[Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. / Évaluation de la mise en application des recommandations 2021 de la Société Européenne de Cardiologie pour l'insuffisance cardiaque à fraction d'éjection réduite chez les patients âgés de plus de 75 ans.

INTRODUCTION: Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS: This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS: A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION: Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.

[Republication of: Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. / Republication de : Évaluation de la mise en application des recommandations 2021 de la Société Européenne de Cardiologie pour l'insuffisance cardiaque à fraction d'éjection réduite chez les patients âgés de plus de 75 ans.

INTRODUCTION: Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS: This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS: A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION: Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.

[Symptomatic atrial fibrillation revealing chronic constrictive pericarditis in a young patient: A case report with a review of the literature]. / Fibrillation atriale symptomatique révélant une péricardite chronique constrictive chez un patient jeune : à propos d'un cas avec revue de la littérature.

Chronic Constrictive pericarditis (CCP) is a rare clinical entity that can pose diagnostic problems. Constrictive pericarditis is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs diastolic filling, reduces cardiac output, and ultimately leads to right heart failure and to atrial dilatation which can caused supravetricular arrythmia. Transthoracic echocardiography, computed tomography, and cardiac magnetic resonance imaging each can reveal severe diastolic dysfunction, increased pericardial thickness and calcifications. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. CCP is the commun cause of recurrent heart failure. At present, idiopathic or viral pericarditis is the predominant cause of CP in the Western world, followed by postcardiotomy irritation and mediastinal irradiation. Tuberculosis is still a cause of pericarditis in developing countries and in immunosuppressed patient. We present a patient with symptomatic atrial fibrillation revealing chronic constrictive pericardis. He underwent to drug cardioversion before radical pericardiectomy and to date has made a good recovery without palpitations with a sinus rythm. The diagnosis of CP is often neglected by physicians, who usually attribute the symptoms to another disease process. This case show the difficulty in diagnosing, illustrated as well as the role of multimodality imaging and the excellent outcome of pericardiectomy for total recovery.

[Factors associated with patient participation in early return to the home Heart Failure program : a case-control study at the Centre Hospitalier de Troyes in 2017-2018]. / Facteurs associés à l'inclusion des patients dans le programme PRADO - Insuffisance Cardiaque : étude cas-témoin au Centre Hospitalier de Troyes en 2017­2018.

OBJECTIVES: In 2013, the French National Health Insurance set up a programme to help patients with heart failure to return home and stay there (PRADO). During a hospitalization for cardiac decompensation, the medical team decides on the inclusion of the patient in the programme based on eligibility criteria defined. The objective of this study was to identify the factors most associated with the inclusion of heart failure patients in the PRADO program. MATERIALS AND METHODS: This was a monocentric retrospective analytical stratified case-control study. It focused on the analysis of patient records hospitalized for cardiac decompensation between 01/01/2017 and 31/12/2018 in the cardiology department of the Centre Hospitalier de Troyes. For each patient included in the PRADO Heart Failure programme, one or two controls, not included in the PRADO Heart Failure programme were matched. The matching was exact without discounting. It was performed on the following criteria: age in 10-year increments, sex, main diagnosis of the stay, major category of diagnosis of the stay and its type (medical or surgical), the severity score of the Homogeneous Group of Patients of the stay and the Charlson score. RESULTS: A total of 40 patients included in PRADO Heart Failure were matched to 56 controls not included in PRADO Heart Failure. Patients with respiratory disease (3.77 [1.07 - 13.29]), as well as patients on renin-angiotensin system inhibitors (2.24 [1.61 - 5.31]) were more often included in the PRADO Heart Failure programme. The most frequent criteria for non-eligibility were the need to transfer the patient to a specialised institution and significant impairment of higher functions. CONCLUSION: Respiratory comorbidity and renin-angiotensin system blocker treatment are the factors most associated with the inclusion of heart failure patients in the PRADO Heart Failure programme.

[Acute coronary syndrome and cannabis use: a retrospective cohort study]. / Syndrome coronarien aigu et consommation de cannabis ; étude monocentrique rétrospective au Centre Hospitalier de Troyes.

INTRODUCTION: Acute coronary syndrome (ACS) is the usual clinical entry point for coronary heart disease. France is the European country with the highest prevalence of cannabis use and an increase in serious cardiovascular complications, including infarction, related to cannabis. The main objective was to compare the clinical and cardiological profile of patients with ACS according to exposure to cannabis use. POPULATION AND METHODS: We conducted a retrospective, single-centre, exposure-non-exposure cohort study of all adult patients (> 18 years) admitted for ACS in the ICU between January 1, 2012 and December 31, 2021 at the Centre Hospitalier de Troyes, with mention of cannabis use in the medical record. A matching was performed so that each patient identified in the exposed group was associated with a comparable unexposed patient on age, sex, period of hospitalisation and cardiovascular event typology (type of ACS and topography for ST+). RESULTS: 2745 patients admitted to the ICU and the coronary angiography room presented an ST+ or ST- ACS from 01/01/2012 to 31/12/2021 at the CHT. For 31 patients of them (1.1%), we noted cannabis consumption, which concern 7,9% of SCA ST+ aged under 50. DISCUSSION: The link between cannabis use and ACS is established, but studies concerning the place of cannabis in the ACS pathway of an ICU are few in France. Our results show the interest of developing a specific pathway focused on the needs of patients and their specificities in post ACS management.

Mitral valve repair in idiopathic hypereosinophilic syndrome.

Idiopathic hypereosinophilic syndrome is a rare systemic disease than can cause multiple organ failure by eosinophilic infiltration. Cardiac involvement is characterized by endocardial fibrosis and overlying thrombus, leading to restrictive cardiomyopathy and valvular dysfunction. Surgical experience of patients with mitral dysfunction caused by this syndrome is limited, and valvular replacement is most often performed. Mechanical valvular replacement has a high incidence of recurrent obstructive thrombosis, and replacement with a bioprosthesis is recommended, despite associated restrictive cardiomyopathy. A patient is described who presented with mitral insufficiency associated with idiopathic hypereosinophilic syndrome, and underwent mitral valve repair.

Mitral valve replacement in idiopathic eosinophilic endocarditis without peripheral eosinophilia.

Idiopathic hypereosinophilic syndrome (IHS) is a rare systemic disease than can cause multiple organ failure by eosinophilic infiltration. Cardiac involvement is characterized by endocardial fibrosis and overlying thrombus leading to restrictive cardiomyopathy and valvular dysfunction. The absence of peripheral eosinophilia does not exclude eosinophilic cardiac involvement. Surgical experience of patients with mitral dysfunction caused by this syndrome is limited and valvular replacement is most often performed. Mechanical valvular replacement has a high incidence of recurrent obstructive thrombosis and replacement by bioprosthesis is recommended despite associated restrictive cardiomyopathy. This report describes a patient who presented mitral insufficiency caused by eosinophilic endocarditis without peripheral eosinophilia who underwent mitral valve replacement.