- Email: [email protected]
Influence of fetunin-A level on progression of calcific aortic valve stenosis – the COFRASA – GENERAC Study
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Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
715
cians and agreeing surgical management in the French National Reference Center (Paris). Primary endpoint was survival regarding PEA expertise.
Influence of fetunin-A level on progression of calcific aortic valve stenosis – the COFRASA – GENERAC Study
Results Fifty-nine CTEPH patients were included. Mean age was 66±13 years, and 56% patients were women. Mean follow-up was 46 months. PEA expertise in the French referral center was conducted in twenty-five patients. In the PEA expertise group, treatment was PEA (68%), pulmonary angioplasty (12%) and medical treatment (20%). As compared to the non-expertise group, survival in the PEA expertise group was significantly better (96%, 96% and 89% at 1, 3 and 5 years versus 82%, 65% and 53% respectively p=0.002). In multivariate analysis, PEA expertise, adjusted for age and creatinine level, was the only significant predictive factor of survival in the CTEPH population (HR 0.26, p=0.039, 95% CI [0.007-0.94]).
A. Testuz*, N. Kubota, V. Nguyen, T. Mathieu, C. Kerneis, I. Codogno, A. Vahanian, D. Messika-Zeitoun APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France *Corresponding author: [email protected] Background In recent years, pathophysiology of aortic stenosis (AS) has been considered as a possibly active inflammatory process, but its determinants remain unclear. Calcium tissue deposition observed in dilaysis patients have been linked to low level of Fetuin-A, a powerful inhibitor of ectopic calcification. It is thus suspected to play a role in development of aortic stenosis. Purpose To assess correlation between Fetuin-A level and AS progression in a prospective cohort of AS patients, COFRASA (clinicalTrial. gov_number_NCT00338676) and GENERAC (clinicalTrial. gov_number_NCT00647088). Methods Comprehensive clinical evaluation and Fetuin-A blood level measurement were performed at baseline. AS severity was evaluated at baseline and yearly thereafter using echocardiography (mean pressure gradient (MPG)) and computed tomography (degree of aortic valve calcification or AVC). Annual progression was calculated as [(final measurement – baseline measurement)/follow-up duration] for both MPG and AVC measurements. Results We enrolled 296 patients with at least 1 year of follow-up. Mean age was 74±10 years, 217 (73%) were men. Mean Fetuin-A level was 0.55±0,15g/L. After a mean follow-up of 3.0±1.7 years, no correlation was found between AS progression and Fetuin-A level, using either MPG (r=0.015, p=0.82) or AVC (r=0.014, p=0.82). This was also true when comparing patients with lower level of Fetuin-A (≤0,53g/L, the median in our cohort) with patients with higher level) (+3±5 mmHg/year (median 2, [0-5] vs +4±4 mmHg/year (median 2, [1-6]) p=0.06, and +205±290 AUC/year (median 122, [32-269]) vs +240±310 AUC/year (median 145, [50-313], p=0.24). This remained true after adjustment for baseline severity and valve anatomy. Conclusions In our prospective cohort of AS patients we found no impact of Fetuin-A on AS progression, both hemodynamic and anatomic. Despite strong capacity to inhibit ectopic calcium deposition, Fetuin-A seems to play minor role in AS progression. The authors hereby declare no conflict of interest
200 Prognostic impact of pulmonary endarterectomy national expertise in patients with chronic thromboembolic pulmonary hypertension: results from a single regional cohort J. Pradier* (1), S. Renard (1), M. Nicolas (2), R. Giorgi (3)-(4), J. Haentjens (1), G. Habib (1) (1) APHM-CHU La Timone, Cardiologie, Marseille, France - (2) Hôpital Saint Joseph, Cardiologie, Marseille, France – (3) Université Aix-Marseille, UMR_S 912 (SESSTIM), IRD, Marseille, France – (4) APHM-CHU La Timone, Biostatistique et technologies de l’information et de la communication, Marseille, France *Corresponding author: [email protected] Background Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by vascular obstruction and remodeling. Pulmonary endarterectomy (PEA) is the recommended curative treatment option for CTEPH. PEA expertise, performed in referral surgical center is required to select surgical candidate. PEA expertise should thus be carried out in all CTEPH patients. However, operability assessment is not routinely conducted especially for patients monitored in non-surgical regional centers. Purpose to evaluate prognostic impact of PEA expertise provided by referral surgical center in a CTEPH remote regional cohort. Materials and Methods This retrospective monocentric cohort study was conducted by the regional center of pulmonary hypertension in Marseille (France) from 2003 to 2016. Patients with symptomatic CTEPH (III-IV functional class) were successively included. The PEA expertise group was defined as all CTEPH patients considered eligible for PEA expertise by clini-
© Elsevier Masson SAS. All rights reserved.
