Early echocardiographic evaluation of right ventricular load adaptability after sequential combination treatment in pulmonary arterial hypertension.

BACKGROUND: Using the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio as an index of right ventricular load adaptability, we aimed to evaluate early changes in right heart contractile function of patients with group 1 pulmonary artery hypertension (PAH) after sequential combination PAH-specific therapy. METHODS: A total of 49 patients with group 1 PAH and 31 control participants were included in the study. The baseline clinical and echocardiographic data of the control and PAH group were compared. Subsequently, clinical and echocardiographic data of PAH patients before treatment and at 6 months after PAH-specific treatment were analyzed. RESULTS: A significant increase in the TAPSE/PASP ratio was found in patients at 6 months of PAH-specific treatment (0.25 ± 0.14; 0.33 ± 0.16, p < 0.001). Right atrial pressure (8 mm Hg [5-10]; 5 mm Hg [3-8], p < 0.001) and PASP (80.8 ± 30.6 mm Hg; 65.9 ± 25.7 mm Hg, p < 0.001) were significantly lower after sequential combination PAH-specific therapy. Negative correlations were found between the TAPSE/PASP ratio and N­terminal pro-B-type natriuretic peptide (r = -0.524, p < 0.001), tricuspid regurgitation velocity (r = -0.749, p < 0.001), right atrial area (r = -0.298, p = 0.037), and right atrial pressure (r = -0.463, p = 0.001). CONCLUSION: In patients with group 1 PAH, echocardiographic evaluation at the early stage of treatment (6 months) shows a significant improvement in the TAPSE/PASP ratio indicating right ventricular load adaptation. Comprehensive studies are needed on the routine use of the TAPSE/PASP ratio in the risk assessment of PAH patients.

Assessment of P wave duration and P wave dispersion in high level football referees.

BACKGROUND: P wave dispersion and P wave maximal duration reflect the activation of atrial muscle and is influenced by the mass of the excited tissue. It may reflect atrial remodelling, most likely atrial fibrosis. The purpose of this study was to measure P wave duration and P wave dispersion in the high level football referees. METHODS: We recruited 104 elite and national referees with a training history of many years. The control group was made of 32 healthy sedentary subjects. The difference between P maximum and P minimum durations was defined as P wave dispersion. Echocardiographic parameters such as left atrial diameter were assessed with a Vivid 3 cardiovascular ultrasound system [3S sector probe (1.5-3.6 MHz), GE]. RESULTS: P wave maximum duration, P wave dispersion, left ventricle posterior wall thickness, inter-ventricular septum thickness and left atrial diameter were increased in the football referees as compared with healthy sedentary subjects. There were significant correlations of P wave dispersion with left atrial diameter and left ventricle posterior wall thickness CONCLUSIONS: P wave maximum duration, P wave dispersion and left atrial diameter were increased in the football referees. Also, there was a significant correlation between P wave dispersion and left atrial diameter.

The frequency of type 2 second-degree and third-degree atrioventricular block induced by blunt chest trauma in the emergency department: A multicenter study.

BACKGROUND: Conduction disturbances including type 2 second-degree atrioventricular block (Mobitz II) and third-degree atrioventricular block following blunt chest trauma are probably rare. Moreover, the pathophysiological mechanisms responsible for this rare dysrhythmia following trauma are not well understood yet. In this study, it was aimed to identify the frequency of this dysrhythmia associated with trauma. METHODS: Two hundred and fifty-three consecutive Mobitz II block and third-degree atrioventricular block patients admitted to the Emergency Department of Internal Medicine between January 2012 and March 2013 were evaluated. Only four patients with Mobitz II block and third-degree atrioventricular block associated with trauma were enrolled into the present study. The level of atrioventricular block was defined according to electrocardiographic characteristics. RESULTS: Only four (mean age: 40.2±19.7 years, two male) of 253 patients were associated with trauma. All patients had normal coronary arteries in coronary angiography or multislice computed tomography. Permanent pacemaker was performed in two patients with third-degree atrioventricular block. None of the patients had coronary artery disease or hypertension. CONCLUSION: Rare clinical cases in the literature confirm that blunt chest trauma can cause conduction defects, which are usually transient. However, patients with blunt chest trauma must need an electrocardiographic evaluation for atrioventricular block upon admission and in the follow-up period.

Acute effects of ultrafiltration on aortic mechanical properties determined by measurement of pulse wave velocity and pulse propagation time in hemodialysis patients.

OBJECTIVE: The effects of acute hemodialysis session on pulse wave velocity are conflicting. The aim of the current study was to assess the acute effects of ultrafiltration on the aortic mechanical properties using carotid-femoral (aortic) pulse wave velocity and pulse propagation time. METHODS: A total of 26 (12 women, 14 men) consecutive patients on maintenance hemodialysis (mean dialysis duration: 40.7±25.6 (4-70) months) and 29 healthy subjects (13 women, 16 men) were included in this study. Baseline blood pressure, carotid-femoral (aortic) pulse wave velocity, and pulse propagation time were measured using a Complior Colson device (Createch Industrie, France) before and immediately after the end of the dialysis session. RESULTS: While systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and pulse wave velocity were significantly higher in patients on hemodialysis than in healthy subjects, pulse propagation time was significantly higher in healthy subjects. Although body weight, systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and pulse wave velocity were significantly decreased, heart rate and pulse propagation time were significantly increased after ultrafiltration. There was a significant positive correlation between pulse wave velocity and age, body height, waist circumference, systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and heart rate. CONCLUSION: Although hemodialysis treatment may chronically worsen aortic mechanical properties, ultrafiltration during hemodialysis may significantly improve aortic pulse wave velocity, which is inversely related to aortic distensibility and pulse propagation time.