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Cardiac chamber remodeling in atrial fibrillation (AF) reflects the progression of cardiac rhythm and may affect functional regurgitation.The purpose of this study was to explore the 3-dimensional echocardiographic variables of cardiac cavity remodeling and the impact on functional regurgitation in patients with AF with/without sinus rhythm restoration at 12 months.A total of 117 consecutive patients hospitalized for AF were examined using serial 3-dimensional transthoracic echocardiography at admission, at 6 months, and at 12 months (337 examinations).During follow-up, 47 patients with active restoration of sinus rhythm (SR) (through cardioversion and/or ablation) had a decrease in all atrial indexed volumes (Vi), end-systolic (ES) right ventricular (RV) Vi, an increase in end-diastolic (ED) left ventricular Vi, and an improvement in 4-chambers function (P 0.05). Patients with absence/failure of restoration of SR (n = 39) had an increase in ED left atrial Vi and ED/ES RV Vi without modification of 4-chambers function, except for a decrease in left atrial emptying fraction (P 0.05). Patients with spontaneous restoration of SR (n = 31) had no changes in Vi or function. The authors found an improvement vs baseline in severity of functional regurgitation in patients with active restoration of SR (tricuspid and mitral regurgitation) and in spontaneous restoration of SR (tricuspid regurgitation) (P 0.05). In multivariable analysis, right atrial and/or left atrial reverse remodeling exclusively correlated with intervention (cardioversion and/or ablation) during 12-month follow-up.Management of AF should focus on restoration of SR to induce anatomical (all atrial Vi, ES RV Vi) and/or functional (4 chambers) cardiac cavity reverse remodeling and reduce severity of functional regurgitation. (Thromboembolic and Bleeding Risk Stratification in Patients With Non-valvular Atrial Fibrillation [FASTRHAC]; NCT02741349).

Introduction: The natural history of tricuspid regurgitation (TR) and right heart chambers remodeling in patients with atrial fibrillation (AF) according to the cardiac rhythm at mid-term follow-up has been poorly assessed. Hypothesis: Restoration of sinus rhythm in AF patients is beneficial to the remodeling of right heart chambers and decrease in TR severity. Methods: We prospectively and serially evaluated 24 consecutive patients hospitalized for AF using three dimensional (3D) transthoracic echocardiography (TTE) at admission (M0) and every 6 months during a 2 years-follow-up (FU, M6, M12, M18, M24) (120 TTE exams). Patients were divided into two groups according to their cardiac rhythm at M24: restoration to SR (SR group, n=14) and persistence of AF (AF group, n=10). TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). 3D indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) as well as 3D tricuspid annulus (TA) area were analyzed in end systole (ES) and end diastole (ED). Results: Beyond 6 months of FU, the SR group had overall significantly lower 3D ES RA Vi, 3D ED RA Vi, 3D TA ES area and TR severity in comparison with AF group (Figure). There were no significant differences between the 2 groups with regard to 3D RV Volumes and 3D ED TA area. Conclusions: According to our results on both TR evolution and right heart cavities reverse remodeling, strategies aiming at SR restoration in patients with AF and TR should be broadly discussed.

Background The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed. Purpose Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus. Methods We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M. Results At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p Conclusion Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted. TR Evolution Funding Acknowledgement Type of funding source: None

Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

Background Acute kidney injury (AKI) frequently occurs after diuretic treatment initiation during acute heart failure (AHF). Treatment-induced hemoconcentration seems associated with improved prognosis. Transient AKI, with or without hemoconcentration, is of unsettled prognosis. Purpose We aimed to determine the independent prognostic values of transient AKI, persistent AKI and hemoconcentration in the context of hospitalized AHF. Methods Data were obtained from our institution's Clinical Data Warehouse. Patients that visited our unit at least once were screened. All hospitalizations in our institution were examined (>30 hospitals). Inclusion criteria were: ≥1 hospitalization with ≥1 recorded furosemide administration and ≥1 AHF ICD-10 code. Only the first hospitalization fulfilling these criteria was considered. AKI during 1–13 days following first furosemide administration was defined based on Kidney Disease Improving Global Outcome guidelines. Hemoconcentration was defined as an increase in serum proteins ≥5 g/l during the same period. We performed multivariate logistic regression to determine which characteristics were predictive of AKI. We used Cox regression of 100-days all-cause mortality using several confounders to determine the prognostic values of transient AKI (lasting Results We included 579 patients in the study. Median follow-up was 114 days. AKI following furosemide initiation occurred in 234 patients (40.4%). Patients that experienced AKI more frequently suffered from chronic kidney disease (43.6% vs. 33%, p=0.01) or presented with right ventricular dilatation (12% vs. 6.7%, p=0.04). Independent predictors of AKI were arterial hypertension (adjusted OR: 1.86 [1.08–3.22]), elevated serum creatinine at baseline (adjusted OR: 1.07 [1.01–1.14] per 10 μmol/l increase) and initial intravenous furosemide (adjusted OR: 2.42 [1.39–4.29]). Death during follow-up occurred in 35% of patients in the AKI group compared to 21% in the non-AKI group (p Conclusion In the context of hospitalized AHF, AKI that developed 1–13 days after furosemide initiation and that lasted ≥14 days was independently associated with decreased 100 days survival. Hemoconcentration, using a clinically relevant definition, was independently associated with improved survival. These findings show that serum creatinine and proteins, routinely used and with limited cost, accurately stratify mortality risk during AHF. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

Background It is unclear whether HIV infection affects the long‐term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV‐uninfected (HIV−) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV− patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36‐month follow‐up. A total of 103 PLHIV and 195 HIV− patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow‐up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− patients (17.8% and 15.1%, P =0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67–3.82 [ P =0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32–30.21 [ P =0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P =0.01) and had smaller total cholesterol decreases (–22.3 versus –35.0 mg/dL; P =0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT00139958.

Background Evaluation of right atrial cavities and right atrial (RA) remodelling in atrial fibrillation (AF) has been poorly studied. Purpose The aim of this study was to evaluate in AF, the role of three-dimensional (3D) transthoracic echocardiography (TTE) and strain to refine the evaluation of the RA according to evolution of cardiac rhythm ad mid-term follow-up. Methods A complete 2D and 3D TTE was performed in patient hospitalized for AF. In addition to the usual parameters, RA parameters were specifically assessed: 3D RA end-systolic (ES) and end-diastolic (ED) volume, RA ejection fraction (EF) and the global longitudinal strain (GLS) of the RA. A complete clinical evaluation and electrocardiogram were performed at admission (M0) and 6 months after inclusion (M6) to determine the cardiac rhythm at follow-up. Results 34 consecutive patients hospitalized for AF were analysed. At M0, there was no significant difference between 2D RA ES volume and the 3D RA ES volume. Three groups of patients were individualized according to cardiac rhythm at M0 and M6: AF at M0 and AF at M6 (AF-AF), AF at M0 and sinus rhythm (SR) at M6 (AF-SR), SR at M0 (spontaneous reduction before the admission ECG) and SR at M6 (SR-SR). At M0 echocardiography, in the AF-AF group and AF-SR in comparison with SR-SR group were as follow: the 3D RA ED volume was significantly higher (respectively 21.6 (18.2-26.6) and 26.9 (19.4-36.8) versus 11.3 (6.9-16.6) mL/m2 ; p = 0.0025), the 3D RAEF was significantly lower (42.2 (35.1-44.7) and 34.5 (24.1-38.6) versus 57.6 (53.4-62.2)%; p = 0.0105) and the RA GLS was also significantly lower (7.6 (6.5-10.5) and 9.1 (5.8-11.2) versus 26.6 (22.0-35.0)%; p = 0.0001) (Figure 1). Conclusion 3D ultrasound and strain could be useful tools for evaluating the anatomical and functional RA remodelling in AF, to be further validated in a larger ongoing study. Abstract P350 Figure 1

Introduction Right cardiac chambers remodeling and evolution of functional tricuspid regurgitation (TR) in atrial fibrillation (AF) has been poorly assessed. Method We prospectively evaluated 117 consecutive patients hospitalized for AF with three dimensional (3D) transthoracic echocardiography at admission, 6 (6 M) and 12 months (12 M) of follow up (FU). Patients were divided into three groups according to cardiac rhythm control strategy and final rhythm at 12 M: absence/failure of restoration of SR with AF at 12 M (AF group n = 39), active restoration of SR (cardioversion, ablation) with SR at 12 M (active SR group n = 47), spontaneous restoration of SR and SR at 12 M (spontaneous SR group n = 31). Results Based on 3D echocardiography, the active SR group had at 6 M and 12 M FU a decrease of end-systolic (ES) and end-diastolic right atrial (RA) indexed volumes (Vi), and ES right ventricle (RV) Vi ( Fig. 1 B); there was also an improvement in RA emptying fraction and RV ejection fraction ( Fig. 1 E). AF group had at 12 M of FU an increase in 3D ED and ES RV Vi ( Fig. 1 A) but no modifications in 3D function ( Fig. 1 D). SR group had no modifications of Vi or function during the FU ( Fig. 1 C, F). TR vena contracta (VC) decreased significantly exclusively in the active SR group (mean of VC 0.26 ± 0.03 cm at admission versus 0.16 ± 0.03 cm after 12 M P Conclusion Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted to improve right cardiac cavities remodelling and TR severity.

Knowledge about lipid interventions in secondary prevention in HIV-infected individuals is limited; studies are sparse.A prospective observational multicenter study enrolled 282 patients on statin 1 month after first acute coronary syndrome (ACS) (95 HIV-infected individuals, 187 HIV-uninfected). Data on fasting lipids (total cholesterol [TC], low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], non-HDL-C, triglycerides, TC/HDL-C ratio) were collected over 3 years. The evolution of lipid concentrations was analyzed using mixed-effects models. Achievement of National Cholesterol Education Program Adult Treatment Panel III lipid goals and prescribed statin intensity was assessed.Mean age of patients was 49.0 years, and 94% were men. Baseline lipids were similar in the 2 groups. Six months after first ACS, less low-density lipoprotein cholesterol reduction was observed in the HIV-infected GROUP (adjusted mean change -10.13; 95% CI -20.63 to 0.37; P=.06) than in the HIV-uninfected group (Adjusted mean change -38.51; 95% CI -46.00 to -31.04; P.0001) Similar trends were observed for TC and non-HDL-C. After ACS, initial statin prescription for HIV-infected compared with HIV-uninfected individuals was more frequently a moderate-intensity statin (66% vs 45%) and less frequently a high-intensity statin (15% vs 45%). Over 3 years of follow-up, the proportion of HIV-infected patients receiving high-intensity statin remained persistently lower than the proportion observed in the HIV-uninfected group.In this observational study, HIV-infected individuals after first ACS exhibited worse lipid profiles than controls particularly during the first 6 months while receiving less potent statins. Appropriate statin intensity should be prescribed in HIV-infected individuals with awareness of potential drug-drug interactions.

Background People living with Human Immunodeficiency Virus (PLWHIV) under antiretrovirals have an increased risk of atherosclerotic cardiovascular disease (ASCVD) events. The risk factors associated with ASCVD events in this high risk population are various including traditional vascular risk factors and specific HIV-related factors. However their respective influence is questionable. Purpose Our aim was to determine the incidence of ASCVD events in a large cohort of PLWHIV and to identify the risk factors associated. Methods We conducted a longitudinal observational cohort study of asymptomatic PLWHIV at high risk of ASCVD addressed to our preventive cardiovascular unit for non-invasive cardiovascular evaluation. The first ASCVD event was censored and included CV death, acute coronary syndromes, coronary and peripheral revascularizations (PCI or CABG or endarterectomy or limb procedures) and ischemic strokes. Results From January 2003 to December 2014, 763 consecutive asymptomatic PLWHIV were enrolled (mean age of 51.3±8.3 years, 87% men, 90% were free of known coronary artery disease, mean Left ventricular ejection fraction 60%). At baseline, traditional CV risk factors were as follow: 54% had dyslipidemia, 43% hypertension, 35% were active smokers, 22% had family history of CAD and 11% were diabetics. Statins were prescribed in 38% of the cohort, aspirin in 14%, clopidogrel in 14% betablockers in 14%, RAS blockers in 32%, Calcium channel blockers in 8%. At baseline, median duration of HIV seropositivity was 19.8 years (14.0–23.6), 94% were under ARV predominantly protease inhibitors (68%). Median CD4 cell count was 545/mm3 (404–745) and 92% had undetectable HIV viral load. During a median follow up of 5.8 years (3.7–8.7), 58 (7.3%) subjects had a first ASCVD event (incidence of 12.70 [9.78–16.51] per 1000 persons-years) including 5 cardiovascular deaths, 14 ACS, 20 coronary revascularizations, 13 peripheral vascular procedures and 6 strokes) with a median time of occurrence of 3.1 years (1.5–5.1). CV death (first and second ASCVD events) occurred in 8 patients (22%) after CV death related to malignancies (33%) but before deaths related to unexplained causes (21%), infectious disease (13%), liver disease (8%) and suicides (3%). Coronary events including coronary death, MI, and coronary revascularization occurred in 39 patients (5.2%); Incidence of 8.28 [6.00–11.43] per 1000 persons-years. Conventional multivariate Cox model shows that age and tobacco were the independent risk factors associated with ACSVD events [Hazard ratio (HR) 1.04, 95% CI 0.99–1.09, p=0.05 and HR 2.17, 95% CI 1.07–4.38, p=0.03]. Conclusion Traditional vascular risk factors (age and active smoking) are associated with the occurrence of ASCVD events predominantly coronary artery disease in our observational cohort of asymptomatic PLWIHV at high risk for ASCVD. Cardiovascular prevention including tobacco cease action is mandatory in the aging HIV population.

