Pub Date : 2024-09-23DOI: 10.1016/j.ancard.2024.101797
Nicolas Amabile , Philippe Garot
The steady development of same-day discharge (SDD) PCIs in recent years means that, by 2024, we will be able to tackle increasingly complex lesions, including those of the left main artery. This strategy is supported by the literature, but requires an appropriate patient selection (based on medical and social criteria) and precise assessment of the anatomical complexity of the lesion and the foreseeable risks of the PCI. Strict adherence to pre-established service protocols for patient preparation and follow-up, as well as the establishment of clinical and paraclinical criteria for discharge to a conventional hospital unit, are essential to the success of an SDD PCI program.
{"title":"L'angioplastie du Tronc commun gauche en ambulatoire : Comment s'y prendre ?","authors":"Nicolas Amabile , Philippe Garot","doi":"10.1016/j.ancard.2024.101797","DOIUrl":"10.1016/j.ancard.2024.101797","url":null,"abstract":"<div><div>The steady development of same-day discharge (SDD) PCIs in recent years means that, by 2024, we will be able to tackle increasingly complex lesions, including those of the left main artery. This strategy is supported by the literature, but requires an appropriate patient selection (based on medical and social criteria) and precise assessment of the anatomical complexity of the lesion and the foreseeable risks of the PCI. Strict adherence to pre-established service protocols for patient preparation and follow-up, as well as the establishment of clinical and paraclinical criteria for discharge to a conventional hospital unit, are essential to the success of an SDD PCI program.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101797"},"PeriodicalIF":0.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.ancard.2024.101798
Taryètba André Arthur Seghda , Temoua Dan Naibé , Yirtièrou Eric Dabiré , Martin Wendlassida Nacanabo , Sandrine Damoué Seghda , Djième Claudine Dah , Abouga Loya Mireille , Nobila Valentin Yaméogo , Georges R.C Millogo , Anna Tall Thiam , Laurence Flork , André K Samadoulougou , Patrice Zabsonré
Objective
To evaluate the performance of the 4PEPS score in the diagnosis of pulmonary embolism at the University Hospital of Bogodogo from January 1, 2021 to July 31, 2023.
Methodology
This was a cross-sectional descriptive and analytical diagnostic study, running from January 1, 2021 to July 31, 2023. It took place in the infectious and tropical diseases departments, including a pneumology unit and a cardiology unit, of the Bogodogo University Hospital. Patients of both sexes with suspected pulmonary embolism who had undergone CT scan were included. The 4PEPS score was calculated and dichotomized into probable and improbable. It thus constituted the diagnostic test. CT scan was the gold standard. The accuracy of the diagnostic test was judged by the area under the ROC curve. An area under the curve between 0.70 and 1 would mean that the score was moderately informative to perfect.
Results
Our study included 472 patients with suspected pulmonary embolism out of a total population of 1228 patients. Hospital prevalence was 21.7%. The mean age of patients was 54.3 years. Females accounted for 52.1% of cases, with a sex ratio of 0.93. The prevalence of pulmonary embolism in the different probability levels of the 4PEPS score was 13.3% for the very low level, 11.7% for the low level, 84.6% for the intermediate level and 93.3% for the high level. Sensitivity and specificity were 92.1% and 86.82% respectively. The positive and negative predictive values were 90.1% and 89.4% respectively. The area under the ROC curve was 0.91.
Conclusion
In our study, the 4PEPS score showed good negative and positive predictive values. The use of this score will enable practitioners faced with diagnostic difficulties to make therapeutic decisions, reducing inappropriate prescriptions for thoracic angioscan.
