51 research outputs found
Extended Anticoagulation After Pulmonary Embolism:A Multicenter Observational Cohort Analysis
BACKGROUND: Pulmonary embolism (PE) has a longâterm risk of adverse events, which can be prevented by extended anticoagulation. We compared clinical characteristics and outcomes between patients treated with 2âyear extended anticoagulation and those who were not, in a population who had completed an initial phase of 3 to 6 months of anticoagulant therapy after acute PE. METHODS AND RESULTS: Observational cohort analysis of patients with PE who survived an initial phase of 3 to 6 months anticoagulation. Primary efficacy outcome was allâcause death or recurrent venous thromboembolism. Primary safety outcome was major bleeding. In total, 858 (71.5%) patients were treated with and 341 (28.5%) were treated without extended anticoagulant therapy during the active study period. Age <65 years, intermediateâhigh or highârisk index PE, normal platelet count, and the absence of concomitant antiplatelet treatment were independently associated with the prescription of extended anticoagulation. The mean duration of the active phase was 2.1±0.3 years. The adjusted rate of the primary efficacy outcome was 2.1% in the extended group and 7.7% in the nonextended group (P<0.001) for patients treated with extended anticoagulant therapy. Rate of bleeding were similar between the extended anticoagulant group and the nonextended group. CONCLUSIONS: Extended oral anticoagulation over 2 and a half years after index PE seems to provide a net clinical benefit compared with no anticoagulation in patients with PE selected to receive extended anticoagulation. Randomized clinical trials are warranted to explore the potential benefit of extended anticoagulation in patients with PE, especially those with transient provoking factors but residual risk
214: Interpreting troponin elevation in relation to symptom onset in intermediate-risk pulmonary embolism
BackgroundTroponin elevation in the setting of acute pulmonary embolism (PE) is of small magnitude and short duration and can go unnoticed in pts referred late after symptom onset.MethodsProspective, single-center registry of pts with confirmed intermediate-risk PE, defined as at least 1 echocardiographic finding of right ventricular (RV) dysfunction (endo-diastolic (EDRV)/left ventricular (EDLV) end-diastolic diameter ratio >=1 in the 4-chamber view, paradoxical septal systolic motion or pulmonary hypertension defined as RV/atrial gradient >30mmHg), or positive troponin test. Combined in-hospital endpoint was defined as death, non-fatal recurrent PE, or residual pulmonary vascular obstruction (RPVO) â„35%.Results282 pts were included, age 66±14 years, 59% women, 174 (62%) referred â€5 days after symptom onset, 108 (38%) after >5 days. Troponin elevation was observed in 126 (72%) treated within â€5 days, in 60 (56%) treated after >5 days (p=0.004). A significant interaction was observed between time since symptom onset and both troponin elevation and persistence of EDRV/EDLV diameter ratio>1 at 48h. The negative predictive value of troponin elevation was 85% in patients treated within 5 days of symptoms, but fell to 70% in those admitted >5 days after symptom onset (p=0.002). Positive troponin was an independent predictor of adverse outcome (OR=1.43 [1.08-5.56]). ROC curves show that prognostic value of positive troponin test was higher in pts referred â€5 days than in pts referred >5 days after symptom onset (p=0.01).ConclusionThere is a significant relation between troponin elevation and time since symptom onset in patients with intermediate-risk PE. Negative predictive value of troponin elevation is adequate in pts treated early (â€5 days) but is suboptimal in pts treated >5 days after symptom onset.TableResults<=5 days since symptom onset>5 days since symptom onsetpSensitivity72% (61.3-82.7)51% (42.4-59.6)0.005Specificity42% (44.5-49.5)47% (39.1-54.9)0.33PPV26% (18.4-33.6)30% (22.2-37.8)0.81NPV85% (78.4-91.6)70% (63-77)0.00
025 Benefit of Drug Eluting Stents over Bare Metal Stents after Rotational Atherectomy. A propensity score adjusted comparison in revascularization, mortality and MACE
