Simulation : Le coeur numérique par Hervé Delingette et Miguel Fernandez. De l'ordinateur à la clinique, entretien avec Jérôme Garot, propos recueillis par Dominique Chouchan. Améliorer les performances des implants cardiaques par Alain Ripart

National audienceUn modèle numérique du coeur et des fonctions cardiaques, c'est presque pour demain. Médecins et informaticiens s'associent pour s'attaquer aux maladies cardiovasculaires, la première cause de mortalité dans le monde

Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction, Resuscitated Cardiac Arrest, and Cardiogenic Shock The Role of Primary Multivessel Revascularization

ObjectivesThis study sought to assess the impact of multivessel (MV) primary percutaneous coronary intervention (PCI) on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS) and resuscitated cardiac arrest (CA).BackgroundThe safety and efficacy of MV primary PCI in patients with STEMI and refractory CS is unknown.MethodsWe conducted a multicenter prospective observational study of consecutive STEMI patients presenting to 5 French centers. Patients were classified as having single-vessel (SVD) or multivessel (MVD) coronary disease, and underwent culprit-only or MV primary PCI. Baseline characteristics and 6-month survival were compared.ResultsAmong 11,530 STEMI patients, 266 had resuscitated CA and CS. Patients with SVD (36.5%) had increased 6-month survival compared to those with MVD (29.6% vs. 42.3%, p = 0.032). Baseline characteristics were similar in those with MVD undergoing culprit-only (60.9%) or MV (39.1%) primary PCI. However, 6-month survival was significantly greater in patients who underwent MV PCI (43.9% vs. 20.4%, p = 0.0017). This survival advantage was mediated by a reduction in the composite of recurrent CA and death due to shock (p = 0.024) in MV PCI patients. In those with MVD, culprit artery PCI success (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.41 to 0.96, p = 0.030) and MV primary PCI (HR: 0.57; 95% CI: 0.38 to 0.84, p = 0.005) were associated with increased 6-month survival.ConclusionsThe results of this study suggest that in STEMI patients with MVD presenting with CS and CA, MV primary PCI may improve clinical outcome. Randomized trials are required to verify these results

Device-Related Thrombus After Left Atrial Appendage Closure

Although left atrial appendage closure (LAAC) has proved non-inferior to oral anticoagulants in patients with AF, there has been recent concern about the occurrence of late complications, especially device-related thrombus (DRT), which was associated with increased risk of stroke. In this article, the incidence, risk factors and time course of DRT after LAAC are discussed, as well as the potential benefits of dedicated strategies in the management of DRT, which remain speculative, especially in patients with a contraindication to oral anticoagulants. In these patients, decision-making should be based on a multidisciplinary evaluation of the ischaemic/bleeding balance on an individual basis

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Mesure automatique de la fraction d'éjection et de la masse du ventricule gauche par une méthode de segmentation 4D d'images de ciné-IRM cardiaque

Nous proposons un nouvel outil entièrement automatique pour la segmentation en 4D du myocarde ventriculaire gauche à partir de coupes ciné-IRM du cœur en petit axe. Cet outil utilise une méthode de segmentation morphologique incluant une nouvelle approche de la ligne de partage des eaux : la ligne de partage des eaux topologique. L'analyse automatique est testée par rapport à la détection manuelle des contours, prise comme référence, en évaluant la masse et la fraction d'éjection ventriculaires gauches chez dix-huit patients consécutifs en post-infarctus. L'analyse statistique des résultats montre une excellente concordance des deux méthodes. Cette nouvelle approche automatisée, en 4D, est donc une méthode fiable pour estimer automatiquement les paramètres ventriculaires gauches, en post-infarctus. De plus, nous montrons que cet outil est également applicable à un petit animal, le lapin. Au delà de la finalité de mesure de l'objet segmenté, la segmentation est aussi un moyen d'accéder à la fusion d'images cardiaque et nous proposons une méthode de fusion entre deux modalités d'IRM cardiaque, le ciné-IRM et l'imagerie de rehaussement tardif, basée sur la segmentation.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Analyse quantifiée de la fonction ventriculaire gauche segmentaire par échocardiographie et imagerie par résonance magnétique (application à la détection de la viabilité myocardique)

Les travaux de recherche expérimentaux et cliniques menés au cours de cette thèse s'inscrivent dans une démarche visant à permettre le développement de méthodes quantitatives fines d'analyse de la fonction ventriculaire gauche segmentaire. L'utilisation de techniques échocardiographiques récentes (Doppler tissulaire) ou le développement de nouvelles techniques d'IRM (imagerie par harmonique de phase HARP, imagerie codant pour les déformations myocardiques SENC) ont permis une description fine et quantifiée des altérations mécaniques de la fonction ventriculaire après infarctus du myocarde, mais également des phénomènes mécaniques complexes impliqués lors du recrutement pharmacologique de myocytes viables. Le caractère objectif et automatisé de certaines de ces techniques devrait permettre leur utilisation plus large dans le domaine clinique, et ainsi une détection plus fiable de la viabilité myocardique après la survenue d'une ischémie myocardique aiguë.Experimental and clinical research studies presented in this work were aimed at the development of noninvasive quantitative imaging techniques for detailed clinical assessment of regional left ventricular function. The use of recent echocardiographic techniques such as tissue Doppler echocardiography, or the new and original development of magnetic resonance imaging techniques such as Harmonic Phase MRI (HARP) or strain-encoded MRI (SENC), have allowed detailed quantitative analysis of regional left ventricular mechanical alterations after myocardial infarction, but also detailed study of complex mechanical changes involved during functional recruitment of viable myocytes. Because they are less operator-dependent and mostly automated, these techniques might be widely used in the clinical arena and should allow more accurate detection of focal myocardial viability after acute myocardial ischemia.PARIS12-CRETEIL BU Multidisc. (940282102) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF