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Background Myocardial Tuberculosis (MT) is exceedingly rare. We aimed to report on myocardial involvement in tuberculosis (TB). Methods All adult patients admitted in a department of Internal Medicine over an 8-year period with microbiologically proven MT were retrospectively reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. Results Six patients (4 women, 37.6 [21.3–62.1] years) with MT were identified. MT included cardiac mass (n = 1), coronaritis (n = 1), left ventricle spontaneous rupture (n = 1) and myocarditis (n = 3). Pericardial effusion was associated with myocardial involvement in 2 cases. Four patients presented with acute heart failure. CRP serum level was high in all cases. The mean delay between the first symptoms and TB diagnosis was of 6 [1–44] months. The time from admission to diagnosis was of 18 (9–28) days. No patient had human immunodeficiency virus infection. Fluorodeoxyglucose - positron emission tomography (FDG-PET) detected extra-cardiac asymptomatic Mycobacterium tuberculosis infection localization and guided biopsy in 5 cases. As compared to TB patients without cardiac involvement, patients with MT were younger and more frequently women. All patients received antituberculosis therapy for 7.5 to 12 months associated with steroids for at least 6 weeks. Cardiac surgery was required in all but one patient. No patient died over a median follow-up of 1.2 [0.2–4.4] years. Conclusion Our study emphasizes the clinical spectrum of life-threatening MT. Early diagnosis using FDG-PET imaging to target biopsy in extra-cardiac tissues and combined treatment strategy associating antituberculosis therapy, corticosteroids and surgery prevent complications and death.

Automated segmentation of three-dimensional (3D) aortic magnetic resonance imaging (MRI) renders a possible retrospective selection of any location to perform quantification of aortic caliber perpendicular to its centerline and provides regional and global 3D biomarkers such as length, diameter, or volume. However, normative age-related values of such measures are still lacking. The aim of this study was to provide normal values for 3D aortic morphological measures and investigate their changes in aging and hypertension. This was a retrospective study, in which 119 healthy controls (HC: 48 ± 14 years, 61 men) and 82 hypertensive patients (HT: 60 ± 14 years, 43 men) were enrolled. 1.5 and 3 T/3D steady state free precession or spoiled gradient echo were used. Automated 3D aortic segmentation provided aortic length, diameter, volume for the ascending (AAo), and descending aorta (DAo), along with cross-sectional diameters at three aortic landmarks. Age, sex, body surface area (BSA), smoking, and blood pressures were recorded. Both groups were divided into two subgroups (≤50 years,50 years). Statistical tests performed were linear regression for age-related normal values and confidence intervals, Wilcoxon rank sum test for differences between groups (HC or HT), and multivariate analysis to identify main determinants of aortic morphological changes. In HC, linear regression revealed an increase in the AAo (respectively DAo) length by 2.84 mm (7.78 mm), maximal diameter by 1.36 mm (1.29 mm), and volume by 4.28 ml (8.71 ml) per decade. AAo morphological measures were higher in HT patients than in HC both ≤50 years but did not reach statistical significance (length: +2 mm, p = 0.531; diameter: +1.4 mm, p = 0.2936; volume:+6.8 ml, p = 0.1857). However, length (+6 mm, p = 0.003), maximal diameter (+4 mm, p 0.001) and volume (+12 ml, p 0.001) were significantly higher in HT patients than in HC, both50 years. In a multivariate analysis, age, sex, and BSA were the major determinants of aortic morphology, irrespective of the presence of hypertension. Global and segmental aortic length, volume, and diameters at specific landmarks were automatically measured from 3D MRI to serve as normative measures of 3D aortic morphology. Such indices increased significantly with age and hypertension among the elderly subjects. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 3.

Objective To evaluate the diagnostic performance of the initial chest CT to diagnose COVID-19 related pneumonia in a French population of patients with respiratory symptoms according to the time from the onset of country-wide confinement to better understand what could be the role of the chest CT in the different phases of the epidemic. Material and method Initial chest CT of 1064 patients with respiratory symptoms suspect of COVID-19 referred between March 18th, and May 12th 2020, were read according to a standardized procedure. The results of chest CTs were compared to the results of the RT-PCR. Results 546 (51%) patients were found to be positive for SARS-CoV2 at RT-PCR. The highest rate of positive RT-PCR was during the second week of confinement reaching 71.9%. After six weeks of confinement, the positive RT-PCR rate dropped significantly to 10.5% (p Conclusion At the peak of the epidemic, chest CT had sufficiently high sensitivity and PPV to serve as a first-line positive diagnostic tool but at the end of the epidemic wave CT is more useful to exclude COVID-19 pneumonia.

