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Background Considering that most patients resuscitated from out-of-hospital sudden cardiac arrests (SCA) die in the intensive care unit (ICU), early systematic etiologic investigation may represent an important strategy towards targeted therapy and appropriate prevention to first-degree relatives at risk. Purpose We aimed to determine the extent to which SCA cases who died in the ICU were investigated. Methods In this prospective ongoing multicentre population-based registry, data from all SCA patients who died in ICU were analyzed. The extent of investigations was defined as complete either in case a combination of coronary angiography (CA), brain, chest CT scan, and trans-thoracic echocardiography (TTE) was performed, or diagnosis found after one of those. SCAs dying in the first 24 hours were excluded because of their poor hemodynamic condition for investigation. Results Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3028 SCA (16%) were admitted alive to ICU, and 2190 (72.3%) died in ICU. After first day exclusion, 947/1417 (66.8%) fulfilled criteria for complete investigations and 470/1417 (33.2%) in the other group. In the group with incomplete investigations, CA was performed in 162 patients (34.6%), TTE in 207 (44.2%), and brain and/or chest CT in 186 (39.6%). A final diagnosis was made for 895 patients (94.5%) in the group with complete investigations: 403 (45.0%) acute CAD, 149 (16.7%) chronic CAD, 115 (12.9%) neurological causes, 80 (8.9%) structural non-ischemic heart disease, 48 (5.4%) pulmonary embolism. Overall, among all unexplained SCA who died in ICU, 434 (89.3%) had incomplete investigation. Conclusions Over a third of SCA who died in ICU did not undergo complete etiologic investigations, preventing from potential adequate familial screening. Improvement in systematic medical assessment is crucial to provide appropriate therapy and prevention to family members. [ABSTRACT FROM AUTHOR]

Introduction Depuis les années 1970, il est connu que les enfants porteurs d’une drépanocytose présentent fréquemment un retard de croissance, souvent associé à un retard pubertaire. Des études plus récentes montrent que la proportion d’enfants drépanocytaires en insuffisance pondérale a fortement diminué, probablement grâce aux traitements modernes (hydroxyurée, transfusions itératives) avec même une tendance au surpoids, voire à l’obésité. Cependant, ces dernières études ont été réalisées dans des pays à hauts revenus, alors que 80 % des enfants atteints naissent en Afrique subsaharienne, où ils ne bénéficient pas de la même prise en charge. Nous avons réalisé une étude cas-témoin nichée dans une cohorte africaine multinationale afin d’étudier la croissance des enfants drépanocytaires et les éventuels facteurs influençant cette croissance. Patients et méthodes CADRE est une cohorte de patients drépanocytaires de cinq pays africains : Cameroun, Gabon, Côte d’Ivoire, Mali et Sénégal. Tous les enfants de 5 à 19 ans issus de cette cohorte ont été inclus dans notre étude, des examens étant programmés régulièrement et à distance de toute crise vaso-occlusive ou de transfusion. Des témoins non drépanocytaires ont été recrutés parmi la famille des patients ou des soignants de chaque Les principaux paramètres étudiés étaient les suivants : antécédents médicaux, taille, poids, pression artérielle ; phénotype drépanocytaire, réparti en 2 sous-groupes (SS ou Sβ0, et SC ou Sβ+) ; numération formule sanguine ; marqueurs d’hémolyse (LDH et bilirubine) ; microalbuminurie ; échographie cardiaque. Le critère de jugement principal était le retard de croissance, défini par un poids, une taille ou un IMC inférieurs au 5 e percentile des normes définies par l’OMS. Nous avons décrit la fréquence du retard de croissance en fonction du phénotype, de l’âge et du sexe et recherché dans les deux groupes phénotypiques drépanocytaires une association entre le retard de croissance et les différents paramètres cliniques et biologiques étudiés par régression logistique multivariée. Résultats Au total, 2070 patients, dont 1741 SS-Sβ0 et 329 SC-Sβ+, ont été inclus et comparés à 243 témoins et aux normes établies par l’OMS. Les garçons représentaient 48 % de la population, l’âge médian était de 11 ans. Un retard de croissance était observé chez 53 % des patients SS-Sβ0, 43 % des SC-Sβ+, et 33 % des témoins. Après ajustement sur l’âge et le pays, la différence de prévalence était hautement significative entre les patients SS-Sβ0 et les témoins (OR = 2,55 [1,83–3,56]) mais pas entre les patients SC-Sβ+ et les témoins (1,35 [0,91–2,01]). En analyse univariée, le retard de croissance était associé au pays (prévalence maximale au Sénégal, minimale au Cameroun), au sexe masculin, à l’âge (prévalence maximale entre 13 et 16 ans), au phénotype SS-Sβ0, à la profondeur de l’anémie et au degré d’hémolyse ( p < 0,0001 pour toutes comparaisons). Après ajustement sur le pays, l’âge, le sexe et le phénotype drépanocytaire, le retard de croissance était associé à la présence de microalbuminurie (OR = 1,4 [1,1–1,8]), et à l’anémie (OR = 1,96 [1,55–2,47] pour le 1er quartile d’hémoglobinémie vs les autres) mais pas aux autres complications de la drépanocytose (ostéonécrose, ulcères de jambe, accident vasculaires cérébraux, priapisme, HTAP, etc.). Par ailleurs, le retard de croissance était maximal entre les âges de 13 et 16 ans, avec une insuffisance pondérale plus profonde que l’insuffisance staturale, et plus marquée chez les garçons que chez les filles. À 18 ans l’IMC moyen des patients redevenait équivalent à celui des témoins pour les filles mais restait inférieur chez les garçons et la taille moyenne était similaire à celle des témoins quel que soit le sexe. Conclusion Le retard de croissance reste fréquent chez les enfants drépanocytaires de phénotype SS-Sβ0 de 5 à 19 ans d’Afrique subsaharienne. Il est plus important en période de puberté, en raison d’un fréquent retard pubertaire, et plus marqué chez les garçons que chez les filles, ces dernières présentant des mesures staturopondérales équivalentes à celles des témoins à partir de l’âge de 18 ans. Le retard de croissance est associé à l’anémie et à l’hyperhémolyse mais ne semble pas influencer de façon indépendante la survenue des complications vasculaires aiguës ou chroniques de la drépanocytose, en dehors de la microalbuminurie. Cependant, les conséquences à long terme du retard de croissance dans la drépanocytose doivent être évaluées par une étude longitudinale. [ABSTRACT FROM AUTHOR]

