Background:Abdominal aortic aneurysm (AAA) is often asymptomatic but carries a high risk of mortality if rupture occurs. Several countries have implemented organized national screening programs to enable early detection of AAA, whereas no institutionalized screening program is currently available in Hungary. This multiregional pilot study aimed to assess the feasibility and diagnostic validity of AAA screening in Hungarian primary care. Methods:Following a structured theoretical and practical ultrasound (US) training program, 11 general practitioners (GPs) participated in a pilot AAA screening program. Screening examinations were performed in routine primary care settings, and all recorded US examinations underwent independent expert validation by two radiologists. Results:A total of 349 examinations were performed in 11 Hungarian primary care practices. Of these, 339 (97.1%) were considered interpretable after expert validation. Among the 339 participants with interpretable examinations, the mean age was 69.5 ± 3.1 years, 97.9% were male, and 22.4% were current smokers. Eight cases of AAA were identified, corresponding to a period prevalence of 2.36% (95% CI 1.02%-4.60%). The mean examination time was 6.6 ± 3.8 min. Agreement between GP-performed US and expert validation was substantial (κ = 0.772). Conclusion:Abdominal aortic aneurysm screening in Hungarian primary care appears feasible and shows high agreement with expert review when performed by trained GPs within a structured validation framework.

Coronary vasospasm, affecting both epicardial arteries and the coronary microcirculation, is a significant yet frequently underdiagnosed and undertreated cause of coronary syndromes. When promptly identified, it carries a relatively benign prognosis. Recognition can be straightforward in non-cardiology settings when triggered by known spasmogenic agents such as misoprostol (obstetrics) or 5-fluorouracil (oncology). Vasospasm may also be incidentally revealed during noninvasive functional testing, typically presenting as ST-segment elevation during early recovery phases, or after administration of agents like aminophylline following dipyridamole or β-blockers following dobutamine. In patients with high clinical suspicion but negative Holter or stress test findings, targeted provocation with ergonovine or hyperventilation protocols can safely induce vasospasm and unmask regional wall motion abnormalities, indicating epicardial involvement. Hyperventilation-Doppler echocardiography enables the detection of microvascular dysfunction through reductions in coronary flow velocity in the mid-distal left anterior descending coronary artery. A multi-stress, multi-marker functional testing approach offers a noninvasive, safe, and effective diagnostic strategy. Inducible wall motion abnormalities are specific for epicardial spasm, while Doppler-detected flow reduction is more sensitive for microvascular dysfunction. Early diagnosis is essential, as coronary vasospasm, though potentially life-threatening, is highly manageable with appropriate therapy. Management of patients with proven epicardial coronary artery or microvascular vasospasm involves starting therapy with calcium channel blockers and nitrates, and avoiding β-blockers, as they can worsen vasospasm by blocking β2-mediated vasodilation and leaving α1-mediated vasoconstriction unopposed.

Focused Cardiac Ultrasound (FCU) is one of the most rapidly evolving applications of point-of-care ultrasound and has received increasing attention among primary care physicians in recent years. The targeted, standardized nature of the method enables rapid identification of clinically relevant cardiac abnormalities in healthcare settings where immediate access to comprehensive imaging modalities is often limited. Based on international literature and consensus recommendations, FCU should be regarded as a decision-support tool that does not replace comprehensive echocardiography but rather complements the physical examination, thereby facilitating appropriate allocation of patient pathways. The available scientific evidence suggests that, when applied with adequate training and clearly defined competence boundaries, FCU may improve early recognition of cardiac conditions, enhance the safety of clinical decision-making, and support collaboration between primary and specialist care.

