Serum brain-derived neurotrophic factor and platelet activation evaluated by soluble P-selectin and soluble CD-40-ligand in patients with acute myocardial infarction

Little is known about the role of neurotrophins (NT) under adult vascular homeostasis in normal and pathological conditions. The NT family, including nerve growth factor and brain-derived neurotrophic factor (BDNF) are expressed in atherosclerotic vessels. Previous studies demonstrated that plasma BDNF levels were increased in the coronary circulation in patients with unstable angina. However, the role of BDNF during the onset and evolution of unstable angina remains to be elucidated. The objective of this study was to evaluate the relationship between BDNF, functional parameters and biological markers associated with inflammatory processes and platelet activation. BDNF serum levels were as…

Metformin and contrast-induced acte kidney injury in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infraction: Amulticenter study

IF 4.638; International audience; AIM : To analyze the association between chronic metformin treatment and the development of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI).METHODS: Patients with type 2 diabetes mellitus (T2DM) treated with PCI 27μmol/l (0.3mg/dl) or >50% over baseline after PCI. Since PCI was urgent, metformin could not be withheld prior to PCI but was usually stopped after PCI.RESULTS:Among the 372 patients included, 147 (40%) were using metformin, which had older diabetes, but had risk factors similar to patients without metformin. Baseline eGFR was better in pati…

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…

Psychosocial factors burden in workers with acute cerebro- or cardiovascular events: A multidisciplinary prospective pilot study

Introduction Psychosocial stress at work has been proposed as a risk factor for cerebro- and cardiovascular event (CVE) such as stroke or acute myocardial infarction (MI). However, data on psychosocial factors (PSF) profile in patients with CVE are scarce. In a multidisciplinary approach, we aimed to characterize PSF burden in patients with acute stroke or MI. Patients In a prospective pilot study, 45 patients aged  Results Among the 44 patients included, 77% had acute MI and 23% stroke. Mean age was 50 years, 77% were male, 43% were current smokers, 39% had hypertension, 41% hypercholesterolemia and 36% obesity. Education level was at 4,65 (secondary education), and most (41%) had low soci…

The Role of Osteoprotegerin and Its Ligands in Vascular Function

International audience; The superfamily of tumor necrosis factor (TNF) receptors includes osteoprotegerin (OPG) and its ligands, which are receptor activators of nuclear factor kappa-B ligand (RANKL) and TNF-related apoptosis-inducing ligand (TRAIL). The OPG/RANKL/RANK system plays an active role in pathological angiogenesis and inflammation as well as cell survival. It has been demonstrated that there is crosstalk between endothelial cells and osteoblasts during osteogenesis, thus establishing a connection between angiogenesis and osteogenesis. This OPG/RANKL/RANK/TRAIL system acts on specific cell surface receptors, which are then able to transmit their signals to other intracellular comp…

Late neointimal tissue growth behind the stent after intravascular gamma-radiation.

To determine the nature of the changes of the vascular wall after intravascular brachytherapy in stented arteries leading to incomplete stent apposition.Stents were implanted in the infrarenal aortas of rabbits, and gamma-intravascular brachytherapy (18 Gy) or a sham radiation procedure was immediately implemented. The arteries were harvested at 6 months for histologic analyses.The external elastic lamina area, as well as the vascular wall area behind the stent, were significantly greater in irradiated vs. control arteries (8.94 +/- 0.68 mm2 vs. 6.87 +/- 0.40 mm2 [p0.001] and 1.56 +/- 0.13 mm2 vs. 0.72 +/- 0.07 mm2 [p0.001], respectively). The ratio of the intimal area behind the stent rela…

Nitric oxide synthase inhibition and oxidative stress in cardiovascular diseases: Possible therapeutic targets?

International audience; Nitric oxide (• NO) is synthetized enzymatically from L-arginine (L-Arg) by three NO synthase isoforms, iNOS, eNOS and nNOS. The synthesis of NO is selectively inhibited by guanidino-substituted analogs of L-Arg or methylarginines such as asymmetric dimethylarginine (ADMA), which results from protein degradation in cells. Many disease states, including cardiovascular diseases and diabetes, are associated with increased plasma levels of ADMA. The N-terminal catalytic domain of these NOS isoforms binds the heme prosthetic group as well as the redox cofactor, tetrahydrobiopterin (BH 4) associated with a regulatory protein, calmodulin (CaM). The enzymatic activity of NOS…

Growth and differentiation factor 11 (GDF11): Functions in the regulation of erythropoiesis and cardiac regeneration

International audience; Members of the TGF-β superfamily transduce their signals through type I and II receptor serine/threonine kinases. The binding of activins to activin type IIA (ActRIIA) or type IIB (ActRIIB) receptors induces the recruitment and phosphorylation of an activin type I receptor (ALK4 and/or ALK7), which then phosphorylates the Smad2 and Smad3 intracellular signaling proteins. The regulation of members of the TGF-β family is known to be complex, because many proteins able to bind the ligands and inhibit their activities have been identified. Growth and differentiation factor 11 (Gdf11) belongs to the TGF-β family. GDF11, like other members of the TGF-β superfamily, is prod…

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…

Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction

Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed …

0326: Prognostic factors and impact of blood pressure level during the first 48 hours after myocardial infarction

Background High blood pressure and low blood pressure are perfectly identified cardio-vascular risk factors, especially in primary prevention. However, their respective role after myocardial infarction is uncertain, with few data available. Objectives To compare cardio-vascular deaths and events after myocardial infarction between the different blood pressure levels observed during the first forty-eight hours. Methods We carried out an observational, prospective, monocentric study, including all consecutive patients admitted in Dijon’s Cardiologic Intensive Care Unit for myocardial infarction, between February 2012 and February 2014. Systolic blood pressure (SBP) was defined as the average …

Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

IF 4.066; International audience

Low Systolic Blood Pressure and Mortality in Elderly Patients After Acute Myocardial Infarction

Background Optimal blood pressure in elderly patients after acute myocardial infarction is still a matter of debate. In a prospective observational study, we aimed to identify optimal systolic blood pressure during the 48 first hours after admission for acute myocardial infarction and its prognostic value for cardiovascular mortality. Methods and Results From the Observatoire des Infarctus de Côte d'Or survey, all consecutive patients aged >75 years admitted for an acute myocardial infarction in a coronary care unit from 2012 to 2015 and discharged alive were included (n=814). Exclusion criteria were in‐hospital death, cardiogenic shock, and end‐stage renal disease. Average systolic blo…

Carbon monoxide: mechanisms of action and potential clinical implications.

International audience; Small amounts of carbon monoxide (CO) are continuously produced in mammals. The intracellular levels of CO can increase under stressful conditions following the induction of HO-1 (heme oxygnase-1), a ubiquitous enzyme responsible for the catabolism of heme. Unlike nitric oxide, which is a free radical, CO does not contain free electrons but may be involved in oxidative stress. The carbonate radical has been proposed to be a key mediator of oxidative damage resulting from peroxynitrite production, likewise, the precursor of the carbonate radical anion being bicarbonate and carbon dioxide. We report herein some of the transcription factors and protein kinases involved …

Effet bénéfique de la transfusion à la phase aiguë de l’infarctus du myocarde du sujet âgé : étude prospective de 3316 cas

IF 0.905; International audience; IntroductionL’anémie est fréquente dans la population âgée à la phase aiguë d’un infarctus du myocarde (IDM) et est associée à une augmentation de la mortalité à long terme. Cependant, le bénéfice de la transfusion de concentrés de globules rouges (TCGR) dans ce contexte reste incertain.Patients et méthodesTous les patients de 65 ans et plus, hospitalisés pour un IDM dans notre centre hospitalier universitaire ont été inclus prospectivement. Ils ont été séparés en deux groupes d’âges : les plus jeunes (65–79 ans) et les plus âgés (80 ans et plus) et trois sous-groupes de nadir de taux d’hémoglobine (NH) (≤ 8,8–10 et > 10 g/dL). Nous avons étudié l’associati…

Evidence of the role of short-term exposure to ozone on ischaemic cerebral and cardiac events: the Dijon Vascular Project (DIVA)

Objectives To confirm the effects of short-term exposure to ozone (O 3 ) on ischaemic heart and cerebrovascular disease. Methods Daily levels of urban O 3 pollution, the incidence of first-ever, recurrent, fatal and non-fatal ischaemic cerebrovascular events (ICVE) and myocardial infarction (MI) were correlated using a case-crossover design. The authors analysed 1574 ICVE and 913 MI that occurred in Dijon, France (150 000 inhabitants) from 2001 to 2007. Sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), carbon monoxide (CO) and particulate matter with an aerodiameter of ≤10 μg/m 3 (PM 10 ) were used to create bi-pollutant models. Using the adjusted OR, the effects of O 3 exposure were calcul…

Symmetric dimethylarginine serum level as a new marker of left ventricular ejection fraction in patients with acute myocardial infarction

Purpose: Asymmetric dimethylarginine (ADMA) is a by-product of protein methylation that has been implicated in the prognosis after acute myocardial infarction (MI) and heart failure through Nitric Oxide Synthase (NOS) inhibition. We aimed to investigate whether SDMA – the endogenous symmetrical stereoisomer of ADMA- that has insignificant inhibitory effects on NOS- might be a marker of left ventricular function in acute MI. Methods: Blood samples from 635 consecutive patients hospitalized 1 (23%). Mean LVEF was 55±13%. Mean ADMA, SDMA and L-arg levels were at 0.72±0.42, 0.51±0.44 and 91±54 μmol/L, respectively. Spearman analysis showed that LVEF was correlated negatively with SDMA (r=-0.151…

0128: CHA2DS2-VASc score estimates in-hospital mortality beyond GRACE score after acute myocardial infarction

