Bénéfice de l’échographie doppler dans le dépistage des complications vasculaires du TAVI transfémoral

Introduction : Le dépistage systématique des complications péri procédurales à la fin du TAVI est une étape essentielle de la procédure. Elle est réalisée, en routine, par une artériographie de l’aorte et des membres inférieurs. L’échographie doppler du scarpa est l’examen de première intention dans le dépistage des complications vasculaires après un cathétérisme artériel fémoral avec l’avantage d’être non invasif, sans besoin d’injection de produit de contraste ni d’exposition à des rayonnements ionisants. Cependant son intérêt dans le dépistage systématique des complications vasculaires péri procédurales du TAVI transfémoral n’a jamais encore été étudié.Objectif : L’objectif est d’évaluer les performances diagnostiques et les paramètres de simplification de la procédure de l’échographie doppler du scarpa et de l’artériographie aortique et des membres inferieur en tant que test de dépistage des complications vasculaires péri procédurales à la fin du TAVI.Méthode : La population était composée de patients ayant bénéficiés d’un TAVI par voie transfémorale à l’hôpital de la Timone entre Février 2017 et Mai 2019. L’inclusion des patients du groupe échographie doppler était prospective à partir de cette population bénéficiant d’une échographie doppler du scarpa. L’inclusion des patients du groupe artériographie était rétrospective et appariée sur l’âge, le sexe et l’antécédent de pathologie vasculaire périphérique à partir de cette population bénéficiant d’un contrôle arteriographique de l’aorte et des membres inférieurs. Le critère de jugement principal était la performance diagnostique l’échographie doppler par rapport à la survenue des complications vasculaires péri procédurales. Le critère de jugement secondaire était l’impact sur les paramètres de simplification de la procédure TAVI de l’échographie doppler et de l’artériographie.Résultat : Au total, 202 patients ont été inclus dans l’étude avec 101 patients inclus prospectivement dans le groupe échographie doppler et 101 patients appariés inclus dans le groupe artériographie. Les performances diagnostiques pour l’échographie doppler étaient de Se: 89% (IC 95%: 0,50-0,99), Sp: 97% (IC 95%: 0,91-0,99), VPP: 80% (IC 95%: 0,44-0,96), VPN: 99% (IC 95%: 0,93-0,99) et pour l’artériographie de Se: 88% (IC 95%: 0,47-0,99), Sp: 100% (IC 95%: 0,95-1), VPP: 100% (IC 95%: 0,56-1), VPN: 99% (IC 95%: 0,93-1).L’échographie Doppler était associée à une simplification de la procédure. La durée de la procédure (92 ±25 mins vs 114 ±34 mins, p<0,001), la dose de radiation (322 ±162 kerma vs 369 ±162 kerma, p=0,03) et la quantité de produit de contraste (63 ±27 ml vs 79 ±32 ml, p<0,001) étaient significativement plus faibles dans le groupe échographie doppler. Conclusion : L’échographie doppler du scarpa systématique en tant que test de dépistage des complications vasculaires péri procédurale du TAVI transfémoral montre une excellente performance diagnostique tout en permettant une simplification et une optimisation de la procédure TAVI

Feasibility of Non-Invasive Coronary Artery Disease Screening with Coronary CT Angiography before Transcatheter Aortic Valve Implantation

International audienceCoronary artery disease (CAD) screening is usually performed before transcatheter aortic valve implantation (TAVI) by invasive coronary angiography (ICA). Computed coronary tomography angiography (CCTA) has shown good diagnostic performance for CAD screening in patients with a low probability of CAD and is systematically performed before TAVI. CCTA could be an efficient alternative to ICA for CAD screening before TAVI. We sought to investigate the diagnostic performance of CCTA in a population of unselected patients without known CAD who were candidates for TAVI. All consecutive patients referred to our center for TAVI without known CAD were enrolled. All patients underwent CCTA and ICA, which were considered the gold standard. A statistical analysis of the diagnostic performance per patient and per artery was performed. 307 consecutive patients were enrolled. CCTA was non-analyzable in 25 patients (8.9%). In the per-patient analysis, CCTA had a sensitivity of 89.6%, a specificity of 90.2%, a positive predictive value of 65.15%, and a negative predictive value of 97.7%. Only five patients were classified as false negatives on the CCTA. Despite some limitations of the study, CCTA seems reliable for CAD screening in patients without known CAD who are candidates for TAVI. By using CCTA, ICA could be avoided in patients with a CAD-RADS score ≤ 2, which represents 74.8% of patients

