Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.056
A. Buschiazzo , G. Lebreton , R. Dorent , E. Flécher , A. Vincentelli , J.-C. Roussel , T. Senage , C.-H. David
Introduction
Predicted heart Mass (PHM) is recommended to assess donor-recipient size matching and predict mortality after heart transplant, based on the UNOS Cohort. UNOS and French cohort presents differences regarding donors and recipients. UNOS and French cohort presents differences regarding donors and recipients.
Objective
To ensure that PHM accurately predicts mortality following heart transplant in France, we assessed survival according to PHM ratio, compared to conventional metrics, in the French cohort.
Method
We analyzed data from the CRISTAL registry (2000–2018), including 5091 heart transplant recipients. For each matching metric, the cohort was divided into 11 equal strata. Survival was assessed at 1 month and 3 years using Kaplan-Meier estimators. Multivariate Cox models were used to compute hazard ratios.
Results
A PHM ratio < 0.825 was associated with significantly increased 1-month mortality (HR 1.45; 95% CI 1.09–2.03; P = 0.044) and 3-year mortality (HR 1.21; 95% CI 1.05–1.39; P = 0.001). No other size-matching metric showed increased risk at 1 month. At 3 years, undersized BSA ratio was also associated with higher mortality (HR 1.66; 95% CI 1.15–2.40; P = 0.034), while other metrics were not significant (Fig. 1).
Conclusion
The PHM ratio is a robust predictor of post-transplant mortality in the French population. We identified a lower threshold (< 0.82) than previously reported, which could enhance donor-recipient matching strategies in France.
基于UNOS队列，推荐使用预测心脏质量（PHM）来评估供体-受体大小匹配和预测心脏移植后的死亡率。UNOS和法国队列在捐赠者和接受者方面存在差异。UNOS和法国队列在捐赠者和接受者方面存在差异。目的：为了确保PHM准确预测法国心脏移植后的死亡率，与传统指标相比，我们根据PHM比率评估法国队列的生存率。方法：我们分析CRISTAL登记处（2000-2018）的数据，包括5091名心脏移植受者。对于每一个匹配的指标，队列被分成11个相等的阶层。使用Kaplan-Meier估计器评估1个月和3年的生存率。多变量Cox模型用于计算风险比。结果sa PHM比0.825与1个月死亡率（HR 1.45; 95% CI 1.09 ~ 2.03; P = 0.044）和3年死亡率（HR 1.21; 95% CI 1.05 ~ 1.39; P = 0.001）显著升高相关。没有其他尺寸匹配指标显示1个月时风险增加。在3年时，过低的BSA比率也与较高的死亡率相关（HR 1.66; 95% CI 1.15-2.40; P = 0.034），而其他指标则不显著（图1）。结论PHM比值是预测法国人群移植后死亡率的可靠指标。我们确定了比以前报道的更低的阈值（< 0.82），这可以增强法国的供体-受者匹配策略。
{"title":"PHM Ratio < 0.82 predicts mortality after heart transplant: Evidence from the French CRISTAL Cohort","authors":"A. Buschiazzo , G. Lebreton , R. Dorent , E. Flécher , A. Vincentelli , J.-C. Roussel , T. Senage , C.-H. David","doi":"10.1016/j.acvd.2025.10.056","DOIUrl":"10.1016/j.acvd.2025.10.056","url":null,"abstract":"<div><h3>Introduction</h3><div>Predicted heart Mass (PHM) is recommended to assess donor-recipient size matching and predict mortality after heart transplant, based on the UNOS Cohort. UNOS and French cohort presents differences regarding donors and recipients. UNOS and French cohort presents differences regarding donors and recipients.</div></div><div><h3>Objective</h3><div>To ensure that PHM accurately predicts mortality following heart transplant in France, we assessed survival according to PHM ratio, compared to conventional metrics, in the French cohort.</div></div><div><h3>Method</h3><div>We analyzed data from the CRISTAL registry (2000–2018), including 5091 heart transplant recipients. For each matching metric, the cohort was divided into 11 equal strata. Survival was assessed at 1 month and 3 years using Kaplan-Meier estimators. Multivariate Cox models were used to compute hazard ratios.</div></div><div><h3>Results</h3><div>A PHM ratio<!--> <!--><<!--> <!-->0.825 was associated with significantly increased 1-month mortality (HR 1.45; 95% CI 1.09–2.03; <em>P</em> <!-->=<!--> <!-->0.044) and 3-year mortality (HR 1.21; 95% CI 1.05–1.39; <em>P</em> <!-->=<!--> <!-->0.001). No other size-matching metric showed increased risk at 1 month. At 3 years, undersized BSA ratio was also associated with higher mortality (HR 1.66; 95% CI 1.15–2.40; <em>P</em> <!-->=<!--> <!-->0.034), while other metrics were not significant (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>The PHM ratio is a robust predictor of post-transplant mortality in the French population. We identified a lower threshold (<<!--> <!-->0.82) than previously reported, which could enhance donor-recipient matching strategies in France.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S31"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.058
G. Coutance , A. Giarraputo , J. Patel , M. Fedrigo , S. Varnous , J.-P. Duong , J. Dagobert , P. Rouvier , P. Leprince , P. Achouh , X. Jouven , P. Bruneval , A. Angelini , J. Kobashigawa , A. Loupy
Introduction
Endomyocardial biopsies (EMB) gene expression profiling is a promising companion tool for rejection diagnosis after heart transplantation. We developped and validated a tissular-based molecular diagnostic system of cardiac allograft rejection.
Objective
Our aim to design an automated report accessible for routine application in clinical practice to support diagnosis of rejection after heart transplantation.
Method
We performed a multicenter, retrospective study (NCT06436027), collecting 591 FFPE-EMBs between 2011 and 2021 representative of the landscape of rejection (antibody-mediated rejection-AMR, n = 188; acute cellular rejection-ACR, n = 289; non-rejection, n = 114). Tissue gene expression was analyzed using the consensus Banff Human Organ Transplant gene panel. Molecular classifiers for AMR and ACR were built using a supervised model, assessing thoroughly the performance. An automated molecular report was developed to provide a comprehensive visualization for clinical use.
Results
In the validation cohort (n = 116), the molecular classifiers demonstrated strong diagnostic performance: AMR detection achieved an accuracy of 81.89% (ROC-AUC = 0.831, Brier score = 0.143), while ACR detection achieved 77.58% accuracy (ROC-AUC = 0.812, Brier score = 0.176). The molecular report provided real-time assessment of molecular-based rejection scores, while allowing to contextualize a novel biopsy within the reference set rejection landscape (Fig. 1). In addition to delivering quantitative scores for AMR and ACR, clinical and biological information are recapitulated in each report, correlating the molecular findings with the pathophysiological insights from primary molecular pathways involved. This tool captured subtle molecular signals in cases of early or sub-clinical rejection, offering insights into potential risks even when histology was inconclusive. The automated nature of the report minimizes variability and considerably reduces turnaround time, seamlessly integrating into clinical workflows.
Conclusion
The molecular diagnostic system, validated and supported by an automated report, demonstrated high reproducibility and reliability in identifying cardiac rejection. This system can complement standard pathology, reduce diagnostic uncertainty, and serve as a practical companion tool in the clinical management of heart transplant patients, ensuring timely and accurate diagnosis.
