Heart Failure (HF) is a major public health problem resulting in high rates of hospitalization and mortality. So far, most HF Surveys have included a selected population of patients with HF and involved mainly one type of cardiologic practice. There is a need for more information on the whole HF population. To collect data on a large French HF population (de novo/chronic/acute; out and in-patients; consultation/hospitalization/rehabilitation; all LVEF classes and any type of cardiologic practice) and to assess low sodium diet prescription and adherence. Prospective enrolment during 6 months in 2017. Data collection included biological, clinical, demographic, dietetary, echocardiographic and treatment characteristics. Supervised and unsupervised analysis methods from the data mining and machine learning fields can be performed to exploit data. Baseline variables involved for the analysis (NYHA classes, NTproBNP, Creatinin, BMI, …) are studied among descriptive variables (Age, Sex, Weight, …). Cluster analysis performed are based on Hierarchical Ascending Approaches in Euclidean distance and on the production of Self-Organizing Maps (SOMs) with the statistical software R. Complete data analysis with identification of new patient profiles will be shown at the congress. Combining a large representative and non selective French HF population, cluster analysis will allow to identify specific patient profiles constituting homogeneous groups within the sampled population reflecting the severity of their heart condition. New data will be shown during the congress.

Heart Failure (HF) is a major public health problem resulting in high rates of hospitalization and mortality. Most HF Surveys have included selected HF patients and did not focus on HF life burden. To describe a large French HF population (de novo/chronic/acute; out and in-patients; consultation/hospitalization/rehabilitation; LVEF preserved/reduced, any type of cardiologist’ practice). Prospective enrolment during 6 months in 2017. Data collection included demographic, burden, clinical, biological, echocardiography, treatment and diet characteristics. A total 2822 HF patients (70% men, mean age 67 ± 14 years) from 79 French departments of cardiology were included (Table 1). Thirty-six percent were outpatients, 53% were hospitalized and 11% were in rehabilitation center. Sixteen percent were de novo and 31% were in Acute HF. Fifty percent have been hospitalized during the previous year for Acute HF. Seventy-nine were in NYHA II or III and the mean LVEF was 38.8 ± 13.7%. 32% lived in the Countryside vs. 68% in Town. Thirty percent lived alone, 50% with a partner and 18% with their family and 1.5% in a Care home. Sixty-eight percent have level of education below Baccalaureat. Eighty-eight percent were non-working patients: 70% were retired; 9% were in sick Leave and 9% were unemployed. Regarding their self-sufficiency, 84% reported limitation of their life activities because of HF symptoms: 45% did not do their own cooking, 51% can not do their shopping, which is done by their partner (33%), by other members of the family (13%), by care givers (2%), by home delivery (2%), or by neighbours (1%). Seventy-four percent had Long Term Public Health Insurance (HI) (ALD), 40% had a Private HI, 4% had a Universal HI (CMU) and 0.5% reported none. Only 33% were asked to enter in an Education Program and of whom 65% did. Heart failure is more prevalent in men with low level of education and leads to heavy life burden because of vital exhaustion and life dependency that are reinforced by social isolation.

In paradigm-HF study, LCZ696 was superior to angiotensin converting enzyme inhibitors (ACEI) and reduced mortality in heart failure with reduced ejection fraction (HFrEF) patients. LCZ696 is now recommended in symptomatic patients with HFrEF despite optimal treatment with beta-blockers, ACEI and mineralocorticoid receptor antagonists (MRA). To evaluate LCZ696 prescription in real-life in and outpatients. Prospective enrolment during 6 months in 2017. Data collection included demographic, burden, clinical, biological, echocardiography and treatment characteristics. A total of 1442 patients with left-ventricular ejection fraction (LVEF) < 40% were included of whom 31% were outpatients. Their mean age was 65 ± 14 years and 77% were men. Eighty-three percent were in NYHA II or III class and the mean LVEF was 28.2 ± 6.3%. Ischemic cardiopathy affected 49.8% of the patients. Heart failure was recently diagnosed (< 3 months) in 19% of the patients. A total of 343 patients were treated with LCZ696 (24%), in association with beta-blocker (91%) and, or MRA (67%). One hundred and nine patients were outpatients (37.1%). Seventeen patients (5%) were treated by LCZ696 and ACEI. As compared with ACEI or angiotensin receptor blockers (ARB) or neither of them, patients treated with LCZ696 were younger (P < 0.0001) and more likely to be men (P = 0.016). NYHA status was better (P < 0.0001), NTpro-BNP was lower (P < 0.0001) and Minnesota physical score was lower (P = 0.003) in LCZ696 patients. Patients treated by LCZ696 were more likely to be outpatients (P < 0.001). Almost one in four patients with LVEF < 40% was treated with LCZ696. Symptoms, cardiac biomarkers and quality of life were improved compared to ACEI, ARB or no treatment. LCZ696 treatment was less prescribed in older patients and women although there is no specific contraindication in this population. The association of ACEI and LCZ696 has to be avoided due to an increased risk of angioedema.

