Archives of Cardiovascular Diseases最新文献

{"title":"Feasibility, efficacity and safety of a fast up-titration program of heart failure treatments in real-life practice","authors":"L. Blasi ,&nbsp;P. Fournier ,&nbsp;M. Galinier ,&nbsp;J. Roncalli ,&nbsp;C. Delmas ,&nbsp;R. Itier","doi":"10.1016/j.acvd.2024.10.015","DOIUrl":"10.1016/j.acvd.2024.10.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Guideline-directed medical therapy (GDMT) of chronic heart failure (HF) associates four drugs: Beta-Blockers (BB), Angiotensin Receptor-Neprilysin Inhibitor (ARNi), Mineralocorticoid Receptor Antagonists (MRA) and Sodium-Glucose co-Transporter 2 (SGLT2) inhibitors. Their initiation and implementation should begin quickly from the diagnostic, but therapeutic inertia leads to higher mortality and hospitalisation rates.</div></div><div><h3>Objective</h3><div>To evaluate the feasibility, efficacity and safety of an intensive and fast up-titration program of GDMT at three months, limiting factors to GDMT up-titration and factors associated with poor outcomes in this population.</div></div><div><h3>Method</h3><div>We retrospectively included all patients participating to our up-titration program from January 2021 to September 2022. Patients were followed every 2 weeks by consultation (on-site or teleconsultation). We collected clinic-biological, echocardiographic data and GDMT doses at the enrolment, at the end of the up-titration, and three months later.</div></div><div><h3>Results</h3><div>222 patients were enrolled. The mean titration duration was 10 weeks (±<!--> <!-->57 days). The proportion of patients with full dose of ARNi was 1.4% at day one and 44.6% at three months, 4.5% then 32.7% for MRA, and 5% then 15.4% for BB. 90% of the population was treated with SGLT2 inhibitor at 3 months (<span><span>Fig. 1</span></span>). Consecutively, the proportion of patients with loop diuretics decreased from 70.7% to 42.9%. In the meantime, we observed a significant improvement of the dyspnoea (from 85.4% to 45.7% of patient in class II of the NYHA and from 10.8% to 51.1% of patients in class I), the LVEF (from 30.8% to 45.2%) and a decline of the NT-proBNP (from 1322 to 484<!--> <!-->pg/ml). Associated adverse events were hypotension (15.3%), acute renal impairment (14.9%) and hyperkalaemia (6.8%) without difference between on-site and teleconsultation groups. Limiting factors to up-titration of ARNi and MRA were advanced age, low eGFR and high value of the NT-proBNP (&gt;<!--> <!-->1000<!--> <!-->pg/ml). 6 patients died during the study (2.7%) and 16 were readmitted in hospital for HF (7.2%). Persistent treatment with loop diuretics at the end of the up-titration was identified as a poor prognostic, whereas prescription of ARNi was identified as a protective factor.</div></div><div><h3>Conclusion</h3><div>A fast up-titration program is feasible, efficient and safe in real-life practice. Combination of on-site and teleconsultation seems appropriate and should be proposed to fight therapeutic inertia without increasing adverse events.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S29-S30"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150704","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}

{"title":"Gender disparities in outcomes following percutaneous coronary intervention for unprotected left main coronary artery disease","authors":"A. Ghrab,&nbsp;S. Charfeddine,&nbsp;M. Derwich,&nbsp;R. Gargouri,&nbsp;A. Bahloul,&nbsp;T. Ellouze,&nbsp;M. Jabeur,&nbsp;F. Triki,&nbsp;L. Abid","doi":"10.1016/j.acvd.2024.10.071","DOIUrl":"10.1016/j.acvd.2024.10.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Understanding the nuanced disparities in clinical outcomes between male and female patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (CAD) is pivotal in refining patient care and treatment protocols.</div></div><div><h3>Objective</h3><div>To determine the sex-specific outcomes in left main PCI.