{"title":"Performance du score de probabilité à 4 niveaux 4PEPS pour le diagnostic de l'embolie pulmonaire dans une population d'Afrique subsaharienne : données du Registre des Embolies Pulmonaires du Centre Hospitalier Universitaire de Bogodogo, Burkina Faso","authors":"Taryètba André Arthur Seghda , Temoua Dan Naibé , Yirtièrou Eric Dabiré , Martin Wendlassida Nacanabo , Sandrine Damoué Seghda , Djième Claudine Dah , Abouga Loya Mireille , Nobila Valentin Yaméogo , Georges R.C Millogo , Anna Tall Thiam , Laurence Flork , André K Samadoulougou , Patrice Zabsonré","doi":"10.1016/j.ancard.2024.101798","DOIUrl":"10.1016/j.ancard.2024.101798","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the performance of the 4PEPS score in the diagnosis of pulmonary embolism at the University Hospital of Bogodogo from January 1, 2021 to July 31, 2023.</div></div><div><h3>Methodology</h3><div>This was a cross-sectional descriptive and analytical diagnostic study, running from January 1, 2021 to July 31, 2023. It took place in the infectious and tropical diseases departments, including a pneumology unit and a cardiology unit, of the Bogodogo University Hospital. Patients of both sexes with suspected pulmonary embolism who had undergone CT scan were included. The 4PEPS score was calculated and dichotomized into probable and improbable. It thus constituted the diagnostic test. CT scan was the gold standard. The accuracy of the diagnostic test was judged by the area under the ROC curve. An area under the curve between 0.70 and 1 would mean that the score was moderately informative to perfect.</div></div><div><h3>Results</h3><div>Our study included 472 patients with suspected pulmonary embolism out of a total population of 1228 patients. Hospital prevalence was 21.7%. The mean age of patients was 54.3 years. Females accounted for 52.1% of cases, with a sex ratio of 0.93. The prevalence of pulmonary embolism in the different probability levels of the 4PEPS score was 13.3% for the very low level, 11.7% for the low level, 84.6% for the intermediate level and 93.3% for the high level. Sensitivity and specificity were 92.1% and 86.82% respectively. The positive and negative predictive values were 90.1% and 89.4% respectively. The area under the ROC curve was 0.91.</div></div><div><h3>Conclusion</h3><div>In our study, the 4PEPS score showed good negative and positive predictive values. The use of this score will enable practitioners faced with diagnostic difficulties to make therapeutic decisions, reducing inappropriate prescriptions for thoracic angioscan.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101798"},"PeriodicalIF":0.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A multidisciplinary therapeutic optimization unit (COT) was created in January 2023 at Versailles Hospital, aimed at therapeutic optimisation of patients with chronic heart failure with reduced left ventricular ejection fraction. The objective of the study was to assess the impact of the first year of COT activity on the sequential implementation and titration of heart failure treatments, the clinical evolution, and improvement of patients’ quality of life.
Methods
This prospective study included consecutive patients treated by the COT after hospitalisation for acute heart failure, from January to December 2023. Clinical, biological, titration, and tolerance data were analysed. Quality of life was assessed at baseline and at the end of the follow-up by COT, using standardized SF-12 and EQ-5D questionnaires.
Results
We included 90 patients (men 73%, mean age 67 years). The mean left ventricular ejection fraction was 34 ± 10 %. At final visit (median number of visits 4 ; median follow-up duration 156 days), 76.7% of patients achieved optimisation with respect to maximum individually tolerated doses, but only 13.3% with respect to theoretical maximum doses for the four therapeutic classes. At 1-year follow up, total mortality was 4.4% (4/90), and 9 patients (10%) were rehospitalised unplanned for acute heart failure. COT monitoring was associated with significant improvement in NYHA class, left ventricular ejection fraction, and SF-12 and EQ-5D-5L quality of life scores.
Conclusion
Although titration of heart failure treatments remained suboptimal, significant improvement was observed for NYHA class, left ventricular ejection fraction, and patient quality of life parameters.
{"title":"Évaluation préliminaire de l'intérêt d'une cellule d'optimisation thérapeutique sur la titration des traitements de l'insuffisance cardiaque à fraction d’éjection ventriculaire gauche réduite et la qualité de vie des patients","authors":"Hanane Aissaoui, Stéphane Pichard, Violaine Gaulupeau, Elodie Gautron, Thibault Wajchert, Franck Assayag, Floriane Gilles, Paul Duvillier, Jean-Louis Georges, Géraldine Gibault-Genty","doi":"10.1016/j.ancard.2024.101802","DOIUrl":"10.1016/j.ancard.2024.101802","url":null,"abstract":"<div><h3>Introduction</h3><div>A multidisciplinary therapeutic optimization unit (COT) was created in January 2023 at Versailles Hospital, aimed at therapeutic optimisation of patients with chronic heart failure with reduced left ventricular ejection fraction. The objective of the study was to assess the impact of the first year of COT activity on the sequential implementation and titration of heart failure treatments, the clinical evolution, and improvement of patients’ quality of life.</div></div><div><h3>Methods</h3><div>This prospective study included consecutive patients treated by the COT after hospitalisation for acute heart failure, from January to December 2023. Clinical, biological, titration, and tolerance data were analysed. Quality of life was assessed at baseline and at the end of the follow-up by COT, using standardized SF-12 and EQ-5D questionnaires.</div></div><div><h3>Results</h3><div>We included 90 patients (men 73%, mean age 67 years). The mean left ventricular ejection fraction was 34 ± 10 %. At final visit (median number of visits 4 ; median follow-up duration 156 days), 76.7% of patients achieved optimisation with respect to maximum individually tolerated doses, but only 13.3% with respect to theoretical maximum doses for the four therapeutic classes. At 1-year follow up, total mortality was 4.4% (4/90), and 9 patients (10%) were rehospitalised unplanned for acute heart failure. COT monitoring was associated with significant improvement in NYHA class, left ventricular ejection fraction, and SF-12 and EQ-5D-5L quality of life scores.</div></div><div><h3>Conclusion</h3><div>Although titration of heart failure treatments remained suboptimal, significant improvement was observed for NYHA class, left ventricular ejection fraction, and patient quality of life parameters.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101802"},"PeriodicalIF":0.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.ancard.2024.101801
M.C. Hoara , B. Simorre , M.R. Belabed , P. Berdague , F. Georger
Libman-Sacks endocarditis is a rare cardiac manifestation of anti-phospholipid syndromes, in which non-infectious thrombotic vegetations are found on the heart valves. Most patients are asymptomatic whereas the risk of thromboembolism is considerable. Diagnostic work-up is based on questioning and clinical examination data looking for extracardiac signs, biological data and also on imaging, and, above all, echocardiography.
We report the case of a 47-year-old female patient with no known history who is admitted to hospital with paresthesia of the right hemi-body associated with dysarthria. Cerebral CT scan confirms a paraventricular ischemic stroke. The etiological work-up for stroke is negative except the transesophageal echocardiogram which reveals mitral valve vegetations. Further investigations lead to the diagnosis of Libman-Sacks endocarditis. Treatment with Coumadin is started, with a target INR of between 2 and 3, as recommended. The clinical course was favourable, with stable lesions on transoesophageal echocardiography carried out later.
{"title":"Endocardite de Libman-Sachs et accident vasculaire cérébral ischémique : à propos d'un cas","authors":"M.C. Hoara , B. Simorre , M.R. Belabed , P. Berdague , F. Georger","doi":"10.1016/j.ancard.2024.101801","DOIUrl":"10.1016/j.ancard.2024.101801","url":null,"abstract":"<div><div>Libman-Sacks endocarditis is a rare cardiac manifestation of anti-phospholipid syndromes, in which non-infectious thrombotic vegetations are found on the heart valves. Most patients are asymptomatic whereas the risk of thromboembolism is considerable. Diagnostic work-up is based on questioning and clinical examination data looking for extracardiac signs, biological data and also on imaging, and, above all, echocardiography.</div><div>We report the case of a 47-year-old female patient with no known history who is admitted to hospital with paresthesia of the right hemi-body associated with dysarthria. Cerebral CT scan confirms a paraventricular ischemic stroke. The etiological work-up for stroke is negative except the transesophageal echocardiogram which reveals mitral valve vegetations. Further investigations lead to the diagnosis of Libman-Sacks endocarditis. Treatment with Coumadin is started, with a target INR of between 2 and 3, as recommended. The clinical course was favourable, with stable lesions on transoesophageal echocardiography carried out later.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101801"},"PeriodicalIF":0.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.ancard.2024.101800
A. Manier , C. Seunes , D. Broucqsault , M. Verhaeghe , H. Behal , V. Petit , G. Hannebicque
Background
Transcatheter aortic valve implantation (TAVI) is the gold standard treatment for aortic stenosis in the elderly. Pre-identification of patients likely to benefit from this procedure remains crucial. A standardised geriatric assessment is used to identify the major geriatric syndromes likely to influence postoperative outcomes.
