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Background Radiofrequency ablation (RFA) is the only curative treatment for typical atrial flutter (AFL) and allows stopping antiarrhythmic drugs. However, atrial fibrillation (AF) is frequent during follow-up but predictive factors of AF onset are unknown while it is necessary to diagnose it in order to apply the correct antithrombotic strategy. Aims To determine prevalence and predictors of AF after AFL RFAAFL. Methods From January 2012 to December 2013, patients who underwent RFA of cavotricuspid isthmus for typical atrial flutter in our centre were retrospectively included. Results Of 166 patients (137 men, mean age: 66.7±10 years), 61 (36.7%) had a history of AF. The mean CHA2DS2VASc and HASBLED scores were 2.49 and 1.11. Mean left ventricular ejection fraction was 53±13% and 77 (46.4%) patients had a subsequent cardiomyopathy, whereas 61 (36.7%) had a history of AF. Of 166 RFA, sinus rhythm was obtain in 160 patients and 141 (84.9%) procedures were considered as a complete success (complete isthmus block). During a mean follow up of 489±244 days, there were 7 (5%) and 9 (36%) AFL recurrence in patients with and without isthmus block respectively. New-onset or recurrent AF were experienced by 63 (39%) patients. History of AF was an independent predictive factor of AF (33 (52.4%) vs. 28 (27.2%) patients; p=0.002). The younger patients (64.4 ±11.7 vs. 68.2±9.9 years; p=0.03) and patients with lower CHA2DS2VASc score had more AF post ablation (2.16±1.53 vs. 2.70±1.57; p=0.03). Conclusion After successful RF ablation, AF was frequent in patients especially in patient with AF history before AFL RFA, but also occurred in patient with lone AFL. Age and CHA2DS2VASc score were inversely associated with onset of AF. Identify AF and risk patients is crucial regarding to long-term antithrombotic therapy. Abstract 0362 – Table: predictive factors of AF No FA post ablation(N=103) FA post ablation (N=63) p Men/Women (N/N) 89/14 48/15 0.09 Age (years) 68.2+/–9.9 64.4+/–11.7 0.03* SAS 10 (9.7) 4 (6.3) 0.57 Cardiopathy 53 (51.5) 24 (38.1) 0.11 History of AF (N [%]) 28 (27.2) 33 (52.4) 0.002* Dilated LA (N [%]) 43 (41.7) 32 (50.8) 0.4 Dilated LV (N [%]) 12 (11.7) 12 (19) 0.41 LVEF <45% (N [%]) 29 (28.2) 10 (15.9) 0.09 High blood pressure (N [%]) 63 (61.2) 31 (49.2) 0.14 Age ≥75 years 29 (28.2) 15 (23.8) 0.59 Diabetes mellitus 18 (17.5) 9 (14.3) 0.66 CHA 2 DS 2 VASc 2.7+/–1.57 2.16+/–1.53 0.03* BMI (kg/m 2 ) 27.4+/–5.5 27.9+/–4.9 0.55 Creatinine clearance (Cockroft) 78.1+/–30.8 85.3+/–37.4 0.19 Creatinine clearance (MDRD) 72.8+/–22.4 73.9+/–23.7 0.76 SAS: sleep apnoea syndrome; AF: atrial fibrillation; LA: left atrial; LV: left ventricular LVEF: left ventricular ejection fraction; BMI: body mass index [ABSTRACT FROM AUTHOR]

Background Radiofrequency ablation (RFA) is the only curative treatment for typical atrial flutter (AFL) and allows stopping antiarrhythmic drugs. However, management of long-term anticoagulant therapy (LT ACT) remains unclear, especially in lone AFL successfully treated and CHA 2 DS 2 VASc score ≥1. Abstract 0163 – Table: Table Long-term anticoagulation therapy management A GROUP (N=74) B GROUP (N=63) C GROUP (N=17) AF YES (N [%]) NO (N [%]) YES (N[%]) NO (N [%]) YES (N [%]) NO (N [%]) TAC YES (N [%]) 14 (18.9) 11 (14.9) 29 (46) 20 (31.7) 4 (23.5) 0 (0) NO (N [%]) 2 (2.7) 43 (58.1) 3 (4.8) 7 (11.1) 6 (35.3) 5 (29.4) LTFUP (N [%]) 4 (5.4) 4 (6.4) 2 (11.8) AF: Atrial fibrillation ACT: anticoagulant therapy LTFUP: lost to follow up patient Aims Assessment of long-term ACT after AFL RFA according to associated atrial fibrillation (AF) and CHA 2 DS 2 VASc score. Methods From January 2012 to December 2013, patients who underwent RFA of cavotricuspid isthmus for typical atrial flutter in our centre were retrospectively included. Results Of 166 patients (137 men, mean age: 66.7±10years), 61 (36.7%) had a history of AF. The mean CHA 2 DS 2 VASc score was 2.49. The patients were classified according to theoretical indication of LT ACT (patients with a non rhythmic ACT indication excluded – N=12; 7.2%): group A (LT ACT unclear) included patients with CHA 2 DS 2 VASc score ≥1, successful RF ablation and without AF history (N=74); group B (LT ACT indicated) included patients with CHA 2 DS 2 VASc score ≥1, AF history and/or failed AFL RFA (N=63); group C (LT ACT not indicated)included patient with CHA 2 DS 2 VASc score=0 (N=17). During a mean follow up of 489±244 days, 45 (60.8), 10 (15.9%) and 11(64.7) patients stopped ACT respectively in group A, B and C differently according to AF onset (table). There were 8 (4.8%) hemorrhagic and 2 (1.2%) ischemic complications, all in patients with correct ACT management. The prevalence of AF during follow-up was 38%. Conclusion After successful AFL RF ablation, ACT was frequently stopped in the absence of associated AF. However, AF was frequent even inpatients with no AF history. Ischemic and hemorrhagic complications were rare. ACT should be regularly evaluated during follow-up especially according to CHA 2 DS 2 VASc score and new onset of AF. [ABSTRACT FROM AUTHOR]

Background Glycemic variabilities have a negative impact on the morbidity and mortality of acute coronary syndromes (ACS). A strict glucose monitoring is recommended on admission in Coronary Care Unit (CCU). The aims of our study were to assess the prevalence of various glucose disorders (diabete mellitus, impared fasting hyperglycemia, glucose intolerance, stress hyperglycemia) among patients hospitalized for ACS, and to assess the efficency and security of an IV insulin protocol adapted on glycemic kinetic, to decrease the risk of hypoglycemia, and for which the goal was to stabilized glycemia between 1.10 and 1,40g/l. Population and Method This retrospective monocenter study concerns all patients admitted for ACS (STEMI and NSTEMI) in Troyes hospital from May 2012 to May 2013. The different glycemic parameters, capillarious and veinous were collect through analysis of medical reports. Results 164 patients were included. The mean age was 65 ± 13 years. Among them, 97 (59%) had diabete mellitus, and 8 (5%) had an intermediate disorder. Stress hyperglycemia was observed in 10 patients (11%) free from glucose abnormalities. Among the patients without hystory of diabete mellitus and with hyperglycemia on admission, 53% were authentic diabetics. The IV insulin protocol was initiated in 36 patients with a average baseline blood glucose 2.7 ± 0,7g/l. thirty-two were diabetics (31 type 2 and 1 and type 1) and diabete mellitus has been found on the occasion of the SCA in 4 of them with HbA1c >6.5%. The average time to reach a glycemia within the target range was 12.7 ± 11h. Only 3 patients (8%) had moderate hypoglycemia (<0.70g / l) and there were no severe hypoglycemia. Conclusion In this study, 59% of patients are diabetics, know or revealed at the opportunity of SCA, higher than the usual literature data. Hyperglycemia at admission reveals glucose disorder in 53% of cases. Our IV insulin protocol is safe and efficient. [ABSTRACT FROM AUTHOR]

