Thierry Le Tourneau | Université de Nantes (original) (raw)

Papers by Thierry Le Tourneau

ESC Heart Failure

Several data suggest that acute myocarditis could be related to genetic variants involved in fami... more Several data suggest that acute myocarditis could be related to genetic variants involved in familial cardiomyopathies, particularly arrhythmogenic cardiomyopathy, but the management of patients with acute myocarditis and their families regarding their risk for having an associated inherited cardiomyopathy is unclear.

Objective. Mitral valve prolapse (MVP) is a common cardiac valve disease, which affects 1 in 40 i... more Objective. Mitral valve prolapse (MVP) is a common cardiac valve disease, which affects 1 in 40 in the general population. Previous GWAS have identified six risk loci for MVP. But these loci explained only partially the genetic risk for MVP. We aim to identify additional risk loci for MVP by adding a dataset from the UK Biobank. Approaches and Results. We re-analyzed 1,007/1,469 cases and 479/862 controls from the MVP-France study and the MVP-Nantes study, respectively. We re-imputed genotypes using HRC and TOPMed, and found this latter to perform better in terms of accuracy in the lower ranges of minor allele frequency (MAF) below 0.1. We then incorporated 434 MVP cases and 4,527 controls from the UKBiobank and conducted a meta-analysis GWAS including ~2000 MVP cases and over 6,800 controls for ~8 million genotyped or imputed common SNPs (MAF>0.01). We replicated the association on chr2 and now provide a finer association map near TNS1. We identified three suggestive risk loci, ...

Clinical Infectious Diseases

Background Diagnostic and patients’ management modifications induced by whole-body 18F-FDG-PET/CT... more Background Diagnostic and patients’ management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients. Methods 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients’ management plan were established jointly by two experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients’ management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established. Results Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (p<0.001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (p=0.005) (net reclassificati...

$Research paper thumbnail of Rational and design of the ROTAS study: a randomized study for the optimal treatment of symptomatic patients with low-gradient severe aortic valve stenosis and preserved left ventricular ejection fraction$

European Heart Journal - Cardiovascular Imaging

Aims Fifteen to thirty percentage of patients with severe aortic stenosis (AS) have preserved lef... more Aims Fifteen to thirty percentage of patients with severe aortic stenosis (AS) have preserved left ventricular ejection fraction (LVEF) and a discordant AS pattern at Doppler echocardiography, which is characterized by a small (<1 cm2) aortic area and low mean aortic gradient (<40 mmHg). The ‘Randomized study for the Optimal Treatment of symptomatic patients with low-gradient severe Aortic Stenosis and preserved left ventricular ejection fraction’ (ROTAS trial) aims at demonstrating the superiority of aortic valve replacement vs. a ‘watchful waiting strategy’ in symptomatic patients with low-gradient (LS), severe AS, and preserved LVEF, stratified according to indexed stroke volume, in terms of all-cause mortality or cardiovascular-related hospitalization during follow-up (FU). Methods and results The ROTAS trial will be a multicentre randomized non-blinded study involving 16 reference centres. AS severity will be confirmed by a multimodality approach (rest and stress echocard...

Structural Heart

ABSTRACT Background: The short and long-term effects of volume overload elimination on left ventr... more ABSTRACT Background: The short and long-term effects of volume overload elimination on left ventricular (LV) volumetric reverse-remodeling and systemic hemodynamic after surgery for chronic primary mitral regurgitation (MR) have been poorly explored. Methods: 224 patients (64 ± 13 years) with primary MR underwent serial MR and LV volumetric measurements at baseline, early (5[4–6] days) and late (428 [355–688] days) after surgery. Results: Early after surgery, the drop in LV end-diastolic volume (EDV index: 119 ± 25 to 75 ± 14 mL/m2, P < 0.0001) was tightly related to pre-operative regurgitant volume (RVol; r = 0.88, P < 0.0001) while end-systolic volume (ESV) index did not change. Although LV ejection fraction (EF) decreased (71 ± 8 to 54 ± 12%, P < 0.0001), forward stroke volume was maintained (P = 0.28). Patients with greater RVol experienced a greater decrease in EDV and LVEF. Later, ESV index decreased (P < 0.0001), EDV index decreased further and LVEF improved to 60 ± 8% (P < 0.0001). Finally, systemic vascular function changes were characterized by an improvement in resistance and compliance. Conclusion: LV volumetric reverse-remodeling after surgery for primary MR is a phased process. The initial response is driven essentially by elimination of MR with a greater decline in EF in patients with larger RVol. In the late phase LV systolic function improvement is generally observed. Overall, the degree of LV reverse-remodeling is related to the magnitude of RVol, which predicts the early decline in EDV. Finally, LV reverse-remodeling is associated to systemic vascular function remodeling.

