Cardiovascular Unit

Toulouse, France

Cardiovascular Unit

Toulouse, France
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Honton B.,Cardiovascular Unit | Honton B.,Center Cardiovasculaire Of Recherche Clinique | Pathak A.,Toulouse University Hospital Center | Pathak A.,Center Cardiovasculaire Of Recherche Clinique | And 5 more authors.
EuroIntervention | Year: 2014

We describe the first use of transradial access renal denervation in a patient with resistant hypertension using a dedicated radiofrequency catheter (Iberis™; Terumo Medical Corporation, Tokyo, Japan). The system includes a generator and a 4 Fr single-use radiofrequency (RF) device which has to be introduced via a 6 Fr guiding catheter. Radiofrequency energy is delivered at the tip of the catheter. The system was CE approved in March 2013. copyright © Europa Digital & Publishing 2014.


Senni M.,Ospedale Papa Giovanni XXIII | Gavazzi A.,Ospedale Papa Giovanni XXIII | Oliva F.,Niguarda Hospital | Mortara A.,Policlinico di Monza | And 10 more authors.
International Journal of Cardiology | Year: 2014

Background To investigate the outcomes of hospitalized patients with both de-novo and worsening heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HFpEF) (LVEF ≤ 50%), compared to those with reduced LVEF (HFrEF). Methods and results We studied 1669 patients (22.6% HFpEF) hospitalized for acute HF in the prospective multi-center nationwide Italian Network on Heart Failure (IN-HF) Outcome Registry. In all patients LVEF was assessed during hospitalization. De-novo HF presentations constituted 49.6% of HFpEF and 43.1% of HFrEF hospitalizations. All-cause mortality during hospitalization was lower in HFpEF than HFrEF (2.9% vs 6.5%, p = 0.01), but this mortality difference was not significant at 1 year (19.6% vs 24.4%, p = 0.06), even after adjusting for clinical covariates. Similarly, there were no differences in 1-year mortality between HFpEF and HFrEF when compared by cause of death (cardiovascular vs non-cardiovascular) or mode of presentation (worsening HF vs de novo). Rehospitalization rates (all-cause, non-cardiovascular, cardiovascular, HF-related) at 90 days and 1 year were also similar. Mode of presentation influenced rehospitalizations in HFpEF, where those presenting with worsening HFpEF had higher all-cause (36.8% vs 21.6%, p = 0.001), cardiovascular (28.1% vs 14.9%, p = 0.002), and HF-related (21.1% vs 7.7%, p = 0.0003) rehospitalization rates at 1 year compared to those with de novo presentations. Conclusions Outcomes at 1 year following hospitalization for HFpEF are as poor as that of HFrEF. A prior history of HF decompensation or hospitalization identifies patients with HFpEF at particularly high risk of recurrent events. These findings may have implications for clinical practice, quality and process improvements and trial design. © 2014 Elsevier Ireland Ltd.


Mortara A.,Policlinico di Monza | Oliva F.,Niguarda Hospital | Metra M.,University of Brescia | Carbonieri E.,Orlandi Hospital | And 8 more authors.
Journal of Heart and Lung Transplantation | Year: 2014

BACKGROUND: In the recent Italian Network on Heart Failure (IN-HF) Outcome registry, including 1,855 patients with acute heart failure (AHF), were viewed the use of inotropes and their prognostic implication onin-hospital and 12-month mortality.METHODS: IN-HF Outcome is aprospective, multicenter, observational, study involving 61 Italian cardiology centers. AHF patients have been enrolled over a 2-year period and followed-up for 1 year. Inotropes were used in 360 patients (19.4%).RESULTS: Patients who received inotropes had a more severe clinical and hemodynamic profile than those who did not and exhibited a significantly higher rate of in-hospital (21.4% vs 2.7%, p < 0.01) and 1-year (50.6% vs 17.7%, p < 0.01) mortality. At entry, systolic blood pressure (SBP) was < 110 mm Hg in 58%, 111 to 130 mm Hg in 24.5%, and > 130 mm Hg in 17.5%. Multivariable analyses showed use of inotropes was the strongest predictor of all-cause death. These data were confirmed by propensity score analyses. According to SBP at entry, the 2 groups with SBP > 110 mm Hg who took inotropes, despite a more favorable clinical profile, exhibited a similar worse prognosis, particularly at 1 year: 56.3% (≤ 110 mmHg), 43.7% (111-130 mm Hg), and 40.3% (4130 mm Hg) vs 17.7%.CONCLUSIONS: Inotropes were used in nearly 20% of the patient admitted for AHF, and this treatment was associated with a short-term to medium-term poor prognosis. An inappropriate use of inotropes in patients with normal to high SBP, and presumably preserved cardiac output, may have significantly contributed to affect the all-group outcome. © 2014 International Society for Heart and Lung Transplantation. All rights reserved.