{"title":"Molecular diagnostic classification for heart allograft rejection: A validated and automated system","authors":"G. Coutance , A. Giarraputo , J. Patel , M. Fedrigo , S. Varnous , J.-P. Duong , J. Dagobert , P. Rouvier , P. Leprince , P. Achouh , X. Jouven , P. Bruneval , A. Angelini , J. Kobashigawa , A. Loupy","doi":"10.1016/j.acvd.2025.10.058","DOIUrl":"10.1016/j.acvd.2025.10.058","url":null,"abstract":"<div><h3>Introduction</h3><div>Endomyocardial biopsies (EMB) gene expression profiling is a promising companion tool for rejection diagnosis after heart transplantation. We developped and validated a tissular-based molecular diagnostic system of cardiac allograft rejection.</div></div><div><h3>Objective</h3><div>Our aim to design an automated report accessible for routine application in clinical practice to support diagnosis of rejection after heart transplantation.</div></div><div><h3>Method</h3><div>We performed a multicenter, retrospective study (<span><span>NCT06436027</span><svg><path></path></svg></span>), collecting 591 FFPE-EMBs between 2011 and 2021 representative of the landscape of rejection (antibody-mediated rejection-AMR, <em>n</em> <!-->=<!--> <!-->188; acute cellular rejection-ACR, <em>n</em> <!-->=<!--> <!-->289; non-rejection, <em>n</em> <!-->=<!--> <!-->114). Tissue gene expression was analyzed using the consensus Banff Human Organ Transplant gene panel. Molecular classifiers for AMR and ACR were built using a supervised model, assessing thoroughly the performance. An automated molecular report was developed to provide a comprehensive visualization for clinical use.</div></div><div><h3>Results</h3><div>In the validation cohort (<em>n</em> <!-->=<!--> <!-->116), the molecular classifiers demonstrated strong diagnostic performance: AMR detection achieved an accuracy of 81.89% (ROC-AUC<!--> <!-->=<!--> <!-->0.831, Brier score<!--> <!-->=<!--> <!-->0.143), while ACR detection achieved 77.58% accuracy (ROC-AUC<!--> <!-->=<!--> <!-->0.812, Brier score<!--> <!-->=<!--> <!-->0.176). The molecular report provided real-time assessment of molecular-based rejection scores, while allowing to contextualize a novel biopsy within the reference set rejection landscape (<span><span>Fig. 1</span></span>). In addition to delivering quantitative scores for AMR and ACR, clinical and biological information are recapitulated in each report, correlating the molecular findings with the pathophysiological insights from primary molecular pathways involved. This tool captured subtle molecular signals in cases of early or sub-clinical rejection, offering insights into potential risks even when histology was inconclusive. The automated nature of the report minimizes variability and considerably reduces turnaround time, seamlessly integrating into clinical workflows.</div></div><div><h3>Conclusion</h3><div>The molecular diagnostic system, validated and supported by an automated report, demonstrated high reproducibility and reliability in identifying cardiac rejection. This system can complement standard pathology, reduce diagnostic uncertainty, and serve as a practical companion tool in the clinical management of heart transplant patients, ensuring timely and accurate diagnosis.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S32-S33"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.080
A. Bouchlarhem, Z. Bazid, N. Ismaili, E.O. Noha
Introduction
The early introduction of SGLT2 inhibitors during acute heart failure was studied in the empulse trial with positive results, but limited reel-world data are currently available.
Objective
Assessing the efficacy of early introducing of ISGLT2 during the acute heart failure.
Method
We prospectively analyzed patients admitted for acute heart failure with an ejection fraction of less than 40%. We excluded patients with glomerular filtration rate (GFR) < 20 ml/min, cardiogenic shock, and ejection fraction > 40%. We studied all-cause mortality as the primary outcome, and as secondary outcomes the duration of decongestion and pro-BNP levels at discharge.
Results
We included 516 patients who met the inclusion criteria. Early introduction of ISGLT2 was adopted in 270 patients (52.8%). No differences were observed in mean age (ISGLT vs. standard car;65.89 vs 65.58 years; P = 0.129), female gender (38.9% vs. 38.2%; P = 0.473), diabetes (48.1% vs. 51.6%; P = 0.242) and hypertension (44.4% vs. 45.5%; P = 0.437). At admission, Ejection fraction was higher in the ISGLT2 group (34% vs. 32%; P = 0.033), and systolic pulmonary pressure was lower (37.4mmhg vs. 41.5mmhg; P < 0.001).GFR was higher in the ISGLT2 group (72 vs 64 ml/min; P = 0.005), with lower Pro-BNP levels in this group but without significant difference (7635 vs 9839 ng/ml; P = 0.063).
Over a mean follow-up of 22 months, the primary endpoint was observed in 95 patients (18.4%), with significantly higher mortality in the standard group (28.5% vs. 9.3%; P < 0.001). After multivariate adjusted Cox proportional hazards analysis, early introduction of ISGLT2 was independently associated with a 23% reduction in all-cause mortality with (HR: 0. 862; 95%CI; 0.444–0.902; P = 0.039), as well as a significant difference on Kaplein meirer survival analysis (Log-rank test P < 0.001) (Fig. 1). For the secondary endpoints, the introduction of ISGLT2 significantly reduced the duration of decongestion (6.25 days in vs. 7.37 days; P = 0.017; with a mean reduction of 1.17 days). ISGLT2 also significantly reduced Pro-BNP levels at discharge (3986 vs. 7029 ng/ml; P = 0.001).
Conclusion
The results of our study support the hypothesis that SGLT2 should not only be introduced in HFrEF patients, but should also be rapidly introduced even during acute heart failure.
