[Coordinated management of arterial hypertension]. / Prise en charge coordonnée de l'hypertension artérielle entre le praticien et les spécialistes - Place de la dénervation rénale dans l'HTA résistante.

Despite major therapeutic progress and the numerous poly-pill combinations available on the market today, the control of arterial hypertension remains widely insufficient. A multidisciplinary management putting together internal medicine, nephrology and cardiology specialist offers the best chances for patients to achieve their blood pressure goals, especially when suffering from resistant hypertension despite adequate prescription of the reference tri therapy: ACEI/ARA2 combined with a thiazide-like diuretic and calcium channel blocker. Recent studies and randomized trials from the last five years shed a new light on the value of renal denervation and its efficacy on lowering blood pressure. This will probably lead to the integration of this technique in the next guidelines and improve its adoption over the next years.

Malgré les progrès thérapeutiques et les nombreuses combinaisons médicamenteuses de type « pilule combinée ¼ disponibles de nos jours, le contrôle de l'hypertension artérielle reste insuffisant. Une prise en charge multidisciplinaire reliant la médecine générale, la néphrologie et la cardiologie offre les meilleures chances aux patients de maîtriser leur hypertension artérielle, notamment en cas de résistance à la trithérapie de référence IECA/ARA2, inhibiteur calcique et diurétique de type thiazidique. Dans l'arsenal thérapeutique actuel, la dénervation rénale mérite à nouveau une attention particulière grâce aux avancées de la technique et aux résultats encourageants des études récentes, ouvrant le chemin à son intégration dans les prochaines recommandations internationales.

[Cardio-oncological risk stratification and follow up: a new challenge for the general practitioner]. / Prise en charge cardio-oncologique : un nouveau défi pour le praticien.

Rise of medical oncology, aging of populations and survival rates' improvement of patients suffering from cancer are all factors contributing to exponential rise of the exposure of patients to -cardiotoxic therapies. A multidisciplinary approach including a close cooperation between general practitioner and specialists will -promote an early identification and treatment of cardiovascular complications related to cancer treatments. This strategy has proven to have a truly positive impact on both cardiovascular and onco-logic prognosis. We will summarize throughout this article the last recommendations established by the European Society of Cardiology in terms of cardiovascular risk stratification and follow up planning through the use of clinical, biological and cardiac imaging data.

L'essor de l'oncologie médicale, le vieillissement des populations et l'amélioration de la survie des patients atteints de cancer sont autant de variables qui expliquent l'exposition grandissante à des thérapies anticancéreuses potentiellement cardiotoxiques. Une approche multidisciplinaire entre le médecin de première ligne et les différents spécialistes permettra de prévenir et de repérer ­précocement les complications cardiovasculaires liées aux traitements, avec un impact réel sur le pronostic oncologique et cardiovasculaire. Nous résumons dans cet article les dernières recommandations de la Société européenne de cardiologie en matière de stratification du risque cardiovasculaire à travers l'utilisation de données cliniques, biologiques et de l'imagerie cardiaque.

Corrigendum: Yield of the electrophysiological study in patients with new-onset left bundle branch block after transcathether aortic valve replacement: The PR interval matters.

[This corrects the article DOI: 10.3389/fcvm.2022.910693.].

Yield of the electrophysiological study in patients with new-onset left bundle branch block after transcathether aortic valve replacement: The PR interval matters.

