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BACKGROUND AND AIMS Hereditary transthyretin amyloidosis (ATTR) is a disabling and life-threatening disease that primarily affects the nervous system and heart. Its kidney involvement has been poorly studied and is not well known to nephrologists. METHOD We conducted a retrospective study describing kidney phenotype of all prevalent patients with ATTR mutations, with symptomatic amyloidosis or asymptomatic carriers, followed-up in two university hospitals from the South of France, between June 2011 and June 2021. RESULTS 103 patients were included, among whom 79 were symptomatic and 24 asymptomatic carriers, and 54% carried a V30M mutation. After a mean follow-up of 7.9 ± 25.7 years, 30.4% of the symptomatic patients had developed chronic kidney disease (CKD) and 20.7% had a urinary protein/creatinine ratio ≥0.5 g/g. None of the asymptomatic carriers had CKD or proteinuria. Median CKD-free survival in the global cohort was 81.0 years, and the average age of CKD onset was 69.3 ± 13.0 years. In a multivariate analysis, late onset of ATTR symptoms (after 60 years), the V122I mutation and proteinuria were significantly associated with CKD. In a 38-year-old V30M female, who presented a kidney-predominant phenotype, treatment with Patisiran resulted in remission of the nephrotic syndrome. CONCLUSION CKD affects almost one-third of patients with symptomatic ATTR amyloidosis. The role of ATTR amyloidosis per se in the development of CKD in this population remains to be determined, but some patients may benefit from specific therapies.

Background Hereditary transthyretin amyloidosis (ATTRv) is a disabling and life-threatening disease that primarily affects the nervous system and heart. Its kidney involvement has not been systematically studied, particularly in non-V30M mutations, and is not well known to nephrologists. Methods We conducted a retrospective study describing the kidney phenotype of all prevalent patients with ATTR mutations, with neurological or cardiac involvement or presymptomatic carriers, followed up in two university hospitals from the South of France between June 2011 and June 2021. Results A total of 103 patients were included, among whom 79 were symptomatic and 24 were presymptomatic carriers. Patients carried 21 different ATTR mutations and 54% carried the V30M mutation. After a mean follow-up of 7.9 ± 25.7 years, 30.4% of the symptomatic patients had developed chronic kidney disease (CKD) and 20.3% had a urinary protein:creatinine ratio ≥0.5 g/g. None of the presymptomatic carriers had CKD or proteinuria. In a multivariate analysis, late onset of symptoms (after 60 years), the V122I mutation and proteinuria were significantly associated with CKD. The median CKD-free survival in symptomatic patients was estimated at 81.0 years (interquartile range 77.1–84.9). It did not differ between V30M and non-V30M patients, but was lower in patients with the V122I mutation. The average age of the onset of CKD was 69.3 ± 13.0 years. In one 38-year-old V30M female who presented a kidney-predominant phenotype, treatment with patisiran resulted in remission of the nephrotic syndrome. Conclusion CKD affects almost one-third of patients with symptomatic ATTRv. The role of ATTRv per se in the development of CKD in this population remains to be determined, but some patients may benefit from specific therapies.

International audience; Heatwaves affect human health and should be more and more frequent because of global warming and could lead to increase mortality in general population, especially regarding cardiovascular mortality. During the summer 2019, Europe experienced a strong episode of heatwave. Telemonitoring of patients with heart failure (HF) provide an elegant tool to monitor closely the weights, and we assumed to be able to assess our hypothesis through a nationwide telemonitoring system. Here, we hypothesize that (i) there will be a change in patients' weight during the heatwave and (ii) that the telemonitoring would enable us to follow these changes. The change in weight would be a surrogate for clinical worsening (with or without decompensated HF). Briefly, 1420 patients with a median age of 73.0 years and mean weight of 78.1 kg have been included in this analysis. The relationship between temperature and weight is very strong (P < 10-7 ). The magnitude of the effect seems clinically relevant with a variation of 1.5 kg during a short period. This could expose patients to increased symptoms, HF decompensations, and poor outcomes. These results suggest a new way to implement weight telemonitoring in HF. This suggests also a direct impact of global warming on Human health, with acute episodes that are expected to occur more often, threatening patients with chronic diseases, especially patients with heart failure. In clinical practice, this urges to take into consideration the episodes of extreme heatwave and suggest that we have already useful tools including telemonitoring available in frail patients.

