0218: Comparison of transvenous versus surgical implantation of left ventricular lead for cardiac resynchronization therapy

BackgroundApproximately 1% of the adult population have heart failure with reduced ejection fraction. Since the 1980s, therapeutic advances in this field have been significant, particularly through the development of cardiac resynchronization therapy (CRT). However, transvenous implantation of the left ventricular (LV) lead is unsuccessful in 5 - 15% of patients. For this group, surgical placement of LV lead is an alternative.ObjectiveCompare the effects of transvenous versus surgical implantation of the LV lead in CRT.MethodsWe included 100 consecutive patients who had received CRT in our centre between January 2008 and July 2012 in a retrospective observational study. Twelve patients who had failed transvenous implantation of LV lead had a surgical placement.ResultsPopulation characteristics were a mean age of 66±11 years, 16% female, New York Heart Association class 2.9±0.5, 45% ischemic cardiomyopathy, left ventricular ejection fraction (LVEF) 24±7%, QRS width 165±23ms. There were no major difference in preoperative variables between two groups except sex category (12.5% female in transvenous group versus 42% in surgical group, p=0.022). During a mean follow-up of 508±429 days, the improvements seen in all variables showed no difference between the groups. At six months, 77% of patients had improved at least one class of their dyspnea stage, LVEF improved significantly (24±7% versus 36±10% at six months).ConclusionsSurgical placement of LV lead offers similar benefits as compared with transvenous implantation

212: Death and cardiovascular events in patients with acute coronary syndrome and abdominal aortic aneurysm

BackgroundAbdominal aortic aneurysm (AAA) is associated with peripheral and coronary artery disease (CAD), however little is known about the prognosis of patients who experienced an acute coronary syndrome (ACS) and have an AAA. The aim of this study was to assess the prevalence of AAA in patients hospitalized for ACS and to evaluate it was associated with an increased cardio-vascular (CV) risk during follow up.MethodsBetween February 1, 2008 and March 30, 2009, patients admitted for ACS with significant (≥50% stenosis) coronary lesions underwent echography to check for presence of AAA. The AAA was defined as dilation of infrarenal aorta with maximum antero-posterior diameter ≥30mm. During a 2 years follow-up we recorded all causes death, CV death and non-fatals CV events. The combination of CV death and CV non-fatals events was defined as the primary endpoint.ResultsAmong 306 patients, 20 AAAs (6,6%) were diagnosed, of average (±sd) diameter 33±3.7mm, with a maximum diameter of 45mm, non requiring surgery. Follow-up at 2 years was available for 292 patients (95,7%). During follow-up, 77 patients (25,5%) experienced an event (all causes death or non-fatals CV event) : 23 deaths (7,6%), of wich 16 were from CV cause, and 55 non-fatals CV event (18,2%). No event was due to AAA. In univariate analysis age, abdominal aortic diameter, diabetes mellitus, previously known CAD and AAA were significantly associated with fatal and non-fatal CV event (p<0,05). In multivariate analysis, age (OR=1.03; 95%CI (1.008,1.058), diabetes mellitus (OR=1.7; 95%CI (1.05,2.7) and AAA (OR=3.2; 95%CI (1.24,8.44) were independantly associated with the risk of fatal or non-fatal CV event. Age (OR=1.18 95%CI (1.10,1.26) and AAA (OR=4.17 95%CI (1.17,14.9) were the only independant predictors of all causes death.ConclusionOur results show that in patients with CAD, the presence of small non surgical AAA is associated with worse CV prognosis and higher all causes mortality at 2 years

Evaluation of sub-acute changes in cardiac function after cisplatin-based combination chemotherapy for testicular cancer

Long-term cardiovascular morbidity is increasingly observed in chemotherapy-treated testicular cancer survivors, but little is known of early sub-clinical changes in cardiac function. We prospectively evaluated cardiac function in testicular cancer patients by echocardiography. Systolic (Wall Motion Score Index) and diastolic (E/A-ratio and Tissue Velocity Imaging (TVI)) parameters, and serum levels of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) were assessed before the start of chemotherapy and 1 year later. Echocardiography data were compared with an age-matched group of healthy controls. Forty-two patients treated with bleomycin, etoposide and cisplatin were evaluated (median age 27 years, range 18–50). Systolic function and E/A-ratio did not change, whereas the median TVI decreased (12.0 vs 10.0 cms−1; P=0.002). Median levels of NT-proBNP increased (5 vs 18 pmoll−1, P=0.034). Compared with controls, TVI before the start of chemotherapy was not significantly different. In conclusion, we found that at a median of 10 months after cisplatin-based treatment for testicular cancer, TVI decreased significantly, indicating a deterioration of diastolic cardiac function. Serum levels of NT-proBNP increased. The prognostic significance of these changes for future cardiovascular morbidity is not clear

Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation

La réeducation cardiaque après infarctus du myocarde revascularisé en pratique quotidienne au centre hospitalo-universitaire de Reims en 2007

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude de la fonction myocardique ventriculaire gauche par Doppler tissulaire en pré et post-opératoire chez les patients porteurs d'une valvulopathie unique chirurgicale

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

L'infarctus du myocarde du sujet de moins de 37 ans : étude rétrospective et suivi à propos de 52 cas au CHU de Reims

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

2D-strain ventriculaire gauche segmentaire à la phase aiguë de l'infarctus du myocarde : intérêt dans la prédiction de la reperfusion et de la viabilité a 7 jours

REIMS-BU Santé (514542104) / SudocSudocFranceF

Safe cooking optimisation by F-value computation in a semi-automatic oven

Cooking represents an important step in food processing for both sensorial and safety aspects. Aim of this study was to optimise the cooking cycles of a semi-automatic oven by de&#64257;nition and settling of minimum thermal conditions to guarantee safety while keeping sensorial quality of cooked foods. To this purpose, the heat penetration curves and the correspondent thermal lethality effect (FT) of cooking cycles conventionally adopted to prepare some foods and dishes characterised by different microbial risk (high: lasagne pie, meat minced roll, meat &#64257;lled peppers; standard: spinach and salmon), were determined. On the basis of the microbial quality and the desired safety level, minimum thermal conditions (F71.1 = 5 min and T = 75 \ub0C at the slowest heating point of the food) were de&#64257;ned and settled in the electronics of the oven. These conditions were found to determine a sufficient number of log reduction of both total microbial count and coliforms able to guarantee safety as well as sensory quality at consumption. The oven with modi&#64257;ed electronics during the heating step of cooking cycles records in real time the temperature in the product by a multipoint thermocouple, detects the slowest heat penetration curve and computes, by an internal computer the correspondent F71.1. After initial setting of the food category, this semi-automatic oven is able to &#64257;nd automatically the proper process conditions during cooking to obtain the correspondent FT, to let the cooking stop at the end of the recipe or to conduct the thermal treatment till the reaching of the set FT according to the risk cat- egory chosen before cooking start

Safe cooking optimisation by F-value computation in a semi-automatic oven

5Cooking represents an important step in food processing for both sensorial and safety aspects. Aim of this study was to optimise the cooking cycles of a semi-automatic oven by definition and settling of minimum thermal conditions to guarantee safety while keeping sensorial quality of cooked foods. To this purpose, the heat penetration curves and the correspondent thermal lethality effect (FT) of cooking cycles conventionally adopted to prepare some foods and dishes characterised by different microbial risk (high: lasagne pie, meat minced roll, meat filled peppers; standard: spinach and salmon), were determined. On the basis of the microbial quality and the desired safety level, minimum thermal conditions (F71.1 = 5 min and T = 75 C at the slowest heating point of the food) were defined and settled in the electronics of the oven. These conditions were found to determine a sufficient number of log reduction of both total microbial count and coliforms able to guarantee safety as well as sensory quality at consumption. The oven with modified electronics during the heating step of cooking cycles records in real time the temperature in the product by a multipoint thermocouple, detects the slowest heat penetration curve and computes, by an internal computer the correspondent F71.1. After initial setting of the food category, this semi-automatic oven is able to find automatically the proper process conditions during cooking to obtain the correspondent FT, to let the cooking stop at the end of the recipe or to conduct the thermal treatment till the reaching of the set FT according to the risk category chosen before cooking start.nonenonePITTIA P; FURLANETTO R; MAIFRENI M; TASSAN MANGINA F; DALLA ROSA MPittia, P; Furlanetto, R; Maifreni, Michela; TASSAN MANGINA, F; DALLA ROSA, M