ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

Introduction. Several diagnostic tests have been recommended for risk assessment in pulmonary hypertension (PH), but the role of electrocardiography (ECG) in monitoring of PH patients has not been yet established. Therefore the aim of the study was to evaluate which ECG patterns characteristic for pulmonary hypertension can predict hemodynamic improvement in patients treated with targeted therapies. Methods. Consecutive patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) were eligible to be included if they had had performed two consecutive right heart catheterization (RHC) procedures before and after starting of targeted therapies. Patients were followed up from June 2009 to July 2017. ECG patterns of right ventricular hypertrophy according to American College of Cardiology Foundation were assessed. Results. We enrolled 80 patients with PAH and 11 patients with inoperable CTEPH. The follow-up RHC was performed within 12.6±10.0 months after starting therapy. Based on median change of pulmonary vascular resistance, we divided our patients into two subgroups: with and without significant hemodynamic improvement. RV1, max⁡RV1,2 + max⁡SI,aVL-SV1, and PII improved along with the improvement of hemodynamic parameters including PVR. They predicted hemodynamic improvement with similarly good accuracy as shown in ROC analysis: RV1 (AUC: 0.75; 95% CI: 0.63–0.84), PII (AUC: 0.67, 95% CI: 0.56–0.77), and max⁡RV1,2+max⁡SI,aVL-SV1 (0.73; 95% CI: 0.63–0.82). In Cox regression only change in RV1 remained significant mortality predictor (HR: 1.12, 95% CI: 1.01–1.24). Conclusion. Electrocardiogram may be useful in predicting hemodynamic effects of targeted therapy in precapillary pulmonary hypertension. Decrease of RV1, max⁡RV1,2+max⁡SI,aVL-SV1, and PII corresponds with hemodynamic improvement after treatment. Of these changes a decrease of R wave amplitude in V1 is associated with better survival

Functional Modification of Cellulose Acetate Microfiltration Membranes by Supercritical Solvent Impregnation

This study investigates the modification of commercial cellulose acetate microfiltration membranes by supercritical solvent impregnation with thymol to provide them with antibacterial properties. The impregnation process was conducted in a batch mode, and the effect of pressure and processing time on thymol loading was followed. The impact of the modification on the membrane's microstructure was analyzed using scanning electron and ion-beam microscopy, and membranes' functionality was tested in a cross-flow filtration system. The antibiofilm properties of the obtained materials were studied against Staphyloccocus aureus and Pseudomonas aeruginosa, while membranes' blocking in contact with bacteria was examined for S. aureus and Escherichia coli. The results revealed a fast impregnation process with high thymol loadings achievable after just 0.5 h at 15 MPa and 20 MPa. The presence of 20% of thymol provided strong antibiofilm properties against the tested strains without affecting the membrane's functionality. The study showed that these strong antibacterial properties could be implemented to the commercial membranes' defined polymeric structure in a short and environmentally friendly process

Supercritical foaming and impregnation of polycaprolactone and polycaprolactone-hydroxyapatite composites with carvacrol

Producción CientíficaPolycaprolactone (PCL) and polycaprolactone-hydroxyapatite (PCL-HA) scaffolds were produced by foaming in supercritical carbon dioxide (scCO2) at 20 MPa, as well as in one-step foaming and impregnation process using carvacrol as an antibacterial agent with proven activity against Gram-positive and Gram-negative bacteria. The experimental design was developed to study the influence of temperature (40 °C and 50 °C), HA content (10 and 20 wt.%), and depressurization rate (one and two-step decompression) on the foams’ morphology, porosity, pore size distribution, and carvacrol impregnation yield. The characterization of the foams was carried out using scanning electron microscopy (SEM, SEM-FIB), Gay-Lussac density bottle measurements, and Fourier–transform infrared (FTIR) analyses. The obtained results demonstrate that processing PCL and PCL-HA scaffolds by means of scCO2 foaming enables preparing foams with porosity in the range of 65.55–74.39% and 61.98–67.13%, at 40 °C and 50 °C, respectively. The presence of carvacrol led to a lower porosity. At 40 °C and one-step decompression at a slow rate, the porosity of impregnated scaffolds was higher than at 50 °C and two- step fast decompression. However, a narrower pore size distribution was obtained at the last processing conditions. PCL scaffolds with HA resulted in higher carvacrol impregnation yields than neat PCL foams. The highest carvacrol loading (10.57%) was observed in the scaffold with 10 wt.% HA obtained at 50 °C.Narodowe Centrum Nauki (Polonia) - (grant 2018/31/B/ ST8/01826)Agencia Nacional de Investigación y Desarrollo de Chile (ANID) - (project 120130)Programa de Financiamiento Basal para Centros Científicos y Tecnológicos de Excelencia - (Project AFB180001

Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension

Low-density lipoprotein cholesterol(LDL-C) is a well established metabolic marker of cardiovascular risk, however, its role in pulmonary arterial hypertension (PAH) has not been determined. Therefore we assessed whether LDL-C levels are altered in PAH patients, if they are associated with survival in this group and whether pulmonary hypertension (PH) reversal can influence LDL-C levels. Consecutive 46 PAH males and 94 females were age matched with a representative sample of 1168 males and 1245 females, respectively. Cox regression models were used to assess the association between LDL-C and mortality. The effect of PH reversal on LDL-C levels was assessed in 34 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing invasive treatment. LDL-C was lower in both PAH (2.6±0.8mmol/l) and CTEPH (2.7±0.7mmol/l) patients when compared to controls (3.2±1.1mmol/l, p<0.001). In PAH patients lower LDL-C significantly predicted death (HR:0.44/1mmol/l, 95%CI:0.26–0.74, p=0.002) after a median follow-up time of 33(21–36) months. In the CTEPH group, LDL-C increased (from 2.6[2.1–3.2] to 4.0[2.8–4.9]mmol/l, p=0.01) in patients with PH reversal but remained unchanged in other patients (2.4[2.2–2.7] vs 2.3[2.1–2.5]mmol/l, p=0.51). We concluded that LDL-C level is low in patients with PAH and is associated with an increased risk of death. Reversal of PH increases LDL-C levels

Percutaneous aspiration of a right atrial thrombus with the AngioVac system

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ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

Introduction. Several diagnostic tests have been recommended for risk assessment in pulmonary hypertension (PH), but the role of electrocardiography (ECG) in monitoring of PH patients has not been yet established. Therefore the aim of the study was to evaluate which ECG patterns characteristic for pulmonary hypertension can predict hemodynamic improvement in patients treated with targeted therapies. Methods. Consecutive patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) were eligible to be included if they had had performed two consecutive right heart catheterization (RHC) procedures before and after starting of targeted therapies. Patients were followed up from June 2009 to July 2017. ECG patterns of right ventricular hypertrophy according to American College of Cardiology Foundation were assessed. Results. We enrolled 80 patients with PAH and 11 patients with inoperable CTEPH. The follow-up RHC was performed within 12.6±10.0 months after starting therapy. Based on median change of pulmonary vascular resistance, we divided our patients into two subgroups: with and without significant hemodynamic improvement. RV1, max⁡RV1,2 + max⁡SI,aVL-SV1, and PII improved along with the improvement of hemodynamic parameters including PVR. They predicted hemodynamic improvement with similarly good accuracy as shown in ROC analysis: RV1 (AUC: 0.75; 95% CI: 0.63–0.84), PII (AUC: 0.67, 95% CI: 0.56–0.77), and max⁡RV1,2+max⁡SI,aVL-SV1 (0.73; 95% CI: 0.63–0.82). In Cox regression only change in RV1 remained significant mortality predictor (HR: 1.12, 95% CI: 1.01–1.24). Conclusion. Electrocardiogram may be useful in predicting hemodynamic effects of targeted therapy in precapillary pulmonary hypertension. Decrease of RV1, max⁡RV1,2+max⁡SI,aVL-SV1, and PII corresponds with hemodynamic improvement after treatment. Of these changes a decrease of R wave amplitude in V1 is associated with better survival

Functionalization of polyamide microfiltration membranes by supercritical solvent impregnation

The study reports the application of supercritical solvent impregnation to deliver antibacterial substance thymol to the defined polymeric structure of commercial polyamide microfiltration membranes. The process performed at a temperature of 40 degrees C and pressures of 10, 15, and 20 MPa was characterized by the fast impregnation in the first 30 min with thymol loadings up to 29 wt%. The maximal achieved thymol loading in the process was around 42 wt%, regardless the pressure. The scanning electron and ion microscopy analyses revealed that the membranes' microstructure was preserved with a thymol content of 20 wt%, while a more prominent swelling effect was observed in samples with 35 wt% of thymol. The cross-flow filtration tests showed that the impregnation process did not harm the membranes' functionality in samples with 20 wt% of thymol. These membranes exhibited strong anti-biofilm activity, and were less prone to the blockage with bacteria in comparison to neat membranes