Publications by authors named "Montalescot G"
Epicardial Adipose Tissue from Computed Tomography: a Missing Link in Premature Coronary Artery Disease?
Eur Heart J Cardiovasc Imaging
January 2025
Article Synopsis
- Epicardial adipose tissue (EAT) may play a role in the unique atherosclerosis seen in premature coronary artery disease (pCAD), leading to more severe plaque characteristics and higher recurrence of ischemic events.
- Researchers studied 208 patients, including 104 with pCAD and 104 matched controls, analyzing EAT volume and density using advanced imaging techniques.
- Results showed pCAD patients had significantly higher EAT volume and lower density compared to controls, indicating that these factors are linked to more severe and potentially vulnerable coronary artery disease features.
Article Synopsis
- The study aims to assess the safety and efficacy of using expanded CD34+ cells for treating patients with acute myocardial infarction (AMI) and reduced left ventricular function, crucial for improving patient outcomes.
- Patients with severe AMI (left ventricular ejection fraction <50%) are randomly assigned to receive either CD34+ cell treatment alongside standard care or standard care only, with a focus on monitoring major adverse cardiac events over six months.
- This trial is groundbreaking as it explores the automated expansion and administration of autologous CD34+ cells, addressing current technological limitations in cell therapy for heart recovery post-AMI.
Article Synopsis
- * A total of 7062 patients participated, and the results showed no significant difference in primary cardiovascular outcomes between the colchicine group (9.1%) and the placebo group (9.3%) over a 3-year follow-up period.
- * Colchicine did lower C-reactive protein levels, indicating some anti-inflammatory effect, but it also caused more diarrhea compared to placebo, though serious infections were similar in both groups.
Background: Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain.
Methods: In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patients with myocardial infarction who had undergone percutaneous coronary intervention to receive either spironolactone or placebo and either colchicine or placebo.
Aims: Low cholesterol efflux capacity and elevated levels of Interleukin-1ß (IL-1ß) are both associated with residual cardiovascular risk in patients with acute myocardial infarction (MI) and may be used as new biomarkers to identify patients at higher cardiovascular risk.
Methods: We evaluated potential synergetic effect of cholesterol efflux capacity and IL-1ß on recurrent major adverse cardiovascular events (MACE) at one-year in 2012 patients with acute ST- segment elevation MI who underwent primary percutaneous coronary intervention. In addition, we evaluated the contribution to residual risk of HDL biological functions from 20 patients of the two extreme subgroups, focusing on cholesterol efflux capacity and anti-inflammatory properties.
Cardiogenic shock (CS) is a devastating and fatal complication of acute myocardial infarction (AMI). CS can affect the pharmacokinetics and pharmacodynamics of medications. The unique properties of cangrelor make it the optimal P2Y12 inhibitor for CS-AMI, in terms of both efficacy and safety.
View Article and Find Full Text PDFLevosimendan in Patients with Cardiogenic Shock Refractory to Dobutamine Weaning.
Am J Cardiovasc Drugs
October 2024
Background: This study examines the effects of levosimendan in patients refractory to dobutamine weaning.
Methods: This retrospective study included patients with cardiogenic shock refractory to dobutamine weaning failure admitted between 2010 and 2022. Patients treated with another type of dobutamine alone were compared with those treated with levosimendan in combination with dobutamine.
Background: The percentage of women <50 years of age hospitalized with myocardial infarction is increasing. We describe the clinical, morphological, and biological characteristics, as well as the clinical outcomes of this population.
Methods And Results: This prospective, observational study included consecutive women <50 years of age admitted for myocardial infarction at 30 centers in France (May 2017-June 2019).
Background: The real incidence of atrial arrhythmia (AA) after patent foramen ovale (PFO) closure and whether this complication can be prevented remain unknown. We assessed whether flecainide is effective to prevent AA during the first 3 months after PFO closure, and whether 6 months of treatment with flecainide is more effective than 3 months to prevent AA after PFO closure.
Methods: AFLOAT (Assessment of Flecainide to Lower the Patent Foramen Ovale Closure Risk of Atrial Fibrillation or Tachycardia Trial) is a prospective, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the end points (PROBE [Prospective Randomized Open, Blinded End Point] design).
Background: The appropriate duration of treatment with beta-blocker drugs after a myocardial infarction is unknown. Data are needed on the safety and efficacy of the interruption of long-term beta-blocker treatment to reduce side effects and improve quality of life in patients with a history of uncomplicated myocardial infarction.
Methods: In a multicenter, open label, randomized, noninferiority trial conducted at 49 sites in France, we randomly assigned patients with a history of myocardial infarction, in a 1:1 ratio, to interruption or continuation of beta-blocker treatment.
Background: Whether saline-induced hyperaemia captures exercise-induced coronary flow regulation remains unknown.
Aims: Through this study, we aimed to describe absolute coronary flow (Q) and microvascular resistance (Rμ) adaptation during exercise in participants with angina with non-obstructive coronary artery disease (ANOCA) and to explore the correlations between saline- and exercise-derived coronary flow reserve (CFR) and microvascular resistance reserve (MRR).
