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Sébastien Hulo,1 Jocelyn Inamo,2 Aurélie Dehon,3 Olivier Le Rouzic,4 Jean-Louis Edme,1 Remi Neviere51Université Lille, CHU Lille, EA 4483, IMPact de l’Environnement Chimique sur la Santé humaine, Lille, France; 2Département de Cardiologie – CHU Fort de France, Martinique – Faculté de Médecine – Université des Antilles, France; 3Pôle d’Anesthésie Réanimation ADRU, CHU Nîmes, Nîmes, France; 4Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France; 5Université Lille, Inserm, CHU Lille, Lille Inflammation Research International Center, Lille, FrancePurpose: Metabolic-chronotropic relationship is the only concept that assesses the entire chronotropic function during exercise, as it takes into account individual fitness. To better understand interrelationships between chronotropic incompetence (CI), dynamic hyperinflation (DH) and exercise limitation among Global initiative for chronic Obstructive Lung Disease (GOLD) stages of chronic obstructive pulmonary disease (COPD) disease severity, we evaluated cardiopulmonary responses to symptom-limited cycle exercise in stable patients.Patients and methods: We prospectively studied 47 COPD patients classified by GOLD stage severity. Pulmonary function tests and cardiopulmonary responses to symptom-limited incremental exercise were studied. CI was defined by regression line between percent heart rate (HR) reserve and percent oxygen uptake (V’O2) reserve, ie, chronotropic-metabolic index (CMI). DH was defined from the knot resulting from the nonlinear regressions of inspiratory capacity changes from rest to peak (dynamic inspiratory capacity (ICdyn)) with percentage of maximal HR and CMI.Results: Aerobic capacity (median interquartile ranges) peak V’O2, 24.3 (23.6; 25.2), 18.5 (15.5; 21.8), 17.5 (15.4; 19.1) mL·kg-1·min-1 and CMI worsened according to GOLD severity. The optimal knot of ICdyn was equal to −0.34 L. The multivariate logistic regression showed a strong relationship between CI (outcome) and DH (odds ratio [confidence interval 95]) 25 (3.5; 191.6). Conclusion: COPD patients with DH have a poor cardiovascular response to exercise, which may be attributed to CI.Keywords: COPD, hyperinflation, chronotropic incompetence, exercise

Except for projections from the Global Burden of Disease (GBD) study, congenital heart disease (CHD) burden remains undetermined in Latin America and Caribbean (LAC), especially for complex types such as functionally univentricular hearts (FUH) responsible for higher disease morbidity and mortality. To describe CHD prevalence, characteristics and related infant mortality in French Guiana, a LAC territory. Population-based registry analysis of all fetal and live birth (LB) CHD cases from January 2012 to December 2016. Overall, 231 CHD were diagnosed, among which 56 fetal diagnoses and 215 resulting LB. Among all CHD (n = 231), there were 18.6% of chromosomal or genetic anomalies, and 6.5% of termination of pregnancy for fetal anomaly. Total and LB CHD prevalence were respectively 68.4 [95% CI: 67.9–68.8] and 65.2 [95% CI: 64.7–65.7] per 10,000, similar to GBD projections for TLA. The total infant mortality in the study sample was 9.4/10,000 LB [95% CI: 9.1–9.7]. Children with FUH presented the highest mortality rates. When compared to mainland France, total FUH prevalence for French Guiana was significantly higher (P = 0.03), as were LB FUH prevalence and related infant mortality respectively two to three-fold higher (P < 0.01). However, no significant difference was observed for FUH prevalence when compared to GBD projections for TLA. FUH infant mortality could not be contrasted due to the lack of GBD data. This first population-based study ever performed in this part of the world suggests a distinct profile for CHD in the LAC region, with elevated prevalence and mortality rates linked to FUH. Another potential determinant of the excess mortality risk might be the frequent presence of chromosomal or genetic anomalies. This constitutes a stepping-stone towards better understanding CHD burden and underlying specificities while providing future keys towards reducing infant mortality in French Guiana and others surrounding countries. [ABSTRACT FROM AUTHOR]

Disparities persist regarding the access to pediatric and congenital cardiac catheterization procedures (PCCC). Developing capacities in French overseas territories located far away from mainland France remains essential to reducing inequalities and mortality. To describe the characteristics of patients, procedures type risk categories (PTRC) and outcomes for all PCCC performed on the French island of Martinique (Caribbean). Single center observational study. We recorded prospectively all consecutives PCCC performed in the catheter laboratory of the university Hospital of Martinique from January 2007 to December 2023. Demographics, procedures characteristics, PTRC, adverse events occurrence, as well as 24-hours mortality were documented. All results were retrospectively analysed. We performed 869 PCCC in 770 consecutives patients (31.3% < 1-year-old; 9.4% aged < 1 month) living in French territories (90%) of Martinique, Guadeloupe, French Guiana, Saint-Martin, or natives from others Caribbean islands (10%). The median age and weight (IQR) were 4 years (0.6–13) and 16 kg (6.4–4.6). There were 126 urgent and 43 (4.9%) rescue procedures. PCCC were predominantly interventional (68.7%; success rate: 95.1%) covering all types of procedures, except revalvulation. The overall median PTRC was 2 (2–3) with a 24-h mortality of 1.1%. Complications occurred in 35 cases (4%), of which 18 were major, either procedure and anaesthesia-related (40%) or likely linked (40%) to the critical condition on admission at the cathlab. Overtime, the case-mix complexity continued to increase (PTRC > 3 in 25% of patients, with a median age and weight of 2.6 years and 6.5 kg, within the past 5 years). Developing permanent PCCC capabilities in French Martinique is efficient and safe. This ongoing international program is sustainable with the inclusion of patients coming from all French territories and neighbouring Caribbean islands and the continuous support of French Health Authorities. [ABSTRACT FROM AUTHOR]