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3. The mortality rates in registries of patients with STEMI are highly affected by inclusion criteria and population characteristics

Author

Pierre Bernard Petitcolin, Valérie Pradel, Henri Karam, Julien Magne, Victor Aboyans, Pierre A. Pages, Elie Martins, Gilles Faugeras, Nicole Darodes, Eric Fleurant, Patrice Virot, Virginie Rousselle, Sebastien Bosle, Dominique Cailloce, Service de cardiologie [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-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), Centre Hospitalier Brive-la-Gaillarde, Service des urgences [CHU Limoges], and Clinical sciences

Subjects
medicine.medical_specialty, ST Elevation Myocardial Infarction/diagnosis, Population, 030204 cardiovascular system & hematology, registry, France/epidemiology, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Registries, 10. No inequality, education, education.field_of_study, business.industry, Mortality rate, methodology, General Medicine, Middle Aged, medicine.disease, mortality, 3. Good health, ST-segment elevation myocardial infarction, surgical procedures, operative, Treatment Outcome, ST Elevation Myocardial Infarction, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, Cardiology and Cardiovascular Medicine, Inclusion (education)
Abstract

International audience; Background: Different mortality rates are reported in registries of patients with ST-segment elevation myocardial infarction (STEMI), but comparisons between registries are challenging. Aims: To determine whether the higher mortality rate in our regional French registry (SCALIM) is related to different inclusion criteria and demographic characteristics. Methods: The SCALIM registry included all patients with STEMI within the first 24 h in the region of Limousin, France (06/2011-01/2015). To compare mortality rates with other contemporary registries in France and European neighbouring countries, the others' inclusion criteria were applied to the SCALIM registry. Results: Among 1501 patients included, in-hospital and 1-month mortality were 8.2% and 8.8% respectively, significantly higher than many other registries. The use of inclusion criteria from EMUST (France), MINAP (UK) or LOMBARDIMA (Italy) markedly decreased the number of enrolled patients by 64%, 36%, and 21%, respectively. When those inclusion criteria were applied to the SCALIM registry, difference in in-hospital and 1-month mortality rates between other registries and ours remained significant. In the multivariate analysis, age, initial acute pulmonary oedema (Killip class ≥2), complication occurring before percutaneous coronary intervention, absence of transfer to an interventional cardiology centre for primary angioplasty and lack of reperfusion therapy within 12 h were associated with higher risk of 1-month mortality (all p < 0.05). Age (65 versus 63.3 years, p < 0.001) was higher and reperfusion rate (84.2 versus 74.7%, p < 0.001) was significantly lower in SCALIM than FAST-MI, the national French registry on STEMI patients. Interestingly, the 3% of patients included in SCALIM who would be excluded from FAST-MI registry had 91% mortality at one month. Conclusion: Higher mortality rate in our regional SCALIM registry is in part due to differences in inclusion criteria and demographic data. Consensus should be made to harmonise inclusion criteria in STEMI registries for the sake of comparability.

