020: Impact of anti-platelets dose fractionation on platelet inhibition in type 2 diabetes mellitus

ObjectiveThe hypothesis of the study was that increased drug administration frequency [twice daily versus once daily] may provide more effective platelet inhibition in patients with type 2 diabetes mellitus.MethodsTwenty patients with type 2 diabetes mellitus with stable coronary artery disease were prospectively recruited. All the patients received once daily 150mg of aspirin and clopidogrel for two weeks. Then patients were switched to aspirin and clopidogrel 75mg twice daily for two weeks. Pharmacodynamic assessment was performed by VerifyNow system accumetrics at fifteen and thirty days.ResultsThere was no difference between the antiplatelet effect produced by 150mg of aspirin given once daily and 75mg of aspirin given twice daily. A twice-daily dose of 75mg of clopidogrel is associated with significantly more effective platelet inhibition on the residual assay: PRU=38.2% once daily vs 53.8% twice daily (p= 0.001) and PRU=187 once daily vs 147 twice daily (p=0.005).ConclusionsIncreasing the frequency of clopidogrel administration to twice daily in patients with type 2 diabetes mellitus is significantly associated with more effective platelet inhibition. But our data do not support a twice-daily dose of aspirin to improve platelet response

Volume overload impact on 3D right ventricular shape and strain: comparative analysis of tetralogy of Fallot and atrial septal defect patients

International audienc

Imaging in pulmonary hypertension: Focus on the role of echocardiography

SummaryPatients with pulmonary hypertension must be evaluated using a multimodality approach to ensure a correct diagnosis and basal evaluation as well as a prognostic assessment. Beyond the assessment of pulmonary pressures, the echocardiographical examination allows the evaluation of right ventricular adaptation to elevated afterload. Numbers of variables are commonly used in the assessment of the pulmonary hypertension patient in order to detect changes in right heart geometry, right-to-left interaction and right ventricular dysfunction. Whereas an isolated change in one echocardiographical variable is not meaningful, multiple echocardiographical variable modifications together provide accurate information. In this review, we will link pulmonary hypertension pathophysiological changes with echocardiographical indices and describe the clinical implications of echocardiographical findings

Right ventricular function in acute pulmonary embolism: a three-dimensional strain study

International audienc

Three-dimensional right-ventricular regional deformation and survival in pulmonary hypertension

International audienceBackground: Survival in pulmonary hypertension (PH) relates to right ventricular (RV) function. However, the RV unique anatomy and structure limit 2D analysis and its regional 3D function has not been studied yet. The aim of this study was to assess the implications of global and regional 3D RV deformation on clinical condition and survival in adults with PH and healthy controls.Methods and Results: We collected a prospective longitudinal cohort of 104 consecutive PH patients and 34 healthy controls between September 2014 and December 2015. Acquired 3D transthoracic RV echocardiographic sequences were analysed by semi- automatic software (TomTec 4D RV-Function 2.0). Output meshes were post-processed to extract regional motion and deformation. Global and regional statistics provided deformation patterns for each subgroup of subjects.RV lateral and inferior regions showed the highest deformation. In PH patients, RV global and regional motion and deformation (both circumferential, longitudinal and area strain) were affected in all segments (p-18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death (AUC 0.83 [0.74-0.90], p<0.001).Conclusions: RV strain patterns gradually worsen in PH patients and provide independent prognostic information in this population

High-density mapping of the average complex interval helps localizing atrial fibrillation drivers and predicts catheter ablation outcomes

