Echocardiographic Prognostic Factors in Pulmonary Hypertension

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure of ≥25 mmHg at rest by right heart catheterization. Echocardiography estimates systolic pulmonary arterial pressure on the tricuspid regurgitation jet velocity, mean and diastolic pressure based on the pulmonary regurgitation jet, and data regarding the function of the right ventricle. ESC guidelines propose an echocardiographic risk assessment in PH according to right atrial area > 26 cm2 and pericardial effusion. Other risk factors correlated with the severity of the PH include right atrial pressure > 15 mmHg, tricuspid regurgitation more than moderate, TAPSE 1.7 combined with TAPSE <15 mm was associated with a higher death rate compared to patients with normal values. However, each of these parameters used in the assessment of the right ventricle has technical limitations, and it is necessary to use multiple tests for a correct evaluation of the prognosis of PH

Diagnostic Pitfalls in a Man with Systemic Lupus Erythematous

Systemic lupus erythematosus (SLE) is a chronic multi-systemic immune-mediated disease with confusing symptoms and delayed diagnosis. We report the case of a 32-year-old man with a persistent Venereal Disease Research Laboratory (VDRL)-positive reaction treated for syphilis 5 years previously, who was admitted for rash, weight loss, pancytopenia, inflammatory syndrome, and an important spontaneous prolongation of activated partial thromboplastin time (aPTT). Antiphospholipid antibodies were identified in the patient and he was diagnosed with SLE. The unrecognized false positive VDRL reaction and the delayed diagnosis of SLE were harmful as the patient had developed renal and cardiac complications by the time of diagnosis

Androgen Deprivation Therapy, Hypogonadism and Cardiovascular Toxicity in Men with Advanced Prostate Cancer

Androgen deprivation therapy (ADT) is successfully used in patients with advanced prostatic cancer, but there are many concerns about its systemic side effects, especially due to advanced age and frequent comorbidities in most patients. In patients treated with ADT there are metabolic changes involving the glycaemic control and lipid metabolism, increased thrombotic risk, an increased risk of myocardial infarction, severe arrhythmia and sudden cardiac death. Still, these adverse effects can be also due to the subsequent hypogonadism. Men with heart failure or coronary artery disease have a lower level of serum testosterone than normal men of the same age, and hypogonadism is related to higher cardiovascular mortality. Many clinical studies compared the cardiovascular effects of hypogonadism post orchiectomy or radiotherapy with those of ADT but their results are controversial. However, current data suggest that more intensive treatment of cardiovascular risk factors and closer cardiological follow-up of older patients under ADT might be beneficial. Our paper is a narrative review of the literature data in this field

Left Ventricular Non-compaction Cardiomyopathy and Polycystic Kidney Disease Revealed by Inappropriate Polycythemia: A Fortuitous Association? Case Report

We present the case of a patient with heart failure with reduced left ventricular (LV) ejection fraction, diagnosed in the first instance by echocardiography and further on by more accurate cardiac magnetic resonance imaging with LV non-compaction (LVNC). Blood tests showed high erythrocyte and hematocrit levels, inappropriate in this setting, whilst Janus Kinase 2V617F mutation was absent, erythropoietin level was slightly increased, and arterial O2 pressure level was normal. At the time of diagnosis, the patient had mild renal impairment, and abdominal echography revealed bilateral polycystic kidney disease (PKD). The patient had one son who fulfilled the echocardiographic criteria for LVNC and had bilateral renal cysts revealed by abdominal ultrasound. The genes responsible for autosomal dominant PKD (ADPKD) development are PKD1, on chromosome 16, coding for polycystin 1 and PKD2, on chromosome 4, coding for polycystin 2. There are some experimental data which suggest that polycystins might play an important role in cardiac development and hence PKD1 and PKD2 mutations may be involved in primary cardiomyopathies. These data could explain this particular association between LVNC and ADPKD. To date, there are only a few isolated cases reported, and only one shows this association in more than one member of the same family. Further genetic testing in the few reported cases would presumably elucidate whether this finding is the result of complex genetic synergy or just a simple coincidence