Search

BACKGROUND The sustainability of the results of Mitraclip procedures is a source of concern. AIMS To investigate risk factors of severe mitral regurgitation (MR) recurrence after Mitraclip in primary MR. METHODS AND RESULTS Eighty-three patients undergoing successful Mitraclip procedures were retrospectively included. Valve anatomy and Mitraclips placement were comprehensively analyzed by post-processing 3D echocardiographic acquisition. The primary composite endpoint was the recurrence of severe MR. The average age was 83±7 years-old, 37 (44%) were female. Median follow-up was 381 days (IQR 195-717) and 17 (20%) patients reached the primary endpoint. Main causes of recurrence of severe MR were relapse of a prolapse (64%) and single leaflet detachment (23%). Posterior coaptation line length (HR 1.06 95%CI 1.01-1.12 p = 0.02), poor imaging quality (HR 3.84, 95%CI 1.12-13.19; p = 0.03), and inter-clip distance (HR 1.60, 95%CI 1.27-2.02; p

BACKGROUND Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. The aim of this study was to compare the predictive value of main RV systolic imaging parameters for outcome. METHODS Seventy-nine patients underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and tomographic equilibrium radionuclide ventriculography (ERV) for the assessment of RV function. The composite primary endpoint (CPE) was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure. RESULTS During a mean follow-up of 13 ± 9 months, 15 (19%) patients reached the CPE. The areas under the receiver operator characteristic curves for the prediction of the CPE were 0.922 (P

BACKGROUND Right ventricular (RV) systolic parameters are difficult to assess in heart transplant recipients (HTRs) compared to healthy people because of discordant data, and their impact on exercise capacity remains undefined. We sought to retrospectively assess the impact of RV systolic function on exercise capacity after heart transplantation. METHODS We analyzed data from 61 HTRs who underwent transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMR), and exercise capacity assessment by 6-minute walking test (6MWT) and cardiopulmonary exercise testing (CPET) at 1- and 2-year follow-ups. RESULTS Transthoracic echocardiography RV longitudinal systolic function including tricuspid annular plan systolic excursion (TAPSE), peak systolic S' wave tricuspid annular velocity (PSVtdi) and RV free wall longitudinal strain was decreased at 1 year (respectively, 15 ± 3 mm, 10 ± 3 cm/s, and -19 ± 5%) and at 2 years (respectively, 15 ± 3 mm, 10 ± 2 cm/s, and -20 ± 5%) with no significant difference between both evaluations; meanwhile, RV ejection fraction (RVEF) measured by CMR was preserved. Mean percentage of predicted peak oxygen consumption was altered, but improved between the first and second year (55 ± 18 vs 60 ± 18%, P = .038). PSVtdi was weakly correlated with 6MWT distance (r = .426, P = .017) and RVEF with the predicted distance at 6MWT (r = .410, P = .027) at the 1-year follow-up. CONCLUSIONS Despite decreasing values, RV longitudinal systolic function has a weak impact on exercise capacity of HTRs. PSVtdi and RVEF are the most pertinent parameters to assess the impact of RV systolic function on exercise capacity after heart transplantation. These results should lead to redefine normal RV systolic function thresholds for HTRs.

Background: The sustainability of the results of mitraclip procedures is a source of concern. Aims: To investigate risk factors of severe mitral regurgitation (MR) recurrence after Mitraclip in primary MR. Methods and results: Eighty-three patients undergoing successful Mitraclip procedures were retrospectively included. Valve anatomy and Mitraclips placement were comprehensively analyzed by post-processing 3D echocardiographic acquisition. The primary composite endpoint was the recurrence of severe MR. Mean age was 83±7 years-old, 37 (44%) were female. Median follow-up was 381 days (IQR 195-717) and 17 (20%) patients reached the primary endpoint. Main causes of recurrence of severe MR were relapse of a prolapse (64%) and single leaflet detachment (23%). Posterior coaptation line length (HR 1.06 95%CI 1.01-1.12 p=0.02), poor imaging quality (HR 3.84, 95%CI1.12-13.19; p=0.03), and inter-clip distance (HR 1.60, 95%CI 1.27-2.02; p