BackgroundHeart failure (HF) is one of the most frequent and clinically important causes of dyspnea, and its recognition in primary care is often hindered by limited access to advanced diagnostics. This study aimed to evaluate whether general practitioners (GPs), after brief training, can use point-of-care ultrasound (PoCUS) to improve the diagnostic accuracy of HF in patients with new-onset dyspnea.MethodsIn this prospective validation study, 112 consecutive adult patients with unexplained new-onset dyspnea were initially enrolled across four primary care practices. After clinical evaluation, 102 patients underwent a standardized lung and focused cardiac ultrasound by GPs, using handheld ultrasound machines. B-line quantification and visual assessment of left ventricular ejection fraction (LVEF) were performed. Diagnoses before and after PoCUS were compared to the final diagnosis established by a cardiologist using standard echocardiography. Agreement metrics and diagnostic accuracy measures were calculated.ResultsPost-PoCUS assessments by GPs showed significantly improved diagnostic performance for HF (sensitivity: 86.8%, specificity: 88.2%, positive predictive value: 93.7%, and negative predictive value: 76.5%) compared to pre-PoCUS clinical judgment (sensitivity: 85.3%, specificity: 38.2%, positive predictive value: 73.4%, and negative predictive value: 56.5%). Agreement with the final diagnosis increased substantially (Cohen’s κ from 0.254 to 0.723). GP-assessed B-lines and LVEF correlated strongly with the cardiologist’s results.ConclusionA brief, focused training enables GPs to use PoCUS effectively for the detection of HF in patients with dyspnea. Integrating lung and focused cardiac ultrasound into routine primary care may substantially improve diagnostic accuracy, optimize patient management, and reduce unnecessary referrals.

A fókuszált echokardiográfia (focused cardiac ultrasound, FCU) a point-of-care ultrahang egyik legdinamikusabban fejlődő alkalmazása, amely az elmúlt években egyre nagyobb figyelmet kap az alapellátásban dolgozó családorvosok körében is. A módszer célzott, standardizált vizsgálati megközelítése lehetővé teszi bizonyos klinikailag releváns kardiális eltérések gyors felismerését olyan ellátási környezetben, ahol a részletes képalkotó vizsgálatokhoz való azonnali hozzáférés gyakran korlátozott. A nemzetközi szakirodalom és konszenzusajánlások alapján az FCU döntéstámogató eszközként értelmezhető, amely nem a teljes körű echokardiográfiát helyettesíti, hanem a fizikális vizsgálatot egészíti ki, elősegítve a betegút megfelelő irányának meghatározását. A rendelkezésre álló tudományos evidenciák arra engednek következtetni, hogy megfelelő képzéssel és a kompetenciahatárok betartásával a módszer javíthatja a korai felismerést, növelheti a klinikai döntéshozatal biztonságát, és támogathatja az alap- és szakellátás közötti együttműködést.

Introduction:Cardiopulmonary complications are common in ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and have an adverse impact on the mortality and quality of life of patients. Myocardial involvement can lead to systolic and diastolic dysfunction, which can be asymptomatic for a long time. Chest wall rigidity, a complication of both diseases, can also lead to cardiac dysfunction, especially in the right heart-pulmonary circulation unit. We aimed to assess the response of the pulmonary circulation-right ventricular function unit and left ventricular function during exercise in AS and PsA patients and hypothesized that stress echocardiography may unmask the early non-invasive hemodynamic changes caused by chest wall rigidity and left heart involvement. Methods:A total of 72 participants were enrolled in the study: 26 had AS, 18 had PsA, and 28 healthy individuals were matched by age and sex. To assess the maximally tolerated workload, all subjects underwent resting and exercise stress echocardiography on a supine bicycle ergometer. Echocardiographic measurements were taken at rest, at 50 watts workload, and at maximal exercise. Detailed clinical characteristics were also assessed, including the advanced ankylotic axial status of both patient groups. Results:At rest, only pulmonary vascular resistance (PVR) values were significantly higher in patients with AS and PsA than in controls. During exercise, the tricuspid regurgitation velocity (TRV) was significantly increased in the AS and PsA groups. PVR stress was significantly higher in patients with AS and PsA than in controls. E/e', which refers to estimation of the left ventricular filling pressure, significantly increases during stress in patients with AS and in the ankylotic group compared to controls at peak stress. In patients with AS and those with PsA, the disease duration was strongly correlated with E/e' mean measured during peak stress but not with TRV or PVR. Discussion:Stress echocardiography is a promising method for assessing subclinical cardiopulmonary changes among AS and PsA patients. Changes in PVR during stress may highlight pulmonary complications related to chest wall restriction and remodeling of the pulmonary vasculature at the subclinical stage.

