[Screening for pulmonary arterial hypertension in patients with systemic sclerosis: Comparison of DETECT algorithm to decisions of a multidisciplinary team, in a competence centre]. / Dépistage de l'hypertension artérielle pulmonaire au cours de la sclérodermie systémique : comparaison de l'algorithme DETECT à une discussion pluridisciplinaire en centre de compétence.

INTRODUCTION: Pulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis and detecting PAH efficiently remains challenging. The DETECT study has offered in 2013 a composite screening tool for PAH. The objective of our study was to compare the indication of right heart catheterisation (RHC) as suggested by the DETECT algorithm with the decisions of a multidisciplinary team. METHODS: This prospective monocentric non-interventional study consecutively included systemic sclerosis patients when data required to apply DETECT algorithm were available. We evaluate the number of RHC as requested by this algorithm and confronted it with the indications of RHC suggested by a multidisciplinary group blinded for the result of DETECT algorithm. RESULTS: In total, 117 systemic sclerosis patients were included. When DETECT algorithm was applied to all patients, RHC was suggested by this algorithm for 70 patients, whereas only 15 indications were required by the multidisciplinary group; among those patients only 7 had PAH. When DETECT algorithm was applied only to the 42 patients with DLCO<60% and disease duration of more than 3 years, RHC was suggested for 31 patients whereas only 13 were indicated by the multidisciplinary group; among those patients only 7 had PAH. CONCLUSION: The DETECT algorithm is able to efficiently detect all PAH patients finally diagnosed by our multidisciplinary team. However, it increases by 3 the number of RHC that should be performed.

Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study.

AIMS: The aim of this article is to assess the left atrial (LA) reservoir function in patients with severe aortic stenosis (AS) and to evaluate its impact on the recurrence of major adverse cardiac events (MACEs). METHODS AND RESULTS: About 128 patients (mean age 79 ± 9 years) with severe AS were included in the study. Global peak LA strain (PLAS) measured by two-dimensional speckle-tracking echocardiography (STE) during left ventricular (LV) systole represented the LA reservoir function. Overall death, hospitalization for cardiac cause, and worsening heart failure were defined as MACEs. With respect to the values observed in a control group of 20 healthy patients, PLAS resulted significantly reduced in AS. According to the multivariate linear regression analysis, LV global longitudinal strain, mitral E/e' ratio, and systolic pulmonary arterial pressure (sPAP) were the best correlates to PLAS. During follow-up, the predefined MACEs occurred in 39 patients. According to the multivariate Cox regression analysis, a PLAS <21% was a significant predictor of MACEs [hazard ratio (HR) 2.88, P = 0.04], as was coronary artery disease (HR 2.68, P = 0.004) and the New York Heart Association functional class (HR 2.08, P = 0.03). CONCLUSION: In patients with severe AS, a global PLAS <21% is an independent predictor of prognosis. Given the combined influence of LV diastolic and systolic function and of LA performance on sPAP, the decline of PLAS might be considered a marker of global myocardial impairment in AS. Further studies are needed to confirm the critical role of LA relaxation in prognosis and to validate its relevance in routine clinical practice.

[Heart transplantation for patients on high emergency list with or without extracorporeal membrane oxygenation support]. / Transplantation cardiaque en super urgence (SU) avec et sans assistance circulatoire mécanique de type extracorporeal membrane oxygenation (ECMO).

OBJECTIVE: Severely impaired patients may wait in France on a special and temporary high emergency national list (called SU). Some of these patients need mechanical circulatory support with ECMO. In order to compare two groups of patients on SU, who acceeded to heart transplantation (HT) with or without ECMO, we reviewed retrospectively 20 consecutive patients transplanted on SU between January 2004 and September 2007 in Rennes. PATIENTS AND METHODS: Among them, 10 were transplanted without ECMO and 10 others were implanted with a femoro-femoral ECMO before HT. RESULTS: (1) Considering the group SU without pretransplantation ECMO: 2 years survival rate was 70%. Mean hospital stay was 26.4 days. Three patients were implanted with ECMO for graft dysfunction during postoperative course, without inherent complication. None graft dysfunction occurred after initial hospitalization; (2) considering the group SU with pretransplantation ECMO: 2 years survival rate was 90% (one early death). Mean hospital stay was 45 days with multiple complications due to the ECMO (leg's ischemia: n = 2; lung oedema: n = 1; lymphorrhea: n = 3, low flow requiring change of canulae: n = 1). None graft dysfunction occurred after initial hospitalization. CONCLUSION: Although we didn't reach statistical significance, it seems that ECMO for patients in SU may be useful as bridge to transplant but with a higher morbidity than for similar patients transplanted without ECMO. Additional data from other transplant centers are needed to confirm our findings.

[Clinical and angiographic parameters affecting the quality of 16 slice spiral CT in the diagnosis of restenosis after stenting the left main coronary artery]. / Paramètres cliniques et angiographiques influant sur la qualité de l'angioscanner spiralé 16 détecteurs dans le diagnostic de resténose après stenting du tronc commun de la coronaire gauche.

The metallic component of coronary stents makes it difficult to study their lumen by angio scanner. The object of this preliminary study was to appreciate the factors influencing the diagnosis of restenosis after stenting the left main coronary artery by 16-slice spiral angio CT. This Monocentric study included 27 patients who underwent 16-slice spiral angio CT six months after stenting of the left main coronary artery. It was possible to assess the stent lumen in 21 patients (78%) and no cases of > 50% restenosis were observed. In 4 patients, hypodense zones adjacent to the stent links were observed suggesting moderate intimal hyperplasia. The tests for ischaemia were normal in 3 of these patients. Coronary angiography and endocoronary ultrasound excluded significant restenosis in the fourth patient. In univariable analysis, the facors associated with good or excellent angioscanner quality (45% of patients) were Ostial stenosis (p = 0.03), no or minimal calcification on initial coronary angiography (p = 0.0S), stent diameters > 3.5mm (p = 0.03), heart rates < 60/min (p = 0.04), absence of extrasystoles (p = 0.05) during acquisition. In multivariable analysis, the only significant factors were absent or minimal calcification and stent diameters > 3.5mm (p = 0.02). The multidetector scanner seems a very promising method of investigating patients who have undergone stenting of the left main coronary artery but this study shows that certain clinical and angiographic parameters are limiting factors of surveillance with a 16-slice angioscanner.

[Valve replacement for aortic regurgitation associated with rheumatoid arthritis: a series of 5 cases]. / Remplacement valvulaire pour insuffisance aortique associée a la polyarthrite rhumatoïde: a propos de 5 cas.

Between 30 and 50% of patients with rheumatoid arthritis (RA) have cardiac involvement but only 2 to 10% have clinical manifestations. The authors report the results of a retrospective study of 5 cases of aortic regurgitation (AR) requiring valve replacement. There were 4 women and 1 man with an average age of 48.4 years. The average duration of the RA was 19.6 years. All patients had cardiac failure. Aortic valve replacement was performed in all cases, with bioprostheses in 4 out of 5 patients. The histopathological examination of the valves showed a rheumatoid nodule in 3 cases and non-specific lesions in one case. In the fifth patient, rheumatoid serology was positive in the pericardial effusion. The average interval between the onset of symptoms and cardiac surgery was 3.6 months (range 1 to 6 months) There were 3 deaths at 3 days, 20 months and 10 years, two patients survive after 12 and 14 years. The characteristic rapid progression of this form of AR, which may be life-threatening, should be emphasised.