<abstract><title style='display:none'>Abstract</title>The significant raise in the number of patients surviving an acute myocardial infarction (AMI) has increased the burden of morbidity and disability due to acute coronary events. This has led to an increasing awareness on the need to develop specific rehabilitation programs, both during the acute phase, as well as in out-patient settings. In the pre-revascularization era, AMI was treated in bed. Regardless of the known therapeutic benefits of bed rest, there are scarce data regarding a standardized protocol for the early rehabilitation of patients with AMI. An extensive group of AMI patients are still exposed to prolonged immobilization, with current data showing a disparity in the length of post-MI bed rest, with a time of immobilization reported to be from 2 to 12 days and 2 to 28 days. The growing body of evidence on the effects of early cardiac rehabilitation programs following an AMI suggests that early mobilization after the index event could improve the inflammatory response and further modulate the ventricular remodeling process. The timing, duration, and intensity of cardiac mobilization has not yet been established, and further research on the effects of mobilization as early as the first 12 to 24 hours after the acute event could be beneficial for both short- and long-term outcomes, inflammation, and ventricular remodeling with subsequent heart failure.</abstract>

Mobilization of Patients Suffering from Acute Myocardial Infarction – When Is It Too Early?

<abstract><title style='display:none'>Abstract</title>Hematological conditions can lead to serious disturbances in blood rheology, being frequently associated with increased systemic inflammation and increased risk of bleeding. The imbalance between coagulation and thrombolytic factors in patients with acute coronary syndromes may lead to undesirable outcomes, and the success of emergency coronary angioplasty or by-pass grafting may be altered by increased bleeding in coagulopathies such as hemophilia. This paper intends to review the present knowledge in the field of acute coronary syndromes in subjects with hematological and onco-hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, von Willebrand disease, hemophilia, polycythemia vera, erythrocyte disorders, myelodysplastic syndrome, leukemia, lymphoma or myeloma.</abstract>

University of Medicine and Pharmacy, Tîrgu Mureș,

Clinic of Hematology and Bone Marrow Transplantation Unit, Tîrgu Mureș,

Acute Coronary Syndromes in Patients with Hematological Disorders

<abstract><title style='display:none'>Abstract</title><bold>Introduction:</bold> We present the case of a young man with multiple atherosclerotic risk factors and a rare cause of angina and supraventricular ectopic beats.<bold>Case presentation:</bold> A 35-year-old man with one-year history of stable angina pectoris and supraventricular ectopic beats, without any medication, presented to the emergency room complaining of anterior chest pain that occurs at moderate physical exertion. The rest electrocardiogram, transthoracic echocardiography, and chest X-ray were normal; the exertion stress test was also normal, except for supraventricular ectopic beats (trigeminal rhythm). Due to the intermediate pre-test probability of coronary artery disease, he was evaluated using coronary computed tomography angiography. An anomalous origin of the right coronary artery from the left coronary sinus, with an inter-arterial course and without any atheroma plaques, was observed. During hospitalization the evolution was stable, without complications. The patient was further referred to a cardiac surgery clinic to evaluate the possibility of surgical treatment of this anomaly.<bold>Conclusions:</bold> Coronary artery anomalies are very rare; however, they present multiple implications in current practice. The most severe complication of this condition is represented by sudden death in young patients due to malignant ventricular arrhythmias. Imaging diagnostic techniques allow for a rapid, noninvasive diagnosis of this rare cause of angina.</abstract>

A Rare Cause of Supraventricular Ectopic Beats and Angina in a Young Patient

<abstract><title style='display:none'>Abstract</title><bold>Background:</bold> Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS) and acute or chronic complications following percutaneous coronary intervention (PCI) as well. Platelet inhibition is a cornerstone treatment in the management of these patients. Thrombocytopenia in patients with ACS is uncommon. Idiopathic thrombocytopenic purpura (ITP) is a rare phenomenon; nevertheless, some case series presenting concomitant ACS and ITP have been described in the literature. The safety of antiplatelet therapy and PCI in patients who have ACS and thrombocytopenia is limited.<bold>Case summary:</bold> We present a case of a 60-year-old patient with ITP who was admitted with unstable angina pectoris. On admission, the platelet count was 23 × 109/L. Coronary CT angiography revealed severe stenosis in the mid portion of RCA. After one-week treatment with high-dose Prednisolone, the platelet count recovered, and coronary catheterization was performed. Successful PCI to the RCA with drug-eluting stent was performed. The patient was discharged on dual antiplatelet therapy.<bold>Conclusion:</bold> The case suggests that PCI is a suitable treatment for ITP patients with ACS. Hemostasis is the major concern in managing these patients. The treatment strategy may be based on platelet function rather than platelet count alone. Further analysis of antiplatelet therapies as mono or dual therapy are needed.</abstract>

