European Journal of Echocardiography最新文献

{"title":"Left ventricular systolic function decreases in lamin a/c cardiomyopathy wihout concomitant ventricular dilatation","authors":"ES Eystein Skjolsvik, Øyvind H. Lie, M. Chivulescu, M. Ribe, Aic Anna Isotta Castrini, T. Edvardsen, K. Haugaa","doi":"10.1093/EHJCI/JEAA356.385","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.385","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): This work was supported by the Norwegian Research Council [203489/030]\u0000 \u0000 \u0000 \u0000 Department of Cardiology, Research group for genetic cardiac diseases and sudden cardiac death, Oslo University Hospital, Rikshospitalet, Oslo, Norwa\u0000 \u0000 \u0000 \u0000 Lamin A/C disease is an inheritable cardiomyopathy characterized by conduction abnormalities, ventricular arrhythmias and end stage heart failure with complete age-related penetrance.\u0000 \u0000 \u0000 \u0000 To assess left ventricular structural and functional progression in patients with lamin A/C cardiomyopathy.\u0000 \u0000 \u0000 \u0000 We included and followed consecutive lamin A/C genotype positive patients with clinical examination and echocardiography at every visit. We evaluated progression of left- ventricular size and function by mixed model statistics.\u0000 \u0000 \u0000 \u0000 We included 101 consecutive lamin A/C genotype positive patients (age 44 [29-54] years, 39% probands, 51%female) with 576 echocardiographic exams during 4.9 (IQR 2.5-8.1) years of follow-up. LV ejection fraction (LVEF) declined from 50 ± 12% to 47 ± 13%, p < 0.001 (rate -0.5%/year). LV end diastolic volumes (LVEDV) remained stationary with no significant dilatation in the total population (136 ± 45ml to 138 ± 43ml, p = 0.60), (Figure). In the subgroup of patients >58 years, we observed a decline in LV volumes 148, SE 9 ml to 140, SE 9 ml p < 0.001 (rate -2.7 ml/year) towards end stage heart failure.\u0000 \u0000 \u0000 \u0000 LVEF deteriorated, while LV size remained unchanged during 4.9 years of follow-up in patients with lamin A/C cardiomyopathy. In patients <58 years, we observed a reduction in LV volumes. These findings represent loss of LV function without the necessary compensatory dilation to preserve stroke volume indicating high risk of decompensated end stage heart failure in lamin A/C.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81896366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of cardiac amyloidosis in patients with aortic stenosis: a systematic review and meta-analysis","authors":"F. Ricci, L. Ceriello, M. Khanji, G. Dangas, C. Ducci, M. Mauro, A. Fedorowski, M. Zimarino, S. Gallina","doi":"10.1093/EHJCI/JEAA356.364","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.364","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000  Cardiac amyloidosis (CA) has been increasingly recognized in elderly patients with aortic stenosis (AS), but with uncertain prognostic significance.\u0000 \u0000 \u0000 \u0000 We performed a systematic review and meta-analysis to clarify whether concurrent CA portends excess mortality in patients with aortic stenosis AS.\u0000 \u0000 \u0000 \u0000 Our systematic review of the literature published through June 2020, sought observational studies reporting summary-level outcome data of all-cause mortality in AS patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was assessed as the primary endpoint. We performed subgroup analysis stratified by severity of left ventricular hypertrophy (LVH) and study-level meta-regression analysis to explore the effect of covariates on summary effect size and to address statistical heterogeneity.\u0000 \u0000 \u0000 \u0000 We identified 4 studies including 609 AS patients (9% AS-CA; 69% men; age, 84 ± 5 years). The average follow-up was 20 ± 5 months. Compared with lone AS, AS-CA was associated with 2-fold increase in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%). When analysed according to LVH severity, pooled ORs (95% CI) for all-cause mortality were 1.29 (0.65-2.22) for mild LVH (≤16 mm), and 4.81 (2.19-10.56) for moderate/severe LVH (>16 mm). Meta-regression analysis confirmed a stronger relationship proportional to the degree of LVH, regardless of age and aortic valve replacement, explaining between-study heterogeneity variance.\u0000 \u0000 \u0000 \u0000 CA heralds significantly higher risk of all-cause death in elderly patients with AS. Severity of LVH appears to be a major prognostic determinant in patients with dual AS-CA pathology.