Objective
To identify factors associated with lack of TAVI management and to compare one-year survival in TAVI vs. non-TAVI patients.
Methods
Retrospective study, between 2016 and 2020, at the Arras hospital. Patients aged 70 years and older with symptomatic severe aortic stenosis who had undergone geriatric assessment were included.
Results
One hundred and ninety-two (192) patients, mean age 82.3 years. The 1-year mortality rate was 18% in the TAVI group and 44% in the non-TAVI group (p < 0.001).
Parameters associated with no TAVI were Euroscore (ESL) 1 (19.6 ± 10.9 vs. 23.2 ± 13.5, p = 0.020), malnutrition (14% vs. 35%, p = 0.004), walking speed < 0.8 m/s (39% vs. 75%, p = 0.001), Activities of Daily Life (ADL) score (5.4 ± 1 vs. 4.2 ± 1. 6, p < 0. 001) and Instrumental Activities of Daily Life (IADL) score (2.6 ± 1.2 vs. 1.8 ± 1.4, p = 0.002), Mini Geriatric Depression Scale (mini GDS) ≥ 1 (16% vs. 38%, p = 0.045), Mini Mental State Examination (MMSE) score (25.1 ± 3.5 vs. 21.6 ± 4.3 < 0.001).
Conclusions
Geriatric syndromes are important determinants of TAVI candidacy. Cardiological surgical risk scores are not effective in discriminating between patients. Coordinated assessment may optimise selection. Therefore, geriatric assessment should be systematically performed as part of the pre-TAVI evaluation.
背景导管主动脉瓣植入术（TAVI）是治疗老年人主动脉瓣狭窄的金标准疗法。预先识别可能从该手术中获益的患者仍然至关重要。方法2016年至2020年间在阿拉斯医院进行的回顾性研究。结果 192（192）名患者，平均年龄 82.3 岁。TAVI 组 1 年死亡率为 18%，非 TAVI 组 1 年死亡率为 44%（P = 0.001）。2 ± 13.5，p = 0.020）、营养不良（14% vs. 35%，p = 0.004）、行走速度 < 0.8 m/s（39% vs. 75%，p = 0.001）、日常生活活动（ADL）评分（5.4 ± 1 vs. 4.2 ± 1.6, p < 0. 001）和器质性日常生活活动（IADL）评分（2.6 ± 1.2 vs. 1.8 ± 1.4, p = 0.002），迷你老年抑郁量表（mini GDS）≥ 1（16% vs. 38%，p = 0.025）。结论 老年综合征是 TAVI 候选资格的重要决定因素。心脏病手术风险评分不能有效区分患者。协调评估可优化选择。因此，作为 TAVI 术前评估的一部分，应系统地进行老年病学评估。
{"title":"TAVIGER : Intérêt d’une expertise coordonnée gériatrique et cardiologique dans le bilan d’éligibilité des patients âgés à un remplacement valvulaire aortique par voie percutanée","authors":"A. Manier , C. Seunes , D. Broucqsault , M. Verhaeghe , H. Behal , V. Petit , G. Hannebicque","doi":"10.1016/j.ancard.2024.101800","DOIUrl":"10.1016/j.ancard.2024.101800","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve implantation (TAVI) is the gold standard treatment for aortic stenosis in the elderly. Pre-identification of patients likely to benefit from this procedure remains crucial. A standardised geriatric assessment is used to identify the major geriatric syndromes likely to influence postoperative outcomes.</div></div><div><h3>Objective</h3><div>To identify factors associated with lack of TAVI management and to compare one-year survival in TAVI vs. non-TAVI patients.</div></div><div><h3>Methods</h3><div>Retrospective study, between 2016 and 2020, at the Arras hospital. Patients aged 70 years and older with symptomatic severe aortic stenosis who had undergone geriatric assessment were included.</div></div><div><h3>Results</h3><div>One hundred and ninety-two (192) patients, mean age 82.3 years. The 1-year mortality rate was 18% in the TAVI group and 44% in the non-TAVI group (<em>p</em> < 0.001).</div><div>Parameters associated with no TAVI were Euroscore (ESL) 1 (19.6 ± 10.9 vs. 23.2 ± 13.5, <em>p</em> = 0.020), malnutrition (14% vs. 35%, <em>p</em> = 0.004), walking speed < 0.8 m/s (39% vs. 75%, <em>p</em> = 0.001), Activities of Daily Life (ADL) score (5.4 ± 1 vs. 4.2 ± 1. 