RESUMEN
BACKGROUND: Quantitative assessment of primary mitral regurgitation (MR) using left ventricular (LV) volumes obtained with three-dimensional transthoracic echocardiography (3D TTE) recently showed encouraging results. Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time consuming. AIMS: To investigate the accuracy and reproducibility of new automated fast 3D TTE software (HeartModelA.I.; Philips Healthcare, Andover, MA, USA) for the quantification of LV volumes and MR severity in patients with isolated degenerative primary MR; and to compare regurgitant volume (RV) obtained with 3D TTE with a cardiac magnetic resonance (CMR) reference. METHODS: Fifty-three patients (37 men; mean age 64±12 years) with at least mild primary isolated MR, and having comprehensive 3D TTE and CMR studies within 24h, were eligible for inclusion. MR RV was calculated using the proximal isovelocity surface area (PISA) method and the volumetric method (total LV stroke volume minus aortic stroke volume) with either CMR or 3D TTE. RESULTS: Inter- and intraobserver reproducibility of 3D TTE was excellent (coefficient of variation≤10%) for LV volumes. MR RV was similar using CMR and 3D TTE (57±23mL vs 56±28mL; P=0.22), but was significantly higher using the PISA method (69±30mL; P<0.05 compared with CMR and 3D TTE). The PISA method consistently overestimated MR RV compared with CMR (bias 12±21mL), while no significant bias was found between 3D TTE and CMR (bias 2±14mL). Concordance between echocardiography and CMR was higher using 3D TTE MR grading (intraclass correlation coefficient [ICC]=0.89) than with PISA MR grading (ICC=0.78). Complete agreement with CMR grading was more frequent with 3D TTE than with the PISA method (76% vs 63%). CONCLUSION: 3D TTE RV assessment using the new generation of automated software correlates well with CMR in patients with isolated degenerative primary MR.
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Ecocardiografía Tridimensional/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Hemodinámica , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Programas Informáticos , Función Ventricular Izquierda , Anciano , Automatización , Estudios de Factibilidad , Femenino , Francia , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/fisiopatología , Mónaco , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Two-dimensional transesophageal echocardiography (2DTEE) is currently validated for left atrial appendage (LAA) thrombus assessment but has some limitations. AIMS: To evaluate the performance and interest of systematic real time three-dimensional transesophageal echocardiography (3DTEE) for LAA thrombus assessment, when performed after 2DTEE. METHODS AND RESULTS: Consecutive patients undergoing TEE were prospectively included. LAA was first evaluated using 2DTEE, and patients were classified as "2D-NT" if no thrombus was found, "2D-T" in case of clear thrombus, or "2D-EQ" if equivocal. Then, 3DTEE of the LAA was performed and patients were similarly classified as "3D-NT," "3D-T," or "3D-EQ." Additional LAA CT scan was only performed if LAA thrombus was not clearly ruled out or confirmed by TEE. Additional value of 3DTEE after 2DTEE LAA evaluation was then assessed. We included 104 patients undergoing TEE. Agreement between 2DTEE and 3DTEE was very good for thrombus diagnosis (k = 0.936), but moderate for vacant LAA (k = 0.562) due to more frequent 2D-EQ than 3D-EQ (11.5% vs 2.9%; P = .016). 3DTEE allowed to refine the LAA status in 11 of 12 (91.7%) 2D-EQ patients: 10 3D-NT, 1 3D-T, and 1 3D-EQ. Coupling 3DTEE to 2DTEE permitted a definite LAA diagnosis in 103 of 104 (99%) vs 92 of 104 (88.5%) patients when 2DTEE was used alone (P = .002). Nine (8.7%) LAA thrombi were diagnosed, and 3 CT scan were performed. CONCLUSION: 3DTEE of the LAA is more effective for thrombus assessment than 2DTEE. 3DTEE should be particularly considered in case of equivocal 2DTEE, as it allows to reach a definite LAA diagnosis in almost all of the patients.
