196 Non response after cardiac resynchronisation therapy is associated with a more severe cardiomyopathy

BackgroundCardiac resynchronisation therapy (CRT) has been shown to improve clinical status in heart failure patients. Some patients treated by CRT fail to respond to the treatment. Predisposing factors for non-response should be investigated to optimize patient selection.ObjectiveThe purpose of the study was to evaluate before device implantation and 3, 6 and 12 month after, echocardiographic and biological parameters with respect to CRT response.MethodsThirty two patients with heart failure (72% of men; age 66±10 years; 59% non-ischaemic cardiomyopathy; NYHA III–IV; left ventricular ejection fraction (LVEF) 22.7±6.7%; QRS width 146±26ms) were implanted with CRT device and followed during twelve month. Responders (R) were defined as patients with improvement of one or more NYHA functional class, with a significant improvement in quality of life and without episode nor hospitalization for heart failure during follow-up.Results34% of the patients constitute the non-responder group (NR). No difference between R and NR was observed in LVEF, QRS width, NYHA, cardiovascular risk factors nor drug medication. Non-ischaemic dilated cardiomyopathy was significantly more present in R (71% vs 27%; p=0.03). Before CRT, NR had more important left ventricular end-diatolic diameter, left ventricular end-systolic diameter and more elevated left pressions. Atrioventricular dyssynchrony was significantly more observed in R (66% vs 9%; p=0.006) so as intraventricular dyssynchrony (95% vs 27%; p=0.001).BNP is significantly more elevated in NR (602±385 vs 320±361; p=0.03) before CRT.After 3 and 6 month, a significant decrease in left ventricular end-diatolic and end-systolic diameters, LVEF and normalisation of left and right pressions occur in R. Likewise, BNP levels were lower in R.ConclusionsNR patients have before implantation a more severe cardiomyopathy. At follow-up, left ventricular remodelling could only be observed in R patients. These data suggest that cardiac CRT should not be proposed too late so that left ventricular remodelling could be expected

0357: Two-dimensional speckle-tracking imaging for the left atrial and ventricular function in patients undergoing atrial fibrillation ablation

IntroductionLeft atrium (LA) structural remodeling associated with atrial fibrillation (AF) contributes to recurrence after AF catheter ablation (CA). Characterizing LA function may be useful to identify patients with higher risk of recurrence and could guide ablation strategy in term of substrate modification. We aimed to identify predictors of recurrence and atrial remodeling by assessing LA and left ventricle (LV) deformation properties using two-dimensional speckle-tracking imaging before and after AF CA.Methods62 patients (age 54±10 years, 90% male) with AF (45 paroxysmal (PAF), 17 persistent (PsAF)) underwent an echocardiography before CA, 3 and 6 months after CA to assess LA strain (S total (S-tot), positive peak (S-pos), negative peak (S-neg)), LA strain rate (SR positive peak (SRs), early (SRe) and late negative peak (SRa)) and LV strain (LV longitudinal and radial S).ResultsPsAF patients baseline had significantly larger LA volumes (41±8 vs 32±10ml/m2), decreased S-tot (10±5 vs 20±6%; p<0.001), SR-LAs (0.6±0.2 vs 1±0.3s−1; p<0.001) and LV strain (−12±3 vs −16±3%; p<0.001) compared to PAF group. After 6 month follow-up, 69% of the patients remained in sinus rhythm. Baseline LA active emptying, reservoir function and LA S-tot (13.2±6.2 vs 20.1±7%, p<0.001), S-neg (−7.2±3.5 vs –10.6±3.3%, p<0.009), SR-s (0.71±0.3 vs 1.01±0.35 s−1, <0.004), SR-a (–0.89±0.56 vs −1.37±0.48 s−1, p<0.01) and LV strain (−13.5±4.8 vs −17.1±3.5%, p<0.003) were significantly decreased in patients with AF recurrence. At multivariate analysis, the unique independent predictor of sinus rhythm maintenance was LA S-tot (HR 0.819 (0.685–0.979), p=0.028). In the overall cohort, LA volumes decreased from baseline to 3 and 6 months but there was no significant change in LA S, LA SR nor LV strain. At multivariate analysis, the unique independent predictor of LA reverse remodeling after CA was the duration of AF history (HR 0.84 (0.73–0.96), p=0.013).ConclusionsAltered global LA and LV strain before CA is associated with AF recurrence. Echocardiographic LA function characterization before ablation procedures may be helpful to guide AF ablation strategy and drug management after CA

