Publications by authors named "Emmanuelle Vermes"

46 Publications

Management of antibody mediated rejection (AMR) in heart transplant patients: The real world in a French single center treating all pathological AMR.

Clin Transplant 2021 06 25;35(6):e14243. Epub 2021 Apr 25.

Department of Cardiothoracic Surgery, University François Rabelais, Tours, France.

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http://dx.doi.org/10.1111/ctr.14243DOI Listing
June 2021

Left ventricular assist device inflow cannula implantation: Why a "Step sideways" technique can be helpful.

Artif Organs 2021 Sep 7;45(9):1114-1116. Epub 2021 Apr 7.

Department of Cardiac Surgery, Tours University Hospital, Tours, France.

Preservation of right ventricle vascularization that is dependent on left coronary network collateral development is essential during left ventricular assist device implantation to avoid postoperative right heart failure. Our technique was performed on a patient who underwent implantation as a bridge to transplantation; the technique is characterized by providing a moderate lateral and inferior displacement of the inflow cannula position, which achieves both the objectives of respecting the apical course of a left anterior descending coronary artery supplying an occluded right coronary and of maintaining a sufficient orientation degree toward the plane of the mitral valve for correct left ventricular unloading.
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http://dx.doi.org/10.1111/aor.13953DOI Listing
September 2021

Response to "Cardiac magnetic resonance in Takotsubo syndrome: Welcome to mapping, but long live late gadolinium enhancement".

Int J Cardiol 2020 11 4;319:36. Epub 2020 Jul 4.

Department of Radiology, University François Rabelais, Tours, France.

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http://dx.doi.org/10.1016/j.ijcard.2020.06.056DOI Listing
November 2020

Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review.

Mycopathologia 2020 Aug 19;185(4):709-716. Epub 2020 Jun 19.

Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France.

Phaeohyphomycosis is a chronic infectious disease caused by dematiaceous fungi. It is characterized by the presence of pigmented septate mycelia within tissues. In the case of superficial infection, the lesion(s) chronically evolve(s) toward painless pseudo-tumor(s) of the soft parts. We report herein the original case of a heart transplanted man who exhibited phaeohyphomycosis of the left hand, with no mention of travels in endemic areas. Trematosphaeria grisea was identified as the causative agent, which is quite innovative since this species has been rather described in mycetoma. The antifungal treatment initially based on isavuconazole alone was not sufficient to cure the patient. In contrast, its association with local terbinafine ointment allowed total clinical improvement. This finding is unusual as diagnosis of phaeohyphomycosis caused by T. grisea is uncommon in nontropical countries, and as the outcome appeared successful by the means of add-on therapeutic strategy with terbinafine.
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http://dx.doi.org/10.1007/s11046-020-00467-4DOI Listing
August 2020

Umbilicated Papules on the Face of an Adult Patient: A Quiz.

Acta Derm Venereol 2020 Jul 28;100(14):adv00213. Epub 2020 Jul 28.

Department of Dermatology, Centre Hospitalier Regional Universitaire de Tours, FR-37044 Tours, France.

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http://dx.doi.org/10.2340/00015555-3528DOI Listing
July 2020

Cardiac magnetic resonance for assessment of cardiac involvement in Takotsubo syndrome: Do we still need contrast administration?

Int J Cardiol 2020 06 19;308:93-95. Epub 2020 Mar 19.

Department of Radiology, University François Rabelais, Tours, France.

Background: This study evaluated the ability of T1 and T2 mapping cardiovascular magnetic resonance to assess myocardial involvement in Takotsubo syndrome (TTS). We hypothesized that non-contrast mapping techniques can be accurate and sufficient.

Methods: We prospectively analysed 30 patients with TTS and 34 controls. CMR was performed a mean 5 days after the onset of symptoms and after a mean 3 month follow-up.

Results: On admission, compared to controls, TTS patients had significantly higher global T2 values (59 ± 8 ms vs 51 ± 4 ms, p < 0.001), native T1 (1053 ± 75 ms vs 960 ± 61 ms, p < 0.001) and extracellular volume (ECV) fraction (29% ± 5 vs 23% ±3, p < 0.001). The sensitivity and specificity for T2 (cut off: 56 ms) were 62% and 97% respectively; for native T1: (cut off 1011 ms) were 72% and 91% respectively; and for ECV (cut off: 27%) were 72% and 97% respectively. Combining T2 and native T1 provided the best sensitivity (91.7%) with a good specificity (88.2%). No patients had late gadolinium enhancement. Segmental analysis showed that T2, native T1 and ECV values were significantly higher in regions with wall motion abnormalities (WMA) compared to normokinetic segments (62 ± 9 ms vs 55 ± 5 ms, p < 0.001; 1060 ± 65 ms vs 1025 ± 56 ms, p = 0.02; and 34% ± 5 vs 29% ± 1, p = 0.02). At follow up, native T1 and ECV values did not normalized.

Conclusion: In TTS patients, a non-contrast mapping technique provides a high diagnostic accuracy allowing identification of acute and persistent myocardial injury. Segmental analysis showed that myocardial injury is preferably detected in segments with WMA.
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http://dx.doi.org/10.1016/j.ijcard.2020.03.039DOI Listing
June 2020

Sarcoidosis diagnosed on granulomas in the explanted heart after transplantation: Results of a French nationwide study.

Int J Cardiol 2020 May 17;307:94-100. Epub 2020 Jan 17.

Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital De la Pitié-Salpêtrière, Service de Médecine Interne 2, Centre de Référence National Maladies Systémiques Rares, 75013 Paris, France. Electronic address:

Background: Cardiac sarcoidosis (CS) is a challenging diagnosis. Patients may progress to end-stage congestive heart failure and require cardiac transplantation without ever having been diagnosed. Characteristics and outcomes of patients with granulomas in the explanted hearts are unknown.

Methods: All French heart transplantation centers were contacted to participate in the study. Each center searched through local databases for the cases of non-caseating granuloma in the explanted hearts between 2000 and 2017. Data before and after transplantation were recorded from medical charts. Survival of CS and all- cause heart transplantation patients were compared.