International audience; Background and aimsCHA2DS2VASc score have recently been suggested to predict death in patients with Atrial Fibrillation (AF). In acute myocardial infarction (AMI), silent AF is more common than symptomatic AF and associated with poor prognosis. In patients with AMI, we aimed to assess the distribution of CHA2DS2VASc score in patients with silent or symptomatic AF and the association of the score with mortality.Methods849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) 30 sec. Symptomatic AF was defined as any AF occurring on ECG during the hospital stay, resulting in clinical symptoms or need for urgent cardioversion. The population was…

Predictors and prognosis for complex coronary lesions in patients with acute myocardial infarction

Background We aimed to investigate the determinants and outcomes of multiple complex lesions (MCLs) on coronary angiography in patients with an acute myocardial infarction. Methods One thousand one hundred fifty-two consecutive nonselected myocardial infarction patients who underwent coronary angiography within 24 hours after admission were analyzed. A complex lesion was defined by the presence of thrombus, ulceration, irregular plaque, and flow impairment. Patients with ≤1 complex lesion were considered with single complex lesion (SCL), and patients with >1 complex lesions with MCLs. Results Multiple complex lesions were identified in 360 patients (31%). Patients from the MCL group were ol…

GDF15: an emerging modulator of immunity and a strategy in COVID-19 in association with iron metabolism

International audience; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic of respiratory and cardiovascular diseases, known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 encodes the structural proteins spike (S), envelope (E), membrane (M), and nucleocapsid (N). The receptor-binding domain on the surface subunit S1 is responsible for attachment of the virus to angiotensin (Ang)-converting enzyme 2 (ACE2), which is highly expressed in host cells. The cytokine storm observed in patients with COVID-19 contributes to the endothelial vascular dysfunction, which can lead to acute respiratory distress syndrome, multiorgan failure, alteration in iron homeostasi…

Prevalence and impact of metabolic syndrome on hospital outcomes in acute myocardial infarction.

The impact of metabolic syndrome after acute myocardial infarction (AMI) has not yet been studied. In a population-based sample of patients with AMI, we sought to determine the prevalence of metabolic syndrome in patients with AMI, its impact on hospital outcomes, and to assess the relative influence of each of the components of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III definition of metabolic syndrome on the risk of death and heart failure.A total of 633 unselected, consecutive patients hospitalized with AMI were categorized according to the NCEP ATP III metabolic syndrome criteria (presence of/=3 of the following: hyperglycemia; triglyceride level/=…

High N-Terminal Pro-B-Type Natriuretic Peptide Levels Are Associated with Reduced Heart Rate Variability in Acute Myocardial Infarction

AIM: We investigated the relationships between the autonomic nervous system, as assessed by heart rate variability (HRV) and levels of N-terminal Pro-B-type Natriuretic Peptide (Nt-proBNP) in patients with acute myocardial infarction (MI). METHODS AND RESULTS: The mean of standard deviation of RR intervals (SDNN), the percentage of RR intervals with >50 ms variation (pNN50), square root of mean squared differences of successive RR intervals (rMSSD), and frequency domain parameters (total power (TP), high frequency and low frequency power ratio (LF/HF)) were assessed by 24 h Holter ECG monitoring. 1018 consecutive patients admitted <24 h for an acute MI were included. Plasma Nt-proBNP (Elecs…

Infections et infarctus du myocarde : étude prospective multicentrique

Introduction Un lien epidemiologique a ete demontre entre les infections aigues et l’infarctus du myocarde (IDM). Toutefois, la pathogenese et le pronostic des IDM associees aux infections n’a pas fait l’objet d’etude de grande ampleur. Materiels et methodes Tous les patients consecutifs admis pour IDM avec un diagnostic d’infection aigue ont ete prospectivement identifies a partir des donnees d’un observatoire regional des IDM. Le diagnostic d’infection aigue etait a l’appreciation du clinicien. Le diagnostic d’IDM de type 1 (rupture ou erosion de plaque) ou de type 2 (fonctionnel sur desequilibre entre apports et besoins myocardiques en oxygene) etait systematiquement adjudique selon les …

Role of humanin, a mitochondrial-derived peptide, in cardiovascular disorders

The mitochondria produce specific peptides-mitochondrial-derived peptides-that mediate the transcriptional stress response by their translocation into the nucleus and interaction with deoxyribonucleic acid. Mitochondrial-derived peptides are regulators of metabolism. This class of peptides comprises humanin, mitochondrial open reading frame of the 12S ribosomal ribonucleic acid type c (MOTS-c) and small humanin-like peptides (SHLPs). Humanin inhibits mitochondrial complex 1 activity and limits the level of oxidative stress in the cell. Data show that mitochondrial-derived peptides have a role in improving metabolic diseases, such as type 2 diabetes. Perhaps humanin can be used as a marker f…

Impact of asymmetric dimethylarginine on mortality after acute myocardial infarction.

Objective— Asymmetrical dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthases. From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyze the predictive value of circulating ADMA concentrations on prognosis. Methods and Results— Blood samples from 249 consecutive patients hospitalized for acute MI &lt;24 hours were taken on admission. Serum levels of ADMA and its stereoisomer, symmetrical dimethylarginine (SDMA), were determined using high-performance liquid chromatography. The independent predictors of ADMA were glomerular filtration rate, female sex, and SDMA ( R 2 =0. 25). Baseline ADMA levels were higher in p…

Major impact of admission glycemia on myocardial perfusion assessed by magnetic resonance imaging, in patients with acute myocardial infarction

International audience

Intramural neovascularization and haemorrhages are major long‐term effects of intravascularγ‐radiation after stenting

Structural changes that might influence the structural integrity of the vessel in response to intravascular brachytherapy (IVB) and stenting were examined, focus being on the importance of neovascularization in rabbit stented arteries. Stents were implanted in the infrarenal aortas of rabbits, immediately followed by gamma IVB or a sham radiation procedure, and the arteries harvested at 6 months. Labelling for von Willebrand factor showed an increase in adventitial and medial neovascularization in irradiated versus control arteries group (5.04+/-0.89 versus 1.51+/-0.23 mm(-2), respectively; p=0.004). Moreover, intramedial haemorrhages (free hemosiderin deposition) and inflammation (macropha…

Soins ambulatoires et facteurs associés à la réhospitalisation précoce des sujets âgés (65+) après un infarctus du myocarde : étude observationnelle à partir des données nationales de l’Échantillon généraliste de bénéficiaires (EGB)

Etat de la question Les rehospitalisations precoces (RHP), dans les 30 jours suivant la sortie d’hospitalisation, sont frequentes chez les sujets âges, notamment apres un infarctus du myocarde (IDM). Elles augmentent la morbi-mortalite et les depenses de sante. Il a ete demontre qu’une meilleure organisation de la sortie d’hospitalisation reduit significativement le risque de RHP. Neanmoins, il n’existe aucune recommandation sur le suivi ambulatoire en sortie d’hospitalisation. L’objectif de l’etude etait d’analyser les soins ambulatoires post-hospitaliers et les facteurs associes a la RHP des sujets âges apres un IDM. Materiel et methodes Etude observationnelle retrospective a partir des d…

Central Obesity and Survival in Subjects With Coronary Artery Disease

Objectives The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. Background The question of which measure of obesity better predicts survival in patients with CAD is controversial. Methods We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months. Results From 2,188 studies found, 6 met inclus…

Prevalence, risk factor burden, and severity of coronary artery disease in patients with heterozygous familial hypercholesterolemia hospitalized for an acute myocardial infarction: Data from the French RICO survey

Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described, especially for French patients.The objective of this study was to assess the prevalence of FH and severity of CAD from a large database of a French regional registry of acute MI.All consecutive patients hospitalized for an acute MI in a multicenter database from 2001 to 2017 were considered. FH was diagnosed using an algorithm adapted from the Dutch Lipid Clinic Network criteria. The prevalence and clinical features of FH and the severity of CAD were assessed.Among the 11,624 patients included i…

014: Underuse of recommended secondary preventive therapies in current routine clinical practice

Aims Recommendations on the use of antithrombotic agents, antihypertensive drugs and statin for secondary prevention of coronary artery (CAD), ischemic cerebrovacular (CVD), and peripheral arterial (PAD) diseases are now well established. However, there may be a gap between clinical practice and evidence-based guidelines. We aimed to investigate the premorbid use of secondary prevention medications in patients with recurrent cardiovascular events. Methods and results We prospectively recorded all patients with CVD and CAD in Dijon, France from 2006 to 2010. Data about medical history and prior use of treatments were collected. Mutivariate analyses were performed to identify predictors of th…

Cardiovascular prevention and at-risk behaviours in a large population of amateur rugby players.

Background and aim We aimed to investigate cardiovascular risk factors and health behaviours prospectively in a large population of French amateur rugby players. Methods An anonymous questionnaire was displayed to rugby players aged over 12 years enrolled in the 2014–2015 French amateur rugby championship from the Burgundy region ( n = 5140). Questions addressed awareness on: (a) cardiovascular prevention; (b) tobacco, alcohol and highly caffeinated beverages consumption; and (c) adherence to prevention guidelines (ECG checks, training in basic life support, avoidance of sports practice during fever/infectious episodes). Results Among the 640 participants who completed the questionnaires, m…

P4550Growth differentiation factor 15 as an integrative biomarker of heart failure in patients with acute myocardial infarction

Abstract Background Growth differentiation factor 15 (GDF15), a stress-responsive cytokine member of the transforming growth factor-β family, is an emerging biomarker in cardiovascular (CV) diseases. GDF15 is weakly expressed in normal condition but increased in pathological situations such as inflammation, oxidative stress, and left ventricular remodeling. Recent data suggest GDF15 as a marker in heart failure (HF). Purpose We aimed to identify the determinants of GDF15 circulating levels in patients admitted for an acute myocardial infarction (AMI). Methods In our prospective study, all consecutive patients admitted from June 2016 to February 2018 for type 1 AMI in the Coronary Care unit …

Pravastatin reverses the membrane cholesterol reorganization induced by myocardial infarction within lipid rafts in CD14(+)/CD16(-) circulating monocytes.

