Benjamin Bonnet

A new method for measurement of left atrial volumes using 64-slice spiral computed tomography: comparison with two-dimensional echocardiographic techniques.

BACKGROUND Left atrial (LA) volume, is related to cardiovascular morbidity. LA enlargement is usually assessed using trans-thoracic echocardiography (TTE). The association of modern multislice computed tomography (MSCT) imaging and new 3D reconstruction software, allows direct cardiac chamber volume measurement without geometrical assumptions. This study was designed to evaluate the maximal (LAmax) and minimal (LAmin) LA volumes during the cardiac cycle using MSCT and TTE approaches. METHODS We screened 26 consecutive patients referred for coronary imaging using a 64-MSCT scanner and a TTE within 12 h. Contiguous multiphase images were generated from axial MSCT data and semi-automated 3D segmentation technique was applied to generate LA volumes. Using TTE, LA volumes and LA ejection fraction (LAEF) were obtained using five assumptions methods: cubing equation, diameter-length formula, area-length formula, ellipsoidal formula and biplane Simpson rule. RESULTS Five patients were excluded for inadequate TTE visualization and one for ectopic beats during MSCT. The sample consisted in 20 patients (11 men, age: 56+/-14 years). Using MSCT, LA volumes indexed to body surface area were: LAmax=74+/-27 ml/m(2), LAmin=49+/-26 ml/m(2), with close correlations with TTE measurements and a significant underestimation by all TTE approaches. A close correlation was observed between LAEF using MSCT and TTE Simpsons method: 36+/-14% vs. 37+/-14%, r=0.99, p<0.0001. CONCLUSION Theses results suggest that the assessment of LA volumes and ejection fraction was reliable using 64-MSCT in patients referred for coronary computed tomography imaging.

Real three-dimensional assessment of left atrial and left atrial appendage volumes by 64-slice spiral computed tomography in individuals with or without cardiovascular disease

CONTEXT Left atrial (LA) volume is a prognosis factor of cardiovascular morbidity in patients with cardiovascular disease (CD). Recent developments of multislice computed tomography (MSCT) have made non invasive coronary angiography reliable for selected patients and new software facilitates truly volume measurements without geometrical assumptions. OBJECTIVE To define, by using MSCT, LA and left atrial appendage (LAA) volumes in patients with or without CD. METHODS AND RESULTS In the population of patients referred to our laboratory for a conventional MSCT coronary angiography, 40 individuals without CD (Normal group) and 80 patients with CD (CD group) were prospectively selected. The CD group was constituted from 4 subgroups of patients with either coronary artery disease (n=20), idiopathic dilated cardiomyopathy (n=20), left ventricular hypertrophy (n=20) or severe mitral regurgitation (MR group, n=20). LAA and LA volumes were measured on a commercially available workstation. LA maximal and minimal volumes were lower in Normal group than in CD group, as LA ejection fraction (54+/-10 versus 67+/-20 ml/m(2), p<0.0001; 31+/-8 versus 46+/-20 ml/m(2), p<0.0001; 43+/-8% versus 33+/- 14%, p<0.001). LAA volume was larger in MR group than in Normal group (15+/-7 ml versus 9+/-3 ml, p<0.0001). CONCLUSION This MSCT study provides normal values of LA and LAA volumes for patients who underwent MSCT coronary angiography and suggests that MSCT is helpful to assess the changes of LA volumes related to various CD.

Apical left ventricular myocardial dysfunction is an early feature of cardiac involvement in myotonic dystrophy type 1.

Left ventricular (LV) dysfunction is a major prognostic determinant in myotonic dystrophy type 1 (DM1). Therefore, markers of early‐stage LV impairment may be useful. The aim of this study was to evaluate 2D echocardiographic LV strain in a cohort of DM1 patients with preserved left ventricular ejection fraction (LVEF) and to compare the results with matched controls.

