A transgenic mouse model mimicking human cardiac amyloidosis

Background

Heart failure (HF) pathophysiology complicating cardiac amyloidosis (CA) is poorly explored due to the lack of relevant animal model. A recently transgenic mouse expressing an amyloidogenic variant of human apolipoprotein AII was developed that showed ubiquitous amyloid deposit but limited data on cardiac involvement.

Purpose

To investigate heart structure and function in transgenic mice expressing an amyloidogenic variant of human apolipoprotein AII

Methods

Seventy-nine mice ageing 2 to 3 months were included in this study as follow: amyloidosis group (n=44) and sham (i.e. genetic mutation without phenotypic expression, n=35). Both were serially imaged by echocardiography (Vevo3100 Fujifilm) and cardiac magnetic resonance imaging (CMR, Biospec 4.7 tesla), and invasively explored by left–sided catheterization (pressure-volume loop [PV loop], Millar Catheterization), before sacrifice and histological investigations.

Results

As soon as 2–3 months of age, the amyloidosis group demonstrated significant left ventricular (LV) hypertrophy, diastolic dysfunction and left atrial dilatation compared with sham group (p<0.01). Left ventricular ejection fraction was initially normal in both groups but deteriorated in amyloidosis mice (p<0.001) before right ventricular function collapses (p<0.001). In amyloidosis group, PV loops showed significant LV end-diastolic pressure increase (p<0.001), stiffer LV (p<0.01) and reduced systolic function LV elastance (p<0.05). Invasive and non-invasive abnormalities paralleled severe CA deposits and subendocardial fibrosis matrix remodeling, both labeling by Congo red and Red Sirius coloration (p<0.001). CMR analysis showed significant T1 (p<0.05) and T2 (p<0.01) signal increase and significant decrease in myocardial perfusion (p<0.01) in the amyloidosis group. Clinically, mice with amyloidosis covered less distance during exercise test (p<0.001) and died earlier (log-rank test, p<0.01).

Conclusion

By mimicking human cardiac amyloidosis, the model of transgenic mouse expressing an amyloidogenic variant of human apolipoprotein AII is promising to investigate the underlying pathophysiology of heart failure due to amyloidosis.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer grant

Efficacy of simulation-based training on transoesophageal echocardiography learning in a multicentre randomised controlled trial: SIMULATOR study

Background

Evidence on the impact of simulation-based training in transesophageal echocardiography (TEE) is scarce.

Purpose

We aimed to assess the efficacy of simulation-based versus traditional teaching on TEE knowledge and skills for cardiology residents.

Methods

Between November 2020 and November 2021, all consecutive cardiology residents inexperienced from TEE were randomised (1:1, n=324) through 42 French University Centers into two groups with or without simulation support (either a simulation group or a traditional group). The coprimary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the feelings of residents were also assessed. An economic analysis was also performed.

Results

While the theoretical and practical test scores were similar between the two groups before the training (respectively P=0.80 and P=0.51), the residents in the simulation group displayed higher theoretical test and practical test scores after the training than those in the traditional group (respectively 47.2±15.6% vs. 38.3±19.8%, P<0.0001 and 74.5±17.7% vs. 59.0±25.1%, P<0.0001). Subgroups analyses showed that the efficacy of the simulation training was even greater when performed at the beginning of residency (P<0.0001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group (respectively 8.3±1.4 min vs. 9.4±1.2 min, P<0.0001). Finally, residents' feelings were better in the simulation group than in the traditional group across all components (P<0.0001). Compared to the traditional group, the average additional cost per resident of the simulation program was respectively €1,785, €942 or €662 for 20, 40 and 60 residents.

Conclusion

Simulation-based teaching on TEE showed a significant improvement in knowledge, skills, and feelings of cardiology residents as well as a reduction in the duration to complete the examination.

Funding Acknowledgement

Type of funding sources: None.

Cardiovascular manifestations secondary to COVID-19: A narrative review

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.

Right ventricular improvement is associated with left ventricular diastolic function and size enhancement in PAH patients: an echocardiographic study

Background

While pulmonary vasodilation therapy improves right ventricular (RV) function in pulmonary arterial hypertension (PAH), data regarding left ventricular (LV) function remain sparse.

Purpose

We aimed to investigate whether PAH therapy improve LV function in PAH patients.

