Mortality Reduction in Acute Coronary Syndromes — How Far Are We From The Goal?

<abstract xmlns="http://www.w3.org/1999/xhtml"> Coronary angiography is still the most widely used method for the assessment of lumen of coronary arteries and for diagnosis and treatment of coronary artery disease. New imaging modalities of coronary arteries play an increasing role in interventional cardiology. Intravascular ultrasound (IVUS) is the oldest technology, however due to its high tissue penetration remains very important for imaging of left main coronary artery and saphenous vein grafts. IVUS was used in many clinical trials and clinical experience with it is huge. Optical coherence tomography (OCT) is a new, very fast developing method. It has ten times higher axial resolution than IVUS. It gives us the opportunity to assess the inner structures of coronary artery wall, to evaluate the characteristics of atherosclerotic plaques, quality of stent implantation and its healing. It helps us to find the culprit lesion of acute coronary syndrome in some cases, to diagnose the cause of stent thrombosis, and to evaluate stent apposition which has a direct relation to prognosis. We use it to perform complex percutaneous coronary interventions and after heart transplantation to diagnose the vascular graft disease. We strongly believe that OCT is important for the assessment of plaque instability and patient´s prognosis. Near infrared spectroscopy combined with IVUS can distinguish fibrous from lipid core plaques. Lipid core burden index is in relation to a risk of periprocedural myocardial infarction and to prognosis. It is the only method which can sufficiently detect the amount of lipids in coronary wall.</abstract>

Department of Cardioangiology, ICRC, St. Anne University Hospital, Brno, Czech Republic

SBALK Varna, Bulgarian Cardiac Institute, Bulgaria

New Imaging Methods of Coronary Arteries in Acute Coronary Syndromes

<abstract xmlns="http://www.w3.org/1999/xhtml"> Ventricular arrhythmias (VAs) in patients without structural heart disease can be found in a significant portion of the general population. The prognosis of patients with idiopathic VA is usually favorable and patients are often asymptomatic. However, sudden cardiac death (SCD) as a consequence of idiopathic VA has been reported. The aim of this review is to present an overview of the association between idiopathic VA and SCD.</abstract>

Sudden Cardiac Death and Idiopathic Ventricular Arrhythmias

<abstract xmlns="http://www.w3.org/1999/xhtml"> Introduction: The recent development of large networks dedicated to ST-segment elevation myocardial infarction (STEMI) led to a significant increase in the number of primary percutaneous interventions (p-PCI) parallel with mortality reduction in Acute Coronary Syndrome (ACS). The number of non ST segment elevation myocardial infarction (NSTEMI) is increasing and the highest mortality rates are encountered in patients with cardiogenic shock and/or out of hospital cardiac arrest associated to ACS. The aim of this study was to identify the factors associated with a higher mortality rate in a global population with acute coronary syndromes presented in the emergency department of a county clinical hospital which serves as a regional center for a STEMI network. Material and method: This is a retrospective study including 684 patients with acute coronary syndrome admitted in the Clinic of Cardiology from the County Clinical Emergency Hospital Tîrgu Mureș in 2014. In all the cases, the factors that correlated with in hospital mortality were identified and analyzed. Results: The incidence of arterial hypertension was significantly higher in patients admitted with unstable angina (75.0%) and STEMI cases with less than 12 hours onset of symptomatology (68.1%), while impaired renal function correlated with the presence of NSTEMI (66.6%). The presence of a multivessel disease was significantly correlated with cardiogenic shock. The localisation of the culprit lesion in the left anterior descending artery (LAD) significantly correlated with the development of cardiogenic shock, LAD culprit lesions being present in 44.4% of CS cases as compared with 21.7% of noCS cases in STEMI patients. In NSTEMI patients, the localisation of the culprit lesion in the left main artery (LM) significantly correlated with the development of cardiogenic shock, culprit lesions in the left main being present in 47.0% of CS cases as compared with 28.5% of noCS cases in STEMI patients. Conclusion: Patients presenting with out-of-hospital resuscitated cardiac arrest due to Acute Myocardial Infarction associate higher in-hospital mortality rates. In-hospital mortality seems to be highly correlated with the female gender, STEMI myocardial infarction and the presence of multivascular lesions.</abstract>

Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome

<abstract xmlns="http://www.w3.org/1999/xhtml"> 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.</abstract>

Family Medicine, Dept M3, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Cardiac Rehabilitation Clinic, Tirgu Mures Emergency Clinical County Hospital, Tîrgu Mureș, Romania

Cardiology Clinic, Institute of Cardiovascular Disease and Transplantation, Tîrgu Mureș, Romania

Left Ventricular Non-Compaction Associated with Atrial Septal Defect — a Rare Cause of Refractory Severe Cardiac Failure

Response to “The Value of Angio CT Multislice for Pre-operative Assessment and Prediction of Post PCI Successful Intervention in Acute Coronary Syndromes Associated by Left Main Disease”

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Journal of Cardiovascular Emergencies

 The Journal of Cardiovascular Emergencies aims to publish top quality papers related to acute conditions in any cardiovascular pathology. The journal will mainly focus on recent advances in the field of diagnosis and treatment of the most common causes of cardiovascular emergencies, including acute coronary syndromes, acute heart failure, acute aortic diseases, pulmonary embolism, peripheral arterial diseases or cardiac arrhythmia. Interdisciplinary approaches will be extremely welcomed, presenting new advances in the approach of different other pathologies (i.e. stroke) from the cardiovascular perspective.  The Journal of Cardiovascular Emergencies will publish high-quality basic and clinical research related to these topics, in a common approach that will integrate the clinical studies with the pre-clinical work dedicated to discovery of new mechanisms involved in the development and progression of acute cardiovascular conditions.  Especially in the case of acute coronary syndromes, the journal will try to provide the entire cardiology community with the perspective of the regional cardiology networks in Central and Eastern European countries, reflecting the regional model of care in cardiovascular acute conditions.  The journal will primarily focus on publishing original research papers, but also other types of materials (such as review articles, case reports, state of the art papers, comments to editor, etc) will be extremely welcomed.  Rejection Rate   30%   Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 