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Background: QT abnormalities have been reported in left ventricular hypertrophy and hypertrophic cardiomyopathy. Objective: To determine the relation between left ventricular hypertrophy and increased QT interval in familial hypertrophic cardiomyopathy. [...]

La gestione dell’arresto cardiorespiratorio (ACR) si basa sulla catena della sopravvivenza, che comporta quattro anelli. Il primo si basa sull’identificazione precoce dell’ACR, che porta a una richiesta di aiuto. Non appena viene identificato l’ACR, il secondo anello è la rianimazione cardiopolmonare di base, la cui componente principale è il massaggio cardiaco esterno. Questo deve essere efficace, ininterrotto ed eventualmente associato a una ventilazione artificiale. Il terzo anello è costituito dalla defibrillazione precoce (per i ritmi defibrillabili), la cui precocità è una delle principali determinanti della sopravvivenza. Infine, l’ultimo anello è costituito dalla rianimazione specialistica, dopo l’arrivo dei servizi di soccorso preospedaliero medicalizzato. Insieme al massaggio cardiaco, la rianimazione specialistica prevede l’intubazione e l’uso di farmaci secondo il ritmo iniziale (adrenalina o amiodarone). Per i pazienti giunti vivi in ospedale, la gestione ospedaliera è sia diagnostica che terapeutica. Sul piano diagnostico è opportuno ricercare le principali eziologie e quindi eseguire un elettrocardiogramma, in alcuni casi una coronarografia, ed eventualmente una TC cerebrale e toracica. Sul piano terapeutico, compare frequentemente uno stato di shock postrianimazione che può richiedere a seconda dei casi un’ottimizzazione volemica, un supporto vasopressorio e/o un trattamento inotropo. Nelle situazioni più gravi, e quando la prognosi neurologica attesa è favorevole, può essere proposta un’assistenza circolatoria. Infine, la principale causa di morte tra i pazienti giunti vivi restano i danni neurologici. Si raccomanda di applicare un controllo termico mirato durante le prime 24 ore (tra i 32 °C e i 36 °C) per evitare gli effetti deleteri dell’ipertermia. Nonostante i recenti progressi, la prognosi dopo un ACR resta sfavorevole, con una sopravvivenza inferiore al 10%. Tuttavia, risultati recenti mostrano un miglioramento della sopravvivenza, in particolare grazie a un miglioramento nella formazione del pubblico generale ai gesti di primo soccorso.

Sickle retinopathy is a severe complication of sickle cell disease than can lead to blindness. We aim to describe the epidemiology of sickle retinopathy in homozygous sickle cell (SS) African patients and to analyze its association with non-ophthalmologic disease complications of sickle cell anemia.

Cette étude a examiné l'effet conjoint de cinq habitudes de sommeil (HdS) à l'inclusion et lors du suivi sur le risque de maladies cardiovasculaires (MCV).

La prévalence des maladies cardiovasculaires devrait dépasser celle des maladies transmissibles d'ici 2030 en Afrique Sub-Saharienne. Cependant, les prévalences des facteurs de risques cardiovasculaires dans les communautés africaines âgées de moins de 40 ans sont mal connues.

La mort subite est définie comme un décès naturel, brutal et inattendu chez un sujet apparemment sain. Elle constitue un problème majeur de santé publique, avec un décès cardiovasculaire sur deux qui survient subitement. À partir des données du registre francilien (centre d’expertise mort subite), cet article synthétise les principales anomalies associées à la survenue d’une mort subite, les différentes approches préventives et propose une stratégie diagnostique systématique.

Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated.

