Reappraisal of the transthoracic echocardiographic algorithm in predicting pulmonary hypertension redefined by updated pulmonary artery mean pressure threshold

BACKGROUND: Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity and suggestive findings for pulmonary hypertension has been utilized in the non-invasive prediction of pulmonary hypertension probability, the reliability of this approach for the updated hemodynamic definition of pulmonary hypertension remains to be determined. In this study, for the first time, we aimed to evaluate the tricuspid regurgitation jet peak velocity and suggestive findings in predicting the probability of pulmonary hypertension as defined by mean pulmonary arterial pressure > 20 mm Hg and > 25 mm Hg, respectively. METHODS: Our study group was comprised of the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. All echocardiographic and right heart catheterization assessments were performed in accordance with the European Society of Cardiology/European Respiratory Society 2015 Pulmonary Hypertension Guidelines. RESULTS: Although tricuspid regurgitation jet peak velocity showed a significant relation with mean pulmonary arterial pressure in both definitions, suggestive findings offered a significant contribution only in predicting mean pulmonary arterial pressure ≥ 25 mm Hg but not for mean pulmonary arterial pressure > 20 mm Hg. In predicting the mean pulmonary arterial pressure > 20 mm Hg, tricuspid regurgitation jet peak velocity and suggestive findings showed an odds ratio of 2.57 (1.59-4.14, P 3.4 m/s were associated with 70% and 84% probability of mean pulmonary arterial pressure > 20 mm Hg and 60% and 76% probability of mean pulmonary arterial pressure ≥ 25 mm Hg, respectively. CONCLUSIONS: In contrast to those in predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, suggestive findings did not provide a significant contribution to the probability of mean pulmonary arterial pressure > 20 mm Hg predicted by tricuspid regurgitation jet peak velocity solely. The impact of the novel mean pulmonary arterial pressure threshold on the echocardiographic prediction of pulmonary hypertension remains to be clarified by future studies

Maternal and fetal outcomes in pregnant women with pulmonary arterial hypertension: A single-center experience and review of current literature

BACKGROUND: Although pregnancy in women with pulmonary arterial hypertension has been considered a high-risk condition, current data regarding pregnancy with pulmonary arterial hypertension are scarce. In this study, we aimed to evaluate our single-center data on maternal and fetal outcomes in pregnant women with PAH and review currently available risk-based management strategies. METHODS: Our single-center study group comprised 35 women who became pregnant after the diagnosis of pulmonary arterial hypertension or in whom pulmonary arterial hypertension was diagnosed within early post-partum period. Clinical, laboratory, echocardiographic, and hemodynamic characteristics of pregnant and non-pregnant productive women with pulmonary arterial hypertension were compared, and similar comparison was also repeated for survivors and non-survivors in pregnant patient group. RESULTS: Pregnancy was noted in 15% of the 228 females with pulmonary arterial hypertension who were of hormonally productive ages, generally well-tolerated until delivery. Elective abortion and pre-term delivery were documented in 1 (2.8%) and 12 (35.3%) pregnant women, respectively. Switching to sildenafil was the standard medication during pregnancy. Cesarian section was the preferred method of delivery in all pregnant women with pulmonary arterial hypertension and was performed without any complication. Clinic deteoriation within the first week of delivery was observed in 5 (41.6%) patients. Maternal mortality was noted in 13 (37.1%) patients and was documented to cumulate within the first month of delivery. However, any sign predicting post-partum clinical deterioration was not found. No fetal mortality was observed. CONCLUSION: Despite the development of advanced therapies, pregnancy in pulmonary arterial hypertension still carries a high mortality risk and requires multi-disciplinary expert center care with more proactive management strategies

A new index for the prediction of in-hospital mortality in patients with acute pulmonary embolism: The modified shock index