Published
2021

4. Temporal Trends in Transcatheter Aortic Valve Replacement in France

Author

Vincent Auffret, Thierry Lefevre, Eric Van Belle, Hélène Eltchaninoff, Bernard Iung, René Koning, Pascal Motreff, Pascal Leprince, Jean Philippe Verhoye, Thibaut Manigold, Geraud Souteyrand, Dominique Boulmier, Patrick Joly, Frédéric Pinaud, Dominique Himbert, Jean Philippe Collet, Gilles Rioufol, Said Ghostine, Olivier Bar, Alain Dibie, Didier Champagnac, Lionel Leroux, Frédéric Collet, Emmanuel Teiger, Olivier Darremont, Thierry Folliguet, Florence Leclercq, Thibault Lhermusier, Patrick Olhmann, Bruno Huret, Luc Lorgis, Laurent Drogoul, Bernard Bertrand, Christian Spaulding, Laurent Quilliet, Thomas Cuisset, Maxence Delomez, Farzin Beygui, Jean-Philippe Claudel, Alain Hepp, Arnaud Jegou, Antoine Gommeaux, Anfani Mirode, Luc Christiaens, Charles Christophe, Claude Cassat, Damien Metz, Lionel Mangin, Karl Isaaz, Laurent Jacquemin, Philippe Guyon, Christophe Pouillot, Serge Makowski, Vincent Bataille, Josep Rodés-Cabau, Martine Gilard, Hervé Le Breton, Herve Le Breton, Marc Laskar, Bernard Chevalier, Philippe Garot, Thomas Hovasse, Patrick Donzeau Gouge, Arnaud Farge, Mauro Romano, Bertrand Cormier, Erik Bouvier, Jean-Jacques Bauchart, Jean-Christophe Bodart, Cédric Delhaye, David Houpe, Robert Lallemant, Fabrice Leroy, Arnaud Sudre, Francis Juthier, Mohamed Koussa, Thomas Modine, Natacha Rousse, Jean-Luc Auffray, Marjorie Richardson, Jacques Berland, Mathieu Godin, Jean-Paul Bessou, Vincent Letocart, Jean-Christian Roussel, Philippe Jaafar, Nicolas Combaret, Nicolas D’Ostrevy, Andréa Innorta, Guillaume Clerfond, Charles Vorilhon, Marc Bedossa, Guillaume Leurent, Amedeo Anselmi, Majid Harmouche, Jean-Philippe Verhoye, Erwan Donal, Jacques Bille, Rémi Houel, Bertrand Vilette, Wissam Abi Khalil, Stéphane Delepine, Olivier Fouquet, Frédéric Rouleau, Jérémie Abtan, Marina Urena, Soleiman Alkhoder, Walid Ghodbane, Dimitri Arangalage, Eric Brochet, Coppelia Goublaire, Olivier Barthelemy, Rémi Choussat, Jean-Philippe Collet, Guillaume Lebreton, Chiro Mastrioanni, Richard Isnard, Raphael Dauphin, Olivier Dubreuil, Guy Durand De Gevigney, Gérard Finet, Brahim Harbaoui, Sylvain Ranc, Fadi Farhat, Olivier Jegaden, Jean-François Obadia, Matteo Pozzi, Saïd Ghostine, Philippe Brenot, Sahbi Fradi, Alexandre Azmoun, Philippe Deleuze, Martin Kloeckner, Didier Blanchard, Christophe Barbey, Stephan Chassaing, Didier Chatel, Olivier Le Page, Arnaud Tauran, Didier Bruere, Laurent Bodson, Yvon Meurisse, Aurélien Seemann, Nicolas Amabile, Christophe Caussin, Simon Elhaddad, Luc Drieu, Alice Ohanessian, François Philippe, Aurélie Veugeois, Matthieu Debauchez, Konstantinos Zannis, Daniel Czitrom, Chrystelle Diakov, François Raoux, Yves Lienhart, Patrick Staat, Oualid Zouaghi, Vincent Doisy, Jean Philippe Frieh, Fabrice Wautot, Julie Dementhon, Olivier Garrier, Fadi Jamal, Pierre Yves Leroux, Frédéric Casassus, Benjamin Seguy, Laurent Barandon, Louis Labrousse, Julien Peltan, Claire Cornolle, Marina Dijos, Stéphane Lafitte, Gilles Bayet, Claude Charmasson, Alain Vaillant, Jacques Vicat, Marie Paule Giacomoni, Eric Bergoend, Céline Zerbib, Jean Louis Leymarie, Philippe Clerc, Emmanuel Choukroun, Nicolas Elia, Jean-Philippe Grimaud, Jean-Philippe Guibaud, Stéphane Wroblewski, Eric Abergel, Emmanuel Bogino, Christophe Chauvel, Patrick Dehant, Marc Simon, Michel Angioi, Julien Lemoine, Simon Lemoine, Batric Popovic, Pablo Maureira, Olivier Huttin, Christine Selton Suty, Guillaume Cayla, Delphine Delseny, Gilles Levy, Jean Christophe Macia, Eric Maupas, Christophe Piot, François Rivalland, Gabriel Robert, Laurent Schmutz, Frédéric Targosz, Bernard Albat, Arnaud Dubar, Nicolas Durrleman, Thomas Gandet, Emmanuel Munos, Stéphane Cade, Frédéric Cransac, Frédéric Bouisset, Etienne Grunenwald, Bertrand Marcheix, Pauline Fournier, Olivier Morel, Patrick Ohlmann, Michel Kindo, Minh Tam Hoang, Hélène Petit, Hafida Samet, Anne Trinh, Guillaume Lecoq, Jean François Morelle, Pascal Richard, Thierry Derieux, Emmanuel Monier, Cédric Joret, Olivier Bouchot, Jean Christophe Eicher, Pierre Meyer, Stéphane Lopez, Michel Tapia, Jacques Teboul, Jean-Pierre Elbeze, Alain Mihoubi, Gérald Vanzetto, Olivier Wittenberg, Vincent Bach, Cécile Martin, Carole Sauier, Charlotte Casset, Philippe Castellant, Eric Bezon, Jean-Noel Choplain, Ahmed Kallifa, Bahaa Nasr, Yannick Jobic, Antoine Lafont, Jean-Yves Pagny, Ramzi Abi Akar, Jean-Noël Fabiani, Rachid Zegdi, Alain Berrebi, Tania Puscas, Bernard Desveaux, Fabrice Ivanes, Christophe Saint Etienne, Thierry Bourguignon, Blandine Aupy, Romain Perault, Jean-Louis Bonnet, Marc Lambert, Dominique Grisoli, Nicolas Jaussaud, Erwan Salaun, Amine Laghzaoui, Christine Savoye, Mathieu Bignon, Vincent Roule, Rémy Sabatier, Calin Ivascau, Vladimir Saplacan, Eric Saloux, Damien Bouchayer, Guillaume Tremeau, Camille Diab, Joel Lapeze, Franck Pelissier, Thomas Sassard, Catherine Matz, Nicolas Monsarrat, Ivan Carel, Franck Sibellas, Alain Curtil, Grégoire Dambrin, Xavier Favereau, Gabriel Ghorayeb, Laurent Guesnier, Wassim Khoury, Christophe Kucharski, Bruno Pouzet, Claude Vaislic, Riadh Cheikh-Khelifa, Loïc Hilpert, Philippe Maribas, Gery Hannebicque, Philippe Hochart, Marc Paris, Max Pecheux, Olivier Fabre, Laurent Leborgne, Marcel Peltier, Faouzi Trojette, Doron Carmi, Christophe Tribouilloy, Jean Mergy, Pierre Corbi, Pascale Raud Raynier, Sylvain Carillo, Arnaud Hueber, Fédéric Moulin, Georges Pinelli, Nicole Darodes, Francis Pesteil, Chadi Aludaat, Frédéric Torossian, Loïc Belle, Nicolas Chavanis, Chrystelle Akret, Alexis Cerisier, Jean Pierre Favre, Jean François Fuzellier, Romain Pierrard, Olivier Roth, Jean Yves