Subclinical Left Ventricular Dysfunction During Chemotherapy

Subclinical left ventricular dysfunction is the most common cardiac complication after chemotherapy administration. Detection and early treatment are major issues for better cardiac outcomes in this cancer population. The most common definition of cardiotoxicity is a 10-percentage point decrease of left ventricular ejection fraction (LVEF) to a value <53%. The myocardial injury induced by chemotherapies is probably a continuum starting with cardiac biomarkers increase before the occurence of a structural myocardial deformation leading to a LVEF decline. An individualised risk profile (depending on age, cardiovascular risk factors, type of chemotherapy, baseline troponin, baseline global longitudinal strain and baseline LVEF) has to be determined before starting chemotherapy to consider cardioprotective treatment. To date, there is no proof of a systematic cardioprotective treatment (angiotensin-converting enzyme inhibitor and/or betablocker) in all cancer patients. However, early cardioprotective treatment in case of subclinical left ventricular dysfunction seems to be promising in the prevention of cardiac events

Clinical Experience of Dabigatran and Rivaroxaban in Electrical Cardioversion of Atrial Fibrillation

&lt;p&gt;Patients scheduled for atrial fibrillation (AF) cardioversion were excluded from clinical trials of novel oral anticoagulants (NOACs).&lt;/p&gt;&lt;p&gt;We evaluated efficacy and safety of NOACs in patients undergoing electrical cardioversion for AF.&lt;/p&gt;&lt;p&gt;We performed a monocentric study of all patients on NOACs who underwent elective electrical cardioversion for non-valvular AF between January 2012 and December 2014. We analyzed incidence of stroke and bleeding  at 30 days.&lt;/p&gt;&lt;p&gt;Fifty patients were included, 28 receiving dabigatran, 22 rivaroxaban. Mean age was 65 ± 12 years. Mean CHADS2-VA2SC and HASBLED scores were 3 ± 1.8 and 2.2 ± 1.1 respectively. Transoesophageal echocardiography was performed in 41 (79%) patients, revealing a thrombus in 2 (5%). No clinical evidence of stroke occurred in the 30 days, 1 major gastrointestinal bleeding (2%) in patient on rivaroxaban (led to premature discontinuation) and 3 minor bleedings.&lt;/p&gt;&lt;p&gt;NOACs seem to be safe in daily practice of electrical cardioversion in our population.&lt;/p&gt;</jats:p

Prognostic value of CMR-derived extracellular volume in AL amyloidosis: a multicenter study

Background: This study aimed to assess the prognostic value of cardiac magnetic resonance (CMR) variables and compare them with biological and echocardiographic markers in patients with AL cardiac amyloidosis (CA). Methods: We conducted a prospective study across three tertiary centres, where patients underwent clinical examination, blood tests, echocardiography, and CMR. The primary endpoint was all-cause mortality. Results: A total of 176 patients with AL CA were included, with a median age of 68 years (IQR 58-75). According to the 2004 Mayo Clinic staging, 121 patients (69%) were in stage 3. During a median follow-up of 22 months (IQR 8-48), 45 patients died, and 55 were hospitalized for heart failure. Patients who died had higher NT-proBNP and troponin levels, and lower LVEF, cardiac output, and longitudinal strain. Among CMR variables, extracellular volume (ECV) was most strongly associated with all-cause mortality. In multivariate Cox models, including Mayo Clinic staging, ECV ≥ 0.45 was independently associated with mortality (HR 2.36, CI 95% 1.47-5.60) and also with heart failure hospitalizations (HR 4.10, 95%CI 2.15-8.8). Conclusion: ECV is a powerful predictor of outcomes in AL CA, providing additional prognostic value on top of Mayo Clinic staging

0042: Left ventricular reverse remodeling in heart failure: a new obesity paradox?

Backgroundheart failure with reduced ejection fraction (HF-REF) is associated with left ventricular remodeling in most patients which is grossly defined by LV dilation, and is associated with poor prognosis. Positive or reverse remodeling (RR) was also described but its exact contribution is poorly documented.Aimto analyze prevalence of RR in a cohort of outpatients with HF-REF and to characterize its determinants and prognostic impact.Methodsinclusion criteria were: available detailed echographic files; beta-blockers ACE-I or ARB introduced before the study; left ventricular EF (LVEF)<0.45 and left ventricular end diastolic dimension>33mm/m2 at the first echography; at least one other examination between 3 and 12 months; clinical follow-up of 3 years or more (cardiac death or cardiac transplantation). RR was defined as the combination of a decrease of LV end diastolic diameter>10% and an increase in LVEF>10% (or last EF>0.50) between the two echocardiographies.Resultswe included 196 patients between 2008 and 2010. RR was observed in 21 patients (10%). As compared with others patients, RR was associated with significantly higher BMI (27.3 vs 25.3), obesity (28 vs 10%), de novo HF (81 vs 46%) and lower initial LVEF (0.26 vs 0.30). In multivariate regression analysis, de novo HF and obesity were independently predictive of the RR. Over amean follow-up of 60 months, the rate of death or cardiac transplantation was 4% in RR patients and 14% in the other group (p<0.01). In Cox-regression analysis, independent predictors of prognosis were de novo HF, obesity and RR (p<0.01). After adjustement, RR remains associated with better prognosis (HR 0.22; CI95% 0.06-0.95; p=0.04).ConclusionRR occurs in a small proportion of patients with HF-REF and is related to good prognosis. While de novo HF appears to be the strongest determinant of RR, our results suggest that obesity could be a novel and intriguing player in underlying mechanisms of RR

