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With the expansion of the indication for transcatheter aortic valve implantation (TAVR), the value of access to on-site emergency heart surgery at performing centers needs to be assessed.To evaluate postoperative mortality after surgical rescue post-TAVR, in a population at high surgical risk.Retrospective analysis of a cohort of patients included in the France-TAVI registry who had undergone TAVR with the latest generation valves between January 2017 and February 2020.Among the 968 patients undergoing TAVR, 6 patients (0.62%) were identified as candidates for surgery: 3 in the peri-operative context and 3 during hospitalization. Four subjects were managed in a salvage situation, two due to tamponade, one due to aortic dissection, and one due to aortic annulus rupture. One patient died of a delayed aortic annulus rupture and one patient presented a right coronary occlusion which was medically treated. All patients who underwent emergency surgery were discharged alive from the hospital.In TAVR patients initially contraindicated for surgery, emergency bailout surgery could be performed successfully with all patients discharged alive. Access to on-site heart surgery represents a life-saving resource for TAVR centers.

Sarcopenia in heart failure (HF) is associated with severe outcomes, increased mortality, and high healthcare cost burden. Systematic muscle screening in patients with chronic HF would improve quality and appropriateness of care. Here we tested handgrip strength (HGS) as a screening tool for sarcopenia in patients with chronic HF, using the EWGSOP 2010 and 2019 reference-standard definitions of sarcopenia.HF inpatients, aged 65 years old or above, were prospectively included between November 2014 and September 2018, and relevant sociodemographic, anthropometric and HF characterization data was collected. The accuracy of HGS as a screening test for sarcopenia was assessed by gender using area under the receiver operating characteristic (ROC) curves (AUC).The population consisted of 118 older patients (age: 78.9 yrs; BMI: 26.6 kg/mHGS can be used as a valid tool to screen for sarcopenia in older (≥65 yrs) patients with chronic HF.NCT03153774.

International audience; Background & aims: Sarcopenia is a multifactorial syndrome resulting in a decrease in both muscle mass and function. Little is known about the prevalence and prognostic impact of sarcopenia in patients with acutely decompensated chronic heart failure (ADHF). We aimed to evaluate the prevalence (main endpoint) and impact of sarcopenia on ADHF patients.Methods: 140 ADHF patients were enrolled between November 2014 and September 2018 in a multi-center prospective longitudinal study. A similar, independent multi-departmental cross-sectional study in 165 ADHF patients was used for external validation of prevalence data. All subjects were assessed on the European Working Group on Sarcopenia criteria.Results: Ninety-one patients (65%) had sarcopenia (vs. 53.6% in the external replication regional cohort). Patients with sarcopenia were older and more likely to have eGFR

Background The access of obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis. The aim of this study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes. Methods We carried out a prospective cohort study using two French registries, the Renal Epidemiology and Information Network and CRISTAL, on 7270 kidney transplant patients between 2008 and 2014 in France. We compared obese patients with non-obese patients and obese patients who lost more than 10% of weight before the transplant (obese WL and obese nWL). Results The mean BMI in our obese patients was 32 kg/m2. Graft survival was lower in obese patients than in non-obese patients {hazard ratio (HR) = 1.40, [95% confidence interval (95% CI) 1.09; 1.78], P = 0.007}, whereas patient survival was similar [HR = 0.94, (95% CI 0.73; 1.23), P = 0.66]. Graft survival was significantly lower in obese WL than in obese nWL [HR = 2.17, (1.02; 4.63), P = 0.045], whereas patient survival was similar in the two groups [HR = 0.79, (0.35; 1.77), P = 0.56]. Conclusion Grade 1 obesity does not seem to be a risk factor for excess mortality after kidney transplantation and should not be an obstacle to having access to a graft. Weight loss before a kidney transplant in these patients should not be essential for registration on waiting list.

Background Chronic heart failure (CHF) is one of the most common causes of mortality in industrialized countries despite regular therapeutic advances. Numerous factors influence mortality in CHF patients, including nutritional status. It is known that malnutrition is a risk factor for mortality, whereas obesity may play a protective role, a phenomenon dubbed the “obesity paradox”. However, the effect of the obesity-malnutrition association on mortality has not been previously studied for CHF. Our aim was to study the effect of nutritional status on overall mortality in CHF patients. Methods This retrospective, multicenter study was based on a French nationwide database (PMSI). We included all CHF patients aged ≥18 years admitted to all public and private hospitals between 2012 and 2016 and performed a survival analysis over 1 to 4 years of follow-up. Results Malnutrition led to a significant decrease in life expectancy in CHF patients when compared with normal nutritional status (aHR=1.16 [1.14-1.18] at one year and aHR=1.04 [1.004-1.08] at four years), obese, and obese-malnutrition groups. In contrast, obesity led to a significant increase in life expectancy compared with normal nutritional status (aHR=0.75 [0.73-0.78] at one year and aHR=0.85 [0.81-0.90] at four years), malnutrition, and obese-malnutrition groups. The mortality rate was similar in patients presenting both malnutrition and obesity and patients with normal nutritional status. Conclusions Our results indicate that the protective effect on mortality observed in obese CHF patients seems to be linked to fat massincrease. Furthermore, malnourished obese and normal nutritional status patients had similar mortality rates. Further studies should be conducted to confirm our results and to explore the physiopathological mechanisms behind these effects.

