Introduction: Cardiovascular disease is the leading cause of death among women irrespective of race or ethnicity, and about half of these deaths are caused by coronary artery disease. Several studies have reported that cardiovascular diseases manifest themself with a delay of about 7–10 years in women and that they have higher in-hospital mortality. It has not yet been established whether female gender itself, through biological and sociocultural differences, represents a risk factor for early in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI). The aim of our study was to identify the angiographic particularities in women with STEMI from North East Romania.
Material and Methods: For one year, 207 (31.7%) women and 445 (68.3%) men diagnosed with acute myocardial infarction were hospitalized in the Cardiology Clinic of the “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases in Iași, Romania.
Results: The highest incidence of symptom onset was between 6:00 a.m. and 12:00 a.m., this morning polarization being more obvious in women. Within the first two hours of admission to the hospital, coronary angiography was performed in 78.1% of men and only 67.3% of women, the difference being statistically significant (p <0.05). We found that a large number of women had multivascular coronary disease (47.9% vs. 42.3%). At the same time, we found that left main disease and multivascular disease were more frequent in women than in men (3.8% vs. 0.7%, p = 0.001 for left main plus two-vessel disease, and 19.4% vs. 14.8%, p = 0.0005 for three-vessel disease).
Conclusions: In women, coronary events began more frequently in the morning, with atypical symptoms; also, fewer women presented to the hospital within the first 12 hours after the onset of the acute event. Compared to men, women from North East Romania present a higher incidence of multivascular atherosclerotic coronary lessions, indicating a higher severity of STEMI in the female population from this geographical area.
Objectives. Cardiovascular risk assessment is continuously improving due to a better understanding of the atherosclerotic pathomechanism by investigating new risk factors. Microalbuminuria is known as a predictor of renal, as well as cardiovascular morbidity and mortality in patients with hypertension. The aim of this study was to determine the clinical relevance of microalbuminuria and its relationship with traditional cardiovascular risk factors in hypertensive high-risk patients with established coronary artery disease. Methods. We have collected clinical and laboratory data from 94 hypertensive patients (currently treated or newly diagnosed) with known coronary artery disease (angiographically documented) admitted in the Institute of Cardiovascular Diseases. From January 2012 to April 2013 they were screened for microalbuminuria. For the diagnosis of microalbuminuria, a first-morning urine sample was analyzed by immunoturbidimetry (MAU range: 20-200 mg/l, the microalbuminuric group). Patients with urinary albumin excretion >200 mg/l were excluded. Patients with values <20 mg/l were considered the normoalbuminuric group. Results. A large percentage (53.2%) of the study group was found with microalbuminuria. Patients with microalbuminuria were older, mostly male, with a longer duration of hypertension, and with a higher prevalence of left ventricular hypertrophy (LVH). None of the traditional cardiovascular risk factors - age, male gender, obesity, smoking, diabetes mellitus, dyslipidemia - indicated a statistical significance in relation with MAU. Although left ventricular ejection fraction (LVEF) didn't influence the level of microalbuminuria, a strong correlation was achieved with the presence of LVH (p=0.005) and duration of hypertension (p=0.046). Conclusion. Hypertensive high-risk patients should be routinely screened for microalbuminuria and when confirmed they may need a more aggressive medical therapy to lower the cardiovascular risk.
Introduction: Cardiac arrhythmias caused by electrical injuries are rare among emergency service admittances. We present a case of ventricular fibrillation (VF) with a rare etiology, confirmed by speckle-tracking imaging.
Case presentation: A 38-year-old man was addressed to our hospital to evaluate the etiology of an episode of VF, promptly resuscitated in a territorial hospital. On admission, his 12-lead electrocardiogram revealed a sinus rhythm, without any ST-T changes or atrioventricular conduction disorders. Transthoracic echocardiography and coronary angiography were normal, and the electrophysiological study did not induce VF. Anamnesis showed that the arrhythmia occurred after an electrical injury, resulting from the contact with a domestic low-voltage source. Speckle-tracking imaging revealed closure of the electric arc within the heart, which could explain the absence of skin-burn injuries in this case. The patient was discharged after seven days of hospitalization, without any complication.
