Thomas Hovasse - Academia.edu (original) (raw)
Papers by Thomas Hovasse
Journal of Cardiovascular Magnetic Resonance, 2011
JACC. Cardiovascular interventions, Jan 16, 2015
The MAVERIC trial (Mitral Valve Repair Clinical Trial) reports the safety and efficacy of the ART... more The MAVERIC trial (Mitral Valve Repair Clinical Trial) reports the safety and efficacy of the ARTO system in patients with symptomatic heart failure and functional mitral regurgitation (FMR). The ARTO system percutaneously modifies the mitral annulus to improve leaflet coaptation in FMR. The MAVERIC trial is a prospective, nonrandomized first-in-human study. Key inclusion criteria were systolic heart failure New York Heart Association functional classes II to IV, FMR grade ≥2+, left ventricular (LV) ejection fraction ≤40%, LV end-diastolic diameter >50 mm and ≤75 mm. Exclusion criteria were clinical variables that precluded feasibility of the ARTO procedure. Primary outcomes were safety (30-day major adverse events) and efficacy (MR reduction, LV volumes, and functional status). Eleven patients received the ARTO system, and there were no procedural adverse events. From baseline to 30 days, there were meaningful improvements. Effective regurgitant orifice area decreased from 30.3 ...
Circulation, 2010
A 15-year-old boy without cardiovascular risk factors or autoimmune diseases was referred for a 4... more A 15-year-old boy without cardiovascular risk factors or autoimmune diseases was referred for a 4-year history of chest pain on exertion. His history was remarkable for a febrile illness at the age of 4 months, associated with heart failure and mildly depressed left ventricular function, from which he had made a full recovery.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 29, 2015
The American Journal of Cardiology, 2015
Several observational studies have compared clinical outcome in patients with a co-existing nonin... more Several observational studies have compared clinical outcome in patients with a co-existing noninfarct-related artery chronic total occlusion (n-IRA CTO) versus those without, suggesting increased all-cause mortality. The goal of this study was to provide a systematic review and meta-analysis evaluating the impact of the presence of an n-IRA CTO on short- and long-term mortality after primary percutaneous coronary intervention. Studies published from January 1980 to January 2014 that compared the incidence of all-cause mortality in patients with ST-segment elevation myocardial infarction with co-existing n-IRA CTO versus those without were identified using an electronic search and reviewed using meta-analytical techniques. Seven studies (5 observational studies and 2 observational analyses of randomized controlled trials) comprising 14,117 patients and 1,554 patients (11.7%) with n-IRA CTO were included. The presence of n-IRA CTO was associated with increased incidence of all-cause mortality at a median follow-up of 25.2 months (interquartile range 24 to 60) compared with no CTO (absolute risk 23.5% vs 9.0%; odds ratio [OR] 2.90, 95% confidence interval [CI] 2.09 to 4.01; p <0.0001). This finding was consistent in the analysis of studies reporting 30-day follow-up (absolute risk 17.2% vs 4.7%; OR 3.79, 95% CI 3.13 to 4.59; p <0.0001). Co-existing n-IRA CTO was also associated with increased mortality in a subanalysis of patients with multivessel disease only (absolute risk 24.2% vs 11.3%; OR 2.23, 95% CI 1.90 to 2.63; p <0.0001). In conclusion, coronary CTO in the nonculprit artery in patients presenting with ST-segment elevation myocardial infarction is associated with increased short- and long-term all-cause mortality.
Archives des maladies du coeur et des vaisseaux
The authors report the case of a 67 year old caucasian female admitted for suspected acute corona... more The authors report the case of a 67 year old caucasian female admitted for suspected acute coronary syndrome with ST segment elevation. Coronary angiography did not show any coronary lesion but ventriculography revealed akinesia of the middle and apical segments with hyperkinesia at the base. An isolated moderate elevation of troponine Ic was noted. On the 10th day the methergin test was negative and ventriculography showed complete recovery of the left ventricular segmental kinetics. Left ventricular transient apical ballooning, or tako-tsubo syndrome, is characterised by reversible akinesia of the middle and apical segments with no associated coronary lesion or enzymatic elevation concordant with the extent of the akinetic areas. It mainly affects women between 50 and 60 years old and follows emotional or physical stress. The prognosis is excellent in survivors with a rapid return of normal systolic function. The pathophysiology remains debatable, excluding myocarditis in favour o...
