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1. Natural History of Isolated Functional Tricuspid Regurgitation

Author

Christophe Tribouilloy, Pierre Vanhaecke, Julien Dreyfus, Thierry Le Tourneau, Yoan Lavie‐Badie, Christine Selton‐Suty, Augustin Coisne, Erwan Donal, Maurice Enriquez‐Sarano, and Yohann Bohbot

Subjects
isolated tricuspid regurgitation, natural history, outcome, survival, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2024
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2. Isolated functional tricuspid regurgitation: how to define patients at risk for event?

Author

Guillaume L'Official, Mathilde Vely, Wojciech Kosmala, Elena Galli, Anne Guerin, Elisabeth Chen, Catherine Sportouch, Julien Dreyfus, Emmanuel Oger, and Erwan Donal

Subjects
Functional tricuspid regurgitation, Echocardiography, Prognosis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Aims Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late. The optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in a simple prognostic model predicting clinical events. Methods and results We designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area > 30 mm2) and left ventricular ejection fraction > 40%. Clinical, echocardiographic, and electrocardiogram data were collected at baseline and at the 1 and 2 year follow‐up. The primary outcome was all‐cause death or hospitalization for heart failure. At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio, reflecting right ventricular–pulmonary arterial coupling, were 73 mL/m2 and 0.40 vs. 64.7 mL/m2 and 0.50 in the event vs. event‐free groups, respectively (both P 0.4 (odds ratio = 0.41, 95% confidence limit 0.2 to 0.82) and RAVI > 60 mL/m2 (odds ratio = 2.13, 95% confidence limit 0.96 to 4.75), providing a clinically valid prognostic evaluation. Conclusions RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2 year follow‐up in patients with an isolated functional TR.

Published
2023
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3. Permanent Pacemaker Implantation After Tricuspid Valve Surgery

Author

Baptiste Bazire, MD, Vincent Algalarrondo, MD, PhD, and Julien Dreyfus, MD

Subjects
atrioventicular block, pacing, tricuspid valve surgery, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Tricuspid valve (TV) surgery carries a high risk of atrioventricular block. In this report, we illustrate several options for managing conduction disorders after TV surgery. The choice of cardiac implantable devices must take account of several parameters such as surgical procedure, patient’s rhythm and history, and etiology of TV disease. (Level of Difficulty: Intermediate.)

Published
2023
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4. Comparison of effective regurgitant orifice area by the PISA method and tricuspid coaptation gap measurement to identify very severe tricuspid regurgitation and stratify mortality risk

Author

Yohann Bohbot, Léa Tordjman, Julien Dreyfus, Thierry Le Tourneau, Yoan Lavie-Badie, Christine Selton-Suty, Benjamin Elegamandji, Guillaume L’official, Antoine Fraix, Samy Aghezzaf, Pierre Yves Turgeon, David Messika Zeitoun, Maurice Enriquez-Sarano, Augustin Coisne, Erwan Donal, and Christophe Tribouilloy

Subjects
very severe tricuspid regurgitation, survival, coaptation gap, effective regurgitant orifice area, mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

IntroductionVarious definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes.Materials and methodsIn this French multicentre retrospective study, we included 606 patients with ≥moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm2) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality.ResultsThe relationship between the EROA and TCG was poor (R2 = 0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA

Published
2023
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5. Rational and Design of the SIMULATOR Study: A Multicentre Randomized Study to Assess the Impact of SIMULation-bAsed Training on Transoesophageal echocardiOgraphy leaRning for Cardiology Residents

Author

Théo Pezel, Anne Bernard, Yoan Lavie Badie, Julien Dreyfus, Etienne Audureau, Yohann Bohbot, Damien Fard, Arnaud Hubert, Lee S. Nguyen, Cécile Monteil, Loïc Bière, Florent Le Ven, Marjorie Canu, Sophie Ribeyrolles, Baptiste Mion, Basile Mouhat, Baptiste Bazire, Charles Fauvel, Julien Ternacle, Jennifer Cautela, Théo Cambet, Thierry Le Tourneau, Erwan Donal, Stéphane Lafitte, Nicolas Mansencal, and Augustin Coisne

Subjects
simulation-based, medical education, residents, transesophageal echoardiography, randomized study, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction: Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies. To assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology.Materials and Methods: Nationwide prospective randomized multicenter study involving 43 centers throughout France allowing for the inclusion of >70% of all French cardiology residents. All cardiology residents naive from TEE will be included. Randomization with stratification by center will allocate residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator in addition.Results: All residents will undergo both a theoretical test (0–100 points) and a practical test on a TEE simulator (0–100 points) before and 3 months after the training. Satisfaction will be assessed by a 5-points Likert scale. The primary outcomes will be to compare the scores in the final theoretical and practical tests between the two groups, 3 months after the completion of the training.Conclusion: Data regarding simulation-based learning in TEE are limited to non-randomized or single-center studies. The randomized multicenter SIMULATOR study will assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology, and whether such an educational program should be proposed in first line for TEE teaching.

Published
2021
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7. Predictive value of the TRI-SCORE for in-hospital mortality after redo isolated tricuspid valve surgery

Author

Julien Dreyfus, Yohann Bohbot, Augustin Coisne, Yoan Lavie-Badie, Michele Flagiello, Baptiste Bazire, Florian Eggenspieler, Florence Viau, Elisabeth Riant, Yannick Mbaki, Damien Eyharts, Thomas Sénage, Thomas Modine, Martin Nicol, Fabien Doguet, Thierry Le Tourneau, Christophe Tribouilloy, Erwan Donal, Jacques Tomasi, Gilbert Habib, Christine Selton-Suty, Costin Radu, Pascal Lim, Richard Raffoul, Bernard Iung, Jean-Francois Obadia, Etienne Audureau, David Messika-Zeitoun, Centre cardiologique du Nord (CCN), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, CHU Lille, Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre hospitalier universitaire de Nantes (CHU Nantes), Pole Cardio-vasculaire et pulmonaire [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Lariboisière-Fernand-Widal [APHP], CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Département de Cardiologie [Hôpital de la Timone - APHM], and Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)

Subjects
tricuspid valve insufficiency, Cardiology and Cardiovascular Medicine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

ObjectivesThe TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores.MethodsUsing a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated.ResultsWe identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure.ConclusionRedo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).

Published
2023

9. Permanent Pacemaker Implantation After Tricuspid Valve Surgery

Author

Baptiste Bazire, Vincent Algalarrondo, and Julien Dreyfus

Subjects
Case Report, Cardiology and Cardiovascular Medicine
Abstract

Tricuspid valve (TV) surgery carries a high risk of atrioventricular block. In this report, we illustrate several options for managing conduction disorders after TV surgery. The choice of cardiac implantable devices must take account of several parameters such as surgical procedure, patient’s rhythm and history, and etiology of TV disease. (Level of Difficulty: Intermediate.)

