G Habib

Institut de France, Lutetia Parisorum, Île-de-France, France

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Publications (159)473.41 Total impact


  • No preview · Dataset · Aug 2015
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    ABSTRACT: To assess the value of cardiac magnetic resonance (CMR) using phase-contrast velocity mapping for paravalvular aortic regurgitation (PAR) quantification. All patients undergoing transcatheter aortic valve implantation (TAVI) in our centre between November 2012 and August 2013, without CMR-contraindication were included. PAR severity was assessed 5 days after TAVI using: transthoracic echocardiography (TTE) and CMR [regurgitant volume (RV), regurgitant fraction (RF)]. Aortic regurgitation (AR) index was obtained during TAVI. Thirty of 51 patients who underwent TAVI were included (COREVALVE, n = 10; or EDWARDS SAPIEN XT, n = 20). At TTE, PAR was mild in 22, moderate in 3, and severe in 5 patients. Reliable phase-contrast images were acquired at the sino-tubular junction for SAPIEN and at the tubular portion of the ascending aorta for COREVALVE. The reproducibility of CMR was high (coefficient of correlation = 0.99 for intra- and inter-operator variability). At CMR, RV, and RF were significantly (P < 0.0005) correlated with AR severity at TTE, with mean RF values at 9.2 ± 7.6% in mild, 20.3 ± 4.2% in moderate, and 46.8 ± 10.8% in severe PAR. A cut-off value of RF < 14% at CMR accurately discriminated mild from moderate/severe (sensitivity: 100%, specificity: 82%). The mean AR index was 29.4 ± 6 for mild and 13.8 ± 5 for moderate/severe PAR. Three patients had a RF > 14% and a low AR index <25 despite a mild PAR at TTE, suggesting an underestimation at TTE. CMR is a reproducible, accurate, and reliable method to assess PAR severity. CMR may allow correcting an underestimation at TTE when AR index is doubtful. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    No preview · Article · Jul 2015 · European Heart Journal Cardiovascular Imaging
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    ABSTRACT: The purpose of the present study was to evaluate the prognostic value of left atrial (LA) mechanics and stiffness in a prospective cohort of 82 asymptomatic patients (31 men, mean age 73±10 years) with severe aortic stenosis (AS) and normal left ventricular ejection fraction. Methods: By the use of 2-dimensional speckle tracking echocardiography, LA reservoir, strain rate and stiffness, LV strain, rotations, and twist were evaluated. The predefined end points were the occurrence of symptoms,aortic valve replacement and death. Results: At study entry, all patients had reduced LA reservoir (19.6±5%) and LV global longitudinal strain (LVGLS) (-15.3±3%), enhanced Zva (7.3 ±0.7 mm Hg/ml/m2) and LA stiffness (0.9±0.1). During follow-up (17.2±15.3 months) 53 patients (64.6%) reached the predefined end-points. No difference was found between symptomatic and asymptomatic patients as regards LV ejection fraction, LA volumes and AS severity. On the contrary, patients with events had lower indexed stroke volume p=0.001), LVGLS (p<0.001), LA reservoir (p<0.001) and higher LV mass (p=0.007), Zva (p<0.001) and LA stiffness (p<0.001), than those asymptomatic. Patients with lower LA reservoir (≤ 19.3%, median value) and higher LA stiffness (≥ 0.89, median value) had significantly worse event-free survival (figure 1). When the global population was split according to the median of LVGLS and Zva (GLS ≥ -15.2% and Zva ≤ 6.26 mmHg/ml/m2), amoung patients with minor impairment of LVGLS and Zva, the subgroup with events had significantly lower LA reservoir (p=0.01 and p=0.02, respectively) and higher LA stiffness (p=0.02 and p=0.02, respectively) if compared to the asymptomatic; Conclusion: LA mechanics may be a relevant contributor to the prognostic stratification of patients with asymptomatic severe AS.
    Full-text · Dataset · Jul 2015
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    Full-text · Dataset · Jul 2015
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    ABSTRACT: Purpose: Although delayed-enhancement magnetic resonance imaging (DEMRI) is essential for diagnosis of cardiac sarcoidosis (CS), the test was not available when pacemaker was implamted. Recently, MR-conditional pacemaker has become avilable and we hypothesized that this device would be useful for diagnosis and management of CS. The aim of this study was to assess the diagnostic ability of MR-conditional pacemaker about CS in patients with advanced A-V nodal block (AAVB). Methods: Twenty-seven AAVB patients (14 men, 13 women; mean age, 69 ± 11 years) who were implanted MR-conditional pacemaker were studied. DEMRI was performed 6 weeks after implantation of permanent pacemaker. In patients with positive for DE, additional examinations like echocardiography, radioisotope imaging, biopsy, and coronary computed-tomography were performed due to confirm the diagnosis of CS and exclude coronary artery disease. Results: DE was observed in 12 patients (44 %). Out of 12 patients, 2 patients were excluded for having prior myocardial infarction. Seven of 10 (70 %) patients were diagnosed of CS by the consensus criteria. Compared with non-CS group, CS group had significantly lower age (61 ± 12 years vs. 72 ± 9 years p = 0.017). There was no significant difference about sex, angiotensin-converting enzyme, brain natriuretic peptide, and left ventricular ejection fraction between 2 groups. Six patients had started corticosteroid therapy and 5 patients (83%) recovered A-V nodal conduction. Conclusion: MR-conditional pacemaker was useful for diagnosis and management of patients with AAVB caused by CS.
    Full-text · Article · Dec 2014 · European Heart Journal – Cardiovascular Imaging
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    ABSTRACT: Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis–Prospective Cohort Study. Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non–S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39–1.15]; P = .15). Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.
    Full-text · Article · Nov 2014 · Clinical Infectious Diseases
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    N. E. Bruun · G. Habib · F. Thuny · P. Sogaard

