Introduction
Left ventricular (LV) dysfunction is a major prognostic determinant in myotonic dystrophy type 1 (DM1). Therefore, markers of early‐stage LV impairment may be useful. The aim of this ...study was to evaluate 2D echocardiographic LV strain in a cohort of DM1 patients with preserved left ventricular ejection fraction (LVEF) and to compare the results with matched controls.
Methods
This prospective single‐center study included 33 consecutive DM1 patients between February 2014 and February 2015. Mean age was 38.2±12.9 years, and 17 (52%) were males. Exclusion criteria were LVEF <55%, QRS >120 milliseconds, history of atrial fibrillation, and presence of a pacemaker with ventricular pacing. DM1 patients were matched to healthy controls according to sex and age.
Results
DM1 patients showed significant impairment of global longitudinal strain (GLS) as compared to controls (−18.0±1.9 vs −19.1±2.4; P=.03), characterized by a marked alteration at the apex (−20.0±3.3 vs −22.7±3.1; P<.001). DM1 patients had also global radial strain impairment (20.0±9.8 vs 27.5±14.9; P=.024) compared to controls while global circumferential strain was not statistically different between groups (P=.94). Intra‐ and inter‐observer analysis showed good reproducibility of GLS.
Conclusion
Despite preserved LVEF, DM1 patients exhibited significantly altered LV GLS, particularly at the apex, as compared with controls. The detection of impaired myocardial deformation at early stages of the disease might help to screen high‐risk patients who need closer follow‐up.
Pancarditis is a rare condition with a poor prognosis combining endocarditis, myocarditis with abscess formation, and purulent pericarditis. Diagnosis is often delayed and the clinical signs are ...predominantly those of the embolic complications. Literature is scarce. We present a unique and rare case of pancarditis, complicating a Streptococcal B infection in an immunocompetent, healthy, 54 year-old woman. The evolution was favourable under medical therapy alone and thanks to multimodality cardiac imaging diagnosis and follow-up.
Abstract Context Left atrial (LA) volume is a prognosis factor of cardiovascular morbidity in patients with cardiovascular disease (CD). Recent developments of multislice computed tomography (MSCT) ...have made non invasive coronary angiography reliable for selected patients and new software facilitates truly volume measurements without geometrical assumptions. Objective To define, by using MSCT, LA and left atrial appendage (LAA) volumes in patients with or without CD. Methods and results In the population of patients referred to our laboratory for a conventional MSCT coronary angiography, 40 individuals without CD (Normal group) and 80 patients with CD (CD group) were prospectively selected. The CD group was constituted from 4 subgroups of patients with either coronary artery disease ( n = 20), idiopathic dilated cardiomyopathy ( n = 20), left ventricular hypertrophy ( n = 20) or severe mitral regurgitation (MR group, n = 20). LAA and LA volumes were measured on a commercially available workstation. LA maximal and minimal volumes were lower in Normal group than in CD group, as LA ejection fraction (54 ± 10 versus 67 ± 20 ml/m2 , p < 0.0001; 31 ± 8 versus 46 ± 20 ml/m2 , p < 0.0001; 43 ± 8% versus 33 ± 14%, p < 0.001). LAA volume was larger in MR group than in Normal group (15 ± 7 ml versus 9 ± 3 ml, p < 0.0001). Conclusion This MSCT study provides normal values of LA and LAA volumes for patients who underwent MSCT coronary angiography and suggests that MSCT is helpful to assess the changes of LA volumes related to various CD.
The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation.
AFL ablation commonly requires ...intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with rising interest, but robust data in electrophysiological procedures are lacking.
This single center, randomized controlled trial compared hypnosis and placebo during AFl ablation. In addition to the randomized intervention, all patients were treated according to the institution’s standard of care analgesia protocol (administration of 1 mg of intravenous morphine in case of self-reported pain ≥5 on an 11-point numeric rating scale or on demand). The primary endpoint was perceived pain quantified by patients using a visual analog scale.
Between October 2017 and September 2019, 113 patients (mean age 70 ± 12 years, 21% women) were randomized to hypnosis (n = 56) or placebo (n = 57). Mean pain score was 4.0 ± 2.2 in the hypnosis group versus 5.5 ± 1.8 in the placebo group (p < 0.001). Pain perception, assessed every 5 min during the whole procedure, was consistently lower in the hypnosis group. Patients’ sedation scores were also better in the hypnosis group than in the placebo group (8.3 ± 2.2 vs. 5.4 ± 2.5; p < 0.001). Finally, morphine requirements were significantly lower in the hypnosis group (1.3 ± 1.3 mg) compared with the placebo group (3.6 ± 1.8 mg; p < 0.001).
In this first randomized trial, hypnosis during AFL ablation was superior to placebo for alleviating pain and reducing morphine consumption.
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Background
Patient prognosis in type 1 myotonic dystrophy (DM1) is very poor. Annual 24‐hour holter ECG monitoring is recommended but its relevance is debated. Main objective was to determine whether ...holter ECG parameters could predict global death in DM1 patients and secondarily to assess whether they could predict cardiovascular events and sudden cardiac death, to compare DM1 patients and healthy controls, and to assess their evolution in DM1 over a 5‐year period.
Methods
This retrospective study included genetically confirmed DM1. Primary endpoint was global death. Secondary endpoints were labeled “sudden cardiac death” which was a composite of sudden cardiac death, aborted sudden cardiac death, implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, atrioventricular block grade 3, pause >3 s; and “cardiovascular events” which was a composite of all‐cause mortality, pacemaker or cardioverter defibrillator implantation, sustained ventricular tachycardia, supraventricular tachycardia, hospitalization for acute cardiac cause and heart failure.
