Cardiac implantable electronic device dysfunctions in patients undergoing radiotherapy: A prospective cohort study.

BACKGROUND: Increasing numbers of patients with cardiac implantable electronic devices (CIEDs) are undergoing radiotherapy (RT) for cancer. The aim of the study was to prospectively evaluate the incidence, characteristics, and associated factors of CIED dysfunctions related to RT. METHODS: Between April 2013 and March 2020, all patients with a CIED who underwent ≥1 RT session were enrolled. Patients were monitored according to a systematic protocol, including device interrogation before the first and after each RT session. The primary endpoint was CIED dysfunction, defined as oversensing, total or partial deprogramming, and/or unrecoverable reset. RESULTS: We included a total of 92 CIED RT courses: 77 (83.7%) in patients with a pacemaker and 15 (16.3%) in those with an implantable cardioverter-defibrillator. Overall, 13 dysfunctions (14.1%) were observed during 92 courses (1509 sessions), giving an incidence of 0.9 per 100 sessions. These included nine deprogramming (three total resets to back-up pacing mode and six partial deprogramming that were all successfully reprogrammed), three transient oversensing, and one unrecoverable oversensing requiring CIED and leads replacement. There were no adverse clinical events related to device dysfunction. In multivariable analysis, neutron-producing irradiation (odds ratio [OR], 5.59; 95% confidence interval [CI], 1.09-28.65; p = .039) and cumulative tumor dose (OR, 1.05; 95% CI, 1.01-1.10; p = .007) remained significantly associated with CIED dysfunction. CONCLUSION: In this prospective study, transient or permanent subclinical CIED dysfunction occurred in 14.1% of RT courses. Our findings emphasize the importance of high-energy beams and neutron-producing irradiation in risk assessment.

[Évaluation de la qualité de vie et description des facteurs associés, chez les patients en insuffisance cardiaque chronique vivant dans un pays d'Afrique de l'Ouest à faible revenu]. / Assessment of quality of life and description of associate factors in patients living with chronic heart failure in a low-income country of West Africa.

OBJECTIVE: To assess the quality of life (QOL) and describe associated factors in patients with chronic heart failure (HF) living in a low-income population in West Africa. METHODS: This is was a cross-sectional study conducted from January 2017 to June 2018, in the department of cardiology of the University Teaching Hospital (CHU-Campus) in Lomé (Togo). Enrolled patients had stable chronic HF and have been hospitalized in the past 6 months; QOL was assessed using the Minnesota Living with Heart Failure questionnaire (MLHFQ). RESULTS: 171 patients were included (women = 40.9%, 33% unschooled, 75% without health insurance; 46.8% in NYHA class II). The prevalence of depression was 62%. The mean total score of MLHFQ was 37.2 ± 22.3. In univariate analysis, there was a positive correlation between the total score and the following factors: age (r= 0.33, p ˂0.0001), NYHA classes (r= 0.67, p ˂0.0001), number of rehospitalizations (r= 0.61, p ˂0.0001), number of comorbidities (r= 0.43, p ˂0.0001), and the depression score (r= 0.67, p ˂0.0001). After adjustments, positive correlation persisted with NYHA classes (p ˂0.0001), number of rehospitalizations (p= 0.02), and depression (p ˂0.0001). CONCLUSION: The QOL of HF patients was moderately impaired and was comparable to values reported among high-income populations. Factors associated with poor quality of life were advanced NYHA classes, number of rehospitalizations, and depression.

[Takotsubo cardiomyopathy]. / Cardiomyopathie de Takotsubo.

Takotsubo cardiomyopathy. Takotsubo cardiomyopathy, or transient apical ballooning syndrome of the left ventricle, affects women after menopause often after mental or physical stress. Mimicking clinical, electrocardiographic and biological features of an acute coronary syndrome, it requires admission to the intensive care unit and an immediate coronary angiography, which will show the absence of coronary occlusion or rupture of atheromatous plaque. Echocardiogram, left ventriculography if performed, and magnetic resonance imaging will confirm the left ventricular deformation and impairment of systolic function, and the absence of myocardial infarction. Evolution is usually towards recovery of ventricular deformation, and improvement of systolic function, but complications in the acute phase, and recurrences are possible. Treatment is not yet standardised and should include psychological care.

