Publications by authors named "Meyer Elbaz"

124 Publications

Left Atrial Appendage Closure in Patients With Atrial Fibrillation and Coexisting Cerebral Amyloid Angiopathy.

Stroke 2021 Dec 9;52(12):e792-e793. Epub 2021 Nov 9.

Department of Neurology, Hôpital Pierre-Paul Riquet (C.B., LC., A.V., J-.F.A., C.G., V.F., M.B.-G., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.

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http://dx.doi.org/10.1161/STROKEAHA.121.037248DOI Listing
December 2021

Prevalence of Posttranscatheter Aortic Valve Implantation Vascular Complications in Real Life.

J Interv Cardiol 2021 12;2021:5563486. Epub 2021 Oct 12.

Department of Cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France.

Background: Vascular complications (VCs) are commonly observed after transfemoral transcatheter aortic valve implantation (TAVI) procedures. Closure devices for the access site were developed to reduce their incidence. We aim to evaluate the prevalence, predictors, and outcomes of the occurrence of post-TAVI VCs.

Materials And Methods: A retrospective study was conducted on 1336 consecutive patients who underwent TAVI at the University Hospital of Toulouse, France, between January 2016 and March 2020. All included procedures were performed through the common femoral artery, and ProGlide was the used closure device. The studied population was divided into two groups depending on the occurrence of VCs defined according to Valve Academic Research Consortium-2 criteria.

Results: The mean age of the studied population was 84.4 ± 6.9, and 48% were male. 90% of TAVI interventions were performed through the right femoral artery. The prevalence of VCs was 18.8%, and 3.7% were major. Prolonged procedure duration was an independent predictor of VCs. Using the right access site and smaller introducer size (14 Fr) were preventive factors. No significant difference in mortality rate was detected between the two groups.

Conclusion: This study showed a low prevalence for post-TAVI VCs, especially for the major type. An increase in bleeding events and prolonged cardiac care unit stay were the common adverse outcomes.
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http://dx.doi.org/10.1155/2021/5563486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8526196PMC
November 2021

Letter by Matta et al Regarding Article, "Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women".

Circulation 2021 Sep 20;144(12):e204. Epub 2021 Sep 20.

Department of Cardiology, CARDIOMET Institute, University Hospital of Toulouse, France (A.M., M.E., J.R.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.053041DOI Listing
September 2021

Prevalence and Prognosis Impact of Frailty Among Older Adults in Cardiac Intensive Care Units.

CJC Open 2021 Aug 26;3(8):1010-1018. Epub 2021 Mar 26.

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

Background: Whether frailty, defined as a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors, may impact the outcomes of elderly patients admitted to a cardiac intensive care unit (CICU) remains unclear. We aimed to determine the prevalence of frailty and its impact on mortality in patients aged ≥ 80 years admitted to a CICU.

Methods: This prospective single-centre observational study was conducted among patients aged ≥ 80 years admitted to a CICU in a tertiary centre. Frailty was assessed using the Edmonton Frail Scale (EFS), which provides a score ranging from 0 (not frail) to 17 (very frail). The population was divided into 3 classes: EFS-score of 0-3, EFS-score of 4-6, and EFS-score > 7.

Results: A total of 199 patients were included, and median follow-up duration was 365 days. The mean age was 84.8 years, and 50 patients (25.1%) died during the follow-up period. In all, 45 (22.6%), 60 (30.2%), and 94 patients (47.2%) had an EFS-score of 0-3, 4-6, and ≥ 7, respectively. The all-cause mortality rate was 4.4%, 27.1%, and 37.2% in the 0-3, 4-6, and ≥ 7 EFS-score groups, respectively ( < 0.001). After multivariate analysis, frailty status remained associated with all-cause mortality: hazard ratio was 2.60 (95% confidence interval 0.54-12.45) within the 4-6 EFS-score group, and 5.46 (95% confidence interval 1.23-24.08) within the ≥ 7 EFS-score group.

Conclusions: Frailty is highly prevalent in older adults admitted to the population hospitalized in a CICU and represents a strong prognostic factor for 1-year all-cause mortality.
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http://dx.doi.org/10.1016/j.cjco.2021.03.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413242PMC
August 2021

Left anterior descending myocardial bridge: Angiographic prevalence and its association to atherosclerosis.

Indian Heart J 2021 Jul-Aug;73(4):429-433. Epub 2021 Jan 19.

Department of Cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France. Electronic address:

Objective: Left anterior descending Myocardial Bridge (LADMB) is considered a benign condition and actually becomes a forgotten cause of serious cardiac events. This study was conducted to estimate the prevalence of LADMB and its association to atherosclerosis.

Methods: An observational retrospective study was conducted on patients referred for coronary angiography between June 2012 and June 2020. Coronary angiography database was revisedand studied population was divided into 2 groups: LADMB group versus Non-LADMB group.

Results: LADMB was detected in 510 patients out of 35813 included in the study resulting in a prevalence at 1.42%. The mean age was 66.5 years. Male gender was more common than female (70vs30%). The prevalence of significant atherosclerotic LAD disease was more than two times higher in the non-LADMB group compared to the LADMB group. Statistical analysis revealed a significant negative association between LADMB and atherosclerosis (p < 0.001). A significant greater rate of MINOCA cases was observed in acute coronary syndrome LADMB patients.

Conclusions: LADMB is an inborn anatomic variation associated to atherosclerotic risk reduction in LAD. Physicians must be aware about the potential complications and pay attention to those classified at high risk for cardiovascular events.
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http://dx.doi.org/10.1016/j.ihj.2021.01.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424261PMC
November 2021

Left main coronary artery thrombus after cannabis consumption: a case report.

Eur Heart J Case Rep 2021 Jun 14;5(6):ytab179. Epub 2021 Jun 14.

Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, 1 Avenue Jean Poulhès, 31059 Toulouse, France.

Background: Left main coronary thrombus is a rare angiographic finding associated with serious outcomes such as sudden death and cardiogenic shock. Rupture of an underlying atherosclerotic plaque is the main risk factor. The role of cannabis consumption in the pathophysiology of acute cardiovascular disease is controversial.

