Archives of Cardiovascular Diseases Supplements最新文献

Introduction

RV-PA coupling can be evaluated, using non-invasive surrogates such as Tricuspid annular plane systolic excursion/Systolic pulmonary artery pressure (TAPSE/SPAP) or RV free wall longitudinal strain/SPAP (RVFWLS/SPAP) emerged. The aim of the present study was: 1) Population 1: in Hemodialysis population (HD), to evaluate RV parameters during important load variations, immediately before and after HD. 2) Population 2: in routine cardiologic population, to evaluate the diagnostic value of RV-PA coupling for RV dysfunction

Method

Population 1: 85 patients (53 men), 64 ± 16 years old, had an echocardiography with RV analysis (s’, TAPSE, RVFWLS)immediately before starting HD(Pre-HD)and at the end of HD(Post-HD). Population 2: 96 patients (60 men), 64 ± 14 years old with various disease in the Department of cardiology had an echocardiography including RVFWLS,RV fractional area change(RVFAC), TAPSE,S’, Tei index, Isovolumic acceleration(IVA),and 3D RVEF. Patients were split in normal RV function (defined by 6 concordant normal indices) and RV dysfunction (defined by the presence of at least 3 abnormal indices)

Results

Population 1: TAPSE, s’, RVFWLS were significantly decreased in post-HD as compared to pre-HD; when indexing these parameters by SPAP (s’/SPAP, TAPSE/SPAP, RVFWLS/SPAP), they remain unchanged. Population 2: RVFWLS/SPAP and TAPSE/SPAP were significantly higher in normal RV function compared to dysfunction (1.02 ± 0.31 vs 0.57 ± 0.34 and 0.83 ± 0.20 vs 0.47 ± 0.21); diagnostic thresholds for RV dysfunction were 0.67 for RVFWLS/SPAP(sensitivity:95%, specificity:78%)and 0.63 for TAPSE/SPAP (sensitivity:86%, specificity:80%)

Conclusion

Surrogates of RV-PA coupling, such as TAPSE/SPAP or RVFWLS/SPAP are load independent in a HD population. Moreover, these parameters may contribute to precisely evaluate RV function.

Introduction

Due to the aging of the population and the diversification of treatment options, finding the right treatment for the right patient becomes a challenge, especially in patients with mitral regurgitation (MR), which is a heterogenous and complex disease, with numerous etiologies. Aims of this study are to describe the profile of patients referred to the Valvular Heart Team (VHT) for management of mitral regurgitation, to highlight the selection process and the main factors guiding allocation for different treatment options, to assess clinical outcomes after treatment.

Method

All patients with mitral regurgitation referred to the VHT between January 1st, 2014, and April 30th, 2021, in University Hospital of Tours, were included.

Results

MR patients referred to our VHT were, mostly, old (mean: 74.2 years), symptomatic (96%), at high or intermediate risk according to “European Society of Cardiology” criteria (44%). Most of them had comorbidities, 34% had LVEF < 50% and 70% a severe primary MR. In 81% of cases, invasive management was decided (surgery [44%], percutaneous edge- to-edge mitral repair [TEER] [35%], transcatheter mitral valve replacement [1.6%]) and in 19% of cases, medical treatment was decided. Distribution of treatments changed significantly (P < 0.01) over time, with a progressive increase in TEER. History of cardiac surgery (P = 0.015), EuroScore II > 4% (P = 0.012), STS score > 8% (P = 0.037), frailty according to the Katz index (P = 0.029), LVEF < 50% (P < 0.001), TAPSE < 15 mm (P < 0,01) secondary MR (P < 0.001) and leaflets calcifications (P = 0.027) were the main factors significantly associated with the choice of a conservative treatment. In 86% of cases, VHT decisions could be implemented.

Conclusion

VHT is a centerpiece in the current management of patients with MR, it opts and more and more, for percutaneous treatments. The organization and the smooth running of VHT meetings will be a real issue in the future, with the increase in patients referred and we will have to find solutions (Fig. 1).

Introduction

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening disease. The purpose was to identify the predictors of left ventricular (LV) recovery.

Method

We retrospectively reviewed 40 patients hospitalized between 2013–2022. We included women with signs of heart failure in the last month of pregnancy and up to 5 months postpartum, with absence of identifiable causes of heart failure, with LV systolic dysfunction by TEE such as depressed shortening fraction (> 30%), EF (> 45%) and LV end-diastolic dimension > 2.7 cm/m². All patients were followed clinically and echocardiography at 6 months and over 1 year.

Results

Thirty-two patients were multiparous, 28 had multifetal pregnancies, caesarean section was performed in 20 patients, 15 patients had severe preeclampsia PPCM was discovered in antepartum in one case 5, postpartum in 35 cases with a mean time: 15 weeks after delivery. The symptomatology was dyspnea in 40 women, orthopnea in 15 cases, signs of pulmonary oedema in 20 cases and right heart failure in 9 cases. TEE at admission revealed dilatation of the LV with a mean EF 26%. A RV dysfunction in 16 cases, a functional MR in 15 cases; PH in 10 cases all patients received iv diuretics in case of AHF, CEI were prescribed in 35 cases, beta blockers and MRA in 22 cases. The duration of treatment was 6 months for 9 patients and over a year for others. Inotropic drug and circulatory support were necessary in 2 cases hospital mortality rate was of 1% because of cardiogenic shock. Twenty-five patients (45%) had “any improvement” in LVEF within 6 months and 3 patients during a mean follow-up of 26 months. Of these patients, 3 had complete improvement, 5 had partial recovery of LVEF. The factors associated with a higher likelihood of recovery were: postpartum diagnosis of PCCM, LVEF > 30%, LVEDD < 6 cm.

Conclusion

PCCM is a complication of pregnancy with unknown causes. Preeclampsia and multiparity appears to be strong associations.

Introduction

Cardiac rehabilitation improves the subjective condition of the patient but little is known about associated structural and functional cardiac adaptations specifically the myocardial strain.

Objective

To evaluate the impact of rehabilitation on structural and functional cardiac parameters using myocardial strain assessment by 2D Speckle Tracking.

Method

The study group consisted of 86 patients: 46 with heart failure with optimal medical treatment and 40 after acute myocardial infarction. A monocentric cohort study has included all patients who performed a 2-months cardiac rehabilitation program during 1 year. Clinical characteristics, a resting ECG, 2-dimensional Doppler echocardiography with tissue Doppler and strain imaging, and an incremental maximal exercise test on a bicycle ergometer were collected before and after the rehabilitation program. Paired student t-test for comparison and Pearson's correlation coefficient were used for the statistical analysis.

Results

Performance capacity was significantly improved after cardiac rehabilitation: performance in watts 112 W (±50) vs. 69.8 W (±34.5); effort test duration 10.7 min (±4.4) vs. 6.9 min (±3.1) and 6 min walking time 565 m (±127) vs. 496 m (±113). TEE parameters were significantly improved: LVFE 52.9% (±13) vs. 46.9% (±12.7), E/E’ 6.7 (±1.54) vs. 7.38 (±2.9). Significant difference of strain before and after cardiac rehabilitation 15.38% (+/4.72) vs. 14.12 (±4,79) has been also recorded. BNP level decreased by 29 ng/dL but not statistically significant from baseline. No significant correlation was found between biological, functional and TTE parameters.

Conclusion

Strain imaging could be an interesting additional parameter to evaluate the positive response and structural improvement in patients with or without chronic heart failure who are undergoing cardiac rehabilitation (Table 1).

Introduction

Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes.

Method

In this French multicentre retrospective study, we included 606 patients with ≥ moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥ 60 mm²) and then according to the TCG (≥ 10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality.

Results

The relationship between the EROA and TCG was poor (R² = 0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA < 60 mm² vs. ≥ 60 mm² (68 ± 3% vs. 64 ± 5%, P = 0.89). A TCG ≥ 10 mm was associated with lower four-year survival than a TCG < 10 mm (53 ± 7% vs. 69 ± 3%, P < 0.001). After adjustment for covariates, including comorbidity, symptoms, dose of diuretics, and right ventricular dilatation and dysfunction, a TCG ≥ 10 mm remained independently associated with higher all-cause mortality (adjusted HR [95%CI] = 1.47 [1.13–2.21], P = 0.019) and cardiovascular mortality (adjusted HR [95%CI] = 2.12 [1.33–3.25], P = 0.001), whereas an EROA ≥ 60 mm² was not associated with all-cause or cardiovascular mortality (adjusted HR [95%CI]: 1.16 [0.81–1.64], P = 0.416, and adjusted HR [95%CI]: 1.07 [0.68–1.68], P = 0.784, respectively).

Conclusion

The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥ 10 mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated functional TR (Fig. 1).

Introduction

The pathophysiology triggering dyspnea in rheumatic MS patients remains not fully understood. Recently introduced echocardiographic techniques allowed the study of left atrial reservoir function (LASr) notably in patients with PH. The objective of this study was to assess the correlation between LASr determined by 2D STE derived from global LA strain and PH.

Method

We performed prospective 2D TTE in patients with rheumatic MS. 2D and doppler TTE parameters, including indexed LA volume, maximal trans tricuspid velocity (TRVmax), mean trans-mitral gradient (MTMG), valve area (MVA) using pressure half time (PHT), 2D and 3D planimetry and left ventricular index stroke volume, were recorded. Doppler parameters are determined as the mean of three measurements. Maximal TRVmax was used as an indicator of the degree of PH to ignore assumptions on the right atrial pressure. A TRVmax cut-off value ≥ 2.9 m/s was retained to determine an intermediate to high probability of PH. NYHA functional status was determined moments before performing the scan.

Results

We enrolled 195 patients with rheumatic MS, with a mean age of 50.55 ± 12.07 years (between February 2018 and October 2021). Patients were divided into two groups: group 1 had TRVmax ≥ 2.9 m/s and group 2 had TRVmax < 2.9 m/s. There was no difference in age (52 ± 12 vs. 49 ± 11, P = 0.16) and in sex (respectively 69.8% and 76.1% were female, P = 0.3). AF was comparable between the two groups (69.8 vs. 65.7%, P = 0.5). There was no difference in the incidence of severe dyspnea (48.8% vs. 43.1%, P = 0.5 had NYHA class III or I symptoms). Incidence of diabetes mellitus was significantly higher among patients with PH (24.4 vs. 10.6%, P = 0.02). Patients in the PH group had significantly higher MTMG (13 ± 6 vs. 8 ± 3 mmHg, P < 0.001) and significantly lower MVA (1.1 ± 0.5 vs. 1.5 ± 0.5 cm², P < 0.001). LASr was significantly higher in patients without PH (11.1 ± 7 vs. 8.9 ± 5%, P = 0.05).

Conclusion

LASr was associated with a lower incidence of pulmonary hypertension in patients with MS.

Introduction

Takotsubo cardiomyopathy (TTS) is characterized by acute reversible left ventricular dysfunction showing typical left ventricular apical ballooning in the absence of obstructive coronary artery disease. Cardiac magnetic resonance (CMR) provides functional and inflammatory findings in contrast with the absence of late gadolinium enhancement (LGE). TTS generally heals within the first two weeks after the onset of symptoms, with the ECG and echocardiogram normalizing. However, data on CMR dynamics are scarce. In the present study, we aimed to describe how CMR findings change over time in acute TTS.

Method

Between December 2008 and May 2021, we retrospectively included all the patients hospitalized in the tertiary University Hospital of Angers, France who underwent CMR and received a diagnosis of acute TTS.

Results

Sixty-two patients fulfilled the diagnostic criteria from the 2018 ESC international expert consensus and underwent CMR. Patients were classified into three groups based on the delay between their first day of hospitalization and their assessment using CMR: less than five days (n = 31, 50%), between 5 and 15 days (n = 16, 25.8%), and more than 15 days [median 27 days (IQR: 20–36)] (n = 15, 24.2%). Compared to the 0–5 d group, the patients in the > 15 d group showed resolution of the LVEF alterations (55.9 ± 10.7 vs. 44.8 ± 13.3, P = 0.07), less apical akinesia (40% vs. 83%, P = 0.01) and normalized apical T2 values (44.5 ± 3.5 vs. 57 ± 2, P = 0.049). T1 and T2 quantitative measurements showed a base-to-apex gradient in 88.2% and 85.7% of patients, irrespective of the delay (P = 0.12 and P = 0.88).

Conclusion

When CMR cannot be performed early after the onset of a suspected TTS, wall motion abnormalities disappear, and LVEF alteration resolve. However, a parametric assessment searching for a base-to-apex gradient in T1 and T2 values with higher apical values may be helpful to confirm the diagnosis. Main CMR findings at different time points (Fig. 1).

Introduction

Conduction system abnormalities and myocardial dysfunction are observed in patients with myotonic dystrophy type 1 (DM1) and may represent the initial manifestations of the disease.

Some studies have shown improvements of outcomes with use of early cardiac resynchronization therapy (CRT) in DM1 patients. Two-dimensional speckle tracking echocardiography (2D-STE) has recently emerged as a non-invasive biomarker for early detection of dyssynchrony. The aim of this study is to assess a left ventricle (LV) dyssynchrony using 2D-STE analysis in this population.

Method

This is a prospective study, conducted from March 2020 to October 2022 which included DM1 with normal LV ejection fraction (LVEF) and control patients with comprehensive resting echocardiography. Three measures were performed to assess LV mechanical dyssynchrony: opposing-wall delays (longitudinal and radial analyses), modified Yu index, and time to-peak delays of each segment.

Results

Mean age was 23 ± 7 years. All three mechanical dyssynchrony criteria were significantly higher in the DM1 group than in healthy subjects: opposing-wall delays in basal inferoseptal to basal anterolateral segments (61.4 ± 45.3 msec vs. 18.3 ± 50.4 msec, P < 0.001, respectively) and in mid inferoseptal to mid anterolateral segments (58.6 ± 35.3 msec vs. 42.4 ± 36.4 msec, P < 0.05, respectively) (Fig. 1), modified Yu index (33.3 ± 10.1 msec vs. 28.5 ± 8.1 msec, P < 0.05, respectively), and most of time-to-peak values, especially in basal and mid anterolateral segments.

Conclusion

The existence of an early LV mechanical dyssynchrony using 2D-STE analysis in DM1 patients before the onset of cardiomyopathy represents a perspective for early prediction of sudden heart death. However, are ICDs really beneficial in terms of improving overall survival, in patients with conduction system disease often presenting more severe forms of myotonic dystrophy itself. Mean corrected time-to-peak delays.

Introduction

In the context of a prospective study for the multimodal characterization of the left atrium in patients undergoing atrial fibrillation ablation, we developed a systematic pipeline to allow the co-registration and analysis of three different imaging modalities: LGE-CMR, 3D catheter-based invasive voltage maps and FDG uptake measured by PET.

Method

The software SLICER3D was choosed as the primary building block. As a free, open source software, it allows for the quick building and deployment of custom solutions thanks to its python wrapper. Several software solutions were developped in python using both the SLICER3D innate capabilities and the Vizualisation toolkit library (VTK) powerful post-processing power.

Results

Building on a previous work from Hohmann S. we developed a program allowing the importation in SLICER3D of CARTOv7 (biosense) voltage maps. Using built-in tools, 3D meshes were created from LGE-CMR and PET studies. Unto those 3D meshes, a custom program calculated a maximum intensity projection of the atrial wall along normal vectors, allowing for the creation of LGE and SUV 3D maps. Lastly, iterative point cloud registration permitted the fusion of all 3 mappings. Point-by-point test of association between low voltage, low FDG uptake and high-LGE was used.

Conclusion

We were able to fusion and do a point-by-point analysis of three different imaging studies of the left atrium in atria fibrillation: voltage maps, LGE-CMR, and PET. Software solutions developed for this post-processing pipeline are generic and could be adapted for other multimodalities studies. A prospective study using this methodology and involving patients in AF undergoing ablation is underway and will be presented at the ESC congress 2023 (Fig. 1).