Introduction Le paradigme dit d’« hyperhémolyse », divisant les patients drépanocytaires en patients hyperhémolyseurs (à risque de développer des ulcères de jambe, des priapisme et de l’hypertension pulmonaire) et en patients hypervisqueux (présentant des crises vaso-occlusives et des ostéonécroses) est actuellement controversé. Cette dichotomisation est fondée sur des études nord-américaines ne prenant pas en compte l’ensemble des complications vasculaires et des phénotypes de la drépanocytose. Ce paradigme n’a jamais été étudié en Afrique, où vit 80 % des patients drépanocytaires. L’objectif de cette étude est d’analyser l’association entre l’hyperhémolyse chronique et les complications vasculaires de la drépanocytose chez des patients d’Afrique subsaharienne. Patients et méthodes CADRE est une cohorte multinationale Africaine incluant prospectivement et à l’état stable des patients drépanocytaires âgés de plus 3 ans. Tous les patients provenant de la Cote d’Ivoire, du Cameroun et du Mali ont été inclus et classés en deux groupes selon leur phénotype : SS-Sβ0 ou SC-Sβ+. Les complications vasculaires de la drépanocytose incluant l’hypertension artérielle pulmonaire (HTAP), la microalbuminurie, les ulcères de jambes, le priapisme, les accidents vasculaires cérébraux (AVC) et l’ostéonécrose ont été recherchés par examen clinique, bilan biologique et échocardiographie. L’hémolyse a été mesurée par un score composite créé par analyse en composante principale et comprenant les LDH, l’hémoglobine, la bilirubine et l’ictère clinique. L’association entre l’hyperhémolyse (définie comme le 4 e quartile du score) et les complications vasculaires a été étudiée par régression logistique multivariée dans toute la population puis après stratification selon le phénotype de l’hémoglobine et enfin dans la population adulte uniquement. Résultats Nous avons inclus 2409 patients parmi lesquels 1751 patients SS-Sβ0 et 658 patients SC-Sβ+. Comparés aux patients SC-Sβ+, les patients SS-Sβ0 étaient plus jeunes (15 ans versus 21 ans), présentaient plus d’ulcères de jambes (166 [9,5 %] versus 24 [3,7 %]), plus de microalbuminurie (573 [42,4 %] versus 119 [20,0 %]) et avaient un score d’hémolyse plus élevé (médiane 1,18 versus 0,43). Après ajustement sur l’âge, le sexe et le pays, l’hyperhémolyse étaient associée à la microalbuminurie (OR = 1,59 [1,17–2,16]) et au priapisme (OR = 1,58 [1,01–2,49]). Chez les patients SS-Sβ0, l’hyperhémolyse était associée à la microalbuminurie (OR = 1,54 [1,10–2,15]) et il y avait une tendance vers une association avec l’HTAP (OR = 1,65 [0,91–2,98]) et les ulcères de jambes (OR = 1,50 [0,95–2,39]). Chez les patients SC-Sβ+, l’hyperhémolyse était associée uniquement à la microalbuminurie. L’analyse de sensibilité sur la population adulte a retrouvé une association entre l’hyperhémolyse et toutes les complications vasculaires en dehors de l’ostéonécrose. Conclusion Chez les patients drépanocytaires africains, l’association entre l’hyperhémolyse chronique et les complications drépanocytaires vasculaires est statistiquement significative mais de faible amplitude, notamment chez les enfants. Notre étude suggère que la dichotomisation clinique fondée sur l’hyperhémolyse qui est actuellement proposée pour les patients drépanocytaires n’est pas pertinente en contexte africain. [ABSTRACT FROM AUTHOR]

