Clinical Characteristics of Patients Undergoing Right Heart Catheterizations in Community Hospitals.

Background Recognition of precapillary pulmonary hypertension (PH) has significant implications for patient management. However, the low a priori chance to find this rare condition in community hospitals may create a barrier against performing a right heart catheterization (RHC). This could result in misclassification of PH and delayed diagnosis/treatment of precapillary PH. Therefore, we investigated patient characteristics and echocardiographic parameters associated with the decision whether to perform an RHC in patients with incident PH in 12 Dutch community hospitals. Methods and Results In total, 275 patients were included from the OPTICS (Optimizing PH Diagnostic Network in Community Hospitals) registry, a prospective cohort study with patients with incident PH; 157 patients were diagnosed with RHC (34 chronic thromboembolic PH, 38 pulmonary arterial hypertension, 81 postcapillary PH, 4 miscellaneous PH), while 118 patients were labeled as probable postcapillary PH without hemodynamic confirmation. Multivariable analysis showed that older age (>60 years), left ventricular diastolic dysfunction grade 2-3, left atrial dilatation were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension-associated conditions, right atrial dilatation, and tricuspid regurgitation velocity ≥3.7 m/s favor an RHC performance. Conclusions Older age and echocardiographic parameters of left heart disease were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension-associated conditions, right atrial dilation, and severe PH on echocardiography favored an RHC performance. As such, especially elderly patients may be at an increased risk of diagnostic delays and missed diagnoses of treatable precapillary PH, which could lead to a worse prognosis.

The diagnostic value of soluble CD163 in patients presenting with chest pain.

BACKGROUND: CD163 is a scavenger receptor for the uptake of haptoglobin-hemoglobin (Hpt-Hb) complexes. The Hpt-Hb complexes are being formed in the plaque in response to intraplaque hemorrhage, a hallmark of atherosclerotic plaque instability. We therefore investigated whether soluble CD163 (sCD163) was elevated in patients with an acute coronary syndrome. METHODS: All subjects presenting with chest pain suggestive of myocardial ischemia referred to either the emergency department or the coronary care unit were included in a prospective follow-up study. Plasma was collected and frozen at -80 degrees C until assayed. sCD163 was measured using a commercially available Elisa assay. RESULTS: Of 526 included chest pain patients, the final diagnosis was non-cardiac chest pain in 244 (46%) patients, non-STEMI in 67 (13%), and STEMI in 215 (41%). The non-STEMI patients were older, used more medication, had undergone more often coronary interventions, but did not differ with respect to risk factors, except for a higher incidence in dyslipidemia. Unexpectedly, sCD163 did not differentiate between patients with non-STEMI or STEMI and the non-cardiac chest pain patients (2.09+/-0.76 versus 2.24+/-0.86). CONCLUSION: Although ACS is characterized by intraplaque hemorrhage, the amount of intraplaque Hb release seems not to be substantial enough to result in a measurable difference in sCD163.

[The role of multidetector computed tomography in the diagnosis in 3 patients with ischaemic heart complaints]. / De rol van multidetector-CT in de diagnostiek bij 3 patiënten met ischemische hartklachten.

Multidetector CT (MDCT) can provide important information before or after coronary angiography (CAG). This is illustrated by three cases. In a 21-year-old female with ventricle fibrillation CAG demonstrated an anomalous right coronary artery, the exact course of which could not be evaluated. MDCT demonstrated a course between the aorta and pulmonary trunk with vessel compression during systole. After a bypass operation and subsequent pacemaker implantation, she was asymptomatic at follow-up six weeks after hospital discharge. In a 46-year-old male with chest pain, MDCT showed triple vessel disease after which percutaneous coronary intervention (PCI) with stent implantation of the three main branches was performed. Two months after discharge, the patient did not report any complaints. In a 51-year-old male scheduled for PCI of the left anterior descending coronary artery (LAD), MDCT detected a LAD thrombus with 90% occlusion prior to PCI. The occlusion was confirmed during CAG and treated with angioplasty. The next day he was discharged. MDCT offers a practical solution for different cardiac problems through its high diagnostic value.

[Multidetector computed tomography of the coronary arteries]. / Multidetectorcomputertomografie van de kransslagaderen.

In the past decade, improvements in CT techniques have enabled non-invasive visualization of the coronary arteries. Multidetector CT (MDCT) is currently the generally accepted technique for the follow-up of coronary stents and by-pass grafts, and for the evaluation of anomalous coronary arteries and coronary artery disease. Both the degree of stenosis, as well as plaque composition can be determined by MDCT. Plaque composition has proven to be a more important predictor for acute coronary syndromes than the degree of stenosis. In addition, MDCT has less risks of complication and lower costs. Limitations of MDCT are: sensitivity to rhythm- and breathing artefacts, a lower spatial and time resolution than coronary angiography (CAG), and difficulties in coronary evaluation close to high density structures such as calcifications and stents. Coronary angiography is still indicated when functional information has to be obtained about coronary flow. MDCT should be considered in all cases in which diagnostic CAG is performed.