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 />
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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 />
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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
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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
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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
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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 />