380 Abstracts / Annales de Cardiologie et d’Angéiologie 62 (2013) 372–381

La ventriculographie retrouvait une masse calcifiée refoulant la valve mitrale.Le scanner cardiaque retrouve une masse calcifiée intrapariétale adjacente à lavavle mitrale postérieure d’environ 4 × 2,5 cm.Confirmation à l’IRM avec une masse en isosignal T1 et T2 ne prenant pas legadolinium mais avec rehaussement de ses pourtours.La patiente a été transférée en chirurgie cardiaque pour subir un double rempla-cement valvulaire mitro-aortique par bioprothèse avec exérèse de la tumeur.L’anatomopathologie confirmera la volumineuse nécrose d’athérome.Conclusion.– L’intérêt de cette observation outre le fait de mettre en lumière unepathologie peu connue réside dans l’iconographie tout à fait inhabituelle.La nécrose d’athérome est une cause rare de valvulopathie pouvant en imposerpour une tumeur cardiaque et dans laquelle la chirurgie cardiaque permet uneévolution clinique favorable.

http://dx.doi.org/10.1016/j.ancard.2013.07.026

Valvulopathies

CT scan measurement of aortic annulusdiameter before TAVI: Which is the mostreliable method?S. Fradi a, N. Amabile a, V. Spagnoli a, S. Ghostine a,A. Azmoun b, R. Ramadan b, R. Nottin b, P. Deleuze b,C. Caussin a

a Department of Cardiology, Marie Lannelongue Hospital, 92350 LePlessis-Robinson, Franceb Department of Cardiac Surgery, Marie Lannelongue Hospital, 92350 LePlessis-Robinson, France

Background.– TAVI has become an alternative therapeutic in patients pre-senting with high-risk symptomatic severe AS. The aortic annulus diameterdetermination prior to intervention is crucial to choose the appropriate devicediameter. However, due to a lack of consensus, the measurements obtai-ned through various methods can generate inhomogeneous and divergingresults.We sought to compare different CT scan methods for aortic annulus measurementin order to establish a standardized and reproducible method its determination.Methods.– We retrospectively studied CT scans data from n = 201 patients whounderwent TAVI in our institution between November 2008 and December 2012.We analyzed five methods of annulus measurement: four using CT scans(basal complete commissural coaptation/BCCC, lowest plane of central val-vular coaptation and virtual annulus planimetry in long and short axis) andone using trans thoracic echocardiography (TTE) in parasternal long axis.We determined the intra and inter-observer reproducibility of these mea-surements and analyzed their predictive value for post-implantation aorticregurgitation.Results.– The annulus diameter varied according to the CT scan methods andranged from 24.6 ± 2.6 mm to 27.7 ± 3.1 mm, whereas it was smaller whenmeasured with TTE (21.5 ± 2.2 mm, P < 0.001).The variability and limits of agreement showed acceptable reliability for the dif-ferent CT methods according to the definitions. Hence, the intra-observer andinter-observer coefficients of variations were < 5% for all parameters, suggestingexcellent reproducibility. A moderate to severe aortic regurgitation was obser-ved in 9.8% of the patients following TAVI. Receiver operating curves (ROC)analysis revealed that the BCCC method was the most accurate to predict asignificant AR (Area under the curve: 0.72 ± 0.05, P = 0.002).Annulus rupture rate was low in our series (1%) and independent from deviceoversizing.Conclusion.– CT scan gives higher values of aortic annulus diameter comparedto TTE evaluation. The basal complete commissural coaptation method is areliable and reproducible index and is the only CT scan method that can predictpost implantation moderate to severe AR.

http://dx.doi.org/10.1016/j.ancard.2013.07.027

Comparison of BARC and VARC criteria forbleeding events assessment after TAVIN. Amabile a, S. Fradi a, S. Ghostine a, P. Brenot a,A. Azmoun b, R. Ramadan b, R. Nottin b, P. Deleuze b,R. Mehran c, C. Caussin a

a Department of Cardiology, Marie Lannelongue Hospital, 92350 LePlessis-Robinson, Franceb Department of Cardiac Surgery, Marie Lannelongue Hospital, 92350 LePlessis-Robinson, Francec Department of Cardiology, Mount Sinai Hospital, New York City, USA

Background.– Transcatheter Aortic Valve Implantation (TAVI) is an alternativesolution for patients with aortic stenosis who are refused for conventional sur-gery. TAVI procedures are frequently complicated with hemorrhagic events thatnegatively impact prognosis. Different bleedings classifications are availablefor interventional cardiologists, but very few have been validated for the TAVIprocedures.Aims.– To compare the Bleeding Academic Research Consortium (BARC) andValve Academic Research Consortium (VARC) classifications for prediction of1-year mortality in patients undergoing TAVI.Patients and results.– Between November 2008 and December 2012, n = 260consecutive patients with symptomatic severe aortic stenosis underwent TAVIin our institution (83.5 ± 6.5 y; 48% men; mean Euroscore = 20.2 ± 12.5)using transfemoral (83.8%), transapical (12.7%) or alternative (3.5%) access.Edwards-Sapien© and Medtronic Corevalve© devices were respectively usedin 74% and 26% of the cases. Bleeding events were assessed with the use ofBARC and VARC classifications. The patients were prospectively followed-upafter the procedure and subsequent clinical events were recorded.A total of n = 98 bleeding events were recorded following the TAVI proce-dure and were related to access-site complications in 72% of the cases. Thesecomplications were classified as Type 1 (4%), Type 2 (7%), Type 3 (25%) andType 5 (2%) in the BARC classification and minor (10%), major (18%) andlife-threatening/disabling (11%) according to the VARC criteria.The actuarial global survival was 81.4% at 1 year (median follow-up: 352days/interquartile range: 374 days). The mortality was significantly higher inpatients with severe bleeding events compared to patients with minor or nobleeding, irrespective of the classification. The receiver operating characteris-tics curves analysis revealed comparable performances of the VARC and BARCscales for prediction of all-cause mortality: the AUCs (area under the curve) wererespectively 0.62 ± 0.05 (P = 0.01) and 0.61 ± 0.05 (P = 0.02). BARC class > 2bleeding was associated with an increased risk of all-cause mortality (HR = 2.4[1.3–4.2], P = 0.004) in univariable Cox regression analysis. This relationshippersisted after adjustment for confounding factors.Conclusion.– Haemorrhagic complications are frequent after TAVI proceduresand are mainly related to local cause. Both BARC and VARC classification areappropriate to assess bleedings severity and provides prognosis information.

http://dx.doi.org/10.1016/j.ancard.2013.07.028

Aspect IRM atypique du syndrome deTako-Tsubo : à propos d’un casM. Melay , N. Ferrier , X. Marcaggi , J.-L. LongService de cardiologie, CH Jacques-Lacarin, 03207, Vichy, France

Introduction.– Depuis les années 1990, une nouvelle entité de cardiomyopathieest décrite : le syndrome de Tako-Tsubo. Des critères ont été définis par la MayoClinic afin de faciliter le diagnostic : dysfonction VG, modifications électriques,récupération complète. . .Cas clinique.– Il s’agit d’une patiente caucasienne âgée de 66 ans hospitaliséepour un syndrome douloureux thoracique survenu au cours de l’enterrementd’un proche. À la prise en charge, on note la présence d’un sus décalage du seg-ment ST. La patiente recoit le traitement conventionnel du syndrome coronaireaigu. L’échographie, la coronarographie sont en faveur d’un syndrome de Tako-Tsubo. L’IRM montre une localisation atypique : un rehaussement tardif sousépicardique associé épanchement péricardique mimant une myopéricardite.Discussion.– Actuellement, le syndrome de ballonisation apicale est affirmé surl’association de critères : douleur thoracique avec troponine positive, absence

Abstracts / Annales de Cardiologie et d’Angéiologie 62 (2013) 372–381 381

d’obstruction des artères coronaires angiographique, cinétique caractéristique àl’échographie du ventricule gauche et/ou ventriculographie.Chaque cardiomyopathie présente des caractéristiques spécifiques à l’IRM,celle-ci apporte une aide précieuse et permet souvent de redresser le diagnostic.Avec l’expérience, on décrit plusieurs types d’atteintes à l’IRM du syndrome deTako-Tsubo : atteinte apicale, médio ventriculaire, bi ventriculaire et basal.

Conclusion.– L’IRM semble désormais indispensable dans le cas de syndromecoronaire aigu à coronaires saines.Cependant, les anomalies IRM n’étant pas encore toutes connues dans ce syn-drome de découverte récente, il faut poursuivre l’étude des caractéristiquesprécises à l’IRM du syndrome de Tako-Tsubo.

http://dx.doi.org/10.1016/j.ancard.2013.07.029