Case Presentation: We present a case of non-ST-elevation myocardial infarction characterized by a mobile left main coronary thrombus in a young male cannabis consumer successfully treated with manual aspiration, dual anti-platelet, and unfractionated heparin therapy.

Conclusion: Cannabis consumption could be a risk factor for coronary artery thrombosis. The pathophysiology mechanism of action is not well understood. Reaching an optimal management is a potential challenge for physicians.
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http://dx.doi.org/10.1093/ehjcr/ytab179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244647PMC
June 2021

Impact of Coronary Artery Disease and Percutaneous Coronary Intervention on Transcatheter Aortic Valve Implantation.

J Interv Cardiol 2021 24;2021:6672400. Epub 2021 Mar 24.

Department of Cardiology, Rangueil University Hospital, Toulouse, France.

Introduction: The prevalence of coronary artery disease (CAD) detected in preoperative work-up for transcatheter aortic valve implantation (TAVI) is high. Instead, the management of a concomitant CAD remains unclear. We evaluate the impact of CAD and percutaneous coronary intervention (PCI) on TAVI procedures.

Materials And Methods: A retrospective study was conducted on 1336 consecutive patients who underwent TAVI in Toulouse University Hospital, Rangueil, France. The studied population was divided into 2 groups: CAD-TAVI group and No CAD-TAVI group. Then, the CAD-TAVI group was segregated into 2 subgroups: PCI-TAVI group and No PCI-TAVI group. In-hospital adverse clinical outcomes were assessed in each group.

Results: Pre-TAVI work-up revealed significant CAD in 36% of 1030 patients eligible for inclusion in the study. The overall prevalence of in-hospital death, stroke, major or life-threatening bleeding, minor bleeding, major vascular complications, minor vascular complications, pacemaker implantation, and acute kidney injury was 2.7%, 2.4%, 2.8%, 3.6%, 3.9%, 7.5%, 12.5%, and 2.7%, respectively. Among the studied population, 55% were admitted to the cardiac care unit. No significant statistical difference was observed between groups. . CAD-TAVI population was not more likely to develop in-hospital adverse clinical outcomes post-TAVI procedure compared to others. Also, no significant difference regarding in-hospital death was observed. In parallel, performing PCI prior to TAVI did not increase the risk of in-hospital death and complications. The difference in terms of the distribution of antithrombotic regimen may explain the higher prevalence of bleeding events in the PCI-TAVI group.

Conclusion: This study provides direct clinical relevance useful in daily practice. No negative impact has been attributed to the presence of a concomitant CAD and/or preoperative PCI on the TAVI hospitalization period.
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http://dx.doi.org/10.1155/2021/6672400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016584PMC
June 2021

Colchicine for Left Ventricular Infarct Size Reduction in Acute Myocardial Infarction: A Phase II, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Study Protocol - The COVERT-MI Study.

Cardiology 2021 12;146(2):151-160. Epub 2021 Feb 12.

Centre d'Investigation Clinique, Inserm 1407, CarMeN Unit Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France,

Inflammatory processes have been identified as key mediators of ischemia-reperfusion injury in ST-segment elevation myocardial infarction (STEMI). They add damage to the myocardium and are associated with clinical adverse events (heart failure and cardiovascular death) and poor myocardial recovery. Colchicine is a well-known alkaloid with potent anti-inflammatory properties. In a proof-of-concept phase II trial, colchicine has been associated with a significant 50% reduction of infarct size (assessed by creatine kinase levels) in comparison to placebo in acute STEMI patients referred for primary percutaneous coronary intervention (PPCI). The Colchicine in STEMI Patients Study (COVERT-MI) is an ongoing confirmative prospective, multicenter, randomized, double-blind trial testing whether a short course oral treatment with colchicine versus placebo decreases myocardial injury in patients presenting with STEMI referred for PPCI. Adult patients, with a first STEMI episode and an initial TIMI flow ≤1, referred for PPCI, will be randomized (n = 194) in a 1:1 ratio to receive an oral bolus of colchicine of 2 mg followed by 0.5 mg b.i.d. treatment during 5 days or matching placebo. The primary endpoint will be the reduction in infarct size as assessed by cardiac magnetic resonance at 5 ± 2 days between both groups. The main secondary endpoints will be tested between groups in hierarchical order with left ventricular ejection fraction at 5 days, microvascular obstruction presence at 5 days, and absolute adverse left ventricular remodeling between 5 days and 3 months. This academic study is being financed by a grant from the French Ministry of Health (PHRCN-16-0357). Results from this study will contribute to a better understanding of the complex pathophysiology underlying myocardial injury after STEMI. The present study describes the rationale, design, and methods of the trial.
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http://dx.doi.org/10.1159/000512772DOI Listing
August 2021

Evaluation of Mitral and Aortic Valvular Disease and Left Ventricular Dysfunction in a Lebanese Population: Retrospective Single-Center Experience.

Med Sci Monit 2021 Feb 9;27:e928218. Epub 2021 Feb 9.

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

BACKGROUND Recently, new therapeutic approaches have revolutionized the management of left ventricular dysfunction (LVD) and valvular heart disease (VHD), which are a growing public health problem. In parallel, there are no available epidemiological data about LVD and VHD in developing countries, especially in the Mediterranean area. This retrospective study was conducted at a single center and aimed to evaluate the associations between mitral and aortic valvular disease and left ventricle systolic and diastolic dysfunction in the Lebanese population. MATERIAL AND METHODS A retrospective study was conducted of 4520 consecutive patients aged >18 years who were referred to the Cardiovascular Department of Notre Dame de Secours-University Hospital in Jbeil-Lebanon for transthoracic echocardiography between December 2016 and December 2019. The study population was divided into different groups based on types of LVD and VHD. Left ventricle systolic dysfunction was defined as a left ventricle ejection fraction (EF) ≤40%. Statistical analysis was carried out using SPSS software version 20. RESULTS VHD and systolic dysfunction were more common in men, whereas diastolic dysfunction was more common in women. Being older than age 65 years and smoking were significantly associated with heart failure with preserved EF, whereas female sex was a significant preventive factor against heart failure with reduced EF. Systemic hypertension was correlated with mitral stenosis and tricuspid regurgitation, whereas diabetes mellitus was associated with tricuspid regurgitation (TR). Smoking and older age also appeared to be associated with aortic stenosis. CONCLUSIONS Mitral valve disease (regurgitation and stenosis) was significantly correlated with systolic dysfunction, whereas aortic and mitral regurgitation were associated with diastolic dysfunction. Better monitoring of cardiovascular disease risk factors may lead to a reduced burden of LVD and VHD.
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http://dx.doi.org/10.12659/MSM.928218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883403PMC
February 2021

Early Evaluation of Patients on Axial Flow Pump Support for Refractory Cardiogenic Shock is Associated with Left Ventricular Recovery.

