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Idiopathic dilated cardiomyopathy (IDCM) is one of the most common forms of non-ischemic cardiomyopathy (NICM) worldwide, possibly leading to cardiogenic shock (CS). Despite this heavy burden, outcomes of CS in IDCM are poorly reported. Based on a large registry of unselected CS, our aim was to shed light on one-year outcomes after CS in IDCM and non-IDCM patients. FRENSHOCK was a prospective registry including 772 CS patients from 49 centers. One-year outcomes (rehospitalizations, mortality, heart transplantation [HTx], ventricular assist devices [VAD]) were analysed, adjusted on independent predictive factors. Within 772 CS included, 78 occurred in IDCM (10.1%) (Fig. 1). IDCM patients had more frequent history of chronic kidney failure and ICD implantation. No difference was found in 1-month all-cause mortality between groups (28.2 vs. 25.8% respectively for IDCM and others, aHR 1.14 [0.73–1.77], P = 0.57). Non-IDCM were more frequently treated with non-invasive ventilation and IABP. At 1-year, IDCM led to higher rates of death or cardiovascular rehospitalizations (aOR 4.77 [95% CI 1.13–20.1], P = 0.03) and higher rate of HTx or VAD for individuals under 65 years old (aOR 2.68 [1.21–5.91], P = 0.02). CS in IDCM is a very common scenario and is associated with a higher rate of 1-year death or cardiovascular rehospitalizations, and a more frequent recourse to HTx or VAD for individuals < 65 years old, encouraging to consider it as a red flag for myocardial decline, urging to closer follow-up and earlier evaluation for advanced heart failure therapies. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare but severe complication. Among 326 patients who underwent TAVI at Grenoble Alpes University Hospital, six (1.8%) cases of IE and 11 (3.4%) cases of bacteraemia were identified. No cases of IE were linked to the intervention; one was due to Staphylococcus aureus despite a screening and targeted decolonization strategy. This underscores the need for randomized studies to evaluate the benefit and cost-effectiveness of this policy. [ABSTRACT FROM AUTHOR]

Coronary microvascular dysfunction (CMVD) is common and associated with poorer outcomes in patients with ST Segment Elevation Myocardial Infarction (STEMI). The index of microcirculatory resistance (IMR) and the index of hyperemic microvascular resistance (HMR) are both invasive indexes of microvascular resistance proposed for the diagnosis of severe CMVD after primary percutaneous coronary intervention (pPCI). However, these indexes are not routinely assessed in STEMI patients. Our main objective was to clarify the association between IMR or HMR and long-term major adverse cardiovascular events (MACE), through a systematic review and meta-analysis of observational studies. We searched Medline, PubMed, and Google Scholar for studies published in English until December 2019. The primary outcome was a composite of cardiovascular death, non-cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and rehospitalization for heart failure occurring after at least 6 months following CMVD assessment. We identified 6 studies, reporting outcomes in 1094 patients (mean age 59.7 ± 11.4 years; 18.2% of patients were women) followed-up from 6 months to 7 years. Severe CMVD, defined as IMR > 40 mmHg or HMR > 33 mmHg/cm/sec was associated with MACE with a pooled HR of 3.42 [2.45; 4.79] (Fig. 1). Severe CMVD is associated with an increased risk of long-term adverse cardiovascular events in patients with STEMI. Our results suggest that IMR and HMR are useful for the early identification of severe CMVD in patients with STEMI after PCI, and represent powerful prognostic assessments as well as new therapeutic targets for clinical intervention. [ABSTRACT FROM AUTHOR]

