Vol. 25, 2010, Suplim A

ISSN: 1583-2996
Preedinte: Dan Deleanu

Preedinte care urmeaz: Ioan Mircea Coman
Fost preedinte: Radu Cplneanu
Vicepreedini: Doina Dimulescu
Gabriel Tatu-Chioiu
Secretar: Adriana Ilieiu
Trezorier: Drago Vinereanu
Membri: Eduard Apetrei
erban Blnescu
Mircea Cintez
Ovidiu Chioncel
Alexandru Grigore Dimitriu
Maria Dorobanu
Dan Dobreanu
Carmen Ginghin
Ctlina Arsenescu Georgescu
Daniel Lighezan
Florin Mitu
Antoniu Petri
Bogdan A. Popescu
Lucian Zarma
CONSILIUL DE CONDUCERE AL
SOCIETII ROMNE DE CARDIOLOGIE
Colectivul de redacie
Redactor ef
Eduard Apetrei
Redactor ef adjunct
Carmen Ginghin
Redactori
Radu Cplneanu
Cezar Macarie
Redactor fondator
Costin Carp
Redactori asociai
Mihaela Rugin
Ruxandra Jurcu
Bogdan A. Popescu
Costel Matei
Colegiul de redacie
Ion V. Bruckner - Bucureti
Alexandru Cmpeanu - Bucureti
G. Cerin - Italia
Mircea Cintez - Bucureti
Radu Ciudin - Bucureti
D. V. Cokkinos - Grecia
Ioan Mircea Coman - Bucureti
G. Andrei Dan - Bucureti
Dan Deleanu - Bucureti
Genevieve Derumeaux - Frana
Doina Dimulescu - Bucureti
Maria Dorobanu - Bucureti
tefan Iosif Drgulescu -
Timioara
Guy Fontaine - Frana
Bradu Fotiade - Bucureti
Alan Fraser - Anglia
Ctlina Arsenescu-Georgescu -
Iai
Mihai Gheorghiade - USA
Leonida Gherasim - Bucureti
E. Grosu - Chiinu, R. Moldova
Assen R. Goudev - Bulgaria
Alexandru Ioan - Bucureti
Dan Dominic Ionescu -
Craiova
Gabriel Kamensky - Slovacia
Andre Keren - Israel
Ioan Maniiu - Sibiu
Martin S. Martin - SUA
Gerald A. Maurer - Austria
erban Mihileanu - Frana
Nour Olinic - Cluj-Napoca
Fausto Pinto - Portugalia
Gian Luigi Nicolosi - Italia
Mariana Rdoi - Braov
Willem J. Remme - Olanda
Doina Rogozea - Bucureti
Michal Tendera - Polonia
Ion intoiu - Bucureti
Panagiotis Vardas - Grecia
Drago Vinereanu - Bucureti
Marius Vintil - Bucureti
Dumitru Zdrenghea -
Cluj-Napoca
Secretar de redacie
Mihaela Slgean
Editura: Media Med Publicis
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Distribuie: Revista Romn de
Cardiologie se distribuie membrilor Societii
Romne de Cardiologie
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1-4 Insufciena cardiac A1
5-8 Cardiopatie ischemic A6
9-15 Poster Forum I A12
16-65 Poster I A21
66-71 Sesiunea tnrului investigator A74
72-75 Aritmii A82
76-79 Varia 1 A86
80-83 Ecocardiografe A91
84-90 Poster Forum II A96
91-139 Poster II A104
140-143 HTA A154
144-147 Varia 2 A159
148-151 Cardiomiopatii A163
152-159 Varia 3 A168
160-166 Poster Forum III A176
167-214 Poster III A184
Index autori A238
Index subiecte A244
Smbt
9 oct ombr i e 2010
Dumi ni c
10 oct ombr i e 2010
Joi
7 oct ombr i e 2010
Vi ner i
8 oct ombr i e 2010
Vol. XXV,
Suplimentul A, 2010
Vol. XXII, Nr. 1, 2008
1-4 Heart Failure A1
5-8 Coronary Heart Disease A6
9-15 Poster Forum I A12
16-65 Poster I A21
66-71 Young investigators award session A74
72-75 Arrhytmias A82
76-79 Varia 1 A86
80-83 Echocardiography A91
84-90 Poster Forum II A96
91-139 Poster II A104
140-143 Hypertension A154
144-147 Varia 2 A159
148-151 Cardiomyopathies A163
152-159 Varia 3 A168
160-166 Poster Forum III A176
167-214 Poster III A184
Authors index A238
Topics index A244
Sat ur day,
9
t h
Oct ober 2010
Sunday,
10
t h
Oct ober 2010
Thur sday,
7
t h
Oct ober 2010
Fr i day,
8
t h
Oct ober 2010
Vol. XXV,
Suplimentul A, 2010
Revista Romn de Cardiologie | Vol. XXV | Suplimentul A, 2010
ratura (0.81). Totusi, adaugarea EPA la acest model de

predictie nu a ameliorat substantial puterea de discri-
minare a SAR.
Concluzii. Studii anterioare au analizat relatia dintre
SAR si EPA indeosebi la pacientii cu disfunctie rena-
la si in SAR bilaterale sau pe rinichi unic functional.
Rezultatele studiului nostru pledeaza pentru o asociere
semnifcativa statistic a EPA cu SAR chiar in absenta
azotemiei si pentru orice varianta topografca de SAR,
inclusiv cea unilaterala. Sunt necesare analize ulterioa-
re pentru determinarea impactului EPA asupra mode-
lelor de predictie a SAR.
Association of acute
pulmonary edema with renal
artery stenosis in hypertensive
patients.
Purpose: Case series have reported that renal revas-
cularization prevents the recurrence of acute pulmo-
nary edema (APE). Terefore, APE might be included
amongst the predictive factors of renal artery stenosis
(RAS). However, few studies have done so. For this re-
ason, we aimed at evaluating the APE prevalence and
the predictive power for RAS in hypertensive patients.
Method: 189 hypertensive patients were investigated
for RAS by duplex ultrasonography (92% negative
predictive value for the diagnosis of a stenosis 50%
formerly confrmed by angiography in our laboratory).
RAS screening was indicated because of insuf cient
blood pressure control, unexplained azotemia, or azo-
temia while on ACE-inhibitors (increase of serum cre-
atinine more than 0.25 mg/dL). Age (a), female gender
(f), abdominal bruit (b), vascular disease (v), serum
creatinine (c), azotemia while on ACE-inhibitors (z),
as well as history of APE were recorded, and a linear
discriminant analysis (LDA) for RAS prediction was
performed.
Results: RAS was identifed in 29% of the cases
(55/189). APE prevalence in RAS was 22% (23% in uni-
lateral stenosis and 20% in bilateral stenosis or on so-
litary functional kidney), whereas in patients without
1. Asocierea dintre edemul
pulmonar acut cardiogen si
stenoza de artere renale la
pacientii cu hipertensiune
arteriala
Roxana Darabont, A. Corlan, M. Cinteza,
D. Vinereanu
Universitatea de Medicina si Farmacie Carol Davila,
Bucuresti
Obiectiv. Serii de cazuri au raportat faptul ca revascu-
larizarea renala previne recurenta edemului pulmonar
acut (EPA). Aceste observatii au condus la includerea
EPA printre factorii de predictie ai stenozelor de artere
renale (SAR), desi putine studii au analizat sistematic
aceasta asoicere. In acest context ne-am propus sa eva-
luam prevalenta EPA si puterea sa predictiva pentru
SAR, la pacienti cu hipertensiune arteriala.
Metoda. SAR a fost investigata prin ultrasonografe
duplex de artere renale la 189 pacienti hipertensivi
(92% valoare predictiva negativa pentru diagnosticul
unei SAR 50%, confrmata angiografc in laboratorul
nostru). Screening-ul de SAR a fost indicat pentru con-
trol insufcient al tensiunii arteriale, pentru azotemie
de cauza inexplicabila sau azotemie sub IEC mai mare
de 0.25 mg/dL. Varsta (a), sexul feminin (f), suful ab-
dominal (b), boala vasculara (v), creatinina serica (c),
azotemia sub IEC (z), ca si istoricul de EPA au fost inre-
gistrate si s-a efectuat o analiza de discriminare lineara
(ADL) pentru predictia de SAR.
Rezultate. SAR a fost identifcata la 29% din cazuri
(55/189). Prevalenta EPA a fost de 22% (23% in steno-
zele unilaterale si 20% in stenozele bilaterale sau pe ri-
nichi unic functional), in timp ce la pacientii fara SAR
a fost de numai 8%. Asocierea dintre EPA si SAR a fost
semnifcativa pentru orice topografe de SAR (unilate-
rala, bilaterala sau pe rinichi unic functional ) (p=0.01)
si a fost independenta de prezenta azotemiei. ADL a ge-
nerat formula 0.22f - 0.0044a + 1.22b + 1.61v + 0.037c
+ 1.28z drept predictiva pentru SAR. Acuratetea (aria
de sub curba) a acestui model predictiv a fost de 0.78,
comparabila cu cea mai buna valoare raportata in lite-
I NSUFI CI ENA CARDI AC | HEART FAI LURE
I NSUFI CI ENA CARDI AC
HEART FAI LURE
Revista Romn de Cardiologie, Vol. XXV
Suplimentul A, 2010
RAS it was only 8%. Te association between APE and

the presence of RAS was signifcant for any RAS topo-
graphy (unilateral, bilateral or on solitary kidney steno-
sis) (p=0.01), and was independent of the presence of
azotemia. LDA generated the formula 0.22f - 0.0044a
+ 1.22b + 1.61v + 0.037c + 1.28z as predictive for RAS.
Te accuracy (area under the curve) of this prediction
model was 0.78, comparable to the best predictive value
in the literature (0.81). Still, adding APE to this model
did not substantially improve the discriminative power
for RAS prediction.
Conclusions: In this vascular ultrasound study of RAS
evaluation, we found that APE has a statistically signi-
fcant association with RAS. While most of the studies
on this issue have focused exclusively on the relations-
hip between APE and RAS for patients with azotemia,
we found that this association holds for both categories
of patientswith renal dysfunction, as well as those
without it and for any topography, including the unila-
teral one. Further studies are needed to investigate the
impact power of EPA on the prediction models of RAS.

2. Rolul prognostic al raportu-
lui E/(ES) la pacientii cu dis-
functie ventriculara stanga
C. Mornos, D. Cozma, Adina Ionac, Irina Popescu, L.
Petrescu, S. Pescariu, ST. I. Dragulescu
Institutul de Boli Cardiovasculare, Timisoara
Studii prealabile au aratat ca o valoare de peste 1.6 pen-
tru raportul E/(ES) estimeaza cu o buna acuratete
un nivel crescut al presiunii telediastolice intraventri-
culare stangi (E=velocitatea precoce maxima transmi-
trala, E=velocitatea precoce diastolica a inelului mitral,
S=velocitatea sistolica maxima a inelului mitral).
Scop: Evaluarea rolul prognostic al unui raport E/
(ES)>1.6 in ceea ce priveste moartea de cauza cardi-
aca la pacientii cu disfunctie ventriculara stanga (VS).
Metoda: Raportul E/(ES) a fost determinat dupa sta-
bilirea unui tratament optim la 110 pacienti consecu-
tivi, spitalizati, cu disfunctie VS, in ritm sinusal. A fost
utilizata media velocitatilor de la nivelul extremitatilor
septala si respectiv laterala ale inelului mitral. Pacientii
cu fereastra ecocardiografca inadecvata, valvulopatii
mitrale semnifcative, sindrom coronarian acut sau by-
pass aorto-coronarian in ultimele 72 de ore nu au fost
inclusi in acest lot de studiu. A fost urmarita incidenta
deceselor de cauza cardiaca la pacientii analizati.
Rezultate: Pe parcursul celor 3612 luni de urmari-
re au fost inregistrate 22 de decese de cauza cardiaca
(20%).Valoare medie a raportului E/(ES) a fost de
3.681.48 la pacientii prezentand deces de cauza car-
diaca, in timp ce la ceilalti bolnavi a fost indentifcata o
medie de 1.780.91 (p=0.017). Un raport E/(ES)>1.6
a avut o sensibilitate de 86% si o specifcitate de 54%
privind estimarea mortii de cauza cardiaca. La pacienti
cu raport E/(ES)1.6 (n=60), rata de supravietuire
a fost semnifcativ mai mare comparativ cu bolnavii
prezentand E/(ES)>1.6 (94% versus 32%, p=0.001,
log-rank). Incluzand raportul E/(ES)>1.6 , E, S, E,
raportul dintre velocitatea transmitrala precoce si cea
tardiva, timpul de decelerare al undei E, fractia de ejec-
tie a VS, volumul indexat al atriului stang, presiunea
sistolica in artera pulmonara, fractiunea N-terminala a
peptidului natriuretic cerebral, varsta si sexul pacienti-
lor, in regresia Cox multivariata, raportul E/(ES)>1.6
a reprezentat cel mai bun predictor independent pen-
tru moartea de cauza cardiaca (hazard ratio=4.76, 95%
interval de confdenta=1.50-15.13, p=0.008).
Concluzie: O valoare a raportului E/(ES)>1.6 poa-
te reprezenta un predictor prognostic puternic pentru
moartea de cauza cardiaca la pacientii prezentand dis-
functie VS afati in ritm sinusal.
Prognostic value of the E/
(ES) ratio in patients with
left ventricular dysfunction
It has been shown that a cut-of value of 1.6 for a novel
Tissue Doppler index, E/(EaSa), is able to predict a
high levels of lef ventricular (LV) end-diastolic pressu-
re (E = early diastolic transmitral velocity, Ea = early di-
astolic mitral annular velocity and Sa = systolic mitral
annular velocity).
Te purpose of our study was to investigate whether
E/(EaSa)>1.6 could be a predictor of cardiac death in
patients with LV dysfunction.
Methods: We determined E/(EaSa) in 110 consecuti-
ve hospitalized patients with LV dysfunction, in sinus
rhythm, afer appropriate medical treatment. Te ave-
rage of the velocities from the septal and lateral mitral
annular sites was used. Patients with inadequate echo-
Suplimentul A, 2010

HEART FAI LURE
cardiographic images, signifcant mitral valvulopathy,
acute coronary syndrome or coronary artery by-pass
within 72 hours were not included. Te primary study
end-point was defnited as cardiac death.
Results: Tere were 22 cardiac deaths (20%) during
3612 months of follow-up. Mean E/(EaSa) was
3.681.48 in those patients, while it was 1.780.91 in
the rest (p=0.017). Te E/(EaSa)>1.6 had 86% sensi-
tivity and 54% specifcity to predict cardiac death. In
patients with E/(EaSa)1.6 (n=60), cardiac survi-
val rate was markedly higher than in the rest with E/
(EaSa)>1.6 (94% versus 32%, p=0.001, log-rank) (Fi-
gure 1). On multivariate Cox regression analysis inclu-
ding E/(EaSa), Ea, Sa, E, early/late diastolic transmi-
tral velocity, E deceleration time, LV ejection fraction,
indexed lef atrial volume, pulmonary artery systolic
pressure, N-terminal pro-brain natriuretic peptide,
age, sex, E/(EaSa)>1.6 was the best independent pro-
gnostic predictor (hazard ratio=4.76, 95% confdence
interval =1.50-15.13, p=0.008).
Conclusions: E/(EaSa)>1.6 could be a powerful pre-
dictor of cardiac death in patients with LV dysfunction.
3. Gradul depresiei se coreleaza
cu evolutia pacientilor cu
insuficienta cardiaca cronica
congestiva
Anca Daniela Farcas, N. Olinic
Universitatea de Medicina si Farmacie Iuliu Hatie-
ganu, Cluj Napoca
Reactiile psihice de adaptare la boala pot avea un rol
important in evolutia pacientilor cu insufcienta cardi-
aca.
Obiectivul acestui studiu a fost de a evalua modul cum
depresia infuenteaza calitatea vietii si evolutia pacien-
tiilor cu insufcienta cardiaca cronica agravata, in ra-
port cu evolutia insufcientei cardiace sub tratament.
Material si metoda: Au fost examinati 150 de pa-
cienti(p) internati pentru insufcienta cardiaca cronica
congestiva agravata. Comportarea clasei functionale
NYHA, a fractiei de ejectie (FE) determinata ecogra-
fc, a testului de mers timp de 6 minute, a scorului de
depresie si a scorului de calitate a vietii, la internare, la
externare, la trei, sase si douasprezece luni de la exter-
nare, au fost analizate, atat individual, cat si comparativ
intre pacientii cu grade diferite de depresie.
Rezultate: Cei 150p, la internare au avut o FE de 30,8
9,2. La 6 luni, aceasta a crescut in medie cu 5 % (32,3
9,6), valoare afata la limita semnifcatiei statistice (p
=0,052). La 12 luni de la externare, la 118 p (78,7%),
FE a crescut in medie cu 10% (35,5 9,4, p < 0,01).
Dintre cei 150p cu insufcienta cardiaca studiati 52,6%
au fost depresivi, 38% dintre ei avand depresii severe
sau moderate. Dintre cei 55 p (36,7%) care au mai avut,
cel putin inca o agravare a insufcientei cardiace, 87,2%
au fost diagnosticati cu depresie moderata sau severa.
Calitatea vietii pacientilor cu insufcienta cardiaca se
coreleaza cu gradul depresiei (r=0,67, p=0,009) si, desi
sub tratament ea se imbunatateste, aceasta imbunatati-
re este semnifcativa doar la pacientii nedepresivi si la
cei cu depresii usoare si moderate. Capacitatea de efort
se imbunatateste semnifcativ la pacientii cu depresii
moderate (332 60m vs 371 51m, p < 0,01) si usoa-
re (380 25m vs 487 32 m, p < 0,001). Pacientii cu
depresii severe, desi sunt in proportie de 73%in clase
functionale NYHA II-III, nu isi cresc in mod semnif-
cativ capacitatea de efort sub tratament.
Concluzie: Gradul depresiei infuenteaza in mod nega-
tiv procesul de reabilitare a pacientilor cu insufcienta
cardiaca. Pacientii cu depresii severe prezinta o evolu-
tie nefavorabila, cu multiple reinternari. De asemenea,
acesti pacienti prezinta o deterioare a calitatii vietii si
a capacitatii de efort, care nu se imbunatatesc in mod
semnifcativ prin tratament.
Cuvinte cheie: insufcienta cardiaca
Severity of depression
correlates with outcome in
chronic congestive heart
failure patients
Psychological coping can have a major efect on disease
outcome in heart failure patients.
Objective: Te study evaluated the efect of depression
on quality of life and outcome in patients with severe
chronic heart failure.
Method: Te authors evaluated 150 patients admitted
with severe chronic congestive heart failure.Te NYHA
class, ejection fraction (EF), 6-minute walk test, depre-
ssion score and quality of life (QoL) score were deter-
HEART FAI LURE
Suplimentul A, 2010
plasmatice crescute ale angiotensinogenului la pacien-

tii cu insufcienta cardiaca. Pe de alta parte, se cunoaste
faptul ca BNP este crescut la pacientii cu IC, nivelul sau
reliefand severitatea bolii.
Scop: studierea asocierii dintre prezenta genotipurilor
M235T, respectiv T174M si nivelul plasmatic al frag-
mentului (8-29) al BNP; infuenta acestor variante asu-
pra nivelului plasmatic al fragmentului (8-29) al BNP.
Metoda: au fost investigati 50 pacienti cu IC (31 bar-
bati), NYHA III-IV, varsta medie 65.766.29 ani. Po-
limorfsmul genetic al AGT a fost evaluat prin metoda
PCR, iar nivelul plasmatic al fragmentului (8-29) al
BNP a fost determinat utilizand metoda ELISA.
Rezultate: Distributia mutatiilor genetice ale AGT
M235T si T174M a fost urmatoarea MT-M235T*+TM-
T174M*- 20%, MT-M235T*+TT-T174M**- 26%, TT-
M235T***+TM - T174M*- 14%, TT-M235T***+TT-
T174M**-20%, MM-M235T**+TT-T174M**-20%
(unde *inseamna heterozigot, **negativ, ***homozi-
got). Valoarea medie a nivelului plasmatic a fragmen-
tului BNP a fost 2991.242034.61 fmol/ml. Valoa-
rea frag mentului BNP a fost surprinzator de ridicata
(p<0.05) in cazul pacientilor MM negativ - TT negati-
ve (4427.252669.95 fmol/ml), comparativ cu cei MT
hetero zigot - TM heterozigot (1600.33893.77 fmol/
ml, heterozigot MT- negative TT (3417.1432170 fmol/
ml, homozigot TT - heterozigot TM (2088.331252.94
fmol/ml) si homozigot TT - negativ TT (3177.52490
fmol/ml). Analizand fecare genotip, nivelele fragmen-
tului BNP au fost mai ridicate (p<0.05) la pacientii fara
mutatia M235T (4427.252669.95 fmol/ml), compara-
tiv cu homozigotii TT (2677.142062.62 fmol/ml) si
heterozigotii MT (2285.621448.45 fmol/ml). Referi-
tor la genotipul T174M, nivelele fragmentului BNP la
pacientii negativ TT (3348.372190.70 fmol/ml), au
fost de asemenea mai ridicate (p<0.05) comparativ cu
cele inregistrate la heterozigotii TM (1764.21007.18
fmol/ml).
Concluzie: La pacientii cu insufcienta cardiaca, exista
o relatie intre polimorfsmul genetic al angiotensino-
genului si nivelul plasmatic al fragmentului BNP, dar,
paradoxal, variantele patogene ale genelor M235T si
T174M au fost asociate cu nivele serice mai scazute ale
fragmentului BNP (CNCSIS ID_2246)
mined at admission, discharge and follow-up at 3, 6
and 12 months and compared for each patient and in
patients with diferent levels of severity of depression.
Results: EF was 30,8 9,2 at admission and 32,3 9,6
at 6-months (5% increase, p=0.052, marginally signif-
cant) for the whole 150 pts study group. At 12-months
follow-up, in 118 pts (78, 7%) EF increased with 10%
(35, 5 9, 4, p < 0, 01). Depression was found in 52.7%
of the patients, 38% of the patients had moderate or se-
vere depression. Of the 55 (36.7%) pts who had at least
one episode of worsening of CHF, 87, 3% had mode-
rate or severe depression. QoL in heart failure patients
correlates with severity of depression (r=0,67, p=0,009)
and improves with heart failure treatment. Te impro-
vement, however, is only signifcant in depression-free,
mild or moderate depression patients. Exercise capacity
signifcantly improves in patients with moderate (332
60m vs 371 51m, p < 0,01) and mild (380 25m vs
487 32 m, p < 0,001) depression. Patients with severe
depression do not signifcantly increase their exercise
capacity, even though they are mainly in NYHA II and
III class (73%).
Conclusion: Severity of depression has a detrimental
efect on heart failure patients rehabilitation. Patients
with severe depression have an unfavourable/severe
outcome with multiple hospital admissions, OoL wor-
sening and decreased exercise capacity which dont im-
prove signifcantly with treatment. KEYWORDS: heart
failure, depression, quality of life
4. Relatia dintre nivelul BNP si
polimorfismul genetic al
angiotensinogenului (AGT) la
pacientii cu insuficienta
cardiaca (IC)
Dana Pop, Lucia Procopciuc, Oana Maria Penciu,
Adela-Viviana Sitar-Taut, G.Bodizs, D. Zdrenghea
ganu, Cluj-Napoca
Ipoteze Doua variante moleculare ale genei angioten-
sinogenului - M235T in care treonina (T) inlocuieste
metionina (M) in pozitia 235 si T174M codand metio-
nina in locul treoninei in pozitia 174- determina nivele
Suplimentul A, 2010

HEART FAI LURE
BNP fragment level and
angiotensinogen M235T and
T174M gene polymorphism in
heart failure (HF) patients
Background: Two molecular variants of the angioten-
sinogen (AGT) gene - M235T, encoding threonine (T)
instead of methionine (M) at position 235 and T174M,
encoding methionine rather than threonine at position
174- are linked to elevated plasma AGT level in HF pa-
tients. On the other hand, BNP increase in HF patients,
in direct relationship with severity.
Purpose: To study the association between the indi-
vidual presence of the M235T and T174M genotypes
and the BNP fragment (8-29) plasmatic level (as a mea-
sure of BNP activity), and the combined infuence of
those variants on the plasmatic level of BNP fragment
(8-29).Methods were analyzed 50 heart failure patients,
31 males, NYHA III- IV functional class, 65.766.29
years. AGT gene polymorphism was detected by PCR,
and the plasmatic BNP fragment (8-29) level was deter-
mined using ELISA-method.
Results: Genotype combination frequencies were
as follows: MT-M235T* + TM-T174M*- 20%,, MT-
M235T* + TT-T174M**- 26% , TT-M235T*** + TM-
T174M*- 14%, TT-M235T*** +TT-T174M**-20%,
MM-M235T** + TT-T174M**-20% (with * meaning
heterozygote, **negative, ***homozygote genotype).
Te mean value of serum BNP fragment levels was
2991.242034.61 fmol/ml. Considering genotype com-
bination of AGT M235T and T174M polymorphisms,
BNP fragment level, for negative MM-negative TT
combination (4427.252669.95 fmol/ml), was surpri-
singly higher (p<0.05) in comparison with heterozygo-
te MT-heterozygote TM combination (1600.33893.77
fmol/ml), heterozygote MT-negative TT combinati-
on (3417.1432170 fmol/ml), homozygote TT- hete-
rozygote TM combination (2088.331252.94 fmol/
ml) and homozygote TT- negative TT combination
(3177.52490 fmol/ml). Analyzing each genotype, BNP
fragment levels were higher (p<0.05) in patients negati-
ve for AGT M235T mutation (4427.252669.95 fmol/
ml, in comparison with the homozygote TT patients
(2677.142062.62 fmol/ml, and the heterozygote MT
patients (2285.621448.45 fmol/ml). For T174M ge-
notype, level of BNP fragment in negative TT patients
(3348.372190.70 fmol/ml), was also higher (p<0.05)
then in heterozygote TM patients (1764.21007.18
fmol/ml.
Conclusion: In HF patients, there is a relationship
between AGT genetic polymorphism and plasmatic
BNP fragment level, but paradoxically, the pathogen
angiotensinogen gene variants, M235T and T174M,
are associated with decreased serum levels of BNP frag-
ment.Funding ID_2246/2009 NURC
tra-spitaliceasca semnifcativ mai redusa (1.63%) a

fost observata la cei 1225 pts tratati cu anticoagulan-
te si A&C;comparativ cu cea de 4.45% inregistrata la
cei 1592 pts care au primit doar anticoagulante si A
(p<0.0001). Incidenta accidentului vascular hemoragic
a fost 0.24%, respectiv, 0.43% (nesemnifcativa statis-
tic). Incidenta altor complicatii hemoragice majore a
fost 1.14%, respectiv, 1.82% (p=0.192). Incidenta cu-
mulata a accidentelor vasculare cerebrale hemoragice si
a hemoragiilor majore a fost de 1.38%, respectiv, 2.26%
(p=0.121).
Concluzii: Registrul RO-STEMI arata faptul ca admi-
nistrarea de clopidogrel la pacientii STEMI cu succes
de reperfuzie trombolitica tratati cu anticoagulante si
aspirina si care nu au avut acces la PCI precoce este
urmata de o reducere cu 64% a mortalitatii intraspita-
licesti fata de pacientii tratati doar cu anticoagulante
si aspirina. Acest impact al clopidogrelului se produ-
ce fara o crestere a riscului de evenimente hemoragice
majore.
Impact of clopidogrel in
patients with ST-elevation
myocardial infarction and
succesfull thrombolysis not
undergoing early angioplasty.
A ten years Romanian registry
(RO-STEMI) data
Background: Current guidelines recomend clopido-
grel (C) combined with aspirin (A) in patients (pts)
with ST-elevation myocardial infarction (STEMI) and
fbrinolytic therapy. However, the specifc impact of C
in pts with succesfull or failed thrombolysis (FT) was
not still evaluated.
Objective: To compare the in-hospital mortality and
the rates of the major bleeding events in STEMI pts
with succesfull thrombolysis not undergoing early (wi-
thin the frst 24 hours) PCI and treated with anticoagu-
lants combined with either A or A plus C (A&C).
5. Impactul administrarii de
clopidogrel la pacientii cu
infarct miocardic acut cu
supradenivelare de segment ST
si reperfuzie trombolitica
neurmata de PCI precoce.
Date pe 10 ani din Registrul
RO-STEMI
G.Tatu-Chitoiu, Maria Dorobantu, Elvira Craiu, Crina
Sinescu, Carmen Ginghina, Doina Dimulescu, G. Lu-
dusan, I. Balea, Alice Balaceanu, B.Minescu, C. Pop
Spitalul Clinic de Urgenta Floreasca Bucuresti
Introducere: Ghidrile actuale recomanda administra-
rea de clopidogrel (C) plus Aspirina (A) la pacientii
(pts) cu terapie trombolitica (TT) cu infarct miocardic
acut cu supradenivelare de segment ST. Efectul admi-
nistrarii de C la pts la care TT a avut succes nu a fost
inca evaluat.
Obiectiv: Compararea mortalitatii intraspitalicesti si a
incidentei hemoragiilor majore la pts cu TT la care PCI
precoce nu a fost disponibila si care au primit tratament
anticoagulant combinat fe cu A fe cu A plus C (A&C;).
Metoda: In intervalul 1.01.2000-31.12.2009 au fost
inrolati consecutiv 15047 pts in Registrul Roman pen-
tru Infarctul Miocardic cu Supradenivelare de Segment
ST (RO-STEMI). In acest grup, 6588 pts au primit TT.
Efcienta TT a fost evaluata prin doua criterii de reper-
fuzie: disparitia rapida a durerii toracice; scaderea cu
peste 50% a sumei supradenivelarilor de segment ST
la 180 min dupa debutul TT. Pacientii au primit beta-
blocante, inhibitori ai enzimei de conversie a angioten-
sinei, statine si anticoagulante (heparina 1000i.u./ora,
48-96ore sau enoxaparina 1 mg/kg la fecare 12 ore,
8-10 zile) combinate fe cu A 150-300 mg/zi sau A&C;
(incarcare 300 mg, apoi 75 mg/zi).
Rezultate: criteriile de reperfuzie coronariana au
fost evaluate la 5732 (87%) pts. A fost identifcat un
subgrup de 2817 pts cu criterii de reperfuzie post TT
la care nu s-a efectuat PCI precoce. O mortalitate in-
CARDI OPATI E I SCHEMI C | CORONARY HEART DI SEASE
Suplimentul A, 2010
CARDI OPATI E I SCHEMI C

CORONARY HEART DI SEASE
Methods: Between 1.01.2000 and 31.12.2009 the Ro-
manian registry for ST-elevation myocardial infarction
(RO-STEMI) enrolled 15047 consecutive STEMI pts.
In this group, 6588 pts received thrombolytic thera-
py. Te ef cacy of thrombolysis was assessed with two
noninvasive reperfusion criteria: rapid cessation of the
chest pain decrease of the sum of the ST-segment ele-
vations by more than 50% at 180 min. afer the start
of thrombolysis. In the absence of contraindication,
all pts. received beta-blockers,angiotensin converting
enzyme inhibitors,statins,and anticoagulants (unfrac-
tionated heparin-1000 i.u./hour, 48-96 hours-or enoxa-
parin-1 mg/kg every 12 hours for 8-10 days) combined
with either A-150-300 mg./day or A&C (loading dose
of 300 mg followed by 75 mg/day).
Results: Te ef cacy of thrombolysis was correctly
assessed in 5732 (87%) pts. A subgroup of 2817 pts
with succesful reperfusion not undergoing early PCI
was identifed. A signifcant lower in-hospital morta-
lity (1.63%) was seen in the 1225 pts treated with anti-
coagulants and A&C compared with the one of 4.45%
seen in pts who received only anticoagulants and A
(p<0.0001). Te rates of the haemorrhagic stroke were
0.24% and 0.43%, respectivelly, below the limit for de-
tection of the signifcant diference. Te rates of other
major bleeding were 1.14% and 1.82%, respectively
(non-signifcant diference, p=0.192). Te combined
haemorrhagic stroke and major bleeding rates were
1.38% and 2.26%, respectivelly (non-signifcant dife-
rence, p=0.121).
Conclusions: Data from the RO-STEMI registry
suggest that clopidogrel induces a 64% reduction of the
in-hospital mortality in STEMI pts with FT not under-
going early PCI when it is added to the classical anti-
coagulant plus aspirin combination. Tis major impact
is obtained without an increased risk of the major hae-
morrhagical events
6. Tratamentul anticoagulant si
antiagregant plachetar maximal
creste succesul trombolizei la
pacientii cu STEMI si diabet
zaharat. Date RO-STEMI
A.Petris, M. D. Datcu, C.Pop, Mariana Radoi, Catalina
Arsenescu-Georgescu, I.Petrescu, L.Petrescu, Lumi-
nita Serban, V.Stanciul, D.Vinereanu, G.Tatu-Chitoiu
Universitatea de Medicina si Farmacie Gr. T. Popa,
Iasi
Introducere: Pacientii (pts) cu diabet zaharat si infarct
miocardic cu supradenivelare de segment ST (STEMI)
au un risc crescut de evenimente cardiovasculare. Ghi-
durile actuale recomanda administrarea de anticoagu-
lante - enoxaparina (E) sau heparina (H) in combina-
tie cu Aspirina (A) si Clopidogrel (C) la pacientii cu
STEMI cu terapie trombolitica (TT). Efcienta H urma-
ta de E plus antiagregare plachetara duala nu a fost inca
evaluata.
Obiectiv: Compararea evolutiei intra-spitalicesti a pts
diabetici cu STEMI inregistrati in Registrul Roman
pentru Infarctul Miocardic Acut cu Supradenivelare de
Segment ST (RO-STEMI) cu TT si diverse strategii de
anticoagulare si terapie antiplachetara.
Metoda: In RO-STEMI au fost inregistrati 6588 pts con-
secutivi cu TT. In aceasta cohorta am identifcat 1136
pts (17.24%) cu diabet zaharat (62+/-10 ani, 69.98% de
sex masculin). In absenta contraindicatiilor, toti acesti
pts au primit inhibitori ai enzimei de conversie ai an-
giotensinei, beta-blocante, statine si urmatoarele com-
binatii de anticoagulante si antiagregante plachetare:
H-1000 i.u./48-96 ore plus A 150-300 mg/zi (430 pts);
H plus A&C;(doza de incarcare 300 mg urmata de 75
mg/zi -145 pts); E 1 mg/kg 8-10 zile plus A (85 pts); E
plus A&C;(89 pts); 5. H urmata de E plus A (45 pts); 6.
H urmata de E plus A&C;(68 pts).
Rezultate: Mortalitatea intra-spitaliceasca a fost
13.25% (H&A;), 12.94% (E&A;), 8.88% (H&A; urma-
ta de E&A;), 6.20% (H plus A&C;) si 5.61% (E plus
A&C;) (diferente nesemnifcative statistic). O mortali-
tate intra-spitaliceasca semnifcativ mai redusa (2,94%)
a fost identifcata in subgrupul tratat cu H&A;urmata
de E plus A&C;comparativ cu celelalte subgrupuri (p<
0.0001). Incidenta accidentului vascular cerebral global
a fost 0.23% (H plus A); in celelalte subgrupuri nu a fost
inregistrat nici un accident vascular cerebral. Angina
Suplimentul A, 2010
precoce post STEMI sau reocluzia precoce a fost semni-

fcativ statistic mai frecventa in subgrupurile H plus A
(22.79), H plus A&C;(15.85%) si E plus A&C;(16.85%)
comparativ cu de H urmata de E plus A&C;(4.41%) (p
< 0.01).
Concluzii: Datele RO-STEMI sugereaza faptul ca ad-
ministrarea combinatiei Heparina nefractionata (48-96
ore) urmata de Enoxaparina si terapie antiagreganta
plachetara duala (Aspirina si Clopidogrel) reprezinta
cea mai buna strategie teraeutica la pacientii STEMI cu
diabet zaharat tratati cu trombolitice.
Full package anticoagulant
and antiplatelet
armamentarium rise the
thrombolysis succes in STEMI
patients with diabetes. The
Romanian registry for ST-
elevation myocardial infarction
(RO-STEMI).
Background: Patients (pts) with diabetes and ST-eleva-
tion myocardial infarction (STEMI have a high risk for
cardiovascular events. Current guidelines recomend
anticoagulants either enoxaparin (E) or unfractiona-
ted heparin (UH) combined with aspirin (A) and clo-
pidogrel (C) in STEMI pts and thrombolitic therapy.
Te ef cacy of a combined anticoagulant strategy (UH
followed by E) and dual platelet therapy was still not
evaluated in these pts.
Objective: To compare the in-hospital outcome of
STEMI pts with diabetes treated with thrombolysis
and diferent strategies of anticoagulants and antipla-
telet therapy and enrolled in the romanian registry for
STEMI (RO-STEMI).
Methods: RO-STEMI enrolled 6588 consecutive
STEMI pts treated with thrombolytics. In this cohort
we identifed 1136 pts (17.24%) with diabetes (62+/-10
years, 69.98% male). In the absence of contraindication
all of these pts received angiotensin convering enzy-
me inhibitors, beta-blocking agents, statins and the
following combination of anticoagulants and antipla-
telets: 1. UH-1000 i.u./48-96 hours and A 150-300 mg/
day (430 pts); 2. UH and A and C a loading dose of
300 mg followed by 75 mg/day (145 pts); 3. E 1 mg/kg
8-10 days and A (85 pts); 4. E and A&C (89 pts); 5.UA
followed by E plus A (45 pts); 6. UH followed by E plus
A&C (68 pts).
Results: Te in-hospital mortality was 13.25%
(UH&A), 12.94% (E&A), 8.88% (UA&A followed by
E&A), 6.20% (UH plus A&C) and 5.61% (E plus A&C),
subgroups, respectivelly (non-signifcant diferences.
However, a signifcant lower in-hospital mortality was
seen in the UH followed by E plus A&C group com-
pared with the other subgroups (2.94%, p< 0.0001).
Te rates of the global stroke were 0.23% (UH plus A);
non stroke was seen in the other subgroups. Early post
STEMI angina or early reoccusion were signifcantly
higher in UH plus A (22.79), UH plus A&C (15.85%)
and E plus A&C (16.85%) subgroups compared with
UH followed by E plus A&C (4.41%) (p < 0.01).
suggest that a combination between Heparin for 48-
96 hours followed by Enoxaparin and the dual therapy
(Aspirin and Clopidogrel) should be the best strategy in
STEMI patients with diabetes treated by thrombolysis.
7. Angio CT multislice 64
versus ecografia intravasculara
cu histologie virtuala in
evaluarea complexa a placii
instabile
Teodora Benedek, Oana Bucur, Monica Chitu, Claudia
Matei, I.Kovacs, P.I.Sarbu, Gabriela Kozma, Zsuzsanna
Suciu, I.Benedek
Universitatea de Medicina si Farmacie, Targu-Mures
Scopul studiului: Scopul studiului este evaluarea gra-
dului de instabilitate a placilor ateromatoase utilizand
analiza angio CT multislice 64, respectiv ecografa in-
travasculara asociata cu analiza histologica virtuala.
Material si metoda: Lot A - 14 pacienti cu semne cli-
nice de angina instabila, Lot B 10 pacienti cu semne
clinice de angina stabila. Toti pacientii au prezentat ste-
noze coronariene semnifcative hemodinamic, de peste
75%, la nivelul arterelor coronare. In toate cazurile s-a
efectuat coronarografe si ecografe intravasculara aso-
Suplimentul A, 2010

roangiography and intravascular ultrasound associated
with virtual histology analysis were performed. In eight
cases a 64 multislice CT analysis of the coronary bed
was performed. We determined: the plaque burden,
plaque volume, percentage of stenosis and calcium sco-
re of the lesions by angio CT analysis.
Results: All patients in group A and 34% of patients in
group B demonstrated the presence of unstable plaque,
with a content of over 30% of unstable, rich in choles-
terol sof plaque. Virtual histology analysis showed a
unstable sof plaque content, averaging 68% in group A
and 25% in group B, while analysis by angio CT showed
a sof plaque content of 65.6% in group A compared
with 22% in group B (p <0.001). Te plaque volume
was in average 148.6 mm3 in group A and 183.4 mm3
in group B (p <0.001). By the 64 multislice angio CT
analisys we accurately identifed the calcium score and
degree of stenosis (78.3% in group A compared with
89.3% in group B) comparative with the coronaryangi-
ographic fndings - 72.4% in group A and 84% in group
B.
Conclusions: 64 multislice CT angiocoronarography
proved to be a non-invasive diagnostic method extre-
mely useful for complex evaluation of both the severity
of intacoronary plaque and its instability degree, the re-
sults being correlated with those obtained by coronaro-
graphy respectively intravascular ultrasound associated
with virtual histology.
8. Corelatiile intre biomarkerii
de hiperactivitate plachetara,
statusul de hipercoagulabilitate,
stresul oxidativ si evenimentele
cardiovasculare la pacientii cu
sindroame coronariene acute
Elena Bobescu, Mariana Radoi, Georgeta Datcu,
Mirela Donea, Bianca Doka, Mariana Anghel, Simona
Cazacu, D. Sergiu
Universitatea Transilvania, Brasov
Corelatiile intre biomarkerii de hiperactivitate plache-
tara, statusul de hipercoagulabilitate, stresul oxidativ si
evenimentele cardiovasculare la pacientii cu sindroame
ciata cu analiza histologica virtuala, iar la 8 cazuri s-a
efectuat si analiza prin angio CT multislice 64 a patu-
lui coronarian. S-au determinat: gradul de incarcare al
placii, volumul placii, procentul de stenoza si scorul de
calciu al leziunilor prin analiza angio CT.
Rezultate: La toti pacientii din lotul A si la 34% din
pacientii din lotul B s-a demonstrat prezenta de placi
ateromatoase instabile, obiectivizate printr-un continut
de peste 30% de placa moale, instabila, bogata in coles-
terol. Analiza histologica virtuala a aratat un continut
in placa moale, instabila, in medie de 68% in lotul A
respectiv 25% in lotul B, in timp ce analiza prin angio
CT a aratat un continut in placa moale de 65,6% in lo-
tul A comparativ cu 22% in lotul B (p<0,001). Volumul
placii ateromatoase a fost in medie de 148.6 mm3 in
lotul A respectiv 183.4 mm3 in lotul B (p<0,001). Prin
analiza angio CT multislice 64 s-a reusit identifcarea
cu mare acuratete a scorului de calciu si a gradului de
stenoza (78.3% la lotul A comparativ cu 89,3% la lotul
B), comparativ cu analiza coronarografca 72,4% la
lotul A comparativ cu 84% la lotul B.
Concluzii: Angiocoronarografa CT multislice 64 s-a
dovedit a f o metoda neinvaziva de diagnostic extrem
de utila pentru evaluarea complexa atat a gradului de
severitate al placii ateromatoase cat si a gradului de in-
stabilitate al acesteia, rezultatele obtinute corelandu-se
cu cele obtinute prin coronarografe, respectiv ecogra-
fe intravasculara asociata cu histologie virtuala. Lu-
crare fnantata prin grantul de cercetare 41-069/2007
LASCOR, fnantat de MEC prin CNMP
64 multislice angio CT versus
intravascular ultrasound with
virtual histology in the
complex evaluation of the
unstable plaque
Te aim of the study: To evaluate the instability degree
of intracoronary plaques using 64 multislice angio CT
respectively intravascular ultrasound virtual histology
analysis.
Material and methods: Lot A - 14 patients with clini-
cal signs of unstable angina, group B - 10 patients with
clinical signs of stable angina. All patients had signif-
cant coronary stenosis (over 75%). In all cases corona-
Suplimentul A, 2010
coronariene acute Bobescu E. 1,2, Radoi M. 1,2, Dat-

cu G.3, Donea M. 1,2, Doka B2, Anghel M2, Cazacu
S2, Dragomir S1 Transilvania University Brasov, 2Cli-
nic County Emergency Hospital Brasov, 3University of
Medicine and Pharmacy Gr.T.Popa Iasi, Romania
Obiective: La pacientii cu sindroame coronariene
acute fara supradenivelare de segment ST (SCA) eve-
nimentele acute cardiovasculare majore au fost evalu-
ate in corelatie cu biomarkerii de instabilitate a placii
aterosclerotice: hiperactivitatea plachetara, statusul de
hipercoagulabilitate si stresul oxidativ.
Metoda: La 240 pacienti (p) cu SCA biomarkerii pentru
hiperactivitate plachetara (ASPItest, ADPtest - agrego-
metria sangelui integral, numarul de trombocite, volu-
mul plachetar mediu), statusul de hipercoagulabilitate
(activitatea plasmatica a factorului von Willebrand ,
proteina C, S, Antitrombina, rezistenta la factorul V
Leiden- APC Resistance V), stresul oxidativ (status an-
tioxidant total, mieloperoxidaza - MPO IgG ELISA), au
fost determinate si evenimentele acute cardiovasculare
majore (MACE) au fost evaluate in corelatie cu biomar-
kerii mentionati la un an de urmarire. Analiza statisti-
ca: testul de corelatie Pearson.
Rezultate: ASPItest >30U ADPtest >50U Volum me-
diu plachetar >11 f Activitate factor von Willebrand
>169.7% Status antioxidant total <1.3 mmol/l Total pa-
cienti cu SCA 240 103(42.9%) 29(12.9%) 51(21.3%) 106
(44.2%) 145(60.4%) Deces cardiovascular 0.01 0.0001
0.001 0,001 0.0001 IMA nonfatal 0.001 0.01 0.01 0.01
0.009 AVC 0.08 0.34 0.16 0.16 0.08 Reinternare pentru
insufcienta cardiaca 0.01 0.01 0.01 0.01 0.001 Reinter-
nare pentru angina recurenta 0.001 0.001 0.001 0.001
0.01 ASPItest >30U - 0.001 0.01 0.001 0.001 ADPtest
>50U 0.001 - 0.01 0.001 0.001 Volum mediu plachetar
>11 f 0.001 0.001 - 0.01 0.01 Activitate factor von Wil-
lebrand >169.7% 0.001 0.001 0.01 - 0.01 Status antioxi-
dant Total <1.3 mmol/l 0.01 0.01 0.01 0.01 - Legenda:
IMA= infarct miocardic acut; ADPtest = testul pentru
adenozin-difosfat; ASPItest = testul pentru aspirina
Concluzii: la pacientii cu SCA o incidenta semnifcativ
crescuta a evenimentelor acute cardiovasculare majore
a fost asociata cu: o incidenta crescuta a raspunsului in-
adecvat la aspirina si clopidigrel, un volum mediu pla-
chetar mare, cresterea activitatii plasmatice a factoru-
lui von Willebrand si reducerea statusului antioxidant
total. plasma activity and lower serum values of total
antioxidant status. Hiperactivitatea plachetara, statusul
de hipercoagulabilitate si stresul oxidativ s-au corelat
inalt semnifcativ la pacientii cu SCA. In sindroamele
coronariene acute fost inregistrata o incidenta crescuta
a raspunsului inadecvat de 4 ori mai mare la aspirina
decat la clopidogrel. Alti markeri determinati nu s-au
corelat cu MACE. Incidenta trombofliei a fost foarte
redusa la pacientii cu SCA. Studiu realizat in cadrul
Proiectului ID_727 Competitia 2008 PN II-ID-PCE.
Correlation between
biomarkers of
platelets hyperactivity,
hypercoagulability status,
oxidative stress and
cardiovascular events in
patients with acute coronary
syndromes
Correlation between biomarkers of platelets hyperac-
tivity, hypercoagulability status, oxidative stress and
cardiovascular events in patients with acute coronary
syndromes Bobescu E. 1,2, Radoi M. 1,2, Datcu G.3,
Donea M. 1,2, Doka B2, Anghel M2, Cazacu S2, Drago-
mir S1 Transilvania University Brasov, 2Clinic County
Emergency Hospital Brasov, 3University of Medicine
and Pharmacy Gr.T.Popa Iasi, Romania
Purpose: In patients with non ST elevation acute co-
ronary syndrome (ACS), major acute cardiovascular
events were evaluated in correlation with biomarkers
of platelets hyperactivity, hypercoagulability status and
oxidative stress as measures of atherosclerotic plaque
instability.
Methods: In 240 patients (pts) with ACS biomarkers
for platelets hyperactivity (ASPItest, ADPtest by mul-
tiple electrode aggregometry, platelets count, mean
platelet volume), hypercoagulability status (Von Wille-
brand factor activity, C, S protein, Antithrombin, Fac-
tor V Leiden- APC Resistance V), oxidative stress (To-
tal antioxidant status, Myeloperoxidase MPO IgG ELI-
SA), were determinate and major acute cardiovascular
events (MACE) were evaluated in correlation with
biomarkers at one year of follow up. Statistic analysis:
Pearson correlation test.
Results: ASPItest >30U ADPtest >50U Mean platelet
volume >11 f Von Willebrand factor activity >169.7%
Total antioxidant status <1.3 mmol/l Total ACS pati-
Suplimentul A, 2010

