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Heart failure (HF) is associated with a high mortality rate and recurrent hospitalizations. Recently, remote monitoring (RM) has emerged as a valuable tool in HF care. Poor digital literacy patients (i.e. patients that do not have access or do not use connected devices) are likely not to receive standard RM as these solutions usually are online based. To compare the characteristics of digitally literate patients (DLP) vs. poor digital literacy patients (PDLP) using RM for HF. Patients were followed by Satelia®Cardio, a HF management solution with a RM system including therapeutic guidance by a dedicated nurse phone platform. The system is accessible from any devices, requiring no software installation, no external sensors. DLP answer the questionnaire online and the PDLP answer by phone thanks to the nurse-lead platform. Within 48 hours after inclusion, patients are contacted by the platform nurse (Figure 1). During the monitoring, SMS with a link to a web page with 7 structured questions related to HF symptoms are sent to all patients. Body weight is also followed. In case of symptoms worsening and/or increase in body weight, the cardiologist in charge of the patient is notified. Since 2018, 11 371 HF patients were followed through Satelia®Cardio, among whom 6822 patients are still monitored. The mean age was 74 years (18–102y). More than a third of patients are PDLP (40%). These PDLP were older (79 vs. 69), less likely to be male (60% vs. 70%) and had higher LVEF (43% vs. 39%). In the overall population, the main reasons for stopping the monitoring are related to the occurrence of death (31%), patient/HCP decision (59%), or other reasons (10%). A total of 16,826 hospitalizations were recorded in the global population, with most of them due to HF (54%), and 19% being conventional hospitalizations. The length of hospital stay ranged up to 12 days. Further data will be presented at the time of the congress related to the number and profile of alerts, as well as their resolution, according to the DLP vs. PDLP status. PDLP represent more than a third of patients included in our large HF tele-monitoring population. This profile is composed of individuals who are a decade older than DLP, and consequently likely represent the majority of patients eligible to HF tele-monitoring. Finding adequate technical solutions for PDLP appears mandatory to ensure the scalability of HF RM. [ABSTRACT FROM AUTHOR]

Several pulmonary arterial hypertension (PAH) risk assessment tools (i.e. risk of all-cause death) exist. Yet their performances within a cohort of heart failure (HF) patients with post-capillary pulmonary hypertension (pcPH) have never been explored. To assess the discrimination performance of usual PAH risk assessment tools in a cohort of pcPH patients. HF patients with stable left heart disease and the need for right heart catheterization at rest were enrolled from 2010 to 2018 and followed-up in this prospective multicenter study. pcPH was defined as a mPAP > 20 mmHg with a PAWP > 15 mmHg according to the 2022 ESC guidelines. The following PAH risk assessment tools were used: REVEAL 2.0 (3-strata and continuous score system), REVEAL Lite (abredged version of REVEAL), COMPERA 2.0 (4-strata) and the French method. Three-years all-cause death was the primary outcome. In total, 519 HF patients were enrolled (59% male, median age 62 yo, mPAP averaged 37 mmHg): 441 (85%) had at least the 7-requested variables for REVEAL2.0 calculation and 319 (61%) the 3-requested variables for COMPERA2.0 or the noninvasive French method calculation. For each of the methods, the higher the score, the better the long-term survival (log-rank P < 0.001, Figures 1 and 2). Each of the method had fair to good discrimination performance. REVEAL2.0 continuous score depicted the highest c-index (0.66, 95%CI [0.62–0.72]) followed by REVEAL2.0 3-strata system (0.63, 95%CI [0.60–0.70]), REVEAL Lite (0.59, 95%CI [0.56–0.62]), COMPERA2.0 (0.59, 95%CI [0.54–0.64]) and the French method (0.54, 95%CI [0.51–0.57]). PAH risk assessment tools may be used for pcPH risk assessment with fair-to-good discrimination power, especially REVEAL2.0. Further research should be focused on risk assessment in this particular population of HF patients. [ABSTRACT FROM AUTHOR]