International audience; Background: The long-term four-chamber cardiac remodelling after sinus rhythm restoration in atrial fibrillation is unknown.Methods: We prospectively evaluated 86 consecutive patients hospitalized for atrial fibrillation. Three-dimensional indexed volumes (3D Vi) and ejection fraction of the right (RA) left atria (LA) right (RV) and left ventricle (LV) were measured using transthoracic echocardiography at admission and at 12 months follow-up. Patients were divided into two groups according to restoration of sinus rhythm (n=47) or persistence of atrial fibrillation (n=39) post cardioversion, ablation or pharmacological therapy.Results: Compared to baseline values at one year the 3D Vi of both atria were smaller at ED and ES. in the sinus group. Interestingly, the RV was significantly smaller only in ES and unchanged in ED whereas the LV was larger in ED and unchanged is ES (Figure A). At one year the 3D ejection fraction of all cardiac chambers were improved (Figure C). In contrast, in the atrial fibrillation group at 12 months, there were no significant differences in 3D Vi of RA, LV and LA end-systolic Vi together with a significant increase of 3D RV Vi and LA end-diastolic Vi (Figure B). No significant changes in ejection fraction were noted in the RA, RV and LV but with a significant decrease LA ejection fraction (Figure D).Conclusion: The management of atrial fibrillation should be focused on restoration of sinus rhythm to improve cardiac remodelling and both atrial and ventricular ejection fractions.

Background Infective endocarditis (IE) is a severe condition with persistent high mortality risk. The aim of this study was to evaluate, in addition to clinical characteristics, the role of valvular lesions natural history based on repeated echocardiograms during in-hospital follow-up. Methods Patients hospitalised for IE with repeated echocardiography (defined by at least 2 in-hospital echocardiograms) at follow-up (FU) were retrospectively analysed. Results Sixty-eight patients with a mean age of 65 ± 17 years old were studied. Only Staphylococcus aureus was associated with a higher mortality in multivariate analysis (P = 0.038). In patients medically treated (n = 19), the global evolution of vegetation size was the following: increase in 15.8%, stability in 26.3%, decrease in 21.1%, and disappearance in 36.8%. There was a significant difference in survival at 1 year between the group with decrease or vegetation disappearance and the group with stability or increased size of the vegetation (respectively 100% versus 37.5%; P = 0.0021; Fig. 1 ). In patients with surgical treatment (n = 11), there was no significant difference regarding survival at 1 year according to preoperative evolution of vegetation size. Conclusion Mortality risk of IE was determined by the presence of Staphylococcus aureus infection. The echocardiographic evolution of valvular lesions in non-surgical patients impacts the prognosis but our preliminary series does not allow to draw definite conclusions.

Atrial fibrillation (AF) is associated with worsening tricuspid regurgitation (TR) in part due to adverse chamber remodeling. We sought to determine the impact of successful cardioversion (CV) for AF on chamber remodeling and TR. We prospectively evaluated 55 patients with AF (median duration of AF

International audience; BACKGROUND: HIV-infected patients have lower bone mineral density and a higher incidence of fractures than the general population of the same age and sex. To assess the impact of antiretroviral (ARV) drugs exposure on the risk of osteoporotic fractures, we conducted a nested case-control study.METHODS: Cases were individuals enrolled while ARV-naive, with a first prospectively recorded fracture between 2000 and 2010. Controls were randomly selected after matching for sex, age (±3 years), period of HIV diagnosis (

Background The association between obstructive sleep apnoea syndrome (OSAS), left ventricular (LV) diastolic dysfunction and LV geometry remains controversial because of coexisting disorders. Aims To evaluate LV diastolic dysfunction and its independent predictors in a real-life cohort of OSAS patients, by a standardized approach. Methods We consecutively included 188 OSAS patients after an overnight polysomnography to undergo clinical evaluation, ambulatory blood pressure measurement and complete echocardiography, combining M-mode, two-dimensional Doppler and tissue Doppler imaging modes. Correlations between OSAS severity and clinical and echocardiographical variables were assessed, and logistic regression models were used to identify possible determining factors of LV diastolic dysfunction. Results Most patients were hypertensive (n = 148, 78.7%) and already receiving treatment by continuous positive airway pressure (n = 158, 84.5%). The prevalence of LV hypertrophy, defined by LV mass index (LVMi) normalized by height2.7, was 12.4%, with a significant correlation with hypertension (P = 0.004). The apnoea-hypopnoea index was correlated with body mass index (P

Background Transthoracic echocardiography (TTE) is the most commonly used method for measuring left ventricular ejection fraction (LVEF), but its reproducibility remains a matter of controversy. Speckle tracking echocardiography assesses myocardial deformation and left ventricular systolic function by measuring global longitudinal strain (GLS), which is more reproducible, but is not used routinely in hospital practice. Aim To investigate the feasibility of on-line two-dimensional GLS in predicting LVEF during routine echocardiographic practice. Methods The analysis involved 507 unselected consecutive patients undergoing TTE between August 2012 and November 2013. Echocardiograms were performed by a single sonographer. Echogenicity was noted as good, moderate or poor. Simple linear regression was used to assess the relationship between LVEF and GLS, overall and according to quality of echogenicity. Receiver operating curve (ROC) analysis was used to identify the threshold GLS that predicts LVEF ≤ 40%. Results Mean LVEF was 64 ± 11% and GLS was –18.0 ± 4.0%. A reasonable correlation was found between LVEF and GLS (r = –0.53; P

International audience; The French Hospital Database on HIV (FHDH) is a hospital-based multicentre open cohort with inclusions ongoing since 1989. The research objectives focus mainly on mid- and long-term clinical outcomes and therapeutic strategies, as well as severe AIDS and non-AIDS morbidities, and public health issues relative to HIV infection. FHDH also serves to describe HIV-infected patients receiving hospital care in France. FHDH includes data on more than 120,000 HIV-infected patients from 70 French general or university hospitals distributed throughout France. Patients are eligible for inclusion if they are infected by HIV-1 or HIV-2 and give their written informed consent. Standardized variables are collected at each outpatient visit or hospital admission during which a new clinical manifestation is diagnosed, a new treatment is prescribed or a change in biological markers is noted, and/or at least every 6 months. Since its inception, variables collected in FHDH include demographic characteristics, HIV-related biological markers, the date and type of AIDS and non AIDS-defining events, antiretroviral treatments and the date and causes of death, as reported in the medical records. Since 2005, data have also been collected on: co-infection with hepatitis B or C virus; alcohol and tobacco use; and non HIV-related biomarkers. Anyone can submit a research project by completing a standardized form available on the FHDH website (http://www.ccde.fr/_fold/fl-1385734776-429.pdf) or from the corresponding author, describing the context and objectives of the study. All projects are reviewed by the scientific committee.

Background Two-dimensional left atrial (LA) size is an independent echocardiographic predictor of atrial fibrillation (AF) occurrence and recurrence. Purpose Our study aimed to evaluate LA and right atrial (RA) three-dimensional (3D) volumes at admission (M0) in patients with AF to define atrial remodeling according to rhythm outcome at 6 month follow-up (M6). Methods 3D RA and LA parameters were assessed at M0 in patients admitted for AF: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and indexed minimum volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF) and atrial expansion index (3D RAEI, 3D LAEI). Results Forty-eight consecutive patients hospitalized for AF were prospectively included. Two groups were individualized according to rhythm outcome: successful cardio version (SuccCV) in 35(72.9%) patients including either spontaneous (n = 10) or electrical cardioversion (n = 25) (AF at M0 and sinus rhythm (SR) at M6); failure or contra indication to cardioversion (FailCV) in 13(27.1%) patients (AF at M0 and AF at M6). 3D echocardiographic evaluation from 41 patients at M0 found: – significantly upper Min 3D RA Voli, Min 3D LA Voli in group FailCV in comparison with SuccCV; – significantly lower 3D RAEF, 3D RAEI, 3D LAEF, 3D LAEI in group FailCV in comparison with SuccCV; – no significant differences regarding Max 3D RA Voli, Max 3D LA Voli between groups FailCV and SuccCV ( Table 1 ). Conclusion 3D atrial echocardiographic parameters could be useful to predict initial atrial remodelling in patients admitted for AF.

