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Objectives The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation. Background AFL ablation commonly requires intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with rising interest, but robust data in electrophysiological procedures are lacking. Methods This single center, randomized controlled trial compared hypnosis and placebo during AFl ablation. In addition to the randomized intervention, all patients were treated according to the institution’s standard of care analgesia protocol (administration of 1 mg of intravenous morphine in case of self-reported pain ≥5 on an 11-point numeric rating scale or on demand). The primary endpoint was perceived pain quantified by patients using a visual analog scale. Results Between October 2017 and September 2019, 113 patients (mean age 70 ± 12 years, 21% women) were randomized to hypnosis (n = 56) or placebo (n = 57). Mean pain score was 4.0 ± 2.2 in the hypnosis group versus 5.5 ± 1.8 in the placebo group (p Conclusions In this first randomized trial, hypnosis during AFL ablation was superior to placebo for alleviating pain and reducing morphine consumption.

International audience; Background: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI.Methods: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290.Findings: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070).Interpretation: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.Funding: ACTION Study Group and AstraZeneca.

International audience; This position paper was intended to update the former consensus between the French Societies of Radiology and Cardiology about the use of stress cardiac magnetic resonance imaging (MRI) in chronic coronary syndrome published in 2009. The Delphi method was used to build the present consensus. This expert panel consensus includes recommendations for indications, procedure with patient preparation, stress inducing drugs, acquisition protocol, interpretation and risk stratification by stress MRI.

Background Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. Objective We aimed to investigate the feasibility and effectiveness of VR in patients undergoing atrial fibrillation (AF) ablation under conscious sedation. Methods All patients who underwent an AF ablation with VR from March to May 2020 were included. Patients were compared to a consecutive cohort of patients who underwent AF ablation in the 3 months prior to the study. Primary efficacy was assessed by using a visual analog scale, summarizing the overall pain experienced during the ablation. Results The AF cryoablation procedure with VR was performed for 48 patients (mean age 63.0, SD 10.9 years; n=16, 33.3% females). No patient refused to use the device, although 14.6% (n=7) terminated the VR session prematurely. Preparation of the VR headset took on average 78 (SD 13) seconds. Compared to the control group, the mean perceived pain, assessed with the visual analog scale, was lower in the VR group (3.5 [SD 1.5] vs 4.3 [SD 1.6]; P=.004), and comfort was higher in the VR group (7.5 [SD 1.6] vs 6.8 [SD 1.7]; P=.03). On the other hand, morphine consumption was not different between the groups. Lastly, complications, as well as procedure and fluoroscopy duration, were not different between the two groups. Conclusions We found that VR was associated with a reduction in the perception of pain in patients undergoing AF ablation under conscious sedation. Our findings demonstrate that VR can be easily incorporated into the standard ablation workflow.

BACKGROUND Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. OBJECTIVE We aimed to investigate the feasibility and effectiveness of VR in patients undergoing atrial fibrillation (AF) ablation under conscious sedation. METHODS All patients who underwent an AF ablation with VR from March to May 2020 were included. Patients were compared to a consecutive cohort of patients who underwent AF ablation in the 3 months prior to the study. Primary efficacy was assessed by using a visual analog scale, summarizing the overall pain experienced during the ablation. RESULTS The AF cryoablation procedure with VR was performed for 48 patients (mean age 63.0, SD 10.9 years; n=16, 33.3% females). No patient refused to use the device, although 14.6% (n=7) terminated the VR session prematurely. Preparation of the VR headset took on average 78 (SD 13) seconds. Compared to the control group, the mean perceived pain, assessed with the visual analog scale, was lower in the VR group (3.5 [SD 1.5] vs 4.3 [SD 1.6]; P=.004), and comfort was higher in the VR group (7.5 [SD 1.6] vs 6.8 [SD 1.7]; P=.03). On the other hand, morphine consumption was not different between the groups. Lastly, complications, as well as procedure and fluoroscopy duration, were not different between the two groups. CONCLUSIONS We found that VR was associated with a reduction in the perception of pain in patients undergoing AF ablation under conscious sedation. Our findings demonstrate that VR can be easily incorporated into the standard ablation workflow.

Symptomatic sinus node disease (SND) most frequently requires the implantation of a dual chamber pacemaker of which the right atrial lead is generally implanted in the right atrial appendage (RAA) or the lateral wall (LW).The aim of this retrospective study was to evaluate the impact of the right atrial lead pacing site regarding the onset of AF in patients with SND. RESULTS: 126 patients were included (53% males; 76 yo). 64 (51%) patients were implanted in the RAA and 62 (49%) in the LW. The two groups were not different in terms of CHA2DS2-VASc score and indexed left atrial volume. Forty-eight months after implantation, AF occurred in 17 (26.6%) of the RAA group and 6 (9.7%) in the lateral group. In the multivariate models, RAA site was the only factor associated with AF onset, with an Hazard Ratio of 2.5 (95%CI 1.1; 5.7; P=0.03). CONCLUSION: In our study, RAA pacing was associated with 2.5 higher risk of AF onset in patients with SND. Further larger randomized studies are needed to confirm these findings.