In recent years, transcatheter aortic valve implantation (TAVI) without predilation (direct TAVI) has become the preferred method for implanting TAVI prostheses. Appropriate patient selection is important to avoid suboptimal outcomes and associated complications.To evaluate whether aortic valve calcification measured with computed tomography predicts suboptimal results from direct TAVI with a self-expanding prosthesis.Single-centre retrospective analysis of patients who received a CoreValve™ prosthesis (Medtronic, Minneapolis, MN, USA) in a direct TAVI procedure between January 2018 and March 2019. Aortic valve calcification assessment (aortic valve calcium score, calcium volume and calcium mass) was calculated from the computed tomography scan before TAVI. Procedural characteristics, need for postdilation and complications were analysed.Of 168 included patients, 18 were postdilated. Aortic valve calcium score (4259 vs. 2578; P0.001), calcium volume (1184 vs. 647mmA high aortic valvular calcium score, assessed by computed tomography scan, is an independent predictor of suboptimal prosthesis implantation outcomes in direct TAVI.

Background Myocarditis is a known cause of sudden cardiac death of the athlete. The impact of direct chest trauma in at-risk sports or activities in patients with a history of myocarditis has never been demonstrated or studied. We report herein two cases of life-threatening ventricular arrhythmia secondary to non-penetrating blunt chest trauma while playing contact sports. Case summary The first patient, a 26-year-old man described a brief loss of consciousness after having received blunt impact to the chest (typical intensity) while playing a rugby match. The loss of consciousness was total and proceeded by rapid and regular palpitations. He had a history of viral myocarditis 10 years prior with a fibrotic sequalae in the inferolateral wall on cardiac magnetic resonance imaging (left ventricular ejection fraction 71%). Right apical ventricular pacing induced a sustained monomorphic ventricular tachycardia reproducing the patient’s symptoms. A subcutaneous implantable cardioverter-defibrillator was implanted. The second patient is a 22-year-old professional rugby player with no known notable history. During a match, a direct blow to the chest wall was followed by a cardiac arrest. A ventricular fibrillation was cardioverted to pulseless electrical activity. Patient died despite cardiopulmonary resuscitation. An autopsy identified a myocardial sequela of fibrosis with no acute inflammatory remodelling compatible with a previous myocarditis. Discussion Myocarditis may increase the risk of life-threatening ventricular arrhythmias caused by blunt impact to the chest, particularly in contact sports. Screening and prevention measures should be considered to reduce this risk.

Many inherited metabolic diseases (IMD) have cardiac manifestations. The aim of this study was to estimate the prevalence of IMD in adult patients with hypertrophic cardiomyopathy (HCM) and cardiac rhythm abnormalities that require cardiac implantable electronic devices (CIEDs). The study included a review of the medical files of patients aged 18 to 65 years who were followed in our cardiology department during the period 2010&ndash, 2017. Metabolic explorations for Fabry disease (FD), mitochondrial cytopathies, and fatty-acid metabolism disorders were carried out in patients with unexplained etiology. The prevalence of IMD in patients with HCM was 5.6% (confidence interval (CI): 2.6&ndash, 11.6). Six cases of IMD were identified: 1 mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome, 1 Hurler syndrome, 2 Friedreich&rsquo, s ataxia, 1 FD, and 1 short-chain acyl-CoA dehydrogenase deficiency. Three cases of IMD were identified in patients requiring CIEDs: 1 patient with Leber hereditary optic neuropathy, 1 FD, and 1 short chain acyl-CoA dehydrogenase (SCAD) deficiency. IMD prevalence in patients with CIEDs was 3.1% (CI: 1.1&ndash, 8.8). IMD evaluation should be performed in unexplained HCM and cardiac rhythm abnormalities adult patients, since the prevalence of IMD is relatively important and they could benefit from specific treatment and family diagnosis.

Cardiac fibrosis is associated with heart failure and poor prognosis. Fibrosis biomarkers have been poorly evaluated as a tool to predict cardiac resynchronization therapy (CRT) response generating conflicting results. The present study assessed the predictive value of cardiac fibrosis biomarkers on CRT response. Patients underwent clinical examination, echocardiography and blood fibrosis biomarker evaluation prior to CRT implantation. At six months, a positive response to CRT was defined by a composite endpoint of no death or hospitalization for heart failure, and presence of left ventricular (LV) reverse remodeling (decrease in LV end-systolic volume ≥15%). Sixty patients were included in a multicenter study. At 6 months, 38 were positive responders to CRT and reached the response criteria (63%). Compared to non-responders, CRT responders displayed lower concentration levels of the fibrosis biomarkers procollagen type I C-terminal propeptide [PICP 135[99–166] ng/ml vs. 179[142–226]ng/ml, p = 0.001)] and procollagen type III N-terminal propeptide [PIIINP 5.50[3.66–8.96] ng/ml vs. 8.01[5.01–11.86]ng/ml, p = 0.014)] at baseline. In multivariate analysis, a PICP ≤ 163 ng/ml was associated with a positive CRT response [OR = 7.8(1.3–46.7), p = 0.023] independently of the presence of LBBB, QRS duration, LV lead position or non-ischemic cardiomyopathy. Altogether, the present findings show that a lower degree of cardiac fibrosis is associated with a positive response after CRT implantation. PICP evaluation before CRT implantation could help improve patient selection.