Aim To assess the benefit of short-term low molecular weight heparin nadroparin compared with unfractionated heparin in unstable angina or non-Q wave myocardial infraction patients and to determine whether a longer, 2-week low molecular weight heparin regimen would offer additional clinical benefit.Patients, Methods and Results This was a multicentre, prospective, randomized, double-blind study in three parallel groups, involving 3468 patients. Patients received one of three treatment regimens: the unfractionated heparin group received an intravenous bolus of unfractionated heparin 5000 IU, followed by an activated partial thromboplastin time adjusted infusion of unfractionated heparin for 6+/-2 days; the nadroparin 6 group received an intravenous bolus of nadroparin 86 anti-Xa IU.kg(-1), followed by twice daily subcutaneous injections of nadroparin 86 anti-Xa IU.kg(-1) for 6+/-2 days, and the nadroparin 14 group received an intravenous bolus of nadroparin 86 anti-Xa IU.kg(-1), followed by twice daily subcutaneous injections of nadroparin 86 anti-Xa IU.kg(-1) for 14 days. No statistically significant differences were observed between the three treatment regimens with respect to the primary outcome (cardiac death, myocardial infarction, refractory angina, or recurrence of unstable angina at day 14). The absolute differences between the groups in the incidence of the primary outcome were: -0.3% (P=0.85) for the nadroparin 6 group vs the unfractionated heparin group and +1.9% (P=0.24) for the nadroparin 14 group vs the unfractionated heparin group. Furthermore, there were no significant intergroup differences regarding any of the secondary efficacy outcomes. However, there was an increased risk of major haemorrhages in the nadroparin 14 group compared with unfractionated heparin (3.5% vs 1.6%; P=0.0035).Conclusions Treatment with nadroparin for 6+/-2 days provides similar efficacy and safety to treatment with unfractionated heparin, for the same period, in the therapeutic management of acute unstable angina or non-Q wave myocardial infarction, and may be easier to administer. A prolonged regimen of nadroparin (14 days) does not provide any additional clinical benefit. (C) 1999 The European Society of Cardiology.

Dual chamber pacing has been proposed as an alternative treatment to patients with cardiac failure refractory to optimal medical therapy.The influence of the site of ventricular pacing was studied in 15 patients with an average age of 68.7 +/- 8.7 years with dilated cardiomyopathies and an average left ventricular ejection fraction of 22.3 +/- 6.8%. Three temporary USCI electrodes were positioned in the right atrium, the right ventricular outflow tract (RVOT) and the right ventricular apex, The average duration of the QRS complexes and the, haemodynamic parameters (PAP, PCP and cardiac index) were measured in sinus rhythm and during DDD apical, RVOT and simultaneous apical and RVOT pacing.The RVOT and simultaneous pacing significantly reduced the QRS duration (135 +/- 14 ms and 137 +/- 17 ms, p < 0.0001 respectively) compared with apical pacing (150 +/- 19 ms). The mean PAP and mean PCP remained unchanged in the different modes of pacing but the cardiac index increased significantly during RVOT pacing (2.99 +/- 0.67 l/min/m(2)) and simultaneous pacing (3 +/- 0.77 l/min/m(2)) compared with apical pacing (2.66 +/- 0.62 l/min/m(2)) (p < 0.001 and p < 0.01 respectively) and compared with sinus rhythm (2.62 +/- 0.7 l/min/m(2)) (p < 0.001 and p < 0.005 respectively).This study suggests that better results may be obtained with RVOT screw in lead than with the traditional right ventricular apical electrode.