RésuméLa fibrillation atriale non valvulaire (FANV) est l’arythmie cardiaque la plus fréquente, en particulier chez le sujet âgé. La FANV augmente le risque et la sévérité des accidents ischémiques cérébraux, elle est associée à une augmentation de la morbi-mortalité cardiovasculaire, à une réduction de la qualité de vie, et à un surcoût pour la Santé Publique.Les recommandations des Sociétés Savantes reconnaissent comme indication aux anticoagulants de la FA à risque, avec cependant une sous-prescription dans le monde réel.De nombreux facteurs de risque clinique, en sus de l’âge, ont limité la diffusion du traitement anticoagulant conventionnel. Les nouveaux anticoagulants (NACOs) apparaissent comme une alternative au traitement par AVK, et le choix du traitement anticoagulant dépend de la prise en compte des facteurs de risque et d’une comorbidité, dysfonction rénale, profil de risque et préférence du patient. Bien que le risque de saignement soit accru chez le sujet âgé, le bénéfice clinique net est en faveur du traitement anticoagulant.L’insuffisance rénale chronique, qui touche 10% de la population adulte et en particulier les sujets âgés, est associée à un excés de risque d’événement cardiovasculaire, y compris la FA. L’apixaban réduit le critère de jugement accident ischémique cérébral-embolie artérielle, ainsi que le risque de saignement majeur, indépendamment de la fonction rénale.Lorsqu’une procédure coronaire percutanée est indiquée chez le coronarien, maladie qui augmente la morbi-mortalité de la FA, avec une indication au traitement anticoagulant et aux antiagrégants plaquettaires, la prise en compte du risque de saignement lié à la triple association antithrombotique, anticoagulant et antiagrégant plaquettaire doit être considérée. Cependant, s’il n’y a pas de données prospectives, des études récentes ayant inclus des syndromes coronaires aigus traités par ces nouveaux anticoagulants suggèrent que la coprescription de ces molécules, anti-IIa et anti-Xa, avec un antiagrégant plaquettaire ne réduit que faiblement le risque d’événement cardiovasculaire avec un risque substantiel d’augmentation du risque hémorragique, plus marqué en particulier lorsque l’association concerne les anticoagulants avec une double antiagrégation plaquettaire.Bien que les données soient limitées concernant la cardioversion, le dabigatran apparaît comme une alternative raisonnable aux AVK chez les patients ayant une indication à une cardioversion ou à une procédure d’ablation ; bien que les études prospectives ne soient pas disponibles, le rivaroxaban et l’apixaban (en attendant l’édoxaban) sont en cours d’investigation dans ces indications.Enfin, le traitement péri-opératoire et l’objectif de réduire le risque de saignement et de thrombose dans ces situations amènent à considérer les NACOs dans leurs modalités de prescriptions, bien que, là encore, des données prospectives ne soient pas disponibles. En effet, l’absence d’antagonistes ou d’antidotes validés, de monitorage biologique et la pharmacocinétique variable rendent difficile la gestion de ces situations, pour lesquelles seules des propositions et non des recommandations sont disponibles à ce jour.Les NACOs représentent donc une alternative prometteuse au traitement conventionnel par AVK dans leurs indications, en particulier la FA, ses agents étant associés entre autres à une réduction du risque d’hémorragie intracrânienne, élément à prendre en considération en particulier chez les patients exposés à un risque accru de saignement (sujet âgé, association à des antiagrégants plaquettaires, relais…).SummaryNon-valvular atrial fibrillation is the most common clinically significant cardiac arrhythmia; it increases both the risk for and the severity of strokes and is associated with substantial morbidity and mortality, decreased quality of life and related health care costs. Guidelines recommend anticoagulation therapy for most patients with atrial fibrillation.Several clinical factors in addition to older age have been linked to anticoagulant-associated bleeding risk. Newer fixed-dose oral anticoagulants have emerged as viable alternatives to warfarin and the choice of anticoagulant should depend on the presence of comorbid conditions such as reduced renal function, side-effect profile, cost and patient preference. Although bleeding risk is elevated in older patients, the net clinical benefit favours anticoagulation for most older adults. Chronic kidney disease affects up to 10% of the adult population, particularly the elderly, and carries a high risk for cardiovascular disease, including atrial fibrillation. Apixaban has demonstrated a reduction in the primary endpoint of stroke or systemic embolism and in major haemorrhage, regardless of renal function.If percutaneous coronary intervention, which increases both the risk, and morbidity and mortality, of atrial fibrillation, is required in patients with coronary artery disease taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. No prospective data are available, but results from clinical trials involving patients with acute coronary syndromes suggest that the addition of a new oral anticoagulant to antiplatelet therapy results in a modest reduction in cardiovascular events but also in a substantial increase in bleeding risk. This risk is most pronounced when new oral anticoagulants are combined with dual antiplatelet therapy.Although available data are scarce, dabigatran is a reasonable alternative to warfarin in patients requiring cardioversion and can be considered in ablation procedures, although additional data on safety are required. Rivaroxaban and apixaban are being investigated in this indication. These agents represent a promising alternative to conventional warfarin therapy and may be associated with lower risk of intracranial haemorrhage, especially in patients exposed to a higher risk of bleeding.Finally, perioperative management for optimal safety regarding the risk of bleeding and thrombosis related to new anticoagulants has been proposed, but has not been validated and approved, as there are no confirmed antagonists, they cannot be monitored by simple standardized labora tory assays, and their pharmacokinetics vary greatly between patients.

Cardiovascular disease, and particularly coronary heart disease, is an emerging area of concern in the HIV population. Since the advent of efficient antiretroviral therapies and the consequent longer patient life span, an increased risk for myocardial infarction has been observed in HIV-infected patients compared with the general population in Western countries. The pathophysiology of this accelerated atherosclerotic process is complex and multifactorial. Traditional cardiovascular risk factors—overrepresented in the HIV population—associated with uncontrolled viral replication and exposure to antiretroviral drugs (per se or through lipid and glucose disturbances) could promote acute ischemic events. Thus, despite successful antiviral therapy, numerous studies suggest a role of chronic inflammation, together with immune activation, that could lead to vascular dysfunction and atherothrombosis. It is time for physicians to prevent coronary heart disease in this high-risk population through the use of tools employed in the general population. Moreover, the lower median age at which acute coronary syndromes occur in HIV-infected patients should shift prevention to include patients

