Diagnostic accuracy of pocket-size handheld echocardiographs used by cardiologists in the acute care setting.

AIMS: Pocket-size echographs may be useful for bedside diagnosis in acute cardiac care, but their diagnostic accuracy in this setting has not been well tested. Our aim was to evaluate this tool in patients requiring an urgent echocardiogram. METHODS: Trained cardiologists performed echocardiograms with a pocket-size echograph (Vscan) in consecutive patients requiring urgent echocardiography. The exams were then compared in a blinded manner with echocardiograms performed with a high-end standard echocardiograph. RESULTS: A total of 104 patients were studied. There was an excellent agreement between the Vscan and the high-end echocardiograph for the left ventricular systolic function and pericardial effusion (Kappa: 0.89 and 0.81, respectively), and the agreement was good or moderate for evaluating the aortic, mitral, and tricuspid valve function and the left ventricular size (Kappa: 0.55-0.66). Visualization of the Vscan images in full-screen format on a PC did not in general confer added value. CONCLUSION: The Vscan used by a trained cardiologist has good diagnostic accuracy in the emergency setting compared with a high-end echocardiograph, despite small screen size and lack of pulse-wave and continuous Doppler.

Transient symptomatic severe mitral regurgitation after electric cardioversion of atrial fibrillation.

INTRODUCTION: After electric cardioversion (EC), several cases of cardiac stunning with cardiogenic shock have been reported. Several hypotheses have been proposed, including stunning of the left ventricle (LV) and modifications in the LV conformation that could lead to severe mitral regurgitation (MR). We report 2 cases of cardiogenic shock with severe MR after EC for atrial fibrillation (AF). CASE 1: A 75-year-old man presented with AF. A transesophageal echocardiography before the EC showed moderate MR. Shortly after successful EC, the patient developed a cardiogenic shock. The transthoracic and a transesophageal echocardiography showed severe MR. Four days later, an echocardiography showed recovery of MR to a moderate grade. CASE 2: An 85-year-old woman with a history of percutaneous aortic valve replacement presented with AF. After EC, she developed a cardiogenic shock. The transthoracic echocardiography showed severe MR. After recovery, the echocardiography showed moderate MR. DISCUSSION: Cardiac stunning after EC is well known and could explain the development of severe MR due to restrictive movement of leaflets. The transient character of the MR favors a functional origin with an alteration in the geometry of the mitral apparatus. Some cases of so-called "eclipsed MR" are described in the literature, however, independently to electric shocks. CONCLUSION: In some patients, flash pulmonary edema seems to be due to transient severe functional MR, although the exact underlying physiopathologic mechanism remains unclear. An ischemic origin with papillary muscle dysfunction due to transient low perfusion could also be advocated.

[Percutaneous left atrial appendage closure: an alternative in patients with atrial fibrillation and high bleeding risk?]. / Fermeture percutanée de l'appendice auriculaire: une option thérapeutique lors de fibrillation auriculaire a haut risque de saignement?

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence increases with age. AF increases the risk of stroke by a factor of 5 and strokes related to AF are associated with higher mortality and morbidity when compared with strokes in patients with sinus rhythm. Oral anticoagulation is efficient to reduce the risk of stroke in AF patients, but with a substantial risk of bleeding. In clinical practice, 50% of the AF patients with an indication for oral anticoagulation do not receive the treatment. Indeed, many patients do not tolerate oral anticoagulation and this is still true despite the new drugs. Recently, percutaneous left atrial appendage closure for AF patients with high risk of stroke became a valid alternative to oral anticoagulation for stroke prevention.