Methods

Between 2002 and 2020, all incident PAH patients from one PH referral centers were included, treated and followed-up according to current ESC/ERS guidelines. All patients had comprehensive echocardiography both investigating right and left ventricular function before and after 1-year of vasodilation therapy. In addition to RV echocardiographic evaluation, we focused on LV ejection fraction from Modified Simpson method, LV diameters by M-mode, transmitral pulsed-wave E/A ratio, Flow to tissue Doppler imaging E/e' ratio, and left atrial size.

Results

126 patients were included (63% female, 57±17 yo), mainly from connectivite tissue associated and idiopathic PAH (24% and 28% respectively) causes. Compared to baseline, 1-year NYHA functional class (p<0.01), NTproBNP plasma level (p<0.001), invasive mean pulmonary arterial pressure (p<0.01) and cardiac index (p<0.01) significantly improved. While LV ejection fraction (p=0.68), LV end-diastolic diameter (p=0.11) as well as LA area and volume (p=0.09) were not significantly enhanced under vasodilation therapy, LV diastolic function, assessed by mitral E wave (p<0.01), tissue doppler imaging mitral e' wave (p=0.04), and E/A ratio (p=0.045) were significantly improved at 1-year. There was a significant correlation between LV end-diastolic diameter (p<0.001) and RV end-diastolic area (p<0.001) owing to the normalization of right- to left ventricular interdependence, as well as between mitral E wave and TAPSE (p=0.045).

Conclusion

By improving RV function, PAH vasodilation therapy enhances LV size and diastolic function and normalizes the biventricular interdependence.

Funding Acknowledgement

Type of funding sources: None.

Inclusion of echocardiographic measure of right ventricular function in the non-invasive French pulmonary arterial hypertension risk stratification method

Background

Although preserved right ventricular (RV) function is consistently associated with better survival in pulmonary arterial hypertension (PAH), the French risk assessment method has not yet considered echocardiographic criteria of RV function.

Purpose

In the present study, we tested the value of tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography for non-invasive PAH risk assessment.

Methods

We retrospectively studied a cohort of 306 incident PAH patients treated in two French expert centers who underwent follow-up TAPSE measurement from echocardiographic apical 4-chamber view in addition to previously validated invasive and non-invasive risk stratification variables. The primary composite outcome was 3-year lung transplantation free survival after follow-up assessment.

Results

At re-evaluation, 66% of patients were in NYHA functional class I-II and mean pulmonary arterial pressure, cardiac index, N-Terminal pro brain natriuretic peptide (NTproBNP), and 6-minute walk distance (6MWD) were 40±16 mmHg, 3.5±1.1 L/min/m2, 270 [interquartile range (IQR) 896] ng/L and 401 (IQR 213) meters, respectively. The primary outcome occurred in 58 (19%) patients. In multivariable Cox regression analysis, NYHA functional class I-II (p=0.02), NTproBNP <300 ng/L or BNP <50 ng/L (p=0.02), 6MWD >440m (p=0.049) and TAPSE≥17 mm (p=0.02) were associated with lung transplantation free survival. TAPSE provided similar information over 6MWD when both were used alternatively to stratify PAH patients at low risk (log-rank<0.001); Harrell's c-index 0.73.

Conclusion

Three dichotomized low-risk criteria (TAPSE, 6MWD and NTproBNP or BNP plasma levels) allow non-invasive risk assessment in PAH.

Funding Acknowledgement

Type of funding sources: None. 3-years transplant-free survival

Right ventricular reverse remodeling assessed by echocardiography as a new goal-oriented treatment strategy in PAH patients

Background

While in heart failure with reduced ejection fraction, left ventricular reverse remodeling assessed by transthoracic echocardiography (TTE) is associated with better prognosis, right ventricular reverse remodeling (RVRR) was less investigated in pulmonary arterial hypertension (PAH)

Purpose

We aimed to investigate whether RVVR assessed by echocardiography could help to stratify PAH patient's prognosis.

Methods

Between 2002 and 2019, all consecutive PAH patients were included, treated and followed in a single PAH center in accordance with the current ESC/ERS guidelines. In addition to regular risk stratification parameters, we measured several echocardiographic RV systolic function and size parameters, including tricuspid annular plane systolic excursion (TAPSE, mm) or RV-end diastolic area (cm2) from apical-4 chamber view both at baseline, 1-year of follow-up as well as their change. Primary composite outcome was three-year transplant-free survival and death from all cause from the 1-year evaluation. Conditional inference trees were used to determine which TTE parameters and cutoffs values were associated with primary outcome from hierarchy of multiple covariates in multivariable Cox regression analysis. Kaplan-Meier curves were then drawn and compared with log-rank test.

