Search

Your search keyword '"Céline Chabanne"' showing total 58 results
Start Over Author "Céline Chabanne"
58 results on '"Céline Chabanne"'

1. Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation

Author

Guillaume Baudry, Guillaume Coutance, Richard Dorent, Fabrice Bauer, Katrien Blanchart, Aude Boignard, Céline Chabanne, Clément Delmas, Nicolas D'Ostrevy, Eric Epailly, Vlad Gariboldi, Philippe Gaudard, Céline Goéminne, Sandrine Grosjean, Julien Guihaire, Romain Guillemain, Mathieu Mattei, Karine Nubret, Sabine Pattier, Emmanuelle Vermes, Laurent Sebbag, Kevin Duarte, and Nicolas Girerd

Subjects
Advanced heart failure, Diuretic, Heart transplant, Congestion, Cardiorenal syndrome, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Aims The prognostic value of ‘high dose’ loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). Methods and results All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into ‘low dose’, ‘intermediate dose’, and ‘high dose’ loop diuretics corresponding to furosemide equivalent doses of ≤40, 40–250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N‐terminal pro‐B‐type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for ‘low dose’, ‘intermediate dose’, and ‘high dose’ patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the ‘high dose’ group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six‐fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P 0.05). Conclusions A ‘high dose’ of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre‐HT patients.

Published
2023
Full Text
View/download PDF

2. Prognosis value of Forrester's classification in advanced heart failure patients awaiting heart transplantation

Author

Guillaume Baudry, Guillaume Coutance, Richard Dorent, Fabrice Bauer, Katrien Blanchart, Aude Boignard, Céline Chabanne, Clément Delmas, Nicolas D'Ostrevy, Eric Epailly, Vlad Gariboldi, Philippe Gaudard, Céline Goéminne, Sandrine Grosjean, Julien Guihaire, Romain Guillemain, Mathieu Mattei, Karine Nubret, Sabine Pattier, Matteo Pozzi, Patrick Rossignol, Emmanuelle Vermes, Laurent Sebbag, and Nicolas Girerd

Subjects
Advanced heart failure, Forrester's classification, Heart transplant, Cardiac oedema, Cardiovascular diseases, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Aims The value of Forrester's perfusion/congestion profiles assessed by invasive catheter evaluation in non‐inotrope advanced heart failure patients listed for heart transplant (HT) is unclear. We aimed to assess the value of haemodynamic evaluation according to Forrester's profiles to predict events on the HT waitlist. Methods and results All non‐inotrope patients (n = 837, 79% ambulatory at listing) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 with right heart catheterization (RHC) were included. The primary outcome was a combined criteria of waitlist death, delisting for aggravation, urgent HT or left ventricular assist device implantation. Secondary outcome was waitlist death. The ‘warm‐dry’, ‘cold‐dry’, ‘warm‐wet’, and ‘cold‐wet’ profiles represented 27%, 18%, 27%, and 28% of patients, respectively. At 12 months, the respective rates of primary outcome were 15%, 17%, 25%, and 29% (P = 0.008). Taking the ‘warm‐dry’ category as reference, a significant increase in the risk of primary outcome was observed only in the ‘wet’ categories, irrespectively of ‘warm/cold’ status: hazard ratios, 1.50; 1.06–2.13; P = 0.024 in ‘warm‐wet’ and 1.77; 1. 25–2.49; P = 0.001 in ‘cold‐wet’. Conclusions Haemodynamic assessment of advanced HF patients using perfusion/congestion profiles predicts the risk of the combine endpoint of waitlist death, delisting for aggravation, urgent heart transplantation, or left ventricular assist device implantation. ‘Wet’ patients had the worst prognosis, independently of perfusion status, thus placing special emphasis on the cardinal prominence of persistent congestion in advanced HF.

Published
2022
Full Text
View/download PDF

3. Impact of Three Different Algorithms for the Screening of SSc-PAH and Comparison with the Decisions of a Multidisciplinary Team

Author

Valentin Coirier, Céline Chabanne, Stéphane Jouneau, Nicolas Belhomme, Alice Ballerie, Claire Cazalets, Vincent Sobanski, Éric Hachulla, Patrick Jégo, and Alain Lescoat

Subjects
systemic sclerosis, pulmonary hypertension, pulmonary arterial hypertension, screening, algorithm, multidisciplinary team meeting, Medicine (General), R5-920
Abstract

Background: to compare three existing screening algorithms of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) with the results of a multidisciplinary team (MDT) meeting from a tertiary center. Methods: we conducted a monocentric longitudinal study from 2015 to 2018. All patients with SSc according to LeRoy’s classification were eligible. Patients were excluded in the case of missing data required by any of the three screening algorithms. The algorithms were applied for each patient at inclusion. Right heart catheterization (RHC) was performed based on the MDT decision. MDT members were all blinded from the results of the three algorithms regarding RHC recommendations. The RHC recommendations of each algorithm were compared with the MDT decision, and the impact on diagnosis and management was evaluated. Results: 117 SSc patients were consecutively included in the study, and 99 had follow-up data over the three-year duration of the study (10 deaths). Among the 117 patients, the MDT suggested RHC for 16 patients (14%), DETECT algorithm for 28 (24%), ASIG for 48 (41%) and ESC/ERS 2015 for 20 (17%). Among the 16 patients who had RHC, SSc-PAH was diagnosed in seven. Among patients with an initial recommendation of RHC based on at least one algorithm but not according to the MDT meeting, no SSc-PAH was diagnosed during the three-year follow-up. Results were unchanged when the new 2018 definition of PAH was applied instead of the previous definition. Conclusion: a MDT approach appears interesting for the screening of SSc-PAH, with a significant reduction of RHC performed in comparison with dedicated algorithms. The specific relevance of a MDT for the management and follow-up of patients with RHC recommended by existing algorithms but with no PAH warrants further studies.

Published
2021
Full Text
View/download PDF

4. Balloon pulmonary angioplasty versus riociguat for the treatment of inoperable chronic thromboembolic pulmonary hypertension (RACE): a multicentre, phase 3, open-label, randomised controlled trial and ancillary follow-up study

Author

Xavier Jaïs, Philippe Brenot, Hélène Bouvaist, Mitja Jevnikar, Matthieu Canuet, Céline Chabanne, Ari Chaouat, Vincent Cottin, Pascal De Groote, Nicolas Favrolt, Delphine Horeau-Langlard, Pascal Magro, Laurent Savale, Grégoire Prévot, Sébastien Renard, Olivier Sitbon, Florence Parent, Romain Trésorier, Cécile Tromeur, Céline Piedvache, Lamiae Grimaldi, Elie Fadel, David Montani, Marc Humbert, and Gérald Simonneau

Subjects
Pulmonary and Respiratory Medicine
Published
2022

5. In-depth characterization of pulmonary arterial hypertension in mixed connective tissue disease: a French national multicenter study

Author

Benjamin Chaigne, Kevin Chevalier, Athenaïs Boucly, Christian Agard, Antoine Baudet, Arnaud Bourdin, Céline Chabanne, Vincent Cottin, Pierre Fesler, François Goupil, Patrick Jego, David Launay, Hervé Lévesque, Arnaud Maurac, Shirine Mohamed, Cécile Tromeur, Laurence Rottat, Olivier Sitbon, Marc Humbert, Luc Mouthon, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Nantes (CHU Nantes), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Infections Virales et Pathologie Comparée - UMR 754 (IVPC), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut Fédératif de Recherches Multidisciplinaires sur les Peptides (IFRMP 23), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université Le Havre Normandie (ULH), Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), and Hôpital Bicêtre

Subjects
Rheumatology, systemic lupus erythematosus, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, systemic sclerosis, pulmonary arterial hypertension, [SDV]Life Sciences [q-bio], mixed connective tissue disease, Pharmacology (medical), survival
Abstract

International audience; Abstract Objective pulmonary arterial hypertension (PAH) is a leading cause of death in mixed connective tissue disease (MCTD). We aimed to describe PAH in well-characterized MCTD patients. Methods MCTD patients enrolled in the French Pulmonary Hypertension Registry with a PAH diagnosis confirmed by right heart catheterization were included in the study and compared with matched controls: MCTD patients without PAH, systemic lupus erythematous (SLE) patients with PAH, and systemic sclerosis (SSc) patients with PAH. Survival rates were estimated by the Kaplan-Meier method and risk factors for PAH in MCTD patients and risk factors for mortality in MCTD-PAH were sought using multivariate analyses. Results thirty-six patients with MCTD-PAH were included in the study. Comparison with MCTD patients without PAH and multivariate analysis revealed that pericarditis, polyarthritis, thrombocytopenia, interstitial lung disease (ILD), and anti-Sm antibodies were independent predictive factors of PAH/PH in MCTD. Estimated survival rates at 1 year, 5 years, and 10 years, following PAH diagnosis were 83%, 67%, and 56%, respectively. MCTD-PAH presentation and survival did not differ from SLE-PAH and SSc-PAH. Multivariate analysis revealed that tobacco exposure was an independent factor predictive of mortality in MCTD-PAH. Conclusion PAH is a rare and severe complication of MCTD, associated with a 56% 10-year survival. We identified ILD, pericarditis, thrombocytopenia, and anti-Sm antibodies as risk factors for PAH in MCTD and tobacco exposure as predictor of mortality in MCTD-PAH.

Published
2023

6. Durability of Mitral Valve Replacement With a Third-generation Bioprosthesis

Author

Marie Aymami, Hervé Corbineau, Jacques Tomasi, Amedeo Anselmi, Céline Chabanne, Xavier Beneux, and Jean-Philippe Verhoye

Subjects
Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Swine, medicine.medical_treatment, Single Center, Postoperative Complications, Mitral valve, medicine, Animals, Humans, Endocarditis, Bioprosthesis, Heart Valve Prosthesis Implantation, Medical treatment, business.industry, Mitral valve replacement, Perioperative, medicine.disease, Third generation, Prosthesis Failure, Surgery, medicine.anatomical_structure, Aortic Valve, Heart Valve Prosthesis, Mitral Valve, Cardiology and Cardiovascular Medicine, Complication, business, Follow-Up Studies
Abstract

Background Our aim was to evaluate the durability of a third-generation porcine bioprosthesis (Epic porcine xenograft; Abbott Cardiovascular Inc, St Paul, MN) in the mitral position, according to patients’ age at surgery. Methods Four hundred eighty-two mitral valve replacements using the Epic valve at a single center were included (2009-2018). Perioperative and early postoperative data were prospectively collected. A systematic follow-up was performed (99% complete, 1609.5 patient-years; average, 3.8 ± 2.5). Standardized definitions of valve-related events were adopted. Mean patient age at mitral valve replacement was 68.1 ± 10.4 years. Results Operative mortality was 9.3%. There were 5 early valve-related reoperations, mainly due to recurrent infectious endocarditis. Global survival at 8.8 years was 69.5% ± 5%. Nine structural valve deterioration (SVD) events occurred during follow-up (3 receiving reoperations, 4 transcatheter mitral valve replacement valve-in-valve, and 2 medical treatment only). The freedom from SVD at 5 and 10 years was 97.4% ± 1.2% and 89.6% ± 4.4% (actuarial) and 97.8% ± 1% and 91.9% ± 3.3%, respectively (competing risks). After stratification into subgroups by age at surgery (≤59 years, 50.8%; 60-69, 32.8%; ≥70, 16.4%) there was no significant intergroup difference in freedom from SVD (log-rank P = .24). The overall freedom from any reintervention for SVD at 10 years was 90.5% ± 4.4% (actuarial) and 92.7% ± 3.3% (competing risks), with no intergroup difference (log-rank P = .14). The freedom from any valve-related complication at 8.4 years was 83.2% ± 4.5% (actuarial). Conclusions The Epic bioprosthesis shows good durability at 5 to 10 years in the mitral position.

Published
2022

7. Blood, cellular, and tissular calcineurin inhibitors pharmacokinetic-pharmacodynamic relationship in heart transplant recipients: the INTRACAR study

Author

Gwendal, Coste, Céline, Chabanne, Camille, Tron, Bernard, Lelong, Marie-Clémence, Verdier, Mikael, Roussel, François, Le Gall, Bruno, Turlin, Mireille, Desille-Dugast, Erwan, Flécher, Bruno, Laviolle, Florian, Lemaitre, Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Microenvironment and B-cells: Immunopathology,Cell Differentiation, and Cancer (MOBIDIC), Université de Rennes (UR)-Etablissement français du sang [Rennes] (EFS Bretagne)-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), Fédération Hospitalo-universitaire SUrvival oPtimization in ORgan Transplantation (FHU SUPORT), Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM)-Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques (RESINFIT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-Cellules Dendritiques, Immunomodulation et Greffes, Université de Tours (UT)-Université de Tours (UT)-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-Institut National de la Santé et de la Recherche Médicale (INSERM), The authors acknowledge the Centre de Ressources Biologiques (CRB) Santé of Rennes BB-0033- 00056 for managing patient samples., and Jonchère, Laurent

Subjects
[SDV.IB] Life Sciences [q-bio]/Bioengineering, [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Pharmacology, Pharmacology (medical), [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences
Abstract

International audience; BACKGROUND: After heart transplantation, calcineurin inhibitors (CNI) (cyclosporin A and tacrolimus) are key immunosuppressive drugs to prevent graft rejection. Whole-blood concentration (Cblood)-guided therapeutic drug monitoring (TDM) is systematically performed to improve graft outcomes. However, some patients will still experience graft rejection and/or adverse events despite CNI Cblood within the therapeutic range. Other pharmacokinetic parameters, such as the intra-graft, or intracellular concentration at the CNI site of action could refine their TDM. Nonetheless, these remain to be explored. The objective of the INTRACAR study was to describe the relationship between whole blood, intra-graft, and intracellular CNI concentrations as well as their efficacy in heart transplant recipients (HTR). METHODS: In a cohort of HTR, protocol endomyocardial biopsies (EMB) were collected to assess rejection by anatomopathological analysis. Part of the EMB was used to measure the intra-graft concentrations of CNI (CEMB). Cblood, and the concentration inside peripheral blood mononuclear cells (CPBMC), a cellular fraction enriched with lymphocytes, were also monitored. Concentrations in the three matrices were compared between patients with and without biopsy-proven acute rejection (BPAR). RESULTS: Thirty-four HTR were included, representing nearly 100 pharmacokinetic (PK) samples for each CNI. Cblood, CEMB and CPBMC correlated for both CNI. BPAR was observed in 74 biopsies (39.6 %) from 26 patients (76.5 %), all except one of low-grade. None of the PK parameters (Cblood, CEMB, CPBMC, CEMB/blood and CPBMC/blood) was associated with BPAR. CONCLUSION: In this cohort of well-immunosuppressed patients, no association was observed for any of the PK parameters including Cblood, with the occurrence of BPAR. However, a trend was noticed for the CEMB and CEMB/blood of cyclosporin A. Further studies in higher-risk patients may help optimize the use of CEMB and CPBMC for CNI TDM in HTR.