A Dual Tissue-Doppler Optical-Flow Method for Speckle Tracking Echocardiography at High Frame Rate

International audienc

0163: Renal arterial resistance index versus biomarkers for predicting acute kidney injury in acute heart failure

Acute kidney injury (AKI) is frequent during acute heart failure (AHF) and worsens the outcome. To predict AKI is important but remains challenging. The aim of this study was to analyze Doppler-derived renal arterial resistance index (RRI) during AHF as well as its determinants and its predictive value of AKI as compared to renal biomarkersMethodscomprehensive echocardiographic examination and Doppler measurement of RRI were performed on admission, at day 3 and at discharge. RRI was the ratio (peak systolic velocity – end diastolic velocity)/ peak systolic velocity of interlobar blood flow. Serial assessment of clinical parameters as well as creatinine, cystatin C, blood NGAL, urinary NGAL and electrolytes was also obtained. AKI was defined by an increase in creatinine ≥ 0.3mg/l relative to the admission level. Exclusion criteria was eGFR < 15ml/min/1.73m² and atrial fibrillation.Resultsamong the 26 included patients, AKI occurred in 8 patients at day 3 and in 10 patients at discharge. Mean RRI values were 0.71±0.08 on admission, 0.71±0.09 at day 3 and 0.74±0.08 at discharge. RRI was related to age, creatinine and cystatin C (p≤0.05 for all) but not to other clinical or echocardiographic variables or BNP or NGAL levels. Only admission RRI was significantly associated with AKI at day 3 (table) as well as RRI at day 3 for AKI at discharge (0.77±0.07 vs 0.67±0.8; p=0.02).Conclusionthis pilot study describes RRI values as well as its early changes and determinants during AHF. Doppler-derived RRI measurement appears to be a relevant tool for predicting AKI.Abstract 0163 – TableAdmission variablesNo AKIAKIpAge60±1769±140.29LVEF25±833±170.78Blood Pressure122±18118±190.63eGFR62±2452±200.35Cystacin C1.4±0.61.8±0.70.08NGAL blood125±84147±1300.76NGAL urinary13±179 ±40.79BNP1979±18151562±8810.95IRR0.68±0.080.76±0.060.0

Coupling myocardium and vortex dynamics in diverging-wave echocardiography

International audienc

High body mass index is a predictor of left ventricular reverse remodelling in heart failure with reduced ejection fraction

AIMS: Structural and functional left ventricular alterations can occur in heart failure (HF), referred to as left ventricular reverse remodelling (LVRR). This study aimed to define novel predictors of LVRR besides well-known effects of medical and device therapy. METHODS AND RESULTS: From echographic database, we included 295 patients with both left ventricular ejection fraction (LVEF) ≤45% and indexed left ventricular end-diastolic diameter ≥33 mm/m2 and who had at least two echocardiographic exams with a delay between 3 and 12 months. LVRR was defined as the combination of (i) normalization of LVEF (LVEF ≥50%) or increase in LVEF ≥10% and (ii) a decrease in indexed left ventricular end-diastolic diameter ≥10%. Clinical follow-up was also obtained. LVRR occurred in 53 (18%) patients. Patients in the LVRR group were more likely to present with de novo HF (75% vs. 42%), had lower LVEF and left ventricular end-diastolic volumes at index examination, yet a higher body mass index (BMI) than non-LVRR patients. Obesity was observed in 25% of LVRR patients vs. 14% in others. In multivariate analyses, BMI (per each 1 kg/m2 increase) emerged as a predictor of LVRR: odds ratio 1.10 (95% confidence interval 1.02-1.19) after adjustment to other predictors of LVRR. During a mean follow-up of 37 months, 32% of patients had a major adverse cardiac event; de novo HF, age, and LVEF were associated with major adverse cardiac event. CONCLUSIONS: We identified significant relationship between high BMI and LVRR. This intriguing novel finding deserves further study.status: publishe