在搏动试验中研究了急性心力衰竭期间早期引入SGLT2抑制剂的积极结果，但目前可获得的数据有限。目的评价急性心力衰竭早期引入ISGLT2的疗效。方法前瞻性分析射血分数小于40%的急性心力衰竭患者。我们排除了肾小球滤过率(GFR)≤20ml /min、心源性休克和射血分数≤40%的患者。我们研究了全因死亡率作为主要结局，次要结局是去充血持续时间和出院时的亲bnp水平。结果纳入516例符合纳入标准的患者。270例患者（52.8%）采用早期引入ISGLT2。在平均年龄（ISGLT vs.标准组；65.89 vs. 65.58岁；P = 0.129）、女性（38.9% vs. 38.2%; P = 0.473）、糖尿病（48.1% vs. 51.6%; P = 0.242）和高血压（44.4% vs. 45.5%; P = 0.437）方面均无差异。入院时，ISGLT2组的射血分数较高（34% vs. 32%; P = 0.033），收缩压较低（37.4mmhg vs. 41.5mmhg; P < 0.001）。ISGLT2组GFR较高（72 vs 64 ml/min; P = 0.005），该组Pro-BNP水平较低，但无显著差异（7635 vs 9839 ng/ml; P = 0.063）。在平均22个月的随访中，95例患者（18.4%）观察到主要终点，标准组的死亡率明显更高（28.5%比9.3%;P < 0.001）。经过多因素调整Cox比例风险分析，早期引入ISGLT2与全因死亡率降低23% （HR: 0）独立相关。862年;95%可信区间;0.444 - -0.902;P = 0.039)，在Kaplein meier生存分析中差异有统计学意义（Log-rank检验P <； 0.001）（图1）。对于次要终点，引入ISGLT2显著减少了缓解充血的持续时间（6.25天vs. 7.37天；P = 0.017；平均减少1.17天）。ISGLT2还显著降低了放电时Pro-BNP水平（3986 vs 7029 ng/ml; P = 0.001）。结论我们的研究结果支持SGLT2不仅应该在HFrEF患者中引入，甚至在急性心力衰竭时也应该快速引入的假设。
{"title":"Early introduction of SGLT2 inhibitors in patients with Heart Failure reduced ejection fraction hospitalized for acute heart failure: Results from Real-world observations","authors":"A. Bouchlarhem, Z. Bazid, N. Ismaili, E.O. Noha","doi":"10.1016/j.acvd.2025.10.080","DOIUrl":"10.1016/j.acvd.2025.10.080","url":null,"abstract":"<div><h3>Introduction</h3><div>The early introduction of SGLT2 inhibitors during acute heart failure was studied in the empulse trial with positive results, but limited reel-world data are currently available.</div></div><div><h3>Objective</h3><div>Assessing the efficacy of early introducing of ISGLT2 during the acute heart failure.</div></div><div><h3>Method</h3><div>We prospectively analyzed patients admitted for acute heart failure with an ejection fraction of less than 40%. We excluded patients with glomerular filtration rate (GFR)<!--> <!--><<!--> <!-->20<!--> <!-->ml/min, cardiogenic shock, and ejection fraction<!--> <!-->><!--> <!-->40%. We studied all-cause mortality as the primary outcome, and as secondary outcomes the duration of decongestion and pro-BNP levels at discharge.</div></div><div><h3>Results</h3><div>We included 516 patients who met the inclusion criteria. Early introduction of ISGLT2 was adopted in 270 patients (52.8%). No differences were observed in mean age (ISGLT vs. standard car;65.89 vs 65.58 years; <em>P</em> <!-->=<!--> <!-->0.129), female gender (38.9% vs. 38.2%; <em>P</em> <!-->=<!--> <!-->0.473), diabetes (48.1% vs. 51.6%; <em>P</em> <!-->=<!--> <!-->0.242) and hypertension (44.4% vs. 45.5%; <em>P</em> <!-->=<!--> <!-->0.437). At admission, Ejection fraction was higher in the ISGLT2 group (34% vs. 32%; <em>P</em> <!-->=<!--> <!-->0.033), and systolic pulmonary pressure was lower (37.4mmhg vs. 41.5mmhg; <em>P</em> <!--><<!--> <!-->0.001).GFR was higher in the ISGLT2 group (72 vs 64<!--> <!-->ml/min; <em>P</em> <!-->=<!--> <!-->0.005), with lower Pro-BNP levels in this group but without significant difference (7635 vs 9839<!--> <!-->ng/ml; <em>P</em> <!-->=<!--> <!-->0.063).</div><div>Over a mean follow-up of 22 months, the primary endpoint was observed in 95 patients (18.4%), with significantly higher mortality in the standard group (28.5% vs. 9.3%; <em>P</em> <!--><<!--> <!-->0.001). After multivariate adjusted Cox proportional hazards analysis, early introduction of ISGLT2 was independently associated with a 23% reduction in all-cause mortality with (HR: 0. 862; 95%CI; 0.444–0.902; <em>P</em> <!-->=<!--> <!-->0.039), as well as a significant difference on Kaplein meirer survival analysis (Log-rank test <em>P</em> <!--><<!--> <!-->0.001) (<span><span>Fig. 1</span></span>). For the secondary endpoints, the introduction of ISGLT2 significantly reduced the duration of decongestion (6.25 days in vs. 7.37 days; <em>P</em> <!-->=<!--> <!-->0.017; with a mean reduction of 1.17 days). ISGLT2 also significantly reduced Pro-BNP levels at discharge (3986 vs. 7029<!--> <!-->ng/ml; <em>P</em> <!-->=<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>The results of our study support the hypothesis that SGLT2 should not only be introduced in HFrEF patients, but should also be rapidly introduced even during acute heart failure.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S46"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.086
A. Zaroui , S. Belaid , M. Kharoubi , S. Oghina , S. Odouard , E. Teiger , T. Damy
Introduction
Cardiac amyloidosis (CA), including light chain (AL), hereditary transthyretin (ATTRv), and wild-type transthyretin (ATTRwt), leads to heart failure (HF). Cardiologists use the ESC guidelines to classify patients with HF tailoring HF treatment accordingly. CA is commonly associated with HFpEF, with a smaller proportion presenting with HFmrEF and HFrEF.
Objective
This study aimed to assess the distribution of HF types in CA and their relationship with other left ventricular (LV) systolic function parameters such as global longitudinal strain (GLS) and cardiac index (CI) across amyloidosis subtypes.
Method
We retrospectively included symptomatic AL, ATTRv, and ATTRwt CA patients from our French referral center. LVEF was classified per ESC guidelines and compared to GLS and CI. Survival was assessed using Kaplan-Meier analyses and Cox regression. A decision tree incorporating LVEF, GLS, and CI was used to stratify patients into prognostic groups.
Results
Among 2244 patients, 557 AL, 392 ATTRv, 1137A TTRwt. Of these, 61.4% presented with HFpEF, 19.0% with HFmrEF, and 19.6% with HFrEF. In AL, 13.6%, 18%, and 68.4% were classified as HFrEF, HFmrEF, and HFpEF, respectively. In ATTRv, 28.3%, 15.3%, and 56.4% were HFrEF, HFmrEF, and HFpEF, respectively. In ATTRwt, 20.2%, 21.2%, and 58.6% were HFrEF, HFmrEF, and HFpEF, respectively. LVEF correlated moderately with GLS (r = 0.673), with stronger correlations in ATTRv (r = 0.776) compared to AL (r = 0.650) and ATTRwt (r = 0.644). LVEF correlated weakly with CI (r = 0.392). Median survival was 7 months [3–31] for AL, 28 months [12–54] for ATTRv, and 23 months [10–38] for ATTRwt. Survival differed by HF type: 30 months [18–41] for HFrEF, 40 months [20–42] for HFmrEF, and 51% survival at 48 months for HFpEF. A CI ≤ 1.96 L/min/m2 was associated with a median survival of 29 months [17–37], with better outcomes in higher CI quartiles. A decision tree identified four prognostic groups, with hazard ratios for 4-year mortality ranging from 1.63 (LVEF ≥ 50%, GLS ≤ 11%) to 3.68 (LVEF ≤ 49%, CI ≤ 1.96 L/min/m2), reaching 12.34 in AL amyloidosis for the most severe group.
Conclusion
In CA, about 40% of patients present with reduced LVEF. Cardiologists should be aware that CA is not exclusively associated with HFpEF and that patients with reduced LVEF have worse prognosis. LV systolic function, assessed via LVEF, GLS, and CI, is a critical predictor of survival in CA, with distinct patterns across AL, ATTRv, and ATTRwt subtypes.