Thrombocytopenia and Coronary Artery Disease, the Existing Dilemmas

<abstract><title style='display:none'>Abstract</title>A hypertensive crisis is an abrupt and severe rise in the arterial blood pressure (BP) occurring either in patients with known essential or secondary hypertension, or it may develop spontaneously. The most frequent cause for the severe and sudden increase in BP is inadequate dosing or stopping antihypertensive treatment in hypertensive patients. Severe hypertension can be defined as either a hypertensive emergency or an urgency, depending on the existence of organ damage. In hypertensive urgencies, there are no signs of acute end-organ damage, and orally administered drugs might be sufficient. In hypertensive emergencies, signs of acute end-organ damage are present, and in these cases, quickly-acting parenteral drugs must be used. The prompt recognition, assessment, and treatment of hypertensive urgencies and emergencies can decrease target organ damage and mortality. In this review, the definitions and therapeutic recommendations in a hypertensive crisis are presented in the light of the 2017 ACC/AHA Hypertension Guidelines.</abstract>

An Updated Review of Hypertensive Emergencies and Urgencies

<abstract><title style='display:none'>Abstract</title>Hypertensive emergencies (HE) represent critical conditions in which extremely high blood pressure values are accompanied by acute hypertension-mediated organ damage. In this clinical setting, the main therapeutic goal is represented by the immediate reduction of blood pressure, in order to limit the extension or promote the regression of target organ damage. At present, HE are classified according to the condition or target organ involved, into: (1) malignant hypertension with or without thrombotic microangiopathy; (2) coronary ischemia or acute cardiogenic pulmonary edema; (3) acute stroke or hypertensive encephalopathy; (4) acute aortic dissection or aneurysm; and (5) eclampsia or severe preeclampsia/HELLP syndrome. The management of these conditions is different in relation to the complex pathophysiology involved in each of these types. This mini-review presents the main characteristics and management strategy for different forms of HE, revealing the particularities of management strategy for each of them.</abstract>

Modern Management of Hypertensive Emergencies

<abstract>
<title style='display:none'>Abstract</title>
Acute limb ischemia (ALI) and chronic limb-threatening ischemia (CLTI) are severe vascular conditions that can be lethal. The inflammatory response in these diseases, characterized by increased levels of neutrophils and platelets, highlights the importance of prompt management. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a useful biomarker during the COVID-19 pandemic and high NLR levels were found to be associated with an increased risk of ALI and other thromboembolic events. The aim of this systematic review was to analyze the prognostic role of the NLR regarding the risk of amputation and mortality in patients diagnosed with ALI and CLTI. We included 12 studies (five for ALI, with 1,145 patients, and seven for CLTI, with 1,838 patients), following the PRISMA guidelines. Treatment results were evaluated, including amputation and mortality. We found that high NLR values were consistently associated with an increased risk of amputation and/or mortality, with pooled odds ratios ranging from 1.28 to 11.09 in patients with ALI and from 1.97 to 5.6 in patients with CLTI. The results suggest that NLR may represent an important tool for informed decision-making in the management of these patients.
</abstract>

University of General Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology

Neutrophil-to-Lymphocyte Ratio – Risk of Amputation and Mortality in Patients with Limb-Threatening Ischemia – a Systematic Review

