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Acute myocarditis (AM) is a rare but severe disease affecting patients of all age. Large multicentric data comparing children and adults are lacking. We aimed to elucidate differences in presentation, management, and outcomes of AM across age groups. A comprehensive French national cohort study, encompassing 53 pediatric and adult units from March 2020 to November 2021, was analysed. Baseline characteristics and evolution, management and in-hospital complications were collected. Major cardiovascular events (MACE) within 30 days included all-cause death, cardiogenic shock, cardiac arrest, ventricular arrhythmias, or complete AV block. We included 745 AM patients (328 children and 417 adults), mainly male (73.4%) with a median age of 19.8 years [IQR: 12.5–30.9]. Multisystem inflammatory syndrome (MIS) was more prevalent among pediatric cases (69.8%), whereas infectious aetiology dominated in adults (13.4 vs. 52.4%). Children exhibited a more severe clinical presentation, with increased risk of heart failure (15.9 vs. 7.2%) and cardiogenic shock (14.4 vs. 6.9%), requiring higher use of inotropes (25.0 vs. 9.4%), vasopressors (12.0 vs. 6.2%), and ventilatory support (12.5 vs. 7.7%). Cardiac treatments such as beta-blockers (33.4 vs. 84.4%) or ACE/ARB (37.3 vs. 63.1%) were less often used in children whereas corticosteroids (68.3 vs. 14.3%) and immunomodulators (65.1 vs. 4.5%) were more often used. MACE occurrence was substantial but not significantly different between children and adults (18.1 vs. 13.4%). Extra-cardiac manifestations at admission were significant predictors of MACE (aOR: 2.40 [1.43–4.38]), regardless of multisystem inflammatory syndrome (MIS) status. AM exhibits variations in presentation, aetiologies, and management, but shares a comparable 30-day prognosis in children and adults. [ABSTRACT FROM AUTHOR]

Acute myocarditis (AM) is a rare but severe disease affecting patients of all age. Large multicentric data in children and comparison with adult are lacking. We aim to compare AM presentation, management, and outcomes according to age of the patients at admission and to identify factors associated with 30-day prognosis. All cases of AM were included between March 2020 and November 2021 in 64 adults and children centres in France. We collected baseline data, AM presentation and evolution, in-hospital management and in-hospital complications. All-cause death and major cardiovascular events (MACE) (acute pulmonary oedema, cardiogenic shock, or cardiac arrest) were investigated with a 30-day systematic follow-up. NCT04375748 In total, 745 AM patients (417 adults and 328 children) were included, mainly men (73.4%) with a median age of 19.8 [12.5–30.9] years old. Children had more extra-cardiac manifestations (78.3% vs. 24.0%, P < 0.01), more clinical signs of heart failure (14.9% vs. 7.0%, P < 0.01) and shock (47.9% vs. 12.7%, P < 0.01). They also had lower left and right ventricular function on TTE. The main aetiology of AM was viral myocarditis (32.6% of the overall population) with a predominance in adults (50 vs. 20% in children). Children had less toxic myocarditis (0 vs. 2.6%, P < 0.01), immunologic myocarditis (1.0 vs. 7.0%, P < 0.01), vaccine-related myocarditis (5.0 vs. 9.0%, P < 0.01) and idiopathic AM (9.0 vs. 28.0%, P < 0.01). Multisystem inflammatory syndrome was predominant in children (66.0 vs. 1.0%, P < 0.01). Cardiac treatments as beta blockers (84.4 vs. 33.4%, P < 0.01) or ACE/ARB2 (63.1 vs. 37.3%, P < 0.01) were significantly more often used in adults. On the contrary, corticosteroids (68.3 vs. 14.3%, P < 0.01) and immunomodulators including antiviral and/or IGIV were significantly more used in children (65.1 vs. 4.5%, P < 0.01). In-hospital complications occurred more in children (23.8 vs. 14.3, P < 0.01) especially acute kidney injury (11.0 vs. 5.3%, P < 0.01) and cardiogenic shock (15.2 vs. 8.1%, P < 0.01). At 30-day, adults presented more composite endpoint including death, cardiac arrest, cardiogenic shock, and acute pulmonary oedema (3.4 vs. 0.9% respectively in adults and children, P < 0.03) AM presentation, aetiologies and management differs according to age. Despite higher rate of in-hospital complications in children, the 30-day prognosis is worse in adult. [ABSTRACT FROM AUTHOR]

Background: Electrical cardioversion is the first-line rhythm control therapy for symptomatic persistent atrial fibrillation (AF). Contemporary use of biphasic shock waveforms and anterior-posterior positioning of defibrillation electrodes have improved cardioversion efficacy; however, it remains unsuccessful in >10% of patients.Objective: The purpose of this study was to assess the efficacy of applying active compression on defibrillation electrodes during AF cardioversion.Methods: We performed a bicenter randomized study including patients referred for persistent AF cardioversion. Elective external cardioversion was performed by a standardized step-up protocol with increasing biphasic shock energy (50-100-150-200 J). Patients were randomly assigned to standard anterior-posterior defibrillation or to defibrillation with active compression applied over the anterior electrode. If sinus rhythm was not achieved at 200 J, a single crossover shock (200 J) was applied. Defibrillation threshold, total delivered energy, number of shocks, and success rate were compared between groups.Results: We included 100 patients, 50 in each group. In the active compression group, defibrillation threshold was lower (103.1 ± 49.9 J vs 130.4 ± 47.7 J; P = .008), as well as total delivered energy (203 ± 173.3 J vs 309 ± 213.5 J; P = .0076) and number of shocks (2.2 ± 1.1 vs 2.9 ± 1.2; P = .0033), and cardioversion was more often successful (48 of 50 patients [96%] vs 42 of 50 patients [84%]; P = .0455) than that in the standard anterior-posterior group. Crossover from the compression group to the standard group was not successful (0 of 2 patients), whereas crossover from the standard group to the compression group was successful in 50% of patients (4 of 8).Conclusion: Active compression applied to the anterior defibrillation electrode is more effective for persistent AF cardioversion than standard anterior-posterior cardioversion, with lower defibrillation threshold and higher success rate. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In September 2018, 22% of Thomas Jefferson University Hospital surgical patient's experienced PACU delay, which decreased to 7% in September 2019. Due to a number of barriers, patients often begin their recovery in the Operating Room under the care of an Anesthesia Provider, as well as board in PACU once their recovery is complete. This negatively affects patient safety, patient experience, and staff satisfaction. The purpose of this project was to reduce the time of patient movement through the perioperative department, while maintaining optimal care in the appropriate location. A Value Stream Mapping was held in March of 2019, which included individuals from multiple disciplines. Participants were broken into groups to identify barriers (by phases of care) that contribute to decreased throughput in the perioperative department. Once barriers were identified, a core group consisting of Champions from Anesthesia, Nursing, and Surgery, as well as support staff from the different perioperative areas, met weekly to develop and implement process changes to optimize patient care. Approximately 30 process improvement plans were developed and executed to decrease length of stay in the perioperative department. Examples of process improvements within the PACU included charge nurse rounding at 61 minutes (based on the national benchmark of wheels in to wheels out of PACU within 77 minutes), PACU discharge criteria education, designated anesthesia attending rounds, staffing pattern changes, surgical charge nurse huddle, and a perioperative hold huddle for increased communication. PACU length of stay (LOS) decreased from 220 minutes in September 2018 to 182 minutes in September of 2019, an 18% reduction. Phase 1 recovery time decreased from 131 minutes in September 2018 to 69 minutes in September 2019, a 48% reduction. A goal of 15% reduction for PACU LOS and Phase 1 recovery was set, which was surpassed. We are able to get our patients to their final destination more efficiently. While maintaining our current results, further projects include inpatient flow throughout the hospital, redesign of hospital transportation, and discharge procedures to decrease PACU LOS even further. [ABSTRACT FROM AUTHOR]

