ABSTRACT
INTRODUCTION: Echocardiographic evaluation of tricuspid regurgitation (TR) velocity is a key measure in screening for pulmonary hypertension. Based on its value and additional features of right ventricle overload patients are classified into low, intermediate or high probability of pulmonary hypertension which transfers into decisions of further invasive evaluation. However, in the presence of severe TR echocardiography underestimates pulmonary artery pressure and therefore pulmonary hypertension may be overlooked in some patients. Accordingly, in the present study we aimed to assess the role of electrocardiography in predicting the presence of pulmonary arterial hypertension (PAH) in patients with severe TR. RESULTS: We analysed 83 consecutive patients with severe TR who were diagnosed in our centre between February 2008 and 2021 and who underwent right heart catheterization. Of them 58 had PAH while 25 had isolated TR (iTR). We found that the following ECG criteria supported the diagnosis of PAH as opposed to the diagnosis of iTR: R:SV1 > 1.0, max RV1 or 2 + max S I or aVL -SV1 > 6 mm, SI/RI > 1 in I. For these parameters using ROC analysis we found that the optimal thresholds suggesting the presence of pulmonary hypertension were: R:SV1 > 1.5 (AUC = 0.74, p = 0.0004, sensitivity 57.1%,specificity of 85%), max RV1 or 2 + max S I or aVL - SV1 > 3 mm (AUC = 0.76, p < 0.0001, sensitivity 91.4%, specificity of 60%) and for SI:RI > 0.71 (AUC = 0.79, p < 0.0001, sensitivity 82.5%,specificity of 70.8%). Presence of atrial fibrillation predicted iTR with 76% sensitivity and 81% specificity. CONCLUSIONS: ECG analysis can improve the diagnostic process for patients with severe TR. The presence of atrial fibrillation facilitates the diagnosis of isolated tricuspid regurgitation (iTR), while increased values of R:SV1, R:SI, and increased max RV1 or 2 + max SI or aVL - SV1 favor the diagnosis of TR secondary to PAH.
Subject(s)
Atrial Fibrillation , Hypertension, Pulmonary , Pulmonary Arterial Hypertension , Tricuspid Valve Insufficiency , Humans , Tricuspid Valve Insufficiency/complications , Tricuspid Valve Insufficiency/diagnosis , Electrocardiography , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosisABSTRACT
OBJECTIVES: The aim of this study was thus to assess the stress level among dental students, characterizing the factors that induce it and describing which students are most susceptible. METHODS: Two international, independent and validated to polish language and environment stress questionnaires were used: the Perceived Stress Scale (PSS-10) and the Perceived Medical School Stress Instrument (PMSS). The present study received approval from the Jagiellonian University Bioethical Committee (no. 1072.6120.290.2020). RESULTS: A total of 272 students from all five years of the dental undergraduate degree at Jagiellonian University Medical College were enrolled to the study, including 197 female and 75 male respondents. The overall response rate was 85%. The PSS-10 score for all dental students was 22.14±6.65. A total of 182 (66.91%) respondents had high levels of stress. Female students had significantly higher stress levels than male students, accordingly 22,9±6,51 and 20,12±6,69. Moreover, first and fifth year students had the highest stress level. In the case of PMSS the total score for all dental students was 36.84±8.65. CONCLUSIONS: Perceived stress among Polish dental students is generally high. These findings suggest that support services should be made widely available to all dental students. Such services should be targeted to the specific needs of male and female students as well as to those in specific years of study.