{"title":"Cardiac amyloidosis and heart failure phenotypes: A prognostic study of systolic function markers","authors":"A. Zaroui , S. Belaid , M. Kharoubi , S. Oghina , S. Odouard , E. Teiger , T. Damy","doi":"10.1016/j.acvd.2025.10.086","DOIUrl":"10.1016/j.acvd.2025.10.086","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac amyloidosis (CA), including light chain (AL), hereditary transthyretin (ATTRv), and wild-type transthyretin (ATTRwt), leads to heart failure (HF). Cardiologists use the ESC guidelines to classify patients with HF tailoring HF treatment accordingly. CA is commonly associated with HFpEF, with a smaller proportion presenting with HFmrEF and HFrEF.</div></div><div><h3>Objective</h3><div>This study aimed to assess the distribution of HF types in CA and their relationship with other left ventricular (LV) systolic function parameters such as global longitudinal strain (GLS) and cardiac index (CI) across amyloidosis subtypes.</div></div><div><h3>Method</h3><div>We retrospectively included symptomatic AL, ATTRv, and ATTRwt CA patients from our French referral center. LVEF was classified per ESC guidelines and compared to GLS and CI. Survival was assessed using Kaplan-Meier analyses and Cox regression. A decision tree incorporating LVEF, GLS, and CI was used to stratify patients into prognostic groups.</div></div><div><h3>Results</h3><div>Among 2244 patients, 557 AL, 392 ATTRv, 1137A TTRwt. Of these, 61.4% presented with HFpEF, 19.0% with HFmrEF, and 19.6% with HFrEF. In AL, 13.6%, 18%, and 68.4% were classified as HFrEF, HFmrEF, and HFpEF, respectively. In ATTRv, 28.3%, 15.3%, and 56.4% were HFrEF, HFmrEF, and HFpEF, respectively. In ATTRwt, 20.2%, 21.2%, and 58.6% were HFrEF, HFmrEF, and HFpEF, respectively. LVEF correlated moderately with GLS (<em>r</em> <!-->=<!--> <!-->0.673), with stronger correlations in ATTRv (<em>r</em> <!-->=<!--> <!-->0.776) compared to AL (<em>r</em> <!-->=<!--> <!-->0.650) and ATTRwt (<em>r</em> <!-->=<!--> <!-->0.644). LVEF correlated weakly with CI (<em>r</em> <!-->=<!--> <!-->0.392). Median survival was 7 months [3–31] for AL, 28 months [12–54] for ATTRv, and 23 months [10–38] for ATTRwt. Survival differed by HF type: 30 months [18–41] for HFrEF, 40 months [20–42] for HFmrEF, and 51% survival at 48 months for HFpEF. A CI<!--> <!-->≤<!--> <!-->1.96<!--> <!-->L/min/m<sup>2</sup> was associated with a median survival of 29 months [17–37], with better outcomes in higher CI quartiles. A decision tree identified four prognostic groups, with hazard ratios for 4-year mortality ranging from 1.63 (LVEF<!--> <!-->≥<!--> <!-->50%, GLS<!--> <!-->≤<!--> <!-->11%) to 3.68 (LVEF<!--> <!-->≤<!--> <!-->49%, CI<!--> <!-->≤<!--> <!-->1.96 L/min/m<sup>2</sup>), reaching 12.34 in AL amyloidosis for the most severe group.</div></div><div><h3>Conclusion</h3><div>In CA, about 40% of patients present with reduced LVEF. Cardiologists should be aware that CA is not exclusively associated with HFpEF and that patients with reduced LVEF have worse prognosis. LV systolic function, assessed via LVEF, GLS, and CI, is a critical predictor of survival in CA, with distinct patterns across AL, ATTRv, and ATTRwt subtypes.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S49"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.090
P. Lemiere , J. Quilici , A.-S. Canu , L. Querion , E. Saunier , A. Vaudron
Introduction
Heart failure (HF) remains a leading cause of hospitalization and mortality worldwide. Remote monitoring programs (RMP) are increasingly implemented to optimize care, yet their real-world impact on hospitalized patient characteristics remains underexplored.
Objective
This study aimed to assess changes in the clinical profiles and outcomes of patients hospitalized for acute heart failure (AHF) before and after the implementation of a RMP in a rural cardiology department.
Method
We conducted a retrospective, single-center, study focusing HF-related hospitalizations (HFRH) in two periods: 2018–2019 with standard care; and 2023–2024 post RMP implementation, combining non-invasive remote weight monitoring, therapeutic education, and early home-based intervention by a mobile HF team. Data were extracted using ICD-10 codes.
Results
Among 4092 admissions, we selected 1364 HFRH (610 in 2018–2019 vs. 754 in 2023–2024), patients in the post RMP period showed higher severity (High GHM levels 51.5% vs. 45.6%, P = 0.031; mean IGS2 score: 37.7 vs. 35.1, P < 0.0001), longer hospital stays (mean 9.5 vs. 8.9 days, P < 0.001), more emergency admissions (66.6% vs. 39.4%, P < 0.0001), non-significant increased mortality (6.1% vs 3.9%, P 0.07). However, rehospitalizations decreased (13.4% vs. 18.1%, P = 0.03), and discharges to home increased (61.0% vs. 49.3%, P < 0.0001) (Fig. 1).
Conclusion
The implementation of the RMP improved post-discharge outcomes and was associated with a shift toward hospitalization of more severe heart failure patients, likely reflecting earlier outpatient management of milder cases. These findings support telemonitoring as an effective tool in real-world heart failure management and underscore its role in the ongoing digital transformation of care pathways.
{"title":"Effect of telemonitoring implementation on heart failure hospitalization profiles: A real-world analysis","authors":"P. Lemiere , J. Quilici , A.-S. Canu , L. Querion , E. Saunier , A. Vaudron","doi":"10.1016/j.acvd.2025.10.090","DOIUrl":"10.1016/j.acvd.2025.10.090","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) remains a leading cause of hospitalization and mortality worldwide. Remote monitoring programs (RMP) are increasingly implemented to optimize care, yet their real-world impact on hospitalized patient characteristics remains underexplored.</div></div><div><h3>Objective</h3><div>This study aimed to assess changes in the clinical profiles and outcomes of patients hospitalized for acute heart failure (AHF) before and after the implementation of a RMP in a rural cardiology department.</div></div><div><h3>Method</h3><div>We conducted a retrospective, single-center, study focusing HF-related hospitalizations (HFRH) in two periods: 2018–2019 with standard care; and 2023–2024 post RMP implementation, combining non-invasive remote weight monitoring, therapeutic education, and early home-based intervention by a mobile HF team. Data were extracted using ICD-10 codes.</div></div><div><h3>Results</h3><div>Among 4092 admissions, we selected 1364 HFRH (610 in 2018–2019 vs. 754 in 2023–2024), patients in the post RMP period showed higher severity (High GHM levels 51.5% vs. 45.6%, <em>P</em> <!-->=<!--> <!-->0.031; mean IGS2 score: 37.7 vs. 35.1, <em>P</em> <!--><<!--> <!-->0.0001), longer hospital stays (mean 9.5 vs. 8.9 days, <em>P</em> <!--><<!--> <!-->0.001), more emergency admissions (66.6% vs. 39.4%, <em>P</em> <!--><<!--> <!-->0.0001), non-significant increased mortality (6.1% vs 3.9%, <em>P</em> 0.07). However, rehospitalizations decreased (13.4% vs. 18.1%, <em>P</em> <!-->=<!--> <!-->0.03), and discharges to home increased (61.0% vs. 49.3%, <em>P</em> <!--><<!--> <!-->0.0001) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>The implementation of the RMP improved post-discharge outcomes and was associated with a shift toward hospitalization of more severe heart failure patients, likely reflecting earlier outpatient management of milder cases. These findings support telemonitoring as an effective tool in real-world heart failure management and underscore its role in the ongoing digital transformation of care pathways.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S51"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.006
M.C. Vu , A. Trimaille , A. Granier , A. Carmona , A. Elidrissi , M. Kibler , L. Jesel , P. Olhmann , L. Sattler , O. Morel
Introduction
Unfractionated heparin (UFH) remains the standard anticoagulant during percutaneous coronary intervention (PCI), with guidelines recommending a target activated clotting time (ACT) ≥ 250 seconds. However, despite receiving a standardized bolus dose, many patients fail to achieve this target.