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Apéndice Atrial/diagnóstico por imagen , Trombosis Coronaria/diagnóstico por imagen , Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica/métodos , Anciano , Sistemas de Computación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Aims: Survival in pulmonary hypertension (PH) relates to right ventricular (RV) function. However, the RV unique anatomy and structure limit 2D analysis and its regional 3D function has not been studied yet. The aim of this study was to assess the implications of global and regional 3D RV deformation on clinical condition and survival in adults with PH and healthy controls. Methods and results: We collected a prospective longitudinal cohort of 104 consecutive PH patients and 34 healthy controls between September 2014 and December 2015. Acquired 3D transthoracic RV echocardiographic sequences were analysed by semi-automatic software (TomTec 4D RV-Function 2.0). Output meshes were post-processed to extract regional motion and deformation. Global and regional statistics provided deformation patterns for each subgroup of subjects. RV lateral and inferior regions showed the highest deformation. In PH patients, RV global and regional motion and deformation [both circumferential, longitudinal, and area strain (AS)] were affected in all segments (P < 0.001 against healthy controls). Deformation patterns gradually worsened with the clinical condition. Over 6.7 [5.8-7.2] months follow-up, 16 (15.4%) patients died from cardio-pulmonary causes. Right atrial pressure, global RV AS, tricuspid annular plane systolic excursion, 3D RV ejection fraction, and end-diastolic volume were independent predictors of survival. Global RV AS > -18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death (AUC 0.83 [0.74-0.90], P < 0.001). Conclusion: Right ventricular strain patterns gradually worsen in PH patients and provide independent prognostic information in this population.
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Ecocardiografía Tridimensional/métodos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/mortalidad , Procesamiento de Imagen Asistido por Computador , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/mortalidad , Anciano , Análisis de Varianza , Área Bajo la Curva , Cateterismo Cardíaco/métodos , Estudios de Casos y Controles , Ecocardiografía/métodos , Femenino , Francia , Humanos , Hipertensión Pulmonar/fisiopatología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Valores de Referencia , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Volumen Sistólico/fisiología , Tasa de Supervivencia , Disfunción Ventricular Derecha/fisiopatologíaRESUMEN
BACKGROUND: The benefit of volume expansion (VE) in submassive pulmonary embolism (PE) with right ventricular (RV) dysfunction is unclear. AIM: To compare the effects of diuretic treatment versus VE in patients hospitalized for PE with RV dysfunction. METHODS: We prospectively included 46 consecutive patients with submassive PE treated on admission with a 40mg bolus of furosemide (D group, n=24) or 500mL of saline infusion (VE group, n=22). The primary endpoint was the timing of normalization of B-type natriuretic peptide and troponin Ic concentrations. The secondary endpoints were variations in RV function variables, recorded at baseline, at the 4th hour after treatment initiation (H4) and every day until discharge, and a clinical composite endpoint of thrombolysis or death at 7 and 30 days. RESULTS: No differences were observed between patients at baseline. The primary endpoint occurred earlier in the D group than in the VE group (67.5±34.8 vs 111.6±63.3hours; P=0.006). Furosemide treatment on admission was well tolerated, and was not associated with serious adverse events. At H4, substantial improvements were observed in the D group versus the VE group in terms of heart rate reduction (-8.15±21.0 vs -0.71±6.30 beats/min; P<0.01) and peak tricuspid annular systolic velocity (Doppler tissue imaging) (11.4±2.10 vs 9.90±2.80cm/s; P=0.02). There was no significant difference between groups in terms of severe outcomes at 7 and 30 days. CONCLUSIONS: In the acute management of submassive PE patients, a single furosemide bolus on admission seems to produce significant and earlier improvements in RV function markers compared with VE, without adverse events.
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Diuréticos/administración & dosificación , Fluidoterapia/métodos , Furosemida/administración & dosificación , Embolia Pulmonar/terapia , Cloruro de Sodio/administración & dosificación , Disfunción Ventricular Derecha/terapia , Función Ventricular Derecha/efectos de los fármacos , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Diuréticos/efectos adversos , Ecocardiografía Doppler , Femenino , Fluidoterapia/efectos adversos , Fluidoterapia/mortalidad , Francia , Furosemida/efectos adversos , Humanos , Infusiones Intravenosas , Inyecciones Intravenosas , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Estudios Prospectivos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidad , Embolia Pulmonar/fisiopatología , Cloruro de Sodio/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Troponina I/sangre , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/mortalidad , Disfunción Ventricular Derecha/fisiopatología , Equilibrio HidroelectrolíticoAsunto(s)
Válvula Aórtica/patología , Válvula Aórtica/cirugía , Calcinosis/diagnóstico por imagen , Calcinosis/cirugía , Cardiomiopatías/diagnóstico , Cardiomiopatías/cirugía , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/cirugía , Calcinosis/complicaciones , Cardiomiopatías/complicaciones , Ecocardiografía Transesofágica , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Aorta Torácica/anomalías , Trastornos de Deglución/etiología , Anillo Vascular/complicaciones , Adulto , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aortografía/métodos , Angiografía por Tomografía Computarizada , Trastornos de Deglución/diagnóstico , Femenino , Humanos , Resultado del Tratamiento , Anillo Vascular/diagnóstico por imagen , Anillo Vascular/cirugíaRESUMEN
BACKGROUND/OBJECTIVES: Cardiac sarcoidosis (CS) is associated with high morbidity and sudden death. The absence of specific symptoms and lack of diagnostic gold standard technique is challenging. New imaging methods could improve the diagnosis of CS. The aim of our study was to assess the role of left ventricular (LV) longitudinal and circumferential strain as estimated by 2D speckle-tracking imaging in patients with diagnosed sarcoidosis without cardiac involvement according to the current guidelines. We investigated the prevalence of LV strain impairment in this population and assessed its relationship with clinical outcomes, composite of mortality, heart failure, arrhythmia and/or secondarily development of CS and cardiac device implantation. METHODS AND RESULTS: We performed a prospective case-control longitudinal study including 35 patients with diagnosed sarcoidosis and normal cardiac function as assessed by standard transthoracic echocardiography and 35 healthy age- and gender-matched controls. All patients underwent a comprehensive echocardiographic study. Mean age of patients was 47.9±14.8years old (22 women). Compared with controls, global LV longitudinal strain (LV GLS) was reduced in sarcoidosis patients: (-17.2±3.1 vs -21.3±1.5%, p<0.0001). Circumferential LV strain was preserved in patients compared to controls (-19.9±-4.3% vs -21.3±1.5%, p=0.12). Impaired LV GLS was significantly associated with clinical outcomes (HR 1.56; [1.16-2.11], p<0.01) on univariate analysis. CONCLUSION: Speckle-tracking echocardiography revealed decreased longitudinal LV strain in sarcoidosis patients that was associated with outcomes. LV GLS may represent an early marker of myocardial involvement in sarcoidosis patients that needs to be studied further.
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Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/fisiopatología , Ecocardiografía/tendencias , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/fisiopatología , Adulto , Estudios de Casos y Controles , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
AIMS: Survival in pulmonary arterial hypertension (PAH) and Eisenmenger syndrome (ES) relates to right ventricular (RV) function. Little is known about differences of ventricular function between ES patients and those suffering from other PAH aetiologies. In this study, we compared global ventricular function assessed by speckle-tracking in adult patients with ES, other PAH aetiologies, or healthy controls; and assessed the relationship between ventricular function and survival. METHODS AND RESULTS: We performed a prospective cohort study recruiting 83 adult PAH patients (43 ES and 40 other PAH aetiologies patients) and 37 controls between March 2011 and June 2015. Patients with complex congenital heart disease were excluded. Fifty-three patients (63.9%) were in NYHA functional class ≥III at baseline and 60 (72.3%) were on advanced therapies. Mean RV peak longitudinal strain was -16.3 ± 7% in ES, lower compared with healthy controls (P < 0.001) but similar to other PAH aetiologies (P = 0.6). Mean RV peak transverse strain was +26.1 ± 17% in ES, lower than in controls (P < 0.001) but higher than in other PAH aetiologies (P < 0.001). No difference was observed between ES and other PAH in LV circumferential and longitudinal strain. Over a median follow-up of 22.6 months (3.3-32.2), 22 (26.5%) patients died all from cardio-pulmonary causes. ES and RV peak transverse strain were independent predictors of survival. RV peak transverse strain ≤22% identified patients with a 14-fold increased risk of death. CONCLUSION: Right ventricular remodelling differs between adults with ES and other PAH aetiologies. ES and increased RV free wall transverse strain are associated with better survival.
