Volume 17 (2020): Issue 4 (June 2020)

Introduction. The standard treatment for myocardial infarction is percutaneous revascularization. In patients with STEMI, is recommended an approach as early as possible, being established a period of less than 2 hours from the moment of diagnosis. Things are not as clear regarding myocardial infarction without ST segment elevation. The current guideline proposes to divide the patients with NSTEMI into 4 risk groups, and to perform coronarography in a range of less than 2 hours up to over 72 hours, depending on the risk group of which the patient is part. Several studies have been conducted to determine the benefit of an invasive approach to the detriment of current recommendations, but no consensus has been reached so far.

Objective. The present study aims to analyze the short and medium term evolution, of a group of 125 patients, with NSTEMI, depending on the time of coronarography.

Material and methods. We have analyzed all cases of NSTEMI, admitted in our hospital, between 1.01.2017-31.12 2017. The following parameters were noted: age, sex, presence of cardiovascular risk factors; personal pathological history, previous treatment, Killip class, GRACE score, left ventricular ejection fraction at admission, risk group, the moment of the coronarography.We have followed: complications, number of days of hospitalization, in-hospital and one year mortality.

Results. Of the 125 patients with NSTEMI, 86 (68.8%) were men. They were divided into 4 risk groups as follows: very high risk (n =31; 16.8%), high risk (n =80; 43.5%), medium (n =58; 31.5%) and low risk (n =15; 8.2%). Coronarography was performed in the first 2 hours after presentation in 13 cases (10.40%), in 24 hours for 48 cases (38.40%), between 24-72 hours in 26 patients (20.80%) and late, after 72 hours in 38 patients (30.40%). Most commonly, coronarography was performed in the first 24 hours in patients in Killip I and II classes. Depending on the risk group, 11 of the 15 patients (73.34%) with very high risk received emergency angiography (within the first 24 hours). In contrast, high risk patients performed the procedure after 24 hours. During the hospitalization, 19 patients (15.20%) had complications. The multivariate analysis shows that the most powerful predictors for the onset of complications were age (p =0.02), Grace score (p =0.004) and the risk group in which the patient is classified. The timing of PCI did not influence the appearance of complications. The number of hospitalization days was 5.92±3.56 days in patients who had PCI under 2 hours, 7.47±5.41 days for those who received the procedure in 24 hours, 7.80±3.67 days between 24-72 hours, 10.28±3.79 for those who performed the procedure late. Applying multiple regression, the most powerful predictors for the number of hospitalization days were age, time of PCI and GRACE score. Intra-hospital mortality was 1.6%, and 11.20% at 1 year. Multiple regression showed that among the variables studied, the predictors for death at 1 year were the complications that occurred and the risk class of the patients.

Conclusion. Performing early coronarography in patients with NSTEMI may represent a cost-effective strategy, by reducing the number of days of hospitalization, but it does not influence the rate of complications, nor the short and medium term mortality. In contrast, the age and the GRACE score are predictors of the cardio-vascular complications. Short- and medium-term mortality is correlated with the risk group and with the complications that occurred during the hospitalization.

Background and aims. Aortic sclerosis associates an increased risk of cardiovascular morbidity and mortality. Recent studies suggest that aortic sclerosis is able to produce ventricular remodeling through inflammatory, non-hemodynamic mechanisms. Our study aims to evaluate the correlation between ventricular remodeling and aortic sclerosis severity.

Method. 68 patients with aortic sclerosis without other signifficant associated valvulopathies were examined clinically, biologically and echocardiographic. In 20 patients, we quantiffied the severity of aortic valve calciffication using the backscatter ecographic technique, in parasternal long and short axis view. Backscatter values obtained at the valvular level were calibrated to the blood and pericardium backscatter values.

Results. In the 68 patients group, transvalvular aortic velocity correlates with left ventricular mass (p =0.031), which in turn incline to augment with increasing calciffication severity assessed by backscatter. Calciffication severity assessed by backscatter corellates with transvalvular aortic velocity in parasternal long axis view (p =0.039 for blood calibrated backscatter, p =0.029 for pericardium calibrated backscatter), and tends to augment with increasing transvalvular aortic velocity in parasternal short axis view. Patients with normal ventricular geometry incline to have lower aortic transvalvular velocities and a lower degree of calciffication (evaluated by backscatter) compared to patients with ventricular remodeling.

Conclusions. Aortic sclerosis is not benign, and may lead, in time, to left ventricular remodeling. With the progression of valvular calciffications in aortic sclerosis patients, the prevalence of ventricular remodeling tends to increase.

Telemedicine has always had an openness to the diagnosis and treatment of respiratory diseases. Over the years, pros and cons arguments have been found to mark the benefits or disadvantages of using this tool for COPD patients. We initiated this remote monitoring activities on a small series of patients before the outbreak of the COVID19 epidemic, and this allowed us during these months of physical and social distance to point out the advantages of this method and also determined us to make a transition to review of the latest data in the field related to these types of interventions.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing prevalence and an enormous clinical impact due to the high stroke rate, left ventricular dysfunction and excess mortality. The occurrence and maintenance of AF is favored by both the degree of left atrial (LA) dilation and the association of fibrotic lesions of the myocardium. The LA is a marker of adverse cardiovascular events in patients with AF. Atrial remodeling can be electrical (shortening atrial refractory), structural (altering geometry and altering collagen content) and contractile (loss of contractility). Cardiac imaging plays a central role in the clinical management of this arrhythmia. Echocardiography represents the routine imaging technique used in patients with AF, with a role in detecting LA dysfunction and cardiac structural changes that predispose to this arrhythmia, also having the ability to predict the maintenance of sinus rhythm after cardioversion and after ablation.

Mortality rates from acute myocardial infarctions have been declining in the past 4 decades since percutaneous coronary interventions (PCIs) became a valid therapeutical option. PCI is a non-surgical revascularization procedure in which blood flow in an occluded or narrowed epicardial coronary artery is re-established by inflating an angioplasty balloon in order to remove the blockage, followed by the insertion of a stent in order to maintain the patency of the artery. Since the late ‘70s when the first bare metal stents (BMS) became available, progress has been made in developing new types of stents in order to lower the incidence of two important and feared complications: and thrombosis restenosis.

While thrombosis is manageable and preventable with antithrombotic therapy, restenosis is a more complex issue of which many clinicians may not be aware or underestimate. The review would like to summarize the current knowledge from the literature on stent restenosis and present to clinicians some tools for recognizing, or at least suspecting, restenosis in their patients.

Cardiometabolic syndrome (CMS), also known as metabolic syndrome X or insulin resistance syndrome is a cluster of metabolic abnormalities including central obesity associated with hyperglycemia, dyslipidemia or hypertension. Each component of CMS is individually associated with an increased risk of coronary events and has a different impact on outcomes and long-term mortality.

Nowadays, incidence of drug-induced acute tubulointerstitial nephritis is on the rise due to increased access of the patients to a variety of both prescribed and over-the-counter drugs. Acute kidney injury and hypersensitivity manifestations are the main features of acute tubulointerstitial nephritis.

Classically considered reversible after prompt withdrawal of the offending medication, recent decades revealed potential for evolution to chronic kidney disease. This article presents the challenges in the diagnosis and treatment and also evolutive features of allergic acute tubulointerstitial nephritis induced by drugs.

Hydatid disease is a zoonotic disease endemic in Eastern Europe, being highly prevalent in Romania. There are some links between echinococcosis and cancer, but the true nature of the relationship between these diseases remains to be established. We present the case of a 49-year-old male with hepatic echinococcosis and concomitant hepatic metastases of a previously undiagnosed pancreatic cancer.