The influence of the right ventricular pacing site was not studied with long term follow-up in patients with dilated cardiomyopathy. 9 patients (7 male and 2 female) with mean age 71.6 years + 7 received DDD pacemaker with 2 ventricular electrodes : the first unipolar screw-in lead positioned at the high portion of the right ventricular outflow tract (RVOT), the second unipolar passive lead at the right ventricular apex (RVAP) connected in series to the ventricular channel, and an atrial electrode in the right atrial appendage. 6 patients had a dilated cardiomyopathy and 3 patients an ischemic cardiomyopathy, and the mean left ventricular ejection fraction was 22.3% + 6.8. With long-term follow-up (23.6 months + 10.2), all patients showed clinical improvement (mean NYHA functional : 3.67 + 0.5 before pacing to 3 + 0.5 after pacing with significant difference, p<0.005). No significant differences about threshold (0.89 V + 0.4 in RVAP vs 0.97 V + 0.28 in RVOT), impedance and R wave (17.3 mV + 4.2 vs 12.8 mV + 4.1) were found at the implantation and in the chronic follow-up. Hemodynamic data obtained at the end of follow-up showed no modification of right atrial pressure, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure compared to sinus rhythm, but the increase of cardiac index persists with RVOT pacing (3.01 l/mn/m2 + 0.6 vs 2.79 l/mn/m2 + 0.61 with bifocal pacing vs 2.65 l/mn/m2 + 0.66 in sinus rhythm). This study suggests to implant a RVOT screw-in lead rather than a traditional lead positioned at the apex in dilated cardiomyopathy.

Dual chamber pacing has been proposed as an alternative treatment to patients with cardiac failure refractory to optimal medical therapy. The influence of the site of ventricular pacing was studied in 15 patients with an average age of 68.7 +/- 8.7 years with dilated cardiomyopathies and an average left ventricular ejection fraction of 22.3 +/- 6.8%. Three temporary USCI electrodes were positioned in the right atrium, the right ventricular outflow tract (RVOT) and the right ventricular apex. The average duration of the QRS complexes and the haemodynamic parameters (PAP, PCP and cardiac index) were measured in sinus rhythm and during DDD apical, RVOT and simultaneous apical and RVOT pacing. The RVOT and simultaneous pacing significantly reduced the QRS duration (135 +/- 14 ms and 137 +/- 17 ms, p < 0.0001 respectively) compared with apical pacing (150 +/- 19 ms). The mean PAP and mean PCP remained unchanged in the different modes of pacing but the cardiac index increased significantly during RVOT pacing (2.99 +/- 0.67 l/min/m2) and simultaneous pacing (3 +/- 0.77 l/min/m2) compared with apical pacing (2.66 +/- 0.62 l/min/m2) (p < 0.001 and p < 0.01 respectively) and compared with sinus rhythm (2.62 +/- 0.7 l/min/m2) (p < 0.001 and p < 0.005 respectively). This study suggests that better results may be obtained with RVOT screw in lead than with the traditional right ventricular apical electrode.

The influence of cardiac pacing on Thallium 201 myocardial perfusion abnormalities is unknown in obstructive hypertrophy cardiomyopathy (O.HCM) treated by dual chamber pacing with long term follow-up. We evaluated prospectively 21 patients with mean age 53.7 +/- 14.2 presenting O.HCM with drug refractory symptoms treated by dual chamber pacing. All patients carried out dipyridamole Thallium 201 tomography with redistribution images, Doppler-echocardiography (thickness of septum and LV posterior free wall) before and after DDD pacing (mean delay : 45 months +/-17.2) and coronary angiography. Angina decreased from 15 patients before pacing to 3 patients after pacing (p< 0.0005). Left ventricular outflow tract gradient was changed from 90.4 +/- 35 mmHg before pacing to 26.5 +/- 24 mmHg after pacing (p<0.00001). DDD pacing has favourable effects on myocardial perfusion, as only 5 patients had Thallium 201 defects after pacing vs. 12 patients before pacing (p<0.05) and the Thallium 201 total score was improved by DDD pacing (18.6 +/- 4.2 vs. 19.9 +/- 4.1, p<0.01), About 10 patients with reduction of septal thickness (2.6 mm +/- 1.2), no correlation was found between improvement of myocardial perfusion and decrease of myocardial hypertrophy. In conclusion, myocardial perfusion is improved in the severe O.HCM treated by DDD pacing with long term follow-up, but the decrease of septal hypertrophy is not always correlated with normal myocardial perfusion.