RationaleRotational atherectomy makes possible to attempt small and calcified arteries while Drug Eluting Stents (DES) properties may reduce the restenosis process, rendering this combination attractive in selected cases. We compared 1year clinical outcome after rotational atherectomy following by either DES or Bare Metal Stents (BMS) implantation.MethodsSingle centre registry including all consecutive cases of rotational atherectomy use. Clinical follow-up was obtained in all patients. Propensity score for being treated with a DES was calculated using 18 clinical, angiographic and procedural variables. Comparison was adjusted on 4 strata of the propensity score.ResultsBetween 2002 and 2008, 223 patients were treated: 114 with BMS and 110 with DES. Most of the patients with BMS between 2002 and 2004 and later with DES. No significant difference was observed in clinical characteristics between groups: age 70 years, reference diameter 2.40±0.60mm, lesion length 10±9mm. Two cases of coronary perforation occurred, 7 lesion failure, and 12 transcient no-reflow. The use of GP2b3a inhibitors was similar in both groups, but, compared with BMS, patients in the DES group had longer duration of combination of aspirin and Clopidogrel. At one year, significantly lower rates of vessel revascularisation (2% vs 12%, p=0.005), of all cause mortality (5% vs 14%, p=0.05) and of MACE (10% vs 22%, p=0.02) were observed in the DES than in the BMS group. Adjustment on the strata of the propensity score did not change significantly these results (figure).ConclusionsDespite propensity score adjusted, this comparison has limitations. After rotational atherectomy we observed clear benefit for DES implantation over BMS on vessel revascularisation, mortality and MACE rates
Impact of post-procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation : a post hoc cohort analysis
International audienceBackground : Glycemic variability is associated with worse outcomes after cardiac surgery, but the prognosis value of early glycemic variability after transcatheter aortic valve implantation is not known. This study was therefore designed to analyze the prognosis significance of post-procedural glycemic variability within 30 days after transcatheter aortic valve implantation.Methods : A post hoc analysis of patients from our center included in the FRANCE and FRANCE-2 registries was conducted. Post-procedural glycemic variability was assessed by calculating the mean daily ÎŽ blood glucose during the first 2 days after transcatheter aortic valve implantation. Major complications within 30 days were death, stroke, myocardial infarction, acute heart failure, and life-threatening cardiac arrhythmias.Results : We analyzed 160 patients (age (median [interquartile]â=â84 [80â88] years; diabetes mellitus (n)â=â41 (26%) patients; logistic Euroscoreâ=â20 [12â32]). The median value of mean daily ÎŽ blood glucose was 4.3 mmol lâ1. The rate of major complications within 30 days after procedure among patients with the lowest quartile of glycemic variability was 12%, increasing from 12 to 26%, and 39% in the second, third, and fourth quartiles, respectively. In multivariate analysis, glycemic variability was independently associated with an increased risk of major complications within 30 days after the procedure (odds ratio [95% CI]â=â1.83 [1.19â2.83]; pâ=â0.006).Conclusions : This study showed that post-procedural glycemic variability was associated with an increased risk of major complications within 30 days after transcatheter aortic valve implantation
The SIB Swiss Institute of Bioinformatics' resources: focus on curated databases
The SIB Swiss Institute of Bioinformatics (www.isb-sib.ch) provides world-class bioinformatics databases, software tools, services and training to the international life science community in academia and industry. These solutions allow life scientists to turn the exponentially growing amount of data into knowledge. Here, we provide an overview of SIB's resources and competence areas, with a strong focus on curated databases and SIB's most popular and widely used resources. In particular, SIB's Bioinformatics resource portal ExPASy features over 150 resources, including UniProtKB/Swiss-Prot, ENZYME, PROSITE, neXtProt, STRING, UniCarbKB, SugarBindDB, SwissRegulon, EPD, arrayMap, Bgee, SWISS-MODEL Repository, OMA, OrthoDB and other databases, which are briefly described in this article
Utility of non-invasive imaging techniques in evaluating thé prognosis of cardiovascular disease