Results: Fifteen patients (10 men, 5 women) received a diagnosis of CS based on pathologic data of the explanted heart and were recruited for the study. All patients were diagnosed as non-ischemic dilated or hypertrophic cardiomyopathy and presented congestive heart failure. Eight patients (53%) had ventricular rhythm disturbances, and 3 (20%) a complete heart block. Ten out of 13 patients (77%) had extracardiac radiological signs compatible with sarcoidosis on chest computed tomography (CT) scans. One patient died 3 months after transplantation from infectious complications. The 14 remaining patients were still alive at the end of the study (median follow-up of 28.8 months). One patient had a second heart transplantation 5 years later because of chronic allograft vasculopathy. One patient presented a relapse of CS confirmed by myocardial biopsies 9 years after transplantation, requiring an escalation of immunosuppressive therapy.

Conclusion: CS may be undiagnosed before heart transplantation. In 77% of cases, sarcoidosis could have been detected before transplantation with non-invasive imaging techniques.
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http://dx.doi.org/10.1016/j.ijcard.2019.12.066DOI Listing
May 2020

Galectin-3 predicts response and outcomes after cardiac resynchronization therapy.

J Transl Med 2018 11 3;16(1):299. Epub 2018 Nov 3.

Cardiology Department, Trousseau Hospital, University of Tours, 37044, Tours, France.

Background: Cardiac resynchronization therapy (CRT) reduces symptoms, morbidity and mortality in chronic heart failure patients with wide QRS complexes. However, approximately one third of CRT patients are non-responders. Myocardial fibrosis is known to be associated with absence of response. We sought to see whether galectin-3, a promising biomarker involved in fibrosis processes, could predict response and outcomes after CRT.

Methods: Consecutive patients eligible for implantation of a CRT device with a typical left bundle branch block ≥ 120 ms were prospectively included. Serum Gal-3 level, Selvester ECG scoring, and cardiac magnetic resonance with analysis of late gadolinium enhancement (LGE) were ascertained. Response to CRT was defined by a composite endpoint at 6 months: no death, nor hospitalization for major cardiovascular event, and a significant decrease in left ventricular end-systolic volume of 15% or more.

Results: Sixty-one patients were included (age 61 ± 5 years, ejection fraction 27 ± 5%), 59% with non-ischemic cardiomyopathy. At 6 months, 49 patients (80%) were considered responders. Responders had a lower percentage of LGE (8 ± 13% vs 22 ± 16%, p = 0.006), and a trend towards lower rates of galectin-3 (16 ± 6 ng/mL vs 19 ± 8 ng/mL, p = 0.13). LGE ≥ 14% and Gal-3 ≥ 22 ng/mL independently predicted response to CRT (OR = 0.17 [0.03-0.62], p = 0.007, and OR = 0.11 [0.02-0.04], p < 0.001, respectively). At 48 months of follow-up, 12 patients had been hospitalized for a major cardiovascular event or had died. Galectin-3 level predicted long-term outcomes (HR = 3.31 [1.00-11.34], p = 0.05).

Conclusions: Gal-3 serum level predicts the response to CRT at 6 months and long-term outcomes in chronic heart failure patients.
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http://dx.doi.org/10.1186/s12967-018-1675-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215623PMC
November 2018

Cardiovascular magnetic resonance in heart transplant patients: diagnostic value of quantitative tissue markers: T2 mapping and extracellular volume fraction, for acute rejection diagnosis.

J Cardiovasc Magn Reson 2018 08 27;20(1):59. Epub 2018 Aug 27.

Department of Radiology, University François Rabelais, Tours, France.

Background: The diagnosis of acute rejection in cardiac transplant recipients requires invasive technique with endomyocardial biopsy (EMB) which has risks and limitations. Cardiovascular magnetic resonance imaging (CMR) with T2 and T1 mapping is a promising technique for characterizing myocardial tissue. The purpose of the study was to evaluate T2, T1 and extracellular volume fraction (ECV) quantification as novel tissue markers to diagnose acute rejection.

Methods: CMR was prospectively performed in 20 heart transplant patients providing 31 comparisons EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5 Tesla scanner including T2 mapping (T2 prepared balanced steady state free precession) and T1 mapping (modified Look-Locker inversion recovery sequences: MOLLI) at basal, mid and apical level in short axis view. Global and segmental T2 and T1 values were measured before and 15 min (for T1 mapping) after contrast administration.

Results: Acute rejection was diagnosed in seven patients: six cellular rejections (4 grade IR, 2 grade 2R) and one antibody mediated rejection. Patients with acute rejection had significantly higher global T2 values at 3 levels: 58.5 ms [55.0-60.3] vs 51.3 ms [49.5-55.2] (p = 0.007) at basal; 55.7 ms [54.0-59.7] vs 51.8 ms [50.1-53.6] (p = 0.002) at median and 58.2 ms [54.0-63.7] vs 53.6 ms [50.8-57.4] (p = 0.026) at apical level. The area under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively. Patients with acute rejection had significantly higher ECV at basal level: 34.2% [32.8-37.4] vs 27.4% [24.6-30.6] (p = 0.006). The AUC for basal level was 0.84. The sensitivity, specificity and diagnosis accuracy for basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63% of EMB.

Conclusions: In heart transplant patients, a combined CMR approach using T2 mapping and ECV quantification provides a high diagnostic accuracy for acute rejection diagnosis and could potentially decrease the number of routine EMB.
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http://dx.doi.org/10.1186/s12968-018-0480-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6114788PMC
August 2018

Coronary Toxicities of Anti-PD-1 and Anti-PD-L1 Immunotherapies: a Case Report and Review of the Literature and International Registries.

Target Oncol 2018 08;13(4):509-515

Department of Pneumology and Respiratory Functional Exploration, University Hospital of Tours, Tours, France.