J Clin Med 2020 Dec 21;9(12). Epub 2020 Dec 21.

Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France.

We investigated prognostic factors associated with refractory left ventricle (LV) failure leading to LV assist device (LVAD), heart transplant or death in patients on an axial flow pump support for cardiogenic shock (CS). Sixty-two CS patients with an Impella CP or 5.0 implant were retrospectively enrolled, and clinical, biological, echocardiographic, coronarographic and management data were collected. They were compared according to the 30-day outcome. Patients were mainly male ( = 55, 89%), 58 ± 11 years old and most had no history of heart failure or coronary artery disease (70%). The main etiology of CS was acute coronary syndrome ( = 57, 92%). They presented with severe LV failure (LV ejection fraction (LVEF) 22 ± 9%), organ malperfusion (lactate 3.1 ± 2.1 mmol/L), and frequent use of inotropes, vasopressors, and mechanical ventilation (59, 66 and 30%, respectively). At 24 h, non-recovery was associated with higher total bilirubin (odds ratios (OR) 1.07 (1.00-1.14); = 0.039), lower LVEF (OR 0.89 (0.81-0.96); = 0.006) and the number of administrated amines (OR 4.31 (1.30-14.30); = 0.016). Early evaluation in patients with CS with an axial flow pump implant may enable the identification of factors associated with an unlikely recovery and would call for early screening for LVAD or heart transplant.
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http://dx.doi.org/10.3390/jcm9124130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767477PMC
December 2020

Remote Atrial Fibrillation Burden Estimation Using Deep Recurrent Neural Network.

IEEE Trans Biomed Eng 2021 08 16;68(8):2447-2455. Epub 2021 Jul 16.

Objective: The atrial fibrillation burden (AFB) is defined as the percentage of time spent in atrial fibrillation (AF) over a long enough monitoring period. Recent research has suggested the added prognostic value of using the AFB compared to a binary diagnosis. We evaluate, for the first time, the ability to estimate the AFB over long-term continuous recordings, using a deep recurrent neutral network (DRNN) approach.

Methods: The models were developed and evaluated on a large database of p = 2,891 patients, totaling t = 68,800 hours of continuous electrocardiography (ECG) recordings from the University of Virginia. Specifically, 24h beat-to-beat time series were obtained from a single portable ECG channel. The network, denoted ArNet, was benchmarked against a gradient boosting (XGB) model, trained on 21 features including the coefficient of sample entropy (CosEn) and AFEvidence that is derived from the number of irregular points revealed by the Lorenz plot. The generalizations of ArNet and XGB were also evaluated on the independent PhysioNet LTAF test database.

Results: the absolute AF burden estimation error [Formula: see text], median and interquartile, on the test set, was 1.2 (0.1-6.7) for ArNet and 2.8 (0.9-11.7) for XGB for AF individuals. Generalization results on LTAF were consistent with [Formula: see text] of 2.7 (1.1-14.7) for ArNet and 3.6 (1.0-16.7) for XGB.

Conclusion: This research demonstrates the feasibility of AFB estimation from 24h beat-to-beat interval time series utilizing DRNNs.

Significance: The novel data-driven approach enables robust remote diagnosis and phenotyping of AF.
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http://dx.doi.org/10.1109/TBME.2020.3042646DOI Listing
August 2021

Acute Coronary Syndrome in the Era of SARS-CoV-2 Infection: A Registry of the French Group of Acute Cardiac Care.

CJC Open 2021 Mar 11;3(3):311-317. Epub 2020 Nov 11.

Univ Paris Est Créteil, INSERM, IMRB, Créteil, France.

Background: In this study, we aimed to report clinical characteristics and outcomes of patients with and without SARS-CoV-2 infection who were referred for acute coronary syndrome (ACS) during the peak of the pandemic in France.

Methods: We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south, and north of France), all performing primary percutaneous coronary intervention.

Results: The study included 237 patients (67 ± 14 years old; 69% male), 116 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2-associated ACS was 11% (n = 26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen > 6 L/min). Patients were comparable regarding medical history and risk factors, except a higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs 25.6%;  = 0.003). In SARS-CoV-2 patients, cardiac arrest on admission was more frequent (26.9% vs 6.6%; < 0.001). The presence of significant coronary artery disease and culprit artery occlusion in SARS-CoV-2 patients respectively, was 92% and 69.4% for those with STEMI, and 50% and 15.5% for those with NSTEMI. Percutaneous coronary intervention was performed in the same percentage of STEMI (84.6%) and NSTEMI (84.8%) patients, regardless of SARS-CoV-2 infection, but no-reflow (19.2% vs 3.3%; < 0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared with noninfected patients (26.9% vs 6.2%; < 0.001).

Conclusions: In this registry, ACS in SARS-CoV-2 patients presented with high a percentage of cardiac arrest on admission, high incidence of no-reflow, and high in-hospital mortality.
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http://dx.doi.org/10.1016/j.cjco.2020.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657607PMC
March 2021

Predictive value of early cardiac magnetic resonance imaging functional and geometric indexes for adverse left ventricular remodelling in patients with anterior ST-segment elevation myocardial infarction: A report from the CIRCUS study.

Arch Cardiovasc Dis 2020 Nov 5;113(11):710-720. Epub 2020 Nov 5.

Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France. Electronic address:

Background: Postinfarction adverse left ventricular (LV) remodelling is strongly associated with heart failure events. Conicity index, sphericity index and LV global functional index (LVGFI) are new LV remodelling indexes assessed by cardiac magnetic resonance (CMR).

Aim: To assess the predictive value of the new indexes for 1-year adverse LV remodelling in patients with anterior ST-segment elevated myocardial infarction (STEMI).

Methods: CMR studies were performed in 129 patients with anterior STEMI (58±12 years; 78% men) from the randomized CIRCUS trial (CMR substudy) treated with primary percutaneous coronary intervention and followed for the occurrence of major adverse cardiovascular events (MACE) (death or hospitalization for heart failure). Conicity index, sphericity index, LVGFI, infarct size and microvascular obstruction (MVO) were assessed by CMR performed 5±4 days after coronary reperfusion. Adverse LV remodelling was defined as an increase in LV end-diastolic volume of ≥15% by transthoracic echocardiography at 1 year.

Results: Adverse LV remodelling occurred in 27% of patients at 1 year. Infarct size and MVO were significantly predictive of adverse LV remodelling: odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05 (P<0.001) and OR 1.12, 95% CI 1.05-1.22 (P<0.001), respectively. Among the newly tested indexes, only LVGFI was significantly predictive of adverse LV remodelling (OR 1.10, 95% CI 1.03-1.16; P=0.001). In multivariable analysis, infarct size remained an independent predictor of adverse LV remodelling at 1 year (OR 1.05, 95% CI 1.02-1.08; P<0.001). LVGFI and infarct size were associated with occurrence of MACE: OR 1.21, 95% CI 1.08-1.37 (P<0.001) and OR 1.02, 95% CI 1.00-1.04 (P=0.018), respectively. Conicity and sphericity indexes were not associated with MACE.

Conclusions: LVGFI was associated with adverse LV remodelling and MACE 1 year after anterior STEMI.
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http://dx.doi.org/10.1016/j.acvd.2020.05.024DOI Listing
November 2020

Machine learning for nocturnal mass diagnosis of atrial fibrillation in a population at risk of sleep-disordered breathing.

Physiol Meas 2020 11 6;41(10):104001. Epub 2020 Nov 6.

Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel. Faculty of Electrical Engineering, Technion, Israel Institute of Technology, Haifa, Israel.

Objective: In this research, we introduce a new methodology for atrial fibrillation (AF) diagnosis during sleep in a large population sample at risk of sleep-disordered breathing.

Approach: The approach leverages digital biomarkers and recent advances in machine learning (ML) for mass AF diagnosis from overnight-hours of single-channel electrocardiogram (ECG) recording. Four databases, totaling n = 3088 patients and p = 26 913 h of continuous single-channel electrocardiogram raw data were used. Three of the databases (n = 125, p = 2513) were used for training a ML model in recognizing AF events from beat-to-beat time series. Visit 1 of the sleep heart health study database (SHHS1, n = 2963, p = 24 400) was used as the test set to evaluate the feasibility of identifying prominent AF from polysomnographic recordings. By combining AF diagnosis history and a cardiologist's visual inspection of individuals suspected of having AF (n = 118), a total of 70 patients were diagnosed with prominent AF in SHHS1.

Main Results: Model prediction on SHHS1 showed an overall [Formula: see text]and [Formula: see text] in classifying individuals with or without prominent AF. [Formula: see text] was non-inferior (p = 0.03) for individuals with an apnea-hypopnea index (AHI) ≥15 versus AHI < [Formula: see text]. Over 22% of correctly identified prominent AF rhythm cases were not previously documented as AF in SHHS1.

Significance: Individuals with prominent AF can be automatically diagnosed from an overnight single-channel ECG recording, with an accuracy unaffected by the presence of moderate-to-severe obstructive sleep apnea. This approach enables identifying a large proportion of AF individuals that were otherwise missed by regular care.
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http://dx.doi.org/10.1088/1361-6579/abb8bfDOI Listing
November 2020

Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach.

World J Cardiol 2020 May;12(5):220-227

Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France.

Background: Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle. Patients are usually asymptomatic, and clinical presentation depends on location and adjacent structures impairment. Right ventricle lipomas are scarce in the literature. Moreover, the previous published cases were reported in over 18-year-old patients.

Case Summary: We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up. The diagnosis was confirmed by histopathological examination, and a conservative approach was performed.

Conclusion: Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis. The therapeutic approach depends on clinical presentation.
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http://dx.doi.org/10.4330/wjc.v12.i5.220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284002PMC
May 2020

Coronary Artery Spasm: New Insights.

J Interv Cardiol 2020 14;2020:5894586. Epub 2020 May 14.

Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France.

Coronary artery spasm (CAS) defined by a severe reversible diffuse or focal vasoconstriction is the most common diagnosis among INOCA (ischemia with no obstructive coronary artery disease) patients irrespective to racial, genetic, and geographic variations. However, the prevalence of CAS tends to decrease in correlation with the increasing use of medicines such as calcium channel blockers, angiotensin converting enzyme inhibitor, and statins, the controlling management of atherosclerotic risk factors, and the decreased habitude to perform a functional reactivity test in highly active cardiac catheterization centers. A wide spectrum of clinical manifestations from silent disease to sudden cardiac death was attributed to this complex entity with unclear pathophysiology. Multiple mechanisms such as the autonomic nervous system, endothelial dysfunction, chronic inflammation, oxidative stress, and smooth muscle hypercontractility are involved. Regardless of the limited benefits proffered by the newly emerged cardiac imaging modalities, the provocative test remains the cornerstone diagnostic tool for CAS. It allows to reproduce CAS and to evaluate reactivity to nitrates. Different invasive and noninvasive therapeutic approaches are approved for the management of CAS. Long-acting nondihydropyridine calcium channel blockers are recommended for first line therapy. Invasive strategies such as PCI (percutaneous coronary intervention) and CABG (coronary artery bypass graft) have shown benefits in CAS with significant atherosclerotic lesions. Combination therapies are proposed for refractory cases.
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http://dx.doi.org/10.1155/2020/5894586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245659PMC
November 2020

Identification of a miRNA Based-Signature Associated with Acute Coronary Syndrome: Evidence from the FLORINF Study.

