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Beáta Jakó and János Sinkó

Abstract

This is a case report of a 36-year-old male who was diagnosed with acute inferior and right ventricular myocardial infarction and treated with percutaneous coronary angioplasty with a drug-eluting stent in the right coronary artery. A profile test for thrombophilia was performed for methylene tetrahydrofolate reductase (MTHFR) gene mutation; the test was positive for a heterozygous mutation - C677C and 1298A. The patient received a long-term treatment with folic acid supplements, taken daily. This case report shows that medical doctors should have an outside-the-box approach for the diagnosis and therapeutic management of young patients who present with acute cardiovascular events. If the patient in question does not present clear cardiovascular risk factors for acute myocardial ischemia, the clinician should seek for possible causes, thus leading to several benefits in the management and secondary prevention of such cases.

Open access

Suciu Zsuzsanna, Benedek Theodora, Jakó Beáta and Benedek I

Abstract

Introduction: 64 multislice CT angiography is a recently introduced imaging technique, increasingly being used as a tool to show the coronary arteries in three-dimensional visualization. One of the advantages of this method is the ability to estimate the degree of calcification of atheromatous plaques via coronary calcium score calculation, which correlates with the severity score of ateromatous systemic burden. The aim of this study was to evaluate the relationship between the severity of coronary calcification, expressed by calcium score, and the left ventricular ejection fraction (LVEF). Material and methods: This retrospective study included 81 patients with symptoms of angina and ECG modifications (at rest or during exercise). Echocardiography and 64 multislice CT angiography were performed in all patients to assess the LVEF and Ca scoring. Results: Calcium score was lower than 100 in 62 patients (50.22%), between 100 and 400 in 11 patients (8.91%), and higher than 400 in 8 patients (6.48%). Mean LVEF was 53.52%, 17 patients having an LVEF of less than 50%. In patients with calcium score less than 100, the corresponding ejection fraction was normal: 55.29%, while in coronary arteries with extensive calcifications (calcium score > 400), the LVEF was significantly lower, 50.5% (p = 0.004). Conclusions: High Calcium score is positively correlated with LVEF reduction, and a high value for calcium score indicates an increased probability of reduced left ventricular ejection fraction

Open access

Suciu Zsuzsanna, Jakó Beáta, Benedek Theodora and Benedek I

Abstract

Background: Coronary arteriovenous malformation is a rare congenital disease consisting mainly in a direct communication between a coronary artery and any one of the four cardiac chambers, coronary sinus, pulmonary arteries or veins. This disease can lead to various cardiovascular events, their severity depending on the degree of the malformation. Case report: We present the case of a 56-year-old male patient, who was admitted to our institution with dyspnea, palpitation and chest pain, having a history of hypertension and hyperlipidemia, and an abnormal electrocardiogram. Physical examination did not reveal any alterations and the cardiac enzymes were in normal ranges. Cardiac computed tomography was performed before any other invasive studies, with a 64-row scanner (Somatom Sensation multislice 64 equipment, Siemens) after intravenous administration of non-ionic contrast material. CT scan revealed a large (2-2.5 mm) coronary fistula originating from the LAD to the main pulmonary artery, and multiple significant atherosclerotic coronary lesions. Coronary angiography confirmed the arteriovenous malformation between LAD and pulmonary artery, associated with three vascular coronary artery disease. Conclusions: Cardiac computed tomography angiography can help for a non-invasive diagnosis of the coronary artery malformations, in the same time revealing anatomic details which can be particulary useful for choosing the appropriate management strategy (surgical planning, interventional treatment or optimum medical treatment)