</div></div><div><h3>Method</h3><div>We analysed data from 213 patients (48 females; 165 males) with unprotected left main CAD who underwent PCI between January 2012 and January 2023 in our catheterization lab. The primary endpoint was a composite of all-cause mortality, myocardial infarction, or stroke.</div></div><div><h3>Results</h3><div>Median follow-up duration was 2.16 years. Although women tended to be older and had higher rates of diabetes mellitus and hypertension, these distinctions were not statistically significant. Men more frequently presented with left main bifurcation lesions and extensive CAD. Baseline findings revealed that wall motion abnormalities were more prevalent in men compared to women (68.3% <em>vs.</em> 50%, respectively; <em>p</em> <!-->=<!--> <!-->0.020). Notably, the presence of wall motion abnormalities emerged as a significant predictor of adverse outcomes, including total mortality (19.2% <em>vs.</em> 5.4%; <em>p</em> <!-->=<!--> <!-->0.007) and cardiac death (16.2% <em>vs.</em> 2.7%; <em>p</em> <!-->=<!--> <!-->0.003). However, the primary endpoint did not exhibit a statistically significant difference between genders (20.8% <em>vs.</em> 24.8%, respectively; <em>p</em> <!-->=<!--> <!-->0.569). Similarly, the requirement for target lesion revascularization was comparable in both groups (7.9% <em>vs.</em> 12.5%, respectively; <em>p</em> <!-->=<!--> <!-->0.566).</div></div><div><h3>Conclusion</h3><div>Despite variations in clinical and lesion characteristics, female and male patients demonstrated similar long-term outcomes post-PCI for left main CAD.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S13"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150839","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}

{"title":"Impact of anomalous aortic origin of a coronary artery on coronary angiography: A retrospective analysis","authors":"A. Brochier ,&nbsp;S. Zayed ,&nbsp;J. Corré ,&nbsp;C. Ferdynus ,&nbsp;L.-M. Desroche","doi":"10.1016/j.acvd.2024.10.073","DOIUrl":"10.1016/j.acvd.2024.10.073","url":null,"abstract":"<div><h3>Introduction</h3><div>Anomalous aortic origins of coronary arteries (AAOCA) are not uncommon and are often a challenge for coronary angiography (CA) operators. A detailed evaluation of the effect of AAOCA on CA may help to target the good levers to improve AAOCA catheterisation.</div></div><div><h3>Objective</h3><div>The objective of this study is to evaluate the impact of AAOCA on the quality of CA catheterisations, as well as the associated costs in terms of time, radiation and contrast injection.</div></div><div><h3>Method</h3><div>We conducted a retrospective analysis at Félix Guyon University Hospital on Réunion Island, reviewing 23,625 CA cases from May 2011 to December 2022. We identified 96 cases of AAOCA, each matched with a control based on examination type, year, operator, sex, and age. The primary endpoint was the rate of optimal catheterization defined according the position of the distal part of the catheter downstream of the coronary ostium, resting on the coronary artery. Secondary measures included catheterization failure rates, optimal image quality rates, procedural time, radiation exposure, and contrast media use. Qualitative variables were independently evaluated by three experienced operators.</div></div><div><h3>Results</h3><div>The study found that the optimal catheterization rate for AAOCA patients was significantly lower compared with controls (27.8% <em>vs.</em> 90.6%, <em>p</em> <!-->&lt;<!--> <!-->0.001). Secondary results highlighted a catheterization failure rate of 7.2% for AAOCA versus 0% for control patients (<em>p</em> <!-->&lt;<!--> <!-->0.001). The AAOCA cases showed inferior image quality, longer procedural times (31.5<!--> <!-->±<!--> <!-->18.2 min <em>vs.</em> 30.9<!--> <!-->±<!--> <!-->20.5 min, <em>p</em> <!-->&lt;<!--> <!-->0.001), increased fluoroscopy time (11.5<!--> <!-->±<!--> <!-->7.8 min <em>vs.</em> 6.9<!--> <!-->±<!--> <!-->5.0 min, <em>p</em> <!-->&lt;<!--> <!-->0.001), increased radiation dose (320.5<!--> <!-->±<!--> <!-->357.3 <em>vs.</em> 189.9<!--> <!-->±<!--> <!-->182.6 mGy·cm², <em>p</em> <!-->&lt;<!--> <!-->0.001), and higher contrast used (99.6<!--> <!-->±<!--> <!-->62.7 ml <em>vs.</em> 61.2<!--> <!-->±<!--> <!-->54.4 ml, <em>p</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>The presence of AAOCA resulted in a significant reduction in the quality of the catheterisation procedure, despite an increase in the cost of time, radiation and contrast. These findings suggest that a standardised protocol may be beneficial in improving the quality of CA catheterisation in cases of AAOCA.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S14"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150841","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}

