Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2023
Review[Pulmonary hypertension associated with left heart disease (group 2)].
Patients with left heart disease (LHD) often display pulmonary hypertension (PH), which impacts morbidity and mortality. The pathophysiology of PH is complex and entails pulmonary congestion due to elevated left-sided filling pressures, pulmonary vasoconstriction as well as vascular remodeling. The recent ESC/ERS Guidelines on pulmonary hypertension updated the hemodynamic definitions of pulmonary hypertension in general, and the subclassification of post-capillary PH. ⋯ Specifically, we summarize revisited hemodynamic definitions and the characteristics of isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH). Furthermore, we review the current knowledge on the pathogenesis of PH-LHD, the prognostic relevance of hemodynamic parameters, and the management strategies, differentiating between treatment of the underlying left heart disease and therapies targeting the pulmonary circulation. The article emphasises the need for precise diagnostic work-up and individualized treatment strategies in patients with PH-LHD.
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Dtsch. Med. Wochenschr. · Nov 2023
Review[Microbiome: from pathophysiology to clinical application?].
The "microbiome" or the intestinal microbiota is currently in the focus of scientific interest. The number of publications on the topic of the microbiome is increasing every year. In particular, the role of the microbiome in the pathophysiology of various diseases has been studied. ⋯ However, some key news stand out from this large number of publications. The first microbiota compounds for the therapy of Clostridioides difficile colitis were approved by the FDA last year or are about to be approved. This means that, for the first time, standardized microbiome products are available in addition to fecal microbiota transplantation (FMT) and are finding their way into everyday clinical practice.
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Based on phase III clinical studies, four multi-kinase inhibitors (MKI) are approved for the treatment of progressive radioiodine-refractory differentiated thyroid carcinoma (rrDTC) and medullary thyroid carcinoma (MTC) in Germany. Only recently, based on the randomized trial COSMIC-311, Cabozantinib has been approved as a second-line treatment option in advanced rrDTC. As first in-label selective RET-Inhibitor, Selpercatinib showed promising efficacy in advanced MTC (first line) with RET mutations and rrDTC (second line) with RET fusions along with fewer side effects. Changes and new approaches for the treatment of ATC have been summarised in the current ATA guidelines.
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Despite clear guideline recommendations, only about every second PAD patient is prescribed statins, women less often than men. There is an international consensus that every PAD patient should be treated with statins, as these not only lower lipids but also stabilize plaque, resulting in a prognostic benefit. Limb-related endpoints (MALE) can be reduced by 24% compared to placebo by lowering lipids. ⋯ About 20% of the population have severely elevated Lp(a) levels that require risk factor management beyond lipid management. A high Lp(a) concentration is associated with PAD progression as an independent risk factor for all atherosclerosis manifestations. Every adult should have an Lp(a) assessment once in their lifetime.