Eric Bonnefoy-Cudraz

Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France

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Publications (26)93.76 Total impact

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    ABSTRACT: The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72h after admission. A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95±0.02 vs. 2.97±0.02, respectively; p=0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32±17g vs. 21±17g, respectively; p=0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p=0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size. Copyright © 2015. Published by Elsevier Ltd.
    Journal of Cardiology 06/2015; DOI:10.1016/j.jjcc.2015.05.008 · 2.57 Impact Factor
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    ABSTRACT: Both acute myocardial ischemia and reperfusion contribute to cardiomyocyte death in ST-elevation myocardial infarction (STEMI). The final infarct size is the principal determinant of subsequent clinical outcome in STEMI patients. In a proof-of-concept phase II trial, the administration of cyclosporine prior to primary percutaneous coronary intervention (PPCI) has been associated with a reduction of infarct size in STEMI patients. CIRCUS is an international, prospective, multicenter, randomized, double-blinded, placebo-controlled trial. The study is designed to compare the efficacy and safety of cyclosporine versus placebo, in addition to revascularization by PPCI, in patients presenting with acute anterior myocardial infarction within 12 hours of symptoms onset and initial TIMI flow ≤1 in the culprit left anterior descending coronary artery. Patients are randomized in a 1:1 fashion to 2.5 mg/kg intravenous infusion of cyclosporine or matching placebo performed in the minutes preceding PCI. The primary efficacy end point of CIRCUS is a composite of 1-year all-cause mortality, rehospitalization for heart failure or heart failure worsening during initial hospitalization, and left ventricular adverse remodeling as determined by sequential transthoracic echochardiography. Secondary outcomes will be tested using a hierarchical sequence of left ventricular (LV) ejection fraction and absolute measurements of LV volumes. The composite of death and rehospitalization for heart failure or heart failure worsening during initial hospitalization will be further assessed at three years after the initial infarction. Recruitment lasted from April 2011 to February 2014. The CIRCUS trial has recruited 975 patients with acute anterior myocardial infarction. The 12-months results are expected to be available in 2015. The CIRCUS trial is testing the hypothesis that cyclosporine in addition to early revascularization with PPCI compared to placebo in patients with acute anterior myocardial infarction reduces the incidence of death, heart failure and adverse LV remodeling at one-year follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.
    American heart journal 06/2015; 169(6):758-766.e6. DOI:10.1016/j.ahj.2015.02.020 · 4.56 Impact Factor
  • Archives of Cardiovascular Diseases 05/2015; 108(5):331-332. DOI:10.1016/j.acvd.2015.05.001 · 1.66 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate bioimpedance vector analysis (BIVA) for the diagnosis of acute heart failure (AHF) in patients presenting with acute dyspnea to the emergency department (ED). Patients with acute dyspnea presenting to the ED were prospectively enrolled. Four parameters were assessed: resistance (R), reactance (Ra), total body water (TBW), and extracellular body water (EBW). Brain natriuretic peptide (BNP) measures and cardiac ultrasound studies were performed in all patients at admission. Patients were classified into AHF and non-AHF groups retrospectively by expert cardiologists. Seventy-seven patients (39 men; age, 68±14years; weight, 79.8±20.6 kg) were included. Of the 4 BIVA parameters, Ra was significantly lower in the AHF compared to non-AHF group (32.7±14.3 vs 45.4±19.7; P<.001). Brain natriuretic peptide levels were significantly higher in the AHF group (1050.3±989 vs 148.7±181.1ng/L; P<.001). Reactance levels were significantly correlated to BNP levels (r=-0.5; P<.001). Patients with different mitral valve Doppler profiles (E/e'≤8, E/e' ≥9 and <15, and E/e'≥15) had significant differences in Ra values (47.9±19.9, 34.7±19.4, and 31.2±11.7, respectively; P=.003). Overall, the sensitivity of BIVA for AHF diagnosis with a Ra cutoff at 39Ω was 67% with a specificity of 76% and an area under the curve at 0.76. However, Ra did not significantly improve the area under the curve of BNP for the diagnosis of AHF (P=not significant). In a population of patients presenting to the ED with dyspnea, BIVA was significantly related to the AHF status but did not improve the diagnostic performance for AHF in addition to BNP alone. Copyright © 2015. Published by Elsevier Inc.
