Severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) was identified as a new coronavirus causing pneumonia and acute respiratory distress syndrome. It has become a pandemic, spreading particularly quickly across Europe and the US. Most deaths are related to severe acute respiratory distress syndrome, but other organ failures, such as acute kidney failure and acute cardiac injury, seem also related to the disease. 1 Inflammatory response is highly increased in coronavirus disease 2019 (COVID-19) infection, and inflammation is known to favor thrombosis. High dimerized plasmin fragment D (D-dimer) levels and procoagulant changes in coagulation pathways were reported among patients with severe COVID-19. 2,3 An elevated rate of venous and arterial thrombotic events associated with COVID-19 infection has also been reported. 4,5 This case series reports a systematic assessment of deep vein thrombosis among patients in an intensive care unit (ICU) in France with severe COVID-19. MethodsThis case series was approved by the ethical committee of the Centre Cardiologique du Nord, which granted a waiver of consent because the research presented no risk of harm and required no procedures for which consent is normally required outside a research context. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Patients with severe COVID-19 pneumonia were admitted to our ICU located in the suburban Paris area from mid-March 2020 to the beginning of April 2020. All patients had acute respiratory distress syndrome according to the Berlin definition and required mechanical ventilation.We prospectively performed a venous ultrasonogram of the inferior limbs for all patients at admission to our ICU, considering previous data that showed increased levels of inflammatory markers, preliminary reports from the intensive care community signaling frequent events of deep vein thrombosis in ICU patients with COVID-19 at the time we received our first patients, and the high rate of deep vein thrombosis found among the first patients with COVID-19 admitted to our unit.Considering the high prevalence of venous thrombosis at admission, we systematically repeated venous ultrasonography after 48 hours if the first examination returned normal results. As recommended, all patients received anticoagulant prophylaxis at hospital admission. Statistical analyses were conducted in Prism version 5.0 (GraphPad) and Excel 365 (Microsoft Corp). Statistical significance was set at P < .05, and all tests were 2-tailed. ResultsA total of 34 consecutive patients were included in this study. COVID-19 diagnosis was confirmed with polymerase chain reaction on nasopharyngeal swabs of 26 patients (76%); 8 patients (24%) had a negative result on polymerase chain reaction but had a typical pattern of COVID-19 pneumonia on chest computed tomography scan. Mean (SD) age was 62.2 (8.6) years, and 25 patients (78%) were men. Major comorbidities were diabetes (15 [44%]), hypertension (13 [38%]), and o...

The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828).

Background-Longitudinal myocardial deformation indexes appear superior to left ventricular ejection fraction (LVEF) in assessing myocardial contractility. However, few studies have addressed the prognostic value of longitudinal motion markers (velocity, strain, and strain rate) in predicting outcome in heart failure patients. Methods and Results-The study included 125 consecutive symptomatic heart failure patients (63Ϯ16 years, 77% male, LVEFϭ31Ϯ10%). All patients underwent a complete echocardiographic and clinical examination, and brain natriuretic peptide level was assessed in 93 patients. Longitudinal myocardial velocity by tissue Doppler imaging, global-, and strain rate by speckle tracking were computed from apical views (4-, 3-, and 2-chambers views) and compared with the occurrence of major adverse cardiac events. On the whole, peak longitudinal velocity, global-, and strain rate averaged 5Ϯ2 cm/s (range, 1 to 9), Ϫ8Ϯ3% (range, Ϫ3 to Ϫ18), and Ϫ0.33Ϯ0.16 s Ϫ1 (range, Ϫ0.83 to Ϫ0.05), respectively. During the follow-up period (266Ϯ177 days), major adverse cardiac events occurred in 47 (38%) patients (15 deaths, 29 recurrent heart failure, and 4 heart transplantations). By univariable analysis using Cox model global-, strain rate, and LVEF were associated with the occurrence of major adverse cardiac events, whereas only global-remained independently predictive of outcome by multivariate analysis. Conclusions-In the heart failure population, longitudinal global strain by speckle tracking is superior to LVEF and other longitudinal markers in identifying patients with poor outcome. (Circ Cardiovasc Imaging. 2010;3:249-256.)

Background:Normal values and the prognostic significance of right ventricle (RV)-2D strain in chronic heart failure (CHF) patients are unknown. Methods and Results:Between 2005 and 2010, we prospectively enrolled 43 controls and 118 stable CHF patients. Standard echocardiographic variables, tricuspid annular plane systolic excursion, peak systolic velocity of tricuspid annular motion using tissue Doppler imaging, and RV and left ventricle (LV) 2D-strain were measured. The primary outcome was death or emergency transplantation or emergency ventricular assist device implantation or acute heart failure. RV-2D strain was measurable in 39 controls (58±17 years, 50% men), whose median value was −30% (95% confidence interval [95%CI], −39%; −20%); and in 104 CHF patients (80% men, mean age 57±11 years, and mean LV ejection fraction 29%±8%), whose median value was −19% (95%CI, −34%; −9%). During the mean follow-up of 37±14 months, 44 experienced the primary outcome. By Cox proportional hazards multivariate analysis, only RV-2D strain and log B-type natriuretic peptide independently predicted experiencing the primary outcome within the first year. The best RV-2D strain cut-off by receiver-operating characteristics analysis was −21%, and patients with values >−21% were at greatest risk ( χ2 -log-rank test=14.1, P<0.0001).Conclusions: RV-2D strain is a strong independent predictor of severe adverse events in patients with CHF and may be superior to other systolic RV or LV echocardiographic variables. (Circ J 2012; 76: 127 - 136)