Assessment of Knowledge, Attitude, and Practice Patterns in Pulmonary Arterial Hypertension among Cardiologists and Pulmonologists: Evidence from Turkey.

Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare chronic disease of the small pulmonary arteries that causes right heart failure and death. Accurate management of PAH is necessary to decrease morbidity and mortality. Understanding current practices and perspectives on PAH is important. For this purpose, we intended to determine physicians' knowledge, attitudes, and practice patterns in adult pulmonary arterial hypertension (PAH) in Turkey. Materials and Methods: Between January and February 2022, an online questionnaire was sent via e-mail to all cardiologists and pulmonologists who were members of the Turkish Society of Cardiology (TSC) and the Turkish Thoracic Society (TTS). Results: A total of 200 physicians (122 pulmonologists and 78 cardiologists) responded to the questionnaire. Cardiologists were more frequently involved in the primary diagnosis and treatment of PAH than pulmonologists (37.2% vs. 23.8%, p = 0.042). More than half of the physicians had access to right heart catheterization. In mild/moderate PAH patients with a negative vasoreactivity test, the monotherapy option was most preferred (82.8%) and endothelin receptor antagonists (ERAs) were the most preferred group in these patients (73%). ERAs plus phosphodiesterase-5 inhibitors (PDE-5 INH) were the most preferred (69%) combination therapy, and prostacyclin analogues plus PDE-5 INH was preferred by only pulmonologists. Conclusions: Overall, clinical management of patients with PAH complied with guideline recommendations. Effective clinical management of PAH in specialized centers that having right heart catheterization achieve better outcomes.

Right atrial reservoir strain and right ventricular strain improves in patients recovered from hospitalisation for non-severe COVID-19.

PURPOSE: Those hospitalised with coronavirus disease 2019 (COVID-19) have recently been shown to have impaired right ventricular (RV) strain, but data about the course of heart function after discharge are limited. Our aim was to compare right ventricular strain and right atrial reservoir strain (RASr) associated with COVID-19 between acute disease (during hospitalisation) and follow-up (after discharge). METHODS: In this retrospective single-center study, we analysed the echocardiograms of 43 patients hospitalised for non-severe COVID-19 between December 2020 and March 2021, undergoing echocardiography both during and after hospitalisation. In addition to conventional echocardiographic parameters, we applied 2-dimensional speckle tracking to obtain RV global longitudinal strain (RV-GLS), RV free wall strain (RV-FWS), and RASr. RESULTS: Mean (standard deviation) age of the study population was 50 (9) years, and 18 (42%) of the participants were women. Median duration between exams was 6 months (range, 5-7 months). Both mean RV-GLS and mean RV-FWS significantly increased at follow-up (-20.8 [3.8] vs. -23.5 [2.8], p < 0.001 and -23.3 [4.2] vs. -28.2 [2.8], p < 0.001; respectively), and RASr significantly improved as well (-32.3 [6.6] vs. -41.9 [9.8], p < 0.001). CONCLUSION: In patients hospitalised for non-severe COVID-19 pneumonia, RV-GLS, RV-FWS, and RASr improved significantly between acute disease and 6 months after discharge.

Increasing modified CHA2DS2-VASc risk score is associated with acute cardiac injury in hospitalised COVID-19 patients.

BACKGROUND: Prediction of hospital mortality in patients with COVID-19 by the CHA2DS2VASc (M-CHA2DS2VASc) has been recently shown. Because COVID-19 patients with acute cardiac injury have higher mortality compared to those without, we assumed that this risk score may also predict acute cardiac injury in these patients. METHODS: In this retrospective, single centre cohort study, we included 352 hospitalised patients with laboratory-confirmed COVID-19 and divided into three groups according to M-CHA2DS2VASc risk score which was created by changing gender criteria of the CHA2DS2VASc from female to male (Group 1, score 0-1 (n = 142); group 2, score 2-3 (n = 138) and group 3, score ≥4 (n = 72)). RESULTS: As the M-CHA2DS2VASc risk score increased, acute cardiac injury was also significantly increased (Group 1, 11.3%; group 2, 48.6%; group 3, 76%; p < 0.001). The higher M-CHA2DS2VASc tertile had higher prevalence of arrhythmias compared to lower tertile. The multivariate logistic regression analysis showed that M-CHA2DS2VASc risk score, admission to intensive care unit and invasive mechanical ventilation were independent predictors of acute cardiac injury (p = 0.001, odds ratio 1.675 per scale for M-CHA2DS2VASc). In receiver operating characteristic analysis, M-CHA2DS2VASc risk score was able to predict acute cardiac injury (Area under the curve value for acute cardiac injury was 0.80; p < 0.001). CONCLUSION: Admission M-CHA2DS2VASc risk score was associated with acute cardiac injury in hospitalised patients with COVID-19.