    American Journal of Emergency Medicine 04/2015; DOI:10.1016/j.ajem.2015.04.021 · 1.15 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 04/2015; 7(2):156. DOI:10.1016/S1878-6480(15)30072-0
  • Romain Vitoux · Didier Bresson · Eric Bonnefoy-Cudraz
    Archives of Cardiovascular Diseases Supplements 04/2015; 7(2):159. DOI:10.1016/S1878-6480(15)30080-X
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    ABSTRACT: Cardiac troponin (cTn) assays have quickly gained in analytical sensitivity to become what are termed 'high-sensitivity cardiac troponin' (hs-cTn) assays, bringing a flurry of dense yet incomplete literature data. The net result is that cTn assays are not yet standardized and there are still no consensus-built data on how to use and interpret cTn assay results. To address these issues, the authors take cues and clues from multiple disciplines to bring responses to frequently asked questions. In brief, the effective use of hs-cTn hinges on knowing: specific assay characteristics, particularly precision at the 99th percentile of a reference population; factors of variation at the 99th percentile value; and the high-individuality of hs-cTn assays, for which the notion of individual kinetics is more informative than straight reference to 'normal' values. The significance of patterns of change between two assay measurements has not yet been documented for every hs-cTn assay. Clinicians need to work hand-in-hand with medical biologists to better understand how to use hs-cTn assays in routine practice. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Archives of Cardiovascular Diseases 02/2015; 108(2). DOI:10.1016/j.acvd.2014.11.001 · 1.66 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1). DOI:10.1016/S1878-6480(15)71502-8
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    ABSTRACT: IntroductionThere are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). The aim of this study was to assess long-term (5-year) mortality among early survivors of AMI, according to the presence of CS at the acute stage.Methods We analyzed 5-year follow-up data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 registry, a nationwide French survey including consecutive patients admitted for ST or non-ST-elevation AMI at the end of 2005 in 223 institutions.ResultsOf 3670 patients enrolled, shock occurred in 224 (6.1%), and 3411 survived beyond 30 days or hospital discharge, including 99 (2.9%) with shock. Early survivors with CS had a more severe clinical profile, more frequent concomitant in-hospital complications, and were less often managed invasively than those without CS.Five-year survival was 59% in patients with, versus 76% in those without shock (adjusted hazard ratio (HR)¿=¿1.72 [1.24-2.38], P¿=¿0.001). The excess of death associated with CS, however, was observed only during the first year (one-year survival: 77% vs 93%, adjusted HR: 2.87 [1.85 to 4.46] P <0.001), while survival from one to 5 years was similar (76% vs 82%, adjusted HR: 1.06 [0.64 to 1.74]). Propensity score-matched analyses yielded similar results.Conclusions In patients surviving the early phase of AMI, CS at the initial stage carries an increased risk of death up to one year after the acute event. Beyond one year, however, mortality is similar to that of patients without shock.ClinicalTrials.gov number, NCT00673036, Registered May 5, 2008.
    Critical care (London, England) 09/2014; 18(5):516. DOI:10.1186/PREACCEPT-1446656168127984
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    ABSTRACT: Fondaparinux is an alternative to low molecular weight heparin (LMWH) for non-ST-elevation myocardial infarction (NSTEMI) with levels of recommendation that differ according to guidelines. The aim of this study was to assess outcomes in real world practice in NSTEMI patients participating in the French Registry of ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010 according to the use of fondaparinux, in comparison with patients receiving enoxaparin.