J Clin Med 2020 Jun 1;9(6). Epub 2020 Jun 1.

Institute of Metabolic and Cardiovascular Diseases, INSERM UMR-1048, 31432 Toulouse, France.

Background: The discovery of novel biomarkers that improve risk prediction models of acute coronary syndrome (ACS) is needed to better identify and stratify very high-risk patients. MicroRNAs (miRNAs) are essential non-coding modulators of gene expression. Circulating miRNAs recently emerged as important regulators and fine-tuners of physiological and pathological cardiovascular processes; therefore, specific miRNAs expression profiles may represent new risk biomarkers. The aims of the present study were: i) to assess the changes in circulating miRNAs levels associated with ACS and ii) to evaluate the incremental value of adding circulating miRNAs to a clinical predictive risk model.

Methods And Results: The study population included ACS patients (n = 99) and control subjects (n = 103) at high to very high cardiovascular risk but without known coronary event. Based on a miRNA profiling in a matched derivation case (n = -6) control (n = 6) cohort, 21 miRNAs were selected for validation. Comparing ACS cases versus controls, seven miRNAs were significantly differentially expressed. Multivariate logistic regression analyses demonstrated that among the seven miRNAs tested, five were independently associated with the occurrence of ACS. A receiver operating characteristic curve analysis revealed that the addition of miR-122 + miR-150 + miR-195 + miR-16 to the clinical model provided the best performance with an increased area under the curve (AUC) from 0.882 to 0.924 (95% CI 0.885-0.933, p = 0.003).

Conclusions: Our study identified a powerful signature of circulating miRNAs providing additive value to traditional risk markers for ACS.
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http://dx.doi.org/10.3390/jcm9061674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356017PMC
June 2020

Nitrous oxide/oxygen plus acetaminophen versus morphine in ST elevation myocardial infarction: open-label, cluster-randomized, non-inferiority study.

Scand J Trauma Resusc Emerg Med 2020 May 12;28(1):36. Epub 2020 May 12.

Hôpital cardiologique Louis-Pradel, 69500, Lyon, France.

Background: Studies have shown disparate results on the consequences of morphine use in ST-segment elevation myocardial infarction (STEMI). No study has evaluated alternative treatments that could be at least non-inferior to morphine without its potentially damaging consequences for myocardial function and platelet reactivity. The aim of this study was to evaluate whether nitrous oxide/oxygen plus intravenous acetaminophen (NOO-A) is non-inferior to morphine to control chest pain in STEMI patients.

Methods: This multicenter, open-label, cluster-randomized, controlled, non-inferiority study compared NOO-A with morphine in 684 prehospital patients with ongoing suspected STEMI of < 12 h duration and a pain rating score ≥ 4. The primary endpoint was the proportion of patients achieving pain relief (numeric rating score ≤ 3) after 30 min. Secondary safety endpoints included serious adverse events and death at 30 days.

Results: The median baseline pain score was 7.0 in both groups. The primary endpoint occurred in 51.7% of the NOO-A group and 73.6% of the morphine group (absolute risk difference - 21.7%; 95% confidence interval - 29.6 to - 13.8). At 30 days, the rate of serious adverse events was 16.0 and 18.8% in the NOO-A and morphine groups respectively (p = NS). The rate of death was 1.8% (NOO-A group) and 3.8% (morphine group) (p = NS).

Conclusion: Analgesia provided by NOO-A was inferior to morphine at 30 min in patients with acute STEMI in the prehospital setting. Rates of serious adverse events did not differ between groups.

Trial Registration: ClinicalTrials.gov: NCT02198378.
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http://dx.doi.org/10.1186/s13049-020-00731-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218609PMC
May 2020

One train may hide another: Acute cardiovascular diseases could be neglected because of the COVID-19 pandemic.

Arch Cardiovasc Dis 2020 May 28;113(5):303-307. Epub 2020 Apr 28.

Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier, France. Electronic address:

Background: Coronavirus disease 2019 (COVID-19) is likely to have significant implications for the cardiovascular care of patients. In most countries, containment has already started (on 17 March 2020 in France), and self-quarantine and social distancing are reducing viral contamination and saving lives. However, these considerations may only be the tip of the iceberg; most resources are dedicated to the struggle against COVID-19, and this unprecedented situation may compromise the management of patients admitted with cardiovascular conditions.

Aim: We aimed to assess the effect of COVID-19 containment measures on cardiovascular admissions in France.

Methods: We asked nine major cardiology centres to give us an overview of admissions to their nine intensive cardiac care units for acute myocardial infarction or acute heart failure, before and after containment measures.

Results: Before containment (02-16 March 2020), the nine participating intensive cardiac care units admitted 4.8±1.6 patients per day, versus 2.6±1.5 after containment (17-22 March 2020) (rank-sum test P=0.0006).

Conclusions: We confirm here, for the first time, a dramatic drop in the number of cardiovascular admissions after the establishment of containment. Many hypotheses might explain this phenomenon, but we feel it is time raise the alarm about the risk for patients presenting with acute cardiovascular disease, who may suffer from lack of attention, leading to severe consequences (an increase in the number of ambulatory myocardial infarctions, mechanical complications of myocardial infarction leading to an increase in the number of cardiac arrests, unexplained deaths, heart failure, etc.). Similar consequences can be feared for all acute situations, beyond the cardiovascular disease setting.
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http://dx.doi.org/10.1016/j.acvd.2020.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186196PMC
May 2020

New insights into cardiogenic shock and coronary revascularization after acute myocardial infarction.

Arch Cardiovasc Dis 2020 Apr 19;113(4):276-284. Epub 2020 Feb 19.

Cardiology Department, Caremeau University Hospital, ACTION Study Group, Montpellier University, 30029 Nîmes, France.