Published
2023

11. A Machine-Learning Framework to Identify Distinct Phenotypes of Aortic Stenosis Severity

Author

Partho P. Sengupta, Sirish Shrestha, Nobuyuki Kagiyama, Yasmin Hamirani, Hemant Kulkarni, Naveena Yanamala, Rong Bing, Calvin W.L. Chin, Tania A. Pawade, David Messika-Zeitoun, Lionel Tastet, Mylène Shen, David E. Newby, Marie-Annick Clavel, Phillippe Pibarot, Marc R. Dweck, Éric Larose, Ezequiel Guzzetti, Mathieu Bernier, Jonathan Beaudoin, Marie Arsenault, Nancy Côté, Russell Everett, William S.A. Jenkins, Christophe Tribouilloy, Julien Dreyfus, Tiffany Mathieu, Cedric Renard, Mesut Gun, Laurent Macron, Jacob W. Sechrist, Joan M. Lacomis, Virginia Nguyen, Laura Galian Gay, Hug Cuéllar Calabria, Ioannis Ntalas, Bernard Prendergast, Ronak Rajani, Arturo Evangelista, and João L. Cavalcante

Subjects
macromolecular substances, 030204 cardiovascular system & hematology, Machine learning, computer.software_genre, Severity of Illness Index, Asymptomatic, 030218 nuclear medicine & medical imaging, Machine Learning, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Predictive Value of Tests, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Decompensation, Adverse effect, Heart Valve Prosthesis Implantation, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Aortic Valve Stenosis, medicine.disease, Confidence interval, 3. Good health, Stenosis, Phenotype, Aortic Valve, Cohort, Artificial intelligence, medicine.symptom, Cardiology and Cardiovascular Medicine, business, computer
Abstract

Objectives The authors explored the development and validation of machine-learning models for augmenting the echocardiographic grading of aortic stenosis (AS) severity. Background In AS, symptoms and adverse events develop secondarily to valvular obstruction and left ventricular decompensation. The current echocardiographic grading of AS severity focuses on the valve and is limited by diagnostic uncertainty. Methods Using echocardiography (ECHO) measurements (ECHO cohort, n = 1,052), we performed patient similarity analysis to derive high-severity and low-severity phenogroups of AS. We subsequently developed a supervised machine-learning classifier and validated its performance with independent markers of disease severity obtained using computed tomography (CT) (CT cohort, n = 752) and cardiovascular magnetic resonance (CMR) imaging (CMR cohort, n = 160). The classifier’s prognostic value was further validated using clinical outcomes (aortic valve replacement [AVR] and death) observed in the ECHO and CMR cohorts. Results In 1,964 patients from the 3 multi-institutional cohorts, 1,346 (68%) subjects had either nonsevere or discordant AS severity. Machine learning identified 1,117 (57%) patients as having high-severity and 847 (43%) as having low-severity AS. High-severity patients in CT and CMR cohorts had higher valve calcium scores and left ventricular mass and fibrosis, respectively than the low-severity group. In the ECHO cohort, progression to AVR and progression to death in patients who did not receive AVR was faster in the high-severity group. Compared with the conventional classification of disease severity, machine-learning–based severity classification improved discrimination (integrated discrimination improvement: 0.07; 95% confidence interval: 0.02 to 0.12) and reclassification (net reclassification improvement: 0.17; 95% confidence interval: 0.11 to 0.23) for the outcome of AVR at 5 years. For both ECHO and CMR cohorts, we observed prognostic value of the machine-learning classifications for subgroups with asymptomatic, nonsevere or discordant AS. Conclusions Machine learning can integrate ECHO measurements to augment the classification of disease severity in most patients with AS, with major potential to optimize the timing of AVR.

Published
2021

12. First-in-human implantation of the Topaz transcatheter tricuspid valve replacement system

Author

Emmanuel Teiger, Mohammed Nejjari, Pascal Lim, Tobias Ruf, Philipp Blanke, Ulrich Schäfer, Hendrik Treede, Romain Gallet, and Julien Dreyfus

Subjects
Heart Valve Prosthesis Implantation, Cardiac Catheterization, Treatment Outcome, Heart Valve Prosthesis, Humans, Tricuspid Valve, Cardiology and Cardiovascular Medicine, Tricuspid Valve Insufficiency
Published
2022

14. Tricuspid valve replacement: The old and the new

Author

Julien Dreyfus, Gilles D. Dreyfus, and Maurizio Taramasso

Subjects
Heart Valve Prosthesis Implantation, Treatment Outcome, Humans, Tricuspid Valve, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, Tricuspid Valve Insufficiency
Abstract

Tricuspid regurgitation is a frequent and serious condition but tricuspid valve (TV) surgery, that may be a valve replacement when a repair is not feasible, is rarely performed. Recent development of transcatheter TV interventions offers new options for those high-surgical risk patients, especially TV replacement for patients who are not eligible for transcatheter TV repair. In this review, we describe indications and outcome after surgical TV replacement, and devices available or in development for transcatheter TV replacement.

Published
2022

15. Cardiac remodelling in secondary tricuspid regurgitation: Should we look beyond the tricuspid annulus diameter?

Author

Anne Guérin, Sylvestre Maréchaux, Yoan Lavie-Badie, Erwan Donal, Julien Dreyfus, Jean-Christophe Eicher, Thierry Le Tourneau, Elsa Vabret, Catherine Sportouch, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre cardiologique du Nord (CCN), CHU Toulouse [Toulouse], Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Centre de génétique - Centre de référence des maladies rares, anomalies du développement et syndromes malformatifs (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Dijon, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Rennes (UR), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, and Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)

Subjects
Male, [SDV]Life Sciences [q-bio], Atrial Function, Right, Tricuspid regurgitation, Right ventricular dilation, 030204 cardiovascular system & hematology, Severity of Illness Index, Right atrial, 0302 clinical medicine, Tricuspid annulus, Medicine, Prospective Studies, Registries, 030212 general & internal medicine, Aged, 80 and over, Ejection fraction, Ventricular Remodeling, Medical treatment, General Medicine, Middle Aged, Prognosis, Tricuspid Valve Insufficiency, Remodelage du ventricule droit, cardiovascular system, Cardiology, Female, France, Tricuspid Valve, Cardiology and Cardiovascular Medicine, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Determinant, Insuffisance tricuspide, Regurgitation (circulation), Right heart remodelling, Effective Regurgitant Orifice Area, 03 medical and health sciences, Internal medicine, Humans, In patient, cardiovascular diseases, Aged, Echocardiography, Doppler, Pulsed, Déterminant, business.industry, Hemodynamics, Atrial Remodeling, Echocardiography, Doppler, Color, Ventricular Function, Right, business
Abstract

International audience; Background. - A better understanding of the mechanism of tricuspid regurgitation severity would help to improve the management of this disease. Aim. - We sought to characterize the determinants of isolated secondary tricuspid regurgitation severity in patients with preserved left ventricular ejection fraction. Methods. - This was a prospective observational multicentre study. Patients with severe tricuspid regurgitation were asked to participate in a registry that required a control echocardiogram after optimization of medical treatment and a follow-up. Patients had to have at least mild secondary tricuspid regurgitation when clinically stable, and were classified according to five grades of tricuspid regurgitation severity, based on effective regurgitant orifice area. Results. - One hundred patients with tricuspid regurgitation (12 mild, 31 moderate, 18 severe, 17 massive and 22 torrential) were enrolled. Right atrial indexed volume and tethering area were statistically associated with the degree of tricuspid regurgitation (P= 50 mm, the probability of having severe tricuspid regurgitation or a higher grade was > 70%. For an increase of 10 mL/m(2) in right atrial volume, the effective regurgitant orifice area increased by 4.2 mm(2), and for an increase of 0.1 cm(2) in the tethering area, the effective regurgitant orifice area increased by 2.35 mm(2). The degree of right ventricular dilation and changes in tricuspid morphology were significantly related to tricuspid regurgitation severity class (P

Published
2021

16. Reproducibility of the 2016 American Society of Echocardiography-European Association of Cardiovascular Imaging Algorithm for Estimation of Left Ventricular Filling Pattern: Not Perfect but Good Enough

Author

Arnaud Hubert, Augustin Coisne, Julien Dreyfus, Yohann Bohbot, Yoan Lavie-Badie, Sammy Aghezzaf, Stéphanie Brun, Martin Nicol, Chloé Di Léna, Emmanuel Oger, Erwan Donal, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Lille, Centre cardiologique du Nord (CCN), CHU Amiens-Picardie, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CHU Toulouse [Toulouse]