ents 240 103(42.9%) 29(12.9%) 51(21.3%) 106(44.2%)
145(60.4%) Cardiovascular death 0.01 0.0001 0.001
0,001 0.0001 Nonfatal AMI 0.001 0.01 0.01 0.01 0.009
Stroke 0.08 0.34 0.16 0.16 0.08 Heart failure with re-
admission 0.01 0.01 0.01 0.01 0.001 Recurrent angina
with readmission 0.001 0.001 0.001 0.001 0.01 AS-
PItest >30U - 0.001 0.01 0.001 0.001 ADPtest >50U
0.001 - 0.01 0.001 0.001 Mean platelet volume >11 f
0.001 0.001 - 0.01 0.01 Von Willebrand factor activity
>169.7% 0.001 0.001 0.01 - 0.01 Total antioxidant status
<1.3 mmol/l 0.01 0.01 0.01 0.01 - Legend: AMI= acute
myocardial infarction; ADPtest = Adenosine dipho-
sphate test; ASPItest = Aspirin test.
Conclusions: In ACS patients a signifcant higher inci-
dence of MACE were associated with higher: inciden-
ce of inadequate response to aspirin and clopidogrel,
mean platelet volume, von Willebrand factor plasma
activity and lower serum values of total antioxidant
status. Platelets hyperactivity, hypercoagulability status
and oxidative stress were signifcantly correlated in pa-
tients with ACS. An increased incidence of inadequate
response, 4 fold higher at aspirin than clopidogrel was
detected. All other markers were no signifcant corre-
lated with MACE. Te incidence of thrombophilia was
very low in ACS patients. Acknowledgement: Project
ID_727 Competition 2008 in National Research Pro-
gram PN II
12
fost de 85% in cazul ecografei 3D comparativ cu 95%
in cazul angio CT multislice 64 (p=0.01).
Concluzii: Atat C3DE cat si angio CT multislice 64 pot
reprezenta metode diagnostice extrem de utile pentru
evaluarea complexa si obiectiva a ischemiei miocardi-
ce, avantajul angiografei CT multislice 64 find posi-
bilitatea evaluarii leziunilor coronariene pe cale nein-
vaziva cu ocazia aceleiasi sedinte, precum si utilizarea
unui parametru mai fdel (ingrosarea peretelui miocar-
dic) ca indicator al gradului de ischemie segmentara.
Lucrare fnantata de CNMP prin grantul 41-069/2007
LASCOR.
64 multislice angio CT
versus computerized 3D
echocardiography in the
objective evaluation of
myocardial ischemia
Te aim of the study: objective evaluation of myocar-
dial kinetic disorders using two recent imaging tech-
niques based on computer analysis of segmental kine-
tic disorders: 64 multislice CT angiocardiography and
computerized 3D echocardiography.
Matherial and methods: 20 patients with angina, is-
chemic changes and signifcant coronary lesions,in
which were performed: (1) computerized 3D echocar-
diography (C3DE) for three-dimensional analysis of
kinetic disorders, using as an indicator of the kinetic
disorder the contraction amplitude by tracing the en-
docardic contour and the analysis of its kinetic curve.
(2) 64 multislice angio CT, for assessment of coronary
lesions and for the computerized evaluation of the
segmental ischemia, using as an indicator for kinetic
disorder contraction amplitude and the degree of wall
thickening by tracing the endocardic and epicardic
contour.
Results: C3DE accurately identifed the location and
extension of contractility disorder, represented as a
spot on the map polar kinetic and an average decrease
of 56% of the maximal amplitude of contraction in is-
9. Angio CT multislice 64
versus ecocardiografia 3D
computerizata in evaluarea
obiectiva a ischemiei
miocardice
Teodora Benedek, Monica Chitu, Claudia Matei,
I.Kovacs, P.I.A.Sarbu, Oana Bucur, Gabriela Kozma,
Zsuzsanna Suciu, I.Benedek
Universitatea de Medicina si Farmacie, Targu-Mures
Scopul studiului: Evaluarea obiectiva a tulburarilor de
cinetica miocardica utilizand doua tehnici imagistice
recente, bazate pe analiza computerizata a tulburarilor
de cinetica segmentara: angiocardiografa CT multisli-
ce 64 respectiv ecocardiografa 3D computerizata.
Material si metoda: 20 pacienti cu angina, modif-
cari ischemice si leziuni coronariene semnifcative, la
care s-a efectuat: (1) ecocardiografe 3D computerizata
(C3DE) pentru analiza tridimensionala a tulburari-
lor de cinetica, utilizandu-se ca indicator al tulburarii
de cinetica amplitudinea contractiei pe baza trasarii
conturului endocardic si analizei curbei de cinetica a
acestuia. (2) angio CT multislice 64, atat pentru eva-
luarea leziunilor coronariene cat si pentru evaluarea
computerizata a ischemiei segmentare, utilizandu-se
ca indicator al tulburarii de cinetica atat amplitudinea
contractiei cat si gradul de ingrosare a peretelui pe baza
trasarii conturului endocardic si epicardic.
Rezultate: C3DE a identifcat cu acuratete localizarea si
extensia tulburarii de contractilitate, reprezentata ca un
spot pe harta polara de cinetica si o scadere medie de
56% a amplitudinii maximale a contractiei segmentelor
ischemice comparativ cu cele non-ischemice la testarea
cu dobutrex. Angio CT multislice 64 a reusit nu numai
localizarea segmentelor ischemice pe baza unui para-
metru mai fdel, gradul de ingrosare a peretelui (care a
fost de 25% pentru segmentele ischemice comparativ
cu 42% pentru cele non-ischemice, p<0,001), dar si co-
relarea acestei localizari cu cea a stenozei coronariene
pe baza coronarografei CT efectuata cu ocazia aceleiasi
examinari. Astfel, gradul de suprapunere a localizarii
segmentului identifcat ca ischemic cu localizarea lezi-
unii la nivelul arterei coronare care iriga acel teritoriu a
POSTER FORUM I | POSTER FORUM I
Suplimentul A, 2010
18
POSTER FORUM I
POSTER FORUM I
chemic compared with non-ischemic segments by do-
butrex testing. 64 multislice angio CT has not only lo-
cated the ischemic segments by using a more accurate
parameter, the degree of thickening of the wall (which
was 25% for ischemic segments compared with 42% for
non-ischemic, p <0.001), but correlate this localization
with that of the coronary stenosis on CT coronaroan-
giography performed during the same examination.
Te degree of overlap of the localization of ischemic
segment and the lesion in the coronary artery was 85%
for 3D ultrasound compared with 95% for 64 multislice
angio CT (p = 0.01).
Conclusions: Both C3DE and 64 multislice angio CT
can be very useful diagnostic methods for comprehen-
sive and objective evaluation of myocardial ischemia,
64 multislice CT angiography advantage is the possi-
bility of non-invasive assessment of coronary lesions at
the same sitting, and the use of a more objective para-
meter (myocardial wall thickening) as indicator of seg-
mental ischemia. Study fnanced within the research
grant no. 41-069/2007 LASCOR, fnanced by MEC
via CNMP
10. Parametrii ecocardiografici
asociati cu cresterea a presiunii
de umplere la pacientii
hipertensivi cu infarct
miocardic acut
Despina Manuela Toader, Rodica Musetescu, Monica
Popescu, D.D. Ionescu
Centrul de Cardiologie, Craiova
Premise: Pacienttii hipertensivi prezinta presiuni de
umplere mari in ventriculul stang, care sunt crescute
suplimentar in timpul fazei acute a infarctului miocar-
dic acut datorita zonelor de necroza si ischemie.
Scopul studiului: a fost evaluarea parametrilor ecocar-
diografci de disfunctie diastolica la pacientii hiperten-
sivi in prima saptamana postinfarct miocardic acut.
Metoda: 98 de pacienti hipertensivi (56 barbati si 43 fe-
mei) internati cu diagnostic de IMA cu supradenivelare
de segment ST au fost evaluati in prima saptamana de
spitalizare prin: examen clinic, ECG 12 derivatii, masu-
rarea ecocardiografca a: indexului de volum al atriu-
lui stang (IVAS) si a indexului de masa al ventriculului
stang (IMVS) folosind ecocardiografa transtoracica,
evaluarea presiuni sistolice in artera pulmonara (PAPs)
din jetul de isufcienta tricuspidiana folosind ecocardi-
ografa Doppler continuu la nivelul valvei tricuspide,
calcularea raportului E/E, E/vp si durata diferentei ar-
A, folosind: ecocardiografa Doppler pulsat la nivelul
valvei mitrale (masurarea velocitatii undei E si durata
undei A), ecocardiografa Doppler tisular la nivelul ine-
lului mitral lateral si medial (masurarea velocitatii un-
dei E), ecocardiografa Mmode color la nivelul valvei
mitrale (masurarea velocitatii de propagare a fuxului
vp), ecocardiografa Doppler pulsat la nivelul venelor
pulmonare (masurarea duratei undei ar); valori limita:
IVAS>32ml/m2, IMAS>131g/m2 la barbati si >125g/
m2 la femei (hipertrofe de ventricul stang, HVS),
PAPs>35mmHg, E/E>15, E/vp>1,5, ar-A>25ms. FEVS
masurata prin metoda Simpson a fost in toate cazurile
mai mica de 45%. Pacientii au fost impartiti in 4 gru-
puri: 1. HVS+ si reperfuzie efcienta 2. HVS- care nu au
prmit terapie de reperfuzie sau cu reperfuzie inefcienta
3. HVS- si reperfuzie efcienta 4.HVS- fara reperfuzie
sau cu reperfuzie inefcienta.
Rezultate: 1. 67 pacienti (68,36%) au prezentat criterii
de HVS. 2. Valorile medii ale parametrilor ecocardio-
grafci de crestere a presiunii de umplere la pacientii cu
HVS si fara reperfuzie au fost: IVAS: 35,04, p=0,00007,
PAPs: 45,57, p= 0,00122, E/E: 14,81, p=0,03992, E/vp:
1,99, p=0,00197, ar-A: 28,79, p=0,00726. 3. Cel mai
mare procent de pacienti cu valori medii ale parametri-
lor de umplere ce au depasit valorile limita a fost gasit
in grupul cu HVS care nu a primit terapie de reperfuzie
sau care desi au primit trombolitic nu au prezentata cri-
terii de reperfuzie: IVAS: 26,53%, PAPs: 26,53%, E/E:
15,31%, E/vp:22,45%, ar-A: 16,33%.
Concluzii: 1. La pacientii hipertensivi fara criterii de
reperfuzie toti parametrii ecocardiografci asociati cu
cresterea presiunii de umplere au avut valori medii mai
mari decat valorile limita, comparativ cu pacientii hi-
pertensivi fara HVS si cu criterii de reperfuzie prezen-
te. 2.Cele mai mari valori au fost intalnite in grupul cu
HVS fara reperfuzie, pacienti care teoretic au cele mai
mari presiuni de umplere.
POSTER FORUM I
POSTER FORUM I
Suplimentul A, 2010
11
Echocardiographic
parameters of filling presure
in hypertensive patients with
acute myocardial infarction
Background: Before acute myocardial infarction
(AMI), hypertensive patients have high flling pressu-
re in lef ventricle which is supplementary rised during
the infarction by the areas of necrosis and ischemia.
Aims of the study: was to evaluate echocardiographic
parameters of diastolic dysfunction in hypertensive pa-
tients during the frst week afer AMI.
Methods: A number of 98 hypertensive patients (56
males and 43 females), admitted with acute myocar-
dial infarction with ST-segment elevation were eva-
luated in the frst week by: clinical examination, 12
lead standard ECG, echocardiographic measurements
of: lef atrium volume index (LAVi) and lef ventricle
mass index (LVMi) using transthoracic echocardiogra-
phy, pulmonary artery systolic pressure (PAPs) using
Doppler echocardiography for tricuspid infow, E/E, E/
vp and ar-A, using Doppler echocardiography for mi-
tral infow (E wave velocity, A wave duration), tissue
Doppler echocardiography at lateral and medial corner
of mitral annulus (E wave velocity), colour Mmode
(fow propagation velocity vp) and pulmonary veno-
us fow (ar wave duration): cut of levels: LAVi>32ml/
m2, LVMi>131g/m2 in males and>125g/m2 in females
(lef ventricular hypertrophy, LVH), PAPs>35mmHg,
E/E>13, E/vp>1,5, ar-A>25ms. LVEF measured by
Simpson method was less than 45%. Patients were di-
vided in 4 groups: 1.LVH+ and reperfusion 2.LVH+
without reperfusion 3.LVH- and reperfusion 4.LVH-
without reperfusion.
Results: 1.LVH was found in 67 patients (68, 36%).
2.Mean values of parameters of flling pressure in
hypertensive patients with LVH and without reper-
fusion were: VASi: 35,04, p=0,00007, PAPs: 45,57, p=
0,00122, E/E: 14,81, p=0,03992, E/vp: 1,99, p=0,00197,
ar-A: 28,79, p=0,00726. 3. Percentages of patients with
LVH and without reperfusion which presented flling
pressure parameters values higer than cut of level
were: VASi: 26,53%, PAPs: 26,53%, E/E: 15,31%, E/
vp:22,45%, ar-A: 16,33%.
Conclusions: 1.In hypertensive patients without or fa-
iled thrombolitic therapy all echocardiographic para-
meters of flling pressure mean values were higher than
cut of levels and than in hypertensive patients without
LVH and with successful medical reperfusion. 2. Te
highest mean values were found in hypertensive pa-
tients with LVH and without reperfusion, which the-
oretical had the highest values of lef ventricle flling
pressure.
11. Alterarea vasodilatatiei
mediate de flux la nivelul
arterei brahiale la pacienti
hipertensivi cu sindrom
metabolic
Simona Dragan, Corina Serban, Ruxandra Christo-
dorescu, Maria Rada, Dana Velimirovici,
Spitalul Clinic Municipal de Urgenta, Clinica de
Cardio logie ASCAR, Timisoara
Premize: Sindromul metabolic este o aglomerare de
factori de risc interconectati care indica pacientii cu
risc crescut de diabet zaharat de tip 2 si boala corona-
riana.
Obiective. Scopul acestui studiu a fost compararea va-
lorilor parametrilor antropometrici si ale vasodilatatiei
mediate de fux la nivelul arterei brahiale la pacienti hi-
pertensivi cu sindrom metabolic in functie de numarul
de criterii ale NCEP ATP III prezente.
Material si metoda: Au fost studiati 48 de pacienti
cu sindrom metabolic 3.67 ani). Sindromul metabo-
lic (varsta medie 57 a fost defnit conform criterii-
lor NCEP ATP III. Pacientii, cu caracteristici similare
in ceea ce privete distributia pe sexe i varsta, au fost
apoi impartiti in patru grupuri in functie de numarul
de criterii ale NCEP ATP III indeplinite: 12 pacienti cu
2, 11 pacienti cu 3, 13 pacienti cu 4 si 12 pacienti cu 5
criterii NCEP ATP III indeplinite. Au fost determinate
la toti participantii parametrii antropometrici: indicele
de masa corporala (IMC), circumferinta abdominala
(CA) si raportul talie-sold (WHR). Au fost efectua-
te studii ultrasonografce de inalta rezolutie pentru a
masura raspunsurile endotelial-dependente [exprimate
ca vasodilatatie-mediata de fux % (FMD)] ale arterei
brahiale.
Rezultate: A fost observata o relatie directa, semnifca-
tiva, gradata intre valorile parametrilor antropometrici
si numarul de criterii NCEP ATP III prezente. Valori-
le medii ale IMC pentru cei cu 2, 3, 4, si 5 0.44,0.52,
32.55 0.62, 30.75 0.34, 27.85 criterii au fost: 25.66
kg/m2, p < 0.001. Valorile medii ale CA pentru cei cu 2,
Suplimentul A, 2010
15
POSTER FORUM I
POSTER FORUM I
Mean BMI values for those with 2, 3, 4, and 5 criteria
were: 0.44, kg/m2, p0.52, 32.55 0.62, 30.75 0.34,
27.85 25.66 < 0.001 for trend. Mean WC values for
those with 2, 3, 4, and 5 criteria were: 1.7, cm, p2.51,
1196.96, 110 7.40, 10090 < 0.001 for trend. Mean
0.03,WHR values for those with 2, 3, 4, and 5 crite-
ria were: 0.90 0.02, cm, p0.02, 1.160.03, 1.060.98 <
0.001 for trend. Te study revealed a signifcant inver-
se graded relationship between the values of brachial
FMD and the number of NCEP criteria present (mean
FMD for 2.96%, 5 2.78%, 5.41.75%, 8.9those with
2, 3, 4, and 5 criteria: 8.49 2.77%, p < 0.001 for trend).
Conclusions: Evaluation of FMD in brachial artery is
a usefull tool in assessing the grade of impairment of
endothelial function in hypertensive patients with me-
tabolic syndrome.
12. Mortalitatea pe termen
scurt si mediu si unii factori
predictivi la pacientii cu SICA
(sindroame de insuficienta
cardiaca acuta) in Sectia de
Cardiologie a Sp. Clinic de
Urgenta Sf. Pantelimon
Liliana Protopopescu, V.A.Molfea, Lenuta Hai-
ducu, Andreea Bjerkestrand, Oana Siminonescu,
T.Protopopescu, M.M.Vintila
Spitalul Clinic de Urgenta Sf. Pantelimon, Bucuresti
Scopul lucrarii: Evaluarea mortalitatii si a factorilor
predictivi de mortalitate pe termen scurt si mediu la
pacientii cu SICA, in Clinica de Cardiologie a Sp. Cli-
nic de Urgenta Sf. Pantelimon Bucuresti.
Material si metoda: S-au analizat 313 pacienti conse-
cutivi, cu SICA, internati in Clinica de Cardiologie pe
o perioada de 6 luni, la care s-a evaluat mortalitatea in-
traspitaliceasca, la 30 zile, 6 luni si un an de la externare
si unii factori predictivi ai acesteia. S-au exclus cazurile
la care nu s-au putut obtine date postexternare.
Rezultate: Mortalitatea intraspitaliceasca a fost de
13,74%, mortalitatea la 30 zile de 18,21%, de 24,92%
la 6 luni si de 34,18 % la 1 an. Mortalitatea s-a corelat
semnifcativ cu valoarea TAs la internare, find maxima
3, 4, si 5 1.7, cm, p2.51, 1196.96, 110 7.40, 100cri-
terii au fost: 90 < 0.001. Valorile medii ale WHR pentru
cei cu 2, 3, 4, si 5 criterii au 0.02, cm, p0.02, 1.160.03,
1.06 0.03, 0.98fost: 0.90 < 0.001. Studiu a relevat
o relatie inversa, gradata, semnifcativa intre valorile
FMD si numarul de criterii NCEP prezente (valoarea
medie a FMD 2.96%, 52.78%, 5.41.75%, 8.9pentru
cei cu 2, 3, 4, si 5 criterii: 8.49 2.77%, p < 0.001).
Concluzii: Evaluarea FMD la nivelul arterei brahiale
este un instrument util pentru aprecierea gradului de
afectare al functiei endoteliale la pacientii hipertensivi
cu sindrom metabolic.
Impairment of flow-mediated
vasodilatation in the brachial
artery in hypertensive patients
with metabolic syndrome
Background: Te metabolic syndrome is an agglome-
ration of interrelated risk factors that identify patients
at increased risk for type 2 diabetes mellitus (DM) and
coronary artery disease.
Purpose: Te aim of this study was to compare the va-
lues of anthropometric parameters and the values of
brachial fow mediated vasodilatation in hypertensive
patiens with metabolic syndrome in function of the
number of NCEP ATP III criteria present in each pa-
tient.
Material and method: Te study included 48 hyper-
tensive patients with 3.67 years). MS was defned me-
tabolic syndrome (MS) (mean age 57 according to the
National Cholesterol Education Program Adult Treat-
ment Panel III guidelines. Te patients were divided in
four groups in function of the number of NCEP criteria
present: 12 patients with 2, 11 patients with 3, 13 pa-
tients with 4, and 12 patients with 5 criteria of NCEP
accomplished, age and sex matched. Anthropometric
parameters: body mass index (BMI), waist circumfe-
rence (WC) and waist-hip ratio (WHR) were determi-
ned for all participants. High-resolution brachial artery
ultrasonographic studies were performed to assess en-
dothelium-dependent [expressed as % fow-mediated
dilatation (FMD)] responses.
Results: A signifcant direct graded relationship was
observed between the values of anthropometric pa-
rameters and the number of NCEP criteria present.
POSTER FORUM I
POSTER FORUM I
Suplimentul A, 2010
16
in grupul cu TAs<90 mmHg (59,1% in spital, 68,18% la
30 zile, 81,81% la 6 luni cat i la 1 an, scznd progre-
siv odat cu creterea valorilor TAs la internare si atin-
gand la cei cu TAs>180 mmHg 3,33% in spital, 5,09%
la 30 zile, 6,78% la 6 luni, 15,25% la 1 an (semnifcative
statistic comparativ cu grupul celor cu valori norma-
le ale TAs la internare). Mortalitatea intraspitaliceasca
cat si la 30 zile este crescuta la cei cu DZ tip II fata de
cei fara DZ tip II (20% fata de 9,5% in spital-p=0,05,
23,80% fata de 14% la 30 zile- p=0,05). Clearance-ul
la creatinina (Cl cr) < 30 ml/min/1,73m2 (MDRD) se
coreleaza semnifcativ statistic cu mortalitatea in spi-
tal, la 30 zile, 6 luni si 1 an ( p=0,01 la toate corelatiile)
comparativ cu cei cu Cl cr > 90 ml/min/1,73m2. Na la
internare se coreleaza cu decesul in spital, la 30 zile, la
6 luni si la 1 an; mortalitatea la cei cu Na>135 mmol/l
este de 12,40% in spital, de 16,80% la 30 zile, 21,60%
la 6 luni, 29,60% la 1 an fata de cei cu Na<130 mmol/l
la care mortalitatea este de 29,17% in spital (p=0,05),
33,33% la 30 zile (p=0,05), 58,33% la 6 luni (p=0,01),
75 % la 1 an (p=0,01).
Concluzii: Mortalitatea in spital, la 30 zile, 6 luni si un
an s-a corelat negativ cu valoarea TAs la internare si
cu Cl cr la internare. Mortalitatea s-a corelat pozitiv cu
hiponatremia marcata la internare (Na<130 mmol/l).
DZ tip II a fost un factor predictiv al mortalitatii cres-
cute in cursul spitalizarii si la 30 zile de la externare.
Valorile crescute ale mortalitatii pe termen scurt ridica
problema reevaluarii managementului terapeutic al pa-
cientilor cu SICA.
Short and medium term
mortality and factors that
predict mortality in patients
with acute heart failure (AHF)
in the Cardiology Department
of St. Pantelimon Emergency
Hospital.
Aim of study: Evaluation of mortality and factors that
predict short and medium term mortality in patients
with acute heart failure (AHF) in the Cardiology De-
partment of St. Pantelimon Emergency Hospital, Bu-
charest.
Methods: We analyzed 313 consecutive patients with
AHF, admitted in the Cardiology Department over a
6 months period, evaluating mortality during hospita-
lization, at 30 days, 6 months and one year afer dis-
charge. We excluded cases which could not be followed
afer discharge.
Results: Hospital mortality was 13,74%, 30 days mor-
tality was 18,21%, at 6 months it reached 24,92% and at
one year 34,18%. Mortality was signifcantly correlated
with the systolic BP value upon admission; it was hi-
ghest in the group with sBP<90 mmHg(59,1% in the
hospital, 68,18% at 30 days, 81,81% at 6 months and at
one year and it decreased progressively with the incre-
ase in sBP, reaching 3,33% in the hospital, 5,09% at 30
days, 6,78% at 6 months and 15,25% at one year in tho-
se with sBP>180 mmHg (statistical signifcance com-
pared to those with normal sBP values). Hospital and
30 days mortality are increased in those with type II
DM compared to those without DM( 20% compared to
9,5% in the hospital-p=0,05, 23,80% compared to 14%
at 30 days- p=0,05). Creatinine clearance (CrCl)< 30
ml/min/1,73m2(MDRD) signifcantly correlates with
mortality in the hospital, at 30 days, 6 months, one year
(p=0,01 in each correlation) compared to those with
CrCl>90ml/min/1,73m2. Na on admission correlates
with mortality in the hospital, at 30 days, 6 months, 1
year, in those with Na> 135 mmol/l it reaches 12,40 %
in the hospital, 16,8% at 30 days, 21,6% at 6 months
and 29,60% at one year compared to those with Na<
130 mmol/l in which mortality is 29.17% in the hos-
pital (p=0,05), 33,33% at 30 days (p=0,05), 58,33% at 6
months (p=0,01) and 75% at one year(p=0,01).
Conclusions: Mortality in the hospital, at 30 days,
6 months and one year afer discharge was inversely
correlated with the sBP value on admission and with
the creatinine clearance. Mortality was correlated with
marked hiponatremia (Na<130 mmol/l) on admission.
Type II DM was an increased mortality predictor in the
hospital and at 30 days afer discharge. Te high values
of short term mortality raise the problem of reevalua-
ting the therapeutic management of AHF patients.
Suplimentul A, 2010
1I
POSTER FORUM I
POSTER FORUM I
0.001), neutra (35.5% - majoritar la elevii clasei a IX-a,
p< 0.001), de ingrijorare (15% din desene) sau pesimis-
ta (in 6.5% din cazuri).
Concluzii: Exista in randul elevilor, indiferent de etapa
de instruire, disponibilitatea de a invata/ aplica masuri-
le BLS, dar cunostintele lor sunt inca fragmentare.
You can also save a life!
Project - Teaching basic life
support in school: perception
and involvement.
Background: Starting the basic life support training in
school would be the better way to obtain the suitable
rescuer skills in an altruistic environment encouraging
this social responsibility.
Objective: To assess the diferences between the per-
ception and the reality in the school feld (You can also
save a life! Project).
Methods: We analyzed the questionnaires and drawings
(non-verbal means of expression and communication)
completed by 110 school children in various stages of
training (class IV 56 subjects, class VIII 25 subjects and
class IX 29 subjects). Subjects completed questionnaires
on previous experience with medical emergencies, the
emergency call number 112 and the correct behavior in
the case of cardiopulmonary arrest. Afer a brief over-
view of BLS steps according to European Resuscitation
Council, 2005 (1. approach safely; 2. check the victim
response; 3. shout for help; 4. open airway; 5. check
breathing; 6. call 112; 7. perform cycles of 30 chest
compressions, 8. and two ventilation) and watching
a video with dynamic BLS the subjects was asked to
make a drawing that expresses the main messages sent
to those involved in cardiopulmonary resuscitation.
Results: Te percentage of complete questionnaire
response was 98.2% and the achievement of drawings
97.3%. We found that 57.3% of subjects had already
witnessed a medical emergency and that 97.3% know
the correct emergencies phone number. Of the eight
elements of BLS subjects correctly identifed the steps
6 (78.2%) and 3 (33.6%) while only 0.9% mentioned
steps 4 and 5. Te drawings were related to step 6
(66.4%), followed by step 1 (44.9%), step 3 (31.8%) and
7 (25.2%). Te main characters shown in the drawing
was the victim (79.4%), the rescuer (79.4%), the emer-
13. Proiectul Poti si tu salva o
viata! - Instruirea elevilor in
masurile elementare de suport
vital: perceptie si implicare
A.Petris, G.Tatu-Chitoiu, Liliana Dohotariu, Adina
Durbaca, A.Zanoschi, Irina Costache, Diana Cim-
poesu
Universitatea de Medicina si Farmacie Gr. T. Popa Iasi
Intoducere: Initierea inca din scoala a instruirii in ma-
surile elementare de suport vital (BLS) poate f cea mai
buna metoda de a dobandi deprinderile necesare unui
bun resuscitator in cadrul unui mediu altruist care in-
curajeaza indeplinirea responsabilitatilor sociale.
Obiectiv: Evaluarea cunostintelor legate de resuscita-
rea cardio-pulmonara in etape diferite de instruire sco-
lara (proiectul Poti si tu salva o viata!).
Metoda: Au fost analizate chestionarele si desenele
(modalitate non-verbala de exprimare si comunicare)
realizate de catre 110 elevi afati in etape diferite de in-
struire (clasa a IV-a 56 subiecti, clasa a VIII-a 25 su-
biecti si clasa a IX-a 29 subiecti). Subiectii au completat
chestionarele referitoare la experienta anterioara cu ur-
gentele medicale, cunoasterea numarului de apel 112 si
conduita corecta in cazul unui stop cardio-pulmonar.
Dupa o scurta prezentare a etapelor BLS conform ECR,
2005 (1. apropie-te in siguranta; 2. verifca raspunsul
victimei; 3. striga dupa ajutor; 4. deschide caile aeriene;
5. verifca respiratia; 6. suna la 112; 7. efectueaza cicluri
de 30 de compresii toracice; 8. si doua ventilatii) si vi-
zionarea unui videoclip cu dinamica BLS s-a solicitat
subiectilor sa realizeze un desen care sa exprime princi-
palele mesaje de transmis celor implicati in resuscitare.
Rezultate: Procentul raspunsului complet la chestio-
nar a fost de 98.2%, iar cel de realizare a desenelor de
97.3%. S-a constatat ca 57.3% dintre subiecti au asis-
tat deja la o urgenta medicala si ca 97.3% cunosc nu-
marul corect al telefonului destinat urgentelor. Dintre
cele opt elemente ale BLS subiectii au identifcat corect
etapa 6 (78.2%) si 3 (33.6%) in timp ce doar 0.9% au
mentionat etapele 4 si 5. Desenele s-au referit la etapa 6
(66.4%), urmata de etapa 1 (44.9%), etapa 3 (31.8%) si
7 (25.2%). Principalele personaje prezente in desene au
fost victima (79.4%), resuscitatorul (79.4%), telefonul
de urgenta (51.4%) si ambulanta (16.8%). Atitudinea
fata de RCP degajata de catre desen a fost optimista in
41.1% din cazuri (majoritar la elevii clasei a IV-a, p <
POSTER FORUM I
POSTER FORUM I
Suplimentul A, 2010
18
IMC si majoritatea parametrilor evaluati. Urmatoarele
date cuprind valorile medii, deviatiile standard si co-
relatiile cu IMC: VB (86.2512.01 ml/bataie, r=-0.326,
p=0.003), RMU (3.050.73 VTD/s, r=-0.335, p=0.003),
FEVD (57.57.3%, r=-0.335, p=0.002). Evolutia para-
metrilor din repaus pana la efortul maxim a fost: VB
a crescut cu 20.81 4.52 %, FEVD cu 19.7 3.45 %,
RMU cu 18.46 2.65%. La analiza ANOVA post-hoc a
celor trei grupuri, variatia VB, FE si RMU a fost semni-
fcativ diferita in grupul 3 comparativ cu grupurile 1 si
2 (p=0.001, 0.0001 si respectiv 0.001)
Concluzii: Rezerva contractila a ventriculului drept si
functia sa diastolica la efort ar putea f afectate la su-
biecti cu obezitate extrema, in absenta altor boli cardi-
ovasculare.
Right ventricle in obesity
- a supine exercise
echocardiographic and
radionuclide study
Obesity is a strong predictor of cardiovascular disease
and is associated with subclinical lef ventricular (LV)
dysfunction. Te right ventricular (RV) systolic and di-
astolic abnormalities in the obese subjects without car-
diac symptoms are less well defned.
Te aim of the study was to evaluate RV function at rest
and during exercise by means of supine exercise echo-
cardiography (SEE) and gated blood pool radionuclide
ventriculography (GBPRV) in subjects with isolated
obesity.
Methods: 81 subjects of either gender (mean age 39.1
4.3 years) with a body mass index (BMI) > 30 Kg/m2,
who were free of hypertension, diabetes, dyslipidemia
and organic heart disease, were included in the study.
All subjects underwent a complete clinical, rest echo-
cardiography and SEE examination and rest and exer-
cise GBPRV. RV end-diastolic and end-systolic volu-
mes (EDV, ESV), stroke volume (SV), ejection fraction
(EF), and peak flling rate (PFR) were measured at rest
and during exercise and contractile reserve and diasto-
lic function of RV were determined. Te subjects were
divided into three groups according to BMI (Group 1
with BMI 30-34.9 kg/m2, group 2 with BMI 35-39.9 kg/
m2, group 3 with BMI 40 kg/m2).
Results: Te mean BMI was 36.48 4.05 kg/m2. In the
pooled subject population we found signifcant correla-
gency phone (51.4%) and the ambulance (16.8%). Te
attitude toward CPR released from the drawing was
optimistic in 41.1% cases (mostly from the children of
class IV, p <0.001), neutral (35.5% - mostly from the
children of class IX, p <0.001), deep concern (15%) or
pessimistic (on 6.5% of cases).
Conclusions: School children in various stages of trai-
ning show a great willingness to learn/ apply BLS mea-
sures, but their knowledge is still fragmentary.
14. Ventriculul drept in
obezitate un studiu
ecocardiografic si scintigrafic
de efort
Cristina Maria Stanescu, G.A.Dan, D.A.Stanescu,
V.Manoliu, K.Branidou, C.Stan, Cristina Chirion,
C.Baicus, Anca Dan, Daniela Gologanu
Spitalul Clinic Colentina, Bucuresti
Rezumat: Obezitatea reprezinta un important factor
de predictie al bolilor cardiovasculare si este asocia-
ta cu disfunctie subclinica a ventriculului stang (VS).
Anomaliile sistolice si diastolice ale ventriculului drept
(VD) sunt mai putin bine defnite la subiectii obezi fara
simptome cardiace.
Scopul acestui studiu a fost evaluarea functiei VD in
repaus si la efort cu ajutorul ecocardiografei de efort in
clinostatism (EEC) si a ventriculografei radionuclidice
(VR), la subiecti cu obezitate izolata.
Metoda: 81 de subiecti de ambele sexe (varsta medie
39.1 4.3), cu indice de masa corporala (IMC) > 30 Kg/
m2, care nu aveau hipertensiune arteriala, diabet, dis-
lipidemie sau boli cardiace organice, au fost inclusi in
studiu. La toti subiectii s-au efectuat : un examen clinic
complet, o ecocardiografe in repaus, EEC si VR in re-
paus si la efort. Volumul tele-diastolic (VTD) si tele-
sistolic (VTS) ale VD, volumul bataie (VB), fractia de
ejectie (FE), si rata maxima de umplere (RMU) au fost
masurate in repaus si la efort si au fost determinate re-
zerva contractila si functia diastolica a VD. Subiectii au
fost impartiti in trei grupuri, in functie de IMC (Gru-
pul 1 cu IMC 30-34.9 kg/m2, grupul 2 cu IMC 35-39.9
kg/m2, grupul 3 cu IMC 40 kg/m2).
Resultate: IMC mediu a fost 36.48 4.05 kg/m2. In
populatia studiata, am gasit corelatii semnifcative intre
Suplimentul A, 2010
19
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POSTER FORUM I
Rezultate: nu au fost decelate diferente semnifcative
intre pacientii cu si fara SM referitor la prezenta fu-
matului (16.2% vs 28.1%), a dislipidemiei (73.5% vs
71.9%), dar au fost decelate in ceea ce priveste hiper-
tensiunea (73.5% vs 37.5%, p=0.001), diabetul zaharat
(26.5% vs 0%, p=0.001) sau obezitatea (44.1% vs 18.8%,
p=0.015). Nu au existat diferente semnifcative intre
pacientii cu si fara SM referitor la parametrii de rigi-
ditate arteriala: AixAo (38.0314.07 vs 40.4713.79),
PWVao (11.8414.34 vs 9.662.12), SAI (49.825.38 vs
48.748.49) for DAI (50.35.49 vs 51.248.49). Ariile
de sub curba determinate au fost 0.55 pentru AixAo,
0.591 pentru PWVAo, 0.607 pentru SAI, 0.598 pentru
DAI. Valorile cut of cu sensibilitate si specifcitate op-
time (derivand din curbele ROC) au fost: AixAo 20.5
(sensibilitate 19.7%, specifcitate 96.9%), PWVAo 8.1
(sensibilitate 89.4%, specifcitate 31.2%), SAI 49.1 (sen-
sibilitate 53.8%, specifcitate 74.2%)si DAI 50.8 (sensi-
bilitate 52.3%, specifcitate 74.2%).
Concluzie: desi rigiditatea arteriala se afa sub infuen-
ta unor factori care nu sunt pe deplin explicati, AixAo
pare sa aiba cea mai buna specifcitate si PWVAo cea
mai buna sensibilitate in identifcarea pacientilor cu
SM. Grant CNCSIS ID_2246/2009
A comparison between
arterial stiffness parameters
in identifying metabolic
syndrome (MetS) patients
Background: Presence of MetS is associated with in-
creased cardiovascular risk, being a common cause of
the development of atherosclerotic vascular disease.
Arterial stifness is related to the arteriosclerosiss sta-
ges.
Purpose: To evaluate the capacity of arterial stifness
parameters (augmentation index, pulse wave velocity,
systolic area index, diastolic area index) to identify
MetS patients, comparing with a standard diagnosis of
MetS.
Methods: we examined 100 patients (78 women, 22
men), mean age 57.71 9.51 years, 68% presenting
MetS. None of the patients presented cardiovascular
diseases. As risk factors have been assessed the body
weight, smoking status, diabetes, hypertension and
dyslipidaemia (defned as total cholesterol>200 mg/dl
tions between BMI and most of the evaluated parame-
ters. Te following are the means, standard deviations
and correlations with BMI: SV (86.2512.01 ml/beat,
r=-0.326, p=0.003), PFR (3.050.73 EDV/s, r=-0.335,
p=0.003), EFRV (57.57.3%, r=-0.335, p=0.002). From
rest to peak exercise, SV increased with 20.81 4.52
%, EFRV with 19.7 3.45 %, PFR with 18.46 2.65%.
At the ANOVA post-hoc analysis of the 3 groups, SV,
EFRV and PFR variations were signifcantly diferent
in group 3 compared with groups 1 and 2 (p=0.001,
0.0001 and 0.001 respectively)
Conclusions: Te contractile right ventricular reserve
and diastolic function at exercise may be impaired in
otherwise healthy subjects with extreme obesity.
15. Compararea parametrilor
de rigiditate arteriala in
identificarea pacientilor cu
sindrom metabolic (SM)
Angela Cozma, Adela Sitar-Taut, Dana Pop, Mirela
Cebanu, D.Zdrenghea
ganu, Cluj-Napoca
Ipoteze: prezenta SM se asociaza cu cresterea riscului
cardiovascular, reprezentand o cauza comuna de dez-
voltare a leziunilor aterosclerotice vasculare. Rigidita-
tea arteriala este infuentata de stadiile aterosclerozei.
Scopul studiului: evaluarea capacitatii parametrilor
de rigiditate arteriala (augmentation index, pulse wave
velocity, systolic area index, diastolic area index) de
a identifca pacientii cu SM, prin compararea cu dia-
gnosticul standard al sindromului metabolic.
Metoda: au fost evaluati 100 pacienti (78 femei, 22 bar-
bati), varsta medie 57.719.51, 68% cu SM. Nici unul
dintre pacienti nu prezenta boli cardiovasculare. Ca si
factori de risc cardiovasculari au fost evaluati greutatea
corporala, fumatul, diabetul zaharat, hipertensiunea
arteriala si dislipidemia (defnita ca si colesterol total
>200 mg/dl sau trigliceride serice >150 mg/dl sau tra-
tament anterior hipolipemiant). Rigiditatea arteriala a
fost evaluata utilizand TensioMedTMArteriograph. Au
fost decelate valorile cutt of, valoarea optima a sensi-
bilitatii, a specifcitatii si AUROC. Clasifcarea SM s-a
facut pe baza defnitiei IDF.
POSTER FORUM I
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Suplimentul A, 2010
20
or serum triglycerides > 150 mg/dl or treatment with
hypolipidemic drugs). Arterial stifness was measured
using TensioMedTMArteriograph. Cut of values, opti-
mum sensitivity, specifcity and area under the receiver
operating characteristic (ROC) curve were evaluated.
Classifcation of the MetS was based on the IDF gui-
delines.
Results: No signifcant diferences were registered
between patients with vs without MetS regarding the
presence of smoking (16.2% vs 28.1%), dyslipidaemia
(73.5% vs 71.9%), but were found out in relationship
with hypertension (73.5% vs 37.5%, p=0.001), dia-
betes (26.5% vs 0%, p=0.001) and obesity (44.1% vs
18.8%, p=0.015). Tere were no signifcant diferences
registered regarding arterial stifness parameters va-
lues between patients with and without MetS: AixAo
(38.0314.07 vs 40.4713.79), PWVAo (11.8414.34
vs 9.662.12), SAI (49.825.38 vs 48.748.49) for DAI
(50.35.49 vs 51.248.49). Determined areas under the
ROC curve were as follows: 0.55 for AixAo, 0.591 for
PwVao, 0.607 for SAI and 0.598 for DAI. Diagnostic
cut of levels with the optimum sensitivity and speci-
fcity derived from the ROC curve were found to be
for AixAo 20.5 (sensitivity 19.7%, specifcity 96.9%),
PWVAo 8.1 (sensitivity 89.4%, specifcity 31.2%), SAI
49.1 (sensitivity 53.8%, specifcity 74.2%) and DAI 50.8
(sensitivity 52.3%, specifcity 74.2%).
Conclusion: Although, arterial stifness parameters are
under the infuence of some factors that are not fully
explained, AixAo seems to have the best specifcity and
PWVAo the best sensibility in identifying MetS pati-
ents. Funding NURC ID_2246/2009
21
Perugia (4 vs 14 vs 14). La pct cu SA si CMH prevalenta
HVS estimata prin indicii Sokolow-Lyon, Cornell pro-
dus, Romhilt-Estes si Perugia, a fost similara (p>0.6). S
septal, S lateral si SGL au fost similare intre pct cu SA si
CMH (p>0.05) si reduse comparativ cu pct hipertensivi
(p<0.01).
Concluzii: Prevalenta HVS exprimata ECG a fost mai
mare in loturile cu SA si CMH decat la HTA pentru
valori similare ale masei VS. Acest lucru sustine ipoteza
conform careia ECG nu exprima masa VS ci mai cu-
rand aduce informatii legate de proprietatile electrice
ale miocardului hipertrofat. Prevalenta similara a cri-
teriilor ECG de HVS si valorile comparabile ale Sseptal,
Slateral si SGL intre pct cu SA si CMH sugereaza ase-
manari structurale si functionale intre cele doua tipuri
de HVS.
Are discrepancies between
electrocardiographic and
echocardiographic diagnosis
of left ventricular hypertrophy
related to the type rather than
the extent of the hypertrophy?
Background. Lef ventricular hypertrophy (LVH) is an
independent cardiovascular risk factor. Electrocardio-
graphy (ECG) and echocardiography are recommen-
ded in clinical practice for LVH diagnosis. However,
discrepancies were reported between echocardiogra-
phically estimated lef ventricular mass (LVM) and
ECG fndings in the diagnosis of LVH.
Purpose: We aimed to assess the ability of ECG to de-
tect a similar increase in LVM, as estimated by echocar-
diography, in patients (pts) with hypertension (HTN),
aortic stenosis (AS) and hypertrophic cardiomyopathy
(HCM).
Methods: We prospectively enrolled pts with preserved
LV ejection fraction (>50%) and a similar extent of LVH
as assessed by echocardiography: 20 pts with isolated
HTN (609 yr, 7 men), 20 pts with severe AS (659 yr,
16. Electrocardiografia versus
ecocardiografie in diagnosticul
hipertrofiei ventriculare stangi:
expresia gradului sau a tipului
hipertrofiei?
F.Matei, Cristiana Carmen Beladan, Andreea Calin,
Monica Rosca, B.A.Popescu, Denisa Muraru, Roxana
Enache, Fabiana Curea, C.Sandu, Carmen Ginghina
Institutul de Urgenta pentru Boli Cardiovasculare Prof.
Dr. C. C. Iliescu, Bucuresti
Premise. Hipertrofa ventriculara stanga (HVS) este un
factor independent de risc cardiovascular. Electrocar-
diografa (ECG) si ecocardiografa sunt recomandate
in practica pentru diagnosticul HVS. Cu toate acestea,
exista adesea discrepante intre masa VS estimata eco-
cardiografc si expresia ECG a HVS.
Obiectiv. Evaluarea capacitatii ECG de detectare a HVS
comparativ cu datele obtinute prin ecocardiografe la
pacienti (pct) cu hipertensiune arteriala (HTA), steno-
za aortica (SA) si cardiomiopatie hipertrofca (CMH).
Metoda: S-au inrolat pct cu fractie de ejectie VS pre-
zervata (>50%) si masa VS comparabila, evaluata eco-
cardiografc: 20 de pct cu HTA izolata (609 ani, 7 bar-
bati), 20 de pct cu SA severa (659 ani, 12 barbati) si
20 de pct cu CMH simetrica (5712 ani, 11 barbati).
Toti pct au fost investigati prin ECG standard in 12
derivatii si ecocardiografe. S-au urmarit urmatoarele
criterii ECG pentru HVS: indicii Sokolow-Lyon, Cor-
nell produs si voltaj, scorurile Romhilt-Estes si Perugia.
Au fost masurate ecocardiografc velocitatile anulare
mitrale longitudinale (Sseptal si Slateral) si strain-ul
global longitudinal (SGL) VS (cuantifcat prin tehnica
speckle tracking).
Rezultate: Nu s-au observat diferente semnifcative
intre loturile studiate in ceea ce priveste varsta, sexul,
indicele de suprafata corporala sau indicele de masa
VS (14756g/m2, 15721g/m2, 17646g/m2, p=0.09).
Numarul pct cu criterii ECG de HVS (HTA vs SA vs
CMH) a fost: indice Sokolow-Lyon (4 vs 12 vs 11), in-
dice Cornell voltaj (1 vs 4 vs 9), indice Cornell produs
(2 vs 6 vs 8), scor Romhilt-Estes (1 vs 10 vs 11), scor
POSTER I | POSTER I
POSTER I
POSTER I
Suplimentul A, 2010
22
12 men) and 20 pts with symmetric HCM (5712 yr,
11 men). Standard 12-lead ECG and a comprehensive
2D echocardiography were performed in all. We tes-
ted the following ECG criteria for LVH: Sokolow-Lyon
index, Cornell voltage and product indexes, Romhilt-
Estes and Perugia scores. Mitral annular longitudinal
velocities (Sseptal and Slateral) and global longitudinal
LV strain (GLS) were assessed from apical views by tis-
sue Doppler and by speckle tracking echocardiography
respectively.
Results: Tere were no signifcant diferences betwe-
en HTN, SA and HCM pts regarding age, gender, body
surface area or LVM index (14756g/m2, 15721g/m2,
17646g/m2, p=0.089). Presence of LVH criteria on
ECG in HTN vs AS vs HCM pts was as follows: Soko-
low-Lyon index (4 vs 12 vs 11), Cornell voltage (1 vs 4
vs 9), Cornell product (2 vs 6 vs 8), Romhilt-Estes (1
vs 10 vs 11), Perugia score (4 vs 14 vs 14). Sseptal, Sla-
teral and GLS were similar between AS and HCM pts
(p>0.05) and lower as compared to HTN pts (p<0.01
for all).
Conclusion: In our study ECG fndings of LVH were
more prevalent in pts with AS and HCM than in hyper-
tensives, for a similar increase in LVM. It confrms the
hypothesis according to which ECG does not have the
ability to measure LVM but rather provides specifc
information on the changes in electrical properties of
myocardium in LVH. Moreover, as the prevalence of
four ECG criteria for LVH and Sseptal, Slateral, GLS
respectively were similar between AS and HCM pts,
structural and functional similarities between these
two types of LVH can be further discussed.
17. Influenta blocului major
de ramura stanga asupra
parametrilor speckle tracking
la pacientii cu insuficienta
cardiaca cu fractie de ejectie
scazuta
C.Mornos, Ionac Adina, D.Cozma, Irina Popescu,
L.Petrescu, S.Pescariu, ST.I.Dragulescu
Rezumat: Torsiunea si strainul longitudinal global ()
reprezinta componente esentiale ale performantei ven-
triculului stang (VS). Blocul major de ramura stanga
(BRS) determina la pacientii cu sau fara insufcienta
cardiaca (IC) reducerea fractiei de ejectie globale a VS
(FEVS) si a debitului cardiac.
Scop: evaluarea infuentei BRS asupra parametrilor
speckle tracking la pacientii cu IC cu FEVS scazuta.
Metoda: Ecocardiografa transtoracica a fost realizata
la 113 pacienti consecutivi cu IC, in ritm sinusal. Au
fost inregistrate imaginile bidimensionale obtinute din
sectiunile parasternale ax scurt bazal si respectiv apical.
VS, twistul VS (diferenta neta dintre unghiul de rotatie
din sectiunea bazala si respectiv apicala) si torsiunea
VS (raportul dintre twistul VS si diametrul longitudi-
nal al VS in telediastola din incidenta apical 4 camere)
au fost determinate utilizand tehnica speckle tracking.
Pacientii au fost impartiti in trei grupe: grupul 1 inclu-
zand 35 de pacienti cu IC cu FEVS normala (50%),
grupul 2 incluzand 47 de bolnavi cu IC cu FEVS scazu-
ta si fara BRS, si grupul 3 incluzand 31 de pacienti cu IC
cu FEVS scazuta prezentand BRS.
Rezultate: FEVS, VS, twistul VS si torsiunea VS au fost
semnifcativ diferite (p<0.05) in grupul 1 comparativ cu
grupurile 2 si 3 (FEVS: 58.25.8%, 34.58.1% si respec-
tiv 30.19.0%; VS: -14.33.4%, -6.21.8% si respectiv
-4.82.4%; twistul VS: 13.54.1, 8.41.6 si respectiv
4.92.8; torsiunea VS: 2.020.68/cm, 1.220.23/cm
si respectiv 0.760.46/cm). La pacientii din grupul 3,
torsiunea si twistul VS au fost semnifcativ mai reduse
comparativ cu grupul 2 (0.760.46 versus 1.220.23/
cm, p=0.01, respectiv 4.92.8 vs 8.41.6, p=0.02), insa
VS si FEVS nu au prezentat diferente semnifcative in-
tre aceste doua grupuri (-4.82.4 vs -6.21.8%, p=0.08,
respectiv 30.19 vs 34.58.1%, p=0.43).
Concluzii: Acest studiu preliminar demonstreaza ca
prezenta BRS la pacientii cu IC cu FEVS scazuta deter-
Suplimentul A, 2010
28
POSTER I
POSTER I
mina reducerea torsiunii si twistului VS, in timp ce VS
este aparent neinfuentat.
The influence of left bundle
branch-block on speckle
tracking parameters in patients
with heart failure with reduced
ejection fraction
Background: Lef ventricular (LV) torsion and global
longitudinal strain (LV strain) are essential compo-
nents of LV performance. Lef bundle branch-block
(LBBB) in patients with or without heart failure can re-
duce global LV ejection fraction (LVEF) and decrease
cardiac output.
Aim: To evaluate the infuence of LBBB on 2D-strain
parameters in patients with systolic lef ventricular dys-
function.
Methods: Standard echocardiogram was performed in
113 consecutive patients with HF, in sinusal rhythm.
Te parasternal apical and basal short-axis planes
were recorded. LV strain, LV twists (the net diference
between rotation angles at base and apex) and LV tor-
sion (LV twist normalized for LV diastolic longitudinal
length) were measured by 2D-strain imaging. Patients
were divided into three groups: group 1 including 35
patients with HF with normal LVEF (>/= 50%), group
2 including 47 patients with HF with reduced LVEF wi-
thout LBBB, and group 3 including 31 patients with HF
with reduced LVEF and LBBB.
Results: LVEF, LV strain, LVtorsion and LV twist were
signifcantly diferent in group 1 compared to group
2 and 3 (LVEF: 58.25.8%, 34.58.1% and 30.19.0%
respectively; LV strain: -14.33.4%, -6.21.8% and
-4.82.4% respectively; LV twist: 13.54.1, 8.41.6
and 4.92.8 respectively; LV torsion: 2.020.68/cm,
1.220.23/cm and 0.760.46/cm respectively). In
patients with LBBB and reduced LVEF (group 3), LV
torsion and LV twist were signifcantly lower compared
to group 2 (0.760.46 versus 1.220.23/cm, p=0.01,
and 4.92.8 vs 8.41.6, p=0.02, respectively), but LV
strain and LVEF were not diferent between group 3
and 2 (-4.82.4 vs -6.21.8%, p=0.08, and 30.19 vs
34.58.1%, p=0.43, respectively).
Conclusions: Tis preliminary study indicates that in
patients with HF with reduced LVEF, in the presence of
LBBB, LV torsion and LV twist are signifcantly decrea-
sed, while LV strain is apparently not infuenced.
18. Evolutia mortalitatii pe
termen scurt la pacientii
diabetici care dezvolta un
supradenivelare de segment ST:
studiu comparativ pe timp de
10 ani a pacientilor internati
intr-un spital fara facilitati de
reperfuzie interventionala
C.F.Pop, Lavinia Pop, Mihaela Roman, Daniela Dicu,
Delia Dan
Universitatea "Vasile Goldis", Spitalul Judetean de
Urgenta Arad
Introducere: Cresterea mortalitatii in prezenta diabe-
tului zaharat (DZ) la pacientii care dezvolta infarct mi-
ocardic acut este cunoscuta, dar persista controversele
privind principalele cauze ale acestui prognostic agra-
vat
Obiective: Compararea mortalitatii pe termen scurt la
pacientii cu sau fara DZ care dezvolta un infarct mio-
cardic acut cu supradenivelare de segment ST (STEMI)
si identifcarea factorilor care contribuie la agravarea
prognosticului.
Metoda: In perioada 1.01.2000 -31.12.2009, un numar
de 1335 pacienti cu STEMI au fost internati in unitatea
de terapie intensiva coronarieni a Spitalului Judetean
de Urgenta din Baia Mare. Dintre acestia 660 nu au be-
nefciat de fbrinoliza, din care 142 (21.51%) prezentau
DZ, iar 675 au fost fbrinolizati, din care 136 (22.14%)
prezentau DZ. Efcacitatea fbrinolizei a fost evaluata
prin 2 criterii neinvazive: 1) Disparitia rapida a durerii
constrictive toracice 2) Reducerea supradenivelarii de
segement ST cu mai mult de 50% la 180 minute de la
debutul fbrinolizei. Toti pacientii au primit in absenta
contraindicatiilor medicatie betablocanta, inhibitori ai
enzimei de conversie a angiotensinei, statine si anticoa-
gulante (heparina solubila -1000 i.u./ora, 48-96 ore, sau
POSTER I
POSTER I
Suplimentul A, 2010
21
Methods: Between 1.01.2000 and 31.12.2009 in the in-
tensive coronary unit of Emergency County Hospital
Baia Mare was admitting 1335 consecutive STEMI pati-
ents. In this group 660 pts had no reperfusion treatment
and beetwen them 142 (21.51%) was diabetic, and 675
pts received thrombolytic therapy and between them
136 (22.14%) was diabetic. Te ef cacy of thrombolysis
was assessed with two noninvasive reperfusion criteria:
1.Rapid cessation of the chest pain 2. Decrease of the
sum of the ST-segment elevations by more than 50% at
180 min. afer the start of thrombolysis. In the absen-
ce of contraindication, all pts. received beta-blockers,
angiotensin converting enzyme inhibitors,statins, and
anticoagulants (unfractionated heparin-1000 i.u./hour,
48-96 hours, or enoxaparin-1 mg/kg every 12 hours for
8-10 days) combined with either aspirin 150-300 mg./
day or aspirin & clopidogrel (loading dose of 300 mg.
followed by 75 mg/day).
Results: Te 278 diabetic pts (20.82%) of this registry
were older and more likely to be woman and they had
additional co morbidities and coronary risk factors. At
30 days, absolute mortality were 19.43% in diabetic pa-
tients and 14.39% in non diabetic patients (p=0.002).
A signifcant lower in-hospital mortality -11.38% was
seen in the 539 pts without diabetes who received
thrombolysis compared with the one of 16.52 % seen
in the 136 diabetic pts who received thrombolysis
(p=0.01) and with the 21.49% mortality seen in 142
diabetic pts with no reperfusion therapy (p<0.0001).
Te ef cacy of thrombolysis was correctly assessed in
578 (85.62 %) pts with a similar number of diabetic and
nondiabetic patients but with more failed thrombolysis
5.8% vs 2.1% and more recurrent ischaemia 9.3 % vs
4.6 % (p=0.002) in diabetic patients.
Conclusion: Our fndings show a signifcantly higher
short-term mortality afer a frst STEMI in diabetic pa-
tients with a risk to be related to a worse clinical profle
but also to a less efective myocardial reperfusion expla-
ined by a lower success rate of trombolytic therapy and
by a high frequencies of rezidual myocardial ischaemia.
enoxaparin-1 mg/kg la12 ore pentru 8-10 zile) asociate
cu aspirina 150-300 mg./zi sau aspirina si clopidogrel
(doza de incarcare 300 mg. urmata de 75 mg/zi).
Rezultate: Cei 257 (20.82%) pacienti cu DZ inrolati in
studiu erau mai varstnici, mai frecvent de sex feminin
si au prezentat semnifcativ mai multe comorbiditati si
factori de risc cardiovasculari. Mortalitatea la 30 de zile
a fost de 19.43% la pacientii cu DZ si de 14.39% la cei
fara DZ (p=0.002). Mortalitatea a fost semnifcativ mai
mica, de 11.38% la cei 539 pacienti fara DZ care au fost
fbrinolizati, in comparatie cu cea de 16.52% inregistra-
ta la cei 136 pacienti cu DZ si fbrinoliza (p=0.01) si cu
cea de 21.49% observata la cei 142 pacienti cu DZ fara
fbrinoliza (p<0.0001). Rata de succes a fbrinolizei a
putut f estimata corect pentru 578 (85.62%) pacienti si
la un numar similar de pacienti cu DZ sau nediabetici:
esecul fbrinolizei 5.8% vs 2.1% si angina recurenta 9.3
% vs 4.6 %, au fost insa semnifcativ mai frecvente la
pacientii cu DZ (p=0.002).
Concluzii: Rezultatele studiului evidentiaza o mortali-
tate pe termen scurt semnifcativ mai ridicata la paci-
entii cu STEMI si DZ, explicata printr-un profl clinic
de risc mai crescut si prin alterarea reperfuziei miocar-
dice, evidentiata printr-o rata mai redusa de succes a
fbrinolizei si prin frecventa mai crescuta a ischemiei
miocardice reziduale.
Short term mortality in
diabetic patients after acute
myocardial infarction with
st-segment elevation: a ten
years comparison in a hospital
without interventional
reperfusion facilities
Background: Te detrimental efect of diabetes on
mortality in patients with acute myocardial infarction
is well documented but a debate still persists regarding
the main cause of their high mortality.
Objectives: To compare short term mortality afer a
frst acute myocardial infarction with ST-segment ele-
vation (STEMI) in patients with and without diabetes
mellitus and to point out the factors associated with a
worse prognosis.
Suplimentul A, 2010
25
POSTER I
POSTER I
19. Determinismul variabilittii
frecventei cardiace asupra
bolilor cardiovasculare la
pacientii obezi
F.Mitu, D.Ilisei, Maria Leon, Corina Dima
Spitalul Clinic de Recuperare, Iasi
Scopul lucrarii. Impactul frecventei cardiace ca factor
de predicie independent in apariia i evoluia bolilor
cardiovasculare rmane un subiect de actualitate. Aso-
cierea acestui factor de risc la pacientii obezi creste ex-
ponential riscul de aparitie al bolilor cardiovasculare.
Studiul nostru si-a propus s demonstreze corelatia din-
tre frecventa cardiac si dezvoltarea comorbidittilor la
pacietii obezi.
Material i metoda: Studiul retrospectiv a cuprins un
numar de 1463 pacieni, internai in Spitalul Clinic de
Recuperare Iai, Secia Recuperare Cardiovasculara, in
perioada 01.01.2009-31.12.2009. Din lotul investigat,
752 (51.40%) pacieni au indeplinit criteriile de inclu-
dere.
Rezultate i discuii: Pentru fecare pacient s-a stabi-
lit frecvena cardiaca in condiii de repaus, existena
factorilor de risc asociai precum fumatul, mediul de
proveniena, sexul, varsta. In repaus, exista o relaie
direct proporionala intre greutatea pacientului i
frecvena cardiaca. In grupul de varsta 50-69 ani, am
inregistrat o pondere semnifcativ crescuta a pacienilor
cu obezitate grad III (44.35%) i frecvena cardiaca
crescuta (31.45%) comparativ cu celelalte grupe de
varsta (ANOVA, p=0,03). Sexul masculin (41.29%)
prezinta o frecvena cardiaca crescuta faa de sexul fe-
minin (4.57%) (student T test, p=0,002). Mediul urban
reprezinta un alt factor de risc, frecvena cardiaca find
crescuta la aceti pacieni (61.45% faa de 43.81%) (stu-
dent T test, p=0,04).
Concluzii: Frecvena cardiaca este un important fac-
tor de risc pentru morbiditatea i mortalitatea cardi-
ovasculara. Analiza statistica coreleaza valorile cres-
cute ale frecvenei cardiace cu impactul i severitatea
afeciunilor cardiovasculare.
The importance of variability
of the cardiac frequence over
cardiovascular diseases in
obeses patients
Background: Te importance of variability of the car-
diac frequence as a predictor factor in the appearance
and evolution of cardiovascular disease is still a subject
to be debated. Te association of this risc factor in obe-
se patient raises the risc of cardiovascular disease.
Te purpose of our study is to demonstrate the corre-
lation between the cardiac frequence and the develop-
ment of the comorbidities to the obese patients.
Methods: Te retrospective study enrolled 1463 pati-
ents, from the Rehabilitation Hospital Iasi, Te Car-
diovascular Rehabilitation Department, between
01.01.2009-31.12.2009. 51.40% (752 patients) has the
inclusion criterias.
Results: For each patient, we establish the cardiac
frequence at rest, the existence of risk factors associated
like smoking, provenience, sex, and age. At rest, the-
re is a direct correlation between the BMI and cardiac
frequence. In the age group 50-69, ther is a high procent
of obese patients (41.35%) and cardiac frequence over
70 (31.45%) (ANOVA, P=0.03). Male gender (41.29%)
has a cardiac frequence higher than woman (4.57%)
(student T test, p=0,002). Te urban area is another risk
factor, the cardiac frequence being higher at these pa-
tients (61.45% fata de 43.81%) (student T test, p=0,04).
Conclusions: Te cardiac frequence is an important
risk factor for cardiovascular morbidity and mortality.
Statistical analyses establish a correlation between the
high values of cardiac frequence and the impact and
severity of cardiovascular diseases.
20. Corelatii anatomo-clinice in
trombembolism pulmonar acut
D.P.Petcu, O. Toni
Introducere. Incidenta trombembolismului pulmonar
acut (TEPA) este mare.Manifestarile clinice TEPA sunt
diverse. Este o discordanta intre semnele clinice, ECG,
ecocardiografce radiologice si angiografce. Diagnos-
POSTER I
POSTER I
Suplimentul A, 2010
26
Anatomopathological and
clinical correlations in Acute
Pulmonary Thromboembolism
Introduction. APTE has a high incidence and various
clinical manifestation.Tere is an inconsistency betwe-
en clinical fndings, EKG, Heart ultrasound, radiology
and angiography in APTE.Positive diagnosis is dif -
cult. D-dimer plasma levels over 500ng/dl has diagnose
value in clinical and paraclinical context.
Purpose. Prospective study of patients with APTE and
anatomopathological and clinical correlations in order
to determine the causes which can generate diagnosis
errors.
Methods and materials: 45 patients have been studied,
33 women an 12 men, admitted in Cardiology Center
of Craiova between 1.01.2009-1.01.2010 with APTE
diagnosis.Parameters which were analized: history,
clinical exam, EKG, Transthoracic ultrasound, venous
doppler, Chest CT, lung scintigraphy, pulmonary an-
giography, D-dimer levels and patient evolution, ana-
tompathology examination (for patients deceased whi-
le admitted) and confrontation with clinical data.
Results: 34 patients from the group of 45 who were
studied had a favorable evolution.Necropsy was per-
formed on 11 patients.PTE diagnosis was not anato-
mopathologically confrmed in 4 cases. In 2 cases the
diagnosis was posterior myocardial infarction, 1 case
had anterolateral myocardial infarction and 1 case had
acute pancreatitis. Discussion. History taken by over-
rating risk factors is usually leading to excesive clinical
diagnosis. Deep venous thrombosis of the legs is rele-
vant in targeted history. Transthoracic heart ultrasound
reveals: VD/VS>1, Interventricular septum fattening,
pressure gradient VD-AD >50 mm Hg, acceleration
time of pulmonary fow velocity, expiratory diameter
of inferior vena cava <60 msec. Venous doppler of fe-
mural and popliteal vein reveals thrombosis. D-dimer
levels >500 ng/mL has high sensitivity but low specif-
city. Lung perfusion scintigraphy, Chest CT, MRI and
pulmonary angiography are improving diagnosis acur-
racy.
Conclusion: Corroboration of clinical, heart ultra-
sound and venous doppler predicted positive diagnosis
of APTE in 84,4%. Diferential diagnose with antero-
lateral and posterior myocardial infarction and acute
pancreatitis.
ticul pozitiv este difcil.Concentratia plasmatica a D-
Dimerului peste 500 ng/mL are valoare diagnostica in
contextul clinic si paraclinic.
Scopul lucrarii Studiul prospectiv al bolnaviilor cu
TEPA si corelatii anatomo-clinice in scopul confrmarii
diagnosticului.
Materiale si metoda: Au fost studiati 45 de pacienti,
33 de femei si 12 barbati, internati in Centrul de Car-
diologie Craiova in perioada 1.01.2009-1.01.2010 cu
diagnosticul de TEPA.Parametrii analizati :anamneza,
examenul obiectiv, electrocardiograma, ecografa tran-
storacica, examenul doppler venos, CT torace, scinti-
grama pulmonara, angiografe pulmonara,valoarea
D-Dimerilor si evolutia pacientilor, examenul anato-
mopatologic( la pacientii decedati in spital) si confrun-
tarea cu datele clinice.
Rezultate: Din lotul de 45 bolnavi studiati, 34 de bol-
navi au avut evolutie favorabila. Necropsia a fost efec-
tuata la 11 pacienti. Confrmarea anatomopatologica
a diag de TEP s-a realizat la 7 cazuri. Diagnosticul de
TEP nu a fost confrmat anatomopatologic la 4 cazuti .
La 2 bolnavi diagnosticul a fost de IM posterior, un caz
diagnosticul de IM anterolateral si un caz diagnosticul
de pancreatita acuta.
Discutii. Anamneza prin supraevaluarea factorilor fa-
vorizanti duce la un exces de diagnostic clinic. Trombo-
zele venoase profunde de la nivelul membrelor inferi-
oare sunt relevante in anamneza tintita. Ecocardiogra-
fa transtoracica releva : raport VD/ VS >1, aplatizarea
septului interventricular, gradient de presiune VD-AD
> 50 mmHg, timpul de accelerare al velocitatii fuxului
pulmonar, diametrul expirator al venei cave inferioa-
re <60 msec ; Examenul doppler al venelor femurale si
poplitee deceleaza trombi in axul venos ; Concentratia
plasmatica a D-Dimerilor >500 ng/mL are sensibilitate
inalta dar specifcitate scazuta. Scintigrafa pulmonara
de perfuze, CT torace, RMN si angiografa pulmonara
maresc acuratetea diagnosticului
Concluzii: Coroborarea datelor clinice, ecocardiogra-
fce si doppler venos a prezis diagnosticul pozitiv de
TEPA la un procent de 84,4%.
Suplimentul A, 2010
2I
POSTER I
POSTER I
22. Reducerea mortalitatii
prin infarct miocardic acut in
cadrul registrului regional de
rezultate la 5 ani
I.Benedek, Monica Chitu, I.Kovacs, P.A.Sarbu, Clau-
dia Matei, Diana Horga, Zsuzsanna Suciu, Teodora
Benedek
Universitatea de Medicina si Farmacie, Targu Mures
Scop: S-a urmarit pe parcursul a 5 ani evolutia mortali-
tatii prin infarct miocardic acut (IMA) intr-un teritoriu
cu aderenta scazuta la ghidurile europene, aferent unei
populatii de 1 milion locuitori, perioada in care toa-
te cazurile de sindrom coronarian acut inregistrate in
acest teritoriu au fost incluse intr-un Registru Regional
de Sindroame Coronariene Acute.
Material si metoda: Registrul a inclus 13 spitale, avand
cel mai apropiat centru interventional la o distanta de
maxim 200 km. Au fost colectate si procesate datele a
3,990 pacienti, din care 1.841 cu IMA cu supradenive-
lare ST si 2.149 cu angina instabila / IMA nonST. Loturi
de bolnavi: gr. 1 1411 pacienti cu IMA cu supradeni-
velare ST tratati in spitalele teritoriale, fara posibilitati
de PCI, gr. 2 430 pacienti cu IMA trimisi direct cen-
trului interventional.
Rezultate: La grupa 1 procentul terapiei de reperfuzie
(PTCA per primam + tromboliza) a fost de 11.28% in
2004 crescand pana la 27.43% in 2009. In gr. 2 terapia
de reperfuzie a fost posibila in 99.39% dintre cazuri,
constand in PTCA primara in 76.96% cazuri, PTCA
facilitata in 15.75% cazuri si tromboliza sistemica in
6.6% cazuri. Ratele mortalitatii au scazut progresiv, de
la 20.77% in 2004 la 11.9% in 2009, corelate cu creste-
rea numarului de cazuri care au benefciat de terapie de
reperfuzie (p=0.001). In gr. 2 mortalitatea globala a fost
de 6.6% pentru pacientii ajunsi in timp util pentru re-
permeabilizare, comparativ cu 17.65% pentru pacientii
cu prezentare tardiva (>12 ore) (p<0.001).
Concluzii: S-a constatat reducerea mortalitatii prin
infarct miocardic acut cu 42.7% intr-o populatie de
1 milion locuitori, de la 20.77% la 11.9%. Aceasta s-a
datorat unor activitati organizatorice si educationale
complexe, care au condus la extinderea aplicabilitatii
recomandarilor terapeutice europene, avand ca si re-
zultat cresterea numarului de pacienti care au benef-
ciat de terapie de reperfuzie, corelata in mod direct cu
21. Aspecte chirurgicale in
patologia aterosclerotica cu
localizare multipla
M.E. Patrut, R. Vasilescu, V. Pop, E. Rachita, Cristina
Voinea, D. Arhire, Nicoleta Arhire, Mirela Coroescu,
V. Barbulescu, E. Oclei, V. Ispas, Olimpia Manta, I.
Burlacu, D. Ramazan, V. Leica
Spitalul Clinic Judetean de Urgenta, Constanta
Introducere: Cea mai raspandita afectiune din grupul
bolilor aterosclerotice, intereseaza arterele mari si me-
dii de tip elastic si muscular si se caracterizeaza prin
depunerea focala, diseminata, de diverse lipide, hidro-
carbonate, componente sanguine, tesut fbros si calciu
in intima arterelor, care isi pierd elasticitatea si isi in-
gusteaza lumenul. Boala aterosclerotica cu localizare
multipla pune mai multe probleme, printre care ar f
diagnosticul corect, indicatia chirurgicala, ordinea re-
zolvarii leziunilor, managementul postoperator, urma-
rirea la distanta.
Material si metoda: Lotul luat in studiu este reprezen-
tat de 463 de pacienti operati pentru o patologie ate-
rosclerotica cu localizare multipla, in perioada noiem-
brie2008 - aprile 2010.
Rezultate: S-au realizat un numar de 212 interventii la
nivelul membrelor pelvine,16 au avut ca tinta mem-
brele superioare, 93 de interventii au fost la nivelul ca-
rotidelor, 140 au fost by-pass-uri aorto-coronariene si
2 la nivelul arterelor renale, cu mentiunea ca afectarea
arteriala a cuprins unul sau mai multe sectoare vascu-
lare pentru care s-a intervenit chirurgical per primam
sau temporizat.
Concluzii: Cele mai frecvente asocieri de localizare a
bolii aterosclerotice au fost existenta simultana a bolii
aterosclerotice la nivelul membrelor pelvine si a arte-
relor coronare, urmata de asocierea carotide boala
coronariana aterosclerotica.
POSTER I
POSTER I
Suplimentul A, 2010
28
23. Ateroscleroza subclinica
particularitati in relatie cu
sexul
Avram Rodica, Florina Parv, Alis Dema, T.Ciocarlie,
Branzan Livia, Mariana Tudoran, M.Balint, V.Moga
Spitalul Clinic Judetean de Urgenta, Timisoara
Scopul lucrarii: Scopul studiului a fost de a identifca
posibile particularitati legate de sex ale aterosclerozei
in teritorii vasculare diferite.
Material si metoda: Am luat in studiu 218 subiecti, din
care 110 femei si 108 barbati, in procente egale aparent
sanatosi, respectiv cu patologie neaterosclerotica si ne-
infamatorie, cu varsta intre 21-80 ani, media 51,917,7
ani. Am procedat la inregistrarea datelor demografce,
a factorilor de risc si la explorare paraclinica generala:
ECG, ecografe carotidiana, abdominala si vasculara,
indice glezna brat si relativ specifc-vasodilatatia medi-
ata de fux, test ergometric si angiocoronarografe com-
puterizata multislice.
Rezultate: Valorile IMT carotidian mai mici la femei
0,440,09 mm vs 0,780,25 mm (p<0,0001) se corelea-
za cu varsta la ambele sexe, factorii de risc de notat pen-
tru IMT carotidian si prezenta placilor aterosclerotice
find fumatul, obezitatea, antecedentele si colesterolul
crescut pentru barbati si respectiv diabetul zaharat si
trigliceridele pentru femei. Ateromatoza aortei si dia-
metrul crescut al aortei s-au intalnit cu frecventa ase-
manatoare la barbati si la femei la menopauza, factorii
predictivi find HTA (p<0,001), obezitatea (p=0,001),
IMT carotidian (p=0,046). IMT patologic si placi-
le femurale au fost mai putin frecvente la femei (16%
vs 44%), predictori find fumatul, diabetul zaharat,
HDL scazut (p<0,01) respectiv pentru barbati varsta
(p<0,0001) si LDL crescut (p<0,05). Indicele glezna-
brat se coreleaza cu un IMT femural crescut. Raspun-
sul vasodilatator arata FMDNTG mai mare la femei
cu boala coronariana, hipertensive si diabet, compa-
rativ cu barbatii cu aceleasi caracteristici. 2 subloturi
de barbati si femei cu accese probabil coronariene au
fost coronarografati in conditiile unui test ergometric
negativ. Simptomatologia subiectiva in lotul de femei
cu boala coronariana a fost particulara (calitatea du-
rerii, simptome insotitoare), coronara stanga pare mai
putin afectata, iar scorul calcic usor redus (155238 vs
373125). Aspectul histologic sugereaza existenta unui
mecanism infamator mai putin important la femei, la
barbati dominand neovascularizatia.
scaderea mortalitatii. Cercetare fnantata prin grantul
de cercetare CEEX nr 171/2006-LOGECA
Mortality reduction in acute
myocardial infarction in a
regional network of acute
coronary syndromes-5 years
results
Purpose: We followed over fve years the evolution of
mortality by acute myocardial infarction (AMI) in an
area with low adherence to European guidelines, for a
population of 1 million inhabitants, during this time
all cases recorded was included in Regional Registry of
ACS in Romania.
Material and method: Te register included 13 hos-
pitals, with the nearest Interventional center at a ma-
ximum distance of 200 km. Data was collected and
processed from 3990 patients, of which 1841 with AMI
with ST elevation and 2149 with unstable angina /non-
STEMI. Groups of patients: gr. 1-1411 patients with ST
elevation AMI treated in the regional hospitals without
PCI facilities, gr.2-430 patients with AMI sent directly
to the interventional Centre.
Results: In Group 1 the percentage of reperfusion the-
rapy (primary PTCA + thrombolysis) was 11.28% in
2004 growing to 27.43% in 2009. In gr. 2 reperfusion
therapy was possible in 99.39% of cases, consisting
of primary PTCA in 76.96% cases, facilitated PTCA
15.75% cases and systemic thrombolysis in 6.6% cases.
Mortality rates fell progressively from 20.77% in 2004
to 11.9% in 2009, correlated with an increased number
of cases who received reperfusion therapy (p = 0.001).
In gr. 2 overall mortality was 6.6% for patients arrived
in time for reperfusion, compared with 17.65% for pa-
tients with late presentation (> 12 hours) (p <0.001).
Conclusions: We noticed a reduction of the morta-
lity in patients with AMI with 42.7% in a population
of 1 million inhabitants, from 20.77% to 11.9%. Tis
was possible due to organizational and complex edu-
cational activities, which led to a better applicability of
European therapeutic recommendations, having as a
result an increase in the number of patients who recei-
ved reperfusion therapy, directly correlated with a de-
crease in mortality. Research suported by CEEX grant
nr 171/2006-LOGECA
Suplimentul A, 2010
29
POSTER I
POSTER I
mechanism less important in women, and in men do-
minating pathological neovascularisation.
Conclusions: Te localisation of atherosclerotic lesions
difers by gender. It identifes varoius risk factors afec-
ting diferent vascular territories, age and menopausal
being still essential. Endothelial dysfunction in women
may difer in relation to hormonal structure.
24. NT- pro BNP marker
important in urmarirea
evolutiei sindroamelor
coronariene acute fara
supradenivelare de ST
L.Lazar, A.Lazar, O.Burta, M.Rus
Universitatea din Oradea
Scopul studiului: Analizele de mortalitate dupa infarc-
tul miocardic, au aratat ca asocierea BNP, cu mortali-
tatea este independenta de varsta, insufcienta cardiaca
sau renala, troponina I si CRP, lucru ce se coreleaza pe
termen lung cu mortalitatea si in cazul NT-pro BNT.
Material si metoda: Am luat in studiu un numar de 48
pacienti, varsta intre31-60 ani, cu sindrom coronarian
acut fara supradenivelare de segment ST, la care in afara
de crizele anginoase, tabloul biologic (troponina, fbri-
nogenul, proteina C reactiva nu au crescut concludent).
Am dozat in momentul internarii la acesti pacienti NT-
proBNP care a fost crescuta-220 pg /ml, fata de valoa-
rea considerata normala la 7 pg/ml.
Rezultate: Pacientii au fost urmariti in continuare prin
examen clinic EKG in serie de 5 zile, dozarile pentru
enzimele de necroza (inclusiv troponina care nu a fost
crescuta in aceasta faza), electrocardiograma ca dupa
5 zile, din cei 48 de pacienti un numar de 12 (25%)
au facut angina instabila (caracteristica durerii, dura-
ta, iradierea, raspunsul la nitroglicerina, variabilitatea
ECG-ului, iar valoarea NT-pro BNP a crescut la 610pg/
ml). Un numar de 8 pacienti au evoluat spre IM (17%)
schimbandu-se caracterul durerii, aparitia, modifcari-
lor EKG de leziune, necroza si ichemie, fosfocreatinki-
naza MB, a crescut troponina deasemene in aceasta
faza a ischemiei a fost mare, iar valoarea NT-pro BNP a
ajuns la 910pg/ml.
Concluzii: 1. Dintre markerii infamatori prezenti pro-
cesul de aterogeneza, pe langa proteina C reactiva in-
Concluzii: Localizarea de predilectie a fenomenelor
aterosclerotice difera in functie de sex. Se identifca fac-
torii de risc diferiti ca pondere in afectarea teritoriilor
vasculare, varsta si menopauza ramanand insa factorii
esentiali.
Subclinical atherosclerosis
gender related particularities
Aim: Te aim of the study was to identify possible gen-
der features of atherosclerosis disease in diferent vas-
cular territories.
Material and method: We studied 218 subjects, of
which 110 women and 108 men, apparently healthy in
equal percentages, respectively nonatherosclerotic and
noninfammatory pathology, aged 21-80 years, mean
51.9 17.7 years. We proceeded to record demographic
data and risk factors, and general paraclinical explora-
tion: ECG, carotid, abdominal and vascular ultrasono-
graphy, ankle-arm index and relative specifc - fow-
mediated vasodilation, ergometry test, and multislice
computed angiocoronarography.
Results: Lower carotid IMT values in women 0.44
0.09 mm vs. 0.78 0.25 mm (p <0.0001) are corelated
with age in both sexes, risk factors for carotid IMT and
for the presence of atherosclerotic plaques were smo-
king, obesity, history and high cholesterol for men and
diabetes and triglycerides for women. Aortic athero-
matosis and increased aortic diameter were met with
similar frequency in men and women at menopause,
predictive factors were hypertension (p <0.001), obe-
sity (p = 0.001), carotid IMT (p = 0.046). Pathological
femoral IMT and plaques were less frequent in women
(16% vs. 44%), predictors being smoking, diabetes,
low HDL (p <0.01) and respective for men the age (p
<0.0001) and increased LDL (p <0.05). Ankle-arm in-
dex is correlated with an increased femoral IMT. Va-
sodilator response shows FMDNTG higher in women
with coronary heart disease, hypertension and diabetes
compared with men with similar characteristics. 2 sub
lots of men and women (15/15) with possible coronary
pain and a negative stress test, were given coronarogra-
py Subjective symptoms in women with coronary heart
disease group was particular (quality of pain, accom-
panying symptoms), lef coronary seems less afected,
and slightly lower calcium score (155 238 vs. 373
125). Histological aspects suggest an infammatory
POSTER I
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Suplimentul A, 2010
80
because its value increased from efort breastplate angi-
na phase to the intermediary syndrom phase and then
IM. 2. It is a marker that doesnt allow us to make the
diferencve between inspiring dispneea present in the
coronary syndroms from the extracardiac dispneea. 3.
It helps to monitor the chronic cardiac insuf ciency. 4.
It is an index of the physical evolution and echographic
acerbity, of the acute sufering.
25. Indexarea ariei valvulare
functionale la suprafata
corporala supraestimeaza
prevalenta stenozei aortice
stranse la pacientii obezi si
nu amelioreaza estimarea
severitatii acesteia la adulti
Denisa Muraru, Andreea Calin, L.P.Badano,
P.Faggiano, B.A.Popescu, Carmen Ginghina,
A.Proclemer
Premise. Deoarece prin raportarea debitului cardiac la
suprafata corporala (SC) rezulta un index aproxima-
tiv constant de 3-4 L/min/m2 la adulti, indexarea la SC
a fost aplicata pentru diversi parametri in absenta do-
vezilor privind validitatea sa. Spre deosebire de copii, la
adulti SC variaza predominant in relatie cu modifca-
rile greutatii corporale (GC) si nu cu cele ale inaltimii.
Metode: Pentru evaluarea impactului GC asupra rela-
tiei dintre aria valvulara functionala aortica indexata
la SC (AVAi) si gradientii transvalvulari, au fost inro-
lati prospectiv 278 pacienti (768 ani, 48% barbati) cu
fractie de ejectie a ventriculului stang >50%, velocitate
aortica maxima >2 m/s (AVA=0.950.37, 0.3-2.27cm2;
gradient maxim (Gmax)=6129, 10-174 mm Hg; gra-
dient mediu (Gmed)=3417, 6-101 mmHg), fara alte
valvulopatii semnifcative. GC si inaltimea au fost
masurate atent imediat dupa efectuarea ecocardiogra-
fei folosind aceleasi scale.
Rezultate: 96 pacienti au fost normoponderali (indexul
de masa corporala, IMC <25 Kg/m2), 107 suprapon-
derali (IMC 25-30 kg/m2), i 75 obezi (IMC >30kg/
terleukina 6 si 18, factorul necrotic nuclear, NT-BNP
s-a dovedit un predictv important deoarece valoarea
lui a crescut de la faza de angina pectorala de efort, la
cea de sindrom intermediar si apoi de IM. 2. Este un
marker ce nu permite sa diferentiem dispneea inspira-
torie prezenta in sindroamele coronariene de dispneea
extracardiaca. 3. Ne ajuta in acelasi timp sa monitori-
zam insufcienta cardiaca cronica. 4. Este deasemeni un
indicator asupra evolutiei clinice si severitatii electroe-
cografce, a suferintelor acute.
NT- pro BNP important
marker for evolution
monitoring of acute coronary
syndroms with no ST increase
Te purpose of the study Mortality tests afer myocar-
dial infarct showed that BNP association with morta-
lity is not age related, or renal or cardiac insuf ciency,
troponine I and CRP related, which on long term is
associated with mortality in the case of NT-pro BNT
as well.
Material and method: We studied a number of 48 pa-
tients with acute coronary syndrome with no ST incre-
ase at which the bilogical chart (troponine, frbrilogen,
reactive C proteine), except sternocardiac crises, pre-
sented no convincing increase. NT- proBNP dosage at
hospitalization was increased -220 pg /ml, compared to
the normal value of 7 pg/ml.
Results: Te patients continued to be monitored
through EKG physical exams in 5 days series, dosage
for necrosis exams (including troponine that was not
increased in this stage), electrocardiogram, so that afer
5 days 12 patients (25%) of 48 presented unstable angi-
na (the characteristic of the pain, the duration, the ir-
radiation, the answer to nitroglicerine, the variation of
ECG, and the value of NT-pro BNP increased to 610pg/
ml). 8 patients evolved to IM ( 17% ) with changes in
the pain character, lesion, necrosis, ischemia, and fo-
sfocreatinkinaza MB EKG changes, as well as a major
troponine increase in this stage, and the value of NT-
pro BNP reached 910pg/ml.
Conclusions: 1. From the present infamatory markers
the aterogenesis process along with reactive C prote-
in, 6 and 18 interleukine, the nuclear necrotic factor,
NT-BNP proved to be an important predictive factor
Suplimentul A, 2010
81
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POSTER I
Results: 96 patients were normal (body mass index,
BMI<25 Kg/m2), 107 overweight (BMI 25-30 kg/
m2), and 75 obese (BMI>30kg/m2). BSA ranged from
1.29 m2 to 2.32 m2. Despite statistically signifcant
(p<0.0001), BSA relationships with stroke volume
(r=0.31) and cardiac output (r=0.26) were weak. As
expected, the relationships with MnG, PkG and valve
resistance were exponential, but similar using absolute
and indexed EOA (z=0.76, p=0.44 for EOA vs EOAI
and PkG; z=0.98, p=0.32 for EOA vs EOAI and MnG).
Despite similar pressure overload, in obese patients the
calculated incidence of severe aortic stenosis increased
from 66% using EOA<1.0 cm2 cut-of, to 83% using
EOAI<0.6cm2/m2 (p=0.027).
Conclusions: Since stroke volume is weakly related
to BSA in adults, aortic stenosis assessment does not
improve by indexing EOA. Severe aortic stenosis is
overestimated by using EOAI in obese patients. Our re-
sults may also have implications in diagnosing patient-
prothesis mismatch.
26. Malformatie congenitala
cardiaca cianogena complexa
cu mapca-sursa de hemoptizie
masiva, care poate conduce
la confuzii de diagnostic cu
hemoragia digestiva superioara
A.Lacatusu, Brigitte Poplicean, Ramona Olariu,
G.Miclaus
Spitalul Judetean de Urgenta, Timisoara
Rezumat: Pacientul I.D, in varsta de 13 ani, cunoscut
de la nastere cu malformatie cardiaca complexa, ciano-
gena, dextrocardie, ventricul unic, atrezie de valva pul-
monara, in context de situs inversus toracic si abdomi-
nal, cu evolutie naturala, fara tratament, dezvoltand in
timp colateralitate abundenta de supleere si poliglobu-
lie severa. Cu o zi inaintea internarii prezinta: hemate-
meza masiva, epistaxis precedate de un acces de tuse cu
deteriorare clinica rapida si progresiva. Examenul clinic
la internare releva stare generala sever infuentata, cia-
noza intensa generalizata, hipocratism digital, semne
clinice de continuarea a unei sangerari inalte-tip respi-
m2). SC a fost cuprinsa intre 1.29 m2 si 2.32 m2. SC s-a
corelat semnifcativ (p<0.0001), dar slab cu volumul
bataie (r=0.31) si debitul cardiac (r=0.26). Relatiile
cu Gmax, Gmed si rezistenta valvulara au fost expo-
nentiale, dar similare utilizand AVA absoluta si AVAi
(z=0.76, p=0.44 pentru AVA vs AVAi si Gmax; z=0.98,
p=0.32 pentru AVA vs AVAi si Gmed). In pofda unei
postsarcini similare, la pacientii obezi incidenta calcu-
lata a stenozei aortice severe a crescut de la 66% utili-
zand limita de AVA<1.0 cm2, la 83% folosind limita de
AVAi<0.6cm2/m2 (p=0.027).
Concluzii: Din moment ce volumul bataie este slab
corelat cu SC la adulti, AVAi nu amelioreaza evaluarea
severitatii stenozei aortice. Prin indexarea AVA la paci-
entii obezi stenoza aortica este supraestimata ca severi-
tate. Rezultatele acestui studiu ar putea avea implicatii
si pentru diagnosticul mismatch-ului pacient-proteza.
Indexing effective orifice
area by body surface area
overestimates prevalence of
severe aortic stenosis in obese
patients and does not improve
the assessment of aortic
stenosis severity in adults
Background. Since dividing cardiac output by body
surface area (BSA) yields an indexof 3-4 L/min/m2,
which is more or less constant until adulthood, inde-
xing has subsequently been applied to various mea-
surements despite no evidence on its validity. Unlike
children, in adults BSA varies due to changes in body
weight (BW) rather than in height.
Method: To assess the impact of BW on the relation
between aortic efective orifce area (EOA) indexed by
BSA and transvalvular gradients in aortic stenosis, we
prospectively studied 278 patients (768y, 48% men)
with LV ejection fraction >50%, aortic peak velocity
>2 m/s (EOA=0.950.37, range 0.3-2.27cm2; peak
gradient (PkG)=6129, range 10-174 mm Hg; mean
gradient (MnG)=3417, range 6-101 mmHg), and no
other signifcant valvular disease. BW and height were
carefully measured immediately afer echo using same
scales.
POSTER I
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Suplimentul A, 2010
82
murmur grade III/VI parasternal right, in the context
of known heart disease. Presented in trend haemate-
mesis (500- 800 ml) preceded by coughs and abundant
melena for four days during hospitalization. Emergency
assesstement excluded digestive bleeding or ORL sour-
ces. In etiological diagnosis, as treatment of established
the bowel resume and normalize progressively, with
the improvement of the pacients clinical condition.
Respiratory and digestive consequences were managed
in parallel with specifc treatment. Te case whas in-
terpreted as massive haemoptysia by tracheo-bronchial
varices (collateral break), followed by swallowing large
amounts of blood and melena (as a cosequence) in the
context of cyanogen cardiac malformation neglected.
Alternate fow is ef cient, but presence a high risk of
recurrence. He entered the discussion as block conges-
tive rith lung, secondary bleeding that was managed
as a block - existing lung resolved; also presented by
blood resorption increases blood bilirubin - remitted
temporary. An alternative long-term treatment cavo-
pulmonary anastomosis would be total (FONTAN)
made mono or bistadial (GLEEN); also a mixed solu-
tion should be followed by angiographic embolization
sistemico-pulmonary shunt.
27. Modificarea stilului de
viata, EA III Romania
follow-up de la ghiduri la
practica medicala
Stela Iurciuc, M.Iurciuc, Adina Avram, S.Ursoniu,
Laura Craciun, Daniela Stancila, Madalina Caprariu,
Suceava Ioana, C.Sarau, D.Gaita, Silvia Mancas
Universitatea de Medicina si Farmacie, Timisoara
Premise: Studiile populationale din ultimii ani au de-
monstrat o incidenta sporita a modului de viata nesa-
natos.
Scop: Cresterea efceintei preventiei cardiovascula-
re prin interventia asupra stilului de viata, intr-o arie
geografca cu subiecti cu risc cardiovascular inalt si cu
obiceiuri alimentare nesanatoase.
Metoda: Am evaluat 325 paceinti (varsta medie: 56+/-
9 ani, 62% femei) din cei 503 asimptomatici cu risc
inalt inclusi in Euroasire III Romania Primary Care.
Am efcientizat interventia pe preventia primara prin
rator, precum si sufu sistolic gradul III/VI parasternal
drept in contextual bolii cardiace cunoscute. In evolu-
tie a prezentat hematemeza (500-800 ml) precedata de
accese de tuse si scaune melenice abundente, timp de 4
zile pe perioada internarii. Evaluarile de urgenta au ex-
clus o sangerare digestiva sau in sfera ORL.In paralel cu
efortul de diagnostic etiologic, sub tratamentul instituit
tranzitul intestinal se reia si se normalizeaza progresiv,
o data cu ameliorarea starii clinice a pacientului.Con-
secintele respiratorii si digestive au fost manageriate in
paralel cu tratamentul specifc. Cazul a fost interpre-
tat ca hemoptizie masiva prin varice traheo-bronsice
(ruptura colateralelor), urmata de inghitirea sangelui in
cantitati mari si melena (ca si consecinta), in contextul
unei malformatii cardiace cianogene neglijata. Circula-
tia de supleere este efcienta,dar prezinta un risc major
de recurenta. A mai intrat in discutie un bloc congestiv
pulmonar drept secundar sangerarii care a fost mana-
geriat ca si un bloc pneumonic-actual remis , de aseme-
nea prin resorbtia sangelui a prezentat cresteri tempo-
rare de bilirubina remisa. O alternativa de tratament
pe termen lung ar f anastomoza cavo-pulmonara totala
(FONTAN), realizata mono sau bistadial (GLENN), de
asemenea o solutie mixta ar f embolizarea angiografca
urmata de shunt sistemico-pulmonar.
Complex cyanogen congenital
heart malformation with
mapca masive haemopthysis
source witch can lead to
confusion diagnostic with
upper gastrointestinal bleeding
Pacient I.D., aged 13 years, known at birth with com-
plex cyanogen cardiac malformation, dextrocardia,
single ventricule, pulmonary valve atresia, in the con-
text of the thoracic and abdominal situs invesus, with
natural evolution, without treatment, developing in
time pulmonary abundance collaterals and severe po-
liglobulia. Te day before admissions shows: massive
haematemesis, epistaxis preceded by a ft of coughing
and rapide progressive clinical deterioration. Clinical
examination on admission revealed severe mood infu-
ence, generalized cyanosis, digital hipocratism, clinical
signs of continued high respiratory bleeding , systolic
Suplimentul A, 2010
88
POSTER I
POSTER I
ents included in EuroAspire III Romania Primary Care.
We perform reinforced primary care intervention con-
sisted of 18 months follow-up by general practitioner
previously trained by cardiologist ad nutritionist. Every
6 months patients were evaluated and advised accor-
ding to ESC Prevention Kit.
Results: Te number of patients who claim they recei-
ved and followed advice of GPs to change of lifestyle
was initially 280 and afer 18 months 308 (p <0.001).
Tey said they increased consumption of fruits and ve-
getables was initially 267 and afer 18 months 230 (p
<0.001). Tey said they decreased the consumption of
sugar, 209 initially and 245 afer 18 months (p = 0.002).
Tey said they decreased the weight by the recommen-
dations of family physician, 210 initially and 280 afer
18 months (p <0.001). We also obtained good results
by: reducing salt and fat consumption, reducing calo-
ries intake, increased consumption of fsh but this re-
sults where statistically not signifcant.
Conclusions: Afer reinforced primary care interventi-
on in a geographic region with many high cardiovascu-
lar risk patients we obtained better results by insisting:
with a mediterranean diet, eating more fruits and vege-
tables, reducing sugar, following dietary recommenda-
tions, following specifc exercise advice from a health
or exercise professional, trying to do more general
everyday physical activities. We obtained also impro-
vement in lifestyle changing at other parameters but
not statistically signifcant perhaps because of the bad
habits in this region. We must take care with this food
habits in the intervention on lifestyle changing.
urmarirea pacientilor timp de 18 luni de catre Medicul
de Familie. Medicul de Familie a fost instruit in acest
sens in prealabil de catre o echipa formata din cardio-
log, nutritionist si nefrolog. La fecare 6 luni pacientii
au fost evaluati si sfatuit conform kitului european de
preventie cardiovasculara. Am evaluat urmatorii para-
metrii (inainte si dupa 18 luni): factorii de risc cardio-
vascular, dieta sanatoasa, cresterea activitatii fzice.
Rezultate: Numarul de pacienti ce au afrmat ca au pri-
mit si urmat sfaturile medicului de Familie, de modif-
carea a stilului de viata este: 280 initial si 308 dupa 18
luni (p<0.001) au crescut consumul de fructe si legume;
230 initial si apoi 267 dupa 18 luni (p<0.001) au scazut
consumul de zaharuri; 209 initial si 245 dupa 18 luni
(p=0.002) au scazut in greutate respectand recomanda-
rile din dieta; 210 initial si 280 dupa 18 luni (p<0.001)
au crescut numarul activitatilor fzice zilnice. Rezultate
nesemnifcative au fost obtinute la reducerea consu-
mului de sare si grasimi, reducerea aportului caloric, la
cresterea consumului de peste si utilizarea medicatiei
in reducerea greutatii.
Concluzii: Dupa efcientizarea interventiei pe preven-
tia primara, am obtinut rezultate mai bune insistand
pe: dieta mediteraneana, consumul de legume si fructe,
reducerea zaharurilor, folosirea dietelor recomanda-
te, recomandarile de exercitiu fzic de catre kinetote-
rapeut si cresterea nivelului de activitate fzica zilnica
in general. Nu am obtinut rezultate satisfacatoare pe
alti parametrii ai modifcarii stilului de viata, desi s-a
folosti kitul recomandat de Societatea Europeana de
Cardiologie. Acest aspect poate f datorat obiceiurilor
alimentare nesanatoase ce nu au putut f modifcate asa
de usor. Este necesara o interventie pe stilul de viata,
adaptata fecarei regiuni geografce in parte.
Healthy lifestyle, geographical
habits and the way we put in
the practice
Background: Population studies have demonstrated a
high prevalence of unhealthy lifestyles.
Purpose: To raise the standard of preventive cardiology
through more lifestyle intervention, in a geographic
area with many people with high cardiovascular risk
and bad food habits.
Methods: We evaluated 325 patients (age 569 years,
62% women) out of 503 asymptomatic high risk pati-
POSTER I
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Suplimentul A, 2010
81
(11.38%) a fost inregistrata la 404 pts tratati cu antico-
agulante si A&C;comparativ cu cea de 21.01% inregis-
trata la 671 pts care au primit numai anticoagulante si
A (p<0.0001). Incidenta accidentului vascular cerebral
hemoragic a fost de 0.99%, respectiv 0.59% sub limi-
ta de detectie a semnifcatiei statistice. Incidenta altor
complicatii hemoragice majore a fost 3.42%, respectiv,
4.20% (p=0.667). Incidenta cumulata a accidentelor
vasculare cerebrale hemoragice si a hemoragiilor majo-
re a fost 5.44%, respectiv, 4.32% (p=0.489).
Concluzii: Registrul RO-STEMI sugereaza faptul ca
administrarea de clopidogrel in combinatie cu aspiri-
na si anticoagulante la pts STEMI cu esec de reperfuzie
trombolitica si fara acces la PCI de salvare sau PCI
precoce este urmata de o reducere cu 45% a mortalitatii
intra-spitalicesti. Acest impact major al clopidogrelului
se produce fara o crestere a riscului de evenimente he-
moragice majore.
Impact of clopidogrel in
patients with ST-elevation
myocardial infarction and
failed thrombolysis not
undergoing rescue or early
angioplasty. RO-STEMI data
Background: Current guidelines recomend clopido-
grel (C) combined with aspirin (A) in patients (pts)
with ST-elevation myocardial infarction (STEMI) and
fbrinolytic therapy. However, the specifc impact of C
in pts with succesfull or failed thrombolysis (FT) was
not evaluated. Objective: To compare the in-hospital
mortality and the rates of the major bleeding events
in STEMI pts with FT, not undergoing rescue or early
(within the frst 24 hours) angioplasty (PCI) treated
with anticoagulants combined with either A or A plus
C (A&C).
In this group, 6588 pts received thrombolytic thera-
py. Te ef cacy of thrombolysis was assessed with two
noninvasive reperfusion criteria: rapid cessation of the
chest pain and decrease of the sum of the ST-segment
elevations more than 50% at 180 min. afer the start
28. Impactul adminstrarii
de clopidogrel la pacientii
cu infarct miocardic acut cu
cu esec al terapiei trombolitice
si fara PCI de salvare sau
precoce. Date RO-STEMI
G.Tatu-Chitoiu, Maria Dorobantu, B.Minescu,
I.Benedek, Catalina Arsenescu-Georgescu, El-
vira Craiu, Mariana Radoi, L.Chiriac, V.Greere,
D.D.Ionescu, A.Petris
Spitalul Clinic de Urgenta Floreasca Bucuresti
Introducere: Ghidurile actuale recomanda administra-
rea de clopidogrel (C) in combinatie cu Aspirina (A) la
pacientii (pts) cu terapie trombolitica (TT) pentru in-
farctul miocardic acut cu supradenivelare de segment
ST (STEMI). Efectul administrarii de C la pts la care
TT nu a avut succes nu a fost inca evaluat. Obiective:
Compararea mortalitatii intra-spitalicesti si a ratei he-
moragiilor majore la pts cu TT pentru STEMI, la care
angioplastia (PCI) de salvare sau precoce (in primele
24 de ore) nu a fost disponibila si care au primit trata-
ment anticoagulant combinat fe cu A fe cu A plus C
(A&C;).
Metoda: in perioada 1.01.2000 - 31.12.2009 au fost
inrolati consecutiv in Registrului Roman pentru In-
farctul Miocardic cu Supradenivelare de Segment ST
(RO-STEMI) 15047 pts. In acest grup, 6588 pts au
primit TT. Efectul TT a fost evaluat prin doua criterii
non-invazive de reperfuzie: disparitia rapida a durerii
toracice si reducerea sumei supradenivelariilor de seg-
ment ST cu peste 50% la 180 min. dupa debutul TT. In
absenta contraindicatiilor, pacientii au primit beta-blo-
cante, inhibitori ai enzimei de conversie a angiotensi-
nei, statine si anticoagulante (heparina -1000 i.u. /ora,
48-96 ore - sau enoxaparina - 1 mg/kg la fecare 12 ore
timp de 8-10 zile) combinate fe cu A -150-300 mg/zi
sau A&C;(C doza de incarcare 300 mg. urmata de 75
mg/zi).
Rezultate: criteriile de reperfuzie coronariana au fost
evaluate corect la 5732 (87%) pts. A fost identifcat un
subgrup de 1075 pts consecutivi fara semne de reperfu-
zie trombolitica si fara PCI de salvare sau precoce. O
mortalitate intra-spitaliceasca semnifcativ mai redusa
Suplimentul A, 2010
85
POSTER I
POSTER I
culara evaluat prin grosimea intimei-media la nivelul
arterei carotide.
Material si metoda: Studiul a inclus 50 de pacienti hi-
pertensivi (varsta: 56 5,60 ani) si 41 pacienti hiper-
tensivi cu sindrom metabolic (varsta: 56 3,62 ani).
Sindromul metabolic a fost defnit conform ghidului
National Cholesterol Education Program Adult Treat-
ment Panel III. Au fost determinate valoarea medie
a grosimii intimei-media la nivelul arterei carotide
(IMT), parametrii antropometrici (indicele de masa
corporala-IMC, circumferinta abdominala-WC, ra-
portul talie-sold-WHR) si parametrii proflului lipidic
(colesterolul total, trigliceridele, LDL-colesterolul si
HDL-colesterolul). Grosimea intimei-media la nivelul
arterei carotide a fost masurata prin ultrasonografe de
inalta rezolutie conform consensului de la Mannheim.
Rezultate: Pacientii hipertensivi cu sindrom metabolic
au avut valori mai mari ale IMC (27,56 1,63 kg/m2 vs.
24,05 1,19 kg/m2, p<0,001), WC (98 6,66 cm vs. 80
6,55 cm, p<0,001) si WHR (1,01 0,09 vs. 0,83 0,11,
p<0,001) comparativ cu pacientii hipertensivi din pri-
mul grup. Am gasit diferente statistic semnifcative ale
valorilor colesterolului total (207 22,22 mg/dL vs. 182
8,52 mg/dL, p<0,001), trigliceridelor (173 7,05 mg/
dL vs. 137 10,22 mg/dL, p<0,001), LDL-colesterolului
(133 22,58 mg/dL vs. 106 6,65 mg/dL, p<0,001),
si HDL-colesterolului (39 4,24 mg/dL vs. 148 4,73
mg/dL, p<0,001). IMT la nivelul arterei carotide a fost
semnifcativ mai mare la pacientii hipertensivi cu sin-
drom metabolic comparativ cu pacientii hipertensivi
(1,270,03 mm vs. 1,000,03 mm, p <0,001).
Concluzii: Masurarea IMT la nivelul arterei carotide
poate f un instrument util pentru evaluarea ateroscle-
rozei la pacientii hipertensivi cu sindrom metabolic.
Increased carotid intima-media
thickness in hypertensive
patients with metabolic
syndrome
Objective: Measurement of carotid intima-media
thickness (IMT), a novel surrogate marker of athe-
rosclerosis can be considered also a marker for genera-
lized atherosclerosis and an indicator of cardiovascular
risk. In this study we investigated whether the metabo-
lic syndrome is related to the extent of vascular damage
evaluated by carotid intima-media thickness.
of thrombolysis. In the absence of contraindication,
all pts. received beta-blockers,angiotensin converting
enzyme inhibitors, statins and anticoagulants (unfrac-
tionated heparin-1000 i.u./hour, 48-96 hours or eno-
xaparin 1 mg/kg every 12 hours, 8-10 days) combined
with either A-150-300 mg./day or A&C (loading dose
of 300 mg. followed by 75 mg/day).
Results: Te ef cacy of thrombolysis was correctly
assessed in 5732 (87%) pts. A subgroup of 1075 con-
secutive pts. with FT, not undergoing rescue or early
PCI was identifed. A signifcant lower in-hospital
mortality (11.38%) was seen in the 404 pts treated with
anticoagulants and A&C compared with 21.01% seen
in the 671 pts who received only anticoagulants and A
(p<0.0001). Te rates of the haemorrhagic stroke were
0.99% and 0.59%, respectivelly, below the limit for de-
tection of the signifcant diference. Te rates of other
major bleeding were 3.42% and 4.20% (non-signif-
cant diference, p=0.667). Te combined haemorrhagic
stroke and major bleeding rates were 5.44% and 4.32%,
respectivelly (non-signifcant diference, p=0.489).
suggest that clopidogrel induces a 45% reduction of the
in-hospital mortality in STEMI pts with FT not under-
going rescue/early PCI when it is added to the classical
anticoagulant plus aspirin combination. Tis major im-
pact is obtained without an increased risk of the major
haemorrhagical events.
29. Cresterea grosimii
intimei-media carotidiene
la pacientii hipertensivi cu
sindrom metabolic
Corina Serban, Simona Dragan, Ioana Mozos, Rux-
andra Christodorescu, Lelia Susan, Germaine Savoiu,
A.Caraba, Alina Pacurari, I.Romosan
Universitatea de Medicina si Farmacie "Victor Babes",
Timisoara
Obiectiv: Masurarea intimei-media la nivelul arterei
carotide (IMT), un marker surogat nou al ateroscle-
rozei, poate f considerat, de asemenea, un marker al
aterosclerozei generalizate si un indicator al riscului
cardiovascular. In acest studiu am investigat daca sin-
dromul metabolic este legat de gradul de afectare vas-
POSTER I
POSTER I
Suplimentul A, 2010
86
Material si metoda: Au fost inclusi 61 pacienti cu var-
sta sub 60 ani, fara boala cardiovasculara sau diabet
zaharat la care s-a pus diagnosticul conform criteriilor
IDF, impartiti in doua loturi A si B, care au urmat, re-
spectiv nu au urmat, tratament cu metformin 2 x 500
mg/zi. Au fost urmariti variatiile urmatorilor parametri
initial si la fnalul studiului: trigliceride, HDL-coleste-
rol, proteina C reactiva inalt sensibila (PCR), vasodila-
tatia mediata de fux (FMD), grosimea intima-medie
la nivelul arterei carotide comune (IMT), severitatea
steatozei hepatice nonalcoolice.
Rezultate: La includerea in studiu, loturile au fost omo-
gene din punct de vedere statistic pentru varsta, sex si
parametrii studiati. In urma tratamentului de 6 luni, lo-
tul A a inregistrat ameliorari ale parametrilor urmariti
fata de lotul B. S-a inregistrat o scadere a trigliceridelor
cu o diferenta semnifcativa a variatiilor acestora intre
cele 2 loturi (-5,15,0 mg/dl vs 0,212,5; p=0,02), cres-
teri fara a atinge pragurile de semnifcatie in cazul vari-
atiilor HDL-colesterol (0,40,2 mg/dl vs 0,030,05 mg/
dl; p=0,15). Sindromul infamator evaluat prin PCR, a
fost semnifcativ ameliorat (-0,24 0,18 mg/l vs. 0,07
0,04; p 0,001). De asemenea, gradul steatozei no-
nalcoolice s-a redus cu o putere mare de semnifcatie.
Asupra parametrilor ecografci vasculari, tratamentul
cu metformin a determinat variatii semnifcative in ca-
zul FMD (1,91,44% vs -0,030,7%; p=0,007), dar ne-
semnifcative pentru IMT (-0,0080,05 vs. 0,0030,04;
p=0,18).
Concluzii: Tratamentul cu metformin s-a dovedit ef-
cace in ameliorarea facorilor de risc cardiometabolici
la pacientii cu sindrom metabolic fara boala cardiovas-
culara manifesta.
Metformin therapy in patients
reduces cardiometabolic risk
Purpose: We aim to evaluate the beneft of a 6 month
metformin therapy on clinical, biological and ultra-
sound parameters in patients with metabolic syndrome
(MS) but without cardiovascular disease or type 2 dia-
betes mellitus
Method: We studied 61 patients (pts), aged between 30
and 60 years, diagnosed with MS by IDF criteria. We
divided the pts in 2 groups: A 29 pts treated 6 month
with metformin 500 mg bid and B 32 pts without
tensive patients (aged 56 5.60 years) and 41 hyperten-
sive patients with metabolic syndrome (aged 56 3.62
years). Metabolic syndrome was defned by the National
Cholesterol Education Program Adult Treatment Panel
III guidelines. Mean carotid intima-media-thickness
(IMT), anthropometric parameters (body mass index-
BMI, waist circumference-WC, waist-hip ratio-WHR)
and lipid profles parameters (total cholesterol, trygli-
cerides, LDL-cholesterol and LDL-cholesterol) were
measured. Te carotid intima-media thickness was
assessed by high resolution B-mode ultrasound ima-
ging according to the Mannheim Consensus.
Results: Hypertensive patients with metabolic syndro-
me had higher values of BMI (27.56 1.63 kg/m2 vs.
24.05 1.19 kg/m2, p<0.001), WC (98 6.66 cm vs. 80
6.55 cm, p<0.001) and WHR (1.01 0.09 vs. 0.83
0.11, p<0.001) compared to the hypertensive patients
of the frst group. We found statistical signifcant di-
ferences for the levels of total cholesterol (207 22.22
mg/dL vs. 182 8.52 mg/dL, p<0.001), triglycerides
(173 7.05 mg/dL vs. 137 10.22 mg/dL, p<0.001),
LDL-cholesterol (133 22.58 mg/dL vs. 106 6.65 mg/
dL, p<0.001), and HDL-cholesterol (39 4.24 mg/dL
vs. 148 4.73 mg/dL, p<0.001). Carotid IMT was sig-
nifcantly increased in hypertensive patients with me-
tabolic syndrome compared to hypertensive patients
(1.270.03 mm vs. 1.000.03 mm, p <0.001).
Conclusions: Measurement of carotid IMT is a useful
tool in assessment of atherosclerosis progression in
hypertensive patients with metabolic syndrome.
30. Tratamentul cu metformin
la pacientii cu sindrom
metabolic reduce riscul
cardiometabolic
Monica Susan, R.Susan, Corina Serban, Lelia Susan,
C.Tudor
Universitatea de Medicina si Farmacie "Victor Babes",,
Timisoara
Scop: Evaluarea efectului terapiei de 6 luni cu metfor-
min asupra parametrilor clinici, biologici si ecografci
la pacientii cu sindrom metabolic (SM) fara boala car-
diovasculara clinic manifesta si diabet zaharat tip 2.
Suplimentul A, 2010
8I
POSTER I
POSTER I
carilor electrocardiografce de orice tip si tulburarilor
de ritm la pacientii cu GGT crescut (grup 1, n=232)
in comparatie cu pacientii cu GGT normal (grup 2,
n=318), la internare.
Rezultate: Valoarea medie a GGT a fost de 100 UI vs
28.5 UI. Varsta medie a fost 64.4 vs 65 de ani iar 44.6%
vs 34.6% dintre pacientii din grupul 1 vs grupul 2 au
fost de sex masculin. In grupul 1 au fost aproximativ de
2 ori mai multi consumatori cronici de alcool. Indicele
de masa corporala a fost net superior in grupul 1 fata de
2 (41 vs 28.5 kg/m2). Proflul lipidic a fost comparabil
in cele 2 grupuri: colesterol 196 vs 206.4 mg/dl, triglice-
ride 134.7 vs 131.6 mg/dl, HDL 49 vs 50.5 mg/dl, LDL
122 vs 131 mg/dl iar raportul mediu trigliceride/HDL
a fost 2.74 vs 2.60. GGT crescut s-a corelat semnifcativ
statistic cu hipertensiunea arteriala (r=0.677, p<0.05),
angina pectorala (r=0.87, p<0.001), tulburarile de ritm
(r=0.91, p<0.001) si modifcarile electrocardiografce
de orice tip (r=0.71, p<0.05). GGT crescut nu s-a core-
lat semnifcativ statistic cu steatoza hepatica, insufci-
enta cardiaca si infarctul de miocard.
Concluzie: In prezenta unui profl lipidic comparabil,
a obezitatii si a consumului cronic de alcool, GGT cres-
cut se coreleaza inalt semnifcativ statistic cu tulburari-
le de ritm si cu angina pectorala.
Gamma-glutamyltransferase
- a novel cardiovascular risk
factor?
Gamma-glutamyltransferase (GGT) is possible to be-
coming an important addition to the multimarker
approach to cardiovascular risk evaluation.
Aim: We aimed to assess the association between GGT
and cardiovascular disease.
Methods: We included 550 patients consecutively at
in-hospital admission. We analyzed the presence of
steato-hepatitis, arterial hypertension, coronary artery
disease, myocardial infarction, heart failure, any elec-
trocardiographically changing and arrhythmias in pa-
tients with elevated GGT (group 1, n=232) in compari-
son with patients with normal GGT (group 2, n=318).
Results: Mean GGT was 100 UI vs 28.5 UI. Mean age
was 64.4 vs 65 years and 44.6% vs 34.6% were men. In
group 1 were 2 fold more alcoholic consumers. BMI
was net superior in group 1 (41 vs 28.5 kg/m2). Lipid
profle was comparable between 2 groups: cholesterol
metformin therapy. We studied the following parame-
ters at baseline and afer 6 months: serum triglycerides,
serum HDL-cholesterol, C reactive proteine high sen-
sitive (CRP-hs), brachial artery fow mediated dilation
(FMD) and carotid intima media thickness (IMT), as
well as the severity of nonalcoholic fatty liver disease
(NFLD).
Results: At baseline, there were no signifcant statistical
diferences between the two groups regarding the stu-
died parameters. Afer 6 months there was a signifcant
improvement in pts treated with metformin (group A)
as compared to group B. Tere was a signifcant reduc-
tion in serum triglycerides (-5,15,0 mg/dl vs 0,212,5;
p=0,02) and a nonsignifcant increase in HDL-choles-
terol (0,40,2 mg/dl vs 0,030,05 mg/dl; p=0,15). In-
fammatory syndrome assessed by CRP-hs, was signif-
cantly improved by 6 months metformin therapy (-0,24
0,18 mg/l vs. 0,07 0,04; p 0,001). Te severity of
NFLD was strongly reduced in metformin-treated
patients. Ultrasound parameters improved in group
A, signifcantly for FMD (1,91,44% vs. -0,030,7%;
p=0,007) and without statistical signifcance for IMT
(-0,0080,05 vs. 0,0030,04; p=0,18).
Conclusions: Metformin therapy proved its efcacy in
reducing cardiometabolic risk in pts with metabolic
syndrome but without cardiovascular disease or type 2
diabetes mellitus
31. Gama-glutamil trasferaza
un nou factor de risc
cardiovascular?
V.Ambarus, Mariana Floria, Lacramioara Pantaru,
Ramona Alina Antal, Elena Ancuta Varlan, Mirela
Paraschiva Ciutea, Paloma Manea, I.G.Rosu
Universitatea de Medicina si Farmacie Gr.T.Popa,
Spitalul Universitar "Sf. Spiridon", Iasi
Gamaglutamil transferaza (GGT) serica este consi-
derata un posibil factor de risc cardiovascular. Scop:
Evaluarea gradului de asociere intre GGT si afectiunile
cardiovasculare.
Metode: Studiul a inclus 550 de pacienti consecutiv
internati in anul 2009. Am analizat prezenta steatozei
hepatice, hipertensiunii arteriale, anginei pectorale,
infarctului de miocard, insufcientei cardiace, modif-
POSTER I
POSTER I
Suplimentul A, 2010
88
apoi insufcienta cardio-respiratorie acuta prin trom-
boembolism pulmonar; drept cauze mai rare de deces
au fost; pancreatitele necrotice (2 cazuri), ocluzia in-
testinala (1 caz) precum si ruptura de ventricul stang
(1caz).
Pentru cazurile amendate chirurgical, cel mai frecvent
cauza mortii s-a datorat bronhopneumoniei in con-
textul unei evolutii septice postoperatorii, cauze mai
rare find decesul intraoperator (2 cazuri), sau chiar in
cursul explorarilor ulterioare prin cateterism cardiac(1
caz). In ce priveste endocarditele, cele mai frecvente
cauze ale decesului ua fost predominant infarctizarile
pluriorganice multiple prin embolizari septice.
Concluzii: Pentru a avea cat mai multe rezultate pozi-
tive in contextul unei patologii valvulare este necesara
abordarea chirurgicala a cat mai multor pacienti inain-
te sa apara leziunile cardio-pulmonare ireversibile si
cu atat mai mult, inaintea aparitiei endocarditei bacte-
riene ca si complicatie de temut a leziunilor valvulare
ulcerate sau calcifcate nerezolvate chirurgical.
Correlations anatomo-clinic in
valvulopathy - study casuistry
in Cardiovascular Institute
C.C. Iliescu - 1999-2010
Aim: Te study aims to complement an overall picture
of positive results, known clinically with postmortem
morphological studies and thus establish a line of con-
duct proper surgical those situations.
Material and methods: A total of 83 cases with val-
vulopathy: aortic, mitral-aortic (majority) but also the
tricuspid, which were assessed by conducting necropsy
and histology stain is: HE, VG, TM, PAS-Alcian, Go-
mory, and by electron microscopy.
Results: Our study highlights the following: 12% of
all cases necropsy showed valvular disease. Of these,
17 cases were diagnosed with bacterial endocarditis,
aortic valves located at (12), mitral (3), mitro-aortic
(a) and tricuspidian (1). Age range was between 23
and 76 years, predominantly male patients (53 and
30 ). Of all cases of valvular disease, only 33% were
fned by prosthetic aorica surgery, mitral, or mitro-aor-
tic and tricuspid valve. If unamended valvular surgery,
the most frequent cause of death was cardio-circulato-
ry impaired consecutive acute myocardial infarction
196 vs 206.4 mg/dl, triglycerides 134.7 vs 131.6 mg/
dl, HDL 49 vs 50.5 mg/dl, LDL 122 vs 131 mg/dl and
triglycerides/HDL was 2.74 vs 2.60. Elevated GGT was
statistically signifcantly correlated with arterial hyper-
tension (r=0.677, p<0.05), coronary artery disease
(r=0.87, p<0.001), arrhythmias (r=0.91, p<0.001) and
electrocardiographically changing (r=0.71, p<0.05).
Elevated GGT was not correlated with steato-hepatitis,
cardiac failure and myocardial infarction.
Conclusions: In presence of similar lipid profle, of
obesity and of chronic alcoholic consume, elevated
GGT was high signifcantly statistically correlated with
arrhythmias and coronary artery disease.
32. Corelatii anatomo-clinice
in valvulopatii studiu pe
cazuistica IUBCV 1999-2010
Liliana Parascan, B.A. Popescu, H. Moldovan, V.
Iliescu
Institutul de Urgenta pentru Boli Cardiovasculare
Prof. Dr. C. C. Iliescu, Bucuresti
Scop: Studiul efectuat urmareste completarea unei
imagini de ansamblu a rezultatelor pozitive, cunoscute
clinic, cu studiile morfologice postmortem si stabilirea
in acest fel a unei linii de conduita chirurgicala adecva-
ta acestor situatii.
Material si metode: Un numar de 83 cazuri cu valvu-
lopatii aortice, mitrale, mitro-aortice (majoritare) dar
si de tricuspida, care au fost evaluate necropsic si histo-
logic efectuindu-se coloratii: HE, VG, TM, PAS-Alcian,
Gomori, si prin microscopie electronica.
Rezultate: Studiul nostru evidentiaza urmatoarele: 12
% din totalul cazurilor necropsiate au prezentat valvu-
lopatii. Dintre acestea, 17 cazuri au fost diagnosticate
cu endocardite bacteriene localizate la nivel valvular
aortic (12), mitral (3), mitro-aortic(1) si tricuspidian
(1). Intervalul de varsta a fost intre 23 si 76 ani, predo-
minind pacientii de sex masculin (53 si 30).
Din totalul cazurilor cu valvulopatii, doar 33 % au fost
amendate chirurgical prin protezare aorica, mitrala,
mitro-aortica sau tricuspidiana.
In cazul valvulopatiilor neamendate chirurgical, cea
mai frecventa cauza de deces a fost insufcieta cardio-
circulatorie acuta consecutiva infarctului de miocard
Suplimentul A, 2010
89
POSTER I
POSTER I
it 25 de copii medicati cu Sildenafl si lotul II - 22 de
pacienti ce au primit tratament conventional. Doza
initiala a Sildenaflului a fost de, apoi la o tolerabilitate
buna - 1 si 2 mg/kg/zi fecare 6 ore.Efcienta si tolera-
bilitatea preparatului au fost analizate lunar, durata de
supraveghere find de la 3 pana 6 luni. Protocolul de
studiu a inclus semnele clinico-paraclinice ale HTP si
un chestionar special de evidenta a reactiilor adverse.
La majoritatea pacientilor ce au primit Sildenafl (92%)
s-a observat ameliorarea CF OMS/NYHA, tolerantei
la efort estimata prin testul mers plat 6 min de la
263,755,24 pana la 468,256,8; cresterea saturatiei
O2 sistemice de la 91,520,88% pana la 96,440,92%;
diminuarea presiunii in a. pulmonara medie (PAPm)
de la 54,482,4 pana la 25,281,8 mmHg; diminuarea
rezistentei vasculare pulmonare (RVP) de la 5,1341,6
pana la 2,370,8 UnWood; imbunatatirii functiei sisto-
lice a VD (indicelui de performanta Tei) de la 0,510,07
pana la 0,310,04. Astfel, rezultatele studiului au de-
monstrat ca Sildenaflul este un remediu efectiv in HTP
secundara sunturilor congenitale sistemico-pulmonare
reparate chirurgical, imbunatatind CF (P<0,01), tole-
rabilitatea la efort (P<0,001), saturatia O2 sistemica
(P<0,05), functia sistolica a VD (P<0,05), diminueaza
PAPm (P<0,001) si RVP (p<0,05) in comparatie cu pla-
cebo. Preparatul are o tolerabilitate buna, suscita reactii
adverse minore si neinsemnate, previne complicatiile
severe, avand un impact benefc asupra calitatii vietii
acestor copii.
The efficacy and tolerability
of Sildenafil in chidren with
pulmonary hypertension
secondary congenital
systemic-to-pulmonary shunt
Pulmonary Hypertension resulting from congeni-
tal cardiac disease remains one of the most dif cult
chilhood illnesses to treat. Sildenafl, a selective inhibi-
tor of phosphodiesterase type 5, is known as an efec-
tive and promising pulmonary vasodilator with few
and minor adverse efects, and less costly. We have eva-
luated the ef cacy and the tolerability of Sildenafl in
chidrens long treatment with PH secondary congenital
cardiac disease with shunts surgical repaired. In this
and then cardio-respiratory failure acute pulmonary
thromboembolism, as causes of death were rare, ne-
crotic pancreatitis (two cases), occlusion bowel (1 case)
and ventricular rupture (1caz). Fined surgical cases,
the most common cause of death was due bronhopneu-
moniei developments in the context of septic postope-
rative, intraoperative death cases are rare (two cases),
or during subsequent explorations by cardiac cathete-
rization (one case). In terms endocarditele, the most
common causes of death were predominantly u pluri-
organice multiple infarction by septic embolization.
Conclusion: To have as many positive results in the
context of valvular pathology surgical approach is
necessary as many patients before cardiopulmonary
lesions appear irreversible and much more, before
the emergence of bacterial endocarditis as a feared
complication of valvular lesions ulcerated or calcifed
surgical unresolved.
33. Eficacitatea si toleranta
Sildenafilului la copiii cu
hipertensiune pulmonara
secundara sunturilor
congenitale
sistemico-pulmonare
Ina Palii, Eleonora Vataman
ICSOSM si C, Chisinau, Republica Moldova
Hipertensiunea pulmonara secundara cardiopatiilor
congenitale ramane a f pana in prezent una din cele
mai difcile probleme in plan de tratament al copiilor
marcati astfel. Sildenaflul inhibitor selectiv al Fosfo-
diesterazei-5 este recunoscut in prezent a f un vaso-
dilatator pulmonar promitator si efectiv, cu putine si
minore reactii adverse, si mai putin costisitor. Noi am
evaluat efcacitatea si toleranta Sildenaflului in trata-
mentul de durata al copiilor cu HTP reziduala, secun-
dara cardiopatiilor congenitale cu sunt operate. In stu-
diu (randomizat, dublu orb, placebo controlat) 47 de
copii cu varsta cuprinsa intre 3 luni si 16 ani, cu HTP
avansata, reziduala secundara sunturilor sistemico -
pulmonare (simple, combinate si complexe) operate
radical sau paleativ au fost inclusi. I lot l-au constitu-
POSTER I
POSTER I
Suplimentul A, 2010
10
Metoda: Am comparat clasa Killip, aparitia de noi arit-
mii, tulburari de conducere, complicatii mecanice si
numarul de decese intre pts STEMI si NSTEMI inter-
nati intr-un spital teritorial timp de 2 ani. Prelucrarea
statistica s-a facut cu programul Anova.
Rezultate: Au fost luati in studiu 238 bolnavi, 60,5%
STEMI si 39,5% NSTEMI. 66,39% au fost barbati (B),
cu varsta medie 65,3+/-11,6 ani, 33,61 % au fost fe-
mei, cu varsta medie 70,7+/-10,6 ani, (p=0,0006). Nu
au existat diferente intre pts STEMI si NSTEMI le-
gate de datele demografce si prevalenta factorilor de
risc cardio-vasculari. In intregul grup, 18,7 % pts au
fost in clasa ll Killip, 8,4% in clasa lll Killip, fara dife-
rente semnifcative intre STEMI si NSTEMI. 18.75%
STEMI si 2,12% NSTEMI au fost in clasa lV Killip,
(OR=10.6154 [2.4613-45.7834]; p=0.0003). La 17,36 %
STEMI si 2,12% NSTEMI au aparut tahicardie ventri-
culara si fbrilatie ventriculara ( OR=9.6638 [2.2321-
41.8403, p=0.0001). 17,36% STEMI si 9,57% NSTEMI
au prezentat blocuri atrio-ventriculare gradul ll si lll
(p=0.0001). Ruptura peretelui liber al ventriculului
stang si a septului interventricular s-a produs numai la
pts STEMI. Decesul a aparut la 26,38% STEMI si 6,38%
NSTEMI (OR=5.2579 [2.1255-13.0064, p=0.0001).
Decesul la pts STEMI a fost corelat cu antecedentele
de infarct miocardic (OR=4.2857 [1.8139-10.1258];
p=0.0005) si insufcienta cardiaca (OR=5.1084 [2.1969-
11.8783]; p=0.0001). Decesul la NSTEMI s-a corelat
cu sexul feminin ((OR=11.2963 [1.2589-101.3658];
p=0.01) si cu antecedentele de insufcienta renala cro-
nica (OR=8.3529 [1.4115-49.4311]; p=0.02)
Concluzii: STEMI s-a asociat mai frecvent ca NSTEMI
cu Killip lV (p=0,0003), tahicardia ventriculara
(p=0,0001), fbrilatia ventriculara (p=0,0001) si deces
(p=0,0001) mai ales la pts cu antecedente de infarct
miocardic si insufcienta cardiaca. Decesul in NSTEMI
s-a asociat cu sexul feminin si antecedentele de insuf-
cienta renala cronica
study (double-blind, placebo-controlled) 47 children
with age between 3 months and 16 years with advan-
ced, residual PH secondary to systemic-to-pulmonary
shunts (simple, mixed and complex), radical or pallia-
tive surgical repaid were included. Te frst group was
consisted of 25 children treated with Sildenafl and the
second one 22 patients received a conventional treat-
ment. Te initial dose of Sildenafl was of 0,5 mg/kg,
then at a good tolerability - 1 and 2 mg/kg/day each
6 hours. In the study protocol were included clinical
and paraclinical signs of PH, and a special questionna-
ire of evidence of adverse reactions. At the majority of
the patients treated with Sildenafl (92%) had been ob-
served an improvement of FC OMS/NYHA, an efort
tolerance estimated by fat - running test of 6 minutes
from 263,755,24 to 468,256,8; the diminishing of the
mean pressure in the pulmonary artery from 54,482,4
to 25,281,8 mmHg; the decreasing of the pulmonary
vascular resistance (PVR) from 5,1341,6 to 2,370,8
UnWood; the improvement of the sistolic function
of RV (the performance index Tei) from 0,510,07 to
0,310,04. Te study results had proved that Sildena-
fl is an ef cient medicine in treating PH secondary
to congenital systemic-to-pulmonary shunts surgical
repaired, improving FC (P<0,01), tolerability at efort
(P<0,001), systemic O2 saturation (P<0,05), diminis-
hing PAPm (P<0,001) and PVR (p<0,05) comparing
with placebo. Tis medicine has good tolerability, with
minors and insignifcant reactions, preventing severe
complications, having a favourable impact on the qua-
lity of life of these children.
34. Particularitati evolutive
in infarctul miocardic acut
cu si fara supradenivelare
de segment ST. Studiu
observational in lumea reala
Gabriela Silvia Gheorghe, Ana Cristea, Irina Andrei,
Andreea Hodorogea, Simona Almarichi, T.Nanea
Spitalul Clinic Caritas, Bucuresti
Scop: studiul evolutiei infarctului miocardic acut
(IMA) cu (STEMI) si fara (NSTEMI) supradenivelare
de segment ST la pacientii (pts) internati consecutiv in-
tr-un spital teritorial.
Suplimentul A, 2010
11
POSTER I
POSTER I
35. Particularitati evolutive ale
HTA de halat alb la copilul
scolar
A.G.Dimitriu, Doina Felea, Lavinia Dimitriu
Universitatea de Medicina si Farmacie Gr.T Popa, Iasi
Scopul studiului: Studiul modalitatilor evolutive ale
HTA halate albe la copil si adolescent, utilitatea dia-
gnosticului la pacientii pediatrici si relatia cu hiperten-
siunea arteriala esentiala ulterioara.
Material si metoda: Autorii au evaluat 1068 scolari, cu
varsta intre 10 si 16 ani, in cadrul unui screening pen-
tru stabilirea prevalentei hipertensiunii arteriale siste-
mice la copilul scolar. Prima determinare a TA a fost
efectuata in conditii standard (cabinetul medical scolar
sau in sala de clasa) si a fost repetata dupa 15-20 minute
doar la pacientii care au prezentat valori ridicate ale TA
la prima determinare. TA a fost deasemenea masurata,
in aceleasi conditii, dupa 4-7 ani, la 955 dintre acesti
copii. In lotul de studiu nu au fost incluse cazurile de
hipertensiune arteriala sistemica secundara.
Rezultate: HTA de halat alb a fost evidentiata la in-
ceputul studiului in 60 cazuri (5.6%) si in 8.73% din
cazuri la fnalul studiului. Monitorizarea copiilor cu
hipertensiune de halate albe a evidentiat 5 cazuri de
HTA stadiul 1 (8% cazuri), 9 cazuri au dezvoltat pre-hi-
pertensiune (15%), 33 cazuri (54%) au mentinut hiper-
tensiune de halat alb si 14 cazuri (23%) au prezentat
valori normale ale TA. Incidenta dezvoltarii in timp a
HTA la copiii cu hipertensiune de halat alb (14 din
60 cazuri -23,3%) a fost mai mare decat formele simi-
lare de HTA care a aparut la pacientii cu valori initia-
le ale TA in limite normale(20 din 953 cazuri, 2,05%).
In timp, frecventa prehipertensiunii si HTA a crescut,
deasemenea de la 5,11% la prima determinare la 7,85%
la ultima determinare.
Concluzie: Incidenta crescuta a hipertensiunii de ha-
lat alb corelata cu o frecventa crescuta a evolutiei catre
HTA sistemica sugereaza ca hipertensiunea de halat
alb nu este complet benigna, ca aceasta reprezinta un
factor de risc si are o valoare predictiva pentru dezvol-
tarea hipertensiunii arteriale sistemice. Urmarirea con-
stanta a acestor pacienti si prevenirea altor factori de
risc pot scadea frecventa HTA la adult.
Early evolution and
complications of acute
myocardial infarction with and
without ST segment elevation.
An observational study in the
real world
Aim: to study the evolution of the acute myocardial in-
farction (AMI) with (STEMI) and without (NSTEMI)
ST segment elevation in patients admitted in a commu-
nity hospital.
Methods: We compared Killip class severity, occurren-
ce of new arrhythmia, new conduction disturbances,
mechanical complications and death in patients (pts)
with STEMI and NSTEMI admitted in a community
hospital during a year.
Results: Tere were 238 AMI pts, 60.5% STEMI and
39.5% NSTEMI. 66.39% were men (M), 65.3 +/-11.6
year old and 33.61% women (W), 70.7+/-10.6 year old
(p=0,0006). 18.07% pts were in Killip ll, 8.4% in Killip
lll, without diferences between STEMI and NSTEMI.
18.75% STEMI and 2.12% NSTEMI pts were in Killip
lV class OR=10.6154 [2.4613-45.7834]; p=0.0003. Ven-
tricular tachycardia and ventricular fbrillation occur-
red in 17.36% STEMI and 2.12% NSTEMI, (OR=9.6638
[2.2321-41.8403, p=0.0001); grad ll and lll atrio-ven-
tricular block occurred in 17.36% STEMI and 9.57%
NSTEMI (p=0.0001). Free wall ventricular rupture and
interventricular septal defect occurred only in STEMI
pts. Death occurred in 26.38% STEMI and 6.38%
NSTEMI, (OR=5.2579 [2.1255-13.0064, p=0.0001).
Death in STEMI was correlated with history of old
myocardial infarction (OR=4.2857 [1.8139-10.1258];
p=0.0005); and chronic heart failure (OR=5.1084
[2.1969-11.8783]; p=0.0001). Death in NSTEMI was
correlated with chronic renal failure (OR=8.3529
[1.4115-49.4311]; p=0.02) and women (OR=11.2963
[1.2589-101.3658]; p=0.01).
Conclusions: STEMI was associated more frequent
than NSTEMI with Killip lV class (p=0.0003), ventri-
cular tachycardia, ventricular fbrillation (p=0.0001)
and death (p=0.0001), especially in pts with previous
myocardial infarction and heart failure. In NSTEMI
death occurs more frequent in W and pts with chronic
renal failure.
POSTER I
POSTER I
Suplimentul A, 2010
12
36. Modificari cardiace
structurale si functionale la
pacientii cu acromegalie
studiu ecocardiografic
Anca Florian, Ruxandra Jurcut, Aurora Vladaia, Oana
Savu, Simona Galoiu, Ionela Baciu, B.A.Popescu,
M.Coculescu, Carmen Ginghina
Introducere: Acromegalia (ACM) se insoteste de risc
cardiovascular crescut prin efectul direct al nivelului
crescut de GH/IGF1 si prin factorii de risc (FR) asoci-
ati. La pacientii cu ACM sunt descrise modifcari car-
diace structurale si functionale.
Scopul studiului este descrierea modifcarilor cardiace
asociate cu ACM si evaluarea abilitatii tehnicilor noi de
imagistica miocardica Doppler (TDI) de a caracteriza
aceste modifcari.
Material si metoda: Au fost evaluati 59 de pacienti
consecutivi cu ACM (varsta medie 46.111.6 ani) si 26
de martori fara ACM (38.312.5 ani, similari ca sex si
FR cardiovascular). Pentru toti subiectii s-au efectuat
inregistrari ecocardiografce standard si TDI, determi-
nandu-se datele de strain sistolic longitudinal (S) atat
pentru ventriculul drept (VD) cat si pentru ventriculul
stang (VS), la nivelul celor 3 segmente (bazal, mediu si
apical)din incidenta apical 4 camere. Nivelul GH a fost
masurat la toti pacientii cu ACM.
Rezultate: Pe baza valorilor GH seric, 38 (64.4%) din-
tre pacientii cu ACM, au avut boala activa (grup A) iar
21 (35.6%) boala controlata (grup B). Cei 26 de martori
au constituit grupul C. Dintre parametrii structurali,
pacientii cu ACM (A si B) au prezentat o masa VS inde-
xata (110.624.94, 116.4432.8 vs 75.719, p<0.0001)
si un volum telediastolic VS (132.944.6, 118.840 vs
86.418.45, p<0.0001) mai mari fata de martori, cu
valori ale grosimii parietale relative crescute, fara di-
ferente semnifcative intre grupuri. Dintre parametrii
functionali conventionali, ambele grupuri cu ACM au
prezentat o functie diastolica (E/A medie 1.090.32,
1.040.28 vs 1.420.3, p<0.0001) si o functie sisto-
lica globala mai scazute (fractia de ejectie VS medie
55.866.23%, 585.09% vs 64.324.37%, p<0.0001)
fata de martori. Valorile de S maxim VS obtinute (me-
dia pe 6 segmente/2 pereti) au fost mai reduse la paci-
entii cu ACM fata de martori: -16.9711.2%, grup A,
-17.858.6%, grup B vs -22.78.27% grup C, p<0.0001.
Evolutive features of the white
coat hypertension of school
child
Purpose: to study the aspects of the evolution of the
white coat hypertension in children and adolescents,
the beneft of diagnosing it in pediatric patients and its
possible link with the subsequent essential hyperten-
sion.
Methods: Te authors have evaluated a number of 1068
schoolchildren, aged between 10 and 16 years, as part
of a screening program for establishing the prevalence
of systemic arterial hypertension and its evolution in
time of blood pressure (BP). Te frst determination of
BP was made in standard conditions (in the school me-
dical room or in the classroom) and was repeated afer
15-20 minutes only in patients who presented high va-
lues of BP at the frst determination. BP was also mea-
sured afer 4-7 years in 955 of these children. In this
study it wasnt included any cases of secondary syste-
mic hypertension.
Results: Te white coat hypertension was present, at
the beginning of this study, in 60 cases (5,6%), and in
8,73% of cases when we fnished our study. Te sur-
veillance of the children with white coat hypertensi-
on revealed 5 children with stage 1 hypertension (8%
cases), 9 cases developed pre hypertension (15%), 33
cases (54%) maintained white coat hypertension and
14 cases (23 %) had normal values of BP. Te inciden-
ce of systemic hypertension developed in time in chil-
dren with white coat hypertension (14 of 60 cases
-23,3%) was greater than that of similar forms of syste-
mic hypertension resulting from patients with initial
normal BP (20 of 953=2,05%). In time, the frequency
of prehypertension and systemic hypertension also in-
creased: 5,11% at frst determination to 7,85% at last
determination.
Conclusion: Te high frequency of white coat hyper-
tension correlated with a high frequency of evolution
to systemic hypertension suggest that white coat
hypertension is not entirely benign, that this repre-
sents a highrisk factor and had a predictive value for
the development of systemic hypertension. Constant
follow-up of this patients and the prevention of other
risk factors may lower the frequency of systemic adult
hypertension
Suplimentul A, 2010
18
POSTER I
POSTER I
vs 1.420.3, p<0.0001) and reduced mean LV ejecti-
on fraction (55.866.23%, 585.09% vs 64.324.37%,
p<0.0001) compared to controls. Averaged S values for
the LV were lower in pts with ACM compared to con-
trols: -16.9711.2%, group A, -17.858.6%, group B vs
-22.78.27% group C, p<0.0001. Tere were no statis-
tical signifcant diferences (for the parameters mentio-
ned above) between group A and group B and for RV S
values in pts with ACM compared to controls.
Conclusions: ACM pts present LV concentric hyper-
trophy and LV systolic and diastolic dysfunction, non-
reversible with ACM control. Altered global LV systolic
function appears mainly to be due to longitudinal dys-
function. No RV dysfunction was detected.
37. Relatia intre rigiditatea
arteriala si predictorii evolutiei
clinice in hipertensiunea
arteriala: studiu prospectiv
Viviana Aursulesei, A.Cozma, M.D.Datcu
Universitatea de Medicina si Farmacie "Gr. T. Popa",
Iasi
Scopul lucrarii: evaluarea relatiei intre rigiditatea ar-
teriala si predictori cu semnifcatie clinica prognostica:
grosimea intima-medie carotidiana (IMT), hipertrofa
ventriculara stanga (HVS), vasodilatatia mediata de
fux (FMD) si microalbuminuria la pacienti cu hiper-
tensiune arteriala esentiala inainte si dupa 12 luni de
tratament.
Material si metoda: au fost studiati 142 pacienti hi-
pertensivi (varsta medie 57,2 3,1 ani, 71% femei, cu
factori de risc cardiovascular asociati) inainte si dupa 6,
12 luni de tratament cu Enalapril/Amlodipina + Inda-
pamida. Rigiditatea arteriala a fost evaluata prin veloci-
tatea undei pulsatile carotida-femurala (PWV) si presi-
unea pulsului la nivel aortic (PP). Au fost evaluate IMT
si FMD prin ecografe vasculara carotidiana, respec-
tiv brahiala. HVS a fost defnita prin indexul de masa
(IMVS) si modelele geometrice (normal, hipertrofe
concentrica/excentrica, remodelare concentrica). Mi-
croalbuminuria a fost defnita ca prezenta sau absenta.
Rezultate: PWV este puternic corelata cu tensiunea ar-
teriala sistolica bazal si la 6 luni de tratament (p<0,002).
Atat PWV cat si PP aortic sunt corelate cu IMVS si hi-
Nu au existat diferente semnifcative pentru paramen-
trii mentionati intre grupurile A si B si nici pentru S la
nivelul VD fata de martori.
Concluzii: Pacientii cu ACM prezinta hipertrofe con-
centrica VS asociata cu disfunctie sistolica si diastolica
VS, fara alterarea functiei VD. Disfunctia sistolica se
datoreaza in principal unei alterari a functiei longitu-
dinale. Controlul ACM nu pare sa amelioreze aceste
modifcari
Cardiac structural and
functional response
to acromegaly an
echocardiographic study
Introduction and Purpose: Acromegaly (ACM) is
associated with high cardiovascular (CV) mortality,
both through associated risk factors (RF) and by direct
efects of GH/IGF1. Heart abnormalities are frequent
fndings in patients with ACM. Doppler myocardial
echocardiography imaging (DMI) was proved a sensi-
tive method for quantifying early abnormalities in car-
diac function in other settings. In this study, we investi-
gated the ability of DMI to characterize cardiac changes
in ACM.
Material and methods: 59 consecutive pts with ACM
(mean age 46.111.6 y) and 26 controls without ACM
(mean age 38.312.5 y, NS, matched for sex and CV
RF) were recruited. Both standard echocardiography
and DMI data were obtained for all patients. Peak
systolic longitudinal strain values (S) and timing were
determined and averaged over mid, basal and apical
segments of the lef (LV) and right (RV) ventricular
walls in 4-chamber view. GH levels were determined in
all the ACM patients.
Results: Of the ACM subjects, 38 (64.4%) had active
disease (grA), and 21 (35.6%) controlled ACM (grB,
defned by GH levels). Gr C consisted of 21 controls.
Pts with ACM (grA, B) presented structural changes:
a higher LV indexed mass (110.624.94, 116.4432.8
vs 75.719, p<0.0001) and a higher end-diastolic vo-
lume (132.944.6, 118.840 vs 86.418.45, p<0.0001)
compared to controls. All the groups had high relative
wall thickness indices, but without signifcant diferen-
ces. Also, pts with ACM had functional changes: redu-
ced mean diastolic function (E/A 1.090.32, 1.040.28
POSTER I
POSTER I
Suplimentul A, 2010
11
(p<0.002). Both PWV and aortic PP are related with
LVMI and concentric hypertrophy pattern irrespec-
tive the moment of evaluation (p=0.01) and gender
(p=0.001). Correlation with eccentric hypertrophy is
evident at baseline only for females (t-test) and infu-
enced by abdominal circumference (ANCOVA). PWV
is related with carotidian IMT (r=0.39, p=0.004) only
in Enalapril + Indapamide subgroup afer 12 months.
When present, microalbuminuria is related with aor-
tic PP and PWV at baseline irrespective the regimen of
treatment (p=0.04). We cannot establish a relation with
FMD, probably because of the heterogeneous infuence
of cardiovascular risk factors (ANCOVA).
Conclusion: our study suggests a complex interrelati-
on between non-invasive parameters with prognostic
signifcance, which is infuenced especially by gender,
abdominal obesity and antihypertensive regimen. Te
combination of these measurements is of stronger cli-
nical relevance.
38. Parametrii aterosclerozei
subclinice la pacientii cu lupus
eritematos sistemic: corelatii cu
scorurile de risc cardiovascular
C.Jurcut, Simona Caraiola, Ruxandra Jurcut, S.Giusca,
Doina Nitescu, I.Copaci, C.Baicus, B.A.Popescu, Car-
men Ginghina, C.Tanasescu
Spitalul Clinic de Urgenta Militar Central, Bucuresti
Background: Studii anterioare au raportat riscul cardi-
ovascular crescut la pacientii cu lupus eritematos siste-
mic (LES). Acesta se refera nu numai la riscul de apa-
ritie a evenimentelor cardiovasculare, dar si la aparitia
bolii arteriale subclinice.
Scopul studiului a fost evaluarea corelatiei dintre sco-
rurile de risc cardiovascular utilizate curent si parame-
trii structurali si functionali ai aterosclerozei subclinice
la un grup de pacienti cu LES.
Material si metode: La 29 de pacienti cu LES (varsta
medie: 44.017.0 ani) am efectuat evaluarea ultrasono-
grafca nivel carotidian, cu evaluarea grosimii intima-
media si a indicilor functionali de rigiditate arteriala
[indicele de rigiditate Beta (), modulul elastic (Ep),
indexul de augmentare (AIx), complianta arteriala si
velocitatea locala a undei pulsului (PWV)] obtinute
pertrofa concentrica indiferent de momentul evaluarii
(p=0,01) si de sex (p=0,001). Relatia cu hipertrofa ex-
centrica este evidenta bazal doar la femei (t-test) si este
infuentata de circumferinta abdominala (ANCOVA).
PWV este corelat cu IMT carotidian (r=0,39; p=0,004)
numai in grupul tratat cu Enalapril + Indapamida la 12
luni de tratament. Microalbuminuria prezenta este in
relatie cu PP aortic si PVW bazal, indiferent de schema
de tratament (p=0,04). Nu s-a gasit o corelatie a para-
metrilor de rigiditate cu FMD, probabil din cauza in-
fuentei heterogene a factorilor de risc cardiovascular
(ANCOVA).
Concluzii: studiul sugereaza interactiunea complexa
intre parametrii noninvazivi cu semnifcatie prognosti-
ca, infuentata in special de sex, obezitatea abdominala
si schema de tratament antihipertensiv. Evaluarea com-
binata a acestor parametri capata semnifcatie clinica
deosebita.
Relation between arterial
stiffness and predictors of
clinical outcome in arterial
hypertension: a prospective
study
Purpose: to evaluate the relation between arterial sti-
fness and some predictors with clinical prognostic
signifcance: carotidian intima media thickness (IMT),
lef ventricular hypertrophy (LVH), fow mediated va-
sodilation (FMD) and microalbuminuria in patients
with essential arterial hypertension.
Material and method: 142 hypertensive patients (aged
57.2 3.1 years, 71% females, with associated cardio-
vascular risk factors) were studied before and afer 6,
12 months of treatment with Enalapril/Amlodipine +
Indapamide. Arterial stifness was assessed by caroti-
dian-femoral pulse wave velocity (PWV) and aortic
pulse pressure (PP). Carotidian and brachial ultra-
sounds were used for assessment of IMT and FMD, re-
spectively. LVH was defned by index of mass (LVMI)
and geometric patterns (normal, concentric/eccentric
hypertrophy, concentric remodeling). Microalbuminu-
ria was noted as absent/present.
Results: PWV is strongly related with systolic blood
pressure only at baseline and 6 months of treatment
Suplimentul A, 2010
15
POSTER I
POSTER I
tic modulus (Ep), augmentation index (AIx), arterial
compliance and local pulse wave velocity (PWV) that
were obtained by a real time echo-tracking system. Te
Framingham risk score and the SCORE risk were eva-
luated according to current guidelines.
Results: IMT correlates with Framingham risk score,
(0.719; p<0.01) and SCORE system values (r=0.755,
p<0.01). Te SCORE evaluation best predict an IMT
higher than 0.5 mm (AUC=0.85 for SCORE risk vs. 0.65
for Framingham risk score). Beta () stifness index
correlates with Framingham risk score (0.67, p=0.03)
and SCORE risk (0.60, p<0.05). Elastic modulus (Ep)
correlates with Framingham risk score (0.63, p=0.04)
and SCORE risk (0.58, p<0.05). Augmentation index
and local pulse wave velocity were positively correla-
ted and arterial compliance was negatively correlated
with these scores, but without reaching the statistical
signifcance.
Conclusions: In patients with SLE, subclinical athe-
rosclerosis evaluated by IMT and arterial stifness in-
dices correlates with the recommended cardiovascular
risk scores. Te SCORE evaluation might be superior
to Framingham risk in predicting the structural subcli-
nical vascular disease. Terefore, in patients with SLE
the assessment of cardiovascular risk using the recom-
mended scores might be useful in the detection of sub-
clinical vascular disease and, consequently, the imple-
mentation of preventive measures.
39. Modificari ale functiei
endoteliale la femeile la
menopauza
Corina Homentcovschi, Adriana Gurghean, Anca
Mihailescu, Simona Avram, I Bruckner
Spitalul Clinic Coltea, Bucuresti
Introducere: Functiile endoteliului au un rol crucial in
aparitia si evolutia aterosclerozei. Avand in vedere ca
femeile pana la menopauza au un avantaj asupra bar-
batilor in ceea ce priveste mentinerea functiei normale
endoteliale- studiul particularitatilor de gen poate oferi
oportunitatea de a intelege mai bine fenomenele asoci-
ate procesului aterosclerotic.
Obiectivul principal al studiului a fost urmarirea rela-
tiei existente intre nivelul de 17 estradiol plasmatic si
printr-un sistem echo-tracking. Am calculat pentru f-
ecare pacient scorul Framingham si riscul SCORE in
conformitate cu recomandarile actuale.
Rezultate: GIM s-a corelat cu scorul Framingham
(0.719; p<0.01) si riscul SCORE (r=0.755, p<0.01). Ris-
cul SCORE a fost cel mai bun predictor al unei GIM
de peste 0.5 mm (AUC area under the ROC curve
de 0.85 pentru SCORE vs. 0.65 pentru scorul Framin-
gham). Indicele de rigiditate Beta s-a corelat cu scorul
Framingham (0.67, p=0.03) si riscul SCORE (0.60,
p<0.05). In mod similar, modulul elastic (Ep) s-a core-
lat cu Scorul Framingham (0.63, p=0.04) si riscul SCO-
RE(0.58, p<0.05). Indexul de augmentare si velocitatea
locala a undei pulsului s-au corelat pozitiv iar compli-
anta arteriala negativ cu scorurile de risc cardiovascu-
lar, totusi fara a atinge semnifcatia statistica.
Concluzii: La pacientii cu LES, parametrii aterosclero-
zei subclinice evaluate prin grosimea intima-media si
indicii de rigiditate arteriala se coreleaza cu scorurile
de risc cardiovascular. La acestia, sistemul SCORE pare
a f superior scorului Framingham in predictia bolii
arteriale subclinice. Astfel, la acest grup de pacienti,
evaluarea riscului cardiovascular cu ajutorul acestor
scoruri ar putea da informatii referitoare si la afectarea
vasculara subclinica si, implicit, implementarea de ma-
suri de ameliorare a acesteia.
Subclinical atherosclerosis in
patients with systemic lupus
erythematosus: correlations
with cardiovascular risk scores
Background: Te increased cardiovascular risk in pati-
ents with systemic lupus erythematosus (SLE) was pre-
viously reported. An increased risk for cardiovascular
events but also for subclinical arterial disease was also
reported.
Objectives: Te aim of this study was the assessment
of the correlations between the cardiovascular risk sco-
res and structural and functional indices of subclinical
atherosclerosis in a group of patients with SLE.
Methods: In 29 consecutive patients (pts) with SLE
(mean age 44.017.0 yrs) we performed the carotid
artery ultrasonography with the assessment of inti-
ma-media thickness and functional indices of arterial
stifness (Beta () stifness index, pressure-strain elas-
POSTER I
POSTER I
Suplimentul A, 2010
16
endothelial function marker) and fux mediated vaso-
dilatation in the brachial artery (as an indirect marker)
in women of diferent ages.
Design and Method: we studied 81 patients, divided
in 4 groups, depending on their menstrual status: A-
fertile age 35 patients, B-the frst 24 months afer the
last menstrual cycle- 10 patients, C- menopause- 23 pa-
tients and D, a control group of aged women-13 sub-
jects. Exclusion criteria: renal failure, ischemic heart
disease, diabetes mellitus, infammatory status and
cancers. Inclusion criteria: age between 40 and 55 years
for the groups A-C and over 65 for the group D. we
performed a careful anamnesis, physical examination,
lab tests (glicemia, lipid profle, uric acid, fbrinogen,
estrogen and von Willebrand factor levels) and fux
mediated vasodilatation in the brachial artery (the Ce-
lermajer method). Te statistic analysis was performed
with Excel 2003.
Results: In the following table are the most important
results:
Group A Group B Group C Group D
Age (years) 44 49.5 51 73.5
Uric acid (mg/dl) 4 4.58 5.5 5.83
Total cholesterol (mg/dl) 191 211 210 184
Triglycerides (mg/dl) 141 185 159 148
17 estradiol (pg/ml) 134 42 32 15
Von Willebrand factor
activity (%)
135 149 173 196
Flux mediated vasodilata-
tion (%)
12.26 8.79 7.33 4.71
Signifcant Pearson correlation coef cients are betwe-
en: von Willebrand factor and uric acid (+0.97); betwe-
en fux mediated vasodilatation and uric acid (-0.96);
between 17 estradiol and von Willebrand factor
(-0.83) and fux mediated vasodilatation (+0.93). Con-
clusions: Te von Willebrand factor correlates with
the estradiol levels, suggesting that deprivation of this
hormone leads to important changes of the normal en-
dothelium.
We found that fux mediated vasodilatation is also cor-
related with the estrogen levels- adding a new proof for
the link between hormone and endothelial function.
Te uric acid level is correlated with age, circulating es-
tradiol levels and endothelial dysfunction (fux media-
ted vasodilatation and von Willebrand factor levels)...
In post menopausal women, the decrease of the estra-
diol levels is an important mechanism that promotes
atherosclerosis.
functia endoteliului. Evaluarea factorilor de risc cardi-
ovasculari in aceasta populatie a constituit un obiectiv
secundar.
Lotul de studiu a cuprins 81 de paciente, formand 4
grupe, in functie de statusul menstrual: A- 35 de paci-
ente de varsta fertile; B- 10 paciente afate in primele 24
de luni dupa ultima menstra; C- 23 paciente la meno-
pauza si D- 13 paciente varstnice (.65 ani)- constituind
un grup martor. Criterii de includere: varsta 40- 55 ani
si pentru D- mai mare de 65 ani; criterii de excludere-
diabetul zaharat, boala renala cronica sau ateroscleroza
clinic manifesta.
Metoda: evaluare anamnestica, examen clinic, teste de
laborator (glicemie, lipidograma, acid uric, fbrinogen,
17 estradiol si activitate plasmatica a factorului von
Willebrand) precum si vasodilatatie mediate de fux
(VMF), prin metoda Celermajer.
Rezultate:
Grup A Grup B Grup C Grup D
Varsta (ani) 44 49.5 51 73.5
Ac. uric (mg/dl) 4 4.58 5.5 5.83
Colesterol total (mg/dl) 191 211 210 184
Trigliceride (mg/dl) 141 185 159 148
17 estradiol (pg/ml) 134 42 32 15
Activitatea factoruluiVon
Willebrand (%)
135 149 173 196
Vasodilatatia fux mediata
(%)
12.26 8.79 7.33 4.71
Concluzii: Nivelurile de factor von Willebrand se core-
leaza cu cele plasmatice de 17 estradiol, la fel si vaso-
dilatatia fux mediate- sugerand ca deprivarea de acest
hormone conduce la modifcari functionale notabile