The therapeutic management of aortic stenosis has been drastically changed by the advent of percutaneous valve replacement (TAVI). Since the first implantation, the indications have progressively been extended from the inoperable patient to the patient at low surgical risk. The main objective of this review is to describe the currently recommended main indications of TAVI depending on an individualized assessment of each patient's risk, technical characteristics and anatomical valvular criteria.

There are currently one million heart failure (HF) patients in France and the rate is progressively increases due to population aging. Acute decompensation of HF is the leading cause of hospitalization in people over 65 years of age with a 25% re-hospitalization rate in the first month. Expenses related to the management of HF in France in 2013 amounted to more than one billion euros, of which 65% were for hospitalizations alone. The management of acute decompensation is a challenge, due to the complexity of clinical and laboratory evaluation leading to therapeutic errors, which in turn leads to longer hospitalization, high early re-hospitalization and complications. Therapeutic adjustment, especially diuretic, in the acute phase (during hospitalization) affects early re-hospitalization rates (within 30 days). These adjustments can be based on clinical estimation and laboratory parameters, but echocardiography has been shown to be superior in estimating filling pressures (FP) compared to clinical and laboratory parameters.We hypothesize that a simple daily bedside echocardiographic assessment could provide a reproducible estimation of FP with an evaluation of mitral inflow and the inferior vena cava (IVC). This could allow a more reliable estimate of the true blood volume of the patient and thus lead to a more suitable therapeutic adjustment. This in turn should lead to a decrease in early re-admission rate (primary endpoint) and potentially decrease six-month mortality and rate of complications. Keywords: Heart failure, Doppler echocardiography, Diuretics, Filling pressure, Cava venous, Trans-mitral doppler, Left ventricular ejection fraction

International audience; Aims Optimizing medical cardiac treatment for sleep apnoea (SA) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is an expert Grade C recommendation based on six studies encompassing a total of 67 patients only. Whether sacubitril-valsartan (SV), a cornerstone of HFrEF medical treatment, impacts SA is unknown and requires evaluation.Methods and results The ENTRESTO-SAS trial is a six-centre, prospective, open-label real-life cohort study (NCT02916160). Ambulatory patients eligible for SV (i.e. HFrEF adults who remain symptomatic despite optimal treatment) were evaluated before and after 3 months of SV (including nocturnal ventilatory polygraphy); 118 patients were final analysed [median age was 66 (IQ 25-75 : 56-73) years, 81.4% male, 36.5% New York Heart Association III-IV, N-terminal pro-B-type natriuretic peptide level of 1564 (701-3376) ng/L, left ventricular ejection fraction of 30 (25-34)%, 60.7% ischaemic HFrEF, 97.5% initially treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, 83.9% with beta-blockers, 64.4% with mineralocorticoid receptor antagonists, and 74.6% with diuretics]. Three groups were defined according to initial central/obstructive apnoea-hypopnoea indices (AHIs): G1 (n = 49, AHI central ≥ 5/h and AHI obstructive < 15/h); G2 (n = 27, AHI obstructive ≥ 15/h); and G3 (n = 42, AHI central < 5/h and AHI obstructive < 15/h). At 3 months, the AHI (main predefined outcome) decreased significantly by À7.10/h (IQ 25-75 : À16.10 to 0.40; P < 0.001) in G1 + G2 without positive airway pressure treatment (45 patients, median initial AHI of 24.20 (IQ 25-75 : 16.40-43.50)/h). Of these, 24.4% presented an AHI decrease ≥50% and 37.78% had a final AHI < 15/h (tendency for improvement from an initial value of 20%: P = 0.0574). For G1 patients (n = 37), AHI significantly decreased from a median of 22.90 (16.00-43.50)/h to 19.20 (12.70-31.10)/h (P = 0.002). For G2 patients (n = 8), AHI decreased from a median of 30.10 (26.40-47.60)/h to 22.75 (14.60-36.90)/h (statistically non-significant, P = 0.059).Conclusions In this real-life population, SV treatment for 3 months in SA patients is associated with a significant decrease in AHI. These results support the current guidelines that recommend first an optimization of the HFrEF treatment in patients with HFrEF and central SA. A potential positive airway pressure sparing effect merits further investigation.