    Full-text · Article · Sep 2014 · European Heart Journal

  • No preview · Article · Jun 2014 · La Revue de Médecine Interne
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    ABSTRACT: Background: Antibiotics, used for 60 years to promote weight gain in animals, have been linked to obesity in adults and in children when administered during early infancy. Lactobacillus reuteri has been linked to obesity and weight gain in children affected with Kwashiorkor using ready-to-use therapeutic food. In contrast, Escherichia coli has been linked with the absence of obesity. Both of these bacteria are resistant to vancomycin. Objectives and methods: We assessed vancomycin-associated weight and gut microbiota changes, and tested whether bacterial species previously linked with body mass index (BMI) predict weight gain at 1 year. All endocarditis patients treated with vancomycin or amoxicillin in our center were included from January 2008 to December 2010. Bacteroidetes, Firmicutes, Lactobacillus and Methanobrevibacter smithii were quantified using real-time PCR on samples obtained during the 4–6 weeks antibiotic regimen. L. reuteri, L. plantarum, L. rhamnosus, Bifidobacterium animalis and E. coli were quantified on stool samples obtained during the first week of antibiotics. Results: Of the193 patients included in the study, 102 were treated with vancomycin and 91 with amoxicillin. Vancomycin was associated with a 10% BMI increase (odds ratio (OR) 14.1; 95% confidence interval (CI; 1.03–194); P=0.047) and acquired obesity (4/41 versus 0/56, P=0.01). In patients treated with vancomycin, Firmicutes, Bacteroidetes and Lactobacillus increased, whereas M. smithii decreased (P<0.05). The absence of E. coli was an independent predictor of weight gain (OR=10.7; 95% CI (1.4–82.0); P=0.02). Strikingly, a patient with an 18% BMI increase showed a dramatic increase of L. reuteri but no increase of E. coli. Conclusion: The acquired obesity observed in patients treated with vancomycin may be related to a modulation of the gut microbiota rather than a direct antibiotic effect. L. reuteri, which is resistant to vancomycin and produces broad bacteriocins, may have an instrumental role in this effect.
    Full-text · Article · Sep 2013 · Nutrition & Diabetes
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    ABSTRACT: Purpose: The improvement of diagnostic strategies in Infective Endocarditis (IE) is challenging. Echocardiography is the reference imaging modality for the identification of IE lesions but is negative or doubtful in almost 30% of cases. Cardiac Computed Tomography (CT) has shown promising data regarding the morphologic evaluation of endocarditis damages. We aimed to determine the performance of CT in diagnosing each lesions of IE. Methods: We prospectively studied consecutive patients with definite IE in a reference centre from 2008 to 2011. All of the patients were subjected to clinical, microbiological, and echocardiographic evaluation. Cardiac and whole-body CT were performed at admission. Each IE lesions were defined according to the recent European guidelines. First, the diagnostic value of cardiac CT was determined in comparison with echocardiography (trans-thoracic and trans-œsophageal). Second, the diagnostic values of cardiac CT and echocardiography were compared according to the intraoperative findings. Finally, the incidences of embolic events and coronary lesions detected by cardiac and whole-body CT were determined. Results: During the study period, 52 patients were included and 156 valves were analysed. Twenty-tree patients were included in the surgical analysis. Cardiac CT identified 40 of 48 (90%) valves with vegetations that were identified by echocardiography (κ=0,86) and 12 of 13 (92%) valves with periannular complications (PAC) that were identified by echocardiography (κ=0,96). Sensitivity, specificity, positive, negative values, and accuracy of cardiac CT for diagnosing vegetation were 83% (69%-92%), de 99% (94%-100%), 98% (86%-100%), 93% (86%-97%), and 94% (89%-96%), respectively. Sensitivity, specificity, positive, negative values, and accuracy of cardiac CT for diagnosing PAC were 92% (62%-100%), 100% (97%-100%), (60%-100%), 99% (96%-100%), and 99% (95%-100%). Of the 27 operated valves, echocardiography and cardiac CT correctly identified vegetations in 11 of 12 (91%) valves with vegetations at surgery. Echocardiography and cardiac CT correctly identified PAC in 5 of 8 (62%) valves with PAC at surgery. Cardiac and whole-body CT identified 53 embolic events (21 silent embolic events) and 22 significant coronary lesions. Conclusions: Cardiac CT shows good results in detecting lesions of IE in comparison with echocardiography. This modality allows also identification of embolic events and preoperative coronary lesions.
