In multiple sclerosis (MS), insufficient blood supply might worsen energy deficiency of the brain tissue. Thus, cerebrovascular reactivity (CVR), which is the capacity of cerebral circulation to match blood supply to metabolic demand, might be important in MS pathology. The objective of this study was to investigate the relationship of CVR to disease activity and neuroimaging markers of disease progression in patients with MS. In 43 patients with relapsing remitting MS (RRMS) in clinical remission, 30 patients with a relapse of MS and 30 healthy controls, we measured CVR with transcranial Doppler as a relative change in flow velocity after breath-holding (breath-holding index) and voluntary hyperventilation (hyperventilation index). All patients in remission underwent brain magnetic resonance imaging at baseline and 33 underwent repeated imaging after 12 months, with various brain volume measurements taken. Cerebrovascular reactivity indices did not differ between patients in remission, patients with a relapse and controls. In patients in remission, CVR did not differ between those with or without contrast-enhancing lesions. In patients with a relapse, glucocorticoids significantly reduced both CVR indices. Cerebrovascular reactivity was not related to brain volume, white matter lesion volume, percent brain volume change, and the change in total white matter lesion volume. In RRMS, CVR appeared normal and unrelated to disease activity. There was no substantial association of CVR to brain atrophy and accumulation of white matter lesions.

DOI: 10.20452/pamw.15515, Published online: July 16, 2020, Authors: Marta Skowrońska, Martyna Skrzyńska, Michał Machowski, Zbigniew Bartoszewicz, Marzanna Paczyńska, Aisha Ou-Pokrzewińska, Katarzyna Kurnicka, Michał Ciurzyński, Marek Roik, Małgorzata Wiśniewska, Piotr Palczewski, Piotr Pruszczyk

Background: Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S’), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients. Methods: 139 consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis. Results. Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4–80.0; p = 0.02); TAPSE and TV S’ showed HR 0.77 (0.67–0.89), p < 0.001, and 0.71 (0.52–0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812–0.932, p = 0.0001, for TV S’ was 0.751; 95% CI 0.670–0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83–0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52–0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE > 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S’ was only of borderline statistical significance. Conclusions: It seems that TV S’ is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism. Background: Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S’), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients. Methods: 139 consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis. Results. Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4–80.0; p = 0.02); TAPSE and TV S’ showed HR 0.77 (0.67–0.89), p < 0.001, and 0.71 (0.52–0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812–0.932, p = 0.0001, for TV S’ was 0.751; 95% CI 0.670–0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83–0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52–0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE > 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S’ was only of borderline statistical significance. Conclusions: It seems that TV S’ is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism.

Introduction: SARS-CoV-2 infection leads to a hypercoagulable state. The prevalence of pulmonary embolism (PE) seems to be higher in this subgroup of patients. Patients and methods: We combined data from two tertiary referral centers specialized in the management of PE. The aims of this study were as follows: (1) to evaluate the prevalence of PE among a large population of consecutive patients admitted for COVID-19 pneumonia in two centers, (2) to identify a plasma D-dimer threshold that may be useful in PE diagnostic assessment, (3) to characterize the abnormalities associated with PE and mortality in COVID-19 patients. Results: The incidence of symptomatic acute PE was 19.3%. For diagnosing PE in COVID-19 patients, based on ROC curve analysis, we identified a D-dimer concentration/patient’s age ratio of 70, which improved D-dimer diagnostic capacity for PE and led to a reclassification improvement of 14% (NRI 0.14, p = 0.03) when compared to a cut-off level of 1000 ng/mL. Especially in severe COVID-19 lung involvement, D-dimer/age ratio cut-off equal to 70 was characterized by high diagnostic feasibility (sensitivity, specificity, negative predictive value, positive predictive value of 83%, 94%, 96%, and 73%, respectively). Apart from PE status, lung involvement and troponin T concentration were also independent predictors of in-hospital mortality. In the subgroup of PE patients, mortality was comparable with non-PE patients (19/88 (21.5%) vs. 101/368 (27.4%) for non-PE, p = 0.26) and was associated with older age, higher Bova scores, and higher troponin T concentrations. Age was the sole independent predictor for mortality in this subgroup. Conclusions: PE in COVID-19 patients is common, but it may not influence mortality when managed at a specialized center. In suspected PE, age-adjusted D-dimer levels (upper limit of normal obtained from the formula patient’s age × 70) may still be a useful tool to start the diagnostic workup. In COVID-19 patients without PE, older age, more extensive parenchymal involvement, or higher D-dimer levels are factors predicting mortality.