6, <em>p</em> < 0. 001) and Instrumental Activities of Daily Life (IADL) score (2.6 ± 1.2 vs. 1.8 ± 1.4, <em>p</em> = 0.002), Mini Geriatric Depression Scale (mini GDS) ≥ 1 (16% vs. 38%, <em>p</em> = 0.045), Mini Mental State Examination (MMSE) score (25.1 ± 3.5 vs. 21.6 ± 4.3 < 0.001).</div></div><div><h3>Conclusions</h3><div>Geriatric syndromes are important determinants of TAVI candidacy. Cardiological surgical risk scores are not effective in discriminating between patients. Coordinated assessment may optimise selection. Therefore, geriatric assessment should be systematically performed as part of the pre-TAVI evaluation.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101800"},"PeriodicalIF":0.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.ancard.2024.101808
Laura Eouzan-Dahan , Alexandre Neyret , Thibaut Wajchert , Virginie Desforges-Bullet , Géraldine Gibault-Genty , Jean-Louis Georges
The relationships between the thyroid and the heart are close and complex. In rare cases, hyperthyroidism induced by Graves' disease can be complicated by an acute myocarditis, which may be life-threatening. We report the case of a 41-year-old woman with Graves' disease not controlled by antithyroid drugs, hospitalized for odynophagia, palpitations due to atrial fibrillation, diffuse ST elevation on ECG and an increase in cardiac troponin. Coronary angiography was normal, cardiac MRI confirmed acute myocarditis. The evolution was favorable after a phase marked by supraventricular and ventricular rhythm disorders. The diagnostic and therapeutic challenge of this association are discussed, with a review of the literature.
{"title":"Myocardite aiguë secondaire à une maladie de Basedow : à propos d'un cas","authors":"Laura Eouzan-Dahan , Alexandre Neyret , Thibaut Wajchert , Virginie Desforges-Bullet , Géraldine Gibault-Genty , Jean-Louis Georges","doi":"10.1016/j.ancard.2024.101808","DOIUrl":"10.1016/j.ancard.2024.101808","url":null,"abstract":"<div><p>The relationships between the thyroid and the heart are close and complex. In rare cases, hyperthyroidism induced by Graves' disease can be complicated by an acute myocarditis, which may be life-threatening. We report the case of a 41-year-old woman with Graves' disease not controlled by antithyroid drugs, hospitalized for odynophagia, palpitations due to atrial fibrillation, diffuse ST elevation on ECG and an increase in cardiac troponin. Coronary angiography was normal, cardiac MRI confirmed acute myocarditis. The evolution was favorable after a phase marked by supraventricular and ventricular rhythm disorders. The diagnostic and therapeutic challenge of this association are discussed, with a review of the literature.</p></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101808"},"PeriodicalIF":0.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is great heterogeneity in lengths of stay in interventional cardiology but the number of outpatient procedures is increasing. The expected benefits of an outpatient procedure are numerous and non-inferiority of this strategy has been demonstrated. Proper selection of patients eligible for this treatment is essential to minimize the risks of unplanned hospitalization and early complications. It is based on clinical, medico-social and organizational criteria. Perfect management of the care pathway based on an organizational unit and a geographical unit is essential.