Background: Studies suggest that performing an electrophysiological study (EPS) may be useful to identify patients with new-onset left bundle branch block (LBBB) post-TAVR at risk of atrioventricular block. However, tools to optimize the yield of such strategy are needed. We therefore aimed to investigate whether 12-lead ECG changes post-TAVR may help identify patients with abnormal EPS findings. Materials and methods: Consecutive patients with new-onset LBBB post-TAVR who underwent EPS were included. PR and QRS intervals were measured on 12-lead ECG pre-TAVR and during EPS. Abnormal EPS was defined as an HV interval > 55 ms. Results: Among 61 patients, 28 (46%) had an HV interval > 55 ms after TAVR. Post-TAVR PR interval and ΔPR (PR-post-pre-TAVR) were significantly longer in patients with prolonged HV (PR: 188 ± 38 vs. 228 ± 34 ms, p < 0.001, ΔPR: 10 ± 30 vs. 34 ± 23 ms, p = 0.001), while no difference was found in QRS duration. PR and ΔPR intervals both effectively discriminated patients with HV > 55 ms (AUC = 0.804 and 0.769, respectively; p < 0.001). A PR > 200 ms identified patients with abnormal EPS results with a sensitivity of 89% and a negative predictive value (NPV) of 88%. ΔPR ≥ 20 ms alone provided a somewhat lower sensitivity (64%) but combining both criteria (i.e., PR > 200 ms or ΔPR ≥ 20 ms) identified almost every patients with abnormal HV (sensitivity = 96%, NPV = 95%). Selecting EPS candidate based on both criteria would avoid 1/3 of exams. Conclusion: PR interval assessment may be useful to select patients with new-onset LBBB after TAVR who may benefit most from an EPS. In patients with PR ≤ 200 ms and ΔPR < 20 ms the likelihood of abnormal EPS is very low independently of QRS changes.

[The influence of summer temperatures on the incidence of Takotsubo cardiomyopathy : a retrospective study]. / Influence des canicules sur l'incidence du syndrome de Takotsubo : étude rétrospective en Valais.

Takotsubo cardiomyopathy (TK-CM) is a reversible acute left ventricular dysfunction that cannot be explained by an obstructive coronary lesion. The aim of our study was to explore the possible correlation between the incidence of TK-CM in summer and the average temperature, number of heat waves or number of days hotter than 30°C. 482 patients presented an acute coronary syndrome in the summers of 2012 until 2017 in our region. 15 patients met the inclusion and exclusion criteria and were diagnosed as TK-CM. The study analysis showed a statistically correlation between the number of heatwaves and the incidence of TK-CM (coefficient of correlation: 0.77; p = 0.04). This comforts the hypothesis of climatic influence on this pathology.

Le syndrome de Takotsubo (STK) est une dysfonction ventriculaire gauche aiguë, le plus souvent réversible, sans rapport avec une maladie coronarienne. L'objectif de notre étude était d'explorer le lien entre l'incidence de cette maladie en été et divers paramètres météorologiques; température moyenne, nombre de canicules et nombre de jours au-dessus de 30 °C. 482 patients ayant présenté un syndrome coronarien aigu entre les étés 2012 et 2017 ont été analysés dans notre région (Valais, Suisse). Après application des critères d'éligibilité et d'exclusion, 15 avec un STK avéré ont été inclus dans l'étude. Les résultats montrent que l'incidence de STK était statistiquement plus élevée pendant les canicules (coefficient de corrélation: 0,77; p = 0,04), ce qui conforte l'hypothèse de l'influence des températures extrêmes sur l'incidence saisonnière de cette pathologie.

Case report: Mechanical mitral prosthetic valve thrombosis in the context of COVID-19 despite effective anticoagulation.

BACKGROUND: The SARS-CoV2 virus has been an emerging virus since December 2019 and is the cause of a global pandemic whose clinical manifestations extend far beyond respiratory disease. CASE SUMMARY: A patient with severe coronavirus disease 2019 respiratory infection, carrying a mechanical mitral valve and under anticoagulation, was admitted to our cardiology department because of a new atrial fibrillation, which turned out to be related to thrombosis of the mitral mechanical valve. CONCLUSION: The pro-coagulant effect of the SARS-CoV2 virus does not spare patients at risk of thrombosis, even under effective anticoagulation. In patients with mechanical valves under vitamin K antagonist treatment, there is a high risk of thrombus formation. The treatment is based on thrombolysis by therapeutic anticoagulation, fibrinolysis, or surgery depending on the size, composition of thrombus, and clinical manifestation.

[Heart failure in year 2021: a review for the general practitioner]. / Insuffisance cardiaque en 2021 : un tour d'horizon pour le généraliste.