Hungarian researchers published the results of 25 investigations in peer-reviewed international journals in 2024, with an overwhelming majority of these papers published in Q1-ranking journals. New achievements in echocardiography were published, including 3D echocardiography, myocardial work, and strain analysis. Radiomics has been implemented in cardiac magnetic resonance studies. Still, the performance analysis of a novel magnetic resonance sequence and the result of an MR-derived strain analysis have also been published. 2024 was the year of photon counting CT in Hungarian imaging, but other interesting cardiac CT-related results have also been revealed related to coronary artery disease, aortic stenosis, and thromboembolic risk estimation.

Magyarországon jelenleg nem működik a hasi aorta aneurysma felismerésére irányuló intézményesített, szervezett, behívásos alapon működő szűrőprogram. Ezzel szemben egyre több ország fejleszti ki és indítja el saját pilot hasi aorta aneurysma szűrőprogramját, ahogyan az a közelmúltban, 2025. január elsejével Csehországban is történt. Hazánkban validációs pilotvizsgálat vette kezdetét 2023 őszén, amelynek során korábban ágy melletti ultrahangvizsgálati képzésen részt vevő és a vizsgálati technika elsajátításáról számot adó családorvosok egy része saját rendelőjében, radiológus által elvégzett validálás mellett a célpopulációba tartozó betegeit szűri a hasi aorta tágulatát keresve. Célunk jelenleg is tartó vizsgálatunkkal, hogy meghatározzuk, vajon van-e létjogosultsága a hazai alapellátásban történő hasi aorta aneurysma ultrahangos szűrésének. Vizsgálatunk során rövid idő alatt pozitív, érsebészeti beavatkozást igénylő szűrési eredmény született az egyik részt vevő családorvos elsődleges diagnózisa által, a felismerés ideje alatt a szűrésen megjelent betegek még viszonylag kis száma mellett. Esettanulmányunkkal célunk felhívni a figyelmet arra, hogy a hasi aorta szűrővizsgálatának egyszerű és rövid időt igénylő elsajátítása után a családorvosok pontos, radiológiailag értékelhető, szabályos vizsgálata során a néhány percet igénybe vevő szűréssel ezt a potenciálisan életveszélyes állapotot időben lehetőségünk lehet felismerni. Ezzel a legtöbbször tünetmentes hasi aorta aneurysma elektív érsebészeti kezelése életmentő lehet az aortafal rupturájának elkerülésével. Orv Hetil. 2025; 166(20): 788–794.

Over the past decade, stress echocardiography has evolved from a test for assessing epicardial artery stenosis to a comprehensive functional test, targeting multiple cardiovascular parameters. The new approach includes several structured steps: (a) evaluating regional wall motion abnormalities to detect epicardial artery stenosis or vasospasm; (b) assessing pulmonary congestion and diastolic function via B-lines with lung ultrasound; (c) gauging preload and contractile reserve with volumetric echocardiography; (d) measuring coronary microvascular reserve using Doppler-based coronary flow velocity in the middistal left anterior descending artery; and (e) determining cardiac sympathetic reserve by tracking heart rate reserve on an ECG. This evolution was supported extensively by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), which played a key role in five areas: (1) developing the initial, curiosity-driven project; (2) disseminating protocols and results at national and international conferences, supporting logistic infrastructure and publication expenses; (3) establishing a digital platform (customized Redcap) for data entry and storage; (4) facilitating patient recruitment across 19 Italian centers; and (5) offering formal endorsement through six presidencies, adding credibility and reach beyond any single institution. The protocol quickly advanced from concept to high-impact publications, earning inclusion in 2024 specialty guidelines. Initially Italian-led, the study now includes 50 centers across 20 countries (e.g. USA and China). Beyond the 50 peer-reviewed papers published in 2016-2024, this study offers a novel, sustainable approach to cardiac stress testing, providing more information at lower costs, with zero radiation and minimal environmental impact. SIECVI's endorsement was instrumental in amplifying the study's rigor and outreach.

