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982 results on '"Clinique Pasteur [Toulouse]"'

151. A cost analysis of complex radiotherapy for patients with head and neck cancer

Author: P. Boisselier, Georges Noël, Enrique Chajon, Sophie Dussart, Valentin Calugaru, David Pérol, Bernard Coche-Dequeant, Magali Morelle, Michel Rives, Hinda Mecellem, Lionel Perrier, Olivier Gallocher, Pascal Pommier, Etienne Bardet, Philippe Giraud, Marc Alfonsi, Centre Léon Bérard [Lyon], Groupe d'Analyse et de Théorie Economique Lyon - Saint-Etienne (GATE Lyon Saint-Étienne), École normale supérieure de Lyon (ENS de Lyon)-Université Lumière - Lyon 2 (UL2)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Clinique Pasteur, Clinique Pasteur [Toulouse], Institut Sainte Catherine [Avignon], Centre de Lutte Contre le Cancer Nantes Atlantique 'René Gauducheau' (CLCC), Institut Claudius Regaud, Génotoxicologie, signalisation et radiothérapie expérimentale, Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), CRLCC Eugène Marquis (CRLCC), Centre Paul Strauss, CRLCC Paul Strauss, Centre Alexis Vautrin (CAV), Unité de Biostatistiques [Lyon], Unité de Biostatistique et d'Evaluation des Thérapeutiques (UBET), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Groupe d'analyse et de théorie économique (GATE Lyon Saint-Étienne), École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Centre National de la Recherche Scientifique (CNRS), Université Lille Nord de France (COMUE)-UNICANCER, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Curie [Paris], Centre Léon-Bérard : Centre de lutte contre le cancer de Lyon et Rhône-Alpes, Groupe d'analyse et de théorie économique ( GATE Lyon Saint-Étienne ), École normale supérieure - Lyon ( ENS Lyon ) -Université Lumière - Lyon 2 ( UL2 ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] ( UJM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Recherche en Cancérologie de Montpellier ( IRCM - U1194 Inserm - UM ), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ), Centre Régional de Lutte Contre le Cancer Oscar Lambret, CRLCC Institut Claudius Regaud, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -INSTITUT CURIE, CRLCC Eugène Marquis ( CRLCC ), Centre Alexis Vautrin ( CAV ), Unité de Biostatistique et d'Evaluation des Thérapeutiques ( UBET ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Centre National de la Recherche Scientifique (CNRS)-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université Lumière - Lyon 2 (UL2)-École normale supérieure - Lyon (ENS Lyon)
Subjects: Cancer Research, Randomization, medicine.medical_treatment, Tomotherapy, coût, 030218 nuclear medicine & medical imaging, JEL: I - Health, Education, and Welfare/I.I1 - Health/I.I1.I18 - Government Policy • Regulation • Public Health, 03 medical and health sciences, 0302 clinical medicine, [ SHS.ECO ] Humanities and Social Sciences/Economies and finances, Medicine, cancer, Radiology, Nuclear Medicine and imaging, Prospective cohort study, Adverse effect, Radiation treatment planning, radiothérapie, health care economics and organizations, ComputingMilieux_MISCELLANEOUS, JEL: D - Microeconomics/D.D2 - Production and Organizations/D.D2.D24 - Production • Cost • Capital • Capital, Total Factor, and Multifactor Productivity • Capacity, Radiation, business.industry, Head and neck cancer, medicine.disease, [SHS.ECO]Humanities and Social Sciences/Economics and Finance, JEL : D - Microeconomics/D.D2 - Production and Organizations/D.D2.D24 - Production • Cost • Capital • Capital, Total Factor, and Multifactor Productivity • Capacity, JEL : O - Economic Development, Innovation, Technological Change, and Growth/O.O1 - Economic Development/O.O1.O14 - Industrialization • Manufacturing and Service Industries • Choice of Technology, Confidence interval, 3. Good health, JEL : I - Health, Education, and Welfare/I.I1 - Health/I.I1.I18 - Government Policy • Regulation • Public Health, Radiation therapy, Oncology, 030220 oncology & carcinogenesis, JEL: O - Economic Development, Innovation, Technological Change, and Growth/O.O1 - Economic Development/O.O1.O14 - Industrialization • Manufacturing and Service Industries • Choice of Technology, business, Nuclear medicine
Abstract: Purpose This cost analysis aimed to prospectively assess differences in costs between TomoTherapy and volumetric modulated arc therapy (VMAT) in patients with head and neck cancer. Methods and Materials Economic data were gathered from a multicenter study. However, randomization was not possible due to the availability of equipment. Costs were calculated using the microcosting technique from the hospital's perspective (in 2013 euros), and the time horizon was radiation therapy. Only resources that entered the hospital production process and which were likely to vary between the strategies being compared were considered. Acute adverse events observed within the time horizon were also assessed. Results The cost analysis was based on a total of 173 patient treatments given between 2010 and 2012 in 14 French cancer centers: 73 patients were treated with TomoTherapy, 92 with VMAT RapidArc, and 8 with VMAT SmartArc. Estimated costs of SmartArc were removed from the comparison due to the small sample size. The mean ± SD cost per patient of the treatment planning phase was €314 (±€214) for TomoTherapy and €511 (±€590) for RapidArc. Mean costs ± SD per patient of irradiation reached €3144 (±€565) for TomoTherapy and €1350 (±€299) for RapidArc. The most sensitive parameter of irradiation was the annual operating time of accelerators. Ninety-five percent confidence intervals for the mean costs of irradiation were €3016 to €3272 for TomoTherapy and €1281 to €1408 for RapidArc. The number of acute adverse events during radiation therapy was not significantly different between strategies. Conclusions TomoTherapy appeared to be more expensive than RapidArc mainly due to the higher price of the accelerator, the higher costs of maintenance, and the longer duration of treatment sessions. Because strategies were not significantly different in clinical effect, RapidArc appeared to be the strategy to be recommended at this stage of knowledge.
Published: 2016

152. Guidelines issued by the French Society of Cardiology concerning the competence, performance and environment required in the practice of diagnostic and interventional cardiac electrophysiology

Author: A. Pisapia, Michel Chauvin, Nicolas Sadoul, Daniel Gras, Pascal Defaye, Jean-Claude Daubert, Jean-Sylvain Hermida, Jean-Yves Le Heuzey, Didier Klug, Jean-Claude Deharo, Serge Cazeau, Olivier Piot, Antoine Leenhardt, Philippe Mabo, Salem Kacet, Michèle Salvador-Mazenq, Serge Boveda, Frédéric Anselme, Centre cardiologique du Nord ( CCN ), Centre cardiologique du Nord, Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Service de cardiologie et maladies vasculaires, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Cardiac Stimulation and Rhythmology, CHU Grenoble, Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), Hôpital cardiologique, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Service de cardiologie [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Département de Rythmologie-Stimulation- Hôpital Saint-Joseph, Paris ( Département de Rythmologie-Stimulation ), Groupe Hospitalier Paris Saint-Joseph, Cardiac Rhythm and Pacing Group, Centre cardiologique du Nord (CCN), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de Rythmologie-Stimulation- Hôpital Saint-Joseph, Paris (Département de Rythmologie-Stimulation), Groupe Hospitalier Paris Saint-Joseph (hpsj), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]
Subjects: medicine.medical_specialty, Recommandations, Cardiology, Ablation par cathéter, Compétence, Guidelines, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Predictive Value of Tests, Competence, Internal medicine, Électrophysiologie, Humans, Medicine, [ SDV.IB ] Life Sciences [q-bio]/Bioengineering, 030212 general & internal medicine, Competence (human resources), Societies, Medical, ComputingMilieux_MISCELLANEOUS, business.industry, Cardiac Pacing, Artificial, Arrhythmias, Cardiac, General Medicine, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Electrophysiology, Treatment Outcome, Education, Medical, Graduate, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Catheter ablation, Clinical Competence, France, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, business
Abstract: a Centre cardiologique du Nord, 32—36, rue des Moulins-Gemeaux, 93207 St. Denis, France b University Hospital, 76031 Rouen, France c Clinique Pasteur, 31076 Toulouse, France d Hopital de Hautepierre, 67000 Strasbourg, France e University Hospital, 35033 Rennes, France f University Hospital, 38043 Grenoble, France g La Timone University Hospital, 13385 Marseille, France h Nouvelles cliniques nantaises, 44277 Nantes, France i University Hospital, 80054 Amiens, France j University Hospital, 59037 Lille, France k Lariboisiere University Hospita
Published: 2011

153. Safety of Deferring the Reimplantation of Pacing Systems After Their Removal for Infectious Complications in Selected Patients: A 1-Year Follow-Up Study

Author: Jean-Paul Albenque, Michel Haïssaguerre, Laurent Sidobre, Olivier Vahdat, Eloi Marijon, Sophie Jacob, Pierre Bordachar, Maxime De Guillebon, Serge Boveda, Antoine Deplagne, Nicolas Combes, Philippe Ritter, Jacques Clémenty, Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France, PRPHOM, SRBE, LEPID, and Institut de Radioprotection et de Sûreté Nucléaire (IRSN)
Subjects: artificial heart pacemaker, Male, Pacemaker, Artificial, [SDV]Life Sciences [q-bio], cardiac resynchronization therapy, reimplantation, 1 year follow up, Arrhythmias, 030204 cardiovascular system & hematology, 0302 clinical medicine, Heart Rate, atrioventricular block, Clinical endpoint, Medicine, 030212 general & internal medicine, article, Shock, Middle Aged, Shock, Septic, 3. Good health, Death, Pacemaker, female, Treatment Outcome, priority journal, Artificial, medicine.symptom, Cardiology and Cardiovascular Medicine, Cardiac, Reoperation, medicine.medical_specialty, Prosthesis-Related Infections, sudden death, bradycardia, Risk Assessment, Sudden death, Asymptomatic, Prosthesis Implantation, 03 medical and health sciences, QRS complex, infectious complication, Physiology (medical), Heart rate, Humans, human, Asystole, Aged, Septic, business.industry, Arrhythmias, Cardiac, Evidence-based medicine, medicine.disease, major clinical study, Sudden, Surgery, Death, Sudden, Cardiac, asystole, business, Follow-Up Studies
Abstract: Introduction: Recent expert consensus guidelines mention that one of the principles for infected device replacement following removal is to “reevaluate carefully if there is a continued need for a new cardiac device replacement.” This is a Class I recommendation, which nevertheless suffers from a very low level of evidence (level of evidence C), since no study has revisited the systematic practice of reimplanting the same device based on a meticulous clinical reassessment. In the present paper, we examined the safety of withholding the implantation of pacing systems in selected patients. Methods and Results: Between January 2005 and December 2007, 188 consecutive patients underwent extractions of infected pacing systems at 2 medical centers. “Low-risk” patients were identified by (1) a spontaneous heart rate >45 bpm, (2) no symptomatic asystole during monitoring, (3) QRS duration
Published: 2010

154. Incidence and prognostic significance of sustained ventricular tachycardias in heart failure patients implanted with biventricular pacemakers without a back-up defibrillator: results from the prospective, multicentre, Mona Lisa cohort study

Author: Marie Lambiez, Nicolas Delarche, Serge Boveda, Eloi Marijon, D. Pavin, Pascal Defaye, Philippe Chevalier, Alan Bulava, Jobst B. Winter, Jean Paul Albenque, Nicolas Combes, Alexander Teubl, Daniel Gras, Sophie Jacob, Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Radiobiologie et épidémiologie (DRPH/SRBE), Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Cardiac Stimulation and Rhythmology, CHU Grenoble, Service de cardiologie et maladies vasculaires, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de cardiologie, Hôpital Est -Lyon, The study was financed by Guidant., Mona Lisa Study Group, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], and CHU Pontchaillou [Rennes]
Subjects: Male, Pacemaker, Artificial, medicine.medical_treatment, 030204 cardiovascular system & hematology, MESH: Epidemiologic Methods, Ventricular tachycardia, law.invention, Sudden cardiac death, MESH: Cause of Death, MESH: Aged, 80 and over, 0302 clinical medicine, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, law, Cause of Death, 030212 general & internal medicine, Aged, 80 and over, MESH: Aged, Cardiac resynchronization therapy, MESH: Middle Aged, Incidence, Mortality rate, Cardiac Pacing, Artificial, Middle Aged, Prognosis, MESH: Electrophysiologic Techniques, Cardiac, 3. Good health, MESH: Pacemaker, Artificial, Cardiology, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Cohort study, medicine.medical_specialty, Defibrillation, Heart failure, MESH: Cardiac Pacing, Artificial, MESH: Prognosis, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, Aged, Electrograms, MESH: Humans, business.industry, MESH: Death, Sudden, Cardiac, medicine.disease, MESH: Male, Death, Sudden, Cardiac, MESH: Heart Failure, Tachycardia, Ventricular, Artificial cardiac pacemaker, MESH: Tachycardia, Ventricular, Epidemiologic Methods, business, MESH: Female
Abstract: International audience; AIMS: The aim of this study was to investigate the 12-month incidence, predictive factors, and prognosis of sustained ventricular tachycardia (VT) in chronic heart failure patients implanted with biventricular pacemakers without a back-up defibrillator (CRT-P), assessed by continuous intracardiac ventricular electrograms. METHODS AND RESULTS: The Mona Lisa study, a prospective, multicentre, cohort study, designed to determine the incidence of sustained VT and its prognostic impact in CRT-P recipients within the year after implant enrolled 198 patients with moderate or severe chronic heart failure, despite optimal pharmacological therapy. An independent committee reviewed the data from all arrhythmic episodes as well as causes of death according to predefined criteria. During a mean follow-up of 9.8 +/- 3.1 months after implantation, 8 patients experienced at least one episode of sustained VT [4.3%; 95% confidence interval (CI), 1.1-7.5] and 21 deaths occurred, giving a 12-month mortality rate of 11.7% (95% CI, 6.4-16.9). The presence of sustained VT was associated with a high risk of sudden cardiac death (SCD) and the lowest 12-month overall survival (P < 0.0001). CONCLUSION: The incidence of sustained VT remains relatively low in the first year after CRT-P implantation, but when present appears closely associated with short-term adverse outcomes, especially SCD. This emphasizes the possible value of remote monitoring to detect high-risk patients for urgent upgrading.
Published: 2009

155. Causes-of-death analysis of patients with cardiac resynchronization therapy: an analysis of the CeRtiTuDe cohort study

Author: Marijon, Eloi, Leclercq, Christophe, Narayanan, Kumar, Boveda, Serge, Klug, Didier, Lacaze-Gadonneix, Jonathan, Defaye, Pascal, Jacob, Sophie, Piot, Olivier, Deharo, Jean-Claude, Perier, Marie-Cécile, Mulak, Genevieve, Hermida, Jean-Sylvain, Milliez, Paul, Gras, Daniel, Cesari, Olivier, Hidden-Lucet, Françoise, Anselme, Frederic, Chevalier, Philippe, Maury, Philippe, Sadoul, Nicolas, Bordachar, Pierre, Cazeau, Serge, Chauvin, Michel, Empana, Jean-Philippe, Jouven, Xavier, Daubert, Jean-Claude, Le Heuzey, Jean-Yves, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Paris-Centre de Recherche Cardiovasculaire ( PARCC - U970 ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de cardiologie et maladies vasculaires, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Hôpital cardiologique, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Cardiac Stimulation and Rhythmology, CHU Grenoble, Radiobiologie et épidémiologie ( DRPH/SRBE ), Institut de Radioprotection et de Sûreté Nucléaire ( IRSN ), Médicaments : Dynamique Intracellulaire et Architecture Nucléaire ( MéDIAN ), Université de Reims Champagne-Ardenne ( URCA ) -Centre National de la Recherche Scientifique ( CNRS ), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), Laboratoire de Recherche en Imagerie : Méthodes d'imagerie des Échanges transcapillaires ( LRI - EA4062 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ), Société française de cardiologie, Hôpital Universitaire d'Amiens, Hôpital Universitaire de Caen, Cardiopathies et mort subite, Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Clinique Saint Gatien, Département de Cardiologie et Centre de Référence pour les Maladies Cardiaques Héréditaires, CHU Pitié-Salpêtrière [APHP], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition ( ICAN ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Hôpital Est -Lyon, CHU Toulouse [Toulouse], Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Département de Rythmologie-Stimulation- Hôpital Saint-Joseph, Paris ( Département de Rythmologie-Stimulation ), Groupe Hospitalier Paris Saint-Joseph, Hôpital universitaire de Strasbourg, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de RadioBiologie et d'Epidémiologie (IRSN/DRPH/SRBE), Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Centre cardiologique du Nord (CCN), Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Laboratoire de Recherche en Imagerie : Méthodes d'imagerie des Échanges transcapillaires (LRI - EA4062), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Amiens-Picardie, Cardiopathies et mort subite [ERL 3147], Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-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], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de Rythmologie-Stimulation- Hôpital Saint-Joseph, Paris (Département de Rythmologie-Stimulation), Groupe Hospitalier Paris Saint-Joseph (hpsj), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Radiobiologie et épidémiologie (DRPH/SRBE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Paris Descartes - Paris 5 (UPD5)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Médicaments : Dynamique Intracellulaire et Architecture Nucléaire (MéDIAN), Université de Reims Champagne-Ardenne (URCA)-Centre National de la Recherche Scientifique (CNRS), and Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]
Subjects: genetic structures, Sudden death, health services administration, Cardiac resynchronization, cardiovascular system, Cardioverter defibrillator, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Heart failure, cardiovascular diseases, [ SDV.IB ] Life Sciences [q-bio]/Bioengineering, Competing risk, circulatory and respiratory physiology
Abstract: International audience; AIMS: The choice of resynchronization therapy between with (CRT-D) and without (CRT-P) a defibrillator remains a contentious issue. Cause-of-death analysis among CRT-P, compared with CRT-D, patients could help evaluate the extent to which CRT-P patients would have additionally benefited from a defibrillator in a daily clinical practice. METHODS AND RESULTS: A total of 1705 consecutive patients implanted with a CRT (CRT-P: 535 and CRT-D: 1170) between 2008 and 2010 were enrolled in CeRtiTuDe, a multicentric prospective follow-up cohort study, with specific adjudication for causes of death at 2 years. Patients with CRT-P compared with CRT-D were older (P \textless 0.0001), less often male (P \textless 0.0001), more symptomatic (P = 0.0005), with less coronary artery disease (P = 0.003), wider QRS (P = 0.002), more atrial fibrillation (P \textless 0.0001), and more co-morbidities (P = 0.04). At 2-year follow-up, the annual overall mortality rate was 83.80 [95% confidence interval (CI) 73.41-94.19] per 1000 person-years. The crude mortality rate among CRT-P patients was double compared with CRT-D (relative risk 2.01, 95% CI 1.56-2.58). In a Cox proportional hazards regression analysis, CRT-P remained associated with increased mortality (hazard ratio 1.54, 95% CI 1.07-2.21, P = 0.0209), although other potential confounders may persist. By cause-of-death analysis, 95% of the excess mortality among CRT-P subjects was related to an increase in non-sudden death. CONCLUSION: When compared with CRT-D patients, excess mortality in CRT-P recipients was mainly due to non-sudden death. Our findings suggest that CRT-P patients, as currently selected in routine clinical practice, would not potentially benefit with the addition of a defibrillator
Published: 2015

156. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E

Author: Laurent Alric, Nassim Kamar, Jean-Pierre Vinel, Jacques Izopet, Christophe Bureau, Pascal Cintas, René Gerolami, Jean-Marie Péron, H. Blasco Perrin, Louis d’Alteroche, J.-N. Raynal, P. Couzigou, J.-M. Liversain, L. Prudhomme, E. Vaucher, Florence Abravanel, Emmanuel Dupuis, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Marseille, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Clinique de l'union, Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Clinique Pasteur, Clinique Pasteur [Toulouse], Centre Hospitalier Intercommunal Castres-Mazamet (CHIC-CM), Centre Hospitalier de Narbonne, CHU Bordeaux [Bordeaux], Intensive Care Unit, Centre Hospitalier de Mont De Marsan, 40000, Mont-de-Marsan, CHU Toulouse [Toulouse], Clinique de l'Union, Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), and Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)
Subjects: Male, Parsonage–Turner syndrome, Pediatrics, Epidemiology, [SDV]Life Sciences [q-bio], viruses, lcsh:Medicine, medicine.disease_cause, chemistry.chemical_compound, Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E, Hepatitis E virus, Autochthonous Acute Hepatitis E, Suggested citation for this article: Blasco Perrin H, d’Alteroche L, Immunocompetent Patients, Guillain-Barre syndrome, biology, Mononeuritis Multiplex, virus diseases, Middle Aged, Guillain-Barré syndrome, Hepatitis E, demyelinating neuropathy, 3. Good health, Infectious Diseases, Acute Disease, Synopsis, Education, Medical, Continuing, Female, Immunocompetence, Antibody, Adult, Microbiology (medical), medicine.medical_specialty, Abravanel F, et al. Neurologic disorders in nonimmunocompromised patients with autochthonous acute hepatitis E. Emerg Infect Dis. 2015 Nov [date cited]. http://dx.doi.org/10.3201/eid2111.141789, meningoradiculitis, hepatitis E virus, Raynal JN, mononeuritis multiplex, lcsh:Infectious and parasitic diseases, medicine, Humans, Gérolami R, lcsh:RC109-216, Aged, Cintas P, business.industry, Ribavirin, lcsh:R, medicine.disease, immunocompetent, digestive system diseases, chemistry, neurological manifestations, HEV, Immunology, biology.protein, hepatitis E, Nervous System Diseases, business, neurologic disorders
Abstract: Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for hepatitis E virus infection., Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage–Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection.
Published: 2015

157. Conditions de mise en œuvre des « nouvelles techniques et pratiques » en radiothérapie: synthèse du rapport du groupe de travail issu du groupe permanent d'experts en radioprotection médicale de l'Autorité de Sûreté Nucléaire

Author: Lartigau, T.-F., Lisbona, A., Isambert, A., Cadot, P., Derreumaux, S., Dupuis, O., Gérard, J.-P., Ledu, D., Mahé, M.-A., Marchesi, V., Mazurier, J., De Oliveira, A., Phare, O., Aubert, B., Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Autorité de Sureté Nucléaire, PRP-HOM/SER/UEM, Radiation Protection and Nuclear Safety Institute, Centre Jean Bernard [Institut Inter-régional de Cancérologie - Le Mans], Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), Clinique Pasteur [Toulouse], and Institut Curie [Paris]
Subjects: [SDV]Life Sciences [q-bio]
Abstract: National audience; In August 2013, the French nuclear safety agency (ASN) requested the permanent group of experts in radiation protection in medicine (GPMED) to propose recommendations on the implementation of new technology and techniques in radiation oncology. These recommendations were finalized in February 2015 by the GPMED. In April 2015, the ASN sent a letter to the French ministry of health (DGS/DGOS), and its national health agencies (ANSM, INCa, HAS). In these letters, ASN proposed that, from the 12 recommendations made by the GPMED, an action plan should be established, whose control could be assigned to the French national cancer institute (INCa), as a pilot of the national committee for radiotherapy and that this proposal has to be considered at the next meeting of the national committee of radiotherapy. © 2015 Société française de radiothérapie oncologique (SFRO).; En août 2013, l’Autorité de sûreté nucléaire (ASN) a saisi le groupe permanent d’experts en radioprotection pour les applications médicales et médicolégales des rayonnements ionisants (GPmed) afin que ce groupe émette des recommandations sur les conditions de mise en œuvre des nouvelles techniques en radiothérapie et des pratiques associées. Ces recommandations ont fait l’objet d’un avis émis par le GPmed et adopté en février 2015. Dès avril 2015, l’ASN a adressé un courrier au ministère de la Santé (Direction générale de la santé [DGS]/Direction générale de l’offre de soins [DGOS]), l’Agence nationale de sécurité du médicament (ANSM), l’Institut national du cancer (INCa) et la Haute Autorité de santé (HAS). Dans ces courriers, l’ASN propose qu’à partir des 12 recommandations émises par la GPmed, un plan d’actions soit établi, dont le pilotage pourrait être confié à l’Institut national du cancer, en tant que pilote du comité national de la radiothérapie et que cette proposition soit examinée lors de la prochaine réunion du comité national de la radiothérapie.
Published: 2015

158. Donepezil decreases annual rate of hippocampal atrophy in suspected prodromal Alzheimer's disease

Author: Amir Ait Ameur, Enrica Cavedo, Simone Lista, Olivier Rouaud, Florence Pasquier, Jacques Touchon, Pierre Jean Ousset, Isabelle Tonelli, Mathieu Ceccaldi, Marie Sarazin, Alain Vighetto, Marie Chupin, Nadine Girard, Françoise Duveau, Didier Dormont, Guy Louis Tisserand, Frédéric Ricolfi, Christine Delmaire, Alain Bonafe, Line Garnero, Bernard Croisile, Bruno Dubois, Olivier Colliot, Carole Dufouil, Stéphane Lehéricy, Harald Hampel, Institut de la Mémoire et de la Maladie d'Alzheimer [CHU Pitié-Salpétriêre] (IM2A), Université Pierre et Marie Curie - Paris 6 (UPMC)-CHU Pitié-Salpêtrière [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), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [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 National de la Recherche Scientifique (CNRS), Algorithms, models and methods for images and signals of the human brain (ARAMIS), Inria Paris-Rocquencourt, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), 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 National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Department of Psychiatry, Psychosomatic Medicine and Psychotherapy [Goethe Universität], Goethe-Universität Frankfurt am Main, Université Pierre et Marie Curie - Paris 6 (UPMC), Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Casselardit - Junod, Clinique Pasteur, Clinique Pasteur [Toulouse], Centre Mémoire Ressources et Recherche [Dijon] (CMRR Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département de neurologie [Lille], Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Roger Salengro [Lille], Hôpital de la Timone [CHU - APHM] (TIMONE), INSERM U897, University of Bordeaux, France, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Eisai, Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), CHU Amiens-Picardie, Hippocampus Study Group, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de la Mémoire et de la Maladie d'Alzheimer [Paris] (IM2A), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Pitié-Salpêtrière [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)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département de neurologie[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Neuroradiologie [CHU Pitié-Salpêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Pitié-Salpêtrière [AP-HP]
Subjects: Male, Epidemiology, Disease, Gastroenterology, Hippocampus, law.invention, 0302 clinical medicine, Randomized controlled trial, Piperidines, law, Hippocampus (mythology), Donepezil, 0303 health sciences, education.field_of_study, Health Policy, Organ Size, Magnetic Resonance Imaging, Hippocampal atrophy, 3. Good health, Psychiatry and Mental health, Neuroprotective Agents, Treatment Outcome, Indans, Disease Progression, Biomarker (medicine), Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], France, Psychology, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, medicine.drug, medicine.medical_specialty, Population, Prodromal Symptoms, Placebo, 03 medical and health sciences, Cellular and Molecular Neuroscience, Developmental Neuroscience, Double-Blind Method, Alzheimer Disease, Internal medicine, mental disorders, medicine, Humans, Psychiatry, education, 030304 developmental biology, Aged, Neurology (clinical), Geriatrics and Gerontology, Atrophy, 030217 neurology & neurosurgery
Abstract: International audience; INTRODUCTION:The purpose of this study was to study the effect of donepezil on the rate of hippocampal atrophy in prodromal Alzheimer's disease (AD).METHODS:A double-blind, randomized, placebo-controlled parallel group design using donepezil (10 mg/day) in subjects with suspected prodromal AD. Subjects underwent two brain magnetic resonance imaging scans (baseline and final visit). The primary efficacy outcome was the annualized percentage change (APC) of total hippocampal volume (left + right) measured by an automated segmentation method.RESULTS:Two-hundred and sixteen only subjects were randomized across 28 French expert clinical sites. In the per protocol population (placebo = 92 and donepezil = 82), the donepezil group exhibited a significant reduced rate of hippocampal atrophy (APC = -1.89%) compared with the placebo group (APC = -3.47%), P < .001. There was no significant difference in neuropsychological performance between treatment groups.DISCUSSION:A 45% reduction of rate of hippocampal atrophy was observed in prodromal AD following 1 year of treatment with donepezil compared with placebo.
Published: 2015

159. Prognostic Factors for Survival in Noncastrate Metastatic Prostate Cancer: Validation of the Glass Model and Development of a Novel Simplified Prognostic Model

Author: Claude El Kouri, Marjorie Baciuchka, Gael Deplanque, Michel Soulié, Loic Mourey, Jean-Pascal Machiels, Brigitte Laguerre, Jochen Walz, Jean-Marie Boher, Patricia Marino, Jean-Marc Ferrero, Guilhem Bousquet, Jérôme Dauba, Stéphane Oudard, Philippe Beuzeboc, Claude Linassier, Christine Theodore, Florence Joly, Ivan Krakowski, Frederic Rolland, Jean-François Berdah, Alain Ravaud, Karim Fizazi, Remy Delva, Gwenaelle Gravis, Muriel Habibian, Igor Latorzeff, Ali Hasbini, Damien Pouessel, Sylvie Zanetta, Christian Platini, Jean-Christophe Eymard, Jean-Luc Labourey, Etienne Suc, Franck Priou, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Gustave Roussy (IGR), Université Paris-Sud - Paris 11 (UP11), Oncologie génito-urinaire, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Côte de Nacre [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Clinique Pasteur [Toulouse], Centre Paul Papin, CRLCC Paul Papin, Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Centre Eugène Marquis (CRLCC), CRLCC René Gauducheau, Hôpital Foch [Suresnes], Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), CRLC Val d'Aurelle-Paul Lamarque, CRLCC Val d'Aurelle - Paul Lamarque, Institut Claudius Regaud, Institut Curie [Paris], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), Hôpital de Toulon/Hyères - Sainte Marguerite [Hyères] (HTH-SM), Centre Hospitalier Layné, Hôpital de la Timone [CHU - APHM] (TIMONE), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Dupuytren [CHU Limoges], Université Catholique de Louvain = Catholic University of Louvain (UCL), Centre Catherine-de-Sienne [Nantes] (CCS), Hôpital Saint-André, Clinique Saint-Jean Languedoc [Toulouse] (CSJL), Institut Jean Godinot [Reims], Clinique Armoricaine de Radiologie [St. Brieuc], Hopital Saint-Louis [AP-HP] (AP-HP), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Descartes - Paris 5 (UPD5), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), CHD Vendée - Hôpital Les Oudairies [La Roche sur Yon], Centre Alexis Vautrin [Vandoeuvre-lès-Nancy], Université Côte d'Azur (UCA)-UNICANCER, Hôpital de Rangueil, CHU Toulouse [Toulouse], UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Unité d'oncologie médicale, and Malbec, Odile
Subjects: Male, Oncology, Time Factors, [SDV]Life Sciences [q-bio], Kaplan-Meier Estimate, Docetaxel, Androgen deprivation therapy, Prostate cancer, Risk Factors, Antineoplastic Combined Chemotherapy Protocols, Medicine, Prospective Studies, 10. No inequality, 2. Zero hunger, education.field_of_study, Univariate analysis, Hazard ratio, Noncastrate, Middle Aged, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Lymphatic Metastasis, Metastatic, Taxoids, France, medicine.drug, medicine.medical_specialty, Antineoplastic Agents, Hormonal, Urology, Population, Bone Neoplasms, Adenocarcinoma, Prognostic factors, Risk Assessment, Decision Support Techniques, Predictive Value of Tests, Internal medicine, Alkaline phosphatase, Biomarkers, Tumor, Humans, education, Aged, Proportional Hazards Models, Performance status, business.industry, Prostatic Neoplasms, Reproducibility of Results, Androgen Antagonists, medicine.disease, Confidence interval, Surgery, Nomograms, business, Orchiectomy
Abstract: BACKGROUND: The Glass model developed in 2003 uses prognostic factors for noncastrate metastatic prostate cancer (NCMPC) to define subgroups with good, intermediate, and poor prognosis. OBJECTIVE: To validate NCMPC risk groups in a more recently diagnosed population and to develop a more sensitive prognostic model. DESIGN, SETTING, AND PARTICIPANTS: NCMPC patients were randomized to receive continuous androgen deprivation therapy (ADT) with or without docetaxel in the GETUG-15 phase 3 trial. Potential prognostic factors were recorded: age, performance status, Gleason score, hemoglobin (Hb), prostate-specific antigen, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), metastatic localization, body mass index, and pain. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: These factors were used to develop a new prognostic model using a recursive partitioning method. Before analysis, the data were split into learning and validation sets. The outcome was overall survival (OS). RESULTS AND LIMITATIONS: For the 385 patients included, those with good (49%), intermediate (29%), and poor (22%) prognosis had median OS of 69.0, 46.5 and 36.6 mo (p=0.001), and 5-yr survival estimates of 60.7%, 39.4%, and 32.1%, respectively (p=0.001). The most discriminatory variables in univariate analysis were ALP, pain intensity, Hb, LDH, and bone metastases. ALP was the strongest prognostic factor in discriminating patients with good or poor prognosis. In the learning set, median OS in patients with normal and abnormal ALP was 69.1 and 33.6 mo, and 5-yr survival estimates were 62.1% and 23.2%, respectively. The hazard ratio for ALP was 3.11 and 3.13 in the learning and validation sets, respectively. The discriminatory ability of ALP (concordance [C] index 0.64, 95% confidence interval [CI] 0.58-0.71) was superior to that of the Glass risk model (C-index 0.59, 95% CI 0.52-0.66). The study limitations include the limited number of patients and low values for the C-index. CONCLUSION: A new and simple prognostic model was developed for patients with NCMPC, underlying the role of normal or abnormal ALP. PATIENT SUMMARY: We analyzed clinical and biological factors that could affect overall survival in noncastrate metastatic prostate cancer. We showed that normal or abnormal alkaline phosphatase at baseline might be useful in predicting survival.
Published: 2015

160. Utilisation des réseaux sociaux par les urologues français : résultats d’une étude de l’Association française d’urologie