Chronic thromboembolic pulmonary hypertension (CTEPH) is a major cause of chronic pulmonary hypertension leading to right heart failure and death. Ventilation/perfusion single photon emission computed tomography (V/Q SPECT) is the screening test of choice showing mismatch in at least one segment or two sub-segments. Our aim was to investigate the relationship between the extent of pulmonary perfusion defects and hemodynamic, echocardiographic, biological and functional parameters. Between 2012 and 2019, 46 patients with CTEPH were retrospectively enrolled in the study. The diagnosis of pulmonary hypertension was made by the referral team of the expert center according to the European guidelines. All patients underwent pulmonary V/Q SPECT, right heart catheterization, transthoracic echocardiography (TTE), functional tests and natriuretic peptides assays. There was a slight correlation between the extent of pulmonary perfusion defects and pulmonary vascular resistances (R=0.510, P < 0.001). However, there was no correlation between the extent of pulmonary perfusion defects and NYHA stage, NT-proBNP level, functional parameters (6 minutes-walk distance-6 MWD), right ventricular function assessed by TTE. Pulmonary perfusion defects extension by V/Q lung SPECT are correlated with pulmonary vascular resistances in CTEPH. However, it is not correlated with right ventricular function and functional parameters.

BACKGROUND The effects of SARS-CoV-2 (COVID-19) on the myocardium and their role in the clinical course of infected patients are still unknown. The severity of SARS-CoV-2 is driven by hyperinflammation, and the effects of SARS-CoV-2 on the myocardium may be significant. This study proposes to use bedside observations and biomarkers to characterize the association of COVID-19 with myocardial injury. OBJECTIVE The aim of the study is to describe the myocardial function and its evolution over time in patients infected with SARS-CoV-2 and to investigate the link between inflammation and cardiac injury. METHODS This prospective, monocentric, observational study enrolled 150 patients with suspected or confirmed SARS-CoV-2 infection at Toulouse University Hospital, Toulouse, France. Patients admitted to the intensive care unit (ICU), regular cardiologic ward, and geriatric ward of our tertiary university hospital were included during the pandemic period. Blood sampling, electrocardiography, echocardiography, and morphometric and demographic data were prospectively collected. RESULTS A total of 100 patients were included. The final enrolment day was March 31, 2020, with first report of results at the end of the first quarter of 2021. The first echocardiographic results at admission of 31 patients of the COCARDE-ICU substudy population show that biological myocardial injury in COVID-19 has low functional impact on left ventricular systolic function. CONCLUSIONS A better understanding of the effects of COVID-19 on myocardial function and its link with inflammation would improve patient follow-up and care. CLINICALTRIAL Clinicaltrials.gov NCT04358952; https://clinicaltrials.gov/ct2/show/NCT04358952 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/24931

Background The effects of SARS-CoV-2 (COVID-19) on the myocardium and their role in the clinical course of infected patients are still unknown. The severity of SARS-CoV-2 is driven by hyperinflammation, and the effects of SARS-CoV-2 on the myocardium may be significant. This study proposes to use bedside observations and biomarkers to characterize the association of COVID-19 with myocardial injury. Objective The aim of the study is to describe the myocardial function and its evolution over time in patients infected with SARS-CoV-2 and to investigate the link between inflammation and cardiac injury. Methods This prospective, monocentric, observational study enrolled 150 patients with suspected or confirmed SARS-CoV-2 infection at Toulouse University Hospital, Toulouse, France. Patients admitted to the intensive care unit (ICU), regular cardiologic ward, and geriatric ward of our tertiary university hospital were included during the pandemic period. Blood sampling, electrocardiography, echocardiography, and morphometric and demographic data were prospectively collected. Results A total of 100 patients were included. The final enrolment day was March 31, 2020, with first report of results at the end of the first quarter of 2021. The first echocardiographic results at admission of 31 patients of the COCARDE-ICU substudy population show that biological myocardial injury in COVID-19 has low functional impact on left ventricular systolic function. Conclusions A better understanding of the effects of COVID-19 on myocardial function and its link with inflammation would improve patient follow-up and care. Trial Registration Clinicaltrials.gov NCT04358952; https://clinicaltrials.gov/ct2/show/NCT04358952 International Registered Report Identifier (IRRID) DERR1-10.2196/24931

