The D-HCM score, a new diagnostic tool for distinguishing hypertrophic cardiomyopathy from hypertensive cardiopathy.

AIM: The diagnosis of hypertrophic cardiomyopathy (HCM) with moderate hypertrophy is challenging. Hypertensive heart disease (HHD) is the most common differential diagnosis that mimics the LVH of HCM. The aim of this study was to compare the QRS duration in HCM and HHD to create a novel diagnostic tool to identify primary HCM. METHODS AND RESULTS: We conducted an international retrospective multicentre study enrolling patients with true HCM and HHD. A total of 547 individuals with HCM and 139 with HHD were included. The median QRS duration was significantly shorter in HCM than in HHD (88 ms [80-94] vs. 98 ms [88-108]; P < 0.01). Multivariable logistic regression identified for the novel diagnostic HCM (D-HCM) score: absence of antihypertensive drugs (+2); family history of unexplained sudden death (+2); QRS duration [<95 ms] = +1; maximum wall thickness (mm) [≥17] = +1. A cumulative QRS-HCM score ≥2 supports the diagnostic certainty of true HCM with a sensitivity of 79%, specificity of 99%, negative predictive value (NPV) of 55%, and positive predictive value (PPV) of 99%. CONCLUSION: The QRS duration in patient with HCM is significantly shorter compared with patients with HHD-related LVH. QRS duration can be used as a diagnosis marker to distinguish between HCM and HHD. The D-HCM score is a novel, simple, and accurate diagnosis tool for HCM patients with mild to moderate phenotypes.

Optimization of patent foramen ovale detection by contrast transthoracic echocardiography using second harmonic imaging.

BACKGROUND: Patent foramen ovale is an anomaly responsible for paradoxical embolizations and cerebral ischemic events. Aims. - We want to show second harmonic transthoracic echography sensitized by contrast agent perfusion is as well as transesophageal echography to patent foramen ovale detection. METHODS: Onene hundred twenty one patients referred for transesophageal echocardiography for patent foramen ovale detection, underwent additive second harmonic transthoracic echocardiography with one of three randomized contrast agents: a mixture A of dextrose and air, mixture B of dextrose and air and blood, or mixture C of hydroxyethylamidon. The severity of atrial shunting was evaluated on recordings by semi-quantitative scoring. Intensity of contrast was also assessed by objective quantitative videodensitometry. RESULTS: No difference was observed between the two techniques, nor between mixture A, B and C in terms of PFO detection during each exam. However, quantitative contrast analysis showed higher intensity with mixtures B and C with mixture A during transthoracic echography. CONCLUSIONS: When performed with a contrast agent, second harmonic transthoracic echography and transoesophageal echography are comparable when it comes to patent foramen ovale detection. Although the composition of the contrast agent does not appear to affect the rate of this detection, contrast quality in the right atrium during transthoracic exam is better with mixtures B and C than with mixture A.

Automated function imaging: a new operator-independent strain method for assessing left ventricular function.

BACKGROUND: Speckle tracking is a new technique based on pure 2D grayscale ultrasound acquisition allowing calculation of segmental strains. To facilitate clinical application, speckle tracking has been integrated into the most recent echocardiographic systems for quick, automated evaluation of left ventricular function (Automated Function Imaging, AFI). OBJECTIVE: To evaluate the feasibility, calculation time, accuracy and reproducibility of global longitudinal strain (GLS) from AFI in determining LV function in comparison to reference echocardiographic and angiographic methods-whatever the operator's experience. METHODS: Echocardiography was performed in 65 patients scheduled for cardiac catheterization using a Vivid 7 system. They were divided into 3 groups according to EF (>55%, 35< or =EF< or =55%,<35%). Image quality, global LV function parameters (ejection fraction, aortic flow, dp/dt) and segmental contraction were analyzed by one experienced operator and one beginner. GLS was obtained from apical 2, 3 and 4 chamber views. GLS was compared to both echocardiographic and angiographic EF, as well as to other echocardiographic parameters. RESULTS: GLS was obtained successfully in 97% of patients. Mean calculation time including correction of endocardial detection was less than 60 seconds. GLS was significantly different between the 3 groups, respectively -18.1+/-2.5%, -11.5+/-2.1% and -6.0+/-1.2% (p<0.01). Strong correlations were observed between GLS and LV function (r from 0.68 to 0.87) with a high level of reproducibility. No difference was observed between experienced and inexperienced operators. CONCLUSION: AFI is clinically applicable and an effective means of assessing LV function due to its short acquisition time, feasibility and accuracy, whatever the experience of the operator.

