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  • Author: Cristian Stătescu x
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Abstract

Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.

Abstract

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.

Abstract

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.

Abstract

Objectives. This study aimed to examine peripheral artery disease severity impact on psychological profile of arteriopathy patients.

Material and methods. The prospective study included consecutive PAD patients admitted to the 2nd Department of Internal Medicine and the Department of Cardiology of the Emergency Clinical Hospital “Sf. Spiridon” Iasi, between January and September, 2017.

Rezults. The group included 139 PAD patients, 80.6% male and 19.4% female, with an average age of 63.23±9.44 years. PAD stages have a very strong association with level of quality of life (p<0.0001). All Leriche-Fontaine classification categories were significantly associated with the depressive symptoms (p<0.0001). The stress level was moderate in stages IIA, IIB and III and extremely severe in the terminal stage. The prevalence of anxiety was lowest in incipient PADstages with the highest value in stage III.

Conclusions. The fragment of the PhD study presented the psychological profile in the PAD staging and advocates a personalized, wide-ranging approach to the arteriopathy patient including pain and depressive-anxiety management, with amajor impact on the quality of life at terminal stages.