Published
2022

8. Pulmonary Hypertension in Patients with Common Variable Immunodeficiency

Author

Matthieu Devilder, Laurent Savale, Pascal de Groote, Frédéric Gagnadoux, Pierre Thoré, Julie Mankikian, Clément Boissin, Nicolas Noel, E. Boiffard, Xavier Jaïs, Athénaïs Boucly, Céline Chabanne, Jérémie Pichon, Peter Dorfmüller, Olivier Meyrignac, Olivier Sitbon, Marc Humbert, Anne Bergeron, Marianne Riou, and David Montani

Subjects
0301 basic medicine, medicine.medical_specialty, Bronchiectasis, business.industry, Common variable immunodeficiency, Immunology, Interstitial lung disease, medicine.disease, Gastroenterology, Pulmonary hypertension, Lymphoid hyperplasia, Pulmonary function testing, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Internal medicine, medicine, Immunology and Allergy, Portal hypertension, medicine.symptom, Complication, business, 030215 immunology
Abstract

Common variable immunodeficiency (CVID) is known to cause infectious, inflammatory, and autoimmune manifestations. Pulmonary hypertension (PH) is an unusual complication of CVID with largely unknown characteristics and mechanisms. We report the clinical, functional, hemodynamics, radiologic and histologic characteristics, and outcomes of CVID-associated PH patients from the French PH Network. Ten patients were identified. The median (range) age at CVID diagnosis was 36.5 (4–49) years and the median delay between CVID and PH diagnosis was 12 (0–30) years. CVID-associated PH affected predominantly women (female-to-male ratio 9:1). Most patients were New York Heart Association functional class III with a severe hemodynamic profile and frequent portal hypertension (n = 6). Pulmonary function tests were almost normal in 70% of patients and showed a mild restrictive syndrome in 30% of patients while the diffusing capacity for carbon monoxide was decreased in all but one patient. High-resolution computed tomography found enlarged mediastinal nodes, mild interstitial infiltration with reticulations and nodules. Two patients had a CIVD-interstitial lung disease, and one presented with bronchiectasis. Pathologic assessment of lymph nodes performed in 5 patients revealed the presence of granulomas (n = 5) and follicular lymphoid hyperplasia (n = 3). At last follow-up (median 24.5 months), 9 patients were alive, and one patient died of Hodgkin disease. PH is a possible complication of CVID whose pathophysiological mechanisms, while still unclear, would be due to the inflammatory nature of CVID. CVID-associated PH presents as precapillary PH with multiple possible causes, acting in concert in some patients: a portal hypertension, a pulmonary vascular remodeling, sometimes a pulmonary parenchymal involvement and occasionally an extrinsic compression by mediastinal lymphadenopathies, which would be consistent with its classification in group 5 of the current PH classification.

Published
2021

9. Septuagenarian population has similar survival and outcomes to younger patients after left ventricular assist device implantation

Author

Jean-François Obadia, Constance Verdonk, Olivier Chavanon, Camille Dambrin, Thomas Senage, Marie-Cécile Bories, Frédéric Anselme, Jean Marc Frapier, Edeline Pelcé, David Hamon, Fabrice Vanhuyse, Gerard Babatasi, Costin Radu, Magali Michel, Eloi Marijon, Erwan Flecher, Marylou Para, Thierry Bourguignon, Vlad Gariboldi, Céline Goéminne, Karine Nubret, Mathieu Pernot, Clément Delmas, Pierre Yves Litlzer, Philippe Gaudard, Aude Boignard, Marie Bielefeld, Anne Flore Plane, André Vincentelli, Romain Eschalier, Christophe Leclercq, Michel Kindo, Bernard Lelong, Céline Chabanne, Thibaud Genet, Raphaël P. Martins, Matteo Pozzi, Fabien Garnier, Nicolas D'Ostrevy, Vincent Galand, Tam Hoang Minh, and Hugues Blangy

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Ventricular Function, Left, Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Interquartile range, Intensive care, medicine, Humans, 030212 general & internal medicine, education, Stroke, Aged, Heart Failure, Heart transplantation, education.field_of_study, business.industry, Age Factors, Recovery of Function, General Medicine, Middle Aged, equipment and supplies, medicine.disease, 3. Good health, Surgery, Treatment Outcome, Heart failure, Ventricular assist device, Female, France, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, Destination therapy
Abstract

Left ventricular assist device (LVAD) implantation may be an attractive alternative therapeutic option for elderly patients with heart failure who are ineligible for heart transplantation.We aimed to describe the characteristics and outcomes of elderly patients (i.e. aged≥70 years) receiving an LVAD.This observational study was conducted in 19 centres between 2006 and 2016. Patients were divided into two groups-younger (aged70 years) and elderly (aged≥70 years), based on age at time of LVAD implantation.A total of 652 patients were included in the final analysis, and 74 patients (11.3%) were aged≥70 years at the time of LVAD implantation (maximal age 77.6 years). The proportion of elderly patients receiving an LVAD each year was constant, with a median of 10.6% (interquartile range 8.0-15.4%) per year, and all were implanted as destination therapy. Elderly and younger patients had similar durations of hospitalization in intensive care units and total lengths of hospital stays. Both age groups experienced similar rates of LVAD-related complications (i.e. stroke, bleeding, driveline infection and LVAD exchange), and the occurrence of LVAD complications did not impact survival in the elderly group compared with the younger group. Lastly, when compared with younger patients implanted as destination therapy, the elderly group also exhibited similar mid-term survival.This work strongly suggests that selected elderly adults can be scheduled for LVAD implantation.

Published
2020

10. Portopulmonary hypertension in the current era of pulmonary hypertension management

Author

François Durand, Laurent Savale, Clément Boissin, Olivier Sitbon, Claire Francoz, Hélène Bouvaist, Jean-Charles Duclos-Vallée, Ari Chaouat, Manuel Guimas, Pamela Moceri, Emmanuel Bergot, Pascal Magro, David Montani, Nicolas Lamblin, Vincent Cottin, Marianne Riou, Filomena Conti, Marc Humbert, Nicolas Favrolt, Romain Trésorier, Xavier Jaïs, Sébastien Renard, Philippe Hervé, Grégoire Prévot, Cécile Tromeur, Bruno Degano, Céline Chabanne, Delphine Bourlier, Nathan Ebstein, Sylvain Palat, Didier Samuel, Gérald Simonneau, Elise Artaud-Macari, Delphine Horeau-Langlard, Pascal de Groote, Anne-Claire Simon, Mitja Jevnikar, Audrey Coilly, and Marie Fertin

Subjects
0301 basic medicine, medicine.medical_specialty, Portopulmonary hypertension, Cirrhosis, Hepatology, business.industry, medicine.medical_treatment, Liver transplantation, Chronic liver disease, medicine.disease, Pulmonary hypertension, Transplantation, 03 medical and health sciences, Liver disease, 030104 developmental biology, 0302 clinical medicine, Internal medicine, medicine, 030211 gastroenterology & hepatology, business, Contraindication
Abstract

Background & Aims Long-term outcomes in portopulmonary hypertension (PoPH) are poorly studied in the current era of pulmonary hypertension management. We analysed the effect of pulmonary arterial hypertension (PAH)-targeted therapies, survival and predictors of death in a large contemporary cohort of patients with PoPH. Methods Data from patients with PoPH consecutively enrolled in the French Pulmonary Hypertension Registry between 2007 and 2017 were collected. The effect of initial treatment strategies on functional class, exercise capacity and cardiopulmonary haemodynamics were analysed. Survival and its association with PAH- and hepatic-related characteristics were also examined. Results Six hundred and thirty-seven patients (mean age 55 ± 10 years; 58% male) were included. Fifty-seven percent had mild cirrhosis, i.e. Child-Pugh stage A. The median model for end-stage liver disease (MELD) score was 11 (IQR 9–15). Most patients (n = 474; 74%) were initiated on monotherapy, either with a phosphodiesterase-5 inhibitor (n = 336) or with an endothelin-receptor antagonist (n = 128); 95 (15%) were initiated on double oral combination therapy and 5 (1%) on triple therapy. After a median treatment time of 4.5 months, there were significant improvements in functional class (p Conclusion Survival of patients with PoPH is strongly associated with the severity of liver disease. Patients who underwent liver transplantation had the best long-term outcomes. Lay summary Portopulmonary hypertension is defined by the presence of pulmonary arterial hypertension in the context of chronic liver disease and is characterized by progressive shortness of breath and exercise limitation. The presence of severe pulmonary arterial hypertension in liver transplant candidates represents a contraindication for such a surgery; however, treatments targeting pulmonary arterial hypertension are efficacious, allowing for safe transplantation and conferring good survival outcomes in those who undergo liver transplantation.

Published
2020

11. COVID-19 in Patients with Pulmonary Hypertension A National Prospective Cohort Study

Author

Montani, David, Certain, Marie-Caroline, Weatherald, Jason, Jaïs, Xavier, Bulifon, Sophie, Noel-Savina, Elise, Nieves, Ana, Renard, Sébastien, Traclet, Julie, Bouvaist, Hélène, Riou, Marianne, de Groote, Pascal, Moceri, Pamela, Bertoletti, Laurent, Favrolt, Nicolas, Guillaumot, Anne, Jutant, Etienne-Marie, Beurnier, Antoine, Boucly, Athénaïs, Ebstein, Nathan, Jevnikar, Mitja, Pichon, Jérémie, Keddache, Sophia, Preda, Mariana, Roche, Anne, Solinas, Sabina, Seferian, Andrei, Reynaud-Gaubert, Martine, Cottin, Vincent, Savale, Laurent, Humbert, Marc, Sitbon, Olivier, Kais, Ahmad, Elise, Artaud-Macari, Céline, Chabanne, Ari, Chaouat, Surnameclaire, Dauphin, Frédéric, Gagnadoux, Anne, Gaudoin, Sébastien, Hascoet, Delphine, Horeau-Langlard, Jocelyn, Inamo, Bouchra, Lamia, Pascal, Magro, Jean-Claude, Meurice, Patrice, Poubeau, Grégoire, Prevot, Roger, Rosario, Servettaz, Amélie, Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay, Hospices Civils de Lyon (HCL), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique - Hôpitaux de Marseille (APHM), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Stress Oxydant et Pathologies Métaboliques (SOPAM), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de Recherche sur le Handicap Ventilatoire (GRHV), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Universitaire de Reims (CHU Reims)

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, COVID-19, pulmonary aterial hypertension, pulmonary hypertension, outcomes, SARS-CoV-2, Hypertension, Pulmonary, Critical Care and Intensive Care Medicine, COVID-19 Testing, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, pulmonary arterial hypertension, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Prospective Studies
Abstract

International audience; Rationale: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with pulmonary endothelial dysfunction. There are limited data available on the outcomes of coronavirus disease (COVID-19) in patients with pulmonary hypertension (PH), a disease characterized by pulmonary endothelial dysfunction. Objectives: To describe characteristics and outcomes of patients with precapillary PH and COVID-19. Methods: We prospectively collected characteristics, management, and outcomes of adult patients with precapillary PH in the French PH network who had COVID-19 between February 1, 2020, and April 30, 2021. Clinical, functional, and hemodynamic characteristics of PH before COVID-19 were collected from the French PH registry. Measurements and Main Results: A total of 211 patients with PH (including 123 with pulmonary arterial hypertension, 47 with chronic thromboembolic PH, and 41 with other types of PH) experienced COVID-19, and 40.3% of them were outpatients, 32.2% were hospitalized in a conventional ward, and 27.5% were in an ICU. Among hospitalized patients (n = 126), 54.0% received corticosteroids, 37.3% high-flow oxygen, and 11.1% invasive ventilation. Right ventricular and acute renal failure occurred in 30.2% and 19.8% of patients, respectively. Fifty-two patients (all hospitalized) died from COVID-19. Overall mortality was 24.6% (95% CI [confidence interval], 18.8-30.5) and in-hospital mortality 41.3% (95% CI, 32.7-49.9). Nonsurvivors were significantly older, more frequently male and suffering comorbidities (diabetes, chronic respiratory diseases, systemic hypertension, chronic cardiac diseases, and/or chronic renal failure), and had more severe PH at their most recent evaluation preceding COVID-19 diagnosis (in terms of functional class and 6-minute-walk distance; all P < 0.05). Use of pulmonary arterial hypertension therapy was similar between survivors and nonsurvivors. Conclusions: COVID-19 in patients with precapillary PH was associated with a high in-hospital mortality. The typical risk factors for severe COVID-19 and severity of PH were associated with mortality in this population.