In Hungary, there is currently no institutionalised, organised, invitation-based screening programme for the detection of abdominal aortic aneurysms. In contrast, an increasing number of countries are developing and launching their own pilot abdominal aortic aneurysm screening programmes, as was recently the case in the Czech Republic on the first of January 2025. In Hungary, a validation pilot study was initiated in the autumn of 2023, in which a subset of general practitioners - who previously participated in point-of-care ultrasound training and demonstrated proficiency in the abdominal aortic aneurysm examination technique - are screening patients belonging to the target population in their own practices, under radiological validation, to detect abdominal aortic aneurysms. The aim of our ongoing study is to determine whether ultrasound-based abdominal aortic aneurysm screening is justified in Hungarian primary care. During the study, a positive screening result requiring vascular surgical intervention was obtained within a short timeframe by one of the participating general practitioners, despite the relatively low number of patients screened at the time of detection. The purpose of our case report is to highlight that, after a simple and brief training period, general practitioners can perform accurate, radiologically evaluable, and standardised examinations, enabling the timely detection of this potentially life-threatening condition through a screening process that takes only a few minutes. By doing so, the elective surgical treatment of mostly asymptomatic abdominal aortic aneurysms can be life-saving, preventing rupture of the aortic wall.

AIMS:Chronotropic incompetence (CI) is a biomarker of cardiac autonomic dysfunction. The aim of the study is to assess the risk stratification value of CI during exercise or pharmacological stress echocardiography in patients with chronic coronary syndromes. METHODS AND RESULTS:In a prospective, multicenter, international, observational study, we enrolled 13 445 patients with known or suspected chronic coronary syndromes who underwent stress echocardiography in 19 clinical sites from 10 countries using either exercise (n = 2594), dobutamine (n = 2440), or dipyridamole (n = 8411). Heart rate was automatically measured from the 1-lead ECG in the echocardiography monitor. We considered CI as failure to reach 85% of the maximal predicted (220-age) heart rate for exercise and dobutamine, and heart rate reserve (peak/rest heart rate) ≤ 1.22 (≤1.17 if in permanent atrial fibrillation) for dipyridamole stress. The primary outcome was all-cause death. CI was observed in 5045 patients (38%) and stress-induced regional wall motion abnormalities in 1648 (13%). Over a median follow-up time of 3.4 years (interquartile range, 1.6-9.1 years), there were 2426 (18%) deaths. The 10-year mortality was 39% in patients with and 21% in patients without CI (P < 0.0001). CI was associated with a significant increase in 10-year mortality in all age groups ranging from ≤54 years to ≥75 years (P < 0.0001). In addition, it was associated with increased mortality (P < 0.0001) irrespective of β-blocker use. Cox multivariable analysis revealed that CI was an independent predictor of mortality (HR: 1.60, 95% confidence interval: 1.47-1.74; P < 0.0001) together with age, male sex, diabetes mellitus, left ventricular ejection fraction, and resting heart rate. CONCLUSION:In patients with chronic coronary syndromes, CI during exercise or pharmacological stress is a simple and objective predictor of survival.