Wiedemann, Nicolas Bischoff, Georghe Gavra, Nicolas Bourrely, Franck Digne, Mohammed Najjari, Victor Stratiev, Nicolas Bonnet, Patrick Mesnildrey, David Attias, Julien Dreyfus, Daniel Karila Cohen, Thierry Laperche, Julien Nahum, Aliocha Scheuble, Geoffrey Rambaud, Eric Brauberger, Michel Ah Hot, Philippe Allouch, Fabrice Beverelli, Julien Rosencher, Stéphane Aubert, Jean Michel Grinda, Thierry Waldman, 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], Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle ( MIVEGEC ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD [France-Sud] ), Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), CHU Gabriel Montpied ( CHU ), CHU Clermont-Ferrand, Institut Pascal - Clermont Auvergne ( IP ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Service de chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de chirurgie cardio-vasculaire et thoracique, CHU Angers, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition ( ICAN ), CHU Pitié-Salpêtrière [APHP]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Université Pierre et Marie Curie - Paris 6 ( UPMC ), Adaptation cardiovasculaire à l'ischemie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Service de cardiologie [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Cochin [AP-HP], Nutrition, obésité et risque thrombotique ( NORT ), Institut National de la Recherche Agronomique ( INRA ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU de Poitiers, Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Optimisation des régulations physiologiques ( ORPHY (EA 4324) ), Université de Brest ( UBO ) -Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Université de Brest ( UBO ), Institut de Chimie de la Matière Condensée de Bordeaux ( ICMCB ), Université de Bordeaux ( UB ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Institut national de recherches archéologiques préventives ( Inrap ), Hémostase et pathologie cardiovasculaire, EA2693-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé, Belgian Institute for Space Aeronomy / Institut d'Aéronomie Spatiale de Belgique ( BIRA-IASB ), ONERA - The French Aerospace Lab ( Toulouse ), ONERA, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Institut de cardiologie [CHU Pitié-Salpêtrière], Service de Chirurgie Thoracique et Cardiovasculaire [CHU Pitié-Salpêtrière], Cardioprotection, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Cardiovasculaire, métabolisme, diabétologie et nutrition ( CarMeN ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hospices Civils de Lyon ( HCL ) -Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Institut National de la Recherche Agronomique ( INRA ), Carnegie Mellon University [Pittsburgh] ( CMU ), Hôpital nord, St Etienne, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Clinique du Tonkin, Unité de recherche Phytopharmacie et Médiateurs Chimiques ( UPMC ), Institut National de la Recherche Agronomique ( INRA ), Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre des Sciences des Littératures en Langue Française ( CSLF ), Université Paris Nanterre ( UPN ), Service de Cardiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Laboratoire de Chimie Physique - Matière et Rayonnement ( LCPMR ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire d'Informatique Fondamentale de Lille ( LIFL ), Université de Lille, Sciences et Technologies-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Université de Lille, Sciences Humaines et Sociales-Centre National de la Recherche Scientifique ( CNRS ), 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 ), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Arnaud de Villeneuve, Institut des Maladies Métaboliques et Cardiovasculaires ( I2MC ), Université Paul Sabatier - Toulouse 3 ( UPS ) -Hôpital de Rangueil-Institut National de la Santé et de la Recherche Médicale ( INSERM ), École de sages-femmes René Rouchy ( ESF Angers ), Université d'Angers ( UA ) -CHU Angers, Laboratoire de Génie Civil et d'Ingénierie Environnementale ( LGCIE ), 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 ), Agriculture and Agri-Food [Ottawa] ( AAFC ), Centre d'études et de recherche sur les contentieux - EA 3164 ( CERC ), Université de Toulon ( UTLN ), Radiopharmaceutiques biocliniques, Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Clinique de chirurgie cardiaque, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Unité Mixte de Recherches sur les Herbivores ( UMR 1213 Herbivores ), VetAgro Sup ( VAS ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Recherche Agronomique ( INRA ), Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Développement artériel, Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de recherche en économie et management ( CREM ), Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Centre National de la Recherche Scientifique ( CNRS ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Récepteurs nucléaires, maladies cardiovasculaires et diabète ( EGID ), Université de Lille, Droit et Santé-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Pasteur de Lille, Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Edwards Lifesciences Medtronic Lead-Up Medicines Company French Cardiology Federation (Federation Francaise de Cardiologie) Eli Lilly WebMD Biosensor ACIST Abbott Biosensors Terumo Daichii-Sankyo Boston Scientific St. Jude Medical Bristol-Myers Squibb Bayer AstraZeneca French Ministry of Health Abiomed Zoll Medpass Cordis Servier, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), Institut Pasteur de Lille, and 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, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille )

Subjects
Aortic valve, medicine.medical_specialty, medicine.medical_treatment, national registry, 030204 cardiovascular system & hematology, outcomes, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Cardiac tamponade, Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Aortic dissection, business.industry, Mortality rate, transfemoral, EuroSCORE, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine.disease, pacemaker, 3. Good health, Surgery, Stenosis, Catheter, medicine.anatomical_structure, Cardiology and Cardiovascular Medicine, business
Abstract

Background - Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited. Objectives - The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period. Methods - TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers. Results - A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium-defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p

Published
2017

5. Impact of Pulmonary Hypertension on Outcome in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction

Author

Alessandro Piccardo, Mathieu Deltreuil, Vincent Petitalot, Cyrille Boulogne, Dania Mohty, Nicole Darodes, Julien Magne, Thibaud Damy, Najmeddine Echahidi, Patrice Virot, Victor Aboyans, Service de cardiologie [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-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 Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], Unité fonctionnelle insuffisance cardiaque, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est (UPE), Cardio-vascular diseases, and Clinical sciences

Subjects
Male, Cardiac Catheterization, medicine.medical_specialty, Hypertension, Pulmonary, 030204 cardiovascular system & hematology, Aortic valve stenosis, Severity of Illness Index, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Pulmonary wedge pressure, Aged, Retrospective Studies, Outcome, Ejection fraction, business.industry, Incidence, Mortality rate, valvular heart disease, Stroke Volume, General Medicine, Prognosis, medicine.disease, Pulmonary hypertension, 3. Good health, Survival Rate, Pulmonary arterial pressure, Echocardiography, Aortic Valve, Heart Valve Prosthesis, Ventricular pressure, Cardiology, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; AIMS:The prognostic impact of elevated pulmonary arterial pressure (PAP) remains controversial in aortic stenosis (AS) and few studies focused on patients with preserved left ventricular ejection fraction (LVEF). We aimed to investigate the impact of pulmonary hypertension (PH), invasively derived, on survival in severe AS with preserved LVEF.METHODS AND RESULTS:Between 2000 and 2010, 749 patients (74 ± 8 years, 57% males) with preserved LVEF and severe AS without other valvular heart disease underwent cardiac catheterization. PH was defined as mean PAP > 25 mmHg. The mean follow-up was 4.6 ± 3.0 years. Overall, 32% (n = 241) of patients had PH. Surgical aortic valve replacement (SAVR) was performed in 91% of patients with 4.5% of 30-day mortality rate, significantly higher in patients with PH than without PH (7.5 vs. 3.5%, p = 0.014). In logistic regression, PH was an independent predictor of increased 30-day mortality (odds-ratio = 2.2, p = 0.04). Overall long-term survival was significantly reduced in patients with PH as compared to those without (10-year: 52 ± 5 vs. 68 ± 3%, p

Published
2017

6. Prevalence and prognostic impact of left-sided valve thickening in systemic light-chain amyloidosis

Author

Bahaa M. Fadel, Nicole Darodes, Victor Aboyans, Cyrille Boulogne, Thibaud Damy, Julien Magne, Vincent Petitalot, Dania Mohty, Arnaud Jaccard, Sarah Pradel, Safaa Raboukhi, Cardio-vascular diseases, Clinical sciences, Service de cardiologie [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-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 Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], Unité fonctionnelle insuffisance cardiaque, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est (UPE)

Subjects
Male, Comorbidity, 030204 cardiovascular system & hematology, VALVE, Ventricular Dysfunction, Left, 0302 clinical medicine, Prevalence, echocardiography, Immunoglobulin Light-chain Amyloidosis, 030212 general & internal medicine, Aged, 80 and over, Ejection fraction, Amyloidosis, Hazard ratio, General Medicine, Organ Size, Middle Aged, Prognosis, 3. Good health, Survival Rate, medicine.anatomical_structure, Aortic Valve, Cardiology, Mitral Valve, Female, Thickening, France, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, Left sided, Risk Assessment, Sensitivity and Specificity, survival, 03 medical and health sciences, medicine.artery, Internal medicine, medicine, Humans, Light chains, In patient, Heart valve, Aged, business.industry, Reproducibility of Results, medicine.disease, Pulmonary artery, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