Author: Misrai, V., Castagnola, C., Descotes, J.-L., Roupret, M., Clinique Pasteur [Toulouse], Clinique de l'Espérance [Mougins], Service d'urologie [CHU Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Universitaire de Cancérologie [Paris] (IUC), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Internet, Web 2.0, Réseau social, Urology, [SDV]Life Sciences [q-bio], Twitter, Network, Réseau, Education, Social media, Journal club, Enseignement, Urologie, Bibliographie
Abstract: International audience; PURPOSE:Social Media (SoMe) have changed the face of modern medicine. Our purpose was to make an inventory on the use of SoMe within urologists members of the French Urological Association (AFU).MATERIAL AND METHODS:A 15 questions-survey was sent by email 2 months to urologists AFU members before the 108th French Congress of Urology (#CFU2014). At the same time, the activity of urologists using Twitter was analyzed over the period of the national conference with the symplur software (www.symplur.com).RESULTS:Overall, 270 (17.3%) surveys were completed. Only 50% of responders had an online SoMe account. The most commonly used social media platforms were: Facebook (36.1%) followed by LinkedIn (28.2%), Google+ (19.6%), YouTube (18.7%) and Twitter (17.4%). The use of SoMe was higher in the age groups 30-40 and 40-50 years than in older age groups (83% versus 36%). Only 38.7% of respondents reported using SoMe in a professional field. At the congress #CFU2014, there were over 1000 tweets generated by 173 different contributors.CONCLUSION:Only a minority of French urologists have reported to be connected to SoMe and a predominantly personal use. The emergence of Twitter in French urological conferences is very new but seems promising. Further studies are needed, especially within the members of the residents French urological association to better characterize the true impact of SoMe in urology.LEVEL OF EVIDENCE:4.
Published: 2015

161. Impact of dynamic IMRT and tomotherapy in pelvic cancers: A prospective dosimetric study with 51 patients

Author: Servagi-Vernat, S., Giraud, P., Fenoglietto, P., Azria, D., Lisbona, A., de La Rochefordière, A., Zefkili, S., Fau, P., Resbeut, M., Huger, S., Peiffert, D., Meyer, P., Noël, G., Mazurier, J., Latorzeff, I., Biston, M.-C., Pommier, P., Ledu, D., Garcia, R., Chauvet, B., Dudouet, P., Belhomme, S., Kantor, G., Mahé, M.-A., Service de Radiothérapie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Service d’oncologie-radiothérapie [HEGP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), CRLCC Val d'Aurelle - Paul Lamarque, Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Curie [Paris], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), CRLCC Paul Strauss, Clinique Pasteur [Toulouse], Centre Léon Bérard [Lyon], Institut Sainte Catherine [Avignon], Clinique Pont-de-Chaume, Institut Bergonié [Bordeaux], CRLCC René Gauducheau, Service de radiothérapie (CHRU Besançon), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Centre de Recherche en Cancérologie / Nantes - Angers (CRCNA), Centre hospitalier universitaire de Nantes (CHU Nantes)-Faculté de Médecine d'Angers-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Centre National de la Recherche Scientifique (CNRS)-Hôpital Laennec-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôtel-Dieu de Nantes, Institut Curie, Institut de Cancérologie de Lorraine - Alexis Vautrin (ICL), and Institut Bergonié - CRLCC Bordeaux
Subjects: Male, Organs at Risk, Tomothérapie hélicoïdale, Pelvic radiotherapy, Models, Statistical, Radiothérapie pelvienne, Prostatic Neoplasms, Radiotherapy Dosage, Dynamic IMRT, Comparaison dosimétrique, RCMI rotationnelle, Anus Neoplasms, Tomotherapy, Rapid’Arc®, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Lymph Nodes, Prospective Studies, Radiotherapy, Intensity-Modulated, Dosimetric comparison, Organ Sparing Treatments
Abstract: International audience; PurposeTo compare the dosimetric results of different techniques of dynamic intensity modulated radiation therapy (IMRT) in patients treated for a pelvic cancer with nodal irradiation.Patients and methodsData of 51 patients included prospectively in the Artpelvis study were analyzed. Thirty-six patients were treated for a high-risk prostate cancer (13 with helical tomotherapy, and 23 with Rapid’Arc®) and 15 patients were treated for a localized anal cancer (nine with helical tomotherapy and six with Rapid’Arc®). Plan quality was assessed according to several different dosimetric indexes of coverage of planning target volume and sparing of organs at risk.ResultsAlthough some dosimetric differences were statistically significant, helical tomotherapy and Rapid’Arc provided very similar and highly conformal plans. Regarding organs at risk, Rapid’Arc® provided better pelvic bone sparing with a lower non-tumoral integral dose.ConclusionIn pelvis cancer with nodal irradiation, Rapid’Arc and helical tomotherapy provided very similar plans. The clinical evaluation of Artpelvis study will verify this equivalence hypothesis.; ObjectifComparaison dosimétrique entre différentes techniques de radiothérapie conformationnelle avec modulation d’intensité (RCMI) rotationnelles chez des patients traités pour un cancer pelvien avec irradiation ganglionnaire.Patients et méthodesLes données dosimétriques de 51 patients inclus prospectivement dans le protocole Artpelvis ont été analysées. Trente-six patients atteints d’un cancer de prostate à haut risque ont été traités, dont 13 par un appareil de tomothérapie hélicoïdale et 23 par RapidArc®. Quinze patients atteints un cancer du canal anal localement évolué ont été traités, dont neuf par un appareil de tomothérapie hélicoïdale et six par RapidArc®. L’analyse a porté sur la comparaison de différents indices de qualité dosimétriques pour les volumes cibles prévisionnels et sur les doses reçues aux organes à risque.RésultatsMalgré de légères différences, l’analyse des paramètres dosimétriques a montré que les deux techniques généraient une bonne et semblable couverture des volumes cibles prévisionnels, conforme à la prescription et aux contraintes prédéfinies. En ce qui concerne les organes à risque, les doses délivrées au bassin et la dose intégrale étaient légèrement plus élevées avec la tomothérapie hélicoïdale.ConclusionPour des cancers pelviens traités avec irradiation une ganglionnaire, le RapidArc®et la tomothérapie hélicoïdale permettent d’obtenir des résultats dosimétriques équivalents. L’évaluation du suivi clinique de l’étude Artpelvis permettra de vérifier cette hypothèse d’équivalence.
Published: 2014

162. Pressure-dependent hemodynamic effect of continuous positive airway pressure in severe chronic heart failure: A case series

Author: Philipe Corne, Jean Marc Davy, Mathieu Granier, Guilhaume Cayla, Olivier Jonquet, Nicolas Combes, Jean-Louis Pépin, Samir Jaber, Dany Jaffuel, Jean-Christian Borel, Clinique Pasteur [Toulouse], Polyclinique Saint Privat, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Grenoble, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Continuous positive airway pressure, Hemodynamics, Severity of Illness Index, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Medicine, Humans, Cardiac Output, ComputingMilieux_MISCELLANEOUS, Aged, Heart Failure, business.industry, Pressure dependent, Middle Aged, medicine.disease, Chronic heart failure, 3. Good health, Sleep apnea syndrome, Treatment Outcome, Echocardiography, Heart failure, Anesthesia, Chronic Disease, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: International audience
Published: 2014

163. In-vivo dosimetry for field sizes down to 6~\texttimes~6~mm2 in shaped beam radiosurgery with microMOSFET

Author: Jean-Albert Lotterie, Isabelle Berry, P. Duthil, E. Cassol, A. Redon, J. Sabatier, Xavier Franceries, A. Sors, I. Latorzeff, Imagerie cérébrale et handicaps neurologiques (ICHN), Institut des sciences du cerveau de Toulouse. (ISCT), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinique Pasteur [Toulouse], Institut de Physique Nucléaire d'Orsay (IPNO), Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11), Hôpital de Rangueil, and CHU Toulouse [Toulouse]
Subjects: Transistors, Electronic, Biophysics, General Physics and Astronomy, Dose profile, Radiation Dosage, Radiosurgery, Imaging phantom, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Calibration, Humans, Dosimetry, Radiology, Nuclear Medicine and imaging, Radiometry, ComputingMilieux_MISCELLANEOUS, Physics, Dosimeter, Phantoms, Imaging, Attenuation, [SCCO.NEUR]Cognitive science/Neuroscience, Isocenter, Oxides, General Medicine, Metals, 030220 oncology & carcinogenesis, Head, Beam (structure), Biomedical engineering
Abstract: The aim of this study is to evaluate microMOSFET as in-vivo dosimeter in 6 MV shaped-beam radiosurgery for field sizes down to 6 × 6 mm2. A homemade build-up cap was developed and its use with microMOSFET was evaluated down to 6 × 6 mm2. The study with the homemade build-up cap was performed considering its influence on field size over-cover occurring at surface, achievement of the overall process of electronic equilibrium, dose deposition along beam axis and dose attenuation. An optimized calibration method has been validated using MOSFET in shaped-beam radiosurgery for field sizes from 98 × 98 down to 18 × 18 mm2. The method was detailed in a previous study and validated in irregular field shapes series measurements performed on a head phantom. The optimized calibration method was applied to microMOSFET equipped with homemade build-up cap down to 6 × 6 mm2. Using the same irregular field shapes, dose measurements were performed on head phantom. MicroMOSFET results were compared to previous MOSFET ones. Additional irregular field shapes down to 8.8 × 8.8 mm2 were studied with microMOSFET. Isocenter dose attenuation due to the homemade build-up cap over the microMOSFET was near 2% irrespective of field size. Our results suggested that microMOSFET equipped with homemade build-up cap is suitable for in-vivo dosimetry in shaped-beam radiosurgery for field sizes down to 6 × 6 mm2 and therefore that the required build-up cap dimensions to perform entrance in-vivo dosimetry in small-fields have to ensure only partial charge particle equilibrium.
Published: 2014

164. Mortality of French participants in the Tour de France (1947-2012)

Author: Nicolas Combes, David S. Celermajer, Nour El Helou, Juliana Antero-Jacquemin, Eloi Marijon, Geoffroy Berthelot, Grégoire Rey, Jean-François Toussaint, Wulfran Bougouin, Muriel Tafflet, Jean-Philippe Empana, Olivier Hermine, Xavier Jouven, Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut national du sport, de l'expertise et de la performance (INSEP), Université Paris Descartes - Paris 5 (UPD5), The University of Sydney, Clinique Pasteur [Toulouse], Centre d'épidémiologie sur les causes médicales de décès (CépiDc), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5)-Hôpital Européen Georges Pompidou [APHP] (HEGP), and Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Change over time, Adult, Male, medicine.medical_specialty, Tour de france, Longevity, Poison control, 030204 cardiovascular system & hematology, Cardiovascular, Occupational safety and health, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, [SHS.SPORT.SS]Humanities and Social Sciences/Sport/Sport heath, Injury prevention, medicine, Doping, Humans, Mortality, Cause of death, [SHS.SPORT]Humanities and Social Sciences/Sport, business.industry, Cycling, 030229 sport sciences, Confidence interval, Bicycling, [SHS.SPORT.DOP]Humanities and Social Sciences/Sport/Doping, Standardized mortality ratio, Athletes, Physical therapy, France, Cardiology and Cardiovascular Medicine, business, Demography
Abstract: International audience; Aims : In the context of recent concerns regarding performance enhancing techniques and potential negative health effects of high-level physical activity, data on the long-term outcomes and causes of death in elite endurance cyclists are of particular interest. Methods and results : Characteristics and vital status of all French participants in the Tour de France were collected for the 1947–2012 period. Causes of death were obtained from 1968. Overall and disease-specific mortalities were compared with the French male population using overall and specific standardized mortality ratios (SMRs) with their 95% confidence intervals (CIs). Among the 786 French cyclists who participated at least once between 1947 and 2012, 208 (26%) died by 1 September 2012. Neoplasms and cardiovascular diseases accounted for 61% of deaths. We observed a 41% lower mortality in French cyclists (SMR: 0.59, 95% CI: 0.51– 0.68, P , 0.0001), which did not change over time (P = 0.70). It was observed for main mortality causes: for neoplasms (SMR: 0.56; 95% CI: 0.42–0.72, P , 0.0001) and for cardiovascular death (SMR: 0.67; 95% CI: 0.50– 0.88, P = 0.004), except mortality related to external causes (SMR: 1.06, 95% CI: 0.71 –1.53, P = 0.80). Conclusion : We observed a substantially and significantly lower mortality in participants in the Tour de France, compared with the general male population. However, our results do not allow us to assess in detail the balance between positive effects of high-level sports activity and selection of healthy elite athletes, vs. any potential deleterious effects of excessive physical exercise or alleged doping.
Published: 2013

165. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry

Author: José M. de la Torre Hernández, Nicolas Dumonteil, Jean Claude Laborde, Christian Hengstenberg, Danny Dvir, Henrik Nissen, Massimo Napodano, Andreas Baumbach, Thierry Lefèvre, Rui Campante Teles, Amit Segev, Raffi Bekeredjian, Victor Guetta, Didier Tchetche, David Roy, Neil Moat, Stephen Brecker, Federico De Marco, John G. Webb, Fleur Descoutures, Luca Testa, Antonio Colombo, Claudia Fiorina, David Hildick-Smith, Sabine Bleiziffer, Mohamed Abdel-Wahab, Ran Kornowski, Michael Gotzmann, [Dvir,D] Washington Hospital Center, Washington, USA. [Dvir,D, Kornowski,R] Rabin Medical Center and Tel-Aviv University, Tel-Aviv, Israel. [Webb,J] St. Paul's Hospital, Vancouver, British Columbia, Canada. [Brecker,S, Roy,D, Laborde,JC] St. George's Hospital, London, United Kingdom. [Bleiziffer,S] German Heart Center, Munich, Germany. [Hildick-Smith,D] Sussex Cardiac Centre, Brighton, UK. [Colombo,A] San Raffaele Scientific Institute, Milan, Italy. [Descoutures,F] Hospital Bichat, Paris, France. [Hengstenberg,C] Universitaetsklinikum Regensburg, Regensburg, Germany. [Moat,NE] Royal Brompton Hospital, London, United Kingdom. [Bekeredjian,R] University of Heidelberg, Heidelberg, Germany. [Napodano,M] Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy. [Testa,L] Clinical Institute S. Ambrogio, Milan, Italy. [Lefevre,T] Hopital Jacques Cartier, Massy, France. [Guetta,V, and Sergev,A] Sheba Medical Center, Tel Hashomer, Israel. [Nissen,H] Odense University Hospital, Odense, Denmark. [Hernández,JM] Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Teles,RC] Hospital de Santa Cruz, Lisboa, Portugal. [Dumonteil,N] Rangueil University Hospital, Toulouse, France. [Fiorina,C] Azienda Ospedaliere Spedali Civili di Brescia, Brescia, Italy. [Gotzmann,M] Bergmannsheil Ruhr University, Bochum, Germany. [Tchetche,D] Clinique Pasteur, Toulouse, France. [Abdel-Wahab,M] Segeberger Kliniken GmbH, Bad Segeberg, Germany. [De Marco,F] Ospedale Niguarda Ca' Granda, Milan, Italy. [Baumbach,A] Bristol Heart Institute, Bristol, United Kingdom.
Subjects: Male, Cardiac Catheterization, medicine.medical_treatment, Diseases::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve Stenosis [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Prostheses and Implants::Heart Valve Prosthesis [Medical Subject Headings], Global Health, New york heart association, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Prótesis Valvulares Cardíacas, Valve replacement, 80 and over, Medicine, Registries, Aged, 80 and over, Heart Valve Prosthesis Implantation, Incidence, Estenosis de la Válvula Aórtica, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Prostheses and Implants::Bioprosthesis [Medical Subject Headings], Treatment Outcome, Aortic Valve, Heart Valve Prosthesis, Diseases::Cardiovascular Diseases::Vascular Diseases::Arterial Occlusive Diseases::Arteriosclerosis::Coronary Artery Disease [Medical Subject Headings], Cardiology, Diseases::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve Insufficiency [Medical Subject Headings], Equipment Failure, Female, Insuficiencia de la Válvula Aórtica, Cardiology and Cardiovascular Medicine, Reoperation, valve-in-valve, medicine.medical_specialty, Transcatheter aortic, Resultado del Tratamiento, Aortic Valve Insufficiency, Regurgitation (circulation), Enfermedad de la Arteria Coronaria, Physiology (medical), Internal medicine, Humans, bioprosthesis, transcatheter aortic valve implantation, Aged, Aortic Valve Stenosis, Bioprosthesis, Follow-Up Studies, Retrospective Studies, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Endovascular Procedures::Catheterization, Central Venous [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], Transcatheter aortic valve implantation, business.industry, Cateterismo Venoso Central, Retrospective cohort study, Surgical valves, medicine.disease, Valve in valve, Surgery, Stenosis, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures [Medical Subject Headings], Valve-in-valve, business, Implantación de Prótesis de Válvulas Cardíacas
Abstract: Background— Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry. Methods and Results— The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (aged 77.7±10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n=85; 42%), regurgitation (n=68; 34%), or combined stenosis and regurgitation (n=49; 24%). Implanted devices included CoreValve (n=124) and Edwards SAPIEN (n=78). Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases and ostial coronary obstruction in 3.5%. After the procedure, valve maximum/mean gradients were 28.4±14.1/15.9±8.6 mm Hg, and 95% of patients had ≤+1 degree of aortic regurgitation. At 30-day follow-up, all-cause mortality was 8.4%, and 84.1% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients. Conclusions— The valve-in-valve procedure is clinically effective in the vast majority of patients with degenerated bioprosthetic valves. Safety and efficacy concerns include device malposition, ostial coronary obstruction, and high gradients after the procedure.
Published: 2012

