Annales de cardiologie et d'angeiologie最新文献

Introduction

Coronary heart disease remains one of the leading causes of morbidity and mortality, and is responsible for significant social costs. Resumption of work is an essential objective when this pathology concerns working patients. French data remain patchy and relatively old. The French Society of Cardiology's Exercise, Rehabilitation, Sport and Prevention Group has proposed a multicentre study to update these data.

Methods

Following an acute coronary syndrome (ACS), the cardiology team asked the patient, who was currently working, to complete a questionnaire on his or her pathology, occupation and plans to return to work. An interview after 6 months enabled the clinical and professional situation of the patient to be analyzed, in order to study the factors predictive of a return to work.

Results

364 patients were included in 6 interventional and 17 cardiac rehabilitation centres between 2018 and 2019. The resumption rate was 81% (n = 295), 93% of them in the same position, with a mean delay of 106 ± 56 days. The cardiologic independent factors for non-return were left ventricular ejection fraction, the presence of an anticoagulant, angina or heart failure, and occupational factors, shift work, exposure to cold, and imposed work rates. Factors that lengthened the time taken to return to work included delayed access to rehabilitation, the carrying of heavy loads, difficult postures and imposed work rates, as well as the patient's lack of a project, the absence of a cardiologist's opinion and the request for a modified workstation.

Conclusion

The rate of return to work remains fairly stable despite the evolution of disease management, and the time to return to work relatively high. One way of improving the situation is to enhance access to cardiac rehabilitation programs, for example by offering alternatives such as tele-rehabilitation for a proportion of patients. This will free up more time for more severe patients, to better prepare them physically and psychologically for a return to work, which will also have a beneficial economic effect.

Progress in coronary angioplasty has enabled outpatients treatment with rates of immediate complications below 1%. This shows a clear improvement in patient's comfort and it represents an important medical and economic gain.

Considering the demographic evolution of the population, there is an increasing number of calcified coronary lesions which represent, according to the series, up to a quarter of angioplasties.

However, their care is more delicate with a greater risk of complications and procedural failure. In fact, with the difficulties of crossing and with the vascular intrusions related to pre-dilation or sub-dilation stent deployment, the complication risk increases by almost 10% in these cases of angioplasties. Similarly, the death rate at 30 days goes from 4.7% in angioplasty in general up to 24.4% in calcified lesions.

Several devices for atherectomy and plaque preparation have been developed in order to better overcome the lesions and better prepare the stent installation at the cost of a risk of complications between 2 and 10%. The three most frequent complications are dissection (1.8 to 7%), slow/no-flow (0.1 to 3%) and coronary perforation (0.2 to 4%).

Nevertheless, despite this procedural increased risk, ambulatory angioplasty of calcified complex lesions can become a reality subject to 4-6 hours monitoring in a specialized unit with dedicated protocols.

Introduction

Congestive heart failure (HF) is associated with prolonged and recurrent hospitalizations; the prognosis remains poor a better follow up might be beneficial. PRADO-IC program is provided in order to improve the transition of care.

Aim of the study

To evaluate PRADO-IC program in term of healthcare consumption and prognosis in a cohort of patients hospitalized for decompensated HF, using the insight of the national data base SNDS (Système National de Données de Santé).

Methods

From September 2016 to September 2018, all patients hospitalized for heart failure at Saint-Joseph Hospital were included in an observational study. The inclusion in the PRADO-IC program was at physician's discretion. Two groups were compared according to the inclusion in PRADO-IC (P group) or not (control group (C)). The primary endpoints were the comparison of one-year mortality and heart failure readmission rate between the two groups. The secondary end points were time to the first contact with a general practitioner (GP), a cardiologist, CHF drugs prescription, and others follow up data.

Results

Six hundred and fifteen patients were included, 254 in the P group and 361 in the C group. Patients in the P cohort presented more frequently severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). Mortality at one year (n = 47; 18.5% P group vs. n = 65; 16.2% C group, p = 0.87) did not differ in both groups. There was no significant difference in one-year re-hospitalization rate for HF (n = 93, 36.6% in P group vs. n = 133, 26.8% in C group, p = 0.95). Time to the first contact with the GP was shorter in P group (8.00 vs. 18.50 days, p < 0.0001). Time to first hospitalization (69.0 vs. 37.0 days, p = 0.028) and the length of hospitalization (6.0 vs. 4.0 days, p = 0.045) were longer in P group. There was no difference for HF drugs prescription rate between the two groups.

Conclusion

Our study shows that the PRADO-IC program concerned more severe patients. Despite this, the one-year mortality and the HF readmission rates are similar between the two groups. The follow up is improved in P group.

