8^th Global Cardiologists and Echocardiography Annual Meeting

Biography

Biography: Guy Hugues Fontaine

Abstract

Echocardiography is nowadays the simplest and less expensive mode of cardiac imaging. However, its value on RV functionrnneeds to know some of the basics in the pathology of this chamber starting by normal RV. RV free wall is very thin (3 mm)rnas compared to the LV (10 mm). Also, in the normal heart there is practically no contribution of RV in hemodynamics andrnfinally a detailed histological feature shows the presence of an exceedingly large amount of fat (without fibrosis) which explains irreversible RV failure in 12% of heart transplant patients. Therefore, it seems obvious that research efforts have to be directedrntowards a proper investigation of these parameters which can be reconsidered with recent advances in echocardiography suchrnas strain, speckle technique, 3D echocardiography, etc. Especially, because the mechanism and the trouble of development of this disease has been properly reproduced in the laboratory from iPSC lines. The other main concern properly identified inrnARVD is the possible deleterious effect of a superimposed inflammatory phenomenon of myocarditis which can be the resultrnof a particular susceptibility of this genetically modified myocardium by the same gene which has produced the trouble inrndevelopment. When myocarditis is involved, a wide spectrum of disorders will be produced leading to RV echocardiographicrnFractional Area Change FAC which looks a better parameter than Tricuspid Annulus Plane Systolic Excursion TAPSE (SagunerrnCirculation 2014) but also involvement of the left ventricle which is finally the cause of irreversible heart failure at the end-stagernof the disease. In that case, follow-up of patients should be performed by serial echocardiograms paying attention to the TAPSErnand FAC but also to the LVEF. Abrupt drop of LVEF associated with troponin release will be the marker of a superimposedrnmyocarditis which may have several patterns of evolution encompassing the fulminant form with irreversible hyper acute heart failure which can be sometimes controlled by LV mechanical myocardial support to minor or even no cardiac deteriorationrnin the most frequent situation. In between, the decrease in LVEF can stop after complete healing of myocarditis of lead torncontinuous deterioration of cardiac function in case of an induced autoimmune phenomenon. It has been also suspected thatrnthe same concept of the deleterious effect of a superimposed myocarditis can be extended to other inherited cardiomyopathies such as IDCM, HCM and even WPW syndrome.