Alban Redheuil

Aortic Stiffness: Current Understanding and Future Directions

The aorta stiffens with aging, a process that is accelerated by arterial hypertension. Decreased arterial compliance is one of the earliest detectable manifestations of adverse structural and functional changes within the vessel wall. The use of different imaging techniques optimized for assessment of vascular elasticity and quantification of luminal and vessel wall parameters allows for a comprehensive and detailed view of the vascular system. In addition, several studies have also documented the prognostic importance of arterial stiffness (AS) in various populations as an independent predictor of cardiovascular morbidity and all-cause mortality. Measurement of AS by applanation tonometry with pulse-wave velocity has been the gold-standard method and is well-validated in large populations as a strong predictor of adverse cardiovascular outcomes. Because aortic stiffness depends on the prevailing blood pressure, effective antihypertensive treatment is expected to reduce it in proportion to the blood pressure reduction. Nevertheless, drugs lowering blood pressure might differ in their effects on structure and function of the arterial walls. This review paper not only will discuss the current understanding and clinical significance of AS but also will review the effects of various pharmacological and nonpharmacological interventions that can be used to preserve the favorable profile of a more compliant and less stiff aorta.

Determinants and Normal Values of Ascending Aortic Diameter by Age, Gender and Race/Ethnicity in the Multi-Ethnic Study of Atherosclerosis (MESA)

To determine the normal size and wall thickness of the ascending thoracic aorta (AA) and its relationship with cardiovascular risk factors in a large population‐based study.

Optimal follow-up in adult patients with congenital heart disease and chronic pulmonary regurgitation: towards tailored use of cardiac magnetic resonance imaging.

BACKGROUNDnPulmonary regurgitation (PR) is a common complication of right ventricular outflow tract (RVOT) reconstruction and leads to right ventricular (RV) dilatation and dysfunction. Although cardiac magnetic resonance (CMR) is the gold standard for evaluating PR and RV dysfunction, cost and limited availability are problems in many centres.nnnAIMSnTo determine clinical, electrocardiographic and echocardiographic predictors of these complications and optimize patient selection for their short-term follow-up by CMR.nnnMETHODSnNinety-four patients with a history of RVOT repair were prospectively included. All patients had a clinical examination, electrocardiography, echocardiography and CMR.nnnRESULTSnQRS duration, indexed end-diastolic RV (EDRV) diameter and area on echocardiography were significantly associated with RV dilatation on CMR (P<0.001). The distal localization of Doppler PR flow was the strongest echocardiographic criterion associated with severe PR (P<0.001). Arrhythmia history and high Tei index were significantly associated with low RV ejection fraction (P<0.001 and P=0.017, respectively). In multivariable analysis, grade of PR, QRS duration, arrhythmia and valvulotomy were strongly associated with severe PR and RV dilatation or systolic RV dysfunction. From these results, an approach based on a scaled scoring system for selecting patients who need short-term CMR evaluation and close follow-up was evaluated. This method should avoid 31% of CMR examinations, with a sensitivity of 97.7%.nnnCONCLUSIONnClinical, electrocardiographic and echocardiographic criteria can be used to accurately evaluate patients with RVOT repair. The combination of such features facilitates identification of patients who do or do not require close CMR evaluation.

Correspondence Between Delayed Enhancement Patterns in Multislice Computed Tomography and Magnetic Resonance Imaging in a Case of Acute Myocarditis

A 42-year-old man who was an active smoker with no significant medical history presented with severe substernal pain 5 days after acute enteritis. The examination showed mild fever, blood pressure of 113/75 mm Hg, and heart rate of 85 beats per minute.nnThe ECG showed sinus rhythm with incomplete left bundle-branch block. Laboratory tests showed elevated levels of troponin I (23 μg/L) and C-reactive protein (104 mg/L). …

Accuracy of multi-detector computed tomographic angiography assisted by post-processing software for diagnosis atheromatous renal artery stenosis

PURPOSEnTo compare the diagnostic performance of MDCTA versus renal angiography in the detection of>50% renal artery stenosis in patients suspected of reno-vascular hypertension.nnnMATERIALS AND METHODSnBetween January 2005 and January 2010, 92 MDCTA and renal arteriographies were retrospectively analysed. Renal angiographies were read by one interventional radiologist. Three blinded independent readers (two senior radiologists and one technician) scored MDCTA images using three different approaches. Reader 1 scored stenosis using only MPR and MIP. Reader 2 (technician) used only proprietary automatic arterial segmentation software. Reader 3 used the cited software, using manual diameter measurements.nnnRESULTSnA total of 92 patients, (235 renal arteries) were assessed in which 48 significant stenosis were found by arteriography. Sensitivity, specificity, of MDCTA compared to renal arteriography were respectively per patient for reader 1: (88%; 80%); for reader 2: (58%; 80%); for reader 3: (96%; 90%) (P<.02).nnnCONCLUSIONnWhen using automated vessel analysis software edited by a radiologist, MDCTA studies had a Sensibility/Specificity of 96%/90% to detect>50% renal artery stenosis.

