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[Display omitted] • One in 14 patients (7%) with severe AS undergoing TAVI diagnosed with ATTR-CM. • Targeted screening with Tc99m BS in those at risk (red flags and/or risk scores). • Monoclonal gammopathy excluded. • Emphasis on tailored management for patients with positive BS. • Management includes consideration of TTR stabilizers. • Continued surveillance for ATTR-CM in high-risk patients with negative BS. • More studies needed to define impact of ATTR-CM on long-term prognosis after TAVI. Transthyretin amyloid cardiomyopathy (ATTR-CM) can manifest as rhythm disorders, heart failure, but also valvular degeneration. Despite aortic stenosis (AS) being prevalent among the elderly, data on ATTR-CM prevalence and outcome in patients with AS undergoing transaortic valve implantation (TAVI) remain scarce. To determine ATTR-CM prevalence and evaluate 1-year survival in patients undergoing TAVI. Between December 2020 and September 2021, 100 consecutive patients underwent TAVI and were screened prospectively for ATTR-CM using bone scintigraphy (BS). Monoclonal gammopathy was ruled out in case of cardiac uptake on BS. All patients were followed prospectively for 1 year after TAVI. The proportion of patients aged ≥ 75 years or with a EuroSCORE II > 8% and possible femoral access was 99%. The abnormal cardiac uptake rate on BS was 7% (95% confidence interval: 2–12%); 86% of these patients were male. The RAISE (remodelling, age, injury, system and electrical) score, indicative of ATTR-CM risk, was higher in case of positive BS (P = 0.04). Patients with positive BS were older and exhibited wider QRS complexes on electrocardiography (P = 0.003), a higher frequency of reduced LVEF (57% vs. 17%), impaired basal LV strain (P = 0.02) and a lower voltage/mass ratio (P = 0.01). History of pacemaker implantation before TAVI was higher in the positive BS group (P = 0.0004) and remained the only statistically significant factor after adjustment using the Holm–Bonferroni method. One-year survival of patients with positive BS did not differ from that of patients with isolated AS. Prevalence of ATTR-CM in patients treated with TAVI, underscoring the need for continued surveillance for potential development of ATTR-CM after TAVI. Caution is warranted regarding the 1-year survival because of the lack of study power. Further investigations are needed to define long-term prognosis of AS with ATTR-CM. [ABSTRACT FROM AUTHOR]

[Display omitted] • We compared patients aged > 75 years treated for IE, who did/did not undergo TEE. • Patients without TEE were older, with more comorbidities. • Patients without TEE had poorer functional, nutritional and cognitive statuses. • Patients without TEE underwent surgery for a recognized indication less often. • Patients without TEE had a poorer prognosis. Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions. To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality. A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1± 5.0; range 75–101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE. Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4 ± 6.0 vs. 81.9 ± 3.9 years; P = 0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9 ± 7.8 vs. 12.8 ± 6.7; P = 0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P = 0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P = 0.13) and less often an abscess (4.7% vs. 22.1%; P = 0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P = 0.0006). Mortality was significantly higher in patients without TEE. Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE. [ABSTRACT FROM AUTHOR]

Echographic evaluation of the cardiopulmonary unit may be difficult in the presence of TR. Purpose: To assess the variation of simple and combined echographic parameters analysing the cardiopulmonary unit according to the severity of TR. Echographic images were reviewed in 179 patients to assess TR grade according to Hahn's 5 grades classification. Classical morphological (RV end diastolic length and area), function [TAPSE, RVFAC, S',RVFWS (RV free wall longitudinal strain)] and load [PASP,TRTVI (TR Time-velocity integral)] parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI × RVFWS), morphology and load (load adaptation index = TRTVIxRVED length/area) and morphology, load, and function [myomechanical index (MMI = RV-RA mean pressure gradient × RVFWS/indexed RAED area × 10–2) and morphology-load-function index (MLF = RVED length/area xTRTVIx RVFWS)] were calculated. We used ROC curves to analyze the diagnostic value of echocardiographic parameters to predict potential high (> 3) or low (< 6) surgical risk of mortality according to TRISCORE. Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of TR. Combined parameters were also significatively different. Among them, MMI and MLF had a linear progression (MMI: grade 1: 0.20 ± 0.09; grade 2: 0.15 ± 0.08; grade 3: 0.10 ± 0.05, grade 4: 0.09 ± 0.08; grade 5: 0.05 ± 0.04 P = 0.000; MLF: grade 1: 7.56 ± 2.06; grade 2: 6.57 ± 2.14; grade 3: 4.85 ± 2.29, grade 4: 4.79 ± 3.17; grade 5: 3.06 ± 1.82 P = 0.000) and had the best predictive value for TRISCORE (MMI: AUC = 0.889 P = 0.000 for low risk, 0.855 P = 0.000 for high risk; MLF: AUC = 0.873 P = 0.000 and 0.822 P = 0.000). Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load (Fig. 1). [ABSTRACT FROM AUTHOR]

Cardiac amyloïdosis (CA) is an emerging disease in cardiology, especially the transthyretine form (TTR) in the elderly. However, data regarding prevalence of TTR-CA in patients with severe aortic stenosis (AS) remain scarce. To precise the prevalence of TTR-CA in patients refered for transcatheter aortic valve implantation (TAVI). All patients undergoing TAVI for severe AS between December 2020 and April 2021 in our center were screened for CA, using bone scintigraphy (BS) with HDP-99mTc before or after TAVI procedure. Cardiac fixation was ranked according to Perugini score (from 0 to III). Patients with Perugini score ≥ I on BS underwent seric and urine assay to rule out light chain amyloïdosis. Among the 50 patients included so far, mean age was 82 ±5.4 years, and 32 (64%) were male. Mean LVEF was 57 ±10%. Mean EuroScore II was 4.0 ±3.1, 42 (84%) had femoral access and 9 (18%) had already pacemaker (Table 1). Abnormal cardiac fixation on BS was observed in 4 patients (8.0%): 3 had Perugini I and 1 Perugini II. All were males. These 4 patients presented more abnormal cardiac parameters on ECG and echocardiography, such as: longer PR delay (208 ± 56 versus 151 ± 81 ms), wider QRS (143 ± 31 versus 113 ± 24 ms, P = 0.03) (Fig. 1B), lower ejection fraction (49 ± 9 versus 58 ± 10%) (Fig. 1A), higher left ventricule mass index (LVMi) (134 ±13 versus 120 ±34 g/m2) (Fig. 1C), lower voltage (1.45 versus 2.2 mV, P = 0.08) and lower voltage/mass ratio (11 ±2 versus 20 ±10 μV/g/m2, P = 0.07) (Fig. 1D). Patients with positive BS tend to have higher pacemaker implantation before TAVI (50% versus 15%, P = 0.08). Prevalence of TTR-CA was 8.0% in our population of AS patients treated with TAVI. All were male sex, and had more frequent conduction disorders, higher LVMi, lower LVEF and lower VMR. Those preliminary results need to be consolidated with the study completion. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic constitutes a challenge in cardiovascular disease management. Little is known about COVID-19 prevalence and incidence in cardiac rehabilitation (CR) programs. To evaluate the prevalence and incidence of COVID-19 in patients undergoing CR in ambulatory setting. From august to October 2020, all patients admitted in a single ambulatory CR program were screened for COVID-19 infection before and after CR, through naso-pharyngeal RT-PCR and serology assays before and after the CR. Number of patients was reduced from 9 to 4 in each group, 2 meters distancing respected, and all patients and staff had to wear surgical mask during sessions. Hand washing and material disinfection were systematic before and after each session for both patients and health professionals. Among the 81 patients included, 63 (76%) were male, mean age was 57 ± 11 years (Table 1). None (0%) had positive RT-PCR before entering CR and only 2 (2.7%) were tested positive after CR. These two patients were asymptomatic. After serological analysis, 3 patients (3.8%) had anti-bodies against SARS-COV-2 before and after participating CR (Fig. 1). These 3 patients were negative on nasal swab before and after CR. No seroconversion was observed. In total (before and after CR), 5 patients (6.0%) were tested positive with COVID-19. Those 5 patients were younger (mean age 51 years old versus 58, P = 0.02), with better functional capacity before and after CR: respectively 7.1 METs (versus 5.2 METs, P = 0.01) and 8.3 METs (versus 6.3 METs, P = 0.03). In COVID+ patients, improvement of functional capacity was similar to COVID–patients: respectively 0.8 METs (P = 0.9) and 15 Watts (P = 0.9). CR is not associated with risk of infection with SARS-COV-2, provided that basic sanitary measures are stricly applied. It is also associated with functional capacity improvement, even in patients who previously had COVID-19. [ABSTRACT FROM AUTHOR]

Iron deficiency (ID) is highly prevalent in patients with cardiovascular diseases (CVD), especially in heart failure (HF). Less is known on ID prevalence in cardiac rehabilitation (CR). To precise prevalence of ID in patient undergoing cardiac rehabilitation, and its impact on functional capacity (FC) and quality of life (QoL). Patients starting ambulatory CR program in our center were checked for ID, defined as ferritin < 100 ng/mL or < 300 ng/mL with transferin saturation (TSAT) < 20%. Functionnal capacity (FC) was defined in Watts with stress test, and QoL assessed with physical score (PS) and emotional score (ES) of SF-36. Left ventricular ejection fraction (LVEF) was tertilized as reduced (rEF < 40%), middly-reduced (mr-EF 40-49%) and preserved (pEF > 50%). Among the 211 patients included, mean age was 58 ± 13 years, and 165 (78%) were male. Main reason of CR referral was coronary artery disease (CAD). At baseline, prevalence of ID was 39% in all population, and equaly prevalent in the three categories of LVEF: rEF (35%), mrEF (38%) and pEF (40%) (P = 0.9). Patients referred after cardiac surgery and HF episode presented most frequently with ID compared to CAD patients, respectively 61%, 46% and 31%. (P = 0.01) (Fig. 1A). Compared to non-ID (NID) patients, ID patients had lower FC: 103W ± 33 versus (vs.) 114W ± 38 (P = 0.02) (Fig. 1B) , and there was a trend toward lower PS and ES in ID compared to NID patients: respectively 40 ± 29 vs. 47 ± 24 (P = 0.08) and 45 ± 33 vs. 52 ± 28 (P = 0.1). Benefice of CR was higher in ID patients according to FC improvement (+21 ± 23% vs. + 15 ± 22%, P = 0.06), and PS et ES improvement were similar to non-ID patients: respectively +22 ±46% vs. +28 ± 45% (P = 0.5) and +33 ± 67% vs. 23 ± 42% (P = 0.3). ID is highly prevalent in patient undergoing CR program, especially after heart surgery and in HF. In ID patients, improvement of FC and QoL are respectively higher and similar to NID patients. [ABSTRACT FROM AUTHOR]

Transthyretine cardiac amyloidosis (TTR-CA) severity can be assessed by bone scintigraphy using HDP-99mTc and Perugini score, depending on intensity of myocardial uptake. Less is known on how Perugini score interplays with routine cardiac structural parameters. To evaluate correlation between Perugini score and myocardial mass and voltage abnormalities in patients with TTR-CA. Patients adressed to our center with confirmed TTR-CA underwent complete evaluation including electrocardiogram (ECG) and transthoracic echocardiography (TTE). Routine parameters were obtained such as: ECG voltage in millivolt (mV) according to Sokolow indice (SV 1 + RV 5) , PR delay (ms), QRS width (ms), left ventricular mass (LVM, grams) and diastolic interventricular septum (dIVS) thickness (mm). Patients were classified into three categories according to Perugini score: I (cardiac uptake < chest bones), II (cardiac uptake = chest bones) and III (cardiac uptake > bones). Main end-point were LVM and Voltage/Mass ratio (VMR, μVolts/g). Among 17 patients, 14 were male (82.4%) and mean age was 82 ± 8 years. Six patients (35.3%) had permanent atrial fibrillation (AF). Mean voltage, PR delay and QRS width were respectively 1.5 ± 0.5 mV, 212 ± 54 ms and 113 ± 19 ms. On TTE, mean LVM and dIVS width were respectively (188 ± 55 g/m2) and 19 ± 4 mm. Mean voltage/mass ratio (VMR) was 4.8 ± 2.6 microVolts/g (Table 1). On bone scintigraphy, 3 patients were scored Perugini I (18%), 4 Perugini II (24%) and 10 Perugini III (58%). According to Pearson test, there was a signicative correlation between Perrugini score and LVM (r = +0.57, P = 0.03) (Fig 1A), and a strong negative correlation between Perrugini score and VMR (r = –0.70, P = 0.003) (Fig 1B). In TTR-CA patients, Perugini score appears to strongly correlates with left ventricle mass and voltage. Larger scale studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Introduction: Preclinical studies have demonstrated the possible role of beta-adrenergic receptors in pancreatic ductal adenocarcinoma (PDAC) tumor invasion and migration. The current study aimed to explore the possible association between survival outcomes and beta-blocker (BB) exposure in patients with advanced PDAC. Methods: This retrospective single-center study included 182 patients with advanced PDAC. Clinical [age, sex, BMI, cardiovascular condition, presence (SBB) or absence (NSBB) of beta-1 selectivity of BB, exposure duration, and multimorbidity], oncological (stage and anticancer treatment regimen), and biological (renal and liver function) data were collected. The endpoints were overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for survival outcomes associated with BB exposure were estimated using Cox regression model and propensity score (PS) methods. Results: Forty-one patients (22.5%) were exposed to BB. A total of 104 patients progressed (57.1%) to PDAC and 139 (76.4%) patients died at the end of follow-up (median, 320 days; IQR, 438.75 days). When compared to the non-exposed group, there was no increase in survival outcomes associated with BB use (OS: HR = 1.38, 95% CI = 0.80-2.39, p = 0.25; PFS: adjusted HR = 0.95, 95% CI = 0.48-1.88, p = 0.88). Similar results were obtained using the PS method. Compared to no BB usage, SBB use was associated with a significant decrease in OS (HR = 1.80, 95% CI = 1.16-2.80, p < 10 -2 ). Conclusion: BB exposure was not associated with improved PDAC survival outcomes. Beta-1-selectivity was not independently associated with any differences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Le Bozec, Brugel, Djerada, Ayad, Perrier, Carlier, Botsen, Nazeyrollas, Bouché and Slimano.)

(1) Background: Receiving the first internal electric shock is a turning point for patients with an implantable cardioverter defibrillator (ICD) for primary prevention. However, no study has investigated whether patients who receive a first device-delivered electric shock have a poor prognosis even at the time of ICD implantation. (2) Methods: We retrospectively identified 55 patients with ischemic (n = 31) or dilated (n = 24) cardiomyopathy who underwent ICD implantation for primary prevention with exercise test at the time of implantation. We recorded baseline characteristics, exercise test parameters, and clinical events. (3) Results: After a median follow-up of 5 years, we observed an association between an appropriate device-delivered electric shock, the occurrence of death or heart transplant, and the occurrence of the composite endpoint. There was also a significant relation between a VE/VCO 2 slope >35 and the occurrence of the composite endpoint. Conversely, there was no significant association between negative outcomes on the exercise test and the occurrence of a device-delivered electric shock. (4) Conclusions: The exercise test performed at the time of ICD implantation do not predict the occurrence of device-delivered electric shock. The exercise test and the first electric shock are two independent markers of poor prognosis.