Subjects
Diastolic function, Acoustics and Ultrasonics, Radiological and Ultrasound Technology, Heart Ventricles, Biophysics, Doppler, Reproducibility of Results, United States, Ventricular Function, Left, Reproducibility, Ventricular Dysfunction, Left, Diastole, Echocardiography, Humans, Radiology, Nuclear Medicine and imaging, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Algorithms
Abstract

International audience; The 2016 American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines for the evaluation of left ventricular diastolic function reported a new algorithm to assess diastolic function and to estimate left ventricular filling pressure (LVFP). At least five to six different parameters were necessary to conclude, each of them with their own inter-observer variability. This article examines the reproducibility of each parameter of the algorithm and its influence on the final decision of the clinician. Echocardiographic exams of 12 non-selected patients without any known cardiac disease or follow-up but addressed to the hospital for symptoms were analyzed by two readers (one junior and one senior) in five French cardiologic tertiary centers. Inter-observer reproducibility at each step of the algorithm and final decision were analyzed. There was mild agreement on the final decision. The main reasons of discrepancy were disagreement on the significance of mitral annular calcifications and measured values that are just around the cut-off (despite good reproducibility, a slight variation could lead to misclassification of a dichotomous choice between a normal measure and a pathologic measure). Without considering performance, this multicentric French study puts forward limits to the actual algorithm recommended for LVFP pattern assessment. Agreement is excellent in caricatural (easy) cases (left ventricular pressure clearly normal or clearly elevated) but a great discordance exists in the gray zone. Improvement in the algorithm and in the method for LVFP determination is proposed.

Published
2022

17. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper

Author

Erwan Donal, Guillaume Leurent, Anne Ganivet, Philip Lurz, Augustin Coisne, Pascal De Groote, Stephane Lafitte, Lionel Leroux, Nicole Karam, Loic Biere, Frederic Rouleau, Catherine Sportouch, Julien Dreyfus, Mohammed Nejjari, Jean-Michel Josselin, Amedeo Anselmi, Elena Galli, Emma Bajeux, Patrice Guerin, Jean-François Obadia, Jean-Noel Trochu, Emmanuel Oger, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Leipzig University, CHU Lille, CHU Bordeaux [Bordeaux], Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Centre cardiologique du Nord (CCN), Institut de recherche en santé, environnement et travail (Irset), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre hospitalier universitaire de Nantes (CHU Nantes), Hospices Civils de Lyon (HCL), Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)

Subjects
Heart Valve Prosthesis Implantation, Cardiac Catheterization, [SDV]Life Sciences [q-bio], heart failure, General Medicine, 030204 cardiovascular system & hematology, Surgical Instruments, Severity of Illness Index, Tricuspid Valve Insufficiency, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Treatment Outcome, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Tricuspid Valve, prognosis, transoesophageal echocardiography, Cardiology and Cardiovascular Medicine, tricuspid regurgitation
Abstract

Aims Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. Methods and results The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. Conclusion Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR.

Published
2021

19. Tricuspid regurgitation: Light at the end of the tunnel?

Author

David Messika-Zeitoun, Julien Dreyfus, Carmen Lab, Team3 Carmen, Centre cardiologique du Nord (CCN), Services de Pneumologie, Exploration Fonctionnelle Respiratoire et Cardiologie (Hôpital Louis Pradel), Hospices Civils de Lyon (HCL), University of Ottawa [Ottawa], and CarMeN, laboratoire

Subjects
Heart Valve Prosthesis Implantation, Cardiac Catheterization, [SDV]Life Sciences [q-bio], Insuffisance tricuspide, Percutané, General Medicine, TRI-SCORE, Tricuspid Valve Insufficiency, [SDV] Life Sciences [q-bio], Tricuspid regurgitation, Treatment Outcome, Transcatheter, Pronostic, Humans, Surgery, Tricuspid Valve, Chirurgie, Cardiology and Cardiovascular Medicine, Outcome
Abstract

International audience; No abstract available

Published
2021

22. Natural history of functional tricuspid regurgitation: impact of cardiac output

Author

Sylvestre Maréchaux, Anne Guérin, Thierry Le Tourneau, Emmanuel Oger, Julien Dreyfus, Guillaume L’official, Catherine Sportouch, Erwan Donal, Jean-Christophe Eicher, Elisabeth Chen, Yoan Lavie-Badie, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre cardiologique du Nord (CCN), Hôpital de Rangueil, CHU Toulouse [Toulouse], Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université catholique de Lille (UCL), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Nantes (UN)-Université de Nantes (UN)

Subjects
Cardiac output, medicine.medical_specialty, Regurgitation (circulation), 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Tricuspid Valve Insufficiency, Functional tricuspid regurgitation, Internal medicine, Heart rate, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Systole, tricuspid regurgitation, Retrospective Studies, Ejection fraction, business.industry, cardiac output, Stroke Volume, General Medicine, 3. Good health, Natural history, right ventricular function, Echocardiography, Ventricular Function, Right, Cardiology, [SDV.IB]Life Sciences [q-bio]/Bioengineering, prognosis, Cardiology and Cardiovascular Medicine, business
Abstract

Aims Tricuspid regurgitation (TR) was long forgotten until recent studies alerting on its prognostic impact. Cardiac output (CO) is the main objective of heart mechanics. We sought to compare clinical and echocardiographic data of patients with TR from inclusion to 1-year follow-up according to initial CO. Methods and results Patients with isolated secondary TR and left ventricular ejection fraction (LVEF) ≥40% were prospectively included. All patients had a clinical and echocardiographic evaluation at baseline and after 1 year. Echocardiographic measurements were centralized. The patients were partitioned according to their CO at baseline. The primary outcome was all-cause death. Ninety-five patients completed their follow-up. The majority of patients had normal CO (n = 64, 67.4%), whereas 16 (16.8%) patients had low-CO and 12 (12.6%) had high-CO. right ventricular function was worse in the low-CO group but with improvement at 1 year (30% increase in tricuspid annular plane systolic excursion). LVEF and global longitudinal strain were significantly worse in the low-CO group. Overall, 18 (19%) patients died during follow-up, of which 10 (55%) patients had abnormal CO. There was a U-shaped association between CO and mortality. Normal CO patients had significantly better survival (87.5% vs. 62.5% and 66.67%) in the low- and high-CO groups, respectively, even after adjustment (heart rate 2.23 for the low-CO group and 9.08 for high-CO group; P = 0.0174). Conclusion Significant isolated secondary TR was associated with 19% of mortality. It is also associated with higher long-term mortality if CO is abnormal, suggesting a possible role for evaluating better and selecting patients for intervention.

Published
2021

23. How to treat severe symptomatic structural valve deterioration of aortic surgical bioprosthesis: transcatheter valve-in-valve implantation or redo valve surgery?

Author

Mohammed Nejjari, Francesco Nappi, Mackram F. Eleid, Julien Dreyfus, David Attias, and Charanjit S. Rihal

Subjects
Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Valve surgery, 030204 cardiovascular system & hematology, Prosthesis Design, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Older patients, Risk Factors, medicine.artery, medicine, Humans, In patient, 030212 general & internal medicine, Risks and benefits, Aged, Aged, 80 and over, Bioprosthesis, Aorta, business.industry, General Medicine, Middle Aged, Optimal management, Valve in valve, Prosthesis Failure, Surgery, Treatment Outcome, Aortic Valve, Heart Valve Prosthesis, Redo surgery, Cardiology and Cardiovascular Medicine, business
Abstract

The optimal management of aortic surgical bioprosthesis presenting with severe symptomatic structural valve deterioration is currently a matter of debate. Over the past 20 years, the number of implanted bioprostheses worldwide has been rapidly increasing at the expense of mechanical prostheses. A large proportion of patients, however, will require intervention for bioprosthesis structural valve deterioration. Current options for older patients who often have severe comorbidities include either transcatheter valve-in-valve (TVIV) implantation or redo valve surgery. The emergence of TVIV implantation, which is perceived to be less invasive than redo valve surgery, offers an effective alternative to surgery for these patients with proven safety and efficacy in high-risk patient groups including elderly and frail patients. A potential caveat to this strategy is that results of long-term follow-up after TVIV implantation are limited. Redo surgery is sometimes preferable, especially for young patients with a smaller-sized aortic bioprosthesis. With the emergence of TVIV implantation and the long experience of redo valve surgery, we currently have 2 complementary treatment modalities, allowing a tailor-made and patient-orientated intervention. In the heart team, the decision-making should be based on several factors including type of bioprosthesis failure, age, comorbidities, operative risk, anatomical factors, anticipated risks and benefits of each alternative, patient's choice and local experience. The aim of this review is to provide a framework for individualized optimal treatment strategies in patients with failed aortic surgical bioprosthesis.

Published
2018

24. Determinants and Prognostic Value of Longitudinal Strain in Asymptomatic Aortic Stenosis and Preserved Left Ventricular Ejection Fraction—The COFRASA/GENERAC Study

Author

David Messika-Zeitoun, Isabelle Codogno, Alec Vahanian, Xavier Duval, Julien Dreyfus, Virginia Nguyen, Maria Melissopoulou, Sarah Tubiana, Claire Cimadevilla, and David Attias

Subjects
medicine.medical_specialty, Ejection fraction, Longitudinal strain, business.industry, medicine.disease, Asymptomatic, Stenosis, Internal medicine, cardiovascular system, medicine, Cardiology, In patient, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Value (mathematics)
Abstract

Background: Longitudinal strain has been proposed as a sensitive marker of left ventricular systolic dysfunction. However its prognostic value in patients with aortic stenosis (AS) remains debated....

Published
2017

25. Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: An echocardiographic and computed tomography study

Author

Laurent Macron, Manuel Toledano, A. Altes, A. Truffier, Cédric Renard, Sylvestre Maréchaux, Yohann Bohbot, Pierre Graux, Gagandeep Chadha, Raphaëlle-Ashley Guerbaai, Julien Dreyfus, Pierre Vladimir Ennezat, Christophe Tribouilloy, David Attias, M. Sochala, Centre cardiologique du Nord (CCN), CHU Amiens-Picardie, University of Basel (Unibas), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), and Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie

Subjects
Male, medicine.medical_specialty, Time Factors, [SDV]Life Sciences [q-bio], Acceleration, Hemodynamics, Computed tomography, Acceleration time, 030204 cardiovascular system & hematology, Severity of Illness Index, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Registries, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Aged, 80 and over, Univariate analysis, Ejection fraction, medicine.diagnostic_test, business.industry, Calcinosis, Stroke Volume, General Medicine, Aortic Valve Stenosis, medicine.disease, Prognosis, Echocardiography, Doppler, Stenosis, Blood pressure, Aortic valve stenosis, Aortic Valve, Cardiology, Female, France, Ejection time, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed
Abstract

An increased acceleration time to ejection time (AT/ET) ratio is associated with increased mortality in patients with aortic stenosis (AS).To identify the factors associated with an increased AT/ET ratio.The relationships between the AT/ET ratio and clinical and Doppler echocardiographic variables of interest in the setting of AS were analysed retrospectively in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (LVEF). The computed tomography aortic valve calcium (CT-AVC) score was studied in a subgroup of 342 patients.In the univariate analysis, the AT/ET ratio was found to correlate with peak aortic jet velocity (r=0.57; P0.0001), mean pressure gradient (r=0.60; P0.0001), aortic valve area (r=-0.50; P0.0001) and CT-AVC score (r=0.24; P0.0001). The AT/ET ratio had good accuracy in predicting a peak aortic jet velocity≥4 m/s, a mean pressure gradient≥40mmHg and an aortic valve area≤1.0cmThe AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond the haemodynamic and anatomical severity of AS influence the AT/ET ratio, including LV geometry, function and systolic blood pressure. These findings should be considered when assessing the AT/ET ratio in patients with AS and preserved LVEF.

Published
2019

26. Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis

Author

Tania Pawade, Marie-Annick Clavel, Christophe Tribouilloy, Julien Dreyfus, Tiffany Mathieu, Lionel Tastet, Cedric Renard, Mesut Gun, William Steven Arthur Jenkins, Laurent Macron, Jacob W. Sechrist, Joan M. Lacomis, Virginia Nguyen, Laura Galian Gay, Hug Cuéllar Calabria, Ioannis Ntalas, Timothy Robert Graham Cartlidge, Bernard Prendergast, Ronak Rajani, Arturo Evangelista, João L. Cavalcante, David E. Newby, Philippe Pibarot, David Messika Zeitoun, and Marc R. Dweck

Subjects
Male, Aortic valve, medicine.medical_specialty, 030204 cardiovascular system & hematology, Severity of Illness Index, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Internal medicine, Multidetector Computed Tomography, Severity of illness, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Registries, Prospective cohort study, Aged, Aged, 80 and over, business.industry, Hazard ratio, Calcinosis, Aortic Valve Stenosis, Prognosis, medicine.disease, Echocardiography, Doppler, Confidence interval, Stenosis, medicine.anatomical_structure, Aortic Valve, Heart Valve Prosthesis, Aortic valve stenosis, Cardiology, Calcium, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background— Computed tomography aortic valve calcium scoring (CT-AVC) holds promise for the assessment of patients with aortic stenosis (AS). We sought to establish the clinical utility of CT-AVC in an international multicenter cohort of patients. Methods and Results— Patients with AS who underwent ECG-gated CT-AVC within 3 months of echocardiography were entered into an international, multicenter, observational registry. Optimal CT-AVC thresholds for diagnosing severe AS were determined in patients with concordant echocardiographic assessments, before being used to arbitrate disease severity in those with discordant measurements. In patients with long-term follow-up, we assessed whether CT-AVC thresholds predicted aortic valve replacement and death. In 918 patients from 8 centers (age, 77±10 years; 60% men; peak velocity, 3.88±0.90 m/s), 708 (77%) patients had concordant echocardiographic assessments, in whom CT-AVC provided excellent discrimination for severe AS (C statistic: women 0.92, men 0.89). Our optimal sex-specific CT-AVC thresholds (women 1377 Agatston unit and men 2062 Agatston unit) were nearly identical to those previously reported (women 1274 Agatston unit and men 2065 Agatston unit). Clinical outcomes were available in 215 patients (follow-up 1029 [126–2251] days). Sex-specific CT-AVC thresholds independently predicted aortic valve replacement and death (hazard ratio, 3.90 [95% confidence interval, 2.19–6.78]; P P =0.010). Conclusions— Sex-specific CT-AVC thresholds accurately identify severe AS and provide powerful prognostic information. These findings support their integration into routine clinical practice. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifiers: NCT01358513, NCT02132026, NCT00338676, NCT00647088, NCT01679431.

Published
2018

27. Timing of Referral of Patients With Severe Isolated Tricuspid Valve Regurgitation to Surgeons (from a French Nationwide Database)

Author

Gilbert Caranhac, Alec Vahanian, Nicolas Ghalem, Julien Dreyfus, Claire Cimadevilla, David Messika-Zeitoun, Patrick Nataf, and Eric Garbarz

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Internal medicine, Severity of illness, medicine, Extracorporeal membrane oxygenation, Humans, 030212 general & internal medicine, Hospital Mortality, Registries, education, Referral and Consultation, Dialysis, Retrospective Studies, Heart Valve Prosthesis Implantation, Surgeons, education.field_of_study, Tricuspid valve, business.industry, Incidence (epidemiology), Incidence, Retrospective cohort study, Middle Aged, Prognosis, Tricuspid Valve Insufficiency, Survival Rate, medicine.anatomical_structure, Echocardiography, Emergency medicine, Cardiology, Female, France, Tricuspid Valve, Tricuspid Valve Regurgitation, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Series evaluating the results of isolated tricuspid valve surgery (ITVS) are rare and often limited by small sample size, selection bias, and/or long period of enrollment. Based on a mandatory administrative national database, we collected all consecutive ITVS performed in France during a 2-year period (2013 and 2014), the type of intervention, clinical profile, and in-hospital mortality and complications. During the 2-year period, 241 patients underwent an ITVS in France (84 repairs and 157 replacements). In-hospital mortality was high (10%), and most patients experienced at least 1 complication (65%) with a 19% rate of major complications (death, need for dialysis, or need for mechanical support using extracorporeal membrane oxygenation). Consequently, hospital duration was remarkably long (26 ± 40 days). Congestive heart failure at presentation was associated with mortality and major complications rates (both p = 0.01). In conclusion, in a contemporary and consecutive series, ITVS was associated with a high mortality and morbidity predicted by clinical presentation at baseline. Our results suggest that patients are often referred too late and that an earlier intervention may improve immediate and possibly midterm outcomes. With the availability of transcatheter therapies in a near future, optimal timing of intervention in this population will be of utmost importance.

Published
2018

28. Transoesophageal echocardiography current practice in France: A multicentre study

Author

Julien Ternacle, Alexis Theron, Yohann Bohbot, Vincent Pelletier, Aurélien Seemann, Laurie Soulat-Dufour, Augustin Coisne, Clément Karsenty, Cécile Alexandrino, Eve Cariou, Thibault Caspar, Sophie Coulibaly, Edouard Collette, Julien Dreyfus, and Arthur Cescau

Subjects
Male, medicine.medical_specialty, Heart Diseases, Visual analogue scale, media_common.quotation_subject, 030204 cardiovascular system & hematology, Transoesophageal echocardiography, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, medicine, Humans, General anaesthesia, 030212 general & internal medicine, Prospective Studies, Practice Patterns, Physicians', Stroke, media_common, Aged, Aged, 80 and over, business.industry, General Medicine, Middle Aged, medicine.disease, Checklist, Feeling, Patient Satisfaction, Practice Guidelines as Topic, Physical therapy, Anxiety, Female, Clinical Competence, France, Guideline Adherence, medicine.symptom, Cardiology and Cardiovascular Medicine, Complication, business, Echocardiography, Transesophageal, Learning Curve
Abstract

BACKGROUND Few data are available on the application of transoesophageal echocardiography (TOE) recommendations in daily practice. AIMS To evaluate TOE practice based on echocardiography societies' guidelines, and to determine complication rates and factors associated with patient feelings. METHODS Between April and June 2017, we prospectively included all consecutive patients referred to 14 French hospitals for a transoesophageal echocardiogram (TOE). A survey was taken just after the examination, which included questions about pre-procedural anxiety, and any pain, unpleasant feeling or breathing difficulties experienced during the examination. RESULTS Overall, 1718 TOEs were performed, mainly for stroke evaluation. A standardized operating procedure checklist was completed in half of the patients before the examination. TOE was unpleasant for 62.4% of patients, but was stopped for agitation or intolerance in 3.5 and 1.4% of cases, respectively. We observed one severe complication (pulmonary oedema). The mean TOE duration was short (9.2±4.6minutes), but was longer with residents than with more experienced physicians (11±4.7 vs. 8.8±4.7minutes for junior physicians [P=0.0027]; vs. 8.9±4.8minutes for senior physicians [P=0.0013]; and vs. 7.5±4.1minutes for associate professors/professors [P

Published
2017

29. Mitral endocarditis: A new management framework

Author

David Attias, Christophe Acar, Ko Bando, Francesco Nappi, Cristiano Spadaccio, and Julien Dreyfus

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Mitral valve, medicine, Endocarditis, Humans, 030212 general & internal medicine, Embolization, Abscess, Native Valve Endocarditis, business.industry, Organ dysfunction, medicine.disease, Surgery, medicine.anatomical_structure, Infective endocarditis, cardiovascular system, Mitral Valve, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

The surgical management of mitral valve endocarditis is still argument of debate. We reviewed the current evidences regarding preoperative assessment, timing for surgery, operative strategy and antibiotic treatment and elaborated a systematic approach to endocarditis management based on clinical and anatomopathological variables known to affect postoperative outcomes. An algorithm to guide decision-making in mitral valve endocarditis, which includes etiology, clinical presentation, and anatomic extension of the infection at preoperative imaging, has been designed. Hemodynamic instability, extensive valvular lesions, elevated risk of embolization and inability to control the infection notwithstanding appropriate antibiotic treatment, are considered indications for urgency or emergency surgery. Type of operation to be performed should be dependent on the etiology (i.e., non-invasive or invasive organism), extent of the infective lesion, involvement of a native or a prosthetic valve, and patient age and comorbidities, including the presence of cardiac and/or extra-cardiac organ dysfunction. In case of single infected scallop, a reparative strategy should be preferred and coupled with vegetectomy or reconstruction of the perforated mitral segment with a pericardial patch. In cases that involve two or three scallops, left ventricular dysfunction, or renal or other extra-cardiac organ failure, valve repair is not recommended and valve replacement with either prosthetic or allogeneic tissues should be performed. Evidence of complex endocarditis with involvement of the mitral annulus or abscess of the mitro-aortic junction, requires extensive demolitive surgery and the use of homografts and synthetic material.

Published
2017

30. Temporal Trends in Transcatheter Aortic Valve Replacement in France

Author

Vincent Auffret, Thierry Lefevre, Eric Van Belle, Hélène Eltchaninoff, Bernard Iung, René Koning, Pascal Motreff, Pascal Leprince, Jean Philippe Verhoye, Thibaut Manigold, Geraud Souteyrand, Dominique Boulmier, Patrick Joly, Frédéric Pinaud, Dominique Himbert, Jean Philippe Collet, Gilles Rioufol, Said Ghostine, Olivier Bar, Alain Dibie, Didier Champagnac, Lionel Leroux, Frédéric Collet, Emmanuel Teiger, Olivier Darremont, Thierry Folliguet, Florence Leclercq, Thibault Lhermusier, Patrick Olhmann, Bruno Huret, Luc Lorgis, Laurent Drogoul, Bernard Bertrand, Christian Spaulding, Laurent Quilliet, Thomas Cuisset, Maxence Delomez, Farzin Beygui, Jean-Philippe Claudel, Alain Hepp, Arnaud Jegou, Antoine Gommeaux, Anfani Mirode, Luc Christiaens, Charles Christophe, Claude Cassat, Damien Metz, Lionel Mangin, Karl Isaaz, Laurent Jacquemin, Philippe Guyon, Christophe Pouillot, Serge Makowski, Vincent Bataille, Josep Rodés-Cabau, Martine Gilard, Hervé Le Breton, Herve Le Breton, Marc Laskar, Bernard Chevalier, Philippe Garot, Thomas Hovasse, Patrick Donzeau Gouge, Arnaud Farge, Mauro Romano, Bertrand Cormier, Erik Bouvier, Jean-Jacques Bauchart, Jean-Christophe Bodart, Cédric Delhaye, David Houpe, Robert Lallemant, Fabrice Leroy, Arnaud Sudre, Francis Juthier, Mohamed Koussa, Thomas Modine, Natacha Rousse, Jean-Luc Auffray, Marjorie Richardson, Jacques Berland, Mathieu Godin, Jean-Paul Bessou, Vincent Letocart, Jean-Christian Roussel, Philippe Jaafar, Nicolas Combaret, Nicolas D’Ostrevy, Andréa Innorta, Guillaume Clerfond, Charles Vorilhon, Marc Bedossa, Guillaume Leurent, Amedeo Anselmi, Majid Harmouche, Jean-Philippe Verhoye, Erwan Donal, Jacques Bille, Rémi Houel, Bertrand Vilette, Wissam Abi Khalil, Stéphane Delepine, Olivier Fouquet, Frédéric Rouleau, Jérémie Abtan, Marina Urena, Soleiman Alkhoder, Walid Ghodbane, Dimitri Arangalage, Eric Brochet, Coppelia Goublaire, Olivier Barthelemy, Rémi Choussat, Jean-Philippe Collet, Guillaume Lebreton, Chiro Mastrioanni, Richard Isnard, Raphael Dauphin, Olivier Dubreuil, Guy Durand De Gevigney, Gérard Finet, Brahim Harbaoui, Sylvain Ranc, Fadi Farhat, Olivier Jegaden, Jean-François Obadia, Matteo Pozzi, Saïd Ghostine, Philippe Brenot, Sahbi Fradi, Alexandre Azmoun, Philippe Deleuze, Martin Kloeckner, Didier Blanchard, Christophe Barbey, Stephan Chassaing, Didier Chatel, Olivier Le Page, Arnaud Tauran, Didier Bruere, Laurent Bodson, Yvon Meurisse, Aurélien Seemann, Nicolas Amabile, Christophe Caussin, Simon Elhaddad, Luc Drieu, Alice Ohanessian, François Philippe, Aurélie Veugeois, Matthieu Debauchez, Konstantinos Zannis, Daniel Czitrom, Chrystelle Diakov, François Raoux, Yves Lienhart, Patrick Staat, Oualid Zouaghi, Vincent Doisy, Jean Philippe Frieh, Fabrice Wautot, Julie Dementhon, Olivier Garrier, Fadi Jamal, Pierre Yves Leroux, Frédéric Casassus, Benjamin Seguy, Laurent Barandon, Louis Labrousse, Julien Peltan, Claire Cornolle, Marina Dijos, Stéphane Lafitte, Gilles Bayet, Claude Charmasson, Alain Vaillant, Jacques Vicat, Marie Paule Giacomoni, Eric Bergoend, Céline Zerbib, Jean Louis Leymarie, Philippe Clerc, Emmanuel Choukroun, Nicolas Elia, Jean-Philippe Grimaud, Jean-Philippe Guibaud, Stéphane Wroblewski, Eric Abergel, Emmanuel Bogino, Christophe Chauvel, Patrick Dehant, Marc Simon, Michel Angioi, Julien Lemoine, Simon Lemoine, Batric Popovic, Pablo Maureira, Olivier Huttin, Christine Selton Suty, Guillaume Cayla, Delphine Delseny, Gilles Levy, Jean Christophe Macia, Eric Maupas, Christophe Piot, François Rivalland, Gabriel Robert, Laurent Schmutz, Frédéric Targosz, Bernard Albat, Arnaud Dubar, Nicolas Durrleman, Thomas Gandet, Emmanuel Munos, Stéphane Cade, Frédéric Cransac, Frédéric Bouisset, Etienne Grunenwald, Bertrand Marcheix, Pauline Fournier, Olivier Morel, Patrick Ohlmann, Michel Kindo, Minh Tam Hoang, Hélène Petit, Hafida Samet, Anne Trinh, Guillaume Lecoq, Jean François Morelle, Pascal Richard, Thierry Derieux, Emmanuel Monier, Cédric Joret, Olivier Bouchot, Jean Christophe Eicher, Pierre Meyer, Stéphane Lopez, Michel Tapia, Jacques Teboul, Jean-Pierre Elbeze, Alain Mihoubi, Gérald Vanzetto, Olivier Wittenberg, Vincent Bach, Cécile Martin, Carole Sauier, Charlotte Casset, Philippe Castellant, Eric Bezon, Jean-Noel Choplain, Ahmed Kallifa, Bahaa Nasr, Yannick Jobic, Antoine Lafont, Jean-Yves Pagny, Ramzi Abi Akar, Jean-Noël Fabiani, Rachid Zegdi, Alain Berrebi, Tania Puscas, Bernard Desveaux, Fabrice Ivanes, Christophe Saint Etienne, Thierry Bourguignon, Blandine Aupy, Romain Perault, Jean-Louis Bonnet, Marc Lambert, Dominique Grisoli, Nicolas Jaussaud, Erwan Salaun, Amine Laghzaoui, Christine Savoye, Mathieu Bignon, Vincent Roule, Rémy Sabatier, Calin Ivascau, Vladimir Saplacan, Eric Saloux, Damien Bouchayer, Guillaume Tremeau, Camille Diab, Joel Lapeze, Franck Pelissier, Thomas Sassard, Catherine Matz, Nicolas Monsarrat, Ivan Carel, Franck Sibellas, Alain Curtil, Grégoire Dambrin, Xavier Favereau, Gabriel Ghorayeb, Laurent Guesnier, Wassim Khoury, Christophe Kucharski, Bruno Pouzet, Claude Vaislic, Riadh Cheikh-Khelifa, Loïc Hilpert, Philippe Maribas, Gery Hannebicque, Philippe Hochart, Marc Paris, Max Pecheux, Olivier Fabre, Laurent Leborgne, Marcel Peltier, Faouzi Trojette, Doron Carmi, Christophe Tribouilloy, Jean Mergy, Pierre Corbi, Pascale Raud Raynier, Sylvain Carillo, Arnaud Hueber, Fédéric Moulin, Georges Pinelli, Nicole Darodes, Francis Pesteil, Chadi Aludaat, Frédéric Torossian, Loïc Belle, Nicolas Chavanis, Chrystelle Akret, Alexis Cerisier, Jean Pierre Favre, Jean François Fuzellier, Romain Pierrard, Olivier Roth, Jean Yves Wiedemann, Nicolas Bischoff, Georghe Gavra, Nicolas Bourrely, Franck Digne, Mohammed Najjari, Victor Stratiev, Nicolas Bonnet, Patrick Mesnildrey, David Attias, Julien Dreyfus, Daniel Karila Cohen, Thierry Laperche, Julien Nahum, Aliocha Scheuble, Geoffrey Rambaud, Eric Brauberger, Michel Ah Hot, Philippe Allouch, Fabrice Beverelli, Julien Rosencher, Stéphane Aubert, Jean Michel Grinda, Thierry Waldman, Service de cardiologie et maladies vasculaires, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle ( MIVEGEC ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD [France-Sud] ), Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), CHU Gabriel Montpied ( CHU ), CHU Clermont-Ferrand, Institut Pascal - Clermont Auvergne ( IP ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Service de chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de chirurgie cardio-vasculaire et thoracique, CHU Angers, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition ( ICAN ), CHU Pitié-Salpêtrière [APHP]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Université Pierre et Marie Curie - Paris 6 ( UPMC ), Adaptation cardiovasculaire à l'ischemie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Service de cardiologie [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Cochin [AP-HP], Nutrition, obésité et risque thrombotique ( NORT ), Institut National de la Recherche Agronomique ( INRA ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU de Poitiers, Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Optimisation des régulations physiologiques ( ORPHY (EA 4324) ), Université de Brest ( UBO ) -Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Université de Brest ( UBO ), Institut de Chimie de la Matière Condensée de Bordeaux ( ICMCB ), Université de Bordeaux ( UB ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Institut national de recherches archéologiques préventives ( Inrap ), Hémostase et pathologie cardiovasculaire, EA2693-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé, Belgian Institute for Space Aeronomy / Institut d'Aéronomie Spatiale de Belgique ( BIRA-IASB ), ONERA - The French Aerospace Lab ( Toulouse ), ONERA, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Institut de cardiologie [CHU Pitié-Salpêtrière], Service de Chirurgie Thoracique et Cardiovasculaire [CHU Pitié-Salpêtrière], Cardioprotection, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Cardiovasculaire, métabolisme, diabétologie et nutrition ( CarMeN ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hospices Civils de Lyon ( HCL ) -Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Institut National de la Recherche Agronomique ( INRA ), Carnegie Mellon University [Pittsburgh] ( CMU ), Hôpital nord, St Etienne, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Clinique du Tonkin, Unité de recherche Phytopharmacie et Médiateurs Chimiques ( UPMC ), Institut National de la Recherche Agronomique ( INRA ), Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre des Sciences des Littératures en Langue Française ( CSLF ), Université Paris Nanterre ( UPN ), Service de Cardiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Laboratoire de Chimie Physique - Matière et Rayonnement ( LCPMR ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire d'Informatique Fondamentale de Lille ( LIFL ), Université de Lille, Sciences et Technologies-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Université de Lille, Sciences Humaines et Sociales-Centre National de la Recherche Scientifique ( CNRS ), Défaillance Cardiovasculaire Aiguë et Chronique ( DCAC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lorraine ( UL ), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Arnaud de Villeneuve, Institut des Maladies Métaboliques et Cardiovasculaires ( I2MC ), Université Paul Sabatier - Toulouse 3 ( UPS ) -Hôpital de Rangueil-Institut National de la Santé et de la Recherche Médicale ( INSERM ), École de sages-femmes René Rouchy ( ESF Angers ), Université d'Angers ( UA ) -CHU Angers, Laboratoire de Génie Civil et d'Ingénierie Environnementale ( LGCIE ), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Institut National des Sciences Appliquées ( INSA ), Agriculture and Agri-Food [Ottawa] ( AAFC ), Centre d'études et de recherche sur les contentieux - EA 3164 ( CERC ), Université de Toulon ( UTLN ), Radiopharmaceutiques biocliniques, Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Clinique de chirurgie cardiaque, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Unité Mixte de Recherches sur les Herbivores ( UMR 1213 Herbivores ), VetAgro Sup ( VAS ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Recherche Agronomique ( INRA ), Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Développement artériel, Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de recherche en économie et management ( CREM ), Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Centre National de la Recherche Scientifique ( CNRS ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Récepteurs nucléaires, maladies cardiovasculaires et diabète ( EGID ), Université de Lille, Droit et Santé-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Pasteur de Lille, Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Edwards Lifesciences Medtronic Lead-Up Medicines Company French Cardiology Federation (Federation Francaise de Cardiologie) Eli Lilly WebMD Biosensor ACIST Abbott Biosensors Terumo Daichii-Sankyo Boston Scientific St. Jude Medical Bristol-Myers Squibb Bayer AstraZeneca French Ministry of Health Abiomed Zoll Medpass Cordis Servier, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), Institut Pasteur de Lille, and Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille )

Subjects
Aortic valve, medicine.medical_specialty, medicine.medical_treatment, national registry, 030204 cardiovascular system & hematology, outcomes, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Cardiac tamponade, Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Aortic dissection, business.industry, Mortality rate, transfemoral, EuroSCORE, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine.disease, pacemaker, 3. Good health, Surgery, Stenosis, Catheter, medicine.anatomical_structure, Cardiology and Cardiovascular Medicine, business
Abstract

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

Published
2017

31. 0583: Prognostic significance of longitudinal strain in asymptomatic aortic stenosis and preserved left ventricular ejection fraction – the OFRASA/GENERAC study

Author

Tiffany Mathieu, David Messika-Zeitoun, Virginia Nguyen, Isabelle Codogno, Alec Vahanian, Maria Melissopoulou, David Attias, and Julien Dreyfus

Subjects
medicine.medical_specialty, Univariate analysis, Ejection fraction, business.industry, medicine.disease, Asymptomatic, Sudden death, Stenosis, Aortic valve replacement, Internal medicine, Heart failure, Cardiology, Medicine, medicine.symptom, business, Prospective cohort study, Cardiology and Cardiovascular Medicine
Abstract

Objectives It has been suggested that myocardial systolic deformation parameters may be a more sensitive marker of left ventricular (LV) systolic dysfunction than LV ejection fraction (LVEF). However, its prognostic value in patients with aortic stenosis (AS) remains debated. Methods In an ongoing prospective cohort of asymptomatic patients with at least mild, pure, isolated AS, global longitudinal strain (GLS) was measured at baseline using 2D speckle tracking imaging, and AS related events (occur-rence of symptoms, congestive heart failure and sudden death) were prospectively collected. Results We prospectively enrolled 176 patients (mean age 72 years, 70% male). Mean aortic valve area was 1.25cm2 and mean gradient 28.8mmHg. Overall, 88 patients had mild AS, 50 patients moderate AS and 38 patients severe AS. During a mean follow up period of 2.2 years, 38 events occurred. GLS was not correlated to pic velocity, mean gradient or aortic valve area (AVA) (all p>0.05). In univariate analysis, neither in the whole cohort (p=0.75), nor in the subgroup of moderate/severe AS, GLS was predictive of future AS related events. Results were unchanged after adjustment for AS hemodynamic severity (p=0.66 and p=0.82, respectively). Conclusions Our data suggest that longitudinal strain assessed by 2D speckle tracking echocardiography, is not predictive of future symptomatic status in asymptomatic patients with AS and preserved LVEF. Thus, this index should not be recommended in daily practice, in order to select patients who should undergo an early aortic valve replacement.

Published
2016
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32. 0402: Assessment of tricuspid annulus shape and orientation using three-dimensional transesophageal echocardiography

Author

Alec Vahanian, Julien Dreyfus, Guillaume Durand-Viel, Claire Cimadevilla, Eric Brochet, and Messika-Zeitoun David

Subjects
Aortic valve, Valve surgery, business.industry, Orientation (computer vision), Matrix Array, Geometry, Free wall, medicine.anatomical_structure, Ventricle, medicine, Tricuspid annulus, Nuclear medicine, business, Cardiology and Cardiovascular Medicine, Interatrial septum, Mathematics
Abstract

BackgroundThe tricuspid annulus (TA) is a complex structure that has been rarely evaluated. Three-dimensional transesophageal echocardiography (3D-TEE) gives us the unique opportunity to evaluate TA shape and dimensions.Methods3D dynamic volumetric datas of the TA were acquired by TEE using a matrix array transducer (X7-2t, Philips) in 184 patients. Multiplanar reconstructions were performed offline using a dedicated software (QLab7, Philips). Long-axis (LA) diameter, short-axis (SA) diameter and the area of the TA at the time of its maximal opening were measured. The eccentricity index (EI) of the TA was defined as LA/SA and TA orientation as the angle between the interatrial septum axis (aortic valve on the top at 0°) and the LA in the surgical view.ResultsMorphology of TA was more often oval (EI=1.35±0.22) but shapes were significantly different among indivuals, from circular to oval (EI values from 1 to 2.15). TA dilatation occurred homogeneously in all the directions of the right ventricle free wall as attested by the very good correlation between the TA area and both LA (r=0.89, p

Published
2015
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33. Feasibility of percutaneous mitral commissurotomy in patients with commissural mitral valve calcification

Author

Dominique Himbert, Eric Brochet, Laurent Lepage, Virginia Nguyen, Julien Dreyfus, Alec Vahanian, Bernard Iung, C. Cimadevilla, and David Messika-Zeitoun