{"title":"Long-term prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance in patients with hypertension without known CVD","authors":"S. Houssany-Pissot ,&nbsp;J. Garot ,&nbsp;T. Hovasse ,&nbsp;F. Sanguineti ,&nbsp;S. Champagne ,&nbsp;T. Unterseeh ,&nbsp;S. Toupin ,&nbsp;J. Florence ,&nbsp;A. Unger ,&nbsp;T. Goncalves ,&nbsp;L. Hamzi ,&nbsp;V. Bousson ,&nbsp;J.-G. Dillinger ,&nbsp;P. Henry ,&nbsp;P. Garot ,&nbsp;T. Pezel","doi":"10.1016/j.acvd.2024.10.098","DOIUrl":"10.1016/j.acvd.2024.10.098","url":null,"abstract":"<div><h3>Introduction</h3><div>Several studies have shown the excellent prognostic value of stress cardiovascular magnetic resonance (CMR) in large cohorts of patients without known cardiovascular disease (CVD). However, its prognostic value in a dedicated cohort of patients in primary prevention with hypertension remains not well established.</div></div><div><h3>Objective</h3><div>The aim of our study was to assess the long-term prognostic value of vasodilator stress perfusion CMR in patients with hypertension but without known CVD.</div></div><div><h3>Method</h3><div>Between December 2008 and January 2022, we conducted a bi-center longitudinal study with consecutive patients with hypertension, and without a known CVD, referred for vasodilator stress perfusion CMR to the Institut cardiovasculaire Paris Sud (ICPS, Massy) and to Lariboisière University Hospital (AP–HP, Paris). All patients were followed up to the occurrence of major cardiovascular events (MACE), defined as cardiac death or non-fatal myocardial infarction (MI). Cox regressions analyses were performed to determine the prognostic value of each parameter.</div></div><div><h3>Results</h3><div>Among 2019 patients (mean age 68.7<!--> <!-->±<!--> <!-->11.7 years; 45.4% men) with a median follow up of 6.7 years, 335 had MACE (16.6%). Patients without inducible ischaemia experienced a lower rate of MACE than those with an inducible ischaemia (12.1 versus 41.3%, respectively, <em>p</em> <!-->&lt;<!--> <!-->0.001). Using Kaplan-Meier analysis, inducible ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio [HR]: 4.39; 95% confidence interval [CI]: 3.52 to 5.47 and HR: 3.49; 95% CI: 2.76 to 4.42, respectively; both <em>p</em> <!-->&lt;<!--> <!-->0.001). <span><span>Figure 1</span></span> shows Kaplan-Meier curve for MACE stratified for the presence of inducible ischaemia.</div><div>In multivariable analysis, the presence of ischaemia and LGE were independent predictors of MACE (HR: 2.91; 95% CI: 2.27 to 3.72 and HR: 2.07; 95% CI: 1.59 to 2.71, respectively; both <em>p</em> <!-->&lt;<!--> <!-->0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.06; net reclassification improvement: 0.307; integrative discrimination index: 0.071; LR test <em>p</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>In patients with hypertension and without known CVD, vasodilator stress CMR has independent and incremental prognostic value to predict MACE over traditional risk factors.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S54"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151193","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}

