Cardiovascular disease is the leading cause of morbidity and mortality in women, and its development results from both traditional risk factors and female-specific determinants that emerge across the life course. This narrative review explores the role of physical activity in reducing risk associated with five major sex-specific cardiovascular determinants: hormonal contraception, polycystic ovary syndrome, endometriosis, pregnancy complications and menopause. This review synthesized up-to-date studies exploring the associations between these conditions and cardiovascular risk in women, as well as research assessing whether physical activity may help to reduce this risk through various mechanisms. Hormonal contraception, polycystic ovary syndrome, endometriosis, pregnancy complications and menopause are each associated with distinct or overlapping pathophysiological pathways that involve metabolic dysfunction, systemic inflammation, endothelial impairment, adverse vascular remodelling or prothrombotic alterations. Together, these mechanisms contribute to an elevated lifetime risk of cardiovascular disease in women. Physical activity appears to improve many of these underlying processes, although the level of evidence, the magnitude and the specificity of these benefits vary by condition. Physical activity is a central and highly relevant approach to preventing cardiovascular disease in women exposed to sex-specific risk factors. Although current evidence is encouraging, further research is needed to clarify mechanistic pathways, strengthen causal inference and refine exercise prescriptions adapted to each condition. Individualized risk assessment and the integration of physical activity into long-term preventive and clinical management strategies are essential to reduce the cardiovascular burden in women.
The last specific international European recommendations regarding the management of cardiogenic shock (CS) regardless of the etiology were issued over 10years ago. We present herein recommendations for the management of CS in adults, developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of from the French Intensive Care Society [Société de réanimation de langue française (SRLF)] and the French Society of Cardiology [Société française de cardiologie (SFC)], with the participation of the French Society of Anesthesia and Intensive Care [Société française d'anesthésie et de réanimation (SFAR)], and the French Society of Thoracic and Cardiovascular Surgery [Société française de chirurgie thoracique et cardio-vasculaire (SFCTCV)]. The recommendations covered six fields of application: CS teams and expert centers, symptomatic medical management, etiological management, organ support, temporary circulatory support and de-escalation and early post-CS management. Twenty-three "Patient Intervention Comparator Outcome" (PICO) questions were identified, leading to 41 recommendations regarding management of CS in adult patients. Seven recommendations were scored with high level of evidence (Grade 1), 11 with moderate level of evidence (Grade 2) and 17 with low level of evidence (Expert opinion). In 6 cases, the experts were not able to give an answer. All of the recommendations obtained strong agreement from the expert committee. The experts highlight the fact that optimal management of CS requires organization including a structured, multidisciplinary shock team and regional referral network, applying standardized protocols for diagnosis and staging. Early etiological treatment-such as culprit-lesion revascularization or urgent valve intervention-is central to improve outcomes. Hemodynamic support should prioritize norepinephrine as first-line vasopressor and privilege selective inotrope use. Temporary mechanical circulatory support (Impella, VA-ECMO) should be reserved for carefully selected patients following discussion by the expert team.
Transthyretin cardiac amyloidosis is an important cause of heart failure. Tafamidis, the only specific treatment for cardiac amyloidosis currently widely available in France, has been shown to reduce mortality efficiently. The purpose of this study was to describe time to cardiovascular events (death or hospitalization) in patients with transthyretin cardiac amyloidosis treated with tafamidis, and to investigate associated factors. We retrospectively included consecutive patients with a new diagnosis of transthyretin cardiac amyloidosis and an indication for tafamidis in a tertiary centre from August 2012 to July 2022. We collected time-to-event data, and associated clinical, biological, ultrasound and therapeutic factors. We included 128 patients, with visits every 6 months and a median follow-up of 15 months. A total of 42 patients (33%) died or were hospitalized for cardiovascular causes, with a median time-to-event of 1050 days (95% confidence interval 897 - not available). The mean time between diagnosis and start of treatment was 127±361 days. Several factors were associated with cardiovascular outcomes: older age at diagnosis correlated with reduced frequency of death or hospitalization (hazard ratio 0.93, 95% confidence interval 0.89-0.97; P<0.01), whereas obesity correlated with increased occurrence of death or hospitalization (hazard ratio 3.95, 95% confidence interval 1.45-10.76; P=0.01). More importantly, N-terminal prohormone of B-type natriuretic peptide>1000ng/L at diagnosis was a major risk factor in the multivariable analysis (hazard ratio 4.10, 95% confidence interval 1.64-10.25; P<0.01). After the initiation of treatment, New York Heart Association class and weight decreased significantly. Patients with transthyretin cardiac amyloidosis have a poor prognosis in the short term, despite the use of tafamidis. Important prognostic factors, including clinical features and biomarkers (especially N-terminal prohormone of B-type natriuretic peptide) are essential for risk stratification. As these surrogate endpoints show significant improvement after starting tafamidis, initiating therapy promptly appears mandatory in the most severe patients.