Scandinavian journal of medicine & science in sports, Nov 1, 2018

We thank Stivalet et al. for their letter about our manuscript studying ankle pressure and ankle ... more We thank Stivalet et al. for their letter about our manuscript studying ankle pressure and ankle brachial index (ABI) after incremental heavy load exercise. The detailed description of procedures and populations of the previous studies are of interest and correct but the suggestion that we calmed that the "American Heart Association (AHA) criteria after a heavy load test on a cycle ergometer are inadequate for the diagnosis of lower extremity peripheral artery disease (PAD)" is not exact… Stivalet et al. have twisted the order of words of our original citation. This article is protected by copyright. All rights reserved.

Archives of Cardiovascular Diseases

Statistics in medicine, Jan 15, 2018

Multistate models with interval-censored data, such as the illness-death model, are still not use... more Multistate models with interval-censored data, such as the illness-death model, are still not used to any considerable extent in medical research regardless of the significant literature demonstrating their advantages compared to usual survival models. Possible explanations are their uncommon availability in classical statistical software or, when they are available, by the limitations related to multivariable modelling to take confounding into consideration. In this paper, we propose a strategy based on propensity scores that allows population causal effects to be estimated: the inverse probability weighting in the illness semi-Markov model with interval-censored data. Using simulated data, we validated the performances of the proposed approach. We also illustrated the usefulness of the method by an application aiming to evaluate the relationship between the inadequate size of an aortic bioprosthesis and its degeneration or/and patient death. We have updated the R package multistat...

Heart (British Cardiac Society), Jan 19, 2018

Mitral valve prolapse (MVP) is a common condition that affects 2%-3% of the general population. M... more Mitral valve prolapse (MVP) is a common condition that affects 2%-3% of the general population. MVP is thought to include syndromic forms such as Marfan syndrome and non-syndromic MVP, which is the most frequent form. Myxomatous degeneration and fibroelastic deficiency (FED) are regarded as two different forms of non-syndromic MVP. While FED is still considered a degenerative disease associated with ageing, frequent familial clustering has been demonstrated for myxomatous MVP. Familial and genetic studies led to the recognition of reduced penetrance and large phenotypic variability, and to the identification of prodromal or atypical forms as a part of the complex spectrum of the disease. Whereas autosomal dominant mode is the common inheritance pattern, an X linked form of non-syndromic MVP was recognised initially, related to Filamin-A gene, encoding for a cytoskeleton protein involved in mechanotransduction. This identification allowed a comprehensive description of a new subtype ...

Journal of Thoracic Disease

Chest, Feb 1, 2017

Discriminating circulatory problems with reduced stroke volume (SV) from deconditioning, in which... more Discriminating circulatory problems with reduced stroke volume (SV) from deconditioning, in which the muscles cannot consume oxygen normally, by gas exchange parameters is difficult. We performed combined stress echocardiography (SE) and cardiopulmonary exercise tests (CPET) in 110 patients (20 with normal effort capacity, 54 with attenuated SV response, and 36 with deconditioning) to evaluate multiple hemodynamic parameters and oxygen content difference (A-V.o2 Diff) in four predefined activity levels to assess which of the gas measures may help in the discrimination. Reduced anaerobic threshold (AT), low unchanging peak oxygen pulse, periodic breathing, shallow Δ peak oxygen consumption (V.o2)/Δwork rate (WR) ratio, and high expired volume per unit time/carbon dioxide production (V.e/V.co2) slope were all associated with abnormal SV response (P < .05 for all). The best discriminator was V.e/V.co2 slope to V.o2 ratio (≥ 2.7; area under the curve [AUC], 0.79; P < .0001). The o...

The American Journal of Cardiology, 2016

Combining echocardiography and cardiopulmonary stress testing allows noninvasive assessment of he... more Combining echocardiography and cardiopulmonary stress testing allows noninvasive assessment of hemodynamics, and oxygen extraction (A-VO2 difference). We evaluated mechanisms of effort intolerance in patients with heart failure with borderline (40% to 49%) left ventricular ejection fraction (EF) (HF and Borderline Ejection fraction). We included 89 consecutive patients with HF and Borderline Ejection fraction (n = 25; 63.6 ± 14 years, 64% men), control subjects (n = 22), patients with HF with preserved EF (n = 26; EF ≥50%), and patients with HF with reduced EF (n = 16; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40%). Various echo parameters (left ventricular volumes, EF, stroke volume, mitral regurgitation [MR] volume, e&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, right ventricle end-diastolic area, and right ventricle end-systolic area), and ventilatory or combined parameters (peak oxygen consumption [VO2] and A-VO2 difference) were measured at 4 predefined activity stages. Effort-induced functional MR was frequent and more prevalent in HF and Borderline Ejection fraction than in all the other types of HF. In multivariable analysis heart rate response (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), A-VO2 difference (p = 0.02), stroke volume (p = 0.002), and right ventricle end-systolic area were the only independent predictors of exercise capacity in HF and Borderline Ejection fraction but peak EF was not. In HF and Borderline Ejection fraction exercise intolerance is predominantly due to chronotropic incompetence, peripheral factors, and limited stroke volume reserve, which are related to right ventricle dysfunction and functional MR but not to left ventricular ejection fraction. Combined testing can be helpful in determining mechanisms of exercise intolerance in HF and Borderline Ejection fraction.