{"title":"Safety of same-day discharge after complex percutaneous coronary intervention","authors":"T. Roussel ,&nbsp;P. Deharo ,&nbsp;T. Cuisset","doi":"10.1016/j.acvd.2024.10.064","DOIUrl":"10.1016/j.acvd.2024.10.064","url":null,"abstract":"<div><h3>Introduction</h3><div>Since 1977 and first coronary angioplasty, developments in this field have been exponential. Outpatient coronary angioplasty is developing rapidly, driven by current economic needs, patients’ preference to be discharged the same day, and the aim of reducing nosocomial risks associated with hospitalisation, while maintaining sufficient safety for the patient.</div><div>The aim of the study was to investigate the safety of same-day discharge after complex percutaneous coronary intervention.</div></div><div><h3>Objective</h3><div>The aim of the study was to investigate the safety of same-day discharge after complex percutaneous coronary intervention.</div></div><div><h3>Method</h3><div>All patients over 18 years of age admitted to the outpatient cardiology unit at the Timone University Hospital (Marseille, France) for coronary angiography between 1 January 2023 and 31 December 2023 were included in the study if they received complex coronary angioplasty during the procedure.</div></div><div><h3>Results</h3><div>185 patients were included. The number of major events (MACE: cardiovascular mortality, myocardial infarction, stroke) at 3 months concerned 4 of the 172 patients, giving a MACE rate of 2.3% [95% CI 0.64% to 5.85%] (<span><span>Table 1</span></span>). These were 2 early events (2 stent thromboses) and 2 late events: 2 myocardial infarctions (NSTEMI). As regards secondary events, there were 6 hospitalisations following the procedure, <em>i.e.</em> 3.5% of patients, and 13 re-hospitalisations within 3 months of angioplasty for unscheduled cardiovascular reasons (7.6% of patients). The rate of major bleeding was 1.7% (3 patients).</div></div><div><h3>Conclusion</h3><div>Performing complex percutaneous coronary intervention in an outpatient unit appears feasible in terms of clinical safety. Patient selection is a key factor in the feasibility of outpatient management. Further randomised studies are needed to compare these patients with those admitted to hospital and confirm the trend observed.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S9-S10"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151199","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}

{"title":"Coronary intravascular lithotripsy: Experience and outcome in real-world patients (about 70 cases)","authors":"H. Chraibi,&nbsp;S. M’barki,&nbsp;A. Ramoum,&nbsp;B. Ahmad,&nbsp;M. Chidiac,&nbsp;R. Ghenim,&nbsp;P. Laury,&nbsp;A. Ziani,&nbsp;T. Hassani","doi":"10.1016/j.acvd.2024.10.069","DOIUrl":"10.1016/j.acvd.2024.10.069","url":null,"abstract":"<div><h3>Introduction</h3><div>Coronary intravascular lithotripsy (CIVL) is an increasingly popular technique to treat severely calcified coronary artery disease.</div></div><div><h3>Objective</h3><div>In this study, we aimed to assess and qualify the indications, modalities, and outcomes of CIVL in real-world patients.</div></div><div><h3>Method</h3><div>This was a retrospective single-center study. We included all patients in which CIVL was indicated and attempted between April 2022 and December 2023. Electronic medical records were used to gather demographic, clinical, and angiographic data. Follow-up data was collected using telephone calls to patients that survived the index hospitalization without complication.</div></div><div><h3>Results</h3><div>Seventy patients were included, with a ratio of one lesion per patient. The cohort was elderly, with a mean age of 76.9<!--> <!-->±<!--> <!-->9.3 years old, and predominantly male (78.6%). The most common cardiovascular risk factor was arterial hypertension (65.7%). Clinical presentations were varied, mostly non-ST-segment elevation myocardial infarction (29.7%), chronic coronary syndrome (25%), and ST-segment elevation myocardial infarction (14.1%). The mean procedural time was 65.6<!--> <!-->±<!--> <!-->28.1 minutes and the mean fluoroscopy time was 25.7<!--> <!-->±<!--> <!-->13.6 minutes, with a mean contrast volume injected of 170.3<!--> <!-->±<!--> <!-->71.6 mL. The left anterior descending was the most common artery treated (44.3%), followed by the right coronary artery (34.3%). Proximal lesions were most common (42.9%). The mean balloon diameter was 3.3<!