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Aims: The clinical features, prognosis, and even definition of left ventricular non-compaction (LVNC) are still the subject of much debate. The aim of this registry was to describe the clinical, echocardiographic, and prognostic features of LVNC in France. The main endpoint was to assess clinical and echocardiographic predictors of adverse outcome, defined as death or heart transplantation. Methods and Results: Between 2004 and 2006, 154 suspected cases of LNVC were identified from a nationwide survey in France. The diagnosis of LVNC was confirmed in 105 cases by echocardiographic evaluation in a core laboratory. Clinical and echocardiographic data for the 105 cases of LVNC are presented. Left ventricular non-compaction was first detected from heart failure symptoms in 45 patients, rhythm disorders in 12, and familial screening in 8. Left ventricular ejection fraction (LVEF) was < 30% in 46% of patients, but ≥ 50% in 16%. The latter had less symptoms of severe heart failure (11 vs. 54%, P = 0.001), but similar extension of the NC zone. During 2.33 ± 1.47 years of follow-up, several complications occurred, including severe heart failure in 33 patients, transplantation in 9, ventricular arrhythmia in 7, embolic events in 9, and death in 12. Factors associated with death or heart transplantation were NYHA 3 or 4 (HR = 6.69; P = 0.0007), high LV filling pressures (HR = 7.59; P = 0.001), LVEF (HR = 0.93; P = 0.006), and hospitalization for heart failure (HR = 13.55; P < 0.0001). Conclusion: In this large reported series of LVNC, we observed that: (i) Left ventricular non-compaction was detected by familial screening in asymptomatic patients in 8% of cases. (ii) Left ventricular non-compaction was frequently over-diagnosed by echocardiography. (iii) Patients identified as LVNC presented with a high risk of severe complications, transplantation or death and needed close follow-up. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a growing epidemic with a prevalence among patients with heart failure (HF) approaching 30%. Diabetes worsens the prognosis of HF, and the pathophysiology is complex and multifactorial. Early detection of subtle alterations in cardiac function by modern tools, such as Doppler echocardiography or brain natriuretic peptide dosage, is thus important in these patients. All drugs known to be effective in HF with systolic dysfunction are also effective in patients with diabetes. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists also seem particularly useful. Overall, however, little is known about the treatment of diabetic patients with HF, especially in case of preserved systolic function. Ongoing and future trials should help to determine the best treatment for these patients with or without associated diabetes. This review assesses the relationships between diabetes mellitus and HF and discusses the various medical strategies. [ABSTRACT FROM AUTHOR]

AIMS: Since colour tissue Doppler (CTD) has been shown to underestimate myocardial velocity, we sought to compare CTD with spectral tissue Doppler (STD) and establish agreement and corresponding thresholds for clinical applications. METHODS AND RESULTS: We included 52 consecutive patients with sinus rhythm referred for echocardiographic assessment. Analysis involved a commercially available echosonographer (Vivid 7, GE-Vingmed) and the Echopac system for offline assessment. Myocardial velocities were recorded by STD and CTD in a 4-chamber apical view. CTD values were lower than those measured by STD: 6.0 +/- 2.5 versus 8.2 +/- 2.8 for Ea; 5.5 +/- 2.3 versus 7.9 +/- 2.9 for Aa, and 5.4 +/- 2.0 versus 7.7 +/- 2.4 for Sa (P < 0.001 for all). CTD overestimated the E/Ea: 14.7 +/- 7.6 versus 10.1 +/- 4.1, P < 0.001. Reliability between the two methods was low to moderate: kappa values ranged from 0.33 +/- 0.10 to 0.57 +/- 0.12. CTD thresholds corresponding to usual STD thresholds were calculated, but reliability was not significantly increased, except for the E/Ea ratio. By using continuous values, the ability of the Ea, Sa and E/Ea to predict the presence of heart failure in this sample was similar whatever the method. CONCLUSION: CTD consistently underestimates myocardial velocity values and overestimates E/Ea. A shift of thresholds between the two methods is not sufficient to obtain good agreement, except when measuring the E/Ea ratio. [ABSTRACT FROM AUTHOR]

Objectives: To assess non-invasively the acute effects of cardiac resynchronisation therapy (CRT) on functional mitral regurgitation (MR) at rest and during dynamic exercise. Methods: 21 patients with left ventricular (LV) systolic dysfunction and functional MR at rest, treated with CRT, were studied. Each patient performed a symptom-limited maximal exercise with continuous two dimensional Doppler echocardiography twice. The first exercise was performed with CRT; the second exercise was performed without CRT. Mitral regurgitant flow volume (RV), effective regurgitant orifice area (ERO) and LV dP/dt were measured at rest and at peak exercise. Results: CRT mildly reduced resting mitral ERO (mean 8 (SEM 2) v 11 (2) mm² without CRT, p = 0.02) and RV (13 (3) v 18 (3) ml without CRT, p = 0.03). CRT attenuated the spontaneous increase in mitral ERO and RV during exercise (1 (1) v 9 (2) mm², p = 0.004 and 1 (1) v 8 (2) ml, p = 0.004, respectively). CRT also significantly increased exercise-induced changes in LV dP/dt (140 (46) v 479 (112) mm Hg/s, p <0.001). Conclusion: Attenuation of functional MR, induced by an increase in LV contractility during dynamic exercise, may contribute to the beneficial clinical outcome of CRT in patients with chronic heart failure and LV asynchrony. [ABSTRACT FROM AUTHOR]

