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Decrease in blood platelet count has been described after percutaneous coronary intervention and surgical valve replacement, although no study has been performed in the setting of transcatheter aortic valve implantation (TAVI). The aim of this study was to address the incidence, mechanism, and impact of blood platelet count decrease after TAVI. One hundred forty-four consecutive patients (mean age 84 ± 7 years, 64 men) with severe symptomatic aortic stenosis who underwent TAVI from December 2007 to July 2011 were enrolled. Blood platelet count was recorded before and after aortic valve implantation. Decrease in blood platelet count was compared with in-hospital major adverse cardiovascular events (death, stroke, and major or life-threatening bleeding). Blood platelet count decreases occurred in all but 1 patient. The percentage of platelet count decrease averaged 34 ± 15% and was 24% greater than blood protein decrease. Decrease in platelet count was associated with a higher rate of prosthesis migration, longer x-ray and procedural times, and larger contrast amounts (230 ± 128 ml for the third tertile vs 170 ± 77 ml for the second and first tertiles, p = 0.0006), but no association was observed with regard to changes in bilirubin. In-hospital major adverse cardiovascular events (n = 50 [35%]) were observed more frequently in patients with severe platelet count decreases (21% for the first tertile, 35% for the second tertile, and 48% for the third tertile, p = 0.02). Finally, the percentage of blood platelet count decrease was the only predictor of in-hospital major adverse cardiovascular events (odds ratio 1.67, 95% confidence interval 1.05 to 2.67, p = 0.03). In conclusion, a decrease in platelet count is a common phenomenon after TAVI, and its severity is associated with poor outcomes.

Diuretics are conventionally prohibited in acute right ventricular myocardial infarction.To assess the benefit of diuretics compared to fluid expansion in patients with inferior myocardial infarction extended to the right ventricule.Of 295 patients admitted for inferior or posterior acute myocardial infarction between November 2008 and November 2010, 77 had a right ventricular extension. Among these 77 patients, 19 presented with oligoanuria (0.5 mL/kg per hour) and no criteria for cardiogenic shock. Overall, 11 patients were treated by low dose of furosemide (40 to 80 mg) and eight received fluid expansion using isotonic saline solution.Baseline right ventricular dilatation and dysfunction, systolic blood pressure and heart rate were similar between the groups. Twenty-four hours after treatment, urine output was similar between the two groups but only the patients in the diuretic group improved their blood pressure (103 ± 16 mmHg versus 127 ± 20 mmHg, P0.001), heart rate (71 ± 15 bpm versus 76 ± 13 bpm, P = 0.03), creatinin level and alanine aminotrasferase plasmatic level. Hospitalization duration and the need of inotropic support were similar in the two groups.Diuretics and fluid expansion provide similar efficiency for triggering diuresis in patients with right ventricular infarction and oligoanuria but only diuretics seem to be associated with improvement in hemodynamic status and venous congestion.

This study compared strain values from 2-dimensional (2D) and real-time 3-dimensional (3D) speckle tracking with hyperenhancement transmural extent by magnetic resonance imaging (MRI). The study included 18 control subjects (mean age 51 ± 10 years) and 25 patients (20 men, mean age 62 ± 16 years) with ischemic left ventricular (LV) dysfunction (mean LV ejection fraction 41 ± 9%) referred for viability assessment using MRI. Longitudinal, radial, and circumferential strain values were computed using 2D speckle tracking. From analysis of 3D speckle tracking, conventional strain markers (longitudinal, radial, and circumferential) and 2 new 3D strain indexes (area and 3D strains) were obtained from apical view 3D datasets. A hyperenhancement transmural extent segment (16-segment model) was defined as delayed contrast enhancement50%. Overall, 661 of 688 segments (96%) were analyzable by MRI and 3D speckle tracking. All 3D strain components in hyperenhancement transmural extent segments (n = 154) were lower than in nontransmural necrosis (n = 219) and control (n = 288) segments. Longitudinal strain by 3D, but not by 2D, differentiated nontransmural segments with scar25%. All 3D global strain indexes correlated with LV ejection fraction (r(2) = 0.67 to 0.26, p0.05 for all comparisons), whereas only area, longitudinal, and circumferential 3D strains correlated with global scar extent. The best reproducibility was provided by 3D longitudinal (6%) and area (8%) strains. In conclusion, longitudinal and area strains by 3D speckle tracking provide an accurate and reproducible measurement of myocardial deformation that correlate with infarct size in patients with ischemic LV dysfunction.

ObjectivesThis study investigated whether aortic valve replacement (AVR) is associated with improved survival in patients with severe low-flow/low-gradient aortic stenosis (LF/LGAS) without contractile reserve (CR) on dobutamine stress echocardiography (DSE).BackgroundPatients with LF/LGAS without CR have a high mortality rate with conservative therapy. The benefit of AVR in this subset of patients remains controversial.MethodsEighty-one consecutive patients with symptomatic calcified LF/LGAS (valve area ≤1 cm2, left ventricular ejection fraction ≤40%, mean pressure gradient [MPG] ≤40 mm Hg) without CR on DSE were enrolled. Absence of CR was defined as the absence of increase in stroke volume of ≥20% compared with the baseline value. Multivariable analysis and propensity scores were used to compare survival according to whether or not AVR was performed (n = 55).ResultsFive-year survival was higher in AVR patients compared with medically managed patients (54 ± 7% vs. 13 ± 7%, p = 0.001) despite a high operative mortality of 22% (n = 12). An AVR was independently associated with lower 5-year mortality (adjusted hazard ratio from 0.16 to 5.21 varying with time [95% confidence interval: 0.12–3.16 to 0.21–8.50], p = 0.00026). In 42 propensity-matched patients, 5-year survival was markedly improved by AVR (65 ± 11% vs. 11 ± 7%, p = 0.019). Associated bypass surgery (p = 0.007) and MPG ≤20 mm Hg (p = 0.035) were independently predictive of operative mortality. Late survival after AVR (excluding operative death) was 69 ± 8% at 5 years.ConclusionsIn patients with LF/LGAS without CR on DSE, AVR is associated with better outcome compared with medical management. Surgery should not be withheld from this subset of patients solely on the basis of lack of CR on DSE.