Summary Background Immediate improvement in kidney function has been reported after surgical aortic valve replacement or transcatheter aortic valve implantation. Long-term data, however, are not available. Aim To assess the evolution of kidney function in chronic kidney disease stage 3b–5, 1 year after surgical aortic valve replacement or transcatheter aortic valve implantation. Methods All patients with chronic kidney disease stage 3b–5 undergoing surgical aortic valve replacement or transcatheter aortic valve implantation for aortic stenosis in a single centre were included. Kidney function was assessed 1 year postprocedure. Improvement or deterioration in estimated glomerular filtration rate was defined by an increase or decrease of 5 mL/min/1.73 m2, respectively. Results Overall, 127 procedures were analysed (54 surgical aortic valve replacements and 73 transcatheter aortic valve implantations). Kidney function improved in 51% of patients at 1 year (45% of the surgical aortic valve replacement group versus 57% of the transcatheter aortic valve implantation group; P = 0.21), and deteriorated in only 14% of patients at 1 year (18% of the surgical aortic valve replacement group versus 10% of the transcatheter aortic valve implantation group; P = 0.22). Almost a quarter of patients (23%) had an improvement in estimated glomerular filtration rate of > 15 mL/min/1.73 m2, and this was consistent at later follow-up. Few patients went onto chronic dialysis at 1 year (three after surgical aortic valve replacement and one after transcatheter aortic valve implantation). Acute kidney injury was an independent prognostic factor for long-term deterioration in kidney function (odds ratio 2.1, 95% confidence interval 1.4–3.6; P = 0.006). Conclusion Aortic valve replacement, whether by surgical aortic valve replacement or transcatheter aortic valve implantation, improved estimated glomerular filtration rate at 1 year in more than half of patients with chronic kidney disease stage 3b–5.

New-onset left bundle branch block (LBBB) is a specific concern of transcutaneous aortic valve implantation (TAVI) given its estimated incidence ranging from 5% to 65%. This high rate of occurrence is dependent on the type of device used (size and shape), implantation methods, and patient co-morbidities. The appearance of an LBBB after TAVI reflects a very proximal lesion of the left bundle branch as it exits the bundle of His. At times transient, its persistence can lead to permanent pacemaker implantation in 15% to 20% of cases, most often for high-degree atrioventricular block. The management of LBBB after TAVI is currently not defined by international societies resulting in individual centers developing their own management strategy. The potential consequences of LBBB are dysrhythmias (atrioventricular block, syncope, and sudden death) and functional (heart failure) complications. Prompt postprocedural recognition and management (permanent pacemaker implantation) of patients prevents the occurrence of potential complications and may constitute the preferred approach in this frail and elderly population despite additional costs and complications of cardiac pacing. Moreover, the expansion of future indications for TAVI necessitates better identification of the predictive factors for the development of LBBB. Indeed, long-term right ventricular pacing may potentially increase the risk of developing heart failure in this population. In conclusion, it is thus imperative to not only develop new aortic prostheses with a less-deleterious impact on the conduction system but also to prescribe appropriate pacing modes in this frail population.

Introduction Sarcopenia is defined by both decrease in muscle mass and function leading to fragility and death. Early identification of sarcopenic patients may help to improve morbidity and mortality of such patients. No data are available in patients with severe aortic stenosis (AS) waiting for trans-cutaneaous aortic-valve implantation (TAVI). The objective of the present study was to evaluate the prevalence of sarcopenia and its impact in patients with severe AS. Methods In a single center prospective study, sarcopenia screening and its impact were systematically conducted in 127 patients with AS waiting for TAVI, according to the EWGSOP criteria and algorithm. Results The prevalence of sarcopenia was 53.5%. Sarcopenic patients were older (83 ± 4.9 vs. 81.3 ± 5.8 years old, P = 0.02), with a lower body mass index (26.4 ± 3.9 vs. 31.0 ± 5.8 kg/m2, P Conclusion Over 50% of patients with aortic stenosis waiting for TAVI are sarcopenic. More data and studies are needed to evaluate the benefit of TAVI in sarcopenic patients and the management of such patients.

Background Transcatheter aortic valve implantation (TAVI) has revolutionized the management of severe aortic stenosis. The development of new-onset complete left bundle branch block (LBBB) is, however, a frequent complication. The objective of the present study was to assess the impact of new-onset LBBB after TAVI on the evolution of left ventricular ejection fraction (LVEF). Methods Forty consecutive patients were included following the development of new-onset LBBB after TAVI implantation and were matched for age and LVEF with 40 patients implanted during the same period who did not develop LBBB. The primary endpoint was evolution of the LVEF measured by echocardiography prior to implantation and between 6-12 months after TAVI. Results The development of a LBBB was associated with a 5-point decrease in LVEF [− 12.5–2.5], contrary to the non-LBBB group (1.5 [− 6.5–9.5], P = 0.007) at 8 months, with the persistence of the LBBB (n = 23) exacerbating this decrease (− 7 [− 13; 2], P = 0.009). When left ventricular dysfunction (LVEF Conclusions The appearance of new-onset LBBB after TAVI has a pejorative impact on left ventricular systolic function, particularly in patients with an initial LVEF

Background Sarcopenia is a multifactorial syndrome resulting in a decrease in both muscle mass and function. It occurs with advancing age or chronic conditions such as chronic heart failure (CHF), with a negative impact on both morbidity and mortality and on the prognosis of chronic diseases. The objective of this study was to evaluate the prevalence of sarcopenia and its impact in patients with chronic heart failure. Methods In a multicenter prospective study, sarcopenia screening and its impact were systematically conducted in 140 patients with CHF, immediately after an episode of acute HF according to the EWGSOP criteria and algorithm. Results The prevalence of sarcopenia was 65% (95% CI [56.5–72.9]) and was associated with impaired functional status and autonomy. Sarcopenic patients were older (78.2 ± 9.0 vs. 71.4 ± 10.9 years, P Conclusions Our study demonstrates an excess prevalence of sarcopenia in CHF patients in the immediate aftermath of decompensation with an observed increase of other causes hospitalizations. This highlights the importance of identifying and managing this pathology in a multidisciplinary approach to improve the prognosis of these fragile patients.

