Glutathione infusion before primary percutaneous coronary intervention: A randomised controlled pilot study

Objective: In the setting of reperfused ST-elevation myocardial infarction (STEMI), increased production of reactive oxygen species (ROS) contributes to reperfusion injury. Among ROS, hydrogen peroxide (H2O2) showed toxic effects on human cardiomyocytes and may induce microcirculatory impairment. Glutathione (GSH) is a water-soluble tripeptide with a potent oxidant scavenging activity. We hypothesised that the infusion of GSH before acute reoxygenation might counteract the deleterious effects of increased H2O2 generation on myocardium. Methods: Fifty consecutive patients with STEMI, scheduled to undergo primary angioplasty, were randomly assigned, before intervention, to receive an infusion of GSH (2500 mg/25 mL over 10 min), followed by drug administration at the same doses at 24, 48 and 72 hours elapsing time or placebo. Peripheral blood samples were obtained before and at the end of the procedure, as well as after 5 days. H2O2 production, 8-iso-prostaglandin F2α (PGF2α) formation, H2O2 breakdown activity (HBA) and nitric oxide (NO) bioavailability were determined. Serum cardiactroponin T (cTpT) was measured at admission and up to 5 days. Results: Following acute reperfusion, a significant reduction of H2O2 production (p=0.0015) and 8-iso-PGF2α levels (p=0.0003), as well as a significant increase in HBA (p<0.0001)and NO bioavailability (p=0.035), was found in the GSH group as compared with placebo. In treated patients, attenuated production of H2O2 persisted up to 5 days from the index procedure (p=0.009) and these changes was linked to those of the cTpT levels (r=0.41, p=0.023). Conclusion: The prophylactic and prolonged infusion of GSH seems to determine a rapid onset and persistent blunting of H2O2 generation improving myocardial cell survival. Nevertheless, a larger trial, adequately powered for evaluation of clinical endpoints, is ongoing to confirm the current finding

Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography

BACKGROUND: The aim of this study was to assess changes in right ventricular (RV) parameters determined by three-dimensional (3D) echocardiography and speckle-tracking echocardiography in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive pulmonary embolism). METHODS: Sixty-six patients were prospectively studied at the onset of the acute episode and after median follow-up periods of 30 days and 6 months. Sixty-six controls were selected. RV fractional area change, tricuspid annular plane systolic excursion, and myocardial performance index were determined. RV systolic pressure was assessed using continuous-wave Doppler echocardiography. Three-dimensional RV ejection fraction (RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal free wall, mid free wall (MFW), and apical free wall and the septum. RESULTS: Tricuspid annular plane systolic excursion and fractional area change were smThe aim of this study was to assess changes in right ventricular (RV) parameters determined by three-dimensional (3D) echocardiography and speckle-tracking echocardiography in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive pulmonary embolism).Sixty-six patients were prospectively studied at the onset of the acute episode and after median follow-up periods of 30 days and 6 months. Sixty-six controls were selected. RV fractional area change, tricuspid annular plane systolic excursion, and myocardial performance index were determined. RV systolic pressure was assessed using continuous-wave Doppler echocardiography. Three-dimensional RV ejection fraction (RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal free wall, mid free wall (MFW), and apical free wall and the septum.Tricuspid annular plane systolic excursion and fractional area change were smaller and myocardial performance index was larger compared with controls (P < .05). Global RVLS (P < .05), MFW RVLS (P < .001), and 3D RVEF (P < .001) were lower in patients with pulmonary embolism than in controls. There was earlier reversal of MFW RVLS values on 30-day follow-up and longer reversal of 3D RVEF and RV systolic pressure values at 6-month follow-up. Receiver operating characteristic curve analysis showed that changes in 3D RVEF and MFW RVLS were the most sensitive predictors of adverse events. By multivariate analysis, RV systolic pressure (P = .007), MFW RVLS (P = .002), and 3D RVEF (P = .001) were independently associated with adverse outcomes.Acute submassive pulmonary embolism has a significant impact on RV function as assessed by 3D echocardiography and speckle-tracking echocardiography. Decreases in MFW RVLS and 3D RVEF may persist during short-term and long-term follow-up and correlate with unfavorable outcomes

Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle tracking echocardiography

Background. We aimed to assess changes in right ventricular (RV) parameters determined by three-dimensional echocardiography (3DE) and speckle tracking echocardiography (STE) in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive PE). Methods. We prospectively studied 66 patients at the onset of the acute episode and after a median follow-up of 30 days and six months. Sixty-six controls were selected. RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and myocardial performance index (MPI) were determined. RV systolic pressure (RVSP) was assessed by continuous wave Doppler echocardiography. Three-dimensional right ventricular ejection fraction (3D-RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal, mid and apical segments of free wall (BFW, MFW, AFW) and septum. Results. TAPSE and FAC were smaller and MPI was larger compared to controls (p<0.05). Global RVLS (p<0.05), MFW-RVLS (p<0.001), and 3D-RVEF (p<0.001) were lower in PE patients than controls. There was earlier reversal of MFW-RVLS values on a 30-day follow-up and longer reversal of 3D-RVEF and RVSP values on a 6-month follow-up. ROC analysis showed that changes in 3D-RVEF and MFW-RVLS were the most sensitive predictors of adverse events. By multivariate analysis, RVSP (p=0.007), MFW-RVLS (p=0.002) and 3D-RVEF (p=0.001) were independently associated with adverse outcomes. Conclusions. Acute submassive PE has a significant impact on RV function as assessed by 3DE and STE. Decrease in MFW-RVLS and 3D-RVEF may persist during short and long-term follow-up and correlate with unfavorable outcome