Context The epidemic of heart failure (HF) in France has not been fully investigated and data on both the systolic and diastolic forms are limited. Objectives To determine the prevalence, aetiology and treatments of both forms in French patients over 65 with HF (NYHA grade II–IV). Participants Cross-sectional study of 446 patients with HF recruited by 273 randomly selected cardiologists in France, with echocardiography and ECG available for central reading. Main measurements Prevalence of diastolic (DHF) and systolic (SHF) HF using the left ventricular ejection fraction (LVEF). Results DHF, with a mean LVEF of 57.6±8.0%, was reported for 245 (54.9%) patients and SHF, with a mean LVEF of 33.33±8.0% was reported for 201 (45.1%) patients. Men were more prone to suffer SHF than DHF whereas for women the reverse was true. As compared to SHF, DHF endsystolic and enddiastolic volumes were smaller, the thickness/radius ratio was greater, with a longer E-wave deceleration time and a shorter peak filling rate. Aetiology and treatments were similar in both types of HF, except for ACE inhibitors and aldosterone antagonists, which were more frequently prescribed in SHF. Conclusion This observational study provides further knowledge of SHF and DHF in outpatients.

Objective. – To assess the use of mobile coronary care units (MCU) in hypertensive patients previously treated for cardiovascular diseases in comparison with those with no history of cardiovascular disease and to estimate the influence of the use of MCU on cardiovascular outcome in this population. Patients. – We used a nationwide prospective registry of all patients admitted for AMI in French intensive care units in 2000. Patients without history of hypertension or patients admitted with pulmonary oedema or cardiogenic shock were excluded. Men (N = 514) and women (N = 291) were analysed separately . Results. – The proportion of patients with history of myocardial infarction, peripheral artery disease and stroke was not significantly higher in subjects who used physician-staffed MCU as compared with patients with no history of myocardial infarction, peripheral artery disease or stroke. In each sex, revascularization (pre hospital fibrinolysis, in hospital fibrinolysis or coronary angioplasty) were more frequent in patients who used MCU. Also, one year cardiovascular mortality was lower in men who used MCU. Conclusion. – known high risk hypertensive patients did not use physician-staffed MCU more than subjects free of such condition. Education of hypertensive patients at risk during routine visits is required to increase of the use of physician-staffed MCU in case of symptoms suggestive of AMI.

Several classes of medications improve survival in patients with coronary artery disease. Whether these medications, as used in the real world, have additive efficacy remains speculative.To assess whether patients discharged on combined secondary prevention medications after acute myocardial infarction (AMI) have improved 1-year survival, compared with the action of any single class of medications.Nationwide registry of consecutive patients admitted to intensive care units for AMI in November 2000 in France. Multivariate Cox regression analysis, including a propensity score for the prescription of combined therapy, was used.Of the 2119 patients discharged alive, 1095 (52%) were prescribed a combination of antiplatelet agents, beta-blockers, and statins (triple therapy), of whom 567 (27%) also received angiotensin-converting enzyme inhibitors (quadruple therapy) and 528 (25%) did not. One-year survival was 97% in patients receiving triple combination therapy versus 88% in those who received either none, 1, or 2 of these medications (P.0001). After multivariate adjustment including the propensity score, the hazard ratio for 1-year mortality in patients with triple combination therapy was 0.52 (95% CI 0.33-0.81). In patients with ejection fractionor = 35%, beta-blockers and angiotensin-converting enzyme inhibitors were independent predictors of survival, and combination therapy had no additional prognostic value.Compared with the prescription of any single class of secondary prevention medications, combination therapy offers additional protection in patients with AMI.

Resume Objectif. – Plusieurs etudes rapportent un pronostic plus sombre apres un infarctus du myocarde (IdM) chez ceux ayant une arteriopathie obliterante des membres inferieurs (AOMI). Notre objectif a ete de decrire la presentation et la prise en charge d'une cohorte de patients avec AOMI victimes d'IdM, comparee a ceux sans AOMI. Materiel et methode. – Le registre USIC 2000, colligeant les donnees des patients pris en charge pour un IdM aigu dans les soins intensifs francais en novembre 2000, a ete utilise. Resultats. – Parmi les 2311 sujets, une AOMI etait rapportee chez 215 sujets (9,3 %). En analyse multivariee, les facteurs positivement lies ( p ≤ 0,05) a une AOMI sont : âge superieur a 75 ans (OR = 2,3), diabete (OR = 2,0), hypertension (OR = 1,4), tabagisme actif (OR = 4,6), insuffisance renale (OR = 3,1), les antiagregants (OR = 3,9), antivitamine K (OR = 1,9), statines (OR = 1,7) et HBPM (OR = 6,8). En introduisant dans le modele les donnees a l'arrivee, le sexe masculin (OR = 1,6) et les antecedents de coronaropathies (OR = 2,2) etaient egalement plus frequents. Ces patients presentaient plus souvent un bloc de branche gauche (OR = 1,8) et moins souvent un sus-decalage du segment ST (OR = 0,7). Une prise en charge tardive superieure six heures etait plus frequente (OR = 1,4). L'introduction des donnees des 48 premieres heures revele un moindre recours au stent (OR = 0,7), et les betabloquants (OR = 0,6). A la sortie de l'hopital, les taux de prescription des therapeutiques de prevention secondaire sont moindres chez l'arteritique. Conclusion. – Au-dela de l'AOMI, un grand nombre de facteurs pejoratifs et une sous-prescription de traitements a interet pronostique, existent chez ces patients.

OBJECTIVES We sought to assess the value of transthoracic echocardiography (TTE) using standardized imaging planes for the functional analysis of mitral regurgitation (MR) as well as for postoperative outcome implications. BACKGROUND The feasibility of mitral valve repair is based on functional assessment of MR, mainly by transesophageal echocardiography (TEE). Considering the recent advances in TTE imaging, the incremental value of TEE in this setting needs to be re-examined. METHODS Consecutive patients (n = 279; 181 men; median age 68 years [quartiles, 61 to 74]) who underwent surgery for MR were enrolled prospectively in two tertiary care centers. The accuracy of TTE (harmonic imaging) versus TEE for functional assessment of MR was evaluated against surgical findings. RESULTS Valve repair (n = 237 patients, 85%) or replacement (n = 42) was predicted accurately by TTE in 97% of cases; TEE added significant information for only two patients. In the subgroup of degenerative MR (n = 190), agreement with surgical findings for the localization of prolapsed segments was 91% for TTE (kappa, 0.81) and 93% for TEE (kappa, 0.85) without incremental value of TEE (p = 0.40). Patients with single prolapse of the middle posterior scallop (P2) had a better postoperative outcome as compared with patients who had non-P2 lesions (p = 0.008). Furthermore, mitral replacement predicted by TTE was an independent predictor for postoperative long-term mortality (odds ratio 5.7, 95% confidence interval 1.97 to 16.4, p = 0.001). CONCLUSIONS In experienced hands, functional assessment of MR by TTE can predict accurately valve repairability and has a strong influence on postoperative outcome. Thus, in most cases preoperative TEE is not mandatory, provided intraoperative TEE is performed.

