- Email: [email protected]
Incidence, characteristics, risk factors and outcomes of supraventricular arrhythmias in Takotsubo cardiomyopathy
34
02 — Heart failure and cardiomyopathies
if they had an ACS with typical TK echocardiographic anomalies and a normal coronary angiogram (CA). Three groups were established: definite TK (D) if cardiac magnetic resonance imaging (MRI) excluded any other etiology; highly, probable TK (HP) if low probability of a differential diagnosis but MRI was not performed; possible TK (P) if lack of data. Weather data was extracted from the Swiss weather institute registries. A HS day is a day with a temperature above 30 ◦ C preceded by 3 days hotter than 30 ◦ C. Results Three hundred and twenty cases of ACS were reviewed, 43 with normal CA, of which 11 TK: 3 D, 6 HP and 2 P. HS days wise, the hottest year was 2015, then 2016, 2012, 2013 and 2014. We recorded a total of 8 cases of TK in the 2 hottest summers vs. 3 TK over the 2 coolest summers (OR: 2.7). The strongest predictor of TK was the number of HS days. Average summer temperature was less correlated to TK incidence and the amount of rainfall seems to have no impact (Table 1). Conclusion Annual variations of the summer incidence of TK seems correlated to the number of HS days rather than just average temperature. Rainfall seems not to be related to the incidence of TK. Those results need to be confirmed on a larger scale. Table 1 Incidence of Takotsubo cardiomyopathy (TK) according to weather. A heat stroke day is a day > 30 ◦ C preceded by 3 consecutive days > 30 ◦ C.
2012 2013 2014 2015 2016
Average temperature (◦ C)
Heat stroke daysa
Days > 30◦ C
TK
20.6 20.2 19.2 21.9 20.4
4 11 0 22 8
20 30 7 45 28
0 2 1 4 4
a Abstract 21 — Incidence of Takotsubo cardiomyopathy (TK) according to weather. A heat stroke day is a day > 30 ◦ C preceded by 3 consecutive days > 30 ◦ C.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.065 166
Incidence, characteristics, risk factors and outcomes of supraventricular arrhythmias in Takotsubo cardiomyopathy O. Auzel 1,2,∗ , H. Mustafic 3 , R. El Mahmoud 1 , R. Pilliere 1 , O. Dubourg 1,2 , N. Mansencal 1,2 1 Department of Cardiology, Ambroise-Paré Hospital, Assistance publique—Hôpitaux de Paris (AP—HP), centre de référence des maladies cardiaques héréditaires, université de Versailles-Saint-Quentin (UVSQ), Boulogne-Billancourt, France 2 Inserm U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France 3 Intensive Care Department, Geneva University Hospital, Geneva, Switzerland ∗ Corresponding author. Department of Cardiology, Ambroise-Paré Hospital, Assistance publique—Hôpitaux de Paris (AP—HP), centre de référence des maladies cardiaques héréditaires, université de Versailles-Saint-Quentin (UVSQ), Boulogne-Billancourt, France. E-mail address: [email protected] (O. Auzel) Background Takotsubo cardiomyopathy (TTC) is a medical entity mimicking an acute coronary syndrome (ACS). During the acute phase, several complications may occur, even if the prognosis is generally favorable. Only small studies reported a description of supraventricular arrhythmia (SA) in TTC and little is known about related incidence. We sought to describe the characteristics, inci-
dence, predictive factors and outcomes of SA inpatients presenting with TTC. Methods Over a twelve-year period, we reviewed all patients (n = 5484) referred to our coronary care unit (CCU) for a suspicion of ACS. All patients presented with a confirmed diagnosis of TTC and a normalization of left ventricular ejection fraction (LEVF) during follow-up. In CCU, all patients were continually monitored by 12-lead ECG to detect the occurrence of SA. Results TTC was diagnosed in 88 patients according to the Mayo Clinic criteria, in sinus rhythm at the time of diagnosis. Incidence of SA among TTC was 14%. A difference was observed between patients with or without SA occurrence: age, hypertension, systolic pulmonary artery pressure and duration of hospitalization. Of note, patient with SA had significantly more depressed left ventricular ejection fraction at admission (P = 