In heart transplantation, there is a lack of robust evidence of the specific causes of late allograft failure. We hypothesized that a substantial fraction of failing heart allografts may be associated with antibody‐mediated injury and immune‐mediated coronary arteriosclerosis. We included all patients undergoing a retransplantation for late terminal heart allograft failure in three referral centers. We performed an integrative strategy of heart allograft phenotyping by assessing the heart vascular tree including histopathology and immunohistochemistry together with circulating donor‐specific antibodies. The main analysis included 40 explanted heart allografts patients and 402 endomyocardial biopsies performed before allograft loss. Overall, antibody‐mediated rejection was observed in 19 (47.5%) failing heart allografts including 16 patients (40%) in whom unrecognized previous episodes of subclinical antibody‐mediated rejection occurred 4.5 ± 3.5 years before allograft loss. Explanted allografts with evidence of antibody‐mediated rejection demonstrated higher endothelitis and microvascular inflammation scores (0.89 ± 0.26 and 2.25 ± 0.28, respectively) compared with explanted allografts without antibody‐mediated rejection (0.42 ± 0.11 and 0.36 ± 0.09, p = 0.046 and p < 0.0001, respectively). Antibody‐mediated injury was observed in 62.1% of failing allografts with pure coronary arteriosclerosis and mixed (arteriosclerosis and atherosclerosis) pattern, while it was not observed in patients with pure coronary atherosclerosis (p = 0.0076). We demonstrate that antibody‐mediated rejection is operating in a substantial fraction of failing heart allografts and is associated with severe coronary arteriosclerosis. Unrecognized subclinical antibody‐mediated rejection episodes may be observed years before allograft failure. This study demonstrates that antibody‐mediated rejection operates in a substantial fraction of late chronic failing heart allografts, including unrecognized subclinical antibody‐mediated rejection episodes observed years before allograft failure. See Burke's editorial on page 9.

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In heart transplants, the significance of very late rejection (after 7 years post‐transplant, VLR) detected by routine endomyocardial biopsies (EMB) remains uncertain. Here, we assessed the prevalence, histopathological and immunological phenotype, and outcome of VLR in clinically stable patients. Between 1985 and 2009, 10 662 protocol EMB were performed at our institution in 398 consecutive heart transplants recipients. Among the 196 patients with >7‐year follow‐up, 20 (10.2%) presented subclinical ≥3A/2R‐ISHLT rejection. The VLR group was compared to a matched control group of patients without rejection. All biopsies were stained for C4d/C3d/CD68 with sera screened for the presence of donor‐specific antibodies (DSAs). In addition to cellular infiltrates with myocyte damage, 60% of VLR patients had evidence of intravascular macrophages. C4d and/or C3d‐capillary deposition was found in 55% VLR EMB. All cases of VLR associated with microcirculation injury had DSAs (mean DSAmax−MFI = 1751 ± 583). This entity was absent from the control group (p < 0.0001). Finally, after a similar follow‐up postreference EMB of 6.4 ± 1 years, the mean of CAV grade was 0.76 ± 0.18 in the control group compared to 2.06 ± 0.26 in the VLR group respectively, p = 0.001). There was no difference in patient survival between study and control groups. In conclusion, VLR is frequently associated with complement‐cascade activation, microvascular injury and DSA, suggesting an antibody‐mediated process. VLR is associated with a dramatic progression to severe CAV in long‐term follow‐up.

Objectives:To investigate the association between resting heart rate (RHR) and mortality and incident coronary heart disease (CHD) in the elderly.Methods:Data derived from the Three-City Study, a French multicentre prospective study including 9294 community-dwelling elderly subjects aged ≥65 years at baseline examination between 1999 and 2001. The study population comprised 7147 participants (61% women) who were free of a pacemaker or any cardiac arrhythmias at baseline. RHR was measured twice at baseline in a seated position using an electronic tensiometer. Participants were then followed up bi-annually for vascular morbidity and mortality over 6 years. CHD events and cardiovascular death were adjudicated by an independent expert committee.Results:After 6 years of follow-up, 615 subjects died including 17.9% from cardiovascular causes. Subjects from the top quintile of RHR (>79 bpm) had respectively a 74% (95% CI, 1.3–2.3), a 87% (95% CI: 0.98–3.6, p= 0.06) and a 72% (95% CI, 1.3–2.3) increased risk of total, cardiovascular and non-cardiovascular mortality compared to those from the lowest quintile (<62 bpm), after adjustment for cardiovascular risk factors and beta-blocker (BB) use in a Cox regression analysis. Associations with total mortality were consistent according to age, gender, BB use, diabetes and hypertension status (all pvalues for interaction >0.10). Conversely, RHR was not predictive of incident CHD (n= 228 events; top vs lowest quintile: HR: 1.0; 95% CI: 0.6–1.5).Conclusions:RHR is an independent risk marker of mortality but not of incident CHD events in community-dwelling elderly. Its routine measurement may help identify those who are at increased risk of mortality in the short term.