Cardiomyopathie de takotsubo. La cardiomyopathie de Takotsubo ou syndrome de ballonisation apicale transitoire du ventricule gauche touche préférentiellement les femmes après la ménopause, souvent après un stress mental ou physique. Simulant un tableau de syndrome coronaire aigu clinique, électrocardiographique et biologique, elle nécessite l'admission en unité de soins intensifs et la réalisation immédiate d'une coronarographie qui montre l'absence d'occlusion coronaire ou de rupture de plaque athéromateuse. L'échocardiogramme, la ventriculographie éventuelle et l'imagerie par résonance magnétique confirment la déformation et l'altération de la fonction systolique ventriculaire gauche et l'absence d'infarctus myocardique. L'évolution habituelle se fait vers une résolution de la dysmorphie ventriculaire, l'amélioration de la fonction systolique, mais des complications sont possibles à la phase aiguë ainsi que d'éventuelles récidives. Le traitement n'est pas codifié et doit comporter une prise en charge psychologique. K. Yayehd déclare des liens d'intérêts avec Clipa, Menarini, Sanofi et Servier. J.-L. Georges déclare des liens d'intérêts avec Amgen, AstraZeneca, Sanofi et Terumo.

Bilateral semilunar perihilar opacities in a patient with pulmonary hypertension.

Pulmonary arterial aneurysm is a rare entity with a high mortality if left untreated. Pulmonary arterial hypertension is an important cause of PAAs although other infective and auto-immune causes must be excluded when an aneurysm is identified.

Belhassen anterior fascicular ventricular tachycardia: a case in a black African.

Belhassen ventricular tachycardia can be characterized by a complete right branch block and a right axial deviation. This type, although rare, must be recognized to properly treat the patient, as verapamil treatment is effective.

Age-Related Differences in Reperfusion Therapy and Outcomes for ST-Segment Elevation Myocardial Infarction.

OBJECTIVES: To compare timely access to reperfusion therapy and outcomes according to age of older adults with ST-segment elevation myocardial infarction (STEM) managed within an integrated regional system of care. DESIGN: Ongoing, prospective, regional, hospital-based clinical registry. SETTING: Twenty-three public and private hospitals in the Northern Alps in France. PARTICIPANTS: Individuals presenting with STEMI evolving for less than 12 hours from symptom onset between January 2009 and December 2015 (N=4,813; 3,716 (77.2%) <75, 782 (16.2%) 75-84, 315 (6.5%) ≥85). MEASUREMENTS: Delivery of any reperfusion therapy (primary percutaneous coronary intervention (PCI), intravenous fibrinolysis), primary PCI, and timely reperfusion therapy and in-hospital outcomes. RESULTS: The percentages of patients receiving any reperfusion therapy were 92.9% for those younger than 75, 89.0% for those aged 75 to 84, and 78.7% for those aged 85 and older (P < .001). The percentages of patients undergoing primary PCI were 63.7%, 70.3%, 72.4% (P < .001); and the percentages of patients receiving timely delivery of reperfusion therapy were 44.6%, 36.8%, 29.9% (P < .001). In-hospital all-cause mortality was 3.4% for those younger than 75, 10.2% for those aged 75 to 84, and 19.8% for those aged 85 and older (P <.001). In multivariable analysis adjusting for baseline characteristics, timely delivery of reperfusion therapy was associated with lower in-hospital mortality (adjusted odds ratio=0.63, 95% confidence interval=0.46-0.85) with no significant heterogeneity between age groups (P-value for interaction = .45). CONCLUSION: Older adults meeting contemporary eligibility criteria for reperfusion therapy continue to receive delayed reperfusion therapy and experience higher mortality than their younger counterparts.

Management of Takotsubo cardiomyopathy in non-academic hospitals in France: The Observational French SyndromEs of TakoTsubo (OFSETT) study.