Transcatheter aortic valve implantation (TAVI) has revolutionized the management of severe aortic stenosis. The development of a new-onset complete left bundle branch block (LBBB) is, however, a frequent complication. The objective of the present study was to assess the impact of a new-onset LBBB after TAVI on the evolution of left ventricular ejection fraction (LVEF).Forty consecutive patients were included after the development of a new-onset LBBB after TAVI and were matched for age and LVEF with 40 patients implanted during the same period who did not develop an LBBB. The primary endpoint was evolution of the LVEF measured by echocardiography before implantation and between 6 and 12 months after TAVI.The development of an LBBB was associated with a 5-point decrease in LVEF [-12.5; 2.5], contrary to the non-LBBB group (1.5 [-6.5; 9.5], P = 0.007) at 8 months, with the persistence of the LBBB (n = 23) exacerbating this decrease (-7 [-13; 2], P = 0.009). When left ventricular dysfunction (LVEF50%) was present before TAVI, the appearance of an LBBB was associated with a reduction in LVEF (-2 [-8; 2]) contrary to the non-LBBB group (20 [9; 22], P = 0.02).The appearance of a new-onset LBBB after TAVI has a pejorative impact on left ventricular systolic function, particularly in patients with an initial LVEF50%, due to a lack of recovery of the latter, thereby potentially affecting their prognosis.

To compare, vs CMR, four softwares: quantitative gated SPECT (QGS), myometrix (MX), corridor 4DM (4DM), and Emory toolbox (ECTb) to evaluate left ventricular ejection fraction (LVEF), end-systolic (ESV), and end-diastolic volumes (EDVs) by gated MPI CZT-SPECT. 48 patients underwent MPI CZT-SPECT and CMR 6 weeks after STEMI, LV parameters were measured with four softwares at MPI CZT-SPECT vs CMR. We evaluated (i) concordance and correlation between MPI CZT-SPECT and CMR, (ii) concordance MPI CZT-SPECT/CMR for the categorical evaluation of the left ventricular dysfunction, and (iii) impacts of perfusion defects > 3 segments on concordance. LVEF: LCC QGS/CMR = 0.81 [+ 2.2% (± 18%)], LCC MX/CMR = 0.83 [+ 1% (± 17.5%)], LCC 4DM/CMR = 0.73 [+ 3.9% (± 21%)], LCC ECTb/CMR = 0.69 [+ 6.6% (± 21.1%)]. ESV: LCC QGS/CMR = 0.90 [− 8 mL (± 40 mL)], LCC MX/CMR = 0.90 [− 9 mL (± 36 mL)], LCC 4DM/CMR = 0.89 [+ 4 mL (± 45 mL)], LCC ECTb/CMR = 0.87 [− 3 mL (± 45 mL)]. EDV: LCC QGS/CMR = 0.70 [− 16 mL (± 67 mL)], LCC MX/CMR = 0.68 [− 21 mL (± 63 mL], LCC 4DM/CMR = 0.72 [+ 9 mL (± 73 mL)], LCC ECTb/CMR = 0.69 [+ 10 mL (± 70 mL)]. QGS and MX were the two best-performing softwares to evaluate LVEF after recent STEMI.

Objective We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. Methods Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS ≥ 1, and normalization where WMS = 1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization Results At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p

SummaryBackgroundCompensatory mechanisms activated after myocardial infarction include an increase in systolic wall stress (SWS) and activation of the neurohormonal system. Nevertheless, left ventricular ejection fraction (LVEF) and infarct size are the established primary predictors of outcome after ST-segment elevation myocardial infarction.AimsTo assess the relative impact of various cardiac magnetic resonance (CMR) imaging variables, such as infarct size, LVEF and SWS, on pre- and post-discharge heart failure (HF).MethodsCMR was performed in a prospective study involving 169 patients with first ST-segment elevation myocardial infarction. Common CMR findings, such as SWS, were computed.ResultsMean SWS was 16.3±5.1×103N·m−2, and was systematically higher in patients exhibiting either pre- or post-discharge HF (18.9±5.7 and 21.3±7.6×103 N·m−2, respectively). SWS was moderately related to initial infarct size (r=0.405; P

Analysis of the causes, outcomes, and mortality of patients with severe symptomatic aortic stenosis requiring the implantation of 2 valves during transcatheter aortic valve implantation was conducted from the French Aortic National CoreValve and Edwards 2 (FRANCE2) registry. Pre- and postprocedural data from 3,919 patients from January 2010 to December 2011 (CoreValve or Edwards) were collated and analyzed. Characteristics of patients requiring immediate second valve procedures were compared with those of the other patients. The 72 patients (1.8%) who underwent implantation of a second valve were studied. Indications were device malpositioning (72%) and embolization (28%). Clinical and echocardiographic characteristics of patients receiving 2 valves were comparable with those of the other patients. The 2-year survival rate was 51.7% for patients with 2 valves as opposed to 62.3% for those with 1 valve (p0.001). The need for a second valve was an independent predictor of all-cause (hazard ratio 2.32, 95% confidence interval 1.50 to 3.60, p0.001) and cardiovascular (hazard ratio 2.64, 95% confidence interval 1.35 to 5.15, p0.001) mortality at 2 years. During follow-up, clinical and echocardiographic data remained similar between the 2 groups. In conclusion, in the FRANCE2 study, the main causes for second valve implantation during the same procedure were malpositioning and embolization. Although the procedure was feasible, it was accompanied by excess mortality. Valve hemodynamic status was preserved during the course of follow-up.