Objective
To evaluate the effectiveness of standard UFH bolus dosing in achieving target ACT and to identify patient-related factors associated with suboptimal anticoagulant response.
Method
This single-center, prospective, observational study included 171 adult patients undergoing PCI between October 2024 and April 2025. All patients received a 100-IU/kg intravenous UFH bolus immediately prior to PCI. ACT was measured 5 minutes post-administration, additional 50 IU/kg boluses were given as needed to achieve the target ACT ≥ 250 seconds. The primary endpoint was the percentage of patients achieving this target. The secondary endpoint was the identification of factors associated with suboptimal anticoagulation.
Results
Among 171 patients (mean age, 68 ± 12 years; 26.3% women), the target ACT was achieved in 35.7% (n = 61), while 64.3% (n = 110) did not (Table 1). Active smoking was independently associated with failure to reach the target ACT (adjusted OR, 6.06; 95% CI, 1.41 to 43.8; P = 0.032) (Fig. 1). Despite similar initial UFH dosing and timing to ACT measurement, smokers had significantly lower ACT values (P < 0.001) and required higher cumulative UFH dose during PCI (P = 0.043) (Fig. 2). Propensity score matching confirmed this independent association (P = 0.004) (Fig. 3).
Conclusion
Nearly two-thirds of patients failed to achieve the recommended target ACT following a standard UFH bolus during PCI, in which active smoking was independently associated with a more than sixfold reduction in the likelihood of reaching therapeutic anticoagulation.
{"title":"Variability in ACT response to standard UFH bolus during PCI: A prospective study on determinants of subtherapeutic anticoagulation","authors":"M.C. Vu , A. Trimaille , A. Granier , A. Carmona , A. Elidrissi , M. Kibler , L. Jesel , P. Olhmann , L. Sattler , O. Morel","doi":"10.1016/j.acvd.2025.10.006","DOIUrl":"10.1016/j.acvd.2025.10.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Unfractionated heparin (UFH) remains the standard anticoagulant during percutaneous coronary intervention (PCI), with guidelines recommending a target activated clotting time (ACT)<!--> <!-->≥<!--> <!-->250<!--> <!-->seconds. However, despite receiving a standardized bolus dose, many patients fail to achieve this target.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of standard UFH bolus dosing in achieving target ACT and to identify patient-related factors associated with suboptimal anticoagulant response.</div></div><div><h3>Method</h3><div>This single-center, prospective, observational study included 171 adult patients undergoing PCI between October 2024 and April 2025. All patients received a 100-IU/kg intravenous UFH bolus immediately prior to PCI. ACT was measured 5<!--> <!-->minutes post-administration, additional 50<!--> <!-->IU/kg boluses were given as needed to achieve the target ACT<!--> <!-->≥<!--> <!-->250<!--> <!-->seconds. The primary endpoint was the percentage of patients achieving this target. The secondary endpoint was the identification of factors associated with suboptimal anticoagulation.</div></div><div><h3>Results</h3><div>Among 171 patients (mean age, 68<!--> <!-->±<!--> <!-->12 years; 26.3% women), the target ACT was achieved in 35.7% (<em>n</em> <!-->=<!--> <!-->61), while 64.3% (<em>n</em> <!-->=<!--> <!-->110) did not (<span><span>Table 1</span></span>). Active smoking was independently associated with failure to reach the target ACT (adjusted OR, 6.06; 95% CI, 1.41 to 43.8; <em>P</em> <!-->=<!--> <!-->0.032) (<span><span>Fig. 1</span></span>). Despite similar initial UFH dosing and timing to ACT measurement, smokers had significantly lower ACT values (<em>P</em> <!--><<!--> <!-->0.001) and required higher cumulative UFH dose during PCI (<em>P</em> <!-->=<!--> <!-->0.043) (<span><span>Fig. 2</span></span>). Propensity score matching confirmed this independent association (<em>P</em> <!-->=<!--> <!-->0.004) (<span><span>Fig. 3</span></span>).</div></div><div><h3>Conclusion</h3><div>Nearly two-thirds of patients failed to achieve the recommended target ACT following a standard UFH bolus during PCI, in which active smoking was independently associated with a more than sixfold reduction in the likelihood of reaching therapeutic anticoagulation.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S7-S8"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.007
C. Thuaire, F. Bahri, A. Benjemaa, C.A.B. Samb, R. Hakim, G. Rangé, F. Albert
Introduction
Coronary computed tomography angiography (CCTA) has become a first-line imaging modality for the diagnosis of coronary atherosclerosis in patients with chronic coronary syndrome (CCS). It is primarily considered a means to reduce unnecessary invasive procedures, particularly normal or non-significant coronary angiographies.
Objective
To evaluate the impact of the implementation of a daily CCTA activity on the rate and diagnostic yield of invasive coronary angiographies performed for CCS at Chartres Hospital.
Method
In February 2024, daily CCTA was introduced at Chartres Hospital using a Canon Aquilion One® wide-detector CT scanner (16 cm coverage). Each scan was systematically coupled with a cardiology consultation at the time of result delivery, including treatment prescription and patient orientation based on CAD-RADS classification. A total of 2490 CCTAs were performed over the year, representing a 2.9-fold increase in imaging activity compared to previous years.
Using data from the France PCI registry, we assessed the impact of this implementation on coronary angiographies performed for stable angina and/or silent ischemia by comparing the rates of normal angiograms, lesions < 50%, and lesions > 50% from February 2024 to April 2025 against the mean of the three previous years (February 2021 to January 2024).
Results
Although total annual coronary angiography volume did not significantly increase (adjusted total for 2024–2025: 846 patients vs. 701 in previous years; P = 0.13), we observed a significant rise in the number of angiographies with lesions < 50% (248 vs. 181; P = 0.029), but more importantly a highly significant increase in angiographies showing lesions > 50%: monovessel (245 vs. 155; P = 0.0017), bivessel (197 vs. 113; P = 0.0009), and trivessel disease (169 vs. 119; P = 0.045).
Conclusion
Compared to the average of the three previous years, daily CCTA implementation did not significantly change the overall volume of coronary angiography in CCS patients in our center, nor did it significantly reduce the rate of normal angiograms. However, it was associated with a moderate but significant increase in < 50% lesions, and most importantly a marked and highly significant increase in angiographies with > 50% stenosis.
Daily CCTA combined with structured cardiology consultation improves patient selection and substantially enhances the diagnostic yield of invasive coronary angiography.