Introduction Le phénotype S-bêta thalassémique 0 (SB0) est une forme rare de la drépanocytose résultant d’une hétérozygotie sur le gène de la chaîne béta de globine associant un allèle drépanocytaire S (S) et un allèle béta-thalassémique, ce dernier aboutissant à l’absence de synthèse d’une des chaînes beta. Il représente moins de 5 % des patients drépanocytaires majeurs. Sa sévérité est considérée comme proche de celle du phénotype homozygote SS, le plus fréquent. Toutefois, les patients SB0 ont rarement été étudiés de façon indépendante et leurs spécificités cliniques et biologiques sont mal connues. Le but de notre étude était de comparer sur des critères cliniques et paracliniques les drépanocytaires SB0 aux SS en Afrique sub-saharienne. Patients et méthodes Nous avons utilisé les données épidémiologiques à l’inclusion de la cohorte CADRE, incluant 4300 patients drépanocytaires de plus de 3 ans dans cinq pays africains : Cameroun, Gabon, Cote d’Ivoire, Mali, et Sénégal. Les sujets inclus ont été explorés à distance de toute crise vaso-occlusive (CVO) ou transfusion. Les phénotypes drépanocytaires étaient établis par électrophorèse de l’hémoglobine (Hb) et HPLC. Le diagnostic de SB0 reposait sur l’absence d’HbA0, la présence d’HbS, une HbA2 > 3,5 % et un VGM < 78. Nous avons comparé les caractéristiques des patients SB0 et SS dans les centres ayant au moins 20 patients SB0, par le biais d’une régression logistique multivariée avec ajustement sur le pays, l’âge et le sexe. Les variables étudiées étaient : antécédents (âge de début des douleurs et du diagnostic, nombre de CVO l’année précédente et de syndrome thoracique aigu (STA) dans la vie, accident vasculaire cérébral, ulcère des membres inférieurs, priapisme, ostéonécrose, méningite, ostéite, septicémie), signes physiques (poids, taille, fréquence cardiaque, pression artérielle, hépatomégalie, ictère) ; signes biologiques (hémogramme, débit de filtration glomérulaire, microalbuminurie/créatininurie, lactates déshydrogénase (LDH), ferritinémie, CRP, taux d’HbF) et signes échocardiographiques (fraction d’éjection ventriculaire gauche (FEVG), vitesse de l’onde de régurgitation tricuspidienne). Résultats Parmi les 3821 patients de la cohorte CADRE, 148 patients (4 %) avaient un phénotype SB0, en Côte d’Ivoire ( n = 104), au Mali ( n = 39) et au Sénégal ( n = 5). Les 143 patients SB0 de Côte d’Ivoire et du Mali ont été comparés aux 714 patients SS originaires des mêmes pays. L’âge médian était de 13 ans chez les SB0 et 17 ans chez les SS ( p = 0,0004) et le sexe ratio H/F de 0,8 dans les deux groupes. En analyse multivariée, aucune différence n’était retrouvée sur l’âge de début de la maladie, la fréquence des CVO et des STA, les antécédents médicaux, et les critères physiques en dehors de l’ictère : 37 % chez les SB0 vs 63 % chez les SS ( p = 0,0001). Comparés aux patients SS, les patients SB0 avaient une anémie hémolytique moins sévère (hémoglobine 8,8 vs 8,3 g/dL, réticulocytes 157 vs 207 G/L ; LDH 538 vs 649 UI/L), un taux d’HbF plus élevé (16 % vs 9 %), des valeurs de leucocytes et des plaquettes inférieurs (respectivement 9,9G/L vs 11,4G/L et 380G/L vs 471G/L) avec p < 0, [ABSTRACT FROM AUTHOR]