Background Pacemaker recipients are at high-risk of sleep apnea (SA). New generation of pacemakers allow day by day, sleep-disordered breathing (SDB) monitoring. These devices measure variations in thoracic impedance and can detect apnea and hypopnea. Purpose The aim was To compare the rate of SA detection in patients implanted with and without pacemaker capable of monitoring (SDB). Methods This retrospective study included all consecutive patients implanted with a pacemaker between 2013 and 2016 at Poitiers university hospital. Pacemaker recipients allowing SDB monitoring (SDB monitoring group) and pacemaker recipients not allowing SDB monitoring (control group) were compared in terms of SA diagnosis, continuous positive airway pressure (CPAP) therapy initiation, newly AF discovered and stroke occurrence. Results Among the 1442 patients included (mean age 79 years, 39% of women, BMI = 27 kg/m2). 653 were in the SDB monitoring group and 789 in the control group. The 2 groups were not different in terms of age, body mass index, cardiovascular risk factor, cardiac function, and medication. Indication for cardiac pacing was atrioventricular block and sinus dysfunction in 56% and 23% of patients respectively. Mean follow-up was 24.7 months. 40 patients (7.5%) have been diagnosed with SA in the SDB monitoring group and 18 (2.7%) in the control group (p Conclusion In real life conditions, pacemakers capable of monitoring SDB improve the diagnosis of SA and CPAP therapy rate. Monitoring of sleep apnea after at least Funding Acknowledgement Type of funding source: None

Background New generation pacemaker allow the assessment day by day of sleep disordered breathing (SDB) based on impedance measurement. A recent study demonstrated that incidence of AF is higher in case of severe SA monitored by pacemaker Purpose The aim was to compare the atrial fibrillation (AF) burden between patients with severe and non-severe sleep apnea (SA) detected with pacemakers monitoring (SDB). Methods This retrospective study was carried out at our University Hospital. We included all patients with Microport CRM pacemaker implanted from 2013 to 2016 at our university hospital. Exclusion criteria were inactivation of sleep apnea monitoring (SAM), history of sleep apnea, missing data or invalid data. AF burden was assessed according to Fallback mode switch (FMS) duration. Respiratory disturbance index (RDI) was calculated as the average number of events (ventilation pause and reductions) per number of hours of monitoring. Patients with RDI Results 404 patients (mean age = 79.7±10 years; 52.0% men) were included. The most prevalent indication for cardiac pacing was atrioventricular block in 57%. Mean RDI was 18.9 events per hour. 234 (58%) of them had a mean RDI Conclusion Severe SA detected by pacemaker was associated with longer AF duration. We did not find higher occurrence of stroke in the severe SA group. Funding Acknowledgement Type of funding source: None

Background Randall-type monoclonal immunoglobulin disease (MIDD) is a rare complication of a monoclonal plasma cell clone. MIDD differs from AL amyloidosis by the presence of Congo red negative non-organized immunoglobulin (Ig) deposits, most commonly light chains (LCDD) along basement membranes and sometimes heavy chains (HCDD) or light and heavy chains (LHCDD). As AL amyloidosis MIDD is a multi-systemic disease, and affects the heart. To date no study has focused on the clinical characteristics of heart disease in MIDD. Purpose The aim of this study was to describe the cardiologic features of patients with biopsy-proven MIDD and suspected cardiac involvement. Methods This multi-center, nation-wide retrospective study extracted from the database of the French reference center for AL amyloidosis and other Ig deposition diseases between 2012 to 2019. Diagnosis of cardiac involvement was assessed according to the International Society of Amyloidosis criteria for amyloid heart disease, as follows: left ventricular hypertrophy with a diastolic septum thickness ≥12mm, NTproBNP serum level ≥332 ng / L, histological evidence on cardiac or extra cardiac biopsy of typical linear non-organized Ig deposits along basement membranes. Severity was defined according to the Mayo Clinic classification for AL amyloidosis. Results Among 20 patients included (mean age was 70±9 years), 11 (55%) were males; 13 (65%) were LCDD, 3 (15%) HCDD and 4 (20%) LHCDD. At diagnosis, 19 (95%) had a history of hypertension, 3 (16%) had atrial fibrillation, 3 (15%) had NYHA grade 3 or 4 dyspnea. Mayo Clinic score was stage 3a in 4 patients (20%) and stage 3b in 6 patients (30%). The most frequent ECG changes were microvoltage (40%) and pseudo Q wave (40%); 64% of patients had altered sinus variability on 24-hour Holter monitoring, one patient had a high-grade conduction disorder and another had ventricular tachycardia. On echocardiography, all showed diastolic dysfunction; mean diastolic septum thickness was 13.5mm; only one patient had LVEF impairment but 38% had global longitudinal strain impairment. 10 patients had cardiac MRI, none showed contrast enhancement after gadolinium injection. After median follow-up of 28 months, 4 patients were hospitalized for heart failure, including 2 with cardiogenic shock. Seven (35%) patients died within a median of 10 months from diagnosis. Among patients with Mayo clinic stage 3 (a or b), 67% died within a median of 8 months from the diagnosis. Conclusions To our knowledge, we present the first case series dedicated to the description of cardiac parameters in MIDD patients with cardiac involvement. Except for MRI appearance of cardiac infiltration, these patients showed features close to that of AL amyloid heart disease. Overall prognosis appears seemingly poor in MIDD patients with Mayo Clinic stage 3 cardiac disease. Funding Acknowledgement Type of funding source: None

International audience; Background: Clopidogrel associated with aspirin is the recommended treatment for patients undergoing elective percutaneous coronary intervention (PCI). Although severe PCI-related events are rare, evidence suggests that PCI-related myocardial infarction and myocardial injury are frequent complications that can impact the clinical prognosis of the patients. Antiplatelet therapy with a potent P2Y12 receptor inhibitor such as ticagrelor may reduce periprocedural ischemic complications while maintaining a similar safety profile as compared with conventional dual antiplatelet therapy by aspirin and clopidogrel in this setting. Methods: Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS) (NCT02617290) is an international, multicenter, randomized, parallel-group, open-label study in patients with stable coronary artery disease who are planned for an elective PCI. In total, 1,900 patients will be randomized before a planned PCI to a loading dose of ticagrelor 180 mg or a loading dose of clopidogrel (300 or 600 mg) in addition to aspirin. Patients will then receive a dual antiplatelet therapy with aspirin and ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily for 30 days. The primary ischemic end point is PCI-related myocardial infarction (myocardial infarction type 4a or 4b) or major myocardial injury within 48 hours (or at hospital discharge if earlier) after elective PCI/stent. Safety will be evaluated by major bleeding events (Bleeding Academic Research Consortium type 3 or 5) at 48 hours (or discharge if it occurs earlier). Conclusion: ALPHEUS is the first properly sized trial comparing ticagrelor to clopidogrel in the setting of elective PCI and is especially designed to show a reduction in periprocedural events, a surrogate end point for mortality.

