Stefania L. MAGDA, Raluca I. MINCU, Maria FLORESCU, Andrea O. CIOBANU, Gabriela F UDREA, Mircea CINTEZA and Dragos VINEREANU

ABSTRACT

Background and purpose: Rheumatoid arthritis (RA) causes frequently cardiovascular complications, probably determined by early atherosclerosis in connection to chronic systemic inflammation. Purpose of our study was to assess subclinical cardiac and vascular dysfunction, and to evaluate the mechanisms of ventriculo-arterial interaction, in patients with correctly treated RA vs. normal subjects.
Methods: We evaluated 46 subjects (55±10 years, 2 men): 29 patients with seropositive treated RA (mean duration of 11±9 years), without documented cardiovascular or pulmonary disease, and 17 control subjects, matched for age, sex, and distribution of conventional major risk factors. All RA patients were under long-term treatment (more than 6 months) with Methotrexat + Sulfasalasine (22 patients) or Methotrexat + Sulfasalasine + Infliximab (7 patients). We determined biomarkers of inflammation (P-selectin, interleukines 1, 6, 10, 18, seric amiloid A, α-TNF, γ-interferon, C-reactive protein, anti-oxidated LDL antibodies), myocardial fibrosis (β-crosslaps) and ventricular overload (BNP). We assessed the parameters of cardiac function by standard and tissue Doppler echocardiography, intima-media thickness and arterial stiffness by “e-tracking” and “wave intensity analysis” (at the level of the right carotid artery), endothelial function by flow mediated dilation (FMD), and carotid-femoral pulse wave velocity by the Complior method.
Results: Biological parameters of inflammation, markers of myocardial fibrosis and of ventricular overload were not different between the 2 study groups. Also, parameters of subclinical cardiac and vascular function were similar between the two groups. RA patients had subclinical RV dysfunction, correlated to the duration of the disease. They also tended to have higher values of systolic pulmonary artery pressure than normals.
Conclusion: Correctly treated patients with RA, with controlled systemic inflammation, have normal LV, endothelial and arterial function. However, in the absence of documented pulmonary disease, they do have subclinical RV dysfunction, correlated with the duration of disease. This suggests an intrinsic RV myocardial involvement but, since pulmonary artery pressure was also higher, a secondary mechanism might be also involved.

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Diana E. CRETU, Cristian A. UDROIU, Claudiu I. STOICESCU, Gabriel TATU-CHITOIU and Dragos VINEREANU

ABSTRACT

Background: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (pPCI) is the preferred therapy for STEMI if it is done within 120 min from the first medical contact, by an experienced team in a high-volume center. The aim of this study was to assess the clinical characteristics and predictors of in-hospital mortality of patients with STEMI treated by percutaneous coronary interventions (PCIs).

Methods: We analyzed data from 15,076 STEMI patients enrolled in the RO-STEMI registry (ROmanian ST-Elevation Myocardial Infarction registry). Patients were divided into 2 groups: PCI (11.669; 77%) and conservative treated (3.407; 23%). PCI group includes both pPCI treated patients (84.3%), and patients undergoing rescue PCI (6.4%) and late PCI (9.3%).

Results: The mean age of STEMI patients was 62.7+/-12.7 years. 70% were males. Patients treated by PCI were younger (61.4+/-12.2 versus 67.2+/-13.3, p<0.0001) and more often men (80% versus 71%, p<0.0001). They were less likely to have acute heart failure (Killip class II-IV) at admission (p<0.0001). During admission, patients treated by PCI received more often dual antiplatelet therapy (97.6% versus 90.8%, p<0.0001), statins (96.3% versus 87.5%, p<0.0001), beta-blockers (83.8% versus 73.2%, p<0.0001), and RAAS blockers (82.6% versus 66.4%, p<0.0001). Overall in-hospital mortality was 7.1%: 4.1% in the PCI group and 15.7% in the conservative treated group. Multivariate analysis showed that, after adjusting for all clinical variables, Killip class II-IV at admission (OR: 9.2; 95%CI: 6.2-13.6; p<0.0001), LVEF<35% (OR: 3.8; 95%CI: 2.6-5.4; p<0.0001), age older than 65 years (OR: 2.2; 95%CI: 1.5-3.2; p<0.0001), and anterior location of myocardial infarction (OR: 2.1; 95% CI: 1.5-3; p<0.0001) remained independent predictors for in-hospital mortality for STEMI patients treated interventionally.

Conclusion: Advanced Killip class, depressed LVEF, advanced age, and anterior location were the most powerful independent predictors of in-hospital mortality in STEMI patients who underwent interventional treatment.