Background Considering morbidity and financial impact on the health care system, it may be helpful to stratify patients who would most benefit from primary ICD treatment. The aim of this study was to assess the prevalence and identify the clinical predictors of appropriate ICD therapy in patients following implantation of an ICD in primary prevention for chronic heart failure. Methods A monocenter retrospective analysis was performed and all patients undergoing implantation of ICD in primary prevention were included. Device interrogations were performed and appropriate therapies, either ATP or shock, were noticed. Results Over the 317 primary prevention patients undergoing ICD implantation, 203 had ischemic cardiomyopathy (ICM) and 114 had nonischemic dilated cardiomyopathy (NIDCM). At the median follow-up time 760±599 days, 56 (17,7%) had received appropriate ICD therapies. Average Figure: Predictors of appropriate ICD therapy LVEF was 26±6%. By univariate comparison, LVDD≥65mm (p=0,035) and lack of diuretic (p=0,024) were significant predictors for ICD therapy. ICM and NIDCM patients benefit equivalently from ICD implantation (p=0,941). By multivariate analysis, elderly patients ≥65y (HR 1,92, p=0,032), LVDD≥65mm (HR 2,01, p=0,022) and lack of diuretic (HR 0,31, p<0,001) were all significant independent predictors for ICD therapy. Absence of CRT device was closed to be significant (HR 0,53, p=0,062), but was significant in NIDCM population (p=0,007). Onset atrial fibrillation (p=0,027) and hospitalization for acute heart failure (p=0,002) were significantly associated with ICD-delivered therapy. Conclusions ICD therapy occurred in 17,7% of primary prevention patients with both ICM and NIDCM. In multivariate analysis, age ≥65y, LVDD≥65mm and absence of diuretic were predictive factors for ICD therapy. Presence of CRT device was closed to be significant. There was no difference by considering heart failure etiology, ICM and NIDCM patients benefited from ICD equivalently. [ABSTRACT FROM AUTHOR]

Background Technological progress has made it possible to reduce the dose of radiation delivered by medical X-ray systems. In parallel, interventional coronary procedures have become increasingly complex and consequently, last longer. Purpose This study aimed to compared to the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs. 2016). Methods The study population included all patients undergoing interventional coronary procedures in one of the catheterization laboratories (cathlabs) of our institution during two periods, namely period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary endpoint was the estimated dose of radiation received by the patient as assessed by dose area product (DAP). Results In 2016, the estimated dose of radiation received by patients undergoing interventional coronary procedures was on average 77.7% lower than that received in 2006 ( P < 0.0001), whereas the fluoroscopy time increased by 54% on average over the same period ( P < 0.0001). By multivariate analysis including age, approach, body mass index, fluoroscopy time and performance of angioplasty, the reduction in radiation remained significant. The radial approach was significantly associated with an increased estimated dose of radiation received ( P < 0.0001) ( Table 1 , Fig. 1 ). Conclusion In our centre, the estimated dose of radiation received by patients undergoing interventional cardiology procedures has been reduced by 77.7% over the last decade. [ABSTRACT FROM AUTHOR]

Background Medical procedures remain the primary source of exposure to ionizing radiation in the general population. Purpose We aimed to measure the reduction in the estimated dose of radiation received by patients that can be achieved using dose-reduction technology (ClarityIQ, Philips Healthcare, The Netherlands), among all patients undergoing interventional cardiology procedures. Methods The study population comprised all patients (without exclusion criteria) undergoing interventional coronary procedures over a 1-year study period in a large referral centre equipped with two catheterization laboratories (cathlabs). Both cathlabs (A and B) were equipped with the Allura Xper FD10 imaging system (Philips Healthcare, The Netherlands), but only cathlab B was equipped with ClarityIQ technology. The primary endpoint was the estimated total dose of radiation received by the patient, as assessed by air kerma (AK) and dose area product (DAP). Results In total, 2095 interventional coronary procedures were analysed. The patients who underwent procedures in Cathlab B received an average estimated dose that was 23% (AK) and 43% (DAP) lower than the dose received by patients undergoing procedures in Cathlab A ( P < 0.0001). The reduction remained significant by multivariate analysis after adjustment for total X-ray time, body mass index, arterial approach, angioplasty of at least one lesion, sex and patient age ( Table 1 ). Conclusion In our study, the Clarity IQ technology reduced the estimated radiation dose received by patients by 23% to 43%, according to the method of measurement. [ABSTRACT FROM AUTHOR]

Introduction Characteristics of patients with atrial fibrillation (AF) are well known, however the patients included in published studies are usually younger than patients encountered in daily practice in hospital. Method We performed a prospective observational study which aimed to describe all patients over 75 years hospitalized in a cardiology department. For each patient we collected cause of hospitalisation, medical and cardiovascular history. We compared patients with and without previous history of AF ("AF group" versus "sinus group"). Results Among 1050 patients admitted during an inclusion period of 4 months, 357 patients were older than 75 years: 150 in the "AF group" and 207 in the "sinus group". AF was paroxysmal, persistent and permanent respectively in 21%, 30%, and 48% of cases. [ABSTRACT FROM AUTHOR]