Cardiogenic shock complicating acute myocardial infarction is challenging, and continues to be associated with high rates of in-hospital and long-term mortality. Coronary revascularization is critical for improving prognosis in CS. Thus, a systematic protocol-driven approach to cardiogenic shock, the development of specialized cardiac care centres, technical advances in interventional cardiology enabling treatment of more complex and severe lesions, the availability of recent antithrombotic therapies and the evolution of new haemodynamic support devices are important considerations in current management of cardiogenic shock complicating acute ischaemic heart disease. Despite these potentially meaningful developments, several substantial gaps in knowledge still exist regarding optimal coronary revascularization of patients with cardiogenic shock. This review will describe current principles in the revascularization of these patients, with a focus on: the time to transfer and revascularize; the choice of vascular access site; the need for complete revascularization or only a culprit lesion strategy; the optimal antithrombotic therapy; the type, place and timing of haemodynamic support; and the medical care system network.
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http://dx.doi.org/10.1016/j.acvd.2019.12.005DOI Listing
April 2020

Mid-Ventricular Takotsubo Cardiomyopathy with Hawk's Beak Appearance: A Case Report.

Am J Case Rep 2020 Jan 2;21:e919563. Epub 2020 Jan 2.

Cardiovascular and Metabolic Pole, CHU Toulouse Rangueil, University Paul Sabatier, Toulouse, France.

BACKGROUND Takotsubo cardiomyopathy is a myocardial infarction-like clinical entity commonly occurring after a stressful incident, leading to reversible systolic dysfunction. It involves several subtypes, most often associated with a good prognosis; however, a late diagnosis can contribute to a poor cardiovascular outcome. CASE REPORT We report an unusual case of mid-ventricular takotsubo cardiomyopathy in a 76-year-old woman who presented with recent-onset shortness of breath and compressive chest pain, typically characterized by a hawk's beak shape on left ventriculogram, highlighting the importance of this helpful descriptive but little-known fluoroscopic sign. The final diagnosis was made using transthoracic echocardiography, contrast-enhanced pulmonary angiography, coronary angiography, and left ventriculography. She was successfully treated by beta-blockers and angiotensin-converting enzyme inhibitor, with a good clinical outcome evaluated at 3-month follow-up after hospital discharge. CONCLUSIONS Ventriculography is an important tool for use in making the differential diagnosis in patients presenting with acute coronary syndrome without obstructive coronary artery disease. The hawk's beak shape is an early fluoroscopic diagnostic marker characterizing the mid-ventricular subtype of takotsubo.
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http://dx.doi.org/10.12659/AJCR.919563DOI Listing
January 2020

Participating in Sports After Mitral Valve Repair for Primary Mitral Regurgitation: A Retrospective Cohort Study.

Clin J Sport Med 2021 09;31(5):414-422

Department of Cardiology, University Hospital of Rangueil, Toulouse, France.

Objective: Participating in either competitive or leisure sports is restrictive after surgical mitral valve repair (MVR). In this study, we examine the impact of sports on outcomes after MVR.

Design: Retrospective cohort study.

Setting: Patients aged 18 to 65 years who underwent a first-time MVR for primary mitral regurgitation (MR) in a tertiary care center.

Patients: One hundred twenty-one consecutive patients were included in the study. The exclusion criteria were as follows: other concomitant procedures, early perioperative death or repeat intervention, noncardiac death or endocarditis during follow-up, and general contraindications for normal physical activity.

Assessment Of Risk Factors: Participation in sports was quantified by the number of hours per week during the past 6 months, classified according to the Mitchell classification and assessed with the International Physical Activity Questionnaire (IPAQ) short form.

Main Outcome Measures: The primary composite endpoint was MVR failure defined as MR grade ≥2 or mean transmitral gradient ≥8 mm Hg, signs and symptoms of heart failure, or late-onset postoperative AF (>3 months).

Results: The mean age was 50 ± 11 years, and there were 85 (71%) men. The median follow-up was 34 months [interquartile range (IQR): 20-50]. Fifty-six (46%) patients participated in sports regularly (median of 3 h/wk; IQR: 2-5). Twenty (17%) patients reached the primary composite endpoint with no correlation with participation in sports (P = 0.537), IPAQ categories (P = 0.849), in any of the Mitchell classification subgroups and a high level of participation in sports ≥6 hours (P = 0.679).

Conclusions: Sports seem to be unrelated to the worst outcome after MVR.
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http://dx.doi.org/10.1097/JSM.0000000000000769DOI Listing
September 2021

Short- and Mid-Term Prognosis of Patients Undergoing Rotational Atherectomy in Aortoostial Coronary Lesions in Left Main or Right Coronary Arteries.

J Interv Cardiol 2019 21;2019:9012787. Epub 2019 Aug 21.

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

Objective: To determine short-term and mid-term prognosis in patients with calcified ostial coronary lesions who underwent rotational atherectomy (RA).

Background: RA was developed to facilitate stenting in complex lesions. Treatment of calcified aortoostial coronary lesions with RA appears to have poorer procedure outcomes than nonostial lesions; yet the literature on this topic is scarce.

Methods: Of 498 consecutive patients who underwent RA, a total of 80 (16.1%) presented with aortoostial lesions. A comparative, monocentric study was performed between patients with aortoostial and nonaortoostial stenosis, in a retrospective registry. The primary endpoint was the procedural success rate. Secondary endpoints were the rates of major adverse cardiac and cardiovascular events (MACE) at 30 days and 24 months.

Results: The procedural success rate was high and similar in patients with and without ostial lesions (96.3% 94.7%, p=0.78), as was the rate of angiographic complications (7.5% 8.4%, p=0.80). However, the 30-day mortality rate was significantly higher in the aortoostial group (11.3% 4.8%, p=0.04), as was the 24-month rate of MACE (43.8% 31.8%, p=0.04). The aortoostial location of the lesion was an independent factor associated with the occurrence of cardiovascular events at 24 months (HR = 1.52, 95% CI, 1.03-2.26, p=0.035).

