Hyperacute graft rejection during heart transplantation for giant cell myocarditis: A case report.
; Delbecque, Katty ; Defraigne, Jean-Olivier et al
in Pathology - Research & Practice (2010), 15(206), 411-4
We report the case of a patient with giant cell myocarditis who was bridged to transplantation with mechanical circulatory support and developed a fatal perioperative hyperacute rejection. The patient had ... [more ▼]
We report the case of a patient with giant cell myocarditis who was bridged to transplantation with mechanical circulatory support and developed a fatal perioperative hyperacute rejection. The patient had received abundant transfusions that had raised her anti-HLA antibody titers. The cross-match test was positive. No pre-transplantation immunosuppressive therapy had been administered given concomitant infection. The severity and acuteness of the rejection in this case likely reflect the combined effect of preformed anti-HLA antibodies in the context of an active organ-specific immune process at the time of transplantation. This case raises the questions of the need for intensive immunosuppressive therapy before transplantation in giant cell myocarditis and of the management of patients with positive cross-match in the context of a giant cell myocarditis. [less ▲]Detailed reference viewed: 30 (7 ULg)
Are ACE-inhibitors or ARB's still needed for cardiovascular prevention in high risk patients? Insights from PRoFESS and TRANSCEND
; ; et al
in Acta Clinica Belgica (2010), 65-2
The HOPE and EUROPA clinical studies have shown that treatment with the angiotensin-converting enzyme (ACE) inhibitors, ramipril and perindopril, may reduce the occurence of major cardiovascular events in ... [more ▼]
The HOPE and EUROPA clinical studies have shown that treatment with the angiotensin-converting enzyme (ACE) inhibitors, ramipril and perindopril, may reduce the occurence of major cardiovascular events in patients with proven atherosclerotic disease. The recently published results of the PRoFESS and TRANSCEND trials completed the much needed information concerning the use of an angiotensin receptor blocker for patients at high risk of cardiovascular events. PRoFESS compared a therapy of telmisartan 80 mg daily with placebo in patients with a recent ischemic stroke. The difference in the primary outcome of first recurrent stroke was not statistically significant between telmisartan and placebo. The secondary outcome of major cardiovascular events showed a relative risk reduction (RRR) of 7% in favour of telmsartan. This tended to be significant (p=0.06) despite a rather short follow-up period of only 28 months. In TRANSCEND 5,926 patients at high risk for cardiovascular events were randomized to a treatment with telmisartan 80 mg daily or placebo for a mean duration of follow-up of 56 months. The primary composite outcome of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure showed a non-significant 8% RRR in favour of the telmisartan treated patients. The main secondary outcome of cardiovascular death and myocardial infarction or stroke as used in the HOPE trial showed a non-significant RRR of 13% in favour of telmisartan treated patients (p=0,068 adjusted for multiplicity of comparisons). In comparing the Kaplan-Meier curves for the endpoint of major cardiovascular events used in HOPE, EUROPA, TRANSCEND and PRoFESS, the trends are similar. Results of most of th recently published trials have been neutral. This could partly be explained by major improvements in the optimal background therapy of the patients included. Nevertheless, the results of PRoFESS and TRANSCEND do not contradict the results from previous studies with the ACE inhibitors ramipril and perindopril and the ARB telmisartan. [less ▲]Detailed reference viewed: 69 (1 ULg)
Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA).
in European Heart Journal (2009), 30(22), 2769-812Detailed reference viewed: 20 (0 ULg)
Traitement percutané d’une cardiomyopathie hypertrophique obstructive
Moonen, Marie ; Legrand, Victor ; Lancellotti, Patrizio et al
in Revue Médicale de Liège (2009), 64(10), 481Detailed reference viewed: 55 (2 ULg)
Ischaemic mitral regurgitation: mechanisms and diagnosis.
; Lancellotti, Patrizio ; Pierard, Luc
in Heart (2009), 95(20), 1711-8Detailed reference viewed: 27 (5 ULg)
Percutaneous transvenous mitral annuloplasty: initial human experience with a novel coronary sinus implant device.