Resume Objectif Identifier les patients qui n’ont pas recours au systeme d’aide medicale d’urgence (SAMU) pour un infarctus du myocarde (IDM). Patients et methodes L’etude USIC 2000 a ete construite a partir du recueil prospectif des donnees des patients admis en novembre 2000 en France pour un IDM en unite de soins intensifs de cardiologie (USIC). Les antecedents cardiovasculaires, les facteurs de risque, les intervenants avant l’admission, le delai entre le debut des symptomes et l’admission en USIC, les modalites de prise en charge pre-hospitalieres et hospitalieres etaient reportes. Resultats Sur les 1 711 patients analyses, 769 (45 %) n’ont pas eu recours au SAMU. Ces patients sont plus âges (66 ± 14 vs 64 ± 14 ans ; p Conclusion Le sexe feminin, l’absence de sus-decalage du ST, l’intervention d’un medecin dans la gestion de l’IDM durant la phase prehospitaliere sont correles a un moindre recours au SAMU, lui-meme associe a une sous-utilisation des procedures de revascularisation et a un allongement de la duree d’hospitalisation. Ces resultats suggerent l’interet d’une campagne d’information aupres des medecins traitants sur le role du SAMU lors d’un syndrome coronarien aigu.

We assessed the in-hospital management and short- and long-term outcomes of two series of patients admitted for acute myocardial infarction, 5 years apart, in France. The most recent cohort was younger and with a less frequent history of cardiac diseases, but was more often diabetic and with anterior infarcts. Five-day mortality significantly improved from 7.7% to 6.1% (P < 0.03) and 1-year survival was also less in the most recent period (15% versus 19%, P < 0.01). Multivariate analyses showed that the period of inclusion (2000 versus 1995) was an independent predictor of both short- and long-term mortality. In analyses restricted to the patients who were alive by day 5, initial treatment with statins was associated with a 38% decrease in the risk of death at 1 year. Likewise, in patients with left ventricular ejection fraction ≤35%, the early prescription of ACE inhibitors was associated with a 41% reduction in the risk of 1-year mortality. Thus, in the real world setting, a continued decline in 1-year mortality is observed in patients admitted to intensive care units for recent acute myocardial infarction. This goes along with a shift in reperfusion therapy towards a broader use of coronary angioplasty and with an increased use of the early prescription of recognised secondary prevention medications.

The use of cardiovascular secondary prevention medications in patients with acute coronary syndromes was compared in 4 sequential observational surveys carried out in France from 1995 to 2000. The Usik 1995 and Usic 2000 surveys included patients admitted for acute myocardial infarction, while the 2 Prevenir surveys (1998 and 1999) assessed the medications prescribed in patients with acute coronary syndromes. Antiplatelet agents were prescribed in 91% of the patients in 1995, 93% in 1998 and 1999 and 96% in 2000; for beta-blockers, the respective figures were: 64%, 68%, 75% and 76%. For ACE-Inhibitors, the figures were: 46%, 41%, 41% and 50%. For statins, the prescription increased from 10% to 36%, 59% and 64%. In 1995, 8% of the patients received both antiplatelet agents, beta-blockers and statins (4% of them also had an ACE-Inhibitor); in 2000, the respective figures were 53% and 27%. The results of the recent trials of secondary prevention medications have had a considerable impact on real-life practice in France during the late 1990s.

Objectives: We sought to characterize regional myocardial perfusion and contraction in a closed-chest swine model during and after coronary blood flow reduction using myocardial contrast and Doppler tissue echocardiography. Methods and Results: Regional myocardial perfusion was assessed by myocardial contrast echocardiography using the corrected contrast peak intensity (baseline-subtracted contrast peak intensity), the peak intensity ratio (contrast peak intensity in ischemic/control wall), and a transmural video-intensity gradient. Regional peak systolic velocities and strain rate were measured using M-mode color Doppler tissue echocardiography. In 12 pigs, coronary blood flow reduction resulted in a significant decrease in peak intensity ratio and in peak systolic velocities in the subendocardium. At baseline and during ischemia, corrected contrast peak intensity and peak systolic velocities in the subendocardium, video-intensity gradient, and strain rate were closely related ( r = 0.88 and 0.93, respectively). After reperfusion, in contrast to peak systolic strain rate that remained altered, the peak intensity ratio and video-intensity gradient recovered nearly baseline values. Conclusion: The combination of myocardial contrast and Doppler tissue echocardiography may distinguish between ischemic and postischemic myocardial wall dysfunction during severe coronary blood flow reduction. (J Am Soc Echocardiogr 2003; 16:1-8.)

OBJECTIVES We sought to assess risk stratification by using dobutamine stress echocardiography (DSE) in patients with aortic stenosis (AS) and severe left ventricular (LV) dysfunction. BACKGROUND Few data are available on risk stratification for valve replacement in patients with AS, LV dysfunction and low transvalvular gradients. METHODS Low-dose DSE was performed in 45 patients (16 women and 29 men; median [quartile range] age in years: 75 [69 to 79]; left ventricular ejection fraction: 0.29 [0.23 to 0.32]; aortic valve area [cm2]: 0.7 [0.5 to 0.8]; mean transaortic gradient [mm Hg]: 26 [21 to 33]). Patients were classified into two groups: group I (n = 32, LV contractile reserve on DSE) and group II (n = 13, no contractile reserve). Valve replacement was performed in 24 and 6 patients in groups I and II, respectively. RESULTS Perioperative mortality was 8% in group I and 50% in group II (p = 0.014). Survival at five years after the operation was 88% in group I. Compared with medical therapy, valve surgery was associated with better long-term survival in group I (hazard ratio for death [HR-D] 0.13, 95% confidence interval [CI] 0.002 to 0.49) and reduced survival in group II (HR-D 19.6, 95% CI 2.7 to 142). The effect of valve surgery on survival remained significant in both groups after adjustment for age, diabetes, respiratory disease and hypertension. Medical therapy had the same effect in both groups. CONCLUSIONS In patients with AS, LV dysfunction and low transvalvular gradients, contractile reserve on DSE is associated with a low operative risk and good long-term prognosis after valve surgery. In contrast, operative mortality remains high in the absence of contractile reserve.