Published
2022

12. Impact of Three Different Algorithms for the Screening of SSc-PAH and Comparison with the Decisions of a Multidisciplinary Team

Author

Vincent Sobanski, Stéphane Jouneau, Nicolas Belhomme, Eric Hachulla, A. Lescoat, Patrick Jego, Claire Cazalets, Alice Ballerie, Valentin Coirier, Céline Chabanne, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Lille, This research received no external funding., HAL UR1, Admin, Université d'Angers (UA)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Right heart catheterization, Medicine (General), Longitudinal study, systemic sclerosis, [SDV]Life Sciences [q-bio], Clinical Biochemistry, 030204 cardiovascular system & hematology, Multidisciplinary team, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Article, 03 medical and health sciences, multidisciplinary team meeting, R5-920, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, pulmonary arterial hypertension, pulmonary hypertension, Medicine, [SDV.IB] Life Sciences [q-bio]/Bioengineering, 030203 arthritis & rheumatology, algorithm, business.industry, screening, Missing data, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business, Algorithm
Abstract

International audience; Background: to compare three existing screening algorithms of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) with the results of a multidisciplinary team (MDT) meeting from a tertiary center. Methods: we conducted a monocentric longitudinal study from 2015 to 2018. All patients with SSc according to LeRoy’s classification were eligible. Patients were excluded in the case of missing data required by any of the three screening algorithms. The algorithms were applied for each patient at inclusion. Right heart catheterization (RHC) was performed based on the MDT decision. MDT members were all blinded from the results of the three algorithms regarding RHC recommendations. The RHC recommendations of each algorithm were compared with the MDT decision, and the impact on diagnosis and management was evaluated. Results: 117 SSc patients were consecutively included in the study, and 99 had follow-up data over the three-year duration of the study (10 deaths). Among the 117 patients, the MDT suggested RHC for 16 patients (14%), DETECT algorithm for 28 (24%), ASIG for 48 (41%) and ESC/ERS 2015 for 20 (17%). Among the 16 patients who had RHC, SSc-PAH was diagnosed in seven. Among patients with an initial recommendation of RHC based on at least one algorithm but not according to the MDT meeting, no SSc-PAH was diagnosed during the three-year follow-up. Results were unchanged when the new 2018 definition of PAH was applied instead of the previous definition. Conclusion: a MDT approach appears interesting for the screening of SSc-PAH, with a significant reduction of RHC performed in comparison with dedicated algorithms. The specific relevance of a MDT for the management and follow-up of patients with RHC recommended by existing algorithms but with no PAH warrants further studies.

Published
2021

13. Association between Leflunomide and Pulmonary Hypertension

Author

Thomas Lacoste Palasset, Sophie Bulifon, Xavier Jaïs, Laurent Savale, Laurent Bertoletti, Gérald Simonneau, Marie-Camille Chaumais, Martine Reynaud-Gaubert, Céline Chabanne, Mathilde Volpato, Frédéric Perros, Grégoire Manaud, Laura C. Price, Kais Ahmad, Nicolas Favrolt, O. Sitbon, Anne Guillaumot, Athénaïs Boucly, Jason Weatherald, Nicolas Lamblin, Grégoire Prévot, Pierre Fesler, Charles Khouri, David Montani, Andrei Seferian, Delphine Horeau-Langlard, Stefana Pancic, Mitja Jevnikar, David Launay, Marc Humbert, Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay, Imperial College London, Centre Hospitalier Universitaire [Grenoble] (CHU), University of Calgary, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Biologie intégrative du tissu osseux, Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC Saint Etienne, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Nord (Saint Etienne), CHU Marseille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), MORNET, Dominique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), CHU Toulouse [Toulouse], Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Nord (Saint Etienne), Biologie Intégrative du Tissu Osseux (LBTO), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Pulmonary and Respiratory Medicine, Cardiac Catheterization, medicine.medical_specialty, antirheumatic agents, Hypertension, Pulmonary, [SDV]Life Sciences [q-bio], Cardiac index, Hemodynamics, 030204 cardiovascular system & hematology, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Pharmacovigilance, pulmonary hypertension, medicine, Humans, Risk factor, Lung, Leflunomide, business.industry, Endothelial Cells, medicine.disease, Pulmonary hypertension, 3. Good health, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, 030228 respiratory system, pharmacovigilance, Toxicity, translational medical research, Vascular resistance, business, medicine.drug
Abstract

International audience; Rationale: Pulmonary hypertension (PH) has been described in patients treated with leflunomide. Objectives: To assess the association between leflunomide and PH. Methods: We identified incident cases of PH in patients treated with leflunomide from the French PH Registry and through the pharmacoVIGIlAnce in Pulmonary ArTerial Hypertension (VIGIAPATH) program between September 1999 to December 2019. PH etiology, clinical, functional, radiologic, and hemodynamic characteristics were reviewed at baseline and follow-up. A pharmacovigilance disproportionality analysis using the World Health Organization's global database was conducted. We then investigated the effect of leflunomide on human pulmonary endothelial cells. Data are expressed as median (min-max). Results: Twenty-eight patients treated with leflunomide before PH diagnosis was identified. A total of 21 (75%) had another risk factor for PH and 2 had two risk factors. The median time between leflunomide initiation and PH diagnosis was 32 months (1-120). Right heart catheterization confirmed precapillary PH with a cardiac index of 2.37 L⋅min-1 ⋅m-2 (1.19-3.1) and elevated pulmonary vascular resistance at 9.63 Wood Units (3.6-22.1) without nitric oxide reversibility. Five patients (17.9%) had no other risk factor for PH besides exposure to leflunomide. No significant hemodynamic improvement was observed after leflunomide withdrawal. The pharmacovigilance disproportionality analysis using the World Health Organization's database revealed a significant overrepresentation of leflunomide among reported pulmonary arterial hypertension-adverse drug reactions. In vitro studies showed the dose-dependent toxicity of leflunomide on human pulmonary endothelial cells. Conclusions: PH associated with leflunomide is rare and usually associated with other risk factors. The pharmacovigilance analysis suggests an association reinforced by experimental data.

Published
2021

14. Hypertension artérielle pulmonaire associée à la prise de léflunomide : 4 cas

Author

Elisabeth Polard, Maxime Fournet, Guillaume Coiffier, Stéphane Jouneau, Patrick Jego, Valentin Coirier, Céline Chabanne, Alain Lescoat, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA)

Subjects
030203 arthritis & rheumatology, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatology, Léflunomide, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Hypertension artérielle pulmonaire, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, 3. Good health
Abstract

Resume L’hypertension arterielle pulmonaire (HTAP) est une pathologie rare, caracterisee par une augmentation des resistances vasculaires pulmonaires. Parmi les multiples etiologies d’HTAP, on retrouve les HTAP induites par la prise de medicaments, principalement representes par les traitements anorexigenes. Nous rapportons les cas de quatre patients ayant developpe une HTAP au cours d’un traitement par leflunomide, molecule prescrite dans le cadre d’une polyarthrite rhumatoide, d’un rhumatisme psoriasique ou d’une connectivite indifferenciee. Les quatre patients consultaient pour une dyspnee d’installation progressive (stade II a IV de la NYHA au moment du diagnostic) ; l’examen clinique retrouvait des signes cliniques d’insuffisance cardiaque, motivant la realisation d’une echographie cardiaque. Des signes echographiques evocateurs d’HTAP faisaient realiser un catheterisme cardiaque droit, retrouvant une hypertension pulmonaire pre-capillaire (pression arterielle pulmonaire moyenne superieure a 25 mmHg et une pression arterielle pulmonaire d’occlusion inferieure a 15 mmHg). Le bilan etiologique d’hypertension pulmonaire pre-capillaire etait realise tel que preconise par les recommandations internationales ; la realisation d’une scintigraphie de ventilation-perfusion et d’un angioscanner thoracique permettait d’exclure les diagnostics d’hypertension pulmonaire post-embolique chronique ou en rapport avec une maladie respiratoire chronique. Le diagnostic d’HTAP etait alors retenu et les explorations realisees a visee etiologique etaient negatives. L’imputabilite du leflunomide etait finalement retenue. Le traitement incrimine etait arrete pour les quatre patients, et trois d’entre eux ont recu un traitement specifique de l’HTAP. L’evolution clinique et/ou hemodynamique etait favorable pour l’ensemble des patients. Ces quatre cas ont ete declares au centre local de pharmacovigilance, permettant de retenir un signal faible. Cela a conduit a la modification de la monographie du leflunomide en ajoutant « hypertension pulmonaire » a la rubrique « effets indesirables » et « de rares cas d’hypertension pulmonaire ont ete rapportes pendant un traitement par leflunomide » a la rubrique « mises en garde ».

Published
2019

15. Pulmonary Hypertension in Patients with Common Variable Immunodeficiency

Author

Pierre, Thoré, Xavier, Jaïs, Laurent, Savale, Peter, Dorfmuller, Athénaïs, Boucly, Matthieu, Devilder, Olivier, Meyrignac, Jérémie, Pichon, Julie, Mankikian, Marianne, Riou, Emmanuel, Boiffard, Clément, Boissin, Pascal, De Groote, Céline, Chabanne, Frédéric, Gagnadoux, Anne, Bergeron, Nicolas, Noel, Olivier, Sitbon, Marc, Humbert, and David, Montani

Subjects
Adult, Male, Adolescent, Hypertension, Pulmonary, Middle Aged, Thorax, Young Adult, Common Variable Immunodeficiency, Child, Preschool, Positron-Emission Tomography, Humans, Female, France, Lymph Nodes, Child, Tomography, X-Ray Computed, Aged
Abstract

Common variable immunodeficiency (CVID) is known to cause infectious, inflammatory, and autoimmune manifestations. Pulmonary hypertension (PH) is an unusual complication of CVID with largely unknown characteristics and mechanisms.We report the clinical, functional, hemodynamics, radiologic and histologic characteristics, and outcomes of CVID-associated PH patients from the French PH Network.Ten patients were identified. The median (range) age at CVID diagnosis was 36.5 (4-49) years and the median delay between CVID and PH diagnosis was 12 (0-30) years. CVID-associated PH affected predominantly women (female-to-male ratio 9:1). Most patients were New York Heart Association functional class III with a severe hemodynamic profile and frequent portal hypertension (n = 6). Pulmonary function tests were almost normal in 70% of patients and showed a mild restrictive syndrome in 30% of patients while the diffusing capacity for carbon monoxide was decreased in all but one patient. High-resolution computed tomography found enlarged mediastinal nodes, mild interstitial infiltration with reticulations and nodules. Two patients had a CIVD-interstitial lung disease, and one presented with bronchiectasis. Pathologic assessment of lymph nodes performed in 5 patients revealed the presence of granulomas (n = 5) and follicular lymphoid hyperplasia (n = 3). At last follow-up (median 24.5 months), 9 patients were alive, and one patient died of Hodgkin disease.PH is a possible complication of CVID whose pathophysiological mechanisms, while still unclear, would be due to the inflammatory nature of CVID. CVID-associated PH presents as precapillary PH with multiple possible causes, acting in concert in some patients: a portal hypertension, a pulmonary vascular remodeling, sometimes a pulmonary parenchymal involvement and occasionally an extrinsic compression by mediastinal lymphadenopathies, which would be consistent with its classification in group 5 of the current PH classification.

Published
2021

16. An unusual story of electrical storm on the graft

Author

Céline Chabanne, Bernard Lelong, Vincent Galand, Erwan Flecher, and etienne charbonneau

Subjects
medicine.medical_specialty, Poor prognosis, business.industry, Radiofrequency ablation, medicine.medical_treatment, MEDLINE, Implantable cardioverter-defibrillator, medicine.disease, Sudden death, Lymphoma, Surgery, law.invention, law, Male patient, hemic and lymphatic diseases, medicine, business, Complication
Abstract

Background: Cancers, and specifically lymphomas, are one of the main causes of morbidity and mortality after heart transplant. We encountered this complication on a 54-year-old male patient, which brought to our attention the lack of a specific and appropriate treatment for a primary cardiac lymphoma on the graft. Objective: This case report highlights the challenging management of primitive heart transplant lymphoma and its treatment. Method: electronic medical record literature reviewed through Pubmed interface of Medline. Result: We report the case of an Epstein-Barr Virus (EBV) induced primary cardiac lymphoma on the graft. The lymphoma spread quickly in spite of the numerous treatments we tried and resulted in rhythmic complication. Endocavitary implantable cardioverter defibrillator was implanted but quickly removed due to local complications. The patient died from a sudden death at home shortly after. Conclusions: Primary cardiac lymphoma on the graft is highly rare with poor prognosis and rhythmic complications. Further studies are needed to assess the benefits of other treatment approaches, such as radiofrequency ablation techniques.

Published
2020

17. Relation of Body Mass Index to Outcomes in Patients With Heart Failure Implanted With Left Ventricular Assist Devices

Author

Céline Chabanne, Romain Eschalier, Marylou Para, Marion Charton, Edeline Pelcé, Fabrice Vanhuyse, Michel Kindo, Raphaël P. Martins, Matteo Pozzi, Thierry Bourguignon, E. Varlet, Nicolas Sadoul, Bernard Lelong, David Hamon, Tam Hoang Minh, Fabien Garnier, Mathieu Pernot, Céline Goéminne, Vlad Gariboldi, Philippe Rouvière, Jean Porterie, Pierre-Yves Litzler, Constance Verdonk, Thibaud Genet, Christophe Leclercq, Magali Michel, Philippe Gaudard, Marie-Cécile Bories, Marie Bielefeld, Katrien Blanchart, Clément Delmas, Olivier Chavanon, Thomas Senage, Costin Radu, Erwan Flecher, Karine Nubret, Nicolas D'Ostrevy, Frédéric Anselme, Vincent Galand, Aude Boignard, Gerard Babatasi, André Vincentelli, Jean-François Obadia, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Bordeaux (UB), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Institut de rythmologie et modélisation cardiaque [Pessac] (IHU Liryc), Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Lapeyronie [Montpellier] (CHU), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire [Grenoble] (CHU), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Institut d'Aménagement et d'Urbanisme de la Région d'Ile-de-France (IAU Île-de-France), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHI Créteil, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, 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), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHRU Nancy], The French Federation of Cardiology, 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), and Jonchère, Laurent

Subjects
Male, medicine.medical_specialty, Population, Left ventricular assist device, 030204 cardiovascular system & hematology, Overweight, 03 medical and health sciences, 0302 clinical medicine, Thinness, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Internal medicine, Humans, Medicine, Obesity, education, Body mass index, Aged, Retrospective Studies, Heart Failure, 2. Zero hunger, education.field_of_study, business.industry, nutritional and metabolic diseases, Middle Aged, medicine.disease, mortality, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Cardiac surgery, Survival Rate, Treatment Outcome, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Heart failure, Cardiology, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Heart-Assist Devices, Underweight, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Destination therapy
Abstract

International audience; We aimed at characterizing the impact of low and high body mass index (BMI) on outcomes after left-ventricular assist device (LVAD) surgery and define the predictors of mortality in patients with abnormal BMI (low/high). This study was conducted in 19 centers from 2006 to 2016. Patients were divided based on their baseline BMI into 3 groups of BMI: low (BMI ≤18.5 kg/m²); normal (BMI = 18.5 to 24.99 kg/m²) and high (BMI ≥25 kg/m²) (including overweight (BMI = 25 to 29.99 kg/m²), and obesity (BMI ≥30 Kg/m²)). Among 652 patients, 29 (4.4%), 279 (42.8%) and 344 (52.8%) had a low-, normal-, and high BMI, respectively. Patients with high BMI were significantly more likely men, with more co-morbidities and more history of ventricular/supra-ventricular arrhythmias before LVAD implantation. Patients with abnormal BMI had significantly lower survival than those with normal BMI. Notably, those with low BMI experienced the worst survival whereas overweight or obese patients had similar survival. Four predictors of mortality for LVAD candidates with abnormal BMI were defined: total bilirubin ≥16 µmol/L before LVAD, hypertension, destination therapy, and cardiac surgery with LVAD. Depending on the number of predictor per patients, those with abnormal BMI may be divided in 3 groups of 1-year mortality risk, i.e., low (0 to 1 predictor: 29% and 31%), intermediate (2 to 3 predictors, 51% and 52%, respectively), and high (4 predictors: 83%). In conclusion, LVAD recipients with abnormal BMI experience lower survival, especially underweight patients. Four predictors of mortality have been identified for LVAD population with abnormal BMI, differentiating those a low-, intermediate-, and high risks of death.

