228 Blood pressure in HIV-infected patients

ObjectifveTo determine the prevalence of hypertension in a cohort of HIV-infected patients (HIV+).MethodsHIV+ patients were enrolled consecutively at ambulatory cardiology consultation. We evaluated:cardiovascular risk factors,office blood pressure,24 hours ambulatory blood pressure monitoring (ABPM).We identified patients with known hypertension, masked hypertension and white-coat effect.Results258 HIV+ patients (mean age 49±7 ans, 91% men) were consecutively included in this study between 2005 and 2009. Cardiovascular risk factors were as follows: 52% had dyslipidemia, 51% were active smokers, 40% with known hypertension and 9% were diabetics. Body mass index of the entire cohort was 24±4kg/mΣ and 89% were under antiretrovirals. Data on blood pressure are depicted in Table 1. 19% (29) were discovered to have hypertension.ConclusionHypertension is frequent in HIV-infected patients and more and more common with aging. The number of non-dipper HIV+ was high in this cohort. Studies on the impact of HIV infection and antiretrovirals on the autonomic nervous system should be performed.ParametersN=258Office systolic BP, mmHg131±19Office diastolic BP, mmHg81±10Mean 24h-systolic BP, mmHg125±13Mean 24-diastolic BP, mmHg77±9Daytime systolic BP, mmHg129±13Daytime diastolic BP, mmHg80±9Nighttime systolic BP, mmHg115±17Nighttime diastolic BP, mmHg68±10BP profile in known hypertensive patientsN=103Number of patients with appropriate BP control, %45%Number of patients with white-coat effect, %17%Non dipper, %43% in known hypertensive patients 39% in unknown hypertensive patient

Increased risk of left heart valve regurgitation associated with benfluorex use in patients with diabetes mellitus: a multicenter study.

International audienceBACKGROUND: Benfluorex was withdrawn from European markets in June 2010 after reports of an association with heart valve lesions. The link between benfluorex and valve regurgitations was based on small observational studies and retrospective estimations. We therefore designed an echocardiography-based multicenter study to compare the frequency of left heart valve regurgitations in diabetic patients exposed to benfluorex for at least 3 months and in diabetic control subjects never exposed to the drug. METHODS AND RESULTS: This reader-blinded, controlled study conducted in 10 centers in France between February 2010 and September 2011 prospectively included 376 diabetic subjects previously exposed to benfluorex who were referred by primary care physicians for echocardiography and 376 diabetic control subjects. Through the use of propensity scores, 293 patients and 293 control subjects were matched for age, sex, body mass index, smoking, dyslipidemia, hypertension, and coronary artery disease. The main outcome measure was the frequency of mild or greater left heart valve regurgitations. In the matched sample, the frequency and relative risk (odds ratio) of mild or greater left heart valve regurgitations were significantly increased in benfluorex patients compared with control subjects: 31.0% versus 12.9% (odds ratio, 3.55; 95% confidence interval, 2.03-6.21) for aortic and/or mitral regurgitation, 19.8% versus 4.7% (odds ratio, 5.29; 95% confidence interval, 2.46-11.4) for aortic regurgitation, and 19.4% versus 9.6% (odds ratio, 2.38; 95% confidence interval, 1.27-4.45) for mitral regurgitation. CONCLUSIONS: Our results indicate that the use of benfluorex is associated with a significant increase in the frequency of left heart valve regurgitations in diabetic patients. The natural history of benfluorex-induced valve abnormalities needs further research

Atteinte myocardique liée à l'infection par le VIH et apport du Doppler tissulaire à l'ère de la trithérapie (étude de cas-témoins)

