ADAMTS13 metalloprotease in the pathogenesis of thromboembolic disorders

ADAMTS13, popularnie zwany białkiem rozcinającym czynnik von Willebranda (vWF), należy do rodziny białek ADAMTS — metaloproteinaz zawierających w swej budowie motyw trombospondyny. Kliniczne znaczenie regulacji wielkości multimerycznego vWF przez ADAMTS13 jest przykładem manifestacji zaburzeń osi vWF–ADAMTS13. Zmniejszenie aktywności tego enzymu skutkuje wystąpieniem wrodzonej lub nabytej zakrzepowej plamicy małopłytkowej.ADAMTS13, popularly known as von Willebrand cleavage protein, belongs to ADAMTS (A Disintegrin-like And Metalloprotease with Thrombospondin motifs) family. The clinical significance of multimeric VWF size regulation by ADAMTS13 is an example of the manifestation of VWF–ADAMTS13 axis disorders. Reduced activity of this enzyme results in the occurrence of thrombotic thrombocytopenic purpura

Kobieta w wieku 41 lat po przedszpitalnym nagłym zatrzymaniu krążenia i z rozpoznaniem zespołu WPW

The paper presents a case of a 41-year-old female patient after pre-hospital sudden cardiac arrest (SCA), hospitalized in the Cardiology Intensive Care Unit and then in the Department of Cardiology. The patient was diagnosed with Wolff-Parkinson-White syndrome (WPW) and ablation of the left secondary road was performed.Przedstawiono przypadek 41-letniej pacjentki po przedszpitalnym nagłym zatrzymaniu krążęnia (SCD), hospitalizowanej na oddziale intensywnej opieki kardiologicznej a następnie w klinice kardiologii. U chorej rozpoznano zespół Wolffa-Parkinsona-White’a (WPW) oraz wykonano ablację lewostronnej drogi dodatkowej

Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters

INTRODUCTION: The left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection. METHODS: That is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation. RESULTS: LAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03-7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02-7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25-10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk. CONCLUSION: Novel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk