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Untitled - Romanian Journal of Cardiology

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CONSILIUL DE CONDUCERE AL<br />

SOCIETĂŢII ROMÂNE DE CARDIOLOGIE<br />

Preşedinte:<br />

Preşedinte care urmează:<br />

Fost preşedinte:<br />

Vicepreşedinţi:<br />

Secretar:<br />

Trezorier:<br />

Membri:<br />

Dan Deleanu<br />

Ioan Mircea Coman<br />

Radu Căpâlneanu<br />

Doina Dimulescu<br />

Gabriel Tatu-Chiţoiu<br />

Adriana Ilieşiu<br />

Dragoş Vinereanu<br />

Eduard Apetrei<br />

Şerban Bălănescu<br />

Mircea Cinteză<br />

Ovidiu Chioncel<br />

Alexandru Grigore Dimitriu<br />

Maria Dorobanţu<br />

Dan Dobreanu<br />

Carmen Ginghină<br />

Cătălina Arsenescu Georgescu<br />

Daniel Lighezan<br />

Florin Mitu<br />

Antoniu Petriş<br />

Bogdan A. Popescu<br />

Lucian Zarma<br />

ISSN: 1583-2996


Colectivul de redacţie<br />

Redactor şef<br />

Eduard Apetrei<br />

Redactor şef adjunct<br />

Carmen Ginghină<br />

Redactori asociaţi<br />

Mihaela Rugină<br />

Ruxandra Jurcuţ<br />

Bogdan A. Popescu<br />

Costel Matei<br />

Redactori<br />

Radu Căpâlneanu<br />

Cezar Macarie<br />

Redactor fondator<br />

Costin Carp<br />

Colegiul de redacţie<br />

Ion V. Bruckner - Bucureşti<br />

Alexandru Câmpeanu - Bucureşti<br />

G. Cerin - Italia<br />

Mircea Cinteză - Bucureşti<br />

Radu Ciudin - Bucureşti<br />

D. V. Cokkinos - Grecia<br />

Ioan Mircea Coman - Bucureşti<br />

G. Andrei Dan - Bucureşti<br />

Dan Deleanu - Bucureşti<br />

Genevieve Derumeaux - Franţa<br />

Doina Dimulescu - Bucureşti<br />

Maria Dorobanţu - Bucureşti<br />

Ştefan Iosif Drăgulescu -<br />

Timişoara<br />

Guy Fontaine - Franţa<br />

Bradu Fotiade - Bucureşti<br />

Alan Fraser - Anglia<br />

Cătălina Arsenescu-Georgescu -<br />

Iaşi<br />

Mihai Gheorghiade - USA<br />

Leonida Gherasim - Bucureşti<br />

E. Grosu - Chişinău, R. Moldova<br />

Assen R. Goudev - Bulgaria<br />

Alexandru Ioan - Bucureşti<br />

Dan Dominic Ionescu -<br />

Craiova<br />

Gabriel Kamensky - Slovacia<br />

Andre Keren - Israel<br />

Ioan Maniţiu - Sibiu<br />

Martin S. Martin - SUA<br />

Gerald A. Maurer - Austria<br />

Şerban Mihăileanu - Franţa<br />

Nour Olinic - Cluj-Napoca<br />

Fausto Pinto - Portugalia<br />

Gian Luigi Nicolosi - Italia<br />

Mariana Rădoi - Braşov<br />

Willem J. Remme - Olanda<br />

Doina Rogozea - Bucureşti<br />

Michal Tendera - Polonia<br />

Ion Ţintoiu - Bucureşti<br />

Panagiotis Vardas - Grecia<br />

Dragoş Vinereanu - Bucureşti<br />

Marius Vintilă - Bucureşti<br />

Dumitru Zdrenghea -<br />

Cluj-Napoca<br />

Secretar de redacţie<br />

Mihaela Sălăgean<br />

Caseta tehnică<br />

Editura: Media Med Publicis<br />

Publicitate: <strong>of</strong>fice@mediamed.ro<br />

Distribuţie: Revista Română de<br />

Cardiologie se distribuie membrilor Societăţii<br />

Române de Cardiologie<br />

Abonamente: <strong>of</strong>fice@mediamed.ro<br />

Răspunderea pentru conţinutul articolelor publicate revine în întregime autorilor. Opiniile,<br />

ideile, rezultatele studiilor publicate în Revista Română de Cardiologie sunt cele ale<br />

autorilor şi nu reflectă poziţia şi politica Societăţii Române de Cardiologie. Nicio parte a<br />

acestei publicaţii nu poate fi reprodusă, stocată, transmisă sub nicio formă sau mijloc (electronic,<br />

mecanic, fotocopie, înregistrare) fără permisiunea scrisă a edito rului.<br />

© Toate drepturile rezervate Societăţii Române de Cardiologie.<br />

Contact: Societatea Română de Cardiologie<br />

Str. Avrig nr. 63, Sector 2, Bucureşti<br />

Tel./Fax: +40.21.250 01 00, +40.21.250 50 86, +40.21.250 50 87;<br />

E-mail: rscardio@rscardio.ro


Vol. XXV,<br />

Suplimentul A, 2010<br />

Joi<br />

7 octombrie 2010<br />

Vineri<br />

8 octombrie 2010<br />

Sâmbătă<br />

9 octombrie 2010<br />

Duminică<br />

10 octombrie 2010<br />

1-4 Insuficienţa cardiacă A1<br />

5-8 Cardiopatie ischemică A6<br />

9-15 Poster Forum I A12<br />

16-65 Poster I A21<br />

66-71 Sesiunea tânărului investigator A74<br />

72-75 Aritmii A82<br />

76-79 Varia 1 A86<br />

80-83 Ecocardiografie A91<br />

84-90 Poster Forum II A96<br />

91-139 Poster II A104<br />

140-143 HTA A154<br />

144-147 Varia 2 A159<br />

148-151 Cardiomiopatii A163<br />

152-159 Varia 3 A168<br />

160-166 Poster Forum III A176<br />

167-214 Poster III A184<br />

Index autori<br />

Index subiecte<br />

A238<br />

A244


Vol. XXV,<br />

Suplimentul A, 2010<br />

Vol. XXII, Nr. 1, 2008<br />

Thursday,<br />

7 th October 2010<br />

Friday,<br />

8 th October 2010<br />

Saturday,<br />

9 th October 2010<br />

Sunday,<br />

10 th October 2010<br />

1-4 Heart Failure A1<br />

5-8 Coronary Heart Disease A6<br />

9-15 Poster Forum I A12<br />

16-65 Poster I A21<br />

66-71 Young investigator’s award session A74<br />

72-75 Arrhytmias A82<br />

76-79 Varia 1 A86<br />

80-83 Echocardiography A91<br />

84-90 Poster Forum II A96<br />

91-139 Poster II A104<br />

140-143 Hypertension A154<br />

144-147 Varia 2 A159<br />

148-151 Cardiomyopathies A163<br />

152-159 Varia 3 A168<br />

160-166 Poster Forum III A176<br />

167-214 Poster III A184<br />

Authors index<br />

Topics index<br />

A238<br />

A244


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

INSUFICIENŢA CARDIACĂ | HEART FAILURE<br />

1. Asocierea dintre edemul<br />

pulmonar acut cardiogen si<br />

stenoza de artere renale la<br />

pacientii cu hipertensiune<br />

arteriala<br />

Roxana Darabont, A. Corlan, M. Cinteza,<br />

D. Vinereanu<br />

Universitatea de Medicina si Farmacie “Carol Davila”,<br />

Bucuresti<br />

ratura (0.81). Totusi, adaugarea EPA la acest model de<br />

predictie nu a ameliorat substantial puterea de discriminare<br />

a SAR.<br />

Concluzii. Studii anterioare au analizat relatia dintre<br />

SAR si EPA indeosebi la pacientii cu disfunctie renala<br />

si in SAR bilaterale sau pe rinichi unic functional.<br />

Rezultatele studiului nostru pledeaza pentru o asociere<br />

semnificativa statistic a EPA cu SAR chiar in absenta<br />

azotemiei si pentru orice varianta topografica de SAR,<br />

inclusiv cea unilaterala. Sunt necesare analize ulterioare<br />

pentru determinarea impactului EPA asupra modelelor<br />

de predictie a SAR.<br />

Obiectiv. Serii de cazuri au raportat faptul ca revascularizarea<br />

renala previne recurenta edemului pulmonar<br />

acut (EPA). Aceste observatii au condus la includerea<br />

EPA printre factorii de predictie ai stenozelor de artere<br />

renale (SAR), desi putine studii au analizat sistematic<br />

aceasta asoicere. In acest context ne-am propus sa evaluam<br />

prevalenta EPA si puterea sa predictiva pentru<br />

SAR, la pacienti cu hipertensiune arteriala.<br />

Metoda. SAR a fost investigata prin ultrasonografie<br />

duplex de artere renale la 189 pacienti hipertensivi<br />

(92% valoare predictiva negativa pentru diagnosticul<br />

unei SAR ≥ 50%, confirmata angiografic in laboratorul<br />

nostru). Screening-ul de SAR a fost indicat pentru control<br />

insuficient al tensiunii arteriale, pentru azotemie<br />

de cauza inexplicabila sau azotemie sub IEC mai mare<br />

de 0.25 mg/dL. Varsta (a), sexul feminin (f), suflul abdominal<br />

(b), boala vasculara (v), creatinina serica (c),<br />

azotemia sub IEC (z), ca si istoricul de EPA au fost inregistrate<br />

si s-a efectuat o analiza de discriminare lineara<br />

(ADL) pentru predictia de SAR.<br />

Rezultate. SAR a fost identificata la 29% din cazuri<br />

(55/189). Prevalenta EPA a fost de 22% (23% in stenozele<br />

unilaterale si 20% in stenozele bilaterale sau pe rinichi<br />

unic functional), in timp ce la pacientii fara SAR<br />

a fost de numai 8%. Asocierea dintre EPA si SAR a fost<br />

semnificativa pentru orice topografie de SAR (unilaterala,<br />

bilaterala sau pe rinichi unic functional ) (p=0.01)<br />

si a fost independenta de prezenta azotemiei. ADL a generat<br />

formula 0.22f - 0.0044a + 1.22b + 1.61v + 0.037c<br />

+ 1.28z drept predictiva pentru SAR. Acuratetea (aria<br />

de sub curba) a acestui model predictiv a fost de 0.78,<br />

comparabila cu cea mai buna valoare raportata in lite-<br />

Association <strong>of</strong> acute<br />

pulmonary edema with renal<br />

artery stenosis in hypertensive<br />

patients.<br />

Purpose: Case series have reported that renal revascularization<br />

prevents the recurrence <strong>of</strong> acute pulmonary<br />

edema (APE). Therefore, APE might be included<br />

amongst the predictive factors <strong>of</strong> renal artery stenosis<br />

(RAS). However, few studies have done so. For this reason,<br />

we aimed at evaluating the APE prevalence and<br />

the predictive power for RAS in hypertensive patients.<br />

Method: 189 hypertensive patients were investigated<br />

for RAS by duplex ultrasonography (92% negative<br />

predictive value for the diagnosis <strong>of</strong> a stenosis ≥50%<br />

formerly confirmed by angiography in our laboratory).<br />

RAS screening was indicated because <strong>of</strong> insufficient<br />

blood pressure control, unexplained azotemia, or azotemia<br />

while on ACE-inhibitors (increase <strong>of</strong> serum creatinine<br />

more than 0.25 mg/dL). Age (a), female gender<br />

(f), abdominal bruit (b), vascular disease (v), serum<br />

creatinine (c), azotemia while on ACE-inhibitors (z),<br />

as well as history <strong>of</strong> APE were recorded, and a linear<br />

discriminant analysis (LDA) for RAS prediction was<br />

performed.<br />

Results: RAS was identified in 29% <strong>of</strong> the cases<br />

(55/189). APE prevalence in RAS was 22% (23% in unilateral<br />

stenosis and 20% in bilateral stenosis or on solitary<br />

functional kidney), whereas in patients without


INSUFICIENŢA CARDIACĂ<br />

HEART FAILURE<br />

RAS it was only 8%. The association between APE and<br />

the presence <strong>of</strong> RAS was significant for any RAS topography<br />

(unilateral, bilateral or on solitary kidney stenosis)<br />

(p=0.01), and was independent <strong>of</strong> the presence <strong>of</strong><br />

azotemia. LDA generated the formula 0.22f - 0.0044a<br />

+ 1.22b + 1.61v + 0.037c + 1.28z as predictive for RAS.<br />

The accuracy (area under the curve) <strong>of</strong> this prediction<br />

model was 0.78, comparable to the best predictive value<br />

in the literature (0.81). Still, adding APE to this model<br />

did not substantially improve the discriminative power<br />

for RAS prediction.<br />

Conclusions: In this vascular ultrasound study <strong>of</strong> RAS<br />

evaluation, we found that APE has a statistically significant<br />

association with RAS. While most <strong>of</strong> the studies<br />

on this issue have focused exclusively on the relationship<br />

between APE and RAS for patients with azotemia,<br />

we found that this association holds for both categories<br />

<strong>of</strong> patients—with renal dysfunction, as well as those<br />

without it and for any topography, including the unilateral<br />

one. Further studies are needed to investigate the<br />

impact power <strong>of</strong> EPA on the prediction models <strong>of</strong> RAS.<br />

2. Rolul prognostic al raportului<br />

E/(E’×S’) la pacientii cu disfunctie<br />

ventriculara stanga<br />

C. Mornos, D. Cozma, Adina Ionac, Irina Popescu, L.<br />

Petrescu, S. Pescariu, ST. I. Dragulescu<br />

Institutul de Boli Cardiovasculare, Timisoara<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Studii prealabile au aratat ca o valoare de peste 1.6 pentru<br />

raportul E/(E’×S’) estimeaza cu o buna acuratete<br />

un nivel crescut al presiunii telediastolice intraventriculare<br />

stangi (E=velocitatea precoce maxima transmitrala,<br />

E’=velocitatea precoce diastolica a inelului mitral,<br />

S’=velocitatea sistolica maxima a inelului mitral).<br />

Scop: Evaluarea rolul prognostic al unui raport E/<br />

(E’×S’)>1.6 in ceea ce priveste moartea de cauza cardiaca<br />

la pacientii cu disfunctie ventriculara stanga (VS).<br />

Metoda: Raportul E/(E’×S’) a fost determinat dupa stabilirea<br />

unui tratament optim la 110 pacienti consecutivi,<br />

spitalizati, cu disfunctie VS, in ritm sinusal. A fost<br />

utilizata media velocitatilor de la nivelul extremitatilor<br />

septala si respectiv laterala ale inelului mitral. Pacientii<br />

cu fereastra ecocardiografica inadecvata, valvulopatii<br />

mitrale semnificative, sindrom coronarian acut sau bypass<br />

aorto-coronarian in ultimele 72 de ore nu au fost<br />

inclusi in acest lot de studiu. A fost urmarita incidenta<br />

deceselor de cauza cardiaca la pacientii analizati.<br />

Rezultate: Pe parcursul celor 36±12 luni de urmarire<br />

au fost inregistrate 22 de decese de cauza cardiaca<br />

(20%).Valoare medie a raportului E/(E’×S’) a fost de<br />

3.68±1.48 la pacientii prezentand deces de cauza cardiaca,<br />

in timp ce la ceilalti bolnavi a fost indentificata o<br />

medie de 1.78±0.91 (p=0.017). Un raport E/(E’×S’)>1.6<br />

a avut o sensibilitate de 86% si o specificitate de 54%<br />

privind estimarea mortii de cauza cardiaca. La pacienti<br />

cu raport E/(E’×S’)≤1.6 (n=60), rata de supravietuire<br />

a fost semnificativ mai mare comparativ cu bolnavii<br />

prezentand E/(E’×S’)>1.6 (94% versus 32%, p=0.001,<br />

log-rank). Incluzand raportul E/(E’×S’)>1.6 , E’, S’, E,<br />

raportul dintre velocitatea transmitrala precoce si cea<br />

tardiva, timpul de decelerare al undei E, fractia de ejectie<br />

a VS, volumul indexat al atriului stang, presiunea<br />

sistolica in artera pulmonara, fractiunea N-terminala a<br />

peptidului natriuretic cerebral, varsta si sexul pacientilor,<br />

in regresia Cox multivariata, raportul E/(E’×S’)>1.6<br />

a reprezentat cel mai bun predictor independent pentru<br />

moartea de cauza cardiaca (hazard ratio=4.76, 95%<br />

interval de confidenta=1.50-15.13, p=0.008).<br />

Concluzie: O valoare a raportului E/(E’×S’)>1.6 poate<br />

reprezenta un predictor prognostic puternic pentru<br />

moartea de cauza cardiaca la pacientii prezentand disfunctie<br />

VS aflati in ritm sinusal.<br />

Prognostic value <strong>of</strong> the E/<br />

(E’×S’) ratio in patients with<br />

left ventricular dysfunction<br />

It has been shown that a cut-<strong>of</strong>f value <strong>of</strong> 1.6 for a novel<br />

Tissue Doppler index, E/(Ea×Sa), is able to predict a<br />

high levels <strong>of</strong> left ventricular (LV) end-diastolic pressure<br />

(E = early diastolic transmitral velocity, Ea = early diastolic<br />

mitral annular velocity and Sa = systolic mitral<br />

annular velocity).<br />

The purpose <strong>of</strong> our study was to investigate whether<br />

E/(Ea×Sa)>1.6 could be a predictor <strong>of</strong> cardiac death in<br />

patients with LV dysfunction.<br />

Methods: We determined E/(Ea×Sa) in 110 consecutive<br />

hospitalized patients with LV dysfunction, in sinus<br />

rhythm, after appropriate medical treatment. The average<br />

<strong>of</strong> the velocities from the septal and lateral mitral<br />

annular sites was used. Patients with inadequate echo-


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

cardiographic images, significant mitral valvulopathy,<br />

acute coronary syndrome or coronary artery by-pass<br />

within 72 hours were not included. The primary study<br />

end-point was definited as cardiac death.<br />

Results: There were 22 cardiac deaths (20%) during<br />

36±12 months <strong>of</strong> follow-up. Mean E/(Ea×Sa) was<br />

3.68±1.48 in those patients, while it was 1.78±0.91 in<br />

the rest (p=0.017). The E/(Ea×Sa)>1.6 had 86% sensitivity<br />

and 54% specificity to predict cardiac death. In<br />

patients with E/(Ea×Sa)≤1.6 (n=60), cardiac survival<br />

rate was markedly higher than in the rest with E/<br />

(Ea×Sa)>1.6 (94% versus 32%, p=0.001, log-rank) (Figure<br />

1). On multivariate Cox regression analysis including<br />

E/(Ea×Sa), Ea, Sa, E, early/late diastolic transmitral<br />

velocity, E deceleration time, LV ejection fraction,<br />

indexed left atrial volume, pulmonary artery systolic<br />

pressure, N-terminal pro-brain natriuretic peptide,<br />

age, sex, E/(Ea×Sa)>1.6 was the best independent prognostic<br />

predictor (hazard ratio=4.76, 95% confidence<br />

interval =1.50-15.13, p=0.008).<br />

Conclusions: E/(Ea×Sa)>1.6 could be a powerful predictor<br />

<strong>of</strong> cardiac death in patients with LV dysfunction.<br />

3. Gradul depresiei se coreleaza<br />

cu evolutia pacientilor cu<br />

insuficienta cardiaca cronica<br />

congestiva<br />

Anca Daniela Farcas, N. Olinic<br />

Universitatea de Medicina si Farmacie “Iuliu Hatieganu”,<br />

Cluj Napoca<br />

INSUFICIENŢA CARDIACĂ<br />

HEART FAILURE<br />

Reactiile psihice de adaptare la boala pot avea un rol<br />

important in evolutia pacientilor cu insuficienta cardiaca.<br />

Obiectivul acestui studiu a fost de a evalua modul cum<br />

depresia influenteaza calitatea vietii si evolutia pacientiilor<br />

cu insuficienta cardiaca cronica agravata, in raport<br />

cu evolutia insuficientei cardiace sub tratament.<br />

Material si metoda: Au fost examinati 150 de pacienti(p)<br />

internati pentru insuficienta cardiaca cronica<br />

congestiva agravata. Comportarea clasei functionale<br />

NYHA, a fractiei de ejectie (FE) determinata ecografic,<br />

a testului de mers timp de 6 minute, a scorului de<br />

depresie si a scorului de calitate a vietii, la internare, la<br />

externare, la trei, sase si douasprezece luni de la externare,<br />

au fost analizate, atat individual, cat si comparativ<br />

intre pacientii cu grade diferite de depresie.<br />

Rezultate: Cei 150p, la internare au avut o FE de 30,8<br />

± 9,2. La 6 luni, aceasta a crescut in medie cu 5 % (32,3<br />

± 9,6), valoare aflata la limita semnificatiei statistice (p<br />

=0,052). La 12 luni de la externare, la 118 p (78,7%),<br />

FE a crescut in medie cu 10% (35,5 ± 9,4, p < 0,01).<br />

Dintre cei 150p cu insuficienta cardiaca studiati 52,6%<br />

au fost depresivi, 38% dintre ei avand depresii severe<br />

sau moderate. Dintre cei 55 p (36,7%) care au mai avut,<br />

cel putin inca o agravare a insuficientei cardiace, 87,2%<br />

au fost diagnosticati cu depresie moderata sau severa.<br />

Calitatea vietii pacientilor cu insuficienta cardiaca se<br />

coreleaza cu gradul depresiei (r=0,67, p=0,009) si, desi<br />

sub tratament ea se imbunatateste, aceasta imbunatatire<br />

este semnificativa doar la pacientii nedepresivi si la<br />

cei cu depresii usoare si moderate. Capacitatea de efort<br />

se imbunatateste semnificativ la pacientii cu depresii<br />

moderate (332 ± 60m vs 371 ± 51m, p < 0,01) si usoare<br />

(380 ± 25m vs 487 ± 32 m, p < 0,001). Pacientii cu<br />

depresii severe, desi sunt in proportie de 73%in clase<br />

functionale NYHA II-III, nu isi cresc in mod semnificativ<br />

capacitatea de efort sub tratament.<br />

Concluzie: Gradul depresiei influenteaza in mod negativ<br />

procesul de reabilitare a pacientilor cu insuficienta<br />

cardiaca. Pacientii cu depresii severe prezinta o evolutie<br />

nefavorabila, cu multiple reinternari. De asemenea,<br />

acesti pacienti prezinta o deterioare a calitatii vietii si<br />

a capacitatii de efort, care nu se imbunatatesc in mod<br />

semnificativ prin tratament.<br />

Cuvinte cheie: insuficienta cardiaca<br />

Severity <strong>of</strong> depression<br />

correlates with outcome in<br />

chronic congestive heart<br />

failure patients<br />

Psychological coping can have a major effect on disease<br />

outcome in heart failure patients.<br />

Objective: The study evaluated the effect <strong>of</strong> depression<br />

on quality <strong>of</strong> life and outcome in patients with severe<br />

chronic heart failure.<br />

Method: The authors evaluated 150 patients admitted<br />

with severe chronic congestive heart failure.The NYHA<br />

class, ejection fraction (EF), 6-minute walk test, depression<br />

score and quality <strong>of</strong> life (QoL) score were deter-


INSUFICIENŢA CARDIACĂ<br />

HEART FAILURE<br />

mined at admission, discharge and follow-up at 3, 6<br />

and 12 months and compared for each patient and in<br />

patients with different levels <strong>of</strong> severity <strong>of</strong> depression.<br />

Results: EF was 30,8 ± 9,2 at admission and 32,3 ± 9,6<br />

at 6-months (5% increase, p=0.052, marginally significant)<br />

for the whole 150 pts study group. At 12-months<br />

follow-up, in 118 pts (78, 7%) EF increased with 10%<br />

(35, 5 ± 9, 4, p < 0, 01). Depression was found in 52.7%<br />

<strong>of</strong> the patients, 38% <strong>of</strong> the patients had moderate or severe<br />

depression. Of the 55 (36.7%) pts who had at least<br />

one episode <strong>of</strong> worsening <strong>of</strong> CHF, 87, 3% had moderate<br />

or severe depression. QoL in heart failure patients<br />

correlates with severity <strong>of</strong> depression (r=0,67, p=0,009)<br />

and improves with heart failure treatment. The improvement,<br />

however, is only significant in depression-free,<br />

mild or moderate depression patients. Exercise capacity<br />

significantly improves in patients with moderate (332 ±<br />

60m vs 371 ± 51m, p < 0,01) and mild (380 ± 25m vs<br />

487 ± 32 m, p < 0,001) depression. Patients with severe<br />

depression do not significantly increase their exercise<br />

capacity, even though they are mainly in NYHA II and<br />

III class (73%).<br />

Conclusion: Severity <strong>of</strong> depression has a detrimental<br />

effect on heart failure patients’ rehabilitation. Patients<br />

with severe depression have an unfavourable/severe<br />

outcome with multiple hospital admissions, OoL worsening<br />

and decreased exercise capacity which don’t improve<br />

significantly with treatment. KEYWORDS: heart<br />

failure, depression, quality <strong>of</strong> life<br />

4. Relatia dintre nivelul BNP si<br />

polimorfismul genetic al<br />

angiotensinogenului (AGT) la<br />

pacientii cu insuficienta<br />

cardiaca (IC)<br />

Dana Pop, Lucia Procopciuc, Oana Maria Penciu,<br />

Adela-Viviana Sitar-Taut, G.Bodizs, D. Zdrenghea<br />

Universitatea de Medicina si Farmacie “Iuliu Hatieganu”,<br />

Cluj-Napoca<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

plasmatice crescute ale angiotensinogenului la pacientii<br />

cu insuficienta cardiaca. Pe de alta parte, se cunoaste<br />

faptul ca BNP este crescut la pacientii cu IC, nivelul sau<br />

reliefand severitatea bolii.<br />

Scop: studierea asocierii dintre prezenta genotipurilor<br />

M235T, respectiv T174M si nivelul plasmatic al fragmentului<br />

(8-29) al BNP; influenta acestor variante asupra<br />

nivelului plasmatic al fragmentului (8-29) al BNP.<br />

Metoda: au fost investigati 50 pacienti cu IC (31 barbati),<br />

NYHA III-IV, varsta medie 65.76±6.29 ani. Polimorfismul<br />

genetic al AGT a fost evaluat prin metoda<br />

PCR, iar nivelul plasmatic al fragmentului (8-29) al<br />

BNP a fost determinat utilizand metoda ELISA.<br />

Rezultate: Distributia mutatiilor genetice ale AGT<br />

M235T si T174M a fost urmatoarea MT-M235T*+TM-<br />

T174M*- 20%, MT-M235T*+TT-T174M**- 26%, TT-<br />

M235T***+TM - T174M*- 14%, TT-M235T***+TT-<br />

T174M**-20%, MM-M235T**+TT-T174M**-20%<br />

(unde *inseamna heterozigot, **negativ, ***homozigot).<br />

Valoarea medie a nivelului plasmatic a fragmentului<br />

BNP a fost 2991.24±2034.61 fmol/ml. Valoarea<br />

frag mentului BNP a fost surprinzator de ridicata<br />

(p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

BNP fragment level and<br />

angiotensinogen M235T and<br />

T174M gene polymorphism in<br />

heart failure (HF) patients<br />

Background: Two molecular variants <strong>of</strong> the angiotensinogen<br />

(AGT) gene - M235T, encoding threonine (T)<br />

instead <strong>of</strong> methionine (M) at position 235 and T174M,<br />

encoding methionine rather than threonine at position<br />

174- are linked to elevated plasma AGT level in HF patients.<br />

On the other hand, BNP increase in HF patients,<br />

in direct relationship with severity.<br />

Purpose: To study the association between the individual<br />

presence <strong>of</strong> the M235T and T174M genotypes<br />

and the BNP fragment (8-29) plasmatic level (as a measure<br />

<strong>of</strong> BNP activity), and the combined influence <strong>of</strong><br />

those variants on the plasmatic level <strong>of</strong> BNP fragment<br />

(8-29).Methods were analyzed 50 heart failure patients,<br />

31 males, NYHA III- IV functional class, 65.76±6.29<br />

years. AGT gene polymorphism was detected by PCR,<br />

and the plasmatic BNP fragment (8-29) level was determined<br />

using ELISA-method.<br />

Results: Genotype combination frequencies were<br />

as follows: MT-M235T* + TM-T174M*- 20%,, MT-<br />

M235T* + TT-T174M**- 26% , TT-M235T*** + TM-<br />

T174M*- 14%, TT-M235T*** +TT-T174M**-20%,<br />

MM-M235T** + TT-T174M**-20% (with * meaning<br />

heterozygote, **negative, ***homozygote genotype).<br />

The mean value <strong>of</strong> serum BNP fragment levels was<br />

2991.24±2034.61 fmol/ml. Considering genotype combination<br />

<strong>of</strong> AGT M235T and T174M polymorphisms,<br />

BNP fragment level, for negative MM-negative TT<br />

combination (4427.25±2669.95 fmol/ml), was surprisingly<br />

higher (p


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

CARDIOPATIE ISCHEMICĂ | CORONARY HEART DISEASE<br />

5. Impactul administrarii de<br />

clopidogrel la pacientii cu<br />

infarct miocardic acut cu<br />

supradenivelare de segment ST<br />

si reperfuzie trombolitica<br />

neurmata de PCI precoce.<br />

Date pe 10 ani din Registrul<br />

RO-STEMI<br />

G.Tatu-Chitoiu, Maria Dorobantu, Elvira Craiu, Crina<br />

Sinescu, Carmen Ginghina, Doina Dimulescu, G. Ludusan,<br />

I. Balea, Alice Balaceanu, B.Minescu, C. Pop<br />

Spitalul Clinic de Urgenta “Floreasca” Bucuresti<br />

Introducere: Ghidrile actuale recomanda administrarea<br />

de clopidogrel (C) plus Aspirina (A) la pacientii<br />

(pts) cu terapie trombolitica (TT) cu infarct miocardic<br />

acut cu supradenivelare de segment ST. Efectul administrarii<br />

de C la pts la care TT a avut succes nu a fost<br />

inca evaluat.<br />

Obiectiv: Compararea mortalitatii intraspitalicesti si a<br />

incidentei hemoragiilor majore la pts cu TT la care PCI<br />

precoce nu a fost disponibila si care au primit tratament<br />

anticoagulant combinat fie cu A fie cu A plus C (A&C;).<br />

Metoda: In intervalul 1.01.2000-31.12.2009 au fost<br />

inrolati consecutiv 15047 pts in Registrul Roman pentru<br />

Infarctul Miocardic cu Supradenivelare de Segment<br />

ST (RO-STEMI). In acest grup, 6588 pts au primit TT.<br />

Eficienta TT a fost evaluata prin doua criterii de reperfuzie:<br />

disparitia rapida a durerii toracice; scaderea cu<br />

peste 50% a sumei supradenivelarilor de segment ST<br />

la 180 min dupa debutul TT. Pacientii au primit betablocante,<br />

inhibitori ai enzimei de conversie a angiotensinei,<br />

statine si anticoagulante (heparina 1000i.u./ora,<br />

48-96ore sau enoxaparina 1 mg/kg la fiecare 12 ore,<br />

8-10 zile) combinate fie cu A 150-300 mg/zi sau A&C;<br />

(incarcare 300 mg, apoi 75 mg/zi).<br />

Rezultate: criteriile de reperfuzie coronariana au<br />

fost evaluate la 5732 (87%) pts. A fost identificat un<br />

subgrup de 2817 pts cu criterii de reperfuzie post TT<br />

la care nu s-a efectuat PCI precoce. O mortalitate in-<br />

tra-spitaliceasca semnificativ mai redusa (1.63%) a<br />

fost observata la cei 1225 pts tratati cu anticoagulante<br />

si A&C;comparativ cu cea de 4.45% inregistrata la<br />

cei 1592 pts care au primit doar anticoagulante si A<br />

(p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Methods: Between 1.01.2000 and 31.12.2009 the <strong>Romanian</strong><br />

registry for ST-elevation myocardial infarction<br />

(RO-STEMI) enrolled 15047 consecutive STEMI pts.<br />

In this group, 6588 pts received thrombolytic therapy.<br />

The efficacy <strong>of</strong> thrombolysis was assessed with two<br />

noninvasive reperfusion criteria: rapid cessation <strong>of</strong> the<br />

chest pain decrease <strong>of</strong> the sum <strong>of</strong> the ST-segment elevations<br />

by more than 50% at 180 min. after the start<br />

<strong>of</strong> thrombolysis. In the absence <strong>of</strong> contraindication,<br />

all pts. received beta-blockers,angiotensin converting<br />

enzyme inhibitors,statins,and anticoagulants (unfractionated<br />

heparin-1000 i.u./hour, 48-96 hours-or enoxaparin-1<br />

mg/kg every 12 hours for 8-10 days) combined<br />

with either A-150-300 mg./day or A&C (loading dose<br />

<strong>of</strong> 300 mg followed by 75 mg/day).<br />

Results: The efficacy <strong>of</strong> thrombolysis was correctly<br />

assessed in 5732 (87%) pts. A subgroup <strong>of</strong> 2817 pts<br />

with succesful reperfusion not undergoing early PCI<br />

was identified. A significant lower in-hospital mortality<br />

(1.63%) was seen in the 1225 pts treated with anticoagulants<br />

and A&C compared with the one <strong>of</strong> 4.45%<br />

seen in pts who received only anticoagulants and A<br />

(p


CARDIOPATIE ISCHEMICĂ<br />

CORONARY HEART DISEASE<br />

precoce post STEMI sau reocluzia precoce a fost semnificativ<br />

statistic mai frecventa in subgrupurile H plus A<br />

(22.79), H plus A&C;(15.85%) si E plus A&C;(16.85%)<br />

comparativ cu de H urmata de E plus A&C;(4.41%) (p<br />

< 0.01).<br />

Concluzii: Datele RO-STEMI sugereaza faptul ca administrarea<br />

combinatiei Heparina nefractionata (48-96<br />

ore) urmata de Enoxaparina si terapie antiagreganta<br />

plachetara duala (Aspirina si Clopidogrel) reprezinta<br />

cea mai buna strategie teraeutica la pacientii STEMI cu<br />

diabet zaharat tratati cu trombolitice.<br />

„Full package” anticoagulant<br />

and antiplatelet<br />

armamentarium rise the<br />

thrombolysis succes in STEMI<br />

patients with diabetes. The<br />

<strong>Romanian</strong> registry for STelevation<br />

myocardial infarction<br />

(RO-STEMI).<br />

Background: Patients (pts) with diabetes and ST-elevation<br />

myocardial infarction (STEMI have a high risk for<br />

cardiovascular events. Current guidelines recomend<br />

anticoagulants – either enoxaparin (E) or unfractionated<br />

heparin (UH) combined with aspirin (A) and clopidogrel<br />

(C) in STEMI pts and thrombolitic therapy.<br />

The efficacy <strong>of</strong> a combined anticoagulant strategy (UH<br />

followed by E) and dual platelet therapy was still not<br />

evaluated in these pts.<br />

Objective: To compare the in-hospital outcome <strong>of</strong><br />

STEMI pts with diabetes treated with thrombolysis<br />

and different strategies <strong>of</strong> anticoagulants and antiplatelet<br />

therapy and enrolled in the romanian registry for<br />

STEMI (RO-STEMI).<br />

Methods: RO-STEMI enrolled 6588 consecutive<br />

STEMI pts treated with thrombolytics. In this cohort<br />

we identified 1136 pts (17.24%) with diabetes (62+/-10<br />

years, 69.98% male). In the absence <strong>of</strong> contraindication<br />

all <strong>of</strong> these pts received angiotensin convering enzyme<br />

inhibitors, beta-blocking agents, statins and the<br />

following combination <strong>of</strong> anticoagulants and antiplatelets:<br />

1. UH-1000 i.u./48-96 hours and A 150-300 mg/<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

day (430 pts); 2. UH and A and C – a loading dose <strong>of</strong><br />

300 mg followed by 75 mg/day (145 pts); 3. E – 1 mg/kg<br />

8-10 days and A (85 pts); 4. E and A&C (89 pts); 5.UA<br />

followed by E plus A (45 pts); 6. UH followed by E plus<br />

A&C (68 pts).<br />

Results: The in-hospital mortality was 13.25%<br />

(UH&A), 12.94% (E&A), 8.88% (UA&A followed by<br />

E&A), 6.20% (UH plus A&C) and 5.61% (E plus A&C),<br />

subgroups, respectivelly (non-significant differences.<br />

However, a significant lower in-hospital mortality was<br />

seen in the UH followed by E plus A&C group compared<br />

with the other subgroups (2.94%, p< 0.0001).<br />

The rates <strong>of</strong> the global stroke were 0.23% (UH plus A);<br />

non stroke was seen in the other subgroups. Early post<br />

STEMI angina or early reoccusion were significantly<br />

higher in UH plus A (22.79), UH plus A&C (15.85%)<br />

and E plus A&C (16.85%) subgroups compared with<br />

UH followed by E plus A&C (4.41%) (p < 0.01).<br />

Conclusions: Data from the RO-STEMI registry<br />

suggest that a combination between Heparin for 48-<br />

96 hours followed by Enoxaparin and the dual therapy<br />

(Aspirin and Clopidogrel) should be the best strategy in<br />

STEMI patients with diabetes treated by thrombolysis.<br />

7. Angio CT multislice 64<br />

versus ecografia intravasculara<br />

cu histologie virtuala in<br />

evaluarea complexa a placii<br />

instabile<br />

Teodora Benedek, Oana Bucur, Monica Chitu, Claudia<br />

Matei, I.Kovacs, P.I.Sarbu, Gabriela Kozma, Zsuzsanna<br />

Suciu, I.Benedek<br />

Universitatea de Medicina si Farmacie, Targu-Mures<br />

Scopul studiului: Scopul studiului este evaluarea gradului<br />

de instabilitate a placilor ateromatoase utilizand<br />

analiza angio CT multislice 64, respectiv ecografia intravasculara<br />

asociata cu analiza histologica virtuala.<br />

Material si metoda: Lot A - 14 pacienti cu semne clinice<br />

de angina instabila, Lot B – 10 pacienti cu semne<br />

clinice de angina stabila. Toti pacientii au prezentat stenoze<br />

coronariene semnificative hemodinamic, de peste<br />

75%, la nivelul arterelor coronare. In toate cazurile s-a<br />

efectuat coronarografie si ecografie intravasculara aso-


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

ciata cu analiza histologica virtuala, iar la 8 cazuri s-a<br />

efectuat si analiza prin angio CT multislice 64 a patului<br />

coronarian. S-au determinat: gradul de incarcare al<br />

placii, volumul placii, procentul de stenoza si scorul de<br />

calciu al leziunilor prin analiza angio CT.<br />

Rezultate: La toti pacientii din lotul A si la 34% din<br />

pacientii din lotul B s-a demonstrat prezenta de placi<br />

ateromatoase instabile, obiectivizate printr-un continut<br />

de peste 30% de placa moale, instabila, bogata in colesterol.<br />

Analiza histologica virtuala a aratat un continut<br />

in placa moale, instabila, in medie de 68% in lotul A<br />

respectiv 25% in lotul B, in timp ce analiza prin angio<br />

CT a aratat un continut in placa moale de 65,6% in lotul<br />

A comparativ cu 22% in lotul B (p


CARDIOPATIE ISCHEMICĂ<br />

CORONARY HEART DISEASE<br />

coronariene acute Bobescu E. 1,2, Radoi M. 1,2, Datcu<br />

G.3, Donea M. 1,2, Doka B2, Anghel M2, Cazacu<br />

S2, Dragomir S1 Transilvania University Brasov, 2Clinic<br />

County Emergency Hospital Brasov, 3University <strong>of</strong><br />

Medicine and Pharmacy ”Gr.T.Popa” Iasi, Romania<br />

Obiective: La pacientii cu sindroame coronariene<br />

acute fara supradenivelare de segment ST (SCA) evenimentele<br />

acute cardiovasculare majore au fost evaluate<br />

in corelatie cu biomarkerii de instabilitate a placii<br />

aterosclerotice: hiperactivitatea plachetara, statusul de<br />

hipercoagulabilitate si stresul oxidativ.<br />

Metoda: La 240 pacienti (p) cu SCA biomarkerii pentru<br />

hiperactivitate plachetara (ASPItest, ADPtest - agregometria<br />

sangelui integral, numarul de trombocite, volumul<br />

plachetar mediu), statusul de hipercoagulabilitate<br />

(activitatea plasmatica a factorului von Willebrand ,<br />

proteina C, S, Antitrombina, rezistenta la factorul V<br />

Leiden- APC Resistance V), stresul oxidativ (status antioxidant<br />

total, mieloperoxidaza - MPO IgG ELISA), au<br />

fost determinate si evenimentele acute cardiovasculare<br />

majore (MACE) au fost evaluate in corelatie cu biomarkerii<br />

mentionati la un an de urmarire. Analiza statistica:<br />

testul de corelatie Pearson.<br />

Rezultate: ASPItest >30U ADPtest >50U Volum mediu<br />

plachetar >11 fl Activitate factor von Willebrand<br />

>169.7% Status antioxidant total 30U - 0.001 0.01 0.001 0.001 ADPtest<br />

>50U 0.001 - 0.01 0.001 0.001 Volum mediu plachetar<br />

>11 fl 0.001 0.001 - 0.01 0.01 Activitate factor von Willebrand<br />

>169.7% 0.001 0.001 0.01 - 0.01 Status antioxidant<br />

Total 30U ADPtest >50U Mean platelet<br />

volume >11 fl Von Willebrand factor activity >169.7%<br />

Total antioxidant status


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

CARDIOPATIE ISCHEMICĂ<br />

CORONARY HEART DISEASE<br />

ents 240 103(42.9%) 29(12.9%) 51(21.3%) 106(44.2%)<br />

145(60.4%) Cardiovascular death 0.01 0.0001 0.001<br />

0,001 0.0001 Nonfatal AMI 0.001 0.01 0.01 0.01 0.009<br />

Stroke 0.08 0.34 0.16 0.16 0.08 Heart failure with readmission<br />

0.01 0.01 0.01 0.01 0.001 Recurrent angina<br />

with readmission 0.001 0.001 0.001 0.001 0.01 AS-<br />

PItest >30U - 0.001 0.01 0.001 0.001 ADPtest >50U<br />

0.001 - 0.01 0.001 0.001 Mean platelet volume >11 fl<br />

0.001 0.001 - 0.01 0.01 Von Willebrand factor activity<br />

>169.7% 0.001 0.001 0.01 - 0.01 Total antioxidant status<br />


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

POSTER FORUM I | POSTER FORUM I<br />

9. Angio CT multislice 64<br />

versus ecocardiografia 3D<br />

computerizata in evaluarea<br />

obiectiva a ischemiei<br />

miocardice<br />

Teodora Benedek, Monica Chitu, Claudia Matei,<br />

I.Kovacs, P.I.A.Sarbu, Oana Bucur, Gabriela Kozma,<br />

Zsuzsanna Suciu, I.Benedek<br />

Universitatea de Medicina si Farmacie, Targu-Mures<br />

Scopul studiului: Evaluarea obiectiva a tulburarilor de<br />

cinetica miocardica utilizand doua tehnici imagistice<br />

recente, bazate pe analiza computerizata a tulburarilor<br />

de cinetica segmentara: angiocardiografia CT multislice<br />

64 respectiv ecocardiografia 3D computerizata.<br />

Material si metoda: 20 pacienti cu angina, modificari<br />

ischemice si leziuni coronariene semnificative, la<br />

care s-a efectuat: (1) ecocardiografie 3D computerizata<br />

(C3DE) pentru analiza tridimensionala a tulburarilor<br />

de cinetica, utilizandu-se ca indicator al tulburarii<br />

de cinetica amplitudinea contractiei pe baza trasarii<br />

conturului endocardic si analizei curbei de cinetica a<br />

acestuia. (2) angio CT multislice 64, atat pentru evaluarea<br />

leziunilor coronariene cat si pentru evaluarea<br />

computerizata a ischemiei segmentare, utilizandu-se<br />

ca indicator al tulburarii de cinetica atat amplitudinea<br />

contractiei cat si gradul de ingrosare a peretelui pe baza<br />

trasarii conturului endocardic si epicardic.<br />

Rezultate: C3DE a identificat cu acuratete localizarea si<br />

extensia tulburarii de contractilitate, reprezentata ca un<br />

spot pe harta polara de cinetica si o scadere medie de<br />

56% a amplitudinii maximale a contractiei segmentelor<br />

ischemice comparativ cu cele non-ischemice la testarea<br />

cu dobutrex. Angio CT multislice 64 a reusit nu numai<br />

localizarea segmentelor ischemice pe baza unui parametru<br />

mai fidel, gradul de ingrosare a peretelui (care a<br />

fost de 25% pentru segmentele ischemice comparativ<br />

cu 42% pentru cele non-ischemice, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

chemic compared with non-ischemic segments by dobutrex<br />

testing. 64 multislice angio CT has not only located<br />

the ischemic segments by using a more accurate<br />

parameter, the degree <strong>of</strong> thickening <strong>of</strong> the wall (which<br />

was 25% for ischemic segments compared with 42% for<br />

non-ischemic, p 32ml/m2, IMAS>131g/m2 la barbati si >125g/<br />

m2 la femei (hipertr<strong>of</strong>ie de ventricul stang, HVS),<br />

PAPs>35mmHg, E/E’>15, E/vp>1,5, ar-A>25ms. FEVS<br />

masurata prin metoda Simpson a fost in toate cazurile<br />

mai mica de 45%. Pacientii au fost impartiti in 4 grupuri:<br />

1. HVS+ si reperfuzie eficienta 2. HVS- care nu au<br />

prmit terapie de reperfuzie sau cu reperfuzie ineficienta<br />

3. HVS- si reperfuzie eficienta 4.HVS- fara reperfuzie<br />

sau cu reperfuzie ineficienta.<br />

Rezultate: 1. 67 pacienti (68,36%) au prezentat criterii<br />

de HVS. 2. Valorile medii ale parametrilor ecocardiografici<br />

de crestere a presiunii de umplere la pacientii cu<br />

HVS si fara reperfuzie au fost: IVAS: 35,04, p=0,00007,<br />

PAPs: 45,57, p= 0,00122, E/E’: 14,81, p=0,03992, E/vp:<br />

1,99, p=0,00197, ar-A: 28,79, p=0,00726. 3. Cel mai<br />

mare procent de pacienti cu valori medii ale parametrilor<br />

de umplere ce au depasit valorile limita a fost gasit<br />

in grupul cu HVS care nu a primit terapie de reperfuzie<br />

sau care desi au primit trombolitic nu au prezentata criterii<br />

de reperfuzie: IVAS: 26,53%, PAPs: 26,53%, E/E’:<br />

15,31%, E/vp:22,45%, ar-A: 16,33%.<br />

Concluzii: 1. La pacientii hipertensivi fara criterii de<br />

reperfuzie toti parametrii ecocardiografici asociati cu<br />

cresterea presiunii de umplere au avut valori medii mai<br />

mari decat valorile limita, comparativ cu pacientii hipertensivi<br />

fara HVS si cu criterii de reperfuzie prezente.<br />

2.Cele mai mari valori au fost intalnite in grupul cu<br />

HVS fara reperfuzie, pacienti care teoretic au cele mai<br />

mari presiuni de umplere.


POSTER FORUM I<br />

POSTER FORUM I<br />

Echocardiographic<br />

parameters <strong>of</strong> filling presure<br />

in hypertensive patients with<br />

acute myocardial infarction<br />

Background: Before acute myocardial infarction<br />

(AMI), hypertensive patients have high filling pressure<br />

in left ventricle which is supplementary rised during<br />

the infarction by the areas <strong>of</strong> necrosis and ischemia.<br />

Aims <strong>of</strong> the study: was to evaluate echocardiographic<br />

parameters <strong>of</strong> diastolic dysfunction in hypertensive patients<br />

during the first week after AMI.<br />

Methods: A number <strong>of</strong> 98 hypertensive patients (56<br />

males and 43 females), admitted with acute myocardial<br />

infarction with ST-segment elevation were evaluated<br />

in the first week by: clinical examination, 12<br />

lead standard ECG, echocardiographic measurements<br />

<strong>of</strong>: left atrium volume index (LAVi) and left ventricle<br />

mass index (LVMi) using transthoracic echocardiography,<br />

pulmonary artery systolic pressure (PAPs) using<br />

Doppler echocardiography for tricuspid inflow, E/E’, E/<br />

vp and ar-A, using Doppler echocardiography for mitral<br />

inflow (E wave velocity, A wave duration), tissue<br />

Doppler echocardiography at lateral and medial corner<br />

<strong>of</strong> mitral annulus (E’ wave velocity), colour Mmode<br />

(flow propagation velocity vp) and pulmonary venous<br />

flow (ar wave duration): cut <strong>of</strong>f levels: LAVi>32ml/<br />

m2, LVMi>131g/m2 in males and>125g/m2 in females<br />

(left ventricular hypertrophy, LVH), PAPs>35mmHg,<br />

E/E’>13, E/vp>1,5, ar-A>25ms. LVEF measured by<br />

Simpson method was less than 45%. Patients were divided<br />

in 4 groups: 1.LVH+ and reperfusion 2.LVH+<br />

without reperfusion 3.LVH- and reperfusion 4.LVHwithout<br />

reperfusion.<br />

Results: 1.LVH was found in 67 patients (68, 36%).<br />

2.Mean values <strong>of</strong> parameters <strong>of</strong> filling pressure in<br />

hypertensive patients with LVH and without reperfusion<br />

were: VASi: 35,04, p=0,00007, PAPs: 45,57, p=<br />

0,00122, E/E’: 14,81, p=0,03992, E/vp: 1,99, p=0,00197,<br />

ar-A: 28,79, p=0,00726. 3. Percentages <strong>of</strong> patients with<br />

LVH and without reperfusion which presented filling<br />

pressure parameters values higer than cut <strong>of</strong>f level<br />

were: VASi: 26,53%, PAPs: 26,53%, E/E’: 15,31%, E/<br />

vp:22,45%, ar-A: 16,33%.<br />

Conclusions: 1.In hypertensive patients without or failed<br />

thrombolitic therapy all echocardiographic parameters<br />

<strong>of</strong> filling pressure mean values were higher than<br />

cut <strong>of</strong>f levels and than in hypertensive patients without<br />

LVH and with successful medical reperfusion. 2. The<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

highest mean values were found in hypertensive patients<br />

with LVH and without reperfusion, which theoretical<br />

had the highest values <strong>of</strong> left ventricle filling<br />

pressure.<br />

11. Alterarea vasodilatatiei<br />

mediate de flux la nivelul<br />

arterei brahiale la pacienti<br />

hipertensivi cu sindrom<br />

metabolic<br />

Simona Dragan, Corina Serban, Ruxandra Christodorescu,<br />

Maria Rada, Dana Velimirovici,<br />

Spitalul Clinic Municipal de Urgenta, Clinica de<br />

Cardio logie ASCAR, Timisoara<br />

Premize: Sindromul metabolic este o aglomerare de<br />

factori de risc interconectati care indica pacientii cu<br />

risc crescut de diabet zaharat de tip 2 si boala coronariana.<br />

Obiective. Scopul acestui studiu a fost compararea valorilor<br />

parametrilor antropometrici si ale vasodilatatiei<br />

mediate de flux la nivelul arterei brahiale la pacienti hipertensivi<br />

cu sindrom metabolic in functie de numarul<br />

de criterii ale NCEP ATP III prezente.<br />

Material si metoda: Au fost studiati 48 de pacienti<br />

cu sindrom metabolic 3.67 ani). Sindromul metabolic<br />

± (varsta medie 57 a fost definit conform criteriilor<br />

NCEP ATP III. Pacientii, cu caracteristici similare<br />

in ceea ce privește distributia pe sexe și varsta, au fost<br />

apoi impartiti in patru grupuri in functie de numarul<br />

de criterii ale NCEP ATP III indeplinite: 12 pacienti cu<br />

2, 11 pacienti cu 3, 13 pacienti cu 4 si 12 pacienti cu 5<br />

criterii NCEP ATP III indeplinite. Au fost determinate<br />

la toti participantii parametrii antropometrici: indicele<br />

de masa corporala (IMC), circumferinta abdominala<br />

(CA) si raportul talie-sold (WHR). Au fost efectuate<br />

studii ultrasonografice de inalta rezolutie pentru a<br />

masura raspunsurile endotelial-dependente [exprimate<br />

ca vasodilatatie-mediata de flux % (FMD)] ale arterei<br />

brahiale.<br />

Rezultate: A fost observata o relatie directa, semnificativa,<br />

gradata intre valorile parametrilor antropometrici<br />

si numarul de criterii NCEP ATP III prezente. Valorile<br />

medii ale IMC pentru cei cu 2, 3, 4, si 5 0.44,±0.52,<br />

32.55± 0.62, 30.75± 0.34, 27.85 ±criterii au fost: 25.66<br />

kg/m2, p < 0.001. Valorile medii ale CA pentru cei cu 2,


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

3, 4, si 5 1.7, cm, p±2.51, 119±6.96, 110± 7.40, 100±criterii<br />

au fost: 90 < 0.001. Valorile medii ale WHR pentru<br />

cei cu 2, 3, 4, si 5 criterii au 0.02, cm, p±0.02, 1.16±0.03,<br />

1.06± 0.03, 0.98±fost: 0.90 < 0.001. Studiu a relevat<br />

o relatie inversa, gradata, semnificativa intre valorile<br />

FMD si numarul de criterii NCEP prezente (valoarea<br />

medie a FMD 2.96%, 5±2.78%, 5.4±1.75%, 8.9±pentru<br />

cei cu 2, 3, 4, si 5 criterii: 8.49 2.77%, p± < 0.001).<br />

Concluzii: Evaluarea FMD la nivelul arterei brahiale<br />

este un instrument util pentru aprecierea gradului de<br />

afectare al functiei endoteliale la pacientii hipertensivi<br />

cu sindrom metabolic.<br />

Impairment <strong>of</strong> flow-mediated<br />

vasodilatation in the brachial<br />

artery in hypertensive patients<br />

with metabolic syndrome<br />

Background: The metabolic syndrome is an agglomeration<br />

<strong>of</strong> interrelated risk factors that identify patients<br />

at increased risk for type 2 diabetes mellitus (DM) and<br />

coronary artery disease.<br />

Purpose: The aim <strong>of</strong> this study was to compare the values<br />

<strong>of</strong> anthropometric parameters and the values <strong>of</strong><br />

brachial flow mediated vasodilatation in hypertensive<br />

patiens with metabolic syndrome in function <strong>of</strong> the<br />

number <strong>of</strong> NCEP ATP III criteria present in each patient.<br />

Material and method: The study included 48 hypertensive<br />

patients with 3.67 years). MS was defined ± metabolic<br />

syndrome (MS) (mean age 57 according to the<br />

National Cholesterol Education Program Adult Treatment<br />

Panel III guidelines. The patients were divided in<br />

four groups in function <strong>of</strong> the number <strong>of</strong> NCEP criteria<br />

present: 12 patients with 2, 11 patients with 3, 13 patients<br />

with 4, and 12 patients with 5 criteria <strong>of</strong> NCEP<br />

accomplished, age and sex matched. Anthropometric<br />

parameters: body mass index (BMI), waist circumference<br />

(WC) and waist-hip ratio (WHR) were determined<br />

for all participants. High-resolution brachial artery<br />

ultrasonographic studies were performed to assess endothelium-dependent<br />

[expressed as % flow-mediated<br />

dilatation (FMD)] responses.<br />

Results: A significant direct graded relationship was<br />

observed between the values <strong>of</strong> anthropometric parameters<br />

and the number <strong>of</strong> NCEP criteria present.<br />

POSTER FORUM I<br />

POSTER FORUM I<br />

Mean BMI values for those with 2, 3, 4, and 5 criteria<br />

were: 0.44, kg/m2, p±0.52, 32.55± 0.62, 30.75± 0.34,<br />

27.85 ±25.66 < 0.001 for trend. Mean WC values for<br />

those with 2, 3, 4, and 5 criteria were: 1.7, cm, p±2.51,<br />

119±6.96, 110± 7.40, 100±90 < 0.001 for trend. Mean<br />

0.03,±WHR values for those with 2, 3, 4, and 5 criteria<br />

were: 0.90 0.02, cm, p±0.02, 1.16±0.03, 1.06±0.98 <<br />

0.001 for trend. The study revealed a significant inverse<br />

graded relationship between the values <strong>of</strong> brachial<br />

FMD and the number <strong>of</strong> NCEP criteria present (mean<br />

FMD for ±2.96%, 5 ±2.78%, 5.4±1.75%, 8.9±those with<br />

2, 3, 4, and 5 criteria: 8.49 2.77%, p < 0.001 for trend).<br />

Conclusions: Evaluation <strong>of</strong> FMD in brachial artery is<br />

a usefull tool in assessing the grade <strong>of</strong> impairment <strong>of</strong><br />

endothelial function in hypertensive patients with metabolic<br />

syndrome.<br />

12. Mortalitatea pe termen<br />

scurt si mediu si unii factori<br />

predictivi la pacientii cu SICA<br />

(sindroame de insuficienta<br />

cardiaca acuta) in Sectia de<br />

Cardiologie a Sp. Clinic de<br />

Urgenta Sf. Pantelimon<br />

Liliana Protopopescu, V.A.Molfea, Lenuta Haiducu,<br />

Andreea Bjerkestrand, Oana Siminonescu,<br />

T.Protopopescu, M.M.Vintila<br />

Spitalul Clinic de Urgenta Sf. Pantelimon, Bucuresti<br />

Scopul lucrarii: Evaluarea mortalitatii si a factorilor<br />

predictivi de mortalitate pe termen scurt si mediu la<br />

pacientii cu SICA, in Clinica de Cardiologie a Sp. Clinic<br />

de Urgenta“ Sf. Pantelimon” Bucuresti.<br />

Material si metoda: S-au analizat 313 pacienti consecutivi,<br />

cu SICA, internati in Clinica de Cardiologie pe<br />

o perioada de 6 luni, la care s-a evaluat mortalitatea intraspitaliceasca,<br />

la 30 zile, 6 luni si un an de la externare<br />

si unii factori predictivi ai acesteia. S-au exclus cazurile<br />

la care nu s-au putut obtine date postexternare.<br />

Rezultate: Mortalitatea intraspitaliceasca a fost de<br />

13,74%, mortalitatea la 30 zile de 18,21%, de 24,92%<br />

la 6 luni si de 34,18 % la 1 an. Mortalitatea s-a corelat<br />

semnificativ cu valoarea TAs la internare, fiind maxima


POSTER FORUM I<br />

POSTER FORUM I<br />

in grupul cu TAs180 mmHg 3,33% in spital, 5,09%<br />

la 30 zile, 6,78% la 6 luni, 15,25% la 1 an (semnificative<br />

statistic comparativ cu grupul celor cu valori normale<br />

ale TAs la internare). Mortalitatea intraspitaliceasca<br />

cat si la 30 zile este crescuta la cei cu DZ tip II fata de<br />

cei fara DZ tip II (20% fata de 9,5% in spital-p=0,05,<br />

23,80% fata de 14% la 30 zile- p=0,05). Clearance-ul<br />

la creatinina (Cl cr) < 30 ml/min/1,73m2 (MDRD) se<br />

coreleaza semnificativ statistic cu mortalitatea in spital,<br />

la 30 zile, 6 luni si 1 an ( p=0,01 la toate corelatiile)<br />

comparativ cu cei cu Cl cr > 90 ml/min/1,73m2. Na la<br />

internare se coreleaza cu decesul in spital, la 30 zile, la<br />

6 luni si la 1 an; mortalitatea la cei cu Na>135 mmol/l<br />

este de 12,40% in spital, de 16,80% la 30 zile, 21,60%<br />

la 6 luni, 29,60% la 1 an fata de cei cu Na 135 mmol/l it reaches 12,40 %<br />

in the hospital, 16,8% at 30 days, 21,6% at 6 months<br />

and 29,60% at one year compared to those with Na<<br />

130 mmol/l in which mortality is 29.17% in the hospital<br />

(p=0,05), 33,33% at 30 days (p=0,05), 58,33% at 6<br />

months (p=0,01) and 75% at one year(p=0,01).<br />

Conclusions: Mortality in the hospital, at 30 days,<br />

6 months and one year after discharge was inversely<br />

correlated with the sBP value on admission and with<br />

the creatinine clearance. Mortality was correlated with<br />

marked hiponatremia (Na


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

13. Proiectul “Poti si tu salva o<br />

viata!” - Instruirea elevilor in<br />

masurile elementare de suport<br />

vital: perceptie si implicare<br />

A.Petris, G.Tatu-Chitoiu, Liliana Dohotariu, Adina<br />

Durbaca, A.Zanoschi, Irina Costache, Diana Cimpoesu<br />

Universitatea de Medicina si Farmacie “Gr. T. Popa” Iasi<br />

Intoducere: Initierea inca din scoala a instruirii in masurile<br />

elementare de suport vital (BLS) poate fi cea mai<br />

buna metoda de a dobandi deprinderile necesare unui<br />

bun resuscitator in cadrul unui mediu altruist care incurajeaza<br />

indeplinirea responsabilitatilor sociale.<br />

Obiectiv: Evaluarea cunostintelor legate de resuscitarea<br />

cardio-pulmonara in etape diferite de instruire scolara<br />

(proiectul “Poti si tu salva o viata!”).<br />

Metoda: Au fost analizate chestionarele si desenele<br />

(modalitate non-verbala de exprimare si comunicare)<br />

realizate de catre 110 elevi aflati in etape diferite de instruire<br />

(clasa a IV-a 56 subiecti, clasa a VIII-a 25 subiecti<br />

si clasa a IX-a 29 subiecti). Subiectii au completat<br />

chestionarele referitoare la experienta anterioara cu urgentele<br />

medicale, cunoasterea numarului de apel 112 si<br />

conduita corecta in cazul unui stop cardio-pulmonar.<br />

Dupa o scurta prezentare a etapelor BLS conform ECR,<br />

2005 (1. apropie-te in siguranta; 2. verifica raspunsul<br />

victimei; 3. striga dupa ajutor; 4. deschide caile aeriene;<br />

5. verifica respiratia; 6. suna la 112; 7. efectueaza cicluri<br />

de 30 de compresii toracice; 8. si doua ventilatii) si vizionarea<br />

unui videoclip cu dinamica BLS s-a solicitat<br />

subiectilor sa realizeze un desen care sa exprime principalele<br />

mesaje de transmis celor implicati in resuscitare.<br />

Rezultate: Procentul raspunsului complet la chestionar<br />

a fost de 98.2%, iar cel de realizare a desenelor de<br />

97.3%. S-a constatat ca 57.3% dintre subiecti au asistat<br />

deja la o urgenta medicala si ca 97.3% cunosc numarul<br />

corect al telefonului destinat urgentelor. Dintre<br />

cele opt elemente ale BLS subiectii au identificat corect<br />

etapa 6 (78.2%) si 3 (33.6%) in timp ce doar 0.9% au<br />

mentionat etapele 4 si 5. Desenele s-au referit la etapa 6<br />

(66.4%), urmata de etapa 1 (44.9%), etapa 3 (31.8%) si<br />

7 (25.2%). Principalele personaje prezente in desene au<br />

fost victima (79.4%), resuscitatorul (79.4%), telefonul<br />

de urgenta (51.4%) si ambulanta (16.8%). Atitudinea<br />

fata de RCP degajata de catre desen a fost optimista in<br />

41.1% din cazuri (majoritar la elevii clasei a IV-a, p <<br />

POSTER FORUM I<br />

POSTER FORUM I<br />

0.001), neutra (35.5% - majoritar la elevii clasei a IX-a,<br />

p< 0.001), de ingrijorare (15% din desene) sau pesimista<br />

(in 6.5% din cazuri).<br />

Concluzii: Exista in randul elevilor, indiferent de etapa<br />

de instruire, disponibilitatea de a invata/ aplica masurile<br />

BLS, dar cunostintele lor sunt inca fragmentare.<br />

“You can also save a life!”<br />

Project - Teaching basic life<br />

support in school: perception<br />

and involvement.<br />

Background: Starting the basic life support training in<br />

school would be the better way to obtain the suitable<br />

rescuer skills in an altruistic environment encouraging<br />

this social responsibility.<br />

Objective: To assess the differences between the perception<br />

and the reality in the school field (“You can also<br />

save a life!” Project).<br />

Methods: We analyzed the questionnaires and drawings<br />

(non-verbal means <strong>of</strong> expression and communication)<br />

completed by 110 school children in various stages <strong>of</strong><br />

training (class IV 56 subjects, class VIII 25 subjects and<br />

class IX 29 subjects). Subjects completed questionnaires<br />

on previous experience with medical emergencies, the<br />

emergency call number 112 and the correct behavior in<br />

the case <strong>of</strong> cardiopulmonary arrest. After a brief overview<br />