La prevalence de la fibrillation atriale (FA) est particulierement elevee chez le sujet âge. Les patients en FA sont exposes a une augmentation du risque embolique arteriel, en particulier du risque ischemique cerebral. Chez ces patients un traitement anticoagulant est recommande car reduisant ce risque des 2/3. Cependant, de nombreux patients eligibles au traitement anticoagulant ne sont pas traites, du fait de limitation liee aux antivitamines K, delai d’action retardee, metabolisme aleatoire, risques de saignements et necessite d’une surveillance biologique. Les nouveaux anticoagulants NACO developpes depuis quelques annees ont ete proposes comme alternative au traitement par warfarine. Cet article resume les donnees des differents essais rapportes a ce jour, comparant le dabigatran (inhibiteur direct de la thrombine), le rivaroxaban et l’apixaban (inhibiteurs du facteur Xa). Le dabigatran (150 mg × 2/j) est d’une efficacite superieure dans la reduction du risque ischemique cerebral et arteriel peripherique, comparativement a la warfarine (1,53 % versus 1,69 %, P < 0,001). Le risque de saignement majeur est similaire (3,32 %/an versus 3,57 %/an, respectivement, P = 0,32). Le rivaroxaban (20 mg/j en 1 prise) n’est pas inferieur a la warfarine dans la reduction du risque d’ischemie cerebrale et d’embolie arterielle peripherique (2,1 % versus 2,4 %, P < 0,001). Il n’y a pas de difference significative entre le rivaroxaban et la warfarine dans le risque de saignement majeur ou de saignement cliniquement pertinent (14,9 %/an versus 14,5 %/an, P = 0,44). l’apixaban (5 mg × 2/j) est superieur a la warfarine dans la prevention du risque ischemique cerebral et des embolies systemiques (1,27 % versus 1,60 %, P = 0,01). L’apixaban reduit de facon significative les saignements majeurs, comparativement a la warfarine (2,13 %/an versus 3,09 %/an, P < 0,001). Comparativement a la warfarine, la mortalite totale est numeriquement plus faible avec le dabigatran (P = 0,051), similaire avec le rivaroxaban (P = 0,15). Le taux de mortalite est plus faible sous apixaban que sous warfarine (3,52 % versus 3,94 %, P = 0,047). Ces 3 NACO (en attendant les donnees de l’etude ENGAGE avec l’edoxaban) reduisent de facon significative les hemorragies intracrâniennes, comparativement a la warfarine. Les NACO constituent donc une alternative a la warfarine dans differentes populations de patients en fibrillation atriale, du fait des risques moindres d’interactions, de saignement et de l’absence de necessite de surveillance biologique du traitement anticoagulant, en dehors de la necessite d’une surveillance de la fonction renale.

OBJECTIVE We compared aortic stiffness between HIV-infected and HIV-uninfected individuals and examined the determinants of vascular aging during HIV infection. METHODS Aortic stiffness using carotid-femoral pulse wave velocity (cf-PWV) was evaluated cross-sectionally between HIV-infected individuals and uninfected controls frequency-matched for age and sex, and longitudinally in a subgroup of HIV-infected individuals. Determinants of elevated cf-PWV levels were assessed using logistic regression. Changes in cf-PWV levels during follow-up (mixed-effect linear regression) and risk factors for achieving cf-PWV below (Group 1) or above the median (Group 2) at last follow-up visit were evaluated only in HIV-infected individuals. RESULTS A total of 133 HIV-infected and 135 HIV-uninfected individuals (mean age: 47.7 ± 8.9 years, 91% men) were enrolled. Median cf-PWV at baseline was similar between HIV-infected individuals and controls [7.5 m/s (interquartile range = 6.7-8.4) vs. 7.5 m/s (interquartile range = 6.6-8.4), respectively; P = 0.64]. In multivariable analysis, only mean arterial pressure showed significant association with elevated cf-PWV in the overall population (P = 0.036). In HIV-infected individuals, elevated cf-PWV was associated with current smoking (P = 0.042), and nadir CD4 T-cell count less than 200 cells/μl (P = 0.048). Ninety-one HIV-infected individuals were followed for a mean 7.6 ± 2.0 years. cf-PWV progression was associated with age (P = 0.018), mean arterial pressure (P = 0.020), and nadir CD4 T-cell count (P = 0.005). Patients from Group 2 had higher baseline waist circumference, pulse pressure, and nadir CD4 T-cell count less than 200 cells/μl. CONCLUSION We observed no difference in aortic stiffness between HIV-infected and controls. Moreover, aortic stiffness aging was independently associated with past severe immunodeficiency, along with other traditional risk factors. Our results call for early antiretroviral initiation.

Background We sought to investigate whether right ventricular deformation parameters as assessed with two-dimensional (2D) speckle tracking imaging (STI) could help in identifying patients at low risk according to the ESC guidelines. Methods From February 2015 to September 2015 all consecutive patients with a PE confirmed by thoracic computed tomography scan or by ventilation/ perfusion scintigraphy were included in the study. 2D Echocardiography was performed at admission. STI Longitudinal strain for the RV free wall and septal wall. We defined as intermediate-to-high risk PE patients with RV systolic dysfunction on echocardiography (defined as RV/LV ratio>0.9) and/or troponin I >0.04 μg/L and/or brain natriuretic peptide >100 pg/mL. When none of these criteria were present, patients were considered at low risk. Results Fifty-eight patients (mean age 66.1 ± 18.5 years, 55% male) were prospectively included. None of these patients exhibit hemodynamic instability. Twenty-three patients (40%) showed a RV/LV ratio > 0.9, 25 patients (43%) an elevated BNP levels (mean: 454±494 pg/mL) and 17 patients (29%) an elevated troponin levels (mean: 0.36±0.46 μg/L). According to the ESC guidelines, 14 patients (24%) were classified at low risk PE, and 44 (76%) at intermediate-to-high risk. Global 2D RV strain differed significantly between the 2 groups (23.0% vs. 19.3%, p=0.0035), as did RV strain of the free wall (26.9% vs. 21.1%, p=0.0038). However, 2D RV strain of the septal wall did not differ significantly in the 2 groups (20.0% vs. 18.5%, p=0.12). ROC curves were determined to evaluate the ability of RV strain parameters derived from STI to identify low risk patients. The best performance was obtained with global 2D RV strain and a cut off value of 23.0%. Conclusion Global longitudinal 2D strain is significantly reduced in patients with intermediate-to-high risk PE compared with low risk PE. A cut off value of 23% allowed to identify PE patients at low risk. Download : Download full-size image Figure . Comparative receiver operative character The author hereby declares no conflict of interest

PurposeThe lack of justification for the various definitions used to characterize valvular atrial fibrillation (VAF) in clinical trials and guidelines lead us to evaluate a strict definition of VAF using echocardiographic-derived classification. We thus sought to investigate whether this pragmatic approach could be useful to predict the risk of stroke and death in such patients.MethodsBetween 1998 and 2011, 172 patients, hospitalised for symptomatic VAF were enrolled in the cohort. The CHA2DS2-VASc score was determined at admission. Echocardiographically significant valve disease was defined as: mitral stenosis (mitral valve area

L’education therapeutique du patient se developpe en France du fait d’enjeux epidemiologiques, sociologiques et economiques indeniables, meme en psychiatrie. Cette activite est de plus en plus encadree par la reglementation tant au niveau de la structuration des programmes que des competences a mobiliser. Cependant, en partant d’un programme specifique tel que PACT (Psychose, aider, comprendre, traiter), peut-on en mesurer l’impact sur l’autonomisation des patients et l’evolution des competences professionnelles ? L’etude realisee au Centre Hospitalier de Jury, sur 3 CMP (Centre medico-psychologique) et aupres des familles concernees explicite l’importance de l’alliance therapeutique soignants-familles dans la mise en œuvre d’une telle demarche, propose des indicateurs pour mesurer l’impact des programmes, bien que ceux-ci demandent a etre valides a plus grande echelle. L’etude conforte la necessite de structurer un projet institutionnel pour en garantir sa perennite. En outre, les evolutions doivent porter sur la mise en place des pratiques avancees en soins infirmiers, notamment dans le secteur ambulatoire. Enfin, la reflexion essentielle reside dans la conception meme du soin educatif base sur l’alterite soignants-familles et le co-apprentissage.