166. An optimized calibration method for surface measurements with MOSFETs in shaped-beam radiosurgery

Author: A. Sors, I. Latorzeff, Jean-Albert Lotterie, Isabelle Berry, Xavier Franceries, J. Sabatier, A. Redon, P. Duthil, E. Cassol, Clinique Pasteur [Toulouse], Imagerie cérébrale et handicaps neurologiques (ICHN), Institut des sciences du cerveau de Toulouse. (ISCT), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de Rangueil, and CHU Toulouse [Toulouse]
Subjects: Transistors, Electronic, Surface Properties, Biophysics, Inverse-square law, General Physics and Astronomy, Radiosurgery, Imaging phantom, Optics, MOSFET, Calibration, Electronic engineering, Dosimetry, Humans, Radiology, Nuclear Medicine and imaging, Radiometry, ComputingMilieux_MISCELLANEOUS, Physics, Dosimeter, business.industry, Phantoms, Imaging, Attenuation, [SCCO.NEUR]Cognitive science/Neuroscience, Isocenter, Oxides, General Medicine, Metals, business
Abstract: Nowadays MOSFET dosimeters are widely used for dose verification in radiotherapy procedures. Although their sensitive area satisfies size requirements for small field dosimetry, their use in radiosurgery has rarely been reported. The aim of this study is to propose and optimize a calibration method to perform surface measurements in 6 MV shaped-beam radiosurgery for field sizes down to 18 × 18 mm(2). The effect of different parameters such as recovery time between 2 readings, batch uniformity and build-up cap attenuation was studied. Batch uniformity was found to be within 2% and isocenter dose attenuation due to the build-up cap over the MOSFET was near 2% irrespective of field size. Two sets of sensitivity coefficients (SC) were determined for TN-502RD MOSFET dosimeters using experimental and calculated calibration; the latter being developed using an inverse square law model. Validation measurements were performed on a realistic head phantom in irregular fields. MOSFET dose values obtained by applying either measured or calculated SC were compared. For calibration, optimal results were obtained for an inter-measurement time lapse of 5 min. We also found that fitting the SC values with the inverse square law reduced the number of measurements required for calibration. The study demonstrated that combining inverse square law and Sterling-Worthley formula resulted in an underestimation of up to 4% of the dose measured by MOSFETs for complex beam geometries. With the inverse square law, it is possible to reduce the number of measurements required for calibration for multiple field-SSD combinations. Our results suggested that MOSFETs are suitable sensors for dosimetry when used at the surface in shaped-beam radiosurgery down to 18 × 18 mm(2).
Published: 2012

167. Validation of the european society of urogenital radiology scoring system for prostate cancer diagnosis on multiparametric magnetic resonance imaging in a cohort of repeat biopsy patients

Author: Raphaëlle Renard-Penna, Matthieu Thoulouzan, Daniel Portalez, Vincent Misrai, Bernard Malavaud, François Cornud, Pierre Mozer, Clinique Pasteur [Toulouse], CHU Pontchaillou [Rennes], Département d'urologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'Hématologie [IUCT Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [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), Institut des Systèmes Intelligents et de Robotique (ISIR), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Assistance aux Gestes et Applications THErapeutiques (AGATHE), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Hématologie - IUCT-Oncopole [CHU Toulouse], Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle IUCT [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, medicine.medical_specialty, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Urology, 030232 urology & nephrology, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, [SPI.AUTO]Engineering Sciences [physics]/Automatic, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, Biopsy, Medicine, Humans, Prospective Studies, Prospective cohort study, Yates's correction for continuity, Multiparametric Magnetic Resonance Imaging, ComputingMilieux_MISCELLANEOUS, Aged, medicine.diagnostic_test, Receiver operating characteristic, business.industry, Biopsy, Needle, Prostatic Neoplasms, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, 3. Good health, 030220 oncology & carcinogenesis, Mann–Whitney U test, Radiology, business
Abstract: Wide variations in acquisition protocols and the lack of robust diagnostic criteria make magnetic resonance imaging (MRI) detection of prostate cancer (PCa) one of the most challenging fields in radiology and urology.To validate the recently proposed European Society of Urogenital Radiology (ESUR) scoring system for multiparametric MRI (mpMRI) of the prostate.An institutional review board-approved multicentric prospective study; 129 consecutive patients (1514 cores) referred for mpMRI after at least one set of negative biopsies.Transfer of mpMRI-suspicious areas on three-dimensional (3D) transrectal ultrasound images by 3D elastic surface registration; random systematic and targeted cores followed by core-by-core analysis of pathology and mpMRI characteristics of the core locations. The ESUR scores were assigned after the procedure on annotated Digital Imaging and Communications in Medicine archives.Relationships between ESUR scores and biopsy results were assessed by the Mann-Whitney U test. The Yates correction and Pearson χ(2) tests evaluated the association between categorical variables. A teaching set was randomly drawn to construct the receiver operating characteristic curve of the ESUR score sum (ESUR-S). The threshold to recommend biopsy was obtained from the Youden J statistics and tested in the remaining validation set in terms of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.Higher T2-weighted, dynamic weighted imaging and dynamic contrast-enhanced ESUR scores were observed in areas yielding cancer-positive cores. The proportion of positive cores increased with the ESUR-S aggregated in five increments (ESUR-S 3-5: 2.9%; ESUR-S 6-8: 11.1%; ESUR-S 9-10: 38.2%; ESUR-S 11-12: 63.4%; and ESUR-S 13-15: 83.3%; p0.0001). A threshold of ESUR-S ≥ 9 exhibited the following characteristics: sensitivity: 73.5%; specificity: 81.5%; positive predictive value: 38.2%; negative predictive value: 95.2%; and accuracy: 80.4%. Although the study was not designed to compare repeat biopsy strategies, more targeted cores than random systematic cores were found to be positive for cancer (36.3% compared with 4.9%, p0.00001).In the challenging situation of repeat biopsies, the ESUR scoring system was shown to provide clinically relevant stratification of the risk of showing PCa in a given location.
Published: 2012

168. Interventricular delay measurement using equilibrium radionuclide angiography before resynchronization therapy should be performed outside the area of segmental wall motion abnormalities

Author: Danchin, N., Fauchier, Laurent, Marijon, E., Barnay, C., Furber, A., Mabo, P., Bernard, P., Blanc, J.-J., Jouven, X., Le Heuzey, J.-Y., Charbonnier, B., Ferrieres, J., Simon, T., Courtehoux, Maxime, Zannad, Noura, Babuty, Dominique, Eder, Veronique, Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), EDF (EDF), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Dpt Cardiologie [CHU Georges Pompidou], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Orange Labs [Lannion], France Télécom, Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Laboratoire de physiopathologie de la paroi artérielle, and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: musculoskeletal diseases, Male, medicine.medical_specialty, medicine.medical_treatment, Heart Ventricles, Movement, Cardiomyopathy, Cardiac resynchronization therapy, [SHS]Humanities and Social Sciences, Cardiac Resynchronization Therapy, QRS complex, Radionuclide angiography, Internal medicine, medicine, Segmental wall motion, Humans, Radiology, Nuclear Medicine and imaging, In patient, cardiovascular diseases, Aged, Heart Failure, Ejection fraction, medicine.diagnostic_test, business.industry, Gated Blood-Pool Imaging, Stroke Volume, General Medicine, musculoskeletal system, medicine.disease, Biomechanical Phenomena, medicine.anatomical_structure, Treatment Outcome, Ventricle, cardiovascular system, Cardiology, Female, Nuclear medicine, business, circulatory and respiratory physiology
Abstract: The aim of this study was to demonstrate that only mechanical dyssynchrony outside the area of segmental wall motion abnormalities (WMA) can be reduced by cardiac resynchronization therapy (CRT). Included in the study were 28 consecutive patients with nonischaemic cardiomyopathy selected for CRT. Equilibrium radionuclide angiography (ERNA) was carried out before and after implantation of a multisite pacemaker. Patients were separated into two groups depending on the presence or absence of segmental WMA. A reduction in QRS duration was observed in all patients after CRT. The interventricular delay (IVD) decreased significantly after CRT only in patients without WMA (homogeneous contraction, HG group; IVD 44 ± 11.4° vs. 17 ± 3.1°, p = 0.04). In contrast, no significant decrease was observed in patients with WMA (WMA group; IVD 51 ± 6° vs. 38 ± 6°, p NS). However, when dyssynchrony was considered outside the WMA area, a significant reduction in IVD was obtained, in the same range as in the HG group (IVD 32 ± 3° vs. 19 ± 3°, p = 0.04). In 9 of 15 patients (60%) with a reduction in IVD after CRT, the left ventricle ejection fraction (LVEF) increased by about +10%. In contrast, in 13 of 13 patients (100%) with no reduction in IVD, no modification of LVEF was obtained. In the presence of segmental WMA without significant delays outside the WMA area, no reduction in IVD was observed and LVEF did not increase (IVD 34 ± 5° before CRT vs. 37 ± 7° after CRT; LVEF 19 ± 4% before CRT vs. 22 ± 3% after CRT, p NS). ERNA can be used to predict good mechanical resychronization (decrease in IVD) in patients after pacing. IVD has to be determined excluding the area of WMA in order to select patients who will show an increase in their left ventricle function after CRT.
Published: 2011

169. Frequency of atrial tachyarrhythmias in patients treated by cardiac resynchronization (from the Prospective, Multicenter Mona Lisa Study)

Author: Eloi, Marijon, Sophie, Jacob, Elisabeth, Mouton, Pascal, Defaye, Olivier, Piot, Nicolas, Delarche, Stéphane, Dennetiere, Daniel, Galley, Pierre, Le Franc, Ursula, Appl, Yves, Guyomar, Jean Paul, Albenque, Philippe, Chevalier, Serge, Boveda, J, Hörnsten, Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Laboratoire d'épidémiologie des rayonnements ionisants (LEPID), Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre cardiologique du Nord (CCN), Centre hospitalier de Pau, Centre Hospitalier de Roubaix, Centre Hospitalier d 'Albi, Clinique Saint-Hilaire [Rouen], Hôpital Saint Philibert [Lomme], Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hôpital Louis Pradel [CHU - HCL], and Hospices Civils de Lyon (HCL)
Subjects: artificial heart pacemaker, Male, Pacemaker, Artificial, Time Factors, medicine.medical_treatment, very elderly, [SDV]Life Sciences [q-bio], Mean QRS Duration, cardiac resynchronization therapy, heart failure, heart pacing, 030204 cardiovascular system & hematology, Cohort Studies, 0302 clinical medicine, cardioversion, Tachycardia, middle aged, 80 and over, Sinus rhythm, 030212 general & internal medicine, pathophysiology, time, Aged, 80 and over, Ejection fraction, sinus rhythm, adult, Incidence, Hazard ratio, Cardiac Pacing, Artificial, article, clinical trial, cohort analysis, 3. Good health, Pacemaker, female, priority journal, supraventricular tachycardia, Artificial, Cardiology, Cardiology and Cardiovascular Medicine, Cohort study, Tachycardia, Ectopic Atrial, medicine.medical_specialty, electrocardiography, Cardiac resynchronization therapy, Electric Countershock, complication, 03 medical and health sciences, Internal medicine, Ambulatory, medicine, electrography, follow up, Humans, human, reproducibility, Aged, business.industry, Reproducibility of Results, medicine.disease, major clinical study, Confidence interval, multicenter study, Ectopic Atrial, Heart failure, Electrocardiography, Ambulatory, Cardiac Pacing, business, heart left ventricle ejection fraction
Abstract: cited By 13; The continuous measurement of sustained atrial tachyarrhythmia (AT) is now possible with some permanently implanted devices. Data on this subject remain controversial. The aim of this study was to evaluate the incidence of sustained AT in patients treated with cardiac resynchronization therapy using pacemakers without backup defibrillators (CRT-P), within the first year after implantation, using strict definition criteria for sustained AT and a systematic review of all high-quality electrographically recorded episodes. The Mona Lisa study was a prospective, multicenter, cohort study carried out from February 2004 to February 2006, with a 12-month follow-up period. Sustained AT was defined as an episode lasting
Published: 2010

170. Occupational cataracts and lens opacities in interventional cardiology (O'CLOC study): are X-Rays involved? Radiation-induced cataracts and lens opacities

Author: Jacob, Sophie, Michel, Morgane, Spaulding, Christian, Boveda, Serge, Bar, Olivier, Brézin, Antoine, Streho, Maté, Maccia, Carlo, Scanff, Pascale, Laurier, Dominique, Bernier, Marie-Odile, Radiobiologie et épidémiologie (DRPH/SRBE), Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Epidémiologie cardiovasculaire et mort subite, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Clinique St Gatien et Groupe Athérome Cardiologie Interventionnelle/SF, Clinique St Gatien, Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Unité de Suivi et d'analyses des Expositions Professionnelles, IRSN - DRPH/SER, This work is supported by a public source of funding: an IRSN grant., BMC, Ed., Service de RadioBiologie et d'Epidémiologie (IRSN/DRPH/SRBE), Unité de Suivi et d'analyses des Expositions Professionnelles (IRSN/DRPH/SER/USEP), Service d'études et d'expertise en radioprotection (IRSN/DRPH/SER), Institut de Radioprotection et de Sûreté Nucléaire (IRSN)-Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Radiobiologie et épidémiologie ( DRPH/SRBE ), Institut de Radioprotection et de Sûreté Nucléaire ( IRSN ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU Cochin [AP-HP], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)
Subjects: Adult, Male, MESH : Cataract, genetic structures, MESH : Male, MESH : Physicians, Cardiology, MESH: Radiation Injuries, Cataract, MESH: Occupational Exposure, MESH : Radiography, Study Protocol, MESH : Cross-Sectional Studies, MESH: Cross-Sectional Studies, Occupational Exposure, Physicians, Surveys and Questionnaires, Humans, MESH: Physicians, MESH : Female, Radiation Injuries, MESH: Radiography, MESH: Humans, MESH: Questionnaires, MESH : Radiation Injuries, MESH : Humans, MESH : Questionnaires, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Adult, MESH : Adult, eye diseases, MESH: Cardiology, MESH: Male, Radiography, MESH : Cardiology, MESH : Occupational Exposure, Cross-Sectional Studies, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Female, MESH: Cataract, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract: International audience; BACKGROUND: The eye is well known to be sensitive to clearly high doses (>2 Gy) of ionizing radiation. In recent years, however, cataracts have been observed in populations exposed to lower doses. Interventional cardiologists are repeatedly and acutely exposed to scattered ionizing radiation (X-rays) during the diagnostic and therapeutic procedures they perform. These "low" exposures may cause damage to the lens of the eye and induce early cataracts, known as radiation-induced cataracts. The O'CLOC study (Occupational Cataracts and Lens Opacities in interventional Cardiology) was designed to test the hypothesis that interventional cardiologists, compared with an unexposed reference group of non-interventional cardiologists, have an increased risk of cataracts. METHOD/DESIGN: The O'CLOC study is a cross-sectional study that will include a total of 300 cardiologists aged at least 40 years: one group of exposed interventional cardiologists and another of non-interventional cardiologists. The groups will be matched for age and sex. Individual information, including risk factors for cataracts (age, diabetes, myopia, etc.), will be collected during a telephone interview. A specific section of the questionnaire for the exposed group focuses on occupational history, including a description of the procedures (type, frequency, radiation protection tool) used. These data will be used to classify subjects into "exposure level" groups according to cumulative dose estimates. Eye examinations for all participants will be performed to detect cataracts, even in the early stages (lens opacities, according to LOCS III, the international standard classification). The analysis will provide an estimation of the cataract risk in interventional cardiology compared with the unexposed reference group, while taking other risk factors into account. An analysis comparing the risks according to level of exposure is also planned. DISCUSSION: This epidemiological study will provide further evidence about the potential risk of radiation-induced cataracts at low doses and contribute to cardiologists' awareness of the importance of radiation protection. TRIAL REGISTRATION: NCT01061463.
Published: 2010

171. Feasibility and Safety of Same-Day Home Discharge After Radiofrequency Catheter Ablation

Author: Marc Zimmermann, Jean-Paul Albenque, Eloi Marijon, Serge Boveda, Mathieu Schmutz, Agustín Bortone, Nicolas Combes, Sophie Jacob, Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Hôpital de la Tour, Laboratoire d'épidémiologie des rayonnements ionisants (LEPID), and Institut de Radioprotection et de Sûreté Nucléaire (IRSN)
Subjects: Tachycardia, Male, Time Factors, patient satisfaction, medicine.medical_treatment, clinical evaluation, [SDV]Life Sciences [q-bio], Left, 030204 cardiovascular system & hematology, Arrhythmias, vascular surgery, Ventricular Function, Left, Cohort Studies, 0302 clinical medicine, ambulatory care, hospital readmission, blood analysis, catheter ablation, 80 and over, Odds Ratio, Ventricular Function, postoperative complication, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, arteriovenous fistula, Aged, 80 and over, adult, article, hematoma, feasibility study, Middle Aged, cohort analysis, femoral artery, 3. Good health, Pulmonary embolism, Cardiac surgery, aged, female, multivariate analysis, Treatment Outcome, priority journal, supraventricular tachycardia, health insurance, medical care, cardiovascular system, France, medicine.symptom, Safety, Cardiology and Cardiovascular Medicine, lung embolism, Cardiac, Switzerland, prospective study, medicine.medical_specialty, Adolescent, electrocardiography, heart arrhythmia, blood transfusion, thrombocyte count, surgical technique, 03 medical and health sciences, transthoracic echocardiography, Young Adult, clinical examination, Angioplasty, medicine, Confidence Intervals, follow up, Humans, human, atrioventricular junction arrhythmia, Atrial tachycardia, cost control, Interventional cardiology, business.industry, Arrhythmias, Cardiac, Stroke Volume, medicine.disease, major clinical study, false aneurysm, Surgery, hospital discharge, Logistic Models, Ambulatory Surgical Procedures, hemostasis, Feasibility Studies, business, Atrial flutter, heart atrium flutter
Abstract: Interventional cardiology in a day-case setting might reduce logistic constraints on hospital resources. However, in contrast with coronary angioplasty, few data support the feasibility and safety of radiofrequency catheter ablation (RCA). The aim of this prospective, multicenter cohort study was to evaluate the feasibility and safety of RCA in 1,342 patients (814 men; mean age 57 ± 17 years) considered eligible for ambulatory RCA, according to specific set of criteria, for common atrial flutter (n = 632), atrioventricular nodal reentrant tachycardia (n = 436), accessory pathways (n = 202), and atrial tachycardia (n = 72). Patients suitable for early discharge (4 to 6 hours after uncomplicated RCA) were scheduled for 1-month follow-up. Predictive factors for delayed complications were studied by multivariate analysis. Of the 1,342 enrolled patients, 1,270 (94.6%) were discharged the same day and followed for 1 month; no deaths occurred, and the readmission rate was 0.79% (95% confidence interval 0.30% to 1.27%). Six patients had significant puncture complications, 2 presented with symptomatic delayed pulmonary embolism, and 2 had new onset of poorly tolerated atrial flutter. None of these complications was life threatening. Multivariate analysis did not identify any significant independent predictors for delayed complications. In conclusion, these data suggest that same-day discharge after uncomplicated RCA for routine supraventricular arrhythmias is safe and may be applicable in clinical practice. This approach is known to be associated with significant patient satisfaction and cost savings and can be considered a first-line option in most patients who undergo routine ablation procedures. © 2009 Elsevier Inc. All rights reserved.
Published: 2009