International audience; BACKGROUND:Left heart valve thickening (LVT) was described in patients with light-chain amyloidosis (AL). This phenomenon reflects likely infiltration of the valve by amyloid proteins. However, the prevalence of LVT and its prognostic value have not been investigated in patients with AL.METHODS AND RESULTS:Comprehensive transthoracic echocardiography was performed at baseline in 150 patients [median age 68 (33-87) years; 59% male] with confirmed AL. The presence of abnormal mitral and/or aortic valve thickening (>3 mm) was assessed in all included patients. Overall, 42% had LVT at the time of diagnosis. Compared to patients without LVT, those with LVT were older and had a more advanced NYHA functional class (63% in patients with NYHA III-IV vs. 33% in NYHA I-II, p < 0.001). They also had higher left ventricular (LV) wall thickness and mass, larger left atrium, higher mitral annulus E/E' ratio and systolic pulmonary artery pressures, and lower LV ejection fraction (all p < 0.05). Patients with more advanced Mayo Clinic stage had a higher incidence of LVT: 58% in stage III vs. 45% in stage II and 5% in stage I (p < 0.001). During a median follow-up of 2 years, 79 deaths occurred. The presence of LVT was significantly associated with reduced 5-year survival (32 ± 7 vs. 64 ± 6%). In multivariate analysis, after adjusting for age, gender, NYHA functional class, and LV ejection fraction, LVT remained significantly associated with higher all-cause mortality (hazard ratio 1.90, 95% CI 1.10-3.34, p = 0.02).CONCLUSION:Left heart valve thickening is common in patients with AL and is associated with worse functional class, LV systolic and diastolic function, and more advanced stage of the disease. In addition, LVT appears to be a powerful marker of all-cause mortality.

Published
2017

7. Coronary Artery Embolism Following Aortic Valve Replacement

Author

Jérémy, Tricard, Alessandro, Piccardo, Alexandre, Le Guyader, Nicole, Darodes, Sébastien, Bosle, and Marc, Laskar

Subjects
Heart Valve Prosthesis Implantation, Male, Fatal Outcome, Postoperative Complications, Aortic Valve, Embolism, Calcinosis, Humans, Aortic Valve Stenosis, Coronary Angiography, Coronary Vessels, Aged
Published
2015

8. 0224: Prevalence and prognostic significance of left-sided valvular thickening in patients with systemic light-chain amyloidosis

Author

Vincent Petitalot, Arnaud Jaccard, Sarah Pradel, Victor Aboyans, Julien Magne, Najmeddine Echahidi, David Lavergne, Nicole Darodes, Dania Mohty, and Thibaud Damy

Subjects
medicine.medical_specialty, business.industry, Amyloidosis, Mean age, Immunoglobulin light chain, medicine.disease, Left sided, Internal medicine, Cardiology, Medicine, In patient, Functional status, Thickening, business, Cardiology and Cardiovascular Medicine, Endocardium
Abstract

BackgroundCardiac involvement is frequent in systemic light chain amyloidosis (AL). Left-sided valvular thickening (LVT) have been described in AL reflecting heavy infiltration of the valvular endocardium by amyloid proteins. However, the exact prevalence at diagnosis and the prognostic significance of LVT in AL patients have never been investigated.Aimsto study the prevalence and the impact on long-term survival LVT in AL patients.Methods and resultsBetween 1998 and 2013, 150 AL patients were included at diagnosis (mean age was 68±11 ans, 59% were male). A comprehensive transthoracic echocardiography was performed at baseline. The presence of LVT was assessed visually and was found in 42% of patients. Compared to patients without LVT, those with LVT have more frequently advanced NYHA functional class. They also had significantly higher left ventricular (LV) wall thickening (p=0.01), LV mass (p=0.02), and mitral E/e’ (p=0.0009) and larger left atrial size (p

Published
2015
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9. 0516: Assessment of left ventricular filling pressure in severe aortic stenosis: a comparison of echocardiographic and catheterization data

Author

Benedicte Tanguy, Julien Magne, Victor Aboyans, Patrice Virot, Najmeddine Echahidi, Dania Mohty, Safaa Raboukhi, Cyrille Boulogne, and Nicole Darodes

Subjects
medicine.medical_specialty, Ejection fraction, business.industry, medicine.medical_treatment, Area under the curve, Hemodynamics, medicine.disease, Coronary artery disease, Stenosis, Diabetes mellitus, Internal medicine, Cardiology, medicine, Cardiology and Cardiovascular Medicine, business, Dyslipidemia, Cardiac catheterization
Abstract

