Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets results from a large international multicenter study

Background-Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study. Methods and Results-The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA<55 mm, those with LA â¥55 mm had lower 8-year overall survival (P<0.001). LA â¥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA â¥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA â¥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA â¥55 mm had no impact on postoperative outcome (P<0.20). Mitral surgery was associated with greater survival benefit in patients with LA â¥55 mm compared with LA <55 mm (P for interaction, 0.008). Conclusions-In MR caused by flail leaflets, LA diameter â¥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction. © 2011 American Heart Association, Inc

Intérêt de la mesure pré-opératoire du diamètre télésystolique et de la fraction d éjection du ventricule gauche pour prédire le risque de dysfonction ventriculaire gauche après plastie pour insuffisance mitrale par prolapsus

INTRODUCTION : Les recommandations actuelles préconisent un traitement chirurgical dans les IM sévères organiques symptomatiques ou associées à une dysfonction VG. Néanmoins, les patients présentant une indication opératoire de classe I encourent une morbidité élevée même en cas de succès chirurgical. Dans cette analyse rétrospective, nous avons étudié l association entre les mesures échographiques VG pré opératoires et la survenue d une dysfonction VG après plastie mitrale. METHODES ET RESULTATS : Nous avons inclus 303 patients ayant bénéficié d une plastie pour IM par prolapsus entre 1991 et 2009. Chaque patient a bénéficié d une échographie pré opératoire puis entre 9 et 12 mois après la chirurgie. Les évènements cardiaques (décès de cause cardiaque, hospitalisations pour insuffisance cardiaque) ont été recueillis durant un suivi moyen de 8.2 années. La FEVG est passée de 68+/-9% avant la chirurgie à 59+/-9% en post opératoire (pou=37mm sont les meilleures valeurs seuils pour prédire l apparition d une dysfonction VG post opératoire (FEVGou=64% et un DTSVGou=37mm (pou=37mm apporte une valeur pronostique incrémentale à notre modèle de régression multivarié (p=0.001). CONCLUSION : Des mesures échographiques simples permettent de prédire la survenue d une dysfonction VG après plastie dans le cadre d IM organique par prolapsus. Les patients avec une FEVG>ou=64% et un DTSVG=37mm were the best cut-off values for the prediction of postoperative LV dysfunction (EF =64% and LVESD =37mm, and 33% with EF=37mm (p for trend =37mm added incremental prognostic value to the multivariable regression model (p=0.001). Conclusion: Simple preoperative echocardiography measures allow accurate prediction of outcome after MVR in patients with MR due to leaflet prolapse. Patients with preoperative EF>=64% and LVES<37mm incur low risk of postoperative LV dysfunction.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Watermark-Driven Acoustic Echo Cancellation

International audienceThe performance of adaptive acoustic echo cancelers (AEC) is sensitive to the non-stationarity and correlation of speech signals. In this article, we explore a new approach based on an adaptive AEC driven by data hidden in speech, to enhance the AEC robustness. We propose a two-stage AEC, where the first stage is a classical NLMS-based AEC driven by the far-end speech. In the signal, we embed-in an extended conception of data hiding-an imperceptible white and stationary signal, i.e. a watermark. The goal of the second stage AEC is to identify the misalignment of the first stage. It is driven by the watermark solely, and takes advantage of its appropriate properties (stationary and white) to improve the robustness of the two-stage AEC to the non-stationarity and correlation of speech, and thus reduce the overall system misadjustment. We test two kinds of implementations: in the first implementation, referred to as A-WdAEC (Adaptive Watermark driven AEC), the watermark is a white stationary Gaussian noise. Driven by this signal, the second stage converges faster than the classical AEC and provides better performance in steady state. In the second implementation, referred to as MLS-WdAEC, the watermark is built from maximum length sequences (MLS). Thus, the second stage performs a block identification of the first stage misalignment, given by the circular correlation watermark/pre-processed version of the first stage residual echo. The advantage of this implementation lies in its robustness against noise and under-modeling. Simulation results show the relevance of the "watermark-driven AEC" approach, compared to the classical "error driven AEC"

