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).

Pulmonary congestion assessed at discharge by lung ultrasonography predicts poor prognosis in heart failure (HF) patients. We investigated the association of B-lines with indices of hemodynamic congestion [BNP, E/e’, pulmonary systolic arterial pressure (PAPs)] in HF patients, and their prognostic value overall and according to concomitant atrial fibrillation (AF), reduced (≤40%) ejection fraction (EF), and timing of quantification during hospitalisation for heart failure (HHF). In 110 HHF patients, B-lines were highly discriminative of BNP >400 pg/ml (AUC ≥ 0.80 for all), and moderately discriminative of PAPs >50 mmHg (AUC = 0.68, 0.56 to 0.80); conversely, B-lines poorly discriminated average E/e’ ≥ 15, except at discharge. B-line count significantly predicted mid-term recurrent HHF or death (overall and in subgroups), regardless of AF status, EF, and timing of quantification during HHF (all p for interaction >0.10). regardless, B-lines ≥30 at discharge were most predictive of outcome (HR = 7.11, 2.06–24.48; p = 0.002) while B-lines ≥45 early during HHF were most predictive of outcome (HR = 9.20, 1.82–46.61; p = 0.007). Lung ultrasound was able to identify patients with high BNP levels, but not with increased E/e’, also showing a prognostic role regardless of AF status, EF or timing of quantification; best B-line cut-off appears to vary according to the timing of quantification during hospitalization.

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We herein report the first case of Takotsubo cardiomyopathy triggered by influenza A virus. Myocardial involvement in influenza virus infection has been described in 10% of cases. The literature has principally reported cases of acute myocarditis ranging from asymptomatic to fulminant heart failure and cardiac tamponade. Takotsubo cardiomyopathy frequently occurs in the setting of significant emotional or physical stress or acute medical illness, with a predominance in postmenopausal women. We report the diagnosis, management and outcomes presented in this case, with the aim of describing a new cardiovascular complication of influenza virus infection. Case ReportA 57-year-old woman presented to the emergency department for pulmonary edema requiring oro-tracheal intubation. She had developed hyperthermia with a temperature of 39 2 days prior to presentation. An electrocardiogram showed ST-segment elevation in leads V3, V4 and V5 (Fig. 1). Laboratory testing revealed an increased troponin I-C level (TnI-C: 0.52 μg/mL, n<0.04 μg/mL) and a normal rate of creatine kinase (116 UI/L initially and 113 UI/L the 24 hours later, n<145 UI/L) (Fig. 1). Her medical history consisted of chronic respiratory failure with oxygen dependency in the context of chronic obstructive pulmonary disease and Takotsubo syndrome 10 years previously. There was no information regarding pheochromocytomas or cerebrovascular disease in her history.Because of suspected acute coronary syndrome, the patient was administered aspirin 250 mg and bivalirudin, both intravenously. She developed severe hypotension requiring intravenous administration of norepinephrine. She was transferred to the catheterization laboratory for emergency cardiac coronary angiography, which showed no significant atherosclerosis. The left ventricular angiogram revealed typical apical ballooning (Fig. 2). Echocardiography demonstrated mid-ventricular and apical akinesia with depressed left ventricular function and an estimated ejection fraction of 30%. The patient was monitored using a pulse index continuous cardiac output (PICCO) device and continuous central venous oxygenation (ScVO2) measurements. The first hemodynamic measurement yielded the following results under norepinephrine treatment (2 μg/kg/min): mean arterial pressure (MAP): 65 mmHg; cardiac index (CI): 1.54 L/min/ m 2 ; ScVO2: 55%, cardiac function index: 2 L/min. The lactate level measured was 7 mmol/L with severe metabolic acidosis (pH 7.15). A multidisciplinary discussion precluded the use of extra corporeal membrane oxygenation (ECMO). Therefore, despite the presence of Takotsubo syndrome, 3 μg/kg/min dobutamine was initiated. Under this therapy, the cardiac function and ScVO2 increased, and the peripheral signs of shock disappeared. Eighteen hours later, echocardiography revealed total restoration of ventricular function. The number of eosinophils and other white blood cells were normal during hospitalization. Influenza A (H1N1) virus infection was diagnosed by a nasal rapid influenza diagnostic test...

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