International audience; Large numbers of monocytes are recruited in the infarcted myocardium. Their cell membranes contain cholesterol-rich microdomains called lipids rafts, which participate in numerous signaling cascades. In addition to its cholesterol-lowering effect, pravastatin has several pleiotropic effects and is widely used as secondary prevention treatment after myocardial infarction (MI). The aim of this study was to investigate the effects of pravastatin on the organization of cholesterol within monocyte membrane rafts from patients who had suffered myocardial infarction. Monocytes from healthy donors and acute MI patients were cultured with or without 4μM pravastatin. Lipid raf…

Prise en charge au long cours par les anti-agrégants plaquettaires oraux après un syndrome coronaire aigu

Cardiovascular disease is the primary cause of early death and morbidity in the industrialized world and is becoming a growing problem in many developing countries. Coagulation inhibitors play a major role in the management of the acute phase of ACS whether in association with reperfusion strategies or not. Currently, and in accordance with the results of major randomised studies, for medium and long-term management, the association of Clopidogrel and aspirin is the treatment of choice. However, despite the recognised benefits of this therapeutic strategy and above all the recommendations of learned societies, which have placed this bi-therapy in class I, according to national and internati…

0133: The Log Book as a new tool for the secondary prevention of coronary artery disease

International audience; IntroductionThe Log book (LB) project was created by a multidisciplinary team of healthcare professionals from a regional care network and aimed to improve secondary prevention (SP) after acute myocardial infarction (MI) in Cote d’Or. LB includes information and advices for increasing self management of risk factors by the patient.MethodsA prospective interventional study on 469 patients hospitalised for an acute MI in the 2 Intensive Coronary Care unit of Côte d’Or (CHU Dijon and Clinique de Fontaine les Dijon) in 2012 and surviving at 1 year follow-up (FU). LB was randomly given at the time of their hospitalisation by the nursing team, also providing oral advices o…

Anti-Aging Effects of GDF11 on Skin

International audience; Human skin is composed of three layers: the epidermis, the dermis, and the hypodermis. The epidermis has four major cell layers made up of keratinocytes in varying stages of progressive differentiation. Skin aging is a multi-factorial process that affects every phase of its biology and function. The expression profiles of inflammation-related genes analyzed in resident immune cells demonstrated that these cells have a strong ability to regenerate adult skin stem cells and to produce endogenous substances such as growth differentiation factor 11 (GDF11). GDF11 appears to be the key to progenitor proliferation and/or differentiation. The preservation of youthful phenot…

Glucose insulin potassium infusion improves systolic function in patients with chronic ischemic cardiomyopathy

Objective: We assessed the effects of glucose–insulin–potassium (GIK) by echocardiography in stable patients with ischemic dysfunction. Methods: Twelve male patients with stable coronary disease (SCD) and ejection fraction (EF) <45% were studied for systolic function. GIK (glucose 30%, 300 insulin units and KCl 6 g/l) was infused at 1 ml/kg per h over 20 min. Hemodynamic and echocardiographic measurements were recorded at rest (T0), at the end (20 min) of GIK infusion (T + 20), 20 and 40 min after the end of the infusion (T + 40 and T + 60). Results: At T + 20, a significant decrease in WMSI (wall motion score index) was observed compared with T0 (2.16±0.14 vs. 2.30±0.16: P<0.05). An increa…

P6389Infection and type 2 myocardial infarction: a large observational study from emergency department

Abstract Background Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin. Methods Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU (n=82 543), patients with a diagnosis of AI and elevated troponin Ic (≥0.10μg/L) (n=714) were systematically adjudicated…

0201: Cardiac surgery associated with cardiopulmonary bypass in patients with stable coronary disease: growth differentiation factor-15 (GDF- 15) as a predictive factor of adverse events?

BackgroundGrowth differentiation factor-15 (GDF-15) has been identified as a strong marker for cardiovascular disease; however, no data are available concerning the role of GDF-15 in the occurrence of organ dysfunction during cardiac surgery associated with cardiopulmonary bypass (CPB).MethodsThirty four patients, programmed to have non-urgent coronary artery bypass grafting (CABG), were included in our study. Arterial blood samples were taken sequentially from anesthesia induction (IND) until 24h after arrival at the cardiovascular intensive care unit (ICU). Plasma levels of GDF-15, follistatin-like 1 (FLST1), myeloperoxidases (MPO), hydroperoxides and plasma antioxidant status (PAS) were …

Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease

Objectives This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background In CAD patients, mortality has been reported to vary inversely with BMI (“obesity paradox”). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified…

Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy

Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only thienopyridine recommended in TAT patients. Whether its response plays a relevant role in this setting remains uncertain. We aimed to evaluate the level of platelet reactivity inhibition (PRI) achieved by oral TAT in Acute Coronary Syndrome (ACS) patients undergoing PCI and its relationship with outcomes. We performed a multicenter prospective observational study and assessed PRI by vasodilator-st…

P4573In patients with acute myocardial infarction, PCSK9 levels do not predict severity and recurrence of cardiovascular events

Abstract Background In patients with coronary artery disease (CAD), it remains unclear whether serum PCSK9 levels can predict the severity of the disease and the risk of future cardiovascular events. Methods Among the patients admitted for an acute myocardial infarction (MI) from September 2015 to December 2016 in an intensive care unit from a university hospital, serum PCSK9 levels were measured on admission in patients not previously receiving statin therapy. We aimed to evaluate the association between PCSK9 levels, metabolic parameters, severity of CAD on coronary angiography, and the risk of in-hospital events and at one-year follow-up. Results In a total of 648 patients (mean age: 66 …

Prévention de la cardiotoxicité des anthracyclines : approche fondamentale des mécanismes mis en jeu ; relations avec les données cliniques

Resume La cardiotoxicite des agents antitumoraux tels que les anthracyclines est un des principaux facteurs limitant leur utilisation prolongee. Cliniquement elle se traduit par une cardiomyopathie conduisant a une insuffisance cardiaque (IC) congestive irreversible, dont la mortalite est elevee. Les mecanismes moleculaires qui pourraient expliquer la toxicite cardiaque sont complexes mais semblent distincts du mecanisme anticancereux. Plusieurs hypotheses ont ete avancees mais il apparait que l'induction d'un stress oxydatif au sein du tissu myocardique constitue le denominateur commun de ces mecanismes. La prevention de cette cardiotoxicite repose sur une surveillance cardiaque etroite, l…

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…

P2485Log Book as a new tool for the secondary prevention of coronary artery disease

Long-term outcomes after acute myocardial infarction in patients with familial hypercholesterolemia: The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction program.

Patients with familial hypercholesterolemia (FH) are prone to develop acute myocardial infarction (AMI) at a younger age.The aim of the present study was to assess 5-year outcomes after AMI according to the presence of FH in a large multicenter cohort of patients.The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction consists of nationwide surveys recruiting patients over a 1- to 2-month period every 5 years. Patients recruited in 2005 and 2010 were followed up to 5 years.Of 5147 patients discharged alive and in whom FH status could be assessed, 2.8% had probable/definite FH, using an adapted Dutch Lipid Clinic score. They were 12 years younger, on average, tha…

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 …

Letter by Putot et al Regarding Article, “Biomarkers Enhance Discrimination and Prognosis of Type 2 Myocardial Infarction”

Association between Serum Osteoprotegerin Levels and Severity of Coronary Artery Disease in Patients with Acute Myocardial Infarction

International audience; Background. Osteoprotegerin (OPG), a glycoprotein of the tumour necrosis factor (TNF) superfamily, is one of the main biomarkers for vascular calcification. Aim. We aimed to evaluate the association between serum OPG levels and extent of coronary lesions in patients with acute myocardial infarction (MI). Methods. Consecutive patients hospitalized for an acute MI who underwent coronary angiography were included. SYNTAX score was calculated to assess the severity of coronary artery disease. The population was analysed in low (5 (3–6)), medium (11 (9–13)) and high (20 (18–23)) tertiles of SYNTAX score. Results. Among the 378 patients included, there was a gradual increa…

0139 : Extrahospital troponin measurement before admission for a ST segment elevation myocardial infarction

International audience; Background and aimEarly and reliable triage of patients is of major importance to promote rapid and appropriate treatments of patients with ST segment elevation myocardial infarction (STEMI). Extrahospital troponin measurement is used in primary care setting to help the identification of patients with suspected MI. From a regional survey (RICO), we aimed to investigate the frequence and hospital prognosis of STEMI patients with prehospital troponin (PT) measurement.Methods and resultsProspective study on 799 consecutive patients with STEMI included in RICO from March 2013 – 31 may 2015. Among the 799 patients, 38(5%) were identified with PT, from source files and pat…

Sport-related acute myocardial infarction; Context of onset and one-year follow-up

Background Sport-related (SR) acute coronary events are the main cause of sudden cardiac in the setting of sport activities; data are very scarce regarding the context of onset and the follow-up of SR acute myocardial infarction (AMI). Methods We prospectively invited subjects admitted in our University Hospital from April 2018 for a SR-AMI to participate in the IMACS observatory program which addresses to SR-AMI including a 12 months follow-up. Results From April 2018 to April 2019, 21 subjects were included. The mean age of this male population was 57.5 ± 11.0 (median 56). The context of event was available for 21 (provided by family for a subject with out of hospital (OH) SCA). Sport was…

Secondary prevention in patients with vascular disease. A population based study on the underuse of recommended medications.