Biological cardiac injury related to the Severe Acute Respiratory Syndrome Coronavirus-2 infection has been associated with excess mortality. However, its functional impact remains unknown. The aim of our study was to explore the impact of biological cardiac injury on myocardial functions in patients with COVID-19. 31 patients with confirmed COVID-19 (CoV+) and 16 controls (CoV−) were prospectively included in this observational study. Demographic data, laboratory findings, comorbidities, treatments and myocardial function assessed by transthoracic echocardiography were collected and analysed in CoV+ with (TnT+) and without (TnT−) elevation of troponin T levels and compared with CoV−. Among CoV+, 13 (42%) exhibited myocardial injury. CoV+/TnT + patients were older, had lower diastolic arterial pressure and were more likely to have hypertension and chronic renal failure compared with CoV+/TnT−. The control group was comparable except for an absence of biological inflammatory syndrome. Left ventricular ejection fraction and global longitudinal strain were not different among the three groups. There was a trend of decreased myocardial work and increased peak systolic tricuspid annular velocity between the CoV− and CoV + patients, which became significant when comparing CoV− and CoV+/TnT+ (2167 ± 359 vs. 1774 ± 521%/mmHg, P = 0.047 and 14 ± 3 vs. 16 ± 3 cm/s, P = 0.037, respectively). There was a decrease of global work efficiency from CoV− (96 ± 2%) to CoV+/TnT− (94 ± 4%) and then CoV+/TnT+ (93 ± 3%, P = 0.042). In conclusion, biological myocardial injury in COVID 19 has low functional impact on left ventricular systolic function.

Background Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. Aims To investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR). Methods and results Sixty-one patients (44 men; mean age 59±12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. RVol tended to be higher using the ERV volumetric method as compared to PISA method (43±35 and 35±33 ml, respectively; P Linear regression (left) and Bland-Altma Conclusion TR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a specific subtype of pulmonary hypertension. Pulmonary ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the reference diagnostic examination of CTPEH showing mismatch in at least one segment or two sub-segments. Purpose To investigate the relationship between the extent of pulmonary perfusion defects and hemodynamic, echocardiographic, biological and functional parameters. Methods Between 2012 and 2019, 46 patients with CTEPH were retrospectively enrolled in the study. The diagnosis of pulmonary hypertension was made by the referral team of the expert centre according European Society of Cardiology and European Respiratory Society guidelines. All patients underwent pulmonary V/Q SPECT, right heart catheterisation, transthoracic echocardiography (TTE), functional tests and natriuretic peptides assays during the same stay. Results There was a slight correlation between the extent of pulmonary perfusion defects and pulmonary vascular resistances (r = 0.510, P Fig. 1 ). However, there was no correlation between the extent of pulmonary perfusion defects or hemodynamic measurements and right ventricular function assessed by TTE, the functional parameters (6 minutes walk distance [6MWD], NYHA class and NT-proBNP level). In contrast, there was a correlation between right ventricular function assessed in TTE (i.e. tricuspid antero-posterior systolic excursion and tricuspid annular S wave) and 6MWD (r = 0.586, P Conclusions Pulmonary perfusion defects extension by V/Q SPECT can provide information on pulmonary vascular resistances. However, it is not correlated with right ventricular function and functional parameters.