    Full-text · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: Early valve surgery reduces the incidence of embolism in patients with endocarditis, however the quantification of the Embolic Risk (ER) is challenging in guiding therapeutic decisions. Methods: In a multicenter observational cohort study, we aimed to develop and validate a model to quantify the ER at admission of patients with infective endocarditis. From 1,022 consecutive patients presenting with a definite diagnosis of infective endocarditis, 847 were randomized into derivation (n=565) and validation (n=282) samples. Clinical, microbiological and echocardiographic data were collected at admission. The primary endpoint was symptomatic embolism that occurred during the 6-month period following the initiation of treatment. The prediction model was developed and validated accounting for competing risks. Results: The 6-month incidence of embolism was similar in the development and validation samples (8.5% in the two samples). Eight variables were associated with the ER and used to create the model: age, diabetes, atrial fibrillation, embolism before antibiotics, mitral localization, vegetation length, Staphylococcus aureus, and bacterial etiology other than oral streptococci. There was an excellent correlation between the predicted and observed ER both in the development and validation samples. The c statistics for the development and validation samples were 0.73 and 0.64, respectively. Finally, a significant higher cumulative incidence of embolic events was observed in patients with a high predicted ER both in the development (P<0.001) and validation (P=0.046) samples. Conclusions: This model is a simple and accurate tool to quantify the ER at admission. It might be used to evaluate the potential benefit of early surgery.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: The Intracranial Haemorrhages (ICH) represent up to 30% of neurological complications of endocarditis. They are due to three mechanisms: the haemorrhagic conversion after cerebral embolism, the rupture of an intracerebral infectious aneurysm (ICIA) and the septic erosion of the arterial wall without infectious aneurysm. These complications lead to an excess mortality and complicate the achievement of valvular surgery. We aimed (1) to determine predictors of ICH, (2) and to describe their management and prognosis in a reference centre. Methods: In a retrospective single centre study, conducted from 2001 to 2012, all consecutive patients with definite infective endocarditis were included. Clinical, biological, microbiological, echocardiographic and complications evaluations were performed on all patients. ICH were assessed by using cerebral computed tomography and/or magnetic resonance imaging, and cerebral angiography. Predictors of ICH were determined by logistic regression analysis. Results: Among the 533 patients included, 34 (6.4%) experienced ICH. We found 12 (2.3%) intracranial haemorrhagic conversions, 11 (2.1%) rupture of ICIA, and 11 (2.1%) septic erosion of the arterial wall without ICIA. Multivariable analysis identified male gender (OR,2.9; 95% CI, 1.02-8.2; p=0.04), thrombocytopenia (OR, 3.2; 95% CI, 1.5-7.0; p<0.005) and the presence of a previous cerebral embolism (OR, 4.9; 95% CI, 2.3-10.5; p<0.005) as the main predictors of ICH. Among the patients with ICH, 5 (15%) died because of this complication, 19 (56%) were treated medically, 7 (21%) had a neurosurgical procedure and 3 (9%) had an interventional endovascular treatment. Of the 27 (79%) patients with an indication of valvular surgery, 3 (11%) died, 6 (22%) were contraindicated because of their neurological status, 2 (7%) were contraindicated for another cause and 16 (59%) were operated (8 during the antibiotic period [median time = 23 days after the ICH]; and 8 after the antibiotic period, [median time= 85 days after ICH]). No postoperative neurological deterioration was observed. Conclusion: The predictors of ICH in infective endocarditis are: thrombocytopenia and the presence of a cerebral embolism. If a surgical indication persists, the presence of an ICH is not always a formal contraindication and must be managed by a multidisciplinary approach.
    Preview · Article · Aug 2013 · European Heart Journal