Immunotherapy medications that target programmed death 1 protein (PD-1) and programmed death-ligand 1 (PD-L1), such as nivolumab, pembrolizumab, and atezolizumab, are currently used in the first- or second-line treatment of non-small cell lung cancers, among other indications. However, these agents are associated with immune-related side effects, the most common of which are endocrinopathies, colitis, hepatitis, and interstitial pneumonitis. In contrast, coronary toxicities are rarely reported and remain poorly understood. Here, we describe the case of a patient who developed an acute coronary syndrome when treated with nivolumab as second-line therapy for metastatic pulmonary adenocarcinoma. A review of the literature, the French pharmacovigilance registry, and the World Health Organization pharmacovigilance database led to the identification of four cases of patients with coronary manifestations attributable to anti-PD1 immunotherapy (with no reported cases of patients undergoing anti-PD-L1 immunotherapy), which we describe herein. The potential mechanisms causing adverse coronary reactions to this type of therapy, which is used to treat lung cancer as well as other solid and hematological neoplastic diseases, are also discussed.
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http://dx.doi.org/10.1007/s11523-018-0579-9DOI Listing
August 2018

Bioprosthetic mitral valve replacement in patients aged 65 years or younger: long-term outcomes with the Carpentier-Edwards PERIMOUNT pericardial valve.

Eur J Cardiothorac Surg 2018 08;54(2):302-309

Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France.

Objectives: Mitral valve replacement using a bioprosthesis remains controversial in young patients because data on long-term outcomes are missing. This study evaluated the long-term results of the PERIMOUNT pericardial mitral bioprosthesis in patients aged 65 years or younger.

Methods: From 1984 to 2010, 148 Carpentier-Edwards PERIMOUNT mitral bioprostheses were implanted in 148 patients aged 65 years or younger. Baseline clinical, perioperative and follow-up data were recorded prospectively. Structural valve deterioration (SVD) was defined by strict echocardiographic assessment.

Results: The mean follow-up period was 8.6 ± 5.5 years, for a total of 1269 valve-years. Operative mortality rate was 2.0%. Fifty-one late deaths occurred (linearized rate 4.0% per valve-year). Actuarial survival rates averaged 70 ± 4%, 53 ± 6% and 31 ± 7% after 10, 15 and 20 years of follow-up, respectively. Actuarial freedom from SVD at 10, 15 and 20 years was 78 ± 5%, 47 ± 7% and 19 ± 7%, respectively. Reoperation was associated with no operative mortality. Actuarial freedom from reoperation due to SVD at 10, 15 and 20 years was 82 ± 4%, 50 ± 6% and 25 ± 8%, respectively. Competing risk analysis demonstrated an actual risk of explantation secondary to SVD at 20 years of 44 ± 5%. Expected valve durability was 14.2 years for this age group.

Conclusions: In the selected patients aged 65 years or younger undergoing mitral valve replacement with a pericardial bioprosthesis, the expected valve durability was 14.2 years. Reoperation for SVD was associated with a low risk of mortality.
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http://dx.doi.org/10.1093/ejcts/ezy029DOI Listing
August 2018

Assessment of potential heart donors: A statement from the French heart transplant community.

Arch Cardiovasc Dis 2018 Feb 23;111(2):126-139. Epub 2017 Dec 23.

Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France.

Assessment of potential donors is an essential part of heart transplantation. Despite the shortage of donor hearts, donor heart procurement from brain-dead organ donors remains low in France, which may be explained by the increasing proportion of high-risk donors, as well as the mismatch between donor assessment and the transplant team's expectations. Improving donor and donor heart assessment is essential to improve the low utilization rate of available donor hearts without increasing post-transplant recipient mortality. This document provides information to practitioners involved in brain-dead donor management, evaluation and selection, concerning the place of medical history, electrocardiography, cardiac imaging, biomarkers and haemodynamic and arrhythmia assessment in the characterization of potential heart donors.
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http://dx.doi.org/10.1016/j.acvd.2017.12.001DOI Listing
February 2018

Predictive value of CMR criteria for LV functional improvement in patients with acute myocarditis.

Eur Heart J Cardiovasc Imaging 2014 Oct 12;15(10):1140-4. Epub 2014 Jun 12.

Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada Department of Cardiology, Philippa and Marvin Carsley Cardiovascular MR Centre at the Montreal Heart Institute, Université de Montréal, 5000 Bélanger Street, Montréal, Quebec, Canada H1T 1C8

Aim: We assessed the value of cardiovascular magnetic resonance (CMR) criteria ('Lake Louise Criteria') for predicting left ventricular (LV) functional improvement in patients with acute myocarditis.

Methods And Results: We studied 37 patients who referred for acute myocarditis during clinically acute myocarditis and after a 12-month follow-up. CMR sequences sensitive for oedema, hyperaemia, and irreversible injury were applied. Global and regional oedema were defined using published quantitative signal intensity (SI) cut-off values (area with an SI of >2 SD above visually normal myocardium). LV function was analysed using six long-axis views, with an increase of at least 5% of left ventricular ejection fraction considered as improvement. Out of a total of 37 patients, 29 met the CMR Lake Louise criteria (LL+) and eight did not (LL-). Baseline and 12-month ejection fraction (EF) were significantly lower in LL+ (53.2 ± 8 vs. 62.2 ± 5, P = 0.007 and 58.9 ± 4 vs. 62.9 ± 5, P = 0.045, respectively). At follow-up, EF increased in LL+ but remained unchanged within normal limits in LL- groups (delta EF: 5.7 ± 9.8 vs. 0.7 ± 2.0). The presence of global or regional myocardial oedema was strongly associated with an increase of EF ≥5%. In a multivariate analysis, the presence of global and/or regional oedema on admission was the only independent predictor of an increase of EF (P = 0.046).

Conclusion: In patients with clinically suspected acute myocarditis, the presence of positive CMR criteria is associated with LV function recovery. Myocardial oedema as defined by CMR was the strongest parameter, indicating that the observed increase of EF may be due to the recovery of reversibly injured (oedematous) myocardium.
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http://dx.doi.org/10.1093/ehjci/jeu099DOI Listing
October 2014

The RIPOST-MI study, assessing remote ischemic perconditioning alone or in combination with local ischemic postconditioning in ST-segment elevation myocardial infarction.

