Gilles Barone-Rochette

Potentially simple score of late gadolinium enhancement cardiac MR in acute myocarditis outcome.

To determine the value of cardiac MRI for the monitoring and the prognosis of patients with acute myocarditis. Cardiac MRI plays an increasingly important role in the diagnosis of acute myocarditis. However, it is less established as a prognostic tool, which requires specific postprocessing of images.

Diagnostic value of stress thallium-201/rest technetium-99m-sestamibi sequential dual isotope high-speed myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

BackgroundThe aim of this study was to determine the diagnostic accuracy of stress thallium-201/rest technetium-99m-sestamibi sequential dual-isotope high-speed myocardial perfusion imaging (DI-HS-MPI) against invasively determined fractional flow reserve (FFR).MethodsFifty-four consecutive patients prospectively underwent DI-HS-MPI before invasive coronary angiography. Perfusion was scored visually by summed stress score on a patient and coronary territory basis. Significant coronary artery disease (CAD) was defined by the presence of ≥xa090% stenosis/occlusion or fractional flow reserve ≤xa00.80 for coronary stenosis ≥xa050%.ResultsFFR was measured in 69 of 162 coronary vessels, with 1.28xa0±xa00.56 vessels assessed/patient. Sensitivity, specificity, and diagnostic accuracy of MPI for the detection of significant CAD were 92.8%, 69.2%, and 81.4%, on a patient basis, and 83.7%, 90.4%, and 88.8% by coronary territory.ConclusionsDI-HS-MPI accurately detects functionally significant CAD as defined by using FFR.

Apport de l’IRM et du scanner cardiaque en pratique clinique courante

Technological advances have enabled the rapid development of cardiovascular imaging techniques. Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have become diagnostic and prognostic tools for the management of patients in routine clinical practice. This review gives the main indications and describes the performance of both techniques.

Carrefour des spécialitésApport de l’IRM et du scanner cardiaque en pratique clinique couranteCardiac magnetic resonance imaging and cardiac computed tomography in clinical practice

Technological advances have enabled the rapid development of cardiovascular imaging techniques. Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have become diagnostic and prognostic tools for the management of patients in routine clinical practice. This review gives the main indications and describes the performance of both techniques.

Imaging of functional and structural alterations of large arteries after acute ischaemic atherothrombotic stroke or acute coronary syndromes

BACKGROUNDnNon-invasive methods allow the evaluation of structural and functional arterial abnormalities. So far, no study has focused on the comparison of vascular parameters by type of cardiovascular event.nnnMETHODSnIn this pilot study, cardiovascular risk factors, carotid parameters, carotid-to-femoral pulse wave velocity (PWV), brachial flow-mediated dilation and ambulatory blood pressure were assessed in patients who presented with acute coronary syndromes (ACS) or ischaemic atherothrombotic stroke (IAS). Groups were matched for age and gender.nnnRESULTSnPrevalences of hypertension, diabetes and dyslipidaemia and heredity, smoking and body mass index were similar in the ACS (n=50) and IAS (n=50) groups. Carotid intima-media thickness (IMT) and PWV were significantly higher in the IAS vs. ACS group (769±180 vs. 701±136 μm; P=0.039 and 12.5±3.5 vs. 10.7±2.4 m/s; P=0.006). Carotid distensibility was significantly lower in the IAS vs. ACS group (16.2±3.2 vs. 18.9±7.6 10(-3)/kPa; P=0.02). These differences persisted after adjustment for blood pressure for carotid distensibility but not for PWV. The prevalences of endothelial dysfunction and carotid plaques were not significantly different in the ACS and IAS groups (86% and 74%; 80% and 78%). In a multivariable model, carotid distensibility remained associated with ACS (odds ratio 1.19; 95% confidence interval 1.03-1.38; P=0.016).nnnCONCLUSIONSnStiffness and carotid wall thickness were higher in IAS than in ACS patients. These differences may support the interest in new therapeutic targets for cardiovascular secondary prevention.nnnNCT NOnNCT00926874.

Metabolic disturbances after acute vascular events: A comparative study of acute coronary syndrome and ischaemic atherothrombotic stroke

OBJECTIVEnThis pilot study aimed to compare metabolic disturbances, particularly insulin resistance (IR) and cardiovascular risk factors (CRFs), following two types of acute vascular atherothrombotic disease events: ischaemic atherothrombotic stroke (AS); and acute coronary syndrome (ACS).nnnDESIGN AND METHODSnA total of 110xa0non-diabetic patients presenting with either AS (n=55) or ACS (n=55) were included in our prospective comparative study, and matched for age and gender. IR was determined using the homoeostasis model assessment of insulin resistance (HOMA-IR) method, and each patients personal and family history were also recorded.nnnRESULTSnIR was significantly higher in the ACS vs AS group (HOMA-IR index 2.17±1.90 vs 1.50±0.81, respectively; P=0.03). The AS group had a significantly higher prevalence of personal history of hypertension (51% vs 31%; P=0.03), while current smoking was more prevalent in the ACS group (30% vs 18%; P=0.04). There were no significant differences between the two groups as regards any other CRFs.nnnCONCLUSIONnThe distribution of CRFs varied depending on the vascular event, and metabolic disturbances differed according to the atherothrombotic disease. IR was greater after ACS than AS.