Atrial septal defect (ASD) is the most common adult congenital heart disease. The left-to-right shunt causes a right ventricular (RV) volume overload. Only little is known about RV remodeling after ASD closure. We aimed to assess RV function using 2D, 3D echocardiography and 3D RV strain before and 1 month after ASD closure. We prospectively included in this monocentric study 9 patients with secundum ASD who underwent percutaneous closure between September 2019 and January 2020. 2D and 3D Echocardiography were performed in all patients before and 1-month after closure. While we initially planned to collect echocardiographic data 3- and 6-months after ASD closure, the COVID-19 pandemic made this impossible. All patients gave their informed consent to the study. Clinical and ultrasound data were collected and anonymized. 3D RV echocardiographic sequences were analyzed by semi-automatic software (Tomtec 4D RV Function, Unterschleissheim, Germany) and output meshes were post-processed to extract regional deformation. Patients' mean age was 31.0 ± 12.3 years, 44.4% were female. Mean ASD diameter was 16.6 ± 7.4 mm. RV end diastolic diameter and right atrial (RA) area were significantly larger than normal values and decreased significantly after ASD closure (45.8 ± 4.9 vs. 37.8 ± 5.7 mm; P = 0.0009 and 21.4 ± 4.2 vs. 16.3 ± 2.7 cm2; P = 0.01, respectively). 3D RV volumes were significantly lower after ASD closure; respectively 156.3 ± 61.7 vs. 82.9 ± 17.40 mL, P = 0.02 for end diastolic volume and 59.4 ± 19.3 vs. 32.6 ± 9.2 mL, P = 0.01 for end systolic volume. RV function decreases after ASD closure as illustrated by TAPSE (23.3 ± 6.0 vs. 29.1 ± 4.2 mm, P = 0.03) as well as 3D RV strain with a significantly decreased in area strain, longitudinal strain as well as circumferential strain (respectively P = 0.006, P = 0.009 and P = 0.02) (Fig. 1). After percutaneous ASD closure, we demonstrate a decrease in RV function in all strain components using 3D strain. This decrease in RV strain probably illustrates the decrease in RV parietal stretch related to the normalization of RV loading conditions. 3D strain can be useful to assess the RV function evolution in response to different loading conditions. [ABSTRACT FROM AUTHOR]