INTRODUCTION: Specialized chest pain units appear to increase the proportion of patients with acute chest pain who are properly evaluated, but some of them remain doubtful. HYPOTHESIS: The aim of this study was to evaluate the survival and occurrence of cardiovascular events in patients without diagnosis at the end of management of chest pain with high‐sensitivity troponin (Tn) elevation. METHOD: All consecutive patients who came to the cardiac emergency room of Poitiers University Hospital between January 1, 2014, and August 7, 2015, for chest pain and Tn elevation were included. The primary endpoint was the number of undiagnosed patients; secondary endpoints included survival and major adverse cardiac events. RESULTS: A total of 1001 patients (695 male; mean age, 68 ±16 years) who had chest pain and Tn elevation were included. Median follow‐up was 24.5 (IQR, 14.7–29.5) months. Forty‐seven (4.7%) patients remained without diagnosis. Compared with patients with diagnosis, these patients were younger (53.6 ±19.7 years; P

Background Right ventricular function is the major determinant of morbidity and mortality in pulmonary arterial hypertension (PAH). The ESC risk assessment strategy for PAH is based on clinical status, exercise testing, NTproBNP, imaging and haemodynamics but does not include right ventricular function. Our aims were to test the power of resting echocardiographic measurements to classify PAH patients according to ESC exercise testing risk stratification cut-offs and to determine if the classification power of echocardiographic parameters varied in chronic thrombo-embolic pulmonary hypertension (CTEPH). Methods We prospectively and consecutively recruited 46 PAH patients and 42 CTEPH patients referred for cardio-pulmonary exercise testing and comprehensive transthoracic echocardiography. Exercise testing parameters analyzed were peak oxygen consumption, percentage of predicted maximal oxygen consumption and the slope of ventilation against carbon dioxide production. Receiver operator characteristic curves were used to determine the optimal diagnostic cut-off values of echocardiographic parameters for classifying the patients in intermediate or high risk category according to exercise testing. Results Measurements of right ventricular systolic function were the best for classifying in PAH (area under the curve 0.815 to 0.935). Measurements of right ventricular pressure overload (0.810 to 0.909) were optimal for classifying according to exercise testing in CTEPH. Measurements of left ventricular function were of no use in either group. Conclusions Measurements of right ventricular systolic function can classify according to exercise testing risk stratification cut-offs in PAH. However, this is not the case in CTEPH where pressure overload, rather than right ventricular function seems to be linked to exercise performance.

While postoperative stroke is a known complication of Transcatheter Aortic Valve Implantation (TAVI), predictors of early stroke occurrence have not been specifically reviewed. The objective of this study was to estimate the predictors and incidence of stroke during the first 30 days post-TAVI.A cohort of 506 consecutive patients having undergone TAVI between January 2017 and June 2019 was extracted from a prospective database. Preoperative, intraoperative and postoperative characteristics were analyzed by univariate analysis followed by logistic regression to find predictors of the occurrence of stroke or death within the first 30 days after the procedure.Incidence of stroke within 30 days post-TAVI was 4.9%, [CI 95% 3.3-7.2], i.e., 25 strokes. Four out of the 25 patients (16%) with a stroke died within 30 days post-TAVI. After logistic regression analysis, the predictors of early stroke related to TAVI were: CHA2Ds2VASc score ≥ 5 (odds ratio [OR] 2.62; 95% CI: 1.06-6.49; p = .037), supra-aortic access vs. femoral access (OR: 9.00, 95%CI: 2.95-27.44; p = .001) and introduction post-TAVI of a single vs. two or three antithrombotic agents (OR: 5.13; CI 95%: 1.99 to 13.19; p = .001). Over the 30-day period, bleeding occurred in 28 patients (5.5%), in 25 of whom, it was associated with femoral or iliac artery access injury. Anti-thrombotic regimen was not associated with bleeding; two patients out of 48 (4.1%) bled with a single anti-thrombotic regimen vs. 26 patients out of 458 (5.6%) with a dual or triple anti-thrombotic regimen (p = 0.94). The overall 30-day mortality rate was 3.9%, [95% CI 2.5-6.0]. Patients with a single post-TAVI antithrombotic agent (OR: 44.07 [CI 95% 13.45-144.39]; p .0001) and patients with previous coronary artery bypass surgery or coronary artery stenting (OR: 6.16, [CI 95% 1.99-21.29]; p = .002) were at significantly higher risk of death within the 30-day period.In this large-scale single-center retrospective study, a single post-TAVI antithrombotic regimen independently predicted occurrence of early stroke or death. Dual or triple antithrombotic regimen was not associated with a higher risk of bleeding and should be considered as an option in patients undergoing TAVI.

Pancarditis is a rare condition with a poor prognosis combining endocarditis, myocarditis with abscess formation, and purulent pericarditis. Diagnosis is often delayed and the clinical signs are predominantly those of the embolic complications. Literature is scarce. We present a unique and rare case of pancarditis, complicating a Streptococcal B infection in an immunocompetent, healthy, 54 year-old woman. The evolution was favourable under medical therapy alone and thanks to multimodality cardiac imaging diagnosis and follow-up.