Introduction Pulmonary hypertension (PH) is frequent among elderly patients. The most common causes of PH in this population are severe valve diseases and heart failure with decreased left ventricular ejection fraction (LVEF). PH in older patients without valve disease and with preserved LVEF is less known: the aim of our study was to determine the characteristics of older patients with PH despite preserved LVEF and normal valves. Methods We included prospectively patients over 70 year of age, with PH suspected during echocardiography and confirmed by pressure measurements during right heart catheterization. The exclusion criteria were significant valve disease and LVEF under 50%. Results Between November 2010 and November 2011, we included 26 consecutive patients (17 women), 78±5 years old with systolic pulmonary arterial pressure of 68±15 mm Hg. Nineteen patients (73%) had been hospitalized for heart failure previously and 59% were in NYHA III-IV functional class. The six-minute walk distance was 226±132 m, the mean NT-proBNP level 1462 pg/ml. Fourteen patients (54%) had atrial fibrillation. Nine patients (35%) had a pre-capillary PH, 6 (23%) a post-capillary PH, and 11 (42%) a reactive post-capillary PH. By using transthoracic echocardiography, the right ventricular diameter was 32±5 mm and the right atrial area 29±11 cm2. The right ventricular systolic function was impaired, with a tricuspid annular plane systolic excursion of 17±4 mm, a peak tricuspid annular S wave of 10±6 cm/s and a peak systolic strain of the right ventricular free wall of −16±6%. Factors associated to more severe symptoms were right atrial and ventricular dilatation and higher levels of PH. Conclusion Reactive post-capillary PH is predominant in elderly patients with preserved left ventricular function and no valve disease. However, more than a third of these patients have pre-capillary PH, which needs a right heart catheterization to be assessed, and could benefit from specific treatments. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for the occurrence of adverse drug reactions (ADRs) based on geriatric evaluation.Design: Longitudinal prospective study from May 2010 to November 2011.Setting: Dedicated acute geriatric care unit specializing in the management of patients with dementia syndrome (Alzheimer disease or related syndromes) at the University Hospital of Reims, France.Participants: Older patients with dementia syndrome (Alzheimer disease or related syndromes).Measurements: Sociodemographic variables and comprehensive geriatric assessment were recorded. Occurrence of ADRs was noted. Risk factors for ADR were identified by multivariate logistic regression.Results: During the study period, 293 patients were included; average age was 82 ± 8 years; the majority were women (61.4%). Average Mini-Mental State Examination score was 13 ± 8; average activities of daily living (ADL) score was 3.6 ± 2.1. Independent risk factors for occurrence of at least one ADR were polypharmacy (≥5 drugs/day) (OR: 4.0, 95% CI: 1.1-14.1) and dependence on at least 1 ADL (OR: 2.6, 95% CI: 1.1-6.5).Conclusions: Risk factors for ADRs were polypharmacy and dependence on at least one ADL. Our findings underline the importance of taking into consideration the characteristics of the patients when prescribing drugs in this specific population. Prescriptions should be re-evaluated at each follow-up. [ABSTRACT FROM AUTHOR]

Background Assessment of left ventricular filling pressures (LVFP) is a key part of echocardiographic evaluation but actual validated parameters aren’t relevant in some routine cases. Use of diastolic strain rates (DSr) may improve the diagnostic of elevated LVFP in specific cardiomyopathies. Our primary objective was to evaluate the diagnostic performance for elevated LVFP of different DSr indexes in a heterogenous cardiological population. Material and Methods We led a prospective mono-centric two-dimensional speckle tracking echocardiography study compared to invasive hemo-dynamic (left catheterization with measurement of pre-atrial pressure (preA)). Elevation of LVFP was defined as preA>15mmHg. Global DSr indexes tested were: isovolumetric relaxation DSr (IvrDSr), early DSr (EarlyDSr) and late DSr (LateDSr). Additional DSr indexes were calculated by meaning of these parameters: EarlyLateDSr and IvrEarlyLateDSr. DSr values were multiplied by 10 factor and ratios of E wave to the obtained result gave different composite E/10DSr indexes. Results Fifty height patients were included. Patients with preA>15mmHg (n=23) were compared with patients with preA<15mmHg (n=35). Mean left ventricular ejection fraction (LVEF) was 55,7±13,3%, mean preA was 13,6±6,2mmHg. 52% of patients had coronaropathy, 43% had regional dysfunction and 31% had significant valvulopathy. Correlations to LVFP were: E/10IvrEarlyLateDSr (R=0,50), E/10LateDSr (R=0,46), E/10EarlyLateDSr (R=0,42). Optimal cut off values were 11,5 for E/10LateDSr (sensitivity (Se) 64%, specificity (Spe) 91%, positive predictive value (PPV) 82% and negative predictive value (NPV) 80%), 9,5 for E/10EarlyLateDSr (Se 68%, Spe 83%, PPV 71%, NPV 81%) and 15 for E/10IvrEarlyLateDSr (Se 75%, Spe 85%, PPV 79%, NVP 82%). Conclusion E/10DSr composite indexes, especially E/10LateDSr and E/ 10IvrEarlyLateDSr are relevant LVFP indexes, which may be applied to a large spectrum of cardiomyopathies. Abstract 0056 - Figure: Used DSr [ABSTRACT FROM AUTHOR]

Introduction Prognosis of coronary heart disease depends on correction of cardiovascular risk factors and long-term maintenance. Little data exist on the relationship between the patient’s profile and durable adhesion to the new learned behaviors in cardiac rehabilitation. The aim of our study was to investigate predictors of maintaining the cardiac rehabilitation program benefits at one year. Methods From November 2012 to December 2013, 127 patients undergoing cardiac rehabilitation after a coronary event were included. One year after the end of the program, four main goals (smoking cessation, body mass index <25, regular physical activity and professional recovery) were collected. We analyzed their relationship with clinical and socio-demographic data. Results Smoking cessation was significantly associated with regular physical activity.Body mass index <25 was significantly associated with absence of diabetes (p=0.016) and dyslipidemia (p=0.005).Regular physical activity was significantly associated with BMI lower (28,8 vs27, p=0.046).Professional recovery was significantly associated with Left Ventricular Ejection Fraction >55% (p=0.037), dyspnea NHYA 1 (p=0.015) and better functional abilities at the end of rehabilitation cycle (8.1 mets vs 6.4 mets, p<0,001) and one year later (7,4 mets vs 5,1 mets p=0.001). Conclusion LVEF preserved, low degree of dyspnea, functional abilities >6 METs appear as positive prognostic factors for professional recovery.Our study highlights the constant interaction between correction of cardiovascular risk factors and adaptation of lifestyle (physical activity, diet). Patients with many cardiovascular risk factors fail in achieving or maintaining the goals acquired during cardiac rehabilitation program, since several simultaneous changes in behavior are recquired. Because of the chronic and multifactorial nature of coronary artery disease, new personnalized monitoring strategies should be thoughtful, to ensure personalized care. [ABSTRACT FROM AUTHOR]

Introduction Exercise training is a fundamental part of heart failure with reduced ejection fraction (HF-REF) treatment. It reduces mortality and hospitalizations and improves functional capacities. The aim of this study was to find predictive factors of improvement of physical ability in HF-REF patients after completion of an exercise training program. Methods Functional, clinical, biological and echocardiographic data, were retrospectively analysed in 50 HF-REF patients who underwent an exercise training program in our center in 2013. The improvement of physical abilities was defined by an increase of 1 or more metabolic equivalent (MET) between the first and the final exercise testing. Results Patients were 58.3±12.1 years old with a mean ejection fraction of 34±10% and an average of 18.7 sessions over a 4 month period was performed. Mean pre and post training MET were respectively 4.9±1.6 and 6.1±2.3 (p<0.001). At the end of the training period, 22 patients displayed an improved exercise testing. Exercise testing improvement was associated with the absence of arterial hypertension (57% versus 27% p=0.04), and a tendency was seen with lower furosemide daily intake (25.7mg versus 84.3mg p=0.05), and lower Heart Failure Risk of Death at 1 year calculation (7.02% versus 10.22% p=0.05). Pre-training exercise capacity was not associated with post-training improvement (4.6±1.5 MET versus 5.2±1.8 MET p=0.17). Conclusion HF-REF patients without previous arterial hypertension had more chance to improve physical capacities after exercise training program. [ABSTRACT FROM AUTHOR]

Implantable cardioverter defibrillator (ICD) has been shown to be associated with a significant reduction in the risk of sudden cardiac death. The aim of this study was to assess the prevalence and to identify the clinical predictors of appropriate ICD therapy in patients with chronic heart failure following implantation of an ICD for primary prevention. A monocenter retrospective analysis was performed and all consecutive patients undergoing implantation of ICD for primary prevention were included. Device interrogations were performed and appropriate therapies were recorded. The endpoint follow-up was the last available device interrogation in our center. Of 317 primary prevention patients undergoing ICD implantation, 203 (64%) had ischemic cardiomyopathy (ICM) and 114 had non-ischemic dilated cardiomyopathy (NIDCM). After a mean follow-up time 760±599 days, 56 (17.7%) had received appropriate ICD therapies. Mean LVEF was 26±6%. By univariate comparison, LVDD≥65mm (p=0.035) and lack of diuretic (p=0.024) were predictors for ICD therapy. Absence of cardiac resynchronization therapy device (CRTD) was close to be significant (p=0.055). ICM and NIDCM patients benefit from ICD implantation did not differ (p=0.941). By multivariate analysis, elderly patients ≥65y (HR 1.92, p=0.032), LVDD≥65mm (HR 2.01, p=0.022) and lack of diuretic (HR 0.31, p<0.001) were all significant independent predictors for ICD therapy. Overall, the absence of CRTD device was close to be significant (H 0.53, p=0.062), but was significant in NIDCM population (p=0.007). During follow-up, the onset of atrial fibrillation (p=0.027) and hospitalization for acute heart failure (p=0.002) were significantly associated with ICD-delivered therapy. ICD therapy occurred in 17.7% of primary prevention patients without any difference between ICM and NIDCM. Older age, LV dilatation and absence of diuretic were predictive factors for ICD therapy. Presence of CRTD was close to be significant (figure next page). Abstract 0470 – Figure [ABSTRACT FROM AUTHOR]

Introduction Les patients insuffisants rénaux chroniques ont un risque élevé de mortalité cardiovasculaire. La physiopathologie et l’évaluation de ce risque chez les patients transplantés rénaux est difficile. Les antagonistes du récepteur minéralocorticoïde ont montré un bénéfice de morbi-mortalité, sont de plus en plus utilisés au cours de l’insuffisance rénale terminale mais sont contre-indiqués au cours de l’insuffisance rénale et en association aux traitements immunosuppresseurs. Nous avons testé la tolérance de l’éplérénone dans une population de 31 patients ayant eu une transplantation rénale traités par ciclosporine ayant une fonction rénale altérée. Patients et méthodes Une étude prospective monocentrique et ouverte a été réalisée selon un plan de Simon en deux étapes. Le critère principal de jugement a été la tolérance de l’éplérénone attestée par l’absence de survenue de ses évènements indésirables : hyperkaliémie, acidose métabolique, hypotension artérielle, insuffisance rénale aiguë ou n’importe quel événement nécessitant l’arrêt du traitement. Tous les patients ont reçu la dose de 25 mg/j pendant 8 semaines. Résultats Parmi les 31 patients inclus, 9 ont présenté au moins un épisode d’hyperkaliémie et un a nécessité l’utilisation d’une résine échangeuse de potassium. Aucune hyperkaliémie sévère n’est survenue. Seul un épisode d’insuffisance rénale aiguë est survenu. La kaliémie et la bicarbonatémie à l’initiation du traitement étaient indépendamment associées au risque de présenter une hyperkaliémie sous traitement (OR 6,5, p = 0,003 et 0,7, p = 0,007, respectivement). Au-dessus d’une kaliémie de 4,35 mmol/L à l’initiation du traitement, le risque peut être prédit avec une bonne sensibilité et spécificité. Discussion Malgré le faible effectif (calculé a priori), il est possible de conclure à bonne tolérance du traitement dans la population cible. Conclusion Lorsque la fonction rénale est altérée et si la kaliémie à l’initiation est supérieure à 4,35 mmol/L, le traitement peut être utilisé en insistant sur le régime pauvre en potassium et la surveillance. [ABSTRACT FROM AUTHOR]

Background Approximately 1% of the adult population have heart failure with reduced ejection fraction. Since the 1980s, therapeutic advances in this field have been significant, particularly through the development of cardiac resynchronization therapy (CRT). However, transvenous implantation of the left ventricular (LV) lead is unsuccessful in 5 - 15% of patients. For this group, surgical placement of LV lead is an alternative. Objective Compare the effects of transvenous versus surgical implantation of the LV lead in CRT. Methods We included 100 consecutive patients who had received CRT in our centre between January 2008 and July 2012 in a retrospective observational study. Twelve patients who had failed transvenous implantation of LV lead had a surgical placement. Results Population characteristics were a mean age of 66±11 years, 16% female, New York Heart Association class 2.9±0.5, 45% ischemic cardiomyopathy, left ventricular ejection fraction (LVEF) 24±7%, QRS width 165±23ms. There were no major difference in preoperative variables between two groups except sex category (12.5% female in transvenous group versus 42% in surgical group, p=0.022). During a mean follow-up of 508±429 days, the improvements seen in all variables showed no difference between the groups. At six months, 77% of patients had improved at least one class of their dyspnea stage, LVEF improved significantly (24±7% versus 36±10% at six months). Conclusions Surgical placement of LV lead offers similar benefits as compared with transvenous implantation. [ABSTRACT FROM AUTHOR]

Introduction Invasive hemodynamic procedures are still necessary to appreciate pulmonary hypertension characteristics. A few studies have adressed the issue of echocardiographic evaluation, but lack an external validation of their results with various settings and patients. The aim of our study was to appreciate the value of 2 published echocardiographic evaluations of pulmonary vascular resistances (PVR) based on tricuspid regurgitation maximal velocity (TRV) and right ventricular outflow tract systolic time velocity integral (TVI). Methods All of the patients presenting during 2013 for invasive haemo-dynamic evaluation with a suspected pulmonary hypertension were prospec-tively included, with echocardiography being done within 24 hours of catheterization. The TRV/TVI and TRV 2 /TVI ratio and echographic estimations of PVR were compared with catheter values; predictive values to detect elevated PVR were assessed. Results 43 patients were included, 12 with atrial fibrillation, 16 with valvular disease, 14 with hypertrophic cardiopathy. Mean pulmonary pressure was 41±11 mmHg. TRV/TVI and TRV 2 /TVI were correlated with PVR (r=0.71 and r=0.78 respectively, p<0.01). Using TRV 2 /TVI, a cutpoint value of 0.98 had a specificity of 86% and a sensitiviy of 80% to predict PVR over 6 UW. Estimation of PVR with the previously published formula PVR = 5,19 TRV 2 /TVI - 0.4 was 100% correct to predict an PVR under 3 UW and 93% correct to predict an PVR over 6 UW. Conclusion Our results confirm the value of echocardiographic measurement of TRV 2 /TVI to evaluate PVR in a routine fashion for a non-selected population with high pulmonary pressure (figure next page). Abstract 0470 – Figure: Bland and Altmann plot [ABSTRACT FROM AUTHOR]

