Volume 15 (2018): Issue 3 (July 2018)

Background. CA-125 is a tumor antigen expressed on the surface of ovarian cells, used to monitor the treatment of ovarian cancer (normal upper limit is 35U/mL), but it seems also to have a role as biomarker in heart failure (HF).

Aim. To determine CA-125 changes in acute-decompensated HF (ADHF) patients.

Method. The study group included 110 patients (mean age 72±10 years, 63% men) with ADHF caused by ischemic cardiomyopathy. The subjects were clinically, ecocardiographically and biologically (NT-proBNP, PCR, serum uric acid (sUA), CA-125) evaluated.

Results. CA-125 at admission was 53±33 U/mL and decreased at discharge to 34±17 U/mL, without any difference between males and females. The mean level of CA-125 was significantly higher in patients with pleural effusion.

There was a significant difference between NT-proBNP at admission in obese versus normoponderal patients, which was maintained at discharge. In the same time, the CA-125 did not show significant differences between obese and normoponderal subjects at admission and discharge. The mean level of CA-125 was significantly higher for subjects with reduced ejection fraction and with elevated left ventricular filling pressures versus subjects with preserved ejection fraction and normal left ventricular filling pressures.

The CA-125 correlated with LVEF (R=-0.221, p=0.02), with NT-proBNP (R=0.371, p<0.001), with the inflammation marker - PCR (R=0.284, p=0.003) and oxidative stress marker - sUA (R=0.234, p=0.015).

Conclusions. The wide availability of CA-125, its relatively low cost, its correlation with known prognostic markers in HF and the additional information provided make it a valuable biomarker that can be used in monitoring ADHF patients.

Objectives. This study aimed to examine peripheral artery disease severity impact on psychological profile of arteriopathy patients.

Material and methods. The prospective study included consecutive PAD patients admitted to the 2^nd Department of Internal Medicine and the Department of Cardiology of the Emergency Clinical Hospital “Sf. Spiridon” Iasi, between January and September, 2017.

Rezults. The group included 139 PAD patients, 80.6% male and 19.4% female, with an average age of 63.23±9.44 years. PAD stages have a very strong association with level of quality of life (p<0.0001). All Leriche-Fontaine classification categories were significantly associated with the depressive symptoms (p<0.0001). The stress level was moderate in stages IIA, IIB and III and extremely severe in the terminal stage. The prevalence of anxiety was lowest in incipient PADstages with the highest value in stage III.

Conclusions. The fragment of the PhD study presented the psychological profile in the PAD staging and advocates a personalized, wide-ranging approach to the arteriopathy patient including pain and depressive-anxiety management, with amajor impact on the quality of life at terminal stages.

Objective. In lower limb peripheral artery disease the most commonly used method for the assessment of the main arterial system is represented by the determination of ankle-brachial index (ABI). The post-occlusive reactive hyperaemia (PORH) is a controversial method used for the evaluation of primary collateral circulation. The follow-up of these patients has an underestimated part, their quality of life. The aim of this study is to evaluate this and highlight the importance of the PORH in the sight of optimal treatment.

Method. 34 patients diagnosed with lower extremity artery disease, receiving conservative treatment, the ankle-brachial index was defined with a Doppler Bistos BT-200, 8 MHz device, the PORH was evaluated with a Bidop ES-100V, an instrument which sends information for a Smart-V-Link software. To assess the quality of life we used the VascuQol-6 test.

Results. The age (mean ± SD) of the patients was 67.24±9.51, 52.92% were active smokers. A significant positive correlation was found between PORH and the results of VascuQol-6 test (p=0.02, r=0.38) and an inverse correlation between ABI <0.5 and VascuQol-6 >12. We noticed a significant difference between the VascuQol-6 result at smokers and non-smokers (p=0.02).

Conclusions. The quality of life can be acceptable at patients with significant stenosis on the main artery and decreased ankle-brachial index due to presence of the collateral artery system with a maintained ability of vasodilatation represented by PORH. The efficiency of the treatmet is based on quitting smoking, starting programs which are helping patients to quit smoking would be useful.