INTRODUCTION Left ventricular (LV) dysfunction is a major prognostic determinant in myotonic dystrophy type 1 (DM1). Therefore, markers of early-stage LV impairment may be useful. The aim of this study was to evaluate 2D echocardiographic LV strain in a cohort of DM1 patients with preserved left ventricular ejection fraction (LVEF) and to compare the results with matched controls. METHODS This prospective single-center study included 33 consecutive DM1 patients between February 2014 and February 2015. Mean age was 38.2±12.9 years, and 17 (52%) were males. Exclusion criteria were LVEF 120 milliseconds, history of atrial fibrillation, and presence of a pacemaker with ventricular pacing. DM1 patients were matched to healthy controls according to sex and age. RESULTS DM1 patients showed significant impairment of global longitudinal strain (GLS) as compared to controls (-18.0±1.9 vs -19.1±2.4; P=.03), characterized by a marked alteration at the apex (-20.0±3.3 vs -22.7±3.1; P

Background The treatment of chronic total occlusion of coronary arteries by percutaneous coronary intervention (CTO PCI) is one of the most representative technical advances in ischemic cardiomyopathy of last decade. However, how the complex histopathological remodeling and the new techniques affect healing processes after stent implantation remains unknown. Objective The objective of the PERFE-CTO study is to analyze stent coverage, malapposition and other mechanical abnormalities 3 months after CTO recanalization using intravascular imaging . Methods In a French prospective interventional multicenter study, stent strut coverage, acquired malapposition and neointimal hyperplasia (NIH) proliferation will be systematically assessed with 3 months angiogram control and intracoronary optical frequency domain imaging (OFDI) after successful CTO PCI of >20 mm in length. The impact of routine systematical intracoronary imaging after these complex procedures will also be evaluated by measuring the rate of significant mechanical abnormalities (strut malapposition, edge dissection, thrombus) that was undetected by fluoroscopy alone and by complementary PCI when needed. Secondarily, these data will be compared according to clinical characteristics, antiplatelet therapy use or desobstruction technique (antegrade vs. retrograde, true lumen vs. subintima). Each patient will undergo a one-year clinical follow-up. A total of 150 analyzed CTO lesions is expected. Conclusion The PERFE-CTO study will provide essential understanding of the early history after CTO recanalization and the identification of inadequate evolution (stent thrombosis, restenosis or late delayed stent endothelization and cardiovascular outcomes) using intravascular imaging to improve long-term CTO results.

While a multicentre trial has demonstrated that the SonR™ contractibility sensor is as effective as echocardiography-guided optimization at improving response to cardiac resynchronization therapy, an association between SonR™ values and clinical endpoints has not been established.The primary objective was to assess the predictive value of SonR™ signal evolution regarding cardiovascular events in patients implanted with a cardiac resynchronization therapy device. The secondary objective was to evaluate whether SonR™ signal evolution was associated with cardiovascular death.All patients with a SonR™ system implanted between 2012 and 2016 were included in this retrospective study. SonR™ signal evolution was calculated over the first 6 months after implantation: ([month 6 value-month 1 value]/month 1 value)*100. The primary endpoint (cardiovascular events) was a composite of cardiovascular death, hospitalization for acute heart failure or ventricular arrhythmia.Seventy-four patients (median age 67 years; 81% men) were followed up over a median 20 (13; 29) months. Cumulative incidence function showed that SonR™ signal evolution was predictive of cardiovascular events (threshold10.70%; P=0.023) and predictive of cardiovascular death (P=0.0018). After multivariable analysis, SonR™ signal evolution was independently associated with the onset of cardiovascular events (hazard ratio: 4.03, 95% confidence interval: 1.31-12.43; P=0.015), even after adjustment for left bundle branch block and chronic kidney disease.In this first study publishing data on SonR™ signals in a real-life setting, SonR™ signal evolution over the first 6 months after cardiac resynchronization implantation was an independent predictor of cardiovascular events at follow-up. This variable could be useful to identify patients at higher risk of further adverse events after cardiac resynchronization implantation.

Background: The development of transcatheter aortic valve replacement (TAVR) has led to an improvement in morbidity–mortality in the treatment of severe aortic stenosis in patients at high surgical risk. However, the procedure is not free from life-threatening cardiovascular outcomes and conductive disturbances. The objective of our study was to analyze the prognostic impact of aortic valve calcium score on the occurrence of complications following the procedure. Materials and Methods: Patients who have benefited from TAVR with the implantation of new-generation Sapien 3 and Evolut R aortic valve prostheses between January 2017 and July 2018 with the prior realization of a cardiac computed tomography with measurement of the aortic valve calcium score were retrospectively analyzed. Primary endpoint was a composite of death, stroke, and myocardial infarction within a period of 1 month after TAVR. Relation between valvular calcium and conductive disturbances was secondarily analyzed over the same period, and occurrences of high-degree atrioventricular block (paroxysmal or permanent), new-onset left bundle branch block, and the need for permanent or transient cardiac stimulation were associated with the secondary endpoint. Results: Overall, 144 patients were included. The aortic valve calcium score was not significantly higher in patients who reached the primary endpoint (2936 ± 1235 vs. 3051 ± 1440, P = 0.93). Among the 106 patients analyzed after excluding subjects with a prior pacemaker or left bundle branch block, aortic valvular calcium score was not statistically associated with the occurrence of conduction disturbances (3210 ± 1436 vs. 2948 ± 1223, P = 0.31). Conclusion: Our results suggest that the measurement of aortic valve calcium score has no prognostic value regarding mortality, cardiovascular events, or conductive disturbances after TAVR using the new generation of valves.

Light-chain (AL) amyloidosis can lead to an infiltrative cardiomyopathy with increased wall thickness (IWT) of very poor prognosis. Our primary aim was to analyse the right ventricle (RV) in patients with IWT to discriminate AL amyloidosis from IWT due to hypertrophic cardiomyopathy (HCM) or to arterial hypertension (HTN). Our secondary aim was to assess if RV dysfunction predicts overall mortality in cardiac AL amyloidosis.We retrospectively and consecutively compared clinical, biological and echocardiographic data of 315 patients with IWT: 105 biopsy-proven AL amyloidosis patients, 105 patients with HCM and 105 patients with HTN. The prognostic value of these parameters was analysed in the AL amyloidosis group.Free-wall right ventricular longitudinal strain (FWRVLS) worse than -21.2% discriminates AL amyloidosis [area under the curve (AUC) = 0.744)] from patients with IWT due to other aetiologies. In AL amyloidosis, FWRVLS is the strongest echocardiographic prognostic marker with AUC =0.722 and -16.5% as the optimal cut-off value, beyond which overall mortality increases significantly. It is also the only independent echocardiographic predictor of overall mortality (HR =1.113; 95%CI 1.029-1.204; p = .007), even when adjusted to the Mayo stage and global left ventricular longitudinal strain.FWRVLS should be considered in the diagnostic and prognostic workup in light-chain amyloidosis.