<strong>of</strong> BLS steps according to European Resuscitation<br />

Council, 2005 (1. approach safely; 2. check the victim<br />

response; 3. shout for help; 4. open airway; 5. check<br />

breathing; 6. call 112; 7. perform cycles <strong>of</strong> 30 chest<br />

compressions, 8. and two ventilation) and watching<br />

a video with dynamic BLS the subjects was asked to<br />

make a drawing that expresses the main messages sent<br />

to those involved in cardiopulmonary resuscitation.<br />

Results: The percentage <strong>of</strong> complete questionnaire<br />

response was 98.2% and the achievement <strong>of</strong> drawings<br />

97.3%. We found that 57.3% <strong>of</strong> subjects had already<br />

witnessed a medical emergency and that 97.3% know<br />

the correct emergencies phone number. Of the eight<br />

elements <strong>of</strong> BLS subjects correctly identified the steps<br />

6 (78.2%) and 3 (33.6%) while only 0.9% mentioned<br />

steps 4 and 5. The drawings were related to step 6<br />

(66.4%), followed by step 1 (44.9%), step 3 (31.8%) and<br />

7 (25.2%). The main characters shown in the drawing<br />

was the victim (79.4%), the rescuer (79.4%), the emer-


POSTER FORUM I<br />

POSTER FORUM I<br />

Right ventricle in obesity<br />

- a supine exercise<br />

echocardiographic and<br />

radionuclide study<br />

Obesity is a strong predictor <strong>of</strong> cardiovascular disease<br />

and is associated with subclinical left ventricular (LV)<br />

dysfunction. The right ventricular (RV) systolic and diastolic<br />

abnormalities in the obese subjects without cardiac<br />

symptoms are less well defined.<br />

The aim <strong>of</strong> the study was to evaluate RV function at rest<br />

and during exercise by means <strong>of</strong> supine exercise echocardiography<br />

(SEE) and gated blood pool radionuclide<br />

ventriculography (GBPRV) in subjects with isolated<br />

obesity.<br />

Methods: 81 subjects <strong>of</strong> either gender (mean age 39.1±<br />

4.3 years) with a body mass index (BMI) > 30 Kg/m2,<br />

who were free <strong>of</strong> hypertension, diabetes, dyslipidemia<br />

and organic heart disease, were included in the study.<br />

All subjects underwent a complete clinical, rest echocardiography<br />

and SEE examination and rest and exercise<br />

GBPRV. RV end-diastolic and end-systolic volumes<br />

(EDV, ESV), stroke volume (SV), ejection fraction<br />

(EF), and peak filling rate (PFR) were measured at rest<br />

and during exercise and contractile reserve and diastolic<br />

function <strong>of</strong> RV were determined. The subjects were<br />

divided into three groups according to BMI (Group 1<br />

with BMI 30-34.9 kg/m2, group 2 with BMI 35-39.9 kg/<br />

m2, group 3 with BMI ≥40 kg/m2).<br />

Results: The mean BMI was 36.48 ± 4.05 kg/m2. In the<br />

pooled subject population we found significant correlagency<br />

phone (51.4%) and the ambulance (16.8%). The<br />

attitude toward CPR released from the drawing was<br />

optimistic in 41.1% cases (mostly from the children <strong>of</strong><br />

class IV, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

tions between BMI and most <strong>of</strong> the evaluated parameters.<br />

The following are the means, standard deviations<br />

and correlations with BMI: SV (86.25±12.01 ml/beat,<br />

r=-0.326, p=0.003), PFR (3.05±0.73 EDV/s, r=-0.335,<br />

p=0.003), EFRV (57.5±7.3%, r=-0.335, p=0.002). From<br />

rest to peak exercise, SV increased with 20.81 ± 4.52<br />

%, EFRV with 19.7 ±3.45 %, PFR with 18.46 ± 2.65%.<br />

At the ANOVA post-hoc analysis <strong>of</strong> the 3 groups, SV,<br />

EFRV and PFR variations were significantly different<br />

in group 3 compared with groups 1 and 2 (p=0.001,<br />

0.0001 and 0.001 respectively)<br />

Conclusions: The contractile right ventricular reserve<br />

and diastolic function at exercise may be impaired in<br />

otherwise healthy subjects with extreme obesity.<br />

15. Compararea parametrilor<br />

de rigiditate arteriala in<br />

identificarea pacientilor cu<br />

sindrom metabolic (SM)<br />

Angela Cozma, Adela Sitar-Taut, Dana Pop, Mirela<br />

Cebanu, D.Zdrenghea<br />

Universitatea de Medicina si Farmacie “Iuliu Hatieganu”,<br />

Cluj-Napoca<br />

Ipoteze: prezenta SM se asociaza cu cresterea riscului<br />

cardiovascular, reprezentand o cauza comuna de dezvoltare<br />

a leziunilor aterosclerotice vasculare. Rigiditatea<br />

arteriala este influentata de stadiile aterosclerozei.<br />

Scopul studiului: evaluarea capacitatii parametrilor<br />

de rigiditate arteriala (augmentation index, pulse wave<br />

velocity, systolic area index, diastolic area index) de<br />

a identifica pacientii cu SM, prin compararea cu diagnosticul<br />

standard al sindromului metabolic.<br />

Metoda: au fost evaluati 100 pacienti (78 femei, 22 barbati),<br />

varsta medie 57.71±9.51, 68% cu SM. Nici unul<br />

dintre pacienti nu prezenta boli cardiovasculare. Ca si<br />

factori de risc cardiovasculari au fost evaluati greutatea<br />

corporala, fumatul, diabetul zaharat, hipertensiunea<br />

arteriala si dislipidemia (definita ca si colesterol total<br />

>200 mg/dl sau trigliceride serice >150 mg/dl sau tratament<br />

anterior hipolipemiant). Rigiditatea arteriala a<br />

fost evaluata utilizand TensioMedTMArteriograph. Au<br />

fost decelate valorile cutt <strong>of</strong>f, valoarea optima a sensibilitatii,<br />

a specificitatii si AUROC. Clasificarea SM s-a<br />

facut pe baza definitiei IDF.<br />

POSTER FORUM I<br />

POSTER FORUM I<br />

Rezultate: nu au fost decelate diferente semnificative<br />

intre pacientii cu si fara SM referitor la prezenta fumatului<br />

(16.2% vs 28.1%), a dislipidemiei (73.5% vs<br />

71.9%), dar au fost decelate in ceea ce priveste hipertensiunea<br />

(73.5% vs 37.5%, p=0.001), diabetul zaharat<br />

(26.5% vs 0%, p=0.001) sau obezitatea (44.1% vs 18.8%,<br />

p=0.015). Nu au existat diferente semnificative intre<br />

pacientii cu si fara SM referitor la parametrii de rigiditate<br />

arteriala: AixAo (38.03±14.07 vs 40.47±13.79),<br />

PWVao (11.84±14.34 vs 9.66±2.12), SAI (49.82±5.38 vs<br />

48.74±8.49) for DAI (50.3±5.49 vs 51.24±8.49). Ariile<br />

de sub curba determinate au fost 0.55 pentru AixAo,<br />

0.591 pentru PWVAo, 0.607 pentru SAI, 0.598 pentru<br />

DAI. Valorile cut <strong>of</strong>f cu sensibilitate si specificitate optime<br />

(derivand din curbele ROC) au fost: AixAo 20.5<br />

(sensibilitate 19.7%, specificitate 96.9%), PWVAo 8.1<br />

(sensibilitate 89.4%, specificitate 31.2%), SAI 49.1 (sensibilitate<br />

53.8%, specificitate 74.2%)si DAI 50.8 (sensibilitate<br />

52.3%, specificitate 74.2%).<br />

Concluzie: desi rigiditatea arteriala se afla sub influenta<br />

unor factori care nu sunt pe deplin explicati, AixAo<br />

pare sa aiba cea mai buna specificitate si PWVAo cea<br />

mai buna sensibilitate in identificarea pacientilor cu<br />

SM. Grant CNCSIS ID_2246/2009<br />

A comparison between<br />

arterial stiffness parameters<br />

in identifying metabolic<br />

syndrome (MetS) patients<br />

Background: Presence <strong>of</strong> MetS is associated with increased<br />

cardiovascular risk, being a common cause <strong>of</strong><br />

the development <strong>of</strong> atherosclerotic vascular disease.<br />

Arterial stiffness is related to the arteriosclerosis’s stages.<br />

Purpose: To evaluate the capacity <strong>of</strong> arterial stiffness<br />

parameters (augmentation index, pulse wave velocity,<br />

systolic area index, diastolic area index) to identify<br />

MetS patients, comparing with a standard diagnosis <strong>of</strong><br />

MetS.<br />

Methods: we examined 100 patients (78 women, 22<br />

men), mean age 57.71 ± 9.51 years, 68% presenting<br />

MetS. None <strong>of</strong> the patients presented cardiovascular<br />

diseases. As risk factors have been assessed the body<br />

weight, smoking status, diabetes, hypertension and<br />

dyslipidaemia (defined as total cholesterol>200 mg/dl


POSTER FORUM I<br />

POSTER FORUM I<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

or serum triglycerides > 150 mg/dl or treatment with<br />

hypolipidemic drugs). Arterial stiffness was measured<br />

using TensioMedTMArteriograph. Cut <strong>of</strong>f values, optimum<br />

sensitivity, specificity and area under the receiver<br />

operating characteristic (ROC) curve were evaluated.<br />

Classification <strong>of</strong> the MetS was based on the IDF guidelines.<br />

Results: No significant differences were registered<br />

between patients with vs without MetS regarding the<br />

presence <strong>of</strong> smoking (16.2% vs 28.1%), dyslipidaemia<br />

(73.5% vs 71.9%), but were found out in relationship<br />

with hypertension (73.5% vs 37.5%, p=0.001), diabetes<br />

(26.5% vs 0%, p=0.001) and obesity (44.1% vs<br />

18.8%, p=0.015). There were no significant differences<br />

registered regarding arterial stiffness parameters’ values<br />

between patients with and without MetS: AixAo<br />

(38.03±14.07 vs 40.47±13.79), PWVAo (11.84±14.34<br />

vs 9.66±2.12), SAI (49.82±5.38 vs 48.74±8.49) for DAI<br />

(50.3±5.49 vs 51.24±8.49). Determined areas under the<br />

ROC curve were as follows: 0.55 for AixAo, 0.591 for<br />

PwVao, 0.607 for SAI and 0.598 for DAI. Diagnostic<br />

cut <strong>of</strong>f levels with the optimum sensitivity and specificity<br />

derived from the ROC curve were found to be<br />

for AixAo 20.5 (sensitivity 19.7%, specificity 96.9%),<br />

PWVAo 8.1 (sensitivity 89.4%, specificity 31.2%), SAI<br />

49.1 (sensitivity 53.8%, specificity 74.2%) and DAI 50.8<br />

(sensitivity 52.3%, specificity 74.2%).<br />

Conclusion: Although, arterial stiffness parameters are<br />

under the influence <strong>of</strong> some factors that are not fully<br />

explained, AixAo seems to have the best specificity and<br />

PWVAo the best sensibility in identifying MetS patients.<br />

Funding NURC ID_2246/2009


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

POSTER I | POSTER I<br />

16. Electrocardiografia versus<br />

ecocardiografie in diagnosticul<br />

hipertr<strong>of</strong>iei ventriculare stangi:<br />

expresia gradului sau a tipului<br />

hipertr<strong>of</strong>iei<br />

F.Matei, Cristiana Carmen Beladan, Andreea Calin,<br />

Monica Rosca, B.A.Popescu, Denisa Muraru, Roxana<br />

Enache, Fabiana Curea, C.Sandu, Carmen Ginghina<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Premise. Hipertr<strong>of</strong>ia ventriculara stanga (HVS) este un<br />

factor independent de risc cardiovascular. Electrocardiografia<br />

(ECG) si ecocardiografia sunt recomandate<br />

in practica pentru diagnosticul HVS. Cu toate acestea,<br />

exista adesea discrepante intre masa VS estimata ecocardiografic<br />

si expresia ECG a HVS.<br />

Obiectiv. Evaluarea capacitatii ECG de detectare a HVS<br />

comparativ cu datele obtinute prin ecocardiografie la<br />

pacienti (pct) cu hipertensiune arteriala (HTA), stenoza<br />

aortica (SA) si cardiomiopatie hipertr<strong>of</strong>ica (CMH).<br />

Metoda: S-au inrolat pct cu fractie de ejectie VS prezervata<br />

(>50%) si masa VS comparabila, evaluata ecocardiografic:<br />

20 de pct cu HTA izolata (60±9 ani, 7 barbati),<br />

20 de pct cu SA severa (65±9 ani, 12 barbati) si<br />

20 de pct cu CMH simetrica (57±12 ani, 11 barbati).<br />

Toti pct au fost investigati prin ECG standard in 12<br />

derivatii si ecocardiografie. S-au urmarit urmatoarele<br />

criterii ECG pentru HVS: indicii Sokolow-Lyon, Cornell<br />

produs si voltaj, scorurile Romhilt-Estes si Perugia.<br />

Au fost masurate ecocardiografic velocitatile anulare<br />

mitrale longitudinale (Sseptal si Slateral) si strain-ul<br />

global longitudinal (SGL) VS (cuantificat prin tehnica<br />

speckle tracking).<br />

Rezultate: Nu s-au observat diferente semnificative<br />

intre loturile studiate in ceea ce priveste varsta, sexul,<br />

indicele de suprafata corporala sau indicele de masa<br />

VS (147±56g/m2, 157±21g/m2, 176±46g/m2, p=0.09).<br />

Numarul pct cu criterii ECG de HVS (HTA vs SA vs<br />

CMH) a fost: indice Sokolow-Lyon (4 vs 12 vs 11), indice<br />

Cornell voltaj (1 vs 4 vs 9), indice Cornell produs<br />

(2 vs 6 vs 8), scor Romhilt-Estes (1 vs 10 vs 11), scor<br />

Perugia (4 vs 14 vs 14). La pct cu SA si CMH prevalenta<br />

HVS estimata prin indicii Sokolow-Lyon, Cornell produs,<br />

Romhilt-Estes si Perugia, a fost similara (p>0.6). S<br />

septal, S lateral si SGL au fost similare intre pct cu SA si<br />

CMH (p>0.05) si reduse comparativ cu pct hipertensivi<br />

(p50%) and a similar extent <strong>of</strong> LVH<br />

as assessed by echocardiography: 20 pts with isolated<br />

HTN (60±9 yr, 7 men), 20 pts with severe AS (65±9 yr,


POSTER I<br />

POSTER I<br />

12 men) and 20 pts with symmetric HCM (57±12 yr,<br />

11 men). Standard 12-lead ECG and a comprehensive<br />

2D echocardiography were performed in all. We tested<br />

the following ECG criteria for LVH: Sokolow-Lyon<br />

index, Cornell voltage and product indexes, Romhilt-<br />

Estes and Perugia scores. Mitral annular longitudinal<br />

velocities (Sseptal and Slateral) and global longitudinal<br />

LV strain (GLS) were assessed from apical views by tissue<br />

Doppler and by speckle tracking echocardiography<br />

respectively.<br />

Results: There were no significant differences between<br />

HTN, SA and HCM pts regarding age, gender, body<br />

surface area or LVM index (147±56g/m2, 157±21g/m2,<br />

176±46g/m2, p=0.089). Presence <strong>of</strong> LVH criteria on<br />

ECG in HTN vs AS vs HCM pts was as follows: Sokolow-Lyon<br />

index (4 vs 12 vs 11), Cornell voltage (1 vs 4<br />

vs 9), Cornell product (2 vs 6 vs 8), Romhilt-Estes (1<br />

vs 10 vs 11), Perugia score (4 vs 14 vs 14). Sseptal, Slateral<br />

and GLS were similar between AS and HCM pts<br />

(p>0.05) and lower as compared to HTN pts (p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

mina reducerea torsiunii si twistului VS, in timp ce VSε<br />

este aparent neinfluentat.<br />

POSTER I<br />

POSTER I<br />

LBBB, LV torsion and LV twist are significantly decreased,<br />

while LV strain is apparently not influenced.<br />

The influence <strong>of</strong> left bundle<br />

branch-block on speckle<br />

tracking parameters in patients<br />

with heart failure with reduced<br />

ejection fraction<br />

Background: Left ventricular (LV) torsion and global<br />

longitudinal strain (LV strain) are essential components<br />

<strong>of</strong> LV performance. Left bundle branch-block<br />

(LBBB) in patients with or without heart failure can reduce<br />

global LV ejection fraction (LVEF) and decrease<br />

cardiac output.<br />

Aim: To evaluate the influence <strong>of</strong> LBBB on 2D-strain<br />

parameters in patients with systolic left ventricular dysfunction.<br />

Methods: Standard echocardiogram was performed in<br />

113 consecutive patients with HF, in sinusal rhythm.<br />

The parasternal apical and basal short-axis planes<br />

were recorded. LV strain, LV twists (the net difference<br />

between rotation angles at base and apex) and LV torsion<br />

(LV twist normalized for LV diastolic longitudinal<br />

length) were measured by 2D-strain imaging. Patients<br />

were divided into three groups: group 1 including 35<br />

patients with HF with normal LVEF (>/= 50%), group<br />

2 including 47 patients with HF with reduced LVEF without<br />

LBBB, and group 3 including 31 patients with HF<br />

with reduced LVEF and LBBB.<br />

Results: LVEF, LV strain, LVtorsion and LV twist were<br />

significantly different in group 1 compared to group<br />

2 and 3 (LVEF: 58.2±5.8%, 34.5±8.1% and 30.1±9.0%<br />

respectively; LV strain: -14.3±3.4%, -6.2±1.8% and<br />

-4.8±2.4% respectively; LV twist: 13.5±4.1°, 8.4±1.6°<br />

and 4.9±2.8° respectively; LV torsion: 2.02±0.68°/cm,<br />

1.22±0.23°/cm and 0.76±0.46°/cm respectively). In<br />

patients with LBBB and reduced LVEF (group 3), LV<br />

torsion and LV twist were significantly lower compared<br />

to group 2 (0.76±0.46 versus 1.22±0.23°/cm, p=0.01,<br />

and 4.9±2.8 vs 8.4±1.6°, p=0.02, respectively), but LV<br />

strain and LVEF were not different between group 3<br />

and 2 (-4.8±2.4 vs -6.2±1.8%, p=0.08, and 30.1±9 vs<br />

34.5±8.1%, p=0.43, respectively).<br />

Conclusions: This preliminary study indicates that in<br />

patients with HF with reduced LVEF, in the presence <strong>of</strong><br />

18. Evolutia mortalitatii pe<br />

termen scurt la pacientii<br />

diabetici care dezvolta un<br />

infarct miocardic acut cu<br />

supradenivelare de segment ST:<br />

studiu comparativ pe timp de<br />

10 ani a pacientilor internati<br />

intr-un spital fara facilitati de<br />

reperfuzie interventionala<br />

C.F.Pop, Lavinia Pop, Mihaela Roman, Daniela Dicu,<br />

Delia Dan<br />

Universitatea "Vasile Goldis", Spitalul Judetean de<br />

Urgenta Arad<br />

Introducere: Cresterea mortalitatii in prezenta diabetului<br />

zaharat (DZ) la pacientii care dezvolta infarct miocardic<br />

acut este cunoscuta, dar persista controversele<br />

privind principalele cauze ale acestui prognostic agravat<br />

Obiective: Compararea mortalitatii pe termen scurt la<br />

pacientii cu sau fara DZ care dezvolta un infarct miocardic<br />

acut cu supradenivelare de segment ST (STEMI)<br />

si identificarea factorilor care contribuie la agravarea<br />

prognosticului.<br />

Metoda: In perioada 1.01.2000 -31.12.2009, un numar<br />

de 1335 pacienti cu STEMI au fost internati in unitatea<br />

de terapie intensiva coronarieni a Spitalului Judetean<br />

de Urgenta din Baia Mare. Dintre acestia 660 nu au beneficiat<br />

de fibrinoliza, din care 142 (21.51%) prezentau<br />

DZ, iar 675 au fost fibrinolizati, din care 136 (22.14%)<br />

prezentau DZ. Eficacitatea fibrinolizei a fost evaluata<br />

prin 2 criterii neinvazive: 1) Disparitia rapida a durerii<br />

constrictive toracice 2) Reducerea supradenivelarii de<br />

segement ST cu mai mult de 50% la 180 minute de la<br />

debutul fibrinolizei. Toti pacientii au primit in absenta<br />

contraindicatiilor medicatie betablocanta, inhibitori ai<br />

enzimei de conversie a angiotensinei, statine si anticoagulante<br />

(heparina solubila -1000 i.u./ora, 48-96 ore, sau


POSTER I<br />

POSTER I<br />

enoxaparin-1 mg/kg la12 ore pentru 8-10 zile) asociate<br />

cu aspirina 150-300 mg./zi sau aspirina si clopidogrel<br />

(doza de incarcare 300 mg. urmata de 75 mg/zi).<br />

Rezultate: Cei 257 (20.82%) pacienti cu DZ inrolati in<br />

studiu erau mai varstnici, mai frecvent de sex feminin<br />

si au prezentat semnificativ mai multe comorbiditati si<br />

factori de risc cardiovasculari. Mortalitatea la 30 de zile<br />

a fost de 19.43% la pacientii cu DZ si de 14.39% la cei<br />

fara DZ (p=0.002). Mortalitatea a fost semnificativ mai<br />

mica, de 11.38% la cei 539 pacienti fara DZ care au fost<br />

fibrinolizati, in comparatie cu cea de 16.52% inregistrata<br />

la cei 136 pacienti cu DZ si fibrinoliza (p=0.01) si cu<br />

cea de 21.49% observata la cei 142 pacienti cu DZ fara<br />

fibrinoliza (p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

19. Determinismul variabilitãtii<br />

frecventei cardiace asupra<br />

bolilor cardiovasculare la<br />

pacientii obezi<br />

F.Mitu, D.Ilisei, Maria Leon, Corina Dima<br />

Spitalul Clinic de Recuperare, Iasi<br />

Scopul lucrarii. Impactul frecventei cardiace ca factor<br />

de predicție independent in apariția și evoluția bolilor<br />

cardiovasculare rãmane un subiect de actualitate. Asocierea<br />

acestui factor de risc la pacientii obezi creste exponential<br />

riscul de aparitie al bolilor cardiovasculare.<br />

Studiul nostru si-a propus sã demonstreze corelatia dintre<br />

frecventa cardiacã si dezvoltarea comorbiditãtilor la<br />

pacietii obezi.<br />

Material și metoda: Studiul retrospectiv a cuprins un<br />

numar de 1463 pacienți, internați in Spitalul Clinic de<br />

Recuperare Iași, Secția Recuperare Cardiovasculara, in<br />

perioada 01.01.2009-31.12.2009. Din lotul investigat,<br />

752 (51.40%) pacienți au indeplinit criteriile de includere.<br />

Rezultate și discuții: Pentru fiecare pacient s-a stabilit<br />

frecvența cardiaca in condiții de repaus, existența<br />

factorilor de risc asociați precum fumatul, mediul de<br />

proveniența, sexul, varsta. In repaus, exista o relație<br />

direct proporționala intre greutatea pacientului și<br />

frecvența cardiaca. In grupul de varsta 50-69 ani, am<br />

inregistrat o pondere semnificativ crescuta a pacienților<br />

cu obezitate grad III (44.35%) și frecvența cardiaca<br />

crescuta (31.45%) comparativ cu celelalte grupe de<br />

varsta (ANOVA, p=0,03). Sexul masculin (41.29%)<br />

prezinta o frecvența cardiaca crescuta fața de sexul feminin<br />

(4.57%) (student T test, p=0,002). Mediul urban<br />

reprezinta un alt factor de risc, frecvența cardiaca fiind<br />

crescuta la acești pacienți (61.45% fața de 43.81%) (student<br />

T test, p=0,04).<br />

Concluzii: Frecvența cardiaca este un important factor<br />

de risc pentru morbiditatea și mortalitatea cardiovasculara.<br />

Analiza statistica coreleaza valorile crescute<br />

ale frecvenței cardiace cu impactul și severitatea<br />

afecțiunilor cardiovasculare.<br />

POSTER I<br />

POSTER I<br />

The importance <strong>of</strong> variability<br />

<strong>of</strong> the cardiac frequence over<br />

cardiovascular diseases in<br />

obeses patients<br />

Background: The importance <strong>of</strong> variability <strong>of</strong> the cardiac<br />

frequence as a predictor factor in the appearance<br />

and evolution <strong>of</strong> cardiovascular disease is still a subject<br />

to be debated. The association <strong>of</strong> this risc factor in obese<br />

patient raises the risc <strong>of</strong> cardiovascular disease.<br />

The purpose <strong>of</strong> our study is to demonstrate the correlation<br />

between the cardiac frequence and the development<br />

<strong>of</strong> the comorbidities to the obese patients.<br />

Methods: The retrospective study enrolled 1463 patients,<br />

from the Rehabilitation Hospital Iasi, The Cardiovascular<br />

Rehabilitation Department, between<br />

01.01.2009-31.12.2009. 51.40% (752 patients) has the<br />

inclusion criterias.<br />

Results: For each patient, we establish the cardiac<br />

frequence at rest, the existence <strong>of</strong> risk factors associated<br />

like smoking, provenience, sex, and age. At rest, there<br />

is a direct correlation between the BMI and cardiac<br />

frequence. In the age group 50-69, ther is a high procent<br />

<strong>of</strong> obese patients (41.35%) and cardiac frequence over<br />

70 (31.45%) (ANOVA, P=0.03). Male gender (41.29%)<br />

has a cardiac frequence higher than woman (4.57%)<br />

(student T test, p=0,002). The urban area is another risk<br />

factor, the cardiac frequence being higher at these patients<br />

(61.45% fata de 43.81%) (student T test, p=0,04).<br />

Conclusions: The cardiac frequence is an important<br />

risk factor for cardiovascular morbidity and mortality.<br />

Statistical analyses establish a correlation between the<br />

high values <strong>of</strong> cardiac frequence and the impact and<br />

severity <strong>of</strong> cardiovascular diseases.<br />

20. Corelatii anatomo-clinice in<br />

trombembolism pulmonar acut<br />

D.P.Petcu, O. Toni<br />

Centrul de Cardiologie, Craiova<br />

Introducere. Incidenta trombembolismului pulmonar<br />

acut (TEPA) este mare.Manifestarile clinice TEPA sunt<br />

diverse. Este o discordanta intre semnele clinice, ECG,<br />

ecocardiografice radiologice si angiografice. Diagnos-


POSTER I<br />

POSTER I<br />

ticul pozitiv este dificil.Concentratia plasmatica a D-<br />

Dimerului peste 500 ng/mL are valoare diagnostica in<br />

contextul clinic si paraclinic.<br />

Scopul lucrarii Studiul prospectiv al bolnaviilor cu<br />

TEPA si corelatii anatomo-clinice in scopul confirmarii<br />

diagnosticului.<br />

Materiale si metoda: Au fost studiati 45 de pacienti,<br />

33 de femei si 12 barbati, internati in Centrul de Cardiologie<br />

Craiova in perioada 1.01.2009-1.01.2010 cu<br />

diagnosticul de TEPA.Parametrii analizati :anamneza,<br />

examenul obiectiv, electrocardiograma, ecografia transtoracica,<br />

examenul doppler venos, CT torace, scintigrama<br />

pulmonara, angiografie pulmonara,valoarea<br />

D-Dimerilor si evolutia pacientilor, examenul anatomopatologic(<br />

la pacientii decedati in spital) si confruntarea<br />

cu datele clinice.<br />

Rezultate: Din lotul de 45 bolnavi studiati, 34 de bolnavi<br />

au avut evolutie favorabila. Necropsia a fost efectuata<br />

la 11 pacienti. Confirmarea anatomopatologica<br />

a diag de TEP s-a realizat la 7 cazuri. Diagnosticul de<br />

TEP nu a fost confirmat anatomopatologic la 4 cazuti .<br />

La 2 bolnavi diagnosticul a fost de IM posterior, un caz<br />

diagnosticul de IM anterolateral si un caz diagnosticul<br />

de pancreatita acuta.<br />

Discutii. Anamneza prin supraevaluarea factorilor favorizanti<br />

duce la un exces de diagnostic clinic. Trombozele<br />

venoase pr<strong>of</strong>unde de la nivelul membrelor inferioare<br />

sunt relevante in anamneza tintita. Ecocardiografia<br />

transtoracica releva : raport VD/ VS >1, aplatizarea<br />

septului interventricular, gradient de presiune VD-AD<br />

> 50 mmHg, timpul de accelerare al velocitatii fluxului<br />

pulmonar, diametrul expirator al venei cave inferioare<br />

500 ng/mL are sensibilitate<br />

inalta dar specificitate scazuta. Scintigrafia pulmonara<br />

de perfuze, CT torace, RMN si angiografia pulmonara<br />

maresc acuratetea diagnosticului<br />

Concluzii: Coroborarea datelor clinice, ecocardiografice<br />

si doppler venos a prezis diagnosticul pozitiv de<br />

TEPA la un procent de 84,4%.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Anatomopathological and<br />

clinical correlations in Acute<br />

Pulmonary Thromboembolism<br />

Introduction. APTE has a high incidence and various<br />

clinical manifestation.There is an inconsistency between<br />

clinical findings, EKG, Heart ultrasound, radiology<br />

and angiography in APTE.Positive diagnosis is difficult.<br />

D-dimer plasma levels over 500ng/dl has diagnose<br />

value in clinical and paraclinical context.<br />

Purpose. Prospective study <strong>of</strong> patients with APTE and<br />

anatomopathological and clinical correlations in order<br />

to determine the causes which can generate diagnosis<br />

errors.<br />

Methods and materials: 45 patients have been studied,<br />

33 women an 12 men, admitted in <strong>Cardiology</strong> Center<br />

<strong>of</strong> Craiova between 1.01.2009-1.01.2010 with APTE<br />

diagnosis.Parameters which were analized: history,<br />

clinical exam, EKG, Transthoracic ultrasound, venous<br />

doppler, Chest CT, lung scintigraphy, pulmonary angiography,<br />

D-dimer levels and patient evolution, anatompathology<br />

examination (for patients deceased while<br />

admitted) and confrontation with clinical data.<br />

Results: 34 patients from the group <strong>of</strong> 45 who were<br />

studied had a favorable evolution.Necropsy was performed<br />

on 11 patients.PTE diagnosis was not anatomopathologically<br />

confirmed in 4 cases. In 2 cases the<br />

diagnosis was posterior myocardial infarction, 1 case<br />

had anterolateral myocardial infarction and 1 case had<br />

acute pancreatitis. Discussion. History taken by overrating<br />

risk factors is usually leading to excesive clinical<br />

diagnosis. Deep venous thrombosis <strong>of</strong> the legs is relevant<br />

in targeted history. Transthoracic heart ultrasound<br />

reveals: VD/VS>1, Interventricular septum flattening,<br />

pressure gradient VD-AD >50 mm Hg, acceleration<br />

time <strong>of</strong> pulmonary flow velocity, expiratory diameter<br />

<strong>of</strong> inferior vena cava 500 ng/mL has high sensitivity but low specificity.<br />

Lung perfusion scintigraphy, Chest CT, MRI and<br />

pulmonary angiography are improving diagnosis acurracy.<br />

Conclusion: Corroboration <strong>of</strong> clinical, heart ultrasound<br />

and venous doppler predicted positive diagnosis<br />

<strong>of</strong> APTE in 84,4%. Differential diagnose with anterolateral<br />

and posterior myocardial infarction and acute<br />

pancreatitis.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

21. Aspecte chirurgicale in<br />

patologia aterosclerotica cu<br />

localizare multipla<br />

M.E. Patrut, R. Vasilescu, V. Pop, E. Rachita, Cristina<br />

Voinea, D. Arhire, Nicoleta Arhire, Mirela Coroescu,<br />

V. Barbulescu, E. Oclei, V. Ispas, Olimpia Manta, I.<br />

Burlacu, D. Ramazan, V. Leica<br />

Spitalul Clinic Judetean de Urgenta, Constanta<br />

Introducere: Cea mai raspandita afectiune din grupul<br />

bolilor aterosclerotice, intereseaza arterele mari si medii<br />

de tip elastic si muscular si se caracterizeaza prin<br />

depunerea focala, diseminata, de diverse lipide, hidrocarbonate,<br />

componente sanguine, tesut fibros si calciu<br />

in intima arterelor, care isi pierd elasticitatea si isi ingusteaza<br />

lumenul. Boala aterosclerotica cu localizare<br />

multipla pune mai multe probleme, printre care ar fi<br />

diagnosticul corect, indicatia chirurgicala, ordinea rezolvarii<br />

leziunilor, managementul postoperator, urmarirea<br />

la distanta.<br />

Material si metoda: Lotul luat in studiu este reprezentat<br />

de 463 de pacienti operati pentru o patologie aterosclerotica<br />

cu localizare multipla, in perioada noiembrie2008<br />

- aprile 2010.<br />

Rezultate: S-au realizat un numar de 212 interventii la<br />

nivelul membrelor pelvine,16 au avut ca tinta membrele<br />

superioare, 93 de interventii au fost la nivelul carotidelor,<br />

140 au fost by-pass-uri aorto-coronariene si<br />

2 la nivelul arterelor renale, cu mentiunea ca afectarea<br />

arteriala a cuprins unul sau mai multe sectoare vasculare<br />

pentru care s-a intervenit chirurgical per primam<br />

sau temporizat.<br />

Concluzii: Cele mai frecvente asocieri de localizare a<br />

bolii aterosclerotice au fost existenta simultana a bolii<br />

aterosclerotice la nivelul membrelor pelvine si a arterelor<br />

coronare, urmata de asocierea carotide – boala<br />

coronariana aterosclerotica.<br />

POSTER I<br />

POSTER I<br />

22. Reducerea mortalitatii<br />

prin infarct miocardic acut in<br />

cadrul registrului regional de<br />

sindroame coronariene acute –<br />

rezultate la 5 ani<br />

I.Benedek, Monica Chitu, I.Kovacs, P.A.Sarbu, Claudia<br />

Matei, Diana Horga, Zsuzsanna Suciu, Teodora<br />

Benedek<br />

Universitatea de Medicina si Farmacie, Targu Mures<br />

Scop: S-a urmarit pe parcursul a 5 ani evolutia mortalitatii<br />

prin infarct miocardic acut (IMA) intr-un teritoriu<br />

cu aderenta scazuta la ghidurile europene, aferent unei<br />

populatii de 1 milion locuitori, perioada in care toate<br />

cazurile de sindrom coronarian acut inregistrate in<br />

acest teritoriu au fost incluse intr-un Registru Regional<br />

de Sindroame Coronariene Acute.<br />

Material si metoda: Registrul a inclus 13 spitale, avand<br />

cel mai apropiat centru interventional la o distanta de<br />

maxim 200 km. Au fost colectate si procesate datele a<br />

3,990 pacienti, din care 1.841 cu IMA cu supradenivelare<br />

ST si 2.149 cu angina instabila / IMA nonST. Loturi<br />

de bolnavi: gr. 1 – 1411 pacienti cu IMA cu supradenivelare<br />

ST tratati in spitalele teritoriale, fara posibilitati<br />

de PCI, gr. 2 – 430 pacienti cu IMA trimisi direct centrului<br />

interventional.<br />

Rezultate: La grupa 1 procentul terapiei de reperfuzie<br />

(PTCA per primam + tromboliza) a fost de 11.28% in<br />

2004 crescand pana la 27.43% in 2009. In gr. 2 terapia<br />

de reperfuzie a fost posibila in 99.39% dintre cazuri,<br />

constand in PTCA primara in 76.96% cazuri, PTCA<br />

facilitata in 15.75% cazuri si tromboliza sistemica in<br />

6.6% cazuri. Ratele mortalitatii au scazut progresiv, de<br />

la 20.77% in 2004 la 11.9% in 2009, corelate cu cresterea<br />

numarului de cazuri care au beneficiat de terapie de<br />

reperfuzie (p=0.001). In gr. 2 mortalitatea globala a fost<br />

de 6.6% pentru pacientii ajunsi in timp util pentru repermeabilizare,<br />

comparativ cu 17.65% pentru pacientii<br />

cu prezentare tardiva (>12 ore) (p


POSTER I<br />

POSTER I<br />

scaderea mortalitatii. Cercetare finantata prin grantul<br />

de cercetare CEEX nr 171/2006-LOGECA<br />

Mortality reduction in acute<br />

myocardial infarction in a<br />

regional network <strong>of</strong> acute<br />

coronary syndromes-5 years<br />

results<br />

Purpose: We followed over five years the evolution <strong>of</strong><br />

mortality by acute myocardial infarction (AMI) in an<br />

area with low adherence to European guidelines, for a<br />

population <strong>of</strong> 1 million inhabitants, during this time<br />

all cases recorded was included in Regional Registry <strong>of</strong><br />

ACS in Romania.<br />

Material and method: The register included 13 hospitals,<br />

with the nearest Interventional center at a maximum<br />

distance <strong>of</strong> 200 km. Data was collected and<br />

processed from 3990 patients, <strong>of</strong> which 1841 with AMI<br />

with ST elevation and 2149 with unstable angina /non-<br />

STEMI. Groups <strong>of</strong> patients: gr. 1-1411 patients with ST<br />

elevation AMI treated in the regional hospitals without<br />

PCI facilities, gr.2-430 patients with AMI sent directly<br />

to the interventional Centre.<br />

Results: In Group 1 the percentage <strong>of</strong> reperfusion therapy<br />

(primary PTCA + thrombolysis) was 11.28% in<br />

2004 growing to 27.43% in 2009. In gr. 2 reperfusion<br />

therapy was possible in 99.39% <strong>of</strong> cases, consisting<br />

<strong>of</strong> primary PTCA in 76.96% cases, facilitated PTCA<br />

15.75% cases and systemic thrombolysis in 6.6% cases.<br />

Mortality rates fell progressively from 20.77% in 2004<br />

to 11.9% in 2009, correlated with an increased number<br />

<strong>of</strong> cases who received reperfusion therapy (p = 0.001).<br />

In gr. 2 overall mortality was 6.6% for patients arrived<br />

in time for reperfusion, compared with 17.65% for patients<br />

with late presentation (> 12 hours) (p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Concluzii: Localizarea de predilectie a fenomenelor<br />

aterosclerotice difera in functie de sex. Se identifica factorii<br />

de risc diferiti ca pondere in afectarea teritoriilor<br />

vasculare, varsta si menopauza ramanand insa factorii<br />

esentiali.<br />

Subclinical atherosclerosis –<br />

gender related particularities<br />

Aim: The aim <strong>of</strong> the study was to identify possible gender<br />

features <strong>of</strong> atherosclerosis disease in different vascular<br />

territories.<br />

Material and method: We studied 218 subjects, <strong>of</strong><br />

which 110 women and 108 men, apparently healthy in<br />

equal percentages, respectively nonatherosclerotic and<br />

noninflammatory pathology, aged 21-80 years, mean<br />

51.9 ± 17.7 years. We proceeded to record demographic<br />

data and risk factors, and general paraclinical exploration:<br />

ECG, carotid, abdominal and vascular ultrasonography,<br />

ankle-arm index and relative specific - flowmediated<br />

vasodilation, ergometry test, and multislice<br />

computed angiocoronarography.<br />

Results: Lower carotid IMT values in women 0.44 ±<br />

0.09 mm vs. 0.78 ± 0.25 mm (p


POSTER I<br />

POSTER I<br />

terleukina 6 si 18, factorul necrotic nuclear, NT-BNP<br />

s-a dovedit un predictv important deoarece valoarea<br />

lui a crescut de la faza de angina pectorala de efort, la<br />

cea de sindrom intermediar si apoi de IM. 2. Este un<br />

marker ce nu permite sa diferentiem dispneea inspiratorie<br />

prezenta in sindroamele coronariene de dispneea<br />

extracardiaca. 3. Ne ajuta in acelasi timp sa monitorizam<br />

insuficienta cardiaca cronica. 4. Este deasemeni un<br />

indicator asupra evolutiei clinice si severitatii electroecografice,<br />

a suferintelor acute.<br />

NT- pro BNP important<br />

marker for evolution<br />

monitoring <strong>of</strong> acute coronary<br />

syndroms with no ST increase<br />

The purpose <strong>of</strong> the study Mortality tests after myocardial<br />

infarct showed that BNP association with mortality<br />

is not age related, or renal or cardiac insufficiency,<br />

troponine I and CRP related, which on long term is<br />

associated with mortality in the case <strong>of</strong> NT-pro BNT<br />

as well.<br />

Material and method: We studied a number <strong>of</strong> 48 patients<br />

with acute coronary syndrome with no ST increase<br />

at which the bilogical chart (troponine, firbrilogen,<br />

reactive C proteine), except sternocardiac crises, presented<br />

no convincing increase. NT- proBNP dosage at<br />

hospitalization was increased -220 pg /ml, compared to<br />

the normal value <strong>of</strong> 7 pg/ml.<br />

Results: The patients continued to be monitored<br />

through EKG physical exams in 5 days series, dosage<br />

for necrosis exams (including troponine that was not<br />

increased in this stage), electrocardiogram, so that after<br />

5 days 12 patients (25%) <strong>of</strong> 48 presented unstable angina<br />

(the characteristic <strong>of</strong> the pain, the duration, the irradiation,<br />

the answer to nitroglicerine, the variation <strong>of</strong><br />

ECG, and the value <strong>of</strong> NT-pro BNP increased to 610pg/<br />

ml). 8 patients evolved to IM ( 17% ) with changes in<br />

the pain character, lesion, necrosis, ischemia, and fosfocreatinkinaza<br />

MB EKG changes, as well as a major<br />

troponine increase in this stage, and the value <strong>of</strong> NTpro<br />

BNP reached 910pg/ml.<br />

Conclusions: 1. From the present inflamatory markers<br />

the aterogenesis process along with reactive C protein,<br />

6 and 18 interleukine, the nuclear necrotic factor,<br />

NT-BNP proved to be an important predictive factor<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

because its value increased from effort breastplate angina<br />

phase to the intermediary syndrom phase and then<br />

IM. 2. It is a marker that doesn’t allow us to make the<br />

differencve between inspiring dispneea present in the<br />

coronary syndroms from the extracardiac dispneea. 3.<br />

It helps to monitor the chronic cardiac insufficiency. 4.<br />

It is an index <strong>of</strong> the physical evolution and echographic<br />

acerbity, <strong>of</strong> the acute suffering.<br />

25. Indexarea ariei valvulare<br />

functionale la suprafata<br />

corporala supraestimeaza<br />

prevalenta stenozei aortice<br />

stranse la pacientii obezi si<br />

nu amelioreaza estimarea<br />

severitatii acesteia la adulti<br />

Denisa Muraru, Andreea Calin, L.P.Badano,<br />

P.Faggiano, B.A.Popescu, Carmen Ginghina,<br />

A.Proclemer<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Premise. Deoarece prin raportarea debitului cardiac la<br />

suprafata corporala (SC) rezulta un „index” aproximativ<br />

constant de 3-4 L/min/m2 la adulti, indexarea la SC<br />

a fost aplicata pentru diversi parametri in absenta dovezilor<br />

privind validitatea sa. Spre deosebire de copii, la<br />

adulti SC variaza predominant in relatie cu modificarile<br />

greutatii corporale (GC) si nu cu cele ale inaltimii.<br />

Metode: Pentru evaluarea impactului GC asupra relatiei<br />

dintre aria valvulara functionala aortica indexata<br />

la SC (AVAi) si gradientii transvalvulari, au fost inrolati<br />

prospectiv 278 pacienti (76±8 ani, 48% barbati) cu<br />

fractie de ejectie a ventriculului stang >50%, velocitate<br />

aortica maxima >2 m/s (AVA=0.95±0.37, 0.3-2.27cm2;<br />

gradient maxim (Gmax)=61±29, 10-174 mm Hg; gradient<br />

mediu (Gmed)=34±17, 6-101 mmHg), fara alte<br />

valvulopatii semnificative. GC si inaltimea au fost<br />

masurate atent imediat dupa efectuarea ecocardiografiei<br />

folosind aceleasi scale.<br />

Rezultate: 96 pacienti au fost normoponderali (indexul<br />

de masa corporala, IMC 30kg/


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Rezumat: Pacientul I.D, in varsta de 13 ani, cunoscut<br />

de la nastere cu malformatie cardiaca complexa, cianogena,<br />

dextrocardie, ventricul unic, atrezie de valva pulmonara,<br />

in context de situs inversus toracic si abdominal,<br />

cu evolutie naturala, fara tratament, dezvoltand in<br />

timp colateralitate abundenta de supleere si poliglobulie<br />

severa. Cu o zi inaintea internarii prezinta: hematemeza<br />

masiva, epistaxis precedate de un acces de tuse cu<br />

deteriorare clinica rapida si progresiva. Examenul clinic<br />

la internare releva stare generala sever influentata, cianoza<br />

intensa generalizata, hipocratism digital, semne<br />

clinice de continuarea a unei sangerari inalte-tip respim2).<br />

SC a fost cuprinsa intre 1.29 m2 si 2.32 m2. SC s-a<br />

corelat semnificativ (p


POSTER I<br />

POSTER I<br />

rator, precum si suflu sistolic gradul III/VI parasternal<br />

drept in contextual bolii cardiace cunoscute. In evolutie<br />

a prezentat hematemeza (500-800 ml) precedata de<br />

accese de tuse si scaune melenice abundente, timp de 4<br />

zile pe perioada internarii. Evaluarile de urgenta au exclus<br />

o sangerare digestiva sau in sfera ORL.In paralel cu<br />

efortul de diagnostic etiologic, sub tratamentul instituit<br />

tranzitul intestinal se reia si se normalizeaza progresiv,<br />

o data cu ameliorarea starii clinice a pacientului.Consecintele<br />

respiratorii si digestive au fost manageriate in<br />

paralel cu tratamentul specific. Cazul a fost interpretat<br />

ca hemoptizie masiva prin varice traheo-bronsice<br />

(ruptura colateralelor), urmata de inghitirea sangelui in<br />

cantitati mari si melena (ca si consecinta), in contextul<br />

unei malformatii cardiace cianogene neglijata. Circulatia<br />

de supleere este eficienta,dar prezinta un risc major<br />

de recurenta. A mai intrat in discutie un bloc congestiv<br />

pulmonar drept secundar sangerarii care a fost manageriat<br />

ca si un bloc pneumonic-actual remis , de asemenea<br />

prin resorbtia sangelui a prezentat cresteri temporare<br />

de bilirubina –remisa. O alternativa de tratament<br />

pe termen lung ar fi anastomoza cavo-pulmonara totala<br />

(FONTAN), realizata mono sau bistadial (GLENN), de<br />

asemenea o solutie mixta ar fi embolizarea angiografica<br />

urmata de shunt sistemico-pulmonar.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

murmur grade III/VI parasternal right, in the context<br />

<strong>of</strong> known heart disease. Presented in trend haematemesis<br />

(500- 800 ml) preceded by coughs and abundant<br />

melena for four days during hospitalization. Emergency<br />

assesstement excluded digestive bleeding or ORL sources.<br />

In etiological diagnosis, as treatment <strong>of</strong> established<br />

the bowel resume and normalize progressively, with<br />

the improvement <strong>of</strong> the pacient’s clinical condition.<br />

Respiratory and digestive consequences were managed<br />

in parallel with specific treatment. The case whas interpreted<br />

as massive haemoptysia by tracheo-bronchial<br />

varices (collateral break), followed by swallowing large<br />

amounts <strong>of</strong> blood and melena (as a cosequence) in the<br />

context <strong>of</strong> cyanogen cardiac malformation neglected.<br />

Alternate flow is efficient, but presence a high risk <strong>of</strong><br />

recurrence. He entered the discussion as block congestive<br />

rith lung, secondary bleeding that was managed<br />

as a block - existing lung resolved; also presented by<br />

blood resorption increases blood bilirubin - remitted<br />

temporary. An alternative long-term treatment cavopulmonary<br />

anastomosis would be total (FONTAN)<br />

made mono or bistadial (GLEEN); also a mixed solution<br />

should be followed by angiographic embolization<br />

sistemico-pulmonary shunt.<br />

Complex cyanogen congenital<br />

heart malformation with<br />

mapca – masive haemopthysis<br />

source – witch can lead to<br />

confusion diagnostic with<br />

upper gastrointestinal bleeding<br />

Pacient I.D., aged 13 years, known at birth with complex<br />

cyanogen cardiac malformation, dextrocardia,<br />

single ventricule, pulmonary valve atresia, in the context<br />

<strong>of</strong> the thoracic and abdominal situs invesus, with<br />

natural evolution, without treatment, developing in<br />

time pulmonary abundance collaterals and severe poliglobulia.<br />

The day before admissions shows: massive<br />

haematemesis, epistaxis preceded by a fit <strong>of</strong> coughing<br />

and rapide progressive clinical deterioration. Clinical<br />

examination on admission revealed severe mood influence,<br />

generalized cyanosis, digital hipocratism, clinical<br />

signs <strong>of</strong> continued high respiratory bleeding , systolic<br />

27. Modificarea stilului de<br />

viata, EA III Romania<br />

follow-up de la ghiduri la<br />

practica medicala<br />

Stela Iurciuc, M.Iurciuc, Adina Avram, S.Ursoniu,<br />

Laura Craciun, Daniela Stancila, Madalina Caprariu,<br />

Suceava Ioana, C.Sarau, D.Gaita, Silvia Mancas<br />

Universitatea de Medicina si Farmacie, Timisoara<br />

Premise: Studiile populationale din ultimii ani au demonstrat<br />

o incidenta sporita a modului de viata nesanatos.<br />

Scop: Cresterea eficeintei preventiei cardiovasculare<br />

prin interventia asupra stilului de viata, intr-o arie<br />

geografica cu subiecti cu risc cardiovascular inalt si cu<br />

obiceiuri alimentare nesanatoase.<br />

Metoda: Am evaluat 325 paceinti (varsta medie: 56+/-<br />

9 ani, 62% femei) din cei 503 asimptomatici cu risc<br />

inalt inclusi in Euroasire III Romania „Primary Care”.<br />

Am eficientizat interventia pe preventia primara prin


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

urmarirea pacientilor timp de 18 luni de catre Medicul<br />

de Familie. Medicul de Familie a fost instruit in acest<br />

sens in prealabil de catre o echipa formata din cardiolog,<br />

nutritionist si nefrolog. La fiecare 6 luni pacientii<br />

au fost evaluati si sfatuit conform kitului european de<br />

preventie cardiovasculara. Am evaluat urmatorii parametrii<br />

(inainte si dupa 18 luni): factorii de risc cardiovascular,<br />

dieta sanatoasa, cresterea activitatii fizice.<br />

Rezultate: Numarul de pacienti ce au afirmat ca au primit<br />

si urmat sfaturile medicului de Familie, de modificarea<br />

a stilului de viata este: 280 initial si 308 dupa 18<br />

luni (p


POSTER I<br />

POSTER I<br />

28. Impactul adminstrarii<br />

de clopidogrel la pacientii<br />

cu infarct miocardic acut cu<br />

supradenivelare de segment ST<br />

cu esec al terapiei trombolitice<br />

si fara PCI “de salvare” sau<br />

precoce. Date RO-STEMI<br />

G.Tatu-Chitoiu, Maria Dorobantu, B.Minescu,<br />

I.Benedek, Catalina Arsenescu-Georgescu, Elvira<br />

Craiu, Mariana Radoi, L.Chiriac, V.Greere,<br />

D.D.Ionescu, A.Petris<br />

Spitalul Clinic de Urgenta “Floreasca” Bucuresti<br />

Introducere: Ghidurile actuale recomanda administrarea<br />

de clopidogrel (C) in combinatie cu Aspirina (A) la<br />

pacientii (pts) cu terapie trombolitica (TT) pentru infarctul<br />

miocardic acut cu supradenivelare de segment<br />

ST (STEMI). Efectul administrarii de C la pts la care<br />

TT nu a avut succes nu a fost inca evaluat. Obiective:<br />

Compararea mortalitatii intra-spitalicesti si a ratei hemoragiilor<br />

majore la pts cu TT pentru STEMI, la care<br />

angioplastia (PCI) “de salvare” sau precoce (in primele<br />

24 de ore) nu a fost disponibila si care au primit tratament<br />

anticoagulant combinat fie cu A fie cu A plus C<br />

(A&C;).<br />

Metoda: in perioada 1.01.2000 - 31.12.2009 au fost<br />

inrolati consecutiv in Registrului Roman pentru Infarctul<br />

Miocardic cu Supradenivelare de Segment ST<br />

(RO-STEMI) 15047 pts. In acest grup, 6588 pts au<br />

primit TT. Efectul TT a fost evaluat prin doua criterii<br />

non-invazive de reperfuzie: disparitia rapida a durerii<br />

toracice si reducerea sumei supradenivelariilor de segment<br />

ST cu peste 50% la 180 min. dupa debutul TT. In<br />

absenta contraindicatiilor, pacientii au primit beta-blocante,<br />

inhibitori ai enzimei de conversie a angiotensinei,<br />

statine si anticoagulante (heparina -1000 i.u. /ora,<br />

48-96 ore - sau enoxaparina - 1 mg/kg la fiecare 12 ore<br />

timp de 8-10 zile) combinate fie cu A -150-300 mg/zi<br />

sau A&C;(C doza de incarcare 300 mg. urmata de 75<br />

mg/zi).<br />

Rezultate: criteriile de reperfuzie coronariana au fost<br />

evaluate corect la 5732 (87%) pts. A fost identificat un<br />

subgrup de 1075 pts consecutivi fara semne de reperfuzie<br />

trombolitica si fara PCI „de salvare” sau precoce. O<br />

mortalitate intra-spitaliceasca semnificativ mai redusa<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

