and despite being systematically smaller than 3D measurements, accurately reflected the degree of TA enlargement as assessed using 3D transesophageal echocardiography. We proposed the thresholds that may be used in future prospective studies to demonstrate whether a preventive strategy would improve the outcome.
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http://dx.doi.org/10.1161/CIRCIMAGING.114.003241DOI Listing
July 2015

(99m)Tc-HMDP scintigraphy rectifies wrong diagnosis of AL amyloidosis.

J Nucl Cardiol 2015 Aug 22;22(4):853-7. Epub 2015 May 22.

UPEC, 94000, Créteil, France,

A 71-year-old African man without history of cardiac disease was referred to our center for dyspnea. Transthoracic echocardiogram and cardiac MRI were suggestive of cardiac amyloidosis (CA). The diagnosis of the light-chain cardiac amyloidosis (AL-CA) was made after a first endomyocardial biopsy. Accordingly chemotherapy was started. Systematic 99mTc-HMDP scintigraphy showed moderate cardiac uptake (visual score of 2), unusual for AL-CA, and permitted to rectify the diagnosis. Hereditary transthyretin cardiac amyloidosis was confirmed by a second endomyocardial biopsy with a positive Congo-red and anti-transthyretin antibody stainings, mass spectrometry and genetic analysis (Val122Ile mutation).
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http://dx.doi.org/10.1007/s12350-015-0176-6DOI Listing
August 2015

Marfan Sartan: a randomized, double-blind, placebo-controlled trial.

Eur Heart J 2015 Aug 2;36(32):2160-6. Epub 2015 May 2.

Centre National de Référence pour le syndrome de Marfan et apparentés, Hôpital Bichat, 46 rue Henry Huchard, Paris 75018, France Service de Cardiologie, AP-HP, Hôpital Bichat, Paris, France INSERM LVTS U1148, Paris 75018, France

Aims: To evaluate the benefit of adding Losartan to baseline therapy in patients with Marfan syndrome (MFS).

Methods And Results: A double-blind, randomized, multi-centre, placebo-controlled, add on trial comparing Losartan (50 mg when <50 kg, 100 mg otherwise) vs. placebo in patients with MFS according to Ghent criteria, age >10 years old, and receiving standard therapy. 303 patients, mean age 29.9 years old, were randomized. The two groups were similar at baseline, 86% receiving β-blocker therapy. The median follow-up was 3.5 years. The evolution of aortic diameter at the level of the sinuses of Valsalva was not modified by the adjunction of Losartan, with a mean increase in aortic diameter at the level of the sinuses of Valsalva of 0.44 mm/year (s.e. = 0.07) (-0.043 z/year, s.e. = 0.04) in patients receiving Losartan and 0.51 mm/year (s.e. = 0.06) (-0.01 z/year, s.e. = 0.03) in those receiving placebo (P = 0.36 for the comparison on slopes in millimeter per year and P = 0.69 for the comparison on slopes on z-scores). Patients receiving Losartan had a slight but significant decrease in systolic and diastolic blood pressure throughout the study (5 mmHg). During the study period, aortic surgery was performed in 28 patients (15 Losartan, 13 placebo), death occurred in 3 patients [0 Losartan, 3 placebo, sudden death (1) suicide (1) oesophagus cancer (1)].

Conclusion: Losartan was able to decrease blood pressure in patients with MFS but not to limit aortic dilatation during a 3-year period in patients >10 years old. β-Blocker therapy alone should therefore remain the standard first line therapy in these patients.
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http://dx.doi.org/10.1093/eurheartj/ehv151DOI Listing
August 2015

Prevalence, clinical characteristics and outcomes of high-risk patients treated for severe aortic stenosis prior to and after transcatheter aortic valve implantation availability.

Eur J Cardiothorac Surg 2015 May 16;47(5):e206-12. Epub 2015 Feb 16.

Interventional Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.

Objectives: Transcatheter aortic valve implantation (TAVI) has emerged as an effective treatment for high-risk patients with severe aortic stenosis (AS). The aim of our study was to compare the prevalence, characteristics and outcomes of high-risk patients treated prior to and after the availability of TAVI in our high-volume surgical institution.

Methods: Among 879 consecutive patients treated 2 years before ('pre-TAVI era') and after ('modern era') the availability of TAVI in our institution, 83 patients were at high risk [defined by logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) >20%].