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Time intervals related to ST-segment myocardial infarction (STEMI) revascularization are central determinants for patient outcomes. The current capability of the Romanian STEMI program to meet guideline-recommended time intervals is largely unknown.
</sec>
<sec><title style='display:none'>Aims</title>
The present study aims to assess the ability of a regional STEMI network to obtain guideline-recommended time intervals for primary percutaneous coronary intervention (pPCI) and to measure the occurrence and the extent of time delays.
</sec>
<sec><title style='display:none'>Materials and Methods</title>
This prospective study included 500 consecutive patients with STEMI at the “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania during a period of 14 months. Complete ischemic timelines were created using several key timepoints.
</sec>
<sec><title style='display:none'>Results</title>
A secondary route (transfer from another hospital) was noted in most cases. The main time intervals were the following: patient delay 209 min, emergency medical system delay 66 min, and PCI center delay at 70 min, totaling an ischemic time of 6.4 h. A provisional stop at another hospital involved the addition of 113 min (1.8 h) until STEMI diagnosis and an additional 83 min (1.3 h) from diagnosis to revascularization, totaling a supplementary ischemic time of 3.1 h. In total, 41.5% of the patients were revascularized between 2 and 6 h from symptoms onset. The objective of revascularization in less than 120 min (from first medical contact) was accomplished in 35.5% of the patients. Prehospital thrombolysis was performed in 6.4% of the cases, although its potential benefits could have been expected in 64.5% of the patients.
</sec>
<sec><title style='display:none'>Conclusions</title>
Patients with STEMI arrive predominantly via secondary routes to the PCI center, which implies significantly increased ischemic times. The ambulance alert system and primary routes represent by far the most efficient, albeit still imperfect methods of pre-hospital approach. Prehospital thrombolysis did not compensate for the gaps existing in the performance of the current system.
</sec>
</abstract>

“Carol Davila” University of Medicine and Pharmacy

Critical Appraisal of Medical System Performance for STEMI Management – a Comprehensive Analysis of Time Efficiency

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Introduction</title>Abdominal aortic aneurysm (AAA) represents the increase of the diameter of the aorta by more than 50% in the absence of surgical or endovascular intervention. The risk of rupture and, therefore, mortality is increased significantly in AAA. The role of the mechanical characteristics of the AAA wall is poorly studied.
The <bold>aim</bold> of this study was to determine the mechanical properties of each layer of the porcine abdominal aorta for a better understanding of the role of the microstructural elements of the arterial wall in the development and risk of AAA rupture.</sec>
<sec><title style='display:none'>Materials and methods</title>In this study, eight tubular segments of the abdominal porcine aorta were examined. From these segments, we processed 13 × 13 mm square samples for biaxial analysis and 15 × 5 mm samples for uniaxial analysis. At the biaxial analysis, the intact wall and each layer (intima, media, and adventitia) were stretched by 25% at a speed of 1% per s and we determined the mechanical characteristics of the samples at the point of failure.</sec>
<sec><title style='display:none'>Results</title>In the circumferential axis, we found the adventitia (0.233 MPa) to be stronger than the media (0.182 MPa, p = 0.007), intima (0.171 MPa, p = 0.008), and the intact wall (0.192 MPa, p = 0.045). In the longitudinal axis, the adventitia (0.199 MPa) was stronger than the intima (0.117 MPa, p &lt;0.001) and the intact wall (0.156 MPa, p = 0.045), but there was no statistically significant difference compared to the media. Additionally, the adventitia had a greater stiffness than the other two layers (p &lt;0.05 for both layers and axes) and the intact wall (p &lt;0.05 for both axes). Stretching until failure, the adventitia was the strongest compared to the other layers and the intact wall (p &lt;0.001 for all), and it also presented better compliance, with the highest stretch ratio.</sec>
<sec><title style='display:none'>Conclusions</title>The results indicate that the adventitia layer is the strongest and stiffest compared to the other two layers, being the last mechanical resistance structure of the arterial wall. It is crucial to avoid injuring and aggressively manipulating the adventitia during surgery to maintain the vascular wall's resistance structure. By taking the measures mentioned above, it is possible to prevent postoperative complications like anastomotic pseudoaneurysm and anastomotic rupture.</sec>
</abstract>

The Role of the Mechanical Characteristics and Microstructure of the Porcine Aortic Wall: Implications for Abdominal Aortic Aneurysm Rupture Risk

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Coronary artery disease is one of the most common causes of death in the world. The outcome of patients with ST-elevation myocardial infarction is influenced by many factors, and the time elapsed from symptom onset to diagnosis and reperfusion have a critical role in this regard.
</sec>
<sec><title style='display:none'>Aim</title>
The aim of this study was to investigate the differences in the diagnosis-to-needle times of patients with STEMI presenting to the hospital during and outside of working hours, and the effect of this relationship on in-hospital clinical events.
</sec>
<sec><title style='display:none'>Methods</title>
This retrospective study analyzed the data of 50 patients admitted for emergency primary percutaneous coronary intervention. We assessed pain onset-to-diagnosis times and diagnosis-to-needle times, and evaluated their relationship with troponin values at admission and after 48 h.
</sec>
<sec><title style='display:none'>Results</title>
The mean age of the patients was 55.64 ± 13.72 years. In total, 60% of the patients presented outside of working hours. Mean patient delay time from the onset of chest pain to seeking medical help was 2.64 ± 2.47 h. Mean troponin values were 4.39 ± 5.26 ng/ml at admission and 36.50 ± 12.95 ng/ml after 48 h. Mean post-angiography ejection fraction values were 47.36 ± 6.53%. We found a statistically significant difference in the pain onset-to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours. We found a positive correlation between diagnosis-to-needle times and the troponin values of patients, and a statistically significant difference between pain onset-to-diagnosis times of patients who presented during and outside of working hours (p &lt; 0.05). Although the relationship between the diagnosis-to-needle time and troponin elevation after 48 h was strong (97%), the relationship between pain onset-to-diagnosis time and troponin elevation after 48 h was weak (8%), suggesting that the duration of surgical intervention is much more important than the time until the first medical contact.
</sec>
<sec><title style='display:none'>Conclusions</title>
In this study, there was a statistically significant difference in the pain onset-to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours.
</sec>
</abstract>