Screening for sports activity: con! Far from the image of the high-level soccer player collapsing on the lawn in the middle of a match, undoubting an emotional impression covered regularly by the media and now part of our collective imagination, sudden death during sports has most commonly been observed among middle aged 'Sunday' athletes. The consistent media coverage on sudden cardiac death among young competitive athletes has provided the opportunity to draw public awareness of cardiac arrest in general, however, overall it is far from being a globally recognized public health issue eligible for an organized screening campaign., Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts

Sudden cardiac death, mostly related to ventricular arrhythmia, is a major public health issue, with still very poor survival at hospital discharge. Although coronary artery disease remains the leading cause, other etiologies should be systematically investigated. Exhaustive and standardized exploration is required to eventually offer specific therapeutics and management to the patient as well as his/her family members in case of inherited cardiac disease. Identification and establishing direct causality of the detected cardiac anomaly may remain challenging, underlying the need for a multidisciplinary and experimented team., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Since the appearance of the COVID-19 pandemic in 2020, the direct mortality related to COVID-19 infections has been monitored worldwide, with a daily count of the number of deaths due to COVID-19. Several measures have been undertaken in the societal and professional field, and the healthcare systems have been reorganized to limit the virus spread, and to cope with the surge of hospital admissions for COVID-19. Questions have been raised regarding the indirect effect of the pandemic, with uncertainties regarding the impact of delays in non-COVID diseases management, due to lockdown, postponement of non-urgent medical consultations and interventions, and decrease in screening. Sudden cardiac death could have been impacted by all those changes, and is generally a good surrogate of public health. In the current article, we review the impact of the COVID-19 pandemic on the epidemiology and outcome of sudden cardiac death., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Tropical endomyocardial fibrosis (FET) is a leading cause of heart failure and the most common restrictive cardiomyopathy worldwide. Extensive fibrosis of the ventricular endocardium causing architectural distortion, impaired filling and valvular insufficiency define the disease. Confined to peculiar and limited geographical areas, the aetiology remains blurred and it carries a grim prognosis. The changing burden reported recently in some endemic areas and the refinement of diagnostic tools have emphasized alternative routes for understanding and treatment of the disease., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Sudden cardiac death is defined as a natural and unexpected death, in a previous apparently healthy individual. It represents a major public health issue, with up to 50% of the cardiovascular mortality. Using data from the Paris Sudden Death Expertise Centre registry, this article summarises the main cardiovascular abnormalities associated with sudden cardiac death, the different preventives approaches, and provides a systematic diagnostic approach., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Sudden cardiac death is a major public health problem with around 40,000 cases per year in France. Epidemiological, clinical and prognostic differences according to gender have been described in most cardiovascular diseases, including sudden cardiac death. In this article, we will review gender differences in sudden cardiac death incidence, circumstance of occurrence, management, and prognosis., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Sudden cardiac death is a major public health issue, with high incidence and disappointing survival. Therefore, prevention of sudden death and identification of high-risk patients are essential tools, especially in the field of coronary artery disease, which is the main cause of sudden death. Prevalence of coronary artery disease is higher among men, leading to a higher rate of coronary artery disease-related sudden cardiac death. The current issues are identification of gender-specificities regarding coronary artery disease, rhythmic complications and management., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Sudden cardiac death is an unexpected cardiac arrest without obvious extra-cardiac cause. Epidemiology of sudden cardiac death has been poorly documented in France, mainly because of challenging requirement in order to capture all cases in a specific area. The Parisian registry (Sudden Death Expertise Center, European Georges Pompidou Hospital, Paris) was initiated in May 2011 and analyzed data of all sudden death in Paris and suburbs (6.6 millions inhabitants). Over 3 years, the annual incidence estimated to 50-70 per 100,000. Those occurred mainly in men (69%), with a mean age of 65 year, and at home (75%). The event was witnessed in 80% of cases, but bystander cardiopulmonary resuscitation was initiated in only half of cases. Initial cardiac rhythm was ventricular fibrillation in 25%. Survival to hospital discharge remains low (8%).

