Archives of Cardiovascular Diseases最新文献

{"title":"Antithrombotic approach in percutaneous pulmonary valve implantation (PPVI): What is our standard of care? A study endorsed by the Association for European Paediatric and Congenital Cardiology.","authors":"Alessia Callegari, Gianfranco Butera, Thomas Krasemann, Ruth Heying, Ina Michel-Behnke, Damien Bonnet, Sophie Malekzadeh-Milani","doi":"10.1016/j.acvd.2025.04.056","DOIUrl":"10.1016/j.acvd.2025.04.056","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread adoption of percutaneous pulmonary valve implantation, there remains a lack of consensus on the optimal management of peri-interventional and long-term antithrombotic therapies because of a lack of evidence.</p><p><strong>Aim: </strong>To clarify current practices in peri/postprocedural antithrombotic strategies for percutaneous pulmonary valve implantation.</p><p><strong>Methods: </strong>An online survey was submitted to the Interventional Working Group of the Association for European Paediatric and Congenital Cardiology, and was completed by 76 congenital interventional cardiologists in 2023-2024.</p><p><strong>Results: </strong>Overall, 86% had standardized protocols for anticoagulation/antiaggregation. Intraprocedural heparin administration of 100IU/kg was common (83%), and postprocedural strategies mostly included acetylsalicylic acid (aspirin) (45%) or a combination of antiaggregation and anticoagulation (29%). Long-term strategies comprised antiaggregation (88%), no therapy (11%) and anticoagulation only (1%). Acetylsalicylic acid monotherapy was prescribed by 91%, whereas 9% used dual antiaggregation therapy. Dual antiaggregation therapy was continued for suspicious medical history of thrombotic complication or microthrombi for 3-6 months. Testing for acetylsalicylic acid resistance was infrequent (36%), and only if clinically indicated. When patients had pre-established anticoagulation therapy, 59% changed their strategy. Treatment changes based on valve type were rare (8%). The primary reasons for anticoagulation/antiaggregation were to increase valve longevity (26%) and for both longevity and endocarditis prophylaxis (68%). Acute valve thrombosis was reported in 11 cases.</p><p><strong>Conclusions: </strong>The survey reveals variability in practices after percutaneous pulmonary valve implantation. Most interventional cardiologists prefer acetylsalicylic acid for postprocedural and long-term management, whereas dual antiaggregation therapy is sometimes used in specific cases. Anticoagulation is limited to pre-existing therapy cases or isolated experiences for 3 months.</p>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the role of percutaneous coronary intervention in acute coronary syndrome with elevated platelet count - A constructive perspective: A letter in response to the article entitled \"Percutaneous coronary intervention in patients with acute coronary syndromes and increased platelet count\" by Zhang et al.","authors":"Naveed Ahmad, Aleena Mumtaz","doi":"10.1016/j.acvd.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.acvd.2025.05.006","url":null,"abstract":"","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring platelet count thresholds and long-term implications of percutaneous coronary intervention in acute coronary syndromes with thrombocytosis: A letter in response to the article entitled \"Percutaneous coronary intervention in patients with acute coronary syndromes and increased platelet count\" by Zhang et al.","authors":"Yan Du, Yimao Wu, Kaisen Huang, Xiaojian Deng","doi":"10.1016/j.acvd.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.acvd.2025.05.005","url":null,"abstract":"","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse coronary artery disease: A challenge in diagnosis and treatment.","authors":"Ikram El Marzouki, Gilles Barone-Rochette","doi":"10.1016/j.acvd.