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Introduction L'artérite à cellules géantes (ACG) est une maladie multifactorielle dont la pathogénie n'est pas encore totalement comprise [1]. Malgré tout, il existe une relation dynamique entre prédispositions génétiques et facteurs environnementaux via des modifications épigénétiques ayant un rôle dans le déclenchement et l'évolution de cette pathologie [2], [3]. Le confinement dû à l'épidémie de COVID-19 a créé une situation sans précédent entraînant un stress physique et psychologique important chez de nombreuses personnes. Par ailleurs, la pression médiatique importante quant à l'usage des corticoïdes qui sont souvent prescrits chez les patients atteints d'ACG, était très anxiogène et pouvait modifier l'observance au traitement. Aussi, nous avions décidé d'étudier l'impact du changement de mode de vie et de l'augmentation du stress psychosocial sur l'histoire naturelle des patients atteints d'ACG. Patients et méthodes Nous avons mené une enquête téléphonique transversale à partir d'un questionnaire standardisé, après un mois de confinement, chez 79 patients atteints d'ACG (n = 79) vivant à domicile et suivis au CHU de Dijon depuis janvier 2018. Résultats Les résultats obtenus montrent une majoration importante du stress psychosocial chez 32 % des patients (n = 24) et une baisse de l'état général chez 29 % des patients (n = 22) ;50 % des patients (n = 39) ont signalé une réduction de leur activité physique, 42 % (n = 33) ont augmenté le temps passé devant les écrans numériques et 16 % (n = 12) ont déclaré avoir pris 2 kg ou plus. Concernant le suivi de l'ACG, 25 % des patients devant avoir un suivi biologique ont annulé leur rendez-vous et seulement un quart des patients devant avoir une consultation l'ont eu en présentiel. En revanche, les patients ont montré une forte adhérence thérapeutique, en particulier aux glucocorticoïdes malgré les messages alarmants diffusés dans divers médias. Cependant, 9,5 % des patients (n = 7) ont rapporté des signes suggérant une poussée d'ACG après un mois de confinement alors que 5 d'entre eux étaient toujours traités. Discussion Notre étude suggère fortement que le changement radical du mode de vie (augmentation de l'inactivité) associé à un stress psychosocial important a été responsable d'un taux inhabituel de rechutes. Par ailleurs, si une nouvelle période de confinement s'avérait nécessaire, l'impact d'un mode de vie sédentaire prolongé sur l'autonomie de cette population fragile ne devrait pas être négligée. Conclusion Cette étude met en évidence l'impact négatif du confinement dû au COVID-19 sur la gestion et le contrôle d'une maladie chronique, l'ACG, ainsi que sur le mode de vie d'un échantillon représentatif de patients atteints d'ACG confinés à leur domicile.
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Introduction Coronary artery disease (CAD) characteristics and severity for sport-related acute myocardial infarction (SR-AMI) remain only poorly investigated, in particular related to sport intensity. Objective To identify coronary angiographic feature of patients with SR-AMI according to sport intensities. Method From the IMACS database, a prospective ongoing monocenter acute MI survey, all consecutive patients hospitalized in a University Hospital from 2010 to 2021 who underwent coronary angiography for SR-MI were included. SR-AMI was defined as MI occurring during sport practice or within the first hour of recovery. Angiographical data were retrospectively analysed by 2 blinded investigators. Sport intensity, expressed in metabolic equivalent (MET), was adapted from Ainsworth classification, with 6 METs as intensity cutoff. Results Among the 173 patients included, median age was 60 y, most were male (90%), and had ST segment elevation MI (STEMI) (Table 1). The SR-AMI often occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly underwent Out of Hospital Cardiac Arrest (OHCA) (17%). The rate of cardiovascular (CV) risk factors was high, including current smoking and history of CAD. Most (91%) had significant lesions (>50% stenosis). Revascularisation was achieved by percutaneous coronary intervention (PCI) [n=131 (77%)] or coronary artery bypass grafting (CABG) [n=11(6%)]. In-hospital death occurred in 12 patients (7%), of whom 11 underwent a OHCA and one was admitted with a cardiogenic shock during the COVID-19 pandemics lockdown. When compared with lower intensity sport (<6 METs), patients in the≥6 METs group had similar age, CV risk factors [except for diabetes rate which was much lower (P=0.005)] and similar CAD severity, as assessed by SYNTAX score. Higher intensity group also had a higher rate of STEMI (P=0.05), of intraluminal thrombus (P=0.024), and showed a trend toward a lower rate of calcified lesions (P=0.103). Conclusion Our retrospective study suggests for the first time that SR-AMI occurring during a≥6 METs intensity exercise were characterized by a more frequent thrombotic burden. If confirmed by larger prospective and coronary plaque imaging studies, these preliminary findings could help to understand the underlying mechanisms of these dramatic events.
