Les anti-agrégants plaquettaires au cours du syndrome coronarien aigu. Données des grandes études

Cardiovascular disease is the leading cause of early death and morbidity in developed countries and is becoming a growing problem in many developing countries. Currently, anti-coagulants play a major role in the management of the acute phase in association or not with reperfusion strategies. The combination of clopidogrel and aspirin, in accordance with the results of large randomized trials, is the treatment of reference. However two new drugs, a thienopyridine (prasugrel), and a cyclo-pentyl-triazolo-pyridine (ticagrelor) have shown their interest in major studies in comparison with clopidogrel. As a result, several effective P2Y12 receptor antagonist anti-platelet agents are now availabl…

C022 Experimental approaches of oxidative stress and cardiotoxicity associated with anthracyclines administration

The chronic cardiotoxicity of anthracyclines anticancer drugs is one of the main factors which limits their prolonged use. Clinically, this cardiotoxicity results in a cardiomyopathy with irreversible congestive heart failure with high mortality. The molecular mechanisms, which could explain this cardiac toxicity, are complex but seem distinct from the anticancer mechanism. Several hypotheses were advanced, but it appears that the production of reactive oxygen and nitrogen species (RONS) constitutes the common denominator.In a first study, we evaluated the acute effect of epirubicin administration on the evolution of cardiac functional parameters and production of RONS. Isolated perfused ra…

Safety and efficacy of left atrial appendage occlusion with the ACP or Watchman device guided by intracardiac echocardiography from the left atrium

Abstract Background There is a paucity of randomized data regarding the safety and efficacy of the use of intracardiac echocardiography (ICE) from the left atrium (LA) to guide left atrial appendage occlusion (LAAO) procedures under local anesthesia using either of the available devices. Hypothesis The aim of this study was to compare the efficacy and safety of ICE from the LA with transesophageal echocardiography (TEE) for guidance during transcatheter LAAO procedures. Methods Single‐center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Watchman device. Procedures were guided by ICE from the LA with local anesthesia (n = 175) or TEE under general anesthesia (n…

Beta-receptor desensitization evoked by a multistage ultralong distance exercise in the desert?

Background Few studies addressed to the evolution of cardiac function during a multistage ultra-long duration exercise (MULDE). Methods Serial echocardiographic assessment of cardiac function was performed in male healthy subjects during the 2014 Marathon des Sables before the race (T1), at the second (T2) and fifth (T3) arrival (236 km) then after 48 h recovery. Analysis were performed by 2 sonographers blind for the results of the other and the time of measure. Statistical analysis was performed using ANOVA-RM to compare the evolution of the different parameters. Results Among the 20 athletes, 18 completed the study (mean age 42.4, median 42). RR intervals and (Left ventricular End Diasto…

0197: Angiographically visible distal embolization is not linked with culprit lesion but with clinical characteristics

Despite the recent improvements in percutaneous coronary intervention (PCI), angiographically visible distal embolization (AVDE) complicates 6 to 18% of ST elevation myocardial infarction (STEMI) treated with PCI, and is associated with poor clinical outcomes. Culprit lesion characteristics have been proved to be the main predictive factor of AVDE. But data regarding clinical characteristics predicting AVDE are lacking. We aimed to identify predictors of AVDE complicating PCI in STEMI management. 769 consecutive patients admitted for STEMI who underwent PCI were included. Clinical, angiographic and therapeutics characteristics were assessed for each patien. AVDE was defined as an abrupt ves…

0432: Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI: Data from the “Observatoire des infarctus de Côte d’Or”

BackgroundRescue percutaneous coronary intervention (PCI) is associated with improved clinical outcomes for ST-segment myocardial infarction (STEMI) patients after failed fibrinolysis therapy. Hyperglycemia on admission has been shown to be a powerful predictor of mortality after acute myocardial infarction, particularly in non-diabetic patients. The aim of our study was to assess the predictive value of admission glucose levels on long-term mortality in patients with rescue PCI.Patients and MethodsFrom the “Observatoire des infarctus de Côte d’Or” (RICO) survey, 510 consecutive non-diabetic STEMI patients admitted to the intensive care unit for rescue PCI after failed fibrinolysis therapy …

The Free Oxygen Radicals Test (FORT) to assess circulating oxidative stress in patients with acute myocardial infarction

International audience; Background and aim: Reactive oxygen species (ROS) play an important role in the pathogenesis of many diseases including cardiovascular diseases. Several methods have been developed for the direct or indirect measurement of oxygen free radical and its by-products. The current study was designed to validate the new Free Oxygen Radicals Test (FORT) and to investigate the potential relationships between ROS and clinical or biological factors in male patients with acute myocardial infarction (AMI). Methods: We analysed FORT values in samples from 66 patients with AMI. Results: FORT values ranged from 324 to 1198 FORT units, with a median value of 581 (494-754) FORT units.…