{"title":"Coronarographie et angioplastie coronaire ambulatoire ; pourquoi, comment, pour quels patients ?","authors":"Marine Quillot , Raphaël Lasserre , Karim Moussa , Mathieu Pankert , Candice Venturelli , Stéphane Andrieu","doi":"10.1016/j.ancard.2024.101805","DOIUrl":"10.1016/j.ancard.2024.101805","url":null,"abstract":"<div><p>There is great heterogeneity in lengths of stay in interventional cardiology but the number of outpatient procedures is increasing. The expected benefits of an outpatient procedure are numerous and non-inferiority of this strategy has been demonstrated. Proper selection of patients eligible for this treatment is essential to minimize the risks of unplanned hospitalization and early complications. It is based on clinical, medico-social and organizational criteria. Perfect management of the care pathway based on an organizational unit and a geographical unit is essential.</p></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101805"},"PeriodicalIF":0.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronary CT-Scan permits non-invasive visualization of all stages of coronary artery atherosclerosis allowing early therapeutic interventions, lifestyle changes and accurate follow-up all of which result in an improved prognosis. We discuss the possibility of a systematic coronary CT-scan in the global population at certain ages such as fifty or sixty years-old (or both). May this strategy decrease the onset of myocardial infarction or ischemic chronic heart failure thus improving quality (and quantity) of life? May it also reduce the medical costs for the individual and the society? Is it technically possible to deploy such a strategy? What would be the obstacles for its set up and what solutions might be proposed?
{"title":"Le coroscanner peut-il être réalisé en dépistage à grande échelle en prévention des syndromes coronaires aigus et de l'insuffisance cardiaque ischémique ?","authors":"Adrien Pasteur-Rousseau , Karam Souibri , Fabien Vannier , Laurent Sebagh","doi":"10.1016/j.ancard.2024.101807","DOIUrl":"10.1016/j.ancard.2024.101807","url":null,"abstract":"<div><p>Coronary CT-Scan permits non-invasive visualization of all stages of coronary artery atherosclerosis allowing early therapeutic interventions, lifestyle changes and accurate follow-up all of which result in an improved prognosis. We discuss the possibility of a systematic coronary CT-scan in the global population at certain ages such as fifty or sixty years-old (or both). May this strategy decrease the onset of myocardial infarction or ischemic chronic heart failure thus improving quality (and quantity) of life? May it also reduce the medical costs for the individual and the society? Is it technically possible to deploy such a strategy? What would be the obstacles for its set up and what solutions might be proposed?</p></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101807"},"PeriodicalIF":0.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.ancard.2024.101796
Bruno Pavy , Marie-Christine Iliou , Sophie Péclet , Bernard Pierre , Catherine Monpère , Jean-Pierre Houppe , Sonia Corone , Alain Dibie , Jean-Michel Nguyen
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.
{"title":"ReTour au Travail du patient coronarien : étude multicentrique française RTT","authors":"Bruno Pavy , Marie-Christine Iliou , Sophie Péclet , Bernard Pierre , Catherine Monpère , Jean-Pierre Houppe , Sonia Corone , Alain Dibie , Jean-Michel Nguyen","doi":"10.1016/j.ancard.2024.101796","DOIUrl":"10.1016/j.ancard.2024.101796","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>364 patients were included in 6 interventional and 17 cardiac rehabilitation centres between 2018 and 2019. The resumption rate was 81% (<em>n</em> = 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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101796"},"PeriodicalIF":0.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.ancard.2024.101806
Arthur Pagezy, Stéphanie Marlière
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.
{"title":"Lésions coronaires calcifiées et résistantes en ambulatoire, mythe ou réalité ?","authors":"Arthur Pagezy, Stéphanie Marlière","doi":"10.1016/j.ancard.2024.101806","DOIUrl":"10.1016/j.ancard.2024.101806","url":null,"abstract":"<div><p>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.</p><p>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.</p><p>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.</p><p>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%).</p><p>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.</p></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101806"},"PeriodicalIF":0.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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