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.acvd.2025.05.004","url":null,"abstract":"","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintenance or improvement of functional capacity, health status, and quality of life with vutrisiran in patients with transthyretin amyloidosis with cardiomyopathy: Data from the HELIOS-B study","authors":"F.H. Sheikh ,&nbsp;G. Habib ,&nbsp;W.H.W. Tang ,&nbsp;J. Gillmore ,&nbsp;U. Egolum ,&nbsp;S. Longhi ,&nbsp;G. Jia ,&nbsp;E. Aldinc ,&nbsp;M. Fontana","doi":"10.1016/j.acvd.2025.04.024","DOIUrl":"10.1016/j.acvd.2025.04.024","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin amyloidosis with cardiomyopathy (ATTR-CM) progressively impairs patients’ (pts) functional capacity, health status, and quality of life (QOL). In HELIOS-B, vutrisiran reduced all-cause mortality and cardiovascular events compared with placebo (pcb) in pts with ATTR-CM and demonstrated significant benefit on multiple clinical measures of disease progression.</div></div><div><h3>Objectives</h3><div>Study aimed to establish the efficacy and safety of vutrisiran in a contemporary population of pts with ATTR-CM.</div></div><div><h3>Methods</h3><div>In HELIOS-B, 6-minute walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) score were secondary endpoints assessing functional capacity and health status/QOL. We present further details on the efficacy of vutrisiran on pts’ functional capacity, health status, and QOL.</div></div><div><h3>Results</h3><div>In the overall population at Month 30, the difference of LS-mean change from baseline (vutrisiran–pcb) was 26.46<!--> <!-->m (95% CI 13.38,39.55; <em>P</em> <!-->&lt;<!--> <!-->0.001) for the 6MWT and 5.80 points (95% CI 2.40,9.20; <em>P</em> <!-->&lt;<!--> <!-->0.001) for the KCCQ-OS. Over 30 months, in the overall population, 64% and 47% of pts treated with vutrisiran and pcb, respectively (<em>P</em> <!-->&lt;<!--> <!-->0.05) [monotherapy population; 65% and 38% (<em>P</em> <!-->&lt;<!--> <!-->0.05)], had an increase or<!--> <!-->&lt;<!--> <!-->5-point decrease in KCCQ-OS. Consistent benefits with vutrisiran were observed for both 6MWT and KCCQ-OS in prespecified subgroups, subdomains and different cut-off values/clinical thresholds. Similar trends were observed in the baseline tafamidis subgroup.</div></div><div><h3>Conclusion</h3><div>Significantly more pts treated with vutrisiran maintained or improved functional capacity and health status/QOL compared with pcb, providing further evidence of the disease-modifying effect of vutrisiran treatment. Secondary endpoint analyses of the HELIOS-B study demonstrated that vutrisiran preserved functional capacity (6MWT) and health status (KCCQ-OS) compared with pcb in pts with ATTR-CM. Benefits observed with vutrisiran were consistent in pre-specified subgroups, subdomains and different cut-off values/clinical thresholds.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 6","pages":"Page S230"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning score using multiparametric assessment for death prediction in cardiac amyloidosis","authors":"R. Mirailles ,&nbsp;T. Pezel ,&nbsp;M. Kharoubi ,&nbsp;M. Nicol ,&nbsp;A. Cohen Solal ,&nbsp;P. Henry ,&nbsp;D. Logeart ,&nbsp;F. Beauvais ,&nbsp;M. Baudet ,&nbsp;T. Goncalves ,&nbsp;E.S. Canuti ,&nbsp;M. Le Maistre ,&nbsp;S. Oghina ,&nbsp;V. Tacher ,&nbsp;E. Audureau ,&nbsp;S. Toupin ,&nbsp;T. Damy","doi":"10.1016/j.acvd.2025.04.026","DOIUrl":"10.1016/j.acvd.2025.04.026","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac amyloidosis (CA) is a severe disease with poor prognosis and increasing incidence. Available scoring systems for prognostic stratification in light chain (AL) and transthyretin (ATTR) amyloidosis are based on limited biological parameters. Allowing process of a greater number and complexity of variables, machine learning (ML) could improve prognostic assessment.</div></div><div><h3>Objectives</h3><div>To investigate the feasibility and accuracy of supervised ML algorithms using clinical, biological and imaging features to predict all-cause mortality in CA patients.</div></div><div><h3>Methods</h3><div>Data were collected from the French Referral Center for Cardiac Amyloidosis database (Hôpital Henri-Mondor, Créteil), including 1513 patients with wild type ATTR (<em>n</em> <!-->=<!--> <!-->777), hereditary ATTR (<em>n</em> <!-->=<!--> <!-->304) and AL (<em>n</em> <!-->=<!--> <!