What consensus in the diagnosis and management of atrial fibrillation?
What consensus in the diagnosis and management of atrial fibrillation?
Strongly involved in research on atrial fibrillation, Professor Stéphane HATEM (Director General of the ICAN IHU and Director of the UMR 1166) participated in the 8th AFNET/EHRA Consensus Conference the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA), where 83 international experts brought together their expertise to support improved AF risk management through prevention, individualized care and research strategies.
Discover below the main results of this consensus!
Atrial fibrillation
Despite major progress in its management, the Atrial Fibrillation (AF) remains associated with significant morbidity and mortality. A major public health issue, it is the 1st cardiac cause of vascular embolic accidents (CVA) and decompensation of heart disease, and is a factor of cognitive decline and epidemic character with the aging of the population.
To combat this scourge, it is necessary to identify patients at risk of AF, those with paroxysmal and clinically silent episodes of AF before the onset of a stroke, and to invent new personalized upstream therapeutic treatments.
Management of atrial fibrillation: what advances?
To improve risk assessment of atrial fibrillation (AF) and to guide treatment of the arrhythmia, further scientific and clinical translational research is needed to better understand the various underlying mechanisms reflected by the electrocardiographic (ECG) pattern of AF.
Prof. Stéphane HATEM, Director of the IHU ICAN
Published on July 27, 2022 in EP Europace, the scientific publication “Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation : the 8th AFNET/EHRA consensus conference” presents the the main results of these interdisciplinary discussions, based on recently published or unpublished scientific observations.
Further improvements for the patient are possible with continued efforts to identify and target atrial cardiomyopathy and associated cognitive impairment, which can be facilitated by Artificial Intelligence (AI).
The main results are as follows:
- Every effort should be made to control the heart rhythm through the individualized use of various drug or interventional anti-arrhythmic therapies, combined with aggressive management of cardiovascular and metabolic risk factors,
- Better characterization of the atrial cardiomyopathy underlying AF is a challenge to improve identification of patients at risk and to implement prevention,
- Standardized assessment of cognitive function in patients with AF is necessary to improve the quality of life of patients,
- Artificial intelligence (AI) has the potential to achieve all of the above, but requires advanced interdisciplinary knowledge and collaboration as well as a better forensic framework,
- New, simple and applicable means of AF detection for the general population.
The IHU ICAN participates in research against atrial fibrillation
MAESTRIA, a highly innovative project to better detect atrial cardiomyopathy
The IHU ICAN participes in MAESTRIA (Machine Learning and Artificial Intelligence for Early Detection of Stroke and Atrial Fibrillation), an ultra-innovative project to better detect atrial cardiomyopathy, which is a major cause of atrial fibrillation and embolic strokes.
The MAESTRIA project is a consortium of 18 partners from Europe, the United States and Canada and responds to an H2020 call for proposals on digital diagnostics. This project is promoted by Sorbonne-University and coordinated by Professor Stéphane HATEM, Director of the IHU ICAN.
The CT-AF study, imaging as a decision aid in atrial ablation?
The CT-AF study, coordinated by Prof. Estelle GANDJBAKHCH and Dr. Mikaël LAREDO (Institute of Cardiology, Rhythmology Unit of the Pitié-Salpêtrière Hospital in Paris) should make it possible to define the criterion vessels to select the patients who could benefit the most from the ablation of Atrial Fibrillation (AF) tissue.
“Indeed, predictive factors for success of atrial ablation remain insufficient, whereas they are necessary for the selection of patients who could benefit the most from this invasive procedure.” Pr Estelle GANDJBAKHCH
Heart failure: an increased risk for patients with type 2 diabetes?
Heart failure: an increased risk for patients with type 2 diabetes?
Linked to 5 million deaths per year worldwide, type 2 diabetes (T2D) is a complex and heterogeneous clinical syndrome, as it represents an increased risk of deterioration of the various organs of the affected patient (heart, kidney, nervous system…).
Indeed, researchers have shown that patients with type 2 diabetes are at greater risk of developing heart failure (HF). To prevent this from happening, the ICAN UHI is setting up a multidisciplinary and personalized approach to patient care, which takes into account the causal relationships of all cardiometabolic diseases (diabetes, obesity, cardiovascular diseases…).
In this context, the ICAN UHI is developing the MET-INF-T2D study, which aims to detect metabolic heart failure associated with type 2 diabetes at an early stage through the identification of imaging biomarkers. Find out the purpose of this research study below!
Heart failure: a high risk in type 2 diabetes
With more than 3.5 million French people affected, diabetes can be a silent disease diagnosed too late, at the onset of an acute episode that requires medical management of the patient.