0.006). A large part of patient presenting SA required the use of diuretic for heart failure during hospitalization (P = 0.026). In multivariate analysis, the factors significantly associated with an increased risk of VA were: age (aOR = 1.19, 95% CI: 1.01—1.39, P = 0.029) and LEVF (aOR = 0.89, 95% CI: 0.8—0.97; P = 0.037). There was no significant difference in mortality rate between patients with or without SA during follow-up. Conclusions SA occurred in 14% of patients at the acute phase of TTC and independent predictive factors of SA were age and LEVF. During the acute phase, identification of high-risk SA patients allows better management, with ECG monitoring and therapeutic intervention in the CCU. Disclosure of interest Fédération franc ¸aise de cardiologie. https://doi.org/10.1016/j.acvdsp.2017.11.066 476
Left bundle branch block in Duchenne muscular dystrophy: Prevalence, genetic relationship and prognosis A. Fayssoil 1,∗ , R. Ben Yaou 2 , A. Ogna 1 , C. Chaffaut 3 , F. Leturcq 4,5 , O. Nardi 1 , F. Lofaso 1 , H. Prigent 1 , B. Clair 1 , S. Chevret 3 , D. Orlikowski 1 , D. Annane 1 1 CHU Raymond-Poincaré, Garches, France 2 Institut de myologie, CHU Pitié-Salpêtrière, France 3 SBIM, hôpital Saint-Louis, France 4 Laboratoire de biochimie et génétique moléculaire, hôpital Cochin, université Paris-Descartes-Sorbonne Paris Cité, AP—HP, Paris, France 5 CHU Cochin, Paris, France ∗ Corresponding author. E-mail address: [email protected] (A. Fayssoil) Background Duchenne muscular dystrophy (DMD) is an inherited myogenic disorder due to mutations in the dystrophin gene on chromosome Xp21.1. We designed this study to determine the prevalence of LBBB, whether there is a relationship between LBBB and genetic pattern and to assess predictive factors of acute cardiac events in adult DMD patients. Methods We reviewed the charts of DMD followed at the Home Mechanical Ventilation Unit of the Raymond Poincare University Hospital. Results A total of 121 patients, aged from 18 years to 41 years were included in our study. Median VC was 12% [7;19.5] of predicted. Almost all patients were on home mechanical ventilation (95%). LBBB was present in 15 patients (13%); among them, 10 disclosed exonic deletions. After a median follow-up of 6 years, 21 patients (17%) experienced acute heart failure (AHF), 7 patients (6%) supraventricular arrhythmia, 3 patients (2.4%) ventricular arrhythmia, 4 patients (3%) significant electrical disturbances. LBBB was significantly associated with cardiac events (OR = 12.7; 95%CI [3.78—42.7]; P < 0.0001) and mortality (OR = 4.4; 95%CI [1.44—13.7]; P: 0.009). Presence of residual dystrophin protein was associated
02 — Heart failure and cardiomyopathies
if they had an ACS with typical TK echocardiographic anomalies and a normal coronary angiogram (CA). Three groups were established: definite TK (D) if cardiac magnetic resonance imaging (MRI) excluded any other etiology; highly, probable TK (HP) if low probability of a differential diagnosis but MRI was not performed; possible TK (P) if lack of data. Weather data was extracted from the Swiss weather institute registries. A HS day is a day with a temperature above 30 ◦ C preceded by 3 days hotter than 30 ◦ C. Results Three hundred and twenty cases of ACS were reviewed, 43 with normal CA, of which 11 TK: 3 D, 6 HP and 2 P. HS days wise, the hottest year was 2015, then 2016, 2012, 2013 and 2014. We recorded a total of 8 cases of TK in the 2 hottest summers vs. 3 TK over the 2 coolest summers (OR: 2.7). The strongest predictor of TK was the number of HS days. Average summer temperature was less correlated to TK incidence and the amount of rainfall seems to have no impact (Table 1). Conclusion Annual variations of the summer incidence of TK seems correlated to the number of HS days rather than just average temperature. Rainfall seems not to be related to the incidence of TK. Those results need to be confirmed on a larger scale. Table 1 Incidence of Takotsubo cardiomyopathy (TK) according to weather. A heat stroke day is a day > 30 ◦ C preceded by 3 consecutive days > 30 ◦ C.