So far, sports-related sudden death has been mainly studied through young competitive athletes. The national sports-related sudden death French registry (2005-2010) is the first study evaluating sudden death during sports activities in the general population, estimating that approximately 1000 cases occur each year in France. The vast majority occurs among middle age men practicing recreational activities, with women presenting a very low risk (up to 30-fold lower) compared to men. Outcomes dramatically vary across districts with survival to hospital discharge from 0 to 50%. Those differences are mainly the result of major disparities between districts regarding cardiopulmonary resuscitation initiated by bystanders. Coronary artery disease remains the most frequent cardiovascular disease associated with such events.

Introduction: ST-segment-elevation acute myocardial infarction (STEMI) is a therapeutic emergency. Early reperfusion is the key to successful reperfusion. Guidelines recommend organizing regional networks. In France, this starts with a call to a medical dispatch center, the SAMU-centre 15. The aim of this study was to evaluate regional STEMI management using data collected from 2002 to 2010., Methods: Observational, prospective, multicenter survey. STEMI patient with chest pain lasting for less than 24hours managed by 40 mobile emergency and resuscitation service (SMUR) and 8 emergency medical system (SAMU) from the Greater Paris Area (Île-de-France) were analyzed. Demographic data, cardiovascular risk factors, infarction location, decision of reperfusion and delays were collected. The rate of coronary reperfusion was chosen as the primary endpoint., Results: Eleven thousand five hundred and eighty-eight patients enrolled from 2002 to 2010 were analyzed. Median age was 59.9 (51.0 to 72.9) years; 9080 (78.5%) were men. The number of patients included decreased from 1376 in 2002 to 1119 in 2010. Reperfusion was achieved by fibrinolysis in 2644 (23%) cases and primary angioplasty in 7999 (69%) cases. The rate of decision of coronary reperfusion significantly increased from 86.7% in 2002 to 94.8% in 2010 (P<0.0001). Interaction between the increasing decision of reperfusion and all factors studied (demographics, cardiovascular risk factors, infarct location and delays) was significant only for family history of coronary artery disease (P=0.03). In-hospital mortality was 2.8% (321 cases)., Conclusion: The number of patients with STEMI managed by the SAMU declined slightly over the past decade. The rate of decision of reperfusion progressively increased up to 95%. Entrance into the network by the SAMU-centre 15 is a guarantee of a wide and early access to the coronary reperfusion., (Copyright © 2015. Published by Elsevier Masson SAS.)

Acute rheumatic fever develops after an inadequate immune response to throat streptococcal infection that induces the production of antibodies reacting against cardiac endothelial cells. Valve damage may lead to irreversible cardiac valve sequela (rheumatic heart disease) with further evolution towards severe valve dysfunction and heart failure. The disease has been almost eradicated in Western countries with the development of living conditions and prevention policies, including primary prevention (treatment of sore throats) and secondary prevention (long term administration of antibiotics). However, rheumatic heart disease remains a major health problem in developing countries. Recently, echocardiography identified children with mild features of the disease, thereby allowing early treatment., (© 2012 médecine/sciences – Inserm / SRMS.)

