Fondation pour l’innovation en Cadiométabolisme et Nutrition

Cardiac graft rejection and allograft vasculopathy (CAV) are major causes of morbidity and mortality in heart transplant (HT) patients. While endomyocardial biopsy and invasive coronary angiography remain diagnostic gold standards, their invasiveness highlights the need for safer, noninvasive alternatives. Cardiac computed tomography (CT) has emerged as a promising modality for evaluating both coronary and myocardial status. The primary aim of this study is to evaluate CT-measured extracellular volume (ECVCT) in HT patients compared to a control group and identify its clinical determinants. The secondary objective is to explore the association between ECVCT and CAV severity. In a reference HT center, we conducted a retrospective cohort study of 163 patients comprising 80 HT patients and 83 age- and sex-matched controls without structural heart disease studied with a standardized CT protocol. Twenty-two control patients had concomitant cardiac CT and magnetic resonance (CMR) to validate ECVCT measurements. Determinants of ECVCT including rejection history, CAD-RADS, CAV and cardiovascular risk factors were studied. Median ECVCT was significantly higher in HT patients (34%, IQR 30-38) compared to controls (29%, IQR 27-31; p<0.001). ECVCT was highly correlated with MR-ECV (r=0.88, p<0.001). In HT recipients, elevated ECVCT was independently associated to hypertension , smoking, presence of CAV, elevated CAD-RADS scores and a history of graft rejection, whereas in controls only higher coronary artery calcium scores correlated with increased ECVCT. CONCLUSION: ECVCT is increased in HT patients compared to controls and associated with rejection history and CAV. ECVCT emerges as a promising noninvasive tool for the simultaneous assessment of myocardial alterations and CAV in HT patients showing strong concordance with CMR and high reproducibility. Further multicenter studies are warranted to confirm its role in transplant surveillance protocols.

<h2>Abstract</h2> Steatotic liver disease (SLD) is a spectrum of highly prevalent liver disease that is encountered at many different healthcare levels. Awareness about metabolic dysfunction-associated SLD (MASLD), MetALD (MASLD and increased alcohol intake) and ALD (alcohol-related liver disease) is increasing beyond hepatology, as highlighted by the various SLD guidelines that have been issued by scientific societies from different disciplines, such as endocrinology. The guidance presented here aims to improve cross-disciplinary knowledge and know-how by providing guidance to healthcare professionals from a global, holistic, multi-society and -stakeholder perspective. The patient trajectory was used as an overarching anchor point to ensure uniform guidance at all points along the SLD spectrum, with the ultimate goal of improving patient identification and optimising their care. This consensus guidance covers patient identification and risk stratification, relevant cross-disciplinary primary and secondary care approaches, referral to and from tertiary care and strategies for disease management and monitoring. Strategies at each point of the patient trajectory are recommended and stratified as optimal (i.e., "nice-to-have") or minimal (i.e., "must-have"), per expert-opinion, making them adaptable to differences in healthcare settings, levels of resource availability and policies.

IntroductionHealthcare systems were reorganised in 2020 to manage the COVID-19 pandemic. Despite their urgent status, hospital admissions for acute heart failure (AHF) were reported to decline from 9% to 66% worldwide between 2020 and 2021, with divergent findings regarding in-hospital mortality. This study aimed to investigate in detail the evolution of AHF hospitalisations and in-hospital mortality in France from 2013 to 2024.MethodsBased on the 2.9 million AHF hospitalisations recorded in France from 2013 to 2024, yearly numbers of hospitalisations and deaths expected in years 2020–2024 were estimated using a Poisson regression model, with 2013–2019 as the reference period. The differences between observed and expected event counts in the years 2020–2024 were used to quantify the disruptions that occurred since the emergence of the pandemic.ResultsA total deficit of −222 913 (−223 908 to −221 926) (mean (95% CI)) AHF hospitalisations was estimated for the years 2020–2024, corresponding to a 16.1% decrease compared with pre-pandemic trends. The yearly reduction in AHF hospitalisations worsened over time, from −39 268 (–39 685 to –38 847) fewer cases in 2020 to –55 521 (–55 984 to −55 051) in 2024. Between 2020 and 2024, 7794 (7557 to 8028) excess in-hospital deaths were estimated, corresponding to an 8.4% excess compared with pre-pandemic trends. From 2021 to 2024, this excess ranged from 9.6% to 16% for females compared with 7.1% to 11.1% for males.ConclusionsThe apparent long-lasting changes in the management of patients with AHF in France observed since the COVID-19 pandemic emergence, particularly among females, suggest further research for better understanding the sustained observed disruptions.