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Background: Pathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after re-perfusion with clinical outcomes after anterior STEMI.Methods: Standard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had re-gression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/ or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year.Results: There were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave re-gression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 +/- 2784 IU/l vs. 3814 +/- 2595 IU/l vs. 1733 +/- 1583 IU/l respectively, p b 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09).Conclusion: Ina population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events.(c) 2019 Elsevier Inc. All rights reserved.

Aims: Periprocedural myocardial infarctions have been reported in the setting of planned percutaneous coronary intervention (PCI). We assessed the prevalence of nonculprit artery acute myocardial infarction (NCAMI) and its relationship with coronary artery characteristics, final infarct size, and 1-year adverse clinical outcomes in a population of anterior ST-elevated myocardial infarction (STEMI) patients. Methods and Results: Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) studies were performed within 7 days of admission in 129 anterior STEMI patients from the CIRCUS trial treated by primary PCI. Infarct in the noninfarct artery territory (circumflex, right coronary) was assessed on LGE-CMR and T2-weighted images. Eleven (8.5%) patients exhibited NCAMI. The only independent characteristic significantly associated with NCAMI was the presence of multiple complex coronary lesions (odds ratio = 12.9, 95% confidence interval [3.1–53.4]; p < 0.001). There was a significantly increased infarct size in NCAMI patients compared to patients without NCAMI (45.8 ± 20.4% of the left ventricle [LV] vs. 31.0 ± 15.1% of LV, respectively; p = 0.02), with lower LV ejection fraction (46 ± 10% vs. 34 ± 8%, respectively; p < 0.001). Conclusion: NCAMIs are present in 8.5% of anterior STEMI patients and are significantly associated with multiple complex coronary lesions without significant relationship to any revascularization procedural technique. NCAMI was associated with a greater infarct size and reduced LVEF but not worse clinical outcomes at 1 year.

Postinfarction adverse left ventricular (LV) remodelling is strongly associated with heart failure events. Conicity index, sphericity index and LV global functional index (LVGFI) are new LV remodelling indexes assessed by cardiac magnetic resonance (CMR).To assess the predictive value of the new indexes for 1-year adverse LV remodelling in patients with anterior ST-segment elevated myocardial infarction (STEMI).CMR studies were performed in 129 patients with anterior STEMI (58±12 years; 78% men) from the randomized CIRCUS trial (CMR substudy) treated with primary percutaneous coronary intervention and followed for the occurrence of major adverse cardiovascular events (MACE) (death or hospitalization for heart failure). Conicity index, sphericity index, LVGFI, infarct size and microvascular obstruction (MVO) were assessed by CMR performed 5±4 days after coronary reperfusion. Adverse LV remodelling was defined as an increase in LV end-diastolic volume of ≥15% by transthoracic echocardiography at 1 year.Adverse LV remodelling occurred in 27% of patients at 1 year. Infarct size and MVO were significantly predictive of adverse LV remodelling: odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05 (P0.001) and OR 1.12, 95% CI 1.05-1.22 (P0.001), respectively. Among the newly tested indexes, only LVGFI was significantly predictive of adverse LV remodelling (OR 1.10, 95% CI 1.03-1.16; P=0.001). In multivariable analysis, infarct size remained an independent predictor of adverse LV remodelling at 1 year (OR 1.05, 95% CI 1.02-1.08; P0.001). LVGFI and infarct size were associated with occurrence of MACE: OR 1.21, 95% CI 1.08-1.37 (P0.001) and OR 1.02, 95% CI 1.00-1.04 (P=0.018), respectively. Conicity and sphericity indexes were not associated with MACE.LVGFI was associated with adverse LV remodelling and MACE 1 year after anterior STEMI.