-->432) CA between 2010 and 2023 (<span><span>Fig. 1</span></span>). Based on comprehensive clinical, biological and imaging features, we assessed accuracy of several supervised ML algorithms (Random Forest, Random Forest Ranger, XGBoost and LASSO) to predict all-cause mortality and compared with traditional logistic regression.</div></div><div><h3>Results</h3><div>Among 1513 CA included, 636 (42%) died during a median follow-up of 1.5 years (IQR: 0.5–3.1). ML score using XGBoost exhibited a higher area under the curve compared with logistic regression for prediction of all-cause mortality (AUC 0.76 vs 0.67, <em>P</em> <!-->&lt;<!--> <!-->0.001; <span><span>Fig. 2</span></span>). In ATTR cohort, ML score using Random Forest ranger evidenced better performance compared with logistic regression (AUC ML score 0.77 vs 0.72 with logistic regression, <em>P</em> <!-->=<!--> <!-->0.008). However, in AL cohort, ML scores were not associated with an incremental prognostic value.</div></div><div><h3>Conclusion</h3><div>A ML-model including clinical, biological and imaging parameters showed the best accuracy to predict all-cause mortality in CA patients compared with any traditional methods.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 6","pages":"Page S231"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac magnetic resonance imaging in patients referred for premature ventricular contractions: Is it useful and for which patient?","authors":"A. Gomez,&nbsp;E. Vermes,&nbsp;A. Otmani,&nbsp;C. Tribouilloy,&nbsp;L. Leborgne,&nbsp;M. Gun","doi":"10.1016/j.acvd.2025.04.022","DOIUrl":"10.1016/j.acvd.2025.04.022","url":null,"abstract":"<div><h3>Background</h3><div>The role of cardiac magnetic resonance (CMR), in case of premature ventricular complexes (PVCs), is not clearly defined.</div></div><div><h3>Objectives</h3><div>The purpose of this study was assess the performance of CMR to detect structural abnormalities in patients routinely referred for PVCs after an initial workup and to determine predictive factors of abnormalities.</div></div><div><h3>Methods</h3><div>200 patients were retrospectively included; all referred by their cardiologist after an initial workup including ECG, echocardiography and treadmill exercise ECG test. Images were acquired on a 1.5 and 3 Tesla scanner with a standard protocol (cine imaging and late gadolinium enhancement sequences after contrast administration). The performance of CMR was defined as the detection of structural abnormalities not previously not found on the initial workup.</div></div><div><h3>Results</h3><div>CMR revealed structural abnormalities in 48% of cases, mainly non-ischemic fibrosis (25.5%) followed by ischemic fibrosis (9%) and mixed fibrosis (2%), as well as the diagnosis of 5 cardiomyopathies. In multivariate analysis, the main predictors of structural abnormalities were age<!--> <!-->&gt;<!--> <!-->64 years (HR 2.23; <em>P</em> <!-->=<!--> <!-->0.028), male sex (HR 2.59; <em>P</em> <!-->=<!--> <!-->0.012), diabetes (HR 6.13; <em>P</em> <!-->=<!--> <!-->0.006), known cardiomyopathy (HR 4.34; <em>P</em> <!-->=<!--> <!-->0.001), and pleomorphic PVCs (HR 3.74; <em>P</em> <!-->=<!--> <!-->0.007). In contrast, left bundle branch block morphology PVCs with inferior axis decreasing with effort in young non-diabetic subjects without known cardiomyopathy and with normal echocardiography all have a normal CMR (<span><span>Figure 1</span></span>, <span><span>Figure 2</span></span>, <span><span>Figure 3</span></span>).</div></div><div><h3>Conclusion</h3><div>CMR is essential in the assessment of PVCs as it enables the detection of structural abnormalities not found with the initial workup in almost half of the cases (48%). Predictive factors of structural abnormalities include men,<!--> <!-->&gt;<!--> <!-->64 years, diabetic with a known cardiomyopathy and pleomorphic PVCs. On the opposite, young and non diabetic patients with normal echocardiography and left bundle branch block morphology PVCs with inferior axis decreasing with effort have a normal CMR in 100% and could potentially not need this examination.