Publikacje

Michał A Potępa, Andrzej Łabyk, Dariusz Zieliński, Piotr Pruszczyk, Marek Roik

Piotr Pruszczyk

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Michał Ciurzyński, Marzanna Paczyńska, Piotr Sobieraj, Piotr Pruszczyk

Joanna Radochońska, Monika Lisicka, Piotr Bienias

Elektrokardiografia (EKG) odgrywa znaczącą rolę w różnicowaniu wielu chorób, w tym przebiegających z zajęciem prawego serca. Rozpoznanie patologii prawej komory (RV) bywa trudne ze względu na złożoną budowę oraz szerokie spektrum zaburzeń hemodynamicznych wynikających z jej dysfunkcji. Standardowy zapis EKG czynności serca uzupełniony o rejestrację odprowadzeń prawokomorowych może być w tym przypadku cennym uzupełnieniem badań obrazowych, zwłaszcza gdy te nie są szybko dostępne. W przebiegu ostrej zatorowości płucnej, nadciśnienia płucnego, zawału prawej komory czy arytmogennej kardiomopatii prawokomorowej obserwuje się liczne nieprawidłowości elektrokardiograficzne pomocne w diagnostyce, a część z nich ma znaczenie prognostyczne. Niestety, mimo swojej prostoty i użyteczności EKG cechuje się niedostateczną czułością i swoistością, by mógł stanowić pojedyncze narzędzie diagnostyczne w wykrywaniu nieprawidłowości RV. Elektrokardiografia to powszechne, tanie, nieinwazyjne i łatwe do wykonania badanie uzupełniające, które może mieć istotne znaczenie w algorytmie diagnostycznym różnych chorób przebiegających z zajęciem RV.

Anna Kaczyńska, Maciej Kostrubiec, Michał Ciurzyński, Piotr Pruszczyk

Myocardial stretch leads to the natriuretic peptides release in acute or chronic left ventricular dysfunction. However, there is an accumulating evidence that B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) may originate from right ventricle and their concentrations are elevated in patients with acute pulmonary embolism (APE) especially when resulting in right ventricular dysfunction (RVD). Recently it is underlined that severity assessment of APE as well as the risk stratification and therapy selection is based both on patients' hemodynamic status and markers of myocardial injury and RVD. BNP and NT-proBNP are helpful in identifying patients with RVD in APE, emerging as an adjunctive tool to echocardiography. Elevated BNP or NT-proBNP levels are also significant predictors of death and/or complicated clinical course in APE.

Justyna Pedowska-Włoszek, Maciej Kostrubiec, Piotr Pruszczyk

Endothelins (ET), a family of three peptides of strong vasoconstrictive properties, participate in the regulation of vascular tone and blood flow. The synthesis and degradation of the ET predominantly take place in the pulmonary vasculature. Elevated plasma ET levels were reported in various forms of arterial pulmonary hypertension including chronic thromboembolic pulmonary hypertension (CTEPH). Moreover, clinical studies with nonselective ET receptor antagonist - bosentan reported improvement in functional class in patients with CTEPH. It has been suggested that endothelins may play an important role in acute pulmonary thromboembolism (APE). However, further studies are necessary to verify these observations. In the current paper we discuss a potential role of endothelins in CTEPH and APE.

Maciej Kostrubiec, Nikola Niewegłowska, Piotr Pruszczyk

Pregnancy and puerperium increase the risk of venous thromboembolic disease. As it is potentially life-threatening, all patients with the suspicion of pulmonary embolism require proper diagnosis and, possibly treatment. Venous ultrasonography is usually applied. However; in most cases the examinations with the use of ionized radiation--computer tomography or scintigraphy--are indispensable. In treatment of pulmonary embolism, low molecular weight heparins play the key role. However; in case of dramatic pulmonary embolism with shock and hypotension, thrombolytic therapy may be necessary. Low molecular weight heparins as well as oral anticoagulants can be used after the delivery.

Piotr Pruszczyk, Stavros Konstantinides

Acute pulmonary embolism (PE) is one of the major causes of in‑hospital mortality, and the short‑term prognosis of patients is strongly related to its hemodynamic consequences. Therefore, a stepwise risk‑stratification approach has been proposed, using a combination of clinical data, imaging, and biochemical markers to define the risk of an early adverse outcome. Patients should be managed according to PE severity: some of them require urgent primary reperfusion; for most patients, anticoagulation alone is sufficient; and selected low‑risk patients are potential candidates for early discharge and continuation of treatment on an outpatient basis. We present the current risk‑adapted approach to management strategies in acute PE.

Magdalena Pływaczewska, Piotr Pruszczyk, Maciej Kostrubiec

Cardiovascular circulation and kidney function are closely interrelated. The impairment of renal function is a well-known hazard of increased mortality and morbidity of patients with heart failure or coronary artery disease. Acute pulmonary embolism (APE) impacts pulmonary and systemic circulation, and can severely impair functions of other organs, including kidneys, as a result of hypoxemia and increased venous pressure. Previous studies indicate that renal dysfunction predicts short- and long-term outcomes and can improve the risk assessment in APE. However, renal function should also be cautiously considered during the diagnostic workup because the contrast-induced nephropathy after computed tomography pulmonary angiography is noticed more frequently in APE. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but imminent complication of APE. This condition promotes renal impairment by increasing venous pressure and decreasing glomerular filtration. The renal function improvement and serum creatinine concentration reduction were noted in CTEPH subgroup with glomerular filtration rate ≤ 60 mL/min/1.73 m2 after successful treatment. In this review, we present the essential research results on the kidney function in thromboembolism disease.Keywords: chronic thromboembolic pulmonary hypertension; contrast-induced nephropathy; mortality; prognosis; pulmonary embolism; renal dysfunction.

Piotr Pruszczyk, Marta Skowrońska, Michał Ciurzyński, Katarzyna Kurnicka, Mareike Lankeit, Stavros Konstantinides

Currently, venous thromboembolism, including deep vein thrombosis and acute pulmonary embolism (PE), is globally the third most frequent acute cardiovascular syndrome with rising incidence rates. The clinical presentation of PE is heterogenous: from incidental findings on imaging studies to sudden cardiac death. Hemodynamic instability identifies patients at high risk of early mortality. In hemodynamically stable patients, further stratification into intermediate- and low-risk categories is advised, preferably using a combined risk assessment strategy based on clinical parameters, laboratory findings, and imaging markers. Treatment should be tailored to the risk of early death, with more aggressive treatments reserved for patients at higher risk of complications. This review offers an update on the current strategies for assessing PE severity and the risk of early death and discusses developments in predicting mortality risk in patients with PE.