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With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in ACHD patients, over a significant period of time, remain scarce. We aimed to describe temporal trends in volume and outcomes of catheter ablation in ACHD patients. Retrospective observational study including all consecutive ACHD patients undergoing attempted catheter ablation in a large tertiary referral center over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 months were analyzed. From November 2004 to November 2019, 302 catheter ablations in 221 ACHD patients (43.6 ± 15.0 years, 58.9% males) were performed. The annual number of catheter ablation increased progressively from 4 to 60 cases per year (P < 0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia (n = 217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% (P < 0.001). Use of irrigated catheters (OR = 4.03, 95% CI: 1.86–8.55), 3D-mapping system (OR = 3.70, 95% CI: 1.72–7.74), contact force catheters (OR = 3.60, 95% CI: 1.81–7.38), and high-density mapping (OR = 3.69, 95% CI: 1.82–8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (P = 0.001). Seven (2.3%) non-fatal complications occurred (Fig. 1). The number of catheter ablation procedures in ACHD patients has considerably increased over the last 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and midterm outcomes. [ABSTRACT FROM AUTHOR]

Heart transplant recipients are at high-risk of sudden cardiac death (SCD). However, risk factors of SCD in heart recipients remained poorly described. To assess the predictors of SCD beyond the first-year post-transplant. We enrolled consecutive patients transplanted between 2004 and 2017 in two French referral centres. We excluded patients deceased during the first year. Patients underwent an evaluation at the day of transplantation and during the first year, comprising clinical, biological, histological, immunological (circulating anti-HLA DSA) and interventional (cardiac allograft vasculopathy assessment) parameters. According to the last consensus, SCD was defined as an unexpected out-of-hospital cardiac arrest without obvious non-cardiac cause, in the first hour after initiation of symptoms. A total of 913 patients were included. The median follow-up post-HT was 5.9 years (IQR = 2.9–8.5). Among the 60 parameters tested in univariate analysis, we identified 4 independent factors independently associated with sudden death after 1 year post-HT: donor age (HR = 1.55; 95% CI: 1.14–2.11; P = 0.005), recipient age (HR = 0.74; 95% CI: 0.59–0.93; P = 0.011), ventricular ejection fraction (LVEF) < 55% any time after transplantation (HR: 3.95; 95% CI: 1.95–8.02; P < 0.001), the presence of circulating anti-HLA DSA at the time of transplantation (HR: 2.18; 95% CI: 1.15–4.11; P = 0.017). The incidence rate of SCD was 2.17 per 100 person-year (95% CI: 1.42–4.60) and 1.21 per 100 person-year (95% CI: 0.80–2.58) in patients with FEVG < 55% (n = 73) and in patients with pre-formed DSA (n = 260), respectively (Table 1). In a large multicentric and highly phenotyped cohort of heart transplant recipients, we identified four independent factors associated with SCD beyond the first year. This study provides fresh evidence of SCD assessment for improving risk stratification of HT recipients. [ABSTRACT FROM AUTHOR]

Dilated cardiomyopathy (DCM) is a major cause of systolic heart failure and therefore a major public health issue. Our objective was to better understand the genetic bases of dilated cardiomyopathy. We conducted a 1000G based genome-wide association study for 9,152,885 SNPs on 2,719 sporadic DCM cases and 4,440 controls of European origin followed by a replication step. We then sought for the most likely culprit genes at the new replicated loci through a dedicated strategy including in silico data mining (including tissue specific gene expressions, expression and methylation quantitative trait loci) as well as functional 4C-sequencing analysis on iPSC-derived cardiomyocytes (Fig. 1). We identified two new DCM loci, on chromosome 3p25.1 (lead SNP rs62232870, p = 8.7 × 10−11 and 7.7 × 10−4 in the discovery and replication steps, respectively) and chromosome 22q11.23 (lead SNP rs7284877, P = 3.3 × 10−8 and 1.4 × 10−3, respectively), while confirming two previously identified ones, BAG3 and HSPB7. A Genetic Risk Score was built from the number of risk allele at these four loci and revealed a 27% increased risk of DCM for individuals with 8 risk alleles compared to individuals with 5 risk alleles (median of the referral population). At chr3p25, our selection strategy pinpointed SLC6A6 as the most likely culprit gene. SLC6A6 encodes a taurine transporter whose involvement in myocardial dysfunction and DCM is supported by numerous observations in humans and animals. At the 22q11.23 locus, the same strategy strongly suggested SMARCB1 as the best candidate gene. This study provides new insights in the genetic architecture of DCM and sheds light on novel biological pathways underlying heart failure, with the potential for a therapeutic perspective especially through taurine modulation. [ABSTRACT FROM AUTHOR]