Acute heart failure is the most frequent reason for hospitalization in people over 65-years-old. The burden on public health justifies the development of tools relevant to diagnose and optimize its treatment. Left atrial reservoir peak strain (PALS) has shown an excellent correlation with left ventricular filling pressures (LVFP) measured invasively but its evolution during hospitalization for heart failure has never been studied. The aim of our study is to investigate the evolution of PALS in patients hospitalized for acute heart failure and its correlation with the usual clinical and biological ultrasound parameters. We included in this study 19 patients hospitalized for acute heart failure in the cardiology department of the Nice University Hospital. Clinical, biological and echocardiographic data were collected daily during the hospitalization. PALS was measured using the 4 chambers view (Tomtec 2D STRAIN, Unterschleissheim, Germany). Our results show that PALS is feasible and reproducible. The average PALS over the first two days was low, below 15% (threshold previously established as best correlated with increased LVFP) and exceeded this threshold by the third day of treatment. No correlation was found between PALS and other ultrasound parameters on admission or during the hospital course. PALS is the only ultrasound marker whose evolution is correlated to the evolution of BNP. The threshold of 12.5%, determined by a ROC curve, was the most discriminating for the prediction of clinically increased LVFP (AUC: 0.680). Using this threshold in the 68% of patients in the grey area of the E/E' ratio and the 41% of patients with low or indeterminate LVFP according to the current algorithm, we reduce the inaccuracy rate by respectively 5 and 20%. The results obtained in the determination of PALS on admission and during hospitalization are consistent with previous studies. In our study, PALS is an independent marker of clinically increased LVFP. PALS allowed to increase the sensitivity of echo to detect increased LVFP and remain useful throughout the acute heart failure hospitalization as it is correlated with BNP and could help monitoring the therapy efficacy. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pulmonary arterial hypertension (PAH) has a major impact on mortality and morbidity on congenital heart disease (CHD) patients. Atrial strain in PAH patients has been related to clinical severity and adverse outcomes. The aim of this study was therefore to assess the prognostic role and compare bi-atrial function in patients with CHD-PAH, PAH from other causes (nPAH) and healthy controls. We included in this prospective cohort study 65 patients with CHD-PAH, 67 patients with nPAH and 65 healthy volunteers. Transthoracic echocardiography, clinical assessment, BNP measurement and 6MWT were performed at baseline. Classic echocardiographic measurements and atrial function studying the 3 different phases strain were measured in both. Atrial strain parameters are decreased in patients with CHD-PAH as compared to healthy volunteers, especially the right atrial (RA) reservoir (RASR 29,67% vs. 44,15%, P < 0,0001) and conduit phase (RASCD −15,85 vs. −28,52, P < 0,0001), but also left atrial (LA) reservoir and conduit phases. Active contractile phase seems preserved in both PAH group. Atrial function was comparable between CHD-PAH and nPAH patients. On multivariate analysis, BNP, pericardial effusion, RA ejection fraction, RASR and RASCD were independently associated with death or transplantation. RASR ≤ 30% or RASCD > −8% strain identified patients with a more than 3-fold-increased risk of death or transplant. Patients with CHD-PAH do not differ in atrial adaptation in comparison with npah. Impaired RASR and RASCD identify high risk PAH patients. RA conduit or reservoir function impairment represents a severity marker of PAH, including in patients with CHD-PAH suggesting the importance of RV diastolic dysfunction. This might be an early marker of poor prognosis (Fig. 1). [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The purpose of this study was to investigate emergency nurses’ knowledge and attitudes about pain. Methods: A descriptive design was used for this study. A validated tool, the Knowledge and Attitudes Survey Regarding Pain (KASRP), was administered to nurses working in 5 U.S. emergency departments. Demographic data also were collected from each participant. Results: Ninety-one emergency nurses completed the survey. The mean total KASRP score was 76%. No significant differences were found in mean total scores by age, education level, years of nursing experience, or years of ED experience. Eight questions were answered incorrectly by more than 50% of participants. Five of these questions were related to opioid pharmacology and dosage, 2 concerned understanding of addiction and dependence, and one was linked to nurse assessment and patient report of pain level. Analysis of these 8 questions revealed that higher education levels had a weak positive association with correct answers. Discussion: Participants taking the survey scored comparably or better than participants in other reported studies using the KASRP. Years of nursing experience was not correlated with correct responses. Findings from this study underscore the Institute of Medicine's Pain in America recommendation to increase pain management education for all providers. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to investigate emergency nurses’ knowledge and attitudes about pain. Methods: A descriptive design was used for this study. A validated tool, the Knowledge and Attitudes Survey Regarding Pain (KASRP), was administered to nurses working in 5 U.S. emergency departments. Demographic data also were collected from each participant. Results: Ninety-one emergency nurses completed the survey. The mean total KASRP score was 76%. No significant differences were found in mean total scores by age, education level, years of nursing experience, or years of ED experience. Eight questions were answered incorrectly by more than 50% of participants. Five of these questions were related to opioid pharmacology and dosage, 2 concerned understanding of addiction and dependence, and one was linked to nurse assessment and patient report of pain level. Analysis of these 8 questions revealed that higher education levels had a weak positive association with correct answers. Discussion: Participants taking the survey scored comparably or better than participants in other reported studies using the KASRP. Years of nursing experience was not correlated with correct responses. Findings from this study underscore the Institute of Medicine's Pain in America recommendation to increase pain management education for all providers. [Copyright &y& Elsevier]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Survival in pulmonary arterial hypertension (PAH) relates to right ventricular (RV) function. Whereas prognosis differs widely between PAH associated with congenital heart disease (CHD) and other causes of PAH, only little is known about differences in RV function. We aimed at comparing RV function assessed by 3D-speckle-tracking in patients with CHD-PAH, other PAH aetiologies and healthy controls; and assess the relationship between ventricular function and prognostic parameters. We performed a prospective multi-centric study between June 2015 and June 2017 recruiting 27 patients with CHD-PAH (3 had closed shunts, 24 had Eisenmenger syndrome; among these, 11 had a pre-tricuspid shunt, 13 had a post-tricuspid shunt), to compare with 27 group 1 non-CHD related-PAH patients (nPAH) and 27 controls matched on age and sex with the CHD-PAH group. Patients with complex CHD were excluded. All patients underwent 2D and 3D transthoracic echocardiography at baseline. 3D RV echocardiographic sequences were analysed by a commercial RV-specific software and output meshes were post-processed to extract deformation data. There was no significant age difference between the subgroups. In CHD-PAH patients, RV global area and longitudinal strain did not significantly differ as compared to nPAH but RV global circumferential strain was significantly better (P = 0.006). All strain components were impaired as compared to controls (P < 0.0001). In the whole patient population, over a mean follow-up of 27.6 ± 13.3 months, 10 patients (17.5%) died from PAH or were transplanted (including 2 patients with CHD-PAH). Global RV circumferential strain was significantly associated to death or transplant (P = 0.004, AUC 0.823; HR 1.41[1.09–1.81]) (Fig. 1). RV remodelling differs between adults with CHD-PAH and PAH from other aetiologies: 3D RV global circumferential strain is better in CHD-PAH patients and associated with survival free from transplant. [ABSTRACT FROM AUTHOR]

Right ventricular (RV) contractile reserve reflects the ability of RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls. We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary VTI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients. Our patient group was composed by PAH patients, 52 ± 11 years; mean age of our control group was 31 ± 6 years. PAH patients achieved an exercise with a mean workload of 70 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (P = 0.17), whereas change in pulmonary VTI, pulmonary output and RV peak systolic strain was highly discriminant (respectively P = 0.03, P = 0.009 and P = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (P = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (P = 0.005, P = 0.0008, P = 0004). Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is a common life-threatening disease, with mortality related to right ventricular (RV) dysfunction. Right atrial (RA) dysfunction may be a new marker of PE severity. In this study, we aimed to assess RA function in patients with acute PE, as compared to a control population and to correlate RA function parameters to classic PE severity parameters. We conducted a case-control study, including 27 consecutive PE patients, excluding high-risk PE patients. All patients underwent 2D transthoracic echocardiography with atrial function study within 6 hours of PE diagnosis including RA longitudinal strain (LS) with reservoir (RArLS), conduit (RAcLS) and contractile (RActLS) phases. RA function was assessed using Autostrain LA (TomTec-Philips Medical System). A control group of 18 patients with no structural heart disease in sinus rhythm was recruited in the outpatient clinic. During acute PE, RA strain was impaired in PE patients as compared to controls: P < 0.001 for RAcLS and P = 0.01 for RArLS while no difference in RActLS was observed. When PE severity was graded from 1 to 3 (from intermediate-high to low risk), RAcLS and RArLS were significantly correlated to age and PE severity (Fig. 1). Our RA strain study demonstrates an impaired RA reservoir and conduit function in PE patients, which seems to be related to PE severity. Further studies should help improve our understanding of RA dysfunction in PE. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is a life-threatening condition. Right atrial (RA) dilatation is a prognostic parameter, however, the role of RA and LA function as assessed by speckle-tracking imaging remains unclear. The aim of our study was to assess in PH patients RA and LA function and its relationship with outcomes. Sixty consecutive PH patients [group 1 (72%) and group 4] not eligible to either pulmonary endarterectomy or angioplasty were prospectively enrolled into this echocardiographic cohort study. In addition to clinical assessment, BNP and 6-minute walk test (6MWT), all patients underwent transthoracic echocardiography (TTE) for PH/RV and RA function assessment with 2D speckle-tracking RA longitudinal strain (LS) including reservoir (RArLS), contractile (RActLS) and conduit (RAcLS) phases analysis, LA LS as well as RA and LA volumes and areas. Patients' mean age was 62.8 ± 17.3 years and 57% were female. After a median follow-up of 16 months, 8 patients (13.3%) died. RArLS, RAcLS and RActLS were impaired in patients who died as compared to those who survived (respectively P = 0.003, 0.06 and 0.02). On univariate analysis, BNP, RV end-diastolic diameter, pericardial effusion, mitral lateral E/e', LVEF, TAPSE, LA volume, RA ejection fraction, RActLS, RArLS, RA volume and area were univariate predictors of death or transplant. After multivariable adjustment for age, NYHA class and univariate predictors of death, RA volume (HR = 0.87; 95% CI: 0.78–0.96) and RArLS (HR = 0.007; 95% CI: 0.78–0.96) were independent predictors of outcomes. RA function is an important predictor of outcomes. RA volume and reservoir function appear as independent predictors of death in our cohort. The impairment of RA reservoir function likely represents an early indicator of RV failure, independent of RA dilatation. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients. To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio-pulmonary exercise test. We prospectively included 11 clinically stable PAH patients over a 6-months period. Exercise echocardiography (EE), cardio-pulmonary exercise test (CPET), SF-12quality of life questionnaire, 6-minute walking test (6MWT), BNP and clinical assessment were performed before and after cardio-pulmonary rehabilitation. Patients underwent 8-weeks of exercise training (3 times a week of aerobic training and at home daily prescribed exercises). All patients underwent EE and CPET without any complication. Five patients experienced a reduction in WHO functional class whereas 5 remained stable. Patients significantly improved their physical quality of life (P = 0.006). They also improved their exercise capacity according to the maximum workload during CPET (P = 0.008) and CPET duration (P = 0.001) whereas a trend toward an improved 6MWT was observed (+58 m, P = 0.10). Anaerobic threshold and peak VO2 (+1.7 ± 2.7 mL/kg/min) improved significantly (P = 0.01 and 0.03). Regarding imaging data, at rest, peak strain improved after rehabilitation (P = 0.05) whereas the RV became more dilated. RV contractile reserve, defined by the change in peak systolic longitudinal RV strain between rest and maximum exercise, significantly improved (−3.9 ± 4.7%, P = 0.03). In this preliminary study, cardio-pulmonary rehabilitation led to improved quality of life and exercise capacity in PAH. The increased RV contractile reserve post-rehabilitation might explain, in association with the peripheral muscular effects of exercise training, the clinical benefits of rehabilitation in PAH. [ABSTRACT FROM AUTHOR]

Right ventricular (RV) contractile reserve reflects the ability of RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. To assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls, using exercise stress echocardiography (ESE). We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary VTI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients. Our patient group was composed by PAH patients, 52 ± 11 years; mean age of our control group was 31 ± 6 years. PAH patients achieved an exercise with a mean workload of 70 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (P = 0.17), whereas change in pulmonary VTI, pulmonary output and RV peak systolic strain was highly discriminant (respectively P = 0.03, P = 0.009 and P = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (P = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (P = 0.005, P = 0.0008, P = 0004). Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve. [ABSTRACT FROM AUTHOR]

Outcomes in pulmonary hypertension (PH) are related to right ventricular (RV) function and remodeling. We hypothesized that changes in RV function, especially area strain (AS), could provide incremental prognostic data as compared to baseline data. We aimed to assess RV function changes between baseline and 6-months visit and evaluate their prognostic value in PH using 3D echocardiography. 95 PH patients were prospectively included in this longitudinal study. All patients underwent 2D and 3D transthoracic echocardiography at baseline and 6-month follow-up. 3D RV echocardiographic sequences were analyzed by semi-automatic software and output meshes were post-processed to extract regional deformation. Improvements in the global area strain (lower 2nd measure of area strain) were associated with stable or improving clinical condition as well as survival free from transplant (P < 0.001). The most significant regional changes occurred within the septum. Over a median follow-up of 24.8 months [22.1–25.7], 21 patients died from PH or were transplanted. On multivariate COX analysis, changes in WHO class, BNP and RV global AS were independent predictors of outcomes. Using follow-up data, RV area strain significantly improves the current risk stratification. Changes in RV function and especially follow-up 3D RV AS and RV end-diastolic volume are of prognostic importance. Our study underlines the importance of follow-up data in comparison with baseline data only and demonstrates the additional prognostic value of following changes in RV deformation using 3D echocardiography (Figure 1 , Death or transplant). [ABSTRACT FROM AUTHOR]

Background Maternal cyanotic congenital heart disease (CHD) is considered a great maternal and fetal risks during pregnancy, but information on management of these pregnancies are lacking. The purpose of this study was to assess maternal and fetal outcome in patients with cyanotic CHD in a large cohort of patients. Methods This multicenter retrospective study included pregnant women with cyanotic CHD followed in 11 French specialized centers from 1997 to 2015. Patients with pulmonary hypertension were excluded. We recorded maternal, obstetrical and neonatal outcome. Results Thirty-one patients (mean age 27 ± 6 years) had 71 pregnancies. There were 17 (26%) miscarriages and 48 (73%) complete pregnancies (≥ 20 week gestation (WG)). All pregnancies were singleton. Severe cardiac events occurred in 7 patients (23%, 95% CI [10–41]) and 6 complete pregnancies (8%, 95% CI [3–17]). Heart failure ( n = 3) and arrhythmia ( n = 2) were the main cardiovascular complications. There was no maternal death. No thromboembolism event occurred, and one patient experienced an infective endocarditis during postpartum. Obstetrical complications included mainly hemorrhages ( n = 9, 13% of pregnancies). Small for gestational age (SGA) was diagnosed in 28%. The mean birth weight was 1897 ± 607 g at a mean gestational age of 33 ± 3WG, and 85% of newborns were premature. These two comorbidities were associated with an 11% neonatal mortality. Pre-pregnancy maternal oxygen saturation ≤ 85% was related to miscarriages and SGA ( P ≤ 0.04). Conclusion Women with cyanotic CHD can go through pregnancy with a low risk for themselves. However, cyanotic CHD is associated with a high incidence of fetal and neonatal complications. [ABSTRACT FROM AUTHOR]