172. Striking phenotypic variability in two familial cases of myosin storage myopathy with a MYH7 Leu1793pro mutation

Author: Pascale Richard, Marie-Christine Arne-Bes, Marie-Bernadette Delisle, Thierry Levade, Dominique Figarella-Branger, François Heitz, Jean-François Pellissier, Emmanuelle Uro-Coste, Service d'anatomie pathologique et histologie-cytologie [Rangueil], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Institut de médecine moléculaire de Rangueil (I2MR), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Neurologie et Explorations Fonctionnelles du Système Nerveux [Toulouse], Service de pathologie et neuropathologie, Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Biochimie [Purpan], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Clinique Pasteur, Clinique Pasteur [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Laboratoire de Biochimie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], and Simon, Marie Francoise
Subjects: DNA Mutational Analysis, Physiology, MESH: Myosin Heavy Chains, MESH: Genotype, 0302 clinical medicine, Myosin, MESH: Genetic Variation, MESH: DNA Mutational Analysis, MESH: Cardiac Myosins, Index case, Genetics (clinical), media_common, 0303 health sciences, Daughter, MESH: Muscle, Skeletal, MESH: Middle Aged, MESH: Genetic Predisposition to Disease, Heart, Middle Aged, MESH: Amino Acid Substitution, medicine.anatomical_structure, Phenotype, Neurology, MESH: Young Adult, Mutation (genetic algorithm), Muscle Hypotonia, Female, Cardiomyopathies, medicine.medical_specialty, Proximal muscle weakness, MESH: Mutation, MESH: Myocardium, Genotype, Proline, media_common.quotation_subject, Biology, MESH: Phenotype, 03 medical and health sciences, Young Adult, Muscular Diseases, Leucine, Internal medicine, medicine, Humans, Genetic Predisposition to Disease, Muscle, Skeletal, 030304 developmental biology, MESH: Proline, MESH: Humans, Myosin Heavy Chains, MESH: Muscle Hypotonia, Myocardium, MESH: Muscular Diseases, Skeletal muscle, Genetic Variation, MESH: Heart, Endocrinology, MESH: Leucine, Amino Acid Substitution, MESH: Cardiomyopathies, Pediatrics, Perinatology and Child Health, Mutation, MYH7, Neurology (clinical), Age of onset, Cardiac Myosins, MESH: Female, 030217 neurology & neurosurgery
Abstract: International audience; Myosin Storage Myopathies (MSM) have emerged as a new group of inherited myopathies with heterogenous clinical severity and age of onset. We have identified in a woman and her daughter, a pLeu1793Pro mutation in MYH7. This mutation has already been reported to be associated with MSM presenting as neonatal hypotony. Our index case complained of proximal muscle weakness at age 30. Her daughter presented at birth with a cardiomyopathy without any skeletal muscle involvement. This report underlines the clinical variability of MSM even with a given mutation or in a same family.
Published: 2009

173. Differential display fingerprints: new approach to characterize smooth muscle cells and human coronary atherectomy tissues

Author: Francis Bayard, Yves Glock, François Heitz, Elizabeth Caussé, Meyer Elbaz, Nelly Blaes, Jacques Puel, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service de cardiologie pédiatrique, Clinique Pasteur [Toulouse], Laboratoire de Biochimie [Purpan], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Hormones, facteurs de croissance et physiopathologie vasculaire, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR 31 Louis Bugnard (IFR 31), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Laboratoire de Biochimie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), IFR 31 Louis Bugnard (IFR 31), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Simon, Marie Francoise
Subjects: Cell type, Pathology, medicine.medical_specialty, Inflammation, Coronary Artery Disease, Biology, MESH: Phenotype, Sensitivity and Specificity, Muscle, Smooth, Vascular, MESH: Gene Expression Profiling, MESH: Reverse Transcriptase Polymerase Chain Reaction, medicine, MESH: DNA Fingerprinting, Humans, Myocyte, MESH: Coronary Artery Disease, Differential display, MESH: Humans, Reverse Transcriptase Polymerase Chain Reaction, Vascular disease, Gene Expression Profiling, General Medicine, MESH: Muscle, Smooth, Vascular, medicine.disease, DNA Fingerprinting, Phenotype, MESH: Sensitivity and Specificity, Gene expression profiling, Cell culture, medicine.symptom
Abstract: International audience; AIM OF THE STUDY: Smooth muscle cells build up the normal media and stabilize atherosclerotic lesions whereas an inflammatory component is determinant for unstable angina. Smooth muscle cells, currently identified by alpha-actin, present a phenotypic heterogeneity and alpha-actin can be reduced in pathology. We tried to characterize vascular cell types, particularly smooth muscle cells, and coronary atherosclerotic tissues, by random genes expression fingerprints. MATERIALS AND METHODS: Expression fingerprints (cDNA electrophoresis) were performed by differential display reverse transcriptase-polymerase chain reaction. Variability of fingerprints was studied for a panel of arterial muscle cell phenotypes and comparisons were made with fingerprints from other cell types (endothelial cells and macrophages). The technique was then applied to human coronary atherectomy samples compared to control human arterial (mammary) smooth muscle. RESULTS: Arterial smooth muscle cells fingerprints were overall similar whatever the cell phenotype (native contractile, dedifferentiated in culture or epithelioid). Moreover, with two primer pairs, the muscular fingerprints markedly differed from the endothelial and the monocytic fingerprints. Application of differential display to coronary atherectomy samples was feasible. Interestingly, the pathological tissues exhibited either smooth muscle-like or smooth muscle-divergent fingerprints. CONCLUSIONS: Smooth muscle cells and inflammatory cells exhibited distinct differential display fingerprint patterns. Thus, a simple expression profile of arbitrary genes provides a molecular bar code tool (pattern signature) useful to characterize vascular cell cultures or tissues. The present work proposes a method to analyze coronary atherectomy samples which estimates their whole quality, muscular versus non muscular (inflammatory), this is of interest for clinical research.
Published: 2007

174. Whole-body strength training with Huber Motion Lab and traditional strength training in cardiac rehabilitation: A randomized controlled study

Author: Atul Pathak, Daniel Rivière, Fabien Pillard, Marc Labrunee, Mathieu Gayda, Thibaut Guiraud, Vincent Gremeaux, Frédéric Sanguignol, Davy Laroche, Jean-Michel Senard, Florent Besnier, L. Richard, Réeducation Cardio-Vasculaire et Pulmonaire [Clinique de Saint-Orens], Clinique Saint-Orens, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de médecine physique et réadaptation [Hôpital Rangueil - Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service d'exploration de la fonction respiratoire et de médecine du sport, CHU Toulouse [Toulouse], Pôle Rééducation - Réadaptation (Médecine Physique et Réadaptation) (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] (CAPS), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinique de Bondigoux, Clinique Pasteur, Clinique Pasteur [Toulouse], Montreal Heart Institute - Institut de Cardiologie de Montréal, Centre EPIC [Institut de Cardiologie de Montréal], Université de Montréal (UdeM)-Montreal Heart Institute - Institut de Cardiologie de Montréal, Institut des Maladies Métaboliques et Cardiovasculaires ( I2MC ), Université Paul Sabatier - Toulouse 3 ( UPS ) -Hôpital de Rangueil-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] ( CAPS ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), and Université de Montréal [Montréal]-Montreal Heart Institute - Institut de Cardiologie de Montréal
Subjects: Adult, Male, medicine.medical_specialty, Strength training, medicine.medical_treatment, Cardiac rehabilitation, Coronary Disease, Isometric exercise, 030204 cardiovascular system & hematology, Isometric contraction, law.invention, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Randomized controlled trial, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, law, Heart rate, Humans, Medicine, Orthopedics and Sports Medicine, Muscle Strength, Muscle, Skeletal, Exercise, Aged, Rehabilitation, business.industry, Resistance training, Resistance Training, 030229 sport sciences, Middle Aged, Anthropometry, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Chest Press, Physical therapy, Female, business
Abstract: International audience; BACKGROUND:Isometric strengthening has been rarely studied in patients with coronary heart disease (CHD), mainly because of possible potential side effects and lack of appropriate and reliable devices.OBJECTIVE:We aimed to compare 2 different modes of resistance training, an isometric mode with the Huber Motion Lab (HML) and traditional strength training (TST), in CHD patients undergoing a cardiac rehabilitation program.DESIGN:We randomly assigned 50 patients to HML or TST. Patients underwent complete blinded evaluation before and after the rehabilitation program, including testing for cardiopulmonary exercise, maximal isometric voluntary contraction, endothelial function and body composition.RESULTS:After 4 weeks of training (16 sessions), the groups did not differ in body composition, anthropometric characteristics, or endothelial function. With HML, peak power output (P=0.035), maximal heart rate (P
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175. Left ventricular diastolic function during the first month of life

Author: A M Carceller, Jean-Claude Fouron, André Davignon, F. Heitz, N H van Doesburg, Gilles R. Ducharme, Clinique Pasteur, Clinique Pasteur [Toulouse], Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Centre Hospitalier Universitaire Sainte-Justine, Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université de Lille, Sciences Humaines et Sociales, and Centre hospitalier universitaire Sainte-Justine [Montréal, Canada]
Subjects: medicine.medical_specialty, business.industry, Infant, Newborn, 030204 cardiovascular system & hematology, 03 medical and health sciences, Myocardial relaxation, 0302 clinical medicine, [MATH.MATH-ST]Mathematics [math]/Statistics [math.ST], Diastole, Echocardiography, Heart Rate, 030225 pediatrics, Internal medicine, Pediatrics, Perinatology and Child Health, Cardiology, Medicine, Humans, Ventricular Function, Diastolic function, business, Developmental Biology
Abstract: In order to assess possible changes in myocardial relaxation occurring during the neonatal period, M-mode echocardiograms were recorded serially in 9 normal term infants and in another group of 10 one-month-old infants. The tracings were studied with an M-mode calculator. Although individual variations were greater in the data collected during the first 24 h, no significant difference was found in the indices of diastolic function of the left ventricle during the first 4 days of age. The following changes were observed between data recorded at 4 days and 1 month, respectively: normalized peak rate of left ventricle filling, 4.03 vs. 4.71 cm/s; diastolic peak velocity of early posterior motion of aortic root, 1.89 vs. 5.15 cm/s; peak velocity of left ventricle posterior wall motion in diastole, 3.31 vs. 3.50 cm/s; mitral valve EF slope, 59.05 vs. 84.92 mm/s; left ventricle isometric relaxation time, 43.88 vs. 28.50 ms. In conclusion: (1) greater individual variations are observed in indices of left ventricle diastolic function during the first day of life, and (2) significant increase in left ventricle compliance occurs during the first month of life. These changes should play a critical role in the clinical course of newborn with cardiopulmonary disease.
Published: 1988

176. Phase II study of preoperative radiation plus concurrent daily tegafur-uracil (UFT) with leucovorin for locally advanced rectal cancer

Author: Erick Gamelin, Christian Chevelle, Pascal Burtin, Christian Carrie, Véronique Vendrely, Patrice Cellier, Augustin Salemkour, Virginie Berger, Michèle Boisdron-Celle, Bernard Leduc, Gilles Calais, Alain Morel, B. Vie, Loïc Campion, Laurent Martin, Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Centre Hospitalier, Centre Hospitalier Brive-la-Gaillarde, Centre Guillaume le Conquérant, Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Clinique Pasteur, Clinique Pasteur [Toulouse], Groupe Hospitalier Saint-André, Groupe hospitalier Saint-André, Centre d'Onco-Radiothérapie d'Eure et Loire, Centre d'Onco-Radiothérapie d'Eure et Loire-Institut national du cancer [Boulogne] (INCA), Centre Léon Bérard [Lyon], Clinique d'Oncologie et de Radiothérapie (CORAD), CHU Bretonneau-Clinique d'Oncologie et de Radiothérapie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre René Gauducheau, CRLCC René Gauducheau, Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), This work was supported in part by a grant from Bristol Myers-Squibb Oncology., BMC, Ed., Centre de radiothérapie Guillaume le Conquérant (CGLC), and Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)
Subjects: Male, Cancer Research, Colorectal cancer, medicine.medical_treatment, Leucovorin, Phases of clinical research, Tegafur/uracil, Gastroenterology, 0302 clinical medicine, Antineoplastic Combined Chemotherapy Protocols, Medicine, Aged, 80 and over, 0303 health sciences, Middle Aged, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Combined Modality Therapy, 3. Good health, Tolerability, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Preoperative Period, Female, Research Article, medicine.drug, Adult, medicine.medical_specialty, Adolescent, [SDV.CAN]Life Sciences [q-bio]/Cancer, Adenocarcinoma, Tegafur, lcsh:RC254-282, Young Adult, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, Dihydropyrimidine dehydrogenase, Genetics, Humans, Uracil, Aged, 030304 developmental biology, Rectal Neoplasms, business.industry, medicine.disease, Surgery, Radiation therapy, Radiotherapy, Adjuvant, business, Chemoradiotherapy
Abstract: Background Considerable variation in intravenous 5-fluorouracil (5-FU) metabolism can occur due to the wide range of dihydropyrimidine dehydrogenase (DPD) enzyme activity, which can affect both tolerability and efficacy. The oral fluoropyrimidine tegafur-uracil (UFT) is an effective, well-tolerated and convenient alternative to intravenous 5-FU. We undertook this study in patients with locally advanced rectal cancer to evaluate the efficacy and tolerability of UFT with leucovorin (LV) and preoperative radiotherapy and to evaluate the utility and limitations of multicenter staging using pre- and post-chemoradiotherapy ultrasound. We also performed a validated pretherapy assessment of DPD activity and assessed its potential influence on the tolerability of UFT treatment. Methods This phase II study assessed preoperative UFT with LV and radiotherapy in 85 patients with locally advanced T3 rectal cancer. Patients with potentially resectable tumors received UFT (300 mg/m/2/day), LV (75 mg/day), and pelvic radiotherapy (1.8 Gy/day, 45 Gy total) 5 days/week for 5 weeks then surgery 4-6 weeks later. The primary endpoints included tumor downstaging and the pathologic complete response (pCR) rate. Results Most adverse events were mild to moderate in nature. Preoperative grade 3/4 adverse events included diarrhea (n = 18, 21%) and nausea/vomiting (n = 5, 6%). Two patients heterozygous for dihydropyrimidine dehydrogenase gene (DPYD) experienced early grade 4 neutropenia (variant IVS14+1G > A) and diarrhea (variant 2846A > T). Pretreatment ultrasound TNM staging was compared with postchemoradiotherapy pathology TN staging and a significant shift towards earlier TNM stages was observed (p < 0.001). The overall downstaging rate was 42% for primary tumors and 44% for lymph nodes. The pCR rate was 8%. The sensitivity and specificity of ultrasound for staging was poor. Anal sphincter function was preserved in 55 patients (65%). Overall and recurrence-free survival at 3 years was 86.1% and 66.7%, respectively. Adjuvant chemotherapy was administered to 36 node-positive patients (mean duration 118 days). Conclusion Preoperative chemoradiotherapy using UFT with LV plus radiotherapy was well tolerated and effective and represents a convenient alternative to 5-FU-based chemoradiotherapy for the treatment of resectable rectal cancer. Pretreatment detection of DPD deficiency should be performed to avoid severe adverse events.
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177. Stent Underexpansion Is an Underestimated Cause of Intrastent Restenosis: Insights From RESTO Registry.