Impact of P2Y12 Inhibition by Clopidogrel on Cardiovascular Mortality in Unselected Patients Treated by Percutaneous Coronary Angioplasty A Prospective Registry

ObjectivesThe aim of this study was to determine whether low platelet response to the P2Y12 receptor antagonist clopidogrel as assessed by Vasodilator-stimulated phosphoprotein flow cytometry test (VASP- FCT) predicts cardiovascular events in a high-risk population undergoing percutaneous coronary intervention (PCI).BackgroundImpaired platelet responsiveness to clopidogrel is thought to be a determinant of cardiovascular events after PCI. The platelet VASP-FCT is a new assay specific to the P2Y12 adenosine diphosphate receptor-pathway. In this test, platelet activation is expressed as platelet reactivity index (PRI).MethodsFour-hundred sixty-one unselected patients undergoing urgent (n = 346) or planned (n = 115) PCI were prospectively enrolled. Patients were classified as low-response (LR) and response (R) to clopidogrel, depending on their PRI. Optimal PRI cutoff was determined by receiver-operator characteristic curve analysis to 61% (LR: PRI ≥61% and R: PRI <61%). Follow-up was obtained at a mean of 9 ± 2 months in 453 patients (98.3%).ResultsAt follow-up, total cardiac mortality rates and possible and total stent thrombosis were higher in LR patients. Multivariate analysis identified creatinine clearance (hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.93 to 0.98, p < 0.001), drug-eluting stent (HR: 5.73; 95% CI: 1.40 to 23.43, p = 0.015), C-reactive protein (HR: 1.01; 95% CI: 1.001 to 1.019, p = 0.024), and LR to clopidogrel (HR: 4.00; 95% CI: 1.08 to 14.80, p = 0.037) as independent predictors of cardiac death. The deleterious impact of LR to clopidogrel on cardiovascular death was significantly higher in patients implanted with drug-eluting stent.ConclusionsIn patients undergoing PCI, LR to clopidogrel assessed by VASP-FCT is an independent predictor of cardiovascular death at the PRI cutoff value of ≥61%. The LR clinical impact seems to be dependent on the type of stent implanted

Effects of ocean biology on the penetrative radiation in a coupled climate model

The influence of phytoplankton on the seasonal cycle and the mean global climate is investigated in a fully coupled climate model. The control experiment uses a fixed attenuation depth for shortwave radiation, while the attenuation depth in the experiment with biology is derived from phytoplankton concentrations simulated with a marine biogeochemical model coupled online to the ocean model. Some of the changes in the upper ocean are similar to the results from previous studies that did not use interactive atmospheres, for example, amplification of the seasonal cycle; warming in upwelling regions, such as the equatorial Pacific and the Arabian Sea; and reduction in sea ice cover in the high latitudes. In addition, positive feedbacks within the climate system cause a global shift of the seasonal cycle. The onset of spring is about 2 weeks earlier, which results in a more realistic representation of the seasons. Feedback mechanisms, such as increased wind stress and changes in the shortwave radiation, lead to significant warming in the midlatitudes in summer and to seasonal modifications of the overall warming in the equatorial Pacific. Temperature changes also occur over land where they are sometimes even larger than over the ocean. In the equatorial Pacific, the strength of interannual SST variability is reduced by about 10%–15% and phase locking to the annual cycle is improved. The ENSO spectral peak is broader than in the experiment without biology and the dominant ENSO period is increased to around 5 yr. Also the skewness of ENSO variability is slightly improved. All of these changes lead to the conclusion that the influence of marine biology on the radiative budget of the upper ocean should be considered in detailed simulations of the earth’s climate