IntroductionThe non-invasive assessment of left ventricular (LV) filling and LA pressure in patients with aortic stenosis (AS) remains challenging. The aim of our study was to identify the echocardiographic parameters that may predict elevated pulmonary capillary wedge pressures (PCWP) measured by cardiac catheterization in patients with severe AS without other valve disease.Methods and resultsFrom January 2010 to December 2012, we included 85 consecutive patients with severe AS scheduled for clinically indicated cardiac catheterization study. Comprehensive transthoracic echocardiography (TTE) was performed in all patients within 24 hours of the hemodynamic study. Mean age was 75±9 years, 65% of them were male, 65%, 22% and 54% had respectively a history of hypertension, diabetes, and dyslipidemia. NYHA functional class was≥III in 63% of patients. By TTE, mean LV ejection fraction, max left atrial (LA) volume indexed, were respectively 60±9%, and 38±16mL/m 2. Mean mitral septal E/e’ ratio was 18.6±9. Cardiac catheterization found 60% cases of coronary artery disease and the mean PCWP was 13.5±7mmHg. As compared to patients with low PCWP (29ml/m 2 predicted a PCWP>13mmhg with a sensitivity of 77% and a specificity of 62% (area under the curve=0.73). Similarly, mitral annular septal E/e’>12 predicted PCP>13mmHg with a sensitivity of 90% and a specificity of 60% (area under the curve=0.73).ConclusionIn severe AS patients, maximal LA indexed volume>29/ml/m2 and E/e’ ratio>12, derived from TTE, appear as good markers of elevated PCWP. Further studies are needed to investigate their prognostic values.

Published
2016

10. Coronary Artery Embolism Following Aortic Valve Replacement

Author

Alessandro Piccardo, Sébastien Bosle, Alexandre Le Guyader, Marc Laskar, Nicole Darodes, and Jérémy Tricard

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Aortic valve replacement, business.industry, Internal medicine, medicine, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, medicine.disease, business, Coronary artery embolism
Published
2015

11. Left atrial size is an independent predictor of overall survival in patients with primary systemic amyloidosis

Author

Najmeddine Echahidi, Dominique Bordessoule, Patrice Virot, Arnaud Jaccard, Nicole Darodes, Jean G. Dumesnil, Dania Mohty, David Lavergne, Philippe Pibarot, Contrôle de la Réponse Immune B et des Lymphoproliférations (CRIBL), Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Centre National de la Recherche Scientifique (CNRS), Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges], and CHU Limoges

Subjects
Male, Time Factors, Survival, Transthoracic echocardiography, MESH: Echocardiography, Doppler, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, MESH: Risk Assessment, MESH: Stroke Volume, Ventricular Function, Left, MESH: Ventricular Function, Left, 030218 nuclear medicine & medical imaging, MESH: Proportional Hazards Models, Ventricular Dysfunction, Left, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, MESH: Ventricular Dysfunction, Left, Échocardiographie, 10. No inequality, Diamètre de l’oreillette gauche, Body surface area, MESH: Aged, Ejection fraction, MESH: Middle Aged, Amyloidosis, Hazard ratio, General Medicine, Middle Aged, Prognosis, Echocardiography, Doppler, MESH: Predictive Value of Tests, 3. Good health, Survival Rate, medicine.anatomical_structure, Survie, Cardiology, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, Hypertrophy, Left Ventricular, France, MESH: Hypertrophy, Left Ventricular, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, MESH: Survival Rate, Diastole, Risk Assessment, MESH: Multivariate Analysis, MESH: Prognosis, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, medicine, Humans, MESH: Amyloidosis, Heart Atria, Interventricular septum, Survival rate, MESH: Kaplan-Meier Estimate, Left atrial diameter, Aged, Proportional Hazards Models, Retrospective Studies, MESH: Humans, Systemic amyloidosis, business.industry, MESH: Time Factors, Stroke Volume, MESH: Retrospective Studies, medicine.disease, MESH: Male, Surgery, MESH: France, Multivariate Analysis, MESH: Heart Atria, Amylose systémique primitive, business, MESH: Female, Primary systemic amyloidosis
Abstract

International audience; BACKGROUND: Primary systemic amyloidosis is a severe plasma cell disorder characterized by the extracellular deposition of amyloid fibrils in different organs. Echocardiography is usually performed to assess cardiac involvement. We hypothesized that in patients with systemic amyloidosis, simple echocardiographic measurement of the left atrial (LA) diameter indexed to the body surface area might provide an important risk marker for this disease. METHODS: Between 1997 and 2011, 134 patients were diagnosed with primary systemic amyloidosis and had echocardiography within 28 days; we collected their baseline characteristics and biological and echocardiographic data retrospectively. LA enlargement was defined as recommended as M-mode LA diameter greater or equal to 23 mm/m(2). RESULTS: One hundred and eleven patients (83%) had echocardiographic LA dimension data available (mean age 63±11 years; 61% men; 31% previously diagnosed with systemic hypertension). Mean left ventricular ejection fraction (LVEF) and interventricular septum thickness (IVST) were 62±12% and 14±4 mm, respectively. Mean follow-up was 2.8±2.9 years (maximum 12 years). Patients with LA enlargement had a slightly lower LVEF (P=0.08) and a significantly greater IVST (P

Published
2011

12. Cardiac toxicity with capecitabine, vinorelbine and trastuzumab therapy: case report and review of fluoropyrimidine-related cardiotoxicity

