Severity of Left Ventricular Dysfunction in Patients With Tachycardia-Induced Cardiomyopathy: Impacts on Remodeling After Atrial Flutter Ablation.

Tachycardia-induced cardiomyopathy is defined as a reversible left ventricular (LV) systolic dysfunction (SeD) resulting from a sustained fast heart rate. LV remodeling in patients with severe LV dysfunction at diagnosis remains poorly understood. In this retrospective cohort study, we described LV remodeling in 50 patients who underwent atrial flutter ablation. These patients were divided into severe LV SeD (LV ejection fraction [EF] ≤30%) and LV nonsevere SeD (LVEF 31% to 50%) at baseline. All continuous variables are expressed as median and interquartile range. LVEF was 18% (13 to 25) and 38% (34 to 41) in the SeD (n = 29) and LV nonsevere SeD (n = 21) groups, respectively. At baseline, patients with SeD had higher LV end-diastolic diameter (56 [54 to 59] vs 49 mm [47 to 52], p <0.01), LV end-systolic diameter (48 [43 to 51] vs 36 mm [34 to 41], p <0.01), LV end-diastolic volume (71 [64 to 85] vs 56 ml/m2 [46 to 68], p <0.01), LV end-systolic volume (56 [53 to 70] vs 36 ml/m2 [27 to 42], p <0.01), and lower tricuspid annular plane systolic excursion (12 [10 to 13] vs 16 mm [13 to 19], p <0.01). At last follow-up, LVEF was not statistically significantly different between groups. However, LV end-systolic diameter (36 [34 to 39] vs 32 mm [32 to 34], p = 0.01) and LV end-systolic volume (29 [26 to 35] vs 25 ml/m2 [20 to 29], p = 0.02) remained larger in the SeD group. Seven patients (14%), all from the SeD group, had a LVEF ≤35% 2 months after rhythm control, and reverse remodeling was observed up to 9 months. In conclusion, more than half of patients with tachycardia-induced cardiomyopathy and atrial flutter had LVEF ≤30% at baseline. LVEF recovery and LV remodeling were observed beyond 2 months, highlighting the importance of rhythm control and early guideline-directed medical therapy in these patients.

Updating normative cross-sectional values and secular trends in body mass, body height and body mass index among Québec children and adolescents.

OBJECTIVE: The main objective of this study was to examine secular trends in body mass, body height and body mass index (BMI) from measured rather than self-reported values between 1972 and 2017. METHODS: A total of 4500 students (males = 51%) were selected from a stratified sampling. The age range varied between 6.0 and 17.9 years. The sample came from 24 elementary schools and 12 high schools located in six urban cities from the province of Québec. All the tests selected were based on standardized procedures that are recognized as valid and reliable. Standardization and modeling of smoothed percentile curves for each variable for both sexes were produced. RESULTS: Regional variations between youth from the province of Québec and those from all other Canadian provinces confirm the relevance of using data specific to the target population. Comparisons with the 1972 and 1982 data show an important increase in body mass (~ 7 kg, i.e. 16.4%) and BMI (~ 1.4 kg·m-2, i.e. 19.9%) with minor change in body height (~ 1.8 cm, i.e. 3.9%). Youth from low-income backgrounds (p = 0.001) as well as those living in large urban cities (p = 0.002) see their probability of developing overweight or obesity greatly increase (low-income = 2.1 times; large urban cities = 1.3 times). However, overweight and obesity rates seem to have stabilized at around 21% since 2004. CONCLUSION: This study provides up-to-date data on factors that contribute to the prevalence of overweight and obesity in youth in urban settings of Québec, and will be instrumental in guiding public health strategies designed to optimize growth outcomes.

