Prediction of Post-Ablation Outcome in Atrial Fibrillation Using Shape Parameterization and Partial Least Squares Regression

International audienceTo analyze left atrial remodeling may reveal shape features related to post-ablation outcome in atrial fibrillation, which helps in identifying suitable candidates before ablation. In this article, we propose an application of diffeomorphometry and partial least squares regression to address this problem. We computed a template of left atrial shape in control group and then encoded the shapes in atrial fibrillation with a large set of parameters representing their diffeomorphic deformation. We applied a two-step partial least squares regression. The first step eliminates the influence of atrial volume in shape parameters. The second step links deformations directly to post-ablation recurrence and derives a few principle modes of deformation, which are unrelated to volume change but are involved in post-ablation recurrence. These modes contain information on ablation success due to shape differences, resulting from remodeling or influencing ablation procedure. Some details are consistent with the most complex area of ablation in clinical practice. Finally, we compared our method against the left atrial volume index by quantifying the risk of post-ablation recurrence within six months. Our results show that we get better prediction capabilities (area under receiver operating characteristic curves (AUC = 0.73) than left atrial dilation (AUC = 0.47), which outperforms the current state of the art

Hypertension artérielle pulmonaire thrombo-embolique chronique et splénectomie (étude cas-contrôle de la prévalence de la splénectomie dans l'HTAPTEC et dans d'autres affections pulmonaires)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Successful pulmonary endarterectomy after heart transplantation

International audienc

Left atrial shape is independent predictor of arrhythmia recurrence after catheter ablation for atrial fibrillation: A shape statistics study

International audienceBACKGROUND Markers of left atrial (LA) shape may improve the prediction of postablation outcomes in atrial fibrillation (AF). Correlations to LA volume and AF persistence limit their incremental value over current clinical predictors. OBJECTIVE To develop a shape score independent from AF persistence and LA volume using shape-based statistics, and to test its ability to predict postablation outcome. METHODS Preablation computed tomography (CT) images from 141 patients with paroxysmal (57%) or persistent (43%) AF were segmented. Deformation of an average LA shape into each patient encoded patient-specific shape. Local analysis investigates regional differences between patient groups. Linear regression was used to remove shape variations related to LA volume and AF persistence, and to build a shape score to predict postablation outcome. Cross-validation was performed to evaluate its accuracy. RESULTS Ablation failure rate was 23% over a median 12-month follow-up. Regions associated with ablation failure mostly consisted of a large area on posteroinferior LA, mitral isthmus, and left inferior vein. On univariate analysis, strongest predictors were AF persistence (P 5 .005), LA indexed volume (P 5 .02), and the proposed shape score (P 5 .001). On multivariate analysis, all 3 were independent predictors of ablation failure, with the LA shape score showing the highest predictive value (odds ratio [OR] 5 6.2 [2.5-15.8], P , .001), followed by LA indexed volume (OR 5 3.1 [1.2-7.9], P 5 .019) and AF persistence (OR 5 2.9 [1.2-7.6], P 5 .022). CONCLUSION Posteroinferior LA, mitral isthmus, and left inferior vein are the regions whose shape have the highest impact on outcome. LA shape predicts AF ablation failure independently from, and more accurately than, atrial volume and AF persistence

Out-of-proportion pulmonary hypertension and heart failure with preserved ejection fraction

A subset of patients with heart failure with preserved ejection fraction (HFpEF) will have a marked increase in pulmonary artery pressure (PAP)

[Contraception, therapeutic abortion, and pulmonary arterial hypertension].

International audienceDespite therapeutic advances, maternal mortality is high in pulmonary arterial hypertension (PAH). PAH treatment may interfere with the proposed method of contraception. Moreover, some treatments (endothelin receptor antagonists, anti-vitamin K) are teratogenic. If pregnancy is strictly not recommended in PAH, few specific contraceptive guidelines are available. The contraceptive method must be discussed on a case by case basis with the patient, the reference team for PAH, and the gynecology department.The advantages of the intrauterine device (IUD) with progesterone (reliability, simplicity, compliance, few contraindications and interactions, possibility of use in the nulliparous patient, reimbursement by the healthcare system) make it a good contraceptive choice in these circumstances. Therapeutic abortion is a situation of contraceptive failure, it must always be performed in hospitals. It must lead to effective contraceptive advice