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1.
J Cardiovasc Magn Reson ; 22(1): 48, 2020 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-32580786

RESUMEN

BACKGROUND: The left ventricular ejection fraction (LVEF) is the key selection criterion for an implanted cardioverter defibrillator (ICD) in primary prevention of sudden cardiac death. LVEF is usually assessed by two-dimensional echocardiography, but cardiovascular magnetic resonance (CMR) imaging is increasingly used. The aim of our study was to evaluate whether LVEF assessment using CMR imaging (CMR-LVEF) or two-dimensional echocardiography (2D echo-LVEF) may predict differently the occurrence of clinical outcomes. METHODS: In this retrospective study, we reviewed patients referred for primary prevention ICD implantation to Caen University Hospital from 2005 to 2014. We included 173 patients with either ischemic (n = 120) or dilated cardiomyopathy (n = 53) and who had undergone pre-ICD CMR imaging. The primary composite end point was the time to death from any cause or first appropriate device therapy. RESULTS: The mean CMR-LVEF was significantly lower than the mean 2D echo-LVEF (24% ± 6 vs 28% ± 6, respectively; p < 0.001). CMR-LVEF was a better independent predictive factor for the occurrence of the primary composite endpoint with a cut-off value of 22% (Hazard Ratio [HR] = 2.22; 95% CI [1.34-3.69]; p = 0.002) than 2D echo-LVEF with a cut-off value of 26% (HR = 1.61; 95% CI [0.99-2.61]; p = 0.056). Combination of the presence of scar with CMR-LVEF< 22% improved the predictive value for the occurrence of the primary outcome (HR = 2.58; 95% CI [1.54-4.30]; p < 0.001). The overall survival was higher among patients with CMR-LVEF≥22% than among patients with CMR-LVEF< 22% (p = 0.026), whereas 2D echo-LVEF was not associated with death. CONCLUSIONS: CMR-LVEF is better associated with clinical outcomes than 2D echo-LVEF in primary prevention using an ICD. Scar identification further improved the outcome prediction. The combination of CMR imaging and echocardiography should be encouraged in addition to other risk markers to better select patients.


Asunto(s)
Cardiomiopatías/terapia , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Ecocardiografía , Cardioversión Eléctrica/instrumentación , Imagen por Resonancia Cinemagnética , Prevención Primaria/instrumentación , Volumen Sistólico , Función Ventricular Izquierda , Anciano , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/mortalidad , Cardiomiopatías/fisiopatología , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/mortalidad , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
2.
Nutr Metab Cardiovasc Dis ; 30(1): 33-39, 2020 01 03.
Artículo en Inglés | MEDLINE | ID: mdl-31753791

RESUMEN

BACKGROUND AND AIMS: High-density lipoprotein (HDL) particles play atheroprotective roles by their ability to efflux cholesterol from foam cells and to protect low-density lipoproteins (LDLs) from oxidative damage in the arterial intima. We hypothesized that antioxidative properties of HDLs can be attenuated in the oxygen-rich prooxidative arterial environment, contributing to the development of atherosclerosis. To evaluate this hypothesis, we compared antioxidative activity of HDLs from arterial and venous plasmas. METHODS AND RESULTS: Arterial and venous blood samples were simultaneously obtained from 16 patients (age 68 ± 10 years; 75% males) presenting with ischemic or valvular heart disease. Major HDL subfractions and total HDLs were isolated by density gradient ultracentrifugation and their chemical composition and the capacity to protect LDLs from in vitro oxidation were evaluated. HDL-cholesterol, triglycerides and apolipoprotein (apo) B-100 levels were slightly but significantly reduced by -4 to -8% (p < 0.01) in the arterial vs. venous samples. Total mass of HDL subpopulations was similar and HDL subpopulations did not reveal marked compositional differences between the arterial and venous circulation. Potent antioxidative activity of the small, dense HDL3c subpopulation was significantly reduced in the particles of arterial origin vs. their counterparts from venous plasma (increase of +21% in the propagation rate of LDL oxidation, p < 0.05). Interestingly, antioxidative properties of venous HDLs were enhanced in statin-treated patients relative to untreated subjects. CONCLUSION: Antioxidative properties of small, dense HDLs from arterial plasma are attenuated as compared to the particles of venous origin, consistent with the development of atherosclerosis in the arterial wall.


Asunto(s)
Antioxidantes/análisis , Arterias , Aterosclerosis/sangre , Enfermedades de las Válvulas Cardíacas/sangre , Lipoproteínas HDL/sangre , Isquemia Miocárdica/sangre , Venas , Adulto , Anciano , Aterosclerosis/diagnóstico , Aterosclerosis/tratamiento farmacológico , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Oxidación-Reducción , Estrés Oxidativo
3.
Biomarkers ; 23(5): 407-413, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29465002

RESUMEN

PURPOSE: The diagnostic and prognostic significance of procalcitonin remains uncertain in HF patients. We reviewed and performed a meta-analysis of studies that measured PCT in HF patients, with or without infection. MATERIALS AND METHODS: We identified seven studies (9514 patients, 5810 with diagnoses of HF) eligible for our analysis, out of 247 examined. We estimated the serum PCT concentrations in patients with and without HF and/or infection and examined the mortality rates of patients with versus without elevated serum PCT concentrations. RESULTS: The mean age of the study samples ranged between 58 and 81 years, the men proportion between 47% and 66%, the follow-up duration between 22 and 180 days. The median PCT concentration in patients with HF and concomitant infections tended to be higher (0.26 ng/l [0.06, 0.46]) than in patients with HF alone (0.10 ng/l [0.08, 0.12]; p = 0.059). The mortality of patients suffering from HF and whose serum PCT concentrations were elevated was significantly higher than that of patients suffering from HF whose PCT concentrations were normal at 30 (2.66 [1.74, 4.05]), 90 (2.12 [1.59, 2.83]) and 180 days (2.06 [1.13, 3.78]). CONCLUSIONS: In patients with HF, an elevated serum PCT concentration predicted the short-term risk of death.


Asunto(s)
Calcitonina/sangre , Insuficiencia Cardíaca/diagnóstico , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Pronóstico , Precursores de Proteínas/sangre
5.
Drug Alcohol Rev ; 30(4): 434-7, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21426418

RESUMEN

Takotsubo cardiomyopathy is a reversible cardiomyopathy frequently precipitated by a sudden emotional or physical stress. The exact physiopathology is still debated and may involve catecholamine-induced myocardial stunning. Alcohol withdrawal is associated with an hyperadrenergic state and may be a period at risk of cardiac events. We report a 56-year-old man with Takotsubo cardiomyopathy triggered by alcohol withdrawal.


Asunto(s)
Síndrome de Abstinencia a Sustancias/complicaciones , Cardiomiopatía de Takotsubo/diagnóstico , Alcoholes/envenenamiento , Etanol/envenenamiento , Humanos , Masculino , Persona de Mediana Edad , Cardiomiopatía de Takotsubo/etiología
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