Introduction The prognosis of STEMI is associated with the delay between the symptoms onset and the reperfusion. Recent recommandations regarding patient care differ widely according to the estimation of this delay, which should depend of the distance between first medical contact and PCI capable center. Our study aimed to appreciate the timing of prehospital and hospital management of STEMI in our settings. Methods We included prospectively between october 2013 and february 2014 incoming patients with acute STEMI and recorded the timings of the onset of symptoms, first medical contact, therapeutic decision, (thrombolysis or primary PCI), arrival in PCI-capable center and revascularization. Distance between first medical contact and the PCI unit was classified as none (emergency room), zone 1 (same town), zone 2 (under 30 km), zone 3 (30 to 100 km) and zone 4 (over 100 km). Results Forty-seven patients were included, 82% men, average age 61±12.2 years. Delay from symptoms onset and first medical contact was 120±123 min (range: 2-585), less than 2 hours for 75% of the patients, and was 2 h longer when patients came by themselves to the emergency department. Delay between medical contact and decision averaged 33 min (1 to 110 min), thrombolysis was performed in 16 patients, 6 of which less than 30 min after contact. The average door-to-balloon delay was 162±12 min. The transfer delay was 127±74 min and was associated with the distance between the first contact location and the PCI center. The difference between the effective delay, and the theoretical travel time ranged from 50 min in zone 1 to 150 min in zone 4, increasing with the distance, mostly because of waiting for transportation in the emergency room. Conclusion The delay between first medical contact and effective arrival in our PCI capable center was always much longer than could be expected from the distance, thus displaying that the recent European recommendations have yet to be explained and enforced. [ABSTRACT FROM AUTHOR]

Background Abdominal aortic aneurysm (AAA) is associated with peripheral and coronary artery disease (CAD), however little is known about the prognosis of patients who experienced an acute coronary syndrome (ACS) and have an AAA. The aim of this study was to assess the prevalence of AAA in patients hospitalized for ACS and to evaluate it was associated with an increased cardio-vascular (CV) risk during follow up. Methods Between February 1, 2008 and March 30, 2009, patients admitted for ACS with significant (≥50% stenosis) coronary lesions underwent echography to check for presence of AAA. The AAA was defined as dilation of infrarenal aorta with maximum antero-posterior diameter ≥30 mm. During a 2 years follow-up we recorded all causes death, CV death and non-fatals CV events. The combination of CV death and CV non-fatals events was defined as the primary endpoint. Results Among 306 patients, 20 AAAs (6,6%) were diagnosed, of average (±sd) diameter 33±3.7 mm, with a maximum diameter of 45 mm, non requiring surgery. Follow-up at 2 years was available for 292 patients (95,7%). During follow-up, 77 patients (25,5%) experienced an event (all causes death or non-fatals CV event) : 23 deaths (7,6%), of wich 16 were from CV cause, and 55 non-fatals CV event (18,2%). No event was due to AAA. In univariate analysis age, abdominal aortic diameter, diabetes mellitus, previously known CAD and AAA were significantly associated with fatal and non-fatal CV event (p<0,05). In multivariate analysis, age (OR=1.03; 95%CI (1.008,1.058), diabetes mellitus (OR=1.7; 95%CI (1.05,2.7) and AAA (OR=3.2; 95%CI (1.24,8.44) were independantly associated with the risk of fatal or non-fatal CV event. Age (OR=1.18 95%CI (1.10,1.26) and AAA (OR=4.17 95%CI (1.17,14.9) were the only independant predictors of all causes death. Conclusion Our results show that in patients with CAD, the presence of small non surgical AAA is associated with worse CV prognosis and higher all causes mortality at 2 years. [ABSTRACT FROM AUTHOR]

Introduction Age is a major thrombo-embolic risk factor in atrial fibrillation (AF), but also a risk factor for bleeding under oral anticoagulation therapy (OAC). However, it appears that older patients are inadequately treated with OAC. The objective of our study was to evaluate the use of OAC in elderly patients hospitalised in a cardiology department according to current guidelines. Method Over a 4-month period, 142 patients over 75 years old with history of AF were included. Clinical and biological data were recorded, and risk scores for bleeding (HASBLED) and thrombo-embolic events (CHADS2 and CHA2DS2VASc) were independently assessed after discharge. The differences between bleeding and thrombo-embolic risk were calculated for each patient. Patients with OAC at discharge and patients without OAC were compared. Results Mean age was 83±13 years (75 men). Mean CHADS, CHADSVASc and HASBLED scores were respectively 2,6±0,1, 4,6±0,1 and 2,3±0,1. According to CHADSVASc score and guidelines all of the patients were eligible for OAC. However 47.8% of patients were not under OAC. Those patients were older (84.6±0.6 vs. 81.8±0.5; p=0.001), predominantly female (66 vs. 35%; p=0.001) with a higher serum creatinine (127.3±7.3 vs. 106±6.3; p=0.03) and HASBLED score (2.7 vs. 2.16; p=0.001). OAC use was not associated with CHADS and CHADSVASc scores values. [ABSTRACT FROM AUTHOR]

Introduction Studies have documented the underuse of oral anticoagulant therapy (OAC) as stroke prophylaxis in older persons with history of atrial fibrillation (AF). Failure to prescribe OAC is often due to the perception by physicians of bleeding because of specific older people clinical factors. We performed a prospective observational study in the University Hospital of Reims, whose aim was to evaluate the management of thromboembolic risk in older patients in everyday-life hospital practice and impact of frailty and dependence objective parameters. Method 150 AF patients over 75 years were consecutively included over a period of four months. Clinical and biological data, risk scores for bleeding (HASBLED) and thrombo-embolic events (CHADS and CHADSVASc) were computed. Several scores and parameters of assessment of autonomy and risk of falling were independently recorded: MMS (Mini-Mental Status), ADL (Activities of Daily Living) and IADL (Instrumental ADL). Results Mean age was 83±13 years (75 men). At discharge, 52.2% of patients were under OAC. Mean CHADS, CHADSVASc and HASBLED score were respectively 2,6±0,1, 4,6±0,1 and 2,3±0,1; all patients had a CHA DS VASc score ≥2 and 86% a CHADS ≥2. The HASBLED score was associated with non-prescription of anticoagulation (p=0.001), while none of the thrombo-embolic scores was significantly associated with prescription. Specific studied parameters are in table. [ABSTRACT FROM AUTHOR]

Introduction Pulmonary Hypertension (PH) is frequent among elderly patients and frequently due to severe valve diseases or heart failure with decreased left ventricular (LV) ejection fraction. The part of other causes is less known. The aim of this prospective study is to determine the aetiology of PH in older patients with preserved LV ejection fraction and no valve disease. Methods We included prospectively patients over 70 years of age with LV ejection fraction >50%, no valve disease. PH was suspected during echocardiography and confirmed by pressure mesurements during right heart catheterization. Each patient had complementary tests (blood tests, pulmonary function tests, ventilation perfusion lung scan, chest CT, abdominal ultrasound scan), conditioned by the haemodynamic characteristics of PH, in order to determine its cause. Results Between November 2010 and November 2011, we included 26 patients (17 women), 78+/-years old, with peak systolic pulmonary pressure of 68+/-15mmHg. Nine patients (35%) had a precapillary PH. Among them, PH was the consequence of thromboembolism (n=3), idiopathic (n=3), due to a connective tissue disease (n=1) and to a chronic lung disease (n=2). Six patients (23%), all with LV distolic dysfunction, had a post capillary PH. Two of them had previously undergone cardiac surgery for atrial septal defect and mitral valve remplacement. Eleven patients (42%) had a reactive post capillary PH. PH was idiopathic in 2 cases and drug induced for one patient. We found 2 connective tissue diseases, one thromboembolic disease, 2 chronic lung diseases. Four patients had a LV distolic dysfunction. One patient had two causes of PH. When LV diastolic dysfunction was the only cause of PH, it was always associated with persistent atrial fibrillation. Conclusion Reactive post capillary PH is predominant in elderly patients with preserved systolic LV function and no valve disease. The main cause of PH is diastolic dysfunction associated to atrial fibrillation. [ABSTRACT FROM AUTHOR]