Keywords: STEMI, percutaneous coronary interventions, mortality

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Claudiu STOICESCU, Vlad VINTILA, Cristian UDROIU, Nicolae FLORESCU, Aws DAWOOD, Mircea CINTEZA and Dragos VINEREANU

ABSTRACT

Background: Stent thrombosis (ST) is a rare, but extremely severe complication of PCI. Outside clinical trials, data are limited regarding the risks and the impact of this phenomenon.

Aims: To assess prevalence, predictors, and clinical outcome of ST after implantation of drug eluting stents (DES) compared with bare metal stents (BMS), in a large case-control study in a real world scenario, as well as the relation between ST and duration of combined antiplatelet treatment.

Methods: In a case-control registry we included 475 patients who received at least 1 DES (sirolimus, zotarolimus, everolimus, paclitaxel), compared with a group of 475 patients who received at least 1 BMS. We used 1.22 DES/patient vs. 1.26 BMS/patient (p=ns), treating 1.02 DES/lesion vs. 1.05 BMS/ lesion (p=ns). Main outcome was ST defined by the Academic Research Consortium (ARC) as definite (acute, sub-acute, late), probable, and possible.

Results: At 15 months we found 0.8% (4) patients in the DES group vs. 1.1% (5) patients in the BMS group with definite ST (ns); 0.4% (2) patients from each group had acute ST, while 0.4% (2) vs. 0.7% (3) patients had sub-acute ST (both comparisons were ns). None of the patients from the DES group died, whereas two patients with definite ST from the BMS group died, with a case fatality rate of 40% (2/5). 0.2% (1) patient from each group had probable ST (ns) and 0.6% (3) vs. 0.4% (2) patients had possible ST (ns). Independent predictors of stent thrombosis in merged groups were antiplatelet therapy discontinuation (HR 3.8; 95%CI 1.9-7.6; p<0.01), diabetes (HR 2.15; 95%CI 1.4-5.1; p<0.01), a lower left ventricular ejection fraction (EF) (HR 1.1; 95%CI 1.0-1.9; p<0.01 for each 10% decrease), and LAD lesions (HR 1.0; 95%CI, 0.93-1.9; P<0.01).

Conclusions: ST is a rare complication (0.95%), similar after DES or BMS implantation. Premature discontinuation of antiplatelet therapy, followed by diabetes and a lower LVEF, are the independent predictors of ST.

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Leonida GHERASIM, Andrea O. CIOBANU, Carmen Lucia GHERGHINESCU, Raluca DULGHERU, Stefania MAGDA, Ruxandra DRAGOI GALRINHO, Maria FLORESCU, Suzana GUBERNA, Mircea CINTEZA and Dragos VINEREANU

ABSTRACT

Background: Blood pressure variability (BPV) was proved as a cardiovascular risk factor. One of its mechanisms is related to arterial stiffness and ventriculo-arterial coupling; however its impact on subclinical cardiovascular dysfunction has not been evaluated yet.

Objectives: To assess the relationship between BPV on 24 hours, and subclinical left ventricle (LV), renal, and vascular dysfunction in diabetic and hypertensive patients. Material and methods: We studied 56 patients (57±9 years, 29 men) with mild-to-moderate hypertension and type 2 diabetes, no cardiovascular disease, normal ejection fraction and normal renal function. 24 hours ambulatory blood pressure monitoring (ABPM) was used to assess BPV, daytime (d) and night time (n), by: 1. mean (M); 2. standard deviation of mean (SD); 3. variance (Vr); 4. coefficient of variation (CV); 5. day/night variation: reverse dippers, non-dippers, dippers and extreme dippers; conventional and 2D speckle tracking echo to assess LV function; myocardial deformation was measured as global longitudinal strain (GLS). Endothelial (flow mediated dilation, FMD) and arterial function (intima media-thickness, IMT; pulse wave velocity, PWV), microalbuminuria were tested.

Outcomes: Daytime BPV correlates inversely with subclinical myocardial function evaluated through GLS. Daytime systolic BPV correlates positively with IMT (all rho > 0.30, all p < 0.05). Also, there is a significantly inverse correlation between mean BP and GLS. We found a direct correlation between mean BP, but not BPV, and microalbuminuria (all rho > - 0.30 and all p < 0.05). We found no correlation between BPV and FMD, PWV. There were no differences for GLS, microalbuminuria and FMD between dipper groups.

Conclusions: In diabetic patients with mild-to-moderate hypertension, increased daytime blood pressure variability correlates with subclinical left ventricular dysfunction and arterial function (IMT), while microalbuminuria correlates with elevated blood pressure, but not with blood pressure variability.

Keywords: blood pressure variability, ventricular dysfunction, diabetes, hypertension

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