Ovidiu Mitu, Florin Mitu, Maria-Magdalena Leon, Mihai Roca, Andreea Gherasim and Mariana Graur
Background and Aims. Risk score questionnaires for the screening of type 2 diabetes mellitus (DM) present high accuracy, especially the Finnish Diabetes Risk Score (FINDRISC). The aim of the study was to assess the FINDRISC score and its correlations with multiple markers of subclinical atherosclerosis in an asymptomatic urban population.
Material and Methods. In the current prospective study, 111 randomized asymptomatic subjects, aged 35-75, were evaluated. FINDRISC score, the cardiovascular and metabolic risk profile were evaluated. Multiple markers of subclinical atherosclerosis were assessed including carotid intima-media thickness (IMT), ankle-brachial index (ABI), pulse wave velocity (PWV) and left ventricular mass index (LVMI).
Results. Mean age was 51.87 ± 10.64 years while FINDRISC score was 10.53 ± 4.53. 77% of the subjects were overweight and all parameters of obesity were well associated with FINDRISC score (p<0.001). This asymptomatic population was dyslipidemic (total cholesterol 212.79±44.99 mg/dl). DM risk correlated with age, blood pressure, fasting plasma glucose and glomerular filtration rate. Increased FINDRISC was associated with IMT (r=0.24, p=0.01), PWV (r=0.26, p=0.008) or LVMI (r=0.23, p=0.01).
Conclusions. This asymptomatic population was metabolically uncontrolled. Easily administered type 2 DM screening questionnaires should be routinely performed as increased risk score values are associated with subclinical atherosclerosis.
Cristina Adam, Magda Mitu, Dana Mîndru, Ana-Karina Gîlcă, Mihai Roca and Florin Mitu
Introduction. Ischemic heart disease is the leading cause of death with increasing prevalence. Acute myocardial infarction is a consequence of prolonged acute myocardial ischemia, which appears secondary to an imbalance between oxygen consumption and intake at this level.
Case report. We present the case of a male patient, aged 53 years old, admitted in the Cardiovascular Recovery Clinic for moderate dyspnea, intermittent dizziness and muscle pain predominantly in the lower limbs. Regarding his medical history, he suffered an antero-lateral myocardial infarction due to excessive physical effort, which was trombolysed. Following the remission of the acute episode, the evolution over the next 6-12 months was towards heart failure clinically manifested by dyspnea. Considering the presence of heart failure associated with severely diminished ejection fraction, the medication is adjusted and Sacubitril/Valsartan is introduced at a dose of 49/51 mg twice a day, under which our patient presents with both clinical and echocardiography improvement. Cardio-pulmonary stress testing is the most accurate as it provides the best information regarding functional capabilities, beyond the ejection fraction of the left ventricle. Following the treatment with RNAi (angiotensin receptor-neprilysin inhibitor), the parameters evaluated during the stress test were improved, which is clinically transposed by improving the quality of life and implicitly the long-term prognosis.
Conclusion. The particularity of this case consists in the occurrence of myocardial infarction at a young age (36 years) in a patient without a heredocolateral history or associated risk factors at that time. The association of ARNI (Sacubitril / Valsartan) in the therapeutic scheme has determined a clinical improvement, as well as paraclinical especially regarding the echocardiographic parameters (the ejection fraction increased from 25% to 40% at the end of the evaluation).
Florin Mitu, Alexandra Maștaleru, Clementina Cojocaru, Mihai Roca, Ovidiu Mitu and Maria-Magdalena Leon-Constantin
Catecholamine tumoral syndrome is caused by lesions of the medulosuprarenal cromafin tissue (pheochromocytoma or pheochromocytoblastoma) or of the neural crest (paraganglioma), from the ganglionar cells (ganglioneurinoma or ganglioneuroblastoma) or from the sympathetic nervous cells (sympathogonia – sympathoblastoma and sympathoblasts – neuroblastoma), tumors that excessively secrete cathecolamines (adrenaline and noradrenaline), but also neuropeptides. Indications for testing are associated with the clinical context. Because the pheochromocytoma means a heterogeneous group of secretory tumours, there is no analysis achieving the 100% accuracy. The diagnosis can be established by hormonal dosages for basal determinations and by dynamic tests or through nonspecific tests. Imagistic explorations like computer tomography, abdominal and pelvic MRI can localise the tumour. Plasma and urinary metanephrines dosage are the first intention tests because have a higher accuracy compared to catecholamines or other metabolites. Considering the low prevalence of catecholamine secreting tumours, we considered it necessary to systematise diagnostic possibilities.