BACKGROUND: Takotsubo cardiomyopathy (TTC) is a rare condition characterized by a sudden temporary weakening of the heart. TTC can mimic acute myocardial infarction and is associated with a minimal release of myocardial biomarkers in the absence of obstructive coronary artery disease. AIMS: To provide an extensive description of patients admitted to hospital for TTC throughout France and to study the management and outcomes of these patients. METHODS: In 14 non-academic hospitals, we collected clinical, electrocardiographic, biological, psychological and therapeutic data in patients with a diagnosis of TTC according to the Mayo Clinic criteria. RESULTS: Of 117 patients, 91.5% were women, mean ± SD age was 71.4 ± 12.1 years and the prevalence of risk factors was high (hypertension: 57.9%, dyslipidaemia: 33.0%, diabetes: 11.5%, obesity: 11.5%). The most common initial symptoms were chest pain (80.5%) and dyspnoea (24.1%). A triggering psychological event was detected in 64.3% of patients. ST-segment elevation was found in 41.7% of patients and T-wave inversion in 71.6%. Anterior leads were most frequently associated with ST-segment elevation, whereas T-wave inversion was more commonly associated with lateral leads, and Q-waves with septal leads. The ratio of peak B-type natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) level to peak troponin level was 1.01. No deaths occurred during the hospital phase. After 1 year of follow-up, 3 of 109 (2.8%) patients with available data died, including one cardiovascular death. Rehospitalizations occurred in 17.4% of patients: 2.8% due to acute heart failure and 14.7% due to non-cardiovascular causes. There was no recurrence of TTC. CONCLUSIONS: This observational study of TTC included primarily women with atherosclerotic risk factors and mental stress. T-wave inversion was more common than ST-segment elevation. There were few adverse cardiovascular outcomes in these patients after 1-year follow-up.

Role of primary care physicians in treating patients with ST-segment elevation myocardial infarction located in remote areas (from the REseau Nord-Alpin des Urgences [RENAU], Network).

BACKGROUND: European guidelines for ST-segment elevation myocardial infarction (STEMI) encourage healthcare networks to increase rates of, and decrease delays to, reperfusion. We examined the impact of training primary care physicians (PCPs) to use equipment for pre-hospital management of STEMI patients in remote areas. METHODS AND RESULTS: A network for cardiac emergencies was set up in the French Northern Alps in 2002 and a registry of STEMI patients has been kept since. In 2005, 24 local volunteer PCPs were trained and equipped with electrocardiograms, fibrinolysis kits, and automated external defibrillators to deal with cardiac emergencies in remote areas (>30-minute ambulance travelling time). In this study, when the central call dispatcher received a telephone call from a patient in a remote area reporting chest pain with a high probability of STEMI, the dispatcher sent a mobile intensive care unit (MICU) with an emergency physician on board and asked the local PCP, if available, to manage the patient while awaiting arrival of the MICU. Patients in whom the diagnosis of STEMI was confirmed were taken by MICU to an interventional cardiology hospital. We report on patients who received care from a PCP before arrival of the MICU. Between 2005 and 2010, 4,015 patients were enrolled in the registry; 180 patients were located in a remote area, of whom 140 were in an area covered by a participating PCP. Of the 62 patients attended by a PCP before MICU arrival, 27 received thrombolysis and eight patients with ventricular tachycardia/fibrillation were shocked with an automated external defibrillator by the PCP. Mean times from telephone call to thrombolysis were shorter when the patient was attended by a PCP (45.0 ± 25.5 vs 62.4 ± 23.4 min without intervention; p = 0.003). STEMI diagnosis without contraindication to thrombolysis was confirmed in 26 of 27 patients treated as such by PCPs and 1 patient was diagnosed with a Tako-Tsubo syndrome. CONCLUSION: PCP care of STEMI patients located in isolated areas appears efficient, with high rates of resuscitation and thrombolysis and a shorter delay to reperfusion.

Detection of paroxysmal atrial fibrillation by prolonged electrocardiographic recording after ischaemic stroke in patients aged<60years: a study with 21-day recording using the SpiderFlash(®) monitor.