Case Presentation A 56-year-old man was admitted to the ICU with chest pain, cough, hemoptysis, increasing dyspnea, and orthopnea for 1 week. The patient reported an 8-kg weight loss over the last month and recurrent wheezing episodes for approximately 1 year. He had a history of tobacco smoking and excessive alcohol consumption, both of which he stopped 15 years ago. His medical history included high BP treated with amlodipine and an episode of drug-induced angioedema 8 years ago. He had no history of recent travel.

Ascending aorta (AA) dilatation is common in aortic valve stenosis (AS) but data regarding AA progression, its determinants and impact of valve anatomy [bicuspid (BAV), or tricuspid (TAV)] are scarce.Asymptomatic AS patients enrolled in a prospective cohort (COFRASA/GENERAC) with at least 2 years of follow-up were considered in the present analysis. A transthoracic echocardiography (TTE) and a computed tomography (CT) scan were performed at inclusion and yearly thereafter. We enrolled 195 patients [mean gradient 22 ± 11 mmHg, 42 BAV patients (22%)]. Mean aorta diameters assessed using TTE were 35 ± 4 and 36 ± 5 mm at the sinuses of Valsalva and tubular level, respectively. Ascending aorta diameter was40 mm in 29% of patients (24% in TAV vs. 52% in BAV, P 0.01). Determinants of AA diameters were age, sex, BSA, and BAV, but not AS severity. After a mean follow-up of 3.8 ± 1.5years, AA enlargement rate assessed using TTE was +0.18 ± 0.34 mm/year and +0.36 ± 0.54 mm/year at the Valsalva and tubular level, respectively. Determinants of the progression of AA size were smaller AA diameter (P 0.01) but not baseline AS severity or valve anatomy (all P 0.05). Only four patients presented an AA progression ≥2 mm/year. Correlations between TTE and CT scan were excellent (all r0.74) and similar results were obtained using CT. During follow-up, two BAV patients underwent a combined AA surgery; no surgery was primarily performed for AA aneurysm and no dissection was observed.In this prospective cohort of AS patients determinants of AA diameters were age, sex, BSA, and valve anatomy but not AS severity. AA progression rates were low and not influenced by AS severity or valve anatomy.

Background Recently an increased prevalence of renal cysts has been reported in patients with aortic aneurysm or dissection. The Marfan Syndrome (MFS) is associated with severe aortic disease. Some cases of cystic lungs have been associated with MFS and one series reported an increased prevalence of hepatic cysts in MFS patients. However, no study focused on multi-organ cystic disease in this particular population. Purposes The aims of this paper were to evaluate the prevalence of renal, hepatic, and pulmonary cysts in MFS patients with FBN1 mutations as compared to matched controls without MFS and analyze the link between a cystic score, defined as 1 point for each organ with at least one cyst, and aortic surgery in MFS patients. Methods All consecutive MFS patients with a mutation in the Fibrillin-1 (FBN1) gene who underwent a CT scan were included in the study. They were matched 1:1 for age and sex with controls without MFS. Results Between 2010 and 2016, 264 patients were included in this study. The prevalence of cysts was significantly increased in MFS patients as compared with controls: 40% for renal cysts in MFS patients versus 23% in controls; P = 0.003, 21% for hepatic cysts in MFS patients versus 8% in controls; P = 0.003, and 28% for pulmonary cysts in MFS patients versus 4% in controls; P Fig. 1 ). Conclusion This study reports for the first time an increased prevalence of renal, hepatic, and pulmonary cysts in MFS patients with FBN1 mutation as compared with matched controls. About 2 out of 3 MFS patients exhibited at least 1 cyst in any of these organs, a prevalence 2 fold higher as compared with controls. In MFS patients, a higher cystic score was associated with aortic surgery and could represent a marker of severity of the disease.

Chronic Coxiella burnetii vascular infection is rare and usually develops on a pre-existing vascular lesion, such as an aneurysm or vascular prosthesis. We report a case of proven C. burnetii aortic infection revealed by a massive retroperitoneal aortoiliac aneurysm rupture in a patient at apparent low risk for chronic Q fever. Emergency treatment consisted of resection of the infected aneurysm and replacement with an in situ graft angioplasty. Doxycycline and hydroxychloroquine therapy was started postoperatively. After 6 months of follow-up, the patient had no signs of infection, and C. burnetii serologic antibody titers had significantly decreased.