OBJECTIVES We sought to evaluate Dobutamine stress echocardiography (DSE) for predicting recovery of viable myocardium after revascularization with cineangiography as a gold standard for left ventricular (LV) function. We studied the influence of late vessel reocclusion on regional LV function. BACKGROUND Dobutamine stress echocardiography is a well established evaluation method for myocardial viability assessment. In previous studies the reference method for assessing LV recovery was echocardiography; long-term vessel patency has not been systematically addressed. METHODS Sixty-eight patients with a first acute myocardial infarction (AMI) and residual stenosis of the infarct related artery (IRA) underwent DSE (mean ± standard deviation) 21 ± 12 days after AMI to evaluate myocardial viability. Revascularization of the IRA was performed in 54 patients by angioplasty (n = 43) or bypass grafting (n = 11). Coronary angiography and LV cineangiography were repeated at four months to assess LV function and IRA patency. RESULTS Sensitivity and specificity of DSE for predicting myocardial recovery after revascularization were 83% and 82%. In the case of late IRA patency, specificity increased to 95%, whereas sensitivity remained unchanged. In the 16 patients with myocardial viability and late IRA patency, echocardiographic wall motion score index decreased after revascularization from 1.83 ± 0.15 to 1.36 ± 0.17 (p = 0.0001), and left ventricular ejection fraction (LVEF) increased from 0.52 ± 0.06 to 0.57 ± 0.06 (p = 0.0004), whereas in five patients, reocclusion of the IRA prevented improvement of segmental or global LV function despite initially viable myocardium. CONCLUSIONS Dobutamine stress echocardiography is reliable to predict recovery of viable myocardium after revascularization in postinfarction patients. Late reocclusion of the IRA may prevent LV recovery and influence the accuracy of DSE.

Accurate echocardiographic parameters for predicting the success of cardioversion or maintenance of sinus rhythm are poorly defined. This prospective transthoracic and transesophageal echocardiographic study was conducted to test the hypothesis that the left atrial appendage flow pattern could be a predictive parameter of the success of cardioversion and maintenance of sinus rhythm in patients with nonvalvular atrial fibrillation. Eighty-two consecutive patients with nonvalvular atrial fibrillation of

Objectives. The aim of this study was to assess the effects of ischemia on diastolic function by analyzing flow propagation velocity with color M-mode Doppler echocardiography.Background. Color M-mode Doppler echocardiography has been proposed as a method of assessing left ventricular filling.Methods. Color M-mode Doppler echocardiography and measurement of hemodynamic data were performed simultaneously at baseline and during angioplasty-induced ischemia. Tau was compared with flow propagation velocity. Late diastolic indexes, left ventricular pressure and flow cessation time were also investigated.Results. During ischemia, left ventricular relaxation rate (tau) increased, whereas flow propagation velocity decreased, from (mean ± SD) 46.8 ± 10 ms to 72.6 ± 18.3 ms and from 59.8 ± 15.8 cm/s to 30 ± 8 cm/s, respectively (all p < 0.0001). The maximal slowing of flow propagation velocity was observed 20 to 30 s after the beginning of the inflation, coexisting with a notch on the ascending limb of the negative rate of rise of the left ventricular pressure (dP/dt) curve. Flow propagation velocity was correlated with tau both at baseline (r = 0.53, p < 0.05) and during inflation (r = 0.53, p < 0.03). Left ventricular end-diastolic pressure increased during ischemia from 13.5 ± 8 mm Hg at baseline to 27.5 ± 7 mm Hg, while a premature cessation of the entering flow occurred −13.8 ± 23 ms before the next Q wave onset, compared with 4.5 ± 19.6 ms after the Q wave onset at baseline (all p < 0.0001).Conclusions. The analysis of flow propagation velocity showed that early filling is highly dependent on left ventricular relaxation rate, particularly through the phenomenon of asynchrony. During ischemia, the premature cessation of late filling is associated with increased diastolic pressures.(J Am Coll Cardiol 1997;29:1246–55)

After successful external cardioversion, the rate of recurrence of atrial fibrillation remains high. The hypothesis that plasma B-type natriuretic peptide could predict the recurrence of atrial fibrillation at 1 year was tested. Plasma B-type natriuretic peptide was measured in 66 consecutive asymptomatic patients who underwent external cardioversion for atrial fibrillation. Twelve-lead electrocardiograms were obtained at 1 year. Sinus rhythm was maintained in 55% of patients. The independent predictors of the recurrence of atrial fibrillation at 1 year were a history of atrial fibrillation, plasma B-type natriuretic peptide, and the energy delivered for conversion. In patients without symptoms of heart failure, plasma B-type natriuretic peptide is an independent predictor of the recurrence of atrial fibrillation.

Many single center studies have reported high diagnostic accuracy of computed tomography coronary angiography (CTCA) for the detection of obstructive coronary artery disease (CAD), but multi-center studies have yielded variable results. We perform a meta-analysis of multi-center studies evaluating

Objectives. This study sought to evaluate the relation, if any, between fluid overload in congestive heart failure (CHF) and a newly discovered endogenous natriuretic factor acting like loop diuretic drugs: contransport inhibitory factor (CIF).Background. The humoral mechanisms regulating volume overload in CHF are not fully understood. Therefore, we investigated whether there is a role for CIF in this pathologic condition.Methods. Plasma and urinary CIF levels were investigated in 23 patients with chronic CHF and compared with changes in plasma atrial natriuretic peptide (ANP). Twelve patients without CHF served as control subjects.Results. CHF was associated with a highly significant threefold increase in both plasma CIF levels (mean ± SD 7.10 ± 3.01 vs. 2.28 ± 0.92 U/ml, p < 0.0001) and urinary CIF excretion (7,849 ± 3,600 vs. 2,351 ± 1,297 U/day, p < 0.0001) with respect to patients without CHF. CIF increased as a function of impairment in left ventricular ejection fraction (r = −0.703, p < 0.0001) and the severity of clinical status. Plasma ANP was also increased in patients with CHF, although to a lesser extent (68%, p = 0.0501) than plasma CIF, and was also significantly correlated with left ventricular ejection fraction (r = −0.552, p = 0.0004).Conclusions. Plasma and urinary CIF activities were strongly and very significantly increased in chronic CHF. In addition to ANP, this long-term natriuretic agent may be of potential importance in reducing fluid overload in CHF.