Résumé: La fibrillation atriale coexiste souvent avec l’infarctus du myocarde, et son incidence au décours de l’infarctus du myocarde varie entre 4% et 25%. La présence d’une fibrillation atriale chez les patients présentant un infarctus du myocarde est associée à un risque accru de mortalité, malgré l’ajustement sur des facteurs de confusion connus et indépendamment du moment de survenue de la fibrillation atriale. Cette augmentation de 40% du risque de mortalité conduit à porter une attention particulière à la fibrillation atriale chez les patients présentant un infarctus du myocarde. Des études sont nécessaires pour identifier les moyens de prévenir la survenue de la fibrillation atriale au cours de l’infarctus du myocarde et déterminer les thérapeutiques optimales de la fibrillation atriale chez les patients présentant un infarctus du myocarde afin de réduire la mortalité. [Copyright &y& Elsevier]

In contrast to acute cellular rejection, non-invasive assessment of antibody-mediated rejection (AMR) remains challenging. The routine surveillance endomyocardial biopsies (EMB) approach to monitor AMR suffers from multiple limitations. The development of an individual AMR risk score may allow for individualization of the EMB protocol. We analyzed a prospective and deeply phenotyped cohort of patients transplanted between 2012 and 2017 at our center (n = 700). Patients were randomly distributed in a training (2/3) and in a test set (1/3). We applied a mixed effect logistic regression with a random intercept to identify predictive variables associated with AMR ≥ pAMR1 at the level of each EMB. An AMR risk score was derived by applying the β-coefficients attributed to each predictive variable. A total of 6403 EMB were analyzed among which 412 (6.4%) were diagnosed as AMR ≥ pAMR 1. In the training set, five predictive variables were independently associated with AMR: time post-transplant (P < 0.001), pre-transplant sensitizing event (P = 0.003), circulating donor-specific antibody at the time of EMB (P = 0.010), left ventricular dysfunction (P = 0.018) and prior history of pAMR2 (P < 0.001). In the test set, the calibration and the discrimination of the model were good (area under the ROC curve = 0.801, Fig. 1A). We observed a stepwise increase in the risk of AMR with increasing AMR risk score, ranging from 1.6% (1.1–2.5%) for score ≤ 1 point to 36.8% of EMB (22.8–53.6%) for scores between 4 and 5 (Fig. 1B). We identified 5 independent predictive variables associated with AMR and derived an AMR risk score that may help clinicians in individualizing the EMB protocol. [ABSTRACT FROM AUTHOR]

A significant increase in the prevalence of sudden cardiac arrest (SCA) with non-shockable rhythm (NSR) has been reported. Factors associated with NSR and the mode to the return of spontaneous circulation (ROSC) may help for a better understanding. We aimed to describe the frequency, characteristics and outcome of NSR related SCA in the community. In this prospective ongoing multicentre population-based registry (6.7 million inhabitants), data from all SCA were analyzed. Medical records for each SCA were reviewed by two cardiologists to identify aetiology and associated conditions. Among the 3,028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 2,904 patients had available information regarding initial rhythm. Among them, 1,314 patients (45.3%) presented with NSR: 1,109 (38.2%) cases with asystole, 197 (6.8%) with pulseless electrical activity and 8 (0.3%) with high degree atrioventricular block. NSR cases were older (60.6 vs. 57.4 years, P < 0.001), with greater proportion of females (34.9 vs. 19.2%, P < 0.001) and less proportion of family history of CAD or SCA. Proportion of symptoms prior to the SCA was higher among patients with NSR (74.3 vs. 64.9%, P < 0.001) but chest pain was lower (24.0 vs. 43.3%, P < 0.001). Survival rate was much lower in NSR cases (7.2 vs. 42.3%, P < 0.001). Among the 1,314 NSR cases, 1,022 (77.8%) did not require external defibrillation although a majority (91.7%) received adrenaline during resuscitation. In this subgroup, main identified cardiac cause was acute coronary syndrome (45.3%), followed by chronic CAD (27.1%), structural non-ischemic heart disease (22.4%), and non-structural heart disease (5.2%). Initial NSR is encountered in almost half of SCA cases admitted alive; mostly occurs in older patients with higher proportion of females. Over three quarters of these cases did not require external defibrillation prior to ROSC. [ABSTRACT FROM AUTHOR]