--> <!-->±<!--> <!-->0.5 mm, with a stent diameter of 3.4<!--> <!-->±<!--> <!-->0.5 mm. The mean number of stents was 1.5<!--> <!-->±<!--> <!-->0.7, with a total length of 34.6<!--> <!-->±<!--> <!-->18.6 mm. In 8.3% of patients, CIVL was used as a bailout strategy for stent underexpansion. Among outcomes, we recorded an angiographic success rate of 92.9% and one case of coronary perforation (1.4%). In 5.7% of cases, the operator was unable to cross the lesion with the balloon, with 2.9% requiring rotational atherectomy. The cardiovascular death rate was 7.1%, with no cases of myocardial infarction, stroke, or target vessel revascularization. <span><span>Fig. 1</span></span> summarizes the main results.</div></div><div><h3>Conclusion</h3><div>Although the target population is older, with more comorbidities, CIVL seems to be an effective strategy for the treatment heavily calcified lesions, with an acceptable complication rate.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S12"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151201","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}

{"title":"Cardiac magnetic resonance imaging-derived right ventricular volume and function, and association with outcomes in isolated tricuspid regurgitation","authors":"Gaspard Suc ,&nbsp;Thibault Dewavrin ,&nbsp;Jules Mesnier ,&nbsp;Eric Brochet ,&nbsp;Kankoe Sallah ,&nbsp;Axelle Dupont ,&nbsp;Phalla Ou ,&nbsp;Marylou Para ,&nbsp;Dimitri Arangalage ,&nbsp;Marina Urena ,&nbsp;Bernard Iung","doi":"10.1016/j.acvd.2024.09.006","DOIUrl":"10.1016/j.acvd.2024.09.006","url":null,"abstract":"<div><h3>Background</h3><div>In patients with significant tricuspid regurgitation, cardiac magnetic resonance imaging (CMR) is the preferred method for the evaluation of right ventricular function and volumes. However validated thresholds are lacking.</div></div><div><h3>Aim</h3><div>The aim of this study was to evaluate CMR assessment of right ventricular volumes in patients with significant (moderate or severe) tricuspid regurgitation, and to define its association with outcomes.</div></div><div><h3>Methods</h3><div>The PRONOVAL study is a retrospective multicentre study using the clinical data warehouse of Greater Paris University Hospitals (AP–HP). Patients were screened for CMR in the PMSI (<em>Programme de médicalisation des systèmes d’information</em>). Hospitalization reports were analysed by natural language processing to include patients with tricuspid regurgitation. Exclusion criteria were left heart valvular disease, heart transplantation and cardiac amyloidosis. Primary outcome was a combined criterion of death or tricuspid surgery.</div></div><div><h3>Results</h3><div>Between September 2017 and September 2021, 151 patients with isolated tricuspid regurgitation were screened. Right ventricular function and volumes were available in 86 (57.0%) CMR reports (the complete CMR group). In the complete CMR group, tricuspid regurgitation was severe in 62 patients (72.1%). Median age was 67.0 years (interquartile range 58.0–75.8). Median right ventricular indexed end-diastolic volume was 98.0 mL/m² (interquartile range 66.8–118.5). At 2-year follow-up, six patients (9.2%) had undergone tricuspid valve surgery, and 12 patients (18.5%) had died. Right ventricular indexed end-diastolic volume was associated with death or surgery at 2<!--> <!-->years, with an area under the receiver operating characteristic curve of 0.76 (95% confidence interval 0.75–0.77) for a threshold of 119<!--> <!-->mL/m².</div></div><div><h3>Conclusion</h3><div>Right ventricular indexed end-diastolic volume &gt;<!--> <!-->119<!--> <!-->mL/m² was found to be an independent indicator of death or surgery in patients with significant tricuspid regurgitation.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages 43-51"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570447","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}

