Delphine Delseny

Depletion of proBNP1-108 in Patients with Heart Failure Prevents Cross-Reactivity with Natriuretic Peptides

Background After synthesis by cardiomyocytes, precursor proBNP1-108 is cleaved into NT-proBNP and BNP. Recently, cross-reactivity between these assays was discussed. The aim of this study was to characterize the cross-reactivities, through a new biochemical innovative approach consisting in the total depletion of the circulating proBNP1-108 in patients with heart failure (HF). Methods This prospective study included 180 patients with chronic HF. BNP and NT-proBNP were dosed with commercial kits. ProBNP1-108 was determined using an ELISA research assay specific to the precursor. ProBNP1-108 depletion was performed by immunocapture with a specific antibody targeting exclusively the ProBNP1-108 hinge region. ProBNP1-108, BNP and NT-proBNP levels were determined before and after depletion using this process in HF patients. Results Mean age was 74.34 +/-12.5 y, and 69% of patients were males. NYHA classes II and III were the most frequent (32% and 45% respectively). Before depletion, ProBNP1-108, NT-proBNP and BNP levels were 316.8+/-265.9 pg/ml; 6,054.0+/-11,539 pg/ml and 684.3+/-82.1 pg/ml respectively, and were closely correlated with NHYA classes. After immuno-depletion, proBNP1-108 was decreased in mean by 96% (p<0.0001), BNP by 53% (p<0.0001) and NT-proBNP by 5%. The relationship between BNP or NT-proBNP and NHYA classes remained unchanged. Conclusion Current BNP and NT-proBNP assays measured as well proBNP molecule. This cross reactivity percentage has been controversial. Thanks to the removal of circulating proBNP1-108 with our immunodepletion process, we are now able to assess the remaining “true” BNP and NT-proBNP molecules and further evaluate their clinical relevance.

Is hypertriglyceridemia atherogenic

ASCVD reduction is based on LDL reduction, especially by statins. Highly elevated TG could be harmful, especially because of the risk of pancreatitis. Elevation of TG is mainly due to metabolic disorders and diabetes, alcohol intake and overweight. Genetic factors have been clearly identified in the most severe cases. TG have been generally considered as bystanders for cardiovascular diseases (CVD). Both biological and basic research provide strong data suggesting that TG-rich lipoproteins could be involved in the pathophysiology of CVD. Recent epidemiological and genetics studies strongly corroborate the causal role of TG in CVD. This paves the way for new approaches in the management of patients both for primary and secondary prevention.

0022 : Transcatheter aortic valve implantation without intensive care unit admission

Objectives The aim of the study was to evaluate feasibility and safety of transcatheter aortic valve implantation (TAVI) performed without subsequent intensive care unit (ICU) admission using simple clinical, ECG and echocardiographic criteria. Methods We included prospectively 177 consecutive patients who underwent TAVI in our center. Low-risk patients, admitted to conventional cardiology unit, had stable clinical state, LVEF > 40%, transfemoral access, no right bundle branch block (RBBB), permanent pacing with self-expandable valve and no complication during the procedure. High-risk group included other patients who were transferred to ICU. The primary endpoint concerned in-hospital events (VARC-2 criteria). Results Mean age of patients was 83.5±6.5 years and mean logistic Euroscore was 14.6±9.7%. The balloon expandable SAPIENS 3 valve was mainly used (n=148; 83.6%), mostly with transfemoral access (n=167; 94,4%). Among the 61 patients (34.5%) included in the low-risk group, only 1 (1.6%) had a minor complication (NPV: 98.4%; 95% CI: 0.91-0.99). Conversely, 47 patients (40.5%) from the high-risk group had clinical events (PPV: 40.5%; 95% CI: 0.31-0.50), mainly conductive disorders requiring pacemaker (n=26; 22.4%). In multivariate analysis, RBBB (OR: 14.1; 95% CI: 3.5-56.3), use of self-expandable valve without pacemaker (OR: 5.5; 95% CI: 2-16.3), vitamin K antagonist treatment (OR: 3.8; 95% CI: 1.1-12.6) and female gender (OR: 2.6; 95% CI 1.003-6.9) were pre-procedural predictive factors of in-hospital adverse events. Conclusions Our results suggested that TAVI can be performed safely without ICU admission in selected patients. This strategy may optimize efficiency and cost-effectiveness of the procedure. The author hereby declares no conflict of interest Table . In hospital major adverse events in the two groups of patients. Post TAVI adverse events Low risk group (n=61; 34.5%) High risk group (n=116: 65.5%) Death (n=1; 0.6%) 0 1 (0.9%) Acute pulmonary oedema (n=1; 0.6%) 0 1 (0.9%) New high conductive disorder (n=36; 20.2%) 0 36 (31%) Permanent pacing requiring (n=26; 14.7%) 0 26 (22.4%) Major vascular complication (n=1; 0.6%) 0 1 (0.9%) Pericardial effusion requiring medical intervention (n=2; 1.2%) 0 2 (1.8%) Acute kidney injury (Akin 2 or 3) (n=3; 1.8%) 0 3 (2.7%) Secondary transfer to ICU (n=1) (pericardial effusion) 1 (1.6%) Total of patient with at least one complication (n=48; 27.1%) 1 (1.6%) 47 (40.5%)

0507: Patients’ understanding of chronic anticoagulant therapy: evaluation of the knowledge of patients admitted in a cardiology unit

Purpose There is good evidence that adherence to medical treatment is enhanced by knowledge and understanding of the drug, its benefits and its side-effects. Objectives To investigate knowledge and perceptions of antithrombotic therapy among a population of patients receiving chronic anticoagulation therapy with vitamine k antagonists (VKA) or direct oral anticoagulants (DOA). Methods We conducted a prospective study among 122 patients admitted in our cardiology unit and receiving anticoagulant therapy for more than 3 months. Atrial fibrillation was the main indication of therapy (n=63, 51.6%) and VKA concerned 87% of patients. All patients were invited to fill in a questionnaire (11 questions), which was handed out by a nurse in a face-to-face interview. None of the patients refused to fill in the questionnaire, which was completed at once and independently. Results While the vast majority of patients know that they have anticoagulant therapy (96,7%), patients presented a clear lack of knowledge concerning mainly food and drug interaction (table 1), the possible consequences of under- or over-anticoagulation (n=31; 25,4%), the reason why they have this therapy (n=39; 32,7%) and how to control their treatment. Comparing the two therapies, we observed a non significant difference in knowledge concerning VKA and DOA except knowledge of risks of therapy which was superior in the DOA group (p In conclusion Patients’ anticoagulant therapy knowledge, either vitamin K antagonists or DOA, is poor. With the increasing use of DOA, from which we have no more biologic control to assess compliance, improved patient education and physician involvement in therapeutic education, is crucial. Download : Download full-size image Abstract 0507 – Figure: Lack of knowledge concerning anticoagluant therapy