While outcomes of intra-atrial re-entrant tachycardia (IART) catheter ablation have considerably improved in adult congenital heart disease (ACHD), recurrences remain common with different circuits frequently encountered. We aimed to assess the value of programmed atrial stimulation after successful clinical IART catheter ablation in ACHD patients. Retrospective study including all ACHD patients undergoing IART catheter ablation in a large tertiary centre. After successful catheter ablation of the clinical arrhythmia, survival free from arrhythmia recurrence was analysed according to whether all inducible IART were targeted. From 2004 to 2020, 238 IART catheter ablations were performed (mean age 44.1 ± 15.0 years, 61.3% males). Acute procedural success of clinical arrhythmia was achieved in 208 (87.4%) procedures. Among 122 (58.7%) patients with programmed atrial stimulation, at least one other IART was induced in 61 (50%) patients. All inducible IART were ablated in 54 (88.5%) patients whereas 7 (11.5%) patients had at least one non-targeted inducible IART. Patients with non-targeted inducible IART had a higher risk of atrial arrhythmia recurrence compared to inducible patients with ablation of all IART (HR = 5.7, 95% CI: 1.7–18.4), with 12-month survival rates of 22.9% and 77.7%, respectively. Inducible patients with successful ablation of all IART had a similar risk of atrial arrhythmia recurrence compared to non-inducible patients (HR = 0.6, 95% CI: 0.3–1.3) (Fig. 1). Our findings suggest that final programmed atrial stimulation is associated with improved outcomes in ACHD patients referred for IART ablation when all inducible IART are targeted and successfully ablated. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) is a major contributor to the rate of mortality after heart transplantation. However, little is known about the incidence of SCD in heart recipients. To assess the incidence of SCD after heart transplantation. We enrolled consecutive patients transplanted between 2004 and 2017 in two French referral centers. We defined 7 main groups of causes of deaths: SCD, cardiovascular (including Cardiac allograft vasculopathy), infection, primary graft dysfunction, graft failure (including late graft dysfunction, rejection), malignancy and others. Causes of deaths were independently adjudicated by two senior cardiologists based on the analysis of death certificates and medical records. Discrepancies were resolved by discussion until a consensus was made. SCD was defined as an unexpected out-of-hospital cardiac arrest without obvious non-cardiac cause, in the first hour after initiation of symptoms. A total of 1,363 patients were included. The median follow-up post-transplant was 3.99 years (IQR = 0.49–7.49). A total of 450 patients (33%) deceased during the first year. The leading cumulative causes of death in the first year after transplantation were infection, primary graft failure, multiple organ failure during the period in intensive car unit. Beyond the post-operative high-risk period of the first year, the leading cumulative cause of death was SCD: among the 213 deaths that occurred beyond the first year, 44 patients (21%) died from SCD. In this period, the incidence rate of SCD reached 0,82 per 100 person-year (95% CI: 0.51–2.05) (Fig. 1). In a large multicentric and highly phenotyped cohort of heart transplant recipients, the leading cumulative cause of death beyond the first-year post transplant was sudden cardiac death. Our results open discussion on management of heart recipient, such as the implementation of cardioverter-defibrillators. [ABSTRACT FROM AUTHOR]

The diagnosis of cardiac allograft rejection is based on the histological analysis of a myocardial tissue sample obtained by endomyocardial biopsy (EMB), an invasive procedure at risk of complications. Our aim is to enable the shift from a protocol biopsy approach, to a precision medicine approach, in which the need for EMB is tailored to each patient's individual risk. To analyze the incidence and the risk factors for biopsy-proven rejections following heart transplantation in a large cohort of highly phenotyped heart-transplant recipients. We performed a multicenter, retrospective, observational study (Pitié-Salpêtrière, HEGP, 2004–2016). We included all patients with ≥ 1 EMB during the first year (n = 1050 patients, 13677 EMB). All EMB performed before 2012 were retrospectively reviewed and graded according to ISHLT guidelines. Rejections were defined as acute cellular rejection (ACR) ≥ 1R1B and/or antibody-mediated rejections (AMR) ≥ pAMR1. Pre-formed DSA were evaluated using Luminex Single Antigen Assay (MFI ≥ 500). Risk factors for rejection were identified using Cox proportional hazard model. Biopsy-proven rejections were diagnosed in 489 patients (46.4%) representing 1009 EMB (7.3%, mostly low-grade rejections: ACR 1R1B or 1R2: n = 724, see Fig. 1). Risk factors for rejection included recipient's age (HR = 0.988 per 1-year increment, P = 0.002), type of transplantation (combined heart-kidney and heart-liver compared to isolated heart: HR = 0.336 and 0.204 respectively, P < 0.001), pre-formed DSA (HR = 1.422, P < 0.001), HLA A-B-DR mismatches (HR = 1.129 per 1-mismatch increment, P = 0.02) and the type of induction (basiliximab compared to anti-thymocyte globulins: HR = 1.725, P = 0.008). We identified five independent risk factors for biopsy-proven rejection during the first-year post-heart transplantation. Our findings might help clinicians to customize post-transplant endomyocardial biopsies monitoring. [ABSTRACT FROM AUTHOR]

