Evaluation du scanner cardiaque multiphases dans l insuffisance mitrale (corrélations anatomiques et fonctionnelles avec l échocardiographie et étude d une approche optimisée de son interprétation)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Arrêt cardio-respiratoire en hémodialyse chronique : facteurs de risque, prévention et conduite à tenir en 2015

International audiencePatients undergoing hemodialysis have a 10 to 20 times higher risk of sudden cardiac arrest (SCA) than the general population. Sudden cardiac death is a rare event (approximately 1 event per 10,000 sessions) but has a very high mortality rate. Epidemiological data comes almost exclusively from North American studies; there is a great lack of European data on the subject. Ventricular arrhythmia is the main mechanism of sudden cardiac deaths in dialysis patients. These patients develop increased sensitivity mainly due to a high prevalence of severe ischemic heart disease and left ventricular hypertrophy and to a frequent trigger event: electrolytic and plasma volume shifts during dialysis sessions. Unfortunately, accurate predictive markers of SCA do not exist, however some primary prevention trials using beta-blockers or angiotensin II receptor blockers are encouraging, while the use of implantable cardioverter defibrillators in the population of chronic dialysis patients remains controversial. Identification of patients at risk, minimizing trigger events such as electrolytic shifts and improving team skills in the diagnosis and initial resuscitation with the latest recommendations from 2010 seem necessary to reduce incidence and improve survival in this high risk population. Organization of European studies would also allow a more accurate view of this reality in our dialysis units.Le patient en hémodialyse chronique a un risque d’arrêt cardio-respiratoire (ACR) 10 à 20 fois plus élevé que la population générale. Il s’agit d’un événement rare (environ 1 événement par 10 000 séances), mais le taux de mortalité reste très élevé. Les données épidémiologiques actuelles proviennent quasi exclusivement d’études nord-américaines et l’on manque de données issues de registres européens sur le sujet. Les troubles du rythme ventriculaires graves sont le mode de survenue majoritaire de l’ACR dans cette population de dialysés chroniques qui cumule, d’une part, un terrain de sensibilité accrue de par la forte prévalence de la cardiopathie ischémique et l’hypertrophie ventriculaire gauche principalement, et, d’autre part, un événement déclencheur fréquent : les variations électrolytiques et volémiques inhérentes aux séances de dialyse. Les marqueurs prédictifs de la survenue d’ACR sont encore imparfaitement définis. Des études de prévention primaire médicamenteuse utilisant les bêtabloquants ou les bloqueurs du système rénine-angiotensine-aldostérone sont encourageantes, tandis que l’utilisation des défibrillateurs automatisés implantables dans la population de dialysés chroniques reste controversée. L’identification des patients à risque, la minimisation des événements déclencheurs comme les variations électrolytiques, et l’amélioration de la formation des équipes au diagnostic et aux premières mesures de réanimation grâce aux dernières recommandations datant de 2010 semblent nécessaires afin de diminuer l’incidence et d’améliorer la survie dans cette population à fort risque. L’organisation d’études européennes permettrait par ailleurs d’avoir une vision plus précise de cette réalité dans nos centres

Iron deficiency in heart failure patients: the French CARENFER prospective study

International audienceAimsIron deficiency (ID) is reported as one of the main co-morbidities in patients with chronic heart failure (CHF), which then influences quality of life and prognosis. The CARENFER study aimed to assess the prevalence of ID in a large panel of heart failure (HF) patients at different stages of the disease.Methods and resultsThis prospective cross-sectional nationwide study was conducted in 48 medical units in France in 2019. Serum ferritin concentration and transferrin saturation (TSAT) index were determined in all eligible patients with a diagnosis of HF. ID diagnosis was based on the European Society of Cardiology (ESC) 2016 guidelines. Patients were classified as having either a decompensated HF or a CHF. Left ventricular ejection fraction (LVEF) was categorized as preserved (≥50%), mildly reduced (40–49%), or reduced (<40%). ID diagnosis was determined in 1661 patients, of whom 1475 could be classified as having a decompensated HF or a CHF. Patients' median age was 78 years. Decompensated HF represented 60.1% of cases. The overall prevalence of ID was 49.6% (47.1–52.1). In CHF and decompensated HF patients, respectively, ID prevalence was 39.0% (35.1–43.1) and 58.1% (54.7–61.4), P < 0.001; TSAT < 20% was respectively reported in 34.7% and 70.0% of patients (P < 0.001). Patients with preserved LVEF were more likely to have an ID (57.5%) compared with patients with mildly reduced (47.4%) or reduced LVEF (44.3%) (P < 0.001).ConclusionsIron deficiency was highly prevalent in patients with decompensated HF or CHF with preserved LVEF. ID prevalence defined by TSAT was higher than by the ESC criteria in decompensated HF patients, questioning the importance of ID definition to assess its prevalence

012: Use of invasive strategy in non-ST-elevation myocardial infarction is a major determinant of improved long-term survival. The FAST-MI registry

ObjectivesWe assessed the impact of invasive strategy (IS) versus a conservative strategy (CS) on in-hospital complications and three-year outcomes in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) from the FAST-MI registry.BackgroundResults from randomized trials comparing IS and CS in patients with NSTEMI are conflicting.MethodsOf the 3,670 patients in the FAST-MI registry, which included patients with acute myocardial infarction (within 48 hours) over a one-month period in France at the end of 2005, 1,645 presented with NSTEMI.ResultsOf the 1,645 patients analyzed, 80% had an IS. Patients in the IS group were younger (67±12 vs. 80±11 years), less often women (29% vs. 51%) and had a lower GRACE risk score (137±36 vs. 178±34) as compared with patient treated with CS. In-hospital mortality and blood transfusions were significantly more frequent in patients with CS as compared with IS (13.1 vs. 2.0%, 9.1 vs. 4.6%). Use of IS was associated with a significant reduction in 3-year mortality and cardiovascular death (17% vs. 60%, adjusted HR: 0.44; 95%CI: 0.35-0.55 and 8% vs. 36%, adjusted HR: 0.37; 95%CI: 0.27-0.50). After propensity score matching (181 patients per group), 3-year survival was significantly higher in patients treated with IS.ConclusionsIn a real-world setting of patients admitted with NSTEMI, the use of IS during the initial hospital stay is an independent predictor of improved 3-year survival, regardless of age

Outcome associated with prescription of cardiac rehabilitation according to predicted risk after acute myocardial infarction: Insights from the FAST-MI registries

International audienceCardiac rehabilitation is strongly recommended in patients after acute myocardial infarction