Abstract Background Atrial fibrillation (AF) is the most prevalent atrial tachyarrhythmia, affecting an estimated 2-4% of adults worldwide. AF is a well-recognized and treatable risk factor for stroke, but it often remains asymptomatic or subclinical, leading to underdiagnosis. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF). Methods An international prospective cohort comprising 1035 consecutive patients was initially considered from 12 cardiology institutions. These patients were referred for clinically-driven ESE as part of the Stress Echo 2020-2030 study network. All patients underwent comprehensive ESE with the ABCDE protocol, which included assessment of B-lines, left ventricle contractile reserve (LVCR), ECG-based heart rate reserve (HRR), LV ejection fraction (EF), LV end-diastolic volume, E/e’, pulmonary artery systolic pressure estimation, tricuspid annular plane sytolic excursion (TAPSE), left atrium volume index (LAVi) and left atrium reservoir phase strain (LASr) at rest and with exercise. Results After excluding 89 patients who were in AF during the ESE, 946 patients in SR were included as the main study cohort (101 with and 845 without a history of PAF). A scoring system was then constructed using all independent variables that differentiate the two groups (those with and without history of PAF). Presence of systemic hypertension, rest LAVI>31ml/m2, rest |LASr|< 21%, stress LAVI >29 ml/m2, stress |LASr| <24%, stress E/e’ >7, ∆TAPSE <4.5 mm, HRR<1.87, and LVCR<1.6 were identified as the discriminators between patients with and without PAF. The composite score, summing all 9 items (with a total score range from 0 to 9), yielded a score of >4 as the best balance between sensitivity (87%) and specificity (60%) in predicting those with PAF. The receiver operating characteristic curve analysis of the scoring model showed an AUC of 0.79 (p-value <0.0001), Figure. Conclusion ESE evaluation can be a valuable adjunct for identifying patients in SR with history of PAF. This multifaceted approach enhances the potential for more accurate detection and clinical management of individuals in SR at risk for AF, who could be considered for aggressive monitoring programs to prevent the development of new onset AF and subsequent increase in cardiovascular risk.

Abstract Background Although the number of point-of-care ultrasound devices available in Hungarian primary care practices are increasing due to government funding, their use in day-to-day patient care is limited and unregulated. Our study aimed to evaluate the attitudes and needs of general practitioners (GPs) and patients in Hungary regarding the introduction of bedside ultrasonography in primary care practices. Methods As a part of a cross-sectional study, an anonymous, self-administered questionnaire was distributed to GPs and patients on a social media platform. Data collection was carried out from August 2023 to October 2023. Chi-square test was used to determine the associations between categorical variables. Results The survey was completed by 415 GPs (mean age 53.8 ± 11.1 years, 54.9% female, mean 19.5 ± 11.9 years of practice) and 693 patients (mean age 45.5 ± 12.3 years, 95.2% female). There was a statistically significant increase in interest in PoCUS among young and middle-aged GPs (age 28–59; p = 0.02). In addition, this population of GPs was also more likely to undertake training in PoCUS than their older colleagues (p < 0.0001). An inverse relationship was found between the duration of practice and training willingness (p = 0.0011). Even with the government’s financial support, only 8.2% of GPs currently use PoCUS in a daily basis, and 59.5% of GPs are unfamiliar with the indications and the ways of using it. Patients would even pay to have the examination done in a primary care setting, even though only 45.9% of patients would pay a GP who is not certified in PoCUS, but the willingness to pay increased to 99.4% for those with formal training (p = 0.024). Conclusion Our findings indicate a significant interest in adapting PoCUS in primary care from both GPs and patients. Based on the fact that a significant proportion of Hungarian GPs are unaware of PoCUS and its indications, it is particularly important to develop educational frameworks, and practical guidelines for the effective incorporation of PoCUS in Hungary.

