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This document discusses the feasibility of using CD19 CAR T-cell therapy in patients with cardiac lymphoma. The article highlights that cardiac non-Hodgkin lymphoma is not well-represented in medical literature, and the exact incidence is unknown. The authors present three cases of patients with cardiac lymphoma who received CAR T-cell therapy. The first two patients had successful outcomes with no significant cardiac events, while the third patient experienced severe cardiotoxicity after CAR T infusion. The authors suggest that a multidisciplinary approach and preventive measures for severe cytokine release syndrome are important in optimizing the safety and efficacy of CAR T-cell therapy in patients with cardiac lymphoma. [Extracted from the article]

The assessment of both thromboembolic and haemorrhagic risks and their management in systemic amyloidosis have been poorly emphasized so far. This narrative review summarizes main evidence from literature with clinical perspective. The rate of thromboembolic events is as high as 5–10% amyloidosis patients, at least in patients with cardiac involvement, with deleterious impact on prognosis. The most known pro‐thrombotic factors are heart failure, atrial fibrillation, and atrial myopathy. Atrial fibrillation could occur in 20% to 75% of systemic amyloidosis patients. Cardiac thrombi are frequently observed in patients, particularly in immunoglobulin light chains (AL) amyloidosis, up to 30%, and it is advised to look for them systematically before cardioversion. In AL amyloidosis, nephrotic syndrome and the use of immunomodulatory drugs also favour thrombosis. On the other hand, the bleeding risk increases because of frequent amyloid digestive involvement as well as factor X deficiency, renal failure, and increased risk of dysautonomia‐related fall. [ABSTRACT FROM AUTHOR]

Aims: In amyloid patients, cardiac involvement dramatically worsens functional capacity and prognosis. We sought to study how the cardiopulmonary exercise test (CPET) could help in functional assessment and risk stratification of patients with cardiac amyloidosis (CA). Methods and results: We carried out a multicentre study including patients with light chain (AL) or transthyretin (TTR) CA. All patients underwent exhaustive examination including CPET and follow‐up. The primary prognostic endpoint was the occurrence of death or heart failure hospitalization. Overall, 150 patients were included (91 AL and 59 TTR CA). Median age, systolic blood pressure, N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin T were 70 (64–78) years, 121 [interquartile range (IQR) 109–139] mmHg, 2806 (IQR 1218–4638) ng/L and 64 (IQR 33–120) ng/L, respectively. New York Heart Association classes were I–II in 64%. Median peak oxygen consumption (VO2) and circulatory power were low at 13.0 (10.0–16.9) mL/kg/min and 1730 (1318–2614) mmHg/mL/min, respectively. The minute ventilation/carbon dioxide production slope was increased to 37 (IQR 33–45). A total of 77 patients (51%) had chronotropic insufficiency. After a median follow‐up of 20 months, there were 37 deaths and 44 heart failure hospitalizations. At multivariate Cox analysis, peak VO2 ≤13 mL/kg/min [hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.6–4.8], circulatory power ≤1730 mmHg/mL/min (HR 2.4, 95% CI 1.2–4.6) and NT‐proBNP ≥1800 ng/L (HR 2.2, 95% CI 1.1–4.3) were found to be associated with the primary outcome. No events occurred in patients with both peak VO2 >13 mL/kg/min and NT‐proBNP <1800 ng/L, while the association of VO2 ≤13 mL/kg/min with NT‐proBNP ≥1800 ng/L identified a very high‐risk subgroup. Conclusion: In CA, CPET is helpful in assessing functional capacity, circulatory and chronotropic responses as well as the prognosis of patients along with cardiac biomarkers. [ABSTRACT FROM AUTHOR]

Aims  Early diagnosis of cardiac involvement is a key issue in the management of AL amyloidosis. Our objective was to establish a diagnostic score of cardiac involvement in AL amyloidosis and to compare it with the current consensus criteria [i.e. left ventricular hypertrophy >12 mm and N-terminal pro b-type natriuretic peptide (NT-proBNP) >332 ng/L]. Methods and results  We carried out a prospective and multicenter study on AL amyloidosis patients who underwent cardiac evaluation including clinical examination, electrocardiography (ECG), cardiac biomarkers, transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR). Cardiac involvement was based on CMR and/or endomyocardial biopsy. In a derivation cohort of 114 patients (82 with cardiac involvement), the highest diagnostic accuracy was observed with NT-proBNP and troponin blood levels, TTE-derived global longitudinal strain (LS), and apical to basal LS gradient. By using multivariate analysis, we established a diagnostic score including global LS ≥−17% (1 point), apical/(basal + median) LS ≥0.90 (1 point), and troponin T >35 ng/L (1 point). A score >1 was associated with sensitivity of 94% and specificity of 97%, an area under the curve of 0.98 [95% confidence interval (CI) 0.93–0.99] as well as a net reclassification index of 0.39 (95% CI 0.28–0.46) when compared with consensus criteria. In a validation cohort of 73 AL amyloidosis patients, the area under the receiver operating characteristic curve of the diagnostic score was 0.97 (95% CI 0.90–0.99). Conclusion  Combining T troponin blood levels and two echo-derived strain parameters leads to very high accuracy for diagnosing cardiac involvement in AL amyloid patients. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is among the leading causes of death in solid organ transplant recipients with a functional graft. Although these patients could theoretically benefit from exercise-based rehabilitation (EBR) programs, their implementation is a challenge., Objective: We present our initial experience on different delivery modes of a pilot EBR program in kidney and liver transplant recipients., Methods: Thirty-two kidney or liver transplant recipients were invited for a 6-month EBR program delivered at the hospital gym, community gym or at home, according to the patient's preference. The significance level adopted was 5%., Results: Ten patients (31%) did not complete their program. Among the 22 who did, 7 trained at the hospital gym, 7 at the community gym, and 8 at home. The overall effect was an 11.4% increase in maximum METs (Hedges' effect size g = 0.39). The hospital gym group had an increase in METs of 25.5% (g= 0.58, medium effect size) versus 10% (g= 0.25), and 6.5% (g= 0.20) for the community gym and home groups, respectively. There was a beneficial effect on systolic and diastolic blood pressures, greater for the hospital gym (g= 0.51 and 0.40) and community gym (g= 0.60 and 1.15) groups than for the patients training at home (g= 0.07 and 0.10). No significant adverse event was reported during the follow-up., Conclusion: EBR programs in kidney and liver transplant recipients should be encouraged, even if they are delivered outside a hospital gym, since they are safe with positive effects on exercise capacity and cardiovascular risk factors.