Objective Aortitis is an exceedingly rare manifestation of tuberculosis. We describe 11 patients with tuberculous aortitis (TA). Methods Multicenter medical charts of patients hospitalized between 2003 and 2015 with TA in Paris, France, were reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. TA was considered when aortitis was diagnosed in a patient with active tuberculosis. Results Eleven patients (8 women; median age, 44.6 years) with TA were identified during this 12-year period. No patient had human immunodeficiency virus infection. Tuberculosis was active in all cases, with a median delay of 18 months between the first symptoms and diagnosis. At disease onset, vascular signs were mainly claudication, asymmetric blood pressure, and diminished distal pulses. Constitutional symptoms or extravascular signs were present in all patients at some point. Aortic pseudoaneurysm was the most frequent lesion, but three patients had isolated inflammatory aortic stenosis. TA appeared as extension from a contiguous infection in only three cases. Tuberculosis was considered because of clinical features, tuberculin skin or QuantiFERON-TB Gold (Quest Diagnostics, Madison, NJ) test results, pathologic findings, and improvement on antituberculosis therapy. A definite Mycobacterium tuberculosis identification was made in only three cases. All patients received antituberculosis therapy for 6 to 12 months. Surgery including Bentall procedures, aortic bypass, and open abdominal aneurysm repair was performed at diagnosis in eight patients. Seven patients received steroids as an adjunct therapy. All patients clinically improved under treatment. No patients died for a median follow-up duration of 4 years. Conclusions TA may result in aneurysms contiguous to regional adenitis but also in isolated inflammatory aortic stenosis. Steroids may be associated with antituberculosis therapy for inflammatory stenotic lesions. Surgery is indicated for aneurysms and in case of worsening stenotic lesions despite anti-inflammatory drugs. No patient died after such combined treatment strategy.

Clinical presentation of acute myocarditis is heterogeneous and often leads to coronary angiography to rule out acute coronary syndrome (ACS). Noninvasive evaluation relies on cardiac magnetic resonance (CMR), with late gadolinium enhancement (LGE) being one of the main parameters [(1)][1]. However

The presence of aortic valve calcifications has been known for many years, but knowledge of their development and relationship with aortic valve stenosis is relatively recent and has been studied extensively with the use of multislice CT (MSCT). The calcium burden shown with MSCT is well correlated with the degree of hemodynamic severity and anatomic surface of aortic stenosis. MSCT is also useful for monitoring valvular calcifications, by evaluating the progression of the disease and the effect of treatments. In parallel, simultaneous MSCT assessment of coronary artery and mitral valve calcifications can help achieve a better overview of the risks of cardiovascular events in these patients.

Objectives Dural ectasia is a major criterion for Marfan syndrome (MFS) diagnosis. However, its definition remains fuzzy with studies on small sample size reporting different criteria to differentiate between Marfan and controls. Methods All MFS patients with a mutation in the Fibrillin-1 gene who underwent a complete CT scan in our center were included in the study. They were matched 1:1 for age and sex with controls and all the measurements of dural ectasia were assessed. Results Between 2010 and 2016, 96 MFS patients and their matched controls were included. Mean age was 38 ± 14 years with 44% of women. According to the 3 validated definitions of the literature, the area under the curve (AUC) of ROC curves for Marfan diagnosis in our population, were 0.65, 0.61 and 0.71 respectively, with a good sensitivity (72–96%) but a poor specificity (25–64%). We performed an ANOVA followed by a logistic regression on all measurements to build a composite criterion for dural ectasia. Based on this method, we found 6 simple parameters to be measured on CT-scan to allow for MFS diagnosis: sensitivity 87%, specificity 94% and AUC 0.91. We also used a modern approach of machine learning using Decision Tree Algorithm, which showed excellent performance: Sensitivity 97%, specificity 98% and AUC 0.97. Conclusion Given the importance of an early diagnosis in MFS and the delay for genetic diagnosis (2–3 years), other criteria are mandatory. We offer here both a classic and modern approaches to help for MFS diagnosis based on a CT-scan.