Archives des maladies du coeur et des vaisseaux, 2006
In the TARGET trial, the lower incidence of cardiac events at one month with abciximab compared w... more In the TARGET trial, the lower incidence of cardiac events at one month with abciximab compared with tirofiban was attributed to a lack of efficacy in the first hour because of suboptimal dosage. The object of this study was to confirm that high dose tirofibal is associated with over 90% platelet inhibition during the first hour and to analyse the effect of this new dosage on platelet activation. Thirty-three patients treated with clopidogrel and aspirin for an acute coronary syndrome without ST elevation were given before angioplasty a bolus of 25 microg/Kg of tirofiban injected in 3 minutes, followed by an infusion of 0.15 microg/kg/min. Blood samples were taken before the treatment (TO) and at the 45th minute (T1) to measure platelet aggregation induced by ADP, the expression of P-selection, the quantification of circulating monocyte-platelet aggregates and the phospholyration of VASP protein. The results showed that all patients had over 90% (100%) inhibition of platelet aggrega...
Background: The purpose of this study was to elucidate impact of annulus ellipticity on clinical ... more Background: The purpose of this study was to elucidate impact of annulus ellipticity on clinical outcomes after transcatheter aortic valve implantation (TAVI).
Background: To evaluate the impact of the presence of a chronic total occlusion (CTO) on short an... more Background: To evaluate the impact of the presence of a chronic total occlusion (CTO) on short and long term mortality after primary percutaneous coronary intervention (PPCI). Methods: We performed MEDLINE, Cochrane Controlled Trials Registry and EMBASE database searches for published articles using predefined terms. Studies that reported data on the incidence of all-cause mortality in STEMI patients with single-or multivessel disease (SVD, MVD) with and without CTO were included. Of the 189 studies identified, 5 articles met the inclusion criteria: 3 observational studies and 2 post-hoc analyses of randomized controlled trials (RCTs). Results: A total of 10,314 patients were included in the meta-analysis with overall 1160 (11%) patients with CTO. The global analysis demonstrated that CTO was associated with an over 3-fold increased incidence of mortality at a median follow up of 36 months compared to patients non-CTO patients (30.4% vs 10.1% OR: 3.24; 95% confidence interval [CI]: 2.79 to 3.75; p 0.0001) . This finding was consistent in a sub-analysis of studies that reported 30-day follow up (17.6% vs 4.2 OR: 4.3; 95% CI: 3.4 to 5.4 p¼0.001). Cardiac mortality and MACE were also higher in patients with CTO (14.7% vs 3.7% OR: 4.42; 95% confidence interval [CI]: 3.18 to 6.15; p <0.0001 and 33.5% vs 20.4% OR: 1.97; 95% confidence interval [CI]: 1.56 to 2.47; p <0.0001 respectively). Conclusions: Coronary chronic total occlusion in the non-culprit artery in patients presenting with STEMI is associated with poor long-term mortality.
measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mea... more measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mean % DCFR pre TAVI to immediately post TAVI 8.6%, 95% CI -23.0 -40.3%, p¼0.41). Conclusions: TAVI does improve coronary flow dynamics as measured by CFR. This improvement does not occur immediately, but requires a period of time post-TAVI to manifest. The improvement in coronary flow reserve may represent a mechanism by which both symptoms and prognosis improve following TAVI.
Presse médicale (Paris, France : 1983)
As the French population is aging, a growing number of elderly patients with symptomatic severe a... more As the French population is aging, a growing number of elderly patients with symptomatic severe aortic stenosis are going to require therapeutic management. Approximately 30 to 40% of these patients do not undergo surgical treatment and a high proportion is considered to be at high risk for surgery. The transluminal aortic valve implantation technique has been increasingly used over the past few years, thus providing a solution to a major therapeutic issue in our industrialized countries. While the cardiology community was rapidly convinced of its efficacy, remaining doubts regarding the outcome of this technique in terms of mortality were erased by the recent publication of results achieved in cohort B of the Partner US trial. This new approach is clearly here to stay and should soon reach a maturity phase with respect to its indications, the selection of patients and technical aspects.