Author

Nicole Tubiana-Mathieu, J. Martin, D Genet, Nicole Darodes, Jean-Luc Labourey, Valérie Le Brun-Ly, and Laurence Venat-Bouvet

Subjects
Oncology, Adult, Cancer Research, medicine.medical_specialty, Chest Pain, Combination therapy, Myocardial Ischemia, Breast Neoplasms, Pharmacology, Vinorelbine, Antibodies, Monoclonal, Humanized, Vinblastine, Deoxycytidine, Capecitabine, Electrocardiography, Nitroglycerin, Trastuzumab, Internal medicine, Cardiac toxicity, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, cardiovascular diseases, skin and connective tissue diseases, Cardiotoxicity, business.industry, Antibodies, Monoclonal, General Medicine, Metastatic Breast Carcinoma, Prognosis, Treatment Outcome, Female, Fluorouracil, business, Capecitabine/vinorelbine, medicine.drug
Abstract

A 45-year-old woman presented with a metastatic breast carcinoma and was treated with capecitabine, oral vinorelbine and trastuzumab combination therapy. The initial echocardiogram and the ECG were considered normal. She began treatment with 3-weekly cycles of the combination therapy. After the fourth dose of capecitabine, she presented with severe chest and arm pain, which was responsive to nitroglycerine spray. ECG at admission demonstrated tachycardia with ST-segment elevation suggesting ischemia. The clinical symptoms returned to baseline after a few hours and within 24 h the ECG showed inverted T in leads V3–V6. Cardiac ultrasonography revealed hypokinesia in the left ventricle without segmentary hypokinesia, with mildly reduced global systolic function, which normalized 1 week later. Two weeks later, she was rechallenged with capecitabine. After the fourth dose, the patient developed chest pain. ECG showed infero-apico-lateral injury, which normalized after administration of nitrates, nicorandil and verapamil and discontinuation of capecitabine. This case suggests that capecitabine can lead to the cardiotoxicity characteristic of other fluoropyrimidines. Therefore, it is important to inform patients about the risk of angina-like chest pain, to stop treatment immediately if symptoms occur, and to monitor the patient in hospital. Fluoropyrimidine rechallenge should be avoided because of the risk of ischemic event or sudden death.

Published
2008

13. Removal of a ventricular mitral valve fibroelastoma by an aortic approach

Author

Karine Nubret, Alexandre Le Guyader, Marc Laskar, and Nicole Darodes

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Aorta, business.industry, medicine.disease, medicine.anatomical_structure, Papillary fibroelastoma, Embolism, Cerebral embolism, medicine.artery, Internal medicine, Mitral valve, Cardiology, Medicine, Surgery, Surgical excision, Cardiology and Cardiovascular Medicine, business, Complication, Cardiac symptoms
Abstract

Cardiac papillary fibroelastomas are rare neoplasms usually incidentally found by echocardiography for unrelated problems. Otherwise they could be diagnosed following cardiac symptoms or after an embolic complication. The treatment is only surgical, whatever their size, to prevent any complications. A patient is described who presented acute psychiatric symptoms as a consequence of cerebral embolism of a mitral valve papillary fibroelastoma. The surgical excision was performed through an aortotomy with videoscopy used to help exposure and removal.

Published
2007

14. 25 LV filling pressure in severe as: An echocardiographic and hemodynamic study

Author

Patrice Virot, Julien Magne, Najmeddine Echahidi, Cyrille Boulogne, Safaa Raboukhi, Dania Mohty, Nicole Darodes, Victor Aboyans, and Benedicte Tanguy

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Cardiology, Medicine, Hemodynamics, Cardiology and Cardiovascular Medicine, business
Published
2015

15. Hyperhomocysteinemia and pregnancy--review of our present understanding and therapeutic implications

Author

Yves Aubard, Nicole Darodes, and Muriel Cantaloube

Subjects
Vitamin, medicine.medical_specialty, Hyperhomocysteinemia, Abortion, Habitual, Homocysteine, Bioinformatics, Miscarriage, chemistry.chemical_compound, Pre-Eclampsia, Pregnancy, Internal medicine, Medicine, Humans, Neural Tube Defects, Risk factor, Fetal Death, Venous Thrombosis, Fetal Growth Retardation, business.industry, Vascular disease, Obstetrics and Gynecology, Anticoagulants, medicine.disease, Pregnancy Complications, Endocrinology, Reproductive Medicine, chemistry, Female, business, Transmethylation
Abstract

Homocysteine results from the transmethylation of methionine. Its metabolism depends primarily on three enzymes and several vitamin cofactors. Genetic abnormality in these enzymes or deficiency of these vitamins lead to hyperhomocysteinemia (HHCh). HHCh is usually biologically defined by a fasting value >15 micromol/l. HHCh belongs among the congenital hypercoagulable states and is a long-known vascular disease risk factor. The discovery that HHCh may also be responsible for several pregnancy complications has only recently been made. Studies in this area are still scarce and report on limited numbers of patients. It nevertheless appears clear that HHCh is associated with the syndromes of repeated miscarriage, pre-eclampsia, placenta abruptio, thromboembolic events, neural tube defects, and perhaps with fetal death-in-utero and intra-uterine growth retardation. Supplementation with vitamin B9 can reduce plasma HC levels, and is thus recommended in patients with HHCh. The prevention of thromboembolic events during pregnancy by anticoagulant treatment is also desirable in these patients.