Objectives We sought to compare 3 methods of measurements of the aortic annulus, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT), and to evaluate their potential clinical impact on transcatheter aortic valve implantation (TAVI) strategy. Background Exact measurement of the aortic annulus is critical for a patient9s selection and successful implantation. Methods Annulus diameter was measured using TTE, TEE, and MSCT in 45 consecutive patients with severe aortic stenosis referred for TAVI. The TAVI strategy (decision to implant and choice of the prosthesis9 size) was based on manufacturer9s recommendations (Edwards-Sapien prosthesis, Edwards Lifesciences, Inc., Irvine, California). Results Correlations between methods were good but the difference between MSCT and TTE (1.22 ± 1.3 mm) or TEE (1.52 ± 1.1 mm) was larger than the difference between TTE and TEE (0.6 ± 0.8 mm; p = 0.03 and p Conclusions In patients referred for TAVI, measurements of the aortic annulus using TTE, TEE, and MSCT were close but not identical, and the method used has important potential clinical implications on TAVI strategy. In the absence of a gold standard, a strategy based on TEE measurements provided good clinical results.

severe repolarization abnormalities occur. However, the reversible nature of the syndrome seems not to justify systematic implantation of PPM or ICD in patients who experienced LTA during hospitalization. Theauthorsof thismanuscripthave certified that theycomplywith the Principles of Ethical Publishing in the International Journal of Cardiology. Supplementary data to this article can be found online at http:// dx.doi.org/10.1016/j.ijcard.2012.09.107.

Background For transcatheter aortic valve implantation (TAVI), transesophageal echocardiography (TEE) and multislice computed tomography (MSCT) measurements of the aortic annulus diameter (AAD) are often regarded as competitive. We evaluated if 1 MSCT method could be interchangeable with TEE measurements. Methods We compared AAD measurements performed using TEE, MSCT, and transthoracic echocardiography (TTE) in 129 consecutive patients with severe aortic stenosis (AS) who were referred for TAVI. Using MSCT, AAD was measured in the 3-chamber (3C) view and at the level of the virtual basal ring (mean diameter [MD] of the long-axis [LA] and short-axis [SA] diameters, and AAD derived from the cross-sectional area [CSA] and the circumference). Correlations with echocardiographic measurements and agreement regarding the TAVI strategy (decision to implant and choice of prosthesis size based on manufacturer cutoff recommendations) were assessed. Results AAD measured in 3C (intraclass correlation [ICC], 0.79) and MD emphasizing the weight of the SA (MD4 [3 SA + LA/4]; ICC, 0.76) and MD5 [4 SA + LA/5; ICC, 0.75]) provided the highest correlation and the best agreement with TEE (kappa = 0.47, 0.27, and 0.31 respectively). However, TTE provided a better a correlation and agreement with TEE than all MSCT methods (ICC, 0.87; kappa=0.66). The agreement between MSCT and TEE varied with AAD eccentricity and degree of aortic valve calcification (AVC), but in all subsets, values observed with MSCT never reached those observed with TTE. Conclusions MSCT and TEE are measuring different landmarks and consequently MSCT and TEE measurements are not interchangeable. Prospective randomized studies aimed at defining which method provides the best clinical results are clearly needed.

A 36-year-old man implanted with pulmonary homograft (Ross procedure) for rheumatic heart disease was admitted for a suspicion of prosthetic valve endocarditis (PVE) in presence of fever persisting 2 weeks after the onset of acute pneumonia treated by antibiotics. Echocardiography evidenced a degenerative pulmonary homograft with severe regurgitation, stenosis, and the presence of small mobile elements appended to thickened and calcified cusps. 18F-fluorodeoxyglucose positron emission …

The use of 18F-fluoro-deoxyglucose positron emission tomography scan (FDG-PET) and computed tomography angiography (CTA) to improve accuracy of diagnosis of giant cell arteritis (GCA) is a very important clinical need. We aimed to compare the diagnostic performance of FDG-PET and CTA in patients with GCA.FDG-PET and CTA were acquired in all consecutive patients suspected for GCA. Results of FDG-PET and CTA were compared with the final diagnosis based on clinical judgment, temporal artery biopsy (TAB) findings, and ACR criteria. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for each method.Twenty-four patients suspected for GCA were included. Fifteen (62.5%) were ultimately diagnosed as having GCA. Among them, all fulfilled ACR criteria and 6 had biopsy-proven GCA. Strong FDG uptake in large vessels was found in 10 patients who all had GCA. Mean maximal standard uptake values (SUVmax) per patient measured at all the arterial territories were of 3.7 (range: 2.8-4.7). FDG uptake was negative in 14 patients including 9 and 5 patients without and with GCA, respectively. Mural thickening suggestive of aortitis or branch vessel arteritis was observed on CTA in 11 patients with and 2 patients without GCA. No mural thickening was observed in 11 patients including 7 patients without and 4 patients with GCA. Overall, sensitivity was 66.7% and 73.3%, specificity was 100% and 84.6%, NPV was 64.3% and 64.6%, and PPV was 100% and 84.6% of FDG-PET and CTA, respectively.Both FDG-PET and CTA have a strong diagnostic yield for the diagnosis of GCA. FDG-PET appeared to have a higher PPV as compared to CTA and may be the preferred noninvasive technique to explore patients with suspected GCA.