BackgroundPersistent Atrial Fibrillation (PersAF) electrogram-based ablation is complex, and appropriate identification of atrial substrate is critical. Little is known regarding the value of the Average Complex Interval (ACI) feature for PersAF ablation.ObjectiveUsing the evolution of AF complexity by sequentially computing AF dominant frequency (DF) along the ablation procedure, we sought to evaluate the value of ACI for discriminating active drivers (AD) from bystander zones (BZ), for predicting AF termination during ablation, and for predicting AF recurrence during follow-up.MethodsWe included PersAF patients undergoing radiofrequency catheter ablation by pulmonary vein isolation and ablation of atrial substrate identified by Spatiotemporal Dispersion or Complex Fractionated Atrial Electrograms (&gt;70% of recording). Operators were blinded to ACI measurement which was sought for each documented atrial substrate area. AF DF was measured by Independent Component Analysis on 1-minute 12-lead ECGs at baseline and after ablation of each atrial zone. AD were differentiated from BZ either by a significant decrease in DF (&gt;10%), or by AF termination. Arrhythmia recurrence was monitored during follow-up.ResultsWe analyzed 159 atrial areas (129 treated by radiofrequency during AF) in 29 patients. ACI was shorter in AD than BZ (76.4 ± 13.6 vs. 86.6 ± 20.3 ms; p = 0.0055), and mean ACI of all substrate zones was shorter in patients for whom radiofrequency failed to terminate AF [71.3 (67.5–77.8) vs. 82.4 (74.4–98.5) ms; p = 0.0126]. ACI predicted AD [AUC 0.728 (0.629–0.826)]. An ACI &lt; 70 ms was specific for predicting AD (Sp 0.831, Se 0.526), whereas areas with an ACI &gt; 100 ms had almost no chances of being active in AF maintenance. AF recurrence was associated with more ACI zones with identical shortest value [3.5 (3–4) vs. 1 (0–1) zones; p = 0.021]. In multivariate analysis, ACI &lt; 70 ms predicted AD [OR = 4.02 (1.49–10.84), p = 0.006] and mean ACI &gt; 75 ms predicted AF termination [OR = 9.94 (1.14–86.7), p = 0.038].ConclusionACI helps in identifying AF drivers, and is correlated with AF termination and AF recurrence during follow-up. It can help in establishing an ablation plan, by prioritizing ablation from the shortest to the longest ACI zone

Technological advances in cardiac pacing and defibrillation

Since more than a half century, cardiac pacing and defibrillation represent a field in constant evolution, and they have shown some great technological advances from its conception to its methods of insertion. In this review, the recent developments about the accesses for pacemakers and ICD will be described: the axillary and the femoral vein. The His bundle pacing and the advantages of the entirely subcutaneous defibrillator will also be presented

Oxidative Stress and Mitochondrial Functions in the Intestinal Caco-2/15 Cell Line

Although mitochondrial dysfunction and oxidative stress are central mechanisms in various pathological conditions, they have not been extensively studied in the gastrointestinal tract, which is known to be constantly exposed to luminal oxidants from ingested foods. Key among these is the simultaneous consumption of iron salts and ascorbic acid, which can cause oxidative damage to biomolecules.The objective of the present work was to evaluate how iron-ascorbate (FE/ASC)-mediated lipid peroxidation affects mitochondrion functioning in Caco-2/15 cells. Our results show that treatment of Caco-2/15 cells with FE/ASC (0.2 mM/2 mM) (1) increased malondialdehyde levels assessed by HPLC; (2) reduced ATP production noted by luminescence assay; (3) provoked dysregulation of mitochondrial calcium homeostasis as evidenced by confocal fluorescence microscopy; (4) upregulated the protein expression of cytochrome C and apoptotic inducing factor, indicating exaggerated apoptosis; (5) affected mitochondrial respiratory chain complexes I, II, III and IV; (6) elicited mtDNA lesions as illustrated by the raised levels of 8-OHdG; (7) lowered DNA glycosylase, one of the first lines of defense against 8-OHdG mutagenicity; and (8) altered the gene expression and protein mass of mitochondrial transcription factors (mtTFA, mtTFB1, mtTFB2) without any effects on RNA Polymerase. The presence of the powerful antioxidant BHT (50 microM) prevented the occurrence of oxidative stress and most of the mitochondrial abnormalities.Collectively, our findings indicate that acute exposure of Caco-2/15 cells to FE/ASC-catalyzed peroxidation produces harmful effects on mitochondrial functions and DNA integrity, which are abrogated by the powerful exogenous BHT antioxidant. Functional derangements of mitochondria may have implications in oxidative stress-related disorders such as inflammatory bowel diseases