Basic Res Cardiol 2014 Mar 10;109(2):400. Epub 2014 Jan 10.

Service de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers, rue Haute de Reculée, 49045, Angers, France,

Local ischemic postconditioning (IPost) and remote ischemic perconditioning (RIPer) are promising cardioprotective therapies in ST-elevation myocardial infarction (STEMI). We aimed: (1) to investigate whether RIPer initiated at the catheterization laboratory would reduce infarct size, as measured using serum creatine kinase-MB isoenzyme (CK-MB) release as a surrogate marker; (2) to assess if the combination of RIPer and IPost would provide an additional reduction. Patients (n = 151) were randomly allocated to one of the following groups: (1) control group, percutaneous transluminal coronary angioplasty (PTCA) alone; (2) RIPer group, PTCA combined with RIPer, consisting of three cycles of 5-min inflation and 5-min deflation of an upper-arm blood-pressure cuff initiated before reperfusion; (3) RIPer+IPost group, PTCA combined with RIPer and IPost, consisting of four cycles of 1-min inflation and 1-min deflation of the angioplasty balloon. The CK-MB area under the curve (AUC) over 72 h was reduced in RIPer, and RIPer+IPost groups, by 31 and 29 %, respectively, compared to the Control group; however, CK-MB AUC differences between the three groups were not statistically significant (p = 0.06). Peak CK-MB, CK-MB AUC to area at risk (AAR) ratio, and peak CK-MB level to AAR ratio were all significantly reduced in the RIPer and RIPer+IPost groups, compared to the Control group. On the contrary, none of these parameters was significantly different between RIPer+IPost and RIPer groups. To conclude, starting RIPer therapy immediately prior to revascularization was shown to reduce infarct size in STEMI patients, yet combining this therapy with an IPost strategy did not lead to further decrease in infarct size.
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http://dx.doi.org/10.1007/s00395-013-0400-yDOI Listing
March 2014

Accuracy of a new method for semi-quantitative assessment of right ventricular ejection fraction by cardiovascular magnetic resonance: right ventricular fractional diameter changes.

Eur J Radiol 2014 Jan 17;83(1):130-4. Epub 2013 Oct 17.

Department of Radiology, University François Rabelais, Tours, France.

Objective: Longitudinal shortening is traditionally considered the predominant part of global right ventricular (RV) systolic function. Less attention has been paid to transverse contraction. The aim of this study was to evaluate RV transverse motion by cardiovascular magnetic resonance (CMR) in a large cohort of patients and to assess its relationship with RV ejection fraction (RVEF).

Study Design: We retrospectively analyzed the CMR scans of 300 patients referred to our center in 2010. RVEF was determined from short axis sequences using the volumetric method. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and mid-level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) as a longitudinal reference.

Results: Our population was divided into 2 groups according to RVEF. 250 patients had a preserved RVEF (>40%) and 50 had a RV dysfunction (RVEF ≤ 40%). Transverse and longitudinal motions were significantly reduced in the group with RV dysfunction (p<.0001). After ROC analysis, areas under the curve for FBDC, FMDC and TAPSE, were respectively 0.79, 0.82 and 0.72, with the highest specificity and sensitivity respectively of 88% and 68% for FMDC (threshold at 20%) for predicting RV dysfunction. FMDC had an excellent negative predictive value of 93%.

Conclusion: RV fractional diameter changes, especially at the mid-level, appear to be accurate for semi-quantitative assessment of RV function by CMR. A cut-off of 20% for FMDC differentiates patients with a low (EF≤40%) or a preserved RVEF.
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http://dx.doi.org/10.1016/j.ejrad.2013.10.004DOI Listing
January 2014

Assessment of acute myocarditis by cardiovascular MR: diagnostic performance of shortened protocols.

Int J Cardiovasc Imaging 2013 Jun 13;29(5):1077-83. Epub 2013 Feb 13.

Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, Foothills Medical Centre, University of Calgary, Suite 0700 Special Services Building, 1403-29th St. NW, Calgary T2N 2T9, Canada.

The recommended cardiovascular magnetic resonance (CMR) diagnostic criteria for active myocarditis ("Lake Louise Criteria") are based on edema-sensitive (T2-weighted) imaging and two different contrast-enhanced techniques, the early gadolinium enhancement ratio (EGEr) and late gadolinium enhancement (LGE). Because fast spin echo sequences used for determining the EGEr and edema-sensitive T2-weighted sequences have inconsistent image quality, these components are often skipped in institutional standard protocols. We aimed to compare the diagnostic performance of the Lake Louise Criteria with and without T2-weighted or early gadolinium-enhanced CMR imaging in a clinical setting. We investigated 35 patients with suspected acute myocarditis (27 males; Age 39.8 ± 16.6) and 10 healthy controls (5 males; age 33.8 ± 10.4). CMR sequences investigated included an edema-sensitive short-T1 triple inversion recovery, T1-weighted turbo spin echo imaging before and within 4 min after gadolinium injection (EGEr), and a phase sensitive inversion-recovery gradient echo sequence 5-10 min after gadolinium injection (LGE). Quantitative and qualitative image analyses, respectively, were performed for EGEr and areas with increased signal in LGE and edema-sensitive images. EGEr, T2, and LGE burden were significantly higher in patients than in controls (EGEr: 5.8 ± 3.0 vs. 2.5 ± 1.7; p = 0.002, T2: 24 vs. 0; p < 0.001, LGE: 27 vs. 4; p < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were as follows: EGEr: 66, 90, 96, 43, and 72%; T2: 69, 100, 100, 53, and 76%; LGE: 77, 60, 87, 43 and 73%; T2 and/or LGE: 91, 60, 89, 67, 84% Lake Louise Criteria, "two out of three": 80, 90, 96, 53, and 82%. The sensitivity of "T2 and/or LGE" was significantly higher than the Lake Louise Criteria (p < 0.05), while the overall diagnostic accuracy was not statistically different. The overall diagnostic accuracy "T2 and/or LGE" was significantly better than that of LGE alone. The positive likelihood ratio was higher for the Lake Louise Criteria (7.7) than for EGE alone (6.3), T2 and/or LGE (2.3) or LGE alone (1.9). In patients with clinical evidence for relevant active myocarditis, skipping T2-weighted imaging or early GD enhancement is associated with a significantly lower positive likelihood ratio, while the removal of Early Gd Enhancement imaging does not change diagnostic overall accuracy, while reducing sensitivity. Thus, in patients where a high positive likelihood ratio is needed, the full Lake Louise Criteria including Early Gd enhancement and edema-sensitive T2-weighted imaging should be used until alternative approaches are developed.
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http://dx.doi.org/10.1007/s10554-013-0189-7DOI Listing
June 2013