Results

126 incident PAH patients were included (63% female, mean age 59±18 yo), mainly due to connectivite-tissue disease and idiopathic PAH (26% and 22% respectively). At baseline, mean pulmonary arterial pressure was 42 (33, 52) mmHg. At 1-y follow-up under pulmonary vasodilation therapy, NYHA (p<0.01), NTproBNP (p<0.01), mean pulmonary arterial pressure (p<0.01) and cardiac index (p<0.01) were significantly improved compared to baseline. Conditional inference trees showed that 1-year TAPSE gain >1 mm and 1-year RV end-diastolic area decreased >2 cm2 were associated with 3-year transplant-free survival in multivariable Cox regression analysis (HR=0.23, 95% CI [0.08–0.61] p=0,0035, HR=0.34, 95% CI [0.12–0.94], p=0.038). Simple score from 0 (absence of RVRR), 1 (partial RVRR) and 2 (complete RVRR), describing the number of TTE parameters reach at 1-year was then investigated. Patients with complete RVRR depicted better transplant-free survival than partial or absence of RVRR, log-rank p<0.001 (figure).

Conclusion

Complete reverse remodeling from right ventricular size and function could represent a new goal-oriented treatment strategy in PAH patients.

Funding Acknowledgement

Type of funding sources: None. RVRR survival curves

Cardiovascular Comorbidities and Covid-19 in Women

Background

While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population.

Purpose

Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19.

Methods

We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death.

Results

Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1).

Conclusions

Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases.

Pulmonary Embolism in Covid-19 patients: A French Multicentre Cohort Study

Background

While pulmonary embolism (PE) appears to be a major issue in Covid-19, data remain sparse.

Purpose

We aimed to describe the risk factors and baseline characteristics of patients with PE in a large cohort of Covid-19 patients.

Methods

In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis, those who were directly admitted to an intensive care unit (ICU), and those still hospitalised without PE experience were excluded.

Results

Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer requirement and mechanical ventilation requirement were significantly higher in the PE group (P < 0.001 and P < 0.001, respectively). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91); P = 0.04 and OR 0.11, 95%CI(0.06-0.18); P < 0.001, respectively). In a multivariable analysis, the following variables (also statistically significant in univariable analysis) were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069); P = 0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), P < 0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), P < 0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), P = 0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), P = 0.002) (Table 1).

Conclusion

Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.

Modeling survival using decision tree analysis in pulmonary hypertension due to left heart disease. the prognostic significance of PVR &lt;3WU when TAPSE &lt;16mm

Aims

In 2019, PVR&lt;3 WU was adopted to stratify patients at low risk of pulmonary hypertension due to left heart disease (PH-LHD) as well those with isolated PH-LHD. We sought to evaluate whether the supervised machine learning with Decision Tree analysis that provides more information than Cox Proportional analysis by forming a hierarchy of multiple covariates, confirms this risk stratification.

Methods

202 consecutive patients (mean age: 69±11 y, females 42%) with mean pulmonary artery pressure (mPAP)≥20mmHg and wedge pressure&gt;15mmHg were recruited. Transpulmonary pressure gradient ≥12mmHg, pulmonary vascular resistance (PVR) ≥3WU, diastolic pressure gradient ≥7mmHg, pulmonary arterial capacitance&lt;1.1 ml/mmHg, TAPSE&lt;16 mm, peak systolic tissue Doppler velocity&lt;10cm/s and right ventricular end-diastolic area ≥25 cm2 were the seven categorical values to enter the model. To predict the mortality from the Decision Tree, we used the CHAID method. Each node and branch were compared using survival analysis at 6-year follow-up.

Results

Mean PAP, wedge pressure, cardiac index, and PVR were 40.3±10.0mmHg, 22.3±7.1mm Hg, 2.9±0.8L/min/m2, and 3.6±2.1WU, respectively. Among the seven dichotomous values linked to the prognosis in PH-LHD, only 2 variables entered the model. To predict the mortality, TAPSE was first selected following by PVR. Compared to patients with PVR&lt;3WU and TAPSE ≥16mm, patients with PVR ≥3WU and TAPSE ≥16mm or patients with PVR ≥3WU and TAPSE &lt;16 mm has significant increased mortality (HR=3,0, 95% CI: [1,4–6,4], p=0.006 and HR=3,3, 95% CI: [1,6–6,9], p=0.002, respectively), while patients with PVR &lt;3WU and TAPSE &lt;16 mm exhibiting the worst prognosis (HR=7,2, 95% CI: [3,3–15,9], p=0.0001).

Conclusion

Used for solving regression and classification problems, decision tree analysis indicates that among 7 prognostic factors, TAPSE and PVR have to be interpreted altogether and simultaneously in PH-LHD for mortality assessment. Therefore, in future research, PVR &lt;3 WU should be understood primarily based on right ventricular systolic function assessed by echocardiography whether TAPSE is or not ≥16 mm.

Funding Acknowledgement

Type of funding source: None

P1529 Impact of the new PH guidelines on echocardiographic definition leading to double demand of right heart catheterization

Background

Doppler echocardiography is the most widespread and well-recognized technique for the screening of patients with pulmonary hypertension (PH). When tricuspid regurgitation peak velocity (TRPV) ≥3.4 m/s, right heart catheterization is requested to confirm mean pulmonary artery pressure &gt;25 mm Hg. In the proceedings from the 6th world symposium on pulmonary arterial hypertension recently released, the new definition of PH has been lowered to mean pulmonary artery pressure &gt; 20 mm Hg.

Purpose

The purpose of our work was twofold : i) to determine a new cut-off value for TRPV to accommodate the new hemodynamic definition of PH, ii) to investigate the impact on the demand of right heart catheterization (RHC) from our echo CORE lab.

Methods

We extracted and analyzed both the haemodynamic and echocardiographic records of 130 patients who underwent investigations the same day. Tricuspid regurgitation peak velocity was measured in apical-4 chamber view using continuous-wave doppler modality and compared to mean pulmonary artery pressure recorded from fluid-filled catheter.

Results

Tricuspid regurgitation peak velocity has a weak correlation with mean pulmonary pressure (y = 9.2x-2.2, r² = 0.22, p &lt; 0.01). Targeting a mean pulmonary pressure on right heart catheterization of 20 mm Hg for the definition of PH, receiver operating characteristic curve analysis demonstrated a good association between TRPV and PH diagnosis (area under the curve, 0.78 ; p &lt; 0.001). The cut-off value obtained for TRPV was 3.0 m/s (Se = 0.78, Sp = 0.37). From 01/01/18 to 31/12/18, 2539 out of 6215 had TRPV recorded from which 283 had TRPV ≥ 3.0 m/s (24,1%) and 615 had TRPV ≥ 3.4 m/s (11,1%). When applied to a community population the new TRPV cutoff &gt; 3m/s used as surrogate for mean pulmonary artery pressure &gt; 20 mm Hg may produce a 111% increase of right heart catheterization demand.

Conclusions

The new definition of pulmonary hypertension (invasive mean pulmonary artery pressure &gt; 20mm Hg) necessitates revisiting tricuspid regurgitation peak velocity &gt; 3 m/s as a screening test leading to more than twice RHC demand.

P1360 Tricuspid peak systolic S wave tissue doppler velocity &gt;12 cm/s avoid 50% of right heart catheterization in Pulmonary Arterial Hypertension

Background

Clinical risk stratification in pulmonary arterial hypertension (PAH) relies on BNP level, NYHA functional class, 6min-walk distance and cardiac output by right heart catheterization (RHC) with no place for non-invasive mean like echocardiography.

Purpose

To avoid systematic RHC in PAH patients, we aimed to determine both tricuspid peak systolic S wave tissue Doppler velocity (S-DTI, cm/s) and tricuspid annular plane systolic excursion (TAPSE, mm) cut-off values that best correlated to invasive cardiac index ≥2.5l/min/m² (CI, meaning low risk clinical worsening or death) in an initial cohort and to test them in a validation cohort.

Methods

From a single referral pulmonary hypertension centre, 125 PAH patients (initial cohort) underwent 406 hemodynamic investigations with RHC and echocardiography on the same day. S-DTI and TAPSE were performed from a standard manner following the 2015 EACVI/ASE recommendations. This initial cohort served for the receiver operating characteristic analysis from which the cut-off values were investigated in a validation cohort, to test the cardiac index stratification.