Objective: Silent myocardial ischemia (SMI) in asymptomatic subjects with no history of myocardial infarction or angina is a frequent condition in diabetic patients. The aim of the study was to examine the predictive value of SMI for cardiac events in a multicenter cohort and to determine whether this value is higher in patients with a particular clinical profile.Research Design and Methods: A total of 370 asymptomatic diabetic patients with at least two additional cardiovascular risk factors was recruited in four departments of diabetology. SMI was assessed by either exercise or dipyridamole single-photon emission-computed tomography myocardial perfusion imaging with thallium-201. If dipyridamole stress was used, an electrocardiogram stress test was performed separately on another day. Follow-up duration was 3-89 months (38 +/- 23 months).Results: There was evidence of SMI in 131 patients (35.4%) on at least one positive noninvasive test. The patients with SMI were significantly older and had significantly higher serum triglycerides and lower HDL cholesterol levels. Cardiac events occurred in 53 patients (14.3%). Major cardiac events (death or myocardial infarction) occurred in 38 patients (10%) and other events (unstable angina, heart failure, or coronary revascularization) occurred in 15 patients. The patients who had cardiac events were older and had higher serum triglyceride levels at baseline. There was a significant association between SMI and cardiac events (hazard ratio 2.79 [95% CI 1.54-5.04]) and in particular major cardiac events (3 [1.53-5.87]). In the patients >60 years of age, the prevalence of SMI was higher (43.4 vs. 30.2% in those <60 years). SMI was associated with a significant risk of cardiac events (2.89 [1.31-6.39]) and in particular major cardiac events (3.66 [1.36-9.87]) for the patients >60 years old but not for those <60 years old.Conclusions: In asymptomatic diabetic patients with additional cardiovascular risk factors, SMI is a potent predictor of cardiac events and should be assessed preferably in the patients >60 years of age. [ABSTRACT FROM AUTHOR]

Atherosclerosis is associated with a worse prognosis in many diseases, but its impact in non-ischemic dilated cardiomyopathy (NIDCM) is not known. This study investigated the prognostic value of coronary atherosclerotic burden, as measured by Gensini score, in a cohort of NIDCM patients. 139 patients with left ventricular (LV) dysfunction due to NIDCM were classified according to both invasive coronary angiography (ICA) and cardiovascular magnetic resonance (CMR) imaging data in 3 subtypes of NIDCM: true NIDCM, NIDCM with bystander coronary artery disease (CAD) and NIDCM with bystander myocardial infarction (MI). Percentage, extent, location of fibrosis was assessed with CMR and coronary atherosclerotic burden by calculating Gensini score. Primary endpoint was a composite of cardiovascular mortality, non-fatal MI and revascularization by percutaneous coronary intervention (PCI). Out of 139 patients (mean age 59.4 ± 14.7 years old, 74% male), there were 101 patients (73%) with true NIDCM, 30 patients (22%) with NIDCM and bystander MI and 8 patients (5%) with NIDCM and bystander MI. 6 patients (4.3%) died and 6 (4.3%) underwent PCI during a median follow-up of 34.2 ± 18 months. Gensini score predicted primary composite endpoint, in univariate and multivariate analysis, hazard ratio = 1.08, confidence interval 95% (1.034-1.13) P = 0.001, as well as a history of CAD, LV ejection fraction (LVEF) and age (P < 0.02, P = 0.008 and P = 0.024 respectively) (Fig. 1). Coronary atherosclerotic burden, as measured by Gensini score, is a new prognostic factor in NIDCM. Assessing this parameter improves risk-stratification and could be used to help personalize treatment in this population. [ABSTRACT FROM AUTHOR]

Objective of this study was to determine the accuracy of Right ventricular function (RVF) assessed by Cadmium Zinc Telluride ECG-gated SPECT equilibrium radionuclide angiocardiography (CZT-ERNA). Twenty-one consecutive patients with cardiomyopathy (aged 54 ± 19 years; 62% male) were included. RV ejection fraction (EF) and volumes were analyzed by CZT-ERNA and compared with values obtained by cardiac magnetic resonance imaging (CMR). Mean values were not different between CZT-ERNA and MRI for RVEF (48.1 ± 10.4% vs. 50.8 ± 10.0%; P = 0.23). Significant correlation (P < 0.0001) was found between CZT-ERNA and MRI for RVEF, RV end-diastolic volume, and end-systolic volume (r = 0.81, r = 0.93, and r = 0.96, respectively). Bland–Altman analysis showed a mean difference (bias) between CZT-ERNA and MRI for RVEF of -2.69% (95% CI: -5.35 to - 0.42) with good agreement between the 2 techniques (limits of agreement, −14.3 to 8.99). Intraobserver, and interobserver reproducibility of RVF measure by CZT-ERNA was high. CZT-ERNA provides accurate, reproducible assessment of RVF and appear as a good alternative of cardiac magnetic resonance to evaluate the magnitude of RVF in patients with cardiomyopathy. [ABSTRACT FROM AUTHOR]

Myocardial perfusion reserve (MPR) is a validated diagnostic and prognostic value by Positron Emission Tomography (PET) scans. However, PET availability stays limited in certain countries as France. Gamma cameras with cadmium-zinc telluride detector (CZT-SPECT) are more available and allow the evaluation of this MPR. However, there is no comparison of its results with the interventional diagnostic procedure. Twenty-seven patients with suspected of epicardial or microcirculatory coronary involvement were prospectively included. All patients benefited from an evaluation of the MPR by CZT SPECT as well as an interventional diagnostic procedure with measure of the Fractionnal Flow Reserve (FFR), coronary flow reserve (CRF) and index of microcirculation resistance (IMR). Correlation between MPR and CFR was measured and sensitivity and specificity to detect severe coronary microcirculation disease (CMVD) defined by FFR > 0.8, CFR < 2 and IMR > 25. Coronary angiography was performed in 27 patients, with a complete functional evaluation (FFR, CFR, IMR) on 33 vessels. Two patients had significant stenosis (50-90% stenosis and FFR < 0.8). MPR was correlate with CRF measurement (r = 0.41; P = 0.017). The sensitivity and specificity per patient to detect severe CMVD were 71% and 65%, respectively. Sensitivity and specificity of MPR by territory were 87% and 76% respectively. MPR was correlated with CRF and presented satisfactory diagnostic performance to discriminate, in the absence of significant stenosis, patients free from patients with severe CMVD. [ABSTRACT FROM AUTHOR]

Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) provides valuable prognostic value. However, the risk stratification of patients with type 2 diabetes mellitus (T2D) remains suboptimal. We hypothesised that myocardial perfusion entropy (MPE) quantified from SPECT myocardial perfusion images may provide an incremental prognostic value in T2D patients independently from the routinely performed assessment of myocardial ischemia. T2D patients with very high and high cardiovascular risk were studied (n = 166, 65 ± 12 years). Ischemia (> 10% of left ventricular area) was assessed by SPECT MPI. In addition, SPECT MPI was used for the quantification of rest and stress MPE. The primary endpoint was major adverse cardiac events (MACEs) defined as cardiac death, Q-wave myocardial infarction (MI) and myocardial revascularisation > 3 months after SPECT. Forty-six patients underwent MACEs over a median follow-up of 4.6 years. Significant differences in stress MPE were observed between patients with and without MACEs (4.19 ± 0.46 vs. 3.93 ± 0.39; P ≤.01). By Kaplan–Meier analysis, the risk of MACEs was significantly higher in patients with higher stress MPE (log-rank P ≤.01). Stress MPE and ischemia were significantly associated with the risk of MACEs (hazard ratio: 2.30 and 1.12, respectively, P ≤.01 for both) after adjustment for clinical and imaging risk factors as identified from preliminary, univariate analysis and including age, hypertension, stress test and ischemia. The incremental prognostic value of MPE over clinical risk factors was quantified using nested models showing improved AIC, reclassification (global continuous Net Reclassification Improvement [NRI]: 54, global Integrated Discrimination Improvement [IDI]: 4.6%), discrimination (change in c-statistic: 0.69 vs. 0.74). Stress MPE provided independent and incremental prognostic information for the prediction of MACEs in diabetic patients. [ABSTRACT FROM AUTHOR]