Role of Serum Amyloid A as a Biomarker for Predicting the Severity and Prognosis of COVID-19

Objective. To detect biomarkers that can be used to predict COVID-19 severity to identify patients with high probability of disease progression and poor prognosis. Methods. Of the 102 patients with confirmed COVID-19 who were admitted to King Fahd General Hospital, Jeddah City, Saudi Arabia, from July 1, 2021 to August 5, 2021, 50 were included in this cross-sectional study to investigate the influence of serum amyloid A (SAA) on disease severity and survival outcomes of COVID-19 patients. Dynamic shifts in SAA, C-reactive protein (CRP), white blood cell (WBC), lymphocytes, neutrophils, biochemical markers, and disease progression were examined. At admission, and at three, five, and seven days after treatment, at least four data samples were collected from all patients, and they underwent clinical status assessments. Results. Critically ill patients showed higher SAA and CRP levels and WBC and neutrophil counts and significantly lower lymphocyte and eosinophil counts compared to the moderately/severely ill patients, especially with regard to disease progression. Similarly, nonsurvivors had higher SAA levels than survivors. The moderately/severely ill patients and the survivors had significantly higher dynamic changes in SAA compared to the critically ill patients and nonsurvivors, respectively, with differences clearly noticed on the fifth and seventh day of treatment. ROC curve analysis revealed that the combination of SAA and CRP was valuable in evaluating the disease progression and prognosis of COVID-19 patients at different time points; however, a combination of SAA and lymphocyte counts was more sensitive for disease severity prediction on admission. The most sensitive parameters for predicting survival on admission were the combination of SAA/WBC and SAA/neutrophil count. Conclusions. The study findings indicate that SAA can be used as a sensitive indicator to assess the degree of disease severity and survival outcomes of COVID-19 patients

Identification of novel pathogenic MSH2 mutation and new DNA repair genes variants: investigation of a Tunisian Lynch syndrome family with discordant twins

International audienceBackground: Lynch syndrome (LS) is a highly penetrant inherited cancer predisposition syndrome, characterized by autosomal dominant inheritance and germline mutations in DNA mismatch repair genes. Despite several genetic variations that have been identified in various populations, the penetrance is highly variable and the reasons for this have not been fully elucidated. This study investigates whether, besides pathogenic mutations, environment and low penetrance genetic risk factors may result in phenotype modification in a Tunisian LS family. Patients and methods: A Tunisian family with strong colorectal cancer (CRC) history that fulfill the Amsterdam I criteria for the diagnosis of Lynch syndrome was proposed for oncogenetic counseling. The index case was a man, diagnosed at the age of 33 years with CRC. He has a monozygotic twin diagnosed at the age of 35 years with crohn disease. Forty-seven years-old was the onset age of his paternal uncle withCRC. An immunohistochemical (IHC) labeling for the four proteins (MLH1, MSH2, MSH6 and PMS2) of the MisMatchRepair (MMR) system was performed for the index case. A targeted sequencing of MSH2, MLH1 and a panel of 85 DNA repair genes was performed for the index case and for his unaffected father. Results: The IHC results showed a loss of MSH2 but not MLH1, MSH6 and PMS2 proteins expression. Genomic DNA screening, by targeted DNA repair genes sequencing, revealed an MSH2 pathogenic mutation (c.1552C>T; p.Q518X), confirmed by Sanger sequencing. This mutation was suspected to be a causal mutation associated to the loss of MSH2 expression and it was found in first and second degree relatives. The index case has smoking and alcohol consumption habits. Moreover, he harbors extensive genetic variations in other DNA-repair genes not shared with his unaffected father. Conclusion: In our investigated Tunisian family, we confirmed the LS by IHC, molecular and in silico investigations. We identified a novel pathogenic mutation described for the first time in Tunisia. These results come enriching the previously reported pathogenic mutations in LS families. Our study brings new arguments to the interpretation of MMR expression pattern and highlights new risk modifiers genes eventually implicated in CRC. Twins discordance reported in this work underscore that disease penetrance could be influenced by both genetic background and environmental factors

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