In this case, diabetes has unfortunately already damaged other organs, resulting in an increased risk of developing other cardiometabolic diseases (cardiovascular accidents, heart failure, renal failure, peripheral neuropathies …).
Indeed, heart failure in patients with type 2 diabetes is associated with a significant risk of deterioration in quality of life, recurrent hospitalizations and death.
It is therefore essential to identify patients with type 2 diabetes and undiagnosed myocardial dysfunction who are at high risk of acute heart failure decompensation.
As a reminder, there are 4 warning signs to watch out for to diagnose the presence of heart failure and prevent its worsening:
- Unusual shortness of breath,
- Swollen feet and ankles (edema),
- Rapid weight gain,
- Excessive fatigue.
The MET-INF-T2D study: towards detection of metabolic heart failure associated with type 2 diabetes
How can cardiac metabolism be acutely affected by changes in blood glucose?
Indeed, the reduction of glucose levels in type 2 diabetes leads to major metabolic changes whose consequences for the heart are not known.
It is therefore essential today to set up a global and personalized management of patients, thanks to a sharing of knowledge between the different disciplines.
Led by Prof. Fabrizio Andreelli (Diabetologist APHP, Pitié-Salpêtrière, IHU ICAN), the MET-INF-T2D study aims to better predict the evolution of type 2 diabetes in order to develop new therapies and improve the management of patients.
The objective of this research project is to demonstrate that cardiac metabolic inflexibility is present in some patients with chronic hyperglycemia and revealed during the treatment of their diabetes by insulin therapy.
This project is supported by Entrepreneurs & Go as a sponsorship.
Heart failure: launch of the ICARD study, with the inclusion of a 1st patient!
Heart failure: launch of the ICARD study, 1st patient included
More than 1 million French people are now affected by Heart Failure (HF), with 120,000 new cases diagnosed each year. This frequent and serious chronic disease occurs when the heart has difficulty pumping enough blood to oxygenate all the organs.
The IHU ICAN scientific research teams set up the ICARD study, which aims to analyze the mechanisms of dapagliflozin, a molecule that has demonstrated metabolic, cardiovascular and renal efficacy with a recognized place in the treatment of heart failure.
The study started in June 2022, with the inclusion of the 1st patient! Find out more about the background and objectives of the ICARD study below.
Heart failure: 1 million French people concerned
The contraction of the heart of patients with Heart Failure (HF) is no longer effective in ensuring the blood flow necessary to supply the organs. shortness of breath, fatigue and/or edema and weight gain.
Heart failure can be the consequence of myocardial infarction, arterial hypertension, diabetes and arrhythmias such as atrial fibrillation, as well as diseases of the heart muscle (cardiomyopathies) often of genetic origin.
- In France, 2.3% of the adult population and 10% of people over 70 suffer from heart failure, i.e. more than 1 million people concerned,
- Each year, 165,000 patients are hospitalized and more than 70,000 deaths are associated with heart failure,
- More than 1 in 2 patients declare themselves to be in “poor” or “very poor” health.
Dapagliflozin: an effective molecule in the treatment of heart failure
To deal with this disease, there are treatments that improve the symptoms, lighten the work of the heart, and reduce morbidity and mortality, but they are not effective for all patients.
Dapagliflozin is a molecule accessible since 2021 for patients with heart failure. It has given very recent results of complementary efficacy, the mechanisms of action of which deserve to be further investigated.
Today, understanding which mechanisms are activated will help to better identify patients who may have an increased benefit from the use of dapagliflozin compared to standard treatments for heart failure.
The objectives of the ICARD study conducted by the IHU ICAN
The ICARD study of the IHU ICAN therefore aims to understand how this molecule improves the energy metabolism of the heart and other organs (liver, kidney, abdominal fat), i.e. the flexibility of the use of different sources of energy (fats and sugar) that the heart needs to pump blood.
The 2 main objectives of the ICARD study are therefore:
- Understand, through MRI, the cardiovascular and metabolic effects of dapagliflozin, which benefit several types of patients,
- Analyze its role in reducing hospitalizations and mortality in patients with heart failure.
The scientific organization of the ICARD study
With the participation of AstraZeneca, this study with academic promotion is planned for a period of 2 years. ICARD will focus on 40 patients presenting with heart failure and followed in the Cardiology Department of the Pitié-Salpêtrière Hospital.
The study is taking place at Pitié-Salpêtrière, within the Heart Institute, in the nuclear medicine department and on the ICAN Clinical Investigation platform of the IHU ICAN.
It also involves the ICAN Imaging scientific platforms for MRI and ICAN Omics acquisitions, the biomedical imaging laboratory (LIB, INSERM 1146) as well as the support services of the IHU.