Objectives To investigate the premorbid use of secondary prevention medications in patients with recurrent vascular events. Design Prospective, observational, population based study. Setting The Dijon Stroke Registry and the registry of myocardial infarction of Dijon and Cote d9Or, France. Patients All patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attacks) or coronary artery disease (CAD) and a history of vascular disease (cerebral ischaemia, CAD or peripheral arterial disease (PAD)) in Dijon, France from 2006 to 2010. Main outcome measures Data on medical history and prior use of treatments were collected. Mutivariate analyses were performed to identify predicto…

Prognostic value of ST-segment resolution after rescue percutaneous coronary intervention. Data from the RICO survey

Objectives: The goal of the present study was to test the impact of ST segment resolution (STR) after rescue percutaneous coronary intervention (PCI) on the short-term prognosis. Background: The prognostic value of STR after rescue PCI for acute ST elevation myocardial infarction (STEMI) remains undetermined. Methods: From the French regional database, we analyzed 168 consecutive patients with STEMI and failed lysis, defined by <50 percent STR, who underwent rescue PCI. Patients were classified into two groups according to the degree of STR from the maximal ST-elevation measured on the single worst ECG lead before lysis and after rescue PCI: the without STR group (<50% STR) vs. the with STR…

Telomere length and cardiovascular disease

SummaryTelomeres are structures composed of deoxyribonucleic acid repeats that protect the end of chromosomes, but shorten with each cell division. They have been the subject of many studies, particularly in the field of oncology, and more recently their role in the onset, development and prognosis of cardiovascular disease has generated considerable interest. It has already been shown that these structures may deteriorate at the beginning of the atherosclerotic process, in the onset and development of arterial hypertension or during myocardial infarction, in which their length may be a predictor of outcome. As telomere length by its nature is a marker of cell senescence, it is of particula…

Association between silent atrial fibrillation and heart failure after acute myocardial infarction

High levels of N-terminal pro B-type natriuretic peptide are associated with ST resolution failure after reperfusion for acute myocardial infarction

Background: B-type natriuretic peptide and the N-terminal fragment of its prohormone, N-terminal pro-brain natriuretic peptide (Nt-proBNP), provide valuable prognostic information on short- and long-term mortality in patients with acute coronary syndrome Aim: To investigate the association between plasma NT-proBNP levels and ST-segment resolution (STR) after reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Consecutive patients from the French regional RICO survey with STEMI who were treated by primary PCI or lysis <12 h were included. Blood sample was taken on admission to measure plasma NT-proBNP. Maximal ST segment elevation was measured on the sin…

Chronic Kidney Disease, Diabetes, and Risk of Mortality After Acute Myocardial Infarction: Insight From the FAST-MI Program

Diabetes is associated with a substantially increased risk of all-cause death, mainly driven by cardiovascular (CV) mortality. Furthermore, diabetes is associated with poorer outcomes after acute myocardial infarction (AMI) (1). Impaired glomerular filtration rate (GFR) is also associated with an increased risk of CV mortality (2). However, whether diabetes still confers a higher risk of mortality in patients with impaired GFR remains unknown. The aim of this study was to assess the long-term prognostic significance of both diabetes and renal impairment in two prospective nationwide cohorts of AMI patients: FAST-MI (French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarc…

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.…

SYNTAX score is associated with in-hospital mortality as assessed by GRACE risk score in patients with acute myocardial infarction

Infections et infarctus du myocarde : étude prospective multicentrique

Introduction Un lien epidemiologique a ete demontre entre les infections aigues et l’infarctus du myocarde (IDM). Toutefois, la pathogenese et le pronostic des IDM associees aux infections n’a pas fait l’objet d’etude de grande ampleur. Materiels et methodes Tous les patients consecutifs admis pour IDM avec un diagnostic d’infection aigue ont ete prospectivement identifies a partir des donnees d’un observatoire regional des IDM. Le diagnostic d’infection aigue etait a l’appreciation du clinicien. Le diagnostic d’IDM de type 1 (rupture ou erosion de plaque) ou de type 2 (fonctionnel sur desequilibre entre apports et besoins myocardiques en oxygene) etait systematiquement adjudique selon les …

Growth Differentiation Factor-15 (GDF-15) Levels Are Associated with Cardiac and Renal Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

International audience; Objective: Growth differentiation factor-15 (GDF-15) has been identified as a strong marker of cardiovascular disease; however, no data are available concerning the role of GDF-15 in the occurrence of organ dysfunction during coronary artery bypass grafting (CABG) associated with cardiopulmonary bypass (CPB). Methods: Five arterial blood samples were taken sequentially in 34 patients from anesthesia induction (IND) until 24 h after arrival at the intensive care unit (ICU). Plasma levels of GDF-15, follistatin-like 1 (FLST1), myeloperoxidases (MPO), hydroperoxides and plasma antioxidant status (PAS) were measured at each time-point. Markers of cardiac (cardiac-troponi…

Relationship between fragmented QRS and no-reflow, infarct size, and peri-infarct zone assessed using cardiac magnetic resonance in patients with myocardial infarction.

International audience; BACKGROUND: The relation between fragmented QRS complex (fQRS) and cardiac magnetic resonance parameters is poorly documented in ischemic cardiopathy. METHODS: Among 209 consecutive patients, those with fQRS were compared with those without fQRS. Cardiac magnetic resonance studies with late gadolinium-enhanced sequences were done during the week after acute myocardial infarction. RESULTS: fQRS was present in 113 (54%) patients, and associated with a significantly lower left ventricular ejection fraction, increased left ventricular volumes, a larger infarct size (IS), and a larger peri-infarct zone. Microvascular obstruction was more frequent in patients with fQRS (62…

Circulating leukocyte telomere length and oxidative stress: A new target for statin therapy

International audience; Objectives: We investigated the relationship between prior statin therapy and leukocyte telomere length (LTL), as well as their interaction with potential new biomarkers of oxidative deoxyribonucleic acid (DNA) lesions and reactive oxygen species-induced inflammation.Methods and results: From patients admitted for an acute myocardial infarction, LTL was assessed by quantitative polymerase chain reaction (Q-PCR), and leukocyte Finkel-Biskis-Jinkins osteosarcoma (FOS) and 8-oxoguanine DNA glycosylase (OGG1) messenger ribonucleic acid (mRNA) levels were measured by retrotranscription Q-PCR. Patients under prior chronic statin therapy were compared with patients without …

Do randomized clinical trial selection criteria reflect levels of risk as observed in a general population of acute myocardial infarction survivors? The PEGASUS trial in the light of the FAST-MI 2005 registry

IF 4.638; International audience; Background: Few clinical trials have focused on populations with a history of distant myocardial infarction (MI). The PEGASUS trial assessed the impact of dual antiplatelet therapy in such patients, selected by enrichment criteria of high cardiovascular risk. Whether the PEGASUS population reflects the risk of a broader post-MI population is questionable. We analyzed whether 4-year mortality of a routine-practice population would differ according to the inclusion and exclusion criteria used in PEGASUS.Methods: FAST-MI is a nationwide French registry recruiting acute MI patients in November 2005; 2490 patients alive and without recurrent MI at one year were …

Temporal trends in prehospital management of ST-segment elevation myocardial infarction from 2002 to 2010 in Cote d’Or: Data from the RICO registry (obseRvatoire des Infarctus de Cote d’Or)

Summary Background Myocardial infarction with ST-segment elevation (STEMI) is a medical emergency requiring specific management, with the main aim of achieving reperfusion as quickly as possible. Guidelines from medical societies have defined optimal management, with proven efficacy on morbi-mortality. Aims Our study aimed to evaluate trends in practices between 2002 and 2010 in the emergency management of STEMI in a single French department, namely Cote d’Or. Methods All patients admitted with a first STEMI to one of the six participating coronary care units (private or public) in Cote d’Or since January 2001 were included in a prospective registry (obseRvatoire des Infarctus de Cote d’Or …

N-Terminal Fragment of Pro B-type Natriuretic Peptide as a Marker of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction.

Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is frequent and associated with long-term renal impairment and mortality. Early markers of CIN are needed to improve risk stratification. We aimed to assess whether N-terminal fragment of pro B-type natriuretic peptide (Nt-proBNP) could be associated with CIN. From the French regional RICO survey, all the consecutive patients who underwent primary PCI for STEMI, from January 1, 2001, to December 3, 2013, were included. Nt-proBNP circulating levels were assessed on admission. CIN was defined as an increase in serum creatinine26.5 μmol/L or50% within 48 to 7…

Severe iatrogenic admissions in a coronary care unit:

Introduction: Iatrogenic complications are defined as adverse drug reactions or complications induced by non drug interventions, such as cardiac devices or stimulation techniques. Iatrogenic complications occurring during hospital stay are known to be associated with increased hospital length of stay and mortality. Only few data are available on iatrogenic as cause of hospital admission, particularly in coronary care unit. In patient admitted in coronary care unit for iatrogenic, we aimed a) to analyse their prevalence, type and characteristics, b) to analyse their in-hospital length of stay and mortality and c) to evaluate the predictive factors of severity and mortality. Methods: From 1st…

Infarctus du myocarde au cours de l’artérite à cellules géantes : étude de cohorte

Introduction Le risque d’evenement cardiovasculaire est accru au cours de l’arterite a cellules geantes (ACG), en particulier dans les premiers mois suivant le diagnostic de la vascularite [1] . L’objectif de ce travail etait de decrire les caracteristiques des infarctus du myocarde (IDM) survenant chez des patients atteints d’ACG et de les comparer avec des IDM survenant chez des patients ne presentant pas d’ACG au moment de leur IDM. Patients et methodes Les patients atteints d’ACG ont ete identifies parmi la liste des biopsies d’artere temporale (BAT) qui montraient des lesions d’ACG et qui avaient ete analysees entre le 1er janvier 2001 et le 31 decembre 2016 dans les deux laboratoires …

Alarming increased rate of smoking and associated lifestyle behaviours in patients with chronic cardiac diseases during COVID-19 pandemic related lockdown

Background COVID-19 outbreak and lockdown is a situation associating social and physical isolation, limited care access, psychological stress, and potential adoption of unhealthy lifestyle behaviours such as smoking. In a cohort of outpatients with chronic cardiac diseases, including congestive heart failure (CHF) and chronic coronary syndromes (CCS), we aimed to evaluate the impact of Covid-19 outbreak on tobacco consumption. Patients and methods During the 6th week of lockdown (which had started on March, 17th), 150 randomly selected CHF patients (from the Dijon HF-Clinic) and 250 CCS patients from the RICO survey were invited to answer an anonymous questionnaire. The 20-min lasting phone…

Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey.

Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir.We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (≤8,8 to ≤10, and10 g/dL) and age (80 or ≥80 years).A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respect…

Arginine and nitric oxide synthase: regulatory mechanisms and cardiovascular aspects

L-Arginine (L-Arg) is a conditionally essential amino acid in the human diet. The most common dietary sources of L-Arg are meat, poultry and fish. L-Arg is the precursor for the synthesis of nitric oxide (NO); a key signaling molecule via NO synthase (NOS). Endogenous NOS inhibitors such as asymmetric-dimethyl-L-Arg inhibit NO synthesis in vivo by competing with L-Arg at the active site of NOS. In addition, NOS possesses the ability to be "uncoupled" to produce superoxide anion instead of NO. Reduced NO bioavailability may play an essential role in cardiovascular pathologies and metabolic diseases. L-Arg deficiency syndromes in humans involve endothelial inflammation and immune dysfunctions…

Anti-hypertensive effects of Rosuvastatin are associated with decreased inflammation and oxidative stress markers in hypertensive rats

International audience; Among their pleiotropic effects, statins exert antioxidant and anti-inflammatory properties. The aim of this study was to evaluate in normotensive (WKY) and in spontaneously hypertensive rats (SHR) the effect of rosuvastatin (ROSU) treatment on (1) plasma inflammation markers and endogenous NO synthase inhibitor (ADMA) levels, (2) reactive oxygen species (ROS) generated by circulating leukocytes and (3) vascular oxidative stress and tissue inflammation markers. Plasma cytokines were higher in SHR than in WKY, except for IL-4, which was lower in SHR than in WKY. SHR monocytes exhibited higher production of ROS than did WKY monocytes. In the experimental conditions, RO…

Underuse of recommended secondary preventive therapies in current routine clinical practice

P4570Prognostic interest of HbA1c and plasma glucose assessment on one-year mortality in non-diabetic patients after acute myocardial infarction

Abstract Background The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in nondiabetic patients remains unclear. Purpose In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in nondiabetic patients after AMI. Methods From the “obseRvatoire des Infarctus de Côte d'Or” (RICO) survey database, we included all consecutive nondiabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: M…

Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction

Abstract Objective To investigate the determinants and the prognostic value of fragmented QRS (fQRS) after AMI. Patients and methods Prospective cohort of 307 consecutive patients with AMI. Main outcomes measured MACE (death plus non-fatal recurrent MI), hospitalization for an episode of heart failure, ventricular arrhythmia (VT or VF) at two years follow-up. Results On the serial 12-lead ECG recorded during the in-hospital stay, 162 (53%) had no fQRS ( no fQRS group ). 145 (47%) presented an fQRS, which was persistent in 108 (34%) patients ( persistent fQRS group ) and transient in 37 (12%) patients ( transient fQRS group ). Patients with a fragmented QRS (transient or persistent) were old…

Utility of Cardiac Magnetic Resonance to assess association between admission hyperglycemia and myocardial damage in patients with reperfused ST-segment elevation myocardial infarction

Abstract Aims to investigate the association between admission hyperglycemia and myocardial damage in patients with ST-segment elevation myocardial infarction (STEMI) using Cardiac Magnetic Resonance (CMR). Methods We analyzed 113 patients with STEMI treated with successful primary percutaneous coronary intervention. Admission hyperglycemia was defined as a glucose level ≥ 7.8 mmol/l. Contrast-enhanced CMR was performed between 3 and 7 days after reperfusion to evaluate left ventricular function and perfusion data after injection of gadolinium-DTPA. First-pass images (FP), providing assessment of microvascular obstruction and Late Gadolinium Enhanced images (DE), reflecting the extent of in…

Incidence and prognostic significance of silent atrial fibrillation in acute myocardial infarction

article Background: Silent atrial fibrillation (AF) has been suggested to be frequent after acute myocardial infarction (MI). Continuous ECG monitoring (CEM) has been shown to improve AF screening in patients at risk of stroke. Objectives: We aimed to assess the incidence and prognosis of silent AF in patients with acute MI. Methods:All the consecutive patients with acute MI were prospectively analyzed by CEM ≥ 48 h after admission. Silent AF was defined as asymptomatic episodes lasting at least 30 s. The population was divided into three groups: no-AF, silent AF and symptomatic AF. Results:Among the 849 patients, 135(16%) developedsilentAF and45(5%)symptomatic AF.Comparedwith the no-AF gro…

Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI

Psychosocial factors burden in workers with acute cerebro- or cardiovascular events: A multidisciplinary prospective pilot study

International audience

Smokeless tobacco, sport and the heart

SummarySmokeless tobacco (snuff) is a finely ground or shredded tobacco that is sniffed through the nose or placed between the cheek and gum. Chewing tobacco is used by putting a wad of tobacco inside the cheek. Smokeless tobacco is widely used by young athletes to enhance performance because nicotine improves some aspects of physiology. However, smokeless tobacco has harmful health effects, including cardiovascular disorders, linked to nicotine physiological effects, mainly through catecholamine release. Nicotine decreases heart rate variability and the ventricular fibrillation threshold, and promotes the occurrence of various arrhythmias; it also impairs endothelial-dependent vasodilation…

2214Prevalence and severity of coronary disease in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the RICO survey

Abstract Aim Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described. From a large database of a regional registry of acute MI, we aimed to address prevalence of FH and severity of CAD. Methods Consecutive patients hospitalized with MI in a multicentre database from 2001–2017 were considered. An algorithm, adapted from Dutch Lipid Clinic Network criteria, was built upon 4 variables (LDL-cholesterol (LDL-C) and lipid lowering agents, premature and family history of CAD) to identify FH probabilities. Results Among the 11624 patients included in the surv…

Comparative Analysis of Patients with Acute Coronary and Cerebrovascular Syndromes from the National French Hospitalization Health Care System Database

&lt;i&gt;Background:&lt;/i&gt; Nationwide evaluations of the epidemiology of acute coronary syndrome (ACS) or cerebrovascular syndrome (CVS) are scarce. We aimed to analyze nationwide French data on patients referred to hospital for either ACS or CVS. &lt;i&gt;Methods:&lt;/i&gt; Using the French national hospital discharge diagnosis records, all patients hospitalized between 2005 and 2008 with a diagnosis of ACS and CVS based on the ICD-10 were identified. We analyzed vascular risk factors and early outcomes in patients with a single hospitalization for ACS or CVS or for both ACV and CVS in a 2-month time window. &lt;i&gt;Results:&lt;/i&gt; 1,187,643 patients were recorded. Among these, 638…

0134 : Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) e48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients wit…

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…

Cutting Edge: IL-1α Is a Crucial Danger Signal Triggering Acute Myocardial Inflammation during Myocardial Infarction

Abstract Myocardial infarction (MI) induces a sterile inflammatory response that contributes to adverse cardiac remodeling. The initiating mechanisms of this response remain incompletely defined. We found that necrotic cardiomyocytes released a heat-labile proinflammatory signal activating MAPKs and NF-κB in cardiac fibroblasts, with secondary production of cytokines. This response was abolished in Myd88−/− fibroblasts but was unaffected in nlrp3-deficient fibroblasts. Despite MyD88 dependency, the response was TLR independent, as explored in TLR reporter cells, pointing to a contribution of the IL-1 pathway. Indeed, necrotic cardiomyocytes released IL-1α, but not IL-1β, and the immune acti…

Type 2 Myocardial Infarction: A Geriatric Population-based Model of Pathogenesis

International audience; Distinction between type 2 myocardial infarction (T2MI), defined as an imbalance between oxygen supply and demand without atherothrombosis, and type 1 myocardial infarction (T1MI), due to plaque disruption, is often a clinical challenge in frail elderly patients. We aimed to identify the characteristics and underlying causes of T2MI using a comprehensive geriatric approach. From a multicentre population-based prospective study in coronary care units, we adjudicated 4572 consecutive patients hospitalized for an acute T1MI or T2MI, according to the 3rd universal definition and a prespecified geriatric model of T2MI pathogenesis. In total, 3710 (81%) had T1MI and 862 (1…

Atrial Fibrillation Is Associated with a Marker of Endothelial Function and Oxidative Stress in Patients with Acute Myocardial Infarction

International audience; Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI.Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) !48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample.Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly o…

Impact pronostique de l’HbA1c et de la glycémie plasmatique (Gp) à la phase aiguë d’un infarctus du myocarde sur la mortalité à un an chez des patients non diabétiques

International audience; Background: The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in non-diabetic patients remains unclear.Purpose: In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in non-diabetic patients after AMI.Methods: From the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey database, we included all consecutive non-diabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondar…

Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database.

