Mathilde Baudet

Prognostic markers of acute decompensated heart failure: the emerging roles of cardiac biomarkers and prognostic scores.

Rapidly assessing outcome in patients with acute decompensated heart failure is important but prognostic factors may differ from those used routinely for stable chronic heart failure. Multiple plasma biomarkers, besides the classic natriuretic peptides, have recently emerged as potential prognosticators. Furthermore, prognostic scores that combine clinical and biochemical data may also be useful. However, compared with the scores used in chronic heart failure, scores for acute decompensated heart failure have not been validated. This article reviews potential biomarkers, with a special focus on biochemical biomarkers, and possible prognostic scores that could be used by the clinician when assessing outcome in patients with acute heart failure.

High body mass index is a predictor of left ventricular reverse remodelling in heart failure with reduced ejection fraction

Structural and functional left ventricular alterations can occur in heart failure (HF), referred to as left ventricular reverse remodelling (LVRR). This study aimed to define novel predictors of LVRR besides well‐known effects of medical and device therapy.

Comment j’explore l’insuffisance cardiaque ?

L’insuffisance cardiaque majeure est actuellement un probleme de sante publique car, selon les donnees europeennes, sa prevalence dans les pays developpes serait de 1 a 2 %. Premiere cause d’hospitalisation parmi les maladies cardiovasculaires, l’insuffisance cardiaque est une pathologie de mauvais pronostic. En effet apres chaque hospitalisation, pour un episode aigu, la mortalite est de 10-12 % a 1 mois et 30-40 % a 1 an.Un des elements cles pour reduire cette morbi-mortalite [...]

0102: High and low platelet reactivity on clopidogrel, prasugrel and ticagrelor in acute coronary syndrome patients: insight from a large cohort

Purpose Dual antiplatelet therapy with a P2Y12 inhibitor is mandatory in acute coronary syndromes (ACS) undergoing angioplasty. New antiplatelet drugs prasugrel and ticagrelor offer more efficient inhibition compared to clopidogrel. Under P2Y12 inhibitor, platelet reactivity (PR) assessment can predict ischemic and bleeding events. The aim of our study was to compare PR of P2Y12 inhibitors in a real-world setting. Methods PR was prospectively assesed in consecutive patients with recurent ACS or undergoing high risk angioplasty. PR was measured 24h after last intake of clopidogrel (C) and prasugrel (P) and 12h for ticagrelor (T) by flow cytometry measured vasodilatator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) and light transmission agregometry with ADP 20µM (LTA-ADP). High Platelet Reactivity (HPR) was defined as VASP-PRI>50% or LTA-ADP>65% (thresholds previously linked to clinical events). Low Platelet Reactivity (LPR) was defined as VASP-PRI Results 619 patients treated with aspirin and C (n=269), P (n=241) or T (n=109) were included from 01/2011 to 07/2013. Mean age was 62±13y.o. 81% were men and 65% STEMI. HPR was more frequent with C compared to P and T and significantly more frequent with P compared to T (Table). At the opposite, LPR was significantly more frequent in patients treated with T. Clinical and biological characteristics were similar between patients on P and those on T, except for hypertension, BMI and prior history of STEMI. In multivariate analysis, the significant predictor of HPR with VASP was P (OR=0.13-CI [0.08-0.22]) or T (OR=0.01-[0.01-0.09]). The significant predictor of LPR with VASP was T (OR=3.37-[2.09-5.44]). Conclusion This observational biological prospective study confirms a more potent platelet inhibition of the new P2Y12 compared to clopidogrel, mainly T. The very high rate of LPR found with T does not match with the bleeding risk found in the PLATO trial.