Transcatheter aortic valve implantation is the standard treatment for symptomatic severe aortic stenosis. Advances in technology and minimally invasive techniques have made early discharge following transcatheter aortic valve implantation a feasible and safe option, optimizing hospital resource utilization without compromising care quality. To evaluate the feasibility and safety of early discharge ("fast-track") following transcatheter aortic valve implantation in a single high-volume centre. This single-centre retrospective study included consecutive patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis between April 2022 and December 2023. Patients were stratified into FT- (ineligible), FT+/+ (next day discharge achieved), and FT+/- (early discharge failed) groups. The primary endpoint was a 3-month composite safety outcome. Between April 2022 and December 2023, 506 patients aged>18 years with severe symptomatic aortic stenosis underwent transcatheter aortic valve implantation at the University Hospital of Marseille Timone; of these, 479 patients were included in the analysis. Overall, 80.8% (n=409; 95% confidence interval 77.2-84.0%) of the total patient population were eligible for fast track (FT+). The primary reason for ineligibility (FT-) was the presence of complete right bundle branch block (49.6%, n=54; 95% confidence interval 40.1-59.2%). Among FT+ patients, 69.9% (n=286; 95% confidence interval 65.3-74.1%) were discharged the next day (FT+/+); the early discharge strategy failed in 30.1% (n=123) (FT+/-). Prolonged rhythm monitoring as a result of acquired conduction disorders delayed discharge in 55.9% (n=76; 95% confidence interval 47.0-64.3%) of FT+/- cases. High-grade conduction disorders necessitated a mean wait of 4.1 days for pacemaker implantation. At 3-month follow-up, cardiovascular events occurred in 4.4% (n=12/275) of FT+/+ patients, 6.9% (n=8/116) of FT+/- patients and 11.4% (n=10/88) of FT- patients (P=0.06). Next-day discharge after transcatheter aortic valve implantation was feasible and safe for 69.9% of eligible patients (representing 56.5% of the overall cohort). Eligibility for the fast track protocol was achieved in 80.8% of patients. Conduction disturbances and vascular complications remain key obstacles leading to prolonged hospital stays and requiring optimization.
Women of reproductive age are an important group to consider in the global burden of rheumatic heart disease (RHD). We aimed to systematically analyse the burden of RHD among women of reproductive age from 1990 to 2021. We used Global Burden of Disease (GBD) 2021 to comprehensively analyse the global burden of RHD among women of reproductive age, including incidence, prevalence, mortality and disability-adjusted life years (DALY) and examined the relationship between the burden of disease and different regions, sociodemographic index (SDI) and age. The incidence and prevalence rates of RHD in women of reproductive age increased globally from 1990 to 2021. The incidence rate (per 100,000 population) increased from 60.37 (95% UI: 44.12-82.42) in 1990 to 64.06 (95% UI: 46.24-86.76) in 2021 and the prevalence rate increased from 951.74 (95% UI: 723.08-1197.48) to 1110.17 (95% UI: 843.45-1402.27). When countries were grouped by SDI, incidence rate and prevalence rate negatively correlated with SDI. Low SDI regions had the highest burden. In 2021, women of reproductive age 15-19years had the most incident cases, and the number of deaths and DALY connected positively with age. The increasing incidence of RHD among women of reproductive age represents an important global health concern, particularly in low-SDI regions where the disease burden remains highest. The early onset of RHD highlights the need for preventive efforts targeting younger women. Prevention and management strategies should be adapted to disease patterns and health-system capacity, with an emphasis on early detection and effective secondary prevention in high-burden settings.