Auto-threshold quantification of late gadolinium enhancement in patients with acute heart disease.

J Magn Reson Imaging 2013 Feb 25;37(2):382-90. Epub 2012 Sep 25.

Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.

Purpose: To assess the Otsu-Auto-Threshold (OAT) for accuracy and reproducibility for sizing irreversible injury in late gadolinium enhancement (LGE) images of patients with acute heart disease. The OAT method automatically identifies high signal intensity areas using a cutoff derived from the signal intensity histogram and therefore is user-independent.

Materials And Methods: LGE was performed in 28 patients with acute myocardial infarction (MI) and 30 patients with acute myocarditis. LGE mass was compared between OAT and thresholds using 2 standard deviations (SD), 3SD, and 5SD above remote myocardium, and full-width-at-half-maximum (FWHM). A separate, blinded visual assessment served as the standard of truth.

Results: In patients with acute MI, OAT and 5SD did not differ (26.1 ± 11.4 g vs. 25.4 ± 11.1 g, P = 0.088), but thresholds of 2SD and 3SD overestimated LGE mass by 37% and 20%, respectively, and FWHM underestimated by 15%. In acute myocarditis, OAT was not different from a visual quantification, but thresholds of 2SD and 3SD overestimated LGE mass by 46% and 19%, respectively, and thresholds of 5SD and FWHM underestimated LGE mass by 17% and 26%, respectively. OAT and FWHM showed the best intraobserver and interobserver reproducibility.

Conclusion: Automatic thresholding using OAT may serve as an accurate and reproducible method to quantify irreversible myocardial injury in acute heart disease.
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http://dx.doi.org/10.1002/jmri.23814DOI Listing
February 2013

Patterns of myocardial late enhancement: typical and atypical features.

Arch Cardiovasc Dis 2012 May 14;105(5):300-8. Epub 2012 Mar 14.

Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada.

Myocardial late enhancement, an imaging technique acquired after gadolinium administration, has become an integral part of cardiovascular magnetic resonance imaging over the past decade. Initially principally utilized for imaging myocardial infarction, more recently it has also become an invaluable tool for identifying myocardial scarring in other cardiomyopathic processes. Our experience using this technique has led us to identify several manifestations of late gadolinium enhancement imaging that can confound interpretation of pathology and potentially lead to misinterpretation and subsequently misdiagnosis for the patient. The purpose of this article is to review and illustrate typical and atypical myocardial late enhancement in the most common myocardial diseases seen in routine clinical practice.
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http://dx.doi.org/10.1016/j.acvd.2011.12.006DOI Listing
May 2012

Importance of monocyte deactivation in determining early outcome after ventricular assist device implantation.

Int J Artif Organs 2012 Mar;35(3):169-76

Department of Cardiothoracic Surgery, AP-HP, Henri Mondor Hospital, Créteil, France.

Background: Patients undergoing mechanical circulatory support using ventricular assist devices (VADs) experience a postoperative mixed antagonistic (proinflammatory and antiinflammatory) response syndrome. This response can result in immunoparalysis, exposing VAD recipients to infection and interfering with patient recovery despite adequate hemodynamic support. We undertook the present study to evaluate whether postoperative monocytic human leukocyte antigen-DR (mHLA-DR) expression is of prognostic value for mortality or infection of VAD recipients during their initial intensive care unit (ICU) stay after implantation.

Methods: Since 2004, we have monitored postoperative mHLA-DR expression in 50 VAD recipients using flow cytometry.

Results: Thirty-seven patients (74%) developed infection, and 22 patients (44%) died during their initial ICU stay. mHLA-DR expression was lowest in the immediate postoperative period (postoperative days [PODs] 1-3) but increased progressively thereafter. Multiple regression analysis showed that preoperative aspartate aminotransferase level was the only significant and independent predictor of the percentage of HLA-DR-positive monocytes on PODs 1-3 (β = -0.726, p = 0.0001). ICU death and infection were associated with significantly lower percentages of HLA-DR-positive monocytes on PODs 1-3. ROC curve analysis revealed that the percentage of HLA-DR-positive monocytes on PODs 1-3 had significant discriminative power for ICU death (area under the curve = 0.73, 95% confidence interval, 0.545-0.912, p = 0.037), but not for infection.

Conclusions: Postoperative mHLA-DR expression was closely related to preoperative hepatic cytolysis. It appeared to be the only early postoperative biological parameter that had some predictive power for death of VAD recipients in the ICU.
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http://dx.doi.org/10.5301/ijao.5000053DOI Listing
March 2012

Impact of the revision of arrhythmogenic right ventricular cardiomyopathy/dysplasia task force criteria on its prevalence by CMR criteria.

JACC Cardiovasc Imaging 2011 Mar;4(3):282-7

Stephenson Cardiovascular MR Centre at Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.

Objectives: The purpose of our study was to assess the impact of revised versus original criteria on the prevalence of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) criteria in cardiac magnetic resonance (CMR) studies.

