Clinical relevance of spectral tissue Doppler-derived E/e′ in older patients with preserved ejection fraction

BackgroundThe E/e′ index measured in spectral tissue Doppler is included in the recommendations for the diagnosis by transthoracic Doppler echocardiography of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction. While E/e′ is influenced by age in healthy individuals, no studies have evaluated this index in elderly patients. This study addressed the clinical relevance of E/e′ in assessment of left ventricular diastolic function in elderly patients with preserved ejection fraction and its relevance from both a diagnostic and prognostic perspective based on the existing literature.MethodsA total of 76 patients ≥ 70 years of age were prospectively included. The analysis of left ventricular diastolic function was adapted from the 2016 ASE/EACVI recommendations without consideration of E/e′.ResultsThe mean age was 85 years. In all, 42 patients had moderate-to-severe diastolic dysfunction (elevated left atrial pressure). Mean E/e′ was significantly correlated with diastolic function (r = 0.58, P < 0.001). Mean E/e′ > 13.3 had a sensitivity of 86% and a specificity of 91% in the diagnosis of moderate-to-severe diastolic dysfunction (AUC: 0.92). E/(e′xs′) (AUC: 0.89) and NT pro-BNP (AUC: 0.80) did not perform better than E/e′. The existing literature offers large body of evidence that E/e′ provides essential diagnostic and prognostic information in older patients with cardiovascular disease.ConclusionE/e′ is accurate in the diagnosis of significant diastolic dysfunction, in the diagnosis of heart failure with preserved ejection fraction and in risk stratification in older patients with cardiovascular disease.     

Combination of hyperuricemia and metabolic syndrome is an independent and powerful predictor for left ventricular hypertrophy in rural Chinese

ObjectivesTo investigate the influence of MetS (metabolic syndrome) in combination with hyperuricemia on left ventricular hypertrophy (LVH) in residents in the rural area of Northeast China.MethodsWe performed a cross-sectional baseline data analysis of 11,170 subjects (mean age: 54 ± 11 years) recruited from the rural area of China. Anthropometric indicators were measured according to standard methods. MetS was defined by the ATP III modified criteria. Hyperuricemia was defined according to sex-specific serum uric acid levels (SUA): SUA ≥ 7.0 mg/dL for male and ≥ 6.0 mg/dL for female. Four groups were listed: normouricemia non-MetS, hyperuricemia non-MetS, MetS normouricemia and hyperuricemia MetS.ResultsLeft ventricular mass index for height^2.7 (LVMH^2.7) in female was significantly higher in hyperuricemia MetS group than that in normouricemia non-MetS (52.43 ± 16.60 vs. 40.04 ± 10.72 g/m^2.7, P < 0.001) group. Similar result was observed in men (48.93 ± 13.17 g/m^2.7 vs. 43.63 ± 11.90 g/m^2.7, P < 0.001). The result of multiple regression analysis indicated that hyperuricemia MetS group had higher risk of LVH than other three groups (OR: 3.427 for female, P < 0.001, OR: 1.987 for male, P < 0.001). Moreover, female subjects in MetS normouricemia group [OR (95% CI): 2.313 (1.991–2.686)] had greater risk of LVH than that in hyperuricemia non-MetS group [OR (95% CI): 1.917 (1.166–3.151)]. Hyperuricemia non-MetS was found to be significantly and independently associated with LVH in women, but not in men.ConclusionOur study finds that the combination of hyperuricemia and MetS are independent and powerful predictor for LVH in rural area of Northeast Chinese. Women with MetS in combination with hyperuricemia have higher risk of LVH than men. It seems that MetS has greater effect on LVH than hyperuricemia does in women but not in men.     

Does syncope change the results of programmed ventricular stimulation in patients with previous myocardial infarction?

The induction of a ventricular tachycardia (VT) after myocardial infarction (MI) is associated with a high risk of VT and sudden death (SD) in asymptomatic patients; the purpose of the study was to know if syncope modifies the results of programmed ventricular stimulation (PVS) and the clinical consequences. METHODS: PVS using two and three extra stimuli delivered in two sites of right ventricle was performed in 1057 patients without spontaneous VT or resuscitated SD at least 1 month after an acute MI; 836 patients (group I) were asymptomatic and were studied for a low ejection fraction or nonsustained VT on Holter monitoring or late potentials; 228 patients (group II) were studied for unexplained syncope. The patients were followed up to 5 years of heart transplantation. RESULTS: Sustained monomorphic VT (< 280 b/min) was induced in 238 group I patients (28%) and 62 group II patients (29%); ventricular flutter (VT > 270 b/min) or ventricular fibrillation (VF) was induced in 245 group I patients (29%) and 42 group II patients (18%) (P < 0.05); PVS was negative in 353 group I patients (42%) and 124 (55%) group II patients (NS). The patients differ by their prognosis; cardiac mortality was 13% in group I patients and 34% in group II patients with inducible VT < 280 b/min (P < 0.01), 4% in group I patients and 13% in group II patients with inducible VF (P < 0.05), 5% in group I patients and 7% in group II patients with negative study (NS). In conclusion, syncope did not change the results of programmed ventricular stimulation after myocardial infarction. However, syncope increased significantly cardiac mortality of patients with inducible ventricular tachycardia, flutter or fibrillation.     

Double tachycardie : association d’un flutter atrial et d’une tachycardie ventriculaire fasciculaire

Double tachycardia is an uncommon type of tachycardia. We report the case of a 42-year-old patient, admitted in our department for palpitations. Two types of tachycardia, narrow and wide QRS one, have been documented in the moment of palpitations. The electrophysiology study highlights an atrial flutter and a fascicular ventricular tachycardia. The patient had no recurrence of palpitations after atrial flutter ablation and medical treatment by verapamil for his ventricular tachycardia. This is the first published case combining an atrial flutter and a ventricular tachycardia.     

Congestive heart failure in postpartum: a case of peripartum cardiomyopathy

We report the case of an acute respiratory failure in a 36-year-old woman who presented a peripartum cardiomyopathy (PPCM). PPCM is a dilated cardiomyopathy with impaired systolic function that occurs between the last month of pregnancy and the five months following delivery. It is a rare disorder of unknown origin associated with high mortality (50%). Echocardiography confirms the diagnosis by showing a left ventricular dilatation and a decreased ejection fraction. Up to date, the treatment remains symptomatic.     

Ventricular tachycardia revealed by a left ventricular non-compaction

We report a case of a 55-year-old woman who has a non-compaction of the left ventricular myocardium diagnosed after a cardiac arrest due to a polymorphic ventricular tachycardia. The patient was implanted with a cardioverter-defibrillator. A review of literature of this recently described cardiopathy is done.     

The results of the artificial heart

The artificial heart is no more a dream but a reality. Over the last 40 years, many circulatory assist devices have been developed. First were the pneumatic devices, external or implantable, providing uni- or biventricular support; next were the partially implantable electromecanical devices. We went from the first generation of devices with all components (pump, energy power, control system) outside of the body to the second generation of devices with the pump and the motor implanted inside the body. Recently, the third generation of artificial hearts appeared with all components implanted inside the body allowing better mobility and quality of life. Results depend on the indication and on the kind of artificial heart implanted: partial (native heart still in place) or total (native heart removed). Essentially developped as a bridge to transplant, the artificial heart is now allowed as destination therapy.