Circulation. Cardiovascular interventions, 2013
Bicuspid aortic valve (BAV) is regarded as a relative contraindication to transcatheter aortic va... more Bicuspid aortic valve (BAV) is regarded as a relative contraindication to transcatheter aortic valve implantation attributable to the risk of uneven expansion of the bioprosthesis. The purpose of this study was to evaluate the efficacy and safety of transcatheter aortic valve implantation in patients with BAV. Of 470 patients included in our prospective transcatheter aortic valve implantation database (October 2006-January 2012), 229 consecutive patients undergoing both echocardiography and multidetector computed tomography were analyzed. We compared clinical outcomes in patients with vs patients without BAV. In this series of 229 patients, BAV was detected by multidetector computed tomography in 21 patients (9.2%). BAV was identified by transthoracic and transoesophageal echocardiography in only 9 of these 21 patients. Patients were 83.1±6.6 years old, and European system for cardiac operative risk evaluation score was 20.0%±11.4%. The BAV group was similar to the non-BAV group exc...
Catheterization and Cardiovascular Interventions, 2014
measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mea... more measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mean % DCFR pre TAVI to immediately post TAVI 8.6%, 95% CI -23.0 -40.3%, p¼0.41). Conclusions: TAVI does improve coronary flow dynamics as measured by CFR. This improvement does not occur immediately, but requires a period of time post-TAVI to manifest. The improvement in coronary flow reserve may represent a mechanism by which both symptoms and prognosis improve following TAVI.
The American Journal of Cardiology, 2015
The Valve Academic Research Consortium-2 has defined body mass index (BMI) &amp;amp;amp;a... more The Valve Academic Research Consortium-2 has defined body mass index (BMI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 as indicative of frailty, which may be one of the co-morbidities not captured by traditional risk factors after transcatheter aortic valve replacement (TAVR). This study aimed to assess the impact of low BMI on clinical outcomes after TAVR. A total of 777 consecutive patients scheduled for TAVR were classified into 3 groups as BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 (n = 56), 20 to 24.9 (n = 322), and ≥25 (n = 399). Procedural complications and clinical outcomes were compared among the 3 groups. They were also analyzed according to propensity-matching model A (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [n = 50] vs ≥20 [n = 50]), model B (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [n = 50] vs 20 to 24.9 [n = 50]), and model C (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [n = 47] vs ≥25 [n = 47]). The differences in baseline characteristics among the 3 groups were adequately adjusted in 3 matched models. Valve Academic Research Consortium-2-defined end points and other complications were similar among the 3 groups in each model. Kaplan-Meier curves indicated no significant differences in cumulative 30-day survival (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [91.0%] vs 20 to 24.9 [86.3%], p = 0.33; BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [91.0%] vs ≥25 [91.4%], p = 0.91, respectively) and 1-year survival (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [74.3%] vs 20 to 24.9 [71.8%], p = 0.71; BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [74.3%] vs ≥25 [77.0%], p = 0.71; respectively). These survival rates were also similar in each of the 3 matched models. In conclusion, BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 was not associated with increased early or midterm mortality. BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 alone may not constitute an additional co-morbidity factor in patients who underwent TAVR.
La Presse Médicale, 2011
As the French population is aging, a growing number of elderly patients with symptomatic severe a... more As the French population is aging, a growing number of elderly patients with symptomatic severe aortic stenosis are going to require therapeutic management. Approximately 30 to 40% of these patients do not undergo surgical treatment and a high proportion is considered to be at high risk for surgery. The transluminal aortic valve implantation technique has been increasingly used over the past few years, thus providing a solution to a major therapeutic issue in our industrialized countries. While the cardiology community was rapidly convinced of its efficacy, remaining doubts regarding the outcome of this technique in terms of mortality were erased by the recent publication of results achieved in cohort B of the Partner US trial. This new approach is clearly here to stay and should soon reach a maturity phase with respect to its indications, the selection of patients and technical aspects.