Oliva F.,Niguarda Hospital | Oliva F.,Outcome Coordinating Center | Mortara A.,Policlinico di Monza | Cacciatore G.,San Giovanni Addolorata Hospital | And 7 more authors.
European Journal of Heart Failure | Year: 2012

Aims Registries and surveys improve knowledge of the 'real world'. This paper Aims to describe baseline clinical profiles, management strategies, and the in-hospital outcome of patients admitted to hospital for an acute heart failure (AHF) episode.Methods and resultsIN-HF Outcome is a nationwide, prospective, multicentre, observational study conducted in 61 Cardiology Centres in Italy. Up to December 2009, 5610 patients had been enrolled, 1855 (33) with AHF and 3755 (67) with chronic heart failure (CHF). Baseline and in-hospital outcome data of AHF patients are presented. Mean age was 72 ± 12 years, and 39.8 were female. Hospital admission was due to new-onset heart failure (HF) in 43 of cases. Co-morbid conditions were observed more frequently in the worsening HF group, while those with de novo HF showed a higher heart rate, blood pressure, and more preserved left ventricular ejection fraction (LVEF). Electrical devices were previously implanted in 13.3 of the entire group. Inotropes were administered in 19.4 of the patients. The median duration of hospital stay was 10 days (interquartile range 7-15). All-cause in-hospital death was 6.4, similar in worsening and de novo HF. Older age, hypotension, cardiogenic shock, pulmonary oedema, symptoms of hypoperfusion, hyponatraemia, and elevated creatinine were independent predictors of all-cause death.ConclusionOur registry confirms that in-hospital mortality in AHF is still high, with a long length of stay. Pharmacological treatment seems to be practically unchanged in the last decades, and the adherence to HF guidelines concerning implantable cardioverter defibrillators/cardiac resynchronization therapy is still very low. Some AHF phenotypes are characterized by worst prognosis and need specific research projects. © 2012 The Author.


Cioffi G.,Villa Bianca Hospital | Giorda C.B.,Diabetes and Metabolism Unit | Chinali M.,University of Naples Federico II | Di Lenarda A.,Cardiovascular Unit | And 8 more authors.
European Journal of Preventive Cardiology | Year: 2012

Background: Individuals with diabetes mellitus (DM) have a higher risk to develop heart failure. Clinical guidelines emphasize the importance of early diagnosis of left ventricular dysfunction (LVD) and preventive interventions in these patients. In this study we assessed the prevalence of LVD, systolic or diastolic, in DM patients without known cardiac disease recruited in the 'left ventricular DYsfunction in DiAbetes (DYDA)' study. Design and methods: We performed clinical, ECG, laboratory, and echocardiographic exams in 960 patients (61 ± 8 years, 59% hypertensive) recruited in the DYDA study from 37 Italian diabetes referral centres. ECG and echo exams were read in central facilities. Systolic LVD was defined as ejection fraction ≤50% or midwall shortening (MFS) ≤15%. Diastolic LVD was identified when transmitral E/A was out of the range of 0.75-1.5 or deceleration time of mitral E wave ≤140 msec. Results: Echocardiographic data were obtained in 751 patients (78.2%). Isolated systolic LVD was detected in 22.0% of patients, isolated diastolic LVD in 21.5%, and combined systolic and diastolic LVD in 12.7%. All patients with systolic LVD had MFS ≤15%, while only 9% had an ejection fraction ≤50%. Higher LV mass, relative wall thickness, prevalence of concentric geometry, and LV hypertrophy characterized the patients with LVD.Conclusions: LVD is present in more than half of DM patients without clinically detectable cardiac disease and is associated with LV hypertrophy and concentric LV geometry. One-third of patients exhibits systolic LVD detectable at the midwall level. © 2011 The European Society of Cardiology.


PubMed | Aix - Marseille University, Cardiovascular Unit and University Pierre and Marie Curie
Type: Journal Article | Journal: Clinical cardiology | Year: 2016

The objective of this study was to provide descriptive statistics on patterns of prasugrel usage in the outpatient setting in France. This retrospective study was conducted to describe treatment patterns for prasugrel in the outpatient setting in France using the Intercontinental Marketing Services (IMS) Disease Analyzer database, which collates electronic medical records updated by a nationally representative database of 1200 French general practitioners (GPs). Anonymous data were collected prospectively at each follow-up visit. The study population consisted of patients with 1 prescription for prasugrel in the outpatient setting from its launch date to 3 years post-launch. Patients were followed up from the date of the first prescription for prasugrel recorded in the database until they died, changed GP, or reached the end of the study, whichever came first. In France, the IMS Disease Analyzer included 1052 patients receiving 1 prescription of prasugrel from January 2010 until October 2012. Eighty-five percent of the population was male. The mean age was 58 years; 94.3% were age <75 years, and 95.0% weighed 60 kg. Of the total, 99.8% of patients were prescribed a daily maintenance dose of 10 mg, and 0.2% had a history of transient ischemic attack/stroke. Concomitant medications were antiplatelet agents (100%; aspirin, 93.7%), lipid-lowering agents (90.1%), -blockers (83.7%), angiotensin-converting enzyme inhibitors (62.2%), and anti-ulcer medications (55.1%). The results reflect good usage of prasugrel by French GPs in the outpatient setting, with excellent implementation of the Prasugrel European Summary Product Characteristics.