Coronary revascularization is a key treatment for coronary artery disease (CAD). Over the past 15years, several randomized trials have shown that it failed to improve life expectancy in most patients with stable CAD. To compare trends in the use of coronary revascularization from 2012 to 2018 in France and the United States (US). Administrative databases were used in both countries to identify patients ≥35years of age, hospitalized for CAD or congestive heart failure (CHF) undergoing coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), as identified from the International Classification of Diseases coding system. Independent correlates of the use of coronary revascularization were also investigated. In France, from 2012 to 2018, coronary revascularization increased by 13.3% among patients aged 35-64years and by 24.6% among those aged ≥65years. In contrast, in the US, it decreased by 16.3% and 19.6%, respectively. These trends were mainly related to the use of PCI: +15.8% and +28.8% in France versus-17.6% and-20.4% in the US. These divergent trends could not be explained solely by changes in the number of hospitalizations for CAD/CHF. In both countries and for both periods, use of revascularization was independently related to age, number of medical diagnoses, sex and income. Divergent trends in the use of coronary revascularization were observed in France and the US that could not be explained by trends in the number of CAD/CHF hospitalizations, nor by differences in the correlates of its use.
Out-of-hospital cardiac arrest in the setting of ST-segment elevation myocardial infarction is associated with high death rates. Chronic total occlusions are frequent in coronary artery disease, and have been linked to poor outcomes in acute coronary syndromes, but their prognostic impact in patients with out-of-hospital cardiac arrest in the setting of ST-segment elevation myocardial infarction is unclear. To evaluate the prognostic impact of coronary chronic total occlusions in patients resuscitated from out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction. We analysed data from the prospective PROCAT registry including consecutive patients with out-of-hospital cardiac arrest with return of spontaneous circulation and ST-segment elevation myocardial infarction who underwent emergent coronary angiography between 2007 and 2024. The presence of chronic total occlusion was assessed at baseline. The primary endpoint was 90-day all-cause death; secondary endpoints included in-hospital death. Logistic regression and Cox models were used to assess associations between chronic total occlusion and outcomes. Among 352 patients included, chronic total occlusion was present in 58 (16%). Patients with chronic total occlusion were older, had more co-morbidities and exhibited more extensive coronary artery disease. Rates of in-hospital death (55.2% vs. 39.8%; P=0.030) and 90-day death (69.0% vs. 49.0%; P=0.005) were higher in the chronic total occlusion group. In the univariate analysis, chronic total occlusion was associated with increased in-hospital deaths (odds ratio: 1.86, 95% confidence interval: 1.05-3.29) and 90-day deaths (hazard ratio: 1.76, 95% confidence interval: 1.18-2.62). However, after multivariable adjustment for clinical and resuscitation-related factors, chronic total occlusion was not independently associated with either endpoint. In patients resuscitated from out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction, chronic total occlusion is associated with increased crude death rates, but does not independently predict outcomes after adjustment. Chronic total occlusion probably reflects a higher atherosclerotic burden rather than being a direct driver of early death. The detection of chronic total occlusion remains clinically relevant for long-term management.
