Validation d un score d aide à la décision médicale pour l orientation des patients présentant une syncope (étude non interventionnelle prospective monocentrique aux urgences du CHU de Grenoble)

INTRODUCTION : La syncope est un motif fréquent d admission aux urgences. Le score SYNSCOR a été développé à partir des paramètres cliniques des recommandations ESC 2009 afin d améliorer l orientation des patients aux urgences. METHODE : Il s agissait d une étude prospective, non interventionelle qui incluait les patients se présentant aux urgences du Centre Hospitalier Universitaire de Grenoble pour une syncope entre juillet 2013 et janvier 2014. SYNCSOR était calculé a posteriori. L objectif principal était de valider SYNSCOR par le calcul des sensibilité et spécificité pour la prédiction d événements à 3 mois (récidive, thérapeutique de cardiologie interventionnelle, évènement cardiovasculaire majeur ou décès). RESULTATS : Ont été inclus, 94 patients. Après évaluation initiale, 39% ont été hospitalisés, 45% ont été adressés en consultation et 16% ont eu une sortie simple. 25 patients (26%) ont présenté un événement dans les 3 premiers mois. Le score présentait une sensibilité et une valeur prédictive négative de 0,96 (IC 95% (0,80-0,99)) et 0,94 (IC 95% (0,73-0,99)) pour le critère primaire. La spécificité et la valeur prédictive positive étaient de 0,24 (IC 95% (0,16-0,36)) et 0,32 (IC 95% (0,23-0,44)). Selon SYNSCOR, 50% des patients auraient dû bénéficier d une évaluation en hospitalisation et 20% auraient pu sortir sans examen complémentaire. CONCLUSION : SYNSCOR semble éviter le retour à domicile sans suivi des patients à risque et limiter les investigations chez les patients à bas risque. Un travail prospectif comparant directement l orientation et le devenir des patients avec ou sans SYNSCOR ainsi que l impact en terme d économie de santé pourrait être utile.Background: Syncope is a frequent symptom in the Emergency Department (ED). The SYNCSCOR tool is developed with clinical parameters of the ESC recommendations 2009 and validated scores regarding syncope to help the clinician for patients (pts) orientation : intensive, differed or no further evaluation. Method: In this non interventionnal monocentric study, pts admitted in the ED of Grenoble University Hospital for syncope were prospectively included from July 2013 to January 2014. The SYNCSCOR was calculated a posteriori for all pts. The main objective was to validate the tool for the prediction of serious outcomes within 3 months (death, major cardiovascular events, cardiovascular interventional therapy, related event). Results: 94 pts were included (males 54%, mean age 66 years old, history of cardiopathy 56%). After the ED evaluation, 39% were admitted, 45% were addressed to outpatient clinic and 16% were released. Serious outcomes occurred in 25 pts. The sensitivity and specificity, of SYNCSCOR for the primary criteria was 96% (95% Confidence interval [CI] 80 to 99%) and 24% (95% CI 16 to 36%). The negative predictive value of the tool was 94% (95% CI 73 to 99%). Conclusion: SYNCSCOR is a useful screening tool to improve reliability to the recommendations in the ED. It can help to limit no necessary complementary exams, overprescribed for patients at low risk, and to lead patients to an immediate intensive evaluation (syncope unit) in case of high risk criteria. As SYNCSCOR is only based on clinical parameters. SYNSCOR can be easily proposed in the community care.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Corrélation entre l'étendue de l'ischémie myocardique en tomoscintigraphie synchronisée et taux plasmatiques de NT-proBNP chez le patient coronarien stable à fonction VG préservée (à propos de 88 patients)

La valeur pronostique du N-Terminal pro-Brain Natriurétic Peptide (NTBNP) n'étant pas démontrée dans la coronaropathie stable, nous avons recherché la relation entre NTBNP et ischémie myocardique étendue en tomoscintigraphie de perfusion -TL201- chez les patients coronariens stables à fraction d'éjection normale (FE>45%). 88 patients ont été inclus, dont 33 ayant une imagerie normale et 55 des anomalies de perfusion significatives. Les taux de NTBNP mesurés avant épreuve d'effort, au pic et en post-stress (3 h après) sont plus élevés chez ces derniers que chez les premiers (p45%). 88 patients were included, 33 with normal SPECT and 55 with significant perfusion abnormalities. NTBNP at baseline, peak exercise test (EST) and 3 hours after (post-EST) are higher in the last group than in the first one (p<0,05). Post-EST NTBNP is predictive of an extensive ischemia (SDS=5, area under the curve=0,61). A rate<190pmol/ml ruled-out it with a negative predictive value of 85%, and the accuracy of combined EST and NTBNP was 74%. NTBNP measure seems promising in SCAD especially for selecting the more severe patients.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Validation of an apnea and hypopnea detection algorithm implemented in implantable cardioverter defibrillators. The AIRLESS study