Journal of the American College of Cardiology, 2014
The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES... more The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES) recipients is 12 months, to reduce the risk of late stent thrombosis, particularly in acute coronary syndrome. It was hypothesized that antiplatelet treatment with DAPT for 6 versus may be non-inferior to DAPT for 24 months in aspirin-sensitive patients METHODS: A multicenter, randomized study assigned patients undergoing implantation of Xience V (Abbott vascular) to receive 6- or 24-month DAPT with confirmed non-resistance to aspirin. The primary endpoint was a composite of death, myocardial infarction, urgent target vessel revascularization, stroke and major bleeding at 12 months post-stenting. 2,031 patients were enrolled in 70 European and Middle East centers. The trial was prematurely terminated due to problems with recruitment. 941 patients were randomized to 24 month-DAPT and 953 to 6 month-DAPT; 137 patients were resistant to aspirin. The two treatment groups had similar baseline and procedural characteristics. There was no significant difference between the 2 treatment groups regarding the primary endpoint (1.5 vs. 1.6%, p=0.85), even in high-risk (ACS) patients. Non-inferiority was demonstrated for 6-month versus 24-month DAPT, with an absolute risk difference of 0.11% (95% CI: -1.04 to 1.26; p for non-inferiority = 0.0002). There were no significant differences in stent thrombosis and in bleeding complications. In the 792 (44%) high-risk patients with ACS, primary and secondary endpoints did not significantly differ 1.7% [95% CI: 0.519 to 6.057; p=0.361]. Interaction between DAPT duration and ACS was non significant (p=0.305). The ITALIC trial showed that rates of bleeding and of thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders. Is There A LIfe for DES after discontinuation of Clopidogrel NCT01476020.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015
Aims This study sought to compare the multislice computed tomography (MSCT) characteristics of bi... more Aims This study sought to compare the multislice computed tomography (MSCT) characteristics of bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) before and after implantation of the CoreValve (Medtronic, Santa Rosa, California) or the Edwards SapienXT (Edwards Lifesciences, Irvine, California). Methods and Results From March 2009 to March 2013, a total of 67 TAVI patients who had both pre- and post-procedural MSCT were studied. Eleven patients underwent TAVI in BAV with the CoreValve (n=6) or SapienXT (n=5) and 56 patients underwent TAVI in TAV with the CoreValve (n=38) or SapienXT (n=18). The BAV group was similar to the TAV group except for a higher pre-procedural mean pressure gradient (53.1±17.4 vs 48.8±20.4mmHg, p=0.03), a larger annulus perimeter (89.3±9.0 vs 81.8±8.1mm, p=0.03) and a higher aortic valve calcium volume (1262.7±396.0 vs 556.4±461.9mm(3) , p<0.01). In the CoreValve group, post-procedural mean pressure gradient was significantly higher in the BAV ...
Journal of Thrombosis and Haemostasis, 2006
identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascu... more identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome. J Thromb Haemost 2006; 4: 542-9. See also Galvani M. High postclopidogrel platelet reactivity in non-ST-elevation acute coronary syndrome treated with stenting: a clue for adverse prognosis? This issue, pp 536-8; Heptinstall S. Variable therapeutic effectiveness of clopidogrel in acute coronary syndromes. This issue, pp 539-41.
Journal of the American College of Cardiology, 2012
Journal of the American College of Cardiology, 2013
Background: Successful CTO treatment is able to increase left ventricular function, exercise capa... more Background: Successful CTO treatment is able to increase left ventricular function, exercise capacity and reduction of mortality. Up to date no adequate information on stent strut endothelialisation after CTO treatment is available. In particular, the duration of dual antiplatelet therapy (DAPT) remains an issue of debate. Following CTO treatment, patients are at risk for restenosis as well as stent thrombosis. DAPT is able to sufficient reduce frequency of stent thrombosis, but keeps an increased risk of major bleeding in case of unnecessarily prolonged ingestion. Intracoronary optical coherence tomography (OCT) is a novel invasive method, which is able to precisely analyse stent strut endothelialisation. We tested the hypothesis, that OCT detects delayed endothelialisation after CTO treatment compared to non-CTO PCI. Methods: We performed diagnostic OCT measurements following successful CTO treatment (n ¼ 22) as well as non-CTO DES PCI of complex lesions (n ¼ 29). All Patients had been treated with 2nd generation DES. Mean time point of OCT analysis was 7.8 months and 6.5 months, respectively (p ¼ 0.83). Results: The two groups were well matched and similar concerning characteristics. Stent struts (in total n ¼ 13629) were analysed and classified by OCT according to previously described methods (CTO recanalization vs. non-CTO DES; mean +/-SEM): covered struts: 81.65 +/-2.9% vs. 97.34 +/-0.78%, p<0.0001; protruding/uncovered struts: 10.1 +/-1.7% vs. 1.4 +/-0.4%, p<0.0001; malapposed/uncovered struts: 7.9 +/-2.0 % vs. 1.3 +/-0.5 %, p<0.001. We performed subgroup analysis concerning CTO recanalization by antegrade vs. retrograde approach as well as subintimal tracking vs. non-subintimal tracking methods. No significant differences were found concerning subgroup analysis. No MACE events were detected in this series. Conclusions: Here we describe delayed stent endothelialisation after CTO treatment. Our results suggest an urgent need to extend the DAPT after CTO treatment to reduce the risk of late stent thrombosis. OCT allows interventional cardiologists to safe and precisely perform follow-up examinations in patients after CTO recanalization with the ability of individualise the duration of DAPT.