2012 2013 2014 2015 2016
Average temperature (◦ C)
Heat stroke daysa
Days > 30◦ C
TK
20.6 20.2 19.2 21.9 20.4
4 11 0 22 8
20 30 7 45 28
0 2 1 4 4
a Abstract 21 — Incidence of Takotsubo cardiomyopathy (TK) according to weather. A heat stroke day is a day > 30 ◦ C preceded by 3 consecutive days > 30 ◦ C.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.065 166
Incidence, characteristics, risk factors and outcomes of supraventricular arrhythmias in Takotsubo cardiomyopathy O. Auzel 1,2,∗ , H. Mustafic 3 , R. El Mahmoud 1 , R. Pilliere 1 , O. Dubourg 1,2 , N. Mansencal 1,2 1 Department of Cardiology, Ambroise-Paré Hospital, Assistance publique—Hôpitaux de Paris (AP—HP), centre de référence des maladies cardiaques héréditaires, université de Versailles-Saint-Quentin (UVSQ), Boulogne-Billancourt, France 2 Inserm U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France 3 Intensive Care Department, Geneva University Hospital, Geneva, Switzerland ∗ Corresponding author. Department of Cardiology, Ambroise-Paré Hospital, Assistance publique—Hôpitaux de Paris (AP—HP), centre de référence des maladies cardiaques héréditaires, université de Versailles-Saint-Quentin (UVSQ), Boulogne-Billancourt, France. E-mail address: [email protected] (O. Auzel) Background Takotsubo cardiomyopathy (TTC) is a medical entity mimicking an acute coronary syndrome (ACS). During the acute phase, several complications may occur, even if the prognosis is generally favorable. Only small studies reported a description of supraventricular arrhythmia (SA) in TTC and little is known about related incidence. We sought to describe the characteristics, inci-
dence, predictive factors and outcomes of SA inpatients presenting with TTC. Methods Over a twelve-year period, we reviewed all patients (n = 5484) referred to our coronary care unit (CCU) for a suspicion of ACS. All patients presented with a confirmed diagnosis of TTC and a normalization of left ventricular ejection fraction (LEVF) during follow-up. In CCU, all patients were continually monitored by 12-lead ECG to detect the occurrence of SA. Results TTC was diagnosed in 88 patients according to the Mayo Clinic criteria, in sinus rhythm at the time of diagnosis. Incidence of SA among TTC was 14%. A difference was observed between patients with or without SA occurrence: age, hypertension, systolic pulmonary artery pressure and duration of hospitalization. Of note, patient with SA had significantly more depressed left ventricular ejection fraction at admission (P = 0.006). A large part of patient presenting SA required the use of diuretic for heart failure during hospitalization (P = 0.026). In multivariate analysis, the factors significantly associated with an increased risk of VA were: age (aOR = 1.19, 95% CI: 1.01—1.39, P = 0.029) and LEVF (aOR = 0.89, 95% CI: 0.8—0.97; P = 0.037). There was no significant difference in mortality rate between patients with or without SA during follow-up. Conclusions SA occurred in 14% of patients at the acute phase of TTC and independent predictive factors of SA were age and LEVF. During the acute phase, identification of high-risk SA patients allows better management, with ECG monitoring and therapeutic intervention in the CCU. Disclosure of interest Fédération franc ¸aise de cardiologie. https://doi.org/10.1016/j.acvdsp.2017.11.066 476
Left bundle branch block in Duchenne muscular dystrophy: Prevalence, genetic relationship and prognosis A. Fayssoil 1,∗ , R. Ben Yaou 2 , A. Ogna 1 , C. Chaffaut 3 , F. Leturcq 4,5 , O. Nardi 1 , F. Lofaso 1 , H. Prigent 1 , B. Clair 1 , S. Chevret 3 , D. Orlikowski 1 , D. Annane 1 1 CHU Raymond-Poincaré, Garches, France 2 Institut de myologie, CHU Pitié-Salpêtrière, France 3 SBIM, hôpital Saint-Louis, France 4 Laboratoire de biochimie et génétique moléculaire, hôpital Cochin, université Paris-Descartes-Sorbonne Paris Cité, AP—HP, Paris, France 5 CHU Cochin, Paris, France ∗ Corresponding author. E-mail address: [email protected] (A. Fayssoil) Background Duchenne muscular dystrophy (DMD) is an inherited myogenic disorder due to mutations in the dystrophin gene on chromosome Xp21.1. We designed this study to determine the prevalence of LBBB, whether there is a relationship between LBBB and genetic pattern and to assess predictive factors of acute cardiac events in adult DMD patients. Methods We reviewed the charts of DMD followed at the Home Mechanical Ventilation Unit of the Raymond Poincare University Hospital. Results A total of 121 patients, aged from 18 years to 41 years were included in our study. Median VC was 12% [7;19.5] of predicted. Almost all patients were on home mechanical ventilation (95%). LBBB was present in 15 patients (13%); among them, 10 disclosed exonic deletions. After a median follow-up of 6 years, 21 patients (17%) experienced acute heart failure (AHF), 7 patients (6%) supraventricular arrhythmia, 3 patients (2.4%) ventricular arrhythmia, 4 patients (3%) significant electrical disturbances. LBBB was significantly associated with cardiac events (OR = 12.7; 95%CI [3.78—42.7]; P < 0.0001) and mortality (OR = 4.4; 95%CI [1.44—13.7]; P: 0.009). Presence of residual dystrophin protein was associated