We undertook this study to evaluate the importance of redistribution images in thallium 201 single-photon emission computed tomography (Tl-201 SPECT) assessment of myocardial viability after acute myocardial infarction. Stress-redistribution-reinjection Tl-201 SPECT was performed in 55 consecutive patients with recent (within 1 month) acute myocardial infarction. The myocardium was divided into 16 segments and activity assessed visually with a score from 0 to 3 on stress-redistribution and stress-reinjection images. A defect was considered moderate if the stress score was 2 and severe if the stress score was 0 or 1. All moderate defects were considered viable, regardless of score on redistribution or reinjection images. Severe defects were considered viable if they were reversible (improvement of 1 score) on redistribution or reinjection images. Stress-redistribution and stress-reinjection images were visually analyzed and compared in terms of viability classification. On visual analysis, 461 segments (52%) were abnormal. One hundred eleven stress defects were moderate; of these, 28 were reversible on reinjection images only and 15 on redistribution images only. However, all of these segments were viable, regardless of the analysis chosen. Of 350 severe stress defects, 48 were reversible on reinjection and irreversible on redistribution images, and 4 were reversible on redistribution and irreversible on reinjection images. Therefore, in viability assessment, 48 segments were misclassified with stress-redistribution analysis, whereas only 4 segments were misclassified using stress-reinjection analysis. Although the usefulness of Tl-201 reinjection imaging is confirmed, redistribution images seem to be of little interest in postmyocardial infarction viability assessment.

Otras entidades de la ESC que han participado en la elaboracion de este documento: Asociaciones: Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention and Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA). Consejos: Council for Cardiology Practice (CCP), Council on Cardiovascular Nursing and Allied Professions (CCNAP), Council on Cardiovascular Primary Care (CCPC). Grupos de Trabajo: Farmacoterapia Cardiovascular, Cirugia Cardiovascular, Cardiopatias Congenitas en el Adulto, Enfermedades del Miocardio y del Pericardio, Circulacion Pulmonar y Funcion Ventricular Derecha, Valvulopatias. El contenido de esta Guia de Practica Clinica de la Sociedad Europea de Cardiologia (ESC) se publica exclusivamente para uso personal y educativo. No se autoriza su uso comercial. No se autoriza la traduccion o reproduccion de ningun fragmento de esta guia sin la autorizacion escrita de la ESC. La autorizacion se solicitara por escrito a Oxford University Press, editorial de European Heart Journal y representante autorizado de la ESC para gestionar tales permisos. Descargo de responsabilidad. Esta guia recoge la opinion de la ESC y se ha elaborado tras el estudio minucioso de los datos y la evidencia disponibles hasta la fecha. La ESC no es responsable en caso de que haya alguna contradiccion, discrepancia o ambiguedad entre la guia de practica clinica (GPC) de la ESC y cualquier otra recomendacion oficial o GPC publicada por autoridades relevantes de la sanidad publica, particularmente en lo que se refiere al buen uso de la atencion sanitaria y las estrategias terapeuticas. Se espera que los profesionales de la salud tengan en consideracion esta GPC a la hora de tomar decisiones clinicas, asi como al implementar estrategias medicas preventivas, diagnosticas o terapeuticas. No obstante, esta guia no anula la responsabilidad individual de cada profesional al tomar las decisiones oportunas relativas a cada paciente, de acuerdo con dicho paciente y, cuando fuera necesario, con su tutor o representante legal. Ademas, las GPC de la ESC no eximen al profesional medico de su obligacion etica y profesional de consultar y considerar atentamente las recomendaciones y las GPC actualizadas emitidas por autoridades sanitarias competentes. Es tambien responsabilidad del profesional verificar la normativa y la legislacion sobre farmacos y dispositivos medicos a la hora de prescribirlos. Los formularios de autorizacion de todos los autores y revisores se encuentran en la pagina web de la ESC: www.escardio.org/guidelines

Background The impact of antidiabetic medications on clinical outcomes in patients developing acute myocardial infarction (MI) is controversial. We sought to determine whether in-hospital outcomes in patients who were on sulfonylureas (SUs) when they developed their MIs differed from those of diabetic patients not receiving SUs, and whether clinical outcomes were related to the pancreatic cell specificity of SUs. Methods and Results we analyzed the outcomes of the 1310 diabetic patients included in the nationwide French registry of Acute ST-elevation and non ST-elevation myocardial infarction (FAST-MI) in 2005. Medications used before the acute episode were recorded. In-hospital complications were analyzed according to prior antidiabetic treatment. Mortality was lower in patients previously treated with SUs (3.9%), versus those on other oral medications (6.4%), insulin (9.4%) or no medication (8.4%) (p = 0.014). Among SU-treated patients, in-hospital mortality was lower in patients receiving pancreatic cell-specific SUs (gliclazide or glimepiride)(2.7%), compared with those on glibenclamide (7.5%) (p = 0.019). Arrhythmias and ischemic complications were also less frequent in patients receiving gliclazide/glimepiride. The lower risk in patients receiving gliclazide/glimepiride versus glibenclamide persisted after multivariate adjustment (OR = 0.15; 95%CI: 0.04–0.56) and in propensity score-matched cohorts. Conclusion In this nationwide registry of patients hospitalized for acute MI, no hazard was associated with the use of SUs before the acute episode. In addition, patients who had previously received gliclazide/glimepiride had better in-hospital outcomes, compared to those on glibenclamide.

Background Diffusion weighted magnetic resonance imaging (DWI) is used to identify tissue injury area in patients admitted for stroke. Limited study has been performed to evaluate its clinical interest in patients with acute ST elevation myocardial infarction (STEMI). Methods The study included 17 patients (14 men, 55 ± 14years, 12 anterior) with a recent STEMI ( Results Large area of hypersignal correlated with impaired baseline LVEF whatever b value (r value range between 0.58 and 0.60, p Conclusion In patients with acute MI, hypersignal area from diffusion weighted magnetic resonance imaging with b = 50 sec/mm2 seems to provide an accurate assessment of myocardial injury and may be used to predict LVEF recovery.