Journal of Cardiovascular Magnetic Resonance, 2011
JACC. Cardiovascular interventions, Jan 16, 2015
The MAVERIC trial (Mitral Valve Repair Clinical Trial) reports the safety and efficacy of the ART... more The MAVERIC trial (Mitral Valve Repair Clinical Trial) reports the safety and efficacy of the ARTO system in patients with symptomatic heart failure and functional mitral regurgitation (FMR). The ARTO system percutaneously modifies the mitral annulus to improve leaflet coaptation in FMR. The MAVERIC trial is a prospective, nonrandomized first-in-human study. Key inclusion criteria were systolic heart failure New York Heart Association functional classes II to IV, FMR grade ≥2+, left ventricular (LV) ejection fraction ≤40%, LV end-diastolic diameter >50 mm and ≤75 mm. Exclusion criteria were clinical variables that precluded feasibility of the ARTO procedure. Primary outcomes were safety (30-day major adverse events) and efficacy (MR reduction, LV volumes, and functional status). Eleven patients received the ARTO system, and there were no procedural adverse events. From baseline to 30 days, there were meaningful improvements. Effective regurgitant orifice area decreased from 30.3 ...
Circulation, 2010
A 15-year-old boy without cardiovascular risk factors or autoimmune diseases was referred for a 4... more A 15-year-old boy without cardiovascular risk factors or autoimmune diseases was referred for a 4-year history of chest pain on exertion. His history was remarkable for a febrile illness at the age of 4 months, associated with heart failure and mildly depressed left ventricular function, from which he had made a full recovery.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 29, 2015
The American Journal of Cardiology, 2015
Several observational studies have compared clinical outcome in patients with a co-existing nonin... more Several observational studies have compared clinical outcome in patients with a co-existing noninfarct-related artery chronic total occlusion (n-IRA CTO) versus those without, suggesting increased all-cause mortality. The goal of this study was to provide a systematic review and meta-analysis evaluating the impact of the presence of an n-IRA CTO on short- and long-term mortality after primary percutaneous coronary intervention. Studies published from January 1980 to January 2014 that compared the incidence of all-cause mortality in patients with ST-segment elevation myocardial infarction with co-existing n-IRA CTO versus those without were identified using an electronic search and reviewed using meta-analytical techniques. Seven studies (5 observational studies and 2 observational analyses of randomized controlled trials) comprising 14,117 patients and 1,554 patients (11.7%) with n-IRA CTO were included. The presence of n-IRA CTO was associated with increased incidence of all-cause mortality at a median follow-up of 25.2 months (interquartile range 24 to 60) compared with no CTO (absolute risk 23.5% vs 9.0%; odds ratio [OR] 2.90, 95% confidence interval [CI] 2.09 to 4.01; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). This finding was consistent in the analysis of studies reporting 30-day follow-up (absolute risk 17.2% vs 4.7%; OR 3.79, 95% CI 3.13 to 4.59; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). Co-existing n-IRA CTO was also associated with increased mortality in a subanalysis of patients with multivessel disease only (absolute risk 24.2% vs 11.3%; OR 2.23, 95% CI 1.90 to 2.63; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). In conclusion, coronary CTO in the nonculprit artery in patients presenting with ST-segment elevation myocardial infarction is associated with increased short- and long-term all-cause mortality.
Archives des maladies du coeur et des vaisseaux
The authors report the case of a 67 year old caucasian female admitted for suspected acute corona... more The authors report the case of a 67 year old caucasian female admitted for suspected acute coronary syndrome with ST segment elevation. Coronary angiography did not show any coronary lesion but ventriculography revealed akinesia of the middle and apical segments with hyperkinesia at the base. An isolated moderate elevation of troponine Ic was noted. On the 10th day the methergin test was negative and ventriculography showed complete recovery of the left ventricular segmental kinetics. Left ventricular transient apical ballooning, or tako-tsubo syndrome, is characterised by reversible akinesia of the middle and apical segments with no associated coronary lesion or enzymatic elevation concordant with the extent of the akinetic areas. It mainly affects women between 50 and 60 years old and follows emotional or physical stress. The prognosis is excellent in survivors with a rapid return of normal systolic function. The pathophysiology remains debatable, excluding myocarditis in favour o...
