11 research outputs found
Coeur droit et volume de l'oreillette gauche dans le rétrécissement mitral (étude échographique de l'impact de la valvuloplastie mitrale percutanée)
Le rétrécissement mitral (RM) a des conséquences sur le remodelage de l oreillette gauche (OG) et sur la fonction ventriculaire droite (VD) en raison de l augmentation passive de la pression OG et des modifications secondaires de la vascularisation artériolaire pulmonaire. Peu de données sont disponibles sur la variation immédiate et à moyen terme du volume de l OG et des paramètres de fonction VD au décours d une valvuloplastie mitrale percutanée (VMP). L'objectif de notre étude était de déterminer l'évolution du volume de l OG, des paramètres de fonction systolique, diastolique et globale du ventricule droit immédiatement et un mois après VMP chez des patients ayant un RM et en rythme sinusal au moyen de paramètres échographiques combinant l échographie 2D-Doppler et le doppler tissulaire (DTI). Trente trois patients consécutifs (70% femmes, age 31 +- 8 ans, 19 à 45 ans) ayant un RM modéré à sévère et ayant bénéficié d une VMP avec succès dans un centre hospitalier universitaire situé à Pondichéry en Inde (JIPMER) ont été inclus de façon prospective. Ils ont bénéficié d un examen échographique avant VMP, 24h à 48h après VMP et un mois après. Le volume indexé de l OG calculé selon la méthode de l ellipse prolate a diminué significativement immédiatement après VMP et dans une moindre mesure au cours du premier mois lorsque le volume initial était >=55 ml/m . Cette baisse est corrélée à la diminution du gradient transmitral à un mois, à la valeur initiale et à la diminution immédiate du gradient artère pulmonaire (AP) VD en protodiastole. L analyse des paramètres de fonction VD a montré une amélioration du TAPSE et des vitesses du flux tricuspide et myocardiques à l anneau tricuspide en DTI lorsque la surface mitrale après VMP est >1.5 cm . Cette amélioration est directement corrélée à la baisse de la postcharge VD: diminution des gradients de pression OD-VD, AP-VD, résistances vasculaires pulmonaires et gradient moyen transmitral. A l inverse, il persiste une onde S abaissée, un temps de relaxation isovolumique allongé et un indice de Tei élevé. L ensemble de ces résultats permet de mieux analyser la plasticité de l OG et de la fonction VD en cas de diminution brutale de la post-charge.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF
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Left atrial spontaneous echocardiographic contrast independently predicts 5-year stroke/death in patients with non-valvular atrial fibrillation
BACKGROUND: Transthoracic echocardiography (TTE) and transesophageal
echocardiography (TEE) can be used to detect the presence of left atrial thrombus and left atrial spontaneous echocardiographic contrast (LASEC).
OBJECTIVES: We sought to evaluate the prognostic value of TTE and TEE in predicting stroke and all-cause death at 5-year follow-up in patients with non-valvular atrial fibrillation (NVAF).
METHODS: This study included patients hospitalized with electrocardiography-diagnosed NVAF in Saint Antoine University Hospital, Paris, between July 1998 and December 2011 who underwent TTE and TEE evaluation within 24 hours of admission. Cox proportionalhazards models were used to identify predictors of the composite outcome (stroke or all
cause death).
RESULTS: During 5 years of follow-up, stroke/death occurred in 185/903 patients (20.5%). By multivariable analysis, independent predictors of stroke/death were CHA2DS2-VASc score (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.25-1.47; p 20 cm2 (HR: 1.59; 95% CI: 1.08-2.35; p =0.018) moderate LASEC (HR: 1.72; 95% CI:
1.13-2.62; p =0.012) and severe LASEC (HR: 2.04; 95% CI: 1.16-3.58; p =0.013). Independent protective predictors were dyslipidemia (HR: 0.60; 95% CI: 0.43-0.83; p =0.002) and discharge prescription of antiarrhythmics (HR: 0.59; 95% CI: 0.40-0.87; p =0.008). Adding LASEC to the CHA2DS2-VASc score modestly improved predictive accuracy and risk classification, with a C index of 0.71 vs. 0.69 (p = 0.004).
