Telemonitoring versus standard care in heart failure: a randomised multicentre trial.

AIMS: The aim was to assess the effect of a telemonitoring programme vs. standard care (SC) in preventing all-cause deaths or unplanned hospitalisations in heart failure (HF) at 18 months. METHODS AND RESULTS: OSICAT was a randomised, multicentre, open-label French study in 937 patients hospitalised for acute HF ≤12 months before inclusion. Patients were randomised to telemonitoring (daily body weight measurement, daily recording of HF symptoms, and personalised education) (n = 482) or to SC (n = 455). Mean ± standard deviation number of events for the primary outcome was 1.30 ± 1.85 for telemonitoring and 1.46 ± 1.98 for SC [rate ratio 0.97, 95% confidence interval (CI) 0.77-1.23; P = 0.80]. In New York Heart Association (NYHA) class III or IV HF, median time to all-cause death or first unplanned hospitalisation was 82 days in the telemonitoring group and 67 days in the SC group (P = 0.03). After adjustment for known predictive factors, telemonitoring was associated with a 21% relative risk reduction in first unplanned hospitalisation for HF [hazard ratio (HR) 0.79, 95% CI 0.62-0.99; P = 0.044); the relative risk reduction was 29% in patients with NYHA class III or IV HF (HR 0.71, 95% CI 0.53-0.95; P = 0.02), 38% in socially isolated patients (HR 0.62, 95% CI 0.39-0.98; P = 0.043), and 37% in patients who were ≥70% adherent to body weight measurement (HR 0.63, 95% CI 0.45-0.88; P = 0.006). CONCLUSION: Telemonitoring did not result in a significantly lower rate of all-cause deaths or unplanned hospitalisations in HF patients. The pre-specified subgroup results suggest the telemonitoring approach improves clinical outcomes in selected populations but need further confirmation.

Feasibility of three-dimensional transthoracic echocardiography to evaluate right ventricular volumes in children and comparison to left ventricular values.

BACKGROUND: Three-dimensional echocardiography (3DE) allows accurate estimation of left ventricular (LV) volumes and function in children. Because of the peculiar morphology of the right ventricle (RV), RV volumes and function assessment remain challenging. 3D software adapted for RV morphology is a promising noninvasive method. AIMS: The aims of this study were to evaluate the feasibility of 3D RV analysis in a normal pediatric population and to compare 3D RV to 3D LV measurements. PATIENTS AND METHODS: 3D transthoracic echocardiography was performed in 50 patients (mean age 9.5 years ± 5.1) with normal cardiac anatomy and function. Measurements were performed with the X3-1 or the X7-2 matrix probe (iE33, Philips Medical Systems, Andover, MA, USA). Ventricular volumes were analyzed with dedicated analysis software (TomTec Imaging Systems, Munich, Germany). RESULTS: Measurements were possible in 100% of LVs and 94% of RVs. The stroke volumes of the two ventricles correlated well (r = 0.81 [95% CI, 0.68-0.89], P < 0.0001) with a mean difference of 3.6 mL (±9.2). Compared to the LV, the RV had higher mean end-diastolic volume (53 mL [±29] versus 46 mL [±46], P = 0.020) and end-systolic volume (29 mL [±17] versus 17 mL [±12], P < 0.0001) but lower mean ejection fraction (49%[±8] versus 67%[±10], P < 0.0001). CONCLUSION: 3DE using dedicated software is a feasible and reproducible method for RV volume quantification in children with normal hearts. Further studies are needed to validate the accuracy of the measurements.

Myocardial Infarction in a newborn from a diabetic mother.

We extracted L., the newborn of a diabetic mother, for antenatal diagnostic of myocardial hypertrophy and anomaly of foetal heart rate. Post-natal echocardiography showed severe septal myocardial hypertrophy with latero-basal myocardial akinesia. We did not observe a Doppler gradient through the left ventricular outflow. Selective coronary angiography showed an occlusion of the circumflex artery. Myocardial hypertrophy is a classic complication in newborns of diabetic mothers. The mother's diabetes and neonatal infarction remain an exceptional association. We discuss a different hypothesis to explain coronary occlusion and how myocardial infarction avoided septal obstruction.

Assessment of left ventricular volumes and function by real time three-dimensional echocardiography in a pediatric population: a TomTec versus QLAB comparison.

BACKGROUND: Three-dimensional echocardiography (3DE) allows accurate calculation of ventricular volumes despite a remaining geometric assumption on the ventricular shape. Few studies involving full volume reconstruction software have been performed on children. Our aim was to compare the left ventricular (LV) volume measurements obtained with the most used 3D analysis software in a pediatric population. METHODS: Fifty patients (median age: 9.5 years) without cardiac disease were included in the study. 3DE was performed with the X4-2 or X7-2 matrix probe (ie33, Philips). The LV volume analysis was performed with QLAB 6.0 (semiautomated border detection) and TomTec 4D LV (primary manual tracking with semiautomated border detection). RESULTS: TomTec analysis feasibility amounted to 94% whereas QLAB analysis feasibility only reached 80% (P = 0.037). The analysis time was shorter with QLAB than TomTec (5 ± 2 versus 6 ± 3 minutes, P < 0.05). The stroke volume, end diastolic and end systolic LV volume measurements performed on the 40 patients were strongly correlated (r > 0.97; P < 0.0001) with minimal bias. The LV ejection fraction was well correlated (r = 0.79; P < 0.0001). CONCLUSION: 3D LV volume quantification is feasible either by using manual or automated reconstruction software in a normal pediatric population. LV Measurements are well correlated. Differences in volume reconstruction algorithms provide specific software performance characteristics. TomTec is a more feasible method but requires a longer analysis time. Further studies are needed to validate the accuracy of the method to calculate enlarged LV volumes in patients with congenital heart diseases.

New echocardiographic prognostic factors for mortality in pulmonary arterial hypertension.

AIMS: The present role of echocardiography is generally restricted to screening for pulmonary arterial hypertension (PAH). The aim of our study was to identify new echocardiographic prognostic factors for mortality in PAH which would give this imaging modality a genuine role in patient management. METHODS AND RESULTS: At inclusion, all patients underwent right cardiac catheterization and echocardiography. Seventy-nine patients were followed for a median of 12 months, of whom 16 died of their pulmonary disease. We identified seven echocardiographic parameters that were associated with mortality, four of which have not previously been described in the literature: mean pulmonary artery pressure (PAP) >or=49 mmHg (P = 0.012), dPAP >or= 29 mmHg (P = 0.006), abnormal end-diastolic septal curve (P = 0.027), and inferior vena cava diameter >or=20 mm with respiratory variation of diameter <50% (P = 0.018). These parameters remained significant after adjustment for NYHA class and 6 min walk test distance. CONCLUSION: Echocardiography should take an important place in the management of PAH and should not be restricted merely to screening for the disease.