Optimal Heart Rate and Prognosis in Patients with Cardiac Amyloidosis

Background: Optimal heart rate (HR) that associates with higher cardiac output and greater clinical outcomes in patients with cardiac amyloidosis remains unknown. Methods: Consecutive patients with sinus rhythm who were diagnosed with cardiac amyloidosis at our institute between February 2015 and February 2021 were retrospectively included. Ideal HR, at which E-wave and A-wave stand adjacent without any overlaps in the trans-mitral flow echocardiography, was calculated by the formula: 86.8−0.08 × deceleration time (msec). The association between optimal HR and cardiac death or heart failure readmission was investigated. Results: Ten patients (median 74 years old, 8 men) were included. On median, actual HR was 64 bpm and ideal HR was 69 bpm. An incidence rate of the primary endpoint in the sub-optimal HR group tended to be higher than optimal HR group: one of the four patients in optimal HR group had events (25%); two of the two patients in higher HR group had events (100%); two of the four patients in lower HR group had events (50%). Conclusions: The optimal HR was associated with greater clinical outcomes in patients with cardiac amyloidosis. The clinical impact of aggressive HR optimization in this cohort remains the next concern.

Abnormal mitral flow, what is the cause?

Diastolic mitral regurgitation is a unique Doppler finding that can be missed if special attention is not paid to it. There are a few causes of such abnormal flow, ranging from a conduction abnormality to abnormal valvular and left ventricle function. Failure to recognize it might lead to unnecessary investigations and delay the primary diagnosis. We are presenting a teaching case and discuss the associated pathology.

Quantitative analysis of left atrial myocardial function and compliance in patients with pre-eclampsia

Background: Pre-eclampsia (PE) is a severe obstetric complication associated with many cardiovascular disorders. Left atrial (LA) function and its relevance to the cardiovascular adaptation changes associated with PE have not been adequately addressed. The aim of this study was to quantify LA myocardial deformation characteristics in women with PE using speckle tracking echocardiography (STE). Methods: Using STE, LA global longitudinal strain (LAGLS), phasic LA strain values and LASr/(E/e'), which was the value of LA reservoir strain (LASr) divided by the quotient of early mitral flow velocity (E) and diastolic mitral ring velocity (e'), were compared among nonpregnant controls (n=39), normotensive pregnant women (n=40), and PE (n=43) patients. Results: LAGLS, LASr and LA conduit strain reduced in PE group in spite of no difference of LA contraction strain among the three groups. LASr/(E/e'), the surrogate of LA compliance, was decreased during PE pregnancy. The multivariate regression analyses showed LAGLS was independently correlated with LASr/(E/e'), left ventricular global longitudinal strain and LA maximum volume. Conclusion: PE cases undergo impaired LA myocardial function and decreased atrial compliance. STE-derived LA strain may be a powerful diagnostic parameter to evaluate diastolic function with the progression of PE pregnancy.

P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography

Background Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification. Purpose Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach. Methods We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR. Results 33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]). Conclusion 4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.