Impact of high-fat diet on antioxidant status, vascular wall thickening and cardiac function in adult female LDLR<sup>–/–</sup> mice

International audience; Background: Western diet, rich in saturated fatty acids and cholesterol, is associated with increased cardiovascular risk. We thus investigated in female mice the influence of this diet on plasma antioxidant status, vascular wall thickening and cardiac function. Methods and Results: Adult female C57BL/6J wild type (WT) and LDLR–/– mice were fed a normal diet (ND) or a high-fat diet (HFD) for 17 weeks. HFD induced an increase in plasma lipids and vitamin C (Vit C) levels in both groups but at a much higher level in LDLR–/– and a decrease in plasma ascorbyl free radical levels to Vit C ratio (an endogenous oxidative stress index) in LDLR–/–. We only found a slight decr…

Dual Diagnostic Role of 123I-MIBG Scintigraphy in Inverted-Takotsubo Pattern Cardiomyopathy

We highlight the dual role of I-MIBG scintigraphy in inverted-Takotsubo pattern cardiomyopathy, the diagnosis of which is sometimes challenging: Firstly, I-MIBG scintigraphy can show myocardial sympathetic dysfunction (low I-MIBG uptake) in the hypokinetic basal segments, sparing the left ventricle apex. It is helpful in the imaging diagnosis of inverted-Takotsubo pattern cardiomyopathy and confirms that acute dysfunction of myocardial sympathetic nerve endings occurs with this cardiomyopathy. Secondly, I-MIBG scintigraphy is an accurate imaging examination to detect and localize pheochromocytoma; it can help in the search for an endogenous cause of this adrenergic stress-related cardiomyop…

General oxidative stress during doxorubicin-induced cardiotoxicity in rats: Absence of cardioprotection and low antioxidant efficiency of alpha-lipoic acid

International audience; To evaluate the effects of alpha-lipoic acid (AL) in a model of doxorubicin (DOX)-induced cardiotoxicity, male Wistar rats were treated with DOX (1 mg/kg/d; 10 d) in combination or not with AL (50 mg/kg/d; 15 d). Plasma oxidative stress was determined by hydroperoxides (ROOH) and the ascorbyl radical/ascorbate ratio. One and two months later, the functional parameters of the hearts were determined in vivo by catheterization and cardiac oxidative stress was assessed by malonedialdehyde (MDA) and O₂*⁻ (dihydroethidium fluorescence) content in tissue. After two months, body weight was higher in the DOX-AL group than in DOX (+16%), but this was due to ascites. Histologic…

Socio-professional status as a major determinant of disparities in cardiovascular outcomes: contemporary data on the prognosis inof manual workersmen after an acute myocardial infarction

Introduction: Over the last decade in France, the early prognosis after acute myocardial infarction (AMI) has markedly improved. However, recent work suggests persistent socioeconomic disparities in outcomes after AMI. From a regional population-based study, we analyzed the prognosis in manual workers after AMI. Patients: Patients recorded in the ObservatoiRe des Infarctus du myocarde de Cote d'Or (RICO) between 2001 and 2011, < 65 y, with a current professional activity and follow-up at one year. Socio-professional categories (SPC) were collected according to INSEE definition. The primary endpoint was combined mortality and hospitalization for heart failure. Results: Among the 1671 patient…

013 Pre-infarction angina and cardiovascular complications in non ST segment elevation myocardial infarction: Data from the RICO survey

BackgroundThe presence of preinfarction angina (PIA) has been shown to confer cardioprotection after ST segment elevation myocardial infarction (MI). However, the impact of PIA in non ST segment elevation (NSTEMI) remains to be determined.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included in the study. Patients who experienced chest pain 1) and 30-day mortality were collected.ResultsAmong the 1541 patients included in the study, 693 patients presented PIA. Baseline clinical characteristics were similar for the 2 groups. There was no significant difference for the GRAC…

Left Atrial Remodeling and Brain Natriuretic Peptide Levels Variation after Left Atrial Appendage Occlusion

Background: Few data are available about brain natriuretic peptide (BNP) variation and left atrial remodeling after the left atrial appendage occlusion (LAAO) technique. Methods: Prospective study included all consecutive patients successfully implanted with an LAAO device. Contrast-enhanced cardiac computed tomography (CT) was performed before and 6 weeks after the procedure with reverse left atrial remodeling defined by an increase in LA volume &gt

Impact du diamètre et de l’âge du thrombus sur la thromboaspiration. Étude expérimentale

Resume Introduction La thrombectomie coronarienne est frequemment integree aux procedures de prise en charge du syndrome coronarien aigu. De nombreuses etudes ont evalue son benefice dans ce contexte, mais peu suggerent une influence des caracteristiques des coronaires sur son efficacite. L’objectif de ce travail est d’evaluer les facteurs morphologiques qui pourraient expliquer le succes ou l’echec d’une thromboaspiration, a partir d’une etude experimentale. Materiels et methodes Des tubes en verre de 150 mm de long ont ete utilises, avec cinq diametres differents : 2,0 ; 2,6 ; 3,0 ; 3,6 et 4 mm ; et pour chaque diametre, nous avions trois angles differents : pas d’angle, angle a 90° et an…