Results: Among all patients treated for severe AS, the prevalence of high-risk patients was higher in the modern era (12.7 vs 4.9%, P < 0.0001). In the modern era, high-risk patients were treated by TAVI in 89% of cases. Despite similar logistic EuroSCORE (34.9 vs 34%, P = 0.96), the clinical characteristics of these patients have evolved: high-risk patients in the modern era were older (85.3 ± 5.9 vs 78.5 ± 6.5 years, P = 0.0005) and presented more frequently with New York Heart Association class III-IV (92.3 vs 61.1%, P = 0.003), while high-risk patients treated by surgical aortic valve replacement in the pre-TAVI era presented more frequently with a critical preoperative status (33.3 vs 7.7%, P = 0.01), lower left ventricular ejection fraction (41 ± 14 vs 49 ± 15%, P = 0.05) and a history of recent myocardial infarction (27.8 vs 6.1%, P = 0.02). The overall 1-year survival was not different for high-risk patients treated in the pre-TAVI era or in the modern era (61 ± 11 vs 68 ± 6%, P = 0.52).

Conclusions: The availability of TAVI has increased the prevalence of high-risk patients treated for severe AS and changed the clinical features of this kind of patients who were rarely surgically treated before. The 1-year survival was similar between pre-TAVI and modern eras.
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http://dx.doi.org/10.1093/ejcts/ezv019DOI Listing
May 2015

Relationship between longitudinal strain and symptomatic status in aortic stenosis.

J Am Soc Echocardiogr 2013 Aug 13;26(8):868-74. Epub 2013 Jun 13.

Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.

Background: Global longitudinal strain (GLS) and basal longitudinal strain (BLS) assessed using two-dimensional speckle-tracking imaging have been proposed as subtle markers of left ventricular (LV) systolic dysfunction with potential prognostic value in patients with aortic stenosis (AS). The aim of this study was to evaluate the relationship between longitudinal strain and symptomatic status in patients with AS.

Methods: GLS and BLS were measured in 171 patients with pure, isolated, at least mild AS prospectively enrolled at two institutions. The population was divided into four groups: asymptomatic nonsevere AS (n = 55), asymptomatic severe AS with preserved LV ejection fraction (LVEF; ≥50%) (n = 37), symptomatic severe AS with preserved LVEF (n = 60), and severe AS with reduced LVEF (<50%) (n = 19).

Results: GLS was significantly different among the four groups (P < .0001), but the difference was due mainly to patients with reduced LVEFs. In addition, there was an important overlap among the groups, and in multivariate analysis, after adjustment for age, gender, AS severity, and LVEF, GLS was not an independent predictor of symptomatic status (P = .07). BLS was also significantly different among the four groups (P < .0001) but in contrast was independently associated with symptomatic status (P < .0001). However, as for GLS, there was an important overlap between groups and differences were close to intraobserver or interobserver variability (1.3 ± 1.1% and 2.0 ± 1.6%, respectively).

Conclusions: In this prospective multicenter cohort of patients with wide ranges of AS severity, symptoms, and LVEFs, BLS but not GLS was independently associated with symptomatic status. However, there was an important overlap among groups, and differences were close to measurements' reproducibility, raising caution regarding the use of longitudinal strain, at least as a single criterion, in the decision-making process for patients with severe asymptomatic AS.
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http://dx.doi.org/10.1016/j.echo.2013.05.004DOI Listing
August 2013

A rare cause of persistent fever in pulmonary homograft endocarditis.

Heart Asia 2013 10;5(1):225. Epub 2013 Oct 10.

Department of Cardiology , AP-HP, Bichat-Claude Bernard Hospital , Paris , France.

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http://dx.doi.org/10.1136/heartasia-2013-010414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832757PMC
June 2016

Persistent fever in a multicomplicated infective endocarditis.

Arch Cardiovasc Dis 2012 Oct 9;105(10):535-6. Epub 2012 Jan 9.

Department of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.

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http://dx.doi.org/10.1016/j.acvd.2011.05.012DOI Listing
October 2012

Heritable pulmonary arterial hypertension with elevated pulmonary wedge pressure.

Circulation 2012 Aug;126(9):e124-7

Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des Moulins Gémeaux, Saint Denis, France.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.112.096271DOI Listing
August 2012