Longitudinal strain of systemic right ventricle correlates with exercise capacity in adult with transposition of the great arteries after atrial switch

BACKGROUNDnSystemic right ventricle (sRV) dysfunction in d-transposition of the great arteries following atrial switch (d-TGA) is associated with increased mortality. We aimed to characterize maladaptive sRV mechanisms in d-TGA patients, analyzing relation of echocardiographic parameters of sRV systolic function to objective measurements of exercise capacity.nnnMETHODSnForty-seven adult patients with d-TGA and atrial switch (mean age 31.6±4.2years) underwent conventional echocardiography, bidimensional strain (2D-strain), cardiac magnetic resonance (CMR) imaging and cardiopulmonary exercise evaluation on the same day. Those with median peak oxygen uptake (VO2)>64.5% (n=23) constituted group A, those with VO2≤64.5% (n=24) constituted group B and 23 healthy age and gender matched subjects constituted the control group.nnnRESULTSnIn group A, global longitudinal peak systolic 2D-strain (GLS) of sRV was significantly reduced compared to GLS of normal RV and LV in the healthy control group (p<0.01), however peak longitudinal 2D strain was similar at basal and mid-segment of sRV free wall than normal LV. In group B, GLS was significantly reduced compared to group A (-10.9±2.9% vs -13.1±2.3%, p<0.05), mostly due to significant decrease of interventricular septum longitudinal strain. Other echocardiographic systolic parameters were not significantly different between groups A and B. Only sRV GLS showed significant correlation with functional capacity as measured by VO2 (r=0.42, p<0.01), while CMR RVEF did not.nnnCONCLUSIONnGLS of sRV predicts functional capacity and may be more sensitive than CMR RVEF in detecting early myocardial damage of sRV in patients with d-TGA and atrial switch.

Supersonic Shear Wave Elastography of Response to Anti-cancer Therapy in a Xenograft Tumor Model

Our objective was to determine if supersonic shear wave elastography (SSWE) can detect changes in stiffness of a breast cancer model under therapy. A human invasive carcinoma was implanted in 22 mice. Eleven were treated with an anti-angiogenic therapy and 11 with glucose for 24xa0d. Tumor volume and stiffness were assessed during 2xa0wk before treatment and 0, 7, 12, 20 and 24xa0d after the start of therapy using SSWE. Pathology was assessed after 12 and 24xa0d of treatment. We found that response to therapy was associated with early softening of treated tumors only, resulting in a significant difference from non-treated tumors after 12xa0d of treatment (pxa0=xa00.03). On pathology, large areas of necrosis were observed at 12xa0d in treated tumors. Although treatment was still effective, treated tumors subsequently stiffened during a second phase of the treatment (days 12-24), with a small amount of necrosis observed on pathology on day 24. In conclusion, SSWE was able to measure changes in the stiffness of tumors in response to anti-cancer treatment. However, stiffness changes associated with good response to treatment may change over time, and increased stiffness may also reflect therapy efficacy.

Definitive diagnosis of ruptured sinus of Valsalva in a patient with ventricular septal defect using cardiac magnetic resonance imaging

A 48-year-old man with a history of peri-membranous ventricular septal defect (VSD) without aortic complication was admitted for dyspnoea 1 month after an unfortunate treatment with amoxicillin for a suspected acute bronchitis. The auscultation revealed a loud continuous systolo-diastolic murmur and a thrill through the precordium. The blood pressure was 140/60 mmHg, the ECG was normal except for sinus tachycardia at 90 bpm Chest X-ray showed cardiomegaly and the C-reactive protein was 25 µg/L.nnTrans-thoracic echocardiography showed a small peri-membranous VSD, a moderate aortic insufficiency and a high-velocity systolo-diastolic flow (5 m/s) in the pulmonary artery, but the different merging flows which confused Doppler …