Infarctus et coronaropathie concomitante dans un contexte de cardiopathie dilatée : prévalence et caractérisation

Introduction: The phenotypic characteristics of bystander infarction and bystander coronary artery disease (CAD) in dilated cardiomyopathy were currently poorly known. Results : We have identified the consecutive patients with LVEF <50% who underwent CMR and coronary angiography (CA). Patients were classed in 6 groups according to Assomull et al.: 1 =true dilated cardiomyopathy, 2 =true ischemic cardiomyopathy, 3=dilated cardiomyopathy with bystander infarction, 4=dilated cardiomyopathy with bystander CAD, 5=ischemic cardiomyopathy with no CAD on CA but with ischemic-LGE on CMR and 6 =ischemic cardiomyopathy with no LGE on CMR and severe CAD. The severity of epicardial involvement was defined by Gensini score. 231 patients were included in the final cohort, 77% were male and the mean age was 60.1±14 years. Bystander infarction represented 13% of the population, with only 3 % of bystander CAD. There is a low correlation between Gensini score and fibrosis for all the population (rpearson = 0, 22 p= 0,001), without correlation between LVEF and fibrosis. Bystander infarction had a lower ischemic necrosis (p<0,01), a higher proportion of atrial fibrillation compared to group 2 (p<0,02) and a higher proportion of extensive trabecular on LV compared to the others (p<0,01). Conclusion: Dilated cardiomyopathy with bystander CAD is a rare pathology, while one with bystander infarct is more frequent, with characteristics suggesting that it should be regarded as true dilated cardiomyopathy with embolism mechanism for infarction. These statements, which need to be confirmed, could have therapeutic implications, including screening for atrial fibrillation in dilated cardiomyopathy.Introduction : L’atteinte coronarienne spectatrice dite bystander ainsi que l’infarctus bystander dans un contexte de cardiomyopathie dilatée (CMD) sont des entités mal connues et mal caractérisées. Résultats : Nous avons recensé les patients consécutifs avec une FEVG <50%, ayant bénéficiés d’une IRM myocardique et d’une coronarographie. Ils ont été classés en 6 groupes selon Assomull et al. : 1=CMD pure, 2=cardiopathie ischémique pure, 3=CMD avec infarctus bystander, 4=CMD avec coronaropathie bystander, 5=cardiopathie ischémique sans sténose serrée en coronarographie mais atteinte ischémique en IRM et 6=atteinte sévère coronarienne sans atteinte IRM. La sévérité de l’atteinte épicardique a été déterminée par le score de Gensini. 231 patients ont été inclus dans cette cohorte avec 77 % d’hommes et un âge moyen de 60.1±14 ans. Les CMD avec infarctus bystander représentaient 13 % des patients de cette cohorte alors que les CMD avec coronaropathie bystander 3%. Il existait une corrélation faible entre le score de Gensini et la fibrose myocardique (rpearson = 0,22 p= 0,001), sans corrélation entre la FEVG et la fibrose. Les infarctus bystander présentaient une étendue de nécroses ischémiques moins importante que le groupe 2 (p<0.01), une proportion accrue d’ACFA comparée au groupe 2 (p<0.01) et de trabéculations VG. Conclusion : La CMD avec coronaropathie bystander est une entité rare. L’infarctus bystander est une entité plus fréquente avec des caractéristiques évoquant un mécanisme embolique sur un terrain de CMD. Ces constatations qui demandent à être confirmées, pourraient avoir des implications thérapeutiques importantes dont le dépistage appuyé de la FA dans les CMD

Prognosis of Coronary Atherosclerotic Burden in Non-Ischemic Dilated Cardiomyopathies