Results

The initial cohort had a mean age of 66.9 ± 14.4 y. Mean pulmonary artery pressure averaged 44 ± 12 mmHg, CI was 2.8 ± 1.0 l/min/m2, S-DTI was 11.2 ± 2.9 cm/s and TAPSE was 18.4 ± 4.7 mm. Both pulsed S-DTI and TAPSE were correlated to invasive CI (p &lt; 0.001 and p &lt; 0.0001, respectively). S-DTI ≥12 cm/s or between &lt;12 cm/s and ≥10 cm/s with TAPSE &gt; 17 mm had a specificity of 0.89 and 0.90, respectively to detect CI ≥ 2.5l/min/m² from the ROC curve analysis. Applying this cutoff-based stratification provided similar results in the validation cohort of 97 PAH patients (mean age = 65 ± 16 y, mean pulmonary artery pressure = 45 ± 16 mmHg, CI = 3.0 ± 1.0 l/min/m2, while S-DTI = 11.1 ± 3.1 cm/s, TAPSE = 17.8 ± 5.4 mm). Overall, almost 50% of patients were appropriately classified avoiding RHC

Conclusion

Considering tricuspid peak systolic S wave tissue Doppler velocity ≥12 cm/s or &lt;12 cm/s but ≥10 cm/s with tricuspid annular plane systolic excursion by M-mode &gt;17 mm, then RHC may be avoided in almost 50% of patient to predict CI≥2.5l/min/m² in PAH patients.

P1389 Less dependent to loading conditions, TAPSE and S peak systolic tricuspid velocity are the 2 most robust indices to investigate right ventricular systolic function

Background

The daily challenge in pulmonary hypertension (PH) is to utilize a non-invasive echocardiographic parameter that is less load-dependent to follow-up right ventricular (RV) systolic function. VMAX, also called the maximum no-load contractile element velocity is known to be a strong load-independent contractility parameter, as good as the end-systolic pressure volume relationship that is simply obtained from pressure tracing.

Purpose

We aimed to investigate which among the 6 most common RV systolic function echocardiographic indices are less load-dependent by comparing them to VMAX.

Population

Sixteen patients scheduled for suspected or established PH had right-heart catheterization and ultrasound study the same day. Tricuspid annular plane systolic excursion (TAPSE), peak S tricuspid annulus velocity, both RV free wall and septal 2D strain, RV TEI index, tricuspid regurgitation - dP/dt and RV fractional area change were acquired from standardized echocardiographic protocol. The PressureWire Certus (Saint Jude Medical, Minnesota, USA) used to monitor invasive RV pressure is a 0.014" wire with high-fidelity sensor technology, operating with a frequency response of 0 to 25 Hz and exhibiting an accuracy of ± 1 mm Hg. A dedicated software was used to display simultaneously RV pressure and dP/dt and tracings where stored for offline analysis. VMAX was the y-axis intercept obtained by fitting a straight line through multiple points on the stress and pressure derivative curves by a least squares technique during isovolumic contraction.

Results

VMAX averaged 2.1 ± 0.9 length/s (range 0.80 to 4.43 length/s). The relationship is acceptable for the 2D strain (y = 0.08 x + 0.89, r = 0.53, p = 0.038) compared with VMAX, is improved between TAPSE and VMAX (y = 1.19x + 0.03, r = 0.76, p &lt; 0.0001) but is best between peak S tricuspid annulus velocity and VMAX (y = 0.26 x – 0.60, r = 0.90, p &lt; 0.0001). The TEI index, non-invasive dP/dt and right ventricular fractional area change did not correlate with VMAX. (FIG 1)

Conclusion

Both TAPSE and S peak systolic velocity are good markers of RV contractility with relatively load-independency in the setting of pulmonary hypertension.

Abstract P1389 Figure.

P344 Echocardiography right atrial area and inferior vena cava diameter interest to predict right atrial pressure in pulmonary arterial hypertension

Background

Risk stratification in Pulmonary Arterial Hypertension (PAH) is based on multiparametric approach including invasive measurement of invasive right atrial pressure (RAP) by right heart catheterization (RHC). Therefore, following 2015 ESC/ERS pulmonary hypertension (PH) guidelines, RHC are frequently repeated every 4 to 6 months until RAP &lt;8 mmHg.

Purpose

To explore the interest of right atrial area (RAA) and inferior vena cava (IVC) diameter measured by transthoracic echocardiography, as a surrogate for right atrial preload to detect RAP &lt;8 mm Hg and avoid repeated RHC in PAH patients.

Methods

From a prospective single PAH referral center, we have included all patients with a diagnosis of PAH (confirmed by PH team). During the follow up, transthoracic echocardiography and a RHC was performed on the same day. RAA (cm2) was measured in the apical four-chamber view, at end-systole, just prior to tricuspid valve opening, excluding the area under tricuspid valve annulus. In the subcostal view, at 1.0 to 2.0 cm from the junction with the right atrium, IVC diameter (mm) was reported. Both RAA and IVC were compared to RAP.