- Project leaders: Pr Richard Isnard, Pr Alban Redheuil, and Pr Fabrizio Andreelli
- Contact: Louise Meyfroit – Scientific operations officer – l.meyfroit@ihuican.org
Latest generation 1.5T cardiovascular MRI from the IHU ICAN
Phosphatidylserine improves the anti-inflammatory function of high density lipoproteins (HDL)
Phosphatidylserine improves the anti-inflammatory function of high density lipoproteins (HDL)
Chronic inflammatory diseases impact the lives of many people and represent a significant cost to our healthcare system today.
They can be treated using anti-inflammatory drugs of natural or synthetic origin. In the human body, a wide variety of molecules have anti-inflammatory properties that can help fight against these diseases.
Recent research conducted at IHU ICAN by Dr. Maryam Darabi and Dr. Anatol Kontush has demonstrated that the inclusion of phosphatidylserine significantly enhances the anti-inflammatory function of reconstituted high-density lipoprotein (rHDL).
How can this approach be used to treat certain chronic inflammatory diseases?
What are the objectives of this research?
Phosphatidylserine (PS) is a substance produced by the body that makes up the bulk of the cell membrane. Phosphatidylserine is a phospholipid that helps resolve inflammation. Indeed, it is one of the main “eat-me” signals involved in the elimination of apoptotic cells by immune cells.
Reconstituted HDL particles. In green, apolipoprotein A-I, the main protein of HDL. In yellow, phosphatidylcholine, the main lipid of HDL.
Present in the blood, human high-density lipoprotein (HDL) is a multimolecular complex with a strong capacity to reduce inflammation. It contains a set of lipid and protein molecules, a minority of which is phosphatidylserine (PS).
Using their major lipid and protein components, HDL (human high density lipoprotein) particles can be artificially reconstituted using apolipoprotein A-I (the major protein of HDL) and phosphatidylcholine (the major lipid of HDL) and thus used as therapeutic agents.
What are the results?
Macrophages are key cells in the body involved in the development of chronic inflammatory diseases.
The results were obtained in vitro using the THP-1 human macrophage cell line, but also with primary human macrophages prepared from circulating monocytes.
- Research has shown that the inclusion of phosphatidylserine (PS) in reconstituted HDL improves its ability to reduce inflammation, with superior anti-inflammatory function to “standard” HDL without PS.
- In particular, HDL with PS helps to further reduce the secretion and expression of interleukin-6 (an inflammatory molecule) by macrophages.
- Finally, they also show superior anti-inflammatory properties in vivo in a mouse model of dyslipidemia and chronic inflammation.
HDL formulations were administered to dyslipidemic mice on a high-cholesterol diet to induce atherosclerosis and chronic inflammation.
In conclusion, phosphatidylserine has been shown to be a potent anti-inflammatory component capable of enhancing the therapeutic potential of HDL-based therapy. These results represent a promising new approach to the treatment of chronic inflammatory diseases.
Who are the actors involved?
The research work was mainly carried out within the UMRS 1166 (AP-HP, Inserm, Sorbonne University, IHU ICAN):
- By Dr. Maryam Darabi (Postdoctoral Researcher),
- Under the supervision of Dr. Anatol Kontush (Research Director),
- In collaboration with the ICAN Omics Lipidomics platform,
- And supported by SATT-Lutech, INSERM and Sorbonne University.
The results of this research were reported in the scientific article “Phosphatidylserine Enhances Anti-inflammatory Effects of Reconstituted HDL in Macrophages via Distinct Intracellular Pathways”, published in The Faseb Journal on April 13, 2022.
Fight against primary liver cancer of metabolic origin: the precious support of the Constance and Andrei Rhoe Foundation
Fight against primary liver cancer of metabolic origin: the precious support of the Constance and Andrei Rhoe Foundation
Primary liver cancer is the 6th most common cancer in terms of incidence and the 4th most common in terms of mortality worldwide.
The Constance and Andrei Rhoe Foundation has chosen to support the actions of the IHU ICAN, whose vocation is to fight against cardiometabolic diseases. This sponsorship will support research on the metabolic causes of liver cancer, and the training of young Romanian researchers and doctors in this field.
Learn about the study that will support this valuable donation to better understand the progression of NASH to primary liver cancer.
The commitment of the Constance and Andrei Rhoe Foundation
Sponsored by the Fondation de France, the Constance and Andrei Rhoe Foundation aims to support medical research projects in biology and biochemistry, in favour of the the fight against cancer, as well as projects in education, music, democracy and civic awareness.
Their founders have chosen to support the IHU ICAN through an annual grant over a period of 3 years. This will enable a Romanian doctoral student to carry out research on primary liver cancer as part of a multicenter study coordinated by Prof. Vlad Ratziu at the Pitié-Salpêtrière Hospital.
