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1. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome

Author

Franck Boccara, Murielle Mary‐Krause, Valérie Potard, Emmanuel Teiger, Sylvie Lang, Nadjib Hammoudi, Marion Chauvet, Stéphane Ederhy, Laurie Dufour‐Soulat, Yann Ancedy, Pascal Nhan, Saroumadi Adavane, Ph. Gabriel Steg, Christian Funck‐Brentano, Dominique Costagliola, Ariel Cohen, S. Weber, K. Wahbi, P. Beaufils, P. Henri, G. Sideris, D. Thomas, G. Montalescot, F. Beygui, C. Meuleman, S. Janower, F. Raoux, G. Dufaitre, N. Benyounes, P. L. Michel, B. Petillon, N. Hammoudi, P. Gueret, J. L. Dubois‐Rande, E. Teiger, P. Lim, M. Slama, P. Colin, C. Saudubray, O. Dubourg, O. Milleron, B. Gallet, F. Duclos, S. Godard, L. Fuchs, V. Dormagen, P. Lewy, S. Cattan, O. Nallet, G. Grollier, J. Shayne, J. E. Wolf, Y. Cottin, J. Machecourt, H. Bouvaist, G. Finet, B. De Breyne, J. N. Trochu, M. Baudouy, E. Ferrari, M. Benhamou, J. Allal, D. Coisne, H. Le Breton, M. Bedossa, J. Puel, M. Elbaz, L. Larifla, S. Matheron, R. Landman, G. Fremont, G. Spiridon, P. Blanche, J. P. Morini, D. Sicard, V. Zeller, D. Batisse, P. Clevenbergh, G. Cessot, E. Dohin, M. A. Valantin, S. Khelifa, P. M. Girard, F. Lallemand, B. Lefebvre, J. P. Laporte, J. L. Meynard, H. Bideault, O. Picard, M. C. Meyohas, P. Campa, J. Tredup, L. Fonquernie, G. Raguin, J. M. Molina, A. Furco, S. Gharakanian, J. P. Vincensini, J. B. Guiard‐Schmid, G. Pialoux, B. Cardon, A. S. Lascaux, F. Chaix, P. Lesprit, R. Fior, F. Boue, C. Dupont, C. Bellier, A. Blanc, T. Lambert, T. Touahri, G. Force, P. de Truchis, M. A. Compagnucci‐Seguenot, I. Cahitte, L. Roudière, M. E. Techer, P. Thelpin, D. Troisvallets, A. Lepretre, M. Echard, Y. Le Mercier, D. Houlbert, S. Dargere, C. Bazin, R. Verdon, B. De Goer, M. Duong, P. Chavanet, E. Gozlan, P. Leclercq, F. Brunel‐Dal Mas, J. Durant, P. Heudier, C. Brunet‐François, G. Le Moal, J. M. Chapplin, C. Arvieux, G. Chaumentin, B. Guerin, E. Bonnet, Y. Poinsignon, F. Boulard, I. De Lacroix, M. T. Goerger‐Sow, M. Kirstetter, M. Volstein, F. Laylavoix, X. Copin, C. Ceppi, Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, CIC Paris Est, Service de pharmacologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre d'investigation clinique Paris Est (CIC Paris-Est), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Service de Pharmacologie médicale [CHU Pitié-Salpêtrière]

Subjects
Male, Heart disease, [SDV]Life Sciences [q-bio], Human immunodeficiency virus (HIV), Aftercare, heart failure, HIV Infections, heart disease, 030204 cardiovascular system & hematology, medicine.disease_cause, Coronary artery disease, 0302 clinical medicine, prevention, Recurrence, Risk Factors, Cardiovascular Disease, Secondary Prevention, Medicine, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Original Research, Middle Aged, Prognosis, 3. Good health, Editorial, myocardial infarction, Anti-Retroviral Agents, Cardiovascular Diseases, Cardiology, Female, France, Cardiology and Cardiovascular Medicine, coronary artery disease, Adult, Acute coronary syndrome, medicine.medical_specialty, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, Humans, Acute Coronary Syndrome, business.industry, dyslipidemia, Coronary Care Units, Editorials, HIV, medicine.disease, HIV infection, Cerebrovascular Disorders, Heart Disease Risk Factors, Case-Control Studies, ST Elevation Myocardial Infarction, business, Dyslipidemia
Abstract

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.