[Cardiomyopathy of the right ventricle revealed by pulmonary embolism]. / Cardiomyopathie du ventricule droit révélée par une embolie pulmonaire.

The authors report a case of cardiomyopathy of the right ventricle revealed suddenly in a presentation of pulmonary embolism in relation to a large thrombus that developed in an enormous, extremely hypokinetic right ventricle. The scenario suggests dysplasia without rhythm disorder. This case allows a discussion on the multiple variants of arhythmogenic dysplasia of the right ventricle.

[Myocardial perfusion and contrast echocardiography. Application to acute coronary syndrome]. / Perfusion myocardique et échocardiographie de contraste. Application au syndrome coronaire aigu.

After mastering epicardial revascularisation, the therapeutic management of acute coronary syndrome has progressively turned towards the preservation of the capillary microcirculation. In this respect, contrast echocardiography provides all the answers to the main questions which arise, and is available within a timeframe and place compatible with the management of such patients. The techniques for microbubble detection, quantification tools, and contrast agents are well optimised for routine use both for initial diagnosis as well as monitoring the therapeutic effectiveness. It is only the administrative authorisation which is currently lacking treatment.

[Echocardiography and biventricular resynchronisation]. / Echocardiographie et resynchronisation biventriculaire.

Biventricular resynchronisation has been recently shown to be an effective therapeutic option in patients with refractory dilated cardiomyopathy. Based on the finding of ventricular asynchrony, the aim of the method is to restore uniform contraction of the ventricular walls. However, the initial electrocardiographic criteria for selection of patients were only associated with a 70% rate of response. Consequently, it became necessary to refocus this method in patients with true ventricular asynchrony. Echocardiography is one of the non-invasive techniques which provides morphological and functional analysis of the myocardium with a high degree of accessibility. The multiplication of tools for echocardiographic quantification has been very valuable from a theoretical point of view for assessing ventricular asynchrony. In practice, techniques such as Doppler tissue imaging are being validated, but already offer the possibility of a multi-directional approach to this pathology. The diagnosis of asynchrony is based on a range of echocardiographic findings which not only improve the selection of patients but also optimise the programming of multisite stimulation.

["Optigo" hand-held echocardiography in post-surgery of coronary artery bypass graft]. / Intérêt de l'échocardiographe portatif Optigo en période postopérative de chirurgie coronarienne.

INTRODUCTION: After all the advances in electronic miniaturization, first hand-held echocardiographs have finally appeared in echocardiographic laboratories. However, questions still remain about their usefulness in our everyday practice and also about their good diagnosis accuracy. Since some of them do not offer modes such as pulsed or continuous wave Doppler, nor M-mode, they cannot compete with conventional devices. However, they do offer advantages such as their long autonomy, the good quality of their image as well as the one obtained with colour-Doppler mode, in addition obviously to the fact that they can be carried around very easily. OBJECTIVES: To better define their possible uses, we assessed capabilities of one of them, the Optigo (Philips Ultrasound) to analyse patients who had undergone coronary artery bypass surgery. METHOD: Fifty patients have been included in this study few days after the surgery. Each of the patients had two echocardiographic examinations, one with a conventional device and one with the Optigo. Two separated and blinded observers for a subsequent and side-by-side criteria comparison performed the two echocardiograms. RESULTS: Hand-held echocardiography had a good diagnosis accuracy varying from 85% to 95% depending on the analysed criteria. It was more specifically good in the analysis of global or regional left heart function and of the right cavities as well as detecting the existence of pericardial effusion. CONCLUSION: Hand-held echocardiographic device demonstrated high accuracy in assessing patients with recent coronary bypass surgery especially regarding cardiac function and pericardial effusion diagnosis.