ale endoteliului. Deci modifcarea constelatiei hormo-
nale este un mechanism important al promovarii ate-
rosclerozei la femeile postmenopauza.
Endothelial function changes
in menopausal women
Te endothelial function plays a crucial role in athe-
rosclerosis development. Because the women have an
advantage over men in maintaining a good endothelial
function, studies about their peculiarities are very good
opportunities to better understand the mechanisms of
vessel ageing. So, studying the estrogen efects on en-
dothelium can bring important information about the
entire atherosclerotic process.
Te aim was to study the correlation between 17 es-
tradiol levels, von Willebrand factor activity (as a direct
Suplimentul A, 2010
1I
POSTER I
POSTER I
dului, pacientii care au benefciat de antrenament fzic
individualizat si standardizat si-au imbunatatit semni-
fcativ starea fzica si statusul functional, precum si sta-
rea mentala, comparativ cu grupa de control.
Quality of life assessment
using the SF 36 questionnaire
in patients after aortic valve
replacement
Purposes: evaluation of life quality improvement at the
end of phase II of cardiovascular rehabilitation, using
the Short Form 36 questionnaire (SF 36) for patients
afer aortic valve replacement.
Methods and materials: monitoring of cardiac reha-
bilitation program efects on life quality for 82 pati-
ents was performed by assessing the two questionnaire
components: physical (PSC36) and mental (MCS-36)
at admission and afer 3 months (the end of phase II
of cardiovascular rehabilitation). Synopsis estimation
of the two components was realized online (www.sf-
36.org/demos/SF-36html). To quantify obtained data,
an original score with limits between 0 and 100 was
used: 0 - the most poor and 100 the best possible health
condition. Study eligible patients were divided in two
groups: training group (A) 43 patients and control
group (B) 39 patients.
Results and discussions: at the beginning of the study,
the physical component (PCS-36) had lower score com-
parative to the mental score (MCS-36) in patients afer
aortic valve replacement included in cardiovascular
rehabilitation program, and also in the control group,
because of physical decoditioning secondary to preo-
peratory disease. Afer phase II of cardiac rehabilitation
program we note a favorable evolution of the PCS-36
component (from an average value of 33.6716.2 to
60.4523, p<0.0001). In opposition, PCS-36 improve-
ment on B-group was less obvious: from 28.8218.2
to 44.4525.1 afer 3 months (p<0.001). Regarding the
MCS-36 component, A-group patients had obtained
more signifcant statistical results from 47.3127.5 to
62.3532.4 (p<0.01), compared to the B-group from
41.322.41 to 51.324.2 (p<0.05).
Conclusions: albeit in both groups lifestyle changes
according to guideline recommendations were preser-
40. Aprecierea calitatii vietii
prin intermediul chestionarului
SHORT FORM 36 la pacientii
valvulari aortici operati
Maria Rada, Dana Emilia Velimirovici, Simona Dra-
gan, Duda-Seiman D.M., Cobzariu F.I.,Velimirovici
M.D., Silvia Mancas
Universitatea de Medicina si Farmacie Victor Babes,
Timisoara
Scop: aprecierea ameliorarii calitatii vietii la fnalul fa-
zei II de recuperare cardiovasculara prin intermediul
chestionarului Short Form 36 (SF 36) la pacientii val-
vulari aortici operati.
Material si metoda: monitorizarea efectelor progra-
mului de recuperare cardiovasculara asupra calitatii
vietii la cei 82 pacienti inclusi in studiu s-a efectuat
prin intermediul scorului celor doua componente fzica
(PCS-36) si mentala (MCS-36) la includere in studiu si
la 3 luni (fnalul fazei II de recuperare cardiovascula-
ra). Calcularea punctajului celor doua componente s-a
efectuat electronic prin accesarea site-ului (www.sf-36.
org/demos/SF-36html). Pentru cuantifcarea punctajul
obtinut s-a utilizat un scor original cu limite intre 0 si
100, 0 cel mai slab si 100 cel mai bun posibil status de
sanatate. Pacienti eligibili pentru studiu, au fost ran-
domizati in doua grupe: grupa de antrenament (A)-43
pacienti si grupa de control (B)-39 pacienti.
Rezultate: la debutul studiului componenta fzica
(PCS-36) prezinta valori mai reduse comparativ cu
cea mentala (MCS-36) atat la pacientii protezati aor-
tic inclusi in program de reabilitare cardiaca cat si la
cei din grupa de control, datorita deconditionarii fzi-
ce secundare bolii existente preoperator. Dupa faza II
de recuperare cardiovasculara la grupa A s-a obtinut
o evolutie favorabila a componentei PCS -36 (de la o
valoare medie de 33.6716.2 la 60.4523, p<0.0001).
In contrast la grupa B ameliorarea PCS-36 a fost mai
putin evidenta, de la 28.8218.2 la 44.4525.1 la 3 luni
(p<0.001). In ceea ce priveste componenta MCS-36, la
pacientii grupei A s-au obtinut rezultate mai semnif-
cative din puncte de vedere statistic, de la 47.3127.5
la 62.3532.4 (p<0.01), comparativ cu cei din gru-
pa B unde aceasta crestere a fost de la 41.322.41 la
51.324.2 (p<0.05).
Concluzii: desi ambele grupe au benefciat de modi-
fcarea stilului de viata, conform recomandarilor ghi-
POSTER I
POSTER I
Suplimentul A, 2010
18
cardiaca dreapta. Acestea s-a asociat cu corectarea di-
sincroniei intra VS si cresterea FEVS la 37%, reduce-
rea IM si disparitia hipertensiunii pulmonare (PAPs 30
mmHg). Aceste benefcii au persistat la controlul de 3
luni, aparand si o usoara remodelare a VS (reducerea
VTS VS cu 13%).
Concluzii: acesta este primul caz in care se demon-
streaza ca TRC poate f efcienta la pacienti cu IC, QRS
larg si afectare VS in cadrul unei DAVD avansate.
Cardiac resynchronization
therapy in a patient
with advanced phase
arrhythmogenic right ventricle
cardiomyopathy and left
vetricle involvement
Background: Arrhythmogenic right ventricle cardi-
omyopathy (ARVC) is associated with SCD due to ven-
tricular arrhythmias, but in advanced phase it produces
RV failure and sometimes LV failure.
Purpose: to test the efects of CRT in a patient with
heart failure (HF), wide QRS and severe LV systolic
dysfunction due to ARVC with LV involvement.
Methods: A 43 years old patient with a 15 years his-
tory of VT due to ARVC, with a single-chamber ICD
(last generator exchange 5 years ago), was referred for
advanced, drug-refractory, NYHA class IV HF (he
was continuously hospitalized in the last 3 weeks). He
was on the heart transplant list on the last year witho-
ut compatible donor. ECG showed sinus rhythm, with
wide intrinsic QRS (130 ms) and ICD interrogation ex-
hibited ERI of the device, no VT episodes in the last 2
years and infrequent (<2%) RV pacing. Echocardiogra-
phy proved severe RV dilatation and dysfunction with
severe tricuspid regurgitation but also revealed severe
LV systolic dysfunction (LVEF 32%), with moderate-
to-severe mitral regurgitation and moderate pulmo-
nary hypertension (systolic PAP 60 mm Hg). Mechanic
intra-LV asynchrony was identifed (SPWMD 170 ms,
LWPSD 70 ms). A RA lead (RA roof) and a LV lead
(postero-lateral vein) were implanted and the patient
was up-graded to a CRT-D device.
Results: Afer 1 week of CRT there was a rapid clinical
improvement to NYHA class II and almost complete
ved, patients who beneft from individual and standar-
dized physical training had a signifcant improvement
of physical condition and functional capacity, also of
mental condition, compared to the control group.
41. Terapie de resincronizare
cardiaca la un pacient cu
forma avansata de displazie
aritmogenica de ventricul drept
si afectare a ventriculului stang
R.G.Vatasescu, D.Dobreanu, C.N.Iorgulescu, Cristina
Ioana Caldararu, Alexandra Vasile, Doina Dimulescu,
Maria Dorobantu
Spitalul Clinic de Urgenta Floreasca, Bucuresti
Premize: displazia aritmogenica de ventricul drept
(DAVD) este asociata cu MSC prin tahiaritmii, dar in
formele avansate produce afectare de ventricul drept si
uneori de ventricul stang.
Scop: testarea efectelor TRC la un pacient cu insufci-
enta cardiaca (IC), QRS larg si disfunctie sistolica seve-
ra de VS prin DAVD cu afectare de VS.
Metode: pacient de 43 ani, cu istoric de 15 ani de TV
in contextul DAVD, purtator de DCI monocameral
(ultima inlocuire de generator in urma cu 5 ani) a fost
referit pentru insufcienta cardiaca clasa IV NYHA
refractara (spitalizare continua de 3 saptamani). Paci-
entul era pe lista de transplant cardiac de un an fara
donor compatibil. ECG-ul a aratat ritm sinusal, QRS
larg (130ms). Verifcarea DCI a aratat baterie in peri-
oada de inlocuire electiva, absenta TV in ultimii 2 ani
si stimulare de VD infrecventa (2%). Ecocardiografa a
aratat dilatare si disfunctie severa de VD cu regurgita-
re tricuspidiana severa dar si disfunctie sistolica severa
de VS (FEVS 32%) cu regurgitare mitrala moderat-se-
vera si hipertensiune pulmonara moderata (PAPs 60
mmHg). A fost obiectivata disincronie mecanica intra
VS (SPWMD 170 ms, LWPSD 70 ms). Au fost implan-
tate o sonda in AD (pe tavanul AD) si o sonda de VS (in
vena postero-laterala stanga) si pacientul a fost upgra-
dat la CRT-D.
Rezultate: dupa o saptamana de TRC a existat o ame-
liorare clinica rapida cu trecerea in clasa II NYHA si
remiterea aproape completa a semnelor de insufcienta
Suplimentul A, 2010
19
POSTER I
POSTER I
sau un BRA, la care s-a adaugat ulterior un diuretic
in cazul lipsei de control a valorilor TA (grupul 1), iar
50 pacienti au primit un blocant de canal calcic de tip
dihidropiridinic, asociat la nevoie cu un beta-blocant
(grupul 2).
Rezultate: Nu au existat diferente semnifcative intre
cele 2 grupuri in ceea ce priveste varsta (52 7 ani vs
546 ani, p ns), sexul masculin (59,6% vs 64%, p ns),
incidenta diabetului (45% vs 44%, p ns), a fumatului
(41,9% vs 38%, p ns) si a dislipidemiei (54,8% vs 54%,
p ns). Diferentele intre cele 2 grupuri nu au fost sem-
nifcative la momentul bazal atunci cand am compa-
rat volumul AS (399 vs 378 ml/m2), IMVS (85 8
vs 86 6 g/m2), pattern-ul diastolic (normal 22,5% vs
26%; relaxare intarziata 56,4% vs 56%; pseudonormal
21% vs 18%), media/24 h TAS (147,47,2 vs 147,96,4
mmHg), media/24 h TAD (90,44 vs 90,84,5 mmHg)
(p ns). Dupa 18 luni, diferentele au fost semnifcative
intre volumele AS (307 vs 357 ml/m2, p 0,01), IMVS
(80 7 vs 85 6 g/m2, p 0,01) si pattern-ul tip rela-
xare intarziata (40,3% vs 60%, p 0,05). Mediile valori-
lor tensionale au fost semnifcativ mai mici in ambele
grupuri comparativ cu momentul bazal, dar fara dife-
rente statistic semnifcative intre grupul 1 si 2 dupa 18
luni de tratament (p ns). (132,87,1 vs 133,76,3 TAS;
82,44,2 vs 82,14,2 TAD). Dupa 18 luni de urmarire,
FiA a fost prezenta la 9,7% pacienti din grupul 1 si la
24% in grupul 2 (p 0,05).
Concluzii: Tratamentul cu blocanti ai sistemului reni-
na-angiotensina la pacientii hipertensivi cu risc inalt
reduce riscul de aparitie a fbrilatiei atriale si a recuren-
telor acesteia. Benefciile terapiei se datoreaza probabil
scaderii valorilor tensionale, ameliorarii disfunctiei di-
astolice si mai ales a efectelor benefce asupra remode-
larii atriului stang.
The benefit of therapy using
renin-angiotensin system
blockers in preventing
recurrent atrial fibrillation in
high risk hypertensive patients
Objective: To assess the beneft of therapy using an-
giotensin converting enzyme inhibitors (ACEI) or an-
giotensin receptor blockers (ARB) in high risk hyper-
remission of signs of right heart failure. Tis was asso-
ciated with elimination of LV asynchrony and impro-
vement in LV systolic function (LVEF 37%), reduction
of MR and disappearance of pulmonary hypertension
(systolic PAP 30 mm Hg). Tese improvements persis-
ted at 3 months follow-up, when there was also mild LV
reverse remodeling (a 13% reduction in LV ESV).
Conclusion: Tis is the frst report demonstrating that
CRT can be efective in patients with HF, wide QRS and
LV systolic dysfunction due to advanced ARVC with
LV involvement.
42. Beneficiul terapiei cu
blocanti ai sistemului renina-
angiotensina in preventia
recurentei fibrilatiei atriale la
pacientii hipertensivi cu risc
inalt
Elisabeta Badila, Sabina Adriana Frunza, Lacramioara
Dumitrache, Cristina Tirziu, Daniela Bartos, Maria
Dorobantu
Obiectiv: Aprecierea benefciilor tratamentului cu IEC
sau BRA la pacientii hipertensivi cu risc inalt in redu-
cerea riscului de aparitie a recurentelor fbrilatiei atri-
ale (FiA).
Metoda: Au fost inclusi 112 pacienti hipertensivi,
care asociau si alti factori de risc CV majori (diabet,
fumat, dislipidemie). La momentul includerii toti pa-
cientii erau in ritm sinusal dar aveau documentat un
episod de FiA in antecedente. Pacientii au fost urmariti
in medie 12 luni. Pentru fecare pacient s-au intregis-
trat date demografce, biochimice; TSH pentru exclu-
derea unei disfunctii tiroidiene. Bazal si dupa 18 luni
s-a efectuat ecocardiografe pentru aprecierea volumul
atriului stang (AS), IMVS, pattern-ului fuxului dias-
tolic transmitral si monitorizare simultana TA si ECG
pe 24 ore pentru detectia tulburarilor de ritm asimpto-
matice. Diagnosticul de FiA s-a bazat pe inregistrarea
obiectiva ECG in cazul pacientilor simptomatici sau pe
inregistrarea Holter ECG la pacientii asimptomatici. 62
pacienti au primit ca terapie antihipertensiva un IEC
POSTER I
POSTER I
Suplimentul A, 2010
50
43. Provocari terapeutice la
pacientii cu trombofilie si boli
cardiovasculare
Ioana Raduta, I.Moscaliuc, B.Moscaliuc, Valeria Usca-
tescu, Melania Dinu
Centrul Clinic de Urgenta de Boli Cardiovasculare al
Armatei, Bucuresti
Scopul lucrarii: Tratamentul cu hidroxiclorochin
(Plaquenil) asociat tratamentului anticoagulant oral si
antiagregant plachetar, previne recurenta evenimente-
lor trombotice la pacientii cu sindrom procoagulant si
determinari trombotice in diverse teritorii( arteriale si
venoase).
Material si metoda: Am efectuat un studiu in perioa-
da 2008-2010 pe 30 pacienti internati in CCUBCVA cu
tromboflie si determinari trombotice in diverse teri-
torii arteriale si venoase. In cadrul repartitiei pe sectie
am observant preponderenta tombofliei la barbati (20
pacienti-66%). Evenimentele trombotice s-au manifes-
tat clinic ca infart miocardic acut cu coronare perme-
abile (9 pacienti-30%), TEP (5 pacienti-16,6%), TVP
iterativa (12 pacienti- 40%), AVC (5 pacienti-16,6%),
tromboza VCI (1 pacient-3,3%), tromboza aorta abdo-
minala (1 pacient-3,3%), tromboza precoce intrastent
(2 pacienti-6,66%), ocluzie precoce graf venos aorto
coronarian (1 pacient-3.3%). In urma investigatilor
hematologice specifce s-au evidentiat urmatoarele:
sindrom antifosfolipidic-18 pacienti-60%, defcit de
proteina C -9 pacienti-30%, defcit de proteina S- 10
pacienti-33%, defcit de proteina C global-18 pacien-
ti-60%. Bolnavii cu sindrom antifosfolipidic prezent
cu evenimente trombotice in antecedente sub trata-
ment antiagregant plachetar si anticoagulant au primit
si tratament antipaludic de sinteza (hidroxiclorochin).
Urmarind pacientii de 2 ani am observant reducerea
recurentelor evenimentelor trombotice ca obiectiv pri-
mar ca si a reinternarilor si a cresterii calitatii vietii ca
obictiv secundar.
tensive patients in decreasing atrial fbrillation (AF)
recurrences.
Methods: 112 hypertensive patients with other associ-
ated major CV risk factors (diabetes, smoking, dyslipi-
demia) were included. All of them had sinus rhythm
at baseline, but have had medical records of AF. Te
mean follow-up was 18 months. Te demographic and
biochemical data were recorded for each patient; TSH
determination was routinely used to exclude thyroid
dysfunction. Echocardiography was performed at ba-
seline and afer 18 months in order to assess lef atrial
(LA) volume and mitral infow Doppler pattern. 24 h
blood pressure (BP) monitoring was indicated in each
case. ECG Holter was performed at 6, 12 and 18 mo
for asymptomatic rhythm disorders detection. AF di-
agnosis was based on objective ECG recording for
symptomatic patients and Holter ECG recording for
asymptomatic patients. 62 patients received ACEI or
ARB as initial antihypertensive therapy and a diuretic
was added in cases of uncontrolled BP (group 1). Te
other 50 patients received a dihydropyridine calcium
blocker, associated, when needed, with a beta-blocker
(group 2).
Results: Tere werent signifcantly diferences between
the 2 groups concerning age (527 vs. 546 yrs), male
gender (59,6% vs 64%), diabetes incidence (45% vs
44%), smoking (41,9% vs 38%) and dyslipidemia(54,8%
vs 54%)(p ns). Te diferences between 2 groups arent
signifcant at baseline in terms of LA volume (399
vs 378 ml/m2), LVMI 858 vs 866 g/m2, diastolic
pattern (normal 22,5% vs 26%; abnormal relaxation
56,4% vs 56%; pseudo-normal 21% vs 18%), mean/24
h SBP (147,47,2 vs 147,96,4 mmHg, mean/24 h DBP
(90,44 vs 90,84,5 mmHg)(p ns). Afer 18 mo, there
were diferences between LA volume (307 vs 357 ml/
m2, p 0,01), LVMI(80 7 vs 85 6 g/m2, p 0,01) and
the prevalence of abnormal relaxation(40,3% vs 60%, p
0,05). Te mean BP values were signifcantly lower in
both groups when compared with baseline, but without
diferences (p ns) between group 1 and 2(132,87,1 vs
133,76,3 for SBP; 82,44,2 vs 82,14,2 for DBP). Afer
18 mo of follow-up, AF was recorded in 9,7% patients
from group 1 and 24% from group 2 (p 0,05).
Conclusions: Renin-angiotensin system blockers the-
rapy in high risk hypertensive patients decreases the
risk of atrial fbrillation and its recurrences. Te be-
nefts of this therapy are based probably on decreasing
BP and lef ventricular mass index, improving diastolic
dysfunction with positive changes on lef atrial remo-
deling.
Suplimentul A, 2010
51
POSTER I
POSTER I
situandu-se pe loc fruntas din acest punct de vedere.
Majoritatea imbolnavirilor se datoreaza acumularii
factorilor de risc cardiovasculari. Cunoasterea, recu-
noasterea si tratamentul lor cat mai precoce, adica pre-
ventia cardiovasculara ar f metoda optima de a infu-
enta aceasta statistica sumbra in mod favorabil.
Scopul lucrarii: Evaluarea prezentei si a cunoasterii
factorilor de risc cardiovasculari legati de stilul de viata
la studentii de medicina.
Material si metoda: Cu ajutorul unor chestionare de
evaluare am intrebat 200 de studenti de medicina (61
baieti si 139 fete) despre alimentatie, acitivitate fzica,
fumat, consum de alcool si droguri, stres respectiv i-am
rugat sa enumere principalii factori de risc cardiovas-
culari.Completarea chestionarelor a fost anonima.
Rezultate: 32% din studenti sunt fumatori, 20% con-
suma in mod cronic alcool, 35% mananca hipersodat,
50% sunt sedentari si la 52% este prezent stresul.
Concluzii: Majoritatea studentilor de medicina au deja
unul, doi sau chiar mai multi factori de risc cardio-
vasculari legati de modul de viata.Evaluarea noastra a
aratat ca nu au cunostinte aprofundate legate de acesti
factori cu toate ca stim, ca preventia bolilor cardiovas-
culare presupune evidentierea si tratamentul factorilor
de risc cardiovasculari. Mesajul cel mai important al
lucrarii noastre ar f acela, ca sa se acorde o mai mare
atentie acumularii cunostintelor de medicina preventi-
va in timpul anilor de facultate la medicina.
Lifestyle and cardiovascular
risk factors among medical
students
Cardiovascular diseases are the main causes of morbi-
dity and mortality worldwide, Romania being one of
the leading countries from this pont of view, due to car-
diovascular risk factor accumulation. Knowledgement,
recognising and treatment of these risk factors-cardi-
ovascular prevention-would be the ideal way of chan-
ging these bad statistics.
Objectives: Evaluation of presence and awareness of
lifestyle related cardiovascular risk factors among me-
dical students.
Material and methods: 200 medical students (61 boys
and 139 girls) answered anonimously a questionnare
which contained questions about eating habits, physi-
cal activity, smoking, alcohol and drug consumption,
Therapeutic challenges in
patients with thrombophilia
and cardiovascular diseases
Aim: Treatment with hydroxychloroquine (Plaquenil)
associated with oral anticoagulant and antiplatelet the-
rapy prevents recurrence of thrombotic events in pati-
ents with procoagulant syndrom and thrombotic deter-
minations in diferent territories (arterial and venous).
Material and method: We conducted a study in 30
patients hospitalized in 2008-2010 CCUBCVA with
thrombophilia and thrombotic determinations in va-
rious arterial and venous territories. In the unit I noti-
ced spreading tombofliei predominance in males (20
patients, 66%). Trombotic events were manifested
clinically as acute coronary infarction infart permea-
ble (9 patients, 30%), MET (5 patients-16, 6%), iterati-
ve DVT (12 patients, 40%), stroke (5 patients-16 6%),
VCI thrombosis (one patient 3, 3%), abdominal aorta
thrombosis (one patient 3, 3%), early thrombosis intr-
astent (two-six patients, 66%), early occlusion of aorto
coronary venous graf (1 patient 3.3%). Haematological
investigation revealed: antiphospholipid syndrome-18
pacients-60%, protein C defciency -9pac 30%, protein
S defciency- 10 patients-33%, protein C defciency glo-
bally-18pacients-60 %. Patients with antiphospholipid
syndrome present with a history of thrombotic events
antiplatelet and anticoagulation therapy and received
treatment antipaludic synthesis (hydroxychloroquine).
Following the patients for two years I have observed
the reduceing of the recurrence of thrombotic events
as primary objective and improvement of the quality of
life as secondary objective.
44. Modul de viata si factorii de
risc cardiovasculari la studentii
de medicina
Marta German-Sallo, Dalma Blint-Szentendrey,
Gza Dsa, Z.Preg, Mnika Szab, Mihaela Hubatsch,
Kinga Pl, Edith Domokos, Katalin Psk
Bolile cardiovasculare reprezinta pe plan mondial prin-
cipala cauza de morbiditate si mortalitate, Romania
POSTER I
POSTER I
Suplimentul A, 2010
52
rile BNP la cei 85 de pacienti s-au situat intre 284pg /
ml si 5000pg/ml ( 35 u; prezentat valori > 900 pg /ml).
Un numar de 16 pacienti au necesitat suport ventilator
mecanic si inotrop pozitiv. Pacientii au fost reevaluati
la externare, la o luna, 3 luni si respectiv 6 luni. Din
cei 30 de pacienti (35%) care au prezentat la interna-
re valoarea BNP > 900pg/ml, 11 (13%) au decedat in
primele 72 ore; ceilalti 19 pacienti au fost reevaluati la
externare, la o luna (5 decese ), la 3 luni (4 decese), la
6 luni (2 decese), totalizand 13% mortalitate pe termen
lung. Din grupul initial de la internare, 55 de pacienti
(65%) au avut valoarea BNP < 900pg/ml. La acesti pa-
cienti mortalitatea in primele 72 de ore a fost de 3.5%
(3 pacienti), pe termen lung (total decese dupa: 1 luna,
3 luni, 6 luni) 7% (6 pacienti), fara a exista o corelatie
cu severitatea afectarii coronariene.
Concluzii: pacientii cu afectare coronariana severa do-
cumentata, care au prezentat la internare edem pulmo-
nar acut cardiogen cu valori ale BNP <900 pg/ml au
avut o evolutie mai buna comparativ cu cei cu afectare
coronariana mai putin severa, dar cu BNP >900 pg/ml.
Dupa cum au demonstrat numeroasele studii efectu-
atein ultimii ani, valoarea BNP in insufcienta cardia-
ca acuta prezinta sensibilitate si specifcitate inalta; ea
este corelata direct cu mortalitatea coronarienilor pe
termen scurt si lung, aceasta din urma find mai putin
modifcabila prin alti parametri utilizati in evaluarea
prognosticului.
The correlation between
BNP value at admission, in
acute cardiogenic pulmonary
oedema and the evolution of
the coronary patients
Papers purpose: the increased value of BNP > 900 pg/
ml in acute heart failure is associated with a high risk of
short and long term mortality, irrespective to the seve-
rity of the coronary disease.
Materials and methods: the study included 85 coro-
nary patients hospitalized in 3rd Medical Clinic of the
St. Spiridon Emergency Hospital, Iasi, during January
2009 - January 2010, with acute cardiogenic pulmonary
oedema. Te exclusion criteria were: associated severe
comorbidities (advanced chronic renal disease, neo-
plasia, sepsis and bronchopneumonia).
stress and we asked them to enumarate the most im-
portant cardiovascular risk factors.
Results: 32% of the students are smokers, 20% consu-
me alcohol,35% eat salted, 50% are sedentars and 52%
are stressed.
Conclusion: Te majority of medical students have
one, two or even more lifestyle related cardiovas-
cular risk factors. Our evaluation shows, that their
knowledgement related to these factors is not well
founded, although we know, that cardiovascular di-
sease prevention presume screening and treatment of
cardiovascular risk factors. According more importan-
ce to accumulation of preventive medicine knowledges
during medical school would be the most important
message of our study.
45. Corelatia prognostica intre
valoarea BNP la internare si
evolutia pacientului coronarian
in edemul pulmonar acut
cardiogen
Paloma Manea, Simona Ionescu, C.Rezus, R.Artenie,
Daniela Tanase, Anca Ouatu, Raluca Arhirii,
V.Ambarus, Elena Mitrea, Codruta Badescu, Mariana
Floria
Universitatea de Medicina si Farmacie Gr.T. Popa,
Iasi; Spitalul de Urgente Sf Spiridon, Iasi
Scopul lucrarii: valoarea crescuta a BNP > 900 pg/ml
in insufcienta cardiaca acuta este asociata cu risc cres-
cut de mortalitate pe termen scurt si lung, indiferent de
severitatea afectarii coronariene.
Material si metoda: studiul a inclus 85 de pacienti co-
ronarieni internati in clinica a III-a Medicala, Spita-
lul de urgenta Sf. Spiridon Iasi, in perioada ianuarie
2009-ianuarie 2010, cu edem pulmonar acut cardiogen.
Criteriile de excludere au fost : comorbiditatile severe
asociate (boala renala cronica in stadii avansate, neo-
plazii, sepsis, bronhopneumonie)
Rezultat: S-au efectuat: examen clinic, determinari bi-
ochimice, hematologice, electrocardiograma, ecocar-
diografe transtoracica, determinarea CPK, CKPMB,
TnI, BNP, mioglobina. Edemul pulmonar acut a fost
documentat clinic si radiologic la toti pacientii. Valo-
Suplimentul A, 2010
58
POSTER I
POSTER I
Metode: In studiu am introdus consecutiv 70 de paci-
enti, cu sau fara fbrilatie atriala, dar cu aria AS peste
20 cm2. Grupul de studiu (2) a inclus pacientii cu AS
remodelat asimetric, restul constituind lotul de control
(1). Remodelarea asimetrica a fost defnita prin dimen-
siunea de la nivelul jonctiunii AS cu venele pulmonare,
mai mare decat cea de la nivelul inelului mitral. Am
evaluat volumul indexat al AS si gradul de corelatie in
cele 2 grupuri a unor parametri ecografci (PW, TDI)
masurati la nivelul peretelui lateral atrial (S, E, A) si ve-
nelor pulmonare (S, D).
Rezultate: Varsta medie a fost 69 vs 68 ani, IMC mediu
a fost 27.7 vs 26.6 kg/cm2, 60 vs 51% dintre pacienti
au fost de sex masculin. Fractia de ejectie in grupul 1
vs 2 a fost de 47 vs 49%. In 70% din cazuri AS a fost
asimetric remodelat. Volumul mediu indexat a fost 46.6
ml/m2 vs 42 ml/m2, find semnifcativ statistic corela-
te (r=0.837, p<0.001). In grupul 1 S>D iar in grupul 2
S<0.05) iar E mediu 8,3 cm/s vs 8 cm/s (p>0.05). Atat
pentru pacientii in FA cat si pentru cei din grupul de
studiu media peak-ului velocitatii diastolice a fuxului
in venele pulmonare a fost semnifcativ mai mare decat
a celei sistolice (46 cm/s vs 39 cm/s, respectiv 48 cm/s
vs 43 cm/s; p<0.001). Remodelarea asimetrica a AS s-a
corelat semnifcativ statistic cu un raport S/D subunitar
a fuxului in venele pulmonare (r=0.778, p<0.05).
Concluzii: Remodelarea asimetrica a atriului stang
se asociaza in multe cazuri cu modifcarea geometriei
acestuia. Modifcarea fuxului in venele pulmonare ar
putea f un predictor important in remodelarea struc-
turala asimetrica a atriului stang, la pacientii cu sau fara
fbrilatie atriala.
Correlation between
pulmonary veins flow and left
atrium asymmetric structural
remodeling
Aim: Lef atrium (LA) asymmetric structural remode-
ling echocardiographically assessment with diagnosis,
prognostic and therapeutically implications.
Methods: We enrolled 70 consecutive patients, with or
without atrial fbrillation, but with LA area more than
20 cm2. Te study group (2) that included the patients
with LA asymmetric remodeling was compared with
the control group (1). Asymmetric remodelling was de-
Results: We have performed: clinical examination, bi-
ochemical and hematological tests, electrocardiogram,
transthoracic echocardiography, CPK, CPKMB, TnI,
BNP and myoglobin tests. Te acute pulmonary oe-
dema was certifed clinically and radiologically for all
patients. Te BNP values for all 85 patients were betwe-
en 284 pg/ml and 5000 pg/ml (35% presented values
> 900 pg/ml). 16 patients required mechanical ventila-
tion and positive inotropic support. All patients were
reevaluated at discharge, afer 1, 3 and 6 months. Out of
30 patients (35%) who presented, at admission, a BNP
value > 900 pg/ml, 11 (13%) deceased during the frst
72 hours; other 19 patients were reevaluated at dischar-
ge, afer 1 month (5 deaths), afer 3 months (4 deaths),
afer 6 months (2 deaths), summing up to 13% long
term mortality. Among the initial group of patients, 55
(65%) had BNP value < 900 pg/ml. In this group, the
mortality during the frst 72 hours was 3.5% (3 pati-
ents) and long term (total deaths afer 1, 3, 6 months),
as follows: 7% (6 patients), with no correlation with the
severity of the coronary disease.
Conclusions: Patients having certifed severe coronary
disease, who presented, at admission, acute cardiogenic
pulmonary oedema with BNP values < 900 pg/ml, had
a better evolution compared to those with less severe
coronary disease, but having BNP > 900 pg/ml. As pro-
ven by multiple studies in the past years, BNP value in
acute heart failure presents high sensibility and speci-
fcity; it is directly correlated to short and long term
mortality of patients with ischemic heart disease, the
latter being less modifable by other parameters used in
evaluating the prognosis.
46. Corelarea fluxului in venele
pulmonare cu remodelarea
structurala asimetrica a atriului
stang
Mariana Floria, Catalina Arsenescu Georgescu
Spitalul Universitar Sf Spiridon, Universitatea de Me-
dicina si Farmacie Gr.T.Popa, Iasi
Scop: Evaluarea ecografca a remodelarii structurale
asimetrice a atriului stang (AS), cu implicatii diagnos-
tice, prognostice si terapeutice.
POSTER I
POSTER I
Suplimentul A, 2010
51
Material si metoda: Au fost inclusi 455 pacienti inter-
nati pentru insufcienta cardiaca (diagnosticati con-
form criteriilor Framingham) in cadrul Institututului
de Urgenta pentru Boli CardiovasculareProf. Dr. C.C.
Iliescu in perioada 1.01 -31.12.2004, a caror evolutie
a fost urmarita timp de 4 ani. A fost analizata evolu-
tia IMC pe perioada de 12 luni inaintea inceperii ur-
maririi pentru aparitia evenimentelor cardiovasculare.
Evenimentele urmarite au fost: decesele totale, decesele
cardiovasculare, reinternarile pentru agravarea insuf-
cientei cardiace.
Rezultate: Dintre pacienti analizati 246(54,06%) au
avut IMC>25 kg/m2. La pacientii supraponderali si
obezi clasa functionala de insufcienta cardiaca a fost
mai putin severa (pacienti in clasa NYHA III =57.32%
fata de 72.25% la normo- si subponderali, p=0.001);
FE a fost mai mare(38,12 9,96% vs. 31,94 9,21%,
p=0.001), iar valoarea BNP seric a fost mai mica(665,78
659,08 ng/dl vs. 906,37 830,58 ng/dl, p=0.001).
Desi numarul total de decese a fost mai mic la paci-
entii cu IMC > 25 kg/m2(12.6% vs. 27.75%, p=0.002),
la analiza multivariata aceasta diferenta nu se mai pas-
treaza, iar numarul total de evenimente adverse nu a
diferit semnifcativ intre cele 2 grupuri (36.57% vs.
44.98%). La pacientii cu evenimente adverse insa(184
pacienti-40.4%) diferenta IMC fata de anul precedent
inceperii urmaririi a fost de -0.970.68 kg/m2 fata de
+0.52 0.69 kg/m2 la pacientii fara evenimente adverse
(p=0.0001), aceasta diferenta find semnifcativa statis-
tic si la analiza multivariata.
Concluzii: Variatia indicelui de masa corporala este un
predictor de risc puternic la pacientii cu insufcienta
cardiaca, scaderea in greutate find factor de predictie
atat pentru decesele de orice cauza, decesele cardiovas-
culare, cat si pentru aparitia decompensarilor insufci-
entei cardiace.
Relationship between body
mass index and prognosis at
patients with heart failure
Background. Altrough a body mass index (BMI) above
25 kg/m2 is a risk factor for heart failure, many studies
established that this value of BMI indicates a good pro-
gnosis at patients with heart failure, but results were in-
consistent. For heart failure prognosis a more relevant
parameter seems to be variation of BMI; cashexia is one
fned as basal dimension, at the level of the atrium-pul-
monary veins junction, greater than the mitral annular
dimension. We assessed indexed LA volume and the
correlation between two groups of some PW and TDI
parameters measured on the lateral LA wall (S,E,A)
and pulmonary veins (S,D).
Results: Mean age was 69 vs 68 years, mean BMI was
27.7 vs 26.6 kg/cm2, 60 vs 51% were men. Ejection frac-
tion in group 1 vs 2 was 47% vs 49%. An asymmetri-
cal remodelation was present in 70% of patients. Mean
indexed volume was 46.6 ml/m2 and 41.9 ml/m2, re-
spectively, and were statistically correlated (r=0.837,
p<0.001). In group 1 S>D and in group 2 S<0.05) and
mean E was 8,3 cm/s vs 8 cm/s (p>0.05). Either for
patients in atrial fbrillation and LA asymmetrical re-
modelled mean D was greater than mean S (46cm/s vs
39cm/s and 48 cm/s vs 43cm/s, respectively; p<0.001).
LA asymetrical remodelled was signifcantly statisti-
cally correlated with S/D<1 (r=0.778, p<0.05).
Conclusions: LA asymmetric remodeling is associated
with a geometrical changing in many cases. Changing
of fow velocity in pulmonary veins might be an impor-
tant predictor for the development of the lef atrium
asymmetric structural remodeling, in patients with or
without atrial fbrillation.
47. Relatia dintre variatia
indicelui de masa corporala
si pronostic la pacientii cu
insuficienta cardiaca
E.Stoica, O.Chioncel, A.Carp, Rodica Stanescu Cio-
ranu, Ileana Tepes Piser, Iulia Kulcsar, C.Macarie
Background. Indicele de masa corporala (IMC) de
peste 25 kg/m2, desi factor de risc pentru aparitia in-
sufcientei cardiace, a fost identifcat in mai multe stu-
dii ca find un factor de prognostic bun la pacientii cu
insufcienta cardiaca, rezultatele find insa discordante.
Variatia IMC pare un parametru mai relevant in ceea ce
priveste prognosticul, casexia find de mult identifcata
ca find unul dintre cei mai puternici predictori de evo-
lutie nefavorabila in insufcienta cariaca.
Obiectiv: Stabilirea relevantei variatiei IMC pentru
prognosticul pacientilor cu insufcienta cardiaca.
Suplimentul A, 2010
55
POSTER I
POSTER I
edem subcutanat la anaflaxie severa. Afectarea cardi-
aca constituie o complicatie cu risc vital. Vasospasmul
coronarian si infarctul miocardic secundar reactiilor
alergice au fost descrise din 1991 ca sindromul Kounis,
secundar degranularii mastocitelor. Au fost descrise
doua tipuri de sindrom Kounis. Tipul I include paci-
enti cu artere coronare normale, la care reactia alergica
acuta induce fe spasm coronarian cu angina instabila,
fe vasospasm coronarian ce evolueaza spre infarct mi-
ocardic acut. Aceasta varianta reprezinta o manifestare
a disfunctiei endoteliale. Tipul II de sindrom Kounis
include pacienti cu leziuni ateromatoase preexistente,
dar oculte, silentioase, la care episodul alergic acut in-
duce eroziunea sau ruptura placii, manifestata ca in-
farct miocardic acut. Prezentam cazul unei tinere de 27
ani, fara factori de risc pentru boala coronariana sau
antecedente patologice, care dezvolta, dupa mai mul-
te intepaturi de albina, urticarie generalizata si edem
palpebral, urmate de durere retrosternala iradiata in
ambele brate, insotita de greturi si varsaturi. Examenul
clinic releva TA 90/70 mmHg, puls 145/minut regulat.
Electrocardiograma (ECG) evidentiaza modifcari de
ischemia miocardica acuta. Saturatia de oxigen a fost
90%, enzimele cardiace, troponinele si tensiunea arteri-
ala au ramas in limite normale. IgE au fost 205 IU/ml si
triptaza a crescut la 27 g/l (normal 5.613.5 g/l), iar
eozinoflele au fost de 9%. Am diagnosticat pacienta cu
sindrom Kounis tip I. Tratamentul a constat in bolus de
500 mg hemisuccinat de hidrocortizon, 50 mg ranitidi-
na IV, si 50 mg difenhidramina per os. Ulterior a fost
transferata in clinica, unde a primit perfuzie cu nitro-
glicerina 30 g/min. Nu s-a efectuat tromboliza deoa-
rece enzimele cardiace au fost normale. Starea pacien-
tei s-a imbunatatit in urmatoarele 24 ore, iar ECG s-a
normalizat in 9 ore. Ecocardiografa a evidentiat fractia
de ejectie normala, fara tulburari de kinetica segmen-
tara. Pacienta a refuzat coronarografa. A fost externata
dupa 48 ore, complet asimptomatica, cu ECG si teste
de laborator normale. Recomandam ca la pacientii cu
intepaturi de Hymenoptera sa se efectueze de rutina
ECG, chiar in absenta unei reactii alergice defnite, sau
chiar in lipsa unui istoric de boala cardiaca ischemica.
of the more powerfull predictors of bad prognosis at
patients with heart failure.
Objective: To establish the relevance of BMI variation
for heaart failure patients prognosis.
Methods: We included 455 patients admitted for heart
failure (according Framingham criterias) at Institututul
de Urgenta pentru Boli CardiovasculareProf. Dr. C.C.
Iliescu between 1.01 and 31.12.2004. We followed the-
se patients for 4 years (4812 months). We analyzed
evolution of BMI the year before inclusion of patients.
As cardiovascular events at this patients were followed
total number of deaths, cardiovascular death and read-
missions for aggravation of heart failure.
Results: BMI was above 25 kg/m2 at 246 (54.06%) of
the patients. At these patients functional class of heart
failure was less severe (class NYHAIII at 57.32% of
patients vs. 72.25% at patients with BMI < 25 kg/m2,
p=0.001); Also, ejection fraction was higher (38.12
9,96% vs. 31.94 9.21%, p=0.001) and seum BNP was
lower (665.78 659.08 ng/dl vs. 906.37 830.58 ng/dl,
p=0.001). Altrough total number of deaths was loer at
patients with BMI above 25 kg/m2 (12.6% vs. 27.75%,
p=0.002), this diference was nonsignifcant at multiva-
riate analysis. Te diference between total number of
cardiovascular events was nonsignifcant, too (36.57%
vs. 44.98%). At the patients with cardiovascular events
the BMI variation up against the year before was sta-
tistic signifcant from the patients withhout cardio-
vascular events at ubivariate and multivariate analysis
(-0.970.68 kg/m2 vs. +0.52 0.69 kg/m2 p=0.0001).
Conclusions: Body mass index variation is a power-
full risk predictor at the patients with heart failure. A
weight decrease of the patients is prediction factor for
death of any cause, cardiovascular death and aggravati-
on of heart failure.
48. Sindrom KOUNIS tip I la o
tanara femeie dupa intepaturi
multiple de albina
Catalina Lionte, Laurentiu Sorodoc, O.R.Petris, Victo-
rita Sorodoc, Cristina Bologa
Universitatea de Medicina si Farmacie Gr.T.Popa, Iasi
Reactiile de hipersensibilizare dupa intepaturi de Hy-
menoptera pot merge de la urticarie simpla si angio-
POSTER I
POSTER I
Suplimentul A, 2010
56
49. Monitorizarea oximetriei
viscerale in chirurgia cardiaca
D. Arhire, M. Patrut, Nicoleta Arhire, E. Rachita,
Cristina Grosu, C. Ardeleanu, B. Cornea, V. Pop, R.
Vasilescu, Cristina Voinea, Olimpia Manta, V. Ispas, E.
Oclei
Obiectivele studiului: determinarea benfciilor clinice
si economice in utilizarea precoce a oximetriei viscerale
Material si metoda: studiul a cuprins un lot de 70 de
pacienti la care s-a folosit aparatul INVOS OXIME-
TER 5100C, in cadrul operatiilor ce au implicat circu-
latie extracorporeala, in perioada ianuarie 2009- mai
2010 in cadrul Clinicii de Chirurgie Cardiovasculara
din Spitalul Judetean Constanta
Rezultate: monitorizarea oximetriei viscerale a evalu-
at functia cerebrala la pacientii sedati, a dat informatii
despre perfuzia cerebrala, informatiile obtinute find
regionale nu globale.Tinta studiului a fost de a eviden-
tia in ce mod utilizarea oximetriei cerebrale poate duce
la evitarea desaturarii cerebrale si la evitarea declinului
neurologic.
Monitoring of visceral
oximetry in cardiac surgery
Objectives: to determine clinical and economical be-
nefts of the early use of visceral oximetry.
Material and method: the study included 70 patients
in which we used the INVOS OXIMETER 5100 C,
during extracorporeal circulation surgeries, between
January 2009 May 2010.
Results: monitoring of visceral oximetry evaluated ce-
rebral function in sedated patients, gave information
about the cerebral perfusion, these being regional, not
global. Te target of the study is to asses the way cere-
bral oximetry can lead to avoid cerebral desaturation
and neurological injury.
KOUNIS syndrome type I in
a young woman after multiple
bee stings
Hypersensitivity reactions from hymenoptera stings
may range from simple urticaria and subcutaneous an-
gioedema to severe anaphylaxis. Cardiac involvement
constitutes a life threatening complication. Coronary
vasospasm and myocardial infarction (MI) secondary
to allergic reactions have been described since 1991 as
the Kounis syndrome, induced by mast cells degranu-
lation. Tere are two types of Kounis syndrome. Type
I includes patients with normal coronary arteries in
whom the acute allergic insult induces either coronary
artery spasm leading to unstable angina or coronary
vasospasm progressing to acute MI. Tis variant might
represent a manifestation of endothelial dysfunction.
Kounis syndrome type II includes patients with pree-
xisting, albeit occult, atheromatous disease, in whom
acute allergic episode induce plaque erosion or rup-
ture manifesting as acute MI. We report the case of a
27-years old woman, with no risk factors or history of
coronary artery disease, who developed a generalized
urticarial reaction and orbital oedema, afer she was
stung several times by bees, followed by retrosternal
pain radiating to both arms associated with nausea and
vomiting. On clinical evaluation, BP was 90/70 mm Hg
with regular pulse 145 beats/ min. Electrocardiogram
(ECG) showed changes of acute myocardial ischemia.
Oxygen saturation was 90%, cardiac enzymes, tropo-
nins and BP remained normal. Total IgE was elevated
to 205 IU/ml, tryptase levels were raised to 27 g/l
(normal 5.613.5 g/l) and eosinophils were 9%. Te
patients diagnosis was type I Kounis syndrome. Patient
received a bolus of 500 mg of hydrocortisone succina-
te, 50 mg ranitidine IV, and 50 mg of diphenydramine
per os. Afer admission in clinic, she received an in-
fusion of nitroglycerin 30 g/min. Trombolysis was
not attempted because cardiac enzymes were normal.
During the following 24 h the patients condition im-
proved and the ECG changes resolved within 9 hours.
Echocardiography revealed normal ejection fraction
without wall motion abnormalities. Patient refused
angiography. She was discharged 48 hours later being
completely asymptomatic, with normal ECG and lab
tests. Our recommendation in a case of hymenoptera
envenomation is to perform a standard ECG, even in
the absence of a clearly defned allergic reaction, and
even if the patient does not present pre-existing coro-
nary artery disease.
Suplimentul A, 2010
5I
POSTER I
POSTER I
tokinaza este cel mai utilizat agent trombolitic; am
constatat insa o tendinta ascendenta a folosirii retepla-
zei, semnifcativa statistic in ultimii 3 ani ai studiului
(p=0,02).
Concluzii: In judetul Constanta, timpul mediu de la
debutul simptomelor pana la prezentarea la camera de
garda a pacientilor cu IMA trombolizati scade cu ~1
ora din 2006 pana in 2009, iar timpul mediu de la in-
ternare si pana la instituirea trombolizei scade cu ~7
minute din 2006 pana in 2009; insa, pentru ambele si-
tuatii, diferentele nu sunt semnifcative de la an la an
(p>0,05); timpii evaluati sunt, in oricare an al studiului,
peste media europeana.
Specific features of
thrombolysis treatment in
patients with ST-Elevation
Myocardial Infarction (STEMI)
in Constanta County, Romania
4 years prospective study
Background: In Constanta County, Romania, there
is only one Intensive Cardiac Care Unit (ICCU); here,
thrombolysis is the only emergency coronary revascu-
larization method available for STEMI patients.
Aim: to evaluate STEMI treatment initiation (either
conservatory or thrombolytic) and to quantify the use
of thrombolysis in Constantza County.
Method: Our study was performed during 4 years
(1st of January 2006 31st of December 2009). It in-
cluded all consecutive STEMI patients diagnosed at
Cardiology Emergency Unit and admitted in Constan-
ta County ICCU. We noticed the time of symptoms
onset, the time of patients presentation to Cardiology
Emergency Unit, the time of treatments initiation in
ICCU and the type of treatment received by patients.
We separately analyzed data for each one of the 4 years
studied.
Results: Among the 1086 subjects diagnosed with
STEMI during the study period, 56.90% received
thrombolysis. Te percentage of thrombolysed STEMI
patients has an ascendig trend from 2006 to 2009. Ave-
rage time from symptoms onset until Emergency Unit
presentation has a descending trend: 12.93 hrs in 2006,
10.84 hrs in 2007, 4.21 hrs in 2008 and 4 hrs in 2009.
50. Particularitati ale
administrarii trombolizei la
pacientii cu infarct miocardic
acut transmural (IMA) in
judetul Constanta studiu
prospectiv pe o perioada de 4
ani
Irinel Raluca Parepa, Violeta Jitari, Violeta Nicoleta
Miu, M.Toringhibel, Elvira Craiu
Universitatea Ovidius, Constanta
Introducere: In judetul Constanta unica modalitate de
reperfuzie miocardica de urgenta la pacientii cu IMA
este tromboliza in singura unitate de terapie intensiva
coronariana (UTIC) din acest judet.
Scop: evaluarea precocitatii instituirii tratamentului
(trombolitic sau conservator) si urmarirea frecventei
utilizarii trombolizei la pacientii cu IMA din judetul
Constanta.
Metoda: Studiul s-a desfasurat pe o perioada de 4 ani
(1 ian 2006-31 dec 2009) si a inclus toti pacientii cu
diagnostic de IMA prezentati consecutiv la Camera de
garda si internati in UTIC. S-au urmarit: ora de debut
a simptomelor, ora prezentarii la Camera de garda, ora
inceperii tratamentului in UTIC, tipul de tratament si
tipul de trombolitic utilizat. Datele obtinute au fost pre-
lucrate separat pentru fecare an de studiu.
Rezultate: In perioada studiata, din cei 1086 subiecti
cu IMA 56,90% au primit tromboliza. De la an la an
procentul pacientilor trombolizati are o tendinta cres-
catoare. Timpul mediu de la debutul simptomelor
pana la prezentarea la camera de garda are o tendin-
ta descrescatoare: 12,93 ore (2006); 10,84 ore (2007);
4,21 ore (2008); 4 ore (2009). Acelasi timp mediu are
deasemenea o tendinta descrescatoare la pacientii care
au benefciat de tromboliza: 3,25 ore (2006); 3,18 ore
(2007); 2,68 ore (2008); 2,39 ore (2009). Timpul mediu
scurs de la internare pana la administrarea tromboli-
ticului are o tendinta descrescatoare: 38,2812,9min
(2006); 37,1421,05min (2007); 33,9818,3min (2008);
25,0215,49min (2009). Prezentarea tardiva a pacien-
tilor este principalul motiv de neadministrare a trom-
bolizei (40,6% cazuri), urmat la distanta semnifcativa
(p=0,023) de: varsta >75 de ani (26,5%), HTA severa
(15,38%), alte contraindicatii absolute (17,52%). Strep-
POSTER I
POSTER I
Suplimentul A, 2010
58
niocardic acut anteroseptal. Datorita absentei factorilor
de risc cardiovascular, durerea toracica a fost trecuta cu
vederea. Afectarea cerebrala a avut o evolutie buna, cu
ameliorare fara sechele, pacientul find indrumat spre
tratarea fracturii mandibulare. consultul cardiologic
preoperator, a descris pe electrocardiograma un aspect
de infarct miocardic recent, cu bloc major de ramura
dreapta.Ecocardiografc s-a evidentiat un tromb intra-
ventricular (2,5/3cm) cu anevrism ventricular stang.
Coronarografa efectuata dupa o luna de la evenimen-
tul traumatic descrie artere coronare normale. Acest
caz evidentiaza importanta interpretarii electrocardio-
gramei la pacienti cu traumatism toracic, chiar in ab-
senta factorilor de risc cardiovascular.
Post-traumatic acute
myocardial infarction
Te incidence of post-traumatic acute myocardial in-
farction is very low, most of the cases being reported
afer autopsy. Te early diagnosis is dif cult because of
nonspecifc clinical fndings, dominated by the symp-
toms of thoracic injury. Te mechanism of acute myo-
cardial infarction could be: coronary artery dissection,
intraluminal thrombosis, vascular spasm at the site of
injury, atherosclerotic plaque rupture. Te next case
presentation illustrates the dif culties of the diagno-
sis in this situation: A patient, 27 years old, arrived by
emergency in a neurosurgical department afer a com-
plex politraumatic injury caused by falling from the
roof of a house. Te patient was in a deep coma for a
week. ECG performed at that time showed acute ante-
roseptal myocardial infarction. Because to the absence
of any cardiovascular risk factors, the chest pain was
interpreted due to the chest trauma and the ECG aspect
was overlooked. Te cerebral trauma improved witho-
ut neurological sequelae and the patient was sent for
resolving a mandible fracture. At cardiological presur-
gery investigation, the interpretation of ECG showed
the aspect of recent myocardial infarction with com-
plete right bundle branch block. At echocardiography,
an intraventricular thrombus (2,5/3cm) in an aneuris-
mal area of the lef ventricle was found. Te coronaro-
graphy done a month afer the chest trauma revealed
normal coronary arteries. Tis case highlights the im-
portance of proper ECG interpretation in patients afer
chest trauma, even without cardiovascular risk factors.
Te same average time has a descending trend in pati-
ents who received thrombolysis: 3.25 hrs in 2006, 3.18
hrs in 2007, 2.68 hrs in 2008 and 2.39 hrs in 2009. Ave-
rage time from admission until thrombolysis (door-to-
needle time) has a descending trend: 38.2812.9min
in 2006; 37.1421.05min in 2007; 33.9818.3min in
2008; 25.0215.49min in 2009. Te main reason for
not giving thrombolysis is late presentation of pati-
ents (40.6% of cases), followed at a signifcant distance
(p=0.023) by: age>75 (26.5%), severe high blood pre-
ssure (15.38%) and other absolute contraindications
(17.52%). Streptokinase is the most used thrombolytic
agent, but we noticed a signifcant (p=0.02) ascending
trend of reteplase usage in the last 3 years of our study.
Conclusion: In Constanta County, the average time
from symptoms onset until Emergency Unit presenta-
tion of STEMI patients who received thrombolysis de-
creases with almost 1 hour from 2006 to 2009; average
door-to-needle time decreases with almost 7 minutes
from 2006 to 2009; the diferences have no signifcance
(p>0.05) for both ituations. Te evaluated average ti-
mes are situated beneath equivalent European times in
either studied year.
51. Infarctul miocardic acut
posttraumatic
Adelina Mavrea, D.Lighezan, I.Citu, I.Petru,
A.Militaru, M.Andor, M.Slovenski, C.Ivanescu, M.C.
Tomescu
Universitatea de Medicina si Farmacie, Timisoara
Incidenta infarctului miocardic acut posttraumatic este
foarte scazuta, cele mai multe cazuri find raportate in
urma efectuarii autopsiei. Diagnosticul precoce este di-
fcil, datorita semnelor clinice nespecifce, dominate de
simptomatologia indusa de traumatismul toracic. Me-
canismele de producere ale infarctului miocardic acut
postraumatic pot f: disectia coronara, tromboza intra-
luminala, spasmul vascular, ruptura placii de aterom.
Urmatoarea prezentare de caz doreste sa evidentieze
difcultatea diagnosticului in aceste situatii; un tanar
de 27 de ani este adus de urgenta in serviciul de neu-
rochirurgie, dupa un traumatism complex, cauzat de o
cadere de pe acoperisul casei. Pacientul a fost in coma
profunda timp de o saptamana. aealectrocardiograma
efectuata in acest timp evidentiaza un aspect de infarct
Suplimentul A, 2010
59
POSTER I
POSTER I
talitatii la pacientii cu trombembolism pulmonar acut
si cord pulmonar acut (25%), la cei ci ICA pe fond de
infarct miocardic acut IMA in clasa Killip III si IV
(20%). In randul valvularilor cu ICC cronica acutiza-
ta mortalitatea a ajuns la 11,9%. La un numar redus
din pacientii cu ICA(4p-2%) s-a dezvoltat un accident
vascular cerebral (AVC) ischemic, mortalitatea find in
randul acestor pacienti de 50%.
Concluzii: Pacientii cu ICA si disfunctie diastolica a
ventriculului stang, cu FE 50 u; prezentat cea mai re-
dusa mortalitate. Prezenta disfunctiei sistolice modera-
te si severe a VS s-a corelat cu o crestere semnifcativa
a mortalitatii. Nu au existat diferente semnifcative de
mortalitate intre pacientii cu ICA de novo si cei cu insu-
fcienta cardiaca cronica acutizata. Asocierea unui AVC
la ICA, putin frecventa in populatia studiata, a condus
la cele mai inalte valori ale mortalitatii (date sub rezer-
va numarului foarte redus de pacienti). Din punct de
vedere etiologic cele mai ridicate valori ale mortalitatii
s-au inregistrat in randul celor cu TEP si IMA.
Conditions correlated with
in-hospital mortality in acute
heart failure
Acute heart failure is one of the diseases with high mor-
tality rates, incompletely controled by the existing the-
rapies.
Purpose: To asses in-hospital mortality (IHM) in pati-
ents hospitalized for acute heart failure (AHF) and its
correlation with the etiology of heart failure, severity
and type of lef ventricular disfunction and the renal
and hepatic function.
Matherial and method: We have studied 196 patients
hospitalized in 2008-2009 for AHF, 90 of them with de
novo AHF and the others(106p) with acute decompen-
sation of chronic heart failure(CHF). We assesed the
etiology of AHF, severity and type of lef ventricular
disfunction (systolic and dyastolic) by measuring echo-
cardiographicaly the EF, E/A ratio, deceleration time of
E (DTE), isovolumic relaxation time (TRI) and S/D
ratio of pulmonary venous fow (Fvp)-in 58% of our
patients. Te renal and hepatic function were estimated
based on the values of creatinine and respectively liver
enzimes (TGO, TGP) and by the level of bilirubine.
Results: IHM was in our patients 10,7%. Tere was no
diference in IHM between patients with de novo AHF
52. Factori corelati cu cresterea
mortalitatii in insuficienta
cardiaca acuta
Anca Iulia Popa, F.Adam, Raluca Ciomag, Catalina
Andrei Calin, Crina Julieta Sinescu
Spitalul Clinic de Urgenta "Prof.Dr. Bagdasar-Arseni",
Bucuresti
Insufcienta cardiaca acuta este una din afectiunile cu o
mortalitate ridicata, insufcient controlata de actualele
demersuri terapeutice.
Obiectiv: Cercetarea corelatiei intre mortalitatea din
insufcienta cardiaca acuta(ICA) si etiologia acesteia,
tipul disfunctiei ventriculare si valorile probelor biolo-
gice refectand functia hepatica si renala.
Material si metoda: Am luat in studiu 196 pacienti cu
ICA internati in 2008-2009, 90 dintre acestia cu ICA
aparuta de novo si 106 pacienti cu acutizarea unei insu-
fciente cardiace cronice preexistente. Am stabilit etio-
logia ICA si gradul afectarii functiei sistolice si diastoli-
ce a ventriculului stang(VS), ecocardiografc transtora-
cic, prin masurarea fractiei de ejectie FE, a raportului
undelor E si A la nivelul fuxului mitral, determinarea
timpului de decelerare a undei E DTE, a timpului de
relaxare izovolumetrica TRI si a raportului undelor
sistolica si diastolica la nivelul fuxului venos pulmo-
nar (Fvp) - la 58% din pacienti. Am notat nivelurile
serice ale transaminazelor (TGO, TGP), bilirubinei si
creatininei. Am urmarit mortalitatea intraspitaliceasca
si relatia ei cu etiologia ICA, cu tipul disfunctiei ventri-
culare si cu prezenta afectarii functiei hepatice si/sau
renale.
Rezultate: Mortalitatea in randul populatiei studiate
cu ICA a fost de 10,7% (21p). Nu au existat diferente
semnifcative de mortalitate intre pacientii cu ICA in-
stalata de novo si cei cu acutizare a unei insufciente
cardiace preexistente (12,2% vs 9,4%). In randul popu-
latiei cu FE 50% mortalitatea a fost semnifcativ mai
mica (3,3%) fata de mortalitatea in grupul pacientilor
cu FE<30%(14,5% - p 0,02) dar si fata de mortalitatea
celor cu FE cuprinsa intre 30% si 50% (13,5% - p 0,03).
Prezenta unor valori crescute ale creatininei (>1,3mg/
dl) s-a corelat cu o mortalitate mai mare (16,6% vs 8%,
p 0,04). Alterarea functiei hepatice exprimata prin va-
lori crescute ale TGO,TGP si bilirubinei s-au corelat de
asemenea cu o mortalitate crescuta(13% vs 8,8%), fara
a atinge insa limita semnifcatiei statistice. Din punct
de vedere etiologic am constatat valori inalte ale mor-
POSTER I
POSTER I
Suplimentul A, 2010
60
Material si metod: Pentru analiza lotului studiat s-au
folosit programele: Microsof Excel si SPSS 10. S-au fo-
losit informatiile din foile de observatie ale pacientilor
cu ICA internati in Clinica de Cardiologie a Sp. Clinic
Sf. Pantelimon in perioada 01.01.2009- 30.06.2009,
in numar de 447 cazuri. Au fost inclusi pacienti cu
insufcient cardiac cronic acutizat (minim clasa III
NYHA dup acutizare), pacienti cu EPA, cu ICA post
IMA, pacienti cu soc cardiogen, pacienti cu IC dreapt
acut.Au fost exclusi pacientii inclusi in alte studii cli-
nice.
Rezultate: Mortalitatea se coreleaz semnifcativ cu ad-
ministrarea de IEC in cursul spitalizrii, astfel ea este
de 4,15% la pacientii ce au primit IEC, fata de 26,36%
(P=0,01) la cei ce nu au primit IEC. Mortalitatea este
de 4,77% la cei tratati cu beta-blocant fata de 18,83%
(P=0,01) la cei netratati cu beta-blocant. Un factor pre-
dictiv semnifcativ al decesului in spital a fost terapia
cu inotrop pozitivi: astfel rata decesului a fost de 3,06%
in grupul celor care nu au necesitat inotrop pozitivi,
fata de cei care au necesitat inotrop pozitivi (36,36%-
p=0,01). Mortalitatea intraspitaliceasc se coreleaz
si cu administrarea de diuretic antialdosteronic, f-
ind 6,13% la cei care au primit spironolacton, fat de
19,32% (p=0,01) la cei care nu au primit spironolacton
pe parcusul spitalizrii. Pacientii care au primit diuretic
de ans oral in spital au avut o mortalitate de 3,15% fat
de 25,58% in cazul celor care nu au primit diuretic de
ans oral (p=0,01).
Concluzii: Posibilitatea adminstrarii de IEC, beta-blo-
cante, diuretic antialdosteronic si diuretic de ans oral
au fost predictori negativi ai mortalitatii intraspitalices-
ti. Pe de alt parte necesarul de amine inotrop pozitive
s-a asociat cu o crestere a mortalittii intraspitalicesti.
Correlation between the
medical therapy and mortality
in the hospital for the patients
with acute heart failure
admitted in the Cardiology
Department of St. Pantelimon
Emergency Hospital
Aim of the study: Te evaluation of patients with acute
heart failure admitted in the Cardiology Department of
and acute decompensation of CHF(12,2% vs 9,4%). Pa-
tients with EF50% had lower mortality (3,3%) com-
parative to those with EF<30%(14,5% mortality p
0,02) and also comparative to the mortality in patients
with EF between 30% and 50% (13,5% - p 0,03). High
creatinine levels were correlated with higher mortality
(16,6% vs 8%; p 0,04). Patients with high bilirubine and
liver enzimes had higher mortality(13% vs 8,8%), but
without reaching statistic signifcance. Etiology of AHF
was important for IHM. Te worst outcome was in pa-
tients sufering of acute cor pulmonale (25% mortality)
and acute myocardial infarction Killip III and IV (20%
mortality). Acute heart failure patients with valvular
disease had IHM of 11,9%. Few patients (4p-2%) with
AHF developed also stroke. Between them IHM was
50%.
Conclusions: Te lower mortality rate was found in
patients with dyastolic disfunction (EF 50%). Patients
with severe but also with moderate systolic disfunc-
tion had a higher mortality. Tere was no signifcant
diference in IHM between patients with de novo AHF
and acute decompensation of CHF. Coexisting stroke
in patients with AHF had seriously rised mortality, but
this data need caution because of the reduce number of
patients who developed stroke. Etiologicaly the highest
mortality rates were found in patients with acute cor
pulmonale and acute myocardial infarction.
53. Relatia intre terapia
medicamentoas si
mortalitatea intraspitaliceasc
la pacientii cu ICA in cadrul
clinicii de Cardiologie a Sp. Sf.
Pantelimon
Liliana Protopopescu, Oana Simionescu, Andreea
Bjerkestrand, V.Molfea, T.Protopopescu, Lenuta Hai-
ducu, M.M.Vintila
Spitalul de Urgenta Sf. Pantelimon, Bucuresti
Scopul lucrrii Evaluarea terapiei pacientilor cu in-
sufcienta cardiaca acuta (ICA) in cadrul clinicii de
Cardiologie a Sp. Clinic Sf. Pantelimon in vederea
optimizrii asistentei medicale de urgent.
Suplimentul A, 2010
61
POSTER I
POSTER I
54. Importanta evaluarii
echocardiografice a curbarii
septului interventricular la
pacientii cu tromboembolism
pulmonar-studiu pe 80 de
cazuri
H.Rus, C.I.Ciurea, Mariana Radoi, Mirela Donea
Universitatea Transilvania, Facultatea de Medicina
Brasov
Tromboembolismul pulmonar este o afectiune severa,
cu incidenta in continua crestere si cu mortalitate ri-
dicata. Ecocardiografa transtoracica are un loc impor-
tant in diagnosticul si urmarirea pacientilor cu trom-
boembolism pulmonar. Curbura normala a septului
interventricular este convexa spre ventriculul drept in
cursul diastolei si sistolei. Curbarea septului interven-
tricular este considerat anormala daca este aplatizata
sau convexa spre ventriculului stang, in ax parasternal
scurt, aspect apreciat in evaluare ecocardiografca 2D.
Scopul studiului este de a evalua corelatia existenta
intre curbarea septului interventricular si valoarea pre-
siunii pulmonare,evaluate echocardiografc, la pacienti
fara hipertensiune arteriala sistemica.
Metoda: Am evaluat prospectiv 80 de pacienti diagnos-
ticati cu tromboembolism pulmonar in perioada ianu-
arie 2008-ianuarie 2009. Toti pacientii au fost evaluati
prin ecocardiografe transtoracica cu determinarea
echo Dopper a presiunii sistolice si diastolice din artera
pulmonara, si cu aprecierea vizuala a curburii septului
interventricular (normala sau anormala).
Rezultate: In perioada de urmarire de 12 luni, 8 paci-
enti au murit de cauza cardiovasculara (rata mortalita-
tii find de 10/100 ani-persoana). Curbarea anormala
telediastolica a septului interventricular s-a asociat cu
o mortalitate cardiovasculara mai ridicata (risc relativ
de moarte 5,66 [95% CI 1.43-22.6]).
Concluzii: La pacientii cu tromboembolism pulmonar,
aspectul septului interventricular: sistolic, diastolic sau
sistolo-diastolic(normal sau anormal), furnizeaza in-
formatii semi-cantitative legate de prezenta si severita-
tea hipertensiunii pulmonare. Curbarea end-diastolica
anormala a septului interventricular este un marker de
prognostic rezervat la pacientii cu tromboembolismul
pulmonar.
St. Pantelimon Emergency Hospital with the purpose
of optimizing the emergency medical care.
Material and methods: For the analysis of the patient
group we used Microsof Excel and SPSS10. We used
the information from the observation charts of patients
with acute heart failure admitted in our clinic in the pe-
riod between 01.01.2009 and 30.06.2009, totaling 447
cases. We included patients with acutely decompensa-
ted chronic heart failure CHF (minimum NYHA III
class on admission), patients with acute pulmonary oe-
dema, with AHF afer AMI, cardiogenic shock, isolated
right heart failure. We excluded patients participating
in other studies.
Results: Mortality is signifcantly correlated with ACEI
administration during hospitalization: it is 4,15% for
patients who received ACEI, and 26,36%(P=0.01) for
those who did not receive ACEI. Mortality is 4,77% for
those treated with beta-blockers compared with 18,83
(P=0.01) for those who did not receive beta-blockers.
A predictive factor for inhospital mortality was the the-
rapy with positive inotropic drugs: mortality rate was
3,06% in the group who did not receive inotrope posi-
tive therapy, compared with those who received inotro-
pe positive therapy (36,36%- p=0,01). Mortality during
hospitalization is also correlated with administration
of antialdosterone therapy, 6,13% for those who recei-
ved spironolactone treatment, compared with 19,32%
(p=0,01) for those who did not receive it. Patients who
received oral loop diuretic during hospitalization had a
mortality of 3,15% compared to 25,58% for those who
did not receive it (p=0,01).
Conclusion: Te possibility of ACEI, beta blocker,
antialdosterone diuretic, oral loop diuretic adminis-
tration was a negative predictor for mortality during
hospitalization. On the other hand the use of inotro-
pic support is associated with an increase in mortality
during hospitalization.
POSTER I
POSTER I
Suplimentul A, 2010
62
55. Aspecte particulare ale
afectarii cardiaca in cursul
infectiei cu HIV la copil
A.G.Dimitriu, Cristina Jitareanu, Lavinia Dimitriu
Universitatea de Medicina si Farmacie Gr T Popa, Iasi
Scopul stdiului: prezentarea aspectelor particulare ale
afectarii cardiace la copilul cu infectie cu virusul imu-
nodefcientei umane (HIV).
Material si metoda: Autorii au evaluat 49 de copii in-
fectati cu HIV cu varsta intre 2 si 16 ani, pentru eviden-
tierea manifestarilor de suferinta cardiaca secundara a
infectiei HIV. Evaluarea pacientilor a fost realizata prin
examen clinic, ECG, Rx cardio-toracica si examen eco-
cardiografc (Echo). Stadializarea infectiei HIV/SIDA a
fost facuta pe baza evaluarii clinice si valorilor limfoci-
telor CD4, intr-o perioada de urmarire de 24 de luni.
Rezultate: Stadializarea clinica: 2/3 din pacienti au fost
inclusi in grupul P2f. Semnele clinice de afectare car-
diaca: insufcienta cardiaca (9 cazuri), tahicardie (20
cazuri), diminuarea zgomotelor cardiace (12), dispnee
(14 cazuri) si 14 cazuri au fost asimptomatice sau cu
semne ale altor afectiuni. ECG: tulburari de repolariza-
rea ventriculara sau tahicardie sinusala. RxCT: cardio-
megalie in 1 / 3 din cazuri si modifcari datorate infec-
tiilor pulmonare. Echocardiografa Doppler: afectarea
cardiaca a fost prezenta in 68% cazuri: cardiomiopatie
dilatativa (12 cazuri), pericardita (10 cazuri), dilatare
izolata a ventriculului stang (6 cazuri) si ventriculul
drept (4 cazuri), disfunctie diastolica VS (11 cazuri),
hipertensiune arteriala pulmonara (4 cazuri). Aspecte-
le cele mai severe de afectare cardiaca au fost observat
in cazurile cu reducerea semnifcativa a valorii CD4,
mai ales sub valori de 400/mmc. Examenu histologic
a fost efectuat la 28 pacienti care au decedat din cauza
infectiilor pulmonare si a relevat aspecte cardiace de
miocardita (1 caz), infltrare infamatorie miocardica si
pericardica si leziuni necrotice (6 cazuri).
Concluzii: Prin incidenta crescuta (68% din cazuri) si
severitatea manifestarilor, afectarea cardiaca indusa de
infectia cu HIV ramane una din cele mai importante
probleme de evaluare a acestor patienti. Evaluarea car-
diologica a pacienti cu HIV / SIDA, in special prin eco-
cardiografe trebuie sa fe realizata in toate etapele de
evolutie a bolii, din primele momente dupa stabilirea
diagnosticului, chiar si la pacienti asimptomatici, in ve-
derea stabilirii unui diagnostic cat mai precis si ulterior
pentru monitorizarea evolutiei acestor pacienti.
Importance of ventricular
septal curvature evaluation
by echocardiography in
patients with pulmonary
thromboembolism-study on 80
cases
Purpose: Pulmonary embolism is a serious disease,
with a growing incidence and a high cardiovascular
mortality rate. Transthoracic echocardiography has an
important place in the diagnosis and surveillance of the
disease. Te normal interventricular septal curvature
(SC), in convex towards the right ventricle in diastole
and systole. It is considered abnormal if it is fattened
or convex towards the lef ventricle in parasternal short
axis, in two-dimensional mode.
Te aim of the study is to evaluate the relation between
SC and pulmonary pressure measurements, in the ab-
sence of arterial hypertension.
Methods: We prospective included 80 patients dia-
gnosed with pulmonary embolism between January
2008-January 2009. All patients were evaluated throu-
gh transthoracic echocardiography with direct mea-
surement of diastolic and systolic pulmonary artery
pressure, and visual assessment of the interventricular
septal curvature (normal or abnormal).
Results: During the medial follow-up of 12 months, 8
patients died of cardiovascular cause (mortality rate of
10 per 100 person-years). An abnormal end diastolic
septal curvature was signifcantly associated with hi-
gher cardiovascular mortality (relative risk of death
5,66[95% CI 1.43-22.6]).
Conclusions: Te aspect of the interventricular SC,
normal or abnormal, and its time period (systolic, dias-
tolic, or systolic and diastolic), provides semi-quantita-
tive information regarding the presence and severity of
pulmonary hypertension. Abnormal end-diastolic SC
is a marker of poor prognosis of the disease.
Suplimentul A, 2010
68
POSTER I
POSTER I
56. Contributia CT angiografiei
in patologia malformativa
cardiovasculara a pacientului
pediatric
D.M.Gratian, Nicoleta Iacob
Centrul de Diagnostic Imagistic NEUROMED,
Timisoara
Patologia malformativa cardiaca reprezinta una dintre
cele mai difcile probleme medicale, atat ca precizare a
diagnosticului, cat si ca sanctiune terapeutica.
Progresele in diagnosticul imagistic al cordului, in-
cepand cu ecocardiografa, apoi CT cardiac si rezo-
nanta magnetica, au facut ca la ora actuala, coroborat
cu angiografa cardiaca, precizarea diagnosticului de
malformatie cardiaca congenitala si mai ales tipul de
malformatie si posibilitatile de tratament ale acesteia sa
reprezinte in unele centre investigatii de rutina.
In ultimii ani, dupa introducerea computer-tomograf-
ei in diagnosticul patologiei cardiace, in centrul nostru,
ca urmare a cooperarii deosebite cu cateva clinici de
chirurgie cardio-vasculara pediatrica, s-au investigat
aproximativ 80 de malformatii cardio-vasculare, in
special preoperator, in vederea stabilirii rapoartelor
anatomice ale structurilor vasculare.
Cele mai frecvente malformatii au fost reprezentate de
tetralogii Fallot, coarctatii de aorta, anomalii de intoar-
cere venoasa.
Metoda s-a dovedit a f extrem de utila chirurgilor in
vederea planifcarii interventiilor chirurgicale.
CT angiography contribution
in evaluation of pediatric
patient with congenital hearth
disease
Congenital hearth disease represents one of the most
challenging medical problems, from diagnostic point
of view and also as therapeutic decision.
Rapid development in diagnostic imaging of the
hearth, starting with cardiac ultrasonography, then CT
and MRI of the hearth, allowed that today, together
with the cardiac catheterization, the diagnostic algori-
Peculiar aspects of cardiac
involvement during HIV
infection in child
Purpose: to emphasize the main cardiac disorders
occurred in children with human immunodef ciency
virus (HIV) infection.
Methods: Te authors evaluated 49 HIV infected chil-
dren (2 -16 years old) for the manifestations of cardi-
ac sufering secondary of HIV infection by the clinical
exam, ECG, Chest X Ray and echocardiographic exam
(echo). Staging of HIV infection /AIDS was made ba-
sed on clinical and CD4 lymphocytes values, in a peri-
od of 24 months of follow - up.
Results: Clinical staging: 2/3 of patients were included
in P2f group. Clinical signs of cardiac involvement:
heart failure (9 cases), tachycardia (20 cases), deafness
of the heart sounds (12), dyspneea (14) and 14 were
non-symptomatic or with signs of others diseases.
ECG: disturbances of ventricular repolarisation or si-
nusal tachycardia. RxCT: cardiomegaly in 1/3 of cases
and modifcations secondary of pulmonary infections.
Echo Doppler: cardiac involvement was present in 68%
cases: dilated cardiomyopathy (12 cases), pericardi-
tis (10 cases), isolated dilation of the lef ventricle (6
cases) and of the right ventricle (4 cases), LV diastolic
dysfunction (11 cases), and pulmonary hypertension
(4 cases). Te most severe aspects of cardiac damage
have been noticed in cases with signifcant reduction
of CD4 value, especially under 400/mmc. Hystological
exam was performed in 28 patients that died because of
pulmonary infections and revealed cardiac aspects of
myocarditis (1), myocardial and pericardial infamma-
tory infltration and necrotic lesions (6 cases).
Conclusions: By high incidence (68% of cases) and
severity of manifestations, cardiac involvement during
HIV infection remains one of the most important pro-
blem of these patients.Cardiological evaluation of pa-
tients with HIV/SIDA, especially by echocardiography
must to be performed in all the stages of the disease,
even in non-symptomatic patients, for the diagnosis
and follow-up of the evolution.
POSTER I
POSTER I
Suplimentul A, 2010
61
angor postinfarct) si mortalitatea intraspitaliceasca si la
12 luni de la externare.
Rezultate: Toti pacientii au avut dislipidemie, in lotul
3 valorilor acestora au fost semnifcativ mai mari com-
parativ cu lotul 1 si lotul 2. In lotul 1, a fost mai frec-
venta angina postinfarct comparativ cu lotul 3 (60% vs
37.5%). Reinfarctizarea si extinderea infarctului au fost
mai frecvente in loturile 2 si 3 comparativ cu lotul 1
(58.3%, 50% vs 20%). Mortalitatea intraspitaliceasca a
atins 8.6% la diabetici si a fost mai inalta decal la non-
diabetici 5.7%. Dintre pacientii cu o vechime a DZ mai
mica de 5 ani nu a decedat nici un pacient. Dintre paci-
entii cu vechimea DZ cuprinsa intre 5 si 10 ani a dece-
dat un pacient, iar dintre pacientii cu DZ de mai mult
de 10 ani au decedat 2 pacienti. La 12 luni mortalitatea
de cauza cardiovasculara a fost de 6.66% (1 pacient) in
primul lot, de 25% in lotul 2 si de 37.5% in lotul 3.
Concluzii: Durata DZ la pacientii cu STEMI a fost aso-
ciata cu cresterea ratei factorilor de risc, a morbiditatii
si mortalitatii ata intra cat si postspitalicesc. Diabetul
zaharat este un factor de prognostic nefavorabil la bol-
navii cu STEMI, iar impactul creste concomitent cu
durata acestuia.
The evolution of ST elevation
myocardial infarction on
diabetics depend of previously
duration of diabetes
Study aimed to analyze the infuence of duration of di-
abetes mellitus (DM) on clinical course and prognosis
of myocardial infarction with ST elevation (STEMI).
Material and method: From the total STEMI patients
(155), hospitalized in the Cardiology Clinic of Oradea
CF Hospital during 2007 and 2008 were selected diabe-
tic patients. Tey were in number of 35, with an average
age of 57.3 0.4 years, 58% were men and 42% were
women, diabetes duration was 9.2 0.9 years, 68.4%
of them used 31.6% hypoglycaemic drugs and various
forms of insulin. STEMI diagnosis was clinical, ECG
and enzyme. We have studied patients with diagnosed
diabetes previously of STEMI. According toduration of
DM patients were divided as follows: group 1 diabe-
tes under fve years of evolution (15 patients), group
2 diabetes with evolution between 5 and 10 years (12
patients), group 3, diabetic with evolution over 10 years
thm for congenital hearth disease to become a routine
in some diagnostic centers.
In past few years, afer introduction of CT angiography
as method in diagnosis of hearth diseases, in our cen-
tre we investigated around 80 patients with congenital
hearth diseases, in preoperative time, to establish ana-
tomical structures and reports of vascular structures
involved in cardiac malformations.
Most frequent congenital hearth diseases were repre-
sented by Fallot tetralogy, aortic coarctation, and ano-
malous venous return. Te method was very useful for
cardiac surgeons to plan surgical intervention.
57. Evolutia infarctului
miocardic cu supradenivelare
de ST la pacientii diabetici, este
influentata de durata diabetului
zaharat
Sorina Magheru, Alina Iacobescu, F.Maghiar,
C.Magheru, M.Popescu
Scopul studiului a fost analiza infuentei duratei diabe-
tului zaharat (DZ) asupra evolutiei clinice si prognos-
ticului in infarctul miocardic cu supradenivelare de ST
(STEMI) la diabetici.
Material si metoda: din totalul de pacientilor cu
STEMI (155 pacienti), spitalizati in Clinica de Cardio-
logie a Spitalului Clinic CF Oradea pe parcursul anilor
2007-2008, au fost selectati bolnavii cu DZ. Acestia au
fost in numar de 35, cu varsta medie de 57,30.4 ani,
58% au fost barbati iar 42% au fost femei, durata DZ
a fost de 9,20.9 ani, 68,4% dintre ei foloseau medica-
mente hipoglicemie iar 31.6% diferite forme de insuli-
na. Diagnosticul de STEMI a fost clinic, EKG si enzi-
matic. S-au luat in studiu pacientii cu diagnostic de DZ
anterior STEMI. Conform duratei DZ pacientii au fost
impartiti: lotul 1 DZ cu evolutie sub 5 ani (15 pacienti),
lotul 2 DZ cu evolutie intre 5 si 10 ani (12 pacienti),
lotul 3, DZ cu evolutie peste 10 ani (8 pacienti). Paci-
entii au fost monitorizati 12 luni de la externare. Am
urmarit prezenta dislipidemiei la internare (colesterol
total, trigliceride si LDL colesterol), aparita complicati-
ilor postinfarct (reinfarctizare, extinderea infarctului si
Suplimentul A, 2010
65
POSTER I
POSTER I
Metoda: Au participat in studiu 80 pts. cu FA iterativa,
incepand cu 1 Nov. 2007, structurati in doua grupuri
comparative, echilibrate demografc (usoara predomi-
nanta masculina, respectiv decada a 6-a, in cele doua
grupuri). Pts. din primul grup au fost tratati farmacolo-
gic cu antiaritmice (Amiodarona (A) 71% sau Propafe-
nona (P) 21% sau Sotalol (S) 8%) + supliment exogen
de potasiu (K+), in timp ce pts. din al doilea grup au
fost tratati cu antiaritmice (A 70% sau P 23% sau S 7%)
+ E. Am comparat aparitia episoadelor de FA inainte
si dupa initierea tratamentului cu E. Un criteriu de ex-
cludere a fost tratamentul anterior cu -blocante (efect
antireninic indirect), IECA/BRA, spironolactona.
Rezultate: Tabelul adiacent structureaza principalele
rezultate ale studiului: Brat Episoade AF Episoade AF
Valoarea p terap. (inainte cu (dupa 24 luni) 24 luni) A +
K+ 8,8+/-1,7 10,5+/-2,5 <0,01 P + K+ 9,1+/-2,4 10,3+/-
1,7 <0,01 S + K+ 8,9+/-0,9 10,3+/-1,1 <0,05 AA + K+
8,9+/-2,6 10,5+/-2,8 <0,005 A + E 9,1+/-2,1 3,7+/-2,0
<0,01 P + E 9,0+/-2,5 3,9+/-2,3 <0,01 S + E 8,7+/-2,4
4,1+/-2,1 <0,05 AA + E 9,1+/-2,3 3,7+/-1,9 <0,005.
Concluzii: E blocantul specifc al receptorului mine-
ralocorticoid, apare la pts. nostri ca optiune terapeutica
aditionala valoroasa in preventia aparitiei episoadelor
de FA. E furnizeaza un potasiu endogen, mai tolerabil
metabolic decat K+ exogen. In plus, reduce activitatea
SRAA si mai poate reduce fbroza implicata in remode-
larea structurala. Aceste efecte benefce sunt indepen-
dente de scaderea TA si sunt datorate, probabil, efecte-
lor antiinfamatorii ale E.
The decrease of atrial
fibrillation recurrences by
specific mineralocorticoid
receptor blockade a 24
months study
Background. Te alterations of atrial structure by the
repetitive atrial fbrillation (AF) includes RAAS overex-
pression which could have a decisive role, aldosterone
being involved in infammation, fbrosis, remodeling.
Te objective of our study is the direct comparison of
two therapeutic regimens (each one including three
subregimens), in order to assess the beneft of eplere-
none (E) in repetitive AF patients (pts).
(8 patients). Patients were followed 12 months afer
discharge. We watched the dyslipidemia at admission
(total cholesterol, triglycerides and LDL cholesterol),
complications which arise afer infarction (reinfarctiza-
tion, infarct expansion and angina post infarction) and
mortality in hospital and 12 months afer discharge.
Results: All patients had dyslipidaemia; their values
in group 3 were signifcantly higher compared with
group 1 and group 2. In group 1, post infarction an-
gina was more frequent compared with group 3 (60%
vs. 37.5%). Reinfarctization and infarct expasion were
more frequent in groups 2 and 3 compared with group
1 (58.3%, 50% vs. 20%). Hospital mortality reached
8.6% in diabetics and was highest than in non diabetes
group: 5.7%. Among patients with diabetes with dura-
tion of less than 5 years no patient has died. Among
patients with disease evolution between 5 and 10 years
one patient died, and among patients with diabetes for
more than 10 years two patients died. At 12 months the
cardiovascular mortality was 6.66% (1 patient) in the
frst batch, 25% in group 2 and 37.5% in group 3.
Conclusions: Duration of diabetes in patients with
STEMI was associated with increasing risk factors, in
and post hospital morbidity and mortality. Diabetes
mellitus is an unfavorable prognostic factor in patients
with STEMI and increase its impact according to its
duration.
58. Reducerea recurentelor de
fibrilatie atriala prin blocarea
specifica a receptorului
mineralocorticoid un studiu
de 24 luni
A.Tase, G.Savoiu, M.Mihaila, S.I.Iorga, Gabriela Stan-
ciulescu, Trache Cristina, O.Tetiu
Spitalul Judetean de Urgenta Arges, Pitesti
Introducere. Alterarile structurale atriale prin fbrila-
tie atriala (FA) repetitiva includ hiperactivarea SRAA
care poate avea un rol decisiv, aldosteronul find impli-
cat in infamatie, fbroza, remodelare.
Obiectivul studiului nostru este comparatia directa a
doua regimuri terapeutice (fecare cuprinzand cate trei
subregimuri), in scopul evaluarii benefciului eplereno-
nei (E) la pacientii (pts.) cu FA repetitiva.
POSTER I
POSTER I
Suplimentul A, 2010
66
Scop: evaluarea efectului coronarodilatator mediat prin
hiperpolarizare in insufcienta cardiaca experimentala.
Material si metode. Insufcienta cardiaca (IC) a fost re-
produsa la sobolani prin administrarea doxorubicinei
(doza cumulativa 10 mg/kg timp de 10 zile). Rezerva
functionala coronariana (RFC) a cordului izolat izo-
volumic a fost apreciata la actiunea acetilcolinei (Ac),
peroxidului de hidrogen (H2O2) si a bradikininei (Br),
inclusiv pe fondalul inhibitiei NOSec prin L-NAME, a
blocarii receptorilor Br, B2 prin HOE-140 sau a meta-
bolizarii H2O2 prin catalaza.
Rezultate: RFC a fost semnifcativ redusa in IC cu circa
34% la stimulare parasimpatica (Ac [10-5 M]) si cu 27%
la actiunea Br (10-6 M). Remarcabil, ca actiunea H2O2,
care deschide canalele de potasiu (KCa si KV) si induce
hiperpolarizarea miocitului neted coronarian, s-a im-
pus printr-o valoare mai mare a fuxului coronarian in
IC: cu 8, 13 si 18% (p<0,05) in concentratiile 10-7, 10-6
si, respectiv 10-5 M. Acest efect ar f datorat cresterii
expresiei receptorilor sensibili la aminopirimidina in
conditiile excesului radicalului liber de oxigen ca rezul-
tat al stresului oxidativ potentat in IC. De mentionat
in cest context ca administrarea vitaminei E in paralel
cu antraciclina a augmentat efectul coronarodilatator al
H2O2 si RFC, inerenta plauzibil legata de capacitatea
acesteia de a majora expresia SOD si dismutarea anio-
nului superoxid in H2O2. Actiunea Br pe fondalul inhi-
bitiei NOSec s-a manifestat printr-o RFC diminuata in
lotul martor versus IC, iar cand actiunea nonapeptidei
a fost precedata de administrarea catalazei, relatia a fost
inversa, fapt ce sugereaza ca efectul coronarodilatator
al bradikininei in IC, asociata de disfunctia endoteliala,
este predilect mediat prin H2O2 eliberat la stimularea
receptorilor endoteliali B2. Important ca in conditiile
blocarii acestora prin HOE-140, Br a indus o crestere
superioara (de circa 2,4 ori) a fuxului coronarian in IC,
fenomen ce ar evidentia expresia in sus a receptorilor
B1, activarea carora relaxeaza miocitul coronarian prin
hiperpolarizare.
Concluzie: coronarodilatarea prin hiperpolarizare este
in insufcienta cardiaca un mecanism compensator al
fenomenului coronarian Gregg periclitat in disfunctia
endoteliala, iar peroxidul de hidrogen, eliberat de apa-
ratul mitocondrial al cardiomiocitului sau la activarea
receptorilor bradikininei ar f un factor important al
reglarii rezervei functionale coronariene, independent
de sistemul NO.
Method: Te study considered 80 pts. with AF, star-
ting with 1st Nov. 2007, structured in two comparati-
ve groups, demographically balanced (slight male and
6th decade pts. predominance, respectively in both
groups). Te pts. from the frst group were treated with
antiarrhythmics {Amiodarone (A) 71% pts. or Propafe-
none (P) 21% pts. or Sotalol (S) 8% pts.} + exogenous
potassium supplement (K+), while the pts. from the se-
cond group were treated with antiarrhythmics {A 70%
pts. or P 23% pts. or S 7% pts.} + E. We compared the
occurrence of AF episodes 24 months before and, re-
spectively, afer the initiation of treatment with E. An
exclusion criterion referred to the pts. previously trea-
ted with bs (indirect antireninic efect), ACE inhibi-
tors, ARBs, spironolactone.
Results: Te adjacent table structures the main out-
comes of the study: Ter. AF Episodes AF Episodes p
value Arm (24 mo. (24 mo. before) afer) A + K+ 8,8+/-
1,7 10,5+/-2,5 <0,01 P + K+ 9,1+/-2,4 10,3+/-1,7 <0,01
S + K+ 8,9+/-0,9 10,3+/-1,1 <0,05 AA + K+ 8,9+/-2,6
10,5+/-2,8 <0,005 A + E 9,1+/-2,1 3,7+/-2,0 <0,01 P +
E 9,0+/-2,5 3,9+/-2,3 <0,01 S + E 8,7+/-2,4 4,1+/-2,1
<0,05 AA + E 9,1+/-2,3 3,7+/-1,9 <0,005.
Conclusions: E the specifc blocker of mineralocor-
ticoid receptor, appears in our pts. as a valuable addi-
tional therapeutic option in prevention of AF episodes
occurrence. E brings endogenous potassium, more
metabolic friendly than K+ exogenic uptake. Beyond,
it reduces RAAS activity and could also reduce the f-
brosis involved in structural remodeling. Tese bene-
fcial efects were independent of BP lowering and are
probably due to the antiinfammatory efects of E.
59. Coronaridilatarea mediata
prin hiperpolarizare in
insuficienta cardiaca
M.Popovici, V.Cobet, I.Popovici, N.Ciobanu, V.Ivanov,
L.Ciobanu, I.Moraru
Institutul de Cardiologie, Republica Moldova, Chisinau
Efectul coronarodilatator al factorilor metabolici locali
mediat prin mecanismul de hiperpolarizare a mioci-
tului neted coronarian este un aspect important de re-
glare a perfuziei coronariene in disfunctia endoteliala,
intrucat este independenta de capacitatea sistemului de
sinteza a oxidului nitric.
Suplimentul A, 2010
6I
POSTER I
POSTER I
Conclusion: the hyperpolarization mediated coronary
dilation in HF is a compensatory mechanism of the
coronary phenomenon Gregg disturbed in endothelial
dysfunction, and hydrogen peroxide released by mito-
chondrial apparatus of cardiomyocyte or during bra-
dykinin receptors activation appears to be an impor-
tant factor of functional coronary reserve regulation
independently of NO system.
60. Aspecte clinico-evolutive
la copiii cu hipertensiune
arteriala pulmonara tratati
cu substante vasodilatatoare
specifice
Ioana Ghiorghiu, Irina Calangea, Serban Marinela,
Ruxandra Jurcut, Carmen Ginghina
Premize: Hipertensiunea arteriala pulmonara (HTP)
este o boala cu o prevalenta mica la copil. Etiologia este
reprezentata de: malformatiile congenitale de cord cu
shunt stanga dreapta, malformatiile congenitale de
cord complexe cu irigarea plamanului din circulatia
sistemica si hipertensiunea pulmonara idiopatica. Exis-
ta putine studii despre tratamentul HTP cu substante
vasodilatatoare specifce la copil.
Material si metoda: lotul de studiu: 7 pacienti, 4 sex
masculin, varsta 5-17 ani (media 11,3 ani), diagnosti-
cati cu HTP severa, presiunea sistolica in artera pul-
monara (Psist AP) 78 si 122 mm Hg, (media: 98,4 mm
Hg), presiunea medie in artera pulmonara (Pm AP) 35
si 67 mm Hg, media: 58,2 mm Hg (valori determinate
invaziv prin cateterismul cavitatilor cardiace drepte).
Etiologia HTP: HTP idiopatica (1 pac), HTP post co-
rectia tardiva a unor malformatii congenitale de cord
(2 pac), HTP secundara unor MCC neoperate (4 pac).
Toti pacientii au primit medicatie cu substante vasodi-
latatoare specifce: Bosentan (2 pac), Sildenafl (3 pac),
terapie dubla (2 pac). Monitorizarea pacientilor pe du-
rata studiului s-a realizat ecocardiografc (masurarea
cavitatilor drepte, a presiunii sistolice si medii in artera
pulmonara, TAPSE), test de mers 6 min. si clasa de in-
sufcienta cardiaca conform clasifcarii NYHA.
Mediated by hyperpolarization
coronary dilation in heart
failure
Te coronarodilatory efect of the local metabolic fac-
tors mediated through mechanism of smooth coronary
myocyte hyperpolarization is an important pattern of
the coronary perfusion regulation in endothelial dys-
function inasmuch is independent of the nitric oxide
synthesis system capacity.
Aim: evaluation of the coronary dilation efect medi-
ated through hyperpolarization in experimental heart
failure.
Material and methods: Heart failure (HF) was indu-
ced in rats by doxorubicin administration (cumulative
dose 10 mg/kg during 10 days). Functional coronary
reserve (FCR) of the isolated izovolumic heart was
assayed on acetylcholine (Ach), hydrogen peroxide
and bradykinin (Br) action, inclusively in conditions of
NOSec inhibition by L-NAME, Br receptors B2 blocka-
ge by HOE-140 or of H2O2 metabolization by catalase.
Results: FCR in HF was reduced by almost 34% in pa-
rasympathetic stimulation (Ach [10-5 M]) and by 27%
on Br (10-6 M) action. Remarkably that the action of
H2O2, which opens potassium channels (KCa si KV)
and induces smooth coronary myocyte hyperpolariza-
tion resulted in a higher value of coronary fux in HF:
by 8, 13 and 18% (p<0,05) in concentrations of 10-7,
10-6 and, respectively 10-5 M. Tis efect could be due
to sensible to amino-pyrimidine receptors expression
elevation in conditions of the oxygen free radical excess
due to activated oxidative stress in HF. To be noted that
in parallel to anthracyclin action the administration
of the vitamin E has augmented the coronary dilation
efect of H2O2 and the FCR, an efect possibly linked
to vitamin capacity to increase the SOD expression and
the anion superoxide dismutation in H2O2. Te Br ac-
tion preceded by NOSec inhibition induced a lowered
FCR in control series versus HF, but then the nonapep-
tide action was preceded by catalase administration the
relation was inverse, suggesting that the Br induced
coronary dilation in HF is mainly mediated by H2O2
released consequently to endothelial B2 receptors acti-
vation. Importantly, in their blockade by HOE-140 bra-
dykinin induced a superior rise (by almost 2,4 times)
of the coronary fux in HF, a phenomenon emphasizing
up expression of B1 receptors, their activation rela-
xes the coronary myocyte through hyperpolarization
mechanism.
POSTER I
POSTER I
Suplimentul A, 2010
68
vasodilator drugs: Bosentan (2 pts), Sildenafl (3 pts),
dual therapy (2 pts). Monitoring patients during the
study was performed by echocardiography (measure-
ment of the right cavities, the average and the systolic
pressure in the pulmonary artery, TAPSE), 6 min walk
test and heart failure class according to NYHA classi-
fcation.
Results: NYHA class enrollment was: NYHA class II
1 pt, NYHA class III - 4 pts, NYHA class IV - 2 pts.
Afer treatment was functional class: NYHA class II - 4
pts, NYHA class III - 3 pts. Tere has been one death, a
patient with idiopathic PAH. One patient experienced
adverse efects from increasing doses of sildenafl, hea-
dache. Test drive at enrollment was between 150 and
520 m, mean: 340.4 m, afer 18 months of treatment
distance was between 200 and 580 m, mean: 384.7 m.
Echocardiographic evaluation showed no changes in
systolic pressure and in average pressure in the pul-
monary artery. Te only echocardiographyc parameter
that improved afer treatment was TAPSE from an ave-
rage of 16.5 mm at baseline to 19.8 mm afer treatment.
(Averaged from the entire study group).
Conclusions: Treatment with specifc vasodilator
drugs is well tolerated in children and lead to an im-
provement in functional class, the distance in the 6 min
walk test and right ventricular function. Changes are
not recorded in values of systolic and mean pulmonary
artery pressure.
61. Aspecte
electrocardiografice in embolia
pulmonara
M.Balint, Rodica Avram, P.Dan, Florina Parv, Livia
Branzan, Mariana Tudoran, Ioana Cotet, Gabriela
Filip
Universitatea de Medicina si Farmacie Victor Babes
Timisoara
Scop: Am evaluat modifcarile electrocardiografce
(ECG) la pacientii diagnosticati cu embolie pulmonara
(EP) in relatie cu aspectele clinice si severitatea EP.
Material si metoda: Am realizat un studiu retrospec-
tiv asupra inregistrarilor ECG la 71 de pacienti, 42 de
femei (varsta medie 56,7116,83 ani) si 29 de barbati
(varsta medie 63,4413,62 ani) diagnosticati cu EP in
Rezultate: Clasa NYHA la includerea in studiu a fost:
clasa NYHA II 1 pac, clasa NYHA III 4 pac, clasa
NYHA IV 2 pac. Dupa tratament clasa functionala a
fost: clasa NYHA II 4 pac, clasa NYHA III 3 pac.
S-a inregistrat un singur deces, o pacienta cu HTP pri-
mitiva. Testul de mers la includerea in studiu, intre 150
si 520 m, media: 340,4 m. Dupa 18 luni de tratament
distanta parcursa a fost: 200 si 580 m, media: 384.7 m.
Evaluarea ecocardiografca nu a evidentiat modifcari
ale presiunii sistolice si ale presiunii medii in artera pul-
monara. Singurul parametru ecografc care s-a amelio-
rat dupa tratament a fost TAPSE de la o valoare medie
de 16,5 mm la includere la 19,8 mm dupa tratament.
Concluzii: Tratamentul cu substante vasodilatatoare
specifce este bine tolerat la copil si determina o ameli-
orare a clasei functionale, a distantei parcurse la testul
de mers de 6 min si a functiei ventriculului drept. Nu
se inregistreaza modifcari ale valorilor presiunii medii
si sistolice din artera pulmonara.
Clinical and developmental
issues in children with
treated with specific
vasodilatator drugs
Background: Pulmonary arterial hypertension (PAH)
is a disease with a low prevalence in children. Etiology
is represented by: congenital heart defects with lef
right shunt, complex congenital heart disease with lung
irrigation from systemic circulation and idiopathic
pulmonary hypertension. Tere are few studies on the
treatment of pulmonary hypertension in children with
specifc vasodilator drugs.
Methods: Tere were studied a total of seven patients,
four male, age 5-17 years (mean 11.3 years), diagnosed
with severe PAH, pulmonary artery systolic pressure
(Psist AP) between 78 and 122 mm Hg (mean: 98.4 mm
Hg), pulmonary artery mean pressure (Pm AP) betwe-
en 35 and 67 mm Hg, mean: 58.2 mm Hg (values deter-
mined by invasive catheterization right heart cavities).
PAH etiology was represented by: idiopathic PAH (1
pt), PAH late afer correction of congenital heart mal-
formations (2 pts), PAH secondary to unoperated MCC
(4 pts). All patients received medication with specifc
Suplimentul A, 2010
69
POSTER I
POSTER I
followed in decreasing manner by negative T wave
aspect in V1-V4 leads (15 cases, 21,12%), right axis
deviation and S1Q3T3 pattern with 10 patients each
(14,08%), associated negative T wave in V1-V4 leads
and S1Q3T3 pattern in 9 cases (12,67%). Right bundle
branch block (RBBB), negative T wave aspect in DIII
and aVF and new atrial tachyarrhythmias were noted
in 6 cases each (8,45%) and high voltage S wave in V5-
V6 in 5 patients (7,04%). Other ECG changes were
isolated and consisted of frst-degree atrioventricular
block, lef axis deviation, lef bundle branch block and
combinations of previous related ECG changes. About
one third (33,80%) from patients had no semnifcative
ECG changes, except sinus tachycardia, especially tho-
se with non-severe forms of PE, despite their suggestive
clinical and imagistic signs.
Conclusions: Te correlation between specifc ECG
changes and PE positive diagnosis is poor in mild and
medium severity forms, but helpful in massive PE. Te-
refore, the absence of ECG modifcations in the presen-
ce of clinical signs of PE must lead to supplementary
investigations for diagnostic confrmation. Key words:
ECG changes, pulmonary embolism.
62. Statusul hormonal
estrogenic si functia endoteliala
Florina Parv, Rodica Avram, M.Balint, Mariana Tudo-
ran, Livia Branzan, Cristina Tudoran, T.Ciocarlie
Universitatea de Medicina si Farmacie Victor Babes,
Timisoara
Introducere. Hormonii estrogeni au efect vasoprotec-
tor, nu numai prin modifcarea lipidelor plasmatice, cat
mai ales prin efect vasodilatator, prin actiuni multiple
la nivelul endoteliului. Scop: De a evidentia relatia din-
tre nivelul estrogenic si functia endoteliala.
Metode: Am luat in studiu un lot de 96 femei, din
care 46 (48%) inainte de menopauza, cu varsta medie
29,699,75 ani si 50 (52%) dupa cel putin trei ani de
menopauza, cu varsta medie 62,649,31 ani. Prin me-
toda vasodilatatiei mediate de fux la nivelul arterei bra-
hiale s-au cercetat vasodilatatia dependenta de endo-
teliu (VDDE), cea independenta de endoteliu (VDIE),
precum si hiperemia reactiva (HR), defnita ca variatie
a vitezei maxime sistolice la 15 secunde postischemic.
La un subgrup de 26 femei cu varsta intre 21-32 ani,
Clinica de Cardiologie in decurs de 3 ani. Inregistrari-
le ECG au fost realizate utilizand tehnica standard cu
12 derivatii si am consemnat de la aspectul normal de
baza toate modifcarile sugestive pentru EP si corelatia
lor cu severitatea EP prin folosirea de metode clinice si
imagistice.
Rezultate si discutii: Tahicardia sinusala a fost cea mai
frecventa modifcare ECG (61 de pacienti, 85,91%), ur-
mata in ordine descrescatoare de unda T negativa in
V1-V4 (15 cazuri, 21,12%), deviatia axiala dreapta si
aspectul S1Q3T3 in cate 9 cazuri (12,67%). Blocul de
ramura dreapta, unda T negativa in DIII si aVF si ta-
hiaritmiile atriale nou instalate au fost consemnate in
cate 6 cazuri (8,45%), iar unda S cu amplitudine mare
in V5-V6 la 5 pacienti (7,04%). Alte modifcari ECG
isolate au constat din bloc atrioventricular gradul I, de-
viatie axiala stanga, bloc de ramura stanga si combinatii
ale acestora. Circa o treime (33,8%) dintre pacienti nu
au prezentat nici o modifcare ECG semnifcativa, ex-
ceptand tahicardia sinusala, mai ales cei cu forme non-
severe de EP, in pofda aspectelor clinice si imagistice
sugestive.
Concluzii: Corelatia dintre modifcarile ECG si dia-
gnosticul pozitiv de EP este redusa in formele cu se-
veritate usoara si medie, dar utila in EP masiva. Din
aceste motive absenta modifcarilor ECG in prezenta
semnelor clinice de EP trebuie sa conduca la investi-
gatii suplimentare pentru confrmarea diagnostica.
Cuvinte cheie. Modifcari electrocardiografce, embolie
pulmonara
Electrocardiographic aspects in
pulmonary embolism
Aims: We assessed electrocardiographic (ECG) chan-
ges in pulmonary embolism (PE) diagnosed patierns in
connection with clinical aspects and severity of PE.
Material and method: We performed an retrospective
study using ECG recordings in 71 patients, 42 women
(mean age 56,7116,83 years) and 29 men (mean age
63,4413,62 years) with PE diagnosed in Cardiology
Clinic during 3 years. Te ECG recordings were made
using standard 12-leads technique and we noted all the
modifcations from the basic normal aspect suggesting
PE reason and the correlation with PE severity establi-
shed using clinical and imagistic methods.
Results and discussions: Sinus tachycardia was the
most frequent ECG modifcation (61 patients, 85,91%),
POSTER I
POSTER I
Suplimentul A, 2010
I0
mal menstrual cycle without risk factors and no use of
preparations containing estrogen, the same parameters
were analyzed according to the increased (preovulator,
on 13-14 day) and low (3-4 day cycle) estrogen levels.
Results: EDDV was signifcantly higher preovulator
(13.00 3.6%) vs. 3-4 day cycle (10.81 7.07%, p =
0.004), higher in women before menopause (14.85
8.88%) vs. afer menopause (8.67 6.37%, p <0.0001)
and decreased progressively in menopause, reaching
signifcantly lower values afer 15 years of menopau-
se (4.40 7.59%, p <0.05). Women in menopause and
hormone replacement therapy had a vasodilator res-
ponse very high: more than 90 percentile (> 22.58%).
EIVD was higher in women before menopause (26.25
9.15%) vs. afer menopause (20.44 10.18%, p =
0.002) and signifcantly decreases afer 15 years of me-
nopause (7.89 3.36, p <0.0001). Reactive hyperemia
was increased before the menopause (94.62 51, 57%)
vs. afer menopause (66.74 29.41%, p = 0.002) and
higher preovulator (93.02 34.44%) vs day 3-4 of men-
strual cycle (75.9719.70%; p=0.03).
Conclusions: It was demonstrated that endothelium-
dependent vasodilation, endothelium-independent
vaso dilation and reactive hyperemia, parameters cha-
racterizing endothelial function, are infuenced in a
positive sense of presence and high level of estrogen
hormones.
63. Dificultati in interpretarea
valorii NT-proBNP la pacientii
cu insuficienta cardiaca acuta si
fractie de ejectie pastrata
Raluca Ciomag-Ianula, Madalina Dasoveanu, Anca
Popa, F.Adam, Crina Sinescu
Spitalul Clinic de Urgenta "Prof. Dr.Bagdasar-Arseni",
Bucuresti
Insufcienta cardiaca (IC) acuta: cea mai frecventa ca-
uza de spitalizare la pacientii peste 65 ani. Acest motiv
justifca eforturile de a imbunatatii prognosticul aces-
tor pacienti. Este cunoscuta importanta NT-proBNP in
diagnosticul si managementul IC: creste ca raspuns la
cresterea stresului parietal miocardic. S-a observat ca el
creste mai putin la cei cu functie sistolica pastrata, dar
nu exista o valoare prag recunoscuta pentru diagnos-
cu ciclu menstrual normal, fara factori de risc si fara
uz de preparate cu continut estrogenic au fost analizati
aceeasi parametri in functie de nivelul estrogenic cres-
cut (preovulator, in ziua 13-14) si scazut (in ziua 3-4 a
ciclului menstrual).
Rezultate: VDDE a fost semnifcativ mai mare in pe-
rioada preovulatorie (13,003,6%) vs in ziua 3-4 a ci-
clului menstrual (10,817,07%; p=0,004), mai mare la
femei inainte de menopauza (14,858,88%) vs dupa
menopauza (8,676,37%; p<0,0001) si scade progresiv
in menopauza, atingand valori semnifcativ mai mici
dupa 15 ani de la instalarea menopauzei (4,407,59%;
p<0,05). Femeile la menopauza si cu terapie hormonala
de substitutie au avut un raspuns vasodilatator foarte
ridicat: peste percentila 90 (>22,58%). VDIE a fost mai
mare la femei inainte de menopauza (26,259,15%)
vs dupa menopauza (20,4410,18%; p=0,002) si scade
semnifcativ dupa 15 ani de la instalarea menopauzei
(7,893,36; p<0,0001). Hiperemia reactiva a fost mai
crescuta inainte de menopauza (94,62v51,57%) vs dupa
menopauza (66,7429,41%; p=0,002) si mai mare in
perioada preovulatorie (93,0234,44%) vs in ziua 3-4 a
ciclului menstrual (75,9719,70%; p=0,03).
Concluzii: S-a demonstrat ca vasodilatatia dependenta
de endoteliu, cea independenta de endoteliu si hipere-
mia reactiva, parametri care caracterizeaza functia en-
doteliala, sunt infuentati in sens pozitiv de prezenta si
nivelul ridicat al hormonilor estrogeni.
Estrogen status and endothelial
function
Background. Vasoprotective efect of estrogen hormo-
nes consist of not only on plasma lipid levels but espe-
cially of vasodilator efect through multiple actions on
the endothelium.
Purpose: To highlight the relationship between estro-
gen level and endothelial function.
Methods: We studied a group of 96 women, of which
46 (48%) before menopause, average age 29.69 9.75
years and 50 (52%) afer at least three years of menopa-
use, average age 62 , 64 9.31 years. Using the method
of fow-mediated vasodilatation in the brachial artery
were investigated endothelium-dependent (EDDV),
endothelium-independent vasodilation (EIVD) and
reactive hyperemia (RH), defned as the maximum
systolic speed variation at 15 seconds postischemia. In
a subgroup of 26 women aged 21-32 years with nor-
Suplimentul A, 2010
I1
POSTER I
POSTER I
fraction (HFNEF), can determine misinterpretati-
on. We explored the relation between acute HFNEF
and only modestly elevated NT-proBNP. One hun-
dred two patients with acute or acute exacerbation of
chronic HFNEF were divided into two groups by NT
-proBNP level: NT- proBNP < 400 pg/ml (NB group,
n = 40) and NT-proBNP 400 pg/ml (B group, n =
62). We compared clinical fndings, echocardiography
results, and neurohormonal factors between these two
groups. In the NB group, a history of coronarian by-
pass was more frequent (68% vs. 18%, p < 0.0001) and
hypertension was less frequent (p = 0.0005). Lef atrial
diameter (LAd) was higher (p = 0.002), while inter-
ventricular septal thickness, posterior wall thickness,
relative wall thickness, lef ventricular mass index were
lower (p = 0.0003, p = 0.0212, p = 0.012, p = 0.0048,
respectively) in the NB group. In patients with HFNEF,
a history of by-pass remained an independent predic-
tor of NT-proBNP level (< 400 pg/ml) afer adjustment
for hypertension, age, LAd, and interventricular septal
thickness (odds ratio 3.3, p = 0.024).We found asso-
ciations between acute HFNEF with small increases
of NT-proBNP and a history of by-pass. In a patient
suspected of HFNEF, a history of coronarian by-pass is
considered diagnostic evidence of presence of diastolic
heart failure when plasma levels of NT-proBNP are less
elevated.
64. Date comparative clinice,
biologice, electrocardiografice
si ecografice la diabetici versus
nondiabetici intr-un lot de
pacienti cu SCA
Arama Laura, S.Barsan, Luminita Ionescu, Simona
Huidu, Andreea Popescu, Roxana Popescu, I. Stanca,
M. Melnic, Doina Dimulescu
Spitalul Universitar de Urgenta ELIAS, Bucuresti
Obiective: analiza diferentelor statistic semnifcative la
diabetici fata de nondiabetici in ceea ce priveste datele
clinice, biologice, ECG si ecografce de la internare.
Material si metoda: studiu retrospective pe 228 paci-
enti cu SCA inrolati succesiv in 2009, impartiti in 2 lo-
turi in functie de prezenta sau nu a diabetului.
ticul IC acute. Datorita timpului de injumatatire rela-
tiv lung al peptidelor natriuretice, schimbarea rapida a
presiunilor de umplere VS nu se refecta in schimbarea
nivelului NT-proBNP. De aceea, rolul NT-proBNP in
diagnosticul si prognosticul IC acute nu este clar.
Scopul studiului a fost de a evalua rolul NT-proBNP in
diagnosticul IC acute si de a stabili o posibila corelatie
intre nivelul NT-proBNP si etiologia IC acute, mai ales
cand acesta este doar usor crescut.
Material si metoda: Au fost inrolati, prospectiv, 102
pacienti cu IC acuta cu functie sistolica pastrata (69
barbati,33 femei, varsta medie 70ani) internati in pe-
rioada 01-10.2009. Diagnosticul de IC acuta s-a bazat
pe recomandarile Societatii Europene de Cardiologie:
coexistenta simptomelor de agravare a IC si a semnelor
de disfunctie cardiaca impreuna cu necesitatea terapiei
injectabile. La internare, toti pacientii au benefciat de
determinarea NT-proBNP+ echocardiografe. Valoarea
prag a NT-proBNP a fost considerata 400 pg/ml, valo-
rile sub 100 pg/ml excluzand IC. S-au impartit pacientii
in 2 grupe in functie de valoarea NT-proBNP: grupul
A (n=32) cei cu NT-proBNP <400 ng/ml si grupul B
(n=70) cei cu NT-proBNP > 400 pg/ml. S-au comparat
caracteristicile clinice, ecografce si parametrii biolo-
gici ai celor doua grupe, incercand sa stabilim corela-
tiile dintre ele.
Rezultatele au aratat o corelatie intre IC acuta cu FE
prezervata cu nivel scazut al NT-proBNP si istoricul
de protezare valvulara si CABG (p<0.0001). In plus,
acest grup prezinta in mai mica proportie istoric de
hipertensiune si parametri de hipertrofe ventriculara
stanga, dar au in proportie mare dilatare atriala stanga
(p=0.002. Nu s-a observat o asociere intre nivelul cres-
ct al NT-proBNP si prezenta fbrilatiei atriale, a diabe-
tului, a insufcientei renale si a valorii hemoglobinei.
Toate aceste date sugereaza ca valoarea diagnostica si
prognostica a NT-proBNP in IC acuta are implicatii di-
ferite fata de cronica.
Difficulties in interpreting NT-
proBNP values in patients with
acute congestive heart failure
and normal ejection fraction
Variability of NT-proBNP levels in patients with acu-
te heart failure with normal lef ventricular ejection
POSTER I
POSTER I
Suplimentul A, 2010
I2
post-ACS: EF, ventricular arrhythmias, proteinuria,
blood glucose at admission.
65. Peptidul natriuretic cerebral
si riscul injuriei de reperfuzie
miocardica la pacientii cu
supradenivelare de ST - studiu
de cohorta prospectiv
Tautu Oana-Florentina, Fruntelata Ana
Introducere: Injuria de reperfuzie (IR), rezultat para-
doxal al restabilirii rapide a fuxului prin artera respon-
sabila de infarct, induce o noua agresiune miocardului
ischemiat, limitand astfel efectele pozitive ale reperfu-
ziei. Nivelurile plasmatice crescute ale peptidului na-
triuretic cerebal (BNP), reprezinta un marker util al
evolutiei clinice la pacientii cu infarct miocardic acut
revascularizati.
Obiectiv: Analiza legaturii dintre rezultatul terapiei de
revascularizare miocardica, in special a IR si valorile
BNP la pacientii cu infarct miocardic acut cu suprade-
nivelare de segment ST (IMASST).
Material si metoda: Lotul de studiu a fost alcatuit din
88 de pacienti cu varsta medie de 51,6 ani, 88,6% de
sex masculin ce au fost internati consecutiv cu IMASST
Killip I si supusi revascularizarii in medie dupa 3,82 ore
de la debutul durerii, [87,5% tromboliza si 11,5% angio-
plastie primara], in urma careia 88,6% s-au considerat
reperfuzati (R) pe criterii noninvazive, din care 19,3%
cu IR defnita prin prezenta post-revascularizare a in-
sufcientei cardiace acute sau a aritmiilor ce au nece-
sitat interventie. Injuria maligna de reperfuzie (IMR),
defnita prin prezenta post-revascularizare a tahicardi-
ei ventriculare sustinute sau a fbrilatiei ventriculare, a
fost consemnata in 2.3% din cazuri. Determinarile BNP
s-au realizat la internare (BNP0), la 24 de ore (BNP24)
si la 30 de zile (BNP30) de la revascularizare.
Rezultate: Pacientii IR au avut cele mai mari valori
BNP0 [121,98 ng/ml IR vs. 45,86 ng/ml R vs 36,78 ng/
ml NR; p = 0,007], valori ce au continut sa cresca atat
la 24 de ore cat si la 30 de zile dupa revascularizare
Rezultate: clasa Killip nu a fost diferita semnifcativ sta-
tistic la diabetici fata de nondiabetici -TA si AV au fost
semnifcativ statistic mai crescute in lotul diabeticilor
-diferente semnifcative s-au obtinut pentru valoarea
colesterolului total,a proteinurie si glicemia de la inter-
nare -incidenta aritmiilor ventriculare a fost mai mare
la diabetici fata de nondiabetici -localizarea modifca-
rilor ECG si incidenta tulburarilor de conducere a fost
similara in cele 2 loturi -fractia de ejectie la internare
si volumul telediastolic al VS au diferit semnifcativ in
cele 2 loturi;severitatea insufcientei mitrale a fost si-
milara.
Concluzii: diferente semnifcative statistic s-au obtinut
la diabeticii cu SCA pentru parametri dovediti cu va-
loare de prognostic defavorabil in evolutia post SCA:
FE, aritmiile ventriculare, proteinuria, glicemia la in-
ternare.
Comparative clinical,
biological, electrocardiographic
and ultrasound data in diabetic
versus nondiabetici a lot of
patients with ACS
Objectives: Analysis statistically signifcant diferences
in diabetics compared nondiabetics regarding clinical,
biological, ECG and ultrasound afer admission.
Material and methods: Retrospective study on 228 pa-
tients with ACS enrolled in succession in 2009, divided
into 2 groups according to presence or not of diabetes.
Results: Killip class was not statistically signifcantly
diferent in diabetics compared nondiabetics AV-TA
and were statistically signifcantly higher in diabetic
group, Signifcant diferences were obtained for total
cholesterol, proteinuria and blood glucose from the ho-
spital -Incidence of ventricular arrhythmias was higher
in diabetics compared nondiabetics -Location of ECG
changes and the incidence of conduction disturbances
was similar in the 2 groups -Hospitalization and ejecti-
on fraction of LV volume telediastolic difered signif-
cantly in the 2 groups, severity of mitral regurgitation
was similar.
Conclusions: Statistically-signifcant diferences were
obtained in diabetics with ACS to prove the value pa-
rameters of unfavorable prognosis in the evolution of
Suplimentul A, 2010
I8
POSTER I
POSTER I
maining 11.4% there was lack of reperfusion (NR). Se-
rum BNP levels were measured on admission (BNP0),
and at 24h (BNP24) and 30 days (BNP30) afer reper-
fusion.
Results: Patients with RI had the highest BNP0 levels
compared to those with or without reperfusion (BNP0
121.98ng/ml RI vs 45.86ng/ml R vs 36.78ng/ml NR; p=
0.007), values that continued to rise, both at 24h and at
30 days afer reperfusion treatment (BNP24: 121.98ng/
ml vs 365.94ng/ml; p=0.0001; BNP30: 121.98ng/ml
vs 423.53ng/ml; p=0.004). Te BNP levels dynamics
analyzed in patients with RI, with or without MRI,
showed that although initially the BNP levels were
similar in both categories (BNP0 127.02ng/ml RI vs
84.2ng/ml MRI; p=0.361), they dramatically increased
in patients with MRI, at 24 h and at 30 days, respectively
(BNP24: 321.9ng/ml RI vs. 695.5ng/ml MRI; p=0.019;
BNP30: 349.53 RI vs 9415 MRI; p=0.011).
Conclusion: BNP levels on admission and at 24 hours
in patients with STEMI may allow early prediction of
patients at risk of developing reperfusion injury afer
revascularization therapy. Key words: reperfusion in-
jury (RI), malignant reperfusion injury (MRI), brain
natriuretic peptide (BNP), reperfusion, STEM
[BNP24 : 121,98 vs. 365,94; p = 0,0001; BNP30: 121,98
vs. 423,53; p = 0,004]. Analiza dinamicii BNP la paci-
entii IR, cu sau fara IMR, a aratat ca, desi initial valo-
rile au fost similare la ambele grupe [BNP0 127.02 ng/
ml IR vs. 84.2 ng/ml RM; p = 0,361], ulterior valorile
BNP ale pacientilor cu IMR au crescut brutal [BNP24:
321,99 IR vs. 695,5 RM; p = 0,019; BNP30: 349,53 IR vs.
941,5 RM; p = 0,011]
Concluzii: Valorile BNP la internare si la 24 de ore de
la revascularizare pot f un marker util pentru identi-
fcarea precoce a pacientilor IMASST la risc de a dez-
volta IR sau IMR dupa revascularizare. Cuvinte cheie:
injurie de reperfuzie (IR), injurie maligna de reperfuzie
(IMR), peptidul natriuretic cerebral (BNP), reperfuzie,
IMASST.
Brain natriuretic peptide and
myocardial reperfusion injury
risk in ST-elevation myocardial
infarction - a prospective
cohort study
Background: Myocardial reperfusion injury (RI), re-
sult of fow restoration in the infarct artery, induces
additional injury, thus limiting the benefcial efects of
reperfusion. Elevated serum levels of brain natriuretic
peptide (BNP) in patients with ST-segment elevation
myocardial infarction (STEMI) represent a marker of
outcomes in these patients.
Purpose of the study was to assess the relation betwe-
en myocardial reperfusion, particularly the presence of
RI, and BNP serum levels in STEMI patients.
Methods: We analyzed a cohort of 88 patients (mean
age 51.6 years, 88.6% males) hospitalized for STEMI in
Killip class I, who underwent reperfusion therapy wi-
thin a mean time from symptoms onset of 3.82 hours.
Trombolysis was used in 87.5% of cases and primary
percutaneous coronary intervention in 11.5% of cases.
Successful reperfusion (R) assessed non-invasively by
classical criteria was obtained in 88.6% of patients, of
whom 19.3% had reperfusion injury (RI) defned by
acute heart failure and episodes of arrhythmias requi-
ring intervention. Malignant reperfusion injury (MRI)
was defned as sustained ventricular fbrillation or ta-
chycardia in 2.3% of the reperfused patients. In the re-
I1
(11.5% vs 15.1%, p=0.03) si deplasarea maxima a inelu-
lui mitral (5.6 vs. 6.4 mm, p=0.05) au fost inferioare in
timpul EPAH fata de reevaluare, independent de frec-
venta cardiaca (94 vs 75 bpm, p<0.001), in ciuda unei
functii VS sistolice globale similare (PC 1.1 vs 1.0 W;
dp/dt 937 vs 948 mmHg/s; Acc 15.5 vs 15.4 m/s2; EF
33% vs 36%; toate p NS). Sincronismul AV a fost afec-
tat in timpul EPAH (40% vs 48%, p<0.001), in ciuda
presiunilor diastolice ridicate dar similare (E/Ea 19 vs
19; E/Vp 2.3 vs 2.4). Indicii de functie diastolica si asin-
cronism, severitatea IM si functia VD au fost similare
intre evaluari.
Concluzie. Disfunctia sistolica longitudinala VS si
afec tarea sincronismului AV sunt mecanisme principa-
le ale EPAH, pe cand disfunctia acuta globala VS si VD,
asin crosimul si IM dinamica nu sunt implicate semni-
fcativ. (ClinicalTrial.gov no.: NCT00829855)
Left ventricular longitudinal
systolic dysfunction and
impaired atrio-ventricular
synchrony are the main
mechanisms of acute
hypertensive pulmonary edema
Purpose: To assess role of lef (LV) and right ventri-
cular (RV) dysfunction, dyssynchrony, and dynamic
mitral regurgitation (MR) during acute hypertensive
pulmonary edema (AHPE).
Methods: 51 consecutive patients (6911 years, 20
men) with acute dyspnoea within the preceding 8h,
pulmonary congestion, systolic BP160 mmHg, and in
sinus rhythm, were evaluated by conventional and tis-
sue Doppler echocardiography at admission, and at 48
to 92h. Acute myocardial infarction and moderate and
severe lef-sided valvar diseases were excluded. Global
systolic function was assessed by cardiac power (CP =
mean BP x cardiac output/451), dp/dt, LV outfow tract
acceleration (Acc), and ejection fraction (EF); longitu-
dinal LV systolic function by mean strain of 6 basal seg-
66. Disfunctia longitudinala
sistolica acuta ventriculara
stanga si deteriorarea
sincronismului
atrio-ventricular sunt
mecanismele principale ale
edemului pulmonar acut
hipertensiv
A.Margulescu, Roxana Cristina Sisu, Maria Florescu,
M.Cinteza, D.Vinereanu
Universitatea de Medicina si Farmacie Carol Davila
Bucuresti. Spitalul Universitar de Urgenta, Bucuresti
Scop: Evaluarea rolului disfunctiei ventriculare stangi
(VS) si drepte (VD), asincronismului si insufcientei
mitrale (IM) dinamice in timpul edemului pulmonar
acut hipertensiv (EPAH).
Metoda: 51 de pacienti consecutivi (6911 ani, 20
barbati) cu dispnee acuta cu debut de <8h, congestie
pulmonara, TA sistolica 160mmHg si ritm sinusal, au
fost evaluati prin ecografe standard si Doppler tisular
la internare si dupa 48-92h. Au fost exclusi pacientii cu
infarct miocardic acut si valvulopatii stangi moderate si
severe. Functia globala sistolica a fost evaluata prin Pu-
terea Cardiaca (PC = TA medie x debit cardiac / 451),
dp/dt, accelerarea in tract ejectie VS (Acc) si fractia de
ejectie (FE); functia longitudinala sistolica prin strain
mediu a 6 segmente bazale si deplasarea maxima a ine-
lului mitral. Functia diastolica VS a fost evaluata prin
proflul de umplere transmitral, si raporturile E/Ea si
E/Vp; sincronismul atrio-ventricular (AV) prin timpul
de umplere diastolica (% din ciclul cardiac). Functia
VD a fost evaluata prin strain perete liber VD bazal si
deplasarea maxima a inel tricuspidian. Au fost masu-
rati indici de asincronism inter- si intra-ventriculari si
severitatea IM.
Rezultate: TA sistolica la internare a fost 19430mmHg.
TA medie a fost similara la cele 2 evaluari (102 mmHg),
ecografa initiala find realizata dupa 6639 min de la
inceperea tratamentului. Strain mediu longitudinal
SESI UNEA TNRULUI I NVESTI GATOR | YOUNG I NVESTI GATORS AWARD SESSI ON
Suplimentul A, 2010
I5
SESI UNEA TNRULUI I NVESTI GATOR
YOUNG I NVESTI GATORS AWARD SESSI ON
ments, and peak displacement of the mitral annulus.
LV diastolic function was assessed from the mitral fow
profle, E/Ea and E/Vp ratios; atrio-ventricular (AV)
synchrony by diastolic flling time (% of cardiac cycle).
RV function was assessed by strain of the basal RV free
wall, and peak displacement of the tricuspid annulus.
Intra- and interventricular dyssynchrony indices, and
MR severity were also measured.
Results: Systolic BP at admission was. Mean BP was
similar between evaluations (102 mmHg), initial echo
being performed afer initiation of treatment. LV lon-
gitudinal mean and peak displacement of the mitral
annulus were lower during AHPE, independent of HR
despite similar global systolic function AV synchrony
was impaired during AHPE Diastolic and dyssyn-
chrony indices, MR severity, and RV function were si-
milar between evaluations.
Conclusions: Acute LV longitudinal systolic dysfunc-
tion and impaired AV synchrony are the main mecha-
nisms of AHPE, whereas acute LV global systolic dys-
function, dyssynchrony, dynamic MR, and RV function
are not involved. (ClinicalTrial.gov no.: NCT00829855)
67. Beneficiu rapid al inlocuirii
percutane de valva aortica
asupra severitatii regurgitarii
mitrale secundare
C.Stoicescu, Nicotera Mariuca Vasa, Chin Derek,
D.Vinereanu, J.Kovac
Universitatea de Medicina si Farmacie "Carol Davila",
Bucuresti
Context: Datele din literatura de specialitate legate de
evolutia regurgitarii mitrale (RM) secundare dupa in-
locuirea percutana de valva aortica (pAVR) sunt puti-
ne si contradictorii. Datele din registrele pAVR arata o
imbunatatire >50% din pacientii tratati cu CoreValve
Medtronic System TM. Mecanismele detaliate ale ame-
liorarii RM nu sunt inca descrise.
Metoda: 71 pacienti (816 ani, 47% barbati) au fost
studiati imediat inainte si dupa pAVR si la 30 de zile.
Au fost masurate ecografc dimensiunile ventriculului
stang (VS) diametrele diastolice si sistolice (DS), grosi-
mea peretilor, functia VS (prin FEVS), indexul de masa
VS (LVMI), diametrul atriului stang (AS), morfologia
aparatului valvular mitral prin punctul de coaptare val-
vular fata de planul inelului mitral (CPMA), diametrul
inelului mitral si severitatea RM prin vena contracta
(VC), volumul regurgitatnt prin PISA si raportul aria
jetului mitral / aria AS. S-a masurat invaziv presiunea
sistolica in VS (PSVS) pre si post procedura.
Rezultate: La 30 de post pAVR DSVS a scazut de la
416 la 374 mm, grosimea septului de la 15.61.7 la
14.11.2 mm, LVMI de la 27870 la 20751 g/m2 (toa-
te cu p<0.05), in timp ce FEVS a crescut de la 4511
la 5210% (p<0.01). Severitatea RM a scazut: VC de
la 3.70.7 la 2.90.6 mm, volumul regurgitant de la
27.13.2 la 20.82.9 ml, aria jetului mitral / aria AS de
la 18.11.8 la 13.91.4% (toate cu p<0.05); diametrul
AS nu s-a schimbat. Ameliorarea severitatii RM secun-
dare s-a datorat reducerii fortelor de tractiune ce acti-
oneaza asupra valvelor: CPMA a scazut de la 10.21.9
la 9.11.6 mm, p<0.05, iar indicele de sfericitate a sca-
zut de la 1.480.13 la 1.430.10, p=0.07. Diamterul
inelului mitral a ramas neschimbat. PSVS a ascazut de
la 155.526.6 la 130.220.8 mmHg (p<0.05). PSVS,
CPMA, indexul de sfericitate reprezinta predictorii in-
dependenti principali pentru reducerea RM (R2=0.49;
p<0.05).
Concluzii: Scaderea PSVS post pAVR este un trigger
pentru scaderea grosimii peretilor VS , DSVS, si inde-
xului de sfericitate; aceasta duce la o ameliorare rapida
a severitatii RM secundare, in special prin reducerea
tractiunii subvalvulare.
Early benefits of transcatheter
aortic valve replacement on the
severity of secondary mitral
regurgitation
Background. Few and contradictory data regarding
the benefts of transcatheter aortic valve replacement
(TAVI) on the severity of secondary mitral regurgitati-
on (MR) are available; thus, data from registries show-
ed that secondary MR is improved in >50% of patients
receiving TAVI with the CoreValve Medtronic System
TM. However detailed mechanisms of early improve-
ment afer TAVI are not available yet.
Methods: 71 patients (816 years, 47% male) were stu-
died immediately before and afer TAVI, and afer 30
days. Echocardiography was used to measure lef ven-
Suplimentul A, 2010
I6
tricular (LV) dimensions (end-systolic and end-dias-
tolic diameters, and wall thickness) in order to assess
LV function (by ejection fraction EF) and LV mass
index (LVMI); lef atrium (LA) diameter; mitral valve
morphology by apical displacement of the coaptation
point from the plane of the mitral annulus (CPMA),
and mitral annulus diameter; and MR severity (by vena
contracta, regurgitant volume by PISA, and mitral jet
area/LA area). Catheterization was used to measure LV
systolic pressure (LVSP) pre- and post- procedure.
Results: At 30 days post TAVI, end-systolic diameter
decreased from 416 to 374 mm, septal wall thickness
from 15.61.7 to 14.11.2 mm, LVMI from 27870 to
20751 g/m2 (all p<0.05), while EF increased from
4511 to 5210% (p<0.01). Severity of MR decreased:
vena contracta from 3.70.7 to 2.90.6 mm, regurgi-
tant volume from 27.13.2 to 20.82.9 ml, mitral jet
area/lef atrium area from 18.11.8 to 13.91.4% (all
p<0.05), however LA diameter did not change. De-
crease of the severity of secondary MR was due to the
reduction of traction forces acting on the mitral val-
ve: CPMA was reduced from 10.21.9 to 9.11.6 mm,
p<0.05, while the sphericity index decreased from
1.480.13 to 1.430.10, p=0.07. Tere were no chan-
ges of the mitral annular diameter. Te LVSP decreased
from 155.526.6 to 130.220.8 mmHg (p<0.05). LVSP,
CPMA, and sphericity index represented the main
independent predictors of MR reduction (R2=0.49;
p<0.05).
Conclusions: Decrease of LVSP afer TAVI is the trigger
for reduction of LV wall thickness, ESD, and sphericity
index; this leads to an early decrease of the severity of
secondary MR, mainly by reducing subvalvar traction
acting on the mitral valve.
68. Impactul cresterii
postsarcinii globale a
ventriculului stang asupra
torsiunii si detorsiunii
ventriculare stangi la pacientii
cu stenoza aortica stransa
Andreea Calin, B.A.Popescu, Cristiana Carmen Be-
ladan, Rosca Monica, Denisa Muraru, Luiza Lupascu,
C.Calin, Ruxandra Jurcut, C.Sandu, Carmen Ginghina
Bucuresti
Introducere. La pacientii cu stenoza aortica (SA),
postsarcina globala a ventriculului stang (VS) este re-
fectata de rezistenta combinata, valvulara si arteriala,
la ejectia VS, care poate f evaluata prin impedanta val-
vuloarteriala (Zva). Rolul torsiunii/detorsiunii VS ca
importante componente ale functiei VS a fost demon-
strat, insa impactul cresterii Zva asupra acestora nu a
fost studiat inca la pacientii cu SA.
Obiectiv: Evaluarea impactului cresterii Zva asupra
torsiunii si detorsiunii VS la pacientii cu SA stransa si
fractie de ejectie (FE) VS pastrata.
Metode: Am examinat prospectiv 71 de pacienti (678
ani, 45 barbati) cu SA stransa (aria valvei aortice in-
dexata 0.180.59 cm2/m2) si FEVS > 50%. Treizeci si
opt de pacienti au avut o postsarcina globala VS cres-
cuta (Zva 4.5 mmHgmL-1m2)(grup 1) si 33 de pa-
cienti au avut postsarcina globala scazuta (Zva < 4.5
mmHgmL-1m2)(grup 2). Rotatia bazala si apicala si
torsiunea VS au fost evaluate utilizand ecocardiogra-
fa speckle tracking. Detorsiunea a fost evaluata prin
masurarea ratelor maxime de derotatie apicala, bazala
si a ratei de detorsiune VS precum si a intervalelor de
timp de la varful undei R (ECG) la fecare dintre aces-
tea.
Rezultate: Intre cele doua grupuri nu au existat dife-
rente semnifcative de varsta, sex, suprafata corporala
si clasa functionala NYHA (p>0,20). In comparatie cu
pacientii din grupul 2, pacientii cu postsarcina globa-
la crescuta au prezentat o complianta arteriala scazuta
(p<0,001), o severitate mai mare a SA (p<0,001), vo-
lume, masa si fractie de ejectie VS similare (p>0,10).
Rotatia apicala si bazala si torsiunea VS, ca si ratele
maxime de derotatie apicala, bazala si detorsiune au
fost similare (p>0,10 pentru toate). Derotatia apicala si
Suplimentul A, 2010
II
Results: Tere were no signifcant diferences regar-
ding age, gender, body surface area, and NYHA class
between groups (p>0.20 for all). When compared to pts
with low global aferload, pts with increased LV afer-
load had lower systemic arterial compliance (p<0.001)
more severe AS (p<0.001), similar LV volumes, inde-
xed LV mass and LVEF (p>0.10 for all). Peak apical and
basal rotation and LV torsion, as well as peak apical and
basal backrotation rates and LV untwisting rate were
similar between groups (p>0.10 for all). However, time
to peak apical and basal backrotation rates and time to
peak LV untwisting rate were higher in group 1 than
in group 2 (p<0.02 for all). Overall, time to peak apical
backrotation and time to peak LV untwisting were cor-
related to E/E ratio.
Conclusions: In severe AS, LV untwisting is signif-
cantly delayed in pts with increased global LV afer-
load, when compared to those with low global afer-
load, despite similar LV dimensions, ejection fraction
and torsion. Tese results suggest that increased global
LV aferload might impair LV untwisting and contribu-
te to increased LV flling pressures in this setting.
69. Evaluarea torsiunii
ventriculului stang la pacientii
cu insuficienta aortica prin
ecocardiografie
speckle-tracking
Roxana Enache, Rita Piazza, A.Roman-Pognuz,
Denisa Muraru, B.A.Popescu, Calin Andreea, Carmen
Beladan, G.L.Nicolosi, Carmen Ginghina
Bucuresti
Torsiunea ventriculului stang (VStor) este un parame-
tru de functie ventriculara stanga (VS), cu rol impor-
tant in ejectia, dar si umplerea VS. Studii anterioare au
demonstrat modifcari ale VStor in diferite conditii de
supraincarcare VS. Nu exista date referitoare la VStor la
pacientii cu insufcienta aortica (IA) cronica.
Obiectiv: Evaluarea VStor prin ecocardiografe
speckle-tracking (STE) la pacienti cu IA cronica, com-
parativ cu subiectii normali.
Metode: Am inrolat prospectiv 28 pacienti cu IA cro-
nica moderat-severa si severa si 20 subiecti normali.
bazala, ca si detorsiunea maxima au fost insa intarziate
semnifcativ la pacientii cu postsarcina globala crescu-
ta fata de grupul 2 (p<0,02).La nivelul intregului lot,
intervalele de timp pana la derotatia apicala maxima
si pana la detorsiunea maxima s-au corelat cu raportul
E/E.
Concluzii: La pacientii cu SA detorsiunea VS este in-
tarziata la pacientii cu postsarcina globala VS crescuta
comparativ cu pacientii cu postsarcina mai scazuta, in
ciuda dimensiunilor, fractiei de ejectie si torsiunii VS
similare. Aceste date sugereaza ca o postsarcina globala
crescuta poate afecta detorsiunea VS si poate contribui
la cresterea presiunilor de umplere.
The impact of increased global
left ventricular afterload on
left ventricular torsion and
untwisting in patients with
severe aortic stenosis
Background. In patients (pts) with aortic stenosis
(AS) lef ventricular (LV) global aferload is refected
by combined valvular and arterial resistance to LV
ejection, which may be assessed by the valvuloarterial
impedance (Zva). Te role of LV torsion/untwisting as
important components of LV function was previously
emphasized, but the impact of Zva on LV torsional de-
formation has not been studied so far in pts with AS.
Objective: We sought to assess the impact of increased
Zva on LV torsional dynamics in pts with severe AS and
preserved LV ejection fraction (EF).
Methods: We prospectively examined LV torsional
deformation by 2D speckle tracking echocardiogra-
phy (STE) in 71 pts (678 yrs, 45 men) with severe AS
(indexed aortic valve area 0.6 cm2/m2, 0.180.59
cm2/m2) and LVEF >50%. Tirty-eight pts had incre-
ased global LV aferload (Zva 4.5 mmHgmL-1m2)
(group 1) and 33 pts had low global aferload (Zva<4.5
mmHgmL-1m2) (group 2). Basal and apical LV rota-
tion and LV torsion were assessed using a dedicated 2D
strain sofware. Untwisting was assessed by measuring
peak apical and basal backrotation rates and peak LV
untwisting rate as well as the time intervals from peak
R wave (ECG) to each of them, normalized to the RR
interval.
Suplimentul A, 2010
I8
Criteriile de excludere pentru pacientii cu IA au fost
fractia de ejectie a VS (FEVS) 50%, leziunile corona-
riene semnifcative, insufcienta mitrala moderata sau
severa, absenta ritmului sinusal. Rotatia si rata rotatiei
au fost masurate prin STE din sectiunile parasternal ax
scurt la baza si apexul VS, utilizand un sofware dedicat
(2D strain, EchoPac). VStor a fost defnita ca diferenta
maxima dintre unghiurile de rotatie a apexului si bazei
VS si a fost raportata la diametrul longitudinal teledias-
tolic al VS, masurat in sectiunea apical 4 camere (VStor
normalizata).
Rezultate: Nu au existat diferente in privinta var-
stei si sexului in grupul cu IA si in grupul control, iar
FEVS medie a fost similara (58,511,4% vs 62,02,8%,
p=0,181). Pacientii din grupul IA au avut diametre si
volume VS, masa VS indexata si grosimea parietala VS
mai mari (toate p<0,01). Torsiunea VS a fost redusa in
grupul IA comparativ cu grupul control (13,86,4 vs
23,36,1, p<0,001). In grupul IA, VStor normalizata
a fost semnifcativ mai mica (1,50,7/cm vs 2,90,8/
cm, p<0,001), precum si velocitatea maxima de torsiu-
ne (85,233,3 vs 131,529,6/s, p<0,001). Rotatia api-
cala maxima a fost semnfcativ mai redusa in grupul
IA (10,85,7 vs 18,46,3, p<0,001); rotatia bazala
maxima a fost similara in cele 2 grupuri (-4,13,3 vs
-5,62,6, p=0,092). Intervalele de timp pana la VStor si
velocitatea maxima de torsiune au fost similare in cele 2
grupuri. La pacientii cu IA, VStor s-a corelat semnifca-
tiv cu rotatia apicala maxima (r=0,87, p<0,001), insa nu
s-a corelat cu rotatia bazala maxima (r=-0,30, p=0,124).
Concluzii: Vstor este redusa la pacientii cu IA semni-
fcativa si FEVS normala, din cauza unei rotatii apicale
semnifcativ scazute. Ramane de stabilit rolul potential
al acestor parametri pentru monitorizarea pacientilor
cu IA.
Left ventricular torsion
in patients with aortic
regurgitation. a
speckle-tracking
echocardiography study
Lef ventricular torsion (LVtor) is a parameter of lef
ventricular (LV) function, important in both LV ejecti-
on and flling. Previous studies have shown an abnor-
mal LVtor in various conditions where LV load is al-
tered. Data regarding LVtor in patients with chronic
aortic regurgitation (AR) are lacking.
Purpose: To assess LVtor by speckle-tracking echocar-
diography (STE) in patients with chronic AR as com-
pared with normal subjects.
Methods: We prospectively studied 28 patients with
moderate-severe and severe chronic AR and 20 normal
subjects. Exclusion criteria for patients with AR were
LV ejection fraction (LVEF) 50%, signifcant coro-
nary artery disease, more than mild associated mitral
regurgitation, non-sinus rhythm. Rotation and rotati-
on rate were measured from two-dimensional greysca-
le LV parasternal basal and apical short-axis images by
STE using dedicated sofware (2D strain, EchoPac). LV
twist was defned as the net diference in clockwise and
counterclockwise rotation of LV apex and base. LVtor
was calculated as the LV twist normalized to LV end-
diastolic longitudinal length (measured in the apical
4-chamber view).
Results: Patients in the AR group and control group
were similar in age and gender, and had similar mean
LVEF (58.511.4% in AR group vs 62.02.8% in con-
trol group, p=0.181). Patients in the AR group had
higher LV diameters and volumes, LV mass and wall
thickness (all p<0.01). LV twist was reduced in the AR
group compared with the control group (13.86.4 vs
23.36.1, p<0.001). Also, LVtor was signifcantly lower
in the AR group (1.50.7/cm vs 2.90.8/cm, p<0.001),
as well as peak systolic torsional velocity (85.233.3 vs
131.529.6/s, p<0.001). Peak apical rotation was signi-
fcantly lower in the AR group (10.85.7 vs 18.46.3,
p<0.001), while peak basal rotation was similar in both
groups (-4.13.3 vs -5.62.6, p=0.092). Time inter-
vals to LVtor and peak systolic torsional velocity were
similar in both groups. In patients with AR, LVtor cor-
related signifcantly with peak apical rotation (r=0.87,
p<0.001), but not with peak basal rotation (r=-0.30,
p=0.124).
Conclusions: LVtor, as assessed by STE, is reduced in
patients with signifcant AR and normal LVEF, and this
is due to a signifcantly decreased apical rotation. Te
possible role of using these parameters to monitor pati-
ents with AR remains to be tested.
Suplimentul A, 2010
I9
Concluzie: Adaptarea cardiaca materna in cursul in-
terventiei fetoscopice este caracterizata prin cresterea
contractilitatii in paralel cu scaderea postsarcinii, mo-
difcari ce se remit in cursul zilelor urmatoare. Supra-
solicitarea importanta de volum asociata interventiei
impune o monitorizare riguroasa a bilantului hidric
perioperator.
How does treatment of a
twin-to-twin transfusion
syndrome affect maternal
cardiac function?
Background: Twin-to-twin transfusion syndrome
(TTTS) is a rare but serious complication of mono-
chorionic multiple gestations requiring fetoscopic la-
ser photocoagulation of the anastomosing placental
vessels. Perioperative re-absorption of the polyhydram-
nios causes severe subacute maternal volume overload.
Tis study aimed at characterizing the adaptation of
maternal LV function to TTTS treatment.
Methods: Conventional echocardiography and tissue
Doppler imaging were performed before, 6 hours af-
ter fetoscopic surgery (OP) and at discharge (48 hours
afer OP) in 12 TTTS cases (mean gestational age 21
weeks) and in 20 gestational age-matched normal preg-
nancies. LV end-systolic and -diastolic volume (LVESV,
LVEDV), stroke volume (SV), total vascular resistan-
ce (TVR) as well as average systolic lef ventricle (LV)
longitudinal strain /~rate (S, SR) were determined. He-
matocrit changes served as indicator of intravascular
volume (IVV) expansion.
Results: Compared to normal pregnancies, TTTS pati-
ents had higher cardiac output (CO) and higher heart
rate (HR) (6.21l/min vs 5.21, respectively 8510 bpm
vs 7310, p<0.05) but comparable TVR, SV, S and SR
before the OP (S -21.43% vs -19.42.2%, SR -1.20.1
vs -1.20.1, p > 0.05). Immediately afer the interven-
tion, SV (7313ml vs 8911, p<0.01) and CO (8.71l/
min vs 6.21l/min, p<0.01) as well as S and SR incre-
ased (-243.6% vs -21.43, p<0.01 for S and -1.60.2
vs -1.20.1s-1 for SR), refecting elevated contractility
and reduced TVR (716186 vs 1092191 dyne*s/cm5,
p<0.01). At 48 hours HR and CO remained mildly
elevated, concordant with the now increased IVV (Ht
362% vs 302% before OP) while other hemodyna-
70. Functia cardiaca materna
si tratamentul sindromului de
transfuzie feto-fetala
Oana Savu, M.T.Van, P.DeKoninck, L.Gucciardo,
Ruxandra Jurcut, S.Giusca, B.A.Popescu, J.Deprest,
Carmen Ginghina, J.U.Voigt
Dr. C.C. Iliescu, Bucuresti
Rezumat: Sindromul de transfuzie feto-fetala (TTTS)
este o complicatie severa a sarcinilor multiple monoco-
rionice ce necesita interventie chirurgicala fetoscopica
cu fotocoagulare laser a anastomozelor placentare. Pe-
rioperator resorbtia lichidului amniotic in exces poate
determina suprasolicitare acuta de volum a cordului
matern.
Obiectivul acestui studiu a fost evaluarea adaptarii cor-
dului matern in cursul tratamentul TTTS.
Metode: Studiul a inclus 12 paciente cu TTTS (varsta
gestationala medie 21 saptamani) si 20 de femei insarci-
nate cu varsta gestationala similara. S-au efectuat studii
ecocardiografce parametri conventionali 2D si ima-
gistica de deformare prin Doppler miocardic (DMI)
inainte, la 6 ore si respectiv 48 de ore postoperator pen-
tru grupul cu TTTS si la includere pentru grupul mar-
tor. Au fost determinate volumele ventriculului stang
(VTDVS, VTSVS), volumul-bataie (VB), rezistenta
vasculara periferica totala (RVT), deformarea sistolica
longitudinala globala a VS (S) si rata deformarii (SR).
Valoarea hematocritului in dinamica a fost folosita ca
indicator al modifcarii volumului intravascular.
Rezultate: Pacientele cu TTTS au avut in momentul
includerii valori mai mari ale debitului cardiac (DC)
si alurii ventriculare fata de martor (6.21l/min vs
5.21, respectiv 8510 bpm vs 7310, p<0.05), dar
valori comparabile ale RVT, VB si parametrilor de de-
formare miocardica (S -21.43% vs -19.42.2%, SR
-1.20.1 vs -1.20.1, p > 0.05). Imediat postoperator
VB (7313ml vs 8911, p<0.01) si DC (8.71l/min vs
6.21l/min, p<0.01) au crescut, in paralel cu scade-
rea RVT (716186 vs 1092191 dyne*s/cm5, p<0.01)
si cresterea valorilor S si SR (-243.6% vs -21.43,
p<0.01, respectiv -1.60.2 vs -1.20.1s-1). La 48 de ore
postoperator DC (6.71l/min) si AV (917) au ramas
usor ridicate, in concordanta cu volumul intravascular
crescut (Ht 362% vs 302% preoperator), in timp ce
ceilalti parametri hemodinamici au revenit la valoarea
de baza.
Suplimentul A, 2010
80
n=74 SM (-) n=116 p Mean Std.Dev. Mean Std.Dev.
Rotatia bazala max() -4.96 1.95 -4.71 1.83 ns Rotatia
apicala max() 12.67 2.49 7.68 2.15 <0.001 Rasucirea
(twist) VS() 15.31 2.93 10.94 2.32 <0.001 Torsiunea
VS (/cm) 2.88 0.76 1.07 0.41 <0.001 EDV/BSA(ml/
m2) 59.55 12.56 54.83 10.93 0.007 EDV/BSA(ml/
m2) 23.33 6.81 20.814 6.44 0.011 LVIDd/BSA(mm/
m2) 23.87 2.27 25.49 2.49 <0.001 LVIDs/BSA(mm/
m2) 16.90 2.49 17.64 2.24 0.037 LVLAd/BSA(mm/m2)
51.22 10.97 48.92 10.67 0.036 LVLAs/BSA(mm/m2)
40.91 10.63 38.87 11.09 0.049 (EDV=volum teledias-
tolic, ESV=volum telesistolic, LVIDd/s=dim. ax scurt
VS sistola/diastola, LVLAd/s dim. ax lung VS sistola/
diastola, BSA=aria SC).
Concluzii: Lucrarea noastra demonstreaza ca sindro-
mul metabolic induce o remodelare complexa structu-
rala si functionala la nivelul ventriculului stang, modi-
fcarea geometriei find corelata cu cea a functiei sisto-
lice de torsiune.
Left ventricular structural
and functional remodeling in
metabolic syndrome
Purpose: To explore the remodeling of lef ventricle in
apparently healthy individuals with metabolic syndro-
me (MS) documented according to IDF 2005 criteria,
by investigating the functional and structural adaptati-
on assessed by a comprehensive ultrasound exam: 3D
real time echocardiography, 2D speckle tracking and
conventional echocardiography.
Methods: In a primary prevention program we regis-
tered 74 persons with metabolic syndrome (MS+) and
compared them with controls (n=116). We recorded
risk factors and ultrasound data: by 3DRT echo- LV
volumes (EDV/ESV) and long axis systolic/diastolic di-
mensions (LVLAd/LVLAs), by 2D speckle tracking- LV
peak basal and apical rotation, instantaneous LV peak
systolic twist (maximal value of net diference betwe-
en instantaneous apical LV systolic rotation and basal
LV systolic rotation), LV torsion (LV twist divided by
LVLAd).
Results: MS is associated with increased peak apical
rotation, twist and torsion and geometric transformati-
on: increased LV mass and volumes with modifcation
of sphericity index: reduced LVIDd and LVIDs indexed
to BSA, increase of indexed LVLAd and LVLAs (Table
mic parameters returned to baseline.
Conclusion: Te response of maternal heart to feto-
scopic surgery for TTTS is characterized by an acutely
increased contractile state combined with reduced af-
terload, which normalizes in the following days. Due to
the important postoperative volume load, a careful pe-
rioperative volume management is crucial under these
circumstances.
71. Remodelarea structurala
si functionala a ventriculului
stang in sindromul metabolic
S.I.Dumitrescu, I.Tintoiu,V.Greere, G.Cristian, Pinte
Florina, L.Chiriac, G.Neagoe, Bica Ramona, S.Stanciu,
V.A.Voicu, Andreea Teodorescu
Armatei, Bucuresti
Scop: Am urmarit remodelarea structurala si functio-
nala a ventriculului stang prin ecocardiografe 3DRT,
2D speckle tracking si ecocardiografe standard la in-
divizii aparent sanatosi diagnosticati cu sindrom meta-
bolic conform criteriilor IDF 2005.
Metode: In cadrul unui program de preventie primara
cardiovasculara am inregistrat 74 de subiecti in grupul
de persoane cu sindrom metabolic SM(+) si le-am
comparat cu un grup de control de 116 persoane
SM(). Am colectat datele referitoare la factorii de risc,
datele ecocardiografce clasice, iar prin ecocardiografe
3DRT volumele si dimensiunile end-sistolice/diasto-
lice ale VS si prin 2D speckle tracking rotatia maxima
apicala si bazala a VS, rasucirea (twist) instantanee
maxima (valoarea maxima a diferentei dintre rotatia
sistolica instantanee apicala si cea bazala) si torsiunea
VS (rasucirea/axul lung al VS).
Rezultate: Sindromul metabolic se asociaza cu cres-
terea rotatiei sistolice apicale, a rasucirii si a torsiunii
VS si cu modfcari structurale si geometrice: cresterea
masei si volumelor VS cu remodelare concentrica si
modifcare indicelui de sfericitate: reducerea dimensi-
unii axului scurt si cresterea axului lung (indexate la
suprafata corporala) (Tabel 1). Analiza corelatiei din-
tre afectarile subclinice si factorii de risc a indicat ca
acestea sunt generate in principal de valorile crescute
ale presiunii arteriale si ale presiunii pulsului. SM(+)
Suplimentul A, 2010
81
1). According to the analysis of subclinical alterations
and risk factors, the widespread subclinical disease is
triggered mainly by increased blood pressure and pulse
pressure. SM (+) n=74 SM (-) n=116 p Mean Std.Dev.
Mean Std. Dev. Peak basal rot()-4.96 1.95 -4.71 1.83 ns
Peak apical rot()12.67 2.49 7.68 2.15 <0.001 LV twist
max 15.31 2.93 10.94 2.32 <0.001 LV torsion(/cm)2.88
0.76 1.07 0.41 <0.001 EDV/BSA(ml/m2) 59.55 12.56
54.83 10.93 0.007 EDV/BSA(ml/m2) 23.33 6.81 20.814
6.44 0.011 LVIDd/BSA(mm/m2)23.87 2.27 25.49 2.49
<0.001 LVIDs/BSA(mm/m2)16.90 2.49 17.64 2.24
0.037 LVLAd/BSA(mm/m2)51.22 10.97 48.92 10.67
0.036 LVLAs/BSA(mm/m2)40.91 10.63 38.87 11.09
0.049.
Conclusions: Te burden of metabolic syndromes in-
duces complex structural and functional remodeling of
the lef ventricle, the shape modifcation being correla-
ted with increased systolic torsion.
Concluzii: TRC cu fuziune optima la pacientii cu po-

zitie concordanta a sondei de VS produce o resincroni-
zare a VS superioara si un raspuns hemodinamic acut
mai bun decat pacing-ul standard atrio-biventricular.
Cardiac resynchronization
with fusion produce a better
LV resynchronization and LV
systolic function vs
atrio-biventricular pacing
an acute study
Background: Recent data showed that CRT with opti-
mal fusion produce a better acute haemodinamic res-
ponse and superior LV reverse remodeling.
Purpose: to explore the mechanisms of this superior
response.
Methods: Speckle tracking radial strain was performed
before and one week afer implantation of a biventri-
cular pace-maker in 20 CHF patients (LBBB, sinus
rhythm, 9 ischemic etiology, 6110 years, 9 women,
baseline NYHA class 3.20.4, baseline LV ejection frac-
tion 215%, baseline LV ESV 18080 ml) with concor-
dant LV lead position (LV segment with the latest peak
strain concordant with LV lead position in LAO X-ray
projection). Measurements at one week were done with
the CRT device programmed consecutively to pace with
optimal fusion (OPT) and atrio-biventricular (AbiV,
VV=0 ms, with shortest AV interval that not truncate A
wave). Mechanical intraventricular dyssynchrony was
assessed as the time diference between peak strain of
the earliest and latest LV segments from the 6 regional
colorcoded time-strain curves. LV systolic performan-
ce was evaluated by dp/dt on the regurgitant fow at mi-
tral valve and or aortic VTI.
Results: CRT with fusion produced a superior acute
haemodinamic response: LV dp/dt 759209 mmHg/s
in OPT vs 721204 mmHg/s in AbiV (p<0.05); aortic
VTI 273 cm in OPT vs 25.53 cm in AbiV (p<0.02).
Tis was associated with superior reduction in intraven-
72. Resincronizarea cardiaca
cu fuziune produce o
resincronizare si o functie
sistolica a VS mai buna
comparativ cu stimularea
atrio-biventriculara un
studiu acut
R.G.Vatasescu, Alexandra Vasile, C.N.Iorgulescu,
Cristina Ioana Caldararu, Dana Constantinescu,
Maria Dorobantu
Premize: datele recente au aratat ca resincronizarea cu
fuziune produce un raspuns hemodinamic superior in
acut si o revers remodelare a VS mai buna.
Scop: explorarea mecanismelor acestui raspuns supe-
rior.
Metode: strain-ul radial in speckle tracking a fost
efectuat ianinte si la o saptamana dupa implantarea
unui stimulator biventricular la 20 de pacienti cu ICC
(BRS, ritm sinusal, 9 ischemici, 6110ani, 9 femei, cla-
sa NYHA bazal 3.20.4, FEVS bazal 215%, VTS VS
bazal 18080 ml), cu pozitie concordanta a sondei de
VS (segmentul VS cu cel mai tardiv peak de contractie
concordant cu pozitia sondei de VS in proiectie radi-
ologica OAS). Masuratorile s-au facut la o saptamana
cu dipozitivul de TRC programat consecutiv pentru a
stimula cu fuziune optima (OPT) si atrio-biventricular
(AbiV, VV=0ms, cu cel mai scurt interval AV care nu
truncheaza unda A). Disincronia mecanica intraventri-
culara a fost determinata prin diferenta intre peak-ul
de contractie al primului si al celui mai tardiv segment
dintre 6 curbe time-strain regionale. Performanta sis-
tolica a VS a fost evaluata prin dP/dT la fuxul regurgi-
tant mitral si/sau VTI aortic.
Rezultate: CRT cu fuziune a produs un raspuns hemo-
dinamic superior in acut: dp/dt VS 759209 mmHg/s
in OPT vs 721204 mmHg/s in AbiV (p<0.05); VTI
aortic 273 cm in OPT vs 25.53 cm in AbiV (p<0.02).
Aceasta s-a asociat cu o ameliorare superioara a disin-
croniei intraventriculare: 8354 ms in OPT vs. 196106
ms in AbiV (p<0.005).
ARI TMI I | ARRHYTMI AS
Suplimentul A, 2010
ARI TMI I
ARRHYTMI AS
tricular dyssynchrony: 8354 ms in OPT vs. 196106
ms with AbiV (p<0.005).
Conclusion: CRT with optimal fusion in patients with
concordant LV lead position produces a superior LV
resynchronization and a better acute haemodinamical
response than standard atrio-biventricular pacing.
73. Remodelarea structurala
a atriului stang in relatie cu
venele pulmonare superioare in
fibrilatia atriala
Mariana Floria, Blommaert Dominique, J.Jamart,
F.Dormal, M.Lacrosse, L.De Roy, Catalina Arsenescu
Georgescu
Spitalul Universitar Sf Spiridon , Iasi
Scop: Evaluarea remodelarii structurale a atriului stang
(AS) in relatie cu evolutia jonctiunii cu venele pulmo-
nare superioare (VPS) la pacientii cu fbrilatie atriala
(FA).
Metoda: Am masurat volumul AS cu formula elipso-
idului prin 2 metode imagistice diferite, ecocardio-
grafe (EEL) si tomografe computerizata (CTEL1 and
CTEL2) la 40 de pacienti inainte si dupa ablatia FA. Cele
2 diametre ortogonale pentru CTEL1 s-au masurat pe
aria cu suprafata cea mai mare a AS (metoda standard)
iar pentru CTEL2 pe prima sectiune transversala de
la nivelul VPS. Coefcientii de corelatie s-au comparat
utilizand testul Z cu transformarea Fisher.
Rezultate: Cea mai mare arie a AS a fost, la 57 din cele
80 de masuratori (71%), la nivelul VPS. Indiferent de
metoda, atat masuratorile prin CTEL1 cat si CTEL2
au fost semnifcativ statistic corelate cu EEL (p<0.001).
Inainte de ablatie coefcientii de corelatie dintre EEL si
CTEL2 (r2=0.915) au fost mai puternici decat cei din-
tre EEL and CTEL1 (r1=0.769) (p<0.001). La 3 luni
dupa ablatie am gasit aproximativ aceiasi coefcienti de
corelatie (r2=0.917 si r1=0.757; p<0.001). Atat r1 cat si
r2 au fost semnifcativ mai puternici pentru corelatia
CTEL1 si CTEL2 (p=0.016 si p=0.010).
Concluzie: Remodelarea structurala a atriului stang se
asociaza in multe cazuri cu remodelarea venelor pul-
monare superioare la pacientii supusi ablatiei fbrilatiei
atriale. Aceasta noua metoda de evaluare a volumului
atriului stang prin metoda dimensiunilor in biplan a
elipsoidulului (CTEL2) este adecvata si permite apreci-
erea mai rapida a remodelarii structurale la acest grup
de pacienti.
Left atrium structural
remodeling in relation with
superior pulmonary veins in
atrial fibrillation
Purpose: We aimed to assess lef atrium (LA) struc-
tural remodeling in relation with superior pulmonary
veins (SPV)-atrium junction alteration in patients with
atrial fbrillation (AF).
Methods: We measured LA volume with the ellipso-
id biplane dimensions length formula using two dife-
rent imaging methods, conventional echocardiography
(EEL) and computer tomography (CTEL1 and CTEL2)
in 40 consecutive patients before and afer AF ablati-
on. For CTEL1 measurements of the orthogonal di-
mensions were taken on the largest LA area (standard
method) and for CTEL2 on the SPV axial view area.
Te correlation coef cients were compared by Z test
with Fisher inverse tank transformation.
Results: Te largest LA area evaluated on CT was
found in 57 out of 80 measurements (71%) at SPV level.
Regardless of the methodology, each measure of LA
volume by computer tomography (CTEL1 and CTEL2)
was signifcantly correlated with EEL (p<0.001). Be-
fore ablation the correlation coef cient between EEL
and CTEL2 (r2=0.915) was stronger than the correla-
tion coef cient between EEL and CTEL1 (r1 = 0.769)
(p<0.001). At 3 months afer ablation we found ne-
arly the same correlation coef cients (r2=0.917 and
r1=0.757; p<0.001). Both r1 and r2 have been signi-
fcantly stronger for the correlation with CTEL1 and
CTEL2 (p = 0.016 and p=0.010).
Conclusion: Lef atrium structural remodeling is asso-
ciated in many cases with superior pulmonary veins
antrum remodeling in patients undergoing atrial f-
brillation ablation. Tis new technique evaluation of
the lef atrium volume is accurate and could aford a
less time consuming method of the lef atrium struc-
tural remodeling assessment in this particularly group
of patients.
ARI TMI I
ARRHYTMI AS
Suplimentul A, 2010
74. Exista remodelare

electrofiziologica in sindromul
de apnee obstructiva in somn?
Mihaela Grecu, D.Nastasa, Camelia Sorea, Daniela
Boisteanu, Catalina Arsenescu Georgescu
Institutul de Boli Cardiovasculare, Iasi
Obiectiv: Evaluarea proprietatilor electrofziologice
a miocardului atrial la pacientii cu sindrom de apnee
de somn obstructiva (OSAS) si futter atrial paroxistic
idiopatic (FAP). Ipoteza noastra a fost ca OSAS ar pu-
tea induce remodelare electrofyiologica la pacientii cu
FAP.
Metoda: 42 pacienti cu FAP idiopatic supusi procedu-
rii de ablatie prin radiofrecventa a istmului cavotricus-
pid au fost evaluati ulterior prin chestionar Berlin si
polisomnografe ambulatorie. 28 pacienti fara OSAS au
fost inclusi in grupul A, ca grup de control, in timp ce
grupul B a inclus 14 pacienti cu OSAS, valoarea medie
a indicelui de apnee-hipopnee 28 13, valoarea medie
a saturatiei de oxigen nocturne 93 3%. La sfarsitul
procedurii de ablatie a istmului cavotricuspidian s-au
calculat la toti pacientii din lotul studiat perioada re-
fractara atriala (PRA), timpul de conducere interatrial
(TC interA) si timpul de conducere intraatrial (TC in-
traA).
Rezultate: Cele doua grupuri au fost omogene din
punct de vedere al varstei (59 9 vs 57 11 ani, p>
0,05), sex (barbati 92% fata de 100%, p = 0.577) si dia-
metrul anteroposterior al atriului stang (44 6mm vs
42 6 mm, p> 0,05). Un s-au gasit diferente statistic
semnifcative ale caracteristicilor electrofziologice in-
tre grupul cu OSAS si grupul fara OSAS: PRA (169.5
50.7ms, fata de 171.7 52.3ms p> 0,05), TC intraA
(55,3 21.7ms vs 51.7 16.9ms p> 0,05 ) si TC InterA
(99.4 17.7ms vs 88.9 32.7 p> 0,05). Printre parame-
trii clinici testati, indexul de masa corporala, perime-
trul abdominal si perimetrul gatului au fost semnifca-
tiv mai mari in grupul B comparativ cu pacientii din
grupul A: IMC (32.73.69 vs. 29.83.5 p=0.02), peri-
metrul abdominal (121.6 12.3cm vs. 110.5 8.4cm,
p <0,05) respectiv perimetrul gatului (44.9 2.4cm vs.
42.2 2,5 cm, p <0,01).
Concluzii: OSAS nu este asociat cu remodelare meca-
nica sau electrofziologica la pacienti cu debut recent
de futter atrial paroxistic idiopatic; unele caracteristici
clinice, cum ar f obezitatea, perimetrul abdominal sau
al gatului par sa se coreleaza semnifcativ cu dezvolta-
rea ulterioara a FAP la acesti pacienti.
Is there any
electrophysiological
remodeling in obstructive sleep
apnea?
Objective: To assess the electrophysiological (EP) re-
modeling in patients with obstructive sleep apnea
syndrome (OSAS) and idiopathic paroxysmal atrial
futter (PAF). Our hypothesis was that OSAS might in-
duce EP remodeling in patients with PAF.
Method: 42 patients with idiopathic PAF underwent
radiofrequency catheter ablation of cavotricuspid isth-
mus; all patients were further screened for OSAS using
Berlin questionnaire and ambulatory sleep polygra-
phy. 28 patients without OSAS were assigned to Group
A, whereas Group B counted 14 patients with OSAS,
mean apnea-hypopnea index 2813, mean nocturnal
oxigen saturation 933%. During the EP study the atri-
al refractory period (ARP), the interatrial conduction
time (inter ACT) and the intraatrial conduction time
(intra ACT) were measured in all patients.
Results: Te two groups were similar with regard to
age (599 vs. 5711 years, p>0.05), gender (men 92%
vs. 100%, p=0.577) and anteroposterior diameter of
lef atrium (446mm vs. 426mm, p>0.05). We found
no statistically signifcant diferences in EP charac-
teristics between OSAS and non-OSAS groups: ARP
(169.550.7ms vs. 171.752.3ms p>0.05), intra ACT
(55.321.7ms vs. 51.716.9ms p>0.05) and inter ACT
(99.417.7ms vs. 88.932.7 p>0.05). Among clinical
parameters tested, body mass index (BMI), abdomi-
nal and neck perimeters were signifcantly larger in
group B when compared with patients in group A BMI
29.83.5 vs. 32.73.69 p=0.02, abdominal diameter
121.612.3cm vs. 110.58.4cm, p<0.05, and neck dia-
meter 44.92.4cm vs. 42.22.5cm, p<0.01.
Conclusions: OSAS is not associated with EP or
mechanical remodeling in patients with new onset
PAF; some clinical features such as obesity, abdominal
or neck perimeter seem to signifcantly correlate with
later development of PAF in these patients.
Suplimentul A, 2010
ARI TMI I
ARRHYTMI AS
Tachyarrhythmias in
professional athletes typical
and atypical
Background Te evaluation of professional atheletes is
sometimes dif cult, because of atypical presentation of
arrhythmias and low addressability, for fear of exclusi-
on from the team.
Method: From november 1998 to july 2010 there were
165 professional athletes admitted in Timisoara In-
stitute of Cardiovascular Disease, with the following
arrhythmias: 1. patent WPW syndrome 88 patients
(53,3%); 2. phase 4 block intermitent WPW syndro-
me 3 patients (1,81%); 3. benign intermitent WPW
syndrome evolving over time to malignant WPW
syndrome 3 patients (1,81%); 4. concealed accessory
pathways 28 patients (16,96%): - with declared ta-
chycardia 16 patients (9,69%); - without declared ta-
chycardia 12 patients (7,27%). 5. intranodal tachycar-
dias 29 pacienti (17,57%); 6. ventricular tachycardias
8 patients (4,84%); 7. ventricular extrasystoles 4
patients (2,42%); 8. lone atrial fbrillation 2 patients
(1,21%). All patients were submitted to electrophysio-
logical study and 163 of them were treated by means of
radiofrequency ablation.
Conclusions: 1. During maximal efort, ventricular or
supraventricular tachyarrhythmias can degenerate into
ventricular fbrillation and cardiac arrest and need to
be treated by radiofrequency ablation in order to pur-
sue with professional sport activity. 2. Atypical and still
undeclared cases represent a source of major accidents
during sport competitions. For this reason, any suspici-
on of tachyarrhythmia in athletes requires electrophy-
siological evaluation.
75. Tipic si atipic in
tahiaritmiile la sportivii de
performanta
G.Ivanica, Eugenia Venescu, Lavinia Albisoru,
A.Gheorghiu, Alina Negru, A.Ivanica, C.T.Luca,
S.Pescariu, St.I.Dragulescu
Premise: Evaluarea sportivului de performanta este
uneori difcila datorita exprimarii atipice a aritmiilor,
precum si datorita neadresabilitatii acestora de teama
excuderii din lot.
Material si metoda: In Institutul de Cardiologie Timi-
soara s-au internat in perioada noiembrie 1998 iulie
2010 un numar de 165 de pacienti sportivi de perfor-
manta cu urmatoarele aritmii: 1. sindrom WPW patent
88 pacienti (53,3%); 2. sindrom WPW intermitent cu
blocaj in faza 4 3 pacienti (1,81%); 3. sindrom WPW
intermitent benign cu evolutie in timp spre WPW ma-
lign 3 pacienti (1,81%); 4. cai accesorii ascunse 28
pacienti (16,96%): - cu declararea tahicardiei 16 pa-
cienti (9,69%); - fara declararea tahicardiei 12 pa-
cienti (7,27%). 5. tahicardii intranodale 29 pacienti
(17,57%); 6. tahicardii ventriculare 8 pacienti (4,84%);
7. extrasistole ventriculare 4 pacienti (2,42%); 8. f-
brilatie atriala pe cord indemn 2 pacienti (1,21%).
Toti pacientii au fost explorati electrofziologic, iar un
numar de 163 pacienti au fost ablatati prin curent de
radiofrecventa.
Concluzii: 1. In conditiile unui efort maximal, tahiarit-
miile supraventriculare sau ventriculare pot degenera
in stop cardiac prin fbrilatie ventriculara si necesita
ablatie prin radiofrecventa ca prima conditie pentru
continuarea activitatii sportive. 2. Cazurile atipice si
nedeclarate de sportivi la examenul medical reprezinta
inca o sursa de accidente majore in timpul competitii-
lor sportive. De acceea, orice suspiciune de tahiaritmie
la sportivi trebuie investigata electrofziologic pentru
confrmare sau infrmare.
zare anterioara doar 12% au avut stenoza semnifcativa