Published
2020

18. Phenotype and Outcomes of Pulmonary Hypertension Associated with Neurofibromatosis Type 1

Author

Pamela Moceri, Maria-Rosa Ghigna, Olivier Sitbon, Céline Chabanne, Marc Humbert, Pascal de Groote, Pierre Wolkenstein, Julie Traclet, Xavier Mignard, Emmanuel Bergot, François Goupil, Delphine Bourlier, Xavier Jaïs, Etienne-Marie Jutant, David Montani, Frédéric Perros, Laurent Bertoletti, Jean-Pierre Gueffet, Gérald Simonneau, Thibaud Soumagne, Nicolas Favrolt, Grégoire Prévot, Cécile Tromeur, Pierre-Yves Brillet, Barbara Girerd, Mitja Jevnikar, Fabrice Bauer, Ari Chaouat, Pascal Magro, Raphael Borie, Elie Fadel, Laurent Savale, and Claire Dauphin

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Lung Neoplasms, Neurofibromatosis 1, Adolescent, Hypertension, Pulmonary, Critical Care and Intensive Care Medicine, Gastroenterology, Young Adult, Internal medicine, medicine, Humans, Neurofibromatosis, neoplasms, Neurofibromin 1, business.industry, Interstitial lung disease, Middle Aged, medicine.disease, Prognosis, Phenotype, Pulmonary hypertension, eye diseases, nervous system diseases, Female, France, business, Complication, Lung Transplantation
Abstract

Rationale: Pulmonary hypertension (PH) associated with neurofibromatosis type 1 (NF1) is a rare and largely unknown complication of NF1.Objectives: To describe characteristics and outcomes of PH-NF...

Published
2020

19. Phenotype and outcome of pulmonary arterial hypertension patients carrying a TBX4 mutation

Author

Caroline Ovaert, Damien Bonnet, Gérald Simonneau, Céline Chabanne, Pierre Thoré, Olivier Sitbon, Marc Humbert, Marilyne Lévy, Claire Dauphin, Florent Soubrier, Laurent Savale, E. Boiffard, Xavier Jaïs, Martine Remy-Jardin, Amélie Servettaz, Barbara Girerd, Anne Guillaumot, Ari Chaouat, Frédéric Perros, Maria-Rosa Ghigna, David Montani, Vincent Cottin, Mélanie Eyries, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Pneumologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Université Paris-Saclay, Centre Chirurgical Marie Lannelongue (CCML), Centre chirurgical Marie Lannelongue, Service d'Oncogénétique et Angiogénétique Moléculaire [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Service de génétique [CHU Pitié-Salpêtrière], Service de cardiologie pédiatrique [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Clermont-Ferrand, CHU Pontchaillou [Rennes], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Service de pneumologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de Référence des Maladies Pulmonaires Rares [Hôpital Louis Pradel - HCL], Hôpital Louis Pradel [CHU - HCL], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Immuno-Régulation dans les Maladies Auto-Immunes Inflammatoires et le Cancer - EA 7509 (IRMAIC), Université de Reims Champagne-Ardenne (URCA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
0301 basic medicine, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Hemodynamics, medicine.disease_cause, Gastroenterology, Vascular remodelling in the embryo, 03 medical and health sciences, 0302 clinical medicine, Diffusing capacity, Internal medicine, Parenchyma, medicine, Lung transplantation, Mutation, business.industry, Phenotype, 3. Good health, 030104 developmental biology, medicine.anatomical_structure, 030228 respiratory system, Vascular resistance, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

IntroductionTBX4 mutation causes small patella syndrome (SPS) and/or pulmonary arterial hypertension (PAH). The characteristics and outcomes of PAH associated with TBX4 mutations are largely unknown.MethodsWe report the clinical, functional, radiologic, histologic and haemodynamic characteristics and outcomes of heritable PAH patients carrying a TBX4 mutation from the French pulmonary hypertension (PH) network.Results20 patients were identified in 17 families. They were characterised by a median age at diagnosis of 29 years (0–76 years) and a female to male ratio of three. Most of the patients (70%) were in New York Heart Association (NYHA) functional class III or IV with a severe haemodynamic impairment (median pulmonary vascular resistance (PVR) of 13.6 (6.2–41.8) Wood units). Skeletal signs of SPS were present in 80% of cases. Half of the patients had mild restrictive or obstructive limitation and diffusing capacity of the lung for carbon monoxide (DLCO) was decreased in all patients. High-resolution computed tomography (HRCT) showed bronchial abnormalities, peri-bronchial cysts, mosaic distribution and mediastinal lymphadenopathies. PAH therapy was associated with significant clinical improvement. At follow-up (median 76 months), two patients had died and two had undergone lung transplantation. One-year, three-year and five-year event-free survival rates were 100%, 94% and 83%, respectively. Histologic examination of explanted lungs revealed alveolar growth abnormalities, major pulmonary vascular remodelling similar to that observed in idiopathic pulmonary arterial hypertension (IPAH) and accumulation of cholesterol crystals within the lung parenchyma.ConclusionPAH due to TBX4 mutations may occur with or without skeletal abnormalities across a broad age range from birth to late adulthood. PAH is usually severe and associated with bronchial and parenchymal abnormalities.

Published
2020

20. Outcomes of Left Ventricular Assist Device Implantation in Patients With Uncommon Etiology Cardiomyopathy

Author

Romain Eschalier, Marie Bielefeld, Nicolas D'Ostrevy, Philippe Rouvière, Aude Boignard, Vincent Galand, Olivier Chavanon, François Picard, Céline Chabanne, Fabien Garnier, Frédéric Anselme, Jérôme Jouan, Katrien Blanchart, Erwan Flecher, Camille Dambrin, Hugues Blangy, Fabrice Vanhuyse, Gerard Babatasi, Edeline Pelcé, Walid Ghodhbane, Tam Hoang Minh, Céline Goéminne, Thierry Bourguignon, Raphaël P. Martins, Matteo Pozzi, Pierre-Yvesl Litzler, Frederic Sacher, Philippe Gaudard, E. Varlet, Constance Verdonk, Nicolas Lellouche, Thomas Senage, Magali Michel, Vlad Gariboldi, Bernard Lelong, Thibaud Genet, Michel Kindo, Christophe Leclercq, David Hamon, Jean-François Obadia, Clément Delmas, André Vincentelli, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Strasbourg, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve-Université de Montpellier (UM), Centre hospitalier universitaire de Nantes (CHU Nantes), CIC - Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire [Grenoble] (CHU), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Carnegie Mellon University [Pittsburgh] (CMU), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Henri Mondor [Créteil], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Clermont-Ferrand, chirurgie cardio-vasculaire, 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), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Fédération Française de Cardiologie, Rennes University Hospital, 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 [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, CHU Henri Mondor, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre de recherches (CRT), Société Lafarge, 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], Chirurgie Cardio-Vasculaire, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CIC Bordeaux, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Strasbourg (CHRU de Strasbourg), Nouvel Hôpital Civil, Strasbourg, France., Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Hospital Bichat Paris, Dysoxie, suractivité : aspects cellulaires et intégratifs thérapeutiques (DS-ACI / UMR MD2), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire de Caen (CHRU Caen), Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques (RESINFIT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Service de cardiologie et maladies vasculaires, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Clermont-Ferrand, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Chirurgie Cardiaque et Transplantations - Hôpital Brabois, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and MORNET, Dominique

Subjects
Adult, Cardiomyopathy, Dilated, Male, medicine.medical_specialty, Myocarditis, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Cardiomyopathy, Myocardial Ischemia, 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, Internal medicine, Idiopathic dilated cardiomyopathy, medicine, Humans, 030212 general & internal medicine, Aged, Retrospective Studies, business.industry, Mortality rate, valvular heart disease, Hypertrophic cardiomyopathy, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Treatment Outcome, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Ventricular assist device, Etiology, Cardiology, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; The impact of uncommon etiology cardiomyopathies on Left-ventricular assist device (LVAD)-recipient outcomes is not very well known. This study aimed to characterize patients with uncommon cardiomyopathy etiologies and examine the outcomes between uncommon and ischemic/idiopathic dilated cardiomyopathy. This observational study was conducted in 19 centers between 2006 and 2016. Baseline characteristics and outcomes of patients with uncommon etiology were compared to patients with idiopathic dilated/ischemic cardiomyopathies. Among 652 LVAD-recipients included, a total of 590 (90.5%) patients were classified as ischemic/idiopathic and 62 (9.5%) patients were classified in the "uncommon etiologies" group. Main uncommon etiologies were: hypertrophic (n = 12(19%)); cancer therapeutics-related cardiac dysfunction (CTRCD) (n = 12(19%)); myocarditis (n = 11(18%)); valvulopathy (n = 9(15%)) and others (n = 18(29%)). Patients with uncommon etiologies were significantly younger with more female and presented less co-morbidities. Additionally, patients with uncommon cardiomyopathies were less implanted as destination therapy compared with ischemic/idiopathic group (29% vs 38.8%). During a follow-up period of 9.1 months, both groups experienced similar survival. However, subgroup of hypertrophic/valvular cardiomyopathies and CTRCD had significantly higher mortality compared to the ischemic/idiopathic or myocarditis/others cardiomyopathies. Conversely, patients with myocarditis/others etiologies experienced a better survival. Indeed, the 12-months survival in the myocarditis/others; ischemic/idiopathic and hypertrophic/CTRCD/valvulopathy group were 77%; 65%, and 46% respectively. In conclusion, LVAD-recipients with hypertrophic cardiomyopathy, valvular heart disease and CTRCD experienced the higher mortality rate.

Published
2020

21. Phenotype and outcome of PAH patients carrying a TBX4 mutation

Author

Pierre Thoré, Barbara Girerd, Xavier Jaïs, Laurent Savale, Maria Rosa Ghigna, Mélanie Eyries, Marilyne Levy, Caroline Ovaert, Amélie Servettaz, Anne Guillaumot, Claire Dauphin, Céline Chabanne, Emmanuel Boiffard, Vincent Cottin, Frédéric Perros, Gérald Simonneau, Sitbon Olivier, Florent Soubrier, Damien Bonnet, Martine Remy Jardin, Ari Chaouat, Marc Humbert, David Montani, Service de Pneumologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hypertension artérielle pulmonaire : physiopathologie et innovation thérapeutique [Le Kremlin-Bicêtre], Institut National de la Santé et de la Recherche Médicale (INSERM), Faculté de Médecine Paris-Saclay, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Université Paris-Saclay, Marie Lannelongue Hospital, 92350 Le Plessis-Robinson, France, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Médecine Interne, Immunologie clinique et maladies infectieuses [CHU Reims], Université de Reims Champagne-Ardenne (URCA)-Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de Cardiologie [La Roche-sur-Yon], Centre Hospitalier Départemental site de la Roche-sur-Yon (CHD de la Roche-sur-Yon), Department of Pneumology [Lyon], Hospices Civils de Lyon (HCL), Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Service de pneumologie [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Centre Chirurgical Marie Lannelongue (CCML), Centre chirurgical Marie Lannelongue, Service de cardiologie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Albert Calmette, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Perros, Frédéric, Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique, Centre Chirurgical Marie Lannelongue (CCML)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Marie-Lannelongue, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), CHU Gabriel Montpied (CHU), Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], and AP-HP - Hôpital Antoine Béclère [Clamart]

Subjects
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Abstract

International audience; INTRODUCTION:TBX4 mutation cause small patella syndrome (SPS) and/or pulmonary arterial hypertension (PAH). The characteristics and outcomes of PAH associated with TBX4 mutations are largely unknown.METHODS:We report the clinical, functional, radiologic, histologic and haemodynamic characteristics and outcomes of heritable PAH patients carrying a TBX4 mutation from the French PH Network.RESULTS:Twenty patients were identified in 17 families. They were characterised by a median age at diagnosis of 29 (0-76) year-old and a female to male ratio of 3. Most of the patients were in NYHA functional class III or IV (70%) with a severe hemodynamic impairment (median pulmonary vascular resistance of 13.6 [6.2-41.8] Wood Units). Skeletal signs of SPS were present in 80% of cases. Half of the patients had mild restrictive or obstructive limitation and diffusing capacity for carbon monoxide was decreased in all patients. High-resolution computed tomography showed bronchial abnormalities, peri-bronchial cysts, mosaic distribution and mediastinal lymphadenopathies. PAH therapy was associated with significant clinical improvement. At follow-up (median 76 months), two patients died and two underwent lung transplantation. One-, three- and five-year event-free survival rates were 100%, 94% and 83%, respectively. Histologic examination of explanted lungs revealed alveolar growth abnormalities, major pulmonary vascular remodelling similar to that observed in idiopathic PAH, and accumulation of cholesterol crystals within the lung parenchyma.CONCLUSION:PAH due to TBX4 mutations may occur with or without skeletal abnormalities across a broad age range from birth to late adulthood. PAH is usually severe and associated with bronchial and parenchymal abnormalities.

Published
2020

22. Is Rifampin Use Associated With Better Outcome in Staphylococcal Prosthetic Valve Endocarditis? A Multicenter Retrospective Study

Author

J.M. Chapplain, Céline Chabanne, Rozenn Le Berre, Matthieu Revest, Matthieu Lesouhaitier, Pierre Tattevin, François Bénézit, David Boutoille, Raphaël Lecomte, Cédric Arvieux, Audrey Le Bot, Erwan Flecher, Séverine Ansart, Loren Dejoies, Pierre Gazeau, CHU Pontchaillou [Rennes], Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], Service des maladies infectieuses et tropicales [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), 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), Jonchère, Laurent, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)

Subjects
Adult, Male, Methicillin-Resistant Staphylococcus aureus, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Prosthesis-Related Infections, [SDV]Life Sciences [q-bio], 030106 microbiology, 030204 cardiovascular system & hematology, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, medicine, Humans, Endocarditis, In patient, Prosthetic valve endocarditis, Aged, Retrospective Studies, Aged, 80 and over, relapse, business.industry, Retrospective cohort study, Endocarditis, Bacterial, Odds ratio, Middle Aged, Staphylococcal Infections, medicine.disease, mortality, Confidence interval, prosthetic valve, 3. Good health, [SDV] Life Sciences [q-bio], Infectious Diseases, Tolerability, Staphylococcus aureus, Heart Valve Prosthesis, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, endocarditis, Rifampin, business
Abstract

Background International guidelines recommend rifampin-based combinations for staphylococcal prosthetic valve endocarditis (PVE). However, no robust clinical data support this recommendation, and rifampin tolerability is an issue. We aimed to evaluate the impact of rifampin for the treatment of staphylococcal PVE. Methods An observational retrospective cohort study of all adults with staphylococcal PVE (modified Duke criteria) was conducted in 3 referral centers for endocarditis, during years 2000–2018. Primary outcome measurement was 1-year mortality. Results We enrolled 180 patients with PVE due to Staphylococcus aureus (n = 114, 63.3%), or coagulase-negative staphylococci (n = 66, 36.7%), on bioprosthesis (n = 111, 61.7%), mechanical valve (n = 67, 37.2%), or both (n = 2). There were 132 males (73.3%), and mean age was 70.4 ± 12.4 years. Valvular surgery was performed in 51/180 (28.3%) cases. Despite all isolates were susceptible to rifampin, only 101 (56.1%) were treated with rifampin, for a median duration of 33.0 days, whereas 79 (43.9%) received no rifampin. Baseline characteristics were similar in both groups. One-year mortality was, respectively, 37.6% (38/101), and 31.6% (25/79), in patients treated with, or without, rifampin (P = .62). Relapse rates were 5.9% (6/101), and 8.9% (7/79), P = .65. Patients treated with rifampin had longer hospital length-of-stay: 42.3 ± 18.6 vs 31.3 ± 14.0 days (P < .0001). On multivariate analysis, only cerebral emboli (odds ratio [OR] 2.95, 95% confidence interval [CI], 1.30–6.70, P = .009), definite endocarditis (OR 7.15, 95% CI, 1.47–34.77, P = .018), and methicillin-resistant S. aureus (OR 6.04, 95% CI, 1.34–27.26, P = .019), were associated with 1-year mortality. Conclusions A large proportion (43.9%) of staphylococcal PVE received no rifampin. One-year survival and relapse rates were similar in patients treated with or without rifampin.

Published
2020

23. Large Granular Lymphocyte Leukemia and Precapillary Pulmonary Hypertension

Author

David Montani, Marc Humbert, Francis R LeBlanc, Thomas P. Loughran, Amandine Le Bourgeois, Cedric Pastoret, Céline Chabanne, Olivier Decaux, Stéphane Dominique, Thierry Lamy, Brieuc Cherel, Matteo Leoncin, Mohamed Hamidou, François Lifermann, Renato Zambello, CHU Pontchaillou [Rennes], Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), University of Virginia [Charlottesville], Universita degli Studi di Padova, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier de Dax, Hôpital Bicêtre, Hôpital Charles Nicolle [Rouen], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), BayerMerckUnited Therapeutics CorporationGlaxoSmithKline Australia, GSK, University of Virginia, Università degli Studi di Padova = University of Padua (Unipd), CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and CCSD, Accord Elsevier

Subjects
Pulmonary and Respiratory Medicine, Male, Pathology, medicine.medical_specialty, Cardiac Catheterization, Hypertension, Pulmonary, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Text mining, Diagnosis, 80 and over, Medicine, Precapillary pulmonary hypertension, Humans, Killer Cells, Antigens, Large Granular Lymphocyte Leukemia, Correlation of Data, ComputingMilieux_MISCELLANEOUS, Aged, Aged, 80 and over, Antigens, Surface, Blood Cell Count, Dyspnea, Female, Killer Cells, Natural, Middle Aged, Symptom Assessment, Leukemia, Large Granular Lymphocytic, Leukemia, business.industry, Pulmonary, 3. Good health, [SDV] Life Sciences [q-bio], Surface, 030228 respiratory system, Differential, Hypertension, Natural, Large Granular Lymphocytic, Cardiology and Cardiovascular Medicine, business, 030215 immunology
Abstract

International audience; [No abstract available]

Published
2020

24. Phenotype and outcome of pulmonary arterial hypertension patients carrying a

Author

Pierre, Thoré, Barbara, Girerd, Xavier, Jaïs, Laurent, Savale, Maria-Rosa, Ghigna, Mélanie, Eyries, Marilyne, Levy, Caroline, Ovaert, Amélie, Servettaz, Anne, Guillaumot, Claire, Dauphin, Céline, Chabanne, Emmanuel, Boiffard, Vincent, Cottin, Frédéric, Perros, Gérald, Simonneau, Olivier, Sitbon, Florent, Soubrier, Damien, Bonnet, Martine, Remy-Jardin, Ari, Chaouat, Marc, Humbert, and David, Montani

Subjects
Adult, Male, Bone Diseases, Developmental, Pulmonary Arterial Hypertension, Hip, Adolescent, Infant, Newborn, Infant, Patella, Middle Aged, Survival Rate, Young Adult, Phenotype, Ischium, Child, Preschool, Mutation, Humans, Female, Vascular Resistance, France, Child, T-Box Domain Proteins, Aged, Lung Transplantation, Retrospective Studies
Abstract

We report the clinical, functional, radiologic, histologic and haemodynamic characteristics and outcomes of heritable PAH patients carrying a20 patients were identified in 17 families. They were characterised by a median age at diagnosis of 29 years (0-76 years) and a female to male ratio of three. Most of the patients (70%) were in New York Heart Association (NYHA) functional class III or IV with a severe haemodynamic impairment (median pulmonary vascular resistance (PVR) of 13.6 (6.2-41.8) Wood units). Skeletal signs of SPS were present in 80% of cases. Half of the patients had mild restrictive or obstructive limitation and diffusing capacity of the lung for carbon monoxide (PAH due to

Published
2019

25. Pulmonary Arterial Hypertension Associated With Systemic Lupus Erythematosus

Author

Vincent Sobanski, Grégoire Prévot, Pierre Clerson, Christophe Pison, Jean-Claude Brouet, Anne-Laure Fauchais, Céline Chabanne, David Montani, Jean-François Mornex, Vincent Cottin, Marie-Hélène Balquet, Alain Didier, Laurence Rottat, Jean-François Chabot, Eric Hachulla, David Launay, Gaël Cinquetti, Gérald Simonneau, Jean-Claude Meurice, J.-F. Velly, Jean-Pierre Clauvel, Jean-Marc Ziza, Olivier Sitbon, Marc Humbert, Elena Fois, Luc Mouthon, Jacques Cadranel, Philippe Mabo, Xavier Jaïs, Pierre-Dominique Dos Santos, Julie Traclet, Loïc Guillevin, Zahir Amoura, Véronique Le Guern, and Gilbert Habib

Subjects
030203 arthritis & rheumatology, Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Hazard ratio, Interstitial lung disease, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, medicine.disease, Pulmonary hypertension, 3. Good health, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Cardiology, Medicine, Risk factor, skin and connective tissue diseases, Cardiology and Cardiovascular Medicine, business, Prospective cohort study, Pulmonary wedge pressure, Survival rate
Abstract

Background Pulmonary arterial hypertension (PAH) is a rare complication of systemic lupus erythematosus (SLE). Methods We identified all patients with SLE and PAH (SLE-PAH) who were enrolled in the French Pulmonary Hypertension Registry with a diagnosis confirmed by right heart catheterization (RHC). A control group of 101 patients with SLE without known PAH was selected from SLE expert centers participating in the Pulmonary Hypertension Registry. Survival was estimated by the Kaplan-Meier method. Hazard ratios associated with potential predictors of death were estimated using Cox proportional hazard models. Results Of the 69 patients with SLE-PAH identified in the French Pulmonary Hypertension Registry, 51 were included in the study. They did not differ from the control group regarding age, sex, or duration of SLE at the time of the analysis but had a higher frequency of anti-SSA and anti-SSB antibodies. The delay between SLE diagnosis and PAH diagnosis was 4.9 years (range, 2.8-12.9) years. The 3- and 5-year overall survival rates were 89.4% (95% CI, 76.2%-96.5%) and 83.9% (95% CI, 68.8%-92.1%), respectively. The survival rate was significantly better in patients with anti-U1-RNP antibodies ( P = .04). Conclusions Patients with SLE-PAH have an overall 5-year survival rate of 83.9% after the PAH diagnosis. Anti-SSA/SSB antibodies may be a risk factor for PAH, and the presence of anti-U1-RNP antibodies appears to be a protective factor regarding survival.

Published
2018

26. Impact of donor comorbidities on heart transplant outcomes in the modern era

Author

Amandine Martin, Céline Chabanne, Bernard Lelong, Marie Aymami, Erwan Flecher, Mathilde Rojo, Julien Guihaire, Pierre Emmanuel Noly, Jean-Philippe Verhoye, and Anne Ingels

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Comorbidity, 030204 cardiovascular system & hematology, Group A, Group B, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Humans, Medicine, Heart transplantation, Framingham Risk Score, business.industry, Incidence (epidemiology), Graft Survival, Middle Aged, medicine.disease, Tissue Donors, Transplantation, 030228 respiratory system, Cardiovascular Diseases, Cardiology, Heart Transplantation, Female, Surgery, France, Primary Graft Dysfunction, Cardiology and Cardiovascular Medicine, business, Body mass index
Abstract

OBJECTIVES The use of marginal donors with cardiovascular risk factors is increasing due to organ shortage but remains controversial in heart transplantation (HTx). We sought to investigate post-transplant outcomes in the recent era taking into account donor characteristics. METHODS We reviewed 261 HTx performed in our hospital between January 1996 and March 2013. Donor characteristics were obtained from the national database. The incidence of primary graft dysfunction (PGD) and cardiac allograft vasculopathy (CAV) and overall survival were compared in 2 groups of HTx recipients: those receiving transplants from 1996 to 2004 (Group A, n = 120) and from 2005 to 2013 (Group B, n = 141). RESULTS The mean age of the donors was 34 ± 12 years in Group A vs 42 ± 13 years in Group B ( P

Published
2017

27. Late Breaking Abstract - Balloon pulmonary angioplasty versus riociguat for the treatment of inoperable chronic thromboembolic pulmonary hypertension: results from the randomised controlled RACE study

Author

Christophe Pison, Anne Claire Simon, Pascal Magro, Gérald Simonneau, Céline Chabanne, Olivier Sitbon, Hélène Bouvaist, Carlos Garcia Alonso, Laurent Savale, Mitja Jevnikar, Romain Trésorier, Marc Humbert, Florence Parent, Philippe Brenot, Elie Fadel, Celine Piedvache, Grégoire Prévot, Cécile Tromeur, Delphine Horeau-Langlard, Hélène Agostini, Sébastien Renard, Nicolas Favrolt, Xavier Jaïs, Ari Chaouat, Matthieu Canuet, Pascal de Groote, David Montani, Vincent Cottin, Benoit Gerardin, and Claire Dromer

Subjects
medicine.medical_specialty, business.industry, Walk distance, medicine.medical_treatment, Balloon, medicine.disease, Riociguat, Pulmonary hypertension, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Internal medicine, Angioplasty, medicine, Vascular resistance, Clinical endpoint, Cardiology, Chronic thromboembolic pulmonary hypertension, 030212 general & internal medicine, business, medicine.drug
Abstract

Background: Medical therapy with riociguat and balloon pulmonary angioplasty (BPA) are two therapeutic options for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Controlled studies comparing these two treatments are lacking. Methods: The multicenter, randomised, controlled RACE trial evaluated the efficacy and safety of riociguat versus BPA in newly diagnosed and treatment-naive patients with CTEPH adjudicated as inoperable. Patients identified as WHO functional class (FC) I-IV with a pulmonary vascular resistance (PVR) >320 dyn.s/cm5 were randomly assigned, in a 1:1 ratio, to receive a treatment with riociguat or BPA. The primary endpoint was resting PVR at week 26, expressed as percentage of PVR at baseline. Secondary endpoints included changes from baseline in 6-min walk distance (6MWD), WHO FC, NT-proBNP, time to clinical worsening, and safety. Results: Between January 2016 and January 2019, 105 patients were randomised in 14 centers belonging to the French Pulmonary Hypertension Network: 53 to riociguat, 52 to BPA. Baseline characteristics are depicted in the table. The full study results will be available in June 2019. Conclusion: RACE study will provide important informations on the effect of riociguat compared to that of BPA as first-line therapy in treatment-naive patients with inoperable CTEPH.