Since a large proportion of patients resuscitated from out-of-hospital sudden cardiac arrest (SCA) die in the intensive care unit (ICU), early systematic investigation towards identifying etiology may be crucial to ensure appropriate future prevention among relatives, especially when the index case is young. We hypothesized that etiologic investigations were not initiated in a timely manner in a significant proportion of young SCA patients prior to death. In this prospective ongoing multicenter, population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed with a specific focus on young patients (< 45 year-old) alive at hospital admission and who eventually died in ICU. Investigations and diagnoses arrived at were analyzed from the medical records by two cardiologists for each case. Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3,028 were admitted alive to ICU. Among them, 2,190 (72.3%) died in ICU, including 367 (16.8%) young cases (< 45 y.o.). Among the young patients, while 163 cases (44.4%) had a specific diagnosis established, 204 (55.6%) remained unexplained. Coronary angiograms (18.3%), CT scan (brain and chest) (24.5%), and transthoracic echocardiography (29.1%) were all underutilized. Main SCA causes were acute coronary syndrome (44.5%), followed by structural non-ischemic heart disease (25.5%), pulmonary embolism (13.6%), chronic CAD (10%), non-structural heart disease (1.8%) and miscellaneous (4.6%). The proportion of autopsy (10.9%), as well as blood sample collection for further genetic testing (1.4%) was low. Information on family screening was rarely provided in the ICU. More than half of young SCA cases who died in ICU remained unexplained. Efforts to promote early systematic investigation through better collaboration between intensivist and cardiologist may improve future targeted preventive strategies for family members. [ABSTRACT FROM AUTHOR]

Implantable Cardioverter Defibrillator (ICD) in sudden cardiac arrest (SCA) is indicated in non-reversible cardiac causes. A systematic description of SCA survivors discharged without an ICD has not been undertaken thus far. We aimed to describe the frequency, characteristics and etiologies of SCA survivors discharged without an ICD. In this prospective ongoing multicentre community-based study (6.7 million inhabitants), data from all SCA cases alive at hospital discharge, over a 5-year period, were analyzed with a specific focus on survivors. All medical records were reviewed by two cardiologists to identify underlying mechanisms and ascertain etiologies. Among the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 717 survivors at hospital discharge fulfilled definition for cardiac SCA. Among them, 247 patients (34.5%) received an ICD and 468 (65.4%) did not. Compared to the ICD group, the group without ICD were older (58.9 vs. 52.6 years, P < 0.001). Main etiologies were acute coronary syndrome (ACS) (397, 84.8%), chronic CAD (28, 6.0%), structural non-ischemic heart disease (31, 6.6%) and non-structural heart disease (12, 2.6%). Among survivors with ACS, 93.6% (397 out of 424) were discharged without an ICD and 18 of those were due to coronary spasm (representing 75% of coronary spasm related-SCAs survivors), including three refractory spasms despite pharmacological therapy. Factors independently associated with ICD non-implantation in ACS were the absence of personal CAD history (OR 2.86, CI95% 0.19–6.67, P = 0.014) and immediate angioplasty at admission (OR 2.77, CI95% 1.02–6.78, P = 0.033). Almost two third of SCA survivors were discharged without an ICD; while this was largely related to ACS and coronary stenting, some cases of chronic CAD as well as drug refractory coronary spasm in this population may represent lost opportunity, warranting further studies addressing this specific issue. [ABSTRACT FROM AUTHOR]

Abstract: Introduction. – Lack of habitual physical activity is an important risk factor for cardiovascular disease. However apparently healthy athletes can die suddenly during exercise. Sudden death in athletes is not well documented. It is still particularly to identify high risk. What is now well known is that the resuscitation rate is lower than 2% in France while it reaches 20% in Seattle (USA). Fact''s synthesis. – We have been commissioned by the CPLD to assess the incidence of sudden death during sport activity. The study began on January 1st 2005. It should last four years. SAMU, firemen''s department, but also referees and medical doctors responsible for sports federation will be asked to fill out a standardized form about the circumstances of death. All those informations will be centralized and analysed at the Inserm unit and verified by a medical committee. Conclusion. – This study will help to: 1) assess the incidence and describe circumstances of sudden death during physical activity; make proposals on resuscitation methods to improve chances of survival. [Copyright &y& Elsevier]

Background Existing studies on sports-related sudden cardiac arrest (SCA) have focused principally on young competitive athletes. There is limited information on sports-related SCA in the general population. Purpose We sought to determine the burden, characteristics and etiology of SCA during sports activity in adults. Cases occurring during sports activity were compared to those unrelated to sports regarding characteristics and previous medical history. Methods All cases of SCA occurring in the area (6.6 million inhabitants) were prospectively ascertained over a five-year period in this ongoing multicentre study. Data from all SCA during sports activity in either a competitive or recreational setting were analyzed. Results From May 2011 to May 2016, 3028 patients fulfilling criteria for SCA were admitted alive to hospital. Out of these, 138 (4.6%) SCA occurred during sports. The 3 most common sport activities during the SCA event were running (34.5%), cycling (14.4%) and soccer (8.6%). Sports-related SCA cases were younger (mean age: 52.7 ± 15.6 vs. 59.6 ± 15.6 years old, P < 0.001), more likely to be male (90.6 vs. 71.9%, P < 0.001), had lower cardiovascular risk factors (≥ 1 CVRF, 72.1 vs. 81.4%, P = 0.012), higher rate of bystander cardiopulmonary resuscitation (84.1 vs. 62.9%, P < 0.001) and higher proportion of ventricular fibrillation at EMS arrival (73.9 vs. 51.1%, P < 0.001) compared to other SCA. Among cases admitted alive to hospital with identified cause of SCA (71%), coronary artery disease (72.4%) was the main cardiovascular abnormality identified, mostly acute coronary syndrome (62.2%). Prior to SCA event, 22 cases (15.9%) were known to have heart disease, including CAD (5.8%) and 77 (66.4%) others presented with ≥ 1 CVRF. Conclusion SCA during sports mostly concerns middle-aged men, with CAD being the frequent underlying cause (up to 75%). These results provide information to enhance sport preparticipation screening. [ABSTRACT FROM AUTHOR]

Background Considerable apprehension often surrounds the issue of sudden cardiac arrest (SCA) during physical activity, and especially SCA related to sexual activity, which has not been well studied in the community. Purpose We sought to assess the burden, characteristics and outcomes of SCA related to sexual activity compared to other physical activities. Methods In this multicentre prospective ongoing study in the general population, every case of SCA was exhaustively collected. Data from all SCA during physical activity, alive at hospital admission, were analyzed with a specific focus on cases occurring during sexual intercourse. Results Among the 3028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 246 (8.1%) SCA (219 men, 89.0%) occurred during physical activity: 138 (56%) during sports, 91 (37%) during moderate-intensity activity and 17 (7%) during (hetero-) sexual intercourse. SCA during sexual activity were more likely to be male (100.0 vs. 88%, P = 0.22), with higher no flow (8.4 vs. 3.1 min, P < 0.001) and lower frequency of shockable rhythm (41.2 vs. 72.5%, P = 0.01) compared to others. There was no difference for age (53.0 vs. 56.1 years old, P = 0.43), cardiovascular risk (CVR) profile (≥ 1 CVR factor, 81.2 vs. 75.6%, P = 0.65), frequency of warning symptoms (37.5 vs. 53.6%, P = 0.23) and family history of coronary artery disease (CAD) (6.3 vs. 11.5%, P = 0.59). However, bystander CPR (47.1 vs. 80.3%, P = 0.004) and survival rate (11.8 vs. 50.2%, P = 0.002) were lower. Acute CAD (52.3%), and subarachnoid hemorrhage (29.4%), were the main identified causes followed by chronic CAD (17.6%) and structural non-ischemic heart disease (5.6%). Conclusion SCA during sexual intercourse is a relatively rare cause of SCA and is associated with a particularly poor outcome. The low rate of CPR in this setting may be related to the uniquely private circumstances of the arrest and could contribute to low survival rate. [ABSTRACT FROM AUTHOR]

