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Ventricular septal myectomy (SM) and alcohol septal ablation (ASA), 2 septal reduction therapies (SRTs), are recommended in symptomatic obstructive hypertrophic cardiomyopathy (HCM) despite maximum tolerated medical therapy. Contradictory results between the outcomes of these 2 types of therapies persist to this day. The objective of this study was to compare in-hospital and mid-term outcomes of SM versus ASA, at a nationwide level in France. We collected information on patients who underwent SRT for HCM using the French nationwide Programme de Médicalisation des Systèmes d'Information database between 2010 and 2019. A total of 1,574 patients were identified in the database, including 340 patients in the SM arm and 1,234 patients in the ASA arm. No difference during the median follow-up of 1.3 years between the 2 groups was noted in terms of mortality (adjusted incidence rate ratio 0.687, 95% confidence interval 0.361 to 1.309, p = 0.25). However, there was a significantly lower risk of all-cause stroke (adjusted incidence rate ratio 0.180, 95% confidence interval 0.058 to 0.554, p = 0.003) in the ASA group. In conclusion, in our "real-life" data from France, mortality after SRT in patients with HCM was similar after ASA or SM. Moreover, ASA was more widely used than SM despite European Society of Cardiology guidelines recommendations.

Ultraminiaturization of echographic systems extraordinarily provides the image "within" the clinical examination. Abdominal aorta aneurysm (AAA) diagnosis based on conventional evaluation with a dedicated operator and ultrasound machine is still controversial due to the lack of evidence of the proposed management and guidelines' cost-effectiveness. We hypothesized that less expensive ultraportable devices could identify AAA with the same level of accuracy as conventional approaches.A first step of this study was to validate the VSCAN's image capabilities in patients referred to the vascular Doppler laboratory. Abdominal aorta measurements were performed by an experienced physician using conventional equipment followed by a second blinded physician using the ultraportable device VSCAN. Then, 204 patients hospitalized in our cardiology institute were prospectively included for a systematic screening of AAA at bedside using the VSCAN in order to determine the feasibility and impact of fast track evaluation compared to clinical examination.A strong correlation was obtained between measurements of abdominal aorta diameters using the two ultrasound systems (r = 0.98, CI: 0.97-0.99, P0.001) with 100% of agreement for AAA diagnosis. In the second part of the study, visualization and measurement of the transverse diameter of the abdominal aorta was obtained in 199 patients, resulting in a feasibility of 97.5%. Among these patients, 18 AAAs were detected, which corresponds to a prevalence of 9%, whereas clinical evaluation did not detect any of them. Patients with AAA were more likely men (77.77% vs. 57.45%, P0.05) and hypertensive (88.8% vs. 56.9%, P0.05) as compared to those without AAA. Two patients with large AAA were quickly referred to the surgery department.Considering its low cost, diagnostic accuracy, and widespread availability, screening for AAA using an ultraportable ultrasound device such as VSCAN by an experienced physician is promising and should be used as an extension of routine physical examination in vascular patients.

Biological and anatomical alterations in the elderly result in modifications of the myocardial deformation detected previously by magnetic resonance imaging (MRI) technology and could have consequences on speckle tracking's parameters in this patient population.To compare left ventricular (LV) 2D strain between elderly patients and young individuals without heart disease.Patients without history of cardiac disease were enrolled from the geriatric department. After echocardiographic examination, exclusion criteria were LV myocardial abnormality, valve disease, and atrial fibrillation. The control group consisted of healthy subjects from the medical staff. 2D strain values were obtained from 16 segments in four-, three-, and two-chamber apical views for longitudinal and transversal strains, and from six basal segments in short-axis view for circumferential strain.Forty-five elderly patients (35 females) with mean age of 83.4±5.0 years (75-95 years) and 45 young subjects (28 females) with mean age of 33.6±7.5 years (17-45 years) were assessed. There was no difference between the two groups considering LV ejection fraction (66±6% vs. 65±4%, P=ns). Feasibility of segmental 2D strain was 55.6% for circumferential strain, 63% for transversal strain, and 82% for longitudinal strain. Global longitudinal strain was significantly lower in elderly patients (-20.9±1.9% vs. -22.2±2.2%, P0.01). There was no significant difference in global transversal and circumferential strain.Aging results in a decrease in global longitudinal strain. This should be taken into account in the assessment of pathological myocardial dysfunction.

In use since 1961, valvular prostheses allow the correction of the severe valvular diseases when conservatrice procedures are not possible. Current prostheses have outstanding haemodynamic features. Mechanical prostheses have a supposedly unlimited life span but require anticoagulant treatment. Bioprostheses do not need such treatment but end up to deteriorate and need reoperation. Both can be affected by valve-related complications (thromboembolic events, endocarditis, deterioration, desinsertion...): an ideal prosthesis does not exist yet. All patients with valvular prosthesis require close follow-up, where echocardiography holds preeminent place.

Introduction: we aimed to determine 12-lead electrocardiogram (ECG) predictive value of major cardiovascular events in patients with sarcomeric hypertrophic cardiomyopathy (HCM) in a monocentric observational retrospective study. Material and Methods: a 12-lead resting ECG was carried out during the initial consultation and a qualitative and quantitative analysis was performed. The study endpoints were major rhythmic events, including aborted or not sudden cardiac deaths, appropriate implantable cardiac defibrillator therapies and poorly tolerated sustained ventricular tachycardia; heart failure (HF) events including deaths and hospitalizations for acute HF and heart transplantations, and first access of atrial fibrillation (AF). Results: 427 patients were included. Only 1.6% of patients had a strictly normal ECG. The most prevalent anomalies were inverted T waves (69%), pseudo-necrosis Q waves (28%), and left atrial enlargement (28%). During a median follow-up of 3.1±2.1 years, 37 patients (8.7%) presented HF events or surrogates, 14 patients (3.3%) experienced a major rhythmic event and 19.4% had a first access of AF. At univariate analysis, a statistically significant association was shown between HF events and surrogates and QRS duration ≥ 120ms (HR 3.97, 95% CI 2.04 to 7.72, p, Introduction : l’objectif était de rechercher, à partir d’une analyse d’électrocardiogrammes (ECG) de repos 12 dérivations, des facteurs pronostiques d’évènements cardiovasculaires majeurs chez les patients porteurs d’une myocardiopathie hypertrophique sarcomérique (CMH), par une étude rétrospective observationnelle monocentrique. Matériels et Méthode : un ECG de repos 12 dérivations était recueilli lors de la consultation initiale et une analyse qualitative et quantitative était réalisée. Les critères de jugement principaux étaient les évènements rythmiques majeurs, incluant mort subite récupérée ou non, thérapies appropriées du défibrillateur automatique implantable et les tachycardies ventriculaires mal tolérées, les évènements d’insuffisance cardiaque (IC) incluant les décès et les hospitalisations pour IC aigue et les transplantations cardiaques et enfin la survenue d’un premier accès de fibrillation atriale (FA). Résultats : 427 patients ont été inclus. Seuls 1.6% des patients avaient un ECG strictement normal. Les anomalies les plus fréquemment retrouvées étaient les ondes T inversées (69%), les ondes Q de pseudo-nécrose (28%) et l’hypertrophie atriale gauche (28%). Durant une médiane de suivi de 3.1±2.1 ans, 37 patients (8.7%) ont présenté des évènements liés à une IC, 14 patients (3.3%) des évènements rythmiques majeurs et 19.4% ont présenté un premier accès de FA. En analyse univariée, une association statistiquement significative était retrouvée entre les évènements d’IC et la durée des QRS ≥ 120ms (HR 3.97, IC 95% 2.04 à 7.72, p