Introduction: L’identification de nouveaux facteurs de risque de gravité de rétinopathie diabétique (RD) constitue un enjeu important, compte-tenu de la menace que celle-ci fait peser sur la fonction visuelle. La lipase endothéliale (LE) est une phospholipase qui joue un rôle important dans le métabolisme des HDL. Nous avons déjà montré que le polymorphisme Thr111Ile (rs 2000813) de la LE s’associait particulièrement à la RD sans préjuger de sa sévérité (Diabetes Metab 2011; 37(1):64-71). Patients et méthodes: Dans cette étude nous avons évalué rétrospectivement dans un groupe de 287 patients diabétiques de type 2 (DT2) (âge=59,7±10,3 ans, BMI=29,0±5,5kg/m2, HbA1C=8,4±1,9 %, durée du diabète=12,0±7,9 ans lors de la visite initiale) la sévérité de la RD en fonction du polymorphisme Thr11Ileu de la LE. Chaque dossier a été revu, les patients classés en fonction de leur génotype (CC, CT, TT) et du stade de gravité de la RD. Résultats: Les sujets homozygotes pour l’allèle rare (TT) présentaient en analyse univariée une association significative avec les formes avancées de RD (sévéres non proliférantes, proliférantes, panphotocoagulées) (OR 4,3 IC95 % [1,4; 13,1]) en comparaison des sujets porteurs de l’allèle fréquent (CC). Le génotype CT était sans effet particulier sur l’expression de la RD. Les facteurs prédictifs de RD étaient dans ce groupe : le génotype TT (p=0,03), la durée du diabète (p=0,01), l’HbA1c (p<0,01) et la créatininémie (p=0,01). En analyse multivariée les sujets TT présentaient un surcroit de risque de RD sévère non proliférante (OR 8,1, 95 % CI [1,23; 53,1]) et de RD proliférante (OR 6,2 95 % CI [1,5; 25,6]). Conclusion: Le polymorphisme Thr111Ile de la lipase endothéliale (rs 2000813) s’associe significativement à un surcroit de risque de RD sévère. Ces résultats devront être confirmés sur de plus larges cohortes et les mécanismes physiopathologiques analysés. [Copyright &y& Elsevier]

Background: Common risk factors for coronary heart disease (CHD) and abdominal aortic aneurysm (AAA) are mainly male gender, past or current smoking and older age. But little is known about AAA prevalence in this well-defined population. The aim of this prospective study was to evaluate the prevalence of AAA in patients presenting with an acute coronary syndrome and coronary stenosis ≥ 50% at coronarography. Material and methods: Between February 2008 and March 2009, 306 patients hospitalized for an acute coronary syndrome (unstable angina, Q-wave myocardial infarction or non Q-wave myocardial infarction) gave informed consent for AAA ultrasound (US) screening. Maximal anteroposterior longitudinal and transverse diameter were measured. AAA was considered if at least one diameter was equal or exceeded 30mm. Risk factors for cardio-vascular disease and coronary status were prospectively collected. Characteristics of patients with or without AAA were compared using Khi2 or Fisher test as appropriate if variables were qualitative and using Wilcoxon test if variables were continuous. Results: Among 304 patients with reliable US (feasibility 99.4%), prevalence of AAA was 6,6% (20/304). Prevalence tended to increase in patients older than 50 years (p=0.09). No AAA was detected in patients less than 50 years. Prevalence reached 7,7% (20/260) in patients > 50 years, 7.4% (13/176) in patients > 60 years and 9,6% (11/114) in patients > 70 years. Previous coronary events were more frequent in patients with AAA (p=0.02). In men older than 50 years, current or past smokers with previous coronary events, prevalence raised to 13% (8/63). Conclusion: Prevalence of AAA in patients with acute coronary syndrome and coronary stenosis ≥ 50% was 6,6% in this study ; furthermore, screening seemed particularly interesting in men aged more than 50 years, smoker with personal history of coronary disease, because of a prevalence more than 10%. [Copyright &y& Elsevier]

Introduction: Preclinical studies have demonstrated the possible role of beta-adrenergic receptors in pancreatic ductal adenocarcinoma (PDAC) tumor invasion and migration. The current study aimed to explore the possible association between survival outcomes and beta-blocker (BB) exposure in patients with advanced PDAC. Methods: This retrospective single-center study included 182 patients with advanced PDAC. Clinical [age, sex, BMI, cardiovascular condition, presence (SBB) or absence (NSBB) of beta-1 selectivity of BB, exposure duration, and multimorbidity], oncological (stage and anticancer treatment regimen), and biological (renal and liver function) data were collected. The endpoints were overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for survival outcomes associated with BB exposure were estimated using Cox regression model and propensity score (PS) methods. Results: Forty-one patients (22.5%) were exposed to BB. A total of 104 patients progressed (57.1%) to PDAC and 139 (76.4%) patients died at the end of follow-up (median, 320 days; IQR, 438.75 days). When compared to the non-exposed group, there was no increase in survival outcomes associated with BB use (OS: HR = 1.38, 95% CI = 0.80-2.39, p = 0.25; PFS: adjusted HR = 0.95, 95% CI = 0.48-1.88, p = 0.88). Similar results were obtained using the PS method. Compared to no BB usage, SBB use was associated with a significant decrease in OS (HR = 1.80, 95% CI = 1.16-2.80, p < 10 -2 ). Conclusion: BB exposure was not associated with improved PDAC survival outcomes. Beta-1-selectivity was not independently associated with any differences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Le Bozec, Brugel, Djerada, Ayad, Perrier, Carlier, Botsen, Nazeyrollas, Bouché and Slimano.)

(1) Background: Receiving the first internal electric shock is a turning point for patients with an implantable cardioverter defibrillator (ICD) for primary prevention. However, no study has investigated whether patients who receive a first device-delivered electric shock have a poor prognosis even at the time of ICD implantation. (2) Methods: We retrospectively identified 55 patients with ischemic (n = 31) or dilated (n = 24) cardiomyopathy who underwent ICD implantation for primary prevention with exercise test at the time of implantation. We recorded baseline characteristics, exercise test parameters, and clinical events. (3) Results: After a median follow-up of 5 years, we observed an association between an appropriate device-delivered electric shock, the occurrence of death or heart transplant, and the occurrence of the composite endpoint. There was also a significant relation between a VE/VCO 2 slope >35 and the occurrence of the composite endpoint. Conversely, there was no significant association between negative outcomes on the exercise test and the occurrence of a device-delivered electric shock. (4) Conclusions: The exercise test performed at the time of ICD implantation do not predict the occurrence of device-delivered electric shock. The exercise test and the first electric shock are two independent markers of poor prognosis.

