REFERENCES 1. Go AS, Mozaffarian D, Roger VL, et al. Heart Disease and Stroke Statistics—2014 Update. Circulation. 2014;129:e28-e292. https://doi.org/10.1161/01.cir.0000441139.02102.80 2. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81:1479-1487. doi: 10.1016/j.resuscitation.2010.08.006. 3. Fukuda T, Ohashi-Fukuda N, Kondo Y, Sera T, Doi K, Yahagi N. Epidemiology, Risk Factors, and Outcomes of Out
Monica Marton-Popovici and Dietmar Glogar
Cardiology. 2010;26:8C-13C. 4. Kozinski M, Pstragowski K, Kubica JM, et al. ACS networkbased implementation of therapeutic hypothermia for the treatment of comatose out-of-hospital cardiac arrest survivors improves clinical outcomes: the first European experience. Scand J Trauma Resusc Emerg Med. 2013;21:22. doi: 10.1186/1757-7241-21-22. 5. Tubaro M, Danchin N, Goldstein P, et al. Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology. Acute Card Care
Andreea Barcan, Istvan Kovacs, Ciprian Blendea, Marius Orzan and Monica Chitu
References 1. Windecker S, Kolh P, Fernando A et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European, The Task Force on Myocardial Revascularization of the Society of Cardiology (ESC) and the European Association for Cardio- Thoracic Surgery (EACTS). Eur Heart J. 2014;35:2541-2619. 2. Garot P, Lefevre T, Eltchaninoff H, et al. Six-Month Outcome of Emergency Percutaneous Coronary Intervention in Resuscitated Patients After Cardiac Arrest Complicating STElevation Myocardial Infarction. Circulation. 2007
Ioan Țilea, Codruța Gal, Andreea Varga and Roxana Rudzik
Left ventricular non-compaction (LVNC) is a cardiomyopathy that can either result from arrested or abnormal myocardial morphogenesis during heart development, or can be acquired later in life. Current practice guidelines recommend different strategies for the management of patients with LVNC. Common clinical features of this disease include cardiac failure, thromboembolism, life-threatening arrhythmia or sudden cardiac death, which could indicate a worse prognosis. The disease may occur alone or in association with other congenital cardiac, neuromuscular, mitochondrial or metabolic disorders. The association of left ventricular non-compaction with other structural cardiac congenital diseases (such as atrial or ventricular septal defect, patent ductus arteriosus, obstruction of ventricular outflow tract) is rare. As clinical manifestations of LVNC are non-specific, particular imaging modalities (echocardiography, cardiovascular magnetic resonance imaging or ECG gated computed tomography) should be used in order to establish the diagnosis of LVNC. Antiarrhythmic drugs and implantable cardioverter defibrillators may be considered for the management of ventricular arrhythmias in patients with ventricular non-compaction. We report the presentation, diagnosis and management of a 46 year-old female with refractory severe cardiac failure, repeated syncope due to LVNC and atrial septal defect, requiring medical therapy and an implantable cardioverter defibrillator as a "life bridge" to heart transplantation.
Diana Opincariu, András Mester, Mihaela Raţiu, Nora Rat, Lehel Bordi, Roxana Hodas, Mirabela Morariu, Beáta Jakó, Camelia Tănăsuc and Zsuzsanna Suciu
Introduction: Pulmonary embolism (PE) is the most common cause of vascular death after myocardial infarction and stroke, being associated with high mortality and morbidity rates. The aim of this study was to assess the factors related to 1-year mortality in patients with acute pulmonary embolism who survived the acute event.
Material and methods: In total, 104 patients who had survived the acute episode of pulmonary embolism and underwent a one-month follow-up after the acute event were included in the study. The patients were divided into two groups: Group 1 – patients who had survived at one year after being diagnosed with acute PE (80.76%, n = 84), and Group 2 – patients who had died after one year (19.23%, n = 20).
Results: There were no differences between the 2 groups in relation to gender (p = 0.3), or cardiovascular risk factors (diabetes: p = 0.5, smoking: p = 0.3, hypertension: p = 1, hypercholesterolemia: p = 0.5, hypertriglyceridemia: p = 0.4). Patients who had deceased were significantly older (73.35 ± 9.37 years vs. 66.36 ± 11.17 years, p = 0.005) and had a higher weight compared to the survivors (85.8 ± 21.09 kg vs. 75.89 ± 22.69 kg, p = 0.03). Left ventricular ejection fraction, measured by cardiac ultrasound, was significantly lower in the deceased group compared to survivors (45.63 ± 8.9% vs. 52.86 ± 6.8%, p = 0.03). Multivariate analysis identified the hemodynamic instability (OR = 3.17, p = 0.007), the presence of left QRS axis deviation (OR = 4.81, p = 0.001), associated pulmonary pathologies (OR = 3.2, p = 0.02) as well as the presence of chronic kidney disease (OR = 5, p = 0.04) as the most powerful predictors of death at 1 year in patients with acute PE surviving the acute event.
Conclusions: Factors associated with a higher mortality rate at 1 year in patients who had survived at 1 month following an acute pulmonary embolism episode included: older age, higher body weight, presence of associated pulmonary pathologies, chronic kidney disease, left axis deviation, low left ventricular ejection fraction, hemodynamic instability requiring inotropic support, cardiogenic shock at presentation or cardiac arrest during the acute phase.