Aims: Early diagnosis of cardiac involvement is a key issue in the management of AL amyloidosis. Our objective was to establish a diagnostic score of cardiac involvement in AL amyloidosis and to compare it with the current consensus criteria [i.e. left ventricular hypertrophy >12 mm and N-terminal pro b-type natriuretic peptide (NT-proBNP) >332 ng/L]., Methods and Results: We carried out a prospective and multicenter study on AL amyloidosis patients who underwent cardiac evaluation including clinical examination, electrocardiography (ECG), cardiac biomarkers, transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR). Cardiac involvement was based on CMR and/or endomyocardial biopsy. In a derivation cohort of 114 patients (82 with cardiac involvement), the highest diagnostic accuracy was observed with NT-proBNP and troponin blood levels, TTE-derived global longitudinal strain (LS), and apical to basal LS gradient. By using multivariate analysis, we established a diagnostic score including global LS ≥-17% (1 point), apical/(basal + median) LS ≥0.90 (1 point), and troponin T >35 ng/L (1 point). A score >1 was associated with sensitivity of 94% and specificity of 97%, an area under the curve of 0.98 [95% confidence interval (CI) 0.93-0.99] as well as a net reclassification index of 0.39 (95% CI 0.28-0.46) when compared with consensus criteria. In a validation cohort of 73 AL amyloidosis patients, the area under the receiver operating characteristic curve of the diagnostic score was 0.97 (95% CI 0.90-0.99)., Conclusion: Combining T troponin blood levels and two echo-derived strain parameters leads to very high accuracy for diagnosing cardiac involvement in AL amyloid patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Competing Interests: M. Nicol déclare avoir été pris en charge lors de congrès par Servier. M. Baudet déclare n’avoir aucun lien d’intérêts. A. Cohen Solal déclare des liens ponctuels (interventions et prise en charge lors de congrès) avec Novartis, Servier, Vifor et Fresenius.

Recent studies have suggested that intracardiac vortex flow imaging could be of clinical interest to early diagnose the diastolic heart function. Doppler vortography has been introduced as a simple color Doppler method to detect and quantify intraventricular vortices. This method is able to locate a vortex core based on the recognition of an antisymmetric pattern in the Doppler velocity field. Because the heart is a fast-moving organ, high frame rates are needed to decipher the whole blood vortex dynamics during diastole. In this paper, we adapted the vortography method to high-frame-rate echocardiography using circular waves. Time-resolved Doppler vortography was first validated in vitro in an ideal forced vortex. We observed a strong correlation between the core vorticity determined by high-frame-rate vortography and the ground-truth vorticity. Vortography was also tested in vivo in ten healthy volunteers using high-frame-rate duplex ultrasonography. The main vortex that forms during left ventricular filling was tracked during two-three successive cardiac cycles, and its core vorticity was determined at a sampling rate up to 80 duplex images per heartbeat. Three echocardiographic apical views were evaluated. Vortography-derived vorticities were compared with those returned by the 2-D vector flow mapping approach. Comparison with 4-D flow magnetic resonance imaging was also performed in four of the ten volunteers. Strong intermethod agreements were observed when determining the peak vorticity during early filling. It is concluded that high-frame-rate Doppler vortography can accurately investigate the diastolic vortex dynamics.

The management of heart failure requires reproducible and easily accessible biomarkers. For diagnosis, measurement of natriuretic peptides is highly recommended as first line. For the stratification of patients, natriuretic peptide testing is highly recommended and other biomarkers such as troponin or fibrosis markers can also be used. For any biomarkers, changes in blood levels over time is more relevant than a single assay. For monitoring as well as guiding heart failure treatment, serial testing of natriuretic peptides is useful in young patients with systolic dysfunction. For the screening of high-risk patients, natriuretic peptides testing is not fully validated yet., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)