pe unul, doua sau 3 vase coronariene. 4 pacienti au avut
stenoze nesemnifcative pe LM, 6 pe LAD, 5 pe CX si
2 pe CD. Scorul de calciu a fost 0 la 20% dintre paci-
enti, 18% au avut scor de calciu care ii incadreaza la
risc de peste 90% pentru rasa, varsta, sex; 16% cu risc
de 75-90%. Dintre toti pacientii, 5 au fost trimisi pen-
tru confrmarea leziunilor la coronografe. Cele doua
leziuni au fost confrmate la un CT coronarian ca find
fals pozitive. Restul nu au avut agiografe coronariana.
10% dintre pacienti au fost diagnosticati cu pericardita
si coronografa a fost normala.
Identification of coronary
atherosclerotic plaque by
MSTC
Purpose: We evaluated the feasibility and quality of
coronary CT imaging excluding coronary disease in
patients with low or intermediate risk according to gui-
delines, and tracking patients afer stenting or coronary
bypass with aortic angio-CT performed in Elias Hospi-
tal Prolife 2009-2010.
Methods and results: Were evaluated 50 patients wei-
ghing less than 100kg, sinus rhythm below 60 beats /
min, afer premedication with metoprolol / bisopro-
lol, age over 30 years, using a 64 slice CT sites and a
scan time between 10-12 seconds which were 80-150
ml of contrast material used per patient, with a rate of
4-5 ml / sec, the total duration of investigation is more
than 30 minutes. Data acquisition was done in diastolic
signal synchronized with ECG, R wave triggered, with
an irradiation between 1-4 mSv. Low heart rate is ne-
cessary to obtain the best image quality at CT angio.
It afects body weight and image quality. All patients
who carried coronarian CT was obtained a good image
quality. Patients who had renal failure or allergy to con-
trast dye were excluded. Of the 50 patients in two could
not perform coronary CT by inability to obtain a heart
rate below 60/min afer metoprolol / bone or bisopro-
lol, 48 patients were performed angio CT. Among pati-
ents who made all 48 angio CT images were excellent,
without any results neinterpretabile. 32 of the patients
76. Identificarea placii
aterosclerotice coronariene
prin MSTC
Simona Huidu, Andreea Popescu, L.Ghilencea, Lu-
minita Ionescu, I.Stanca, S.Barsan, M.Melnic, Laura
Arama, Smaranda Lacau, Doina Dimulescu
Scop: Am evaluat fezabilitatea si calitatea imaginilor
TC coronarian privind excluderea bolii coronariene la
pacienti cu risc mic sau intermediar, conform ghidu-
rilor, sau urmarire a pacientilor dupa stentare sau by-
pass aorto coronarian prin angio CT efectuat in Spita-
lul Elias-Prolife in anul 2009-2010.
Metode si rezultate: Au fost evaluati 50 pacienti cu
greutate sub 100kg, ritm sinusal sub 60 batai/min, dupa
premedicatie cu metoprolol/bisoprolol, varsta peste 30
ani, utilizand un sistem CT cu 64 slice-uri si un timp de
scanare intre 10-12 secunde la care s-au folosit 80-150
ml substanta de contrast/pacient, cu un debit de 4-5
ml/sec, durata totala a investigatiei find de maxim 30
min. Achizitia de date s-a facut in diastola, sincronizat
cu semnalul EKG, declansat de unda R, cu o iradiere
intre 1-4 mSv. Frecventa cardiaca scazuta e necesara
pentru obtinerea unei imagini calitative mai bune la
angio CT. Greutatea corporala infuenteaza si ea cali-
tatea imaginilor. La toti pacientii care au efectuat TC
coronarian s-a obtinut o imagine buna calitativ. Au fost
exclusi de la inceput pacientii care aveau insufcienta
renala sau alergie la substanta de contrast. Dintre cei 50
pacienti la 2 nu s-a putut efectua CT coronare prin im-
posibilitatea obtinerii unei frecvente cardiace sub 60/
min dupa metoprolol / os sau bisoprolol; 48 pacienti
au efectuat angio CT. Dintre pacientii care au efectuat
angio CT toate cele 48 imagini au fost excelente, fara
a avea rezultate neinterpretabile. 32 dintre pacienti au
fost barbati si 16 femei. 16 pacienti au avut varsta sub 55
ani. 90% din pacienti au prezentat durere precordiala.
11% aveau stent sau bypass anterior investigatiei si au
efectuat CT coronare pentru verifcarea permeabilitatii
stenturilor sau a grafurilor. Probabilitatea de restenoza
a fost mica astfel la un singur pacient s-a diagnosticat
o stenoza semnifcativa pe un alt vas decat cel stentat si
s-a indicat coronarografe. Dintre cei fara revasculari-
VARI A 1 | VARI A 1
Suplimentul A, 2010
VARI A 1
VARI A 1
were men and 16 women. 16 patients were aged less
than 55 years. 90% of patients had chest pain. 11% had
stents or bypass previous investigation and CT scan
were performed to verify the permeability of coronary
stents or grafurilor. Was little likelihood of restenosis
as one patient was diagnosed as a signifcant stenosis
in another vessel than the stent and showed corona-
rography. Of those without previous revascularization
only 12% had signifcant stenosis in one, two or three
coronary vessels. Four patients had signifcant LM ste-
nosis, 6 on LAD, CX and 5 on CD 2. Calcium score was
0-20% of patients, 18% had calcium scores who belong
to the risk of over 90% for race, age, sex, 16% risk of
75-90%. Of all patients, 5 were sent for confrmation to
coronarografy. Te two lesions were confrmed lesions
present at CT coronary stent and were to be found a fal-
se positive. Te rest did not have coronary angiography.
10% of patients have been diagnosed pericarditis and
coronary was normal.
77. Rolul Angio CT multislice
in asociere cu tehnici
interventionale complexe in
imbunatatirea rezultatelor
tratamentului interventional in
leziunile aortoiliace
I.Benedek, Oana Bucur, Monica Chitu, Claudia Matei,
I.Kovacs, P.I.A.Sarbu, Gabriela Kozma, Zsuzsanna
Suciu, Theodora Benedek
Scop: Evidentierea rolului procedurilor interventio-
nale complexe in extinderea indicatiilor tratamentului
interventional in afectiunile arteriale iliace, si a rolului
evaluarii preoperatorii prin angiografe CT 64 multisli-
ce in imbunatatirea tehnicii operatorii si a rezultatelor
tratamentului interventional.
Materiale si metoda: Au fost inclusi in studiu 144 pa-
cienti la care s-au efectuat 205 interventii la nivel aorto-
iliac. S-au implantat 102 stenturi iliace, iar in 14 cazuri
s-a asociat angioplastie laser (10 la nivelul axului iliac
si 4 cazuri de angiolastie aorto-iliaca). Leziunile au fost
incadrate in functie de clasifcarea TASC astfel: TASC
D- 29.16%, TASC C 20.84%, TASC B 28.5% si TASC
A- 21.5%. La 36 pacienti s-a efectuat preinterventional
si evaluarea complexa prin angioCT 64 slice a patului
vascular periferic.
Rezultate: Succesul tehnic inregistrat a fost de 97.71%.
Valoarea indexului Doppler s-a imbunatatit cu 51% in
grupul cu PTA comparativ cu 93% in grupul cu implan-
tare de stent iliac (p< 0,001). Asocierea preangioplastie
a evaluarii angioCt a axului arterial a dus la reducerea
timpilor opratori in medie de la 40 minute la 25 minu-
te. Permeabilitatea primara a fost de 88.34% la 24 luni,
iar permeabilitatea secundara a fost de 95.13%. Rata de
supravietuire a fost de 93% la 30 luni, iar rata de salvare
a membrului inferior la 30 luni a fost de 98.61%. Eva-
luarea complexa prin AngioCt preoperator a permis o
mai buna pregatire a strategiei interventionale ducand
la reducerea numarului cailor de abord necesare si la
evitarea complicatiile hemoragice chiar in ciuda unor
leziuni vasculare complexe (20 leziuni arotoiliace si 12
leziuni ale axului iliac bilateral).
Concluzii: Angioplastia axului iliac este sigura si efci-
enta in tratamentul stenozelor si ocluziilor de la acest
nivel, progresele tehnice din ultimii ani permitand
extinderea indicatiilor acesteia si la leziuni din cla-
sa TASC C sau D. Evaluarea preoperatorie a patului
vascular periferic prin AngioCt 64 multislice permite
evaluarea exacta a leziuniilor si calcifcarilor prezente
permitand alegerea strategiei terapeutice optime, ceea
ce duce la reducerea timpilor operatori si evitarea com-
plicatiilor. Lucrare fnantata prin grantul de cercetare
41-069/2007 LASCOR, fnantat de MEC prin CNMP.
Role of multislice angio CT
in association with complex
interventional techniques
in improving interventional
treatment results in aortoiliac
lesions
Purpose: Highlighting the role of complex interventio-
nal procedures in the interventional treatment indicati-
ons of iliac arterial disease, and the role of preoperative
evaluation by 64 multislice CT angiography in order to
improve the operating technique and the results of in-
terventional treatment.
VARI A 1
VARI A 1
Suplimentul A, 2010
Materials and methods: Tere were 144 patients in-

cluded in the study and 205 interventions at the aorto-
iliaclevel were performed. 102 stents were implanted,
and in 14 cases laser angioplasty was associated (on 10
iliac interventions and 4 aortoiliac procedures). Lesion
type was TASC D in 29.16% cases, TASC C in 20.84%
cases, TASC B in 28.5% cases and TASC A in 21.5% ca-
ses. In 36 patients complex evaluation of the peripheral
vascular bed was performed by 64 multislice angioCT.
Results: Technical success was recorded 97.71%.
Doppler index increased with 51% in PTA group, 93%
in stented group (p<0,001). Te association of preinter-
ventional AngioCt evaluation leaded to the reduction
of PTA procedure times from aan average of 40minu-
tes to 25 minutes. Primary patency was 88.34% at 24
months, and secondary patency rates were 95.13%.
Survival rate was 93% at 30 months and the limb salva-
ge rate at 30 months was 98.61%. Complex evaluation
by AngioCt allowed a better interventional strategy le-
ading to a reduction in the necessary accsess sites num-
ber and to avoid bleeding complications and even in
spite of complex vascular lesions (20 aortoiliac lesions
and 12 bilateral iliac lesions).
Conclusions: Iliac angioplasty appears to be safe and
efective in iliac stenoses or occlusions; technical pro-
gress in recent years allowed the extension of its in-
dications to complex cases (TASC C and TASC D).
Preoperative evaluation of peripheral vascular bed by
64 multislice AngioCt allowes the exact evaluation of
the lesions and calcifcations allowing the operator to
choose the optimal therapeutic strategy, avoiding the
complications andleading to a reduced intervention
time. Study fnanced within the research grant no. 41-
069/2007 LASCOR, fnanced by MEC via CNMP.
78. Rigiditatea arteriala si
disfunctia endoteliala sunt
pricipalii determinanti ai
albuminuriei la pacientii
cu diabet zaharat tip 2 si
hipertensiune arteriala
Stefania Magda, Raluca Dulgheru, Andrea Cio-
banu, Maria Florescu, Raluca Mincu, M.Cinteza,
D.Vinereanu
Spitalul Universitar de Urgenta, Bucuresti
Context: Pacientii cu diabet zaharat tip 2 si hiperten-
siune arteriala prezinta o crestere a rigiditatii arteria-
la datorata mai ales disfunctiei endoteliale. In acelasi
timp, majoritatea acestor pacienti au si micoalbuminu-
rie, datorata la randul ei disfunctiei endoteliale difuze.
Am pornit de la ipoteza ca acesti markeri de disfunctie
endoteliala subclinica sunt relationati si am analizat
puterea de corelatie precum si infuenta altor parametri
asupra acestei corelatii.
Metoda: Am evaluat 53 de pacienti (cu varsta 579 ani,
28 barbati) cu hipertensiune arteriala usoara-moderata
(TA medie la monitorizarea pe 24 ore 146/93mmHg)
si diabet zaharat tip 2 ( durata medie de la diagnostic
3.65 ani). Functia arteriala a fost evaluata prin ana-
liza e-tracking si wave intensity la nivelul arterei
carotide comune drepte. S-au masurat: indicele inti-
ma-medie (IMT), indicele beta (), modulul elastic
(Ep), viteza undei pulsului la nivelul arterei carotide
(WS) si complianta arteriala (AC). Functia endoteliala
a fost evaluata prin masurarea dilatatiei mediate de fux
(FMD) la nivelul arterei brahiale drepte. Albuminuria a
fost determinata printr-o metoda imunoturbidica.
Rezultate: IMT si parametrii de rigiditate arteriala (,
Ep, WS si AC) au avut valori situate la limita superioara
a normalului. Valorile masurate prin FMD au fost usor
mai mici decat cele considerate normale, indicand dis-
functie endoteliala usoara. Proteinuria masurata a avut
valori in limitele ce defnesc microalbuminuria (tabel).
Proteinuria s-a corelat pozitiv cu parametrii de rigidita-
te arteriala (r=0.45 pentru indicele , r=0.50 pentru Ep,
p<0.01 pentru ambele si r=0.36 pentru WS cu p<0.05).
Prin analiza multiparametrica ( folosind un model care
include varsta, durata hipertensiunii, durata diabetului,
valorile TA la monitorizarea 24 de ore, valorile HbA1c
si parametrii de functie arteriala) cei mai buni determi-
Suplimentul A, 2010
VARI A 1
VARI A 1
buminuria (table). Proteinuria correlated positively
with arterial stifness parameters (r=0.45 for , r=0.50
for Ep, both p<0.01, and r=0.36 for WS, p<0.05). By
stepwise multiple regression analysis (using a model
including age, duration of hypertension, duration of
diabetes, ABPM values, HbA1c values, and all arteri-
al function parameters), best determinants of albumi-
nuria were indices of arterial stifness (beta index and
arterial compliance) and of endothelial dysfunction
(FMD): r=0.64, r2=0.40, p=0.001.
Conclusion: Arterial stifness and endothelial dysfunc-
tion, but not duration of disease and blood pressure or
diabetes control, are the main determinants of albumi-
nuria in patients with mild to moderate hypertension
and type 2 diabetes mellitus. Tis should be considered
when new targets for preventive treatment are imple-
mented. Parameter Value IMT (mm) 0.8 0.2 Beta in-
dex 8.9 3.0 Ep (kPA) 129.3 47.2 WS (m/s) 6.7 1.2
AC (mm2/kPa) 0.7 0.3 FMD (%) 9.2 4.2 Albuminu-
ria (mg/l) 55.6 146.1
79. Hipertensiunea arteriala
pulmonara se amelioreaza
rapid dupa inlocuirea
percutana de valva aortica
C.Stoicescu Bucuresti, Nicotera Mariuca Vasa, D.Chin,
D.Vinereanu, J.Kovac
Bucuresti
Context: Pacientii care asociaza stenoza aortica seve-
ra (SA) si hipertensiune arteriala pulmonara severa
(HTP) au un prognostic rezervat. Datele din literatura
care urmaresc efectul inlocuirii percutane a valvei aorte
(TAVI) asupra HTP la acesti pacienti sunt limitate. Am
evaluat efectul pe care il are TAVI prin eliminarea gra-
dientului trans-aortic, asupra HTP, la pacientii care au
primit dispozitivul CoreValve Medtronic System TM.
Metoda: 67 pacienti consecutivi (826.2 ani, 52% fe-
mei) cu TAVI au fost divizati in doua loturi: grup I, cu
25 pacienti (37%), cu istoric de boala pulmonara cro-
nica obstructiva (COPD) si cu HTP severa (defnita
ca presiune sistolica in artera pulmonara (sPAP) >50
mmHg); grup II, cu 42 pacienti (63%), fara istoric de
COPD, divizati si ei in doua subloturi: - IIa, cu sPAP<50
nanti ai albuminuriei au fost indicii de rigiditate arteri-
ala ( si AC) si parametrii ce evalueaza functia endote-
liala (FMD): r=0.64, r2=0.40, p=0.001.
Concluzii: Rigiditatea arteriala si disfunctia endoteli-
ala, nu durata bolii si nici controlul diabetului sau al
hipertensiunii arteriale, sunt principalii determinanti
ai albuminuriei la pacientii cu hipertensiune usoara-
moderata si diabet zaharat tip 2. Parametri de rigidi-
tate arteriala si cei de evaluare a functiei endoteliale ar
trebui luati in discutie si considerati noi tinte pentru
tratamentul preventiv. Parametru Valoare IMT (mm)
0.8 0.2 Beta index 8.9 3.0 Ep (kPA) 129.3 47.2 WS
(m/s) 6.7 1.2 AC (mm2/kPa) 0.7 0.3 FMD (%) 9.2
4.2 Albuminuria (mg/l) 55.6 146.1
Arterial stiffness and
endothelial dysfunction are
the main determinants of
albuminuria in patients with
diabetes and hypertension
Background: Patients with type II diabetes and associ-
ated arterial hypertension have increased arterial stif-
ness due mainly to endothelial dysfunction. Meanwhi-
le, they usually have microalbuminuria, also as a result
of difuse endothelial dysfunction. We hypothesized
that these markers of subclinical organ damage are re-
lated and, therefore, we assessed the strength of corre-
lation and the infuence of other parameters.
Methods: We evaluated 53 patients (579 years, 28
males), with mild to moderate hypertension (mean
ABPM values: 146/93 mmHg) and type II diabetes
(mean duration of 3.65 years). Arterial function was
assessed by e-tracking and wave intensity analysis, at
the level of the RCCA, with measurements of intima-
media thickness (IMT), beta index (), elastic module
(Ep), carotid wave speed (WS), and arterial compliance
(AC). Endothelial function was assessed by fow me-
diated dilation (FMD) at the level of the right brachial
artery. Albuminuria was measured by an imunoturbi-
dic method.
Results: IMT and arterial stifness parameters (, Ep,
WS, and AC) were at the upper limit of normal. FMD
was slightly decreased, indicating mild endothelial dys-
function. Proteinuria was into the limits for microal-
VARI A 1
VARI A 1
Suplimentul A, 2010
mmHg (26 pacienti), si IIb, cu sPAP>50 mmHg (16 pa-

cienti). Echocardiografa inainte si la 30 zile de TAVI a
evaluat functia VS (prin fractia de ejectie FE), functia
VD (prin TAPSE) si dimensiunile acestora, severitatea
regurgitarii tricuspidiene (RT) secundare (aria jetului
tricuspidian TJA), si sPAP.
Rezultate: Nu au existat diferente semnifcative de
varsta, gradient valvular aortic, arie valva aorta. La 30
zile post TAVI, pacientii cu sPAP>50 mmHg au avut o
scadere semnifcativa a HTP cu imbunatatire concomi-
tenta a functiei si dimensiunilor VD (PAPs: 75.818.9
vs. 62.116.1 mm Hg, p=0.01, diametru atriu drept:
41.311.1 vs. 35.78.8 mm, p=0.04, diametru VD:
43.512.2 vs. 37.19.3 mm, p=0.035, TJA: 5.52.6 vs.
4.22 cm2, p=0.03 si TAPSE: 20.56.1 vs. 25.27.2,
p=0.05), iar pacientii cu sPAP<50 mmHg au avut doar
ameliorare a HTP (sPAP: 40.810.6 vs. 33.28.8 mm
Hg, p=0.05). Cum era de asteptat nu s-a gasit nicio
imbunatatire in termeni de cord drept pentru HTP
secundara (sPAP: 82.620.3 vs. 79.618.8 mm Hg,
p=ns). FEVS generala a crescut de la 4712 la 5310%
(p<0.01), semnifcativ in toate cele trei grupuri. Exista
o corelatie pozitiva intre cresterea FEVS si ameliorarea
HTP secundara SA (R2=0.52, p= 0.02). HTP severa si
FEVS <30% au fost predictori independenti de morta-
litate intra-spitaliceasca (R2=0.49, p= 0.03).
Concluzie: HTP secundara SA severa este des intalnita
si se amelioreaza dupa TAVI. HTP este un important
predictor pentru mortalitatea intraspitaliceasca.
Pulmonary artery hypertension
improves rapidly in patients
with severe aortic stenosis who
underwent transcatheter aortic
valve replacement
Background: Patients who associate severe aortic ste-
nosis (AS) and severe pulmonary arterial hypertension
(PAH) have a bad prognosis. Tere are poor data on the
efect of transcatheter aortic valve replacement (TAVI)
in these patients. We assessed the efects of improved
lef ventricular output on PAH in patients receiving
TAVI with the CoreValve Medtronic System TM.
Methods: 67 consecutive patients (826.2 years, 52%
female) with TAVI were divided in two groups: group I,
of 25 patients (37%), with history of chronic obstructive
pulmonary disease (COPD) and with severe secondary
PAH (defned as systolic pressure in pulmonary artery
(sPAP) >50 mmHg); group II, of 42 patients (63%),
with no history of COPD, divided in two subgroups -
IIa, with sPAP<50 mmHg (26 patients), and IIb, with
sPAP>50 mmHg (16 patients). Echocardiography be-
fore TAVI and afer 30 days assessed LV function (by
ejection fraction - LVEF), RV function (by TAPSE) and
dimensions, severity of secondary tricuspid regurgita-
tion (tricuspid jet area - TJA), and sPAP.
Results: Tere were no signifcant diferences for age,
aortic valve gradient, valve area between groups. At 30
days post TAVI, patients with sPAP>50 mmHg had a
signifcant decrease of PAH with concomitant improve-
ment of RV function and dimensions (sPAP: 75.818.9
to 62.116.1 mm Hg, p=0.01, right atrium diameter:
41.311.1 to 35.78.8 mm, p=0.04, right ventricle di-
ameter: 43.512.2 to 37.19.3 mm, p=0.035, TJA:
5.52.6 to 4.22 cm2, p=0.03 and TAPSE: 20.56.1
to 25.27.2, p=0.05), whereas patients with PAP<50
mmHg had only an improvement of PAH (sPAP:
40.810.6 to 33.28.8 mm Hg, p= 0.05). As expected,
there was no improving for patients with secondary
PAH (sPAP: 82.620.3 to 79.618.8 mm Hg, p= ns).
LVEF increased from 4712 to 5310% (p<0.01), sig-
nifcant among all three groups. Tere was a positive
correlation between the increase of LVEF and decrea-
se of PAP secondary to AS (R2=0.52, p= 0.02). Severe
PAH and ejection fraction less than 30% were an inde-
pendent predictors of in-hospital mortality (R2=0.49,
p= 0.03).
Conclusion: PAH secondary to severe AS is common
and can be expected to improve afer TAVI. PAH is an
important predictor for in-hospital mortality.
mai multe detalii despre morfologia valvei prin evalu-

area 3D, identifcand: 1)un clef P1/P2; 2) un prolaps
mai extins al foitei posterioare cu implicarea scalopului
P3 si ruptura de cordaje; 3) ruptura de cordaje; 4) un
prolaps mai extins al foitei mitrale posterioare prin im-
plicarea scalopului P1. ETE-3D a adus informatii supli-
mentare la pacientii cu stenoza mitrala, dehiscenta de
proteza mitrala si mixom atrial.
Concluzii: ETE-3D in chirurgia cardiaca este fezabila,
ofera chirurgului informatii suplimentare despre mor-
fologia valvulara si masuratorile standard ar putea f
efectuate cu mai multa acuratete.
Domeniu: 11.02 Ecografe transesofagiana
Media obtinuta: 8,7
Oral/Poster: oral
Additional value of real
time three dimensional
transoesophageal
echocardiography in elective
cardiac surgery
Background: Perioperative two-dimensional transe-
sophageal echocardiography (2D-TEE) has had a ma-
jor impact on clinical decision-making. However, it
has signifcant limitations for LV volumes and valves
assessment. Not enough perioperative data is available.
We hypothesized that real time three-dimensional TEE
(3D-TEE), a novel and revolutionary technique, adds
incremental value in cardiac surgery.
Methods: 52 patients (6712 years, 38 men) referred
for cardiac surgery underwent perioperative 2D-TEE
and 3D-TEE exams. LV volumes were assessed by
Simpsons method (2D-TEE), tracing the cardiac bor-
ders 1 mm inside the visible endocardium, and semi-
automated border detection technique (3D-TEE). 3D-
TEE was also used to assess abnormal valves. We report
the level of agreement (Bland-Altman analysis) betwe-
en 2D-TEE and 3D-TEE and the qualitative analysis.
Results: 3D-TEE was feasible in all patients. Tere was
a good agreement between 2D-TEE and 3D-TEE for
80. Valoarea aditionala a
ecografiei transesofagiene
tridimensionale in timp real in
chirurgia cardiaca electiva
Andrea Ciobanu
1
, Raluca Dulgheru
1
, S.Bennett
2
,
D.Vinereanu
1

Bucuresti
1
, Hull (UK)
2
Context: Ecografa transesofagiana bidimensionala
(ETE-2D) perioperatorie a avut o infuenta majora asu-
pra deciziilor terapeutice si evolutiei pacientilor. Aceas-
ta metoda subestimeaza volumul ventriculului stang
(VS) in comparatie cu RMN, considerata standardul
de aur actual. Evaluarea 2D a valvelor poate avea limi-
tari semnifcative. Majoritatea studiilor au demonstrat
superioritatea evaluarii 3D fata de 2D, fara sa existe
sufciente dovezi in context operator pana in prezent.
Ipoteza de la care am pornit a fost ca ecografa transe-
sofagiana tridimensionala (ETE-3D) aduce informatii
suplimentare in chirurgia cardiaca.
Metode: 52 de pacienti (6712 ani, 38 barbati) cu in-
dicatie chirurgicala cardiaca au fost inclusi si evaluati
prin ETE-2D si 3D. Volumul VS a fost masurat folosind
in 2D metoda Simpson, trasand limita VS cu 1 mm in-
auntrul marginii endocardului, iar in 3D tehnica semi-
automata de delimitare a endocardului. Am evaluat
gradul de intelegere dintre cele 2 metode prin analiza
Bland-Altman.
Rezultate: ETE-3D a fost tehnic posibila la toti pacien-
tii. A existat un nivel de intelegere bun intre ETE-2D si
ETE-3D pentru volumele telediastolic (average bias =7
ml; 7.8%) si telesistolic (average bias =2.2 ml; 5.5%) ale
VS. Am obtinut un nivel de intelegere excelent intre di-
mensiunea protezei aleasa de chirurg si diametrul ine-
lului aortic masurat in 3D (average bias =0.19 mm; 0.7
%), mai bun decat in 2D (0.9 mm; 3.45 %). Nivelul de
intelegere intre cele 2 metode pentru aria valvei aortice
masurata planimetric a fost mai putin satisfacator (ave-
rage bias =0.18 cm2, 17%). Pentru 3 pacienti, morfolo-
gia valvei aortice a fost mai bine evaluata in 3D. 4 din
9 pacienti care au benefciat de inlocuire/reconstructie
valvulara mitrala pentru prolaps semnifcativ au avut
ECOCARDI OGRAFI E | ECHOCARDI OGRAPHY
ECOCARDI OGRAFI E
ECHOCARDI OGRAPHY
Suplimentul A, 2010
the end-diastolic (average bias = 7 ml; 7.8%, 95% CI)

and end-systolic (average bias = 2.2 ml; 5.5%, 95% CI)
volumes. Tere was an excellent agreement between the
aortic prosthesis dimension chosen by the surgeon and
the aortic annulus measured in 3D-TEE (average bias
= 0.19 mm; 0.7 %, 95% CI), better than with 2D-TEE
(0.9 mm; 3.45 %, 95% CI). Tere was a less satisfac-
tory agreement between planimetry of the aortic valve
area (AVA) by the 2 methods (average bias = 0.18cm2,
17%, 95% CI). 3D-TEE provided better views for AV
morphology in 3 cases. It provided additional informa-
tion regarding the mitral valve (MV) morphology in
4 out of 9 patients who underwent MV replacement/
repair for MV prolapse by identifying (1) a P1/P2 clef;
(2) a more extensive prolapse of the posterior mitral
leafet (PML) involving P3 scallop, and ruptured chor-
dae; (3) ruptured chordae; (4) a more extensive prolap-
se of the PML involving P1 scallop. 3D-TOE provided
additional information for patients with mitral stenosis
(the only method able to measure MVA by planime-
try), mitral prosthesis dehiscence, and atrial myxoma.
Conclusions: 3D-TEE during cardiac surgery is feasi-
ble, adds additional information for the surgeon for the
assessment of valves morphology, and might be more
accurate than 2D-TEE for the standard measurements.
81. Evaluarea functiei
atriale stangi la pacientii
cu hipertrofie ventriculara
stanga: studiu comparativ la
pacientii cu stenoza aortica si
hipertensiune arteriala
Calin Andreea, B.A.Popescu, Cristiana Carmen Bela-
dan, Monica Rosca, Bianca Moise, Florina Voinea, Lu-
iza Lupascu, Denisa Muraru, Roxana Enache, Carmen
Ginghina
Bucuresti
Introducere. Importanta functiei atriale stangi (AS)
la pacientii cu hipertrofe ventriculara stanga (HVS) a
fost deja demonstrata. Recent s-a aratat ca parametrii
de deformare atriala stanga sunt utili in evaluarea ne-
invaziva a performantei AS. Obiectiv: Evaluarea defor-
marii si a ratei de deformare longitudinala a AS in HVS
patologica (masa VS indexata > 115 g/m2 la barbati si >
95 g/m2 la femei), comparativ la pacienti cu hiperten-
siune arteriala (HTA) si la pacienti cu stenoza aortica
(SA) stransa, toti cu fractie de ejectie (FE) VS pastrata
(> 50%).
Metode: Am inrolat prospectiv 36 de pacienti consecu-
tivi (59 9 ani, 11 barbati) cu HTA izolata si 37 pacien-
ti cu varste similare, cu SA stransa (62 7 ani, 31 bar-
bati, aria valvei aortice indexata AVAi < 0,6 cm2/m2).
Tuturor pacientilor li s-a efectuat o ecocardiografe
completa care a inclus parametrii de functie diastolica a
VS evaluati prin Doppler tisular. Presiunile de umplere
VS au fost evaluate utilizand raportul E/E. Parametrii
de deformare longitudinala a AS au fost evaluati din
sectiunea apical 4 camere prin ecocardiografe speckle
tracking. Au fost masurate valorile maxime ale defor-
marii longitudinale globale a AS si ale ratei deforma-
rii sistolice a AS (SSr, functia de rezervor), deformarii
diastolice precoce (ESr, functia de conduct) si tardive
(ASr, functia de pompa).
Rezultate: La pacientii cu SA, AVAi a fost de 0,4 0,1
cm2/m2, iar gradientul mediu transvalvular a fost 53
19 mmHg. Volumul indexat al AS, masa, volumele VS
si FEVS au fost similare la pacientii cu SA si la cei cu
HTA (p >0,30). Pacientii cu SA au prezentat valori mai
mari ale raportului E/E (p< 0,001). La pacientii cu SA,
deformarea longitudinala a AS a fost semnifcativ redu-
sa fata de pacientii cu HTA (197 vs 24 5%,p=0,003).
SSr si ESr au fost semnifcativ reduse la pacientii cu SA
(p=0,04 si respectiv p=0,002) iar ASr a fost similar in
ambele grupuri (p=0,50). La pacientii cu SA deforma-
rea longitudinala a AS, SSr si ESr s-au corelat semnif-
cativ cu raportul E/E.
Concluzii: In pofda gradului similar de HVS si de di-
latare AS, pacientii cu SA au prezentat o afectare mai
importanta a functiilor de rezervor si de conduct ale
AS fata de pacientii cu HTA. Reducerea functiei AS la
pacientii cu SA a fost asociata cu presiuni de umplere
VS crescute, aratand legatura stransa intre functia AS si
cea a VS la acesti pacienti.
Suplimentul A, 2010
ECOCARDI OGRAFI E
ECHOCARDI OGRAPHY
Assessment of left atrial
function in patients with
left ventricular hypertrophy:
comparison between aortic
stenosis and hypertension
Background. Te importance of lef atrial (LA) func-
tion in patients (pts) with lef ventricular (LV) hyper-
trophy was previously demonstrated. LA myocardial
deformation parameters recently emerged as a robust
tool for the noninvasive assessment of LA performance.
Purpose: We aimed to assess LA strain() and strain-
rate (Sr) in pathological LV hypertrophy (LV mass in-
dex > 115g/m2 in men and > 95 g/m2 in women) in pts
with hypertension (HTN) and in pts with severe aortic
stenosis (AS), all of them with preserved LV ejection
fraction (>50%).
Methods: We prospectively enrolled 36 consecutive pts
(599 years, 11 men) with isolated arterial hypertensi-
on (HTN) and 37 age-matched pts with severe AS (62
7years, 31 men, indexed aortic valve area, AVAi<0.6
cm2/m2). A comprehensive echocardiogram was per-
formed in all, including TDI-derived parameters of LV
diastolic function. LV flling pressures were assessed
using the E/E ratio. Longitudinal LA strain parameters
were assessed from apical 4-chamber view by speckle
tracking echocardiography using 2D strain sofware.
Peak values of global LA and LA systolic Sr (SSr, reser-
voir function); early diastolic Sr (ESr, conduit functi-
on); and late diastolic Sr (ASr, booster pump function)
were measured in all pts.
Results: in pts with AS, AVAi was 0.40.1 cm2/m2 and
mean transvalvular gradient was 5319 mm Hg. Inde-
xed LA volume, LV mass, LV volume and LVEF were
similar in pts with AS and pts with HTN (p >0.30 for
all). Pts with AS had higher E/E ratios both at the sep-
tal and lateral sites (p<0.001). In pts with AS, peak LA
was signifcantly lower than in pts with HTN (197 vs
24 5%,p=0.003). SSr and ESr were also signifcantly
lower in pts with AS (p=0.04; p=0.002, respectively).
Conversely, ASr was similar in both groups (p=0.50). In
pts with AS signifcant correlations were found betwe-
en LA, SSr, ESr and E/Eseptal ratio (r=-0.36, p=0.03;
r=-0.36, p=0.03; r=0.47, p=0.005, respectively).
Conclusions: Patients with AS had a greater impair-
ment of LA reservoir and conduit functions than pts
with HTN, despite similar extent of LV hypertrophy
and LA dilatation. Te reduction of LA function in pts
with AS was related to increased LV flling pressures,
showing the close interplay between LA and LV func-
tion in this setting. Te additive clinical value of asses-
sing LA deformation in pts with LV hypertrophy needs
further study.
82. Disfunctia diastolica a
ventriculului stang evaluata
prin Doppler spectral si tisular
in timpul intervalelor pre si
postextrasistolic in insuficienta
cardiaca cu fractie de ejectie
pastrata
T.Nanea, Gabriela Silvia Gheorghe, S.Visan, Adriana
Iliesiu, N.Paun, Camelia Nicolae
Introducere. Aritmiile cu umplere ventriculara varia-
bila produc diferite tipare de umplere ventriculara. Ex-
trasistolele ventriculare duc la reducerea presarcinii si
scurtarea timpului de relaxare ventriculara. Modifcari
in sens opus apar in intervalele diastolice postextrasis-
tolice. Scop. Studiul functiei diastolice a ventriculului
stang (VS) in insufcienta cardiaca (IC) cu fractie de
ejectie pastrata (pFEVS) utilizand diferite modele de
umplere ventriculara create de extrasistolele ventricu-
lare (EV).
Metoda: Au fost examinati ecocardiografc 51 pacienti
(pts), 55% barbati cu varsta medie 60 +/- 10 ani, avand
IC cu pFEVS (FEVS > 50%). S-au folosit tehnica 2D
pentru masurarea FEVS (metoda Simpson), Doppler
spectral pentru evaluarea fuxului diastolic transmitral
(FDT) si Doppler tisular (TDI) pentru determinarea
vitezelor longitudinale de relaxare protodiastolica (Ea)
si telediastolica (Aa) inainte si dupa EV. EV se produc
inaintea depolarizarii atriale si de aceea efectele con-
tractiei atriale nu se identifca in diastola cardiaca.
Rezultate: Modelul TMF a fost: relaxare intarziata (RI)
(E/A <1, Ea=5+/-3.1 cm/sec) la 59% pts si pseudonor-
mal (PN) (E/A>1, Ea=6+/-2.5 cm/sec) la 41% pts. In
timpul pauzei postextrasistolice, la 20% pts cu RI fuxul
devine normal(E/A>1 si E/Ea<8) iar la 80 % pts rama-
ECOCARDI OGRAFI E
ECHOCARDI OGRAPHY
Suplimentul A, 2010
Results: Te pattern of TMF was delayed relaxation