Adrian Corneliu Iancu, Mihaela Ioana Dregoesc, Aurelia Solomoneanu and Theodora Benedek
Balloon Support for Myocardial Infarction with Cardiogenic Shock. N Engl J Med. 2012;367:1287-1296. doi: 10.1056/NEJMoa1208410. 33. Ouweneel DM, Schotborgh JV, Limpens J, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016;42:1922-1934. doi: 10.1007/s00134-016-4536-8. 34. Flaherty MP, Khan AR, O'Neill WW. Early Initiation of Impella in Acute Myocardial Infarction Complicated by Cardiogenic Shock Improves Survival: A Meta-Analysis. JACC Cardiovasc
Monica Marton-Popovici and Aura-Gabriela Casu
.07.006. 6. Bækgaard JS, Viereck S, Palsgaard Møller T, Kjær Ersbøll A, Lippert F, Folke F. The Effects of Public Access Defibrillation on Survival After Out-of-Hospital Cardiac Arrest – A Systematic Review of Observational Studies. Circulation. 2017;136:954-965. https://doi.org/10.1161/CIRCULATIONAHA.117.029067 . 7. Ringh M, Fredman D, Nordberg P, Stark T, Hollenberg J. Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival. Resuscitation. 2011;82:1514-1518. doi: 10.1016/j
-German cohort study. Br J Haematol. 2014;167:385-393. doi: 10.1111/bjh.13039. 6. Zhu T, Pan K, Wang Y. Successful resuscitation with thrombolysis of pulmonary embolism due to thrombotic thrombocytopenic purpura during cardiac arrest. Am J Emerg Med. 2015;33:132.e3-4. doi: 10.1016/j.ajem.2014.06.025. 7. Berntorp E. Thrombosis in patients with hemorrhagic disorders. Minerva Med. 2013;104:169-173. 8. Riva N, Donadini MP, Ageno W. Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation. Thromb
Victoria Rus, Diana Opincariu, Roxana Hodas, Tiberiu Nyulas, Marian Hintea and Theodora Benedek
Background: The impact of nutritional status on the early outcome of subjects with acute myocardial infarction (AMI) is still not completely elucidated. This study aimed to assess the correlation between nutritional status, as expressed by the CONUT and PIN scores, and (1) clinical and laboratory characteristics, (2) complication rates, and (3) length of hospitalization, in patients with AMI.
Materials and methods: We included 56 consecutive patients with AMI who underwent primary percutaneous intervention and stenting. Evaluation of the nutritional status was comprised in the calculation of the CONUT and PNI scores. The study population was divided into 2 groups according to the calculated CONUT score, as follows: group 1 – CONUT score <3 points (normal to mildly impaired nutritional status) and group 2 – CONUT score ≥3 points (moderate to severe malnutrition). The primary end-point of the study was the rate of in-hospital complications (left ventricular free wall rupture, hemodynamic instability requiring inotropic medication, high-degree atrioventricular block, the need for temporary cardiostimulation, supraventricular and ventricular arrhythmias and in-hospital cardiac arrest). The secondary end-points included the duration of hospitalization and the length of stay in the intensive cardiac care unit.
Results: In total, 56 patients (44.64% with STEMI, 55.35% with NSTEMI) with a mean age of 61.96 ± 13.42 years, 58.92% males were included in the study. Group distribution was: group 1 – 76.78% (n = 43), group 2 – 23.21% (n = 23). There were no differences between the two groups regarding age, gender, cardiovascular risk factors, or comorbidities. PNI index in group 1 was 54.4 ± 10.4 and in group 2 41.1 ± 2.8, p <0.0001. Serum albumin was significantly lower in group 1 – 4.1 ± 0.3 vs. group 2 – 3.6 ± 0.3 (p <0.0001), similarly to total cholesterol levels (group 1 – 194.9 ± 41.5 vs. group 2 – 161.2 ± 58.2, p = 0.02). The complete blood cell count showed that group 2 presented lower levels of hematocrit (p = 0.003), hemoglobin (p = 0.002), and lymphocytes (p <0.0001) compared to group 1, but a significantly higher platelet count (p = 0.001), mean platelet volume (p = 0.03), neutrophil/lymphocyte (p <0.0001) and platelet/lymphocyte (p <0.0001) ratios, indicating enhanced blood thrombogenicity and inflammation. Regarding in-hospital complications, group 2 presented a higher rate of hemodynamic instability (group 1 – 11.6% vs. group 2 – 38.4%, p = 0.02). The overall hospitalization period was 7.7 ± 1.4 days in group 1 vs. 10.2 ± 4.8 days in group 2, p = 0.06; while the duration of stay in the intensive cardiac care unit was 2.6 ± 0.5 days in group 1 vs. 4.0 ± 2.5 days in group 2, p = 0.02.
Conclusions: This study proved that nutritional deficit in acute myocardial patients who undergo revascularization is associated with an increased rate of in-hospital complications and with a longer observation time in a tertiary intensive cardiac care unit.
Alexandru Florin Rogobete, Ovidiu Horea Bedreag, Sonia Elena Popovici, Adriana Mariana Sas, Adrian Tudor Stan, Emil Robert Stoicescu and Dorel Sandesc
REFERENCES 1. Oddo M, Rossetti AO. Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care. 2011;17:254-259. doi: 10.1097/MCC.0b013e328344f2ae. 2. Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther. 2015;154:13-20. doi: 10.1016/j.pharmthera.2015.06.009. 3. Doehner W, Haehling S Von, Pschowski R, Storm C, Schroeder T. Influence of core body temperature on Tryptophan metabolism, kynurenines, and estimated IDO activity in