RéSUMé: OBJECTIF: L'objectif principal de cette étude était d'examiner les tendances séculaires de la masse corporelle, de la taille et de l'indice de masse corporelle (IMC) de 1972 à 2017 à partir de valeurs mesurées plutôt que de valeurs autodéclarées. MéTHODE: Un total de 4 500 étudiants (garçons = 51 %) ont été sélectionnés à partir d'un échantillon stratifié. La fourchette d'âge variait entre 6,0 et 17,9 ans. L'échantillon provenait de 24 écoles primaires et 12 écoles secondaires situées dans six villes de la province de Québec (Canada). Tous les tests sélectionnés reposaient sur des procédures standardisées, reconnues comme valides et fidèles. Une standardisation et une modélisation des courbes centiles lissées ont été produites pour chaque variable pour les deux sexes. RéSULTATS: Les variations régionales entre les jeunes du Québec et ceux du reste du Canada confirment la pertinence d'utiliser des données spécifiques à la population cible. Les comparaisons entre les données de 1972 et de 1982 montrent une augmentation importante de la masse corporelle et de l'IMC (p ≤ 0,05) sans changement important de la taille corporelle. Les jeunes issus de milieux à faibles revenus (p = 0,001) ainsi que ceux vivant dans les grandes villes (p = 0,002) voient leurs risques de développer un surpoids ou de l'obésité augmenter considérablement (faibles revenus = 2,1 fois; grandes villes urbaines = 1,3 fois). Toutefois, les taux de surpoids et d'obésité semblent s'être stabilisés autour de 21 % depuis 2004. CONCLUSION: Cette étude fournit des données à jour sur les facteurs qui contribuent à la prévalence de l'embonpoint et de l'obésité chez les jeunes des milieux urbains du Québec et contribuera à orienter les stratégies de santé publique afin d'optimiser le suivi sur la croissance physique des jeunes.

Left common carotid artery to left innominate vein arteriovenous fistula after transvenous laser lead extraction.

Transvenous lead extraction (TLE) is used for lead infection, lead debulking, venous recanalization and device upgrades. Lead extraction is performed using specialized tools including locking stylets, mechanical or rotating sheaths, femoral snares or laser sheaths. The most feared complications associated with lead extraction are bleeding, vascular tear, cardiac avulsion and tamponade. Despite technological progress, the incidence of major procedural complications including death remains slightly above 1%. This case depicts an asymptomatic left common carotid artery (LCCA) to left innominate vein arteriovenous fistula (AVF) after laser-assisted TLE successfully treated with an endovascular covered stent.

Secular trends of cardiorespiratory fitness in children and adolescents over a 35-year period: Chronicle of a predicted foretold.

Background: In the context of concerns regarding the cardiorespiratory fitness (CRF) of youth populations, the aims of this study were: (1) to update reference values for the VO2max for school-aged Canadians and (2) to document secular trends in CRF after a 35-year interval. Methods: Between September 2014 and April 2017, the CRF of 3725 students (53.2% boys; 6.0 to 17.9 yrs) was determined using the 20-m shuttle run test. The sample was collected in 36 different schools from six cities of Québec (Canada). Results: Median values of VO2max decreased with age in both sexes (p ≤ 0.05). By the age of 10, more than 20% of boys showed VO2max values below the recommended value (42 ml·kg-1·min-1). At the age of 17, that proportion reached 56.8%. A similar proportion of 12 yrs girls (20%) were under the recommended minimal value (37 ml·kg-1·min-1) and that value reached 69.9% at the age of 17. Compared to 1982, the VO2max at age 17 has declined by 18% for boys and 12% for girls. The situation is worse in terms of functional capacity (number of stages completed) with an overall decrease of more than 30%. Conclusion: This study demonstrates that, compared to data obtained using the same methodology 35 years ago, the CRF and functional capacity of children and adolescents has declined to levels that should raise concerns from a public health perspective. Thus, the development of strategies to promote a physically active lifestyle in youth is more relevant than ever.

Gold(I)-catalyzed domino cyclization for the synthesis of polyaromatic heterocycles.

Gold(I) complexes have emerged as powerful and useful catalysts for the formation of new C-C, C-O and C-N bonds. Taking advantage of the specificity of [IPrAuNCMe][SbF6] complexes to favor the 5-exo-dig cyclization over the 6-endo-dig pathway, we report a high yielding and efficient method to generate substituted polyaromatic heterocycles under remarkably mild reaction conditions.

Synthesis of fused carbocycles via a selective 6-endo dig gold(I)-catalyzed carbocyclization.

A gold-catalyzed synthesis of fused carbocycles via a regioselective 6-endo dig process is reported. The selectivity can be modulated by the steric and electronic properties of gold(I) complexes. The ligands can influence the pathway selectivity for the first bond formation rather than through a common intermediate generated after an initial bond formation. This gold(I)-catalyzed transformation provides access to synthetically useful carbocyclic motifs that are found in numerous diterpenoid natural products.

Synthesis of substituted indole from 2-aminobenzaldehyde through [1,2]-aryl shift.

A mild, efficient, and simple method for the synthesis of 3-ethoxycarbonylindoles has been developed. Addition of ethyl diazoacetate (EDA) to 2-aminobenzaldehydes cleanly affords the indole core. As opposed to other common approaches for the synthesis of indole, this method displays both excellent functional group tolerance and perfect regiochemical control. This allowed the synthesis of a variety of useful indole building blocks from 2-aminobenzaldehydes derived from readily available anthranilic acids.