Background: Acute infarction patterns have been described in cardioembolic stroke, mainly with atrial fibrillation (AF) or patent foramen ovale. We aimed to analyse acute infarction magnetic resonance imaging (MRI) characteristics in stroke patients with intracardiac thrombus (ICT) compared with stroke patients with AF. Methods: We performed a retrospective study analysing brain MRI scans of consecutive acute symptomatic cardioembolic infarction patients associated with ICT or AF who were recruited and registered in the stroke database between June 2018 and November 2019. Diffusion-weighted imaging performed within 1 week after symptom onset, intra-/extracranial vessel imaging, echocardiography, and ≥24-h ECG monitoring were required for inclusion. Baseline, biological, and echocardiography characteristics were assessed. Analysed MRI characteristics were infarction location (anterior/middle/posterior cerebral artery territory; anterior/posterior/mixed anterior-posterior circulation; multiterritorial infarction; brainstem; cerebellum; small cortical cerebellar infarctions [SCCIs] or non-SCCI; cortical/subcortical/cortico-subcortical), lesion number, subcortical lesion size (> or

International audience; The prevalence of non-alcoholic fatty liver disease (NAFLD) in heart failure (HF) preserved left ventricular ejection fraction (HFpEF) patients could reach 50%. Therefore, NAFLD is considered an emerging risk factor. In 20% of NAFLD patients, the condition progresses to non-alcoholic steatohepatitis (NASH), the aggressive form of NAFLD characterized by the development of fibrosis in the liver, leading to cirrhosis. The purpose of this review is to provide an overview of the relationships between NAFLD and HFpEF and to discuss its impact in clinical setting. Based on international reports published during the past decade, there is growing evidence that NAFLD is associated with an increased incidence of cardiovascular diseases, including impaired cardiac structure and function, arterial hypertension, endothelial dysfunction, and early carotid atherosclerosis. NAFLD and HFpEF share common risk factors, co-morbidities, and cardiac outcomes, in favour of a pathophysiological continuum. Currently, NAFLD and NASH are principally managed with non-specific therapies targeting insulin resistance like sodium-glucose co-transporter-2 inhibitors and liraglutide, which can effectively treat hepatic and cardiac issues. Studies including HFpEF patients are ongoing. Several specific NAFLD-oriented therapies are currently being developed either alone or as combinations. NAFLD diagnosis is based on a chronic elevation of liver enzymes in a context of metabolic syndrome and insulin resistance, with fibrosis scores being available for clinical practice. In conclusion, identifying HF patients at risk of NAFLD is a critically important issue. As soon as NAFLD is confirmed and its severity determined, patients should be proposed a management focused on symptoms and co-morbidities.

Pathological studies have revealed spontaneous recanalized coronary thrombi as a frequent evolution of coronary occlusions; however, they are poorly recognized on coronary angiography, and the optimal therapeutic strategy for clinical evolution is unknown. We report the role of optical coherence tomography in identifying a recanalized coronary thrombus causing myocardial ischemia after 11 years of follow-up. (Level of Difficulty: Intermediate.), Graphical abstract

International audience; Aims: Transition care programmes are designed to improve coordination of care between hospital and home. For heart failure patients, meta-analyses show a high efficacy but with moderate evidence level. Moreover, difficulties for implementation of such programmes limit their extrapolation.Methods and results: We designed a mixed-method study to assess the implementation of the PRADO-IC, a nationwide transition programme that aims to be offered to every patient with heart failure in France. This programme consists essentially in an administrative assistance to schedule follow-up visits and in a nurse follow-up during 2 to 6 months and aims to reduce the annual heart failure readmission rate by 30%. This study assessed three quantitative aims: the cost to avoid a readmission for heart failure within 1 year (primary aim, intended sample size 404 patients), clinical care pathways, and system economic outcomes; and two qualitative aims: perceived problems and benefits of the PRADO-IC. All analyses will be gathered at the end of study for a joint interpretation. Strengths of this study design are the randomized controlled design, the population included in six centres with low motivation bias, the primary efficiency analysis, the secondary efficacy analyses on care pathway and clinical outcomes, and the joint qualitative analysis. Limits are the heterogeneity of centres and of intervention in a control group and parallel development of other new therapeutic interventions in this field.Conclusions: The results of this study may help decision-makers to support an administratively managed transition programme.

Summary Background The effectiveness of transitional care services for patients discharged from hospital after acute heart failure is challenging, especially in terms of reducing subsequent heart failure hospitalizations. The increased adoption of smartphone applications in society offers a new opportunity to interact with patients to avoid rehospitalization. Thus, electronic health (e-health) can enhance the impact of existing therapeutic education programmes. Aims To determine the prevalence of smartphone use among patients with chronic heart failure, and to assess the epidemiological characteristics and therapeutic management of these patients, with a broader aim of developing smartphone-based therapeutic education programmes for patients. Methods The French Observatoire francais de l’insuffisance cardiaque et du sel (OFICSel) registry was conducted in 2017 by 300 cardiologists, and included both inpatients and outpatients who had been hospitalized for heart failure at least once in the previous 5 years. Data collection included demographic and heart failure-related variables, which were provided by the cardiologist and by the patient via a questionnaire. Results Among the 2822 patients included, 2517 completed the questionnaire. Of this total, 907 patients (36%) were smartphone users. Compared with non-users, smartphone users were younger, were more frequently men, more frequently lived in cities, had a higher educational level and were more frequently professionally active. Smartphone users less frequently had diabetes, hypertension, atrial fibrillation or ischaemic cardiopathy. Only 22% of patients were actively participating in a therapeutic education programme. Conclusion Smartphones were used by more than one-third of patients with heart failure in France in 2017, underscoring the feasibility of developing a smartphone application to deliver therapeutic education to the population with chronic heart failure.

Aims Sleep-disordered breathing (SDB) is a highly prevalent co-morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril-valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin-converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. Methods and results The ENTRESTO-SAS trial is a 3-month, multicentric, prospective, open-label real-life cohort study. Patients eligible for sacubitril-valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin-converting enzyme inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea-Hypopnoea Index with a power of 90% at an alpha risk of 5%. Conclusions In the context of the SERVE-HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO-SAS trial whether sacubitril-valsartan could improve the outcome of SDB in CHF patients.

Aims Acute Heart Failure (AHF) management is challenging, with high morbidity and readmission rates. There is little evidence of the benefit of HF monitoring during hospitalization. We hypothesized that a fast, daily bedside echocardiographic assessment (JetEcho) would improve therapeutic adjustment and outcome. Methods and results In this prospective, open, two parallel-arm randomized study, 248 patients hospitalized for AHF were assigned to either JetEcho aimed to achieve normal left ventricular filling pressure (LVFP) and volemia, or standard care (SC). The primary outcome was the 30-day readmission rate. Key secondary outcomes were readmission and mortality rates at six months. The primary outcome occurred in 22 of 115 patients (19%) in the JetEcho group and in 17 of 112 patients (15%) in the SC group (relative risk [RR] 1.26; 95% confidence interval [CI], 0.70–2.24; P = 0.4). Six-month readmission rate for cardiac or renal causes was lower in the JetEcho group [N = 23 (21%)] versus the SC group [N = 38 (36%)] (RR 0.58; 95%CI, 0.37–0.90; P = 0.01). Six-month mortality did not differ [HR 0.63 (95% CI; 0.3–1.4) P = 0.3] ( Table 1 ) ( Fig. 1 ). Conclusion The study found no benefit of bedside echography in reducing 30-day readmission rate. However, readmissions for cardiac and renal causes was lower at six months in the JetEcho group, suggesting delayed beneficial effects.

International audience; Heart failure (HF) has become a global pandemic. Despite recent developments in both medical and device treatments, HF incidences continues to increase. The current definition of HF restricts itself to stages at which clinical symptoms are apparent. In advanced heart failure (AdHF), it is universally accepted that all patients are refractory to traditional therapies. As the number of HF patients increase, so does the need for additional treatments, with an increased proportion of patients requiring advanced therapies. Areas covered: This review discusses extensive evidence for the effect of medical treatment on HF, although the data on the effect on AdHF is scare. Authors review the relevant literature for treating AdHF patients. Furthermore, mechanical circulatory devices (MCD) have emerged as an alternative to heart transplantation and have been shown to enhance quality of life and reduce mortality therefore authors also review the current literature on the different MCD and technologies. Expert commentary: More patients will need advanced therapies, as the access to heart transplantation is limited by the number of available donors. AdHF patients should be identified timely since the window of opportunities for advanced therapy is narrow as their morbidity is progressive and survival is often short.

Background Echocardiograms are largely performed for suspicion of infective endocarditis (IE), and usually have a poor diagnosis yield, especially if there is a low clinical probability. The ESC Guidelines of 2009 and 2015 proposed very large criteria that define clinical suspicion of IE and justify an echocardiogram request. We studied if the patients referred for suspicion of IE had clinical criteria who respected the ESC Guidelines for screening echocardiography, and we tried to identify the factors associated with the diagnosis of IE. Methods We retrospectively examined all the transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE), performed for suspicion of IE between January 2017 and December 2017 in the University Hospital of Nimes, France. Results Three hundred and fifty patients were referred for a suspicion of IE. Two hundred and eighty three (80,9%) TTEs and 67 (19,1%) TOEs were performed in first intention. A second exam was performed in 99 (28,3%) patients: a TTE for 56 patients and a TOE for 43 patients. For 61 (17,4%) patients, the echocardiogram request was not appropriate according to referral of the ESC Guidelines, with no sufficient clinical criteria that may allow to suspect an IE. None of these 61 patients was diagnosed with an IE. IE was finally diagnosed in 51 (14,6%) patients. The significant independent factors associated with the diagnosis of IE were: positive blood culture (OR = 26,6 IC95% = [3,6–195,9] P = 0,001), embolic phenomena (OR = 2,4 IC95% = [1,3–4,5] P = 0,005), previous valvular heart disease (OR = 2,7 IC95% = [1,1–6,7] P = 0,003) and sepsis in absence of an extra cardiac source of infection (OR = 12,6 IC95% = [4,4–35,9] P Fig. 1 ). Conclusion One fifth of the patients referred for an echocardiogram had no sufficient clinical criteria to suspect an IE according to the referral of the ESC Guidelines, and none of them was diagnosed with an IE. The use of these criteria for screening echocardiography for suspicion of IE may avoid many unnecessary echocardiograms.

Background Therapeutic education (TE) and follow-up in heart failure (HF) patients are mandatory. This could be eased by new technologies, particularly with smartphone use. There is no data about the characteristics of the patients using a smartphone in this population. Purpose Evaluate the prevalence and the epidemiological characteristics of HF patients with smartphone in a large sample of HF patients. Methods The OFICsel observatory include 180 French HF centers. Out and in-patients hospitalized for acute HF during the last five years were included in the study. Data collection included a Physician and Patient questionnaires including clinical, echocardiographical, biological and treatment characteristics. Patients recorded their own sociodemographic data. Results From March to June 2017, a total of 2517 patients completed the questionnaire. Of these patients, 907 (36%) patients had a smartphone, 1553 (59%) had an Internet connection and 1454 (58%) had an e-mail address. When comparing with patients who didn’t have a smartphone, patients who had a smartphone were younger (59.5 vs. 71.6 years old P Conclusion HF Patients using a smartphone represented 1/3 of our population, were younger, more likely to have a urban way of life, and with a higher level of education. This highlights the type of patients who would benefit from an educational program supported by a HF smartphone's application.

