Antonin Flavian

Epicardial Fat Volume Is Associated With Coronary Microvascular Response in Healthy Subjects: A Pilot Study

Epicardial fat (EF) is an active ectopic fat depot, which has been associated with coronary atherosclerosis, and which could early influence endothelial function. We thus investigated the relationship between EF and endothelium‐dependent vasoreactivity of the coronary microcirculation, in highly selected healthy volunteers. Myocardial blood flow (MBF) was determined by measuring coronary sinus flow with velocity‐encoded cine magnetic resonance imaging (MRI) at 3T. We measured MBF at baseline and in response to sympathetic stimulation by cold pressor testing (CPT) in 30 healthy volunteers with normal left ventricular (LV) function (age 22 ± 4 years, BMI = 21.3 ± 2.8 kg/m2). EF volume was volumetrically assessed by manual delineation on short‐axis views. CPT was applied by immersing one foot in ice water for 4 min. Mean EF volume was 56 ± 26 ml and mean LV mass 100 ± 28 g. CPT significantly increased heart rate (HR) by 32 ± 19%, systolic blood pressure by 14 ± 10%, and rate‐pressure product by 45 ± 25%, P < 0.0001. The increase in HR, reflecting sympathetic stimulation, was not influenced by sex, age or EF volume. CPT induced a decrease in coronary vascular resistance (135 ± 72 vs. 100 ± 42 mm Hg.ml−1.min.g, P = 0.0006), and a significant increase in MBF (0.81 ± 0.37 vs. 1.24 ± 0.56 ml.min−1.g−1, P < 0.0001). Interestingly, we found a significant negative correlation between EF volume and ΔMBF (r= − 0.40, P = 0.03), which remained significant after adjusting for ΔHR. ΔMBF was also associated with adiponectin (r = 0.41, P = 0.046), but not with waist circumference, BMI, C‐reactive protein, lipid or glycemic parameters. In multivariate analysis, adiponectin and EF volume remained both independently associated with ΔMBF. A high EF amount is associated with a lower coronary microvascular response, suggesting that EF could early influence endothelial function.

Contrast enhanced CMR in acute myocarditis: what is the optimal moment for imaging?

The pathological processes (ie alteration of myocardial perfusion) that occur during the acute phase of a myocarditis, are different from those of myocardial infarction. Myocardial enhancement kinetics might be different in acute myocarditis compared to myocardial infarct that may impact the optimal moment for imaging acute myocarditis.

Gender differences in response to cold pressor test assessed with velocity-encoded cardiovascular magnetic resonance of the coronary sinus

BackgroundGender-specific differences in cardiovascular risk are well known, and current evidence supports an existing role of endothelium in these differences. The purpose of this study was to assess non invasively coronary endothelial function in male and female young volunteers by myocardial blood flow (MBF) measurement using coronary sinus (CS) flow quantification by velocity encoded cine cardiovascular magnetic resonance (CMR) at rest and during cold pressor test (CPT).MethodsTwenty-four healthy volunteers (12 men, 12 women) underwent CMR in a 3 Tesla MR imager. Coronary sinus flow was measured at rest and during CPT using non breath-hold velocity encoded phase contrast cine-CMR. Myocardial function and morphology were acquired using a cine steady-state free precession sequence.ResultsAt baseline, mean MBF was 0.63 ± 0.23 mL·g-1·min-1 in men and 0.79 ± 0.21 mL·g-1·min-1 in women. During CPT, the rate pressure product in men significantly increased by 49 ± 36% (p < 0.0001) and in women by 52 ± 22% (p < 0.0001). MBF increased significantly in both men and women by 0.22 ± 0.19 mL·g-1·min-1 (p = 0.0022) and by 0.73 ± 0.43 mL·g-1·min-1 (p = 0.0001), respectively. The increase in MBF was significantly higher in women than in men (p = 0.0012).ConclusionCMR coronary sinus flow quantification for measuring myocardial blood flow revealed a higher response of MBF to CPT in women than in men. This finding may reflect gender differences in endothelial-dependent vasodilatation in these young subjects. This non invasive rest/stress protocol may become helpful to study endothelial function in normal physiology and in physiopathology.

Assessment of myocardial partition coefficient of gadolinium (λ) in dilated cardiomyopathy and its impact on segmental and global systolic function

1) To assess the myocardial partition coefficient (λ) of gadolinium quantified using T1 mapping in dilated cardiomyopathy (DCM); and 2) to assess the impact of increased λ on left ventricular (LV) circumferential strain and ejection fraction in DCM.