Abstract Background Systemic sclerosis (SSc) is characterised by persistent immune-inflammatory system activation and excessive extracellular matrix (ECM) accumulation leading to fibrosis. Exercise Doppler Echocardiography (EDE) is a promising method to detect the early changes of fibrosis-related pulmonary and myocardial complications, like elevated left ventricular filling pressure or stress-induced pulmonary hypertension (PH). Aims The study aims to assess the linkage between the activity of fibrosis markers and abnormal exercise haemodynamics during stress in patients with SSc. Methods A total of 18 patients with SSc were enrolled in the single-centre prospective study (age 54±15,5years, 94,4 % women). SSc patients with resting PH and moderate to severe pulmonary fibrosis were excluded. According to a standardised protocol, all subjects underwent resting and exercise echocardiography on a semi-recumbent cycle ergometer with an incremental (25 watts) workload up to the maximally tolerated workload. Measurements focused on the left ventricular diastolic function (E/e’) and right ventricular haemodynamics (estimated systolic pulmonary pressure: PASP, right ventricular coupling: TAPSE/PASP, pulmonary vascular resistance: PVR). Blood samples were taken immediately before the stress test, and the Matrix Metalloproteinase-9 and 2 (MMP-9, MMP-2) levels were assessed with gelatin zymography method. Results During the EDE, PASP from baseline increased significantly (24,6mmHg±11 vs 38±16mmHg, p <0,0001), also PVR (1,2±0,49 vs 1,5±0,15 Wood unit, p<0,001) RV coupling was decreased significantly (1,2±0,68 vs 0,93±0,5, p<0,001). Left ventricular E/e’ was also increased during the stress (8,2±2 vs 10,5±5,1, p<0,05). Enzymatically active MMP-9 level was significantly correlated with RV coupling at rest and stress (p<0,05, r 0,63 at rest and r 0,52 at stress) and negatively correlated with PASP (p<0,05, r:-0,62 at rest and r -0,5 at stress). MMP-2 level only negatively correlated with resting PASP (p<0,05, r:-0,527). The left ventricular parameters did not show any relationship with MMP levels. Conclusions The level of circulating MMP-9 predicts haemodynamic behaviour during stress in SSc. MMPs could be a promising marker for detecting early changes in the right ventricle-pulmonary circulation unit.

Abstract Introduction After pulmonary embolism (PE), patients frequently complain about reduced exercise capacity and dyspnea on exertion, even without pulmonary hypertension (PH). The underlying condition is often chronic thromboembolic disease, which is caused by residual pulmonary obstruction with preserved resting pulmonary haemodynamics. The symptoms are the consequences of the increased dead space ventilation, exercise-induced PH and right ventricular (RV) dysfunction. We aimed to assess the pathologic differences in the echocardiographic parameters of the RV- pulmonary circulation unit among patients with previous PE and the healthy control group. Furthermore, an objective was to compare the hemodynamic response to stress after different treatment strategies (thrombolysis vs. heparin administration). Methods 21 patients after PE (mean age 58,5±12,1 years; 53% men) have been included in the study. All of them were effectively anticoagulated for at least three months, and none had any signs of PH on echocardiography at rest. The control group included 20 healthy volunteers (mean age 56,9±11,5 years; 55% men). Each patient underwent resting and exercise stress echocardiography on a semi-recumbent bicycle ergometer according to a standardised protocol until the maximally tolerated workload. Echocardiography was performed at rest, at 50 Watt workload and during peak stress. The measurements focused on the RV's systolic function (TAPSE), the estimated pulmonary artery systolic pressure (PASP), and the Doppler measurements in the RV and left ventricular outflow tracts. Pulmonary vascular resistance (PVR) and RV-pulmonary artery coupling (RV-PA) were calculated from the echocardiographic parameters. Results The post-PE group had significantly higher PASP (39,2 ±16,6 vs. 27,7±12,5 mmHg; p<0,05) and PVR (1,5±0,4 vs. 1,1±0,3 Wood Units; p<0,05) at peak stress, than the controls. 55% of post-PE patients remained symptomatic, but there were no significant differences between the symptomatic and asymptomatic groups regarding TAPSE, PASP, RV-PA coupling and PVR. 30% of post-PE patients had thrombolysis. In the patients where thrombolysis was performed, the coupling at peak stress was significantly higher than in heparin-treated patients (1,4±0,1 vs 0,9±0,4 mm/mmHg, p<0,05). Conclusion Post-PE patients without resting PH have higher PVR and PASP than the healthy control group, even after at least 3 months of adequate therapy. Post-PE patients treated with thrombolysis may have more preserved RV-PA coupling than the heparin-treated patients.