Background: Recently, the ARVC/D task force criteria have been revised, aiming for a better diagnostic sensitivity. The implications of this revision on clinical decision making are unknown.

Methods: We retrospectively evaluated the CMR scans of 294 patients referred for ARVC/D between 2005 and 2010, and determined the presence or absence of major and minor CMR criteria using the original and the revised task force criteria. Previously, major and minor abnormalities were identified by the presence of right ventricle dilation (global or segmental), right ventricle microaneurysm, or regional hypokinesis. The revised criteria require the combination of severe regional wall motion abnormalities (akinesis or dyskinesis or dyssynchrony) with global right ventricle dilation or dysfunction (quantitative assessment).

Results: Applying the original criteria, 69 patients (23.5%) had major original criteria, versus 19 patients (6.5%) with the revised criteria. Forty-three patients (62.3%) with major original criteria did not meet any of the revised criteria. Using the original criteria, 172 patients (58.5%) had at least 1 minor criterion versus 12 patients (4%) with the revised task force criteria; 167 patients (97%) with minor original criteria did not meet any of the revised criteria. In the subgroup of 134 patients with complete diagnostic work-up of ARVC, 10 patients met the diagnosis of proven ARVC/D without counting imaging criteria. Only 4 of 10 met major criteria according to the revised CMR criteria; none met minor criteria. However, 112 of 124 patients without ARVC/D were correctly classified as negative by major and minor criteria (specificity 94% and 96%, respectively).

Conclusions: In our experience, the revision of the ARVC/D task force imaging criteria significantly reduced the overall prevalence of major and minor criteria. The revision, although maintaining a high specificity, may not have improved the sensitivity for identifying patients with ARVC/D. Larger studies including follow-up are required.
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http://dx.doi.org/10.1016/j.jcmg.2011.01.005DOI Listing
March 2011

Left ventricle remodelling is associated with sleep-disordered breathing in non-ischaemic cardiopathy with systolic dysfunction.

J Sleep Res 2011 Mar;20(1 Pt 1):101-9

Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier, Créteil, France.

Sleep-disordered breathing (SDB) is associated with left ventricle (LV) remodelling in patients with normal LV function. Sleep-disordered breathing is common in chronic heart failure (CHF) with systolic LV dysfunction, and may contribute to LV remodelling and CHF progression. Our aim was to determine the consequence of SDB on LV geometry in patients with CHF. We hypothesised that SDB severity was correlated with the degree of LV hypertrophy (LVH). One-hundred and sixty patients with CHF with a non-ischaemic systolic LV dysfunction were assessed by overnight polygraphy and echocardiography. Patients were classified in four groups according to their apnoea-hypopnoea index (AHI): <5 (no-SDB); 5-14 (mild); 15-29 (moderate); ≥30 (severe). Left ventricular mass index (LVM Ind) was calculated using the usual echocardiographic M-Mode parameters. Their mean age, New York Heart Association and left ventricular ejection fraction were, respectively: 56 ± 13 years, 2.4 ± 0.8 and 30 ± 10%, and 77% were men. Body mass index, interventricular septal and posterior LV wall thicknesses, and LVM Ind were significantly increased in severe SDB versus no-SDB. LVM Ind was correlated to the AHI (R = 0.27, P = 0.0006) and, using logistic regression, AHI was the unique independent factor of LVH in this population. In non-ischaemic CHF, SDB severity is associated with LV remodelling.
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http://dx.doi.org/10.1111/j.1365-2869.2009.00817.xDOI Listing
March 2011

Resolution of sleep-disordered breathing with a biventricular assist device and recurrence after heart transplantation.

J Clin Sleep Med 2009 Jun;5(3):248-50

AP-HP Groupe Henri Mondor Albert Chenevier, Service de Chirurgie Cardiaque, Créteil, France.

Sleep-disordered breathing (SDB) is common in chronic heart failure. Both obstructive sleep apnea syndrome (OSAS) and central sleep apnea with periodic Cheyne-Stokes respiration (CSA-CSR) can occur. CSA-CSR is believed to correlate with heart function. Little information exists about the impact of mechanical assist devices and heart transplantation on SDB in patients with end-stage heart failure. Here, we describe, for the first time, the effects on SDB of a biventricular external assist device and of heart transplantation used successively in the same patient.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699171PMC
June 2009

Heart rate increment analysis is not effective for sleep-disordered breathing screening in patients with chronic heart failure.

J Sleep Res 2010 Mar 31;19(1 Pt 2):131-8. Epub 2009 Aug 31.

Fédération de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier, Hôpital Henri Mondor, 51 Avenue Maréchal de Lattre de Tassigny, Créteil, France.

Frequency domain analysis of heart rate variation has been suggested as an effective screening tool for sleep-disordered breathing (SDB) in the general population. The aim of this study was to assess this method in patients with chronic congestive heart failure (CHF). We included prospectively 84 patients with stable CHF, left ventricular ejection fraction (LVEF) <45% and sinus rhythm. The patients underwent polygraphy to measure the apnoea/hypopnoea index (AHI) and simultaneous Holter electrocardiogram monitoring to measure the power spectral density of the very low frequency component of the heart rate increment, expressed as the percentage of total power spectral density [% very low frequency increment (%VLFI)]. %VLFI could be determined in 54 patients (mean age, 52.8 +/- 12.3 years; LVEF, 33.5 +/- 9.8%). SDB defined as AHI > or =15 h(-1) was diagnosed in 57.4% of patients. Percent VLFI was not correlated with AHI (r = 0.12). Receiver-operating characteristic curves constructed using various AHI cut-offs (5-30 h(-1)) failed to identify a %VLFI cut-off associated with SDB. The 2.4% VLFI cut-off recommended for the general population of patients with suspected SDB had low specificity (35%) and low positive and negative predictive values (35% and 54%, respectively). Heart rate increment analysis has several limitations in CHF patients and cannot be recommended as an SDB screening tool in the CHF population.
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http://dx.doi.org/10.1111/j.1365-2869.2009.00779.xDOI Listing
March 2010

Temporary right ventricular support with Impella Recover RD axial flow pump.