Background— We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction. Methods and Results— From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.…

The Crosstalk of Adipose-Derived Stem Cells (ADSC), Oxidative Stress, and Inflammation in Protective and Adaptive Responses

International audience; The potential use of stem cell-based therapies for the repair and regeneration of various tissues and organs is a major goal in repair medicine. Stem cells are classified by their potential to differentiate into functional cells. Compared with other sources, adipose-derived stem cells (ADSCs) have the advantage of being abundant and easy to obtain. ADSCs are considered to be tools for replacing, repairing, and regenerating dead or damaged cells. The capacity of ADSCs to maintain their properties depends on the balance of complex signals in their microenvironment. Their properties and the associated outcomes are in part regulated by reactive oxygen species, which medi…

Impact du confinement dû au COVID-19 sur la prise en charge et le contrôle de l’artérite à cellules géantes

Introduction L’arterite a cellules geantes (ACG) est une maladie multifactorielle dont la pathogenie n’est pas encore totalement comprise [1] . Malgre tout, il existe une relation dynamique entre predispositions genetiques et facteurs environnementaux via des modifications epigenetiques ayant un role dans le declenchement et l’evolution de cette pathologie [2] , [3] . Le confinement du a l’epidemie de COVID-19 a cree une situation sans precedent entrainant un stress physique et psychologique important chez de nombreuses personnes. Par ailleurs, la pression mediatique importante quant a l’usage des corticoides qui sont souvent prescrits chez les patients atteints d’ACG, etait tres anxiogene …

Asymmetric dimethylarginine (ADMA) and hyperhomocysteinemia in patients with acute myocardial infarction

We sought to investigate the association between increased levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and total plasma homocysteinemia (tHcy) in patients with acute myocardial infarction (AMI).In 138 patients hospitalized for AMI24 h on admission, serum levels of ADMA, its symmetric stereoisomer (SDMA) and tHcy were measured.ADMA was positively associated with SDMA (p0.001) and tHcy (p=0.03) but not with estimated glomerular filtration rates (eGFR, p=0.96), while tHcy strongly correlated with eGFR (p=0.002) and SDMA (p0.001). By multiple linear regression, SDMA but not ADMA was independently associated with tHcy (p=0.005).Our findings sugges…

Impact of Fasting Glycemia on Short-Term Prognosis after Acute Myocardial Infarction

The prognosis of patients with acute myocardial infarction (MI), according to the new criteria for impaired fasting glucose (IFG) (FG 100-126 mg/dl), has not been evaluated.A total of 2353 patients with acute MI and surviving at d 5 after admission were analyzed for short-term morbidity and mortality. FG was obtained at d 4 and 5. Patients were classified as diabetes mellitus (known diabetes or FGor = 126 mg/dl), high IFG (110or = FG126 mg/dl), low IFG (100or = FG110 mg/dl), and normal fasting glucose (NFG) (FG100 mg/dl).Among the 2353 patients, 968 (41%) had diabetes mellitus, 262 (11%) had high IFG, 332 (14%) had low IFG, and 791 (34%) had NFG. Compared with NFG patients, 30-d cardiovascu…

015: Relation between platelet activation and inflammation indexes measured on admission and new onset atrial fibrillation in patients with acute myocardial infarction

ObjectivePlatelet activation is present in atrial fibrillation (AF), but there is some debate whether this is due to AF itself and/or to underlying cardiovascular diseases. We aim to determine the association between a marker of platelet reactivity (mean platelet volume (MPV)) and systemic inflammation (CRP) measured on admission, and new onset episode of AF in patients with MI.Patients and methodsProspective cohort of 4994 consecutive patients with AMI. Patients with paroxysmal or persistent AF were excluded.Results426 (8.5%) patients were diagnosed with a new onset of AF during the in-hospital-stay (mean stay 3±2 days). These patients were older (75 vs 65, p<0.001), predominantly male, an…

P2482Prediction of in-hospital cardiogenic shock development among patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review

International audience; This review was conducted to emphasize the complex interplay between atrial fibrillation (AF) and myocardial infraction (MI). In type 1 (T1) MI, AF is frequent and associated with excess mortality. Moreover, AF after hospital discharge for T1MI is not rare, suggesting the need to improve AF screening and to develop therapeutic strategies for AF recurrence. Additionally, AF is a common trigger for type 2 MI (T2MI), and recent data have shown that tachyarrhythmia or bradyarrhythmia could be a causal factor in, respectively, 13–47% or 2–7% of T2MI. In addition, AF is involved in T2MI pathogenesis as a result of severe anemia related to anticoagulants. AF is also an unde…

249 Validation of assessment of circulate oxidative stress markers by the Free Oxygen Radicals Testing (FORT) assay among patients with an acute myocardial infarction

BackgroundFree oxygen radicals play an important role in the pathogenesis of many diseases including cardiovascular diseases, diabetes, cancer and aging. Several methods were developed for the direct or indirect measurement of oxygen free radical and its by-products. Using a new Free Oxygen Radicals Testing (FORT) the current study is designed first to validate the device and to investigate the potential relationships between the ROS and clinical or biological factors in human serum from a population of men with an acute myocardial infarction (AMI).MethodsWe first determined the effect of storage, variability and reproducibility of the FORT test in serum. Then we used the test in 66 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…

0132: Identifying familial hypercholesterolemia from registries of patients with acute myocardial infarction: an algorithm-based approach

Background and aims Familial hypercholesterolemia (FH) is at very high risk of early myocardial infarction (MI). The prevalence of FH, which is estimated to be at least 1:500 in the general population, remains unclear in patients with acute MI. From databases of 2 French regional and nationwide registries of acute MI (RICO and FAST-MI, respectively), we aimed to determine FH prevalence by developing a specific algorithm. Methods and results Consecutive patients with AMI ≤48 hours of onset included 1) in FAST-MI: during a one-month period in 213 institutions at the end of 2005 and 2) in RICO: from January 2001 December 2013 (≈13y), were considered in the 2 databases. The algorithm was adapte…

Tobacco-related cardiovascular risk in women: New issues and therapeutic perspectives

Smoking is the main modifiable risk factor for stroke and myocardial infarction, particularly in women; its prevalence in France is evolving, and new patterns of nicotine consumption have emerged.To present contemporary data on smoking prevalence and the use of electronic cigarettes, and to describe current knowledge of the cardiovascular risk specificities and the effectiveness of withdrawal methods in women.We identified studies by searching the MEDLINE bibliographic database between 1995 and 2020, and the Weekly Epidemiological Bulletin (Bulletin Épidémiologique Hebdomadaire) published by the French health authorities.In recent years, smoking prevalence among French women has decreased o…

Simultaneous cardiocerebral embolization in patients with atrial fibrillation

0126: New regulators of iron metabolism, Hepcidin and Erythroferrone, in acute myocardial infarction.

Background Dysfunctional iron storage and transport are common in patients with chronic heart failure and associated with poor prognosis. Body iron could contribute to the pathogenesis of coronary artery disease (CAD) through its ability to induce oxidative stress. However, studies on the relationship between iron metabolism and CAD have yielded conflicting results. Patients and Methods From the obseRvatoire des Infarctus de Cote d’Or (RICO) survey, 31 consecutive patients admitted in Intensive Care Unit for a first AMI were included. Serum concentrations of iron, transferrin, ferritin, the iron-regulatory hormone hepcidin and erythroferrone (a new hepcidin-regulating hormone), transferrin …

Diabetes, oxidative stress and therapeutic strategies.

Abstract Background Diabetes has emerged as a major threat to health worldwide. Scope of Review The exact mechanisms underlying the disease are unknown; however, there is growing evidence that excess generation of reactive oxygen species (ROS), largely due to hyperglycemia, causes oxidative stress in a variety of tissues. Oxidative stress results from either an increase in free radical production, or a decrease in endogenous antioxidant defenses, or both. ROS and reactive nitrogen species (RNS) are products of cellular metabolism and are well recognized for their dual role as both deleterious and beneficial species. In type 2 diabetic patients, oxidative stress is closely associated with ch…

0133 : Identifying familial hypercholesterolemia from registries of patients with acute myocardial infarction: an algorithm-based approach

Background and aim Familial hypercholesterolemia (FH) is at very high risk of early myocardial infarction (MI). The prevalence of FH, which is estimated to be at least 1:500 in the general population, remains unclear in patients with acute MI. From databases of 3 French regional and nationwide registries of acute MI (RICO and FAST-MI 2005 and 2010, respectively), we aimed to determine FH prevalence by developing a specific algorithm. Methods and results Consecutive patients with AMI ≤48 hours of onset included 1) in FAST-MI : during a one-month period in 223 institutions at the end of 2005 and 213 institutions at the end of 2010, and 2) in RICO :from January 2001 – December 2013 (≈ 13 y), w…

Comparative epidemiology of stroke and acute myocardial infarction: the Dijon Vascular Project (DIVA)

Despite a common pathophysiological mechanism (ie, atherosclerosis) and similar vascular risk factors, few reliable studies have compared the epidemiology of stroke and acute myocardial infarction (AMI).All first ever cases of stroke and AMI in Dijon, France (151 846 inhabitants) from 2001 to 2006 were prospectively recorded. The 30 day case fatality rates (CFRs) and vascular risk factors were assessed in both groups.Over the 6 years, 1660 events (1020 strokes and 640 AMI) were recorded. Crude incidence of stroke was higher than that of AMI (112 vs 70.2/100 000/year; p0.001). With regard to sex, the relative incidence of stroke compared with AMI was 0.88 (95% CI 0.60 to 1.29; p = 0.51) in w…

Short-term atorvastatin treatment does not modify neointimal morphology but reduces MMP-2 expression in normocholesterolemic rabbit stented arteries.

The aim of our study was to explore some potential pleiotropic effects of atorvastatin, after stenting in the iliac arteries of normocholesterolemic rabbits. On day 0, 27 rabbits underwent stent implantation and were randomized into either the control group (standard chow, CTRL, n = 15) or the atorvastatin group (10 mg/kg/d per os, Ator, n = 12). On day 30, the stented arteries were harvested for histomorphometry and neointimal analysis [macrophages, matrix metalloproteinases (MMP-2), tissue inhibitor of metalloproteinase-2, vascular smooth muscle cells, and collagen]. Atorvastatin did not induce significant histomorphometric and inflammatory modifications but reduced neointimal expression …

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…

The role of osteoprotegerin in the crosstalk between vessels and bone: Its potential utility as a marker of cardiometabolic diseases

International audience; Among the numerous molecules that are being studied for their potential utility as biomarkers of cardiovascular diseases, much interest has been shown in the superfamily of tumor necrosis factor (TNF) receptors. Members of this family include osteoprotegerin (OPG) and its ligands, which are receptor activators of nuclear factor κB ligand (RANKL) and TNF-related apoptosis-inducing ligand (TRAIL). These signals may be expressed and regulated, and their functions could be involved in several physiological and pathological processes. The relationship between bone regulatory proteins and vascular biology has attracted attention, and it has been suggested that OPG may medi…

The iron-regulatory hormone hepcidin: A possible therapeutic target?