Conclusion National PEA expertise improve survival in symptomatic CTEPH patients from remote regional cohort. The authors hereby declare no conflict of interest
225 Should diuretic first attempted in patients with severe secondary tricuspid regurgitation? H. Doan*, L. Oliver, T. D’Humières, L. Faivre, JL. Monin, JL. Dubois Randé, P. Lim, J. Ternacle APHP-CHU Henri Mondor, Créteil, France *Corresponding author: [email protected] Background Medical treatment based on diuretic is often attempted in patients with severe functional tricuspid regurgitation (TR) even when surgery risk is acceptable. However, the efficiency of this therapy strategy is uncertain and may delay tricuspid repair. Methods The study included 30 patients (mean age 71±12 years, 50% female) with a moderate-to-severe secondary TR (PISA radius ≥7mm at Nyquist limit of 28cm/s). TR severity was assessed by echocardiography before and after diuretic treatment (furosemide or equivalent). Reduction in TR was defined by a decrease in PISA radius > 50%. Primary outcome included heart failure hospitalization and cardiac mortality. Results Overall, most of patients included had previous history of left side surgery (40%) and right ventricular dysfunction [57% with tricuspid annular plane systolic excursion (TAPSE)<16mm]. Mean left ventricular ejection fraction was 39±14%. Following the first echocardiography evaluation, furosemide was started at 244±325mg. Decrease in TR severity was observed in only 7 patients (23%) after a median period of 60 days. Death (N=7, 23%) and heart failure hospitalization (N=14, 47%) reported in 50% (N=15) of patients was associated with history of cardiogenic shock (P=0.03), TAPSE (P=0.03), and pulmonary systolic pressure (P=0.02). In contrast, decrease in TR severity had no impact on patient outcome. Conclusion Decrease in TR severity under diuretic is limited (23% of patients) and had no impact on patient outcome. These data suggest that medical treatment should not delay cardiac surgery. The authors hereby declare no conflict of interest
701 Does tricuspid annuloplasty increases surgical mortality and morbidity during mitral valve replacement? A. Darmon*, C. Verdonk, L. Lepage, C. Cimadevilla, P. Nataf, A. Vahanian, D. Messika-Zeitoun APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France *Corresponding author: [email protected] Background Current recommendation considers performing tricuspid annuloplasty at the time of mitral valve surgery based on degree of tricuspid regurgitation (TR) and tricuspid annulus size. However, both surgeons and cardiologist are reluctant to perform a tricuspid surgery arguing an increased surgical risk.
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
715
cians and agreeing surgical management in the French National Reference Center (Paris). Primary endpoint was survival regarding PEA expertise.
Influence of fetunin-A level on progression of calcific aortic valve stenosis – the COFRASA – GENERAC Study
Results Fifty-nine CTEPH patients were included. Mean age was 66±13 years, and 56% patients were women. Mean follow-up was 46 months. PEA expertise in the French referral center was conducted in twenty-five patients. In the PEA expertise group, treatment was PEA (68%), pulmonary angioplasty (12%) and medical treatment (20%). As compared to the non-expertise group, survival in the PEA expertise group was significantly better (96%, 96% and 89% at 1, 3 and 5 years versus 82%, 65% and 53% respectively p=0.002). In multivariate analysis, PEA expertise, adjusted for age and creatinine level, was the only significant predictive factor of survival in the CTEPH population (HR 0.26, p=0.039, 95% CI [0.007-0.94]).