Avant l'introduction des multi thérapies antirétrovirales (MARV), l'infection par le virus de l'immunodéficience humaine (VIH) était associée fréquemment à des atteintes cardiaques. L'introduction des thérapeutiques modernes essentiellement en diminuant le taux d'infections opportunistes a transformé le pronostic de ces patients. Au plan cardiovasculaire les patients traités par MARV paraissent particulièrement exposés aux coronaropathies. La prévalence des affections myocardiques et péricardiques semble en revanche diminuer. Dans une étude cas-témoins, 47 patients VIH ayant une échocardiographie " conventionnelle " normale et 47 sujets sains appariés sur l'age et le sexe ont été prospectivement explorés en utilisant les modes Doppler tissulaires pulsé et de déformation (strain et strain rate). Comparativement aux témoins, nous avons identifié chez les patients VIH des anomalies de la fonction diastolique et de l'indice de performance du ventricule droit (VD). Les fonctions systolique VD, et systolo-diastolique du ventricule gauche étaient comparables dans les deux groupes. Ces anomalies n'étaient pas expliquées par des variations des conditions de charges et paraissaient témoigner d'une altération de la relaxation VD. En analyse multivariée, l'infection par le VIH était un prédicteur indépendant des altérations du VD. A l'ère des MARV l'utilisation du Doppler tissulaire myocardique pourrait dépister des anomalies isolées de la fonction VD non accessibles en échocardiographie conventionnelle. L'atteinte VD pourrait représenter un signe précoce d'atteinte cardiaque chez ces patients. La signification physiopathologique et les éventuelles implications pronostiques de ces résultats restent à établirPARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Valeur prédictive négative de la CRP chez les patients en fibrillation auriculaire à risque thromboembolique intermédiaire

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Pronostic des patients en fibrillation atriale non valvulaire avec un score CHADS2 égal à 1

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Intérêt de la CRPus comme facteur prédictif de récurrence dans la fibrillation auriculaire

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Traitements antithrombotiques dans la fibrillation atriale (résultats d'une enquête dans un service hospitalier de Cardiologie)

PARIS-BIUP (751062107) / SudocSudocFranceF

Cardio-oncology: Clinical and imaging perspectives for optimal cardiodetection and cardioprotection in patients with cancer

cardiaqueBackgroundCardio-oncology is a recent field that has emerged fromthe growing need to manage the cardiovascular health ofpatients with cancer. It was first developed in the 1960s,with the use of anthracyclines and the discovery of theirmyocardial toxicity, which led to the development of heartfailure, particularly in patients who received high doses.Over the years, the interest in cardio-oncology has grownconsiderably in response to epidemiological changes in thecancer population and major advances made in cancer treat-ment [1]. The increase in life expectancy, the decrease incancer mortality and the development of new cancer drugshave led to greater involvement of cardiologists in the mana-gement of patients with cancer. Indeed, the associationbetween cancer and cardiovascular disease/risk factors hasbecome more and more frequent, and various cardiovascularadverse events have been described with new treatments,such as targeted therapies or immunotherapies (Table 1).Now, every cardiologist should have skills in cardio-oncology,because the risk of cancer survivors developing cardiovascu-lar events can become greater than their risk of recurrentmalignancy [2]. At the same time, we need expert car-diologists (cardio-oncologists) who can manage the mostcomplex cases, and who know the cardiovascular effects ofthe most recent cancer treatments. Recently, the EuropeanSociety of Cardiology outlined the rationale for creatingcardio-oncology teams, clinics and services, to provide amultidisciplinary patient-centred approach in a dedicatedenvironment [3].In this context, cardiologists are new actors in the mana-gement of many patients with cancer, and their role shouldno longer be limited to the measurement of left ventricu-lar ejection fraction (LVEF) alone. They have to be involvedbefore, during and after cancer treatment, to prevent, pre-dict, screen and eventually treat a range of cardiovasculardiseases related to, or associated with, cancer therapy,without compromising its effectiveness. These missions ofcardiodetection and cardioprotection are essential in theshort term to reduce discontinuation of cancer treatment,and in the long term to improve overall survival; they involvethe cardiologists’ clinical skills, but also their ability to userelevant cardiovascular imaging modalities

Cardiac Events Associated With Chimeric Antigen Receptor T-Cells (CAR-T)

International audienc

Response by Thuny et al. to Letter Regarding Article, “Clinical Features, Management, and Outcomes of Immune Checkpoint Inhibitor–Related Cardiotoxicity”

Response to Letter Regarding Article : Clinical Features, Management, and Outcomes of Immune Checkpoint Inhibitor–Related Cardiotoxicity by Marion Escudier, Jennifer Cautela, Nausicaa Malissen, Yann Ancedy, Morgane Orabona, Johan Pinto, Sandrine Monestier, Jean-Jacques Grob, Ugo Scemama, Alexis Jacquier, Nathalie Lalevee, Jeremie Barraud, Michael Peyrol, Marc Laine, Laurent Bonello, Franck Paganelli, Ariel Cohen, Fabrice Barlesi, Stephane Ederhy, and Franck Thuny.doi.org/10.1161/CIRCULATIONAHA.117.03057