Published
2019

28. Pulmonary Arterial Hypertension Associated With Systemic Lupus Erythematosus Results From the French Pulmonary Hypertension Registry

Author

Eric, Hachulla, Xavier, Jais, Gaël, Cinquetti, Pierre, Clerson, Laurence, Rottat, David, Launay, Vincent, Cottin, Gilbert, Habib, Grégoire, Prevot, Céline, Chabanne, Eléna, Foïs, Zahir, Amoura, Luc, Mouthon, Véronique, Le Guern, David, Montani, Gérald, Simonneau, Marc, Humbert, Vincent, Sobanski, Olivier, Sitbon, Alain, Didier, Service de médecine interne [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Paris-Sud - Paris 11 - Faculté de médecine (UP11 UFR Médecine), Université Paris-Sud - Paris 11 (UP11), Orgamétrie biostatistiques, Lille Inflammation Research International Center - U 995 (LIRIC), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Department of Pneumology [Lyon], Hospices Civils de Lyon (HCL), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service de pneumologie [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), 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], Immunité et Infection, IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique, Centre Chirurgical Marie Lannelongue (CCML)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Immunologie (EA 2686), Université de Lille, Droit et Santé, Inflammation: mécanismes et régulation et interactions avec la nutrition et les candidoses, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Service de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies rares-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), CHU Toulouse [Toulouse]-Hôpital Larrey [Toulouse], CHU Toulouse [Toulouse], 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), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR113-Sorbonne Université (SU), Centre chirurgical Marie Lannelongue-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lille, Droit et Santé-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud 11 - Faculté de médecine (UP11 UFR Médecine), Lille Inflammation Research International Center (LIRIC), CHU Toulouse [Toulouse]-Hôpital Larrey, Service de cardiologie et maladies vasculaires [CHU de Rennes], and CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)

Subjects
Male, Hypertension, Pulmonary, Kaplan-Meier Estimate, Middle Aged, survival, Respiratory Function Tests, systemic lupus erythematosus, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Case-Control Studies, pulmonary arterial hypertension, Humans, Lupus Erythematosus, Systemic, Female, France, Longitudinal Studies, Prospective Studies, Registries, skin and connective tissue diseases
Abstract

International audience; BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare complication of systemic lupus erythematosus (SLE). METHODS: We identified all patients with SLE and PAH (SLE-PAH) who were enrolled in the French Pulmonary Hypertension Registry with a diagnosis confirmed by right heart catheterization (RHC). A control group of 101 patients with SLE without known PAH was selected from SLE expert centers participating in the Pulmonary Hypertension Registry. Survival was estimated by the Kaplan-Meier method. Hazard ratios associated with potential predictors of death were estimated using Cox proportional hazard models. RESULTS: Of the 69 patients with SLE-PAH identified in the French Pulmonary Hypertension Registry, 51 were included in the study. They did not differ from the control group regarding age, sex, or duration of SLE at the time of the analysis but had a higher frequency of anti-SSA and anti-SSB antibodies. The delay between SLE diagnosis and PAH diagnosis was 4.9 years (range, 2.8-12.9) years. The 3- and 5-year overall survival rates were 89.4% (95% CI, 76.2%-96.5%) and 83.9% (95% CI, 68.8%-92.1%), respectively. The survival rate was significantly better in patients with anti-U1-RNP antibodies (P = .04). CONCLUSIONS: Patients with SLE-PAH have an overall 5-year survival rate of 83.9% after the PAH diagnosis. Anti-SSA/SSB antibodies may be a risk factor for PAH, and the presence of anti-U1-RNP antibodies appears to be a protective factor regarding survival.

Published
2018

29. Pulmonary arterial hypertension in four patients treated by leflunomide

Author

Guillaume Coiffier, Elisabeth Polard, A. Lescoat, Stéphane Jouneau, Maxime Fournet, Céline Chabanne, Patrick Jego, Valentin Coirier, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], Jonchère, Laurent, Université d'Angers (UA)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Male, medicine.medical_specialty, Hypertension, Pulmonary, Physical examination, 030204 cardiovascular system & hematology, Pulmonary arterial hypertension, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Arthritis, Rheumatoid, 03 medical and health sciences, Psoriatic arthritis, 0302 clinical medicine, Rheumatology, Internal medicine, medicine, Humans, Pulmonary Wedge Pressure, Pulmonary wedge pressure, Leflunomide, medicine.diagnostic_test, business.industry, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, medicine.disease, Connective tissue disease, Pulmonary hypertension, 3. Good health, [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, 030228 respiratory system, Heart failure, Rheumatoid arthritis, Cardiology, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Female, Tomography, X-Ray Computed, business, Immunosuppressive Agents, medicine.drug
Abstract

International audience; Pulmonary arterial hypertension (PAH) is a rare disorder that can be drug-induced, mostly following treatment by appetite-suppressant drugs. We report four cases of patients who developed PAH following a treatment by leflunomide for rheumatoid arthritis, psoriatic arthritis or undetermined connective tissue disease. All patients described a progressive dyspnea from grade II to IV of NYHA classification; clinical examination found signs of heart failure. PAH was finally diagnosed and confirmed by right heart catheterisation. Haemodynamic explorations found pre-capillary pulmonary hypertension with mean pulmonary arterial pressure above 25mmHg, and pulmonary capillary wedge pressure under 15mmHg. Explorations of this pre-capillary pulmonary hypertension were conducted according to international guidelines: pulmonary or chronic thromboembolic aetiologies were excluded after ventilation/perfusion lung scan and high-resolution computed tomography. All other etiologic explorations were negative. Imputability of leflunomide was finally retained. Leflunomide was stopped for all patients; three of them received specific PAH treatments. A favourable clinical and/or haemodynamic evolution was observed for all patients. The conclusions of the investigations conducted by our pharmacovigilance centre were communicated to the European Medicines Agency, leading to the addition of "pulmonary hypertension" in the paragraph "special warning and precautions of use" of the package leaflet of leflunomide.

Published
2018

30. Risk categories from European guidelines applied to the French Pulmonary Hypertension (PH) registry

Author

Emmanuel Bergot, Laurence Rottat, David Montani, Vincent Cottin, Laurent Savale, Xavier Jaïs, Gérald Simonneau, Arnaud Bourdin, Jason Weatherald, Olivier Sitbon, Ari Chaouat, Céline Chabanne, Athénaïs Boucly, Marc Humbert, François Picard, Grégoire Prévot, Caroline O’Connell, and Pascal de Groote

Subjects
Univariate analysis, medicine.medical_specialty, Proportional hazards model, business.industry, Cardiac index, Central venous pressure, medicine.disease, Pulmonary hypertension, Risk category, Internal medicine, medicine, In patient, Risk assessment, business
Abstract

Background: Current European (ERS/ESC) PH guidelines recommend risk assessment in patients with pulmonary arterial hypertension (PAH). The aim of our study were to analyze the association between the number of determinants of low-risk criteria achieved and long-term outcome. Methods: All patients with idiopathic, heritable and drug-induced PAH entered into the French Registry from 2006 and reassessed within a year were analyzed. The Cox model was used to determine the weight of 4 low-risk criteria achieved at first follow-up visit: NYHA FC, 6MWD, right atrial pressure (RAP) and cardiac index (CI). Results: 1017 patients were analyzed (mean age 57 yrs, 59% female, 75% iPAH). After a median follow-up of 34 months, 23% had died. In univariate analysis, HR (95%CI) for NYHA FC I-II, 6MWD>440 m, RAP Conclusion: These results support the relevance of ESC/ERS guidelines risk stratification to define treatment goals in patients with PAH.

Published
2017

31. Heart transplantation in selected patients aged 60 years and older: a two-decade retrospective and multicentre analysis

Author

Richard Dorent, Sabine Pattier, Christophe Leclercq, Jean-Noël Trochu, Jean-Christian Roussel, Bernard Lelong, Christian Bosseau, Sirinelli A, Erwan Flecher, Jean-Philippe Verhoye, Michel Aupart, Philippe Mabo, Christelle Cantrelle, Céline Chabanne, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Département de Cardiologie et Transplantation, Hôpital Guillaume et René Laënnec, CIC - Nantes, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service de Chirurgie Cardiaque, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence de la biomédecine [Saint-Denis la Plaine], unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), 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), and Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Population, 030232 urology & nephrology, Kaplan-Meier Estimate, Heart transplantation, outcomes, elderly, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, education, Survival rate, Aged, Retrospective Studies, Cause of death, Heart Failure, education.field_of_study, Ischemic cardiomyopathy, business.industry, Hazard ratio, Retrospective cohort study, General Medicine, End-stage heart failure, Middle Aged, 3. Good health, Treatment Outcome, 030220 oncology & carcinogenesis, Cohort, Female, Surgery, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; OBJECTIVES: This study analysed survival and long-term outcomes of heart transplantation in patients aged 60 years and older. We also analysed the impact of a national graft allocation priority [Super Emergency (SE)] and compared survival with younger patients in our centres and in France. METHODS: We performed a multicentre (University Hospitals in Nantes, Rennes and Tours), 2-decade retrospective study between 1 January 1994 and 31 December 2013. Elderly recipients were placed on the same list as younger patients; the use of marginal donors remained occasional. RESULTS: A total of 212 patients aged between 60 and 68 years were included. The 1-, 5-, and 10-year survival rates were 83.2%, 77.4% and 63.8%, respectively, which were significantly worse than those of recipients aged

Published
2017

32. Comparison of cardiac allograft vasculopathy in heart and heart–lung transplantations: A 15-year retrospective study

Author

Elie Fadel, Céline Chabanne, Sacha Mussot, Bernard Lelong, Marie Aymami, Jean-Philippe Verhoye, Olaf Mercier, Bertrand De Latour, Julien Guihaire, Erwan Flecher, Philippe Dartevelle, Jacques Cerrina, Soly Fattal, Thierry Langanay, Alain Leguerrier, Dominique Fabre, Hervé Corbineau, and François Le Roy Ladurie

Subjects
Adult, Graft Rejection, Lung Diseases, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Heart-Lung Transplantation, medicine.medical_treatment, Bronchiolitis obliterans, Disease-Free Survival, Pulmonary Heart Disease, Internal medicine, Humans, Medicine, Lung transplantation, Survival rate, Retrospective Studies, Heart transplantation, Transplantation, Lung, business.industry, Graft Survival, Retrospective cohort study, Middle Aged, medicine.disease, Surgery, Survival Rate, medicine.anatomical_structure, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after heart transplantation (HTx). Specific determinants of CAV and long-term outcome after CAV occurrence have been poorly investigated after heart-lung transplantation (HLTx).Between January 1996 and December 2006, 79 patients underwent HLTx (36.3 ± 12.2 years old; 47% men) and 141 patients underwent HTx (49.2 ± 12.3 years old; 77% men) at two different institutions. CAV grading was reviewed in both groups according to the 2010 standardized nomenclature of the International Society for Heart and Lung Transplantation. The mean post-transplant follow-up was 94 (1 to 181) months.Overall 10-year survival rate was 58% after HTx and 43% after HLTx (p = 0.11). The Grade 1 (or higher) CAV-free survival rate was 95% at 4 years and 69% at 10 years after HLTx, and 77% and 39%, respectively, after HTx (p0.01). Mean cyclosporine blood levels were similar between the groups at 3, 6, 12, 24 and 36 months. The main causes of mortality beyond 5 years after HTx and HLTx were malignancies and bronchiolitis obliterans, respectively. By multivariate analysis, recipients who developed3 acute myocardial rejections during the first year post-transplant were exposed to a higher risk of CAV (95% CI 1.065 to 2.33, p = 0.02). Episodes of acute pulmonary rejection and bronchiolitis obliterans were not associated with an increased risk of CAV (p = 0.52 and p = 0.30).HLTx recipients appeared protected from CAV compared with HTx patients in this retrospective study. Repeated acute cardiac rejections were independent predictors of CAV. Unlike bronchiolitis obliterans, CAV had a very low impact on long-term survival after HLTx.

Published
2014

34. Heterotopic heart transplantation: where do we stand?

Author

Bernard Lelong, Céline Chabanne, Olivier Fouquet, Vito G. Ruggieri, Alain Leguerrier, and Erwan Flecher

Subjects
Pulmonary and Respiratory Medicine, Waiting time, medicine.medical_specialty, Transplantation, Heterotopic, medicine.medical_treatment, Internal medicine, otorhinolaryngologic diseases, medicine, Animals, Humans, Donor pool, Heart transplantation, business.industry, Immunosuppression, General Medicine, medicine.disease, Pulmonary hypertension, Surgery, Transplantation, Heart failure, Circulatory system, Cardiology, Heart Transplantation, Cardiology and Cardiovascular Medicine, business
Abstract

Orthotopic heart transplantation (OHT) is a well established and commonly utilized procedure for end-stage heart failure patients. Heterotopic heart transplantation (HHT) is a surgical procedure that allows the graft to be connected to the native heart in a parallel fashion. The main advantage of HHT is to assist the patient's native heart and to maintain circulation in the cases of severe acute rejection. HHT has also been proposed to overcome pulmonary hypertension, to increase the size of the donor pool and to decrease waiting times without increasing morbidity caused by the procedure. However, only a few papers have reported the short- or long-term results of HHT, and most of these studies have included

Published
2013

35. A prospective study of the 6 min walk test as a surrogate marker for haemodynamics in two independent cohorts of treatment-naive systemic sclerosis-associated pulmonary arterial hypertension

Author

Sébastien Sanges, Pascal de Groote, L. Rottat, David Launay, Clément Boissin, Gérald Simonneau, Emmanuel Bergot, Grégoire Prévot, Christophe Gut-Gobert, Claire Dauphin, Loïc Guillevin, Matthieu Canuet, François Conesa, Pascal Magro, Céline Chabanne, Pierre Clerson, David Montani, Olivier Sitbon, Vincent Cottin, Rennie L. Rhee, Marc Humbert, Sylvie Leroy, Fabrice Bauer, Jean-François Cordier, Martine Reynaud-Gaubert, Gilbert Habib, Olivier Sanchez, Christophe Pison, Eric Hachulla, Steven M. Kawut, Luc Mouthon, Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon, Service de Pneumologie, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), CHU Caen, 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], Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), Hôpital Nord [CHU - APHM], Service de Pneumologie ( NICE - Pneumo ), CHU Nice, Service de pneumologie (Strasbourg), CHU Strasbourg-Nouvel Hôpital Civil, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Département de Médecine Interne et Pneumologie [Brest] ( DMIP - Brest ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Service de médecine interne, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, Laboratoire de bioénergétique fondamentale et appliquée ( LBFA ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Grenoble Alpes ( UGA ), European Institute for Systems Biology and Medicine ( EISBM ), Clinique de pneumologie, 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 ), Orgamétrie biostatistiques, Hospices Civils de Lyon ( HCL ), Service de Pneumologie et Réanimation Respiratoire ( DHU TORINO ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre-Centre de Référence de l'Hypertension Pulmonaire Sévère, Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique, Centre chirurgical Marie Lannelongue-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Paris-Sud - Paris 11 ( UP11 ), Lille Inflammation Research International Center ( LIRIC ), Institut Pasteur de Lille, Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), CREAK Grenoble, Service de médecine interne [Lille], Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Claude Bernard Lyon 1 (UCBL), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de pneumologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), 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], Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Service de Pneumologie (NICE - Pneumo), Centre Hospitalier Universitaire de Nice (CHU Nice), 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), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Médecine Interne [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), European Institute for Systems Biology and Medicine (EISBM), Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Hospices Civils de Lyon (HCL), Service de Pneumologie et Réanimation Respiratoire (DHU TORINO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre-Centre de Référence de l'Hypertension Pulmonaire Sévère, Centre Chirurgical Marie Lannelongue (CCML)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11), Lille Inflammation Research International Center - U 995 (LIRIC), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de référence des angiœdèmes à kinines (CREAK), CHU Grenoble-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Centre chirurgical Marie Lannelongue-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Centre de référence des angioedèmes à kinines (CREAK), and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble

Subjects
Adult, Male, Cardiac Catheterization, medicine.medical_specialty, Cardiac output, Pathology, Multivariate analysis, Hypertension, Pulmonary, Immunology, Hemodynamics, Walk Test, Systemic Sclerosis, 030204 cardiovascular system & hematology, General Biochemistry, Genetics and Molecular Biology, Autoimmune Diseases, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Humans, Immunology and Allergy, Medicine, Prospective Studies, Cardiac Output, Prospective cohort study, Arterial Hypertension, Antihypertensive Agents, Associated Pulmonary Arterial Hypertension, Aged, 030203 arthritis & rheumatology, Scleroderma, Systemic, business.industry, Surrogate endpoint, Reproducibility of Results, Middle Aged, 3. Good health, Clinical trial, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Outcomes research, Cohort, Cardiology, Female, France, business, Follow-Up Studies
Abstract

International audience; Objectives Despite the wide use of the 6 min walk distance (6MWD), no study has ever assessed its validity as a surrogate marker for haemodynamics and predictor of outcome in isolated pulmonary arterial hypertension associated with systemic sclerosis (SSc-PAH). We designed this work to address this issue. Methods Treatment-naive patients with SSc-PAH were prospectively included from two sources: the French PAH Network (a prospective epidemiological cohort) (n=83) and randomised clinical trials submitted for drug approval (Food and Drug Administration) (n=332). Correlations between absolute values of the 6MWD and haemodynamics at baseline, as well as between variations of 6MWD and haemodynamics during follow-up, were studied in both populations. Results In the French cohort, baseline cardiac output (CO) (R-2=0.19, p=0.001) and New York Heart Association class (R-2=0.10, pConclusions In SSc-PAH, CO independently correlates with 6MWD at baseline, but accounts for a small amount of the variance of 6MWD in both study samples. This suggests that other non-haemodynamic factors could have an impact on the walk distance. Moreover, variations of 6MWD do not reflect changes in haemodynamics among treated patients. Our results suggest that 6MWD is not an accurate surrogate marker for haemodynamic severity, nor an appropriate outcome measure to assess changes in haemodynamics during follow-up in treated SSc-PAH.

Published
2016

36. Long-term follow-up of bioprosthetic aortic valve replacement in patients aged ≤60 years

Author

Vito G. Ruggieri, Thierry Langanay, Céline Chabanne, Alain Leguerrier, Jean-Philippe Verhoye, Amedeo Anselmi, Erwan Flecher, and Hervé Corbineau

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, Reoperation, medicine.medical_specialty, Long term follow up, Heart Valve Diseases, Long Term Adverse Effects, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Aortic valve replacement, Internal medicine, Outcome Assessment, Health Care, Medicine, Humans, In patient, Bioprosthesis, Heart Valve Prosthesis Implantation, Adult patients, business.industry, Patient Selection, Middle Aged, medicine.disease, Surgery, Prosthesis Failure, 030228 respiratory system, Infective endocarditis, Bioprosthetic aortic valve replacement, Aortic Valve, Heart Valve Prosthesis, Cardiology, Lifetime risk, Female, Risk Adjustment, France, Cardiology and Cardiovascular Medicine, Complication, business, Follow-Up Studies
Abstract

To address the long-term durability of bioprostheses used for aortic valve replacement (AVR) in adult patients aged ≤60 years at the time of surgery.Through a retrospective review of a prospectively collected database, we identified 416 bioprosthetic AVRs performed between 1977 and 2013. A prospective follow-up of valve-related and non-valve-related events was performed.Follow-up was 98.5% complete (2423.1 patient-years; average, 6 ± 5.5 years). At 15 years, overall survival was 62.1 ± 4.4%; freedom from valve-related death was 97.1 ± 1.6%. There were 68 SVD events (11.9 ± 28.8 years after surgery). Freedom from SVD at 15 years was 48.7 ± 5.5% for Kaplan-Meier analysis and 61.4 ± 4.3% for competing-risks analysis. After stratification into age subgroups (40 years, ≥40 and 50 years, and ≥50 and ≤60 years), we observed no significant difference in freedom from SVD (P = .50). The average delay to SVD was not statistically different among subgroups (P = .30). There were 57 reoperations for SVD (11.8 ± 5.2 years after implantation). The 15 year freedom from reoperation for SVD was 55.4 ± 5.6% by Kaplan-Meier analysis and 67.1 ± 4.2% by competing-risks analysis. After stratification by age, freedom from reoperation for SVD was comparable (P = .13). Freedom from any valve-related complication or death was 42 ± 5% by Kaplan-Meier analysis and 54.4 ± 4.1% by competing-risks analysis.The lifetime risk of SVD is considerable in patients aged ≤60 years at the time of bioprosthesis implantation. Nonetheless, durability remains consistent during the first decade; additional data are required for the second decade. Patients' information is pivotal for valve choice (competing-risks method).

Published
2016

37. Oral pulmonary vasoactive drugs achieve hemodynamic eligibility for liver transplantation in portopulmonary hypertension

Author

Céline Chabanne, Caroline Jezequel, Edouard Bardou-Jacquet, Michel Rayar, Marianne Latournerie, Christophe Camus, Karim Boudjema, Maxime Fournet, Ludivine Legros, Dominique Guyader, and Pauline Houssel-Debry

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, Ambrisentan, Sildenafil, medicine.medical_treatment, Hypertension, Pulmonary, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Liver transplantation, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Hypertension, Portal, medicine, Humans, Antihypertensive Agents, Retrospective Studies, Portopulmonary hypertension, Hepatology, Phenylpropionates, business.industry, Gastroenterology, Hemodynamics, Middle Aged, medicine.disease, Tadalafil, Bosentan, Surgery, Liver Transplantation, Pyridazines, chemistry, Cardiology, Portal hypertension, 030211 gastroenterology & hepatology, Female, Vascular Resistance, France, business, medicine.drug
Abstract

Background and aims Portopulmonary hypertension (POPH) hampers survival of patients with cirrhosis and portal hypertension and may preclude liver transplantation (LT). Management of such patients with oral pulmonary vasoactive drugs (PVD) has not been standardized. Our aim was to assess the efficacy and safety of oral PVD for management of POPH. Methods All patients treated by oral PVD (bosentan, ambrisentan, sildenafil, tadalafil) for POPH were retrospectively studied. Significant response was defined for the patients who reached the following LT eligibility criteria: mean pulmonary artery pressure (MPAP) −5 . Results 20 patients were followed for 38 (19–57) months. Oral PVD improved MPAP (−8 [−19, +2] mmHg), PVR (−201 [–344, –68] dyn s cm −5 ) and 6-min walk distance (+52 [−51, +112] m). Fifty-three percent of evaluable patients reached eligibility to LT criteria, of whom 5 were transplanted. Baseline MPAP > 51 mmHg and/or PVR > 536 dyn s cm −5 predicted non response to treatment. Five-years survival was 53%. No worsening of cirrhosis or serious adverse effect was recorded. Conclusion Oral pulmonary vasoactive drugs are safe in cirrhotic patients with POPH. These treatments improved hemodynamic conditions allowing patients access to liver transplantation eligibility.

Published
2016

38. Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study

Author

Philippe Mabo, Elena Galli, Maxime Fournet, Alain Leguerrier, Erwan Flecher, Bernard Lelong, Erwan Donal, Céline Chabanne, 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 [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_specialty, Diastolic function, Systole, Diastole, 030204 cardiovascular system & hematology, Sensitivity and Specificity, Severity of Illness Index, Body Mass Index, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Peak left atrial strain, 030212 general & internal medicine, Aged, Aged, 80 and over, Heart Failure, Proportional hazards model, business.industry, Aortic stenosis, Hazard ratio, Systolic function, Aortic Valve Stenosis, General Medicine, Prognosis, medicine.disease, 3. Good health, Stenosis, Echocardiography, Case-Control Studies, Heart failure, Aortic valve stenosis, Left atrium, Cardiology, Atrial Function, Left, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

International audience; Aims The aim of this article is to assess the left atrial (LA) reservoir function in patients with severe aortic stenosis (AS) and to evaluate its impact on the recurrence of major adverse cardiac events (MACEs).Methods and results About 128 patients (mean age 79 ± 9 years) with severe AS were included in the study. Global peak LA strain (PLAS) measured by two-dimensional speckle-tracking echocardiography (STE) during left ventricular (LV) systole represented the LA reservoir function. Overall death, hospitalization for cardiac cause, and worsening heart failure were defined as MACEs. With respect to the values observed in a control group of 20 healthy patients, PLAS resulted significantly reduced in AS. According to the multivariate linear regression analysis, LV global longitudinal strain, mitral E/e′ ratio, and systolic pulmonary arterial pressure (sPAP) were the best correlates to PLAS. During follow-up, the predefined MACEs occurred in 39 patients. According to the multivariate Cox regression analysis, a PLAS \textless21% was a significant predictor of MACEs [hazard ratio (HR) 2.88, P = 0.04], as was coronary artery disease (HR 2.68, P = 0.004) and the New York Heart Association functional class (HR 2.08, P = 0.03).Conclusion In patients with severe AS, a global PLAS \textless21% is an independent predictor of prognosis. Given the combined influence of LV diastolic and systolic function and of LA performance on sPAP, the decline of PLAS might be considered a marker of global myocardial impairment in AS. Further studies are needed to confirm the critical role of LA relaxation in prognosis and to validate its relevance in routine clinical practice

Published
2016

39. Rest and Exercise Adaptation of the Right Ventricular Function in Long-Term Left Ventricular Assist Device Patients: a Prospective, Pilot Study

Author

François Carré, Céline Chabanne, Erwan Donal, Hervé Corbineau, Elena Galli, Alain Le Helloco, Alain Leguerrier, Marie Federspiel, Jean-Philippe Verhoye, Julien Guihaire, Bernard Lelong, Marie Aymami, Erwan Flecher, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], 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), Jonchère, Laurent, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Rest, Pilot Projects, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, left ventricular assist device, Medicine, Humans, Prospective Studies, Adaptation (computer science), Exercise, Rest (music), ComputingMilieux_MISCELLANEOUS, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Ventricular function, business.industry, exercise capacities, Middle Aged, Adaptation, Physiological, Term (time), right ventricular function, 030228 respiratory system, Ventricular assist device, Cardiology, Exercise Test, Ventricular Function, Right, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

International audience; no abstract

Published
2016

40. Three-year haemodynamic performance of the St Jude Trifecta bioprosthesis

Author

Erwan Flecher, Alain Leguerrier, Amedeo Anselmi, Vito G. Ruggieri, Bernard Lelong, Jean-Philippe Verhoye, Céline Chabanne, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], 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 [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Pulmonary and Respiratory Medicine, Aortic valve, Male, medicine.medical_specialty, medicine.medical_treatment, Population, Hemodynamics, 030204 cardiovascular system & hematology, Prosthesis, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Internal medicine, medicine, Humans, aortic valve replacement, Prospective Studies, education, Prospective cohort study, Trifecta, Aged, Aged, 80 and over, Bioprosthesis, Heart Valve Prosthesis Implantation, education.field_of_study, Haemodynamics, business.industry, Effective orifice area, General Medicine, Aortic Valve Stenosis, medicine.disease, 3. Good health, medicine.anatomical_structure, 030228 respiratory system, Aortic valve stenosis, Aortic Valve, Heart Valve Prosthesis, Cardiology, Surgery, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; OBJECTIVES To examine the haemodynamic performance of the St Jude Trifecta valve for aortic valve replacement (AVR) at 3 years after implantation. METHODS In a single-centre, prospective, observational, independent study, we enrolled 122 patients who had AVR using a Trifecta bioprosthesis in the July 2010–June 2011 period. A clinical and echocardiographic in-house follow-up was scheduled. RESULTS In our series, 14.7% of patients received a 19-mm, 28.7% had a 21-mm, 35.2% had a 23-mm and 21.3% had a greater-size prosthesis. There were no cases of operative mortality or of valve-related complications both early and at follow-up (except one sudden unexplained death). Completeness of the 3-year echocardiographic follow-up was 80% among survivors. The average mean transvalvular gradient (mTVG) at 3 years was 14.2, 10.8, 8.6, 7.1 and 6.8 mmHg (sizes 19 to 27/29, respectively). There was no statistically significant difference between average mTVGs measured immediately after implantation versus at the 3-year follow-up in the overall population. The average peak transvalvular gradient (pTVG) at 3 years was 25, 20, 16.8, 13.9 and 14.4 mmHg (sizes 19 to 27/29, respectively). The average indexed effective orifice area (iEOA) at 3 years was 0.8, 0.9, 1, 1.3 and 1.3 cm2/m2 (sizes 19–27, respectively). The rate of moderate patient–prosthesis mismatch (PPM) at 3 years was 15.7%; there were two instances of severe PPM (2.2%). All cases of PPM occurred in the 19, 21 and 23 mm size subgroups. CONCLUSIONS The Trifecta valve retains its excellent haemodynamic properties at the 3-year follow-up. The rate of PPM is considerably low

Published
2016

41. Transplantation cardiaque en super urgence (SU) avec et sans assistance circulatoire mécanique de type extracorporeal membrane oxygenation (ECMO)

Author

I. Abouliatim, B. Lelong, M. Harmouche, Alain Leguerrier, Olivier Fouquet, Erwan Flecher, Jean-Philippe Verhoye, and Céline Chabanne

Subjects
Gynecology, Transplantation, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, 030228 respiratory system, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, 3. Good health
Abstract

Resume But de l’etude Pour evaluer les resultats immediats et a court terme de la transplantation cardiaque en super urgence (SU) et l’impact de l’extracorporeal membrane oxygenation (ECMO) chez les patients en attente de greffe, nous avons realise une etude retrospective comparative portant sur 20 patients transplantes consecutivement entre janvier 2004 et septembre 2007 a Rennes. Patients et methodes Deux groupes de dix patients ont pu etre constitues : un groupe transplante en SU sans ECMO ; un groupe transplante en SU avec une ECMO preoperatoire. Resultats (1) Groupe SU sans ECMO : la survie a deux ans etait de 70 %. La duree moyenne d’hospitalisation etait de 26,4 jours. Trois patients ont beneficie d’une ECMO postgreffe pour defaillance du greffon, sans complication observee en rapport avec l’assistance. Il n’y a eu aucun rejet ni retransplantation. A deux ans, tous les patients ayant quitte l’hopital etaient vivants ; (2) groupe SU avec ECMO : la survie a deux ans etait de 90 %. Plusieurs complications en rapport avec l’assistance ont ete observees : deux ischemies de membre inferieur, trois lymphorrhees de scarpa, un changement de canules pour drainage insuffisant et un œdeme aigu du poumon traite par septostomie interauriculaire percutanee. La duree moyenne d’hospitalisation etait de 45 jours. Il n’y a eu aucun rejet ni retransplantation et a deux ans, tous les patients ayant quitte l’hopital etaient vivants. Conclusion Bien que non significatifs, ces resultats donnent une photographie de notre pratique actuelle. L’ECMO permet d’amener a la greffe des patients graves, au prix d’une morbidite non negligeable. Une etude comparative de plus grande ampleur et multicentrique serait souhaitable.