The maintenance of stable extracellular and intracellular iron concentrations requires the coordinated regulation of iron transport into plasma. Iron is a fundamental cofactor for several enzymes involved in oxidation-reduction reactions. The redox ability of iron can lead to the production of oxygen free radicals, which can damage various cellular components. Therefore, the appropriate regulation of systemic iron homeostasis is decisive in vital processes. Hepcidin has emerged as the central regulatory molecule of systemic iron homeostasis. It is synthesized in hepatocytes and in other cells and released into the circulation. It inhibits the release of iron from enterocytes of the duodenum…

Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up

Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in patients experiencing silent AF in AMI.All consecutive patients with AMI who were prospectively analysed by CEM during the first 48 h after admission and who survived at hospital discharge were included. Silent AF was defined as asymptomatic episodes lasting at least 30 s. Patients were followed up at 1 year for cardiovascular (CV) outcomes.Among the 737 patients analysed, 106 (14%) developed silent AF and…

Cardiomyopathie de Takotsubo secondaire à des évènements cérébraux aigus

Introduction La cardiomyopathie de Takotsubo est caracterisee par une dysfonction ventriculaire apicale transitoire typiquement induite par un stress. Les evenements neurologiques aigus comme les infarctus cerebraux (IC) ou les crises epileptiques (CE) peuvent etre associes avec un relargage massif de catecholamines. Objectifs Notre objectif etait d’identifier les caracteristiques et l’evolution des patients ayant presente un syndrome de Takotsubo compliquant un IC ou une CE. Methodes Entre 2008 et 2013, 87 patients furent admis dans notre unite de soins intensifs pour une suspicion de syndrome de Takotsubo. Parmi eux, 6 ont presente un IC ou une CE dans les deux jours precedents. Le syndro…

0135 : New regulators of iron metabolism, hepcidin and erythroferrone, in acute myocardial infarction

Background Dysfunctional iron storage and transport are common in patients with chronic heart failure and associated with poor prognosis. Body iron could contribute to the pathogenesis of coronary artery disease (CAD) through its ability to induce oxidative stress. However, studies on the relationship between iron metabolism and CAD have yielded conflicting results. Patients and methods from the obseRvatoire des Infarctus de Cote d’Or (RICO) survey, 31 consecutive patients admitted in Intensive Care Unit for a first AMI were included. Serum concentrations of iron, transferrin, ferritin, the iron-regulatory hormone hepcidin and erythroferrone (a new hepcidinregulating hormone), transferrin s…

Admission glycemia and in-hospital death following cardiac arrest during myocardial infarction outside hospital

0127: Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) ≥48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients wit…

270 Increased hospital mortality in HIV-infected patients with acute coronary or cerebrovascular syndromes. Analysis from a French nationwide hospital medical information database

Background After more than two decades of the AIDS epidemic, the spectrum of HIV-associated vascular diseases has considerably evolved from infectious disease with improved survival, to premature atherosclerosis. As a consequence, acute atherosclerosis complications, such as acute coronary and cerebrovascular syndromes (ACS and CVS) are currently growing. However, only few data are available on HIV-infected patients in the setting of ACS/CVS. The aim of the present study was to determine the prevalence of HIV, as well as the characteristics and hospital case fatality of HIV-infected patients with CVS and ACS. Methods From the French nationwide hospital medical information database, data fro…

Iron, oxidative stress, and redox signaling in the cardiovascular system.

The redox state of the cell is predominantly dependent on an iron redox couple and is maintained within strict physiological limits. Iron is an essential metal for hemoglobin synthesis in erythrocytes, for oxidation-reduction reactions, and for cellular proliferation. The maintenance of stable iron concentrations requires the coordinated regulation of iron transport into plasma from dietary sources in the duodenum, from recycled senescent red cells in macrophages, and from storage in hepatocytes. The absorption of dietary iron, which is present in heme or nonheme form, is carried out by mature villus enterocytes of the duodenum and proximal jejunum. Multiple physiological processes are invo…

Combining Sirolimus-eluting Stents and External Irradiation in Cholesterol-fed Rabbits Increased Incomplete Stent Apposition and Decreased Re-endothelialization

Restenosis after the implantation of a drug-eluting stent or after vascular irradiation therapy shares similar physiopathological mechanisms. No experimental data are currently available on vascular wall behavior after external irradiation on arteries stented with sirolimus-eluting stents (SES). Ten New Zealand white rabbits received a 0.5% cholesterol-enriched chow for 1 month. Bilateral iliac artery stent implantation was then performed with an SES (Cypher; Cordis Corp). The animals were randomized into either an irradiated group (I, 2 Gy external x-ray irradiation, n = 5) or a control group (C, n = 5). The cholesterol-enriched chow was continued for 1 additional month after stent implant…

High Serum Cholesteryl Ester Transfer Rates and Small High-Density Lipoproteins Are Associated With Young Age in Patients With Acute Myocardial Infarction

Objectives Our aim was to characterize cholesteryl ester transfer protein (CETP) activity in the early phase of acute myocardial infarction (MI). Background Cholesteryl ester transfer protein catalyzes the transfer of cholesteryl esters from high-density lipoprotein (HDL) donors to apolipoprotein B-containing lipoprotein acceptors. Methods The CETP concentration, lipid profiles, and the rate of cholesteryl ester transfer (CET) from a tracer dose of radiolabeled HDL toward endogenous lipoproteins were determined within 24 h after symptom onset. Results Among 347 patients with first MI, CETP concentration, triglycerides, and non–HDL-cholesterol increased across tertiles of the CET rate, where…

274 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database

Objective To compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008. Setting All French hospitals. Design Retrospective analysis. Data sources National database called “Hospital Discharge Diagnosis Records”. Main outcomes measured Number and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window. Results Over the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) h…

002 Impact of diverting general practitioner's after-hours calls to emergency medical dispatch centers on time delays and acute revascularization procedures for patients with STsegment-elevation myocardia

Jean Ferrieres [Orateur] (1), Guy Berkenboom (2), Zdenek Coufal (3), Stefan James (4), Attila MohaCsi (5), Gregory Pavlides (6), Kirsi Norrbacka (7), Magali Sartral (8), Marie-Ange Paget (8), Molly Tomlin (9), Uwe Zeymer (10) (1) CHU Rangueil, Cardiologie B, Toulouse, France – (2) ULB Erasme University Hospital, Department of Cardiology, Brussels, Belgium – (3) Batova Krajska Nemocnice Zlin, Department of Cardiology, Zlin, Republique Tcheque – (4) Uppsala University Hospital, Dept. of Cardiology and Uppsala Clinical Research Center, Uppsala, Suede – (5) Gottsegen Institute of Hungarian Cardiology, Budapest, Hungaria – (6) Onassis Cardiac Surgery Center, Kallithea, Grece – (7) Lilly Research…

Retinal optical coherence tomography angiography as a biomarker of acute kidney injury after acute coronary syndrome

Background Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) is frequent and associated with long-term renal impairment and mortality. Retinal vessel density (RVD) measured by OCT-Angiography could reflect the global cardiovascular burden of ACS patients and thus provide a fast and non-invasive assessment of the systemic microcirculation, that may be involved in CIN occurrence. Methods Between October 2016 and March 2017, 452 ACS patients were admitted in our coronary care unit. Retinal OCT-A was performed within two days after PCI. Patients were divided in two groups, according to Acute kidney injury (AKI) occurrence (KDIGO …

Obesity and new-onset atrial fibrillation in acute myocardial infarction: a gender specific risk factor

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…

225 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database

ObjectiveTo compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008.SettingAll French hospitals.DesignRetrospective analysis.Data sourcesNational database called “Hospital Discharge Diagnosis Records”.Main outcomes measuredNumber and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window.ResultsOver the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) had ACS alon…

Prognostic value of N-terminal pro-brain natriuretic peptide in elderly people with acute myocardial infarction: prospective observational study

Objective To examine the influence of age on the predictive value of N-terminal pro-brain natriuretic (NT-proBNP) peptide assay in acute myocardial infarction. Design Prospective observational study. Setting All intensive care units in one French region. Participants 3291 consecutive patients admitted for an acute myocardial infarction, from the RICO survey (a French regional survey for acute myocardial infarction). Main outcome measure Cardiovascular death at 1 year. Results Among the 3291 participants, mean age was 68 (SD 14) years and 2356 (72%) were men. In the study population, the median NT-proBNP concentration was 1053 (interquartile range 300-3472) pg/ml. Median values for age quart…

Detection of Myocardial Infarction by Cardiac Magnetic Resonance in Embolic Stroke Related to First Diagnosed Atrial Fibrillation

Elevated troponin levels are found in a significant number of patients who are diagnosed with acute embolic stroke (AES) after first diagnosed atrial fibrillation (AF). These myocardial injuries, which are known as cardiocerebral infarction (CCI), are potentially caused by coronary embolism and correspond to simultaneous cardiac and cerebral embolisms. However, this severe condition remains poorly understood. In this prospective study, we aimed to investigate the prevalence and the cardiac magnetic resonance (CMR) characteristics of CCI.Consecutive patients with first diagnosed AF hospitalized for AES in a neurovascular intensive care unit from 2019 to 2020 were included. Troponin Ic kineti…

Influence of gender on delays and early mortality in ST-segment elevation myocardial infarction: Insight from the first French Metaregistry, 2005–2012 patient-level pooled analysis