Open access

Jakó Beáta, Benedek Theodora, Suciu Zsuzsanna and Benedek I

Abstract

Introduction: Coronary calcium score, as determined by Angio CT multislice, has been proved to represent a reliable parameter which reflects the global cardiovascular risk. We aimed to study the characteristics of culprit lesions in Acute Coronary Syndrome (ACS) patients with low versus high calcium score. Material and methods: A total of 45 patients with ACS underwent 64-slice CCTA. Group 1 - 19 patients with Ca score below 400HU, Group 2 - 26 patients with calcium score >400HU. In all patients a complex CT analysis of the culprit plaque was performed. Results: There were no significant differences between the groups at baseline as regard to age, gender, cardiovascular risk factors (p>0.2). In patients with high calcium score, culprit lesions presented a significantly larger amount of plaque burden than in patients with low calcium score (82.8ml versus 131.81ml, p <0.0001). This was also true when assessing in a subanalysis different cut-off points for definition of relatively higher calcium score (89.66ml versus 137.93ml, p <0.0001, for calcium score cut off 600HU, 97.88ml versus 137.57ml, p<0.0001 for calcium score cut-off of 1000HU). Conclusion: Our data shows that patients with high calcium score who develop an acute coronary syndrome present larger atheromatous plaque than those with low calcium scores, and theseverity of the culprit lesions correlates with global cardiovascular risk as expressed by a high calcium score

Open access

Jakó Beáta, Benedek Theodora, Suciu Zsuzsanna and Benedek I

Abstract

Introduction: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event. Material and methods: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed. Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r = 0.85. p = 0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p <0.0001 for left anterior descending artery, 111.09 ml vs 82.5 ml, p = 0.0005 for circumflex artery, and 132.78 ml vs 76.23 ml for right coronary artery). Conclusion: Our data shows that in ACS, the severity of the culprit lesions correlates with regional accumulation of calcium within the vessel wall.

Open access

Theodora Benedek, Beata Jako, Zsuzsa Suciu and Imre Benedek

Abstract

Introduction: We aimed to assess the relationships between the persistence of elevated circulating levels of hs-CRP, a powerful inflammatory marker, determined at 30 days after an acute myocardial infarction (AMI), and the characteristics of the pre-existing coronary lesions. Material and methods: The study included 83 consecutive patients 30 days post AMI, who were subjected to coronary angiography and primary PCI. The patients were divided into two groups according to their hsCRP levels at 30 days after AMI: group 1 included 35 low-risk patients, with hsCRP levels <2 mg/l, and group 2 included 48 high-risk patients, with hsCRP levels >2 mg/l. Results: Angiographic analysis revealed the presence of a multivascular disease in 48.5% of the patients in group 1 versus 72.9% of the patients in group 2 (p=0.037). The Syntax scores for groups 1 and 2 were 22.2 +/- 6.6 and 27.07+/-0.94, respectively (p=0.001), and these values were significantly correlated with the hsCRP values (r=0.56, p<0.0001). LAD culprit lesions were found in 47.9% of the patients in group 1 and 20% of the patients in group 2 (p=0.01), and 42.8% of the group 1 patients and 83.3% of the group 2 patients had at least one significant stenosis in the LAD (p=0.0002). The ejection fraction at 30 days was significantly lower in the patients with elevated levels of hsCRP (52.91+/-4.03 vs 49.04+/-5.74, p=0.001), showing an inverse correlation with hsCRP levels (r=-0.52, p<0.0001). Conclusions: A more severe coronary artery disease was associated with am increased inflammatory status in the postinfarction phase, as evidenced by the high levels of circulating hsCRP. hsCRP can help for risk stratification in post AMI patients by identifying the subsets of patients who are at risk based on persistent elevated circulating levels of hsCRP at 30 days after infarction.

Open access

Kinga Pal, Nora Rat, Beata Jako, B. Bajka and I. Benedek

Abstract

Aortic intramural hematoma frequently appear in elderly hypertensive patients who suffered a vasa vasorum rupture into the media, presenting clinical symptoms similar to aortic dissection. The current available data suggest a similar treatment strategy as in aortic dissection, although intramural hematoma is a different pathophysiological entity. The issue of the vulnerable contact of the intraaortic plaque, which is prone to rupture and to trigger the formation of an intramural hematoma, has not been elucidated so far. We present a brief literature review regarding complex plaque analysis, which opens a new area in identification of vulnerable patients with intramural hematoma, important for management of these patients and optimization of their treatment in order to avoid complications.

Open access

Marius Orzan, Beata Jako, Ciprian Blendea, Annabell Benedek, Balazs Bajka and Imre Benedek

Abstract

Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.

