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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]

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: Classical fluoroscopic criteria for the documentation of septal right ventricular (RV) lead positioning have poor accuracy. We sought to evaluate the individualized left anterior oblique (LAO) projection as a novel fluoroscopy criterion.Methods: Consecutive patients undergoing pacemaker or defibrillator implantation were prospectively included. RV lead positioning was assessed by fluoroscopy using posteroanterior, right anterior oblique 30° to rule out coronary sinus positioning, and LAO 40° in the classical group or individualized LAO in the individualized group. Individualized LAO was defined by the degree of LAO that allowed the perfect superposition of the RV apex (using the tip of the RV lead temporarily placed at the apex) and of the superior vena cava-inferior vena cava axis (materialized by a guidewire), hence providing a true profile view of the interventricular septum. Accuracy of fluoroscopy for RV lead positioning was then assessed by comparison with true RV lead positioning using transthoracic echocardiography.Results: We included 100 patients, 50 in each study group. Agreement between RV lead septal/free wall positioning in transthoracic echocardiography and fluoroscopy was excellent in the individualized group (k=0.91), whereas it was poor in the classical group (k=0.35). Septal/free wall RV lead positioning was correctly identified in 48/50 (96%) patients in the individualized group versus 38/50 (76%) in the classical group (P=0.004). For septal lead positioning, fluoroscopy had 100% Se and 89.5% Sp in the individualized group versus 91.4% Se and 40% Sp in the classical group. Complications and procedural data were comparable in both groups.Conclusion: Individualized LAO is a quick and highly reliable patient-tailored fluoroscopy projection for RV lead positioning. [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]

BackgroundCardiac involvement is central in MIS-C and represents the main cause of morbidity. In this study, we aimed to assess myocardial damage in patients with MIS-C using cardiac magnetic resonance (CMR) during the acute phase, as well as left ventricular and atrial longitudinal strain on admission, at discharge, and after 3 months.MethodsWe performed a single-center prospective cohort study and case–control study. Between September 2020 and February 2022, we enrolled 39 patients hospitalized for MIS-C at our center. We performed left ventricular and atrial longitudinal 2D strain analysis on admission and during follow-up; echocardiographic data were compared to a matched control population. Patients above 4 years old with increased troponin underwent CMR.ResultsOf 24 patients (mean age: 8.2 ± 4.9 years) who underwent CMR, 14 (58%) presented myocardial edema and 6 (25%) late gadolinium enhancement (LGE). LGE was associated with older age (p

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]