Suboptimal performance of cardiovascular magnetic resonance imaging for the assessment of myocardial viability at the early phase of an acute coronary syndrome: Usefulness of SPECT myocardial perfusion imaging

Suboptimal performance of cardiovascular magnetic resonance imaging for the assessment of myocardial viability at the early phase of an acute coronary syndrome: Usefulness of SPECT myocardial perfusion imaging Loı̈c Djaileb, MD, Adrien Jankowski, MD, Marjorie Canu, MSc, Alex Calizzano, MD, Laurent Riou, PhD, Alexis Broisat, PhD, Daniel Fagret, MD, PhD, Catherine Ghezzi, PhD, Gerald Vanzetto, MD, PhD, and Gilles Barone-Rochette, MD, PhD

Evaluation of Imaging Strategy to Optimize and Improve Outcome of Transcatheter Aortic Valvular Implantation

Cardiac computed tomography (CT) provides additional information with ultrasound in the transcatheter heart valve (THV) size selection. However, the influence of these incremental data on outcomes has not been evaluated in a randomized study. A single-center prospective, randomized, and open study was performed. Patients referred for transfemoral transcatheter aortic valve implantation with a balloon-expandable endoprothesis were included. THV size selection was performed using either transthoracic and transesophageal echocardiography data (control group) or ultrasound and CT results (CT group). The primary composite end point included the occurrence of stroke, major vascular complications, and moderate or severe paravalvular aortic regurgitation (PAR) at 1 year. Fifty patients (nu2009=u200925 in the control and CT groups) were enrolled. The primary composite end point occurred in 40% and 8% of patients from the control and CT groups, respectively (pu2009=u20090.008). The Kaplan-Meier analysis revealed a pejorative association with not performing the CT (pu2009=u20090.007). A decrease in the occurrence of PAR was observed in the CT group compared with the control group (PAR 28% vs 4%, pu2009=u20090.04; major vascular complications 12% vs 4%, pu2009=u20090.6; all-cause death 16% vs. 4%, pu2009=u20090.34; no stroke). In conclusion, the use of cardiac CT in addition to ultrasound data in THV size selection reduced the long-term occurrence of cardiovascular events.

Joint Segmentation of Myocardium on Rest and Stress Spect Images

This paper presents a level set segmentation of the myocardium, endocardium and epicardium surfaces of the heart from 2D SPECT rest and stress perfusion images of the same patient to compute a heterogeneity index. Cardiac SPECT images have low resolution, low signal to noise ratio and lack of anatomical information. So accurate segmentation is difficult. The proposed method adds joint constraints of shape, parallelism and intensity in a level-set framework to simultaneously extract myocardium from rest and stress images. Results are compared to classical level-set segmentation.

Preclinical characterization of a novel radiolabeled analog of practolol for the molecular imaging of myocardial β-adrenoceptor density

BackgroundThe great clinical potential of myocardial β-AR imaging has been shown by recent studies evaluating the β-AR-specific, non-selective agent [11C]-CGP12177 in the setting of idiopathic-dilated cardiomyopathy, and myocardial infarction. However, the short half-life of 11C hampers the potential of [11C]-CGP12177 for routine clinical use. AMI9 is an analog of the β-adrenoceptor ligand practolol that can readily be labeled using radioactive isotopes of iodine. The present study was aimed at characterizing the in vitro, ex vivo, and in vivo β-AR binding properties of [125I]-AMI9.Methods and ResultsNewborn rat cardiomyocytes were used for saturation and kinetic binding assays as well as for displacement and competition experiments. Isolated perfused rat hearts were used to evaluate the pharmacological activity of AMI9. The in vivo kinetics of [125I]-AMI9 were studied using biodistribution experiments in mice. [125I]-AMI9 displayed high specific affinity for β-AR with no β-AR subtype selectivity (KD, 5.6xa0±xa00.3xa0nM; Bmax, 231xa0±xa07xa0fmol·(mgxa0protein)−1). AMI9 potently inhibited the inotropic effects of isoproterenol. The early in vivo cardiac and lung activities of [125I]-AMI9 compared favorably with those of the clinically validated tracer CGP12177.ConclusionIodine-labeled AMI9 is a promising agent for the molecular imaging of myocardial β-AR density.