    European Heart Journal: Acute Cardiovascular Care 07/2014; 4(3). DOI:10.1177/2048872614544857
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    ABSTRACT: L’évolution rapide des méthodes de dosage des troponines cardiaques (cTn) vers une meilleure sensibilité analytique (cTn de haute sensibilité ou cTn HS) s’accompagne de nombreuses données de la littérature, mais encore incomplètes. En l’absence de standardisation des cTn et de données consensuelles sur l’utilisation et l’interprétation des résultats, les auteurs de cette revue proposent, à partir d’une revue de la littérature, et de façon multidisciplinaire, des éléments de réponses aux questions fréquemment posées. En conclusion, le bon usage des cTn HS repose sur la connaissance : 1) des caractéristiques propres de la méthode utilisée, en particulier de la précision obtenue au 99e percentile d’une population de référence ; 2) des facteurs de variation de la valeur du 99e percentile ; 3) de la forte individualité des dosages de cTn HS, pour lesquels la notion de cinétique individuelle est plus informative que la simple référence à des valeurs usuelles. La significativité des variations entre deux dosages n’est pas encore documentée pour toutes les méthodes HS. La collaboration entre cliniciens et biologistes est nécessaire à une meilleure utilisation des troponines au quotidien. Abstract The recent evolution of cardiac troponin assays (cTn) for acquisition of a better analytical sensitivity (high-sensitivity cTn, or cTn HS) is widely described in the literature; however, actual data remain incomplete. Considering the absence of cTn assays standardisation and of consensual data for using and interpreting cTn results, the authors propose multidisciplinary responses to frequently asked questions. Proper use of cTn HS relies upon knowledge of 1) the assay characteristics, and mainly the observed precision at the 99th percentile value; 2) the variation factors of the 99th percentile value; and 3) the high individuality of cTn HS tests, for which the notion of kinetics is more informative than the single reference to ‘normal’ values. Significant variation between 2 measurements, is not already documented for every HS assay. A strong partnership between clinicians and biologists is needed for a better understanding and use of cTn HS in routine.
    07/2014; 4(4):221-241. DOI:10.1007/s13341-014-0423-5
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    ABSTRACT: Aims: The relationship of cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) with myocardial biomarkers and markers of inflammation in acute viral myocarditis is not clearly defined. We assessed the relationship of LGE with myocardial and inflammatory biomarkers measured during the acute phase of myocarditis and their predictive value on clinical outcome. Methods: Patients with first clinical episode of acute viral myocarditis and complete CMR study, including cine and LGE images, were included. The peak values of troponin I, creatine kinase, C-reactive protein value at admission and LGE extent were reported for each case. A 29-month clinical follow-up was performed, and cardiac symptoms and adverse cardiac events (all-cause death, heart transplant, hospitalization for heart failure) were reported. Results: Forty-one patients (39 +/- 15 years and 78% men) were included. Median LGE extent was 13% [interquartile range (IQR) (9%, 19%)] of left-ventricular mass and mean left-ventricular ejection fraction was 56 +/- 11%. There was a significant correlation between peak troponin I and LGE extent (r = 0.51, P < 0.001), and between peak creatine kinase and LGE extent (r = 0.66, P < 0.001). There was no correlation between C-reactive protein at admission and LGE extent (r = 0.27, P = 0.09). At follow-up, eight (20%) patients had an adverse clinical event. LGE extent was significantly associated with a worse New York Heart Association status at follow-up [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.07, 1.37, P = 0.002]. After adjustment for left-ventricular ejection fraction, age and clinical presentation category, LGE extent remained an independent predictor of cardiovascular events (hazard ratio 1.42; 95% CI 1.05, 1.95, P = 0.027). Conclusions: LGE extent on CMR studies is significantly correlated to biomarkers of myocardial injury in patients with acute viral myocarditis, and is a significant independent predictor of adverse cardiovascular outcome.