Assessment of the Diagnosis-To-Needle Times for Patients Admitted to the Emergency Department with Acute ST-Segment Elevation Myocardial Infarction

Air Lock Syndrome – an Unusual Complication of Pacemaker Implantation

<abstract>
<title style='display:none'>Abstract</title>
Pyopneumopericardium is a rare pathology with a poor prognosis. Accurate diagnosis may be difficult and, in very rare cases, can mimic ST-elevation myocardial infarction (STEMI). We present the case of a 44-year-old man, with clinical, ECG, and ultrasound criteria of inferior STEMI. Emergency coronary angiography excluded obstructive coronary artery disease. However, a hydroaeric level image in the pericardium drew our attention. The chest computed tomography scan and Gastrografin study confirmed the diagnosis of pyopneumopericardium. An exploratory thoracotomy was performed to drain the liquid from the pericardium, without highlighting a fistulous path. The etiology of the pyopneumopericardium was detected by performing an upper endoscopy, which revealed a complex lesion suggestive for a foreign body perforation, which was treated with a covered esophageal stent. The outcome of the patient was unfavorable despite the complex treatment, with cardiac arrest and death occurring on the 14th day of hospitalization.
</abstract>

A Rare Case of Pyopneumopericardium Diagnosed by Coronary Angiography in a Patient Presented as STEMI

<abstract><title style='display:none'>Abstract</title>The <bold>aim</bold> of this systematic review was to analyze studies characterizing vulnerable coronary plaques using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), in order to identify the most efficient invasive technique permitting plaque characterization in patients with acute myocardial infarction.<bold>Method:</bold> A total number of 432 studies were identified, 420 through database searching and 12 through manual searching. Eight duplicate studies were removed, leaving a total number of 424 studies to be screened. Twenty-six studies only available in Abstract-only form were excluded, resulting in 398 studies checked for eligibility. Eleven studies fulfilled the eligibility criteria and were included in this systematic analysis. Plaque vulnerability was investigated in plaques with thin cap fibroatheroma (TCFA) versus those with thick cap fibroatheroma, in ruptured coronary plaques versus non-ruptured coronary plaques, in culprit versus non-culprit lesions and in lipid-rich versus non-lipid-rich plaques.<bold>Results:</bold> A total of 1,568 coronary plaques in 1,225 patients with acute coronary syndromes (ACS) who underwent both IVUS and OCT for analysis of plaque features were included in the final analysis. The review identified the following IVUS-derived features as significantly correlated with plaque vulnerability: plaque burden (p &lt;0.001), remodeling index (p &lt;0.001), external elastic membrane cross-sectional area (p &lt;0.001), and the amount of necrotic core (p &lt;0.001), while OCT-derived features characterizing unstable plaque were TCFA (p &lt;0.001), lipid arch (p &lt;0.001), accumulation of macrophages (p = 0.03), and presence of intracoronary thrombus (p &lt;0.001).<bold>Conclusion:</bold> Both IVUS and OCT are invasive imaging techniques able to provide relevant information on the vulnerability of coronary atheromatous plaques, identifying, as they do, various plaque features significantly associated with unstable plaques. Information provided by the two techniques is complementary, and both methods can serve as a useful clinical diagnostic tool, especially in cases of ACS patients undergoing a revascularization procedure.</abstract>

Assessment of Coronary Plaque Vulnerability in Acute Coronary Syndromes using Optical Coherence Tomography and Intravascular Ultrasound. A Systematic Review

