Cardiovascular and digestive diseases frequently share the same risk factors such as obesity, unhealthy diet, or several social behaviors, and the increasing prevalence of patients with overlapped cardiovascular and digestive symptoms is a challenging problem in the daily practice. Patients with gastro-esophageal reflux disease can exhibit various forms of chest pain that can be very similar to angina. Furthermore, antithrombotic therapies used for preventive or curative purposes in patients with cardiovascular diseases are frequently associated with gastrointestinal side effects including bleeding. At the same time, in patients with coronary stents presenting to the emergency department with chest pain, angina triggered by stent thrombosis or restenosis should be differentiated from angina-like symptoms caused by a gastrointestinal disease. The aim of this review was to present the complex inter-relation between gastroesophageal diseases and angina in patients on dual antiplatelet therapy following an acute coronary syndrome, with a particular emphasis on the role of anemia resulting from occult or manifest gastrointestinal bleeding, as a precipitating factor for triggering or aggravating angina.
Diana Opincariu, András Mester, Imre Benedek and István Benedek
Peripheral artery diseases include all arterial diseases with the exception of coronary and aortic involvement, more specifically diseases of the extracranial carotids, upper limb arteries, mesenteric and renal vessels, and last but not least, lower limb arteries. Mononuclear stem cells, harvested from various sites (bone marrow, peripheral blood, mesenchymal cells, adipose-derived stem cells) have been studied as a treatment option for alleviating symptoms in peripheral artery disease, as potential stimulators for therapeutic angiogenesis, thus improving vascularization of the ischemic tissue. The aim of this manuscript was to review current medical literature on a novel treatment method — cell therapy, in patients with various peripheral vascular diseases, including carotid, renal, mesenteric artery disease, thromboangiitis obliterans, as well as upper and lower limb artery disease.
András Mester, Diana Opincariu, Imre Benedek and István Benedek
Wound healing is a complex restorative process of the altered cutaneous tissue, which is impaired by numerous local and systemic factors, leading to chronic non-healing lesions with few efficient therapeutic options. Stem cells possess the capacity to differentiate into various types of cell lines. Furthermore, stem cells are able to secrete cytokines and growth factors, modulating inflammation and ultimately leading to angiogenesis, fibrogenesis, and epithelization. Because of their paracrine activity, these cells are able to attract other cell types to the base of the wound, improving the formation of new skin layers. Mesenchymal stem cells derived from the adipose tissue, bone marrow, and placenta, offer numerous ways of implementation. The process of harvesting, growing, and administrating stem cells depends on the site and type of the cells, but recent trial results showed improvement of wound healing independent of the administration site. Bioengineered skin substitutes are validated for treatment of chronic wounds with direct application on the skin surface. These offer physical scaffolding for the migrating cells and promote secretion of growth factors, thus facilitating rapid wound healing. Obtaining further clinical data is essential, but stem cell therapy may become a first-line therapeutic choice for the treatment of non-healing chronic wounds.
Beáta Jakó, Laura Jani, Diana Opincariu, András Mester, István Kovács and Monica Chițu
Aortic intramural haematoma (AIH) is a rarely recognized disease characterized by a sudden haemorrhage into aortic media in the absence of any intimal tear. The clinical evolution and mortality rates of AIH are similar to those of acute aortic dissection. However, in the acute clinical care of patients presenting with chest pain of aortic origin, it is important to differentiate intramural haematoma from aortic dissection. A case of an elderly patient with an intramural hematoma (IMH), which progressed to very large dimensions and involved the entire aortic wall, resulting in fatal complications is presented here.
Monica Chiţu, Nora Rat, Diana Opincariu, Alexandra Stănescu, András Mester, Theodora Benedek and Imre Benedek
Myocardial ischemia caused by coronary atherosclerosis is the main cause of cardiovascular mortality, which is the first cause of death in developed countries. Inducible myocardial ischemia is a negative prognostic factor for coronary artery disease patients, and it represents a major risk stratification marker for predicting mortality. The evolution of these patients depends largely on the extension of the ischemic myocardial mass and the severity of the inducible ischemia. Most patients do not show angiographically significant coronary stenosis. Therefore, such patients do not undergo coronary revascularization therapies, even though they present functional stenoses that trigger myocardial ischemia under stress conditions, which subsequently lead to a high risk for major adverse cardiovascular events. We performed a review that aims to pinpoint invasive techniques used for evaluating the functional impact of a coronary lesion that is considered non-significant upon angiographic examination, but which triggers episodes of myocardial ischemia under stress conditions, and to describe the functional markers that show the highest specificity for predicting ischemic risk, in order to recommend invasive coronary revascularization.
Diana Opincariu, András Mester, Mihaela Dobra, Nora Rat, Roxana Hodas and Mirabela Morariu
Introduction: The prognostic value of epicardial fat thickness (EFT) and inflammatory biomarkers such as hs-CRP have not been fully investigated in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM). The study aim was to assess the correlation between the EFT, the persistence of elevated circulating levels of hs-CRP at 7 ± 2 days after an AMI and the amplitude of the left ventricular (LV) remodeling, in patients with type 2 DM. Methods: The study included 98 patients (45 with type 2 DM and 43 with no DM): Group 1 included 22 low-to-intermediate risk patients (hsCRP <3 mg/l) and Group 2 had 23 high-risk, (hsCRP >3 mg/l) patients. EFT, LV function and remodeling were assessed at baseline and at six months after AMI in both groups. Results: In the diabetic population, the EFT was significantly higher in patients who developed ventricular remodeling as compared with those who did not (8.02 ± 1.80 mm vs. 6.65 ± 2.17 mm, p = 0.02) and significantly correlated with the circulating levels of hs-CRP (r = 0.6251, p <0.0001). The levels of circulating hs-CRP, at baseline, significantly correlated with the RI at six months (r = 0.39, p <0.001). Also, in the diabetic population, the epicardial fat thickness was significantly higher in patients who developed ventricular remodeling as compared with those who did not (8.02 ± 1.80 mm vs. 6.65 ± 2.17 mm, p = 0.02). The epicardial adipose tissue thickness significantly correlated with the circulating levels of hs-CRP (r = 0.6251, p <0.0001), while in the non-diabetic population, EFT was not significantly higher in patients who developed ventricular remodeling as compared with those who did not (71.38 ± 9.09 vs. 67.4 ± 10.17, p = 0.23). Multivariate analysis identified the hs-CRP values (OR: 4.09, p = 0.03) and the EFT (OR: 6.11, p = 0.01) as significant independent predictors for LV remodeling in diabetic population. Conclusions: A larger EFT is associated with a more severe remodeling and impairment of ventricular function in patients with type 2 DM and AMI.