冠状动脉ct血管造影（CCTA）已成为慢性冠状动脉综合征（CCS）患者冠状动脉粥样硬化诊断的一线成像方式。它主要被认为是一种减少不必要的侵入性手术的手段，特别是正常或不重要的冠状动脉造影。目的评价每日CCTA活动对Chartres医院有创冠状动脉造影诊断率和诊断率的影响。方法2024年2月，Chartres医院开始使用Canon Aquilion One®宽探测器CT扫描仪（16 cm覆盖范围）进行每日CCTA。每次扫描在结果发布时系统地与心脏病学咨询相结合，包括基于CAD-RADS分类的治疗处方和患者定位。全年共进行了2490次ccta，与前几年相比，成像活动增加了2.9倍。使用来自法国PCI登记处的数据，我们通过比较2024年2月至2025年4月正常血管造影、病变<； 50%和病变>； 50%与前三年（2021年2月至2024年1月）的平均值，评估了该实施对稳定性心绞痛和/或无症状缺血进行冠状动脉造影的影响。ResultsAlthough年度冠状动脉造影总量没有显著增加(2024 - 2025年调整后的总:846名患者和701名在前几年;P = 0.13),我们观察到显著上升的数量与病变血管摄影& lt; 50% (248 vs 181; P = 0.029),但更重要的是一个高度显著增加血管造影显示病变在50%:monovessel (245 vs 155; P = 0.0017), bivessel (197 vs 113; P = 0.0009),和trivessel疾病(169 vs 119; P = 0.045)。结论与前三年的平均值相比，每日CCTA的实施并没有显著改变我中心CCS患者冠状动脉造影总容积，也没有显著降低正常血管造影率。然而，它与中度但显著增加50%病变相关，最重要的是，血管造影显示50%狭窄的显著且高度显著增加。每日CCTA结合结构化的心脏病学会诊，改善了患者的选择，大大提高了有创冠状动脉造影的诊断率。
{"title":"Impact of daily coronary CT angiography implementation on invasive coronary angiography in chronic coronary syndrome: A single-center experience","authors":"C. Thuaire, F. Bahri, A. Benjemaa, C.A.B. Samb, R. Hakim, G. Rangé, F. Albert","doi":"10.1016/j.acvd.2025.10.007","DOIUrl":"10.1016/j.acvd.2025.10.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Coronary computed tomography angiography (CCTA) has become a first-line imaging modality for the diagnosis of coronary atherosclerosis in patients with chronic coronary syndrome (CCS). It is primarily considered a means to reduce unnecessary invasive procedures, particularly normal or non-significant coronary angiographies.</div></div><div><h3>Objective</h3><div>To evaluate the impact of the implementation of a daily CCTA activity on the rate and diagnostic yield of invasive coronary angiographies performed for CCS at Chartres Hospital.</div></div><div><h3>Method</h3><div>In February 2024, daily CCTA was introduced at Chartres Hospital using a Canon Aquilion One® wide-detector CT scanner (16<!--> <!-->cm coverage). Each scan was systematically coupled with a cardiology consultation at the time of result delivery, including treatment prescription and patient orientation based on CAD-RADS classification. A total of 2490 CCTAs were performed over the year, representing a 2.9-fold increase in imaging activity compared to previous years.</div><div>Using data from the France PCI registry, we assessed the impact of this implementation on coronary angiographies performed for stable angina and/or silent ischemia by comparing the rates of normal angiograms, lesions<!--> <!--><<!--> <!-->50%, and lesions<!--> <!-->><!--> <!-->50% from February 2024 to April 2025 against the mean of the three previous years (February 2021 to January 2024).</div></div><div><h3>Results</h3><div>Although total annual coronary angiography volume did not significantly increase (adjusted total for 2024–2025: 846 patients vs. 701 in previous years; <em>P</em> <!-->=<!--> <!-->0.13), we observed a significant rise in the number of angiographies with lesions<!--> <!--><<!--> <!-->50% (248 vs. 181; <em>P</em> <!-->=<!--> <!-->0.029), but more importantly a highly significant increase in angiographies showing lesions<!--> <!-->><!--> <!-->50%: monovessel (245 vs. 155; <em>P</em> <!-->=<!--> <!-->0.0017), bivessel (197 vs. 113; <em>P</em> <!-->=<!--> <!-->0.0009), and trivessel disease (169 vs. 119; <em>P</em> <!-->=<!--> <!-->0.045).</div></div><div><h3>Conclusion</h3><div>Compared to the average of the three previous years, daily CCTA implementation did not significantly change the overall volume of coronary angiography in CCS patients in our center, nor did it significantly reduce the rate of normal angiograms. However, it was associated with a moderate but significant increase in<!--> <!--><<!--> <!-->50% lesions, and most importantly a marked and highly significant increase in angiographies with<!--> <!-->><!--> <!-->50% stenosis.</div><div>Daily CCTA combined with structured cardiology consultation improves patient selection and substantially enhances the diagnostic yield of invasive coronary angiography.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S8-S9"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.072
O. Simon , A. Quessard , N. Labaste , P.-G. Guinot , N. Nesseler , A. Beurton , P. Gaudard , A. Ouattara
Introduction
Among patients treated by temporary mechanical circulatory support (tMCS) for refractory cardiogenic shock, some of them suffer from persistent cardiac dysfunction incompatible with a successful weaning. In eligible patients, the heart transplantation is still the gold standard therapy. However, due to the shortage of grafts and/or contraindications, some patients will not be transplanted. In these patients, for whom the Left ventricular Assist Device (LVAD) represents an alternative therapy, the best approach of tMCS as a bridge to durable LVAD remains to be clarified.
Objective
We tested the hypothesis that the use of IMPELLA® as bridge to LVAD should improve early postoperative outcomes by offering the opportunité of active rehabilitation under tMCS.
Method
The ECI-BLAD trial was a multicentre retrospective study including adults, supported with IMPELLA® or ECLS as a bridge to LVAD between January 2012 and December 2020 in 5 French cardiac intensive care units. The IMPELLA® group included patients assisted by an IMPELLA® alone at least five days prior the implantation of the LVAD while the ECLS group included patients treated by a ECLS with or without IMPELLA®. The primary endpoint was the proportion of patients alive with a John Hopkins Highest Level of Mobility score = 8, discharged from the critical care unit and not perfused at 30 days after LVAD implantation. Secondary endpoints included rehabilitation under tMCS (tracheal extubation, mobilization to chair, walking and cyclo-ergometer), 6-month survival rate after the LVAD implantation. This study was approved by our ethics committee and registered on Clinical trials (NCT04480151).
Results
From 388 consecutive patients implanted by LVAD, 92 patients treated as bridge to LVAD have been included in our study (ECLS group n = 42/IMPELLA group n = 50). Most of patients of IMPELLA group (72%) were implanted through an axillary approach. Early mobilization on tMCS was more frequently achieved in IMPELLA group (seating 50% vs 2%, P < 0.001 and walking 18% vs 0%, P < 0.01). A larger proportion of patients in IMPELLA group reached the primary endpoint (52% vs 26%, P = 0.018). The 6-month survival rate after LVAD implantation was significantly better in IMPELLA group (Fig. 1).
Conclusion
Implantation of IMPELLA through axillary approach as bridge to LVAD by allowing active and early rehabilitation might be associated with better outcomes.
