Hélène Aelion

Mid-regional pro atrial natriuretic peptide allows the accurate identification of patients with atrial fibrillation of short time of onset: A pilot study

OBJECTIVES Atrial fibrillation (AF) is a common arrhythmia; its most prevalent and devastating complication is stroke. A delay of AF onset >48 h is believed to be clinically significant. Mid-regional pro A-type natriuretic peptide (MR-proANP) could be of interest in the identification of the time from onset of AF to presentation. DESIGN AND METHODS We measured MR-proANP plasma concentration at presentation in consecutive patients in whom onset of AF was determined, without evidence of concomitant acute heart failure. RESULTS Forty-seven patients were included. Patients with an AF onset <48 h (n=19) had decreased MR-proANP concentrations versus patients with onset >48 h (144.0 [129.2-213.7] versus 321.7 [236.4-425.6] pmol/L, p<0.001); MR-proANP was the only independent variable associated with AF <48 h according to multivariate analysis. Area under the ROC curve for identify AF onset <48 h was 0.878 [95%CI 0.778-0.978]. CONCLUSIONS MR-proANP concentration may reliably identify the time from onset of AF to presentation.

Spontaneous rupture of a coronary artery

MOTS CLÉS Anévrisme ; Chirurgie de pontage ; Infarctus du myocarde ; Chirurgie en urgence Coronary artery aneurysms are rare and giant forms (> 2 cm diameter) are even less common, with a prevalence of 0.02% and spontaneous rupture rarely observed. Most aneurysms in young patients are congenital, traumatic or due to Kawasaki disease. Other aetiologies include inflammatory disease, such as Behçet’s disease, polyarteritis nodosa, systemic lupus erythematosus and syphilis. The main cause in older patients remains atherosclerosis, although some cases of coronary aneurysm formation related to bare-metal stent implantation have also been described. The aneurysms generally remain silent or induce myocardial ischaemia but are rarely revealed by life-threatening complications. In our case, a 59-year-old man was admitted in emergency to our catheterization laboratory for primary percutaneous coronary intervention (PCI) for inferior myocardial infarction. The patient was a former smoker and had dyslipidaemia and high blood pressure. He had a past history of coronary disease: after admission for an ST-segment elevation myocardial infarction in 2005, coronary angiography found ectasic coronary arteries — especially the right artery — with distal occlusion of the right posterior atrioventricular segment. After failure of PCI, medical therapy, including a vitamin K antagonist, was initiated and he remained asymptomatic. A coronary angiogram showed diffuse atheromatous infiltration on the left branch, with ectasic deformation of the proximal left anterior descending artery (Fig. 1). As we first injected the right coronary artery (RCA), before any wiring, we noted not only an aneurysm of the mid segment but also pericardial effusion due to spontaneous rupture (Fig. 2). Haemodynamic variables

N-Terminal-proBrain natriuretic peptide measurement at presentation to identify patients with recent onset of atrial fibrillation.

patients with recent onset of atrial fibrillation Christophe Meune ⁎, Karim Wahbi , Adeline Vermillet , Sylvie Guerin , Hélène Aelion , Simon Weber , Camille Chenevier-Gobeaux b a Département de Cardiologie, Université Paris Descartes, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris (APHP), Paris France b Département de Biochimie Générale, Urgences et Gardes, Université Paris Descartes, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris (APHP), Paris France

0315: Cardiovascular protection of statins could be mediated by an increase of total bile acids concentration in sera? A pilot study

Introduction in animal models of atheroma (ApoE-/- and LDL -/- mice), bile acids (BAs) exerts an anti-atherosclerotic effect through the anti-inflammatory action of their receptors, TGR5 and FXR, decreasing dramatically the surface of the atheroma plaque. BAs are cholesterol derivatives synthetized by the liver. In a previous study, we found that a decrease in BAs (lithocholic acid) is an independent risk factor of coronary disease in human. Aim Statins are known to reduce cardiovascular events in atherosclerotic patients. Given the experimental protective effect of BAs against atherosclerosis, the aim of this preliminary study was to dertermine the total BAs concentration in sera after statins administration. Methods Between January 2015 and April 2015, patients hospitalized for a coronary angiogram and starting a statins treatment for coronary atheroma were included. Exclusion criteria were post cardiac arrest, non-fasting status, hepatic disease, antibiotics and corticosteroids. The total BAs concentration was measured before and 1 month after the initiation of statin therapy by liquid chromarography mass spectrometry. Wilcoxon test was used for statistical analysis. Results On a cohort of 360 patients, 37 were eligible and 17, aged of 54±9.6 years old have been retrospectively included. 95% were prescribed with atorvastatin (68% with atorvastatin 40mg). The mean concentration of the total BAs before statin was 0.68µmol/L (SEM 0.08µmol/L) and 1.37µmol/L after (SEM 0.21µmol/L) (p=0.013, figure 1). Conclusion statins administration is associated with a doubling of circulating BAs after one month of treatment. This raises a question about statins increasing BAs synthesis by the liver: the deflection of the cholesterol synthesis by the liver into BAs instead, could participate to the efficacy of statins. This could theoretically be beneficial by slowing down the atheroma development through anti-inflammatory effects of BAs on the macrophage of the plaque. Download : Download high-res image (70KB) Download : Download full-size image Abstract 0315 – Figure

230: Heightened risk of coronary atheroma conferred by a decrease in the plasma concentrations of lithocholic acid

Context The bile acids receptors Farsenoid X and TGR5 protect against the formation of atheroma in mice, though no evidence have linked coronary atheroma and bile acid in human. Bile acids links these receptors with more or less efficient activation, depending on the species. Objective To test the hypothesis that changes in concentrations of circulating bile acid species influence the risk of developing coronary atheromas in humans. Methods Pilot, prospective, observational study conducted between June and September 2010. The serum concentrations of cholic, chenodeoxycholic, deoxycholic, and lithocholic acids were measured in a fasting blood sample. Consecutive hospitalized or ambulatory patients undergoing emergency or elective coronary angiograms were eligible for inclusion. Post-cardiac arrest and non-fasting states, hepatic disease, and treatment with antimicrobials, corticosteroids, statins or fibrates were exclusion criteria. Of 393 screened patients, 44 met the study entry criteria, and were divided between 27 patients with (Group A) and 17 without (Group B) angiographically visible coronary atheromas. The pool of circulating bile acids was analyzed to measure the plasmatic concentrations of 28 different bile acid species. The variables associated with the presence of angiographically visible coronary atheromas were examined by single and multiple variable logistic regression analysis. Results The serum lithocholic acid concentration was significantly lower in group A than in group B. By multiple variable analysis, lithocholic acid was the only predictor of coronary atheroma independently of patient gender (odds ratio 2.41 per 0.05 decrease; 95% confidence interval 1.11 to 5.25, P=0.027 Conclusion A low serum concentration of lithocholic acid was an independent predictor of coronary atheroma in human. Download : Download full-size image