IntroductionRight ventricular dysfunction (RVD) is an indicator of poor prognosis in normotensive patients with acute pulmonary embolism (APE). The aim of this study was to compare right ventricular (RV)/left ventricular (LV) ratio measured by echocardiography and multidetector computed tomography (MDCT) with tricuspid annulus plane systolic excursion (TAPSE) as a prognostic factor of APE-related 30-day mortality.Material and methodsWe examined 76 patients with confirmed APE, hemodynamically stable at admission. We evaluated the prognostic value of RV/LV ratio in the apical 4-chamber view and TAPSE measured at echocardiography and the MDCT RV/LV ratio.ResultsThirty-day APE-related mortality was 10.5% (8 patients). The area under the curve (AUC) for TAPSE in the prediction of APE-related mortality was higher (p < 0.00001) (0.905, 95% CI: 0.828–0.983) than the AUC of the echo RV/LV ratio (0.427, 95% CI: 0.183–0.672) and MDCT RV/LV ratio (0.371, 95% CI: 0.145–0.598). In univariable Cox analysis, TAPSE was the only significant mortality predictor, with hazard ratio (HR) 0.73 (95% CI: 0.62–0.87, p = 0.0004). In multivariable Cox analysis TAPSE was the only significant mortality predictor, with HR 0.62 (95% CI: 0.46–0.85; p = 0.003), while age, heart rate, and RV/LV ratio in echo or MDCT were non-significant. TAPSE ≤ 15 mm was a significant predictor of APE-related mortality, with HR 26.2 (95% CI: 3.2–214.1; p = 0.002), PPV 44% and NPV 98%.ConclusionsThe TAPSE is preferable to echo and MDCT RV/LV ratio for risk stratification in initially normotensive patients with APE. The TAPSE ≤ 15 mm identifies patients with an increased risk of 30-day APE-related mortality.

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Quality management frameworks (QMFs) are becoming increasingly crucial in the public administration sector due to the demands and expectations of the stakeholders. Used properly, they provide a structured approach to assessing the current service quality level and the organisational performance and help to identify where improvements can be made. The article analyses and discusses the Polish local government offices experience and involvement in the QMFs implementation, like the ISO 9001 standard, Common Assessment Framework and European Foundation for Quality Management (EFQM) models. The aim of the article, on the basis of the case-study method, is to present the efforts of QMFs implementation in two selected local governments in Poland -The City Office in Dzierżoniów, and The City Office in Trzebnica, and to confirm that QMFs implementation positively affects overall service quality and the key performance indicators, as well as to confirm that the EFQM model with its general and universal structure can be successfully used by public institutions, such as local government offices.

INTROduCTION Growth differentiation factor 15 (GDF-15) is a distant member of the transforming growth factor superfamily (TGF-β), first identified as a chemokine secreted by activated macrophages in response to oxidative stress. 1 A growing body of evidence confirms its diagnostic and prognostic value in patients with acute myocardial

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