(11.38%) a fost inregistrata la 404 pts tratati cu anticoagulante<br />

si A&C;comparativ cu cea de 21.01% inregistrata<br />

la 671 pts care au primit numai anticoagulante si<br />

A (p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

<strong>of</strong> thrombolysis. In the absence <strong>of</strong> contraindication,<br />

all pts. received beta-blockers,angiotensin converting<br />

enzyme inhibitors, statins and anticoagulants (unfractionated<br />

heparin-1000 i.u./hour, 48-96 hours or enoxaparin<br />

1 mg/kg every 12 hours, 8-10 days) combined<br />

with either A-150-300 mg./day or A&C (loading dose<br />

<strong>of</strong> 300 mg. followed by 75 mg/day).<br />

Results: The efficacy <strong>of</strong> thrombolysis was correctly<br />

assessed in 5732 (87%) pts. A subgroup <strong>of</strong> 1075 consecutive<br />

pts. with FT, not undergoing rescue or early<br />

PCI was identified. A significant lower in-hospital<br />

mortality (11.38%) was seen in the 404 pts treated with<br />

anticoagulants and A&C compared with 21.01% seen<br />

in the 671 pts who received only anticoagulants and A<br />

(p


POSTER I<br />

POSTER I<br />

Material and method: The study included 50 hypertensive<br />

patients (aged 56 ± 5.60 years) and 41 hypertensive<br />

patients with metabolic syndrome (aged 56 ± 3.62<br />

years). Metabolic syndrome was defined by the National<br />

Cholesterol Education Program Adult Treatment Panel<br />

III guidelines. Mean carotid intima-media-thickness<br />

(IMT), anthropometric parameters (body mass index-<br />

BMI, waist circumference-WC, waist-hip ratio-WHR)<br />

and lipid pr<strong>of</strong>iles parameters (total cholesterol, tryglicerides,<br />

LDL-cholesterol and LDL-cholesterol) were<br />

measured. The carotid intima-media thickness was<br />

assessed by high resolution B-mode ultrasound imaging<br />

according to the Mannheim Consensus.<br />

Results: Hypertensive patients with metabolic syndrome<br />

had higher values <strong>of</strong> BMI (27.56 ± 1.63 kg/m2 vs.<br />

24.05 ± 1.19 kg/m2, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

metformin therapy. We studied the following parameters<br />

at baseline and after 6 months: serum triglycerides,<br />

serum HDL-cholesterol, C reactive proteine high sensitive<br />

(CRP-hs), brachial artery flow mediated dilation<br />

(FMD) and carotid intima media thickness (IMT), as<br />

well as the severity <strong>of</strong> nonalcoholic fatty liver disease<br />

(NFLD).<br />

Results: At baseline, there were no significant statistical<br />

differences between the two groups regarding the studied<br />

parameters. After 6 months there was a significant<br />

improvement in pts treated with metformin (group A)<br />

as compared to group B. There was a significant reduction<br />

in serum triglycerides (-5,1±5,0 mg/dl vs 0,21±2,5;<br />

p=0,02) and a nonsignificant increase in HDL-cholesterol<br />

(0,4±0,2 mg/dl vs 0,03±0,05 mg/dl; p=0,15). Inflammatory<br />

syndrome assessed by CRP-hs, was significantly<br />

improved by 6 months metformin therapy (-0,24<br />

± 0,18 mg/l vs. 0,07 ± 0,04; p 0,001). The severity <strong>of</strong><br />

NFLD was strongly reduced in metformin-treated<br />

patients. Ultrasound parameters improved in group<br />

A, significantly for FMD (1,9±1,44% vs. -0,03±0,7%;<br />

p=0,007) and without statistical significance for IMT<br />

(-0,008±0,05 vs. 0,003±0,04; p=0,18).<br />

Conclusions: Metformin therapy proved its eficacy in<br />

reducing cardiometabolic risk in pts with metabolic<br />

syndrome but without cardiovascular disease or type 2<br />

diabetes mellitus<br />

31. Gama-glutamil trasferaza<br />

– un nou factor de risc<br />

cardiovascular<br />

V.Ambarus, Mariana Floria, Lacramioara Pantaru,<br />

Ramona Alina Antal, Elena Ancuta Varlan, Mirela<br />

Paraschiva Ciutea, Paloma Manea, I.G.Rosu<br />

Universitatea de Medicina si Farmacie “Gr.T.Popa”,<br />

Spitalul Universitar "Sf. Spiridon", Iasi<br />

Gamaglutamil transferaza (GGT) serica este considerata<br />

un posibil factor de risc cardiovascular. Scop:<br />

Evaluarea gradului de asociere intre GGT si afectiunile<br />

cardiovasculare.<br />

Metode: Studiul a inclus 550 de pacienti consecutiv<br />

internati in anul 2009. Am analizat prezenta steatozei<br />

hepatice, hipertensiunii arteriale, anginei pectorale,<br />

infarctului de miocard, insuficientei cardiace, modifi-<br />

POSTER I<br />

POSTER I<br />

carilor electrocardiografice de orice tip si tulburarilor<br />

de ritm la pacientii cu GGT crescut (grup 1, n=232)<br />

in comparatie cu pacientii cu GGT normal (grup 2,<br />

n=318), la internare.<br />

Rezultate: Valoarea medie a GGT a fost de 100 UI vs<br />

28.5 UI. Varsta medie a fost 64.4 vs 65 de ani iar 44.6%<br />

vs 34.6% dintre pacientii din grupul 1 vs grupul 2 au<br />

fost de sex masculin. In grupul 1 au fost aproximativ de<br />

2 ori mai multi consumatori cronici de alcool. Indicele<br />

de masa corporala a fost net superior in grupul 1 fata de<br />

2 (41 vs 28.5 kg/m2). Pr<strong>of</strong>ilul lipidic a fost comparabil<br />

in cele 2 grupuri: colesterol 196 vs 206.4 mg/dl, trigliceride<br />

134.7 vs 131.6 mg/dl, HDL 49 vs 50.5 mg/dl, LDL<br />

122 vs 131 mg/dl iar raportul mediu trigliceride/HDL<br />

a fost 2.74 vs 2.60. GGT crescut s-a corelat semnificativ<br />

statistic cu hipertensiunea arteriala (r=0.677, p


POSTER I<br />

POSTER I<br />

196 vs 206.4 mg/dl, triglycerides 134.7 vs 131.6 mg/<br />

dl, HDL 49 vs 50.5 mg/dl, LDL 122 vs 131 mg/dl and<br />

triglycerides/HDL was 2.74 vs 2.60. Elevated GGT was<br />

statistically significantly correlated with arterial hypertension<br />

(r=0.677, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

and then cardio-respiratory failure acute pulmonary<br />

thromboembolism, as causes <strong>of</strong> death were rare, necrotic<br />

pancreatitis (two cases), occlusion bowel (1 case)<br />

and ventricular rupture (1caz). Fined surgical cases,<br />

the most common cause <strong>of</strong> death was due bronhopneumoniei<br />

developments in the context <strong>of</strong> septic postoperative,<br />

intraoperative death cases are rare (two cases),<br />

or during subsequent explorations by cardiac catheterization<br />

(one case). In terms endocarditele, the most<br />

common causes <strong>of</strong> death were predominantly u pluriorganice<br />

multiple infarction by septic embolization.<br />

Conclusion: To have as many positive results in the<br />

context <strong>of</strong> valvular pathology surgical approach is<br />

necessary as many patients before cardiopulmonary<br />

lesions appear irreversible and much more, before<br />

the emergence <strong>of</strong> bacterial endocarditis as a feared<br />

complication <strong>of</strong> valvular lesions ulcerated or calcified<br />

surgical unresolved.<br />

33. Eficacitatea si toleranta<br />

Sildenafilului la copiii cu<br />

hipertensiune pulmonara<br />

secundara sunturilor<br />

congenitale<br />

sistemico-pulmonare<br />

Ina Palii, Eleonora Vataman<br />

ICSOSM si C, Chisinau, Republica Moldova<br />

Hipertensiunea pulmonara secundara cardiopatiilor<br />

congenitale ramane a fi pana in prezent una din cele<br />

mai dificile probleme in plan de tratament al copiilor<br />

marcati astfel. Sildenafilul – inhibitor selectiv al Fosfodiesterazei-5<br />

este recunoscut in prezent a fi un vasodilatator<br />

pulmonar promitator si efectiv, cu putine si<br />

minore reactii adverse, si mai putin costisitor. Noi am<br />

evaluat eficacitatea si toleranta Sildenafilului in tratamentul<br />

de durata al copiilor cu HTP reziduala, secundara<br />

cardiopatiilor congenitale cu sunt operate. In studiu<br />

(randomizat, dublu orb, placebo controlat) 47 de<br />

copii cu varsta cuprinsa intre 3 luni si 16 ani, cu HTP<br />

avansata, reziduala secundara sunturilor sistemico -<br />

pulmonare (simple, combinate si complexe) operate<br />

radical sau paleativ au fost inclusi. I lot l-au constitu-<br />

POSTER I<br />

POSTER I<br />

it 25 de copii medicati cu Sildenafil si lotul II - 22 de<br />

pacienti ce au primit tratament conventional. Doza<br />

initiala a Sildenafilului a fost de, apoi la o tolerabilitate<br />

buna - 1 si 2 mg/kg/zi fiecare 6 ore.Eficienta si tolerabilitatea<br />

preparatului au fost analizate lunar, durata de<br />

supraveghere fiind de la 3 pana 6 luni. Protocolul de<br />

studiu a inclus semnele clinico-paraclinice ale HTP si<br />

un chestionar special de evidenta a reactiilor adverse.<br />

La majoritatea pacientilor ce au primit Sildenafil (92%)<br />

s-a observat ameliorarea CF OMS/NYHA, tolerantei<br />

la efort estimata prin testul „mers plat” 6 min de la<br />

263,75±5,24 pana la 468,25±6,8; cresterea saturatiei<br />

O2 sistemice de la 91,52±0,88% pana la 96,44±0,92%;<br />

diminuarea presiunii in a. pulmonara medie (PAPm)<br />

de la 54,48±2,4 pana la 25,28±1,8 mmHg; diminuarea<br />

rezistentei vasculare pulmonare (RVP) de la 5,134±1,6<br />

pana la 2,37±0,8 UnWood; imbunatatirii functiei sistolice<br />

a VD (indicelui de performanta Tei) de la 0,51±0,07<br />

pana la 0,31±0,04. Astfel, rezultatele studiului au demonstrat<br />

ca Sildenafilul este un remediu efectiv in HTP<br />

secundara sunturilor congenitale sistemico-pulmonare<br />

reparate chirurgical, imbunatatind CF (P


POSTER I<br />

POSTER I<br />

study (double-blind, placebo-controlled) 47 children<br />

with age between 3 months and 16 years with advanced,<br />

residual PH secondary to systemic-to-pulmonary<br />

shunts (simple, mixed and complex), radical or palliative<br />

surgical repaid were included. The first group was<br />

consisted <strong>of</strong> 25 children treated with Sildenafil and the<br />

second one – 22 patients received a conventional treatment.<br />

The initial dose <strong>of</strong> Sildenafil was <strong>of</strong> 0,5 mg/kg,<br />

then at a good tolerability - 1 and 2 mg/kg/day each<br />

6 hours. In the study protocol were included clinical<br />

and paraclinical signs <strong>of</strong> PH, and a special questionnaire<br />

<strong>of</strong> evidence <strong>of</strong> adverse reactions. At the majority <strong>of</strong><br />

the patients treated with Sildenafil (92%) had been observed<br />

an improvement <strong>of</strong> FC OMS/NYHA, an effort<br />

tolerance estimated by „flat - running” test <strong>of</strong> 6 minutes<br />

from 263,75±5,24 to 468,25±6,8; the diminishing <strong>of</strong> the<br />

mean pressure in the pulmonary artery from 54,48±2,4<br />

to 25,28±1,8 mmHg; the decreasing <strong>of</strong> the pulmonary<br />

vascular resistance (PVR) from 5,134±1,6 to 2,37±0,8<br />

UnWood; the improvement <strong>of</strong> the sistolic function<br />

<strong>of</strong> RV (the performance index Tei) from 0,51±0,07 to<br />

0,31±0,04. The study results had proved that Sildenafil<br />

is an efficient medicine in treating PH secondary<br />

to congenital systemic-to-pulmonary shunts surgical<br />

repaired, improving FC (P


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Early evolution and<br />

complications <strong>of</strong> acute<br />

myocardial infarction with and<br />

without ST segment elevation.<br />

An observational study in the<br />

real world<br />

Aim: to study the evolution <strong>of</strong> the acute myocardial infarction<br />

(AMI) with (STEMI) and without (NSTEMI)<br />

ST segment elevation in patients admitted in a community<br />

hospital.<br />

Methods: We compared Killip class severity, occurrence<br />

<strong>of</strong> new arrhythmia, new conduction disturbances,<br />

mechanical complications and death in patients (pts)<br />

with STEMI and NSTEMI admitted in a community<br />

hospital during a year.<br />

Results: There were 238 AMI pts, 60.5% STEMI and<br />

39.5% NSTEMI. 66.39% were men (M), 65.3 +/-11.6<br />

year old and 33.61% women (W), 70.7+/-10.6 year old<br />

(p=0,0006). 18.07% pts were in Killip ll, 8.4% in Killip<br />

lll, without differences between STEMI and NSTEMI.<br />

18.75% STEMI and 2.12% NSTEMI pts were in Killip<br />

lV class OR=10.6154 [2.4613-45.7834]; p=0.0003. Ventricular<br />

tachycardia and ventricular fibrillation occurred<br />

in 17.36% STEMI and 2.12% NSTEMI, (OR=9.6638<br />

[2.2321-41.8403, p=0.0001); grad ll and lll atrio-ventricular<br />

block occurred in 17.36% STEMI and 9.57%<br />

NSTEMI (p=0.0001). Free wall ventricular rupture and<br />

interventricular septal defect occurred only in STEMI<br />

pts. Death occurred in 26.38% STEMI and 6.38%<br />

NSTEMI, (OR=5.2579 [2.1255-13.0064, p=0.0001).<br />

Death in STEMI was correlated with history <strong>of</strong> old<br />

myocardial infarction (OR=4.2857 [1.8139-10.1258];<br />

p=0.0005); and chronic heart failure (OR=5.1084<br />

[2.1969-11.8783]; p=0.0001). Death in NSTEMI was<br />

correlated with chronic renal failure (OR=8.3529<br />

[1.4115-49.4311]; p=0.02) and women (OR=11.2963<br />

[1.2589-101.3658]; p=0.01).<br />

Conclusions: STEMI was associated more frequent<br />

than NSTEMI with Killip lV class (p=0.0003), ventricular<br />

tachycardia, ventricular fibrillation (p=0.0001)<br />

and death (p=0.0001), especially in pts with previous<br />

myocardial infarction and heart failure. In NSTEMI<br />

death occurs more frequent in W and pts with chronic<br />

renal failure.<br />

POSTER I<br />

POSTER I<br />

35. Particularitati evolutive ale<br />

HTA de “halat alb” la copilul<br />

scolar<br />

A.G.Dimitriu, Doina Felea, Lavinia Dimitriu<br />

Universitatea de Medicina si Farmacie ”Gr.T Popa”, Iasi<br />

Scopul studiului: Studiul modalitatilor evolutive ale<br />

HTA “halate albe” la copil si adolescent, utilitatea diagnosticului<br />

la pacientii pediatrici si relatia cu hipertensiunea<br />

arteriala esentiala ulterioara.<br />

Material si metoda: Autorii au evaluat 1068 scolari, cu<br />

varsta intre 10 si 16 ani, in cadrul unui screening pentru<br />

stabilirea prevalentei hipertensiunii arteriale sistemice<br />

la copilul scolar. Prima determinare a TA a fost<br />

efectuata in conditii standard (cabinetul medical scolar<br />

sau in sala de clasa) si a fost repetata dupa 15-20 minute<br />

doar la pacientii care au prezentat valori ridicate ale TA<br />

la prima determinare. TA a fost deasemenea masurata,<br />

in aceleasi conditii, dupa 4-7 ani, la 955 dintre acesti<br />

copii. In lotul de studiu nu au fost incluse cazurile de<br />

hipertensiune arteriala sistemica secundara.<br />

Rezultate: HTA de “halat alb” a fost evidentiata la inceputul<br />

studiului in 60 cazuri (5.6%) si in 8.73% din<br />

cazuri la finalul studiului. Monitorizarea copiilor cu<br />

hipertensiune de “halate albe” a evidentiat 5 cazuri de<br />

HTA stadiul 1 (8% cazuri), 9 cazuri au dezvoltat pre-hipertensiune<br />

(15%), 33 cazuri (54%) au mentinut hipertensiune<br />

de “halat alb” si 14 cazuri (23%) au prezentat<br />

valori normale ale TA. Incidenta dezvoltarii in timp a<br />

HTA la copiii cu hipertensiune de “halat alb” (14 din<br />

60 cazuri -23,3%) a fost mai mare decat formele similare<br />

de HTA care a aparut la pacientii cu valori initiale<br />

ale TA in limite normale(20 din 953 cazuri, 2,05%).<br />

In timp, frecventa prehipertensiunii si HTA a crescut,<br />

deasemenea de la 5,11% la prima determinare la 7,85%<br />

la ultima determinare.<br />

Concluzie: Incidenta crescuta a hipertensiunii de “halat<br />

alb” corelata cu o frecventa crescuta a evolutiei catre<br />

HTA sistemica sugereaza ca hipertensiunea de “halat<br />

alb” nu este complet benigna, ca aceasta reprezinta un<br />

factor de risc si are o valoare predictiva pentru dezvoltarea<br />

hipertensiunii arteriale sistemice. Urmarirea constanta<br />

a acestor pacienti si prevenirea altor factori de<br />

risc pot scadea frecventa HTA la adult.


POSTER I<br />

POSTER I<br />

Evolutive features <strong>of</strong> the white<br />

coat hypertension <strong>of</strong> school<br />

child<br />

Purpose: to study the aspects <strong>of</strong> the evolution <strong>of</strong> the<br />

“white coat hypertension” in children and adolescents,<br />

the benefit <strong>of</strong> diagnosing it in pediatric patients and its<br />

possible link with the subsequent essential hypertension.<br />

Methods: The authors have evaluated a number <strong>of</strong> 1068<br />

schoolchildren, aged between 10 and 16 years, as part<br />

<strong>of</strong> a screening program for establishing the prevalence<br />

<strong>of</strong> systemic arterial hypertension and its evolution in<br />

time <strong>of</strong> blood pressure (BP). The first determination <strong>of</strong><br />

BP was made in standard conditions (in the school medical<br />

room or in the classroom) and was repeated after<br />

15-20 minutes only in patients who presented high values<br />

<strong>of</strong> BP at the first determination. BP was also measured<br />

after 4-7 years in 955 <strong>of</strong> these children. In this<br />

study it wasn’t included any cases <strong>of</strong> secondary systemic<br />

hypertension.<br />

Results: The “white coat” hypertension was present, at<br />

the beginning <strong>of</strong> this study, in 60 cases (5,6%), and in<br />

8,73% <strong>of</strong> cases when we finished our study. The surveillance<br />

<strong>of</strong> the children with “white coat” hypertension<br />

revealed 5 children with stage 1 hypertension (8%<br />

cases), 9 cases developed pre hypertension (15%), 33<br />

cases (54%) maintained “white coat” hypertension and<br />

14 cases (23 %) had normal values <strong>of</strong> BP. The incidence<br />

<strong>of</strong> systemic hypertension developed in time in children<br />

with “white coat” hypertension (14 <strong>of</strong> 60 cases<br />

-23,3%) was greater than that <strong>of</strong> similar forms <strong>of</strong> systemic<br />

hypertension resulting from patients with initial<br />

normal BP (20 <strong>of</strong> 953=2,05%). In time, the frequency<br />

<strong>of</strong> prehypertension and systemic hypertension also increased:<br />

5,11% at first determination to 7,85% at last<br />

determination.<br />

Conclusion: The high frequency <strong>of</strong> “white coat” hypertension<br />

correlated with a high frequency <strong>of</strong> evolution<br />

to systemic hypertension suggest that “white coat”<br />

hypertension is not entirely benign, that this represents<br />

a highrisk factor and had a predictive value for<br />

the development <strong>of</strong> systemic hypertension. Constant<br />

follow-up <strong>of</strong> this patients and the prevention <strong>of</strong> other<br />

risk factors may lower the frequency <strong>of</strong> systemic adult<br />

hypertension<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

36. Modificari cardiace<br />

structurale si functionale la<br />

pacientii cu acromegalie –<br />

studiu ecocardiografic<br />

Anca Florian, Ruxandra Jurcut, Aurora Vladaia, Oana<br />

Savu, Simona Galoiu, Ionela Baciu, B.A.Popescu,<br />

M.Coculescu, Carmen Ginghina<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Introducere: Acromegalia (ACM) se insoteste de risc<br />

cardiovascular crescut prin efectul direct al nivelului<br />

crescut de GH/IGF1 si prin factorii de risc (FR) asociati.<br />

La pacientii cu ACM sunt descrise modificari cardiace<br />

structurale si functionale.<br />

Scopul studiului este descrierea modificarilor cardiace<br />

asociate cu ACM si evaluarea abilitatii tehnicilor noi de<br />

imagistica miocardica Doppler (TDI) de a caracteriza<br />

aceste modificari.<br />

Material si metoda: Au fost evaluati 59 de pacienti<br />

consecutivi cu ACM (varsta medie 46.1±11.6 ani) si 26<br />

de martori fara ACM (38.3±12.5 ani, similari ca sex si<br />

FR cardiovascular). Pentru toti subiectii s-au efectuat<br />

inregistrari ecocardiografice standard si TDI, determinandu-se<br />

datele de strain sistolic longitudinal (S) atat<br />

pentru ventriculul drept (VD) cat si pentru ventriculul<br />

stang (VS), la nivelul celor 3 segmente (bazal, mediu si<br />

apical)din incidenta apical 4 camere. Nivelul GH a fost<br />

masurat la toti pacientii cu ACM.<br />

Rezultate: Pe baza valorilor GH seric, 38 (64.4%) dintre<br />

pacientii cu ACM, au avut boala activa (grup A) iar<br />

21 (35.6%) boala controlata (grup B). Cei 26 de martori<br />

au constituit grupul C. Dintre parametrii structurali,<br />

pacientii cu ACM (A si B) au prezentat o masa VS indexata<br />

(110.6±24.94, 116.44±32.8 vs 75.7±19, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Nu au existat diferente semnificative pentru paramentrii<br />

mentionati intre grupurile A si B si nici pentru S la<br />

nivelul VD fata de martori.<br />

Concluzii: Pacientii cu ACM prezinta hipertr<strong>of</strong>ie concentrica<br />

VS asociata cu disfunctie sistolica si diastolica<br />

VS, fara alterarea functiei VD. Disfunctia sistolica se<br />

datoreaza in principal unei alterari a functiei longitudinale.<br />

Controlul ACM nu pare sa amelioreze aceste<br />

modificari<br />

Cardiac structural and<br />

functional response<br />

to acromegaly – an<br />

echocardiographic study<br />

Introduction and Purpose: Acromegaly (ACM) is<br />

associated with high cardiovascular (CV) mortality,<br />

both through associated risk factors (RF) and by direct<br />

effects <strong>of</strong> GH/IGF1. Heart abnormalities are frequent<br />

findings in patients with ACM. Doppler myocardial<br />

echocardiography imaging (DMI) was proved a sensitive<br />

method for quantifying early abnormalities in cardiac<br />

function in other settings. In this study, we investigated<br />

the ability <strong>of</strong> DMI to characterize cardiac changes<br />

in ACM.<br />

Material and methods: 59 consecutive pts with ACM<br />

(mean age 46.1±11.6 y) and 26 controls without ACM<br />

(mean age 38.3±12.5 y, NS, matched for sex and CV<br />

RF) were recruited. Both standard echocardiography<br />

and DMI data were obtained for all patients. Peak<br />

systolic longitudinal strain values (S) and timing were<br />

determined and averaged over mid, basal and apical<br />

segments <strong>of</strong> the left (LV) and right (RV) ventricular<br />

walls in 4-chamber view. GH levels were determined in<br />

all the ACM patients.<br />

Results: Of the ACM subjects, 38 (64.4%) had active<br />

disease (grA), and 21 (35.6%) controlled ACM (grB,<br />

defined by GH levels). Gr C consisted <strong>of</strong> 21 controls.<br />

Pts with ACM (grA, B) presented structural changes:<br />

a higher LV indexed mass (110.6±24.94, 116.44±32.8<br />

vs 75.7±19, p


POSTER I<br />

POSTER I<br />

pertr<strong>of</strong>ia concentrica indiferent de momentul evaluarii<br />

(p=0,01) si de sex (p=0,001). Relatia cu hipertr<strong>of</strong>ia excentrica<br />

este evidenta bazal doar la femei (t-test) si este<br />

influentata de circumferinta abdominala (ANCOVA).<br />

PWV este corelat cu IMT carotidian (r=0,39; p=0,004)<br />

numai in grupul tratat cu Enalapril + Indapamida la 12<br />

luni de tratament. Microalbuminuria prezenta este in<br />

relatie cu PP aortic si PVW bazal, indiferent de schema<br />

de tratament (p=0,04). Nu s-a gasit o corelatie a parametrilor<br />

de rigiditate cu FMD, probabil din cauza influentei<br />

heterogene a factorilor de risc cardiovascular<br />

(ANCOVA).<br />

Concluzii: studiul sugereaza interactiunea complexa<br />

intre parametrii noninvazivi cu semnificatie prognostica,<br />

influentata in special de sex, obezitatea abdominala<br />

si schema de tratament antihipertensiv. Evaluarea combinata<br />

a acestor parametri capata semnificatie clinica<br />

deosebita.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

(p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

printr-un sistem echo-tracking. Am calculat pentru fiecare<br />

pacient scorul Framingham si riscul SCORE in<br />

conformitate cu recomandarile actuale.<br />

Rezultate: GIM s-a corelat cu scorul Framingham<br />

(0.719; p


POSTER I<br />

POSTER I<br />

functia endoteliului. Evaluarea factorilor de risc cardiovasculari<br />

in aceasta populatie a constituit un obiectiv<br />

secundar.<br />

Lotul de studiu a cuprins 81 de paciente, formand 4<br />

grupe, in functie de statusul menstrual: A- 35 de paciente<br />

de varsta fertile; B- 10 paciente aflate in primele 24<br />

de luni dupa ultima menstra; C- 23 paciente la menopauza<br />

si D- 13 paciente varstnice (.65 ani)- constituind<br />

un grup martor. Criterii de includere: varsta 40- 55 ani<br />

si pentru D- mai mare de 65 ani; criterii de excluderediabetul<br />

zaharat, boala renala cronica sau ateroscleroza<br />

clinic manifesta.<br />

Metoda: evaluare anamnestica, examen clinic, teste de<br />

laborator (glicemie, lipidograma, acid uric, fibrinogen,<br />

17 β estradiol si activitate plasmatica a factorului von<br />

Willebrand) precum si vasodilatatie mediate de flux<br />

(VMF), prin metoda Celermajer.<br />

Rezultate:<br />

Grup A Grup B Grup C Grup D<br />

Varsta (ani) 44 49.5 51 73.5<br />

Ac. uric (mg/dl) 4 4.58 5.5 5.83<br />

Colesterol total (mg/dl) 191 211 210 184<br />

Trigliceride (mg/dl) 141 185 159 148<br />

17 β estradiol (pg/ml) 134 42 32 15<br />

Activitatea factoruluiVon<br />

Willebrand (%)<br />

135 149 173 196<br />

Vasodilatatia flux mediata<br />

(%)<br />

<br />

12.26 8.79 7.33 4.71<br />

Concluzii: Nivelurile de factor von Willebrand se coreleaza<br />

cu cele plasmatice de 17β estradiol, la fel si vasodilatatia<br />

flux mediate- sugerand ca deprivarea de acest<br />

hormone conduce la modificari functionale notabile<br />

ale endoteliului. Deci modificarea constelatiei hormonale<br />

este un mechanism important al promovarii aterosclerozei<br />

la femeile postmenopauza.<br />

Endothelial function changes<br />

in menopausal women<br />

The endothelial function plays a crucial role in atherosclerosis<br />

development. Because the women have an<br />

advantage over men in maintaining a good endothelial<br />

function, studies about their peculiarities are very good<br />

opportunities to better understand the mechanisms <strong>of</strong><br />

vessel ageing. So, studying the estrogen effects on endothelium<br />

can bring important information about the<br />

entire atherosclerotic process.<br />

The aim was to study the correlation between 17β estradiol<br />

levels, von Willebrand factor activity (as a direct<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

endothelial function marker) and flux mediated vasodilatation<br />

in the brachial artery (as an indirect marker)<br />

in women <strong>of</strong> different ages.<br />

Design and Method: we studied 81 patients, divided<br />

in 4 groups, depending on their menstrual status: A-<br />

fertile age 35 patients, B-the first 24 months after the<br />

last menstrual cycle- 10 patients, C- menopause- 23 patients<br />

and D, a control – group <strong>of</strong> aged women-13 subjects.<br />

Exclusion criteria: renal failure, ischemic heart<br />

disease, diabetes mellitus, inflammatory status and<br />

cancers. Inclusion criteria: age between 40 and 55 years<br />

for the groups A-C and over 65 for the group D. we<br />

performed a careful anamnesis, physical examination,<br />

lab tests (glicemia, lipid pr<strong>of</strong>ile, uric acid, fibrinogen,<br />

estrogen and von Willebrand factor levels) and flux<br />

mediated vasodilatation in the brachial artery (the Celermajer<br />

method). The statistic analysis was performed<br />

with Excel 2003.<br />

Results: In the following table are the most important<br />

results:<br />

Group A Group B Group C Group D<br />

Age (years) 44 49.5 51 73.5<br />

Uric acid (mg/dl) 4 4.58 5.5 5.83<br />

Total cholesterol (mg/dl) 191 211 210 184<br />

Triglycerides (mg/dl) 141 185 159 148<br />

17 β estradiol (pg/ml) 134 42 32 15<br />

Von Willebrand factor<br />

activity (%)<br />

135 149 173 196<br />

Flux mediated vasodilatation<br />

(%)<br />

12.26 8.79 7.33 4.71<br />

Significant Pearson correlation coefficients are between:<br />

von Willebrand factor and uric acid (+0.97); between<br />

flux mediated vasodilatation and uric acid (-0.96);<br />

between 17 β estradiol and von Willebrand factor<br />

(-0.83) and flux mediated vasodilatation (+0.93). Conclusions:<br />

The von Willebrand factor correlates with<br />

the estradiol levels, suggesting that deprivation <strong>of</strong> this<br />

hormone leads to important changes <strong>of</strong> the normal endothelium.<br />

We found that flux mediated vasodilatation is also correlated<br />

with the estrogen levels- adding a new pro<strong>of</strong> for<br />

the link between hormone and endothelial function.<br />

The uric acid level is correlated with age, circulating estradiol<br />

levels and endothelial dysfunction (flux mediated<br />

vasodilatation and von Willebrand factor levels)...<br />

In post menopausal women, the decrease <strong>of</strong> the estradiol<br />

levels is an important mechanism that promotes<br />

atherosclerosis.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

40. Aprecierea calitatii vietii<br />

prin intermediul chestionarului<br />

SHORT FORM 36 la pacientii<br />

valvulari aortici operati<br />

Maria Rada, Dana Emilia Velimirovici, Simona Dragan,<br />

Duda-Seiman D.M., Cobzariu F.I.,Velimirovici<br />

M.D., Silvia Mancas<br />

Universitatea de Medicina si Farmacie „Victor Babes”,<br />

Timisoara<br />

Scop: aprecierea ameliorarii calitatii vietii la finalul fazei<br />

II de recuperare cardiovasculara prin intermediul<br />

chestionarului Short Form 36 (SF 36) la pacientii valvulari<br />

aortici operati.<br />

Material si metoda: monitorizarea efectelor programului<br />

de recuperare cardiovasculara asupra calitatii<br />

vietii la cei 82 pacienti inclusi in studiu s-a efectuat<br />

prin intermediul scorului celor doua componente fizica<br />

(PCS-36) si mentala (MCS-36) la includere in studiu si<br />

la 3 luni (finalul fazei II de recuperare cardiovasculara).<br />

Calcularea punctajului celor doua componente s-a<br />

efectuat electronic prin accesarea site-ului (www.sf-36.<br />

org/demos/SF-36html). Pentru cuantificarea punctajul<br />

obtinut s-a utilizat un scor original cu limite intre 0 si<br />

100, 0 cel mai slab si 100 cel mai bun posibil status de<br />

sanatate. Pacienti eligibili pentru studiu, au fost randomizati<br />

in doua grupe: grupa de antrenament (A)-43<br />

pacienti si grupa de control (B)-39 pacienti.<br />

Rezultate: la debutul studiului componenta fizica<br />

(PCS-36) prezinta valori mai reduse comparativ cu<br />

cea mentala (MCS-36) atat la pacientii protezati aortic<br />

inclusi in program de reabilitare cardiaca cat si la<br />

cei din grupa de control, datorita deconditionarii fizice<br />

secundare bolii existente preoperator. Dupa faza II<br />

de recuperare cardiovasculara la grupa A s-a obtinut<br />

o evolutie favorabila a componentei PCS -36 (de la o<br />

valoare medie de 33.67±16.2 la 60.45±23, p


POSTER I<br />

POSTER I<br />

ved, patients who benefit from individual and standardized<br />

physical training had a significant improvement<br />

<strong>of</strong> physical condition and functional capacity, also <strong>of</strong><br />

mental condition, compared to the control group.<br />

41. Terapie de resincronizare<br />

cardiaca la un pacient cu<br />

forma avansata de displazie<br />

aritmogenica de ventricul drept<br />

si afectare a ventriculului stang<br />

R.G.Vatasescu, D.Dobreanu, C.N.Iorgulescu, Cristina<br />

Ioana Caldararu, Alexandra Vasile, Doina Dimulescu,<br />

Maria Dorobantu<br />

Spitalul Clinic de Urgenta Floreasca, Bucuresti<br />

Premize: displazia aritmogenica de ventricul drept<br />

(DAVD) este asociata cu MSC prin tahiaritmii, dar in<br />

formele avansate produce afectare de ventricul drept si<br />

uneori de ventricul stang.<br />

Scop: testarea efectelor TRC la un pacient cu insuficienta<br />

cardiaca (IC), QRS larg si disfunctie sistolica severa<br />

de VS prin DAVD cu afectare de VS.<br />

Metode: pacient de 43 ani, cu istoric de 15 ani de TV<br />

in contextul DAVD, purtator de DCI monocameral<br />

(ultima inlocuire de generator in urma cu 5 ani) a fost<br />

referit pentru insuficienta cardiaca clasa IV NYHA<br />

refractara (spitalizare continua de 3 saptamani). Pacientul<br />

era pe lista de transplant cardiac de un an fara<br />

donor compatibil. ECG-ul a aratat ritm sinusal, QRS<br />

larg (130ms). Verificarea DCI a aratat baterie in perioada<br />

de inlocuire electiva, absenta TV in ultimii 2 ani<br />

si stimulare de VD infrecventa (2%). Ecocardiografia a<br />

aratat dilatare si disfunctie severa de VD cu regurgitare<br />

tricuspidiana severa dar si disfunctie sistolica severa<br />

de VS (FEVS 32%) cu regurgitare mitrala moderat-severa<br />

si hipertensiune pulmonara moderata (PAPs 60<br />

mmHg). A fost obiectivata disincronie mecanica intra<br />

VS (SPWMD 170 ms, LWPSD 70 ms). Au fost implantate<br />

o sonda in AD (pe tavanul AD) si o sonda de VS (in<br />

vena postero-laterala stanga) si pacientul a fost upgradat<br />

la CRT-D.<br />

Rezultate: dupa o saptamana de TRC a existat o ameliorare<br />

clinica rapida cu trecerea in clasa II NYHA si<br />

remiterea aproape completa a semnelor de insuficienta<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

cardiaca dreapta. Acestea s-a asociat cu corectarea disincroniei<br />

intra VS si cresterea FEVS la 37%, reducerea<br />

IM si disparitia hipertensiunii pulmonare (PAPs 30<br />

mmHg). Aceste beneficii au persistat la controlul de 3<br />

luni, aparand si o usoara remodelare a VS (reducerea<br />

VTS VS cu 13%).<br />

Concluzii: acesta este primul caz in care se demonstreaza<br />

ca TRC poate fi eficienta la pacienti cu IC, QRS<br />

larg si afectare VS in cadrul unei DAVD avansate.<br />

Cardiac resynchronization<br />

therapy in a patient<br />

with advanced phase<br />

arrhythmogenic right ventricle<br />

cardiomyopathy and left<br />

vetricle involvement<br />

Background: Arrhythmogenic right ventricle cardiomyopathy<br />

(ARVC) is associated with SCD due to ventricular<br />

arrhythmias, but in advanced phase it produces<br />

RV failure and sometimes LV failure.<br />

Purpose: to test the effects <strong>of</strong> CRT in a patient with<br />

heart failure (HF), wide QRS and severe LV systolic<br />

dysfunction due to ARVC with LV involvement.<br />

Methods: A 43 years old patient with a 15 years history<br />

<strong>of</strong> VT due to ARVC, with a single-chamber ICD<br />

(last generator exchange 5 years ago), was referred for<br />

advanced, drug-refractory, NYHA class IV HF (he<br />

was continuously hospitalized in the last 3 weeks). He<br />

was on the heart transplant list on the last year without<br />

compatible donor. ECG showed sinus rhythm, with<br />

wide intrinsic QRS (130 ms) and ICD interrogation exhibited<br />

ERI <strong>of</strong> the device, no VT episodes in the last 2<br />

years and infrequent (


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

The benefit <strong>of</strong> therapy using<br />

renin-angiotensin system<br />

blockers in preventing<br />

recurrent atrial fibrillation in<br />

high risk hypertensive patients<br />

Objective: To assess the benefit <strong>of</strong> therapy using angiotensin<br />

converting enzyme inhibitors (ACEI) or angiotensin<br />

receptor blockers (ARB) in high risk hyperremission<br />

<strong>of</strong> signs <strong>of</strong> right heart failure. This was associated<br />

with elimination <strong>of</strong> LV asynchrony and improvement<br />

in LV systolic function (LVEF 37%), reduction<br />

<strong>of</strong> MR and disappearance <strong>of</strong> pulmonary hypertension<br />

(systolic PAP 30 mm Hg). These improvements persisted<br />

at 3 months follow-up, when there was also mild LV<br />

reverse remodeling (a 13% reduction in LV ESV).<br />

Conclusion: This is the first report demonstrating that<br />

CRT can be effective in patients with HF, wide QRS and<br />

LV systolic dysfunction due to advanced ARVC with<br />

LV involvement.<br />

42. Beneficiul terapiei cu<br />

blocanti ai sistemului reninaangiotensina<br />

in preventia<br />

recurentei fibrilatiei atriale la<br />

pacientii hipertensivi cu risc<br />

inalt<br />

Elisabeta Badila, Sabina Adriana Frunza, Lacramioara<br />

Dumitrache, Cristina Tirziu, Daniela Bartos, Maria<br />

Dorobantu<br />

Spitalul Clinic de Urgenta Floreasca, Bucuresti<br />

Obiectiv: Aprecierea beneficiilor tratamentului cu IEC<br />

sau BRA la pacientii hipertensivi cu risc inalt in reducerea<br />

riscului de aparitie a recurentelor fibrilatiei atriale<br />

(FiA).<br />

Metoda: Au fost inclusi 112 pacienti hipertensivi,<br />

care asociau si alti factori de risc CV majori (diabet,<br />

fumat, dislipidemie). La momentul includerii toti pacientii<br />

erau in ritm sinusal dar aveau documentat un<br />

episod de FiA in antecedente. Pacientii au fost urmariti<br />

in medie 12 luni. Pentru fiecare pacient s-au intregistrat<br />

date demografice, biochimice; TSH pentru excluderea<br />

unei disfunctii tiroidiene. Bazal si dupa 18 luni<br />

s-a efectuat ecocardiografie pentru aprecierea volumul<br />

atriului stang (AS), IMVS, pattern-ului fluxului diastolic<br />

transmitral si monitorizare simultana TA si ECG<br />

pe 24 ore pentru detectia tulburarilor de ritm asimptomatice.<br />

Diagnosticul de FiA s-a bazat pe inregistrarea<br />

obiectiva ECG in cazul pacientilor simptomatici sau pe<br />

inregistrarea Holter ECG la pacientii asimptomatici. 62<br />

pacienti au primit ca terapie antihipertensiva un IEC<br />

POSTER I<br />

POSTER I<br />

sau un BRA, la care s-a adaugat ulterior un diuretic<br />

in cazul lipsei de control a valorilor TA (grupul 1), iar<br />

50 pacienti au primit un blocant de canal calcic de tip<br />

dihidropiridinic, asociat la nevoie cu un beta-blocant<br />

(grupul 2).<br />

Rezultate: Nu au existat diferente semnificative intre<br />

cele 2 grupuri in ceea ce priveste varsta (52 ±7 ani vs<br />

54±6 ani, p ns), sexul masculin (59,6% vs 64%, p ns),<br />

incidenta diabetului (45% vs 44%, p ns), a fumatului<br />

(41,9% vs 38%, p ns) si a dislipidemiei (54,8% vs 54%,<br />

p ns). Diferentele intre cele 2 grupuri nu au fost semnificative<br />

la momentul bazal atunci cand am comparat<br />

volumul AS (39±9 vs 37±8 ml/m2), IMVS (85 ±8<br />

vs 86 ± 6 g/m2), pattern-ul diastolic (normal 22,5% vs<br />

26%; relaxare intarziata 56,4% vs 56%; pseudonormal<br />

21% vs 18%), media/24 h TAS (147,4±7,2 vs 147,9±6,4<br />

mmHg), media/24 h TAD (90,4±4 vs 90,8±4,5 mmHg)<br />

(p ns). Dupa 18 luni, diferentele au fost semnificative<br />

intre volumele AS (30±7 vs 35±7 ml/m2, p 0,01), IMVS<br />

(80 ±7 vs 85 ± 6 g/m2, p 0,01) si pattern-ul tip relaxare<br />

intarziata (40,3% vs 60%, p 0,05). Mediile valorilor<br />

tensionale au fost semnificativ mai mici in ambele<br />

grupuri comparativ cu momentul bazal, dar fara diferente<br />

statistic semnificative intre grupul 1 si 2 dupa 18<br />

luni de tratament (p ns). (132,8±7,1 vs 133,7±6,3 TAS;<br />

82,4±4,2 vs 82,1±4,2 TAD). Dupa 18 luni de urmarire,<br />

FiA a fost prezenta la 9,7% pacienti din grupul 1 si la<br />

24% in grupul 2 (p 0,05).<br />

Concluzii: Tratamentul cu blocanti ai sistemului renina-angiotensina<br />

la pacientii hipertensivi cu risc inalt<br />

reduce riscul de aparitie a fibrilatiei atriale si a recurentelor<br />

acesteia. Beneficiile terapiei se datoreaza probabil<br />

scaderii valorilor tensionale, ameliorarii disfunctiei diastolice<br />

si mai ales a efectelor benefice asupra remodelarii<br />

atriului stang.


POSTER I<br />

POSTER I<br />

tensive patients in decreasing atrial fibrillation (AF)<br />

recurrences.<br />

Methods: 112 hypertensive patients with other associated<br />

major CV risk factors (diabetes, smoking, dyslipidemia)<br />

were included. All <strong>of</strong> them had sinus rhythm<br />

at baseline, but have had medical records <strong>of</strong> AF. The<br />

mean follow-up was 18 months. The demographic and<br />

biochemical data were recorded for each patient; TSH<br />

determination was routinely used to exclude thyroid<br />

dysfunction. Echocardiography was performed at baseline<br />

and after 18 months in order to assess left atrial<br />

(LA) volume and mitral inflow Doppler pattern. 24 h<br />

blood pressure (BP) monitoring was indicated in each<br />

case. ECG Holter was performed at 6, 12 and 18 mo<br />

for asymptomatic rhythm disorders detection. AF diagnosis<br />

was based on objective ECG recording for<br />

symptomatic patients and Holter ECG recording for<br />

asymptomatic patients. 62 patients received ACEI or<br />

ARB as initial antihypertensive therapy and a diuretic<br />

was added in cases <strong>of</strong> uncontrolled BP (group 1). The<br />

other 50 patients received a dihydropyridine calcium<br />

blocker, associated, when needed, with a beta-blocker<br />

(group 2).<br />

Results: There weren’t significantly differences between<br />

the 2 groups concerning age (52±7 vs. 54±6 yrs), male<br />

gender (59,6% vs 64%), diabetes incidence (45% vs<br />

44%), smoking (41,9% vs 38%) and dyslipidemia(54,8%<br />

vs 54%)(p ns). The differences between 2 groups aren’t<br />

significant at baseline in terms <strong>of</strong> LA volume (39±9<br />

vs 37±8 ml/m2), LVMI 85±8 vs 86±6 g/m2, diastolic<br />

pattern (normal 22,5% vs 26%; abnormal relaxation<br />

56,4% vs 56%; pseudo-normal 21% vs 18%), mean/24<br />

h SBP (147,4±7,2 vs 147,9±6,4 mmHg, mean/24 h DBP<br />

(90,4±4 vs 90,8±4,5 mmHg)(p ns). After 18 mo, there<br />

were differences between LA volume (30±7 vs 35±7 ml/<br />

m2, p 0,01), LVMI(80 ±7 vs 85 ± 6 g/m2, p 0,01) and<br />

the prevalence <strong>of</strong> abnormal relaxation(40,3% vs 60%, p<br />

0,05). The mean BP values were significantly lower in<br />

both groups when compared with baseline, but without<br />

differences (p ns) between group 1 and 2(132,8±7,1 vs<br />

133,7±6,3 for SBP; 82,4±4,2 vs 82,1±4,2 for DBP). After<br />

18 mo <strong>of</strong> follow-up, AF was recorded in 9,7% patients<br />

from group 1 and 24% from group 2 (p 0,05).<br />

Conclusions: Renin-angiotensin system blockers therapy<br />

in high risk hypertensive patients decreases the<br />

risk <strong>of</strong> atrial fibrillation and its recurrences. The benefits<br />

<strong>of</strong> this therapy are based probably on decreasing<br />

BP and left ventricular mass index, improving diastolic<br />

dysfunction with positive changes on left atrial remodeling.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

43. Provocari terapeutice la<br />

pacientii cu tromb<strong>of</strong>ilie si boli<br />

cardiovasculare<br />

Ioana Raduta, I.Moscaliuc, B.Moscaliuc, Valeria Uscatescu,<br />

Melania Dinu<br />

Centrul Clinic de Urgenta de Boli Cardiovasculare al<br />

Armatei, Bucuresti<br />

Scopul lucrarii: Tratamentul cu hidroxiclorochin<br />

(Plaquenil) asociat tratamentului anticoagulant oral si<br />

antiagregant plachetar, previne recurenta evenimentelor<br />

trombotice la pacientii cu sindrom procoagulant si<br />

determinari trombotice in diverse teritorii( arteriale si<br />

venoase).<br />

Material si metoda: Am efectuat un studiu in perioada<br />

2008-2010 pe 30 pacienti internati in CCUBCVA cu<br />

tromb<strong>of</strong>ilie si determinari trombotice in diverse teritorii<br />

arteriale si venoase. In cadrul repartitiei pe sectie<br />

am observant preponderenta tomb<strong>of</strong>iliei la barbati (20<br />

pacienti-66%). Evenimentele trombotice s-au manifestat<br />

clinic ca infart miocardic acut cu coronare permeabile<br />

(9 pacienti-30%), TEP (5 pacienti-16,6%), TVP<br />

iterativa (12 pacienti- 40%), AVC (5 pacienti-16,6%),<br />

tromboza VCI (1 pacient-3,3%), tromboza aorta abdominala<br />

(1 pacient-3,3%), tromboza precoce intrastent<br />

(2 pacienti-6,66%), ocluzie precoce graft venos aorto<br />

coronarian (1 pacient-3.3%). In urma investigatilor<br />

hematologice specifice s-au evidentiat urmatoarele:<br />

sindrom antifosfolipidic-18 pacienti-60%, deficit de<br />

proteina C -9 pacienti-30%, deficit de proteina S- 10<br />

pacienti-33%, deficit de proteina C global-18 pacienti-60%.<br />

Bolnavii cu sindrom antifosfolipidic prezent<br />

cu evenimente trombotice in antecedente sub tratament<br />

antiagregant plachetar si anticoagulant au primit<br />

si tratament antipaludic de sinteza (hidroxiclorochin).<br />

Urmarind pacientii de 2 ani am observant reducerea<br />

recurentelor evenimentelor trombotice ca obiectiv primar<br />

ca si a reinternarilor si a cresterii calitatii vietii ca<br />

obictiv secundar.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Therapeutic challenges in<br />

patients with thrombophilia<br />

and cardiovascular diseases<br />

Aim: Treatment with hydroxychloroquine (Plaquenil)<br />

associated with oral anticoagulant and antiplatelet therapy<br />

prevents recurrence <strong>of</strong> thrombotic events in patients<br />

with procoagulant syndrom and thrombotic determinations<br />

in different territories (arterial and venous).<br />

Material and method: We conducted a study in 30<br />

patients hospitalized in 2008-2010 CCUBCVA with<br />

thrombophilia and thrombotic determinations in various<br />

arterial and venous territories. In the unit I noticed<br />

spreading tomb<strong>of</strong>iliei predominance in males (20<br />

patients, 66%). Thrombotic events were manifested<br />

clinically as acute coronary infarction infart permeable<br />

(9 patients, 30%), MET (5 patients-16, 6%), iterative<br />

DVT (12 patients, 40%), stroke (5 patients-16 6%),<br />

VCI thrombosis (one patient 3, 3%), abdominal aorta<br />

thrombosis (one patient 3, 3%), early thrombosis intrastent<br />

(two-six patients, 66%), early occlusion <strong>of</strong> aorto<br />

coronary venous graft (1 patient 3.3%). Haematological<br />

investigation revealed: antiphospholipid syndrome-18<br />

pacients-60%, protein C deficiency -9pac 30%, protein<br />

S deficiency- 10 patients-33%, protein C deficiency globally-18pacients-60<br />

%. Patients with antiphospholipid<br />

syndrome present with a history <strong>of</strong> thrombotic events<br />

antiplatelet and anticoagulation therapy and received<br />

treatment antipaludic synthesis (hydroxychloroquine).<br />

Following the patients for two years I have observed<br />

the reduceing <strong>of</strong> the recurrence <strong>of</strong> thrombotic events<br />

as primary objective and improvement <strong>of</strong> the quality <strong>of</strong><br />

life as secondary objective.<br />

44. Modul de viata si factorii de<br />

risc cardiovasculari la studentii<br />

de medicina<br />

Marta German-Sallo, Dalma Bálint-Szentendrey,<br />

Géza Dósa, Z.Preg, Mónika Szabó, Mihaela Hubatsch,<br />

Kinga Pál, Edith Domokos, Katalin Püsök<br />

Universitatea de Medicina si Farmacie, Targu Mures<br />

Bolile cardiovasculare reprezinta pe plan mondial principala<br />

cauza de morbiditate si mortalitate, Romania<br />

POSTER I<br />

POSTER I<br />

situandu-se pe loc fruntas din acest punct de vedere.<br />

Majoritatea imbolnavirilor se datoreaza acumularii<br />

factorilor de risc cardiovasculari. Cunoasterea, recunoasterea<br />

si tratamentul lor cat mai precoce, adica preventia<br />

cardiovasculara ar fi metoda optima de a influenta<br />

aceasta statistica sumbra in mod favorabil.<br />

Scopul lucrarii: Evaluarea prezentei si a cunoasterii<br />

factorilor de risc cardiovasculari legati de stilul de viata<br />

la studentii de medicina.<br />

Material si metoda: Cu ajutorul unor chestionare de<br />

evaluare am intrebat 200 de studenti de medicina (61<br />

baieti si 139 fete) despre alimentatie, acitivitate fizica,<br />

fumat, consum de alcool si droguri, stres respectiv i-am<br />

rugat sa enumere principalii factori de risc cardiovasculari.Completarea<br />

chestionarelor a fost anonima.<br />

Rezultate: 32% din studenti sunt fumatori, 20% consuma<br />

in mod cronic alcool, 35% mananca hipersodat,<br />

50% sunt sedentari si la 52% este prezent stresul.<br />

Concluzii: Majoritatea studentilor de medicina au deja<br />

unul, doi sau chiar mai multi factori de risc cardiovasculari<br />

legati de modul de viata.Evaluarea noastra a<br />

aratat ca nu au cunostinte apr<strong>of</strong>undate legate de acesti<br />

factori cu toate ca stim, ca preventia bolilor cardiovasculare<br />

presupune evidentierea si tratamentul factorilor<br />

de risc cardiovasculari. Mesajul cel mai important al<br />

lucrarii noastre ar fi acela, ca sa se acorde o mai mare<br />

atentie acumularii cunostintelor de medicina preventiva<br />

in timpul anilor de facultate la medicina.<br />

Lifestyle and cardiovascular<br />

risk factors among medical<br />

students<br />

Cardiovascular diseases are the main causes <strong>of</strong> morbidity<br />

and mortality worldwide, Romania being one <strong>of</strong><br />

the leading countries from this pont <strong>of</strong> view, due to cardiovascular<br />

risk factor accumulation. Knowledgement,<br />

recognising and treatment <strong>of</strong> these risk factors-cardiovascular<br />

prevention-would be the ideal way <strong>of</strong> changing<br />

these bad statistics.<br />

Objectives: Evaluation <strong>of</strong> presence and awareness <strong>of</strong><br />

lifestyle related cardiovascular risk factors among medical<br />

students.<br />

Material and methods: 200 medical students (61 boys<br />

and 139 girls) answered anonimously a questionnare<br />

which contained questions about eating habits, physical<br />

activity, smoking, alcohol and drug consumption,


POSTER I<br />

POSTER I<br />

stress and we asked them to enumarate the most important<br />

cardiovascular risk factors.<br />

Results: 32% <strong>of</strong> the students are smokers, 20% consume<br />

alcohol,35% eat salted, 50% are sedentars and 52%<br />

are stressed.<br />

Conclusion: The majority <strong>of</strong> medical students have<br />

one, two or even more lifestyle related cardiovascular<br />

risk factors. Our evaluation shows, that their<br />

knowledgement related to these factors is not well<br />

founded, although we know, that cardiovascular disease<br />

prevention presume screening and treatment <strong>of</strong><br />

cardiovascular risk factors. According more importance<br />

to accumulation <strong>of</strong> preventive medicine knowledges<br />

during medical school would be the most important<br />

message <strong>of</strong> our study.<br />

45. Corelatia prognostica intre<br />

valoarea BNP la internare si<br />

evolutia pacientului coronarian<br />

in edemul pulmonar acut<br />

cardiogen<br />

Paloma Manea, Simona Ionescu, C.Rezus, R.Artenie,<br />

Daniela Tanase, Anca Ouatu, Raluca Arhirii,<br />

V.Ambarus, Elena Mitrea, Codruta Badescu, Mariana<br />

Floria<br />

Universitatea de Medicina si Farmacie “Gr.T. Popa”,<br />

Iasi; Spitalul de Urgente “Sf Spiridon”, Iasi<br />

Scopul lucrarii: valoarea crescuta a BNP > 900 pg/ml<br />

in insuficienta cardiaca acuta este asociata cu risc crescut<br />

de mortalitate pe termen scurt si lung, indiferent de<br />

severitatea afectarii coronariene.<br />

Material si metoda: studiul a inclus 85 de pacienti coronarieni<br />

internati in clinica a III-a Medicala, Spitalul<br />

de urgenta ”Sf. Spiridon” Iasi, in perioada ianuarie<br />

2009-ianuarie 2010, cu edem pulmonar acut cardiogen.<br />

Criteriile de excludere au fost : comorbiditatile severe<br />

asociate (boala renala cronica in stadii avansate, neoplazii,<br />

sepsis, bronhopneumonie)<br />

Rezultat: S-au efectuat: examen clinic, determinari biochimice,<br />

hematologice, electrocardiograma, ecocardiografie<br />

transtoracica, determinarea CPK, CKPMB,<br />

TnI, BNP, mioglobina. Edemul pulmonar acut a fost<br />

documentat clinic si radiologic la toti pacientii. Valo-<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

rile BNP la cei 85 de pacienti s-au situat intre 284pg /<br />

ml si 5000pg/ml ( 35 u; prezentat valori > 900 pg /ml).<br />

Un numar de 16 pacienti au necesitat suport ventilator<br />

mecanic si inotrop pozitiv. Pacientii au fost reevaluati<br />

la externare, la o luna, 3 luni si respectiv 6 luni. Din<br />

cei 30 de pacienti (35%) care au prezentat la internare<br />

valoarea BNP > 900pg/ml, 11 (13%) au decedat in<br />

primele 72 ore; ceilalti 19 pacienti au fost reevaluati la<br />

externare, la o luna (5 decese ), la 3 luni (4 decese), la<br />

6 luni (2 decese), totalizand 13% mortalitate pe termen<br />

lung. Din grupul initial de la internare, 55 de pacienti<br />

(65%) au avut valoarea BNP < 900pg/ml. La acesti pacienti<br />

mortalitatea in primele 72 de ore a fost de 3.5%<br />

(3 pacienti), pe termen lung (total decese dupa: 1 luna,<br />

3 luni, 6 luni) 7% (6 pacienti), fara a exista o corelatie<br />

cu severitatea afectarii coronariene.<br />

Concluzii: pacientii cu afectare coronariana severa documentata,<br />

care au prezentat la internare edem pulmonar<br />

acut cardiogen cu valori ale BNP 900 pg/ml.<br />

Dupa cum au demonstrat numeroasele studii efectuatein<br />

ultimii ani, valoarea BNP in insuficienta cardiaca<br />

acuta prezinta sensibilitate si specificitate inalta; ea<br />

este corelata direct cu mortalitatea coronarienilor pe<br />

termen scurt si lung, aceasta din urma fiind mai putin<br />

modificabila prin alti parametri utilizati in evaluarea<br />

prognosticului.<br />

The correlation between<br />

BNP value at admission, in<br />

acute cardiogenic pulmonary<br />

oedema and the evolution <strong>of</strong><br />

the coronary patients<br />

Paper’s purpose: the increased value <strong>of</strong> BNP > 900 pg/<br />

ml in acute heart failure is associated with a high risk <strong>of</strong><br />

short and long term mortality, irrespective to the severity<br />

<strong>of</strong> the coronary disease.<br />

Materials and methods: the study included 85 coronary<br />

patients hospitalized in 3rd Medical Clinic <strong>of</strong> the<br />

“St. Spiridon” Emergency Hospital, Iasi, during January<br />

2009 - January 2010, with acute cardiogenic pulmonary<br />

oedema. The exclusion criteria were: associated severe<br />

comorbidities (advanced chronic renal disease, neoplasia,<br />

sepsis and bronchopneumonia).