  • No preview · Article · Jun 2013 · La Revue de Médecine Interne
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    Full-text · Article · Apr 2013 · Archives of Cardiovascular Diseases

  • No preview · Article · Apr 2011 · Revue d Épidémiologie et de Santé Publique
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    Preview · Article · Apr 2011 · Archives of Cardiovascular Diseases
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    ABSTRACT: La cardiomyopathie hypertrophique (CMH) est une affection d’origine génétique (transmission autosomique dominante) caractérisée par une hypertrophie localisée ou diffuse du ventricule gauche (VG). La prévalence de cette affection est de 0,2 % et elle représente la première cause de mort subite chez l’adulte jeune et le sportif. La place de l’IRM dans l’évaluation pronostique de ces patients est double à la fois sur le diagnostic positif de l’affection et plus directement sur l’évaluation du risque de mort subite lié à cette affection. Un dépistage précoce et de qualité de la CMH apparaît donc nécessaire afin de pouvoir au mieux prévenir le risque de mort subite. Le diagnostic de CMH débutante est parfois délicat, surtout lorsque l’affection est suspectée chez un sportif de bon niveau (⩾ 10 heures de sport par semaine). Le diagnostic différentiel entre l’hypertrophie physiologique du sportif et la cardiomyopathie hypertrophique requiert des explorations spécifiques qui doivent inclure la réalisation d’une IRM cardiaque. L’échocardiographie reste, évidemment, l’examen de référence et de première intention. Néanmoins, l’IRM a l’avantage par rapport à l’échocardiographie de : 1) explorer l’ensemble des segments du VG y compris sa paroi latérale et la zone apicale, 2) de permettre des mesures très précises de l’épaisseur télédiastolique, des volumes et de la masse ventriculaire gauche, 3) de permettre la visualisation des zones de fibrose dans le myocarde. Le but de cette mise au point est : 1) d’exposer le rôle de l’IRM dans le diagnostic positif des CMH, 2) de préciser le rôle de l’IRM et des séquences de rehaussement tardif dans l’évaluation du risque de mort subite.
    No preview · Chapter · Dec 2010
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    G Habib · A Torbicki
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    ABSTRACT: Pulmonary hypertension (PH) is defined as an increased mean pulmonary artery pressure (P(pa)) >25 mmHg at rest as assessed by right heart catheterisation (RHC). However, this technique is invasive and noninvasive alternatives are desirable for early diagnosis of PH. Although estimation of systolic pulmonary arterial pressure is easily obtained using Doppler echocardiography, cases of under- and over-estimations are not rare and direct measurement of P(pa) is not possible using this method. Therefore, echocardiography should be considered as a tool for assessment of the likelihood rather than the definite presence or absence of PH. Transthoracic echocardiography may be useful for noninvasive screening of patients at risk of PH. On the basis of an echocardiographic assessment, patients showing signs suggestive of PH can be referred for a confirmatory RHC. A number of variables measured during echocardiography reflect the morphological and functional