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Objective The underlying pathophysiology of right ventricular (RV) dysfunction in heart failure with preserved ejection fraction (HFpEF) is still debated. The aim of this study is to assess the prognostic significance of echocardiographic right ventricular abnormalities in HFpEF. Methods We enrolled 150 patients with HFpFE in sinus rhythm and no history of chronic lung disease in this observational study. Over a median follow-up of 18 months, 58 patients (38.6%) reached the end point study of hospitalization for heart failure or death (group 1) and 92 remained asymptomatic (group 2). Results While mean ages, sex-ratio, BMI, creatinine level, left ventricular (LV) ejection fraction, LV and RV dimensions were similar between the 2 groups, group 1 patients compared to group 2, had higher ratio of early mitral diastolic inflow velocity E to early diastolic mitral annular velocity e’ (E/e’ ratio: 17 ± 6 vs. 13 ± 7; P Conclusion In HFpEF patients, right ventricular dysfunction progresses with increasing afterload PA pressures, and is associated with worse outcome.

Background Patients with hypertrophic cardiomyopathy (HCM) are prone to develop atrial fibrillation (AF) due to diastolic dysfunction and left atrial (LA) remodeling. According to guidelines, 48-hour ambulatory ECG is recommended every 12–24 months in stable patients and every 6–12 months in case of LA dimension ≥ 45 mm or if new palpitations. Purpose The aim of this study is to investigate the predictive value of LA speckle tracking in detecting paroxysmal atrial fibrillation in HCM patients with enlarged left atrium. Methods We enrolled 62 patients with HCM in sinus rhythm and LA diameter ≥ 45 mm. All patients had previously underwent 24 or 48-hour ambulatory ECG in the last 12 months without detecting any paroxysmal AF. In this study, all our patients underwent standard echocardiographic with left ventricular (LV) and LA speckle tracking examination followed by 7-days long-term ambulatory ECG monitoring. Results Among 62 patients, 19 patients (30.6%) were diagnosed with asymptomatic paroxysmal AF detected by 7-days long-term ambulatory ECG recorder (group1). In the same conditions, no paroxysmal FA was detected in the remaining 43 patients (group2). Group 1 patients showed no differences from group 2 patients with regards to mean ages, BMI, LV dimensions and ejection fraction, E/e’ ratio and even in LA diameter. However, they had significantly impaired left atrial strain indices with significantly lower LA conduit strain 12.15 ± 3.7% vs.17.34 ± 4.08% (P Conclusion Among HCM patients with enlarged LA, those with impaired LA strain indices were prone to higher risk for paroxysmal FA. Thus, LA strain may provide additional functional information for predicting AF susceptibility and may lead in case of impaired indices to propose prolonged ECG monitoring in order to enhance the detection of undiagnosed AF.

Introduction L’angioplastie coronaire est un challenge quotidien. Depuis son avenement dans les annees 1980, bon nombre de progres a ete realise notamment grâce aux stents actifs, nous permettant d’etendre les indications d’angioplastie. Il demeure certaines limites, mais quel est le meilleur moment pour referer le patient au chirurgien ? Observation Une patiente de 62 ans, hypertendue, diabetique non insulino-requerante, tabagique active et obese, est adressee au service pour coronarographie diagnostique devant une dyspnee d’effort stade 2 de la NYHA et une scintigraphie myocardique positive en apical. La coronarographie realisee par voie radiale droite 6 French, retrouve un reseau de dominance droite, un atherome ectasiant et une lesion monotronculaire de l’IVA moyenne. Il s’agit d’une lesion tres calcifiee de 10 mm de long. Une premiere tentative d’angioplastie est debutee ad hoc. Nous decidons d’arreter la procedure devant la persistance d’une empreinte lors de l’inflation d’un ballon non compliant de 3,5 mm malgre l’utilisation prealable de fraises d’atherectomie rotative de Rotablator de 1,25 et 1,75 mm. La patiente etant parfaitement stable nous programmons, 3 semaines plus tard, une nouvelle tentative d’angioplastie apres avoir commande le materiel adequat. Nous sommes confrontes a un nouvel echec malgre l’utilisation d’un Rotablator de 2 mm et de Cutting Ballons de 3,5 et 4 mm. Nous decidons alors de tenter une troisieme angioplastie apres avoir commande une fraise de Rotablator de 2,5 mm. Nous realisons au prealable un Coroscanner pour comprendre le mecanisme de cette lesion indilatable. Nous mettons alors en evidence un anneau calcaire de l’IVA moyenne dont la lumiere fait 2 mm. Cette procedure a lieu dans notre centre chirurgical referent. Cette fois nous faisons face a un echec de l’utilisation de la fraise de 2,5 mm, qui ne passe pas dans les sondes de 8 French. La solution vient finalement de l’utilisation d’un Cutting ballon le plus court possible (6 mm de long par 3,5 mm de diametre) mene a haute pression (22 atm) lors d’une inflation prolongee (> 1 minute). Discussion L’utilisation de l’atherectomie rotative ne date pas d’hier puisqu’elle a ete mise au point par D. Auth en 1987. La possibilite de mordancage de la plaque calcaire (epargnant le tissu sain) a l’aide d’une fraise en rotation a tres haute vitesse (180 000 tr/min), recouverte de microparticules de diamant, en fait une arme majeure dans l’abord des lesions resistantes. Neanmoins, il est exceptionnel d’utiliser des fraises de diametre superieur a 1,75 mm, il en resulte un challenge technique supplementaire. De nouveaux outils se developpent dans ces indications, tels que les ballons a double paroi capables de supporter de tres hautes pressions (plus de 30 bars), venant etoffer notre arsenal d’angioplastie. Cependant, il ne faut pas oublier le risque lie a de telles procedures et l’angioplastie coronaire ne saurait remplacer la chirurgie de pontage coronaire. Conclusion Nous presentons un cas d’anneau calcaire stenosant de l’IVA moyenne particulierement resistant. L’emploi de Rotablator de 2 mm et de Cutting ballons courts, portes a hautes pressions, lors d’inflations prolongees nous a permis de proposer a cette patiente une alternative au mono-pontage de l’IVA.

Background The medical care of Jehovah’s Witness patients, because they refuse blood transfusion, becomes problematic in cases of severe life-threatening anaemia. Purpose To describe the case of a patient with severe anaemia who received erythropoietin (EPO) treatment as the result of a literature review. Materials and Methods A 77-year old woman was sent to the emergency department with thoracoepigastric pain, blood clots and vomiting for a week. Cardiac examination revealed a coronary syndrome caused by gastrointestinally-induced anaemia at 5.6 g/dl (haematocrit = 18.9%). On day 3 the haemoglobin fell to 4 g/dl (haematocrit = 14.4%) upon which a treatment with EPO beta at 30,000 IU per week (380 IU/kg/week) associated with high intravenous iron supplementation (300 mg/48 hours) was instituted. After 16 days of treatment haemoglobin (8.9 g/dl) and haematocrit (31.6%) had doubled and clinical improvement was observed. The patient was discharged on day 22 of treatment with a total of 4 EPO injections (haemoglobin = 9.6 g/dl). Results Currently in emergency there is no alternative to transfusion and a higher mortality is linked to a low haemoglobin level. In a multicentre study with 148 patients, Georgopoulos et al, showed the efficacy of EPO, used off-label, administered once weekly, to reduce transfusions. Thirteen recent publications reported experiences with the intravenous or subcutaneous administration of EPO in anaemia treatment. The optimal dose of EPO remains unclear: dosage ranges from 200 μg/week darbepoetin alfa (Gutierrez et al), to 130 IU/kg of EPO three times weekly (Walton et al), to 600 Iu/kg/day for 2 days to 300 IU/kg/day (Cothren et al). After starting treatment the haemoglobin level doubled in 19 days (in an average of 4 days–30 days). Conclusions Our weekly EPO protocol is in the lower targets found in the literature but it appears as effective as other protocols. Significant variability without a major difference in efficacy appears when EPO is used for Jehovah’s Witness patients, but EPO may provide an alternative treatment in life-threatening anaemia, when blood transfusions are not accepted. No conflict of interest.

9016 Background: Liposarcoma (LS) is a heterogeneous group of tumors comprising 5 pathologic subtypes: well-differentiated (WD), dedifferentiated (DD), myxoid (MY), round cell (RC), and pleomorphic...