Coronary sinus reducer implantation is a percutaneous technique creating a narrowing in the coronary sinus through the implantation of an hourglass-shaped endoprosthesis. It is proposed to reduce symptoms in patients suffering from refractory angina pectoris. This innovative treatment is experiencing a major craze among interventional cardiologists. It is associated with very high procedural success rates. Complications are rare and include coronary sinus dissection or perforation and migration of the device.

This review exposes the device implantation technique, the potential anatomical difficulties, the tips and tricks to overcome challenging situations. It also focuses on the prevention and management of potential complications.

Background

A coronary artery fistula is an abnormal connection between one or more coronary arteries and a cardiac chamber or great vessel, often discovered incidentally through cardiac imaging. Although coronary artery fistulas are typically asymptomatic during the first two decades of life, particularly when small, they can become clinically significant over time.

Case presentation

We present the case of a 71-year-old female patient with a history of exertional dyspnea. Diagnostic coronary angiography revealed a significant coronary artery fistula originating from the proximal right coronary artery and draining into the pulmonary artery trunk. Given the patient's symptoms and the anatomical features of the fistula, she was successfully treated with transcutaneous closure using a liquid embolic agent (Onyx).

Conclusion

Although surgical intervention has historically been the primary treatment for CAF, minimally invasive techniques such as transcutaneous closure are proving to be effective alternatives.

Objectives

The aim of the study was to determine the prevalence of AF in the cardiology department of the Hospital Principal of Dakar, then to evaluate the clinical, paraclinical, etiological and evolutionary profiles of AF and finally to identify the limits of its management in our context.

Patients and methods

This was a retrospective, descriptive, analytical, mono-centric study carried out at Hospital Principal of Dakar from January 2019 to August 2021. Were included, all patients admitted for atrial fibrillation, or patients who presented an atrial fibrillation during hospitalization, confirmed by electrocardiogram or long-term electrocardiographic recording during the study period.

Results

The prevalence of atrial fibrillation during the period of our study compared to the hospital population was 7.71%, with a sex ratio of 1.03. The mean age was 67.88 ± 14.09 years. We noted that 83.64% of patients had at least one cardiovascular risk factor, with 56.36% suffering from hypertension, 50.91% of sedentary person and 23.64% of diabetics. Clinically, 92.72% of the patients were symptomatic, with dyspnea predominating (70.91%). Cardiac arrhythmia was present in 85.45% of patients, and congestive heart failure in 47.27%. Long-term electrocardiographic recording was performed in 10 patients, showing 50% of paroxysmal atrial fibrillation. Sixty-three patients (57.27%) had permanent AF, twenty-three patients (20.91%) had persistent AF, fourteen patients (12.73%) had long-term persistent AF and ten patients (9.09%) had paroxysmal AF. Transthoracic echocardiography showed 57.27% of left atrial dilatation and 72.3% of reduced left ventricular ejection fraction. Etiologies for cardiac causes were dominated by dilated cardiomyopathy (21.82%), followed by ischemic heart disease (17.27%). In terms of treatment, the most commonly used molecule was bisoprolol (38.18%), followed by digoxin (21.81%). Anticoagulants were used in 85.46% of cases. Acenocoumarol alone was used in 69.09% of patients. Drug-induced cardioversion was attempted in 2 patients without success, and 4 patients benefited from external electric shock with 3 successes. Most patients had a favorable outcome, but 34.54% suffered hemodynamic complications (18.18%) and thromboembolic ones as well (16.36%). In-hospital mortality in our series was 20%. It was significantly related to heart failure, with a left ventricular ejection fraction < 35% (p < 0.001).

Conclusion

Atrial fibrillation is serious because of its hemodynamic, thromboembolic and rhythmic complications. The high mortality is explained by the underlying condition, but also by the delay in management with late diagnosis and, above all, the unavailability of ablation procedures in our context.

Pulmonary embolism (PE) is a common and serious cardiovascular disease. The management of PE patients with myocardial damage but without hemodynamic instability (intermediate/high risk) has long remained limited to anticoagulant therapy with no demonstrated positive effect of thrombolysis. In this specific population, percutaneous techniques have been developed and appear as interesting alternative in patients with clinical, biological and morphological severity criteria to reduce the evolutive risk to a more severe form and improve patients’ prognosis. We report here the case of a 49-year-old patient treated for a massive bilateral and proximal PE revealed by syncope with right ventricular impact in whom percutaneous pulmonary thrombectomy was proposed in the absence of clinical improvement after the initiation of anticoagulant therapy. The precise indications for percutaneous techniques need to be clarified in patients with intermediate/high risk PE and ongoing randomized studies should provide additional results to better identify their place in the therapeutic arsenal.