CONCLUSIONS: Presence of moderate/severe LASEC is a strong and independent predictor of stroke/death at 5-year follow-up in patients with NVAF. The inclusion of LASEC in stroke risk scores could improve risk stratification
Corrélation entre la présence de contraste spontané dans l’oreillette gauche et le risque d’AVC ou de décès chez des patients en fibrillation atriale
International audienceBackground: Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) can be used to detect the presence of left atrial thrombus and left atrial spontaneous echocardiographic contrast (LASEC).Aim: To evaluate the prognostic value of TTE and TOE in predicting stroke and all-cause death at 5-year follow-up in patients with non-valvular atrial fibrillation (NVAF).Methods: This study included patients hospitalised with electrocardiography-diagnosed NVAF in Saint-Antoine University Hospital, Paris, between July 1998 and December 2011, who underwent TTE and TOE evaluation within 24hours of admission. Cox proportional-hazards models were used to identify predictors of the composite outcome (stroke or all-cause death).Results: During 5 years of follow-up, stroke/death occurred in 185/903 patients (20.5%). By multivariable analysis, independent predictors of stroke/death were CHA2DS2-VASc score (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.25-1.47; P20 cm2 (HR 1.59, 95% CI 1.08-2.35; P=0.018), moderate LASEC (HR 1.72, 95% CI 1.13-2.62; P=0.012) and severe LASEC (HR 2.04, 95% CI 1.16-3.58; P=0.013). Independent protective predictors were dyslipidaemia (HR 0.60, 95% CI 0.43-0.83; P=0.002) and discharge prescription of anti-arrhythmics (HR 0.59, 95% CI 0.40-0.87; P=0.008). Adding LASEC to the CHA2DS2-VASc score modestly improved predictive accuracy and risk classification, with a C index of 0.71 vs. 0.69 (P=0.004).Conclusions: In this retrospective monocentric study, the presence of moderate/severe LASEC was an independent predictor of stroke/death at 5-year follow-up in patients with NVAF. The inclusion of LASEC in stroke risk scores could modestly improve risk stratification.ContexteL’échocardiographie transthoracique (ETT) et transoesophagienne (ETO) peuvent être utilisées pour détecter la présence d’un thrombus et le contraste spontané dans l’oreillette gauche (CS OG).ObjectifLe but de l’étude est d’évaluer la valeur pronostique de l’ETT et de l’ETO, pour prédire la survenue d’un AVC et la mortalité toute cause à 5 ans de suivi, chez le patient en FA non valvulaire (FANV).MéthodesL’étude a inclus des patients hospitalisés pour FA non valvulaire (diagnostiqué par électrocardiogramme) au sein de l’hôpital universitaire Saint-Antoine, Paris, entre juillet 1998 et décembre 2011, et qui ont eu une ETT-ETO dans les 24 heures après l’admission. Un modèle de régression de Cox a été utilisé pour identifier les prédicteurs du critère composite: infarctus cérébral ou mortalité toute cause.RésultatsDurant les 5 années de suivi, l’infarctus cérébral/décès est survenu pour 185/903 patients (20,5%). En analyse multivariée, les facteurs prédicteurs indépendants d’infarctus cérébral/décès étaient le score CHA2DS2-VASc (hazard ratio [HR] 1,35, intervalle de confiance à 95% [IC 95%] 1,25–1,47; p 20 cm2 (HR 1,59, IC 95% IC 1,08–2,35; p = 0,018), un CS OG moyen (HR 1,72, IC 95% 1,13–2,62; p = 0,012) et un CS OG sévère (HR 2,04, IC 95% 1,16–3,58; p = 0,013). Les facteurs indépendants protecteurs étaient la dyslipidémie (HR 0,60, IC 95% 0,43–0,83; p = 0,002) et la prescription d’antiarythmiques à la sortie d’hospitalisation (HR 0,59, IC 95% 0,40–0,87; p = 0,008). L’ajout du CS OG au score CHA2DS2-VASc améliore modestement la précision et la classification du risque, avec un C index à 0,71 vs 0,69 (p = 0,004).ConclusionsLa présence d’un CS OG moyen/sévère est un prédicteur fort et indépendant d’infarctus cérébral/décès à 5 ans de suivi chez le patient en FA non valvulaire. L’inclusion du CS OG dans les scores de risque thromboembolique pourrait améliorer la stratification du risque
Fraction d’éjection ventriculaire gauche un marqueur de risqué additionnel dans la COVID-19
International audienc
263 Arterial hypertension profile is associated with both the severity of OSAS and metabolic syndrome
Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight
International audienceBackground: Atrial remodelling has been poorly investigated in atrial fibrillation (AF), and few studies have focused on biatrial remodelling.Aim: To evaluate right atrial (RA) and left atrial (LA) remodelling in AF using global atrial reservoir strain and three-dimensional (3D) atrial volumes, according to rhythm outcome at mid-term follow-up.Methods: Two-dimensional and 3D transthoracic echocardiography (TTE) were performed within 24hours after admission (M0) and at 6-month follow-up (M6) in patients admitted for AF. RA and LA variables were assessed: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF); atrial expansion index (3D RAEI, 3D LAEI); and global RA and LA reservoir strain.Results: Forty-eight consecutive patients were included prospectively. Three groups were identified depending on rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) in 25 (52.1%) patients; AF at M0 and AF at M6 (AF-AF) in 13 (27.1%) patients; and SR at M0 (spontaneous cardioversion before first TTE) and SR at M6 (SR-SR) in 10 (20.8%) patients. Between M0 and M6 in the AF-SR group, we found: significant decreases in Max 3D RA Voli (P=0.020), Min 3D RA Voli (P=0.0008), Max 3D LA Voli (P=0.001) and Min 3D LA Voli (P=0.0021); significant increases in 3D RAEF (P=0.037) and 3D RAEI (P=0.034); no significant differences in 3D LAEF and 3D LAEI; and significant increases in global RA and LA reservoir strain (both P<0.0001). There was no significant difference with regard to these variables in the AF-AF and SR-SR groups.Conclusion: 3D volume and strain analyses were useful in the evaluation of RA and LA reverse remodelling in successfully cardioverted patients with AF
HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome
International audienceBackground It is unclear whether HIV infection affects the long-term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV-uninfected (HIV-) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV- patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36-month follow-up. A total of 103 PLHIV and 195 HIV- patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow-up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- patients (17.8% and 15.1%, P=0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67-3.82 [P=0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32-30.21 [P=0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P=0.01) and had smaller total cholesterol decreases (-22.3 versus -35.0 mg/dL; P=0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00139958