International audience; BACKGROUND: Recent publications suggest that left atrial (LA) myopathy is a potential source of thromboembolism, independent of atrial fibrillation. AIMS: We sought to investigate whether the presence of atrial premature activity after an ischaemic stroke is associated with LA remodelling and dysfunction, and might be a surrogate marker of LA myopathy. METHODS: After an ischaemic stroke or a transient ischaemic attack, patients without known atrial fibrillation or overt heart disease were included prospectively in the study. All patients had a standard workup, including ambulatory Holter electrocardiogram monitoring and transthoracic echocardiography. In some patients, transoesophageal echocardiography was also performed. Anatomical and functional LA remodelling were assessed using minimal and maximal volumes and LA emptying fraction in two-dimensional and three-dimensional echocardiography. Patients were separated into two groups according to the burden of atrial premature complexes (APCs), measured by Holter electrocardiography. RESULTS: Among 148 eligible patients recruited from October 2015 to May 2016, 93 were included in the group with non-frequent APCs (nf-APC:\textless100 APCs/24hours) and 43 in the group with frequent APCs (f-APC:\textgreater100 APCs/24hours). Twelve patients had paroxysmal atrial fibrillation, and were not included in the statistical analysis. Maximal and minimal indexed LA volumes were significantly higher in the f-APC group than in the nf-APC group (P\textless0.01). LA emptying fraction was worse in the f-APC group than in the nf-APC group. In addition, LA appendage emptying velocity was impaired in the f-APC group, and was correlated with LA remodelling variables, especially LA emptying fraction (r=0.621). CONCLUSIONS: After an ischaemic stroke or a transient ischaemic attack, excessive APCs are associated with LA remodelling. Thus, LA dilatation and dysfunction reflect early LA myopathy, which might itself be responsible for cardioembolic stroke.

International audience; Background: The link between hs-Tn and infarct size has already been proved in several articles. However few is known about the kinetic of the troponin and its link to the infarct characteristics, likewise MVO. Our primary objective was to study which hs-Tn characterizes the best infarction.Methods and results: We identified 29 consecutive STEMI patients to study. The kinetics of hs-TnT (Roche) and two different TnIs (hs-TnI from Abbott, s-TnI from Siemens) were evaluated for all patients. Area under curves (AUC), first peak (FP) and second peak (SP), for hs-TnT, were compared to IS and MVO size using contrast-enhanced cardiac magnetic resonance. For IS, statistically SP of hs-TnT presented the best correlation compared to other peak values [r = 0.9 vs. 0.73 for FP hs-TnT; vs. 0.69 for hs-TnI; vs. 0.57 for s-TnI; respectively P < 0.01, P < 0.01, P < 0.01]. For MVO size, statistically SP of hs-TnT presented the best correlation compared to other peak values [r = 0.84 vs. 0.75 for FP hs-TnT; vs. 0.72 for hs-TnI; vs. 0.62 for s-TnI; respectively P = 0.01, P < 0.01, P < 0.01]. The best AUC were archived by the hs-TnT (AUC = 0.95) but there were no statistical differences when compared to other hs-Tn AUC.Conclusion: The SP of hs-TnT had the greatest level of correlation and therefore seems to be the best biological parameter to evaluate and characterize infarct size.; Introduction: La relation en troponine hypersensible et taille d’infarctus a été prouvée dans de nombreux articles. Cependant, peu de relations ont été établies entre cinétique de troponine et les caractéristiques de l’infarctus, notamment l’obstruction microvasculaire. Notre objectif principal était d’étudier quelle troponine de haute sensibilité caractérisait le mieux l’infarctus du myocarde.Méthodes et résultats: 29 patients ayant subi un infarctus du myocarde aigu ont été inclus consécutivement dans cette étude. Les cinétiques de la troponine T-hs (Roche) et deux troponines I (hs-TnI de chez Abbott, s-TnI de chez Siemens) ont été évaluées pour tous les patients. Les aires sous la courbe, la valeur du premier pic (PP) et du second pic (SP), pour la troponine T-hs, étaient comparées aux valeurs de taille d’infarctus et d’obstruction microvasculaire mesurées par IRM cardiaque. Concernant la taille de la nécrose, le second pic (SP) de troponine T-hs (hs-TnT) avait la meilleure corrélation en comparaison des autres valeurs de pic (r = 0,9 vs 0,73 pour le PP de hs-TnT ; vs 0,69 pour le pic de hs-TnI ; vs 0,57 pour le pic de s-TnI ; respectivement p < 0,01, p < 0,01, p < 0,01). Concernant la taille de l’obstruction microvasculaire, le SP de hs-TnT présentait la meilleure corrélation également en comparaison des autres valeurs de pics (r = 0,84 vs 0,75 pour PP de hs-TnT ; vs 0,72 pour le pic de hs-TnI ; vs 0,62 pour le pic de s-TnI ; respectivement p = 0,01, p < 0,01, p < 0,01). La meilleure aire sous la courbe de troponine était retrouvée avec la hs-TnT (AUC = 0,95), sans différence significative cependant comparativement aux autres troponines.Conclusion: Le second pic de troponine T-hs semblait être le meilleur paramètre biologique d’évaluation des caractéristiques de l’infarctus du myocarde.

