Application of multidetector computed tomography in the diagnosis of pulmonary embolism and new directions of development

Introduction: Pulmonary embolism (PE) is a condition involving the mechanical part of the closure of the pulmonary arterial thrombus or other embolic material. Is the third the most typical cardiovascular disease - vascular, immediately after a heart attack and stroke. Clinical symptoms are often nonspecific and may result in an incorrect diagnosis. The most common complications of PE include: attack the lungs, impaired heart function, superinfection and development of pulmonary hypertension. Objective: The purpose of the work was to discuss of the technical aspects and the use of multi-slice computed tomography in the diagnosis of PE. The presentation emphasized new directions of development of tomographic methods in imaging thromboembolic events of pulmonary arteries, including multi-energy CT and low-dose techniques. Description of the state of knowledge: Angiography-CT is currently the gold standard in the diagnosis of PE, especially in patients with high and indirect clinical risk. It is characterized by high sensitivity and specificity in contrast enhancement imaging defects within the pulmonary vasculature and blood changes in the pulmonary parenchyma, which may accompany the EP. It also allows to assess the features of right heart overload in the course of massive PE or radiological symptoms associated with the development of chronic PE. Summary: Nowadays, the greatest challenges of CT diagnostics in PE are the improvement of image quality, minimization of artifacts and reduction of the radiation dose to which the patient is exposed. Effective diagnosis of PE is not only good quality CT imaging, but also the efficiency of the process of diagnosis. Hence the development of new applications of CT - called. computer aided diagnosis (CAD)

Assessment of cardiovascular function following transcatheter aortic valve implantation based on six-minute walk test

Background: Transcatheter aortic valve implantation (TAVI) is presently a recognized treatment mo­dality for patients with severe aortic stenosis ineligible for surgery. It reduces mortality as compared to the conservative treatment. It is further expected from this therapy to improve quality of life by improving of the cardiovascular function performance. The aim of this study is to compare patients’ cardiovascular system efficiency in the 6-minute walk test (6MWT) made before and after TAVI and at the 6–12-month follow-up. Methods: From January 2009 until February 2012, in the Silesian Center for Heart Diseases in Zabrze, TAVI was performed in 104 patients. Eighty-two patients who underwent 6MWT before surgery were qualified for the analysis. The average age of the patients was 76.0 ± 9.17 years, women made 45.1%. The risk of surgical treatment according to the Logistic Euroscore averaged 22.76 ± 12.63%, and by the Society of Thoracic Surgeons — 5.55 ± 3.34%. The 6MWT was performed within 1 month before the TAVI procedure, up to a month after the procedure and during the 6–12-month follow-up. Results: The 6-minute walk test after TAVI was performed by 64 patients, and after 6–12 month follow-up by 46 patients. The average distance in 6MWT increased from 268.4 ± 89.0 m before treat­ment to 290.0 ± 98.2 m after the procedure (p = 0.008) and 276.1 ± 93.5 m to 343.1 ± 96.7 m after 6–12 months (p < 0.0001). Conclusions: Transcatheter aortic valve implantation procedures significantly improve function of the cardiovascular system evaluated by the 6MWT in 1- and 6–12-month observations. (Cardiol J 2017; 24, 2: 167–175

Tricuspid regurgitation after implantable cardioverter-defibrillator implantation in patients with arrhythmogenic right ventricular cardiomyopathy

Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation.As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons.Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR).Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant).Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Furtherstudies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted.Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation.As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons.Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR).Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant).Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Furtherstudies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted

Virtual histology to evaluate mechanisms of pulmonary artery lumen enlargement in response to balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) results from an obstruction of pulmonary arteries (PAs) by organized thrombi. The stenosed PAs are targeted during balloon pulmonary angioplasty (BPA). We aimed to evaluate the mechanism of BPA in inoperable patients with CTEPH. We analyzed stenosed PAs with intravascular grey-scale ultrasound (IVUS) to determine the cross-sectional area (CSA) of arterial lumen and of organized thrombi. The composition of organized thrombi was assessed using virtual histology. We distinguished two mechanisms of BPA: Type A with dominant vessel stretching, and type B with dominant thrombus compression. PAs were assessed before (n = 159) and after (n = 98) BPA in 20 consecutive patients. Organized thrombi were composed of dark-green (57.1 (48.0–64.0)%), light-green (34.0 (21.4–46.4)%), red (6.4 (2.9–11.7)%;) and white (0.2 (0.0–0.9)%) components. The mechanism type depended on vessel diameter (OR = 1.09(1.01–1.17); p = 0.03). In type B mechanism, decrease in the amount of light-green component positively correlated with an increase in lumen area after BPA (r = 0.50; p = 0.001). The mechanism of BPA depends on the diameter of the vessel. Dilation of more proximal PAs depends mainly on stretching of the vessel wall while dilation of smaller PAs depends on compression of the organized thrombi. The composition of the organized thrombi contributes to the effect of BPA

Fast approach for clarification of chromosomal aberrations by using LM-PCR and FT-CGH in leukaemic sample

Chromosomal abnormalities, like deletions, amplifications, inversions or translocations, are recurrent features in haematological malignancies. However, the precise molecular breakpoints are frequently not determined. Here we describe a rapid analysis of genetic imbalances combining fine tiling comparative genomic hybridization (FT-CGH) and ligation-mediated PCR (LM-PCR). We clarified an inv(14)(q11q32) in a case of T cell acute lymphoblastic leukaemia with a breakpoint in the TRA/D in 68% of cells detected by fluorescence in situ hybridization. FT-CGH showed several mono- and biallelic losses within TRA/D. LM-PCR disclosed a TRA/D rearrangement on one allele. The other allele revealed an inv(14)(q11q32), joining TRDD2 at 21,977,000 of 14q11 together with the IGH locus at 105,948,000 and 3'-sequence of TRAC at 22,092,000 joined together with IGHV4-61 at 106,166,000. This sensitive approach can unravel complex chromosomal abnormalities in patient samples with a limited amount of aberrant cells and may lead to better diagnostic and therapeutic options

Sun exposure among young people

We are exposed to ultraviolet radiation every day. The amount of absorbed dose depends on the latitude, time of day, season of the year and the content of melanin in the skin. Deficiencies are the cause of many health problems and deterioration of the course of many disease processes. Negative effects on the cardiovascular system, on the formation of tumors or on the development of autoimmune diseases have been confirmed. In daily consumed foods, the dose of vitamin D is about 10% of the daily requirement. Increased physical activity, sunbathing when using radiation protection and oral supplementation allow you to achieve your goals. The level of vitamin D should be monitored regularly. There was a significant deficiency of vitamin D among athletes regardless of the type of sport performed. In addition to the benefits of sun exposure, we also get the risk of developing skin cancer. Risky behavior in the sun, the occurrence of erythema can contribute to the future of serious skin problems associated with cancer. We can prevent them by applying prophylaxis and individually selected sun protection. Education of patients, parents with small children families of patients with diagnosed melanoma and people with skin cancer may have positive effects in the future. Smoking and drinking alcohol have an adverse effect on sunbathing and the risk of sunburn. Planning for a pro-health policy should be based on preventive and public education programs. The increase in skin cancer cases around the world is alarming