Transcatheter aortic valve implantation (TAVI) is currently becoming an alternative to surgical valve replacement for patients at low risk, a population that is likely to experience an increase in the radiation-induced cancer risk following TAVI. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent transfemoral TAVI, including the procedure itself as well as the procedures performed in the preintervention work-up and the post-TAVI interventions. All patients who underwent transfemoral TAVI for symptomatic aortic stenosis in our center over a 26 months period were included. Dosimetric indicators from preprocedural coronary angiography and computed tomography (CT), the TAVI procedure, and any postprocedural interventions (electrophysiology study and/or pacemaker implantation) were collected and converted into an effective dose. A total of 119 transfemoral TAVI procedures were included. The mean cumulative effective dose (ED) was 37.3 mSv. Three irradiating procedures were necessary for 84 patients (71% of the population, i.e., coronary angiography, CT scan and the TAVI procedure itself), whereas 30 patients (25%) required a fourth procedure, and 5 required a fifth (4%). The majority of the dose was from the CT, while only 11% of the dose derived from the TAVI procedure itself. In conclusion, overall exposure to ionizing radiation for patients who underwent transfemoral TAVI seems acceptable, and the majority of the overall ED comes from the CT scan., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Interventional cardiologists count among the health professionals that are most exposed to ionising radiation. To minimise exposure, it is recommended that the patient be placed at the maximum distance possible from the X-ray source, but this recommendation has not been clinically validated. We aimed to investigate the impact of the average table height on the level of radiation delivered to cardiologists performing coronary interventions. The population for analysis included all invasive coronary procedures performed in our centre from March to June 2017. The primary endpoint was operator radiation exposure, as assessed using personal electronic dosimeters located on the operator's left arm. In total, 225 invasive coronary procedures were analysed. When the average table height was 1126 mm or more, the operators received a radiation dose that was, on average, 53% lower than when the table was lower than 1126 mm. This reduction remained significant by multivariate analysis adjusted for the operator., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Patients who underwent radiofrequency ablation of atrial fibrillation are exposed to X-rays not only during the procedure but also during the preprocedural computed tomography. No study has investigated the cumulative effective dose received by patients who underwent atrial fibrillation ablation and identified factors influencing this dose. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent radiofrequency ablation of atrial fibrillation. The secondary objective was to estimate the impact of obesity on this exposure. All patients who underwent a first attempt of radiofrequency ablation of atrial fibrillation in our center over a 21 months period were included. Dosimetric indicators from preprocedural computed tomography and the ablation procedure were collected and converted into an effective dose. A total of 144 radiofrequency ablation of atrial fibrillation were included. The mean cumulative effective dose was 11.4 mSv, and 82% of the dose was from the computed tomography. Obese patients received a dose that was 75% higher than normal-weight patients, and this increase remained significant by multivariate analysis. In conclusion, overall exposure to ionizing radiation for patients who underwent radiofrequency ablation of atrial fibrillation seems acceptable, and the majority of the overall effective dose comes from the computed tomography. Obese patients are exposed to a 75% higher dose than normal-weight patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The SEGA instrument has demonstrated good performance in screening for frailty. However, its predictive ability in elderly patients presenting with acute coronary syndrome have never been evaluated. We aimed to study the prognostic value at one year of the frailty level assessed by the SEGA instrument, in a population of patients aged 80 years old or more hospitalised for acute coronary syndrome. All consecutive patients aged 80 years or older hospitalised for myocardial infarction type 1 between November 2016 and October 2017 were included. All underwent standardised geriatric assessment including estimation of frailty by the SEGA instrument. The primary outcome was the time to death from any cause. In all 64 patients were included for a mean age of 85.3±4 years. Using the SEGA instrument, 24% patients were classified "frail" and 44% "very frail"; 18 (28%) deaths were observed during follow-up. When adjusted for patient age, body mass index and arterial hypertension, survival status was not significantly related with frailty status (HR=1.1, 95% CI=0.4-3.1, p=0.8).

Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no recent study quantifying overexposure of physicians during cardiac resynchronisation therapy (CRT) procedures compared to 'classical' implantation of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). We aimed to measure and compare operator exposure to radiation during implantation of PM and ICD with or without CRT. The study population comprised all PMs and ICDs implanted in a large referral centre over a six months period. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on operator's chest. In total, 169 PM/ICD implantations were analysed, 19 of which included CRT. Compared with 'classical' implantation, cardiologist radiation exposure was 9-fold greater during CRT procedures (p < 0.001). Physician exposure was related to dose-area product (R 2  = 0.21 during 'classical' implantations and R 2  = 0.57 during CRT procedures). Our study shows that cardiologists' exposure to radiation during CRT implantation was 9-fold greater than during procedures without CRT.

Objectives: We aimed to measure the reduction in the estimated dose of radiation received by patients that can be achieved using dose-reduction technology (ClarityIQ, Philips Healthcare, The Netherlands), among all patients undergoing invasive cardiology procedures., Background: Medical procedures remain the primary source of exposure to ionizing radiation in the general population., Methods: The study population comprised all patients (without exclusion criteria) undergoing invasive coronary procedures over a 1-year study period in a large referral centre equipped with two catheterization laboratories (cathlabs). Both cathlabs (A and B) were equipped with the Allura Xper FD10 imaging system (Philips Healthcare, The Netherlands), but only Cathlab B was equipped with ClarityIQ technology. The primary endpoint was the estimated total dose of radiation received by the patient, as assessed by Air Kerma (AK) and dose area product (DAP)., Results: In total, 2095 invasive coronary procedures were analyzed. The patients who underwent procedures in Cathlab B received an average estimated dose that was 23% (AK) and 43% (DAP) lower than the dose received by patients undergoing procedures in Cathlab A (P < .0001). The reduction remained significant by multivariate analysis after adjustment for total X-ray time, body mass index, arterial approach, PCI of at least one lesion, sex, and patient age., Conclusion: In our study, the ClarityIQ technology reduced the estimated radiation dose received by patients by 23-43%, according to the method of measurement., (© 2017 Wiley Periodicals, Inc.)