Heart failure has become a real public health problem impacting both the hospital system and the outpatient sector. In constant evolution, the therapeutic armamentarium has been enriched with new molecules, making treatment more effective. Optimal management of patients suffering from heart failure are multileveled and require a multidisciplinary team. The team consists of the in-charge general physician, a cardiologist, a trained nurse in therapeutic education, and optimally a dietician and/or physiotherapist. A limiting step towards the efficiency of patient management is the communication skills of the network.

À l'heure actuelle, l'insuffisance cardiaque est devenue un réel problème de santé publique qui impacte le système hospitalier comme le secteur ambulatoire. En constante évolution, le traitement médicamenteux s'est étoffé de nouvelles molécules, rendant la prise en charge plus efficace. Les défis pour une prise en charge optimale des patients souffrant d'insuffisance cardiaque sont multiples et requièrent une approche multidisciplinaire incluant bien évidemment le généraliste, le cardiologue mais aussi l'infirmière spécialisée en éducation thérapeutique, la diététicienne ou encore le physiothérapeute. L'augmentation du nombre d'intervenants nécessite une communication optimale et active entre les intervenants de l'hôpital et du cabinet.

[Heart and thromboembolic events: situation in 2021]. / Cœur et événements thromboemboliques : situation en 2021.

In daily practice, ischemia of embolic origin is frequent. The clinical spectrum can range from minor ischemia to stroke or myocardial infarction. This article summarizes the common etiologies of a cardioembolic event, such as atrial fibrillation or atrial flutter, presence of a patent foramen ovale or intracardiac masses (endocarditis, thrombi or tumors). This paper aims to serve as a short repository of information to guide every physician might need to initiate the diagnostic investigations and therapy according to recent recommendations.

Dans son quotidien, le praticien sera couramment confronté à une ischémie d'origine embolique. L'éventail clinique va d'une ischémie mineure à un AVC ou un infarctus du myocarde. Cet article résume les étiologies courantes d'un événement cardioembolique, notamment la fibrillation ou le flutter auriculaire, la présence d'un foramen ovale perméable ou de masses intracardiaques (végétations, thrombi, tumeurs). Il vise à guider le praticien dans sa prise en charge diagnostique et thérapeutique selon les recommandations cliniques récentes. Cette prise en charge est très souvent multidisciplinaire.

Case Report: Coronary-Pulmonary Fistula Closure by Percutaneous Approach: Learning From Mistakes.

Coronary-pulmonary artery fistulas (CPAF) are congenital vascular anomalies detected incidentally in most cases. When a significant left-right shunt exists, surgical, or percutaneous treatment is indicated. We describe a challenging case of CPAF closure, by percutaneous approach, in a patient symptomatic for dyspnea and evidence of a significant left-right shunt. A first attempt to close the fistula was performed implanting a vascular plug but it quickly embolized. The plug was successfully retrieved. In a second attempt, we deployed several coils before implanting the vascular plug with total closure of the fistula. The combination of plugs and coils is associated with a higher success rate of closure.

[Cardiology]. / Cardiologie.

In 2019, the guidelines on the new entity « chronic coronary syndrome ¼ have been published. They influence importantly the work-up and treatment of patients with stable coronary artery disease. We will also report on publications showing the benefit of percutaneous aortic valve implantation (TAVI) in patients with aortic stenosis and low risk surgical risk. With regard to infectious endocarditis, we elucidate the importance of the vegetation's size for predicting mortality and the prognostic value of the positron emission tomography in predicting septic embolism. We highlight the spectacular results of the DAPA-HF study in patients with heart failure and review publications showing the important role of the detection of myocardial fibrosis and scar by cardiac MRI for risk stratification of sudden cardiac death.