Background Laminopathies are associated with a broad spectrum of clinical manifestations, from lipodystrophy to cardiac diseases. The purpose of this study was to assess genotype-phenotype correlations in a lipodystrophic laminopathy caused by the Lamin A (LMNA) mutation T655fsX49. This mutation leads to synthesis of nonfarnesylated-mutated prelamin A that does not undergo the physiologic lamin A maturation process. Methods and results We studied 35 patients originating from Reunion Island who carried the LMNA T655fsX49 mutation. Comparisons of cardiac and endocrinologic features were made between homozygous and heterozygous patients. Homozygous patients presented more overlapping syndromes with severe cardiac phenotypes, defined by cardiolaminopathy, early atheroma with coronary heart disease (CHD) and high-degree conduction disorder compared with heterozygous (40% vs 4%; P = .016). Moreover, homozygous patients had earlier onset (49.6 vs 66 years old; P = .0002). Left ventricle lowered ejection fraction associated with heart failure was more frequent in homozygous than in heterozygous patients (40% vs 0%, respectively). Lipodystrophic traits were more marked in the homozygous group but only reached statistical significance for L4 subcutaneous fat measurement (2.8 ± 2.16 vs 18.7 ± 8.9 mm; P = .008) and leptin levels (2.45 ± 1.6 vs 11.26 ± 7.2 ng/mL; P = .0001). Conclusions Our results suggest that there is a relationship between mutated prelamin-A accumulation and the severity of the phenotypes in homozygous familial partial lipodystrophy type 2 patients who harbor the LMNA T655fsX49 mutation. A dose-dependent effect seems likely.

Background: Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance. Methods and Results: A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a >= 0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean +/- SD] 4,231 +/- 2,656 vs. 3,993 +/- 2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7 +/- 11.6% vs. 52.2 +/- 10.8%; P=0.186), LV adverse remodeling (20.1 +/- 38.9% vs. 18.3 +/- 30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. Conclusions: Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.

Aims Paroxysmal atrial fibrillation (PAF) is common, often silent, and can be difficult to detect. Echocardiographic parameters assessing left atrial (LA) remodelling correlated with atrial fibrosis in permanent AF, but less is known about earlier stages such as PAF. We aimed to evaluate whether 2D and 3D echocardiographic (2DE and 3DE) assessment of LA anatomy and function is able to identify patients with PAF. Methods and results This case–control study included 102 patients without overt heart disease, 44 patients with PAF. Anatomical remodelling was assessed using indexed maximal, minimal, and pre-atrial contraction volumes. Reservoir, conduit, and pump functions were assessed by volume and strain methods. All parameters were assessed by 2DE and 3DE and were compared between the two groups. Receiver-operating characteristic curves were constructed for each parameter for PAF prediction. PAF patients had bigger LA volumes than non-PAF group. Using 3DE, all atrial functions were impaired in the PAF group, regardless of the parameters used (all P < 0.05), whereas using 2DE, conduit function did not reach significant difference. Areas under the curve (AUCs) for 3D parameters were higher than those for equivalent 2DE parameters. PAF was best predicted by LA minimal indexed volume assessed by 2DE or 3DE (AUC 0.82 and 0.86, respectively) and 3D-LA ejection fraction and area strain (AUC = 0.82 and 0.81, respectively). Conclusion Anatomical and functional LA remodelling assessed by 2DE and 3DE is independently and strongly associated with PAF, suggesting that these parameters can help identify PAF.