Results
Forty‐seven patients (22 women, 40 ± 13 years old) were included. Three (7%) DM1 patients died, 9 (19%) experienced "sudden cardiac death" endpoint and 21 (45%) experienced "cardiovascular event" endpoint during mean follow‐up of 95 ± 22 months. None of holter ECG parameters were discriminant to predict death or secondary endpoints. Compared to healthy controls, DM1 patients had higher SDNN and LF/HF ratio. Finally, heart rate variability parameters remained stable over a mean interval of 61 ± 15 months excepting pNN50 which decreased significantly.
Conclusion
Results suggest that annually‐repeated holter ECG in DM1 is not useful for stratifying risk of sudden death and cardiovascular outcomes.
Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective ...multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio OR 1.97, p <0.001), male gender (OR 1.5, p <0.002), diabetes (OR 1.5, p <0.0001), and age (OR 1.2, p <0.0001). In conclusion, in this large multicenter study, CTCA identified significant CAD with high sensitivity. However, in routine clinical practice, each patient should be individually evaluated, and the pretest probability of obstructive CAD should be taken into account when deciding which method, CTCA or CA, to use to diagnose its presence and severity.
Cardiac shunts are often described in congenital or pediatric populations, but systemic-to-pulmonary venous shunts in adult patients are reported in literature in isolated case reports. We present ...the case of a 70-year-old female with a left superior vena cava (SVC) draining into the left atrium by the left superior pulmonary vein, with a complete right-to-left shunt of the superior venous circulation caused by a former catheter thrombosis in the right SVC. Diagnosis was suspected after a contrast echocardiography showing an exclusive perfusion of left heart after intravenous injection and confirmed by helical computed tomography with three-dimensional reconstruction. After medico-surgical discussion, a first-line conservative treatment with oxygen therapy was chosen, due to the stability of symptoms and high predicted risk of perioperative mortality. The particularities of this case are that we cannot determine if the origin of this shunt is a latent persistent left SVC becoming symptomatic after the SVC obstruction or an abnormal collateral pathway due to the thrombosis and the unusual indirect communication through a pulmonary vein.
Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics ...and clinical outcomes over time are limited.
The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period.
TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers.
A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation EuroSCORE: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium–defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p < 0.001 for both). Stroke and potentially life-threatening complications, such as annulus rupture or aortic dissection, remained stable over time, whereas rates of cardiac tamponade and pacemaker implantation significantly increased.
The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter FRANCE TAVI; NCT01777828)
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This study assessed the clinical or echographic factors predisposing to dynamic left ventricular obstruction (LVO) during dobutamine echocardiography (DE) in patients with angina‐like chest pain but ...without coronary artery disease (CAD). DE is an effective technique for the noninvasive diagnosis of underlying CAD. During DE, an LVO is not unusual in ischemic patients. Methods: DE (5–40 μg/kg/min) was performed in 52 consecutive patients with angina‐like chest pain and normal coronary angiogram. Mean (standard deviation) age was 61 ± 10 years (27 men, 25 women). Dobutamine‐induced LVO was defined as a new intracavitary flow acceleration of at least 3 msec in the left ventricle. Results: Dynamic LVO was observed during DE in 20 (38%) of the 52 patients and was not related to clinical or baseline echocardiographic parameters. The chronotropic response and the systolic blood pressure during DE were higher in the group with LVO (P < 0.03 and P < 0.05, respectively). Appearance of chest pain during the test was also more frequent when LVO occurred (P < 0.02). Conclusion: Dynamic LVO is common during DE in a population of patients with angina‐like chest pain without epicardial CAD and is associated with a higher hemodynamic responsiveness to dobutamine.
Current guidelines recommend the use of Dual antiplatelet therapy (DAT) aspirin and a thienopyridine, such as clopidogrel or prasugrel or ticagrelor, for 12 months after an acute coronary syndrome ...(ACS). Limited information is available on medication adherence especially on prasugrel and ticagrelor.
Comparison of the patient adherence to these 3 recommended treatments. A secondary objective was to identify risk factors of non-adherence to each treatment.
We conducted a retrospective observational study on patients admitted for ACS in two cardiology care units of the west of France (a) (b) between 1/10/2012 and 01/10/ 2013. Patients were grouped according to the DAT in 3 groups: clopidogrel, prasugrel and ticagrelor. Medication adherence was assessed by telephone interview, with a validated scale, after at least 6 months of treatment. The treatments’ side-effects were also appraised.
From a total of 1077 patients with a ACS, 335 surviving patients with usable response were included. The median follow-up was 9 months. 119 patients in clopidogrel group, 123 patients in prasugrel group and 93 patients in ticagrelor group were included. A non-adherence was noted in 19% of the cohort group. A significant difference in non-adherence was noted between clopidogrel (13%), prasugrel (18%) and ticagrelor (27%) (p=0.05). Younger age (< 50 years old) (OR 10, 65; p < 0.001) and minor hemorrhage (OR 2.495; p=0.009) were independent risk factors of non-adherence for each treatment. In Clopidogrel group, the predictors of non-adherence were hypercholesterolemia (OR 3.02; p=0.01), and major digestive hemorrhage (OR 33; p 0.009). In Prasugrel group, patients with high blood pressure (OR 6.77; p=0.007); or with a high number of medications were statistically associated with non-adherence (OR 3.41; p=0.04). In Ticagrelor group, minor hemorrhage (epistaxis, gingivorrhagia...) were also associated with non-adherence (OR 5.17; p=0.05)
After ACS, non-adherence to antiplatelet treatments was observed in about 1 out of 5 patients with significant difference between the different drugs in this non randomized study. Younger ages, higher number of total medications, and side effects such as minor hemorrhage were associated with non-adherence.
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