Summary Background & aims There is an increase in the number of patients worldwide with cardiac implantable electronic devices (CIEDs). Current medical practice guidelines warn against performing bioimpedance analysis (BIA) in this group of patients in order to avoid any electromagnetic interference. These recommendations restrict using the BIA in patients undergoing heart failure or with nutrition disorders in whom BIA could be of major interest in detecting peripheral congestion and to help guide treatment. The present study was conducted to evaluate whether BIA caused electromagnetic interference in patients having CIEDs. Methods Patient enrollment was conducted during routine face-to-face consultations for scheduled CIEDs interrogations. Device battery voltage, lead impedance, pacing thresholds and device electrograms were recorded before and after each BIA measurement to detect any electromagnetic interference or oversensing. Results A total of 200 patients were enrolled. During BIA, no significant changes in battery voltage, lead impedance or pacing thresholds were detected, nor were there any inappropriate over- or undersensing observed in intracardiac electrograms. Furthermore, 6- and 12-month follow-up did not reveal any changes in CIEDs. Conclusions This study shows no interference in patients equipped with CIEDs and suggests that BIA can be securely performed in these patients. Trial registered under the identifier NCT03045822 .

Background - Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited. Objectives - The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period. Methods - TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers. Results - A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium-defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p

A two-step strategy of invasive management without stenting, guided by optical coherence tomography (OCT), in selected patients with acute coronary syndrome (ACS), might avoid systematic stent implantation and allow medical therapy alone.To assess the feasibility and safety of such a procedure, and to define coronary imaging characteristics in a specific population.This single-centre proof-of-concept study included all patients with ACS who benefited from a two-step revascularization procedure with optimal reperfusion during primary percutaneous coronary intervention followed by delayed angiography and OCT. OCT imaging determined medical therapy treatment alone without stenting in case of absence of vulnerable plaque rupture and70% stenosis. Follow-up consisted of screening for major adverse cardiac events (MACE) at 12months.Forty-six patients were included, mainly men (86.9%) and smokers (65.2%), with a mean age of 47.1years. Most cases (80.4%) were large thrombus burden lesions. Delayed angiography and OCT were performed in a median period of 6 [3-10] days. No adverse events occurred between the initial and second angiograms. Plaque rupture was detected in 39.1% of patients, plaque erosion in 54.3% and calcified nodule in 6.5%. Twenty-three patients benefited from systematic delayed OCT over a median period of 171days, showing an increase in minimal lumen area. At 12months, two patients (4.3%) presented MACE and were stented. No sudden death or myocardial infarction recurrence occurred.Analysing ACS mechanisms by OCT might facilitate treatment decisions in patients with ST-segment elevation myocardial infarction managed by a two-step procedure. Conservative treatment with antithrombotic therapy without stenting seems to be a reliable option in a selected population.

Introduction Bicuspid aortic root pathology is accompanied by valve leaflet abnormality that requires repair during valve sparing root replacement (VSRR). Valve stability following VSRR, were compared between tricuspid aortic (T) and bicuspid (B) aortic valves using clinical and echocardiographic examination. Methods From January 2003 to February 2018, 140 consecutive patients (37 B and 103 T) underwent VSRR surgery. Mean age was 48.5 years in B and 59.1 years in T. All B presented NYHA functional class I or II versus 88% of T. B presented with aortic regurgitation (AR) grade III or IV in 38% versus 58% of T (P = 0,001). B had presented grade III or IV aortic regurgitation (AR) in 38% versus 58% of T. Mean left ventricular ejection fraction (LVEF) was 62% ± 8 for B versus 61% ± 9 for T (P = NS). Leaflet repair was performed in all B versus 73% of T. Other procedures were performed in 18% for T and nil for B. Patients were yearly followed by referent cardiologists. The follow-up was 96% complete with an average mean duration of 5 years (range: 6 months–14.3 years). Results In-hospital mortality was nil in B and 2% in T. On mid-term, there were no clinical and echocardiographic differences in the two groups: all B and T presented NYHA class 1 or 2, mean LVEF was 65% in B and 60% in T; no patient in both groups presented AR > Grade 2 and mean gradient median was 9 and 4 mm Hg respectively for B and T. There were 14 late deaths (10%) including 2 B (stroke 1, drowning 1) and 12 T (cardiac 5, Cancer 5, Trauma 1 and unknown in 1). Four T were re-operated: Bentall 2, transcatheter Aortic Valve Implantation 1 and mitral valve repair 1. Late major complications were reported in four patients. Conclusion VSRR ensures excellent mid-term aortic valve function independently of its morphology. In B associated with aortic root aneurysm, leaflet repair does not increase the valve-related events.

Objectives Infarct size is a major surrogate marker for prognosis in the context of myocardial infarction. There is a growing interest in validating a quantitative assessment approach in order to: (1) standardize these analyses; (2) to precise the individual prognosis of our patients. Several methods are available and were tested across their capacity to predict left ventricular (LV) remodeling at three months. Patients and methods Late gadolinium enhancement-MRI was performed on day 5 and after a period of three months in 92 patients with STEMI. LV volumes and scar parameters were assessed visually (by using a four scale score) and quantitatively on day 5 and at three months. Dichotomous thresholds were defined first visually (VISUAL), then by 2, 5 and 6 standard deviations above remote myocardium, and by the full-width at half-maximum (FWHM) method. Results All infarct sizing methods showed great relation to LV remodeling at three months (ROC analysis). Univariate predictors of an LV end-systolic volume index (LVESVi) superior to 70 mL/m 2 were: heart failure, creatin kinase peak and infarct size at day 5. FWHM was shown to be the best of all quantitative methods. An infarct size superior to 44 grams predicted a LVESVi > 70 mL/m 2 with a sensitivity of 90% and a specificity of 92.5%. FWHM reproducibility was good ( r = 0.895, P Conclusion In the context of STEMI, FWHM is a tough and reproducible algorithm to quantitatively assess late gadolinium hyperenhancement, greatly related to functional prognosis at three months follow-up.

Summary Background Takotsubo cardiomyopathy (TTC) continues to be under-diagnosed, due to its varying presentation, with potentially serious consequences if treatment is delayed. Aims To demonstrate the consistent involvement of catecholaminergic stress in TTC, regardless of the trigger. Methods Between 01 July 2009 and 31 August 2013, patients managed in our centre for thoracic pain syndrome, with or without troponin release, were followed up prospectively. TTC was diagnosed from the apical ballooning seen on left ventricular imaging (angiography or transthoracic echocardiography) in the absence of a significant coronary artery lesion. Triggers (emotional trauma, surgical stress and β2-mimetic intoxication) were recorded; catecholamine-secreting tumours were screened for with a urinary methoxylate-derivative assay. Results TTC was diagnosed in 40 out of 2754 (1.5%) patients with thoracic pain syndrome, with or without troponin release. Triggers were emotional trauma ( n = 29, 72.5%), surgical stress ( n = 5, 12.5%), adrenergic intoxication ( n = 3, 7.5%) and catecholaminergic tumour ( n = 3, 7.5%). Mean left ventricular ejection fraction at admission was 38.0 ± 15.7%. Eight (20%) patients initially showed cardiogenic shock. In-hospital mortality was 7.5%, with no deaths from cardiogenic causes. Thirty-five (94.6%) of the survivors had recovered a normal left ventricular ejection fraction (> 55%) by discharge. Conclusion Whatever the trigger, the common denominator in TTC is catecholaminergic stress. Classically suggested after emotional trauma, TTC may also be induced by surgical stress or endogenous or iatrogenic β2-mimetic intoxication. The various contexts all have a similarly excellent cardiovascular prognosis if treated early.

International audience; Background. - Multicentre registries of myocardial infarction management show a steady improvement in prognosis and greater access to myocardial revascularization in a more timely manner. While French registries are the standard references, the question arises: are data stemming solely from the activity of French cardiac intensive care units (ICUs) a true reflection of the entire French population with ST-segment elevation myocardial infarction (STEMI)? Aim. - To compare data on patients hospitalized for STEMI from two French registries: the French registry of acute ST-elevation or non-ST-elevation myocardial infarction (FAST-MI) and the Echantillon generaliste des beneficiaires (EGB) database. Methods. - We compared patients treated for STEMI listed in the FAST-MI 2010 registry (n=1716) with those listed in the EGB database, which comprises a sample of 1/97th of the French population, also from 2010 (n=403). Results. - Compared with the FAST-MI 2010 registry, the EGB database population were older (67.2 +/- 15.3 vs 63.3 +/- 14.5 years; P < 0.001), had a higher percentage of women (36.0% vs 24.7%; P < 0.001), were less likely to undergo emergency coronary angiography (75.2% vs 96.3%; P < 0.001) and were less often treated in university hospitals (27.1% vs 37.0%; P = 0.001). There were no significant differences between the two registries in terms of cardiovascular risk factors, comorbidities and drug treatment at admission. Thirty-day mortality was higher in the EGB database (10.2% vs 4.4%; P < 0.001). Conclusions. - Registries such as FAST-MI are indispensable, not only for assessing epidemiological changes over time, but also for evaluating the prognostic effect of modern STEMI management. Meanwhile, exploitation of data from general databases, such as EGB, provides additional relevant information, as they include a broader population not routinely admitted to cardiac ICUs.

Purpose To assess whether a first-pass perfusion sequence (FPP) improved the detection of left ventricular thrombus (LVT). Materials and methods Three hundred and twenty-nine patients with a first STEMI were prospectively included to undergo cardiac magnetic resonance (CMR) at baseline and after a 3-month follow-up. A CMR delayed analysis was performed by three blinded examiners (2 CMR experts and 1 novice) according to a two-step reading protocol. First, an analysis was performed on cine CMR and late gadolinium enhancement (routine stage). Then, the FPP stage was performed following initial protocol along with a FPP sequence. Results LVT was found in 31 out of a total of 638 (4.9%) CMR scans, affecting 30 (9.1%) individuals. All were located in the left ventricular apex. The FPP stage improved significantly the LVT diagnosis for all readers, in 10 and 13 cases (32% and 42%) of LVT suspicion for the experts and 16 cases (41%) for the novice. Respectively 1, 2 and 6 LVT were not detected during the routine stage by the CMR experts and the novice. For the novice, the FPP stage improved diagnosis sensitivity from 78.1 to 91.2%. Conclusions The prevalence of LVT following a myocardial infarction reached 9.1% and increased with the reading of FPP sequence. The FPP stage improved expert diagnostic certitude and the novice’s abilities to reach expert level.

Objective: Early and long-term valve stability following VSRR, were comparatively analyzed between tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV).Methods: From January 2003 to Februar...

Purpose To assess myocardial strain using cine displacement encoding with stimulated echoes (DENSE) using 1.5T and 3.0T MRI in healthy adults. Materials and Methods Healthy adults without any history of cardiovascular disease underwent magnetic resonance imaging (MRI) at 1.5T and 3.0T within 2 days. The MRI protocol included balanced steady‐state free‐precession (b‐SSFP), 2D cine‐echo planar imaging (EPI)‐DENSE, and late gadolinium enhancement in subjects >45 years. Acquisitions were divided into six segments; global and segmental peak longitudinal and circumferential strain were derived and analyzed by field strength, age, and gender. Results In all, 89 volunteers (mean age 44.8 ± 18.0 years, range: 18–87 years) underwent MRI at 1.5T, and 88 of these subjects underwent MRI at 3.0T (1.4 ± 1.4 days between the scans). Compared with 3.0T, the magnitudes of global circumferential (–19.5 ± 2.6% vs. –18.47 ± 2.6%; P = 0.001) and longitudinal (–12.47 ± 3.2% vs. –10.53 ± 3.1%; P = 0.004) strain were greater at 1.5T. At 1.5T, longitudinal strain was greater in females than in males: –10.17 ± 3.4% vs. –13.67 ± 2.4%; P = 0.001. Similar observations occurred for circumferential strain at 1.5T (–18.72 ± 2.2% vs. –20.10 ± 2.7%; P = 0.014) and at 3.0T (–17.92 ± 1.8% vs. –19.1 ± 3.1%; P = 0.047). At 1.5T, longitudinal and circumferential strain were not associated with age after accounting for sex (longitudinal strain P = 0.178, circumferential strain P = 0.733). At 3.0T, longitudinal and circumferential strain were associated with age (P < 0.05). Longitudinal strain values were greater in the apico‐septal, basal‐lateral, and mid‐lateral segments and circumferential strain in the inferior, infero‐lateral, and antero‐lateral LV segments. Conclusion Myocardial strain parameters as revealed by cine‐DENSE at different MRI field strengths were associated with myocardial region, age, and sex. J. Magn. Reson. Imaging 2016;44:1197–1205.

Pheochromocytoma and paraganglioma (PPG) are rare and late-diagnosed catecholamine secreting tumors, which may be associated with unrecognized and/or severe cardiomyopathies. We performed a computer-assisted systematic search of the electronic Medline databases using the MESH terms “myocarditis,” “myocardial infarction,” “Takotsubo,” “stress cardiomyopathy,” “cardiogenic shock”, or “dilated cardiomyopathy,” and “pheochromocytoma” or “paraganglioma” from 1961 to August 2012. All detailed case reports of cardiomyopathy due to a PPG, without coronary stenosis, and revealed by acute symptoms were included and analyzed. A total of 145 cases reports were collected (49 Takotsubo Cardiomyopathies [TTC] and 96 other Catecholamine Cardiomyopathies [CC]). At initial presentation, prevalence of high blood pressure (87.7%), chest pain (49.0%), headaches (47.6%), palpitations (46.9%), sweating (39.3%), and shock (51.0%) were comparable between CC and TTC. Acute pulmonary edema (58.3% vs 38.8%, P = 0.03) was more frequent in CC. There was no difference in proportion of patients with severe left ventricular systolic dysfunction (LV Ejection Fraction [LVEF]

Purpose To use magnetic resonance imaging (MRI) at two field strengths to assess healthy adults' regional myocardial noncontrast (native) T 1 relaxation time distribution, and global myocardial native T 1 between sexes and across age groups. Materials and Methods In all, 84 healthy volunteers underwent MRI at 1.5T and 3.0T. T 1 maps were acquired in three left ventricular short axis slices using an optimized modified Look–Locker inversion recovery investigational prototype sequence. T 1 measurements in msec were calculated from 16 regions‐of‐interest, and a global T 1 value from all evaluable segments per subject. Associations were assessed with a multivariate linear regression model. Results In total, 1297 (96.5%) segments were evaluable at 1.5T and 1263 (94.0%) segments at 3.0T. Native T 1 was higher in septal than lateral myocardium (1.5T: 956.3 ± 44.4 vs. 939.2 ± 54.2 msec; P < 0.001; 3.0T: 1158.2 ± 45.9 vs. 1148.9 ± 56.9 msec; P = 0.012). Native T 1 decreased with increasing age in females but not in males. Among lowest age tertile (

Summary Background The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. Management of HF with reduced ejection fraction (HF-REF) in patients aged 80 years or more follows international guidelines, despite the lack of a dedicated study in this frail population. Aims To determine whether optimized management of HF-REF in patients aged 80 years or more can improve quality of life at 6 months. Methods Patients aged 80 years or more hospitalized for acute HF-REF were randomized prospectively into an optimized group or a control group (usual care). All patients benefitted from the same in-hospital management. Optimized group patients were also managed at 3, 6 and 9 weeks, and 3, 6, 9 and 12 months after initial hospitalization, to optimize HF-REF treatment. The primary endpoint was quality of life at 6 months. Results The trial was stopped prematurely, according to prespecified rules and an independent data monitoring board, after 34 patients were included ( n = 17 in each group). There was no difference in quality of life at baseline and at 6 months between the two groups ( P = 0.14 and 0.64, respectively), although a significant improvement was observed between baseline and 6 months in the optimized group compared with the control group: −20.2 ± 25.2 ( P = 0.01) versus −9.9 ± 19.0 ( P = 0.19). Mortality at 12 months was lower in the optimized group (17.7% vs 47.1%; P = 0.03). There was no increase in acute renal failure, hyperkalaemia or falls in the optimized group ( P = 0.49, 1 and 1, respectively). Conclusions Optimizing the management of HF-REF in patients aged 80 years or more, according to the modalities of the HF80 study, seems to be both effective and safe.

The aim of the study was to identify the determinants of pericardial effusion (PE) after a first myocardial infarction (MI). Cardiac magnetic resonance enables early analysis of multiple post-MI parameters; 193 patients with a first ST-elevation MI admitted to the Angers University Hospital (France) were enrolled prospectively. Cardiac magnetic resonance was performed at baseline (median of 5 days [4 to 7]) and repeated at a 3-month follow-up to investigate left ventricular (LV) volumes, LV ejection fraction, infarct size, microvascular obstruction (MVO), systolic wall stress (SWS), and PE presence and extent. A 1-year follow-up was also performed. Overall, 113 patients (58.5%) showed a PE with a median size of 31.6 ± 24.0 ml in the event that a PE was present. Patients with PE typically presented larger initial infarct sizes and LV volumes, and higher SWS, with more depressed LV ejection fraction and more frequent MVO and pleural effusions. Patients with PE exhibited higher rates of heart failure during hospitalization. At follow-up, there was no relevant PE, with no pericardiocentesis required. The multivariate analysis revealed SWS (odds ratio [OR] 1.092 [95% CI 1.007 to 1.184], p = 0.042), infarct size (OR 1.048 [95% CI 1.014 to 1.083], p = 0.003), and MVO extent (OR 1.274 [95% CI 1.028 to 1.579], p = 0.018) to be independent predictors for PE presence and volume. One patient died of LV free wall rupture during initial hospitalization, with only "small" PE found. In conclusion, infarct size, MVO, and SWS were independently related to PE presence and volume. Post-MI PE was found in 58.5% of cases, being regressive at follow-up. Among these patients with early reperfusion and optimal medical therapy, PE volume did not seem to be related to future clinical events.

