Mode of delivery and peripartum outcome in women with heart disease according to the ESC guidelines: an Italian multicenter study.

INTRODUCTION: The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. MATERIAL AND METHODS: Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. RESULTS: Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49-9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). CONCLUSION: Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth.

Contrast echo and perfusion stress (2D/3D): which role in clinical practice?

In this review we will clarify some key technical aspects of myocardial contrast echocardiography (MCE) but we will mostly address its potential clinical application during stress-echocardiography in today's cardiology practice, according to the literature and to the author's view. MCE is a bedside technique, it is cheap and has a very high diagnostic accuracy and safety. Nonetheless MCE use remains confined to the few echolabs which pioneered and developed the technique: Why is that? We here suggest a number of potential explanations for this research/clinical practice "mismatch", and how to overcome it, putting MCE in its proper cardinal role among diagnostic methods in cardiology.

P981Lvot area measurement using gated ct data reclassifies aortic stenosis severity as graded by echocardiography.

BACKGROUND: Measurement of left ventricular outflow tract (LVOT) diameter and area for estimation of aortic valve area (AVA) using transthoracic echocardiography (TTE) and the continuity equation assumes circular LVOT. The use of direct planimetric measurement of LVOT area by gated-CT can theoretically improve accuracy of AVA calculation. PURPOSE: We aim to assess reproducibility of LVOT echo measurement and its correlation and agreement with Gated CT measurements. In the subgroup with aortic stenosis (AS) we secondarily assessed the potential change in AS severity using LVOT area by CT instead of TTE in the continuity equation. METHODS: We retrospectively studied 93 patients, 43 of whom with severe AS. LVOT Area was measured with 2D TTE by 2 expert echocardiographers and gated-CT by 2 expert radiologists; inter-reader agreement and inter-method (Echo vs gated CT) agreement and correlation were measured. Finally we used the measurement of CT scan in the continuity equation instead of TTE measurement to assess potential reclassification of AS severity. RESULTS: Mean age was 78±11. Table shows inter-reader and inter-method agreement and correlation.The correlation between 2 echocardiophers for LVOT measurements was good (rho = 0,77) although not perfect. Out of 43 severe AS, defined as AVA<1 cm2 using TTE in the continuity equation, 18 were reclassified by gated-CT LVOT measurements into moderate AS. This was due to gated-CT LVOT area resulting on average 1.4 cm2 larger than LVOT area by TTE. CONCLUSION: LVOT is elliptical and TTE tends to underestimate LVOT area and AVA due to the measurement of the shorter diameter of this ellipse. CT scan can provide more geometrically accurate measurement and requires different cut-offs compared with traditional TTE AVA measurement. By the way, in the current study the LVOT area by CT was on average 38% larger of the LVOT area measured by TTE. Such correcting factor (increase TTE LVOT area by 38%) should apparently be used to assess anatomical true planimetric area to be compared with gated-CT LVOT.summary tableTTE Inter-reader correlation LVOT area (Spearman rho)0.77TTE reader A vs CT 3-chamber equivalent correlation (Spearman rho)0.49TTE reader B vs CT 3-chamber equivalent correlation (Spearman rho)0.38TTE reader A area vs CT planimetric area correlation (Spearman rho)0.41TTE reader B area vs CT planimetric area correlation (Spearman rho)0.31Mean LVOT Area by TTE reader A3,60SD 0,6038%Mean LVOT Area by CT scan4,99SD 0,98 Abstract P981 Figure.summary table.Abstract P981 Figure.

Tako-Tsubo cardiomyopathy with coronary artery stenosis: a case-series challenging the original definition.

We report a case-series of seven patients with Tako-Tsubo cardiomyopathy (TTC) and at least one concomitant >or=50% coronary stenosis. Each case involves a female patient who presented symptoms and an electrocardiogram compatible with acute coronary syndrome, mild troponin I elevation, a ventriculogram showing left ventricle (LV) apical or midventricular ballooning (classical or variant TTC), an angiogram showing at least one >or=50% stenosis and a cardiac magnetic resonance showing no myocardial late Gadolinium enhancement. Full recovery of normal LV contractility after the event was required to confirm TTC. Our report presents the case for the opportunity to modify the TTC definition, removing the requirement for absence of coronary stenosis not to exclude patients with bystander coronary lesions, who are probably under diagnosed as per the original TTC definition.