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82381038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global longitudinal strain in patients with severe aortic stenosis: a comparison between cardiac magnetic resonance imaging feature tracking and speckle tracking echocardiography","authors":"Minna M Kylmälä, S. Syvaranta, R. Halva, R. Orn, H. Rajala, M. Holmström, S. Kivistö, J. Lommi, S. Suihko, V. Uusitalo","doi":"10.1093/EHJCI/JEAA356.270","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.270","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Global longitudinal strain (GLS) by echocardiography is a sensitive method for measuring left ventricular (LV) function, and of better prognostic value in valvular heart disease than ejection fraction (EF). Cardiac magnetic resonance imaging (CMR) is the most accurate method for measuring LV volume and EF, but GLS has not been possible to measure by CMR until recently.\u0000 \u0000 \u0000 \u0000 This study compares GLS obtained by CMR and echocardiography in patients with severe aortic valve stenosis. Normal values for GLS by CMR are reported as well.\u0000 \u0000 \u0000 \u0000 GLS was measured in 32 patients with severe aortic valve stenosis with speckle tracking echocardiography, using GE Vivid E95 (n = 15) and Philips EPIQ (n = 17) ultrasound machines, as well as with CMR (Avanto 1.5T FIT, Siemens Medical Solutions). For normal values, GLS was measured by CMR in 9 healthy controls. Endo- and epicardial borders of two, three and four chamber cine images were traced for CMR GLS using dedicated software (Qstrain 2.0, Medis, NL). Both CMR and Vivid E95 measured midmyocardial strain, whereas the EPIQ AutoStrain method measures endomyocardial strain. Absolute values of GLS are reported. Pearson correlation coefficient was calculated and paired Student’s t-test was used for comparisons.\u0000 \u0000 \u0000 \u0000 A significant correlation (r = 0.45, p = 0.01) was found between echocardiographic and CMR GLS (Figure). GLS by Vivid E95 had a very good correlation with CMR GLS (r = 0.84, p = 0.0001), whereas GLS by Philips EPIQ did not correlate significantly (r = 0.14, p = 0.01). In patients with aortic stenosis and healthy controls, the average GLS by CMR was 18.3 ± 3% and 20.9 ± 2% respectively. The average GLS by CMR was comparable to that obtained by GE Vivid E95 (17.3 ± 4% vs. 17.2 ± 3%, p = 0.92), and higher than by Philips EPIQ (19.2 ± 2% vs. 15.4 ± 2%, p < 0.0001).\u0000 \u0000 \u0000 \u0000 This study shows that GLS by CMR is feasible and correlates with GLS obtained by echocardiography, especially when quantifying midmyocardial strain. Echocardiographic GLS values based on endomyocardial strain were lower.\u0000 Patient characteristics Age 75 ± 14 y NYHA 1 1 (3 %) NYHA 2 20 (67 %) NYHA 3 8 (27 %) NYHA 4 1 (3 %) CMR EF 66 ± 8 % AVA 0.7 ± 0.2 cm² NYHA = NYHA class of symptoms, EF = ejection fraction by CMR, AVA = aortic valve area by echocardiography Abstract Figure. GLS by CMR vs. Echocardiography\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82675009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of quantitative myocardial perfusion mapping by CMR for characterisation of ischaemia in patients post coronary artery bypass graft surgery","authors":"A. Seraphim, K. Knott, A. Beirne, J. Augusto, K. Menacho, G. Joy, J. Artico, A. Bhuva, R. Torii, T. Triebel, H. Xue, J. Moon, Daniel A. Jones, P. Kellman, C. Manisty","doi":"10.1093/EHJCI/JEAA356.295","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.295","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): British Heart Foundation\u0000 \u0000 \u0000 \u0000 Quantitative myocardial perfusion mapping using Cardiac Magnetic Resonance (CMR) imaging is used for evaluation of ischaemia in the context of native vessel coronary disease, but its diagnostic performance in patients with grafts is not well established. Perfusion defects are often detected in these patients, but whether these are a consequence of a technical limitation (delayed contrast arrival from graft conduits) or a true reflection of reduced myocardial blood flow is unclear.\u0000 \u0000 \u0000 \u0000 39 patients undergoing stress perfusion CMR with previous coronary artery bypass graft (CABG) surgery, unobstructed left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) artery on coronary angiography and no CMR evidence of prior LAD infarction were included. Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were evaluated with quantitative perfusion mapping and the factors determining MBF in the LIMA-LAD territory (AHA segments 1,2,7,8,13,14), including the impact of delayed contrast arrival through the LIMA graft were evaluated.\u0000 \u0000 \u0000 \u0000 In 28 out of 39 cases a myocardial perfusion defect was reported on visual assessment in LIMA-LAD myocardial territory, despite the presence of unobstructed LIMA graft and no LAD infarction. Chronic total occlusion (CTO) of the native LAD was an independent predictor of stress MBF (B=-0.36, p =0.027) and the strongest predictor of MPR (B=-0.55, p 0.005) within the LIMA-LAD myocardial territory after adjusting for age, left ventricular (LV) ejection fraction, and presence of diabetes. CTO of the native LAD was associated with a reduction in stress MBF in the basal myocardial segments (-0.57ml/g/min, p = 0.002) but had no effect on the MBF of apical segments (-0.31ml/g/min, p = 0.084). Increasing the maximum value for allowable arterial delay (TA) of contrast in the quantitative mapping algorithm resulted in a small increase in myocardial blood flow in the LIMA-LAD territory both at stress (0.07 ± 0.08ml/g/min, p < 0.001) and rest (0.06 ± 0.05ml/g/min, p < 0.001).\u0000 \u0000 \u0000 \u0000 Perfusion defects detected in LIMA-LAD subtended territories are common despite graft patency. These defects are likely to represent genuine reduction in MBF, resulting from native LAD coronary occlusion. Prolonged contrast transit time associated with LIMA grafts results in small underestimation of MBF as measured by quantitative CMR perfusion mapping, but does not account for the degree of MBF reduction seen in these patients.\u0000 Figure 1. Study patient with unobstructed LIMA to LAD graft and evidence of inducible perfusion defect in LIMA-LAD territories. (A): First pass perfusion CMR imaging. (B): Perfusion mapping showing reduced stress MBF in mid antero-septum (0.85ml/g/min) compared to the apical septum (1.65ml/g/min). (C): Late gadolinium enhancement showing no evidence of previous infarction. (D,E): Coronary angiograph","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89133310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A CMR first strategy in patients with suspected NSTEMI may help identify MINOCA and infarct related artery","authors":"M. Shanmuganathan, A. Barlotti, R. Scarsini, C. Nikolaidou, E. Gara, M. Burrage, D. Terentes-Printzios, R. Kotronias, OxAMI Study Investigators, A. Lucking, R. Choudhury, G. L. Maria, A. Pitcher, K. Channon, V. Ferreira","doi":"10.1093/EHJCI/JEAA356.255","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.255","url":null,"abstract":"","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88799629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular and left atrial deformation imaging early after pPCI: does diabetes mellitus make any difference?","authors":"D Trifunovic Zamaklar, G. Krljanac, M. Ašanin, L. Savic-Spasic, J. Vratonjic, N. Arnautovic, S. Aleksandric, V. Šulović, L. Čučić, I. Mrdovic","doi":"10.1093/EHJCI/JEAA356.046","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.046","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 PREDICT-VT\u0000 More extensive coronary atherosclerosis in diabetes mellitu (DM) induces poorer clinical outcomes after STEMI, but there are data suggesting that impaired myocardial function in DM, even independently from epicardial coronary lesions severity, might have detrimental effect, predominately on heart failure development in DM.\u0000 \u0000 \u0000 \u0000 the current study is a sub-study of PREDICT-VT study (NCT03263949), aimed to analyse LV and LA function using myocardial deformation imaging based on speckle tracking echocardiography after pPCI in STEMI patients with and without DM.\u0000 \u0000 \u0000 \u0000 in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and analysis of LV rotation mechanic.\u0000 \u0000 \u0000 \u0000 from 242 patients who completed 1 year follow up, 48 (20%) had DM. Pts with DM were older (60 ± 1,01 vs 57 ± 10; p = 0.067) and had insignificantly higher SYNTAX score (18.5 ± 9.2 vs 15.8 ± 9.8, p = 0.118) . However, diabetics had more severely impaired EF (44.2 ± 8.6 vs 49.2 ± 9.8, p = 0.001), E/A ratio (0.78 ± 0.33 vs 0.90 ± 0.34; p = 0.036) and MAPSE (1.18 ± 0.32 vs 1.32 ± 0.33; p = 0.001).  