Aetiology and outcomes of severe right ventricular dysfunction.

AIMS: Right ventricular dysfunction (RVD) is an important determinant of functional status and survival in various diseases states. Data are sparse on the epidemiology and outcome of patients with severe RVD. This study examined the characteristics, aetiology, and survival of patients with severe RVD. METHODS AND RESULTS: Retrospective study of consecutive patients with severe RVD diagnosed by transthoracic echocardiography (TTE) between 2011 and 2015 in a single tertiary referral institution. Patients with prior cardiac surgery, mechanical assist devices, and congenital heart disease were excluded. Primary endpoint was all-cause mortality. In 64 728 patients undergoing TTE, the prevalence of ≥mild RVD was 21%. This study focused on the cohort of 1299 (4%) patients with severe RVD; age 64 ± 16 years; 61% male. The most common causes of severe RVD were left-sided heart diseases (46%), pulmonary thromboembolic disease (18%), chronic lung disease/hypoxia (CLD; 17%), and pulmonary arterial hypertension (PAH; 11%). After 2 ± 2 years of follow-up, 701 deaths occurred, 66% within the first year of diagnosis. The overall probability of survival at 1- and 5 years for the entire cohort were 61% [95% confidence interval (CI) 58-64%] and 35% (95% CI 31-38%), respectively. In left-sided heart diseases, 1- and 5-year survival rates were 61% (95% CI 57-65%) and 33% (95% CI 28-37%), respectively; vs. 76% (95% CI 68-82%) and 50% (95% CI 40-59%) in PAH, vs. 71% (95% CI 64-76%) and 49% (95% CI 41-58%) in thromboembolic diseases, vs. 42% (95% CI 35-49%) and 8% (95% CI 4-15%) in CLD (log-rank P < 0.0001). Presence of ≥moderate tricuspid regurgitation portended worse survival in severe RVD. CONCLUSION: One-year mortality of patients with severe RVD was high (∼40%) and dependent on the aetiology of RVD. Left-sided heart diseases is the most common cause of severe RVD but prognosis was worst in CLD.

The Eyes Cannot See What the Mind Does Not Know: Endocrinological Side Effects of Ibrutinib.

INTRODUCTION: Over the last 7 years, ibrutinib has been given US Food and Drug Administration approval for a rising number of indications ranging from chronic lymphocytic leukemia (CLL) and marginal zone lymphoma to Waldenstrom macroglobulinemia. CASE PRESENTATION: An 85-year-old man with a history of CLL who had been treated with ibrutinib over 6 weeks developed a rash and progressive weakness, and he was ultimately admitted to the hospital for obtundation. He was hypotensive, hyponatremic, and hypothyroid. Despite extensive testing and treatment for syndrome of inappropriate antidiuretic hormone (SIADH), he remained unimproved. Results of an adrenocorticotropic hormone stimulation test indicated secondary adrenal insufficiency. He was treated with hydrocortisone, and his symptoms subsequently resolved. DISCUSSION: Previous studies have demonstrated the presence of endocrine dysfunction, such as adrenal insufficiency, thyroid dysfunction, hyperparathyroidism, and gonadal failure in some tyrosine kinase inhibitors (TKI). To our knowledge, no previous literature has reported this association specifically with the TKI ibrutinib. The case highlights the importance of spreading awareness amongst clinicians of potential side effects that can occur with targeted therapy such as ibrutinib. This, in turn, will facilitate prompt recognition and early management when such cases arise in a hospital setting.