Large electrocardiogram (ECG) dataset analyses have emerged as potential game-changers in the field of personalized predictive medicine. ECG parameters have been described in cohorts of apparently healthy subjects and from primary care but seldom in community-based representative populations. To describe the ECG phenotypes of a representative subset of the adult French general population. ECGs recorded at inclusion in the CONSTANCES cohort were automatically analysed using the Glasgow diagnostic algorithm. Extreme values and abnormal statements were adjudicated to detect false positives. A subset of ECGs that were classified as normal were also adjudicated to estimate false negative statements. The data obtained were used to describe the prevalence and distribution of quantitative parameters and diagnostic statements. We automatically analysed the ECGs of 143,763 subjects (54% female; mean±standard deviation age 47.0±13.5 years in females and 46.9±13.5 years in males; P=0.44) and adjudicated>10,000 ECGs. We describe the distribution of automatic ECG interval measurements and the prevalence of different ECG statements provided by the automatic analysis, before and after adjudication. Heart rate and interval durations were dependent on both sex and age (ANOVA P<0.0001). At the population level, the Fridericia formula appeared to be less biased than that of Bazett. We describe the adjudicated ECG phenotypes of a representative subset of the adult French general population. The automated measurement and interpretation provided by the Glasgow algorithm proved highly efficient for epidemiological evaluation. This ECG phenotype characterization will open up the possibilities for cross-analyses, for artificial intelligence-based algorithm development and will serve as a reference to evaluate serial ECG changes during extended follow-up.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.
Transcatheter aortic valve implantation (TAVI) has become widely used to treat symptomatic patients with aortic stenosis (AS), but increasing demand has led to treatment delays, which are associated with increased morbi-mortality. To reduce time to treatment in patients awaiting a TAVI, we constructed a multi-component intervention which includes (1) a paper- and internet-based component aimed at improving AS and TAVI knowledge and (2) an organizational component aimed at TAVI centres to improve scheduling of examinations and procedures. Their effectiveness, cost-effectiveness and implementation were evaluated in a cluster randomized controlled trial (cRCT). The cRCT (NCT_05237804) used a factorial design to evaluate the two components of the intervention, alone and together. The cluster was the TAVI centre. As patients may be referred to TAVI centres by regional hospitals, participating regional hospitals were included in the cluster of their referral TAVI centre. Clusters were allocated to one of four treatment groups after stratification on annual number of TAVI procedures, presence of a coordinating nurse and participation of a regional hospital. Patients aged ≥18 years with symptomatic AS and a TAVI indication were included in the study. The expected sample size was 798 patients. The primary outcome is the percentage of patients treated within 2 months of the TAVI indication. Secondary outcomes are time to treatment, mortality, quality of life, knowledge regarding TAVI and AS, medication compliance and incremental cost-effectiveness ratios. Implementation measures include dose, fidelity, adaptations, reached population, satisfaction and acceptability. Overall, 828 patients have been enrolled. Data had not been analysed at the time the protocol was submitted.
Heart transplantation following donation after controlled circulatory death (DCD) is not authorized in France, hence a feasibility study was mandatory. To conduct a preclinical study to validate the feasibility of DCD heart procurement. We further sought to investigate the metabolic signature of DCD hearts during normothermic ex-situ perfusion (NESP). The study design was approved by the Agence de la biomedecine (PFS20-004, La Plaine Saint-Denis, France). Five patients were considered for DCD heart procurement. Femoral vessels were canulated to ensure abdominal normothermic regional perfusion (A-NRP). Direct procurement followed by 4hours of NESP was performed. Donors' demographics and duration of functional warm ischaemic time (fWIT) were collected. Lactate levels were assessed every 30minutes during NESP. Plasma and left ventricular biopsies were collected every 30 and 60minutes, respectively, for untargeted metabolomic analyses using liquid chromatography coupled to high-resolution mass spectrometry. Mean±standard deviation donor age was 40±11 years and fWIT for the hearts was 26±10min. DCD lungs and kidneys were transplanted except in one case each (impaired ex vivo lung perfusion and premature arrest of A-NRP, respectively). DCD livers were all transplanted when allocated. All hearts were successfully perfused for 4hours. Lactate decreased during NESP for all hearts with a mean±standard deviation initial lactate at 5.42±0.98mmol/L and a final concentration at 3.02±0.86mmol/L (P=0.003). In plasma samples, there were notable changes for 166 metabolites. Most of them either initially increased and stabilized (64/166; 38.6%, e.g. carnitines) or continuously increased (67/166; 40.4%, e.g. purines, medium-chain fatty acids and amino acids). In biopsy samples, there were notable changes for 103 metabolites. Most of them initially decreased and stabilized, such as carnitines and nucleotides. DCD heart procurement is feasible in France. Lactate trends were consistent with suitability of these hearts for transplantation. The metabolomic signature was characterized by nucleotide catabolism along with consumption of carnitines.
