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• We analysed data on illicit drug use in patients with acute myocardial infarction. • Over 12 years, 1,011,706 patients with acute myocardial infarction were identified. • In very young adults, acute myocardial infarction was rare. • However, in very young adults, there was a 161% increase in illicit drug use. • Studies on toxicology screening in acute myocardial infarction are warranted. [ABSTRACT FROM AUTHOR]

Left ventricular thrombus (LVT) is a serious post-myocardial infarction complication which increases length of hospital stay and cost of hospitalization but above all, leads to severe consequences when responsible for systemic embolization or cerebral stroke (up to 15% of patients with LVT). Evaluate the prevalence of LVT after ST-segment elevated myocardial Infarction (STEMI) by trans thoracic echocardiography (TTE) and cardiac magnetic resonance (CMR), identify risk factors and better screening strategy. In total, 330 patients were included in three prospective studies requiring TTE and CMR in the aftermath of a STEMI. In total, 136 patients finally underwent both of these exams. Twelve LVT were detected (8.8% of post-STEMI patients) including 5 only by CMR and one only by TTE. With an univariate analysis, we observed more LVT in patients with a left anterior descending (LAD) involved (100% vs. 46%; P < 0.001), EKG anterior STEMI (100% vs. 47%; P < 0.001), lower left ventricular ejection fraction (LVEF) at baseline (35% vs. 46%; P < 0.001) and after revascularization (45% vs. 52%; P < 0.001), LV aneurysm (42% vs. 2%; P < 0.001), anterior akinesia (75% vs. 20%; P < 0.001), apical akinesia (92% vs. 31%; P < 0.001), higher indexed LV end-diastolic and end-systolic volumes (65 vs. 55 mL/m2; P = 0.04, 38 vs. 27 mL/m2 P < 0.01), lower left ventricular outflow tract velocity time integral (LVOT VTI) (17 vs. 19 cm/s; P < 0.01) and global longitudinal strain (−10 vs. −14%; P = 0.02), fever (33% vs. 12% P = 0.04), lower creatinine level (65 vs. 76 μmol/L; P = 0.04), higher glomerular filtration rate (110 vs. 95 mL/min/m2; P = 0.01) and Creatin Kinase peak (5773 vs. 2776 UI/L; P < 0.001) (Fig. 1). LVT remains common after STEMI, even more in certain subgroups of patients like anteriors ones, those with altered LVEF and/or dilated LV. CMR allows better diagnosis than TTE, but, because of its availability, the nature of the examinations to carry out and their timing remains to be defined. [ABSTRACT FROM AUTHOR]

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Abstract Background Allograft shortage might be overcome by the use of hearts from expanded-criteria donors (ECD) but their estimated high-risk of coronary artery disease (CAD) results in a limited utilization of these hearts for transplantation. We aimed to determine if performing coronary angiography (CA) in ECD enhances cardiac procurement and to develop a predictive model estimating their probability of absence of CAD. Methods We retrospectively used the French National Transplant Registry CRISTAL and considered all donors aged 45 to 70 with ≥ 1 organ harvested between March 2012 and June 2014 to derive a high-risk donor population. Of 515 donors with ≥ 1 CAD risk factor and no obvious contraindication for cardiac procurement, 230 underwent CA. Coefficients estimated by multivariate logistic regression models were used to evaluate the impact of CA on procurement and build the predictive model. Results Among CA donors, 133 had CAD, 53 (23%) with at least one stenosis ≥ 50%. Predictors of cardiac graft offer were female gender, age below 60, no cardiac arrest, no intravenous adrenaline/dobutamine requirement and no treated hypercholesterolemia. CA increased the probability of procurement by 9% (p = 0.028). Female gender, non-vascular cause of death, absence of diabetes and BMI ≥ 25 kg/m2 (p < 0.05) were associated with a normal CA and used for the prediction model. The area under the ROC curve of the model was 0.70. Specificity for the highest quartile was 82%. Conclusion Performing CA in ECD enhances cardiac procurement. When CA is not feasible, we defined a clinical score allowing accurate estimation of normal CA probability. Highlights • Coronary angiography in high-risk donors increased cardiac graft acceptance by 9%. • We developed a normal coronary angiography prediction score with an 82% specificity. • Coronary angiography should be performed in every expanded-criteria donor. • If not, our normal coronary angiography prediction score is a valuable alternative. [ABSTRACT FROM AUTHOR]

This study evaluated the ability of T1 and T2 mapping cardiovascular magnetic resonance to assess myocardial involvement in Takotsubo syndrome (TTS). We hypothesized that non-contrast mapping techniques can be accurate and sufficient. We prospectively analysed 30 patients with TTS and 34 controls. CMR was performed a mean 5 days after the onset of symptoms and after a mean 3 month follow-up. On admission, compared to controls, TTS patients had significantly higher global T2 values (59 ± 8 ms vs 51 ± 4 ms, p < 0.001), native T1 (1053 ± 75 ms vs 960 ± 61 ms, p < 0.001) and extracellular volume (ECV) fraction (29% ± 5 vs 23% ±3, p < 0.001). The sensitivity and specificity for T2 (cut off: 56 ms) were 62% and 97% respectively; for native T1: (cut off 1011 ms) were 72% and 91% respectively; and for ECV (cut off: 27%) were 72% and 97% respectively. Combining T2 and native T1 provided the best sensitivity (91.7%) with a good specificity (88.2%). No patients had late gadolinium enhancement. Segmental analysis showed that T2, native T1 and ECV values were significantly higher in regions with wall motion abnormalities (WMA) compared to normokinetic segments (62 ± 9 ms vs 55 ± 5 ms, p < 0.001; 1060 ± 65 ms vs 1025 ± 56 ms, p = 0.02; and 34% ± 5 vs 29% ± 1, p = 0.02). At follow up, native T1 and ECV values did not normalized. In TTS patients, a non-contrast mapping technique provides a high diagnostic accuracy allowing identification of acute and persistent myocardial injury. Segmental analysis showed that myocardial injury is preferably detected in segments with WMA. • Non-contrast mapping technique allows non-invasive quantification of acute myocardial injury in Takotsubo cardiomyopathy. • Native T1 mapping could diagnose persistent inflammation in TC. • Segments with wall motion abnormalities are more involved by the acute process than normokinetic segments. [ABSTRACT FROM AUTHOR]

Purpose: Sinusoidal obstruction syndrome (SOS) is a likely side effect of colorectal liver metastases (CRLM) chemotherapy. This study aimed to assess computed tomography scan (CT-scan) performance for SOS diagnosis for patients receiving neoadjuvant chemotherapy (NC) prior to CRLM surgery, comparing obtained results with pathological gold standard.Methods: Preoperative CT-scans of 67 patients who had received a NC prior to liver resection for CRLM from 2011 to 2016 were retrospectively analysed. Positive diagnosis and severity of SOS were established after consensual review of the slides by three pathologists. Preoperative CT-scans were separately interpreted by two radiologists and evocative signs of SOS were sought, defined according to a literature review and operators experience. In order to identify SOS predictors, univariate analysis and multivariate logistic regression were used to study CT-scan signs and pathological results correlation.Results: Twenty-nine patient (43%) had an SOS, 22 (33%) were low-grade and 7 (10%) were high-grade. All patient had received a median of 6 cures (3-27) containing Oxaliplatin for 53 (79%) of them. In univariate analysis, hepatic heterogeneity (p<0.001), puddle-like or micronodular appearance (p<0.001), peripheral distribution of heterogeneity (p=0.085), clover-like sign (p=0.02), splenomegaly (p=0.0026), spleen volume increase ≥30% (p=0.04) or splenic length increase ≥15% (p=0.04), as well as the subjective impression of the observer (P<0.001) were significantly associated with SOS diagnosis. In multivariate analysis, clover-like sign (OR 1.87, 95% CI 1.18-2.95, p=0.0081), increase in spleen volume ≥30% (OR 1.29, 95% CI 1.01-1.64, p=0.04), and the peripheral distribution of heterogeneity (OR 1.53, 95% CI 1.21-1.94, p<0.001) were independent SOS predictors. The area under the ROC curve was 0.804. The inter-observer agreement for SOS diagnosis was moderate (Kappa=0.546).Conclusion: CT-scan can detect suggestive signs of SOS in patients receiving chemotherapy for CRLM. By integrating clinical and biological information into CT-scan data, it may be fruitful to create a positive diagnostic and severity score for chemotherapy-induced SOS. [ABSTRACT FROM AUTHOR]