Marc Badoz

Acutely decompensated heart failure with preserved and reduced ejection fraction present with comparable haemodynamic congestion

Congestion is a central feature of acute heart failure (HF) and its assessment is important for clinical decisions (e.g. tailoring decongestive treatments). It remains uncertain whether patients with acute HF with preserved ejection fraction (HFpEF) are comparably congested as in acute HF with reduced EF (HFrEF). This study assessed congestion, right ventricular (RV) and renal dysfunction in acute HFpEF, HFrEF and non‐cardiac dyspnoea.

Brugada syndrome induced by BRAF and MEK inhibitors in a melanoma patient.

Charlée Nardin, Morgane Colas, Marc Badoz, Blandine Roche-Kubler, Nicolas Meneveau, Eve Puzenat, and François Aubin* Centre Hospitalier Universitaire, Service de Dermatologie, CHU, 3 Bd Fleming, 25030, Besançon, France; Université de Bourgogne-Franche Comté, Besançon, EA3181, France; and Centre Hospitalier Universitaire, Service de Cardiologie, CHU, 3 Bd Fleming, 25030 Besançon, France * Corresponding author. Tel: 133382218483, Fax: 133381218482, Email: francois.aubin@univ-fcomte.fr

Role of cardiovascular biomarkers for the assessment of mitral stenosis and its complications

Abstract Background Mitral stenosis (MS) may cause progressive dyspnea on exertion, pulmonary hypertension (PH), atrial fibrillation and right ventricular (RV) failure. Patients with MS presenting with change in dyspnea severity often require a complete cardiologic assessment, but the use of biomarkers may be an alternative for the initial assessment of MS and its complications. The aim of this study was to evaluate the role of several cardiovascular biomarkers for this purpose. Methods Clinically stable patients with moderate or severe MS were included in this prospective multicenter observational study. ECG, transthoracic echocardiography and biomarker measurement (BNP, MR-proANP and sCD146) were performed at inclusion. One cohort of patients with pre-capillary PH (PAH) was included for comparison of biomarker levels in different etiologies of PH. Results A total of 117 MS (70% severe, 30% moderate stenosis) were included. Plasma levels of all three biomarkers were higher in severe MS compared to moderate MS. PH was associated with higher levels of BNP and MR-proANP. The presence of atrial fibrillation increased plasma levels of BNP and sCD146, whereas MR-proANP was not affected by atrial fibrillation. PAH patients had higher levels of sCD146 compared to MS patients with PH. RV dysfunction was associated with higher levels of sCD146. Conclusion MS and its complications affect plasma levels of cardiovascular biomarkers. The use of MR-proANP may be helpful for the assessment of severe stenosis and the presence of PH in the early phase. sCD146 might help identifying patients with more advanced PH and RV-dysfunction.

NON-COMPLIANCE WITH GUIDELINES FOR THE MANAGEMENT OF PULMONARY EMBOLISM: PREDICTORS AND IMPACT ON CLINICAL OUTCOME

Initial management of Pulmonary Embolism (PE) has been the subject of guidelines issued by the European Society of Cardiology (ESC). The aims of this study were to describe non-compliance with guidelines and identify predictive factors of non-compliance; to evaluate the impact of non-compliance on

Incidence, Predictors, and Impact on Six-Month Mortality of Three Different Definitions of Contrast-Induced Acute Kidney Injury After Coronary Angiography

We assessed incidence, predictors, and impact on 6-month mortality of contrast-induced acute kidney injury (CI-AKI) after coronary angiography with or without percutaneous coronary intervention in patients with acute coronary syndrome (ACS), according to 3 different CI-AKI definitions. Serum creatinine (sCr) was assessed at baseline and 48 to 72 hours after procedure to classify patients into 3 CI-AKI groups: Group 1: increase in sCR ≥25% over baseline but absolute increase <0.5 mg/dl; Group 2: absolute increase ≥0.5 mg/dl; Group 3: absolute increase ≥0.3 mg/dl or ≥50% over baseline. The association between CI-AKI and all-cause 6-month mortality was assessed using multivariate Cox regression. Among 1,002 patients included, median age was 68 [57 to 79] years. The sample had the following characteristics: 70% men, 25% diabetics, 22% had a history of myocardial infarction, 21% had baseline estimated glomerular filtration rate (as calculated by the Modification of Diet in Renal Disease)  <60 ml/min/1.72 m2, 34% had ST-segment elevation myocardial infarction, 61% underwent percutaneous coronary intervention, and 43% had multivessel disease. Based on changes in sCr, 89 patients (8.9%) were classified in Group 1; 69 (6.9%) in Group 2; and 157 (15.7%) in Group 3, whereas sCr did not increase >25% in the remaining 844 (84.2%). CI-AKI was significantly associated with 6-month all-cause mortality using the definitions for Group 2 (hazard ratio 3.1, 95% confidence interval [CI] 1.5 to 6.6, p = 0.002) and Group 3 (hazard ratio 2.03, 95% CI 1.03 to 4.0, p = 0.04), but not Group 1. In conclusion, based on the definition used for CI-AKI, CI-AKI is observed in 6% to 15.7% of patients. An increase of 25% over baseline sCr does not identify high-risk patients. CI-AKI defined as an increase in sCr >0.3 mg/dl identifies 15.7% of the population at 2-fold higher risk of mortality.

IMPACT OF LEFT ATRIAL PRESSURE ON RECURRENCE OF ATRIAL FIBRILLATION 3 MONTHS AFTER CATHETER ABLATION

Background: Catheter ablation is the treatment of choice for the management of atrial fibrillation (AF). The main limitation of this technique is the success rate, which is in the range of 70 to 80%. It is therefore critical to identify patients likely to benefit from this procedure, and who will

Prognostic impact of thrombus burden as evaluated by OCT in patients with non-ST elevation acute coronary syndromes undergoing PCI

Introduction: We aimed to evaluate the impact of thrombus burden quantified by optical coherence tomography (OCT) on the risk of peri-procedural myocardial infarction (MI) (type IVa) in patients un...

LONG-TERM CLINICAL IMPLICATIONS OF RESIDUAL PULMONARY VASCULAR OBSTRUCTION AFTER PULMONARY EMBOLISM: A VENTILATION-PERFUSION LUNG SCAN FOLLOW-UP STUDY AT TWO TIMEPOINTS

Little is known about the clinical implications of residual pulmonary vascular obstruction(RPVO) on long-term outcomes and about the optimal timing of V-Q scan control during patient follow-up. We aimed to investigate the prognostic value on 5-year adverse events of RPVO, measured by two ventilation