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

Background Selection of appropriate elderly who can benefit from transcatheter aortic valve implantation (TAVI) is challenging. We evaluated the prognosis of this procedure according to the comprehensive geriatric assessment (CGA) based on the multidimensional prognostic index (MPI). Methods Prospective observational monocentric study from January 2013 to December 2015. Consecutive patients aged ≥ 75 who underwent TAVI and a complete CGA were included. Baseline demographic, geriatric and cardiologic data were collected. CGA was used to calculate the MPI score that is divided in three groups according to the mortality risk. Follow up was performed until December 2016 and mortality rate was assessed at one, six and 12 months. Results 116 patients were included. Mean age was 86.2 ± 4.2 years, mean European system for cardiac operative risk evaluation (EuroSCORE) was 19.2 ± 11.3%, mean MPI score was 0.39 ± 0.13. Forty-five (38.8%) patients belonged to MPI-1 group, 68 (58.6%) to MPI-2 group and three to MPI-3 group. MPI score and Euroscore were moderately correlated (Spearman correlation coefficient rs = 0.27, p = 0.0035). Mortality rate was significantly different between MPI groups at six and 12 months (p = 0.040 and p = 0.022). Kaplan Meier survival estimates at one year stratified by MPI groups was significantly different (hazard ratio HR = 2.83, 95%confidence interval (CI) 1.38–5.82, p = 0.004). Among variables retained to perform logistic regression analysis, the score of instrumental activities of daily living appeared the most relevant (p

Le scanner multidetecteur avec acquisition synchronisee a l’ECG au cours d’une injection veineuse peripherique de produit de contraste, ou coroscanner, a fait la preuve de son efficacite pour exclure la presence de stenose coronaire significative en cas de suspicion de coronaropathie. Son utilisation n’est pas recommandee pour evaluer la progression de stenoses coronaires deja documentees, du fait d’une valeur predictive positive trop faible. Pres de 20 % des patients coronariens necessitent des pontages et la diversite des pontages realises augmente. Les etudes prospectives revelent que le coroscanner est une technique efficace pour mettre en evidence une occlusion de pontage. Le coroscanner est egalement fiable pour s’assurer de l’absence d’occlusion ou de stenose sur les pontages coronaires et sur le reseau d’aval, avec une valeur predictive negative superieure a 96 %. Malgre cette efficacite, le coroscanner ne doit toutefois pas etre realise pour des controles systematiques quelle que soit l’anciennete du pontage mais uniquement en cas de recidive ischemique. Les renseignements obtenus permettent de guider la therapeutique sans coronarographie complementaire chez pres de 1 patient sur 2. Si une coronarographie reste indiquee, sa realisation et les decisions d’eventuelles angioplasties seront facilitees par le scanner prealable, notamment en l’absence de compte rendu operatoire.

Background The elderly are often underrepresented in ICD trials and evidence of ICD relevance in patients ≥ 75 years is not clear. Objective We aimed to evaluate the complications, and the rate of appropriate therapy in this population. Methods This monocentric case-control study included ICD recipients ≥ 75 years (cases) matched with ICD recipients Results A total of 363 patients were enrolled: 121 cases (78 yo 82.6% male; primary prevention 74.4%; CRT 51.2%) and 242 controls (mean age 66. yo). The mean follow was 3.7 ± 3.5 years. The elderly had longer PR interval (210 ± 44 vs. 196 ± 38; P Conclusion In our study, the elderly population had very few comorbidities. ICD implantation was associated with a higher rate of appropriate therapy in the elderly group compared to youngsters without excess in inappropriate therapy.

Background Coronary artery diseases and heart failure are the main causes of morbimortality in diabetes. Screening of silent myocardial ischemia in asymptomatic diabetic patients is very important and is still controversial. Coronary artery calcium (CAC) belongs to innovative technology in non-invasive imagery technique based on tomography without injection and permits cardiovascular risk assessment; its threshold usually is 400. Purpose Principal objective was to diagnose silent myocardial ischemia in asymptomatic diabetics based on CAC measurement. A secondary objective was to determine patients’ characteristics when CAC was Methods CAC imaging was performed in every asymptomatic diabetic patient and all patients with CAC ≥ 400 underwent myocardial perfusion scintigraphy. Results Two hundred and sixty-three patients were included between 2014 and 2017. Eighty patients had a CAC score ≥ 400 and sixty-two of them underwent myocardial perfusion scintigraphy. Silent myocardial ischemia was detected in 14 patients (5%). The predictors of elevated CAC were: age, male gender, hypertension, duration of diabetes, dyslipidemia and microalbuminuria. Conclusion In this study, evaluating silent ischemia screening, CAC followed by myocardial scintigraphy have an important role in cardiovascular risk assessment. Thirty percent of patients required an imaging test such as perfusion scintigraphy and 5% had silent myocardial ischemia. CAC and myocardial perfusion scintigraphy can improve screening and risk stratification in this population. CAC score can help to guide medical treatment.

International audience; Left ventricular remodeling (LVR) typically manifests as compensatory changes in ventricular mass, composition, and volume as a response to cardiac performance inadequacy...