The influence of gender on healthcare resource access and prognosis in heart failure (HF) remain unclear. We aimed to assess the association between follow-up (FU) and outcome after HF decompensation according to gender. All adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand-Est region were studied. Association between FU and outcomes was assessed with time-dependent survival analysis model. A total of 67,476 patients were analyzed (mean age 80.3 ± 11.3 years, 53% female). Among them, women were older but experienced less comorbidities. In hospital mortality was 8.1% in women and 7.7% in men (P = 0.07). Appointment with a general practitioner (GP) (P < 0.0001), cardiologist (P < 0.0001), blood ionogram (P < 0.0001), and natriuretic peptide assays (P < 0.0001) after discharge were lower in women. Women have reduced access to cardiologist follow-up, adjusted odd-ratio, 0.77 [95% CI, 0.75–0.80], P < 0.0001. Mortality was 27.1% at 1 year, in both sexes (P = 0.58) but one-year HF readmission was slightly higher in men (28.9% versus 27.6%, P < 0.0001). Using men as reference, women were associated with a decrease of 19% of one-year mortality (adjusted HR (aHR), 0.81 [95% CI, 0.79–0.84], P < 0.0001) and 9% of one-year HF readmission (aHR, 0.91 [95% CI, 0.88–0.94], P < 0.0001). Cardiologist FU was associated with a more than 40% reduction of one-year mortality and a 20% increase of one-year HF readmission in both groups without significant interaction between genders (interaction P -value = 0.074 for one-year mortality and 0.83 for one-year HF readmission respectively). Although cardiological follow-up after cardiac decompensation provides similar benefits in both sexes, women have too limited access. Female gender was associated with 19% and 9% reduction in one-year mortality and rehospitalization respectively. Increasing cardiology follow-up in women after cardiac decompensation could significantly improve prognosis in this population. [ABSTRACT FROM AUTHOR]

Echocardiographic assessment of the athlete's heart remains challenging because of a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The lower range of normal values of left ventricle systolic ejection fraction (LVEF) and global longitudinal strain (GLS) in athletes makes it difficult to differentiate changes related to adaptive remodelling or indicative of early cardiomyopathy. This study sought to identify echocardiographic phenotype of endurance athletes using 2D speckle tracking imaging with a multi-layer approach and to define predictive factors of subtle LV systolic dysfunction. Healthy male athletes who underwent a pre-participation medical evaluation at the University Hospital of Nancy between 2013 and 2020 were included. Clinical and echocardiographic data were compared with healthy men from the STANISLAS cohort. Subtle LV dysfunction was defined as a GLS < 17.5%. A total of 191 athletes and 161 control subjects were studied. Athletes demonstrated lower LVEF (57.9% vs. 62.6%; P < 0.01) and lower GLS (17.8% vs. 21.1%; P < 0.01). No significant differences were found between athletes with and without subtle LV dysfunction regarding clinical characteristics, structural echocardiographic features, and exercise capacity. Athletes with subtle LV dysfunction exhibited a lower endocardial GLS (18.8% vs. 22.7%; P < 0.02), a lower epicardial GLS (14.0% vs. 16.6%; P < 0.01) and a greater endocardial/epicardial GLS ratio (1.36 vs. 1.32; P < 0.01). No significant difference was found regarding mechanical dispersion (P = 0.46). The endurance athlete's heart is characterized by a specific myocardial deformation pattern with a greater endocardial/epicardial GLS ratio. Subtle LV dysfunction seems mainly driven by a decreased epicardial GLS and not related to exercise capacity, structural remodelling or mechanical dispersion (Fig. 1). [ABSTRACT FROM AUTHOR]