Exposure of operators to ionising radiation in interventional cardiology has likely diminished, but data confirming the magnitude of the reduction are lacking. The aim of this study was to compare the dose of radiation received by interventional cardiology operators at 11 years interval (2006 vs 2017). The study population comprised all interventional coronary procedures performed by a single operator in one catheterization laboratory (cathlab) of a large university hospital in north-eastern France. Exposure was compared between two periods, namely period 1 (from October 2005 to March 2006) and period 2 (from March 2017 to June 2017). The primary endpoint was the dose of radiation received by the operator, measured using an electronic dosimeter placed on the operator's left arm. In 2017, the dose of radiation received by the operators was, on average, 95% lower than the dose received in 2006 (p < 0.0001), even though the average fluoroscopy time increased by 73% over the same period (p < 0.0001). By multivariable analysis including body mass index, fluoroscopy time and performance of at least one (1) coronary angioplasty, the reduction in the operator's exposure to radiation remained significant. The dose of radiation received by interventional cardiology operators has decreased by 95% over the last ten years., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Technological progress has made it possible to reduce the dose of radiation delivered by medical x-ray systems. In parallel, interventional coronary procedures have become increasingly complex and consequently, last longer. This study aimed to compare the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs 2016). The study population included all patients who underwent interventional coronary procedures in one of the catheterization laboratories of our institution during 2 periods, namely, period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary end point was the estimated dose of radiation received by the patient as assessed by dose area product. In 2016, the estimated dose of radiation received by patients who underwent interventional coronary procedures was on average 78% lower than that received in 2006 (p <0.0001), whereas the fluoroscopy time increased by 54% on average over the same period (p <0.0001). By multivariate analysis, including age, approach, body mass index, fluoroscopy time, and performance of angioplasty, the reduction in radiation remained significant. The radial approach was significantly associated with an increased estimated dose of radiation received (p <0.0001). In conclusion, the estimated dose of radiation received by patients who underwent interventional cardiology procedures has been reduced by 78% over the last decade., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Acute coronary syndromes (ACS) frequently occur in elderly subjects. The high mortality associated with ACS in this population justifies the identification of factors related to poor prognosis. We aimed to evaluate the short-term prognostic performance of the SYNTAX score in a population of patients aged 85years or more presenting ACS and undergoing coronary angiography. Secondary objectives were to identify factors related to length of stay and potential markers of in-hospital death. We performed a retrospective, single-centre prognostic study including patients aged 85years or more who underwent coronary angiography for ACS over a 4year period. The primary endpoint was length of stay, and the secondary endpoint was in-hospital mortality. In total, 70 patients were included (37 men), average age 87.0±2.5years. Average SYNTAX score was 19.0±14.9. Average length of stay was 13.1±7.8days. By multivariate analysis, SYNTAX score was correlated with length of stay (p=0.008). Seven (10%) patients died in-hospital. Patients who died had a higher SYNTAX score (p=0.013) (threshold value of 25) and a lower left ventricular ejection fraction (p=0.001). They more frequently had signs of heart failure at admission (p=0.002), ST segment elevation ACS (p=0.046) and left main stem involvement (p=0.041) than survivors. In our study, SYNTAX score was associated with length of stay and in-hospital mortality. A SYNTAX score of 25 or more seems to be an indicator of poor short-term prognosis in very elderly patients with ACS., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: We have been intrigued by the observation that aortic stenosis (AS) may be associated with characteristic features of mitral drug-induced valvular heart disease (DI-VHD) in patients exposed to valvulopathic drugs, thus suggesting that beyond restrictive heart valve regurgitation, valvulopathic drugs may be involved in the pathogenesis of AS., Methods: Herein are reported echocardiographic features, and pathological findings encountered in a series of patients suffering from both AS (mean gradient >15mmHg) and mitral DI-VHD after valvulopathic drugs exposure. History of rheumatic fever, chest radiation therapy, systemic disease or bicuspid aortic valve disease were exclusion criteria., Results: Twenty-five (19 females, mean age 62years) patients having both AS and typical features of mitral DI-VHD were identified. Mean transaortic pressure gradient was 32+/-13mmHg. Aortic regurgitation was ≥ mild in 24 (96%) but trivial in one. Known history of aortic valve regurgitation following drug initiation prior the development of AS was previously diagnosed in 17 patients (68%). Six patients underwent aortic valve replacement and 3 both aortic and mitral valve replacement. In the 9 patients with pathology analysis, aortic valvular endocardium was markedly thickened by dense non-inflammatory fibrosis, a characteristic feature of DI-VHD., Conclusion: The association between AS and typical mitral DI-VHD after valvulopathic drug exposure may not be fortuitous. Aortic regurgitation was usually associated to AS and preceded AS in most cases but may be lacking. Pathology demonstrated the potential role of valvulopathic drugs in the development of AS., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE., Methods: From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation., Results: Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality., Conclusions: The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results.

Background: Animal studies have highlighted the role of vascular mineralocorticoid receptor during Cyclosporine A-induced nephrotoxicity. Mineralocorticoid receptor antagonists could improve kidney survival but are not commonly used during renal impairment and in association with several immunosuppressive drugs due to a supposed higher risk of adverse events. We tested the tolerance of eplerenone according to its expected adverse events: hyperkalemia, metabolic acidosis, hypotension, acute kidney failure, or any other adverse event., Methods: We conducted a single-center, prospective, open-label study in 31 kidney-transplant recipients with impaired renal function (30 and 50 mL/min/1.73 m2) and receiving cyclosporine A. All patients received eplerenone 25 mg/d for 8 weeks. Serum potassium, renal function and expected adverse events were closely monitored., Results: Eight patients experienced mild hyperkalemia (>5 mmol/L), one moderate hyperkalemia (>5.5 mmol/L) and had to receive potassium-exchange resin. No severe hyperkalemia (>6 mmol/L) occurred. One acute kidney failure was observed, secondary to diarrhea. Basal serum potassium and bicarbonate were independently associated with a higher risk of developing mild hyperkalemia (>5 mmol/L) under treatment (OR 6.5, p = 0.003 and 0.7, p = 0.007, respectively). A cut-off value of 4.35 mmol/L for basal serum potassium was the best factor to predict the risk of developing mild hyperkalemia (>5 mmol/L)., Conclusions: Until eGFR falls to 30 mL/min/1.73 m2, eplerenone could be safely given to kidney-transplant recipients receiving cyclosporine A, if kalemia is closely monitored. When renal function is impaired and if basal kalemia is >4.35 mmol/L, then clinicians should properly balance risk and benefit of eplerenone use and offer dietary advice. An adequately powered prospective randomized study is now needed to test its efficiency (and safety) in this population., Trial Registration: ClinicalTrials.gov NCT01834768.

Elderly subjects with cognitive disorders are at particularly high risk of adverse drug reactions (ADRs). The objectives of our systematic review were to describe the prevalence of ADRs in elderly patients with cognitive disorders, the different types of ADRs and the medications suspected of involvement; to describe whether the ADRs were preventable or not, and to identify risk factors for occurrence of ADRs in this population. A bibliographic search was performed in the following databases: PubMed, Embase, Google Scholar, Opengrey and Scopus. The search included all publications up to and including 4th February 2015, with no specific start date specified. Studies concerning ADRs in elderly patients with cognitive disorders or dementia were included. Two senior authors identified eligible studies and extracted data independently. In total, 113 studies were identified by the bibliographic search, of which six full-text articles were retained and analyzed. Prevalence of ADRs ranged from 4.8 to 37%. The main ADRs reported were neurological and psychological disorders, gastro-intestinal disorders, dermatological and allergic disorders, falls, renal and urinary disorders, cardiovascular disorders, metabolic disorders and electrolyte imbalance, and hemorrhagic events. The medications most commonly suspected of involvement in the ADRs were drugs affecting the nervous system, cardiovascular drugs, anticoagulants, and painkillers. Medical prescriptions should take into account the presence of Alzheimer's disease and related syndromes. Compliance should systematically be evaluated, and cognitive disorders need to be better recognized. Therapeutic education of patients and/or their caregiver is key to management of elderly patients with cognitive disorders., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)