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1.
Int J Cardiol ; 266: 56-60, 2018 Sep 01.
Article in English | MEDLINE | ID: mdl-29887473

ABSTRACT

PURPOSE: Aortic stenosis (AS) in bicuspid aortic valve (BAV) remains a challenge for transcatheter aortic valve implantation (TAVI). BAV is a condition encountered in young adults as well as elderly patients. Frequently we face in clinical practice elderly patients with BAV and severe AS, but there is little evidence concerning TAVI in this population. The aim of our study was to compare anatomic features and outcomes of bicuspid and tricuspid patients with AS undergoing TAVI. METHODS: 83 consecutive BAV patients undergoing TAVI were matched, in a 1:2 ratio, to 166 tricuspid patients. Multi-detector computed tomography (MDCT) and transthoracic echocardiogram (TTE) were assessed at baseline. Primary endpoint was all-cause mortality and early safety at 30 days according to Valve Academic Research Consortium criteria 2 (VARC-2). Secondary endpoint included device success. RESULTS: BAV patients presented more aortic root calcifications, smaller diameter of left ventricular outflow tract (LVOT) and dilated aorta. We did not observe any statistically significant difference concerning all-cause mortality and early safety at 30 days. However higher intra-procedural TAV-in-TAV bailout procedure was observed in the BAV cohort, with consequent reduction of device success rate. CONCLUSIONS: Patients with BAV present more complex anatomy at baseline as compared to tricuspid AS patients. These anatomical features lead to more frequent TAV-in-TAV bailout procedure and lower device success rate, but are not associated with higher mortality rate at 30 days. Our findings support the feasibility of TAVI in BAV, but larger studies with longer follow-up and a focus on sizing are required.


Subject(s)
Aortic Valve/abnormalities , Aortic Valve/anatomy & histology , Aortic Valve/diagnostic imaging , Heart Valve Diseases/diagnostic imaging , Transcatheter Aortic Valve Replacement/mortality , Transcatheter Aortic Valve Replacement/trends , Aged , Aged, 80 and over , Bicuspid Aortic Valve Disease , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Mortality/trends , Multidetector Computed Tomography/mortality , Multidetector Computed Tomography/trends , Treatment Outcome
2.
Catheter Cardiovasc Interv ; 89(1): 144-153, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27152677

ABSTRACT

BACKGROUND: Women comprise almost 50% of patients undergoing transcatheter aortic valve replacement (TAVR) and previous studies have indicated higher rates of procedural complications and bleeding in women compared to men. It is unknown whether men and women demonstrate a differential response to bivalirudin versus unfractionated heparin (UFH) in TAVR. We sought to evaluate outcomes by sex and type of anticoagulant from the Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement (BRAVO-3) trial of transfemoral TAVR. METHODS: BRAVO-3 was a randomized multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH (31 centers, n = 802). The primary endpoint was 48 h major bleeding defined as Bleeding Academic Research Consortium (BARC) type ≥3b. Major adverse cardiovascular events (MACE) were a composite of 30-day death, myocardial infarction, or stroke. Net adverse cardiovascular events (NACE) were a composite of BARC ≥3b bleeding or 30-day MACE. We examined the outcomes in men and women. RESULTS: The total cohort included 49% women (n = 391, 195 received bivalirudin and 196 UFH) and 51% men (n = 411, 209 received bivalirudin and 202 UFH). Women were older than men with fewer comorbidities including coronary artery disease, atrial fibrillation, diabetes but similar EuroSCORE I. Women received smaller sheath and device sizes compared with men without differences in the use of vascular closure devices. At 48-hr post-TAVR there was no difference in bleeding or vascular complications in women compared to men. The use of bivalirudin did not result in significantly lower bleeding at 48 hr or 30-days compared to UFH. CONCLUSIONS: There was no difference in early outcomes with bivalirudin versus UFH in men or women undergoing contemporary TAVR. © 2016 Wiley Periodicals, Inc.