Aims Dilated cardiomyopathy (DCM) is an important cause of heart failure with a strong familial component. We performed an exome-wide array-based association study (EWAS) to assess the contribution of missense variants to sporadic DCM. Methods and results Overall, 116,855 single nucleotide variants (SNVs) were analyzed in 2796 DCM patients and 6877 control subjects from 6 populations of European ancestry. We confirmed two previously identified associations with SNVs in BAG3 and ZBTB17 and discovered six novel DCM-associated loci (Q-value < 0.01). The lead-SNVs at novel loci are common and located in TTN, SLC39A8, MLIP, FLNC, ALPK3 and FHOD3 . In silico fine mapping and protein interaction experiment with BAG3 identified HSPB7 as the most likely candidate at the ZBTB17 locus. Rare variant analysis (MAF < 0.01) demonstrated significant association for TTN variants only ( P = 0.0085). All candidate genes at associated loci but one ( SLC39A8 ) exhibit preferential expression in striated muscle tissues and mutations in TTN, BAG3, FLNC and FHOD3 are known to cause familial cardiomyopathy. These candidate genes also share structural and functional roles suggesting sarcomeric maintenance as an important feature protecting against DCM. Conclusion We identified eight loci independently associated with sporadic DCM. Overlap between susceptibility gene and familial DCM causing gene suggests a continuum of effect size, or penetrance, in DCM associated molecular variants. The functions of the best candidate genes at these loci also suggest that proteostasis regulation might play a role in DCM pathophysiology. [ABSTRACT FROM AUTHOR]

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]

Background Sudden cardiac arrest (SCA) is a major cause of deaths in Europe, but population-based data on specific etiologies, such as structural non ischemic heart disease (SNIHD) are lacking. Purpose We sought to determine the frequency, characteristics and outcomes of SCA associated with SNIHD in the general population. Methods In this prospective ongoing multicentre population-based registry, data from all SCA were analyzed. SNIHD included different non ischemic cardiomyopathies, as well as valvular, hypertensive and congenital heart diseases. Medical records were reviewed by cardiologists to identify clinical conditions underlying SCA. Results Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3028 SCAs (16.2%) were admitted alive to hospital. Two hundred and twenty four (7.4%) SNIHD were diagnosed during hospitalization, including dilated cardiomyopathy (DCM) (44.2%), valvular heart disease (19.2%), hypertrophic cardiomyopathy (13.4%), myocarditis (6.7%), congenital heart disease (3.1%) and arrhythmogenic right ventricular dysplasia (2.7%). As compared to other causes of SCA, SNIHD patients were significantly younger (55.2 vs. 59.6 years, P < 0.001), more likely to be women (35.7% vs. 26.4%, P = 0.003) had fewer cardiovascular risk factors (≥ 1 CVRF, 72.7% vs. 81.8%, P = 0.002), but known heart disease was more likely to be identified (67.4% vs. 30.2%, P < 0.001) in SNIHD. Among patients with previously known DCM, only 46% of cases presented with a left ventricular ejection fraction < 35%. Among survivors, only 87 (74.3%) were implanted with ICD. Conclusion In our registry, SCA associated with SNIHD presented distinctive features compared to non-SNIHD, and overall accounted for only 7% of the overall SCA burden. Main causes were DCM and valvular heart disease. Better characterization of this population, especially the sizeable subgroup with left ventricular ejection fraction > 35% can improve sudden death risk stratification in this group. [ABSTRACT FROM AUTHOR]

La mort subite de l'adulte, mode de décès correspondant le plus souvent à un trouble du rythme cardiaque ventriculaire, est un problème majeur de santé publique. Bien que la maladie coronaire soit la principale cause de mort subite cardiaque, d'autres étiologies doivent être systématiquement envisagées et recherchées. Un bilan étiologique exhaustif et standardisé est nécessaire pour optimiser la prise en charge du patient et de sa famille dans le cas d'une maladie cardiaque héréditaire. L'identification d'une anomalie cardiaque et la question de son imputabilité pouvant être délicates, la prise en charge par une équipe pluridisciplinaire expérimentée se justifie pleinement. 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. [ABSTRACT FROM AUTHOR]