0200: Predictors of angiographically visible distal embolization in ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention and thrombectomy

Aspiration thrombectomy during primary percutaneous coronary intervention (p-PCI) in ST elevation myocardial infarction (STEMI) has been proposed to restore myocardial reperfusion. But important controversies remain concerning the usefulness of thrombectomy to improve this perfusion. Our objective was to evaluate the impact of manual thrombectomy on the occur-rence of angiographically visible distal embolization (AVDE) during p-PCI in STEMI. 346 consecutive patients admitted for STEMI who underwent p-PCI and thrombectomy were included. Clinical, angiographic and therapeutics characteristics were assessed. AVDE was defined as an abrupt vessel closure occurring at any point during the PCI pro…

L’association inhibiteur de l’enzyme de conversion et antagoniste calcique. Quelle place chez le patient coronarien stable ?

Resume Les maladies cardiovasculaires representent l’une des plus importantes cause de mortalite et de morbidite precoce dans le monde industriel et deviennent un probleme de sante publique croissant dans de nombreux pays en voie de developpement. Les recommandations americaine et europeenne soulignent que le traitement medical associe a la correction des facteurs de risque et aux modifications de style de vie sont la pierre angulaire du traitement de cette pathologie. En raison de leur impact sur le pronostic, les inhibiteurs de l’enzyme de conversion (IEC) sont systematiques chez le coronarien stable. Recemment, plusieurs grands essais ont demontre l’interet de l’adjonction d’un antagonis…

Frequency and predictors of stroke after acute myocardial infarction: specific aspects of in-hospital and postdischarge events.

Background and Purpose— Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods— Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. Results— One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 da…

Cardiotoxicity of cancer therapy

Despite the development of new anti-cancer drugs such as anti-tyrosine kinases or anti-angiogenic therapy, cancer mortality remains high. These new molecules associated with advances in cancer surgery, radiotherapy and chemotherapy have succeeded in improving life expectancy in these patients. It has also allowed a long-term evaluation of the cardiovascular impact of these therapies. Many chemotherapy drugs, such as anthracyclines, lead to impaired cardiac function. The pathophysiological mechanisms of this cardiac dysfunction are complex, intricate and remain partially unknown. To reduce this cardiotoxicity, different pathways concerning administration modalities, drug presentation and the…

Pre-Infarction Angina and Outcomes in Non-ST-Segment Elevation Myocardial Infarction: Data from the RICO Survey

BACKGROUND: The presence of pre-infarction angina (PIA) has been shown to confer cardioprotection after ST-segment elevation myocardial infarction (STEMI). However, the clinical impact of PIA in non-ST-segment elevation myocardial infarction (NSTEMI) remains to be determined. METHODS AND RESULTS: From the obseRvatoire des Infarctus de Côte d'Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included. Patients who experienced chest pain <7 days before the episode leading to admission were defined as having PIA and were compared with patients without PIA. Incidence of in-hospital ventricular arrhythmias (VAs), heart failure and 30-day mortali…

Direct and indirect antioxidant properties of α-lipoic acid and therapeutic potential.

International audience; Diabetes has emerged as a major threat to worldwide health. The exact mechanisms underlying the disease are unknown; however, there is growing evidence that the excess generation of reactive oxygen species (ROS) associated with hyperglycemia, causes oxidative stress in a variety of tissues. In this context, various natural compounds with pleiotropic actions like lipoic acid (LA) are of interest, especially in metabolic diseases such as diabetes. LA, either as a dietary supplement or a therapeutic agent, modulates redox potential because of its ability to match the redox status between different subcellular compartments as well as extracellularly. Both the oxidized (d…

C023 Evaluation de l’effet protecteur de l’acide dihydro-lipoïque vis-à-vis d’une séquence d’ischémie-reperfusion sur coeur isolé perfusé de rat et d’un stress oxydant induit in vitro sur le globule rouge

L’acide alpha-lipoique (AL) est un dithiol endogene aux proprietes antioxydantes. Au niveau intracellulaire, l’AL subit une reduction pour former l’acide dihydro-lipoique (DHLA) qui represente son metabolite le plus actif. L’objectif de ce travail a ete de preciser les effets d’un traitement in vitro par le DHLA sur 1) des coeurs isoles perfuses de rats soumis a une sequence d’ischemie-reperfusion (IR) et 2) des globules rouges (GR) soumis a une agression radicalaire. Les coeurs ont ete isoles, perfuses en mode Langendorff et soumis a une ischemie globale totale de 30 min suivie d’une reperfusion de 30 min. Cinq minutes avant l’ischemie et pendant toute la periode de reperfusion, il a ete a…

003 Pericardial effusion in acute myocardial infarction: new insights from the French regional RICO survey