Resume Les recommandations les plus recentes publiees, notamment par l’ACCP en 2008, clarifient la place respective des Antivitamines K et de l’aspirine chez les patients en fibrillation auriculaire non valvulaire. Les recommandations europeennes ont ete mises a jour et s’en demarquent. Elles proposent en effet d’adopter le score CHA 2 DS 2 Vasc, modifiant ainsi la strategie de prescription des anti-thrombotiques basee jusqu’ici sur le score de risque thromboembolique, CHADS 2 . La prescription de ces molecules depend du niveau de risque thromboembolique du patient evalue sur des marqueurs cliniques (âge > 75 ans, Antecedent d’AVC, d’insuffisance cardiaque, d’hypertension arterielle et de diabete) et du risque hemorragique du patient. Ainsi, les patients identifies a faible risque (Aucun marqueur de risque) doivent recevoir de l’Aspirine, les patients presentant deux marqueurs de risque ou un antecedent d’AVC doivent etre traites par Antivitamine K. Les patients avec un marqueur de risque hors AVC peuvent etre traites par Aspirine ou Antivitamine K. Malgre la mise a jour recente de ces publications, le niveau de prescription des Antivitamines K ne depasse pas 50 % des patients devant theoriquement etre eligibles a cette therapeutique. Les difficultes d’equilibration des INR, la crainte d’un evenement hemorragique ou une mauvaise appreciation du risque thromboembolique sont autant de limites a la prescription des AVK. Outre la fermeture percutanee de l’auricule, de nouvelles voies therapeutiques (Anti-Xa, anti thrombine) sont actuellement explorees pour repondre aux limites des Antivitamine K.

Aims Natural history and prognosis of acute coronary syndrome (ACS) in HIV-infected patients remain to be determined. We sought to compare coronary risk factors, angiographic features, acute results of percutaneous coronary intervention, in-hospital outcomes, and pre-specified 1 year prognosis of HIV-infected and HIV-uninfected patients with ACS. Methods and results HIV-infected and HIV-uninfected patients with a first episode of ACS were matched for age (±5 years), sex, and type of ACS. The primary endpoint was the rate of major adverse cardiac and cerebral events (MACCE), comprising cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke. Overall, 103 HIV-infected and 195 HIV-uninfected patients were enrolled (mean age 49.0 ± 9.4 years, 94% men). Coronary risk factors were well balanced, but HIV-infected patients more frequently used illicit drugs (23 vs. 6%, P = 0.001) and had higher triglyceride concentrations (246 ± 189 vs. 170 ± 139 mg/dL, P = 0.002) compared with HIV-uninfected patients. Angiographic features of coronary artery disease were similar (multivessel disease 41 vs. 39%, P = 0.96; ACC/AHA type culprit lesion ≥B2, both 77%, P = 0.83). At 1 year, the rate of occurrence of first MACCE did not differ between groups [hazard ratio (HR) 1.4, 95% CI 0.6–3.0]. Recurrent ACS was more frequent in HIV-infected patients (HR 6.5, 95% CI 1.7–23.9) with no difference in the rate of clinical restenosis. Conclusions These results suggest that the acute management of ACS in HIV-infected patients can routinely be the same as that of HIV-uninfected patients, but that specific secondary prevention measures are needed to alleviate the increased risk of recurrent ACS.

Depuis l’avenement des multitherapies antiretrovirales au milieu des annees 90, la morbi-mortalite des patients atteints du virus de l’immunodeficience humaine (VIH) a diminue de facon spectaculaire dans les pays industrialises. Parallelement, des complications metaboliques secondaires au traitement antiretroviral sont apparus, pouvant accelerer l’atherosclerose et favoriser les evenements coronariens aigus (infarctus du myocarde et angor instable). Dans les pays ayant acces a ce traitement antiretroviral efficace, nous sommes passes de complications cardiovasculaires liees a l’etat d’immunodepression avant 1996 (myocardite, pericardite), a des complications lies aux troubles metaboliques secondaires a ce meme traitement antiretroviral. Dans cet article, nous traiterons de facon prioritaire de la pathologie coronaire mettant en jeu le pronostic vital immediat du patient, l’atteinte myocardique et pericarditique ayant regresse depuis l’avenement du traitement antiretroviral efficace.

Summary Background Transthoracic echocardiography is the most commonly used tool for the detection of left ventricular wall motion (LVWM) abnormalities using “naked eye evaluation”. This subjective and operator-dependent technique requires a high level of clinical training and experience. Two-dimensional speckle-tracking echocardiography (2D-STE), which is less operator-dependent, has been proposed for this purpose. However, the role of on-line segmental longitudinal peak systolic strain (LPSS) values in the prediction of LVWM has not been fully evaluated. Aim To test segmental LPSS for predicting LVWM abnormalities in routine echocardiography laboratory practice. Methods LVWM was evaluated by an experienced cardiologist, during routine practice, in 620 patients; segmental LPSS values were then calculated. Results In this work, reflecting real life, 99.6% of segments were successfully tracked. Mean (95% confidence interval [CI]) segmental LPSS values for normal basal ( n = 3409), mid ( n = 3468) and apical ( n = 3466) segments were –16.7% (–16.9% to –16.5%), –18.2% (–18.3% to –18.0%) and –21.1% (–21.3% to –20.9%), respectively. Mean (95% CI) segmental LPSS values for hypokinetic basal ( n = 114), mid ( n = 116) and apical ( n = 90) segments were –7.7% (–9.0% to –6.3%), –10.1% (–11.1% to –9.0%) and –9.3% (–10.5% to –8.1%), respectively. Mean (95% CI) segmental LPSS values for akinetic basal ( n = 128), mid ( n = 95) and apical ( n = 91) segments were –6.6% (–8.0% to –5.1%), –6.1% (–7.7% to –4.6%) and –4.2% (–5.4% to –3.0%), respectively. LPSS allowed the differentiation between normal and abnormal segments at basal, mid and apical levels. An LPSS value ≥ –12% detected abnormal segmental motion with a sensitivity of 78% for basal, 70% for mid and 82% for apical segments. Conclusions Segmental LPSS values may help to differentiate between normal and abnormal left ventricular segments.

SummaryThe widespread use of combination antiretroviral therapy (cART) among people living with HIV in developed countries has lead to significantly improved life expectancy. However, extensive use of the effective cART coincides with increasing reports of coronary heart disease (CHD) among people living with HIV, and CHD has become a major cause of death. CHD results from a complex and multifactorial atherosclerotic process involving the over-representation of traditional cardiovascular risk factors, particularly smoking, uncontrolled viral replication, chronic inflammation, immune activation, and exposure to antiretroviral drugs. Consequently careful selection of antiretroviral drugs, cardiovascular risk reduction, and lifestyle modifications are needed. In individuals living with HIV, cardiovascular risk assessment is becoming an important element of care.