0082: Multimodality imaging in cardiac amyloidosis: respective contributions of echocardiography, MRI and scintigraphy

Context Amyloidosis(A) prognosis is determined by cardiac involvement.The main types of A are immunoglobulin light chain(AL) and transthyretin-related(TTR), which can be mutated(TTRm) or senile(TTRwt). Specific treatments can’t be administrated unless A has been typed histologically.Literature suggests echocardiography,99mTc DPD scintigraphy and cardiac MRI could help typing A. We described these imaging modalities to assess these potential tools for an uninvasive typing. Material and methods We analysed these imaging modalities in patients examined at Cardiomyopathies Competence Center(CCC) of La Timone Hospital in Marseille, with an histologically proven diagnosis of cardiac A(CA). Results We included 75patients examined between September 2006 and March 2014 at CCC, with a strongly suspected diagnosis of CA.CA could be histologically confirmed and typed in 45 patients(10 TTRm, 4 TTRwt, 6 TTR undeterminated; 19 AL;6 of other type).In 11 patients, CA was confirmed but untyped.No statistically significant difference was found between TTR and AL patients for the various imaging modalities.We observed 71% of men, aged 66, NYHA stage 2,4 on average.In all patients, cardiac biomarkers rates were increased. Myocardic mass and interventricular septal thickness were increased (199g/m² and 19mm), restrictive filling pattern was observed in 83% of patients.Despite a relatively preserved left ventricular ejection fraction, Global Longitudinal Strain was impaired at – 11%, with an apical sparing. Scintigraphy showed a frequent myocardic fixation (69%), slightly more intense in TTR patients.Cardiac MRI showed a constant late gadolinium enhancement, more extended in AL patients. Conclusion We didn’t observe the differences described between CA types, probably because of a lack of statistical power.This encouraged us to develop a protocol for multidisciplinary evaluation of CA, to improve the management of this disease, and to keep on evaluating the diagnostic accuracy of these imaging modalities.

Repermeation Without Pharmacological Thrombolysis of the Extracranial Symptomatic Occlusions of the Internal Carotid Artery: Results of the Early Carotid Endarterectomy

Objectives: Two types of carotid endarterectomies (CE) are currently practiced, longitudinal CE with patch (CEP) or by eversion. We propose a new technique, the ‘‘carotidoplasty’’ (CP), which is freed from an excess length of the carotid bifurcation (sometimes problematic for the CEP) and of the stop of plaque (sometimes problematic for eversion). The objective of our study was to evaluate the results of CP in the short and long term. Materials and Methods: Technique: CP consists in a skeletonization of the carotid bifurcation to mobilize it, divide the internal carotid obliquely, and carry out a longitudinal arteriotomy of the carotid bulb then an endarterectomy of the bulb and external carotid. The internal carotid is endarterectomized a minima under visual control then obliquely reimplanted in the bulb by a circular running suture, which makes it possible to secure an atherosclerotic plaque if necessary, to correct a possible excess of length, and to obtain a quasi-anatomical restitution of the carotid bifurcation. From a prospective database, we studied the CE (n1⁄4748) carried out in our unit by CEP (n1⁄4624, 83.4%) and by CP (n1⁄4 73.9.8%) between January 1st, 2007 and December 31st, 2011. We analyzed the demographic criteria (sex, age, cardiovascular risk factors, and comorbidities), the degree of stenosis, the symptomatic character and the type of symptoms of the carotid stenoses, the status of the contralateral carotid, the type of anesthesia, the cross clamp time, the need for a shunt, the early reinterventions, and the longterm follow-up. The principal criterion of judgment was the CRMM (rate of stroke or death at 30 days). The secondary criteria of judgment were the rates of residual stenosis, of postoperative thrombosis, of restenosis, and of long term survival. Results: The average time of follow-up was 30.5 months (1 to 72 months). The significantly different elements between CP and CEP were: the age (75.8 years ± 8.9 vs 72.9 years ± 9.6, p1⁄4 0.015), the cross clamp time (36 min ± 7.6 vs 40.3 min ± 11.0, p1⁄40.005), and the rate of restenosis (0 vs 5.3%, p1⁄40.039), respectively. The CRMM were 0% vs 3.4%, respectively, without significance (p1⁄40.153). The other analyzed parameters were not different. Conclusion: The carotidoplasty, a new surgical technique, showed satisfactory results in the short and long term, in this monocentric experience. Its interest must be confirmed in more patients with a multicentric evaluation.

Gender differences in response to cold pressor test assessed with velocity-encoded cine-MR imaging of the coronary sinus.

Gender-specific differences in cardiovascular risk are well known, and current evidence supports an existing role of coronary endothelium function in these differences.

Epicardial fat volume is associated with coronary endothelium-dependent vasomotor response in healthy subjects

Epicardial fat (Efat) is an active ectopic fat depot, directly surrounding coronary arteries, and secreting high level of inflammatory adipokines; its development has been associated with coronary atherosclerosis. We investigated the relationship between Efat and endothelium dependent vasoreactivity of the coronary microcirculation.