; ; et al
in Circulation Cardiovascular Interventions (2009), 2(4), 277-84Detailed reference viewed: 10 (1 ULg)
Risk Score for Predicting Outcome in Patients With Asymptomatic Aortic Stenosis
; Lancellotti, Patrizio ; et al
in Circulation (2009), 120(1), 69-75
Background— The management of patients with asymptomatic severe aortic stenosis remains controversial. We sought to develop a continuous risk score for predicting the midterm development of symptoms or ... [more ▼]
Background— The management of patients with asymptomatic severe aortic stenosis remains controversial. We sought to develop a continuous risk score for predicting the midterm development of symptoms or adverse events in this setting. Methods and Results— We prospectively followed 107 patients with asymptomatic aortic stenosis (aged 72 years [63 to 77]; 35 women; aortic-jet velocity, 4.1 m/s [3.5 to 4.4]) at a single center in France. Predefined end points for assessing outcome were the occurrence within 24 months of death or aortic valve replacement necessitated by symptoms or by a positive exercise test. Variables independently associated with outcome were used to build a score that was validated in an independent cohort of 107 patients from Belgium. Independent predictors of outcome were female sex, peak aortic-jet velocity, and B-type natriuretic peptide at baseline. Accordingly, the score could be calculated as follows: Score=[peak velocity (m/s)x2]+(natural logarithm of B-type natriuretic peptidex1.5)+1.5 (if female sex). Event-free survival after 20 months was 80% for patients within the first score quartile compared with only 7% for the fourth quartile. Areas under the receiver operating characteristic curve for the score were 0.90 and 0.89 in the development and validation cohorts, respectively. Conclusions— If further validation is achieved, this score may be useful to predict outcome in individual patients with asymptomatic aortic stenosis to select those who might benefit from early surgery. [less ▲]Detailed reference viewed: 51 (1 ULg)
Baseline inflammation is not predictive of periprocedural troponin elevation after elective percutaneous coronary intervention.
Gach, Olivier ; Louis, Olivier ; Chapelle, Jean-Paul et al
in Heart & Vessels (2009), 24(4), 267-70
High-sensitivity C-reactive protein predicts future cardiovascular events in both healthy individuals and patients with unstable and stable coronary syndromes. Few data are available about the incidence ... [more ▼]
High-sensitivity C-reactive protein predicts future cardiovascular events in both healthy individuals and patients with unstable and stable coronary syndromes. Few data are available about the incidence and the relation to inflammation of troponin elevation following percutaneous coronary intervention (PCI), a potential predictor of longterm outcome. We sought to confirm the impact of embolization on long-term outcome and evaluate the ability of baseline inflammation to predict troponin elevation induced by PCI. We prospectively analyzed 200 patients treated by PCI for stable or Braunwald IIA class unstable angina. The patients were recruited between January 1997 and May 1999, and the population was followed during a mean follow-up of 32 months. Major adverse cardiac events (MACEs) were defined as the occurrence of death, myocardial infarction or recurrent angina requiring repeat PCI, or coronary artery bypass grafting. During the follow-up period, 58 MACEs were observed. By multivariate analysis, independent predictors for the occurrence of MACEs were unstable angina and troponin I level after PCI (P < 0.0001 for both). No correlation was found between baseline inflammation and significant troponin I elevation post PCI and by multivariate analysis, no biological variable was a predictor of troponin I elevation post PCI. Baseline inflammation cannot predict onset of minor myonecrosis damage (expressed by troponin elevation) induced by PCI, a significant predictor of long-term outcome in this setting. [less ▲]Detailed reference viewed: 23 (7 ULg)
Dynamic left ventricular dyssynchrony: a potential cause of no contractile reserve in patients with low-gradient aortic stenosis
Lancellotti, Patrizio ; ; Moonen, Marie et al
in European Journal of Echocardiography (2009)Detailed reference viewed: 23 (6 ULg)
Afterload mismatch revealed by an exercise biphasic response in aortic stenosis
Lancellotti, Patrizio ; Moonen, Marie ; Garweg, Christophe et al
in Archives of Cardiovascular Diseases (2009), 102(6-7), 593-594Detailed reference viewed: 47 (8 ULg)
Rosuvastatin in Patients with Elevated C-Reactive Protein
in New England Journal of Medicine [=NEJM] (2009), 360(10), 1040Detailed reference viewed: 18 (3 ULg)