Results

97 PAH patients were included (35 males, mean age 65 ± 16y, mean arterial pressure was 45 ± 16 mmHg, cardiac index 3.0 ± 1.0 l/min/m² and right atrial pressure was 7.6 ± 4.7 mm Hg). Both IVC diameter and RAA averaged 18.1 ± 6.3mm and 22.5 ± 8.2 mm by echocardiography, respectively. IVC diameter and RAA had a significant but weak correlation with right atrial pressure &lt;8 mmHg measured by RHC (r = 0.42, p &lt; 0.01 and r = 0.41, p &lt; 0.01, respectively). Targeting a good specificity (Sp = 0.75), ROC curves analysis identified 10 mm for the IVC diameter and 20 cm² for RAA if IVC diameter was &gt; 10 but &lt; 20 mm to predict RAP &lt;8 mmHg (area under the curve = 0.72). Thus, in our cohort, 40% could have been followed-up non-invasively by echocardiography with IVC diameter ≤10 mm or &gt;10 but &lt;20 mm with RAA ≤20 cm² with only 2% of misclassification. For the remaining 58% unclassified PAH patients out of these echocardiographic ranges, RHC would have been requested.

Conclusion

In a cohort of PAH patients, targeting a low risk clinical worsening or death (identified by RAP &lt;8 mmHg in RHC), echocardiography, with the use of IVC diameter ≤10 mm or &gt;10 but &lt;20 mm with RAA ≤20 cm², right heart catheterisation may be avoided in 40% of cases with extremely low misclassification.

1409Use of phenomapping to determine response of treatment by sacubitril/valsartan in patients with heart failure with reduced ejection fraction

Background

Treatment by sacubitril/valsartan decreases mortality, improves KCCQ score and ejection fraction in patients with heart failure with reduced ejection fraction (HF REF), but there is currently no data to predict response to treatment.

Purpose

The purpose of our work was to assess whether unbiased clustering analysis, using dense phenotypic data, could identify phenotypically distinct HF-REF subtypes with good or no response after 6 months of sacubitril/valsartan administration.

Methods

A total of 78 patients in NYHA functional class 2–3 and treated by ACE inhibitor or AAR2, were prospectively assigned to equimolar sacubitril/valsartan replacement. We collected demographic, clinical, biological and imaging continuous variables. Phenotypic domains were imputed with 5 eigenvectors for missing value, then filtered if the Pearson correlation coefficient was >0.6 and standardized to mean±SD of 0±1. Thereafter, we used agglomerative hierarchical clustering for grouping phenotypic variables and patients, then generate a heat map (figure 1). Subsequently, participants were categorized using Penalized Model-Based Clustering. P<0,05 was considered significant.

Results

Mean age was 60.4±13.4 yo and 79.0% patients were males. Mean ejection fraction was 29.3±7.0%. Overall, 16 phenotypic domains were isolated (figure 1) and 3 phenogroups were identified (Table 1). Phenogroup 1 was remarkable by isolated left ventricular involvement (LVTDD 64.3±5.9mm vs 73.9±8.7 in group 2 and 63.8±5.7 in group3, p<0.001) with moderate diastolic dysfunction (DD), no mitral regurgitation (MR) and no pulmonary hypertension (PH). Phenogroups 2 and 3 corresponded to patients with severe PH (TRMV: 2.93±0.47m/s in group 2 and 3.15±0.61m/s in groupe 3 vs 2.16±0.32m/s in group 1), related to severe DD (phenogroup 2) or MR (phenogroup 3). In both phenogroups, the left atrium was significantly enlarged and the right ventricle was remodeled, compared with phenogroup 1. Despite more severe remodeling and more compromised hemodynamic in phenogroups 2 and 3, the echocardiographic response to sacubitril/valsartan was comparable in all groups with similar improvement of EF and reduction of cardiac chambers dimensions (response of treatment, defined by improvement of FE +15% and/or decreased of indexed left ventricule diastolic volume −15% = group 2: 22 (76%); group 3: 18 (60%); group 1: 9 (50%); p=0.17; OR group 2 vs 1: OR=3.14; IC95% [0.9–11.03]; p=0.074; OR group 3 vs 1: OR=1.5; IC95% [0.46–4.87]; p=0.5)). The clinical response was even better in phenogroups 2 and 3 (Group 2: 19 (66%); group 3: 21 (78%) vs group 1: 9 (50%); p=0.05).

Heat map

Conclusion

HF-REF patients with severe diastolic dysfunction, significant mitral regurgitation and elevated pulmonary hypertension by echocardiographic had similar reverse remodeling but better clinical improvement than patients with isolated left ventricular systolic dysfunction.

Rearing in captivity affects spermatogenesis and sperm quality in greater amberjack, Seriola dumerili (Risso, 1810)

The greater amberjack, (Risso, 1810), is a promising candidate for the diversification of European aquaculture production, but inconsistent reproduction in captivity prevents commercial production. Recent studies showed that greater amberjack confined in sea cages exhibited scarce gonad development and early interruption of gametogenic activity during the reproductive season. The aim of the present study was to improve our understanding of the observed impairment of spermatogenesis. Adult wild and captive-reared males were sampled during 3 different phases of the reproductive cycle: early gametogenesis (EARLY; late April to early May), advanced gametogenesis (ADVANCED; late May to early June), and spawning (SPAWNING; late June to July). Spermatogonial stem cells and proliferating germ cells were identified through the immunohistochemical localization of and proliferating cell nuclear antigen, respectively. Apoptotic germ cells were identified throughout the terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate nick end labeling method. Sperm quality of captive-reared fish was evaluated using computer-assisted sperm analysis. Captive-reared males exhibited seminiferous lobules of a smaller diameter, a precocious and progressive decrease of spermatogonial mitosis, and a high level of apoptosis at the beginning of the reproductive season, concomitant with a many-fold higher 17β-estradiol plasma concentration. The motile spermatozoa percentage of captive greater amberjack was lower than in other teleosts, and a drastic decrease of spermatozoa motility duration, velocity, and ATP content occurred along the reproductive season. An abnormal increase of sperm concentration as well as an increase of dead spermatozoa occurred during the SPAWNING phase, probably because of lack of sperm hydration and ejaculation and consequent sperm ageing. The present study demonstrates the extreme susceptibility of greater amberjack to rearing stress and underscores the need for improvement of the rearing and handling procedures to ameliorate gametogenesis dysfunctions in commercial aquaculture production.

The Nme gene family in fish

The Nme gene family, also known as Nm23 or NDPK, is a very ancient gene family that can be found in all kingdoms of life. In the late eighties, a gene of the Nme family, NME1, was identified as the first metastatic suppressor gene, resulting in a major interest for this family. Due to the complexity of the family, the need for a unified and evolutionary-supported gene nomenclature was recently stressed by the scientific community. Based on a complete evolutionary history study of the gene family in metazoans and vertebrates, a unified nomenclature was recently proposed and accepted by gene nomenclature consortia. In addition to its well-documented role in tumor metastasis, members of the Nme family are also involved in a wide variety of cellular and physiological processes. Available data in non-mammalian species remain, however, scarce with the noticeable exception of Drosophila in which a major role in development was reported. In fish, very few studies have specifically investigated the role of nme genes. Several transcriptomic and proteomic studies have, however, revealed the expression of nme genes in various fish organs and tissues, in mature oocytes, and during embryonic development. Altogether, interest for the Nme gene family in fish is growing and new functions/roles in fish biology are expected to be discovered in the forthcoming years. Here, we briefly review the current knowledge of the Nme family in fish.

GnRHa-mediated stimulation of the reproductive endocrine axis in captive Atlantic bluefin tuna, Thunnus thynnus

A controlled-release implant loaded with GnRH agonist (GnRHa) was used to induce spawning in Atlantic bluefin tuna (Thunnus thynnus) during two consecutive reproductive seasons. The fish were implanted underwater and sampled between days 2 and 8 after treatment. At the time of GnRHa treatment, females were in full vitellogenesis and males in spermiation. There was a rapid burst of pituitary luteinizing hormone (LH) release at day 2 after treatment in GnRHa-treated fish, and circulating LH remained elevated up to day 8 after treatment. In contrast, control fish had significantly lower levels in the plasma, but higher LH content in the pituitary, as observed in many other cultured fishes that fail to undergo oocyte maturation, ovulation and spawning unless induced by an exogenous GnRHa. Plasma testosterone (T) and 17β-estradiol (E(2)) were elevated in response to the GnRHa treatment in females, while 11-ketotestosterone (11-KT) but not T was elevated in males. Even though oocyte maturation and ovulation did occur in GnRHa-induced fish, no significant elevations in 17,20β-dihydroxy-4-pregnen-3-one (17,20β-P) or 17,20β,21-trihydroxy-4-pregnen-3-one (20β-S), in either the free, conjugated or 5β-reduced,3α-hydroxylated forms was observed in fish sampled within 6 days after treatment. Interestingly, a significant peak in plasma free 17,20β-P levels occurred in both males and females at day 8 after treatment. Histological sections of the ovaries in these females contained oocytes at the migrating germinal vesicle stage, suggesting the role of this hormone as a maturation-inducing steroid in Atlantic bluefin tuna. In conclusion, the GnRHa implants activated effectively the reproductive endocrine axis in captive Atlantic bluefin tuna broodstocks, through stimulation of sustained elevations in plasma LH, which in turn evoked the synthesis and secretion of the relevant sex steroids leading to gamete maturation and release.

The NME gene family in zebrafish oogenesis and early development

After the recent report of the expression of several nme genes in the zebrafish gonads, the present study aimed at further analyzing the expression of nme genes in the ovary with special attention for the nme transcripts that are maternally inherited and could thus participate in the determination of oocyte developmental competence. The expression levels of all groups I and II nme genes were characterized by QPCR in a panel of zebrafish tissues. The nme genes exhibiting an ovarian expression were subsequently monitored throughout oogenesis and early development, and their expression sites characterized using in situ hybridization. Here, we show that nme2b1, nme3, nme4, and nme6 are highly expressed in the ovary and present in the zebrafish oocyte throughout oogenesis. While the four transcripts are maternally inherited, nme3 and nme6 display a typical maternal profile and are detected in the zebrafish early embryo. In contrast to nme3, nme6, abundance exhibits a sharp decrease during early embryogenesis. After zygotic genome activation, we observed an increased expression of nme2b1, nme2b2, nme3, and nme6. The present study provides a comprehensive overview of the expression of nme family members during zebrafish oogenesis and early development. In addition, the maternal origin of two nme transcripts in the early embryo is reported here for the first time in any vertebrate species. Together, our observations suggest an important role of the nme family in oocyte and embryo development in vertebrates.

Sea bass Dicentrarchus labrax nervous necrosis virus isolates with distinct pathogenicity to sea bass larvae

Reproduction of nodavirus disease was performed by experimental infection of sea bass eggs during fertilization or at larval stage 4 with 2 genetically distinguishable nodavirus strains (Sb1 and Sb2) isolated from sea bass collected along the Atlantic and Mediterranean French coast. The pathogenicity of the virus strains was assigned after detection of the virus by ELISA and immunohistochemistry (IHC). The Atlantic (Sb1) strain was more pathogenic than the Mediterranean (Sb2) strain during the fertilization step whilst both strains were pathogenic following experimental exposure of 4 d old larvae. Virus lesions developed in the brain 4 to 6 d following experimental exposure. Experimental ELISA proved very sensitive for detecting the nodavirus in Sb1 or Sb2 experimentally infected larvae, as well as in naturally infected sea bass larvae collected in French hatcheries or in barramundi larvae reared in the Pacific area. The development of an ELISA specific for the 2 nodavirus strains isolated from the sea bass should be useful for the detection of the virus, in addition to other techniques recommended by the Office International des Epizooties (OIE).

Effects of osmolality, morphology perturbations and intracellular nucleotide content during the movement of sea bass (Dicentrarchus labrax) spermatozoa

Sea bass spermatozoa are maintained immotile in the seminal fluid, but initiate swimming for 45 s at 20 degrees C, immediately after dispersion in a hyperosmotic medium (1100 mOsm kg-1). The duration of this motile period could be extended by a reduction of the amplitude of the hyperosmotic shock. Five seconds after the initiation of motility, 94.4 +/- 1.8% of spermatozoa were motile with a swimming velocity of 141.8 +/- 1.2 microns s-1, a flagellar beat frequency of 60 Hz and a symmetric type of flagellar swimming, resulting in linear tracks. Velocity, flagellar beat frequency, percentage of motile cells and trajectory diameter decreased concomitantly throughout the swimming phase. After 30 s of motility, the flagellar beat became asymmetric, leading to circular trajectories. Ca2+ modulated the swimming pattern of demembranated spermatozoa, suggesting that the asymmetric waves produced by intact spermatozoa after 30 s of motility were induced by an accumulation of intracellular Ca2+. Moreover, increased ionic strength in the reactivation medium induced a dampening of waves in the distal portion of the flagellum and, at high values, resulted in an arrest of wave generation in demembranated spermatozoa. In non-demembranated cells, the intracellular ATP concentration fell immediately after transfer to sea water. In contrast, the AMP content increased during the same period, while the ADP content increased slightly. In addition, several morphological changes affected the mitochondria, chromatin and midpiece. These results indicate that the short swimming period of sea bass spermatozoa is controlled by energetic and cytoplasmic ionic conditions and that it is limited by osmotic stress, which induces marked changes in cell morphology.