L’accompagnement therapeutique de femmes enceintes evoquant l’adoption de leur enfant questionne la singularite du « travail psychique » de leur grossesse et la place devolue « a l’enfant porte ». Que nous enseigne notre pratique clinique sur leur parcours interieur d’elaboration de l’impossible innommable de l’abandon a une pensee contenante de sens a valeur de projet pour l’enfant anticipe ? Quel espace specifique est cree par les professionnels du service pour tenter de reinstaurer une continuite d’existence pour la mere et l’enfant, et ouvrir a une transmission autorisee d’un bebe imagine porte par la mere de naissance a un bebe reel confie a la famille adoptive ?

Background The purpose of this study was to investigate intervendor variability when measuring multilayer strain in cancer patients treated with oral chemotherapy. Methods Patients enrolled to receive oral chemotherapy were prospectively included. Firstly, a same operator performed a 2 dimensional echocardiography within a delay of 10 minutes using Vivid 9 (Vendor A) and SC 2000 Siemens (Vendor B) ultrasound systems for each patient. Thereafter, we assessed myocardial deformation by using their respective speckle tracking softwares for strain multilayer measurement. Thus, we compared GLS multilayer values for the 2 vendors in each apical view (4c, 3c and 2c) and for each layer (endocardial, mid and epicardial layer). Comparisons between the 2 vendors were evaluated using intra class correlation coefficient. Results Eighty patients planned to receive chemotherapy were prospectively included between February and June 2015. Mean age was 55.3±16.3 years and 61% were female. Median left ventricular ejection fraction was 62% (57-66). Results of GLS multilayer values according to vendor, incidence, layer and their comparison are summarized in Table 1 There was a poor agreement between GLS multilayer as measured with GE system and Siemens system, whatever the layers, the incidence and the vendor. Conclusion We found a poor agreement for layer specific strain evaluation between GE and Siemens system using their dedicated softwares for strain multilayer assessment. These results suggest that in patient receiving chemotherapy the same system and software from the same vendor should be used for a longitudinal follow-up. The author hereby declares no conflict of interest Table. Values of GLS according to vendor, layer and views Vendor A Vendor B ICC±SD 4c GLS endo 20.7 (18.5-23.5) 18.8 (17.1-21.0) 0.315±0.089 4c GLS mid 18.2 (16.1-20.5) 15.5 (13.6-17.2) 0.222±0.075 4c GLS epi 15.9 (14.1-17.9) 11.8 (10.6-14.2) 0.125±0.055 3c GLS endo 22.2 (19.8-25.7) 18.5 (16.6-21.4) 0.310±0.078 3c GLS mid 19.2 (17.3-22.3) 15.1 (13.6-17.5) 0.291±0.061 3c GLS epi 16.9 (15.2-14.2) 12.0 (9.6-13.5) 0.189±0.045 2c GLS endo 21.7 (19.0-24.1) 18.0 (16.7-20.9) 0.234±0.075 2c GLS mid 19.3 (17.0-21.8) 15.3 (13.2-17.1) 0.180±0.057 2c GLS epi 17.3 (15.1-19.4) 12.0 (10.3-14.0) 0.042±0.040 GLS: Global longitudinal strain, 4c: 4 chamber view, 3c: 3 chamber view, 2c: 2 chamber view, endo: endocardial layer, mid: mid layer, epi: epicardial layer, ICC: intraclass correlation coefficient, SD: Standard deviation. Full-size table Table options View in workspace Download as CSV

We examined whether impaired kidney function is an independent risk factor for myocardial infarction in HIV-infected individuals without pre-existing coronary artery disease. The odds ratio for impaired kidney function fell from 1.22 (95% confidence interval 0.90-1.66) to 0.99 (95% confidence interval 0.69-1.41) after adjustment for cardiovascular risk factors and HIV-related parameters, with hypertension, high-density lipoprotein cholesterol, smoking and the CD4 T-cell nadir as most influential confounders. In this setting, no association was found between impaired kidney function and the risk of myocardial infarction.

With >24 million people affected worldwide, dementia is one of the main public health challenges modern medicine has to face. The path leading to dementia is often long, with a wide spectrum of clinical presentations, and preceded by a long preclinical phase. Previous studies have demonstrated that clinical strokes and covert vascular lesions of the brain contribute to the risk for developing dementia. Although it is not yet known whether preventing such lesions reduces the risk for dementia, it is likely that starting preventive measures early in the course of the disease may be beneficial. Echocardiography is a widely available, relatively inexpensive, noninvasive imaging modality whereby morphologically or hemodynamically derived parameters may be integrated easily into a risk assessment model for dementia. The aim of this review is to analyze the information that has accumulated over the past two decades on the prognostic value of echocardiographic factors in cognitive impairment. The associations between cognitive impairment and echocardiographic parameters, including left ventricular systolic and diastolic indices, left atrial morphologic parameters, cardiac output, left ventricular mass, and aortic root diameter, have previously been reported. In the light of these studies, it appears that echocardiography may help further improve currently used risk assessment models by allowing detection of subclinical cardiac abnormalities associated with future cognitive impairment. However, many limitations, including methodologic heterogeneity and the observational designs of these studies, restrict the scope of these results. Further prospective studies are required before integrating echocardiography into a preventive strategy.

The lack of justification for the various definitions used to characterize valvular atrial fibrillation (VAF) in clinical trials and guidelines lead us to evaluate a strict definition of VAF using echocardiographic-derived classification. We thus sought to investigate whether this pragmatic approach

Background: Individuals infected by human immunodeficiency virus (HIV) have a higher risk of cardiovascular disease than the general population. The specific effects of virological and immunological parameters on the risk of myocardial infarction (MI) in HIV-infected individuals are debated. Methods: We conducted a nested case-control study within the French Hospital Database on HIV. Case patients (n = 289) were patients who, between January 2000 and December 2006, had a prospectively recorded and validated first MI. Up to 5 HIV-infected controls (n = 884) matched for age, sex, and clinical center were selected, at random with replacement, among patients with no history of MI. Conditional logistic regression models were used to identify predictors of the risk of MI. Results: Plasma HIV-1 RNA levels >50 copies/mL, a low CD4 T-cell nadir, and a high CD8 T-cell count were independently associated with an increased risk of MI, with respective odds ratios of 1.51 (95% confidence interval, 1.09-2.10), 0.90 (.83-.97) per log(2) unit, and 1.48 (1.01-2.18) for the highest tertile of CD8 T-cell counts (>1150 cells/mm(3)) compared with the lowest (≤760 cells/mm(3)). Conclusions: Independently of cardiovascular risk factors and antiretroviral therapy, HIV replication, a low CD4 T-cell nadir and a high current CD8 T-cell count are associated with an increased risk of MI in HIV-infected individuals. This suggests new paths for interventions to diminish the risk of MI in HIV-infected patients.