Published
2000

16. Left Atrium Enlargement Is An Independent Predictor of Overall Mortality In Patients with Cardiac AL Amyloidosis

Author

Dominique Bordessoule, Benedict Tanguy, Nicole Darodes, Najmeddine Echahidi, Arnaud Jaccard, Philippe Pibarot, Dania Mohty, David Lavergne, and Patrice Virot

Subjects
medicine.medical_specialty, Ejection fraction, business.industry, Surrogate endpoint, Immunology, valvular heart disease, Diastole, Cell Biology, Hematology, medicine.disease, Biochemistry, Muscle hypertrophy, Internal medicine, Cohort, AL amyloidosis, Cardiology, Medicine, business, Primary systemic amyloidosis
Abstract

Abstract 4621 Background: Primary systemic amyloidosis (AL) is a severe plasma cell disorder characterized by amyloid fibrils extracellular deposition in different organs. Myocardial involvement is frequent and has major impact on prognosis. Echocardiography (TTE) is the most common test performed when cardiac involvement is suspected. We hypothesized that a simple measurement of left atrium enlargement (LA) by TTE may provide an important risk marker for this disease. Methods and results: Between 1997 and 2010, 114 patients were diagnosed with systemic AL. Sixty one patients of the cohort (54%) had cardiac involvement on the basis of standard criteria defined as: mean LV wall thickness >12mm with no other cardiac causes. They had first TTE within 16 days of diagnosis. Patients were mainly treated with conventional chemotherapy (M-Dex) or with new agents for refractory or relapsing patients We retrospectively collected demographic baseline characteristics along with biological and echo data of these patients. Mean age was 61±11 years; 60% were male; 19% had hypertension. Mean left ventricular ejection fraction and mean LV wall thickness were respectively 58±13% and 15±3 mm. Mean follow up time was 2.1±2 years. None had significant valvular heart disease. LA enlargement was defined by M mode as > 40 mm in male and > 36 mm in female. Patients with enlarged LA had significantly more hypertension and lower ejection fraction and more hypertrophied LV walls (All P< 0.05). At 3 years, survival rate was markedly reduced in patients with enlarged LA vs. those with normal LA: 34±9% vs.75 ±9% (P =0.02). By multivariate analysis, after adjusting for age, gender, and presence of hypertension, LA enlargement remained an independent predictor of overall mortality at 3 years (HR=2.88; CI (1.12-8.84); P=0.03). Conclusion: In patients with systemic AL amyloidosis and cardiac involvement, LA enlargement, a surrogate marker of diastolic dysfunction and elevated LV filling pressure, is a powerful independent predictor of long-term mortality. Therefore LA enlargement may help to enhance risk stratification in patients presenting with this disease. Disclosures: No relevant conflicts of interest to declare.

Published
2010

17. 109 Left atrium enlargement is an independent predictor of overall mortality in patients with systemic amyloidosis

Author

Patrice Virot, Philippe Pibarot, David Lavergne, Arnaud Jaccard, Najmeddine Echahidi, Dominique Bordessoule, Dania Mohty, and Nicole Darodes

Subjects
medicine.medical_specialty, Ejection fraction, Surrogate endpoint, business.industry, valvular heart disease, Diastole, Disease, medicine.disease, Refractory, Internal medicine, medicine, Cardiology, AL amyloidosis, Cardiology and Cardiovascular Medicine, business, Primary systemic amyloidosis
Abstract

BackgroundPrimary systemic amyloidosis (AL) is a severe plasma cell disorder characterized by amyloid fibrils extracellular deposition in different organs. Myocardial involvement is frequent and has major impact on prognosis. Echocardiography (TTE) is the most common test performed when cardiac involvement is suspected. We hypothesized that a simple measurement of left atrium enlargement (LA) by TTE may provide an important risk marker for this disease.Methods and resultsBetween 1997 and 2010, 109 patients were diagnosed with systemic AL and had first TTE within 21 days. Patients were mainly treated with conventional chemotherapy (M-Dex) with new agents for refractory or relapsing patients We retrospectively collected demographic baseline characteristics along with biological and echo data of these patients. Mean age was 63±11 years; 58% were male; 24% had hypertension. Mean left ventricular ejection fraction and mean LV wall thickness were respectively 62±13% and 13±3mm. Mean follow up time was 2.42±2 years. None had significant valvular heart disease. LA enlargement was defined by M mode as > 40mm in male and > 36mm in female. Patients with enlarged LA were more often male, slightly older (p=0.05) and with slightly more hypertension (p=0.07) but had significantly lower ejection fraction and more hypertrophied LV walls (All P

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