<abstract>
<title style='display:none'>Abstract</title>
Acute pulmonary embolism is a cardiovascular emergency with a significant morbidity and mortality. In the last decade, attempts have been made to find prognostic markers for pulmonary embolism. We conducted a systematic review of the literature for studies that assess the relationship between the neutrophil-to-lymphocyte ratio (NLR) and disease progression in patients with pulmonary embolism. We included a total of seven studies published between 2016 and 2021, reporting on a total of 4,272 patients. The mean NLR observed in these studies was 5.93, with values ranging from 5.12 to 7.3. Elevated NLR was significantly associated with an increased rate of mortality in all studies. Furthermore, the collected data revealed a 2-to-15 times higher mortality rate in the group with NLR values higher than the mean. Due to its accessibility and the simplicity with which it can be calculated, as well as the outcomes revealed in this review, we strongly emphasize that NLR should be used more in medical practice.
</abstract>

The Neutrophil-to-Lymphocyte Ratio’s Predictive Utility in Acute Pulmonary Embolism: Systematic Review

<abstract><title style='display:none'>Abstract</title> Introduction: The prognostic value of epicardial fat thickness (EFT) and inflammatory biomarkers such as hs-CRP have not been fully investigated in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM). The study aim was to assess the correlation between the EFT, the persistence of elevated circulating levels of hs-CRP at 7 ± 2 days after an AMI and the amplitude of the left ventricular (LV) remodeling, in patients with type 2 DM. Methods: The study included 98 patients (45 with type 2 DM and 43 with no DM): Group 1 included 22 low-to-intermediate risk patients (hsCRP &lt;3 mg/l) and Group 2 had 23 high-risk, (hsCRP &gt;3 mg/l) patients. EFT, LV function and remodeling were assessed at baseline and at six months after AMI in both groups. Results: In the diabetic population, the EFT was significantly higher in patients who developed ventricular remodeling as compared with those who did not (8.02 ± 1.80 mm vs. 6.65 ± 2.17 mm, p = 0.02) and significantly correlated with the circulating levels of hs-CRP (r = 0.6251, p &lt;0.0001). The levels of circulating hs-CRP, at baseline, significantly correlated with the RI at six months (r = 0.39, p &lt;0.001). Also, in the diabetic population, the epicardial fat thickness was significantly higher in patients who developed ventricular remodeling as compared with those who did not (8.02 ± 1.80 mm vs. 6.65 ± 2.17 mm, p = 0.02). The epicardial adipose tissue thickness significantly correlated with the circulating levels of hs-CRP (r = 0.6251, p &lt;0.0001), while in the non-diabetic population, EFT was not significantly higher in patients who developed ventricular remodeling as compared with those who did not (71.38 ± 9.09 vs. 67.4 ± 10.17, p = 0.23). Multivariate analysis identified the hs-CRP values (OR: 4.09, p = 0.03) and the EFT (OR: 6.11, p = 0.01) as significant independent predictors for LV remodeling in diabetic population. Conclusions: A larger EFT is associated with a more severe remodeling and impairment of ventricular function in patients with type 2 DM and AMI.</abstract>

Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania, 76, 22 Decembrie 1989 St, 540124

Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania 76, 22 decembrie 1989 St 540124

Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania, 38 Gheorghe Marinescu St, 540139

Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Prognostic Value of Epicardial Fat Thickness as a Biomarker of Increased Inflammatory. Status in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction

<abstract><title style='display:none'>Abstract</title> Background: This systematic review seeks to evaluate the role of epicardial adipose tissue (EAT), quantified either by thickness, assessed by transthoracic echocardiography, or by volume, assessed by cardiac computed tomography (CT), in the follow-up of patients with acute coronary syndromes (ACS). Method: One-hundred forty-four articles were screened, from which 56 were reviewed in full-text. From those, 47 studies were excluded for the following reasons: they did not meet the inclusion criteria; they were either reviews or meta-analyses; the study cohorts included only stable coronary artery disease patients; they did not state a clear and concise study design, endpoints, or follow-up. The final draft included nine studies for systematic evaluation. Results: Of the 2,306 patients included in the review, 170 underwent cardiac CT while the remaining 2,136 underwent transthoracic echocardiography for the measurement of EAT. The analysis found that the EAT thickness was significantly associated with major adverse cardiovascular events (MACE) rates during hospitalization (OR: -1.3, 95% CI: 1.05-1.62, p = 0.020) and at three years (HR: 1.524, 95% CI: 1.0-2.2, p = 0.038). The included studies found that EAT was correlated with the following clinical and angiographic risk scores for ACS: GRACE (r = 0.438, p &lt;0.001), TIMI risk score (r = 0.363, p = 0.001), SYNTAX score (r = 0.690, p &lt;0.0001; r = 0.610, p &lt;0.01), and Gensini score (r = 0.438, p = 0.001). There was an inverse correlation between ST-segment resolution of &lt;70% after revascularization and EAT (r = −0.414, p = 0.01), and the myocardial blush grade (r = −0.549, p &lt;0.001). The EF aggregation ranged between 2.65 mm and 4.7 mm within the included studies. Conclusions: EAT, evaluated either by echocardiography or cardiac CT, correlates with the severity of coronary lesions, with the clinical and angiographic risk scores for acute coronary syndromes, with indicators for coronary reperfusion, and with short- and long-term MACE rates. Further studies are required to fully elucidate the role of this extensively studied but still novel cardiovascular biomarker as part of a risk prediction tool.</abstract>

