Pulmonary MALT lymphoma associated with interstitial pulmonary disease.

Interstitial lung disease (ILD) and low-grade Mucosa-associated B-cell lymphoma (MALT lymphoma) are two different disorders of the respiratory system. In some cases, pulmonary MALT lymphoma is seen presenting with interstitial lung disease. We report a case of 42-year-old man presenting with a pulmonary MALT lymphoma associated with interstitial lung disease.

Assessment of right ventricular remodeling and dysfunction in obstructive sleep apnea syndrome: a prospective monocentric study.

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-related disorder that has been implicated in many serious cardiovascular diseases including cardiac remodeling and dysfunction. Since most investigations have focused on the left heart, little is known on right ventricular (RV) involvement in OSA. The role of the RV in the management of cardiovascular outcomes has become increasingly recognized. Early detection of subtle signs of RV dysfunction and remodeling in patients with OSA is crucial for optimal medical care. PURPOSE: We aimed to investigate the effect of OSA and its severity on the RV structure and function using conventional echocardiography. METHODS: We conducted a cross-sectional analytical study including patients with OSA who did not have heart failure or chronic pulmonary disease comparing them to controls without OSA. All patients underwent respiratory polygraphy at the Pneumology Department and standard echocardiography performed by the same blinded cardiologist at the Cardiology Department of Taher Sfar University Hospital. RESULTS: A total of 139 patients with OSA and 45 controls were enrolled in the study. Amonth the patients, there were 32% (n = 44) with mild, 20% (n = 28) with moderate, and 48% (n = 67) with severe OSA. Sixty-three percent of the study population were women. The mean age was 54.1 ± 11.0 years. Early RV dilatation was present in the mild disease stage (RVID = 42.0 ± 7.7 mm vs. 32.4 ± 5.5 mm in controls; p < 0.0001) without obvious RVH. The systolic pulmonary artery pressure was significantly higher in patients with OSA (31.2 ± 8.2 vs. 20.9 ± 9.8; p < 0.0001). Tricuspid annular plane systolic excursion was borderline normal and significantly lower in patients with OSA (17.7 ± 4.7 vs. 26.0 ± 5.7, p < 0.0001). In multivariate analysis, an OSA was independently associated with RV remodeling (OR: 0.257, 95% CI [0.114-0.582], p = 0.001) but not with RV dysfunction. CONCLUSION: OSA was independently associated with structural alterations of RV early in the disease course, suggesting that the reversibility of these deleterious effects requires earlier detection and initiation of treatment.

Predictive echocardiographic factors of severe obstructive sleep apnea.

INTRODUCTION: obstructive sleep apnea (OSA) is a common chronic pulmonary disease, characterized by repetitive collapse of the upper respiratory airways, leading to oxygen desaturation. This condition is recognized to be associated with cardiovascular disease. Several studies have shown the effects of OSA on both geometry and cardiac function, with conflicting results. We aimed to investigate the relationship between echocardiographic abnormalities and the severity of OSA. METHODS: this is a cross-sectional single center study including patients, without any cardiovascular or pulmonary comorbidities, with polygraphy proven OSA. All participants underwent a detailed transthoracic echocardiography (TTE). RESULTS: a total of 93 patients were included in the study, with 62.2% (n=56) females. According to the apnea hypopnea index (AHI), patients were divided into two groups: mild to moderate OSA (5≤ AHI< 30/H) and severe OSA (AHI≥ 30/H). There were no differences in baseline characteristics between the two groups. The assessment of echocardiographic parameters demonstrated that severe OSA have a higher left ventricular end-systolic (LVES) (47.6±7.2 VS 46.2±4.7), left ventricular end-diastolic (LVED) (31.3±6.2 VS 28.9±4.5) diameters and interventricular septum (IVS) thickness (12.7±2.4 VS11.7±2.5) diameters rather than mild to moderate OSA without a significant difference between the two groups. Furthermore, severe OSA patients had lower mean value of left ventricular ejection fraction (LVEF) and fractional shortening (FS) equal to 62.1±9.7 and 32.5±6.3 respectively. The difference between the two groups was not statistically significant. However, a significant association was shown between severity of OSA and left ventricular (LV) diastolic dysfunction, right ventricular internal diameter (RVID) and systolic pulmonary artery pressure (sPAP), with p=0.05, p=0.05 and p= 0.03 respectively. The RVID was also independently associated to the severity of the OSA (aOR 1.33, 95%CI: 0.99-1.79; p=0.05). CONCLUSION: using bidimensional echocardiography showed a relationship between severe OSA and right ventricular parameters (diastolic dysfunction and RVID) and sPAP.