Subject(s)
Anticoagulants/therapeutic use , Antithrombins/therapeutic use , Aortic Valve Stenosis/therapy , Aortic Valve , Cardiac Catheterization , Heart Valve Prosthesis Implantation , Heparin/therapeutic use , Peptide Fragments/therapeutic use , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Antithrombins/adverse effects , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Cardiac Catheterization/mortality , Europe , Female , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis Implantation/mortality , Hemorrhage/chemically induced , Heparin/adverse effects , Hirudins/adverse effects , Humans , Male , Multicenter Studies as Topic , Myocardial Infarction/etiology , North America , Peptide Fragments/adverse effects , Randomized Controlled Trials as Topic , Recombinant Proteins/adverse effects , Recombinant Proteins/therapeutic use , Retrospective Studies , Risk Factors , Sex Factors , Stroke/etiology , Time Factors , Treatment Outcome
4.
Biomed Res Int ; 2013: 847069, 2013.
Article in English | MEDLINE | ID: mdl-24175304

ABSTRACT

BACKGROUND: There is no data about the serotonergic activity during the acute phase of Tako-Tsubo Cardiomyopathy (TTC). The objective of our study was to investigate evidence of serotonin release from patients with TTC in comparison with patients with ST elevation myocardial infarction (STEMI) and healthy control subjects (HCS). METHODS AND RESULTS: Plasma serotonin levels in 14 consecutive patients with TTC were compared with those in 14 patients with STEMI and 14 HCS. Plasma serotonin levels at admission were markedly higher in patients with TTC and STEMI as compared to HCS (3.9 ± 4.6, P = 0.02 versus control; 5.7 ± 5.6, P = 0.001 versus control; and 1 ± 0.4 ng/mL, resp.). There was no difference in serotonin levels between patients with TTC and those with STEMI (P = 0.33). CONCLUSION: This finding suggests that serotonin could participate to the pathophysiology of TTC.


Subject(s)
Serotonin/blood , Takotsubo Cardiomyopathy/blood , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Middle Aged , Myocardial Infarction/blood , Myocardial Stunning/blood , Serotonin/physiology , Stress, Physiological , Stress, Psychological , Takotsubo Cardiomyopathy/etiology , Takotsubo Cardiomyopathy/physiopathology
5.
Ann Cardiol Angeiol (Paris) ; 59(6): 362-6, 2010 Dec.
Article in French | MEDLINE | ID: mdl-21056404

ABSTRACT

Cardiogenic shock is the leading cause of in-hospital death for myocardial infarction. Despite therapeutic improvements, such as medical treatment with inotropes, myocardial revascularization, circulatory assistance can be an option. Intra-aortic balloon pumping is highly recommended in the presence of haemodynamic impairment. If the patient continues to deteriorate and cardiac function cannot maintain adequate circulation to prevent end-organ failure, several mechanical circulatory assist devices can be considered: extracorporeal membrane oxygenator (ECMO), Impella(®)… These devices should be used at tertiary centres either as bridge to recovery or as bridge to transplantation or as bridge to long-term left ventricle assist device.


Subject(s)
Heart-Assist Devices , Shock, Cardiogenic/surgery , Humans
6.
Ann Cardiol Angeiol (Paris) ; 56(6): 316-8, 2007 Dec.
Article in French | MEDLINE | ID: mdl-17963717

ABSTRACT

Pseudoaneurysm is a rare complication of left ventricle myocardial infarction. Rupture with tamponade and sudden death is the usual outcome. Surgical intervention remains the treatment of choice. Long term survival cases without surgery are rare. Infection of the thrombus is also a possible event. We report the case of a patient with postinfarction left ventricular pseudoaneurysm complicated by infection of the thrombus and purulent pericarditis involving a peptostreptococcus. Infection must be considered a potential complication of left ventricular pseudoaneurysms.


Subject(s)
Aneurysm, False/complications , Heart Aneurysm/complications , Heart Ventricles/pathology , Pericarditis/etiology , Thrombosis/etiology , Adult , Gram-Positive Bacterial Infections/diagnosis , Humans , Male , Myocardial Infarction/complications , Peptostreptococcus/isolation & purification , Pericarditis/microbiology , Thrombosis/microbiology
7.
J Mol Cell Cardiol ; 42(3): 526-39, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17222424