Archives des maladies du coeur et des vaisseaux, 2006
In the TARGET trial, the lower incidence of cardiac events at one month with abciximab compared w... more In the TARGET trial, the lower incidence of cardiac events at one month with abciximab compared with tirofiban was attributed to a lack of efficacy in the first hour because of suboptimal dosage. The object of this study was to confirm that high dose tirofibal is associated with over 90% platelet inhibition during the first hour and to analyse the effect of this new dosage on platelet activation. Thirty-three patients treated with clopidogrel and aspirin for an acute coronary syndrome without ST elevation were given before angioplasty a bolus of 25 microg/Kg of tirofiban injected in 3 minutes, followed by an infusion of 0.15 microg/kg/min. Blood samples were taken before the treatment (TO) and at the 45th minute (T1) to measure platelet aggregation induced by ADP, the expression of P-selection, the quantification of circulating monocyte-platelet aggregates and the phospholyration of VASP protein. The results showed that all patients had over 90% (100%) inhibition of platelet aggrega...
Background: The purpose of this study was to elucidate impact of annulus ellipticity on clinical ... more Background: The purpose of this study was to elucidate impact of annulus ellipticity on clinical outcomes after transcatheter aortic valve implantation (TAVI).
Background: To evaluate the impact of the presence of a chronic total occlusion (CTO) on short an... more Background: To evaluate the impact of the presence of a chronic total occlusion (CTO) on short and long term mortality after primary percutaneous coronary intervention (PPCI). Methods: We performed MEDLINE, Cochrane Controlled Trials Registry and EMBASE database searches for published articles using predefined terms. Studies that reported data on the incidence of all-cause mortality in STEMI patients with single-or multivessel disease (SVD, MVD) with and without CTO were included. Of the 189 studies identified, 5 articles met the inclusion criteria: 3 observational studies and 2 post-hoc analyses of randomized controlled trials (RCTs). Results: A total of 10,314 patients were included in the meta-analysis with overall 1160 (11%) patients with CTO. The global analysis demonstrated that CTO was associated with an over 3-fold increased incidence of mortality at a median follow up of 36 months compared to patients non-CTO patients (30.4% vs 10.1% OR: 3.24; 95% confidence interval [CI]: 2.79 to 3.75; p 0.0001) . This finding was consistent in a sub-analysis of studies that reported 30-day follow up (17.6% vs 4.2 OR: 4.3; 95% CI: 3.4 to 5.4 p¼0.001). Cardiac mortality and MACE were also higher in patients with CTO (14.7% vs 3.7% OR: 4.42; 95% confidence interval [CI]: 3.18 to 6.15; p <0.0001 and 33.5% vs 20.4% OR: 1.97; 95% confidence interval [CI]: 1.56 to 2.47; p <0.0001 respectively). Conclusions: Coronary chronic total occlusion in the non-culprit artery in patients presenting with STEMI is associated with poor long-term mortality.
measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mea... more measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mean % DCFR pre TAVI to immediately post TAVI 8.6%, 95% CI -23.0 -40.3%, p¼0.41). Conclusions: TAVI does improve coronary flow dynamics as measured by CFR. This improvement does not occur immediately, but requires a period of time post-TAVI to manifest. The improvement in coronary flow reserve may represent a mechanism by which both symptoms and prognosis improve following TAVI.
Presse médicale (Paris, France : 1983)
As the French population is aging, a growing number of elderly patients with symptomatic severe a... more As the French population is aging, a growing number of elderly patients with symptomatic severe aortic stenosis are going to require therapeutic management. Approximately 30 to 40% of these patients do not undergo surgical treatment and a high proportion is considered to be at high risk for surgery. The transluminal aortic valve implantation technique has been increasingly used over the past few years, thus providing a solution to a major therapeutic issue in our industrialized countries. While the cardiology community was rapidly convinced of its efficacy, remaining doubts regarding the outcome of this technique in terms of mortality were erased by the recent publication of results achieved in cohort B of the Partner US trial. This new approach is clearly here to stay and should soon reach a maturity phase with respect to its indications, the selection of patients and technical aspects.
Circulation. Cardiovascular interventions, 2013
Bicuspid aortic valve (BAV) is regarded as a relative contraindication to transcatheter aortic va... more Bicuspid aortic valve (BAV) is regarded as a relative contraindication to transcatheter aortic valve implantation attributable to the risk of uneven expansion of the bioprosthesis. The purpose of this study was to evaluate the efficacy and safety of transcatheter aortic valve implantation in patients with BAV. Of 470 patients included in our prospective transcatheter aortic valve implantation database (October 2006-January 2012), 229 consecutive patients undergoing both echocardiography and multidetector computed tomography were analyzed. We compared clinical outcomes in patients with vs patients without BAV. In this series of 229 patients, BAV was detected by multidetector computed tomography in 21 patients (9.2%). BAV was identified by transthoracic and transoesophageal echocardiography in only 9 of these 21 patients. Patients were 83.1±6.6 years old, and European system for cardiac operative risk evaluation score was 20.0%±11.4%. The BAV group was similar to the non-BAV group exc...
