0371: Bifurcation techniques with ABSORB® bioresorbable vascular scaffold: optical frequency-domain imaging and micro-computed tomography assessment

AimsWe aimed to determine the correlation between optical frequency-domain imaging (OFDI) and micro-computed tomography (mCT) in the quantitative and qualitative assessment of ABSORB® bioresorbable vascular scaffold (BVS) in a bench test of multiple bifurcation technique.MethodBVS were deployed in bifurcation silicon phantoms divided into two benches. Bench A is a LAD-diagonal bifurcation with a 40° angle and bench B, a left main bifurcation with a 70° angle. Finet’s law was respected. Different bifurcation techniques (provisional T stenting, kissing balloon, mini crush and culotte) were performed with a total of 16 procedures, 8 for each bench. All procedures were imaged by OFDI and mCT. BVS area, lumen area, number of struts, maximal stent thickness, disruption, lumen protrusion and deformation were the parameters collected. The analysis was performed in each segment, proximal, bifurcation and distal.ResultsIn bench A, we found no differences between OFDI and mCT for each proximal, bifurcation and distal segments concerning BVS area, lumen area, number of struts, maximal stent thickness, fractures, lumen protrusion, BVS deformation or BVS fragments. In the proximal segment, length was higher in mCT (13.2mm vs 10.4mm; p<0.0001) and there was more malapposition detected in mCT (75% vs 0%, p=0.007). In bench B, for the proximal segment, lumen area was higher (13.7mm2 vs 13.mm2, p=0.01) and we found more BVS malapposition in mCT (100% vs 0%, p=0.0002). All the other parameters were similar. In each bench, the apposition defect measured by mCT remained minimal.ConclusionWe demonstrated an excellent correlation between OFDI and mCT which is considered as the gold standard to evaluate stent in bench tests. In vitro techniques can now be validated in vivo using OFDI

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Application rétrospective d'un algorithme diagnostique d'interprétation des cathétérismes cardiaques droits dans une population âgée de plus de 70 ans (difficultés diagnostiques et de classification des hypertensions pulmonaires)

La classification de l'hypertension pulmonaire (HTP) est primordiale pour sa bonne prise en charge. Elle peut être particulièrement difficile chez la personne âgée. Les pathologies cardiaques gauches sont la première cause d'HTP. Les critères diagnostiques actuels semblent être insuffisants. Nous avons mené une étude dans laquelle un nouvel algorithme diagnostique, créé au CHU de Nantes, a été appliqué rétrospectivement chez les personnes âgées suspectes d'HTP pré-capillaire et comparé aux critères de Dana Point. Dans notre étude, nous avons pu mettre en évidence des caractéristiques cliniques, échographiques et hémodynamiques qui sont proches de l'ICFEP. Chez la personne âgée, dans certains cas, la dysfonction diastolique semble être au premier plan et de nouveaux critères doivent être utilisés.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Speckle tracking analysis allows sensitive detection of stress cardiomyopathy in severe aneurysmal subarachnoid hemorrhage patients

International audiencePURPOSE: Stress cardiomyopathy is a common life-threatening complication after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that left ventricular (LV) longitudinal strain alterations assessed with speckle tracking could identify early systolic function impairment. METHODS: This was an observational single-center prospective pilot controlled study conducted in a neuro-intensive care unit. Forty-six patients with severe SAH with a World Federation of Neurological Surgeons grade (WFNS) ≥III were included. Transthoracic echocardiography (TTE) was performed on day 1, day 3, and day 7 after the patient's admission. A cardiologist blinded to the patient's management analyzed the LV global longitudinal strain (GLS). The control group comprised normal subjects matched according to gender and age. RESULTS: On day 1 median (25th-75th percentile) GLS was clearly impaired in SAH patients compared to controls [-16.7 (-18.7/-13.7) % versus -20 (-22/-19) %, p \textless 0.0001], whereas LVEF was preserved [65 (59-70) %]. GLS was severely impaired in patients with a WFNS score of V versus III-IV [-15.6 (-16.9/-12.3) % versus -17.8 (-20.6/-15.8) %, p = 0.008]. Seventeen (37 %) patients had a severe GLS alteration (\textgreater-16 %). In these patients, GLS improved from day 1 [-12.4 (-14.8/-10.9) %] to last evaluation [-16.2 (-19/-14.6) %, p = 0.0007] in agreement with the natural evolution of stress cardiomyopathy. CONCLUSIONS: On the basis of LV GLS assessment, we demonstrated for the first time that myocardial alteration compatible with a stress cardiomyopathy is detectable in up to 37 % of patients with severe SAH while LVEF is preserved. GLS could be used for sensitive detection of stress cardiomyopathy. This is critical because cardiac impairment remains a major cause of morbidity and mortality after SA

Results of a Phase 1b study to confirm safety and tolerability of olesoxime in multiple sclerosis patients

International audienc

Results of a Phase 1b study to confirm safety and tolerability of olesoxime in multiple sclerosis patients

International audienc

Results of a Phase 1b study to confirm safety and tolerability of olesoxime in multiple sclerosis patients

International audienc

Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study

International audienceBackground: The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (&gt; 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods: Characteristics, management, and prognosis of critically ill old patients (&gt; 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. Results: The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO2/FiO2 ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27; p &lt; 0·001). Conclusion: Patients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission

Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study

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