Myocardial dysfunction without coronary involvement may occur in acute cerebral diseases. We report 4 cases where, in the context of acute cerebral disorder, the echocardiograms revealed an extensive left ventricular circumferential akinesis except at the apex. Besides, for three of those cases no coronary disease has been highlighted. Recognition of such a pattern of LV dysfunction should lead to the search for an acute cerebral disease. (ECHOCARDIOGRAPHY, Volume 22, August 2005) [ABSTRACT FROM AUTHOR]

Objectives: We compared the accuracy of B-type natriuretic peptide (BNP) assay with Doppler echocardiography for the diagnosis of decompensated congestive left-heart failure (CHF) in patients with acute dyspnea.Background: Both BNP and Doppler echocardiography have been described as relevant diagnostic tests for heart failure.Methods: One hundred sixty-three consecutive patients with severe dyspnea underwent BNP assay and Doppler echocardiogram on admission. The accuracy of the two methods for etiologic diagnosis was compared on the basis of the final diagnoses established by physicians who were blinded to the BNP and Doppler findings.Results: The final etiologic diagnosis was CHF in 115 patients. Twenty-four patients (15%) were misdiagnosed at admission. The BNP concentration was 1,022 +/- 742 pg/ml in the CHF subgroup and 187 +/- 158 pg/ml in the other patients (p < 0.01). A BNP cutoff of 300 pg/ml correctly classified 88% of the patients (odds ratio [OR] 85 [19 to 376], p < 0.0001), but a high negative predictive value (90%) was only obtained when the cutoff was lowered to 80 pg/ml. The etiologic value of BNP was low in patients with values between 80 and 300 pg/ml (OR 1.85 [0.4 to 7.8], p = 0.4) and also in patients who were studied very soon after onset of acute dyspnea. Among the 138 patients with assessable Doppler findings, a "restrictive" mitral inflow pattern had a diagnostic accuracy for CHF of 91% (OR 482 [77 to 3,011], p < 0.0001), regardless of the BNP level.Conclusions: Bedside BNP measurement and Doppler echocardiography are both useful for establishing the cause of acute dyspnea. However, Doppler analysis of the mitral inflow pattern was more accurate, particularly in patients with intermediate BNP levels or "flash" pulmonary edema. [ABSTRACT FROM AUTHOR]

Objectives This study was designed to assess the prognostic value of a new variable derived from a cardiopulmonary exercise test, the circulatory power, a surrogate of cardiac power, at peak exercise, in patients with chronic heart failure.Background Peak exercise cardiac power and stroke work are invasive parameters with recently proven prognostic value. It is unclear whether these variables have better prognostic value than peak oxygen uptake (VO2).Methods The study population comprised 175 patients with chronic heart failure (ejection fraction <45%) who underwent a cardiopulmonary exercise test. Circulatory power and circulatory stroke work were defined as the product of systolic arterial pressure and VO2 and oxygen pulse, respectively. Prognostic value was assessed by survival curves (Kaplan–Meier method) and uni- and multivariate Cox analyses.Results With a mean follow-up of 25±10 months, ejection fraction, heart rate, systolic arterial pressure, peak VO2, VCO2, the anaerobic threshold, minute ventilation, the ventilatory equivalents of oxygen and carbon dioxide, the half times of VO2 and VCO2 recoveries, and the circulatory stroke work and power predicted outcome. Multivariate analysis demonstrated that the peak circulatory power (chi-square=19·9,P <0·001) (but not peak circulatory stroke work) was the only variable predictive of prognosis.Conclusion The prognostic value of cardiopulmonary exercise tests in heart failure patients can be improved by assessing a new variable, the circulatory power—a surrogate of cardiac power—at peak exercise. [ABSTRACT FROM PUBLISHER]

Aim The aim of this prospective study was to compare the prognostic value of the mitral inflow pattern and peak oxygen uptake in patients with systolic heart failure.Background Peak oxygen uptake is a major prognostic parameter in heart failure. It is not known whether a restrictive mitral inflow pattern has similar prognostic value.Methods One hundred heart failure patients (ejection fraction <45%) underwent exercise testing after Doppler evaluation; prognosis was assessed after a mean follow-up of 17 months.Results The ejection fraction was larger in group 1 (non-restrictive pattern: E/A mitral wave ratio <1 or between 1 and 2 with E wave deceleration time ≥140ms, n=45) than in group 2 (restrictive pattern: E/A ratio >2 or between 1 and 2 with E deceleration time <140ms, n=40) (29±9 vs 22±10%, P<0·05). Peak oxygen uptake was lower in group 2 (17±4 vs 22±5ml.min−1.kg−157±11 vs 75±15% of predicted values;P<0·05 for both comparisons). Univariate analysis showed that the deceleration time (r=0·65), E/A ratio (r=−0·50) and heart rate increment (r=0·47) correlated best with peak oxygen uptake. A third group of patients with persistent fusion of the E and A waves (n=15) had exercise responses similar to those of group 2 patients. A short deceleration time (P=0·006), a restrictive or a fusion pattern (P=0·04) were associated with a poor outcome; the prognostic value of these Doppler variables was greater than that of ejection fraction, but remained less than peak oxygen uptake indexed by predicted values (P=0·0004).Conclusion The left ventricular filling pattern is a strong predictor of exercise capacity, and outcome, in patients with systolic heart failure and is independent of the left ventricular ejection fraction. Peak oxygen uptake remains a more powerful prognostic variable. [ABSTRACT FROM PUBLISHER]

Isolated acute right ventricular (RV) infarction is rare, and ECG diagnosis may be difficult. We report two cases of acute myocardial infarction with ST-segment elevation in anterior precordial leads caused by such an RV involvement. Potential mechanisms for the relationship are given. [ABSTRACT FROM AUTHOR]