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Results: We have performed: clinical examination, biochemical<br />

and hematological tests, electrocardiogram,<br />

transthoracic echocardiography, CPK, CPKMB, TnI,<br />

BNP and myoglobin tests. The acute pulmonary oedema<br />

was certified clinically and radiologically for all<br />

patients. The BNP values for all 85 patients were between<br />

284 pg/ml and 5000 pg/ml (35% presented values<br />

> 900 pg/ml). 16 patients required mechanical ventilation<br />

and positive inotropic support. All patients were<br />

reevaluated at discharge, after 1, 3 and 6 months. Out <strong>of</strong><br />

30 patients (35%) who presented, at admission, a BNP<br />

value > 900 pg/ml, 11 (13%) deceased during the first<br />

72 hours; other 19 patients were reevaluated at discharge,<br />

after 1 month (5 deaths), after 3 months (4 deaths),<br />

after 6 months (2 deaths), summing up to 13% long<br />

term mortality. Among the initial group <strong>of</strong> patients, 55<br />

(65%) had BNP value < 900 pg/ml. In this group, the<br />

mortality during the first 72 hours was 3.5% (3 patients)<br />

and long term (total deaths after 1, 3, 6 months),<br />

as follows: 7% (6 patients), with no correlation with the<br />

severity <strong>of</strong> the coronary disease.<br />

Conclusions: Patients having certified severe coronary<br />

disease, who presented, at admission, acute cardiogenic<br />

pulmonary oedema with BNP values < 900 pg/ml, had<br />

a better evolution compared to those with less severe<br />

coronary disease, but having BNP > 900 pg/ml. As proven<br />

by multiple studies in the past years, BNP value in<br />

acute heart failure presents high sensibility and specificity;<br />

it is directly correlated to short and long term<br />

mortality <strong>of</strong> patients with ischemic heart disease, the<br />

latter being less modifiable by other parameters used in<br />

evaluating the prognosis.<br />

POSTER I<br />

POSTER I<br />

Metode: In studiu am introdus consecutiv 70 de pacienti,<br />

cu sau fara fibrilatie atriala, dar cu aria AS peste<br />

20 cm2. Grupul de studiu (2) a inclus pacientii cu AS<br />

remodelat asimetric, restul constituind lotul de control<br />

(1). Remodelarea asimetrica a fost definita prin dimensiunea<br />

de la nivelul jonctiunii AS cu venele pulmonare,<br />

mai mare decat cea de la nivelul inelului mitral. Am<br />

evaluat volumul indexat al AS si gradul de corelatie in<br />

cele 2 grupuri a unor parametri ecografici (PW, TDI)<br />

masurati la nivelul peretelui lateral atrial (S, E, A) si venelor<br />

pulmonare (S, D).<br />

Rezultate: Varsta medie a fost 69 vs 68 ani, IMC mediu<br />

a fost 27.7 vs 26.6 kg/cm2, 60 vs 51% dintre pacienti<br />

au fost de sex masculin. Fractia de ejectie in grupul 1<br />

vs 2 a fost de 47 vs 49%. In 70% din cazuri AS a fost<br />

asimetric remodelat. Volumul mediu indexat a fost 46.6<br />

ml/m2 vs 42 ml/m2, fiind semnificativ statistic corelate<br />

(r=0.837, pD iar in grupul 2<br />

S0.05). Atat<br />

pentru pacientii in FA cat si pentru cei din grupul de<br />

studiu media peak-ului velocitatii diastolice a fluxului<br />

in venele pulmonare a fost semnificativ mai mare decat<br />

a celei sistolice (46 cm/s vs 39 cm/s, respectiv 48 cm/s<br />

vs 43 cm/s; p


POSTER I<br />

POSTER I<br />

fined as basal dimension, at the level <strong>of</strong> the atrium-pulmonary<br />

veins junction, greater than the mitral annular<br />

dimension. We assessed indexed LA volume and the<br />

correlation between two groups <strong>of</strong> some PW and TDI<br />

parameters measured on the lateral LA wall (S,E,A)<br />

and pulmonary veins (S,D).<br />

Results: Mean age was 69 vs 68 years, mean BMI was<br />

27.7 vs 26.6 kg/cm2, 60 vs 51% were men. Ejection fraction<br />

in group 1 vs 2 was 47% vs 49%. An asymmetrical<br />

remodelation was present in 70% <strong>of</strong> patients. Mean<br />

indexed volume was 46.6 ml/m2 and 41.9 ml/m2, respectively,<br />

and were statistically correlated (r=0.837,<br />

pD and in group 2 S0.05). Either for<br />

patients in atrial fibrillation and LA asymmetrical remodelled<br />

mean D was greater than mean S (46cm/s vs<br />

39cm/s and 48 cm/s vs 43cm/s, respectively; p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

<strong>of</strong> the more powerfull predictors <strong>of</strong> bad prognosis at<br />

patients with heart failure.<br />

Objective: To establish the relevance <strong>of</strong> BMI variation<br />

for heaart failure patients’ prognosis.<br />

Methods: We included 455 patients admitted for heart<br />

failure (according Framingham criterias) at Institututul<br />

de Urgenta pentru Boli Cardiovasculare”Pr<strong>of</strong>. Dr. C.C.<br />

Iliescu” between 1.01 and 31.12.2004. We followed these<br />

patients for 4 years (48±12 months). We analyzed<br />

evolution <strong>of</strong> BMI the year before inclusion <strong>of</strong> patients.<br />

As cardiovascular events at this patients were followed<br />

total number <strong>of</strong> deaths, cardiovascular death and readmissions<br />

for aggravation <strong>of</strong> heart failure.<br />

Results: BMI was above 25 kg/m2 at 246 (54.06%) <strong>of</strong><br />

the patients. At these patients functional class <strong>of</strong> heart<br />

failure was less severe (class NYHA≥III at 57.32% <strong>of</strong><br />

patients vs. 72.25% at patients with BMI < 25 kg/m2,<br />

p=0.001); Also, ejection fraction was higher (38.12 ±<br />

9,96% vs. 31.94 ± 9.21%, p=0.001) and seum BNP was<br />

lower (665.78 ± 659.08 ng/dl vs. 906.37 ± 830.58 ng/dl,<br />

p=0.001). Altrough total number <strong>of</strong> deaths was loer at<br />

patients with BMI above 25 kg/m2 (12.6% vs. 27.75%,<br />

p=0.002), this difference was nonsignificant at multivariate<br />

analysis. The difference between total number <strong>of</strong><br />

cardiovascular events was nonsignificant, too (36.57%<br />

vs. 44.98%). At the patients with cardiovascular events<br />

the BMI variation up against the year before was statistic<br />

significant from the patients withhout cardiovascular<br />

events at ubivariate and multivariate analysis<br />

(-0.97±0.68 kg/m2 vs. +0.52 ±0.69 kg/m2 p=0.0001).<br />

Conclusions: Body mass index variation is a powerfull<br />

risk predictor at the patients with heart failure. A<br />

weight decrease <strong>of</strong> the patients is prediction factor for<br />

death <strong>of</strong> any cause, cardiovascular death and aggravation<br />

<strong>of</strong> heart failure.<br />

48. Sindrom KOUNIS tip I la o<br />

tanara femeie dupa intepaturi<br />

multiple de albina<br />

Catalina Lionte, Laurentiu Sorodoc, O.R.Petris, Victorita<br />

Sorodoc, Cristina Bologa<br />

Universitatea de Medicina si Farmacie “Gr.T.Popa”, Iasi<br />

POSTER I<br />

POSTER I<br />

edem subcutanat la anafilaxie severa. Afectarea cardiaca<br />

constituie o complicatie cu risc vital. Vasospasmul<br />

coronarian si infarctul miocardic secundar reactiilor<br />

alergice au fost descrise din 1991 ca sindromul Kounis,<br />

secundar degranularii mastocitelor. Au fost descrise<br />

doua tipuri de sindrom Kounis. Tipul I include pacienti<br />

cu artere coronare normale, la care reactia alergica<br />

acuta induce fie spasm coronarian cu angina instabila,<br />

fie vasospasm coronarian ce evolueaza spre infarct miocardic<br />

acut. Aceasta varianta reprezinta o manifestare<br />

a disfunctiei endoteliale. Tipul II de sindrom Kounis<br />

include pacienti cu leziuni ateromatoase preexistente,<br />

dar oculte, silentioase, la care episodul alergic acut induce<br />

eroziunea sau ruptura placii, manifestata ca infarct<br />

miocardic acut. Prezentam cazul unei tinere de 27<br />

ani, fara factori de risc pentru boala coronariana sau<br />

antecedente patologice, care dezvolta, dupa mai multe<br />

intepaturi de albina, urticarie generalizata si edem<br />

palpebral, urmate de durere retrosternala iradiata in<br />

ambele brate, insotita de greturi si varsaturi. Examenul<br />

clinic releva TA 90/70 mmHg, puls 145/minut regulat.<br />

Electrocardiograma (ECG) evidentiaza modificari de<br />

ischemia miocardica acuta. Saturatia de oxigen a fost<br />

90%, enzimele cardiace, troponinele si tensiunea arteriala<br />

au ramas in limite normale. IgE au fost 205 IU/ml si<br />

triptaza a crescut la 27 μg/l (normal 5.6–13.5 μg/l), iar<br />

eozin<strong>of</strong>ilele au fost de 9%. Am diagnosticat pacienta cu<br />

sindrom Kounis tip I. Tratamentul a constat in bolus de<br />

500 mg hemisuccinat de hidrocortizon, 50 mg ranitidina<br />

IV, si 50 mg difenhidramina per os. Ulterior a fost<br />

transferata in clinica, unde a primit perfuzie cu nitroglicerina<br />

30 μg/min. Nu s-a efectuat tromboliza deoarece<br />

enzimele cardiace au fost normale. Starea pacientei<br />

s-a imbunatatit in urmatoarele 24 ore, iar ECG s-a<br />

normalizat in 9 ore. Ecocardiografia a evidentiat fractia<br />

de ejectie normala, fara tulburari de kinetica segmentara.<br />

Pacienta a refuzat coronarografia. A fost externata<br />

dupa 48 ore, complet asimptomatica, cu ECG si teste<br />

de laborator normale. Recomandam ca la pacientii cu<br />

intepaturi de Hymenoptera sa se efectueze de rutina<br />

ECG, chiar in absenta unei reactii alergice definite, sau<br />

chiar in lipsa unui istoric de boala cardiaca ischemica.<br />

Reactiile de hipersensibilizare dupa intepaturi de Hymenoptera<br />

pot merge de la urticarie simpla si angio-


POSTER I<br />

POSTER I<br />

KOUNIS syndrome type I in<br />

a young woman after multiple<br />

bee stings<br />

Hypersensitivity reactions from hymenoptera stings<br />

may range from simple urticaria and subcutaneous angioedema<br />

to severe anaphylaxis. Cardiac involvement<br />

constitutes a life threatening complication. Coronary<br />

vasospasm and myocardial infarction (MI) secondary<br />

to allergic reactions have been described since 1991 as<br />

the Kounis syndrome, induced by mast cells degranulation.<br />

There are two types <strong>of</strong> Kounis syndrome. Type<br />

I includes patients with normal coronary arteries in<br />

whom the acute allergic insult induces either coronary<br />

artery spasm leading to unstable angina or coronary<br />

vasospasm progressing to acute MI. This variant might<br />

represent a manifestation <strong>of</strong> endothelial dysfunction.<br />

Kounis syndrome type II includes patients with preexisting,<br />

albeit occult, atheromatous disease, in whom<br />

acute allergic episode induce plaque erosion or rupture<br />

manifesting as acute MI. We report the case <strong>of</strong> a<br />

27-years old woman, with no risk factors or history <strong>of</strong><br />

coronary artery disease, who developed a generalized<br />

urticarial reaction and orbital oedema, after she was<br />

stung several times by bees, followed by retrosternal<br />

pain radiating to both arms associated with nausea and<br />

vomiting. On clinical evaluation, BP was 90/70 mm Hg<br />

with regular pulse 145 beats/ min. Electrocardiogram<br />

(ECG) showed changes <strong>of</strong> acute myocardial ischemia.<br />

Oxygen saturation was 90%, cardiac enzymes, troponins<br />

and BP remained normal. Total IgE was elevated<br />

to 205 IU/ml, tryptase levels were raised to 27 μg/l<br />

(normal 5.6–13.5 μg/l) and eosinophils were 9%. The<br />

patient’s diagnosis was type I Kounis syndrome. Patient<br />

received a bolus <strong>of</strong> 500 mg <strong>of</strong> hydrocortisone succinate,<br />

50 mg ranitidine IV, and 50 mg <strong>of</strong> diphenydramine<br />

per os. After admission in clinic, she received an infusion<br />

<strong>of</strong> nitroglycerin 30 μg/min. Thrombolysis was<br />

not attempted because cardiac enzymes were normal.<br />

During the following 24 h the patient’s condition improved<br />

and the ECG changes resolved within 9 hours.<br />

Echocardiography revealed normal ejection fraction<br />

without wall motion abnormalities. Patient refused<br />

angiography. She was discharged 48 hours later being<br />

completely asymptomatic, with normal ECG and lab<br />

tests. Our recommendation in a case <strong>of</strong> hymenoptera<br />

envenomation is to perform a standard ECG, even in<br />

the absence <strong>of</strong> a clearly defined allergic reaction, and<br />

even if the patient does not present pre-existing coronary<br />

artery disease.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

49. Monitorizarea oximetriei<br />

viscerale in chirurgia cardiaca<br />

D. Arhire, M. Patrut, Nicoleta Arhire, E. Rachita,<br />

Cristina Grosu, C. Ardeleanu, B. Cornea, V. Pop, R.<br />

Vasilescu, Cristina Voinea, Olimpia Manta, V. Ispas, E.<br />

Oclei<br />

Spitalul Clinic Judetean de Urgenta, Constanta<br />

Obiectivele studiului: determinarea benficiilor clinice<br />

si economice in utilizarea precoce a oximetriei viscerale<br />

Material si metoda: studiul a cuprins un lot de 70 de<br />

pacienti la care s-a folosit aparatul INVOS OXIME-<br />

TER 5100C, in cadrul operatiilor ce au implicat circulatie<br />

extracorporeala, in perioada ianuarie 2009- mai<br />

2010 in cadrul Clinicii de Chirurgie Cardiovasculara<br />

din Spitalul Judetean Constanta<br />

Rezultate: monitorizarea oximetriei viscerale a evaluat<br />

functia cerebrala la pacientii sedati, a dat informatii<br />

despre perfuzia cerebrala, informatiile obtinute fiind<br />

regionale nu globale.Tinta studiului a fost de a evidentia<br />

in ce mod utilizarea oximetriei cerebrale poate duce<br />

la evitarea desaturarii cerebrale si la evitarea declinului<br />

neurologic.<br />

Monitoring <strong>of</strong> visceral<br />

oximetry in cardiac surgery<br />

Objectives: to determine clinical and economical benefits<br />

<strong>of</strong> the early use <strong>of</strong> visceral oximetry.<br />

Material and method: the study included 70 patients<br />

in which we used the INVOS OXIMETER 5100 C,<br />

during extracorporeal circulation surgeries, between<br />

January 2009 – May 2010.<br />

Results: monitoring <strong>of</strong> visceral oximetry evaluated cerebral<br />

function in sedated patients, gave information<br />

about the cerebral perfusion, these being regional, not<br />

global. The target <strong>of</strong> the study is to asses the way cerebral<br />

oximetry can lead to avoid cerebral desaturation<br />

and neurological injury.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

50. Particularitati ale<br />

administrarii trombolizei la<br />

pacientii cu infarct miocardic<br />

acut transmural (IMA) in<br />

judetul Constanta – studiu<br />

prospectiv pe o perioada de 4<br />

ani<br />

Irinel Raluca Parepa, Violeta Jitari, Violeta Nicoleta<br />

Miu, M.Toringhibel, Elvira Craiu<br />

Universitatea “Ovidius”, Constanta<br />

Introducere: In judetul Constanta unica modalitate de<br />

reperfuzie miocardica de urgenta la pacientii cu IMA<br />

este tromboliza – in singura unitate de terapie intensiva<br />

coronariana (UTIC) din acest judet.<br />

Scop: evaluarea precocitatii instituirii tratamentului<br />

(trombolitic sau conservator) si urmarirea frecventei<br />

utilizarii trombolizei la pacientii cu IMA din judetul<br />

Constanta.<br />

Metoda: Studiul s-a desfasurat pe o perioada de 4 ani<br />

(1 ian 2006-31 dec 2009) si a inclus toti pacientii cu<br />

diagnostic de IMA prezentati consecutiv la Camera de<br />

garda si internati in UTIC. S-au urmarit: ora de debut<br />

a simptomelor, ora prezentarii la Camera de garda, ora<br />

inceperii tratamentului in UTIC, tipul de tratament si<br />

tipul de trombolitic utilizat. Datele obtinute au fost prelucrate<br />

separat pentru fiecare an de studiu.<br />

Rezultate: In perioada studiata, din cei 1086 subiecti<br />

cu IMA 56,90% au primit tromboliza. De la an la an<br />

procentul pacientilor trombolizati are o tendinta crescatoare.<br />

Timpul mediu de la debutul simptomelor<br />

pana la prezentarea la camera de garda are o tendinta<br />

descrescatoare: 12,93 ore (2006); 10,84 ore (2007);<br />

4,21 ore (2008); 4 ore (2009). Acelasi timp mediu are<br />

deasemenea o tendinta descrescatoare la pacientii care<br />

au beneficiat de tromboliza: 3,25 ore (2006); 3,18 ore<br />

(2007); 2,68 ore (2008); 2,39 ore (2009). Timpul mediu<br />

scurs de la internare pana la administrarea tromboliticului<br />

are o tendinta descrescatoare: 38,28±12,9min<br />

(2006); 37,14±21,05min (2007); 33,98±18,3min (2008);<br />

25,02±15,49min (2009). Prezentarea tardiva a pacientilor<br />

este principalul motiv de neadministrare a trombolizei<br />

(40,6% cazuri), urmat la distanta semnificativa<br />

(p=0,023) de: varsta >75 de ani (26,5%), HTA severa<br />

(15,38%), alte contraindicatii absolute (17,52%). Strep-<br />

POSTER I<br />

POSTER I<br />

tokinaza este cel mai utilizat agent trombolitic; am<br />

constatat insa o tendinta ascendenta a folosirii reteplazei,<br />

semnificativa statistic in ultimii 3 ani ai studiului<br />

(p=0,02).<br />

Concluzii: In judetul Constanta, timpul mediu de la<br />

debutul simptomelor pana la prezentarea la camera de<br />

garda a pacientilor cu IMA trombolizati scade cu ~1<br />

ora din 2006 pana in 2009, iar timpul mediu de la internare<br />

si pana la instituirea trombolizei scade cu ~7<br />

minute din 2006 pana in 2009; insa, pentru ambele situatii,<br />

diferentele nu sunt semnificative de la an la an<br />

(p>0,05); timpii evaluati sunt, in oricare an al studiului,<br />

peste media europeana.<br />

Specific features <strong>of</strong><br />

thrombolysis treatment in<br />

patients with ST-Elevation<br />

Myocardial Infarction (STEMI)<br />

in Constanta County, Romania<br />

– 4 years prospective study<br />

Background: In Constanta County, Romania, there<br />

is only one Intensive Cardiac Care Unit (ICCU); here,<br />

thrombolysis is the only emergency coronary revascularization<br />

method available for STEMI patients.<br />

Aim: to evaluate STEMI treatment initiation (either<br />

conservatory or thrombolytic) and to quantify the use<br />

<strong>of</strong> thrombolysis in Constantza County.<br />

Method: Our study was performed during 4 years<br />

(1st <strong>of</strong> January 2006 – 31st <strong>of</strong> December 2009). It included<br />

all consecutive STEMI patients diagnosed at<br />

<strong>Cardiology</strong> Emergency Unit and admitted in Constanta<br />

County ICCU. We noticed the time <strong>of</strong> symptoms’<br />

onset, the time <strong>of</strong> patients’ presentation to <strong>Cardiology</strong><br />

Emergency Unit, the time <strong>of</strong> treatment’s initiation in<br />

ICCU and the type <strong>of</strong> treatment received by patients.<br />

We separately analyzed data for each one <strong>of</strong> the 4 years<br />

studied.<br />

Results: Among the 1086 subjects diagnosed with<br />

STEMI during the study period, 56.90% received<br />

thrombolysis. The percentage <strong>of</strong> thrombolysed STEMI<br />

patients has an ascendig trend from 2006 to 2009. Average<br />

time from symptoms onset until Emergency Unit<br />

presentation has a descending trend: 12.93 hrs in 2006,<br />

10.84 hrs in 2007, 4.21 hrs in 2008 and 4 hrs in 2009.


POSTER I<br />

POSTER I<br />

The same average time has a descending trend in patients<br />

who received thrombolysis: 3.25 hrs in 2006, 3.18<br />

hrs in 2007, 2.68 hrs in 2008 and 2.39 hrs in 2009. Average<br />

time from admission until thrombolysis (“door-toneedle”<br />

time) has a descending trend: 38.28±12.9min<br />

in 2006; 37.14±21.05min in 2007; 33.98±18.3min in<br />

2008; 25.02±15.49min in 2009. The main reason for<br />

not giving thrombolysis is late presentation <strong>of</strong> patients<br />

(40.6% <strong>of</strong> cases), followed at a significant distance<br />

(p=0.023) by: age>75 (26.5%), severe high blood pressure<br />

(15.38%) and other absolute contraindications<br />

(17.52%). Streptokinase is the most used thrombolytic<br />

agent, but we noticed a significant (p=0.02) ascending<br />

trend <strong>of</strong> reteplase usage in the last 3 years <strong>of</strong> our study.<br />

Conclusion: In Constanta County, the average time<br />

from symptoms onset until Emergency Unit presentation<br />

<strong>of</strong> STEMI patients who received thrombolysis decreases<br />

with almost 1 hour from 2006 to 2009; average<br />

“door-to-needle” time decreases with almost 7 minutes<br />

from 2006 to 2009; the differences have no significance<br />

(p>0.05) for both ituations. The evaluated average times<br />

are situated beneath equivalent European times in<br />

either studied year.<br />

51. Infarctul miocardic acut<br />

posttraumatic<br />

Adelina Mavrea, D.Lighezan, I.Citu, I.Petru,<br />

A.Militaru, M.Andor, M.Slovenski, C.Ivanescu, M.C.<br />

Tomescu<br />

Universitatea de Medicina si Farmacie, Timisoara<br />

Incidenta infarctului miocardic acut posttraumatic este<br />

foarte scazuta, cele mai multe cazuri fiind raportate in<br />

urma efectuarii autopsiei. Diagnosticul precoce este dificil,<br />

datorita semnelor clinice nespecifice, dominate de<br />

simptomatologia indusa de traumatismul toracic. Mecanismele<br />

de producere ale infarctului miocardic acut<br />

postraumatic pot fi: disectia coronara, tromboza intraluminala,<br />

spasmul vascular, ruptura placii de aterom.<br />

Urmatoarea prezentare de caz doreste sa evidentieze<br />

dificultatea diagnosticului in aceste situatii; un tanar<br />

de 27 de ani este adus de urgenta in serviciul de neurochirurgie,<br />

dupa un traumatism complex, cauzat de o<br />

cadere de pe acoperisul casei. Pacientul a fost in coma<br />

pr<strong>of</strong>unda timp de o saptamana. aealectrocardiograma<br />

efectuata in acest timp evidentiaza un aspect de infarct<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

niocardic acut anteroseptal. Datorita absentei factorilor<br />

de risc cardiovascular, durerea toracica a fost trecuta cu<br />

vederea. Afectarea cerebrala a avut o evolutie buna, cu<br />

ameliorare fara sechele, pacientul fiind indrumat spre<br />

tratarea fracturii mandibulare. consultul cardiologic<br />

preoperator, a descris pe electrocardiograma un aspect<br />

de infarct miocardic recent, cu bloc major de ramura<br />

dreapta.Ecocardiografic s-a evidentiat un tromb intraventricular<br />

(2,5/3cm) cu anevrism ventricular stang.<br />

Coronarografia efectuata dupa o luna de la evenimentul<br />

traumatic descrie artere coronare normale. Acest<br />

caz evidentiaza importanta interpretarii electrocardiogramei<br />

la pacienti cu traumatism toracic, chiar in absenta<br />

factorilor de risc cardiovascular.<br />

Post-traumatic acute<br />

myocardial infarction<br />

The incidence <strong>of</strong> post-traumatic acute myocardial infarction<br />

is very low, most <strong>of</strong> the cases being reported<br />

after autopsy. The early diagnosis is difficult because <strong>of</strong><br />

nonspecific clinical findings, dominated by the symptoms<br />

<strong>of</strong> thoracic injury. The mechanism <strong>of</strong> acute myocardial<br />

infarction could be: coronary artery dissection,<br />

intraluminal thrombosis, vascular spasm at the site <strong>of</strong><br />

injury, atherosclerotic plaque rupture. The next case<br />

presentation illustrates the difficulties <strong>of</strong> the diagnosis<br />

in this situation: A patient, 27 years old, arrived by<br />

emergency in a neurosurgical department after a complex<br />

politraumatic injury caused by falling from the<br />

ro<strong>of</strong> <strong>of</strong> a house. The patient was in a deep coma for a<br />

week. ECG performed at that time showed acute anteroseptal<br />

myocardial infarction. Because to the absence<br />

<strong>of</strong> any cardiovascular risk factors, the chest pain was<br />

interpreted due to the chest trauma and the ECG aspect<br />

was overlooked. The cerebral trauma improved without<br />

neurological sequelae and the patient was sent for<br />

resolving a mandible fracture. At cardiological presurgery<br />

investigation, the interpretation <strong>of</strong> ECG showed<br />

the aspect <strong>of</strong> recent myocardial infarction with complete<br />

right bundle branch block. At echocardiography,<br />

an intraventricular thrombus (2,5/3cm) in an aneurismal<br />

area <strong>of</strong> the left ventricle was found. The coronarography<br />

done a month after the chest trauma revealed<br />

normal coronary arteries. This case highlights the importance<br />

<strong>of</strong> proper ECG interpretation in patients after<br />

chest trauma, even without cardiovascular risk factors.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

52. Factori corelati cu cresterea<br />

mortalitatii in insuficienta<br />

cardiaca acuta<br />

Anca Iulia Popa, F.Adam, Raluca Ciomag, Catalina<br />

Andrei Calin, Crina Julieta Sinescu<br />

Spitalul Clinic de Urgenta "Pr<strong>of</strong>.Dr. Bagdasar-Arseni",<br />

Bucuresti<br />

Insuficienta cardiaca acuta este una din afectiunile cu o<br />

mortalitate ridicata, insuficient controlata de actualele<br />

demersuri terapeutice.<br />

Obiectiv: Cercetarea corelatiei intre mortalitatea din<br />

insuficienta cardiaca acuta(ICA) si etiologia acesteia,<br />

tipul disfunctiei ventriculare si valorile probelor biologice<br />

reflectand functia hepatica si renala.<br />

Material si metoda: Am luat in studiu 196 pacienti cu<br />

ICA internati in 2008-2009, 90 dintre acestia cu ICA<br />

aparuta de novo si 106 pacienti cu acutizarea unei insuficiente<br />

cardiace cronice preexistente. Am stabilit etiologia<br />

ICA si gradul afectarii functiei sistolice si diastolice<br />

a ventriculului stang(VS), ecocardiografic transtoracic,<br />

prin masurarea fractiei de ejectie –FE, a raportului<br />

undelor E si A la nivelul fluxului mitral, determinarea<br />

timpului de decelerare a undei E –DTE, a timpului de<br />

relaxare izovolumetrica – TRI si a raportului undelor<br />

sistolica si diastolica la nivelul fluxului venos pulmonar<br />

(Fvp) - la 58% din pacienti. Am notat nivelurile<br />

serice ale transaminazelor (TGO, TGP), bilirubinei si<br />

creatininei. Am urmarit mortalitatea intraspitaliceasca<br />

si relatia ei cu etiologia ICA, cu tipul disfunctiei ventriculare<br />

si cu prezenta afectarii functiei hepatice si/sau<br />

renale.<br />

Rezultate: Mortalitatea in randul populatiei studiate<br />

cu ICA a fost de 10,7% (21p). Nu au existat diferente<br />

semnificative de mortalitate intre pacientii cu ICA instalata<br />

de novo si cei cu acutizare a unei insuficiente<br />

cardiace preexistente (12,2% vs 9,4%). In randul populatiei<br />

cu FE ≥50% mortalitatea a fost semnificativ mai<br />

mica (3,3%) fata de mortalitatea in grupul pacientilor<br />

cu FE1,3mg/<br />

dl) s-a corelat cu o mortalitate mai mare (16,6% vs 8%,<br />

p 0,04). Alterarea functiei hepatice exprimata prin valori<br />

crescute ale TGO,TGP si bilirubinei s-au corelat de<br />

asemenea cu o mortalitate crescuta(13% vs 8,8%), fara<br />

a atinge insa limita semnificatiei statistice. Din punct<br />

de vedere etiologic am constatat valori inalte ale mor-<br />

POSTER I<br />

POSTER I<br />

talitatii la pacientii cu trombembolism pulmonar acut<br />

si cord pulmonar acut (25%), la cei ci ICA pe fond de<br />

infarct miocardic acut – IMA in clasa Killip III si IV<br />

(20%). In randul valvularilor cu ICC cronica acutizata<br />

mortalitatea a ajuns la 11,9%. La un numar redus<br />

din pacientii cu ICA(4p-2%) s-a dezvoltat un accident<br />

vascular cerebral (AVC) ischemic, mortalitatea fiind in<br />

randul acestor pacienti de 50%.<br />

Concluzii: Pacientii cu ICA si disfunctie diastolica a<br />

ventriculului stang, cu FE ≥50 u; prezentat cea mai redusa<br />

mortalitate. Prezenta disfunctiei sistolice moderate<br />

si severe a VS s-a corelat cu o crestere semnificativa<br />

a mortalitatii. Nu au existat diferente semnificative de<br />

mortalitate intre pacientii cu ICA de novo si cei cu insuficienta<br />

cardiaca cronica acutizata. Asocierea unui AVC<br />

la ICA, putin frecventa in populatia studiata, a condus<br />

la cele mai inalte valori ale mortalitatii (date sub rezerva<br />

numarului foarte redus de pacienti). Din punct de<br />

vedere etiologic cele mai ridicate valori ale mortalitatii<br />

s-au inregistrat in randul celor cu TEP si IMA.<br />

Conditions correlated with<br />

in-hospital mortality in acute<br />

heart failure<br />

Acute heart failure is one <strong>of</strong> the diseases with high mortality<br />

rates, incompletely controled by the existing therapies.<br />

Purpose: To asses in-hospital mortality (IHM) in patients<br />

hospitalized for acute heart failure (AHF) and it’s<br />

correlation with the etiology <strong>of</strong> heart failure, severity<br />

and type <strong>of</strong> left ventricular disfunction and the renal<br />

and hepatic function.<br />

Matherial and method: We have studied 196 patients<br />

hospitalized in 2008-2009 for AHF, 90 <strong>of</strong> them with de<br />

novo AHF and the others(106p) with acute decompensation<br />

<strong>of</strong> chronic heart failure(CHF). We assesed the<br />

etiology <strong>of</strong> AHF, severity and type <strong>of</strong> left ventricular<br />

disfunction (systolic and dyastolic) by measuring echocardiographicaly<br />

the EF, E/A ratio, deceleration time <strong>of</strong><br />

E (DTE), isovolumic relaxation time (TRI) and S/D<br />

ratio <strong>of</strong> pulmonary venous flow (Fvp)-in 58% <strong>of</strong> our<br />

patients. The renal and hepatic function were estimated<br />

based on the values <strong>of</strong> creatinine and respectively liver<br />

enzimes (TGO, TGP) and by the level <strong>of</strong> bilirubine.<br />

Results: IHM was in our patients 10,7%. There was no<br />

difference in IHM between patients with de novo AHF


POSTER I<br />

POSTER I<br />

and acute decompensation <strong>of</strong> CHF(12,2% vs 9,4%). Patients<br />

with EF≥50% had lower mortality (3,3%) comparative<br />

to those with EF


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

St. Pantelimon Emergency Hospital with the purpose<br />

<strong>of</strong> optimizing the emergency medical care.<br />

Material and methods: For the analysis <strong>of</strong> the patient<br />

group we used Micros<strong>of</strong>t Excel and SPSS10. We used<br />

the information from the observation charts <strong>of</strong> patients<br />

with acute heart failure admitted in our clinic in the period<br />

between 01.01.2009 and 30.06.2009, totaling 447<br />

cases. We included patients with acutely decompensated<br />

chronic heart failure CHF (minimum NYHA III<br />

class on admission), patients with acute pulmonary oedema,<br />

with AHF after AMI, cardiogenic shock, isolated<br />

right heart failure. We excluded patients participating<br />

in other studies.<br />

Results: Mortality is significantly correlated with ACEI<br />

administration during hospitalization: it is 4,15% for<br />

patients who received ACEI, and 26,36%(P=0.01) for<br />

those who did not receive ACEI. Mortality is 4,77% for<br />

those treated with beta-blockers compared with 18,83<br />

(P=0.01) for those who did not receive beta-blockers.<br />

A predictive factor for inhospital mortality was the therapy<br />

with positive inotropic drugs: mortality rate was<br />

3,06% in the group who did not receive inotrope positive<br />

therapy, compared with those who received inotrope<br />

positive therapy (36,36%- p=0,01). Mortality during<br />

hospitalization is also correlated with administration<br />

<strong>of</strong> antialdosterone therapy, 6,13% for those who received<br />

spironolactone treatment, compared with 19,32%<br />

(p=0,01) for those who did not receive it. Patients who<br />

received oral loop diuretic during hospitalization had a<br />

mortality <strong>of</strong> 3,15% compared to 25,58% for those who<br />

did not receive it (p=0,01).<br />

Conclusion: The possibility <strong>of</strong> ACEI, beta blocker,<br />

antialdosterone diuretic, oral loop diuretic administration<br />

was a negative predictor for mortality during<br />

hospitalization. On the other hand the use <strong>of</strong> inotropic<br />

support is associated with an increase in mortality<br />

during hospitalization.<br />

POSTER I<br />

POSTER I<br />

54. Importanta evaluarii<br />

echocardiografice a curbarii<br />

septului interventricular la<br />

pacientii cu tromboembolism<br />

pulmonar-studiu pe 80 de<br />

cazuri<br />

H.Rus, C.I.Ciurea, Mariana Radoi, Mirela Donea<br />

Universitatea “Transilvania”, Facultatea de Medicina<br />

Brasov<br />

Tromboembolismul pulmonar este o afectiune severa,<br />

cu incidenta in continua crestere si cu mortalitate ridicata.<br />

Ecocardiografia transtoracica are un loc important<br />

in diagnosticul si urmarirea pacientilor cu tromboembolism<br />

pulmonar. Curbura normala a septului<br />

interventricular este convexa spre ventriculul drept in<br />

cursul diastolei si sistolei. Curbarea septului interventricular<br />

este considerat anormala daca este aplatizata<br />

sau convexa spre ventriculului stang, in ax parasternal<br />

scurt, aspect apreciat in evaluare ecocardiografica 2D.<br />

Scopul studiului este de a evalua corelatia existenta<br />

intre curbarea septului interventricular si valoarea presiunii<br />

pulmonare,evaluate echocardiografic, la pacienti<br />

fara hipertensiune arteriala sistemica.<br />

Metoda: Am evaluat prospectiv 80 de pacienti diagnosticati<br />

cu tromboembolism pulmonar in perioada ianuarie<br />

2008-ianuarie 2009. Toti pacientii au fost evaluati<br />

prin ecocardiografie transtoracica cu determinarea<br />

echo Dopper a presiunii sistolice si diastolice din artera<br />

pulmonara, si cu aprecierea vizuala a curburii septului<br />

interventricular (normala sau anormala).<br />

Rezultate: In perioada de urmarire de 12 luni, 8 pacienti<br />

au murit de cauza cardiovasculara (rata mortalitatii<br />

fiind de 10/100 ani-persoana). Curbarea anormala<br />

telediastolica a septului interventricular s-a asociat cu<br />

o mortalitate cardiovasculara mai ridicata (risc relativ<br />

de moarte 5,66 [95% CI 1.43-22.6]).<br />

Concluzii: La pacientii cu tromboembolism pulmonar,<br />

aspectul septului interventricular: sistolic, diastolic sau<br />

sistolo-diastolic(normal sau anormal), furnizeaza informatii<br />

semi-cantitative legate de prezenta si severitatea<br />

hipertensiunii pulmonare. Curbarea end-diastolica<br />

anormala a septului interventricular este un marker de<br />

prognostic rezervat la pacientii cu tromboembolismul<br />

pulmonar.


POSTER I<br />

POSTER I<br />

Importance <strong>of</strong> ventricular<br />

septal curvature evaluation<br />

by echocardiography in<br />

patients with pulmonary<br />

thromboembolism-study on 80<br />

cases<br />

Purpose: Pulmonary embolism is a serious disease,<br />

with a growing incidence and a high cardiovascular<br />

mortality rate. Transthoracic echocardiography has an<br />

important place in the diagnosis and surveillance <strong>of</strong> the<br />

disease. The normal interventricular septal curvature<br />

(SC), in convex towards the right ventricle in diastole<br />

and systole. It is considered abnormal if it is flattened<br />

or convex towards the left ventricle in parasternal short<br />

axis, in two-dimensional mode.<br />

The aim <strong>of</strong> the study is to evaluate the relation between<br />

SC and pulmonary pressure measurements, in the absence<br />

<strong>of</strong> arterial hypertension.<br />

Methods: We prospective included 80 patients diagnosed<br />

with pulmonary embolism between January<br />

2008-January 2009. All patients were evaluated through<br />

transthoracic echocardiography with direct measurement<br />

<strong>of</strong> diastolic and systolic pulmonary artery<br />

pressure, and visual assessment <strong>of</strong> the interventricular<br />

septal curvature (normal or abnormal).<br />

Results: During the medial follow-up <strong>of</strong> 12 months, 8<br />

patients died <strong>of</strong> cardiovascular cause (mortality rate <strong>of</strong><br />

10 per 100 person-years). An abnormal end diastolic<br />

septal curvature was significantly associated with higher<br />

cardiovascular mortality (relative risk <strong>of</strong> death<br />

5,66[95% CI 1.43-22.6]).<br />

Conclusions: The aspect <strong>of</strong> the interventricular SC,<br />

normal or abnormal, and its time period (systolic, diastolic,<br />

or systolic and diastolic), provides semi-quantitative<br />

information regarding the presence and severity <strong>of</strong><br />

pulmonary hypertension. Abnormal end-diastolic SC<br />

is a marker <strong>of</strong> poor prognosis <strong>of</strong> the disease.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

55. Aspecte particulare ale<br />

afectarii cardiaca in cursul<br />

infectiei cu HIV la copil<br />

A.G.Dimitriu, Cristina Jitareanu, Lavinia Dimitriu<br />

Universitatea de Medicina si Farmacie “Gr T Popa”, Iasi<br />

Scopul stdiului: prezentarea aspectelor particulare ale<br />

afectarii cardiace la copilul cu infectie cu virusul imunodeficientei<br />

umane (HIV).<br />

Material si metoda: Autorii au evaluat 49 de copii infectati<br />

cu HIV cu varsta intre 2 si 16 ani, pentru evidentierea<br />

manifestarilor de suferinta cardiaca secundara a<br />

infectiei HIV. Evaluarea pacientilor a fost realizata prin<br />

examen clinic, ECG, Rx cardio-toracica si examen ecocardiografic<br />

(Echo). Stadializarea infectiei HIV/SIDA a<br />

fost facuta pe baza evaluarii clinice si valorilor limfocitelor<br />

CD4, intr-o perioada de urmarire de 24 de luni.<br />

Rezultate: Stadializarea clinica: 2/3 din pacienti au fost<br />

inclusi in grupul P2f. Semnele clinice de afectare cardiaca:<br />

insuficienta cardiaca (9 cazuri), tahicardie (20<br />

cazuri), diminuarea zgomotelor cardiace (12), dispnee<br />

(14 cazuri) si 14 cazuri au fost asimptomatice sau cu<br />

semne ale altor afectiuni. ECG: tulburari de repolarizarea<br />

ventriculara sau tahicardie sinusala. RxCT: cardiomegalie<br />

in 1 / 3 din cazuri si modificari datorate infectiilor<br />

pulmonare. Echocardiografia Doppler: afectarea<br />

cardiaca a fost prezenta in 68% cazuri: cardiomiopatie<br />

dilatativa (12 cazuri), pericardita (10 cazuri), dilatare<br />

izolata a ventriculului stang (6 cazuri) si ventriculul<br />

drept (4 cazuri), disfunctie diastolica VS (11 cazuri),<br />

hipertensiune arteriala pulmonara (4 cazuri). Aspectele<br />

cele mai severe de afectare cardiaca au fost observat<br />

in cazurile cu reducerea semnificativa a valorii CD4,<br />

mai ales sub valori de 400/mmc. Examenu histologic<br />

a fost efectuat la 28 pacienti care au decedat din cauza<br />

infectiilor pulmonare si a relevat aspecte cardiace de<br />

miocardita (1 caz), infiltrare inflamatorie miocardica si<br />

pericardica si leziuni necrotice (6 cazuri).<br />

Concluzii: Prin incidenta crescuta (68% din cazuri) si<br />

severitatea manifestarilor, afectarea cardiaca indusa de<br />

infectia cu HIV ramane una din cele mai importante<br />

probleme de evaluare a acestor patienti. Evaluarea cardiologica<br />

a pacienti cu HIV / SIDA, in special prin ecocardiografie<br />

trebuie sa fie realizata in toate etapele de<br />

evolutie a bolii, din primele momente dupa stabilirea<br />

diagnosticului, chiar si la pacienti asimptomatici, in vederea<br />

stabilirii unui diagnostic cat mai precis si ulterior<br />

pentru monitorizarea evolutiei acestor pacienti.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Peculiar aspects <strong>of</strong> cardiac<br />

involvement during HIV<br />

infection in child<br />

Purpose: to emphasize the main cardiac disorders<br />

occurred in children with human immunodefficiency<br />

virus (HIV) infection.<br />

Methods: The authors evaluated 49 HIV infected children<br />

(2 -16 years old) for the manifestations <strong>of</strong> cardiac<br />

suffering secondary <strong>of</strong> HIV infection by the clinical<br />

exam, ECG, Chest X Ray and echocardiographic exam<br />

(echo). Staging <strong>of</strong> HIV infection /AIDS was made based<br />

on clinical and CD4 lymphocytes values, in a period<br />

<strong>of</strong> 24 months <strong>of</strong> follow - up.<br />

Results: Clinical staging: 2/3 <strong>of</strong> patients were included<br />

in P2f group. Clinical signs <strong>of</strong> cardiac involvement:<br />

heart failure (9 cases), tachycardia (20 cases), deafness<br />

<strong>of</strong> the heart sounds (12), dyspneea (14) and 14 were<br />

non-symptomatic or with signs <strong>of</strong> others diseases.<br />

ECG: disturbances <strong>of</strong> ventricular repolarisation or sinusal<br />

tachycardia. RxCT: cardiomegaly in 1/3 <strong>of</strong> cases<br />

and modifications secondary <strong>of</strong> pulmonary infections.<br />

Echo Doppler: cardiac involvement was present in 68%<br />

cases: dilated cardiomyopathy (12 cases), pericarditis<br />

(10 cases), isolated dilation <strong>of</strong> the left ventricle (6<br />

cases) and <strong>of</strong> the right ventricle (4 cases), LV diastolic<br />

dysfunction (11 cases), and pulmonary hypertension<br />

(4 cases). The most severe aspects <strong>of</strong> cardiac damage<br />

have been noticed in cases with significant reduction<br />

<strong>of</strong> CD4 value, especially under 400/mmc. Hystological<br />

exam was performed in 28 patients that died because <strong>of</strong><br />

pulmonary infections and revealed cardiac aspects <strong>of</strong><br />

myocarditis (1), myocardial and pericardial inflammatory<br />

infiltration and necrotic lesions (6 cases).<br />

Conclusions: By high incidence (68% <strong>of</strong> cases) and<br />

severity <strong>of</strong> manifestations, cardiac involvement during<br />

HIV infection remains one <strong>of</strong> the most important problem<br />

<strong>of</strong> these patients.Cardiological evaluation <strong>of</strong> patients<br />

with HIV/SIDA, especially by echocardiography<br />

must to be performed in all the stages <strong>of</strong> the disease,<br />

even in non-symptomatic patients, for the diagnosis<br />

and follow-up <strong>of</strong> the evolution.<br />

POSTER I<br />

POSTER I<br />

56. Contributia CT angiografiei<br />

in patologia malformativa<br />

cardiovasculara a pacientului<br />

pediatric<br />

D.M.Gratian, Nicoleta Iacob<br />

Centrul de Diagnostic Imagistic NEUROMED,<br />

Timisoara<br />

Patologia malformativa cardiaca reprezinta una dintre<br />

cele mai dificile probleme medicale, atat ca precizare a<br />

diagnosticului, cat si ca sanctiune terapeutica.<br />

Progresele in diagnosticul imagistic al cordului, incepand<br />

cu ecocardiografia, apoi CT cardiac si rezonanta<br />

magnetica, au facut ca la ora actuala, coroborat<br />

cu angiografia cardiaca, precizarea diagnosticului de<br />

malformatie cardiaca congenitala si mai ales tipul de<br />

malformatie si posibilitatile de tratament ale acesteia sa<br />

reprezinte in unele centre investigatii de rutina.<br />

In ultimii ani, dupa introducerea computer-tomografiei<br />

in diagnosticul patologiei cardiace, in centrul nostru,<br />

ca urmare a cooperarii deosebite cu cateva clinici de<br />

chirurgie cardio-vasculara pediatrica, s-au investigat<br />

aproximativ 80 de malformatii cardio-vasculare, in<br />

special preoperator, in vederea stabilirii rapoartelor<br />

anatomice ale structurilor vasculare.<br />

Cele mai frecvente malformatii au fost reprezentate de<br />

tetralogii Fallot, coarctatii de aorta, anomalii de intoarcere<br />

venoasa.<br />

Metoda s-a dovedit a fi extrem de utila chirurgilor in<br />

vederea planificarii interventiilor chirurgicale.<br />

CT angiography contribution<br />

in evaluation <strong>of</strong> pediatric<br />

patient with congenital hearth<br />

disease<br />

Congenital hearth disease represents one <strong>of</strong> the most<br />

challenging medical problems, from diagnostic point<br />

<strong>of</strong> view and also as therapeutic decision.<br />

Rapid development in diagnostic imaging <strong>of</strong> the<br />

hearth, starting with cardiac ultrasonography, then CT<br />

and MRI <strong>of</strong> the hearth, allowed that today, together<br />

with the cardiac catheterization, the diagnostic algori-


POSTER I<br />

POSTER I<br />

thm for congenital hearth disease to become a routine<br />

in some diagnostic centers.<br />

In past few years, after introduction <strong>of</strong> CT angiography<br />

as method in diagnosis <strong>of</strong> hearth diseases, in our centre<br />

we investigated around 80 patients with congenital<br />

hearth diseases, in preoperative time, to establish anatomical<br />

structures and reports <strong>of</strong> vascular structures<br />

involved in cardiac malformations.<br />

Most frequent congenital hearth diseases were represented<br />

by Fallot tetralogy, aortic coarctation, and anomalous<br />

venous return. The method was very useful for<br />

cardiac surgeons to plan surgical intervention.<br />

57. Evolutia infarctului<br />

miocardic cu supradenivelare<br />

de ST la pacientii diabetici, este<br />

influentata de durata diabetului<br />

zaharat<br />

Sorina Magheru, Alina Iacobescu, F.Maghiar,<br />

C.Magheru, M.Popescu<br />

Universitatea din Oradea<br />

Scopul studiului a fost analiza influentei duratei diabetului<br />

zaharat (DZ) asupra evolutiei clinice si prognosticului<br />

in infarctul miocardic cu supradenivelare de ST<br />

(STEMI) la diabetici.<br />

Material si metoda: din totalul de pacientilor cu<br />

STEMI (155 pacienti), spitalizati in Clinica de Cardiologie<br />

a Spitalului Clinic CF Oradea pe parcursul anilor<br />

2007-2008, au fost selectati bolnavii cu DZ. Acestia au<br />

fost in numar de 35, cu varsta medie de 57,3±0.4 ani,<br />

58% au fost barbati iar 42% au fost femei, durata DZ<br />

a fost de 9,2±0.9 ani, 68,4% dintre ei foloseau medicamente<br />

hipoglicemie iar 31.6% diferite forme de insulina.<br />

Diagnosticul de STEMI a fost clinic, EKG si enzimatic.<br />

S-au luat in studiu pacientii cu diagnostic de DZ<br />

anterior STEMI. Conform duratei DZ pacientii au fost<br />

impartiti: lotul 1 DZ cu evolutie sub 5 ani (15 pacienti),<br />

lotul 2 DZ cu evolutie intre 5 si 10 ani (12 pacienti),<br />

lotul 3, DZ cu evolutie peste 10 ani (8 pacienti). Pacientii<br />

au fost monitorizati 12 luni de la externare. Am<br />

urmarit prezenta dislipidemiei la internare (colesterol<br />

total, trigliceride si LDL colesterol), aparita complicatiilor<br />

postinfarct (reinfarctizare, extinderea infarctului si<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

angor postinfarct) si mortalitatea intraspitaliceasca si la<br />

12 luni de la externare.<br />

Rezultate: Toti pacientii au avut dislipidemie, in lotul<br />

3 valorilor acestora au fost semnificativ mai mari comparativ<br />

cu lotul 1 si lotul 2. In lotul 1, a fost mai frecventa<br />

angina postinfarct comparativ cu lotul 3 (60% vs<br />

37.5%). Reinfarctizarea si extinderea infarctului au fost<br />

mai frecvente in loturile 2 si 3 comparativ cu lotul 1<br />

(58.3%, 50% vs 20%). Mortalitatea intraspitaliceasca a<br />

atins 8.6% la diabetici si a fost mai inalta decal la nondiabetici<br />

5.7%. Dintre pacientii cu o vechime a DZ mai<br />

mica de 5 ani nu a decedat nici un pacient. Dintre pacientii<br />

cu vechimea DZ cuprinsa intre 5 si 10 ani a decedat<br />

un pacient, iar dintre pacientii cu DZ de mai mult<br />

de 10 ani au decedat 2 pacienti. La 12 luni mortalitatea<br />

de cauza cardiovasculara a fost de 6.66% (1 pacient) in<br />

primul lot, de 25% in lotul 2 si de 37.5% in lotul 3.<br />

Concluzii: Durata DZ la pacientii cu STEMI a fost asociata<br />

cu cresterea ratei factorilor de risc, a morbiditatii<br />

si mortalitatii ata intra cat si postspitalicesc. Diabetul<br />

zaharat este un factor de prognostic nefavorabil la bolnavii<br />

cu STEMI, iar impactul creste concomitent cu<br />

durata acestuia.<br />

The evolution <strong>of</strong> ST elevation<br />

myocardial infarction on<br />

diabetics depend <strong>of</strong> previously<br />

duration <strong>of</strong> diabetes<br />

Study aimed to analyze the influence <strong>of</strong> duration <strong>of</strong> diabetes<br />

mellitus (DM) on clinical course and prognosis<br />

<strong>of</strong> myocardial infarction with ST elevation (STEMI).<br />

Material and method: From the total STEMI patients<br />

(155), hospitalized in the <strong>Cardiology</strong> Clinic <strong>of</strong> Oradea<br />

CF Hospital during 2007 and 2008 were selected diabetic<br />

patients. They were in number <strong>of</strong> 35, with an average<br />

age <strong>of</strong> 57.3 ± 0.4 years, 58% were men and 42% were<br />

women, diabetes duration was 9.2 ± 0.9 years, 68.4%<br />

<strong>of</strong> them used 31.6% hypoglycaemic drugs and various<br />

forms <strong>of</strong> insulin. STEMI diagnosis was clinical, ECG<br />

and enzyme. We have studied patients with diagnosed<br />

diabetes previously <strong>of</strong> STEMI. According toduration <strong>of</strong><br />