Author: Souteyrand G, Mouyen T, Honton B, Mulliez A, Lattuca B, Dilinger JG, Levesque S, Range G, Combaret N, Marliere S, Lamallem O, Quillot M, Gerbaud E, Motreff P, and Amabile N
Subjects: Humans, Male, Female, Middle Aged, Aged, Prospective Studies, Neointima, Treatment Outcome, Coronary Vessels diagnostic imaging, Coronary Vessels pathology, Coronary Artery Disease therapy, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Risk Factors, Time Factors, Incidence, Registries, Coronary Restenosis epidemiology, Coronary Restenosis etiology, Coronary Restenosis diagnostic imaging, Tomography, Optical Coherence, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Drug-Eluting Stents adverse effects
Abstract: Background: Despite improvement in devices, in-stent restenosis remains a frequent and challenging complication of percutaneous coronary interventions., Methods and Results: The RESTO (Morphological Parameters of In-Stent Restenosis Assessed and Identified by OCT [Optical Coherence Tomography]; study NCT04268875) was a prospective multicenter registry including patients presenting with coronary syndromes related to in-stent restenosis. All patients underwent preintervention OCT analysis, which led to analysis of in-stent restenosis phenotype, number of strut layers, and presence of stent underexpansion. The primary end point was the in-stent restenosis type according to the OCT morphological classification. The 1-year incidence of target vessel failure (a composite of death from cardiac causes, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization) was assessed. The study included 297 patients. The culprit stent was a drug-eluting stent in 74.2% of cases. OCT analysis revealed the presence of neoatherosclerosis in 57% (52% calcified), neointimal hyperplasia in 43% (58% homogeneous), stent underexpansion (minimal stent area <4.5 mm 2 ) in 43%, and multiple stent layers in 30%. The prepercutaneous coronary intervention OCT analysis modified the operator's strategy for management in 30% of cases. Treatment involved drug-eluting stent implantation in 61.6% and drug-eluting balloon angioplasty in 36.1% of cases with only 63.2% optimal results. The 1-year target vessel failure incidence was 11% (95% CI, 9%-13%). Residual postpercutaneous coronary intervention stent underexpansion was associated with significantly higher target vessel failure incidence (19% [95% CI, 14%-24%] versus 7% [95% CI, 5-9], P =0.01)., Conclusions: OCT identified neoatherosclerosis and neointimal hyperplasia in comparable proportions. Stent underexpansion was frequent and favored subsequent adverse clinical outcomes.
Published: 2024
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178. Refining the Prothrombotic State in Atrial Fibrillation with Left Atrial Appendage 3D Echocardiography.

Author: Soulat-Dufour L, Lang S, Ponnaiah M, Simon T, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Capderou E, Arnaud C, Sotto E, Cohen R, d'Izarny Gargas T, Scheuble A, Hammoudi N, Beraud AS, Addetia K, Boccara F, Lang RM, and Cohen A
Published: 2024
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179. Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion.

Author: Charbonneau H, Savy S, Savy N, Pasquié M, Mayeur N, Angles O, Balech V, Berthelot AL, Croute-Bayle M, Decramer I, Duterque D, Julien V, Mallet L, M'rini M, Quedreux JF, Richard B, Sidobre L, Taillefer L, Thibaud A, Abouliatim I, Berthoumieu P, Garcia O, Soula P, Vahdat O, Breil C, Brunel P, and Sciacca G
Subjects: Humans, Male, Female, Prospective Studies, Aged, Middle Aged, Anemia, Iron-Deficiency prevention & control, Hematinics administration & dosage, Anemia therapy, Quality Improvement, Iron Deficiencies, Cardiac Surgical Procedures adverse effects, Retrospective Studies, Iron administration & dosage, France, Length of Stay statistics & numerical data, Erythrocyte Transfusion statistics & numerical data, Elective Surgical Procedures adverse effects, Perioperative Care methods, Cardiopulmonary Bypass adverse effects
Abstract: Study Objective: The aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery., Design: Prospective, non-randomized, two-step protocol design., Setting: Cardiac surgery department of Clinique Pasteur, Toulouse, France., Patients: 897 patients undergoing for elective CPB surgery., Interventions: We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents., Measurements: The PBM program's effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed., Main Results: After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44-0.79] and 0.44 [95% CI 0.32-0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays., Conclusions: This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application., Competing Interests: Declaration of competing interest All the authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)
Published: 2024
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180. Corrigendum to "Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion" [J Clin Anesth. 2024 Nov:98:111560. doi:10.1016/j.jclinane.2024.111560. Epub 2024 Aug 14].

Author: Charbonneau H, Savy S, Savy N, Pasquié M, and Mayeur N
Published: 2024
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181. Polymer Everolimus-Eluting Stent as Bailout Stenting for Below-the-Knee Artery Repair in Patients with Critical Limb-Threatening Ischemia: A Real-World National Registry.

Author: Sebbag W, Sauguet A, Demicheli T, Declemy S, Lecorvec T, Brunet J, Della Schiava N, Sobocinski J, Steinmetz E, and Goueffic Y
Abstract: Objectives: Percutaneous old balloon angioplasty is still the preferred treatment for the treatment of below-the-knee (BTK) arteries in chronic limb-threatening ischemia (CLTI). In the case of a suboptimal angioplasty result, a bailout stenting is required. So far, few data are available to assess the outcomes of bailout stenting after BTK angioplasty. This study aims to investigate the 1-year efficacy and safety after implantation of a polymer everolimus-eluting stent (PEES) as bailout stenting for BTK repair in patients with CLTI in a real-world setting., Design: This was a national multicenter prospective observational study., Methods: Patients with CLTI (Rutherford 4 to 6) BTK lesions (including P3) and requiring a bailout PEES due to dissection, thrombosis, or residual stenosis ≥30% after angioplasty were included. The freedom of a major adverse limb event at 12 months of the target limb was the primary endpoint., Results: XIENCE assessed 106 limbs (CLTI, 96.2%; chronic total occlusion, 2.8%) in 106 patients (mean age 77.1 years; males, 71.7%; diabetes mellitus, 66.9%; chronic kidney failure, 36.8%) with CLTI undergoing PEES stenting as a bailout for BTK lesions. Bailout stenting was required after 75.5% and 26.4% of residual stenosis and dissection, respectively. The mean diameter and length of the PEES were 3 mm and 3.4 ± 0.5 cm, respectively. At 1 year, the freedom of a major adverse limb event was 79.6% (95% CI, 71.5%-88.7%), the major amputation rate was 6.2% (95% CI, 1.3%-11%), and the target revascularization rate was 14.9% (95% CI, 6.5%-22.5%)., Conclusions: In CLTI patients with BTK lesions, PEES stenting showed safety and efficacy as bailout stenting for BTK arterial lesions. This confirms the need for PEES stenting in a real-world practice., Clinical Impact: The XIENCE study introduces the PEES as an effective bailout stenting option for patients with CLTI undergoing BTK revascularization, particularly for lesions under 4 cm. The study focuses on real-world cases where POBA alone is insufficient, demonstrating that PEES significantly improves outcomes by enhancing limb salvage and reducing the need for major amputations. For clinicians, this innovation offers a precise, size-adaptable solution, especially in cases where bailout stenting is required for short, focal lesions, improving both clinical and procedural results., Competing Interests: Declaration of Conflicting InterestsWilliam Sebbag, Antoine Sauguet, Serge Declemy, Tom Lecorvec, Jérôme Brunet, Nellie Della Schiava, Jonathan Sobocinski, and Eric Steinmetz have no conflict of interest to disclose. Yann Gouëffic reports research funding from Abbott, Boston Scientific, Cook, General Electric, and WL Gore and personnal fees and grants from Abbott, Biotronik, Boston Scientific, Medtronic, Penumbra, Terumo, and WL Gore (medical advisory board, educational course, speaking).
Published: 2024
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182. Prostate cancer screening and management in patients candidate for endoscopic enucleation of the prostate: an international survey.

Author: Uleri A, Cornu JN, Pradere B, Herrmann TRW, Misrai V, Roupret M, De Nunzio C, Hashim H, Ploussard G, and Baboudjian M
Abstract: Background: To explore how urologists manage prostate cancer (PCa) screening and treatment in patients undergoing endoscopic enucleation of the prostate (EEP)., Methods: A team of experts in EEP collaboratively formulated the survey questions through an interactive process. The survey opened in January 2024 and closed in February 2024., Results: 102 urologists responded, revealing that most use PSA and digital rectal examination for screening, with high PSA and abnormal DRE prompting prostate MRI. 75% perform pre-EEP biopsies. For incidental low-grade PCa, active surveillance is preferred. For intermediate-grade PCa, most use PSA and MRI for workup, often choosing active surveillance if post-EEP biopsies are negative. There's no consensus on abnormal post-operative PSA thresholds., Conclusions: While urologists are aware of PCa management in EEP candidates, future work should focus on developing optimal post-EEP screening protocols., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)
Published: 2024
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183. Three-Year Outcomes Following TAVR in Younger (<75 Years) Low-Surgical-Risk Severe Aortic Stenosis Patients.

Author: Modine T, Tchétché D, Van Mieghem NM, Deeb GM, Chetcuti SJ, Yakubov SJ, Sorajja P, Gada H, Mumtaz M, Ramlawi B, Bajwa T, Crouch J, Teirstein PS, Kleiman NS, Iskander A, Bagur R, Chu MWA, Berthoumieu P, Sudre A, Adrichem R, Ito S, Huang J, Popma JJ, Forrest JK, and Reardon MJ
Abstract: Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients aged <75 years receiving TAVR versus surgery., Methods: The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged <75 years., Results: In patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum 74); Society of Thoracic Surgeons Predicted Risk of Mortality was 1.7±0.6%. At 3 years, all-cause mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery ( P =0.241). Although there was no difference between TAVR and surgery in all-cause mortality, the incidence of disabling stroke was lower with TAVR (0.6%) than surgery (2.9%; P =0.019), while surgery was associated with a lower incidence of pacemaker implantation (7.1%) compared with TAVR (21.0%; P <0.001). Valve reintervention rates (TAVR 1.5%, surgery 1.5%, P =0.962) were low in both groups. Valve performance was significantly better with TAVR than surgery with lower mean aortic gradients ( P <0.001) and lower rates of severe prosthesis-patient mismatch ( P <0.001). Rates of valve thrombosis and endocarditis were similar between groups. There were no significant differences in rates of residual ≥moderate paravalvular regurgitation., Conclusions: Low-risk patients <75 years treated with supra-annular, self-expanding TAVR had comparable 3-year all-cause mortality and lower disabling stroke compared with patients treated with surgery. There was significantly better valve performance in patients treated with TAVR., Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT02701283.
Published: 2024
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184. Maintenance of sinus rhythm after electrical cardioversion to identify patients with persistent atrial fibrillation who respond favorably to pulmonary vein isolation: the pre-pacific study.

Author: Limite LR, Laborie G, Ramirez FD, Albenque JP, Combes S, Lagrange P, Khoueiry Z, and Bortone A
Abstract: Background: Pulmonary vein isolation (PVI) is successful in approximately 50% of patients with persistent atrial fibrillation (PsAF) at one year. Identifying pre-procedurally the patients who respond favorably to a PVI alone strategy could improve their management. The present study aims to assess the predictive value of clinical response to pre-ablation electrical cardioversion (ECV) to identify the responders to PVI., Methods: Consecutive patients undergoing catheter ablation for PsAF were retrospectively classified, as "ECV successful" vs. "ECV failure", according to the rhythm of presentation after an ECV performed ≥4 weeks. Clinical and procedural data were analyzed in both groups according to the ablation strategy applied (PVI vs. PVI + substrate modification)., Results: In total, 58 patients (39.4%) had successful ECVs and 89 (60.6%) had failed ECV. Preprocedural characteristics were similar in both groups. Compared to the ECV failure group, patients with successful ECV presented less frequently (34% vs. 60%; P = 0.004) and less extended (21.3 ± 22.2% vs. 38.9 ± 27.4% of LA surface, P = 0.008) low-voltage areas. Over 55 ± 19 weeks of follow-up, AF-free survival was similar in both groups (72.7% vs. 67.8%, p = 0.39). PVI alone resulted in 83% AF-free survival among patients in the ECV successful group at 13 months., Conclusion: In approximately 40% of patients with PsAF, sinus rhythm can be restored by ECV and maintained for at least 1 month prior to catheter ablation. This clinical response is associated with less abnormal substrate as identified by left atrial voltage mapping and a procedural success rate of >80% with PVI alone., 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., (© 2024 Limite, Laborie, Ramirez, Albenque, Combes, Lagrange, Khoueiry and Bortone.)
Published: 2024
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185. Left atrial appendage closure guided by fusion of 3D computational modelling on real-time fluoroscopy: A multicenter experience.

Author: Garot P, Gall E, Zendjebil S, Cepas-Guillén P, Iriart X, Farah B, Skurk C, Gautier A, Ho CB, Bavo AM, Vaillant R, Horvilleur J, Freixa X, Saw J, and de Backer O
Abstract: Background: Patient-specific 3-dimensional (3D) computational modelling offers a tailored approach with promising results, but experience using digital-twin fusion on real-time fluoroscopy to guide left atrial appendage closure (LAAC) is unreported., Objectives: To assess whether LAAC guided by fusion of a 3D computational model on real-time fluoroscopy is safe and effective., Methods: We included retrospectively through a multicenter registry all consecutive patients with non-valvular atrial fibrillation (AF) who underwent LAAC guided by artificial intelligence (AI)-enabled computer simulations (FEops, Gent, Belgium) fusion with real-time fluoroscopy. Operators selected the appropriate device size and position in relation to the LAA using FEops HEARTguide™, and a digital twin was provided for image fusion. The primary efficacy endpoint was successful LAAC with the use of a single device, without moderate or greater peri-device leak and/or device related thrombus (DRT) on follow-up imaging. The primary safety endpoint was a composite of major procedural complications including tamponade, stroke, systemic embolism, major bleeding, and device embolization., Results: A total of 106 patients underwent LAAC with an Amulet™ or Watchman FLX™ device using CT-model-fluoroscopy fusion imaging. Device implantation was successful in 100 % of cases. The primary efficacy endpoint was met in 82 patients (89 %). A single-device SINGLE-deployment LAAC procedure was observed in 49 cases (46 %). The primary safety endpoint occurred in 2 patients (1.9 %). After a median follow-up of 405 days, two patients suffered an ischemic stroke and four expired., Conclusions: Fusion of a CT-based 3D computational model on real-time fluoroscopy is a safe and effective approach that may optimize transcatheter LAAC outcomes., Competing Interests: Declaration of competing interest P. Garot is medical director and shareholder of CERC, a CRO dedicated to cardiovascular research. He is proctor for Abbott and has received Advisory/speaker's fees from Abbott, Biosensors, Boston Scientific, Cordis, GE Healthcare, and Terumo outside the submitted work. C. Skurk has received speakers fees from Abiomed and Boston Scientific. A. Gautier has received consulting fees from Abbott, Boston Scientific, GE HealthCare, Medtronic and Terumo outside the submitted work. A.M. Bavo is an employee of FEops. R. Vaillant is an employee of General Electric HealthCare. J. Horvilleur is proctor for Abbott. X. Freixa is proctor for Abbott, Boston Scientific and Lifetech Medical. J. Saw is Consultant and Proctor for Abbott and Boston Scientific. O. De Backer has received institutional research grants and consulting fees from Abbott and Boston Scientific. The other co-authors have nothing to disclose., (Copyright © 2024. Published by Elsevier B.V.)
Published: 2024
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186. Transcatheter Aortic Valve Implantation by Valve Type in Women With Small Annuli: Results From the SMART Randomized Clinical Trial.

Author: Tchétché D, Mehran R, Blackman DJ, Khalil RF, Möllmann H, Abdel-Wahab M, Ben Ali W, Mahoney PD, Ruge H, Bleiziffer S, Lin L, Szerlip M, Grubb KJ, Byku I, Guerrero M, Gillam LD, Petronio AS, Attizzani GF, Batchelor WB, Gada H, Rogers T, Rovin JD, Whisenant B, Benton S, Gardner B, Padang R, Althouse AD, and Herrmann HC
Abstract: Importance: Historically, women with aortic stenosis have experienced worse outcomes and inadequate recognition compared to men, being both underdiagnosed and undertreated, while also facing underrepresentation in clinical trials., Objective: To determine whether women with small aortic annuli undergoing transcatheter aortic valve replacement have better clinical and hemodynamic outcomes with a self-expanding valve (SEV) or balloon-expandable valve (BEV)., Design, Setting, Participants: The Small Annuli Randomized to Evolut or SAPIEN Trial (SMART) was a large-scale randomized clinical trial focusing on patients with small aortic annuli undergoing transcatheter aortic valve replacement, randomized to receive SEVs or BEVs and included 716 patients treated at 83 centers in Canada, Europe, Israel, and the US from April 2021 to October 2022. This prespecified secondary analysis reports clinical and hemodynamic findings for all 621 women enrolled in SMART. Data for this report were analyzed from February to April 2024., Interventions: Transcatheter aortic valve replacement with an SEV or a BEV., Main Outcomes and Measures: The composite coprimary clinical end point comprised death, disabling stroke, or heart failure-related rehospitalization. The coprimary valve function end point was the incidence of bioprosthetic valve dysfunction, both assessed through 12 months. Secondary end points included the incidence of moderate or severe prosthesis-patient mismatch., Results: A total of 621 women (mean [SD] age, 80.2 [6.2] years; 312 randomized to the SEV group and 309 to the BEV group) were included in the present analysis. At 12 months, there were no significant differences in the coprimary clinical end point between the SEV and BEV groups (9.4% vs 11.8%, absolute risk difference -2.3%; 95% CI -7.2 to 2.5, P = .35). However, SEV implantation was associated with less bioprosthetic valve dysfunction (8.4% vs 41.8%; absolute risk difference, -33.4%; 95% CI, -40.4 to -26.4; P < .001). SEV implantation resulted in lower aortic valve gradients and larger effective orifice areas at 30 days and 12 months and less mild or greater aortic regurgitation at 12 months compared to BEV implantation. Prosthesis-patient mismatch was significantly lower with SEVs, regardless of the definition used and adjustment for body mass index. Use of SEVs was associated with better quality of life outcomes as assessed by the Valve Academic Research Consortium-3 ordinal quality of life measure., Conclusions and Relevance: Among women with severe symptomatic aortic stenosis and small aortic annuli undergoing transcatheter aortic valve replacement, the use of SEVs, compared to BEVs, resulted in similar clinical outcomes and a markedly reduced incidence of bioprosthetic valve dysfunction through 12 months, including a lower risk of prosthesis-patient mismatch and better 12-month quality of life., Trial Registration: ClinicalTrials.gov Identifier: NCT04722250.
Published: 2024
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187. Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts.

