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BackgroundWhereas first-line bronchial artery embolisation (BAE) is considered standard of care for the management of severe haemoptysis, it is unknown whether this approach is warranted for non-severe haemoptysis.Research questionTo assess the efficacy on bleeding control and the safety of first-line BAE in non-severe haemoptysis of mild abundance.Study design and methodsThis multicentre, randomised controlled open-label trial enrolled adult patients without major comorbid condition and having mild haemoptysis (onset ResultsBleeding recurrence at day 30 after randomisation (primary outcome) occurred in 4 (11.8%) of 34 patients in the BAE strategy and 17 (44.7%) of 38 patients in the medical strategy (difference −33%; 95% CI −13.8% to −52.1%, p=0.002). The 90-day bleeding recurrence-free survival rates were 91.2% (95% CI 75.1% to 97.1%) and 60.2% (95% CI 42.9% to 73.8%), respectively (HR=0.19, 95% CI 0.05 to 0.67, p=0.01). No death occurred during follow-up and no bleeding recurrence needed surgery.Four adverse events (one major with systemic emboli) occurred during hospitalisation, all in the BAE strategy (11.8% vs 0%; difference 11.8%, 95% CI 0.9 to 22.6, p=0.045); all eventually resolved.ConclusionIn non-severe haemoptysis of mild abundance, BAE associated with medical therapy had a superior efficacy for preventing bleeding recurrences at 30 and 90 days, as compared with medical therapy alone. However, it was associated with a higher rate of adverse events.Trial registration numberNCT01278199

International audience; 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

SummaryIn pregnant women, the reported cases of hemoptysis were most often mild and had an identified cause. Between November 2003 and January 2006, three pregnant women at 16–20 weeks gestation were admitted to our respiratory intensive care unit for massive hemoptysis. One of the women had experienced mild hemoptysis, considered as idiopathic, during her first pregnancy, with no recurrence until her second pregnancy. In all three cases, hemoptysis was massive. CT scan after iodine injection did not reveal any cause. Opacification of the bronchial artery showed hyperemia from abnormally dilated and tortuous bronchial arteries. Bronchial artery embolization (BAE) was performed in all three patients, successfully in two. Intravenous vasopressin was used as second-line treatment for recurrent bleeding after BAE in one patient. The women carried the pregnancy to term with delivery of healthy infants. Further complete investigation after the births did not identify any possible local (pulmonary) or general cause of bleeding in these three patients. Although these cases could be considered idiopathic, the close association with duration of pregnancy suggests the hemoptysis may be related to hormonal changes.

PurposeHypertrophic cardiomyopathies (HCM) are often associated with left ventricular (LV) outflow tract obstruction, which can explain symptoms. The aim of our work was to study the relation between LV obstruction and LV shape.Methods and results36 patients with HCM who underwent cardiac magnetic resonance imaging (CMR) were retrospectively included. Clinical diagnosis of HCM was based on the demonstration by bi-dimensional trans-thoracic echocardography (TTE) of a hypertrophied and nondilated LV (wall thickness >15mm) in the absence of another disease capable of producing a similar degree of hypertrophy. Obstructive HCM was defined by a LV outflow gradient >30mmHg at rest. LV shape and mitral angle were assessed by CMR. Tricuspid - mitral angle (TMA) and LV - mitral angle (LVMA) were defined by the angle between the tricuspid annulus and the mitral annulus, and the angle between the LV axis and the mitral annulus in the 4-chamber view respectively. Mitral papillary muscles angle (MPMA) was defined by the angle between both mitral papillary muscles and the center of the LV in the LV short axis view. There were 20 (56%) men and the mean age was 55±14. There were 24 (67%) patients with obstructive HCM with a mean LV outflow tract gradient of 90(46mmHg. TMA, LVMA and MPMA were smaller in obstructive HCM patients than in non-obstructive HCM patients (7±3 versus 11±4°, p

Background Idiopathic dilated cardiomyopathies (IDC) frequently develop left ventricle (LV) hypertrabeculation which bring to doubt about the diagnostic of LV non compaction (LVNC). The high spatial resolution of cardiac magnetic resonance imaging (CMR) allows distinguishing myocardial trabeculations explaining the exponential rise in the number of reports describing LVNC. Objective To study the correlation between the LV shape and myocardial trabeculations regarding the BNP level in a population of IDC. Methods Between November 2007 and November 2009, 48 IDC were prospectively assessed by CMR. Patients with echocardiographic LV ejection fraction (LVEF) > 45%, severe valvulopathy or usual criteria of LVNC were excluded. Patients with significant coronary artery disease (coronary stenosis > 50%) at the angiogram or subendocardium gadolinium delayed enhancement at the CMR were considered as ischemic cardiomyopathy and were excluded. LV end-diastolic volume (EDV) and end-systolic volume were measured by summing cine-CMR LV short axis slice. Sphericity index (SI) was defined as the ratio of LV end-diastolic diameter (EDD) on LV length measured respectively in midventricular short axis and midventricular 4 chambers cine-CMR views. LV trabeculation index (LVTI) was defined as the ratio of trabeculated on compacted layers thickness in a 16-segment model excluding apex. BNP was measured for each patient. Results Mean age was 52 ± 14 years with 29 (60%) men. Mean LVEF was 25 ± 10% with a mean indexed EDD of 37 ± 5 mm/m 2 and EDV of 135 ± 45 ml/m 2 . LVTI was not correlate with indexed EDV (r = 0.14; p = 0.34) and LVEF (r = 0.02, p = 0.9) but it was linearly correlated with SI (r = 0.26; p = 0.046) and had a tendency to have a negative correlation with BNP level (r = −0.26; p = 0.07). Conclusion These results suggest that LV myocardial trabeculation thickness increases linearly with the LV shape sphericity and has a tendency to decrease with the rise of LV pressure regime assessed by BNP level.