Left atrial appendage luxation and incomplete ligature demonstrated with 64-slice computed tomography

A 77-year-old man was referred to our institution to assess the absence of pulmonary vein stenosis by an ECG-gated 64-multislice computed tomography (MSCT). One month before, he was surgically treated for a severe mitral insufficiency associated with paroxysmal atrial fibrillation: a plasty of the mitral valve was performed in association with ligature of the left atrial appendage (LAA) and …

EVALUATION OF INTRACORONARY THROMBUS BY OPTICAL COHERENCE TOMOGRAPHY (OCT): CHARACTERIZATION, QUANTIFICATION AND PROGNOSTIC IMPACT IN PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROME - A DOCTORS SUBSTUDY

We aimed to evaluate the impact of thrombus burden as measured by Optical Coherence Tomography on the occurrence of peri-procedural myocardial infarction (type IVa MI) among patients undergoing percutaneous coronary intervention (PCI) in non ST elevation acute coronary syndrome (NSTE-ACS).

IMPACT OF LEFT ATRIAL PRESSURE ON RECURRENCE OF ATRIAL FIBRILLATION 3 MONTHS AFTER CATHETER ABLATION

Background: Catheter ablation is the treatment of choice for the management of atrial fibrillation (AF). The main limitation of this technique is the success rate, which is in the range of 70 to 80%. It is therefore critical to identify patients likely to benefit from this procedure, and who will

Prognostic impact of thrombus burden as evaluated by OCT in patients with non-ST elevation acute coronary syndromes undergoing PCI

Introduction: We aimed to evaluate the impact of thrombus burden quantified by optical coherence tomography (OCT) on the risk of peri-procedural myocardial infarction (MI) (type IVa) in patients un...

LONG-TERM CLINICAL IMPLICATIONS OF RESIDUAL PULMONARY VASCULAR OBSTRUCTION AFTER PULMONARY EMBOLISM: A VENTILATION-PERFUSION LUNG SCAN FOLLOW-UP STUDY AT TWO TIMEPOINTS

Little is known about the clinical implications of residual pulmonary vascular obstruction(RPVO) on long-term outcomes and about the optimal timing of V-Q scan control during patient follow-up. We aimed to investigate the prognostic value on 5-year adverse events of RPVO, measured by two ventilation

0025 : Myocardial revascularization modalities in 200 patients with venous coronary artery bypass graft failure

Introduction The therapeutic management of bypass failure has been little studied. Objectives Compare prognosis and the occurrence of cardiovascular events at 2 years in patients with venous bypass graft failure by differentiating between three patient groups: medical therapy, percutaneous coronary intervention (PCI) in native vessels (native PCI), and PCI in coronary artery bypass grafts (PCI-CABG). Methods Retrospective observational study in patients with bypass graft failure diagnosed between February 2009 and September 2013 at Poitiers University Hospital, France. Follow-up data at 1 year and at 2 years regarding major adverse cardiac events (MACEs), defined as death, acute coronary syndrome (ACS) or revascularization, were collected during patient visits to the department. Results From a series of 320 CABG patients examined using coronary angiography, all patients with bypass graft failure were included in the study (200 patients). Mean age was 69 years (+/- 11). Coronary angiography was performed a mean of 117 months after bypass surgery. Medical therapy alone was chosen in 88 patients, 75 patients underwent native PCI, and 37 patients underwent PCI-CABG. Patients in the PCI-CABG group were older (73.6 years; p = 0.027) and had significantly older bypass grafts (22% for a period of more than 10 years; p = 0.018), and their typical clinical presentation was one of ACS without ST-segment elevation (41%; p = 0.006). The groups were comparable in terms of hospital complications, except for vascular complications, which were more common in the PCI-CABG group (8%; p=0.01). At 1 year, no significant difference in terms of MACEs was found, but there was a trend towards an increase in ACS without ST-segment elevation (11%; p=0.06) in the PCI-CABG group, and towards an increase in ACS with STsegment elevation (7%; p = 0.06) in the medical therapy group. At 2 years, the medical therapy group stood out by virtue of a significant increase in MACEs compared with the other two groups (63%; p = 0.02). The native PCI group presented both fewer MACEs and fewer vascular complications. Conclusion MACEs were common and more severe in the medical therapy group. When coronary lesions are amenable to PCI, PCI in native vessels should be proposed as first-line treatment. PCI of CABG is performed in a riskier setting and has poorer prognosis.