Asian Cardiovasc Thorac Ann 2009 Aug;17(4):395-400

Department of Cardiothoracic Surgery, Henri Mondor Hospital, Créteil, France.

Post-cardiotomy right ventricular failure is a serious complication that frequently results in adverse outcomes. We reviewed our experience with the Impella Recover RD (Impella Cardiosystems GMbH, Aachen, Germany). From January 2007 to December 2007, 7 patients (5 males, 54 +7 years old) had this device implanted for temporary support after heart transplantation in 4, after repeat mitral valve replacement in 2, and with a left ventricular assist device in 1. Devices were implanted during initial operation (n =5) or shortly thereafter (n =2). Six patients underwent implantation without cardiopulmonary bypass. Effective support with pump flows of 4.0-4.5 L x min(-1) and adequate unloading (central venous pressure decreased from 15.3 +/- 1.4 to 9.4 +/- 1.2 mm Hg) was achieved in all patients. Patients were assisted for a mean duration of 4.9 +/- 4.5 days. Three patients could be weaned after 7.0 +/- 5.6 days of support and underwent device explantation without cardiopulmonary bypass. One of these patients died of recurrent right ventricular failure, 2 remained stable but died later of sepsis. The patient with a left ventricular assist device was switched to an alternative device for prolonged support. Two patients experienced pump dysfunction. Our preliminary experience shows that the Impella Recover RD is an effective device that can be easily implanted and explanted. However, its mechanical reliability needs to be improved.
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http://dx.doi.org/10.1177/0218492309338121DOI Listing
August 2009

Comparison of four right ventricular systolic echocardiographic parameters to predict adverse outcomes in chronic heart failure.

Eur J Heart Fail 2009 Sep;11(9):818-24

Fédération de cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier, 51 Avenue Maréchal de Lattre de Tassigny, 94010 Créteil, France.

Aims: Heart failure (HF) has a poor prognosis. Several right ventricular (RV) echocardiographic parameters have been proposed as sensitive markers to detect patients at risk. Our objective was to compare the predictive value of four RV systolic echocardiographic parameters for outcomes in patients with HF.

Methods And Results: One hundred and thirty-six patients with stable HF and a left ventricular ejection fraction <35% were assessed for the following: (i) RV fractional area (RVFA), (ii) tricuspid annular plane systolic excursion (TAPSE), (iii) integral of the systolic wave (ISW(tdi)), and (iv) peak systolic velocity (PSV(tdi)). ISW(tdi) and PSV(tdi) were measured using tissue Doppler imaging at the tricuspid annulus. The primary endpoint was death, urgent transplantation, urgent ventricular assist device implantation, or an acute HF episode. During a mean follow-up of 295 days, 33 patients reached the primary endpoint. The cut-off thresholds for RVFA, TAPSE, PSV(tdi), and ISW(tdi) defined using receiver-operating characteristic curves were 36.8%, 13.5 mm, 9.5 cm s(-1), and 1.75 cm, respectively. On Cox multivariate analysis, NYHA, log BNP, and only PSV(tdi) from the RV systolic parameters were found to be independent predictors of outcome.

Conclusion: PSV(tdi) is a strong independent predictor of outcome in HF at a threshold value of 9.5 cm s(-1) and appears to be superior to other RV systolic echocardiographic parameters.
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http://dx.doi.org/10.1093/eurjhf/hfp111DOI Listing
September 2009

Single-centre experience with the Thoratec paracorporeal ventricular assist device for patients with primary cardiac failure.

Arch Cardiovasc Dis 2009 Jun-Jul;102(6-7):509-18. Epub 2009 May 23.

Service de chirurgie thoracique et cardiovasculaire, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil cedex, France.

Background: Temporary mechanical circulatory support may be indicated in some patients with cardiac failure refractory to conventional therapy, as a bridge to myocardial recovery or transplantation.

Aims: To evaluate outcomes in cardiogenic shock patients managed by the primary use of a paracorporeal ventricular assist device (p-VAD).

Methods: We did a retrospective analysis of demographics, clinical characteristics and survival of patients assisted with a Thoratec p-VAD.

Results: p-VADs were used in 84 patients with cardiogenic shock secondary to acute myocardial infarction (35%), idiopathic (31%) or ischaemic (12%) cardiomyopathy, myocarditis or other causes (23%). Before implantation, 23% had cardiac arrest, 38% were on a ventilator and 31% were on an intra-aortic balloon pump. Cardiac index was 1.6+/-0.5 L/min/m(2) and total bilirubin levels were 39+/-59 micromol/L. During support, 29 patients (35%) died in the intensive care unit and seven (10%) died after leaving. Forty-seven patients (56%) were weaned or transplanted, with one still under support. Despite significantly more advanced preoperative end-organ dysfunction, survival rates were similar in patients with biventricular devices (74%) and those undergoing isolated left ventricular support (24%) (63% versus 45%, respectively; p=0.2). Actuarial survival estimates after transplantation were 78.7+/-6.3%, 73.4+/-6.9% and 62.6+/-8.3% at 1, 3 and 5 years, respectively.

Conclusions: Our experience validates the use of p-VAD as a primary device to support patients with cardiogenic shock. In contrast to short-term devices, p-VADs provide immediate ventricular unloading and pulsatile perfusion in a single procedure. Biventricular support should be used liberally in patients with end-organ dysfunction.
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http://dx.doi.org/10.1016/j.acvd.2009.03.010DOI Listing
December 2009

Long-term results of combined heart and kidney transplantation: a French multicenter study.

J Heart Lung Transplant 2009 May 14;28(5):440-5. Epub 2009 Mar 14.

Department of Cardiac Surgery, Henri-Mondor University Hospital, Créteil, France.

Background: Outcomes in recipients who have undergone combined heart and kidney transplantation have mainly been addressed in small, single-center studies. We studied long-term results of combined heart and kidney transplantation in a large multicenter cohort.