DM patients were divided as follows: group 1 diabetes<br />

under five years <strong>of</strong> evolution (15 patients), group<br />

2 diabetes with evolution between 5 and 10 years (12<br />

patients), group 3, diabetic with evolution over 10 years


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

(8 patients). Patients were followed 12 months after<br />

discharge. We watched the dyslipidemia at admission<br />

(total cholesterol, triglycerides and LDL cholesterol),<br />

complications which arise after infarction (reinfarctization,<br />

infarct expansion and angina post infarction) and<br />

mortality in hospital and 12 months after discharge.<br />

Results: All patients had dyslipidaemia; their values<br />

in group 3 were significantly higher compared with<br />

group 1 and group 2. In group 1, post infarction angina<br />

was more frequent compared with group 3 (60%<br />

vs. 37.5%). Reinfarctization and infarct expasion were<br />

more frequent in groups 2 and 3 compared with group<br />

1 (58.3%, 50% vs. 20%). Hospital mortality reached<br />

8.6% in diabetics and was highest than in non diabetes<br />

group: 5.7%. Among patients with diabetes with duration<br />

<strong>of</strong> less than 5 years no patient has died. Among<br />

patients with disease evolution between 5 and 10 years<br />

one patient died, and among patients with diabetes for<br />

more than 10 years two patients died. At 12 months the<br />

cardiovascular mortality was 6.66% (1 patient) in the<br />

first batch, 25% in group 2 and 37.5% in group 3.<br />

Conclusions: Duration <strong>of</strong> diabetes in patients with<br />

STEMI was associated with increasing risk factors, in<br />

and post hospital morbidity and mortality. Diabetes<br />

mellitus is an unfavorable prognostic factor in patients<br />

with STEMI and increase its impact according to its<br />

duration.<br />

58. Reducerea recurentelor de<br />

fibrilatie atriala prin blocarea<br />

specifica a receptorului<br />

mineralocorticoid – un studiu<br />

de 24 luni<br />

A.Tase, G.Savoiu, M.Mihaila, S.I.Iorga, Gabriela Stanciulescu,<br />

Trache Cristina, O.Tetiu<br />

Spitalul Judetean de Urgenta Arges, Pitesti<br />

Introducere. Alterarile structurale atriale prin fibrilatie<br />

atriala (FA) repetitiva includ hiperactivarea SRAA<br />

care poate avea un rol decisiv, aldosteronul fiind implicat<br />

in inflamatie, fibroza, remodelare.<br />

Obiectivul studiului nostru este comparatia directa a<br />

doua regimuri terapeutice (fiecare cuprinzand cate trei<br />

subregimuri), in scopul evaluarii beneficiului eplerenonei<br />

(E) la pacientii (pts.) cu FA repetitiva.<br />

POSTER I<br />

POSTER I<br />

Metoda: Au participat in studiu 80 pts. cu FA iterativa,<br />

incepand cu 1 Nov. 2007, structurati in doua grupuri<br />

comparative, echilibrate demografic (usoara predominanta<br />

masculina, respectiv decada a 6-a, in cele doua<br />

grupuri). Pts. din primul grup au fost tratati farmacologic<br />

cu antiaritmice (Amiodarona (A) 71% sau Propafenona<br />

(P) 21% sau Sotalol (S) 8%) + supliment exogen<br />

de potasiu (K+), in timp ce pts. din al doilea grup au<br />

fost tratati cu antiaritmice (A 70% sau P 23% sau S 7%)<br />

+ E. Am comparat aparitia episoadelor de FA inainte<br />

si dupa initierea tratamentului cu E. Un criteriu de excludere<br />

a fost tratamentul anterior cu β-blocante (efect<br />

antireninic indirect), IECA/BRA, spironolactona.<br />

Rezultate: Tabelul adiacent structureaza principalele<br />

rezultate ale studiului: Brat Episoade AF Episoade AF<br />

Valoarea p terap. (inainte cu (dupa 24 luni) 24 luni) A +<br />

K+ 8,8+/-1,7 10,5+/-2,5


POSTER I<br />

POSTER I<br />

Method: The study considered 80 pts. with AF, starting<br />

with 1st Nov. 2007, structured in two comparative<br />

groups, demographically balanced (slight male and<br />

6th decade pts. predominance, respectively in both<br />

groups). The pts. from the first group were treated with<br />

antiarrhythmics {Amiodarone (A) 71% pts. or Propafenone<br />

(P) 21% pts. or Sotalol (S) 8% pts.} + exogenous<br />

potassium supplement (K+), while the pts. from the second<br />

group were treated with antiarrhythmics {A 70%<br />

pts. or P 23% pts. or S 7% pts.} + E. We compared the<br />

occurrence <strong>of</strong> AF episodes 24 months before and, respectively,<br />

after the initiation <strong>of</strong> treatment with E. An<br />

exclusion criterion referred to the pts. previously treated<br />

with βb’s (indirect antireninic effect), ACE inhibitors,<br />

ARB’s, spironolactone.<br />

Results: The adjacent table structures the main outcomes<br />

<strong>of</strong> the study: Ther. AF Episodes AF Episodes p<br />

value Arm (24 mo. (24 mo. before) after) A + K+ 8,8+/-<br />

1,7 10,5+/-2,5


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Mediated by hyperpolarization<br />

coronary dilation in heart<br />

failure<br />

The coronarodilatory effect <strong>of</strong> the local metabolic factors<br />

mediated through mechanism <strong>of</strong> smooth coronary<br />

myocyte hyperpolarization is an important pattern <strong>of</strong><br />

the coronary perfusion regulation in endothelial dysfunction<br />

inasmuch is independent <strong>of</strong> the nitric oxide<br />

synthesis system capacity.<br />

Aim: evaluation <strong>of</strong> the coronary dilation effect mediated<br />

through hyperpolarization in experimental heart<br />

failure.<br />

Material and methods: Heart failure (HF) was induced<br />

in rats by doxorubicin administration (cumulative<br />

dose 10 mg/kg during 10 days). Functional coronary<br />

reserve (FCR) <strong>of</strong> the isolated izovolumic heart was<br />

assayed on acetylcholine (Ach), hydrogen peroxide<br />

and bradykinin (Br) action, inclusively in conditions <strong>of</strong><br />

NOSec inhibition by L-NAME, Br receptors B2 blockage<br />

by HOE-140 or <strong>of</strong> H2O2 metabolization by catalase.<br />

Results: FCR in HF was reduced by almost 34% in parasympathetic<br />

stimulation (Ach [10-5 M]) and by 27%<br />

on Br (10-6 M) action. Remarkably that the action <strong>of</strong><br />

H2O2, which opens potassium channels (KCa si KV)<br />

and induces smooth coronary myocyte hyperpolarization<br />

resulted in a higher value <strong>of</strong> coronary flux in HF:<br />

by 8, 13 and 18% (p


POSTER I<br />

POSTER I<br />

Rezultate: Clasa NYHA la includerea in studiu a fost:<br />

clasa NYHA II – 1 pac, clasa NYHA III – 4 pac, clasa<br />

NYHA IV – 2 pac. Dupa tratament clasa functionala a<br />

fost: clasa NYHA II – 4 pac, clasa NYHA III – 3 pac.<br />

S-a inregistrat un singur deces, o pacienta cu HTP primitiva.<br />

Testul de mers la includerea in studiu, intre 150<br />

si 520 m, media: 340,4 m. Dupa 18 luni de tratament<br />

distanta parcursa a fost: 200 si 580 m, media: 384.7 m.<br />

Evaluarea ecocardiografica nu a evidentiat modificari<br />

ale presiunii sistolice si ale presiunii medii in artera pulmonara.<br />

Singurul parametru ecografic care s-a ameliorat<br />

dupa tratament a fost TAPSE de la o valoare medie<br />

de 16,5 mm la includere la 19,8 mm dupa tratament.<br />

Concluzii: Tratamentul cu substante vasodilatatoare<br />

specifice este bine tolerat la copil si determina o ameliorare<br />

a clasei functionale, a distantei parcurse la testul<br />

de mers de 6 min si a functiei ventriculului drept. Nu<br />

se inregistreaza modificari ale valorilor presiunii medii<br />

si sistolice din artera pulmonara.<br />

Clinical and developmental<br />

issues in children with<br />

pulmonary hypertension<br />

treated with specific<br />

vasodilatator drugs<br />

Background: Pulmonary arterial hypertension (PAH)<br />

is a disease with a low prevalence in children. Etiology<br />

is represented by: congenital heart defects with left –<br />

right shunt, complex congenital heart disease with lung<br />

irrigation from systemic circulation and idiopathic<br />

pulmonary hypertension. There are few studies on the<br />

treatment <strong>of</strong> pulmonary hypertension in children with<br />

specific vasodilator drugs.<br />

Methods: There were studied a total <strong>of</strong> seven patients,<br />

four male, age 5-17 years (mean 11.3 years), diagnosed<br />

with severe PAH, pulmonary artery systolic pressure<br />

(Psist AP) between 78 and 122 mm Hg (mean: 98.4 mm<br />

Hg), pulmonary artery mean pressure (Pm AP) between<br />

35 and 67 mm Hg, mean: 58.2 mm Hg (values determined<br />

by invasive catheterization right heart cavities).<br />

PAH etiology was represented by: idiopathic PAH (1<br />

pt), PAH late after correction <strong>of</strong> congenital heart malformations<br />

(2 pts), PAH secondary to unoperated MCC<br />

(4 pts). All patients received medication with specific<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

vasodilator drugs: Bosentan (2 pts), Sildenafil (3 pts),<br />

dual therapy (2 pts). Monitoring patients during the<br />

study was performed by echocardiography (measurement<br />

<strong>of</strong> the right cavities, the average and the systolic<br />

pressure in the pulmonary artery, TAPSE), 6 min walk<br />

test and heart failure class according to NYHA classification.<br />

Results: NYHA class enrollment was: NYHA class II<br />

– 1 pt, NYHA class III - 4 pts, NYHA class IV - 2 pts.<br />

After treatment was functional class: NYHA class II - 4<br />

pts, NYHA class III - 3 pts. There has been one death, a<br />

patient with idiopathic PAH. One patient experienced<br />

adverse effects from increasing doses <strong>of</strong> sildenafil, headache.<br />

Test drive at enrollment was between 150 and<br />

520 m, mean: 340.4 m, after 18 months <strong>of</strong> treatment<br />

distance was between 200 and 580 m, mean: 384.7 m.<br />

Echocardiographic evaluation showed no changes in<br />

systolic pressure and in average pressure in the pulmonary<br />

artery. The only echocardiographyc parameter<br />

that improved after treatment was TAPSE from an average<br />

<strong>of</strong> 16.5 mm at baseline to 19.8 mm after treatment.<br />

(Averaged from the entire study group).<br />

Conclusions: Treatment with specific vasodilator<br />

drugs is well tolerated in children and lead to an improvement<br />

in functional class, the distance in the 6 min<br />

walk test and right ventricular function. Changes are<br />

not recorded in values <strong>of</strong> systolic and mean pulmonary<br />

artery pressure.<br />

61. Aspecte<br />

electrocardiografice in embolia<br />

pulmonara<br />

M.Balint, Rodica Avram, P.Dan, Florina Parv, Livia<br />

Branzan, Mariana Tudoran, Ioana Cotet, Gabriela<br />

Filip<br />

Universitatea de Medicina si Farmacie “Victor Babes”<br />

Timisoara<br />

Scop: Am evaluat modificarile electrocardiografice<br />

(ECG) la pacientii diagnosticati cu embolie pulmonara<br />

(EP) in relatie cu aspectele clinice si severitatea EP.<br />

Material si metoda: Am realizat un studiu retrospectiv<br />

asupra inregistrarilor ECG la 71 de pacienti, 42 de<br />

femei (varsta medie 56,71±16,83 ani) si 29 de barbati<br />

(varsta medie 63,44±13,62 ani) diagnosticati cu EP in


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Clinica de Cardiologie in decurs de 3 ani. Inregistrarile<br />

ECG au fost realizate utilizand tehnica standard cu<br />

12 derivatii si am consemnat de la aspectul normal de<br />

baza toate modificarile sugestive pentru EP si corelatia<br />

lor cu severitatea EP prin folosirea de metode clinice si<br />

imagistice.<br />

Rezultate si discutii: Tahicardia sinusala a fost cea mai<br />

frecventa modificare ECG (61 de pacienti, 85,91%), urmata<br />

in ordine descrescatoare de unda T negativa in<br />

V1-V4 (15 cazuri, 21,12%), deviatia axiala dreapta si<br />

aspectul S1Q3T3 in cate 9 cazuri (12,67%). Blocul de<br />

ramura dreapta, unda T negativa in DIII si aVF si tahiaritmiile<br />

atriale nou instalate au fost consemnate in<br />

cate 6 cazuri (8,45%), iar unda S cu amplitudine mare<br />

in V5-V6 la 5 pacienti (7,04%). Alte modificari ECG<br />

isolate au constat din bloc atrioventricular gradul I, deviatie<br />

axiala stanga, bloc de ramura stanga si combinatii<br />

ale acestora. Circa o treime (33,8%) dintre pacienti nu<br />

au prezentat nici o modificare ECG semnificativa, exceptand<br />

tahicardia sinusala, mai ales cei cu forme nonsevere<br />

de EP, in p<strong>of</strong>ida aspectelor clinice si imagistice<br />

sugestive.<br />

Concluzii: Corelatia dintre modificarile ECG si diagnosticul<br />

pozitiv de EP este redusa in formele cu severitate<br />

usoara si medie, dar utila in EP masiva. Din<br />

aceste motive absenta modificarilor ECG in prezenta<br />

semnelor clinice de EP trebuie sa conduca la investigatii<br />

suplimentare pentru confirmarea diagnostica.<br />

Cuvinte cheie. Modificari electrocardiografice, embolie<br />

pulmonara<br />

Electrocardiographic aspects in<br />

pulmonary embolism<br />

Aims: We assessed electrocardiographic (ECG) changes<br />

in pulmonary embolism (PE) diagnosed patierns in<br />

connection with clinical aspects and severity <strong>of</strong> PE.<br />

Material and method: We performed an retrospective<br />

study using ECG recordings in 71 patients, 42 women<br />

(mean age 56,71±16,83 years) and 29 men (mean age<br />

63,44±13,62 years) with PE diagnosed in <strong>Cardiology</strong><br />

Clinic during 3 years. The ECG recordings were made<br />

using standard 12-leads technique and we noted all the<br />

modifications from the basic normal aspect suggesting<br />

PE reason and the correlation with PE severity established<br />

using clinical and imagistic methods.<br />

Results and discussions: Sinus tachycardia was the<br />

most frequent ECG modification (61 patients, 85,91%),<br />

POSTER I<br />

POSTER I<br />

followed in decreasing manner by negative T wave<br />

aspect in V1-V4 leads (15 cases, 21,12%), right axis<br />

deviation and S1Q3T3 pattern with 10 patients each<br />

(14,08%), associated negative T wave in V1-V4 leads<br />

and S1Q3T3 pattern in 9 cases (12,67%). Right bundle<br />

branch block (RBBB), negative T wave aspect in DIII<br />

and aVF and new atrial tachyarrhythmias were noted<br />

in 6 cases each (8,45%) and high voltage S wave in V5-<br />

V6 in 5 patients (7,04%). Other ECG changes were<br />

isolated and consisted <strong>of</strong> first-degree atrioventricular<br />

block, left axis deviation, left bundle branch block and<br />

combinations <strong>of</strong> previous related ECG changes. About<br />

one third (33,80%) from patients had no semnificative<br />

ECG changes, except sinus tachycardia, especially those<br />

with non-severe forms <strong>of</strong> PE, despite their suggestive<br />

clinical and imagistic signs.<br />

Conclusions: The correlation between specific ECG<br />

changes and PE positive diagnosis is poor in mild and<br />

medium severity forms, but helpful in massive PE. Therefore,<br />

the absence <strong>of</strong> ECG modifications in the presence<br />

<strong>of</strong> clinical signs <strong>of</strong> PE must lead to supplementary<br />

investigations for diagnostic confirmation. Key words:<br />

ECG changes, pulmonary embolism.<br />

62. Statusul hormonal<br />

estrogenic si functia endoteliala<br />

Florina Parv, Rodica Avram, M.Balint, Mariana Tudoran,<br />

Livia Branzan, Cristina Tudoran, T.Ciocarlie<br />

Universitatea de Medicina si Farmacie “Victor Babes”,<br />

Timisoara<br />

Introducere. Hormonii estrogeni au efect vasoprotector,<br />

nu numai prin modificarea lipidelor plasmatice, cat<br />

mai ales prin efect vasodilatator, prin actiuni multiple<br />

la nivelul endoteliului. Scop: De a evidentia relatia dintre<br />

nivelul estrogenic si functia endoteliala.<br />

Metode: Am luat in studiu un lot de 96 femei, din<br />

care 46 (48%) inainte de menopauza, cu varsta medie<br />

29,69±9,75 ani si 50 (52%) dupa cel putin trei ani de<br />

menopauza, cu varsta medie 62,64±9,31 ani. Prin metoda<br />

vasodilatatiei mediate de flux la nivelul arterei brahiale<br />

s-au cercetat vasodilatatia dependenta de endoteliu<br />

(VDDE), cea independenta de endoteliu (VDIE),<br />

precum si hiperemia reactiva (HR), definita ca variatie<br />

a vitezei maxime sistolice la 15 secunde postischemic.<br />

La un subgrup de 26 femei cu varsta intre 21-32 ani,


POSTER I<br />

POSTER I<br />

Insuficienta cardiaca (IC) acuta: cea mai frecventa cauza<br />

de spitalizare la pacientii peste 65 ani. Acest motiv<br />

justifica eforturile de a imbunatatii prognosticul acestor<br />

pacienti. Este cunoscuta importanta NT-proBNP in<br />

diagnosticul si managementul IC: creste ca raspuns la<br />

cresterea stresului parietal miocardic. S-a observat ca el<br />

creste mai putin la cei cu functie sistolica pastrata, dar<br />

nu exista o valoare prag recunoscuta pentru diagnoscu<br />

ciclu menstrual normal, fara factori de risc si fara<br />

uz de preparate cu continut estrogenic au fost analizati<br />

aceeasi parametri in functie de nivelul estrogenic crescut<br />

(preovulator, in ziua 13-14) si scazut (in ziua 3-4 a<br />

ciclului menstrual).<br />

Rezultate: VDDE a fost semnificativ mai mare in perioada<br />

preovulatorie (13,00±3,6%) vs in ziua 3-4 a ciclului<br />

menstrual (10,81±7,07%; p=0,004), mai mare la<br />

femei inainte de menopauza (14,85±8,88%) vs dupa<br />

menopauza (8,67±6,37%; p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

ticul IC acute. Datorita timpului de injumatatire relativ<br />

lung al peptidelor natriuretice, schimbarea rapida a<br />

presiunilor de umplere VS nu se reflecta in schimbarea<br />

nivelului NT-proBNP. De aceea, rolul NT-proBNP in<br />

diagnosticul si prognosticul IC acute nu este clar.<br />

Scopul studiului a fost de a evalua rolul NT-proBNP in<br />

diagnosticul IC acute si de a stabili o posibila corelatie<br />

intre nivelul NT-proBNP si etiologia IC acute, mai ales<br />

cand acesta este doar usor crescut.<br />

Material si metoda: Au fost inrolati, prospectiv, 102<br />

pacienti cu IC acuta cu functie sistolica pastrata (69<br />

barbati,33 femei, varsta medie 70ani) internati in perioada<br />

01-10.2009. Diagnosticul de IC acuta s-a bazat<br />

pe recomandarile Societatii Europene de Cardiologie:<br />

coexistenta simptomelor de agravare a IC si a semnelor<br />

de disfunctie cardiaca impreuna cu necesitatea terapiei<br />

injectabile. La internare, toti pacientii au beneficiat de<br />

determinarea NT-proBNP+ echocardiografie. Valoarea<br />

prag a NT-proBNP a fost considerata 400 pg/ml, valorile<br />

sub 100 pg/ml excluzand IC. S-au impartit pacientii<br />

in 2 grupe in functie de valoarea NT-proBNP: grupul<br />

A (n=32) cei cu NT-proBNP 400 pg/ml. S-au comparat<br />

caracteristicile clinice, ecografice si parametrii biologici<br />

ai celor doua grupe, incercand sa stabilim corelatiile<br />

dintre ele.<br />

Rezultatele au aratat o corelatie intre IC acuta cu FE<br />

prezervata cu nivel scazut al NT-proBNP si istoricul<br />

de protezare valvulara si CABG (p


POSTER I<br />

POSTER I<br />

Rezultate: clasa Killip nu a fost diferita semnificativ statistic<br />

la diabetici fata de nondiabetici -TA si AV au fost<br />

semnificativ statistic mai crescute in lotul diabeticilor<br />

-diferente semnificative s-au obtinut pentru valoarea<br />

colesterolului total,a proteinurie si glicemia de la internare<br />

-incidenta aritmiilor ventriculare a fost mai mare<br />

la diabetici fata de nondiabetici -localizarea modificarilor<br />

ECG si incidenta tulburarilor de conducere a fost<br />

similara in cele 2 loturi -fractia de ejectie la internare<br />

si volumul telediastolic al VS au diferit semnificativ in<br />

cele 2 loturi;severitatea insuficientei mitrale a fost similara.<br />

Concluzii: diferente semnificative statistic s-au obtinut<br />

la diabeticii cu SCA pentru parametri dovediti cu valoare<br />

de prognostic defavorabil in evolutia post SCA:<br />

FE, aritmiile ventriculare, proteinuria, glicemia la internare.<br />

Comparative clinical,<br />

biological, electrocardiographic<br />

and ultrasound data in diabetic<br />

versus nondiabetici a lot <strong>of</strong><br />

patients with ACS<br />

Objectives: Analysis statistically significant differences<br />

in diabetics compared nondiabetics regarding clinical,<br />

biological, ECG and ultrasound after admission.<br />

Material and methods: Retrospective study on 228 patients<br />

with ACS enrolled in succession in 2009, divided<br />

into 2 groups according to presence or not <strong>of</strong> diabetes.<br />

Results: Killip class was not statistically significantly<br />

different in diabetics compared nondiabetics AV-TA<br />

and were statistically significantly higher in diabetic<br />

group, Significant differences were obtained for total<br />

cholesterol, proteinuria and blood glucose from the hospital<br />

-Incidence <strong>of</strong> ventricular arrhythmias was higher<br />

in diabetics compared nondiabetics -Location <strong>of</strong> ECG<br />

changes and the incidence <strong>of</strong> conduction disturbances<br />

was similar in the 2 groups -Hospitalization and ejection<br />

fraction <strong>of</strong> LV volume telediastolic differed significantly<br />

in the 2 groups, severity <strong>of</strong> mitral regurgitation<br />

was similar.<br />

Conclusions: Statistically-significant differences were<br />

obtained in diabetics with ACS to prove the value parameters<br />

<strong>of</strong> unfavorable prognosis in the evolution <strong>of</strong><br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

post-ACS: EF, ventricular arrhythmias, proteinuria,<br />

blood glucose at admission.<br />

65. Peptidul natriuretic cerebral<br />

si riscul injuriei de reperfuzie<br />

miocardica la pacientii cu<br />

infarct miocardic acut cu<br />

supradenivelare de ST - studiu<br />

de cohorta prospectiv<br />

Tautu Oana-Florentina, Fruntelata Ana<br />

Spitalul Clinic de Urgenta Floreasca, Bucuresti<br />

Introducere: Injuria de reperfuzie (IR), rezultat paradoxal<br />

al restabilirii rapide a fluxului prin artera responsabila<br />

de infarct, induce o noua agresiune miocardului<br />

ischemiat, limitand astfel efectele pozitive ale reperfuziei.<br />

Nivelurile plasmatice crescute ale peptidului natriuretic<br />

cerebal (BNP), reprezinta un marker util al<br />

evolutiei clinice la pacientii cu infarct miocardic acut<br />

revascularizati.<br />

Obiectiv: Analiza legaturii dintre rezultatul terapiei de<br />

revascularizare miocardica, in special a IR si valorile<br />

BNP la pacientii cu infarct miocardic acut cu supradenivelare<br />

de segment ST (IMASST).<br />

Material si metoda: Lotul de studiu a fost alcatuit din<br />

88 de pacienti cu varsta medie de 51,6 ani, 88,6% de<br />

sex masculin ce au fost internati consecutiv cu IMASST<br />

Killip I si supusi revascularizarii in medie dupa 3,82 ore<br />

de la debutul durerii, [87,5% tromboliza si 11,5% angioplastie<br />

primara], in urma careia 88,6% s-au considerat<br />

reperfuzati (R) pe criterii noninvazive, din care 19,3%<br />

cu IR definita prin prezenta post-revascularizare a insuficientei<br />

cardiace acute sau a aritmiilor ce au necesitat<br />

interventie. Injuria maligna de reperfuzie (IMR),<br />

definita prin prezenta post-revascularizare a tahicardiei<br />

ventriculare sustinute sau a fibrilatiei ventriculare, a<br />

fost consemnata in 2.3% din cazuri. Determinarile BNP<br />

s-au realizat la internare (BNP0), la 24 de ore (BNP24)<br />

si la 30 de zile (BNP30) de la revascularizare.<br />

Rezultate: Pacientii IR au avut cele mai mari valori<br />

BNP0 [121,98 ng/ml IR vs. 45,86 ng/ml R vs 36,78 ng/<br />

ml NR; p = 0,007], valori ce au continut sa cresca atat<br />

la 24 de ore cat si la 30 de zile dupa revascularizare


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

[BNP24 : 121,98 vs. 365,94; p = 0,0001; BNP30: 121,98<br />

vs. 423,53; p = 0,004]. Analiza dinamicii BNP la pacientii<br />

IR, cu sau fara IMR, a aratat ca, desi initial valorile<br />

au fost similare la ambele grupe [BNP0 127.02 ng/<br />

ml IR vs. 84.2 ng/ml RM; p = 0,361], ulterior valorile<br />

BNP ale pacientilor cu IMR au crescut brutal [BNP24:<br />

321,99 IR vs. 695,5 RM; p = 0,019; BNP30: 349,53 IR vs.<br />

941,5 RM; p = 0,011]<br />

Concluzii: Valorile BNP la internare si la 24 de ore de<br />

la revascularizare pot fi un marker util pentru identificarea<br />

precoce a pacientilor IMASST la risc de a dezvolta<br />

IR sau IMR dupa revascularizare. Cuvinte cheie:<br />

injurie de reperfuzie (IR), injurie maligna de reperfuzie<br />

(IMR), peptidul natriuretic cerebral (BNP), reperfuzie,<br />

IMASST.<br />

Brain natriuretic peptide and<br />

myocardial reperfusion injury<br />

risk in ST-elevation myocardial<br />

infarction - a prospective<br />

cohort study<br />

Background: Myocardial reperfusion injury (RI), result<br />

<strong>of</strong> flow restoration in the infarct artery, induces<br />

additional injury, thus limiting the beneficial effects <strong>of</strong><br />

reperfusion. Elevated serum levels <strong>of</strong> brain natriuretic<br />

peptide (BNP) in patients with ST-segment elevation<br />

myocardial infarction (STEMI) represent a marker <strong>of</strong><br />

outcomes in these patients.<br />

Purpose <strong>of</strong> the study was to assess the relation between<br />

myocardial reperfusion, particularly the presence <strong>of</strong><br />

RI, and BNP serum levels in STEMI patients.<br />

Methods: We analyzed a cohort <strong>of</strong> 88 patients (mean<br />

age 51.6 years, 88.6% males) hospitalized for STEMI in<br />

Killip class I, who underwent reperfusion therapy within<br />

a mean time from symptoms onset <strong>of</strong> 3.82 hours.<br />

Thrombolysis was used in 87.5% <strong>of</strong> cases and primary<br />

percutaneous coronary intervention in 11.5% <strong>of</strong> cases.<br />

Successful reperfusion (R) assessed non-invasively by<br />

classical criteria was obtained in 88.6% <strong>of</strong> patients, <strong>of</strong><br />

whom 19.3% had reperfusion injury (RI) defined by<br />

acute heart failure and episodes <strong>of</strong> arrhythmias requiring<br />

intervention. Malignant reperfusion injury (MRI)<br />

was defined as sustained ventricular fibrillation or tachycardia<br />

in 2.3% <strong>of</strong> the reperfused patients. In the re-<br />

POSTER I<br />

POSTER I<br />

maining 11.4% there was lack <strong>of</strong> reperfusion (NR). Serum<br />

BNP levels were measured on admission (BNP0),<br />

and at 24h (BNP24) and 30 days (BNP30) after reperfusion.<br />

Results: Patients with RI had the highest BNP0 levels<br />

compared to those with or without reperfusion (BNP0<br />

121.98ng/ml RI vs 45.86ng/ml R vs 36.78ng/ml NR; p=<br />

0.007), values that continued to rise, both at 24h and at<br />

30 days after reperfusion treatment (BNP24: 121.98ng/<br />

ml vs 365.94ng/ml; p=0.0001; BNP30: 121.98ng/ml<br />

vs 423.53ng/ml; p=0.004). The BNP levels dynamics<br />

analyzed in patients with RI, with or without MRI,<br />

showed that although initially the BNP levels were<br />

similar in both categories (BNP0 127.02ng/ml RI vs<br />

84.2ng/ml MRI; p=0.361), they dramatically increased<br />

in patients with MRI, at 24 h and at 30 days, respectively<br />

(BNP24: 321.9ng/ml RI vs. 695.5ng/ml MRI; p=0.019;<br />

BNP30: 349.53 RI vs 9415 MRI; p=0.011).<br />

Conclusion: BNP levels on admission and at 24 hours<br />

in patients with STEMI may allow early prediction <strong>of</strong><br />

patients at risk <strong>of</strong> developing reperfusion injury after<br />

revascularization therapy. Key words: reperfusion injury<br />

(RI), malignant reperfusion injury (MRI), brain<br />

natriuretic peptide (BNP), reperfusion, STEM


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

SESIUNEA TÂNĂRULUI INVESTIGATOR | YOUNG INVESTIGATOR’S AWARD SESSION<br />

66. Disfunctia longitudinala<br />

sistolica acuta ventriculara<br />

stanga si deteriorarea<br />

sincronismului<br />

atrio-ventricular sunt<br />

mecanismele principale ale<br />

edemului pulmonar acut<br />

hipertensiv<br />

A.Margulescu, Roxana Cristina Sisu, Maria Florescu,<br />

M.Cinteza, D.Vinereanu<br />

Universitatea de Medicina si Farmacie “Carol Davila”<br />

Bucuresti. Spitalul Universitar de Urgenta, Bucuresti<br />

Scop: Evaluarea rolului disfunctiei ventriculare stangi<br />

(VS) si drepte (VD), asincronismului si insuficientei<br />

mitrale (IM) dinamice in timpul edemului pulmonar<br />

acut hipertensiv (EPAH).<br />

Metoda: 51 de pacienti consecutivi (69±11 ani, 20<br />

barbati) cu dispnee acuta cu debut de


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

ments, and peak displacement <strong>of</strong> the mitral annulus.<br />

LV diastolic function was assessed from the mitral flow<br />

pr<strong>of</strong>ile, E/Ea and E/Vp ratios; atrio-ventricular (AV)<br />

synchrony by diastolic filling time (% <strong>of</strong> cardiac cycle).<br />

RV function was assessed by strain <strong>of</strong> the basal RV free<br />

wall, and peak displacement <strong>of</strong> the tricuspid annulus.<br />

Intra- and inter- ventricular dyssynchrony indices, and<br />

MR severity were also measured.<br />

Results: Systolic BP at admission was. Mean BP was<br />

similar between evaluations (102 mmHg), initial echo<br />

being performed after initiation <strong>of</strong> treatment. LV longitudinal<br />

mean and peak displacement <strong>of</strong> the mitral<br />

annulus were lower during AHPE, independent <strong>of</strong> HR<br />

despite similar global systolic function AV synchrony<br />

was impaired during AHPE Diastolic and dyssynchrony<br />

indices, MR severity, and RV function were similar<br />

between evaluations.<br />

Conclusions: Acute LV longitudinal systolic dysfunction<br />

and impaired AV synchrony are the main mechanisms<br />

<strong>of</strong> AHPE, whereas acute LV global systolic dysfunction,<br />

dyssynchrony, dynamic MR, and RV function<br />

are not involved. (ClinicalTrial.gov no.: NCT00829855)<br />

67. Beneficiu rapid al inlocuirii<br />

percutane de valva aortica<br />

asupra severitatii regurgitarii<br />

mitrale secundare<br />

C.Stoicescu, Nicotera Mariuca Vasa, Chin Derek,<br />

D.Vinereanu, J.Kovac<br />

Universitatea de Medicina si Farmacie "Carol Davila",<br />

Bucuresti<br />

Context: Datele din literatura de specialitate legate de<br />

evolutia regurgitarii mitrale (RM) secundare dupa inlocuirea<br />

percutana de valva aortica (pAVR) sunt putine<br />

si contradictorii. Datele din registrele pAVR arata o<br />

imbunatatire >50% din pacientii tratati cu CoreValve<br />

Medtronic System TM. Mecanismele detaliate ale ameliorarii<br />

RM nu sunt inca descrise.<br />

Metoda: 71 pacienti (81±6 ani, 47% barbati) au fost<br />

studiati imediat inainte si dupa pAVR si la 30 de zile.<br />

Au fost masurate ecografic dimensiunile ventriculului<br />

stang (VS) diametrele diastolice si sistolice (DS), grosimea<br />

peretilor, functia VS (prin FEVS), indexul de masa<br />

VS (LVMI), diametrul atriului stang (AS), morfologia<br />

SESIUNEA TÂNĂRULUI INVESTIGATOR<br />

YOUNG INVESTIGATOR’S AWARD SESSION<br />

aparatului valvular mitral prin punctul de coaptare valvular<br />

fata de planul inelului mitral (CPMA), diametrul<br />

inelului mitral si severitatea RM prin vena contracta<br />

(VC), volumul regurgitatnt prin PISA si raportul aria<br />

jetului mitral / aria AS. S-a masurat invaziv presiunea<br />

sistolica in VS (PSVS) pre si post procedura.<br />

Rezultate: La 30 de post pAVR DSVS a scazut de la<br />

41±6 la 37±4 mm, grosimea septului de la 15.6±1.7 la<br />

14.1±1.2 mm, LVMI de la 278±70 la 207±51 g/m2 (toate<br />

cu p


SESIUNEA TÂNĂRULUI INVESTIGATOR<br />

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tricular (LV) dimensions (end-systolic and end-diastolic<br />

diameters, and wall thickness) in order to assess<br />

LV function (by ejection fraction EF) and LV mass<br />

index (LVMI); left atrium (LA) diameter; mitral valve<br />

morphology by apical displacement <strong>of</strong> the coaptation<br />

point from the plane <strong>of</strong> the mitral annulus (CPMA),<br />

and mitral annulus diameter; and MR severity (by vena<br />

contracta, regurgitant volume by PISA, and mitral jet<br />

area/LA area). Catheterization was used to measure LV<br />

systolic pressure (LVSP) pre- and post- procedure.<br />

Results: At 30 days post TAVI, end-systolic diameter<br />

decreased from 41±6 to 37±4 mm, septal wall thickness<br />

from 15.6±1.7 to 14.1±1.2 mm, LVMI from 278±70 to<br />

207±51 g/m2 (all p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

bazala, ca si detorsiunea maxima au fost insa intarziate<br />

semnificativ la pacientii cu postsarcina globala crescuta<br />

fata de grupul 2 (p50%. Thirty-eight pts had increased<br />

global LV afterload (Zva ≥ 4.5 mmHg·mL-1·m2)<br />

(group 1) and 33 pts had low global afterload (Zva0.20 for all). When compared to pts<br />

with low global afterload, pts with increased LV afterload<br />

had lower systemic arterial compliance (p0.10 for all). However, time<br />

to peak apical and basal backrotation rates and time to<br />

peak LV untwisting rate were higher in group 1 than<br />

in group 2 (p


SESIUNEA TÂNĂRULUI INVESTIGATOR<br />

YOUNG INVESTIGATOR’S AWARD SESSION<br />

Criteriile de excludere pentru pacientii cu IA au fost<br />

fractia de ejectie a VS (FEVS) ≤50%, leziunile coronariene<br />

semnificative, insuficienta mitrala moderata sau<br />

severa, absenta ritmului sinusal. Rotatia si rata rotatiei<br />

au fost masurate prin STE din sectiunile parasternal ax<br />

scurt la baza si apexul VS, utilizand un s<strong>of</strong>tware dedicat<br />

(2D strain, EchoPac). VStor a fost definita ca diferenta<br />

maxima dintre unghiurile de rotatie a apexului si bazei<br />

VS si a fost raportata la diametrul longitudinal telediastolic<br />

al VS, masurat in sectiunea apical 4 camere (VStor<br />

normalizata).<br />

Rezultate: Nu au existat diferente in privinta varstei<br />

si sexului in grupul cu IA si in grupul control, iar<br />

FEVS medie a fost similara (58,5±11,4% vs 62,0±2,8%,<br />

p=0,181). Pacientii din grupul IA au avut diametre si<br />

volume VS, masa VS indexata si grosimea parietala VS<br />

mai mari (toate p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

70. Functia cardiaca materna<br />

si tratamentul sindromului de<br />

transfuzie feto-fetala<br />

Oana Savu, M.T.Van, P.DeKoninck, L.Gucciardo,<br />

Ruxandra Jurcut, S.Giusca, B.A.Popescu, J.Deprest,<br />

Carmen Ginghina, J.U.Voigt<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C.C. Iliescu”, Bucuresti<br />

Rezumat: Sindromul de transfuzie feto-fetala (TTTS)<br />

este o complicatie severa a sarcinilor multiple monocorionice<br />

ce necesita interventie chirurgicala fetoscopica<br />

cu fotocoagulare laser a anastomozelor placentare. Perioperator<br />

resorbtia lichidului amniotic in exces poate<br />

determina suprasolicitare acuta de volum a cordului<br />

matern.<br />

Obiectivul acestui studiu a fost evaluarea adaptarii cordului<br />

matern in cursul tratamentul TTTS.<br />

Metode: Studiul a inclus 12 paciente cu TTTS (varsta<br />

gestationala medie 21 saptamani) si 20 de femei insarcinate<br />

cu varsta gestationala similara. S-au efectuat studii<br />

ecocardiografice – parametri conventionali 2D si imagistica<br />

de deformare prin Doppler miocardic (DMI)<br />

inainte, la 6 ore si respectiv 48 de ore postoperator pentru<br />

grupul cu TTTS si la includere pentru grupul martor.<br />

Au fost determinate volumele ventriculului stang<br />

(VTDVS, VTSVS), volumul-bataie (VB), rezistenta<br />

vasculara periferica totala (RVT), deformarea sistolica<br />

longitudinala globala a VS (S) si rata deformarii (SR).<br />

Valoarea hematocritului in dinamica a fost folosita ca<br />

indicator al modificarii volumului intravascular.<br />

Rezultate: Pacientele cu TTTS au avut in momentul<br />

includerii valori mai mari ale debitului cardiac (DC)<br />

si alurii ventriculare fata de martor (6.2±1l/min vs<br />

5.2±1, respectiv 85±10 bpm vs 73±10, p 0.05). Imediat postoperator<br />

VB (73±13ml vs 89±11, p


SESIUNEA TÂNĂRULUI INVESTIGATOR<br />

YOUNG INVESTIGATOR’S AWARD SESSION<br />

mic parameters returned to baseline.<br />

Conclusion: The response <strong>of</strong> maternal heart to fetoscopic<br />

surgery for TTTS is characterized by an acutely<br />

increased contractile state combined with reduced afterload,<br />

which normalizes in the following days. Due to<br />

the important postoperative volume load, a careful perioperative<br />

volume management is crucial under these<br />

circumstances.<br />

71. Remodelarea structurala<br />

si functionala a ventriculului<br />

stang in sindromul metabolic<br />

S.I.Dumitrescu, I.Tintoiu,V.Greere, G.Cristian, Pinte<br />

Florina, L.Chiriac, G.Neagoe, Bica Ramona, S.Stanciu,<br />

V.A.Voicu, Andreea Teodorescu<br />

Centrul Clinic de Urgenta de Boli Cardiovasculare al<br />

Armatei, Bucuresti<br />

Scop: Am urmarit remodelarea structurala si functionala<br />

a ventriculului stang prin ecocardiografie 3DRT,<br />

2D speckle tracking si ecocardiografie standard la indivizii<br />

aparent sanatosi diagnosticati cu sindrom metabolic<br />

conform criteriilor IDF 2005.<br />

Metode: In cadrul unui program de preventie primara<br />

cardiovasculara am inregistrat 74 de subiecti in grupul<br />

de persoane cu sindrom metabolic – SM(+) si le-am<br />

comparat cu un grup de control de 116 persoane –<br />

SM(–). Am colectat datele referitoare la factorii de risc,<br />

datele ecocardiografice clasice, iar prin ecocardiografie<br />

3DRT – volumele si dimensiunile end-sistolice/diastolice<br />

ale VS si prin 2D speckle tracking – rotatia maxima<br />

apicala si bazala a VS, rasucirea („twist”) instantanee<br />

maxima (valoarea maxima a diferentei dintre rotatia<br />

sistolica instantanee apicala si cea bazala) si torsiunea<br />

VS (rasucirea/axul lung al VS).<br />

Rezultate: Sindromul metabolic se asociaza cu cresterea<br />

rotatiei sistolice apicale, a rasucirii si a torsiunii<br />

VS si cu modficari structurale si geometrice: cresterea<br />

masei si volumelor VS cu remodelare concentrica si<br />

modificare indicelui de sfericitate: reducerea dimensiunii<br />

axului scurt si cresterea axului lung (indexate la<br />

suprafata corporala) (Tabel 1). Analiza corelatiei dintre<br />

afectarile subclinice si factorii de risc a indicat ca<br />

acestea sunt generate in principal de valorile crescute<br />

ale presiunii arteriale si ale presiunii pulsului. SM(+)<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

n=74 SM (-) n=116 p Mean Std.Dev. Mean Std.Dev.<br />

Rotatia bazala max(º) -4.96 1.95 -4.71 1.83 ns Rotatia<br />

apicala max(º) 12.67 2.49 7.68 2.15


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

SESIUNEA TÂNĂRULUI INVESTIGATOR<br />

YOUNG INVESTIGATOR’S AWARD SESSION<br />

1). According to the analysis <strong>of</strong> subclinical alterations<br />

and risk factors, the widespread subclinical disease is<br />

triggered mainly by increased blood pressure and pulse<br />

pressure. SM (+) n=74 SM (-) n=116 p Mean Std.Dev.<br />

Mean Std. Dev. Peak basal rot(º)-4.96 1.95 -4.71 1.83 ns<br />

Peak apical rot(º)12.67 2.49 7.68 2.15


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

ARITMII | ARRHYTMIAS<br />

72. Resincronizarea cardiaca<br />

cu fuziune produce o<br />

resincronizare si o functie<br />

sistolica a VS mai buna<br />

comparativ cu stimularea<br />

atrio-biventriculara – un<br />

studiu acut<br />

R.G.Vatasescu, Alexandra Vasile, C.N.Iorgulescu,<br />

Cristina Ioana Caldararu, Dana Constantinescu,<br />

Maria Dorobantu<br />

Spitalul Clinic de Urgenta Floreasca, Bucuresti<br />

Premize: datele recente au aratat ca resincronizarea cu<br />

fuziune produce un raspuns hemodinamic superior in<br />

acut si o revers remodelare a VS mai buna.<br />

Scop: explorarea mecanismelor acestui raspuns superior.<br />

Metode: strain-ul radial in speckle tracking a fost<br />

efectuat ianinte si la o saptamana dupa implantarea<br />

unui stimulator biventricular la 20 de pacienti cu ICC<br />

(BRS, ritm sinusal, 9 ischemici, 61±10ani, 9 femei, clasa<br />

NYHA bazal 3.2±0.4, FEVS bazal 21±5%, VTS VS<br />

bazal 180±80 ml), cu pozitie concordanta a sondei de<br />

VS (segmentul VS cu cel mai tardiv peak de contractie<br />

concordant cu pozitia sondei de VS in proiectie radiologica<br />

OAS). Masuratorile s-au facut la o saptamana<br />

cu dipozitivul de TRC programat consecutiv pentru a<br />

stimula cu fuziune optima (OPT) si atrio-biventricular<br />

(AbiV, VV=0ms, cu cel mai scurt interval AV care nu<br />

truncheaza unda A). Disincronia mecanica intraventriculara<br />

a fost determinata prin diferenta intre peak-ul<br />

de contractie al primului si al celui mai tardiv segment<br />

dintre 6 curbe “time-strain” regionale. Performanta sistolica<br />

a VS a fost evaluata prin dP/dT la fluxul regurgitant<br />

mitral si/sau VTI aortic.<br />

Rezultate: CRT cu fuziune a produs un raspuns hemodinamic<br />

superior in acut: dp/dt VS 759±209 mmHg/s<br />

in OPT vs 721±204 mmHg/s in AbiV (p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

tricular dyssynchrony: 83±54 ms in OPT vs. 196±106<br />

ms with AbiV (p


ARITMII<br />

ARRHYTMIAS<br />

74. Exista remodelare<br />

electr<strong>of</strong>iziologica in sindromul<br />

de apnee obstructiva in somn<br />

Mihaela Grecu, D.Nastasa, Camelia Sorea, Daniela<br />

Boisteanu, Catalina Arsenescu Georgescu<br />

Institutul de Boli Cardiovasculare, Iasi<br />

Obiectiv: Evaluarea proprietatilor electr<strong>of</strong>iziologice<br />

a miocardului atrial la pacientii cu sindrom de apnee<br />

de somn obstructiva (OSAS) si flutter atrial paroxistic<br />

idiopatic (FAP). Ipoteza noastra a fost ca OSAS ar putea<br />

induce remodelare electr<strong>of</strong>iyiologica la pacientii cu<br />

FAP.<br />

Metoda: 42 pacienti cu FAP idiopatic supusi procedurii<br />

de ablatie prin radi<strong>of</strong>recventa a istmului cavotricuspid<br />

au fost evaluati ulterior prin chestionar Berlin si<br />

polisomnografie ambulatorie. 28 pacienti fara OSAS au<br />

fost inclusi in grupul A, ca grup de control, in timp ce<br />

grupul B a inclus 14 pacienti cu OSAS, valoarea medie<br />

a indicelui de apnee-hipopnee 28 ± 13, valoarea medie<br />

a saturatiei de oxigen nocturne 93 ± 3%. La sfarsitul<br />

procedurii de ablatie a istmului cavotricuspidian s-au<br />

calculat la toti pacientii din lotul studiat perioada refractara<br />

atriala (PRA), timpul de conducere interatrial<br />

(TC interA) si timpul de conducere intraatrial (TC intraA).<br />

Rezultate: Cele doua grupuri au fost omogene din<br />

punct de vedere al varstei (59 ± 9 vs 57 ± 11 ani, p><br />

0,05), sex (barbati 92% fata de 100%, p = 0.577) si diametrul<br />

anteroposterior al atriului stang (44 ± 6mm vs<br />

42 ± 6 mm, p> 0,05). Un s-au gasit diferente statistic<br />

semnificative ale caracteristicilor electr<strong>of</strong>iziologice intre<br />

grupul cu OSAS si grupul fara OSAS: PRA (169.5<br />

± 50.7ms, fata de 171.7 ± 52.3ms p> 0,05), TC intraA<br />

(55,3 ± 21.7ms vs 51.7 ± 16.9ms p> 0,05 ) si TC InterA<br />

(99.4 ± 17.7ms vs 88.9 ± 32.7 p> 0,05). Printre parametrii<br />

clinici testati, indexul de masa corporala, perimetrul<br />

abdominal si perimetrul gatului au fost semnificativ<br />

mai mari in grupul B comparativ cu pacientii din<br />

grupul A: IMC (32.7±3.69 vs. 29.8±3.5 p=0.02), perimetrul<br />

abdominal (121.6 ± 12.3cm vs. 110.5 ± 8.4cm,<br />

p 0.05). We found<br />

no statistically significant differences in EP characteristics<br />

between OSAS and non-OSAS groups: ARP<br />

(169.5±50.7ms vs. 171.7±52.3ms p>0.05), intra ACT<br />

(55.3±21.7ms vs. 51.7±16.9ms p>0.05) and inter ACT<br />

(99.4±17.7ms vs. 88.9±32.7 p>0.05). Among clinical<br />

parameters tested, body mass index (BMI), abdominal<br />

and neck perimeters were significantly larger in<br />

group B when compared with patients in group A BMI<br />

29.8±3.5 vs. 32.7±3.69 p=0.02, abdominal diameter<br />

121.6±12.3cm vs. 110.5±8.4cm, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

75. Tipic si atipic in<br />

tahiaritmiile la sportivii de<br />

performanta<br />

G.Ivanica, Eugenia Venescu, Lavinia Albisoru,<br />

A.Gheorghiu, Alina Negru, A.Ivanica, C.T.Luca,<br />

S.Pescariu, St.I.Dragulescu<br />

Institutul de Boli Cardiovasculare, Timisoara<br />

Premise: Evaluarea sportivului de performanta este<br />

uneori dificila datorita exprimarii atipice a aritmiilor,<br />

precum si datorita neadresabilitatii acestora de teama<br />

excuderii din lot.<br />

Material si metoda: In Institutul de Cardiologie Timisoara<br />

s-au internat in perioada noiembrie 1998 – iulie<br />

2010 un numar de 165 de pacienti sportivi de performanta<br />

cu urmatoarele aritmii: 1. sindrom WPW patent<br />

– 88 pacienti (53,3%); 2. sindrom WPW intermitent cu<br />

blocaj in faza 4 – 3 pacienti (1,81%); 3. sindrom WPW<br />

intermitent benign cu evolutie in timp spre WPW malign<br />

– 3 pacienti (1,81%); 4. cai accesorii ascunse – 28<br />

pacienti (16,96%): - cu declararea tahicardiei – 16 pacienti<br />

(9,69%); - fara declararea tahicardiei – 12 pacienti<br />

(7,27%). 5. tahicardii intranodale – 29 pacienti<br />

(17,57%); 6. tahicardii ventriculare – 8 pacienti (4,84%);<br />

7. extrasistole ventriculare – 4 pacienti (2,42%); 8. fibrilatie<br />

atriala pe cord indemn – 2 pacienti (1,21%).<br />

Toti pacientii au fost explorati electr<strong>of</strong>iziologic, iar un<br />

numar de 163 pacienti au fost ablatati prin curent de<br />

radi<strong>of</strong>recventa.<br />

Concluzii: 1. In conditiile unui efort maximal, tahiaritmiile<br />

supraventriculare sau ventriculare pot degenera<br />

in stop cardiac prin fibrilatie ventriculara si necesita<br />

ablatie prin radi<strong>of</strong>recventa ca prima conditie pentru<br />

continuarea activitatii sportive. 2. Cazurile atipice si<br />

nedeclarate de sportivi la examenul medical reprezinta<br />

inca o sursa de accidente majore in timpul competitiilor<br />

sportive. De acceea, orice suspiciune de tahiaritmie<br />

la sportivi trebuie investigata electr<strong>of</strong>iziologic pentru<br />

confirmare sau infirmare.<br />

ARITMII<br />

ARRHYTMIAS<br />

Tachyarrhythmias in<br />

pr<strong>of</strong>essional athletes – typical<br />

and atypical<br />

Background The evaluation <strong>of</strong> pr<strong>of</strong>essional atheletes is<br />

sometimes difficult, because <strong>of</strong> atypical presentation <strong>of</strong><br />

arrhythmias and low addressability, for fear <strong>of</strong> exclusion<br />

from the team.<br />

Method: From november 1998 to july 2010 there were<br />

165 pr<strong>of</strong>essional athletes admitted in Timisoara Institute<br />

<strong>of</strong> Cardiovascular Disease, with the following<br />

arrhythmias: 1. patent WPW syndrome – 88 patients<br />

(53,3%); 2. phase 4 block intermitent WPW syndrome<br />

– 3 patients (1,81%); 3. benign intermitent WPW<br />

syndrome evolving over time to malignant WPW<br />

syndrome – 3 patients (1,81%); 4. concealed accessory<br />

pathways – 28 patients (16,96%): - with declared tachycardia<br />

– 16 patients (9,69%); - without declared tachycardia<br />

– 12 patients (7,27%). 5. intranodal tachycardias<br />

– 29 pacienti (17,57%); 6. ventricular tachycardias<br />

– 8 patients (4,84%); 7. ventricular extrasystoles – 4<br />

patients (2,42%); 8. lone atrial fibrillation – 2 patients<br />

(1,21%). All patients were submitted to electrophysiological<br />

study and 163 <strong>of</strong> them were treated by means <strong>of</strong><br />

radi<strong>of</strong>requency ablation.<br />

Conclusions: 1. During maximal effort, ventricular or<br />

supraventricular tachyarrhythmias can degenerate into<br />

ventricular fibrillation and cardiac arrest and need to<br />

be treated by radi<strong>of</strong>requency ablation in order to pursue<br />

with pr<strong>of</strong>essional sport activity. 2. Atypical and still<br />

undeclared cases represent a source <strong>of</strong> major accidents<br />

during sport competitions. For this reason, any suspicion<br />

<strong>of</strong> tachyarrhythmia in athletes requires electrophysiological<br />

evaluation.


