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Open access

Daniel Cernica, Roxana Hodas, Elisabeta Himcinschi, Elena Beganu and Theodora Benedek

Abstract

Computed tomography (CT) in cardiac examination is a powerful imaging tool that has developed rapidly during the last decade and continues to increase its potential by bringing novel technologies. Due to its noninvasive character, cardiac CT became a largely used method in detecting coronary diseases or functional issues at the expense of conventional coronary angiography. The accuracy of images has also increased, especially since new generation dual-source multi-slice detectors were developed. Although there are continuous improvements that serve to gain better-quality images, thus increasing their diagnostic accuracy, there is an inconvenient that became a serious topic for debate in the current literature: exposure to higher doses of radiation during cardiac CT examinations. Fortunately, physicians and manufacturers are taking into consideration the need to apply new strategies for radiation dose-reduction. Thus, this objective can be achieved by using patient-tailored dose-reduction strategies and by modulating the technical features of the CT scanners in order to gather high-quality images with minimal radiation exposure. The aim of this manuscript was to review the current literature data on dose-reduction strategies that are used for cardiovascular computed tomography scans.

Open access

Theodora Benedek and Roxana Hodas

Open access

Laura Jani, Roxana Hodas, Elena Beganu and Lehel Bordi

Abstract

Coronary artery malformations are rare congenital abnormalities, which present non-specific symptoms such as atypical chest pain, malignant arrhythmia, or sudden cardiac death. The proper diagnosis of these abnormalities in emergency conditions can be very difficult, and noninvasive imaging techniques, such as computed tomography or magnetic resonance imaging, along with the gold standard represented by invasive coronary angiography, remain the most frequently used modalities for diagnosing these rare cases. We present four cases of coronary anomalies represented by an abnormal origin of the coronary arteries from the coronary ostium, presenting in emergency conditions with symptoms of acute myocardial infarction, which were diagnosed by urgent angiography.

Open access

Ioana Rodean, Elena Beganu, Roxana Hodas, Elisabeta Himcinschi, Lehel Bordi and Theodora Benedek

Abstract

For a better assessment of ischemic heart diseases, myocardial viability should be quantified. Current studies underline the importance and the evolution of several techniques and methods used in the evaluation of myocardial viability. Taking into account these considerations, the aim of this manuscript was to present the recent points of view regarding myocardial viability and its clinical significance in patients with ischemic cardiomyopathies and left ventricular dysfunction. On the other hand, the manuscript points out the role of magnetic resonance imaging (MRI), one of the most useful noninvasive imaging techniques, in the assessment of myocardial viability. By comparing the advantages and disadvantages of cardiac MRI, its usefulness can be better appreciated by the clinician. In the following years, it is considered that MRI will be an indispensable imaging tool in the assessment of ischemic heart disease, guiding interventions for revascularization and long-term risk stratification in patients with stable angina or myocardial infarction.

Open access

Ioana Rodean, Elisabeta Himcinschi, Daniel Cernica, Roxana Hodas, Elena Beganu and Imre Benedek

Open access

Annabella Benedek, Diana Opincariu, Imre Benedek, Ionuț Ferenț, Roxana Hodaș, Emese Marton and Theodora Benedek

Abstract

Acute coronary syndromes are usually triggered by the erosion or rupture of a vulnerable coronary plaque. A vulnerable plaque (VP) is an atheromatous plaque which, after suffering different transformations, is prone to rupture causing an acute coronary event. Such a VP carries inside several biomarkers considered as “signatures of vulnerability”, which, if identified, can prompt timely initiation of therapeutic measures in order to prevent the development of an acute myocardial infarction. The most freqeuntly used techniques for identification of vulnerability markers are computed tomographic angiography (CTA), intravascular ultrasound and optical coherence tomography. Endothelial shear stress (ESS) represents a new promising biomarker associated with plaque vulnerability. Determination of ESS is nowadays possible using noninvasive imaging techniques, based on complex computational post-processing of multiple datasets extracted from CTA images and advanced computational fluid dynamics technologies. The aim of this systematic review was to evaluate the role of the coronary ESS, determined using advanced computational techniques for image post-processing, as a feature associated with CTA-derived biomarkers of atheromatous plaque vulnerability, underlining the conceptual differences between high ESS and low ESS as promotors of vulnerability.

Open access

Elena Beganu, Elisabeta Himcinschi, Roxana Hodas, Daniel Cernica and Ioana Rodean

Abstract

Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

Open access

Elisabeta Himcinschi, Elena Beganu, Lehel Bordi, Roxana Hodas and Theodora Benedek

Abstract

Given the higher amount of detail it offers, the use of magnetic resonance (MR) in the field of cardiology has increased, thus leading to a decrease in the use of invasive and irradiating methods for diagnosing various cardiovascular disorders. The only precautions for MR imaging are metallic implants and advanced-stage chronic kidney disease. For the acquisition of clear and dynamic myocardial images, methods such as spin echo imaging for anatomical description, steady-state free precession imaging for the assessment of ventricular cavity size and function, flow velocity encoding for blood flow measurements, radiofrequency tagging for dynamics, and even spectroscopy for metabolism evaluation are used. Cardiac magnetic resonance (CMR) is considered the gold standard imaging method for the anatomical characterization of the heart and obtaining information related to myocardial dynamics. In case of ischemic events, CMR is used for a detailed description of the necrotic area and the complications, and for tracking the ventricular remodeling. By administrating a contrast agent (gadolinium), the difference between sub-endothelial and transmural infarctions can be distinguished, highlighting even microvascular lesions responsible for the extension of the necrosis. The assessment of the dynamics of ventricular remodeling and viability through late gadolinium enhancement (LGE) technology highlights the area of fibrosis and the occurrence of late complications.

Open access

Alina Cordunean, Roxana Hodas, Edvin Benedek, Lehel Bordi, Imre Benedek and Theodora Benedek

Abstract

Patients who suffer from diabetes mellitus and present coronary artery disease are at a higher risk of cardiovascular events. The coronary arteries of diabetic patients present a diffuse process of atherosclerosis with frequent distal involvement, being prone to acute cardiovascular events. Diabetics present an increased rate of developing coronary artery remodeling, negative remodeling being representative for this class of patients; this process is characterized by vessel shrinkage and an increased rate of coronary calcium accumulation that is a predictor for cardiovascular risk. Currently, it is desired to improve the treatment of diabetic patients with bioresorbable vascular scaffolds (BVS), because of their reduced risk of restenosis and the ability to restore coronary function, including vasomotion, adaptive shear stress, and expansive remodeling. Optical coherence tomography, intravascular ultrasound and multi-slice computed tomography are imaging techniques used for a high accuracy of diagnosis in coronary artery disease. This manuscript is a review that aims to highlight imaging techniques used for evaluating the functional impact of coronary lesions in diabetic patients who underwent coronary PCI with bioresorbable scaffolds and to describe the functional markers that show the specificity for predicting coronary artery disease.

Open access

Diana Opincariu, András Mester, Mihaela Dobra, Nora Rat, Roxana Hodas and Mirabela Morariu

Abstract

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.