L'année 2019 a été marquée par la publication de recommandations sur une nouvelle entité, appelée « syndrome coronarien chronique ¼, qui modifient de manière importante la prise en charge et le traitement des patients avec une maladie coronarienne stable. On relève plusieurs publications démontrant, chez les patients ayant une sténose aortique, et étant à bas risque chirurgical, le bénéfice d'un traitement percutané par rapport à un traitement chirurgical. La prise en charge de l'endocardite a été challengée par deux publications montrant que la taille de la végétation est un facteur de risque de mortalité et la valeur pronostique de la tomographie par émission de positons dans la survenue d'emboles septiques. Nous discutons les résultats spectaculaires de l'étude DAPA-HF dans le domaine d'insuffisance cardiaque et plusieurs études montrant l'intérêt de la recherche de cicatrice myocardique à l'IRM cardiaque dans la stratification du risque de mort subite.

[Beta-blockers : myths and facts]. / Bêtabloquants: entre mythes et réalité.

Beta-blockers are very commonly drugs used in clinical practice, but whose mechanisms and clinical impacts are not always well understood, especially in certain specific clinical situations. This article proposes a review of some pharmacology notions over the different generations of ß-blockers, as well as a review of indications and side effects in particular clinical situations, such as COPD, portal hypertension with esophageal varices and erectile dysfunction. Finally, an overview of response variability of these treatments is discussed from a genetic point of view.

Les bêtabloquants sont des traitements médicamenteux couramment utilisés en pratique clinique mais dont les mécanismes et les impacts demeurent parfois méconnus, notamment dans certaines situations cliniques spécifiques. Cet article propose une revue de quelques notions pharmacologiques des différentes générations de bêtabloquants, ainsi que les indications et effets secondaires dans des situations cliniques particulières, comme la BPCO, l'hypertension portale avec varices œsophagiennes et la dysfonction érectile. Enfin, un survol de la variabilité de réponses à ces traitements est abordé notamment d'un point de vue génétique.

Total Endovascular Repair of Post-Trauma Ascending Aortic Pseudoaneurysm and Secondary Superior Vena Cava Syndrome.

BACKGROUND: Clavicular fracture or sternoclavicular luxation is observed in 10% of all polytrauma patients and is frequently associated with concomitant intrathoracic life-threatening injuries. Posterior sternoclavicular luxation is well known to induce underlying great vessels damage. The gold standard treatment usually is a combined orthopedic and cardiovascular surgical procedure associating vascular repair, clavicular open reduction, and internal fixation. METHODS: A 59-year-old wheelchair ridden, institutionalized woman, known for psychiatric disorder, severe scoliosis, malnutrition, and chronic obstructive pulmonary disease was admitted in our hospital for chronic chest pain 3 months after a stairway wheelchair downfall. A thoracic computed tomography (CT) scan revealed a voluminous ascending aortic pseudoaneurysm (63 × 58 mm, orifice 5 mm) consecutive to perforation following posterior sternoclavicular luxation. The patient refused all therapies and was lost to follow-up. Six months later, she was readmitted for a symptomatic superior vena cava syndrome. Thoracic CT scan revealed pseudoaneurysm growth with innominate vein thrombosis and superior vena cava subocclusion. Pseudoaneurysm orifice was stable. In the presence of symptoms with massive facial edema and inability to open her eyelids, the patient accepted an endovascular treatment. RESULTS: The procedure was performed under general anesthesia using both fluoroscopic and transesophageal echocardiographic guidance. Through a femoral arterial access, a 10-mm atrial septal defect occluder device was used to seal successfully the pseudoaneurysm orifice. The superior vena cava was then opened with a 26-mm nitinol high radial force stent through a femoral venous access. Postoperative course was uneventful. At 3-month follow-up, the patient remains symptom free and a CT scan confirmed pseudoaneurysm thrombosis and superior vena cava permeability. CONCLUSION: Post-traumatic sternoclavicular posterior luxation is a cause of great vessels and ascending aorta injuries. Minimally invasive endovascular approaches can be considered to treat vascular injuries and their consequences, especially in elderly patients and those at high risk for surgery.

Reduction of falls and fractures after permanent pacemaker implantation in elderly patients with sinus node dysfunction.