Author: Peek N, Hindricks G, Akbarov A, Tijssen JGP, Jenkins DA, Kapacee Z, Parkes LM, van der Geest RJ, Longato E, Sprague D, Taleb Y, Ong M, Miller CA, Shamloo AS, Albert C, Barthel P, Boveda S, Braunschweig F, Johansen JB, Cook N, de Chillou C, Elders P, Faxén J, Friede T, Fusini L, Gale CP, Jarkovsky J, Jouven X, Junttila J, Kautzner J, Kiviniemi A, Kutyifa V, Leclercq C, Lee DC, Leigh J, Lenarczyk R, Leyva F, Maeng M, Manca A, Marijon E, Marschall U, Merino JL, Mont L, Nielsen JC, Olsen T, Pester J, Pontone G, Roca I, Schmidt G, Schwartz PJ, Sticherling C, Suleiman M, Taborsky M, Tan HL, Tfelt-Hansen J, Thiele H, Tomaselli GF, Verstraelen T, Vinayagamoorthy M, Olesen KKW, Wilde A, Willems R, Wu KC, Zabel M, Martin GP, and Dagres N
Abstract: Background and Aims: Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation., Methods: The analysis pooled 20 data sets with 140 204 post-myocardial infarction patients containing information on demographics, medical history, clinical characteristics, biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance imaging. Separate analyses were performed in patients (i) carrying a primary prevention cardioverter-defibrillator with LVEF ≤ 35% [implantable cardioverter-defibrillator (ICD) patients], (ii) without cardioverter-defibrillator with LVEF ≤ 35% (non-ICD patients ≤ 35%), and (iii) without cardioverter-defibrillator with LVEF > 35% (non-ICD patients >35%). Primary outcome was sudden cardiac death or, in defibrillator carriers, appropriate defibrillator therapy. Using a competing risk framework and systematic internal-external cross-validation, a model using LVEF only, a multivariable flexible parametric survival model, and a multivariable random forest survival model were developed and externally validated. Predictive performance was assessed by random effect meta-analysis., Results: There were 1326 primary outcomes in 7543 ICD patients, 1193 in 25 058 non-ICD patients ≤35%, and 1567 in 107 603 non-ICD patients >35% during mean follow-up of 30.0, 46.5, and 57.6 months, respectively. In these three subgroups, LVEF poorly predicted sudden cardiac death (c-statistics between 0.50 and 0.56). Considering additional parameters did not improve calibration and discrimination, and model generalizability was poor., Conclusions: More accurate risk stratification for sudden cardiac death and identification of low-risk individuals with severely reduced LVEF or of high-risk individuals with preserved LVEF was not feasible, neither using LVEF nor using other predictors., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2024
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188. Stage III NSCLC treatment options: too many choices.

Author: Asmara OD, Hardavella G, Ramella S, Petersen RH, Tietzova I, Boerma EC, Tenda ED, Bouterfas A, Heuvelmans MA, and van Geffen WH
Abstract: Stage III nonsmall cell lung cancer (NSCLC) represents a wide range of tumour (T1 to T4) and nodal (N0 to N3) components, requiring variable management and a multidisciplinary approach. Recent advancements in minimally invasive techniques, molecular biology and novel drug discoveries have accelerated the refinement of stage III NSCLC management. The latest developments in staging include the forthcoming update of the nodal component in the 9th TNM (tumour-node-metastasis) edition, which emphasises the critical role for endobronchial ultrasonography in mediastinal staging. Recent treatment developments include the use of immunotherapy and targeted molecular therapy in both the neoadjuvant and adjuvant setting, either in combination with other modalities or used alone as consolidation. Surgical and radiotherapy advancements have further enhanced patient outcomes. These developments have significantly improved the prognosis for patients with stage III NSCLC. Fast-changing recommendations have also brought about a challenge, with clinicians facing a number of options to choose from. Therefore, a multimodal approach by a multidisciplinary team has become even more crucial in managing stage III NSCLC., Competing Interests: Conflict of interest: S. Ramella reports payment for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from MSD Italia, Genetec, Amgen and Istituto Gentili, outside the submitted work; and has participated on a Data Safety Monitoring Board or Advisory Board for Roche and AstraZeneca, outside the submitted work. R.H. Petersen reports receiving speaker fees from Medtronic, AstraZeneca, AMBU and Medela, outside the submitted work; and participation on Advisory Boards for AstraZeneca, BMS, Roche and MSD, outside the submitted work. A. Bouterfas reports receiving payment for expert testimony from AstraZeneca, outside the submitted work. M.A. Heuvelmans reports being a member of IASLC Screening and Early Detection Committee (unpaid), and ERS Under-40 representative of the Thoracic Oncology Assembly (unpaid), outside the submitted work. W.H. van Geffen reports being a Board Member of Dutch Society of Respiratory Physicians (NVALT) Education Council Chair, and a member of ERS Long Range Planning Committee Thoracic Oncology; he is a local PI of clinical trials for MSD and Roche, outside the submitted work. The remaining authors have nothing to disclose., (Copyright ©ERS 2024.)
Published: 2024
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189. Characterization and Clinical Significance of Hemolysis After Pulsed Field Ablation for Atrial Fibrillation: Results of a Multicenter Analysis.

Author: Popa MA, Venier S, Menè R, Della Rocca DG, Sacher F, Derval N, Hocini M, Dulucq S, Caluori G, Combes S, Albenque JP, Saitta F, Haller B, Chierchia GB, de Asmundis C, Defaye P, Boveda S, and Jaïs P
Subjects: Humans, Female, Male, Aged, Middle Aged, Treatment Outcome, Biomarkers blood, Time Factors, Europe, Pulmonary Veins surgery, Pulmonary Veins physiopathology, Incidence, Risk Factors, Clinical Relevance, Hemolysis, Atrial Fibrillation surgery, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Atrial Fibrillation blood, Catheter Ablation adverse effects
Abstract: Background: Pulsed field ablation (PFA) is increasingly used in clinical practice for the treatment of atrial fibrillation. While the susceptibility of erythrocytes to electroporation is well established, the effect of cardiac PFA technologies on hemolysis has remained underreported. The aim of this study was to investigate the incidence, severity, and clinical impact of PFA-induced hemolysis., Methods: We included n=145 patients undergoing atrial fibrillation catheter ablation with a pentaspline PFA catheter (biphasic, bipolar pulses of 2 kV) and n=70 patients receiving radiofrequency ablation (40-90 W) at 4 high-volume European centers. The lesion set comprised pulmonary vein isolation for paroxysmal atrial fibrillation and pulmonary vein isolation±additional lesions for persistent atrial fibrillation. Hemolysis and renal function biomarkers were analyzed in blood samples at baseline, at the end of ablation, and 24 hours after the procedure., Results: Baseline characteristics were well balanced between groups (overall mean 65.7±9.4 years; 69.3% men). The ablation procedures comprised a mean of 61.6±27.4 PFA deliveries and 26.3±15.0 minutes RF duration. Hemolysis was detected in 94.3% versus 6.8% of patients after PFA versus radiofrequency ablation ( P <0.001): PFA was associated with significantly lower haptoglobin levels (0.5±0.4 versus 1.0±0.4 g/L), while free plasma hemoglobin (592.8±330.6 versus 147.8±183.0 mg/L), bilirubin (21.3±11.3 versus 14.8±8.8 µmol/L), and LDH (lactate dehydrogenase, 352.7±115.7 versus 253.2±56.5 U/L) were significantly higher after PFA compared with radiofrequency ablation (all P <0.001). Hemolysis correlated with the number of PFA deliveries (r=0.62 [95% CI, 0.33-0.80]; P <0.001), with the highest severity occurring ≥54 PFA deliveries. After PFA, hemoglobinuria occurred in 36.4%, while creatinine increase was higher in patients with baseline glomerular filtration rate <50 mL/min than with baseline glomerular filtration rate >50 mL/min (Δcrea, 27.0±103.1 versus -0.2±12.1 µmol/L; P =0.010)., Conclusions: Intravascular hemolysis is a frequent finding after PFA and increases with the number of PFA deliveries. Until the clinical impact of PFA-associated hemolysis is fully elucidated, a careful titration of PFA deliveries during the ablation procedure is warranted., Competing Interests: LIRYC, a research institute lead by Dr Jais, received an unrestricted research grant from Boston scientific. Dr Boveda is a consultant for Medtronic, Boston Scientific, Microport, and Zoll. The other authors report no conflicts.
Published: 2024
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190. Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical Trial.

Author: Legrand M, Falcone J, Cholley B, Charbonneau H, Delaporte A, Lemoine A, Garot M, Joosten A, Meistelman C, Cheron-Leroy D, Rives JP, Pastene B, Dewitte A, Sigaut S, Danguy des Deserts M, Truc C, Boisson M, Lasocki S, Cuvillon P, Schiff U, Jaber S, Le Guen M, Caillard A, Bar S, Pereira de Souza Neto E, Colas V, Dimache F, Girardot T, Jozefowicz E, Viquesnel S, Berthier F, Vicaut E, and Gayat E
Subjects: Aged, Female, Humans, Male, Middle Aged, Hypotension epidemiology, Hypotension etiology, Hypotension prevention & control, Length of Stay, Preoperative Care methods, Renin-Angiotensin System drug effects, Time Factors, Hospital Mortality, Intraoperative Complications epidemiology, Intraoperative Complications etiology, Intraoperative Complications prevention & control, Angiotensin Receptor Antagonists administration & dosage, Angiotensin Receptor Antagonists adverse effects, Angiotensin-Converting Enzyme Inhibitors administration & dosage, Angiotensin-Converting Enzyme Inhibitors adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control, Surgical Procedures, Operative adverse effects
Abstract: Importance: Before surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines., Objective: To evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery., Design, Setting, and Participants: Randomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France., Intervention: Patients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115)., Main Outcomes and Measures: The primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery., Results: Of the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes., Conclusions and Relevance: Among patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy., Trial Registration: ClinicalTrials.gov Identifier: NCT03374449.
Published: 2024
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191. EVOQUE Tricuspid Valve Replacement System: State-of-the-Art Screening and Intraprocedural Guidance.

Author: Hahn RT, Makkar R, Makar M, Davidson C, Puthamana J, Zahr F, Chadderdon S, Fam N, Ong G, Yadav PK, Thourani VH, Vannan MA, Tchétché D, Dumonteil N, Bonfils L, Lepage L, Smith R, Grayburn PA, Webb JG, Moss R, Windecker S, Brugger N, Nabauer M, Hausleiter J, and Kodali S
Subjects: Humans, Consensus, Patient Selection, Recovery of Function, Risk Factors, Severity of Illness Index, Treatment Outcome, Practice Guidelines as Topic, Cardiac Catheterization instrumentation, Cardiac Catheterization adverse effects, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Predictive Value of Tests, Prosthesis Design, Tricuspid Valve surgery, Tricuspid Valve diagnostic imaging, Tricuspid Valve physiopathology, Tricuspid Valve Insufficiency surgery, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency physiopathology
Abstract: With the recent approval of the transcatheter EVOQUE tricuspid valve replacement system to treat severe, symptomatic tricuspid regurgitation, there is a need to define the appropriate patient population and anatomical considerations for this device. In this consensus document, the authors review these considerations, describe the procedural steps and imaging requirements to ensure technical success, and discuss management of complex intraprocedural circumstances., Competing Interests: Funding Support and Author Disclosures Dr Hahn has received speaker fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, Philips Healthcare, and Siemens Healthineers; and is chief scientific officer for the echocardiography core laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr Makkar has received research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Makkar is a consultant for Abbott Vascular, Boston Scientific, Edwards Lifesciences, GE Healthcare. Dr Davidson has received research grant support from Edwards Lifesciences, Abbott Vascular; is an advisor for Philips Healthcare; and is an uncompensated advisor for Edwards Lifesciences. Dr Puthamana has received speaker honoraria from Edwards Lifesciences and Abbott Structural; and has received consultant fees from Edwards Lifesciences. Dr Zahr has received consulting, research, and educational grants from Edwards Lifesciences, Medtronic, and Philips. Dr Chadderdon is a consultant to Edwards Lifesciences, Medtronic, and Phillips Healthcare. Dr Fam is a consultant to Edwards Lifesciences, Abbott, Medtronic, and Cardiovalve. Dr Ong has received speaker honoraria and consultant fees from Abbott Vascular and Edwards Lifesciences. Dr Yadav has received consultant and speaker fees from Edwards Lifesciences, Abbott, and Boston Scientific; is an advisory board member for and has stock options in Dasi Simulations; has received institutional research funding from Edwards Lifesciences, Abbott Vascular, Medtronic, Boston Scientific, Innovalve, JenaValve, HighLife, Trisol, and CroiValve. Dr Thourani has received research grants from and is an advisor for Edwards Lifesciences. Dr Vannan has received institutional research grants and equipment support from Siemens Healthineers, Philips, GE Healthcare; and has received institutional speaker honoraria from Siemens, Philips, Abbott, and Medtronic (no direct industry compensation). Dr Tchétché has received consulting fees from Edwards Lifesciences. Dr Dumonteil is a consultant for Abbott, Ancora Heart, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Smith has received institutional research grants from Edwards Lifesciences, Medtronic, NeoChord, and Artivion; has received speaker honoraria from Medtronic and Edwards Lifesciences; and is on the advisory board of Edwards Lifesciences. Dr Grayburn has received research grants from Abbott Vascular, Boston Scientific, Cardiovalve, Cardiomech, Edwards Lifesciences, Medtronic, NeoChord, Restore Medical, and 4C Medical; and has received consulting and advisory board fees from Abbott Vascular, Edwards Lifesciences, Medtronic, and 4C Medical. Dr Webb has received research grants from Edwards Lifesciences, Abbott, Medtronic, and Boston Scientific; and is a consultant to Edwards Lifesciences. Dr Moss is a consultant to Edwards Lifesciences; and has received speaker fees and travel support from Edwards Lifesciences, Abbott, Medtronic, Boston Scientific. Dr Windecker has received research, travel, or educational grants to the institution without personal remuneration from Abbott, Abiomed, Amgen, AstraZeneca, Bayer, B. Braun, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, Cardiovalve, Cordis Medical, Corflow Therapeutics, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Farapulse, Fumedica, Guerbet, Idorsia, Inari Medical, Infraredx, Janssen-Cilag, Johnson & Johnson, MedAlliance, Medicure, Medtronic, Merck Sharp & Dohme, Miracor Medical, MonarQ, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pharming Tech, Pfizer, Polares, Regeneron, Sanofi, Servier, Sinomed, Terumo, Vifor, and V-Wave; has served as an advisory board member and/or member of the steering or executive groups of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, and V-Wave with payments to the institution but no personal payments; and is a member of the steering or executive committee group of several investigator-initiated trials that receive funding from industry without impact on his personal remuneration. Dr Nabauer has received consultant and speaker fees from Edwards Lifesciences and Abbott Vascular. Dr Hausleiter is a consultant to Edwards Lifesciences; and has received research funding and speaker honoraria from Edwards Lifesciences. Dr Kodali is a consultant for Admedus, TriCares, TriFlo, X-Dot, Micro-Interventional Devices, Supira, Adona, Tioga, Helix Valve Repair, and Moray Medical; has served as an advisory board member for Dura, Biotech, Thubrikar Aortic Valve, Philips, Medtronic, and Boston Scientific; and has received institutional grant support from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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192. Outcomes Following Transcatheter Mitral Valve Replacement Using Dedicated Devices in Patients With Mitral Annular Calcification.