(DR) (E/A <1, Ea=5+/-3.1 cm/sec) in 59% pts and pse-
udonormal (PN) (E/A>1, Ea=6+/-2.5 cm/sec) in 41%
pts. During the postextrasistolic interval 20% pts with
DR change to normal pattern (E/A>1 and E/Ea<8) and
80 % pts remain in the same pattern (E/A<1, Ea=5,2+/-
3cm/sec). In the PN group, 61% pts remain in this
pattern during the postextrasistolic interval (E/A>1,
Ea=6,6+/-2,4cm/sec) and 39% pts change to DR (E/A
<1 and Ea=5+/-3.2cm/sec).
Conclusions: Te enhancement of the ventricular
flling afer VPB indicates the improvement of the
Doppler parameters of diastolic function evaluated in
the postextrasistolic pause. Tis improvement could
sugest the existence of a myocardial diastolic reserve.
Te change of the diastolic parameters occurs by the
decrease of the preload and the shortening of the di-
astole, due to the precocity of the premature beats. Ar-
rhythmias with variable ventricular flling could be use
for the dynamic exploration of the diastolic function of
the lef ventricle without a pharmacological and inva-
sive intervention.
83. Inacuratetea criteriilor
radiologice pentru implantarea
sondelor de stimulare
endocavitara - comparatie cu
ecografia tridimensionala
A.Margulescu, Roxana Cristina Sisu, Raluca Dulgh-
eru, C. Siliste, D.Vinereanu
Introducere. Pentru reducerea incidentei insufcientei
cardiace induse de stimularea din apexul ventricului
drept (VD) au fost cautate localizari alternative pentru
plasarea sondelor permanente. Criteriile radiologice
pentru impantarea sondelor in locurile alternative au
fost descrise, dar acordul (agreement-ul) acestor cri-
terii cu localizarea anatomica exacta a sondelor, docu-
mentata prin ecografe 3D, este dubitabil.
Metoda: Pozitia exacta a sondelor de stimulare perma-
nenta a fost documentata la 30 de pacienti, utilizand
ecografa 3D (Vivid 7, sonda 3V, GE). Au fost inregis-
trate imagini volumetrice complete din incidente mul-
ne neschimbat (E/A<1, Ea=5,2+/-3cm/sec). In grupul
PN , 61% pts nu-si modifca pattern-ul in timpul pauzei
postextrasistolice (E/A>1, Ea=6,6+/-2,4cm/sec) si 39%
pts trec in tipul RI (E/A <1 and Ea=5+/-3,2 cm/sec).
Concluzii: Cresterea umplerii ventriculare dupa EV
indica imbunatatirea parametrilor Doppler ai func-
tiei diastolice determinati in pauza postextrasisotlica.
Amelioaarea parametrilor functiei diastolice ar suge-
ra existenta unei rezerve diastolice miocardice. Aceste
modifcari ale parametrilor diastolici apar prin scade-
rea presarcinii si scurtarea diastolei indusa de preco-
citatea extrasistolei ventriculare. Aritmiile cu umplere
ventriculara variabila ar putea f folosite pentru ex-
plorarea dinamica a functiei diastolice a ventriculului
stang fara interventii farmacologice sau invasive.
Diastolic function of left
ventricule evaluated by spectral
and tissue Doppler techniques
during pre and postextrasistolic
interval in heart failure with
preserved ejection fraction
Background: Rhythm disturbances with variable ven-
tricular flling produce diferent hemodynamic pat-
terns without invasive and pharmacological interventi-
on. Premature ventricular beats create reduction of the
preload and shortening of the relaxation time of the lef
ventricle. Opposite changes occur during the postex-
trasistolic diastolic intervals.
Aim: To study the diastolic function of the lef ventricle
during heart failure (HF) with preserved ejection frac-
tion (pLVEF), using diferent patterns of ventricular
flling created by ventricular premature beats (VPB).
Method: 51 patients (pts), 55% men with the avera-
ge age of 60 +/- 10 years with HF and pLVEF > 50%
underwent 2D echo examinations for LVEF measu-
rement (Simpson method), spectral Doppler for the
assessment of the pattern of diastolic transmitral fow
(TMF) and tissue Doppler (TDI) for the assessment of
protodiastolic (Ea) and telediastolic (Aa) longitudinal
relaxation velocities, before and afer VPB. VPBs occu-
re before the atrial depolarization, therefore the efects
of the atrial contraction do not appear during diastolic
interval.
Suplimentul A, 2010
ECOCARDI OGRAFI E
ECHOCARDI OGRAPHY
tiple; au fost realizate planuri de sectiune prin aceste
imagini astfel incat sa se vizualizeze pozitia exacta a
locului de insertie a sondelor. Pozitia radiologica a fost
determinata folosind incidentele standard (PA, LAO
40, RAO 40). Au fost defnite 4 locatii: tract ejectie VD
(TEVD), sept interventricular, apex VD si perete liber
VD. TEVD a fost impartit in TEVD septal si TEVD an-
terior. Septul interventricular a fost de asemenea im-
partit in sept anterior (jonctiunea intre peretele liber
VD si septul adevarat, la nivelul bandeletelor septomar-
ginale) si sept adevarat (corpul septului).
Rezultate: Localizarea sondelor conform ecografei 3D
a fost: TEVD5 pacienti (1 septal, 4 anterior); sept in-
terventricular15 pacienti (8 anterior, 7 sept adevarat);
apex VD7 pacienti; perete liber VD3 pacienti. Acor-
dul general intre criteriile radiologice si ecografa 3D a
fost doar moderat (=0.587; 95I; = 0.378 - 0.796). Crite-
riile radiologice au discriminat localizarea apicala VD
(=1) de cea septala (=0.733; 95I; = 0.490 - 0.977) si
de TEVD (=0.870, 95I; = 0.618 - 1.121). Totusi, aceste
criterii nu au discriminat pozitiile anterioare TEVD de
cele septale TEVD (=0.048; 95I; = -0.370 - 0.465), si au
fost relativ imprecise pentru discriminarea localizarilor
septale anteriore si septale adevarate (=0.452; 95I; =
0.054 - 0.850), precum si in identifcarea peretelui liber
de VD (=0.348; 95I; = -0.352 - 1.048).
Concluzie: Criteriile radiologice pot identifca pre-
cis doar localizarile apicale ale sondelor de stimulare
ventriculara, dar nu si pe cele alternative. Studiile care
compara efectul stimularii VD apicale fata de localiza-
rile alternative pot utiliza ecografa 3D pentru defnirea
pozitiei sondelor, dar nu criteriile radiologice.
Inaccuracy of radiological
criteria for pacemaker
lead implantation by
comparison with assessment
of lead position using 3D
echocardiography
Introduction. Alternatives to right ventricular (RV)
apical pacing have been sought in an attempt to decre-
ase the incidence of pacing-induced heart failure. Ra-
diological criteria for implantation of pacemaker leads
at alternative sites have been described, but agreement
of these criteria compared with the exact location of the
lead by 3D echocardiography is debatable.
Methods: We documented the exact location of ventri-
cular pacemaker leads in 30 implanted patients, using
3D echocardiography (Vivid 7, 3V probe, GE). Full vo-
lume data sets were acquired from multiple views and
appropriate slices were cropped, in order to detect the
exact location of the tip of the lead inserted into the
myocardium. Radiological location of the leads was
assessed from 3 standard fuoroscopic views (posteri-
or-anterior; LAO 40; RAO 40); lead placement was at-
tributed to 4 locations: RV outfow tract (RVOT), inter-
ventricular septum, RV apex, and RV free wall. RVOT
was divided into septal RVOT and anterior RVOT;
interventricular septum was also divided into anteri-
or septum (the junction between RV free wall and true
septum, at the level of septomarginal trabeculations)
and true septal position (the body of the septum).
Results: Exact lead positions by 3D echocardiography
were: RVOT - 5 patients (1 septal, 4 anterior); interven-
tricular septum - 15 patients (8 anterior, 7 true septal);
apical - 7 patients; RV free wall - 3 patients. Overall
agreement between radiological criteria and 3D echo-
cardiography was only moderate ( = 0.587; 95% CI =
0.378 - 0.796). Radiological criteria were able to dis-
criminate apical ( = 1) from septal ( = 0.733; 95% CI
= 0.490 - 0.977) and RVOT positions ( = 0.870, 95%
CI = 0.618 - 1.121); however, they did not discriminate
septal RVOT from anterior RVOT ( = 0.048; 95% CI
= -0.370 - 0.465), and were only moderately accurate in
discriminating anterior septal from true septal position
( = 0.452; 95% CI = 0.054 - 0.850), and in identifying
RV free wall locations ( = 0.348; 95% CI = -0.352 -
1.048).
Conclusions: Current radiological criteria can accu-
rately identify only apical but not alternative sites for
pacemaker lead implantation. Studies which compare
the efects of apical versus alternative site pacing should
use 3D echocardiography instead of radiological crite-
ria for documentation of lead placement.
96
denta de endoteliu (dupa administrare de nitrogliceri-
na) nu a diferit semnifcativ la nici unul dintre grupu-
rile analizate.
Concluzii: Disfunctia endoteliala analizata prin vaso-
dilatatia dependenta de endoteliu (FMD) s-a corelat
doar cu genotipurile genei IL-6 (atat-174 G/C, cat si nt
565 G/A), dar nu si cu genotipurile celorlate gene pro-
infamatorii (IL-1 -889 T/C, IL-1 (-511 C/T si +3962
C/T ), IL-2 (+166 G/T si -130 G/T) si IL-4 -590 T/C).
Influence of proinflammatory
citokines polymorphism on
endothelial function at patients
with peripheral arterial disease
Objective: To identify genotypes of proinfammato-
ry citokines genes with negative efect on endothelial
function at patients with peripheral arterial disease.
Methods: We included 48 patients with peripheral ar-
terial disease stages IIB-IV Fontaine admitted for elec-
tive surgical interventions at Institutul de Boli Cardi-
ovasculare Prof. Dr. C.C. Iliescu between 1.07.2007
and 1.07.2008. We exclude patients with recend acute
coronary syndrome and stroke (last 3 months), with
decompensated heart failure, severe renal dysfuncti-
on, neoplasms and cardiac or vascular surgical inter-
ventions in the last 6 months. We analyzed the pro-
infammatory citokines genes IL-1(-889 T/C), IL-1
(-511 C/T and +3962 C/T), IL-2 (+166 G/T and-130
G/T), IL-4 -590(T/C) and IL-6(-174 G/C and nt565
G/A). Endothelial function was evaluated preoperati-
vely in all subjects by endothelium dependent (FMD)
and independent (afer nytroglycerine administration)
vasodilation on the brachial artery.
Results: Patients mean age was 61.758.66 years.
Mean FMD was 8.82.28%, and mean endothelium
independent vasodilation afer nitroglycerine admi-
nistration was of 14.89 2.11%. FMD variation was
signifcantly lower only at patients with genotype IL-
6-174CC (7.051.49% versus 8.41 1.9 % for Il-6 -174
GC and 9.422.46 % for IL-6-174 GG, p=0.009)) and
at patients with genotype IL-6 nt 565 AA (7.141.61 %
84. Influenta polimorfismului
citokinelor proinflamatorii
asupra functiei enoteliale la
pacientii cu boala arteriala
periferica
Adina Liliana Stoica, Ileana Constantinescu,
Ana Moise, Carmen Ginghina
Institutul de Urgenta pentru Boli Cardiovasculare
"Prof.Dr. C.C.Iliescu", Bucuresti
Obiective: Identifcarea unor genotipuri ale genelor ci-
tokinelor proinfamatorii cu efect negativ asupra func-
tiei endoteliale la pacientii cu boala arteriala periferica.
Material si metoda: Au fost inclusi 48 pacienti inter-
nati consecutiv cu boala arteriala periferica stadiile II
B IV Fontaine, la care s-au practicat interventii chi-
rurgicale elective de revascularizare periferica, in peri-
oada 1.07.20071.07.2008 in cadrul Institutului de Boli
Cardiovasculare Prof. Dr. C.C. Iliescu. Au fost exclusi
pacientii cu sindrom coronarian acut si/sau AVC/AIT
in ultimele 3 luni, cu insufcienta cardiaca decom-
pensata, afectiuni renale severe, neoplazii, interventii
cardiace/vasculare in ultimele 6 luni. A fost analizat
promotorul genelor citokinelor proinfamatorii IL-1
(-889 T/C), IL-1 (-511 C/T si +3962 C/T), IL-2 (+166
G/T si -130 G/T), IL-4 -590 (T/C) si IL-6 (-174 G/C
si nt565 G/A). Functia endoteliala fost evaluata la toti
pacientii preoperator prin vasodilatatia dependenta de
endoteliu(FMD) si independenta (dupa administare de
nitroglicerina) de endoteliu, masurata ultrasonografc
la nivelul arterei brahiale.
Rezultate: Pacientii inclusi au avut o varsta me-
die de 61.758.66 ani. Variatia FMD medie a fost de
8.82.28%, iar variatia medie a vasodilatatiei indepen-
denta de endoteliu dupa administrarea de nitrogliceri-
na a fost de 14.892.11%. Dintre citokinele proinfama-
torii studiate variatia FMD a fost semnifcativ mai mica
doar la pacientii cu genotip IL-6 -174CC (7,051,49%
fata de 8,41 1,9 % pentru Il-6 -174 GC si 9,422,46
% pentru IL-6-174 GG, p=0,009)) si la pacientii cu ge-
notip IL-6 nt 565 AA (7,141,61 % fata de 8,491,91
% pentru IL-6 nt 565 GA si 9,42 2,46% pentru IL-6
nt565 GG, p=0,018), la celelalte citokine analizate nee-
xistand diferente semnifcative. Vasodilatatia indepen-
POSTER FORUM I I | POSTER FORUM I I
Suplimentul A, 2010
9I
POSTER FORUM I I
POSTER FORUM I I
vs. 8,491,91 % for IL-6 nt 565 GA and 9.42 2.46% for
IL-6 nt565 GG , p=0.018). For the rest of analyzed ci-
tokines there were no signifcant diferences. Endothe-
lium independent vasodilatation (afer nytroglycerine
administration) was not dignifcantly diferent at any
of analyzed subgroups.
Conclusions: Endothelial dysfunction analyzed by
endothelium dependent vaodilatation (FMD) was cor-
related only with gene IL-6 genotypes (174 G/C, and
nt 565 G/A), not with other proinfammatory gene ge-
notypes (IL-1 -889 T/C, IL-1 (-511 C/T and +3962
C/T ), IL-2 (+166 G/T and -130 G/T) and IL-4 -590
T/C).
85. Poate disfunctia aortei sa
explice angina la pacientii cu
artere coronare permeabile
angiografic?
Marinela Serban, Madalina Iancu, Ileana Craciunescu,
Aneida Hodo, Ioana Ghiorghiu, B.A.Popescu, Carmen
Ginghina
Premise. Angina cu artere coronare normale (ACN)
angiografc inca are mecanisme controversate. Rigi-
tatea aortica (Ao) este recunoscuta acum ca find un
marker de morbi- mortalitate cardiovasculara si s-a
demonstrat a f crescuta la pacientii cu boala cardiaca
ischemica (BCI).
Obiective: Evaluarea functiei vasculare Ao prin mai
multe tehnici ecocardiografce, la pacienti cu angina si
ACN versus BCI confrmata angiografc.
Metoda: Studiul a cuprins 54 pacienti care s-au pre-
zentat cu angina si au efectuat coronarografe. Subiectii
au fost impartiti in 2 grupuri, imperecheate ca varsta:
ACN, n=17 si BCI, n= 37. Functia vasculara Ao a fost
evaluata prin Doppler tisular (TDI), determinandu-se
of ine velocitatile sistolica (SW) si diastolice precoce
(EW) si tardiva (AW) ale peretelui Ao anterior. Indi-
cii de rigiditate Ao, calculati pe baza diametrelor Ao
ascendente si a TA au fost: pulsatilitatea aortica (Ao
Strain), distensibilitatea aortica (Ao Dis), indexul de
rigiditate aortica (Ao SI). Postsarcina a fost evaluata
prin: elastanta arteriala efectiva: Ea=0.9 X TA sistolica/
volumul bataie. Indexul de rezistenta vasculara siste-
mica (SVRI)= TA medie/indexul cardiac. Complianta
arteriala totala (Ca)= volum bataie/presiunea pulsului.
Rezultate: Varsta medie a pacientilor a fost 63.28.2
ani in grupul cu ACN vs 60.910.3 ani la pacientii cu
BCI (p=0,54). Velocitatile TDI ale peretelui Ao, para-
metrii de rigiditate Ao, Ea, SVRI and Ca au prezentat
valori similare in grupul cu ACN vs pacientii cu BCI:
SW 6.571.8 vs 6.21.9 cm/s (p=0.32), EW 5.42.1
vs 4.71.5 cm/s (p=0.32), AW 6.92.3 vs 7.12.3
cm/s (p=0.77), Ao Strain 21.210.9% vs 23.114.6%
(p=0.79), Ao Dis 0.80.4 vs 10.6 cm2/dyne (p=0.26),
Ao SI 2.891.40 vs 2.61.4 (p=0.78), Ea 2.20.7 vs
2.30.6 mmHg/ml (p=0.52), SVRI 3.21.1 vs 3.40.8
dyne *s *m2/cm-5 (p=0.2), Ca 1.10.4 vs 1.20.4 ml/
mm Hg (p= 0.81).
Concluzii: In pofda permeabilitatii arterelor epicardi-
ce, subiectii din grupul cu angina si ACN au avut velo-
citati ale peretelui Ao, parametrii de rigiditate Ao, Ea,
SVRI si Ca similare cu cele ale pacientilor cu BCI con-
frmata angiografc. Intrucat s-a demonstrat anterior
faptul ca pacientii cu BCI au functie vasculara Ao alte-
rata, angina in absenta stenozelor coronariene ar putea
f consecinta fziopatologica a cresterii rigiditatii Ao si
a alterarii propagarii si secventialitatii undei pulsului.
Could aortic dysfunction
explain angina in patients
with angiographically normal
coronary arteries?
Background: Angina with angiographically normal co-
ronary arteries (NCA) still has controversial pathophy-
siological mechanisms. Aortic (Ao) stifness is now
known as a marker of cardiovascular morbi-mortality
and it was demonstrated to be increased in patients
with coronary artery disease (CAD).
Objective: To assess aortic function by diferent echo-
cardiographic techniques in patients with angina and
NCA versus those with coronary stenoses.
Methods: 54 patients (pts) who underwent coronary
angiography for angina were enrolled in this study.
Tey were divided into two age-matched groups: NCA,
n=17 and CAD, n= 37. Aortic function was evaluated
in tissue Doppler imaging (TDI), by measuring of ine
systolic (SW), early and late diastolic (EW, AW) veloci-
POSTER FORUM I I
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Suplimentul A, 2010
98
ties of the anterior aortic wall. Aortic stifness indices,
calculated using systolic and diastolic ascending Ao di-
ameters and blood pressure values, were: Ao Strain, Ao
distensibility (Ao Dis), Ao stifness index (Ao SI). Total
aferload was defned by the efective arterial elastance
(Ea=0.9XSBP/SV, SV=stroke volume). Systemic vascu-
lar resistance index (SVRI) = mean arterial pressure/
cardiac index. Total arterial compliance (Ca)=SV/pulse
pressure.
Results: Te mean age was 63.28.2 years in NCA
group vs 60.910.3 years in CAD pts (p=0.54). Aortic
wall tissue velocities, aortic stifness parameters, Ea,
SVRI and Ca showed similar values in the group of pa-
tients with NCA vs CAD: SW 6.571.8 vs 6.21.9 cm/s
(p=0.32), EW 5.42.1 vs 4.71.5 cm/s (p=0.32), AW
6.92.3 vs 7.12.3 cm/s (p=0.77), AoStrain 21.210.9%
vs 23.114.6% (p=0.79), Ao Dis 0.80.4 vs 10.6 cm2/
dyne (p=0.26), Ao SI 2.891.40 vs 2.61.4 (p=0.78), Ea
2.20.7 vs 2.30.6 mmHg/ml(p=0.52), SVRI 3.21.1
vs 3.40.8 dyne *s *m2/cm-5 (p=0.2), Ca 1.10.4 vs
1.20.4 ml/mm Hg (p= 0.81).
Conclusion: Despite having normal coronary arteries,
patients with angina and NCA have aortic wall velociti-
es, aortic stifness parameters, Ea, SVRI and Ca compa-
rable with patients with established CAD. As impaired
aortic stifness was previously demonstrated in CAD
patients, these results might explain angina in the ab-
sence of coronary stenoses, as a consequence of increa-
sed aortic stifness and altered pulse wave propagation
sequentiality.
86. Antrenamentul fizic
supravegheat poate imbunatati
o parte din parametrii
hemodinamici si de rigiditate
arteriala la pacientii
hipertensivi
M.Iurciuc, C.Avram, Stela Iurciuc, V.Adrian, G. Cio-
riaca, Silvia Mancas
Universitatea de Medicina si Farmacie V. Babes,
Timisoara
Premize: Majoritatea evenimenteelor cardiovascula-
re au loc in cursul diminetii. Acest fapt este asociat cu
cresterea stresului hemodinamic matinal (MBPS).
Scop: De a demonstra ca efortul fzic poate imbunatati
o parte din parametrii hemodinamici ai monitorizarii
tensionale automate / 24 ore (MATA); stresului hemo-
dinamic matinal si indicele glezna brat (ABI).
Metoda: Am selectat 212 pacienti cu HTA esentiala
cu varsta cuprinsa intre 35 si 70 ani. Pacientii se ga-
seau sub tratament antihipertensiv neschimbat timp
de cel putin 1 luna si la tinta terapeutica recomandata
de ESC/ESH 2007. Am evaluat acesti pacienti inainte si
dupa 4 luni de antrenament fzic controlat. Am studiat
urmatorii parametrii masurati prin MATA: tensiunea
arteriala sistolica (TAS), tensiunea arteriala diastolica
(TAD), tensiunea arteriala medie (TAM), presiunea
pulsata (PP), frecventa cardiaca (FC), indexul de ri-
giditate arteriala ambulatorie (IRAA) defnit ca 1-alfa
(panta de regresie statistica intre diastolica si sistolica);
MBPS2 = media TAS in primele 2h dupa trezire - me-
dia TAS in ultimele 2 ore de somn; MBPS1 = media
TAS in primele 2 h de la trezire media celor mai joase
3 valori TAS nocturne. Pentru ABI am impartit lotul in
2 grupe: grupul cu ABI 1 si ABI* >1.
Rezultate: TAS a scazut de la 128,14 la 122,9 mmHg
(,0001); TAD a scazut de la 72,12 la 71,89 mmHg
(,1695); TAM a scazut de la 90,79 la 88,91mmHg
(,0426); PP a scazut de la 56,02 la 50,89 mmHg (,0018);
FC a scazut de la 72,66 la 68,51 b/min (,0048); AASI
a scazut de la 0,5509 la 0,4246; MBPS1 a scazut de la
15,82 la 12,07mmHg (,0019); MBPS2 a scazut de la
12,69 la 9,49 mmHg (,0028); ABI a crescut de la 0,917
la 0,964; ABI* a scazut de la 1,25 la 1,121.
Concluzii: Programele de recuperare pot imbunatati
o parte din parametrii hemodinamici masurati prin
MATA. Antrenamentul fzic, parte esentiala a progra-
mului de recuperare cardiovasculara, poate ameliora:
stresul tensional matinal; unii din parametrii de rigi-
ditate arteriala defniti prin PP si ABI*. Programele de
exercitii fzice controlate sunt sigure si efciente in di-
minuarea riscului cardiovascular.
Supervised exercise training
may improve the ambulatory
blood pressure monitoring and
arterial stiffness parameters
Background: Cardiovascular events have their grea-
test impact in the morning period. Tis is thought to
be associated with and dependent on morning blood
Suplimentul A, 2010
99
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87. Enoxaparina plus terapia
antiplachetara duala cea mai
buna solutie pentru pacientii
fara tratament de reperfuzie
a infarctului miocardic cu
supradenivelare de segment
ST? Registrul RO-STEMI
G.Tatu-Chitoiu, Maria Dorobantu, Elvira Craiu,
I.Benedek, D.Vinereanu, C.Macarie, Crina Sinescu,
Lacramioara Topolnitchi, V.Firastrau, Eugenia Nechi-
ta, A.Petris
Introducere: Efcienta terapiei antiplachetare dua-
le aspirina plus clopidogrel (A&C;) - combinata cu
heparina (H) sau Enoxaparina (E) la pacientii (pts) cu
infarct miocardic acut cu supradenivelare de segment
ST (STEMI) si fara tratament de reperfuzie continua sa
fe un subiect controversat.
Obiective: compararea mortalitatii intra-spitalicesti si
a incidentei complicatiilor hemoragice la pts fara trata-
ment de reperfuzie pentru STEMI tratati cu H sau E in
combinatie fe cu A fe cu A&C.
Metoda: in perioada 1.01.2002-31.12.2009 Registrul
Roman pentru Infarct miocardic cu Supradenivelare
de Segment ST (RO-STEMI) a inrolat consecutiv 11325
de pacienti. Am identifcat 2214 pts internati in prime-
le 12 ore dupa debutul STEMI si care nu au benefciat
de tratment de reperfuzie coronariana. Un subgrup de
1119 pts au primit H (1000 i.u./ora, 48-96 ore) in com-
binatie fe cu A 150-300 mg/zi (subgrupul H&A;, 823
pts) sau cu aceeasi doza de A plus C 75 mg/zi (subgru-
pul H&A;&C;, 296 pts). Un alt subgrup de 818 pts au
primit E (1 mg/kg la fecare 12 ore timp de 8-10 zile)
combinata fe cu A (subgrupul E&A; 490 pts) sau A
plus C (subgrupul E&A;&C;, 328 pts). Un subgrup de
277 pts tratati cu H timp de 48 ore urmata de E a fost
exclus din aceasta analiza. Toti pacientii au primit beta-
blocante, inhibitori ai enzimei de conversie a angioten-
sinei si statine in absenta contraindicatiilor.
Rezultate: Mortalitatea intra-spitaliceasca a fost simila-
ra in subgrupurile H&A;&C;(18.24%), H&A;(16.88%)
sau E&A;(16.93%). O reducere semnifcativa a morta-
litatii intra-spitalicesti a fost constatata in subgrupul
E&A;&C;(6.40%) comparativ cu fecare dintre celelalte
pressure surge (MBPS).
Aims: To show that exercise training, may improve
some of the hemodynamic parameters of the ambula-
tory BP monitoring, the MBPS and the ankle brachial
index (ABI).
Methods: We selected 212 patients with essential
hypertension, aged: 35-70y. Tey were under unchan-
ged medication at least 1 month and at target BP. We
evaluate these patients before and afer 4 months of su-
pervised physical training. We studied the ambulatory
blood pressure monitoring/24h: systolic blood pressure
(SBP), diastolic blood pressure (DBP), mean blood pre-
ssure (MBP), pulse pressure (PP), heart rate (HR), am-
bulatory arterial stifness index(AASI) defned as 1-
( = regression slope between TAD and TAS), MBPS1=
mean SBP in the frst 2h afer awaken the average of
the lowest 3 nocturnal values, MBPS2 = mean SBP in
the frst 2h afer awaken mean SBP value in the frst
2h pre awake. We divided these 212p into to groups:
with ABI1; and with ABI*>1.
Results: Te SBP has decreased from 128,14 to
122,91mmHg (p,0001); the DBP has decreased from
72,12-71,89mmHg (p,1695); the MBP has decreased
from 90,79-88,91mmHg(p,0426); the PP has decreased
from 56,02-50,99mmHg (p,0018); the HR has decrea-
sed from 72,66-68,51 b/min (p,0048); the AASI has de-
creased from 0,5509-0,4246 (p,0069); MABS1 has de-
creased from 15,82-12.07mmHg(p,0019); MABS2 has
decreased from 12,69-9,49mmHg(p,0028) Te ABI has
increased from 0,917- 0,963 (p,0021); ABI* has decrea-
sed from 1,254- 1,121 (p,0014).
Conclusion: Rehabilitation programs can improve
some of the hemodynamic parameters: SBP, MBP, and
HR. Exercise training, may decrease MBPS. Physical
training may also improve some of the parameters that
describe arterial stifness: AASI and PP. Rehabilitation
programs are a safe and efective method for reducing
cardiovascular risk.
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Suplimentul A, 2010
100
trei subgrupuri (p< 0.0001 pentru toate comparatiile).
Diferentele de incidenta a accidentelor vasculare ce-
rebrale (1.01%, 0,60%, 0.81% si, respectiv, 0.30%) si a
hemoragiilor majore (0.0%, 0,97%, 0,81% si, respectiv,
0.30%) au fost fara semnifcatie statistica.
Concluzii: Registrul RO-STEMI sugereaza faptul ca
administrarea combinatiei Enoxaparina, Aspirina si
Clopidogrel constituie cea mai buna strategie terape-
utica la pacientii cu STEMI care nu au benefciat de o
terapie de reperfuzie coronariana.
Enoxaparin combined with
dual antiplatelet therapy -
the best solution in patients
not undergoing reperfusion
for ST-elevation myocardial
infarction? RO-STEMI data
Background: Te ef cacy of the dual antiplatelet thera-
py (aspirin+clopidogrel) combined with either unfrac-
tionated heparin (UH) or Enoxaparin (E) in ST-eleva-
tion myocardial infarction (STEMI) patients (pts) not
undergoing reperfusion is a subject of debate.
Objective: To compare the in-hospital mortality and
the rates of the major bleeding events in STEMI pts not
undergoing reperfusion who received either aspirin
(A) or Aspirin plus Clopidogrel (A&C) both combined
with either UH or E.
In this registry we identifed 2214 pts admitted within
the frst 12 hours afer the STEMI onset who did not
receive reperfusion therapy. A subgroup of 1119 pts. re-
ceived UH (1000 i.u./hour, 48-96 hours) either combi-
ned with 150-300 mg./day of A (UH&A subgroup, 823
pts) or with the same dose of A plus 75 mg/day of C
(UH&A&C subgroup, 296 pts). Another subgroup of
818 pts received E (1 mg/kg every 12 hours for 8-10
days) combined with either A (the E&A subgroup, 490
pts) or A plus C (the E&A&C subgroup, 328 pts). A
small subgroup of 277 treated with UH for 48 hours
followed by E was excluded from this analysis.All pts
received beta-blockers, angiotensin converting enzyme
inhibitors, and statins if not contraindicated.
Results: Te in-hospital mortality were similar in
the UH&A&C (18.24%), UH&A (16.88%) and E&A
(16.93%) subgroups, respectively. However, signifcant
lower in-hospital mortality was seen in the E&A&C
subgroup (6.40%) compared with each of the other
three subgroups (p< 0.0001 for all comparisons). Te
rates of the global stroke (1.01%, 0,60%, 0.81% and
0.30%, respectively) and of the major bleeding (0.0%,
0,97%, 0,81%, and 0.30%, respectively) were low and in
all soubgroups, below the threshold of statistical signi-
fcance.
suggest that a combination between Enoxaparin, As-
pirin and Clopidogrel should be the best strategy in
STEMI patients not undergoing reperfusion.
88. Stenoza de artera renala -
aspecte diagnostice
R.C.Motoc, Motoc Adriana Crina, Laszlo Mihaly,
I.Tilea, Monica Borda
Spitalul Clinic Judetean de Urgenta, Clinica Medicala 3,
Targu Mures
Obiectiv: Diagnosticare rapida si cu cat mai mare acu-
ratete a stenozei de artera renala cu ajutorul examina-
rii ecografce Doppler,evidentiind leziunile stenotice
semnifcativ hemodinamic. Orientarea screening-ului
de boala renovasculara implica incercarea de cunoste-
re a celor mai puternici factori de predictie care se pot
asocia cu aceasta patologie, precum si asocierea cu alte
afectari vasculare.
Material si metoda: S-au inclus in studiu 122 hiperten-
sivi, internati in perioada 2000-2009 in clinica noastra.
Toti pacientii au avut aspecte semnifcative anamnestic,
clinic si paraclinic pentru stenoza de artera renala. Cu
ajutorul ecografei Doppler in sistem duplex am masu-
rat o serie de parametrii la nivelul arterei renale si a
arterelor interlobare. Examenul angiografc a verifcat
prezenta stenozei precum si gradul ei de severitate.
Rezultate: Din cei 122 de pacienti hipertensivi intro-
dusi in studiu, in functie de viteza maxima sistolica
masurata >1,8m/sec este caracteristica ptr. SAR sem-
nifcativ hemodinamic, indice de rezistenta sub 0,6),
au rezultat doua loturi: fara stenoza - 86 de pacien-
ti(70,49%) si cu stenoza - 36 de pacienti(29,51%). Media
valorilor tensiunii arteriale sistolice a fost semnifcativ
mai mare(p<0,001), in lotul cu stenoza(194mmHg)
Suplimentul A, 2010
101
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higher in the group with stenosis (194mmHg) vs. the
group without stenosis (160mmHg), with the value of
p<0.001. A larger proportion of patients required 3
antihypertensive drugs in the group with the stenosis
86.11% vs. 56.98% in the group without stenosis, the
value of p<0.01. Coronary disease was found in 58.33%
of the patients with stenosis vs. 19.77% in those without
stenosis (p<0.01). In the group with stenosis 55.56% of
the patients had peripheral arteriopathy versus 24.42%
in the group without stenosis (p<0.001). Cerebrovas-
cular disease was signifcantly more frequent (p<0.001)
in the group with stenosis 41.67% versus no stenosis
17.44%.
Conclusions: Coronary disease, peripheral arterio-
pathy and cerebrovascular disease have a much higher
frequency in the group with stenosis. In the group with
stenosis blood pressure values were signifcantly higher
and required more ofen over 3 antihypertensives. Te
angiographic examination confrms that Doppler vas-
cular ultasonography is an ef cient relatively inexpen-
sive and reproducible examination in the diagnosis of
renal artery stenosis.
89. Activitatea fosfolipazei A2
asociata LDL la pacientii cu
insuficienta cardiaca si fractia
de ejectie conservata
Elena Moldoveanu, Daciana Silvia Marta, M.Serban,
Irina Serban, Lazar Mihai, Sorina Crenguta Serboiu,
Tetsuya Kosaka
INCD in Domeniul Patologiei si Stiintelor Biomedicale
Victor Babes, Bucuresti
Scop: IC se manifesta si la pacientii cu insufcienta
cardiaca (IC) si fractia de ejectie a ventriculului stang
conservata (cFEVS). Diferite studii au gasit proportii
diferite ale cFEVS si anume intre 13-74% din totalul
pacientilor cu IC. Datele din literatura care compara
din punct de vedere clinic si al prognosticului pacientii
cu IC cu fractia de ejectie normala si scazuta sunt con-
tradictorii. Fosfolipaza A2 asociata LDL (LpPLA2) este
un marker al infamatiei vasculare cu o caracteristica
unica find independenta de indicele de masa corporala
si de rezistenta la insulina. Deoarece stresul oxidativ si
infamatia sunt implicate in evolutia IC am investigat
comparativ cu lotul martor(160mmHg). Mai multi
pacienti sunt tratati cu 3 antihipertensive(p<0,01)
la lotul cu stenoza 86,11%, comparativ cu 56,98%-lo-
tul martor.Boala coronariana a fost descoperita in
proportie de 58,33% in lotul cu stenoza, comparativ
19,77% in lotul martor(p<0,01). In lotul cu stenoza am
avut 55,56% dintre pacienti cu arteriopatie periferica
(p<0,001), comparativ 24,42% in lotul fara stenoza.
In lotul cu stenoza de artera renala s-a decelat boa-
la cerebrovasculara(p<0,01) in proportie de 41,67%,
comparativ cu 17,44% din lotul fara stenoza.
Concluzii: Boala coronariana, arteriopatia cronica pe-
riferica si boala cerebrovasculara au o frecventa mult
mai ridicata la cei cu stenoza. In lotul cu stenoza se in-
talneste un numar mai mare de tratamente ce necesita
peste 3 antihipertensive, valorile tensionale find mai
ridicate. Raportarea la angiografe, confrma, ca ultra-
sonografa Doppler vasculara este o metoda efcace, re-
lativ iefina, reproductibila, in diagnosticul stenozei de
artera renala.
Renal artery stenosis -
diagnosis aspects
Objective: Te rapid and accurate diagnosis of renal
artery stenosis with the aid of duplex mode Doppler
ultrasonography, that provides functional information
revealing hemodynamicaly signifcant stenosis (with
more than 60% decrease in arterial diameter). Gui-
ding the screening for renovascular disease implies
identifying the prediction factors associated with this
pathology and its relation to other vascular diseases
(coronary, carotid, peripheral).
Material and method: We included in our study 122
patient with hypertension admitted to hospital and
with a follow-up between 2000 and 2009. Using duplex
mode Doppler ultrasonography we measured a series
of parameters (maximum systolic speed, pulsatility and
resistivity indexes) in the renal artery and interlobar
arteries. Angiographic examination has confrmed the
presence of the stenosis and its severity.
Results: Te 122 patients included in the study were
included in two groups according to the maximum
systolic speed (Max speed >1.8m/s is characteristic for
hemodinamicaly signifcant renal artery stenosis): wi-
thout stenosis 86 patients (70.49%), and with stenosis
36 patients (29.51%). Te average blood pressure was
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Suplimentul A, 2010
102
plicated in HF evolution we investigated LpPLA2 in HF
in function of EF.
Methods: We measured LpPLA2 (spectrophotometric
methods) in 100 patients with HF with NYHA II, III
and IV and 20 controls. Baseline evaluation for pati-
ents with HF included clinical examination, 12-lead
ECG, estimation of NYHA functional class, transtora-
cic echocardiography (lef ventricular ejection fraction
LVEF- and lef ventricular end diastolic diameter -
LVED), and routine laboratory tests.
Results: LpPLA2 activity was higher (412.1 85.29
U/L) in HF patients than in normal (225.65 20.8
U/L). pLVEF patients (ejection fraction > 50) represen-
ted 35% from total HF patients. Te incidence of lef
ventricular hypertrophy was higher in pLVEF patients
than in the patients with ejection fraction < 50, but the
incidence of diabetes was the same. LpPLA2 activity
was higher [444.9 80.6 (U/L) (p<0.002)] in pLVEF
patients than the other [401 74.9 (U/L) (p<0.003)].
Conclusion: Elevated plasma values of LpPLA2 are
in concordance with exacerbated infammatory state
existing in pLVEF patients with lef ventricular hyper-
trophy. Te present study was supported by the Grants
42-146/2008 and PN 09.33.02.06/2009.
90. Adenozin deaminaza
- marker de prognostic la
cardiaca si fractia de ejectie
conservata
Daciana Silvia Marta, M.Serban, Irina Serban, Gabri-
ela Catalin, V.G.Dinca, Simona Tudor, N.Radulescu,
Elena Moldoveanu
INCD in Domeniul Patologiei si Stiintelor Biomedicale
Victor Babes, Bucuresti
Scop: Diferite studii semnaleaza existenta fractiei de
ejectie ventriculare stangi conservate (cFEVS) la 13-
74% din pacientii cu insufcienta cardiaca (IC). Datele
din literatura care compara din punct de vedere clinic
si al prognosticului pacientii cu IC cu fractia de ejectie
(FE) normala si scazuta sunt contradictorii. Adenozin
deaminaza (AD) catalizeaza conversia extracelulara a
adenozinei si a deoxiadenozinei la inozina si respec-
variatia concentratiei Lp-PLA2 in functie de fractia de
ejectie.
Metode: Activitatea plasmatica a LpPLA2 a fost masu-
rata spectrofotometric la 100 pacienti cu IC din clasele
NYHA II, III and IV si la 20 normali. Evaluarea bazala
a pacientilor a inclus: examinarea clinica, ECG cu 12
derivatii, estimarea clasei functionale NYHA, ecocar-
diografe transtoracica (fractia de ejectie ventriculara
stanga si diametrul ventricular stang telediastolic) si
teste de laborator de rutina.
Rezultate: Activitatea plasmatica a LpPLA2 a fost mai
mare la pacientii cu IC (412.1 85.29 U/L) comparativ
cu normalii (225.65 20.8 U/L). Pacientii cu cFEVS
(FE > 50) reprezinta 35% din totalul pacientilor IC. In-
cidenta hipertrofei ventriculare stangi a fost mai mare
in lotul pacientilor cu cFEVS comparativ cu pacientii
cu fractia de ejectie scazuta (EF < 50), iar incidenta
diabetului a fost asemanatoare. Activitatea LpPLA2 a
fost mai mare la pacientii cu cFEVS [444.9 80.6 (U/L)
(p<0.002)] comparativ cu ceilalti [401 74.9 (U/L)
(p<0.003)].
Concluzie: Concentratiile plasmatice crescute ale Lp-
PLA2 sunt in concordanta cu statusul infamator ac-
centuat la pacientii cFEVS cu hipertrofe ventriculara
stanga. Acest studiu a fost fnantat din contractele PN
42-146/2008 si Nucleu 09.33.02.06/2009
Lipoprotein associated
phospholipase A2 activity
in heart failure patients with
preserved left ventricular
ejection fraction
Purpose: It has now been clear established that heart
failure (HF) may occur in patients with preserved lef
ventricular ejection fraction (pLVEF), but diferent stu-
dies reported proportion of preserved ejection fraction
(EF) among patients varying between 13-74%. Te lite-
rature data which compare clinical and prognostic cha-
racteristics of HF patients with pLVEF and low EF are
contradictory. Lipoprotein associated phospholipase
A2 (LpPLA2) is now recognized as a marker of vascular
infammation which has a relative unique characteris-
tic being independent from BMI and insulin resistance.
Because the oxidative stress and infammation are im-
Suplimentul A, 2010
108
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vely. Endogenous adenosine can protect the overloaded
heart against the development of hypertrophy and HF,
in part due to its anti-infammatory activity. Because
the oxidative stress and infammation are involved in
HF progression we investigated the relation between
AD and EF in patients with HF.
Methods: We measured AD (spectrophotometric
methods) in 100 patients with HF with NYHA II, III
and IV and 20 controls. Baseline evaluation for pati-
ents with HF included clinical examination, 12-lead
ECG, estimation of NYHA functional class, transtora-
cic echocardiography (lef ventricular ejection fracti-
on LVEF, and lef ventricular end diastolic diameter
- LVEDD), and routine laboratory tests.
Results: AD activity was higher (14.47 3.61 UI/L) in
HF patients than in normal (7.35 0.63 UI/L). AD ac-
tivity was higher (15.87 3.33 UI/L) in pLVEF patients
than in those with EF < 50% (13.22 2.3 UI/L). Te
incidence of lef ventricular hypertrophy was higher in
pLVEF patients than in patients with EF < 50%.
Conclusion: Te increased values of AD activity in pL-
VEF patients may be correlated with a decreased ade-
nosine concentration, which may in part be associated
to the increased incidence of patients with lef ventri-
cular hypertrophy in pLVEF group and with exacerba-
ted infammatory status existing in these HF patients.
AD may contribute to evaluate HF progression in pL-
VEF patients. Te present study was supported by the
Grants 42-146/2008 and PN 09.33.02.06/2009.
tiv deoxinozina. Adenosina endogena, prin activitatea
ei antiinfamatoare, previne aparitia unor complicatii
cardiace prin suprasarcina (insufcienta ventriculara si
hipertrofe ventriculara). Deoarece stresul oxidativ si
infamatia sunt implicate in evolutia IC am investigat
corelatia dintre AD si FE.
Metode: Activitatea plasmatica a AD a fost masurata
spectrofotometric la 100 de pacienti cu IC din clasele
NYHA II, III and IV si la 20 de normali. Evaluarea ba-
zala a pacientilor a inclus: examinarea clinica, ECG cu
12 derivatii, estimarea clasei functionale NYHA, eco-
cardiografe transtoracica (fractia de ejectie ventricula-
ra stanga si diametrul ventricular stang telediastolic) si
teste de laborator de rutina.
Rezultate: Activitatea plasmatica a AD a fost mai mare
la pacientii cu IC (14.47 3.61 UI/L) comparativ cu
normalii (7.35 0.63 UI/L). Activitatea AD a fost mai
mare la pacientii cu cFEVS (FE > 50) comparative cu
cei cu FE < 50% (13.22 2.3 UI/L). Incidenta hipertro-
fei ventriculare stangi a fost mai mare in lotul pacien-
tilor cu cFEVS comparativ cu pacientii cu FE scazuta
(FE <50).
Concluzie: Valorile crescute ale AD la pacientii cFEVS
ar putea f corelate cu scaderea concentratiei adenozi-
nei, care partial ar putea f asociata cu cresterea inci-
dentei hipertrofei ventriculare stangi in grupul cFEVS
si cu statusul infamator crescut prezent la acesti paci-
enti. AD poate contribui la evaluarea progresiei IC la
pacientii cFEVS. Acest studiu a fost fnantat din con-
tractele PN 42-146/2008 si Nucleu 09.33.02.06/2009
Adenosine deaminase - a
prognostic marker for heart
failure patients with preserved
left ventricular ejection
fraction
Purpose: Several studies reported a proportion of pre-
served lef ventricular ejection fraction (pLVEF) in pa-
tients with heart failure (HF) varying between 13-74%.
Te literature data which compare clinical and prognos-
tic characteristics of HF patients with pLVEF and with
low EF are contradictory. Adenosine deaminase (AD)
catalyzes the extracellular conversion of adenosine and
deoxyadenosine to inosine and deoxyinosine, respecti-
101
ei sistolice (FE) sau cu clasa NYHA de ICC. Cresterea
AUS s-a asociat cu disfunctia diastolica de tip restrictiv.
Nivelul AUS a fost mai mult crescut la bolnavii cu ICC
de etiologie ichemica sau hipertensiva. AUS ar putea
f un biomarker de agravare al ICC, dar sunt necesare
mai multe studii.
Serum uric acid levels
in patients with recent
decompensated chronic heart
failure a new biomarker?
Purpose: Seric uric acid (SUA), a marker of oxidative
stress is involved in the development and evolution of
cardiovascular diseases. Recent studies have suggested
that SUA level is related with the occurrence, evolution
and severity of chronic heart failure (CHF). Te SUA
levels were evaluated in patients with recent decom-
pensation of CHF.
Methods: Screening real world of SUA levels in 90
patients (age 6219 years, 44 men, 46 women) admitted
to the hospital with NYHA II-IV decompensated CHF,
using a colorimetric method. Te patients were un-
der the treatment with ACEI/ARB (93%), betablocker
(81%), diuretics (97%), and digoxin (31%). CHF de-
compensation was due to diet deviations and therape-
utic non-compliance (53%), arrhythmias (29%), acute
coronary syndromes (10%), infections (7%), pulmo-
nary embolism (1%). All patients were assessed clini-
cally, 12 lead ECG, echocardiography (systolic and di-
astolic lef ventricular function) and routine laboratory
tests.
Results: SUA level was increased in 58% of patients.
Te mean SUA level was 7.3 mg/dl (6.7 mg/dl in wo-
men and 7.7 mg/dl in men). All patients had serum
creatinine <2 mg/dl. Te mean SUA level was 7.39mg/
dl in NYHA class II patients, 7.83 ms/dl in NYHA class
III patients and 6.68 mg/dl in NYHA class IV class pa-
tients (p=ns). Mean SUA levels were 7.45mg/dl in pa-
tients with EF> 40 % (62.3% of CHF patients) and 7.15
% in patients with EF <40% (37.7% of CHF patients)
(p=ns). 26% CHF patients had restrictive pattern of di-
91. Nivelul seric al acidului
uric la pacientii cu insuficienta
cardiaca recent decompensate
un nou biomarker?
A.Campeanu, Adriana Iliesiu, D. Nistorescu, B. Stra-
jean, G. Uscoiu, D. Dusceac, T. Nanea
Scop: Acidul uric seric (AUS), un marker de stress oxi-
dative, este implicat in aparitia si progresia bolilor car-
diovasculare. In studii recente AUS pare sa se coreleze
cu aparitia, evolutia si severitatea insufcientei cardiace
cronice (ICC). Scopul studiului este evaluarea nivelelor
AUS la pacienti cu ICC decompensata.
Metoda: S-a determinat AUS la 90 de bolnavi (varsta
medie 62 ani, 44 de barbati si 46 de femi), spitalizati
pentru ICC clasele II-IV NYHA. Balnavii se afau sub
tratament cu inhibitori de enzima e conversie ai angi-
otensinei/ sartani (93%), betablocante (81%), diuretice
(97%), digoxin (31%). Cauzele decompensarii ICC au
fost non-complianta la dieta sau la terapia medicamen-
toasa (53%), tulburari de ritm (29%), sindroame coro-
nariene acute (10%), infectii (10%), tromboembolism
pulmonar (1%). Toti pacientii au fost evaluati clinic,
electrocardiografc, ecocardiografc (functia sistolica si
diastolica) si biologic.
Rezultate: AUS a fost crescut la 58% dintre bolnavi. Ni-
velul mediu al AUS a fost de 7.3mg/dl (6.7mg/dl la fe-
mei si 6.7mg/dl la barbati). Toti bolnavii au avut creati-
nina serica sub 2mg/dl. Valorile medii ale AUS au fost
7.38mg/dl in clasa NYHA II, 7.83mg/dl in clasa NYHA
III si 6.68mg/dl in clasa NYHA IV de ICC (p=ns). La
bolnavii cu fractie de ejectie ( FE) peste 40% (62.3% din
cazuri) nivelul mediu al AUS a fost de 7.45mg/dl iar la
bolnavii cu FE < 40% (37.7% cazuri) nivelul mediu al
AUS a fost de 7.5 mg/dl (p=ns). 26% dintre bolnavi au
avut disfunctie diastolica de tip restrictiv (E/A > 2 sau
E/A >1 si TDE<140msec) iar la acest subgrup de bol-
navi valoarea medie a AUS a fost de 7.9mg/dl . Media
a AUS a fost crescuta la bolnavii cu ICC de etiologie
ischemica sau hipertensiva (7.7mg/dl vs 7.6mg/dl).
Concluzii: ICC decompensata s-a asociat cu cresterea
AUS. Nivelul AUS nu s-a asociat cu parametrii functi-
POSTER I I | POSTER I I
Suplimentul A, 2010
105
POSTER I I
POSTER I I
astolic dysfunction (E/A> 2 or E/A>1 and DTE<140ms)
and the mean SUA level was 7.9mg/dl. SUA mean level
was increased in patients with ischemic or hypertensive
CHF (7.7 and 7.6 mg/dl).
Conclusion: Recent decompensation of CHF was asso-
ciated with elevated SUA. SUA levels was not related
with markers of systolic function (EF) or with NYHA
class, but was related with restrictive pattern of dias-
tolic function. SUA levels were higher in patients with
hypertensive and ischemic CHF. SUA could be a bio-
marker of worsening CHF, but systematic studies are
needed.
92. Corelatii intre NT-proBNP
si disfunctia diastolica de VS la
pacientii cu infarct miocardic
acut
A.Rusali, Lucia Cojocaru, Lucia Cojocaru, Elvira
Craiu
Introducere. Deoarece NT-proBNP este eliberat in cir-
culatie de la nivel cardiac ca urmare a intinderii mio-
cardice secundare incarcarii de presiune si de volum,
nivelurile circulante ale acestuia sunt de asteptat sa se
coreleze cu anomalii de structura si functie cardiace.
Scop: Scopul studiului nostru este de a evidentia pre-
zenta unor corelatii intre nivelurile de NT-proBNP cir-
culante la pacientii cu infarct miocardic acut (IMA) si
disfunctia diasolica a ventriculului stang (VS) la acesti
pacienti.
Material si metoda: Este un studiu prospectiv efectuat
pe 100 de pacienti cu infarct miocardic acut internati in
Clinica de Cardiologie I a SCJU Constanta in perioada
2008-2009. La acesti pacienti s-au determinat nivelurile
circulante de NT-proBNP in primele 24 de ore de la in-
ternare si ecocardiografc, gradul disfunctiei diastolice
a VS.
Rezultate: Am demonstrat o corelatie pozitiva intre ni-
velurile circulante de NT-proBNP si gradul disfunctiei
diastolice a VS (coefcient de corelatie=0,526, p<0,001).
Observam o corelatie mai buna a nivelurilor circulan-
te de NT-proBNP cu stadiul 2 de disfunctie diastolica
comparativ cu stadiul 1 de disfunctie (1 pacient cu dis-
functie diastolica stadiul 2 in Q1, 2 in Q2, 4 in Q3 si 7 in
Q4 de NT-proBNP, p<0,05, in timp ce avem 6 pacienti
cu disfunctie diastolica stadiul 1 in Q1, 3 in Q2, 7 in Q3
si 16 in Q4, cu un p<0,05 pentru diferenta dintre Q1
si Q4). Am demonstrat statistic ca NT-proBNP are o
valoare prediciva puternica fata de aparitia disfunctiei
diastolice a vetriculului stang (aria de sub curba pentru
NT-proBNP = 0,757, p=0,02). NT-proBNP ramane un
predictor puternic al mortalitatii cardiovasculare la 6
luni de urmarire (aria de sub curba =0, 705), in timp ce
disfunctia diastolica are o valoare predictiva slaba fata
de mortalitatea cardiovasculara ( aria de sub curba =
0,577).
Concluzii: Intre NT-proBNP si gradul disfunctiei dias-
tolice al VS exista o corelatie pozitiva, nivelrile acestuia
find un predictor important pentru existenta disfunc-
tiei distolice de VS la pacientii cu IMA. NT-proBNP
este un predictor al mortalitatii cardivasculare post
IMA mult mai puternic comparativ cu prezenta dis-
functiei diastolice de VS.
Correlations between NT-
proBNP and left ventricular
diastolic dysfunction in
patients with acute myocardial
infarction
Introduction. NT-proBNP is released in the circulato-
ry fow because of the myocardial stretch secondary to
the pressure and volume overload, thus it is expected
that plasma levels of NT-proBNP would correlate with
cardiac structure and function abnormalities.
Aim: Te aim of our study is to establish the existence
of correlations between plasma levels of NT-proBNP in
patients with acute myocardial infarction (AMI) and
lef ventricular (LV) diastolic dysfunction.
Material and method: It is a prospective study, on 100
patients with AMI hospitalized in the cardiology clinic
of SCJU Constanta between 2008-2009. In these pati-
ents we determined plasma levels of NT-proBNP in the
frst 24 hours from admission and the level of LV dias-
tolic dysfunction.
Results: We showed a positive correlation between plas-
ma levels of NT-proBNP and the grade of LV diastolic
dysfunction (correlation coef cient=0,526, p<0,001).
We noticed a better correlation between plasma levels
POSTER I I
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Suplimentul A, 2010
106
of NT-proBNP and second degree diastolic dysfuncti-
on compared with frst degree diastolic dysfunction (1
patient with diastolic dysfunction stage 2 in Q1, 2 in
Q2, 4 in Q3 and 7 in Q4 of NT-proBNP, p<0,05, whi-
le we had 6 patients with diastolic dysfunction stage 1
in Q1, 3 in Q2, 7 in Q3 and 16 in Q4, p<0,05 for the
diference between Q1 and Q4). We have established
that NT-proBNP is a powerful predictor for LV diasto-
lic dysfunction (area under the curve for NT-proBNP =
0,757, p=0,02). NT-proBNP remains a strong predictor
for cardiovascular mortality afer 6 months of follow
up (area under the curve =0, 705), while LV diastolic
dysfunction is a weak predictor (area under the curve
= 0,577).
Conclusions: Tere is a positive correlation between
NT-proBNP and the degree of LV diastolic dysfuncti-
on, its levels being a powerful predictor for the exis-
tence of LV diastolic dysfunction in patients with AMI.
NT-proBNP is a much powerful predictor for cardio-
vascular mortality afer AMI compared to LV diastolic
dysfunction.
93. Evaluarea functiei diastolice
a ventriculului stang la
pacientii cu sindrom metabolic
Ana-Maria Vintila, Corina Grigore, Ileana Hantulie,
Simona Avram, Minerva Muraru, I.Bruckner
Obiectiv: Identifcarea unor biomarkeri pentru dis-
functia diastolica a VS la pacienti cu sindrom metabo-
lic.
Materiale si metoda: Studiu prospectiv incluzand 40
de pacienti cu sindrom metabolic, varsta medie 60.2
10.2 ani, la care s-au determinat nivelurile plasmatice
ale factorului von Willebrand, NT-proBNP, proteinei C
reactive (PCR), profl lipidic si s-a efectuat ecocardio-
grafe transtoracica. Toti pacientii au fost in ritm sinu-
sal si cu fractie de ejectie a VS normala. Functia diasto-
lica a VS a fost evaluata prin index de volum al atriului
stang, velocitatea undei E transmitrale (E), timp de de-
celerare a undei E (TDE), raport E/A transmitral, timp
de relaxare izovolumetrica (TRIV), velocitatea undei A
transmitrale (A) si durata acesteia (durA), amplitudi-
nea si durata undei a in vena pulmonara superioara
dreapta, viteza de propagare a fuxului transmitral (vp)
si parametrii de Doppler tisular, incluzand velocitatea
undei E la nivelul inelului mitral (E), velocitatea un-
dei A la nivelul inelului mitral (A) si raportul E/E. Au
fost exclusi pacientii cu boala cardiaca ischemica sau
cu alte conditii cunoscute a infuenta functia endotelia-
la. Riscul cardiovascular global a fost calculat utilizand
programul SCORE.
Rezultate: Valorile plasmatice ale factorului von Wil-
lebrand au fost corelate cu parametrii ecocardiografci
clasici de functie diastolica a VS (A: r=0.514, p=0.001,
E/A: r=-0.483, p=0.002, TDE: r=0.398, p=0.011; TRIV:
r=0.313, p=0.049 si vp: r=-0.389, p=0.014) si cu unii din-
tre parametrii de Doppler tisular (A: r=0.592, p=0.043,
tendinta de corelare cu E/E: r=0.537, p=0.072). NT-
proBNP s-a corelat mai puternic cu parametrii deri-
vati din Doppler tisular (E/E: r=0.787, p=0.007) si cu
indexul de volum al AS (r=0.709, p=0.032), dar a fost
slab corelat cu parametrii derivati din fuxul trans-
mitral. PCR a inregistrat o corelatie cu raportul E/E
(r=0.607, p=0.036) si cu riscul cardiovascular global
(r=0.709,p=0.01). A existat o corelatie intre factorul
von Willebrand si NT-proBNP (r=0.399, p=0.026).
Concluzii: Factorul von Willebrand, NT-proBNP si
proteina C reactiva se coreleaza cu parametrii ecocar-
diografci ai functiei diastolice a VS la pacientii cu sin-
drom metabolic. Strategia multimarker ar putea f utila
in evaluarea afectarii cardiovasculare la aceasta catego-
rie de pacienti.
Evaluation of left ventricle
diastolic function in patients
Objective: To identify possible biochemical markers of
lef ventricular diastolic dysfunction in patients with
metabolic syndrome.
Design and Method: Prospective study of 40 pati-
ents with metabolic syndrome, aged 60.2 10.2 years,
assessed by plasma levels of von Willebrand factor,
NT-proBNP, C reacive protein (CRP), lipid profle
and transthoracic echocardiography. All patients were
in sinus rythm and with normal lef ventricular ejec-
tion fraction. Lef ventricular (LV) diastolic function
was assessed using lef atrium volume index, mitral E
wave velocity (E) and deceleration time (EDT), mitral
E/A ratio, isovolumic relaxation time (IVRT), mitral A
Suplimentul A, 2010
10I
POSTER I I
POSTER I I
Scopul acestui studiu a fost depistarea factorilor de risc
in hipertensiunea arteriala primara la copii. Cercetarea
a fost realizata pe un esantion de 2055 (995 baieti si
1060 fete) subiecti, clinic sanatosi, cu varsta cuprinsa
intre 10 si 18 ani. Au fost stabilite valorile tensiunii ar-
teriale (TA), inaltimea si masa corporala. Obezitatea
a fost apreciata in baza indicelui de masa corporala.
Conform unui chestionar special elaborat s-a studi-
at: greutatea la nastere, durata alimentatiei naturale,
anamneza eredocolaterala etc. In cadrul acestui studiu,
au fost depistati 326 (15,86%) copii cu valori ale tensi-
unii arteriale ce depaseau percentila 90, dintre care 159
(7,7%) copii in diapazonul percentilelor 9094 si 167
(8,1%) copii cu valorile TA ce depaseau percentila 95.
Prevalenta generala a obezitatii in cadrul cercetarii in
cauza este de 1,8% (n=38 copii), iar a supraponderabi-
litatii 5,7% (n=117 copii). Prevalenta hipertensiunii
arteriale la copiii supraponderali, in lotul dat de stu-
diu constituie 36,75% din cazuri, find de 2,6 ori mai
mare decat la copiii normoponderali (14,22%), iar la
copiii obezi 50% (de 3,5 ori) (2=81,84; p<0001). In
studiul nostru, s-a observat o tendinta spre o asociere
intre greutate mica la nastere si valori mai mari ale ten-
siunii arteriale in adolescenta (x2=5,5; p>0,05; p=0,14).
Istoricul familial al patologiei hipertensive se asociaza
cu o prevalenta mai inalta a hipertensiunii arteriale la
descendenti. In cadrul studiului dat, am stabilit ca, in
familiile cu ambii parinti normotensivi, valorile TA la
copiii lor depasesc percentila 90 in 16,98% din cazuri,
in familiile cu un parinte hipertensiv si unul normo-
tensiv in 24,43% cazuri, iar in cele cu ambii parinti
hipertensivi in 30,41% cazuri. Supraponderabilitatea
sau obezitatea, antecedentele familiale de maladie hi-
pertensiva au fost principalii factori de risc depistati la
copiii cu valorile TA peste percentila 90.
Risk factors associated to
arterial hypertension in
children and adolescents
Hypertension in children presents a high interest.
Although the prevalence of pediatric hypertension has
been calculated to be between 1 and 5 percent in SUA,
this number is expected to increase. Te second hyper-
tension is more common in infants and young chil-
dren, while the essential hypertension is more common
in adolescents and has multiple risk factors, including
wave velocity (A) and duration (Adur), amplitude and
duration of a wave in the upper right pulmonary vein
fow, mitral fow propagation velocity (fpv) and tissue
Doppler parameters, including mitral annulus E wave
velocity (E), mitral annulus A wave velocity (A) and
E/E ratio. Patients with ischemic heart disease or other
possible endothelial damaging conditions were exclu-
ded. Te total cardiovascular risk was calculated using
SCORE programme.
Results: Von Willebrand factor was correlated with
classic echocardiographic parameters of LV diastolic
function (A: r=0.514, p=0.001, E/A: r=-0.483, p=0.002,
EDT: r=0.398, p=0.011; IVRT: r=0.313, p=0.049 and fpv:
r=-0.389, p=0.014) and with some tissue Doppler para-
meters (A: r=0.592, p=0.043, trend for E/E: r=0.537,
p=0.072). NT-proBNP was more strongly correlated
with parameters derived from tissue Doppler echocar-
diography (E/E: r=0.787, p=0.007) and with lef atrium
volume index (r=0.709, p=0.032), but was weakly cor-
related with parameters derived from transmitral fow.
CRP was correlated with E/E ratio (r=0.607, p=0.036)
and with total cardiovascular risk (r=0.709,p=0.01).
Tere was also a correlation between von Willebrand
factor and NT-proBNP (r=0.399, p=0.026).
Conclusions: Von Willebrand factor, NT-proBNP and
C reactive protein are correlated with echocardiogra-
phic parameters of lef ventricular diastolic function in
patients with metabolic syndrome. A multimarker stra-
tegy may be useful in evaluating cardiovascular status
in this type of patients.
94. Factorii de risc in
hipertensiunea arteriala la copii
si adolescenti
Lucia Pirtu, M.Rudi, Ina Palii
Universitatea de Medicina si Farmacie Nicolae Tes-
temitanu, Chisinau
Hipertensiunea arteriala la copii prezinta un interes
sporit. Desi incidenta hipertensiunii arteriale la copii
in Statele Unite ale Americii este de 1-5%, ea este in
continua crestere. Hipertensiunea arteriala secunda-
ra este comuna sugarilor si prescolarilor, pe cand cea
primara este mai frecvent intalnita la adolescenti si are
multipli factori de risc, inclusiv obezitatea, antecedente
familiale cardiovasculare, greutate mica la nastere, etc.
POSTER I I
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Suplimentul A, 2010
108
obesity, family history of hypertension, low birth wei-
ght, etc.
Te purpose of the study was to determine the risk
factors associated to essential arterial hypertension in
children. Tis study was performed to assess blood
pressure and some cardiovascular risk factors in, appa-
rently, healthy children, residents of rural and urban
areas from Moldova. Tere were assessed weight, hei-
ght, waist circumference, birth weight, family history
of hypertension. Obesity was assessed on the basis of
body mass index (BMI). According to a specifcally
designed questionnaire, was studied: birth weight, a
family history of hypertension, the duration of natu-
ral feeding. In 2055 children (995 boys and 1060 gir-
ls), aged between 10-18 years were found 326 children
(15,86%) with blood pressure values above 90 percenti-
le (7,74% - percentiles 90 95; 8,12% - over percentile
95). Te prevalence of overweight children is 5,7% and
obese 1,8%. Te prevalence of hypertension increases
signifcantly with BMI. Children with BMI in normal
range had values of blood pressure over 90 percentile
14,22% (n = 262), overweight children 36,75% (n
= 43) and obese 50% (n = 19) ( 2=81,84; p<0001).
In our study, it has been noted a tendency toward the
association between low birth weight and hypertensi-
on in adolescence (2=5,5; p>0,05; p=0,14). Te family
history of pathology of hypertensive patients, especially
in case that mother is hypertensive, is associated with
values of blood pressure over 90 percentile ( 2 = 30,03;
p<0001). In our study, overweight, obesity and fami-
ly history of hypertension (mother with hypertension)
were the main risk factors for hypertension in children
and teenagers.
95. Sunt parametrii Doppler
tisular superiori celor
ecografici conventionali
in studiul hipertensiunii
pulmonare?
Flavia Catalina Antoniu, Catalina Arsenescu
Georgescu
Institutul de Boli Cardiovasculare Prof. Dr. George
Georgescu, Iasi
Scop: Identifcarea valorii predictive a parametrilor
ecografci (standard si Doppler tisular) in studiul hi-
pertensiunii pulmonare, prin comparatie cu datele he-
modinamice.
Material si metoda: Am studiat un lot de 46 pacienti
cu hipertensiune pulmonara, idiopatica sau secunda-
ra (tromboembolism pulmonar, sunturi congenitale,
valvulopatii ale cordului stang, boli parenchimatoase
pulmonare, boli ale tesutului conjunctiv). Datele eco-
grafce au fost comparate cu presiunea pulmonara me-
die obtinuta la cateterismul cardiac, utilizand testul de
corelatie lineara Pearson.
Rezultate: PAP medie a fost de 48,82 mm Hg (DS 18,4
mm Hg). A existat o corelatie puternica pentru PAPs
calculata ecografc (61,33 mm Hg, DS 24,47 mm Hg): r
0,84, p< 0,001. Am obtinut corelatii semnifcative sta-
tistic pentru timpul de acceleratie pulmonara (r -0,56,
p 0,014), TAPSE (r -0,34, p 0,02), indicele TEI pentru
ventriculul drept (r 0,32, p 0,04), fractia de modifcare
sistolica a ariei ventriculului drept (r -0,4, p< 0,01), vi-
teza de contractie izovolumica (r -0,336, p 0,02), unda
E la nivelul inelului tricuspidian (r -0,373, p 0,01), tim-
pul de relaxare izovolumica (r 0,28, p 0,04), timpul de
relaxare izovolumica raportat la intervalul RR (r 0,35,
p 0,01). Nu am constatat corelatii semnifcative statis-
tic pentru indexul de excentricitate diastolic (r 0,21, p
0,22) sau sistolic (r 0,11, p 0,34), acceleratia contractiei
izovolumice (r -0,15, p 0,2), unda S la nivelul inelului
tricuspidian (r -0,085, p 0,3), unda A la nivelul inelu-
lui tricuspidian (r 0,2, p 0,11) si pentru timpul de con-
tractie izovolumica raportat la intervalul RR (r -0,05,
p 0,36).
Concluzii: examinarea Doppler tisular aduce informa-
tii utile in evaluarea hipertensiunii pulmonare, fara a
se dovedi insa semnifcativ superioara examenului eco-
grafc standard. Examenul Doppler tisular a evidenti-
at in special disfunctia diastolica a ventriculului drept
prezenta la pacientii cu hipertensiune pulmonara.
Suplimentul A, 2010
109
POSTER I I
POSTER I I
96. EUROASPIRE III Romania
follow-up: intensificarea
masurilor de schimbare a
stilului de viata a imbunatatit
rezultatele profilului lipidic
Laura Craciun, C.Avram, Adina Avram, Stela Iurciuc,
M.Iurciuc, Daniela Stancila, C.Sarau, Silvia Mancas,
D.Gaita
Timisoara
Scop: Evaluarea benefciului intensifcarii masurilor de
proflaxie primara asupra proflului lipidic la pacientii
asimptomatici cu risc crescut (cu hipertensiune tratati
cu antihipertensive si/sau dislipidemie tratati cu hipo-
lipemiante si/sau diabet zaharat tratati cu medicatie sau
dieta) inclusi in EuroAspire III Romanian Follow-Up.
Material si metoda: Din 503 pacienti eligibili din Eu-
roAspire III Romania, 325 asimptomatici cu risc cres-
cut (varsta 56+9 ani, 62% femei) au fost acceptati in
EuroAspire III Romania Follow-Up. Acesti pacienti au
fost evaluati la un interval fx de 6 luni pe toata peri-
oada studiului de catre medicii de familie ce au par-
ticipat la sesiuni de instruire in vederea intensifcarii
masurilor de schimbare a stilului de viata si optimizarii
terapiei hipolipemiante, special organizate de medicii
cardiologi si diabetologi.
Rezultate: La fnalul perioadei de interventie, am
inregistrat ameliorare semnifcativa pentru colestero-
lul total (235.11+52.98mg/dl versus 203.82+42.25mg/
dl, p<0.001), LDL-colesterol (167.53+39.99mg/dl ver-
sus 118.47+35.50mg/dl, p<0.001), HDL-colesterol
(46.38+10.54mg/dl versus 52.22+14.14mg/dl, p<0.001)
si nivelul seric al trigliceridelor (178.16+135.90mg/dl
versus 159.13+114.29mg/dl, p=0.04). Desi un numar
semnifcativ mai mare de pacienti a atins tinta pentru
colesterolul total (17.5% versus 62%, p<0.001), LDL-
colesterol (8.8% versus 48.4%, p<0.001), HDL-coleste-
rol (58.1% versus 80.8%, p<0.001) si trigliceridele se-
rice (31.3% versus 58.6%, p<0.001), acesta continua sa
fe suboptimal.
Concluzii: Intensifcarea masurilor de preventie a dus
la imbunatatirea proflului lipidic, desi atingerea tinte-
lor conform recomandarilor de ghid ramane subopti-
mala. Rezultatele studiului EUROASPIRE III Romania
Follow-Up ofera o imagine comprehensiva la nivel na-
tional asupra masurilor de identifcare si management
Are tissue Doppler parameters
superior to conventional
echocardiographic ones
in the study of pulmonary
hypertension?
Te aim of the study was to identify the predictive va-
lue of echocardiographic parameters (standard and tis-
sue Doppler) in the study of pulmonary hypertension,
compared to haemodynamic data.
Methods: We studied 46 patients with pulmonary
hypertension, either idiopathic or secondary (pulmo-
nary thromboembolism, congenital lef- right shunts,
lef sided valvulopathies, pulmonary parenchimatous
diseases, connective tissue diseases). Te ehocardio-
graphic data were compared to the mean pulmonary
artery pressure, obtained at the cardiac catheterization.
We used the Pearson correlation test.
Results: Te mean pulmonary pressure was 48,82 mm
Hg (SD 18,4 mm Hg). We noticed a strong correlati-
on for the systolic pulmonary pressure measured using
echocardiography (mean 61, 33 mm Hg, SD 24,47 mm
Hg): r 0,84, p< 0,001. We obtained signifcant correla-
tions for the pulmonary acceleration time (r -0,56, p
0,014), TAPSE (r -0,34, p 0,02), the right ventricle Tei
index (r 0,32, p 0,04), the fractional systolic change of
the right ventricle area (r -0,4, p<0,01), the isovolumic
contraction wave velocity (r -0,336, p 0,02) , the E wave
at the tricuspid annulus (r -0,373, p 0,01), the isovo-
lumic relaxation time (r 0,28, p 0,04), the isovolumic
relaxation time related to RR interval (r 0,35, p 0,01).
We didnt see any statistic signifcant correlation for the
diastolic eccentricity index (r 0,21, p 0,22), the systolic
eccentricity index (r 0,11, p 0,34), the acceleration of
the isovolumic contraction wave (r -0,15, p 0,2), the S
wave at the tricuspid annulus (r -0,085, p 0,3), the A
wave at the tricuspid annulus (r 0,2, p 0,11) and for the
isovolumic contraction time related to RR interval (r
-0,05, p 0,36).
Conclusion: Te tissue Doppler imaging brings use-
ful information for the pulmonary hypertension eva-
luation, but doesnt prove to be signifcantly superior
to conventional echocardiogram. Te tissue Doppler
exam proved to be particularly useful for the study
of diastolic dysfunction in patients with pulmonary
hypertension.
POSTER I I
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Suplimentul A, 2010
110
strong need to intensifcate preventive intervention in
primary care.
97. Cardiomiopatia prin
noncompactare miocardica -
impactul clinic
Geana Alina Caloianu, Marinela Serban, Aura Popa,
Ioana Gheorghiu, A.Rusali, Carmen Ginghina
Scopul studiului: Noncompactarea miocardica este o
afectiune caracterizata de morbiditate inalta prin insu-
fcienta cardiaca, tahiaritmii, in special tahicardie ven-
triculara, si embolii sistemice. Afectiunea este prezenta
de la nastere si se considera ca exista un stadiu preclinic
mai scurt sau mai indelungat, nefind inca foarte clar
stabiliti factorii de pronostic. Ne-am propus sa anali-
zam impactul clinic al cardiomiopatiei prin noncom-
pactare miocardica din punct de vedere al manifestari-
lor clinice majore si al unor parametri ecografci.
Material si metoda: Am analizat retrospectiv un nu-
mar de 30 de pacienti cu varste intre 4 si 63 de ani (var-
sta medie 40,1 ani) dintre care 56,67% femei internati
in perioada 2002-2010 cu diagnosticul de cardiomio-
patie prin noncompactare miocardica. Au fost exclusi
pacientii care prezentau malformatii cardiace asociate
sau valvulopatii. Am analizat pacientii atat din punct
de vedere clinic prin clasa functionala NYHA a insuf-
cientei cardiace cat si din punctul de vedere al functiei
sistolice a ventriculului stang, al tulburarilor de ritm
cardiac sau al complicatiilor embolice. Am avut in ve-
dere date legate de afectarea biventriculara de parame-
tri de asincronism si de insufcienta mitrala.
Rezultate: Din lotul analizat 5 pacienti (16,6%) pre-
zentau afectare biventriculara 3 dintre acestia find
incadrati in clasa functionala III/IV NYHA. Un pro-
cent semnifcativ de pacienti din lot se incadrau in
clasa functionala III/IV NYHA (23% in clasa III, 20%
in clasa IV), acestia avand o afectare mai importanta a
functiei sistolice a ventriculului stang. Fractia de ejectie
a VS a fost scazuta sub 35% la 47% din pacientii din
lotul analizat, find intre 35-50% la 27% dintre acestia.
Toti pacientii afati in clasa I NYHA prezentau frac-
tie de ejectie peste 50%, in timp ce in clasa II NYHA
al factorilor de risc la asimptomaticii cu risc crescut,
reprezentand un model aplicabil si altor centre.
EUROASPIRE III Romania
follow-up: reinforced primary
care improved lipid profile
results
Purpose: To investigate the lipid profle improve-
ment according to ESC 2007 Prevention Guidelines
in asymptomatic high risk patients (without a history
of coronary or other atherosclerotic disease, who have
been prescribed one or more of the following medica-
tions: anti-hypertensive and/or lipid lowering and/or
anti-diabetes treatments - diet and/or oral hypoglycae-
mics and/or insulin) included in the frst EuroAspire
III Follow-Up.
Methods: We followed-up 325 patients (age 569
years, 62% women) out of 503 asymptomatic high risk
patients included in EuroAspire III Romania Primary
Care. Tese patients were evaluated every 6 months for
a period of 18 months of follow-up by general prac-
titioners that participated in a professional training
performed by diabetologists and cardiologists and have
been advised to reinforce lifestyle changes and to opti-
mize hipolipemiant drug therapy in order to reach the
targets mentioned in the current guidelines.
Results: A signifcant improvement was observed
bet ween baseline evaluation and 18 month interven-
tion, for total cholesterol (235.11+52.98mg/dl ver-
sus 203.82+42.25mg/dl, p<0.001), LDL-choleste-
rol (167.53+39.99mg/dl versus 118.47+35.50mg/dl,
p<0.001), HDL-cholesterol (46.38+10.54mg/dl versus
52.22+14.14mg/dl, p<0.001) and serum trygliceri-
des (178.16+135.90mg/dl versus 159.13+114.29mg/
dl, p=0.04). Te percentage of patients reaching lipid
targets increased between 2 times for total cholesterol
(17.5% versus 62%, p<0.001), LDL-cholesterol (8.8%
versus 48.4%, p<0.001), HDL-cholesterol (58.1% versus
80.8%, p<0.001) and serum tryglicerides (31.3% versus
58.6%, p<0.001), but continued to be suboptimal.
Conclusions: Preventive intervention, conducted by
general practitioners, improved the lipid profle in dys-
lipidemic patients, even though the guidelines targets
are far from being achieved. Te datas are similar with
real life lipid management and highlighted that it is a
Suplimentul A, 2010
111
POSTER I I
POSTER I I
was below 35% in 47% of patients in the group exami-
ned and it was between 35-50% in 27% of them. All pa-
tients in NYHA class I showed ejection fraction above
50%, while in NYHA class II low ejection fraction was
present in 76 patients (23% EF <35%, 53%, FE between
35 to 50%) . In class III/IV NYHA patients impaired
systolic function was more important, almost all pa-
tients with NYHA class III having EF <50%, while in
those with NYHA class IV EF was <35%. Association of
mitral regurgitation is also proportional to the clinical
severity assessed by NYHA class. It was mild or absent
in patients with NYHA class I, while three patients in
NYHA class III (42.85%) had moderate regurgitation
and one patient (14.28%) had severe regurgitation. All
patients in NYHA class IV had moderate (4 pacienti
-66.67%) or severe (2 pacienti-33.33%) mitral insuf -
ciency.
98. Asocierea dintre
hiperuricemie si
microalbuminurie la pacientii
hipertensivi cu sindrom
metabolic
Corina Serban, Simona Dragan, Ioana Mozos, Rux-
andra Christodorescu, Lelia Susan, Alina Pacurari,
Monica Susan, Savoiu Germaine, R.Susan, I.Romosan
Timisoara
Obiectiv: Hiperuricemia a fost asociata cu boala car-
diovasculara si este foarte frecventa la persoanele cu
hipertensiune arteriala, sindrom metabolic sau boala
renala.
Scopul acestui studiu a fost compararea valorilor aci-
dului uric seric si microalbuminuriei la pacienti hiper-
tensivi cu sau fara sindrom metabolic (SM) si evaluarea
asocierii dintre hiperuricemie si microalbuminurie la
acesti pacienti.
Material si metoda: Studiul a inclus 50 de pacienti hi-
pertensivi (varsta: 56 5,60 ani) si 41 pacienti hiper-
tensivi cu sindrom metabolic (varsta: 56 3,62 ani).
Diagnosticul SM a fost realizat daca trei dintre urma-
toarele patru criterii au fost indeplinite: 1) indicele de
masa corporala (IMC) > or = 25; 2) tensiunea arteriala
fractia de ejectie scazuta era prezenta la 76 din pacienti
(23% FE<35%, 53%, FE intre 35 si 50%). La pacientii
afati in clasa III/IV NYHA afectarea functiei sistolice
a fost mai importanta, practic toti pacientii cu clasa III
NYHA avand FE<50%, in timp ce la toti cei cu clasa
IV NYHA s-a inregistrat o FE <35%. Asocierea insu-
fcientei mitrale este de asemenea proportionala cu se-
veritatea clinica oferita de clasa NYHA. Era usoara sau
absenta la pacienti din clasa NYHA I, in timo ce trei
pacienti din clasa III NYHA (42,85%) ave regurgitare
moderata si un pacient (14,28%) avea regurgitare seve-
ra. Toti pacientii in clasa IV NYTA aveau insufcienta
mitrala moderata (4 pacienti- 66,67%) sau severa (2
pacienti 33,33%).
Myocardial noncompaction -
clinical impact
Te aim of the study: Myocardial noncompaction is
a condition characterized by high morbidity including
heart failure, tachyarrhythmias, especially ventricular
tachycardia, and systemic embolic events. Te disease
is present from birth and is believed that is has a precli-
nical stage, shorter or longer, but the prognostic factors
are not yet clearly established. We aimed to analyze the
clinical impact of myocardial noncompaction in terms
of major clinical manifestations and ultrasonographic
parameters.
Materials and methods: We retrospectively analyzed
a total of 30 patients aged between 4 and 63 years
(mean age 40.1 years) of which 56.67% were women.
Tey were hospitalized between 2002 and 2010 with
a diagnosis of myocardial noncompaction. We exclu-
ded from our study patients who had associated car-
diac malformations and valvular disease. We analyzed
patients both clinically by NYHA functional class and
also in terms of lef ventricular systolic function, heart
rhythm disturbances or embolic complications. We
took into account data about the parameters afecting
biventricular asyncronism and mitral insuf ciency.
Results: 5 patients (16.6%) from the group examined
showed biventricular noncompaction, three of whom
are situated in functional class III/IV NYHA. A signi-
fcant percentage of patients in our group belonged to
functional class III/IV NYHA (class III - 23%, class IV
- 20%), those having a more important impairment of
lef ventricular systolic function. LV ejection fraction
POSTER I I
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Suplimentul A, 2010
112
> or = 140 mmHg or diastolic blood pressure > or = 90
mmHg; 3) fasting triglycerides > or = 1.7 mmol/L (150
mg/dL), high density lipoprotein cholesterol (HDL-C)
< 0.9 mmol/L (35 mg/dL) in men and <1.0 mmol/L
(39 mg/dL) in women; 4) fasting glucose > or = 6.1
mmol/L (109 mg/dL). Biochemical and haematological
parameters were measured by standard methods. Te
immunoturbidimetric method was used for the mea-
surement of microalbuminuria.
Results: Serum uric acid concentration was signif-
cantly higher in hypertensive patients with metabolic
syndrome than in hypertensive patients (p < 0.001).
Te level of microalbuminuria was found to increase
signifcantly in hypertensive patients with metabolic
syndrome, compared to that of the hypertensive pati-
ents (p < 0.001). We obtained a moderate signifcantly
correlation between serum uric acid and microalbumi-
nuria (r = 0.64, p < 0.001).
Conclusions: Hypertensive patients with metabolic
syndrome have increased serum acid uric levels, mi-
croalbuminuria and serious endothelial dysfunction.
99. Factorii determinati,
localizarea si magnitudinea
dilatarii aortice dupa corectia
coarctatiei de aorta
Madalina Iancu, Ioana Ghiorghiu, Marinela Serban,
Hodo Aneida, Ileana Craciunescu, B.A.Popescu, Car-
men Ginghina
Background: Coarctatia de aorta (CoAo) este asociata
cu un pronostic negativ pe termen lung, chiar si dupa
corectia cu succes chirurgicala sau interventionala.
Formarea de anevrisme si disectia de aorta (Ao), unele
dintre cele mai severe complicatii intalnite la acesti pa-
cienti, sunt, de obicei, precedate de dilatarea Ao.
Obiective: Identifcarea magnitudinii, localizarii si a
principalilor factori determinanti ai dilatarii Ao dupa
corectia CoAo.
Metoda: Grupul de studiu a fost alcatuit din 23 pacienti
cu CoAo operata (varsta medie 28.6 10 ani, 17 de sex
masculin) din 20 subiecti imperecheati ca varsta si sex,
alcatuind lotul de cotrol). Toti pacientii indeplineau
sistolica >or= 140 mmHg sau tensiunea arteriala di-
astolica > or = 90 mmHg; 3) trigliceridele > or = 1,7
mmol/L (150 mg/dL), HDL-colesterolul (HDL-C) <
0,9 mmol/L (35 mg/dL) la barbati si <1,0 mmol/L (39
mg/dL) la femei; 4) glicemia >or= 6,1 mmol/L (109
mg/dL). Parametrii biochimici si hematologici au fost
masurati prin metode standard. Pentru masurarea mi-
croalbuminuriei a fost folosita metoda imunoturbidi-
metrica.
Rezultate: Concentratia acidului uric seric a fost sem-
nifcativ mai mare la pacientii hipertensivi cu sindrom
metabolic comparativ cu pacientii hipertensivi (p <
0,001). Nivelul microalbuminuriei a fost semnifcativ
mai mare la pacientii hipertensivi cu sindrom meta-
bolic comparativ cu cel al pacientilor hipertensivi (p <
0,001). Am obtinut o corelatie semnifcativa moderata
intre nivelul acidului uric seric si microalbuminurie (r
= 0,64, p < 0,001).
Concluzii: Pacientii hipertensivi cu sindrom metabo-
lic au niveluri serice mai mari ale acidului uric si mi-
croalbuminuriei si o disfunctie endoteliala mai severa,
comparativ cu pacientii hipertensivi fara sindrom me-
tabolic.
Association between
hyperuricemia and
microalbuminuria in
hypertensive patients with
metabolic syndrome
Objective: Hyperuricemia has been associated with
cardiovascular disease, and it is particularly common
in people with hypertension, metabolic syndrome, or
kidney disease.
Te purpose of this study was to compare the values of
serum uric acid and microabuminuria in hypertensive
patients with and without metabolic syndrome (MS)
and to evaluate the association between hyperuricemia
and microalbuminuria in these patients.
tensive patients (aged 56 5.60 years) and 41 hyper-
tensive patients with metabolic syndrome (aged 56
3.62 years). Te diagnosis of the MS was made when
three or four of the following criteria were met: 1) body
mass index (BMI) > or = 25; 2) systolic blood pressure
Suplimentul A, 2010
118
POSTER I I
POSTER I I
Methods: Te study group consisted of 23 pts with
successfully repaired AoCo (mean age 28.6 10 years,
17 men) and 20 age- and gender-matched control sub-
jects. Te duration from repair moment was 11,19,5
years. All had clinical and echocardiographic evidence
of successful repair. Te mean value of preak gradient
across AoCo was 23 9.6 mmHg. Tere were 16 hyper-
tensive pts, all on antihypertensive therapy and 14 pts
with bicuspid Ao valves. Pts with Ao valve dysfunc-
tion (stenosis/regurgitation) were excluded. Ao size
was assessed at diferent levels: Ao annulus, Valsalva
sinuses, ascending Ao 3 cm above the Ao valves, and
was normalized to body surface area. Ao stifness was
assessed using an M-mode evaluation of ascending Ao
diameters: systolic (AoS) and diastolic (AoD); Aortic
stifness index (Ao SI) = ln(SBP/DBP)/[(AoS AoD)/
AoD], (SBP, DBP= systolic, diastolic blood pressures).
Results: Ao size was higher in pts than in controls:
111.5 vs 9.90.8 mm/m2 at the annulus level (p=0.04);
18.55.8 mm/m2 vs 151.8 mm/m2 at the level of
Valsalva sinuses (p=0.01); and 17.35.6 mm/m2 vs
13.41.8 mm/m2 at the ascending Ao level (p=0.003).
In the AoCo group, there were 6 pts with a dilated as-
cending Ao> 21mm/m2. Te presence of hypertension
correlated only with ascending Ao diameter (r=0.42,
p=0.048). Te presence of bicuspid Ao valves correla-
ted only with the Ao diameter measured at the level of
Valsalva sinuses (r=0,585, p=0,003). Ao stifness index
correlated with Ao diameter measured at the level of
the annulus (r=0,42, p<0,01), Valsalva sinuses (r=0,67,
p<0,01) and ascending Ao (r=0,756, p<0,01). Age and
gender, type of intervention (surgery/angioplasty), age
at the moment of repair, duration from repair moment
or peak residual gradient at AoCo level did not corre-
late with any of the measured Ao diameters (p>0.05).
Conclusions: Ao dilatation is a frequent and signifcant
problem in AoCo pts even afer successful repair. Te
main determinant of ascending
criteriile clinice si ecocardiografce de corectie cu suc-
cess a leziunii. Valoarea medie a gradientului maxim la
nivelul CoAo a fost 23 9.6 mmHg. 16 pacienti prezen-
tau hipertensiune arteriala (HTA) secundara, cu valori
controlate sub tratament antihipertensiv. 14 pacienti
asociau bicuspidie aortica. Pacientii cu valvulopatii Ao
semnifcative hemodinamic au fost exclusi din studiu.
Dimensiunile Ao au fost determinate la urmatoarele
niveluri: inel, sinusuri Vaalsalva, Ao ascendenta la 3
cm deasupra valvelor aortice; toate diametrele au fost
indexate pe suprafata corporala. Rigiditatea Ao a fost
calculata dupa masurarea diametrelor aortice sistolic
(AoS) si diastolic (AoD). Indexul de rigiditate aortica
(Ao SI) = ln(TAS/TAD)/[(AoS AoD)/AoD], (TAS,
TAD= tensiunea arteriala sistolica, diastolica).
Rezultate: Dimensiunile Ao au fost mai mari in grupul
de pacienti fata de lotul de control: 111.5 vs 9.90.8
mm/m2 la nivelul inelului aortic (p=0.04); 18.55.8
mm/m2 vs 151.8 mm/m la nivelul sinusurilor Valsal-
va (p=0.01); si 17.35.6 mm/m2 vs 13.41.8 mm/m2
la nivelul Ao ascendentel (p=0.003). 6 dintre pacientii
cu CoAo au prezentat o dilare importanta a Ao ascen-
dente > 21mm/m2. Prezenta HTA s-a corelat numai cu
diametrul Ao ascendente (r=0.42, p=0.048). Prezenta
bicuspidiei Ao s-a corelat numai cu diametrul masu-
rat la nivelul sinusurilor Valsalva (r=0,585, p=0,003).
Ao SI s-a corlat cu toate cele 3 diametre masurate- inel
(r=0,42, p<0,01), sinusuri Valsalva (r=0,67, p<0,01) si
Ao ascendenta (r=0,756, p<0,01). Varsta si sexul paci-
entilor, tipul interventiei (chirugie/ angioplastie), var-
sta la care s-a efectuat corectia, durata de la operatie si
pana la data studiului sau gradientul rezidual la
Determinants, pattern and
magnitude of ascending aorta
dilatation in patients with
repaired aortic coarctation
Background: Aortic coarctation (AoCo) is associated
with a long term negative prognosis even afer success-
ful correction. Aneurysm formation and aortic (Ao)
dissection/rupture, some of the most severe complica-
tions found in these patients (pts), are usually preceded
by Ao dilatation.
Objective: Te aim of the study was to identify the
magnitude, pattern and main determinants of Ao dila-
tation afer AoCo repair.
POSTER I I
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Suplimentul A, 2010
111
la 6 din 21 de pacienti (28,57 %), iar in lotul martor la
2 din 19 pacienti (10,52%), decesul de cauz genera-
l a fost inregistrat la 3 pacienti din grupul de studiu
(14,28%) fat de 1 pacient din lotul martor (5,26%). Li-
mitele studiului: Numr mic de pacienti inclusi in stu-
diu; utilizarea unei singure metode de determinare a
rezistentei la antiagregante plachetare, avand in vedere
lipsa unei metode standardizate in prezent; inabilitatea
de a diferentia rezistenta la aspirin vs rezistenta la clo-
pidogrel; neomogenitatea pacientilor inclusi.
Concluzii: Pacientii cu rezistent la antiagregante pla-
chetare sunt mai frecvent obezi, fumtori (cu semnif-
catie statistic) si diabetici. Numrul femeilor in grupul
celor cu rezistent este mai mare fat de numrul feme-
ilor din grupul celor sensibili la antiagregante placheta-
re. Pacientii cu rezistent la antiagregante plachetare au
numr mai mare de trombocite si un MPV crescut fat
de cei fr rezistent, avand semnifcatie statistic. Pa-
cientii cu rezistent la antiagregante plachetare au risc
mai crescut de deces si de evenimente aterotrombotice
cardiovasculare, pe o perioad medie de urmrire de
10.45 luni, (cu semnifcatie statistic). Rezultatele obti-
nute in cadrul studiului sunt comparabile cu datele din
literatur.
Clinical characteristics and
prognosis of patients with
antiplatelet drug resistance
Despite of the fact that antiplatelet drugs has shown
clear beneft in reducing atherothrombotic events, by
using them in primary and secondary prevention, the-
re is however a variable percentage (5-60%) from the
patients who are under treatment with aspirin and clo-
pidogrel which not beneft from the prevention of this
cardiovascular events, this ones being resistant to anti-
platelet drugs.
Te purpose of the study: evaluation of clinical cha-
racteristics, laboratory assessment and appreciation of
the risk of death and cardiovascular events in the study
group, in patients with resistance to antiplatelet drugs
versus those who are sensitive to antiplatelet agents.
Material and method: we retrospectively analyzed a
total of 40 patients (11 women and 29 men), with an-
tiplatelet therapy, aged between 34 and 84 years (mean
age 61.85 years), watch for an average of 10.45 months,
which was assessed antiplatelet drug resistance. Labo-
100. Caracteristicile clinice
si prognosticul pacientilor
cu rezistenta la antiagregante
plachetare
E.G.Botu, Ileana Tepes Piser, Valentina Uscatescu,
C.E.Macarie
Medicatia antiagregant plachetar si-a dovedit bene-
fciul clar in reducerea evenimentelor aterotrombotice,
prin folosirea lor in preventia primar si cea secundar.
Totusi un procent variabil, (5-60%), din pacientii afati
sub tratament cu aspirin si/sau clopidogrel, nu benef-
ciaz de preventia evenimentelor aterotrombotice car-
dio-vasculare, acestia avand rezistent la antiagregante
plachetare.
Scopul studiului: Evaluarea caracteristicilor clinice
si aprecierea riscului de deces si de evenimente ate-
rotrombotice cardiovasculare in cadrul lotului studiat
la cei cu rezistent versus cei sensibili la antiagregante
plachetare.
Material si metoda: am analizat retrospectiv un numr
de 40 de pacienti afati sub tratament antiagregant pla-
chetar (11 femei si 29 barbati), cu varsta intre 34 si 84
ani (varsta medie de 61.85 ani), urmriti pe o perioad
medie de 10,45 luni, la care s-a evaluat rezistenta la an-
tiagregante plachetare. Metoda de laborator utilizat a
fost agregometria optic, pentru care s-au folosit drept
agonisti ai agregrii plachetare ADP-ul si colagenul.
Rezultate: Din lotul utilizat, 21 de pacienti (52,50%)
au fost diagnosticati cu rezistent la antiagregante pla-
chetare (lotul de studiu) si 19 pacienti (47,50%) au fost
sensibili la medicatia antiagregant plachetar (lotul
martor).In lotul de studiu vs lotul martor femeile sunt
6 (28,57%) vs 5 (26,31%), fumtori sunt 11 (52,38%) vs
4 (21,05%), 6 au diabet zaharat (28,57%) vs 5 (26,31%),
cu obezitate sunt 11 (52,38%) vs 3 (15,78%), prezint
dislipidemie 18 (85,71%) vs 17 (89,17%),18 pacienti
(85,71%) s-au prezentat cu SCA vs 15 (78,94%) , iar
stenoz in stent au prezentat 8 pacienti (38,09 %) vs 6
(31,57%). Pacientii din lotul de studiu au un numr mai
mare de trombocite (285.000/mm3) si un MPV crescut
(9,25) fat de pacientii inclusi in lotul martor (nr trom-
bocite=235.000/mm3 si MPV =8,96). Pe o perioad
medie de urmrire de (10,45 luni) au aprut complica-
tii aterotrombotice cardiovasculare in grupul de studiu
Suplimentul A, 2010
115
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101. Efectul aritmic al
Ivabradinei la pacientii cu
boala coronariana
Alina Iacobescu, Sorina Magheru, F.Maghiar,
M.Popescu
Obiective: Ivabradina este primul inhibitor specifc al
nodului sinusal, cu rol in scaderea frecventei cardiac ce
a fost aprobat pentru tratamentul anginei stabile. Por-
nind de la studii deja existente, scopul acestui studiu a
fost de a evalua efectul aritmic al ivabradinei la pacien-
tii cu boala coronariana dovedita angiografc. Studiile
anterioare au monitorizat acest efect la 1 luna dupa ini-
tierea tratamentului cu ivabradina.
Scopul studiului nostru a fost de a evalua durata si dis-
persia intervalului QT si a undei P la 6 luni de la initie-
rea terapiei cu ivabradina.
Material si metoda: Au fost urmariti 30 de pacienti
consecutivi, in ritm sinusal, tratati cu ivabradina mi-
nim 6 luni, cu boala coronariana dovedita angiografc.
Consimtamantul informat a fost obtinut in toate cazu-
rile. Pacientii prezentau medicatie antiaritmica asocia-
ta (blocanti de calciu sau betablocante) dar nu au fost
efectuate modifcari ale dozelor recomandate 3 luni
inainte de includerea in studiu si nici pe parcursul stu-
diului. Tratamentul cu ivabradina a fost timp de 2 sap-
tamani 5mgx2/zi, iar apoi 7.5 mgx2/zi in toate cazurile.
Electrocardiograma a fost efectuata la initierea terapiei
cu ivabradina si apoi lunar in toate cazurile, timp de 6
luni. Durata intervalului QT, durata minima si maxima
a intervalului QT precum si dispersia intervalului QT
au fost calculate la 6 luni de la initierea tratamentului.
Durata minima si maxima precum si dispersia undei
P au fost de asemenea calculate la 6 luni de la initierea
tratamentului cu ivabradina.
Rezultate: Frecventa cardiaca a scazut in toate cazurile
de la 7513 batai/min la 598 batai/min. Nu s-a no-
tat o diferenta intre valorile minime, respectiv maxi-
me ale duratei undei P, si a dispersiei undei P inainte si
dupa tratament. Intervalul QT a fost mai lung la 6 luni,
(41115 ms la 43014 ms, P=0.005), lucru explicabil
prin scaderea frecventei cardiace, intervalul QTc dupa
tratament, find mai mic (452 12 ms vs 4379 ms).
Dispersia intervalului QT a ramas neschimbata dupa 6
luni de tratament (4918 vs 4711).
Concluzie: Intervalul QT a fost prelungit, dar inter-
valul QT corectat, durata unei P si dispersia unei P si
ratory method used was optical aggregometry. We used
as agonists of platelet aggregation ADP and collagen.
Results: from the entire lot, 21 patients (52.50%) were
diagnosed with resistance to antiplatelet agents (study
group) and 19 patients (47.50%) were sensitive to anti-
platelet medication (control group). In the study group
vs control group they are six (28.57%) vs. 5 (26.31%)
women, 11 (52.38%) vs. 4 (21.05%) smokers, six had
diabetes mellitus (28, 57%) vs. 5 (26.31%), 11 (52.38%)
vs. 3 (15.78%) are obese, 18 (85.71%) vs. 17 (89.17%)
presented dyslipidemia, 18 (85.71%) vs. 15 (78.94%)
are presented with ACS, and stenosis in stent had 8
(38,09%) vs. 6 (31,57 %) patients. Patients in the study
group had a higher number of platelets (285.000/mm3)
and an increased MPV (9.25) than patients in control
group (No = 235.000/mm3 platelets and MPV = 8.96).
During a period of 10.45 months, atherothrombotic
cardiovascular complications have appeared in the
study group on 6 of 21 patients (28.57%) and in control
group on 2 of 19 patients (10.52%) and death of ove-
rall cause was recorded in 3 patients in the study group
(14.28%) toward 1 patient in the control group (5.26%).
Te study limits: - Small number of patients included
in the study; we used a single method for determining
the antiplatelet agents resistance, given the lack of a
standardized method currently; the inability of making
the diference between the resistance at aspirin versus
the resistance at clopidogrel; the non homogeneity of
the included patients.
Conclusions: Patients with resistance to antiplatelet
agents are more frequently obese, smokers (statistically
signifcant) and diabetics, and the number of women in
the resistance group is higher than the number of wo-
men in the group with sensitivity to antiplatelet agents.
Patients with resistance to antiplatelet agents have gre-
ater number of platelets and an increased MPV towards
the ones without resistance (statistically signifcant).
Patients with resistance to antiplatelet drugs are at in-
creased risk of atherothrombotic cardiovascular events
and death, for an average follow up of 10.45 months
(statistically signifcant). Te study confrmed that the
results obtained are consistent with literature data.
POSTER I I
POSTER I I
Suplimentul A, 2010
116
102. Relatii intre adiponectina
si factorii de risc
cardiovasculari la pacientii
cu diabet zaharat tip 2 sau cu
intoleranta la glucoza
Oana Vittos, Iulia Teodorescu, Florentina Halici
Medcenter, Bucuresti
Background: Corelatiile dintre adiponectina, infama-
tie si alti factori de risc cardiovasculari sunt indelung
discutate in multiple studii. In plus, se considera ca va-
riatiile genetice ale adiponectinei sunt associate cu bo-
lile metabolice, incluzand diabetul zaharat si intolerant
la glucoza.
Scopul studiului a fost de a investiga 2 grupuri de pa-
cienti, unul cu DZ tip 2 si celalalt cu pacienti cu into-
leranta la glucoza, si anume o serie de factori de risc
cardiovasculari si relatiile acestora cu adiponectina.
Material si metoda: Au fost investigati clinic, electro-
cardiografc si ecocardiografc 65 de patienti, cu var-
ste intre 50 si 78 ani, evaluandu-se urmatorii factori
de risc (IMC, fumatul, tensiunea arterial sistolica si
diastolica, scorul de risc cardiovascular Framingham)
S-au urmarit de asemenea testele de laborator: glicemia
serica, testul oral de toleranta la glucoza, hemoglobina
glicozilata, VSH, PCR, colesterol total, HDL-colesterol,
LDL-colesterol, triglyceride, adiponectina) S-au folosit
T test, corelatii partiale si regresie liniara (SPSS).
Rezultate: S-au observat corelatii negative intre valorile
adiponectinei si glucoza serica in ambele grupuri. Di-
ferente semnifcative statistic au existat intre cele doua
grupuri de pacienti pentru adiponectina (p<0.01), PCR
(p<0.01), HDL-colesterol (p<0.05), IMC (p<0.05). In
grupul cu diabet zaharat, s-a notat o corelare pozitiva
intre adiponectina si HDL-colesterol. Nu s-au observat
corelatii semnifcative statistic intre adiponectina si alti
factori de risc cardiovasculari in grupul cu pacienti cu
intoleranta la glucoza.
Discutii: Adiponectina este un marker cardiovascular
important si poate reprezenta de asemenea si un pre-
dictor al bolilor metabolice. Studii ulterioare sunt nece-
sare a evalua rolul adiponectinei ca predictor al bolilor
cardiovasculare si metabolice.
a intervalului QT au ramas nemodifcate dupa 6 luni
de tratament. Nu se poate dovedi existenta unei relatii
intre tratamentul cu ivabradina si aparitia tulburarilro
de ritm atriale sau ventriculare la bacientii cu boala co-
ronariana.
Arrhythmic effects of
Ivabradine in patients with
coronary artery disease
Objectives: Ivabradine is the frst specifc heart rate-
lowering agent that has completed clinical develop-
ment for stable angina pectoris.
Te aim of the present study was to investigate the
efects of ivabradine therapy on P-wave duration, dis-
persion and QT duration, dispersion in coronary artery
disease patients.
Methods: Te study population consisted of 21 patients
with CAD who have confrmed by coronary angiogra-
phy previously. Written informed consent was obtained
in all patients. Twelve-lead electrocardiogram was re-
corded for each subject at a rate of 50mm/s on admissi-
on and repeated afer 6 months ivabradine therapy. QT
duration, QT dispertion, maximum and minimum QT
duration calculated. Maximum and minimum P wave
and P wave dispersion has been calculated.
Results: Heart rate was decreased afer ivabradine the-
rapy. (7513 and 598, P=0.02).Tere was no diferen-
ce between Pmax, Pmin and Pdis values before and af-
ter treatment. QTmax value was prolonged afer treat-
ment. (41115 and 43014, P=0,005) but there was
no diference between cQTmax value.( 452 12 and
4379) Tere was no diference between QTdis values
before and afer treatment. (4918 & 4711). QTmax
was prolonged afer ivabradine therapy but cQTmax,
Pdis, QTdis were not prolonged.
Conclusion: Tere is no relationship between ivabradi-
ne therapy and increased risk of ventricular and atrial
arrhythmia in coronary artery disease patient.
Suplimentul A, 2010
11I
POSTER I I
POSTER I I
103. Profilul de risc
cardiovascular al pacientilor
cu sept sigmoid gasit
ecocardiografic
Jzmin Buzogny, A.Frigy, Annamria Antal,
C.Podoleanu, E.Carasca
Spitalul Clinic Judetean, Clinica Medicala IV, Targu
Mures
Septul sigmoid (SIS), caracterizat de bombarea porti-
unii a septului interventricular spre tractul de ejectie a
ventricolului stang, este gasit ecocardiografc de regula
la bolnavii varstinici si/sau hipertensivi. Ne-am propus
caracterizarea proflului de risc cardiovascular al paci-
entilor cu aceasta modifcare.
Metoda: Din cei 1460 pacienti examinati in cursul anu-
lui 2009 in laboratorul nostru de ecocardiografe la 74
pacienti (39 barbati, 35 femei, varsta medie 67,4 10,4
ani) am gtsit descrierea de SIS in buletinul ecografc.
Pacientii cu patologie mitrala si aortica moderata/seve-
ra, respectiv cazurile de cardiomiopatie hipertrofca au
fost excluse din analiza. Date clinice, paraclinice si eco-
cardiografce au fost culese la fecare pacient in vederea
caracterizarii proflului de risc cardiovascular.
Rezultate: Prezenta SIS a fost asociata cu hipetrofe
septala in 54% si cu hipertrofe a peretelui posterior in
32,5%. Numai in 3 cazuri am gasit obstructie semnif-
cativa (viteza maxima > 3 m/s) a tractului de ejectie.
Modifcarile degenerative (calcifcari, ingrosare) ale
valvei aortice si mitrale au fost frecvente (60,8%, re-
spectiv 65,5%). Functia sistolica a ventricolului stang
a fost pastrata in 95%, in timp ce disfunctia diastolica
a fost prezenta in 49,55 din cazuri (majoritatea relaxare
alterata). Cardiopatia ischemica era prezenta in 47,3%,
fbrilatia atriala in 33,8%, iar hipertensiunea pulmona-
ra semnifcativa in 14,9%. Dintre factorii de risc clasici
hipertensiunea arteriala era prezenta 67,5%, hiperco-
lesterolemia in 41,9% iar hipertrigliceridemia in 39,2%.
Concluzii: Pacientii cu SIS prezinta un grup cu risc
cardiovascular crescut datorita varstei avansate, cumu-
larii factorilor de risc clasici, prevalentei crecute a car-
diopatiei ischemice si leziunilor valvulare degeneratve,
precum si a asocierii frecvente a disfunctiei diastolice
ventriculare stangi.
Relationships between
adiponectin and some
cardiovascular risk factors in
patients with diabetes mellitus
type 2 or glucose intolerance
Background: Te relationships between adiponectin,
infammation and other cardiovascular risk factors are
well discussed in various studies. Moreover, its seems
that his genetic variations are associated with metabo-
lic disease, including glucose intolerance and diabetes.
Our aim was to investigate 2 groups of patients, one
with diabetes mellitus type 2 controlled under treat-
ments and the other one with glucose intolerance, re-
garding various cardiovascular risk factors and their
relationship with adiponectin.
Material and method: 65 patients age range (50-78
yrs) were clinically evaluated (clinically, BMI, habit of
smoking, systolic and diastolic arterial pressure, car-
diovascular risk score Framingham, electrocardiogra-
phy and echocardiography) and laboratory test were
done (serum glucose, oral glucose tolerance test,HbA1,
VSH, CRP, leucocytes, total cholesterol, HDL-choles-
terol, LDL-cholesterol, trygicerides, adiponectin). T
test, partial correlation and liniar regression were used
(SPSS).
Results: We noticed a negative correlation between
adiponectin values and serum glucose levels in both
studied groups. Tere were found signifcant statisti-
cally diferences between 2 groups of patients regarding
adiponectin (p<0.01), CRP (p<0.01), HDL-cholesterol
(p<0.05), BMI (p<0.05). In group with diabetes melli-
tus patients there was a positive correlation between
adiponectin and HDL-cholesterol. We also found posi-
tive correlation between. Tere were no signifcant cor-
relations found between adiponectin and other cardio-
vascular risk factors in group with glucose intolerance
patients.
Discussions: Adiponectin is an important marker of
cardiovascular disease and could be also a valuable
predictor of glucose intolerance. Further studies need
to be done to evaluate role of adiponectin in predicting
CVD and metabolic diseases.
POSTER I I
POSTER I I
Suplimentul A, 2010
118
104. Tratamentul cu alprostadil
la pacientii cu boala arteriala
periferica - de la recomandarile
ghidului la experienta clinica
F.Purcarea, Aura Popa, Carmen Ginghina
Premize si scop: Tratamentul cu prostaglandine E1
e prezentat sub diferite grade de recomandare in ghi-
durile pentru managementul pacientilor cu boala ar-
teriala periferica. Ne-am propus sa studiem efectele
terapeutice ale alprostadilului la un lot de pacienti cu
arteriopatie obliteranta stadiile III si IV dupa clasifca-
rea Fontaine.
Material si metoda: Au fost analizati retrospectiv 25
de pacienti consecutivi (varsta medie 61ani, 20 barbati)
cu boala arteriala periferica stadiile III si IV Fontaine
fara solutie de revascularizare, internati in sectia de
cardiologie in perioada ianuarie 2009 - mai 2010. Toti
pacientii au primit timp de 30 zile alprostadil 20 micro-
grame 2 fole diluate in 250 ml ser fziologic perfuzie
intravenoasa de 2 ori pe zi. Au fost evaluate pentru toti
pacientii: prezenta durerii de repaus si pragul de clau-
dicatie inainte si dupa tratamentul cu alprostadil. S-a
considerat raspuns pozitiv la tratament fe disparitia
durerii de repaus fe cresterea pragului de claudicatie
cu peste 50 m.
Rezultate: Din lotul total, 18 pacienti au descris creste-
rea distantei de mers cu cel putin 50 m, iar din cei 6 pa-
cienti cu durere de repaus 4 au descris disparitia durerii
dupa 30 zile; 12 pacienti au prezentat leziuni trofce din
care 8 au prezentat ameliorare, iar 3 pacienti au evoluat
catre amputatie. Au fost instrumentati angiografc 23
pacienti. Din grupul pacientilor cu cresterea distantei
de mers la 30 zile 63% au avut doar afectare arteria-
la inalta (iliaca si femurala), 6% doar afectare arteriala
joasa (poplitee si tibiala), iar 31% afectare mixta. 83%
din pacientii hipertensivi, 73% din pacientii diabetici,
76% din pacientii fumatori, 73% din pacientii dislipide-
mici, 60% pacientii cu boala renala cronica si 64% din
pacientii cu sindrom infamator au prezentat cresterea
distantei mers la 30 zile.
Concluzii: Tratamentul cu alprostadil la pacientii cu
arteriopatie obliteranta stadiile III si IV Fontaine im-
bunatateste evolutia prin cresterea distantei de mers cu
peste 50 m si ameliorarea durerii de repaus dupa 30 zile
de tratament.
Cardiovascular risk profile
of patients with sigmoid
interventricular septum found
by echocardiography
Sigmoid interventricular septum (SIS) is characteri-
zed by a protrusion of the basal septum toward the lef
ventricular outfow tract and is encountered mainly in
elderly and/or hypertensive patients. We proposed to
evaluate the cardiovascular risk profle of the patients
presenting this fnding.
Methods: From the 1460 patients examined in our
echo lab during 2009 we found 74 patients (39 men, 35
women, mean age 67,410,4 years) with description of
sigmoid septum in the echo report. Te patients with
moderate-severe aortic and mitral valve disease and
cases of hypertrophic cardiomyopathy were excluded
from analysis. Relevant clinical, laboratory and echo
data were collected at each patient, for characterising
their cardiovascular risk profle.
Results: Te presence of SIS was associated in 54%
with septal and in 32,5% with lef ventricular posterior
wall hypertrophy. Only in 3 cases we found a signifcant
outfow tract obstruction (peak velocity > 3 m/s). De-
generative modifcations of the aortic and mitral val-
ve (calcifcations, increased thickness) were observed
frequently (60,8% and 65,5%). We found a preserved
lef ventricular systolic function in 95% of the patients,
while diastolic dysfunction was present in 49,5% (ma-
inly impaired relaxation). Coronary heart disease was
present in 47,3%, atrial fbrillation in 33,8% and signif-
cant pulmonary hypertension in 14,9% of the patients.
Among the classical risk factors hypertension was pre-
sent in 67,5%, elevated cholesterol in 41,9%, and hyper-
trigliceridemia in 39,2% of cases.
Conclusions: Patients with SIS have a high cardio-
vascular risk due to advanced age, cummulation of
classical risk factors, and due to the high prevalence
of degenerative valvular lesions and coronary disease,
frequently associated with lef ventricular diastolic dys-
function.
Suplimentul A, 2010
119
POSTER I I
POSTER I I
105. Factorii prognostici
ai respitalizarii precoce
in insuficienta cardiaca: o
abordare pragmatica
Madalina Dasoveanu, Raluca Ianula-Ciomag, Anca
Popa, Crina Sinescu
Spitalul Clinic de Urgenta "Prof. Dr. Bagdasar-Arseni",
Bucuresti
Insufcienta cardiaca (IC) este o problema majora de
sanatate publica, cu o incidenta si prevalenta crescan-
da. IC decompensata este o cauza majora de spitalizare
si se asociaza cu o rata crescuta de mortalitate.
Scopul acestui studiu este de a evalua valoarea markeri-
lor clinici, ecografci si biologici care ar putea sa prezica
respitalizarea pacientilor cu IC de origine ischemica.
Am incercat sa dezvoltam un model pentru prezicerea
respitalizarii in IC folosind variabile usor accesibile in
practica clinica.
Material si metoda: A fost un studiu prospectiv care
a inrolat 510 pacienti (292 barbati si 218 femei) spi-
talizati in clinica noastra intre noiembrie 2007 si de-
cembrie 2008 cu IC de etiologie ischemica, avand FE
45%. Evenimentul cardiac a fost defnit ca respitalizare
pentru IC. Pe perioada urmaririi, 49 de pacienti au ie-
sit din studiu datorita instalarii fbrilatiei atriala, a fut-
terului atrial sau stroke. Toti pacientii au benefciat in
prima zi de spitalizare de o ecocardiografe si de deter-
minari biologice. Valoarea Cut-of pentru NT-proBNP
a fost considerata 400 ng/l. Dintre parametrii analizati,
cel mai bine s-au corelat cu respitalizarea dilatarea de
atriu stang (p=0.0007) (valoarea cut-of a diametrului
antero-posterior indexat la suprafata corporala a fost
de 26 mm/m2), NT-proBNP crescut (p=0.003), clasa
NYHA III-IV (p=0.003), FE 45-55% (p= 0.0005). Mari-
mea atriului stang si nivelul NT-proBNP sunt mai utili
pentru evaluarea riscului de respitalizare la pacientii cu
IC de etiologie ischemica decat alti parametri ecogra-
fci sau biologici. Combinatia celor doi parametri are
putere mare de prezicere a respitalizarii. Alte variabile
precum anemia, functia renala si semnele eco-Doppler
de presiune de umplere crescuta a VS, desi au valoare
prognostica semnifcativa la analiza univariabila, isi pi-
erd valoarea la analiza multivariabila.
Alprostadil treatment in
patients with peripheral arterial
disease - from the guidelines
recommendation to the clinical
experience
Premises and purpose. Te treatment with prostaglan-
dins E1is described under diferent grades of recom-
mendation in the guidelines for the management of pa-
tients with peripheral arterial disease. We studied the
efects of alprostadil in patients with peripheral arterial
disease stages III and IV in Fontaine classifcation.
Methods: We made a retrospective analysis of 25 con-
secutive patients (mean age was 61, 20 were men) with
peripheral arterial disease stages III and IV Fontaine
without interventional solution. Te patients were trea-
ted in our cardiology department from January 2009
to May 2010. All patients received daily intravenous
administration of 20 g alprostadil in 250 ml saline
solution twice per day for 30 days. We evaluate for all
patients: the rest pain and the walking distance before
and afer alprostadil treatment. We consider a positi-
ve treatment response the increase of walking distance
with 50 m or the absence of rest pain afer 30 days.
Results: 18 patients from the total group described
an increase in walking distance more than 50 m and
4 patients from the 6 patients group with rest pain
were painless afer 30 days of treatment. 12 patients
had trophic changes and afer 30 days of treatment 8
of them were better and 3 sufered amputation. 23 pa-
tients had made an angiography before the treatment
with alprostadil. In the group of patients with increase
in walking distance more than 50 m afer 30 days of
treatment 63% had only high arterial lesions (iliac and
femoral), 6% had only lower arterial lesions (popliteal
and tibial ) and 31% had combined arterial lesions. 83%
of hypertensive patients, 73% of diabetic patients, 76%
of smokers, 63% of patients with hypercholesterolemia,
60% of patients with kidney disease and 64% of pati-
ents with infammatory syndrome had an increase in
walking distance more than 50 m afer 30 days of treat-
ment with alprostadil.
Conclusions: Alprostadil therapy in patients with pe-
ripheral arterial disease stages III and IV Fontaine in-
crease the walking distance more than 50 m and could
relieve the rest pain afer 30 days of treatment.
POSTER I I
POSTER I I
Suplimentul A, 2010
120
106. Influenteaza varsta si sexul
pacientilor prognosticul dupa
STEMI? Date din registrul
national de infarct miocardic
acut cu supravenivelare de ST
V.Vintila, Oana Enescu, C.Stoicescu, C.Udroiu,
Berenice Suran, P.Stanciulescu, S Garbea, I Malaescu,
Context: Accesul rapid la terapia de reperfuzie este
mandatorie pentru supravietuirea unui paient cu in-
farct miocardic cu supradenivelare de ST. Sunt date
care sugereaza diferente de prognostic pe termen scurt
in functie de varsta si sexul pacientilor.
Obiective: Am analizat infuenta varstei si sexului pa-
cientilor asupra accesului la terapia de reperfuzie in ca-
drul populatiei cu infarct miocadic cu supradenivelare
de ST inrolata de-a lungul a 11 ani in registrul national
de infarct miocardic, ROSTEMI.
Metoda: Au fost analizate retrospectiv datele medica-
le a 12894 pacienti, inrolati intre 1997 si 2008. 8866
pacienti au fost barbati (69%, p<0.05). Varsta medie a
acestora a fost de 6012 ani, in timp ce femeile au fost
semnifcativ mai in varsta, 6811 ani (p=0.001).
Rezultate: Accesul la treapia de reperfuzie a fost dife-
rentiat, 41% dintre barbati find internati in primele 3
ore de la debutul simptomatologiei vs. 28% dintre femei
(p<0.001); intre 3 si 6 ore, un numar mai mare de femei
au fost intrenate (31% barbati vs. 40% femei, p<0.001).
la internare femeile prezentau un tablou clinic mai se-
ver, cu o incidenta mai mare a socului cardiogen (8.8%
femei vs. 5.7% barbati, p<0.05). Tehnicile de repefuzie
postinfarct au fost utilizate predominant in cazul bar-
batilor: 53% vs. 40% pentru repefuzia farmacologica
(p<0.05), respectiv 3.4% vs. 2.5% pentru PCI primar
(p<0.05). Angioplastia coronariana de salvare precum
si angioplastia electiva dupa infarctul miocardic acut
au fost mai frecvent utilizate in cazul barbatilor, 7.2 %
vs. 4.6%, p<0.01. Terapia adjuvanta reperfuziei (anti-
agregante, anticoagulante, beta blocante, inhibitori ai
enzimei de conversie, statine) a fost utilizata in pro-
cente mai inalte la barbati. Consecutiv, pacientii de sex
masculin au avut un prognostic post infarct pe termen
scurt mai bun: soc cardiogen 1.4 % vs. 2.0%, insufcien-
ta cardiaca 20.5% vs. 26.1%, mortalitate totala 10.4% vs.
18.5%, (pt. toate p<0.01).
Factors predicting early
re-hospital isation in heart
failure: a pragmatic approach
Chronic heart failure (CHF) is a major public health
problem, with an increasing incidence and prevalen-
ce. Acute decompensate heart failure is a major cause
of hospitalization and is associated with high rates of
mortality and repeated hospitalizations. In this very
high risk group of patients, early prognostic stratifcati-
on may be useful in order to guide treatment intensity.
Te aim of this study was to assess the value of clinical,
echocardiographyc and biochemical markers which
could predict new hospitalization in patients with HF
of ischemic origin.
Material and method: We tried to develop a model for
predicting re-admission for HF using variables easily
assessable in clinical practice. Five hundred ten con-
secutive patients with HF of known ischemic origin
(292 males and 218 females, mean age 66,4 years) ha-
ving an EF >/= 45% were prospectively included in the
study between November 2007 and December 2008.
Te cardiac event was defned as re-admission for HF.
During the follow-up period, 49 patients (27 males and
22 females) were excluded because of new onset atri-
al fbrillation, atrial futter or stoke. All subjects had a
baseline echocardiographic and NT-proBNP measure-
ments (in the day of admission). Te cut-of value for
NT-proBNP was 400 ng/l. Te cut-of of 26 mm/m2 for
LA anteroposterior linear dimension indexed to body
surface area defnes, according to the recommendations
of the European Society of Cardiology, the lower limit
of a moderately abnormal LA. Among HF of ischemic
origin patients, indexed LA size and NT-proBNP levels
are more useful to stratify the risk of rehospitalisation
than others clinical, echocardiographic or biochemical
variables. Te combination of these two parameters
should be considered for predicting rehospitalization
in patients with HF. Important prognostic variables like
anaemia, renal function and echo-Doppler signs of in-
creased ventricular flling pressures, though signifcant
at invariable analysis, lost their value at multivariable
analysis.
Suplimentul A, 2010
121
POSTER I I
POSTER I I
Conclusions: Late presentation, higher age, and a less
aggressive treatment strategy can explain the worse
short term prognosis in female patients with STEMI.
107. Acidul uric - factor de
risc la pacientii cu sindroame
coronariene acute
Roxana Mustafa Edme, O.Istratoaie, D.D.Ionescu
Scop: Hiperuricemia se insoteste de cresterea produc-
tiei de radicali liberi de oxigen, stimuleaza infamati-
ei si induce disfuntie endoteliala. Studiul isi propune
sa determine prevalenta hiperuricemiei la pacientii
cu sindroame coronariene acute (SCA), sa stabileasca
corelatia acidului uric cu factorii de risc coronarieni
clasici- HTA, diabet zaharat, dislipidemie, sindrom
metabolic, hsCRP, cu clasa Killip, functia sistolica si di-
astolica VS si aparitia complicatiilor precoce.
Metoda: Au fost urmariti 100 pacienti cu SCA inter-
nati in primele 3 luni ale anului 2010 la care s-a facut
evaluare clinica, EKG, examinare ecocardiogafca, s-au
dozat nivelul acidului uric, glicemia, colesterolul, tri-
gliceridele, RFG, hsPCR, troponina T, clasa Killip si am
urmarit aparitia complicatiilor.
Rezultate: Lotul ales a inclus 37pacienti cu infarct mi-
ocardic (15 pacienti cu STEMI si 22 cu NSTEMI) si 63
cazuri de angina pectorala instabila. Cresterea nivelului
acidului uric a aparut la 65p (65%), cu o valoare medie
de 8.23mg/dl, fara diferenta intre cele 2 tipuri de SCA.
Hiperuricemia se coreleaza cu prezenta sindromului
metabolic- r=0.78(p=0.03), cu prezenta hipertensi-
unii arteriale r=0.68(p=0.05) si cu valoarea hs PCR-
r=0.75(p=0.004). In lotul de pacienti fara sindrom me-
tabolic sau insufcienta renala, hiperuricemia se core-
leaza cu clasa Killip (r=0.76, p=0.04) si cu valoarea FE,
fara corelatie cu alte complicatii precoce.
Concluzii: Hiperuricemia este prezenta la 65% din pa-
cientii cu SCA, se coreleaza cu prezenta sindromului
metabolic, hipertensiunii arteriale, cu valoarea hs PCR
si se coreleaza independent cu clasa Killip si valoarea
FE. Acidul uric desi strans legat de alti factori de risc se
coreleaza independent cu infamatia si cu disfunctia VS
la pacientul cu SCA.
Concluzii: Prezentarea intarziata, varsta mai avansata
si o strategie terapeutica mai putin agresiva pot explica
prognosticul pe termen scurt mai rezervat in cazul fe-
meilor cu infarct miocardic acut cu supradenivelare de
segment ST.
Does gender and age influence
the prognosis of patients
after STEMI? Data from the
Romanian STEMI registry,
ROSTEMI
Background: Fast access to reperfusion treatment of
a STEMI patient is mandatory for survival. However,
there are data suggesting diferences based to age and
gender of patients, infuencing the short-term progno-
sis.
Objective: We assessed age and gender diferences for
the access to reperfusion therapy in the population
with STEMI, enrolled over 11 years in the Romanian
ST-elevation myocardial infarction registry.
Method: 12894 patients, enrolled between 1997 and
2008, have been analyzed retrospectively from the me-
dical records, using a nationwide database. 8866 were
males (69%, p<0.05), with a mean age of 6012 years,
whereas women were signifcantly older (6811 years,
p=0.001).
Results: Access to reperfusion therapy was diferent:
41% of men were admitted to the hospital in the frst
3 hours from the onset of myocardial infarction (MI)
versus 28% of women; 31% of men were admitted af-
ter 6 hours versus 40% of women (both p<0.001). On
admission, women were more severe, with higher inci-
dence of cardiogenic shock (8.8% versus 5.7%, p<0.05).
Pharmacological reperfusion and primary PCI were
predominantly used in men: 53% vs. 40%, and 3.4%
versus 2.5%, respectively (both p<0.05). Similarly, re-
scue and elective PCI were more frequently used in
men: 7.2% versus 4.6% (p<0.01). Concomitant thera-
py (antiplatelets, anticoagulants, beta-blockers, ACE-
inhibitors, statins) were used in a higher rate for men.
Consequently, men had a better short term prognosis
that women: cardiogenic shock 1.4% versus 2.0%, heart
failure 20.5% versus 26.1%, death 10.4% versus 18.5%
(all p<0.01).
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Suplimentul A, 2010
122
108. Regresia hipertrofiei
ventriculare stangi dupa
protezare valvulara aortica
pentru stenoza aortia - corelatii
clinice
R.A.Sascau, C.Statescu, Catalina Arsenescu Georgescu
Institutul de Boli Cardiovasculare Prof.dr. George I.M.
Georgescu, Iasi
Scop: Efectele regresiei masei ventriculare stangi asu-
pra evolutiei clinice dupa protezarea valvei aortice ra-
man inca insufcient dovedite. Acest studiu are intentia
sa stabileasca impactul proflului clinic al pacientilor
referiti pentru protezare valvulara aortica asupra evo-
lutiei postoperatorii in mod particular privind regresia
masei ventriculare stangi (MVS).
Metoda si rezultate: 130 pacienti consecutivi protezati
valvular aortic pentru stenoza aortica au fost urmariti
prospectiv timp de 2 ani. S-a efectuat o analiza uni sau
multivariata asocierii supravietuirii postoperatorii cu
regresia MVS si caracteristicile clinice ale pacientilor.
MVS a scazut in medie de la 190 43 la 158 70 g/m2
(p < 0.001). Varsta avansata, clasa functionala NYHA,
fractia de ejectie ventriculara stanga (FEVS) scazuta,
asocierea hipertensiunii arteriale si un index de masa
ventriculara stanga (IMVS) crescut preoperator au fost
asociati cu o reducere a supravietuirii postoperatorii. 5
decese s-au inregistrat imediat postoperator si 20 dece-
se la distanta postoperator pe parcursul urmaririi. Cu
toate acestea gradul regresiei MVS nu a infuentat re-
zultatele clinice, desi precoce postoperator (sub 6 luni)
regresia MVS a fost asociata cu rezultatele pe termen
mediu.
Concluzii: Supravietuirea dupa protezare aortica este
in principal determinata de statusul functional cardi-
ac sistemic preoperator. Gradul regresiei MVS nu se
coreleaza cu rezultatele clinice, in timp ce tratamentul
agresiv al hipertensiunii arteriale poate imbunatati su-
pravietuirea postoperatorie.
Uric acid as risk factor in
syndrome
Purpose: Hyperuricemia is related to increased free ra-
dicals, stimulates infammation and produces endothe-
lial dysfunction. Te purpose of our study is to deter-
mine the prevalence of hyperuricemia in patients with
acute coronary syndrome (ACS), to fnd if hyperurice-
mia correlates with classical risk factors- hypertension,
diabetes mellitus, metabolic syndrome, hs CRP, Killip
class, LV systolic and diastolic function and early com-
plications.
Method: We evaluated 100 patients with ACS admited
in the frst 3 months of 2010. We performed a physical
examination in each case, an ECG, echocardiogram,
we measured uric acid , glycemia, cholesterol, triglyce-
rides, GFR, hs CRP, troponin T, Killip class and we
checked for complications.
Results: We included 37 pts with myocardial infarction
(15 pts with STEMI and 22 pts with NSTEMI) and 63
pts with unstable angina. Increased uric acid was found
in 65 pts (65%), mean value was 8.23 mg/dl, without
diference between the 2 types of ACS. Hyperuricemia
correlates with the presence of metabolic syndrome-
r=0.78 (p=0.03), with hypertension- r=0.68(p=0.05)
and with hs CRP- r=0.75 (p=0.004). In the group of pts
without metabolic syndrome or chronic kidney disea-
se, hyperuricemia correlates with Killip class - r=0.76
(p=0.04) and with EF and it does not correlate with
other early complications.
Conclusion: Hyperuricemia was found in 65% of pts
with ACS, correlates with metabolic syndrome, hyper-
tension, hs CRP, Killip class and EF; uric acid correla-
tes with infammation and LV dysfunction in pts with
ACS.
Suplimentul A, 2010
128
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POSTER I I
109. Analiza riscului
cardiovascular la pacientii
cu sindroame coronariene
acute fara supradenivelare de
segment ST
Alexandra Fleancu, Elena Bobescu, Mariana Radoi,
Nicoleta Aldulea
Spitalul Clinic Judetean de Urgenta, Brasov
Obiective: Evaluarea comparativa a riscului cardiovas-
cular (CV) la pacientii cu infarct miocardic acut fara
supradenivelare de segment ST (NSTEMI) si angina in-
stabila (AI) prin analiza factorilor de risc, a modifcari-
lor ECG, a factorilor ecocardiografci de risc si aparitia
evenimentelor CV majore (deces de cauza CV, infarct
miocardic acut, angina recurenta) la 7 zile.
Material si metoda: Studiu restrospectiv a 202 pacien-
ti (p) cu sindrom coronarian acut fara supradenivelare
de segment ST, impartiti in 2 grupuri: Grup AI 110 p ,
Grup NSTEMI 92 p. Parametrii urmariti au fost: fac-
tori de risc CV, electrocardiografc - subdenivelarea de
segment ST si modifcari ale undei T, ecocardiografc
- tulburarile de cinetica segmentara si analiza functiei
sistolice prin determinarea fractiei de ejectie (FE).
Rezultate: Factorii de risc cu valoare predictiva semni-
fcativa pentru evenimente cardiovasculare majore in
grupul NSTEMI au fost: diabetul zaharat (p=0,00196),
obezitatea (p=0,00011), varsta > 65 de ani (p=0,01909),
boala arteriala periferica (p = 0,00286), fbrinogenul
(p=0,0000004), troponina I, CK-MB, subdenivelarea
de segment ST2 mm (p=0,03720) si undele T negati-
ve, adanci, simetrice (p= 0,02763). Incidenta localizarii
anterioare a modifcarilor ECG ischemo-lezionale este
preponderenta si asociata cu un risc CV crescut la am-
bele grupuri studiate, find semnifcativ mai frecventa
in grupul NSTEMI (p=0,00753). Ecocardiografc, in-
cidenta valorilor reduse ale FE <40 % a fost similara
ambele grupuri studiate. Majoritatea pacientilor au
prezentat hipokinezie de sept interventricular si apex,
asociate cu un risc CV inalt. Riscul aparitie a decesu-
lui, infarctului miocardic sau revascularizarea de ur-
genta a crescut semnifcativ de la 14,5% cand unul din
factorii de risc CV a fost prezent la 19,3% si respectiv
27,3% cand 2 sau 3 factori de risc CV au fost prezenti
(p<0,0001).
Concluzii: Factorii de risc CV, modifcarile ECG si
ecocardiografce cu cea mai mare valoare predictiva
Regression oft left ventricular
mass after aortic valve
replacement for aortic stenosis
- clinical correlationes
Aim: Te efects of post-operative lef ventricular mass
regression (LVMR) on clinical outcome afer aortic
valve surgery remains to be established. Tis study was
intended to establish the impact of patient characteris-
tics on post-operative survival in patients referred for
aortic valve replacement (AVR), with particular regard
to LVMR.
Methods and results: 130 consecutive cases submitted
to aortic valve replacement for valvular stenosis were
prospectively followed for 2 years. Baseline, characte-
ristics and extent of LVMR were tested for associati-
on with survival by uni-and multivariable analysis. 5
deaths occurred during hospital stay and 20 during
out-of-hospital follow-up. Mean lef ventricular mass
decreased from 190 43 la 158 70 g/m2 (p < 0.001).
Older age, advanced functional class, hypertension,
reduced lef ventricle ejection fraction, and high pre-
operative lef ventricular mass index were associated
with reduced survival. Overwall the extent of LVMR
did not infuence the clinical results, while only early
(< 6 months) LVMR was associated with mid-term out-
come.
Conclusions: Survival afer aortic valve surgery is ma-
inly determined by the pre-operative functional cardi-
ac and systemic status. Te extent of LVMR does not
correlate with clinical outcome, whereas aggressive
treatment of hypertension may improve post-operative
survival.
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Suplimentul A, 2010
121
cardiovascular events were: diabetes mellitus, obesity,
age > 65 years, arterial peripheral disease, fbrinogen,
troponin I, CK-MB, ST depression 2 mm, negative,
deep, symmetric T wave with anterior localisation, in-
terventricular sept and apex hypokinesia. CV events
incidence was signifcantly correlated with risc factors
incidence.
110. Preventia secundara
medicamentoasa la femeile in
postmenopauza cu accidente
vasculare cerebrale ischemice
Adela-Viviana Sitar-Taut, Mirela Cebanu, Dana Pop,
D.Zdrenghea
ganu, Cluj-Napoca
Ipoteze: este bine cunoscut faptul ca femeile care au
suferit un accident vascular cerebral sunt subtratate,
inclusiv in ceea priveste tratamentul medicamentos.
Acest aspect a fost mai putin studiat referitor la drogu-
rile care sunt utilizate pentru preventie secundara.
Scop: evaluarea preventiei secundare medicamentoase
la femeile in postmenopauza, cu accidente vasculare
cerebrale ischemice.
Metoda: intr-o comunitate urbana din Romania, a fost
studiat, un lot reprezentativ cuprinzand 108 femei in
postmenopauza, cu varste peste 55 de ani, cu antece-
dente de accidente vasculare cerebrale ischemice. A
fost urmarita preventia secundara medicamentoasa.
Rezultatele au fost comparate cu cele inregistrate intr-
un esantion similar de barbati (84 pacienti, varste>55
de ani, cu patologie similara). Studiul s-a desfasurat
utilizand fsele medicilor de familie.
Rezultate: varsta medie a femeilor (69.30 8.90 ani) a
fost semnifcativ mai ridicata comparativ cu cea a bar-
batilor (66.51 7.93ani, p=0.02), dar nu au fost inregis-
trate diferente semnifcative intre cele doua sexe (femei
vs barbati) referitor la prevalenta diabetului zaharat
(32.4% vs 26.2%), a hipertensiunii arteriale (98.1% vs
94 %) sau a dislipidemiei (46.3% vs 36.9%). In concor-
danta cu literatura, au fost considerate ca facand parte
din categoria drogurilor de preventie antiagregantele
plachetare, statinele. Aspirina a fost utilizata de catre
72.2% dintre femei si 76.2% dintre barbati (p=NS),
pentru aparitia evenimentelor CV majore in grupurile
studiate au fost: diabetul zaharat, obezitatea, varsta > 65
de ani, boala arteriala periferica, fbrinogenul, tropo-
nina I, CK-MB, subdenivelarea ST 2 mm si undele T
negative, adanci, simetrice cu localizare anterioara, dis-
functia sistolica de ventricul stang, hipokinezie de sept
interventricular si apex. Incidenta evenimentelor CV a
Analysis of cardiovascular
risk in patients with non ST
elevation acute coronary
syndrome
Objective: Comparative evaluation of cardiovascular
risk in patients with non ST elevation myocardial in-
farction (NSTEMI) and unstable angina (UA) by cardi-
ovascular, ECG, echocardiography risk factors analysis
and evolution with major acute cardiovascular events
(cardiovascular death, acute myocardial infarction, re-
current angina) at 7 days.
Methods: Retrospective study of 202 patients (pts) with
non ST elevation acute coronary syndrome divided in 2
groups: Group UA 110 pts and Group NSTEMI 92 pts.
It was analyzed the followed parameters: CV risk fac-
tors, ECG changes ST depression and T wave changes,
echocardiography wall kinetics alteration and systolic
function analysis by ejection fraction (EF) evaluation.
Results: Risk factors with high predictive value for
major cardiovascular events were: diabetes melli-
tus (p=0.00196), obesity (p=0.00011), age > 65 years
(p=0.01909), arterial peripheral disease (p=0.00286),
fbrinogen (p=0.0000004), troponin I, CK-MB, ST de-
pression 2 mm (p=0.03720), negative, deep, symme-
tric T wave (p=0.02763). Anterior localization of ECG
changes was majoritar and associated with high CV risk
in both groups of study, signifcant higher in NSTEMI
group (p=0.00753). At echocardiography incidence of
low EF<40 % were simmilar in both groups. Majority
of patients had interventricular sept and apex hypoki-
nesia associated with high CV risk. Risk of death, AMI
and rescue revascularization was signifcantly higher
from 14.5% when only one CV risk factor was present
to 19.3% respectively 27.3% when 2 or 3 CV risk factors
were present (p<0.0001).
Conclusions: CV risk factors, ECG and echocardio-
graphy changes with high predictive value for major
Suplimentul A, 2010
125
POSTER I I
POSTER I I
95% 1.562-5.57). Considering separately the patients
under and above 75 years, aspirin was similarly used
in women (74.3% vs 67.6 %, p=NS) and men (75.7% vs
78.6 %, p=NS), but statins were signifcantly less used
afer 75 years, especially in men (w 52.7% vs 32.4 %,
p<0.05; m 25.7% vs 7.1 %, p<0.01).Using univariate
and multivariate analysis, aspirin use was not signif-
cantly infuenced by sex, age, cardiovascular risk fac-
tors or cardiovascular disease. In turn, statine use was
under the infuence of age, female sex, dyslipidemia
and diabetes mellitus.
Conclusions: In postmenopausal women with ische-
mic stroke the secondary prevention through aspirin,
but mainly through statins is underused, with signif-
cant diferences in comparison with men in whom the
statine use is even less.Funding: MENOCARD CEEX
nr. 98/2006
111. Functia renala
deteriorare tranzitorie - in
tratamentul insuficientei
cardiace decompensate
Madalina Cozma, Izabela-Roxana Voina, Mariana
Radoi
Spitalul Clinic Judetean de Urgenta, Brasov
Introducere: Pacientii cu insufcienta cardiaca cro-
nica (ICC) si clearance al creatininei (Cl-Cr) normal
sau scazut, uneori chiar in prezenta creatininei serice
normale, sunt frecvent varstnici, cu comorbiditati di-
verse, inclusiv boli renale, consum de antiinfamatoare
nesteroidiene (AINS), anemii de diverse etiologii. Tra-
tamentul ICC decompensate asociaza uneori scaderea
Cl-Cr care la internare era normal sau variat redus.
Scopul lucrarii: analiza cauzelor asociate cu deterio-
rarea functiei renale in cursul tratamentului ICC de-
compensate, frecventa acestui fenomen si metodele de
evitare.
Material si metoda: 100 de pacienti, cu ICC clasa III-
IV NYHA si Cl-Cr la internare normal sau variat alte-
rat; cu sau fara: boli renale, comorbiditati, anemie aso-
ciata; fara terapie AINS sau antibiotice nefrotoxice. Am
studiat relatia intre clasa functionala a ICC, FE% a VS,
tratamentul administrat, nivelul hemoglobinei, gradul
de hidratare si evolutia disfunctiei renale apreciata prin
OR=0.813 (CI 95% 0.422-1.565) si statinele de catre
46.3%, respectiv de 22.6%, (p = 0.001), OR = 2.949 (CI
95% 1.562-5.57). Luand in considerare pacientii sub si
peste 75 de ani, aspirina a fost utilizata in proportii si-
milare de catre femei (74.3% vs 67.6 %, p=NS) si bar-
bati (75.7% vs 78.6 %, p=NS), dar statinele au fost sem-
nifcativ mai putin utilizate la pacientii peste 75 de ani,
(femei 52.7% vs 32.4 %, p<0.05; barbati 25.7% vs 7.1
%, p<0.01). Utilizarea aspirinei nu a fost semnifcativ
infuentata de sexul, varsta, factorii de risc cardiovas-
culari sau de prezenta bolii cardiovasculare. In schimb,
utilizarea statinelor a fost infuentata de varsta, sexul fe-
minin, prezenta dislipidemiei sau a diabetului zaharat.
Concluzie: la femeile in postmenopauza care au suferit
un accident vascular cerebral ischemic, drogurile utili-
zate pentru preventie secundara (aspirina, dar in speci-
al statinele) sunt subutilizate.
Drug secondary prevention in
postmenopausal women with
ischemic stroke
Background: It is known that women with stroke are
under treated, including drug treatment. Tis aspect
was less studied with respect to drugs used for secon-
dary prevention.
Purpose: to evaluate secondary prevention through
medication in postmenopausal women with ischemic
stroke.
Methods: In an urban Romanian community, there
was studied a representative sample of 108 postmeno-
pausal women with ischemic stroke aged > 55 years.
We considered the secondary prevention by drugs. Te
results were compared with those registered in a similar
sample of 84 men aged >55 years with ischemic stroke.
Te study was carried out using general practitioners
fles, during 2007 year.
Results: Women mean age (69.30 8.90y.) was greater
in comparison with men (66.51 7.93y, p=0.02), but no
signifcant diferences were registered between females
and males with respect to diabetes mellitus (32.4% vs
26.2%), hypertension (98.1% vs 94 %), dyslipidemia
(46.3% vs 36.9%). According to literature, there were
considered as preventive drugs, antiplatelet agents and
statins. Aspirin was used in 72.2% of women and 76.2%
of men (p=NS), OR=0.813 (CI 95% 0.422-1.565) and
statins in 46.3% and 22.6% p= 0.001, OR= 2.949 (CI
POSTER I I
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Suplimentul A, 2010
126
antibiotic therapy or NSAID. We studied the relations-
hip between functional class of CHF, LV EF%, received
treatment, hemoglobin level, degree of hydration and
development of renal dysfunction assessed by Cr-Cl
(Cockcrof-Gault formula). Monitoring Cr-Cl and se-
rum ionograma was made within three days. Statistics
by Student test.
Results: ~ 20% of patients had decreased Cr-Cl, the
more frequent association with LV EF < 30%, advan-
ced age, poor hydration, anemia, hiponatremia, thera-
py with diuretics in high dose, angiotensin converting
enzyme inhibitors (ACEI), sartan drugs.Renal dysfunc-
tion rehabilitation included optimal hydration, hypo-
natremia and hypo/hyperkalaemia correction, and in
patients without obvious cause of worsening renal dys-
function stopped temporarily/permanently treatment
with ACEI, sartan drugs, antialdosteronic diuretics.
Newly installed or pronounced renal dysfunction led to
signifcant increase in duration of hospitalization, re-
quired transient dialysis in 0.2% of cases, and although
being improved, persisted at discharge ~ 25% of pati-
ents in which the Cr-Cl hospitalization decreased over
time (5% of patients).
Conclusions: Deterioration of RF assessed by Cr-Cl
is common in the treatment of decompensated CHF,
NYHA class III-IV, in combination with older age, sig-
nifcant decrease of LV EF, anemia and require opti-
mum hydration, frequent monitoring of Cr-Cl and se-
rum ionogram, with strict dosage adjustment of ACEI,
sartan drugs, diuretics especially those antialdostero-
nic.
112. Eficienta masurilor de
preventie primara privind
aderenta la programul de
recuperare cardiovasculara
C.Sarau, M.Iurciuc, Adina Avram, Laura Craciun,
Stela Iurciuc, Gabrijela Gojka, Delia Berceanu-Vaduva,
S.Ursoniu, Corina Vernic, D.Gaita, Silvia Mancas
Timisoara
Scop: S-a urmarit atingerea valorilor tinta in conformi-
tate cu ghidul Societatii Europene de Cardiologie 2007
la pacientii cu dislipidemie si/sau hipertensiune arteri-
ala si/sau diabet zaharat atat prin masuri farmacologi-
Cl-Cr (formula Cockcrof-Gault). Monitorizarea Cl-Cr
si a ionogramei serice s-a efectuat la maxim 3 zile. Sta-
tistica prin testul Student.
Rezultate: ~20% din pacienti au prezentat scaderea Cl-
Cr, in asociere mai frecventa cu FE a VS <30%, var-
sta avansata, hidratarea insufcienta, anemia, hiposo-
demia, terapia cu diuretice in doze mari, inhibitori ai
enzimei de conversie a angiotensinei (IECA), sartani.
Reabilitarea disfunctiei renale a inclus hidratarea op-
tima, corectia hiposodemiei, hipo/hiperpotasemiei, iar
la pacientii fara cauze evidente de agravare a disfunctiei
renale s-a intrerupt temporar/defnitiv tratamentul cu
IECA, sartani, diuretice antialdosteronice. Disfunctia
renala nou aparuta sau accentuata a condus la cresterea
semnifcativa a duratei de spitalizare, a necesitat dializa
tranzitorie in 0,2% din cazuri, si desi in curs de ameli-
orare a persistat la externare la ~25% dintre pacientii
la care Cl-Cr a scazut fata de momentul internarii (5%
din totalul pacientilor).
Concluzii: Deteriorarea functiei renale apreciata prin
Cl-Cr este frecventa in perioada de tratament al ICC
decompensate, clasele III-IV NYHA, in asociere cu
varsta inaintata, scaderea importanta a FE a VS, anemia
si impune hidratarea optima, monitorizare frecventa a
Cl-Cr si ionogramei, cu adaptarea stricta a dozelor de
IECA, sartani, diuretice in special antialdosteronice.
Renal function - transient
deterioration - in the treatment
of decompensated heart failure
Introduction: Patients with chronic heart failure
(CHF) and creatinine clearance (Cr-Cl) normal or low,
even in the presence of normal serum creatinine, are
ofen elderly, with various comorbidities, renal disea-
se, consumption of anti-infammatory drugs (NSAID),
and anemia of diferent etiologies. Sometimes, associa-
ted with decompensated CHF treatment, Cr-Cl decrea-
se, which at admission was normal or various low.
Aim of the study: analysis of causes associated with de-
terioration of renal function (RF) during treatment of
decompensated CHF, frequency and methods of pre-
venting this phenomenon.
Material and methods: 100 patients with NYHA class
III-IV CHF and Cr-Cl at admission ranged normal or
various altered, with or without: kidney disease, co-
morbidity, associated anemia, without nephrotoxic
Suplimentul A, 2010
12I
POSTER I I
POSTER I I
The efficacy of primary
prevention measures
regarding the adherence on
cardiovascular rehabilitation
program
Purpose: Te purpose was achieving the target valu-
es conform with European Cardiology Guideline 2007
for dislypidemic and/or hypertensive and/or diabetes
mellitus status patients through pharmacological or
non pharmacological measures (for example physi-
cal activities) Patients are included in Euroaspire III
Romanian follow-up Study. Euroaspire III Romanian
follow-up intends to demonstrate the achieving of tar-
get values in conformity with the recommendations
from the European Prevention Guideline for high risk
asymptomatic patients followed on long term from the
GPs.
Material and method: Tere were studied 325 asymp-
tomatic patients with high risk of cardiovascular events
(age 569 years, 60% women) no history for cardiovas-
cular events, on hypolipemiant treatment +/- hypoten-
sive drugs). Afer initial clinical and biological evalu-
ation, the GP recommended pharmacological adjust-
ments and non pharmacological measures (diet, weight
loss and physical activity). Te patients were evaluated
initially, at 6, 12 and 18 months, both clinically, biolo-
gically and also the adherence to the lifestyle changing
measures.
Results: From the 325 patients included in the study
62% were females, main age 57,09 +/- 9,8 years. Initi-
ally only 19 patients were included in the rehabilitation
program, but at the end of the 18 months, there were
171 patients included (p<0.0001). From 171 patients
recommended for the rehabilitation program, only 103
patients were compliant. From the 103 patients inclu-
ded in the rehabilitation program 59 patients attended
less than half of sessions, 22 patients attended more
than half of sessions, and 22 patients attended all the
sessions. Te participation quantum of men vs. women
in the rehabilitation sessions afer 18 months was: less
than half of sessions 63 vs. 37 (p<0.0001), more than
half of sessions 1 vs. 17 (p<0.0001), all the sessions 1 vs.
15 (p<0.0001).
Conclusions: - there was a signifcant increase in num-
ber of patients who were included in the rehabilitation
program - Women registered a better adherence to the
rehabilitation program
ce cat si in special prin masuri non-farmacologice, aici
find inclusa si activitatea fzica. Pacientii fac parte din
studiul Euroaspire III Romania follow-up. EuroAspire
III Romanian Follow-Up intentioneaza sa demonstreze
atingerea tintelor conform recomandarilor din Ghidul
European de Preventie pentru pacientii asimptomatici
cu risc crescut urmariti pe termen lung de catre medi-
cul de familie.
Material si metoda: Au fost studiati 325 pacienti
asimptomatici cu risc inalt de boala cardiovasculara
(varsta 569 ani, 60% femei) fara istoric de boala cardi-
ovasculara, afati sub tratament hipolipemiant +/- me-
dicatie hipotensoare). Dupa evaluarea clinica initiala
si investigatiile de laborator, medicul de familie a facut
recomandarile de ajustare farmacologica si interventie
non-farmacologica (dieta, scaderea in greutate si ac-
tivitatea fzica). Pacientii au fost evaluati initial si din
6 in 6 luni pana la 18 luni din punct de vedere clinic,
biologic si aderenta la masurile de schimbare a stilului
de viata.
Rezultate: Din cei 325 pacienti inclusi in studiu 62%
sunt de sex feminin, varsta medie a lotului 57,09+/-9,8
ani. Daca initial au fost inclusi doar 19 pacienti in pro-
gramul de recuperare, la sfarsitul celor 18 luni, erau 171
de pacienti participanti (p<0,0001). Din cei 171 paci-
enti la care a fost recomandat programul de recuperare
au fost aderenti la program doar 103 pacienti. Din cei
103 pacienti participanti la programu de recuperare,
59 au participat la mai putin de jumatate din sedinte,
22 la mai putin de jumatate din sedinte si 22 la toate
sedintele. Cuantumul de participare al pacientilor din
barbati vs. femei la sedintele de recuperare la fnele ce-
lor 18 luni a fost urmatorul: la mai putin de jumatate
din sedinte 63 vs. 37 (p<0,0001), la mai mult de juma-
tate din sedinte 1 vs. 17 (p<0,0001), la toate sedintele 1
vs.15 (p<0,0001).
Concluzii: A crescut semnifcativ numarul pacientilor
care au aderat la programul de recuperare. Femeile au
inregistrat o aderenta mai mare in cadrul programului
de recuperare
POSTER I I
POSTER I I
Suplimentul A, 2010
128
si 52,56% din cele nediabetice. Pacientele diabetice au
prezentat mai frecvent afectare coronariana (84,62%
versus 74,36%) iar leziunile coronariene au fost mai
severe (leziuni tricoronariene 34,62% versus 19,23 %).
Revascularizarea miocardica chirurgicala a fost indica-
ta in de 24,36% din femeile diabetice si 11,54% din cele
nediabetice.
Concluzii: Diabetul infuenteaza negativ evolutia bo-
lii cardiace. Factorii de risc (obezitate, hipertensiune,
dislipidemie) sunt mai bine reprezentati la femeile dia-
betice. Afectarea coronariana la diabetice este mai frec-
venta si mai severa comparativ cu femeile non diabe-
tice si necesita mai frecvent tehnici de revascularizare
miocardica chirurgicala.
Ischemic heart disease -
premises, gravity and evolution
in diabetic women
Background: Te worldwide prevalence of diabetes
mellitus has reached dramatically levels because of in-
creasing sedentary life and the fast food alimentation.
Tis metabolic disorder is strongly correlated with the
cardio-vascular pathology which imposes a cardio-dia-
betological approach of these patients.
Objective: To evaluate the particular features of the is-
chemic heart disease in diabetic women.
Materials and methods: A retrospective, comparative
study which included 156 women divided into 2 groups
similar as age - group distribution. Te frst group in-
cluded all the diabetic women with ischemic heart di-
sease that were admitted and investigated in Te Cardi-
ovascular Institute of Iasi, between January December
2008. Te second group consisted of women with is-
chemic heart disease but with no diabetes mellitus, in-
vazively investigated in the same period correspondent
as age distribution.
Results: Te diabetic group consisted of 78 patients,
with an average age of 62,53 years. Te diabetes had a
medium evolution of 7,3 years (9% - new cases of di-
abetes), and there were complications (retino/nephro/
neuropathy) in 26,65% cases. 33% of the diabetics were
treated with insulin. Te percentage of women with
normal weight was 2 times higher in the non diabetic
group (21,79% versus 11,54%). Te obesity was predo-
minant in the diabetic group (53,85% versus 39,74%),
especially type 2 obesity (20,51% versus 3,05%). Dys-
113. Cardiopatia ischemica -
premize, gravitate si evolutie la
femeile diabetice
Carmen Elena Boldea Colcear, Geanina Coada, Magda
Mariana Badescu, Catalina Arsenescu Georgescu
Institutul de Boli Cardiovasculare Prof. Dr. George I.
M. Georgescu, Iasi
Introducere: In conditiile unei vieti tot mai sedentare
si a unui mod de alimentatie bazat tot mai frecvent pe
produse tip fast-food, diabetul zaharat a atins cote alar-
mante. Aceasta tulburare metabolica este strans core-
lata cu patologia sistemului cardiovascular impunand
adoptarea unei abordari cardio-diabetologice in evalu-
area si tratarea pacientilor.
Obiectiv: Evaluarea particularitatilor cardiopatiei is-
chemice la femeile diabetice.
Material si metoda: Studiu retrospectiv, comparativ,
care a inclus 156 de paciente repartizate in 2 loturi si-
milare ca distributie pe intervale de varsta evaluate pe
baze clinice, paraclinice si imagistice. Primul lot a in-
clus toate pacientele diabetice cu cardiopatie ischemica
investigate angiografc in Institutul de Boli Cardiovas-
culare Prof. Dr. George I. M. Georgescu Iasi in peri-
oada 1 ianuarie - 31 decembrie 2008. Lotul martor a
fost alcatuit din paciente nediabetice cu cardiopatie is-
chemica investigate coronarografc in aceeasi perioada
alese aleatoriu din intervalul de varsta corespondent.
Rezultate: Lotul diabetic a totalizat 78 de paciente cu o
varsta medie de 62,53 ani. Vechimea diabetului a fost in
medie de 7,3 ani (9% - cazuri nou diagnosticate) iar in
26,65% din cazuri acest a prezentat complicatii (retino/
nefro/neuropatie). 33% din paciente au avut insulino-
terapie, in 8,91% din cazuri aceasta find introdusa pe
parcursul spitalizarii. Comparativ, normoponderabi-
litatea a fost dubla la lotul nediabetic (21,79% versus
11,54%). Obezitatea a predominat la lotul diabetic
(53,85% versus 39,74%), mai ales in cazul obezitatii de
grad II (20,51% versus 3,05%). Dislipidemia si steatoza
hepatica au fost mai frecvente la lotul diabetic (71,79%
versus 67,94%, respectiv 12,82% versus 5,12%). S-a re-
marcat o prevalenta dubla a pacientelor normotensive
nediabetice (38,46% versus 19,23%). Hipertensiunea
arteriala grad 3 a fost mai frecventa la femeile diabetice
(55,13% versus 28,21%). Prevalenta accidentului vas-
cular cerebral a fost dubla la femeile diabetice fata de
cele nediabetice (13,12% versus 7,05%). Infarctul mio-
cardic a fost prezent la 39,74% dintre femeile diabetice
Suplimentul A, 2010
129
POSTER I I
POSTER I I
embolizarii selective de artera septala sau cardiostimu-
larii bicamerale. Lucrarea isi propune sa analizeze o se-
rie de cazuri formata din 13 pacienti cu cardiomiopatie
hipertrofca obstructiva din cazuistica Institutului de
Boli Cardio- Vasculare CC Iliescu. Aproape jumatate
din pacienti au avut indicatii de cardiostimulare (pauze
sinusale simptomatice mai mari de 2,5 secunde, bloc
atrio-ventricular de grad inalt), in cealalta jumatate
din cazuri cardiostimularea bicamerala find destinata
exclusiv tratamentului bolii de baza. De mentionat ar
f faptul ca in acest ultim subgrup varsta medie a fost
de aproximativ 60 de ani si ca toti pacientii erau simp-
tomatici sub tratament beta blocant in doza maxima.
Am analizat datele de la 10 pacienti in ceea ce priveste
evolutia gradientului inainte si dupa cardiostimulare:
in toate cazurile asistam la o reducere a gradientului,
in 5 cazuri aceasta reducere este mai mare de 50% iar
valorile medii au scazut de la 76 mmHg initial la 35
mmHg dupa procedura. In ceea ce priveste gradul in-
sufcientei mitrale in 5 cazuri asistam la o scadere a gra-
dului regurgitarii mitrale. Din seria de cazuri va pre-
zentam pentru exemplifcare doua cazuri: primul este
al unei paciente la care cardiostimulare bicamerala s-a
realizat ca si modalitate de tratament specifca pentru
cardiomiopatie hipertrofca obstructiva fara a avea alta
indicatie si care a fost urmarita timp de 12 ani, obser-
vandu-se o scadere progresiva a gradientului dinamic
in tractul de ejectie al ventricului stang de pana la 60%
iar cel de-al doilea este al unui pacient la care asocierea
tulburarilor de ritm si de conducere la un pacient cu
un gradient provocat de 80 mmHg a impus implanta-
rea unui defbrilator bicameral. Concluzionand in seria
de cazuri prezentata asistam la o scadere a gradientu-
lui dinamic ca urmare a cardiostimularii bicamerale in
cardiomiopatiei hipertrofca obstructiva, fara a putea
aprecia insa o imbunatatire a testelor functionale.
lipidemia and hepatic steatosis were more common in
the diabetic group (71,79% versus 67,94%, 12,82% ver-
sus 5,12% respectively). More non diabetic women had
a normal blood pressure (38,46% versus 19,23%). Te
hypertension grade 3 was more frequently encountered
among diabetic women (55,13% versus 28,21%). Stroke
was 2 times more frequent in the frst group (13,12%
versus 7,05%). Myocardial infarction was diagnosed in
39,74% of diabetic and 52,56% of non diabetic women.
Te diabetic women had more frequently coronary le-
sions (84,62% versus 74,36%) and more vessels were
usually afected (three vessel disease - 34,62% versus
19,23%). Surgical myocardial revascularization was
indicated in 24,36% of diabetics and 11,54% of non-
diabetics.
Conclusions: Te diabetes infuences negatively the
ischemic heart disease. Te risk factors (obesity, hyper-
tension, dyslipidemia) are better expressed in the dia-
betic women population. Te coronary disease is more
frequent and more severe in the diabetic women and
ofen requires surgical myocardial revascularization te-
chniques.
114. Este cardiostimularea
bicamerala o solutie de
tratament pentru pacientii cu
cardiomiopatie hipertrofica
obstructiva refractara la
tratamentul medicamentos
(experienta Institutului C.C.
Iliescu)?
Maria-Magdalena Gurzun, R.Ciudin, Irina Serban
Cardiomiopatia hipertrofca, cea mai comuna afectiune
genetica cardio-vasculara reprezinta o adevarata pro-
vocare pentru cardiologi in incercarea de diagnostic in
cazul persoanelor asimptomatice dar si in ceea ce pri-
veste alegerea modalitatii optime de tratament, mai ales
in cazurile care nu raspund la terapia medicamentoasa
si care raman rezervate fe tratamentului chirurgical fe
POSTER I I
POSTER I I
Suplimentul A, 2010
180
115. Analiza caracteristicilor
clinice si paraclinice ale
pacientilor cu fibrilatie atriala
spitalizati cu supradozaj
dicumarinic
Daniela Ceptureanu, Loredana Dan, A.Frigy,
C.Szabados, E.Carasca
Spitalul Clinic Judetean, Clinica Medicala IV, Targu
Mures
Anticoagularea in fbrilatia atriala este un tratament de
baza, dar comporta riscul hemoragiilor cu diverse loca-
lizari, mai ales pe fondul supradozajului tratamentului
anticoagulant oral. Ne-am propus o analiza complexa a
cazurilor cu fbrilatie atriala si supradozaj dicumarinic,
avand ca scop gasirea unor eventuali factori asociati
riscului de hemoragie/supradozaj.
Material si metoda: Studiu retrospectiv pe perioada
20062009, selectand 33 de pacienti, la care am urmarit
urmatorii parametrii: tipul fbrilatiei atriale, etiologia
acesteia, valorea tensiunii arteriale la internare, frec-
venta cardiaca, INR ul la internare, prezenta anumitor
comorbiditati, functia sistolica a ventriculului stang si
asocierile medicamentoase.
Rezultate: Incidenta supradozajului dicumarinic la toti
pacientii cu fbrilatie atriala anticoagulati spitalizati a
fost 2,5 %. Majoritatea pacientilor au fost varstnici, cu
varsta medie de 68,3 11 ani, predominand sexul femi-
nin cu o pondere de 65%. Mai mult de jumatate (56%)
dintre pacienti erau cu fbrilatie permanenta, intrunind
un scor CHADS cu o valoare medie de 2,3. Hiperten-
siunea arteriala esentiala, valvulopatiile si cardiopatia
ischemica find factorii etiologici cei mai frecventi.
Aproape toti pacientii (91%) au asociat insufcienta
cardiaca, o treime find cu disfunctie sistolica a ventri-
culului stang (FE 40%). Valoarea medie a INRului la
internare a fost 8,6 3,66, la 56% din pacienti aparand
hemoragii manifeste clinic, rezultand un sindrom ane-
mic de obicei usoara (valoarea medie a Hb find 12,05
g/dL). Hematuria (35%) si hemoragiile cutanate (18%)
au fost cel mai frecvent intalnite, la care se adauga cele
din sfera ORL si hemoptiziile.
Concluzii: Din analiza datelor s-a putut contura un
profl de risc pentru supradozaj dicumarinic si sange-
rare, de care trebuie tinut cont si in practica cotidiana.
Is permanent dual-chamber
pacing a therapeutic
solution for drug-refractory
symptomatic patients with
obstructive hypertrophic (C.C.
Iliescu Institute experience)?
Hypertrophic cardiomyopathy, the most common in-
herited cardiac disorder, represents a real challenge for
the cardiologists frstly to establish the diagnostic of
the disease in case of asymptomatic patients and secon-
dly to choose the most correct treatment ,especially in
symptomatic patients refractory to drug therapy which
are candidates either for surgical myectomy, alcohol
septal ablation or dual chamber pacing. Te work pre-
sents a case series study with 13 patients, treated in Te
Emergency Cardiovascular Disease CC Iliescu Institu-
te. Almost half of the patients have classical indication
for pacing (sinus node disease, third or second degree
atrioventricular block). For the rest of them dual cham-
ber pacing was considered as a specifc treatment for
hypertrophic obstructive cardiomyopathy only. In this
last group the average age was 60 years and all patients
were symptomatic despite of correct medical treatment.
Dynamic lef ventricle outfow gradient was analyzed
in 10 patients before and afer dual chamber pacing
and showed a decrease of outfow tract gradient in all
patients afer the procedure (the average value of 76
mmHg versus 35 mmHg afer the procedure). Te pa-
tients also presented mitral regurgitation and 5 of them
had a change in mitral regurgitation grade afer the
procedure. From this case series we present two cases:
frst patient was followed 12 years afer the dual cham-
ber pacing. Te second patient associated conduction
and rhythm disturbances and needed a dual chamber
pacing and an ICD too. Te case series reveals a decre-
ase of the dynamic gradient in hypertrofc obstructive
cardiomyopathy afer dual chamber pacing, but doesnt
show any improvement of functional capacity.
Suplimentul A, 2010
181
POSTER I I
POSTER I I
116. Torsiunea este un
mecanism compensator,
mediat de rigiditatea arteriala,
la pacientii cu disfunctie
ventriculara stanga subclinica
Stefania Magda, Raluca Dulgheru, Maria Florescu,
Andrea Ciobanu, M.Cinteza, D.Vinereanu
Context: Studii recente indica faptul ca in stadiile initi-
ale ale disfunctiei subclinice de VS augmentarea gradu-
lui de torsiune si twist actioneaza ca si mecanism com-
pensator, probabil prin intermediul rigiditatii arteriale
crescute si cuplarii ventriculo-arteriale inadecvate.
Metode: La 31 de pacienti (varsta medie 579 ani ,
18 barbati) cu hipertensiune arteriala usoara-mode-
rata (valori medii ale TA la monitorizarea pe 24 ore
148/93mmHg), diabet zaharat de tip 2 (durata medie
de la diagnostic 3.23.3 ani) si functie sistolica de VS
normala ( FEVS>50%) am analizat prin ecocardiogra-
fe 2D speckle tracking urmatorii parametri de torsi-
une a VS: rotatia maxima a bazei si apexului, timpul
pana la rotatia maxima a bazei si apexului, gradul de
twist al VS si timpul pana la twist-ul maxim, precum
si torsiunea VS. Functia arteriala a fost evaluata prin
analiza e-tracking si wave intensity la nivelul arterei
carotide comune drepte, cu determinarea indicelui in-
tima-medie (IMT) si a ariei undei refectate (NA). Am
determinat de asemenea si markerii de fbroza miocar-
dica (peptidul amino-terminal al procolagenului de tip
1) prin analiza bazata pe electrochemiluminescenta.
Rezultate: Torsiunea si twist-ul VS au fost supranor-
male, probabil din cauza ca rotatia maxima bazala si
rotatia maxima apicala au fost simultane (vezi tabel).
Torsiunea si twist-ul VS s-au corelat pozitiv cu IMT
(r=0.40 si r=0.40) si cu NA (r=0.40 si r=0.43). Gradul
de torsiune si twist a VS s-au corelat pozitiv si cu mar-
kerii de fbroza miocardica (r=0.41 si r=0.43), pentru
toate corelatiile p<0.05. Timpul pana la rotatia apicala
maxima si timpul pana la twist-ul maxim s-au corelat
cu durata diabetului (r=0.4 si r=0.38, p<0.05).
Concluzii: La pacientii cu hipertensiune arteriala, dia-
bet zaharat tip 2 si functie sistolica a VS normala, twist-
ul si torsiunea VS cresc compensator, probabil prin
intarzierea rotatiei apicale datorata afectarii difuze a
tesutului excitoconductor prin fbroza subendocardica.
Aceste mecanisme sunt mediate de ateroscleroza sub-
Analysis of clinical and
paraclinical characteristics
of the patients with atrial
fibrillation hospitalized with
dicumarinic overdose
Anticoagulation is a basic treatment in atrial fbrillati-
on, but involves the risk of bleeding at diferent sites,
primarily in the setting of oral anticoagulant overdose.
Objectives: Te purpose of this study was a complex
assessment of cases hospitalized with atrial fbrillation
and dicumarinic overdose, to fnd possible factors rela-
ted with overdose/bleeding risk.
Methods: We performed a retrospective study of 33 pa-
tients, admitted between 20062009, being evaluated
the following parameters: type and etiology of atrial f-
brillation, blood presure values, heart rate, INR values
on admission, co-existing conditions, lef ventricular
systolic function and drug associations.
Results: Te incidence of dicumarinic overdose for all
the patients with atrial fbrillation was 2.5%. Te ma-
jority was aged patients, with a mean age of 68.3 11
years; there was a female predominance of 65%. More
then half (56%) of the patients had permanent atrial
fbrillation, with an average CHADS score of 2.3; es-
sential arterial hypertension, valvulopathies and ische-
mic cardiomiopathy were the most frequent etiological
factors. In almost all patients (91%) heart failure was
associated, one-third of them having lef ventricular
systolic dysfunction (EF 40%). Te average of INR va-
lues on admission was found to be 8.6 3.66, bleeding
appeared in 56% of cases, causing mild anemic syndro-
me (the mean Hb being 12.05 g/dL). Hematuria (35%)
and cutaneous bleedings (18%) were the most frequent
signs of dicumarinic overdose, ENT bleeding and he-
moptysis have been also noted.
Conclusions: Analysis of data revealed a risk profle for
dicumarinic overdose and bleeding. Tis has to be con-
sidered in daily practice.
POSTER I I
POSTER I I
Suplimentul A, 2010
182
citatory pathways secondary to increased subendocar-
dial fbrosis. Tese mechanisms are mediated through
increased subclinical atherosclerosis (IMT) and arterial
stifness, and positively related to the progression of di-
sease in its early stages. Rotation of LV base (degr) -7.9
3.6 Time to peak basal rotation (ms) 333.6 86.4 Ro-
tation of LV apex (degr) 9.8 6.2 Time to peak apical
rotation (ms) 333.6 79.8 LV twist (degr) 16.1 7.4
Time to peak twist (ms) 336.9 81.4 LV torsion (degr/
cm) 2.0 0.9
117. Relatia dintre terapia
de substitutie hormonala
(TSH) si nivelele circulante
ale moleculelor de adeziune la
femeile in postmenopauza
Adela-Viviana Sitar-Taut, Mirela Cebanu, Dana Pop,
Olga Soritau, Carmen Stugren, G.Bodizs, Oana Maria
Penciu, D.Zdrenghea
ganu, Cluj-Napoca
Ipoteze: menopauza este responsabila de alterarea
proflului de risc cardiovascular. Ateroscleroza este cu-
noscuta ca o boala infamatori cronica, iar molecu-
lele de adeziune reprezinta markeri infamatori, cu rol
important in initierea leziunilor aterosclerotice. TSH
reprezinta o terapie controversata, efectele sale asupra
aparatului cardiovascular find contradictorii. Scopul
studiului: evaluarea modifcarilor produse de TSH asu-
pra moleculelor de adeziune.
Metoda: Au fost evaluate 57 femei in postmenopauza,
varsta medie 47.734.62 ani, fara boli cardiovasculare.
17 (29.8%) au inceput in anul 2008 TSH. Ca si factori
de risc cardiovasculari au fost evaluati obezitatea, fu-
matul, diabetul zaharat, hipertensiunea arteriala si dis-
lipidemia (colesterol total >200 mg/dl sau trigliceride
serice >150 mg/dl sau tratament anterior hipolipemi-
ant). Pacientele au fost urmarite doi ani consecutivi
(2008-2009). Au fost determinate moleculele de adezi-
une (sICAM1 si sVCAM1 in ng/ml), din seruri stocate
si congelate - metoda ELISA.
Rezultate: initial nu au fost decelate diferente semnif-
cative intre cele doua grupuri (cu vs fara TSH) referi-
clinica accentuata (IMT) si de rigiditatea arteriala si se
coreleaza pozitiv cu progresia bolii in stadiile initiale.
Rotatia bazei VS (grd ) -7.9 3.6 Timpul pana la rotatia
maxima a bazei (ms) 333.6 86.4 Rotatia apexului VS
(grd) 9.8 6.2 Timpul pana la rotatia maxima a apexu-
lui (ms
Torsion is a compensatory
mechanism in patients with
subclinical left ventricular
dysfunction, related to arterial
stiffness
Context. Recent studies suggest that increased LV twist
and torsion act as a compensatory mechanism in early
stages of subclinical LV dysfunction. Tis might be me-
diated by increased arterial stifness, through inappro-
priate ventriculo-arterial coupling.
Methods: In 31 patients (579 yrs, 18 males) with mild
to moderate hypertension (mean ABPM values 148/93
mmHg), type II diabetes (mean duration of 3.23.3
yrs) and normal ejection fraction (>50%), we assessed
the following LV torsion parameters by 2D speckle
tracking echocardiography: peak rotation of LV base
and apex, time to peak rotation of LV base and apex,
LV twist and time to peak twist and LV torsion. Arterial
function was evaluated by e-tracking and wave in-
tensity analysis at the level of the RCCA by measuring
intima-media thickness (IMT), and area of the refecti-
ve wave (NA). We also determined markers of myocar-
dial fbrosis (procollagen type-1 amino terminal) by an
electrochemiluminescence immunoassay.
Results: LV twist and torsion were supranormal, pro-
bably because peak basal and apical rotation occurred
concomitently (table). LV twist and torsion correlated
positively with IMT (r=0.42 and r=0.40), and with
NA (r=0.44 and r=0.40). Also, they correlated positi-
vely with markers of myocardial fbrosis (r=0.43 and
r=0.41), all p<0.05. Time to peak apical rotation/peak
twist correlated with the duration of diabetes mellitus
(r=0.40 and r=0.38, p<0.05).
Conclusions: In patients with hypertension, diabetes,
and normal systolic function, LV twist and torsion are
increased compensatory, probably because of the delay
of apical rotation due to difuse involvement of the ex-
Suplimentul A, 2010
188
POSTER I I
POSTER I I
assessed the body weight, smoking status, diabetes,
hypertension and dyslipidaemia (defned as total cho-
lesterol>200 mg/dl or serum triglycerides > 150 mg/dl
or treatment with hypolipidemic drugs). Patients were
followed two consecutive years (2008-2009). Adhesion
molecule (sICAM1 and sVCAM1) were measured (in
ng/ml) in stored serum samples collected, using ELISA
method.
Results: No signifcant diferences were initially regis-
tered between the two groups (with vs without HRT)
regarding the presence of obesity (11.8% vs 35%,
p=NS), smoking (35.3% vs 25%, p=NS), diabetes (0%
vs 7.5%, p=NS), hypertension (23.5% vs 37.5%, p=NS),
dyslipidaemia (76.5% vs 60%, p=NS). In 2009, 17 wo-
men did not present to reevaluation and no statistical
signifcant diferences between the two groups (with vs
without HRT) was recorded regarding the prevalence
of obesity (72.7% vs 69%, p=NS), smoking (9.1% vs
27.6%, p=NS), diabetes (0% vs 6.9%, p=NS), hyper-
tension (27.3% vs 48.3%, p=NS), dyslipidaemia (72.7%
vs 69%, p=NS). With exception of signifcant greater
prevalence of obesity in 2009 (in comparison with
2008) in both groups, no other risk factors registered
signifcant changes. Adhesion molecules registered
mean values in two groups were as follows: for HRT sI-
CAM1 in 2008 372.87144.45 vs in 2009 195.45 67.17
(p<0.05), for sVCAM1 in 2008 638.81 144.45 vs in
2009 482.36177.38 (p<0.05). For no HRT group mean
values were for sICAM1 in 2008 376.71112.47 vs in
2009 183.1047.64 (p<0.05) and for sVCAM1 in 2008
615.28156.78 vs in 2009 438.27118.28 (p<0.05).
Conclusions: HRT on short time determined favorable
changes of adhesion molecules values (as marker of en-
dothelial dysfunction). Funding NURC TD 158/2008
118. Severitatea leziunilor
coronariene la pacientii
aflati la prima indicatie de
coronarografie
I.Stanca, Raluca Aflorii
Obiectivul principal a fost stabilirea severitatii leziuni-
lor coronariene la pacientii cu prima indicatie de coro-
narografe si corelarea acestora cu factorii de risc si cu
tor la prezenta obezitatii (11.8% vs 35%), a fumatului
(35.3% vs 25%), a diabetului zaharat (0% vs 7.5%), a
hipertensiunii arteriale (23.5% vs 37.5%), a dislipide-
miei (76.5% vs 60%). In 2009, 17 femei nu s-au prezen-
tat la reevaluare si nu s-au decelat diferente semnifca-
tive intre cele doua grupuri (cu si fara TSH) referitor la
prevalenta obezitatii (72.7% vs 69%), a fumatului (9.1%
vs 27.6%), a diabetului (0% vs 6.9%), a hipertensiunii
(27.3% vs 48.3%), a dislipidemiei (72.7% vs 69%). Cu
exceptia unei prevalente semnifcativ mai crescute a
obezitatii in 2009 vs 2008 (la ambele grupuri), nici un
alt factor de risc nu a inregistrat modifcari importan-
te. Valorile medii ale moleculelor de adeziune in cele
doua grupuri a fost urmatoarea: in grupul cu TSH pen-
tru sICAM1 in 2008 372.87144.45 vs in 2009 195.45
67.17 (p<0.05), pentru sVCAM1 in 2008 638.81
144.45 vs in 2009 482.36177.38 (p<0.05). Pentru gru-
pul fara TSH, valorile medii au fost pentru sICAM1 in
2008 376.71112.47 vs in 2009 183.1047.64 (p<0.05),
pentru sVCAM1 in 2008 615.28156.78 vs in 2009
438.27118.28 (p<0.05).
Concluzii: TSH, pe termen scurt, a determinat scade-
rea valorii moleculelor de adeziune (ca marker al dis-
functiei endoteliale Grant: CNCSIS TD 158/2008
The relationship between
circulating levels of endothelial
adhesion molecules and
hormone replacement therapy
(HRT) in postmenopausal
women
Background: Menopause is responsible for alteration
of cardiovascular risk profle. Atherosclerosis is known
as a chronic infammatory disease and cellular adhe-
sion molecules are infammation markers, playing a
major role in initiation of atherosclerotic lesions. Hor-
mone replacement therapy represents, a controversial
therapy, its efects over cardiovascular system being
contradictory. Objective: to evaluate the efect of HRT
over the adhesion molecule.
Methods: we examined 57 postmenopausal women,
mean age 47.73 4.62 years, 17(29.8%) patients star-
ted in 2008 HRT. Initially, none of the patients presen-
ted cardiovascular diseases. As risk factors have been
POSTER I I
POSTER I I
Suplimentul A, 2010
181
ronary angiography and correlation with risk factors
and diagnosis for coronary angiography is performed.
Material and methods: During October 2009 - April
2010 all patients who made coronary angiography were
selected. Were excluded patients who have history of
coronary angiography. Included in the study were 114
patients, average age 60.4 years, the majority being
men (77.6%). As risk factors were: hypertension 80.2%,
82.8% dyslipidemia, 65.7% smokers or former smo-
kers, 35.5% diabetics. Te diagnosis for coronary angi-
ography is performed was: stable angina in 24 patients,
unstable angina in 30 patients, myocardial infarction
without ST segment elevation in 15 patients, myocardi-
al infarction with ST segment elevation in 45 patients.
Results: Of the 114 patients, 56 (49.2%) had a history of
ischemic heart disease and 58 (50.8%) patients were at
the frst manifestation of coronary disease. 18 patients
(15.7%) showed no signifcant coronary lesions (ste-
nosis over 70% LAD, CX, CD or stenosis over 50% of
lef main), while 45 patients presents single-vessel co-
ronary artery lesions and 24 patients (21 %) had signi-
fcant three coronary artery lesions. If we consider both
signifcant lesions, and the no signifcant lesions, note
that all patients had coronary lesions and the majority
(68.4%) had three coronary artery lesions. Note that
41% of patients, who were at frst coronary event in life,
had two or three coronary artery signifcant lesions. Se-
verity of coronary lesions was signifcantly correlated
with the following risk factors: age, history of hyperten-
sion, history of cardiovascular disease. Regarding the
diagnosis which was performed coronary angiography;
severity of coronary lesions was signifcantly correlated
only with stable angina (RR 1.36) and unstable angina
(RR 1.4), not with myocardial infarction.
Conclusions: Multi-coronary impairment is common
at the frst manifestation of ischemic heart disease.
Multi-coronary impairment at frst indication of co-
ronary angiography is more common in patients with
stable angina and unstable angina compared with acute
myocardial infarction.
diagnosticul pentru care se efectueaza coronarografa.
Material si metode: In perioada octombrie 2009- apri-
lie 2010 au fost selectati toti pacientii care au efectuat
coronarografe. Au fost exclusi pacientii care au efec-
tuat in antecedente cel putin o coronarografe. Au fost
inclusi in studiu astfel 114 pacienti, cu varsta medie de
60,4 ani, majoritatea find barbati (77,6%). Ca si fac-
tori de risc asociati au fost 80,2% hipertensivi, 82,8%
dislipidemici, 65,7 fumatori sau fosti fumatori, 35,5%
diabetici. Diagnosticul pentru care s-a efectuat corona-
rografe a fost: angina stabila la 24 pacienti, angina in-
stabila la 30 pacienti, infarct miocardic acut fara supra-
denivelare segment ST la 15 pacienti, infarct miocardic
acut cu supradenivelare segment ST la 45 pacienti.
Rezultate: Din cei 114 pacienti, 56 (49,2%) au avut is-
toric de boala cardiaca ischemica, iar 58 (50,8%) paci-
enti se afau la prima manifestarea din viata a bolii co-
ronariene. 18 pacienti (15,7%) nu au prezentat leziuni
coronariene semnifcative (stenoze peste 70% pe IVA,
CX, CD sau stenoze peste 50% de trunchi comun), in
timp ce 45 pacienti au fost unicoronarieni, 27 bicoro-
nariene si 24 (21%) au prezentat leziuni tricoronarie-
ne semnifcative angiografc. Daca luam in calcul atat
leziuni semnifcative, cat si cele nesemnifcative angi-
ografc, remarcam faptul ca toti pacientii au prezentat
leziuni coronariene, iar majoritatea (68,4%) au fost tri-
coronarieni. De remarcat ca 41% dintre pacientii care
se afau la primul eveniment coronarian din viata, au
prezentat afectare bi- sau tricoronariana semnifcativa.
Severitatea leziunilor coronariene s-a corelat semni-
fcativ cu urmatorii factori de risc: varsta, istoricul de
hipertensiune, antecedentele de boala cardiovasculara.
In ceea ce priveste diagnosticul pentru care s-a efectuat
coronarografe, severitatea leziunilor coronariene s-a
corelat semnifcativ doar cu angina stabila (RR 1,36) si
instabila (RR 1,4), nu si cu infarctul miocardic.
Concluzii: Afectare multicoronariana este frecventa la
prima manifestarea din viata a bolii cardiace ischemice.
Afectare multivasculara coronariana la prima indicatie
de coronarografe este mai frecventa la cei cu angina
stabila si instabila, fata de cei cu infarct miocardic acut.
Severity of coronary lesions in
patients at the first indication
of coronarography
Te main objective was to determine the severity of
coronary lesions in patients with frst indication of co-
Suplimentul A, 2010
185
POSTER I I
POSTER I I
Infective endocarditis:
epidemiology, risk factors and
microbiology
Introduction: Despite the medical progress, the inci-
dence of infective endocarditis (IE) hasnt decreased in
the last decades. Tis paradox is explained by the risk
factors evolution; while some predisposing conditions
(eg, AAR) have been eradicated, new ones have appea-
red (IV. drugs, valvular sclerosis in the elderly, valvular
prosthesis, nosocomial afections).
Aim: Te aim of our study is to create a perspective
over the epidemiology, risk factors and patogens invol-
ved in the pathology of infective endocarditis.
Material and method: It is a retrospective study on
61 patients with infective endocarditis hospitalized in
IBCV Prof. Dr. C.C. Iliescu in 2009.
Results: From the total of patients with infective endo-
carditis 62.2% were male and 37.8% female. Te mean
age in the study lot was 58.6 years old. 80.3% from the
total number of cases had infective endocarditis on na-
tive valves and only 19.7% on valvular prosthesis. Te
majority of patients (91.8%) had the acute form. Sta-
phylococus aureus was the most frequent pathogen in-
volved (24.6%), and endocarditis with negative hemo-
cultures was also frequent (14.75%). Te most afected
valves were mitral (45.9%) and aortic (40.98%). Sur-
gery for valvular prosthesis was performed in 21.31%
of the cases and intrahospital mortality remained rela-
tively high (6,5%).
Conclusions: Staphylococus aureus is the most
frequent pathogen involved in the etiology of infective
enocarditis. Te majority of the cases were on native
valves, the most frequently afected being the mitral
valve. Inhospital mortality is still relatively high (6.5%).
119. Endocardita infectioasa:
epidemiologie, factori de risc si
microbiologie
A.Rusali, Marinela Serban, Otilia Banu, Loredana
Benea, Carmen Ginghina
Introducere: In ciuda progreselor in medicina, inci-
denta endocarditei infectioase (EI) nu a scazut in ul-
timele decade. Acest paradox aparent este explicat de
progresia factorilor de risc; in timp ce conditii predis-
pozante ca de ex RAA au fost eradicate, au aparut noi
factori de risc (administrarea de droguri iv., sclero-
za valvulara la pacientii in varsta, protezele valvulare,
afectiunile nozocomiale).
Scop: Scopul studiului este acela de a realiza un tablou
actual al epidemiologiei, factorilor de risc si a speciilor
bacteriene implicate in patologia endocarditei infecti-
oase.
Material si metoda: Este un studiu retrospectiv realizat
pe un numar de 61 de pacienti cu endocardita infecti-
oasa, internati in IBCV Prof. C.C. Iliescu in anul
2009.
Rezultate: Din totalul pacientilor cu endocardita
62,2% au fost barbati si 37,8% femei. Varsta medie a
lotului de studiu a fost de 58,6 ani. 80,3% din totalul
cazurilor au prezentat endocardita infectioasa pe valve
native si numai 19,7% pe proteze. Majoritatea pacienti-
lor (91,8%) au prezentat forma acuta. Staflococul auriu
a fost cel mai intalnit patogen (24,6%), iar endocardita
cu culturi negative a fost deasemenea destul de frec-
venta (14,75%). Valvele cele mai afectate au fost mitrala
(45,9%) si aortica (40,98%). Interventia chirurgicala de
protezare valvulara s-a efectuat la 21,31% dintre paci-
entii studiati, iar mortalitatea intraspitaliceasca a fost
de 6,5%.
Concluzii: Staflococul auriu este agentul patogen cel
mai frecvent implicat in etiologia EI. Majoritatea cazu-
rilor au fost pe valve native, cea mai frecvent afectata
find valva mitrala. Mortalitatea intraspitaliceasca ra-
mane relativ ridicata (6,5%).
POSTER I I
POSTER I I
Suplimentul A, 2010
186
121. Relatia fibrilatiei atriale cu
sindromul de apnee in somn
D.P.Petcu, O.Toni
Introducere. Fibrilatia atriala se asociaza cu diverse
afectiuni cardiac si extracardiace. Sindromul de apnee
in somn poate contribuii la aparitia fbrilatiei atriale si
la recurenta acesteia. Sindromul de apnee in somn se
caracterizeaza prin obstructia cailor aeriene superioare
determinat de colapsul cailor aeriene. In aceste conditii
scade nivelul de oxigen in sange cu modifcari din par-
tea sistemului nervos simpatic.
Scop: In aceasta lucrare am studiat asocierea fbrilatiei
atriale sau a futterului atrial cu sindromul de apnee in
somn.
Metoda: Studiul este prospectiv. Au fost luati in studiu
28 de pacienti si sindrom de apnee in somn la care s-au
efectuat polisomnografi, Holter ECG si ECG standard.
Sindromul de apnee in somn a fost defnit prin inde-
xul tulburarilor respiratorii (RDI). Analiza statistica a
aratat ca un RDI crescut a fost asociat cu o crestere a
incidentei fbrilatiei atriale cu p=0,1 - <0,01 , OR=2,1.
Concluzii: Sindromul de apnee in somn de tip central
se asociaza cu fbrilatia atriala. Tratamentul sindromu-
lui de apnee in somn se insoteste de conversia la RS si
scaderea recurentei fbrilatieii atriale.
The relation between the
atrial fibrilation and the apnea
syndrome during sleep
Introduction. Te atrial fbrilation is associated with
several cardiac and extracardiac disfunctions.Te ap-
nea during sleep can contribute to the appearance of
the atrial fbrillation and its recurrence. Te sleep ap-
nea is characterised by the superior airway obstruction
determined by the airway collapse. In this conditions,
the blood oxigen level degreses with changes in the
nervous system.
Purpose: In this work we studied the association of the
atrial fbrillation or atrial futter with sleeping apnea.
Methods: Te study is prospective.Tere have been
taken to study 28 patients with sleeping apnea who
took polysomnographic tests,Holter ECG and stan-
120. Asistarea circulatorie
perioperatorie cu balonul de
contrapulsatie intraaortic
Arhire D., Arhire N., Patrut M., Cornea B., Ardeleanu
C., Grosu C., Pop V., Rachita E., Manta O., Vasilescu
R., Voinea C., Oclei E., Barbulescu V.
Obiective: sindromul de debit cardiac scazut (SDCS) a
fost defnit ca nevoia de IABP postoperator sau suport
inotropic mai lung de 30 de minute in unitatea de tera-
pie intensiva, pentru a mentine presiunea sistolica > 90
mmHg si un index cardiac >2,2l/min/m2.
Obiectivul acestui studiu a fost de a arata efcienta uti-
lizarii IABP in aceste cazuri.
Metoda si rezultate: au fost studiati un numar de 704
pacienti supusi operatiei pe cord sub CEC. Incidenta
SDCS a fost de 11,8 % iar 6,2 % au necesitat utilizarea
IABP.
Concluzii: SDCS este asociat cu cresterea semnifcativa
a morbiditatii si mortalitatii, iar IABP a ajutat la imbu-
natatirea rezultatelor dupa operatiile pe cord sub CEC.
Perioperatively circulatory
assistance with IABP
Objectives: low cardiac output syndrome was defned
as the need of intraaortic balloon pump counterpulsa-
tion postoperatively or inotrop support longer than 30
minutes, for maintaining a systolic blood pressure >90
mmHg and a cardiac index >2,2 l/min/ m2.
Te objective of this study was to show the ef ciency
of intraaortic balloon pump counterpulsation in these
cases.
Method: the study is on 704 patients subjected to car-
diac surgey with extracorporeal circulation.
Results: Te incidence of low cardiac output syndrome
was 11,8% and 6,2% needed intraaortic balloon pump
counterpulsation.
Conclusions: low cardiac output syndrome is associa-
ted with high morbidity and mortality, and intraaortic
balloon pump counterpulsation helped to improve re-
sults afer cardiac surgery with extracorporeal circula-
tion.
Suplimentul A, 2010
18I
POSTER I I
POSTER I I
perfuzie). Conform experientei clinice, durerea de re-
paus poate f redusa semnifcativ sau eliminata dupa
5-14 zile la aproximativ 70% din pacientii cu BOAP
stadiul III si IV prin tratament consistent cu pros-
taglandina E1. Se poate identifca o tendinta de vinde-
care a ulcerelor dupa aproximativ 14-20 de zile. Daca
nu se obtine nici un succes terapeutic dupa trei sapta-
mani de tratament cu VASAPROSTAN, acesta trebuie
intrerupt.
Post-thrapeutical aspects of
Vasaprostan therapy in stage
IV atherosclerotic disease
Introduction: E prostaglandin, (VASAPROSTAN)
has a special place in conservative therapy of periferic
arterial oclusive disease. Beeing a very used product,
the need of information among the phisicians is also
growing; questions regarding special indications, si-
multaneous diseases and ways of administrating it, also
possible adverse reactions must be addressed according
to most recent research.
Material and method: In our study were allowed pa-
tients with stage III and IV chronical oclusive disease.
105 patients in stage III or IV were treated on an ave-
rage 38 days period. On a 6 month to 2 years follow-up
the successful results persisted. Te afected limb was
still functional at 48% of the patients, 19 (38%) remain
in IIb stage, 66% with intermittent claudication, surgi-
cal intevention was necessary in 32%, necrossis apears
in 2%.
Results: Most of the patients in tratment with Vasa-
prostan had a favourable evolution, with a great increa-
se of distance of walking without pains.
Conclusions: As a question of principle, the i.a and i.v
treatment with VASAPROSTAN must be administra-
ted as equable possible on a four weeks period (at least
20 days of i.v.s). According our clinical experience, re-
cumbency pain can be signifcantly reduced or elimi-
nated afer 5-14 days of consisstent treatment with E1
prostaglandin, at 70% of the patients with stage III and
IV oclusive arterial disease. A clousure tendency in ul-
cers cans occure in 14-20 days. If no terapeutical succes
is visible afer 3 weeks in VASAPROSTAN therapy, the
treatment must be stopped.
dard ECG.Te sleeping apnea has been defned as in
respiratory distress index.(RDI).Te statistic review
showed that an incresed RDI has been associated with
an incress of the atrial fbrillation with p=0,1 - <0,01,
OR=2,1.
Conclusions: Te central sleeping apnea is associated
with atrial fbrillation.Te treatment of the sleeping ap-
nea is followed by the conversion to RS and the decrea-
se of the atrial fbrillation recurence.
122. Aspecte post-terapeutice
in terapia cu vasaprostan in
arteriopatiile aterosclerotice
stadiul IV
Introducere: prostaglandina E, (VASAPROSTAN) are
o pozitie speciala in tratamentul conservator al bolii
ocluzive arteriale periferice. Fiind un produs utilizat
din ce in ce mai mult, nevoia de informatii a medicilor
curanti este de asemenea in crestere; intrebarile privind
indicatiile speciale, bolile concomitente si caile de ad-
ministrare si privind reactiile adverse posibile trebuie
adresate conform celor mai recente cercetari.
Material si metoda: Au fost investigati si urmariti pa-
cienti angiologici cu arteriopatie cronica obliteranta
stadiul III sau IV. Au fost tratati 105 pacienti in stadiul
III sau IV pe o perioada medie de 38 de zile. Intr-o faza
de urmarire care a durat intre 6 luni si 2 ani dupa sfar-
situl terapiei, succesul tratamentului a persistat. Mem-
brul afectat era inca functional la 48% din pacienti ur-
mariti, pe cand 19 pacienti (38%) au ramas in stadiul
IIb, 66% cu claudicatie intermitenta, 32% s-a intervenit
chirurgical, 2% cu necroza.
Rezultate: Majoritatea pacientilor la care s-a efectuat
tratamentul cu Vasaprostan au prezentat o evolutie fa-
vorabila, cu o mai mare crestere semnifcativa in dis-
tanta de mers fara durere.
Concluzii: In principiu, terapia i.a. si i.v. cu VASA-
PROSTAN trebuie administrata cat de regulat posibil
pe o perioada de 4 saptamani (cel putin 20 de zile de
POSTER I I
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Suplimentul A, 2010
188
Considerations on deep venous
thrombosis associated with the
Leiden Syndrome
Te 24 year-old patient, named V.A., having the
following personal pathological history (PPH): Acu-
te thrombophlebitis at the age of 13, Post-thrombotic
syndrome in the lef shin, Deep thrombophlebitis in
the lef leg at the age of 14. As far as his hereditary colla-
teral history (HCH) is concerned: Father: recurrent
pulmonary embolism (PE); chronic thrombophlebitis
afecting both legs; varicose veins afecting both legs,
for which he underwent surgery; Leiden Syndrome.
Younger sister: right thighbone artery thrombosis; ri-
ght ovary artery thrombosis, right ovary necrosis; right
ovariectomy; Leiden Syndrome. Clinical and paraclini-
cal investigations at the age of 14; vascular lower limb
Doppler scan (February 2002), CT scan reveals throm-
bosis, of the inferior vena cava, iliac vein, thighbone
vein and lef superfcial popliteal vein. Te disease
treated with oral (coumarin based) anticoagulants has
a satisfactory evolution until July 2009, when a lef shin
thrombophlebitis relapse occurs, complicated with
trophic disorders in the lower of the shin. Te vascu-
lar computer tomography scan (Angio CT) reveals ve-
nous circulatory system agenesis. Te intrahepatic sec-
tion of the IVC (inferior vena cava) undergoes a sudden
dacalibration and a circumference thrombosis leaving
a 4-8mm lumen progressing towards the subhepatic
section of the IVC, behind the pancreas head it has a
4,4mm diameter; the right vena cava has a 10mm dia-
meter 2,7cm from its fowing in the IVC. Note the lack
of view on the suprahepatic signs. Dilated inferior me-
senteric vein. Important superfcial collateral circulati-
on especially in the lef anterior and lateral area of the
abdomen and pelvis. Important deep circulation in the
lef perirenal, mesenteric, perirectal and lef paraverte-
bral areas, as well as in the spleen hilus. Lack of view on
the bilateral internal and external iliac areas. 1,2/1,6cm
sof tissue mass in the thymic bed - remaining thymic
tissue. Due to a defcient venous circulation, the pati-
ent developed chronic class II NYHA heart failure. He
is currently undergoing a treatment consisting of oral
anticoagulants, antiagregant drugs, peripheral vasodi-
latators and cardioselective - blockers in small doses.
His health state evolution is currently favorable.
123. Consideratii privind
tromboza profunda din
Sindromul Leiden
Lucia Chetreanu, Danisia Haba, D.Zdrenghea
CMI Procardia, Iasi; Universitatea de Medicina si
Farmacie Grigore T. Popa, Iasi;Universitatea de
Medicina si Farmacie Iuliu Hatieganu Cluj Napoca
Pacient V.A. in varsta de 24ani cunoscut cu anteceden-
te personale patologice (APP) de: Trombofebita acuta
la varsta de 13 ani, Sindrom posttrombofebitic gamba
stanga, rombofebita profunda membru inferior stang
la 14ani. Antecedente heredo colaterale (AHC) eviden-
tiaza: Tata embolie pulmonara (EP)repetata; trom-
bofebita cronica memebre inferioare; boala varicoasa
membre inferioare operata; Sindrom Leiden. Sora (mai
mica) tromboza artera femurala dreapta; tromboza
artera ovariana dreapta; necroza ovar drept; anexecto-
mie dreapta; Sindrom Leiden.
Investigatiile clinice si paraclinice la momentul re-
spectiv (14 ani): Ecografa Doppler vascular la nivelul
membrelor inferioare (februarie 2002), examenul CT
(computer tomografe) evidentiaza tromboza vena cava
inferioara, vena iliaca, femurala si poplitee superfciala
stanga. Evolutia bolii sub anticoagulante orale (cuma-
rinice) satisfacatoare pana in 2009 iulie, cand repeta
trombofebita la nivelul gambei stangi complicate cu
tulburari trofce la nivelul inferioare. CT vasculara
(Angio CT) evidentiaza aghenezia sistemului circula-
tor venos. Segmentul intrahepatic al VCI (vena cava
inferioara) se decalibreaza brusc cu tromboza circum-
ferintiala ce lasa un lumen restant de 4-8mm cu di-
mensuiune progresiva a acestuia la nivelul segmentului
subhepatic al VCI, posterior de capul pancreasului are
un de 4,4mm; vena renala dreapta 10mm la 2,7cm
de varsarea in VCI. De notat lipsa vizualizarii semne-
lor suprahepatice. Vena mezenterica inferioara dilatata.
Importanta circulatie colaterala superfciala predomi-
nant anterior si lateral stang abdominal si pelvin. Im-
portanta circulatie profunda perirenala stanga in hilul
splinei, mezenterica, perirectala, paravertebrala stanga.
Lipsa vizualizarii zonelor iliace interne si externe bila-
teral . Masa de tesut moale de 1,2/1,6cm in loja timica
tesut timic restant. Datorita circulatiei venoase critice,
pacientul a dezvoltat insufcienta cardiaca cronica clasa
II NYHA. In prezent este sub tratament cu anticoagu-
lante orale, antiagregante, vasodilatatoare periferice si
blocant cardioselectiv in doze mici, cu evolutie favo-
rabila a starii de sanatate.
Suplimentul A, 2010
189
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The Relationship between
Metabolic Syndrome and
Serum Uric Acid Level:
Differences by Sex and Age in
Patients included in annual
checkup for circulation safety
Introduction: Metabolic syndrome (MetS) and hype-
ruricemia are important risk factors for cardiovascular
disease. However, fndings regarding the relationship
between serum uric acid (UA) level and components of
MetS have been inconsistent in our country. Tis study
was performed to explore the potential value of UA le-
vel as a marker of MetS among male and female of di-
ferent ages who perform annual checkup for safety of
circulation on CF Clinical Hospital Oradea.
Methods: A total of 589 subjects (296 females and 293
males) were recruited from the patients who perform
annual checkup for safety of circulation on CF Clinical
Hospital Oradea. Hyperuricemia was defned as a se-
rum UA value >7.0 mg/dL for males or >6.0 mg/dL for
females. MetS was defned according to the criteria of
the International Diabetes Federation in 2005.
Results: Te sensitivity and specifcity of serum UA
concentration as a marker of MetS were 58.3% and
66.9%, respectively. Subjects with high UA had a higher
risk of MetS, with odds ratios of 1.6 (P < 0.01). Serum
UA and the occurrence of MetS rose with increasing
age in females; in males, however, UA values did not
vary with age.
Conclusions: Serum UA is more closely associated
with MetS in females than in males. High UA among
middle-aged women may predict the development of
MetS.
124. Relatia dintre acidul uric
seric si sindromul metabolic:
diferentierea pe sexe si varsta
la pacientii inclusi in siguranta
circulatiei.
F.Maghiar, Alina Iacobescu, Sorina Magheru,
C.Magheru, M.Popescu
Introducere: Sindromul metabolic si hiperuricemia
sunt factori de risc important pentru bolile cardiovas-
culare. Cercetarile actuale privind relatia dintre valorile
acidului uric seric si sindromul metabolic sunt relative
putine in tara noastra. Acest studiu a fost efectuat pen-
tru a explora evetualul potential al valorilor acidului
uric seric ca marker al sindromului metabolic atat la
barbati cat si la femei, de varsta diferite.
Metoda: Au fost inclusi in studiu 589 de pacienti (296
femei si 293 barbati) consecutivi inclusi in examenul
annual pentru siguranta circulatiei la Spitalul Clinic
CF Oradea. Hiperuricemia a fost defnite ca valori ale
acidului uric seric >7.0 mg/dL pentru barbate si >6.0
mg/dL pentru femei. Sindromul metabolic a fost defnit
conform cu Federatia Internationala de Diabet in 2005.
Rezultate: Acidul uric seric crescut are o sensibilitate
de 58.3% si o specifcitate de 66.9% ca si marker a sin-
dromului metabolic. Pacientii care prezinta valori cres-
cute ale acidului uric au un risc de a prezenta sindrom
metabolic de 1.6 ori mai mare (P < 0.01) decat cei cu
valori normale ale acestuia. Valorile acidului uric seric
si incidenta sindromului metabolic cresc odata cu var-
sta in grupul femeilor dar ramane constant in grupul
barbatilor.
Concluzii: Valorile acidului uric seric sunt mai strans
asociate cu sindromul metabolic la femei decat la bar-
bati. Valori crescute ale acidului uric seric la femeile de
varsta mijlocie prezic sindromul metabolic.
POSTER I I
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Suplimentul A, 2010
110
ring diagnostic and cardiac fndings afer performing
cardiac MRI exploration.
Te method is used in our center starting January 2007,
and during 2007-2008 we examined 70 patients. From
total number of cases, we investigated 57 male patients
(75,7%) and 13 female patients (24,3%), with age range
between 1-73 years, and average age of 41,9 years.
Te pathology investigated included a large variety of
cardiac diseases, from congenital cardiac disease to
cardiac tumors, evaluation of right and lef ventricle
afer myocardial infarction or ischemic cardiac disease.
Nine of these patients presented with normal ventricu-
lar function and cardiac morphology.
In conclusion, cardiac MRI represents a powerful tool
for diagnostic, with high sensibility and specifcity, very
useful in evaluation of cardiovascular diseases.
126. Investigarea anomaliilor
de emergenta a arterelor
coronare prin CT
angiocoronarografie
Nicoleta Iacob, M.D.Gratian
Timisoara
Progresul rapid al tehnicilor de imagistica medicala, in
special aparitia computer tomografei multislice, a per-
mis investigarea neinvaziva a arterelor coronare.
Coronarografa CT s-a impus in diagnosticul patologi-
ei cardio-vasculare prin acuratetea, rapiditatea si nein-
vazivitatea metodei.
Elaborarea ghidurilor privind investigarea patologiei
cardio-vasculare recomanda utilizarea metodei ca in-
dicatie de prima intentie in detectarea anomaliilor de
emergenta a arterelor coronare.
In centrul nostru de diagnostic imagistic, din numarul
total de peste 2300 de coronarografi, am identifcat 8
cazuri de anomalii de emergenta a coronarelor.
Metoda s-a dovedit utila in detectarea acestor anomalii,
in 7 cazuri find descoperiri accidentale, pacientii find
investigati pentru simptomatologie atipica, intr-un sin-
gur caz pacientul find adresat dupa o examinare coro-
narografca invaziva in vederea stabilirii cu exactitate a
raporturilor anatomice pentru interventia chirurgicala.
125. Explorarea cordului
prin rezonanta magnetica-
experienta Centrului
de Diagnostic Imagistic
NEUROMED
M.Gratian, Gabriela Catau
Timisoara
Obiectivul lucrarii actuale este de a prezenta experi-
enta Centrului de Diagnostic Imagistic NEUROMED
Timisoara in explorarea cordului prin rezonanta mag-
netica.
Am luat in studiu toate explorarile de RM cardiac efec-
tuate in clinica noastra pe perioada 2007-2008 urma-
rind parametrii demografci ai pacientilor, diagnosticul
de trimitere si leziunile cardiace descoperite.
Metoda se practica de rutina incepind cu ianuarie
2007, in perioada 2007-2008 find examinati 70 de pa-
cienti. Din numarul total de cazuri, au fost investigati
57 de pacienti de sex masculin (75,7%) si 13 pacienti de
sex feminin (24,3%), cu varste cuprinse intre 1 si 73 de
ani, cu o varsta medie de 41,9 ani. Patologia investigata
a cuprins o mare varietate de afectiuni, de la malfor-
matii cardiace congenitale, tumori cardiace, evaluare a
functiei ventriculului drept, evaluare a functiei ventri-
culului stang post infarct miocardic sau pentru suspi-
ciune de infarct miocardic, 9 pacienti din numarul total
prezentand morfologie normala si valori normale ale
parametrilor evaluati.
Concluzii: Investigarea cordului prin rezonanta mag-
netica reprezinta o unealta diagnostica puternica, cu
sensibilitate si specifcitate ridicate, utila in evaluarea
patologiei cardiovasculare.
Diagnostic Imaging Centre
NEUROMED Timisoara
Te purpose of this work is to present the experience
gained in cardiac MRI in Diagnostic Imaging Centre
NEUROMED Timisoara.
We used in our study all cardiac MRI examinations
performed in our center during 2007-2008, using for
evaluation demographic parameters of patients, refer-
Suplimentul A, 2010
111
POSTER I I
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sionala si Doppler, ecografe carotidiana si prin analize
de sange si urina. IPM a fost determinat ca suma tim-
pului de relaxare izovolumetrica (TRIV) si a timpu-
lui de contractie izovolumetrica (TCIV), impartita la
timpul de ejectie (TE) al ventriculului stang. Grosimea
intimamedie (GIM) 0.9 mm a fost considerata cres-
cuta. S-au determinat glicemia a jeun, creatinina plas-
matica, proteinuria si albuminuria. Analiza statistica
s-a realizat cu SPSS 11.5 pentru Windows. P sub 0.05 a
fost considerat statistic semnifcativ.
Rezultate: Fumatorii cu SM si BCVA au avut sem-
nifcativ crescute glicemia (10212, 9410, p 0.04),
trigliceridele (241126, 14175, p 0.001), in timp ce
HDL-colesterolul a fost semnifcativ scazut (389,
4511, p 0.003). Prevalenta hipertensiunii a fost mai
mare la fumatorii cu SM (p <0.001). Fumatorii cu SM
si BCVA au avut circumferinta abdominala mai mare
(p<0.001). Timpul de decelerare (TD), TRIV si TCIV
au fost semnifcativ crescute, iar TE si raportul E/A
au fost semnifcativ mai scazute la fumatorii cu SM si
BCVA (p<0.001). IPM a fost mai mare la fumatorii cu
SM si BCVA comparativ cu lotul de control (0.560.05,
0.390.05, p 0.001). Fumatorii cu SM si BCVA au avut
GIM carotidiana crescuta 28.1%, comparativ cu lotul
de control 12.9 % (p<0.001). Obezitatea abdominala
si glicemia a jeun modifcata au fost singurele compo-
nente ale SM asociate independent cu GIM carotidiana
crescuta (p 0.001 si respectiv 0.03).
Concluzii: Am constatat asocierea intre SM si BCVA si
prezenta unei functii globale a ventriculului stang mo-
difcata la fumatorii cu SM si BCVA. Trebuie realizat
un diagnostic si tratament precoce al SM pentru a pre-
veni progresia disfunctiei ventriculare la boala cardiaca
simptomatica.
Index of myocardial
performance in smokers with
metabolic syndrome and
asymptomatic cardiovascular
disease
Aim: To assess global lef ventricular function using
the myocardial performance index (MPI) in smokers
with metabolic syndrome (MS) and asymptomatic
cardiovascular disease (ACVD), and in control group,
non-smokers, without MS.
Anomalous origin of coronary
arteries investigated with CT
angiography
Rapid developement of imaging medical techniques,
especially the multislice computer tomography has
allowed non invasiv coronary artery investigation.
Te CT angiography has imposed in the diagnosis of
cardiovascular pathology by accuracy, speed and noni-
vasivenes of the method.
Te guidelines regarding the diagnosis and investi-
gation of cardiovascular pathology recommend this
method as frst line indication in detecting the anor-
malous origin of the coronary artery.
In our diagnostic center, from more than 2300 CT co-
ronary angiographies, we identifed 8 cases of anorma-
lous origin of the coronary artery.
Tis method has showed the usefulness in detecting
these anomalies. 7 of the patients were incidental fn-
dings.Te patients were investigated for atipic sympto-
matology. In one particular case, the patient was refe-
red to us afer cardiac cathetherization for description
of anatomical structures involved in anomaly.
127. Indexul performantei
miocardice la fumatorii cu
sindrom metabolic si boala
cardiovasculara asimptomatica
Catalina Lionte, L.Sorodoc, O.R.Petris, Victorita Soro-
doc, Narcisa Paula Marcu
Universitatea de Medicina si Farmacie Gr.T.Popa, Iasi
Scop: Evaluarea functiei globale a ventriculului stang
utilizand indexul performantei miocardice (IPM) la
fumatorii cu SM si BCVA asociata si la un grup de con-
trol, nefumatori, fara SM.
Metode: Populatia de studiu a inclus 96 fumatori cu
SM si BCVA asociata (61 barbati, 35 femei, varsta me-
die=4311 ani) si 93 subiecti nefumatori, fara SM sau
BCVA, cu aceeasi structura privind varsta si sexul. S-au
exclus pacientii cu istoric de diabet, infarct miocardic,
cardiomiopatie, boli valvulare cardiace, fbrilatie atriala
sau blocuri atrioventriculare de grad inalt. Toti pacien-
tii au fost evaluati clinic, prin ecocardiografe bidimen-
POSTER I I
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Suplimentul A, 2010
112
128. Corelatii ale unor factori
modificabili si nemodificabili
cu tipul sindromului
coronarian acut intr-un lot
de pacienti cu SCA, cu si fara
Laura Arama, S.Barsan, Andreea Popescu, Luminita
Ionescu, Simona Huidu, M.Melnic, L.Ghilencea,
I.Stanca, Doina Dimulescu
Obiective - analiza datelor obtinute la internare (sex,
factori de risc cardiovascular asociati, medicatie ante-
rioara evenimentului index) in vederea stabilirii unor
corelatii cu valoare semnifcativa statistic cu tipul SCA
Material si metoda: 228 pacienti cu Sindroame co-
ronariene acute, inrolati succesiv in 2009,impartiti in
doua loturi in functie de prezenta sau nu a diabetului
zaharat.
Rezultate: -68% din pacienti au avut ca forma de pre-
zentare angina instabila -diabeticii au avut mai frecvent
ca forma de prezentare infarctul miocardic (36,7% fata
de 28,6%) -pacientii diabetici cu vechime a bolii mai
mica de 6 ani au avut mai frecvent ca forma de prezen-
tare STEMI -barbatii cu DZ au avut mai frecvent IM
decat femeile diabetice(49% vs.21%) -la nondiabetic
sexul nu a infuentat tipul SCA -singurul factor de risc
care s-a corelat semnifcativ statistic cu tipul SCA a fost
fumatul si doar in lotul pacientilor diabetici: STEMI a
fost de 4,5 ori mai frecvent la diabeticii fumatori -pre-
medicatia s-a corelat cu tipul SCA in cazul betablocan-
telor si a IECA,care s-a asociat cu prevalenta scazuta a
STEMI.
Concluzii -sexul masculin,fumatul si absenta preme-
dicatiei cu betablocante si IECA s-au corelat cu preva-
lenta crescuta a STEMI ca forma de prezentare a SCA
Methods: Te study population included 96 smokers
with MS and associated ACVD (61 male, 35 female,
mean age=4311 years), and 93 subjects, non-smokers,
without MS or ACVD, matched for age and sex. Exclu-
sion criteria included history of diabetes, myocardial
infarction, cardiomyopathy, valvular heart disease, atri-
al fbrillation and high degree atrioventricular block.
All patients underwent physical examination, a two-
dimensional and Doppler echocardiographic exami-
nation, ultrasound of carotid arteries, and biochemical
tests. MPI was determined as the sum of isovolumic re-
laxation time (IVRT) and isovolumic contraction time
(IVCT) divided by lef ventricular ejection time (ET).
Intimamedia thickness (IMT) 0.9mm was conside-
red increased. Fasting glucose, creatinine, proteinuria
and albuminuria were also assessed. Statistical analysis
was performed using SPSS 11.5 for Windows. P value
of less than 0.05 was considered statistically signifcant.
Results: Smokers with MS and ACVD had signifcantly
higher fasting plasma glucose (10212, 9410, p 0.04),
and triglycerides (241126, 14175, p 0.001), while
HDL-cholesterol was signifcantly lower (389, 4511,
p 0.003). Te prevalence of hypertension was higher in
smokers with MS (p <0.001), which had also a higher
waist circumference (p <0.001). Te deceleration time
(DT), IVRT and IVCT were signifcantly higher and ET
and E/A ratio were signifcantly lower in smokers with
MS and ACVD (p<0.001). MPI was signifcantly higher
in smokers with MS with ACVD compared with con-
trols (0.560.05, 0.390.05, p 0.001). Smokers with MS
and ACVD had increased carotid IMT 28.1%, compa-
red with controls 12.9 % (p<0.001). Abdominal obesity
and impaired fasting glucose were criteria of MS that
showed an independent association with increased ca-
rotid IMT (p 0.001, and 0.03 respectively).
Conclusions: In the present study, we have shown asso-
ciation between the MS and ACVD, and the presence
of impaired global lef ventricular function in smokers
with MS and associated ACVD. An early diagnosis and
management of MS must be done to prevent progres-
sion of ventricular dysfunction to symptomatic cardiac
disease.
Suplimentul A, 2010
118
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device-uri este asociata cu cresterea ratei infectiilor de
dispozitive. Rata infectiilor sondelor de pacemaker va-
riaza intre 0,13% si 19,9% si constituie 10% din totalul
endocarditei infectioase de device. Datele din literatura
pentru defnirea si tratamentul endocarditei infectioa-
se device-related sunt putine, de aceea managementul
acestor cazuri este foarte difcil.
Prezentare de caz: Prezentam cazul unei paciente in
varsta de 72 ani, veche hipertensiva, cu urmatorul is-
toric al bolii: cardiostimulare permanenta bicamerala
in 2005, ulterior cu infectie de loja, schimbarea pozitiei
buzunarului generatorului de 4 ori, plastie de muschi
pectorali, fractura de sonda in 2009, reimplantare de
pacemaker subpectoral drept, in fnal cu 4 sonde de
stimulare: 3 in ventriculul drept si una in atriul drept.
Se prezinta in serviciul de urgenta cu sindrom infecti-
os, frisoane cu durata de ora, aparute intermitent de 2
ori pe saptamana, febra, simptome, cu debut cu apro-
ximativ 6 luni inaintea internarii. Cu 7 zile inaintea
internarii starea pacientei se agraveaza, prezinta tuse,
hemoptizie, dispnee. Clinic, laborator (VSH crescut,
leucocitoza, anemie, fbrinogen crescut, PCR cantitati-
va elevata, hemocultura pozitiva cu Corynebacterium
amycolatum-considerat saproft) si imagistic (ecocar-
diografe, radiografe toracica si tomografe computeri-
zata toracica) se stabileste diagnosticul de endocardita
infectioasa device-related (de sonda atriala) si infarct
pulmonar septic. Desi la o internare anterioara (mar-
tie 2010) o hemocultura a evidentiat acelasi germene,
a fost considerat nepatogen, ca fora normala cutana-
ta si verosimil suprainfectie. Dupa consultul infectio-
nistului s-a administrat tratament cu Cefriaxon 2 g/
zi si Teicoplanin 400 mg/zi timp de o luna, cu evolutie
spectaculara din punct de vedere clinic si normalizarea
testelor de laborator.
Concluzie. La pacienta prezentata s-a constatat o evo-
lutie net favorabila pe termen scurt, in absenta ex-
plantarii dispozitivului intracardiac datorita refuzului
acesteia. In astfel de cazuri, la pacientii cu device-uri
intracardiace este necesar a se lua in discutie si germe-
nii considerati uneori ca si saprofti.
4 pacemaker leads, just one
vegetation - case report
Background. Use of permanent pacemakers for vari-
ous cardiac rhytm disturbances has rapidly increased
lately. Tis increase is associated with a rising incidence
Correlations of modifiable and
unmodifiable factors such as
acute coronary syndrome with
a group of patients with ACS,
with and without ST-segment
elevation
Objectives. Analysis of data obtained at admission
(sex, associated cardiovascular risk factors, and previo-
us medication index event) in order to establish statis-
tically signifcant correlations with the type value ACS.
Material and methods: 228 patients with acute coro-
nary syndromes, sequentially enrolled in 2009, divided
into two groups according to presence or not of diabe-
tes.
Results: -68% of patients had unstable angina presen-
tation -Diabetes had more frequently as presentation
of myocardial infarction (36.7% vs. 28.6%) Old-dia-
betic patients with disease less than 6 years had more
frequently STEM presentation -Men with diabetes
were more frequently diabetic MI than women (49%
vs. 21%) Not in nondiabetic sex-infuenced type SCA
-Te only risk factor statistically signifcantly correla-
ted with smoking and type of ACS was only in diabetic
patients group armorial was 4.5 times more frequently
in diabetic smokers Premedication was associated with
type-ACS when beta-blockers and ACE, which was
associated with low prevalence STEM.
Conclusions: Male sex, smoking and lack of preme-
dication with beta blockers and ACE inhibitors were
correlated with the prevalence of STEM presentation
of ACS.
129. 4 sonde de stimulare, doar
o vegetatie - prezentare de caz
Maria-Cristina Tatar, I.Tilea, Brindusa Tilea, L.Cozlea,
Sallo Marta German
Universitatea de Medicina si Farmacie, Tirgu Mures
Introducere. Utilizarea cardiostimulatoarelor si a de-
fbrilatoarelor implantabile pentru diferite tulburari
de ritm a crescut in ultima perioada intr-un ritm ac-
celerat. Aceasta crestere a numarului de implantari de
POSTER I I
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Suplimentul A, 2010
111
Metoda: Am studiat 24 pts. consecutivi cu HTA mo-
derata impartiti in doua grupuri echilibrate demo-
grafc (usoara predominanta masculina, varsta me-
die=58,9+/-4,7 ani). Durata studiului a fost de 6 luni
(debut la 1 iunie 2009). Pts. din grupul de studiu au
fost tratati cu combinatia v+t, cei din grupul martor cu
combinatia b+d, doze adaptate pana la optimizarea va-
lorilor tensionale. Fiecarui pacient i s-au efectuat doua
ABPM si doua examinari ecocardiografce, la initiere
si la 6 luni. Variabilitatea frecventei cardiace (FC) a
fost calculata scazand cea mai mica valoare din cea mai
mare pe 24 ore. Ecocardiografa furnizeaza masa VS
(MVS) si TRIV.
Rezultate: Tabelul adiacent structureaza principalele
rezultate ale studiului: Parametru v+t b+d Initial Dupa
6 luni Initial Dupa 6 luni p FC (b/m) 75+/-28 67+/-26
75+/-28 67+/-26 <0,01 FC (b/m) 10+/-4 9+/-4 10+/-4
5+/-2 <0,01 MVS (g/m2) 125+/-43 118+/-38 124+/-42
117+/-38 <0,01 TRIV (ms) 95+/-14 87+/-12 94+/-14
87+/-12 <0,01.
Concluzii: Potrivit rezultatelor noastre, reducerea FC
nu a infuentat semnifcativ variabilitatea in grupul de
studiu. In contrast, in grupul comparator, au fost inre-
gistrate scaderi atat pentru FC, cat si pentru FC. Re-
zultatele au fost independente de MVS si functia dias-
tolica exprimata prin TRIV. Datorita limitelor de ordin
statistic, sunt necesare studii ulterioare.
The influence of heart rate
lowering antihypertensive
combos upon heart rate
variability - a 6 months study
According to the literature, heart rate (HR) lowering
diminishes the risk of complications in cardiovascular
patients (pts). On the other side, the HR variability pre-
servation is desirable in this context.
Te aim of our study was the comparative assessment
from this perspective of verapamil + trandolapril (v+t)
combination vs. -blocker + diuretic (b+d).
Method: We studied 24 consecutive moderate hyper-
tensive pts. divided in two groups demographically ba-
lanced (slight male predominance, mean age=58,9+/-
4,7 yrs). Te study duration was 6 months (started 1st
June 2009). Te pts. from study group were treated
with v+t combo, while controls with b+d, adapted do-
of infection among patients with cardiac devices. Te
reported rate of infection ranges from 0.13% to 19.9%
for PPMs. Data to guide diagnosis and treatment in
patients with infective endocarditis device-related
(CDIE) are limited. Moreover the defnition of CDIE
has varied in previously published reports, that variati-
on has made it dif cult to determine the most appropi-
ate management.
Case report: We present a case of 72 y.o. woman, with
4 pacemaker leads: 3 wires in right ventricle and 1 in
right atrium. Te generator has been moved from a lo-
cation to another in the last 5 years for signs of pocket
infections. At presentation in EMU she had fever,
chilies, haemoptysis and dyspnoea. Using Duke crite-
ria (with positive blood culture for Corynebacterium
amycolatum - saprophitic germ), imaging techniques
(TTE and thoracic CT) we diagnosed CDIE and sep-
tic pulmonary infarct. Treatment was performed for a
month with: Cefriaxone 2 g b.i.d. and Teicoplanin 400
mg once a day intravenously, with a spectacular recover
of clinical and laboratory fndings.
Conclusions: In this case we observed a very good
short-term evolution, but unfortunately the patient
refused the explantation of the device. In such cases,
in patients with intracardiac devices is mandatory to
consider the saprophytic germs in the etiology of CDIE
also.
130. Influenta combinatiilor
antihipertensive cu efect
bradicardizant asupra
variabilitatii frecventei cardiace
- un studiu pe 6 luni
A.Tase, S.Marinescu, O.Tetiu, I.Iorga-Siman, G.
Savoiu, D.Blajan, M.Mihaila
Spitalul Judetean de Urgenta Arges, Pitesti
Intro: Potrivit datelor din literatura, scaderea frecven-
tei cardiace (FC) reduce riscul complicatiilor la pacien-
tii (pts.) cardiovasculari. Pe de alta parte, este dezirabila
prezervarea variabilitatii FC in acest context.
Scopul studiului nostru a fost evaluarea comparativa
din aceasta perspectiva a combinatiei verapamil + tran-
dolapril (v+t) vs. -blocant + diuretic(b+d).
Suplimentul A, 2010
115
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de varsta 25-38 ani (11.35%) (diferenta semnifcativa
statistic intre grupele de varsta, p=0,001). Afectiunile
coronariene au inregistrat aceeasi tendinta, inregis-
trandu-se o diferenta semnifcativa statistic intre gru-
pele de varsta 48-69 ani (41.80%), si 25-38 ani (7.55%)
(p=0,003). Insufcienta cardiaca se incadreaza in aceea-
si curba de distributie pe varsta (45%, respectiv 6.8%)
(p=0,02). In afara de varsta, au fost luate in consideratie
si alte variabile pentru analiza statistica precum distri-
butia pe sexe, mediul de provenienta, indicele de masa
corporala, perimetrul abdominal, statusul de fumator
sau nefumator.
Concluzii: Rezultatele studiului pledeaza pentru de-
terminismul sindromului cardiometabolic ca factor de
predictie in aparitia si evolutia bolilor cardiovascula-
re. Cresterea riscului afectiunilor cardiovasculare de 5
(cinci) ori mai mare la pacientii cu sindrom cardiome-
tabolic a fost confrmata si in cadrul studiului nostru.
The influence of the
metabolic syndrome on the
cardiovascular function
Background: Although metabolic syndrome is a very
well known and easily diagnosed disease, the compli-
cations arising are more numerous and with a great
impact on the increased incidence of cardiovascular
diseases.
Our study aims to identify correlations between the
metabolic syndrome and cardiovascular diseases de-
terminism.
Methods: A retrospective study conducted in Te Car-
diac Rehabilitation Hospital Iasi, from 01.06.2008 to
31.12.2009 included a total of 2450 patients, of which
734 patients met the diagnostic criteria of cardiometa-
bolic syndrome: National Cholesterol Education Pro-
gram Adult Treatment Panel III criteria, International
Diabetes Federation and World Health Organization.
Results: In our study we establishe that the incidence
of hypertension was highest in the patients group 48-
69 years (53.70%) and lowest in the patients group 25-
38 years (11.35%) (signifcant diference between age
groups, demonstrated by ANOVA test, p=0.001). Te
coronary heart diseases showed a signifcant diference
between age groups: 48-69 years (41.80%), compared to
25-38 years (7.55%) (p=0.003). Heart failure is part of
the same age distribution curve (45%, 6.8%) (p=0.02).
ses for optimal HTN treatment. We performed twice
ABPM and echocardiography in all pts., initially and
at 6 months. Te HR variability (FC) was calculated
by subtracting the lowest value from the highest value
in 24-hrs. ABPM. Echo provides LV mass (LVM) and
IVRT.
Results: Te adjacent table structures the main results
of the study: Issue v+t b+d Initially Afer 6 mo. Initially
Afer 6 mo. p HR (b/m) 75+/-28 67+/-26 75+/-28 67+/-
26 <0,01 HR (b/m) 10+/-4 9+/-4 10+/-4 5+/-2 <0,01
LVM (g/m2) 125+/-43 118+/-38 124+/-42 117+/-38
<0,01 IVRT (ms) 95+/-14 87+/-12 94+/-14 87+/-12
<0,01.
Conclusions: According to our results, the HR lowe-
ring did not signifcantly infuence variability in study
group. In contrast, in controls, we registered not only
HR, but also HR lowering. Te outcomes were inde-
pendent of LVM and diastolic function expressed by
IVRT. Further studies are necessary in order to impro-
ve the statistical signifcance.
131. Impactul sindromului
metabolic asupra functiei
cardiovasculare
Maria Leon, D.Ilisei, Corina Dima, F.Mitu
Universitatea de Medicina si Farmacie, Iasi
Scopul lucrarii: Desi sindromul metabolic este o afec-
tiune cunoscuta si facil de diagnosticat, complicatiile
ce deriva sunt tot mai numeroase si cu un impact deo-
sebit in cresterea incidentei afectiunilor cardiovascula-
re. Studiul nostru si-a propus identifcarea corelatiilor
existente intre sindromul cardiometabolic si determi-
nismul afectiunilor cardiovasculare.
Material si metoda: Studiul retrospectiv, desfasurat
in cadrul Clinicii de Recuperare Cardiovasculara a
Spitalului de Recuperare Iasi, in perioada 01.06.2008-
31.12.2009 a cuprins un numar de 2450 pacienti, din
care 734 au indeplinit criteriile de diagnostic ale sin-
dromului cardiometabolic conform National Choles-
terol Education Program Adult Treatment Panel III,
International Diabetes Federation si World Health Or-
ganization.
Rezultate si discutii: In cadrul studiului s-a constatat
incidenta maxima a hipertensiunii la pacientii din gru-
pul de varsta 48-69 ani (53.70%) si minima la grupul
POSTER I I
POSTER I I
Suplimentul A, 2010
116
Renal artery reconstruction in
renovascular hypertension
Introduction: Revovascular hypertension is a secon-
dary disease which apears afer lessions of the renal
artery or one of its branches, and it is complete reversi-
bile afection, by rebuilding arterial branches or nefrec-
tomy. Surgical treatment must occurre on time, and in
carefully selected patients, and is represented by aor-
to-renal by-pass with venous inversed graf or sintethic
prosthesis.
Material and method: Our clinical experience is based
to 43 pacients, and by-passes were performed betwe-
en 2000 2009, with venous inversed graf or sintethic
prosthesis.
Results: All patients with arterial reconstruction had
a favorable evolution, with dissapearance of secondary
HTA and renal function amelioration.
Conclusions: Rebuilding renal artery may be a viable
solution when medical treatment is useless, with fast
patient recovery and signifcant improvement of his life
quality.
133. Rolul monitorizarii
continue a tensiunii arteriale in
hipertensiunea sistolica izolata
Elena Alistar
Spitalul Judeean de Urgena Bacau
Introducere: Prevalenta hipertensiunii sistolice izola-
te in populatia generala creste progresiv cu inaintarea
in varsta, ajungand ca dupa varsta de 65 de ani sa pre-
domine (79%) faa de hipertensiunea sistolodiastolica.
Prezena acestui patern hipertensiv crete morbiditatea
cardiovasculara i mortalitatea de orice cauza de doua
ori i tripleaza mortalitatea cardiovasculara.
Scopul studiului: Prevalenta hipertensiunii sistolice
izolate (HSI) la pacientii diagnosticati cu hipertensiune
arteriala la determinarea de cabinet i analizarea prof-
lurilor tensionale prin monitorizare continua pe 24 ore
la un lot de pacieni in serviciul de medicina interna al
Spitalului Judeean de Urgena Bacau.
Material i metoda: Este un studiu prospectiv, rando-
mizat, unicentric pe un lot de 321 pacieni hiperten-
sivi, desfaurat in perioada ianuarie 2007 decembrie
Beside ages, other variables taken into account for sta-
tistical analysis were sex distribution, environment of
origin, body mass index, abdominal perimeter, smo-
king or non smoking status.
Conclusions: Te results of study advocate the deter-
minism of metabolic syndrome as predictor of cardi-
ovascular disease in the occurence and development.
Recent studies have demonstred increased risk of car-
diovascular diseases fve times higher at the patients
with cardiometabolic syndrome from healthy indivi-
duals, and proven in our
132. Reconstructia arterei
renale in hipertensiunea
arteriala renovasculara
Introducere: HTA renovasculara este o afectiune se-
cundara aparuta in urma lezarii arterei renale sau a
unei ramuri a acesteia, si este o afectiune corectabila
prin refacerea circulatiei arteriale sau prin nefrectomie.
Tratamentul chirurgical este benefc daca este efectuat
la timp si la pacienti atent selectionati, si este reprezen-
tat de by-pass-ul aorto-renal cu grefon venos inversat
sau cu material protetic sintetic.
Material si metoda: Lotul luat in studiu este reprezen-
tat de 43 de pacienti operati in perioada 2000-2010,
la care s-a practicat reconstructia arterei renale, prin
montarea de by-passuri aorto-renale cu grefon venos
inversat sau proteza.
Rezultate: Toti pacientii la care s-a practicat recon-
structia arterei renale au prezentat o evolutie favorabi-
la, cu remiterea HTA secundare si ameliorarea functiei
renale.
Concluzii: Reconstructia arterei renale este o alterna-
tiva de luat in calcul atunci cand tratamentul medica-
mentos se dovedeste inefcient, cu recuperarea rapida a
pacientului si ameliorarea semnifcativa a calitatii vietii
acestuia.
Suplimentul A, 2010
11I
POSTER I I
POSTER I I
Concluzii: Prevalena hipertensiunii sistolice izolate
este foarte inalta la pacienii care se adreseaza seciei
noastre, datorita proporiei ridicate de varstnici. Mo-
nitorizarea continua pe 24 ore a tensiunii arteriale per-
mite identifcarea hipertensiunii de halat alb i proflul
circadian. Statusul nondipper i reversedipper este in
proporie semnifcativ mai mare la hipertensiunea sis-
tolica izolata.
The role of ambulatory blood
pressure monitoring in isolated
systolic hypertension
Introduction: Te prevalence of isolated systolic hyper-
tension in the general population is growing progressi-
vely by ageing, so that afer the age of 65 prevails (79%)
over the systolic-diastolic hypertension. Te existence
of this hypertensive pattern increases the cardiovascu-
lar morbidity, doubles any case of mortality and triples
the cardiovascular mortality.
Te purpose of the study: Te prevalence of isolated
systolic hypertension at patients diagnosed with arteri-
al hypertension at of ce assessment and the analysis of
tensional profles by 24 ours continuous monitoring of
a batch of patients by the County Emergency Hospital
in Bacau.
Materials and method: Tis is a prospective, randomi-
zed and unicentral study on a batch of 321 hypertensive
patients, carried from January 2007 to December 2009.
Te batch is statistically representative for the popula-
tion of Bacau County. Te patient selection was done
using the systemic selection method. Confrmation on
the diagnostic was done by the ESC 2007 guide crite-
ria. Te monitoring system used is ABPM-04, which
uses the MediBase sofware for viewing and statistic
processing of the data. Te data has been loaded and
processed with the statistic functions in EPIINFO and
EXCEL.
Results: Te mean age of patients entering the study
was de 66,4210,35 years, varrying from 18 to 93, the
ratio F/B=3/1. Group structure shows that 63.7% of pa-
tients are older than 65 and 59.1% come from urban
areas. Te mean of ce arterial blood pressure values
were: systolic blood pressure: 163.56 14.62 mmHg,
dyastolic blood pressure 84.30 8.84 mmHg. Te dis-
tribution of cases by the degree of of ce measured ar-
terial blood pressure was: degree 1: 14.3%, degree 2:
2009.Lotul este reprezentativ statistic pentru populaia
judeului Bacau. Selectia pacientilor a fost efectuata
utilizand ca metoda selecia sistemica. Confrmarea di-
agnosticului s-a facut pe criteriile ghidului ESC 2007.
Sistemul de monitorizare utilizat este ABPM-04, care
utilizeaza programul MediBase pentru vizualizare si
pentru prelucrarea statistica a datelor. Datele au fost
incarcate si prelucrat cu ajutorul functiilor statistice din
EPIINFO si EXCEL.
Rezultate: Varsta medie a pacientilor la intrarea in
studiu a fost de 66,4210,35 ani, variind intre 18 si 93
ani, raportul F/B=3/1. Structura lotului evidentiaza ca
63,7% dintre pacienti au varsta peste 65 ani si 59,1%
provin din mediul urban. Valorile medii ale tensiunii
arteriale la cabinet au fost: tensiunea sistolica 163,56
14,62 mmHg, tensiunea diastolica 84,30 8,84 mmHg.
Distributia cazurilor in functie de gradul tensiunii ar-
teriale masurate la cabinet a fost: grad 1: 14,3%; grad
2: 54,8%; grad 3: 30,9%. Din cazuistica studiata 259
pacienti (80,7%) au prezentat hipertensiune sistolica
izolata, 44 pacieni (13,7%) hipertensiune sistolodias-
tolica iar 18 pacieni (5,6%) hipertensiune de halat alb.
La lotul cu hipertensiune sistolica izolata tensiunea sis-
tolica medie inregistrata a fost de 147,8815,18 mmHg,
tensiunea diastolica medie a fost de 74,985,42 mmHg
iar presiunea pulsului medie a fost de 69,1728,45. In
functie de indexul diurn s-a constatat: 30,5% reversdi-
pperi, 43,2% nondipperi, 22,8% dipperi i 3,5% hip-
perdipperi. Lotul de pacienti cu hipertensiune sistolica
izolata se caracterizeaza prin corelatie directa (r =0,78)
a tensiunii sistolice cu presiunea pulsului, ceea ce evi-
dentiaza ca la valori mari ale tensiunii sistolice crete
in proportie de 76% presiunea pulsului i o corelare
indirecta cu indexul diurn (r=0,36). La lotul cu hi-
pertensiune sistolodiastolica tensiunea sistolica medie
inregistrata a fost de 152,9617,47 mmHg, tensiunea
diastolica medie a fost de 86,606,37 mmHg iar presiu-
nea pulsului medie a fost de 66,3615,64. In functie de
indexul diurn s-a constatat: 22,7% reversdipperi, 27,3%
nondipperi, 45,5% dipperi i 4,5% hiperdipperi. Se re-
marca ponderea semnifcativ mai mare a pacientilor cu
varsta de peste 65 ani cu hipertensiune sistolica izola-
ta, cu o valoare predictiv pozitiva de 72%. Comparand
valorile tensionale monitorizate pe 24 ore se evidenti-
aza urmatoarele aspecte:tensiunea sistolica medie, in-
tre cele doua loturi, nu prezinta diferente semnifcative
(p>0,05); tensiunea diastolica medie a fost semnifca-
tiv mai mare la lotul cu hipertensiune sistolodiastoli-
ca (p<0,001); presiunea pulsului nu a inregistrat valori
medii semnifcative intre cele doua loturi comparate.
POSTER I I
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Suplimentul A, 2010
118
134. Efecte posibile ale
medicatiei antihipertensive
asupra parametrilor functiilor
sistolica si diastolica ale
ventriculului stang la pacientii
hipertensivi
L. Lucaci, Catalina Arsenescu-Georgescu
Institutul de Boli Cardiovasculare Prof.Dr.George I. M.
Georgescu, Iasi
Scop: Studiul infuentelor exercitate de trei tipuri de
medicamente antihipertensive asupra parametrilor
functiilor sistolica si diastolica ale ventriculului stang
(VS), la pacienti hipertensivi.
Metoda: 11 pacienti (4B,7F), cu varsta medie 51+/-10
ani, cu valori anamnestice ale TA > 140/90 mmHg,
normoponderali (IMC 27+/-2 kg/m2), nondiabetici, cu
functie renala normala, fara simptome cardiovasculare
majore si netratati, au fost evaluati ecocardiografc si
prin monitorizare ambulatorie a TA (MAPA) in absen-
ta medicatiei si, pe rand, la sfarsitul a cate unei luni de
monoterapie cu quinapril (Accupro doza medie 12+/-4
mg/zi), metoprolol (Metoprolol Terapia Cluj 100+/-31
mg/zi) si amlodipina (Tenox 12+/-6 mg/zi).
Rezultate: Dintre cele trei medicamente, doar Accu-
pro si Tenox au redus semnifcativ valorile TA, evaluate
prin MAPA. Nici un medicament nu a modifcat sem-
nifcativ dimensiunile cavitatilor cardiace stangi, func-
tia sistolica globala sau cea longitudinala a VS. Raportul
E/A scade in cursul tratamentelor cu Accupro (0.89+/-
0.25 vs 1.07+/- 0.26, p=0.01) sau Tenox (0.93+/- 0.22 vs
1.07+/- 0.26, p=0.03), iar timpul de decelerare a undei
E (TDE) creste in timpul tratamentului cu IEC (171+/-
26 vs 145+/- 15 ms, p=0.02). Restul parametrilor de-
rivati din examenul Doppler al fuxului transmitral si
al celui venos pulmonar raman nemodifcati in cur-
sul tratamentelor. Fara tratament, cu cat aria sectiunii
transversale a atriului stang (AS) sau volumul lui in sis-
tola sunt mai mari, cu atat viteza protodiastolica Vp a
fuxului transmitral, masurata in modul M color este
mai mare (Aria AS: r=0.74, p=0.013; volum AS: r=0.86,
p=0.001). Relatia se inverseaza in cursul tratamentului
cu metoprolol (Aria AS: r=-0.69, p=0.01; volum AS:
r=-0.71, p=0.01). In cursul tratamentelor cu Accupro,
respectiv Tenox, viteza A a fuxului transmitral este cu
atat mai mare, cu cat aria sectiunii transversale a AS sau
54.8%, degree 3: 30.9%. From the studied casuistry 259
patients (80.7%) sufered from isolated systolic hyper-
tension, 44 patients (13.7%) systolic-diastolic hyper-
tension and 18 patients (5.6%) white coat hypertensi-
on. At the systolic hypertension batch the mean systolic
hypertension recorded was 147.8815.18 mmHg, the
mean diastolic blood pressure was 74.985.42 mmHg
and the mean pulse pressure was 69.1728.45. De-
pending on the diurnal index it was concluded the
following: 30.5% reversedippers, 43.2% nondippers,
22.8% dippers and 3.5% hyperdippers. Te batch with
isolated systolic hypertension is characteryzed by di-
rect correlation (r =0,78) of systolic blood pressure with
pulse pressure, which points out that at high values of
systolic blood pressure, the pulde pressure increases by
76% and an indirect correlation with the diurnal index
(r=0.36). At the batch with systolic-diastolic hyperten-
sion the mean systolic blood pressure recorded was
152,9617,47 mmHg, the mean diastolic blood pressu-
re was 86,606,37 mmHg and the mean pulse pressu-
re was 66,3615,64. Depending on the diurnal index
it was concluded the following: 22,7% reversdippers,
27.3% nondippers, 45.5% dippers i 4.5% hiperdip-
pers. A signifcantly higher ratio of patients aged over
65 with isolated systolic hypertension is noted, with a
predictively positive value of 72%. Comparing the ten-
sional values monitored over 24 hours, the following
aspects are emphasized: the mean systolic blood pre-
ssure, among the two batches, doesnt show signifcant
diferences (p>0,05); the mean diastolic blood pressure
was signifcantly higher at the systolic-diastolic batch
(p<0,001); the pulse pressure did not show signifcant
mean values among the two batches.
Conclusions: Te prevalence of isolated systolic hyper-
tension is very high among patients which address our
section, due to the high proportions of old people. Te
continuous 24 hour arterial blood pressure monitoring
allows the identifcation of white coat hypertension and
circadian profle. Te no-dipper and reverse dipper
status is in signifcantly higher proportions at isolated
systolic hypertension.
Suplimentul A, 2010
119
POSTER I I
POSTER I I
transmitral fow velocity (Vp) was (LA area: r=0.74,
p=0.013; LA volume: r=0.86, p=0.001). During beta-
blocker therapy, the relationship becomes opposite (LA
area: r=-0.69, p=0.01; LA volume: r=-0.71, p=0.01). On
ACE inhibitor and calcium channel blocker, the higher
the A wave velocity, the smaller the LA cross-sectional
area in systole or its volume were (Accupro: r=-0.63,
p=0.03; Tenox: r=-0.78, p=0.004). Such a relationship
did not hold on under metoprolol.
Conclusions: In hypertensive patients with normal LV
systolic and diastolic functions, single-drug therapy
can produce only modest changes in the diastolic para-
meters, suggesting small variations of the LV relaxation
speed or of its flling pressure. Despite these minor out-
comes, this study was intended to facilitate the attempt
to understand the individual footprints of some single
drugs, before using multiple drug regimens in daily
practice.
135. Trombendarterectomia
carotidiana prin eversiune
Introducere: Trombendarterectomia carotidiana prin
eversiune reprezinta o tehnica relativ noua in manage-
mentul chirurgical al bolii aterosclerotice carotidiene.
Principalul avantaj al tehnicii este acela ca artera ca-
rotida interna este separata de artera carotida comuna
in zona unde vasele au cel mai mare calibru, facand ca
anastomoza sa fe mai usor de realizat, si riscul de reste-
nozare sa fe mai mic.
Material si metoda: Va prezentam concluziile noastre,
raportate la un lot de 75 de pacienti, care au fost operati
in clinica noastra prin techica trombendarterectomiei
carotidiene prin eversiune in ultimul an, ca si o serie de
avantaje ale tehnicii mai sus mentionate.
Rezultate: 94,6% dintre pacienti au prezentat remite-
rea semnelor neurologice manifestate la internare, 4%
ameliorarea acestora, iar 1,3% au prezentat complicatii
postoperatorii (AVC urmat de deces).
Concluzii: Tehnica trombendarterectomiei carotidie-
ne prin eversiune este sigura, mai rapida, cu mai bune
volumul lui in sistola sunt mai mari (Accupro: r=-0.63,
p=0.03; Tenox: r=-0.78, p=0.004).
Concluzii: La hipertensivii cu functie normala a VS,
monoterapia antihipertensiva poate modifca modest
parametrii diastolici, sugerand ca medicamentele pot
varia viteza de relaxare sau presiunea de umplere a VS.
Studiul incearca intelegerea efectelor individuale ale f-
ecarui drog, inainte de folosirea in practica a tratamen-
telor combinate.
Possible influences of some
antihypertensive drugs on
the left ventricular systolic
and diastolic functions in
hypertensive patients
Aim: To look for the infuences of three types of anti-
hypertensive drugs exerted over the parameters of the
lef ventricular (LV) systolic and diastolic functions in
hypertensive patients.
Method: 11 nondiabetic patients (4M,7F), aged 51+/-
10 years, without being previously treated for a histo-
ry of elevated blood pressure (BP) were included in a
protocol consisting of ultrasound examination and
ambulatory BP monitoring (ABPM) before any treat-
ment and subsequently afer each one-month period
of monotherapy with quinapril (Accupro, average daily
dose 12+/-4 mg), metoprolol (Metoprolol Terapia Cluj
100+/-31 mg) and amlodipine (Tenox 12+/-6 mg) re-
spectively.
Results: Accupro and Tenox have signifcantly lowe-
red the BP values compared to baseline (as indicated
by ABPM data), while Metoprolol did not. Neither the
lef heart cavities dimensions, nor the global or longi-
tudinal LV systolic function have been signifcantly al-
tered by anyone of the three drugs. Te E/A ratio was
signifcantly reduced during the treatments with Accu-
pro (0.89+/- 0.25 vs 1.07+/- 0.26, p=0.01) and Tenox
(0.93+/- 0.22 vs 1.07+/- 0.26, p=0.03), while the E wave
deceleration time (DT) increased under the ACE inhi-
bitor (171+/- 26 vs 145+/- 15 ms, p=0.02). Other in-
dices derived from the mitral fow and the pulmonary
venous fow did not change. Without treatment, the
bigger the cross-sectional area of the lef atrium (LA)
or its volume in systole, the higher the protodiastolic
POSTER I I
POSTER I I
Suplimentul A, 2010
150
Rezultate: Terapia cu Levosimendan in sindromul de
debit cardiac scazut post CEC a imbunatatit semnifca-
tiv functia hemodinamica, a redus morbiditatea, mor-
talitatea si costurile de spitalizare
The use of Levosimendan in
low cardiac output states
Objectives: Cardiac output improvement afer the use
of Levosimendan in our clinic
Material and method: the study included 28 patients
which received Levosimendan; a series of hemodyna-
mic parameters were followed: CO, SV, MAP, PCWP,
and CVP.
Results: post-ECC therapy with Levosimendan greatly
improved hemodynamic function in low cardiac out-
put states, reduced mortality and morbidity as well as
postoperative ICU costs.
137. Studiul corespondentei
dintre modificarile
electrocardiografice si
ecocardiografice la atleti de
performanta
A.Frigy, Katalin Mezei, C.Szabados, C.Podoleanu,
E.Carasca
Spitalul Clinic Judetean, Clinica Medicala IV, Timisoara
Cordul sportiv este rezultatul adaptarii morfofuncti-
onale a sistemului cardiovascular la eforturi fzice de
lunga durata, prezintand trasaturi specifce electro- si
echocardiografce.
Scopul lucrarii a fost stabilirea relatiei dintre modif-
carile ECG cu datele ecocardiografce in cadrul unei
evaluari cardiace complexe efectuat pe un lot de atleti
tineri de performanta.
Pacienti si metoda: Am efectuat evaluarea (anteceden-
te personale si heredocolaterale, factori de risc, examen
obiectiv, ECG standard) unui grup de 25 de sportivi
(toti de sex masculin, varsta medie 22,4 ani, vechime
medie in activitate sportiva 10,2 ani, tipul sportului: 16
rezultate la distanta si cu mai putine complicatii decat
trombendarterectomia clasica cu patch de largire.
Eversion carotid
trombendarterectomy
Introduction: eversion carotid trombendarterectomy
is a relative new technique in the surgical management
of carotid atherosclerotic disease. Te main advanta-
ge of this technique is that the internal carotid artery
is separated by the common carotid artery in the area
where the vessels have the biggest caliber, making the
anastomosis more easy, and increasing its patency.
Material and method: We present our conclusions,
reported to a lot of 75 patients, which were operated
with the help of eversion carotid trombendarterec-
tomy during the last year in our clinic, along with some
advantages of mentioned technique.
Results: Afer surgey, 94,6% of the patient presented
neurological signs amelioration, and 1,3% had posto-
perative complication (stroke folowed by death).
Conclusions: Eversion carotid trombendarterectomy
is safer, faster, has better outgoing results and far less
complications than classical trombendarterectomy.
136. Utilizarea
Levosimendanului in terapia
sindromului de debit cardiac
scazut
D. Arhire, M. Patrut, Nicoleta Arhire, E. Rachita, B.
Cornea, Cristina Grosu, C. Ardeleanu, V. Pop, R.
Vasilescu, Cristina Voinea, Olimpia Manta, V. Ispas,
E. Oclei
Obiectivele studiului: estimarea imbunatatirii functiei
cardiace dupa utilizarea Levosimendanului in clinica
noastra
Material si metoda: studiul a cuprins un numar de 28
de pacienti la care s-a administrat Levosimendan si la
care s-au urmarit o serie de parametrii hemodinamici:
cardiac output, SV, TAM, PCWP, PVC
Suplimentul A, 2010
151
POSTER I I
POSTER I I
Results: ECG changes: Sokolov-Lyon index > 3.5 mV
in 11 cases, more frequent in the strength athletes
group, right ventricular hypertrophy pattern:3 cases,
minor right bundle block: 3 cases, increased QTc in-
terval: 4 cases. Early repolarisation pattern was present
in 88% of the cases. Echocardiographical fndings: the
body surface indexed lef ventricular mass was signif-
cantly increased in the group of strenght athletes (91,4
vs. 79,8 g/m2), not reaching pathological values in any
case; frequent minor valvular (mitral and tricuspid) re-
gurgitations (68,5% each).
Conclusions: In the group of athletes studied we found
an increased prevalence of ECG changes, none of them
having structural, echocardiographical correspondent.
Tis underscores the careful selection (based on clini-
cal and ECG criteria) of athletes referred to echocardi-
ographic evaluation.
138. Anticoagularea orala in
fibrilatia atriala cronica- risc
sau beneficiu?
Georgiana Margarit, Diana Maftei, Corina Homent-
covschi, I.Bruckner
Scopul studiului nostru a fost determinarea frecven-
tei complicatiilor hemoragice care apar la bolnavii in
fbrilatie atriala permanenta in tratament anticoagu-
lant oral cronic si, secundar, a indicatiilor si controlului
acestei terapii.
Material si metoda: am efectuat o analiza retrospecti-
va a pacientilor cu fbrilatie atriala permanenta inter-
nati in Clinicile de Cardiologie si Medicina Interna in
perioada ianuarie 2009-decembrie 2009. Studiul a cu-
prins 246 pacienti, din care 114 (46,3%) in tratament
anticoagulant oral initiat anterior internarii, acestia din
urma find impartiti in trei grupe conform criteriilor de
stratifcare a riscului de accident embolic din Ghidul de
tratament al fbrilatiei atriale al ACC/AHA/ESC 2006:
risc inalt (A)-52 pacienti (46%), risc moderat (B)- 49
pacienti (43%) si risc scazut (C) -13 pacienti (11%).
Rezultate: Am analizat lotul de pacienti in functie de
semnele de sangerare activa (epistaxis, HDS, hematu-
rie) sau sangerare cronica (anemie feripriva), precum si
de prezenta comorbiditatilor ce ar putea creste riscul de
de anduranta, 9 de rezistenta). Am completat examina-
rea cu o evaluare ecocardiografca complexa 2D, M,
Doppler clasic si tisular. Am urmarit modifcarile ECG
benigne (specifce cordului sportiv) si potential pato-
logice, datele ecocardiografce, respectiv relatia dintre
ele.
Rezultate: Principalele modifcari ECG: indicele Soko-
low-Lyon > 3,5 mV in 11 cazuri, mai frecvent in ca-
zul atletilor de rezistenta, aspect de supraincarcare
ventriculara dreapta: 3 cazuri, BRD minor: 3 cazuri,
prelungirea intervalului QTc: 4 cazuri, sindrom de re-
polarizare precoce prezenta in 88% din cazuri. Date
ecocardiografce: masa indexata la suprafata corporala
a ventricolului stang a fost semnifcativ mai crescuta
in cazul atletilor de rezistenta (91,4 vs. 79,8 g/m2) dar
nu a atins valoare patologica in nici un caz; regurgi-
tari valvulare (mitrala, tricuspidiana) minore frecvente
(68,5% fecare).
Concluzii: In lotul de atleti studiat am gasit o prevalenta
crecuta a modifcarilor electrocardiografce, dar nu am
gasit o corespondenta morfologica, ecocardiografca a
acestora in nici un caz, ceea ce sublinieaza selectarea
mai atenta (clinica si electrocardiografca) a sportivilor
referiti pentru evaluare ecocardiografca.
Study of relationship between
electrocardiographic and
echocardiographic findings in
competitive athlets
Athletes heart is the result of morfofunctional cardi-
ovascular remodelling in highly conditioned athle-
tes, frequently associated with physiological ECG and
echocardiographical changes.
Our aim was to study the relationship between ECG
and echo data as a part of a complex cardiac evaluation
of a group of young athletes.
Patients and methods: We did a workup (personal
and family history, risk factors analysis, clinical eva-
luation, standard 12-lead ECG) of 25 young athletes
(males, mean age 22.4 years, years in sport: 10,24 yrs;
type of exercise performed: 9 strength, 16 endurance).
Te examination was completed with a complex echo-
cardiographic examination - 2D, M, classic and tissue
Doppler. Te ECG changes (benign and potentially
malign) and their relationship with echocardiographic
fndings were evaluated.
POSTER I I
POSTER I I
Suplimentul A, 2010
152
Material and method: Our study was a retrospective
analysis of patients with chronic atrial fbrillation ad-
mitted in the Cardiology and Internal Medicine Units
of Coltea Hospital during January 2009 - December
2009. We have enrolled 246 patients in this study. 114
of them were in chronic atrial fbrillation, receiving
oral anticoagulant therapy previous to their hospital
admission and were divided into three groups accor-
ding to the risk of embolic events: high (A) - 52 patients
(46%), moderate risk- 49 patients (43%) and low risk-
13 patients (11%) (ACC/AHA/ESC Guidelines for the
Management of Patients with Atrial Fibrillation- 2006).
Results: We have considered the signs of active bleeding
(epistaxis, superior digestive hemorrhage, and hematu-
ria) or chronic bleeding (iron defciency anemia) and
the comorbidities that might increase the hemorrhagic
risk (gastritis, gastoduodenal ulcer, and neoplasia). We
have also determined the association of chronic kidney
disease (GFR < 60 ml/min/1,73 m2) to each risk group.
Te signs of bleeding, both acute and chronic, were
most frequent in the group with the highest risk of em-
bolic events (9,6% acute bleeding, 28,8% chronic blee-
ding).
Less than 40% of all patients had an INR value in the
therapeutic range, regardless of the group of risk, while
in most of the patients, the INR value was below range
( <1,5) or above range (> 3,5). Most of the patients ad-
mitted with an INR value above the therapeutic range
(23%) had a low risk of embolic events.
Patients with high risk of embolic events also associa-
ted a high incidence of chronic kidney disease, compa-
red to the other groups of patients. In these patients, as
the glomerular fltration rate (GFR) decreased, the INR
value increased above the therapeutic range.
Complications/ comorbidities Grup A Grup B Grup C
Active bleeding (epistaxis, SDH, hema-
turia)
5 4 -
Gastritis/ GDU 6 5 4
Iron defciency anemia (negative SDE,
IDE)
15 6 2
Neoplasia (digestive, renal) 3 3 -
Cognitive dysfunctions (dementia,
depression)
1 1 -
Chronic kidney disease (RFG< 60ml/
min/1,73mp)
25 8 2
We concluded that most of the patients admitted with
active bleeding had an INR value above the therapeutic
range, proving that anticoagulant therapy was insuf -
ciently monitored (only one third of the patients recei-
ving oral anticoagulant therapy had a therapeutic INR
sangerare (gastrita, UGD, neoplazie). De asemenea am
studiat asocierea bolii cronice de rinichi (RFG< 60 ml/
min/1,73 m2) in cele trei grupe. Semnele de sangerare,
atat acuta cat si cronica, au aparut cu frecventa cea mai
mare in grupul cu risc tromboembolic inalt (9,6% acut,
respectiv 28,8% cronic). Controlul optim al terapiei an-
ticoagulante a fost realizat pentru mai putin de 40%
din pacienti, din toate cele trei grupe de risc, in timp ce
majoritatea pacientilor au fost inefcient anticoagulati
(INR sub 1,5) sau au avut supradozaj cumarinic (INR
peste 3,5). Cel mai mare procent (23%) din bolnavii
cu supradozaj cumarinic au apartinut grupului cu risc
scazut de accident tromboembolic. Boala cronica de ri-
nichi a fost prezenta cu o frecventa crescuta la bolnavii
cu risc mare de accident tromboembolic, fata de cele-
lalte grupe, iar supradozajul cumarinic a variat invers
proportional cu rata fltrarii glomerulare.
Complicatii/ comorbiditati Grup A Grup B Grup C
Sangerari active (epistaxis, HDS, hema-
turie)
5 4 -
Gastrita/ UGD 6 5 4
Anemie feripriva(EDS, EDI negative) 15 6 2
Neoplazii (digestive, renale) 3 3 -
Afectare cognitiva (dementa, depresie
majora)
1 1 -
Nefropatie cronica (RFG< 60 ml/
min/1,73mp)
25 8 2
In concluzie, majoritatea bolnavilor care s-au internat
cu sangerare activa au avut supradozaj cumarinic, do-
vedind ca tratamentul anticoagulant oral nu este bine
monitorizat si ajustat in ambulatoriu (numai o treime
din pacientii in tratament anticoagulant au INR in li-
mite terapeutice). Pe de alta parte, o evaluare corecta a
indicatiilor individualizate de anticoagulare si a comor-
biditatilor cu potential hemoragic face aceasta terapie
rezonabil de sigura si cu benefciu mare.
Oral anticoagulant therapy in
chronic atrial fibrillation risk
or benefit?
Te main purpose of our study was to establish the in-
cidence of hemorrhagic complications in patients with
chronic atrial fbrillation who received oral anticoagu-
lant therapy and, secondary, to evaluate the indications
and follow-up of this therapy.
Suplimentul A, 2010
158
POSTER I I
POSTER I I
Oxidative stress and
inflammation in chronic heart
failure - Preliminary data
Purpose: Oxidative stress and infammation are patho-
physiological processes involved in the occurence, pro-
gression and the severity of chronic heart failure. In the
present study the relationship between oxidative stress
and infamation was assessed in patients with chronic
heart failure (CHF) and lef ventricular systolic dys-
function.
Method: Malondialdehyde (MDA), a marker of oxi-
dative stress, lipoprotein-associated phospholipase
A2 (LpPLA2), a marker of vascular infammation and
myeloperoxidase (MPO), a marker of white blood cells
activation were assessed in 25 patients (19 men and 6
women, mean age 6411 years) with CHF. Te pati-
ents had ischemic or idiopathic cardiomyopathy with
moderate to severe systolic dysfunction (FE<35%) and
were in functional class NYHA II or III. Te patients
with CHF and signifcant valvular heart diseases or
with evolving ischemia were not included in the study.
Results: Te MDA plasma level, the LpPLA2 plasma
activity and MPO plasma level were increased in pa-
tients with CHF. Te mean value of MDA was 1.154
nmol/ml (normal value between 0.27 1.02 nmol/ml),
the mean value of LpPLA2 plasma activity was 415.4
U/l (normal values between 150-260 U/ml) and the
mean value for MPO was 311.7 U/L (normal values
between 225 271 U/L). MDA plasma level was corre-
lated with LpPLA2 activity (r=0.49) and MPO plasma
level (r=0.39).
Conclusion: In patients with CHF and systolic dys-
function due to ischemic and idiopathic cardiomyo-
pathy the increase in oxidative stress correlates with
increased infammatory status, contributing to the car-
diac remodelling and CHF progression.
value). However, by evaluating the indications of oral
anticoagulant treatment and the comorbidities that mi-
ght increase the risk of bleeding, one can assure a safe
therapeutic profle, with low risks and high benefts.
139. Stresul oxidativ si
inflamatia in insuficienta
cardiaca cronica - Studiu
preliminar
Adriana Iliesiu, Elena Moldoveanu, A.Campeanu,
D. Nistorescu, B. Strajean, G. Uscoiu, D. Dusceac, T.
Nanea
Scop: Stresul oxidativ si infamatia sunt procese fzio-
patologice implicate in aparitia , progresia si severita-
tea insufcientei cardiace cronice. In studiul prezent se
evalueaza relatia dintre stresul oxidativ si infamatie la
bolnavi cu insufcienta cardiaca cronica (ICC) si dis-
functie sistolica a ventriculului stang.
Metoda: Au fost evaluati 25 de bolnavi (19 de barbati si
6 femei, cu varsta medie de 64 11 ani) cu insufcienta
cardiaca cronica clasa II si III NYHA, cardiomiopatie
dilatativa ischemica sau idiopatica si disfunctie sistolica
moderat severa (FE < 35%). Nu au fost inclusi in stu-
diu bolnavii cu ICC secundara valvulopatiilor severe
sau cu ischemie miocardica evolutiva. La acesti bolnavi
s-au determinat malondialdehida (MDA) - marker de
stres oxidativ (SO), fosfolipaza A2 asociata LDL-coles-
terolului (LpPLA2) - marker de infamatie vasculara si
mieloperoxidaza (MPO) - marker al activarii leucoci-
tare.
Rezultate: Bolnavii cu ICC au avut valori crescute
ale MDA, LpPLA2, si MPO. Valorile medii ale MDA
au fost de 1.154 nmol/ml (valori normale 0.27 1.02
nmol/ml), ale LpPLA2 au fost de 415.4 U/l (valori nor-
male 150-260 U/ml), iar ale MPO au fost de 311.7 U/L
(valori normale 225 271 U/L). Cresterea MDA s-a co-
relat cu nivele serice crescute ale LpPLA2 (r=0.49) si ale
MPO (r=0.39).
Concluzii: In ICC prin disfunctie sistolica, cresterea
stresului oxidativ se coreleaza cu exacerbarea statusului
infamator, contribuind la procesul de remodelare si de
progresie a insufcientei cardiace.
apicala maxima (r=-0,35, p=0,03), viteza maxima de

