Accurate quantification of chronic aortic regurgitation (AR) using 2D-TTE is sometimes challenging. Cardiac magnetic resonance imaging (CMR) is increasingly used to refine this assessment by estimating measurement of regurgitation fraction (RF), but remains not widely available. 3D echocardiography (3D-ETT) allows a non-invasive approach of right ventricular (RV) and left ventricular (LV) volumes with a good correlation with CMR measurements. The 3D-TTE volume method is based on the comparison of RV and LV stroke volumes, which is then used to calculate the RF of the aortic valve in isolated AR.The primary objective of this study was to investigate the ability of 3D-TTE to assess the severity of chronic AR based on the criterion of regurgitation fraction (RF) obtained by the volume method in comparison to PC-CMR. We enrolled 42 patients with isolated AR who underwent ASE algorithm-guided 2D echocardiography (2D-TTE), 3D echocardiography and CMR. Regurgitation fraction (RF) was calculated by 3D-TTE using the formula [(LV Stroke Volume–RV Stroke Volume)/LV Stroke Volume] × 100. Correlation and concordance between 3D-TTE-RF and PC-CMR-RF were analyzed. Reproducibility of 3D-TTE-RF measurement was evaluated. Seven (17%) had mild AR, 27 (64%) moderate AR, and 8 (19%) severe AR in PC-CMR. Mean RF was 32.7 ± 13.9% by 3D-TTE and 30,7 ± 14,9% by PC-CMR-RF (P < 0,05). 3D-TTE-RF and PC-CMR-RF had a good correlation (r = 0.90, P < 0,05). We found a good intra-operator (r:0.95, P < 0.05) and inter-operator (r:0.87, P < 0.05) reproductibility. The final gradation of AR was concordant between 3D TTE and PC-CMR in 88% of the cases. The assessment of isolated aortic regurgitation fraction in 3D-TTE by the volumetric method is a feasible and reproducible method in daily clinical practice, with a good correlation to PC-CMR. Estimation of the aortic regurgitation fraction in (Fig. 1).

Transthyretin cardiac amyloidosis (ATTR-CA) is an emerging cause of heart failure. The screening of ATTR-CA remains difficult since its echocardiographic features are analogous to those observed in patients with age- and hypertension-related cardiac remodeling. We retrospectively included 264 patients (76 ± 13 years old, 59% male) referred for suspected ATTR-CA. A supervised machine learning diagnosis algorithm differentiating patients with (n = 112) and without (n = 152) ATTR-CA was constructed based on echocardiographic data, and subsequently validated in an external multicenter cohort of 455 patients (76 ± 13 years old, 61% male). Patients with ATTR-CA had a lower systolic function (LVEF 47.4 ± 11 vs. 54.3 ± 12%, P < 0.001), left ventricular (LV) global longitudinal strain (GLS) (11.0 ± 3.7 vs. 14.2 ± 4.5%, P < 0.001) and more significant relative apical longitudinal sparing (RALS) (1.5 ± 1.2 vs. 0.9 ± 0.4, P < 0.001) compared to controls. Machine learning identified right ventricular free wall thickness (RVFWT), RALS, relative wall thickness (RWT), and LV mass index as key variables for identifying ATTR-CA (AUC 0.88 [0.84–0.92]; P < 0.001). The diagnostic value of this R3M (RVFWT, RALS, RWT and LV Mass index) algorithm was good in the validation multicenter cohort with an AUC of 0.79 [0.75–0.83] P < 0.001. The R3M algorithm further improved diagnostic accuracy over the IWT (Increased Wall Thickness) guidelines score (increase in C-index of 0.15 [0.10–0.21], P < 0.001). The simple R3M algorithm based on echocardiographic data exploring RVFWT, apical sparing, and concentric hypertrophy displays good diagnostic accuracy for ATTR-CA and could represent an efficient screening tool (Fig. 1).

Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative to reduce the risk of stroke for patients with non-valvular atrial fibrillation. It still remains however unclear whether LAAC can cause a potential hemodynamic impairment or not. Our retrospective monocentric study included 62 patients who underwent LAAC between 2015 and 2019. Patients were put into two groups based on new onset or worsening of heart failure (HF) signs within 12 months after LAAC procedure: HF patients ( n = 19) and no HF patients ( n = 49). In comparison with no HF patients, those who experienced new onset heart failure or worsening HF had lower left ventricular ejection fraction (LVEF) at presentation (no HF pts 60.7 ± 9% vs. HF pts 49.1 ± 12.5%, P < 0.001), higher left atrial diameter (3.6 ± 0.6 cm vs. 4.2 ± 0.5 cm, P < 0.001), higher left atrial area (26.5 ± 8 cm 2 vs. 32.1+/6.4 cm 2 , P < 0.01) and tended to have a higher left atrial volume index (52.8 ± 28 mL/m 2 vs. 62.4 ± 22 mL/m 2 , P = 0.07). 12 weeks after LAAC procedure, a B-type natriuretic peptide (BNP or NT-proBNP) increase > 30% was more frequently observed in HF patients (30.8% vs. 80%, P < 0.001) without significant difference in left atrial remodeling. Device-related thrombus was observed in 3 patients with HF (2,3% vs. 15,8%, P = 0,05) and residual peridevice leak in 4 patients (15,4% vs. 20%, P = 0,4). After 2 years of follow-up, Kaplan–Meier estimated that survival was not significantly different among these two groups. Our results suggested that monitoring possible occurrence of heart failure should be tested after LAAC, especially in the patients with previous HF. Further investigations concerning biological and imaging data predictive factors of heart failure in a large population are needed.