Published
2020
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2. [Cure of superacute eosinophilic myocarditis treated by temporary circulatory assistance]

Author

J N, Trochu, O, Baron, M, Burban, C, Sagan, J C, Chevallier, A, Tirouvanziam, M, Treilhaud, J F, Godin, D, Duveau, and J B, Bouhour

Subjects
Adult, Myocarditis, Ventricular Dysfunction, Left, Treatment Outcome, Echocardiography, Biopsy, Myocardium, Shock, Cardiogenic, Humans, Female, Steroids, Assisted Circulation
Abstract

The authors report the case of a 31 year old woman, admitted as an emergency for acute myopericarditis, in cardiogenic shock. Echocardiography showed severe left ventricular dysfunction associated with concentric biventricular hypertrophy with increased echogenicity of the myocardial walls. Poor response to treatment with intravenous inotropic drugs led to referral for biventricular circulatory assistance with a Biomedicus pump, which was withdrawn on the 9th day after recovery of normal left ventricular function. Myocardial biopsies showed massive interstitial inflammation with a predominance of eosinophilic cells suggesting a hypersensitivity reaction. Steroid therapy was prescribed when the results of biopsy were known and stopped after 6 months. This case emphasises the value of echocardiography and myocardial biopsy in diagnosis and treatment of acute myocarditis with cardiogenic shock.

Published
2002

3. [Recurrent syncope and Chiari malformation]

Author

B, Guillon, J N, Trochu, S, Olindo, H, Desal, S, Martin, D, Ménégalli, and J R, Fève

Subjects
Male, Recurrence, Humans, Female, Budd-Chiari Syndrome, Middle Aged, Syncope
Abstract

Downward herniation of the cerebellar tonsils through the foramen magnum (Chiari I malformation) is usually revealed by head and neck pain, often associated with brain-stem or spinal cord disturbances. Syncopes are rarely reported and may be difficult to link to their cause when they occur alone. We report two cases with brief and repetitive syncopes revealing a Chiari I malformation. These manifestations may be attributed to transient compression of brain stem or vascular structures at the craniocervical junction, triggered by intracranial pressure increase, as they disappear after posterior fossa decompression.

Published
2001

4. [Late cerebrovascular complications of cardiac transplantation]

Author

B, Guillon, S, Wiertlewski, J N, Trochu, H, Desal, M, Treilhaud, J L, Michaud, J B, Bouhour, and J R, Fève

Subjects
Male, Stroke, Brain, Heart Transplantation, Humans, Female, Middle Aged, Tomography, X-Ray Computed, Magnetic Resonance Imaging, Medical Records, Aged, Retrospective Studies
Abstract

The occurrence of stroke after the post-operative period of cardiac transplantation is a rare event, and the role of the cardiac transplant in these patients, who often have various vascular risk factors, is unclear. We reviewed the clinical records of 303 consecutive patients with orthotopic cardiac transplantation performed from March 1985 to December 1996 and selected those who developed a stroke over the first 2 months postoperatively, in order to evaluate the frequency and the mechanisms of late cerebrovascular complications. Four patients had presented cerebral infarct and two intracranial hemorrhage. The overall risk of late cerebrovascular complications was 2.6p.100 at 5 years. Ischemic stroke was related to cardiac embolus in one patient, lacunar infarction in another, and was of undetermined etiology in two cases. In addition to vascular risk factors prior to transplantation and the development of intracardiac thrombus, immunosuppressive therapy, the surgical procedure and cardiac rejection may play a role in the occurrence of stroke in such patients.

Published
2000

5. [Detection of residual myocardial ischemia by Thallium-201 myocardial scintigraphy after myocardial infarction. Apropos of 53 patients treated with thrombolytic agents during the acute phase and with coronary transluminal angioplasty]

Author

J, Hélias, J R, Hazard, R, Grossetête, J C, Chevallier, D, Crochet, J N, Trochu, and J F, Godin

Subjects
Adult, Male, Myocardial Infarction, Myocardial Ischemia, Middle Aged, Coronary Angiography, Thallium Radioisotopes, Exercise Test, Humans, Female, Thrombolytic Therapy, Prospective Studies, Angioplasty, Balloon, Coronary, Radionuclide Imaging
Abstract

The prognosis of silent ischemia after myocardial infarction is similar to that of post-infarction angina. In order to detect this condition two stress myocardial scintigraphies were performed: three weeks after hospital admission for myocardial infarction treated by thrombolytic therapy without any complications or recurrence of chest pain; one month later, after percutaneous transluminal coronary angioplasty on the infarct-related artery in 24 patients or after medical therapy alone when this procedure was not possible (29 patients). Silent ischemia, initially present in two thirds of patients, was less frequently observed in the patients undergoing angioplasty (p0.05). In the remaining one third of patients with no silent ischemia, myocardial scintigraphy was unchanged at the follow-up procedure whether or not angioplasty had been performed. These results show that silent ischemia is commonly observed during stress myocardial scintigraphy after acute myocardial infarction treated by thrombolysis, but that this condition can be significantly reduced by coronary angioplasty. When no silent ischemia is observed, coronary angiography and angioplasty do not seem to be indicated.

Published
1993

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