    Journal of Cardiovascular Medicine 06/2014; Publish Ahead of Print. DOI:10.2459/JCM.0000000000000024 · 1.51 Impact Factor
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    ABSTRACT: Aims: To assess fractional flow reserve (FFR) variability in case of arterial hypotension in the clinical setting. FFR measurement is supposed to be independent of haemodynamics; there is, however, a strong relationship between trans-stenotic pressure variation and coronary flow. Non-clinical models suggest an inverse relationship between arterial pressure and FFR, but no clinical data have as yet confirmed this hypothesis. Methods and results: In case of arterial hypotension (mean arterial pressure [Pa] ≤80 mmHg) during routine clinical FFR measurement (FFR1), a second measurement (FFR2) was performed after pressure normalisation by 0.5 mg IV phenylephrine. Fourteen intermediate chronic stenoses (%DS 58±21%, FFR1=0.81±11) in 12 male patients showed 70±10 mmHg Pa at the time of measurement. After phenylephrine, Pa increased to 101±14 mmHg and FFR2 decreased to 0.75±12 (p<0.001) without heart rate variation. After Pa elevation, 40% of cases with FFR1 >0.80 changed to FFR2 ≤0.80. Conclusions: In the present study, in case of arterial hypotension, FFR decreased with rising pressure. Whether repeated FFR measurement after haemodynamic normalisation is of clinical benefit remains at this point speculative and should be validated in a larger data set.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 04/2014; · 3.76 Impact Factor
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    ABSTRACT: Proof-of-concept evidence suggests that mechanical ischaemic post-conditioning (PostC) reduces infarct size when applied immediately after culprit coronary artery re-opening in ST-elevation myocardial infarction (STEMI) patients with thrombolysis in myocardial infarction 0-1 (TIMI 0-1) flow grade at admission. Whether PostC might also be protective in patients with a TIMI 2-3 flow grade on admission (corresponding to a delayed application of the post-conditioning algorithm) remains undetermined. In this multi-centre, randomized, single-blinded, controlled study, STEMI patients with a 2-3 TIMI coronary flow grade at admission underwent direct stenting of the culprit lesion, followed (PostC group) or not (control group) by four cycles of (1 min inflation/1 min deflation) of the angioplasty balloon to trigger post-conditioning. Infarct size was assessed both by cardiac magnetic resonance at Day 5 (primary endpoint) and cardiac enzymes release (secondary endpoint). Ninety-nine patients were prospectively enrolled. Baseline characteristics were comparable between control and PostC groups. Despite comparable size of area at risk (AAR) (38 ± 12 vs. 38 ± 13% of the LV circumference, respectively, P = 0.89) and similar time from onset to intervention (249 ± 148 vs. 263 ± 209 min, respectively, P = 0.93) in the two groups, PostC did not significantly reduce cardiac magnetic resonance infarct size (23 ± 17 and 21 ± 18 g in the treated vs. control group, respectively, P = 0.64). Similar results were found when using creatine kinase and troponin I release, even after adjustment for the size of the AAR. This study shows that infarct size reduction by mechanical ischaemic PostC is lost when applied to patients with a TIMI 2-3 flow grade at admission. This indicates that the timing of the protective intervention with respect to the onset of reperfusion is a key factor for preventing lethal reperfusion injury in STEMI patients. NCT01483755.
    European Heart Journal 02/2014; 35(25). DOI:10.1093/eurheartj/ehu054 · 14.72 Impact Factor
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    ABSTRACT: After acute myocardial infarction, the presence of no-reflow (or microvascular obstruction: MVO) has been associated with adverse left ventricular (LV) remodeling and worse clinical outcome. This study examined the effects of mechanical ischemic postconditioning on early and late MVO size in acute ST-elevation myocardial infarction (STEMI) patients. Fifty patients undergoing primary coronary angioplasty for a first STEMI with TIMI grade flow 0-1 and no collaterals were randomized to ischemic postconditioning (PC) (n = 25) or control (n = 25) groups. Ischemic PC consisted in the application of four consecutive cycles of a 1-min balloon occlusion, each followed by a 1-min deflation at the onset of reperfusion. Early (3 min post-contrast) and late (10 min post-contrast) MVO size were assessed by contrast-enhanced cardiac-MRI within 96 h after reperfusion. PC was associated with smaller early and late MVO size (3.9 ± 4.8 in PC versus 7.8 ± 6.6 % of LV in controls for early MVO, P = 0.02; and 1.8 ± 3.1 in PC versus 4.1 ± 3.9 % of LV in controls for late MVO; P = 0.01). This significant reduction was persistent after adjustment for thrombus aspiration, which neither had any significant effect on infarct size, nor on early or late MVO (P = NS for all). Attenuation of MVO was associated to infarct size reduction. Mechanical postconditioning significantly reduces MVO in patients with acute STEMI treated with primary angioplasty.
