0035 : Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: experience of Clermont-Ferrand hospital

BackgroundThe out-of-hospital cardiac arrest represent the leading cause of death worldwide. Several therapeutic elements such as early reperfusion developed in recent years to reduce the high morbidity and mortality observed in this situation. The objective of this study was to evaluate the influence of emergency coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) on the outcome of patients survivors after out-of-hospital cardiac arrest.MethodsBetween January 2012 and June 2013, a total of 54 consecutive patients survivors of out-of-hospital cardiac arrest underwent systematic emergency coronary angiography.ResultsThirty five of the 54 patients had clinically significant coronary disease on angiography, 23 of whom had coronary-artery occlusion (43%). Angioplasty was attempted in 20 patients and was technically successful in 18. The in-hospital survival rate was 48%. Multivariate logistic-regression analysis revealed that angioplasty was an independent predictor of survival (95 percent confidence interval, 3.1 to 750.1; P =0.006).ConclusionsAcute coronary-artery occlusion is frequent in survivors of out-of-hospital cardiac arrest. Accurate diagnosis by immediate coronary angiography can be followed in suitable candidates by coronary angioplasty, which seems to improve survival

0036 : Predictive value of clinical and electrocardiographic features in survivors of out-of-hospital cardiac arrest

BackgroundAcute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). But the diagnosis of acute coronary artery disease in survivors of out-of-hospital cardiac arrest is difficult. The aim of the present study was to assess the predictive value clinical and electrpcardiographic features in diagnosing the presence of acute coronary lesions among out-of-hospital cardiac arrest patients.MethodsClinical and electrocardiographic data collected before coronary angiography were analyzed to determine whether they could be used to predict the presence of recent coronary – artery occlusion on angiography.Results54 patients underwent coronarography angiography after OHCA; 42% of patients had ST-segment elevation and 57% of patients had other ECG patterns on post-restoration of spontaneous circulation (ROSC) ECG. Acute coronary lesions was found in 66% of patients; Significant coronary artery disease was observed in 83% of patients with ST-segment elevation and in 55% of patients with other ECG patterns on post-ROSC ECG (p = 0.03).Significant coronary artery disease was observed in 100% of patients with chest pain before the arrest and in 55% of patients without chest pain (p=0.02). Chest pain has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (100% and 45%, respectively).ConclusionST-segment elevation and chest pain before arrest after OHCA should not be considered as strict selection criteria for performing emergent coronary angiography in patients resuscitated from OHCA; even in the absence of ST-segment elevation on post- return of spontaneous circulation ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest

Effets d'une dose de charge de curcumine sur la vasoactivité artérielle du fumeur sain d'âge moyen

Le but de cette étude était de déterminer les effets de la curcumine sur la fonction endothéliale de fumeurs sains âgés de 50 à 70 ans. D'autres polyphénols comme le flavonols du cacao ou l'hespéridine de l'orange ont déjà montré des effets sur la fonction vasculaire. La curcumine, un bioactif semblant avoir des effets pléiotropes, n'a été que peu étudiée dans le champ cardiovasculaire. Nous avons proposé une étude randomisée en double aveugle et en cross-over sur 9 hommes et 9 femmes ménopausées. Les effets potentiels d'une dose orale unique de curcumine ont été évalués par une approche clinique non-invasive basée sur l'étude de la fonction endothéliale. Nous avons comparé deux méthodes actuellement standards de l'évaluation de la fonction endothéliale : la vasodilatation dépendante du débit (VDD) sur l'artère brachiale par échographie bidimensionnelle et la tonométrie artérielle périphérique (PAT). Ces deux mesures ont été réalisées avant et deux heures après l'ingestion de curcumine ou de placebo. Selon les intégrateurs de risque de Framingham et SCORE, les sujets de l'étude présentaient un risque cardiovasculaire modéré à élevé. La VDD et les paramètres du sphygmocor (réalisés à l'inclusion) étaient significativement corrélés entre eux et avec les scores de risques. Il n'y avait aucune corrélation pour l'épaisseur intima-media et les paramètres de PAT. Nous n'avons pas montré de différence significative entre la prise du placebo et de la curcumine pour le VDD (p=0,24), et le Reactive Hyperemia Index (RHI) (p=0,74), un paramètre obtenu par PAT, en grande partie à cause la forte variabilité inter-individuelle des paramètres. En complétant l'analyse statistique de façon exploratoire sur les groupes des hommes et des femmes, en raison d'une grande différence entre les sexes pur le FMD, il apparait un effet significatif de la curcumine sur le paramètre de FMD (p<0,001) chez les femmes, mais pas chez les hommes. Les résultats cliniques de cette étude ne permettent pas de conclure à un effet bénéfique de la curcumine à dose unique sur la fonction endothéliale, bien qu'une différence se dégage chez les femmes de notre population. Toutefois, des analyses complémentaires concernant la biodisponibilité de la curcumine sont nécessaires pour comprendre ces différences entre les sexes.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Clinical and mechanistic evidences of the interest of curcumin in protecting vascular health