Dolara A.,Cardiovascular Unit
Journal of Cardiovascular Medicine | Year: 2011

A review of recent articles dealing with long-term outcomes of catheter ablation in patients with atrial fibrillation has confirmed the success rates obtained in the short period. Repetition of the ablation procedure was necessary often in a high percentage of patients. Repeat ablation as well as continued vigilance for atrial fibrillation recurrence must be considered by clinicians when discussing the pros and cons of the ablation procedure with patients. © 2011 Italian Federation of Cardiology.


Serra J.L.,Cardiovascular Unit | Figueroa J.A.,Cardiovascular Unit | Allende G.E.,Cardiovascular Unit | Moreyra E.,Cardiovascular Unit
Journal of Cardiovascular Electrophysiology | Year: 2011

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology; up to 27% of cases entail cardiac involvement. Conduction abnormalities and ventricular tachycardia are the most common arrhythmias and can cause sudden death. We describe a patient who developed cardiac sarcoidosis 9 years after undergoing surgery for neurosarcoidosis. He presented with 2:1 second-degree atrioventricular block. Ventricular tachycardia with 3 morphologies was induced by exercise stress test. A DDD pacer/implantable cardioverter defibrillator (ICD) was implanted, which prevented exercise-induced ventricular tachycardia in a follow-up stress test. Treatment with steroids was initiated. The AVB disappeared, and no further arrhythmias were documented at the 1-year follow-up. © 2011 Wiley Periodicals, Inc.


Rivas-Estilla A.M.,Autonomous University of Nuevo León | Bryan-Marrugo O.L.,Autonomous University of Nuevo León | Trujillo-Murillo K.,Autonomous University of Nuevo León | Perez-Ibave D.,Autonomous University of Nuevo León | And 8 more authors.
American Journal of Physiology - Gastrointestinal and Liver Physiology | Year: 2012

We evaluated the participation of oxidative stress in the negative regulation of hepatitis C virus (HCV)- RNA induced by acetylsalicylic acid (ASA). We used the HCV subgenomic replicon cell system that stably expresses HCV-nonstructural proteins (Huh7 HCV replicon cells) and the parental cell line. Cells were exposed to 4 mM ASA at different times (12-72 h), and pyrrolidine dithiocarbamate (PDTC) was used as an antioxidant control. Reactive oxygen species (ROS) production, oxidized protein levels, cytosolic superoxide dismutase (Cu/Zn-SOD), and glutathione peroxidase (GPx) activity were measured to evaluate oxidative stress. In addition, viral RNA and prostaglandin (PGE 2) levels were determined. We observed that ASA treatment decreased ROS production and oxidized protein levels in a time-dependent fashion in both parental and HCV replicon cells with a greater extent in the latter. Similar results were found with PDTC exposure. Average GPx activity was decreased, whereas a striking increase was observed in average cytosolic SOD activity at 48 and 72 h in both cells exposed to ASA, compared with untreated cells. HCV replicon cells showed higher levels of Cu/Zn-SOD expression (mRNA and protein) with ASA treatment (48 and 72 h), whereas NS5A protein levels showed decreased expression. In addition, we found that inhibition of SOD1 expression reversed the effect of ASA. Interestingly, PDTC downregulated HCV-RNA expression (55%) and PGE 2 (60%) levels, imitating ASA exposure. These results suggest that ASA treatment could reduce cellular oxidative stress markers and modify Cu/Zn- SOD expression, a phenomenon that may contribute to the mechanisms involved in HCV downregulation. © 2012 by the American Physiological Society.


PubMed | Nuclear Medicine Unit, Cardiovascular Unit, Hospital Sant Pau and The Second University of Naples
Type: Journal Article | Journal: European journal of nuclear medicine and molecular imaging | Year: 2016

To investigate changes in sympathetic activity, perfusion, and left ventricular (LV) functionality in takotsubo cardiomyopathy (TTC) patients from onset (TTwenty-two patients (7011 years) underwent serial gated single photon emission tomography (G-SPECT) studies with Patients presented at TOutcome for TTC is not limited to a reversible contractile and perfusion abnormalities, but it includes residual adrenergic dysfunction, depending on the level of adrenergic impairment and age of patients at onset. The number of patients, as well as degree of perfusion abnormalities were found to be higher than those previously reported possibly depending on the time-interval between hospital admission and perfusion scan.

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