Original research. The Assessment of Epicardial Adipose Tissue in Acute Coronary Syndrome Patients. A Systematic Review

<abstract><title style='display:none'>Abstract</title>Acute coronary syndromes represent the most severe consequences of atherosclerosis, most often triggered by the rupture of a coronary plaque, which, for various reasons, has become unstable. In many cases, these rupture-prone vulnerable plaques are difficult to diagnose, because they do not always cause significant obstruction noticeable by coronary angiography. Therefore, new methods and tools for the identification of vulnerable plaques have been proposed, many of which are currently under study. Various biomarkers have been suggested as predictors of a vulnerable plaque, as well as indicators of an increased inflammatory status associated with higher patient susceptibility for plaque rupture. Integration of such biomarkers into multiple biomarker platforms has been suggested to identify superior diagnostic algorithms for the early detection of the high-risk condition associated with an unstable plaque. The aim of this review is to summarize recent research related to biomarkers used for the early detection of vulnerable plaques and vulnerable patients.</abstract>

Department of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureş,

MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest,

Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest,

The Use of Biomarkers for the Early Detection of Vulnerable Atherosclerotic Plaques and Vulnerable Patients. A Review

<abstract><title style='display:none'>Abstract</title>Recent studies have shown that systemic inflammation caused by periodontal disease (PD) can determine important changes in the coronary arteries, favoring atherosclerosis progression and the development of acute coronary syndromes (ACS). The <bold>aim</bold> of the ATHERODENT study (Protocol Record Number CM0117-ATD) is to assess the interrelation between PD, inflammation, and the progression of coronary atherosclerosis in patients with ACS.<bold>Material and methods:</bold> This case-control observational study will enroll 100 patients (group 1 – ACS and associated PD, and group 2 – ACS and no PD), in whom the following data will be collected: (1) demographic and clinical data; (2) cardiovascular risk factors; (3) full characterization of PD markers; (4) systemic inflammatory biomarkers; (5) imaging biomarkers derived from transthoracic echocardiography, computed tomography, coronary angiography, optical coherence tomography, and intravascular ultrasound; and (6) assessment of the presence of specific oral bacteria in samples of coronary plaques collected by coronary atherectomy, which will be performed during percutaneous revascularization interventions, when indicated in selected cases, in the atherectomy sub-study. The follow-up will be performed at 1, 3, 6, 12, 15, 18, and 24 months. The primary endpoint of the study will be represented by the rate of major adverse cardiovascular events (MACE) in PD vs. non-PD patients and in correlation with: (1) the level of systemic inflammation triggered by PD and/or by ACS at baseline; (2) the vulnerability degree of atheromatous plaques in the coronary tree (culprit and non-culprit lesions); and (3) the presence and burden of oral bacteria in atheromatous plaques. Secondary endpoints will be represented by: (1) the rate of progression of vulnerability degree of non-culprit coronary plaques; (2) the rate of progression of atheromatous burden and calcium scoring of the coronary tree; and (3) the rate of occurrence of left ventricular remodeling and post-infarction heart failure. The ATHERODENT study has been registered in clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT03395041).</abstract>

Periodontal Disease, Inflammation and Atherosclerosis Progression in Patients with Acute Coronary Syndromes – the ATHERODENT Study

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Journal of Cardiovascular Emergencies

 The Journal of Cardiovascular Emergencies aims to publish top quality papers related to acute conditions in any cardiovascular pathology. The journal will mainly focus on...

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 The Journal of Cardiovascular Emergencies aims to publish top quality papers related to acute conditions in any cardiovascular...