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 6","pages":"Pages S228-S229"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of screening for myocardial ischemia and revascularization on cardiovascular outcomes: Insights from the Nancy ischemia registry","authors":"Z. Chati ,&nbsp;S. Tissier ,&nbsp;C. Balaj ,&nbsp;N. Benzaghou ,&nbsp;M. Angioi ,&nbsp;M. Amor ,&nbsp;J. Lemoine","doi":"10.1016/j.acvd.2025.04.037","DOIUrl":"10.1016/j.acvd.2025.04.037","url":null,"abstract":"<div><h3>Background</h3><div>Early detection and management of myocardial ischemia, particularly in high-risk individuals, represent a critical strategy for reducing major adverse cardiovascular events (MACE). The benefit of screening and revascularization in primary prevention remains less clear.</div></div><div><h3>Objectives</h3><div>Nancy Ischemia Registry aims to study the real-world impact of myocardial ischemia screening and revascularization on cardiovascular outcomes in both primary and secondary prevention settings.</div></div><div><h3>Methods</h3><div>Between May 2021 and December 2022, 3020 patients were prospectively enrolled.</div><div>Primary prevention: CACS, CCTA.</div><div>Secondary prevention: Stress Echo or Stress CMR.</div><div>Patients with suspected myocardial ischemia underwent coronary angiography. Revascularization was performed if at least one significant coronary lesion (stenosis<!--> <!-->≥<!--> <!-->70% or fractional flow reserve [FFR]<!--> <!-->≤<!--> <!-->0.80) was identified. The primary endpoint was the occurrence of MACE, defined as myocardial revascularization or cardiovascular death, by the end of 2023.</div></div><div><h3>Results</h3><div>Among the 3020 patients screened.</div><div>Primary prevention cohort (<em>n</em> <!-->=<!--> <!-->1732): 80% had no myocardial ischemia, while 9.6% (207 patients) underwent revascularization.</div><div>Secondary prevention cohort (<em>n</em> <!-->=<!--> <!-->693): 78% had no myocardial ischemia, while 11.6% (103 patients) underwent revascularization.</div><div>At follow-up: The cumulative incidence of MACE was 15% in the primary prevention group versus 20% in the secondary prevention group (HR: 1.06; 95% CI: [1.02–1.10]; <em>P</em> <!-->&lt;<!--> <!-->0.01).</div><div>Among patients with moderate ischemia but no indication for revascularization, MACE incidence was 4%, compared to 2% in those without ischemia (HR: 1.03; 95% CI: [1.01–1.06]; <em>P</em> <!-->&lt;<!--> <!-->0.05) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>In a real-world clinical setting, screening for myocardial ischemia using anatomical imaging and implementing timely revascularization significantly reduced the incidence of major adverse cardiovascular events in high-risk patients. This benefit was particularly evident in the primary prevention cohort, highlighting the importance of early detection and intervention.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 6","pages":"Page S237"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rendu Osler Stress Echocardiography (ROSE)","authors":"C. Bergerot ,&nbsp;S. Dupuis-Girod ,&nbsp;A. Guilhem ,&nbsp;A.E. Fargeton ,&nbsp;T. Barret ,&nbsp;Q. Barrier ,&nbsp;H. Thibault","doi":"10.1016/j.acvd.2025.04.041","DOIUrl":"10.1016/j.acvd.2025.04.041","url":null,"abstract":"<div><h3>Background</h3><div>The hepatic involvement in Hereditary Hemorrhagic Telangiectasia (HHT) is characterized by arterio-sus-hepatic shunts that can lead to high cardiac output heart failure (HCO-HF). This develops from asymptomatic diastolic heart failure to rest pulmonary hypertension (PH), which is actually required for liver tranplantation (LT) candidacy. However, when PH is present, HCO-HF improvement after LT is uncertain since such referral may possibly occur too late.</div></div><div><h3>Objectives</h3><div>We hypothesized that abnormal pulmonary pressure response during exercice in HHT patients with hepatic involvement can precede rest PH can be detected during exercise echocardiography and may be partially related to rest cardiac output indexed to BSA (CO).</div></div><div><h3>Methods</h3><div>ROSE is a pilot study of 40 HHT patients with hepatic involvement as defined by a hepatic artery diameter<!--> <!-->≥<!--> <!-->6<!--> <!