Cardiovascular outcomes in patients with cancer during a 5-year follow-up: Results from a French administrative database

International audienceBackground: Limited data are available regarding the optimal management and prognosis of patients with cancer who develop an acute myocardial infarction. Aim: The objective of this study was to analyse the characteristics and outcomes of patients according to cancer and myocardial infarction occurrence. Methods: Based on the French administrative hospital discharge database, the study collected information for all consecutive patients seen in French hospitals in 2013, excluding those with a history of myocardial infarction. The population was divided into two groups according to their history of cancer. We studied the following outcomes: all-cause and cardiovascular mortality; acute myocardial infarction; and ischaemic stroke. Data were collected after a 5-year follow-up. Results: Between 2013 and 2019, 3,381,472 patients were seen in French hospitals; among them, 3,323,757 had no history of myocardial infarction. Patients with a history of cancer (n = 497,593) had higher incidences of all-cause mortality (17.82%/year vs 3.79%/year), cardiovascular mortality (1.61%/year vs 1.17%/year), myocardial infarction (0.82%/year vs 0.61%/year) and ischaemic stroke (0.91%/yearvs 0.62%/year) compared with patients without cancer (n = 2,826,164). After performing an adjusted competing-risk analysis, the cumulative incidence of acute myocardial infarction, cardiovascular death and ischaemic stroke incidence was found to be lower in patients with a history of cancer, whereas death of non-cardiac origin was more prevalent in patients with a history of cancer. Conclusions: In this observational study, we have shown that patients with cancer have a higher incidence of all-cause mortality, cardiovascular mortality and myocardial infarction. However, multivariableanalysis showed a lower cumulative incidence of these events

Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry

International audienceBackground: Transcatheter aortic valve implantation (TAVI) is the preferred treatment for symptomatic severe aortic stenosis (AS) in a majority of patients across all surgical risks. Patients and methods: Paravalvular leak (PVL) and patient–prosthesis mismatch (PPM) are two frequent complications of TAVI. Therefore, based on the large France-TAVI registry, we planned to report the incidence of both complications following TAVI, evaluate their respective risk factors, and study their respective impacts on long-term clinical outcomes, including mortality. Results: We identified 47,494 patients in the database who underwent a TAVI in France between 1 January 2010 and 31 December 2019. Within this population, 17,742 patients had information regarding PPM status (5138 with moderate-to-severe PPM, 29.0%) and 20,878 had information regarding PVL (4056 with PVL ≥ 2, 19.4%). After adjustment, the risk factors for PVL ≥ 2 were a lower body mass index (BMI), a high baseline mean aortic gradient, a higher body surface area, a lower ejection fraction, a smaller diameter of TAVI, and a self-expandable TAVI device, while for moderate-to-severe PPM we identified a younger age, a lower BMI, a larger body surface area, a low aortic annulus area, a low ejection fraction, and a smaller diameter TAVI device (OR 0.85; 95% CI, 0.83–0.86) as predictors. At 6.5 years, PVL ≥ 2 was an independent predictor of mortality and was associated with higher mortality risk. PPM was not associated with increased risk of mortality. Conclusions: Our analysis from the France-TAVI registry showed that both moderate-to-severe PPM and PVL ≥ 2 continue to be frequently observed after the TAVI procedure. Different risk factors, mostly related to the patient’s anatomy and TAVI device selection, for both complications have been identified. Only PVL ≥ 2 was associated with higher mortality during follow-up