BACKGROUND: Pulmonary embolism severity index, its simplified version, and shock index have been used for risk stratification in acute pulmonary embolism. In this study, we proposed a modification in severity index and evaluated the correlates and prognostic value of modification in severity index in this setting. METHODS: The study group comprised retrospectively evaluated 181 patients with acute pulmonary embolism. Systematic workup including pulmonary embolism severity index, its simplified version, shock index, biomarkers, and echocardiographic and multidetector computed tomography assessments was performed in all patients. Moreover, we calculated modification in severity index by multiplying original shock index (heart rate/systolic blood pressure ratio) and a third component, 1/pulse oxymetric saturation (pSat O2%) ratio. The primary endpoint was defined as all-cause mortality and hemodynamic collapse during the hospital stay. RESULTS: On the basis of initial risk stratification, ultrasound-assisted thrombolysis, systemic tissue-type plasminogen activator, and unfractionated heparin therapies were utilized in 83 (45.9%), 37 (20.4%), and 61 (33.7%) patients, respectively. The primary end-point occurred in 13 (7.2%) patients. Receiver-operating curve analysis revealed that modification in severity index had the highest area under the curve of 0.739 (0.588-0.890, P =.002) compared with shock index, pulmonary embolism severity index, or its simplified version. The modification in severity index > 0.989 predicted primary endpoint with 73% sensitivity and 54% specificity. CONCLUSIONS: The modification in severity index seems to be a simple, quick, and compre-hensive risk assessment tool for bedside evaluation at initial stratification, in monitoring the clinical benefit from therapies, and decision-making for escalation to other reperfusion strategies in patients with acute pulmonary embolism. However, the prognostic value of modification in severity index needs to be validated with further studies

A novel composed index to evaluate the right ventricle free-wall adaptation against ventricular wall stress in acute pulmonary embolism

Background: Pulmonary embolism severity index and simplified pulmonary embolism severity index have been utilized in initial risk evaluation in patients with acute pulmonary embolism. However, these models do not include any imaging measure of right ventricle function. In this study, we proposed a novel index and aimed to evaluate the clinical impact. Methods: Our study population comprised retrospectively evaluated 502 patients with acute pulmonary embolism managed with different treatment modalities. Echocardiographic and computed tomographic pulmonary angiography evaluations were performed at admission to the emergency room within maximally 30 minutes. The formula of our index was as follows: (right ventricle diameter × systolic pulmonary arterial pressure-echo)/(right ventricle free-wall diameter × tricuspid annular plane systolic excursion). Results: This index value showed significant correlations to clinical and hemodynamic severity measures. Only pulmonary embolism severity index, but not our index value, independently predicted in-hospital mortality. However, an index value higher than 17.8 predicted the long-term mortality with a sensitivity of 70% and specificity of 40% (areas under the curve = 0.652, 95% CI, 0.557-0.747, P = .001). According to the adjusted variable plot, the risk of long-term mortality increased until an index level of 30 but remained unchanged thereafter. The cumulative hazard curve also showed a higher mortality with high-index value versus low-index value. Conclusions: Our index composed from measures of computed tomographic pulmonary angiography and transthoracic echocardiography may provide important insights regarding the adaptation status of right ventricle against pressure/wall stress in acute pulmonary embolism, and a higher value seems to be associated with severity of the clinical and hemodynamic status and long-term mortality but not with in-hospital mortality. However, the pulmonary embolism severity index remained as the only independent predictor for in-hospital mortality

Remembering the Occam’s Razor: Could simple electrocardiographic findings provide relevant predictions for current hemodynamic criteria of pulmonary hypertension?

Background: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC). Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH. Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU). Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH

Studies on the reproductive effects of chronic treatment with agomelatine in the rat

Agomelatine is an antidepressant with a novel mechanism of action. It is a melatonergic agonist for MT1 and MT2 receptors and a serotonin (5-HT2C) receptor antagonist. Agomelatine has been suggested not to have adverse effects on sexual functions. However, the effects of chronic agomelatine administration on reproductive functions have not been sufficiently studied in animal models. We mainly aimed to explore the effects of agomelatine on reproductive functions in the male and female rats. For the experimental studies, Sprague Dawley rats were used. The animals started to receive daily oral agomelatine (10mg/kg) on post-natal day 21. Agomelatine advanced vaginal opening in the female rats whereas it delayed puberty onset in the male rats. Agomelatine treatment significantly decreased intromission frequencies, which indicates a facilitator role of this antidepressant on male sexual behavior. In the forced swimming test (FST) used for assessing antidepressant efficacy, agomelatine induced a significant decrease in duration of immobility, and an increase in the swimming time, respectively, which confirms the antidepressant-like activity of agomelatine. The present findings suggest that agomelatine shows a strong antidepressant effect in the male rats without any adverse influences on sexual behavior, and its effects on pubertal maturation seem to show sex-dependent differences.TÜBiTAK – 113S19