Pour ce travail de thĂšse, nous avons rĂ©alisĂ© cinq Ă©tudes originales en utilisant trois technologies d'imageries cardiovasculaires non-invasives.-Nous avons dĂ©montrĂ©, Ă partir d'une Ă©tude ex-vivo sur des artĂšres coronaires humaines, que le scanner64 dĂ©tecteurs ne permettait pas de caractĂ©riser prĂ©cisĂ©ment les diffĂ©rents composants des plaques. Ladistinction des plaques fibreuses et des plaques lipidiques est en effet impossible. Par ailleurs, notretravail a montrĂ© que l'IVUS ne devait pas servir d'imagerie de rĂ©fĂ©rence lors des Ă©tudes sur la plaque carcet examen prĂ©sente lui aussi de nombreuses imprĂ©cisions.-Notre travail sur la thrombo-aspiration rapporte un effet trĂšs significatif de l'extraction effective dethrombus lors des thrombo-aspirations Ă la phase aiguĂ« des STEMI, avec une rĂ©duction de la taille du no-reflow et de l'infarctus, Ă©valuĂ©es en IRM ; une thrombo-aspiration positive reprĂ©sentant par ailleurs dansnotre travail, un critĂšre indĂ©pendamment liĂ© Ă la taille finale de l'infarctus. L'extraction effective dethrombus pourrait ĂȘtre considĂ©rĂ©, en salle de cathĂ©tĂ©risme, comme un critĂšre de jugement de l'efficacitĂ©de la thrombo-aspiration.-Notre Ă©tude sur les syndomes coronaires Ă coronaires angiographiquement normales a confirmĂ© l'intĂ©rĂȘtde l'IRM dans le bilan Ă©tiologique de cette prĂ©sentation clinique, permettant un diagnostic Ă©tiologiquedans 2/3 des cas. Par ailleurs, nous avons observĂ© une excellente Ă©volution pour le tiers des patients chezqui l'IRM ne dĂ©cĂšle pas d'anomalie myocardique. Des Ă©tudes d'une plus grande envergure serontnĂ©cessaires afin de confirmer nos rĂ©sultats.-A partir d'IRM cardiaque rĂ©alisĂ©es chez des patients ayant prĂ©sentĂ© un premier Ă©pisode de STEMI, nousavons pu dĂ©terminer une valuer seuil de troponine prĂ©dictive de la survenue d'un no-reflow.-Enfin, Ă partir d'analyses en Speckle Tracking, nous avons mis en Ă©vidence une dysfonction systolique VD,objectivĂ©e par une altĂ©ration des valeurs de Strain longitudinal VD, chez les patients prĂ©sentant une EPgrave ou de gravitĂ© intermĂ©diaire, comparativement Ă un groupe de patients avec une EP non grave.In this doctoral thesis, we report on five original studies that use three diffĂ©rent non-invasive cardiovascular imaging techniques:- In an ex vivo study of human coronary arteries, we show that 64-slice computed tomography (CT) scan isnot capable of distinguishing between diffĂ©rent components of plaques. Indeed, it is impossible todifferentiate between fibrous and lipid plaques. Our study also showed that intravascular ultrasound(IVUS) should not be used as thĂ© rĂ©fĂ©rence method in studies of plaque composition, since this techniquealso suffers from numerous limitations.- Our study of thĂ© efficacy of thrombo-aspiration showed a significant benefit with effective extraction ofthrombus during thrombo-aspiration at thĂ© acute phase of ST Ă©lĂ©vation myocardial infarction (STEMI),notably with a rĂ©duction of thĂ© extent of no-reflow and of infarct size as evaluated by magnetic rĂ©sonanceimaging (MRI). Productive thrombo-aspiration was shown in our study to be an independent predictor offinal infarct size. Effective extraction of thrombotic material could be considered in thĂ© cathlab as acriterion for evaluating thĂ© success of thĂ© thrombo-aspiration procĂ©dure.- Our study of acute coronary syndromes with normal coronary arteries confirmed thĂ© utility of MRI inestablishing thĂ© etiology of this clinical prĂ©sentation, and made it possible to establish an etiologicaldiagnosis in two-thirds of patients. We also observed excellent outcomes in thĂ© third of patients in whomMRI did not find any myocardial anomalies. Larger studies are warranted to confirm thĂšse findings.- Based on cardiac MRI performed in patients presenting a first Ă©pisode of STEMI, we established athreshold value of troponin that predicts thĂ© occurrence of no-reflow.- Lastly, using speckle-tracking analysis, we demonstrated impaired systolic right ventricular function inpatients with intermediate to high risk pulmonary embolism (PE), evaluated by altĂ©rations in longitudinalstrain values at thĂ© level of thĂ© right ventricle, compared to a control group of patients with low risk PE
Est-ce que l'échographie endocoronaire est une méthode appropriée pour évaluer les performances du scanner multi-détecteurs dans la caractérisation des composants de la plaque coronaire ? (étude ex vivo avec comparaison histopathologique)
LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Apport des technologies d'imagerie non invasives dans l'Ă©valuation du pronostic des pathologies cardiovasculaires.