    Archiv für Kreislaufforschung 11/2013; 108(6):383. DOI:10.1007/s00395-013-0383-8 · 5.96 Impact Factor
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    ABSTRACT: Deformation imaging is undergoing continuous development with the emergence of new technologies allowing the evaluation of the different components of strain simultaneously in three dimensions. Assessment of all global strain parameters in 2D and 3D modes and comparison with LVEF have been the focus of our study. Out of 166 patients, 147 were evaluated with the use of both 2D and 3D speckle-tracking echocardiography (STE). Global strain parameters including longitudinal (GLS), circumferential (GCS), radial (GRS) and area strain (AS), as well as left ventricular volumes and ejection fraction were examined. Analysis of strain with 3D STE was faster than with 2D STE (7 ± 2 vs. 24 ± 4 min, P < 0.05). GLS values were similar between 2D and 3D modes (-14 ± 4 vs. -13 ± 3, NS), while slight differences were observed for GCS (-24 ± 7 vs. -27 ± 7, P < 0.05) and GRS (27 ± 9 vs. 24 ± 9, P < 0.05). All 2D and 3D strain parameters showed good accuracy in the identification of 2D-LVEF <55% with AS demonstrating superiority over GCS and GRS but not GLS. Three-dimensional STE allows accurate and faster analysis of deformation when compared with 2D STE and might represent a viable alternative in the evaluation of global LV function.
    09/2013; 15(3). DOI:10.1093/ehjci/jet103
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    ABSTRACT: Recent studies have shown that the decrease in ventricular septal rupture (VSR) incidence after acute myocardial infarction is related to the improvement of reperfusion strategies. Our main objective was to explore the influence of therapeutic management changes on post-infarct VSR patient outcomes in a single reference center over a period of 30 years. We analyzed therapeutic management strategies and mortality rates in 228 patients with VSR after acute myocardial infarction admitted from 1981 to 2010. Patients were classified in 3 successive decades. There were no significant differences in clinical characteristics of patients with VSR at admission among those decades. Overall, surgery was performed in 159 patients (71.9%), primary transcatheter VSR closure was attempted in 5 patients (2.2%), and 64 patients (27.6%) were managed medically. Independent predictors of in-hospital mortality were VSR surgical repair (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.1 to 0.7, p = 0.008), cardiogenic shock (OR 6.06, 95% CI 2.8 to 13.1, p <0.0001), and Killip class on admission (OR 1.75, 95% CI 1.1 to 9.9, p = 0.02). We found a significant 1-year mortality reduction between the first and second decades (hazard ratio 0.48, 95% CI 0.28 to 0.80; p = 0.005), with no significant change in the last decade (p = 0.2). This change was related to a systematic referral to surgical repair and shorter delays to VSR surgery (5.2 ± 6.3 vs 1.9 ± 3.2 days from first to second decade; p = 0.012). In conclusion, surgical repair remains the only significant efficient therapy to reduce mortality in patients with VSR (p <10(-3)). In-hospital prognosis remains disappointing. This contrasts with the favorable long-term outcome of patients who survive the perioperative period and are discharged from hospital.
    The American journal of cardiology 07/2013; 112(9). DOI:10.1016/j.amjcard.2013.06.009 · 3.43 Impact Factor
  • S. Ledochowski · J.-M. Fayet · D. Collin-Chavagnac · E. Bonnefoy-Cudraz
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    ABSTRACT: Introduction Une méthode fiable et rapide d’exclusion de l’infarctus du myocarde (IDM) représente un objectif médical crucial à atteindre. Une des pistes de la recherche actuelle est d’associer des marqueurs indépendants de la physiopathologie ischémique pour améliorer le diagnostic d’IDM. Matériel et méthodes Notre étude, observationnelle, rétrospective et monocentrique, a été réalisée sur une population de patients se présentant au service d’accueil des urgences du centre hospitalier Lyon-Sud pour une douleur thoracique apparue dans les six heures précédentes. Quatre-vingt-trois patients ont été inclus d’âge moyen de 64 ans dont neuf cas d’infarctus non ST+. Son objectif principal a été de déterminer la performance statistique de la copeptine dans l’exclusion des syndromes coronariens sans élévation du segment ST (SCA NST+). L’objectif secondaire a été d’estimer le gain de temps potentiel d’un schéma décisionnel utilisant le couple copeptine-première troponine par rapport au schéma classique double dosage de la troponine dans l’exclusion de l’IDM. Résultats Notre évaluation d’une stratégie double, associant copeptine et le premier dosage de troponine avec un cut-off de 9 pmol/l, retrouve un rapport de vraisemblance négatif proche de 0,0 (0,01–1,92), une sensibilité à 1,0 (IC 95 %: 0,66–1), une valeur prédictive négative à 1,0 (IC 95 %: 0,88–1) et un taux d’erreurs semblant être inférieur à 10 %. Le gain de temps potentiel en utilisant une stratégie double est de 310 minutes, soit un peu plus de cinq heures. Conclusion L’association de la copeptine améliore significativement la valeur diagnostique de la troponine pour l’exclusion des SCA NST+ aux urgences, tout en permettant au clinicien de réduire les délais de prise en charge.