Curcumin exerts a range of biological activities of potential interest in cardiovascular prevention. However, the vascular protective effect of curcumin is still poorly investigated in humans and the cellular and molecular mechanisms by which this compound could modulate the vascular endothelial integrity and function remain to be established. In a randomized control trial, we showed that after an acute intake of curcumin and a subgroup analysis of our study population, curcumin induced a positive effect of on endothelial function only in women and in subjects at lower cardiovascular risk. This observation indicates that curcumin intake could be of better interest to prevent endothelial dysfunction rather than to restore the more established dysfunction, ultimately suggesting that curcumin could be a nutraceutical of special interest to maintain endothelial function. In addition, at the cellular level, we showed that the pre-exposure of endothelial cells to curcumin prior to their activation reduced monocyte adhesion and their trans-endothelial migration in both static and shear stress conditions mimicking the blood flow. Our findings also demonstrated the ability of curcumin, in physiologically relevant conditions, to reduce monocyte TEM through a multimodal regulation of the endothelial cell dynamics with a potential benefit on the vascular endothelial function barrier. In conclusion, taken together these results provide new clinical and mechanistic insights supporting the capacity of curcumin to promote vascular integrity and function. However, further investigation are warranted, especially to better understand the substantial between-subject variability observed in the vascular response to curcumi

Grapefruit Juice Flavanones Modulate the Expression of Genes Regulating Inflammation, Cell Interactions and Vascular Function in Peripheral Blood Mononuclear Cells of Postmenopausal Women

International audienceGrapefruit is a rich source of flavanones, phytochemicals suggested excreting vasculoprotective effects. We previously showed that flavanones in grapefruit juice (GFJ) reduced postmenopausal women’s pulse-wave velocity (PWV), a measure of arterial stiffness. However, mechanisms of flavanone action in humans are largely unknown. This study aimed to decipher molecular mechanisms of flavanones by multi-omics analysis in PBMCs of volunteers consuming GFJ and flavanone-free control drink for 6 months. Modulated genes and microRNAs (miRNAs) were identified using microarrays. Bioinformatics analyses assessed their functions, interactions and correlations with previously observed changes in PWV. GFJ modified gene and miRNA expressions. Integrated analysis of modulated genes and miRNA-target genes suggests regulation of inflammation, immune response, cell interaction and mobility. Bioinformatics identified putative mediators of the observed nutrigenomic effect (STAT3, NF-κB) and molecular docking demonstrated potential binding of flavanone metabolites to transcription factors and cell-signaling proteins. We also observed 34 significant correlations between changes in gene expression and PWV. Moreover, global gene expression was negatively correlated with gene expression profiles in arterial stiffness and hypertension. This study revealed molecular mechanisms underlying vasculoprotective effects of flavanones, including interactions with transcription factors and gene and miRNA expression changes that inversely correlate with gene expression profiles associated with cardiovascular risk factors. Clinical Trial Registration [ ClinicalTrials.gov ], identifier [NCT01272167]

How plant food bioactives may have benefits for vascular health? The case of curcumin

How plant food bioactives may have benefits for vascular health? The case of curcumin. Bordeaux VIVA Winter School - XXXIII LIAC MEETIN

Curcumin modulates endothelial permeability and monocyte transendothelial migration by affecting endothelial cell dynamics

Abstract du posterCurcumin modulates endothelial permeability and monocyte transendothelial migration by affecting endothelial cell dynamics. 8. international conference on polyphenols and healt

Acute intake of curcumin differentially affects endothelial function in male and female smokers: a clinical and molecular analysis

