BACKGROUND:Electrocardiogram (ECG) is commonly used in diagnosis of heart diseases, including many life-threatening disorders. We aimed to assess skills in ECG interpretation among Polish medical students and to analyze the determinants of these skil...

Background: Inflammatory response and endothelial dysfunction contribute to the progression of chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to assess changes in biomarkers involved in those processes in inoperable CTEPH patients treated with balloon pulmonary angioplasty (BPA). Methods: We enrolled 20 patients with inoperable CTEPH qualified for BPA and a control group. Interleukin 6, 8, 10 (IL-6, IL-8, IL-10), monocyte chemoattractant protein-1 (MCP-1), and C-reactive protein (hsCRP) constituted the markers of systemic inflammation. Endothelin 1 (ET-1) served as a marker of endothelial dysfunction. Selected markers were assessed before the BPA treatment, 24 h after the first BPA, and six months after completion of the BPA treatment. Results: At baseline, the CTEPH patients had increased serum concentrations of IL-6, IL-8 and ET-1. Twenty-four hours after a BPA session, we observed an increase in concentrations of IL-6 (∆ = 3.67 (1.41; 7.16); p < 0.001), of IL-10 (∆ = 0.25 (0; 0.47); p = 0.003), of MCP-1 (∆ = 111 (60.1; 202.8); p = 0.002), and of hsCRP (∆ = 4.81 (3.46; 8.47); p < 0.001). Six months after completion of the BPA treatment, there was a decrease in concentrations of IL-6 (∆ = −1.61 (−3.11; −0.20); p = 0.03), of IL8 (∆ = −3.24 (−7.72; 0.82); p = 0.01), and of ET-1 (∆ = −0.47 (−0.96; 0.05); p = 0.005). Conclusions: Patients with inoperable CTEPH exhibit increased systemic inflammation and endothelial dysfunction, which improves after completion of the BPA treatment. A single BPA session evokes an acute inflammatory response.

Chronic thromboembolic pulmonary hypertension (CTEPH) results from an obstruction of pulmonary arteries (PAs) by organized thrombi. The stenosed PAs are targeted during balloon pulmonary angioplasty (BPA). We aimed to evaluate the mechanism of BPA in inoperable patients with CTEPH. We analyzed stenosed PAs with intravascular grey-scale ultrasound (IVUS) to determine the cross-sectional area (CSA) of arterial lumen and of organized thrombi. The composition of organized thrombi was assessed using virtual histology. We distinguished two mechanisms of BPA: Type A with dominant vessel stretching, and type B with dominant thrombus compression. PAs were assessed before (n = 159) and after (n = 98) BPA in 20 consecutive patients. Organized thrombi were composed of dark-green (57.1 (48.0–64.0)%), light-green (34.0 (21.4–46.4)%), red (6.4 (2.9–11.7)%;) and white (0.2 (0.0–0.9)%) components. The mechanism type depended on vessel diameter (OR = 1.09(1.01–1.17); p = 0.03). In type B mechanism, decrease in the amount of light-green component positively correlated with an increase in lumen area after BPA (r = 0.50; p = 0.001). The mechanism of BPA depends on the diameter of the vessel. Dilation of more proximal PAs depends mainly on stretching of the vessel wall while dilation of smaller PAs depends on compression of the organized thrombi. The composition of the organized thrombi contributes to the effect of BPA.

INTRODUCTION Metabolic dysregulation has been recognized as a prognostic marker in idiopathic pulmonary arterial hypertension (IPAH). OBJECTIVES We aimed to investigate the association between cardiometabolic risk factors and vascular reactivity of pulmonary arteries in patients with IPAH. PATIENTS AND METHODS Between June 2009 and January 2015, we recruited 66 consecutive patients with IPAH. We assessed main cardiometabolic risk factors, inflammatory markers, and markers of IPAH severity. Hemodynamic evaluation included pulmonary vasoreactivity testing with the use of inhaled nitric oxide. Reduced mean pulmonary artery pressure was considered a marker of acute vasoreactivity. Acute responders were treated with calcium channel blockers and classified as long-term responders if they had sustained vasoreactivity (near-normal hemodynamics and World Health Organization functional class I or II) for at least 1 year. RESULTS Thirteen patients (19.7%) showed a positive response to acute pulmonary vasoreactivity testing; however, only 9 (13.6%) remained vasoreactive at follow-up. Machine-learning algorithms indicated 4 variables associated with acute vasoreactivity of pulmonary arteries: high-density lipoprotein cholesterol (HDL-C), right atrial pressure, cardiac index, and creatinine level, and 4 predictors of long-term vasoreactivity: HDL-C, 6-minute walking distance, creatinine level, and high-sensitive C-reactive protein level. CONCLUSIONS HDL-C level is associated with pulmonary vasoreactivity in acute testing and predicts long-term responsiveness to calcium channel blockers in patients with IPAH.

INTRODUCTION Interpretation of the electrocardiogram (ECG) is an essential skill in most medical specialties; however, the best method of teaching how to read ECGs has not been determined. Objectives The aim of the study was to compare the effectiveness of collaborative (C-eL) and self (S-eL) e-learning of ECG reading among medical students. Patients and methods A total of 60 fifth-year medical students were randomly assigned to the C-eL and S-eL groups. S-eL students received 15 ECG recordings with a comprehensive description by email (one every 48 hours), while C-eL students received the same ECG recordings without description. C-eL students were expected to analyze each ECG together within the subgroups using an internet platform and to submit the interpretation within 48 hours. Afterwards, they received a description of each ECG. C-eL students' activity was assessed based on the number of words written on the internet platform during discussion. A final test consisted of 10 theoretical questions and 10 ECG recordings. The final score was a sum of points obtained for the interpretation of ECG recordings. The main endpoint of the study was the number of students whose final score was 56% or higher. Results The final test was completed by 53 students (88.3%). The main endpoint was achieved in 20 C-eL students (77%) and in 13 S-eL students (48.1%), P = 0.03. The final score was 6.4 (interquartile range [IQR], 5.8-7.6) in the C-eL group and 5.6 (IQR, 4.2-7.2) in the S-eL group, P = 0.04. It correlated with the results of the theoretical test and students' activity during C-eL (r = 0.42, P = 0.002 and r = 0.4, P = 0.04, respectively). Conclusions C-eL of ECG reading among fifth-year medical students is superior to S-eL.