Cristina Adam, Magda Mitu, Dana Mîndru, Ana-Karina Gîlcă, Radu Sebastian Gavril, Mihai Roca and Florin Mitu
Introduction: Going through a complete cardiac rehabilitation is essential for all cardiac patients undergoing complex surgery, including those who wear intracardiac devices. Determining the effort capacity after the surgical intervention might provide satisfactory results with the improvement of the quality of life.
Case presentation: We present the case of a male patient, 44 years old, known with aortic bicuspid valve, aortic mechanical valve evolved with prosthesis mismatch and aortocoronary bypass (right coronary artery), followed by total atrioventricular block which required cardiac pacemaker VVI, who is admitted in the Cardiovascular Rehabilitation Clinic to continue the second phase of the rehabilitation program. The ergospirometry test (which was performed in order to evaluate the impairment of the effort capacity) showed a moderate-severe decrease of effort capacity (42% of maximal oxygen consumption, class C Weber), effort hypotension and chronotropic incompetence which led to pausing cardiopulmonary test before anaerobic threshold. Stepper exercise or climbing stairs did not cause the lowering of blood pressure and heart rate, which led to the idea of controlling and adjusting the stimulation parameters. Within cardiopulmonary testing in patients with pacemaker special regards should be paid towards: parameters assessment during effort (heart rate during the test in pacemakers without adaptation to exercise, heart rate during the test in pacemakers with adaptation to exercise, evaluation of the effort response in patients undergoing resynchronization therapy) and diagnosis of exercise-induced arrhythmia (atrial fibrillation, ventricular extrasystoles, ventricular tachycardia, as well as identification of arrhythmias in patients with implantable cardioverter defibrillator).
Conclusion: The cardiopulmonary stress test in patients with cardiostimulation should respect certain conditions in conducting the test in order to obtain realistic results of functional capacity. Due to the position of the piezoelectric crystal and the immobilization of the limbs during the cycle ergometer test it is recommended testing using the treadmill.
Manta Andrei, Maștaleru Alexandra, Oancea Andra, Anghel Razvan Constantin, Roca Mihai, Leon-Constantin Maria Magdalena and Mitu Florin
Obesity, a component of the metabolic syndrome, is a rising public health problem, continuously increasing in the European countries. The therapeutic success of the patient with metabolic syndrome requires a multidisciplinary approach to lifestyle changes, weight loss, continuous and dynamic dietary improvement, sedentary reduction, normalization of blood pressure, glycemia and lipid parameters. We performed a retrospective study that was conducted in the Clinical Rehabilitation Hospital in Iasi, with 4627 patients that were admitted in the Cardiovascular Rehabilitation Clinic from January 2011 to December 2015 with the diagnosis of metabolic syndrome according to WHO definition (Group 1) or with other comorbidities (Group 2). In the first group were included 1064 patients diagnosed with metabolic syndrome. This group has predominantly smoking female patients. Also, in group 1 were diagnosed more patients with left ventricular hypertrophy and coronary heart disease compared to group 2. Most of the patients with inflammatory syndrome were included in the group without metabolic syndrome (group 2). The results of our study confirm that metabolic syndrome is a cluster of abnormalities whose evolution determines the development of coronary heart disease. All this would advocate for treating metabolic syndrome as the primary method of preventing cardiovascular disease.
Cristian Baicus, Paul Balanescu, Adriana Gurghean, Camelia Georgeta Badea, Vlad Padureanu, Ciprian Rezus, Florin Mitu, Ruxandra Jurcut, Andra Rodica Balanescu, Ioana Daha, Eugenia Balanescu, Mihai Bojinca, Larisa Pinte, Alexandru Marian Constantin, Nicoleta Dima, Mariana Floria, Maria Magdalena Leon-Constantin, Mihai Roca, Magda Mitu, Silvia Chiriac, Codruta Minerva Badescu, Simona Daniela Ionescu, Elena Mitrea, Gabriel Rosu, Georgeta Daniela Ionescu, Ana Maria Visinescu, Gabriela Mihailescu, Rozalina Lapadatu, Emilia Oprisan, Stefan Zeh, Isabelle Scholl and Martin Härter
Background. Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients’ point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9.
Material and methods. A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9.
Results. Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading.
Conclusion. SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.