Hyponatremia-Long-Term Prognostic Factor for Nonfatal Pulmonary Embolism.

Over recent years, studies have shown that in patients with left-sided heart failure, arterial hypertension, and acute coronary syndrome, hyponatremia is a negative prognostic factor. In this context, there is raising interest in the association between hyponatremia and pulmonary embolism (PE). This retrospective cohort study includes 404 consecutive patients with confirmed acute nonfatal pulmonary embolism divided into four groups according to their sodium fluctuation pattern. The primary outcome was all-cause mortality and determining the recurrence rate among patients with nonfatal PE using serum sodium levels as a continuous variable. Patients with acquired and persistent hyponatremia had a significantly higher rate of mortality rate than those in the normonatremia group (12.8% and 40.4%, OR- 7.206, CI: 2.383-21.791, p = 0.000 and OR-33.250, CI: 11.521-95.960, p = 0.000 vs. 2%, p < 0.001, respectively). Mean survival time decreases from 23.624 months (95% CI: (23.295-23.953)) in the normonatremia group to 16.426 months (95% CI: (13.17-19.134)) in the persistent hyponatremia group, statistically significant (p = 0.000). The mean survival time for all patients was 22.441 months (95% CI: (21.930-22.951)). The highest recurrence rate was recorded at 12 and 24 months in the acquired hyponatremia group (16.7% and 14.1%, respectively). Serum sodium determination is a simple and cost-effective approach in evaluating the short and long-term prognosis in patients with acute PE.

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase "AF begets AF". A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.

Comparative study of the inhibitory effects of adrenomedullin on angiotensin II contraction in rat conductance and resistance arteries.

Adrenomedullin (ADM), a ubiquitous vasoactive peptide, has been the target of a multitude of studies concerning its effect on the vascular tone. The present work aims at clarifying a series of its interactions with the renin-angiotensin system. The study uses the rat aorta ring as a model of conductance vessels, with or without vascular endothelium, and the second order branch of rat mesenteric arteries as a model of resistance arteries. Interactions between various concentrations of ADM and angiotensin II (Ang II) were studied, in the presence of L-NAME (a nitric oxide [NO] synthase inhibitor) and methylene blue (MB; a soluble guanylate cyclase inhibitor). Results point out differences in the mechanism of the inhibitory action of ADM upon Ang II effects in the two vessel types studied. Inhibition of Ang II contraction by ADM involves guanylate cyclase in both cases. However, NO is involved in ADM-induced inhibition of angiotensinergic vasoconstriction only in the conductance arteries, not in the resistance ones.

[Cytosolic calcium dynamics and smooth muscle contraction.III Plasmalemmal calcium fluxes]. / Dinamica citosolica a calciului si contractia muschiului neted. III. Fluxuri de calciu plasmalemale.

Smooth muscle contractile activity depends upon cytosolic Ca2+, the Ca(2+)-sensitivity of actin-myosin interaction and several auxiliary mechanisms. This section presents the plasmalemmal Ca2+ fluxes in relation with the functional structure of their supportive proteins and the contractile impact. Summaries of classical data are accompanied by examples of recent advances. Ca2+ influx occurs mainly via the L and T types of voltage-operated Ca2+ channels, the store-operated Ca2+ channels and the non-selective cation channels (operated by membrane receptors or mechanical stimuli). The plasmalemmal Ca2+ ATPase and Na/Ca antiport function to limit increases in cytosolic Ca2+; Na/Ca effect is opposite when driven to operate in the reverse mode.

[Cytosolic calcium dynamics and smooth muscle contraction(II): Reticular calcium fluxes]. / Dinamica citosolica a calciului si contractia muschiului neted (II): Fluxuri de calciu reticulare.

The contractile status of smooth muscle depends upon cytosolic Ca2+, the Ca(2+)-sensitivity of actin-myosin interaction and various calcium-independent mechanisms. This second part of our overview is devoted to the complex involvement of endoplasmic reticulum in the cytosolic Ca2+ signals related to smooth muscle contractile activity, with a focus on the functional structure of reticular membrane proteins that ensure the respective Ca2+ fluxes. Ca2+ release is activated by cytosolic Ca2+, involving reticular channels called inositol triphosphate receptors and ryanodine receptors. Beside calcium and inositol triphosphate, cyclic ADP-ribose and nicotinic acid adenine dinucleotide phosphate have recently emerged as intracellular signals that activate Ca2+ release. The reticular Ca2+ pump is essential both for the control of cytosolic Ca2+ and for the preservation of reticular stores.