Atherosclerosis is associated with a worse prognosis in many diseases, but its impact in non-ischemic dilated cardiomyopathy (NIDCM) is not known. This study investigated the prognostic value of coronary atherosclerotic burden, as measured by Gensini score, in a cohort of NIDCM patients. In total, 139 patients with left ventricular (LV) dysfunction due to NIDCM were classified according to both invasive coronary angiography (ICA) and cardiovascular magnetic resonance (CMR) imaging data in 3 subtypes of NIDCM: true NIDCM, NIDCM with bystander coronary artery disease (CAD) and NIDCM with bystander myocardial infarction (MI). Percentage, extent, location of fibrosis was assessed with CMR and coronary atherosclerotic burden by calculating Gensini score. Primary endpoint was a composite of cardiovascular mortality, non-fatal MI and revascularisation by percutaneous coronary intervention (PCI). Out of 139 patients (mean age 59.4 ± 14.7 years old, 74% male), there were 101 patients (73%) with true NIDCM, 30 patients (22%) with NIDCM and bystander MI and 8 patients (5%) with NIDCM and bystander MI. 6 patients (4.3%) died and 6 (4.3%) underwent PCI during a median follow-up of 34.2 ± 18 months (Table 1). Gensini score predicted primary composite endpoint, in univariate and multivariate analysis, hazard ratio = 1.08, confidence interval 95% (1.034–1.13) P = 0.001, as well as a history of CAD, LV ejection fraction (LVEF) and age (P < 0.02, P = 0.008 and P = 0.024 respectively), while fibrosis did not. Coronary atherosclerotic burden, as measured by Gensini score, is a new prognostic factor in NIDCM. Assessing this parameter improves risk stratification and could be used to help personalise treatment in this population (Fig. 1). [ABSTRACT FROM AUTHOR]

We aimed to investigate whether micro-net on stent could preserve the index of msicrocirculatory resistance (IMR) after primary percutaneous coronary intervention (PCI) in patients with acutemyocardial infarction (AMI). Fifty deux patients with AMI were randomized into two groups: primary PCI with micro-net on stent (MGUARD group, n = 25) and primary PCI with any commercially available (DES group, n = 27). As the primary endpoint, IMR was measured immediately after primary PCI using a pressure-temperature sensor-tipped coronary wire. The secondary endpoint was the left ventricular ejection fraction (LVEF) at six-month follow-up. The IMR in MGUARD group was significantly lower than in DES group (39.6 ± 26.2 U vs. 75.4 ± 60.5 U, P = 0.01). No significant differences in baseline EF (56.2 ± 10.3% vs. 54.9 ± 7.73%, P = 0.7), however, there were significant differences in follow-up EF (63.2 ± 3.8% vs. 54.7 ± 7.79%, P = 0.001). A micro-net on stent significantly improved CMVD compared with a traditional DES in primary PCI and appear as a useful technological option to manage the thrombus. [ABSTRACT FROM AUTHOR]

Bronchopleural fistula (BPF) is a feared postoperative complication of pneumonectomy that carries significant morbidity and mortality. BPF can be treated by various surgical and medical techniques. Endobronchial techniques have been used for the delivery of biological glue, sealants, coils, and covered stents with variable degrees of success, depending on the size of the fistula. A recent case report described the endobronchial closure of a BPF through the implantation of an Amplatzer ASD device, commonly used for transcatheter closure of atrial septal defects. In this case report, we describe closure of a BFP using the Amplatzer PFO device. [ABSTRACT FROM AUTHOR]

Abstract A 24-year-old patient was admitted for dyspnoea and syncope. He had a previous history of complete atrio-ventricular septal defect and trisomy 21. At the age of 6 months, in 1984, cardiac catheterization revealed a quasi-systemic pulmonary arterial hypertension with a bidirectional shunt corresponding to an Eisenmenger syndrome. Corrective cardiac surgery was not performed at this time because surgical risk was considered too high. Until the age of 20 years old, he showed few symptoms while under medical treatment. But since 2006, his functional status became worse with an increased dyspnoea, syncopes, and severe cyanosis. In these conditions, haemodynamic parameters have been re-evaluated in 2006 and 2008. They highlighted a late and progressive development of a valvular and infundibular pulmonary stenosis leading to a normalisation of pulmonary arterial pressures. At the age of 24 , the patient underwent corrective cardiac surgery which was successful. Late development of both infundibular and valvular pulmonary stenosis have not been described before in non operated congenital ventricular septal defects, but development of one or the other abnormality would be found in 8% of patients. The physiopathological mechanism of this obstruction is unclear. Nevertheless, in unoperated congenital cardiac shunt lesions, reversibility of severe pulmonary arterial hypertension should be reconidered and re-assessed during follow up.