Author: Coisne A, Ludwig S, Scotti A, Ben Ali W, Weimann J, Duncan A, Webb JG, Kalbacher D, Rudolph TK, Nickenig G, Hausleiter J, Ruge H, Adam M, Petronio AS, Dumonteil N, Søndergaard L, Adamo M, Regazzoli D, Garatti A, Schmidt T, Dahle G, Taramasso M, Walther T, Kempfert J, Obadia JF, Redwood S, Tang GHL, Goel S, Fam N, Metra M, Andreas M, Muller DW, Denti P, Praz F, von Bardeleben RS, Leroux L, Latib A, Granada JF, Conradi L, and Modine T
Subjects: Humans, Aged, Male, Female, Treatment Outcome, Aged, 80 and over, Time Factors, Risk Factors, Severity of Illness Index, Europe, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency mortality, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve surgery, Registries, Cardiac Catheterization instrumentation, Cardiac Catheterization adverse effects, Cardiac Catheterization mortality, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Calcinosis diagnostic imaging, Calcinosis surgery, Calcinosis mortality, Calcinosis physiopathology, Calcinosis therapy, Prosthesis Design, Heart Valve Prosthesis, Feasibility Studies, Recovery of Function
Abstract: Background: Patients with mitral regurgitation (MR) and morphologic presence of relevant mitral annular calcification (MAC) represent a challenging phenotypic subset with limited treatment options., Objectives: The aim of this study was to assess the feasibility of transcatheter mitral valve replacement (TMVR) using dedicated devices for the treatment of MAC patients., Methods: Consecutive patients with symptomatic MR receiving TMVR and with available computed tomography data from the CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) multicenter registry were stratified by the presence of none or mild mitral annular calcification (MAC none/mild ) vs moderate or severe mitral annular calcification (MAC mod/sev )., Results: Among 279 eligible patients (median age = 76.0 years [Q1-Q3: 71.0-81.0 years], EuroSCORE II = 6.2% [Q1-Q3: 3.9%-12.1%]), 222 (79.6%) presented with MAC none/mild and 57 (20.4%) with MAC mod/sev . Patients with MAC mod/sev had a higher prevalence of extracardiac arteriopathy (P = 0.011) and primary MR (P < 0.001). Although the technical success rate and the extent of MR elimination did not differ, TMVR treatment in MAC mod/sev patients was associated with higher rates of postprocedural bleeding complications (P = 0.02) and renal failure (P < 0.001). Functional improvement at the 1- and 2-year follow-up did not differ between groups. At the 2-year follow-up, there were no differences between patients with MAC mod/sev and MAC none/mild regarding all-cause mortality (38.5% vs 37.7%; P = 0.76), cardiovascular mortality (21.3% vs 24.9%; P = 0.97), and all-cause mortality or heart failure hospitalization (52.4% vs 46.7%; P = 0.28) CONCLUSIONS: TMVR in patients with MAC mod/sev is associated with higher rates of postprocedural complications but similar rates of survival, MR resolution, and functional improvement compared to MAC none/mild . Further studies are necessary to define the role of dedicated TMVR devices in this population. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI]; NCT04688190)., Competing Interests: Funding Support and Author Disclosures This study was supported by a grant from the German Heart Foundation. Dr Coisne is a proctor for Abbott Vascular; and has received speaker fees for Abbot Vascular, Edwards Lifesciences, GE Healthcare, Merck Sharp & Dohme, and Pfizer. Dr Ludwig has received travel compensation from Edwards Lifesciences; has received honoraria from Bayer and Abbott; is a consultant for NVT; and was supported by a research grant from the German Heart Foundation. Dr Ali has received research grants from Medtronic and Edwards Lifesciences. Dr Duncan is a consultant for and has received honoraria from Abbott Laboratories, Edward Lifesciences, and Medtronic. Dr Kalbacher has received personal fees from Abbott, Edwards Lifesciences, Pi-Cardia Ltd, and Medtronic. Dr Rudolph has received speaker honoraria from Abbott Vascular. Dr Hausleiter has received consulting fees, speaker honoraria, and support of research projects paid to the institution from Abbott Vascular and Edwards Lifesciences. Dr Ruge serves as a physician proctor for Abbott and Edwards Lifesciences; is a consultant for Medtronic, Abbott, and Edwards Lifesciences; and is a member of the Abbott Advisory Board. Dr Schmidt has received consultant fees and travel support from Cardiovalve. Dr Taramasso is consultant or has received consultancy fees from Abbott, Edwards Lifesciences, Medtronic, Boston Scientific, Shenqi Medical, MEDIRA, PiCardia, CoreMedic, Cardiovalve, Simulands, CoreQuest, HiD Imaging, and OneCrea Medical. Dr Denti has received speaker honoraria from Abbott and Edwards Lifesciences; and has received consultant fees from Approxima, HVR, InnovHeart, and Pi-Cardia Ltd. Dr Andreas is a proctor, consultant, and speaker for Edwards Lifesciences, Abbott, Medtronic, Boston, and Zoll; and has received institutional research grants from Edwards Lifesciences, Abbott, Medtronic, and LSI. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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193. Prognostic value of ventricular arrhythmia in early post-infarction left ventricular dysfunction: the French nationwide WICD-MI study.

Author: Echivard M, Sellal JM, Ziliox C, Marijon E, Bordachar P, Ploux S, Benali K, Marquié C, Docq C, Klug D, Eschalier R, Maille B, Deharo JC, Babuty D, Genet T, Gandjbakhch E, Da Costa A, Piot O, Minois D, Gourraud JB, Mondoly P, Maury P, Boveda S, Pasquié JL, Martins R, Leclercq C, Guenancia C, Laurent G, Becker M, Bertrand J, Chevalier P, Manenti V, Kubala M, Defaye P, Jacon P, Desbiolles A, Badoz M, Jesel L, Lellouche N, Milliez PU, Ollitrault P, Fareh S, Bercker M, Mansourati J, Guy-Moyat B, Chabert JP, Luconi N, Winum PF, Anselme F, Extramiana F, Delahaye C, Jourda F, Bizeau O, Nasarre M, Olivier A, Fromentin S, Villemin T, Levavasseur O, Hammache N, Magnin-Poull I, Blangy H, Sadoul N, Duarte K, Girerd N, and de Chillou C
Abstract: Background and Aims: Prophylactic implantable cardioverter-defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study., Methods: Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF ≤ 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter-defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction., Results: ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained ≤35% at the end of the early post-infarction phase (VA-/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA-/WCD patients, respectively (P < .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73-12.81; P < .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37-6.30; P < .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28-6.39; P = .012)., Conclusions: In patients with LVEF ≤ 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Published: 2024
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194. Impact of Catheter Ablation on Atrial Fibrillation Burden and Symptoms in Patients With Hypertrophic Cardiomyopathy.

Author: Ahluwalia N, Honarbakhsh S, Assadi R, Martin S, Mohiddin S, Elliott PM, Creta A, Zeriouh S, Boveda S, Baran J, de Vere F, Rinaldi CA, Ding WY, Gupta D, El-Nayir M, Ginks M, Ozturk S, Wong T, Procter H, Page SP, Lambiase P, and Hunter RJ
Abstract: Background: Atrial fibrillation (AF) is more common in patients with hypertrophic cardiomyopathy (HCM) and is often highly symptomatic. The impact of catheter ablation (CA) may be under-reported when evaluated by long-term freedom from any atrial arrhythmia., Objectives: This study aims to evaluate whether CA of AF in patients with HCM would significantly reduce AF burden and improve symptoms., Methods: A multicenter registry was established to enroll HCM patients with pre-existing cardiac implantable electronic devices undergoing CA of AF between 2017 and 2021. The first AF recurrence and burden 12 months before and after CA were determined., Results: Eighty-one HCM patients with cardiac implantable electronic devices underwent CA of AF. Patients were followed-up for a minimum of 1-year (35 [Q1-Q3 range: 23-50] months). AF was paroxysmal in 38 of 81 (46.9%) patients and burden pre-CA was 27.0% (Q1-Q3 range: 3.0% to 99.0%). Thirty-five (43.2%) patients had AF/atrial tachycardia recurrence within 12 months. AF burden reduced after CA to 0.5% (Q1-Q3 range: 0.0% to 11.1%) (P = 0.001); a 95% CI (range: 13.8% to 100%) relative reduction. European Hearth Rhythm Association class improved by 1.8 ± 1.3 classes (P < 0.001). Of those with AF/atrial tachycardia recurrence, the reduction in AF burden was -33.7% (Q1-Q3 range: -88.9% to -13.8%) (P < 0.001) and 20 (57.1%) patients reported symptomatic improvement by ≥1 European Hearth Rhythm Association class. AF burden reduction was associated with symptomatic improvement. (r = -0.67; P < 0.001) CONCLUSIONS: AF recurrence is common after CA in HCM patients, but this may under-represent the impact of CA in this cohort. CA significantly reduced AF burden and improved symptoms. A comprehensive evaluation of AF burden, symptoms, and hard endpoints is needed to determine the utility of CA in this context., Competing Interests: Funding Support and Author Disclosures Dr Boveda has received consulting fees from Medtronic, Boston Scientific, Microport, and Zoll. Dr Rinaldi has received research funding and consulting fees from Abbott, Medtronic, Boston Scientific, Microport, and Siemens/EBR systems. Dr Ginks has received speaker fees and travel grants from Biosense Webster, Atricure, and Abbott. Dr Lambiase has received research grants from Medtronic, Abbott, and Boston Scientific; and his work has been supported by UCLH Biomedicine NIHR and Barts BRC. Dr Hunter has received research grants and educational grants from Medtronic and Biosense Webster; and has received speaker fees and travel grants from Medtronic, Biosense Webster, and Abbott. Drs Honarbakhsh and Hunter invented the STAR mapping system and are shareholders in Rhythm AI Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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195. Self-Expanding or Balloon-Expandable TAVR with a Small Aortic Annulus. Reply.

Author: Herrmann HC, Mehran R, and Tchétché D
Subjects: Humans, Aortic Valve surgery, Aortic Valve diagnostic imaging, Prosthesis Design, Aorta, Thoracic anatomy & histology, Equivalence Trials as Topic, Heart Ventricles anatomy & histology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement instrumentation
Published: 2024
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196. Editorial: Atrial fibrillation: selection of management strategy and evaluation of outcomes.

Author: Gomes DA, Strisciuglio T, Almorad A, Boveda S, and Providência R
Abstract: 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. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Published: 2024
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197. Cerebrovascular Events in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation: A Pooled Patient-Level Study.

Author: van Nieuwkerk AC, Aarts HM, Hemelrijk KI, Urbano Carrillo C, Tchétché D, de Brito FS Jr, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, García-Blas S, Dumonteil N, Abizaid A, Sartori S, D'Errigo P, Tarantini G, Lunardi M, Orvin K, Pagnesi M, Navarro F, Dangas G, Mehran R, and Delewi R
Subjects: Aged, Aged, 80 and over, Female, Humans, Male, Aortic Valve surgery, Femoral Artery, Incidence, Ischemic Attack, Transient epidemiology, Ischemic Attack, Transient etiology, Postoperative Complications epidemiology, Postoperative Complications mortality, Postoperative Complications etiology, Risk Assessment methods, Risk Factors, Stroke epidemiology, Stroke etiology, Time Factors, Treatment Outcome, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality
Abstract: Background: Cerebrovascular events remain one of the most devastating complications of transcatheter aortic valve implantation (TAVI). Data from real-world contemporary cohorts on longitudinal trends and outcomes remain limited. The aim of this study was to assess incidence, temporal trends, predictors, and outcomes of cerebrovascular events following transfemoral TAVI., Methods and Results: The CENTER2 (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves 2) study includes patients undergoing TAVI between 2007 and 2022. The database contains pooled patient-level data from 10 clinical studies. A total of 24 305 patients underwent transfemoral TAVI (mean age 81.5±6.7 years, 56% women, median Society of Thoracic Surgeon Predicted Risk of Mortality 4.9% [3.1%-8.5%]). Of these patients, 2.2% (n=534) experienced stroke in the first 30 days after TAVI, and 40 (0.4%) had a transient ischemic attack. Stroke rates remained stable during the treatment period (2007-2010: 2.1%, 2011-2014: 2.5%, 2015-2018: 2.1%, 2019-2022: 2.1%; P trend =0.28). Moreover, 30-day cerebrovascular event rates were similar across Society of Thoracic Surgeon Predicted Risk of Mortality risk categories: 2.1% in low-risk, 2.6% in intermediate-risk, and 2.5% in high-risk patients ( P =0.21). Mortality was higher in patients with 30-day stroke than without at 30 days (20.3% versus 4.7%; odds ratio, 5.1 [95% CI, 4.1-6.5]; P <0.001) and at 1 year (44.1% versus 15.0%; hazard ratio, 3.5 [95% CI, 3.0-4.2]; P <0.001). One-year mortality rates for stroke did not decline over time (2007-2010: 46.9%, 2011-2014: 46.0%, 2015-2018: 43.0%, 2019-2022: 39.1%; P trend =0.32). At 1 year, 7.0% of patients undergoing TAVI had a stroke., Conclusions: In 24 305 patients who underwent transfemoral TAVI, 30-day cerebrovascular event incidence remained ≈ 2.2% between 2007 and 2022. Thirty-day stroke rates were similar throughout Society of Thoracic Surgeon Predicted Risk of Mortality risk categories. Mortality rates after stroke remain high., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03588247.
Published: 2024
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198. Outcomes of transcatheter aortic valve implantation for native aortic valve regurgitation.

Author: Le Ruz R, Leroux L, Lhermusier T, Cuisset T, Van Belle E, Dibie A, Palermo V, Champagnac D, Obadia JF, Teiger E, Ohlman P, Tchétché D, Le Breton H, Saint-Etienne C, Piriou PG, Plessis J, Beurtheret S, Du Chayla F, Leclère M, Lefèvre T, Collet JP, Eltchaninoff H, Gilard M, Iung B, Manigold T, Letocart V, and Of Stop-As And France-Tavi Investigators OB
Subjects: Humans, Male, Female, Aged, Aged, 80 and over, Treatment Outcome, Aortic Valve surgery, Aortic Valve diagnostic imaging, Risk Factors, France, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement instrumentation, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Aortic Valve Insufficiency surgery, Heart Valve Prosthesis, Registries
Abstract: Background: Large datasets of transcatheter aortic valve implantation (TAVI) for pure aortic valve regurgitation (PAVR) are scarce., Aims: We aimed to report procedural safety and long-term clinical events (CE) in a contemporary cohort of PAVR patients treated with new-generation devices (NGD)., Methods: Patients with grade III/IV PAVR enrolled in the FRANCE-TAVI Registry were selected. The primary safety endpoint was technical success (TS) according to Valve Academic Research Consortium 3 criteria. The co-primary endpoint was defined as a composite of mortality, heart failure hospitalisation and valve reintervention at last follow-up., Results: From 2015 to 2021, 227 individuals (64.3% males, median age 81.0 [interquartile range {IQR} 73.5-85.0] years, with EuroSCORE II 6.0% [IQR 4.0-10.9]) from 41 centres underwent TAVI with NGD, using either self-expanding (55.1%) or balloon-expandable valves (44.9%; p=0.50). TS was 85.5%, with a non-significant trend towards increased TS in high-volume activity centres. A second valve implantation (SVI) was needed in 8.8% of patients, independent of valve type (p=0.82). Device size was ≥29 mm in 73.0% of patients, post-procedure grade ≥III residual aortic regurgitation was rare (1.2%), and the permanent pacemaker implantation (PPI) rate was 36.0%. At 30 days, the incidences of mortality and reintervention were 8.4% and 3.5%, respectively. The co-primary endpoint reached 41.6% (IQR 34.4-49.6) at 1 year, increased up to 61.8% (IQR 52.4-71.2) at 4 years, and was independently predicted by TS, with a hazard ratio of 0.45 (95% confidence interval: 0.27-0.76); p=0.003., Conclusions: TAVI with NGD in PAVR patients is efficient and reasonably safe. Preventing the need for an SVI embodies the major technical challenge. Larger implanted valves may have limited this complication, outweighing the increased risk of PPI. Despite successful TAVI, PAVR patients experience frequent CE at long-term follow-up.
Published: 2024
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199. [Definitions and epidemiology of varicose vein disease].

Author: Josnin M and Neaume N
Subjects: Humans, Quality of Life, Varicose Veins epidemiology, Varicose Veins diagnosis
Abstract: DEFINITIONS AND EPIDEMIOLOGY OF VARICOSE VEIN DISEASE. Chronic superficial venous disorders are a frequent reason for medical consultation. Depending on the study, between 20% and 60% of the general population suffer from varicose veins of the lower limbs. The socio-economic cost of venous disease is considerable, accounting for between 1% and 3% of national healthcare budgets. The factors leading to the formation of varicose veins and the pathogenesis are not clearly elucidated, but two factors have been identified: weakness of the venous wall and hemodynamic disorders. Symptoms and clinical signs are highly variable, ranging from aesthetic dissatisfaction to leg ulcers. The CEAP classification (clinical, etiological, anatomical, pathophysiological) enables the practitioner to precisely define chronic venous disease, providing a precise diagnostic description as well as enabling the patient to be monitored over time. Various quality-of-life scales have also been developed., Competing Interests: M. Josnin déclare avoir participé à des interventions ponctuelles pour Sigvaris, Mölnlycke Health Care, LEO Pharma, Aspen France, Urgo, Kreussler Pharma, Servier et Medtronic. N. Néaume déclare avoir participé à des interventions ponctuelles pour Medtronic, Biolitec, Urgo, Pfizer, BMS, Servier et Exeltis Santé.
Published: 2024

200. [Liquid and foam sclerotherapy and echosclerosis].

Author: Josnin M and Neaume N
Subjects: Humans, Sclerosing Solutions therapeutic use, Ultrasonography methods, Varicose Veins therapy, Sclerotherapy methods
Abstract: Competing Interests: M. Josnin déclare avoir participé à des interventions ponctuelles pour Sigvaris, Mölnlycke Health Care, LEO Pharma, Aspen France, Urgo, Kreussler Pharma, Servier et Medtronic. N. Neaume déclare avoir participé à des interventions ponctuelles pour Medtronic, Biolitec, Urgo, Pfizer, BMS, Servier et Exeltis San
Published: 2024

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