International audience; Background - Women show greater mortality after acute myocardial infarction. We decided to investigate whether gender affects delays and impacts in-hospital mortality in a large population.Methods and results - We performed a patient-level analysis of 7 French MI registries from different regions from January 2005 to December 2012. All patients with acute STEMI were included within 12 h from symptom onset and a first medical contact with a mobile intensive care unit an emergency department of a hospital with percutaneous coronary intervention facility. Primary study outcomes were STEMI, patient and system, delays. Secondary outcome was in-hospital mortality. 16,733 p…

Increased Symmetric Dimethylarginine Level Is Associated with Worse Hospital Outcomes through Altered Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction

International audience; Objectives: We aimed to investigate whether SDMA-symmetric dimethylarginine-the symmetrical stereoisomer of ADMA-might be a marker of left ventricular function in AMI.Background: Asymmetric dimethylarginine (ADMA) has been implicated in the prognosis after acute myocardial infarction (AMI) and heart failure (HF).Methods: Cross sectional prospective study from 487 consecutive patients hospitalized 2, and death.Results: Patients were analysed based on SDMA tertiles. Sex, diabetes, dyslipidemia, and prior MI were similar for all tertiles. In contrast, age and hypertension increased across the tertiles (p<0.001). From the first to the last tertile, GRACE risk score was e…

Les admissions pour iatrogénie sévère en unité de soins intensifs de cardiologie : étude prospective sur 7244 patients

Resume Introduction Les complications iatrogeniques sont definies comme des reactions nocives induites par l’utilisation d’un medicament, mais aussi comme complications suite aux techniques invasives ou a l’implantation de materiel. Les complications iatrogenes survenant durant un sejour hospitalier sont bien connues et associees a une augmentation de la duree du sejour hospitalier et de la mortalite. En revanche, il existe peu de donnees concernant la iatrogenie comme motif d’admission a l’hopital ; particulierement en soins intensifs cardiologiques. Les objectifs de cette etude sont : (a) d’analyser la prevalence de la iatrogenie et ses caracterisques ; (b) de connaitre le retentissement …

P852Frequency and prognosis of type 2 myocardial infarction vs non ischemic myocardial injury: large observational study from an emergency department

Abstract Background Type 2 Myocardial Infarction (T2MI), due to myocardial oxygen supply-demand mismatch in the absence of atherothrombosis and non-ischemic myocardial injury (NIMI), corresponding to troponin elevation without overt ischemia, are emerging concepts which are suspected to be common in patients hospitalized. However, their respective frequencies, risk profiles and short term prognosis in current routine clinical practice of emergency unit remains to be investigated. Methods Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital emergency unit (n=82 543), patients with elevated troponin Ic (≥0.10μg/L) (n=4568) were sys…

280 Impact of ozone air pollution on ischemic cerebral and cardiac events in Dijon, France

Background There is strong evidence that short-term exposure to ozone (O3) is associated with respiratory disease and death, but the effects of short-term exposure to ozone on ischemic heart and cerebrovascular disease have not been clearly established. Methods Daily levels of urban O3 pollution, the incidence of first-ever, recurrent, fatal and non-fatal ischemic cerebro-vascular events (ICVE) and myocardial infarction (MI) were compared using a bi-directional case-crossover design analysis. We analysed 1 574 ICVE and 913 MI that occurred in Dijon, France from 2001 to 2007. Sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), particulate matter with an aerodiameter of 10μg/…

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…

Post-Infectious Myocardial Infarction: New Insights for Improved Screening

Acute infection is suspected of involvement in the onset of acute myocardial infarction (MI). We aimed to assess the incidence, pathogenesis and prognosis of post-infectious MI. All consecutive patients hospitalized for an acute MI in coronary care units were prospectively included. Post-infectious MI was defined by a concurrent diagnosis of acute infection at admission. Type 1 MI (acute plaque disruption) or Type 2 MI (imbalance in oxygen supply/demand) were adjudicated according to the universal definition of MI. From the 4573 patients admitted for acute MI, 466 (10%) had a concurrent acute infection (median age 78 (66–85) y, 60% male), of whom 313 (67%) had a respiratory tract infection.…

Post-infectious myocardial Infarction: Does percutaneous coronary intervention improve outcomes? A propensity-score matched analysis

Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (&gt

Smoking and FOS expression from blood leukocyte transcripts in patients with coronary artery disease.

International audience; OBJECTIVE: Analysis of the leukocyte transriptome, in particular the Finkel-Biskis-Jinkins Osteosarcoma (c-Fos) gene, which has a prominent role in inflammation, provides new insights into atherosclerosis mechanisms. Although smoking is a major risk factor, the links between smoking status and coronary artery disease (CAD) remains unclear. We aimed to analyze the relationship between smoking status and c-Fos expression in circulating leukocytes of patients with CAD. METHODS: c-Fos expression was measured by RT-Q-PCR, from blood leukocytes of 239 consecutive patients after acute myocardial infarction (MI). The patients were asked about their smoking status and stratif…

Silent atrial fibrillation during the acute phase of myocardial infarction

0137 : Takotsubo cardiomyopathy following acute cerebral events

International audience; ObjectiveTakotsubo cardiomyopathy is characterized by a transient apical ventricular dysfunction typically induced by an acute stress. Acute cerebral events including ischemic stroke (IS) or Epileptic Event (EE) may both be associated with massive catecholamine release. We aimed to identify the characteristics and outcomes of patients who experienced Takotsubo syndrome complicating an IS or EE.MethodsBetween 2008 and 2013, 87 patients were admitted in our Intensive Care Unit for suspected Takotsubo syndrome, of whom 6 previously experienced acute cerebral symptoms with either IS or EE, within two days. Takotsubo syndrome was diagnosed on Cardiac Magnetic Resonance, e…

Type 1 or Type 2 Myocardial Infarction in Patients with a History of Coronary Artery Disease: Data from the Emergency Department

A type 2 myocardial infarction (T2MI) is the result of an imbalance between oxygen supply and demand, without acute atherothrombosis. T2MI is frequent in emergency departments (ED), but has not been extensively evaluated in patients with previously known coronary artery disease (CAD). Our study assessed the incidence and characteristics of T2MI compared to type 1 (T1MI) in CAD patients admitted to an ED. Among 33,669 consecutive patients admitted to the ED, 2830 patients with T1MI or T2MI were systematically included after prospective adjudication by the attending clinician according to the universal definition. Among them, 619 (22%) patients had a history of CAD. Using multivariable analys…

High Levels of Asymmetric Dimethylarginine Are Strongly Associated with Low HDL in Patients with Acute Myocardial Infarction

International audience; Objectives: Low levels of high-density lipoprotein (HDL) cholesterol are associated with an increased risk of acute myocardial infarction possibly through impaired endothelial atheroprotection and decreased nitric oxide (NO) bioavailability. Asymmetric dimethylarginine (ADMA) mediates endothelial function by inhibiting nitric oxide synthase activity. In patients with acute myocardial infarction, we investigated the relationship between serum levels of HDL and ADMA. Approach and Results: Blood samples from 612 consecutive patients hospitalized for acute MI ,24 hours after symptom onset were taken on admission. Serum levels of ADMA, its stereoisomer, symmetric dimethyl…

Épidémiologie du syndrome coronaire aigu en Europe

Epidemiological data concerning acute coronary syndromes in Europe are based on national registries, studies by the European Society of Cardiology within the framework of the EuroHeart Survey and on the study of European population sub-groups in large international cohorts. In this article, recently published studies will be reviewed, and the principal developments in different countries as well as the characteristics and particularities of the most recent epidemiological data will be highlighted. In Europe, the presentation of acute coronary syndromes (ACS) has evolved considerably over the last ten years. This evolution is characterized by a reduction in the proportion of acute coronary s…

0437: SYNTAX score is associated with in-hospital mortality as assessed by GRACE risk score in patients with acute myocardial infarction

BackgroundCurrent guidelines for the management of patients with acute myocardial infarction (AMI) recommend the GRACE score for risk stratification with assessment of admission variables. The syntax score (SS) is a comprehensive angiographic scoring system that is derived entirely from the coronary anatomy and lesion characteristics. We investigated the relationship between severity of coronary artery disease (CAD) assessed with SYNTAX Score (SS) and GRACE Score (GS) in patients with AMI.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 614 consecutive patients hospitalized for an AMI from 1st march 2011 to 30 august 2012 and who underwent coronary angiogr…

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

Bedside chest ultrasound to distinguish heart failure from pneumonia‐related dyspnoea in older COVID‐19 patients

Abstract Aims In the older population, acute heart failure is a frequent, life‐threatening complication of COVID‐19 that requires urgent specific care. We aimed to explore the impact of point‐of‐care chest ultrasound (CUS) use in older bedridden inpatients during the COVID‐19 pandemic as a tool to distinguish between cardiogenic pulmonary oedema and isolated viral pneumonia‐related dyspnoea. Methods and results This prospective series included 16 patients aged 75 or older, hospitalized for acute dyspnoea in an acute geriatric unit of a university hospital and testing positive for a SARS‐Cov2 infection. We collected demographic characteristics, medical history, biological screening, clinical…

Time course of asymmetric dimethylarginine (ADMA) and oxidative stress in fructose-hypertensive rats: A model related to metabolic syndrome

Asymmetric dimethylarginine (ADMA) is an endogenous modulator of endothelial function and oxidative stress, and increased levels of this molecule have been reported in some metabolic disorders and cardiovascular diseases. The aim of this work was to analyze the time course of dimethylarginine compounds and oxidative stress levels and the relationship between these and cardiovascular function in fructose-hypertensive rats.90 male Sprague-Dawley rats were randomized into 2 groups, fed for 3 months with standard (C) chow supplemented or not with fructose (F, 60%). After sacrifice at different weeks (W), the aorta and plasma were harvested to assess the vascular and biochemical parameters. Our …