Conclusion: Procedural success and complication rates were similar in patients with and without aortoostial lesions. Despite a poor short- and mid-term prognosis, rotational atherectomy appears to be a feasible and safe treatment option for calcified aortoostial coronary lesions.
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http://dx.doi.org/10.1155/2019/9012787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739796PMC
February 2020

In-hospital outcomes and 5-year mortality following an acute myocardial infarction in patients with a history of cancer: Results from the French registry on Acute ST-elevation or non-ST-elevation myocardial infarction (FAST-MI) 2005 cohort.

Arch Cardiovasc Dis 2019 Nov 21;112(11):657-669. Epub 2019 Nov 21.

Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; INSERM U 970, 75015 Paris, France. Electronic address:

Background: Cancer and acute myocardial infarction (AMI) have important prognostic consequences. Treatment of some cancers may affect coronary artery disease, myocardial function and/or AMI management. Whether the early and long-term mortality of patients with AMI differ according to their history of cancer remains questionable.

Aims: To determine in-hospital outcomes and 5-year mortality following AMI according to patient history of cancer.

Methods: The FAST-MI registry is a nationwide French survey collecting data on characteristics, management and outcomes of 3670 consecutive patients admitted for AMI during October 2005.

Results: Overall, 246/3664 patients (6.7%) admitted for an AMI (47.6% with ST-segment elevation myocardial infarction [STEMI]; 52.4% with non-STEMI [NSTEMI]) had a history of cancer. In-hospital mortality was not significantly different for patients with versus without a history of cancer, overall (adjusted odds ratio [OR]: 1.15, 95% confidence interval [CI]: 0.68-1.94; P=0.61) and in patients with STEMI (adjusted OR: 1.37, 95% CI: 0.69-2.71; P=0.37) or NSTEMI (adjusted OR: 0.97, 95% CI: 0.41-2.28; P=0.95). All-cause mortality at 5 years was higher among patients with a history of cancer (adjusted hazard ratio [HR]: 1.36, 95% CI: 1.08-1.69; P=0.008), whereas 5-year cardiovascular mortality did not differ (adjusted HR: 1.17, 95% CI: 0.89-1.53; P=0.25), regardless of whether the patients had STEMI or NSTEMI. Similar results were found in populations matched on a propensity score including baseline characteristics and early management.

Conclusion: A history of cancer, per se, does not appear to be a risk factor for increased in-hospital mortality or long-term cardiovascular mortality in patients admitted for AMI.
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http://dx.doi.org/10.1016/j.acvd.2019.06.012DOI Listing
November 2019

Mechanical circulatory support with the Impella® LP5.0 pump and an intra-aortic balloon pump for cardiogenic shock in acute myocardial infarction: The IMPELLA-STIC randomized study.

Arch Cardiovasc Dis 2020 Apr 15;113(4):237-243. Epub 2019 Nov 15.

Department of Intensive Cardiac Care, Hôpital Louis Pradel, Hospices Civils de Lyon, 59, boulevard Pinel, 69677 Bron, France. Electronic address:

Background: Percutaneous assist devices may be used as a bridge to recovery in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI).

Aim: To test the hypothesis that the Impella® LP5.0 pump (Abiomed Europe GmbH, Aachen, Germany) provides haemodynamic benefits and improves left ventricular ejection fraction (LVEF) in patients with CS-AMI already managed with an intra-aortic balloon pump (IABP).

Methods: This was a prospective randomized study. The primary endpoint was change in cardiac power index (CPI) from baseline to 12hours after implantation, measured with a Swan-Ganz catheter. Secondary endpoints included LVEF at 30 days.

Results: Fifteen patients with CS-AMI were randomized; 12 were available for primary endpoint analysis (IABP group, n=6; Impella LP5.0+IABP group, n=6). Baseline characteristics were similar in both groups. Change in CPI after 12hours was not significantly different between the two groups (IABP group: ΔCPI=0.08±0.08W/m; Impella LP5.0+IABP group: ΔCPI=-0.02±0.25W/m; P=0.4). There was no significant change from baseline CPI in either group over 96hours, and no difference in CPI between groups at each timepoint. In the Impella LP5.0+IABP group, the part of the CPI provided by the native heart decreased from 0.37±0.10 to 0.10±0.20 (P=0.01). LVEF was similar at baseline (29.7%±8.4% and 29.3%±6.7%) and 1 month (40.6%±12.5% and 38.6%±14.4%) in the IABP and Impella LP5.0+IABP groups, respectively. Adverse events, especially major bleeding, were common, and occurred mainly in the Impella LP5.0+IABP group.

Conclusions: In patients with CS-AMI stabilized by initial treatment with inotropes and an IABP, the Impella LP5.0 did not provide additional haemodynamic support or improvement in LVEF at 1 month; its use in this setting might be futile and possibly harmful.
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http://dx.doi.org/10.1016/j.acvd.2019.10.005DOI Listing
April 2020

Long-term Prognostic Impact of Physical Activity in Patients With Stable Coronary Heart Disease.

Am J Cardiol 2020 01 28;125(2):176-181. Epub 2019 Oct 28.

Department of Cardiology, Rangueil University Hospital, Toulouse, France; Department of epidemiology, INSERM UMR 1027, Toulouse, France.

Stable coronary heart disease (CHD) patients are advised to practice regular physical activity (PA). However, data on very long-term prognosis impact of regular exercise remain scarce. We aimed to evaluate the impact of physical activity level on mortality at long term in stable CHD patients. We analyzed 822 patients with stable CHD. They answered questionnaires on medical history, underwent a standardized clinical examination, and provided a fasting blood sample. PA was evaluated by the MOSPA questionnaire. Three tertiles of patients were individualized according to PA level: 0.0-9 Metabolic Equivalent of Task (METs) hour per week (n = 267); 10-39.9 METs hour per week (n = 279); and ≥40 METs hour per week (n = 276). After a median follow-up of 14.6 years, 324 patients had died. In a multivariate analysis adjusted for age, dyslipidemia, smoking status, diabetes, high blood pressure, waist circumference, left ventricular ejection fraction, Gensini score, heart rate, ankle-brachial index and duration of disease, physical activity was significantly and independently associated with all-cause mortality. Compared to the lowest PA tertile, both the median and the highest PA tertiles, were associated to a reduction of all-cause mortality risk with hazard ratios at 0.79 (95%confidence interval [0.61:1.03], P = 0.08) and 0.71 ([0.53:0.96], P = 0.025) respectively; P for trend = 0.02. Adjusted hazard ratios for an increase of 10 METs hour per week was 0.95 [0.92 to 0.98], (P <0.002). In conclusion, our study demonstrates an independent association between PA and long term vital prognosis with a 5% total mortality decrease for an increase of 10 METs hour per week.
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http://dx.doi.org/10.1016/j.amjcard.2019.10.017DOI Listing
January 2020

Coronary angiography in the setting of acute infective endocarditis requiring surgical treatment.