Transthyretin cardiac amyloidosis (ATTR-CA) is an emerging cause of heart failure. The screening of ATTR-CA remains difficult since its echocardiographic features are analogous to those observed in patients with age- and hypertension-related cardiac remodeling. We retrospectively included 264 patients (76 ± 13 years old, 59% male) referred for suspected ATTR-CA. A supervised machine learning diagnosis algorithm differentiating patients with (n = 112) and without (n = 152) ATTR-CA was constructed based on echocardiographic data, and subsequently validated in an external multicenter cohort of 455 patients (76 ± 13 years old, 61% male). Patients with ATTR-CA had a lower systolic function (LVEF 47.4 ± 11 vs. 54.3 ± 12%, P < 0.001), left ventricular (LV) global longitudinal strain (GLS) (11.0 ± 3.7 vs. 14.2 ± 4.5%, P < 0.001) and more significant relative apical longitudinal sparing (RALS) (1.5 ± 1.2 vs. 0.9 ± 0.4, P < 0.001) compared to controls. Machine learning identified right ventricular free wall thickness (RVFWT), RALS, relative wall thickness (RWT), and LV mass index as key variables for identifying ATTR-CA (AUC 0.88 [0.84–0.92]; P < 0.001). The diagnostic value of this R3M (RVFWT, RALS, RWT and LV Mass index) algorithm was good in the validation multicenter cohort with an AUC of 0.79 [0.75–0.83] P < 0.001. The R3M algorithm further improved diagnostic accuracy over the IWT (Increased Wall Thickness) guidelines score (increase in C-index of 0.15 [0.10–0.21], P < 0.001). The simple R3M algorithm based on echocardiographic data exploring RVFWT, apical sparing, and concentric hypertrophy displays good diagnostic accuracy for ATTR-CA and could represent an efficient screening tool (Fig. 1). [ABSTRACT FROM AUTHOR]

Background and Aims: Elevated serum uric acid (sUA) concentrations have been associated with worse prognosis in heart failure (HF) but little is known about elderly patients. We aimed to assess long-term additive prognostic value of sUA in elderly patients hospitalized for HF.Methods and Results: Clinical and echocardiographic characteristics of 310 consecutive elderly patients hospitalized for HF were collected. During index period, 206 had sUA concentrations available, which were obtained within 24 h prior to discharge; 10 patients were lost to follow-up, leaving 196 patients available. Patients had a median age of 77 (IQR 69-83) years, and were mostly male (64.5%). sUA ranges for tertiles I-III were: 1.5-6.1, 6.2-8.3, and 8.4-18.9 mg/dl, respectively. During a median follow-up of 27 months (IQR 10.5-39.5), 122 combined events occurred (87 deaths and 73 HF rehospitalizations). Four-year event-free survival for the combined endpoint was 46 ± 7% for tertile I, 34 ± 7% for tertile II, and 21 ± 5% for tertile III (P = 0.001). By multivariable Cox backward analysis, sUA was retained as a significant predictor. Compared with the lowest sUA tertile, tertile III showed a strong association with outcome, also after adjustment for other predictors (HR 1.84, 95% CI 1.16-2.93; P = 0.01). Importantly, addition of sUA to the other significant predictors of outcome resulted in improved risk classification (net reclassification improvement 0.19, P = 0.017).Conclusions: High sUA at discharge is a strong predictor of adverse outcome in elderly hospitalized for HF, and it significantly improves risk classification. Measuring sUA can be a simple and useful tool to identify high-risk elderly hospitalized for HF. [ABSTRACT FROM AUTHOR]