Introduction. - Cardiac MRI is increasingly used to assess and monitor pulmonary vascular disease. State of the art. - In pulmonary arterial hypertension, the role of cardiac MRI has become more clearly defined due to its proven capacity to assess the morphology and function not only of the heart, but also of pulmonary circulation. Complementarily to echocardiography, technological advances have rendered it possible for MRI to search and assess shunts. More generally, MRI provides prognostic information on the follow-up of patients undergoing treatment. In cases of chronic thromboembolic pulmonary hypertension, chest MRI locates lesions and assesses pulmonary microcirculation, thereby guiding therapeutic choice. It is also an important prognostic marker in diagnosis and follow-up of patients undergoing treatment. To ensure high-quality examination, it is essential that the patient having to carry out repeated apneas cooperate. Prospects. - Studies are ongoing in view of clarifying the role of cardiac MRI as compared to right cardiac catheterization in the follow-up of patients with pulmonary arterial hypertension. Conclusions. - Cardiac MRI is the examination of choice in assessment of right ventricular morphology and function. It is a minimally invasive technique with good inter- and intra-operator reproducibility in the evaluation of patients with pulmonary arterial hypertension and chronic pulmonary thromboembolic hypertension. (C) 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Introduction: T1-based method is considered as the gold standard for extracellular volume fraction (ECV) mapping. This technique requires at least a 10 min delay after injection to acquire the post injection T1 map. Quantitative analysis of Dynamic Contrast Enhancement (DCE) images could lead to an earlier estimation of an ECV like parameter (2 min). The purpose of this study was to design a quantitative pixel-wise DCE analysis workflow to assess the feasibility of an early estimation of ECV. Methods: Fourteen patients with mitral valve prolapse were included in this study. The MR protocol, performed on a 3 T MR scanner, included MOLLI sequences for T1 maps acquisition and a standard SR-turboFlash sequence for dynamic acquisition. DCE data were acquired for at least 120 s. We implemented a full DCE analysis pipeline with a pre-processing step using an innovative motion correction algorithm (RC-REG algorithm) and a post-processing step using the extended Tofts Model (ECVETM). Estimated ECVETM maps were compared to standard T1-based ECV maps (ECVT1) with both a Pearson correlation analysis and a group-wise analysis. Results: Image and map quality assessment showed systematic improvements using the proposed workflow. Strong correlation was found between ECVETM, and ECVT1 values (r-square = 0.87). Conclusion: A DCE analysis workflow based on RC-REG algorithm and ETM analysis can provide good quality parametric maps. Therefore, it is possible to extract ECV values from a 2 min-long DCE acquisition that are strongly correlated with ECV values from the T1 based method.

Les objectifs de l'imagerie dans les anévrysmes ou faux-anévrymes infectieux de l'aorte sont de confirmer la suspicion clinicobiologique, d'établir un diagnostic de gravité (risque de rupture), d'extension, et de suivre le patient pendant et après son traitement. Ceci nécessite une approche multimodale, associant scanner, échographie, imagerie par résonance magnétique (IRM) et tomographie par émission de positons (TEP). Ainsi, il est possible de bénéficier de la haute résolution spatiale et de la large couverture du scanner, première étape dans le contexte de l'urgence en particulier, et qui permet le suivi des dimensions de l'anévrysme grâce à une très bonne reproductibilité. L'IRM, avec sa très bonne résolution en contraste, et surtout la TEP apportent des informations fonctionnelles complémentaires, concernant l'inflammation et l'infection, et de rechercher d'autres foyers infectieux dont une éventuelle porte d'entrée. Il est donc souhaitable qu'en cas de suspicion clinicobiologique, éventuellement étayée par un scanner, le patient soit transféré vers un centre qui dispose d'un plateau technique complet et des différents spécialistes de l'imagerie médicale.

Le CIRTACI propose dans cet article des recommandations pour optimiser la qualité des examens oncologiques en tomodensitométrie et la dose d’iode injectée. La recommandation propose une méthodologie de minimisation de la dose d’iode injectée en partant d’une dose de 0,5 gramme d’iode/kg à 120 kV, ou 0,4 gI/kg à 100 kV ou 0,3 gI/kg à 80 kV. Chez les obèses, il faut calculer la dose en fonction de la surface corporelle plutôt qu’au poids. L’utilisation des produits de contraste iodé doit répondre à des objectifs de qualité de prise en charge des patients. Ces recommandations répondent à cet impératif. In this article, CIRTACI offers recommendations to optimize the quality of oncologic computed tomography examinations and the iodine dose. The paper describes a method to minimize the injected iodine dose, starting with a dose of 0.4 gI/kg at 100 kV ou 0.3 gI/kg at 80 kV. In obese patients, the paper proposes to calculate the dose based on body surface rather than weight. These recommendations provide useful points to help radiologists concerning the use of iodine contrast agent.

Abstract Introduction Mitral annular disjunction (MAD) is an anatomical variation of the mitral annulus, characterized by an atrial displacement of the leaflet’s hinge points. It is associated with severe ventricular arrhythmias (VA) in mitral valve prolapse (MVP). Purpose The aim of this study was to assess MAD in MVP by echocardiography, analyze the reproducibility of measurements and evaluate its importance for arrhythmic risk stratification along with strain analysis of myocardial deformation. Methods Two hundred and sixty patients with MVP were included. MAD was evaluated and measured by two observers in the parasternal long axis and in the apical views. Myocardial longitudinal strain was analyzed by speckle-tracking. Results Ninety four patients (36.2%) of MVP patients presented MAD. These patients were younger (53.7 ± 15.1 vs 58.4 ± 17.6, p = 0.033) with higher rate of atypical chest pain (21.3% vs 11.5%, p = 0,041) and bileaflet prolapse (50.5% vs 32.3%, p = 0.004). Para-sternal long-axis view was the incidence of choice to detect MAD with a moderate inter-observer concordance (Kappa of 0.55), good correlation (r = 0.69, p < 0.01) and inter-class correlation coefficient (0.82; 0.67 – 0.90). Twenty patients (7.7%) had a history of severe VA. Among them, no difference was noted in terms of presence (35% vs 36.3%, p = 0.911) or length of MAD (11.1 ± 2.5 vs 11.2 ± 3.1, p = 0.937). However, deformation analysis showed reduced global longitudinal strain (18.6 ± 3.1 vs 21.3 ± 3.3%, p = 0.001) and higher mechanical dispersion values (46 ± 13 vs 37.4 ± 12.9 ms, p = 0.002)in comparison to the rest of the MVP population. Conclusion No significant association was found between severe VA and the presence or severity of MAD in MVP patients. Increased mechanical dispersion and reduced global longitudinal strain may be helpful for arrhythmic risk stratification. Abstract P668 Figure. Comparison of MD and GLS

Le suivi hémodynamique dans l’hypertension artérielle pulmonaire (HTAP) est actuellement principalement basé sur les résultats du cathétérisme cardiaque droit (CCD). L’objectif principal de l’étude EVITA est de comparer l’imagerie par résonance magnétique cardiaque (IRMc) au CCD afin d’établir un diagnostic d’état hémodynamique défavorable. Les objectifs secondaires permettront de préciser le rôle de l’IRMc dans une stratégie de suivi. L’ensemble des patients réaliseront lors du diagnostic et du suivi une IRMc et un CCD. Les patients seront suivis et traités selon les recommandations actuelles. Le critère principal d’évaluation sera un état hémodynamique défavorable défini par un index cardiaque<2,5L/min/m2 ou une pression auriculaire droite≥8mm Hg par CCD en comparaison à un index cardiaque<2,5L/min/m2 ou une fraction d’éjection ventriculaire droite (FEVD)<35 % ou une diminution en valeur absolue de 10 % de la FEVD par rapport à la précédente mesure effectuée par IRMc. Les valeurs exactes de sensibilité, de spécificité et les intervalles de confiance à 95 % seront calculés. Un effectif de 180 patients permettra d’avoir une puissance de 90 % à un risque α de 5 %. Les analyses de Cox univariées et multivariées permettront de répondre aux objectifs secondaires. Nous espérons démontrer que l’IRMc peut en partie se substituer au CCD lors du suivi des patients ayant une HTAP.