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

VARIA 1 | VARIA 1<br />

76. Identificarea placii<br />

aterosclerotice coronariene<br />

prin MSTC<br />

Simona Huidu, Andreea Popescu, L.Ghilencea, Luminita<br />

Ionescu, I.Stanca, S.Barsan, M.Melnic, Laura<br />

Arama, Smaranda Lacau, Doina Dimulescu<br />

Spitalul Universitar de Urgenta ELIAS, Bucuresti<br />

Scop: Am evaluat fezabilitatea si calitatea imaginilor<br />

TC coronarian privind excluderea bolii coronariene la<br />

pacienti cu risc mic sau intermediar, conform ghidurilor,<br />

sau urmarire a pacientilor dupa stentare sau bypass<br />

aorto coronarian prin angio CT efectuat in Spitalul<br />

Elias-Prolife in anul 2009-2010.<br />

Metode si rezultate: Au fost evaluati 50 pacienti cu<br />

greutate sub 100kg, ritm sinusal sub 60 batai/min, dupa<br />

premedicatie cu metoprolol/bisoprolol, varsta peste 30<br />

ani, utilizand un sistem CT cu 64 slice-uri si un timp de<br />

scanare intre 10-12 secunde la care s-au folosit 80-150<br />

ml substanta de contrast/pacient, cu un debit de 4-5<br />

ml/sec, durata totala a investigatiei fiind de maxim 30<br />

min. Achizitia de date s-a facut in diastola, sincronizat<br />

cu semnalul EKG, declansat de unda R, cu o iradiere<br />

intre 1-4 mSv. Frecventa cardiaca scazuta e necesara<br />

pentru obtinerea unei imagini calitative mai bune la<br />

angio CT. Greutatea corporala influenteaza si ea calitatea<br />

imaginilor. La toti pacientii care au efectuat TC<br />

coronarian s-a obtinut o imagine buna calitativ. Au fost<br />

exclusi de la inceput pacientii care aveau insuficienta<br />

renala sau alergie la substanta de contrast. Dintre cei 50<br />

pacienti la 2 nu s-a putut efectua CT coronare prin imposibilitatea<br />

obtinerii unei frecvente cardiace sub 60/<br />

min dupa metoprolol / os sau bisoprolol; 48 pacienti<br />

au efectuat angio CT. Dintre pacientii care au efectuat<br />

angio CT toate cele 48 imagini au fost excelente, fara<br />

a avea rezultate neinterpretabile. 32 dintre pacienti au<br />

fost barbati si 16 femei. 16 pacienti au avut varsta sub 55<br />

ani. 90% din pacienti au prezentat durere precordiala.<br />

11% aveau stent sau bypass anterior investigatiei si au<br />

efectuat CT coronare pentru verificarea permeabilitatii<br />

stenturilor sau a grafturilor. Probabilitatea de restenoza<br />

a fost mica astfel la un singur pacient s-a diagnosticat<br />

o stenoza semnificativa pe un alt vas decat cel stentat si<br />

s-a indicat coronarografie. Dintre cei fara revasculari-<br />

zare anterioara doar 12% au avut stenoza semnificativa<br />

pe unul, doua sau 3 vase coronariene. 4 pacienti au avut<br />

stenoze nesemnificative pe LM, 6 pe LAD, 5 pe CX si<br />

2 pe CD. Scorul de calciu a fost 0 la 20% dintre pacienti,<br />

18% au avut scor de calciu care ii incadreaza la<br />

risc de peste 90% pentru rasa, varsta, sex; 16% cu risc<br />

de 75-90%. Dintre toti pacientii, 5 au fost trimisi pentru<br />

confirmarea leziunilor la coronografie. Cele doua<br />

leziuni au fost confirmate la un CT coronarian ca fiind<br />

fals pozitive. Restul nu au avut agiografie coronariana.<br />

10% dintre pacienti au fost diagnosticati cu pericardita<br />

si coronografia a fost normala.<br />

Identification <strong>of</strong> coronary<br />

atherosclerotic plaque by<br />

MSTC<br />

Purpose: We evaluated the feasibility and quality <strong>of</strong><br />

coronary CT imaging excluding coronary disease in<br />

patients with low or intermediate risk according to guidelines,<br />

and tracking patients after stenting or coronary<br />

bypass with aortic angio-CT performed in Elias Hospital<br />

Prolife 2009-2010.<br />

Methods and results: Were evaluated 50 patients weighing<br />

less than 100kg, sinus rhythm below 60 beats /<br />

min, after premedication with metoprolol / bisoprolol,<br />

age over 30 years, using a 64 slice CT sites and a<br />

scan time between 10-12 seconds which were 80-150<br />

ml <strong>of</strong> contrast material used per patient, with a rate <strong>of</strong><br />

4-5 ml / sec, the total duration <strong>of</strong> investigation is more<br />

than 30 minutes. Data acquisition was done in diastolic<br />

signal synchronized with ECG, R wave triggered, with<br />

an irradiation between 1-4 mSv. Low heart rate is necessary<br />

to obtain the best image quality at CT angio.<br />

It affects body weight and image quality. All patients<br />

who carried coronarian CT was obtained a good image<br />

quality. Patients who had renal failure or allergy to contrast<br />

dye were excluded. Of the 50 patients in two could<br />

not perform coronary CT by inability to obtain a heart<br />

rate below 60/min after metoprolol / bone or bisoprolol,<br />

48 patients were performed angio CT. Among patients<br />

who made all 48 angio CT images were excellent,<br />

without any results neinterpretabile. 32 <strong>of</strong> the patients


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

were men and 16 women. 16 patients were aged less<br />

than 55 years. 90% <strong>of</strong> patients had chest pain. 11% had<br />

stents or bypass previous investigation and CT scan<br />

were performed to verify the permeability <strong>of</strong> coronary<br />

stents or grafturilor. Was little likelihood <strong>of</strong> restenosis<br />

as one patient was diagnosed as a significant stenosis<br />

in another vessel than the stent and showed coronarography.<br />

Of those without previous revascularization<br />

only 12% had significant stenosis in one, two or three<br />

coronary vessels. Four patients had significant LM stenosis,<br />

6 on LAD, CX and 5 on CD 2. Calcium score was<br />

0-20% <strong>of</strong> patients, 18% had calcium scores who belong<br />

to the risk <strong>of</strong> over 90% for race, age, sex, 16% risk <strong>of</strong><br />

75-90%. Of all patients, 5 were sent for confirmation to<br />

coronarografy. The two lesions were confirmed lesions<br />

present at CT coronary stent and were to be found a false<br />

positive. The rest did not have coronary angiography.<br />

10% <strong>of</strong> patients have been diagnosed pericarditis and<br />

coronary was normal.<br />

77. Rolul Angio CT multislice<br />

in asociere cu tehnici<br />

interventionale complexe in<br />

imbunatatirea rezultatelor<br />

tratamentului interventional in<br />

leziunile aortoiliace<br />

I.Benedek, Oana Bucur, Monica Chitu, Claudia Matei,<br />

I.Kovacs, P.I.A.Sarbu, Gabriela Kozma, Zsuzsanna<br />

Suciu, Theodora Benedek<br />

Universitatea de Medicina si Farmacie, Targu Mures<br />

Scop: Evidentierea rolului procedurilor interventionale<br />

complexe in extinderea indicatiilor tratamentului<br />

interventional in afectiunile arteriale iliace, si a rolului<br />

evaluarii preoperatorii prin angiografie CT 64 multislice<br />

in imbunatatirea tehnicii operatorii si a rezultatelor<br />

tratamentului interventional.<br />

Materiale si metoda: Au fost inclusi in studiu 144 pacienti<br />

la care s-au efectuat 205 interventii la nivel aortoiliac.<br />

S-au implantat 102 stenturi iliace, iar in 14 cazuri<br />

s-a asociat angioplastie laser (10 la nivelul axului iliac<br />

si 4 cazuri de angiolastie aorto-iliaca). Leziunile au fost<br />

incadrate in functie de clasificarea TASC astfel: TASC<br />

VARIA 1<br />

VARIA 1<br />

D- 29.16%, TASC C –20.84%, TASC B –28.5% si TASC<br />

A- 21.5%. La 36 pacienti s-a efectuat preinterventional<br />

si evaluarea complexa prin angioCT 64 slice a patului<br />

vascular periferic.<br />

Rezultate: Succesul tehnic inregistrat a fost de 97.71%.<br />

Valoarea indexului Doppler s-a imbunatatit cu 51% in<br />

grupul cu PTA comparativ cu 93% in grupul cu implantare<br />

de stent iliac (p< 0,001). Asocierea preangioplastie<br />

a evaluarii angioCt a axului arterial a dus la reducerea<br />

timpilor opratori in medie de la 40 minute la 25 minute.<br />

Permeabilitatea primara a fost de 88.34% la 24 luni,<br />

iar permeabilitatea secundara a fost de 95.13%. Rata de<br />

supravietuire a fost de 93% la 30 luni, iar rata de salvare<br />

a membrului inferior la 30 luni a fost de 98.61%. Evaluarea<br />

complexa prin AngioCt preoperator a permis o<br />

mai buna pregatire a strategiei interventionale ducand<br />

la reducerea numarului cailor de abord necesare si la<br />

evitarea complicatiile hemoragice chiar in ciuda unor<br />

leziuni vasculare complexe (20 leziuni arotoiliace si 12<br />

leziuni ale axului iliac bilateral).<br />

Concluzii: Angioplastia axului iliac este sigura si eficienta<br />

in tratamentul stenozelor si ocluziilor de la acest<br />

nivel, progresele tehnice din ultimii ani permitand<br />

extinderea indicatiilor acesteia si la leziuni din clasa<br />

TASC C sau D. Evaluarea preoperatorie a patului<br />

vascular periferic prin AngioCt 64 multislice permite<br />

evaluarea exacta a leziuniilor si calcificarilor prezente<br />

permitand alegerea strategiei terapeutice optime, ceea<br />

ce duce la reducerea timpilor operatori si evitarea complicatiilor.<br />

Lucrare finantata prin grantul de cercetare<br />

41-069/2007 – LASCOR, finantat de MEC prin CNMP.<br />

Role <strong>of</strong> multislice angio CT<br />

in association with complex<br />

interventional techniques<br />

in improving interventional<br />

treatment results in aortoiliac<br />

lesions<br />

Purpose: Highlighting the role <strong>of</strong> complex interventional<br />

procedures in the interventional treatment indications<br />

<strong>of</strong> iliac arterial disease, and the role <strong>of</strong> preoperative<br />

evaluation by 64 multislice CT angiography in order to<br />

improve the operating technique and the results <strong>of</strong> interventional<br />

treatment.


VARIA 1<br />

VARIA 1<br />

Materials and methods: There were 144 patients included<br />

in the study and 205 interventions at the aortoiliaclevel<br />

were performed. 102 stents were implanted,<br />

and in 14 cases laser angioplasty was associated (on 10<br />

iliac interventions and 4 aortoiliac procedures). Lesion<br />

type was TASC D in 29.16% cases, TASC C in 20.84%<br />

cases, TASC B in 28.5% cases and TASC A in 21.5% cases.<br />

In 36 patients complex evaluation <strong>of</strong> the peripheral<br />

vascular bed was performed by 64 multislice angioCT.<br />

Results: Technical success was recorded 97.71%.<br />

Doppler index increased with 51% in PTA group, 93%<br />

in stented group (p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

nanti ai albuminuriei au fost indicii de rigiditate arteriala<br />

(β si AC) si parametrii ce evalueaza functia endoteliala<br />

(FMD): r=0.64, r2=0.40, p=0.001.<br />

Concluzii: Rigiditatea arteriala si disfunctia endoteliala,<br />

nu durata bolii si nici controlul diabetului sau al<br />

hipertensiunii arteriale, sunt principalii determinanti<br />

ai albuminuriei la pacientii cu hipertensiune usoaramoderata<br />

si diabet zaharat tip 2. Parametri de rigiditate<br />

arteriala si cei de evaluare a functiei endoteliale ar<br />

trebui luati in discutie si considerati noi tinte pentru<br />

tratamentul preventiv. Parametru Valoare IMT (mm)<br />

0.8 ± 0.2 Beta index 8.9 ± 3.0 Ep (kPA) 129.3 ± 47.2 WS<br />

(m/s) 6.7 ±1.2 AC (mm2/kPa) 0.7 ± 0.3 FMD (%) 9.2 ±<br />

4.2 Albuminuria (mg/l) 55.6 ± 146.1<br />

Arterial stiffness and<br />

endothelial dysfunction are<br />

the main determinants <strong>of</strong><br />

albuminuria in patients with<br />

diabetes and hypertension<br />

Background: Patients with type II diabetes and associated<br />

arterial hypertension have increased arterial stiffness<br />

due mainly to endothelial dysfunction. Meanwhile,<br />

they usually have microalbuminuria, also as a result<br />

<strong>of</strong> diffuse endothelial dysfunction. We hypothesized<br />

that these markers <strong>of</strong> subclinical organ damage are related<br />

and, therefore, we assessed the strength <strong>of</strong> correlation<br />

and the influence <strong>of</strong> other parameters.<br />

Methods: We evaluated 53 patients (57±9 years, 28<br />

males), with mild to moderate hypertension (mean<br />

ABPM values: 146/93 mmHg) and type II diabetes<br />

(mean duration <strong>of</strong> 3.6±5 years). Arterial function was<br />

assessed by e-tracking and wave intensity analysis, at<br />

the level <strong>of</strong> the RCCA, with measurements <strong>of</strong> intimamedia<br />

thickness (IMT), beta index (β), elastic module<br />

(Ep), carotid wave speed (WS), and arterial compliance<br />

(AC). Endothelial function was assessed by flow mediated<br />

dilation (FMD) at the level <strong>of</strong> the right brachial<br />

artery. Albuminuria was measured by an imunoturbidic<br />

method.<br />

Results: IMT and arterial stiffness parameters (β, Ep,<br />

WS, and AC) were at the upper limit <strong>of</strong> normal. FMD<br />

was slightly decreased, indicating mild endothelial dysfunction.<br />

Proteinuria was into the limits for microal-<br />

VARIA 1<br />

VARIA 1<br />

buminuria (table). Proteinuria correlated positively<br />

with arterial stiffness parameters (r=0.45 for β, r=0.50<br />

for Ep, both p


VARIA 1<br />

VARIA 1<br />

mmHg (26 pacienti), si IIb, cu sPAP>50 mmHg (16 pacienti).<br />

Echocardiografia inainte si la 30 zile de TAVI a<br />

evaluat functia VS (prin fractia de ejectie – FE), functia<br />

VD (prin TAPSE) si dimensiunile acestora, severitatea<br />

regurgitarii tricuspidiene (RT) secundare (aria jetului<br />

tricuspidian – TJA), si sPAP.<br />

Rezultate: Nu au existat diferente semnificative de<br />

varsta, gradient valvular aortic, arie valva aorta. La 30<br />

zile post TAVI, pacientii cu sPAP>50 mmHg au avut o<br />

scadere semnificativa a HTP cu imbunatatire concomitenta<br />

a functiei si dimensiunilor VD (PAPs: 75.8±18.9<br />

vs. 62.1±16.1 mm Hg, p=0.01, diametru atriu drept:<br />

41.3±11.1 vs. 35.7±8.8 mm, p=0.04, diametru VD:<br />

43.5±12.2 vs. 37.1±9.3 mm, p=0.035, TJA: 5.5±2.6 vs.<br />

4.2±2 cm2, p=0.03 si TAPSE: 20.5±6.1 vs. 25.2±7.2,<br />

p=0.05), iar pacientii cu sPAP


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

ECOCARDIOGRAFIE | ECHOCARDIOGRAPHY<br />

80. Valoarea aditionala a<br />

ecografiei transes<strong>of</strong>agiene<br />

tridimensionale in timp real in<br />

chirurgia cardiaca electiva<br />

Andrea Ciobanu 1 , Raluca Dulgheru 1 , S.Bennett 2 ,<br />

D.Vinereanu 1<br />

Universitatea de Medicina si Farmacie “Carol Davila”,<br />

Bucuresti 1 , Hull (UK) 2<br />

Context: Ecografia transes<strong>of</strong>agiana bidimensionala<br />

(ETE-2D) perioperatorie a avut o influenta majora asupra<br />

deciziilor terapeutice si evolutiei pacientilor. Aceasta<br />

metoda subestimeaza volumul ventriculului stang<br />

(VS) in comparatie cu RMN, considerata “standardul<br />

de aur” actual. Evaluarea 2D a valvelor poate avea limitari<br />

semnificative. Majoritatea studiilor au demonstrat<br />

superioritatea evaluarii 3D fata de 2D, fara sa existe<br />

suficiente dovezi in context operator pana in prezent.<br />

Ipoteza de la care am pornit a fost ca ecografia transes<strong>of</strong>agiana<br />

tridimensionala (ETE-3D) aduce informatii<br />

suplimentare in chirurgia cardiaca.<br />

Metode: 52 de pacienti (67±12 ani, 38 barbati) cu indicatie<br />

chirurgicala cardiaca au fost inclusi si evaluati<br />

prin ETE-2D si 3D. Volumul VS a fost masurat folosind<br />

in 2D metoda Simpson, trasand limita VS cu 1 mm inauntrul<br />

marginii endocardului, iar in 3D tehnica semiautomata<br />

de delimitare a endocardului. Am evaluat<br />

gradul de intelegere dintre cele 2 metode prin analiza<br />

Bland-Altman.<br />

Rezultate: ETE-3D a fost tehnic posibila la toti pacientii.<br />

A existat un nivel de intelegere bun intre ETE-2D si<br />

ETE-3D pentru volumele telediastolic (average bias =7<br />

ml; 7.8%) si telesistolic (average bias =2.2 ml; 5.5%) ale<br />

VS. Am obtinut un nivel de intelegere excelent intre dimensiunea<br />

protezei aleasa de chirurg si diametrul inelului<br />

aortic masurat in 3D (average bias =0.19 mm; 0.7<br />

%), mai bun decat in 2D (0.9 mm; 3.45 %). Nivelul de<br />

intelegere intre cele 2 metode pentru aria valvei aortice<br />

masurata planimetric a fost mai putin satisfacator (average<br />

bias =0.18 cm2, 17%). Pentru 3 pacienti, morfologia<br />

valvei aortice a fost mai bine evaluata in 3D. 4 din<br />

9 pacienti care au beneficiat de inlocuire/reconstructie<br />

valvulara mitrala pentru prolaps semnificativ au avut<br />

mai multe detalii despre morfologia valvei prin evaluarea<br />

3D, identificand: 1)un cleft P1/P2; 2) un prolaps<br />

mai extins al foitei posterioare cu implicarea scalopului<br />

P3 si ruptura de cordaje; 3) ruptura de cordaje; 4) un<br />

prolaps mai extins al foitei mitrale posterioare prin implicarea<br />

scalopului P1. ETE-3D a adus informatii suplimentare<br />

la pacientii cu stenoza mitrala, dehiscenta de<br />

proteza mitrala si mixom atrial.<br />

Concluzii: ETE-3D in chirurgia cardiaca este fezabila,<br />

<strong>of</strong>era chirurgului informatii suplimentare despre morfologia<br />

valvulara si masuratorile standard ar putea fi<br />

efectuate cu mai multa acuratete.<br />

Domeniu : 11.02 Ecografie transes<strong>of</strong>agiana<br />

Media obtinuta: 8,7<br />

Oral/Poster: oral<br />

Additional value <strong>of</strong> real<br />

time three dimensional<br />

transoesophageal<br />

echocardiography in elective<br />

cardiac surgery<br />

Background: Perioperative two-dimensional transesophageal<br />

echocardiography (2D-TEE) has had a major<br />

impact on clinical decision-making. However, it<br />

has significant limitations for LV volumes and valves<br />

assessment. Not enough perioperative data is available.<br />

We hypothesized that real time three-dimensional TEE<br />

(3D-TEE), a novel and revolutionary technique, adds<br />

incremental value in cardiac surgery.<br />

Methods: 52 patients (67±12 years, 38 men) referred<br />

for cardiac surgery underwent perioperative 2D-TEE<br />

and 3D-TEE exams. LV volumes were assessed by<br />

Simpson’s method (2D-TEE), tracing the cardiac borders<br />

1 mm inside the visible endocardium, and semiautomated<br />

border detection technique (3D-TEE). 3D-<br />

TEE was also used to assess abnormal valves. We report<br />

the level <strong>of</strong> agreement (Bland-Altman analysis) between<br />

2D-TEE and 3D-TEE and the qualitative analysis.<br />

Results: 3D-TEE was feasible in all patients. There was<br />

a good agreement between 2D-TEE and 3D-TEE for


ECOCARDIOGRAFIE<br />

ECHOCARDIOGRAPHY<br />

the end-diastolic (average bias = 7 ml; 7.8%, 95% CI)<br />

and end-systolic (average bias = 2.2 ml; 5.5%, 95% CI)<br />

volumes. There was an excellent agreement between the<br />

aortic prosthesis dimension chosen by the surgeon and<br />

the aortic annulus measured in 3D-TEE (average bias<br />

= 0.19 mm; 0.7 %, 95% CI), better than with 2D-TEE<br />

(0.9 mm; 3.45 %, 95% CI). There was a less satisfactory<br />

agreement between planimetry <strong>of</strong> the aortic valve<br />

area (AVA) by the 2 methods (average bias = 0.18cm2,<br />

17%, 95% CI). 3D-TEE provided better views for AV<br />

morphology in 3 cases. It provided additional information<br />

regarding the mitral valve (MV) morphology in<br />

4 out <strong>of</strong> 9 patients who underwent MV replacement/<br />

repair for MV prolapse by identifying (1) a P1/P2 cleft;<br />

(2) a more extensive prolapse <strong>of</strong> the posterior mitral<br />

leaflet (PML) involving P3 scallop, and ruptured chordae;<br />

(3) ruptured chordae; (4) a more extensive prolapse<br />

<strong>of</strong> the PML involving P1 scallop. 3D-TOE provided<br />

additional information for patients with mitral stenosis<br />

(the only method able to measure MVA by planimetry),<br />

mitral prosthesis dehiscence, and atrial myxoma.<br />

Conclusions: 3D-TEE during cardiac surgery is feasible,<br />

adds additional information for the surgeon for the<br />

assessment <strong>of</strong> valves morphology, and might be more<br />

accurate than 2D-TEE for the standard measurements.<br />

81. Evaluarea functiei<br />

atriale stangi la pacientii<br />

cu hipertr<strong>of</strong>ie ventriculara<br />

stanga: studiu comparativ la<br />

pacientii cu stenoza aortica si<br />

hipertensiune arteriala<br />

Calin Andreea, B.A.Popescu, Cristiana Carmen Beladan,<br />

Monica Rosca, Bianca Moise, Florina Voinea, Luiza<br />

Lupascu, Denisa Muraru, Roxana Enache, Carmen<br />

Ginghina<br />

Universitatea de Medicina si Farmacie "Carol Davila",<br />

Bucuresti<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Introducere. Importanta functiei atriale stangi (AS)<br />

la pacientii cu hipertr<strong>of</strong>ie ventriculara stanga (HVS) a<br />

fost deja demonstrata. Recent s-a aratat ca parametrii<br />

de deformare atriala stanga sunt utili in evaluarea neinvaziva<br />

a performantei AS. Obiectiv: Evaluarea deformarii<br />

si a ratei de deformare longitudinala a AS in HVS<br />

patologica (masa VS indexata > 115 g/m2 la barbati si ><br />

95 g/m2 la femei), comparativ la pacienti cu hipertensiune<br />

arteriala (HTA) si la pacienti cu stenoza aortica<br />

(SA) stransa, toti cu fractie de ejectie (FE) VS pastrata<br />

(> 50%).<br />

Metode: Am inrolat prospectiv 36 de pacienti consecutivi<br />

(59 ± 9 ani, 11 barbati) cu HTA izolata si 37 pacienti<br />

cu varste similare, cu SA stransa (62 ± 7 ani, 31 barbati,<br />

aria valvei aortice indexata AVAi < 0,6 cm2/m2).<br />

Tuturor pacientilor li s-a efectuat o ecocardiografie<br />

completa care a inclus parametrii de functie diastolica a<br />

VS evaluati prin Doppler tisular. Presiunile de umplere<br />

VS au fost evaluate utilizand raportul E/E’. Parametrii<br />

de deformare longitudinala a AS au fost evaluati din<br />

sectiunea apical 4 camere prin ecocardiografie speckle<br />

tracking. Au fost masurate valorile maxime ale deformarii<br />

longitudinale globale a AS si ale ratei deformarii<br />

sistolice a AS (SSr, functia de rezervor), deformarii<br />

diastolice precoce (ESr, functia de conduct) si tardive<br />

(ASr, functia de pompa).<br />

Rezultate: La pacientii cu SA, AVAi a fost de 0,4 ± 0,1<br />

cm2/m2, iar gradientul mediu transvalvular a fost 53<br />

±19 mmHg. Volumul indexat al AS, masa, volumele VS<br />

si FEVS au fost similare la pacientii cu SA si la cei cu<br />

HTA (p >0,30). Pacientii cu SA au prezentat valori mai<br />

mari ale raportului E/E’ (p< 0,001). La pacientii cu SA,<br />

deformarea longitudinala a AS a fost semnificativ redusa<br />

fata de pacientii cu HTA (19±7 vs 24 ±5%,p=0,003).<br />

SSr si ESr au fost semnificativ reduse la pacientii cu SA<br />

(p=0,04 si respectiv p=0,002) iar ASr a fost similar in<br />

ambele grupuri (p=0,50). La pacientii cu SA deformarea<br />

longitudinala a AS, SSr si ESr s-au corelat semnificativ<br />

cu raportul E/E’.<br />

Concluzii: In p<strong>of</strong>ida gradului similar de HVS si de dilatare<br />

AS, pacientii cu SA au prezentat o afectare mai<br />

importanta a functiilor de rezervor si de conduct ale<br />

AS fata de pacientii cu HTA. Reducerea functiei AS la<br />

pacientii cu SA a fost asociata cu presiuni de umplere<br />

VS crescute, aratand legatura stransa intre functia AS si<br />

cea a VS la acesti pacienti.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Assessment <strong>of</strong> left atrial<br />

function in patients with<br />

left ventricular hypertrophy:<br />

comparison between aortic<br />

stenosis and hypertension<br />

Background. The importance <strong>of</strong> left atrial (LA) function<br />

in patients (pts) with left ventricular (LV) hypertrophy<br />

was previously demonstrated. LA myocardial<br />

deformation parameters recently emerged as a robust<br />

tool for the noninvasive assessment <strong>of</strong> LA performance.<br />

Purpose: We aimed to assess LA strain(ε) and strainrate<br />

(Sr) in pathological LV hypertrophy (LV mass index<br />

> 115g/m2 in men and > 95 g/m2 in women) in pts<br />

with hypertension (HTN) and in pts with severe aortic<br />

stenosis (AS), all <strong>of</strong> them with preserved LV ejection<br />

fraction (>50%).<br />

Methods: We prospectively enrolled 36 consecutive pts<br />

(59±9 years, 11 men) with isolated arterial hypertension<br />

(HTN) and 37 age-matched pts with severe AS (62<br />

± 7years, 31 men, indexed aortic valve area, AVAi0.30 for<br />

all). Pts with AS had higher E/E’ ratios both at the septal<br />

and lateral sites (p 50%). S-au folosit tehnica 2D<br />

pentru masurarea FEVS (metoda Simpson), Doppler<br />

spectral pentru evaluarea fluxului diastolic transmitral<br />

(FDT) si Doppler tisular (TDI) pentru determinarea<br />

vitezelor longitudinale de relaxare protodiastolica (Ea)<br />

si telediastolica (Aa) inainte si dupa EV. EV se produc<br />

inaintea depolarizarii atriale si de aceea efectele contractiei<br />

atriale nu se identifica in diastola cardiaca.<br />

Rezultate: Modelul TMF a fost: relaxare intarziata (RI)<br />

(E/A 1, Ea=6+/-2.5 cm/sec) la 41% pts. In<br />

timpul pauzei postextrasistolice, la 20% pts cu RI fluxul<br />

devine normal(E/A>1 si E/Ea


ECOCARDIOGRAFIE<br />

ECHOCARDIOGRAPHY<br />

Introducere. Pentru reducerea incidentei insuficientei<br />

cardiace induse de stimularea din apexul ventricului<br />

drept (VD) au fost cautate localizari alternative pentru<br />

plasarea sondelor permanente. Criteriile radiologice<br />

pentru impantarea sondelor in locurile alternative au<br />

fost descrise, dar acordul (agreement-ul) acestor criterii<br />

cu localizarea anatomica exacta a sondelor, documentata<br />

prin ecografie 3D, este dubitabil.<br />

Metoda: Pozitia exacta a sondelor de stimulare permanenta<br />

a fost documentata la 30 de pacienti, utilizand<br />

ecografia 3D (Vivid 7, sonda 3V, GE). Au fost inregistrate<br />

imagini volumetrice complete din incidente mulne<br />

neschimbat (E/A1, Ea=6,6+/-2,4cm/sec) si 39%<br />

pts trec in tipul RI (E/A 50%<br />

underwent 2D echo examinations for LVEF measurement<br />

(Simpson method), spectral Doppler for the<br />

assessment <strong>of</strong> the pattern <strong>of</strong> diastolic transmitral flow<br />

(TMF) and tissue Doppler (TDI) for the assessment <strong>of</strong><br />

protodiastolic (Ea) and telediastolic (Aa) longitudinal<br />

relaxation velocities, before and after VPB. VPBs occure<br />

before the atrial depolarization, therefore the effects<br />

<strong>of</strong> the atrial contraction do not appear during diastolic<br />

interval.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Results: The pattern <strong>of</strong> TMF was delayed relaxation<br />

(DR) (E/A 1, Ea=6+/-2.5 cm/sec) in 41%<br />

pts. During the postextrasistolic interval 20% pts with<br />

DR change to normal pattern (E/A>1 and E/Ea


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

tiple; au fost realizate planuri de sectiune prin aceste<br />

imagini astfel incat sa se vizualizeze pozitia exacta a<br />

locului de insertie a sondelor. Pozitia radiologica a fost<br />

determinata folosind incidentele standard (PA, LAO<br />

40, RAO 40). Au fost definite 4 locatii: tract ejectie VD<br />

(TEVD), sept interventricular, apex VD si perete liber<br />

VD. TEVD a fost impartit in TEVD septal si TEVD anterior.<br />

Septul interventricular a fost de asemenea impartit<br />

in sept anterior (jonctiunea intre peretele liber<br />

VD si septul adevarat, la nivelul bandeletelor septomarginale)<br />

si sept adevarat (corpul septului).<br />

Rezultate: Localizarea sondelor conform ecografiei 3D<br />

a fost: TEVD–5 pacienti (1 septal, 4 anterior); sept interventricular–15<br />

pacienti (8 anterior, 7 sept adevarat);<br />

apex VD–7 pacienti; perete liber VD–3 pacienti. Acordul<br />

general intre criteriile radiologice si ecografia 3D a<br />

fost doar moderat (κ=0.587; 95I; = 0.378 - 0.796). Criteriile<br />

radiologice au discriminat localizarea apicala VD<br />

(κ=1) de cea septala (κ=0.733; 95I; = 0.490 - 0.977) si<br />

de TEVD (κ=0.870, 95I; = 0.618 - 1.121). Totusi, aceste<br />

criterii nu au discriminat pozitiile anterioare TEVD de<br />

cele septale TEVD (κ=0.048; 95I; = -0.370 - 0.465), si au<br />

fost relativ imprecise pentru discriminarea localizarilor<br />

septale anteriore si septale adevarate (κ=0.452; 95I; =<br />

0.054 - 0.850), precum si in identificarea peretelui liber<br />

de VD (κ=0.348; 95I; = -0.352 - 1.048).<br />

Concluzie: Criteriile radiologice pot identifica precis<br />

doar localizarile apicale ale sondelor de stimulare<br />

ventriculara, dar nu si pe cele alternative. Studiile care<br />

compara efectul stimularii VD apicale fata de localizarile<br />

alternative pot utiliza ecografia 3D pentru definirea<br />

pozitiei sondelor, dar nu criteriile radiologice.<br />

Inaccuracy <strong>of</strong> radiological<br />

criteria for pacemaker<br />

lead implantation by<br />

comparison with assessment<br />

<strong>of</strong> lead position using 3D<br />

echocardiography<br />

Introduction. Alternatives to right ventricular (RV)<br />

apical pacing have been sought in an attempt to decrease<br />

the incidence <strong>of</strong> pacing-induced heart failure. Radiological<br />

criteria for implantation <strong>of</strong> pacemaker leads<br />

at alternative sites have been described, but agreement<br />

ECOCARDIOGRAFIE<br />

ECHOCARDIOGRAPHY<br />

<strong>of</strong> these criteria compared with the exact location <strong>of</strong> the<br />

lead by 3D echocardiography is debatable.<br />

Methods: We documented the exact location <strong>of</strong> ventricular<br />

pacemaker leads in 30 implanted patients, using<br />

3D echocardiography (Vivid 7, 3V probe, GE). Full volume<br />

data sets were acquired from multiple views and<br />

appropriate slices were cropped, in order to detect the<br />

exact location <strong>of</strong> the tip <strong>of</strong> the lead inserted into the<br />

myocardium. Radiological location <strong>of</strong> the leads was<br />

assessed from 3 standard fluoroscopic views (posterior-anterior;<br />

LAO 40; RAO 40); lead placement was attributed<br />

to 4 locations: RV outflow tract (RVOT), interventricular<br />

septum, RV apex, and RV free wall. RVOT<br />

was divided into septal RVOT and anterior RVOT;<br />

interventricular septum was also divided into anterior<br />

septum (the junction between RV free wall and true<br />

septum, at the level <strong>of</strong> septomarginal trabeculations)<br />

and true septal position (the body <strong>of</strong> the septum).<br />

Results: Exact lead positions by 3D echocardiography<br />

were: RVOT - 5 patients (1 septal, 4 anterior); interventricular<br />

septum - 15 patients (8 anterior, 7 true septal);<br />

apical - 7 patients; RV free wall - 3 patients. Overall<br />

agreement between radiological criteria and 3D echocardiography<br />

was only moderate (κ = 0.587; 95% CI =<br />

0.378 - 0.796). Radiological criteria were able to discriminate<br />

apical (κ = 1) from septal (κ = 0.733; 95% CI<br />

= 0.490 - 0.977) and RVOT positions (κ = 0.870, 95%<br />

CI = 0.618 - 1.121); however, they did not discriminate<br />

septal RVOT from anterior RVOT (κ = 0.048; 95% CI<br />

= -0.370 - 0.465), and were only moderately accurate in<br />

discriminating anterior septal from true septal position<br />

(κ = 0.452; 95% CI = 0.054 - 0.850), and in identifying<br />

RV free wall locations (κ = 0.348; 95% CI = -0.352 -<br />

1.048).<br />

Conclusions: Current radiological criteria can accurately<br />

identify only apical but not alternative sites for<br />

pacemaker lead implantation. Studies which compare<br />

the effects <strong>of</strong> apical versus alternative site pacing should<br />

use 3D echocardiography instead <strong>of</strong> radiological criteria<br />

for documentation <strong>of</strong> lead placement.


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

POSTER FORUM II | POSTER FORUM II<br />

84. Influenta polimorfismului<br />

citokinelor proinflamatorii<br />

asupra functiei enoteliale la<br />

pacientii cu boala arteriala<br />

periferica<br />

Adina Liliana Stoica, Ileana Constantinescu,<br />

Ana Moise, Carmen Ginghina<br />

Institutul de Urgenta pentru Boli Cardiovasculare<br />

"Pr<strong>of</strong>.Dr. C.C.Iliescu", Bucuresti<br />

Obiective: Identificarea unor genotipuri ale genelor citokinelor<br />

proinflamatorii cu efect negativ asupra functiei<br />

endoteliale la pacientii cu boala arteriala periferica.<br />

Material si metoda: Au fost inclusi 48 pacienti internati<br />

consecutiv cu boala arteriala periferica stadiile II<br />

B – IV Fontaine, la care s-au practicat interventii chirurgicale<br />

elective de revascularizare periferica, in perioada<br />

1.07.2007–1.07.2008 in cadrul Institutului de Boli<br />

Cardiovasculare „Pr<strong>of</strong>. Dr. C.C. Iliescu”. Au fost exclusi<br />

pacientii cu sindrom coronarian acut si/sau AVC/AIT<br />

in ultimele 3 luni, cu insuficienta cardiaca decompensata,<br />

afectiuni renale severe, neoplazii, interventii<br />

cardiace/vasculare in ultimele 6 luni. A fost analizat<br />

promotorul genelor citokinelor proinflamatorii IL-1α<br />

(-889 T/C), IL-1β (-511 C/T si +3962 C/T), IL-2 (+166<br />

G/T si -130 G/T), IL-4 -590 (T/C) si IL-6 (-174 G/C<br />

si nt565 G/A). Functia endoteliala fost evaluata la toti<br />

pacientii preoperator prin vasodilatatia dependenta de<br />

endoteliu(FMD) si independenta (dupa administare de<br />

nitroglicerina) de endoteliu, masurata ultrasonografic<br />

la nivelul arterei brahiale.<br />

Rezultate: Pacientii inclusi au avut o varsta medie<br />

de 61.75±8.66 ani. Variatia FMD medie a fost de<br />

8.8±2.28%, iar variatia medie a vasodilatatiei independenta<br />

de endoteliu dupa administrarea de nitroglicerina<br />

a fost de 14.89±2.11%. Dintre citokinele proinflamatorii<br />

studiate variatia FMD a fost semnificativ mai mica<br />

doar la pacientii cu genotip IL-6 -174CC (7,05±1,49%<br />

fata de 8,41 ±1,9 % pentru Il-6 -174 GC si 9,42±2,46<br />

% pentru IL-6-174 GG, p=0,009)) si la pacientii cu genotip<br />

IL-6 nt 565 AA (7,14±1,61 % fata de 8,49±1,91<br />

% pentru IL-6 nt 565 GA si 9,42 ±2,46% pentru IL-6<br />

nt565 GG, p=0,018), la celelalte citokine analizate neexistand<br />

diferente semnificative. Vasodilatatia indepen-<br />

denta de endoteliu (dupa administrare de nitroglicerina)<br />

nu a diferit semnificativ la nici unul dintre grupurile<br />

analizate.<br />

Concluzii: Disfunctia endoteliala analizata prin vasodilatatia<br />

dependenta de endoteliu (FMD) s-a corelat<br />

doar cu genotipurile genei IL-6 (atat-174 G/C, cat si nt<br />

565 G/A), dar nu si cu genotipurile celorlate gene proinflamatorii<br />

(IL-1α -889 T/C, IL-1β (-511 C/T si +3962<br />

C/T ), IL-2 (+166 G/T si -130 G/T) si IL-4 -590 T/C).<br />

Influence <strong>of</strong> proinflammatory<br />

citokines polymorphism on<br />

endothelial function at patients<br />

with peripheral arterial disease<br />

Objective: To identify genotypes <strong>of</strong> proinflammatory<br />

citokines genes with negative effect on endothelial<br />

function at patients with peripheral arterial disease.<br />

Methods: We included 48 patients with peripheral arterial<br />

disease stages IIB-IV Fontaine admitted for elective<br />

surgical interventions at Institutul de Boli Cardiovasculare<br />

„Pr<strong>of</strong>. Dr. C.C. Iliescu” between 1.07.2007<br />

and 1.07.2008. We exclude patients with recend acute<br />

coronary syndrome and stroke (last 3 months), with<br />

decompensated heart failure, severe renal dysfunction,<br />

neoplasms and cardiac or vascular surgical interventions<br />

in the last 6 months. We analyzed the proinflammatory<br />

citokines genes IL-1α(-889 T/C), IL-1β<br />

(-511 C/T and +3962 C/T), IL-2 (+166 G/T and-130<br />

G/T), IL-4 -590(T/C) and IL-6(-174 G/C and nt565<br />

G/A). Endothelial function was evaluated preoperatively<br />

in all subjects by endothelium dependent (FMD)<br />

and independent (after nytroglycerine administration)<br />

vasodilation on the brachial artery.<br />

Results: Patients’ mean age was 61.75±8.66 years.<br />

Mean FMD was 8.8±2.28%, and mean endothelium<br />

independent vasodilation after nitroglycerine administration<br />

was <strong>of</strong> 14.89 ± 2.11%. FMD variation was<br />

significantly lower only at patients with genotype IL-<br />

6-174CC (7.05±1.49% versus 8.41 ±1.9 % for Il-6 -174<br />

GC and 9.42±2.46 % for IL-6-174 GG, p=0.009)) and<br />

at patients with genotype IL-6 nt 565 AA (7.14±1.61 %


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

vs. 8,49±1,91 % for IL-6 nt 565 GA and 9.42 ±2.46% for<br />

IL-6 nt565 GG , p=0.018). For the rest <strong>of</strong> analyzed citokines<br />

there were no significant differences. Endothelium<br />

independent vasodilatation (after nytroglycerine<br />

administration) was not dignificantly different at any<br />

<strong>of</strong> analyzed subgroups.<br />

Conclusions: Endothelial dysfunction analyzed by<br />

endothelium dependent vaodilatation (FMD) was correlated<br />

only with gene IL-6 genotypes (174 G/C, and<br />

nt 565 G/A), not with other proinflammatory gene genotypes<br />

(IL-1α -889 T/C, IL-1β (-511 C/T and +3962<br />

C/T ), IL-2 (+166 G/T and -130 G/T) and IL-4 -590<br />

T/C).<br />

85. Poate disfunctia aortei sa<br />

explice angina la pacientii cu<br />

artere coronare permeabile<br />

angiografic<br />

Marinela Serban, Madalina Iancu, Ileana Craciunescu,<br />

Aneida Hodo, Ioana Ghiorghiu, B.A.Popescu, Carmen<br />

Ginghina<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Premise. Angina cu artere coronare normale (ACN)<br />

angiografic inca are mecanisme controversate. Rigitatea<br />

aortica (Ao) este recunoscuta acum ca fiind un<br />

marker de morbi- mortalitate cardiovasculara si s-a<br />

demonstrat a fi crescuta la pacientii cu boala cardiaca<br />

ischemica (BCI).<br />

Obiective: Evaluarea functiei vasculare Ao prin mai<br />

multe tehnici ecocardiografice, la pacienti cu angina si<br />

ACN versus BCI confirmata angiografic.<br />

Metoda: Studiul a cuprins 54 pacienti care s-au prezentat<br />

cu angina si au efectuat coronarografie. Subiectii<br />

au fost impartiti in 2 grupuri, imperecheate ca varsta:<br />

ACN, n=17 si BCI, n= 37. Functia vasculara Ao a fost<br />

evaluata prin Doppler tisular (TDI), determinandu-se<br />

<strong>of</strong>fline velocitatile sistolica (SW) si diastolice precoce<br />

(EW) si tardiva (AW) ale peretelui Ao anterior. Indicii<br />

de rigiditate Ao, calculati pe baza diametrelor Ao<br />

ascendente si a TA au fost: pulsatilitatea aortica (Ao<br />

Strain), distensibilitatea aortica (Ao Dis), indexul de<br />

rigiditate aortica (Ao SI). Postsarcina a fost evaluata<br />

prin: elastanta arteriala efectiva: Ea=0.9 X TA sistolica/<br />

POSTER FORUM II<br />

POSTER FORUM II<br />

volumul bataie. Indexul de rezistenta vasculara sistemica<br />

(SVRI)= TA medie/indexul cardiac. Complianta<br />

arteriala totala (Ca)= volum bataie/presiunea pulsului.<br />

Rezultate: Varsta medie a pacientilor a fost 63.2±8.2<br />

ani in grupul cu ACN vs 60.9±10.3 ani la pacientii cu<br />

BCI (p=0,54). Velocitatile TDI ale peretelui Ao, parametrii<br />

de rigiditate Ao, Ea, SVRI and Ca au prezentat<br />

valori similare in grupul cu ACN vs pacientii cu BCI:<br />

SW 6.57±1.8 vs 6.2±1.9 cm/s (p=0.32), EW 5.4±2.1<br />

vs 4.7±1.5 cm/s (p=0.32), AW 6.9±2.3 vs 7.1±2.3<br />

cm/s (p=0.77), Ao Strain 21.2±10.9% vs 23.1±14.6%<br />

(p=0.79), Ao Dis 0.8±0.4 vs 1±0.6 cm2/dyne (p=0.26),<br />

Ao SI 2.89±1.40 vs 2.6±1.4 (p=0.78), Ea 2.2±0.7 vs<br />

2.3±0.6 mmHg/ml (p=0.52), SVRI 3.2±1.1 vs 3.4±0.8<br />

dyne *s *m2/cm-5 (p=0.2), Ca 1.1±0.4 vs 1.2±0.4 ml/<br />

mm Hg (p= 0.81).<br />

Concluzii: In p<strong>of</strong>ida permeabilitatii arterelor epicardice,<br />

subiectii din grupul cu angina si ACN au avut velocitati<br />

ale peretelui Ao, parametrii de rigiditate Ao, Ea,<br />

SVRI si Ca similare cu cele ale pacientilor cu BCI confirmata<br />

angiografic. Intrucat s-a demonstrat anterior<br />

faptul ca pacientii cu BCI au functie vasculara Ao alterata,<br />

angina in absenta stenozelor coronariene ar putea<br />

fi consecinta fiziopatologica a cresterii rigiditatii Ao si<br />

a alterarii propagarii si secventialitatii undei pulsului.<br />

Could aortic dysfunction<br />

explain angina in patients<br />

with angiographically normal<br />

coronary arteries<br />

Background: Angina with angiographically normal coronary<br />

arteries (NCA) still has controversial pathophysiological<br />

mechanisms. Aortic (Ao) stiffness is now<br />

known as a marker <strong>of</strong> cardiovascular morbi-mortality<br />

and it was demonstrated to be increased in patients<br />

with coronary artery disease (CAD).<br />

Objective: To assess aortic function by different echocardiographic<br />

techniques in patients with angina and<br />

NCA versus those with coronary stenoses.<br />

Methods: 54 patients (pts) who underwent coronary<br />

angiography for angina were enrolled in this study.<br />

They were divided into two age-matched groups: NCA,<br />

n=17 and CAD, n= 37. Aortic function was evaluated<br />

in tissue Doppler imaging (TDI), by measuring <strong>of</strong>fline<br />

systolic (SW), early and late diastolic (EW, AW) veloci-


POSTER FORUM II<br />

POSTER FORUM II<br />

ties <strong>of</strong> the anterior aortic wall. Aortic stiffness indices,<br />

calculated using systolic and diastolic ascending Ao diameters<br />

and blood pressure values, were: Ao Strain, Ao<br />

distensibility (Ao Dis), Ao stiffness index (Ao SI). Total<br />

afterload was defined by the effective arterial elastance<br />

(Ea=0.9XSBP/SV, SV=stroke volume). Systemic vascular<br />

resistance index (SVRI) = mean arterial pressure/<br />

cardiac index. Total arterial compliance (Ca)=SV/pulse<br />

pressure.<br />

Results: The mean age was 63.2±8.2 years in NCA<br />

group vs 60.9±10.3 years in CAD pts (p=0.54). Aortic<br />

wall tissue velocities, aortic stiffness parameters, Ea,<br />

SVRI and Ca showed similar values in the group <strong>of</strong> patients<br />

with NCA vs CAD: SW 6.57±1.8 vs 6.2±1.9 cm/s<br />

(p=0.32), EW 5.4±2.1 vs 4.7±1.5 cm/s (p=0.32), AW<br />

6.9±2.3 vs 7.1±2.3 cm/s (p=0.77), AoStrain 21.2±10.9%<br />

vs 23.1±14.6% (p=0.79), Ao Dis 0.8±0.4 vs 1±0.6 cm2/<br />

dyne (p=0.26), Ao SI 2.89±1.40 vs 2.6±1.4 (p=0.78), Ea<br />

2.2±0.7 vs 2.3±0.6 mmHg/ml(p=0.52), SVRI 3.2±1.1<br />

vs 3.4±0.8 dyne *s *m2/cm-5 (p=0.2), Ca 1.1±0.4 vs<br />

1.2±0.4 ml/mm Hg (p= 0.81).<br />

Conclusion: Despite having normal coronary arteries,<br />

patients with angina and NCA have aortic wall velocities,<br />

aortic stiffness parameters, Ea, SVRI and Ca comparable<br />

with patients with established CAD. As impaired<br />

aortic stiffness was previously demonstrated in CAD<br />

patients, these results might explain angina in the absence<br />

<strong>of</strong> coronary stenoses, as a consequence <strong>of</strong> increased<br />

aortic stiffness and altered pulse wave propagation<br />

sequentiality.<br />

86. Antrenamentul fizic<br />

supravegheat poate imbunatati<br />

o parte din parametrii<br />

hemodinamici si de rigiditate<br />

arteriala la pacientii<br />

hipertensivi<br />

M.Iurciuc, C.Avram, Stela Iurciuc, V.Adrian, G. Cioriaca,<br />

Silvia Mancas<br />

Universitatea de Medicina si Farmacie “V. Babes”,<br />

Timisoara<br />

Premize: Majoritatea evenimenteelor cardiovasculare<br />

au loc in cursul diminetii. Acest fapt este asociat cu<br />

cresterea stresului hemodinamic matinal (MBPS).<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Scop: De a demonstra ca efortul fizic poate imbunatati<br />

o parte din parametrii hemodinamici ai monitorizarii<br />

tensionale automate / 24 ore (MATA); stresului hemodinamic<br />

matinal si indicele glezna brat (ABI).<br />

Metoda: Am selectat 212 pacienti cu HTA esentiala<br />

cu varsta cuprinsa intre 35 si 70 ani. Pacientii se gaseau<br />

sub tratament antihipertensiv neschimbat timp<br />

de cel putin 1 luna si la tinta terapeutica recomandata<br />

de ESC/ESH 2007. Am evaluat acesti pacienti inainte si<br />

dupa 4 luni de antrenament fizic controlat. Am studiat<br />

urmatorii parametrii masurati prin MATA: tensiunea<br />

arteriala sistolica (TAS), tensiunea arteriala diastolica<br />

(TAD), tensiunea arteriala medie (TAM), presiunea<br />

pulsata (PP), frecventa cardiaca (FC), indexul de rigiditate<br />

arteriala ambulatorie (IRAA) definit ca 1-alfa<br />

(panta de regresie statistica intre diastolica si sistolica);<br />

MBPS2 = media TAS in primele 2h dupa trezire - media<br />

TAS in ultimele 2 ore de somn; MBPS1 = media<br />

TAS in primele 2 h de la trezire – media celor mai joase<br />

3 valori TAS nocturne. Pentru ABI am impartit lotul in<br />

2 grupe: grupul cu ABI ≤ 1 si ABI* >1.<br />

Rezultate: TAS a scazut de la 128,14 la 122,9 mmHg<br />

(,0001); TAD a scazut de la 72,12 la 71,89 mmHg<br />

(,1695); TAM a scazut de la 90,79 la 88,91mmHg<br />

(,0426); PP a scazut de la 56,02 la 50,89 mmHg (,0018);<br />

FC a scazut de la 72,66 la 68,51 b/min (,0048); AASI<br />

a scazut de la 0,5509 la 0,4246; MBPS1 a scazut de la<br />

15,82 la 12,07mmHg (,0019); MBPS2 a scazut de la<br />

12,69 la 9,49 mmHg (,0028); ABI a crescut de la 0,917<br />

la 0,964; ABI* a scazut de la 1,25 la 1,121.<br />

Concluzii: Programele de recuperare pot imbunatati<br />

o parte din parametrii hemodinamici masurati prin<br />

MATA. Antrenamentul fizic, parte esentiala a programului<br />

de recuperare cardiovasculara, poate ameliora:<br />

stresul tensional matinal; unii din parametrii de rigiditate<br />

arteriala definiti prin PP si ABI*. Programele de<br />

exercitii fizice controlate sunt sigure si eficiente in diminuarea<br />

riscului cardiovascular.<br />

Supervised exercise training<br />

may improve the ambulatory<br />

blood pressure monitoring and<br />

arterial stiffness parameters<br />

Background: Cardiovascular events have their greatest<br />

impact in the morning period. This is thought to<br />

be associated with and dependent on morning blood


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

pressure surge (MBPS).<br />

Aims: To show that exercise training, may improve<br />

some <strong>of</strong> the hemodynamic parameters <strong>of</strong> the ambulatory<br />

BP monitoring, the MBPS and the ankle brachial<br />

index (ABI).<br />

Methods: We selected 212 patients with essential<br />

hypertension, aged: 35-70y. They were under unchanged<br />

medication at least 1 month and at target BP. We<br />

evaluate these patients before and after 4 months <strong>of</strong> supervised<br />

physical training. We studied the ambulatory<br />

blood pressure monitoring/24h: systolic blood pressure<br />

(SBP), diastolic blood pressure (DBP), mean blood pressure<br />

(MBP), pulse pressure (PP), heart rate (HR), ambulatory<br />

arterial stiffness index(AASI) defined as 1-α<br />

(α = regression slope between TAD and TAS), MBPS1=<br />

mean SBP in the first 2h after awaken – the average <strong>of</strong><br />

the lowest 3 nocturnal values, MBPS2 = mean SBP in<br />

the first 2h after awaken – mean SBP value in the first<br />

2h pre awake. We divided these 212p into to groups:<br />

with ABI≤1; and with ABI*>1.<br />

Results: The SBP has decreased from 128,14 to<br />

122,91mmHg (p,0001); the DBP has decreased from<br />

72,12-71,89mmHg (p,1695); the MBP has decreased<br />

from 90,79-88,91mmHg(p,0426); the PP has decreased<br />

from 56,02-50,99mmHg (p,0018); the HR has decreased<br />

from 72,66-68,51 b/min (p,0048); the AASI has decreased<br />

from 0,5509-0,4246 (p,0069); MABS1 has decreased<br />

from 15,82-12.07mmHg(p,0019); MABS2 has<br />

decreased from 12,69-9,49mmHg(p,0028) The ABI has<br />

increased from 0,917- 0,963 (p,0021); ABI* has decreased<br />

from 1,254- 1,121 (p,0014).<br />

Conclusion: Rehabilitation programs can improve<br />

some <strong>of</strong> the hemodynamic parameters: SBP, MBP, and<br />

HR. Exercise training, may decrease MBPS. Physical<br />

training may also improve some <strong>of</strong> the parameters that<br />

describe arterial stiffness: AASI and PP. Rehabilitation<br />

programs are a safe and effective method for reducing<br />

cardiovascular risk.<br />

POSTER FORUM II<br />

POSTER FORUM II<br />

87. Enoxaparina plus terapia<br />

antiplachetara duala – cea mai<br />

buna solutie pentru pacientii<br />

fara tratament de reperfuzie<br />

a infarctului miocardic cu<br />

supradenivelare de segment<br />

ST Registrul RO-STEMI<br />

G.Tatu-Chitoiu, Maria Dorobantu, Elvira Craiu,<br />

I.Benedek, D.Vinereanu, C.Macarie, Crina Sinescu,<br />

Lacramioara Topolnitchi, V.Firastrau, Eugenia Nechita,<br />

A.Petris<br />

Spitalul Clinic de Urgenta “Floreasca”, Bucuresti<br />

Introducere: Eficienta terapiei antiplachetare duale<br />

– aspirina plus clopidogrel (A&C;) - combinata cu<br />

heparina (H) sau Enoxaparina (E) la pacientii (pts) cu<br />

infarct miocardic acut cu supradenivelare de segment<br />

ST (STEMI) si fara tratament de reperfuzie continua sa<br />

fie un subiect controversat.<br />

Obiective: compararea mortalitatii intra-spitalicesti si<br />

a incidentei complicatiilor hemoragice la pts fara tratament<br />

de reperfuzie pentru STEMI tratati cu H sau E in<br />

combinatie fie cu A fie cu A&C.<br />

Metoda: in perioada 1.01.2002-31.12.2009 Registrul<br />

Roman pentru Infarct miocardic cu Supradenivelare<br />

de Segment ST (RO-STEMI) a inrolat consecutiv 11325<br />

de pacienti. Am identificat 2214 pts internati in primele<br />

12 ore dupa debutul STEMI si care nu au beneficiat<br />

de tratment de reperfuzie coronariana. Un subgrup de<br />

1119 pts au primit H (1000 i.u./ora, 48-96 ore) in combinatie<br />

fie cu A 150-300 mg/zi (subgrupul H&A;, 823<br />

pts) sau cu aceeasi doza de A plus C 75 mg/zi (subgrupul<br />

H&A;&C;, 296 pts). Un alt subgrup de 818 pts au<br />

primit E (1 mg/kg la fiecare 12 ore timp de 8-10 zile)<br />

combinata fie cu A (subgrupul E&A; 490 pts) sau A<br />

plus C (subgrupul E&A;&C;, 328 pts). Un subgrup de<br />

277 pts tratati cu H timp de 48 ore urmata de E a fost<br />

exclus din aceasta analiza. Toti pacientii au primit betablocante,<br />

inhibitori ai enzimei de conversie a angiotensinei<br />

si statine in absenta contraindicatiilor.<br />

Rezultate: Mortalitatea intra-spitaliceasca a fost similara<br />

in subgrupurile H&A;&C;(18.24%), H&A;(16.88%)<br />

sau E&A;(16.93%). O reducere semnificativa a mortalitatii<br />

intra-spitalicesti a fost constatata in subgrupul<br />

E&A;&C;(6.40%) comparativ cu fiecare dintre celelalte


POSTER FORUM II<br />

POSTER FORUM II<br />

trei subgrupuri (p< 0.0001 pentru toate comparatiile).<br />

Diferentele de incidenta a accidentelor vasculare cerebrale<br />

(1.01%, 0,60%, 0.81% si, respectiv, 0.30%) si a<br />

hemoragiilor majore (0.0%, 0,97%, 0,81% si, respectiv,<br />

0.30%) au fost fara semnificatie statistica.<br />

Concluzii: Registrul RO-STEMI sugereaza faptul ca<br />

administrarea combinatiei Enoxaparina, Aspirina si<br />

Clopidogrel constituie cea mai buna strategie terapeutica<br />

la pacientii cu STEMI care nu au beneficiat de o<br />

terapie de reperfuzie coronariana.<br />

Enoxaparin combined with<br />

dual antiplatelet therapy -<br />

the best solution in patients<br />

not undergoing reperfusion<br />

for ST-elevation myocardial<br />

infarction RO-STEMI data<br />

Background: The efficacy <strong>of</strong> the dual antiplatelet therapy<br />

(aspirin+clopidogrel) combined with either unfractionated<br />

heparin (UH) or Enoxaparin (E) in ST-elevation<br />

myocardial infarction (STEMI) patients (pts) not<br />

undergoing reperfusion is a subject <strong>of</strong> debate.<br />

Objective: To compare the in-hospital mortality and<br />

the rates <strong>of</strong> the major bleeding events in STEMI pts not<br />

undergoing reperfusion who received either aspirin<br />

(A) or Aspirin plus Clopidogrel (A&C) both combined<br />

with either UH or E.<br />

Methods: Between 1.01.2002 and 31.12.2009 the <strong>Romanian</strong><br />

registry for ST-elevation myocardial infarction<br />

(RO-STEMI) enrolled 11325 consecutive STEMI pts.<br />

In this registry we identified 2214 pts admitted within<br />

the first 12 hours after the STEMI onset who did not<br />

receive reperfusion therapy. A subgroup <strong>of</strong> 1119 pts. received<br />

UH (1000 i.u./hour, 48-96 hours) either combined<br />

with 150-300 mg./day <strong>of</strong> A (UH&A subgroup, 823<br />

pts) or with the same dose <strong>of</strong> A plus 75 mg/day <strong>of</strong> C<br />

(UH&A&C subgroup, 296 pts). Another subgroup <strong>of</strong><br />

818 pts received E (1 mg/kg every 12 hours for 8-10<br />

days) combined with either A (the E&A subgroup, 490<br />

pts) or A plus C (the E&A&C subgroup, 328 pts). A<br />

small subgroup <strong>of</strong> 277 treated with UH for 48 hours<br />

followed by E was excluded from this analysis.All pts<br />

received beta-blockers, angiotensin converting enzyme<br />

inhibitors, and statins if not contraindicated.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Results: The in-hospital mortality were similar in<br />

the UH&A&C (18.24%), UH&A (16.88%) and E&A<br />

(16.93%) subgroups, respectively. However, significant<br />

lower in-hospital mortality was seen in the E&A&C<br />

subgroup (6.40%) compared with each <strong>of</strong> the other<br />

three subgroups (p< 0.0001 for all comparisons). The<br />

rates <strong>of</strong> the global stroke (1.01%, 0,60%, 0.81% and<br />

0.30%, respectively) and <strong>of</strong> the major bleeding (0.0%,<br />

0,97%, 0,81%, and 0.30%, respectively) were low and in<br />

all soubgroups, below the threshold <strong>of</strong> statistical significance.<br />