Global LV LS on all layers (endo: -13.6 ± 4.0 vs-16.2 ± 4.7; mid: -11.9 ± 3.5 vs -14.1 ± 4.1; epi: -10.4 ± 3.1 vs -12.3 ± 3.6; p < 0.005 for all) was impaired in DM patients, as well as longitudinal systolic SR (-0.71 ± 0.23 vs -0.84 ± 0.24; p = 0.001) and SR during early diastole (0.65 ± 0.26 vs 0.83 ± 0.33, p < 0.001). Patients with DM had more pronounced longitudinal posts-systolic shortening throughout LV wall (endo: 21.4 ± 16.1 vs 13.7 ± 13.3, p = 0.005; mid: 21.9 ± 16.1 vs 14.3 ± 13.1, p = 0.006; epi: 22.4 ± 16.5 vs 15.3 ± 13.7, p = 0.010) and higher LV mechanical dispersion (MDI: 71.3 ± 38.3 vs 59.0 ± 18.9, p = 0.037). LA strain was significantly impaired in DM patients (18.9 ± 7.7 vs 22.6 ± 10.0, p = 0.011) and even more profoundly LA strain rate during early diastole (-0.73 ± 0.48 vs -1.00 ±0.58, p = 0.002). Patients with DM also had more impaired LV global (15.7 ± 9.1 vs 19.8 ± 10.4, p = 0.013) radial strain, global LV circumferencial strain, especially at the mid-wall level (-13.9 ± 4.2 vs -16.0 ± 4.3, p = 0.005) and impaired circumferential SR E (1.25± 0.44 vs 1.49 ± 0.46, p = 0.003). End-systolic rotation of the LV apex was more impaired in DM (4.7 ± 5.1 vs 6.8 ± 5.5, p= 0.022). During 1 year follow-up heart failure and all-cause mortality tend to be higher among DM pts (46.7% vs 35.2%, p = 0.153).\u0000 \u0000 \u0000 \u0000 STEMI patients with DM have more severely impaired LV systolic and diastolic function estimated both by traditional parameter and advanced echo techniques. These results might, at least partially, explain why outcomes after STE","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86409152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of idiopathic tricuspid regurgitation","authors":"Lw Li, Huang, WH Lee, W. Tsai","doi":"10.1093/EHJCI/JEAA356.058","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.058","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Executive Yuan, Taiwan\u0000 \u0000 \u0000 \u0000 Tricuspid regurgitation (TR) were traditionally classified as primary and secondary TR. Recently a new category of TR was developed and named as idiopathic TR. However, diagnosis and characteristics of idiopathic TR were not consisted. We tried to identify idiopathic TR by a new systemic approach and studied its characteristics.\u0000 \u0000 \u0000 \u0000 207 consecutive patients (mean age 71.2 ± 14.7 years, 40.6% male) identified as significant TR (moderate and severe) by echocardiography were recruited. We classified TR by a new systemic approach. The classification process started from identified primary TR, then pacemaker related TR, left heart disease related TR, congenital heart related TR, right ventricular (RV) myopathy, pulmonary hypertension and, finally idiopathic TR step by step.\u0000 \u0000 \u0000 \u0000 There were 29 (14%) primary TR, 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Mean age of idiopathic TR was 72.9 ± 11.4 years and 39.5% was male which were not different from other groups. Atrial fibrillation was presented highest in patients with pacemaker related TR (77.8%) and left heart disease (55.6%), lowest in primary TR (24.1%) and pulmonary HT (25.9%), and modest in idiopathic TR (44.2%). Among the echocardiographic characteristics of right heart measurements, idiopathic TR had lowest TR maximal velocity (3.0 ± 0.3 m/s), pulmonary (41.2 ± 8.7 mmHg) and right atrium pressure (5.3 ± 0.3 mmHg; all p <0.001). Idiopathic TR had smallest RV wall thickness (4.5 ± 1.4 mm; p = 0.008), tricuspid annulus diameter (3.2 ± 0.7 cm; p = 0.001), and right atrial area (18.9 ± 8.4 cm2; p <0.001). RV function represented as tricuspid annulus velocity S’ (12.8 ± 3.3 cm/s; p = 0.011) and RV fractional area change FAC (42.6 ± 16.0 %; p <0.001) were best in idiopathic TR. RV dysfunction (FAC < 35%) was lowest (14%) in idiopathic TR.\u0000 \u0000 \u0000 \u0000 Idiopathic TR had better RV function then other types of TR. Idiopathic TR can be regarded as a unique disease category in studying TR.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78287345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global longitudinal strain at rest predicts significant coronary artery stenosis in patients with peripheral arterial disease","authors":"L. Fiorillo, C. Santoro, M. Scalise, V. Capone, L. L. Mura, Mec Mario Enrico Canonico, T. Fedele, O. Casciano, SO Silvia Orefice, F. Luciano, V. Cuomo, R. Esposito","doi":"10.1093/EHJCI/JEAA356.154","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.154","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Critical peripheral artery disease (PAD) is expression of systemic chronic atherosclerosis, it being often associated with  cardiovascular events. The assessment of global longitudinal strain (GLS) at rest by speckle tracking echocardiography could be useful to unmask significant coronary artery disease (CAD) in asymptomatic PAD patients.\u0000 \u0000 \u0000 \u0000 To determine whether resting GLS is able to predict significant coronary artery stenosis in PAD patients selected for peripheral or carotid angiography.\u0000 \u0000 \u0000 \u0000 One-hundred three clinically relevant PAD patients (M/F = 76/27, age = 66.8 ± 10,2 years, 72 with significant  lower limb artery stenosis and 31 with carotid artery stenosis ≥50%), asymptomatic for CAD,  underwent standard echo-Doppler exam at rest, comprehensive of GLS analysis, prior peripheral and coronary angiography. Information on cardiovascular (CV) risk factors and comorbidities were collected. Patients with know CAD and previous myocardial infarction, left ventricular (LV) ejection fraction < 50% and inadequate echocardiographic imaging were excluded. According to the results of coronary angiography, patients were divided in two groups: with significant coronary artery stenosis (>50% of obstruction. n = 73) and without significant coronary artery lesions (n = 30).\u0000 \u0000 \u0000 \u0000 No intergroup difference in the prevalence of CV risk factors and comorbidities was found. Age, body mass index and blood pressure were comparable between the two groups. LV ejection fraction (59.9 ± 4.2% in patients with significant coronary stenosis vs. 60.2 ± 4.7% in those without coronary stenosis, p = 0.75) and wall motion score index (1.02 ± 0.09 vs 1.03 ± 0.09 respectively, p = 0.67) did not differ significantly. Conversely, GLS was lower in patients with significant coronary artery stenosis than in those without (21.6 ± 2.7% vs. 22.8 ± 2%, p < 0.02) (Figure 1). This difference remained significant comparing the carotid subgroup with coronary stenosis vs. those without (p < 0.05) whereas it did not achieve the statistical significance in patients with lower limb artery lesions (p = 0.42).\u0000 \u0000 \u0000 \u0000 In PAD patients, GLS at rest shoes the capability in identifying patients at higher probability of significant coronary artery stenosis. This involves in particular patients with carotid artery stenosis. GLS might be helpful to select patients who need to extend the peripheral angiographic evaluation to the coronary tree.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91302321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the CHA2DS2-VASc score in predicting ischemic stroke and death in patients with acute myocardial infarction without atrial fibrillation","authors":"A. Marques, A. Briosa, A. R. Pereira, S. Alegria, J. Santos, I. Rangel, I. João, H. Pereira","doi":"10.1093/EHJCI/JEAA356.432","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.432","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 on behalf of the investigators of the Portuguese Registry of Acute Coronary Syndromes\u0000 \u0000 \u0000 \u0000 The CHA2DS2-VASc score is used in clinical practice to stratify the risk of stroke in patients (pts) with atrial fibrillation (AF). Its usefulness in the population of pts with acute myocardial infarction without AF is not well known.\u0000 \u0000 \u0000 \u0000 To investigate whether CHA2DS2-VASc predicts ischemic stroke and death during hospital stay in pts with acute myocardial infarction without known AF. To determine independent predictors of ischemic stroke in this population.\u0000 \u0000 \u0000 \u0000 A multicentre, retrospective study was performed during 01/10/2010-04/09/2019 period, and included all pts admitted due to acute myocardial infarction. Pts with previous AF, AF rhythm in the electrocardiogram at admission or AF during hospital stay were excluded. Statistical analysis with Kaplan-Mayer and Cox regression was applied.\u0000 \u0000 \u0000 \u0000 Of 29851 pts admitted with acute myocardial infarction, were included in our study 19218 pts (74% male, mean age of 65 ± 14 years). \u0000 During hospital stay, 78 (0.4%) pts had an ischemic stroke and 462 (2.4%) pts died. \u0000 The event-free survival analysis showed significant differences according to the CHA2DS2-VASc score at admission (log rank test p = 0.015 for ischemic stroke; log rank test p < 0.001 for in-hospital mortality). (Figure) \u0000 The CHA2DS2-VASc score demonstrated a good predictive accuracy for in-hospital mortality (area under the ROC curve 0.69; 95% CI 0.67-0.72; p < 0.001). The area under the ROC curve indicates that the CHA2DS2-VASc score performed modestly for ischemic stroke (0.62; 95% CI 0.56-0.68; p < 0.001). \u0000 In univariate analysis, the factors that were positively associated with ischemic stroke during hospital stay were CHA2DS2-VASc, absence of previous therapy with statin, time between cardiac symptoms and hospital admission, absence of chest pain, Killip-Kimball class, cardiorespiratory arrest, complete left ventricular block and left ventricle ejection fraction <50% (p < 0.05). \u0000 After multivariate analysis, CHA2DS2-VASc≥3 (HR 2.25; 95% CI 1.37-3.71; p = 0.001), absence of chest pain (HR 3.17; CI 1.44-6.14, p < 0.001) and previous therapy with statin (HR 0.39; 95% CI 0.22-0.67; p = 0.001) were independent predictors of ischemic stroke.\u0000 \u0000 \u0000 \u0000  Among patients with acute myocardial infarction without known atrial fibrillation, the CHA2DS2-VASc score was associated with risk of ischemic stroke and death during hospital stay. This score may be useful for estimating the risk of stroke and in-hospital mortality in these population without known atrial fibrillation.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87584542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive assessment of cardiac percutaneous occluders healing process using computed tomography imaging: a proof of concept study","authors":"E. Perdreau, Z. Jalal, R. Walton, M. Sigler, H. Cochet, J. Naulin, B. Quesson, O. Bernus, J. Thambo","doi":"10.1093/EHJCI/JEAA356.246","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.246","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Other. Main funding source(s): National Research Agency (ANR) French Federation of Cardiology : “Aide à la recherche par équipe 2018, Cardiopathies de l’enfant”\u0000 \u0000 \u0000 \u0000 After percutaneous implantation of an atrial septal defect (ASD) occluder device, a complex healing process leads to the device coverage within several months. However, an unexplained incomplete device coverage is at risk of complications such as thrombosis or infectious endocarditis.\u0000 \u0000 \u0000 \u0000 The aim of the study was to assess the device coverage process of ASD occluder devices in a chronic sheep model using micro-CT technology.\u0000 \u0000 \u0000 \u0000 After percutaneous creation of an ASD by catheterization, 8 ewes (mean age 5.4 ± 0.7 yo and mean weight 55.6 ± 7.9 kg) were implanted with a 16-mm Nit-Occlud ASD-R occluder (PFM medical, Cologne, Germany) and were followed for 1 month (N = 3) and 3 months (N =5). After heart explantation, a iodine contrast agent was used to enhance the tissue signal. The device coverage was then assessed by micro-CT and the results were compared to histology, used as the gold standard for healing evaluation. The micro-CT image resolution was 41.7 µm. Reconstruction was performed in 2D and 3D with Amira® software, allowing to obtain images that were exploited by a code to measure the surface for each disk of the analyzed devices. Histological study was performed after resin embedding and Richardson blue staining was used.  The pathologist was blinded to the duration of animals’ follow-up and micro-CT results.\u0000 \u0000 \u0000 \u0000 ASD creation and device closure was successful in 100% animals without complications. Following heart explantation, macroscopic assessment of devices showed that the coverage was complete for the left-side disk regardless of the duration of the follow-up and variable for the right-side disk, depending of the protrusion of this disk. 2D and 3D micro-CT analysis allowed an accurate evaluation of device coverage of each disk and was overall well correlated to histology slices (cf Figure). Surface calculation from micro-CT images showed that the median surface of coverage was 93 ± 8% for the left-side disk and 55 ± 31% for the right-side disk.\u0000 \u0000 \u0000 \u0000 This preliminary study made the proof of concept that micro-CT is a reliable tool to assess the coverage of intra-cardiac occluders in vitro. The translation to clinical practice is challenging but would allow an individual follow-up, to avoid thrombotic or infective complications.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84843238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}