Aim: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of perioperative hemodynamic instability is currently unknown. Methods: A prospective study was conducted on a group of 708 consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary end point was postoperative hemodynamic instability. The secondary end point was death from all causes in patients with perioperative hemodynamic instability. Results: The postoperative hemodynamic instability occurred in 131 patients. At multivariate analysis hs-TnT measured immediately after surgery and New York Heart Association classes remained independent predictors of the primary end point. Age and hs-TnT measured immediately after surgery were associated with an increased risk of death. Conclusion: Elevated postoperative hs-TnT was associated with a higher risk of postoperative hemodynamic instability and death.
Background Patients with primary biliary cholangitis (PBC) have decreased health‐related quality of life (HRQoL). Here, we investigate HRQoL in two cohorts of transplanted patients with PBC and compare their results to healthy subjects. Patients and Methods We used generic SF‐36 and disease‐specific PBC‐40 questionnaires to evaluate HRQoL in 26 patients with PBC (23 females, age 59.4 ± 5.7 years) before and after liver transplantation (LT), and in 107 patients with PBC (99 females, age 62.8 ± 6.7 years) who were previously transplanted. The control group was comprised of 60 healthy controls (55 females, age 54.6 ± 8.8 years). Results Health‐related quality of life improved after LT in 85% of PBC patients. The SF‐36 measure showed significant (all P < 0.05) improvements in the majority of domains after LT, and in the summary scores both physical and mental. We also documented significant improvements in pruritus and fatigue after LT (all P < 0.01). However, liver graft recipients had significantly worse physical functioning, physical role, and emotional role domains, and physical component score (all P < 0.001), as compared to healthy subjects. No differences in HRQoL were detected between patients evaluated after short and prolonged post‐LT periods (P > 0.05). Conclusion Liver transplantation substantially improves most aspects of life quality in PBC patients. Nevertheless, their HRQoL remains worse in comparison to healthy individuals, mainly in physical aspects.
A 61-year-old woman with a history of hypertension and asthma was transferred to the Institute of Cardiology in Warsaw from another hospital due to a suspicion of pulmonary valve infective endocarditis (IE). The symptoms began five months previously, with progressive weakness, fever up to 39°C, muscle pain, and weight loss of 6 kg. Prior to admission she had been repeatedly hospitalised for over two months. During the first hospitalisation transthoracic echocardiography (TTE) revealed a round mobile echogenic mass attached to the arterial side of the pulmonary valve, without valvular dysfunction. The pulmonary trunk was not expanded. Computed tomography (CT) confirmed the presence of a mobile mass attached to the pulmonary valve. Moreover, diffuse consolidation in both lungs was present. Repeated blood cultures remained negative. Doppler ultrasonography excluded deep vein thrombosis. Abdominal ultrasonography, oesophagogastroduodenoscopy, and gynaecological examination did not reveal any abnormalities. Bronchoscopy demonstrated features of chronic bronchitis. Tuberculosis was excluded. Finally, the patient was diagnosed with IE, and antibiotic therapy was initiated. The treatment with ceftriaxone, vancomycin, levofloxacin, ciprofloxacin, and fluconazole did not improve the patient's status, and she was referred to our centre. On admission, the woman was in good general condition, her pulse rate was 61 bpm and blood pressure was 111/73 mmHg. Laboratory tests showed an elevated level of C-reactive protein (0.07 g/L; reference range, 0.0-0.005 g/L) and a reduced haemoglobin level (90 g/L; reference range, 120-160 g/L). During hospitalisation, fever up to 39.2°C was observed. Blood cultures in our hospital were also negative. TTE confirmed a round mobile additional mass attached to the arterial side of the pulmonary valve (Fig. 1A, B), suspicious of a tumour. Electrocardiogram-gated cardiac CT showed a hypodense, microlobulated mass, sized 16 × 14 mm, attached to the leaflet of the pulmonary valve by a narrow stalk ( Fig. 2A, B). The attenuation value was 150 Hounsfield units after contrast administration. Due to morphological features on CT and the location of the lesion, cardiac tumour was suspected. Pulmonary embolism and infection were excluded. The patient was referred for a surgical intervention and underwent a successful removal of the pulmonary valve mass. Histopathological examination showed cardiac papillary fibroelastoma (CPF) (Suppl. Fig. 1 -see journal website). The patient was discharged home in good condition. CPFs are benign primary cardiac tumours. They are the second most common primary cardiac tumours, and the most common cardiac valvular tumours [1,2]. More than 95% of CPFs arise in the left heart [2], whereas pulmonary valve papillary fibroelastomas are extremely rare. CPFs are mostly valvular, < 25% of them arise from nonvalvular endocardial surfaces [2,3]. The most common location of CPFs is the aortic valve (44%-59%), followed by the mitral valve (13%-35%), the tricuspid valve (4%-15%), and th...
Introduction: Several studies have reported that elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with poor outcomes in patients with heart failure or coronary artery disease. Its prognostic utility in patients undergoing aortic valve replacement (AVR) has not been fully described. Aim: To assess the predictive abilities of the NT-proBNP parameter in terms of the occurrence of serious postoperative complications in the early observation period in patients undergoing aortic valve replacement surgery. Material and methods: A prospective study was conducted on a group of consecutive patients with hemodynamically significant aortic stenosis who underwent aortic valve replacement surgery. One day before surgery a blood sample for the measurement of biomarker levels was collected from each patient. The primary endpoint was any major adverse events including death within 30 days. Results: The study included 245 patients who underwent aortic valve replacement surgery with or without concomitant procedures on the ascending aorta. The mean age in the study group was 66 ±11 and there were 149 (61%) men. In 160 patients a biological aortic valve prosthesis was implanted, and in 85 a mechanical valve. The composite endpoint occurred in 74 patients. The actual mortality was 3.2% vs. the mortality of 2.9% predicted by the EuroSCORE II model. In multivariate analysis NT-proBNP (p = 0.01), age (p = 0.02) and NYHA class (p = 0.01) remained independent predictors of the composite end point. A correlation was found between the level of NT-proBNP and hs-TnT (r = 0.27; p < 0.001), ejection fraction (EF) (r = -0.48; p < 0.001), NYHA class (r = 0.3; p < 0.001) and pulmonary blood pressure (r = 0.48; p < 0.001). Conclusions: Elevated preoperative NT-proBNP was associated with a poorer outcome following AVR.
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