Conclusions: Data from the RO-STEMI registry<br />

suggest that a combination between Enoxaparin, Aspirin<br />

and Clopidogrel should be the best strategy in<br />

STEMI patients not undergoing reperfusion.<br />

88. Stenoza de artera renala -<br />

aspecte diagnostice<br />

R.C.Motoc, Motoc Adriana Crina, Laszlo Mihaly,<br />

I.Tilea, Monica Borda<br />

Spitalul Clinic Judetean de Urgenta, Clinica Medicala 3,<br />

Targu Mures<br />

Obiectiv: Diagnosticare rapida si cu cat mai mare acuratete<br />

a stenozei de artera renala cu ajutorul examinarii<br />

ecografice Doppler,evidentiind leziunile stenotice<br />

semnificativ hemodinamic. Orientarea screening-ului<br />

de boala renovasculara implica incercarea de cunostere<br />

a celor mai puternici factori de predictie care se pot<br />

asocia cu aceasta patologie, precum si asocierea cu alte<br />

afectari vasculare.<br />

Material si metoda: S-au inclus in studiu 122 hipertensivi,<br />

internati in perioada 2000-2009 in clinica noastra.<br />

Toti pacientii au avut aspecte semnificative anamnestic,<br />

clinic si paraclinic pentru stenoza de artera renala. Cu<br />

ajutorul ecografiei Doppler in sistem duplex am masurat<br />

o serie de parametrii la nivelul arterei renale si a<br />

arterelor interlobare. Examenul angiografic a verificat<br />

prezenta stenozei precum si gradul ei de severitate.<br />

Rezultate: Din cei 122 de pacienti hipertensivi introdusi<br />

in studiu, in functie de viteza maxima sistolica<br />

masurata >1,8m/sec este caracteristica ptr. SAR semnificativ<br />

hemodinamic, indice de rezistenta sub 0,6),<br />

au rezultat doua loturi: fara stenoza - 86 de pacienti(70,49%)<br />

si cu stenoza - 36 de pacienti(29,51%). Media<br />

valorilor tensiunii arteriale sistolice a fost semnificativ<br />

mai mare(p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

comparativ cu lotul martor(160mmHg). Mai multi<br />

pacienti sunt tratati cu ≥ 3 antihipertensive(p


POSTER FORUM II<br />

POSTER FORUM II<br />

Scop: Diferite studii semnaleaza existenta fractiei de<br />

ejectie ventriculare stangi conservate (cFEVS) la 13-<br />

74% din pacientii cu insuficienta cardiaca (IC). Datele<br />

din literatura care compara din punct de vedere clinic<br />

si al prognosticului pacientii cu IC cu fractia de ejectie<br />

(FE) normala si scazuta sunt contradictorii. Adenozin<br />

deaminaza (AD) catalizeaza conversia extracelulara a<br />

adenozinei si a deoxiadenozinei la inozina si respecvariatia<br />

concentratiei Lp-PLA2 in functie de fractia de<br />

ejectie.<br />

Metode: Activitatea plasmatica a LpPLA2 a fost masurata<br />

spectr<strong>of</strong>otometric la 100 pacienti cu IC din clasele<br />

NYHA II, III and IV si la 20 normali. Evaluarea bazala<br />

a pacientilor a inclus: examinarea clinica, ECG cu 12<br />

derivatii, estimarea clasei functionale NYHA, ecocardiografie<br />

transtoracica (fractia de ejectie ventriculara<br />

stanga si diametrul ventricular stang telediastolic) si<br />

teste de laborator de rutina.<br />

Rezultate: Activitatea plasmatica a LpPLA2 a fost mai<br />

mare la pacientii cu IC (412.1 ± 85.29 U/L) comparativ<br />

cu normalii (225.65 ± 20.8 U/L). Pacientii cu cFEVS<br />

(FE > 50) reprezinta 35% din totalul pacientilor IC. Incidenta<br />

hipertr<strong>of</strong>iei ventriculare stangi a fost mai mare<br />

in lotul pacientilor cu cFEVS comparativ cu pacientii<br />

cu fractia de ejectie scazuta (EF < 50), iar incidenta<br />

diabetului a fost asemanatoare. Activitatea LpPLA2 a<br />

fost mai mare la pacientii cu cFEVS [444.9 ± 80.6 (U/L)<br />

(p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

tiv deoxinozina. Adenosina endogena, prin activitatea<br />

ei antiinflamatoare, previne aparitia unor complicatii<br />

cardiace prin suprasarcina (insuficienta ventriculara si<br />

hipertr<strong>of</strong>ie ventriculara). Deoarece stresul oxidativ si<br />

inflamatia sunt implicate in evolutia IC am investigat<br />

corelatia dintre AD si FE.<br />

Metode: Activitatea plasmatica a AD a fost masurata<br />

spectr<strong>of</strong>otometric la 100 de pacienti cu IC din clasele<br />

NYHA II, III and IV si la 20 de normali. Evaluarea bazala<br />

a pacientilor a inclus: examinarea clinica, ECG cu<br />

12 derivatii, estimarea clasei functionale NYHA, ecocardiografie<br />

transtoracica (fractia de ejectie ventriculara<br />

stanga si diametrul ventricular stang telediastolic) si<br />

teste de laborator de rutina.<br />

Rezultate: Activitatea plasmatica a AD a fost mai mare<br />

la pacientii cu IC (14.47 ± 3.61 UI/L) comparativ cu<br />

normalii (7.35 ± 0.63 UI/L). Activitatea AD a fost mai<br />

mare la pacientii cu cFEVS (FE > 50) comparative cu<br />

cei cu FE < 50% (13.22 ± 2.3 UI/L). Incidenta hipertr<strong>of</strong>iei<br />

ventriculare stangi a fost mai mare in lotul pacientilor<br />

cu cFEVS comparativ cu pacientii cu FE scazuta<br />

(FE


Revista Română de Cardiologie | Vol. XXV | Suplimentul A, 2010<br />

POSTER II | POSTER II<br />

91. Nivelul seric al acidului<br />

uric la pacientii cu insuficienta<br />

cardiaca recent decompensate<br />

– un nou biomarker<br />

A.Campeanu, Adriana Iliesiu, D. Nistorescu, B. Strajean,<br />

G. Uscoiu, D. Dusceac, T. Nanea<br />

Spitalul Clinic Caritas, Bucuresti<br />

Scop: Acidul uric seric (AUS), un marker de stress oxidative,<br />

este implicat in aparitia si progresia bolilor cardiovasculare.<br />

In studii recente AUS pare sa se coreleze<br />

cu aparitia, evolutia si severitatea insuficientei cardiace<br />

cronice (ICC). Scopul studiului este evaluarea nivelelor<br />

AUS la pacienti cu ICC decompensata.<br />

Metoda: S-a determinat AUS la 90 de bolnavi (varsta<br />

medie 62 ±ani, 44 de barbati si 46 de femi), spitalizati<br />

pentru ICC clasele II-IV NYHA. Balnavii se aflau sub<br />

tratament cu inhibitori de enzima e conversie ai angiotensinei/<br />

sartani (93%), betablocante (81%), diuretice<br />

(97%), digoxin (31%). Cauzele decompensarii ICC au<br />

fost non-complianta la dieta sau la terapia medicamentoasa<br />

(53%), tulburari de ritm (29%), sindroame coronariene<br />

acute (10%), infectii (10%), tromboembolism<br />

pulmonar (1%). Toti pacientii au fost evaluati clinic,<br />

electrocardiografic, ecocardiografic (functia sistolica si<br />

diastolica) si biologic.<br />

Rezultate: AUS a fost crescut la 58% dintre bolnavi. Nivelul<br />

mediu al AUS a fost de 7.3mg/dl (6.7mg/dl la femei<br />

si 6.7mg/dl la barbati). Toti bolnavii au avut creatinina<br />

serica sub 2mg/dl. Valorile medii ale AUS au fost<br />

7.38mg/dl in clasa NYHA II, 7.83mg/dl in clasa NYHA<br />

III si 6.68mg/dl in clasa NYHA IV de ICC (p=ns). La<br />

bolnavii cu fractie de ejectie ( FE) peste 40% (62.3% din<br />

cazuri) nivelul mediu al AUS a fost de 7.45mg/dl iar la<br />

bolnavii cu FE < 40% (37.7% cazuri) nivelul mediu al<br />

AUS a fost de 7.5 mg/dl (p=ns). 26% dintre bolnavi au<br />

avut disfunctie diastolica de tip restrictiv (E/A > 2 sau<br />

E/A >1 si TDE


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

astolic dysfunction (E/A> 2 or E/A>1 and DTE


POSTER II<br />

POSTER II<br />

<strong>of</strong> NT-proBNP and second degree diastolic dysfunction<br />

compared with first degree diastolic dysfunction (1<br />

patient with diastolic dysfunction stage 2 in Q1, 2 in<br />

Q2, 4 in Q3 and 7 in Q4 <strong>of</strong> NT-proBNP, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

wave velocity (A) and duration (Adur), amplitude and<br />

duration <strong>of</strong> “a” wave in the upper right pulmonary vein<br />

flow, mitral flow propagation velocity (fpv) and tissue<br />

Doppler parameters, including mitral annulus E wave<br />

velocity (E’), mitral annulus A wave velocity (A’) and<br />

E/E’ ratio. Patients with ischemic heart disease or other<br />

possible endothelial damaging conditions were excluded.<br />

The total cardiovascular risk was calculated using<br />

SCORE programme.<br />

Results: Von Willebrand factor was correlated with<br />

classic echocardiographic parameters <strong>of</strong> LV diastolic<br />

function (A: r=0.514, p=0.001, E/A: r=-0.483, p=0.002,<br />

EDT: r=0.398, p=0.011; IVRT: r=0.313, p=0.049 and fpv:<br />

r=-0.389, p=0.014) and with some tissue Doppler parameters<br />

(A’: r=0.592, p=0.043, trend for E/E’: r=0.537,<br />

p=0.072). NT-proBNP was more strongly correlated<br />

with parameters derived from tissue Doppler echocardiography<br />

(E/E’: r=0.787, p=0.007) and with left atrium<br />

volume index (r=0.709, p=0.032), but was weakly correlated<br />

with parameters derived from transmitral flow.<br />

CRP was correlated with E/E’ ratio (r=0.607, p=0.036)<br />

and with total cardiovascular risk (r=0.709,p=0.01).<br />

There was also a correlation between von Willebrand<br />

factor and NT-proBNP (r=0.399, p=0.026).<br />

Conclusions: Von Willebrand factor, NT-proBNP and<br />

C reactive protein are correlated with echocardiographic<br />

parameters <strong>of</strong> left ventricular diastolic function in<br />

patients with metabolic syndrome. A multimarker strategy<br />

may be useful in evaluating cardiovascular status<br />

in this type <strong>of</strong> patients.<br />

94. Factorii de risc in<br />

hipertensiunea arteriala la copii<br />

si adolescenti<br />

Lucia Pirtu, M.Rudi, Ina Palii<br />

Universitatea de Medicina si Farmacie “Nicolae Testemitanu”,<br />

Chisinau<br />

Hipertensiunea arteriala la copii prezinta un interes<br />

sporit. Desi incidenta hipertensiunii arteriale la copii<br />

in Statele Unite ale Americii este de 1-5%, ea este in<br />

continua crestere. Hipertensiunea arteriala secundara<br />

este comuna sugarilor si prescolarilor, pe cand cea<br />

primara este mai frecvent intalnita la adolescenti si are<br />

multipli factori de risc, inclusiv obezitatea, antecedente<br />

familiale cardiovasculare, greutate mica la nastere, etc.<br />

POSTER II<br />

POSTER II<br />

Scopul acestui studiu a fost depistarea factorilor de risc<br />

in hipertensiunea arteriala primara la copii. Cercetarea<br />

a fost realizata pe un esantion de 2055 (995 baieti si<br />

1060 fete) subiecti, clinic sanatosi, cu varsta cuprinsa<br />

intre 10 si 18 ani. Au fost stabilite valorile tensiunii arteriale<br />

(TA), inaltimea si masa corporala. Obezitatea<br />

a fost apreciata in baza indicelui de masa corporala.<br />

Conform unui chestionar special elaborat s-a studiat:<br />

greutatea la nastere, durata alimentatiei naturale,<br />

anamneza eredocolaterala etc. In cadrul acestui studiu,<br />

au fost depistati 326 (15,86%) copii cu valori ale tensiunii<br />

arteriale ce depaseau percentila 90, dintre care 159<br />

(7,7%) copii – in diapazonul percentilelor 90–94 si 167<br />

(8,1%) copii cu valorile TA ce depaseau percentila 95.<br />

Prevalenta generala a obezitatii in cadrul cercetarii in<br />

cauza este de 1,8% (n=38 copii), iar a supraponderabilitatii<br />

– 5,7% (n=117 copii). Prevalenta hipertensiunii<br />

arteriale la copiii supraponderali, in lotul dat de studiu<br />

constituie 36,75% din cazuri, fiind de 2,6 ori mai<br />

mare decat la copiii normoponderali (14,22%), iar la<br />

copiii obezi – 50% (de 3,5 ori) (χ2=81,84; p0,05; p=0,14).<br />

Istoricul familial al patologiei hipertensive se asociaza<br />

cu o prevalenta mai inalta a hipertensiunii arteriale la<br />

descendenti. In cadrul studiului dat, am stabilit ca, in<br />

familiile cu ambii parinti normotensivi, valorile TA la<br />

copiii lor depasesc percentila 90 in 16,98% din cazuri,<br />

in familiile cu un parinte hipertensiv si unul normotensiv<br />

– in 24,43% cazuri, iar in cele cu ambii parinti<br />

hipertensivi – in 30,41% cazuri. Supraponderabilitatea<br />

sau obezitatea, antecedentele familiale de maladie hipertensiva<br />

au fost principalii factori de risc depistati la<br />

copiii cu valorile TA peste percentila 90.<br />

Risk factors associated to<br />

arterial hypertension in<br />

children and adolescents<br />

Hypertension in children presents a high interest.<br />

Although the prevalence <strong>of</strong> pediatric hypertension has<br />

been calculated to be between 1 and 5 percent in SUA,<br />

this number is expected to increase. The second hypertension<br />

is more common in infants and young children,<br />

while the essential hypertension is more common<br />

in adolescents and has multiple risk factors, including


POSTER II<br />

POSTER II<br />

obesity, family history <strong>of</strong> hypertension, low birth weight,<br />

etc.<br />

The purpose <strong>of</strong> the study was to determine the risk<br />

factors associated to essential arterial hypertension in<br />

children. This study was performed to assess blood<br />

pressure and some cardiovascular risk factors in, apparently,<br />

healthy children, residents <strong>of</strong> rural and urban<br />

areas from Moldova. There were assessed weight, height,<br />

waist circumference, birth weight, family history<br />

<strong>of</strong> hypertension. Obesity was assessed on the basis <strong>of</strong><br />

body mass index (BMI). According to a specifically<br />

designed questionnaire, was studied: birth weight, a<br />

family history <strong>of</strong> hypertension, the duration <strong>of</strong> natural<br />

feeding. In 2055 children (995 boys and 1060 girls),<br />

aged between 10-18 years were found 326 children<br />

(15,86%) with blood pressure values above 90 percentile<br />

(7,74% - percentiles 90 – 95; 8,12% - over percentile<br />

95). The prevalence <strong>of</strong> overweight children is 5,7% and<br />

obese – 1,8%. The prevalence <strong>of</strong> hypertension increases<br />

significantly with BMI. Children with BMI in normal<br />

range had values <strong>of</strong> blood pressure over 90 percentile<br />

– 14,22% (n = 262), overweight children – 36,75% (n<br />

= 43) and obese – 50% (n = 19) (χ 2=81,84; p0,05; p=0,14). The family<br />

history <strong>of</strong> pathology <strong>of</strong> hypertensive patients, especially<br />

in case that mother is hypertensive, is associated with<br />

values <strong>of</strong> blood pressure over 90 percentile (χ 2 = 30,03;<br />

p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Are tissue Doppler parameters<br />

superior to conventional<br />

echocardiographic ones<br />

in the study <strong>of</strong> pulmonary<br />

hypertension<br />

The aim <strong>of</strong> the study was to identify the predictive value<br />

<strong>of</strong> echocardiographic parameters (standard and tissue<br />

Doppler) in the study <strong>of</strong> pulmonary hypertension,<br />

compared to haemodynamic data.<br />

Methods: We studied 46 patients with pulmonary<br />

hypertension, either idiopathic or secondary (pulmonary<br />

thromboembolism, congenital left- right shunts,<br />

left sided valvulopathies, pulmonary parenchimatous<br />

diseases, connective tissue diseases). The ehocardiographic<br />

data were compared to the mean pulmonary<br />

artery pressure, obtained at the cardiac catheterization.<br />

We used the Pearson correlation test.<br />

Results: The mean pulmonary pressure was 48,82 mm<br />

Hg (SD 18,4 mm Hg). We noticed a strong correlation<br />

for the systolic pulmonary pressure measured using<br />

echocardiography (mean 61, 33 mm Hg, SD 24,47 mm<br />

Hg): r 0,84, p< 0,001. We obtained significant correlations<br />

for the pulmonary acceleration time (r -0,56, p<br />

0,014), TAPSE (r -0,34, p 0,02), the right ventricle Tei<br />

index (r 0,32, p 0,04), the fractional systolic change <strong>of</strong><br />

the right ventricle area (r -0,4, p


POSTER II<br />

POSTER II<br />

al factorilor de risc la asimptomaticii cu risc crescut,<br />

reprezentand un model aplicabil si altor centre.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

strong need to intensificate preventive intervention in<br />

primary care.<br />

EUROASPIRE III Romania<br />

follow-up: reinforced primary<br />

care improved lipid pr<strong>of</strong>ile<br />

results<br />

Purpose: To investigate the lipid pr<strong>of</strong>ile improvement<br />

according to ESC 2007 Prevention Guidelines<br />

in asymptomatic high risk patients (without a history<br />

<strong>of</strong> coronary or other atherosclerotic disease, who have<br />

been prescribed one or more <strong>of</strong> the following medications:<br />

anti-hypertensive and/or lipid lowering and/or<br />

anti-diabetes treatments - diet and/or oral hypoglycaemics<br />

and/or insulin) included in the first EuroAspire<br />

III Follow-Up.<br />

Methods: We followed-up 325 patients (age 56±9<br />

years, 62% women) out <strong>of</strong> 503 asymptomatic high risk<br />

patients included in EuroAspire III Romania Primary<br />

Care. These patients were evaluated every 6 months for<br />

a period <strong>of</strong> 18 months <strong>of</strong> follow-up by general practitioners<br />

that participated in a pr<strong>of</strong>essional training<br />

performed by diabetologists and cardiologists and have<br />

been advised to reinforce lifestyle changes and to optimize<br />

hipolipemiant drug therapy in order to reach the<br />

targets mentioned in the current guidelines.<br />

Results: A significant improvement was observed<br />

bet ween baseline evaluation and 18 month intervention,<br />

for total cholesterol (235.11+52.98mg/dl versus<br />

203.82+42.25mg/dl, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

fractia de ejectie scazuta era prezenta la 76 din pacienti<br />

(23% FE


POSTER II<br />

POSTER II<br />

sistolica >or= 140 mmHg sau tensiunea arteriala diastolica<br />

> or = 90 mmHg; 3) trigliceridele > or = 1,7<br />

mmol/L (150 mg/dL), HDL-colesterolul (HDL-C) <<br />

0,9 mmol/L (35 mg/dL) la barbati si or= 6,1 mmol/L (109<br />

mg/dL). Parametrii biochimici si hematologici au fost<br />

masurati prin metode standard. Pentru masurarea microalbuminuriei<br />

a fost folosita metoda imunoturbidimetrica.<br />

Rezultate: Concentratia acidului uric seric a fost semnificativ<br />

mai mare la pacientii hipertensivi cu sindrom<br />

metabolic comparativ cu pacientii hipertensivi (p <<br />

0,001). Nivelul microalbuminuriei a fost semnificativ<br />

mai mare la pacientii hipertensivi cu sindrom metabolic<br />

comparativ cu cel al pacientilor hipertensivi (p <<br />

0,001). Am obtinut o corelatie semnificativa moderata<br />

intre nivelul acidului uric seric si microalbuminurie (r<br />

= 0,64, p < 0,001).<br />

Concluzii: Pacientii hipertensivi cu sindrom metabolic<br />

au niveluri serice mai mari ale acidului uric si microalbuminuriei<br />

si o disfunctie endoteliala mai severa,<br />

comparativ cu pacientii hipertensivi fara sindrom metabolic.<br />

Association between<br />

hyperuricemia and<br />

microalbuminuria in<br />

hypertensive patients with<br />

metabolic syndrome<br />

Objective: Hyperuricemia has been associated with<br />

cardiovascular disease, and it is particularly common<br />

in people with hypertension, metabolic syndrome, or<br />

kidney disease.<br />

The purpose <strong>of</strong> this study was to compare the values <strong>of</strong><br />

serum uric acid and microabuminuria in hypertensive<br />

patients with and without metabolic syndrome (MS)<br />

and to evaluate the association between hyperuricemia<br />

and microalbuminuria in these patients.<br />

Material and method: The study included 50 hypertensive<br />

patients (aged 56 ± 5.60 years) and 41 hypertensive<br />

patients with metabolic syndrome (aged 56 ±<br />

3.62 years). The diagnosis <strong>of</strong> the MS was made when<br />

three or four <strong>of</strong> the following criteria were met: 1) body<br />

mass index (BMI) > or = 25; 2) systolic blood pressure<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

> or = 140 mmHg or diastolic blood pressure > or = 90<br />

mmHg; 3) fasting triglycerides > or = 1.7 mmol/L (150<br />

mg/dL), high density lipoprotein cholesterol (HDL-C)<br />

< 0.9 mmol/L (35 mg/dL) in men and or = 6.1<br />

mmol/L (109 mg/dL). Biochemical and haematological<br />

parameters were measured by standard methods. The<br />

immunoturbidimetric method was used for the measurement<br />

<strong>of</strong> microalbuminuria.<br />

Results: Serum uric acid concentration was significantly<br />

higher in hypertensive patients with metabolic<br />

syndrome than in hypertensive patients (p < 0.001).<br />

The level <strong>of</strong> microalbuminuria was found to increase<br />

significantly in hypertensive patients with metabolic<br />

syndrome, compared to that <strong>of</strong> the hypertensive patients<br />

(p < 0.001). We obtained a moderate significantly<br />

correlation between serum uric acid and microalbuminuria<br />

(r = 0.64, p < 0.001).<br />

Conclusions: Hypertensive patients with metabolic<br />

syndrome have increased serum acid uric levels, microalbuminuria<br />

and serious endothelial dysfunction.<br />

99. Factorii determinati,<br />

localizarea si magnitudinea<br />

dilatarii aortice dupa corectia<br />

coarctatiei de aorta<br />

Madalina Iancu, Ioana Ghiorghiu, Marinela Serban,<br />

Hodo Aneida, Ileana Craciunescu, B.A.Popescu, Carmen<br />

Ginghina<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Background: Coarctatia de aorta (CoAo) este asociata<br />

cu un pronostic negativ pe termen lung, chiar si dupa<br />

corectia cu succes chirurgicala sau interventionala.<br />

Formarea de anevrisme si disectia de aorta (Ao), unele<br />

dintre cele mai severe complicatii intalnite la acesti pacienti,<br />

sunt, de obicei, precedate de dilatarea Ao.<br />

Obiective: Identificarea magnitudinii, localizarii si a<br />

principalilor factori determinanti ai dilatarii Ao dupa<br />

corectia CoAo.<br />

Metoda: Grupul de studiu a fost alcatuit din 23 pacienti<br />

cu CoAo operata (varsta medie 28.6 ± 10 ani, 17 de sex<br />

masculin) din 20 subiecti imperecheati ca varsta si sex,<br />

alcatuind lotul de cotrol). Toti pacientii indeplineau


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

criteriile clinice si ecocardiografice de corectie cu success<br />

a leziunii. Valoarea medie a gradientului maxim la<br />

nivelul CoAo a fost 23± 9.6 mmHg. 16 pacienti prezentau<br />

hipertensiune arteriala (HTA) secundara, cu valori<br />

controlate sub tratament antihipertensiv. 14 pacienti<br />

asociau bicuspidie aortica. Pacientii cu valvulopatii Ao<br />

semnificative hemodinamic au fost exclusi din studiu.<br />

Dimensiunile Ao au fost determinate la urmatoarele<br />

niveluri: inel, sinusuri Vaalsalva, Ao ascendenta la 3<br />

cm deasupra valvelor aortice; toate diametrele au fost<br />

indexate pe suprafata corporala. Rigiditatea Ao a fost<br />

calculata dupa masurarea diametrelor aortice sistolic<br />

(AoS) si diastolic (AoD). Indexul de rigiditate aortica<br />

(Ao SI) = ln(TAS/TAD)/[(AoS – AoD)/AoD], (TAS,<br />

TAD= tensiunea arteriala sistolica, diastolica).<br />

Rezultate: Dimensiunile Ao au fost mai mari in grupul<br />

de pacienti fata de lotul de control: 11±1.5 vs 9.9±0.8<br />

mm/m2 la nivelul inelului aortic (p=0.04); 18.5±5.8<br />

mm/m2 vs 15±1.8 mm/m la nivelul sinusurilor Valsalva<br />

(p=0.01); si 17.3±5.6 mm/m2 vs 13.4±1.8 mm/m2<br />

la nivelul Ao ascendentel (p=0.003). 6 dintre pacientii<br />

cu CoAo au prezentat o dilare importanta a Ao ascendente<br />

> 21mm/m2. Prezenta HTA s-a corelat numai cu<br />

diametrul Ao ascendente (r=0.42, p=0.048). Prezenta<br />

bicuspidiei Ao s-a corelat numai cu diametrul masurat<br />

la nivelul sinusurilor Valsalva (r=0,585, p=0,003).<br />

Ao SI s-a corlat cu toate cele 3 diametre masurate- inel<br />

(r=0,42, p


POSTER II<br />

POSTER II<br />

100. Caracteristicile clinice<br />

si prognosticul pacientilor<br />

cu rezistenta la antiagregante<br />

plachetare<br />

E.G.Botu, Ileana Tepes Piser, Valentina Uscatescu,<br />

C.E.Macarie<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Medicatia antiagregantă plachetară si-a dovedit beneficiul<br />

clar in reducerea evenimentelor aterotrombotice,<br />

prin folosirea lor in preventia primară si cea secundară.<br />

Totusi un procent variabil, (5-60%), din pacientii aflati<br />

sub tratament cu aspirină si/sau clopidogrel, nu beneficiază<br />

de preventia evenimentelor aterotrombotice cardio-vasculare,<br />

acestia avand rezistentă la antiagregante<br />

plachetare.<br />

Scopul studiului: Evaluarea caracteristicilor clinice<br />

si aprecierea riscului de deces si de evenimente aterotrombotice<br />

cardiovasculare in cadrul lotului studiat<br />

la cei cu rezistentă versus cei sensibili la antiagregante<br />

plachetare.<br />

Material si metoda: am analizat retrospectiv un număr<br />

de 40 de pacienti aflati sub tratament antiagregant plachetar<br />

(11 femei si 29 barbati), cu varsta intre 34 si 84<br />

ani (varsta medie de 61.85 ani), urmăriti pe o perioadă<br />

medie de 10,45 luni, la care s-a evaluat rezistenta la antiagregante<br />

plachetare. Metoda de laborator utilizată a<br />

fost agregometria optică, pentru care s-au folosit drept<br />

agonisti ai agregării plachetare ADP-ul si colagenul.<br />

Rezultate: Din lotul utilizat, 21 de pacienti (52,50%)<br />

au fost diagnosticati cu rezistentă la antiagregante plachetare<br />

(lotul de studiu) si 19 pacienti (47,50%) au fost<br />

sensibili la medicatia antiagregantă plachetară (lotul<br />

martor).In lotul de studiu vs lotul martor femeile sunt<br />

6 (28,57%) vs 5 (26,31%), fumători sunt 11 (52,38%) vs<br />

4 (21,05%), 6 au diabet zaharat (28,57%) vs 5 (26,31%),<br />

cu obezitate sunt 11 (52,38%) vs 3 (15,78%), prezintă<br />

dislipidemie 18 (85,71%) vs 17 (89,17%),18 pacienti<br />

(85,71%) s-au prezentat cu SCA vs 15 (78,94%) , iar<br />

stenoză in stent au prezentat 8 pacienti (38,09 %) vs 6<br />

(31,57%). Pacientii din lotul de studiu au un număr mai<br />

mare de trombocite (285.000/mm3) si un MPV crescut<br />

(9,25) fată de pacientii inclusi in lotul martor (nr trombocite=235.000/mm3<br />

si MPV =8,96). Pe o perioadă<br />

medie de urmărire de (10,45 luni) au apărut complicatii<br />

aterotrombotice cardiovasculare in grupul de studiu<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

la 6 din 21 de pacienti (28,57 %), iar in lotul martor la<br />

2 din 19 pacienti (10,52%), decesul de cauză generală<br />

a fost inregistrat la 3 pacienti din grupul de studiu<br />

(14,28%) fată de 1 pacient din lotul martor (5,26%). Limitele<br />

studiului: Număr mic de pacienti inclusi in studiu;<br />

utilizarea unei singure metode de determinare a<br />

rezistentei la antiagregante plachetare, avand in vedere<br />

lipsa unei metode standardizate in prezent; inabilitatea<br />

de a diferentia rezistenta la aspirină vs rezistenta la clopidogrel;<br />

neomogenitatea pacientilor inclusi.<br />

Concluzii: Pacientii cu rezistentă la antiagregante plachetare<br />

sunt mai frecvent obezi, fumători (cu semnificatie<br />

statistică) si diabetici. Numărul femeilor in grupul<br />

celor cu rezistentă este mai mare fată de numărul femeilor<br />

din grupul celor sensibili la antiagregante plachetare.<br />

Pacientii cu rezistentă la antiagregante plachetare au<br />

număr mai mare de trombocite si un MPV crescut fată<br />

de cei fără rezistentă, avand semnificatie statistică. Pacientii<br />

cu rezistentă la antiagregante plachetare au risc<br />

mai crescut de deces si de evenimente aterotrombotice<br />

cardiovasculare, pe o perioadă medie de urmărire de<br />

10.45 luni, (cu semnificatie statistică). Rezultatele obtinute<br />

in cadrul studiului sunt comparabile cu datele din<br />

literatură.<br />

Clinical characteristics and<br />

prognosis <strong>of</strong> patients with<br />

antiplatelet drug resistance<br />

Despite <strong>of</strong> the fact that antiplatelet drugs has shown<br />

clear benefit in reducing atherothrombotic events, by<br />

using them in primary and secondary prevention, there<br />

is however a variable percentage (5-60%) from the<br />

patients who are under treatment with aspirin and clopidogrel<br />

which not benefit from the prevention <strong>of</strong> this<br />

cardiovascular events, this one’s being resistant to antiplatelet<br />

drugs.<br />

The purpose <strong>of</strong> the study: evaluation <strong>of</strong> clinical characteristics,<br />

laboratory assessment and appreciation <strong>of</strong><br />

the risk <strong>of</strong> death and cardiovascular events in the study<br />

group, in patients with resistance to antiplatelet drugs<br />

versus those who are sensitive to antiplatelet agents.<br />

Material and method: we retrospectively analyzed a<br />

total <strong>of</strong> 40 patients (11 women and 29 men), with antiplatelet<br />

therapy, aged between 34 and 84 years (mean<br />

age 61.85 years), watch for an average <strong>of</strong> 10.45 months,<br />

which was assessed antiplatelet drug resistance. Labo-


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

ratory method used was optical aggregometry. We used<br />

as agonists <strong>of</strong> platelet aggregation ADP and collagen.<br />

Results: from the entire lot, 21 patients (52.50%) were<br />

diagnosed with resistance to antiplatelet agents (study<br />

group) and 19 patients (47.50%) were sensitive to antiplatelet<br />

medication (control group). In the study group<br />

vs control group they are six (28.57%) vs. 5 (26.31%)<br />

women, 11 (52.38%) vs. 4 (21.05%) smokers, six had<br />

diabetes mellitus (28, 57%) vs. 5 (26.31%), 11 (52.38%)<br />

vs. 3 (15.78%) are obese, 18 (85.71%) vs. 17 (89.17%)<br />

presented dyslipidemia, 18 (85.71%) vs. 15 (78.94%)<br />

are presented with ACS, and stenosis in stent had 8<br />

(38,09%) vs. 6 (31,57 %) patients. Patients in the study<br />

group had a higher number <strong>of</strong> platelets (285.000/mm3)<br />

and an increased MPV (9.25) than patients in control<br />

group (No = 235.000/mm3 platelets and MPV = 8.96).<br />

During a period <strong>of</strong> 10.45 months, atherothrombotic<br />

cardiovascular complications have appeared in the<br />

study group on 6 <strong>of</strong> 21 patients (28.57%) and in control<br />

group on 2 <strong>of</strong> 19 patients (10.52%) and death <strong>of</strong> overall<br />

cause was recorded in 3 patients in the study group<br />

(14.28%) toward 1 patient in the control group (5.26%).<br />

The study limits: - Small number <strong>of</strong> patients included<br />

in the study; we used a single method for determining<br />

the antiplatelet agents resistance, given the lack <strong>of</strong> a<br />

standardized method currently; the inability <strong>of</strong> making<br />

the difference between the resistance at aspirin versus<br />

the resistance at clopidogrel; the non homogeneity <strong>of</strong><br />

the included patients.<br />

Conclusions: Patients with resistance to antiplatelet<br />

agents are more frequently obese, smokers (statistically<br />

significant) and diabetics, and the number <strong>of</strong> women in<br />

the resistance group is higher than the number <strong>of</strong> women<br />

in the group with sensitivity to antiplatelet agents.<br />

Patients with resistance to antiplatelet agents have greater<br />

number <strong>of</strong> platelets and an increased MPV towards<br />

the ones without resistance (statistically significant).<br />

Patients with resistance to antiplatelet drugs are at increased<br />

risk <strong>of</strong> atherothrombotic cardiovascular events<br />

and death, for an average follow up <strong>of</strong> 10.45 months<br />

(statistically significant). The study confirmed that the<br />

results obtained are consistent with literature data.<br />

101. Efectul aritmic al<br />

Ivabradinei la pacientii cu<br />

boala coronariana<br />

Alina Iacobescu, Sorina Magheru, F.Maghiar,<br />

M.Popescu<br />

Universitatea din Oradea<br />

POSTER II<br />

POSTER II<br />

Obiective: Ivabradina este primul inhibitor specific al<br />

nodului sinusal, cu rol in scaderea frecventei cardiac ce<br />

a fost aprobat pentru tratamentul anginei stabile. Pornind<br />

de la studii deja existente, scopul acestui studiu a<br />

fost de a evalua efectul aritmic al ivabradinei la pacientii<br />

cu boala coronariana dovedita angiografic. Studiile<br />

anterioare au monitorizat acest efect la 1 luna dupa initierea<br />

tratamentului cu ivabradina.<br />

Scopul studiului nostru a fost de a evalua durata si dispersia<br />

intervalului QT si a undei P la 6 luni de la initierea<br />

terapiei cu ivabradina.<br />

Material si metoda: Au fost urmariti 30 de pacienti<br />

consecutivi, in ritm sinusal, tratati cu ivabradina minim<br />

6 luni, cu boala coronariana dovedita angiografic.<br />

Consimtamantul informat a fost obtinut in toate cazurile.<br />

Pacientii prezentau medicatie antiaritmica asociata<br />

(blocanti de calciu sau betablocante) dar nu au fost<br />

efectuate modificari ale dozelor recomandate 3 luni<br />

inainte de includerea in studiu si nici pe parcursul studiului.<br />

Tratamentul cu ivabradina a fost timp de 2 saptamani<br />

5mgx2/zi, iar apoi 7.5 mgx2/zi in toate cazurile.<br />

Electrocardiograma a fost efectuata la initierea terapiei<br />

cu ivabradina si apoi lunar in toate cazurile, timp de 6<br />

luni. Durata intervalului QT, durata minima si maxima<br />

a intervalului QT precum si dispersia intervalului QT<br />

au fost calculate la 6 luni de la initierea tratamentului.<br />

Durata minima si maxima precum si dispersia undei<br />

P au fost de asemenea calculate la 6 luni de la initierea<br />

tratamentului cu ivabradina.<br />

Rezultate: Frecventa cardiaca a scazut in toate cazurile<br />

de la 75±13 batai/min la 59±8 batai/min. Nu s-a notat<br />

o diferenta intre valorile minime, respectiv maxime<br />

ale duratei undei P, si a dispersiei undei P inainte si<br />

dupa tratament. Intervalul QT a fost mai lung la 6 luni,<br />

(411±15 ms la 430±14 ms, P=0.005), lucru explicabil<br />

prin scaderea frecventei cardiace, intervalul QTc dupa<br />

tratament, fiind mai mic (452± 12 ms vs 437±9 ms).<br />

Dispersia intervalului QT a ramas neschimbata dupa 6<br />

luni de tratament (49±18 vs 47±11).<br />

Concluzie: Intervalul QT a fost prelungit, dar intervalul<br />

QT corectat, durata unei P si dispersia unei P si


POSTER II<br />

POSTER II<br />

a intervalului QT au ramas nemodificate dupa 6 luni<br />

de tratament. Nu se poate dovedi existenta unei relatii<br />

intre tratamentul cu ivabradina si aparitia tulburarilro<br />

de ritm atriale sau ventriculare la bacientii cu boala coronariana.<br />

Arrhythmic effects <strong>of</strong><br />

Ivabradine in patients with<br />

coronary artery disease<br />

Objectives: Ivabradine is the first specific heart ratelowering<br />

agent that has completed clinical development<br />

for stable angina pectoris.<br />

The aim <strong>of</strong> the present study was to investigate the<br />

effects <strong>of</strong> ivabradine therapy on P-wave duration, dispersion<br />

and QT duration, dispersion in coronary artery<br />

disease patients.<br />

Methods: The study population consisted <strong>of</strong> 21 patients<br />

with CAD who have confirmed by coronary angiography<br />

previously. Written informed consent was obtained<br />

in all patients. Twelve-lead electrocardiogram was recorded<br />

for each subject at a rate <strong>of</strong> 50mm/s on admission<br />

and repeated after 6 months ivabradine therapy. QT<br />

duration, QT dispertion, maximum and minimum QT<br />

duration calculated. Maximum and minimum P wave<br />

and P wave dispersion has been calculated.<br />

Results: Heart rate was decreased after ivabradine therapy.<br />

(75±13 and 59±8, P=0.02).There was no difference<br />

between Pmax, Pmin and Pdis values before and after<br />

treatment. QTmax value was prolonged after treatment.<br />

(411±15 and 430±14, P=0,005) but there was<br />

no difference between cQTmax value.( 452± 12 and<br />

437±9) There was no difference between QTdis values<br />

before and after treatment. (49±18 & 47±11). QTmax<br />

was prolonged after ivabradine therapy but cQTmax,<br />

Pdis, QTdis were not prolonged.<br />

Conclusion: There is no relationship between ivabradine<br />

therapy and increased risk <strong>of</strong> ventricular and atrial<br />

arrhythmia in coronary artery disease patient.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

102. Relatii intre adiponectina<br />

si factorii de risc<br />

cardiovasculari la pacientii<br />

cu diabet zaharat tip 2 sau cu<br />

intoleranta la glucoza<br />

Oana Vittos, Iulia Teodorescu, Florentina Halici<br />

Medcenter, Bucuresti<br />

Background: Corelatiile dintre adiponectina, inflamatie<br />

si alti factori de risc cardiovasculari sunt indelung<br />

discutate in multiple studii. In plus, se considera ca variatiile<br />

genetice ale adiponectinei sunt associate cu bolile<br />

metabolice, incluzand diabetul zaharat si intolerant<br />

la glucoza.<br />

Scopul studiului a fost de a investiga 2 grupuri de pacienti,<br />

unul cu DZ tip 2 si celalalt cu pacienti cu intoleranta<br />

la glucoza, si anume o serie de factori de risc<br />

cardiovasculari si relatiile acestora cu adiponectina.<br />

Material si metoda: Au fost investigati clinic, electrocardiografic<br />

si ecocardiografic 65 de patienti, cu varste<br />

intre 50 si 78 ani, evaluandu-se urmatorii factori<br />

de risc (IMC, fumatul, tensiunea arterial sistolica si<br />

diastolica, scorul de risc cardiovascular Framingham)<br />

S-au urmarit de asemenea testele de laborator: glicemia<br />

serica, testul oral de toleranta la glucoza, hemoglobina<br />

glicozilata, VSH, PCR, colesterol total, HDL-colesterol,<br />

LDL-colesterol, triglyceride, adiponectina) S-au folosit<br />

T test, corelatii partiale si regresie liniara (SPSS).<br />

Rezultate: S-au observat corelatii negative intre valorile<br />

adiponectinei si glucoza serica in ambele grupuri. Diferente<br />

semnificative statistic au existat intre cele doua<br />

grupuri de pacienti pentru adiponectina (p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Relationships between<br />

adiponectin and some<br />

cardiovascular risk factors in<br />

patients with diabetes mellitus<br />

type 2 or glucose intolerance<br />

Background: The relationships between adiponectin,<br />

inflammation and other cardiovascular risk factors are<br />

well discussed in various studies. Moreover, it’s seems<br />

that his genetic variations are associated with metabolic<br />

disease, including glucose intolerance and diabetes.<br />

Our aim was to investigate 2 groups <strong>of</strong> patients, one<br />

with diabetes mellitus type 2 controlled under treatments<br />

and the other one with glucose intolerance, regarding<br />

various cardiovascular risk factors and their<br />

relationship with adiponectin.<br />

Material and method: 65 patients age range (50-78<br />

yrs) were clinically evaluated (clinically, BMI, habit <strong>of</strong><br />

smoking, systolic and diastolic arterial pressure, cardiovascular<br />

risk score Framingham, electrocardiography<br />

and echocardiography) and laboratory test were<br />

done (serum glucose, oral glucose tolerance test,HbA1,<br />

VSH, CRP, leucocytes, total cholesterol, HDL-cholesterol,<br />

LDL-cholesterol, trygicerides, adiponectin). T<br />

test, partial correlation and liniar regression were used<br />

(SPSS).<br />

Results: We noticed a negative correlation between<br />

adiponectin values and serum glucose levels in both<br />

studied groups. There were found significant statistically<br />

differences between 2 groups <strong>of</strong> patients regarding<br />

adiponectin (p


POSTER II<br />

POSTER II<br />

Cardiovascular risk pr<strong>of</strong>ile<br />

<strong>of</strong> patients with sigmoid<br />

interventricular septum found<br />

by echocardiography<br />

Sigmoid interventricular septum (SIS) is characterized<br />

by a protrusion <strong>of</strong> the basal septum toward the left<br />

ventricular outflow tract and is encountered mainly in<br />

elderly and/or hypertensive patients. We proposed to<br />

evaluate the cardiovascular risk pr<strong>of</strong>ile <strong>of</strong> the patients<br />

presenting this finding.<br />

Methods: From the 1460 patients examined in our<br />

echo lab during 2009 we found 74 patients (39 men, 35<br />

women, mean age 67,4±10,4 years) with description <strong>of</strong><br />

sigmoid septum in the echo report. The patients with<br />

moderate-severe aortic and mitral valve disease and<br />

cases <strong>of</strong> hypertrophic cardiomyopathy were excluded<br />

from analysis. Relevant clinical, laboratory and echo<br />

data were collected at each patient, for characterising<br />

their cardiovascular risk pr<strong>of</strong>ile.<br />

Results: The presence <strong>of</strong> SIS was associated in 54%<br />

with septal and in 32,5% with left ventricular posterior<br />

wall hypertrophy. Only in 3 cases we found a significant<br />

outflow tract obstruction (peak velocity > 3 m/s). Degenerative<br />

modifications <strong>of</strong> the aortic and mitral valve<br />

(calcifications, increased thickness) were observed<br />

frequently (60,8% and 65,5%). We found a preserved<br />

left ventricular systolic function in 95% <strong>of</strong> the patients,<br />

while diastolic dysfunction was present in 49,5% (mainly<br />

impaired relaxation). Coronary heart disease was<br />

present in 47,3%, atrial fibrillation in 33,8% and significant<br />

pulmonary hypertension in 14,9% <strong>of</strong> the patients.<br />

Among the classical risk factors hypertension was present<br />

in 67,5%, elevated cholesterol in 41,9%, and hypertrigliceridemia<br />

in 39,2% <strong>of</strong> cases.<br />

Conclusions: Patients with SIS have a high cardiovascular<br />

risk due to advanced age, cummulation <strong>of</strong><br />

classical risk factors, and due to the high prevalence<br />

<strong>of</strong> degenerative valvular lesions and coronary disease,<br />

frequently associated with left ventricular diastolic dysfunction.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

104. Tratamentul cu alprostadil<br />

la pacientii cu boala arteriala<br />

periferica - de la recomandarile<br />

ghidului la experienta clinica<br />

F.Purcarea, Aura Popa, Carmen Ginghina<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Premize si scop: Tratamentul cu prostaglandine E1<br />

e prezentat sub diferite grade de recomandare in ghidurile<br />

pentru managementul pacientilor cu boala arteriala<br />

periferica. Ne-am propus sa studiem efectele<br />

terapeutice ale alprostadilului la un lot de pacienti cu<br />

arteriopatie obliteranta stadiile III si IV dupa clasificarea<br />

Fontaine.<br />

Material si metoda: Au fost analizati retrospectiv 25<br />

de pacienti consecutivi (varsta medie 61ani, 20 barbati)<br />

cu boala arteriala periferica stadiile III si IV Fontaine<br />

fara solutie de revascularizare, internati in sectia de<br />

cardiologie in perioada ianuarie 2009 - mai 2010. Toti<br />

pacientii au primit timp de 30 zile alprostadil 20 micrograme<br />

2 fiole diluate in 250 ml ser fiziologic perfuzie<br />

intravenoasa de 2 ori pe zi. Au fost evaluate pentru toti<br />

pacientii: prezenta durerii de repaus si pragul de claudicatie<br />

inainte si dupa tratamentul cu alprostadil. S-a<br />

considerat raspuns pozitiv la tratament fie disparitia<br />

durerii de repaus fie cresterea pragului de claudicatie<br />

cu peste 50 m.<br />

Rezultate: Din lotul total, 18 pacienti au descris cresterea<br />

distantei de mers cu cel putin 50 m, iar din cei 6 pacienti<br />

cu durere de repaus 4 au descris disparitia durerii<br />

dupa 30 zile; 12 pacienti au prezentat leziuni tr<strong>of</strong>ice din<br />

care 8 au prezentat ameliorare, iar 3 pacienti au evoluat<br />

catre amputatie. Au fost instrumentati angiografic 23<br />

pacienti. Din grupul pacientilor cu cresterea distantei<br />

de mers la 30 zile 63% au avut doar afectare arteriala<br />

inalta (iliaca si femurala), 6% doar afectare arteriala<br />

joasa (poplitee si tibiala), iar 31% afectare mixta. 83%<br />

din pacientii hipertensivi, 73% din pacientii diabetici,<br />

76% din pacientii fumatori, 73% din pacientii dislipidemici,<br />

60% pacientii cu boala renala cronica si 64% din<br />

pacientii cu sindrom inflamator au prezentat cresterea<br />

distantei mers la 30 zile.<br />

Concluzii: Tratamentul cu alprostadil la pacientii cu<br />

arteriopatie obliteranta stadiile III si IV Fontaine imbunatateste<br />

evolutia prin cresterea distantei de mers cu<br />

peste 50 m si ameliorarea durerii de repaus dupa 30 zile<br />

de tratament.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Alprostadil treatment in<br />

patients with peripheral arterial<br />

disease - from the guidelines<br />

recommendation to the clinical<br />

experience<br />

Premises and purpose. The treatment with prostaglandins<br />

E1is described under different grades <strong>of</strong> recommendation<br />

in the guidelines for the management <strong>of</strong> patients<br />

with peripheral arterial disease. We studied the<br />

effects <strong>of</strong> alprostadil in patients with peripheral arterial<br />

disease stages III and IV in Fontaine classification.<br />

Methods: We made a retrospective analysis <strong>of</strong> 25 consecutive<br />

patients (mean age was 61, 20 were men) with<br />

peripheral arterial disease stages III and IV Fontaine<br />

without interventional solution. The patients were treated<br />

in our cardiology department from January 2009<br />

to May 2010. All patients received daily intravenous<br />

administration <strong>of</strong> 20 μg alprostadil in 250 ml saline<br />

solution twice per day for 30 days. We evaluate for all<br />

patients: the rest pain and the walking distance before<br />

and after alprostadil treatment. We consider a positive<br />

treatment response the increase <strong>of</strong> walking distance<br />

with 50 m or the absence <strong>of</strong> rest pain after 30 days.<br />

Results: 18 patients from the total group described<br />

an increase in walking distance more than 50 m and<br />

4 patients from the 6 patients group with rest pain<br />

were painless after 30 days <strong>of</strong> treatment. 12 patients<br />

had trophic changes and after 30 days <strong>of</strong> treatment 8<br />

<strong>of</strong> them were better and 3 suffered amputation. 23 patients<br />

had made an angiography before the treatment<br />

with alprostadil. In the group <strong>of</strong> patients with increase<br />

in walking distance more than 50 m after 30 days <strong>of</strong><br />

treatment 63% had only high arterial lesions (iliac and<br />

femoral), 6% had only lower arterial lesions (popliteal<br />

and tibial ) and 31% had combined arterial lesions. 83%<br />

<strong>of</strong> hypertensive patients, 73% <strong>of</strong> diabetic patients, 76%<br />

<strong>of</strong> smokers, 63% <strong>of</strong> patients with hypercholesterolemia,<br />

60% <strong>of</strong> patients with kidney disease and 64% <strong>of</strong> patients<br />

with inflammatory syndrome had an increase in<br />

walking distance more than 50 m after 30 days <strong>of</strong> treatment<br />

with alprostadil.<br />

Conclusions: Alprostadil therapy in patients with peripheral<br />

arterial disease stages III and IV Fontaine increase<br />

the walking distance more than 50 m and could<br />

relieve the rest pain after 30 days <strong>of</strong> treatment.<br />

105. Factorii prognostici<br />

ai respitalizarii precoce<br />

in insuficienta cardiaca: o<br />

abordare pragmatica<br />

POSTER II<br />

POSTER II<br />

Madalina Dasoveanu, Raluca Ianula-Ciomag, Anca<br />

Popa, Crina Sinescu<br />

Spitalul Clinic de Urgenta "Pr<strong>of</strong>. Dr. Bagdasar-Arseni",<br />

Bucuresti<br />

Insuficienta cardiaca (IC) este o problema majora de<br />

sanatate publica, cu o incidenta si prevalenta crescanda.<br />

IC decompensata este o cauza majora de spitalizare<br />

si se asociaza cu o rata crescuta de mortalitate.<br />

Scopul acestui studiu este de a evalua valoarea markerilor<br />

clinici, ecografici si biologici care ar putea sa prezica<br />

respitalizarea pacientilor cu IC de origine ischemica.<br />

Am incercat sa dezvoltam un model pentru prezicerea<br />

respitalizarii in IC folosind variabile usor accesibile in<br />

practica clinica.<br />

Material si metoda: A fost un studiu prospectiv care<br />

a inrolat 510 pacienti (292 barbati si 218 femei) spitalizati<br />

in clinica noastra intre noiembrie 2007 si decembrie<br />

2008 cu IC de etiologie ischemica, avand FE≥<br />

45%. Evenimentul cardiac a fost definit ca respitalizare<br />

pentru IC. Pe perioada urmaririi, 49 de pacienti au iesit<br />

din studiu datorita instalarii fibrilatiei atriala, a flutterului<br />

atrial sau stroke. Toti pacientii au beneficiat in<br />

prima zi de spitalizare de o ecocardiografie si de determinari<br />

biologice. Valoarea Cut-<strong>of</strong>f pentru NT-proBNP<br />

a fost considerata 400 ng/l. Dintre parametrii analizati,<br />

cel mai bine s-au corelat cu respitalizarea dilatarea de<br />

atriu stang (p=0.0007) (valoarea cut-<strong>of</strong>f a diametrului<br />

antero-posterior indexat la suprafata corporala a fost<br />

de 26 mm/m2), NT-proBNP crescut (p=0.003), clasa<br />

NYHA III-IV (p=0.003), FE 45-55% (p= 0.0005). Marimea<br />

atriului stang si nivelul NT-proBNP sunt mai utili<br />

pentru evaluarea riscului de respitalizare la pacientii cu<br />

IC de etiologie ischemica decat alti parametri ecografici<br />

sau biologici. Combinatia celor doi parametri are<br />

putere mare de prezicere a respitalizarii. Alte variabile<br />

precum anemia, functia renala si semnele eco-Doppler<br />

de presiune de umplere crescuta a VS, desi au valoare<br />

prognostica semnificativa la analiza univariabila, isi pierd<br />

valoarea la analiza multivariabila.


