106 Determinants of B-type natriuretic peptide levels and left atrial volume in stable patients in sinus rhythm: an echocardiographic-catheterization study

BackgroundB-type natriuretic peptide (BNP) (Advia Centaur System) and left atrial volume index (LAVi) are regarded as powerful markers of global myocardial function. Several confounding factors are known to potentially influence this relation. The aim of the present study was to evaluate the determinants of BNP and LAVi in the same population of stable patients referred for catheterism.Methods74 consecutive patients were included. Exclusion criteria were arrhythmias, acute coronary syndrome, exacerbation of heart failure and severe left-sided valve disease. All the data were obtained within the same morning for each patient. All following variables were tested: age, gender, body mass index, systolic arterial pressure, heart rate, LV ejection fraction (LVEF), LV mass index (LVM), significant mitral regurgitation (MR), serum hemoglobin (Hb), creatinine clearance (CC), LV end-diastolic pressure (LVEDP), extent of coronary disease.ResultsUnivariate determinants of BNP were age, LVEF, LVM, MR, LVEDP, extent of coronary disease, Hb and CC. By multiple regression analysis, the independant determinants of BNP were age, LVEDP and LVEF (p<0,005 for all). Univariate determinants of LAVI were age, significant MR, LVM, LVEF and LVEDP. By multiple regression analysis, the independent predictors were LVM and LVEDP (p=0,001 for all). BNP was not predicted by LAVi in the multivariate model.ConclusionOur study confirms that both BNP and LAVi can be used as markers of global myocardial dysfunction in stable patients in sinus rhythm. However, age must be taken into consideration before interpreting BNP results

Alcohol Consumption and Ambulatory Blood Pressure: A Community-Based Study in an Elderly Cohort

BACKGROUND Although heavy alcohol consumption is associated with hypertension, the impact of lighter consumption on blood pressure (BP) is controversial. The protective effect of light alcohol consumption on cardiovascular disease described in previous studies could be, in part, mediated by effects of alcohol on BP. However, only a few studies investigating the association between alcohol and BP included elderly subjects, despite their higher risk of hypertension sequelae. Accordingly, we evaluated the relationship between alcohol consumption and 24-hour ambulatory BP in a community-based elderly cohort. METHODS Among the participants in the Cardiac Abnormalities and Brain Lesion study, 553 subjects (mean age = 70.6±9.6 years) who underwent 24-hour ambulatory BP monitoring were examined. Alcohol consumption was categorized as (i) none (reference; 1 drink/day). Former drinkers were excluded. RESULTS After adjustment for relevant covariables, mean values of daytime diastolic BP (DBP), nighttime DBP, and 24-hour DBP were significantly higher in moderate-to-heavy drinkers than in the reference group, whereas systolic BP parameters were not significantly different across consumption groups. Daytime systolic BP and DBP variability (SD of the measurements) were significantly lower in very light drinkers than in the reference group, independent of potential confounders. CONCLUSIONS Moderate-to-heavy alcohol consumption was associated with higher DBP values. Very light alcohol consumption was associated with reduced daytime BP variability. The latter association may contribute to the known beneficial cardiovascular effects of light alcohol consumption

Facteurs contributifs au volume de l'oreillette gauche et à la sécrétion du BNP (une étude par échocardiographie doppler trans-thoracique et cathétérisme cardiaque simultanés)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Le village médiéval et son environnement

Depuis les années 1960, la contribution de J.-M. Pesez a été déterminante dans la définition des méthodes et des buts de l'archéologie médiévale en France. Initiateur des grandes enquêtes lancées autour de la question des désertions des habitats ruraux dans le courant du Moyen Age, il est une autorité en ce qui concerne le village et la civilisation matérielle médiévale. Il a présidé durant de nombreuses années le Conseil Supérieur de l'Archéologie. Au moment de son départ à la retraite, ses élèves et ses amis ont souhaité constituer un recueil thématique d'articles, et le lui offrir en hommage. Le volume est divisé en trois sections, qui correspondent aux trois axes des travaux et de renseignement de Jean-Marie Pesez : la maison (techniques de construction, distribution de l’espace, fonction de ses éléments), les habitants et les objets (technique de formation et de conservation), le finage (constitution du paysage, utilisation des terroirs) sont tour à tour abordes dans ce recueil qui présente un état de la recherche sur ces questions

Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial

International audienc

Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia

International audienceImportance Severe pneumonia with hyperinflammation and elevated interleukin-6 is a common presentation of coronavirus disease 2019 (COVID-19).Objective To determine whether tocilizumab (TCZ) improves outcomes of patients hospitalized with moderate-to-severe COVID-19 pneumonia.Design, Setting, and Particpants This cohort-embedded, investigator-initiated, multicenter, open-label, bayesian randomized clinical trial investigating patients with COVID-19 and moderate or severe pneumonia requiring at least 3 L/min of oxygen but without ventilation or admission to the intensive care unit was conducted between March 31, 2020, to April 18, 2020, with follow-up through 28 days. Patients were recruited from 9 university hospitals in France. Analyses were performed on an intention-to-treat basis with no correction for multiplicity for secondary outcomes.Interventions Patients were randomly assigned to receive TCZ, 8 mg/kg, intravenously plus usual care on day 1 and on day 3 if clinically indicated (TCZ group) or to receive usual care alone (UC group). Usual care included antibiotic agents, antiviral agents, corticosteroids, vasopressor support, and anticoagulants.Main Outcomes and Measures Primary outcomes were scores higher than 5 on the World Health Organization 10-point Clinical Progression Scale (WHO-CPS) on day 4 and survival without need of ventilation (including noninvasive ventilation) at day 14. Secondary outcomes were clinical status assessed with the WHO-CPS scores at day 7 and day 14, overall survival, time to discharge, time to oxygen supply independency, biological factors such as C-reactive protein level, and adverse events.Results Of 131 patients, 64 patients were randomly assigned to the TCZ group and 67 to UC group; 1 patient in the TCZ group withdrew consent and was not included in the analysis. Of the 130 patients, 42 were women (32%), and median (interquartile range) age was 64 (57.1-74.3) years. In the TCZ group, 12 patients had a WHO-CPS score greater than 5 at day 4 vs 19 in the UC group (median posterior absolute risk difference [ARD] −9.0%; 90% credible interval [CrI], −21.0 to 3.1), with a posterior probability of negative ARD of 89.0% not achieving the 95% predefined efficacy threshold. At day 14, 12% (95% CI −28% to 4%) fewer patients needed noninvasive ventilation (NIV) or mechanical ventilation (MV) or died in the TCZ group than in the UC group (24% vs 36%, median posterior hazard ratio [HR] 0.58; 90% CrI, 0.33-1.00), with a posterior probability of HR less than 1 of 95.0%, achieving the predefined efficacy threshold. The HR for MV or death was 0.58 (90% CrI, 0.30 to 1.09). At day 28, 7 patients had died in the TCZ group and 8 in the UC group (adjusted HR, 0.92; 95% CI 0.33-2.53). Serious adverse events occurred in 20 (32%) patients in the TCZ group and 29 (43%) in the UC group (P = .21).Conclusions and Relevance In this randomized clinical trial of patients with COVID-19 and pneumonia requiring oxygen support but not admitted to the intensive care unit, TCZ did not reduce WHO-CPS scores lower than 5 at day 4 but might have reduced the risk of NIV, MV, or death by day 14. No difference on day 28 mortality was found. Further studies are necessary for confirming these preliminary results.Trial Registration ClinicalTrials.gov Identifier: NCT0433180

Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial

International audienc

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed