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International audience; Background: A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided.Methods: To report the incidence of myocardial infarction (MI) admission during COVID-19 pandemic and in particular during national lockdown in two unequally affected French provinces (10-million inhabitants) with a different media strategy, and to describe the magnitude of MI incidence changes relative to the incidence of COVID-19-related deaths. A longitudinal study to collect all MIs from January 1 until May 17, 2020 (study period) and from the identical time period in 2019 (control period) was conducted in all centers with PCI-facilities in northern "Hauts-de-France" province and western "Pays-de-la-Loire" Province. The incidence of COVID-19 fatalities was also collected.Findings: In "Hauts-de-France", during lockdown (March 18-May 10), 1500 COVID-19-related deaths were observed. A 23% decrease in MI-IR (IRR=0.77;95%CI:0.71-0.84, p

We present a case which developed a typical tako-tsubo-like cardiomyopathy (TTC) during dobutamine stress echocardiography (DSE). Its originality is related to several findings, which have never been described simultaneously in the same patient. This 63-year-old woman with normal coronary angiography and no evidence of coronary vasospasm had a biphasic response to DSE, a finding which usually occurs in coronary artery disease. Moreover, the symmetric extensive wall motion abnormalities (WMA) occurred simultaneously with the development of a systolic anterior motion of the mitral valve (SAM) and left ventricular obstruction, and was clinically asymptomatic. Although in TTC the stunning usually occurs for several days, WMA and SAM resolved within few minutes after cessation of dobutamine and administration of a beta-blocker. And finally, exercise echo performed at the same target heart rate few days later did not induce neither a SAM nor WMA, which suggests that left ventricular obstruction could have played a role in the pathogenesis of this case by supply-demand mismatch. Concomitant coronary microvascular dysfunction was also demonstrated by a reduction of the non-invasive coronary flow reserve in the distal part of the left anterior descending artery.

Paradoxical embolism is rarely demonstrated, often suggested, and the diagnosis has been largely presumptive in most cases. The patent foramen ovale (PFO) is an important predisposing anatomic factor for such a complication. We describe a case where a voluminous thrombus straddling the PFO was diagnosed by echocardiography including the 3D modality, in the setting of acute massive pulmonary embolism. The treatment is not codified in this setting, and the thrombus was successfully removed by surgery, associated with PFO closure, and anticoagulation.

To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50–70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 μg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 μg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p

IntroductionAssessment of the functional significance of left anterior descending coronary artery (LAD) stenosis of intermediate severity (IS) is challenging. A direct comparison of fractional flow reserve (FFR), instantaneous wave-free ratio (IFR), and non-invasive coronary flow reserve (CFR) has never been performed. Our objective was to test the usefulness of noninvasive CFR by comparison to invasive FFR and IFR in patients with LAD stenosis of angiographic IS and stable coronary artery disease.Methods58 stable consecutive patients (mean age, 68±10 years; with angiographic proximal or mid LAD stenosis of IS (40-70% diameter stenosis on quantitative coronary angiography), no previous anterior myocardial infarction, were prospectively studied. They underwent iFR which was calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, FFR with intracoronary bolus adenosine (150μg), and CFR using intravenous adenosine (140μg/kg/min over 2min) in the distal part of the LAD, the same day. CFR was defined as hyperemic peak diastolic LAD flow velocity divided by baseline flow velocity, and FFR was defined as distal pressure divided by mean aortic pressure during maximal hyperemia.ResultsThe mean values of iFR, FFR, and CFR were 0.88±0.07, 0.81±0.08, and 2.4±0.6 respectively. A significant correlation was found between CFR and FFR (r=0.72, curvilinear relationship), FFR and IFR (r=0.63, linear relationship), and between CFR and IFR (r=0.44) (all, p

Background Left atrial (LA) enlargement is associated with a poorer prognosis in several diseases, including aortic stenosis (AS). However, apart diastolic dysfunction, the main determinants of LA size in the setting of aortic stenosis are poorly understood. Objective to assess the factors correlated with LA size in patients with severe AS (aortic valve area (AVA) 2 or 2 /m 2 ) with preserved left ventricular ejection fraction (LVEF >50%). Methods 80 consecutive patients with isolated severe AS in sinus rhythm (mean age 72±10 years, AVA 0.8±0.2cm 2 , 0.44±0.1cm 2 /m 2 , mean gradient 45±15mmHg, LVEF 68±10%) underwent a comprehensive transthoracic Doppler echocardiography including the measurement of the LA volume at end-systole by the biplane area-length method (from the 4-and 2-apical chamber views), indexed to body surface area (ml/m 2 ), LVEF by the biplane Simpson’s method, LV mas by the ASE M-mode method, and early (e’), late diastolic (a’), and systolic (Sa) mitral annular Doppler tissue velocities were calculated as an average of the septal and lateral values. Results The mean LA volume was 33±12mL/m 2 (extreme values: 13 and 72mL/m 2 ), and dilated LA (defined as LA ≥34ml/m 2 ) was found in 34 cases (43%). In univariate analysis, indexed LA volume was significantly linked to age, hypertension (all, p 2 (r=0.5), pulmonary artery systolic pressure (PASP) (r=0.55), mitral E/A ratio (r=0.32), E/e’ ratio (r=0.46), a’ (r=–0.4), LVEF (r=–0.3) (all, p 2 , E/e’, and PASP (all, p 2 , p Conclusion in severe AS with preserved LVEF, LA size is higher in symptomatic patients, and is independently linked to LV remodeling, LV diastolic dysfunction, and PASP, as well as to NT-proBNP a surrogate of increased LV wall stress.