Objective Human immunodeficiency virus (HIV)-infected patients receiving combined active antiretroviral therapy (cART) are at higher risk of cardiovascular disease, due in part to metabolic complications such as lipodystrophy syndrome, insulin resistance, and dyslipidemia. Whether lipodystrophy and cART impact on the vasculature is debated. We investigated the impact of lipodystrophy and protease inhibitors (PIs) on aortic stiffness. Methods Aortic stiffness was evaluated using carotid-femoral pulse wave velocity (PWV) in consecutive HIV-infected patients without a history of cardiovascular disease referred to a cardiovascular clinic. Results 175 patients were enrolled (mean age 48.2 ± 8.7 years; 89% men). Eighty six per cent of patients were receiving cART. Dyslipidemia, tobacco, and hypertension were the most prevalent cardiovascular risk factors (39%, 38%, and 31%, respectively). Seventy-nine (45%) HIV-infected patients had lipodystrophy and 80 (46%) were on PIs. Aortic PWV was similar in patients with or without lipodystrophy (9.7 ± 1.9 vs 9.8 ± 2.5 ms−1, respectively; P = 0.81) and in patients on or not on PIs (9.8 ± 2.6 vs 9.7 ± 1.9 ms−1; P = 0.71). In univariate analysis, aortic PWV was associated with increasing age, waist/hip ratio, systolic and diastolic blood pressures, mean arterial and pulse pressures, but not with presence of lipodystrophy, PIs, or specific factors related to HIV infection. Linear regression analysis showed an association between aortic PWV and age (= 0.49, P = 0.001) and systolic arterial pressure (= 0.21, P = 0.006). Conclusions Aortic stiffness is associated with traditional cardiovascular risk factors, particularly ageing and blood pressure. Hypertension is becoming an emerging complication in HIV-infected patients.

Aims Natural history and prognosis of ACS in HIV-infected patients remain to be determined. The aim of our study was to compare coronary risk factors, angiographic features, acute results of PCI, in-hospital outcomes, and prespecified 1and 3-year prognosis of HIV-infected and HIV-uninfected patients with ACS. Methods and results HIV-infected and HIV-uninfected patients with a first episode of ACS were matched for age (± 5 years), sex, and type of ACS. The primary endpoint was the rate of major adverse cardiac and cerebral events (MACCE), comprising cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke. Overall 103 HIV-infected and 195 HIV-uninfected patients were enrolled (mean age 49.0 ± 9.4 years, 94% men). Coronary risk factors were well balanced, but HIV-infected patients more frequently used illicit drugs (23% vs 6%, P = 0.001) and had higher triglyceride level (246 ± 189 vs 170 ± 139 mg/dl, P = 0.002) compared with HIV-uninfected patients. Angiographic features of CAD was similar (multivessel disease 41% vs 39%, p = 0.96; ACC/AHA type culprit lesion ≥ B2, both 77%, P = 0.83). At 1 year, the rate of occurrence of first MACCE did not differ between groups (hazard ratio [HR:] 1.4; 95% CI: 0.6 to 3.0). Recurrent ACS was more frequent in HIV-infected patients (HR: 4.6; 95% CI: 1.4 to 15.0) with no difference in the rate of clinical restenosis. Conclusion These results suggest that acute management of ACS in HIV-infected patients can routinely be the same as that of HIV-uninfected patients but that specific secondary prevention measures are needed to alleviate this increased risk of recurrent ACS. The 3-year follow up will be obtained and analyzed before the end of 2010.

The role of exposure to specific antiretroviral drugs on risk of myocardial infarction in human immunodeficiency virus (HIV)-infected patients is debated in the literature.To assess whether we confirmed the association between exposure to abacavir and risk of myocardial infarction (MI) and to estimate the impact of exposure to other nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and non-NRTIs on risk of MI, we conducted a case-control study nested within the French Hospital Database on HIV. Cases (n = 289) were patients who, between January 2000 and December 2006, had a prospectively recorded first definite or probable MI. Up to 5 controls (n = 884), matched for age, sex, and clinical center, were selected at random with replacement among patients with no history of MI already enrolled in the database when MI was diagnosed in the corresponding case. Conditional logistic regression models were used to adjust for potential confounders.Short-term/recent exposure to abacavir was associated with an increased risk of MI in the overall sample (odds ratios [ORs], 2.01; 95% confidence interval [CI], 1.11-3.64) but not in the subset of matched cases and controls (81%) who did not use cocaine or intravenous drugs (1.27; 0.64-2.49). Cumulative exposure to all PIs except saquinavir was associated with an increased risk of MI significant for amprenavir/fosamprenavir with or without ritonavir (OR, 1.53; 95% CI, 1.21-1.94 per year) and lopinavir with ritonavir (1.33; 1.09-1.61 per year). Exposure to all non-NRTIs was not associated with risk of MI.The risk of MI was increased by cumulative exposure to all the studied PIs except saquinavir and particularly to amprenavir/fosamprenavir with or without ritonavir and lopinavir with ritonavir, whereas the association with abacavir cannot be considered causal.

Since the presentation of the D:A:D study results at the Conference on Retroviruses and Opportunistic Infections in February 2008, 10 studies have explored the association between exposure to abacavir and the risk of myocardial infarction. Among the five larger studies, three conclude that there is an association and two that the association is not robust. Based on these studies, it is impossible to refute or confirm a causal relationship, as it is not possible to exclude remaining confounding (smoking in two of the studies, kidney function in two of the studies, cocaine and/or intravenous drug use) and selection bias in studies that report a robust association. In addition, no convincing mechanism has been described.

The incidence of myocardial infarction (MI) is lower in France than in English-speaking and northern European countries. We estimated the incidence of MI in the HIV-infected population in France, on the basis of the data from the FHDH-ANRS CO4 cohort, by comparison with the general population. The sex- and age-standardized morbidity ratio was estimated as 1.5 [95% confidence interval (CI) 1.3-1.7] overall, 1.4 (95% CI 1.3-1.6) in men and 2.7 (95% CI 1.8-3.9) in women.

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. The prevalence and incidence of AF are rising, as confirmed in several European and American registries. Guidelines published in 2008 from the European Society of Cardiology/American Heart Association and from the American College of Chest Physicians, clarified the strategy of antithrombotic treatment in AF, which is based on the presence of risk factors for thromboembolism. This approach allows physicians to classify patients as at low, moderate or high risk, according to their individual risk characteristics, which are relatively similar in both sets of recommendations. Patients at moderate risk, however, who might justify anticoagulant or antiplatelet treatment, could be better characterized using morphological (echocardiographic) and/or biological factors or risk markers. Recent data have shown that the existence of a thrombogenic milieu in the left atrium (e.g., dilatation of the left atrial appendage and/or thrombus and/or spontaneous echocontrast and/or reduced emptying/filling flow velocity) indicates a higher risk of embolism and mortality. Furthermore, high-sensitivity C-reactive protein and haemostasis markers of coagulation are associated with thromboembolic risk and excess mortality in AF. Although current recommendations for the management of AF are not based on such markers, both could help physicians choose the optimal antithrombotic treatment (either vitamin K antagonists or antiplatelet drugs) according to the patient's specific risk profile. Nowadays, registries confirm under-prescription of vitamin K antagonist treatment in the 'real world,' even in patients at high thromboembolic risk, and over-prescription for at least one-third of low-risk patients. It is crucially important to realize that the risk of bleeding in patients with risk factors (e.g., older age, hypertension) is close to the risk of thromboembolism, which can have devastating outcomes in patients in AF. Alternative and efficient strategies (new oral anticoagulants, non-surgical closure of the left atrial appendage using percutaneous devices) are currently under investigation. Therefore reducing the risk of thromboembolism should be physicians' primary aim, particularly with the advent of alternative treatments and the development of new antithrombotic drugs such as oral thrombin and factor Xa inhibitors, which are currently being evaluated in clinical trials.