Main goals are:
- Identification of risk factorsfor primary liver cancer related to the metabolic syndrome,
- Estimating the prevalence of metabolic liver cancer in the French population,
- Estimation of temporal trends (incidence) of this condition over the past 10 years.
What you need to know about primary liver cancer
Primary liver cancer, also known as hepatocellular carcinoma, is one of the few cancers that is increasing. It occurs mainly in people who already have liver disease.
- 6th most common cancer in terms of incidence,
- 4th most frequent in terms of mortality in the world,
- An incidence that is increasing by 9% each year in the USA.
Hepatic consequence of the metabolic syndrome, metabolic steatosis has become the 1st cause of chronic liver disease, affecting 25-30% of the general adult population in its most frequent and least severe form. A progressive form of steatosis, metabolic steatohepatitiscan lead to hepatic fibrogenesis, resulting in liver cirrhosis.
This explains why the incidence of primary metabolic liver cancer has become the fastest growing indication for liver transplantation.
Unfortunately, primary liver cancers occurring in subjects with metabolic steatohepatitis are often detected at a later and therefore more advanced stage, which limits the possibilities of curative therapies.
It is therefore important today to better understand, identify and stratify :
- Mechanisms of carcinogenesis associated with the metabolic syndrome,
- The role of metabolic and inflammatory factors in the pathogenesis of primary liver cancer,
- Carcinological risk in subjects with metabolic syndrome,
- The circumstances of occurrence of primary liver cancer in a non-cirrhotic liver,
This is the objective of our study which will be conducted over a period of 3 years in 300 patients with primary metabolic liver cancer, using a multicenter cohort with a biobank.
The entire IHU ICAN team warmly thanks the Constance Foundation and Andrei Rhoe for their trust!
Your donations are essential to help the IHU ICAN fighting against cardiometabolic diseases.
Carbohydrate-restricted diets: what is the link with elevated cholesterol?
Carbohydrate-restricted diets:
what is the link with elevated cholesterol?
Following a carbohydrate-restricted diet is often indicated for weight loss and treatment of chronic diseases such as type 2 diabetes.
However, some studies have noted that this dietary change can lead to an increase in so-called “LDL” or “bad” cholesterol, which is an important risk factor in the development of cardiovascular disease.
Given the increasing popularity of carbohydrate-restricted dietand the high mortality from cardiovascular disease, there is a need to understand the mechanisms that impact LDL cholesterol levels and lipid metabolism in response to reduced carbohydrate intake.
Anatol Kontush (Research Director at UMRS 1166 – IHU ICAN)contributed, as co-last author, to the scientific article “The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets”, published on May 20, 2022 in Metabolites.
What is the purpose of this study?
The study is based on self-collected data from 548 individuals following a carbohydrate-restricted diet, corresponding to less than 130 grams per day, with an average carbohydrate intake of 27 grams per day.
An initial analysis identified predictors of increased LDL cholesterol (LDL-C):
- The body mass index (BMI) of the individual,
- Metabolic markers of his health,
- The level of HDL cholesterol (HDL-C),
- Triglyceride (TG) levels before the diet.
Reminder: Carbohydrates are the main energy nutrients of the human body, divided into two families: simple carbohydrates (fruit, milk, yogurt, chocolate, jams, refined sugar…) and complex carbohydrates (bread, cereals, rice, pasta, legumes, potatoes…)
The analysis revealed that lean people (thus having a low BMI) with a low TG/HDL-C ratio, and following a low-carbohydrate diet, were the most likely to experience increases in their LDL cholesterol levels.
This allowed us to isolate a subset of 100 “Lean Mass Hyper-responder” (LMHR) individuals with particularly large increases in both LDL and HDL cholesterol levels in the context of carbohydrate restriction, combined with low triglyceride levels. The mechanism was reversible with reintroduction of carbohydrates into the diet, and no significant genetic factors were revealed in testing.
The objective of this scientific publication is therefore to provide an explanation for the LMHR phenotype, using the “Lipid Energy Model” (LEM).
What is Lipid Energy Model? (LEM) (LEM)
The Lipid Energy Model (LEM) is a hypothesis that under conditions of carbohydrate restriction and the presence of fat in the subcutaneous cellular tissue, it resides greater reliance on fat as a metabolic substrate, as provided by triglyceride-rich lipoproteins, including VLDL (very low density lipoproteins) synthesized and secreted by the liver
Increase in LDL-C and HDL-C by lipoprotein lipase
In the presence of increased VLDL synthesis and secretion, lipoprotein lipase (LPL) activity releases free fatty acids (FFA = non-esterified fatty acids = NEFA) to adipocytes and oxidative tissue. As TGs are lipolyzed, VLDL shrinks with the loss of surface residues (including cholesterol, phospholipids, and apolipoproteins) to HDL-accepting particles and is then catabolized into LDL, resulting in an increase in LDL particle mass, LDL-C, HDL particle mass, and HDL-C. Source: Metabolites 2022, 12(5), 460.
This increased dependence leads to increased hepatic secretion of VLDL and lipolysis of VLDL by lipoprotein lipase with high production of free fatty acids (FFA), which are an important source of energy for the body.
Then, the peripheral absorption of these acids increases, as does the accumulation in the circulation of LDL (which is the end product of VLDL lipolysis) and the level of LDL-C. In parallel, cholesterol-containing fragments of the VLDL surface are released and transferred to HDL, resulting in marked elevation of HDL-C. Finally, circulating triglyceride levels decrease as a result of lipolysis. According to the Lipid Energy Model (LEM), this pathway is particularly active in lean individuals with a low baseline TG/HDL-C ratio, because these individuals are characterized by particularly efficient VLDL lipolysis.
The Lipid Energy Model (LEM)
(A) In the context of carbohydrate restriction, (1) glycogen depletion and (2) changes in circulating hormones stimulate hormone-sensitive lipase (HSL)-mediated secretion of free fatty acids (FFAs = NEFAs) from adipocytes to supply oxidative tissues. (3) The liver captures circulating NEFA and repackages it into triglycerides (TG), (4) secreted on board VLDL (5) Increased lipoprotein lipase (LPL)-mediated VLDL destruction generates increased LDL-C and HDL-C. (B) The magnitude of carbohydrate restriction, adiposity, and energy expenditure each contribute as independent variables to the degree of LPL-mediated VLDL turnover and, therefore, to the magnitude of variation in the components of the triad. Source: Metabolites 2022, 12(5), 460.
What is the conclusion of this research work?
The research work carried out concludes that the Lipid Energy Model (LEM) could explain the inverse association observed between the individual’s BMI (Body Mass Index) and the change in his or her LDL cholesterol level in a context of carbohydrate consumption restriction. Indeed, high levels of LDL cholesterol are an important cardiovascular risk factor. This work therefore calls for further research to assess this risk in individuals on low-carbohydrate diets.
This model provides specific and testable predictions to be evaluated in future studies to better understand the mechanisms underlying the change in LDL cholesterol on low-carbohydrate diets. This will advance our knowledge of lipid and lipoprotein dynamics in human metabolism.
The authors of the publication: Nicholas G.Norwitz, Adrian Soto-Mota, Bob Kaplan, David S. Ludwig, Matthieu Boudoff, Anatol Kontush, David Felman.
The excellence of the ICAN Omics lipidomics platform
The ICAN IHU has a “lipidomics” platform specialized in metabolic diseases (NASH, T2DM, atherosclerosis, hypercholesterolemia, cardiomyopathy…) which combines metabolomic and lipidomic approaches and bioinformatics tools. Thanks to cutting-edge technologies, it allows the identification of new biomarkers to improve the prediction of metabolic pathologies
Located at the Pitié-Salpêtrière Hospital in Paris, our platform has been awarded the IBiSA label(Infrastructures in Biology, Health and Agronomy) label in 2021.
National Foot Health Week 2022: How to prevent diabetic foot wounds?
National Foot Health Week 2022: How to prevent diabetic foot wounds?
Impacting more than 3.5 million French people, the diabetes is a serious metabolic disease characterized by high blood sugar levels. Often under-diagnosed because it can be asymptomatic for many years, this disease is constantly on the rise and has become a major health issue: an estimated 693 million cases in 2045 worldwide (INSERM study 2019).
Among the health complications associated with diabetes, the most common is degeneration of the sensory and motor nerves in the lower limbs of the body, also known as “diabetic foot”. 15% of diabetics develop foot ulcers in their lifetimeand 85% of amputations performed in diabetic patients are due to a foot wound.
As part of the National Foot Health Week from June 13 to 18, 2022, the IHU ICAN presents the research work of Jérôme Haddad(MSc Podiatrist – Podiatrist at the Pitié Salpêtrière University Hospital) on the risks of foot ulceration in diabetic patients.
The diabetic foot: causes and consequences
According to some studies, plantar pressure is the main risk factor for a chronic foot wound in a diabetic patient. Indeed, diabetic patients with neuropathy have a thinner plantar epidermis and more rigid plantar soft tissues than non-diabetic patients, exposing the diabetic foot to skin tissue degradation that can lead to ulcer formation.
As a consequence of the metabolic abnormalities caused by diabetes, the range of motion of the foot and ankle joints is effectively reduced in diabetic neuropathic patients. This leads to significant disturbances in the function of the foot, due to abnormally high plantar pressures that can cause chronic foot ulcer. Patients with this type of ulcer have decreased physical activity, decreased sociability, increased stress levels, and a overall negative impact on their quality of life and well-being.
The number of people with diabetes is increasing dramatically worldwide over the years, so finding solutions to reduce the rate of foot ulceration associated with diabetes is essential.
How to predict and assess the risk of diabetic foot wounds?
Jérôme Haddad’s research work (MSc Podiatrist – Podiatrist at the University Hospital of Pitié Salpêtrière) focus on design and evaluation of a predictive biomarker of foot ulceration risk for a population of diabetic patients with lower extremity peripheral neuropathy, by the use of analysis tools practiced in clinical routine.
The hypothesis of this research project is that the wounds of diabetic patients are not only due to pressure, but also to the deformation in the thickness of the plantar tissue. As the neuropathy progresses, the patient’s biomechanical and structural characteristics deteriorate. The discovery of this neuropathy or diabetes often comes too late, once the wound has appeared, because despite the presence of risk factors, some patients do not necessarily have a wound.
It is therefore fundamental to identify both morphological and functional data in order to study the transition from grade 2 to grade 3 in the patient (see diagram above), and avoid a critical situation. By taking these 2 types of variables into account, the identification of a biomarker that would allow the establishment of a standard for the risk of wounds associated with neuropathy would be a major advance in the fight against this public health problem.
Jérôme Haddad’s project therefore plans to use routine clinical tools to propose a simple tool of evaluating and predicting the risk of wounds related to the diabetic foot, accessible in primary care.
How is this diabetic foot research project structured?
The project includes several study phases:
- Observational descriptive study of skin rheology of patients grades 1, 2 and 3: In vivo and by numerical simulation,
- Prospective observational descriptive study of grade 3 patients comparing areas with wound history and areas that remained healthy: In vivo and by digital simulation,
- Prospective observational longitudinal analytical cohort study: monocentric study in the form of a day hospital entitled “HDJ dépistage de la neuropathie”, with prospective longitudinal monitoring of all parameters at day 1, 6 months and 1 year.
Do not hesitate to contact us if you wish to know more about the process of this study.
What are the expected results?
The tool was created for use in clinical practice, research and clinical trials.
The research project plans to explore several aspects and hypotheses, such as:
- Analysis of inter-patient kinetics(e.g. which individuals move faster than others?),
- Evaluation of the parameters over time(What evolution? What reliability of the data?),
- The discrimination of functional risk groups and groups that would allow the creation of a new functional gradation, in order to complete the usual gradation by default of baresthesia and fine tact,
- Exploration of questions such as:Will this study lead to a functional classification? A functional clustering? A biomarker? Is grade 2 heterogeneous? Can we normalize the plantar pressure to all the different variables obtained? Can we create a prediction algorithm? Is it possible to discriminate the patient who enters the risk?
Who are the actors of this project?
- Jérôme Haddad: MSc Podiatrist – Podiatrist at the University Hospital of Pitié Salpêtrière
- Pierre-Yves Rohan: Assistant Professor – Lecturer at the Institute of Human Biomechanics Georges Charpak
- Dr Georges Ha Van Hospital Practitioner: Podiatry in Diabetes at AP-HP, Assistance Publique
- Antoine Perrier Podiatrist DE: Biomechanical engineer, PhD
- Pr Agnès Hartemann: Head of the diabetology and metabolism department at the Pitié Salpetrière Hospital
How to support diabetic foot research?
This innovative research project is financed by external funds. Donations are therefore essential to accelerate medical research and improve the care of patients suffering from diabetes.
- Would you like to support this specific research project related to the diabetic foot? You can contact Francine Trocmé by e-mail at f.trocme@ihuican.org or by phone +33 (0)1 88 40 64 05.
- Would you like to support the activities of the IHU ICAN in the fight against cardiometabolic diseases? Make a donation below.
Data sources, from Jérôme Haddad’s research:
• Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet 2005
• Boulton A.J.M. et al. 2004
• Etudes Veves et al. (1992), Ahroni et al. (1999), Stess et al. (1997) et Fernando et al. (2013)
• Pirart J. et al 1977
• Chao et al., 2011
• Morag et Cavanagh, 1999, Morag et al., 1997
• Rao et al., 2011, Fernando et al. 1991
• Maluf et Mueller, 2003
• W. G. Meijer, 2001
The CT-AF study: imaging as a decision support in atrial ablation?
The CT-AF study: imaging as a decision support in atrial ablation?
In heart disease, Atrial Fibrillation (AF) is the most common arrhythmia. It is responsible for almost 20% of ischemic strokes (obstruction of the cervical artery).
The standard treatment for Atrial Fibrillation includes anticoagulant therapy and antiarrhythmic therapy, and very often catheter ablation of foci of arrhythmias. This intervention consists, using catheters introduced into the heart via the blood vessels,to destroy the diseased area of the heart muscle at the origin of the occurrence of the arrhythmia.
However, the predictive factors of the success of this practice remain insufficient whereas they are necessary for the selection of the patients who could derive the most benefit from this invasive procedure.
How to better assess the relevance of an ablation of AF foci?
Magnetic resonance imaging (MRI) is now capable of a detailed analysis of the atrial remodelingwhich makes the bed of Atrial Fibrillation (AF). In particular, MRI can visualize the abundance and texture of fat around the heart, which is known to contribute to the substrate of AF. Thus, this imaging has imposed itself in clinical practice before ablation of AF.
The CT-AF study, coordinated by Pr Estelle GANDJBAKHCH of the Institute of Cardiology, Rhythmology Unit of the Pitié-Salpêtrière Hospital in Paris, aims to to evaluate the value of multimodal imaging for the volume measurement of atrial intramyocardial fat in cardiac CT and the measurement of global atrial strain in MRI in patients who are candidates for a first AF ablation.
Four centers will include 130 patients in whom a first radiofrequency AF ablation procedure is scheduled in the next 6 months, with a follow-up over 18 months:
- The Pitié-Salpêtrière Hospital,
- Bordeaux University Hospital,
- The Northern Heart Center (CCN),
- The CHI of Poissy.
Each patient will have clinical examinations, blood tests (assay of biomarkers, serum library and plasma library) as well as scanner imaging, echocardiography, ECG and MRI examinations.
What is the role of the IHU ICAN in this study?
Several expertises of the IHU ICAN will be mobilized on this study:
- Imaging acquisition will be carried out within the ICAN Imaging platform, and the images will be analyzed at the end of the study within the CoreLab ICAN and of the Biomedical Imaging Laboratory(LIB) which has unique expertise in the modeling, instrumentation, signal and image processing and analysis,
- The CRB ICAN BioCollection, will ensure the storage and the plasma assays of the different samples,
- The ICAN Clinical Investigation Platform will receive patients included during follow-up visits.
How to support this study?
The CT-AF study should therefore make it possible to define the criteria vessels for selecting the patients who could derive the most benefit from the ablation of Atrial Fibrillation (AF) tissue.
This project is funded through a PHRC (clinical research hospital program) and sponsorship.
You can act alongside the IHU ICAN teams to accelerate the fight against cardiometabolic diseases. Make a donation by clicking here.
The entire IHU ICAN team thanks you!
Projet CMRAI : Detecting the vulnerable aorta in MRI for precision cardiovascular medicine
CMRai project: Detecting the vulnerable aorta in MRI for precision cardiovascular medicine
The aortic aneurysm is a permanent dilation of the aorta whose consequences, in the event of rupture, can be fatal. If diagnosed early enough, treatment often relies on managing high blood pressure. In other cases, surgery is considered to treat the aneurysm as soon as possible. But unfortunately the diagnosis is often late, made during the rupture, and constitutes a dramatic event associated with a mortality rate of 80-90%. It is in this context that it is necessary to better detect aortic aneurysms in the French population. So how can we better prevent aortic ruptures? This is the challenge taken up by the CMRAI project led by the IHU-ICAN and Sorbonne University and funded by EIT Health.
This project, set up at the initiative of the IHU-ICAN and coordinated by its founder Sorbonne University, brings together 9 European partners: Assistance Publique-Hôpitaux de Paris (France), the Hanover School of Medicine (Germany), the Medical University of Vienna (Austria), Vall d’Hebron Hospital (Spain), Santa Cruz Hospital (Portugal), Lisbon University of Sciences (Portugal), including 2 industrial partners: Imageens (France ) and Siemens Healthineers (Germany).
The objective of the CMRAI project is to create a platform that will make it possible to define, from the first signs of the disease, an aortic aneurysm risk score for each patient, and therefore to define a personalized follow-up and management strategy.
This project proposes to go beyond the practice based on diameter alone by proposing an evaluation of new functional parameters in MRI accounting for the elasticity of the wall of the aortic aneurysm, the shear forces applied to its wall, the pressure regime and the disturbances of the resulting blood flows.
These innovative parameters from algorithms developed by the LIB biomedical imaging laboratory (Inserm/SU/CNRS) will be studied in two populations: in patients with a thoracic aortic aneurysm as part of a clinical study in 5 European reference centers and in healthy subjects recruited from the Constances cohort (Inserm) in France in order to establish the normal values expected in the general population.
