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Natalia PATRASCU

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Articles signed on MÆDICA, JCM:

Left Ventricular Systolic Function in Pregnant Women with Inherited Thrombophilia

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MÆDICA - a Journal of Clinical Medicine | Vol. 14, No. 3, 2019
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Left Ventricular Systolic Function in Pregnant Women with Inherited Thrombophilia

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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

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Advanced Atherosclerosis with Leriche Syndrome, in a Patient with Carney Complex

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MÆDICA - a Journal of Clinical Medicine | Vol. 13, nr. 2, 2018
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Advanced Atherosclerosis with Leriche Syndrome, in a Patient with Carney Complex

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ABSTRACT

Carney complex (CNC) is a rare autosomal dominant syndrome. Spotty skin pigmentation is the major clinical manifestation of CNC, followed by cardiac myxomas, benign tumors that usually present with features from the classical triad of obstructive cardiac, embolic and non-specific constitutional symptoms (NCS). NCS are caused by the overproduction of interleukin-6 (IL-6), a pro-inflammatory cytokine which mediates the induction of intercellular adhesion molecule 1 (ICAM-1) and promotes endothelial dysfunction and atherosclerosis. Thus, myxomas may be directly linked to an increased risk of atherosclerotic events.
We report here a case of a 74-year-old woman with left atrial myxoma, skin pigmentary abnormalities, thyroid disorder and extensive atherosclerosis, with non-embolic occlusion of infrarenal abdominal aorta.
Keywords: Carney complex, critical limb ischemia, Leriche syndrome, cardiac myxoma, atherosclerosis, autoimmune thyroid disorder

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The Role of Obstructive Sleep Apnea in Developing Gestational Hypertension and Preeclampsia

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MÆDICA - a Journal of Clinical Medicine | Vol. 11, nr. 4, 2016 CNCSIS - CMR - B+ OBBCSSR

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The Role of Obstructive Sleep Apnea in Developing Gestational Hypertension and Preeclampsia

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ABSTRACT

Gestational hypertension and preeclampsia are the most frequent medical complications in pregnancy and major causes of maternal and fetal morbidity and mortality. It is also known that these conditions are associated with a long term increased cardiovascular global risk for these young women. Obstructive sleep apnea (OSA) seems to be not only a frequent pathology associated with pregnancy but also an independent factor for developing gestational hypertension. It is well known the relationship between gestational hypertension, preeclampsia and intrauterine growth restriction of the foetus so the outcomes of this pathologies are important for both mother and child. Increasing awareness of OSA among pregnant women with gestational hypertension and preeclampsia is important given the potential benefits of the treatment with continuous positive airway pressure (CPAP) on these patients.
Keywords: Gestational hypertension, preeclampsia, obstructive sleep apnea, continuous positive airway pressure, pregnancy

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Assessment of Systolic and Diastolic Cardiac Function beyond Traditional Markers in Hypertensive Patients. Role of Cardiac Reserve

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MÆDICA - a Journal of Clinical Medicine | Vol. 8 (11), no. 2 2013

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Assessment of Systolic and Diastolic Cardiac Function beyond Traditional Markers in Hypertensive Patients. Role of Cardiac Reserve

ABSTRACT

Background: the mechanical performance of the cardiac pump should be evaluated not only at rest but also in relation to its response to peak stimulation, since the earliest consequence of the cardiac pump capacity in the evolution of heart failure is the decrease of the maximal performance. This can be assessed by measuring the cardiac functional reserve, usually by a physical or a pharmacological stress test combined with echocardiography imaging.

Content and comments: in symptomatic heart failure, the main purpose is to objectively identify the point to which the impairment of the pump function is irreversible. Moreover, there is growing evidence that the functional systolic and diastolic reserve is decreased even in the early, subclinical stages of cardiac dysfunction that exists for example in hypertensive disease and that the decrease seems to be related to the number of the associated cardiovascular risk factors.

Conclusion: thus, better preventive and therapeutic strategies could be established by detecting a reduced functional reserve in this category of patients at high risk of heart failure development, with important public-health implications.

Keywords: functional reserve, stress test with dobutamine, subclinical heart failure, beta-blockers, tissue Doppler imaging, speckle tracking

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Diastolic Heart Failure in Hypertension: Possible Preventive Benefits of Nebivolol Beyond Lowering Blood Pressure

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MÆDICA - a Journal of Clinical Medicine | Vol. 8 (11), no. 3 2013

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What is plagiarism

Plagiarism’s meaning comes from the Latin word ‘plagiarius,’ which means to kidnap. When someone uses the work of another writer or artist without properly citing the source or giving credit, that’s plagiarism. [...]

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Diastolic Heart Failure in Hypertension: Possible Preventive Benefits of Nebivolol Beyond Lowering Blood Pressure

ABSTRACT

Arterial hypertension is one of the most prevalent cardiovascular diseases and one of the most important causes of heart failure with low or preserved ejection fraction. Although many drugs are highly effective in lowering blood pressure, the optimal treatment for preventing progression to heart failure is still uncertain. Beta-blockers, a class of drugs with well-established indications and benefits for both hypertension and heart failure seem to show different pharmacological properties with different consequences on the cardiovascular hemodynamic. The third class beta-blocker nebivolol, by its particular mechanism of vasodilatation mediated by nitric oxide release, has been proven to provide substantial benefits beyond the effect of blood pressure lowering, such as reversal of endothelial dysfunction, improvement of ventricular-arterial coupling, improvement of coronary flow reserve and an overall improvement of the diastolic function which is independent of the changes in ventricular geometry. Thus, nebivolol seems to be superior to other “classical” beta-blockers for the reversal of subclinical left ventricular dysfunction in hypertensive patients, before the onset of overt heart failure. This could be an important fact to take into consideration especially for the early stages of heart failure with preserved ejection fraction for which the optimal management is not established yet.

Keywords: beta-blockers, nebivolol, diastolic dysfunction, longitudinal function, conduit arterial stiffness

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