International audienceDiagnosis of sleep apnea (SA) using simple tools has the potential to improve the efficacy of cardiac implants in the prevention of cardiac arrhythmias. The aim of the present study was to validate a transthoracic impedance sensor for SA diagnosis in patients with cardiac implants. We compared the apnea-hypopnea index (AHI) obtained from polysomnography (AHIPSG) with the AHI obtained from autoscoring algorithms of the ApneaScan implantable impedance respiration sensor (AHIAS) three months after implantation of cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. Twenty-five patients with indications for implantation of ICD or CRT-D (INCEPTA; Boston Scientific) (24 men, 59.9 ± 14.4 years; LVEF 30.3 ± 6.4%; body mass index 25.9 ± 4.2 kg/m²) were included. Mean AHI-PSG was 21.9 ± 19.1 events/hr. A significant correlation was found between AHIPSG and AHIAS especially for the most severe SA (Spearman correlation: 0.71, p < 0.001). Intraclass Correlation Coefficient (was in the expected range: 0.67, 95% CI: 0.39–0.84. The mean bias was 5.4 events per hour (mean AHI: 23.3 ± 14.6 versus 29.7 ± 13.7 for AHI-PSG and AHI-AS, respectively). An optimal cutoff value for the AHIAS at 30 events/h was obtained from the Receiver Operator Characteristic (ROC) curve analysis, which yielded a sensitivity of 100%, a specificity of 80%, PPV = 67%, NPV = 100%. Using an advanced algorithm for autoscoring of transthoracic impedance included in ICDs is reliable to identify SA and has the potential to improve the management of patients with cardiac implants

Validation of an apnea and hypopnea detection algorithm implemented in implantable cardioverter defibrillators. The AIRLESS study

International audienceDiagnosis of sleep apnea (SA) using simple tools has the potential to improve the efficacy of cardiac implants in the prevention of cardiac arrhythmias. The aim of the present study was to validate a transthoracic impedance sensor for SA diagnosis in patients with cardiac implants. We compared the apnea-hypopnea index (AHI) obtained from polysomnography (AHIPSG) with the AHI obtained from autoscoring algorithms of the ApneaScan implantable impedance respiration sensor (AHIAS) three months after implantation of cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. Twenty-five patients with indications for implantation of ICD or CRT-D (INCEPTA; Boston Scientific) (24 men, 59.9 ± 14.4 years; LVEF 30.3 ± 6.4%; body mass index 25.9 ± 4.2 kg/m²) were included. Mean AHI-PSG was 21.9 ± 19.1 events/hr. A significant correlation was found between AHIPSG and AHIAS especially for the most severe SA (Spearman correlation: 0.71, p < 0.001). Intraclass Correlation Coefficient (was in the expected range: 0.67, 95% CI: 0.39–0.84. The mean bias was 5.4 events per hour (mean AHI: 23.3 ± 14.6 versus 29.7 ± 13.7 for AHI-PSG and AHI-AS, respectively). An optimal cutoff value for the AHIAS at 30 events/h was obtained from the Receiver Operator Characteristic (ROC) curve analysis, which yielded a sensitivity of 100%, a specificity of 80%, PPV = 67%, NPV = 100%. Using an advanced algorithm for autoscoring of transthoracic impedance included in ICDs is reliable to identify SA and has the potential to improve the management of patients with cardiac implants

Validation of an apnea and hypopnea detection algorithm implemented in implantable cardioverter defibrillators. The AIRLESS study