Diabetes mellitus represents a public health problem because of its growing prevalence and the enormous costs for its treatment and complications. There are numerous risk factors for diabetes mellitus development but the most important ones are the modifiable factors. In Bihor County the prevalence of obesity and sedentary behaviour in the population of newly diagnosed patients are increased compared to their prevalence in the population without diabetes. Promotion of healthy eating habits and increased physical effort are the most important measures to prevent diabetes mellitus type 2, which accounts for 90-95% of total diabetes cases. Public health programs that bring together physicians, nutritionists, teachers and target groups (children, young people, obese and overweight people)must be initiated in general population from an early age and maintained in order to promote the adherence to a healthy lifestyle.

Diabetes incidence in Bihor County in 2016 was 0.55% or 558/100.000 and in 2017 was 0.43% or 437/100.000. The prevalence of diabetes was 5.24% in 2016 and 5.48% in 2017. Age adjusted prevalence was 7.20% in 2016 and 7.66% in 2017, in the 20-79 age group. This prevalence is lower than the national prevalence from PREDATORR study of 11.6%. Data from diabetes registers underestimate diabetes prevalence. As a consequence it is mandatory to effectuate a screening of diabetes mellitus in Bihor County.

Subclinical hypothyroidism (HSC) is a relatively common thyroid dysfunction, characterized by the increase of the thyroid stimulating hormone (TSH) in the presence of normal free thyroxine values. Thyroid hormones are known for the cardiovascular effects, and the consequences of HSC on the cardiovascular system have become the focus of many studies lately. There are clear indications of the relationship between HSC and cardiovascular risk factors such as hypertension, dyslipidemia and atherosclerosis; also, HSC is associated with metabolic syndrome, BMI increase and cardiac insufficiency. Therefore, many clinical trials investigate the benefits and risks of HSC treatment with L-thyroxine.

Introduction. The treatment of neoplasia has advanced due to targeted molecular therapies. Erlotinib, a tyrosine kinase inhibitor that acts by blocking epidermal growth factor receptor (EGFR), is used to treat advanced or metastatic chemotherapy-resistant non-small cell lung cancers (NSCLC).

Erlotinib is a safe and well tolerated medication. Although the most common adverse effects are cutaneous or gastrointestinal, its cardiotoxicity is an important topic in the treatment and follow-up of neoplastic patients.

Clinical case. A 76-year-old male patient with 40 Pack Year history of smoking that has quitted 20 years ago, was admitted in 2009 for night sweats, dry cough and weight loss. He is diagnosed with lung cancer in the right upper lobe (T4N2M1), with the histopathological diagnosis of clear cell adenocarcinoma. The patient performs radiotherapy and chemotherapy with 6 series of Gemcitabine and Cisplatin with partial response, followed by Erlotinib treatment with favorable progression with regression of tumor size.

In December 2017, he presents recurrent episodes of atypical angina lasting about 2 weeks. The electrocardiographic examination reveals ST segment elevation, with tall T waves and Q waves are present in the lower branches, associated with the increase of myocardial necrosis enzymes. Echocardiography highlights inferior hypokinesia with left ventricle ejection rate estimated at 45%. The patient has a favorable evolution during admission without recurrence of pain. Coronary angiography is performed at distance with evidence of vascular atherosclerotic lesions and the installation of active pharmacodynamic stents.

Discussions. Tyrosine kinase inhibitors may be the cause of acute coronary events both by affecting myocardiocytes following EGFR inhibition, but also by increasing atheromatic plaque instability and by prolonging theQT segment.

In conclusion a systemic cardiologic assessment of Erlotinib-treated patients may be recommended throughout the course of therapy.

Atrial myxomas are common benign tumors localized in the left atrium (85%). The diagnosis is often made during routine examination due to the fact that they are usually asymptomatic. Sometimes the complications of these benign tumors, consisting in embolic events and obstructive valvular disfunction, may be alarm signs that reveal the underlying pathological condition.

We report the case of a 63-years-old female presenting with non-specific symptoms, the echocardiography was the one that showed the left atrial mass. The particularity that made this case special was the fact that the anticoagulation indication for the atrial fibrillation discovered on the ECG was correlated with the presence of the thrombocytopenia, so the final decision was to postpone it till the surgery. After the removal of the atrial tumor the sinusal rhythm was restored and the combination of beta-blockers and antiplatelet was the best therapeutic choice.