The consensus guidelines recommended implantable cardioverter defibrillators (ICD) for sudden cardiac death prevention in patient with non-ischemic dilated cardiomyopathy (DCM) and LVEF < 35%. However, recent data suggest that it will not affect prognosis. Some markers have identified patients with higher risk of ventricular arrhythmias independently of LVEF. Better optimization of risk stratification for sudden cardiac death and specify implantation criteria are necessary. We performed comprehensive cardiac evaluation including imaging to predict ventricular arrhythmias in a population of non-ischemic DCM. We conducted a monocentric retrospective study including 107 patients with non-ischemic DCM and implanted with ICD as primary prevention from 2013 to 2019. Primary outcome is composite of appropriate therapy by ICD for ventricular tachycardia and ventricular fibrillation or sudden cardiac death. All-cause mortality and LVEF progress are secondary outcome. Primary outcome occurred in 21 patients (20%). In univariate analysis, GFR especially when it is < 50 mL.min-1.1.73 m-2(HR 4.62, P = 0.003), right ventricle ejection fraction under 40% (HR 2.48, p 0.04), number of segments with LGE (HR 1.22, P < 0.001) especially when there are 3 or more (HR 5.47, P < 0.001) or subepicardial location (HR 3.33, P = 0.03) are associated with ventricular arrhythmias. In a multiparametric assessment, this study highlights one important parameter associated with ventricular arrhythmias in selected population of non-ischemic DCM and LVEF < 35%: the extend of myocardial fibrosis, especially with 3 or more segments with LGE. It supports the concept of "critical mass" of fibrosis necessary for initiation and maintenance of ventricular arrhythmias. It was demonstrated in ischemic heart disease but a threshold value remains to be determined in non-ischemic DCM. The main result (Fig. 1). [ABSTRACT FROM AUTHOR]

Our society is currently facing an epidemic of diabetes and heart failure. Historically, certain cardiology treatments, mainly beta-blockers, have been considered ‘dangerous’ in diabetic patients, but the time has come for personalized medicine to be applied in the field of cardiology, especially in heart failure (HF). To determine whether HF treatment should be individualized according to diabetes status, this review of the available randomized evidence was carried out, with special emphasis on treatment-effect modification in relation to diabetes. Based on a large body of evidence in the literature, our review concludes that HF treatment should be the same for diabetic and non-diabetic patients. In concurrence, international guidelines now strongly advocate the use of HF drugs, including beta-blockers, in diabetic HF patients. The benefit of HF treatment is at least as favourable in such patients as in non-diabetic patients on a relative basis. Given the higher risk of events in diabetics, this could translate to an even greater absolute impact of HF treatment in these patients, which should further encourage caregivers to more aggressively manage HF in diabetic patients. To this end, non-cardiologists, including general practitioners and endocrinologists/diabetologists who treat diabetic HF patients, should be considered part of the HF drug optimalization process, including the referral of patients to specialized centres for possible implantable cardiac defibrillators and/or cardiac resynchronization indication assessment. [ABSTRACT FROM AUTHOR]

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Epicardial adipose tissue (EAT), through a paracrine secretion of various molecules, seems to be implicated in left atrial (LA) adverse remodelling, promoting persistent atrial fibrillation (PersAF). Computed tomography (CT) density appears to be a marker of EAT secretory activity. We sought to assess whether EAT density alone or combined with EAT volume is associated with the occurrence of PersAF after a first catheter ablation (CA) procedure. This retrospective study included all consecutive patients undergoing a first CA procedure for PersAF in Nancy University Hospital in 2016 and 2017 with a one-year follow-up. Cardiac CT performed before the ablation allowed quantitative (volume) and qualitative (density) analysis of EAT. One hundred and seventy-seven patients were included. After adjustment, determinants of EAT volume were age (β = 0.97, P = 0.014), triglycerides level (β = 10.61, P = 0.002), LA area (β = 4.06, P < 0.001), and LA volume (β = −1.05, P = 0.005). Overall EAT density was associated with increased BMI (β=0.19, P = 0.005) and BNP level (β = 0.002, P = 0.005), while peri-LA EAT density correlated with higher BMI (β = 0.37, P = 0.01) and total cholesterol level (β = 2.53, P = 0.017). Patients showing AF recurrence were more likely to be females (30.2% vs. 14.8%, P = 0.016), diabetics (21.9% vs. 9.9%, P = 0.032) and symptomatic (NYHA III/IV: 20.8% vs. 8.6%, P = 0.025). AF recurrence was associated with a lower density of overall EAT (−97.7 ± 4.4 vs. −96.3 ± 3.9, P = 0.024) and peri-LA EAT (P < 0.001). EAT density assessed by cardiac CT seems to be correlated with the risk of recurrence after a first PersAF CA. EAT density might be useful to predict PersAF recurrence after CA and could also become a therapeutic target. [ABSTRACT FROM AUTHOR]