Haemodynamic follow up in pulmonary arterial hypertension (PAH) is currently based on right heart catheterisation (RHC). The primary objective of the EVITA study is to compare the use of cardiac magnetic resonance imaging (cMRI) with RHC in the identification of an unfavourable hemodynamic status. The secondary objectives are to determine the role of cMRI in the follow up process. Patients will undergo at diagnosis and at follow up visits both RHC and cMRI. Patients will be followed and treated according to the current guidelines. The primary endpoint will be an unfavourable haemodynamic status defined by cardiac index<2.5L/min/m2 or a right atrial pressure≥8mm Hg measured with RHC compared with a cardiac index<2.5L/min/m2 or right ventricle ejection fraction<35% or an absolute decrease of 10% from the previous measurement with cMRI. Exact values of sensitivity, specificity and 95% confidence intervals will be computed. A population of 180 subjects will have a power of 90% with an α risk of 5%. Univariate and multivariate Cox analysis will allow answering to the secondary objectives. We expect to demonstrate that cMRI could be partly used instead of RHC in the follow up of patients with PAH.

Poster: EANM 17 / E-PW001 / The FDG-PET metabolic pattern, involving a low baseline-level and a subsequent increase, remains a landmark of less favorable outcome for the abdominal aortic aneurysms treated by endovascular prosthesis by: P.-Y. Marie1, D. Plisonnier2, S. Bravetti1, R. Coscas3, M. Rouer2, S. Haulon4, D. Mandry1, J.-M. Alsac5, S. Malikov1, N. Settembre1, Y. Goueffic6, O. Morel7, V. Roch1, E. Micard1, Z. Lamiral1, J.-B. Michel8, P. Rossignol1; 1CHRU-Nancy, Vandoeuvre, FRANCE, 2CHU-Rouen, Rouen, FRANCE, 3Hopital Ambroise Pare, Paris, FRANCE, 4CHRU-Lille, Lille, FRANCE, 5Hopital HEGP, Paris, FRANCE, 6CHU-Nantes, Nantes, FRANCE, 7CHU-Besancon, Besancon, FRANCE, 8INSERM Bichat, UMR 698, Paris, FRANCE

Objective: Central pressure waveform can be decomposed into pressure transmission and reflection waves. Aorta impedance (Zc) can be measured through recording pulse pressure signal and aortic flow signal. Zc reflects structural and functional properties of elastic central and peripheral muscular arteries. Design and method: This study proposed a novel method using wave intensity analysis to assess reflected waves by decomposition of magnetic resonance imaging (MRI) of central aortic flow and central aortic pressure waveforms measured by tonometry in 30 older subjects allowing to obtain Zc in time domain, reflection index (IR) and reflection magnitude (MR). Therefore a graphical user interfaces and methods for automatic signal treatments were programmed. Results: Elderly patients were mean aged of 75.25 ± 5.85 years (14 female, 16 male). No significant differences were observed between gender groups in terms of weight, height, pressure parameters and impedances parameters. Mean Zc value was 424.34 ± 94.41 DSC for the whole aging population. We found a strong negative association between Zc and LVET (r = −0.53, p = 0.004) and a trend of negative association between Zc and aortic diameter, at the aortic root, (r = −0.36, p = 0.05). RM associated positively with thoracic aorta length (r2 = 0.15, p = 0.04) after adjustment to age and height, IR also associated positively with thoracic aorta length (r2 = 0.16, p = 0.04) after adjustment to age and height. Conclusions: This automatical signal treatment of aortic flow and pulse pressure waveform is a good MRI method for assessment of wave reflections in older subjects allowing obtaining reflection magnitude. What can be observed is that reflected waves depended strongly on thoracic aorta length. Moreover, Zc is inversely correlated to left ventricular ejection time and aortic diameter.

INTRODUCTION:The pneumonic form is very characteristic of lepidic pattern adenocarcinoma of the lung. However, the diagnosis and treatment of the disease when it presents in this way may be delayed by atypical radiological findings and severity of hypoxemia. CASE REPORT:A 48-year-old female, non-smoker, asthmatic since the age of 20 years, was hospitalized for a diffuse infiltrative pneumonia complicated by severe respiratory failure. The history included chronic cough, gradually increasing dyspnoea on exertion lasting for 14 months and the onset of haemoptysis of low abundance associated with arthralgia in the previous month. She had no professional or domestic exposure to any risk factors. Chest CT scan revealed bilateral alveolar condensations, ground glass areas with thickened septa creating a crazy paving pattern, and numerous large cysts of various sizes and locations, often with irregular thin walls. Microbiological and immunological tests were negative. She required early invasive ventilation and then venovenous ECMO together with broad-spectrum empiric antibiotic therapy, but died after 39 days in intensive care. The autopsy revealed lesions consistent with mucinous lepedic adenocarcinoma with no EGFR mutation and KRAS mutation. There was also associated pulmonary suppuration. CONCLUSION:Mucinous lepidic adenocarcinoma is an alternative diagnosis for pneumonic consolidation associated with multiple cysts.