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1. Lozano F, Trujillo-Santos J, Barron M, et al; RIETE Investigators. Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs. J Vasc Surg. 2014;59(5):1362-7. 2. Lopes LC, Eikelboom J, Spencer FA, et al. Shorter or longer anticoagulation to prevent recurrent venous thromboembolism: systematic review and meta-analysis. BMJ Open. 2014 Jul 4;4(7):e005674. BACKgROuND: There is a debate regarding importance of national registries vs. multinational ones. A comparison of national vs. international registry on the venous thromboembolism (VT = deep venous thrombosis and/or pulmonary embolism) was done in this paper.

Background: We wanted to evaluate the presence of coronary atherosclerosis and myocardial ischemia in asymptomatic patients with intermediate and high cardiovascular (CV) risk, the influencing clinical factors and the impact of ischemia on the final management decision and prognosis. Patients and Methods: 75 asymptomatic patients (35 with intermediate and 40 patients with high CV risk-SCORE risk system), underwent single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the detection of suspected coronary artery disease. We used a 17-segment model for the scan perfusion and function analysis using perfusion scores. All of the patients have full blood laboratory analyses including lipid values, and presence of urine albuminuria. Multislice computer tomography with coronary calcium Agatston score (CAC) for coronary atherosclerosis detection was also performed. The patients were followed up for 12-18 months for cardiovascular events (new chest pain, hospitalization for acute coronary syndrome, revascularization, cardiac death). Logistic regression analysis was used to assess predictive parameters for myocardial ischemia and cardiovascular events. Results: Stress-inducible ischemia was found in 19 patients (33%), fixed defects were found in 13% and mixed defects in 9% of cases. The average ischemia amount was 10%. Mild ischemia was found in 12 patients (64%) summed stress score (SDS) 7. Severe ischemia was only related to the duration of diabetes (DM). Patients with at least moderate ischemia had Agatston CAC score 465+/-112. The patients with normal MPI scan had CAC score 98+/-45. 3 pts with moderate risk were reclassified to high risk by using CAC and MPI scan results. Stepwise logistic regression analysis for the prediction of stress-induced ischemia showed OR 2.4 (95% CI 1.7_3.6) for the stress-induced ECG changes, OR 2.8 for CAC >400 (95% CI 1.9-3.2) and OR 3.9 for the presence of DM over 10y (95% CI 2.3_6.6). Seven patients with ischemia >10%, were referred for coronary angiography. One patient was hospitalized due to the acute coronary syndrome and no cardiac death was registered during the 12 months follow-up. Conclusions: MPI is a valuable method for preclinical assessment of myocardial ischemia in asymptomatic intermediate and high risk patients, which can improve the prognosis and guide the treatment decision. Coronary calcium score can predict the presence of myocardial ischemia and reclassify the patient's risk.

Cardiologia CROATICA We are presenting the case of a 51-year-old man who has been admitted at our clinic with dyspnea, cardiogenic shock and severe pain and swelling of the left leg. At the admission he was cyanotic, severely hypotensive, with tachypnea, an oxygen saturation of 70%. An acute massive pulmonary embolism was suspected, and an emergency bedside transthoracic echocardiogram was performed. Bedside echocardiography showed significantly enlarged right ventricle (46 mm tricuspid annular size), hypokinesia of the free right ventricular wall and increased pulmonary artery size (34 mm), with signs of RV overload. There was large mobile thrombus with dimensions (34x37 mm) prolabing from right ventricle to the right atrium. Severe tricuspid regurgitation, with dilated right atrium and dilated vena cava inferior — 24 mm were found. Indirect estimation of the pulmonary hypertension with the value of the maximal velocity of the tricuspid regurgitation showed increased pulmonary pressure (estimated systolic pulmonary atrial pressure — SPAP was 59 mmHg). Color Duplex sonography of lower extremities was also performed at the bed site with the finding of non compressible left common femoral vein, which was consistent with the deep vein thrombosis. D-dimmers were significantly increased (>4.500 nq/l). Multislice computed tomography performed next day confirmed central filling defect of the left pulmonary artery consistent with acute thrombus. Based on the patient’s clinical condition and the echocardiographic findings, he has been treated with fibrinolysis therapy with alteplase. Control echocardiography performed three days after fibrinolytic therapy showed decrease in SPAP pressure from 59 mmHg to 40 mmHg, moderate tricuspid regurgitation, normal right ventricular size and function. The patient had excellent clinical recovery and was discharged from the hospital after 20 days. This case confirms the role of urgent bedside echocardiography in fast diagnosis of acute pulmonary embolism, which leads to proper management and favorable patient outcome.