    05/2013; 3(3). DOI:10.1007/s13341-013-0303-4
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    ABSTRACT: Purpose: Atherosclerotic plaques progress in a highly individual manner. Plaque eccentricity has been associated with a rupture-prone phenotype and adverse coronary events in humans. Endothelial shear stress (ESS) critically determines plaque growth and low ESS leads to high-risk lesions. However, the factors responsible for rapid disease progression with increasing plaque eccentricity have not been studied. We investigated in vivo the effect of local hemodynamic and plaque characteristics on progressive luminal narrowing with increasing plaque eccentricity in humans. Methods: Three-dimensional coronary artery reconstruction using angiographic and intravascular ultrasound data was performed in 374 patients at baseline (BL) and 6-10 months later (FU) to assess plaque natural history as part of the PREDICTION Trial. A total of 874 coronary arteries were divided into consecutive 3-mm segments. We identified 408 BL discrete luminal narrowings with a throat in the middle surrounded by gradual narrowing proximal and distal to the throat. Local BL ESS was assessed by computational fluid dynamics. The eccentricity index (EI) at BL and FU was computed as the ratio of max to min plaque thickness at the throat. Mixed-effects logistic regression was used to investigate the effect of BL variables on the combined endpoint of substantial worsening of luminal narrowing (decrease in lumen area >1.8 mm2 or >20%) with an increase in plaque EI. Results: Lumen worsening with an increase in plaque EI was evident in 73 luminal narrowings (18%). Independent predictors of worsening lumen narrowing with plaque EI increase were low BL ESS (<1 Pa) distal to the throat (odds ratio [OR] =2.2 [95% CI: 1.3-3.7]; p=0.003) and large BL plaque burden (>51%) at the throat (OR=1.7 [95% CI: 1.0-2.8]; p=0.051). The incidence of worsening lumen narrowing with increasing plaque eccentricity was 30% in the presence of both predictors versus 15% in luminal narrowings without this combination of characteristics (OR=2.4 [95% CI: 1.4-4.3]; p=0.002). Conclusions: Low local ESS independently predicts areas with rapidly progressive luminal narrowing and increasing plaque eccentricity. Coronary regions manifesting an abrupt anatomic change, i.e., at highest risk to cause an adverse event, can be identified early by assessment of ESS and plaque burden.
    European Heart Journal 08/2012; 33(suppl 1):355. DOI:10.1093/eurheartj/ehs282 · 14.72 Impact Factor
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    ABSTRACT: This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI). Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans. Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release. The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 ± 7 g/m(2) vs. 21 ± 14 g/m(2); p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 ± 16 g/m(2) vs. 34 ± 18 g/m(2); p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk. This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.
    Journal of the American College of Cardiology 06/2012; 59(24):2175-81. DOI:10.1016/j.jacc.2012.03.026 · 15.34 Impact Factor

Publication Stats

124 Citations
93.76 Total Impact Points

Institutions

  • 2015
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 2012–2015
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2014
    • CHU de Lyon - Hôpital Cardio-vasculaire et Pneumologique Louis Pradel
      Lyons, Rhône-Alpes, France
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France