Prospective comparison of speckle tracking longitudinal bidimensional strain between two vendors

SummaryBackgroundSpeckle tracking is a relatively new, largely angle-independent technique used for the evaluation of myocardial longitudinal strain (LS). However, significant differences have been reported between LS values obtained by speckle tracking with the first generation of software products.AimsTo compare LS values obtained with the most recently released equipment from two manufacturers.MethodsSystematic scanning with head-to-head acquisition with no modification of the patient's position was performed in 64 patients with equipment from two different manufacturers, with subsequent off-line post-processing for speckle tracking LS assessment (Philips QLAB 9.0 and General Electric [GE] EchoPAC BT12). The interobserver variability of each software product was tested on a randomly selected set of 20 echocardiograms from the study population.ResultsGE and Philips interobserver coefficients of variation (CVs) for global LS (GLS) were 6.63% and 5.87%, respectively, indicating good reproducibility. Reproducibility was very variable for regional and segmental LS values, with CVs ranging from 7.58% to 49.21% with both software products. The concordance correlation coefficient (CCC) between GLS values was high at 0.95, indicating substantial agreement between the two methods. While good agreement was observed between midwall and apical regional strains with the two software products, basal regional strains were poorly correlated. The agreement between the two software products at a segmental level was very variable; the highest correlation was obtained for the apical cap (CCC 0.90) and the poorest for basal segments (CCC range 0.31–0.56).ConclusionsA high level of agreement and reproducibility for global but not for basal regional or segmental LS was found with two vendor-dependent software products. This finding may help to reinforce clinical acceptance of GLS in everyday clinical practice

Increased risk of left heart valve regurgitation associated with benfluorex use in patients with diabetes mellitus: a multicenter study.

International audienceBACKGROUND: Benfluorex was withdrawn from European markets in June 2010 after reports of an association with heart valve lesions. The link between benfluorex and valve regurgitations was based on small observational studies and retrospective estimations. We therefore designed an echocardiography-based multicenter study to compare the frequency of left heart valve regurgitations in diabetic patients exposed to benfluorex for at least 3 months and in diabetic control subjects never exposed to the drug. METHODS AND RESULTS: This reader-blinded, controlled study conducted in 10 centers in France between February 2010 and September 2011 prospectively included 376 diabetic subjects previously exposed to benfluorex who were referred by primary care physicians for echocardiography and 376 diabetic control subjects. Through the use of propensity scores, 293 patients and 293 control subjects were matched for age, sex, body mass index, smoking, dyslipidemia, hypertension, and coronary artery disease. The main outcome measure was the frequency of mild or greater left heart valve regurgitations. In the matched sample, the frequency and relative risk (odds ratio) of mild or greater left heart valve regurgitations were significantly increased in benfluorex patients compared with control subjects: 31.0% versus 12.9% (odds ratio, 3.55; 95% confidence interval, 2.03-6.21) for aortic and/or mitral regurgitation, 19.8% versus 4.7% (odds ratio, 5.29; 95% confidence interval, 2.46-11.4) for aortic regurgitation, and 19.4% versus 9.6% (odds ratio, 2.38; 95% confidence interval, 1.27-4.45) for mitral regurgitation. CONCLUSIONS: Our results indicate that the use of benfluorex is associated with a significant increase in the frequency of left heart valve regurgitations in diabetic patients. The natural history of benfluorex-induced valve abnormalities needs further research

From excessive high-flow, high-gradient to paradoxical low-flow, low-gradient aortic valve stenosis : hemodialysis arteriovenous fistula model

The coexistence of aortic valve stenosis (AS) with hemodialysis arteriovenous (AV) fistula complicates the assessment of the severity of valvular disease. We describe the physiological changes in stenotic indices which occur following manual compression of the AV fistula. The manual compression of the AV fistula is capable of inducing significant alterations in transvalvular flow rates and valvulo-arterial impedance that translates into important changes in aortic valve hemodynamics and grading of stenosis severity

Studies Evaluating Statin Adherence and Outcome Should Adjust for Smoking Persistence and Antiplatelet Treatment Discontinuation

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Secondary mitral regurgitation in heart failure with reduced or preserved left ventricular ejection fraction

Secondary mitral regurgitation (MR) has been extensively studied in heart failure due to reduced ejection fraction. In contrast, the occurrence and the pathogenesis of secondary MR are much less known in heart failure with preserved ejection fraction (HFpEF). The present review aimed at describing this common but ignored feature of HFpEF

Sub-aortic obstruction of left ventricular outflow tract secondary to benfluorex-induced endocardial fibrosis

Patients exposed to benfluorex have an increased risk of restrictive organic valvular heart disease. Aortic and mitral regurgitations caused by fibrotic valve disease are the most common features observed in exposure to fenfluramine derivatives in general and benfluorex in particular. We report here, for the first time to our knowledge, a well-documented case in which obstructive sub-aortic endocardium fibrosis within the left ventricular outflow tract is related with exposure to a drug that modifies the metabolism of serotonin. It now remains to be established whether extensive fibrosis of the myocardium in addition to well-documented valvular fibrosis may develop in patients exposed to amphetamine-derived drugs affecting the serotonin system

An unusual cause of low-flow, low-gradient severe aortic stenosis : left-to-right shunt due to atrial septal defect

Paradoxical low-flow, low-gradient severe aortic valve stenosis (AVS) may occur despite preserved left-ventricular (LV) ejection fraction in older females with marked LV concentric remodeling and small LV cavity size or in patients with coexisting severe mitral regurgitation. This report illustrates the case of a paradoxical low-flow, low-gradient severe AVS despite preserved LV function related to an ostium secundum atrial septal defect (ASD) in a patient presenting with congestive heart failure. Left-to-right shunt ASD that lowers forward LV stroke volume translating into lower transvalvular gradients is an underrecognized cause of paradoxical low-flow, low-gradient severe AVS. In addition, if not detected before open-heart surgery, ASD may result in cardiopulmonary bypass life-threatening complications