Methods: Rμ, Q, CFR and MRR were assessed in the left anterior descending artery using continuous thermodilution with saline infusion at 10 mL/min (rest), 20 mL/min (hyperaemia) and finally at a 10 mL/min infusion rate during stress testing with a dedicated supine cycling ergometer.
Article Synopsis
- The study aimed to explore outcomes of transcatheter patent foramen ovale (PFO) closure in patients over 60 years old, particularly looking at recurrent cerebrovascular events (CVE) and atrial fibrillation (AF).
- Involving 689 patients, the procedural success rate was high at 99.4%, but there were notable risks: 9.6% of patients died during follow-up, and diabetes and atrial septal aneurysm were linked to increased CVE events.
- The findings suggest that while most older patients experience low rates of CVE and AF post-procedure, factors like diabetes, atrial septal aneurysms, and increasing age are important in guiding clinical decisions regarding PFO closure.
Percutaneous transcatheter structural heart interventions have considerably expanded within the last two decades, improving clinical outcomes and quality of life versus guideline-directed medical therapy for patients frequently ineligible for surgical treatment. Transcatheter structural heart interventions comprise valve implantation or repair and also occlusions of the patent foramen ovale, atrial septal defects and left atrial appendage. These procedures expose structural devices to arterial or venous blood flow with various rheological conditions leading to potential thrombotic complications and embolisation.
View Article and Find Full Text PDFBackground: The ACTION-SHOCK registry offers a decade-long perspective on patients admitted with cardiogenic shock (CS).
Aims: To assess trends in the management and outcomes of patients with CS over 10 years.
Methods: Trends in the characteristics, management and outcomes of patients with CS admitted into the cardiac intensive care unit of Pitié-Salpêtrière hospital from 2011 to 2020 were analysed.
Early and late hospital readmissions after percutaneous left atrial appendage closure.
Rev Esp Cardiol (Engl Ed)
August 2024
Article Synopsis
- Percutaneous left atrial appendage closure (LAAC) is a procedure to prevent blood clots in patients with nonvalvular atrial fibrillation, but there is limited information on readmission rates following the procedure.
- A study of 1419 patients found that 18.1% were readmitted within a year, primarily due to bleeding and heart failure, with specific health conditions increasing the likelihood of readmission.
- Both early and late readmissions were linked to a higher risk of mortality within two years, highlighting the importance of managing patient health before and after LAAC.
Article Synopsis
- Device-related thrombosis (DRT) occurs frequently after left atrial appendage closure (LAAC), with notable differences in diagnosis timing and outcomes between men and women.
- Women make up 34.7% of DRT patients in the study and tend to be older and have fewer comorbidities compared to men, but DRT in women is diagnosed significantly later.
- Both genders have similar treatment outcomes and overall mortality rates, indicating that treatment strategies are equally effective regardless of sex.
Article Synopsis
- * Recent studies have raised concerns about this 12-month regimen, suggesting adjustments based on patients' bleeding or ischemic risks, arguing some may benefit from shorter or longer durations.
- * Several strategies to modify DAPT practices, such as de-escalating to less potent medications or shortening therapy, have shown to reduce bleeding risks without significantly increasing cardiovascular issues, yet the 12-month recommendation remains unchanged in guidelines.
Early Nonprocedural Bleeding After Left Atrial Appendage Occlusion.
JACC Cardiovasc Interv
August 2024
Article Synopsis
- The study examined early nonprocedural bleeding in patients who underwent left atrial appendage occlusion (LAAO), finding that about 7% experienced bleeding unrelated to the procedure within three months, with more than half categorized as major bleeding.
- Key predictors for early bleeding included receiving dual antiplatelet therapy at discharge, a history of gastrointestinal bleeding, and multiple previous bleeding episodes.
- Furthermore, early nonprocedural bleeding was linked to a higher risk of all-cause mortality, emphasizing the serious implications of such events, regardless of their severity.
Article Synopsis
- - The CLEAR SYNERGY trial is investigating the safety and effectiveness of low-dose colchicine and spironolactone in reducing major cardiovascular events in patients recovering from a heart attack (myocardial infarction).
- - This large, randomized controlled study includes 7,062 participants from 104 centers across 14 countries and uses a factorial design to compare the treatments against placebos, focusing on specific cardiovascular outcomes.
- - Results are expected to be presented in fall 2024, and the study aims to provide valuable data on these medications' impact on post-MI patients who have undergone a procedure called percutaneous coronary intervention.
Article Synopsis
- The study aimed to analyze whether ticagrelor is more effective than clopidogrel in reducing heart damage during elective coronary procedures for patients with and without prior clopidogrel treatment.
- Out of 1,882 participants, those who were not on clopidogrel had a lower rate of heart injury compared to those who had been, but overall, ticagrelor did not show significant benefits over clopidogrel for reducing complications.
- The findings suggest that clopidogrel-naive patients generally experienced fewer complications due to a lower risk profile and simpler procedures, with no notable differences in outcomes based on previously taking clopidogrel.