Résumé La fibrose endomyocardique tropicale (FET) est la première cause de cardiomyopathie restrictive dans le monde. Elle se caractérise par une fibrose diffuse de l’endocarde ventriculaire responsable d’une déformation des ventricules et d’une insuffisance cardiaque restrictive. Confinée à certaines régions du monde, l’étiologie de la FET demeure mystérieuse. Les formes sévères sont greffées d’un très mauvais pronostic. Les changements épidémiologiques récemment constatés dans certains foyers endémiques et l’amélioration des moyens diagnostics ouvrent des perspectives dans la compréhension et le traitement de la maladie. 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. [ABSTRACT FROM AUTHOR]

Résumé 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. 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. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude Le poids et la taille tels qu’ils étaient à différents âges de la vie sont difficiles à obtenir. Afin d’améliorer la connaissance de l’historique du poids, Sörensen et al. en 1983, ont développé un outil à partir de silhouettes permettant d’évaluer la corpulence à différents âges de la vie. Les études de validité ont montré que le poids et la taille mesurés étaient corrélés à 80 % à la silhouette rapportée. D’autres études ont montré que l’évaluation des silhouettes est un bon moyen de retracer l’historique du poids d’un individu. Très peu d’études épidémiologiques ont utilisé cet outil. Une étude française a permis de mettre en évidence une diminution du risque de cancer du sein chez les fillettes qui étaient obèses entre l’âge de 8 ans et l’adolescence. Une autre étude a montré qu’un faible poids de naissance ou une silhouette mince avant l’âge adulte sont associées à une augmentation du risque de diabète. À partir de ces constatations, il nous a semblé intéressant d’évaluer la relation entre la silhouette à 20 ans et le risque d’hypertension à l’âge de 60 ans. Résultats On a observé que la prévalence de l’hypertension à l’âge de 60 était plus élevée chez les sujets obèses à 20 ans que chez les sujets minces (45,3 % vs 36,7 % ; p < 0,05). Conclusion Cet outil permet une classification pertinente entre minceur et obésité. L’historique de la corpulence est un élément important à considérer dans les déterminants d’une pathologie, en particulier dans celle de l’hypertension artérielle. Purpose of the study In epidemiological studies, recall of weight and height are not readily available at different ages of life. In order to improve the knowledge of the weight history, Sörensen et al. in 1983, developed a tool from silhouettes allowing an individual to evaluate his corpulence at different ages of life. Validity studies showed that measured weight and size were correlated to 80% in the reported silhouette. Studies have also shown that silhouettes are a good way to trace the weight history in an individual's life. Very few epidemiological studies have used this tool. A French study revealed a decrease of the risk of breast cancer in obese girls between the age of 8 and adolescence. Another study showed that a low birth weight or a thin silhouette before adulthood was associated with an increased risk of diabetes. On the basis of these findings, it was interesting to evaluate the relationship between the silhouette at 20 years and the risk of hypertension at the age of 60 years. Results It was shown that the prevalence of hypertension at age 60 was higher among obese subjects at 20 years than among thin subjects (45.3% vs 36.7% ( P < 0.05). Conclusion The classification between slimness and obesity is relevant using this tool. The history of corpulence is an important element to consider in the determinants of pathology, especially in hypertension. [ABSTRACT FROM AUTHOR]

Circulating microRNAs (miRNA) have been identified as non-invasive biomarkers of cardiac rejection in retrospective studies but their clinical utility has not yet been evaluated in large prospective and unselected cohorts of patients. We designed a longitudinal prospective study (NCT02672683) including 11 heart transplant referral centers. Patients were included from 2016 to 2018. Either de-novo HTx recipients or patients transplanted ≥ 1 year were included at the time of an endomyocardial biopsy (EMB, protocol or for-cause). The primary endpoint was to validate the association between the peripheral expression of 3 previously identified circulating miRNA (miR-10a, miR-92a, and miR-155) with allograft rejection on concomitant EMB. Relative miRNA measurements were performed by normalizing miRNA PCR copy numbers by an endogenous control. A sensitivity analysis was performed by applying an absolute quantification method of microRNA using standard dilution curves of microRNA mimics. The association between miRNA and rejection was tested using mixed effect logistic regression. A total of 461 patients were included representing 831 EMB. Overall, 79 rejection episodes occured, including 25 ACR ≥ 2 R and/or 56 AMR ≥ pAMR 1. In a first pre-specified interim analysis based on 258 EMB from 184 patients including 49 rejection episodes (62% of overall rejections, ACR ≥ 2R = 17, pAMR1(H+) = 14, pAMR1(I+) = 9, pAMR2 = 11), no association between any of circulating miRNA and rejection was found (Figure 1-A). A sensitivity analysis performed with the absolute quantification method on 191 EMB from 134 patients including 94% of overall rejections confirmed those results (Figure 1-B). The analysis of remaining sera was stopped for futility. In this prospective multicenter study of unselected patients, the clinical utility of 3 circulating miRNA as non-invasive biomarkers of cardiac rejection was not confirmed. [ABSTRACT FROM AUTHOR]

Résumé La mort subite constitue un problème majeur de santé publique avec près de 40 000 victimes par an en France. Des différences épidémiologiques, cliniques et pronostiques ont déjà été constatées entre hommes et femmes dans les pathologies cardiovasculaires. La mort subite ne fait pas exception à la règle. Dans cet article, nous détaillerons les spécificités féminines dans la mort subite en termes d’incidence et de circonstances de survenue, ainsi qu’en termes de prise en charge et pronostic. 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. [ABSTRACT FROM AUTHOR]

Objective To examine whether values of arterial base excess or lactate taken 3 h after starting ECLS indicate poor prognosis and if this can be used as a screening tool to follow Extra Corporeal Life Support after Out Hospital Cardiac Arrest due to acute coronary syndrome. Design Single Centre retrospective observational study. Setting University teaching hospital general adult intensive care unit. Patients 15 consecutive patients admitted to the intensive care unit after refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. Interventions Arterial base excess and lactate concentrations were measured immediately after starting ECLS and every 3 h after. Results Both base excess and arterial lactate measured 3 h after starting ECLS effectively predict multiorgan failure occurrence and mortality in the following 21 h (area under the curve on receiver operating characteristic analysis of 0.97, 0.95 respectively). The best predictive values were obtained with a base excess level measured 3 h after starting ECLS of less than −10 mmol/l and lactate concentrations greater than 12 mmol/l. The combination of these two markers measured 3 h after starting ECLS predicted multiorgan failure occurrence and mortality in the following 21 h with a sensitivity of 70% and a specificity of 100%. Conclusions Combination of base excess and lactate, measured 3 h after starting ECLS, can be used to predict multiorgan failure occurrence and mortality in the following 21 h in patients admitted to an intensive care unit for refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. These parameters can be obtained simply and rapidly and help in the decision process to continue ECLS for refractory CA. [ABSTRACT FROM AUTHOR]

Purpose To identify distinct profiles of cardiac allograft vasculopathy (CAV) trajectory and their determinants. Methods We performed a multicenter study (Pitié & HEGP, Paris). We included all patients transplanted between 2004 and 2011 who had at least 2 coronary angiograms during follow-up (n = 436). We performed an comprehensive evaluation of potential risk factors that might be associated with CAV including in-depth characterization of donor-specific antibodies (DSA) and retrospective endomyocardial biopsies reviewing. A semi parametric mixture model was used to identify distinct trajectories of CAV progression from year 1 to year 10 post-transplantation among the 1407 coronary angiograms (3.4±1.4 angiograms per patient). Multivariable logistic regression model was used to determine risk factors associated with each trajectory. Results Median follow-up post-transplant was 7 years. Four latent classes of CAV trajectories were identified: #1-non-progressors (n=240, 55%), #2- late progressors (n=35, 8%), #3- early progressors (n=99, 22.7%) and #4- severe progressors (n = 62, 14.3%, figure). Taking latent class #1 as reference, 5 parameters were associated with CAV progression: donor age (HR = 1.06 and 1.08 per 1-yr increment for latent classes #3 and #4, respectively, p < 0.001), donor tobacco consumption (HR = 2.49, 2.02 and 2.23 for classes #2, #3 and #4, respectively, p < 0.001), donor gender (male donors: HR = 2.3 and 3.94 for classes #3 and #4, respectively, p < 0.001), 1-year post-transplant dyslipidemia (HR = 2.21 for class #3, p = 0.02) and pre-formed DSA (HR = 3.85 for class #3). Conclusion In a large and highly phenotyped cohort of heart transplant recipients, we identified 4 distinct prototypes of CAV trajectories. Donor-derived cardiovascular risk factors, 1-year post-transplant cardiovascular profile (dyslipidemia) and immunological parameters (pre-formed DSA) were independent risk factors for CAV severity and progression. [ABSTRACT FROM AUTHOR]