In this doctoral thesis, we report on five original studies that use three diffĂ©rent non-invasive cardiovascular imaging techniques:- In an ex vivo study of human coronary arteries, we show that 64-slice computed tomography (CT) scan isnot capable of distinguishing between diffĂ©rent components of plaques. Indeed, it is impossible todifferentiate between fibrous and lipid plaques. Our study also showed that intravascular ultrasound(IVUS) should not be used as thĂ© rĂ©fĂ©rence method in studies of plaque composition, since this techniquealso suffers from numerous limitations.- Our study of thĂ© efficacy of thrombo-aspiration showed a significant benefit with effective extraction ofthrombus during thrombo-aspiration at thĂ© acute phase of ST Ă©lĂ©vation myocardial infarction (STEMI),notably with a rĂ©duction of thĂ© extent of no-reflow and of infarct size as evaluated by magnetic rĂ©sonanceimaging (MRI). Productive thrombo-aspiration was shown in our study to be an independent predictor offinal infarct size. Effective extraction of thrombotic material could be considered in thĂ© cathlab as acriterion for evaluating thĂ© success of thĂ© thrombo-aspiration procĂ©dure.- Our study of acute coronary syndromes with normal coronary arteries confirmed thĂ© utility of MRI inestablishing thĂ© etiology of this clinical prĂ©sentation, and made it possible to establish an etiologicaldiagnosis in two-thirds of patients. We also observed excellent outcomes in thĂ© third of patients in whomMRI did not find any myocardial anomalies. Larger studies are warranted to confirm thĂšse findings.- Based on cardiac MRI performed in patients presenting a first Ă©pisode of STEMI, we established athreshold value of troponin that predicts thĂ© occurrence of no-reflow.- Lastly, using speckle-tracking analysis, we demonstrated impaired systolic right ventricular function inpatients with intermediate to high risk pulmonary embolism (PE), evaluated by altĂ©rations in longitudinalstrain values at thĂ© level of thĂ© right ventricle, compared to a control group of patients with low risk PE.Pour ce travail de thĂšse, nous avons rĂ©alisĂ© cinq Ă©tudes originales en utilisant trois technologies d'imageries cardiovasculaires non-invasives.-Nous avons dĂ©montrĂ©, Ă partir d'une Ă©tude ex-vivo sur des artĂšres coronaires humaines, que le scanner64 dĂ©tecteurs ne permettait pas de caractĂ©riser prĂ©cisĂ©ment les diffĂ©rents composants des plaques. Ladistinction des plaques fibreuses et des plaques lipidiques est en effet impossible. Par ailleurs, notretravail a montrĂ© que l'IVUS ne devait pas servir d'imagerie de rĂ©fĂ©rence lors des Ă©tudes sur la plaque carcet examen prĂ©sente lui aussi de nombreuses imprĂ©cisions.-Notre travail sur la thrombo-aspiration rapporte un effet trĂšs significatif de l'extraction effective dethrombus lors des thrombo-aspirations Ă la phase aiguĂ« des STEMI, avec une rĂ©duction de la taille du no-reflow et de l'infarctus, Ă©valuĂ©es en IRM ; une thrombo-aspiration positive reprĂ©sentant par ailleurs dansnotre travail, un critĂšre indĂ©pendamment liĂ© Ă la taille finale de l'infarctus. L'extraction effective dethrombus pourrait ĂȘtre considĂ©rĂ©, en salle de cathĂ©tĂ©risme, comme un critĂšre de jugement de l'efficacitĂ©de la thrombo-aspiration.-Notre Ă©tude sur les syndomes coronaires Ă coronaires angiographiquement normales a confirmĂ© l'intĂ©rĂȘtde l'IRM dans le bilan Ă©tiologique de cette prĂ©sentation clinique, permettant un diagnostic Ă©tiologiquedans 2/3 des cas. Par ailleurs, nous avons observĂ© une excellente Ă©volution pour le tiers des patients chezqui l'IRM ne dĂ©cĂšle pas d'anomalie myocardique. Des Ă©tudes d'une plus grande envergure serontnĂ©cessaires afin de confirmer nos rĂ©sultats.-A partir d'IRM cardiaque rĂ©alisĂ©es chez des patients ayant prĂ©sentĂ© un premier Ă©pisode de STEMI, nousavons pu dĂ©terminer une valuer seuil de troponine prĂ©dictive de la survenue d'un no-reflow.-Enfin, Ă partir d'analyses en Speckle Tracking, nous avons mis en Ă©vidence une dysfonction systolique VD,objectivĂ©e par une altĂ©ration des valeurs de Strain longitudinal VD, chez les patients prĂ©sentant une EPgrave ou de gravitĂ© intermĂ©diaire, comparativement Ă un groupe de patients avec une EP non grave
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