Background Patient prognosis in type 1 myotonic dystrophy (DM1) is very poor. Annual 24-hour holter ECG monitoring is recommended but its relevance is debated. Main objective was to determine whether holter ECG parameters could predict global death in DM1 patients and secondarily to assess whether they could predict cardiovascular events and sudden cardiac death, to compare DM1 patients and healthy controls, and to assess their evolution in DM1 over a 5-year period. Methods This retrospective study included genetically confirmed DM1. Primary endpoint was global death. Secondary endpoints were labeled "sudden cardiac death" which was a composite of sudden cardiac death, aborted sudden cardiac death, implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, atrioventricular block grade 3, pause >3 s; and "cardiovascular events" which was a composite of all-cause mortality, pacemaker or cardioverter defibrillator implantation, sustained ventricular tachycardia, supraventricular tachycardia, hospitalization for acute cardiac cause and heart failure. Results Forty-seven patients (22 women, 40 ± 13 years old) were included. Three (7%) DM1 patients died, 9 (19%) experienced "sudden cardiac death" endpoint and 21 (45%) experienced "cardiovascular event" endpoint during mean follow-up of 95 ± 22 months. None of holter ECG parameters were discriminant to predict death or secondary endpoints. Compared to healthy controls, DM1 patients had higher SDNN and LF/HF ratio. Finally, heart rate variability parameters remained stable over a mean interval of 61 ± 15 months excepting pNN50 which decreased significantly. Conclusion Results suggest that annually-repeated holter ECG in DM1 is not useful for stratifying risk of sudden death and cardiovascular outcomes.

Aspirin inhibits platelet activation and reduces major vascular events in patients with stable coronary artery disease. The extent of platelet inhibition, denoted as aspirin resistance, however, is not always sufficient. A correlation between aspirin resistance as measured by aggregometry and adverse clinical events has been demonstrated. The point-of-care platelet function analyzer PFA-100 is usually used to detect aspirin resistance, but the relation between PFA-100 results and the vascular prognosis is not assessed. We prospectively enrolled 97 patients with stable coronary artery disease who were on aspirin (160 mg per day since 1 month or longer). Aspirin resistance was measured by the PFA-100 analyzer. Median follow-up was 2.5 years and the primary outcome was the composite of death, myocardial infarction, and ischemic cerebral infarction or acute limb ischemia. In our study, 29 patients (29.9%) showed resistance to aspirin, with a higher percentage of female patients (38 vs. 15%; P=0.01). During the follow-up, aspirin resistance was not associated with an increased risk of death, myocardial infarction, or ischemic vascular event compared with the aspirin-sensitive patients (17 vs. 13%; P0.60). In this cohort of stable coronary artery disease, patients on aspirin dose of 160 mg per day, the aspirin-resistance status based on the PFA-100 results is not associated with a significant increase in major vascular clinical events.

A 66-year-old patient was admitted to the emergency unit for chest pain. The electrocardiogram showed a ST-segment elevation in leads V2-V4 and a slight STsegment depression in lead III. The coronary angiography was normal but CMR imaging and CT scan revealed a tumor surrounding the left anterior artery. Finally, further investigations disclosed a metastasis of squamous cell carcinoma lung cancer.

Objectives We investigated whether three platelet gene polymorphisms, PlA1/A2, C807T, and C-5T Kozak (encoding, respectively, for platelet membrane glycoproteins (GP) IIIa, GP Ia/IIa, GP Ibα), could contribute to the resistance to a low dose of aspirin (160 mg/day). Background Aspirin antiplatelet effect is not uniform in all patients, and the mechanism by which some patients are in vitro resistant to aspirin remains to be determined. However, it has been suggested that polymorphisms of platelet membrane glycoproteins might contribute to aspirin resistance. Methods Ninety-eight patients on aspirin (160 mg/day) for at least one month were enrolled. Aspirin resistance was measured by the platelet function analyzer (PFA)-100 analyzer; genotyping of the three polymorphisms was performed using a polymerase chain reaction-based restriction fragment-length polymorphism analysis. Results Using a collagen/epinephrine–coated cartridge on the PFA-100, the prevalence of aspirin resistance was 29.6% (n = 29). Aspirin-resistant patients were significantly more often PlA1/A1(86.2%; n = 25) than sensitive patients (59.4%; n = 41; p = 0.01). Of the 29 patients, 25 were reevaluated after having taken 300 mg/day aspirin for at least one month. Only 11 patients still have nonprolonged collagen epinephrine closure time, and these were all PlA1/A1. No relation was found between resistance status and C-5T Kozak or C807T genotypes. Conclusions Platelets homozygous for the PlA1allele appear to be less sensitive to inhibitory action of low-dose aspirin. This differential sensitivity to aspirin may have potential clinical implications whereby specific antiplatelet therapy may be best tailored according to the patient9s PlAgenotype.

Background : Acetylsalicylic acid, or aspirin, is widely used in secondary prevention of coronary artery diseases, but the inhibition of platelet aggregation is not uniform in all individuals. Objective : To investigate the prevalence of aspirin resistance at rest and during exercise in coronary artery disease patients. Materials and methods : Fifty patients with stable coronary artery disease were prospectively studied. All patients received aspirin (75–300 mg/day for >1 month) and no other antiplatelet therapy. Aspirin resistance was studied, at rest and immediately after a stress test, using the standardized platelet function analyzer (PFA-100®, Dade-Behring). Aspirin resistance was defined as a normal collagen/epinephrine closure time ( Results : Ten patients (20%) were aspirin-resistant at rest. Out of the 40 patients who were aspirin-sensitive at rest, 9 (22%) were aspirin-resistant immediately after the exercise stress test. There were no differences in aspirin sensitivity regarding gender, age, diabetes, hypertension, dyslipidemia, platelet count, medical treatment or number of the coronary arteries involved. Conclusions : Aspirin resistance is detected, at rest, in 20% of our patients with stable coronary artery disease. Aspirin treatment does not seem to protect against exercise-induced platelet activation in 22% of such patients, despite aspirin sensitivity at rest.

