Acute Pericarditis: Aetiologic Diagnosis and Practical Aspect of the Management.

Pericarditis is an uncommon pathology that represents 0.1% of patients hospitalized for chest pain with a wide etiological spectrum and whose cause is uncommonly highlighted. In order to determine the incidence of specific acute microbiological or autoimmune pericarditis and identify subsets of patients with a higher incidence of specific etiologies; and analyze the conformity of the management of acute pericarditis according to the recommendations, a retrospective inclusion of all patients admitted to our hospital from January 2010 to December 2018 with the diagnosis of acute pericarditis was conducted. Data concerning clinical, paraclinical and treatment items were collected. Ninety-nine patients were included. Specific etiologic exams were completely conducted in 63.6% of the patients. There was no link between the decision to conduct etiology exams and the age, gender, a history of acute pericarditis or relapse. There was a trend between an elevated CRP and the realization of the kit. There was a statistically significant link between the achievement of etiologic exams and the presence of severity criteria or the presence of a pericardial effusion. An etiology was found in 52.4%, more frequently microbiological (viral and Mycoplasma pneumoniae). Approximately 85.9% of all patients were hospitalized. Treatment was in accordance with the recommendations in 76.8%. Despite the percentage of microbiological etiologies found, it does not impact the therapeutic strategy. The criteria for hospitalization must be better suited since half of those hospitalized after the european society of cardiology (ESC) 2015 recommendations had no need to be. However, monitoring after discharge is not clearly defined by learned societies.

Setting up the Back Home Program for Heart Failure Patients: Perception by Health Professionals and Patients and Outcomes.

Heart failure is a challenge in reducing re-admissions and deaths, particularly high during the first month following hospitalization. In our study, the majority of health professionals seem to support educational programs. The rate of hospital re-admission was 50% and 21.6% for heart failure. Among the factors of re-admission, none corresponded to a therapeutic break or a diet gap. Thus, there was a trend toward shorter re-admissions. These results suggest that the therapeutic education sessions were successful.

Dynamic iron status after acute heart failure.

BACKGROUND: Iron deficiency (ID) is common in heart failure (HF), and is associated with unfavourable clinical outcomes. Although it is recommended to screen for ID in HF, there is no clear consensus on the optimal timing of its assessment. AIM: To analyse changes in iron status during a short-term follow-up in patients admitted for acute HF. METHODS: Iron status (serum ferritin concentration and transferrin saturation) was determined in 110 consecutive patients (median age: 81 years) admitted to a referral centre for acute HF, at three timepoints (admission, discharge and 1 month after discharge). ID was defined according to the guidelines. RESULTS: The prevalence rates of ID at admission, discharge and 1 month were, respectively, 75% (95% confidence interval [CI] 67-83%), 61% (95% CI: 52-70%), and 70% (95% CI: 61-79%) (P=0.008). Changes in prevalence were significant between admission and discharge (P=0.0018). Despite a similar ID prevalence at admission and 1 month (P=0.34), iron status changed in 25% of patients. Between admission and discharge, variation in C-reactive protein correlated significantly with that of ferritin (ρ=0.30; P=0.001). Advanced age, anaemia, low ferritin concentration and low creatinine clearance were associated with the persistence of ID from admission to 1 month. CONCLUSIONS: Iron status is dynamic in patients admitted for acute HF. Although ID was as frequent at admission as at 1 month after discharge, iron status varied in 25% of patients.

COMparison of Platelet reactivity following prAsugrel and ticagrelor loading dose in ST-Segment elevation myocardial infarctION patients: The COMPASSION study.

Prasugrel and ticagrelor are potent P2Y12-ADP receptor antagonists which are superior to clopidogrel in acute coronary syndromes. To date no clinical trial directly compared these two drugs. Platelet reactivity correlates with ischemic and bleeding events in patients undergoing percutaneous coronary intervention. Recent pharmacological studies have observed a delayed onset of action of these two drugs in ST-segment elevation myocardial infarction (STEMI). We provide the first adequately powered pharmacological study comparing PR following ticagrelor and prasugrel loading dose (LD) in STEMI patients when the maximal biological effect is reached. In the present study, ticagrelor was associated with a lower rate of high on-treatment PR compared to prasugrel.

Pulmonary vein isolation using a single size cryoballoon chosen according to transesophageal echocardiography information.

BACKGROUND: Pulmonary vein isolation (PVI) using cryoballoon (CB) catheter is a new technique for atrial fibrillation (AF) ablation. Previous studies used computer tomography (CT) or magnetic resonance imaging (MRI) scan to determine the pulmonary vein (PV) diameter and anatomy for choosing the CB size. We evaluated pre-ablation transoesophageal-echocardiography (TEE) as an alternative to CT/MRI scan in patients undergoing AF ablation for determining the appropriate size of the CB. METHODS: Fifty-five consecutive patients (men=43, women=12) with a mean age of 63 ± 12.5 years, and with drug-refractory paroxysmal AF (34 patients) or persistent AF (21 patients) were included in this prospective study. All patients underwent pre-ablation TEE. RESULTS: Hypertension was present in 19 patients (34%). Mean anterior-posterior left atrium diameter was 45.1 ± 8.9 mm. In total, 217 PV were targeted using a single 23-mm (n=14) or 28-mm (n=40) CB catheter chosen according to TEE-obtained measurements. PVI was achieved in 195 PV (90%). Mean number of CB applications per patient was 9.8 ± 2.1 (range 8-14). Mean procedure duration and fluoroscopy times were 131 ± 27 min (90-190 min) and 36 ± 12 min (22-66 min) respectively. Phrenic nerve palsy occurred in 3 patients (5.4%) and was transient (<1 month) in all of them. CONCLUSION: This study suggests that TEE is an easily available and effective tool to select the size of the CB for PVI according to evaluated PV diameters and anatomy.