{"title":"Prognostic outcomes in heart failure based on simple severity criteria: Insights from the French national healthcare coverage database","authors":"G. Baudry ,&nbsp;O. Pereira ,&nbsp;F. Roubille ,&nbsp;M. Villaceque ,&nbsp;T. Damy ,&nbsp;S. Schramm ,&nbsp;K. Duarte ,&nbsp;P. Tangre ,&nbsp;N. Girerd","doi":"10.1016/j.acvd.2024.10.022","DOIUrl":"10.1016/j.acvd.2024.10.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) is a significant and severe health condition, ideally requiring severity-based management.</div></div><div><h3>Objective</h3><div>This study aimed to outline the prognosis of HF on a national scale, based on straightforward severity criteria.</div></div><div><h3>Method</h3><div>This comprehensive cohort study utilized the French national healthcare coverage database, including patients over 18 diagnosed with HF, or hospitalized for HF within the last five years, and alive in January 2020, followed until December 2022. Patients were classified into four groups by severity: 1- Not Hospitalized without loop diuretics (NoHFH/D−), 2- Not Hospitalized with loop diuretics (NoHFH/D+), 3- HF hospitalization more than a year ago (HFH<!--> <!-->&gt;<!--> <!-->1y), and 4- Hospitalization within the past year for HF (HFH<!--> <!-->&lt;<!--> <!-->1y). Outcomes were analyzed using adjusted Cox models.</div></div><div><h3>Results</h3><div>The final analysis included 655,919 patients (mean age 77.5<!--> <!-->±<!--> <!-->13 years, 48% female), with a relatively balanced distribution between groups (respectively 23.8%, 28.3%, 27.6%, and 20.4% in NoHFH/D−, NoHFH/D+, HFH<!--> <!-->&gt;<!--> <!-->1Y, and HFH<!--> <!-->&lt;<!--> <!-->1Y groups). The predominant comorbidities were coronary artery disease (36%), atrial fibrillation (34%), diabetes (29%), and chronic respiratory diseases (25%), with prevalence increasing with HF severity. Mortality rates at one year were 8.0%, 14.8%, 17.2%, and 25.0%, and the risks of HF hospitalization or death within a year were 9.9%, 20.5%, 24.9%, and 37.6% for NoHFH/D−, NoHFH/D+, HFH<!--> <!-->&gt;<!--> <!-->1Y, and HFH<!--> <!-->&lt;<!--> <!-->1Y respectively. After adjusting for demographics, medical history, and baseline treatments, the risks of mortality and the combined outcome of death or HF hospitalization progressively increased across the groups (HR for death: 1.57, (1.55–1.60); 1.82, (1.80–1.85); 2.24, (2.20–2.27); and HR for the combined criterion: 1.74 (1.72–1.76), 2.11 (2.08–2.14), 2.70 (2.67–2.74) for NoHFH/D+, HFH<!--> <!-->&gt;<!--> <!-->1Y, and HFH<!--> <!-->&lt;<!--> <!-->1Y respectively, <em>P</em> <!-->&lt;<!--> <!-->0.0001 for all, using NoHFH/D− as a reference).</div></div><div><h3>Conclusion</h3><div>This national cohort analysis revealed that patient risk profiles significantly vary by HF hospitalization timing and loop diuretic use. The progressively increasing risk of mortality and combined HF hospitalization or death highlights the need for severity-adjusted management strategies.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S33-S34"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149744","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}

{"title":"Telemonitoring leads to a low incidence of emergency admissions among chronic heart failure patients","authors":"J. Florence ,&nbsp;S. Ploux ,&nbsp;C. Riocreux ,&nbsp;R. Eschalier","doi":"10.1016/j.acvd.2024.10.034","DOIUrl":"10.1016/j.acvd.2024.10.034","url":null,"abstract":"<div><h3>Introduction</h3><div>Worsening heart failure (WHF) is the leading cause of hospitalization after the age of 65 in Western countries, with a major impact on quality of life and a high cost for healthcare systems. Moreover, heart failure contributes to exacerbating the pressure on emergency departments, representing the gateway for 64% of hospital admissions for heart failure, particularly during the winter months. Telemonitoring emerges as a viable and effective strategy, enabling early identification of WHF symptoms and facilitating preventive interventions to reduce hospitalization rate.</div></div><div><h3>Objective</h3><div>Therefore, we aimed to describe the effect of a telemonitoring program on the rate of emergency admissions for WHF in chronic heart failure patients.