Xenotransplantation, 2016

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 20, 2016

Cardiac cell therapy is a promising treatment for acute myocardial infarction (AMI), leading to c... more Cardiac cell therapy is a promising treatment for acute myocardial infarction (AMI), leading to cardiac function improvement. However, whether it translates into quality of life (QoL) improvement is unclear. We hypothesized that administration of bone marrow cells (BMC) to patients with AMI improves QoL. In the multicenter BONAMI trial (NCT00200707), patients with reperfused AMI and decreased myocardial viability were randomized to intracoronary autologous BMC infusion (n = 52) or state-of-the-art therapy (n = 49). QoL data, derived from the Minnesota Living with Heart Failure questionnaire (MLHFQ), were obtained 1, 3, and 12 months after AMI and analyzed using a Rasch-family model. Using this model, QoL improved over time in the BMC group (p = 0.025) but not in the control group. Furthermore, the BMC-group patients displayed a better QoL than the control-group patients at 3 and 12 months post-AMI (p = 0.034 and p = 0.003, respectively). These findings were not detected when analyzi...

The Journal of Heart Valve Disease, Oct 1, 2007

Intensive Care Medicine, 2015

Stress cardiomyopathy is a common life-threatening complication after aneurysmal subarachnoid hem... more Stress cardiomyopathy is a common life-threatening complication after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that left ventricular (LV) longitudinal strain alterations assessed with speckle tracking could identify early systolic function impairment. This was an observational single-center prospective pilot controlled study conducted in a neuro-intensive care unit. Forty-six patients with severe SAH with a World Federation of Neurological Surgeons grade (WFNS) ≥III were included. Transthoracic echocardiography (TTE) was performed on day 1, day 3, and day 7 after the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s admission. A cardiologist blinded to the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s management analyzed the LV global longitudinal strain (GLS). The control group comprised normal subjects matched according to gender and age. On day 1 median (25th-75th percentile) GLS was clearly impaired in SAH patients compared to controls [-16.7 (-18.7/-13.7) % versus -20 (-22/-19) %, 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;lt; 0.0001], whereas LVEF was preserved [65 (59-70) %]. GLS was severely impaired in patients with a WFNS score of V versus III-IV [-15.6 (-16.9/-12.3) % versus -17.8 (-20.6/-15.8) %, p = 0.008]. Seventeen (37 %) patients had a severe GLS alteration (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;-16 %). In these patients, GLS improved from day 1 [-12.4 (-14.8/-10.9) %] to last evaluation [-16.2 (-19/-14.6) %, p = 0.0007] in agreement with the natural evolution of stress cardiomyopathy. On the basis of LV GLS assessment, we demonstrated for the first time that myocardial alteration compatible with a stress cardiomyopathy is detectable in up to 37 % of patients with severe SAH while LVEF is preserved. GLS could be used for sensitive detection of stress cardiomyopathy. This is critical because cardiac impairment remains a major cause of morbidity and mortality after SAH.

Journal de Radiologie, 2006

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La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne, 2012

Myocarditis is an inflammatory disease of the myocardium associated with cardiac dysfunction. Eti... more Myocarditis is an inflammatory disease of the myocardium associated with cardiac dysfunction. Etiologies of myocarditis are numerous - viral causes being the most frequent - as well as their clinical presentations which varies from isolated increase in cardiac enzymes during a viral pericarditis, fulminant myocarditis associated with cardiogenic shock to endomyocardial biopsy proven inflammation discovered during the etiologic diagnosis of a dilated cardiomyopathy. This article will discuss the importance of recognition of specific clinical scenarios of myocarditis and their echocardiographic presentations that are very useful for the etiologic diagnosis and to decide the medical strategy. Recent advances in the field of myocarditis concern improvement in understanding the pathophysiology, in the diagnostic approach with the use of noninvasive imaging (MRI) and molecular biology. However, specific treatment is still limited. Clinical trials with antiviral medications are not conclus...