Coronary Microvascular Dysfunction in Asymptomatic Patients with Severe Psoriasis.

Severe psoriasis is associated with an increased cardiovascular risk, which may be independent of the traditional risk factors. Coronary microvascular dysfunction (CMD) has been shown to predict a poor cardiovascular prognosis in the general population and in patients with psoriasis. In this study, we assessed the prevalence and predictors of CMD in a large cohort of patients with psoriasis without clinical cardiovascular disease. A total of 503 patients with psoriasis were enrolled and underwent transthoracic Doppler echocardiography to evaluate coronary microcirculation. Of these, 55 patients were excluded from the analyses because of missing data. Of the 448 patients in this study, 31.5% showed CMD. Higher PASI, longer disease duration, the presence of psoriatic arthritis, and hypertension were independently associated with CMD. An increase of 1 point of PASI and 1 year of psoriasis duration were associated with a 5.8% and 4.6% increased risk of CMD, respectively. In our study, CMD was associated with the severity and duration of psoriasis. This supports the role of systemic inflammation in CMD and suggests that the coronary microcirculation may represent an extracutaneous site involved in the immune-mediated injury of psoriasis. We should diagnose and actively search for CMD in patients with severe psoriasis.

Pregnancy in a Patient With Tetralogy of Fallot and Borderline Pulmonary Arterial Hypertension.

Management of pregnancy in patients with complex congenital heart disease and pulmonary arterial hypertension has always been a challenge. We are presenting a patient with complex congenital heart disease and borderline pulmonary arterial hypertension who complicated with pulmonary embolism during pregnancy. (Level of Difficulty: Beginner.).

Prognostic value of high sensitivity troponin T in patients with acutely decompensated heart failure and non-detectable conventional troponin T levels.

BACKGROUND: High-sensitivity troponin Τ (hs-TnΤ) allows the detection of very minor myocardial injury and has emerged as a novel prognostic marker in patients with cardiovascular disease. The aim of the present study was to determine the prognostic utility of hs-TnΤ levels in patients admitted to hospital for acutely decompensated heart failure (ADHF) and non-detectable conventional TnΤ levels. METHODS: We prospectively enrolled 113 consecutive ADHF patients [77 (68%) men], mean age: 72.7±11.3 years, presented at admission with normal (<0.03 ng/ml) conventional (4th generation) TnΤ levels. Hs-TnΤ levels were measured by relevant commercially available kits and patients were monitored for major adverse events during a median follow-up period of 174 days (94-728 days). RESULTS: In the univariate Cox proportional hazard analysis, hs-TnΤ was significantly related to death (HR=1.002 with 95%: confidence interval (CI) 1.001-1.003, P=0.001). In multivariate analysis, it remained a significant predictor of death after adjustment for age, gender, ejection fraction and creatinine levels (HR=1.003 with 95%: CI 1.001-1.005, P=0.008). CONCLUSION: hs-TnΤ seems to identify high risk patients hospitalized for ADHF, independently of other classical prognostic biomarkers. Further studies are necessary to confirm the utility of this novel biomarker in risk stratification and management of patients with ADHF.