The article discusses a study that investigated the impact of the drug cyclosporine on patients with acute myocardial infarction. Under this study, 970 patients with an acute anterior ST-segment elevation myocardial infraction (STEMI) undergoing percutaneous coronary intervention (PCI) were given either a bolus injection of cyclosporine or matching placebo. Findings on patient outcomes and adverse events such as death, worsening heart failure and adverse left ventricular remodeling are tackled.

Background Many patients with acute ST-segment elevation myocardial infarction (STEMI) are admitted to emergency departments (EDs) of centres without percutaneous coronary intervention (PCI) facilities. The 2012 European Society of Cardiology guidelines recommend transfer to a PCI centre with a “door in - door out” (DI-DO) time ≤ 30 min. Purpose To report DI-DO times in a registry of patients with acute STEMI. Methods The RESeau des Urgences CORonarienne (RESUCOR) is a permanent registry of patients admitted with acute STEMI in 16 hospitals in the north French Alps since 2002. In patients admitted to a non-PCI centre, the DI-DO times were split into “diagnostic time” (from admission to transfer decision) and “logistical time” (from transfer decision to discharge). Results Of 2081 patients included in the registry from 2012 to 2014, 493 were admitted directly into an ED (254 PCI centre and 239 non-PCI centre). Of those admitted into an ED of a non-PCI centre, 228 were immediately transferred to a PCI centre (76 treated with thrombolysis and 132 with primary PCI). The proportions of patients with DI-DO ≤ 30 min and median (interquartile range [IQR]) DI-DO times are reported in the Table 1 . Median (IQR) DIDO times were 90.5 (69–118) min for patients treated with thrombolysis and 88 (62–147) min for primary PCI. Conclusions DI-DO times were longer than recommended. Efforts to decrease these delays are required. Transfer with a non-PCI centre ambulance is preferable. [ABSTRACT FROM AUTHOR]

Background Rapid reperfusion is crucial in the treatment of acute ST-elevation myocardial infarction (STEMI). The latest STEMI guidelines from the European Society of Cardiology (ESC) recommend primary percutaneous coronary intervention (PPCI) if the delay between first medial contact (FMC) and wire passage is ≤ 120 min and fibrinolysis for delays > 120 min. With a ≤ 120 min delay from FMC to wire acceptable for PPCI, it appears that most patients would be eligible for/have access to PPCI. We sought to assess time to reperfusion in STEMI patients in a real-life registry and according to ESC guidelines. Methods RESURCOR is an ongoing registry of all cases of acute STEMI in the north French Alps, an area that covers three French departments (Isere, Savoie, Haute-Savoie), with 1.8 million inhabitants, and a population that doubles during the summer and winter holidays. In RESURCOR, delays and care pathway for STEMI patients, from symptoms onset to reperfusion, were recorded by the physicians. Results Between October 2002 and December 2011, 6169 patients were enrolled in the RESURCOR registry. Of these, 2573 patients were treated with PPCI and had data recorded for delay from FMC to artery puncture; 329 patients had a contraindication to fibrinolysis and 556/2244 (25%) of the PPCI patients without a contraindication to fibrinolysis had a delay from FMC-to-artery puncture > 120 min. A total of 2768 patients were treated with fibrinolysis with recorded delays and 1381/2768 (50%) were admitted to a PCI-capable hospital with a delay from FMC-to-admission (or artery puncture in case of urgent coronary angiogram) < 120 min. Conclusion When the latest ESC STEMI guidelines are applied to a real-world population, it appears that one-quarter of patients treated with PPCI would have been recommended for fibrinolysis and half of those who received fibrinolysis would have been recommended for PPCI. [ABSTRACT FROM AUTHOR]