Conclusions: VF can occur after an unexpected electrical shock during a household accident. This case report underlines the need for a complex interdisciplinary approach in such difficult cases, when the absence of any electrical injuries on the skin makes it difficult to recognize the electrical shock that triggered the ventricular fibrillation.
Background: In just a few years, cardiac resynchronization therapy (CRT) has emerged as a key player in the treatment of advanced heart failure (HF). However, approximately 30% of patients with CRT device implantation do not achieve a favorable response. The purpose of the present study was to identify clinical, electrocardiographic, and echocardiographic predictors of a positive response to biventricular pacing in patients with advanced decompensated HF.
Methods: This prospective, observational study involved 42 consecutive patients admitted in emergency settings in our clinic with HF in New York Heart Association (NYHA) functional class III/IV, with QRS duration ≥120 ms and left ventricle ejection fraction (LVEF) ≤35%, who underwent cardiac resynchronization therapy (CRT-P or CRT-D) between January 2010 and July 2014. Statistical analysis was performed using IBM SPSS statistical software.
Results: The clinical response (improvement in NYHA class) was recorded in 6 patients (14.3%), while echocardiographic response (change in ejection fraction and/or in endsystolic or end-diastolic volumes) was recorded in 10 patients (23.8%). The most frequently observed type of response to CRT was the double (clinical plus echocardiographic) response, recorded in 23 out of 42 patients (54.8%). ROC analysis identified the absence of chronic renal disease and the duration from onset of symptoms to CRT implantation as good predictors for clinical improvement after CRT (AUC = 0.625, 95% CI: 0.400–0.850 for absence of renal failure and AUC = 0.516, 95% CI: 0.369–0.853 for symptoms duration). However, gender, age, duration from symptom onset, and comorbidities were not good predictors for the echocardiographic response (AUC <0.600).
Conclusions: CRT represents an important therapeutic option for selected patents with advanced decompensated HF and prolonged QRS interval; however, only some of the commonly used criteria can predict a favorable outcome in patients undergoing CRT.
Introduction. Hypertrophic cardiomyopathy (HCM) is a disease with increased left ventricular (LV) wall thickness not solely explained by abnormal loading conditions, with great heterogeneity regarding clinical expression and prognosis. The aim of the present study was to collect data on HCM patients from different centres across the country, in order to assess the general characteristics and therapeutic choices in this population.
Methods. Between December 2014 and April 2017, 210 patients from 11 Romanian Cardiology centres were enrolled in the National Registry of HCM. All patients had to fulfil the diagnosis criteria for HCM according to the European Society of Cardiology guidelines. Clinical, electrocardiographic, imaging and therapeutic characteristics were included in a predesigned online file.
Results. Median age at enrolment was 55 ± 15 years with male predominance (60%). 43.6% of the patients had obstructive HCM, 50% non-obstructive HCM, while 6.4% had an apical pattern. Maximal wall thickness was 20.3 ± 4.8 mm (limits 15-37 mm) while LV ejection fraction was 60 ± 8%. Heart failure symptoms dominated the clinical picture, mainly NYHA functional class II (51.4%). Most frequent arrhythmias were atrial fibrillation (28.1%) and non-sustained ventricular tachycardia (19.9%). Mean sudden cardiac death risk score (SCD-RS) was 3.0 ± 2.3%, with 10.4% of the patients with high risk of SCD. However, only 5.7% received an ICD. Patients were mainly treated with beta-blockers (72.9%), diuretics (28.1%) and oral anticoagulants (28.6%). Invasive treatment of LVOT obstruction was performed in a small number of patients: 22 received myomectomy and 13 septal ablation. Cardiac magnetic resonance was reported in only 14 patients (6.6%).
Conclusions. The Romanian registry of HCM illustrates patient characteristics at a national level as well as the gaps in management which need improvement – accessibility to high-end diagnostic tests and invasive methods of treatment.