derotatie apicala (r=0,43, p=0,007). Corelatia dintre
raportul Ea/Ees si E/E a fost la limita semnifcatiei
statistice (r=0,33, p=0,05). Masa indexata VS si viteza
maxima de detorsiune au fost singurele variabile care
s-au corelat independent cu raportul Ea/Ees (p<0,001).
Concluzii: Cuplarea V-A este direct corelata cu seve-
ritatea hipertrofei VS la pacientii hipertensivi. Exista
o relatie semnifcativa statistic intre cuplarea V-A si
parametrii de torsiune VS: cu cat raportul de cuplare
V-A creste cu atat parametrii de torsiune si detorsiune
VS sunt mai putin favorabili. Sunt necesare studii su-
plimentare pentru evaluarea relevantei clinice a acestor
date.
Ventricular-arterial coupling
and left ventricular torsional
dynamics in hypertensive heart
disease
Background. Patients (pts) with hypertension (HTN)
exhibit increased arterial and ventricular stifness lea-
ding to reduced cardiac mechanic ef ciency and exer-
cise capacity. Ventricular-arterial (V-A) coupling and
lef ventricular (LV) torsional dynamics are key deter-
minants of cardiovascular performance and are both
related to changes in arterial load and LV contractility.
Purpose: To assess the relationship between V-A cou-
pling and LV torsional dynamics in pts with HTN and
normal LV ejection fraction (LVEF).
Methods: Forty hypertensive pts (5810 years, 19 men)
with normal ejection fraction (>50%) were consecuti-
vely enrolled. A comprehensive echocardiogram was
performed in all. Basal and apical LV rotation, peak
systolic LV torsion (LVtor), and peak LV untwisting
rate were measured by speckle tracking echocardio-
graphy using dedicated sofware (2D strain, EchoPac).
V-A coupling was assessed as the ratio between the
arterial elastance (Ea) and the end-systolic ventricular
elastance (Ees). Ea was calculated from stroke volume
(SV) and end-systolic pressure: Ea= (Systolic BP x 0.9)/
SV and Ees was calculated by a modifed single-beat
140. Relatia dintre torsiunea
ventriculara stanga si cuplarea
ventriculo-arteriala la pacientii
hipertensivi
Carmen Beladan, B.A.Popescu, Andreea Calin,
Rosca Monica, Bianca Moise, Florina Voinea, Roxana
Enache, Denisa Muraru, Ruxandra Jurcut, F.L.Matei,
Carmen Ginghina
Bucuresti
Premise. Cresterea rigiditatii arteriale si ventriculare
demonstrate la pacientii (pct) hipertensivi se asocia-
za cu scaderea efcientei mecanice cardiace si a capa-
citatii de efort. Cuplarea ventriculo-arteriala (V-A) si
torsiunea ventriculara stanga (VS) sunt determinanti
esentiali ai performantei cardiovasculare, ambele find
infuentate de sarcina arteriala si de contractilitatea VS.
Obiectiv: Evaluarea relatiei dintre cuplarea V-A si tor-
siunea VS la pct hipertensivi cu fractie de ejectie VS
(FEVS) pastrata.
Metoda: Au fost inrolati 40 de pct hipertensivi (5810
ani, 19 barbati) cu FEVS>50%. Toti pct au fost evaluati
ecocardiografc complet. Rotatia bazala si apicala VS,
torsiunea VS, si viteza maxima de detorsiune VS au fost
masurate prin ecocardiografe speckle tracking folo-
sind un sofware dedicat (2D,EchoPac). Cuplarea V-A
a fost calculata prin raportul dintre elastanta arteriala
(Ea) si elastanta ventriculara tele-sistolica (Ees). Ea a
fost evaluata in functie de volumul bataie (VB) si pre-
siunea telesistolica: Ea=(Tensiunea arteriala sistolica
X 0,9)/VB iar Ees a fost evaluata prin metoda single-
beat modifcata, descrisa anterior, folosind formula
Ees=[TA diastolica-(ENd(est) x TA sistolica x 0.9)]/
(ENd(est) x VB)unde End reprezinta elastanta ventri-
culara estimata normalizata.
Rezultate: In lotul studiat valorea indexata a masei a
VS a fost 12145g/m2, FEVS 597%, iar raportul E/E
8,82,3. Raportul Ea/Ees a fost 0,810,27, Ea 2,61,1
mmHg/ml si Ees 3,41,4 mmHg/m. Valoarea raportu-
lui Ea/Ees s-a corelat semnifcativ cu: masa VS indexata
(r=0,51, p=0,003), torsiunea VS(r=-40, p=0,01), viteza
maxima de detorsiune VS (r=0,49, p=0,002), rotatia
HTA | HYPERTENSI ON
Suplimentul A, 2010
HTA
HYPERTENSI ON
method, as previously described, using an estimated
normalized ventricular elastance at arterial end-diasto-
le (ENd): Ees= [Diastolic BP-(ENd(est) x Systolic BP x
0.9)]/(ENd(est) x SV).
Results: In this cohort LV mass index was 12145 g/
m2, LVEF was 597% and E/E ratio was 8.82.3. Ea/
Ees ratio was 0.810.27, Ea was 2.61.1 mmHg/ml and
Ees was 3.41.4 mmHg/mL. In univariate analyses the
Ea/Ees ratio correlated signifcantly with LV mass in-
dex (r=0.51, p=0.003) LVtor (r=-0.40, p=0.01), peak
LV untwisting rate (r=0.49, p=0.002), peak apical ro-
tation (r=-0.35, p=0.03), peak apical backrotation rate
(r=0.43, p=0.007). Te correlation between Ea/Ees ra-
tio and E/E ratio was borderline signifcant (r=0.33,
p=0.05). At multivariate analysis, LV mass index and
peak LV untwisting rate were the only independent
correlates of Ea/Ees ratio (p<0.001).
Conclusions: Ventricular-arterial coupling is directly
related to the severity of LV hypertrophy in pts with
HTN. Tere is a signifcant relation between V-A cou-
pling and LV torsional dynamics parameters: the hi-
gher the V-A coupling the worse the LV twisting and
untwisting parameters. Further studies are needed to
assess the clinical relevance of these fndings.
141. Reversibilitatea disfunctiei
ventriculare stangi subclinice
sub tratament antihipertensiv:
un studiu prospectiv al
tratamentului cu Nebivolol
comparativ cu Metoprolol,
studiul ENESYS
Carmen-Lucia Gherghinescu, D.Vinereanu, Andrea O
Ciobanu, Stefania Magda, Natalia Niculescu, Raluca
Dulgheru, Ruxandra Dragoi, M.Cinteza, A.G.Fraser
Bucuresti
Obiective: Evaluarea efectelor tratamentului antihiper-
tensiv asupra disfunctiei ventriculare stangi, si compa-
rarea efectelor nebivololului cu ale metoprololului.
Metoda: Studiu prospectiv, randomizat, paralel, ac-
tiv-controlat, PROBE ca design, la 60 pacienti(539
ani, 67% barbati)cu hipertensiune arteriala, hipertro-
fe ventriculara stanga, fractie de ejectie normala, fara
boala coronariana, care au fost randomizati tratamen-
tului bazat pe nebivolol 5 mg sau metoprolol tartrat 100
mg;toti pacientii au fost examinati ecocardigrafc con-
ventional si prin ecocardiografe tisulara miocardica de
repaus si la stress cu dobutamina, la inceputul studiului
si dupa 6 luni de tratament.
Rezultate: Tensiunea arteriala sistolica si diastolica,
frecventa cardiaca -au scazut cu 13%, 13%, si 12%, re-
spectiv, sub nebivolol, si cu 11%, 13%, si 7%, respec-
tiv, sub metoprolol (pentru toate p < 0.01). Media vi-
tezei precoce diastolicea crescut cu 12 pentru intregul
grup,(de la 5.9 1.8 la 6.6 1.1 cm/s, p < 0.01), pentru
toate cele 8 segmente miocardice, si cu16% (p < 0.05)
pentru nebivolol comparat cu 9% (p ns) pentru me-
toprolol (p ns pentru diferentele intergroup).Valorea
medie a deplasarii longitudinale a crescut cu 10% sub
nebivolol (p < 0.05= si nu s-a schimbat cu metoprolol
p < 0.05 for inter-group diferences),in timp ce timpul
de ejectie a crescut cu 5% cu nebivolol (p < 0.05)si nu
s-a schimbat cu metoprolol.Toti ceilalti parametri ai
functiei ventriculare stangi nu au diferit intre cele doua
brate de tratament.
Concluzii: Pacientii cu hipertensiune arteriala forma
usoara si moderata benefciaza de ameliorarea functiei
diastolice longitudinale si a deplasarii sistolice longitu-
dinale dupa 6 luni de tratament antihipertensiv;efectele
sunt semnifcative cu nebivololul dar nu cu metopro-
lolul
Reversal of subclinical left
ventricular dysfunction by
antihypertensive treatment:a
prospective trial of Nebivolol
against Metoprolol, ENESYS
study
Objectives: To assess the efects of anti-hypertensive
treatment on subclinical lef ventricular dysfunction,
and to compare the efects of nebivolol with metopro-
lol.
Methods: Tis is a prospective, randomised, parallel,
active-controlled, PROBE design study in 60 patients
(539 years, 67% men) with arterial hypertension, lef
ventricular hypertrophy, normal ejection fraction, and
HTA
HYPERTENSI ON
Suplimentul A, 2010
no coronary heart disease, randomized to either a nebi-

volol-based (5 mg) or a metoprolol tartrate-based (100
mg) treatment; all patients had conventional and tissue
Doppler echocardiography (TDE), at rest and during
dobutamine stress, at baseline and afer 6 months.
Results: Systolic and diastolic blood pressure, and re-
sting heart rate decreased by 13%, 13%, and 12%, re-
spectively, on nebivolol, and by 11%, 13%, and 7%,
respectively, on metoprolol (all p < 0.01). Mean lon-
gitudinal early diastolic velocity increased by 12% for
the whole group (from 5.9 1.8 to 6.6 1.1 cm/s, p <
0.01), consistent for all 8 myocardial segments, and by
16% (p < 0.05) on nebivolol compared with 9% (p ns)
on metoprolol (p ns for intergroup diferences), while
fow propagation velocity increased by 34% on nebi-
volol (p < 0.05) and did not change on metoprolol (p
< 0.01 for inter-group diferences). Mean longitudinal
displacement increased by 10% on nebivolol (p < 0.05)
and did not change on metoprolol (p < 0.05 for inter-
group diferences), while ejection time increased by 5%
on nebivolol (p < 0.05) and did not change on metopro-
lol. All the other parameters of lef ventricular function
were not diferent between the two treatment arms.
Conclusions: Patients with mild-to-moderate hyper-
tension have a benefcial efect from 6 months anti-
hypertensive treatment on diastolic longitudinal lef
ventricular function and longitudinal systolic displace-
ment; efects are signifcant with nebivolol, but not with
metoprolol.
142. Evaluarea si ajustarea
telemetrica a tratamentului
hipertensiv (modelul
Procardia)
P.I.Kikeli, M.I.Laszlo, Z.Preg, Andreea Bocicor, Mi-
haela Hubatsch, L.Lang
Clinica de Recuperare Cardiovasculara, Oradea
Introducere: Hipertensiunea arteriala este un factor
de risc cardiovascular important. Atingerea unui co-
trol adecvat se realizeaza in realitate la mai putin de o
treime din pacientii hipertensivi si care in consecinta
necesita o modalitate obiectiva de evaluare si urmarire.
Material si metoda: Am efectuat un studiu prospec-
tiv pe un numar de 44 de pacienti consultati si tratati
in ambulatorul de specialitate Procardia - la care sub
tratament tensiunea arteriala nu a fost controlata in
mod corespunzator. In urma evaluarii complexe profl
de riscuri cardiovasculare, examen clinic, examinari de
laborator, monitorizare pe 24 ore a valorilor tensionale
s-a instituit tratament antihipertensiv si s-a utilizat mo-
nitorizarea telemetrica a valorilor tensionale pe o peri-
oada de 2 saptamani. Dupa 1 saptamana de tratament
s-au evaluat valorile tensionale si dupa caz s-a reajustat
tratamentul prin interventie telefonica si s-a continuat
monitorizarea timp de inca 1 saptamana. Analiza sta-
tistica s-a realizat utilizand testul ANOVA pentru date
pereche cu ajutorul programului statistic GraphPad
3.1, atat pentru intregul lot cat si pe subgrupuri stabilite
in functie de gradul hipertensiunii.
Rezultate: S-a constatat o reducere a valorilor tensio-
nale sistolice in primele 3 zile de tratament de la 147.06
la 140.53 mmHg (p<0.05) urmat de o stablizare pana
in ziua 8. In ziua 9 de monitorizare In urma reajustarii
telefonice a tratamentului mai constatam o scadere a
valorilor tensionale atingandu-se o scadere pana la va-
lori medii de 136,86 mmHg (fata de ziua 1 p<0.001) cu
stabilizarea acestora pana la sfarsitul perioadei de ur-
marire la intregul lot. Valorile diastolice au prezentat o
scadere de la 91,85mmHg la 87,22 mmHg in primele 5
zile(p<0.05) iar la sfarsitul perioadei de urmarire dupa
rejustarea tratamentului mai prezinta o scadere pana la
media de 85,9 mmHg mmHg fata de ziua 1 (p<0.001).
Concluzii: Telemetria pe durata de 2 saptamani este
o metoda efcienta de urmarire a valorilor tensionale
si ofera un feedback util pentru titrarea efcienta a tra-
tamentului antihipertensiv si atingerea valorilor tinta
Cuvinte cheie: Hipertensiune, telemetrie, monitorizare
Telemetric evaluation and
adjustment of hypertensive
treatment (the Procardia
model)
Introduction: Hypertension is a major cardiovascular
risk factor. Te adequate control of hypertension is not
realized in everyday practice in less than one third of
hypertensive patients Tats why there is a compelling
necessity for adequate follow up and monitoring of an-
tihypertensive therapies.
Study design: Our study was carried out in the pro-
cardia ambulatory cardiology setting. A prospective
Suplimentul A, 2010
HTA
HYPERTENSI ON
143. Relatia dintre markerii
inflamatori si grosimea intima-
media carotidiana la pacientii
hipertensivi
Ruxandra Christodorescu, Corina Serban, Simona
Dragan, Maria Rada, Dana Velimirovici
Spitalul Clinic Municipal de Urgenta, Clinica ASCAR,
Timisoara
Premize: Grosimea intima-media (IMT) la nivelul ar-
terei carotide este un marker subclinic al aterosclero-
zei. Studii recente au indicat ca o crestere a tensiunii
arteriale poate stimula infamatia vasculara, care poate
induce modifcari patologice arteriale.
Scopul acestui studiu a fost evaluarea relatiei dintre
proteina reactiva inalt sensibila(hsCRP) si fbrinogen,
ca markeri infamatori si IMT la pacienti hipertensivi
si compararea nivelurilor plasmatice ale hsCRP si fbri-
nogenului la pacienti hipertensivi cu leziune de organ
tinta (TOD) si la pacienti hipertensivi fara TOD.
Material si metoda: Studiul a cuprins 44 de pacienti
cu hipertensiune 4,80arteriala fara TOD (33% barbati
si 67% femei, varsta medie 54 ani) si 48 de pacienti
cu hipertensiune arteriala si TOD (39% barbati si 4,73
ani). Complicatiile hipertensive au61% femei, varsta
medie 59 fost evaluate pe baza istoricului clinic si al
urmatoarelor investigatii: ecocardiografe de tip M (hi-
pertrofe ventriculara stanga), ultrasonografe vascula-
ra de tip 2D (grosimea intima-media la nivelul arterei
carotide comune-IMT), microalbuminuria si valoarea
creatininei serice (functia renala). La toti pacientii au
fost determinate proflul lipidic plasmatic, hsCRP si f-
brinogenul. Grosimea intima-media la nivelul arterei
carotide a fost determinata conform Consensului de la
Mannheim din anul 2006.
Rezultate: Pacientii hipertensivi cu TOD au avut ni-
veluri semnifcativ mai mari ale of hsCRP si fbrino-
genului decat pacientii hipertensivi fara TOD (5,02
0,33 g/l vs. 2,65 0,23 g/l, p<0,001 si 6,830,23 g/l vs.
2,73 0,34 g/l, p<0,001), respectiv o valoare semnif-
cativ 0,03 mm, p 0,04 mm vs. 0,84 mai mare a IMT
(1,30 <0,001). Am observat o corelatie pozitiva puter-
nica intre fbrinogen si IMT (r = 0,87, p < 0,001) si o
corelatie pozitiva, puternica intre hsCRP si IMT (r =
0,86, p<0,001).
Concluzii: Valorile markerilor infamatori (hsCRP, f-
brinogenul) sunt crescute la pacientii hipertensivi cu
leziune leziune de organ tinta. Masurarea IMT la ni-
evaluation of 44 hypertensive patients with inadequa-
te initial control of blood pressure values was made.
According to our practice model patients had a com-
prehensive clinical and laboratory evaluation as well as
a 24 hour ambulatory blood pressure monitoring. Afer
the initial adjustment in antihypertensive treatments
we used the telemetric monitoring of blood pressure
values for a period of 2 weeks. Afer one week, if it was
necessary, additional adjustments were made in anti-
hypertensive therapy, and telemetric monitoring was
continued for one more week. Statistical analysis was
made with ANOVA test for paired data for the whole
study group, as well as for subgroups according to the
grade of hypertension. Te statistics sofware GraphPad
3.1 was used for performing statistical calculations.
Results: We observed a signifcant reduction of systolic
blood pressure values in the frst 3 days of antihyper-
tensive treatment medium reduction from 147.06 to
140.53 mmHg (p<0.05), followed by a stabilization of
values until the 8th day of monitoring. In the 9th day
of monitoring, afer the therapeutic adjustments per-
formed we observed an additional lowering of blood
pressure values reaching a medium of 136,86 mmHg
(compared with the values on the frst monitoring day
p<0.001). Blood pressure values were stabilized af-
ter the 10th monitoring day. Diastolic blood pressure
values showed a decrease from 91,85 mmHg to 87,22
mmHg in the frst 5 days (p<0.05) At the end of the
monitoring period afer therapeutic adjustments a me-
dium of 85,9 mmHg was reached (compared with the
values on the frst monitoring day p<0.001).
Conclusions: Telemetric monitoring is an ef cient
method for the monitoring of blood pressure values,
and ofers an adequate feedback for the adjustment of
blood pressure medications in order to reach blood
pressure targets. Keywords: Hypertension, telemetric
monitoring
HTA
HYPERTENSI ON
Suplimentul A, 2010
velul arterei carotide si determinarea markerilor in-

famatori pot f metode valoroase pentru a monitoriza
subiectii hipertensivi cu sau fara leziune de organ tinta.
The relationship between
inflammatory markers and
intima-media thickness in
hypertensive patients
Background: Carotid intima-media thickness (IMT) is
a subclinical marker of atherosclerosis. Recent studies
have indicated that increased blood pressure may sti-
mulate vascular infammation, which may itself induce
pathological arterial changes.
Te aim of this study was to to assess the relationship
between high-sensitivity C-reactive protein (hsCRP)
and fbrinogen as infammatory markers and carotid
intima-media thickness in hypertensive patients and to
compare plasma hsCRP and fbrinogen levels between
hypertensive patients with target organ damage (TOD)
and hypertensive patients without TOD.
Material and method: Te study included 44 pati-
ents with arterial 4.80hypertension without TOD
(33% men and 67% women, mean age 54 years) and
48 patients with arterial hypertension and TOD (39%
men and 4.73 years). Hypertensive complications
were61% women, mean age 59 assessed on the basis
of clinical history and the following investigations: M-
mode echocardiography (lef ventricular hypertrophy),
B-mode vascular ultrasound (carotid artery intima-
media thickness-IMT), and microalbuminuria and se-
rum creatinine levels (renal function). In all patients,
serum lipid profle, hsCRP and fbrinogen levels were
evaluated.
Results: Hypertensive patients with TOD had higher
levels of hsCRP and fbrinogen than hypertensive pa-
tients without TOD (5.02 0.33 g/l vs. 2.650.23 g/l,
p<0.001, and 6.830.23 g/l vs. 2.730.34 g/l, p<0.04
mm vs.0.001), and an increased value of carotid IMT
(1.30 0.03 mm, p0.84 <0.001), respectively. We found
a strong positive correlation between fbrinogen and
carotid IMT (r = 0.87, p < 0.001), and a strong positive
correlation between hsCRP and carotid IMT (r = 0.86,
p<0.001).
Conclusions: Infammatory markers (hsCRP, fbrino-
gen) are elevated in hypertensive patients with TOD.
Measurement of carotid IMT and evaluation of in-
fammatory markers can be valuable tools to monitor
hypertensive subjects with or without TOD.
Matrix GLA protein is

correlated with carotid stenosis
Serum matrix GLA protein was correlated with vascu-
lar calcifcation and with risk factors for atherosclero-
sis, but the relationship with carotid stenosis was not
studied until now.
Objectives: to study the relationship between matrix
GLA protein and carotid stenosis and its degree.
Methods: there were studied 60 patients, 23 males and
37 females aged 67.25 9.42 years. Each patient was
submitted to an Eco Doppler carotid examination, ca-
rotid stenosis being classifed as unsignifcant <20%,
moderate 20-50%, severe >50%. In each patient, ma-
trix GLA protein was determined using ELISA method
(normal values <7nmol/L).
Results: there were signifcant diferences of matrix
GLA protein serum level between subjects with (>20%)
and without carotid stenosis (22.85 2.92 nmol/L vs
19.70 3.06 nmol/L, p<0.0001). Te values were also
correlated with the degree of the stenosis (<50% 21.48
3.19 nmol/L vs >50% 23.46 3.83 nmol/L) and it
was possible to establish a cut of value for the seve-
re stenosis (cut of value 21.5 nmol/L, AUROC 0.637,
sensibility 75%, specifcity 55.8%). In turn, the matrix
GLA protein level concentration did not correlate with
cardiovascular risk factors, no signifcant diferen-
ces being registered in relationship with sex (22.10
3.33 nmol/L in females vs 21.18 3.29 nmol/L in ma-
les), hypertension (21.85 3.45 nmol/L vs 21.1 2.36
nmol/L), diabetes mellitus (21.77 3.49 vs 21.74 3.29
nmol/L), obesity (21.44 3.82 vs 21.87 3.09 nmol/L)
or smoking habit (20.91 3.71 vs 21.86 3.29 nmol/L).
Conclusion: serum matrix GLA protein can be used
not only as an index of arterial calcifcation, but also of
carotid atherosclerosis and its severity independently
of cardiovascular risk factors.
144. Relatia dintre matrix GLA
proteina si stenoza carotidiana
D.Zdrenghea, Adela-Viviana Sitar-Taut, Elena Gligor,
Dana Pop
ganu, Cluj-Napoca
Ipoteze: se stie ca nivelul seric al matrix GLA proteinei
se coreleaza cu calciferile vasculare si cu factorii de risc
ai aterosclerozei, dar relatia cu stenoza carotidiana nu a
fost investigata pana in prezent.
Scopul studiului a fost reprezentat de evidentierea po-
sibilei relatii intre nivelul seric al matrix GLA proteinei
si gradul stenozei carotidiene.
Metoda: Au fost investigati 60 pacienti, 23 barbati si
37 femei, varsta medie 67.25 9.42. Fiecarui pacient i
s-a efectuat examinarea Doppler a carotidelor, stenoze-
le carotidiene find clasifcate ca nesemnifcative <20%,
moderate 20-50%, severe>50%. Matrix GLA proteina
a fost determinata pentru fecare pacient, utilizand
metoda ELISA, valori normale find considerate sub 7
nmol/L.
Rezultate: au fost identifcate diferente semnifcati-
ve privind valoarea medie a nivelelor serice a matrix
GLA proteinei intre subiectii cu (>20%) si cei fara ste-
noze carotidiene (22.85 2.92 nmol/L vs 19.70 3.06
nmol/L, p<0.0001).De asemenea, valorile s-au core-
lat cu gradul stenozei (<50% 21.48 3.19 nmol/L vs
>50% 23.46 3.83 nmol/L) si a fost posibila stabilirea
unei valori cutt-of pentru stenoza severa (valoare cut
of 21.5 nmol/L, AUROC 0.637, sensibilitate 75%, spe-
cifcitate 55.8%). In schimb, nivelele serice ale matrix
GLA proteinei nu s-au corelat cu factorii de risc car-
diovascular, diferente semnifcative nefind inregistrate
in raport cu sexul pacientilor (22.10 3.33 nmol/L la
femei vs 21.18 3.29 nmol/L la barbati), cu prezenta
hipertensiunii arteriale (21.85 3.45 nmol/L vs 21.1
2.36 nmol/L), a diabetului zaharat (21.77 3.49 vs
21.74 3.29 nmol/L), a obezitatii (21.44 3.82 vs 21.87
3.09 nmol/L) sau a fumatului (20.91 3.71 vs 21.86
3.29 nmol/L).
Concluzie: matrix GLA proteina poate f utilizata nu
doar ca un index a calciferilor arteriale, dar si a ate-
rosclerozei carotidiene, a severitatii sale (independent
de prezenta factorilor de risc cardiovascular).
VARI A 2 | VARI A 2
VARI A 2
VARI A 2
Suplimentul A, 2010
145. Cardiostimularea
permanenta ventriculara
dreapta septala induce un
sincronism si o functie
diastolica mai bune pe termen
lung, comparativ cu cea
apicala, la pacientii stimulo-
dependenti
Roxana Cristina Sisu, A.D.Margulescu, C.Siliste,
Cardiostimularea apicala VD poate genera disfunctie
semnifcativa de ventricul stang (VS) la 50% din paci-
entii stimulodependenti. Ca alternativa stimularea sep-
tala, printr-o activare probabil mai fziologica, ar putea
f o alternativa mai buna pe termen lung.
Metoda: Am comparat efectele asupra sincronismului
si functiei VS, pentru cele 2 situsuri, la pacientii stimu-
lati permanent, afati la 114 luni postimplantare. Am
analizat 40 de pacienti (749 ani, 21 barbati), 20 im-
plantati septal; 30 cu evaluare la 1 an de la vizita initia-
la. Analiza Doppler tisular (DTI) a fost facuta la nive-
lul celor 12 segmente bazale si medii VS pentru strain,
strain rate sistolic si timpi miocardici corespunzatori
de la debut spike la varf strain sistolic. Functia sistolica
a fost evaluata prin fractia de ejectie (EF), debit cardi-
ac (CO), strain mediu sistolic longitudinal (MLSS) si
strain rate mediu sistolic longitudinal (MLSR). Functia
diastolica prin raport E/E; sincronismul intraventricu-
lar prin deviatia standard (SDS) si diferenta maxima
(MAXS) a tuturor timpilor sistolici, iar cel interventri-
cular prin intarziere aorto-pulmonara (APD).
Rezultate: 4 pacienti au decedat, toti din grupul stimu-
lat apical (p=0.036). Clasa functionala NYHA si functia
sistolica nu au fost diferite. Desi la evaluarea initiala a
existat un asincronism intraventricular mai mare pen-
tru grupul stimulat septal, acesta nu a progresat la 1 an,
in timp ce pentru situsul apical asincronismul a crescut
(Tabel). In acelasi timp, pentru stimularea apicala s-a
inregistrat o presiune de umplere mai mare la 1 an, eva-
luata prin raportul E/E.
Concluzii: Stimularea apicala, nu si cea septala, afec-
teaza negativ sincronismul VS la bolnavii stimulode-
pendenti, asociind crestere a presiunii de umplere ven-
triculara. Aceste modifcari subtile pot f detectate prin
ecografe TDI. Urmarirea mai lunga ar putea releva o
evolutie diferita clinica si de functie sistolica pentru
cele 2 situsuri de implantare. Tabel Comparatie apex
- sept Situs Pacing Baseline 12 luni MedieSD Septal
Apical P Septal Apical P LVEF 5311 548 n.s. 4914
548 n.s. CO 2.92.2 2.31 n.s. 2.61 2.20.8 n.s. MLSS
-114 -135 n.s -124 -113 n.s MLSR -10.5 -10.5
n.s. -10.4 -10.5 n.s. E/E 147 179 n.s 136 186
0.04 SDS 7932 5726* n.s 9249 9054* n.s MAXS
275134 195101*0.074 280153 274122*n.s APD
4121 4034 n.s. 4120 4125 n.s
Better synchrony and diastolic
function for septal versus apical
right ventricular permanent
pacing in an 1-year follow-up
study
Pacing at the apex might cause signifcant LV dysfuncti-
on in about 50% of patients. Terefore, septal pacing by
using more physiological electrical activation pathways
might be a better alternative.
Methods: We compared long-term efects on cardiac
synchrony and function, between the 2 pacing sites,
in chronically implanted patients (114 months afer
implantation), in 40 pacing-dependent patients (749
yrs, 21 men), 20 paced at the apex; 30 of them were re-
studied afer 1 year. TDI measurements (peak systolic
strain and strain rate, and time-to-peak systolic strain)
were made from 12 basal and mid LV segments. Systo-
lic function was assessed from ejection fraction (EF),
cardiac output (CO), mean longitudinal systolic strain
(MLSS), and mean longitudinal strain rate (MLSR); di-
astolic function from E/E ratio; intraventricular syn-
chrony from standard deviation (SDS) and maximal
diference (MAXS) of all timings; interventricular syn-
chrony from the aorto-pulmonary delay (APD).
Results: 4 patients died from the apical group
(p=0.036). NYHA class and systolic function (table)
were not diferent. Although at baseline there was a
greater dyssynchrony for the septal site, this did not
progress at follow-up, whereas it became greater for
Suplimentul A, 2010
VARI A 2
VARI A 2
the apical site. Meanwhile, there was a higher LV flling
pressure (E/E ratio) for the apical site at 1 year.
Conclusion: Apical but not septal site afects LV syn-
chrony at 1 year in pacing dependent patients, associa-
ted with increased flling pressure. Tese subtle changes
can be detected by TDI strain echo. Longer follow-up
might reveal diferences in clinical and systolic functi-
on parameters between the 2 pacing sites. Comparison
between Apical vs Septal site Pacing sites meanSD Ba-
seline 12 months Septal Apical P Septal Apical P LVEF
5311 548 n.s. 4914 548 n.s. CO 2.92.2 2.31
n.s. 2.61 2.20.8 n.s. MLSS -114 -135 n.s -124
-113 n.s MLSR -10.5 -10.5 n.s. -10.4 -10.5 n.s.
E/E 147 179 n.s 136 186 0.04 SDS 7932 5726*
n.s 9249 9054* n.s MAXS 275134 195101* 0.074
280153 274122* n.s APD 4121 4034 n.s. 4120
4125 n.s.
146. Remodelarea atriului stang
la pacientii cu hipertensiune
arteriala
Lucia Agoston Coldea, Teodora Mocan, Lacramioara
Dobie, Silvia Lupu
ganu Cluj-Napoca
Background: Lef atrial (LA) enlargement in hyperten-
sive patients is an important component in LA remo-
delling as a response to various stress factors.
Te aim of this study was to establish a correlation
between LA and lef ventricular (LV) remodelling in
hypertensive patients.
Methods: Te study group included 60 consecutive
hypertensive patients and a control group of 44 healthy
volunteers with an average age of 48.2(1.3) vs. 46.4(1.5)
years. LA remodelling was evaluated using echocardi-
ography by measuring LA diameter, surface and volu-
me, all reported to body surface. LV remodelling was
assessed by evaluating the systolic function (LV mass
index, ejection fraction, Tei index) and the diastolic
function (transmitral fow velocities, mitral annular
motion velocity, and the myocardial strain (S) and stra-
in rate (SR) imaging in the lateral lef atrial wall). Total
deformation (ST), early (SE) and late (SA) lef atrial re-
modelling were measured.
Results: In hypertensive patients, LA volume was in-
creased and LV function was altered when compared
to the control group. LA volume was signifcantly cor-
related with LV Tei index (r=0.78, p=0.03), early diasto-
lic transmitral fow velocity (r=0.62, p<0.05), the peak
early diastolic mitral annular motion velocity (r=-0.49,
p<0.002), and the peak early diastolic strain rates of
lef ventricular walls (r=0.67, p=0.001) and lef ven-
tricular mass (r=0.69, p<0.001). Systolic and diastolic
mitral annular motion velocities were also correlated
and an inverse relation was noted between these para-
meters and LV mass index. In hypertensive patients,
ST (p=0.001), SA (p=0.004) and SR (p=0.0001) during
atrial contraction were higher than in normal subjects
and proportional with diastolic arterial pressure.
Conclusion: LA remodelling, as a consequence of
systolic and diastolic LV dysfunction, is best shown by
LA indexed volume. LA enlargement and myocardial
remodelling assessed by strain rate imaging are useful
parameters in detecting subclinical LA dysfunction.
147. Rigiditatea arteriala,
hipertrofia ventriculara stanga
si rezistenta la insulina sunt
crescute in obezitatea extrema,
independent de prezenta
hipertensiunii arteriale
C.R.Ticulescu, Vriz Olga, Lina Sparacino,
B.A.Popescu, Carmen Ginghina, GL Nicolosi,
F.Antonini-Canterin
Spitalul S. Maria degli Angeli, Pordenone, Italia
Background: Mecanismele adaptarii cardiovasculare la
obezitatea extrema, incluzand hipertrofa ventriculara
stanga si rigiditatea arteriala, nu sunt pe deplin intelese,
datele de pana acum nefind concludente. De aseme-
nea, rolul rezistentei la insulina in acest context este su-
biect de dezbatere. Am dorit sa caracterizam remode-
larea cardiaca si arteriala si relatia acesteia cu rezistenta
la insulina la pacientii cu obezitate extrema.
Metode: Grupul de studiu a inclus 42 de pacienti cu
obezitate extrema (15 B, 27 F, 5313 ani, indice de masa
corporala -IMC 464 kg/m2) iar grupul de control 37
de subiecti cu distributie pe sexe si varsta comparabi-
le (14 B, 23 F, 516 ani, IMC 252 kg/m2). Prevalenta
VARI A 2
VARI A 2
Suplimentul A, 2010
Methods: Te study group included 42 patients with

morbid obesity (15 M, 27 F, 5313 years, Body Mass
Index, BMI 464 kg/m2) and 37 gender- and age-mat-
ched control subjects (14 M, 23 F, age 516 years, BMI
252 kg/m2). Te prevalence of hypertension was si-
milar in the 2 groups (85% in obese patients, 78% in
controls), while diabetes and metabolic syndrome were
more prevalent in the obese group (21% vs 3%, and
45% vs 19% respectively, p<0.001). All patients un-
derwent echocardiography and carotid echo tracking
analysis for the measure of stifness index . Insulin
resistance was determined using the homeostatic mo-
del assessment (HOMA), calculated as the product of
the fasting plasma insulin level (microU/mL) and the
fasting plasma glucose level (mmol/L), divided by 22.5.
Results: Arterial stifness was higher in the obese group
( index 8.03.2 vs 6.4 2.0, p=0.009), and so were the
HOMA index (7.04,1 vs 2.21.4, p<0.001) and LV
mass index (11528 vs 10321 g/m2, p<0.05). In obese
patients, the determinants of stifness index at mul-
tivariate analysis were age (p<0.001), waist-hip ratio
(p=0.024), and LDL cholesterol (p=0.036). HOMA and
LV mass index were not signifcantly correlated with
arterial stifness.
Conclusions: Morbid obesity is associated with increa-
sed LV mass and arterial stifness irrespective of hyper-
tension. Age, central obesity and LDL cholesterol levels
are the main determinants of arterial stifness in these
patients.
hipertensiunii arteriale a fost similara in cele doua gru-
puri (85% in grupul pacientilor obezi,78% in grupul de
control), in timp ce diabetul si sindromul metabolic au
avut o prevalenta mai mare in grupul pacientilor obezi
(respectiv 21vs; 3% si 45% vs 19%, p<0,001). Fiecare
pacient a fost evaluat din punct de vedere ecocardiogra-
fc precum si al determinarii rigiditatii arteriale la nivel
carotidian (indicele de stifness ), folosind un sistem
echo-tracking de inalta defnitie. Rezistenta la insulina
a fost evaluata folosind indicele HOMA (homeostatic
model assessment), calculat ca produsul dintre nivelul
plasmatic al insulinei si cel al glicemie, masurate a jeun
(mmol/L), impartit la 22,5.
Rezultate: Rigiditatea arteriala a fost mai mare in gru-
pul pacientilor obezi (indicele 8.03.2 vs 6.4 2.0,
p=0.009), ca si indicele HOMA (7.04,1 vs 2.21.4,
p<0.001) si masa ventriclului stang (VS) indexata
(11528 vs 10321 g/m2, p<0.05). La pacientii obezi,
determinantii indicelui de rigiditate la analiza multi-
variata au fost varsta (p<0.001), raportul circumferin-
telor talie-coapsa (p=0.024) si valoarea LDL- coleste-
rolului seric (p=0.036). Masa VS indexata si indicele
HOMA nu s-au corelat statistic semnifcativ cu rigidi-
tatea arteriala.
Concluzii: Obezitatea extrema este asociata cu cres-
terea masei VS si a rigiditatii arteriale independent de
prezenta hipertensiunii arteriale. Varsta, obezitatea de
tip central si valoarea LDL- colesterolului seric sunt
principalii determinati ai rigiditatii arteriale la acesti
pacienti.
Arterial stiffness, left
ventricular hypertrophy and
insulin resistance are increased
in morbid obesity, irrespective
of hypertension
Background: Te mechanisms of cardiovascular adap-
tation to morbid obesity, in terms of lef ventricular
(LV) hypertrophy and arterial stifness, are not fully
understood, the reported results being rather confic-
ting. Also, the role of insulin resistance in this context
is debated. We sought to characterize cardiac and ar-
terial remodeling and their relationship with insulin
resistance in severely obese patients.
statat o scadere semnifcativa a deformarii VS atat in

plan radial, cat si plan longitudinal. Aceaste modifcari
au fost observate imediat dupa primul ciclu si au per-
sistat dupa cel de-al saselea ciclu de epirubicina (vezi
tabel). Analiza univariata a aratat ca doza cumulative
de epirubicina s-a corelat direct cu reducerea SL si a
T de VS dupa 6 luni de tratament (r=0.59 and r=0.79;
both p<0.01).
Concluzie: Parametrii de torsiune si deformare mi-
ocardica sistolica, evaluati prin 2D speckle tracking,
identifca disfunctia subclinica de VS, si astfel pot f
utili pentru monitorizarea cardiotoxicitatii indusa de
epirubicina. Parametrii de torsiune si deformare ai
VS Epirubicina RotA() RotB() T() RT(/s) Sr (%)
RSr(1/s) SL(%) RSL(1/s) Baseline 7.11.5 -4.21.2
11.71.9 8928 49.56.8 1.80.2 -23.32.7 -1.520.2 1
ciclu 5.20.7 -4.11.8 9.31.4 7034 37.45.6 1.20.8
-18.052.5 -1.11 0.6 Al 6lea ciclu 4.90.9 -3.91.8
9.11.7 6231 35.46.6 1.30.6 -20.52.5 -1.31 0.6 P
(1 ciclu vs baseline) 0.001 0.89 0.01 0.01 0.001 0.001
0.001 0.01 P (Al 6lea ciclu vs baseline) 0.001 0.67 0.01
0.005 0.001 0.001 0.01 0.01
Left ventricular systolic torsion
and deformation assessed by
speckle tracking imaging can
detect subclinical epirubicin-
induced cardiac dysfunction in
patients with breast cancer
Epirubicin is a potent and widely used citotoxic drug,
but its application is ofen limited by the cumulative do-
se-dependent cardiotoxicity. LV ejection fraction (EF)
and fractional shortening (FS) are the most commonly
used indices to demonstrate cardiac dysfunction. Since
normal EF or FS can mask signifcant LV impairment,
we hypothesized that LV systolic torsion and deforma-
tion represent better markers of epirubicin-induced
subclinical cardiac dysfunction.
Methods: 40 women with breast cancer (589 years),
without known associated cardiac disease, scheduled to
148. Torsiunea si deformarea
sistolica a ventriculului
stang evaluate prin speckle
tracking in detectia disfunctiei
cardiace subclinica indusa de
epirubicina la pacientele cu
neoplasm de san
Maria Florescu, Jinga Dan, Stefania Magda, Oana En-
escu, Diana Mihalcea, M.Cinteza, D.Vinereanu
Epirubicina este un agent citotoxic efcient si frecvent
recomandat, dar utilizarea lui poate f limitata datori-
ta efectului cardiotoxic dependent de doza cumulativa.
Fractia de ejectie a VS (FE) si fractia de scurtare (FS)
sunt cei mai utilizati parametrii pentru demonstarea
disfunctiei cardiace. Din moment ce o FE sau FS nor-
male pot masca o afectare miocardica semnifcativa,
am formulat ipoteza ca torsiunea si deformarea sis-
tolica a VS evaluate prin speckle tracking reprezenta
markeri mai buni pentru detectia disfunctiei cardiace
subclinice indusa de epirubicina.
Metode: 40 paciente diagnosticate cu neoplasm de san
(589 ani), fara patologie cardiaca cunoscuta asociata,
programate pentru a primi tratament chimioterapic
bazat pe epirubicina, au fost evaluate inainte, precum si
dupa primul si al saselea ciclu de epirubicina (doza cu-
mulativa de 29315 g/m2). Am utilizat ecocardiografa
conventionala pentru evaluarea geometriei VS, a FE si
a FS; si 2D speckle tracking pentru masurarea parame-
trilor de torsiune sistolica a VS: rotatia apicala maxima
(RotA), rotatia bazala maxima (RotB), twist al VS (T)
(diferenta de rotatie a VS intre planul apical si bazal),
si rata de twist al VS (RT); precum si a parametrilor
de deformare a VS: strain si rata de strain radial (Sr si
RSr), si strain si rata de strain longitudinal (SL si RSL).
Rezultate: Nu au fost observate diferente in ceea ce
priveste dimensiunile VS, ale FE sau FS pe parcursul
perioadei de urmarire; in schimb s-a constatat redu-
cerea semnifcativa a RotA, si in consecinta a T si RT
a VS, fara modifcarea RotB. De asemnenea, s-a con-
CARDI OMI OPATI I | CARDI OMYOPATHI ES
CARDI OMI OPATI I
CARDI OMYOPATHI ES
Suplimentul A, 2010
be treated with epirubicin-based chemotherapy, were

assessed at baseline, and afer 1 and 6 cycles of epiru-
bicin (cumulative dose of 29315 g/m2). Conventio-
nal echocardiography was used to assess LV geometry,
EF and FS. 2D speckle tracking imaging was used to
measure LV systolic rotation parameters: peak apical
rotation (RotA), peak basal rotation (RotB), LV twist
(LVT) (as the diference in LV rotation between api-
cal and basal planes), and twist rate (LVTR); and also
LV systolic deformation indices: radial strain (rS) and
strain rate (rSR), and longitudinal strain (LS) and strain
rate (LSR).
Results: No changes in LV dimensions, EF, and FS were
observed during follow-up. However, there were signi-
fcant reductions in RotA, and consequently in LVT
and LVTR, with no changes in RotB; and also a signi-
fcant decrease of LV radial and longitudinal deforma-
tion found afer the frst cycle of epirubicin and persis-
tent afer the sixth cycle (see table). Univariate analysis
showed that epirubicin cumulative dose was directly
correlated with longitudinal strain and LV twist reduc-
tion afer 6 months of treatment (r=0.59 and r=0.79;
both p<0.01).
Conclusion: LV torsion and deformation parameters,
assessed by 2D speckle tracking imaging, detect sub-
clinical LV dysfunction and, therefore, can be used to
monitor epirubicin-induced cardiac dysfunction. LV
systolic torsion and deformation parameters Epirubi-
cin RotA() RotB() LVT() LVTR(/s) rS (%) rSR(1/s)
LS(%) LSR(1/s) Baseline 7.11.5 -4.21.2 11.71.9
8928 49.56.8 1.80.2 -23.32.7 -1.520.2 1st cycle
5.20.7 -4.11.8 9.31.4 7034 37.45.6 1.20.8
-18.052.5 -1.11 0.6 6th cycle 4.90.9 -3.91.8 9.11.7
6231 35.46.6 1.30.6 -20.52.5 -1.31 0.6 P (1stcycle
vs baseline) 0.001 0.89 0.01 0.01 0.001 0.001 0.001 0.01
P (6thcycle vs baseline) 0.001 0.67 0.01 0.005 0.001
0.001 0.01 0.01
149. Relatia deformarii
atriului stang cu deformarea
miocardica a ventriculului
stang si statusul simptomatic
la pacientii cu cardiomiopatie
hipertrofica
Monica Rosca, B.A.Popescu, Carmen Cristina Bela-
dan, Andreea Calin, Denisa Muraru, Elena C Popa,
Roxana Enache, M.Ghionea, I.M.Coman, Ruxandra
Jurcut, Carmen Ginghina
Institutul de Urgenta pentru Boli Cardiovasculare "C.C.
Iliescu", Bucuresti
Premize: Functia mecanica a atriului stang (AS) are un
rol important in mentinerea performantei cardiovascu-
lare. Cardiomiopatia hipertrofca (CMH) reprezinta un
proces miopatic generalizat ce afecteaza atat miocardul
ventricular cat si pe cel atrial. Relatia functiei AS cu
gradul disfunctiei ventriculare stangi (VS) si statusul
clinic nu a fost inca studiata in CMH.
Obiectiv: Evaluarea functiei AS si a relatiei ei cu func-
tia VS si cu prezenta simptomelor de insufcienta cardi-
aca la pacientii cu CMH.
Metoda: Am irolat prospectiv 37 pc consecutivi (5116
ani, 8 barbati) cu CMH si 37 de subiecti normali, simi-
lari ca varsta si sex. S-a efectuat o evaluare ecocardio-
grafca completa. Parametrii de deformare longitudina-
la VS si AS au fost evaluati din apical 4 camere, folosind
un sofware dedicat de 2D strain. Au fost masurate va-
lorile maxime ale mediei segmentelor pentru strain ()
VS, AS si strain rate (Sr) AS (SSr, ESr si ASr). Statusul
functional a fost defnit conform clasifcarii New York
Heart Association (NYHA).
Rezultate: Pc au avut valori mai mari ale volumului
AS (6735 vs 338 ml/m2), raportului E/E (155 vs
61) si velocitati mai mici ale undei S la Doppler ti-
sular (p<0,001 pentru toti parametrii). Doisprezece
pc au fost asimptomatici (in clasa NHYA I), 15 pc in
clasa NYHA II, 7 in clasa NYHA III si 3 pc in clasa
NYHA IV. La pc, IAS maxim a fost semnifcativ mai
mic (15.66.3 vs 328.5%) si rata deformarii AS (SSr,
Esr, Asr) a fost semnifcativ mai mica dacat la subiectii
normali. IVS maxim a fost de asemenea mai mic la
pc (-12.33.6% vs -20.52.7%, p < 0.001). La pc, toti
parametrii de functie AS s-au corelat cu VS (p<0.003
for all). AS, SSr and ESr s-au corelat cu E/E dar nu
Suplimentul A, 2010
CARDI OMI OPATI I

CARDI OMYOPATHI ES
si ASr. Clasa NYHA s-a corelat cu volumul indexat AS
(r=0.55, p<0.001), parametrii de functie atriala (AS,
SSr, ESr and ASr), gradul regurgitarii mitrale (r =0.39,
p=0.01) si VS (r=0.36, p=0.04) dar nu cu masa VS,
fractia de ejectie VS sau E/E (p>0.05 for all). La anali-
za multivariata, ASr s-a dovedit a f singurul predictor
independent al prezentei simptomelor de insufcienta
cardiaca la pc cu CMH.
Concluzii: La pacientii cu CMH, deformarea miocar-
dica a AS este semnifcativ redusa si se coreleaza cu de-
formarea miocardica a VS si cu presiunile de umplere
VS. Mai mult, disfunctia AS reprezinta un determinant
important al statusului clinic la acesti pacienti.
Relationship of left atrial
myocardial deformation with
left ventricular deformation
and clinical status in
patients with hypertrophic
cardiomyopathy
Background: Te mechanical function of the lef
atrium (LA) plays an important role in the overall car-
diovascular performance. Hypertrophic cardiomyo-
pathy (HCM) represents a generalized myopatic pro-
cess afecting both ventricular and atrial myocardium.
Te relationships of LA myocardial function with the
degree of lef ventricular (LV) dysfunction and with
the clinical status in patients (pts) with HCM have not
been studied yet.
Purpose: To assess LA function by 2D speckles tracking
echocardiography and its relation with LV function and
with clinical status in patients with HCM.
Methods: We prospectively enrolled 37 consecutive
pts (5116 years, 18 men) with HCM and 39 age- and
gender-matched normal subjects. A comprehensive
echocardiogram was performed in all. Longitudinal LV
strain () and LA and strain rate (Sr) parameters (SSr,
ESr and ASr) were assessed from the apical views using
a commercially available 2D Strain sofware. Te func-
tional status was defned according to the New York
Heart Association (NYHA) classifcation.
Results: Pts had higher LA volume (6735 vs 338
ml/m2), E/E ratio (155 vs 61), and lower S wave
velocities (p<0.001 for all). Twelve pts were in NYHA
class 1, 15 pts in NYHA class 2, 7 in NYHA class 3,
and 3 pts in NYHA class 4. Peak LA was signifcantly
lower (15.66.3 vs 328.5%) and LA strain rate para-
meters (SSr, ESr and ASr) were reduced in patients,
compared to normals (p0.001 for all). Peak LV was
also signifcantly lower in patients (-12.33.6% vs
-20.52.7%, p < 0.001). In pts, all LA function para-
meters were correlated with LV (p<0.003 for all). LAS
SSr and ESr have been correlated with E/E ratio while
ASr was not. NYHA class has been related to indexed
LA volume (r=0.55, p<0.001), LA function parameters
(LA, SSr, ESr and ASr), mitral regurgitation degree (r
=0.39, p=0.01), and marginally to LVS(r=0.36, p=0.04)
but not to indexed LV mass, LV ejection fraction or
E/E (p>0.05 for all). Moreover, in logistic regression
analysis, ASr emerged as the only independent predic-
tor of heart failure symptoms in HCM pts.
Conclusions: In pts with HCM, LA reservoir, conduit
and booster pump function are signifcantly reduced
and are related to LV myocardial deformation and to
LV flling pressures. Moreover, LA dysfunction repre-
sents an important determinant of functional class in
pts with HCM.
150. Determinantii afectarii
miocardice la pacientii cu
scleroza sistemica studiu
ecocardiografic
Ruxandra Jurcut, Mihaela Silvia Amzulescu, Ali-
na Lemeni, Laura Isac, S.Giusca, Daniela Opris,
B.A.Popescu, Ionescu Ruxandra, Carmen Ginghina
Bucuresti
Introducere: Afectarea cardiaca si hipertensiunea pul-
monara (HP) sunt frecvente in sclerodermia sistemica
(Ss), dar pot ramane subclinice pentru multi ani.
Scopul studiului a fost evaluarea functiei cardiace la pa-
cientii cu Ss si corelarea parametrilor ecocardiografci
cu prezenta HP.
Metoda: Au fost investigati 28 pacienti (pts) conse-
cutivi cu Ss si 26 pts control similari ca varsta si sex.
Functia ventriculului stang (VS) si drept (VD) a fost
evaluata prin ecocardiografe conventionala si imagis-
tic Doppler tisular (TDI). Au fost analizati urmato-
CARDI OMI OPATI I
CARDI OMYOPATHI ES
Suplimentul A, 2010
tricuspid annular plane systolic excursion (TAPSE),

right ventricular fractional area change (RVFAC), peak
systolic velocity of the tricuspid ring (Vt) and of the mi-
tral ring (Vm) at the lateral site, average systolic strain
of the RV free wall (StrainRV) and of the LV free wall
(Strain LV).
Results: Based on a cutof sPAP of 35 mmHg, we di-
vided the SSc pts in Group A = 7 pts with pulmonary
hypertension (PH), and Group B=21 pts without PH.
Pts in group B had more advanced age (58.010.8 vs
48.67.4 years in group A, p<0.05) and more pro-
longed disease duration (15.09.5 vs 6.13.6 years in
group A, p<0.05). Subclinical systolic dysfunction of
the RV and LV was present in all SSc pts, more pro-
nounced in the presence of PH (strainRV -19.6 4.3%
group B vs -23.14.4% group A, vs -29.44.5% group
control, p ANOVA<0.01; strainLV -12.85.1% group B
vs -16.33.4% group A vs -23.42.6% group control, p
ANOVA<0.01). In a multivariate regression model in-
cluding age, disease duration, pulmonary fbrosis and
sPAP, only disease duration appeared to be a signifcant
predictor of RV dysfunction (p=0.04).
Conclusions: Both LV and RV subclinical dysfuncti-
on can be detected in SSc patients using TDI derived
deformation imaging, irrespective of the presence of
PH. Disease duration appears to be the main determi-
nant of myocardial dysfunction, suggesting an intrinsic
myocardial process as main mechanism.
151. Studiu comparativ
al functiei ventriculului
drept in diverse etiologii ale
hipertensiunii pulmonare
S.Giusca, Ruxandra Jurcut, Ioana Ghiorghiu,
I.M.Coman, B.A.Popescu, Mihaela Amzulescu,
Ruxandra Maria Ionescu, Marion Delcroix, U.J.Voigt,
Carmen Ginghina
Instititul de Urgenta pentru Boli Cardiovasculare Prof
Dr C C Iliescu, Bucuresti
Scop: Supravietuirea pacientilor cu hipertensiune pul-
monara (HTP) depinde de etiologie chiar la niveluri si-
milare ale suprasolicitarii de presiune. Scopul studiului
a constat in analiza functiei ventriculului drept (VD)
in diverse etiologii congenitale si non-congenitale ale
HTP.
rii parametri: presiunea sistolica in artera pulmonara
(PAPS), excursia sistolica a planului inelului tricuspidi-
an (TAPSE), fractia de modifcare a ariei VD (RVFAC),
peak-ul velocitatii sistolice a inelului tricuspidian (Vt)
si a inelului mitral lateral (Vm), strain-ul sistolic al pe-
retelui liber al VD (strainVD) si al peretelui liber al VS
(strainVS).
Rezultate: Pe baza unei valori prag de 35 mmHg pen-
tru PAPS, pacientii au fost imprtiti in grupul A=7 pts
cu HP si grupul B=21 pts fara HP. Pts din grupul B au
avut varsta mai avansat (58.010.8 vs 48.67.4 ani in
grupul A, p<0.05) si durata bolii mai lung (15.09.5
vs 6.13.6 ani in grupul A, p<0.05). Disfunctia sistolica
subclinica de VD si VS a fost prezenta la toti pacien-
tii cu Ss, find mai pronuntata in prezenta HP (stra-
in VD -19.6 4.3% grup B vs -23.14.4% grup A, vs
-29.44.5% grup control, p ANOVA<0.01; strain VS
-12.85.1% grup B vs -16.33.4% grup A vs -23.42.6%
grup control, p ANOVA<0.01). Intr-un model de re-
gresie multivariata care a inclus varsta, durata bolii, f-
broza pulmonara si PAPS, doar durata bolii s-a dovedit
a f un predictor al disfunctiei VD (p=0.04).
Concluzii: La pacientii cu Ss, disfunctia sistolica sub-
clinica de VS si VD poate f detectata utilizand tehnica
TDI de deformare miocardica si este independenta de
prezenta HP. Durata bolii apare ca pricipalul determi-
nant al disfunctiei miocardice, sugerand ca mecanism
principal un proces miocardic intrinsec.
Determinants of myocardial
involvement in patients
with systemic sclerosis an
echocardiographic study
Background: Cardiac involvement and pulmonary
hypertension (PH) are frequent in systemic sclerosis
(SSc), but ofen clinically occult for several years.
Te aim of this study was to evaluate the cardiac func-
tion in patients with SSc and to correlate the echocardi-
ographic parameters with presence of PH.
Methods: 28 consecutive patients (pts) with SSc and 26
age-matched controls were investigated. Conventional
and Tissue Doppler imaging (TDI) were used in all pts,
to assess the lef (LV) and right (RV) ventricular func-
tion. Te following parameters were assessed: echo-
derived systolic pulmonary artery pressure (sPAP),
Suplimentul A, 2010
CARDI OMI OPATI I