The impact of right ventricular dysfunction on transcatheter mitral valve implantation outcomes and the evolution of right ventricular function after the procedure has not been described. To analyse the impact of right ventricular dysfunction on immediate and mid-term outcomes of transcatheter mitral valve implantation, and the evolution of right ventricular function in these patients. Consecutive patients who underwent transcatheter mitral valve implantation in our institution were included. Right ventricular function was assessed before transcatheter mitral valve implantation by transthoracic echocardiography, using a multivariable approach. Patients were divided into two groups according to the preprocedural presence of right ventricular dysfunction. Patients were followed up at 3 months and 1 year with a new echocardiographic assessment at each time point. Among 109 patients finally included (mean age 65±19 years; 66% women), 77 (71%) had normal right ventricular function and 32 (29%) had right ventricular dysfunction before transcatheter mitral valve implantation. Technical success was achieved in 92 (84%) patients. At 30 days, there were no differences between the group with normal right ventricular function and the group with right ventricular dysfunction in terms of death (5 vs. 6%; P=0.86), all-cause rehospitalization (20 vs. 31%; P=0.17) and heart failure without hospitalization (13 vs. 6%; P=0.5). Although the 1-year survival rate was higher in the group with normal right ventricular function (83.1%, 95% confidence interval 74.3% to 92.9%) than in the group with right ventricular dysfunction (68.2%, 95% confidence interval 52.9% to 88.1%) (P=0.09), these differences were not significant after adjustment. Transcatheter mitral valve implantation was associated with improved right ventricular function in the group with initial right ventricular dysfunction at 1-year follow-up (P<0.01). Right ventricular dysfunction does not appear to have an impact on the early outcomes of transcatheter mitral valve implantation. However, it was associated with an increased rate of late death, although differences were not statistically significant after adjustment. Successful transcatheter mitral valve implantation in patients with severe mitral valve disease associated with right ventricular dysfunction leads to significant improvement in right ventricular function.
Cardiovascular disease is a leading cause of morbidity in patients with hypertension. Developing a highly accurate and interpretable prediction model is crucial for facilitating early intervention. This study aimed to construct and validate a machine-learning-based risk prediction model for cardiovascular disease in patients with hypertension to improve the effectiveness of clinical screening. The data were sourced from the National Health and Nutrition Examination Survey conducted from 2009 to 2018. We integrated the Least Absolute Shrinkage and Selection Operator, the Boruta algorithm and Recursive Feature Elimination to screen key variables. Four machine-learning algorithms were employed to construct the prediction model. The performance of the model was evaluated through 10-fold cross-validation and an independent test set, and the SHapley Additive exPlanations (SHAP) method was used to analyse the feature contribution mechanism. A total of 2781 participants were included, and eight key variables were finally selected for constructing the prediction model. After a comprehensive evaluation, the Balanced Bagging Classifier model demonstrated the best performance. SHAP analysis revealed that the top-ranked features by descending importance were: neutrophil-lymphocyte ratio, waist-to-height ratio, age, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, kidney disease, sleep disturbance and diabetes. The machine-learning model developed in this study demonstrates good effectiveness and promising generalizability for predicting cardiovascular disease in patients with hypertension, with its utility further enhanced by high interpretability via SHAP analysis. The model shows promise as a practical tool for early cardiovascular disease screening, risk assessment and clinical decision-making in hypertensive populations. Future research should explore the model's applicability across diverse populations and clinical scenarios.