Arch Cardiovasc Dis 2020 Jan 13;113(1):50-58. Epub 2019 Nov 13.

Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France. Electronic address:

Background: International guidelines recommend that preoperative coronary angiography is performed on patients at risk of coronary disease who have infective endocarditis requiring surgical treatment. However, the risks of contrast-induced nephropathy or vegetation embolization in case of aortic endocarditis should be considered.

Aims: To assess the safety, therapeutic implications and prognostic impact of coronary angiography in patients requiring surgical treatment for active infective endocarditis.

Methods: This retrospective monocentric study was conducted in patients referred to a tertiary care centre for active endocarditis management with a theoretical indication for surgery between January 2013 and February 2017.

Results: One hundred and ninety-three patients were included; 73.1% were men, the mean age was 61.9±16.3 years and the median EuroSCORE II was 5.8%. One hundred and nineteen patients (61.7%) had aortic endocarditis, which was associated with aortic vegetation in 74 cases (38.3%). Invasive coronary angiography was performed in 142 patients (73.6%) - 130 (91.6%) by radial approach - and 14 patients were evaluated by coronary multislice computed tomography (one patient had exploration with both techniques). Acute renal failure after coronary angiography was observed in 15 patients (10.6%), two patients (1.4%) presented a stroke within 24h after coronary angiography, but none had aortic endocarditis. Among the 178 patients (92.2%) who underwent surgery, 35 (19.7%) had significant coronary lesion(s) and 25 (14.0%) underwent an associated coronary artery bypass graft.

Conclusions: Preoperative coronary angiography in patients affected by infective endocarditis provides relevant information in a significant proportion of patients and can be performed safely.
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http://dx.doi.org/10.1016/j.acvd.2019.09.007DOI Listing
January 2020

Blood Microbiota Modification After Myocardial Infarction Depends Upon Low-Density Lipoprotein Cholesterol Levels.

J Am Heart Assoc 2019 10 28;8(19):e011797. Epub 2019 Sep 28.

Metabolic and Cardiovascular Diseases Department Rangueil Hospital CHU Toulouse Toulouse France.

Background The role of bacteria on the onset of cardiovascular disease has been suggested. Reciprocally, increased intestinal bacterial translocation and bloodstream infection are common comorbidities associated with heart failure and myocardial infarction (MI). In this context, the aim of this study was to analyze the blood microbiome in patients shortly after acute myocardial infarction. Methods and Results We carried out a case control study comparing 103 patients at high cardiovascular risk but free of coronary disease and 99 patients who had an MI. The blood microbiome was analyzed both quantitatively by 16S quantitative polymerase chain reaction and qualitatively by 16S targeted metagenomic sequencing specifically optimized for blood samples. A significant increase in blood bacterial 16S rDNA concentration was observed in patients admitted for MI. This increase in blood bacterial DNA concentration was independent of post-MI left ventricular function and was more marked in patients with low-density lipoprotein cholesterol ≥1 g/L. In addition, differences in the proportion of numerous bacterial taxa in blood were significantly modified with the onset of MI, thus defining a blood microbiota signature of MI. Among the bacterial taxa whose proportions are decreased in patients with MI, at least 6 are known to include species able to metabolize cholesterol. Conclusions These results could provide the basis for the identification of blood microbiome-based biomarkers for the stratification of MI patients. Furthermore, these findings should provide insight into the mechanism underlying the negative correlation reported between low-density lipoprotein cholesterol concentration and the prognosis at the acute onset of MI and mortality. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02405468.
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http://dx.doi.org/10.1161/JAHA.118.011797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806051PMC
October 2019

Effects of remote ischemic conditioning on kidney injury in at-risk patients undergoing elective coronary angiography (PREPARE study): a multicenter, randomized clinical trial.

Sci Rep 2019 08 19;9(1):11985. Epub 2019 Aug 19.

Institut MITOVASC, UMR INSERM U1083 and CNRS 6015, Service de Cardiologie, CHU Angers, Université Angers, Angers, France.

The ability of remote ischemic preconditioning (RIPC) to prevent contrast-induced nephropathy (CIN) following percutaneous coronary angiography in at-risk patients is controversial. No evidence exists regarding potential RIPC positive effects on renal function and clinical outcomes in the long-term. The PREPARE study was a randomized, prospective, multicenter, and double-blinded trial. A total of 222 patients scheduled for coronary angiography and/or percutaneous transluminal coronary angioplasty with an estimated glomerular filtration rate (eGFR) < 40 mL/min/1.73 m, or eGFR between 40 and 60 mL/min/1.73 m and two further risk factors were allocated to RIPC or control groups. Preventive measures were applied to all patients, including continuous intravenous saline infusion, withdrawal of nephrotoxic drugs, and limited volume of contrast medium. The primary endpoint, namely incidence of CIN, was 3.8% in the control group and 5.1% in the RIPC group (p = 0.74). The secondary endpoints, i.e., changes in serum creatinine and eGFR levels from baseline to 48 hours and from baseline to 12 months following contrast medium exposure, did not differ between both groups. The incidences of all major clinical events at 12 months were similar in both groups. In this population at risk of CIN, preventive strategies were associated with low CIN incidence. RIPC impacted neither the CIN incidence nor both the renal function and clinical outcomes at 1-year follow-up.
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http://dx.doi.org/10.1038/s41598-019-47106-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700075PMC
August 2019
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