Catheterization and Cardiovascular Interventions, 2014
measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mea... more measurements to follow-up, there was no significant improvement in CFR immediately post TAVI (mean % DCFR pre TAVI to immediately post TAVI 8.6%, 95% CI -23.0 -40.3%, p¼0.41). Conclusions: TAVI does improve coronary flow dynamics as measured by CFR. This improvement does not occur immediately, but requires a period of time post-TAVI to manifest. The improvement in coronary flow reserve may represent a mechanism by which both symptoms and prognosis improve following TAVI.
The American Journal of Cardiology, 2015
The Valve Academic Research Consortium-2 has defined body mass index (BMI) &amp;amp;amp;a... more The Valve Academic Research Consortium-2 has defined body mass index (BMI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 as indicative of frailty, which may be one of the co-morbidities not captured by traditional risk factors after transcatheter aortic valve replacement (TAVR). This study aimed to assess the impact of low BMI on clinical outcomes after TAVR. A total of 777 consecutive patients scheduled for TAVR were classified into 3 groups as BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 (n = 56), 20 to 24.9 (n = 322), and ≥25 (n = 399). Procedural complications and clinical outcomes were compared among the 3 groups. They were also analyzed according to propensity-matching model A (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [n = 50] vs ≥20 [n = 50]), model B (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [n = 50] vs 20 to 24.9 [n = 50]), and model C (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [n = 47] vs ≥25 [n = 47]). The differences in baseline characteristics among the 3 groups were adequately adjusted in 3 matched models. Valve Academic Research Consortium-2-defined end points and other complications were similar among the 3 groups in each model. Kaplan-Meier curves indicated no significant differences in cumulative 30-day survival (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [91.0%] vs 20 to 24.9 [86.3%], p = 0.33; BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [91.0%] vs ≥25 [91.4%], p = 0.91, respectively) and 1-year survival (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [74.3%] vs 20 to 24.9 [71.8%], p = 0.71; BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 [74.3%] vs ≥25 [77.0%], p = 0.71; respectively). These survival rates were also similar in each of the 3 matched models. In conclusion, BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 was not associated with increased early or midterm mortality. BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 alone may not constitute an additional co-morbidity factor in patients who underwent TAVR.
La Presse Médicale, 2011
As the French population is aging, a growing number of elderly patients with symptomatic severe a... more As the French population is aging, a growing number of elderly patients with symptomatic severe aortic stenosis are going to require therapeutic management. Approximately 30 to 40% of these patients do not undergo surgical treatment and a high proportion is considered to be at high risk for surgery. The transluminal aortic valve implantation technique has been increasingly used over the past few years, thus providing a solution to a major therapeutic issue in our industrialized countries. While the cardiology community was rapidly convinced of its efficacy, remaining doubts regarding the outcome of this technique in terms of mortality were erased by the recent publication of results achieved in cohort B of the Partner US trial. This new approach is clearly here to stay and should soon reach a maturity phase with respect to its indications, the selection of patients and technical aspects.
