Livia Florentina TRASCA, Elena POENARU, Natalia PATRASCU, Ramona BRUJA, Octavian MUNTEANU, Monica CIRSTOIU and Dragos VINEREANU

ABSTRACT

Objectives: The impact of the gestational changes on left ventricular contractility is not clearly defined. Our aim was to evaluate the subtle changes of left ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia.
Material and methods: Eighty seven consecutive pregnant women, with a mean age of 32±4 years, genetically tested for inherited thrombophilia (22 with thrombophilic mutations and risk of thrombosis and 65 without significant mutations, considered as the control group) were included. All participants had four clinical and echocardiographyc visits: three during pregnancy (one in each trimester) and the forth six months after giving birth. Left ventricular (LV) systolic function was assessed from ejection fraction (EF) by 2D and 3D echocardiography, mitral annular velocities by tissue Doppler, and strain rate by 2D speckle tracking.
Outcomes: There were no differences between groups for any of the echo parameters at each of the four visits. Comparing the third visit with the first one, all parameters of LV systolic function had significantly lower values at the end of pregnancy; EF decreased from 58% to 55% (2D echo), from 60% to 56% (3D TomTec), and from 58% to 55% (Auto4DLVQ), with p<0.001 for all three methods. Moreover, strain assessed by speckle traking decreased during pregnancy, with no differences between groups. In addition to this, mitral annular velocities obtained by tissue Doppler assessment decreased during the gestational period, with no differences between groups. At six months after giving birth, all values were normalized.
Conclusion: During pregnancy, LV contractility has a slight decrease, with no criteria of systolic dysfunction. Thrombophilic mutations, with correct anticoagulant treatment, has no impact on LV systolic function.
Keywords: pregnancy, contractility, thrombophilia

Full text | PDF

Alexandru George COTOBAN, Cristian Alexandru UDROIU and Dragos VINEREANU

ABSTRACT

Introduction: Non-ST segment elevation acute coronary syndromes (NSTE-ACS) form a large part of the number of annual emergency admissions in the Cardiology Departments in Romania, representing a significant burden on the health care system resources. The European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of NSTE-ACS patients represent ideal standards, which are difficult to implement, given the significant differences in the socio-economic climates of the various European Union countries, as the access to modern reperfusion techniques for NSTE-ACS patients, including Romania, is usually suboptimal.
Objectives: The evaluate the current implementation state of the ESC recommended protocols for the diagnosis and treatment of NSTE-ACS patients in Romania. There are no data regarding the number of patients who benefit from modern revascularization techniques, the time intervals between symptom onset, positive diagnosis and revascularization procedures, and the impact of these strategies on in-hospital and one-year mortality.
Materials and methods: We support the development of an online National Registry of NSTE-ACS patients, in which data obtained from the in-hospital medical records of patients undergoing invasive management will be prospectively recorded. The platform will initially be accessible to 11 interventional centers, and will include patients diagnosed and treated according to local protocols. Patient status at one year after the acute event will also be recorded. The Registry will eventually be accessible to any center in Romania caring for NSTE-ACS patients. The recorded variables will be based on those with a significant impact on the time from symptom onset to the positive diagnosis, type of clinical presentation, appropriate treatment initiation and the type of applied treatment.
Expected outcomes: Local clinical expertise, the number of treated patients and center-level technical barriers are expected to significantly influence the reported diagnostic and therapeutic measures. The performance of the various local in-hospital guidelines and transfer protocols between non-interventional and interventional centers will be analyzed, based on which recommendations and objectives can be defined in order to optimize the ESC guidelines implementation.
Conclusion: The National Registry of non-ST elevation acute coronary syndromes will provide an essential tool that facilitates the implementation of optimal ESC guideline-driven diagnostic and treatment measures, by adapting its recommendations to the socio-economic status in Romania and ensuring the best possible outcomes for the NSTE-ACS patient.
Keywords: ischemic heart disease, non-ST elevation acute coronary syndromes, unstable angina, myocardial infarction, registry, Romania

Full text | PDF

Maria-Claudia-Berenice SURAN, Andrei-Dumitru MARGULESCU, Ramona BRUJA, Calin SILISTE and Dragos VINEREANU

ABSTRACT

Background. Cardiac memory (CM) refers to persistent T-wave changes that appear after cessation of a period of abnormal ventricular activation, such as ventricular pacing. Prior animal studies using tagged magnetic resonance imaging have suggested that CM is associated with prolonged action potential duration and increased strain of late-activated myocardial segments.
Objective. The aim of the present study is to determine whether CM induced by ventricular pacing in human subjects is accompanied by regional mechanical changes in late-activated myocardial segments, assessed by left ventricular (LV) longitudinal strain (peak LS) and time-to-peak longitudinal strain (TTP-LS), using 2D-speckle tracking echocardiography (2DSE).
Material and methods. We included 20 patients (16 women, age 71±11 years), with DDD pacemakers and with normal AV conduction and QRS/T morphology at baseline. CM was induced by DDD pacing with a short AV delay. ECGs and 2DSE were performed before pacing (baseline), at peak CM (immediately after two weeks of pacing), and at CM washout (4 weeks after cessation of pacing). We measured by echocardiography: left ventricular (LV) ejection fraction, LV diastolic function (E, A, E/E’), peak LS and TTP-LS for the earliest (i.e. adjacent to the pacing site) and latest (i.e. latest-activated during ventricular pacing) segments, using an 18-segment LV model.
Results. All patients had electrical (ECG) CM changes, which disappeared by CM washout. LV global systolic and diastolic functions, as well as regional LS (peak LS for both the latest and earliest activated segments) were similar between evaluations. TTP for the latest and earliest activated segments, as well as mean TTP-LS, increased from baseline to peak CM, but did not decrease at CM washout. The dispersion of TTP-LS was not changed.
Conclusion. These results suggest that regional mechanical changes, as can be assessed by 2DSE longitudinal strain, do not overlap electrical CM.
Keywords: 2-dimensional strain, 2DSE, echocardiography, cardiac memory.

Full text | PDF

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.

Full text | PDF