Purpose The relationship between pulmonary arterial hypertension-specific drug therapy (PAH-SDT) and mortality in Eisenmenger syndrome (ES) is controversial. We aimed to investigate outcomes of patients with ES and their relationship with PAH-SDT. Methods Retrospective, observational, nationwide, multicenter, cohort study. Results We included 340 patients with ES (genetic syndrome, n = 119, 35.3%; pre-tricuspid defect, n = 75, 22.1%). Overall, 276 patients (81.2%) received PAH-SDT (monotherapy: endothelin receptor antagonist (ERA) or phosphodiesterase 5 inhibitor (PDE5i), 46.7%; dual therapy: ERA + PDE5i, 40.9%; triple therapy: ERA + PDE5i + prostanoid, 9.1%). Median PAH-SDT duration was 5.5 years [3.0–9.1]. Events (death, lung or heart-lung transplantation) occurred in 95 (27.9%) patients at a median age of 40.5 years [29.4–47.6]. Cumulative occurrence of events was 16.7% [95% CI 12.8–21.6%] and 46.4% [95% CI 38.2–55.4%] at 40 and 60 years of age, respectively. With age at evaluation or time since PAH diagnosis as time scales, cumulative occurrence of events was lower in patients taking one or two PAH-SDTs ( P = 0.0001 and P = 0.004, respectively), with the largest differences in the post-tricuspid defect subgroup ( P < 0.001 and P < 0.02, respectively) versus patients without PAH-SDT. By multivariate Cox analysis with time since PAH diagnosis as the time scale, NYHA/WHO functional class III/IV, lower SaO 2 , and pre-tricuspid defect were associated with a higher risk of events ( P = 0.002, P = 0.01, and P = 0.04, respectively) and one or two PAH-SDTs with a lower risk of events ( P = 0.009). Conclusion In ES, outcomes are poor but seem better with PAH-SDT. ES with pre-tricuspid defects has worse outcomes despite the delayed onset of the disease. [ABSTRACT FROM AUTHOR]

Introduction Speckle tracking imaging is a recent technique that can be achieved using either vendor dependent or vendor-independent software. Right ventricular (RV) strain is increasingly used as a prognostic tool in both left and right ventricular diseases. Only little is known regarding the variability of vendor-dependent and - independent speckle-tracking imaging software in the assessment of RV free wall longitudinal strain (RLS). The aim of our study was to compare a vendor-dependent (Qlab 9.0, Philips Medical System, Andover, MA, USA) and - independent (Cardiac Performance Analysis, Tomtec Imaging Systems, Germany) software for RLS analysis. Methods and results We prospectively enrolled 90 consecutive patients with pulmonary hypertension (mean age 55,8±19years) and 26 control patients (mean age 33,9±13years) who underwent a comprehensive echocardiogram including a RV focused 4-chamber view optimised for speckle-tracking analysis. DICOM data sets were stored and analysed by 2 different cardiologists using Qlab and TomTec, blindly to the context and each other. In the whole population, mean RLS was -17,3%±9 and -8,6% ±7,2 respectively using Qlab and Tomtec. Qlab and Tomtec intra-observer coefficients of variation (CV) were -13,19% and -9,56% and interobserver CVs were -22% and -15% respectively. The concordance correlation coefficient was 0,55, indicating poor agreement between the two methods. In the control population, Qlab CV was - 3,63%, whereas CV was -17,8% in RV disease patients. Conclusion Despite an acceptable level of variability for both techniques, Tomtec appears less variable. Variability of Qlab is excellent in control patients but is highly influenced by RV morphology. The agreement between the two software products is low and should lead in clinical practice to the follow-up of patients with the same software and advocates for the development of dedicated RV speckle-tracking software products. [ABSTRACT FROM AUTHOR]

Background Cardiac sarcoidosis (CS) is associated with high morbidity and sudden death. Currently, cardiac magnetic resonance (CMR) is the most sensitive method for the diagnosis of CS, however as CMR is being positive relatively late, new imaging methods to improve the early diagnosis of CS are lacking. The aim of this study was to assess the role of left ventricular (LV) strain estimated by 2D speckle tracking imaging in patients with newly diagnosed sarcoidosis without cardiac involvement according to the current guidelines. Methods and results We performed a prospective cohort study including 10 patients with newly diagnosed sarcoidosis and normal cardiac function as assessed by classic echocardiography and CMR and 10 healthy age- and gender- matched controls. All patients underwent a comprehensive LV strain echocardiographic study. Speckle tracking analysis was performed by 2 experienced cardiologists blinded to each other and to clinical data. Mean age of patients was 53±14 years old (5 women). All patients presented mediastinal lymphadenopathy, 1 had renal involvement and 4 had pulmonary manifestations. Compared with controls, LV longitudinal strain was reduced: long axis longitudinal (-16.1±2.8% vs -21.7±2.2%, p<0.001), 4-chamber LV longitudinal strain (-15±2.8% vs -22.3±1.6%, p<0.001), 2-chamber LV longitudinal strain (-15.8±3.2% vs -20±1.4%, p<0.001) and overall global LV longitudinal strain (-14.4±2.5% vs -21.7±1.4%, p<0.0001). Circumferential LV strain was preserved in patients compared to controls (-21.7±5.4% vs -23.3±2.7%, p=0.5). Conclusion In this pilot study, Speckle-tracking echocardiography revealed impaired LV longitudinal strain in 100% of patients with normal CMR. Decreased longitudinal LV strain could represent an early sign of myocardial involvement in sarcoidosis patients. Therefore further assessment of cardiac deformation imaging in the setting of sarcoidosis is needed to improve the diagnosis of CS (figure above). Abstract 0325 - Figure: Means values of 4 chamber longitudinal strain (LS-4c) and global longitudinal strain (GLS) [ABSTRACT FROM AUTHOR]

Background Computed tomography pulmonary angiography (CTPA) is routinely used to diagnose pulmonary embolism (PE). Reflux of contrast medium into the inferior vena cava or hepatic veins (IVC) on CTPA is a simple sign that could help for PE risk stratification. The purpose of this study was therefore to investigate prognosis significance of contrast reflux into IVC in acute PE. Methods and results 141 consecutive patients with acute PE confirmed by CTPA were prospectively included between March 2010 and February 2013. Degree of reflux into the IVC and the hepatic veins was graded from 1 (none) to 6 (severe) by 2 independent observers, blinded to each other. The presence of reflux in IVC was compared with clinical parameters used in the ESC guidelines for PE risk stratification: electrocardiographic signs, Troponine I, BNP and right ventricular dilatation (RV/ LV>0,9) or dysfunction (TAPSE < 17 mm, S’<10 cm/s) by echocardiography. Composite endpoint was 30-days mortality or clinical deterioration requiring treatment escalation (catecholamine infusion, thrombolytic treatment or cardiopulmonary resuscitation). The composite end-point was observed in 5% of patients with a 30-day mortality rate of 2.1%. Heart rate >110 bpm (OR 5.6, 1.03-30), atrial fibrillation (OR 6.3, 1.05-37.7), negative anterior T waves (OR 6.1, 1.3-29.1), elevated Troponin Ic (OR 5.4, 1.1-25.8), elevated BNP (OR 11.5, 1.3-98.2), right ventricular dysfunction (OR 5.3, 1.1-25.1) were predictors of death or clinical deterioration. Contrast reflux into IVC from grade 4 to 6 was observed in 17% of patients. Interobserver agreement was excellent (Concordance correlation coefficient 0.91). Grade 4 reflux or greater was a strong predictor of events (OR 15.1, 2.8-83.7) and had a 86% specificity and 71% sensitivity to predict adverse outcomes (AUC 0.88). Conclusion A grade 4 or higher contrast reflux into the IVC is a simple and frequent CTPA sign, highly predictive of adverse outcomes in PE patients. [ABSTRACT FROM AUTHOR]

The specific kinetic of copeptin secretion during the course of an acute coronary syndrome (ACS) had poorly been studied, with most studies assessing copeptin levels in the very first hours of chest pain onset and not ACS itself. To overcome this issue, we took advantage of septal embolization technique for hypertrophic obstructive cardiomyopathy (HOCM) treatment, a unique situation during which myocardial infarction (MI) is provoked, to measure plasmatic copeptin levels variation. [ABSTRACT FROM AUTHOR]

Left ventricular filling pressures’ evaluation is still challenging. The ratio of the transmitral and myocardial early diastolic velocities (E/E’) can be used to estimate LV filling pressures (LVFP), but between 8 and 15 it remains unclear. Additionally, the time difference between the onset of E and E’ (Δ (RE-E’)), the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity (Δ (IVRT-IVRT’)) and the mitral early diastolic velocity (E)/Strain rate ratio during the isovolumetric relaxation period also correlate to LVFP. The aim of this study was to evaluate the incremental value of those indices to evaluate LVFP (as measured by left ventricular end diastolic pressure (LVEDP)) in a heterogeneous group of patients during a simultaneous invasive procedure. Simultaneous cardiac catheterization, BNP dosage and doppler echocardiography were performed in 30 patients. LVEDP was elevated (>16mm Hg) in 14 patients (46,7%). The 3 previously described “new” parameters are significantly correlated to LVEDP, but particularly highly significant correlation was found between Δ (IVRT-IVRT’) and LVEDP (r=−0,74, p<0,005). ROC curves predict a 80% sensibility and specificity of Δ (IVRT-IVRT’). Δ (RE-E’) sensibility and specificity at lateral site are 87% and 93% respectively. E/SRivr has a 71% sensibility and a specificity. The incremental diagnostic value of each parameter and BNP in combination with “classic” parameters (E/A, E/E’) was evaluated by kappa coefficient. Δ (IVRT-IVRT’) at septal site (k=0,777) and Δ (RE-E’) (k=0,73) are the most accurate parameters, whereas additional use of E/SRivr (k=0,41) isn’t more useful than “classic” echocardiographic strategy (k=0,478) such as BNP (k=0,533). Δ (IVRT-IVRT’) and Δ (RE-E’) can predict LV filling pressures with reasonable accuracy. [Copyright &y& Elsevier]

Background In submassive pulmonary embolism (PE), when a right ventricular (RV) dysfunction (RVD) is present, the benefit of fluid expansion (FE) is questionable. The Franck-Starling law suggests that the reduction of the RV overload may enhances the RV systolic function. Purpose The aim of our study was to compare the effects of a diuretic treatment (DT) versus FE in patients hospitalized for normotensive PE with RVD. Methods We performed a prospective study. Consecutive patients hospitalized for normotensive PE were treated with diuretic (40mg IV furosemide at admission) or FE (500cc of sodium chloride infusion during four hours at admission). The primary endpoint was the timing for normalization of BNP and troponin Ic values. The secondary endpoints were variations of clinical and RV echographic parameters. Results Forty five patients were included. Timing for Troponin and BNP normalization was 60,7±28 hours in the DT versus 93,2±42 hours in the FE group (figure 1, p=0.02). Normalization of RV dilatation took 91,7±14,2 hours in the DT group versus 108,4±17,5 hours in the FE group (p=0.01). Normalization of the RVD took 81,2±18 hours in the DT group versus 94,9±13,1 hours in the FE group (p=0.03). Conclusion In the early management of normotensive PE with RVD, DT may be superior to FE in order to improve the time to normalization of biological and echocardiographic markers. Abstract 0358 – Figure 1 [ABSTRACT FROM AUTHOR]

Purpose Pulmonary artery (PA) dilatation is often seen in patients with pulmonary hypertension (PH). The objective of our study was to identify factors associated with PA dilatation and to assess its prognosis significance in group 1 and 4 PH patients. Methods We performed a longitudinal cohort study, including consecutive patients with group 1 and 4 PH hospitalized in our center. All patients underwent clinical and biological evaluation, transthoracic echocardiography (TTE), CT scan and right heart catheterization and were followed every 3 months. Results 70 patients were recruited (70% group 1, 30% group 4). Mean age was 67±15 years and 70% were in functional class NYHA III or IV. PA dilatation (>30mm on CT) was observed in 87% of patients. Mean PA diameter was 37.2± 8.2mm and it was significantly larger in congenital heart disease patients: 46.2±8.6mm (p= 0.01). In multiple regression analysis, duration of symptoms (p= 0.01) and myocardial performance index (p= 0.02) were correlated with PA diameter. During a mean follow up of 59±19 months, 18 patients died (26%) (16 from heart failure and 2 from sudden death). On univariate analysis, while NYHA class (HR 2.37, 1.18-4.75), low 6-minute walk distance (HR 0.99 per 50m, 0.98-0.99), low cardiac index (HR 0.25 per 1L/min/m 2 , 0.09-0.71), right atrial pressure (HR 1.12 per 1 mmHg, 1.02- 1.2), low TAPSE (HR 0.84 per 1mm, 0.76-0.93), right atrial area (HR 1.08 per 1cm 2 ,1.03-0.12) and high BNP were associated with mortality, PA diameter was not (HR: 0.97 per 1mm, 0.91-1.04). On multivariate analysis low TAPSE and high BNP level were independent predictors of all-cause mortality (respectively HR 0.72, 0.52-0.98 and 3.0, 1.01-8.90). Conclusion PA dilatation is frequent in PH and is associated with the duration of symptoms and poor myocardial performance index. However, in group 1 and 4 PH patients, PA dilatation is not predictor of mortality. [ABSTRACT FROM AUTHOR]

Background Breast cancer is the most frequent female cancer. Treatment of HER2+ tumours evolved with immunotherapy, leading to improved survival. Cardiac toxicity associated to trastuzumab is frequent but reversible in 75% of cases. However, only little is know about the cardiotoxicity of new anti-VEGF antibodies associated to trastuzumab. In this study, we aimed to assess the cardiac tolerance of bevacizumab associated with trastuzumab and chemotherapy in HER2+ breast cancer patients. Methods and results This is a post-hoc analysis of the BEVERLY-2 study, aiming to assess the efficacy of neoadjuvant bevacizumab, trastuzumab, and chemotherapy for primary inflammatory HER2+ breast cancer. A cohort of 52 patients was prospectively included. Left ventricular ejection fraction (LVEF) was assessed by echocardiography and/or isotopic ventriculography every three months during the mean follow-up of 33±3,42 months. Mean age prior to chemotherapy was 49,75 years ±11,60. On inclusion, mean LVEF was 66,56±6,13.There was no significant difference between LVEF on inclusion and before the 5th cycle of chemotherapy fifth cycle (C5)(66,56%±6,13 vs 65,11%±7,68 ; p=0,24), whereas LVEF was significantly reduced at the end of the neoadjuvant therapy (62,07%±7,84 vs 66,56±6,13; p=0,0001). The nadir of LVEF was 57,87%±8,79 and occured generally during the adjuvant period. In 16 patients, LVEF decreased below 50% after neoadjuvant therapy but complete recovery of LVEF was observed in all at the end of the follow-up, 3 months after the end of the treatment (Figure 1, next page). Conclusion In this study, with an effective treatment protocol for inflammatory breast cancer, reduction in LVEF was observed in 30% of patients, however, it was reversible in all. Nadir of LVEF was observed after the final adjuvant therapy (31%). This timing and the possibility of recovery should be considered when discussing the interruption of chemotherapy because of reduced LVEF during the follow up. Fig. 1 – Treatment protocol Fig.2 Evolution of LVEF during the follow up Abstract 0380 - Figures 1,2 [ABSTRACT FROM AUTHOR]

Background Survival is improved in pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) patients and is related to right ventricular (RV) function. In this study we aimed to investigate the prognostic role of RV mechanics in Eisenmenger Syndrome (ES) compared with other causes of PAH using speckle-tracking imaging. Methods and results We performed a prospective cohort study. We recruited 80 consecutive adult PAH patients: 39 patients with ES and noncomplex CHD (mean age 41,5±15,6 years) and 41 patients with group 1 PAH (mean age 58,9±17,8). Clinical assessment, BNP and echocardiography were realised at the time of inclusion and then clinical outcomes were collected during the regular follow-up. Normal strain values were obtained from 37 control volunteers. On inclusion, 53 patients (66.3%) were in functional class III or higher. Mean BNP was lower in ES (p<0,001) but TAPSE (p=0,6) and peak RV longitudinal strain (p=0,9) were similar in both groups. Global longitudinal LV strain was midly reduced in ES (–16,2±5 vs –17,9±8%, p=0,03), whereas no difference was found for circumferential strain. Mean RV transverse strain was higher in ES patients (27,3±17 vs 14±11%; p<0,001) but still reduced in comparison with normal values (44,9±16%, p<0,001). Whereas normal RVs present a base to apex transverse strain gradient, ES patients more frequently present a predominant apical function (p<0,001). Over a median follow-up of 20,6 months, 32 patients were hospitalized for PAH and 16 died from cardio-pulmonary causes. On multivariate survival analysis (including age, NYHA class and advanced therapies), peak transverse strain (HR 0.92 [0.87–0.98]) and CHD (HR 0.17 [0.05–0.6]) were associated and were the strongest predictors of event-free survival. Conclusion The increased RV transverse strain and predominant apical function in ES could explain their survival advantage as transverse strain is a strong independent predictor of outcomes in PAH. Abstract 0418 - Figure: RV Transverse strain predicts event-free survival [ABSTRACT FROM AUTHOR]

We report the case of a middle age patient presenting with Tako-Tsubo cardiomyopathy (TTC) complicated by cardiogenic shock that was successfully handled with milrinone. A 64-year old man presented with cardiogenic shock after benzodiazepine and alcohol intoxication. A slight elevation of troponin and typical left ventricular ballooning without coronary lesions suggested TTC. Within a few hours milrinone infusion normalized the cardiac index. TTC is responsible for severe transient left ventricular dysfunction occurring after physical or psychological stress. The major pathophysiological mechanism involved is disproportionate catecholamine secretion, which may stun the myocardium. We considered if treatment of this unique physiopathology with catecholamines could be dangerous in these patients and if alternative inotropes such as milrinone should be preferred. [ABSTRACT FROM AUTHOR]

Management options for patients with Eisenmenger syndrome (ES) were limited to palliative measures or transplantation before the advent of advanced therapies (AT). Little data is available on the impact of disease targeting therapies on BNP and echocardiographic variables in patients with ES. We wanted to investigate the effects of AT on echocardiographic measures and BNP in patients with ES. Methods and results We prospectively included 63 patients with ES who were started on AT (46% were treated with endothelin receptor antagonists, 44.4% with PDE5 inhibitors and 9.6% with an association. Clinical, 6 min walk test and BNP data were collected at baseline (before introduction of AT) and after a mean period of 2years of sustained therapy. Mean age was 42±13 years, most of patients were WHO III (97%) whereas a vast majority had post-tricuspid defects. At baseline, echocardiographic findings were consistent with abnormalities of the RV function and adaptation: overall dilated RV (mean inlet 44.9±6.2 mm), reduced TAPSE (16.4± 3.5 mm). AT was responsible for an improvement in WHO functional class (p=0.001) and walked distance (+35.1 m; p=0.01), however, it was not associated with any change in BNP (p=0.85). RV systolic function and adaptation was improved (decreased systolic/diastolic duration ratio and total isovolumic time, p<0.001 and p=0.003; decreased RV dP/dT, p=0.05; increased TAPSE and tricuspid Sm, p=0.01 and p=0.03), however, no significant right ventricular structural remodeling was observed. Agreement between the echocardiographic score (previously described as associated with outcomes in ES: reduction in TAPSE, RA area, RA/LA ratio or S/D ratio) and clinical response (decrease in WHO and improved 6MWT) was moderate but higher than BNP. Conclusion Our results support the notion that therapy is associated with improved symptoms, RV systolic function and adaptation but not with reduction in BNP concentrations. [ABSTRACT FROM AUTHOR]

Purpose Prior studies have recognised non-O blood type as a risk factor for venous thromboembolism (VTE). Though, ABO blood type contribution to VTE recurrence risk is poorly studied. We sought to determine the impact of blood type on VTE recurrences. Methods Our prospective cohort included 120 subsequent patients presenting a first episode of pulmonary embolism (PE). In all cases, PE were diagnosed with a CT scan. All participants were followed for at least 12 months after anticoagulation therapy discontinuation. Results Over a mean follow-up period of 30 months, the rate of recurrence was 8.9% per patient and per year. PE was unprovoked in 63 patients (52.5%). Mean duration of oral anticoagulation was 6 months. Compared to O blood type, the unadjusted hazard ratio (HR) of VTE recurrence for non-O blood type was 1.97 (95%CI, 0.91-4.26, p=0.07). B blood type exposed to a higher risk of VTE recurrence than O blood type with a HR of 2.6 (95%CI, 1.12-6.06, p=0.03). A and AB blood types were not associated with an increased risk of VTE recurrence when compared to O blood type. Conclusion Non O blood type are involved not only in the occurrence of a first episode of VTE but tend to contribute to VTE recurrence. Patients with B blood type develop more VTE recurrence than others. The ABO blood type could be one of the characteristics to be studied for the determination of the length of anticoagulant treatment after a first episode of VTE. [ABSTRACT FROM AUTHOR]

Objectives We sought to analyze B-type natriuretic peptide (BNP)/troponin I (TnI) ratio and TnI kinetics to differentiate apical ballooning syndrome (ABS) from acute coronary syndrome (ACS). Methods In 62 ABS, TnI and BNP measurements were collected prospectively and compared to 90 patients with anterior ST-segment elevation myocardial infarctions (STEMI) (n=47) and anterior non-STEMI (n=43). Results In case of persistent ST-segment elevation, BNP/TnI ratio above 165 can identify ABS with accuracy (sensitivity: 95%, specificity: 98%). In the absence of persistent ST-segment elevation, a ratio above 515 can identify ABS (sensitivity: 57%, specificity: 86%). Decreasing TnI profile was found more in ABS than in ACS. TnI peak occurred earlier in ABS than in ACS. A normal TnI on patient admission may exclude ABS. Conclusions Analysis of BNP and TnI provides a simple, non-invasive method to differentiate ABS from ACS. [ABSTRACT FROM AUTHOR]

Purpose To demonstrate the abnormal kinetics of copeptin during stress in patients with Tako-Tsubo cardiomyopathy (TTC). Methods We analyzed prospectively copeptin kinetics before and after dobutamine echocardiography in 12 TTC compared to 10 controls, matched for age and gender. The level of the other main stress hormones (adrenaline, noradrenaline, dopamine, insulin, cortisol) were also collected. Results All dobutamine echocardiographies were normal. Before and after echocardiography, there were no differences in hormones values between TTC and controls. Surprisingly, after echocardiography in TTC, copeptin decreased, as did cortisol, noradrenaline, and insulin. In the control group, no variation was found. Conclusions Surprisingly, in TTC after dobutamine echocardiography, most hormones, including copeptin, decreased. [ABSTRACT FROM AUTHOR]

Aims: Accurate quantification of left ventricular (LV) volumes and ejection fraction (EF) is important, especially in heart failure patients. Cardiac magnetic resonance imaging (MRI) is considered as the reference and then we sought to compare three-dimensional echocardiography (3DE) for LV volumes and EF estimation, relative to MRI in heart failure patients. Methods: We studied 24 patients (17 men, age 58±15 years) with history of heart failure who underwent 3DE (Full volume real-time 3DE – iE33 (Philips Medical system) QLAB workstation) and MRI in a 48-hour delay. No patient was excluded from the study due to poor image quality. Results/Discussion: The heart failure etiology was: 41,7% (n=10) ischemic cardiomyopathy, 50% (n=12) dilated idiopathic cardiomyopathy and 8,3% (n=2) of patients suffered from heart failure with preserved EF. Mean LV end-diastolic volume (LVEDV) evaluated by MRI was 208±108mL (121±64 mL/m2), mean EF 31±13% and mean LV end-systolic volume (LVESV) was 149±97 mL. 3DE data sets highly correlated with MRI, especially concerning EF (r : 0.86, 0.88, and 0.96 for LVEDV, LVESV, and EF, respectively) with small biases (-55 mL, -44 mL, 1,1%) and acceptable limits of agreement, but LV volumes are significantly underestimated by 3DE particularly in our patients with severe LV dysfunction, and 3DE data sets do not correlate as well as expected. We then determined that with a LVEDV below 120 mL/m2, 3D was more accurate for volumes and EF evaluation. The degree of underestimation of LV volumes is significatively correlated with the LV dilatation degree (r=0,60 p=0,01). Conclusion: Compared with MRI, 3DE is a good method to evaluate LVEF, but 3DE appears to underestimate significantly LV volumes, with the problem of foreshortened apical views in heart failure patients. As the LVEDV increase, 3D accuracy simultaneously decrease. [Copyright &y& Elsevier]