PurposePost systolic shortening (PSS) and stretching motion occur early during ischemia. Delayed contraction in PSS and stretching motion does not fully contribute to left ventricular end systolic (ES) function and contribute to the left ventricular dysfunction. The wasted energy can be quantified as the difference between peak strain and end systolic strain and used to identify ischemic segments.MethodsAcute myocardial ischemia was induced in 9 anesthetized pigs by balloon coronary occlusion (left coronary descending artery, n=6). Circumferential strain by speckle tracking was computed from short axis view during ischemia at 5’, 30’and 60’. PSS was defined as peak strain occurring after ES and stretching motion as positive systolic peak strain.ResultsBefore induced ischemia, PSS was observed in 38% segments and stretching motion was low (0±1%), then the wasted energy was limited (1±0%). During acute (5’) and prolonged (60’) coronary occlusion, stretching motion increased (4±2% at 5’, and 8±2% at 60’) and PSS became more prevalent (54% and 54%, respectively) and delayed in ischemic segment (3% and 12% of RR interval, respectively). This result the wasted energy was greater in ischemic than non ischemic segment (5±1% vs. 1±1% at 5’, p

ObjectiveTo assess the predictive value of peak global longitudinal strain (e) and e rate by speckle tracking to predict outcome in heart failure (HF) patients.MethodsThe study included 112 consecutive patients admitted for HF (64±13 years, 81% male, 52% ischemia) with reduced left ventricular ejection fraction (LVEF

IntroductionLatest generation continuous flow left ventricular assist devices (LVADs) have been proposed as an alternative to heart transplantation for end-stage heart failure. However, postoperative right ventricle (RV) dysfunction remains common and has a negative impact on prognosis. Purpose of our study was to identify echocardiographic or hemodynamic parameters that could predict early RV failure after LVAD implantation in patients with biventricular dysfunction.MethodsFourteen patients with biventricular dysfunction who have been evaluated for LVAD implantation were included. Right and left ventricular dysfunction were respectively defined as: tricuspid annular plane excursion < 16 mm (TAPSE) and LV ejection fraction < 35%. In all patients, preoperative measurements were obtained at rest. In 7 patients, right heart catheterization was performed simultaneously with increasing doses of dobutamine (15γ/Kg/min). Primary endpoint was death caused by right ventricle systolic dysfunction or need for right ventricle mechanical support within 30 days after surgery (RVSD+).ResultsMean recipient age was 58±7 years. Primary end-point (RVSD+) was noted in five patients. Preoperative demographic, echocardiographic and hemodynamic data were similar between RVSD+ and RVSD- patients (Table). Percent increase of TAPSE and systolic PAP between basal and high dobutamine dose was significantly lower in RVSD+ than in RVSD- patients.ConclusionPercent increase of TAPSE and systolic PAP induced by high dose dobutamine infusion might be two interesting criteria to assess RV contractile reserve and predict RV outcome after LVAD implantation in patient with biventricular dysfunction.Baseline Measurement (n=14)Change after Dobutamine infusion,% (n=7)RVSD-RVSD+pRVSD-RVSD+pN95TAPSE, mm14±214±20.955±526±20.03Systolic PAP, mmHg51±753±60.842±84±70.05Cardiac Output, l/min3.3±0.53.5±0.50.987±1093±470.7Pulm Vasc Res, Wood3.9±14.3±10.62±41-36±70.8

Objective To assess the usefulness of miniature transoesophageal echocardiography using AcuNav probe (10F, TEO-AcuNav) for the monitoring of atrial fibrillation ablation in awake patients. Methods TEO-AcuNaV was used in 30 consecutive patients (55±13 years, 67% male) referred for atrial fibrillation ablation (76% paroxysmal, 24% persistent or permanent) to guide trans-septal catheterisation and to identify the occurrence of thrombosis during the procedure. Results Transseptal catheterisation monitored by TEO-AcuNaV was successfully performed in all patients but one where standard TEE confirmed the presence of a left auricular thrombus. Importantly, TEO-AcuNav identified a right sided catheter related thrombus leading to retrieve the catheter. In addition, 3 pericardial effusions were documented during the procedure. Finally, TEO-AcuNAV was perfectly tolerated in all patients even though maintained awake. Conclusion Transoesophageal AcuNav echography is safe and well tolerated and allows efficacious monitoring of atrial fibrillation ablation without general anesthesia.

Background Fetuin-A is an ubiquitary anti-inflammatory protein that counteracts CRP effects and has a protective effect against inflammation and myocardial ischemia. Low fetuin-A has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. Low fetuin-A combined with high CRP level may be used to severe inflammatory imbalance and to predict outcome in acute coronary syndromes (ACS). Methods We measured admission plasma fetuin-A and CRP level in 748 consecutive patients (65 ± 13 years, sex, 389 with ST and 337 without ST elevation) included in the ACS French registry (Fast MI) and correlated these data with the outcome. Tertile was used to define low fetuin-A (tertile 1) and high CRP level (tertile 3). Results: Plasma fetuin-A and CRP concentrations at admission averaged 95 ± 27 mg/L and 11 ± 16UI, respectively with low fetuin-A defined as Conclusions Inflammatory imbalance assessed by combining fetuin-A and CRP values is an important predictor of cardiovascular death in ACS patients. Download : Download full-size image

ObjectivesTo investigate the impact of LV dyssynchrony on exercise capacity in patients with hypertrophic cardiomyopathy (HCM) and preserved left ventricular ejection fraction (LVEF>50%).MethodsThe study included 31 patients (57±14 years, 23 males) with HCM and preserved LVEF (65±8%, range 50 to 79%) without significant LV obstruction (

BackgroundPost-systolic shortening (PSS) is considered as a marker of viability in ischemic left ventricular dysfunction. However, experimental data suggest that PSS can be observed in viable and non viable segments. The aim of the present study was to differentiate PSS segments with and without contractile reserve (CR) using longitudinal strain derived from speckle tracking analysis.MethodsTwenty seven patients (22 males, 5 females; mean age 59±13 yrs.) with ischemic LV dysfunction (mean LVEF 44±12%) underwent low-dose dobutamine echocardiography for viability assessment. Longitudinal strain (ɛ) and strain rate (SR) were assessed at rest and under dobutamine in the 16 segments using speckle tracking analysis. PSS was defined as peak strain occurring after the end-systole. We sought to determine: 1) PSS prevalence according to CR 2) the best indice to predict CR in PSS segments.ResultsOf the 415/432 analysable segments, 148 (38%) exhibited normal and 267 (62%) abnormal contractility at rest (147 hypokinetic, 120 akinetic). PSS was more prevalent in segments without CR than with CR [61% (50/82) vs. 45% (84/185), p=0.002]. Importantly, only peak systolic SR under dobutamine differed between PSS with and without CR (-0.54 ±0.02 s-1 vs. -0.37±0.02 s-1, p

Purpose In some patients, extensive myocardial dysfunction may be observed during acute coronary syndromes despite limited coronary lesions. Mechanism of depressed contractility during ischemia in remote segments is unclear. In the present study, we addressed the changes in myocardial deformation in remote segments during acute experimental ischemia. Methods Acute myocardial ischemia was induced in 9 anesthetized pigs by balloon coronary occlusion (left coronary descending artery, n=6). Radial and circumferential strain by speckle tracking were computed in the 6 mid short axis segment using 2D echocardiography data acquired at 5’, 15’, 30’and 60’of induced ischemia. Results Reduced in peak circumferential (−16%±2 vs. –6±2% p=0.04) and radial (45±5% vs. 17±6 p=0.002) strain occurred early after 5’of coronary occlusion and persisted during ischemia. Interestingly, reduced in peak radial strain (45±4% vs. 22±5% p=0.0005) was also observed in control segments (Figure) during the first stage of ischemia (5’). Compared to ischemic segments, impaired contraction in control segments was brief and recovered after 15’ of ischemia. Importantly only radial but not circumferential strain was affected in control segments. Conclusions A brief reduction in radial motion was observed during acute myocardial ischemia in control segments. This may explain the occurrence of transient and extensive myocardial dysfunction during acute coronary syndromes despite limited lesions. Download : Download full-size image

IntroductionIvabradine is a selective heart-rate-lowering agent that acts on the sinoatrial node without influence on myocardial contractility and cardiac output. Physiological effects of ivabradine during dobutamine infusion have never been studied.MethodsThe study included 11 healthy subjects (82% men, aged 29.1± 4.7 years). All underwent dobutamine transthoracic echocardiography before and after ivabradine (3 hours after 5mg of ivabradine). Baseline left ventricular longitudinal global strain by speckle tracking and stroke volume at rest and during low dose of dobutamine (when heart rate increased by more than 10 points from baseline) were compared to those obtained under ivabradine.ResultsBaseline heart rate (64±8bpm) decreased in 7 subjects (68±7bpm vs. 60±6bpm, P=0.009) but paradoxically increased in 3. Dobutamine rate required to increase the heart rate by 10 points was similar with and without ivabradine (11±2γ/kg/min vs. 12±3 γ/kg/min, P=0.4). Overall, global strain increased under low dose dobutamine before (−20±2% vs. −23±2%, P=0.008) and after ivabradine (−21±2% vs. −23±3%, P< 0.001). Interestingly, in the 7 subjects that responded to ivabradine, global strain (−23±2% vs. −25±1%, P=0.006) and stroke volume (102±17ml vs. 110±20ml, P=0.05) more increased under dobutamine with ivabradine.ConclusionIn healthy subjects, heart rate reduction obtained by ivabradine allows to increase myocardial contractility and stroke volume for a similar rate of dobutamine. This propriety may be useful in decompensate heart failure patients with rapid tachycardia induced by catecholamine infusion.

A comprehensive description of transesophageal echocardiographic (TEE) findings associated with traumatic aortic rupture (TAR) is still lacking. To correlate TEE and anatomic findings, a prospective study was conducted in 29 consecutive patients suffering from blunt chest trauma and suspected TAR. Confirmation of the diagnosis of TAR was obtained by either aortography, surgery, or necropsy in all patients. TEE studies were performed during the first day of admission using a monoplane probe. TEE studies and aortograms were reviewed by independent experienced observers. The diagnosis of subadventitial TAR was made in 9 patients and intimal tears in 2 patients (one confirmed and one missed by aortography). Subadventitial TAR appeared as an abnormal thick structure composed of intima and media, and mobile within the isthmus lumen. Color flow mapping revealed no differences in blood flow velocity on both sides of the disrupted aortic wall with turbulent flow surrounding the traumatic tear. Symmetric or asymmetric localized aortic enlargement reflecting the adventitia under tension was also noted. This type of lesion requires prompt surgical repair. In contrast. intimal aortic tears appeared as very mobile thin appendages of the aortic wall. Color flow mapping demonstrated a localized mosaic of colors reflecting blood flow turbulence around the intimal laceration, Aortic diameter remained unchanged, since the tear was too small and superficial to induce adventitial distention. Since these lesions appear to regress spontaneously, conservative management and TEE follow-up was undertaken. TEE failed to diagnose a two-millimeter long medial aortic rupture with integrity of the adventitia (demonstrated at necropsy). Aortography must be obtained when the TEE study is equivocal or when a laceration of the aortic arch and the brachiocephalic arteries is suspected. Conclusions In this study, transesophageal echocardiographic and anatomic findings in patients with traumatic aortic rupture were strongly correlated. In experienced hands, TEE can be considered as an accurate firstline imaging technique for the diagnosis and management of traumatic aortic rupture.

ObjectiveTo assess whether LV mechanical dyssynchrony may be used to predict response to CRT in patients with narrow QRS complex (15% in 66%, 92/139) correlated with SDI (r=0.41, p15% in 39% (25/41) failed to correlate with mechanical dyssynchrony before CRT. Importantly, increase in QRS duration after CRT in narrow QRS population was associated with adverse remodeling (r=0.43, p=0.01) and tended to correlate with an increase in SDI after CRT (r=0.32, p=0.08).ConclusionResponse to CRT does not correlate to the importance of mechanical dyssynchrony in narrow QRS population. The benefice of CRT despite a significant LV dyssynchrony appears counterbalanced by a significant QRS enlargement after CRT implantation in narrow QRS population.