Journal of the American College of Cardiology, 2014
The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES... more The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES) recipients is 12 months, to reduce the risk of late stent thrombosis, particularly in acute coronary syndrome. It was hypothesized that antiplatelet treatment with DAPT for 6 versus may be non-inferior to DAPT for 24 months in aspirin-sensitive patients METHODS: A multicenter, randomized study assigned patients undergoing implantation of Xience V (Abbott vascular) to receive 6- or 24-month DAPT with confirmed non-resistance to aspirin. The primary endpoint was a composite of death, myocardial infarction, urgent target vessel revascularization, stroke and major bleeding at 12 months post-stenting. 2,031 patients were enrolled in 70 European and Middle East centers. The trial was prematurely terminated due to problems with recruitment. 941 patients were randomized to 24 month-DAPT and 953 to 6 month-DAPT; 137 patients were resistant to aspirin. The two treatment groups had similar baseline and procedural characteristics. There was no significant difference between the 2 treatment groups regarding the primary endpoint (1.5 vs. 1.6%, p=0.85), even in high-risk (ACS) patients. Non-inferiority was demonstrated for 6-month versus 24-month DAPT, with an absolute risk difference of 0.11% (95% CI: -1.04 to 1.26; p for non-inferiority = 0.0002). There were no significant differences in stent thrombosis and in bleeding complications. In the 792 (44%) high-risk patients with ACS, primary and secondary endpoints did not significantly differ 1.7% [95% CI: 0.519 to 6.057; p=0.361]. Interaction between DAPT duration and ACS was non significant (p=0.305). The ITALIC trial showed that rates of bleeding and of thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders. Is There A LIfe for DES after discontinuation of Clopidogrel NCT01476020.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015
Aims This study sought to compare the multislice computed tomography (MSCT) characteristics of bi... more Aims This study sought to compare the multislice computed tomography (MSCT) characteristics of bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) before and after implantation of the CoreValve (Medtronic, Santa Rosa, California) or the Edwards SapienXT (Edwards Lifesciences, Irvine, California). Methods and Results From March 2009 to March 2013, a total of 67 TAVI patients who had both pre- and post-procedural MSCT were studied. Eleven patients underwent TAVI in BAV with the CoreValve (n=6) or SapienXT (n=5) and 56 patients underwent TAVI in TAV with the CoreValve (n=38) or SapienXT (n=18). The BAV group was similar to the TAV group except for a higher pre-procedural mean pressure gradient (53.1±17.4 vs 48.8±20.4mmHg, p=0.03), a larger annulus perimeter (89.3±9.0 vs 81.8±8.1mm, p=0.03) and a higher aortic valve calcium volume (1262.7±396.0 vs 556.4±461.9mm(3) , p<0.01). In the CoreValve group, post-procedural mean pressure gradient was significantly higher in the BAV ...
Journal of Thrombosis and Haemostasis, 2006
identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascu... more identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome. J Thromb Haemost 2006; 4: 542-9. See also Galvani M. High postclopidogrel platelet reactivity in non-ST-elevation acute coronary syndrome treated with stenting: a clue for adverse prognosis? This issue, pp 536-8; Heptinstall S. Variable therapeutic effectiveness of clopidogrel in acute coronary syndromes. This issue, pp 539-41.
Journal of the American College of Cardiology, 2012
Journal of the American College of Cardiology, 2013
Background: Successful CTO treatment is able to increase left ventricular function, exercise capa... more Background: Successful CTO treatment is able to increase left ventricular function, exercise capacity and reduction of mortality. Up to date no adequate information on stent strut endothelialisation after CTO treatment is available. In particular, the duration of dual antiplatelet therapy (DAPT) remains an issue of debate. Following CTO treatment, patients are at risk for restenosis as well as stent thrombosis. DAPT is able to sufficient reduce frequency of stent thrombosis, but keeps an increased risk of major bleeding in case of unnecessarily prolonged ingestion. Intracoronary optical coherence tomography (OCT) is a novel invasive method, which is able to precisely analyse stent strut endothelialisation. We tested the hypothesis, that OCT detects delayed endothelialisation after CTO treatment compared to non-CTO PCI. Methods: We performed diagnostic OCT measurements following successful CTO treatment (n ¼ 22) as well as non-CTO DES PCI of complex lesions (n ¼ 29). All Patients had been treated with 2nd generation DES. Mean time point of OCT analysis was 7.8 months and 6.5 months, respectively (p ¼ 0.83). Results: The two groups were well matched and similar concerning characteristics. Stent struts (in total n ¼ 13629) were analysed and classified by OCT according to previously described methods (CTO recanalization vs. non-CTO DES; mean +/-SEM): covered struts: 81.65 +/-2.9% vs. 97.34 +/-0.78%, p<0.0001; protruding/uncovered struts: 10.1 +/-1.7% vs. 1.4 +/-0.4%, p<0.0001; malapposed/uncovered struts: 7.9 +/-2.0 % vs. 1.3 +/-0.5 %, p<0.001. We performed subgroup analysis concerning CTO recanalization by antegrade vs. retrograde approach as well as subintimal tracking vs. non-subintimal tracking methods. No significant differences were found concerning subgroup analysis. No MACE events were detected in this series. Conclusions: Here we describe delayed stent endothelialisation after CTO treatment. Our results suggest an urgent need to extend the DAPT after CTO treatment to reduce the risk of late stent thrombosis. OCT allows interventional cardiologists to safe and precisely perform follow-up examinations in patients after CTO recanalization with the ability of individualise the duration of DAPT.