Background: There is evidence that right ventricular (RV) contractile function, especially its coupling with the pulmonary circulation, has an important prognostic value in patients with left ...ventricular dysfunction. Aims: This study aimed to identify the best echocardiographic parameters of RV function and pulmonary artery systolic pressure (PASP) alone or in the form of the index of right ventricular-pulmonary artery coupling (RV-PA coupling) to determine the best predictor of 1-year major adverse cardiovascular events (MACE), which were defined as cardiovascular death and cardiac decompensation in heart failure patients with reduced ejection fraction (HFrEF). Methods and results: The study enrolled 191 HFrEF patients (mean age 62.28 ± 12.79 years, 74% males, mean left ventricular ejection fraction (LVEF) 25.53 ± 6.87%). All patients underwent clinical, laboratory, and transthoracic echocardiographic (TTE) evaluation, focusing on assessing RV function and non-invasive parameters of RV-PA coupling. RV function was evaluated using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and peak tricuspid annular systolic velocity (TAS’). PASP was estimated by peak tricuspid regurgitation velocity (TRVmax) and corrected by assumed right atrial pressure relative to the dimension and collapsibility of the inferior vena cava. The TAPSE/PASP and TAS’/PASP ratios were taken as an index of RV-PA coupling. During the follow-up (mean period of 340 ± 84 days), 58.1% of patients met the composite endpoint. The independent predictors of one-year outcome were shown to be advanced age, atrial fibrillation, indexed left atrial systolic volume (LAVI), LVEF, TAPSE/PASP, and TAS’/PASP. TAS’/PASP emerged as the strongest independent predictor of prognosis, with a hazard ratio (HR) of 0.67 (0.531–0.840), p < 0.001. Reconstructing the ROC curve 0.8 (0.723–0.859), p < 0.001, we obtained a threshold value of TAS’/PASP ≤ 0.19 (cm/s/mm Hg) (sensitivity 74.0, specificity 75.2). Patients with TAS’/RVSP ≤ 0.19 have a worse prognosis (Log Rank p < 0.001). Conclusions: This study confirmed previously known independent predictors of adverse outcomes in patients with HfrEF—advanced age, atrial fibrillation, LAVI, and LVEF—but non-invasive parameters of RV-PA coupling TAPSE/PASP and TAS’/PASP improved risk stratification in patients with HFrEF. Variable TAS’/PASP has been shown to be the most powerful, independent predictor of one-year outcome.
Background/Aim. The influenza virus is often the cause of exacerbations among chronic obstructive pulmonary disease (COPD) patients, especially during the winter season. However, vaccination rates ...are still below recommended even in developed countries. The aim of the study was to determine the rates and examine the effectiveness of immunization against seasonal influenza in preventing exacerbations among COPD patients in Serbia. Methods. The prospective cohort study of stable COPD outpatients was conducted over three years (between October 1, 2014, and September 30, 2017) at the Polyclinic Department of Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. The rates and effects of seasonal flu vaccination on COPD exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account comorbidity, age, and body mass index (BMI). Results. The study included 840 patients. The flu vaccination rate was 37.1%. Exacerbations occurred more frequently in unvaccinated patients 176 (31.9%) vs. 375 (68.1%), p = 0.043. In elderly vaccinated patients (? 65 years) there were fewer exacerbations compared to unvaccinated patients 89 (56.0%) vs. 188 (69.4%), p = 0.005. Lower frequency of exacerbations was also observed in vaccinated patients with comorbidities 165 (61.1%) vs. 327 (69.4%), p = 0.021 and low BMI 27 (64.3%) vs. 78 (83.9%), p = 0.011. Multivariate logistic regression analysis identified BMI < 21 kg/m2 relative risk (RR): 0.490; 95% confidence interval (CI): 0.318?0.758; p = 0.001 and heart failure (RR: 2.734; 95% CI: 1.121?6.669; p = 0.027) as independent predictors of COPD exacerbations. Conclusion. Immunization for seasonal influenza in Serbia is below recommended rates. Flu vaccination was associated with a significant reduction in COPD exacerbation rates, particularly in elderly patients and patients with heart failure and low BMI.
Physical activity is a common stimulus of asthmatic symptoms manifestation. Airway hyperreactivity is a predisposing cause of exercise induced bronchial obstruction, diagnosed by histamine ...inhalation. The aim of this study was to determine the relation between the amounts of histamine needed to induce non-specific airway hyperreactivity and exercise-induced bronchial obstruction.
This randomized cross-over study included 160 male patients (age 19-27 years) suffering from bronchial asthma who showed positive results as the reaction after the histamine bronchial provocation test. Histamine concentrations were in a range of 0.03 to 4 mg/mL. Each patient participated in the exercise stress test conducted on a conveyor belt. The results of the exercise stress test were considered positive if the FEV1 level dropped by at least 15% from its initial value, 5-10 minutes after the test.
All the patients showed positive results as the reaction after the histamine bronchial provocation test, while 50 of them showed positive results after the exercise-induced stress test. There was a statistically highly significant difference in administrated histamine concentrations between the group of patients that had positive results on exercise stress test and those who did not (1 mg/mL vs 0.5 mg/mL; U = 1678; p < 0.01). Also, there was a statistically significant difference concerning the frequency of the positive results regarding histamine concentration after induced stress test (chi2 = 10.885; p = 0.001). Among the patients with positive results, there was a statistically highly significant number of patients with bronchial obstruction induced by less than 2 mg/mL of histamine (p < 0.01). A statistically significant relation between the amount of histamine needed to induce bronchial obstruction and the results of the exercise stress test (p < 0.01) was also observed after the testing.
In the group of patients with positive results after the exercise-induced stress test, there were significantly more patients with positive results to non-specific bronchial provocation test with lower histamine concentrations. Histamine concentrations needed to induce non-specific hyperreactivity of asthmatic airway were shown to be related to the reactivity to physical effort.
Introduction. Left ventricular hypertrophy is defined as an increase in the left ventricular mass. Electrocardiography is a widely used and cost-effective method for the initial screening of the ...condition, but it has limited sensitivity and specificity. The Sokolow-Lyon and Cornell criteria are still most commonly used in diagnosing the disease; their sensitivity, however, is low. On the contrary, the Romhilt-Estes scoring system incorporates atrial abnormalities and repolarization phases making this scoring system a better diagnostic tool. This study explores the correlation between electrocardiography and echocardiography in the diagnosis of left ventricular hypertrophy. Material and Methods. The study enrolled 30 patients with median age of 62, diagnosed with arterial hyperten?sion, who underwent a 12-lead electrocardiogram and transthoracic echocardiogram. The analysis included the assessment of correlation between the relevant electrocardiographic parameters and the left ventricular mass index, as well as calculation of their diagnostic capability including the area under the ROC curve. Re?sults. Positive correlation of moderate intensity has been observed between the left ventricular mass index and Sokolow-Lyon (?=0.479), Cornell index (?=0.366), and Cornell product (?=0.423). Cornell product had the highest sensitivity (0.82), while the Romhilt-Estes criteria exhibited the highest specificity (0.85). Sokolow-Lyon yielded the highest area under the curve (0.733), followed by Cornell product (0.640), Cornell voltage (0.622), and Romhilt-Estes criteria (0.570). Conclusion. The Sokolow-Lyon criterion exhibited the best balance between sensitivity and specificity, the highest and significant area under the ROC curve and the strongest correlation with the left ventricular mass index.
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