Background Bioprosthesis (BP) structural deterioration after aortic valve replacement (AVR) is generally defined by re-operation for BP failure. This approach underestimates the incidence of structural valve deterioration. We intended to determine the incidence, predictors and impact of valve hemodynamic deterioration (VHD) assessed by echocardiography (TTE). Methods A total of 1387 patients (62.2% male; 70.5 ± 7.8 years old) were retrospectively included. A baseline TTE was performed at a median time of 4.1 (1.3–6.5) months post-AVR. TTE follow-up was performed at least 2-years post-AVR in all patients, at least 5-years in 926 patients and at least 10-years in 385 patients. VHD was defined as: > 10 mmHg increase in mean gradient (MG) and/or worsening of regurgitation > 1/3 grade from baseline to last TTE follow-up. Results Overall, VHD was identified in 428 patients (30.9%). The VHD occurred within the first 5 years in 181 (42.3%) patients and after 5 years in 247(57.7%) patients. VHD was a predictor of death (HR: 2.18, 95% CI: 1.86 to 2.57, P < 0.001). Diabetes (HR: 1.33, 95% CI: 1.06 to 1.66, P = 0.01), post-surgery MG > 15 mmHg (HR: 1.30, 95% CI: 1.05 to 1.62, P = 0.02), severe PPM (HR: 1.85, 95% CI: 1.12 to 2.87, P = 0.02) and type of BP ( P < 0.001) were associated with VHD. Predictors of early VHD identified (within the first 5-years post-AVR) were: diabetes ( P = 0.01), active smoker status ( P = 0.01), renal insufficiency ( P = 0.01), post-surgery MG > 15 mmHg ( P = 0.04), post-surgery > mild transprosthetic regurgitation ( P = 0.04) and type of BP ( P = 0.003). Predictors of late VHD (i.e. after the 5 years) were: female sex ( P = 0.03), coumadin ( P = 0.007) and type of BP ( P < 0.001). Conclusions VHD as documented by TTE is frequent (30%) following AVR and associated with 2.2-fold increase in mortality. The main factors associated with VHD were female sex, diabetes, smoking, coumadin, presence of severe prosthesis-patient mismatch, high residual gradient, and/or regurgitation early after AVR. [ABSTRACT FROM AUTHOR]