Abstract Background Crohn’s disease and ulcerative colitis, two forms of inflammatory bowel disease (IBD) require lifelong treatment and patient monitoring. Current predictors of relapse and therapeutic success have limitations, therefore there is high unmet need to identify novel biomarkers in IBD. Monitoring approaches for IBD are mostly invasive, time-consuming, and expensive. Therefore, a simple, rapid, and non-invasive test, with ability to differentiate IBD from other gastrointestinal conditions and to monitor disease activity, will have important clinical implications. Our previous mucosal cytokine profiling identified that Plasminogen activator inhibitor type 1 (PAI-1) is expressed in IBD patients with active disease, but not in control. Therefore, our aim was to assess the utility of PAI-1 in monitoring disease activity and therapeutic response of IBD patients in different biological samples. Methods Serum, biopsy and faecal samples were collected from 132 IBD patients and 30 controls without IBD. ELISA method was used to define the level of PAI-1 in the mucosa, serum, and faecal samples and the serum CRP levels were also determined. For the mucosal gene expression analysis qRT-PCR was used. The correlation and ROC analyses were applied to observe the relationship between the disease activity and PAI-1 level. Results The applied screening approach detected significant higher expression of PAI-1 in active IBD. We demonstrated that the serum, mucosal and faecal PAI-1 concentration was significantly elevated in IBD patients showing clinical and endoscopic activity. Additionally, in responder patients the initial PAI-1 level decreased significantly upon successful therapy, whereas it remained unchanged in non-responders. We also showed that faecal PAI-1 selectively increases in active IBD patients, but not in other organic gastrointestinal diseases. In addition, the stability analysis of faecal PAI-1 showed that the protein was detectable up to one week at room temperature and 4ºC. The serum, mucosal and faecal PAI-1 level showed positive correlation to the endoscopic activity. ROC curves demonstrated that faecal PAI-1 showed a relatively high power to distinguish between active and control patients. However, the serum CRP level no reflected to the therapeutic response. Conclusion Our results suggest that serum, mucosal and faecal PAI-1 expression reflects to the disease activity in IBD, which could be used to disease monitoring and possibly therapeutic response. The correlation between the faecal PAI-1 level and the endoscopic activity promotes that it could be used as a novel non-invasive disease specific faecal biomarker in the IBD diagnosis.

Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF). A prospective cohort of 1055 patients in SR was enrolled across 12 centers. The main study cohort was divided into two groups: the modeling group (n = 513) and the verification group (n = 542). All patients underwent ESE, which included B-lines, LA volume index (LAVi), and LA strain of the reservoir phase (LASr). Age, resting and stress LAVi and LASr, and B-lines were identified as a combination of detectors for PAF in both groups. In the entire cohort, aside from resting and stress LAVi and LASr, additional parameters differentiating PAF and non-PAF patients were the presence of systemic hypertension, exercise E/e’ > 7, worse right ventricle (RV) contraction during exercise (∆ tricuspid annular plane systolic excursion < 5 mm), a lower left ventricular contractile reserve (< 1.6), and a reduced chronotropic reserve (heart rate reserve < 1.64). The composite score, summing all 9 items, yielded a score of > 4 as the best sensitivity (79

Patients with calcified, fibrotic native coronary vessels with prior suboptimal stenting outcomes are at major risk of stent thrombosis and could face serious consequences if untreated. In cases of multiple layers of under-expanded stents, the risk is multiplied. If conventional balloon post-dilatation is unsuccessful after stent implantation without proper lesion preparation, few interventional options remain. The authors report on a patient with prior numerous right coronary unsuccessful coronary interventions resulting in partially crushed multiple layers of stent material with critical lumen narrowing caused by stent under-expansion. Balloon angioplasty and stent rotational atherectomy (ROTA) had been attempted to overcome stent under-expansion but were unsuccessful. The authors investigated a new combination therapy of laser atherectomy (ELCA) and super high-pressure balloon (OPN non-compliant balloon) to treat single or multiple layers of stent with severe under-expansion due to fibrotic, calcified tissue surrounding the under-expanded stent structure.