Lamin A/C (LMNA) cardiomyopathy is an inherited form of dilated cardiomyopathy associated with high rates of arrhythmias, conduction disease and sudden cardiac death, often preceding overt heart failure. Although LMNA mutations account for a minority of dilated cardiomyopathy cases, they portend a particularly malignant course. Cardiac magnetic resonance (CMR) imaging, particularly the detection of late gadolinium enhancement, has emerged as a valuable tool for assessing myocardial fibrosis and risk stratification in laminopathy. This study aims to systematically evaluate the structural, functional and prognostic CMR features in LMNA mutation carriers, and to quantify the diagnostic and clinical implications of myocardial fibrosis. A comprehensive literature search was conducted through June 2025. Studies involving genetically confirmed LMNA mutation carriers with CMR data were included. Outcomes included ventricular variables (left ventricular ejection fraction, left ventricular end-diastolic volume index, left ventricular end-systolic volume index, left ventricular wall mass index), late gadolinium enhancement (LGE) presence and arrhythmic events. Between-group comparisons were made: LMNA cardiomyopathy versus healthy controls; laminopathy with versus without LGE; and LMNA-positive versus LMNA-negative cardiomyopathy. We identified 10 studies involving 847 individuals. The LGE risk ratio for patients with LMNA cardiomyopathy versus healthy controls was 14.39 (P<0.001); the LGE risk ratio for patients with LMNA-positive versus LMNA-negative cardiomyopathy was 2.14 (P<0.001). In patients with laminopathy, LGE was associated with an increased risk of atrioventricular block (risk ratio 6.94; P=0.004) and a trend towards more ventricular tachyarrhythmia (risk ratio 3.32; P=0.056). Despite these fibrotic changes, left ventricular volumes and wall mass did not differ significantly from controls. CMR imaging identifies a high burden of fibrosis in LMNA cardiomyopathy, even in early disease, with strong prognostic implications. LGE presence is a key risk marker for arrhythmia and conduction disease, supporting early imaging-based risk stratification and possible preventive implantable cardioverter-defibrillator implantation in mutation carriers.
Out-of-hospital cardiac arrest (OHCA) remains associated with poor outcomes despite advances in care. Coronary artery disease is the leading cause, yet the prognostic role of initial coronary flow status, assessed by Thrombolysis In Myocardial Infarction (TIMI) grade at angiography, has not been fully explored in OHCA survivors. To evaluate the prognostic impact of preprocedural TIMI flow in this population, and to identify predictive factors for reduced TIMI flow. We analysed data from the prospective PROCAT registry, including consecutive patients with OHCA with no extracardiac cause who underwent early coronary angiography between May 2016 and August 2022 at Cochin Hospital, Paris. Patients were categorized into three groups: non-ischaemic OHCA (OHCAni); ischaemic OHCA with preserved flow (TIMI 2-3; OHCAi2-3); and ischaemic OHCA with reduced flow (TIMI 0-1; OHCAi0-1). The primary endpoint was 1-year death; secondary endpoints included in-hospital death, neurological outcome at discharge and major bleeding (Bleeding Academic Research Consortium types 3-5). Among 330 patients, 181 (55%) had OHCAni, 58 (18%) had OHCAi2-3 and 91 (27%) had OHCAi0-1. The 1-year death rate was significantly higher in the OHCAni group (66.7%) than in the ischaemic OHCA groups (OHCAi2-3, 34.5%; OHCAi0-1, 36.7%; P<0.001). Favourable neurological outcome (Cerebral Performance Category 1-2) at hospital discharge was observed in 64.4% of the OHCAni group versus 64.9% and 58.9% in the OHCAi2-3 and OHCAi0-1 groups, respectively (P<0.001). Major bleeding was more frequent in the OHCAi2-3 group (28.1%) than the OHCAi0-1 group (11.5%; P=0.02). In multivariable analysis restricted to ischaemic OHCA, reduced TIMI flow independently predicted 1-year death (odds ratio 2.58, 95% confidence interval 1.02-7.22; P=0.05), along with older age, longer low-flow duration and absence of shockable rhythm. Ischaemic and non-ischaemic OHCA represent distinct clinical entities, with markedly poorer outcomes in the non-ischaemic group. In ischaemic OHCA, reduced preprocedural TIMI flow is an independent predictor of 1-year death despite high procedural success rates. Early assessment of coronary flow may thus provide important prognostic information, and should be integrated into risk stratification models for OHCA survivors.
The management of heart failure relies on categorizing patients by left ventricular ejection fraction: reduced (HFrEF), mildly reduced (HFmrEF) or preserved (HFpEF). This study aimed to examine the characteristics, management and outcomes across left ventricular ejection fraction categories within a large real-world cohort. Using the French national health database, adults hospitalized at least once for heart failure in 2019 with a left ventricular ejection fraction coding were identified. Characteristics, including demographics, comorbidities, medications and medical consultations, were described. Clinical outcomes, including all-cause mortality, all-cause hospitalization and heart failure-related hospitalization, were assessed across left ventricular ejection fraction categories using Cox multivariable analyses. Of 27,294 patients, 37% had HFrEF, 20% had HFmrEF and 43% had HFpEF. Patients with HFpEF were older and more comorbid than those with HFrEF; patients with HFmrEF showed intermediate features. Adjusted analyses found that the HFmrEF and HFpEF categories had lower risks of all-cause mortality (hazard ratio 0.71, 95% confidence interval 0.63-0.80 and hazard ratio 0.65, 95% confidence interval 0.60-0.72, respectively) and heart failure hospitalization (hazard ratio 0.65, 95% confidence interval 0.59-0.72 and hazard ratio 0.89, 95% confidence interval 0.82-0.96, respectively) compared with the HFrEF category. Although polypharmacy was frequent - ranging from 53% in the HFrEF category to 65% in the HFpEF category receiving at least 10 drugs - only 24% of patients with HFrEF received guideline-recommended heart failure triple therapy. The mean annual rate of cardiologist consultations remained low - nearly one per patient - regardless of left ventricular ejection fraction. In our nationwide study, left ventricular ejection fraction categories were associated with distinct patient profiles and outcomes, supporting the tripartite categorization. There was notable underuse of guideline-directed heart failure therapy, despite widespread polypharmacy, and infrequent specialist follow-up, underscoring the need for strategies to improve heart failure management in clinical practice.
In end-stage biventricular heart failure, heart transplantation remains the gold standard, but graft shortage and temporary contraindications may preclude access. Among patients who are ineligible for a total artificial heart (TAH), biventricular implantation of continuous-flow left ventricular assist devices (LVADs) has been reported as an off-label salvage strategy in highly selected patients. From 2023 to 2025, we included consecutive patients who underwent - as a bridge to transplantation - simultaneous biventricular HeartMate 3 implantation at Rennes University Hospital. All had refractory biventricular heart failure and met strict eligibility criteria. We used a previously published surgical approach, with right-sided implantation through an atrial inflow. This retrospective single-centre analysis included 10 patients who underwent simultaneous biventricular HeartMate 3 implantation. The procedure proved technically feasible. Early mortality occurred in 30% of patients, while the remaining patients achieved initial haemodynamic stabilization under biventricular support. A successful bridge to transplantation was achieved in 30%, after a median (interquartile range) support duration of 223 (153-256) days. Major complications included reoperation for bleeding in 20%, significant infection in 30% but no ischaemic strokes. At discharge, end-organ function was preserved, with median creatinine of 61μmol/L and median bilirubin of 10μmol/L. The so-called HeartMate 6 procedure may represent a feasible salvage bride-to-transplant option in highly selected patients when TAH is unavailable or anatomically unsuitable. Careful selection of patients and a highly trained surgical team is mandatory.