Introduction La cardiopathie urémique est une entité complexe qui touche 75 % des patients dialysés. La mortalité cardiovasculaire du patient transplanté reste nettement supérieure à celle de la population générale. L’objectif de ce travail est d’étudier des facteurs influençant l’évolution des paramètres échocardiographiques après transplantation rénale et l’impact des comorbidités prégreffe sur l’évolution cardiaque après transplantation. Patients et méthodes Cette étude monocentrique rétrospective observationnelle a inclus les patients ayant bénéficié d’une première transplantation rénale entre le 1 er janvier 2007 et le 31 août 2015. Chaque patient a bénéficié d’une ETT avant la greffe et au minimum 6 mois après la greffe. Tous les paramètres échocardiographiques ont été relus par un opérateur indépendant en aveugle des résultats de la greffe. L’impact des facteurs suspectés a été étudié par une analyse multivariée par régression linéaire. Résultats Cinquante-six patients ont constitué notre cohorte. Il n’a pas été observé de modification significative de la masse ventriculaire gauche indexée (MVGi) (114,0 g/m 2 versus 105,9 g/m 2 ; p = 0,13). Il a été observé un gain significatif de la FEVG en postgreffe (69,6 % versus 63,9 % ; p = 0,0046). Il n’a pas été observé de variation significative des autres paramètres échocardiographiques. En analyse multivariée, le diabète était associé à une moindre amélioration des pressions de remplissage et du remodelage ventriculaire ( â = 4,15, p = 0,046 ; et â = −0,15, p = 0,06). Les coronaropathies étaient associées à une moins bonne évolution de la FEVG ( β = 7,17 ; p = 0,02). Les valvulopathies étaient associées à une moins bonne évolution de la MVGi ( β = −27,3, p = 0,037) Discussion Les comorbidités avant la greffe, notamment cardiovasculaire, semblent avoir un impact plus important que les paramètres néphrologiques après la greffe. Dans cette étude, on retrouvait une faible amélioration des paramètres échocardiographiques et un impact modéré de la transplantation rénale sur l’évolution de ces paramètres. Conclusion L’impact de la transplantation rénale sur l’évolution des paramètres échocardiographiques était faible dans cette étude. La coexistence d’une cardiopathie diabétique et d’une cardiopathie urémique pourrait avoir un rôle non négligeable dans cette absence d’amélioration après la greffe. [ABSTRACT FROM AUTHOR]

Severe degenerative mitral stenosis (DMS) is a known predictor of mortality in patients with symptomatic aortic stenosis (AS) considered for transcatheter aortic valve replacement (TAVR) but little data exist regarding mild to moderate DMS. We assessed the association of DMS with mitral annulus calcification (MAC) and evaluated the association of non-severe DMS and MAC with morbidity and mortality in patients with severe AS undergoing TAVR. In a retrospective cohort of 346 patients with isolated severe AS undergoing TAVR, we evaluated the association of different DMS severities (based on transmitral mean pressure gradient (TMPG, mmHg)) and MAC severity with all-cause mortality and cardiovascular (CV) hospitalization/death. Severe DMS (TMPG > 10 mmHg) was excluded from the analysis. Non-severe DMS (TMPG > 2 mmHg) was present in 42% of patients (n = 147) and moderate to severe MAC in 46% (n = 131). Patients with TMPG > 2 mmHg were predominantly female (66.7% vs. 41.7%, P < 0.001) with a higher LVEF and smaller diastolic LV volume than patients with no DMS (P < 0.05). In a multivariate analysis, TMPG (> 2 mmHg) and MAC (moderate to severe) were found to be independent predictors of mortality (HR = 1.17 [1.02–1.35], P = 0.0245 and HR = 2.01 [1.18–3.44], P = 0.01 respectively). Non-severe DMS is frequently associated with MAC in patients with severe AS undergoing TAVR. In the challenging context of DMS and MAC in patients undergoing TAVR, TMPG > 2 mmHg appears as an independent prognostic factor that discriminates high-risk patients. [ABSTRACT FROM AUTHOR]