Subjects
Male, medicine.medical_specialty, Cardiac Catheterization, Percutaneous, Mitral valve stenosis, Mitral valve, Internal medicine, medicine, Humans, Mitral Valve Stenosis, Vascular Calcification, Mitral valve calcification, Heart Valve Prosthesis Implantation, business.industry, Atrial fibrillation, Commissure, Middle Aged, medicine.disease, Stenosis, medicine.anatomical_structure, Case-Control Studies, Cardiology, Feasibility Studies, Female, Cardiology and Cardiovascular Medicine, business, Calcification
Abstract

Whether a percutaneous mitral commissurotomy (PMC) should be attempted in patients with mitral stenosis (MS) and valvular calcification, especially located at the commissural level remained debated. We sought to evaluate the impact of the degree and location of mitral valve calcifications on PMC results.Over a 3-year period, we enrolled 464 consecutive patients who underwent a PMC at our institution. According to the location (within the body valve leaflets' or at the commissural level) and the degree of calcification, patients were divided into three groups: 261 patients were in Group 1 (no leaflets' or commissural calcification), 141 in Group 2 (leaflets' calcification with no significant commissural calcification), and 62 in Group 3 (at least one commissure significantly calcified). Final valve area (1.83 ± 0.26, 1.71 ± 0.25, and 1.60 ± 0.24 cm(2), P0.00001) and the rate of complete opening of at least one commissure (92, 94, and 84%, P = 0.05) were significantly different. However, the rate of post-PMC mitral regurgitation (MR) of grade ≥ 3 (10, 10, and 8%, P = 0.90) was not different among the groups and if the rate of good immediate result, defined as valve area ≥ 1.5 cm(2) with no MR2/4 was different among the three groups (88, 78, and 73%, P = 0.004), an overallprocedural success could be achieved in most patients with calcified commissures.In this large contemporary series of patients with MS, a procedural success was obtained less frequently in patients with calcified commissure but a successful PMC could still be safely achieved in a large proportion of patients. Our results support the use of PMC as a first-line treatment of patients with severe MS even in the presence of significant commissural calcifications with otherwise favourable clinical characteristics.

Published
2014

34. 0407: Evaluation of the tricuspid annulus size: clinical implications from comparison between 2D-transthoracic and 3D-transesophageal echocardiography

Author

Eric Brochet, Guillaume Durand-Viel, David Messika-Zeitoun, Alec Vahanian, C. Cimadevilla, and Julien Dreyfus

Subjects
medicine.medical_specialty, Valve surgery, business.industry, Matrix Array, Routine practice, Surgery, Tricuspid annuloplasty, medicine.anatomical_structure, Parasternal line, Ventricle, Healthy volunteers, medicine, Tricuspid annulus, Nuclear medicine, business, Cardiology and Cardiovascular Medicine
Abstract

Background Tricuspid annuloplasty is recommended during left-heart valve surgery when tricuspid annulus (TA) is dilated, independently of the degree of tricuspid regurgitation, but the methodology to measure TA and thresholds are not clearly defined. We aimed to compare TA diameter (TAD) measurements performed using bi-dimensional transthoracic echocardiography (2D-TTE) in the 4 different views to three-dimensional measurements performed during transesophageal echocardiography (3D-TEE) and to define thresholds of TA enlargement for routine practice. Methods 2D-TTE measurement of the TAD was performed in parasternal long-axis view of the right ventricle inflow, parasternal short-axis, apical 4-chamber (A4C) and sub-costal views in 195 prospectively enrolled patients and 66 healthy volunteers. 3D dynamic volumetric datas of the TA were also acquired by TEE using a matrix array transducer (X7-2t, Philips) in the 195 patients. Multiplanar reconstructions were performed offline using dedicated software (QLab7, Philips) to measure the long-axis (LA) of the TA. Results In the 195 patients, TAD measurements were not different between the 4 TTE views (P=0.13), but A4C was the most feasible and the most reproducible method (Table). TAD measurement in A4C view by TTE (3.90±0.62cm) was well correlated (r=0.84, p Conclusion TAD measurement in A4C view by 2D-TTE was highly feasible, reproducible and accurately reflected TA size, even if it was systematically underestimating its maximal diameter. Based on measurements in healthy volunteers, we suggest to consider tricuspid annuloplasty during left-heart valve surgery when TA is more than 2.3cm/m² or 4.2cm in A4C.

Published
2015
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35. Eligibility of patients with atrial fibrillation for new oral anticoagulants

Author

Ghassan Moubarak, Constantin Simion, Aurélie Delos Paquet, Serge Cazeau, Romain Cador, Nicolas Badenco, and Julien Dreyfus

Subjects
Male, medicine.medical_specialty, Administration, Oral, Dabigatran, Internal medicine, Atrial Fibrillation, medicine, Humans, Aged, Retrospective Studies, Aged, 80 and over, Rivaroxaban, business.industry, Anticoagulants, Atrial fibrillation, medicine.disease, Cardiology, beta-Alanine, Apixaban, Benzimidazoles, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug, Factor Xa Inhibitors
Published
2012

36. 141 Age-related variations of diastolic parameters assessed by Doppler echocardiography and phase-contrast cardiovascular magnetic resonance in asymptomatic volunteers

Author

Eric Bruguière, Elie Mousseaux, Nadjia Kachenoura, Emilie Bollache, Julien Dreyfus, Alban Redheuil, Arshid Azarine, Ludivine Perdrix, Golmehr Ashrafpoor, and Benoit Diebold

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Phase contrast microscopy, Diastole, Magnetic resonance imaging, Doppler echocardiography, Asymptomatic, law.invention, law, Internal medicine, Age related, medicine, Cardiology, Radiology, medicine.symptom, business, Cardiology and Cardiovascular Medicine
Published
2012
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37. Age-related variations in left ventricular diastolic parameters assessed automatically from phase-contrast cardiovascular magnetic resonance data: comparison against doppler echocardiography

Author

Nadjia Kachenoura, Eric Bruguière, Golmehr Ashrafpoor, Emilie Bollache, Elie Mousseaux, Benoit Diebold, Arshid Azarine, Julien Dreyfus, Ludivine Perdrix, Alban Redheuil, Imagerie cardiovasculaire, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), Laboratoire d'Imagerie Fonctionnelle (LIF), Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR14-IFR49-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), BMC, Ed., Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ) -Université Paris Descartes - Paris 5 ( UPD5 ), Laboratoire d'Imagerie Fonctionnelle ( LIF ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -IFR14-IFR49-Institut National de la Santé et de la Recherche Médicale ( INSERM ), and Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP )

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Pathology, animal structures, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Phase contrast microscopy, Diastole, Doppler echocardiography, Asymptomatic, law.invention, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, law, Age related, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, [ SDV.IB.IMA ] Life Sciences [q-bio]/Bioengineering/Imaging, Angiology, Medicine(all), Ejection fraction, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, lcsh:RC666-701, Poster Presentation, Cardiology, cardiovascular system, medicine.symptom, Cardiology and Cardiovascular Medicine, business, circulatory and respiratory physiology
Abstract

International audience; Relationship with age and comparison of phase-contrast- CMR and Doppler-echocardiography derived left ventricular diastolic function parameters in asymptomatic individuals with preserved ejection fraction.

Published
2012

38. 139 Measurement of the left atrium volume does the method matter?

Author

Claire Cimadevilla, Andrea Chiampan, Julien Dreyfus, Alec Vahanian, Nadia Berjeb, Caroline Cueff, David Messika-Zeitoun, and Michaela Malanca

Subjects
medicine.anatomical_structure, business.industry, Left atrium, medicine, Anatomy, Cardiology and Cardiovascular Medicine, business, Volume (compression)
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