International audience; The aim of this project is to design a generic formalism for parietal and regional tracking of the left ventricle (LV) and to adapt it to 3D+t3D+t cardiac imaging modalities used in clinical routine (echocardiography, gated-SPECT, cine-MRI). The estimated displacement field must be reliable enough and insensitive to various artifacts to assess regional myocardial function in 3D from the accurate and precise computation of strain. The strain has recently proved to be of great interest for diagnosis and prognostic in cardiology, but its interpretation remains difficult because of the relative nature of the indices. The clinical objective of the 3DStrain project is to bring answers about the knowledge of normality.

Heart failure (HF) is a major public health issue. This study conducted a real-life analysis of the impact of clinical characteristics and medical management of HF on its prognosis. Analysis was based on the EGB (“Echantillon Generaliste des Beneficiaires”) database. A cohort comprising 1825 adult patients with a first admission for HF between 2009 and 2011 was created and followed until June 2013 (median 22.3 [7.7–34.5] months) for survival analysis. Mean age was 77.3 ± 13.2 years (53 % ≥80 years). The overall incidence of HF admission was 117 [112–122] per 100,000 population with a marked increase in patients >80 years (1297 [1217–1348]). At discharge, only 8 % of patients received recommended combination of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers (BB) and mineralocorticoid receptor antagonists (MRA). Only prescription levels of BB and vitamin K antagonists, at discharge, increased during the study period. In-hospital mortality was 9 % and survival was 71.6 %[69.5–73.6] and 52.0 %[49.4–54.6] at 12 and 36 months, respectively. In multivariate analysis, female gender [HR:0.78 (0.67–0.91), p = 0.001], ACEi/ARB + BB + MRA [0.41 (0.28–0.60), p

Introduction Cardiac fibrosis is associated to heart failure and poor prognosis. Cardiac fibrosis biomarkers have not been evaluated to predict cardiac resynchronization therapy (CRT) response. Methods Patient included according to CRT European guidelines underwent before CRT implantation clinical examination, functional test, electrocardiogram, echocardiography and blood fibrosis biomarkers evaluation. At six months, positive response to CRT was defined with a composite endpoint: no death, nor hospitalization for a cardiac cause, and presence of a left ventricular (LV) reverse remodelling (decrease in LV end-systolic volume ≥ 15%). Results A total of 60 patients were consecutively included in a multicenter study. At 6 months, 38 were positive responders to CRT and reach the composite response criteria (63%). In the CRT responders group compared to non-responders, we observed a longer QRS duration (171 ± 22 ms vs 150 ± 21 ms, P Fig. 1 ). Conclusion A lower degree of cardiac fibrosis is associated to positive response after CRT implantation. PICP evaluation before CRT implantation may improve patient selection usually only based on electrical asynchronism and LV function.

Background Rognosis of heart failure with reduced ejection fraction (HFREF) is improved by tailored drugs optimization but poor is known concerning such optimization in HFREF patients implanted by implantable cardiac defibrillator (ICD) or cardiac resynchronization therapy (CRT). We conduct an evaluation of European guidelines implement before device implantation. Methods Between January 2009 and December 2014, data were extracted from the echantillon generaliste des beneficiaires (EGB) database, a representative 1/97 random sample of the population covered by the French national health insurance system. We included HFREF patients implanted by ICD or CRT. Survival and treatments were analyzed at baseline, 3 months and until January 2016. Results We included a sample of 378 patients (135 CRT, 243 ICD) with a mean age of 68 ± 13 years old. Mean follow-up was 23 months (11–42). At baseline, 36% of patients had only one or no HF drug among beta-blocker (BB), angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blockers (ARB) and mineralocorticoid receptor antagonist (MRA). Twenty-six percent had an optimal treatment (all the 3 classes). At 3 months, prescription rate was higher compared to baseline but not at the end of follow-up. HF hospitalization rate was higher in non-optimized patient group 28% vs. 14% (P = 0.001). HFrEF optimal treatment was associated with a better survival (HR = 0.27 [0.15–0.46], P Fig. 1 ). Conclusion HFREF drugs are under prescribed before CRT and ICD implantations despite we demonstrated that treatment optimization reduced HF hospitalization.

Objectivesinvestigate whether the end-systolic wall stress is a predictor of left ventricular remodeling (LVR) in the aftermath of an acute myocardial infarction after successful reperfusion.BackgroundLVR is a poor prognosis outcome associated with a greater number of major adverse cardiovascular events. It remains difficult to predict which patients will remodel.Methods169 STEMI patients were prospectively included in a CMR study. We calculate, among other parameters, end-systolic wall stress (WS) by three-dimensional MRI method with an home-made software. CMR was performed at day 5±2 and repeated at 3 months follow-up. LVR was defined as a LV end-diastolic volume indexed (LVEDVi) >120ml/m2 at 3 months.Results13 patients presented LVR, including 11 due to anterior MI. LVR patients presented worse initial CMR parameters: WS 25.9±6 vs 16.0±4103N•m-2 (p

Background: The segmental extent of late gadolinium enhancement imaged with cardiac magnetic resonance early after acute ST-segment elevation myocardial infarction (STEMI) has weak spatial correspondence with final infarct on follow-up, thus its prognostic value is uncertain. We hypothesized that