Material and Method: We evaluated retrospectively 30 patients with angina and coronary luminal narrowing, who underwent 64-slice Coronary Computed Tomography Angiography. We measured the stenosis degree, intraluminal contrast density (Hounsfield units [HU]) at two levels, proximal and distal to stenosis, and the attenuation gradient was calculated on this basis.

Results: The average contrast density was 77,96 UH proximal to the stenosis and 67,6 UH distal to the stenosis. The average transluminal gradient was 10,36. The average length of the coronary lesions was 16,93 mm. In those lesions with significant stenosis, expressed by >70% luminal narrowing, we recorded a significantly higher transluminal attenuation gradient as compared to those with <70% luminal narrowing (6.16 +/−3.7, 95%CI 4.3-80 vs 16.6 +/− 8.4, 95% CI 11.3 – 21.9). The degree of luminal narrowing significantly correlated with the contrast attenuation gradient (r=0.71, p<0.001).

Conclusions: The assessment of intraluminal contrast density by Coronary Computed Tomography Angiography may represent a new noninvasive tool to obtain relevant information about the clinical significance of a coronary stenosis. Larger studies are requested to emphasize the benefits brought by CCTA in evaluating coronary lesions.

Open access

Zsuzsanna Suciu, Alexandra Stănescu and Beáta Jakó

Open access

Balázs Bajka, Marius Orzan, Beáta Jakó and István Kovács

Abstract

Introduction: The aim of the study was to assess the differences in critical network times and mortality in STEMI patients presenting to hospitals in the same STEMI network, but located at different distances from the pPCI center.

Methods: Four-hundreed sixteen patients with STEMI were studied. Group 1: 101 patients presenting to any of the six regional hospitals in the network located at less than 70 km from the pPCI center, with a maximum transport time of 30 minutes. Group 2: 81 patients presenting to any of the three territorial hospitals in the network located at 70–150 km from the pPCI center, with a transport time between 30 and 70 minutes. Group 3: 93 patients presenting to any of the four territorial hospitals in the network located at 150–250 km from the pPCI center, with a transport time between 70 and 150 minutes. Group 4: 141 patients presenting directly to the emergency room of the pPCI center. The following time intervals were recorded: presentation time (PT), from the onset of symptoms to arrival at the pPCI center; protocol initiation time (PIT), from arrival at the pPCI center to STEMI protocol initiation; ischemic time (IT), from the onset of symptoms to repermeabilisation; door to balloon time (DTB), from arrival in the pPCI center to balloon.

Results: PT showed no significant difference between the groups – 183.08 ± 25.2 minutes vs. 199.1 ± 32.4 minutes vs. 166.7 ± 42.5 minutes vs. 161.91 ± 36.8 minutes, respectively (p=0.4). PIT was significantly lower in Group 3 (61.66 ± 15.4 minutes in Group 3 vs. 92 ± 11.5 minutes in Group 2 vs. 107.4 ± 12.5 minutes in Group 1, p = 0.002). DTB time was significantly longer for patients presenting directly to the pPCI center compared to those arriving from Zone 1, 2 or 3 hospitals, 86.96 ± 11.6 minutes vs. 52.27 ± 11.2 minutes vs. 39.94 ± 10.3 minutes vs. 43.9 ± 5.3 minutes, p <0.001). Despite the differences in distance to the pPCI center, there was no significant difference in total IT between the groups (Group 1, 344.6 ± 53.4 minutes; Group 2, 369.3 ± 42.6 minutes; Group 3, 366.65 ± 36.4 minutes; and 340.2 ± 26.9 minutes in the pPCIcenter, p = 0.2), and this was reflected in similar rates of mortality (Group 1, 3.9%; Group 2, 3.7%; Group 3, 3.2%; and 3.5% in the pPCI center).

Conclusion: A well organized STEMI network can shorten protocol initiation and DTB times, achieving similar ischemic times and resulting in similar mortality rates with the centers located closer to the pPCI center. Early activation of the STEMI protocol could lead to superior results even in areas situated at longer distances from the pPCI center.