POSTER II<br />

POSTER II<br />

Factors predicting early<br />

re-hospital isation in heart<br />

failure: a pragmatic approach<br />

Chronic heart failure (CHF) is a major public health<br />

problem, with an increasing incidence and prevalence.<br />

Acute decompensate heart failure is a major cause<br />

<strong>of</strong> hospitalization and is associated with high rates <strong>of</strong><br />

mortality and repeated hospitalizations. In this very<br />

high risk group <strong>of</strong> patients, early prognostic stratification<br />

may be useful in order to guide treatment intensity.<br />

The aim <strong>of</strong> this study was to assess the value <strong>of</strong> clinical,<br />

echocardiographyc and biochemical markers which<br />

could predict new hospitalization in patients with HF<br />

<strong>of</strong> ischemic origin.<br />

Material and method: We tried to develop a model for<br />

predicting re-admission for HF using variables easily<br />

assessable in clinical practice. Five hundred ten consecutive<br />

patients with HF <strong>of</strong> known ischemic origin<br />

(292 males and 218 females, mean age 66,4 years) having<br />

an EF >/= 45% were prospectively included in the<br />

study between November 2007 and December 2008.<br />

The cardiac event was defined as re-admission for HF.<br />

During the follow-up period, 49 patients (27 males and<br />

22 females) were excluded because <strong>of</strong> new onset atrial<br />

fibrillation, atrial flutter or stoke. All subjects had a<br />

baseline echocardiographic and NT-proBNP measurements<br />

(in the day <strong>of</strong> admission). The cut-<strong>of</strong>f value for<br />

NT-proBNP was 400 ng/l. The cut-<strong>of</strong>f <strong>of</strong> 26 mm/m2 for<br />

LA anteroposterior linear dimension indexed to body<br />

surface area defines, according to the recommendations<br />

<strong>of</strong> the European Society <strong>of</strong> <strong>Cardiology</strong>, the lower limit<br />

<strong>of</strong> a moderately abnormal LA. Among HF <strong>of</strong> ischemic<br />

origin patients, indexed LA size and NT-proBNP levels<br />

are more useful to stratify the risk <strong>of</strong> rehospitalisation<br />

than others clinical, echocardiographic or biochemical<br />

variables. The combination <strong>of</strong> these two parameters<br />

should be considered for predicting rehospitalization<br />

in patients with HF. Important prognostic variables like<br />

anaemia, renal function and echo-Doppler signs <strong>of</strong> increased<br />

ventricular filling pressures, though significant<br />

at invariable analysis, lost their value at multivariable<br />

analysis.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

106. Influenteaza varsta si sexul<br />

pacientilor prognosticul dupa<br />

STEMI Date din registrul<br />

national de infarct miocardic<br />

acut cu supravenivelare de ST<br />

V.Vintila, Oana Enescu, C.Stoicescu, C.Udroiu,<br />

Berenice Suran, P.Stanciulescu, S Garbea, I Malaescu,<br />

M.Cinteza, D.Vinereanu<br />

Spitalul Universitar de Urgenta, Bucuresti<br />

Context: Accesul rapid la terapia de reperfuzie este<br />

mandatorie pentru supravietuirea unui paient cu infarct<br />

miocardic cu supradenivelare de ST. Sunt date<br />

care sugereaza diferente de prognostic pe termen scurt<br />

in functie de varsta si sexul pacientilor.<br />

Obiective: Am analizat influenta varstei si sexului pacientilor<br />

asupra accesului la terapia de reperfuzie in cadrul<br />

populatiei cu infarct miocadic cu supradenivelare<br />

de ST inrolata de-a lungul a 11 ani in registrul national<br />

de infarct miocardic, ROSTEMI.<br />

Metoda: Au fost analizate retrospectiv datele medicale<br />

a 12894 pacienti, inrolati intre 1997 si 2008. 8866<br />

pacienti au fost barbati (69%, p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Concluzii: Prezentarea intarziata, varsta mai avansata<br />

si o strategie terapeutica mai putin agresiva pot explica<br />

prognosticul pe termen scurt mai rezervat in cazul femeilor<br />

cu infarct miocardic acut cu supradenivelare de<br />

segment ST.<br />

Does gender and age influence<br />

the prognosis <strong>of</strong> patients<br />

after STEMI Data from the<br />

<strong>Romanian</strong> STEMI registry,<br />

ROSTEMI<br />

Background: Fast access to reperfusion treatment <strong>of</strong><br />

a STEMI patient is mandatory for survival. However,<br />

there are data suggesting differences based to age and<br />

gender <strong>of</strong> patients, influencing the short-term prognosis.<br />

Objective: We assessed age and gender differences for<br />

the access to reperfusion therapy in the population<br />

with STEMI, enrolled over 11 years in the <strong>Romanian</strong><br />

ST-elevation myocardial infarction registry.<br />

Method: 12894 patients, enrolled between 1997 and<br />

2008, have been analyzed retrospectively from the medical<br />

records, using a nationwide database. 8866 were<br />

males (69%, p


POSTER II<br />

POSTER II<br />

Uric acid as risk factor in<br />

patients with acute coronary<br />

syndrome<br />

Purpose: Hyperuricemia is related to increased free radicals,<br />

stimulates inflammation and produces endothelial<br />

dysfunction. The purpose <strong>of</strong> our study is to determine<br />

the prevalence <strong>of</strong> hyperuricemia in patients with<br />

acute coronary syndrome (ACS), to find if hyperuricemia<br />

correlates with classical risk factors- hypertension,<br />

diabetes mellitus, metabolic syndrome, hs CRP, Killip<br />

class, LV systolic and diastolic function and early complications.<br />

Method: We evaluated 100 patients with ACS admited<br />

in the first 3 months <strong>of</strong> 2010. We performed a physical<br />

examination in each case, an ECG, echocardiogram,<br />

we measured uric acid , glycemia, cholesterol, triglycerides,<br />

GFR, hs CRP, troponin T, Killip class and we<br />

checked for complications.<br />

Results: We included 37 pts with myocardial infarction<br />

(15 pts with STEMI and 22 pts with NSTEMI) and 63<br />

pts with unstable angina. Increased uric acid was found<br />

in 65 pts (65%), mean value was 8.23 mg/dl, without<br />

difference between the 2 types <strong>of</strong> ACS. Hyperuricemia<br />

correlates with the presence <strong>of</strong> metabolic syndromer=0.78<br />

(p=0.03), with hypertension- r=0.68(p=0.05)<br />

and with hs CRP- r=0.75 (p=0.004). In the group <strong>of</strong> pts<br />

without metabolic syndrome or chronic kidney disease,<br />

hyperuricemia correlates with Killip class - r=0.76<br />

(p=0.04) and with EF and it does not correlate with<br />

other early complications.<br />

Conclusion: Hyperuricemia was found in 65% <strong>of</strong> pts<br />

with ACS, correlates with metabolic syndrome, hypertension,<br />

hs CRP, Killip class and EF; uric acid correlates<br />

with inflammation and LV dysfunction in pts with<br />

ACS.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

108. Regresia hipertr<strong>of</strong>iei<br />

ventriculare stangi dupa<br />

protezare valvulara aortica<br />

pentru stenoza aortia - corelatii<br />

clinice<br />

R.A.Sascau, C.Statescu, Catalina Arsenescu Georgescu<br />

Institutul de Boli Cardiovasculare “Pr<strong>of</strong>.dr. George I.M.<br />

Georgescu”, Iasi<br />

Scop: Efectele regresiei masei ventriculare stangi asupra<br />

evolutiei clinice dupa protezarea valvei aortice raman<br />

inca insuficient dovedite. Acest studiu are intentia<br />

sa stabileasca impactul pr<strong>of</strong>ilului clinic al pacientilor<br />

referiti pentru protezare valvulara aortica asupra evolutiei<br />

postoperatorii in mod particular privind regresia<br />

masei ventriculare stangi (MVS).<br />

Metoda si rezultate: 130 pacienti consecutivi protezati<br />

valvular aortic pentru stenoza aortica au fost urmariti<br />

prospectiv timp de 2 ani. S-a efectuat o analiza uni sau<br />

multivariata asocierii supravietuirii postoperatorii cu<br />

regresia MVS si caracteristicile clinice ale pacientilor.<br />

MVS a scazut in medie de la 190 ± 43 la 158 ± 70 g/m2<br />

(p < 0.001). Varsta avansata, clasa functionala NYHA,<br />

fractia de ejectie ventriculara stanga (FEVS) scazuta,<br />

asocierea hipertensiunii arteriale si un index de masa<br />

ventriculara stanga (IMVS) crescut preoperator au fost<br />

asociati cu o reducere a supravietuirii postoperatorii. 5<br />

decese s-au inregistrat imediat postoperator si 20 decese<br />

la distanta postoperator pe parcursul urmaririi. Cu<br />

toate acestea gradul regresiei MVS nu a influentat rezultatele<br />

clinice, desi precoce postoperator (sub 6 luni)<br />

regresia MVS a fost asociata cu rezultatele pe termen<br />

mediu.<br />

Concluzii: Supravietuirea dupa protezare aortica este<br />

in principal determinata de statusul functional cardiac<br />

sistemic preoperator. Gradul regresiei MVS nu se<br />

coreleaza cu rezultatele clinice, in timp ce tratamentul<br />

agresiv al hipertensiunii arteriale poate imbunatati supravietuirea<br />

postoperatorie.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Regression <strong>of</strong>t left ventricular<br />

mass after aortic valve<br />

replacement for aortic stenosis<br />

- clinical correlationes<br />

Aim: The effects <strong>of</strong> post-operative left ventricular mass<br />

regression (LVMR) on clinical outcome after aortic<br />

valve surgery remains to be established. This study was<br />

intended to establish the impact <strong>of</strong> patient characteristics<br />

on post-operative survival in patients referred for<br />

aortic valve replacement (AVR), with particular regard<br />

to LVMR.<br />

Methods and results: 130 consecutive cases submitted<br />

to aortic valve replacement for valvular stenosis were<br />

prospectively followed for 2 years. Baseline, characteristics<br />

and extent <strong>of</strong> LVMR were tested for association<br />

with survival by uni-and multivariable analysis. 5<br />

deaths occurred during hospital stay and 20 during<br />

out-<strong>of</strong>-hospital follow-up. Mean left ventricular mass<br />

decreased from 190 ± 43 la 158 ± 70 g/m2 (p < 0.001).<br />

Older age, advanced functional class, hypertension,<br />

reduced left ventricle ejection fraction, and high preoperative<br />

left ventricular mass index were associated<br />

with reduced survival. Overwall the extent <strong>of</strong> LVMR<br />

did not influence the clinical results, while only early<br />

(< 6 months) LVMR was associated with mid-term outcome.<br />

Conclusions: Survival after aortic valve surgery is mainly<br />

determined by the pre-operative functional cardiac<br />

and systemic status. The extent <strong>of</strong> LVMR does not<br />

correlate with clinical outcome, whereas aggressive<br />

treatment <strong>of</strong> hypertension may improve post-operative<br />

survival.<br />

109. Analiza riscului<br />

cardiovascular la pacientii<br />

cu sindroame coronariene<br />

acute fara supradenivelare de<br />

segment ST<br />

POSTER II<br />

POSTER II<br />

Alexandra Fleancu, Elena Bobescu, Mariana Radoi,<br />

Nicoleta Aldulea<br />

Spitalul Clinic Judetean de Urgenta, Brasov<br />

Obiective: Evaluarea comparativa a riscului cardiovascular<br />

(CV) la pacientii cu infarct miocardic acut fara<br />

supradenivelare de segment ST (NSTEMI) si angina instabila<br />

(AI) prin analiza factorilor de risc, a modificarilor<br />

ECG, a factorilor ecocardiografici de risc si aparitia<br />

evenimentelor CV majore (deces de cauza CV, infarct<br />

miocardic acut, angina recurenta) la 7 zile.<br />

Material si metoda: Studiu restrospectiv a 202 pacienti<br />

(p) cu sindrom coronarian acut fara supradenivelare<br />

de segment ST, impartiti in 2 grupuri: Grup AI 110 p ,<br />

Grup NSTEMI 92 p. Parametrii urmariti au fost: factori<br />

de risc CV, electrocardiografic - subdenivelarea de<br />

segment ST si modificari ale undei T, ecocardiografic<br />

- tulburarile de cinetica segmentara si analiza functiei<br />

sistolice prin determinarea fractiei de ejectie (FE).<br />

Rezultate: Factorii de risc cu valoare predictiva semnificativa<br />

pentru evenimente cardiovasculare majore in<br />

grupul NSTEMI au fost: diabetul zaharat (p=0,00196),<br />

obezitatea (p=0,00011), varsta > 65 de ani (p=0,01909),<br />

boala arteriala periferica (p = 0,00286), fibrinogenul<br />

(p=0,0000004), troponina I, CK-MB, subdenivelarea<br />

de segment ST≥2 mm (p=0,03720) si undele T negative,<br />

adanci, simetrice (p= 0,02763). Incidenta localizarii<br />

anterioare a modificarilor ECG ischemo-lezionale este<br />

preponderenta si asociata cu un risc CV crescut la ambele<br />

grupuri studiate, fiind semnificativ mai frecventa<br />

in grupul NSTEMI (p=0,00753). Ecocardiografic, incidenta<br />

valorilor reduse ale FE


POSTER II<br />

POSTER II<br />

pentru aparitia evenimentelor CV majore in grupurile<br />

studiate au fost: diabetul zaharat, obezitatea, varsta > 65<br />

de ani, boala arteriala periferica, fibrinogenul, troponina<br />

I, CK-MB, subdenivelarea ST ≥2 mm si undele T<br />

negative, adanci, simetrice cu localizare anterioara, disfunctia<br />

sistolica de ventricul stang, hipokinezie de sept<br />

interventricular si apex. Incidenta evenimentelor CV a<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

cardiovascular events were: diabetes mellitus, obesity,<br />

age > 65 years, arterial peripheral disease, fibrinogen,<br />

troponin I, CK-MB, ST depression ≥ 2 mm, negative,<br />

deep, symmetric T wave with anterior localisation, interventricular<br />

sept and apex hypokinesia. CV events<br />

incidence was significantly correlated with risc factors<br />

incidence.<br />

Analysis <strong>of</strong> cardiovascular<br />

risk in patients with non ST<br />

elevation acute coronary<br />

syndrome<br />

Objective: Comparative evaluation <strong>of</strong> cardiovascular<br />

risk in patients with non ST elevation myocardial infarction<br />

(NSTEMI) and unstable angina (UA) by cardiovascular,<br />

ECG, echocardiography risk factors analysis<br />

and evolution with major acute cardiovascular events<br />

(cardiovascular death, acute myocardial infarction, recurrent<br />

angina) at 7 days.<br />

Methods: Retrospective study <strong>of</strong> 202 patients (pts) with<br />

non ST elevation acute coronary syndrome divided in 2<br />

groups: Group UA 110 pts and Group NSTEMI 92 pts.<br />

It was analyzed the followed parameters: CV risk factors,<br />

ECG changes – ST depression and T wave changes,<br />

echocardiography – wall kinetics alteration and systolic<br />

function analysis by ejection fraction (EF) evaluation.<br />

Results: Risk factors with high predictive value for<br />

major cardiovascular events were: diabetes mellitus<br />

(p=0.00196), obesity (p=0.00011), age > 65 years<br />

(p=0.01909), arterial peripheral disease (p=0.00286),<br />

fibrinogen (p=0.0000004), troponin I, CK-MB, ST depression<br />

≥ 2 mm (p=0.03720), negative, deep, symmetric<br />

T wave (p=0.02763). Anterior localization <strong>of</strong> ECG<br />

changes was majoritar and associated with high CV risk<br />

in both groups <strong>of</strong> study, significant higher in NSTEMI<br />

group (p=0.00753). At echocardiography incidence <strong>of</strong><br />

low EF


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

OR=0.813 (CI 95% 0.422-1.565) si statinele de catre<br />

46.3%, respectiv de 22.6%, (p = 0.001), OR = 2.949 (CI<br />

95% 1.562-5.57). Luand in considerare pacientii sub si<br />

peste 75 de ani, aspirina a fost utilizata in proportii similare<br />

de catre femei (74.3% vs 67.6 %, p=NS) si barbati<br />

(75.7% vs 78.6 %, p=NS), dar statinele au fost semnificativ<br />

mai putin utilizate la pacientii peste 75 de ani,<br />

(femei – 52.7% vs 32.4 %, p


POSTER II<br />

POSTER II<br />

Cl-Cr (formula Cockcr<strong>of</strong>t-Gault). Monitorizarea Cl-Cr<br />

si a ionogramei serice s-a efectuat la maxim 3 zile. Statistica<br />

prin testul Student.<br />

Rezultate: ~20% din pacienti au prezentat scaderea Cl-<br />

Cr, in asociere mai frecventa cu FE a VS


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

ce cat si in special prin masuri non-farmacologice, aici<br />

fiind inclusa si activitatea fizica. Pacientii fac parte din<br />

studiul Euroaspire III Romania follow-up. EuroAspire<br />

III <strong>Romanian</strong> Follow-Up intentioneaza sa demonstreze<br />

atingerea tintelor conform recomandarilor din Ghidul<br />

European de Preventie pentru pacientii asimptomatici<br />

cu risc crescut urmariti pe termen lung de catre medicul<br />

de familie.<br />

Material si metoda: Au fost studiati 325 pacienti<br />

asimptomatici cu risc inalt de boala cardiovasculara<br />

(varsta 56±9 ani, 60% femei) fara istoric de boala cardiovasculara,<br />

aflati sub tratament hipolipemiant +/- medicatie<br />

hipotensoare). Dupa evaluarea clinica initiala<br />

si investigatiile de laborator, medicul de familie a facut<br />

recomandarile de ajustare farmacologica si interventie<br />

non-farmacologica (dieta, scaderea in greutate si activitatea<br />

fizica). Pacientii au fost evaluati initial si din<br />

6 in 6 luni pana la 18 luni din punct de vedere clinic,<br />

biologic si aderenta la masurile de schimbare a stilului<br />

de viata.<br />

Rezultate: Din cei 325 pacienti inclusi in studiu 62%<br />

sunt de sex feminin, varsta medie a lotului 57,09+/-9,8<br />

ani. Daca initial au fost inclusi doar 19 pacienti in programul<br />

de recuperare, la sfarsitul celor 18 luni, erau 171<br />

de pacienti participanti (p


POSTER II<br />

POSTER II<br />

113. Cardiopatia ischemica -<br />

premize, gravitate si evolutie la<br />

femeile diabetice<br />

Carmen Elena Boldea Colcear, Geanina Coada, Magda<br />

Mariana Badescu, Catalina Arsenescu Georgescu<br />

Institutul de Boli Cardiovasculare “Pr<strong>of</strong>. Dr. George I.<br />

M. Georgescu“, Iasi<br />

Introducere: In conditiile unei vieti tot mai sedentare<br />

si a unui mod de alimentatie bazat tot mai frecvent pe<br />

produse tip fast-food, diabetul zaharat a atins cote alarmante.<br />

Aceasta tulburare metabolica este strans corelata<br />

cu patologia sistemului cardiovascular impunand<br />

adoptarea unei abordari cardio-diabetologice in evaluarea<br />

si tratarea pacientilor.<br />

Obiectiv: Evaluarea particularitatilor cardiopatiei ischemice<br />

la femeile diabetice.<br />

Material si metoda: Studiu retrospectiv, comparativ,<br />

care a inclus 156 de paciente repartizate in 2 loturi similare<br />

ca distributie pe intervale de varsta evaluate pe<br />

baze clinice, paraclinice si imagistice. Primul lot a inclus<br />

toate pacientele diabetice cu cardiopatie ischemica<br />

investigate angiografic in Institutul de Boli Cardiovasculare<br />

“Pr<strong>of</strong>. Dr. George I. M. Georgescu“ Iasi in perioada<br />

1 ianuarie - 31 decembrie 2008. Lotul martor a<br />

fost alcatuit din paciente nediabetice cu cardiopatie ischemica<br />

investigate coronarografic in aceeasi perioada<br />

alese aleatoriu din intervalul de varsta corespondent.<br />

Rezultate: Lotul diabetic a totalizat 78 de paciente cu o<br />

varsta medie de 62,53 ani. Vechimea diabetului a fost in<br />

medie de 7,3 ani (9% - cazuri nou diagnosticate) iar in<br />

26,65% din cazuri acest a prezentat complicatii (retino/<br />

nefro/neuropatie). 33% din paciente au avut insulinoterapie,<br />

in 8,91% din cazuri aceasta fiind introdusa pe<br />

parcursul spitalizarii. Comparativ, normoponderabilitatea<br />

a fost dubla la lotul nediabetic (21,79% versus<br />

11,54%). Obezitatea a predominat la lotul diabetic<br />

(53,85% versus 39,74%), mai ales in cazul obezitatii de<br />

grad II (20,51% versus 3,05%). Dislipidemia si steatoza<br />

hepatica au fost mai frecvente la lotul diabetic (71,79%<br />

versus 67,94%, respectiv 12,82% versus 5,12%). S-a remarcat<br />

o prevalenta dubla a pacientelor normotensive<br />

nediabetice (38,46% versus 19,23%). Hipertensiunea<br />

arteriala grad 3 a fost mai frecventa la femeile diabetice<br />

(55,13% versus 28,21%). Prevalenta accidentului vascular<br />

cerebral a fost dubla la femeile diabetice fata de<br />

cele nediabetice (13,12% versus 7,05%). Infarctul miocardic<br />

a fost prezent la 39,74% dintre femeile diabetice<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

si 52,56% din cele nediabetice. Pacientele diabetice au<br />

prezentat mai frecvent afectare coronariana (84,62%<br />

versus 74,36%) iar leziunile coronariene au fost mai<br />

severe (leziuni tricoronariene 34,62% versus 19,23 %).<br />

Revascularizarea miocardica chirurgicala a fost indicata<br />

in de 24,36% din femeile diabetice si 11,54% din cele<br />

nediabetice.<br />

Concluzii: Diabetul influenteaza negativ evolutia bolii<br />

cardiace. Factorii de risc (obezitate, hipertensiune,<br />

dislipidemie) sunt mai bine reprezentati la femeile diabetice.<br />

Afectarea coronariana la diabetice este mai frecventa<br />

si mai severa comparativ cu femeile non diabetice<br />

si necesita mai frecvent tehnici de revascularizare<br />

miocardica chirurgicala.<br />

Ischemic heart disease -<br />

premises, gravity and evolution<br />

in diabetic women<br />

Background: The worldwide prevalence <strong>of</strong> diabetes<br />

mellitus has reached dramatically levels because <strong>of</strong> increasing<br />

sedentary life and the fast food alimentation.<br />

This metabolic disorder is strongly correlated with the<br />

cardio-vascular pathology which imposes a cardio-diabetological<br />

approach <strong>of</strong> these patients.<br />

Objective: To evaluate the particular features <strong>of</strong> the ischemic<br />

heart disease in diabetic women.<br />

Materials and methods: A retrospective, comparative<br />

study which included 156 women divided into 2 groups<br />

similar as age - group distribution. The first group included<br />

all the diabetic women with ischemic heart disease<br />

that were admitted and investigated in The Cardiovascular<br />

Institute <strong>of</strong> Iasi, between January –December<br />

2008. The second group consisted <strong>of</strong> women with ischemic<br />

heart disease but with no diabetes mellitus, invazively<br />

investigated in the same period correspondent<br />

as age distribution.<br />

Results: The diabetic group consisted <strong>of</strong> 78 patients,<br />

with an average age <strong>of</strong> 62,53 years. The diabetes had a<br />

medium evolution <strong>of</strong> 7,3 years (9% - new cases <strong>of</strong> diabetes),<br />

and there were complications (retino/nephro/<br />

neuropathy) in 26,65% cases. 33% <strong>of</strong> the diabetics were<br />

treated with insulin. The percentage <strong>of</strong> women with<br />

normal weight was 2 times higher in the non diabetic<br />

group (21,79% versus 11,54%). The obesity was predominant<br />

in the diabetic group (53,85% versus 39,74%),<br />

especially type 2 obesity (20,51% versus 3,05%). Dys-


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

lipidemia and hepatic steatosis were more common in<br />

the diabetic group (71,79% versus 67,94%, 12,82% versus<br />

5,12% respectively). More non diabetic women had<br />

a normal blood pressure (38,46% versus 19,23%). The<br />

hypertension grade 3 was more frequently encountered<br />

among diabetic women (55,13% versus 28,21%). Stroke<br />

was 2 times more frequent in the first group (13,12%<br />

versus 7,05%). Myocardial infarction was diagnosed in<br />

39,74% <strong>of</strong> diabetic and 52,56% <strong>of</strong> non diabetic women.<br />

The diabetic women had more frequently coronary lesions<br />

(84,62% versus 74,36%) and more vessels were<br />

usually affected (three vessel disease - 34,62% versus<br />

19,23%). Surgical myocardial revascularization was<br />

indicated in 24,36% <strong>of</strong> diabetics and 11,54% <strong>of</strong> nondiabetics.<br />

Conclusions: The diabetes influences negatively the<br />

ischemic heart disease. The risk factors (obesity, hypertension,<br />

dyslipidemia) are better expressed in the diabetic<br />

women population. The coronary disease is more<br />

frequent and more severe in the diabetic women and<br />

<strong>of</strong>ten requires surgical myocardial revascularization techniques.<br />

114. Este cardiostimularea<br />

bicamerala o solutie de<br />

tratament pentru pacientii cu<br />

cardiomiopatie hipertr<strong>of</strong>ica<br />

obstructiva refractara la<br />

tratamentul medicamentos<br />

(experienta Institutului C.C.<br />

Iliescu)<br />

Maria-Magdalena Gurzun, R.Ciudin, Irina Serban<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

POSTER II<br />

POSTER II<br />

embolizarii selective de artera septala sau cardiostimularii<br />

bicamerale. Lucrarea isi propune sa analizeze o serie<br />

de cazuri formata din 13 pacienti cu cardiomiopatie<br />

hipertr<strong>of</strong>ica obstructiva din cazuistica Institutului de<br />

Boli Cardio- Vasculare CC Iliescu. Aproape jumatate<br />

din pacienti au avut indicatii de cardiostimulare (pauze<br />

sinusale simptomatice mai mari de 2,5 secunde, bloc<br />

atrio-ventricular de grad inalt), in cealalta jumatate<br />

din cazuri cardiostimularea bicamerala fiind destinata<br />

exclusiv tratamentului bolii de baza. De mentionat ar<br />

fi faptul ca in acest ultim subgrup varsta medie a fost<br />

de aproximativ 60 de ani si ca toti pacientii erau simptomatici<br />

sub tratament beta blocant in doza maxima.<br />

Am analizat datele de la 10 pacienti in ceea ce priveste<br />

evolutia gradientului inainte si dupa cardiostimulare:<br />

in toate cazurile asistam la o reducere a gradientului,<br />

in 5 cazuri aceasta reducere este mai mare de 50% iar<br />

valorile medii au scazut de la 76 mmHg initial la 35<br />

mmHg dupa procedura. In ceea ce priveste gradul insuficientei<br />

mitrale in 5 cazuri asistam la o scadere a gradului<br />

regurgitarii mitrale. Din seria de cazuri va prezentam<br />

pentru exemplificare doua cazuri: primul este<br />

al unei paciente la care cardiostimulare bicamerala s-a<br />

realizat ca si modalitate de tratament specifica pentru<br />

cardiomiopatie hipertr<strong>of</strong>ica obstructiva fara a avea alta<br />

indicatie si care a fost urmarita timp de 12 ani, observandu-se<br />

o scadere progresiva a gradientului dinamic<br />

in tractul de ejectie al ventricului stang de pana la 60%<br />

iar cel de-al doilea este al unui pacient la care asocierea<br />

tulburarilor de ritm si de conducere la un pacient cu<br />

un gradient provocat de 80 mmHg a impus implantarea<br />

unui defibrilator bicameral. Concluzionand in seria<br />

de cazuri prezentata asistam la o scadere a gradientului<br />

dinamic ca urmare a cardiostimularii bicamerale in<br />

cardiomiopatiei hipertr<strong>of</strong>ica obstructiva, fara a putea<br />

aprecia insa o imbunatatire a testelor functionale.<br />

Cardiomiopatia hipertr<strong>of</strong>ica, cea mai comuna afectiune<br />

genetica cardio-vasculara reprezinta o adevarata provocare<br />

pentru cardiologi in incercarea de diagnostic in<br />

cazul persoanelor asimptomatice dar si in ceea ce priveste<br />

alegerea modalitatii optime de tratament, mai ales<br />

in cazurile care nu raspund la terapia medicamentoasa<br />

si care raman rezervate fie tratamentului chirurgical fie


POSTER II<br />

POSTER II<br />

Is permanent dual-chamber<br />

pacing a therapeutic<br />

solution for drug-refractory<br />

symptomatic patients with<br />

obstructive hypertrophic (C.C.<br />

Iliescu Institute experience)<br />

Hypertrophic cardiomyopathy, the most common inherited<br />

cardiac disorder, represents a real challenge for<br />

the cardiologists – firstly to establish the diagnostic <strong>of</strong><br />

the disease in case <strong>of</strong> asymptomatic patients and secondly<br />

to choose the most correct treatment ,especially in<br />

symptomatic patients refractory to drug therapy which<br />

are candidates either for surgical myectomy, alcohol<br />

septal ablation or dual chamber pacing. The work presents<br />

a case series study with 13 patients, treated in The<br />

Emergency Cardiovascular Disease CC Iliescu Institute.<br />

Almost half <strong>of</strong> the patients have classical indication<br />

for pacing (sinus node disease, third or second degree<br />

atrioventricular block). For the rest <strong>of</strong> them dual chamber<br />

pacing was considered as a specific treatment for<br />

hypertrophic obstructive cardiomyopathy only. In this<br />

last group the average age was 60 years and all patients<br />

were symptomatic despite <strong>of</strong> correct medical treatment.<br />

Dynamic left ventricle outflow gradient was analyzed<br />

in 10 patients before and after dual chamber pacing<br />

and showed a decrease <strong>of</strong> outflow tract gradient in all<br />

patients after the procedure (the average value <strong>of</strong> 76<br />

mmHg versus 35 mmHg after the procedure). The patients<br />

also presented mitral regurgitation and 5 <strong>of</strong> them<br />

had a change in mitral regurgitation grade after the<br />

procedure. From this case series we present two cases:<br />

first patient was followed 12 years after the dual chamber<br />

pacing. The second patient associated conduction<br />

and rhythm disturbances and needed a dual chamber<br />

pacing and an ICD too. The case series reveals a decrease<br />

<strong>of</strong> the dynamic gradient in hypertr<strong>of</strong>ic obstructive<br />

cardiomyopathy after dual chamber pacing, but doesn’t<br />

show any improvement <strong>of</strong> functional capacity.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

115. Analiza caracteristicilor<br />

clinice si paraclinice ale<br />

pacientilor cu fibrilatie atriala<br />

spitalizati cu supradozaj<br />

dicumarinic<br />

Daniela Ceptureanu, Loredana Dan, A.Frigy,<br />

C.Szabados, E.Carasca<br />

Spitalul Clinic Judetean, Clinica Medicala IV, Targu<br />

Mures<br />

Anticoagularea in fibrilatia atriala este un tratament de<br />

baza, dar comporta riscul hemoragiilor cu diverse localizari,<br />

mai ales pe fondul supradozajului tratamentului<br />

anticoagulant oral. Ne-am propus o analiza complexa a<br />

cazurilor cu fibrilatie atriala si supradozaj dicumarinic,<br />

avand ca scop gasirea unor eventuali factori asociati<br />

riscului de hemoragie/supradozaj.<br />

Material si metoda: Studiu retrospectiv pe perioada<br />

2006−2009, selectand 33 de pacienti, la care am urmarit<br />

urmatorii parametrii: tipul fibrilatiei atriale, etiologia<br />

acesteia, valorea tensiunii arteriale la internare, frecventa<br />

cardiaca, INR –ul la internare, prezenta anumitor<br />

comorbiditati, functia sistolica a ventriculului stang si<br />

asocierile medicamentoase.<br />

Rezultate: Incidenta supradozajului dicumarinic la toti<br />

pacientii cu fibrilatie atriala anticoagulati spitalizati a<br />

fost 2,5 %. Majoritatea pacientilor au fost varstnici, cu<br />

varsta medie de 68,3± 11 ani, predominand sexul feminin<br />

cu o pondere de 65%. Mai mult de jumatate (56%)<br />

dintre pacienti erau cu fibrilatie permanenta, intrunind<br />

un scor CHADS cu o valoare medie de 2,3. Hipertensiunea<br />

arteriala esentiala, valvulopatiile si cardiopatia<br />

ischemica fiind factorii etiologici cei mai frecventi.<br />

Aproape toti pacientii (91%) au asociat insuficienta<br />

cardiaca, o treime fiind cu disfunctie sistolica a ventriculului<br />

stang (FE≤ 40%). Valoarea medie a INR−ului la<br />

internare a fost 8,6 ±3,66, la 56% din pacienti aparand<br />

hemoragii manifeste clinic, rezultand un sindrom anemic<br />

de obicei usoara (valoarea medie a Hb fiind 12,05<br />

g/dL). Hematuria (35%) si hemoragiile cutanate (18%)<br />

au fost cel mai frecvent intalnite, la care se adauga cele<br />

din sfera ORL si hemoptiziile.<br />

Concluzii: Din analiza datelor s-a putut contura un<br />

pr<strong>of</strong>il de risc pentru supradozaj dicumarinic si sangerare,<br />

de care trebuie tinut cont si in practica cotidiana.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Analysis <strong>of</strong> clinical and<br />

paraclinical characteristics<br />

<strong>of</strong> the patients with atrial<br />

fibrillation hospitalized with<br />

dicumarinic overdose<br />

Anticoagulation is a basic treatment in atrial fibrillation,<br />

but involves the risk <strong>of</strong> bleeding at different sites,<br />

primarily in the setting <strong>of</strong> oral anticoagulant overdose.<br />

Objectives: The purpose <strong>of</strong> this study was a complex<br />

assessment <strong>of</strong> cases hospitalized with atrial fibrillation<br />

and dicumarinic overdose, to find possible factors related<br />

with overdose/bleeding risk.<br />

Methods: We performed a retrospective study <strong>of</strong> 33 patients,<br />

admitted between 2006−2009, being evaluated<br />

the following parameters: type and etiology <strong>of</strong> atrial fibrillation,<br />

blood presure values, heart rate, INR values<br />

on admission, co-existing conditions, left ventricular<br />

systolic function and drug associations.<br />

Results: The incidence <strong>of</strong> dicumarinic overdose for all<br />

the patients with atrial fibrillation was 2.5%. The majority<br />

was aged patients, with a mean age <strong>of</strong> 68.3 ±11<br />

years; there was a female predominance <strong>of</strong> 65%. More<br />

then half (56%) <strong>of</strong> the patients had permanent atrial<br />

fibrillation, with an average CHADS score <strong>of</strong> 2.3; essential<br />

arterial hypertension, valvulopathies and ischemic<br />

cardiomiopathy were the most frequent etiological<br />

factors. In almost all patients (91%) heart failure was<br />

associated, one-third <strong>of</strong> them having left ventricular<br />

systolic dysfunction (EF≤ 40%). The average <strong>of</strong> INR values<br />

on admission was found to be 8.6 ±3.66, bleeding<br />

appeared in 56% <strong>of</strong> cases, causing mild anemic syndrome<br />

(the mean Hb being 12.05 g/dL). Hematuria (35%)<br />

and cutaneous bleedings (18%) were the most frequent<br />

signs <strong>of</strong> dicumarinic overdose, ENT bleeding and hemoptysis<br />

have been also noted.<br />

Conclusions: Analysis <strong>of</strong> data revealed a risk pr<strong>of</strong>ile for<br />

dicumarinic overdose and bleeding. This has to be considered<br />

in daily practice.<br />

POSTER II<br />

POSTER II<br />

116. Torsiunea este un<br />

mecanism compensator,<br />

mediat de rigiditatea arteriala,<br />

la pacientii cu disfunctie<br />

ventriculara stanga subclinica<br />

Stefania Magda, Raluca Dulgheru, Maria Florescu,<br />

Andrea Ciobanu, M.Cinteza, D.Vinereanu<br />

Spitalul Universitar de Urgenta, Bucuresti<br />

Context: Studii recente indica faptul ca in stadiile initiale<br />

ale disfunctiei subclinice de VS augmentarea gradului<br />

de torsiune si twist actioneaza ca si mecanism compensator,<br />

probabil prin intermediul rigiditatii arteriale<br />

crescute si cuplarii ventriculo-arteriale inadecvate.<br />

Metode: La 31 de pacienti (varsta medie 57±9 ani ,<br />

18 barbati) cu hipertensiune arteriala usoara-moderata<br />

(valori medii ale TA la monitorizarea pe 24 ore<br />

148/93mmHg), diabet zaharat de tip 2 (durata medie<br />

de la diagnostic 3.2±3.3 ani) si functie sistolica de VS<br />

normala ( FEVS>50%) am analizat prin ecocardiografie<br />

2D speckle tracking urmatorii parametri de torsiune<br />

a VS: rotatia maxima a bazei si apexului, timpul<br />

pana la rotatia maxima a bazei si apexului, gradul de<br />

twist al VS si timpul pana la twist-ul maxim, precum<br />

si torsiunea VS. Functia arteriala a fost evaluata prin<br />

analiza “e-tracking” si “wave intensity” la nivelul arterei<br />

carotide comune drepte, cu determinarea indicelui intima-medie<br />

(IMT) si a ariei undei reflectate (NA). Am<br />

determinat de asemenea si markerii de fibroza miocardica<br />

(peptidul amino-terminal al procolagenului de tip<br />

1) prin analiza bazata pe electrochemiluminescenta.<br />

Rezultate: Torsiunea si twist-ul VS au fost “supranormale”,<br />

probabil din cauza ca rotatia maxima bazala si<br />

rotatia maxima apicala au fost simultane (vezi tabel).<br />

Torsiunea si twist-ul VS s-au corelat pozitiv cu IMT<br />

(r=0.40 si r=0.40) si cu NA (r=0.40 si r=0.43). Gradul<br />

de torsiune si twist a VS s-au corelat pozitiv si cu markerii<br />

de fibroza miocardica (r=0.41 si r=0.43), pentru<br />

toate corelatiile p


POSTER II<br />

POSTER II<br />

Ipoteze: menopauza este responsabila de alterarea<br />

pr<strong>of</strong>ilului de risc cardiovascular. Ateroscleroza este cunoscuta<br />

ca o “boala inflamatori cronica”, iar moleculele<br />

de adeziune reprezinta markeri inflamatori, cu rol<br />

important in initierea leziunilor aterosclerotice. TSH<br />

reprezinta o terapie controversata, efectele sale asupra<br />

aparatului cardiovascular fiind contradictorii. Scopul<br />

studiului: evaluarea modificarilor produse de TSH asupra<br />

moleculelor de adeziune.<br />

Metoda: Au fost evaluate 57 femei in postmenopauza,<br />

varsta medie 47.73±4.62 ani, fara boli cardiovasculare.<br />

17 (29.8%) au inceput in anul 2008 TSH. Ca si factori<br />

de risc cardiovasculari au fost evaluati obezitatea, fumatul,<br />

diabetul zaharat, hipertensiunea arteriala si dislipidemia<br />

(colesterol total >200 mg/dl sau trigliceride<br />

serice >150 mg/dl sau tratament anterior hipolipemiant).<br />

Pacientele au fost urmarite doi ani consecutivi<br />

(2008-2009). Au fost determinate moleculele de adeziune<br />

(sICAM1 si sVCAM1 in ng/ml), din seruri stocate<br />

si congelate - metoda ELISA.<br />

Rezultate: initial nu au fost decelate diferente semnificative<br />

intre cele doua grupuri (cu vs fara TSH) refericlinica<br />

accentuata (IMT) si de rigiditatea arteriala si se<br />

coreleaza pozitiv cu progresia bolii in stadiile initiale.<br />

Rotatia bazei VS (grd ) -7.9 ± 3.6 Timpul pana la rotatia<br />

maxima a bazei (ms) 333.6 ± 86.4 Rotatia apexului VS<br />

(grd) 9.8 ± 6.2 Timpul pana la rotatia maxima a apexului<br />

(ms<br />

Torsion is a compensatory<br />

mechanism in patients with<br />

subclinical left ventricular<br />

dysfunction, related to arterial<br />

stiffness<br />

Context. Recent studies suggest that increased LV twist<br />

and torsion act as a compensatory mechanism in early<br />

stages <strong>of</strong> subclinical LV dysfunction. This might be mediated<br />

by increased arterial stiffness, through inappropriate<br />

ventriculo-arterial coupling.<br />

Methods: In 31 patients (57±9 yrs, 18 males) with mild<br />

to moderate hypertension (mean ABPM values 148/93<br />

mmHg), type II diabetes (mean duration <strong>of</strong> 3.2±3.3<br />

yrs) and normal ejection fraction (>50%), we assessed<br />

the following LV torsion parameters by 2D speckle<br />

tracking echocardiography: peak rotation <strong>of</strong> LV base<br />

and apex, time to peak rotation <strong>of</strong> LV base and apex,<br />

LV twist and time to peak twist and LV torsion. Arterial<br />

function was evaluated by “e-tracking” and “wave intensity”<br />

analysis at the level <strong>of</strong> the RCCA by measuring<br />

intima-media thickness (IMT), and area <strong>of</strong> the reflective<br />

wave (NA). We also determined markers <strong>of</strong> myocardial<br />

fibrosis (procollagen type-1 amino terminal) by an<br />

electrochemiluminescence immunoassay.<br />

Results: LV twist and torsion were “supranormal”, probably<br />

because peak basal and apical rotation occurred<br />

concomitently (table). LV twist and torsion correlated<br />

positively with IMT (r=0.42 and r=0.40), and with<br />

NA (r=0.44 and r=0.40). Also, they correlated positively<br />

with markers <strong>of</strong> myocardial fibrosis (r=0.43 and<br />

r=0.41), all p


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

tor la prezenta obezitatii (11.8% vs 35%), a fumatului<br />

(35.3% vs 25%), a diabetului zaharat (0% vs 7.5%), a<br />

hipertensiunii arteriale (23.5% vs 37.5%), a dislipidemiei<br />

(76.5% vs 60%). In 2009, 17 femei nu s-au prezentat<br />

la reevaluare si nu s-au decelat diferente semnificative<br />

intre cele doua grupuri (cu si fara TSH) referitor la<br />

prevalenta obezitatii (72.7% vs 69%), a fumatului (9.1%<br />

vs 27.6%), a diabetului (0% vs 6.9%), a hipertensiunii<br />

(27.3% vs 48.3%), a dislipidemiei (72.7% vs 69%). Cu<br />

exceptia unei prevalente semnificativ mai crescute a<br />

obezitatii in 2009 vs 2008 (la ambele grupuri), nici un<br />

alt factor de risc nu a inregistrat modificari importante.<br />

Valorile medii ale moleculelor de adeziune in cele<br />

doua grupuri a fost urmatoarea: in grupul cu TSH pentru<br />

sICAM1 in 2008 372.87±144.45 vs in 2009 195.45±<br />

67.17 (p


POSTER II<br />

POSTER II<br />

diagnosticul pentru care se efectueaza coronarografia.<br />

Material si metode: In perioada octombrie 2009- aprilie<br />

2010 au fost selectati toti pacientii care au efectuat<br />

coronarografie. Au fost exclusi pacientii care au efectuat<br />

in antecedente cel putin o coronarografie. Au fost<br />

inclusi in studiu astfel 114 pacienti, cu varsta medie de<br />

60,4 ani, majoritatea fiind barbati (77,6%). Ca si factori<br />

de risc asociati au fost 80,2% hipertensivi, 82,8%<br />

dislipidemici, 65,7 fumatori sau fosti fumatori, 35,5%<br />

diabetici. Diagnosticul pentru care s-a efectuat coronarografie<br />

a fost: angina stabila la 24 pacienti, angina instabila<br />

la 30 pacienti, infarct miocardic acut fara supradenivelare<br />

segment ST la 15 pacienti, infarct miocardic<br />

acut cu supradenivelare segment ST la 45 pacienti.<br />

Rezultate: Din cei 114 pacienti, 56 (49,2%) au avut istoric<br />

de boala cardiaca ischemica, iar 58 (50,8%) pacienti<br />

se aflau la prima manifestarea din viata a bolii coronariene.<br />

18 pacienti (15,7%) nu au prezentat leziuni<br />

coronariene semnificative (stenoze peste 70% pe IVA,<br />

CX, CD sau stenoze peste 50% de trunchi comun), in<br />

timp ce 45 pacienti au fost unicoronarieni, 27 bicoronariene<br />

si 24 (21%) au prezentat leziuni tricoronariene<br />

semnificative angiografic. Daca luam in calcul atat<br />

leziuni semnificative, cat si cele nesemnificative angiografic,<br />

remarcam faptul ca toti pacientii au prezentat<br />

leziuni coronariene, iar majoritatea (68,4%) au fost tricoronarieni.<br />

De remarcat ca 41% dintre pacientii care<br />

se aflau la primul eveniment coronarian din viata, au<br />

prezentat afectare bi- sau tricoronariana semnificativa.<br />

Severitatea leziunilor coronariene s-a corelat semnificativ<br />

cu urmatorii factori de risc: varsta, istoricul de<br />

hipertensiune, antecedentele de boala cardiovasculara.<br />

In ceea ce priveste diagnosticul pentru care s-a efectuat<br />

coronarografie, severitatea leziunilor coronariene s-a<br />

corelat semnificativ doar cu angina stabila (RR 1,36) si<br />

instabila (RR 1,4), nu si cu infarctul miocardic.<br />

Concluzii: Afectare multicoronariana este frecventa la<br />

prima manifestarea din viata a bolii cardiace ischemice.<br />

Afectare multivasculara coronariana la prima indicatie<br />

de coronarografie este mai frecventa la cei cu angina<br />

stabila si instabila, fata de cei cu infarct miocardic acut.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

ronary angiography and correlation with risk factors<br />

and diagnosis for coronary angiography is performed.<br />

Material and methods: During October 2009 - April<br />

2010 all patients who made coronary angiography were<br />

selected. Were excluded patients who have history <strong>of</strong><br />

coronary angiography. Included in the study were 114<br />

patients, average age 60.4 years, the majority being<br />

men (77.6%). As risk factors were: hypertension 80.2%,<br />

82.8% dyslipidemia, 65.7% smokers or former smokers,<br />

35.5% diabetics. The diagnosis for coronary angiography<br />

is performed was: stable angina in 24 patients,<br />

unstable angina in 30 patients, myocardial infarction<br />

without ST segment elevation in 15 patients, myocardial<br />

infarction with ST segment elevation in 45 patients.<br />

Results: Of the 114 patients, 56 (49.2%) had a history <strong>of</strong><br />

ischemic heart disease and 58 (50.8%) patients were at<br />

the first manifestation <strong>of</strong> coronary disease. 18 patients<br />

(15.7%) showed no significant coronary lesions (stenosis<br />

over 70% LAD, CX, CD or stenosis over 50% <strong>of</strong><br />

left main), while 45 patients presents single-vessel coronary<br />

artery lesions and 24 patients (21 %) had significant<br />

three coronary artery lesions. If we consider both<br />

significant lesions, and the no significant lesions, note<br />

that all patients had coronary lesions and the majority<br />

(68.4%) had three coronary artery lesions. Note that<br />

41% <strong>of</strong> patients, who were at first coronary event in life,<br />

had two or three coronary artery significant lesions. Severity<br />

<strong>of</strong> coronary lesions was significantly correlated<br />

with the following risk factors: age, history <strong>of</strong> hypertension,<br />

history <strong>of</strong> cardiovascular disease. Regarding the<br />

diagnosis which was performed coronary angiography;<br />

severity <strong>of</strong> coronary lesions was significantly correlated<br />

only with stable angina (RR 1.36) and unstable angina<br />

(RR 1.4), not with myocardial infarction.<br />

Conclusions: Multi-coronary impairment is common<br />

at the first manifestation <strong>of</strong> ischemic heart disease.<br />

Multi-coronary impairment at first indication <strong>of</strong> coronary<br />

angiography is more common in patients with<br />

stable angina and unstable angina compared with acute<br />

myocardial infarction.<br />

Severity <strong>of</strong> coronary lesions in<br />

patients at the first indication<br />

<strong>of</strong> coronarography<br />

The main objective was to determine the severity <strong>of</strong><br />

coronary lesions in patients with first indication <strong>of</strong> co-


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

119. Endocardita infectioasa:<br />

epidemiologie, factori de risc si<br />

microbiologie<br />

A.Rusali, Marinela Serban, Otilia Banu, Loredana<br />

Benea, Carmen Ginghina<br />

Institutul de Urgenta pentru Boli Cardiovasculare “Pr<strong>of</strong>.<br />

Dr. C. C. Iliescu”, Bucuresti<br />

Introducere: In ciuda progreselor in medicina, incidenta<br />

endocarditei infectioase (EI) nu a scazut in ultimele<br />

decade. Acest paradox aparent este explicat de<br />

progresia factorilor de risc; in timp ce conditii predispozante<br />

ca de ex RAA au fost eradicate, au aparut noi<br />

factori de risc (administrarea de droguri iv., scleroza<br />

valvulara la pacientii in varsta, protezele valvulare,<br />

afectiunile nozocomiale).<br />

Scop: Scopul studiului este acela de a realiza un tablou<br />

actual al epidemiologiei, factorilor de risc si a speciilor<br />

bacteriene implicate in patologia endocarditei infectioase.<br />

Material si metoda: Este un studiu retrospectiv realizat<br />

pe un numar de 61 de pacienti cu endocardita infectioasa,<br />

internati in IBCV « Pr<strong>of</strong>. C.C. Iliescu » in anul<br />

2009.<br />

Rezultate: Din totalul pacientilor cu endocardita<br />

62,2% au fost barbati si 37,8% femei. Varsta medie a<br />

lotului de studiu a fost de 58,6 ani. 80,3% din totalul<br />

cazurilor au prezentat endocardita infectioasa pe valve<br />

native si numai 19,7% pe proteze. Majoritatea pacientilor<br />

(91,8%) au prezentat forma acuta. Stafilococul auriu<br />

a fost cel mai intalnit patogen (24,6%), iar endocardita<br />

cu culturi negative a fost deasemenea destul de frecventa<br />

(14,75%). Valvele cele mai afectate au fost mitrala<br />

(45,9%) si aortica (40,98%). Interventia chirurgicala de<br />

protezare valvulara s-a efectuat la 21,31% dintre pacientii<br />

studiati, iar mortalitatea intraspitaliceasca a fost<br />

de 6,5%.<br />

Concluzii: Stafilococul auriu este agentul patogen cel<br />

mai frecvent implicat in etiologia EI. Majoritatea cazurilor<br />

au fost pe valve native, cea mai frecvent afectata<br />

fiind valva mitrala. Mortalitatea intraspitaliceasca ramane<br />

relativ ridicata (6,5%).<br />

POSTER II<br />

POSTER II<br />

Infective endocarditis:<br />

epidemiology, risk factors and<br />

microbiology<br />

Introduction: Despite the medical progress, the incidence<br />

<strong>of</strong> infective endocarditis (IE) hasn’t decreased in<br />

the last decades. This paradox is explained by the risk<br />

factor’s evolution; while some predisposing conditions<br />

(eg, AAR) have been eradicated, new ones have appeared<br />

(IV. drugs, valvular sclerosis in the elderly, valvular<br />

prosthesis, nosocomial affections).<br />

Aim: The aim <strong>of</strong> our study is to create a perspective<br />

over the epidemiology, risk factors and patogens involved<br />

in the pathology <strong>of</strong> infective endocarditis.<br />

Material and method: It is a retrospective study on<br />

61 patients with infective endocarditis hospitalized in<br />

IBCV “Pr<strong>of</strong>. Dr. C.C. Iliescu” in 2009.<br />

Results: From the total <strong>of</strong> patients with infective endocarditis<br />

62.2% were male and 37.8% female. The mean<br />

age in the study lot was 58.6 years old. 80.3% from the<br />

total number <strong>of</strong> cases had infective endocarditis on native<br />

valves and only 19.7% on valvular prosthesis. The<br />

majority <strong>of</strong> patients (91.8%) had the acute form. Staphylococus<br />

aureus was the most frequent pathogen involved<br />

(24.6%), and endocarditis with negative hemocultures<br />

was also frequent (14.75%). The most affected<br />

valves were mitral (45.9%) and aortic (40.98%). Surgery<br />

for valvular prosthesis was performed in 21.31%<br />

<strong>of</strong> the cases and intrahospital mortality remained relatively<br />

high (6,5%).<br />

Conclusions: Staphylococus aureus is the most<br />

frequent pathogen involved in the etiology <strong>of</strong> infective<br />

enocarditis. The majority <strong>of</strong> the cases were on native<br />

valves, the most frequently affected being the mitral<br />

valve. Inhospital mortality is still relatively high (6.5%).


POSTER II<br />

POSTER II<br />

120. Asistarea circulatorie<br />

perioperatorie cu balonul de<br />

contrapulsatie intraaortic<br />

Arhire D., Arhire N., Patrut M., Cornea B., Ardeleanu<br />

C., Grosu C., Pop V., Rachita E., Manta O., Vasilescu<br />

R., Voinea C., Oclei E., Barbulescu V.<br />

Spitalul Clinic Judetean de Urgenta, Constanta<br />

Obiective: sindromul de debit cardiac scazut (SDCS) a<br />

fost definit ca nevoia de IABP postoperator sau suport<br />

inotropic mai lung de 30 de minute in unitatea de terapie<br />

intensiva, pentru a mentine presiunea sistolica > 90<br />

mmHg si un index cardiac >2,2l/min/m2.<br />

Obiectivul acestui studiu a fost de a arata eficienta utilizarii<br />

IABP in aceste cazuri.<br />

Metoda si rezultate: au fost studiati un numar de 704<br />

pacienti supusi operatiei pe cord sub CEC. Incidenta<br />

SDCS a fost de 11,8 % iar 6,2 % au necesitat utilizarea<br />

IABP.<br />

Concluzii: SDCS este asociat cu cresterea semnificativa<br />

a morbiditatii si mortalitatii, iar IABP a ajutat la imbunatatirea<br />

rezultatelor dupa operatiile pe cord sub CEC.<br />

Perioperatively circulatory<br />

assistance with IABP<br />

Objectives: low cardiac output syndrome was defined<br />

as the need <strong>of</strong> intraaortic balloon pump counterpulsation<br />

postoperatively or inotrop support longer than 30<br />

minutes, for maintaining a systolic blood pressure >90<br />

mmHg and a cardiac index >2,2 l/min/ m2.<br />

The objective <strong>of</strong> this study was to show the efficiency<br />

<strong>of</strong> intraaortic balloon pump counterpulsation in these<br />

cases.<br />

Method: the study is on 704 patients subjected to cardiac<br />

surgey with extracorporeal circulation.<br />

Results: The incidence <strong>of</strong> low cardiac output syndrome<br />

was 11,8% and 6,2% needed intraaortic balloon pump<br />

counterpulsation.<br />

Conclusions: low cardiac output syndrome is associated<br />

with high morbidity and mortality, and intraaortic<br />

balloon pump counterpulsation helped to improve results<br />

after cardiac surgery with extracorporeal circulation.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

121. Relatia fibrilatiei atriale cu<br />

sindromul de apnee in somn<br />

D.P.Petcu, O.Toni<br />

Centrul de Cardiologie, Craiova<br />

Introducere. Fibrilatia atriala se asociaza cu diverse<br />

afectiuni cardiac si extracardiace. Sindromul de apnee<br />

in somn poate contribuii la aparitia fibrilatiei atriale si<br />

la recurenta acesteia. Sindromul de apnee in somn se<br />

caracterizeaza prin obstructia cailor aeriene superioare<br />

determinat de colapsul cailor aeriene. In aceste conditii<br />

scade nivelul de oxigen in sange cu modificari din partea<br />

sistemului nervos simpatic.<br />

Scop: In aceasta lucrare am studiat asocierea fibrilatiei<br />

atriale sau a flutterului atrial cu sindromul de apnee in<br />

somn.<br />

Metoda: Studiul este prospectiv. Au fost luati in studiu<br />

28 de pacienti si sindrom de apnee in somn la care s-au<br />

efectuat polisomnografii, Holter ECG si ECG standard.<br />

Sindromul de apnee in somn a fost definit prin indexul<br />

tulburarilor respiratorii (RDI). Analiza statistica a<br />

aratat ca un RDI crescut a fost asociat cu o crestere a<br />

incidentei fibrilatiei atriale cu p=0,1 -


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

dard ECG.The sleeping apnea has been defined as in<br />

respiratory distress index.(RDI).The statistic review<br />

showed that an incresed RDI has been associated with<br />

an incress <strong>of</strong> the atrial fibrillation with p=0,1 -


POSTER II<br />

POSTER II<br />

123. Consideratii privind<br />

tromboza pr<strong>of</strong>unda din<br />

Sindromul Leiden<br />

Lucia Chetreanu, Danisia Haba, D.Zdrenghea<br />

CMI “Procardia”, Iasi; Universitatea de Medicina si<br />

Farmacie ”Grigore T. Popa“, Iasi; Universitatea de<br />

Medicina si Farmacie “Iuliu Hatieganu” Cluj Napoca<br />

Pacient V.A. in varsta de 24ani cunoscut cu antecedente<br />

personale patologice (APP) de: Tromb<strong>of</strong>lebita acuta<br />

la varsta de 13 ani, Sindrom posttromb<strong>of</strong>lebitic gamba<br />

stanga, romb<strong>of</strong>lebita pr<strong>of</strong>unda membru inferior stang<br />

la 14ani. Antecedente heredo colaterale (AHC) evidentiaza:<br />

Tata – embolie pulmonara (EP)repetata; tromb<strong>of</strong>lebita<br />

cronica memebre inferioare; boala varicoasa<br />

membre inferioare operata; Sindrom Leiden. Sora (mai<br />

mica) – tromboza artera femurala dreapta; tromboza<br />

artera ovariana dreapta; necroza ovar drept; anexectomie<br />

dreapta; Sindrom Leiden.<br />

Investigatiile clinice si paraclinice la momentul respectiv<br />

(14 ani): Ecografia Doppler vascular la nivelul<br />

membrelor inferioare (februarie 2002), examenul CT<br />

(computer tomografie) evidentiaza tromboza vena cava<br />

inferioara, vena iliaca, femurala si poplitee superficiala<br />

stanga. Evolutia bolii sub anticoagulante orale (cumarinice)<br />

satisfacatoare pana in 2009 iulie, cand repeta<br />

tromb<strong>of</strong>lebita la nivelul gambei stangi complicate cu<br />

tulburari tr<strong>of</strong>ice la nivelul ⅓ inferioare. CT vasculara<br />

(Angio CT) evidentiaza aghenezia sistemului circulator<br />

venos. Segmentul intrahepatic al VCI (vena cava<br />

inferioara) se decalibreaza brusc cu tromboza circumferintiala<br />

ce lasa un lumen restant de 4-8mm cu dimensuiune<br />

progresiva a acestuia la nivelul segmentului<br />

subhepatic al VCI, posterior de capul pancreasului are<br />

un Ø de 4,4mm ; vena renala dreapta 10mm la 2,7cm<br />

de varsarea in VCI. De notat lipsa vizualizarii semnelor<br />

suprahepatice. Vena mezenterica inferioara dilatata.<br />

Importanta circulatie colaterala superficiala predominant<br />

anterior si lateral stang abdominal si pelvin. Importanta<br />

circulatie pr<strong>of</strong>unda perirenala stanga in hilul<br />

splinei, mezenterica, perirectala, paravertebrala stanga.<br />

Lipsa vizualizarii zonelor iliace interne si externe bilateral<br />

. Masa de tesut moale de 1,2/1,6cm in loja timica –<br />

tesut timic restant. Datorita circulatiei venoase critice,<br />

pacientul a dezvoltat insuficienta cardiaca cronica clasa<br />

II NYHA. In prezent este sub tratament cu anticoagulante<br />

orale, antiagregante, vasodilatatoare periferice si<br />

β blocant cardioselectiv in doze mici, cu evolutie favorabila<br />

a starii de sanatate.<br />

Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

Considerations on deep venous<br />

thrombosis associated with the<br />

Leiden Syndrome<br />

The 24 year-old patient, named V.A., having the<br />

following personal pathological history (PPH): Acute<br />

thrombophlebitis at the age <strong>of</strong> 13, Post-thrombotic<br />

syndrome in the left shin, Deep thrombophlebitis in<br />

the left leg at the age <strong>of</strong> 14. As far as his hereditary collateral<br />

history (HCH) is concerned: Father: recurrent<br />

pulmonary embolism (PE); chronic thrombophlebitis<br />

affecting both legs; varicose veins affecting both legs,<br />

for which he underwent surgery; Leiden Syndrome.<br />

Younger sister: right thighbone artery thrombosis; right<br />

ovary artery thrombosis, right ovary necrosis; right<br />

ovariectomy; Leiden Syndrome. Clinical and paraclinical<br />

investigations at the age <strong>of</strong> 14; vascular lower limb<br />

Doppler scan (February 2002), CT scan reveals thrombosis,<br />

<strong>of</strong> the inferior vena cava, iliac vein, thighbone<br />

vein and left superficial popliteal vein. The disease<br />

treated with oral (coumarin based) anticoagulants has<br />

a satisfactory evolution until July 2009, when a left shin<br />

thrombophlebitis relapse occurs, complicated with<br />

trophic disorders in the lower ⅓ <strong>of</strong> the shin. The vascular<br />

computer tomography scan (Angio CT) reveals venous<br />

circulatory system agenesis. The intrahepatic section<br />

<strong>of</strong> the IVC (inferior vena cava) undergoes a sudden<br />

dacalibration and a circumference thrombosis leaving<br />

a 4-8mm lumen progressing towards the subhepatic<br />

section <strong>of</strong> the IVC, behind the pancreas head it has a<br />

4,4mm diameter; the right vena cava has a 10mm diameter<br />

2,7cm from its flowing in the IVC. Note the lack<br />

<strong>of</strong> view on the suprahepatic signs. Dilated inferior mesenteric<br />

vein. Important superficial collateral circulation<br />

especially in the left anterior and lateral area <strong>of</strong> the<br />

abdomen and pelvis. Important deep circulation in the<br />

left perirenal, mesenteric, perirectal and left paravertebral<br />

areas, as well as in the spleen hilus. Lack <strong>of</strong> view on<br />

the bilateral internal and external iliac areas. 1,2/1,6cm<br />

s<strong>of</strong>t tissue mass in the thymic bed - remaining thymic<br />

tissue. Due to a deficient venous circulation, the patient<br />

developed chronic class II NYHA heart failure. He<br />

is currently undergoing a treatment consisting <strong>of</strong> oral<br />

anticoagulants, antiagregant drugs, peripheral vasodilatators<br />

and cardioselective β- blockers in small doses.<br />

His health state evolution is currently favorable.


Revista Română de Cardiologie, Vol. XXV<br />

Suplimentul A, 2010<br />

124. Relatia dintre acidul uric<br />

seric si sindromul metabolic:<br />

diferentierea pe sexe si varsta<br />

la pacientii inclusi in siguranta<br />

circulatiei.<br />

F.Maghiar, Alina Iacobescu, Sorina Magheru,<br />

C.Magheru, M.Popescu<br />

Universitatea din Oradea<br />

Introducere: Sindromul metabolic si hiperuricemia<br />

sunt factori de risc important pentru bolile cardiovasculare.<br />

Cercetarile actuale privind relatia dintre valorile<br />

acidului uric seric si sindromul metabolic sunt relative<br />

putine in tara noastra. Acest studiu a fost efectuat pentru<br />

a explora evetualul potential al valorilor acidului<br />

uric seric ca marker al sindromului metabolic atat la<br />