Cardiac shunts are often described in congenital or pediatric populations, but systemic-to-pulmonary venous shunts in adult patients are reported in literature in isolated case reports. We present the case of a 70-year-old female with a left superior vena cava (SVC) draining into the left atrium by the left superior pulmonary vein, with a complete right-to-left shunt of the superior venous circulation caused by a former catheter thrombosis in the right SVC. Diagnosis was suspected after a contrast echocardiography showing an exclusive perfusion of left heart after intravenous injection and confirmed by helical computed tomography with three-dimensional reconstruction. After medico-surgical discussion, a first-line conservative treatment with oxygen therapy was chosen, due to the stability of symptoms and high predicted risk of perioperative mortality. The particularities of this case are that we cannot determine if the origin of this shunt is a latent persistent left SVC becoming symptomatic after the SVC obstruction or an abnormal collateral pathway due to the thrombosis and the unusual indirect communication through a pulmonary vein.

Anomalies of the coronary arteries are uncommon but may produce life-threatening symptoms and myocardial ischemia. Multislice computed tomography (MSCT) has become a major technique for imaging the coronary arteries. We present a case of a patient with a septal and a circumflex arteries originating from the right coronary sinus and a duplicate left anterior descending artery. The interarterial course of the septal branch is clearly demonstrated with MSCT technique as the abnormal circumflex artery that coursed posterior to the aortic root.

Objective : To investigate the potential of Power Doppler (PD) imaging for three-dimensional (3D) reconstruction of the flow of a pulmonary artery. Methods : The authors worked with a pulmonary artery bifurcation attached to a pulsatile flow apparatus. A set of planar images, in PD mode, transverse to the vessel plane is acquired while translating the probe along the artery. The digital data were acquired directly from the commercially available sonography system and stored into a dekstop computer. Results : PD images of the pulmonary artery were obtained, in vitro, and a 3D volume reconstruction of the flow performed pre- and post-induction of stenosis. Conclusion : PD imaging in combination with total digital transfer for 3D reconstruction affords a very interesting view of vascular blood flow even in case of bifurcation and in vivo applications are expected on carotid bifurcations.

International audience; Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p

International audience; BACKGROUND: Preclinical studies and pilot clinical trials have shown that high-dose erythropoietin (EPO) reduces infarct size in acute myocardial infarction. We investigated whether a single high-dose of EPO administered immediately after reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) would limit infarct size. METHODS: A total of 110 patients undergoing successful primary coronary intervention for a first STEMI was randomized to receive standard care either alone (n = 57) or combined with intravenous administration of 1,000 U/kg of epoetin β immediately after reperfusion (n = 53). The primary end point was infarct size assessed by gadolinium-enhanced cardiac magnetic resonance after 3 months. Secondary end points included left ventricular (LV) volume and function at 5-day and 3-month follow-up, incidence of microvascular obstruction (MVO), and safety. RESULTS: Erythropoietin significantly decreased the incidence of MVO (43.4% vs 65.3% in the control group, P = .03) and reduced LV volume, mass, and function impairment at 5-day follow-up (all P < .05). After 3 months, median infarct size (interquartile range) was 17.5 g (7.6-26.1 g) in the EPO group and 16.0 g (9.4-28.2 g) in the control group (P = .64); LV mass, volume, and function were not significantly different between the 2 groups. The same number of major adverse cardiac events occurred in both groups. CONCLUSIONS: Single high-dose EPO administered immediately after successful reperfusion in patients with STEMI did not reduce infarct size at 3-month follow-up. However, this regimen decreased the incidence of MVO and was associated with transient favorable effects on LV volume and function.

Our two-centre prospective study evaluates the usefulness of 64-slice coronary computed tomography (CCT) to rule out significant coronary artery stenosis in patients admitted in emergency departments (ED) for acute coronary syndromes (ACS) with low-to-intermediate risk score.Patients (175) admitted for acute chest pain (ACP), unmodified electrocardiogram and first troponin measurement within normal ranges were included. A second troponin measurement and a 64-slice CCT within 24 h were performed. Major adverse cardiac events (MACE) were recorded during follow-up (6 months ± 2).64-slice CCT was either normal or showed non-significant coronary stenosis in the majority of patients (78%). 64-slice CCT depicted significant stenosis (50% diameter) in 22% of patient whereas initial clinical and biological evaluation was reassuring. For negative CCTs, elevated troponin at second measurement did not modify the strategy or treatment of patients. No MACEs were noted during follow up. In 12% of patients CCT identified unsuspected non-coronary abnormalities.Our study confirms 64-slice CCT utility to rule out significant coronary artery stenosis in 8/10 patients admitted in ED with ACP or ACS with low-to-intermediate risk score. Early discharge with a negative 64-slice CCT is associated with very low risk of cardiac events at 6 months.• 64-slice coronary computed tomography (CCT) offers a critical role in acute chest pain. • 64-slice CCT allows differentiation between significant and non-significant coronary artery stenosis. • Normal 64-slice CCT allows rapid discharge of patients with ACP. • 64-slice CCT helps make appropriate therapeutic decision in patients with ACP.

A 77-year-old man was referred to our institution to assess the absence of pulmonary vein stenosis by an ECG-gated 64-multislice computed tomography (MSCT). One month before, he was surgically treated for a severe mitral insufficiency associated with paroxysmal atrial fibrillation: a plasty of the mitral valve was performed in association with ligature of the left atrial appendage (LAA) and …

Left atrial (LA) volume is a prognosis factor of cardiovascular morbidity in patients with cardiovascular disease (CD). Recent developments of multislice computed tomography (MSCT) have made non invasive coronary angiography reliable for selected patients and new software facilitates truly volume measurements without geometrical assumptions.To define, by using MSCT, LA and left atrial appendage (LAA) volumes in patients with or without CD.In the population of patients referred to our laboratory for a conventional MSCT coronary angiography, 40 individuals without CD (Normal group) and 80 patients with CD (CD group) were prospectively selected. The CD group was constituted from 4 subgroups of patients with either coronary artery disease (n=20), idiopathic dilated cardiomyopathy (n=20), left ventricular hypertrophy (n=20) or severe mitral regurgitation (MR group, n=20). LAA and LA volumes were measured on a commercially available workstation. LA maximal and minimal volumes were lower in Normal group than in CD group, as LA ejection fraction (54+/-10 versus 67+/-20 ml/m(2), p0.0001; 31+/-8 versus 46+/-20 ml/m(2), p0.0001; 43+/-8% versus 33+/- 14%, p0.001). LAA volume was larger in MR group than in Normal group (15+/-7 ml versus 9+/-3 ml, p0.0001).This MSCT study provides normal values of LA and LAA volumes for patients who underwent MSCT coronary angiography and suggests that MSCT is helpful to assess the changes of LA volumes related to various CD.