在接受临时机械循环支持（tMCS）治疗难治性心源性休克的患者中，一些患者患有持续性心功能障碍，与成功脱机不相容。在符合条件的患者中，心脏移植仍然是金标准治疗。然而，由于移植物短缺和/或禁忌症，一些患者不会进行移植。在这些患者中，左心室辅助装置（LVAD）是一种替代疗法，tMCS作为持久左心室辅助装置的桥梁的最佳方法仍有待明确。目的：通过提供tMCS下主动康复的机会，我们验证了使用IMPELLA®作为LVAD桥应改善早期术后预后的假设。ECI-BLAD试验是一项多中心回顾性研究，包括成人，在2012年1月至2020年12月期间，在5个法国心脏重症监护病房中使用IMPELLA®或ECLS作为LVAD的桥梁。IMPELLA®组包括在LVAD植入前至少5天单独使用IMPELLA®辅助的患者，而ECLS组包括使用或不使用IMPELLA®的ECLS治疗的患者。主要终点是在LVAD植入后30天，John Hopkins最高活动水平评分= 8、从重症监护病房出院且未进行灌注的存活患者比例。次要终点包括tMCS下的康复（气管拔管，椅子活动，步行和循环计劳器），LVAD植入后6个月的生存率。本研究经伦理委员会批准，注册临床试验（NCT04480151）。结果在连续388例LVAD植入患者中，92例作为LVAD桥接患者纳入我们的研究（ECLS组42例/IMPELLA组50例）。IMPELLA组大部分患者（72%）采用腋窝入路植入术。IMPELLA组在tMCS上的早期活动更频繁（坐下50%对2%，P < 0.001，步行18%对0%，P < 0.01）。IMPELLA组达到主要终点的患者比例较大（52% vs 26%, P = 0.018）。IMPELLA组LVAD植入后6个月生存率明显优于IMPELLA组（图1）。结论经腋窝入路植入IMPELLA作为LVAD的桥梁，早期主动康复治疗效果较好。
{"title":"ExtraCorporeal life support versus IMPELLA® pump as Bridge to Left ventricular Assist Device (ECI-BLAD trial)","authors":"O. Simon , A. Quessard , N. Labaste , P.-G. Guinot , N. Nesseler , A. Beurton , P. Gaudard , A. Ouattara","doi":"10.1016/j.acvd.2025.10.072","DOIUrl":"10.1016/j.acvd.2025.10.072","url":null,"abstract":"<div><h3>Introduction</h3><div>Among patients treated by temporary mechanical circulatory support (tMCS) for refractory cardiogenic shock, some of them suffer from persistent cardiac dysfunction incompatible with a successful weaning. In eligible patients, the heart transplantation is still the gold standard therapy. However, due to the shortage of grafts and/or contraindications, some patients will not be transplanted. In these patients, for whom the Left ventricular Assist Device (LVAD) represents an alternative therapy, the best approach of tMCS as a bridge to durable LVAD remains to be clarified.</div></div><div><h3>Objective</h3><div>We tested the hypothesis that the use of IMPELLA® as bridge to LVAD should improve early postoperative outcomes by offering the opportunité of active rehabilitation under tMCS.</div></div><div><h3>Method</h3><div>The ECI-BLAD trial was a multicentre retrospective study including adults, supported with IMPELLA® or ECLS as a bridge to LVAD between January 2012 and December 2020 in 5 French cardiac intensive care units. The IMPELLA® group included patients assisted by an IMPELLA® alone at least five days prior the implantation of the LVAD while the ECLS group included patients treated by a ECLS with or without IMPELLA®. The primary endpoint was the proportion of patients alive with a John Hopkins Highest Level of Mobility score<!--> <!-->=<!--> <!-->8, discharged from the critical care unit and not perfused at 30 days after LVAD implantation. Secondary endpoints included rehabilitation under tMCS (tracheal extubation, mobilization to chair, walking and cyclo-ergometer), 6-month survival rate after the LVAD implantation. This study was approved by our ethics committee and registered on Clinical trials (<span><span>NCT04480151</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>From 388 consecutive patients implanted by LVAD, 92 patients treated as bridge to LVAD have been included in our study (ECLS group <em>n</em> <!-->=<!--> <!-->42/IMPELLA group <em>n</em> <!-->=<!--> <!-->50). Most of patients of IMPELLA group (72%) were implanted through an axillary approach. Early mobilization on tMCS was more frequently achieved in IMPELLA group (seating 50% vs 2%, <em>P</em> <!--><<!--> <!-->0.001 and walking 18% vs 0%, <em>P</em> <!--><<!--> <!-->0.01). A larger proportion of patients in IMPELLA group reached the primary endpoint (52% vs 26%, <em>P</em> <!-->=<!--> <!-->0.018). The 6-month survival rate after LVAD implantation was significantly better in IMPELLA group (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Implantation of IMPELLA through axillary approach as bridge to LVAD by allowing active and early rehabilitation might be associated with better outcomes.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S41"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.013
A. Hassimi, Y. Outifa, A. Ech-Chenbouli, B. El Boussaadani, Z. Raissouni
Introduction
Perivascular retinal ischemic lesions (RIPL) may represent an ophthalmological marker of the severity of coronary artery disease.
Objective
Evaluate the correlation between the presence of RIPL and the severity of coronary lesions detected by coronary angiography in patients with acute coronary syndrome (ACS).
Method
This study included 200 patients who had presented with acute coronary syndrome (ACS) and significant coronary lesions (≥50% stenosis). All patients underwent a systematic ophthalmological evaluation to screen for perivascular retinal ischemic lesions (RIPL). To minimize bias related to diabetic retinopathy, diabetic patients were excluded from the study. The mean age of the patients was 61.4 years (±12.3), with a sex distribution of 41.1% male and 57.9% female. The most prevalent cardiovascular risk factors included hypertension (49.6%) and smoking (34.9%). The mean SYNTAX score was 14.3 (±5.0), reflecting varying degrees of coronary lesion complexity. Regarding the extent of coronary involvement, 16.4% of patients had single-vessel disease, 11.6% had two-vessel disease, and 9.6% had three-vessel disease. The most commonly affected arteries were the left anterior descending artery (75.7%), the circumflex artery (52.0%), and the right coronary artery (50.9%). In terms of treatment approach, 41.2% of patients underwent percutaneous coronary intervention (PCI) with stenting, while 14.6% required coronary artery bypass grafting (CABG) due to the complexity of their coronary disease.
Results
The results were satisfactory, highlighting an association between the presence of RIPL and the severity of coronary lesions. The presence of RIPL was significantly associated with multivessel disease (≥2 vessels) and bifurcation lesions. Furthermore, patients who underwent coronary artery bypass grafting or complex percutaneous intervention had an increased frequency of RIPL.
Conclusion
These findings suggest that the presence of RIPL could serve as a non-invasive ophthalmological marker to identify patients at high risk of developing ACS (STEMI, NSTEMI). A multidisciplinary approach integrating ophthalmology into cardiovascular risk assessment could improve coronary risk stratification. Long-term follow-up of patients with RIPL is necessary to confirm their prognostic value and refine their role in early diagnostic strategies.