AIMS: Elderly patients with sinus node dysfunction (SND) are at increased risk of falls with possible injuries. However, the incidence of these adverse events and its reduction after permanent pacemaker (PPM) implantation are not known. METHODS AND RESULTS: Eighty-seven patients (mean [SD] age 75.4 [8.3] years, 51% women) with SND and an indication for cardiac pacing were included and were examined by a standardized interview targeting fall history. The incidence and total number of falls, falls with injury, falls requiring treatment, and falls resulting in a fracture were assessed for the time period of 12 months before (retrospectively) and after PPM implantation (prospectively). Furthermore, symptoms such as syncope, dizziness, and dyspnea were evaluated before and after PPM implantation. The implantation of a PPM was associated with a reduced proportion of patients experiencing at least one fall by 71% (from 53 to 15%, P < 0.001) and a reduction of the absolute number of falls by 90% (from 127 to 13, P < 0.001) during the 12 months before vs. after PPM implant. Falls with injury (28 vs. 10%, P = 0.005), falls requiring medical attention (31 vs. 8%, P < 0.001), and falls leading to fracture (8 vs. 0%, P = 0.013) were similarly reduced. Notably, fewer patients had syncope (4 vs. 45%, P < 0.001) and dizziness after PPM implantation (12 vs. 45%, P < 0.001). CONCLUSION: Falls, fall-related injuries, and fall-related fractures are frequent in SND patients. Permanent pacemaker implantation is associated with a significantly reduced risk of these adverse events, although no causal relationship could be established due to the study design.

[News about pericardial diseases in 2016]. / Maladies du péricarde : quoi de neuf en 2016 ?

The European Society of Cardiology published in 2015 the new Guidelines on the management of pericardial diseases. Based on experts' opinions and recent clinical studies of respectable size, the new guidelines thoroughly revisit the criteria for hospitalization and precisely define severe cases. Another highlight regards medication. From now, first-line medical therapy should include the association of colchicine to the traditional non steroidal anti-inflammatory drugs or aspirin. The bi-therapy is recommended as soon as the first episode of pericarditis, for duration of 3 months. The experts also recommend systematically performing a heart ultrasound for any form of pericardial disease and restricting physical activities especially if myocardial damage (perimyocarditis) is associated.

La Société européenne de cardiologie a publié de nouvelles recommandations en 2015 à propos des maladies du péricarde, apportant des précisions au niveau des thérapies avec notamment l'introduction en première ligne de la colchicine en association aux anti-inflammatoires non stéroïdiens (AINS) ou à l'aspirine, et ce dès le premier épisode de péricardite idiopathique. Les corticoïdes restent contre-indiqués en première ligne. Les experts préconisent en outre la réalisation systématique d'une échocardiographie cardiaque. Les critères d'hospitalisation sont précisés (fièvre, échec du traitement aux anti-inflammatoires non stéroïdiens) et il est rappelé la nécessité d'une restriction au niveau des activités sportives, en particulier lors d'une atteinte associée du myocarde.

Very long-term follow-up after percutaneous closure of patent foramen ovale.

AIMS: To evaluate the very long-term risk of recurrent thromboembolic events in patients treated by percutaneous PFO closure. METHODS AND RESULTS: Between 1998 and 2008, a total of 232 consecutive patients with PFO and a high suspicion of paradoxical embolism were treated by percutaneous closure. The following major events were observed during hospitalisation: implantation failure (one patient) and appearance of an acute left-sided device thrombus requiring surgery (one patient). The primary endpoint of the study was a recurrent embolic event beyond at least five years' follow-up. During a mean follow-up of 7.6±2.4 years, this event occurred in five patients, representing a 0.28% annual/patient risk. Other major complications during follow-up were the following: late thrombus formation on the device (two patients) and transient atrial fibrillation (15 patients). Three patients died during follow-up from cardiovascular causes considered not related to the index procedure. The PFO was judged closed on follow-up echocardiography in 92.3% of patients. CONCLUSIONS: Long-term follow-up following percutaneous PFO closure for presumed paradoxical embolism reveals very low recurrence rates. This observation should be put in perspective with recent published randomised trials comparing percutaneous closure and medical therapy.