Objectives We investigated the relationship of traditional left ventricular (LV) volume indices, LV ejection fraction (LVEF) infarct size, LV sphericity and conicity indices and longitudinal shortening with left ventricular remodeling at one year. Background LV sphericity and conicity indices have been presented as pathological indices of LV remodeling in the general population. Small studies have reported a predictive value of these indices at the acute phase of MI on chronic LV remodeling. Methods Contrast enhanced cardiac magnetic resonance (CMR) studies were performed in 102 anterior ST-elevated myocardial infarction patients from the CIRCUS trial (CMR substudy) treated with primary percutaneous coronary intervention (PCI). CMR examination was performed 5±2 days after reperfusion. LV remodeling was measured as the relative increase in LV enddiastolic volume between the acute phase and and one-year follow-up as assessed by cardiac ultrasound. Adverse LV remodeling was defined as an increase in LV-end-diastolic volume ≥20%. Results LV remodeling in the study population was 10.0% IQR [–10.9%; 30.2%]. Upon univariate linear regression, One-year LV remodeling was significantly related to infarct size (R=0.51; p Conclusion At the acute phase of MI, LVEF and longitudinal shortening showed the strongest correlation with infarct size whereas there were modest or non significant correlation with more sophisticated LV indices of remodeling. The author hereby declares no conflict of interest Table 1 . Table CMR Parameter R value P value Infarct size 0,51 0,001 LVEF % –0,28 0,03 LVEDV index, ml/m2 0,09 0,50 LVESV index, ml/m2 0,23 0,08 Sphericity index –0,0009 0,94 Conicity index 0,20 0,15 Longitudinal shortening, % 0,32 0,03 Download : Download full-size image Figure . Regression between LV remodeling and infarct size

International audience; OBJECTIVE: The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). METHODS: In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow \textless/=1, and patency was defined by an i-TIMI flow \textgreater/=2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72h after admission. RESULTS: A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95+/-0.02 vs. 2.97+/-0.02, respectively; p=0.44). In the i-TIMI flow \textless/=1 group, infarct size was significantly larger (32+/-17g vs. 21+/-17g, respectively; p=0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p=0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI \textgreater/=2 patient group. CONCLUSION: Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.

Background Regression of ST segment elevation after reperfusion is a strong prognostic factor in ST Elevation Myocardial Infarction (STEMI) patients. Up to 25% patients have ST segment re-elevation after the initial regression and there is little data regarding its prognostic significance. Methods Standard 12-leads electrocardiograms (ECG) were recorded in 662 anterior STEMI patients referred for Primary Percutaneous Coronary Intervention (PPCI), from the CIRCUS trial. ECGs were recorded at admission, 60–90 minutes after PPCI, and at discharge. ST segment elevation was measured on STmax, and ST segment re-elevation was defined by an increase ≥ 0.1 mV between post-PPCI and discharge ECG. Infarct size by Creatin Kinase (CK) peak, echocardiography at baseline and follow-up, and all-cause death and heart failure events were assessed at one year. Results 128 (19%) patients had ST segment re-elevation (ReST+ group). There was no difference between ReST+ patients and patients without re-elevation (ReST− group) on infarct size (CK peak: 4231 ± 2656 IU/l vs. 3993 ± 2819 IU/l, respectively, P = 0.402). There was no difference for 1-year Left Ventricular (LV) Ejection Fraction (50.7 ± 11.6% vs. 52.2 ± 10.8%, P = 0.186) or LV adverse remodeling (20.1 ± 38.9% vs. 18.3 ± 30.9%, P = 0.631). There was no difference in all-cause mortality and heart failure events at one year (22 [19.8%] vs. 106 [19.2%], P = 0.887). Conclusion In anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size and major adverse events at one year.

We read with great interest the article by Jablonowski et al. [(1)][1] showing that contrast-enhanced cardiac magnetic resonance (ce-CMR) overestimates infarct size at 6 h post-reperfusion compared with pathology and that infarct imaging timing by ce-CMR is critical. Although this is not an