Florence Rollé

Reliability of the measurement of the abdominal aortic diameter by novice operators using a pocket-sized ultrasound system

BACKGROUND Despite favorable results of randomized studies and several guidelines, screening for abdominal aortic aneurysm is poorly implemented in most countries. In order to implement an effective abdominal aortic aneurysm screening programme, training of physicians other than cardiovascular imaging specialists is necessary. Also, the use of pocket-sized ultrasound systems seems an appealing alternative to conventional echography machines for large-scale screening. AIMS To test the hypothesis that, after a short period of specific training with a pocket-sized ultrasound system, novice operators could reliably measure the abdominal aortic diameter. We assessed the agreement between abdominal aortic diameter measurements from novice operators using a pocket-sized ultrasound system and experts using conventional machines. METHODS After focused training of novice operators, the abdominal aortic diameter was independently measured at least four times: by two experts using conventional ultrasound, by one expert using a pocket-sized ultrasound system and by at least one novice operator using the pocket-sized system; each operator was blinded to the others. RESULTS The aortic diameters of 56 patients were measured. The intraclass correlation coefficients between the four sets of measurement were all>0.91 and the mean difference between the measurements was negligible (<1mm). The interoperator variability for experts using conventional machines versus novices using pocket-sized machines was ≤ 4mm in 92.0% of cases. No learning curve over time was noted. CONCLUSION In order to screen for abdominal aortic aneurysm, the abdominal aortic diameter can be accurately measured by non-specialist physicians with pocket-sized ultrasound devices after a short period of training.

Fulminant giant-cell myocarditis on mechanical circulatory support: Management and outcomes of a French multicentre cohort

AIMS Giant-cell myocarditis (GCM) is a rare and often fatal form of myocarditis. Only a few reports have focused on fulminant forms. We describe the clinical characteristics, management and outcomes of GCM patients rescued by mechanical circulatory support (MCS). METHODS AND RESULTS The clinical features, diagnoses, treatments and outcomes of MCS-treated patients in refractory cardiogenic shock secondary to fulminant GCM admitted to eight French intensive care units (2002-2016) were analysed. We also conducted a systematic review of this topic. Thirteen patients (median age 44 [range 21-76]years, Simplified Acute Physiology Score II 55 [40-79]) in severe cardiogenic shock (median [range] left ventricular ejection fraction 15% [15-35%] and blood lactate 4 mmol/L) were placed on MCS 4 [0-28]days after hospital admission. Severe arrhythmic disturbances were frequent (77%), with six (46%) patients experiencing an electrical storm prior to MCS. Venoarterial extracorporeal membrane oxygenation was the first MCS option for 11 (85%) patients. GCM was diagnosed in five (38%) patients before transplant or death and treated with immunosuppressants; infections were the main complication (80%). Four patients died on MCS and no patient presented long-term survival free from heart transplant (nine patients, 69%). All transplanted patients were alive 1year later and no GCM recurrence was reported after median follow-up of 42 [12-145]months. CONCLUSION Outcomes of fulminant GCMs may differ from those of milder forms. In this context, heart transplant might likely be the only long-term survival option.

Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary bypass surgery: A prospective study.

Objective: Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation. Methods: We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min. Results: Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older (p=0.008), had more frequently a history of hypertension (p=0.009), history of atrial fibrillation (p<0.001) and New York Heart Association class ⩾III (p=0.004). They also had longer PR interval (p=0.005), higher preoperative NT-pro brain natriuretic peptide level (p=0.006), left ventricle end-diastolic volume (p=0.002), indexed left ventricle mass (p<0.0001), indexed maximal left atrial volume (p<0.0001), maximal right atrial area (p<0.001) and lower left ventricle ejection fraction (p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4–26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1–1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ2) of the model, from 34 to 57. Conclusion: A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.