Publications by authors named "Pascal Lim"

Background: Although recreational drug use is a strong risk factor for acute cardiovascular events, systematic testing is currently not performed in patients admitted to intensive cardiac care units, with a risk of underdetection. To address this issue, machine learning methods could assist in the detection of recreational drug use.

Aims: To investigate the accuracy of a machine learning model using clinical, biological and echocardiographic data for detecting recreational drug use in patients admitted to intensive cardiac care units.

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This study aimed to analyze the outcomes and challenges associated with surgical redo procedures following aortic valve replacement for acute infective endocarditis. While transcatheter aortic valve implantation is growing in terms of its utilization for degenerative bioprostheses failure, valve-in-valve procedures are limited in acute aortic endocarditis. Surgical interventions for aortic prosthesis endocarditis carry a significant risk, with a higher mortality and morbidity, often requiring concomitant complex procedures.

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Background: Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis.

Methods: FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France.

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Article Synopsis
  • FDG-PET/CT is valuable for diagnosing infective endocarditis (IE) and detecting additional septic sites, with prior studies revealing osteoarthritic septic grafts (OASGs) in 19.1% of IE patients.
  • A larger study included 174 patients suspected of IE, finding OASGs in 27.6% of them, predominantly located in the spine, with 43.8% of cases being asymptomatic.
  • The presence of OASGs was linked to musculoskeletal pain and tricuspid valve involvement, indicating that early identification could influence antibiotic treatment and orthopedic management.
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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.

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Background And Aims: Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery.

Methods: In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, and high: ≥6).

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Background: Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock.

Methods: FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres.

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Inflammatory processes are involved not only in coronary artery disease but also in heart failure (HF). Cardiogenic shock (CS) and septic shock are classically distinct although intricate relationships are frequent in daily practice. The impact of admission inflammation in patients with CS is largely unknown.

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Background: It remains unclear today whether risk scores created specifically to predict early mortality after cardiac operations for infective endocarditis (IE) outperform or not the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).

Methods: Perioperative data and outcomes from a European multicenter series of patients undergoing surgery for definite IE were retrospectively reviewed. Only the cases with known pathogen and without missing values for all considered variables were retained for analyses.

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Article Synopsis
  • * In a study involving 772 patients with cardiogenic shock, 21.3% had CKD, and these patients were generally older and had more health issues, which contributed to increased mortality.
  • * Renal replacement therapy (RRT) was associated with a higher risk of death regardless of CKD status, highlighting the need for collaborative care between cardiac and kidney specialists to better manage these patients.
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Background: Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial.

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Background: The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline-directed heart failure (HF) medical therapy (GDMT) and one-year survival rate in patients who are post-CS.

Methods And Results: FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units.

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Article Synopsis
  • The 2023 Duke-ISCVID criteria for diagnosing infective endocarditis (IE) were tested against the previous 2000 Modified Duke and 2015 ESC criteria using a large patient cohort treated for the condition.
  • A total of 1194 patients were analyzed, revealing that the 2023 criteria had the highest sensitivity (97.6%) but the lowest specificity (46.0%) compared to the other criteria.
  • The lower specificity in the 2023 criteria was largely due to the inclusion of patients with cardiac implanted electronic devices (CIED), highlighting the need for cautious interpretation in this group.
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  • The study examines heart failure and cardiogenic shock (CS) in older adults, highlighting that the incidence is rising due to an aging population, with limited data available on this demographic.
  • The research involved a registry called FRENSHOCK, which included 772 CS patients, revealing that 30.6% were over 75 years old, with higher comorbidities and lower treatment intensity compared to younger patients.
  • Results indicated that older adults have more than double the risk of death at 1 month and 1 year post-CS, emphasizing the need for targeted research to determine effective treatment strategies for this age group.
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Background: Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS.

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  • The study investigates the impact of skin mottling on patients with cardiogenic shock, finding that nearly 39% of patients showed mottling at admission, which is linked to worse outcomes.
  • In a cohort of 772 patients, those with mottling had higher rates of invasive support, longer hospital stays, and increased mortality at both 30 days and 1 year compared to those without mottling.
  • The study concludes that skin mottling can be a valuable assessment tool in guiding therapy for cardiogenic shock patients, indicating the need for more aggressive treatment to improve survival chances.
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  • Cardiogenic shock is a rare condition in adults with congenital heart disease (ACHD), making up only 0.9% of cases in a nationwide registry study in France.
  • The study found that ACHD patients were younger and had fewer risk factors for cardiovascular issues compared to non-ACHD patients, but they still experienced a high rate of severe outcomes after one year, similar to non-ACHD patients.
  • Management strategies differed significantly, with ACHD patients more likely to receive catheterizations and device implantations while less likely to use temporary circulatory support or invasive ventilation.
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Background: Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale.

Method: The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year.

Results: The patients included (n = 602) represented 29.

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  • This study explored the characteristics, management, and outcomes of patients with active cancer who were admitted for cardiogenic shock, finding that they made up about 6.6% of the 772 enrolled patients.
  • Although active cancer patients had similar initial in-hospital outcomes as non-cancer patients, they required more intensive drug management but received less mechanical support.
  • While both groups had similar 30-day mortality rates, the active cancer group had significantly higher long-term mortality rates at 1 year, indicating that active cancer dramatically impacts survival after initial treatment for cardiogenic shock.
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Objectives: The TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores.

Methods: Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017.

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Background: Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers  remains  unclear.  The  aim  of  this  study  was  to  evaluate  1-year  outcomes [mortality, heart transplantation, ventricular assist devices (VAD)] between VA-triggered and non-VA-triggered CS.

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