Endodontik Tedavi Prognozunun Dental İmplantlarla Karşılaştırılması ve Hekimlerin Endodontik Tedavi Sırasındaki Stres Düzeylerinin Belirlenmesi: Bir Anket Çalışması

Evaluation of Endodontic Treatment Prognosis with Dental Implants and Determination of Stress Levels of Dentists During Endodontic Treatment: A Survey Study. Hacettepe University Faculty of Dentistry, Specialization Thesis in Endodontics, Ankara, 2017. In this study, it was aimed to investigate the preference trends of dentists between doing root canal treatment to teeth or applying dental implant after extraction for different cases and to determine the levels of stress experienced during endodontic treatment stages through a survey. Surveys were delivered via e-mail to 642 participants using the Turkish Dental Association's database; 430 of these participants are general dentists, 65 of whom are endodontists and 147 of whom are specialist dentists in other specialized fields. Descriptive statistics such as mean, median, standard deviation, minimum, maximum, weighted percentages were used with SPSS 22.00 program in statistical analysis of collected data. Values were analyzed visually (percent graphs) and analytical (Chi square test) according to their normal distribution. Statistically significant results were obtained when the P value was below 0.05. It has been shown that dentists’ preference trends between endodontic treatment and implant and stress levels experienced at the endodontic treatment stages are related to their expertise, the institutions they work with, their gender, the time since graduation and the time they have been actively engaged in specialist areas of expertise. In the future, further studies detailed evaluation of these factors might help to obtain more detailed results.Endodontik Tedavi Prognozunun Dental İmplantlarla Karşılaştırılması ve Hekimlerin Endodontik Tedavi Sırasındaki Stres Düzeylerinin Belirlenmesi: Bir Anket Çalışması, Hacettepe Üniversitesi Diş Hekimliği Fakültesi Endodonti Programı, Uzmanlık Tezi, Ankara 2017. Bu çalışmada, anket yoluyla hekimlerin çeşitli vakalar karşısında kanal tedavisi yapmak veya dişi çekip dental implant uygulamak arasındaki tercih eğilimlerinin araştırılması ve endodontik tedavi aşamalarında yaşadıkları stres düzeyinin belirlenmesi amaçlanmıştır. Anketler, Türk Diş Hekimleri Birliği’nin veritabanı kullanılarak 642 adet katılımcıya elektronik posta yoluyla ulaştırılmış olup; bu katılımcıların 430’unu pratisyen diş hekimleri, 65’ini endodonti uzmanları ve 147’sini de diğer uzmanlık dallarındaki uzman diş hekimleri oluşturmaktadır. Toplanan verilerin istatistiksel analizinde SPSS 22.00 programı ile ortalama, ortanca, standart sapma, minimum, maksimum, ağırlıklı yüzde hesapları gibi tanımlayıcı istatistik kullanılmıştır. Değerlerin normal dağılıp dağılmamalarına göre görsel (yüzde grafikleri) ve analitik yöntemle (Ki kare testi) inceleme yapılmıştır. P değerinin 0.05’in altında olduğu durumlar istatistiksel olarak anlamlı sonuçlar şeklinde değerlendirilmiştir. Hekimlerin endodontik tedavi ve implant arasındaki tercih eğilimleri ve endodontik tedavi aşamalarında yaşadıkları stres düzeyleri ile uzmanlık alanları, çalıştıkları kurum, cinsiyetleri, mezun olduktan sonra geçen süre ve uzman hekimlerin uzmanlık alanlarında aktif olarak çalıştıkları süre arasında ilişki olduğu görülmüştür. İleride bu faktörlerin daha geniş popülasyonlarda ayrıntılı olarak incelendiği çalışmalar yapılması, daha detaylı sonuçların elde edilmesine yardımcı olabilir