Sudden death is a major problem in public health, affecting around 50 000 people a year in France. The prognosis for cardiac arrest is abysmal because for every minute lost the chances of survival diminish by 10%. The aim of this work was to prospectively evaluate the characteristics of cardiac arrest victims across an entire 6000 km? area, the Seine-et-Marne district, distinguished by the paradox of lying just outside the capital whilst actually being semi-rural, and to determine the current methods of dealing with this emergency. The DEFI 77 prospective epidemiological survey was carried out with the collaboration of the SAMU emergency medical service, the SDIS fire/ambulance service, the general hospitals and the Paris-Ile-de-France cardiological association. Between January 2001 and December 2005 there were 2001 cardiac arrests (mean age 68 +/- 20 years, 67% male) at home in 80% of cases. The arrest was in front of a witness in 72% of cases, but they performed resuscitation in only 14.3% of cases. The SAMU and SMUR emergency medical services attempted cardio-pulmonary resuscitation in 78% of cases. In 29% of cases, one or more external electric shocks were carried out, using a semi-automatic defibrillator 79% of the time. Only 11.5% of patients arrived at the emergency department alive, the overall hospital survival rate being less than 2%. Only eight patients subsequently underwent automatic defibrillator implantation. The results of this observational study are to a large extent explained by an extremely long delay (12 minutes) before help was called for, the delay between the call and the arrival of medical assistance (9.5 +/- 4 min), the low percentage of active witnesses, and the variability in management (invasive in particular). In conclusion, at the dawn of the third millennium the prognosis of cardiac arrest remains very poor and fully justifies educating the general public about calling for help early and about actions that can save lives, particularly external cardiac massage before the arrival of the emergency services, as well as the benefits of using automated external defibrillators.

Sudden cardiac death (SCD) remains a major health problem in developed countries with a rate of incidence close to 1/1000 inhabitants/year. In most cases (>80%), SCD occurs as the initial manifestation of a previously ignored cardiac disease, usually coronary artery disease. As a consequence, known risk factors for SCD overlap with those for coronary artery disease and thus are not contributive to identify individuals prone to SCD in the general population. Several clinical studies have demonstrated an increased risk for SCD if one family first-degree relative has experienced SCD, suggesting a genetically acquired susceptibility. Discovering the molecular determinant of this genetic susceptibility may demonstrate extreme value to stratify the risk in the community and to guide prevention. The present review analyses state-of-the-heart research conducted in this field and tentatively measure the distance to be covered before large-scale genetic tests are routinely available in clinical practice.

It is difficult to summarize in a few pages the wealth of information appeared during the year 2005 in the field of epidemiology and cardiovascular prevention. The general epidemiological data on the evolutionary tendencies of coronary mortality and morbidity make it possible to underline the effectiveness of the control of the great risk factors within the framework of the primary prevention. Although lipids and diabetes have still this year held the front of the scene through many trials, this analysis is also focused on smoking, subject more and more tackled in the cardiologic journals, and to which a larger attention should be paid in our daily practice. The Paris Prospective Study I brought new data concerning the early identification of the subjects at risk of sudden death, starting from the analysis of the evolution of heart rate profile during and after exercise. Is the concept of metabolic syndrome a phenomenon of mode or does it constitute in itself an autonomous prognostic factor beyond the risk related to the plurality of the factors which define it? The cardiologist will have to be interested more and more in the living conditions of his patients and in particular with the environmental factors such as the air pollution, who seems to have a considerable impact on the incidence of the acute coronary events. Lastly, the ADMA (asymmetric dimethylarginine), seems a possible new marker of cardiovascular risk, but its real prognostic interest remains to be defined.

Prevalence of heart failure is ranging in European countries between 0.4% to 2%. It increases rapidly with age. The number of patients in heart failure reaches 500,000 in France and there are 120,000 new cases every year. Two-thirds are older than 74 years. 3.5 million of outpatients clinics and 150,000 hospital admissions are due to heart failure every year. Mean hospital stay is 11 days. More than 32,000 deaths are related to cardiac failure. Money spent for cardiac failure represents more than 1% of all medical budget.