BACKGROUND: Many studies have suggested that longer duration of cardiac monitoring is suitable for the detection of occult paroxysmal atrial fibrillation (AF) after stroke; however, most studies involved patients aged≥65years - a population with a high stroke rate. AIMS: To assess the incidence of paroxysmal AF in unselected young patients presenting with stroke. METHODS: We included consecutive patients aged<60years with a stroke diagnosis on magnetic resonance imaging. Aetiological screening included clinical history and examination, and biological and cardiac tests. Patients were included if they had no history of AF and if a 24-hour electrocardiogram recording detected no AF or atrial flutter. Patients wore the SpiderFlash(®) monitor for 21days after discharge from hospital. The primary outcome was detection of paroxysmal AF episodes lasting>30seconds during monitoring. The secondary outcome was detection of paroxysmal AF episodes lasting<30seconds and any arrhythmia during monitoring. RESULTS: Among the 56 patients included (mean age 48±9years), 39 had cryptogenic stroke (CS) and 17 had stroke of known cause (SKC). Cardiac monitoring was achieved in 54 patients (37 CS, 17 SKC); one CS patient had a paroxysmal AF episode lasting>30seconds and one CS patient had a paroxysmal AF episode lasting<30seconds (versus no patients in the SKC group). Two CS patients and one SKC patient presented numerous premature atrial complexes. Non-sustained ventricular tachycardia was detected in one CS patient. CONCLUSION: This prospective observational study showed a low rate of paroxysmal AF among young patients presenting with stroke, on the basis of 21-day cardiac monitoring. This result highlights the need to identify patients who would benefit from such long monitoring.

Thrombotic and bleeding events after coronary stenting according to clopidogrel and aspirin platelet reactivity: VerifyNow French Registry (VERIFRENCHY).

BACKGROUND: Dual antiplatelet therapy, comprising aspirin and clopidogrel, is recommended in patients undergoing coronary stenting to avoid the occurrence of stent thrombosis and others ischaemic events. Interindividual response to clopidogrel varies, however, with poor response associated with an increased risk of ischaemic events. New assays are available for testing aspirin and clopidogrel response routinely at the bedside. AIM: To evaluate the prognostic value of testing antiplatelet response in an intermediate-risk population undergoing stent implantation. METHODS: We prospectively assessed clopidogrel and aspirin response using the VerifyNow assay at the time of coronary stenting in 1001 patients who presented with stable coronary disease or non-ST-segment elevation acute coronary syndrome. The main ischaemic endpoint was the composite of definite and probable stent thrombosis, cardiovascular death or spontaneous myocardial infarction at one year. The safety endpoint was major bleeding. RESULTS: Overall, 36.0% of patients had high on-clopidogrel platelet reactivity (OCR) and 8.6% had high on-aspirin platelet reactivity (OAR). The main ischaemic composite endpoint occurred in 3.9% of patients with high vs. 2.3% of patients with normal OCR (hazard ratio 1.66, 95% confidence interval 0.78-3.54; P=0.18). Definite or probable stent thrombosis occurred in 1.1% of patients with high vs. 0.3% of patients with normal OCR (P=0.86). There was no significant difference in ischaemic endpoints according to OAR and there was no difference in rates of major bleeding between patients with high versus normal on-treatment platelet reactivity. CONCLUSIONS: On-treatment platelet reactivity was not associated with 1-year ischaemic or bleeding events in an intermediate-risk population undergoing stent implantation.

Mortality associated with cardiovascular diseases in three hospitals of Lomé-city.

The aims of present study were; to determine the mortality rate related to cardiovascular diseases and the causes of those deaths in local hospitals. We conducted a cross sectional study carried out from January 2005 to June 2006, in three hospitals of Lomé. All deaths registered in the departments of cardiology and neurology from cardiovascular diseases were taken into account. The number of patients who died from cardiovascular diseases was 200 on 2386 admitted patients (11.86%). The average age was 54.4 ± 15.6 years (range: 18-102). Cerebrovascular stroke was the most represented disease (56.9%), followed by heart failure (35.7%), and cardiac arrhythmias (15.9%). Hospital mortality due to cardiovascular afflictions was high in Lome-city due to the deficient organization of the cardiovascular resuscitation units. Better organization, more equipment for cardiovascular care units and better public health efforts surrounding control of cardiovascular risk factors could go a long way towards the reduction of this high mortality rate of cardiovascular diseases in our hospitals.