-->mm,. Median CO value divided the population in 2 groups: high cardiac output (HCO group) vs normal cardiac output (NCO group). Patients were in sinus rhythm without betablocker treatment. Stress echocardiography was performed for CO, left ventricular (LV) and atrial (LA) volumes and functions, and systolic pulmonary arterial pressure (sPAP) at rest, 20<!--> <!-->W, and peak exercise. Endpoints were the comparison between groups of the evolution of sPAP (primary) and sPAP/CO slopes (secondary) from rest to peak exercise.</div></div><div><h3>Results</h3><div>Among 33 patients, we found no difference in sPAP at rest nor at peak exercise between HCO and NCO patients (<span><span>Table 1</span></span>). However, sPAP/CO slopes were higher in the HCO group especially in 4 patients exhibiting a greater sPAP increase for a relative smaller CO increase during exercise (<span><span>Figure 1</span></span>, <span><span>Figure 2</span></span>).</div></div><div><h3>Conclusion</h3><div>In HHT patients with hepatic involvement, sPAP assessment during exercise echocardiography for the identification of earlier stages of HCO-HF can be promising, especially when assessing the relationships between CO increase and sPAP increase. The sPAP/CO slope should be further investigated as an early marker nearly preceding rest PH.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 6","pages":"Pages S239-S240"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasability of wall motion analysis plus coronary flow reserve, and myocardial perfusion analysis during dobutamine stress echocardiography","authors":"P. Garcon ,&nbsp;Y. Moeuf ,&nbsp;Y. Antakly ,&nbsp;M. Youinou ,&nbsp;A. Prevot ,&nbsp;G. Roger ,&nbsp;J. Soltani ,&nbsp;N. Grinberg ,&nbsp;A. Jagu ,&nbsp;P. Abassade ,&nbsp;R. Cador","doi":"10.1016/j.acvd.2025.04.038","DOIUrl":"10.1016/j.acvd.2025.04.038","url":null,"abstract":"<div><h3>Background</h3><div>The 2024 ESC guidelines highlights the importance of myocardial perfusion (class 1, level B) and coronary flow reserve (CFR) (class 2b, level B) in stress echocardiography. However, these remain under-utilized in France, likely due to the predominant use of Dobutamine. This study assesses the feasibility of CFR and myocardial perfusion evaluation during Dobutamine stress echocardiography.</div></div><div><h3>Objectives</h3><div>To assess CFR measurement and myocardial perfusion feasibility during Dobutamine stress echocardiography.</div></div><div><h3>Methods</h3><div>Three years monocentric open interventional study. All consecutive patients receiving Dobutamine stress echocardiography were included. The test was performed following EAE guidelines. Sonovue® contrast was used for myocardial perfusion. CFR was calculated as the ratio of peak to resting diastolic velocity in the left anterior descending (LAD) artery. Myocardial perfusion was assessed using the Flash/Replenishment method before peak stress.</div></div><div><h3>Results</h3><div>Among 196 patients (mean age 71 years, 56% men), the target heart rate was achieved in 97%. CFR measurement was feasible in 90%, and myocardial perfusion in 98% (assessing<!--> <!-->≥<!--> <!-->80% of myocardial segments). Triple modality assessment (wall motion, CFR, and myocardial perfusion) was successful in 90% (<span><span>Fig. 1</span></span>). Median CFR was 2.55, lower in patients with wall motion abnormalities in the LAD territory (2.00, <span><span>Fig. 2</span></span>), and even lower in left ventricular dysfunction (1.61, <span><span>Figure 2</span></span>, <span><span>Figure 3</span></span>).</div></div><div><h3>Conclusion</h3><div>A multiparametric approach integrating WMA, CFR, and myocardial perfusion during Dobutamine stress echocardiography is highly feasible. CFR measurement was feasible in 90%, and myocardial perfusion in 98%, despite small attenuation artifacts. The lower CFR in patients with regional wall motion abnormalities and LV dysfunction suggests a strong link with myocardial ischemia. This supports CFR's role in refining ischemia assessment beyond wall motion analysis alone. Further studies are needed to evaluate its diagnostic impact.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 6","pages":"Pages S237-S238"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}