A. Testuz*, N. Kubota, V. Nguyen, T. Mathieu, C. Kerneis, I. Codogno, A. Vahanian, D. Messika-Zeitoun APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France *Corresponding author: [email protected] Background In recent years, pathophysiology of aortic stenosis (AS) has been considered as a possibly active inflammatory process, but its determinants remain unclear. Calcium tissue deposition observed in dilaysis patients have been linked to low level of Fetuin-A, a powerful inhibitor of ectopic calcification. It is thus suspected to play a role in development of aortic stenosis. Purpose To assess correlation between Fetuin-A level and AS progression in a prospective cohort of AS patients, COFRASA (clinicalTrial. gov_number_NCT00338676) and GENERAC (clinicalTrial. gov_number_NCT00647088). Methods Comprehensive clinical evaluation and Fetuin-A blood level measurement were performed at baseline. AS severity was evaluated at baseline and yearly thereafter using echocardiography (mean pressure gradient (MPG)) and computed tomography (degree of aortic valve calcification or AVC). Annual progression was calculated as [(final measurement – baseline measurement)/follow-up duration] for both MPG and AVC measurements. Results We enrolled 296 patients with at least 1 year of follow-up. Mean age was 74±10 years, 217 (73%) were men. Mean Fetuin-A level was 0.55±0,15g/L. After a mean follow-up of 3.0±1.7 years, no correlation was found between AS progression and Fetuin-A level, using either MPG (r=0.015, p=0.82) or AVC (r=0.014, p=0.82). This was also true when comparing patients with lower level of Fetuin-A (≤0,53g/L, the median in our cohort) with patients with higher level) (+3±5 mmHg/year (median 2, [0-5] vs +4±4 mmHg/year (median 2, [1-6]) p=0.06, and +205±290 AUC/year (median 122, [32-269]) vs +240±310 AUC/year (median 145, [50-313], p=0.24). This remained true after adjustment for baseline severity and valve anatomy. Conclusions In our prospective cohort of AS patients we found no impact of Fetuin-A on AS progression, both hemodynamic and anatomic. Despite strong capacity to inhibit ectopic calcium deposition, Fetuin-A seems to play minor role in AS progression. The authors hereby declare no conflict of interest
200 Prognostic impact of pulmonary endarterectomy national expertise in patients with chronic thromboembolic pulmonary hypertension: results from a single regional cohort J. Pradier* (1), S. Renard (1), M. Nicolas (2), R. Giorgi (3)-(4), J. Haentjens (1), G. Habib (1) (1) APHM-CHU La Timone, Cardiologie, Marseille, France - (2) Hôpital Saint Joseph, Cardiologie, Marseille, France – (3) Université Aix-Marseille, UMR_S 912 (SESSTIM), IRD, Marseille, France – (4) APHM-CHU La Timone, Biostatistique et technologies de l’information et de la communication, Marseille, France *Corresponding author: [email protected] Background Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by vascular obstruction and remodeling. Pulmonary endarterectomy (PEA) is the recommended curative treatment option for CTEPH. PEA expertise, performed in referral surgical center is required to select surgical candidate. PEA expertise should thus be carried out in all CTEPH patients. However, operability assessment is not routinely conducted especially for patients monitored in non-surgical regional centers. Purpose to evaluate prognostic impact of PEA expertise provided by referral surgical center in a CTEPH remote regional cohort. Materials and Methods This retrospective monocentric cohort study was conducted by the regional center of pulmonary hypertension in Marseille (France) from 2003 to 2016. Patients with symptomatic CTEPH (III-IV functional class) were successively included. The PEA expertise group was defined as all CTEPH patients considered eligible for PEA expertise by clini-
© Elsevier Masson SAS. All rights reserved.
Conclusion National PEA expertise improve survival in symptomatic CTEPH patients from remote regional cohort. The authors hereby declare no conflict of interest
225 Should diuretic first attempted in patients with severe secondary tricuspid regurgitation? H. Doan*, L. Oliver, T. D’Humières, L. Faivre, JL. Monin, JL. Dubois Randé, P. Lim, J. Ternacle APHP-CHU Henri Mondor, Créteil, France *Corresponding author: [email protected] Background Medical treatment based on diuretic is often attempted in patients with severe functional tricuspid regurgitation (TR) even when surgery risk is acceptable. However, the efficiency of this therapy strategy is uncertain and may delay tricuspid repair. Methods The study included 30 patients (mean age 71±12 years, 50% female) with a moderate-to-severe secondary TR (PISA radius ≥7mm at Nyquist limit of 28cm/s). TR severity was assessed by echocardiography before and after diuretic treatment (furosemide or equivalent). Reduction in TR was defined by a decrease in PISA radius > 50%. Primary outcome included heart failure hospitalization and cardiac mortality. Results Overall, most of patients included had previous history of left side surgery (40%) and right ventricular dysfunction [57% with tricuspid annular plane systolic excursion (TAPSE)<16mm]. Mean left ventricular ejection fraction was 39±14%. Following the first echocardiography evaluation, furosemide was started at 244±325mg. Decrease in TR severity was observed in only 7 patients (23%) after a median period of 60 days. Death (N=7, 23%) and heart failure hospitalization (N=14, 47%) reported in 50% (N=15) of patients was associated with history of cardiogenic shock (P=0.03), TAPSE (P=0.03), and pulmonary systolic pressure (P=0.02). In contrast, decrease in TR severity had no impact on patient outcome. Conclusion Decrease in TR severity under diuretic is limited (23% of patients) and had no impact on patient outcome. These data suggest that medical treatment should not delay cardiac surgery. The authors hereby declare no conflict of interest
701 Does tricuspid annuloplasty increases surgical mortality and morbidity during mitral valve replacement? A. Darmon*, C. Verdonk, L. Lepage, C. Cimadevilla, P. Nataf, A. Vahanian, D. Messika-Zeitoun APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France *Corresponding author: [email protected] Background Current recommendation considers performing tricuspid annuloplasty at the time of mitral valve surgery based on degree of tricuspid regurgitation (TR) and tricuspid annulus size. However, both surgeons and cardiologist are reluctant to perform a tricuspid surgery arguing an increased surgical risk.