International audienceDiagnosis of sleep apnea (SA) using simple tools has the potential to improve the efficacy of cardiac implants in the prevention of cardiac arrhythmias. The aim of the present study was to validate a transthoracic impedance sensor for SA diagnosis in patients with cardiac implants. We compared the apnea-hypopnea index (AHI) obtained from polysomnography (AHIPSG) with the AHI obtained from autoscoring algorithms of the ApneaScan implantable impedance respiration sensor (AHIAS) three months after implantation of cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. Twenty-five patients with indications for implantation of ICD or CRT-D (INCEPTA; Boston Scientific) (24 men, 59.9 ± 14.4 years; LVEF 30.3 ± 6.4%; body mass index 25.9 ± 4.2 kg/m²) were included. Mean AHI-PSG was 21.9 ± 19.1 events/hr. A significant correlation was found between AHIPSG and AHIAS especially for the most severe SA (Spearman correlation: 0.71, p < 0.001). Intraclass Correlation Coefficient (was in the expected range: 0.67, 95% CI: 0.39–0.84. The mean bias was 5.4 events per hour (mean AHI: 23.3 ± 14.6 versus 29.7 ± 13.7 for AHI-PSG and AHI-AS, respectively). An optimal cutoff value for the AHIAS at 30 events/h was obtained from the Receiver Operator Characteristic (ROC) curve analysis, which yielded a sensitivity of 100%, a specificity of 80%, PPV = 67%, NPV = 100%. Using an advanced algorithm for autoscoring of transthoracic impedance included in ICDs is reliable to identify SA and has the potential to improve the management of patients with cardiac implants

Technical feasibility of leadless left bundle branch area pacing for cardiac resynchronization:A case series

BACKGROUND: Left bundle branch area pacing (LBBAP) is a novel form of conduction system pacing which can reverse left bundle branch block and deliver cardiac resynchronization therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing with symptomatic and left ventricular (LV) remodelling improvements following intervention. We report the technical feasibility of delivering leadless LBBAP using the WiSE-CRT system. CASE SUMMARY: In Case 1, a 57-year-old male with ischaemic cardiomyopathy and complete heart block underwent implantation of the WiSE-CRT system, using a retrograde transaortic approach, after failed conventional CRT. Temporary left bundle stimulation from the LV septum achieved superior electrical resynchronization and equivalent haemodynamic response compared to endocardial pacing at the lateral LV wall. In Case 2, an 82-year-old gentleman with tachyarrhythmia-induced cardiomyopathy underwent WiSE-CRT implantation via a trans-septal inter-atrial approach, with the endocardial electrode successfully deployed in the LV septum. DISCUSSION: Here we report the first case of deployment of the WiSE-CRT endocardial electrode in the LV septum and demonstrate the technical feasibility of leadless LBBAP. Entirely leadless CRT is an attractive option for patients with venous access issues or recurrent lead complications and has previously been successful using the WiSE-CRT system and a leadless pacemaker in the right ventricle. Further studies are required to assess long-term efficacy and safety of leadless LBBAP

Subcutaneous Implantable Cardioverter-Defibrillator Lead Extraction First Multicenter French Experience

International audienceObjectives - The aim of this multicenter study was to characterize the efficacy and safety of subcutaneous implantable cardioverter-defibrillators (S-ICDs) lead extraction procedures. Background - S-ICDs have been developed to limit lead-related complications inherent to transvenous ICD devices. To date, no study has specifically investigated the safety and feasibility of S-ICD lead extraction procedures. Methods - Patients requiring S-ICD lead extraction between February 1, 2014, and February 28, 2019, were retrospectively included in 10 centers. The primary endpoint of the study was procedural success, defined as the removal of all the lead and lead material from the subcutaneous space. Secondary endpoints included procedural complications and the need for specific extraction tools. Results - S-ICD lead extraction procedures were performed in 32 patients (mean age 45.7 ± 13.8 years, 75.0% men, 65.6% in primary prevention). The median time from S-ICD lead implantation was 9.3 months (5.4 to 17.5 months). The primary endpoint, that is, complete removal of the material, was achieved in 96.9% of the patients, and only 1 procedural failure occurred (3.1%). Simple traction of the S-ICD lead was successful in 19 patients (59.4%), whereas 3 patients (9.4%) needed an additional incision and 9 patients (28.1%) required mechanical sheath to remove lead adhesions around the coil. No procedure-related complications occurred. Patients with successful simple traction extraction were implanted more recently (7.1 months [2.8 to 12.2 months] vs. 16.5 months [7.5 to 20.8 months]; p = 0.04) and had less prior history of sternotomy (2 [10.5%] vs. 5 [38.5%] patients; p = 0.09). Conclusions - S-ICD lead extraction is an efficient and safe procedure, but may require some specific tools like mechanical sheath, specifically when fibrotic adhesions developed around the parasternal coil