The significance of C4d‐Banff scores in protocol biopsies of kidney transplant recipients with preformed donor‐specific antibodies (DSA) has not been determined. We reviewed 157 protocol biopsies from 80 DSA+ patients obtained at 3 months and 1 year post‐transplant. The C4d Banff scores (1,2,3) were associated with significant increments of microcirculation inflammation (MI) at both 3 months and 1 year post‐transplant, worse transplant glomerulopathy and higher class II DSA‐MFI (p < 0.01). Minimal‐C4d had injury intermediate between negative and focal, while focal and diffuse‐C4d had the same degree of microvascular injury. A total of 54% of patients had variation of C4d score between 3 months and 1 year post‐transplant. Cumulative (3 month + 1 year) C4d scores correlated with long‐term renal function worsening (p = 0.006). However, C4d staining was not a sensitive indicator of parenchymal disease, 55% of C4d‐negative biopsies having evidence of concomitant MI. Multivariate analysis demonstrated that the presence of MI and class II DSA at 3 months were associated with a fourfold increased risk of progression to chronic antibody‐mediated rejection independently of C4d (p < 0.05). In conclusion, the substantial fluctuation of C4d status in the first year post‐transplant reflects a dynamic humoral process. However, C4d may not be a sufficiently sensitive indicator of activity, MI and DSA being more robust predictors of bad outcome.

Summary Twenty-four patients presenting with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ventricular tachycardia of right ventricular origin associated with structural abnormalities of the right ventricle) were divided into two groups with left ventricular ejection fraction (LVEF) above or below 45%. The distribution of LVEF in the group with LVEF below 45% was comparable with the distribution in 6 patients with idiopathic dilated cardiomyopathy who had ventricular tachycardia originating in the left ventricle (P = 0.2). They also had the same unfavorable long-term prognosis. Therefore, it is suggested that the term, arrhythmogenic right ventricular cardiomyopathy (ARVC), be restricted to patients with a LVEF below 45%. Histological data obtained in the ARVC group showed signs of acute or chronic myocarditis (in the right and left ventricles). It can be hypothesized that patients with arrhythmogenic right ventricular dysplasia (ARVD) may be prone to develop infectious myocarditis. In patients in whom an abnormal host immune response had been seen, progressive deterioration of right and left ventricular function could be observed. This pattern may be superimposed on the genetically determined background of ARVD. This could explain the wide spectrum of clinical presentation observed in patients with tachycardia originating in an abnormal right ventricle.

BackgroundSub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and salt-restriction diet are the cornerstone of effective hypertension control.PurposeWe therefore, assessed adherence to medication and salt restriction in 12 sub-Saharan countries and studied their relationship with blood pressure (BP) control among hypertensive patients.Material and methodsWe conducted a cross-sectional survey in urban clinics of 12 sub-Saharan countries (Benin, Democratic Republic of Congo, Guinea, Mozambique, Niger, Togo, Cameroon, Congo (Brazzaville), Gabon, Céééãôte d’Ivoire, Mauritania, Senegal). Data collected on demographics, treatment and standardised BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP <140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. Poor adherence was defined as a score <8 on the validated 8-Item Morisky Medication Adherence Scale (MMAS 8) completed by the patients. We developed a scale (ranging from 0 to 9) to assess salt consumption: poor adherence to salt restriction was defined as a score ≥2. The association between adherence to medication and salt restriction and BP control was investigated using multilevel logistic regression analysis adjusting for age, sex and countries.ResultsA total of 2198 hypertensive patients (mean age 58.4±11.8 years; 39.9% male) were included. Among these patients, 77.4% had uncontrolled BP, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% had poor adherence to both. Poor adherence to salt restriction (OR: 1.33, 95% CI: 1.03 to 1.72), medication (OR: 1.56, 95% CI: 1.25 to 1.93) or both (OR: 1.91, 95% CI: 1.39 to 2.66) was related to uncontrolled BP. Moreover, poor adherence to both medication and salt restriction was related to 1.52 fold (95% CI: 1.04 to 2.22), 1.8 fold (95% CI: 1.22 to 2.65) and 3.08 fold (95% CI: 2.02 to 4.69) increased the likelihood of hypertension grade 1, 2 and 3 respectively.ConclusionHigh levels of non-adherence to medication and salt restriction were noted in this urban sub-Saharan study. Both were significantly associated with uncontrolled BP, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.No conflict of interest