Recent clinical studies have shown that the consumption of polyphenols, like cocoa flavanols or orange hesperidin, presents beneficial effects on vascular function. Curcumin, a phenolic bioactive plant compound exhibiting pleiotropic effects, is until now poorly studied regarding cardiovascular health. The aim of this study was to determine the effect of curcumin on vascular endothelial function in healthy smokers and its nutrigenomic impact on circulating white blood cells. We proposed a randomized, double blind, cross-over study on 9 men and 9 women (50-70 years old). The potential effect of an acute intake of curcumin (5g) has been evaluated by non-invasive assessments of endothelial function. Flow mediated dilatation (FMD) and Reactive Hyperaemia Index (RHI) were compared. These non-invasive measurements have been done before and 2 hours after curcumin or placebo intake. Impact of curcumin consumption on expression of 93 target genes involved in inflammation, cell adhesion and cholesterol absorption/efflux in PBMCs was evaluated by PCR using TaqMan Low Density Array (TLDA). In the studied population, we failed to show any significant difference between curcumin and placebo treatments for FMD (p=0.24) and RHI (p=0.74) partly because of a high inter-individual variability. Interestingly, analysis of data separately for men and women has revealed a significant effect of curcumin for FMD (p<0.001) in women, but not in men. Preliminary PCR analysis suggests that curcumin can modulate expression of genes in volunteers, genes involved in chemotaxis and cholesterol efflux as well as cell adhesion. The nutrigenomic response to curcumin in white blood cells seems to be different between women and men volunteers. Although the clinical results of this study did not account for a beneficial effect of an acute intake of curcumin on vascular function in the whole studied population, gender comparison and preliminary molecular analysis seem to reveal a difference in response to curcumin consumption between male and female

Effects of single and multiple sessions of lower body diastole-synchronized compressions using a pulsating pneumatic suit on endothelium function and metabolic parameters in patients with type 2 diabetes: two controlled cross-over studies

Abstract Background Endothelium function is often impaired in patients with type 2 diabetes. We hypothesized that by improving endothelial function using diastole-synchronized compressions/decompressions (DSCD) to the lower body may improve the metabolic profile. The objective of this research was to evaluate the effects of single and multiple DSCD sessions on microcirculation, endothelium function and metabolic parameters of patients with type 2 diabetes. Methods Two monocentric, controlled, randomized cross-over studies (Study 1 and Study 2) were performed. In Study 1, 16 patients received one 20 min DSCD and one simulated (control) session at 2 week intervals; continuous glucose monitoring and cutaneous blood flow were recorded continuously before, during and after DSCD or Control session; other vascular assessments were performed before and after DSCD and control sessions. In Study 2, 38 patients received 60 min DSCD sessions three times/week for three months followed by a 4–6 week washout and 3 month control period (without simulated sessions); vascular, metabolic, body composition, physical activity and quality of life assessments were performed before and after 3 months. Results Both studies showed significant, multiplex effects of DSCD sessions. In Study 1, cutaneous blood flow and endothelium function increased, and plasma and interstitial glucose levels after a standard breakfast decreased after DSCD sessions. In Study 2, cutaneous endothelium function improved, LDL-cholesterol and non-HDL cholesterol decreased, extra-cell water decreased and SF-36 Vitality score increased after 3 months of DSCD sessions. Conclusions Our findings support the beneficial effect of DSCD on the endothelium and show concomitant beneficial metabolic and vitality effects. Future clinical trials need to test whether DSCD use translates into a preventive measure against microvascular diabetic complications and its progression. Trial registration ClinicalTrials.gov identifiers: NCT02293135 and NCT02359461.Background: Endothelium function is often impaired in patients with type 2 diabetes. We hypothesized that by improving endothelial function using diastole-synchronized compressions/decompressions (DSCD) to the lower body may improve the metabolic profile. The objective of this research was to evaluate the effects of single and multiple DSCD sessions on microcirculation, endothelium function and metabolic parameters of patients with type 2 diabetes.Methods: Two monocentric, controlled, randomized cross-over studies (Study 1 and Study 2) were performed. In Study 1, 16 patients received one 20 min DSCD and one simulated (control) session at 2 week intervals; continuous glucose monitoring and cutaneous blood flow were recorded continuously before, during and after DSCD or Control session; other vascular assessments were performed before and after DSCD and control sessions. In Study 2, 38 patients received 60 min DSCD sessions three times/week for three months followed by a 4-6 week washout and 3 month control period (without simulated sessions); vascular, metabolic, body composition, physical activity and quality of life assessments were performed before and after 3 months.Results: Both studies showed significant, multiplex effects of DSCD sessions. In Study 1, cutaneous blood flow and endothelium function increased, and plasma and interstitial glucose levels after a standard breakfast decreased after DSCD sessions. In Study 2, cutaneous endothelium function improved, LDL-cholesterol and non-HDL cholesterol decreased, extra-cell water decreased and SF-36 Vitality score increased after 3 months of DSCD sessions.Conclusions: Our findings support the beneficial effect of DSCD on the endothelium and show concomitant beneficial metabolic and vitality effects. Future clinical trials need to test whether DSCD use translates into a preventive measure against microvascular diabetic complications and its progression

Management of ST-elevation myocardial infarction in young patients by limiting implantation of durable intracoronary devices and guided by optical frequency domain imaging: “proof of concept” study

International audienc