N. Baron

Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity.

Aims We sought to assess whether global longitudinal strain (GLS) measured early during treatment with anthracyclines (at a cumulative dose of 150 mg/m2) can predict subsequent alterations in left ventricular ejection fraction. Methods and results Eighty-six patients with Hodgkins disease, non-Hodgkins lymphoma, or acute leukaemia and receiving anthracyclines were prospectively included. Patients underwent complete echocardiography on four occasions: baseline (V1); after reaching a cumulative dose of 150 mg/m2 (V2); end of treatment (V3); and 1 year follow-up (V4). Six patients developed cardiotoxicity, defined as a decrease in left ventricular ejection fraction of >10 percentage points, to a value <53%, at V4. GLS measured at V1 and V2 was significantly lower in the cardiotoxicity group vs. the controls (P = 0.042 and P = 0.01, respectively). Compared with GLS at V1, GLS obtained at V2 provided incremental predictive information and appeared to be the strongest predictor of cardiotoxicity (area under the receiver-operating-characteristic curve, 0.82). At a threshold of -17.45% for GLS measured at V2, the sensitivity and specificity of detecting cardiotoxicity were 67% (95% confidence interval 33-100) and 97% (95% confidence interval 94-100), respectively. Conclusion GLS greater than -17.45%, obtained after 150 mg/m2 of anthracycline therapy, is an independent predictor of future anthracycline-induced cardiotoxicity. These findings should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.

Intra-aortic coronary stent fracture revealed by stent boost imaging and confirmed by multislice computed tomography.

A 77-year-old man was admitted with unstable angina. He had a history of 2-vessel coronary artery bypass grafting and percutaneous coronary intervention of each anastomosis. The proximal anastomosis of the marginal branch (circumflex) bypass grafting was directly stented with a TITAN-2 3.5 × 19-mm

Coronary graft angioplasty guided by MSCT: an unexpected ostial stent deformation

A 76-year-old man with a history of two-vessel coronary artery bypass grafting was admitted with recurrent angina. The proximal anastomosis of the left anterior descending (LAD) bypass grafting was directly stented with a bare-metal stent 2 years before. Conventional angiography was performed, but selective LAD bypass catheterization failed. In this …

Scanner cardiaque basse dose : comment l’obtenir ?

Since the introduction of Multi-slice computed tomography (CT), cardiac CT has been the increasingly used as a noninvasive modality for the diagnosis of coronary disease. Despite its potential benefits and promising clinical results, it has suffered from high doses of radiation associated with a risk of radiation-induced cancers. This has raised serious concerns in clinical practice. A number of strategies were then implemented to reduce the radiation dose associated with cardiac CT. The aim of this review is not to compare doses of different CT systems available on the market but to present an overview of different approaches to dose reduction and future directions.

Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy for the prediction of subsequent cardiotoxicity

OBJECTIVES The aim of this study was to assess whether global longitudinal strain (GLS) measured early during treatment with anthracycline (at a cumulative dose of 150mg/m2) can predict subsequent alterations in left ventricular ejection fraction (LVEF). METHODS AND RESULTS Eighty-six patients suffering from Hodgkins disease, non-Hodgkins lymphoma or acute leukemia and receiving anthracyclines were prospectively included. They underwent complete echocardiography on four separate occasions: baseline (V1); after reaching a cumulative dose of 150mg/m2 (V2); end of treatment (V3); one year follow-up (V4). Six patients developed cardiotoxicity defined by a decrease in LVEF by more than 10 percentage points to a value of at least less than 53% at V4. Both GLS measured at V1 and at V2 were significantly lower in the cardiotoxicity group compared with the control group (P=0.042 and P=0.01, respectively). Compared to GLS at V1, GLS obtained at V2 provided implemental predictive information and appeared to be the strongest predictor of cardiotoxicity (area under the receiver operating characteristic curve, 0.823). At a threshold of -17.45% for GLS measured at V2, the sensitivity and specificity of detecting cardiotoxicity were 67% (95%CI: [33-100%]) and 97% (95%CI: [94-100%]) respectively. CONCLUSION GLS>-17.45%, obtained after 150mg/m2 of anthracycline therapy, is a significant predictor of future anthracycline-induced cardiotoxicity. This study should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.

Love of Children Touched Mother’s Heart

In the literature, the foreign bodies described in the cardiac cavities are medical devices such as embolization of a catheter or a fragment from the catheter.1,2 We report a case of an unusual finding in the heart. A 42-year-old woman was admitted to the cardiac intensive care unit because of syncope associated with atypical chest pain and palpitations. She had no significant medical history with no previous cardiac, venous, or artery catheterization. She described a lipothymia event a few weeks ago. Her physical examination was unremarkable except for a tattoo on the left parasternal skin done 3 years before. Her electrocardiogram revealed multiple ventricular premature beats. Treadmill stress test showed a sustained right ventricular tachycardia without ST depression. Transthoracic echocardiography revealed a linear hyperechogenic image in the right ventricle …

Endocardite infectieuse sur TAVI compliqué d’abcès et pseudo-anévrysme : apport du scanner cardiaque synchronisé à l’ECG

A 80-year-old man was admitted to catheterization room for an acute infero-lateral ST-elevation myocardial infarction (STEMI). Coronary angiography showed a thrombotic occlusion of the second left marginal branch, and normal other coronary arteries. The thrombo-embolic mechanism of the STEMI, and the infectious context in this patient who had had a transcatheter aortic valve implantation (TAVI) two months earlier, led us to suspect a bioprosthesis endocarditis. It was confirmed by transthoracic and transoesophageal echocardiography, which showed an aortic-mitral curtain abscess and aortic bioprosthesis vegetations, associated to Enterococcus faecalis bacteriemia. In order to specify the diagnosis, an ECG-gated multidetector CT angiography (MDCTA) had been performed. Additionally to echocardiographic findings, MDCTA showed a pseudo-aneurysm, sized 20 to 22mm, beginning from the outflow tract of the left ventricle to end on the antero-lateral face of the aorta. The patient was referred for emergency aortic bioprosthesis removal and replacement. Through this case, MDCTA showed its importance for the diagnosis and the prognostic evaluation of cardiac prosthesis endocarditis. MDCTA provided additional informations that echocardiography could not detect, because of artifacts caused by the prosthetic material and calcifications, frequent in elderly patients with comorbidities.