Introduction L’échographie pulmonaire permet d’évaluer la quantité d’eau pulmonaire extravasculaire grâce à la recherche de lignes B également appelées « comètes ». Le nombre de lignes B est proportionnel à la quantité d’eau pulmonaire extravasculaire. Afin de prévenir les complications liées à l’hyperhydratation extracellulaire, la recherche de comètes pourrait permettre d’améliorer l’évaluation de l’état d’hydratation des patients transplantés rénaux dans la période postopératoire immédiate. Patients et méthodes Cette étude a inclus 37 patients hospitalisés pour transplantation rénale. Un opérateur unique, en aveugle des résultats de la greffe, a réalisé une échographie pulmonaire et une mesure du diamètre de la veine cave inférieure (VCI) de manière quotidienne jusqu’au retour à domicile des patients. Le volume plasmatique instantané estimé (ePV) a été calculé par le formule : [(1 − hématocrite)/hémoglobine] × 100. Résultats Le nombre de comètes augmente légèrement jusqu’au 5 e jour après la greffe (jour 1 (j1) : 1,7 ± 1,7 ; jour 4 (j4) : 2,5 ± 2,5), puis diminue jusqu’au dixième jour (j10) (1,4 ± 2,2 ; en comparaison avec j4 p < 0,05). À j4, 60 % des receveurs âgés de plus de 60 ans ont plus de 3 comètes contre seulement 14,3 % des receveurs de moins de 60 ans ( p = 0,01). Chez les sujets âgés, le nombre de comètes est corrélé à la variation du poids à j1 ( r = 0,64, p < 0,05) et au diamètre de la VCI à j4 et j10 (respectivement r = 0,59 et r = 0,58, p < 0,05). Entre j1 et j10, la variation du nombre de lignes B est corrélée à la variation du diamètre de la VCI ( r = 0,62, p < 0,05). Discussion L’échographie pulmonaire pourrait bénéficier aux patients à risque de développer une congestion pulmonaire en cas d’hyperhydratation extracellulaire (patients âgés, aux antécédents de cardiopathie ou recevant un rein issu de donneurs marginaux). Ceci pourrait permettre d’éviter les complications cardiovasculaires précoces en post-transplantation et d’optimiser la reprise de fonction des greffons les plus fragiles pour lesquels la congestion est probablement néfaste. Conclusion Chez les sujets âgés bénéficiant d’une transplantation rénale, l’échographie pulmonaire semble utile pour l’évaluation de l’état d’hydratation. [ABSTRACT FROM AUTHOR]

Introduction L’épargne en inhibiteurs de la calcineurine (ICN) permet d’améliorer la fonction et la survie des greffons rénaux à court terme mais pas à long terme. Les donor specific antibodies (DSA) peuvent être impliqués dans la dysfonction du greffon à long terme. L’objectif de cette étude est d’évaluer l’impact de la minimisation des ICN sur la survenue des DSA. Patients et méthodes Il s’agit d’une étude rétrospective monocentrique réalisée entre janvier 2007 et décembre 2013. Les taux résiduels en ICN, les DSA avec leur MIF, le nombre de rejets, la survie des patients et des greffons ont été recueillis. Les patients ont été considérés comme minimisés si leur taux résiduel était inférieur aux cibles internationales plus de 50 % du temps d’exposition aux ICN. Résultats Au total, 247 patients ont été inclus (âge moyen 50 ans, 27,5 % de greffes avec donneur vivant). Cent soixante-cinq patients ont été minimisés d’après la définition retenue ; 21,8 % des patients minimisés ont présenté des DSA (seuil MFI : 1000) versus 3,7 % des patients non minimisés (HR en analyse multivariée pour l’apparition d’un DSA avec MFI > 1000 = 6,79 [2,08–22,15], p = 0,001 ; HR pour une somme de DSA avec MFI > 6000 = 3,84 [1,14–12,92], p = 0,03). Au cours du suivi, 9,4 % des patients minimisés sont retournés en dialyse versus 3,4 % des patients non minimisés (HR = 3,22 [0,93–11,22], p = 0,066). Au sein du sous-groupe n’ayant présenté ni cancer ni infection grave au cours du suivi ( n = 136), la minimisation reste associée à un sur-risque d’apparition de DSA (HR multivarié pour l’apparition d’un DSA avec MFI > 1000 = 7,50 [1,77–31,88], p = 0,006). Discussion L’originalité de ce travail tient à la prise en compte des taux résiduel en ICN et non des posologies. D’autres facteurs de confusion sur le risque de développer des DSA n’ont pas pu être évalués comme les transfusions ou les grossesses. Par ailleurs, l’inobservance est un facteur qui n’a pu être exploré dans cette étude. Conclusion La minimisation des ICN est un facteur de risque de développer des DSA de novo y compris dans une population à faible risque immunologique. Ces résultats doivent être confirmés par une étude prospective de grande ampleur. [ABSTRACT FROM AUTHOR]