</div></div><div><h3>Method</h3><div>All patients enrolled in the heart failure remote management program of the Clermont Ferrand and Bordeaux University Hospitals between 13 April 2020 and 31 January 2023 were included in the study. Follow-up data were collected until 31 January 2023. Inclusion criteria were chronic heart failure (HF) with New York Heart Association<!--> <!-->≥<!--> <!-->II and an elevated B-type natriuretic peptide (BNP<!--> <!-->&gt;<!--> <!-->100<!--> <!-->pg/mL or N-terminal-pro-BNP<!--> <!-->&gt;<!--> <!-->1000<!--> <!-->pg/mL). Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available.</div></div><div><h3>Results</h3><div>A total of 1095 patients (72<!--> <!-->±<!--> <!-->11.8 years old, 69.7% male), were followed for a median [IQR] of 437 [182; 739] days with a mean adherence to the remote monitoring system of 67.6<!--> <!-->±<!--> <!-->30.3%. Over this period, 168 (15.3%) patients were hospitalized for HF and 198 (18.1%) patients had 949 WHF events. One hundred and nineteen (12.5%) were not detected by telemonitoring, and 830 (87.5%) were detected, of which 703 (84.7%) were successfully managed out-of-hospital (<span><span>Table 1</span></span>). The remaining events required hospitalisation (<em>n</em> <!-->=<!--> <!-->127, 15.3%), of which 28 (22%) required an admission to emergency department before hospitalization (<span><span>Table 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Our study suggests a very low rate of hospitalizations and admissions in emergency department in a large cohort of chronic heart failure patients, using a telemonitoring program with multiparametric platform.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S40"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149746","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}

{"title":"Bleeding risk scores in elderly Algerian patients with acute coronary syndromes","authors":"I. Bouaguel ,&nbsp;A. Trichine","doi":"10.1016/j.acvd.2024.10.087","DOIUrl":"10.1016/j.acvd.2024.10.087","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of acute coronary syndromes is high in the elderly population. Bleeding is associated with a poorer prognosis in this clinical setting.</div></div><div><h3>Objective</h3><div>Our aim was to assess predictive ability of the most important bleeding risk scores in Algerian patients with acute coronary syndrome aged<!--> <!-->&gt;<!--> <!-->75 years.</div></div><div><h3>Method</h3><div>We prospectively included consecutive acute coronary syndromes patients. Baseline characteristics, laboratory findings, and hemodynamic data were collected. In-hospital bleeding was defined according to CRUSADE, Mehran, ACTION, and BARC definitions. CRUSADE, Mehran, and ACTION bleeding risk scores were calculated for each patient. The ability of these scores to predict major bleeding was assessed by binary logistic regression, receiver operating characteristic curves, and area under the curves.</div></div><div><h3>Results</h3><div>We included 645 patients, with mean age of 61.2 years; 122 patients (19%) were<!--> <!-->&gt;<!--> <!-->75 years. Older patients had higher bleeding risk (CRUSADE, 42 <em>vs.</em> 22; Mehran, 25 <em>vs.</em> 15; ACTION, 36 <em>vs.</em> 28; <em>P</em> <!-->&lt;<!--> <!-->0.001) and a slightly higher incidence of major bleeding events (CRUSADE bleeding, 5.1% <em>vs.</em> 3.8%; <em>P</em> <!-->=<!--> <!-->0.250). The predictive ability of these 3 scores was lower in the elderly (area under the curve, CRUSADE: 0.63 in older patients, 0.81 in young patients; <em>P</em> <!-->=<!--> <!-->0.027; Mehran: 0.67 in older patients, 0.73 in younger patients; <em>P</em> <!-->=<!--> <!-->0.340; ACTION: 0.58 in older patients, 0.75 in younger patients; <em>P</em> <!-->=<!--> <!-->0.041).</div></div><div><h3>Conclusion</h3><div>Current bleeding risk scores showed poorer predictive performance in elderly patients with acute coronary syndromes than in younger patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S21"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149753","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}