The value of 2D strain imaging during stress testing
Moonen, Marie ; Lancellotti, Patrizio ; et al
in Echocardiography (2009), 26(3), 307
Stress echocardiography is increasingly used but its major limitation is the subjective interpretation of wall motion changes requiring experience. Speckle tracking enables simultaneous evaluation of ... [more ▼]
Stress echocardiography is increasingly used but its major limitation is the subjective interpretation of wall motion changes requiring experience. Speckle tracking enables simultaneous evaluation of radial, longitudinal, and circumferential myocardial deformation. Recently, two-dimensional (2D) strain has been found to be as reliable as sonomicrometry for the assessment of left ventricular (LV) regional function. In the presence of inducible ischemia, longitudinal and circumferential abnormalities preceed the decrease in radial deformation. Optimal cutoffs have been obtained from 2D strain rate (SR) at peak dobutamine stress to predict coronary artery disease. However, 2D strain rate does not yet provide incremental accuracy to visual interpretation by experts. Speckle tracking strain could be useful to better identify contractile reverse and biphasic response of viable myocardium but there are not yet clinical studies published in this setting. Preliminary results suggest that 2D strain obtained during exercise could be useful in asymptomatic patients with severe aortic stenosis or organic mitral regurgitation (MR). In conclusion, the reliability and clinical importance of 2D strain during stress will be specified by further investigations. [less ▲]Detailed reference viewed: 111 (6 ULg)
Echocardiography in the emergency roon: non-invasive imaging.
Pierard, Luc ; Lancellotti, Patrizio
in Heart (2009), 95(2), 164Detailed reference viewed: 16 (3 ULg)
Guia de practica clinica para la valoracion del riesgo cardiaco preoperatorio y el manejo cardiaco perioperatorio en la cirugia no cardiaca
; ; et al
in Revista Española de Cardiología (English version) (2009), 62(12), 14671-146756Detailed reference viewed: 3 (1 ULg)
Stratification du risque dans la cardiomyopathie hypertrophique.
; ; Pierard, Luc
in Revue medicale de Liege (2009), 64(11), 576-80
Hypertrophic cardiomyopathy is of genetic origin, characterized by asymmetric left ventricular hypertrophy and variable clinical presentation. The physiopathology includes diastolic dysfunction and, in ... [more ▼]
Hypertrophic cardiomyopathy is of genetic origin, characterized by asymmetric left ventricular hypertrophy and variable clinical presentation. The physiopathology includes diastolic dysfunction and, in one third of the patients, dynamic left ventricular outflow tract obstruction. Patients are at increased risk of sudden death. Risk stratification in the individual patient is an essential component of management. This article describes the clinical presentation of a patient and his mother and summarizes essential features of the disease and the current recommendations for the prevention of sudden cardiac death. [less ▲]Detailed reference viewed: 2 (0 ULg)
L'image du mois. Traitement percutane d'une cardiomyopathie hypertrophique obstructive.
Moonen, Marie ; Legrand, Victor ; Lancellotti, Patrizio et al
in Revue Médicale de Liège (2009), 64(10), 481-3Detailed reference viewed: 6 (2 ULg)
Medical therapy for rheumatic heart disease: is it time to be proactive rather than reactive?
; ; et al
in Indian Heart Journal (2009), 61(1), 14-23
Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the ... [more ▼]
Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease. However, the prospective randomized clinical trials have been negative to date. This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease. Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis. An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions. Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late. This is important in calcific aortic stenosis as well as in rheumatic valve disease. There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis. In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves. This review will summarize the potential for statin therapy for this patient population. [less ▲]Detailed reference viewed: 8 (2 ULg)
Myocardial contractile reserve during exercise predicts left ventricular reserve remodelling after cardiac resynchromization therapy
Lancellotti, Patrizio ; ; Moonen, Marie et al
in European Journal of Echocardiography (2009), 10(5), 663-8Detailed reference viewed: 37 (8 ULg)
Resting left ventricular longitudinal function predicts exercise pulmonary hypertension in organic mitral regurgitation.
Magne, Julien ; MOONEN, Marie ; et al
Conference (2009)Detailed reference viewed: 2 (0 ULg)