consequences of PH and have prognostic value. The presence of pericardial effusion, reduced tricuspid annular plane excursion and right atrial enlargement are associated with a poorer prognosis. Echocardiography is also an important procedure for monitoring the response of patients to therapy, and is recommended 3-4 months after initiation of, or a change in, therapy. Echocardiographic assessment as part of a goal-oriented approach to therapy is essential for the effective management of PH patients.
    Preview · Article · Dec 2010 · European Respiratory Review
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    ABSTRACT: To analyse characteristics and outcomes of infective endocarditis (IE) on bicuspid aortic valves (BAV) and to compare the risk of death according to the presence or absence of BAV. 5-year observational study. Population of 856 patients with definite IE according to the Duke criteria from two tertiary centres (Amiens and Marseille, France). 310 consecutive patients with definite native aortic valve IE enrolled between 1991 and 2007. Patients underwent transthoracic and transoesophageal echocardiography during hospitalisation. Surgery was performed on a case-by-case basis according to conventional guidelines. In-hospital mortality and 5-year overall mortality. Patients with BAV IE (n=50, 16%) were younger, had fewer comorbidities and a higher frequency of aortic perivalvular abscess (50%). Presence of BAV (OR 3.79 (1.97-7.28); p<0.001) was independently predictive of abscess formation. Early surgery was performed in 36 BAV patients (72%) with a peri-operative mortality of 8.3%, comparable to that of patients with tricuspid aortic valve IE (p=0.89). BAV was not independently predictive of in-hospital mortality (OR 0.89 (0.28-2.85); p=0.84) or 5-year survival (HR 0.71 (0.37-1.36); p=0.30). Age, comorbidities, heart failure, Staphylococcus aureus and uncontrolled infection were associated with increased 5-year mortality in BAV patients. BAV is frequent in adults with native aortic valve IE. Patients with BAV IE incur high risk of abscess formation and require early surgery in almost three-quarters of cases. IE is a severe complication in the setting of BAV and warrants prompt diagnosis and treatment.
    No preview · Article · Nov 2010 · Heart (British Cardiac Society)
  • G. Habib

    No preview · Article · Oct 2010 · Archives des Maladies du Coeur et des Vaisseaux - Pratique

Publication Stats

2k Citations
473.41 Total Impact Points

Institutions

  • 2011
    • Institut de France
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • MIT Portugal
      Porto Salvo, Lisbon, Portugal
    • Policlinico Federico II di Napoli
      Napoli, Campania, Italy
  • 2008
    • Aix-Marseille Université
      • Faculté de Médecine
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2003
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      Lutetia Parisorum, Île-de-France, France
  • 2002
    • French National Centre for Scientific Research
      • Laboratoire Information Génomique et Structurale (IGS)
      Lutetia Parisorum, Île-de-France, France
    • Hospital Centre University of Fort de France
      Fort Royal, Martinique, Martinique
  • 1992-1998
    • Hôpital Européen, Marseille
      Marsiglia, Provence-Alpes-Côte d'Azur, France