Led by Prof. Alban Redheuil, head of Cardiovascular and Thoracic Imaging (ICT) at Pitié-Salpêtrière hospital and medical manager of the ICAN Imaging platform, by Dr Nadjia Kachenoura, head of the cardiovascular imaging team ( iCV) of the Biomedical Imaging Laboratory (LIB) and by Ted Baldwin CEO of the start-up Imageens, the CMR projectAI involves several departments of the IHU-ICAN:
- The Scientific Operations Service(SOS) for setting up the project, monitoring the clinical study and scientific coordination
- The Clinical Investigation Platform for the management of clinical study patients
- The ICAN Imaging Platform for the acquisition of 550 MRI scans of the Parisian participants of the clinical study
Expected results
CMRAI will therefore allow the screening of the aortic aneurysm, the therapeutic decision-making and the adapted and personalized care thanks to Magnetic Resonance Imaging (MRI) coupled with the automated and multiparametric analysis of the aorta.
This study contributes to the development of precision medicine in cardiometabolic diseases. This is a major project that has obtained EIT Health funding.
Launch of the META INF T2D study
Launch of the META INF T2D study
The MET INF T2D study
The MET-INF-T2D study carried out by Pr Fabrizio Andreelli, diabetologist APHP, Pitié-Salpêtrière, IHU ICAN, received the favorable opinion of the CPP (Personal Protection Committees) in January 2022.
The opportunity for the IHU ICAN to present to you this project which aims to detect early metabolic heart failure associated with type 2 diabetes through the identification of imaging biomarkers and thus to improve the prediction of the evolution of diabetes.
Type 2 diabetes and heart failure: a complex and little-known link
In France, nearly 4 million people take medication for their diabetes. In recent decades, the number of diabetics has doubled worldwide with nearly 8.5% of the world’s population affected. Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body is unable to use the insulin it produces effectively. This results in an increased concentration of glucose in the blood (hyperglycemia).
Type 2 diabetes develops silently and can be diagnosed when an acute episode appears requiring medical care of the patient. Unfortunately in this case diabetes has already damaged the organs. This disease represents an increased risk of cardiovascular accidents, heart failure, and is the cause of renal failure and peripheral neuropathy.
The IHU ICAN teams are particularly mobilized to better understand the pathological mechanisms associated with diabetes in order to develop new therapies and improve patient care.
Heart failure (HF) in patients with type 2 diabetes (T2D) represents a complex and heterogeneous clinical syndrome. HF in patients with T2DM is associated with a significant risk of death, recurrent hospitalizations and deterioration in quality of life.
It is therefore essential to recognize patients with T2D and undiagnosed myocardial dysfunction who are at high risk for acute HF decompensation.
The reduction in glucose levels in type 2 diabetes leads to major metabolic changes and requires metabolic adaptation of the tissues. It is not known how cardiac metabolism can be acutely affected by changes in blood sugar.
To date, the consequences of the short-term reduction in glucose levels in the heart are not known. There is no previous publication with a similar protocol for the heart. It is therefore essential that the disciplines talk to each other in order to provide comprehensive and personalized care to patients.
The objective of our research is to demonstrate that cardiac metabolic inflexibility is present in some patients with chronic hyperglycemia and revealed during the treatment of their diabetes by insulin therapy.
Defects in metabolic flexibility will be evidenced by changes in cardiac segmental contractility on MRI and by extracellular expansion. This study uses state-of-the-art imaging, which is possible at the IHU ICAN thanks to the recent acquisition of a latest-generation 1.5T cardiovascular MRI specifically dedicated to cardiovascular and metabolic research on humans.
The IHU ICAN is very involved in setting up this project and in its execution, in particular with the participation of several of these platforms:
- ICAN BioCollection for the storage of samples and their preparations
- ICAN Imaging for MRI image acquisition and CoreLab imaging for reading and interpreting MRI images
- ICAN Omics for the assay and interpretation of relevant biomarkers
This study will therefore:
- Identify biomarkers for early detection of metabolic heart failure associated with type 2 diabetes
- Improving the prediction of the evolution of type 2 diabetes thanks to imaging
Project leader:
Pr Fabrizio Andreelli, diabetologist AP-HP, Pitié -Salpêtrière, IHU ICAN
Scientific team
- Pr Richard Isnard, cardiologist, Pitié Salpêtrière Cardiology Institute, IHU ICAN,
- Pr Alban Redheuil, medical manager of the Imaging IHU ICAN platform, head of the Cardiovascular and Thoracic Imaging (ICT) unit, Pitié Salpêtrière,
- Nadjia Kachenoura, scientific manager of the Imaging IHU ICAN platform, head of the cardiovascular imaging team of the Biomedical Imaging Laboratory, (LIB, Sorbonne University)