A 51-year-old patient, treated for dental abscess 3 months ago, was admitted for an acute coronary syndrome and fever. He had a fever of 38.5°C and a diastolic murmur. Blood cultures were positive for Streptococcus anginosus . Echocardiography confirmed an aortic valvular endocarditis with severe aortic regurgitation and highly mobile vegetations. Because of the vegetations, non-invasive coronary angiography using ECG-gated 64-multislice computed tomography (MSCT) was performed instead of conventional angiography. MSCT demonstrated two mobile …

Antiplatelet therapy is used to reduce the risk of ischemic events in patients with cardiovascular disease. The balance of benefits and risks of antiplatelet drugs in coronary artery disease has been evaluated in large-scale randomised trials, however the absolute benefit for an individual patient and a specific platelet-active drug need further evaluation. Several well-conducted studies have demonstrated a substantial inter-individual variability in the platelet responsiveness to drugs. The historical "gold standard" test of platelet function (optical aggregation) has well established limitations for measuring the effect of antiplatelet drugs. Other new tests developed (i.e. PFA-100, VerifyNow) may overcome some of these limitations but they do not correlate well with each other. Despite these unresolved methodological questions, several recent clinical studies, but not all, suggest a significant correlation between antiplatelet resistance status and serious vascular events. In these conditions, laboratory monitoring for antiplatelet therapies raises several questions: (i) the necessity for a consensus on the definition of resistance and on the best test for evaluation of the condition, (ii) the demonstration that biological resistance has clinical significance, and (iii) the clinical impact of adapting the antiplatelet therapy. Therefore, it is not currently appropriate to test patients or to change therapy on the basis of such tests, other than in prospective and adequately powered clinical trials.

Background Left atrial (LA) volume, is related to cardiovascular morbidity. LA enlargement is usually assessed using trans-thoracic echocardiography (TTE). The association of modern multislice computed tomography (MSCT) imaging and new 3D reconstruction software, allows direct cardiac chamber volume measurement without geometrical assumptions. This study was designed to evaluate the maximal (LAmax) and minimal (LAmin) LA volumes during the cardiac cycle using MSCT and TTE approaches. Methods We screened 26 consecutive patients referred for coronary imaging using a 64-MSCT scanner and a TTE within 12 h. Contiguous multiphase images were generated from axial MSCT data and semi-automated 3D segmentation technique was applied to generate LA volumes. Using TTE, LA volumes and LA ejection fraction (LAEF) were obtained using five assumptions methods: cubing equation, diameter-length formula, area-length formula, ellipsoidal formula and biplane Simpson rule. Results Five patients were excluded for inadequate TTE visualization and one for ectopic beats during MSCT. The sample consisted in 20 patients (11 men, age: 56±14 years). Using MSCT, LA volumes indexed to body surface area were: LAmax=74±27 ml/m 2 , LAmin=49±26 ml/m 2 , with close correlations with TTE measurements and a significant underestimation by all TTE approaches. A close correlation was observed between LAEF using MSCT and TTE Simpson's method: 36±14% vs. 37±14%, r =0.99, p Conclusion Theses results suggest that the assessment of LA volumes and ejection fraction was reliable using 64-MSCT in patients referred for coronary computed tomography imaging.

Multidetector row computed tomography (MDCT) is a developing technique mainly used to evaluate the coronary arteries, but less attention has been paid to the coronary venous system. However, with the dramatic technological advancement of percutaneous therapies for heart failure or mitral insufficiency, a better knowledge about the anatomy of the coronary venous system may be of great utility. We sought the efficacy of MDCT imaging to delineate the coronary venous system.16 row MDCT scans were performed in 50 consecutive patients (42 men, age 61+/-15 years, all in sinus rhythm). The inter-individual variability in terms of diameter, distance, angle of the main tributaries of the coronary venous system was reported.The coronary venous system was always visualized. A remnant Thebesian valve was observed in 18 patients, the diameter of the coronary sinus ostium was found 12.2+/-3.6 mm and 15.3+/-3.7 mm respectively in the antero-posterior and supero-inferior directions, the distance between the posterior vein of the left ventricle (PVLV) and the anterior interventricular vein (AIV) was found 108.6+/-15.2 mm with a significant correlation with the mitral annulus diameter (p.002) and the left ventricular diameter (p0.01). The left marginal vein (LMV) was more often tortuous when the angle between the LMV and the great cardiac vein was less than 60 degrees (p0.01).16 row MDCT imaging can be used to investigate non-invasively the coronary venous anatomy and may serve as a useful tool before percutaneous therapies involving the coronary veins.

Summary The human platelet antigen 1 (HPA-1) system has been implicated in rare but severe diseases, such as neonatal alloimmune thrombocytopenic purpura, post-transfusion purpura and immune platelet refractoriness. We developed a flow cytometry assay for HPA-1 phenotyping using two commercial monoclonal antibodies, P2 and SZ21, directed against glycoprotein (GP) IIb–IIIa and GP IIIa respectively. One hundred and twenty-seven healthy controls were studied and ratios of mean fluorescence intensity for P2 and SZ21 discriminated between HPA-1a homozygotes and heterozygotes. These two monoclonal antibodies, coupled with flow cytometry represent a rapid and reliable tool for platelet HPA-1 typing to aid diagnosis.