Background Face-to-face Patient's Education Programs (PEP) have been widely developed in France to improve treatment and diet restriction regimens (DRR) observance in Heart Failure (HF). Internet or Smartphone's Application Used (ISAU) may improve communication and education therefore data are lacking concerning the use of these technics in this Elderly population. Purpose Determine prevalence of ISAU, DRR and PEP prescription and their observance in HF. Methods OFICSel observatory included out and in HF patients hospitalized for HF at least one time for the last five years (whatever their LVEF). Data were obtained from a physician and patient questionnaires. Results Of the 2822 patients included in 2017, 2517 completed the questions regarding the use of new technologies of whom 1553(59%) had an Internet Connection (IC), 1454(58%) an e-mail address and 907(36%) were Smartphone's Application Used (SAU). Prescription of salt, sugar, lipid and fluid DRR in the overall cohort were respectively of 79.3%, 40.0%, 49,6% and 26.2%. Only 33.5% reported having being invited to PEP of whom only 66.2% did. The every day life compliances of these DRR were respectively for salt, sugar, lipid and fluid of: 44.2%, 45.4%, 33.1% and 41.8%. 20.4% of the overall population weighed every day. When comparing with patients who didn’t have ISAU, patients who had ISAU were younger (63 vs. 73 years old for IC and 60 vs. 72 years old for SAU, P Conclusion Restriction diet regimens are frequently prescribed in HF therefore their observance is low. Usage of internet is large in HF patients suggesting that developing new HF education tools through dedicated website or smartphone application might be useful in HF population.

Aims Sleep‐disordered breathing (SDB) is a highly prevalent co‐morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril–valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin‐converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. Methods and results The ENTRESTO‐SAS trial is a 3‐month, multicentric, prospective, open‐label real‐life cohort study. Patients eligible for sacubitril–valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin‐converting enzyme inhibitor, a beta‐blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality‐of‐life and SDB questionnaires). The primary outcome is the change in the Apnoea–Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea–Hypopnoea Index with a power of 90% at an alpha risk of 5%. Conclusions In the context of the SERVE‐HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO‐SAS trial whether sacubitril–valsartan could improve the outcome of SDB in CHF patients.

A 56-year-old woman was admitted to our institution for an ischaemic stroke. Transthoracic echocardiography (TTE) was performed and revealed a mass developed at the expense of the anterior wall of the left ventricle ( Figure 1A ). Endocardial border and intracardiac mass delimitation was appreciated by contrast-enhanced echocardiography (SonoVue) ( Figure 1B ). Transoesophageal echocardiography (TOE) confirmed a mass with irregular outlines and a mobile and filiform intra-ventricular element ( Figure …

A 65-year-old male was admitted to the emergency department after sustaining a gunshot wound to his chest and abdomen, owing to a hunting accident. He was initially haemodynamically stable with a blood pressure of 120/70, and his ECG showed no particular disturbance. Computed tomography revealed multiple buckshot in his thorax and his abdomen (Figure 1). In the heart, two lead shots were situated in the interventricular septum, accompanied with a slight hemopericardium.

International audience; OBJECTIVE:The aim of this study was to comprehensively investigate left atrial (LA) reservoir, conduit, and booster pump functions, as well as their predictors in patients with primary systemic arterial hypertension (HTN) and left ventricular (LV) hypertrophy.METHODS:Thirty patients with HTN and LV hypertrophy, but no history of atrial arrhythmia or heart failure, were compared with 29 normotensive controls. Speckle-tracking echocardiography of the LA wall was used to measure systolic and diastolic strains and strain rates. Early diastolic velocity of transmitral flow/early diastolic mitral annular motion velocity (E/E')/peak systolic LA strain (S-LAs) was used as an index of LA stiffness.RESULTS:HTN patients had higher LV mass index, impaired LV diastolic function, and higher LA volume index than controls. LA reservoir, conduit, and booster pump functions were significantly lower and LA stiffness was greater. Multiple regression analysis indicated that increased LV mass and LV filling pressures as well as reduced LV strain or E' were predictors for reduced atrial function.CONCLUSION:HTN patients showed a significant impairment of the three components of LA function. These changes were correlated with LV hypertrophy and dysfunction, and presumably related to LA fibrotic changes, underlining the importance of LA-LV coupling. The prognostic value of these new speckle-tracking echocardiography-based LA strain indices needs to be evaluated by future studies.

BackgroundGalectin-3 (Gal-3) is an emerging biomarker promising to assess prognosis in various pathophysiological conditions including heart failure (HF). The aim of this work was to investigate the prognosis interest of this marker in ambulatory patients with stable HF.MethodsPatients were included in this study in 2010. All patients gave informed consent. Clinical characteristics were registered and biomarkers were assessed. Clinical outcomes were registered regularly by a clinical follow-up or by phone by a dedicated physician.Results180 patients (mean age 72.5y±12.5y) were included. Left ventricular ejection fraction was 37.1%±14.2%. Median (1st quartile – 3rd quartile) follow-up was 42.3 (12.3-47.1) months. Survival curves were built and data presented as means±SD when normally distributed. Patients who died during follow up had higher Gal-3 levels at baseline. In partial correlation analysis, Gal-3 level was negatively correlated to renal function assessed by CKD-EPI estimated glomerular filtration rate (Spearman’s rho=-0.252, p=0.003) and positively correlated to NT-proBNP (rho=0.367, p

Neurological disorders are rare complications of foam sclerotherapy. Visual disturbances and headache are the most commonly reported events and are thought to be equivalent to migraine with aura. Exceptionally, strokes have been reported. Papillary fibroelastoma is a rare cardiac tumor, which may embolize in cerebral arteries. We report the case of a patient in whom neurological disorders occurred during a session of foam sclerotherapy, and led to the discovery of a cardiac fibroelastoma.

Background ST2, an interleukin-1 (IL-1) receptor family member, is an emerging biomarker promising to assess prognosis in various pathophysiological conditions including heart failure (HF). The aim of this work was to investigate the prognosis interest of this marker in ambulatory patients with stable HF. Methods Patients were included in this study in 2010. All patients gave informed consent. Clinical characteristics were registered and biomarkers were assessed. Clinical outcomes were registered regularly by a clinical follow-up or by phone by a dedicated physician. We use the prognostic score of Lupon et al. including clinical data, NT pro-BNP, hs-c TnT and SST2 assay. Survival curves were built and data presented as means±SD when normally distributed. Results 180 patients (mean age 72.5y±12.5y) were included. Left ventricular ejection fraction was 37.1%±14.2%. ST2 concentrations are strongly predictive of all cause mortality [HR 3.15 (95% CI: 1.46-6.8)] and cardiovascular mortality [HR 4.28 (95% CI: 1.5-12.26)] regardless of NT pro-BNP concentrations. Estimation of the risk of all-cause and cardiovascular mortality was significantly improved by adding SST2, NT pro-BNP and hs-c TnT levels to clinical covariates. Risk of mortality was estimated using Cox proportionnal hazard models. Discrimination, assessed by c-index, rose from 0.678 for the clinical model to 0.715 after addition of biomarkers for prediction of all-cause mortality. For cardiovascular mortality, c-index was improved from 0.703 to 0.753. Added value of biomarkers was also evaluated by reclassification analysis. Associated net reclassification improvement (NRI) [95% CI] for 48 months death were 0.395 [0.068-0.653], p=0.033 and 0.395 [0.068-0.653], p=0.020 for all cause and cardiovascular death, respectively. Conclusions SST2 appears as a promising prognostic biomarker. It could provide additional information to natriuretic peptides Download : Download high-res image (117KB) Download : Download full-size image Abstract 0074 – Figure: Kaplan Meier, all cause mortality.Pronostic score of Lupon et al (clinival and biomarkers)