Published
2011

42. Incidence and Management of Device-related Infections With the Jarvik 2000 Axial Flow Pump

Author

R. Nottin, Alexandre Azmoun, Y. Lepers, A. Anselmi, M. Gaillard, Céline Chabanne, Philippe Deleuze, R. Ramadan, J. Guihaire, and Erwan Flecher

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, Axial-flow pump, business.industry, Incidence (epidemiology), Internal medicine, Cardiology, medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2018

43. 24 Prognostic value of left atrial reservoir function in patients with severe aortic stenosis

Author

Elena Galli, Erwan Flecher, Céline Chabanne, Bernard Lelong, Alain Leguerrier, Maxime Fournet, Erwan Donal, Philippe Mabo, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], 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), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, Reservoir function, business.industry, medicine.disease, Stenosis, Left atrial, Internal medicine, Cardiology, medicine, In patient, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business, Cardiology and Cardiovascular Medicine, Value (mathematics), ComputingMilieux_MISCELLANEOUS
Abstract

International audience; no abstract

Published
2015

44. 0230 : Effectiveness of extracorporeal life support for patients with cardiogenic shock due to intractable arrhythmic storm

Author

Bernard Lelong, Raphaël P. Martins, Solène Le Pennec-Prigent, Christophe Leclercq, Céline Chabanne, Jean-Claude Daubert, Philippe Mabo, Erwan Flecher, 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 [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Heart transplantation, medicine.medical_specialty, endocrine system, Ischemic cardiomyopathy, Myocarditis, business.industry, Cardiogenic shock, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Dilated cardiomyopathy, 030204 cardiovascular system & hematology, medicine.disease, Extracorporeal, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Heart failure, Internal medicine, Cardiology, medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Survival rate
Abstract

Background Extracorporeal life support (ECLS) provides mechanical cardiopulmonary support and has been used for intractable heart failure as a bridge to heart transplantation or to recovery. Intractable arrhythmic storm is associated with high mortality. Little is known about the effectiveness of ECLS to treat refractory ventricular arrhythmias responsible for cardiogenic shock in patients non eligible for an urgent ablation. Methods Patients with intractable refractory ventricular arrhythmias and cardiogenic shock despite optimal medical therapy, and treated by ECLS implantation were retrospectively included. Patients’ characteristics and outcome were analyzed. Results 20 patients (53±10 yo) were included. The underlying etiology to the refractory ventricular storm was ischemic cardiomyopathy (75%), short coupled Torsades de Pointes (10%), dilated cardiomyopathy (5%), myocarditis (5%) or unknown (5%). Mean LVEF was 33±17%. An average of 2.3±1.2 anti-arrhythmic drugs was tried before implantation. Arrhythmic storm stopped after a median time of 15min after ECLS implantation. 8 patients (40%) eventually died, none of them because of a complication of ECLS implantation. The remaining 12 patients (60%) had ECLS withdrawn after a median time of 5.3 days, and were discharged after a median time of 29 days after admission (survival curve in the figure). Conclusion This is the largest database of patients temporary implanted with ECLS for refractory ventricular arrhythmia responsible for cardiogenic shock and non eligible for ablation. It provides efficient hemodynamic support to these critically ill patients, and survival rate after the implantation is 60%. Download : Download full-size image Figure: Survival curve

Published
2015

45. 0384: Are prognostic scores useful for risk stratification in cardiac transplantation? Insight from a French cardiac surgery center experience

Author

Bernard Lelong, Julien Guihaire, Amandine Martin, Corbineau Hervé, Pierre Noly, Jean-Philippe Verhoye, Céline Chabanne, Erwan Flecher, Alain Leguerrier, Thierry Langanay, and Amedeo Anselmi

Subjects
Heart transplantation, medicine.medical_specialty, education.field_of_study, business.industry, medicine.medical_treatment, Population, Impact score, Hospital mortality, medicine.disease, Surgery, Cardiac surgery, Transplantation, Heart failure, Emergency medicine, Risk stratification, medicine, education, business, Cardiology and Cardiovascular Medicine
Abstract

PurposeThe Seattle Heart Failure Model (SHFM), the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score are newly used in heart transplantation for graft allocation. We aimed if these scores could be useful in risk stratification for cardiac transplantation in our center.MethodsThe SHFM, the INTERMACS model and the IMPACT score were retrospectively calculated for 182 heart transplantation candidates and 152 non-VAD patients who underwent urgent and non-urgent heart transplantation between January 2004 and April 2013 in our center. Results were compared with actual mortality at 1, 2 and 5 years. The performance of these score in predicting hospital mortality was evaluated with ROC curve.ResultsPredicted mortality at 1, 2 and 5 years with the SHFM score was significantly higher (p

Published
2015
Full Text
View/download PDF

46. Severe Pulmonary Hypertension Associated with COPD: Hemodynamic Improvement with Specific Therapy

Author

Philippe Delaval, Céline Chabanne, Julie Traclet, Vincent Cottin, Anne Girard, Ségolène Turquier, Chahéra Khouatra, Jean-François Cordier, Stéphane Jouneau, Morgane Lannes, Service de pneumologie [Rennes] = Pneumology [Rennes], CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Service de Pneumologie, Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de pneumologie, Hôpital Pontchaillou-CHU Pontchaillou [Rennes], 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], and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Hypertension, Pulmonary, Vasodilator Agents, [SDV]Life Sciences [q-bio], Hemodynamics, Comorbidity, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, Severity of Illness Index, Sildenafil Citrate, Statistics, Nonparametric, Pulmonary function testing, chronic obstructive pulmonary disease, Cohort Studies, Hospitals, University, Pulmonary Disease, Chronic Obstructive, Internal medicine, Severity of illness, pulmonary hypertension, medicine, Humans, echocardiography, right heart catheterization, Aged, Retrospective Studies, Sulfonamides, COPD, business.industry, Bosentan, Middle Aged, medicine.disease, Pulmonary hypertension, respiratory tract diseases, 3. Good health, Treatment Outcome, medicine.anatomical_structure, Cardiology, Vascular resistance, Female, Vascular Resistance, France, business, Follow-Up Studies, medicine.drug
Abstract

Background: There is no recommendation for treating pulmonary hypertension (PH) when associated with chronic obstructive pulmonary disease (COPD). Objective: To evaluate the effect of PH-specific therapy in patients with COPD. Methods: All successive patients with severe PH [mean pulmonary arterial pressure (mPAP) ≥35 mm Hg] and COPD, who received specific PH medication and who underwent right heart catheterization at baseline and after 3-12 months of treatment, were analyzed from a prospective database. Results: Twenty-six patients were included with a median follow-up of 14 months. Mean forced expiratory volume in 1 s was 57 ± 20% of predicted, and mean forced expiratory volume in 1 s/forced vital capacity was 47 ± 12%. Dyspnea was New York Health Association classification stage (NYHA) II in 15%, NYHA III in 81% and NYHA IV in 4%. First-line treatments were endothelin receptor antagonists in 11 patients, phosphodiesterase-5 inhibitors in 11 patients, calcium blocker in 1 patient, combination therapy in 3 patients including 2 with a prostanoid. After 6 ± 3 months, pulmonary vascular resistance decreased from 8.5 ± 3 to 6.6 ± 2 Wood units (p < 0.001), with significant improvement of cardiac index from 2.44 ± 0.43 to 2.68 ± 0.63 liters × min × m-2 (p = 0.015) and mPAP from 48 ± 9 to 42 ± 10 mm Hg (p = 0.008). There was no significant difference in dyspnea, 6-min walking distance, echocardiographic parameters or N-terminal pro-brain natriuretic peptide levels. There was no significant difference in arterial oxygen saturation after 3-12 months of treatment. Conclusions: Specific PH medications may improve hemodynamic parameters in COPD patients with severe PH. Appropriate prospective randomized studies are needed to evaluate the potential long-term clinical benefit of treatment.

Published
2015

47. Acute severe hypoxaemia after mechanical ventilation in a patient with an Ebstein anomaly requiring extracorporeal membrane oxygenation

Author

Erwan Flecher, Y. Le Tulzo, Loïc Chimot, Céline Chabanne, S. Mascle, B. De Latour, and Sylvain Lavoué

Subjects
Mechanical ventilation, medicine.medical_specialty, Anesthesiology and Pain Medicine, EBSTEIN ANOMALY, business.industry, medicine.medical_treatment, Internal medicine, Anesthesia, Extracorporeal membrane oxygenation, medicine, Cardiology, business
Published
2011

48. Rest and Exercise Adaptation of the Right Ventricle in Long-Term Left Ventricular Assist Device Patients: A Prospective, Pilot Study

Author

Marie Aymami, Erwan Flecher, François Carré, Hervé Corbineau, J. Guihaire, Céline Chabanne, A. Le Helloco, Elena Galli, Bernard Lelong, M. Federspiel, and Erwan Donal

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Term (time), medicine.anatomical_structure, Ventricle, Internal medicine, Ventricular assist device, medicine, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, Adaptation (computer science), business, Rest (music)
Published
2015

49. [The role of the mechanical circulatory support nurse coordinator]

Author

Véronique, Desriac, Pascale, Rouault, Bernard, Lelong, Céline, Chabanne, Marie-Annick, Jean, Alain, Leguerrier, and Erwan, Flecher

Subjects
Heart Failure, Extracorporeal Membrane Oxygenation, Humans, Heart-Assist Devices, Nurse's Role
Abstract

Faced with the growing number of people suffering from heart failure, mechanical circulatory support techniques have developed in order to improve the survival of patients not responding to optimal medical treatment. Rennes university hospital therefore decided to create a VAD (Ventricular Assist Device) nurse coordinator position to improve and optimise the quality of the follow-up of these patients. She plays a crucial role in the care of the patient, before, during and after hospitalisation.

Published
2013

50. Argument for a Doppler echocardiography during exercise in assessing asymptomatic patients with severe aortic stenosis

Author

M. Laurent, Alain Le Helloco, Philippe Mabo, Christian de Place, Erwan Donal, Céline Chabanne, Guillaume Leurent, Renaud Gervais, Jean-Claude Daubert, Claire Fougerou, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Aortic valve, Cardiac output, 030204 cardiovascular system & hematology, Doppler echocardiography, Aortic valve stenosis, Severity of Illness Index, 0302 clinical medicine, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, Heart Rate, Reference Values, Prospective Studies, 030212 general & internal medicine, Cardiac Output, Prospective cohort study, medicine.diagnostic_test, General Medicine, Middle Aged, Echocardiography, Doppler, Exercise stress test, medicine.anatomical_structure, Echocardiography, Cardiology, Regression Analysis, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, medicine.symptom, Cardiology and Cardiovascular Medicine, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Echocardiography, Stress, medicine.medical_specialty, Risk Assessment, Sensitivity and Specificity, Asymptomatic, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Adverse effect, Aged, Probability, business.industry, Hemodynamics, Reproducibility of Results, Stroke Volume, medicine.disease, Stenosis, business
Abstract

International audience; Aims : Exercise stress testing (EST) is recommended by guidelines to risk-stratify patients with asymptomatic valvular aortic stenosis (AS), though the role of quantitative exercise-Doppler echocardiography has rarely been studied. This prospective study sought to correlate standard EST results with the haemodynamic measurements made during exercise by Doppler echocardiography. Methods and results : We performed rest and semi-supine exercise Doppler echocardiography in 44 consecutive patients (mean age = 68 ± 12 years) with aortic valve areas ≤0.6 cm2/m2. The effective aortic valve area (EOA), cardiac output (CO), maximal transvalvular velocity, and pulmonary pressure were monitored over the test. No serious adverse event was observed. EST was positive in 26 (Group 1) and negative in 18 (Group 2) patients. Baseline echocardiographic measurements were similar (EOA 0.77 ± 0.15 vs. 0.78 ± 0.14 cm2; CO 5.5 ± 1.6 vs. 5.9 ± 2 L/min) in both groups. Exercise-induced changes in CO (+2.9 ± 2 vs. +4.3 ± 1.8 L/min, P = 0.04) and EOA (−0.04 ± 0.18 vs. +0.15 ± 0.24 cm2, P = 0.015) were significantly greater in Group 2. A correlation between changes in EOA and changes in CO during exercise was observed, but significantly higher in Group 2 (P = 0.04). Conclusion : In the presence of severe asymptomatic AS, exercise Doppler echocardiography, assessing the mechanisms behind a positive EST, appears very promising but further studies with prognosis assessment remain necessary.

Published
2009

Catalog

Books, media, physical & digital resources
See catalog results