Outcomes after TAVI in patients with atrial fibrillation and a history of recent PCI:Results from the ENVISAGE-TAVI AF trial

Background: Patients with atrial fibrillation (AF) and a recent (≤ 90 days) percutaneous coronary intervention (PCI) undergoing transcatheter aortic valve implantation (TAVI) are at high bleeding risk due to the addition of oral antiplatelet (OAP) agents on top of oral anticoagulants. Data on outcomes of these patients are needed to optimize antithrombotic treatment. Methods: This analysis compared annualized clinical event rates in patients with and without a recent PCI enrolled in ENVISAGE-TAVI AF, a prospective, randomized, open-label, adjudicator-masked trial comparing edoxaban and vitamin K antagonists in AF patients after TAVI. The primary efficacy and safety outcomes were net adverse clinical events (NACE) and major bleeding. Results: Overall, 132 (94.3%) patients with a recent PCI (n = 140) received OAP after TAVI, compared with 692 (55.9%) patients without a recent PCI (n = 1237). Among patients with a recent PCI on OAP agents, use of dual antiplatelet therapy decreased to 5.5%, and use of single antiplatelet therapy (SAPT) increased to 78.0% over 3 months post-randomization. Conversely, use of SAPT predominated at all time points in patients without a recent PCI history. There were no significant differences in the incidence of NACE or other outcomes assessed, except for major bleeding events, which were more frequent in patients with vs without a recent PCI history (hazard ratio [95% confidence interval]: 2.17 [1.27, 3.73]; P = 0.005). Conclusions: Patients with AF undergoing TAVI with a recent PCI have a similar risk of ischemic events and mortality, but an increased risk of major bleeding compared with patients without a recent PCI. Graphical abstract: [Figure not available: see fulltext.].</p

Impact of gender on left atrial low-voltage zones in patients with persistent atrial fibrillation: results of a voltage-guided ablation

BackgroundGender-related differences have been reported in atrial fibrotic remodeling and prognosis of atrial fibrillation (AF) patients after ablation. We assessed in persistent AF the regional distribution of left atrial (LA) bipolar voltage and the extent of low-voltage zones (LVZ) according to gender as well as the results of a voltage-guided substrate ablation.MethodsConsecutive patients who underwent a voltage-guided AF ablation were enrolled. LA endocardial voltage maps were obtained using a 3D electro-anatomical mapping system in sinus rhythm. LVZ was defined as &lt;0.5 mV.ResultsA total of 115 patients were enrolled (74 men, 41 women). The LA bipolar voltage amplitude was twice lower in the whole LA (p &lt; 0.01) and in each atrial region in women compared with men, whereas the LA indexed volume was similar. LVZ were found in 56.1% of women and 16.2% of men (p &lt; 0.01). LVZ were also more extensive in women (p = 0.01), especially in the anterior LA. Atrial voltage alteration occurred earlier in women than in men. In a multivariate analysis, the female sex (OR 12.99; 95% CI, 3.23–51.63, p = 0.0001) and LA indexed volume (OR 1.09; 95% CI, 1.04–1.16, p = 0.001) were predictive of LVZ. Atrial arrhythmia-free survival was similar in men and women 36 months after a single ablation procedure.ConclusionThe study reports a strong relationship between the female gender and atrial substrate remodeling. The female gender was significantly associated with higher incidence, earlier occurrence, and greater extent of LVZ compared with men. Despite the female-specific characteristics in atrial remodeling, LVZ-guided ablation may improve the AF ablation outcome in women

Valeur diagnostique et pronostique de l'élévation du taux plasmatique des D-Dimères dans les dissections aigües de l'aorte

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Variabilité intra-individuelle des activités opératoires et dépendance-indépendance à l'égard du champ

Ohlmann Théophile, Mendelsohn P. Variabilité intra-individuelle des activités opératoires et dépendance-indépendance à l'égard du champ. In: L'année psychologique. 1982 vol. 82, n°1. pp. 131-154

"No-reflow" et extension de la nécrose mesurés par IRM (impact sur la regression du segment ST au cours de l'infarctus du myocarde traité par angioplastie primaire)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF