Acta cardiologica最新文献

Objective: Right ventricular (RV) overload findings affect the risk classification and treatment approach in acute pulmonary embolism (APE). Recently, it was reported that a new electrocardiography (ECG) parameter, terminal D1S + D3R (T-D1S + D3R) pattern, supported the diagnosis of APE. We aim to search the relationship between T-D1S + D3R pattern and right ventricular dilatation (RVD) in APE.

Methods: This single-centre, retrospective study was designed with patients aged > 18 years. We screened 267 patients who underwent transthoracic echocardiography (TTE) because of confirmed APE in our emergency department. This study included 72 patients with RVD and 139 patients without RVD [male 41.7%, median age 73,0 (20.8) years; 49.6% male, median age 64,0 (24.0) years]. We compared T-D1S + D3R between RVD (+) and RVD (-) groups.

Results: We determined that RVD (+) group had more patients with the T-D1S + D3R parameter than RVD (-) group [51 (70.8%) vs. 25 (18.0%), p < 0.001]. In the univariate logistic regression analyses S1Q3T3, (in)complete right bundle branch block (RBBB), T-D1S + D3R, D3-V1 T wave inversion (TWI), V1-3/4 TWI, V1-3/4 ST-segment elevation, and frontal QRS-T [f(QRS-T)] angle predicted RVD, while T-D1S + D3R, V1-3/4 ST-segment elevation, and f(QRS-T) angle remained independent predictors of RVD in patients with APE.

Conclusions: T-D1S + D3R, a new ECG parameter, was an independent predictor of RVD in patients with APE.

Pulmonary arterial hypertension (PAH) is a rare disease affecting the small pulmonary vessels, ultimately leading to right ventricular failure and death. Current treatment options target three different pathways (endothelin, nitric oxide/cGMP and prostacyclin pathways). Despite their demonstrated efficacy, these therapies (commonly used in combination) do not cure the disease which is why novel pathways beyond the traditional 'big three' are being developed. Sotatercept is a ligand trap for multiple proteins within the TGF-β superfamily that was recently approved in the US for the treatment of PAH. Unlike currently available therapies, sotatercept has the potential to act as an anti-remodelling agent rather than a vasodilator. The safety and efficacy of subcutaneous (SC) sotatercept have been established in two multicentre, placebo-controlled randomised-controlled trials. The compound has been shown to consistently improve a variety of measurable endpoints, including exercise capacity, haemodynamics, quality of life and delay of clinical worsening. The drug appears to have an acceptable safety profile, although it is associated with an increased risk in developing telangiectasia and biological changes affecting platelet counts and haemoglobin. This study reviews the current evidence on SC sotatercept and provides a Belgian perspective on its place in the future treatment strategy for PAH.

Introduction: Subclinical hypothyroidism (SCH) is a biochemical condition that is diagnosed when peripheral free thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone (TSH) levels are mildly elevated. The aim of this study was to investigate the relationship between SCH and arterial stiffness using two different non-invasive methods, including echocardiography and oscillometric arteriography.

Material and methods: The study included 33 newly diagnosed SCH patients and 34 age- and gender-matched healthy controls. Systolic and diastolic diameters and elastic parameters of the aorta were calculated by 2D Transthoracic echocardiography (TTE). Central blood pressure and aortic stiffness values of patient groups were measured noninvasively from the brachial artery using Mobil-O-Graph arteriography. Pulse wave velocity (PWV) and augmentation index (AIx) were used as arterial stiffness indicators.

Results: There was no significant difference between SCH and control groups with regard to age, gender, and body mass index (BMI). Aortic strain and aortic distensibility, were significantly lower in the SCH group than in the control group (p < 0.001). PWV and AIx which measured by Mobil-O-Graph arteriography were found to be significantly higher in the subclinical hypothyroid group compared to the control group (p < 0.05).

Conclusion: Aortic stiffness assessed by TTE and Mobil-O-Graph arteriography deteriorated in patients with SCH after excluding other cardiovascular risk factors. The assessment of aortic stiffness by the oscillometric method was easy and useful for widespread clinical use.