Background Diagnosis of giant cell arteritis (GCA) is still a challenge. 18F-fluoro-deoxyglucose positron emission tomography scan (FDG-PET) and computed tomography angiography (CTA) are promising imaging techniques for the detection of GCA Objectives To compare the diagnostic performance of FDG-PET and CTA in patients with giant cell arteritis (GCA). Methods FDG-PET and CTA were acquired in 24 consecutive patients in whom temporal artery biopsy (TAB) was performed for suspected GCA. Results of FDG-PET and CTA were compared with the final clinical diagnosis based on a) the American College of Rheumatology GCA criteria set, b) clinical judgment including outcome under corticosteroids, and c) the absence of an alternative diagnosis after a 6 months follow-up. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for each method. Results Fifteen of the 24 patients (62.5%) were ultimately diagnosed as having GCA. Strong FDG uptake in large vessels was found in 10 patients who all had GCA. Mean maximal standard uptake values (SUVmax) per patient measured at all the arterial territories were of 3.7 [range: 2.8–4.7]. FDG uptake was negative in 14 patients including 9 and 5 patients without and with GCA, respectively. Mural thickening suggestive of aortitis or branch vessel arteritis was observed on CTA in 11 patients with and 2 patients without GCA. No mural thickening was observed in 11 patients including 7 patients without and 4 patients with GCA. Overall, sensitivity of FDG-PET and CTA was 66.7% and 73,3%, respectively; specificity was 100% and 84.6%, NPV was 64.3% and 64.6%, and PPV was 100% and 84.6%, respectively. Conclusions Both FDG-PET and CTA have a strong diagnostic yield for the diagnosis of GCA. FDG-PET appeared to have a higher PPV as compared to CTA and may be the preferred noninvasive technique to evaluate patients with suspected GCA. Disclosure of Interest None declared

Over the last 20 years, diagnostic cross-sectional imaging of arterial diseases has become less and less invasive, with the advent of MR angiography (MRA) and CT angiography (CTA). However, with the increasing proportion of elderly patients, some precautions are needed to avoid the two main complications of these techniques: development of nephrogenic systemic fibrosis with the former, and aggravation of a preexisting renal insufficiency with the latter. Moreover, CT angiography is inevitably associated with a high radiation dose that is problematic when younger patients need to be examined and monitored for various artery diseases (for example, patients with Marfan disease, Takayasu arteritis…). All the manufacturers have attempted during the 3 last years to find solutions in order to decrease potential hazards due to contrast medium administration with either CT or MR, and to reduce radiation dose with

Aims: Vascular complications remain the main limitation of transfemoral aortic valve implantation. Based on a single-centre experience, we aim to detail the type, management and impact of those vascular complications. Methods and results: From October 2006 to January 2009, 54 transfemoral aortic valve implantations were performed using the Edwards SAPIEN™ prosthesis. Nine patients (16.7%) developed vascular complications. Five patients (9.3%) had ruptures which necessitated a surgical bypass. Four patients (7.4%) had dissection necessitating repair using stenting in all four patients and associated bypass in two of them. Vascular complications led to death in one patient (1.9%), reintervention in one (1.9%), and transfusions in seven (13%). Five vascular complications occurred in the first 20 patients (25%), and only four in the last 34 (12%). Conclusions: Vascular complications of transfemoral aortic valve implantation are frequent and seem to be influenced by experience. They are associated with a high need for transfusion and could lead to major events such as death or reintervention. These findings highlight the importance of a multidisciplinary approach for patient selection and management of the procedure.

Delayed enhancement MR sequences (DE) are recognized as highly sensitive to detect recent and chronic myocardial infarction (MI) by visualizing contrast media accumulation in infarcted segments. Diffusion-weighted imaging (DWI) has recently been implemented in order to depict infarct-related myocardial edema and/or necrosis as a marker of acute but not chronic myocardial injury.