Background Persistence of symptoms and discomfort after pulmonary embolism (PE) is frequent and poorly understood. Purpose To identify patients who remained symptomatic 6 months after an acute PE, and to determine factors associated with a 6-months functional impairment. Methods One hundred and fifty-three patients with acute symptomatic PE were prospectively included from February 2015 to January 2017 at the University hospital of Toulouse, France. Clinical and paraclinical data were evaluated at inclusion and after 6 months of follow-up. Six-month follow-up included clinical evaluation, psychiatric survey, echocardiography and functional cardiopulmonary test. Symptomatic patients (i.e. patients with dyspnea and/or chest discomfort) underwent a ventilation-perfusion scintigraphy scan. Results Sixty (39%) patients remained symptomatic 6 months after the acute PE. After multivariate analysis, only an initial history of deep vein thrombosis (DVT) was predictive of 6-months symptoms (OR 3.35, 95% CI [1.19–9.39], P = 0.022), while initial use of low molecular weight heparin (LMWH) was protective (OR 0.36, 95% CI [0.13–0.96], P = 0.041). The six-month functional test appears to be related to symptoms. There was no difference in clinical, laboratory or echocardiographic parameters between symptomatic and asymptomatic patients. No pathological defect was found on ventilation-perfusion scintigraphy for 27 (52%) of symptomatic patients. Conclusion Persistence of symptoms at six months of PE is frequent and is associated with a history of DVT and less frequent with initial LMWH therapy. Pathophysiology of post-pulmonary embolism syndrome is complex and not related to the initial PE severity nor the parameters of echocardiography.

Background Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. Several RV imaging parameters have been proposed to detect patients at risk new-onset acute heart failure. The objective of our study was to compare the predictive value of main RV systolic parameters for outcome. Methods Seventy nine patients who underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance imaging (CMR) and tomographic equilibrium radio nuclide ventriculography (ERV) for the assessment of RV function were retrospectively included. The composite was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device or new-onset acute heart failure. Results Mean NYHA class and left ventricular ejection fraction were 1.7 ± 0.9 and 46 ± 17%, respectively. During a mean follow-up of 13 ± 9 months, 13 (20%) patients reached the composite primary end-point. The areas under the receiver operator characteristic curves for the prediction of MACE were 0.922 (P Conclusion Among comprehensive cardiovascular imaging modalities allowing the assessment of RV function, echocardiographic parameters, and particularly integral systolic S’ wave tricuspid annular velocity and RVFWLS, have the best prognostic performance and the best rater reliabilities.

Background Because the right ventricle is not assisted, its function is a critical determinant of the hemodynamic inpatients with left ventricular (LV) assist devices (LVADs) and contributes significantly to postoperative morbidity and mortality. Right ventricular (RV) failure remains a challenge in the area of continuous-flow LVADs. The aim of this study was to evaluate the evolution of RV volumes and function before and after LVAD implantation. Methods Ten patients underwent tomographic equilibrium radionuclide ventriculography for the assessment of LV and RV volumes and functions before and after LVAD implantation. Results Mean LV and RV ejection fractions before implantation were 20 ± 8 and 46 ± 14%, respectively. LVAD implantation had no impact on RV ejection fraction (46 ± 11% after implantation, P = 0.961) but tended to increase LV ejection fraction (31 ± 21% after implantation, P = 0.09). LVAD led to a decrease of LV end-diastolic volume (Δ = −136 ± 96 after implantation, P = 0.001) and RV end-diastolic volume (Δ = −59 ± 49 after implantation, P = 0.004) ( Fig. 1 ). Conclusion Inpatients with preserved RV ejection fraction, LVAD implantation leads to a decrease of RV volumes without impact on RV ejection fraction. The increase of cardiac output induced by the LVAD does not increase RV volumes, which could be explained by the decrease of RV after load. These results highlight the importance of after load on the right ventricle inpatients with heart failure.

Background Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. Purpose To investigate the accuracy of equilibrium radionuclide ventriculography (ERV) for the quantification of tricuspid regurgitation (TR) severity. Methods Thirty-three patients (25 men; mean age 63 ± 10 years) who underwent both ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. Patients with significant mitral regurgitation by TTE were excluded of the study. TR was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke stroke volume) from ERV. Results TR tended to be higher using the ERV volumetric method as compared to PISA method (48 ± 36 vs. 43 ± 31 ml, respectively; P = 0.06). There was a significant correlation between TR as assess by ERV and by TTE (r = 0.8, P Fig. 1 ). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.9 (P Conclusion TR assessment using the ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.