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Ecocardiografía Doppler/métodos , Complejo de Eisenmenger/complicaciones , Complejo de Eisenmenger/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/etiología , Remodelación Ventricular , Adulto , Estudios de Casos y Controles , Complejo de Eisenmenger/mortalidad , Femenino , Humanos , Hipertensión Pulmonar/mortalidad , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Tasa de SupervivenciaAsunto(s)
Neoplasias de las Glándulas Suprarrenales , Colitis Isquémica , Feocromocitoma , Cardiomiopatía de Takotsubo , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/fisiopatología , Colitis Isquémica/diagnóstico por imagen , Colitis Isquémica/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Feocromocitoma/diagnóstico por imagen , Feocromocitoma/fisiopatología , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/fisiopatologíaRESUMEN
PURPOSE: To evaluate proton beam therapy (PBT) as a means to preserve the eye and spare some vision while not deteriorating survival in patients with large choroidal melanomas. DESIGN: This is a retrospective, consecutive cohort study of patients with T3-4 choroidal melanomas according to the 7th edition of the American Joint Cancer Classification treated with PBT over a 24-year period. RESULTS: A total of 492 patients were included. Mean (range) tumor thickness and diameter were 8.77 (2-15) mm and 14.91 (7-24.1) mm, respectively. Mean macular and optic disc distance were 4.56 (0-19.9) mm and 4.59 (0-22.1) mm, respectively. Mean follow-up was 61.9 months. Rates of neovascular glaucoma (NVG) and enucleation (mainly for local recurrence or NVG) were 27.0% and 19.5%, respectively. Enucleation rates decreased over time. The 5-year local control was 94%. Mean baseline visual acuity was 20/63, and visual acuity ≥20/200 was preserved in 20% of patients. At 5 years, 25% of T3 patients presented with metastasis; overall and specific survival rates were 65% and 75%, respectively. CONCLUSION: Local control after PBT remained good with increasingly manageable complications and fewer secondary enucleations over time for these large melanomas. As PBT does not seem to deteriorate survival in these patients having a high risk of metastasis, PBT may be considered as a safe and efficient alternative to enucleation in patients with large choroidal melanoma, and may help to spare some vision.
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Neoplasias de la Coroides/radioterapia , Melanoma/radioterapia , Terapia de Protones , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Coroides/diagnóstico por imagen , Neoplasias de la Coroides/patología , Estudios de Cohortes , Femenino , Humanos , Masculino , Melanoma/diagnóstico por imagen , Melanoma/patología , Microscopía Acústica , Persona de Mediana Edad , Dosificación Radioterapéutica , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
BACKGROUND: Non-O blood group patients are at higher risk of first episode of venous thromboembolism (VTE). However, only little is known about the risk of recurrence according to the blood group. In this study, we aimed to determine the impact of ABO blood group on VTE recurrence. METHODS: We prospectively recruited 106 consecutive patients with a first documented episode of pulmonary embolism (PE). Patients were followed at least 12months after anticoagulation discontinuation. The main endpoint was recurrence of symptomatic VTE. RESULTS: Data from 100 patients were analyzed. Median follow-up was 28months [24-34.8]. PE was unprovoked in 48 patients. Mean anticoagulation duration was 5.3±2.2months. The rate of VTE recurrence was 12.7 per 100 patient-years (30 recurrences). B blood group patients had a 2.7-fold increased risk of VTE recurrence (95%CI 1.1-6.2, p=0.03). On multivariate analysis, B blood group was the strongest independent predictor of VTE recurrence (Hazard Ratio (HR) 2.6, 95%CI 1.1-6.1, p=0.04). In contrast, A and AB blood groups were not associated with VTE recurrence. VTE recurrences were less frequent in O blood group compared to non-O patients (HR 0.5, 95%CI 0.2-1.1, p=0.09). O blood group women had a 5-fold decreased risk of VTE recurrence (HR 0.2, 95%CI 0.1-0.8, p=0.01). CONCLUSIONS: Non-O blood groups, beyond being involved in the occurrence of a first VTE event, also contribute to VTE recurrence. B blood group is strongly associated with VTE recurrence, thus high-risk B blood group patients could benefit from long-term anticoagulation therapy after a first VTE event.
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Sistema del Grupo Sanguíneo ABO/sangre , Tromboembolia Venosa/sangre , Anciano , Anticoagulantes/uso terapéutico , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/patologíaRESUMEN
An 89-year-old female was referred to the authors' institution for repeating pulmonary edema. Recent transthoracic echocardiography (TTE) showed only a mild mitral regurgitation (MR), but a transient severe reversible functional MR was observed during an episode of respiratory distress. TTE demonstrated the functional nature of the regurgitation with a transient tenting of the mitral leaflets, resulting in a total absence of coaptation.
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Hemodinámica , Insuficiencia de la Válvula Mitral/diagnóstico , Válvula Mitral/fisiopatología , Anciano de 80 o más Años , Femenino , Humanos , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/fisiopatología , Valor Predictivo de las Pruebas , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiología , Recurrencia , Índice de Severidad de la EnfermedadRESUMEN
The specific kinetic of copeptin secretion during the course of an acute coronary syndrome (ACS) had poorly been studied, with most studies assessing copeptin levels in the very first hours of chest pain onset and not ACS itself. To overcome this issue, we took advantage of septal embolization technique for hypertrophic obstructive cardiomyopathy (HOCM) treatment, a unique situation during which myocardial infarction (MI) is provoked, to measure plasmatic copeptin levels variation.