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Background: Underlying mechanisms for sport-related acute myocardial infarction (SR-AMI) are only poorly understood. Moreover, their coronary artery disease (CAD) characteristics and lesion complexity are poorly described. Purpose: To characterize coronary angiographic feature of patients with SR-AMI Methods: From the RICO database, a large regional acute MI survey, all consecutive patients hospitalized in our University Hospital from 2010 to 2021 who underwent coronary angiography for SR-MI were retrospectively analysed. SR-MI was defined as MI occurring during sport activity or within the first hour of recovery. Results: Among the 174 patients included, most were male (n=157(91%)). Median (IQR) age was 59 y (48-66), and had ST segment elevation MI (STEMI) (n= 112 (64%)). The SR-MI often occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly experienced pre-hospital (PH) sudden cardiac arrest (SCA) (17%). Atherothrombotic risk factors were dyslipidaemia (32%), current smoking (31%) or hypertension (28%). A history of CAD was documented in 31 (18%) patients. Most (n=156(91%)) had significant lesions, of whom 140 (81%) were considered as culprit. Culprit lesions were located on left anterior descending (39%), circumflex (14%) and right coronary artery (33%). Median (IQR) Syntax score was 10.5 (6-15). The vast majority of patients (n=152 (87%)) had at least one complex lesion;114 of them had several characteristics of complex lesion. Lesions were eccentric in 68 (39%) patients;an intraluminal thrombus was documented in 85 patients (49%), in 55% of STEMI and 37% of non-STEMI (p =0.027). However, 18 subjects (10%) had optically normal coronary angiogram or non-significant lesions, suggesting alternative mechanism such as type 2 MI. Treatment of the lesions was mainly achieved by PCI and/or stenting (n=132(77%)) or coronary artery bypass grafting (n=11(6%)). In-hospital death occurred in 11 patients (6%), of whom 10 experienced a PH-SCA and one was admitted with a cardiogenic shock during the Covid-19 pandemics lockdown. Among the 5 patients treated with extracorporeal membrane oxygenator, only one survived. Conclusion: In our large retrospective study, SR-MI was commonly associated with complex coronary lesions, often characterized by intraluminal thrombus. Our findings suggest that the mechanisms of these events could be mainly related to type 1 MI patterns Moreover, PH-SCA was frequent, thus justifying mass-education to basic life support and deployment of automated external defibrillators, especially in the sport settings.
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Background: Healthy lifestyle, which are keystones in management of chronic cardiac patients, could be challenged during the lockdown. Purpose: In patients with Chronic coronary syndrome (CCS) or congestive heart failure (CHF), to evaluate the impact of the place of residence during the Covid-19 lockdown on lifestyle behaviours. Methods: Randomly selected subjects among 250 patients with CCS (from RICO survey) and 150 patients with CHF (from a HF clinic) were invited to answer to a phone-call questionnaire during the 1st COVID-19 lockdown. Urban zone was defined as ≥ 2000 inhabitants. Psychological distress was assessed by Kessler-6 score. Results: 344 questionnaires were fit for analysis (220 CCS and 124 CHF), including 66.6% male, with median (IQR) age at 70(59-78) y (Table 1). Rural location of lockdown residence was frequent (53%), and associated with less lifestyle impairment (i.e. decrease in physical activity and increase in screen-time). In contrast, patients living in urban area felt more often cramped and had a higher psychologic distress. Conclusions: During the 1st lockdown, chronic cardiac subjects from rural areas reported less unhealthy behaviors and lower rate of psychological impairment. These data may help to implement preventive action targeting urban patients.
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Background Congestive heart failure (CHF) alters the course of COVID-19 (C19);pandemic and lockdown can destabilize CHF. Purpose To evaluate impact of lockdown in CHF patients. Methods 150 out patients from the HF Clinic of our hospital were invited to answer t o a phone-call interview during the 7th week of first C19 lockdown. Results 124 questionnaires were fit for analysis. Almost all patients declared to respect the nationwide lockdown policies. More than one fifth felt worse than before the lockdown and almost one fourth declared a significant psychologic distress (Kessler-6 score≥5). Approximately 10% declared modifications of their CHF medications, always on medical prescription. No patients declared a medication supply failure. Decrease in physical activity was common, almost twice as much in urban than in rural population (50.0 vs 26.2%, P=0.009). Almost half declared increased screen time and 4 of the 9 smokers increased tobacco consumption. Adherence to dietary counselling was reduced by 17.7% of patients. Increase in weight and HF symptoms were commonly reported. During lockdown time frame, 23 patients who benefitted from a teleconsultation, of whom 16 switched from a planned physical examination they cancelled (Fig. 1). Conclusions Our patients with CHF exhibited weel-being impairment and unhealthy behaviours, thus suggesting increased risk of future events. Medication adherence was not diminished and the reduction in care access was counterbalanced by a switch toward telehealth. This work was supported by a grant from Dijon Football Côte d’Or and CHU Dijon Bourgogne.
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Background: COVID-19 outbreak and lockdown is a situation associating social and physical isolation, limited care access, psychological stress, and potential adoption of unhealthy lifestyle behaviours such as smoking. In a cohort of outpatients with chronic cardiac diseases, including congestive heart failure (CHF) and chronic coronary syndromes (CCS), we aimed to evaluate the impact of Covid-19 outbreak on tobacco consumption. Patients and methods: During the 6th week of lockdown (which had started on March, 17th), 150 randomly selected CHF patients (from the Dijon HF-Clinic) and 250 CCS patients from the RICO survey were invited to answer an anonymous questionnaire. The 20-min lasting phone interview was conducted by 8 trained research assistants. The questionnaire, which was validated through internal and external control procedures, addressed medical, lifestyle topics and psychological distress through Kessler 6 score (K6) ≥ 5. Results: Among the 400 patients, 325 were responders (81.2%), including 201 CCS and 124 CHF. Among the current smokers (n = 43), 13 (30.3%) declared increased tobacco consumption, including one woman who started smoking during the lockdown and one man who relapsed after quitting. The main reported explanations for increased smoking was stress (7) and inactivity (5);none declared the influence of media messages on a potential protective effect of nicotine as a cause of increase. Main results are summarized in Table 1. Conclusion: During COVID-19 lockdown, a significant rate of cardiac patients has increased their tobacco consumption, which is often associated with psychological distress and other deleterious lifestyle behaviours, in particular in men. These alarming findings may have major implications for disease destabilization and event recurrence in such high-risk patients at both short and long term. This may help to define preventive strategies to target after lockdown relief in chronic cardiac populations.