Methods: Between 1984 and 2007, 67 consecutive patients (61 men and 6 women) from 3 French centers underwent combined heart and kidney transplantation. At transplantation, 38 (57%) were receiving dialysis. All patients received immediate triple immunosuppression therapy (anti-calcineurin, steroids, azathioprine, or mycophenolate).

Results: Overall actuarial survival rates were 62.0%, 60.3%, 53.3%, and 46.5% at 1, 3, 5, and 10 years, respectively. These rates were similar to those observed in 2981 isolated heart recipients at the 3 participating centers during the same period (respectively, 71.0%, 65.2%, 60.1%, and 47.2%, p = 0.6). Survival tended to improve during the last decade (1996 to 2007) and reached 71.1%, 67.5%, and 60% at 1, 3, and 5 years. Cardiac allograft rejection requiring treatment occurred in 12 (17.9%). Coronary artery vasculopathy developed in 3 (9.3%). Kidney allograft rejection occurred in 9 (13.4%). Kidney graft survival was 95.9% at 1, 3, 5, and 10 years.

Conclusions: Long-term survival rates in a large cohort of combined heart and kidney recipients are similar to those of isolated heart recipients in France. The rates of acute heart and kidney rejection and angiographic coronary artery vasculopathy were low in this patient population.
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http://dx.doi.org/10.1016/j.healun.2009.01.020DOI Listing
May 2009

Prevalence of sleep-disordered breathing in a 316-patient French cohort of stable congestive heart failure.

Arch Cardiovasc Dis 2009 Mar 9;102(3):169-75. Epub 2009 Mar 9.

Fédération de cardiologie, hôpital Henri-Mondor, groupe hospitalier Henri-Mondor Albert-Chenevier, AP-HP, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.

Background: Heart failure with systolic dysfunction occurs frequently. Studies in North America and Germany have shown a high prevalence of sleep-disordered breathing in patients with heart failure.

Aims: To assess the prevalence of sleep-disordered breathing and its associated risk factors in French patients with heart failure.

Methods: A total of 316patients with stable heart failure and a left ventricular ejection fraction less or equal to 45% underwent polygraphy prospectively to diagnose sleep apnoea syndrome, defined as an apnoea-hypopnoea index greater or equal to 10events/h.

Results: Mean age, left ventricular ejection fraction, and body mass index were 59+/-13years, 30+/-11% and 28+/-6kg/m(2), respectively. The prevalence of sleep breathing disorder was 81% (n=256); 30% of syndromes were classified as central and 70% as obstructive. The mean apnoea-hypopnoea index was high (30+/-3events/h) and a large proportion (41%) of syndromes had an apnoea-hypopnoea index greater or equal to 30events/h. A central sleep apnoea syndrome pattern was associated with more severe heart failure and a more elevated apnoea-hypopnoea index than an obstructive pattern. The prevalence of sleep-disordered breathing was lower in women than in men (64% versus 85%; chi(2)=0.0003) as was its severity (mean apnoea-hypopnoea index 15+/-13events/h versus 27+/-19events/h, p=0.0001).

Conclusion: The prevalence of sleep-disordered breathing was high in a French heart failure population, with most syndromes having an obstructive pattern. Prevalence and severity were higher in men than in women.
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http://dx.doi.org/10.1016/j.acvd.2008.12.006DOI Listing
March 2009

Off-pump replacement of the INCOR implantable axial-flow pump.

J Heart Lung Transplant 2009 Feb;28(2):199-201

Service de Chirurgie Thoracique et Cardiovasculaire, AP-HP, Hôpital Henri Mondor, Créteil, France.

Owing to the actual increase of mechanical circulatory support durations, total or partial replacement of ventricular assist devices (VADs) will most certainly have to be performed with increasing frequency. Herein we report the case of a patient in whom an INCOR (Berlin Heart AG, Berlin) implantable axial-flow pump was replaced without the use of cardiopulmonary bypass (CPB), underscoring some of the unique features provided by this system.
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http://dx.doi.org/10.1016/j.healun.2008.11.904DOI Listing
February 2009

Heart transplantation in systemic (AL) amyloidosis: a retrospective study of eight French patients.

Arch Cardiovasc Dis 2008 Sep 17;101(9):523-32. Epub 2008 Nov 17.

Department of Cardiology, CHU of Poitiers, University of Poitiers, Poitiers, France.

Background: Immunoglobulinic (AL) amyloidosis is a complication of plasma cell dyscrasia, characterized by widespread deposition of amyloid fibrils derived from monoclonal light chains. Cardiac amyloid is the main prognostic factor, with a median survival of six months. Cardiac transplantation in AL amyloidosis is associated with high mortality, due to disease recurrence in the allograft and systemic progression. Suppression of light chain (LC) production with chemotherapy by melphalan plus dexamethasone (MD) or high dose melphalan followed by autologous stem cell transplantation (HDM/ASCT) improves survival. However, both the indications and results of chemotherapy in patients transplanted for cardiac AL amyloidosis remain unclear.

Aims: To assess the outcome of cardiac transplantation and haematological therapy in patients with cardiac AL amyloidosis.

Methods: Eight French patients, who underwent heart transplantation for cardiac AL amyloidosis between 2001 and 2006 were studied retrospectively.

Results: Before transplantation, six patients received MD (n=5) or HDM/ASCT (n=1). Haematological remission was obtained in three patients treated with MD. In the three remaining patients, postoperative HDM/ASCT (n=2) or allogeneic bone marrow transplantation (n=1) resulted in haematological remission in one patient. In 2 patients not treated before transplantation, post-operative treatment with MD resulted in complete hematological remission in one. After a median follow-up of 26 months from cardiac transplantation, six patients were alive and four had sustained haematological remission, as indicated by normal serum free LC levels.

Conclusion: Appropriate haematological therapy, including MD, may result in a survival benefit in AL amyloidosis patients with advanced heart failure requiring transplantation.
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http://dx.doi.org/10.1016/j.acvd.2008.06.018DOI Listing
September 2008
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