The MonCœur smartphone application (app) was developed to meet the specific needs of individuals living with heart failure (HF). To evaluate whether the MonCœur smartphone app improves self-care at 6months in patients with HF, and to assess effects on quality of life, physical activity and medication adherence. APPLIMONCOEUR was a prospective, multicentre, randomized, controlled, open-label trial conducted in 12 HF centres in France. Adults with HF (left ventricular ejection fraction ≤40%) hospitalized for de novo or decompensated HF, or within 3months of discharge, were randomized 1:1 to usual care or usual care plus MonCœur mobile app. Follow-up occurred at baseline, 3, 6 (primary timepoint) and 12months. The primary endpoint was change in self-care (European Heart Failure Self-care Behaviour Scale [EHFSCB] score) at 6months. Secondary endpoints included health-related quality of life (Minnesota Living with Heart Failure Questionnaire [MLWHFQ] score), weekly physical activity (mins/week per World Health Organization categories) and medication adherence (Girerd questionnaire). Analyses were performed on the intention-to-treat population with multiple imputation; between-group differences at follow-up were assessed using analysis of covariance adjusted for baseline values. Among 123 randomized patients (control n=64; app n=59), baseline characteristics and therapies were well balanced. At 6months, no significant difference was found for self-care (EHFScB total P=0.23). Quality of life improved similarly in both groups (MLWHFQ total P=0.87). Physical activity increased in both groups, with no between-group differences at 6months (intensive P=0.92; moderate-to-intensive P=0.63), but exploratory 12-month analyses favoured the app (P=0.002 and P=0.008, respectively). Medication adherence increased modestly in both groups (P=0.12). Only 25/59 (42.4%) of app users were active (i.e. used the app at least 3 times during the study). The MonCœur randomized trial suggests that a mobile app dedicated to HF management may contribute to behavioural changes, particularly in physical activity, although patient engagement with the app was moderate. GOV: NCT04198779.
Aortic stenosis is the most frequent valvular heart disease in industrialized countries, affecting about 10% of individuals aged>75years, with 2-4% presenting severe disease; nearly half of them are asymptomatic. No medical therapy halts aortic stenosis progression, and aortic valve replacement remains the only curative option. Managing asymptomatic patients is challenging because of a persistent risk of sudden death, and the potential for irreversible myocardial damage if intervention is delayed, but also because aortic valve replacement carries procedural risks and long-term prosthesis-related complications. Functional assessment, especially exercise testing, is essential as it can identify a substantial proportion of "falsely asymptomatic" patients who will benefit from timely aortic valve replacement. Accurate assessment of aortic stenosis severity is crucial, with echocardiography as the cornerstone, although additional imaging modalities may be required in selected cases. Modern risk stratification integrates markers of subclinical myocardial dysfunction, haemodynamic compromise and procedural risk. Although observational studies and randomized trials suggest that early aortic valve replacement may reduce adverse events in selected low-risk patients, results are heterogeneous and methodological concerns remain. Meta-analyses have shown reductions in unplanned hospitalizations but no clear survival benefit with early intervention. Current guidelines recommend aortic valve replacement for classical indications, such as symptom onset or reduced ejection fraction, and suggest early aortic valve replacement only in carefully selected asymptomatic patients with low procedural risk. Shared decision-making within a multidisciplinary heart valve team remains essential, taking into account patient preferences, co-morbidities, life expectancy and lifestyle. Close follow-up with regular echocardiography and functional testing is critical to optimize timing and outcomes.
The TRI-SCORE is a dedicated risk-stratification tool for patients with isolated severe tricuspid regurgitation (TR) that is freely accessible via a web-based platform or mobile application. To evaluate the global uptake of the TRI-SCORE and to describe the clinical characteristics of patients considered for intervention. We collected all TRI-SCORE calculations and related parameters entered by users into the web-based calculator or mobile application between June 2024 and June 2025, along with the users' geographic location. The clinical profiles derived from these data were compared with those of the TRIGISTRY cohort. Overall, 36,001 calculations were recorded across 117 countries, with 83% performed through the web-based platform. Most patients were aged≥70 years (70%), 58% were women and 70% had atrial fibrillation or flutter. TR was functional in 73% of cases. Patients were generally severely symptomatic (58% in New York Heart Association class III-IV, 58% with right heart failure signs) and many presented with advanced disease stages, with 33% and 27% falling into intermediate (4-5 points) and high (≥6 points) TRI-SCORE categories, respectively. Patient profiles were broadly consistent with those in TRIGISTRY, although left ventricular, hepatic and renal dysfunction were less commonly encountered. These findings demonstrate the widespread adoption of the TRI-SCORE through free, user-friendly digital platforms and suggest its potential utility as a tool to monitor disease stage when considering interventions in patients with TR.