Background: Atherosclerosis is associated with a worse prognosis in many diseases such as ischemic cardiomyopathy, but its impact in non-ischemic dilated cardiomyopathy (dCMP) is lesser known. Our aim was to study the prognostic impact of coronary atherosclerotic burden (CAB) in patients with dCMP. Methods: Consecutive patients with dCMP and left ventricular (LV) dysfunction diagnosed by concomitant analysis of invasive coronary angiography (ICA) and CMR imaging were identified from registry-database. CAB was measured by Gensini score. The primary composite endpoint was the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular (CV) mortality, non-fatal MI and unplanned myocardial revascularization. The results of 139 patients constituting the prospective study population (mean age 59.4 ± 14.7 years old, 74% male), average LV ejection fraction was 31.1 ± 11.02%, median Gensini score was 0 (0–3), and mid-wall late gadolinium enhancement (LGE) was the most frequent LGE pattern (42%). Over a median follow-up of 2.8 years, 9% of patients presented MACE. Patients with MACE had significantly higher CAB compared to those who were free of events (0 (0–3) vs. 3.75 (2–15), p &lt; 0.0001). CAB remained the significant predictor of MACE on multivariate logistic analysis (OR: 1.12, CI: 1.01–1.23, p = 0.02). Conclusion: High CAB may be a new prognostic factor in dCMP patients.</jats:p

Prognosis of Coronary Atherosclerotic Burden in Non-Ischemic Dilated Cardiomyopathies

International audienceBackground: Atherosclerosis is associated with a worse prognosis in many diseases such as ischemic cardiomyopathy, but its impact in non-ischemic dilated cardiomyopathy (dCMP) is lesser known. Our aim was to study the prognostic impact of coronary atherosclerotic burden (CAB) in patients with dCMP. Methods: Consecutive patients with dCMP and left ventricular (LV) dysfunction diagnosed by concomitant analysis of invasive coronary angiography (ICA) and CMR imaging were identified from registry-database. CAB was measured by Gensini score. The primary composite endpoint was the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular (CV) mortality, non-fatal MI and unplanned myocardial revascularization. The results of 139 patients constituting the prospective study population (mean age 59.4 ± 14.7 years old, 74% male), average LV ejection fraction was 31.1 ± 11.02%, median Gensini score was 0 (0–3), and mid-wall late gadolinium enhancement (LGE) was the most frequent LGE pattern (42%). Over a median follow-up of 2.8 years, 9% of patients presented MACE. Patients with MACE had significantly higher CAB compared to those who were free of events (0 (0–3) vs. 3.75 (2–15), p &lt; 0.0001). CAB remained the significant predictor of MACE on multivariate logistic analysis (OR: 1.12, CI: 1.01–1.23, p = 0.02). Conclusion: High CAB may be a new prognostic factor in dCMP patients

Impact of Tafamidis on survival in elderly patients: Insights from the Healthcare European Amyloidosis Registry

International audienceBackground: Cardiac transthyretin amyloidosis (ATTR-CM) is a life-threatening cardiomyopathy. Tafamidis has been demonstrated to be an effective treatment. Our aim was to analyze clinical characteristics and survival of patients with ATTR-CM aged ≥80 years diagnosed after November 2018, treated with tafamidis 80/61 mg, and compare them with a non-treated group diagnosed before that date.Methods: Data from the two groups were extracted from the Healthcare European Amyloidosis Registry (HEAR). Propensity score matching was used to adjust for baseline differences between the groups. Kaplan-Meier survival curves and Cox regression analyses were applied to assess survival outcomes.Results: Out of 1380 patients, 1194 were treated with tafamidis 80/61 mg. Treated patients were significantly less severe at baseline, with a lower occurrence of NYHA class III-IV compared to the untreated group (24 vs. 46 %, p &lt; 0.001). The median NT-proBNP at baseline was lower in the treated group (2330 vs. 4854 pg/ml, p &lt; 0.001), as was the average level of high-sensitivity troponin T (55 vs. 74 ng/ml, p &lt; 0.001), and the interventricular septal thickness (16 vs. 18 mm, p &lt; 0.001). The 3-year survival rate for treated patients was 57 %, and 40 % for untreated patients. In the treated group, the 3-year survival rate was 68 % for patients aged 80-85 years and 58 % for those over 85 years. Survival rates were confirmed after propensity score analyses.Conclusions: This study demonstrates that tafamidis provides significant survival benefits for elderly patients with ATTR-CM, even in those over 85 years old. The findings emphasize the importance of early diagnosis and treatment