PurposeThe aim of the study was to compare the accuracy of longitudinal diastolic velocity and strain rate (SR) obtained by tissue Doppler imaging (TDI), 2D and 3D speckle tracking in assessing left ventricular end diastolic pressure (LVEDP)MethodsLVEDP measurements were performed in 40 consecutive patients referred for coronary angiogram (mean age=60±15 years, mean EF=41±14%). A comprehensive transthoracic echocardiography (Artida, Toshiba) study was performed immediately after LVEDP measurement. Echocardiography data acquired included mitral early diastolic velocity (E) by conventional pulsed Doppler, early diastolic mitral annulus velocity by TDI (E’), and high frame rate 2 and 3D apical views. Global longitudinal SR by 2D (2DEGSR) and 3D (3DEGSR) were assessed using longitudinal strain curves from speckle tracking analysis. LV filling pressure estimated using echocardiography data (E/E’, E/2DE GSR, E/3DE GSR) were correlated to invasive LVEDP measurements.ResultOn the whole, LVEDP averaged 13mmHg (5 to 32,) and best correlated with LV filling pressure assessed by 2D speckle tracking (r2=0.65, p

IntroductionCentral venous oxygen saturation (SvO2) provides an accurate assessment of oxygen delivery and organs consumption balance, and correlate with outcome in extra cardiac shock. Its prognosis value has never been specifically validated in heart failure patients with cardiogenic shock.MethodsSvO2 was prospectively assessed in 27 patients (60±17 years, 17 male, LVEF=25±6%) admitted for heart failure with cardiogenic shock. SvO2 before and after 24 hours (24H SvO2) of intra-venous inotropic and diuretic support in patients with cardiogenic shock was compared to control subject with compensate heart failure (n=12) and to in hospital outcome (death and heart transplant).ResultsDuring hospitalisation period, major cardiovascular event occurred in 10 (36%) patients (6 deaths, 4 heart transplants). In patients with cardiogenic shock, admission SvO2 was lower than in patients with compensated heart failure (50±12, 66±6, 95% CI>58%) but increased after 24H of treatment (50±12, 59±8, p=0.002). Importantly, improvement in Sv02 at 24H (>58%, n=15) was associated with an excellent in hospital outcome (93%, 14/15), while a persistently low ScvO2 at 24H (< 58%) correlated with the occurrence of major cardiac adverse outcome (75%, 9/12).Furthermore, there was no difference regarding to clinical or echographical features between event free and poor outcome groups.ConclusionChange in SvO2 under intra-venous inotropic and diuretic treatment is a strong predictor of outcome in patients with cardiogenic shock.

Objectifs Evaluer la sensibilite des sequences de cine MR apres injection dans le diagnostic des myocardites aigues (MA) comparativement a la sequence T2 IR et a la sequence de rehaussement tardif. Materiels et methodes Trente-quatre patients (âge moyen 36 ± 13 ans), suspects de MA, ont beneficie d’une IRM cardiaque, comportant des sequences T2, cine avant injection, cine apres injection et des sequences de rehaussement tardif (RT). Une analyse qualitative et quantitative des images a ete realisee. Resultats Des hypersignaux evocateurs de MA ont ete detectes dans 50%, 12%, 23%, 91%, 97% et 82% des patients, respectivement en T2, en cine diastole pre injection, en cine systole pre injection, en cine diastole post injection, en cine systole post injection et sur le RT. Quinze % (5/34) des patients presentaient des hypersignaux sur la sequence cine post injection, non visibles sur le RT. La surface des lesions etait significativement plus elevee sur les images systoliques de la sequence cine post injection que sur le RT (3,4 ± 2 versus 2,3 ± 1 cm2 ; P Conclusion Comparativement a la sequence classique de RT, la sequence de cine MR apres injection semble performante dans le diagnostic des patients suspects de MA.

Objectifs Connaitre les differentes modalites de post-traitement utiles en scanner cardiaque. Savoir rediger un compte rendu d’imagerie cardiaque. Savoir decrire une lesion atheromateuse coronaire. Savoir analyser les parametres de taille, de volume et de fonction des cavites cardiaques. Messages a retenir Le post-traitement en imagerie cardiaque est une etape essentielle de l’interpretation des examens d’imagerie cardiaque mais est consommatrice de temps medecin. Une acquisition de bonne qualite, dependante de la synchronisation ECG, facilite le post-traitement. Le mode de reconstruction 2D curviligne est indispensable pour l’evaluation du degre de stenose coronaire. Les comptes rendus doivent mentionner : les parametres d’injection, l’utilisation eventuelle de beta-bloquants, la presence d’artefacts (techniques ou lies au patient dont la presence de calcifications), les eventuels segments coronaires non analysables, et la dose d’irradiation. Le compte rendu doit aussi preciser : la FEVG (et eventuellement les volumes ventriculaires gauches systolique et diastolique), les diametres VG et l’epaisseur des parois myocardiques. Resume De la qualite d’acquisition des images dependent la fiabilite et la rapidite du post-traitement en scanner comme en IRM. En scanner cardiaque, les modes de visualisation 3D servent essentiellement a l’identification des differentes arteres coronaires et a la determination de la dominance. La selection de la phase optimale precede l’etape d’analyse des arteres coronaires qui utilise principalement le mode 2D curviligne avec etude du grand axe et du petit axe. L’etude des bifurcations requiert une attention particuliere et necessite l’analyse d’images MPR obliques et MIP fins. La quantification des stenoses decoule des mesures de surface et de diametre minimal de la lumiere du vaisseau. Une surface luminale inferieure a 6 mm2 pour le tronc commun gauche, et inferieure a 4 mm2 pour les troncs coronaires epicardiques definissent une stenose significative. La description des stenoses de bifurcation releve d’une classification specifique. L’analyse d’un scanner cardiaque ne doit pas se limiter a l’etude des arteres coronaires. Une etude cinetique des cavites cardiaques et des parois myocardiques et de l’ensemble des structures thoraciques extra-cardiaques (mediastin, poumon et plevre) doit etre systematique.

Objectifs Connaitre la gamme diagnostique des masses cardiaques. Savoir differencier un thrombus d’une tumeur intracardiaque. Connaitre l’aspect IRM et TDM des lesions les plus frequentes. Messages a retenir Les thrombus intracardiaques sont les lesions les plus frequemment rencontree. Le myxome de l’oreillette gauche est la tumeur benigne la plus frequente. Les metastases cardiaques sont plus frequentes que les tumeurs malignes primitives. La recherche d’une prise de contraste est un element cle du diagnostic radiologique. Resume La caracterisation d’une masse intracardiaque est une demande courante en imagerie de coupe. L’IRM est une technique pertinente pour etudier une masse cardiaque du fait de sa resolution en signal eleve. Elle permet notamment de rechercher des composants specifiques dans la lesion (graisse), d’etudier sa mobilite avec des sequences cine MR et d’analyser son rehaussement dynamique et tardif. Un thrombus est en general avasculaire (sauf exception). Le scanner offre un moins bon contraste tissulaire mais du fait de sa resolution spatiale elevee permet de mieux preciser les rapports anatomiques d’une lesion (coronaires, pericarde). Ces 2 examens peuvent donc s’averer complementaires.