{"title":"Correlation between perivascular retinal ischemic lesions (RIPL) and the severity of coronary lesions in patients with acute coronary syndrome","authors":"A. Hassimi, Y. Outifa, A. Ech-Chenbouli, B. El Boussaadani, Z. Raissouni","doi":"10.1016/j.acvd.2025.10.013","DOIUrl":"10.1016/j.acvd.2025.10.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Perivascular retinal ischemic lesions (RIPL) may represent an ophthalmological marker of the severity of coronary artery disease.</div></div><div><h3>Objective</h3><div>Evaluate the correlation between the presence of RIPL and the severity of coronary lesions detected by coronary angiography in patients with acute coronary syndrome (ACS).</div></div><div><h3>Method</h3><div>This study included 200 patients who had presented with acute coronary syndrome (ACS) and significant coronary lesions (≥50% stenosis). All patients underwent a systematic ophthalmological evaluation to screen for perivascular retinal ischemic lesions (RIPL). To minimize bias related to diabetic retinopathy, diabetic patients were excluded from the study. The mean age of the patients was 61.4 years (±12.3), with a sex distribution of 41.1% male and 57.9% female. The most prevalent cardiovascular risk factors included hypertension (49.6%) and smoking (34.9%). The mean SYNTAX score was 14.3 (±5.0), reflecting varying degrees of coronary lesion complexity. Regarding the extent of coronary involvement, 16.4% of patients had single-vessel disease, 11.6% had two-vessel disease, and 9.6% had three-vessel disease. The most commonly affected arteries were the left anterior descending artery (75.7%), the circumflex artery (52.0%), and the right coronary artery (50.9%). In terms of treatment approach, 41.2% of patients underwent percutaneous coronary intervention (PCI) with stenting, while 14.6% required coronary artery bypass grafting (CABG) due to the complexity of their coronary disease.</div></div><div><h3>Results</h3><div>The results were satisfactory, highlighting an association between the presence of RIPL and the severity of coronary lesions. The presence of RIPL was significantly associated with multivessel disease (≥2 vessels) and bifurcation lesions. Furthermore, patients who underwent coronary artery bypass grafting or complex percutaneous intervention had an increased frequency of RIPL.</div></div><div><h3>Conclusion</h3><div>These findings suggest that the presence of RIPL could serve as a non-invasive ophthalmological marker to identify patients at high risk of developing ACS (STEMI, NSTEMI). A multidisciplinary approach integrating ophthalmology into cardiovascular risk assessment could improve coronary risk stratification. Long-term follow-up of patients with RIPL is necessary to confirm their prognostic value and refine their role in early diagnostic strategies.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S11-S12"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.094
D.-D. Batouche , D. Boumendil , D. Batouche , Z.Z. Addou , H. Saddok , A. Bouguerra , F. Bounoua , F. Latreche , N.-F. Benatta , R. Okbani
Introduction
Scorpion envenomation is a common pediatric emergency in endemic regions. In its severe form, it may trigger a catecholaminergic storm leading to acute fulminant myocarditis. This cardiac involvement is a major prognostic factor but potentially reversible with intensive care management.
Objective
To describe the clinical, therapeutic, and prognostic features of severe scorpion envenomation (SE) in children, with a focus on cardiac involvement related to catecholaminergic myocarditis.
Method
We conducted prospective descriptive study involving 10 children admitted to pediatric intensive care for stage III scorpion envenomation between 2016 and 2024. Clinical, biological, echocardiographic, and outcome data were analyzed from medical records.
Results
The cohort included 8 boys and 2 girls, aged between 4 and 15 years. The average delay between the sting and admission was 8.5 ± 1.2 hours.
All patients presented with respiratory distress: tachypnea, severe hypoxemia (average SpO2: 70%), and crackles on auscultation. Neurological signs included agitation (7 cases), stage II coma (2 cases), fasciculations (7 cases), and myoclonus (4 cases). Hemodynamically, all children exhibited cardiovascular collapse with a mean heart rate of 132 bpm. Chest imaging revealed fluffy pulmonary opacities consistent with acute pulmonary edema. Echocardiography showed marked left ventricular depression with global hypokinesia, apical ballooning, and significantly reduced ejection fraction (average 12%). Biological findings included elevated CPK and troponin levels, hyperglycemia in 2 cases, and acute kidney injury classified as stage R of the pediatric RIFLE score in 2 patients.
All children required mechanical ventilation, vasopressor support, cautious fluid resuscitation guided by echocardiographic preload assessment, and diuretics in 2 cases. Clinical outcomes were favorable in 9 patients, with one fatal case.
Conclusion
Catecholaminergic myocarditis represents the cornerstone of clinical severity in pediatric severe scorpion envenomation. Although dramatic, it is potentially reversible with appropriate and timely intensive care management.
{"title":"Catecholaminergic strom and cardiac failure in children: Insights from severe scorpion envenomation cases","authors":"D.-D. Batouche , D. Boumendil , D. Batouche , Z.Z. Addou , H. Saddok , A. Bouguerra , F. Bounoua , F. Latreche , N.-F. Benatta , R. Okbani","doi":"10.1016/j.acvd.2025.10.094","DOIUrl":"10.1016/j.acvd.2025.10.094","url":null,"abstract":"<div><h3>Introduction</h3><div>Scorpion envenomation is a common pediatric emergency in endemic regions. In its severe form, it may trigger a catecholaminergic storm leading to acute fulminant myocarditis. This cardiac involvement is a major prognostic factor but potentially reversible with intensive care management.</div></div><div><h3>Objective</h3><div>To describe the clinical, therapeutic, and prognostic features of severe scorpion envenomation (SE) in children, with a focus on cardiac involvement related to catecholaminergic myocarditis.</div></div><div><h3>Method</h3><div>We conducted prospective descriptive study involving 10 children admitted to pediatric intensive care for stage III scorpion envenomation between 2016 and 2024. Clinical, biological, echocardiographic, and outcome data were analyzed from medical records.</div></div><div><h3>Results</h3><div>The cohort included 8 boys and 2 girls, aged between 4 and 15 years. The average delay between the sting and admission was 8.5<!--> <!-->±<!--> <!-->1.2<!--> <!-->hours.</div><div>All patients presented with respiratory distress: tachypnea, severe hypoxemia (average SpO<sub>2</sub>: 70%), and crackles on auscultation. Neurological signs included agitation (7 cases), stage II coma (2 cases), fasciculations (7 cases), and myoclonus (4 cases). Hemodynamically, all children exhibited cardiovascular collapse with a mean heart rate of 132 bpm. Chest imaging revealed fluffy pulmonary opacities consistent with acute pulmonary edema. Echocardiography showed marked left ventricular depression with global hypokinesia, apical ballooning, and significantly reduced ejection fraction (average 12%). Biological findings included elevated CPK and troponin levels, hyperglycemia in 2 cases, and acute kidney injury classified as stage R of the pediatric RIFLE score in 2 patients.</div><div>All children required mechanical ventilation, vasopressor support, cautious fluid resuscitation guided by echocardiographic preload assessment, and diuretics in 2 cases. Clinical outcomes were favorable in 9 patients, with one fatal case.</div></div><div><h3>Conclusion</h3><div>Catecholaminergic myocarditis represents the cornerstone of clinical severity in pediatric severe scorpion envenomation. Although dramatic, it is potentially reversible with appropriate and timely intensive care management.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S53"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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