ABSTRACT

Obesity is a risk factor for heart failure through a set of hemodynamic and hormonal adaptations, but its contribution at the molecular level is not clearly known. Therefore, we investigated the kinetic cardiac transcriptome and metabolome in the Spontaneous Hypertensive Heart Failure (SHHF) rat. The SHHF rat is devoid of leptin signaling when homozygous for a mutation of the leptin receptor (ObR) gene. The ObR-/- SHHF rat is obese at 4 months of age and prone to heart failure after 14 months whereas its lean counterpart ObR-/+ is prone to heart failure after 16 months. We used a set of rat pangenomic high-density macroarrays to monitor left ventricle cardiac transcriptome regulation in 4- and 10-month-old, lean and obese animals. Comparative analysis of left ventricle of 4- and 10-month-old lean rat revealed 222 differentially expressed genes while 4- and 10-month-old obese rats showed 293 differentially expressed genes. (1)H NMR analysis of the metabolome of left ventricular extracts displayed a global decrease of metabolites, except for taurine, and lipid concentration. This may be attributed to gene expression regulation and likely increased extracellular mass. The glutamine to glutamate ratio was significantly lower in the obese group. The relative unsaturation of lipids increased in the obese heart; in particular, omega-3 lipid concentration was higher in the 10-month-old obese heart. Overall, several specific kinetic molecular patterns act as a prelude to heart failure in the leptin signaling deficient SHHF obese rat.


Subject(s)
Glutamates/metabolism , Glutamine/metabolism , Heart Failure/metabolism , Intracellular Membranes/metabolism , Lipid Metabolism , Obesity/metabolism , Transcription, Genetic/genetics , Adaptation, Biological , Aging/physiology , Animals , Gene Expression Profiling , Heart Failure/genetics , Magnetic Resonance Spectroscopy , Male , Multigene Family , Obesity/genetics , Oligonucleotide Array Sequence Analysis , Phenotype , Rats
8.
Arch Mal Coeur Vaiss ; 99(9): 823-7, 2006 Sep.
Article in English | MEDLINE | ID: mdl-17067102

ABSTRACT

The effectiveness of thrombolytics has been clearly demonstrated in more than half the cases in the large cohorts of patients selected for trials during the acute phase of myocardial infarction. At individual level, thrombolysis will clinically either succeed or fail so, for the medical team managing the patient, choice of treatment may be likened to a gamble which in the best of cases (most often) leads to an uncomplicated success and, in the worst of cases, failure worsened by a severe complication. OPTIMAL is a multidisciplinary and multicentre, prospective cohort study associating mobile medical teams and interventional cardiology units to test the hypothesis that the outcome of prehospital thrombolysis does not depend on chance alone but also varies according to demographic, etiological, clinical and logistic factors involved in the occurrence and management of myocardial infarction. The primary objective of this French study, conducted over one year on more than 800 subjects, is to identify the predictors of the results of prehospital thrombolysis from a very early angiographic evaluation. The results for this cohort may be useful for setting up appropriate management strategies for acute myocardial infarction, from the prehospital phase (thrombolysis or not) up to in-hospital orientation of the patients (angiography room or Intensive Care Unit) and to determine the most judicious time for coronary angiography. OPTIMAL is to date the largest prospective serie of prehospital thrombolysis evaluated by an early angiographic control.


Subject(s)
Emergency Medical Services/organization & administration , Myocardial Infarction/drug therapy , Research Design , Thrombolytic Therapy , Coronary Angiography , Data Collection/methods , Electrocardiography , France , Humans , Myocardial Infarction/diagnostic imaging , Patient Selection , Prospective Studies , Registries
9.
Ann Cardiol Angeiol (Paris) ; 55(3): 164-8, 2006 Jun.
Article in French | MEDLINE | ID: mdl-16792035

ABSTRACT

The authors report a case of paroxysmal, complete atrioventricular block during an anterior acute myocardial infarction, leading to asystolia. The different possible physiopathological mechanisms are discussed, suggesting a paroxysmal nodal conduction defect, secondary to transient parasympathetic stimulation, triggered by a Bezold-Jarish type of cardiac reflex. This reflex is frequently involved in various pathologic situations or diagnostic procedures, usual in cardiology. Although it is frequently observed in inferior myocardial infarction, it can occur during an anterior acute myocardial infarction.


Subject(s)
Heart Arrest/etiology , Myocardial Infarction/complications , Aged , Atrial Fibrillation/etiology , Atrioventricular Node/physiopathology , Baroreflex/physiology , Cardiac Pacing, Artificial , Female , Follow-Up Studies , Heart Block/etiology , Humans , Reflex, Abnormal/physiology , Resuscitation
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