CARDI OMYOPATHI ES
Material si metoda: Au fost evaluati 48 de pacienti
(pts) cu varste similare, 14 cu HTP idiopatica (HTPI,
4214 ani), 7 cu HTP asociata bolilor de tesut conjunc-
tiv (HTPBTC, 5315 ani), 16 cu HTP cronica trombo-
embolica (HTPCT, 5312 ani) si 11 cu Sindrom Eisen-
menger (SE, 4116 ani). Utilizand ecocardiografa, au
fost determinati parametrii: presiunea sitolica in artera
pulmonara (PSAP), diametrul tele diastolic al VD, gro-
simea peretelui liber al VD, TAPSE, rata de modifcare
a ariei VD (RVFAC), indicele de performanta miocar-
dica VD (TeiVD), velocitatea maxima a inelului tricus-
pidian (Vt) si Strainul global derivat prin metoda de tip
speckle tracking la nielul peretelui liber al VD (Strain
VD).
Rezultate: Nivelul PSAP a fost similar intre cele 4 gru-
puri (96.836, 71.412.5, 89.412, 96 15mmHg, pA-
NOVA=0.1). Valorile TAPSE, Vt si TeiVD au fost simi-
lare intre grupuri (pANOVA=0.2, 0.6 si respective 0.3).
VD-ul pts cu HTPBTC a fost mai putin dilatat decat al
celor cu HTPCT (36.56 vs 47.86, pANOVA=0.05).
Pacientii cu SE au avut o grosime a peretelui liber al
VD mai mare comparativ cu pacientii cu HTPBTC
si HTPCT (9.21.5 vs 6.31.2 si respectiv 7.21.4,
p<0.001). Grupul de SE a prezentat o RVFAC mai buna
comparativ cu HTPI, HTPBTC si HTPCT (39.98.5
vs 30.910, 27.510 si respectiv 27.510, p=0.01) si
un Strain VD superior HTPI si HTPCT (-203.5 vs
-16.57 si respectiv -12.64.8, p=0.01).
Concluzii: Pacientii cu Sindrom Eisenmenger prezinta
o adaptare morfologica si functionala a VD mai buna
comprativ cu formele dobandite de HTP, ceea ce poate
explica supravietuirea mai buna a pacientilor cu sun-
turi cardiace dreapta-stanga.
Comparison of right
ventricular function between
different etiologies of
Aims: Survival in patients (pts) with pulmonary hyper-
tension (PH) depends on etiology even if levels of pre-
ssure overload are similar. We analyzed right ventricu-
lar (RV) morphology and function in diferent conge-
nital and non-congenital etiologies of PH using con-
ventional and deformation imaging echocardiography.
Material and method: We evaluated 48 age matched pts,
14 with idiopathic PH (IPH, 4214years), 7 with con-
nective tissue disease (PHCTD, 5315 years), 16 with
chronic thromboembolic PH (CTEPH, 5312 years)
and 11 with Eisenmenger Syndrome (ES, 4116years,
4 ASD and 7 VSD). We measured the echo derived
systolic pulmonary pressure (sPAP), RV end-diastolic
diameter (RVEDD), RV free wall thickness (RVFWT),
TAPSE, RV fractional area change (RVFAC), RV myo-
cardial performance index (RVMPI), peak systolic ve-
locity of the tricuspid ring (Vt) and speckle tracking-
derived global strain of the RV free wall.
Results: Te level of sPAP was similar between groups
(96.836, 71.412.5, 89.412, 96 15mmHg, pANO-
VA=0.1). TAPSE, RVMPI and Vt were similar between
groups (pANOVA=0.2, 0.6 and 0.3 respectively). Te
RV of pts with PHCTD was less dilated than CTEPH
pts(36.56 vs 47.86, pANOVA=0.05). Pts with ES had
an increased thickness of the free wall compared to
PHCTD and CTEPH (9.21.5 vs 6.31.2 and 7.21.4 re-
spectively, p<0.001).RVFAC was better in the ES group
compared to IPH, PHCTD and CTEPH (39.98.5 vs
30.910, 27.510 and 27.510, respectively p=0.01).
Te RV free wall of pts with ES showed better deforma-
tion compared to IPH and CTEPH (-203.5 vs -16.57
and -12.64.8,respectively p=0.01).
Conclusions: Patients with congenital abnormality
(Eisenmenger Syndrome) show a better morphologic
adaptation and performance of the RV compared to
acquired types of PH.Tese fndings could explain the
better survival profle of patients with right to lef car-
diac shunts.
168
New aspect of the restenosis
pathogenesis
Te intrastent restenosis remains quite high and is clo-
sely linked with the stent type, and biologic medicati-
on. Although the restenosis pathogenesis is now largely
studied there are no obtained proved data. In this con-
cern it is opportune the elucidation of the cellular and
molecular mechanisms which trigger and sustain the
neointimal proliferation, which modulation thereby di-
ferent pharmacological adherents appears as a relevant
possibility of intrastent restenosis risk preventing and
reducing. Te phenotypic modulation of the smooth
coronary myocyte is reviewed as a feasible mechanism
of proliferation, and accordingly to actual conceptual
reports the micro-RNA represents one of the key fac-
tors controlling the phenotype ratio contractile/synthe-
tic myocyte from coronary artery wall.
Aim: evaluation of the expression and quantity of mi-
cro-RNA 143/145 in the tissue pattern of the intrastent
restenosis.
Material and methods: Te stenosis stent was taken
from 5 died patients with intrastent restenosis. Using
the method of hybridisation, confocal and immunofu-
orescent microscopy, Western Blot the expression and
quantity of micro-RNA has been estimated.
Results: Both expression and quantity of micro-RNA
was signifcantly reduced in the tissue pattern of the
intrastent restenosis. Importantly to be noted that the
quantity and expression decline degree authentically
correlated with neointimal proliferation degree as well
as with ratio of synthetic type coronary myocyte raise.
Conclusions: 1. Te established micro-RNA expressi-
on and quantity decrease in the coronary artery wall
media from the tissue pattern of the intrastent resteno-
sis is an important mechanism of the neointimal pro-
liferation. 2. Te pharmacological modalities of micro-
RNA expression increasing could be a real possibility of
the intrastent restenosis risk prevention and reducing.
152. Aspecte noi in patogenia
restenozei
I.Popovici
Incidenta restenozei intrastent ramane destul de inalta
si este in functie de tipul de stent aplicat si de medicatia
biologica. Desi patogenia restenozei este actualmen-
te studiata multidirectional, raman necunoscute inca
o serie de aspecte ale problemei abordate. La aceasta
conotatie este oportuna elucidarea mecanismelor celu-
lare si moleculare care declanseaza si coroboreaza pro-
liferarea neointimala, modularea carora prin diferite
aderente farmacologice se anunta drept o posibilitate
de prevenire si reducere a riscului restenozei intrastent.
Modularea fenotipica a miocitului neted coronarian
este vizata drept un mecanism fabil al proliferarii, iar
potrivit relatarilor conceptuale actuale, acidul micro-
ARN reprezinta unul din factorii cheie care controlea-
za rata fenotipului contarctil/secretor al miocitului din
peretele arterei coronariene.
Scopul: evaluarea expresiei si a cantitatii acidului mi-
cro-ARN 143/145 in paternul tisular al restenozei in-
trastent.
Material si metode. La 5 pacienti cu restenoza intras-
tent care au decedat s-a preluat stentul stenozant. Uti-
lizand metoda de hibridizare, microscopia confocala
si imunofuorescenta, Wstern Blot, a fost apreciata ex-
presia si cantitatea micro-ARN in paternul tisular al
restenozei intrastent.
Rezultate: Atat expresia, cat si cantitatea micro-ARN a
fost semnifcativ redusa in paternul tisular al restenozei
intrastent. Important de mentionat, ca gradul declinu-
lui cantitativ si al expresiei s-a corelat autentic cu gradul
proliferarii neointimale, precum si cu rata de crestere a
miocitelor netede coronariene cu fenotip secretor.
Concluzii: 1. Micsorarea expresiei si a cantitatii acidu-
lui micro-ARN in media peretelui arterei coronariene
constatata in paternul tisular al stenozei intrastent este
un mecanism important de potentare a proliferarii ne-
ointimale. 2. Modalitatile farmacologice de crestere a
expresiei micro-ARN pot oferi o posibilitate relevanta
de prevenire si reducere a riscului restenozei intrastent.
VARI A 3 | VARI A 3
Suplimentul A, 2010
169
VARI A 3
VARI A 3
153. Infarct miocardic
si tromboza venoasa
profunda secundare
hiperhomocisteinemiei
prezentare de caz
F.Maghiar, Alina Iacobescu, Sorina Magheru, Lerintiu
O., Alina Borza
Introducere: Hiperhomocisteinemia poate f asociata
cu difcitul vitaminelor de grup B sau a acidului folic.
Poate f de asemenea secundara insufcientei renale,
diabetului, hipotiroidiei si afectiunilor maligne. Hi-
perhomocisteinemia poate f deasemenea genetica,
iar aceasta afectiune determina un risc crescut pentru
tromboze arteriale si venoase.
Prezentare de caz: In aceasta lucrare va f prezentat
cazulunei paciente cu hiperhomocisteinemie ce a pre-
zentat atat tromboza venoasa cat si infarct miocardic,
posibil datorate acestei afectiuni. Aceasta pacienta a
prezentat infarct miocardic acut inferior la varsta de 31
de ani si infarct miocardic acut anteroseptal la 37 ani,
iar la varsta de 43 de ani a prezentat tromboza de vena
iliaca externa si iliaca comuna. Pacienta nu a prezentat
valori crescute ale colesterolului dar a fost documen-
tata hiperhomocisteinemia la cea de a doua internare.
Pentru precizarea diagnosticului au fost evaluate cau-
zele primare si secundare de hiperhomocisteinemie.
De asemenea s-au facut determinari pentru a eviden-
tia o eventuaal mutatie genica care sa cauzeze hiper-
homocisteinemia. Nu au fost gasite nici o mutatie in
genele ce controleaza activitatea metilentetrahidrofolat
reductazei si cistationin beta sintetazei. Tratamentul de
lunga durata cu acid folic, vitamina B12 si B6 a dus la
normalizarea valorilor hoociteinei serice.
Concluzie: acest caz evidentiaza cat de important este
adausul de vitamine in dieta pacientilor cu hiperhomo-
cisteinemie. Tratamentul precoce al hiperhomocistei-
nemiei poate preveni complicatiile tromboembolice.
Hyperhomocysteinemia
complicated by myocardial
infarction and deep vein
thrombosis-case report
Introduction: Hyperhomocysteinemia (HHcy) can be
associated with defciency of group B vitamins and folic
acid. HHcy might also results from renal insuf ciency,
diabetes, hypothyreosis or malignant diseases. In some
cases HHcy is connected with mutations of genes in-
volved in its metabolism. HHcy causes the increased
risk of arterial and vein thrombosis.
Methods and results: In this paper we show case report
of woman with HHcy, who developed several compli-
cations, probably because of HHcy. Tis patient in the
age of 31 and 37 years developed twice myocardial
infarction, whereas in the age of 43 she sufered from
deep vein thrombosis. According to documentation,
the level of cholesterol has never been elevated, howe-
ver HHcy was observed. During diagnostic process, the
primary and secondary causes of HHcy were assessed.
Mutations of genes involved in Hcy metabolism were
also assessed. We did not fnd any mutation in prote-
in products of methylenotetrahydrofolate reductase
(MTHFR) or cystationine beta-synthase (CBS). Te
patient was treated with the use of folic acid, vitamin
B12 and B6 supplementation, and normalization of
Hcy level was received.
Conclusion: Tis case report underline, how important
role in the case of HHcy play vitamin supplementation.
Te early treatment of HHcy might limit thromboem-
bolic complication.
154. Endocardita infectioasa cu
cinci localizari: mitrala, aortica,
pulmonara, tricuspida, varful
cordului. Prezentare de caz
C.Iordache, Alina-Costina Luca, Stefana-Maria Moisa
Spitalul Clinic de Urgenta pentru Copii Sfanta Maria,
Iasi
Rezumat: Prezentam cazul unui pacient in varsta de 8
ani si 2 luni internat in Clinica I Pediatrie sectia Te-
VARI A 3
VARI A 3
Suplimentul A, 2010
1I0
rapie intensiva a Spitalului de Urgenta pentru Copii
Sfanta Maria, Iasi prin transfer din sectia Oncologie a
aceluiasi spital, pentru alterarea brusca a starii de con-
stienta survenita cu 7 ore anterior internarii si hipoto-
nie marcata. Pacientul fusese diagnosticat la varsta de
7 ani si 2 luni cu gliom de trunchi cerebral si sindrom
pontomezencefalic. Examen CT cerebral- gliom pon-
tin. Ecocardiografe- Endocardita infectioasa pe VMA
si VP, perforatie VMA, formatiune tumorala la varful
cordului, insufcienta mitrala grad III, insufcienta tri-
cuspidiana grad III, insufcienta pulmonara grad III.
Tratament: antibiotic cu spectru larg, antifungic, gas-
troprotector, suportiv si simptomatic. Particularitatea
cazului consta in prezenta celor 5 focare de endocar-
dita. Prima localizare a fost descrisa ecografc la varful
ventriculului drept, cu dimensiuni de 1/1 cm; ulterior
pacientul a primit tratament cu antibiotice cu spectru
larg si antifungice, pentru ca o luna mai tarziu sa fe
descrise 5 localizari ale endocarditei. O alta particu-
laritate a cazului este reprezentata de varsta aparitiei
gliomului cerebral- situata in afara celor doua varfuri
de incidenta a bolii in functie de varsta (16-20 si 40-50
ani). Evolutia a fost nefavorabila, cu deces la 9 luni de
la stabilirea diagnosticului de gliom pontin si la o luna
de la decelarea focarelor de endocardita.
Cuvinte cheie: endocardita infectioasa, gliom pontin
Infectious endocarditis with
five localisations: mitral, aortic,
tricuspid, pulmonary, heart
apex. Case Presentation.
We present the case of a 8 years and 2 months old boy
hospitalized in Ist Pediatrics Clinic, Sfanta Maria
Childrens Emergency Hospital, Iassy- Intensive Care
Unit by transfer from the Oncology Ward of the same
hospital, for the sudden alteration of consciousness and
marked hypotonia. Te patient had been diagnosed at
the age of 7 years and 2 months with cerebral trunk
glioma and pontomezencefalic syndrome. Cerebral
CT scan- pontine glioma. Echocardiography- infective
endocarditis on anterior mitral valve and pulmonary
valve, mitral valve perforation, tumor at the apex at the
heart, IIIrd degree mitral, tricuspid and pulmonary re-
gurgitation. He received wide spectrum antibiotic, an-
tifungal, gastroprotector supportive and symptomatic
treatment. Te case particularity consists of the presen-
ce of the fve endocarditis focuses. Te frst focus had
been described through echocardiography at the apex
of the heart; afer that, the patient has received proper
antibiotic and antifungal treatment, and one month la-
ter the 5 focuses were described. Another case parti-
cularity consists of the age of diagnosis of the pontine
glioma, outside of the 2 incidence peaks of this disease
(16-20 and 40-50 years). Te evolution was not favora-
ble, the patient died 9 months afer the glioma diagnose
was established and one month afer the endocarditis
diagnose was established.
Key-words: infectious endocarditis, pontine glioma
155. Sindrom de QT lung si
sindrom WPW o asociere
rara de cauze de moarte subita
la un pacient tanar
C.Iorgulescu, G. Tatu-Chitoiu, D. Mincu, R. Ciomag,
R. Vatasescu
Spitalul Clinic de Urgenta, Bucuresti
Rezumat: O femeie de 26 ani s-a prezentat pentru
sincope recurente. ECG-ul a aratat interval PR scurt,
QRS larg (150 ms) prin prezenta undei delta si QT lung
(QT 580 ms, QTc 620 ms). Monitorizarea ECG a ara-
tat episoade repetate de tahicardie cu QRS larg remise
spontan, discret polimorfa, uneori cu aspect de torsa-
da varfurilor (TdP), asocieate cu episoadele sincopale/
presincopale. Au fost suspectate episoade de fbrilatie
atriala/ futter atrial cu conducere anterograda rapida
pe calea accesorie. Istoricul familial a aratat o sora cu
moarte subita la 18 ani si mama cu episoade sincopale
recurente induse de efort pana la varsta de 45 de ani.
ECG-ul mamei a aratat absenta preexcitatiei si QT lung
(QT 480 ms, QTc 550 ms). Testarea electrofziologica a
aratat o cale accesorie parahisiana cu perioada refrac-
tara efectiva scurta (240 ms bazal, <200 ms dupa iso-
proterenol), care a fost tratata cu succes prin ablatie cu
radiofrecventa. Desi QRS-ul a devenit ingust (80 ms),
alungirea QT a persistat dupa ablatie (QT 620 ms, QTc
654 ms), cu alternate macroscopica de unda T si pase
scurte de TdP inclusiv sub tratament cu beta-blocant
in doze mari, impunand implantarea unui defbrilator
bicameral.
Suplimentul A, 2010
1I1
VARI A 3
VARI A 3
156. Manifestari
cardiovasculare in mixedem.
cardiologi, atentie la tiroida!
Prezentare de caz
Maxim George-Razvan, Anca Radulescu, Elvira Craiu
Spitalul Clinic Judetean De Urgenta, Constanta
Introducere: Hipotiroidismul reprezinta expresia cli-
nica a insufcientei biosintezei hormonilor tiroidieni, a
transportului sau receptiei acestora, avand manifestari
cardiovasculare secundare: revarsatul pericardic, insu-
fcienta cardiaca, ateroscleroza accelerata si modifcari
electrocardiografce.
Material si metode: Prezentam cazul unei paciente de
51 ani, cu hepatita cronica cu VHC, tratata cu Interfe-
ron si Ribavirina, care se interneaza in clinica noastra
pentru mixedem cu manifestari cardiovasculare, pre-
cum si evolutia acesteia la trei luni de la instituirea te-
rapiei de substitutie cu levotiroxina.
Rezultate: Pacienta A.E., 51 ani, se interneaza pentru
durere toracica anterioara cu caracter constrictiv, cu
durata prelungita, dispnee la efort mediu, simptomato-
logie debutata in urma cu o luna si accentuata progre-
siv. Pacienta este cunoscuta cu hepatita cronica VHC
pentru care a urmat tratament specifc cu Interferon
alfa 2a si Ribavirina in perioada 06.2009-03.2010, in-
trerupt prematur din cauza reactiilor adverse hema-
tologice (pancitopenie severa). Obiectiv la internare:
pacienta cu stare generala infuentata, bradilalie, bra-
dipsihie, facies infltrat, tegumente uscate, palide, du-
reri articulare difuze, TA=110/90mmHg, AV 60/min,
regulat, frecatura pericardica. Biologic: pancitopenie
(Hb=9,6g/dl, L=2800/mmc, Tr=108.000/mmc), hiper-
colesterolemie (colest.total=313mg/dl, LDLc=230mg/
dl), CK=1435U/l, LDH=841U/l, insufcienta tiroidiana
severa (FT4=0,8pmol/l, TSH=114,4 mcUI/ml). EKG:
RS, AV 70/min, Ax QRS intermediar, microvoltaj, unde
T negative difuz. Ecocardiografa: hipokinezie globala
cu disfunctie sistolica usoara si disfunctie diastolica grd
I tip anomalie de relaxare de tip intarziat, lama de lichid
pericardic de 3 mm posterior de VS. Ecografa tiroidi-
ana: parenchim cu ecostructura dezorganizata prin
alternarea de zone cu ecogenitati diferite, cu aspect
trabecular, dimensiuni glandulare reduse. S-a instituit
terapie de substitutie cu levotiroxina, pacienta find re-
evaluata la 3 luni.
Concluzii: Prezentam acest caz pentru a sublinia im-
portanta evaluarii periodice a functiei tiroidiene la pa-
Concluzie: aceasta este prima raportare a unei asocieri
de WPW si QT lung in care ambele conditii au prezen-
tat un risc de moarte subita.
Long QT syndrome and WPW
syndrome: an extremely rare
association of two causes of
sudden cardiac death in a
young patient
Abstract: A 26 year old women presented with recur-
rent syncope. ECG showed short PR interval, wide
QRS (150ms) due to delta wave and QT prolongation
(QT 580 ms, QTc 620 ms). ECG monitoring revealed
repeated episodes of a self-terminating wide QRS ta-
chycardia, mostly discrete polymorphic, sometimes
with torsade des pointes (TdP) appearance, associa-
ted with the syncopal/presyncopal episodes. Episodes
of atrial futter/fbrillation with rapid anterograde con-
duction over the accessory pathway were suspected.
Family history revealed a sister with sudden death at 18
years old and her mother with recurrent efort-induced
syncope till the age of 45 years.Her mother ECG show-
ed no pre-excitation with long QT (QT 480ms, QTc
550 ms). Results: Electrophysiologic testing revealed
a right parahisian accessory pathway with short ERP
(240 ms baseline, <200 ms afer isoproterenol), which
was successfully treated by RF ablation. Despite QRS
narrowing (80 ms), QT prolongation persisted afer
ablation (QT 620 ms, QTc 654 ms), with macroscopic
T wave alternance and short runs of TdP even afer hi-
gh-dose beta-blocker treatment. A dual chamber ICD
was implanted.
Conclusion: Tis is the frst case report of an associati-
on of LQT and WPW syndrome in which both conditi-
ons carry a high risk of SCD.
VARI A 3
VARI A 3
Suplimentul A, 2010
1I2
cientii afati in tratament cu Interferon, prevenindu-se
astfel aparitia manifestarilor cardiovasculare potential
severe si cu prognostic infaust in lipsa terapiei de sub-
stitutie tiroidiana.
Cardiovascular events in severe
hypothyroidism. cardiologists,
attention to thyroid! case study
Introduction: Hypothyroidism is the clinical expressi-
on of insuf cient thyroid hormone biosynthesis, trans-
port or their reception, with secondary cardiovascular
events: pericardial efusion, heart failure, accelerated
atherosclerosis and electrocardiographic changes.
Material and methods: We present the case of a fema-
le patient of 51 years, with chronic hepatitis C treated
with interferon and ribavirin, who is hospitalized in
our clinic for myxedema with cardiovascular events,
and her evolution on three months afer the establish-
ment of levothyroxine replacement therapy.
Results: Patient A.E., 51 years old, is hospitalized for
chest pain, dyspnea on exertion, symptoms wich began
one month ago and gradually accentuated. Te patient
is known with chronic hepatitis C treated with inter-
feron alfa-2a and Ribavirin in 06.2009-03.2010, stop-
ped prematurely because of haematological side efects
(severe pancytopenia). On clinical examination: the
patient with malaise, slow spech, slow thinking, infl-
trated facies, dry and pale skin, difuse joint pain, BP
= 110/90mmHg, AV 60/min, regular, pericardial fric-
tion. Biology: pancytopenia (Hb=9.6 g/dl, L=2800/
mmc, Tr=108.000/mmc), hypercholesterolemia (co-
lest.total=313mg/dl, LDLc=230mg/dl), CK=1435U/L,
LDH=841U/l, severe thyroid failure (FT4=0.8 pmol/l,
TSH=114.4 mcUI/ml). ECG: SR, AV 70/min, QRS
with normal axis, low voltage, difuse negative T waves.
Echocardiography: global hypokinesia with mild systo-
lic dysfunction and diastolic dysfunction type I - dela-
yed relaxation abnormality, pericardial efusion 3 mm
posterior VS. Ultrasound Tyroid: disorganized paren-
chyma with alternating echogenic areas with diferent
aspect trabecular, glandular size reduced. Our pacient
received levothyroxine replacement therapy, and she
was reevaluated at three months afer.
Conclusions: We present this case to highlight the im-
portance of regular assessment of thyroid function in
patients treated with interferon, thus preventing the
occurrence of cardiovascular events and potentially se-
vere prognosis in the absence of thyroid replacement
therapy.
157. Infarctul miocardic cu
coronare permeabile
Simona Almarichi, Andreea Hodorogea, Ana Cristea,
Mihaela Marculescu, T.Nanea
Armatei, Bucuresti
Scop: Analiza particularitatilor clinice si etiopatogeni-
ce la bolnavii cu infact miocardic acut (IMA) cu coro-
nare angiografc normale.
Metoda: Prezentam 3 cazuri de IMA cu coronare nor-
male, discutand cauzele si mecanismele posibile.
Rezultate: Cazul 1: Barbat, 26 ani, fumator, se prezinta
cu durere retrosternala, de 4 ore, avand supradenive-
lare segment ST 4 mm V1-V5 si troponina pozitiva.
Nu se evidentiaza ecocardiografc anomalii de kinetica
parietala. Coronarografa in urgenta arata artere coro-
nare normale, fux TIMI 2 global. Testele penru trom-
boflie sunt negative. Cazul 2: Barbat, 17 ani, sportiv,
consumator de substante anabolizante, prezinta durere
retrosternala, dupa un episod de intercurenta respira-
torie, supradenivelare de segment ST de 1,5 mm DIII
si AVF, hipokinezie de sept interventricular ecocardi-
ografc si troponina pozitiva. Angiografa nu deceleaza
leziuni coronariene. Testele de tromboflie deceleaza
defcit de proteina C si S. Cazul 3: Barbat, 53 ani, fuma-
tor, dislipidemic, hipertensiv prezinta durere retroster-
nala de 1 ora,supradenivelare ST de 7 mm in V1-V3,
CKMB crescut,hipertrofe ventriculara stanga si hipo-
kinezie apicala ecocardiografc. Primeste streptokinaza,
intrerupta dupa 800000u pentru colaps greu reversibil.
Prezinta bradicardie marcata si scade supradenivelarea
segmentului ST la 90 min. Coronarografa efectuata in
primele 24 ore arata coronare permeabile.
Concluzii: Aspectul de coronare normale la bolnavii
cu IMA prezentati ar putea f explicat prin tromboli-
za spontana (cazul 3) si etiologia nonaterosclerotica a
IMA (cazurile 1 si 2).
Suplimentul A, 2010
1I8
VARI A 3
VARI A 3
158. Malformatie complexa
arterio-venoasa si cardiaca
Prezentare de caz
Alina Luca, Alina Costina, C.Iordache, Stefana-Maria
Moisa
Spitalul Clinic de Urgenta pentru Copii Sfanta Maria,
Iasi
Rezumat: Prezentam cazul unui pacient in varsata de
14 ani si 11 luni, internat in Clinica I Pediatrie sectia
Cardiologie a Spitalului de Urgenta pentru Copii Sfan-
ta Maria, Iasi pentru dureri la nivelul gambei drepte si
cresterea diametrului acesteia (diametru cu 3 cm mai
mare decat gamba stanga), fara semne de infamatie.
Pacientul fusese apendicectomizat cu aproximativ o
luna anteior instalarii acestei patologii. Examenul cli-
nic a mai decelat un sufu sistolic grad II/6 paraster-
nal stang, cu maxim de intensitate in focarul mitralei.
Paraclinic: usoara eozinoflie, usoara citoliza hepatica,
PTTK, TQ, INR- usor crescute. Ecocardiografe- pro-
laps de valva mitrala, coarctatie larga de aorta. Ecogra-
fe Doppler venos membre inferioare- Varianta anato-
mica de drenaj venos in sistemul cav inferior, trombo-
za partiala iliaca comuna externa si femurala comuna
(repermeabilizare periferica incepand de la confuentul
safenofemural), tromboza femurala superfciala si po-
plitee. Angio CT: vena cava inferioara (VCI) aberanta:
hipoplazie in partea superioara (vizibila pana la hilul
RD, apoi extrem de subtire); o vena cava inferioara
abernata (a doua VCI) latero- aortic stang ce pare ca
se uneste cu hemiazygos (dilatata); VCI stanga as-
pect moniliform; vena azygos-dilatata. Vascularizatie
venoasa hipogastrica dilatata (staza venoasa- posibila
circulatie colaterala).Vena renala stanga se varsa in VCI
aberanta Dilatatia venei poplitee drepte, venei femurale
drepte, venei iliace externa si interna drepte; contrast-
normal; venele suprahepatice nu se evidentiaza satisfa-
cator- aparent normale. A primit tratatment cu Trom-
bostop, cu evolutie favorabila. Particularitatea cazului
consta in descoperirea malformatiei venoase complexe
tardiv, la varsta de 14,5 ani in mod incidental, cu ocazia
internarii pentru tromboza venoasa profunda ileo- fe-
muro-poplitee. Tromboza venoasa a aparut sub varsta
de 15 ani, 0,005% din numarul total de cazuri find di-
agnosticate la aceasta varsta.
Cuvinte cheie: tromboza venoasa profunda, malfor-
matie arterio-venoasa complexa
Myocardial infarction with
normal coronary arteries
Our aim is to analyze the clinical aspects and etio-
pathogenesis of the acute myocardial infarction with
normal coronary arteries.
Methods: We present 3 cases of acute myocardial in-
farction with normal coronary arteries, discussing the
possible causes and pathogenesis.
Results: Case 1: Male, 26 years old, smoker, presented
with retrosternal pain for 4 hours. EKG showed ST
elevation of 4 mm in V1-V5, troponine was positive
and cardiac ultrasound revealed no abnormalities of
parietal kinetics. Te angiogram showed normal co-
ronary arteries with global TIMI 2 fow. Te tests for
thrombophilia were negative. Case 2: Male, 17 years
old, athlete, with anabolic substance intake, presented
retrosternal pain afer an episode of fu. EKG showed
ST elevation of 1,5mm in DIII and AVF and the cardiac
ultrasound revealed septal hipokinesia. Troponine was
positive and the angiogram showed no coronary lesi-
ons. Te tests for coagulation disorders showed a def-
cit of C and S protein. Case 3: Male, 53 years old, smo-
ker, with dyslipidemia and hypertension, was admitted
for chest pain lasting for an hour. Te EKG revealed
ST elevation of 7 mm in V1-V3. CKMB was high. Car-
diac ultrasound found lef ventricle hypertrophia and
apical hipokinesia. Te patient received streptokinasis
that was stopped afer 800000u, because of refractory
collapse. He had marked bradycardia and the ST ele-
vation reduced afer 90 minutes. Te angiogram taken
in the frst 24 hours showed normal coronary arteries.
Conclusions: Te aspect of normal coronary arteries
in patients with acute myocardial infarction can be ex-
plained by spontaneous thrombolysis (case 3) and the
non-atherosclerotic etiology of the acute myocardial
infarction (cases 1 and 2).
VARI A 3
VARI A 3
Suplimentul A, 2010
1I1
ocardic non-Q, pericardita), iar pe RX toracic s-a evi-
dentiat o gusa tiroidiana (in rest normala). Laboratorul
releva patologic doar anemie severa (Hb=6,8mg%,
Ht=23,2%) si o trombocitoza usoara, functia renala
si hormoni tiroidieni normali. Ecocardiac cu cavitati
drepte usor dilatate cu hipertensiune pulmonara usoa-
ra. La 12 ore de la internare pacientul repeta simptoma-
tologia si se decide efectuarea angioCT toracic cu sub-
stanta de contrast care evidentiaza imagine de infarct
pulmonar drept (trombembolism pulmonar acut), iar
ecocardiac efectuat dupa 1 zi, releva cresterea dimen-
siunilor cavitatilor drepte si hipertensiune pulmonara
medie. Paraclinic (Doppler periferic, CT abdominal)
nu s-a putut evidentia sursa trombilor. Laboratorul nu
a aratat nici sindrom antifosfolipidic si nici defcit de
factor V Leyden sau de alte proteine, iar frotiul peri-
feric a aratat anemia hemolitica (multe drepanocite si
sferocite). Discutii si concluzii. Dispneea putea f inter-
pretata in context de gusa tiroidiana sau de anemie , dar
a fost bine ca s-a retinut pacientul pentru investigatii
suplimentare. A fost probabil tromboza in situ dato-
rata ocluziei vasculare prin staza hematiilor sau unei
embolizari de la nivelul maduvei osoase care caracteri-
zareaza anemia hemolitica. Posibil si cu microembolii
pulmonare si in antecedente. S-a anticoagulat pacientul
(minim 6 luni), dar din pacate se stie ca in acest caz
anticoagularea are efecte limitate.
Trap diagnosis in a case of
acute thromboembolism
43 year-old man, obese, with no pathological history,
presents chest pain for three days, paroxysmal dyspnea,
and fatigue. Resting ECG with difuse repolarizati-
on changes (to exclude non-Q myocardial infarction,
pericarditis), and chest X-ray revealed a thyroid goi-
ter (otherwise normal). Laboratory revealed only se-
vere anemia (Hb = 6.8 mg%, Ht = 23.2%) and a mild
thrombocytosis, normal renal function and normal
thyroid hormones. Ecocardiography revealed slightly
dilated right cavities with mild pulmonary hypertensi-
on. At 12 hours afer admission the patient repeats the
symptoms and it is decided to conduct chest angioCT
with contrast material, which shows right pulmonary
infarction image and ecocardiography performed afer
1 day revealed increased right cavity dimensions and
mean pulmonary hypertension. Peripheral Doppler
Complex arterio-venous and
cardiac malformation. Case
presentation
We present the case of a 14 years and 11 months old
boy hospitalized in Ist Pediatrics Clinic, Sfanta Maria
Childrens Emergency Hospital, Iassy, for pain in the
right calf and the increase by 3 cm of its diameter com-
parative to the lef calf, with no signs of infammation.
Te patient had his appendix removed 1 month ago.
Clinical examination: IInd degree systolic murmur in
the mitral area. Other tests: prolonged INR, QT, APTT,
mild eosinophilia, mild hepatic cytolysis. Echocardio-
graphy- mitral valve prolapse, mild coarctation of the
aorta. Doppler echography of the inferior limbs: ana-
tomic variant of venous drain in the inferior vena cava,
partial thrombosis of the common iliac vein and com-
mon femoral vein, superfcial femoral and popliteal
vein thrombosis. Angio CT: aberrant inferior vena cava:
hypoplasia in the superior area and a second abnormal
inferior vena cava on the lef of the aorta, that combines
with hemiazygos vein. Dilated azygos vein. Lef renal
vein combines with the abnormal inferior vena cava.
Right popliteal, femoral, external and internal iliac ve-
ins- dilated. Apparently normal suprahepatic veins. He
received treatment with acenocumarolum. Case parti-
cularity: late detection of the complexe arterio-veno-
us and cardiac malformation, by accident, because the
patient was hospitalized for deep venous thrombosis.
Te thrombosis appeared under the age of 15, 0,005%
of cases being diagnosed at that age.
Key words: deep venous thrombosis, complex arterio-
venous malformation
159. Capcane diagnostice
intr-un caz de trombembolism
acut
Doina Rosu, L.Vasiluta
Spitalul Clinic Judetean de Urgenta, Timisora
Barbat de 43ani, obez, fara antecedente patologice cu-
noscute, prezinta de 3 zile dureri toracice, crize paro-
xistice de dispnee, fatigabilitate. ECG de repaus cu mo-
difcari difuze de repolarizare ( s-a exclus infarctul mi-
Suplimentul A, 2010
1I5
VARI A 3
VARI A 3
tigations. It was probably thrombosis in situ due to
vascular occlusion due to red cell stasis or embolization
of bone marrow from which characterizes hemolytic
anemia. Possible also with history of pulmonary mi-
croembolia. Patient was anticoagulated (minimum 6
months), but unfortunately in this case it is known that
anticoagulation has minimum efects.
and abdominal CT could not highlight the source of
the thrombus. Laboratory showed no antiphospholipid
syndrome or factor V Leyden defciency or other pro-
teins, and peripheral smear showed hemolytic anemia.
Discussion and conclusions. Dyspnea can be interpre-
ted in the context of thyroid goiter or anemia, but it
was good to remember the patient for further inves-
1I6
te cardiovasculare Crelatiile nivelului inalt plasmatic al
vWf (p) Corelatiile valorilor reduse ale FMD (p) Initi-
al 3 luni Initial 3 luni Deces de cauza cardiovasculara
0,0001 0,001 0,0001 0,0001 IMA nonfatal 0,02 0,01 0,01
0,009 Accident vascular cerebral 0,34 0,17 0,16 0,04
Reinternare pentru angina recurenta 0,009 0,03 0,001
0,001 Reinternare pentru insufcienta cardiaca 0,007
0,001 0,0001 0,0001.
Concluzii: La pacientii cu sindroame coronariene acu-
te si angina stabile, valorile plasmatice crescute ale fac-
torului von Willebrand si reducerea dilatatiei mediate
de fux initial si la 3 luni s-au corelat semnifcativ cu
decesul de cauza cardiovasculara, IMA nonfatal, angi-
na recurenta si insufcienta cardiaca cu reinternare.
Predictive value of Von
Willebrand factor and flow
mediated dilatation for
evolution with heart failure in
syndromes
Background: High lasma levels of von Willebrand fac-
tor and and low value of fow- mediated dilatation are
risc factors for major acute cardiovascular events, with
no certain defnition of this factors role in heart failure
evolution at these patients.
Objective: Evaluation of correlation between endothe-
lial dysfunction markers assessed by high plasma levels
of von Willebrand factor (vWf) and low value of fow-
mediated dilatation (FMD) determined by Doppler ul-
trasound at brachiale artery and evolution with acute
cardiovascular events including readmission for heart
failure in patients (pts) with acute coronary syndromes
(ACS) and stable angina (SA).
Methods: Prospective study of 120 pts with ACS divi-
ded into 4 groups: 30 pts with unstable angina (UA);
30 pts with non ST elevation myocardial infarction
(NSTEMI); 30 pts with ST elevation myocardial infarc-
tion (STEMI) and 30 pts with SA. vWf plasma levels
were determined by ELISA method. FMD was calcu-
160. Valoarea predictiva a
factorului Von Willebrand
si a dilatatiei mediate de flux
pentru evolutia cu insuficienta
cardiaca la pacientii cu
Mirela Donea, Mariana Radoi, Georgeta Datcu, Elena
Bobescu, H.Rus, Mariana Anghel, Celia Ciobanu
Universitatea Transilvania din Brasov, Facultatea de
Medicina, Brasov
Premise: Nivelul plasmatic crescut al factorului von
Willebrand si reducerea dilatatiei mediate de fux sunt
factori de risc pentru evenimentele acute cardiovascu-
lare majore nefind defnit cu certitudine rolul acestor
factori in evolutia insufcientei cardiace la pacienti cu
sindroame coronariene acute.
Obiective: Evaluarea corelatiilor dintre markerii dis-
func tiei endoteliala reprezentati de nivelul inalt plas-
matic al factorului von Willebrand (vWf), dilatatia me-
dia ta de fux (FMD) determinata prin ecografe Doppler
la nivelul arterei brahiale si evolutia cu evenimen te car-
diovasculare majore incluzand si reinternarea pentru
agravarea insufcientei cardiace la pacientii cu sindroa-
me coronariene acute (SCA) si angina stabila (AS).
Material si metoda: Studiu prospectiv a 120 pacien-
ti (p) cu SCA impartiti in 4 grupuri: 30 p cu angina
instabila (AI), 30 p cu infarct miocardic acut fara su-
pradenivelare de segment ST (NSTEMI), 30 p cu in-
farct miocardic acut cu supradenivelare de segment ST
(STEMI), 30 p cu angina stabila (AS). Nivelul plasmatic
al vWf a fost determinat prin metoda ELISA; FMD a
fost calculata in conformitate cu Ghidul din 2002 pen-
tru Determinarea ecocardiografca a dilatatiei mediate
de fux la nivelul arterei brahiale. Perioada de urma-
rire pentru evenimente cardiovasculare majore a fost
de 16,04 7,8 luni, evaluate in corelatie cu markerii de
disfunctie endoteliala determinati initial si la 3 luni.
Analiza statistica: testul de corelatie Pearson.
Rezultate: Tabelul 1. Corelatiile intre valorile plasmati-
ce crescute ale vWf, reducerea FMD initial, la 3 luni si
evenimentele acute cardiovasculare majore: Evenimen-
POSTER FORUM I I I | POSTER FORUM I I I
Suplimentul A, 2010
1II
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lated according to 2002 Guidelines for the Ultrasound
Assessement of Endothelial-Dependent Flow-Medi-
ated Vasodilatation of Te Brachial Artery. Follow up
period for acute cardiovascular events was 16.047.8
months evaluated in correlation with initial and 3
months values of endothelial dysfunction markers. Sta-
tistical analysis: Pearson correlation test.
Results: Table 1. Correlation between initial and 3
months high plasma levels of von Willebrand factor
(vWf), reduced fow-mediated vasodilatation (FMD)
and evolution with major acute cardiovascular events:
Cardiovascular events vWf high levels correlation (p)
FMD low value correlation (p) Initial 3 months Initi-
al 3 months Cardiovascular death 0.0001 0.001 0.0001
0.0001 Nonfatal AMI 0.02 0.01 0.01 0.009 Stroke 0.34
0.17 0.16 0.04 Recurrent angina with readmission 0.009
0.03 0.001 0.001 Heart failure with readmission 0.007
0.001 0.0001 0.0001
Conclusions: In patients with acute coronary syndro-
mes and stable angina initial and 3 months high plas-
ma levels of von Willebrand factor and low values of
were signifcantly correlated with cardiovascular death,
nonfatal AMI, recurrent angina and heart failure with
readmission.
161. Diferente in
caracteristicile populatiei cu
insuficienta cardiaca acuta in
functie de fractia de ejectie a
VS; date din Registrul Roman
de Insuficienta Cardiaca Acuta
O.Chioncel, D.Vinereanu, R.Capalneanu, D.D.Ionescu,
M.D.Datcu, M.Vladoianu, V.Ochean, Lucica Grig-
orica, C.Macarie
Introducere: Registrul Roman de Insufcienta Cardi-
aca Acuta (RRICA) a fost conceput ca un studiu nati-
onal, multicentric, observational cu scopul de a evalua
populatia cu ICA din spitalele romanesti. Un numar de
3224 pacienti au fost inrolati consecutiv din 13 spitale
romanesti pastrandu-se rprezentativitatea geografca si
a facilitatilor. Ecocardiografa (fractia de ejectie si di-
mensiunile ventricul stang) la internare a fost inregis-
trata conform protocolului.
Obiective: Evaluarea caracterelor demografce, a facto-
rilor de risc, proflul clinic, EKG si a medicatiei i.v. ad-
ministrate la internare la pacientii cu fractie de ejectie
prezervata(FEP) comparativ cu pacientii cu fractie de
ejectie scazuta(FES).
Metodologie: Pacientii din RRICA au fost separati in
doua grupuri: FEP (FE VS>40%) si FES (FE VS<40%).
Caracterele demografce, factorii de risc, proflul clinic,
EKG si medicatia i.v. au fost comparate intre cele doua
grupuri.
Rezultate: FE la internare a fost determinate la 89.4%
pacienti. Pacientii cu FEP au fost mai varstnici(69.9 vs
65.8 ani;p<0,001), mai frecvent de sex feminin(51% vs.
40.3%, p<0.001) si hipertensivi intr-o proportie mai
mare (64% vs. 49%, p < 0,001), comparativ cu pacientii
cu FES. Prevalenta diabetului a fost similara (36.1% vs
35.2 %; p=0.6). Tensiunea arteriala sistolica (TAs) la in-
ternare a fost de 12928 mmHg in grupul cu FES si de
14125 mmHg la pacientii cu FEP (p<0.001). Singura
diferenta semnifcativa in probele biologie a fost notate
pentru creatinina care la internare a fost mai mare la
pacientii cu FEP comparativ cu cei cu FES (1.510.26
vs 1.370.22;p<0.001). pacientii cu FEP au avut mai
frecvent fbrilatie atriala (51% vs 42%; p=0.001) com-
parativ cu pacientii cu FES. O durata a QRS>120msec
a fost gasita la 44% din pacientii cu FES si la 23% din
cei cu FEP (p<0.001). Proflul clinic la internare a fost
de asemenea diferit intre grupul cu FEP si cel cu FES:
socul cardiogen (2% vs 9%; p=0.001), edemul pulmo-
nar acut (28% vs 19%; p=0.001), insufcienta cardiaca
hipertensiva (24% vs 3%; p=0.001), insufcienta cardi-
aca dreapta izolata (6% vs 1%; p=0.03) si decompen-
sarea acuta a insufcientei cardiace cronice(40% vs
68%;p<0.001). Cu privire la medicatia i.v. administrata
de la internare, cele doua grupuri au primit diuretice
(89% FES vs 87% PEF;p=0.37), nitrati (24% FES vs
35% PEF; p=0.02) si substante inotrope (20% FES vs
6% FEP; p<0.001). Durata terapiei i.v. a fost mai lunga
in grupul cu FES. Durata internarii a fost similara (9.1
vs 9.8 zile) dar mortalitatea la externare a fost diferita
(4.9% la FEP vs 7.1% la FES;p=0.034).
Concluzii: Cele doua grupuri au caracteristici demo-
grafce, clinice si de evolutivitate diferite. Pacientii cu
FEP sunt mai varstnici, procentul sexului feminin este
mai mare, au o TA s mai mare, au o prevalent mai mare
a fbrilatiei atriale si o functie renala mai alterata, com-
parativ cu pacientii cu FES. Mortalitatea intraspitali-
ceasca este mai mare in grupul cu FES.
POSTER FORUM I I I
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Suplimentul A, 2010
1I8
Differences in acute heart
failure populations according
to left ventricular ejection
fraction; data from Romanian
Registry of Acute Heart Failure
Introduction: Romanian Registry of Acute Heart Fa-
ilure (RRAHF) was designed as a nationalwide, mul-
ticentric, observational study to evaluate population
with AHF from Romanian hospitals. A number of 3224
pts were consecutivelly enrolled from 13 hospitals, ma-
intaining geographic and facilities representativity.
Ecocardiographic data at admission was required per
protocol. Aim: To evaluate demography, risk factors,
ECG and i.v. therapeutic interventions in patients with
preserved lef ventricular efection fraction (PLVEF)
as compared to patients with reduced lef ventricular
efection fraction (RLVEF).
Methods: We separate RRAHF population in two
groups with preserved (>40%) and reduced (<40%)
LVEF. Demography, risk factors, clinical profle, ECG
and i.v. therapies were compared between the two
groups.
Results: EF measurements were available at admission
in 89% of pts. Patients with PLVEF were older (69.9 vs
65.8 years;p<0,001) more ofen women (51% vs. 40.3%,
p<0.001) and more likely to have hypertension (64%
vs. 49%, p < 0,001) as compared to RLVEF patients.
Te prevalence of diabetes was similar. Systolic blood
pressure at admission was 12928 mmHg in group
with RLVEF and 14125mmHg in those with PLVEF
(p<0.001). Te diferences in biologic profle at ad-
mission were noted only for creatinine which was hi-
gher in PLVEF as compared to RLVEF pts (1.510.26
vs 1.370.22;p<0.001). Patients with PLVEF had more
frequent atrial fbrillation (51% vs 42%; p=0.001) as
compared to RLVEF patients. QRS duration>120msec
was found in 44% of patients with RLVEF and in 23%
of PLVEF (p<0.001). Clinical profles at admission
were diferent between PLVEF and RLVEF: cardiogenic
shock (2% vs 9%; p=0.001), acute pulmonary edema
(28% vs 19%; p=0.001), hypertensive heart failure (24%
vs 3%; p=0.001), isolated right heart failure (6% vs
1%; p=0.03) and worsening heart failure (40% vs 68%;
p<0.001). As regard to i.v. therapies, the two groups re-
cieved diuretics (89% RLVEF vs 87% PLVEF; p=0.37),
nitrates (24% RLVEF vs 35% PLVEF; p=0.02) and ino-
tropes (19% RLVEF vs 4% PLVEF; p<0.001).Te dura-
tion of i.v. therapies was longer in RLVEF group. Te
length of hospitalization was similar (9.1 vs 9.8 days)
but inhospital mortality was diferent (4.9% for PLVEF
vs 7.1% for RLVEF; p=0.034).
Conclusions: As regard to baseline characteristics, po-
pulations with preserved and reduced LVEF are dife-
rent. Patients with PLVEF are older, more frequent wo-
men, had a higher SBP, more frequent AF and a worse
renal function as compared to RLVEF. Tere are also
diferences in discharge mortality.
162. Influenta factorilor de risc
presi postoperatori asupra
incidentei fibrilatiei atriale la
pacientii protezati aortic
Dana Velimirovici, Maria Rada, Simona Dragan,
Duda-Seiman D.M., D.Gaita, Delia Berceanu Vaduva,
Cobzariu F.I.,Velimirovici M, Silvia Mancas
Scopul lucrarii: S-a urmarit infuenta factorilor presi
postoperatori asupra incidentei fbrilatiei atriale (FA),
post-inlocuire valvulara aortica cu proteza mecanica
sau biologica.
Material si metoda: Au fost inclusi in studiu 45 paci-
enti (27 barbati, 18 femei) protezati aortic (in medie la
8,5 zile postoperator). Toti pacientii au fost monitori-
zati electrocardiografc (ECG si Holter ritm/24 ore) pe
perioada internarii si la o luna postoperator. Factorii
de risc presi postoperatori studiati sunt reprezentati
de: varsta, sex masculin, obezitate, dimensiunea atriu-
lui stang, istoric de fbrilatie atriala, pericardita, dise-
lectrolitemie, precum si prezenta insufcientei cardiace.
Rezultate: Din cei 45 pacienti inclusi in studiu 20 au
prezentat fbrilatie atriala (44.44%); la 6.66% din paci-
enti FA a fost instalata preoperator, iar la 37.77% FA
a survenit ca si complicatie postoperatorie. Analizand
comparativ in dinamica, la includere in studiu si la o
luna postoperator se remarca o reducere semnifcati-
va a incidentei FA de la 44.44% la 11.11% (p < 0.001).
Conversia la ritm sinusal la o luna postoperator a fost
semnifcativ crescuta la pacientii cu FA survenita post-
operator (82.35%). Dintre factorii de risc incriminati
in aparitia FA varsta peste 65 ani a fost prezenta la 70%
din pacientii cu FA, obezitatea la 40% (din care 20%
Suplimentul A, 2010
1I9
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gree in 20% of the patients). Increased dimension of the
lef atrium was shown in 45% of the patients. Patients
afer surgery with systolic dysfunction had a higher in-
cidence of AF onset (70.58% vs. 28.57%). Pericarditis
was present in 35.55% of patients with post-operative
AF. Hypokalemia was more frequent in patients with
AF.
Conclusions: AF is the most frequent complication
afer cardiac surgery. Arrhythmias in patients with
aortic prosthesis is associated with clinical, biological
and echocardiographical factors (lef atrium diameter,
end-systolic and end-diastolic LV volume, LV ejection
fraction), suggesting thus multiple pathways in their
occurrence.
163. Evaluarea riscului
cardiovascular la pacientii cu
sindrom metabolic
R.Susan, Monica Susan, Elena Ardeleanu, Daniela
Gurgus, T. Constantin
Timisoara
Scop: Ne-am propus evaluarea riscului cardiovascular
(CV) prin ali parametri decat cei clasici la pacienti cu
sindrom metabolic incadrati cu risc CV scazut sau in-
termediar prin folosirea metodelor standard de calcul.
Metoda: Au fost inclusi 61 pacienti cu risc CV scazut
sau intermediar, avand sindrom metabolic (SM), cu
varsta intre 30 si 60 ani, fara boala CV sau diabet za-
harat (DZ) tip 2. SM a fost defnit prin criteriile IDF,
iar riscul CV standard a fost calculat cu ajutorul pro-
gramului HeartSCORE. Am analizat HDL-colesterolul,
LDL-colesterolul, colesterolul total, proteina C reactiva
(PCR) inalt sensibila si markerii vasculari surogat pen-
tru ateroscleroza: vasodilatatia mediata de fux (FMD)
si grosimea intima-medie (IMT).
Rezultate: Valoarea medie a PCR a fost de 3,75 1,54
mg/l, peste limita care defneste un risc CV crescut
conform CDC/AHA. 41 (67,21%) pacienti au prezen-
tat PCR peste 3 mg/dl, incadrandu-se in clasa de risc
crescut, restul pacientilor avand valori cuprinse intre
1-3 mg/l, corespunzator unui risc moderat. PCR s-a
corelat cu numarul de componente al SM (r=-0,29,
p=0,02), tensiunea arteriala sistolica (r=0,28, p=0,02)
si IMT (r=0,20, p=0,08), dar nu s-a corelat cu FMD
obezitate de gradul I). Dimensiunea crescuta a atriului
stang, predictor important al aparitiei atriale postope-
ratorii, a fost remarcata 45% din pacienti. Postoperator
incidenta FA a fost semnifcativ mai crescuta la grupa
pacientilor cu disfunctie sistolica (70.58%) comparativ
cu cei cu functie sistolica pastrata unde incidenta aces-
teia a fost de 28.57%. Pericardita, complicatie frecvent
intalnita postoperator, a fost prezenta la 35.55% din
pacientii cu FA. Incidenta hipopotasemiei, diselectro-
litemie frecvent intalnita postoperator, a fost mult mai
crescuta in randul pacientilor cu FA.
Concluzii: Fibrilatia atriala este cea mai frecventa
complicatie dupa chirurgia cardiaca. Prezenta tulbura-
rilor de ritm la pacientii cu proteza aortica este asociata
cu existenta unor factori clinici, biologici si ecocardi-
ografci (diametrul atriului stang, volumul telesistolic
si telediastolic, fractia de ejectie a ventriculului stang),
sugerand astfel mecanisme multiple de producere.
Influence of pre- and post-
operative risk factors upon the
incidence of atrial fibrillation
in patients after aortic valve
replacement
Purposes: We studied the infuence of pre- and post-
operative risk factors upon the incidence of atrial f-
brillation in patients afer aortic valve replacement with
mechanical or biological prosthesis.
Material and method: 45 patients were included (27
men and 18 women) in average 8.5 days afer aortic val-
ve replacement. All patients were monitored by means
of resting ECG and ECG-Holter/24 hrs. Following risk
factors were considered: age, male gender, obesity, lef
atrium size, history of atrial fbrillation, pericarditis, di-
selectrolytemia, signs of heart failure.
Results: 20 of the 45 studied patients revealed by the
ECG atrial fbrillation (AF). 6.66% had already pre-
operative AF, and in 37.77% of the patients AF was a
post-operative outcome. One month afer surgery, only
11.11% of patients had AF (p<0.001). Conversion to
sinus rhythm was signifcantly higher in patients with
AF with post-operative onset (82.35%). AF was related
with the presence of following risk factors: age > 65 yrs.
(70% of patients), obesity (40% of patients and 1st de-
POSTER FORUM I I I
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Suplimentul A, 2010
180
(r=0,05, p=0,68), cu HDL-colesterolul (r=0,04, p=0,75)
si cu factorul predictiv major clasic, LDL-colesterolul
(r=0,03, p=0,76). FMD medie a fost de 7,93 5,89. 39
(63,93%) din cazuri nu au prezentat un procent de di-
latare mai mare de 10%. IMT medie a fost 0,760,15
mm. La 12 (19,67%) pacienti s-au intalnit valori mai
mari decat pragul de 0,9 mm. Placa de aterom a fost
prezenta la 5 pacienti, toti de sex masculin, cu varste
intre 54 si 60 ani: 3 au prezentat risc SCORE 10%, iar
2 au prezentat un risc SCORE scazut, sub 5%. Riscul
SCORE a avut o valoare medie de 3,443,61. Un risc
SCORE crescut a fost prezent doar la 10% din pacienti.
Riscul SCORE s-a corelat cu FMD (r=-0,22; p=0,08),
dar nu s-a corelat cu IMT si PCR (r=0,4; p=0,51, re-
spectiv r=0,06; p=0,60).
Concluzii: Toti pacientii cu SM fara boala CV si DZ
tip 2 din studiul nostru au prezentat valori PCR cores-
punzatoare unui risc CV moderat sau crescut conform
recomandarilor CDC/AHA, in contradictie cu un risc
SCORE scazut. Pacientii cu SM fara boala CV si DZ tip
2 ar trebui sa benefcieze de efectuarea ecografei caro-
tidiene si de analiza PCR inalt sensibile pentru evalua-
rea corecta a riscului CV.
Assessment of cardiovascular
risk in patients with metabolic
syndrome
Purpose: We aimed to assess cardiovascular (CV) risk
by other means than classical risk parameters in pati-
ents with metabolic syndrome with low or intermediate
CV risk evaluated by standard methods of calculation.
Method: Tis study included 61 patients aged between
30 and 60 years, considered at low or intermediate CV
risk, diagnosed with metabolic syndrome (MS) and wi-
thout CV disease or type 2 diabetes (T2DM). MS was
defned by IDF criteria and standard CV risk was cal-
culated using the program HeartSCORE. We analyzed
HDL-cholesterol, LDL cholesterol, total cholesterol,
C-reactive protein (CRP) high sensitive and surroga-
te vascular markers for atherosclerosis: fow-media-
ted vasodilation (FMD) and intimate-media thickness
(IMT).
Results: Te mean PCR was 3.75 1.54 mg/L, above
the limit that defnes an increased CV risk according
to CDC / AHA. 41 (67.21%) patients had CRP above 3
mg/L, falling within the class of high risk patients; the
remaining patients (32.79%) had CRP values betwe-
en 1-3 mg/L, corresponding to a moderate risk. CRP
correlated with the number of components of MS (r
=- 0.29, p = 0.02), systolic blood pressure (r = 0.28, p =
0.02) and IMT (r = 0.20, p = 0.08) but was not correla-
ted with FMD (r = 0.05, p = 0.68), with HDL choleste-
rol (r = 0.04, p = 0.75) and the major classical predictive
factor LDL cholesterol (r = 0.03, p = 0.76). Mean FMD
was 7.93 5.89. 39 (63.93%) pts did not show a dilation
procent greater than 10%. Mean IMT was 0.76 0.15
mm. 12 (19.67%) patients met threshold values greater
than 0.90 mm. Atheromatous plaque was present in 5
patients, all male, aged between 54 and 60 years: three
had a SCORE risk 10% and 2 had a low SCORE risk, <
5%. Te SCORE risk had a mean value of 3.44 3.61.
A high value of SCORE risk was present only in about
10% of patients. SCORE risk was correlated with FMD
(r =- 0.22, p = 0.08) but did not correlate with IMT and
CRP (r = 0.4, p = 0.51 respectively r = 0.06, p = 0.60).
Conclusions: All MS patients without CV disease or
T2DM included in our study had CRP values corres-
ponding to a moderate or high risk according to CDC
/ AHA, in contradiction with a low SCORE risk. MS
patients without CV disease or T2DM should be per-
formed carotid ultrasound and high sensitive CRP
analysis for proper evaluation of CV risk.
164. Evaluarea eficientei
agentilor terapeutici cu
mecanisme complementare de
reducere a stresului oxidativ,
hiperactivarii plachetare si
statusului procoagulant in
sindroamele coronariene acute
Elena Bobescu, Mariana Radoi, Georgeta Datcu, Alina
Pascu, A.Burducea, C.Ciurea, Bianca Doka, Raluca Fit,
Monica Moarcas
Universitatea Transilvania din Brasov, Facultatea de
Medicina, Brasov
Obiectiv: La pacientii (p) cu sindroame coronariene
acute (SCA) incidenta evenimentelor cardiovascula-
re majore a fost evaluata in corelatie cu administrarea
Suplimentul A, 2010
181
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Efficacy evaluation of the
drugs with complementary
mechanisms in reduction
of oxidative stress,
platelets hyperactivity and
hypercoagulability status in
syndromes
Purpose: In patients with non ST elevation acute co-
ronary syndrome (ACS), major acute cardiovascular
events were evaluated in relation with administration
of drugs with complementary mechanisms in reducti-
on of oxidative stress, platelets hyperactivity and hyper-
coagulability status.
Methods: 240 patients (pts) with ACS were divided in 2
groups: Group A treated with drugs with complemen-
tary mechanisms mentioned above: nebivololum, zofe-
noprilum, rosuvastatinum, trimetazidine and omega-3
polyunsaturated fatty acids; Group non A treated with
drugs without mentioned proprieties: metoprololum,
enalaprilum/trandolaprilum, simvastatinum. All other
drugs recomanded for treatment were simillar on both
groups of study. Biomarkers for platelets hyperactivity
(ASPItest, ADPtest by multiple electrode aggregome-
try), hypercoagulability status (von Willebrand factor
activity), oxidative stress (Total antioxidant status) and
major acute cardiovascular events (MACE) were evalu-
ated at one year of follow up. Statistic analysis: multiple
regression, chi square test.
Results: Group A Group non A p Total ACS patients
- 240 115(47.9%) 125(52.1%) ns Cardiovascular death
3(2.6%) 10(8.0%) ns Nonfatal AMI 5(4.3%) 18(14.4%)
0.025 Stroke 2(1.7%) 3(2.4%) ns Heart failure with re-
admission 8(7.0%) 30(24.0%) 0.005 Recurrent angina
with readmission 10 (8.7%) 36(28.8%) 0.005 baseline
1 year p baseline 1 year p - ASPItest >30U 49(42.6%)
26 (24.3%) 0.025 50 (40%) 48 (38.4%) ns 0.05 ADPtest
>50U 14(12.2%) 10(8.7%) ns 15 (12%) 16(12.8%) ns
ns Von Willebrand factor activity >169.7% 52(45.2%)
11(9.6%) 0.001 56(44.8%) 32 (25.6%) 0.05 0.01 Total
antioxidant status <1.3 mmol/l 70(60.8%) 12(10.4%)
0.001 75 (60%) 35( 28.0%) 0.001 0.01 Legend: AMI=
acute myocardial infarction; ADPtest = Adenosine di-
phosphate test; ASPItest = Aspirin test.
Conclusions: In patients with ACS incidence of acute
myocardial infarction, recurrent angina, heart failure
agentilor terapeutici cu mecanisme complementare de
reducere a stresului oxidativ, hiperactivarii plachetare
si statusului procoagulant.
Metoda: 240 p cu SCA au fost impartiti in 2 grupuri:
Grup A tratat cu agenti terapeutici cu mecanisme com-
plementare mentionate: nebivolol, zofenopril, rosuvas-
tatin, trimetazidina si acizi grasi omega-3 polinesatu-
rati; Grup non A tratat cu medicamente fara propri-
etatile mentionate: metoprolol, enalapril/trandolapril,
simvastatin. Toate celelalte clase terapeutice recoman-
date au fost similare in grupurile studiate. Biomarkerii
de hiperactivitate plachetara respectiv raspuns inadec-
vat la terapia antiplachetara (ASPItest, ADPtest - agre-
gometria sangelui integral), status hipercoagulant (ac-
tivitatea factorului von Willebrand), stres oxidativ (sta-
tus antioxidant total) au fost evaluati initial, la un an
si evenimentele acute cardiovasculare majore) la un an
de urmarire. Analiza statistica: regresie multipla, testul
chi patrat.
Rezultate: Grup A Grup non A p Total p cu SCA
- 240 115(47.9%) 125(52.1%) ns Deces cardiovas-
cular 3(2.6%) 10(8.0%) ns IMA Nonfatal 5(4.3%)
18(14.4%) 0.025 AVC 2(1.7%) 3(2.4%) ns Reinter-
nare pentru insufcienta cardiaca 8(7.0%) 30(24.0%)
0.005 Reinternare pentru angina recurenta 10(8.7%)
36(28.8%) 0.005 baseline 1 year p baseline 1 year p -
ASPItest >30U 49(42.6%) 26(24.3%) 0.025 50(40%)
48(38.4%) ns 0.05 ADPtest >50U 14(12.2%) 10(8.7%)
ns 15(12%) 16(12.8%) ns ns Activitate factor von Wil-
lebrand >169.7% 52(45.2%) 11(9.6%) 0.001 56(44.8%)
32(25.6%) 0.05 0.01 Status antioxidant total <1.3
mmol/l 70(60.8%) 12(10.4%) 0.001 75(60%) 35(28.0%)
0.001 0.01 Legenda: ADPtest = test pentru adenozin-
difosfat; ASPItest = test pentru aspirina.
Concluzii: La pacientii cu SCA tratati cu agenti tera-
peutici cu mecanisme complementare de reducere a
stresului oxidativ, hiperactivarii plachetare si statusului
procoagulant, s-a inregistrat o incidenta semnifcativ
redusa a: IMA nonfatal, a reinternarilor pentru angi-
na recurenta/ insufcienta cardiaca, a raspunsului in-
adecvat la aspirina si clopidogrel, a cresterii activitatii
plasmatice factorului von Willebrand si a deprimarii
statusului antioxidant total comparativ cu grupul de
control. Studiu realizat in cadrul Proiectului ID_727
Competitia 2008 PN II-ID-PCE.
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Suplimentul A, 2010
182
lul seric al trigliceridelor au fost semnifcativ mai cres-
cute, iar titrul seric al HDL-colesterolului mai scazut.
Prevalenta hipertensiunii arteriale a fost semnifcativ
crescuta in grupul cu SM, fara diferente statistic sem-
nifcative in ceea ce priveste medicatia antihiperensiva
administrata comparativ la cele doua grupuri. Circum-
ferinta taliei si IMC au fost mai crescuti in grupul cu
SM. Nu s-au inregistrat diferente semnifcative intre
cele doua grupuri la evaluarea fractiei de ejectie a VS
(FEVS) a diametrului end-sistolic si end-diastolic al
VS. La grupa de pacienti cu SM timpul de decelerare
al undei E, de relaxare izovolumetrica si de contractie
izovolumetrica au fost semnifcativ crescuti, iar timpul
de ejectie si raportul E/A semnifcativ scazut. Indexul
de performanta miocardica a fost statistic semnifcativ
crescut in grupul cu SM comparativ cu grupul de con-
trol (0.55 0.06 vs 0.38 0.04, p<0.001).
Concluzii: In prezentul studiu am evidentiat prezenta
disfunctiei globale de VS la pacientii cu sindrom meta-
bolic comparativ cu grupul de control (fara SM). Aceste
rezultate subliniaza importanta diagnosticului si mana-
gementul cat mai precoce al SM in vederea preventiei
progresiei disfunctiei VS spre boala cardiaca ischemica
simptomatica.
Left atrial ejection fraction as
a predictor of cardiovascular
events in patients with
metabolic syndrome
Aim: To evaluate the impact of metabolic syndrome
(MS) on global lef ventricular function by using the
index of myocardial performance.
Materials and methods: Te study population inclu-
ded 36 patients with MS (23 male, 13 female, mean
age=54 11 years) and 36 control subjects without
MS (26 male, 10 female, mean age=53 10 years). Te
diagnosis of MS was based on IDF 2005 criteria. All
subjects underwent M-mode, two-dimensional and
Doppler echocardiographic examination. Te index of
myocardial performance was determined as the sum
of isovolumic relaxation time (IVRT) and isovolumic
contraction time (IVCT) divided by lef ventricular
ejection time. Values for each parameter were obtained
by averaging measurements from fve consecutive car-
diac cycles.
with readmission, inadequate response to aspirin and
clopidogrel, von Willebrand factor high plasma value
and total antioxidant status low serum values were
signifcantly reduced in group treated with drugs with
complementary mechanisms in reduction of oxidative
stress, platelets hyperactivity and hypercoagulability
status in comparison with control group. Acknowledge-
ment: Project ID_727 Competition 2008 in National
Research Program PN II
165. Evaluarea impactului
sindromului metabolic (SM)
pe functia globala ventriculara
stanga(VS) apreciata
echocardiografic prin indicele
de performanta miocardica.
R.Horatiu, C.Ciurea, Mariana Radoi, Oxana Neagu,
Bianca Cotet
Universitatea Transilvania, Facultatea de Medicina
Brasov
Obiectiv: Evaluarea impactului sindromului metabolic
(SM) pe functia globala ventriculara stanga (VS) apre-
ciata echocardiografc prin indicele de performanta
miocardica.
Material si metoda: Au fost evaluati 36 de pacienti cu
SM-Grup A (23 de sex masculin, 13 de sex feminin,
varsta medie = 54 11 ani) si 36 subiecti de control
fara SM-Grup B (26 de sex masculin, 10 de sex femi-
nin, varsta medie = 53 10 ani). Diagnosticul SM s-a
bazat pe criteriile IDF din 2005 (International Diabetes
Federation). Evaluarea globala a functiei ventriculare
stangi s-a realizat ecocardiografc prin indicele de per-
formanta miocardica, calculat ca suma dintre timpul de
relaxare isovolumetrica (IVRT)si timpul de contractie
isovolumetrica (IVCT), impartita la timpul de ejectie al
VS. Valorile pentru fecare parametru au fost obtinute
folosind media masuratorilor de la cinci cicluri cardia-
ce consecutive.
Rezultate si discutii: In ceea ce priveste varsta si genul
pacientilor nu au existat diferente semnifcative intre
cele doua grupuri studiate. Dintre parametrii biochi-
mici la grupa de pacienti cu SM glicemia bazala si nive-
Suplimentul A, 2010
188
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Material si metoda: Am observant 98 de pacienti cu
tromboza venoasa profunda si antecedente oncologice,
dar fara activitate tumorala cunoscuta in ultimele 12
luni anterioare TVP, ce s-au prezentat pentru ecografe
Doppler venoasa in serviciul de cardiologie a Spitalului
clinic CF Oradea in perioada 2006 -2008. Acesti paci-
enti au fost urmariti pana in prezent. S-a urmarit recu-
renta tumorala la acesti pacienti.
Rezultate: Incidenta recidivei tumorale a fost de
52.04%. In primele 6 luni de la diagnosticarea TVP re-
cidiva a fost manifesta clinic in 79.59 % din cazurile
de recurenta neoplazica. Acest lucru s-a intamplat mai
ales in cazurile de neoplazii mamare, carcinoame ale
tubului digestiv si la cei la care a fost diagnosticata pre-
zenta metastazelor in antecedente.
Concluzii: TVP a fost primul semn al recurentei tu-
morale in 52.04% din cazuri. De aceea, consideram ca
pacientii cu antecedente neoplazice care se prezinta cu
TVP ar trebui adresati unui serviciu de oncologie pen-
tru a exclude existent unei recidive tumorale.
Could deep vein thrombosis be
a marker of tumor recurrence?
Aim of the study: Tere is an association between ne-
oplasia and deep vein thrombosis (DVT). Te aim of
the study is to assess the incidence of cancer recurrence
afer diagnosis of DVT and determine the predictive
value of DVT for cancer recurrence.
Method: Tis was a observational study. Te observati-
ons were made in our Cardiology Clinic between 2006
and 2008. Te study included 98 patients diagnosed
with a deep vein thrombosis (DVT) between January
2006 and December 2008 and had a cancer without ac-
tivity in the last 12 months in their medical history. Te
cancer recurrence was assessed.
Results: Te incidence of cancer recurrence afer dia-
gnosis with DVT was 52.04%. Tis recurrence occur-
red in the frst 6 months in 79.59% of cases, and more
frequent and earlier in patients with breast tumors,
with carcinoma of digestive tube, and in patients with
previous presence of metastasis.
Conclusions: In 52.04 % of patients without neoplasic
activity in the last year, DVT was the frst sign of tu-
mor recurrence. Tese patients should be referred to an
oncology department in order to diagnose the tumor
recurrence.
Results and discussions: Tere was no signifcant di-
ference between two groups regarding the age and gen-
der. Among biochemical parameters, fasting plasma
glucose, and triglyceride level were signifcantly higher
and HDL-cholesterol level was signifcantly lower in
metabolic syndrome group. Te prevalence of hyper-
tension was found to be signifcantly higher in MS
group but we detected no signifcant diference betwe-
en two groups regarding the anti-hypertensive medi-
cation. Te waist circumference and body mass index
were found to be higher in MS group. Lef ventricular
ejection fraction , lef ventricular end-sytolic diameter
and lef ventricular end-diastolic diameter were detec-
ted to be within normal ranges in both groups and no
signifcant diference was found between two groups
regarding these echocardiographic parameters. Howe-
ver, deceleration time, isovolumic relaxation time, iso-
volumic contraction time were signifcantly higher and
the ejection time and E/A ratio were signifcantly lower
in MS group. Te index of myocardial performance
was found to be signifcantly higher in patients with
MS compared with control subjects (0.55 0.06 vs 0.38
0.04, p<0.001).
Conclusion: In the present study, we have shown the
presence of impaired global lef ventricular function in
patients with MS compared with control subjects wi-
thout MS. Tis fnding emphasizes the importance of
early diagnosis and management of metabolic syndro-
me to prevent the progression of ventricular dysfuncti-
on to overt structutal and symptomatic cardiac disease.
166. Poate fi tromboza venosa
profunda un marker al
recidivei tumorale?
Sorina Magheru, Alina Iacobescu, F.Maghiar,
C.Magheru
Introducere: Studii precedente au demosntrat exis-
tenta unei asocieri intre neoplazii si tromboza venoasa
profunda (TVP). Exista o asociere directa intre pre-
zenta TVP si suspiciunea de neoplazie, precum si in-
tre prezenta unei neoplazii confrmate si aparitia TVP.
Aceasta lucrare isi propune sa studieze in ce masura
aparitia unei TVP la pacientii cu tumori in remisie, are
valoare predictive asupra recurentei tumorii.
181
infarctului miocardic repetat, a insufcientei cardiace,
a accidentului vascular cerebral dupa externare a fost
mai inalta la persoanele cu TAG comparativ cu pacien-
tii cu TNG.
Concluzie: Toleranta anormala la glucoza este un pre-
dictor de prognostic nefast la pacientii cu infarct mio-
cardic acut si se asociaza cu evenimente cardiovascu-
lare recurente si supravietuire mai proasta postinfarct.
Abnormal glucose tolerance
marker of poor prognosis in
patients with acute myocardial
infarction.
Aim. Diabetes mellitus (DM) and abnormal gluco-
se tolerance (AGT) are common among patients with
acute myocardial infarction. Te present study aimed
to assess the clinical in-hospital characteristics and
long term prognosis in patients with acute myocardial
infarction (AMI) and AGT.
Methods. Of 304 patients with AMI admitted to the
coronary care unit within one year, mean age 647
years, 63% males, 25% - diabetics (18, 5% with known
DM and 6, 5% with newly diagnosed DM according to
repeated fasting glucose levels), 189 non-diabetic hos-
pital survivors, mean age 629, 8 years, 77% males, un-
derwent an oral tolerance test with 75 gr glucose before
hospital discharge. According to the 2-h glucose level
patients were classifed (WHO 1998) as having normal
glucose tolerance or abnormal glucose tolerance. Afer
discharge patients were followed for 226 months with
regards to the occurrence of nonfatal re-infarction,
stroke, and death.
Results. Post challenge glucose level revealed abnor-
mal glucose tolerance in 31% of non-diabetic patients
and a normal glucose tolerance in 69%. Te former
were older, but there were no diferences in the preva-
lence of cardiovascular risk factors and co-morbidities
among the groups. Infarct size and its location didnt
difer in the two groups. Patients with abnormal gluco-
se tolerance had a higher heart rate on admission, were
167. Toleranta anormala la
glucoza factor prognostic
nefavorabil la bolnavii cu
infarct miocardic acut
Lilia David
Institutul de cardiologie, Chisinau
Tulburarile de glicoreglare (diabetul zaharat cunoscut
si toleranta anormala la glucoza) sunt frecvent intalnite
la bolnavii cu infarct miocardic acut (IMA).
Obiectiv: In studiul realizat a fost evaluata evolutia
IMA in spital si prognosticul pe termen lung la subiec-
tii cu toleranta anormala la glucoza (TAG).
Material si metode: Din 304 pacienti cu IMA spita-
lizati consecutiv in clinica Institutului de cardiologie,
virsta medie 6311,5 ani, 68% barbati, 25% - diabetici
(18,5% cu diabet zaharat (DZ) cunoscut, 6,5% - cu DZ
nou diagnosticat dupa nivelul glicemiei a jeun) in stu-
diu au fost inclusi 189 subiecti nediabetici, varsta medie
629,8 ani, 77% barbati, care au supravietuit in spital.
Ultimii au fost supusi unui test standard de toleranta la
glucoza inainte de externare (la a 7- 10 zi).
Rezultatele testului au fost analizate conform criteriilor
OMS (1998). Pacientii au fost supravegheati timp de
226 luni. Punctele fnale urmarite: decesul, infarctul
miocardic repetat, accidentul vascular cerebral. Rezul-
tate. Nivelul glicemiei la 2 ore dupa incarcare cu glu-
coza a evidentiat toleranta normala la glucoza (TNG)
la 69% si TAG la alti 31% subiecti nediabetici. Ultimii
au avut virsta mai mare. Grupurile nu s-au deosebit
dupa factorii de risc si comorbiditatile prezente. Lo-
calizarea si incidenta infarctului miocardic cu si fara
unda Q au fost asemanatoare. Pacientii cu TAG au avut
mai frecvent la internare un ritm cardiac accelerat, f-
brilatie atriala, clasa Killip >2, au dezvoltat mai des pe
parcursul spitalizari ischemie recurenta de miocard,
insufcienta cardiaca, FE <45%. Curba de supravietu-
ire Kaplan-Meier la indivizii cu TAG a fost aproape de
curba subiectilor diabetici si s-a deosebit semnifcativ
de cea a pacientilor cu TNG (p<0,001). In perioada de
supraveghere a decedat fecare al cincilea subiect cu
TAG, majoritatea evenimentelor fatale find inregistra-
te pe parcursul primelor 12 luni postinfarct. Incidenta
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185
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more ofen in atrial fbrillation and in class Killip >2
at presentation, developed more frequently in-hospital
recurrent ischemia, heart failure and EF<45%. Kaplan-
Meier survival curves for the abnormal glucose tole-
rance group were poorer than for normal glucose tole-
rance and were similar to DM group (p<0,001). During
follow-up died every ffh patient with abnormal glu-
cose tolerance, the most of the fatal events occurred
within the frst post infarct year. In comparison with
normal glucose tolerance group patients with AGT had
a higher incidence of recurrent coronary events, heart
failure, stroke.
Conclusions. Abnormal glucose tolerance in patients
with acute myocardial infarction is a strong predictor
of future cardiovascular events and a worse post infarct
survival.
168. Pericardul ingrosat
decelat ecocardiografic un
marker posibil al riscului
cardiovascular crescut
A.Frigy, J.Buzogny, Szke Szidnia, O.Szakcs, Kocsis
Ildik, E.Carasca
Spitalul Clinic Judetean, Clinica medicala IV, Targu
Mures
Datele recente din literatura indica un rol important al
grasimii pericardice in geneza unui risc cardiovascular
crescut. In lucrarea de fata am studiat semnifcatia pe-
ricardului ingrosat, decelat ecocardiografc, ca surogat
al grasimii epicardice, intr-un lot de pacienti cardiaci
neselectati, fara o patologie pericardica cunoscuta.
Pacienti si metoda: Am prelucrat datele a 61 pacienti
(39 femei, 22 barbati), cu varsta medie de 65,5 12 ani,
internati in clinica noastra intre anii 2005-2009, la care
in buletinul ecocardiografc fgura termenul de peri-
card ingrosat. S-au urmarit la acesti bolnavi prevalenta
factorilor de risc cardiovasculari clasici, diagnosticele
cardiace, precum si unele date clinice si paraclinice re-
levante.
Rezultate: Dintre factorii de risc cardiovasculari hiper-
tensiunea arteriala si obezitatea au aratat o prevalenta
crescuta, find gasite la 77% dintre pacienti. Valori cres-
cute ale colesterolului s-au gasit la 52,4% dintre bolnavi,
iar 49% prezentau hipertrigliceridemie. 16 persoane
(26%) sufereau de diabet zaharat, respectiv la 6 bolnavi
am decelat glicemie bazala modifcata. La majoritatea
pacientilor am constatat asocierea a doi sau mai multi
factori de risc. Aproape jumatate (42,6%) dintre acesti
bolnavi au fost diagnosticati cu insufcienta ventricu-
lara stanga, iar la un procent scazut s-a depistat insu-
fcienta cardiaca congestiva, cardiopatie ischemica sau
valvulopatii mitrale si aortice. Functia sistolica a fost
pastrata (FE>40%) la majoritatea cazurilor (82%), in
schimb am gasit disfunctie diastolica la 54% din cazuri.
Concluzii: Datele noastre sugereaza ca pacientii de-
pistati ecocardiografc cu pericard ingrosat prezinta o
cumulare a factorilor de risc cardio-metabolici. Ingro-
sarea pericardica poate f interpretata ca marker al unui
risc crescut, consemnarea ei find obligatorie in buleti-
nele ecocardiografce de rutina.
Thickened pericardium found
by echocardiography a
possible marker of increased
cardiovascular risk
Recent data from the literature indicate a possible role
of pericardial fat in the genesis of an increased cardi-
ovascular risk. We evaluated the signifcance of the
presence of anterior pericardial fat found on standard
echocardiographic examination in an unselected cardi-
ac patient population.
Methods: Te data of 61 patients (39 men, 22 women,
mean age 65,5 years) - from 970 consecutive echocar-
diografc examinations - were reviewed retrospectively.
Te prevalence of classic cardiovascular risk factors
associated cardiac conditions and relevant laboratory
data were collected at each case.
Results: Arterial hypertension and obesity had the hi-
gher prevalence, being found each in 77% of the pati-
ents. Elevated cholesterol levels were observed in 52,4%
of patients, 49% of them having also hypertriglyceride-
mia. 16 patients (26%) had diabetes, while 6 patients
had impaired fasting glucose. We found an accumula-
tion of three or more major cardiac risk factor in 53%
of the patients. Almost half (42,6%) of the cases were
diagnosed with lef ventricular failure, while ischemic
heart disease and valvular pathology were present in
18% and 27% respectively. Systolic function of lef ven-
tricle was preserved (EF>40%) in the majority of the
patients (82%), while impaired diastolic function was
found in 54% of the cases.
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Suplimentul A, 2010
186
Conclusions: Our data indicate that patients with peri-
cardial fat found by standard echocardiography present
an accumulation of cardio-metabolic risk factors and
have an increased incidence of structural heart disease
with impaired lef ventricular function. Te presence
of pericardial fat could be translated as a marker of in-
creased cardiovascular risk, thus, its mentioning in the
echocardiographic report is important.
169. Stratificarea nonnvaziva a
riscului la 6 saptamani dupa un
infarct miocardic acut (STEMI)
si riscul de moarte subita
cardiaca la 1 an la pacientii
diabetici versus nondiabetici
L.Vasiluta, Doina Rosu
Scop: Identifcarea precoce, neinvaziva a pacientilor
(P) diabetici si nondiabetici, la 6 saptamani dupa un
STEMI, care au un risc crescut de a prezenta evenimen-
te cardiace ulterioare nefavorabile pe termen mediu
(1 an) este utila si in preventia mortii subite cardiace
(MSC).
Material si metoda: 175 P cu STEMI clasa Killip I-III,
din care 71 P cu diabet zaharat (DZ) au fost grupati
in 135 P trombolizati (T),48 P find cu DZ si in 40 P
netrombolizati (NT) din care 23 P find cu DZ; sex:
110 masculin, 65 feminin, varsta medie 54 22 ani.
S-au evaluat neinvaziv fecare P la 6 saptamani post-
infarct (vezi tabel): FEVS si indexul-volum diastolic al
VS (ecocardiografc) si prin monitorizare Holter/24ore:
variabilitatea ritmului cardiac (HRV) si extrasistolia
ventriculara(EV) clasa Lown 3. P au fost dispensari-
zati timp de 1 an.In functie de tromboliza si prezenta
DZ s-au impartit P in 4 loturi: Lot I: NonDZ- tromboli-
zati; Lot II: DZ trombolizati; lot III - NonDZ -netrom-
bolizati; lot IV DZ- netrombolizati.
Rezultate (tabel): Lot P FEVS index VTD HRV Lown
EV>3 MSC la 1an (%) (ml/m2sc) (msec) (%) (%) I. 45
15 76 26 65 28 8 6 II. 39 12 85 21 47 16 15
13 III. 36 10 93 17 49 15 18 15 IV. 35 10 90 22
38 18 23 22 Indiferent de DZ,analiza statistica a ara-
tat ca valorile independente de la care riscul de MSC
a fost semnifcativ crescut au fost: <32% pentru FEVS;
Indexul VS >95ml/m2sc; HRV <45msec; clasa Lown>4.
Concluzii: Revascularizarea prin tromboliza scade
riscul de MSC indiferent de prezenta diabetului (se re-
comanda coronaroangiografe pentru statusul corona-
rian). Riscul de MSC creste paralel cu scaderea FEVS
si HRV (ambii parametrii sunt independenti pentru
risc si nu exista neaparat o relatie proportionala intre
ei), dar si cu cresterea indexului VS si a clasei Lown de
EV. Totusi limitele inferioare a acestor parametri de la
care creste riscul nu sunt absolute, find infuentate si
de alti factori (varsta, sex, HTA, neuropatie autonoma
vegetativa preexistenta la diabetici, medicatie, tulburari
metabolice si acido-bazice). La 6 saptamani postinfarct
cand riscul de MSC se considera crescut, se va adminis-
tra amiodarona si daca este posibil se va efectua studiu
electrofziologic cu implant de ICD.
Non-invasive risk stratification
in six weeks after a STEMI
and the risk of sudden cardiac
death at 1 year in patients with
diabetic versus nondiabetic
Aims: Early identifcation, at 6 weeks afer a STEMI, of
patients (P) with diabetic or nondiabetici, who have an
increased risk of adverse cardiac events on a medium-
term (one year), is useful in preventing sudden cardiac
death (SCD).
Material and methods: 175 P with STEMI, Killip class
I to III , in which 71 P with diabetes mellitus (DM) ,
were grouped in 135 P thrombolysed, 48 P being dia-
betic and 40 P non-thrombolysed, 23 P being diabetic;
110 male, 65 female, average age 54 22 years. Each
P was non-invasively assessed at 6 weeks postmyocar-
dial infarction (see table): LVEF and LV diastolic vo-
lume index (determined by echocardiography) and by
24 hour - Holter ECG monitoring: heart rate variability
(HRV) and ventricular extrasystolic arrhythmia (VE)
Lown 3 class. P were followed up for a year.Depen-
ding on thrombolysis and diabetes, P were divided into
four groups (see table): I lot: Non-DM thrombolysed;
II lot: DM thrombolysed; III lot: Non-DM non- throm-
bolysed; IV lot: DM non-thrombolysed.
Suplimentul A, 2010
18I
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Rezultate: monitorizarea oximetriei cerebrale a evalu-
at functia cerebrala la pacientii sedati, a dat informatii
despre perfuzia cerbrala, informatiile obtinute find re-
gionale nu globale. Tinta studiului find de a evidentia
in ce mod utilizarea oximetriei cerebrale poate duce
la evitarea desaturarii cerebrale si la evitarea declinului
neurologic.
Perioperative monitoring of
cerebral oximetry in carotid
trombendarterectomy, using
INVOS OXIMETER
Objectives: to determine clinical and economical be-
nefts of the early use of cerebral oximetry.
Material and method: the study included 205 pati-
ents in which we used the INVOS OXIMETER 5100 C,
during carotid trombendarterectomy surgeries, betwe-
en January 2009 May 2010.
Results: monitoring of cerebral oximetry evaluated ce-
rebral function in sedated patients, gave information
about the cerebral perfusion, these being regional, not
global. Te target of the study is to asses the way cere-
bral oximetry can lead to avoid cerebral desaturation
and neurological injury.
171. Caracteristici
epidemiologice ale pacientilor
cu infarct miocardic acut
transmural (IMA) din judetul
Constanta studiu prospectiv
pe o perioada de 4 ani
Irinel Raluca Parepa, Violeta Jitari, Violeta Nicoleta
Miu, M.Toringhibel, Elvira Craiu
Universitatea Ovidius Facultatea de Medicina, Con-
stanta
Introducere: In judetul Constanta exista o singura uni-
tate de terapie intensiva coronariana (UTIC), aici pre-
Results: (table). P lot LVEF index EDV HRV LownEV>3
SCD in (%) (ml/m2sc) (msec) (%) 1 year(%) I. 45 15
76 26 65 28 8 6 II. 39 12 85 21 47 16 15 13 III.
36 10 93 17 49 15 18 15 IV. 35 10 90 22 38
18 23 22 In our study, regardless of diabetes, statistical
analysis showed that independent values of the risk of
SCD was signifcantly increased were < 32% for LVEF;
LV index > 95ml/m2sc; HRV < 45 msec, Lown class > 4.
Conclusion: Revascularization through thrombolysis
decreases the risk of SCD in both diabetics and non-
diabetics (coronarography is recommended for coro-
nary state). SCD risk increases parallel with decreasing
LVEF and HRV (both are independent risk parameters,
and there isnt necessarily a proportional relationship
between them), but also with the increased LV index
and VE Lown class. Still lower limits of these parame-
ters from which the risk increases are not absolute, be-
ing infuenced by other factors (age, sex, hypertension
with hypertrophy LV, pre-existing diabetic autonomic
neuropathy, medication, metabolic and acid-base di-
sorders). At 6 weeks afer STEMI, when SCD is con-
sidered high risk, Amiodarone is administered and if
possible an electrophysiologic study is done, with ICD
implant.
170. Monitorizarea
perioperatorie a oximetriei
cerebrale cu INVOS in
trombendarterectomia
carotidiana
D. Arhire, M. Patrut, Nicoleta Arhire, E. Rachita,
Cristina Grosu, C. Ardeleanu, B. Cornea , V. Pop, R.
Vasilescu, Cristina Voinea, Olimpia Manta, V. Ispas, E.
Oclei
Obiectivele studiului: determinarea benfciilor clinice
si economice in utilizarea precoce a oximetriei cerebra-
le.
Material si metoda: studiul a cuprins un lot de 205 de
pacienti la care s-a folosit aparatul INVOS OXIMETER
5100C, in cadrul operatiilor de trombendarterectomie
carotidiana, in perioada ianuarie 2009 - mai 2010 in
Clinica de Chirirgie Cardiovasculara din Spitalul Jude-
tean Constanta.
POSTER I I I
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Suplimentul A, 2010
188
zentandu-se si internandu-se toti pacientii cu IMA din
acest judet.
Scop: Evaluarea caracteristicilor epidemiologice si a
proflului particular al factorilor de risc cardiovascular
(CV) la pacientii cu IMA din judetul Constanta.
Metoda: Studiul s-a desfasurat pe o perioada de 4 ani (1
ian 2006-31 dec 2009) si a inclus toti pacientii cu IMA
prezentati consecutiv la Camera de garda si internati in
UTIC Constanta. S-au urmarit: date demografce (var-
sta, sex, mediu de provenienta) si prezenta factorilor
de risc CV (fumat, HTA, diabet zaharat, dislipidemie,
obezitate). Datele obtinute s-au analizat separat pentru
fecare an de studiu.
Rezultate: Din cei 1086 subiecti inclusi in studiu 68,32%
au fost barbati; acestia au fost de ~2 ori mai multi decat
femeile in oricare din anii studiati.Varsta medie (ani) a
subiectilor a fost 60,4412,64; la barbati varsta medie a
fost 57,891,92, respectiv la femei 65,064,76. Majori-
tatea cazurilor (81,4%) au provenit din mediul urban.
Global, proportia fumatorilor a fost 35,54%; procentul
femeilor fumatoare cu IMA a fost 19,18%, respectiv al
barbatilor 43,12%. 59,48% dintre pacienti au avut HTA
(cunoscuta/nou diagnosticata) si doar 40,52% au fost
normotensivi (fara istoric/valori crescute TA in timpul
spitalizarii). 71,51% dintre femei au avut HTA, semnif-
cativ mai multe (p=0,03) fata de barbatii cu IMA si HTA
(53,9%); diferenta dintre barbatii si femeile cu IMA si
HTA a fost semnifcativa (p=0,0003) in fecare an de
studiu. Diabetul zaharat, respectiv dislipidemia au avut
prevalenta semnifcativ mai mare in randul femeilor cu
IMA, in oricare din anii studiului (p=0,006, respectiv
p=0,015). Numai 22,1% din cazuri au fost obezi; preva-
lenta obezitatii a fost semnifcativ (p=0,048) mai mare
in randul femeilor, in orice an de studiu; asocierile obe-
zitate-dislipidemie, respectiv obezitate-HTA au fost
inalt semnifcative (p<0,0001).
Concluzii: In judetul Constanta, IMA afecteaza mai
ales sexul masculin.Varsta medie de imbolnavire este
semnifcativ mai mare la femei (p=0,0314). Majorita-
tea pacientilor cu IMA au HTA, respectiv dislipidemie.
Expunerea la fumat este mai mare la barbatii cu IMA,
dar toti ceilalti factori de risc CV studiati au prevalenta
semnifcativ mai mare in randul femeilor cu IMA din
aceasta regiune geografca.
Epidemiologic features of
ST-Elevation Myocardial
Infarction (STEMI) patients in
Constanta County, Romania
4 years prospective study
Background: In Constanta County, Romania, there is
only one Intensive Cardiac Care Unit (ICCU), all the
STEMI patients in this region being admitted here.
Aim: to evaluate the specifc epidemiologic features
and cardiovascular risk factors of STEMI patients in
this geographic region.
Methods: Our study was performed during 4 years
(1st of January 2006 31st of December 2009). It in-
cluded all consecutive STEMI patients diagnosed at
Cardiology Emergency Unit and admitted in Constan-
ta County ICCU. We observed patients age, sex, urban
af liation and cardiovascular risk factors (smoking,
high blood pressure, diabetes mellitus, dyslipidemia,
obesity). We separately analyzed data for each one of
the 4 years studied.
Results: Among the 1086 subjects diagnosed with
STEMI during the study period, 68.32% were men.
Men were approximately 2 times more than women in
any of the studied years. Subjects average age (years)
was 60.4412.64; average mens age was 57.891.92, re-
spectively womens was 65.064.76. Most cases (81.4%)
arrived from urban environment. We globally registe-
red 35.54% smokers; among STEMI women there were
19.18% smokers and among STEMI men there were
43.12% smokers. 59.48% of the studied patients had
known/newly diagnosed high blood pressure (HBP),
and only 40.52% had normal blood pressure (no HBP
record, no HBP during hospitalization). STEMI wo-
men with HBP were 71.51%, signifcantly (p= 0.03)
more than STEMI men with HBP (53.9%); the dife-
rence between men and women with STEMI and HBP
remained signifcant (p= 0.0003) in any of the studied
years. We noticed a signifcantly higher prevalence of
diabetes mellitus and dyslipidemia among STEMI wo-
men, in any of the studied years (p= 0.006, respectively
p= 0.015). Only 22.1% of cases had abdominal obesity;
obesity prevalence was signifcantly higher among wo-
men during each year of study (p= 0.048); the associ-
ation between obesity and dyslipidemia, and between
obesity and HBP was highly signifcant in any of the
studied years (p<0.0001).
Conclusion: In Constanta County, STEMI afects most-
ly men. Average age of illness is signifcantly higher in
Suplimentul A, 2010
189
POSTER I I I
POSTER I I I
riatii minore intre formele de ICA, cu exceptia celor cu
SC unde nu s-au administrat sartani), 45,7% digoxin
(intre 33,90% la cei cu IMA si 51,72% la cei cu SC). La
externare, recomandarile au continut la 71,78% diure-
tice de ansa oral (intre 60% la cei cu IMA si 81,81%
la cei cu SC), 65,57% diuretice antialdosteronice( intre
62,24% la cei cu IMA si 81,81% la cei cu SC), 70,79%
beta-blocante(intre 63,63% la cei cu SC si 90,81% la
cei cu IMA), 72,52% IEC (intre 45,45% la cei cu SC si
81,63% la cei cu IMA), 5,19% sartani(variatii minore
intre tipurile de ICA, cu exceptia celor cu SC unde nu
s-a administrat sartan) iar 44% au primit digoxin (intre
21,24% la cei cu IMA si 63,63% la cei cu SC).
Concluzii: Internarea in spital a pacientilor cu ICA a
dus la cresterea ratelor de administrare a terapiei cu
diuretice de ansa, IEC, diuretice antialdosteronice, be-
ta-blocante, digitala atat in cursul spitalizarii cat si la
externare. Ratele de administrare ale diverselor clase au
variat in functie de forma de prezentare a ICA.
Drug therapy relative to clinical
form in pacients with acute
heart failure in the Cardiology
Department of St. Pantelimon
Clinica Hospital
Aim of study: To analyze the management of patients
admitted with acute heart failure in the Cardiology De-
partment of St. Pantelimon Clinical Hospital, in view of
optimization of emergency medical treatment.
Method: We used information from medical charts of
patients with AHF, admitted in the hospital on a period
of 6 month, a total of 447 cases. We excluded patients
enrolled in other clinical trials.
Results: AHF manifested as: 26.62% as acute pulmo-
nary edema (APE), 25.72% as AHF post myocardial
infarction, 6.48% as cardiogenic shock, 2.01% as acute
right heart failure, 38% as hypertensive AHF, 55.25% as
decompensated CHF. Home medical treatment inclu-
ded: loop diuretic in 30.87%, antialdosteronic diuretic
in 25.7%, beta-blockers in 45.63%, ACEI in 40.77%, di-
gitalis in 23.2 %, and ARBs in 6.62%.During admission
these percentages changed as follows: 78.7% received
i.v. loop diuretics (variation between 66% in the AMI
group and 95% in the APE group), 71.55% oral loop
women (p=0.0314). Most of the STEMI patients has
HBP, respectively has dyslipidemia. In this particular
geographic region smoking exposure is higher among
STEMI men, but all the other studied cardiovascular
risk factors have a higher prevalence among STEMI
women.
172. Terapia medicamentoasa
in functie de formele clinice,
la pacientii cu insuficient
cardiac acut (ICA) in Clinica
de Cardiologie a Sp. de Urgent
Sf. Pantelimon
Liliana Protopopescu, Lenuta Haiducu, Oana
Simionescu, Andreea Bjerkestrand, V.Molfea,
T.Protopopescu, M.M.Vintila
Spitalul Clinic de Urgenta Sf. Pantelimon, Bucuresti
Scopul lucrarii Analiza managementului pacientilor
cu insufcienta cardiaca acuta (ICA) in cadrul clinicii
de Cardiologie a Sp. Clinic Sf. Pantelimon in vederea
optimizarii asistentei medicale de urgenta.
Material si metoda: S-au folosit informatiile din foile
de observatie ale pacientilor cu ICA internati pe o pe-
rioada de 6 luni, in numar de 447 cazuri.Au fost exclusi
pacientii inclusi in alte studii clinice.
Rezultate: ICA s-a manifestat sub urmatoarele for-
me: 26,62% ca EPA, 25,72% tip ICA post IMA, 6,48%
tip soc cardiogen(SC), 2,01% tip insufcienta cardiaca
dreapta izolata, 38% tip ICA hipertensiva, 55,25% tip
ICC decompensata. La prezentare pacientii se afau in
tratament cronic cu: diuretice de ansa 30,87%, diureti-
ce antialdosteronice 25,7%, beta-blocant 45,63%, IEC
40,77%, digoxin 23,2%, sartan 6,62%. Pe parcursul spi-
talizarii aceste procentaje s-au modifcat astfel: 78,7%
au primit diuretice de ansa iv (variatie intre 66% in gru-
pul cu IMA si 95% la cei cu EPA), 71,55% diuretice de
ansa oral (intre 27,5% in grupul cu SC si 83,6% la cei cu
EPA), 73,25% diuretice antialdosteronice (intre 24,1%
in grupul cu SC si 73,7 % la cei cu EPA), 66,4% beta-
blocante (variatie intre 34,5% in grupul cu SC si 81,7%
in grupul cu IMA), 76,6% IEC(intre 30,7% la cei cu SC
si 87,81% la cei cu ICA hipertensiva), 5,9% sartani (va-
POSTER I I I
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Suplimentul A, 2010
190
si LDL col, trigliceridelor, clearance-ului la creatinina,
examen RM pentru anevrismul de aorta ascendenta
sau descendenta.
Rezultate: HTA a fost diagnosticata la 38 pacienti
(71,7%). Singurul factor de risc care s-a corelat statistic
cu valorile tensionale ridicate a fost varsta efectuarii co-
rectiei chirurgicale (p < 0,001). Varsta de corectie a le-
ziunii la pacientii hipertensivi a fost de 22,1812,6 ani
comparativ cu 10,337 ani la pacientii normotensivi.
Restenoza a fost diagnosticata la 14 pacienti (26,4%).
Aparitia ei a fost frecventa la pacientii la care s-a re-
alizat angioplastie cu balon fara implantare de stent 4
pacienti (66,7% din cei la care s-a realizat aceasta meto-
da) si aortoplastia cu interpozitie de petec de pericard
6 pacienti (22% din cei la care s-a realizat aceasta meto-
da). Anevrismele de aorta ascendenta s-au diagnosticat
la 2 pacienti (3,8%) si de aorta descendenta 5 pacienti
(9,45%). Factorii favorizanti au fost: bicuspidia aortica
pentru anevrismele de aorta ascendenta si aortoplastia
cu petec de pericard pentru anevrismele de aorta des-
cendenta. Incidenta complicatiilor a fost asemanatoare
la pacientii cu valva aortica tricuspida versus pacien-
tii cu valva aortica bicuspida. S-au inregistrat diferen-
te doar in ceea ce priveste dimensiunile aortei la inel
(12,631,96 versus 11,411,14 mm/m2 sc) si ale aortei
ascendente (20,555,97 versus 14,492,67mm/m2 sc),
in bicuspidie find valori mai mari.
Concluzii: La un interval de timp de 11 ani 6 luni dupa
corectia unei coarctatii de aorta numarul complicati-
ilor cardiovasculare este semnifcativ. Pentru apari-
tia fecarei complicatii exista factori de risc care pot
f identifcati. Evitarea acestora poate scadea numarul
complicatiilor pe termen lung.
Risk factors for occurrence of
complications after correction
of the aortic coarctation
Background: Patients who achieved correction of the
aortic coarctation shows a long-term cardiovascular
morbidity. Te main complications are: hypertension,
restenosis, aortic aneurysms of ascending and descen-
ding.
Methods: Te study group: 53 patients who previously
completed the correction of the aorta coarctation, ad-
mitted during 2001-2007, 30 male, mean age 31 years
diuretics (between 27.5% in the CS group and 83.6%
in the APE group), 73.25% antialdosteronic diuretics
(between 24.1% in the CS group and 73.3% in the APE
group), 66.4% beta-blockers (between 34.5% in the
CS group and 81.7% in the AMI group), 76.6% ACEI
(between 30,7% in CS patients and 87,81% in those
with hypertensive AHF), 5,9% ARBs (minor variations
between AHF groups except CS patients witch did not
receive ARBs), 45,7% digitalis (between 33,9% in the
IMA group and 51,72% in the CS group). Upon relea-
se recommendations included loop diuretics in 71,78%
(between 60% in the IMA group and 81,81% in the CS
group), antialdosterone diuretics in 65,57% (between
62,24% in the IMA group and 81,81% in the CS group),
ACEI in 72,52% (between 45,45% in CS patients and
81,63% in the IMA group), ARBs in 5,19% (minor
variations between AHF groups except CS patients
witch did not receive ARBs ), digitalis in 44%( between
21,24% in the IMA group and 63,63% in the CS group).
Conclusions: Hospital admission of AHF patients
led to a rise in administration rates for loop diuretics,
ACEI, antialdosterone diuretics, beta-blockers, digita-
lis both during hospitalization and aferwards. Drug
admistration rates varied between classes of AHF.
173. Factori de risc pentru
aparitia complicatiilor post
corectia coarctatiei de aorta
Ioana Ghiorghiu, Madalina Iancu, Marinela Serban,
Carmen Ginghina
Premize: Post corectia coarctatiei de aorta apare pe
termen lung o morbiditate cardiovasculara complexa.
Principalele complicatii sunt: HTA, restenoza, anevris-
mele de aorta ascendenta si descendenta.
Material si metoda: Lotul de studiu: 53 pacienti cu
coarctatie de aorta corectata, internati in 2001 2007,
30 sex masculin, varsta medie 31 ani (6-68 ani), varsta
de corectie 19 ani (2 54 ani), interval corectie control
11 ani 6 luni (2-54 ani), interval corectie diagnostic
al complicatiei 10 ani si 3 luni. Evaluarea pacientilor a
cuprins: masurarea TA la membrele superioare si in-
ferioare, examen ecocardiografc, determinarea HDL
Suplimentul A, 2010
191
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174. Rezultate pe termen mediu
a terapiei cu Levosimendan in
cardiomiopatia dilatativa
Doina Rosu, L.Vasiluta
Scop: Vom evalua pe termen mediu, la 6 luni, evolutia
pacientilor dupa administrarea in perfuzie de Levosi-
mendan la pacientii cu cardiomiopatie dilatativa(CMD)
internati cu insufcienta cardiaca acuta(ICA) si daca se
imbunatateste prognosticul.
Material si metoda: La 15 pacienti(P) cu CMD, bar-
bati, varsta medie 56 10 ani, cu fractia de ejectie ven-
tricul stang(FEVS) intre 20-30%, afati in ritm sinusal,
care s-au internat cu ICA cu TA <100mmHg, li s-a ad-
ministrat Levosimendan in perfuzie cu 0,1 g/kg timp
de 48 ore, pe langa tratamentul standard. P s-au impar-
tit in 3 loturi egale de cate 5 P, in functie de etiologie:
ischemica (lot A), alcoolica (lot B) si idiopatica (lot C)
P s-au dispensarizat si evaluat clinic si ecocardiografc
(parametrii functiei sistolice si diastolice) la internare
si dupa 6 luni.
Rezultate: La 6 luni evaluarea clinica a aratat o amelio-
rare a scorului calitatii vietii, nu au mai fost reinternari
pentru IC acuta (2 P din lotul A s-au reinternat pentru
angina pectorala si 1P din lotul B cu aritmie extrasis-
tolica ventriculara, 1 P din lotul C a intrat in fbrilatie
atriala). Obiectiv ecocardiografc la 6 luni comparativ
cu valorile de la internare, FEVS a crescut in medie
cu 6,94% la lotul B, 4,95% la lotul C si 3,2% la lotul
A. Valorile volumului endsistolic au scazut in medie cu
26,2 ml/m2sc la lotul B, cu 19,6ml/m2sc la lotul C si
cu 11,3ml/ m2sc la lotul A. Valorile volumului enddi-
astolic au scazut cu 15,3ml/ m2sc la lotul B, cu 8,9ml/
m2sc la lotul C si 5,2ml/ m2sc la lotul A. Hipertensiunea
pulmonara a scazut in medie cu 11mmHg la lotul C,
7mmHg la lotul B si cu 6 mmHg la lotul A. Parametrii
functiei sistolice s-au imbunatatit semnifcativ statistic
la toate loturile in ordinea B-C-A, a crescut FEVS si
s-au redus mai ales volumele endsistolic si mai putin
enddiastolic. De asemenea a scazut si hipertensiunea
pulmonara. Parametrii functiei diastolice nu s-au im-
bunatatit semnifcativ statistic.
Concluzie: Tratamentul cu Levosimendan este sigur si
efcace si imbunateste prognosticul P cu CMD si ICA,
ameliorand performanta sistolica.
(6-68 years), correction age 19 years (2-54 years), time
between correction and control 11 years 6 months (2-
54 years), time between correction - diagnosis of com-
plications 10 years and three months. Patient assess-
ment included: measuring the BP in arms and legs,
echocardiographic examination, determination of
HDL and LDL cholesterol, triglycerides, and creatinine
clearance, MRI in patients with ascending or descen-
ding aortic aneurysm.
Results: Hypertension was diagnosed in 38 patients
(71.7%). Te only one factor statistically correlated
with high blood pressure was age of performing sur-
gical correction (p <0.001).(the age of correction for
hypertensive patients was 22,1812,6 years compared
to 10,337 years for patients with normal blood pressu-
re). Restenosis was diagnosed in 14 patients (26.4%). Its
appearance was common in patients with balloon an-
gioplasty performed without stent implantation: 4 pa-
tients (66.7% of patients who developed this method)
and aortoplasty with the patch of pericardium 6 pa-
tients (22% of which was done this way). Ascending
aortic aneurysms were diagnosed in 2 patients (3.8%)
and descending aorta in 5 patients (9.45%). Associa-
ted factors were: bicuspid aortic valve for aneurysms of
the ascending aorta and aortoplasty with pericardium
patch for aneurysms of the descending aorta. Te in-
cidence of complications was similar in patients with
tricuspid aortic valve versus bicuspid aortic valve pati-
ents. It have been recorded statistically signifcant dife-
rences only in terms of aortic anullus size (12.63 1.96
vs. 11.41 1.14 mm / m2/BSA) and the ascending aorta
(20.55 5.97 vs. 14.49 2.67 mm / m sc) in bicuspid
valve patients versus tricuspid valve patients.
Conclusions: In 11 years 6months afer correction of
the aortic coarctation the number of cardiovascular
complications is signifcant. For each occurrence of
complications risk factors can be ididentifed. Avoiding
these risk factors may lead to fewer long-term compli-
cations.
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Suplimentul A, 2010
192
175. SCA-date comparative la
diabetici versus nondiabetici
despre demografie,istoric
medical relevant, premedicatie
si asociere de factori de risc
cardiovascular intr-un lot de
pacienti cu SCA
Laura Arama, S.Barsan, Luminita Ionescu, Huidu
Simona, I. Stanca, M.Melnic, Andreea Popescu,
L.Ghilencea, Doina Dimulescu
Spitalul Universitar de Urgenta ELIAS, Clinica de Car-
diologie, Bucuresti
Obiective Analiza diferentelor semnifcative statistic a
datelor obtinute la internare din anamneza.
Material si metoda: studiu retrospectiv pe 228 pacien-
ti cu SCA inrolati succesiv in 2009, impartiti in doua
loturi in functie de prezenta sau a diabetului zaharat.
Rezultate: Prevalenta diabetului a fost de 40,6%,mai
mare decat in studiile internationale publicate -Hiper-
tensiunea la diabetici a fost de 5,7 ori mai frecventa
decat la nondiabetici -obezitatea s-a asociat de 3 ori
mai frecvent -asocierea multipla de factori de risc a fost
de 3 ori mai frecventa la diabetici -diabeticii nu s-au
dovedit a f mai bine tratati anterior internarii -46,7%
din pacienti erau premedicati cu aspirina, 51,4% cu
IECA,43,7% cu betablocante si 25,7% cu statina.
Concluzii: diabeticii au avut mai frecvent, semnifcativ
statistic asociere unica sau multipla de factori de risc
pentru boala cardiovasculara -pacientii diabetici, desi
aveau incarcatura mai mare de factori de risc pentru
boala cardiovasculara nu s-au dovedit a f mai bine tra-
tati in ambulatory decat nondiabeticii -prevalenta dia-
betului a fost mai mare
Medium-term results of
treatment with Levosimendan
in dilative cardiomyopathy
Aims: Asses if the 6 month prognosis in patients with
dilative cardiomyopathy (DCM), hospitalized with
acute heart failure (AHF) is improoved under treat-
ment with Sindax (Levosimendan).
Material and methods: In 15 patients (P) with DCM,
men, average age 56 10 years, with lef ventricular
ejection fraction (LVEF) between 20-30%, having si-
nus rhythm who were hospitalized with AHF with BP
<100mmHg, having recieved i.v. Levosimendan 0.1
mg / kg for 48 hours, along with standard treatment.
P were divided into three equal groups each 5 P accor-
ding to etiology: ischemic (group A), alcohol (group
B) and idiopathic (group C) P were followed-up, clini-
cally evaluated and echocardiography was performed
(systolic and diastolic function parameters) at admissi-
on and afer six months.
Results: At 6 months clinical evaluation showed an
improvement in quality of life, there werent any re-
addmissions for acute HF (2 P in group A were readd-
mitted for angina, in group B 1P presented extrasystole
ventricular arrhythmia, and 1 P from group C went
into atrial fbrillation). Objective echocardiography at
6 months compared with values on admission, LVEF
increased by an average 6.94% in group B, 4.95% in
group C and 3.2% in group A. Te values of the endsis-
tolic volume decreased on average 26.2 ml / m2sc in
group B, 19.6 ml / m2sc in group C and 11.3 ml / m2sc
in group A. Te values enddiastolic volume fell 15.3 ml
/ m2sc in group B, 8.9 ml / m2sc in group C hectares
and 5.2 ml / m2sc in group A. Pulmonary hypertensi-
on has decreased an average of 11mmHg in group C,
7mmHg in group B and 6 mmHg in group A. Systolic
function parameters were statistically signifcantly im-
proved in all groups in order of ACC, increased LVEF
and decreased especially endsistolic volumes and less
enddiastolic. Also pulmonary hypertension has decrea-
sed. Diastolic function parameters were not statistically
signifcantly improved.
Conclusion: Levosimendan treatment is safe and efec-
tive and improves prognosis of P with DCM and AHF,
improving systolic performance.
Suplimentul A, 2010
198
POSTER I I I
POSTER I I I
Obiectiv: A fost evaluata relatia dintre nivelul glicemiei
la internare (GI) si evolutia clinica a IMA in spital si la
supraveghere de durata.
Material si metode: In studiu au fost inclusi 304 pacien-
ti cu IMA internati in Clinica de cardilogie in perioada
ianuarie 2007 aprilie 2008, varsta medie 6311,5 ani,
68% barbati, 18,5% - cu diabet zaharat (DZ) cunoscut.
In raport cu nivelul GI au fost formate 4 grupuri (Gr):
Gr1 (n=51) <5 mm/l, Gr 2 (n=105) 5-7 mm/l, Gr 3
(n=76) 7-11 mm/l si Gr 4 (n=70) >11 mm/l. Au fost
analizate caracteristica clinica a bolnavilor si evolutia
IMA in spital si la distanta in relatie cu GI. Pacientii au
fost urmariti timp de 186 luni dupa externare.
Rezultate: HGI a fost constatata la 48% bolnavi.Varsta
medie a pacientilor nu s-a deosebit intre grupuri. Rata
femeilor, indicele masei corpului si circumferinta ab-
dominala au fost mai mari in Gr 4 (p<0,05). Pacientii
din Gr 3 si Gr 4 au fost mai des hipertensivi, cu ante-
cedente de insufcienta cardiaca (IC), accident vascu-
lar cerebral, afectare arteriala periferica. Ei au avut mai
frecvent la adresare tablou clinic atipic, edem pulmo-
nar, soc cardiogen, bloc AV, tahiaritmii ventriculare, IC
Killip clasa >2, ECG cu elevatie de segment ST. Evolutia
IMA a fost mai des complicata la acesti bolnavi cu an-
gor pectoral periinfarctic, fbrilatie atriala persistenta,
avansarea IC, sindrom Dressler. Pacientii cu HGI au
dezvoltat semnifcativ mai frecvent IMA cu unda Q
(p<0,001). Localizarea IMA nu s-a deosebit intre gru-
puri. Regurgitatie mitrala grad sever si FE % redusa au
fost depistate mai des in Gr 4 (p<0,05). Majoritatea su-
biectilor cu HGI >11 mm/l au prezentat la angiografe
afectare tricoronariana . Rata de deces in spital a fost de
2,5 ori mai inalta in Gr 4 comparativ cu Gr 1 (p<0,05).
Mortalitatea dupa externare nu s-a deosebit statistic in-
tre grupuri, dar durata de supravietuire a fost cea mai
mica la subiectii cu GI >11,0 mm/l. Rata de deces a su-
biectiilor nediabetici cu GI >11 mm/l a fost semnif-
cativ mai inalta fata de pacientii din celelalte grupuri
(p<0,0001) si fata de subiectii cu DZ cunoscut din Gr
4 (p<0,001).
Concluzii: Hiperglicemia la internare la pacientii cu
infarct miocardic acut indica un risc sporit de afectare
severa, evolutie complicata a bolii, prognostic nefavo-
rabil, inclusiv fatal in spital. Rata de deces in spital la
subiectii fara diabet zaharat cunoscut si glicemie > 11
mm/l la internare este considerabil mai inalta fata de
cea a diabeticilor.
ACS-comparative data in
diabetics versus nondiabetics
on demographics, relevant
medical history, premedication,
and association of
cardiovascular risk factors in a
group of patients with ACS
Objectives: Analysis of data obtained statistically sig-
nifcant diferences in hospitalization of history.
Method: retrospective study on 228 patients with ACS
enrolled in succession in 2009, divided into two groups
according to presence or diabetes.
Results: Te prevalence of diabetes was 40.6% higher
than in international studies published -Hypertension
in diabetics was 5.7 times more frequently than non-
diabetici. Obesity was associated with 3 times more
frequently Multiple-association of risk factors was 3
times more common in diabetics -Diabetes have not
proven to be better treated before admission Premedi-
cation -46.7% of patients were aspirin, 51.4% with ACE
inhibitors, beta blockers and 43.7% to 25.7% with sta-
tin.
Conclusions: Diabetes were more frequent, statistically
signifcant association of single or multiple risk factors
for cardiovascular disease -Diabetic patients, although
the load had more risk factors for cardiovascular disea-
se have not proven to be better treated in ambulatory
than nondiabetics -Prevalence of diabetes was higher
176. Nivelul glicemiei la
internare - marker prognostic
in infarctul miocardic acut
Lilia David, A.Grosu, V.Racila, O.Cenusa, Tatiana
Cuzor, Veronica Turcanu
Institutul de cardiologie, Chisinau
Hiperglicemia la internare (HGI) este frecvent intalnita
in infarctul miocardic acut (IMA) indiferent de statutul
diabetic al bolnavului. Unii autori au remarcat o morta-
litate mai inalta la acesti pacienti.
POSTER I I I
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Suplimentul A, 2010
191
Conclusion: Hyperglycaemia at admission is a predic-
tor of inhospital complications and a high mortality in
AMI patients. Admission blood glucose level may ser-
ve to identify subjects at high risk, in particular among
those without known diabetes.
177. Caracteristicile
epidemiologice ale afectarii
arteriale periferice la femei:
exista diferente comparativ cu
barbatii?
Viviana Aursulesei, R.Popa, Genoveva Baroi,
M.D.Datcu
Universitatea de Medicina si Farmacie "Gr.T.Popa", Iasi
Scopul lucrarii: evidentierea diferentelor intre caracte-
risticile la prezentare si evolutia clinica a afectarii arte-
riale periferice (PAD) in functie de sex.
Material si metoda: studiul a inclus 1232 pacien-
ti consecutivi evaluati angiografc si urmariti timp de
1.30.2 ani dupa revascularizare/amputatie. Factorii de
risc cardiovascular inclusiv indicele glezna-brat (IGB),
grosimea intima-medie carotidiana (IMT), indexul de
masa a ventriculului stang (IMVS), microalbuminuria
au fost evaluati la toti pacientii. Parametrii au fost com-
parati intre grupul 1 (femei) si grupul 2 (barbati).
Rezultate: Prevalenta la femei a fost de 31,6% in PAD
simptomatic si 24,3% in PAD asimptomatic. In lotul de
studiu femeile au avut varsta mai inaintata comparativ
cu barbatii (diferenta medie de 6,3 ani, p <0,01) si au
constituit in proportie mai mare subgrupul peste 70 de
ani (54,7% vs 41,2%) in PAD simptomatic. Diabetul za-
harat si fumatul au avut prevalenta mai mare la barbati
(76,2% vs 59,7%; 86,1% vs 23,5%, p0,05), indiferent
de stadiul clinic. Hipertensiunea arteriala si obezitatea
abdominala au avut prevalenta mai mare la femei com-
parativ cu barbatii cu PAD asimptomatic (53% vs 16,5%
si 43,7 vs 19,2%, p0,05). In grupul 1 istoricul de
boala coronariana a existat in 13,5% din cazuri (37,2%
la barbati, p0,02); 27,6% dintre femei au avut IMT
>0,02), fara<0,9 mm (39,1% la barbati, p diferenta sem-
nifcativa pentru prevalenta IMVS si microalbuminuri-
ei (p>0,05). Distributia in stadiile III si IV Leiche a fost
de 81% in 0,001), iar succesul revascularizarii<grupul
Admission glycaemia a
prognostic marker in patients
with acute myocardial
infarction
Hyperglycaemia at admission (AHG) is common in
patients with acute myocardial infarction (AMI) irre-
spective of their diabetic state. Some studies reported a
higher mortality rates in these subjects.
Aim: Te study aimed to evaluate the relation between
the blood glucose level at admission (GlA) and the out-
comes of AMI in hospital and during long term follow-
up.
Material and methods: 304 AMI patients admitted to
the Clinic of cardiology within January 2007 and April
2008 were enrolled in the study. Te mean age of the
study population was 6311,5 yrs, 68% was men, 18,5%
had known diabetes. Patients were divided in four
groups (Gr) according to their GlA: Gr1 (n=51) <5
mm/l, Gr 2 (n=105) 5-7 mm/l, Gr 3 (n=76) 7-11
mm/l and Gr 4 (n=70) >11 mm/l. Baseline clinical
characteristics, the inhospital and long term outcomes
of the AMI patients were studied in relation with the
GlA. Patients were followed-up for 186 months.
Results: AHG was present in 48% AMI patients. Te
mean age of the subjects was similar in the four groups.
Te proportion of women, the body mass index and
the abdominal circumference were higher in Gr 4
(p<0,05). Patients with AHG were more likely to have
a history of hypertension, congestive heart failure, stro-
ke and peripheral arterial disease and presented more
ofen at admission atypical symptoms, pulmonary ede-
ma, ventricular tachyarrhythmias, AV block and heart
failure Killip class>2. Patients with AHG developed
more ofen Q-wave AMI (p<0,001), though its location
didnt difer among the groups. A higher proportion of
patients in Gr3 and Gr 4 experienced inhospital recur-
rent ischemia, atrial fbrillation, worsening of the heart
failure. Severe mitral valve regurgitation and EF <45%
occurred more ofen in Gr 4 (p<0,05). Most of the sub-
jects with GlA >11 mm/l had a three-artery coronary
disease. Te inhospital mortality rate in Gr 4 was 2,5
fold higher in comparison with Gr1 (p<0,05). Te long-
term mortality didnt difer between groups, but the
survival duration was shorter in subjects with Gl >11,0
mm/l. Te mortality rate in non-diabetic subjects with
GlA>11 mm/l was signifcantly higher than that in the
other groups (p<0,0001) and in comparison with the
diabetic patients of Gr 4 (p<0,001).
Suplimentul A, 2010
195
POSTER I I I
POSTER I I I
obesity were more prevalent in females compared with
males with 0.05). Among<asymptomatic PAD (53% vs
16.5% and 43.7 vs 19.2%, p females, 13.5% had a his-
tory of coronary heart disease (37.2% in males, 0.02),
27.6% had a IMT<p > 0.02), without<0.9 mm (39.1%
in males, p signifcant diference for LVMI and mi-
croalbuminuria prevalence (p>0.05). Te distribution
according to clinical presentation was 81% for stages III
and IV Leriche in group 1 compared with 73% in group
2 0.001), with a higher incidence of successful revascu-
larization in<(p males (43% vs 32.7% in females). ABI
was signifcant lower in females 0.05). In group 2 there
were more<compared with males (-0.210.02, p preva-
lent extended arterial lesions and iliac thrombosis (17%
vs 5.3%, 0.01).<p.
Conclusions: In our study the higher prevalence of
PAD in females is not confrmed, except the subgroup
over 70 years old. PAD is ofen a systemic disease in
females, so using the noninvasive parameters of clinical
outcome the accuracy of clinical evaluation is higher.
Tere is a later diagnosis for PAD compared with ma-
les, advanced clinical status and poor prognosis. Im-
proved active detection, aggressive risk factor modif-
cation and adequate therapy are strongly necessary for
controlling incidence and evolution of PAD in females.
178. Particularitati clinice
si implicatii prognostice
ale sindromului coronarian
acut la pacientii cu boala
cerebrovasculara
Adriana Salajan, Ioana Cote, V.Popa
Spital Clinic Judetean de Urgenta, Oradea
Pacientii cu boal cerebrovascular (AVC ischemic,
atac ischemic tranzitor) prezint factori de risc iden-
tici si elemente fziopatologice comune cu pacientii
coronarieni. Cu toate acestea, tratamentul de urgent
al acestor pacienti prezint cateva particularitti ce pot
greva prognosticul ulterior.
Scopul studiului este de a analiza incidenta, paritcu-
larittile de terapie si impactul bolii cerebrovasculare
preexistente privind evolutia si prognosticul sindromu-
lui coronarian acut.
1 versus 73% in grupul 2 (p a fost mai mare la barbati
(43% vs 32,7%). IGB a fost semnifcativ mai 0,05).
In grupul 2<scazut la femei comparativ cu barbatii
(-0,210,02, p au fost mai frecvente leziunile extinse
arteriale si tromboza iliaca 0,01).<(17% vs 5,3%, p.
Concluzii: In studiul nostru nu a fost confrmata pre-
valenta PAD mai mare la femei comparativ cu barba-
tii, cu exceptia subgrupului peste 70 de ani. PAD este
frecvent o boala sistemica, de aceea evaluarea prin pa-
rametri noninvazivi cu semnifcatie prognostica creste
acuratetea evaluarii clinice. La femei PAD este diagnos-
ticata mai tardiv, in stadiu avansat clinic si are prognos-
tic nefavorabil. Se impune ameliorarea detectiei active,
modifcarea agresiva a factorilor de risc si aplicarea
unei terapii adecvate pntru controlul incidentei si evo-
lutiei PAD la femei.
The epidemiological
characteristics of lower
extremity arterial disease in
women: is it different from that
in men?
Purpose: to highlight the diferences in the presenta-
tion features and clinical outcome of lower extremity
arterial disease (PAD) based on gender.
Material and method: we studied 1232 consecutive pa-
tients evaluated by contrast angiography and followed
up for 1.30.2 years afer revascularization/lower limb
amputation. Te cardiovascular risk profle including
ankle-brachial index (ABI), carotidian intima-media
thickness (IMT), index of lef ventricular mass (LVMI),
microalbuminuria was evaluated in the entire cohort.
All parameters were compared between females (group
1) and males (group 2).
Results: Te overall prevalence according to gender was
31.6% in symptomatic PAD and 24.3% in asymptoma-
tic PAD for females. In our cohort females were signif-
cantly older than males (mean 6.3 years older, p <0.01)
and composed a higher proportion of patients over 70
years old (54.7% vs 41.2%) in symptomatic PAD. Dia-
betes and smoking had a higher 0.05),<prevalence in
males (76.2% vs 59.7%; 86.1% vs 23.5%, p irrespective
the clinical stage. Arterial hypertension and abdominal
POSTER I I I
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Suplimentul A, 2010
196
Results: Patients with previous cerebrovascular disea-
se represented 8.87% of the study population; they had
more risk factors (diabetes mellitus, previous acute co-
ronary syndromes, Killip class>1) but still received less
thrombolythic treatment and cardioprotective medica-
tion. Even more, patients with previous cerebrovascu-
lar disease had a worse in hospital clinical course and
had a further worse prognosis.
Conclusion: Tis observation underlines the necessity
of reconsidering more agressive therapy options for pa-
tients with preexisting cerebrovascular disease, in or-
der to improve in hospital and late prognosis.
179. Reprezinta beta-blocantele
o optiune terapeutica la
cardiaca cronica avansata si
bronhopneumopatie cronica
obstructiva?
Elisabeta Badila, Mihaela Bazac, Cristina Tirziu, Flo-
rentina Mehic, Daniela Bartos, Maria Dorobantu
Obiectiv: Evaluarea tolerabilitatii terapiei cu beta-blo-
cante la pacientii care asociaza insufcienta cardiaca
(IC) cronica avansata si bronhopneumopatie cronica
obstructiva (BPOC).
Metode: IC cronica avansata a fost defnita conform
recomandarilor din 2007 ale Grupului de studiu al IC
cronice avansate al Societatii Europene de Cardiologie;
BPOC a fost defnit conform ghidului GOLD. Studiul a
inclus 46 pacienti, selectati dintr-un numar de 270 bol-
navi cu IC cronica avansata internati in sectia noastra in
2009. 28 pacienti (60,8%) nu urmau terapie -blocanta
anterior includerii in studiu. Functia pulmonara a fost
evaluata la momentul bazal (dupa remisia statusului
congestiv) si dupa 3 luni de terapie -blocanta. 8,1 ani;
82,6% au fost.
Rezultate: Varsta medie a subiectilor a fost 58,5 barbati.
56,5% erau fumatori, 32,6% fosti fumatori si 10,8% ne-
fumatori. 69,5% pacienti au fost in clasa NYHA III si
30,5% in clasa NYHA IV. Fractia de ejectie medie a fost
244,2%. Prezenta fbrilatiei atriale s-a inregistrat la
Material si metoda: Am analizat retrospectiv un nu-
mr de 1284 pacienti cu sindrom coronarian acut
(STEMI si NSTEMI) internati in S. Cardiologie I si
II a Spitalului Cl. Jud. de Urgente Oradea in decursul
ultimilor 3 ani. Pacientii au fost subclasifcati in lotul
A (pacienti cu antecedente de boala cerebrovascular-
114 p= 8.87%) si B (pacienti fr boala cerebrovascula-
ra: 1170 p= 91.1%).
Rezultate: Pacientii cu antecedente de boala cerebro-
vascular au reprezentat 8.87% din populatia de studiu
si desi au prezentat mai multi factori de risc (DZ, IMA
in antecedente, clasa Killip>1) au primit in proportie
mai mic tratament trombolitic si medicatie cardiopro-
tectiv. Mai mult, lotul de pacienti cu boala cerebro-
vascular a avut o evolutie intraspitaliceasc mai grav,
constituind un grup de pacienti cu prognostic rezervat.
Concluzii: Aceast observatie impune reconsiderarea
unor optiuni terapeutice mai agresive pentru pacien-
tii cu boala cerebrovascular si sindroame coronariene
acute, in vederea optimizrii evolutiei intraspitalicesti
si a prognosticului de durat.
Clinical particularities and
prognostic implications of
acute coronary syndromes in
patients with cerebrovascular
disease
Patients with cerebrovascular disease (ischemic stroke,
transient ischemic attacks) have similar risk factors and
common pathophysiological mechanisms with coro-
nary patients. Still, emergency treatment of these pati-
ents shows some particularities that can afect further
prognosis.
Aim of the study: analysis of the incidence, treatment
particularities and impact of preexisting cerebrovas-
cular disease on the evolution and prognosis of acute
coronary syndromes.
Material and methods: We retrospectively analized a
number of 1284 patients with acute coronary sndro-
mes (STEMI and NSTEMI) admitted in Cardiology
Dep. I and II during the last 3 years. Patients were clas-
sifed in group A (patients with previous cerebrovascu-
lar disease- 114 p= 8.87%) and group B (patients witho-
ut cerebrovascular disease: 1170 p= 91.1%).
Suplimentul A, 2010
19I
POSTER I I I
POSTER I I I
46 patients with ACHF and associated COPD were
included (from a total number of 270 patients with
ACHF admitted in our department in 2009). 28 pati-
ents (60,8%) werent on previous -blockers therapy.
Te pulmonary function was evaluated at baseline (af-
ter remission of congestive status) and afer 3 months
of -blocker therapy. 8,1 yrs; 82,6% were male. 56,5%
were.
Results: Te mean age was 58,5 smokers, 32,6% ex-
smokers and 10,8% non-smokers. 69,5% patients were
in NYHA class III and 30,5% in NYHA class IV. Te
mean ejection fraction was 244,2%. Atrial fbrilla-
tion was present in 65,2% cases. 86,9% patients were
on digoxin treatment. 71,7% patients were in stage II
COPD (moderate) and 28,3% in stage III COPD (seve-
re). At baseline, the mean 5,7%. 18 patients with previ-
ous treatmentvalue of FEV1 was 54,2 continued the
-blockers therapy and 28 patients without -blockers
before the admission started this therapy. Te initiation
of therapy was possible only afer signifcant improve-
ment of systemic and pulmonary congestion. Te used
-blockers were: 36,9% - bisoprolol, 19,5% - nebivolol
and 43,5% - carvedilol. Terapy with -blocker was
interrupted in 13% patients, caused by aggravation
of dispneea and bronchospasm. All the patients were
also treated with anti-infammatory and bronchodi-
latatory therapy (tiotropium/ipratropium bromide +
combination of futicasone-salmeterol or budesonide-
formoterol). Te evaluation of pulmonary function af-
ter 3 months of -blocker therapy noted a mean FEV1
7,2%, without signifcant diferences when compared
to the53,8 beginning of beta-blocker therapy (p ns).
In 50% of patients, the FEV1 values at 3 months were
increased when compared with the baseline, in 4,3%
the FEV1 values were the same, and in 41,3% the FEV1
values are decreased versus baseline. During the 3
months of follow-up, 2 patients (4,3%) died.
Conclusion: In most patients with advanced chronic
heart failure and associated COPD, therapy with beta-
blockers was well tolerated, without signifcant chan-
ges in pulmonary function, and irrespective of NYHA
classes or COPD stages.
65,2% subiecti. 86,9% pacienti au primit tratament cu
digoxin. 71,7% pacienti s-au incadrat in BPOC stadiul
II GOLD (moderat), iar 28,3% in stadiul III (sever).
La evaluarea bazala, 5,7%. 18 pacienti au continuat
terapiavaloarea medie a FEV1 a fost 54,2 -blocanta
urmta deja in momentul internarii, iar la restul de 28
pacienti s-a initiat terapia -blocanta pe perioada inter-
narii. Initierea tratamentului cu -blocant a fost posibi-
la doar dupa ameliorarea semnifcativa a congestiei sis-
temice si pulmonare. Beta-blocantele utilizate au fost:
36,9% - bisoprolol, 19,5% - nebivolol si 43,5% - carve-
dilol. Tratamentul -blocant a fost intrerupt la 13% pa-
cienti, datorita agravarii dispneei si bronhospasmului.
Toti pacientii au primit de asemenea tratament antiin-
famator si bronhodilatator (tiotropium/ipratropium
bromid + combinatia futicazon-salmeterol sau bude-
sonid-formoterol). Evaluarea functiei pulmonare dupa
3 luni de 7,2%, faraterapie -blocanta a aratat o valoa-
re medie a FEV1 de 53,8 diferente semnifcative fata de
momentul bazal al initierii terapiei -blocante (p ns).
La 50% pacienti, valoarea FEV1 dupa 3 luni a crescut
comparativ cu evaluarea initiala, la 4,3% pacienti va-
loarea FEV1 a fost aceeasi, iar la 41,3% valoarea FEV1 a
scazut comparativ cu momentul bazal. In timpul celor
3 luni de urmarire, s-a inregistrat decesul a 2 pacienti
(4,3%).
Concluzii: La majoritatea pacientilor cu insufcien-
ta cardiaca cronica avansata si BPOC asociat, terapia
beta-blocanta a fost bine tolerata, fara modifcari sem-
nifcative ale functiei pulmonare, indiferent de clasa
NYHA sau stadiul BPOC.
Are beta-blockers a therapeutic
option in patients with
advanced chronic heart
failure and associated chronic
obstructive pulmonary disease?
Objective: To evaluate the tolerability of beta-blockers
therapy in patients with advanced chronic heart failure
(ACHF) and associated chronic obstructive pulmonary
disease (COPD).
Methods: ACHF was defned in accord with 2007 re-
commendations of Study Group of ACHF of ESC;
COPD was defned according to the GOLD guidelines.
POSTER I I I
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Suplimentul A, 2010
198
Concluzie: la pacientii cu ICA si SCA, prezenta BCRS
pe ECG de la internare, este asociata in mod indepen-
dent cu cresterea semnifcativa a mortalitatii
Left bundle branch block as
independent negative marker
of prognosis in acute heart
failure
Introduction Acute heart failure (AHF) is an impor-
tant problem of morbidity and mortality in Romania,
and a burden for the national healthcare system. Iden-
tifying markers of prognosis could help to better stra-
tify the patients, in order to apply urgent nonpharma-
cological strategies.
Aim of the study To assess the prognosis of lef bundle
branch block (LBBB) in patients admitted for acute
heart failure, related to general and specifc mortality,
in the population enrolled in Romanian Registry of
Acute Heart Failure.
Material and method: We analyzed data from 3224
patients (pts) with acute heart failure. We studied the
relationships between LBBB on the ECG at admission
and mortality in the whole group and in the defned
subgroups (acute pulmonary oedema, cardiogenic
shock and acutely decompensated chronic heart failure
and AHF post Acute Coronary Syndromes).
Results: Mean age in study lot was 69.7 years and 56,4%
of patients were men.A number of 506 pts(15.6%)
had LBBB on admission ECG, respectivelly 14,1% of
patients with decompensated heart failure, 19,6% of
those with pulmonary edema, 18,6% of those with
cardiogenic shock and 16.1% of patients with Acute
Coronary Syndromes(ACS) at admisssion; p=0,038.
In univariate analysis, in hospital mortality in glo-
bal study lot in patient with LBBB was 8,2% vs 7.3%
in those without LBBB (p = 0,037), and was 12,4% vs
11.1% in Pulmonary Edema (p=0,056), 2,7% vs 1,9%
in decompensated heart failure (p=0,033), 64.1% vs
61% in cardiogenic shock(p=0.41) and was 18.1% vs
10.4% in ACS(p=0.018). Multivariate analysis perfor-
med in global lot and in the subgroups, demonstates
that only in patients with acute heart failure postACS,
LBBB is independently associated to in hospital mor-
tality (OR=1.270, CI 95% OR=1.018-1.578, p=0.024).
Conclusion: the presence of LBBB on the admission
ECG of patients with AHF post ACS represents an in-
180. Blocul complet de ramura
stanga, factor independent
de prognostic negativ in
insuficienta cardiaca acuta
Alina Giuca, I.Donoiu, D.D.Ionescu, D.Vinereanu,
R.Capalneanu, M.D.Datcu, O.Chioncel, C.Macarie
Premise teoretice Insufcienta cardiaca acuta este o
importanta problema de morbiditate si mortalitate in
Romania, reprezentand o povara fnanciara pentru so-
cietate. Identifcarea unor factori de prognostic negativ
ar putea duce la selectarea unui gup de pacienti ce au
nevoie de tratament urgent sau de interventii nonfar-
macologice.
Scopul studiului Aprecierea infuentei prognostice a
blocului complet de ramura stanga (BCRS) la pacientii
internati cu insufcienta cardiaca acuta (ICA) asupra
mortalitatii intraspitalicesti, in lotul global si in proflu-
rile clinice analizate in Registrul Roman de Insufcienta
Cardiaca Acuta (RRICA).
Material si metoda de lucru Au fost analizate date de
la 3224 pacienti cu ICA ischemica sau nonischemica
inrolati in RRICA, la care in afara datelor demograf-
ce, clinice , functie VS, tratament s-au inregistrat mo-
difcarile pe ECG de la internare. Astfel, BCRS a fost
mentionat la internare si apoi s-a analizat relatia sa cu
mortalitatea atat global, cat si in functie de forma clini-
ca de prezentare: edem pulmonar acut cardiogen, soc
cardiogen, decompensare acuta a IC sau ICA asociata
sindromului coronarian acut(SCA).
Rezultate: Varsta medie in lotul studiat a fost de 69.7
ani si 56,4% au fost barbati. Un numar de 506 pacien-
ti(15.6%) au avut BCRS pe EKG la internare, respectiv
14,1% din pts cu decompensare acuta, 19,6% din pts
cu edem pulmonar, 18,6% din cei cu soc cardiogen si
16.1% din cei cu SCA; p=0,038. In analiza univariata,
prezenta BCRS s-a asociat cu o mortalitate in lotul glo-
bal de 8,2% vs 7.3% in absenta acestuia (p = 0,037), de
12,4% vs 11.1% in edemul pulmonar (p=0,056), 2,7%
vs 1,9% in decompensarea acuta a IC (p=0,033), de
64.1% vs 61% in socul cardiogen(p=0.41) si de 18.1% vs
10.4% in SCA(p=0.018). Analiza multivariata efectuata
in lotul global si in subgrupuri arata ca doar la pacientii
cu SCA, BCRS este asociat in mod independent mor-
talitatii intraspitalicesti (OR=1.270, CI 95% OR=1.018-
1.578, p=0.024).
Suplimentul A, 2010
199
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and CV: 12,56; p=0,00007. 2. La un an valorile medii
ale VASI la pacientii hipertensivi cu HVS si fara bene-
fciu al trombolizei sau care nu au primit terapie de re-
perfuzie au fost 36,35, DS:2,10, CV:5,77, comparativ cu
hipertensivii fara HVS si cu tomboliza efcienta: 31,20,
DS:4,42, CV:14,15, p=0,00003. 3. Pentru gasirea unor
posibile corelatii intre VASI si aspectele ecocardiogra-
fce, respectiv pattern-ul diastolic transmitral, s-au fo-
losit testele: chi patrat calcularea pragului, odd ratio
(OR) si riscul relativ (RR) calcularea intervalelor de
incredere. Corelatii semnifcative statistic au fost gasi-
te intre: VASI>34ml/m2 si IMVS (CS=12,65518, OR=
4,949495, RR=1,724074), VASI si aspectul fuxului di-
astolic transmitral CS=12,70696, in prima saptamana
postinfarct inainte de externare; intre VASI si IMVS:
CS=24,001872, IVAS si pattern-ul diastolic transmita-
ral la un an: CS=7,2975811.
Concluzii: 1. Indexul de volum al atriului stang a avut
valori medii mai mari la pacientii hipertensivi cu HVS
si fara criterii de reperfuzie, care, in timpul fazei acute a
infarctului miocardic acut au presiuni de umplere mai
mari in ventriculul stang. 2. S-au gasit corelatii sem-
nifcative statistic intre acest parametru si disfunctia
diastolica la pacientii hipertensivi, atat pe termen scurt
cat si pe termen lung. 3. VASI poate f considerat un
marker al presiunii de umplere crescute in ventriculul
stang la acesti pacienti.
Left atrial volume index in
hypertensive patients after
acute myocardial infarction
Purpose: Lef atrial volume index above 34ml/m2 af-
ter an acute myocardial infarction was associated with
increased mortality, independent of the presence of
mitral regurgitation. Diastolic dysfunction is very early
afer an acute myocardial infarction. Increased flling
pressure was also associated with a high rate of morta-
lity in these patients. Aim of the study was to fnd cor-
relations between LAVi and: echocardiographic aspects
and diastolic pattern of mitral infow in hypertensive
patients afer acute myocardial infarction.
Methods: A number of 98 hypertensive patients (56
males and 43 females), admitted with acute myocar-
dial infarction with ST-segment elevation were evalu-
ated during the frst week by: clinical examination, 12
lead standard ECG, echocardiographic measurements
dependent negative prognostic factor and is associated
with high in hospital mortality.
181. Indexul de volum
al atriului stang (IVAS)
la pacientii hipertensivi
postinfarct miocardic acut
Despina Manuela Toader, Rodica Musetescu, Monica
Popescu, D.D. Ionescu
Premise: Valori ale indexul de volum al atriului stang
(IVAS) mai mari de 34 ml/m2 postinfarct miocardic
acut au fost asociate cu mortalitate crescuta, indepen-
dent de prezenta regurgitarii mitrale. Disfunctia dias-
tolica este prezenta precoce dupa infarctul miocardic
acut, presiunile de umplere crescute in ventriculul
stang find de asemenea asociate cu cresterea mortali-
tatii la acesti pacienti.
Scopul studiului: a fost gasirea unor corelatii intre
IVAS si aspectele ecocardiografce, precum si intre
IVAS si pattern-ul diastolic mitral la pacientii hiper-
tensivi postinfarct miocardic acut.
Metoda: 98 de pacienti hipertensivi (56 barbati si 43
femei) internati cu diagnostic de IMA cu supradenive-
lare de segment ST au fost evaluati in prima saptama-
na de spitalizare prin: examen clinic, ECG 12 derivatii,
masurarea ecocardiografca a: indexului de volum al
atriului stang (IVAS) si a indexului de masa al ventri-
culului stang (IMVS) folosind ecocardiografa transto-
racica, valori limita: IVAS>34ml/m2, IMAS>131g/m2
la barbati si >125g/m2 la femei (hipertrofe de ventri-
cul stang, HVS), evaluarea pattern-ul fuxului Doppler
transmitral. FEVS masurata prin metoda Simpson a
fost in toate cazurile mai mica de 45%. Pacientii au fost
impartiti in 4 grupuri: 1. HVS+ si reperfuzie efcien-
ta 2. HVS+ care nu au prmit terapie de reperfuzie sau
cu reperfuzie inefcienta 3. HVS- si reperfuzie efcienta
4.HVS- fara reperfuzie sau cu reperfuzie inefcienta.
Rezultate: 1. Valorile medii ale VASI in timpul primei
saptamani de spitalizare, la pacientii cu HVS si fara
criterii de reperfuzie au fost 35,04, cu o deviatie stan-
dard (DS): 1,95 and coefcient de variatie (CV): 5,57,
comparativ cu pacientii hipertensivi fara HVS si cu be-
nefciu al terapiei trombolitice: 30,09 ml/m2, DS: 3,78
POSTER I I I
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Suplimentul A, 2010
200
sau fbrilatie ventriculara sau, prin permanentizare, re-
petitivitate si/sau evolutie pe cord afectat organic, pot
determina deteriorari hemodinamice severe. Ablatia
prin radiofrecventa, desi uneori difcil de realizat, vin-
deca in cea mai mare parte tahiaritmia.
Material si metoda: In Institutul de Boli Cardiovas-
culare Timisoara s-au internat in perioada noiembrie
1998-iulie 2010 un numar de 124 de pacienti cu tahi-
cardie ventriculara de ventricul drept, dintre care: 1.
tahicardie ventriculara de tract de ejectie de ventricul
drept 85 pacienti (68,54%), din care: a) 4 au degenerat
in fbrilatie ventriculara resuscitata prin SEE; b) 2 au
degenerat in futter ventricular resuscitata prin SEE. 2.
tahicardii ventriculare septale 6 pacienti (4,83%), din
care 1 pacient a prezentat TV cu caracter incesant; 3. ta-
hicardii de apex de ventricul drept 3 pacienti (2,41%);
4. tahicardie laterala dreapta subvalvulara 2 pacien-
ti (1,61%). Ablatia prin radiofrecventa s-a efectuat la
toti pacientii mentionati cu rata de succes de 90%. Din
numarul total de pacienti internati cu TV, 92 (74,19%)
pacienti au dezvoltat tahicardie ventriculara pe cord
aparent indemn, iar un substrat patologic a fost decelat
dupa cum urmeaza: - displazie de ventricul drept 6
pacienti (4,83%); - cardiopatie ischemica 8 pacienti
(6,45%); - valvulopatii 3 pacienti (2,41%); - hiperten-
siune arteriala 15 pacienti (12,09%).
Concluzie: Tahicardia ventriculara de ventricul drept
benefciaza de ablatie prin radiofrecventa mai ales cand
evolueaza pe cord aparent indemn, cu impact major
asupra prognosticului pacientului.
Right ventricle tachycardias
Background: Right ventricle tachycardias are not
always benign and may degenerate into ventricular fut-
ter or ventricular fbrillation or, by becoming perma-
nent, repetitive and/or evolution on a previous afected
heart, may lead to severe hemodynamic decompensati-
on. Radiofrequency ablation, although sometimes dif-
fcult to achieve, mostly cures the arrhythmia.
Method: From november 1998 to july 2010 there were
124 patiens with right ventricle tachycardia admitted
in Timisoara Institute of Cardiovascular Disease, as
follows: 1. right ventricle outfow tract tachycardia 85
patients (68,54%). Among them: a) 4 degenerated into
ventricular fbrillation, resuscitated by means of exter-
nal electric shock; b) 2 degenerated into ventricular
futter, resuscitated by means of external electric shock.
of: lef atrium volume index (LAVi) and lef ventricle
mass index (LVMi) using transthoracic echocardiogra-
phy, cut of levels: LAVi>34ml/m2, LVMi>131g/m2 in
males and>125g/m2 in females (lef ventricular hyper-
trophy, LVH), diastolic pattern of mitral infow using
Doppler echocardiography. LVEF measured by Simp-
son method was less than 45%. Patients were divided
in 4 groups: 1.LVH+ and reperfusion 2.LVH+ without
reperfusion 3.LVH- and reperfusion 4.LVH- without
reperfusion.
Results: 1. During the frst week of hospitalisation:
LAVi mean value in hypertensive patients with LVH
and without reperfusion was: 35,04, standard deviation
(SD): 1,95 and coefcient of variation (CV): 5,57, com-
pare to hypertensive patients without LVH and with
reperfusion criterias: 30,09 ml/m2, SD: 3,78 and CV:
12,56; p=0,00007. 2. Afer one year: LAVi mean value in
hypertensive patients with LVH and without reperfusi-
on was 36,35, SD:2,10, CV:5,77, compare to hypertensi-
ve patients without LVH and with reperfusion criterias:
31,20, SD:4,42, CV:14,15, p=0,00003. 3. Using chi squa-
red (CS), odd ratio (OR) and relative risk (RR) we found
signifcant correlation between LAVi>34ml/m2 and
LVMi: (CS=12,65518, OR= 4,949495, RR=1,724074),
LAVi and diastolic pattern CS=12,70696, during the
frst week afer acute myocardial infarction, before dis-
charge; LAVi and LVMi: CS=24,001872, LAVi and dias-
tolic pattern: CS=7,2975811, afer one year.
Conclusions: 1. Lef atrial volume index had higher
mean values in hypertensive patients with LVH and
without reperfusion criterias, who had an increased
flling pressure in lef ventricle during acute phase of
myocardial infarction. 2. We found a good correlation
between LAVi and diastolic dysfunction in hypertensi-
ve patients in short and long time afer acute myocardi-
al infarction. 3. LAVi could be considered a marker of
increased flling pressure in these patients.
182. Tahicardiile ventriculare
de ventricul drept
G.Ivanica, A.Gheorghiu, Eugenia Venescu, Lavinia
Albisoru, Alina Negru, A.Ivanica, C.Luca, C.Blaj,
S.Pescariu, St.I.Dragulescu
Premise: Tahicardiile de ventricul drept nu sunt intot-
deauna benigne si pot degenera in futter ventricular
Suplimentul A, 2010
201
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trasistole ventriculare la 18,75% copii din lotul de baza
vs 3,33% copii sanatosi (p<0,05), tahicardie sinusala in
75,50% cazuri cu PVM vs 43,33% cazuri din lot martor
(p<0,01) si tahicardii supraventriculare la 44,38% copii
cu PVM vs 13,33% copii sanatosi (p<0,001). Valorile
medii ale parametrilor spectrali a VRC au exprimat
predominarea parametrilor de frecventa joasa si foarte
joasa la copii cu PVM, lotul martor a demonstrat valori
mai mari a parametrilor spectrali de frecventa inalta.
Monitorizarea ambulatorie a TA timp de 24 ore a apre-
ciat valori medii ale TAs si TAd, ziua si noaptea cu di-
ferenta statistica nesemnifcativa in loturile de referinta
(p>0,05), FCC maxima ziua cu valori mai mari la copii
cu PVM: 120,932,79 c/min vs 110,523,94 c/min la
copii sanatosi (p<0,05).
Concluzii: Rezultatele studiului au confrmat predomi-
narea extrasistolelor supraventriculare la pacientii cu
PVM in 86,25% cazuri. Analiza VRC la monitorizarea
Holter ECG 24 ore a exprimat prezenta parametrilor
spectrali de frecventa joasa si foarte joasa la copii cu
PVM ce explica activitatea tonusului vegetativ simpa-
tic. Monitorizarea TA 24 ore nu a depistat diferente
semnifcative a valorilor medii a TAs si TAd in loturile
de referinta. Predominarea FCC maxime ziua la copii
cu PVM a explicat prezenta tonusului vegetativ initial
simpaticotonic si reactivitatii vegetative hipersimpati-
cotonice.
Features of hemodynamic and
heart rate variability at children
with mitral valve prolapse
Objective: Evaluation of the hemodynamic features
and heart rate variability at children with mitral valve
prolapse (MVP).
Materials and methods: Te study included 190 chil-
dren: I group 160 (84,2 %) children with mitral valve
prolapse, average age (13,320,23) years and II group
30 (15,79 %) healthy children, average age (12,20,72)
years, who were examined with ECG, ECG Holter mo-
nitoring over 24 hours, and monitoring blood pressure
over 24 hours.
Results: In 75,62% cases the syndrome of an early re-
polarization in the lef ventricle myocardium prevails
at children with MVP versus (vs) 23,33% healthy chil-
dren (p<0,001). Rhythm disorders: supraventricular
extrasystoles have been determined in 32 (16,84%)
2. septal ventricular tachycardia 6 patients (4,83%),
one of them presenting incessant ventricular tachycar-
dia; 3. right ventricular apex tachycardia 3 patients
(2,41%); 4. lateral right subvalvular tachycardia 2
patients (1,61%). All patient were treated by radio-
frequency ablation, with a 90% rate of succes. Among
all patients with ventricular tachycardia, in 92 (74,19%)
of them a pathological substrate was not identifed.
Among the remaining, we could fnd the following: -
right ventricle dysplasia 6 patients (4,83%); - ische-
mic heart disease 8 patients (6,45%); - valvular heart
disease 3 patients (2,41%); - systemic hypertension
15 patients (12,09%).
Conclusion: Right ventricular tachycardia can be
treated by radiofrequency ablation, especially when it
appears in patients with appartently normal heart con-
dition, having a major impact upon the patients pro-
gnosis.
183. Particularitatile
hemodinamice si variabilitatii
ritmului cardiac la copii cu
prolaps de valva mitrala
Lilia Romanciuc, N.Revenco
Institutul de Cercetari Stiintifce in Domeniul Ocrotirii
Sanatatii Mamei si Copilului, Chisinau, Moldova
Scopul lucrarii: Evaluarea particularitatilor hemodi-
namice si variabilitatii ritmului cardiac (VRC) la copii
cu prolaps de valva mitrala (PVM).
Material si metode: Studiul a fost efectuat pe un lot
de 190 copii: 160 (84,2%) copii cu PVM, varsta medie
13,320,23 ani si 30 (15,79%) copii sanatosi (lot mar-
tor), varsta medie 12,20,72 ani (p>0,05), examinati
ECG, ECG Holter monitorizare timp de 24 ore si mo-
nitorizarea ambulatorie a TA timp de 24 de ore.
Rezultate: Sindromul repolarizarii precoce in miocar-
dul ventriculului stang a predominat la copii cu PVM
in 75,62% vs 23,33% copii din lot martor (p<0,001).
Dereglari de ritm: extrasistole supraventriculare la 32
(16,84%) copii, cu predominarea in lotul de baza in 29
(18,12%) vs 3 (10,0%) cazuri din lot martor (p>0,05).
Monitorizarea Holter ECG timp de 24 ore a permis
depistarea extrasistolelor supraventriculare in 86,25%
copii cu PVM vs 13,33% copii sanatosi (p<0,001), ex-
POSTER I I I
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Suplimentul A, 2010
202
renala in stadiu terminal), in program de hemodializa
cronica 3 sedinte / saptamana. Pacientii au fost exami-
nati clinic si li s-a efectuat EKG de suprafata inainte
de sedinta de dializa; au fost masurate manual pe trei
cicluri cardiace succesive, valorile intervalului QT, ale
dispersiei QT, intervalul QT corectat-QTc(formula Ba-
zett) si disperse QTc. Inainte si dupa sedinta de dializa
au fost determinate si valorile electrolitilor, ureei si cre-
atininei serice. Dispersia intervalelor QT si QTc de la
pacienti a fost comparata cu valorile similare obtinute
la 20 copii sanatosi, fara antecedente de afectare renala
si / sau cardiovasculara cat si valorile similare obtinute
la 10 copii cu glomerulonefrita acuta postinfectioasa.
Rezultate: Valorile dispersiei QT si QTc la pacientii cu
IRC tratati cu hemodializa cronica au fost mai mari de-
cat cele la copii sanatosi in 10/15 cazuri si la 4/10 cazuri
la copii cu glomerulonefrita acuta postinfectioasa. Va-
lorile medii ale dispersiei intervalelor QT si QTc: *co-
piii cu insufcienta renala cronica dispersia QT: 59,67
21,32 msec si dispersia QTc: 77,25 44msec; *copiii cu
glomerulonefrita acuta postinfectioasa: dispersia QT:
46,86 20,3 msec si dispersia QTc: 71,58 31,22 msec;
*lotul martor:dispersia QT: 399,63 msec si dispersia
QTc: 64,2811,45 mses. Chiar daca dispersia QT si QTc
este mai mare in cazurile cu glomerulonefrita acuta
postinfectioasa decat la subiectii sanatosi, acestea sunt
semnifcativ mai mici decat cele la copiii cu insufcienta
renala cronica. Nu a putut f stabilita nici o corelatie
intre cresterea dispersiei QT/QTc si modifcarile bio-
chimice dinn timpul sesiunii de hemodializa.
Concluzie: Cresterea semnifcativa a dispersiei QT si
in special a dispersiei intervalul QTc la copii in stadii
avansate de insufcienta renala cronica, chiar daca a
fost prezenta doar cu o incidenta moderata, constituie
o indicatie utila investigare de rutina a acestor parame-
tri EKG. Dispersia intervalelor QT si QTc este un mar-
ker util pentru estimarea riscului ridicat de aritmii ven-
triculare grave la copiii cu insufcienta renala cronica
Study of changes in QT/QTc
intervals dispersion in children
with chronic renal failure
dialysed
Purpose: To investigate the utility of electrocardiogra-
phic study of QT and QTc dispersion, in children with
children, with prevails in the I group in 29 (18,12%)
vs 3 (10,0%) II group and ventricular extrasystoles in
12 (7,50%) only I group (p>0,05). Ambulatory ECG
monitoring for 24 hours have been determined supra-
ventricular extrasystoles in 86,25% cases with MVP
vs 13,33% healthy children (p<0,001), ventricular ex-
trasystoles in 18,75% cases I group vs 3,33% II group
(p<0,05), sinus tachycardia in 75,50% children with
MVP vs 43,33% healthy children (p<0,001) and su-
praventricular tachycardia in 43,38% cases I group vs
13,33% II group (p<0,001). Spectral parameters of the
heart rate variability at children have been calculated
during 24 hours period and there were observed a pre-
valence of waves with low and very low frequency at
children with MVP. Monitoring blood pressure over 24
hours has revealed, average values of systolic and dyas-
tolic blood pressure day and night without statistical
distinctions (p>0,05), the maximum pulse in the afer-
noon with the high average values at children with mi-
tral valve prolapse: 120,932,79 b/min vs 110,523,94
b/min in healthy children (p<0,05).
Conclusions: Results of the study showed that MVP
are associated with supraventricular extrasystoles in
86,25% cases. Analysis of the heart rate variability on
ECG Holter monitoring over 24 hours, demonstrates
prevalence of waves with low and very low frequency
at children with MVP, an autonomic imbalance charac-
terized by sympathetic over activity. Monitoring blood
pressure over 24 hours has revealed, average values of
systolic and dyastolic blood pressure day and night wi-
thout statistical distinctions between research groups.
184. Studiul modificarilor
dispersiei intervalelor QT/QTc
la copiii cu insuficienta renala
cronica dializati
A.G.Dimitriu, Genoveva Hiastru, Lavinia Dimitriu
Universitatea de Medicina si Farmacie Gr T Popa, Iasi
Scopul lucrarii: Cercetarea utilitatii studiului disper-
siei intervalelor QT si QTc, la copiii cu insufcienta
renala cronica (IRC) afati in program de hemodializa
cronica.
Material si metoda: Pacienti: 15 copii, varsta intre 12-
17 ani, cu IRC in ESRD-end stage renal disease (boala
Suplimentul A, 2010
208
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185. Evaluarea disfunctiei
diastolice de ventricul stang
la bolnavii asimptomatici
cu diabet zaharat tip 2,
necomplicat
Mihaela Ioana Bolog, Mihaela Dumitrescu, Elena
Pacuraru, Florentina Romanoschi, Simona Crintea,
Gabriela Badea, Gina Ursu, M.Tudose, Ileana Craci-
unescu
Spitalul Militar de Urgenta "Agrippa Ionescu", Bucuresti
Scopul lucrarii: Deteminarea precoce a afectarii mio-
cardului in diabetul zaharat este importanta deoarece
poate infuenta decizia terapeutica. Obiectivul lucrarii
a fost evaluarea disfunctiei diastolice la pacientii cu
diabet zaharat tip 2, corect controlat, asimptomatici si
fara complicatii cunoscute.
Metoda: Au fost examinati ecocardiografc 48 de bol-
navi cu diabet zaharat tip 2, corect controlat, 20 femei
si 28 barbati, cu varsta intre 36 si 74 ani,asimptomatici
si fara : boala cardiaca ischemica, valvulopatii, insu-
fcienta cardiaca, fbrilatie atriala, HTA severa,boala
arteriala periferica, complicatii ale diabetului zaharat,
boala cronica de rinichi. Functia diastolica a fost eva-
luata prin metode conventionale (parametrii de fux
transmitral), doppler tisular miocardic, doppler mod
M color. In vederea diferentierii patternului normal
de cel pseudonormal s-a folosit manevra Valsalva si
examenul doppler venos pulmonar. Masa ventriculara
stanga a fost determinata prin formula Devereux. Au
fost inclusi doar pacientii cu FE peste 50%.
Rezultate: Din cei 48 bolnavi 25 (75%) au prezen-
tat disfunctie diastolica tip alterarea relaxarii, 2 bol-
navi(4,1%) au prezentat pattern restrictiv si 9 bolnavi
(18,7%) aveau pattern pseudonormal. Disfunctia di-
astolica a fost mai frecventa la bolnavii care asociau
HTA comparativ cu cei normotensivi (66% vs 33%),
dar gradul de severitate al disfunctiei diastolice nu s-a
corelat cu gradul hipertrofei ventriculare (220 21 g
la bolnavii cu disfunctie diastolica moderata si severa
vs 211 32 g la cei cu disfunctie diastolica tip alterarea
relaxarii).
Concluzii: 75% din pacientii cu diabet zaharat tip 2,
corect controlati si asimptomatici au prezentat disfunc-
tie diastolica.Dintre acestia 66,6% aveau HTA usoara
sau moderata, iar 33,3% erau normotensivi. Severitatea
disfunctiei diastolice nu s-a corelat cu masa ventricu-
lara. Examenul Doppler tisular s-a dovedit a f extrem
chronic renal failure treated with chronic haemodi-
alysis.
Materials and methods: Patients: 15 patients, aged
between 12-17 years, with chronic renal failure in ESRD
(end stage renal disease), treated with haemodialysis
in 3 sessions/week. All patients have been clinically
examined and surface electrocardiogram to manually
measure on three successive cardiac cicles the values
of QT interval, QT dispersion and corrected QT(QTc)
dispersion (Bazetts formula) was performed before the
dialysis session. We also investigated values of plasma
electrolytes, serum urea, creatinine, which was deter-
mined before and afer the dialytic session. Dispersions
of QT and QTc intervals in these patients were compa-
red to similar values from 20 healthy children, without
any history of renal and/or cardiovascular disease and
also to those measured in 10 children with acute post-
infectious glomerulonephritis.
Results: Te QT dispersion and QTc dispersion values
in patients with chronic renal failure treated with chro-
nic haemodialysis were higher than those in normal
children in 10/15 cases and in 4/10 cases with acute
postinfectious glomerulonephritis. In children with
chronic renal failure QT dispersion: 59,67 21,32msec
and QTc dispersion: 77,25 44msec, while in children
with acute postinfectious glomerulonephritis QT dis-
persion: 46,86 20,3msec, and QTc dispersion: 71,58
31,22msec. Even if QT dispersion and QTc dispersion
are higher in cases with acute postinfectious glomeru-
lonephritis than in normal subjects, they are signif-
cantly lower than those in children with chronic renal
failure. We could not establish any correlation between
the increased QT dispersion and the biochemical chan-
ges during the haemodialysis session.
Conclusion: Te signifcant increasing in QT dispersi-
on and especially in QTc interval dispersion in children
in advanced stages of chronic renal failure, even with a
moderate frequency, are indicators for common inves-
tigation of these ECG parameters; the QT dispersion
is one precious marker for predicting the high risk of
severe ventricular arrhythmias in children with chro-
nic renal failure.
POSTER I I I
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Suplimentul A, 2010
201
186. Trombembolismul
pulmonar tendinte de
reconfigurare
Luminita Ionescu, I.Stanca, L. Ionescu, S. Barsan, A.
Popescu, L.Arama, S. Huidu, I. Stanca, M. Melnic, L.
Ghilencea, Doina Dimulescu
Premize: Trombembolismul pulmonar este o patologie
frecventa, asociata cu o rata de mortalitate ridicata, ce
poate f redusa prin diagnostic promt, o stratifcare pre-
coce dupa risc si tratament intensive.
Scopul: a fost identifcarea unor elemente de prognos-
tic la pacientii cu TEP confrmat si, eventual, a unor
date noi de etiologie sau de factori predispozanti.
Material si metoda: studiul a inclus 75 pacienti 34
barbati si 41 femei cu varste cuprinse intre 41 si 88
de ani, care s-au internat consecutiv intre 01.01.2009
si 31.05.2010 la Spitalul Elias Bucuresti; pacientii au
fost examinati clinic(TA sistolica, HR, SaO2, comorbi-
ditati tumori, IC, BPOC, IRC, TVP, recidive TEP);
markeri pentru stratifcarea riscului (VD, VD/VS, hi-
pokinezie VD, gradient VD-AD), troponina I, markeri
electrici(BRD major, T negativ V1-V3, S1Q3T3); bol-
navii au benefciat de CT multidetector pentru confr-
marea TEP.
Rezultate: Dispneea a fost prezenta la 70 p (93%), ca
motiv de prezentare, 3p (4%) s-au prezentat pentru
sincopa, 2p (2,4%) pentru fatigabilitate; 35p(46,6%)
au prezentat tahicardie >90BPM, 8p (10,6%)- hipo-
tensiune sau soc, 12p (16%) Sao2 <90%; 17p (22,6%)
au prezentat TVP clinic si la inca 4 p (5,33%)s-a gasit
TVP la examen Doppler vascular; 3p (4% )au avut
tromboza AD; 32% au prezentat tumori, iar in grupul
cu varsta mai mare de 50 de ani 45% au avut cancer
(8p 10,66% au avut tumori digestive- colon pancreas,
stomac; 2p 2,66% au avut neo mamar; 7p 9,33% au
avut neo genital si 1p 1,33% neoplasm pulmonar).36
p (48%) au avut alte stari patologice (BPOC, IRC, bron-
siectazii). 4 p (5,3%) au facut TEP postoperator (gineco
1p si chirurgie ortopedica 3p). La pacientii cu varsta
sub 50 de ani 4p, toti au prezentat tulburari de coagu-
lare. 9p (12%) au prezentat recidiva TEP, dar riscul de
TEP fatal nu s-a corelat cu recidiva. 7p (9,3%)au avut
troponina pozitiva; 20p (26,6%) BRD major; 12p (16%)
S1Q3T3 si 46 p (61,3%) au prezentat VD >30mm,
52p(69,3%) au prezentat VD/VS>0,6 ecografc si 39p
(52%) hipokinezie de VD. Privind tratamentul toti cei
de util si salvator de timp in diferentierea patternului
pseudonormal.
Left ventricular diastolic
dysfunction in asymptomatic
type 2 diabetic patients with no
evidence of complications
Background: Early determination of myocardial mani-
festations of diabetes is important since it may inf uen-
ce the therapeutic decisions.
Te aim of the study was to evaluate the prevalence
of distolic dysfunction in asymptomatic patients with
type 2 diabetes mellitus, with no evidence of complica-
tions and a good glycemic control.
Methods: Echocardiography was performed in 48 type
2 diabetic patients, 20 women and 28 men, aged between
36 and 74 ani, asymptomatics with good glycemic con-
trol and without: ischemic heart disease,valvulopaties,
heart failure,atrial fbrillation,severe hypertension, pe-
ripheral arterial disease,complications of dibetes, chro-
nic kidney disease. Diastolic function was evaluated by
conventional echocardiography (transmitral fow velo-
city), myocardial tissue doppler, color M-mode propa-
gation velocity.To unmask a psedonormal pattern we
used the Vvalsalva maneuver and pulmonary fow re-
cordings.Lef ventricular mass was assesd by Devereux
formula. Patients with EF 50% were excluded.
Results: Diastolic dysfunction had 36 patients (75%),
impaired relaxation type had 25 patients (52%), 2
patients (4,1%) had restrictive pattern and 9 pati-
ents(18,7%) had pseudonormal pattern. Diastolic dys-
function was more frecquent in hypertensive vs nor-
motensive patients (66% vs 33%), but the severity did
not correlate with the lef ventricular mass (220 21 g
in patients with moderate/severe diastolic dysfunction
vs 211 32 g in patients with impaired relaxation).
Conclusions: 75% of asymptomatic patients with
type 2 diabetes mellitus, with no evidence of com-
plications and a good glycemic control presented
diastolic dysfunction. 66,6% had mild to moderate
hypertension,and 33,3% were normotensive. Te seve-
rity of diastolic disfunction did not correlate with the
lef ventricular mass. Myocardial tissue Doppler proved
to be extremely useful and time sparing in unmasking
pseudonormal pattern.
Suplimentul A, 2010
205
POSTER I I I
POSTER I I I
had tumors and the group older than 50 years - 45%
had cancer (8p - 10.66% had gastrointestinal tumors -
colon pancreas, stomach, 2p - 2.66% had breast neo,
7P - 9.33% had genital neo and 1p - 1.33% lung cancer)
.36 p (48%) had other pathologic conditions ( COPD,
IRC bronchiectasis). 4 g (5.3%) did PTE surgery (ort-
hopedic surgery gineco 1p and 3p). In patients under
50 years - 4p, all showed clotting. 9p (12%) presented
relapse PTE, but the risk of fatal PTE did not corre-
late with relapse. 7P (9.3%) had positive troponin,
20p (26.6%) major BRD, 12p (16%) S1Q3T3 and 46 p
(61.3%) had VD> 30mm, 52p (69.3%) had VD / VS>
0.6 ultrasound and 39p (52%) of RV hypokinesia. Te
treatment of all 8 patients with high risk PTE throm-
bolysed not having contraindications, 18p (24%) recei-
ved heparin fractional and 32P (42.6%), unfractionated
heparin. PTE showed massive 8p (10.6%), of which six
have died (8%) - two men and four women. Death rate
was correlated with positive trop (p = 0.09), major BRD
(P = 0.2) and did not correlate with recurrence of PTE.
Conclusions: 1. PTE clinical score can not be standar-
dized, yet it is rarely achieved as PTE surgery (hep wi-
dely used to split), in contrast to patients over 50 years
have sought a tumor (digestive, genital, breast, lung)
and the young - a defciency of coagulation. 2. Report
RV / LV> 0.6 ultrasound in conjunction with statisti-
cal diagnosis of acute PTE is practically easy to deter-
mine, in March. Tere were no statistically signifcant
diferences in mortality or relapse, the treatment with
unfractionated heparin in patients with broken or PTE
without high risk.
187. Asocierea unica a doua
mecanisme intr-o tahicardie
incesanta cu interval RP lung
R.G.Vatasescu, C.N.Iorgulescu, R.Alexandru
Femeie de 71 ani, cu un istoric de peste 30 ani de epi-
soade de palpitatii, s-a prezentat pentru palpitatii ince-
sante. Examenul clinic a fost in limite normale. ECG-ul
in ritm sinusal a fost normal. ECG-ul in timpul pal-
pitatiilor a aratat o tahicardie cu QRS ingust, cu de-
but din ritmul sinusal, RP mai lung decat PR si doua
morfologii diferite ale undei P, desi lungimea de ciclu
8 pacienti cu TEP cu risc inalt nu au fost trombolizati,
avand contraindicatii; 18p (24%) au primit heparina
fractionata si 32p (42,6%) heparina nefractionata. TEP
masiv au prezentat 8p (10,6 %), dintre care 6 au decedat
(8%) 2 barbati si 4 femei. Rata de deces s-a corelat
cu trop pozitiva (p=0,09), BRD major (p=0,2) si nu s-a
corelat cu recidiva de TEP.
Concluzii: 1. Scorul clinic de TEP nu poate f standar-
dizat, totusi s-a obtinut ca TEP e rar postoperator (folo-
sire pe scara larga a hep fractionate), in schimb la paci-
entii peste 50 de ani trebuie cautata o tumora(digestiva,
genitala, san, pulmonar), iar la cei tineri un defcit de
coagulare. 2. Raportul VD/VS>0,6 ecografc, coroborat
statistic cu diagnosticul de TEP acut este practic, usor
de determinat; 3. Nu au existat diferente semnifcativ
statistic de mortalitate sau recidiva, privind tratamen-
tul cu heparina fractionate sau nefractionata la pacien-
tii cu TEP fara risc inalt.
Pulmonary embolism - trends
reconfiguration
Background: Pulmonary embolism is a common
pathology associated with a high mortality rate, which
can be reduced by prompt diagnosis, risk stratifcation
and early afer intensive treatment.
Purpose: to identify the elements of prognosis in pa-
tients with confrmed pulmonary tromboembolism
(PTE) possibly new data on etiology and predisposing
factors.
Methods: Te study included 75 patients - 34 men and
41 women aged between 41 and 88 years who were
hospitalized consecutively between 01/01/2009 and
05/31/2010 at Elias Hospital Bucharest, patients were
examined clinically ( systolic BP, HR, SaO2, comorbi-
dities - tumors, C., COPD, IRC, DVT, recurrence PTE)
markers for risk stratifcation (RV, RV / LV, hypokine-
sia VD, VD-D gradient), troponin I, Electric markers
(BRD major negative T V1-V3, S1Q3T3) patients re-
ceived multidetector CT to confrm PTE.
Results: Dyspnea was present in 70 p (93%) as a reason
for presentation, 3p (4%) were presented for synco-
pe, 2p (2.4%) for fatigue, 35p (46.6%) had tachycar-
dia> 90BPM, 8p (10.6%) - hypotension or shock, 12p
(16%) Sao2 <90%, 17p (22.6%) had clinical DVT and
another 4 p (5.33%) was found DVT on Doppler vas-
cular examination, 3p (4%) had thrombosis AD, 32%
POSTER I I I
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Suplimentul A, 2010
206
the tricuspid annulus showed atrial primoactivation
on the Hiss catheter, suggesting an atypical form of AV
nodal reentrant tachycardia or a concealed parahissian
accessory pathway. RF application during the tachycar-
dia in the area of earliest atrial activation without a Hiss
potential did not stop the tachycardia. Radiofrequency
was then applied during sinus rhythm in the area with
slow pathway potential, inducing an accelerated juncti-
onal rhythm. Post-ablation testing showed tachycardia
noninducibility and concentric decremental retrograde
conduction with short VA interval. Conclusions: Te
case represents the frst report of a unique association
between a Coumel type lef posterior CBT and atypi-
cal fast-slow AV nodal reentrant tachycardia.
188. Tromboembolismul venos
si insuficienta cardiaca o
asociere frecventa
Rodica Avram, Livia Branzan, M.Balint, D.Pascut,
Simina Laicu, Mariana Tudoran, Florina Parv, Dema
Alis, T.Ciocarlie, V.Moga
Scopul lucrarii: Scopul lucrarii il constituie stabilirea
prevalentei EP si TVP la pacientii internati in Clinica
de Cardiologie pentru IC si alte boli cardiovasculare,
evaluarea mortalitatii globale si pe grupuri de comor-
biditati, si aprecierea datelor clinice si demografce la
pacientii cu TVP si respectiv EP.
Material si metoda: Am inclus pacienti internati in cli-
nica noastra in ultimii 3 ani, evaluand caracteristicile
clinice, etiologice ale IC si ale altor patologii cardiace,
mortalitatea globala si mortalitatea pe grupe de patolo-
gii, datele demografce si clinice ale pacientilor cu TVP,
respectiv EP.
Rezultate: 127 pacienti cu tromboembolism venos
(TEV) au fost spitalizati in clinica noastra cu varste in-
tre 17 si 83 de ani. Au fost 50 (39,37%) de cazuri de
IC, 60 (47,2%) de cazuri de hipertensiune, 17 (13,3%)
de cazuri de fbrilatie atriala si 30 (23,6%) de cazuri de
boala coronariana. 74 de pacienti au fost diagnosticati
cu embolie pulmonara conform ghidurilor actuale (D-
Dimeri, ecocardiografe, eco doppler, si angio CT) si 53
p au fost diagnosticati cu tromboza venoasa izolata (D-
Dimeri si ecografe vasculara). Repartitia anuala arata
s-a mentinut relativ constanta. S-a efectuat studiu elec-
trofziologic cu pozitionarea unui cateter decapolar in
sinusul coronar. S-a indus prin stimulare programata o
tahicardie reintranta cu interval V-A lung, cu cel mai
scurt interval V-A la nivelul perechii a treia de elec-
trozi de la nivelul cateterului de sinus coronar. Maparea
inelului mitral prin abord retrograd transaortic a ara-
tat primoactivare atriala retrograda la nivelul regiunii
posterioare. Dupa aplicatia de radiofrecventa (RF) in
aceasta regiune tahicardia nu s-a oprit iar primoactiva-
rea atriala a trecut la nivelul ostiului sinusului coronar.
Maparea regiunii medioseptale a inelului tricuspidian
a aratat primoactivare atriala pe cateterul de His, suge-
rand o forma atipica de reintrare AV intranodala sau o
cale accesorie oculta parahisiana. Aplicarea de radio-
frecventa in timpul tahicardiei in zona cea mai precoce
de activare atriala retrograda fara potential de His nu a
oprit aritmia. Ulterior s-a aplicat radiofrecventa in ritm
sinusal in zona cu potential de cale lenta cu inducerea
unui ritm jonctional accelerat. Testarea post ablatie a
aratat non-inductibilitatea tahicardiei si conducere re-
trograda excentrica cu interval VA scurt. Concluzie:
acest caz este prima raportare a unei asoceri unice de
fascicul ocult stang de tip Coumel si tahicardie atipi-
ca intranodala forma fast-slow.
Unique association of two
rare mechanism in a long RP
incessant tachycardia
A 71 years old women presented for incessant episodes
of palpitations, with a history of over 30 years. Physical
examination was normal. ECG during sinus rhythm
was normal. ECG during the tachycardia showed a
narrow QRS tachycardia which started during si-
nus rhythm, with RP longer than PR and 2 discrete
morphologies of the P wave despite relatively stable
CL. During EP study a decapolar catheter was placed in
the coronary sinus. A long VA tachycardia was induced
using programmed extrastimulus, showing the shortest
VA on the third pair of electrodes on the coronary si-
nus catheter. Mapping of the mitral annulus during ta-
chycardia by retrograde transaortic approach revealed
retrograde atrial primoactivation in the posterior regi-
on. Afer RF application in this region tachycardia did
not stop and retrograde atrial primoactivation swiched
on CS ostium. Mapping of the medio-septal region of
Suplimentul A, 2010
20I
POSTER I I I
POSTER I I I
HF, VTE was present in 4 p(10,81%). In 2009 36 p died
from HF, VTE was present in 3 cases (8,33%). Te se-
verity of HF is in direct correlation (p<0,03) with the
clinic form of pulmonary thromboembolism and is less
correlated with age (p<0,07). 7 deaths were in patients
with NYHA 4 HF.
Conclusions: We observed an increase of HF-VTE
correlation but also an increase in independent VTE.
Te predominant afected age group was above 50. Te
risk for VTE doubles in heart failure and mortality is
clearly higher in these cases (although some cases were
not recognized because of family refusal of autopsy).
189. Relatia dintre rigiditatea
arteriala si presiunile de
umplere ventriculare stangi
la pacientii cu cardiomiopatie
hipertrofica
Monica Rosca, Andreea Calin, B.A.Popescu, Carmen
Beladan, Elena C Popa, Denisa Muraru, Ruxandra
Jurcut, Vriz Olga, F.Antonini-Canterin, Carmen Gin-
ghina
Bucuresti
Premize: Date recente din literatura sugereaza ca rigi-
ditatea aortica este crescuta la pacientii cu cardiomi-
opatie hipertrofca (CMH). Proprietatile mecanice la
nivel local, carotidian, semnifcatia clinica a alterarii
acestora si relatia cu functia ventriculara stanga (VS)
nu au fost inca studiate la acesti pacienti.
Scop: Ne-am propus sa evaluam proprietatile mecanice
carotidiene folosind un sistem echo-tracking cu inalta
rezolutie spatiala si relatia dintre rigiditatea carotidiana
si functia VS la pacientii cu CMH.
Metoda: Am inrolat prospectiv 27 de pacienti conse-
cutivi (5214 ani, 15 barbati) cu CMH si 27 subiecti
normali, similari ca varsta si sex (lotul control). Tuturor
subiectilor inclusi in studiu li s-a efectuat un examen
ecocardiografc complet, incluzand parametri de func-
tie sistolica si diastolica evaluati prin Doppler tisular.
In grupul de pacienti, presiunile de umplere VS s-au
estimat utilizand raportul E/E. Indicele de rigiditate
arteriala ( index), modulul elastic presiune-rigiditate
38 de p cu TEV (17 barbati (b)/21 femei (f)) in 2007 din
care 13 (10,23%) au avut IC (NYHA II-IV). In 2008 au
fost 60 de cazuri de VTE (25b/35f) din care 23(37,7%)
au avut IC. In 2009, din cei 29p (6b/23f) cu TEV, 9
(32,14%) au avut IC. In anul 2007 33 p au decedat prin
IC, la 2 dintre ei find prezent TEV. In 2008, din cele
37 de decese prin IC, TEV a fost prezent in 4 cazuri
(10.81%). In 2009, 36 p au decedat prin IC iar TEV a
fost diagnosticat in 3 cazuri (8,33%). Severitatea IC se
coreleaza direct (p<0,03) cu forma clinica de trombo-
embolism pulmonar, mai putin cu varsta (p<0,07), iar
decesele au survenit la 7 pacienti cu IC NYHA IV.
Concluzii: Am observat o crestere a corelatiei IC-TEV
dar si o crestere a cazurilor de TEV izolata. Cea mai
afectata grupa de varsta a fost <50 de ani. Riscul de
TEV se dubleaza in IC iar mortalitatea este evident mai
mare in aceste cazuri (desi unele cazuri nu sunt recu-
noscute din cauza refuzului autopsiei de catre familii).
Venous thromboembolism
and heart failure a frequent
association
Aims: Te aim of the study is to assess prevalence of PE
and DVT in patients admitted in our Cardiology Clinic
for HF and other cardiac disorders.
Material and methods: We included p admitted in our
clinic in the past 3 years, assessing clinical and etiolo-
gical features of HF and other cardiac disorders, global
mortality and mortality by groups of disorders, demo-
graphic and clinical data of p with DVT and PE respec-
tively.
Results: 127p with VTE were hospitalized in our clinic
aged 17-83, 50 (39,37%) of whom had HF, 60(47,2%)
had hypertension, 17 (13,3%) had atrial fbrillation
and 30 (23,6%) had coronary heart disease. 74P were
diagnosed with PE (with or without DVT) according
to current guidelines (D-Dimers, echocardiography,
venous doppler ultrasonography and angio CT) and
53 p were diagnosed with isolated DVT . Repartition
by year showed the following: in 2007, 38p with VTE
(17m/21f) 13(10,23%) of whom had HF (class II-IV
NYHA), in 2008 there were 60p with VTE (25m/36f)
23(37,7%) of whom had HF and in 2009, of the 29p
(6m/22f) with VTE, 9 (32,14%) had HF (NYHA class
II-IV ). In 2007, 33 p died from HF, VTE was present
in 2 (6,06%) cases. In 2008 there were 37 deaths from
POSTER I I I
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Suplimentul A, 2010
208
and gender- matched control subjects (5214 years, 15
men). A comprehensive echocardiogram was perfor-
med, including TDI-derived parameters of LV diastolic
and systolic function. In pts, LV flling pressures were
assessed using the E/E ratio. Arterial stifness index (
index), pressure-strain elastic modulus (Ep), arterial
compliance (AC), augmentation index (AIx), and local
pulse-wave velocity (PWV) were obtained in all sub-
jects at the level of the right common carotid artery.
Results: Tere were no signifcant diferences between
the two groups with respect to height, heart rate, blood
pressure values at the time of examination, prevalence
of hypertension or hypercholesterolemia (p>0.05 for
all). Pts had higher body mass index (285 vs 254
kg/m2, p=0.03). Arterial stifness index ( index) was
signifcantly higher in pts than in controls (9.03.6 vs
6.82.9, p=0.02) and had a direct correlation with E/E
(r=0.43, p=0.03), but not with peak S wave or with LV
ejection fraction (p>0.05 for both). None of the other
arterial function parameters were signifcantly diferent
between the two groups. Local PWV was marginally
higher in pts (6.31.5 vs 5.61.1, p=0.06).
Conclusions: In patients with HCM, arterial stifness
is signifcantly increased, which could have detrimental
consequences on LV performance. In our study popu-
lation arterial stifness had a direct, signifcant correla-
tion with LV flling pressures. Te clinical relevance of
these fndings needs further study.
190. Parametrii de rigiditate
arteriala evaluati prin echo-
tracking impactul varstei si
greutatii in populatia sanatoasa
Maria Florescu, Stefania Magda, Oana Enescu, Andrea
Ciobanu, M.Cinteza, D.Vinereanu
Premize. Rigiditatea arteriala este considerata un de-
terminant important al bolii aterosclerotice, datorita
faptului ca modifcarile proprietatilor elastice ale ar-
terelor mari apar precoce in evolutia bolii. Pentru ca
masurarea parametrilor de rigiditate arteriala sa fe in-
trodusa in practica clinica curenta, este esential sa fe
defnite valorile de referinta, precum si modifcarile
acestora cu varsta.
(Ep), complianta arteriala (CA), indicele de augmenta-
re (AIx), si velocitatea pulsului la nivel local (PWV) au
fost masurate la toti subiectii la nivelul arterei carotide
comune drepte.
Rezultate: Nu au existat diferente intre grupuri in ceea
ce priveste inaltimea, frecventa cardiaca, valorile tensiu-
nii arteriale in momentul examinarii, prevalenta hiper-
tensiunii arteriale sau a hipercolesterolemiei (p>0.05
pentru toti parametrii). Indicele de masa corporala a
fost crescut in grupul cu CMH (285 vs 254 kg/m2,
p=0.03). Indicele de rigiditate arteriala ( index) a fost
semnifcativ mai mare in grupul de pacienti comparativ
cu lotul control (9.03.6 vs 6.82.9, p=0.02). In grupul
de pacienti index s-a corelat cu E/E (r=0.43, p=0.03),
dar nu cu S sau cu fractia de ejectie VS (p>0.05 pentru
ambii parametri). Nici unul dintre ceilalti parametri
de functie arteriala nu au fost diferiti intre cele doua
grupuri. Velocitatea pulsului la nivel local (PWV) a fost
marginal mai mare in grupul de pacienti (6.31.5 vs
5.61.1, p=0.06).
Concluzii: La pacientii cu CMH, rigiditatea arteriala
carotidiana este semnifcativ crescuta si poate avea con-
secinte negative asupra functiei VS. In studiul nostru,
rigiditatea arteriala a avut o corelatie directa, semnif-
cativa cu presiunile de umplere VS. Relevanta clinica a
acestor rezultate necesita studii ulterioare.
Arterial stiffness and
its relationship with left
ventricular filling pressures
in patients with hypertrophic
cardiomyopathy
Background: It has been recently suggested that aortic
stifness is increased in patients (pts) with hypertrophic
cardiomyopathy (HCM). Tere is lack of information
about local stifness at the carotid artery level, and
about its clinical signifcance and relationship with lef
ventricular (LV) performance in pts with HCM.
Purpose: Te aim of the study was to assess the carotid
mechanical properties in pts with HCM using a high
spatial resolution echo-tracking system and to evaluate
the correlations between arterial stifness and LV func-
tion in this setting.
Methods: We have prospectively enrolled 27 consecu-
tive pts (5214 years, 15 men) with HCM and 27 age-
Suplimentul A, 2010
209
POSTER I I I
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sease, diabetes, hypertension, or dyslipidemia were stu-
died. Height and weight were measured and the body
mass index (BMI) was calculated. Arterial mechanics
was evaluated at the right common carotid artery
(RCCA) by an ultrasound machine (Aloka with a 7.5
MHz linear array probe) implemented with an echo-
tracking system. RCCA diameter and blood-velocity
change waveforms was obtain and, by calibrating for
BP, pressure-elastic modul (Ep), pressure independent
stifness index (), augmentation index (Aix), arterial
compliance (AC), and a single point local wave speed
(LWS) were provided. Intima media thickness (IMT)
was also measured at the same level.
Results: Age and BMI were strongly correlated with Ep,
, Aix, LWS, and IMT (r = 0.73, r = 0.75, r = 0.65, r =
0.76, r = 0.72, all p <0.0001), and inversely related with
AC (r = -0.65, p<0.0001), in both men and women. Ep,
, and LWS increased with age (all, p<0.0001) non-li-
nearly with accelerated rate in later decades. Multivari-
ate regression analysis showed that, afer adjusting for
age, BMI was the strongest independent predictor of Ep
(r2 = 0.32) and of LWS (r2 = 0.34).
Conclusion: In healthy subjects, arterial stifness evalu-
ated by an echo-tracking method showed a signifcant
increase with age and BMI, suggest that these functi-
onal and structural alteration of the arteries could be
used to detect early stages of vascular dysfunction.
191. Ablatia cu radiofrecventa
induce revers remodelare
extensiva de ventricul stang
cardiaca si tahiaritmii
supraventriculare
Cristina Ioana Caldararu, Elena Ene, Maria Doroban-
tu, R.G.Vatasescu
Introducere: Cardiomiopatiile dilatative sunt frecvent
o cauza de aritmii supraventriculare. Nu rareori insa
disfunctia de ventricul stang (VS) poate f determinata
sau agravata de o tahiaritmie persistenta.
Materiale si metode: Intre Decembrie 2007 si Ianu-
arie 2010 15 pacienti diagnosticati cu cardimiopatie
Metode: Au fost studiati 125 de subiecti sanatosi (4019
ani, 90 barbati) fara boala cardiaca cunoscuta, boala ce-
rebrovasculara, diabet, hipertensiune sau dislipidemie.
Au fost masurate inaltimea si greutatea pentru calcu-
larea Indexului de Masa Corporeala (IMC). Rigidita-
tea arteriala a fost evaluata la nivelul arterei carotide
comune dreapta (ACCD) folosind un ecograf dotat cu
sistem de evaluare prin echo-tracking (Aloka cu sonda
de 7.5 MHZ). Astfel, au fost obtinute diametrul si viteza
sangelul la nivelul ACCD, iar prin calibrarea in func-
tie de TA, au fost masurati: modulul elastic de presiune
(Ep), indicele de rigigditate independent de presiune
(), indexul de augmentare (Aix), complianta arteriala
(AC) si viteza locala a undei pulsului (LWS). De aseme-
nea a fost masurata grosime intima-medie (IMT).
Rezultate: Varsta si IMC au fost puternic corelati cu
Ep, , Aix, LWS, si IMT (r = 0.73, r = 0.75, r = 0.65, r =
0.76, r = 0.72, all p <0.0001), si invers corelati cu AC (r
= -0.65, p<0.0001), atat la femei, cat si la barbati. Ep, ,
si LWS cresc cu varsta (toti, p<0.0001) non-linear cu o
rata accelerat in ultimele decade. Analiza multivariata a
aratat, ca dupa ajustarea in functie de varsta, IMC a fost
cel mai puternic predictor independent pentru Ep (r2 =
0.32), si pentru LWS (r2 = 0.34).
Concluzie: In populatia sanatoasa, rigiditatea arteria-
la evaluata prin echo-tracking a demonstrat o crestere
semnifcativa corelata cu varsta si cu IMC, sugerand ca
aceste modifcari functionale si structurale ale peretelui
arterial pot f folosite pentru detectarea stadiilor preco-
ce ale disfunctiei vasculare.
Arterial stiffness assessed by
echo-tracking impact of
aging and weight in healthy
population
Background. Arterial stifness is emerging as an im-
portant determinant of the atherosclerotic disease, due
to the fact that changes in elastic properties of the large
arteries appear early in the course of the disease. How-
ever, in order to introduce the measuring of the arterial
stifness parameters into the routine clinical practice, it
is essential to defne reference ranges and their changes
over time in healthy population.
Methods: A total of 125 healthy subjects (4019 years,
90 men) free of overt heart disease, cerebrovascular di-
POSTER I I I
POSTER I I I
Suplimentul A, 2010
210
study (15 males, age 56 8 years, baseline NYHA class
3.5). Baseline tachyarrhythmia were atrial futter (AFl)
(n=10), atrial tachycardia (AT) (n=4) and atrial fbrilla-
tion (AFi) (n=1). Mean HR was 142 21 bpm. All pa-
tients were on standard heart failure medication. Sinus
rhythm was achieved in those patients with AFl and AT
by radiofrequency catheter ablation and by pulmonary
veins isolation in one case with AFib.
Results: Echocardiography and ECG Holter monito-
ring were performed at 1 and 3 months and persistent
sinus rhythm was maintained during follow-up in 14
patients and one patient experienced intermitent relap-
ses. Tere was a signifcant clinical improvement in all
patients (NYHA class 1.4 vs baseline 3). In 13 out of
15 patients there was concomitant extensive recovery
of lef ventricle (LV) function (LVEF 44% 5% vs ba-
seline 27% 8%, p<0.05), LV reverse remodeling (i.e.
LVEDD 53 5 mm vs baseline 57 6.4 mm, p=0.01)
and LV mass index ( 212 37 g vs baseline 242 54g,
p=0.009). In the remaining 2 patients incomplete
structural recovery (LVEDD 65.50.5 mm vs baseli-
ne 66.50.5 mm,p=NS and LV mass index 30423 g
vs baseline 31938 g, p=NS) was associated with the
presence of a wide QRS complex during sinus rhythm.
Conclusion: Tachycardiomyopathy should be consi-
dered at least partially responsible for LV dysfunction
in patients with DCM and persistent tachyarrhythmia.
Te reversibility might be less signifcant in patients
with baseline wide QRS complex.
192. Utilizarea stenturilor
active farmacologic la pacientii
diabetici: noi date din registrul
roman de stenturi active
farmacologic RODESINO
(2004-2010)
A.Burlacu, C.Stoicescu, N.Florescu, C.Udroiu,
V.Vintila, D.Vinereanu
Obiective: In ultimii ani, recomandarile standard pri-
vind implantarea stenturilor active farmacologic (DES)
s-au extins, in special la pacientii cu diabet zaharat
dilatativa (CMD) idiopatica si tahiaritmii supraven-
triculare persistente sau repetitive au fost referiti clini-
cii noastre pentru studiu electrofziologic (15 barbati,
varsta medie 56 8 ani, clasa NYHA initial 3.5). Din
numarul total de pacienti 10 sufereau de futter atri-
al (FlA), 4 de tahicardii atriale (TA) si respectiv unul
de fbrilatie atriala (FiA). Alura ventriculara medie in
timpul tahiaritmiei a fost 142 21 bpm. Toti pacientii
urmau medicatie standard pentru insufcienta cardia-
ca. Ritmul sinusal s-a obtinut prin ablatie cu current
de radiofrecventa si prin izolare de vene pulmonare in
cazul unui pacient cu FiA.
Rezultate: Pacientii au fost urmariti la o luna si trei luni
prin intermediul ecocardiografei si Holter ECG; ritmul
sinusal persistent s-a mentinut la 14 pacienti si un paci-
ent a avut recidive intermitente. Pe parcursul urmaririi
s-a constatat o imbunatatire clinica semnifcativa la to-
tii pacientii (clasa NYHA 1.4 vs initial 3.5). La 13 din 15
pacienti s-a constatat recuperarea extensiva a functiei
VS (FEVS 44% 5% vs initial 27% 8%, p<0.05) , re-
vers remodelarea semnifcativa a VS (i.e. DTDVS 53
5 mm vs initial 57 6.4 mm, p=0.01; indexul de masa
al VS 212 37 g vs initial 242 54g, p=0.009) . La cei-
lalti 2 pacienti recuperarea structural incompleta a fost
asociata cu prezenta unui QRS larg persistent.
Concluzii: Tahicardiomiopatia ar trebui considerata
cel putin partial responsabila de disfunctia de VS la
pacientii cu CMD si tahiaritmii persistente. Reversibi-
litatea poate f mai putin semnifcativa la pacientii cu
QRS larg.
Radiofrequency catheter
ablation induces extensive
LV reverse remodeling in
heart failure associated with
supraventricular tachycardia
Introduction: Dilated cardiomyopathies (DCM) are
ofen a cause of supraventricular arrhythmias due to
disease progression. However, LV dysfunction may be
produced or aggravated by persistent tachyarrhythmia.
Materials and methods: Between December 2007 and
January 2010 15 patients with idiopathic dilated car-
diomyopathy and persistent or repetitive supraventri-
cular tachycardia were referred to electrophysiological
Suplimentul A, 2010
211
POSTER I I I
POSTER I I I
Use of drug eluting stents in
diabetic patients: new data
from the romanian registry of
drug eluting stent implantation
in the real world scenario
(RODESINO) (2004-2010)
Aims: Standard recommendation for drug eluting
stents (DES) implantation has extended in the last
years, especially in diabetic (DM) patients, in which co-
ronary lesions are more complex and have a greater risk
of restenosis (40%) in bare metal stents. Te objective
of this study was to describe the clinical and angiogra-
phical features linked with standard and of-label use
of DES in DM patients.
Materials and methods: RODESINO is an unicentric
registry that included 910 consecutive patients that re-
ceived at least 1 DES. We recorded demographic, clini-
cal, and angiographic (stent- and lesion- related) varia-
bles. Of-label indications were unprotected lef main
stenting, chronic total occlusion (CTO), vessel diame-
ter < 2.5 mm or > 3.75 mm, length lesion > 30 mm, in-
trastent restenosis (ISR), bifurcation, and ostial lesions.
Results: Since 2004, for 6 years, 1112 DES were implan-
ted, of which 418 DES (38%) for of-label indications;
262 DES (24%) were implanted in DM patients, 112 of
which were of-label. Percentage of of-label use in
DM is 43% and raised from 2004 to 2009 with no sig-
nifcance (30 to 43 %, p=N.S). Use of DES in DM was
associated with of-label indication (p<0.05), mainly
driven by their indication in ostial lesions (p=0.02). In
order to determine which variables are predictive for
of-label use of DES, use of DES in DM, and of-la-
bel use of DES in DM, 3 multivariate models were ge-
nerated: the independent clinical variables predictible
for of-label use of DES were hypertension (p=0.01),
DM (p<0.05) and smoking (p<0.05); clinical and angi-
ographical variables that predicted use of DES in DM
were associated hypertension, associated dislipidemia,
previous MI, male gender (all p<0.001), and ostial le-
sions (p=0.02); the only independent clinical variable
predictible for of-label use of DES in DM was asso-
ciated hypertension (p<0.001).
Conclusions: 24% of DES are used in patients with
DM, from which 43% for of-label indication. Varia-
bles predictible for use of DES in DM were associated
risk factors (hypertension, dislipidemia, male gender),
(DZ), la care leziunile coronariene sunt mai complexe
si stenturile metalice simple au un risc crescut de reste-
noza (40%). Obiectivele au constat in descrierea carac-
teristicilor clinice si angiografce corelate cu indicatiile
standard si of-label de utilizare a DES la DZ.
Materiale si metode: RODESINO este un registru uni-
centric cu 910 pacienti consecutivi la care s-a implantat
cel putin 1 DES. S-au inregistrat variabile demografce,
clinice si angiografce. Indicatiile of-label constau in:
stentarea trunchiului comun, ocluzii cronice totale, di-
ametrul vasului <2,5 mm sau >3,75 mm, lungimea le-
ziunii>30 mm, restenoza intrastent, bifurcatii si leziuni
ostiale.
Rezultate: Din 2004 pana in ian. 2010 (6 ani) au fost
implantate 1112 DES(din care 418 DES, 38%, cu indi-
catie of-label); 262 DES(24%) au fost implantate la
DZ, 112 - of-label. Procentul utilizarii of-label la
DZ a fost 43% si a crescut nesemnifcativ din 2004 pana
in 2010. Folosirea DES la DZ s-a asociat cu indicatia
of-label (p<0,05), in principal pe seama implantarii
pentru leziunile ostiale (p=0,02). Am generat 3 modele
multivariate pentru a determina variabilele predictive
pentru utilizarea of-label a DES, utilizarea DES la
DZ si pentru folosirea DES indicate of-label la DZ.
Variabilele clinice independente predictive pentru uti-
lizarea of-label a DES au fost: hipertensiunea arteria-
la (HTA), DZ si fumatul (p=0,01, p<0,05 resp. p<0,05).
Variabilele clinice si angiografce care au prezis implan-
tarea DES la DZ au fost: HTA, dislipidemia, anteceden-
tele de IM, sexul masculin (p<0,001 pt. toate), si leziu-
nile ostiale (p=0,02). Singura variabila clinica indepen-
denta predictibila pentru utilizarea of-label a DES la
DZ a fost HTA (p<0,001).
Conlcuzii: La DZ s-au folosit 24% din DES, din care
43% au fost indicatii of-label. Variabilele predictibi-
le pentru utilizarea DES la DZ au fost factorii de risc
asociati (HTA, dislipidemia, sexul masculin), anteced.
IM si leziunile ostiale. Singura variabila independen-
ta predictiva pentru utilizarea of-label a DES la DZ
a fost HTA. Aceste rezultate sugereaza ca pacientii cu
sindrom metabolic constituie o indicatie frecventa de
implantare a DES in practica clinica curenta.
POSTER I I I
POSTER I I I
Suplimentul A, 2010
212
modifcari semnifcative in fractia de ejectie VS, E/Em,
deformare sistolica la nivelul peretelui inferior VS dupa
1 luna de urmarire. Acceleratia izovolumetrica (IVA) a
scazut cu 15.43%(p<0.05. 20 pacienti au avut o fereastra
ecografca buna pentru a se putea calcula torsiunea. In
timp ce twist systolic la nivel VS nu a variat semnif-
cativ, untwisting rate protodiastolic a scazut cu 9.50%
(de la -38.29 5.17/s la -34.65 2.68/s (p <0.05.)
Untwisting rate protodiastolic se coreleaza cu modi-
fcarea IVA la nivel septal bazal (r=-0.797, p<0.05). Am
inregistrat corelatii intre untwisting rate protodiasto-
lic initial si modifcarea IVA (r=0.63, p<0.01), diame-
trul telediastolic VS (r=0.49, p<0.05), TRIV (r=-0.76,
p<0.05) si deformare sistolica la nivelul peretelui infe-
rior VS (r=0.70, p<0.01) la 1 luna.
Concluzii: La pacientii cu STEMI inferior fara scade-
rea ejectie, untwisting rate protodiastolic e un pre-
dictor bun pentru evolutie, Limitari: Numarul mic de
cazuri durata scurta de urmarire nu permit concluzii
defnitive
Can LV early untwisting rate be
used as a global parameter in
assessment of cardiac function
after myocardial infarction?
Background: Classic echocardiographic parameters
and tissue Doppler velocities values have been de-
monstrated in the follow-up of myocardial infarction
patients. Tere is increasing data regarding the use of
speckle tracking twisting techniques to assess the LV
global function. Tere is fewer data regarding early
untwisting in assessing the diastolic function.
Aim: To assess the new speckle tracking untwisting
technique in predicting the evolution of patients with
inferior STEMI.
Methods: We prospectively analyzed a group of 24
patients, mostly men (22), mean age 62.6 9.8 years,
admitted with inferior ST myocardial infarction in our
clinic over a period of 2 months. Afer giving an in-
formed consent, patients were followed for 1 month.
We determined classic echographic parameters (lef
ventricle ejection fraction (LVEF), telediastolic LV
diameter, mitral E/A ratio, izovolumetric relaxation
time (IVRT)), tissue Doppler parameters (systolic and
diastolic velocities, E/Em, izovolumetric acceleration
previous MI, and ostial lesions. Only independent va-
riable predictable for of-label use of DES in DM was
associated hypertension. Tese results suggest that pa-
tients with metabolic syndrome are a common indica-
tion for use of DES in routine clinical practice.
193. Poate fi untwisting
rateprotodiastolic utilizat
ca parametru global de
functie ventriculara stanga in
aprecierea functiei cardiace
dupa infarct miocardic acut?
V.Vintila, Oana Enescu, Maria Florescu, Ana-Maria
Vintila, A.D.Margulescu, Roxana Sisu, M.Cinteza,
D.Vinereanu
Context: Utilizarea parametrilor de ecocardiografe
clasica si velocitatile Doppler tisular a fost dovedita
in urmarirea pacientilor postinfarct miocardic. Exista
date referitoare la utilizarea speckle tracking in eva-
luarea functiei VS globale. Sunt putine date referitoare
la untwisting rate protodiastolic in evaluarea functiei
VS.
Obiectiv: Sa evaluam puterea de predictie a tehnicii de
untwisting la pacientii cu STEMI inferior.
Metoda: Am analizat prospectiv 24 pacienti, majorita-
tea barbati (22), varsta medie 62.6 9.8 ani internati
cu STEMI inferior pe o perioada de 2 luni. Dupa con-
simtamantul informat, pacientii au fost urmariti pen-
tru 1 luna. S-au determinat parametrii ecocardiografci
clasici (fractie de ejectie VS, diametru telediastolic VS,
E/A, timp de relaxare izovolumetrica(TRIV)), para-
metrii de Doppler tisular (velocitati sistolice si diasto-
lice, E/Em, acceleratie izovolumetrica), parametrii de
deformare miocardica la nivelul segmentelor bazale
VS si VD. Twist systolic la nivel VS, untwisting si
untwisting rate protodiastolic s-au calculat din 2 sec-
tiuni de ax scurt, una la nivelul inelului mitral, alta la
nivel apical VS. Indexarea cu diametrul longitudinal VS
al twisting defneste torsiunea.
Rezultate: Toti pacientii au fost tratati conservator,
complianta 100% la 1 luna de medicatie. Nu au existat
Suplimentul A, 2010
218
POSTER I I I
POSTER I I I
Scopul studiului este de a determina prevalenta ano-
maliilor tromboflice unice/asociate la pacientii tineri
cu evenimente tromboembolice acute venoase sau ar-
teriale.
Material si metode: Au fost inclusi 43 pacienti (pts)
consecutivi cu varsta <45 de ani, asociind maxim 3 fac-
tori de risc cardio-vasculari (FRCV) clasici, internati in
perioada Ianuarie-Mai 2010 in Clinica noastr pentru
boal tromboembolic venoas (BTV, tromboza ve-
noasa profunda sau trombembolism pulmonar) sau ar-
terial (BTA, infarct miocardic acut sau ischemie acuta
periferica). La toti pts s-a recoltat o baterie de teste de
screening pentru tromboflii: proteina C, proteina S,
antitrombina III, probe pentru diagnosticarea sindro-
mului antifosfolipidic, teste pentru rezistenta la protei-
na C activata (ProCGlobal) si homocisteina seric.
Rezultate: Dintre cei 43 pts inclusi (19 F), 26 s-au pre-
zentat cu BTA iar 17 cu BTV. BTA a fost mai frecventa
la barbati (76.9% vs. 23.5% in grupul BTV, p=0.001) si
a aparut la o varsta mai inaintata (38.85.5 vs. 31.19.6
in grupul BTV, p=0.01). In grupul de BTA s-a observat
o frecventa mai mare a hiperhomocisteinemiei (38.5%
fata de 11.8% la BTV, p=0.05). Pentru anomaliile
ProCGlobal, defcitul de PC, defcitul de PS si SAFL nu
au fost observate diferente semnifcative intre cele doua
loturi. La subpopulatia de IMA (24 pts, 18 B) coronaro-
grafa a artat coronare permeabile la 8 pts.
Concluzii: Pacientii tineri cu evenimente trombotice
acute asociaz frecvent anomalii tromboflice. Dintre
acestia, pacientii cu tromboze arteriale sunt mai frec-
vent de sex masculin, evenimentul apare la o varst mai
inaintat decat BTV, find asociat mai frecvent cu pre-
zenta hiperhomocisteinemiei, fr alte diferente intre
distributia celorlalti factori tromboflici.
Screening for trombophilia
in young patients with acute
venous thromboembolism or
arterial thrombosis
Introduction: In recent years, a parallel growth betwe-
en the incidence and the awareness of the prognostic
importance of the thrombotic events in young patients
was observed, having a diferent profle of cardiovascu-
lar risk factors than older people. Trombophilic ano-
(IVA)) and tissue Doppler derived strain in LV and RV
basal segments. LV systolic twist, early untwisting and
untwist rate were computed from two short axis sec-
tions, one through mitral plane and the other at apex
of LV. Total twisting in both planes indexed by the LV
longitudinal diameter defned torsion.
Results: All patients were managed conservatively
with 100% therapy compliance at 1 month. Tere were
no signifcant changes in LV ejection fraction, E/Em,
systolic strain and strain rate on inferior wall afer 1
month, with a decrease of 15.43% in basal septum IVA
(p<0.05). 20 patients had good enough quality of echo-
cardiography to compute torsion. While LV systolic
twist did not change signifcantly, the early untwis-
ting rate decreased by 9.50% (from -38.29 5.17/s to
-34.65 2.68/s (p <0.05). Early untwisting rate cor-
related with change in basal septum IVA (r=-0.797,
p<0.05). Tere were good correlations between early
untwisting rate at baseline and change in IVA (r=0.63,
p<0.01), LV end diastolic diameter (r=0.49, p<0.05),
IVRT (r=-0.76, p<0.05) and systolic strain on inferior
wall (r=0.70, p<0.01) at follow-up.
Conclusions: In patients with inferior ST elevation
myocardial infarction without LVEF change, early
untwisting rate is a good predictor. Limitations: Small
number of cases and short follow-up period do not
allow defnitive conclusions.
194. Screeningul anomaliilor
trombofilice la pacientii tineri
cu tromboze acute arteriale sau
venoase
Ruxandra Jurcut, Ana Maria Daraban, Cristina
Vaduva, Anca Florian, Adriana Istrate, Laura Dima,
Valentina Uscatescu, D. Coriu, Carmen Ginghina
Introducere: Se observ recent o crestere in paralel a
incidentei si constientizrii importantei prognostice
a evenimentelor trombotice la pacienti tineri, la care
proflul factorilor de risc cardiovasculari (FRCV) este
diferit fat de al populatiei varstnice. Anomaliile trom-
boflice reprezint in aceast populatie un factor de risc
important pentru tromboza venoasa sau arterial.
POSTER I I I
POSTER I I I
Suplimentul A, 2010
211
195. Comparatie intre doua
spitale din estul si vestul ue
in indicatiile de folosire on-
versus off label a stenturilor
active farmacologic
C.Stoicescu, K.Chitkara, A.Burlacu, V.Vintila,
C.Udroiu, N.Florescu, O.Pirvu, M.Cinteza, J.Kovac,
D.Vinereanu
Bucuresti
Context: Date recente au pus in discutie cresterea nu-
marului de evenimente adverse dupa folosire stenturi-
lor active farmacologic (DES) in indicatiile of-label.
Am urmarit frecventa, siguranta si efcienta pacientilor
tratati cu DES pentru indicatiile of-label in doua Spita-
le Universitare mari din U.K si Romania.
Metoda: 910 pacienti consecutivi in fecare centru care
au primit 1 DES au fost urmariti un an. Grupul of-
label a fost defnit ca leziuni de bypass graf; trunchi
stang principal (TCS); restenoza intrastent (ISR); lezi-
uni ostiale, bifurcatii, ocluzii totale, pacienti cu vas de
referinata (RVD) <2.5 mm sau >3.75 mm, leziuni mai
lungi de >30 mm; grupul normal a fost defnit ca cei ce
au primit DES pentru indicatii general aprobate.
Rezultate: Nu au existat diferenta de varsta, sex
(59.810.8 ani, 73% barbati in Vest vs. 58.010.1, 75%
in Est), diabet zaharat - DZ (24.2 vs. 23.6%) sau istoric
de PCI (23.3 vs. 23.4%) intre cele doau grupuri, dar au
existat diferente semnifcative pentru istoric de infarct
de miocard (34.5 vs. 55.4%, p<0.001) istoric de By-pass
(9.7 vs. 1.1%, p<0.001). Indicatiile of-label au fost in
46 vs. 37%, p<0.01 din cazuri (by-pass grafs 3.2 vs.
0.4%, p<0.01; TCS 1.9 vs. 1.7%, p=ns; ISR 4.5 vs. 6%,
p=0.06; leziuni ostiale 4 vs. 2.9%, p=0.01; bifurcatii 9.3
vs. 2.5%, p<0.01; ocluzii totale 8.7 vs. 7%, p=ns; RVD
<2.5 mm 11.2 vs. 7.8%, p=0.02; RVD >3.75 mm 5.3 vs.
4.5%, p=ns; lungime >30 mm 8.3 vs. 12.6%, p=0.03).
Aceasta arata o frecventa mai mare a pacientilor cu by-
pass, bifurcatii, leziuni ostiale si de vase mici Vestul UE
si un numar mai mare de cazuri cu ISR si leziuni lungi
in Estul Europei, ceea ce sugereaza o probabilitate mai
mare de adresabilitate si rezolvare chirurgicala in Ves-
tul UE. Procedurile on-label a DES s-au asociat cu un
trend nesemnifcativ de risc scazut a complicatiilor in
timpul procedurii, de moarte si infarct nonfatal la un
an de la procedura, in ambele grupuri. A existat o co-
malies represent an important risk factor for arterial or
venous thrombosis in this population.
Aims: To determine the prevalence of single/multiple
thrombophilic anomalies in young patients with acute
venous or arterial thrombosis.
Materials and methods: We enrolled 43 consecutive
patients (pts) aged under 45 years, with maximum 3
classical cardio-vascular risk factors (CVRF), hospita-
lized between January-May 2010 in our Department
for thromboembolic venous disease (TVD, deep vein
thrombosis or pulmonary thromboembolism) or arte-
rial disease (TAD, acute myocardial infarction or acu-
te peripheral ischemia). A panel of tests for screening
of thrombophilic anomalies was done in all patients:
protein C, protein S, antithrombine III, tests for dia-
gnosing the antiphospholipidic syndrome, tests for
activated protein C resistance (ProCGlobal) and seric
homocysteine.
Results: From the 43 pts included (19F), 23 presented
with TAD and 17 with TVD. In the acute myocardi-
al infarction (AMI) group (24 pts, 18 B), 8 had per-
meable coronary arteries. TAD was more frequent in
men (76.9% vs. 23.5% in the TVD group, p=0.001)
and appeared at an older age (38.85.5 vs. 31.19.6
in the TVD group, p=0.01). Hyperhomocysteinemia
was found with increased frequency in the TAD group
(38.5% vs. 11.8% in the TVD group, p=0.05). Tere
were no diferences in the frequency of the activated
PC resistance (ProCGlobal anomalies), PC defciency,
PS defciency, APS between the two groups.
Conclusion: Trombophilic anomalies are frequent in
young patients with acute thrombotic events. Patients
with arterial thrombosis are more likely men, with frst
event at an older age than in venous thrombosis, and is
associated frequently with hyperhomocysteinemia, wi-
thout other diferences in the distribution of the others
thrombophilic factors.
Suplimentul A, 2010
215
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procedures, in both groups. Tere was a positive corre-
lation between the incidence of diabetes mellitus and
previous PCI and the frequency of of-label lesions
(R2=0.49, p= 0.01).
Conclusions: DES for non-approved indications seems
to be ef cacious and safe when compared with a DES
cohort for classical indications as well in West and East
Europe.
196. Registrul de
Trombembolism Pulmonar
Acut al Spitalului Universitar
de Urgenta Bucuresti
Roxana Cristina Sisu, Diana Mihalcea, Alina Emanoil,
A.Draghici, B.Spiru, D.Vinereanu
Trombembolismul pulmonar acut (TEP) este o boala
cu potential fatal. Desi stratifcarea riscului a imbu-
natatit abordarea clinica, exista inca probleme de dia-
gnostic si tratament.
Metoda: Am evaluat retrospectiv datele de diagnostic
si tratament ale pacientilor spitalizati in 2009 cu dia-
gnosticul de TEP acut. Au fost analizate manifestarile
clinice, stratifcarea riscului, modalitatile de diagnostic
si tratament.
Rezultate: Am inclus 60 de pacienti (6216 ani, 45%
barbati). Probabilitatea clinica a fost stabilita la 13691
minute de la prezentare. Concordanta diagnostic inter-
nare-externare a fost de 86%. Cei mai frecventi factori
de risc au fost: obezitatea (50%), boala trombembolica
(18%) si cancerul activ (16%). Manifestarile clinice cele
mai frecvente: dispneea, durerea toracica si tahicar-
dia sinusala. TEP a fost considerat cu risc inalt (HR)
de mortalitate la 21%, risc intermediar 64% si risc
mic la 15% din cazuri.Mortalitatea generala a fost de
17%, 58% la HR vs. 3% la risc intermediar (p<0.001).
Stopul cardiac a fost mai frecvent in grupul HR (75%
vs. 3%, p<0.001), doar 3% din pacientii cu HR f-
ind resuscitati(p=0.005). In grupul HR, comparativ
cu non-HR s-au inregistrat mai multe femei (75%) si
vastnici(p=0.029). Tromboza venoasa concomitenta a
fost decelata la 41% din cazuri, mai frecvent la grupul
non-HR(17% vs 46%). Ecocardiografa a fost cea mai
utilizata procedura de diagnostic (70%), 66% efectuata
relatie pozitiva intre incidenta DZ si istoricul de PCI si
frecventa leziunilor of-label (R2=0.49, p= 0.01).
Concluzii: Indicatiile of-label a DES par a f efciente
si sigure cand sunt comparate cu indicatiile clasice ale
acelorasi stenturi atat in Vestul cat si in Estul UE.
On- versus off-label use of
drug-eluting coronary stents in
two major hospitals from west
and east europe
Background: Safety concerns have arisen from recent
reports that suggested increased of adverse event afer
usage of DES in of-label indications. We evaluate the
frequency, safety, and efectiveness of DES in patients
treated with DES for of-label indications in two Uni-
versity Hospitals from U.K and Romania.
Methods: 910 consecutive patients for each centre who
received 1 DES have been followed for one year. Of-
label group was defned as use of stents in lesions in a
bypass graf; lef main coronary artery disease (LMS);
restenotic lesions (ISR); or ostial, bifurcated, or totally
occluded lesions, and in patients with a reference-vessel
diameter (RVD) <2.5 mm or >3.75 mm or a lesion len-
gth >30 mm and normal group defned as use of stents
in approved indications.
Results: No diferences for age, sex (59.810.8 years,
73% males in West vs. 58.010.1 years, 75% males in
East), diabetes mellitus (24.2 vs. 23.6%) and previous
PCI (23.3 vs. 23.4%) between two groups, but signi-
fcant for previous MI (34.5 vs. 55.4%, p<0.001) and
previous By-pass (9.7 vs. 1.1%, p<0.001). Of-label was
occurred in 46 vs. 37%, p<0.01 (by-pass grafs 3.2 vs.
0.4%, p<0.01; LMS 1.9 vs. 1.7%, p=ns; ISR 4.5 vs. 6%,
p=0.06; ostial 4 vs. 2.9%, p=0.01; bifurcations 9.3 vs.
2.5%, p<0.01; total occlusion 8.7 vs. 7%, p=ns; RVD
<2.5 mm 11.2 vs. 7.8%, p=0.02; RVD >3.75 mm 5.3
vs. 4.5%, p=ns; length >30 mm 8.3 vs. 12.6%, p=0.03).
Data above showed a higher number of patients with
by-pass, ostial, bifurcations and small vessels lesi-
ons in West Europe and a higher number of ISR and
long lesions in East Europe probably because of a hi-
gher addressability and acceptance of surgery in West.
On-label stent procedures were associated with non
signifcant trend for lower risk of complication during
procedure, death and MI at 1 year than of-label stent
POSTER I I I
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Suplimentul A, 2010
216
Concomitant deep venous thrombosis was seen in
about 41%, higher in non-HR group (17% vs. 46%).
Echocardiography was the most frequently performed
diagnostic procedure (70%), 66% in the frst 24hours
from admission. About 70% of patients had right ven-
tricle dysfunction. CT angiography was done in 66% of
patients, 73% in the frst day. Troponin I and BNP were
done for risk stratifcation only in 15%. Trombolytic
agents were given in 25% of cases, ofen over 12hours.
Te frequency of thrombolysis was higher in HR than
in non-HR PE (33% vs. 23%). Non-fractioned hepa-
rin was the most used treatment, initiated in the frst
24hours (96%).It was decided before echocardiography
(83%), and CT angiography (57%), based only on the
clinical suspicion.
Conclusions: Our study revealed a higher rate of mor-
tality than previous studies, especially in the HR PE
(58%). Echo was the most ofen used for risk stratifca-
tion, CT was the second one, both in the frst 24hours.
Non-fraction heparin was the main treatment, initiated
early afer admission, before the echo and CT, based
only on the clinical probability. Trombolysis was initi-
ated mostly afer 12 hours. Tis could explain the ove-
rall high mortality
197. Factori predictivi ai
mortalitatii intraspitalicesti
cardiaca acuta in Sectia de
Cardiologie a Spitalului Clinic
de Urgenta Sf Pantelimon
V.A.Molfea, Oana Simionescu, Liliana Protopopescu,
Andreea Bjerkestrand, Lenuta Haiducu, M.M.Vintila
Spitalul de Urgenta Sf. Pantelimon, Bucuresti
Scopul lucrarii: Evaluarea factorilor care sunt asociati
cu cresterea mortalitatii intraspitalicesti la pacientii cu
ICA, in clinica de Cardiologie a Sp. Clinic Sf. Pante-
limon.
Material si metoda: S-au folosit informatiile din foile
de observatie ale pacientilor cu ICA internati in clinica
de Cardiologie a Sp. Clinic Sf. Pantelimon pe o pe-
rioada de 6 luni, totalizand 447 cazuri. Au fost exclusi
pacientii cu ICA inclusi in alte studii clinice.
in primele 24 ore; AngioCT la 66% din cazuri, 73 % in
prima zi. 75% din cazuri au avut disfunctie ventricula-
ra dreapta. Troponina I si BNP au fost dozate pentru
stratifcarea de risc doar in 15% si respectiv 3% din ca-
zuri. Tromboliza a fost initiata in 25% din cazuri, ade-
sea dupa 12 ore, mai frecvent la grupul HR vs.non-HR
(33% vs. 23%). Heparina nefractionata a fost cea mai
des utilizata, introdusa inaintea CT si ecocardiografei,
in primele 24 ore (96%), bazat pe probabilitatea clinica.
Concluzii: Studiu nostru a relevant o mortalitate mai
mare comparativ cu datele publicate, in special in gru-
pul HR (58%). Pentru stratifcarea riscului ecografa a
fost cea mai utilizata, CT-ul a fost al 2-lea, ambele in
primele 24 ore. Heparina nefractionata, a fost initiata
inaintea acestora, bazat doar pe probabilitatea clini-
ca. Tratamentul trombolitic a fost initiat predominant
dupa 12 ore. Aceasta ar putea explica mortalitatea inal-
ta a intregului lot.
The Acute Pulmonary
Embolism Registry: a 1-year
study
Pulmonary embolism (PE) is a potentially fatal disea-
se. Althought risk stratifcation improved the clinical
management; there are still problems in diagnosis and
treatment of acute PE.
Methods: In a retrospective registry we evaluated data
on diagnosis and management of patients with acute
PE hospitalized in 2009. All records were examined for
clinical course, risk stratifcation, diagnosis and treat-
ment plans.
Results: 60 patients (6216 years, 45% male) were
included. High probability of PE was established in
13691minutes. Tere was an accordance of 86% ad-
mission - discharged diagnosis. Most prevalent risk
factors were: obesity (50%), prior thrombembolic di-
sease (18%), and active cancer (16%). Most frequent
clinical fndings: dyspneea, sinus tachycardia, and chest
pain. PE was considered at high risk (HR) in 21%, at
intermediate risk in 64%, and at low risk in 15% of
patients. Te overall in-hospital mortality was 17%,
58% in HR vs. 3% in intermediate (p<0.001). Cardiac
arrest was signifcantly higher in HR PE (75% vs.3%,
p<0.001). Only 3% of cases with HR PE were resusci-
tated (p=0.005). In the HR PE vs. non-HR PE we re-
gistered more women (75%), and older age (p=0.029).
Suplimentul A, 2010
21I
POSTER I I I
POSTER I I I
ents in the Cardiology Department of St. Pantelimon
Hospital.
Methods: We used information from the observati-
on charts of patients admitted in the Cardiology De-
partment of St. Pantelimon Hospital over a period of 6
months, a total of 447 cases. We excluded patients who
were included in other clinical trials.
Results: Over the course of hospitalization 43 pa-
tients died, 9,62% of total number. Te mortality
rate grew with the decrease in systolic BP on admis-
sion; mortality reached 50%(p=0,01) in cases with
sBP<90 mmHg, 12,5% in cases with sBP between 90
and 140 mmHg(reference), 6,97%(p>0,05) in cases
with sBP between 140 and 160 mmHg, 2,5 % (p=0,05)
in the group with sBP between 160 and 180 mmHg,
2,19%(p=0,01) in the group with sBP>180 mmHg. Te
mortality rate signifcantly correlates with the presen-
ce of type II diabetes mellitus(DM), reaching 6,57%
in those without DM compared to 15,18%(p=0,01)
in patients with DM. A creatinine clearance below 30
ml/min/1,73m2(MDRD) correlates with inhospital
mortality( 4 times increase compared to those with
creatinine clearance>90 ml/min/m2). Admittance Na
values correlate with in hospital death rate; mortality
in those with seric Na>130 mmol/l is 8,55% compared
to 21%(p=0,01) in those with Na<130 mmol/l. Death
rates reach 4,15% in patients that received ACEI in the
hospital, compared to 26,36%(p=0,01) in those that did
not receive it. Mortality reached 4,77% in those that
received beta-blocker therapy versus 18,83% (p=0,01)
in those that did not. A signifcant hospital mortality
predicting factor was the need for positive inotro-
pic support; rate reached 3,06% in pacients that did
not receive this treatment, versus 36,36%(p=0,01) in
those requiring it. Hospital death rate correlates with
the ejection fraction. Tose with EF>50% had a mor-
tality rate of 1,5%, compared to 11,26% in those with
EF<35%(p=0,01).
Conclusions: Hospital mortality rate were inversely
correlated with the sBP on admission, with the crea-
tinine clearance on admission and with the possibility
of beta-blocker and ACEI treatment during admission.
Death rates were correlated with hiponatremia on ad-
mission ( Na<130 mmol/l), with the presence of type
II DM and with a reduced EF(<35%).
Rezultate: Pe parcursul spitalizarii au decedat 43 de
pacienti, 9,62% din total. Rata deceselor a crescut cu
scaderea valorilor TAs la internare; astfel mortalitatea
a fost de 50% (p=0,01) la cei cu TAs<90 mmHG la pre-
zentare; la cei cu TAs intre 90 si 140 mmHg mortalita-
tea a fost de 12,5%(referinta), la cei cu TAs de 140-160
mmHg, de 6,97%(p>0,05) la TAs de 160-180 mmHg
de 2,5% (p=0,05) iar la TAs>180 mmHg mortalitatea
a fost de 2,19 %(p=0,01). Rata deceselor se coreleaza
semnifcativ cu prezenta DZ tip II, find de 6,57% la
cei fara DZ tip II fata de 15,18%(p= 0,01) la cei cu DZ
tip II. Clearance-ul la creatinina< 30 ml/min/1,73m2
(MDRD) se coreleaza semnifcativ statistic cu mortali-
tatea intraspitaliceasca(p=0,01-crestere de 4 ori fata de
cei cu Cl creat >90 ml/min/1,73m2). Na la internare se
coreleaza cu decesul intraspitalicesc; mortalitatea la cei
cu Na>130 mmol/l este de 8,55% fata de 21%(p=0,01)
la cei cu Na<130 mmol/l. Mortalitatea este de 4,15% la
pacienii ce au primit IEC, fata de 26,36%(P=0,01)
la cei ce nu au primit IEC. Mortalitatea este de 4,77%
la cei tratati cu beta-blocant fata de 18,83%(P=0,01) la
cei netratati cu beta-blocant.Un factor predictiv sem-
nifcativ al decesului in spital a fost terapia cu inotrop
pozitivi: rata decesului a fost de 3,06% in grupul celor
care nu au necesitat inotrop pozitivi, fata de cei care au
necesitat inotrop pozitivi (36,36%-p=0,01).Rata dece-
selor intraspitalicsti se coreleaza cu FE<35%; mortali-
tatea este de 1,5% la cei cu FE>50%, fata de 11,26% in
grupul celor cu FE< 35%(p=0,01).
Concluzii: Mortalitatea intraspitaliceasca s-a corelat
negativ cu valoarea TA la internare, cu clearance-ul la
creatinina la internare, cu posibilitatea de administrare
de beta-blocant, IEC in cursul internarii. Mortalitatea
intraspitaliceasca s-a corelat pozitiv cu hiponatremia
marcata la internare (Na<130 mmol/l), cu prezenta DZ
tip II si cu FE<35%.
Factors that predict hospital
mortality of acute heart failure
pacients in the Cardiology
department of St. Pantelimon
Emergency Clinical Hospital
Aim of the study: Te evaluation of factors associated
with an increase of inhospital mortality in AHF pati-
POSTER I I I
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Suplimentul A, 2010
218
PCI registry: a real necessity
All European Survey Registries that were developed
during the last few years appeared to assess the adhe-
rence to ESC Guidelines and to provide a Quality Con-
trol tool to the participating centres. Each centre may
monitor and compare his unit with National and Eu-
ropean data.Romanian National Registry of PCI, was
born in Nov 2005, having the main objectives to de-
termine the regional variation in the indications for
revascularization, the use of diferent procedures and
their outcomes.Also want to determine the adherence
to existing guidelines of indication of PCI, to test pro-
spectively the value of existing algorithms to predicted
procedural related outcomes in patients undergoing
PCI or surgery and, not the last to assess immediate,
in-hospital and one year outcome of patients assigned
to diferent treatment strategies stratifed by severity
and clinical presentation of coronary artery disea-
ses as well as co morbidities.With less than 500 PCIs
per 1 million citizens, Romania is considered a low-
workload EU country.Meanwhile, morbidity from co-
ronary heart disease is one of the highest in Romania,
and therefore, selection of patients for PCIs becomes
very dif cult.Romania is the third reporting country,
3.387 patients from Romania (8.72%) versus 35.434 pa-
tients from other centres in Europe have been analyzed.
Te conclusions were that we have more young pati-
ents with a lot of risk factors, and more patients with
prior myocardial infarction.Te complexity of lesi-
ons treated was the same in Romania and Europe.Te
main diference (p<0.01) consist in the type of stents
used (72.35% of the stent used in Romania are bare
metal,vs.63.46% in Europe) and in utilization of GP
IIbIIIa inhibitors (1.39% used in Romania vs. 30.62%
in Europe).Numbers of peri-procedural complicati-
on are fewer in Romania (3.13%) vs. Europe (3.51%).
Dual antiplatelet therapy over 6 months is more use in
Romania (90.98%vs.62.68%).In conclusion, selection
of patients for PCIs in a country with low resources is
restricted mainly to younger and male patients, pati-
ents with risk factors and previous heart disease. Less
emergencies and less complex multi-vessel diseases are
treated.However, for those benefting from the proce-
dure, medication is carefully optimized.PCI registry
represent an useful tool for best medical judgment and
a good assessment of medical resource utilization in di-
ferent hosp.
198. Registrul National de
Angioplastii: o necesitate
C. Udroiu, N. Florescu, O. Pirvu, C. Stoicescu,
V.Vintila, D. Vinereanu
Toate Registrele europene care s-au dezvoltat in ultimii
ani au ca scop cresterea aderentei la ghidurile actuale
de practica medicala, precum si de a f un instrument
de control al calitatii pentru centrele participante. Re-
gistrul national de angioplastii, a fost infintat in no-
iembrie 2005 ca un proiect pilot, parte a Registrului
European CARDS cu scopul de a cuantifca indicatiile
procedurilor de dilatare percutana in Romania, ade-
renta la ghidurile de cardiologie, precum si toate as-
pectele medicale legate de pacientii dilatati, pe termen
scurt si lung, in conditiile in care morbiditatea cadio-
vasculara in Romania este una dintre cele mai mari din
Europa, iar numarul de angioplastii cel mai mic (<500
la un million de locuitori). Au fost analizati 3.387 pa-
cienti din Romania vs 35.434 din Europa (8.72%). In
Romania sunt semnifcativ mai multi pacienti tineri,
cu istorc de infarct miocardic si cu multiplii factori de
risc cardio-vasculari.Complexitatea leziunilor rezolva-
te este similara, dar numarul de angioplastii primare
este foarte mic.Difera major tipul stenturilor utiliza-
te (mai multe BMS in Romania 72.35% vs 63.46% in
Europa) precum si utilizarea inhibitorilor de GPIIbI-
IIa (1.39% in Romania vs 30.62%). Numarul compli-
catiilor periprocedurale este semnifcativ mai mic in
Romania (3.13% vs 3.51%).Dubla antiagregare pana
la 6 luni este mai des utilizata in Romania (90.98% vs
62.68%). In concluzie, selectia pacientilor dilatati per-
cutan intr-o tara cu resurse limitate este limitata la pa-
cienti tineri, barbati, cu istoric de IM si multiplii fac-
tori de risc. Medicatia acestora este optimala.Registrul
National de PCI reprezinta un instrument util pentru
luarea celor mai bune decizii terapeutice, un element
de control al calitatii, precum si un indicator necesar
la alocarea judicioasa a resurselor materiale si umane
intre diversele spitale, in diverse regiuni. ROMANIA
EUROPA P VARSTA>65 ANI 31.65% 49.46% <0.05
BARBATI 77.47% 72.48% <0.05 ISTORIC IM 69.54%
53.8 % <0.05 FUMATORI 67.77% 49.45% <0.05 DI-
ABETICI 24.99% 24.65% ns HIPERTENSIVI 78.66%
77.62% <0.05 DISLIPIDEMICI 76.05% 66.34% <0.05
PCI PRIMAR 5.12 % 16.72% <0.05
Suplimentul A, 2010
219
POSTER I I I
POSTER I I I
semnifcativ sub nivelul normal acceptat de varsta la
pacientii cu ICC, cu 19 si, respectiv, cu 34%. Pe acest
fondal s-a urmarit micsorarea veritabila cu circa 26%
a rezistentei vasculare periferice, fenomen datorat in
mare masura reducerii compliantei arteriolelor rezisti-
ve, care potrivit evidentelor obtinute in vitro raspund
mai redutabil la stimulare adrenergica, endotelinica si
angiotensinica.
Concluzii: 1. Reactivitatea vasculara periferica in in-
sufcienta cardiaca se impune prin diminuarea efectu-
lui vasorelaxant al acetilcolinei si al Ang 1-7, care se
asociaza relevant cu potentarea efectului constrictor
adrenergic, endotelinic si angiotensinic. 2. Disfunctia
endoteliala rezulta pe plan functional in reducerea elas-
ticitatii arteriale si in majorarea rezistentei vasculare.
Peripheral vascular reactivity
in heart failure
Aim: the in vitro evaluation of aortic response on vaso-
relaxant and constrictor stimuli action in experimental
doxorubicin induced cardiomyopathy, as well as of the
peripheral artery elasticity in patients with congestive
heart failure.
Material and methods. Te aorta rings of intact and
with doxorubicin induced cardiomyopathy (DCM)
rats, perfused in isolated organ bath were contracted
thereby depolarization (solution KCl, 50 mM), to whi-
ch constricting level the phenylephrine (Phe) or NE or
ET-1 or Ang II induced plateau in concentration range
(10-8-10-6 M) was compared. Te endothelium depen-
dent relaxation was assayed thereby the acetylcholine
(10-6 M) or Ang 1-7 (10-8-10-6 M) administration in
the Phe induced constrictor plateau. Te indices of the
conduit (C1) and resistive arteries (C2) elasticity, and
vascular peripheral resistance were estimated in 37 pa-
tients with congestive heart failure (HF), NYHA II-III
using techniques Pulse Wave CR2000.
Results: In DCM the constricting aorta response is
signifcantly increased on all estimated vasoconstric-
tor factors action, the plateau being in direct ratio with
applied concentration. Tus, in comparison with ma-
ximal control plateau Phe contracts stronger the aortic
rings by 22%, NE by 37%, ET-1 by 27%, and Ang II
by 19%. Acetylcholine decreased the Phe induced con-
strictor plateau by almost 37% that is notably lowered
than the decline fxed in control series where the pa-
199. Reactivitatea vasculara
periferica in insuficienta
cardiaca
M.Popovici, V.Cobet, N.Ciobanu, I.Popovici, V.Ivanov,
L.Ciobanu, I.Moraru, M.Todiras
Scopul: evaluarea in vitro a raspunsului aortei la actiu-
nea stimulilor vasorelaxanti si constrictori in cardiomi-
opatia doxorubicinica experimentala, precum si a elas-
ticitatii arterelor periferice la pacientii cu insufcienta
cardiaca congestiva.
Material si metoda: Inelele de aorta de sobolan intact
sau cu cardiomiopatie doxorubicinica (CMD), per-
fuzate in baia de organ izolat au fost contractate prin
depolarizare (KCL, 50 mM), cu platoul respectiv find
comparate nivele constrictoare induse de fenilefrina
(Phe), NE, ET-1 sau Ang II in concentratiile 10-7-10-
5 M. Relaxarea endoteliu dependenta s-a estimat prin
administrarea in platoul constrictor al Phe a acetilco-
linei (Ac, 10-6 M) sau a Ang 1-7 (10-8-10-6 M). Indi-
cii elasticitatii arterelor de conduita (C1) si a arterelor
rezistive (C2), precum si rezistenta vasculara periferica
s-au determinat la 37 pacienti cu insufcienta cardiaca
congestiva, NYHA II-III prin dispozitivul Pulse Wave
CR2000.
Rezultate: In CMD raspunsul constrictor aortic este
semnifcativ majorat la actiunea tuturor factorilor va-
soconstrictori explorati superioritatea platoului find in
raport direct cu concentratia aplicata a acestora. Astfel,
comparativ cu platoul contractil maxim de referinta
Phe contracta cu 22% mai puternic inelele aortice, NE
cu 37%, ET-1 cu 27%, iar Ang II cu 19%. Acetilcolina a
diminuat platoul constrictor al Phe cu circa 34%, ceea
ce este notabil inferior reculului decelat in lotul de refe-
rinta, unde stimularea parasimpatica a cauzat un declin
al platoului in medie de 56%. Ang 1-7 nu a indus o rela-
xare apreciabila a platoului constrictor in concentratiile
10-8-10-6 M, desi paternul de referinta s-a impus prin
micsorarea contractiei aortice in medie cu 13-18%, iar
la concentratia 10-6 M relaxarea de circa 12% a fost sub
nivelul martor (23%). Asadar, afectarea raspunsului
aortic mediat prin oxidul nitric este o inerenta a certa
a CMD si, care poate f vizata drept o cauza determi-
nanta a potentarii raspunsului constrictor. Disfunctia
endoteliala si periclitarea sistemului NO ar f un fac-
tor oportun si in cresterea stifness-lui arterial. Indicii
elasticitatii arterelor periferice, C1 si in special C2 sunt
POSTER I I I
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Suplimentul A, 2010
220
Metode: Au fost comparati 45 subiecti (5410 ani,
barbati): 15 pacienti cu PAR tratata (metotrexat + sul-
fasalazina infiximab), 15 pacienti cu DZ controlat
(HbA1C 5.50.4%), echivalenti din punct de vedere al
duratei bolii (3.93.4 ani), si 15 subiecti sanatosi. Para-
metrii de torsiune a VS au fost evaluati prin ecografe
cardiaca 2D speckle tracking: rotatia maxima a bazei si
apexului VS, timpul pana la rotatia maxima a bazei si
apexului VS, twist-ul VS, timpul pana la twist-ul ma-
xim, velocitatile de twist si untwist si torsiunea VS.
Rezultate: Toti parametrii de torsiune ai VS au fost si-
milari intre cele 3 grupuri (tabel), cu exceptia rotatiei
bazei VS si a velocitatii de twist, care au fost semnifca-
tiv mai mari la pacientii cu DZ fata de normali.
Concluzie: Parametrii de torsiune sunt similari la paci-
enti cu PAR si DZ corect tratate, de durata similara. Ei
sunt normali in PAR tratata, in concordanta cu rezul-
tatele din studiile noastre anterioare, care au evidentiat
ca PAR corect tratata nu prezinta semne de disfunctie
cardiaca subclinica precoce, dar sunt usor crescuti la
pacienti cu DZ, probabil ca si mecanism compensator
pentru fbroza subendocardica (longitudinala) preco-
ce. Rotatia bazei VS (degr) Timp pana la rotatia bazala
maxima (ms) Rotatia apexului VS (degr) Timp pana
la rotatia apicala maxima (ms) Twist VS (degr) Timp
pana la twist maxim (ms) Viteza de twist VS (degr/s)
Viteza diastolica de untwist VS (degr/s) Torsiunea VS
(degr/cm) PAR -6.9 4.4 320.1 64.7 6.4 4.8 322.0
84.7 12.5 7.0 340.1 79.1 98.0 31.4 -115.9 55.9
1.6 0.9 DZ -9.3 4.5 317.1 92.8 8.9 5.5 347.3
79.5 16.2 6.8 351.1 100.7 117.6 45.4 -98.3 43.3
2.0 0.8 Normali -5.5 3.6 335.7 57.7 8.9 3.9 352.5
75.8 13.8 3.7 357.5 52.9 83.9 31.2 -114.0 48.8
1.8 0.5 p PAR vs DZ p = 0.3 p = 0.8 p = 0.3 p = 0.6 p =
0.8 p = 0.8 p = 0.6 p = 0.9 p = 0.8 p PAR vs.normali p =
0.6 p = 0.9 p = 0.4 p = 0.7 p = 0.2 p = 0.9 p= 0.6 p = 0.6
p = 0.3 p DZ vs normali p = 0.05 p = 0.8 p = 0.9 p = 0.9
p = 0.6 p = 0.9 p = 0.05 p = 0.7 p = 0.7
Left ventricular torsion is
unaltered in patients with well-
controlled rheumatoid arthritis
Context: Recent studies suggest that cardiac invol-
vement in (RA) is similar to that of diabetes mellitus
(DM). However, benefts of efective control of both di-
seases on subclinical cardiac dysfunction, measured as
rasympathetic stimulation caused a plateau down ave-
ragely by 56%.
Ang 1-7 did not induce an evident relaxation of the con-
strictor plateau in concentration of 10-8-10-6 M range,
although the control pattern represented an average fall
of 13-18%. In concentration of 10-6 M the relaxation
was about 12% and has been under control level (23%).
Hence, disturbance of the mediated by nitric oxide aor-
tic response is a certain sign of DCM which could be
reviewed as a determinative cause of constrictor res-
ponse augmentation. Te endothelial dysfunction and
NO-linked system derangement would be an opportu-
ne factor of arterial stifness rise. Te peripheral artery
elasticity indices C1, and especially C2 are signifcantly
under the normal level in patients with HF by 19 and
34%, respectively. In this regard a signifcant reducing
by 26% of peripheral vascular resistance was establi-
shed, a phenomenon due mainly to resistive arteriole
compliance diminution which accordingly to obtained
in vitro data respond stronger on adrenergic, endothe-
lin and angiotensin stimulation.
Conclusions: 1. Te peripheral vascular reactivity in
HF is characterized by acetylcholine and Ang 1-7 indu-
ced vasorelaxant efect diminution which is relevantly
associated by adrenergic, endothelinic and angioten-
sinic constrictor efects enhancement. 2. Endotheli-
al dysfunction results functionally in artery elasticity
lowering and in vascular resistance elevation.
200. Torsiunea ventriculara
stanga este nemodificata
la pacientii cu poliartrita
reumatoida corect tratata
Magda Stefania, Florescu Maria, Ciobanu Andrea,
Dulgheru Raluca, Mincu Raluca, D.Vinereanu
Context: Studii recente sugereaza ca afectarea cardiaca
din poliartrita reumatoida (PAR) este similara cu cea
din diabetul zaharat (DZ). Nu au fost insa studiate pana
in prezent benefciile controlului efcient al ambelor
boli asupra disfunctiei cardiace subclinice, masurata
prin torsiunea ventriculului stang (VS), un parametru
ecocardiografc nou, ce refecta atat functia sistolica cat
si pe cea diastolica.
Suplimentul A, 2010
221
POSTER I I I
POSTER I I I
201. Surse de variabilitate
si eroare in evaluarea
asincronismului ventricular
stang prin ecocardiografie
tridimensionala
Denisa Muraru, L.P.Badano, P.Gianfagna, Ermacora
Davide, B.A.Popescu, Carmen Ginghina, A.Proclemer
Institutul de Urgente pentru Boli Cardiovasculare Prof.
Premise. Dovezile obiective privind sursele de eroa-
re in evaluarea asincronismului ventriculului stang
(VS) prin ecocardiografe tridimensionala (E3D) sunt
in prezent limitate. Am evaluat infuenta unor factori
tehnici multipli in masurarea indexului de asincronism
sistolic (SDI).
Metode: La 100 pacienti consecutivi (pt, 33 cu bloc
major de ramura stanga), am evaluat impactul: editarii
manuale; rezolutiei temporale; modelului VS cu 16 sau
17 segmente; nivelului sensibilitatii pentru detectarea
automata a endocardului; si al calitatii imaginii. Achi-
zitiile 3D volum complet VS obtinute din 2 si 4 cicluri
cardiace consecutive cu Vivid E9 (GE Healthcare, Hor-
ten, N) au fost analizate cu un sofware semi-automat
(TomTec 4D LV function 2.6, Unterschleissheim, D).
Mentinand acelasi contur trasat manual, sensibilitatea
standard (inalta, 75%) a fost redusa la un nivel mediu
(50%) si, respectiv, mic (25%).
Rezultate: 37/100 pt (5818 ani, 51 barbati) aveau dis-
functie sistolica VS (FE=389%). Editarea manuala a
conturului endocardic a indus un asincronism artefac-
tual (SDI16: 5.10.3% vs 3.60.5%, SDI17: 5.60.5%
vs 4.30.3%; p<0.0001) la 10 pt normali, de aceea nu
a fost aplicata in analiza ulterioara. Cresterea rezoluti-
ei temporale (2 cicluri vs 4 cicluri: 256 vs 5216 vps,
p<0.0001) nu a avut un impact semnifcativ asupra
SDI (p=NS). Prin adaugarea celui de-al 17 segment la
modelul de 16 segmente, SDI a crescut nesemnifcativ
(SDI16 6.02.6% vs SDI17 6.73.3%,p=NS). Scaderea
sensibilitatii in detectia automata a endocardului a re-
dus dramatic SDI (sensibilitate inalta vs mica - SDI16:
6.02.6% vs 2.12.8%; SDI17 6.73.3% vs 2.93.7%,
p<0.05 pentru ambele). Impactul sensibilitatii sofwa-
re-ului asupra SDI a fost mai mare la pacientii cu ima-
gine ecografca suboptimala (SDI16 bias 5% vs 3.2%,
SDI17 bias 4.5% vs 3.2%, p<0.05). Reproductibilitatea
intra-observator si inter-observator a SDI16 la 15 pt au
fost de 10.49.6% si, respectiv, 16.213.4%.
LV torsion, a new parameter that can assess both systo-
lic and diastolic function, have not been reported yet.
Methods: 45 subjects (5410 years, 7 males) were com-
pared: 15 patients with treated RA (methotrexate + sul-
fasalasine infiximab), 15 patients with well-treated
DM (HbA1C 5.50.4%), matched for the duration of
disease (3.93.4 yrs), and 15 healthy controls. Parame-
ters of LV torsion were assessed by 2D speckle tracking
echocardiography: peak rotation of LV base and apex,
time to peak rotation of LV base and apex, LV twist,
time to peak twist, twist and untwist rates, and LV tor-
sion.
Results: All parameters of LV torsion were similar
between groups (table), excepting for LV base rotation
and LV twist rate which were signifcantly higher in pa-
tients with DM than in controls.
Conclusion: Torsion parameters are similar in patients
with well-controlled RA and DM of similar duration.
Tey are normal in patients with treated RA, in concor-
dance with our previous results showing that correctly
treated RA has no signs of early subclinical dysfuncti-
on, but they are mildly increased in patients with DM,
probably as a compensatory mechanism for early sub-
endocardial (longitudinal) fbrosis. Rotation of LV base
(degr) Time to peak basal rotation (ms) Rotation of LV
apex (degr) Time to peak apical rotation (ms) LV twist
(degr) Time to peak twist (ms) LV twist rate (degr/s)
LV diastolic untwist rate (degr/s) LV torsion (degr/cm)
RA -6.9 4.4 320.1 64.7 6.4 4.8 322.0 84.7 12.5
7.0 340.1 79.1 98.0 31.4 -115.9 55.9 1.6 0.9 DM
-9.3 4.5 317.1 92.8 8.9 5.5 347.3 79.5 16.2 6.8
351.1 100.7 117.6 45.4 -98.3 43.3 2.0 0.8 Con-
trols -5.5 3.6 335.7 57.7 8.9 3.9 352.5 75.8 13.8
3.7 357.5 52.9 83.9 31.2 -114.0 48.8 1.8 0.5 p
RA vs DM p = 0.3 p = 0.8 p = 0.3 p = 0.6 p = 0.8 p = 0.8
p = 0.6 p = 0.9 p = 0.8 p RA vs.controls p = 0.6 p = 0.9 p
= 0.4 p = 0.7 p = 0.2 p = 0.9 p= 0.6 p = 0.6 p = 0.3 p DM
vs controls p = 0.05 p = 0.8 p = 0.9 p = 0.9 p = 0.6 p =
0.9 p = 0.05 p = 0.7 p = 0.7
POSTER I I I
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Suplimentul A, 2010
222
SDI17 bias 4.5% vs 3.2%, p<0.05). SDI16 intra-obser-
ver and inter-observer reproducibility in 15 pts were
10.49.6% and 16.213.4%, respectively.
Conclusions: Our study is the frst to detail the signif-
cant impact of manual editing, sofware border detecti-
on sensitivity and image quality on LVD assessment by
3DE. In contrast, temporal resolution and LV segment
model did not impact on SDI. Insuf cient knowledge
of these confounders may lead to misinterpretation of
SDI value in clinical practice.
202. Cuplarea ventriculo-
arteriala in cursul
tratamentului sindromului de
transfuzie feto-fetala studiu
ecocardiografic
Oana Savu, T.Van Mieghem, P.DeKoninck,
L.Gucciardo, Ruxandra Jurcut, S.Giusca, B.A.Popescu,
J.Deprest, Carmen Ginghina, U.J.Voigt
Sindromul de transfuzie feto-fetala (TTTS) este o com-
plicatie severa a sarcinilor multiple monocorionice ce
necesita interventie chirurgicala fetoscopica cu fotoco-
agulare laser a anastomozelor placentare. Perioperator
resorbtia lichidului amniotic in exces poate determina
suprasolicitare acuta de volum a cordului matern.
Obiectivul acestui studiu a fost evaluarea cuplarii ven-
triculo-arteriale a cordului matern in cursul tratamen-
tul TTTS.
Metode: 12 paciente cu TTTS (varsta gestationala 203
saptamani) si 20 de femei insarcinate cu varsta gestati-
onala similara. S-au efectuat studii ecocardiografce
parametri 2D si Doppler inainte, la 6 ore si respectiv
48 de ore postoperator (OP) pentru grupul cu TTTS
si la includere pentru grupul martor. Pentru evaluarea
adaptarii vasculare au fost determinate rezistenta vas-
culara totala (RVT) si elastanta arteriala (Ea). In afara
parametrilor conventionali elastanta telesistolica ven-
triculara (Ees) a fost calculata pe baza formulei validate
de Chen (JACC 2001). Indexul de cuplare ventriculo-
arteriala a fost calculat ca si raport intre elastanta arte-
riala si telesistolica. Modifcarea parametrilor in grupul
Concluzii: Studiul nostru detaliaza in premiera impac-
tul semnifcativ al editarii manuale, al sensibilitatii in
detectarea automata a endocardului si al calitatii imagi-
nii in evaluarea asincronismului VS. In contrast, rezo-
lutia temporala si modelul segmentarii VS nu afecteaza
semnifcativ SDI. Cunoasterea insufcienta a acestor
infuente ar putea duce la interpretarea eronata a im-
portantei clinice a SDI.
Sources of variation and bias
in assessing left ventricular
dyssynchrony using three-
dimensional echocardiography
Background. Objective evidence to identify sources of
bias in assessing lef ventricular dyssynchrony (LVD)
by 3D echocardiography (3DE) is limited. We assessed
how technical factors infuence the measurement of
systolic dyssynchrony index (SDI).
Methods: In 100 consecutive patients (pts, 33 with lef
bundle branch block), we assessed the impact of: ma-
nual editing; temporal resolution; 16- or 17-segment
LV model; sensitivity settings for automated border
detection; and image quality. LV full-volume 2- and
4-beat data sets acquired using a Vivid E9 scanner (GE
Healthcare, Horten, N) were analyzed with semi-auto-
mated sofware (TomTec 4D LV function 2.6, Unter-
schleissheim, D). Keeping the same manual contour,
default border detection sensitivity (high, 75%) was
lowered to mid (50%) and low (25%).
Results: 37/100 pts (5818 y, 51 men) had LV dys-
function (EF=389%). Manual editing of endocardial
border induced an artifactual dyssynchrony (SDI16:
5.10.3% vs 3.60.5%, SDI17: 5.60.5% vs 4.30.3%;
p<0.0001) in 10 normal pts, therefore it was not appli-
ed in further analysis. Increasing time resolution (4-
beat vs 2-beat: 5216 vs 256 vps, p<0.0001) had no
signifcant impact on SDI (p=NS). By adding 17th to
16-segment LV model, SDI increased non-signifcantly
(SDI16 6.02.6% vs SDI17 6.73.3%,p=NS). Lowering
sofware sensitivity settings of automated endocar-
dial border detection dramatically reduced SDI (SDI
16 high vs low: 6.02.6% vs 2.12.8%; SDI7 high vs
low 6.73.3% vs 2.93.7%, p<0.05 for both). Impact
of sofware sensitivity on SDI was higher in pts with
suboptimal image quality (SDI16 bias 5% vs 3.2%,
Suplimentul A, 2010
228
POSTER I I I
POSTER I I I
(JACC 2001), and ventriculo-arterial coupling index
was derived as the Ea/Ees ratio. Changes in parame-
ters for the TTTS group were assessed using ANOVA
for repeated measurements and data were compared to
normal pregnancies using t-testing.
Results: Afer fetoscopic surgery we found an incre-
ase in stroke volume (7313ml vs 8911, p<0.01)
and cardiac output (8.71l/min vs 6.21l/min,
p<0.01) associated with decreased TVR (716186 vs
1092191 dyne*s/cm5, p<0.01). Diastolic blood pre-
ssure (566 vs 668mmHg, p<0.01), but not systo-
lic one (11212mmHg vs 11713, p 0.23) decreased
afer surgery. Ea decreased signifcantly (1.460.2 vs
1.150.1, p<0.001) and was paralleled by a decrease of
Ees (1.80.4 vs 2.140.5, p 0.02), so that the ventriculo-
arterial coupling index remained unchanged (0.680.2
postOP, 0.680.1 before OP, 0.680.1 for normal preg-
nancy group, p not signifcant).
Conclusions: Despite signifcant early postOP changes
in hemodynamics, through Ea and Ees matching, ven-
triculo-arterial coupling remains stable in TTTS pati-
ents, at values similar to normal pregnancies.
203. Presiunea centrala aortica
rol in estimarea afectarii
organelor tinta la pacientul
hipertensiv
Roxana Mustafa Edme, O.Istratoaie, Doriana Mustafa,
D.D.Ionescu
Scop: Lucrarea isi propune sa determine la un lot de
pacienti hipertensivi corelatia intre presiunea centrala
aortica si alti parametrii (presiunea pulsului, indice-
le de augmentare, presiunea de augmentare) estimati
prin tonometrie prin aplanatie la nivelul arterei radiale
si prezenta afectarii organelor tinta si daca au o valoare
predictiva mai mare decat TA sistolica brahiala.
Metoda: Lotul ales a inclus 100 pacienti hipertensivi cu
varste intre 40-85 ani, la care s-a masurat TA brahiala,
s-a efectuat tonometrie prin aplanatie la nivelul arterei
radiale pentru determinarea TA centrale aortice si a al-
tor parametrii, am determinat glicemia, proflul lipidic,
rata de fltrare glomerulara, masa VS, FE, am evaluat
functia diastolica, grosimea intima medie la nivelul ca-
rotidei comune.
cu TTTS a fost evaluata prin ANOVA, iar pentru com-
pararea cu grupul martor s-a utilizat ttest.
Rezultate: Dupa interventia chirurgicala fetoscopica
volumul bataie (7313ml vs 8911, p<0.01) si debitul
cardiac (8.71l/min vs 6.21l/min, p<0.01) au cres-
cut, in paralel cu scaderea rezistentei vasculare totale
(716186 vs 1092191 dyne*s/cm5, p<0.01). Valoa-
rea tensiunii arteriale diastolice (566 vs 668mmHg,
p<0.01) , dar nu si a celei sistolice (11212mmHg vs
11713, p 0.23) s-a modifcat postoperator. Elastanta
arteriala a inregistrat o scadere semnifcativa (1.460.2
vs 1.150.1, p<0.001) la 6 ore postoperator, asociata cu
scaderea elastantei telesistolice (1.80.4 vs 2.140.5, p
0.02), astfel incat indicele de cuplare ventriculo-arteri-
ala a ramas constant, (0.680.2 postOP, 0.680.1 pre-
OP, 0.680.1 in grupul martor, p nesemnifcativ).
Concluzii: Desi interventia chirurgicala fetoscopica
este asociata cu modifcari hemodinamice importante,
indexul de cuplare ventriculo-arteriala este mentinut
constant prin modifcarea in paralel a elastantei arte-
riale si telesistolice, cu valori comparabile cu sarcina
normala.
Maternal ventriculo-arterial
coupling during treatment
of twin-to-twin transfusion
syndrome
Purpose: Twin-to-twin transfusion syndrome (TTTS)
is a serious complication of monochorionic multiple
gestations requiring fetoscopic laser photocoagulation
of the anastomosing placental vessels. Perioperative re-
sorption of the polyhydramnios causes severe subacute
maternal volume overload. Tis study aimed at charac-
terizing maternal ventriculo-arterial coupling during
TTTS treatment.
Methods: 12 TTTS patients (293years, gestational age
203 weeks) and 20 normal pregnancies (293years,
gestational age 213 weeks) were included. Echocardi-
ography was performed before, 6 hours afer fetosco-
pic surgery (OP) and at discharge (48 hours afer OP).
Total vascular resistance (TVR) and arterial elastance
(Ea) were calculated for characterization of vascular
adaptation. Beside conventional echocardiographic pa-
rameters, lef ventricular end-systolic elastance (Ees)
was calculated based on the formula published by Chen
POSTER I I I
POSTER I I I
Suplimentul A, 2010
221
augmentation index (r=0.72) than with brachial pre-
ssure (r=0.6); a better correlation with aortic augmen-
tation index is found for intima- media thickness.
Conclusion: Central aortic pressure and related varia-
bles correlate better with LV hypertrophy, GFR, intima-
media thickness in hypertensive patients than brachial
pressure.
204. Fibrilatia atriala
persistenta convertita la
ritm sinusal din insuficienta
cardiaca
D.P.Petcu, O.Toni
Introducere: Insufcienta cardiaca si fbrilatia atriala
sunt cnditii patologice cu relatie reciproca.Fibrilatia
triala precipita si agraveaza insufcienta cardiaca iar
insufcienta cardiaca clasa III si IV NYHA se asociaza
frecvent cu fbrilatia atriala.Au fost desfasurate multi-
ple trialuri pe plan international pentru a demonstra
care este optiunea terapeutica benefca la pacientii cu
fbrilatie atriala persistenta (PIAF, RACE, AFFIRM,
ALPHA).
Scop: Ne propunem sa apreciem evolutia pacientilor cu
insufcienta cardiaca clasa II si III NYHA in conditii
etiopatogenice diverse.
Metode: Studiul prospectiv desfasurat in perioada
1.03.2008 1.03.2009. Au fost luati in studiu 64 de bol-
navi su FiA persistenta si insufcienta cardiaca clasa II
si III NYHA (FE>40%) de diverse cauze nonvalvulare si
valvulare. Pacientii au fost impartitii in doua subloturi.
Sublotul A 30 de pacienti cu insufcienta cardiaca clasa
III NYHA si FiA persistenta convertita la ritm sinusal si
Sublotul B 34 de pacienti cu insufcienta cardiaca clasa
III NYHA si FiA persistenta in tratament pentru con-
trolul frecventei cardiace.Pacientii din ambele loturi au
primit tratament cu beta-blocante, inhibitori ai enzi-
mei de conversie, blocanti ai receptorilor angiotensinei,
diuretic de ansa, antialdosteronic, antivitamine K si
medicatie pentru controlul frecventei cardiace.Pacien-
tii au fost reevaluati la 3, 6, 12 luni. Evolutia pacientilor
a fost apreciata prin urmatorii parametrii: mortalitate,
agravarea insufcientei cardiace, respitalizare, accidente
trombembolice, FE a VS si NTproBNP. Datele au fost
Rezultate: Varsta medie in lotul studiat a fost de 65.4
ani; TA brahiala medie a fost de 163/84 mmHg, pre-
siunea sistolica aortica medie a fost 157 mmHg; pre-
zenta diabetului zaharat si RFG< 60ml/min se core-
leaza cu valori mai mari ale presiunii pulsului la nivel
aortic (54.2 mmHg vs 39 mHg, p=0.04) si cu un indice
de augmentare mai mare (43% vs 34%, p=0.05); masa
VS se coreleaza mai bine cu presiunea centrala aorti-
ca (r=0.68) si cu indicele de augmentare (r=0.7) decat
cu TA sistolica brahiala (r=0.56); de asemenea valorea
RFG se coreleaza mai strans cu indicele de augmentare
aortic (r=0.72) decat cu TA brahiala (r=0.6). Corelatie
mai buna se obtine si pentru grosimea medie- intima
cu indicele de augmentare aortic.
Concluzii: Presiunea centrala aortica si parametrii
inruditi se coreleaza mai bine cu prezenta hipertrofei
ventriculare stangi, cu rata de fltrarea glomerulara si
grosimea intima medie la pacientul hipertensiv decat
valoarea tensiunii arteriale sistolice brahiale.
The role of central aortic
pressure for evaluation of target
organ damage in hypertensive
patients
Purpose: We wanted to determine in hypertensive pa-
tients the correlation between central aortic pressure
and other variables (pulse pressure, augmentation in-
dex, augmentation pressure) estimated by radial appla-
nation tonometry and the presence of target organ da-
mage and if these variables have higher predictive value
than brachial systolic pressure.
Method: We chose 100 pts with age between 40-85
years; we measured brachial pressure, performed radi-
al applanation tonometry, measured glycemia, lipids,
GFR, LV mass, EF, diastolic function, intima- media
thickness at the level of common carotid artery.
Results: Mean age was 65.4 years, mean brachial pre-
ssure was 163/83 mmHg, mean aortic systolic pressure
was 157 mmHg; diabetes mellitus and a value of GFR<
60 ml/min correlates with higher values of aortic pulse
pressure (54.2 vs 39 mmHg, p=0.04) and with a higher
augmentation index (43% vs 34%, p=0.05); LV mass
correlates better with central aortic pressure (r=0.68)
and with augmentation index (r=0.7) than with bra-
chial pressure (r=0.56); also GFR correlates better with
Suplimentul A, 2010
225
POSTER I I I
POSTER I I I
months.Te evolution of the patients has been appre-
ciated with the help of the following parameters: mor-
tality, thromboembolic accidents , FE a VS, NTproBNP.
Te data have been statistically analyzed with mean
and standard deviation with the help of the student and
chi-squared tests.
Results: Patients with atrial fbrillation and heart fa-
ilure have bigger mortality than patients with atrial
fbrillation converted to sinus rhythm and heart fai-
lure respectively 28% vs 18% (p<0.001). Te heart fa-
ilure aggravation was more frequently in patients with
atrial fbrillation and heart failure than than in those
converted to sinus rhythm, respectively 71% vs. 35%.
Tromboembolic accidents have been more frequently
in patients with atrial fbrillation and heart failure 3,5%
vs. 1,5%.
Conclusions: Persistent atrial fbrillation electrically
converted to sinus rhythm represents the frst therape-
utic option in the treatment of the patients with heart
failure of of diferent causes.
205. Detorsiunea ventriculului
stang si relatia sa cu parametri
de functie diastolica la pacientii
cu insuficienta aortica
Roxana Enache, Rita Piazza, A.Roman-Pognuz, Deni-
sa Muraru, B.A.Popescu., Andreea Calin, Carmen
Beladan, F.Antonini-Canterin, Elisa Leiballi, Nicolosi
L.Gian, Carmen Ginghina
Universitate de Medicina si Farmacie "Carol Davila",
Bucuresti
Torsiunea ventriculului stang (VS), rezultat al rotatiei
in sens opus a apexului si bazei VS in sistola, si detor-
siunea sa in diastola sunt componente importante ale
contractilitatii VS si ale suctiunii diastolice. Nu exis-
ta date referitoare la detorsiunea VS ca parametru de
functie diastolica la pacientii cu insufcienta aortica
(IA). Obiectiv. Evaluarea detorsiunii VS prin ecocardi-
ografe speckle tracking (STE) la pacientii cu IA croni-
ca, comparativ cu subiectii normali.
Metode: Am inrolat prospectiv 28 pacienti cu IA croni-
ca moderat-severa si severa si 20 subiecti normali. Cri-
teriile de excludere pentru pacientii cu IA au fost frac-
tia de ejectie a VS (FEVS) 50%, leziunile coronariene
semnifcative, insufcienta mitrala moderata sau severa,
analizate statistic cu medie si deviatie standard cu testul
STUDENT si CHI-PATRAT.
Rezultate: Pacientii cu FiA si insufcienta cardiaca au
mortalitate mai mare decat pacientii cu FiA converti-
ta la RS si insufcienta cardiaca respectiv 28% vs. 18%
(p<0,001) Agravarea insufcientei cardiace a fost mai
frecventa la pacientii cu FiA si insufcienta cardiaca de-
cat la cei convertiti la RS, respectiv 71% vs. 35%. Acci-
dente trombembolice au fost mai frecvente la pacientii
cu FiA si insufcienta cardiaca 3,5% vs. 1,5%.
Concluzii: Fibrilatia atriala persistenta convertita elec-
tric la RS reprezinta in practica medicala prima optiu-
ne terapeutica in tratamentul bolnavilor cu insufcienta
cardiaca de diverse etiologi.Aceasta reduce riscul com-
plicatiilor si scade mortalitatea pe perioada de un an.
Persistent atrial fibrillation
convertet from heart failure to
sinus rhythm
Introduciton: Heart failure and atrial fbrillation are
two pathogenic conditions with a mutual relation
between them. Te atrial fbrillation precipitates and
worsens the heart failure and the heart failure III and
IV NYHA class is frequently associated with atrial f-
brillation.Tere have been issued many international
trials to demonstrate which is the best therapeutic op-
tion in patients with persistent atrial fbrillation (PIAF,
RACE, AFFIRM, ALPHA.
Purpose: We propose to appreciate the evolution of pa-
tients with class II and III NYHA heart failure in dife-
rent etiopathogenestic conditions.
Methods: Te prospective trial developed between
1.03.2008-1.03.2009.64 patients with persistent FA
and class II and III NYHA heart failure (FE>40%) of
diferent nonvalvular or valvular etiology have been
included in the trial.Te patients have been distribu-
ted in two groups. Group A with 30 patients sufering
from heart failure class II NYHA and persistent atri-
al fbrillation converted to sinus rhythm, and group B
with 34 patients with class III NYHA heart failure and
persistent atrial fbrillation in treatment for heart rate
control.Patients from both groups received treatment
with beta blockers, converting enzyme inhibitors, an-
giotensin receptor blockers, loop diuretic, antialdost-
eronic, antivitamins K,and medication for heart rate
control.Te patients have been reevaluated in 3,6,12
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Suplimentul A, 2010
226
Purpose: To assess LV untwisting by speckle tracking
echocardiography (STE) in patients with chronic AR as
compared with normal subjects.
Methods: We enrolled 28 patients with moderate-seve-
re and severe chronic AR and 20 normal subjects. Ex-
clusion criteria for patients with AR were LV ejection
fraction (LVEF) 50%, coronary artery disease, more
than mild associated mitral regurgitation, non-sinus
rhythm. An echocardiographic study was performed in
all patients. Basal and apical LV rotation and LV tor-
sion were quantifed from two-dimensional greyscale
LV parasternal basal and apical short-axis images by
STE using dedicated sofware (2D strain, EchoPac). LV
untwisting was assessed by measuring peak apical and
basal diastolic rotation rates and peak untwisting velo-
city (calculated as the net diference in peak diastolic
apical and basal rotation rates on the torsional velocity
curve).
Results: Patients in the AR and control groups had
similar age and gender, and mean LVEF (58.511.4%
vs 62.02.8%, p=0.181). Patients in the AR group had
lower E velocity, E velocity at septal site, E/A ratio
(all p<0,05), and a trend toward a higher E decelera-
tion time (EDT) (21846 vs 19049 ms, p=0.05). E/E
at septal site was similar in both groups (9.13.3 vs
81.9, p=0.119). Peak LV untwisting velocity was sig-
nifcantly reduced in the AR group compared with the
control group (-77.834.4 vs -143.147.6/s, p<0.001).
Both peak apical and basal diastolic rotation rates
were lower in the AR group (p<0.001). Time interval
to peak untwisting velocity was similar in both groups
(p>0.05). In patients with AR, LV untwisting velocity
signifcantly correlated with peak apical diastolic rota-
tion rate (r=0.77, p<0.001). Time to peak untwisting
velocity correlated signifcantly with EDT (r=0.46,
p=0.013).
Conclusions: LV untwisting, as assessed by STE, is
reduced in patients with signifcant AR and normal
LVEF, and this is due to signifcantly decreased apical
and basal diastolic rotation rates.
absenta ritmului sinusal. Rotatia apicala si bazala si tor-
siunea VS au fost masurate prin STE din sectiunile 2D
parasternal ax scurt la baza si apexul VS, utilizand un
sofware dedicat (2D strain, EchoPac). Detorsiunea VS
a fost evaluata prin masurarea ratelor de rotatie apicala
si bazala si a velocitatii maxime de detorsiune (calcu-
lata ca diferenta neta dintre ratele maxime de rotatie
diastolica apicala si bazala pe curba velocitatii torsio-
nale).
Rezultate: Nu au existat diferente in privinta var-
stei si sexului in grupul cu IA si in grupul control, iar
FEVS medie a fost similara (58,511,4% vs 62,02,8%,
p=0,181). Pacientii cu IA au avut valori mai mici ale
velocitatii E, velocitatii E la nivel septal, raportului
E/A (toate p<0,05) si o tendinta catre TDE mai mare
(21846 vs 19049 ms, p=0,05). E/Eseptal a fost simi-
lar in ambele grupuri (9,13,3 vs 81,9, p=0,119). Ve-
locitatea maxima de detorsiune VS a fost semnifcativ
scazuta in grupul IA fata de grupul control (-77,834,4
vs -143,147,6/s, p<0,001). Ratele de rotatie diastolica
la nivel apical si bazal au fost mai mici in grupul cu
IA (p<0,001). Timpul pana la velocitatea maxima de
detorsiune diastolica a fost similar in ambele grupuri
(p>0,05). La pacientii cu IA, velocitatea maxima de
detorsiune VS s-a corelat semnifcativ cu rata maxima
a rotatiei diastolice apicale (r=0,77, p<0,001). Timpul
pana la velocitatea maxima de detorsiune s-a corelat
semnifcativ cu TDE (r=0,46, p=0,013).
Concluzii. Detorsiunea VS este redusa la pacientii cu
IA semnifcativa si FEVS normala, din cauza scaderii
ratelor de rotatie apicala si bazala.
Assessment of left ventricular
untwisting and its relationship
with parameters of left
ventricular diastolic function
in patients with aortic
regurgitation
Lef ventricular (LV) twist, as a result of counter-rotati-
on of the apex and base during systole, and its untwis-
ting during diastole are important components of LV
contractility and diastolic suction. Data regarding LV
untwisting as a parameter of diastolic function in pati-
ents with AR are lacking.
Suplimentul A, 2010
22I
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ofera informatii aditionale fata de factorii de risc tradi-
tionali in prezicerea aterosclerozei subclinice la pacien-
tii cu insufcienta renala moderata. Aceasta poate f re-
levant in practica clinica pentru o mai buna stratifcare
a riscului la acesti pacienti.
Incremental value of arterial
stiffness over traditional risk
factors in predicting subclinical
atherosclerosis in patients with
moderate chronic renal failure
Background: Renal insuf ciency is associated with a
high burden of atherosclerosis, which represents the
main cause of mortality in these patients. Te preva-
lence of atherosclerosis in chronic renal failure is not
entirely explained by the existence of traditional risk
factors.
Te aim of this study was to evaluate the determinants
of subclinical atherosclerosis, in terms of carotid inti-
ma media thickness (IMT) in patients with moderate
chronic renal failure.
Methods: We included 90 patients (24 M, 66 F, age
6510 years) with moderate chronic kidney disease
(creatinine clearance measured with the Cockcrof-
Gault formula < 60 ml/m, mean 518 ml/min). All
patients underwent a supra-aortic trunks scan using a
machine implemented with an echo tracking system.
Both carotid IMT and stifness beta index were measu-
red. A model to predict carotid IMT was created, inclu-
ding traditional risk factors (LDL cholesterol, triglyce-
rides, presence of hypertension, diabetes, smoking sta-
tus), creatinine clearance and stifness beta index.
Results: Te model was highly signifcant in predicting
IMT (p<0.001). Te mean IMT value was 0.940.18
mm. A history of hypertension was present in 79% of
patients; 17% had diabetes and 9% were smokers. At
multivariate analysis, three parameters emerged as in-
dependent predictors of IMT: age (p=0.005), beta in-
dex (p=0.012) and presence of diabetes (p=0.015). Te
beta index of stifness was correlated with IMT even
when corrected for age (r=0.30, p=0.004).
Conclusions: Beta index of arterial stifness measured
at carotid level with the echo-tracking technique gives
additional information over traditional risk factors in
206. Valoarea independenta
a rigiditatii arteriale fata de
factorii de risc traditionali
in prezicerea aterosclerozei
subclinice la pacientii cu
insuficienta renala moderata
C.R.Ticulescu, Olga Vriz, B.A.Popescu, Carmen
Ginghina, GL Nicolosi, Simone Carerj, F.Antonini-
Canterin
Spital S. Maria degli Angeli, Pordenone, Italia
Background: Insufcienta renala este asociata cu un
grad crescut de afectare aterosclerotica care reprezinta
principala cauza de mortalitate la acesti pacienti. Nive-
lul incarcarii aterosclerotice la pacientii cu insufcienta
renala cronica nu este explicat doar de asocierea cu fac-
torii de risc traditionali.
Scopul acestui studiu a fost evaluarea determinanti-
lor aterosclerozei subclinice, exprimata prin grosimea
complexului intima- medie (IMT), la pacientii cu insu-
fcienta renala moderata.
Metode: Au fost inclusi 90 de pacienti (24 B, 66 F, var-
sta medie 6510 ani), cu afectare moderata a functiei
renale (clearance al creatininei calculate cu formula
Cockcrof-Gault< 60 ml/min, valoare medie 518 ml/
min). La fecare pacient s-a efectuat o ecografe vascula-
ra la nivel carotidian folosind o aparatura dotata cu un
sistem echo-tracking de inalta defniie, determinandu-
se atat IMT cat si indicele de rigiditate arteriala beta. A
fost creat un model care sa prezica IMT carotidian, care
a inclus factori de risc traditionali (LDL cholesterol, tri-
gliceride, prezenta hipertensiunii arteriale, a diabetului
si a fumatului), precum si clearance-ul la creatinina si
indicele de rigiditate arteriala beta.
Rezultate: Valoarea medie a IMT a fost 0.940.18 mm.
Istoric de hipertensiune arteriala au avut 79% din pa-
cienti, 17% erau diabetici si 9% fumatori Modelul ca
intreg a fost inalt semnifcativ statistic in prezicerea
variantei IMT (p<0.001). La analiza multivariata, trei
parametri s-au detasat ca si predictor independenti ai
IMT: varsta (p=0,005), indicele beta (p=0,012) si pre-
zenta diabetului (p=0,015). Semnifcatia statistica a
corelatiei dintre indicele de rigiditate arteriala beta si
IMT s-a pastrat chiar si dupa controlul pentru varsta
(r=0,30, p=0,004).
Concluzii: Indicele beta de rigiditate arteriala determi-
nat la nivel carotidian folosind tehnica echo-tracking
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Suplimentul A, 2010
228
tarile subclinice si factorii de risc a indicat ca acestea
sunt generate in principal de valorile crescute ale pre-
siunii arteriale si ale presiunii pulsului. In cadrul gru-
pului de studiu masuratorile functiei endoteliale s-au
imbunatatit semnifcativ la 3 saptamani (crestere cu
27.88% a FMD fata de valoarea bazala) si la 6 saptamani
(crestere cu 27.88% a FMD fata de valaoarea bazala),
concordant cu o reducere modesta dar semnifcativa
a TA dupa 3 saptamani dar necorelata semnifcativ cu
valorile TA dupa 6 saptamani. Tabel 1 S0 S3 p* S6 p**
FMD (%) 5.112.43 6.512.23 <0.001 6.532.27 <0.001
SBP(mmHg)131.46.1 129.25.7 0.025 129.75.8 0.11
DBP(mmHg) 85.13.2 84.13.1 0.046 84.12.9 0.06
*Semnifcatia statistica este calculata prin t-test pere-
che intre S0 si S3,** respectiv S0 si S6.
Concluzii: Administrarea de IECA la persoanele cu
sindrom metabolic si TA normala sau normal inalta
imbunatateste functia endoteliala printr-un mecanism
ce este partial independent de reducerea presiunii ar-
teriale.
Effect of ACE inhibition on
endothelial function in persons
with metabolic syndrome and
normal and high normal blood
pressure
Purpose: To investigate in individuals with metabolic
syndrome and normal and high-normal blood pressu-
re the efect of ACE inhibition on endothelial functi-
on evaluated by serial measurements of brachial artery
fow mediated dilatation.
Methods: We screened 198 persons in a primary pre-
vention program registering 79 persons (39.89%) in
the metabolic syndrome group (MS+). We recorded
risk factors and cardiac and vascular ultrasound data:
LV dimensions, wall thickness, mass, ejection fracti-
on, shortening fraction, diastolic function parameters,
myocardial performance index, brachial artery fow
mediated dilatation (FMD), carotid artery intima me-
dia thickness. We selected from the metabolic syndro-
me group those individuals (n=63) with normal and
high-normal blood pressure, i.e. a systolic BP between
120 and 139 mmHg and a diastolic BP between 70 and
89 mmHg, practically excluding those optimal blood
predicting subclinical atherosclerosis in patients with
moderate chronic renal failure. Tese fndings could
be relevant in clinical practice for risk stratifcation of
these patients.
207. Efectul inhibarii enzimei
de conversie a angiotensinei
asupra functiei endoteliale
la persoanele cu sindrom
metabolic si presiune arteriala
normala si normal-inalta
S.I.Dumitrescu, I.Tintoiu, V.Greere, G.Cristian,
L.Chiriac, Pinte Florina, G.Neagoe, R.Bolohan, I.Droc,
S.Stanciu, V.Voicu
Armatei, Bucuresti
Scop: Am urmarit la persoanele cu sindrom metabolic
si presiune arteriala normala si normal-inalta efectul
inhibarii enzimei de conversie a angiotensinei asupra
functiei endoteliale, evaluata prin masuratori seriate
ale vasodilatatiei mediate de fux la nivelul arterei bra-
hiale (FMD).
Metoda: Am realizat screeningul a 198 subiecti, dintre
care 79 (39.8%) au fost diagnosticate cu sindrom meta-
bolic SM(+). Am inregistrat datele referitoare la factorii
de risc si cele de ecografce: dimensiunile VS, masa VS,
parametri de functie sistolica si diastolica, grosimea
complexului intima-medie la nivelul arterelor carotide,
vasodilatatia mediata de fux la nivelul arterei brahiale
(FMD). Am selectat din grupul persoanelor cu SM pe
acelea (n=63) cu TA normala sau normal inalta (TA
sistolica intre 120 si 139 mmHg si TA diastolica intre
70 si 89 mmHg), excluzand practic persoanele cu TA
optima si pe cele cu hipertensiune (cunoscuta, nou-di-
agnosticata sau in tratament). Am intiat tratament cu
IECA (perindopril 5 mg od) si am repetat masuratoa-
rea FMD la interval de 3 si 6 saptamani.
Rezultate: Sindromul metabolic se asociaza cu afec-
tare subclinica extensiva, 83.5% din cei din subgrupul
SM(+) avand cel putin o forma de afectare subclinica,
cea mai frecvent intalnita find disfunctia endoteliala
defnita ca FMD < 7.5%. Analiza corelatiei dintre afec-
Suplimentul A, 2010
229
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teractiunii lor ca factori noi in stratifcarea riscului in
HTP. Acest studiu evalueaza relatia intre pulsatilitatea
AP, severitatea HTP si functia VD la pacientii cu HTP
asociata bolilor cordului stang.
Material si metoda: S-a analizat pulsatilitatea ramului
drept al AP folosind modul M ecocardiografc in fe-
reastra suprasternala la 35 de pacienti (pts) cu varsta
medie 639.66 ani (15 sex feminin) cu HTP asociata
boliilor cordului stang (8 pts cu regurgitare mitrala
severa, 9 pacienti cu stenoza aortica severa, 7 pacienti
cu cardiomiopatie dilatativa, 1 pacient cu regurgitare
aortica severa, 7 cu stenoza mitrala severa, 2 cu infarct
miocardic si unul cu disfunctie diastolica izolata de
ventricul stang). Au fost masurate presiunea sistolica in
artera pulmonara (PsAP), timpul de accelerare in arte-
ra pulmonara (TAP), excursia sistolica a inelului tricus-
pidian (TAPSE) precum si diametrul maxim telesistolic
(DTSmax) si telediastolic (DTDmax) al ramului drept
a AP. Pulsatilitatea arterei pulmonare a fost calculata
folosind formula: [(DTSmax DTDmax)/DTDmax] *
100.
Rezultate: Din punct de vedere clinic, 1 pacient a fost
in clasa functionala I NYHA, 12 in clasa II NYHA, 17
in clasa III si 7 pacienti au fost in clasa functionala IV
NYHA. In grupul studiat, PsAP a fost de 65.320.2
mmHg , TAP de 84.625.1 ms si TAPSE de 19.04.7
mm. Pulsatilitatea AP a fost de 9.7 5.64%. Pulsatili-
tatea s-a corelat cu TAPSE (R=0.34, p=0.043), fara a
se corela cu alti parametri hemodinamici : PsAP, TAP
si clasa functionala NYHA. TAPSE s-a corelat cu TAP
(R=0.42, p= 0.011), PsAP (R=0.51, p=0.002 ) si clasa
functionala NYHA (R=-0.4, p=0.01).
Concluzii: La pacientii cu hipertensiune pulmonara
asociata boliilor cordului stang, pulsatilitatea arterei
pulmonare se coreleaza pozitiv cu parametri de functie
ventriculara dreapta, si nu cu indicii hemodinamici ai
circulatiei pulmonare, fapt care sprijina existenta unei
interactiuni ventriculo-arteriale drepte in acest grup de
pacienti.
pressure and with overt hypertension. We initiated
treatment with ACE inhibitor (perindopril 5 mg od)
and repeated the brachial artery FMD examination at
3 and 6 weeks.
Results: Metabolic syndrome is associated with wi-
despread (83.54%) subclinical disease represented ma-
inly by the endothelial dysfunction (defned as FMD
<7.5%). Te risk factor analysis pointed toward increa-
sed blood pressure and pulse pressure as the most im-
portant triggers for subclinical impairment. Te study
group improved signifcantly endothelial function
measurements at week 3 (27.39% increase of FMD) and
week 6 (27.88% increase of FMD), concordant with
the decrease of the blood pressure values which were
slightly but signifcantly modifed at week 3, but irre-
spective of blood pressure values at week 6. (Table 1).
S0 S3 p* S6 p** FMD (%) 5.112.43 6.512.23 <0.001
6.532.27 <0.001 SBP(mmHg)131.46.1 129.25.7
0.025 129.75.8 0.11 DBP(mmHg) 85.13.2 84.13.1
0.046 84.12.9 0.06 *Statistical signifcance is calcula-
ted by paired t-test between Week 0 and Week 3 data
**Statistical signifcance is calculated by paired t-test
between Week 0 and Week 6 data.
Conclusion: Our study indicates that ACE inhibition
improves endothelial function in persons with meta-
bolic syndrome and normal or high-normal blood
pressure by a mechanism that is partly independent of
blood pressure lowering.
208. Evaluarea ecocardiografica
a pulsatilitatii arterei
pulmonare la pacienti cu HTP
asociata bolilor cordului stang
Aneida Hodo-Vevecka, Marinela Serban, Madalina
Iancu, Ruxandra Jurcut, S.Giusca, Ioana Ghiorghiu,
B.A.Popescu, Carmen Ginghina
Obiective: Bolile cordului stang sunt una dintre prin-
cipalele cauze de hipertensiune pulmonara (HTP) care
asociaza un prognostic prost mai ales in prezenta dis-
functiei de ventricul drept (VD). Studii recente subli-
niaza importanta evaluarii morfologice si functionale
nu doar a VD ci si a arterei pulmonare (AP) si a in-
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Suplimentul A, 2010
280
ters of right ventricular function and no relationship
with hemodynamics of the right heart, which supports
the existence of arterial-ventricular interaction in this
group.
209. Factori determinanti ai
rigiditatii si aterosclerozei
precoce carotidiene in
acromegalie
Anca Florian, Ruxandra Jurcut, Simona Galoiu, Auro-
ra Vladaia, Ionela Baciu, Oana Savu, Mariana Purice,
M.Coculescu, B.A.Popescu, Carmen Ginghina
Introducere. Pacientii cu acromegalie (ACM) au o du-
rata de viata scazuta, in principal datorita complicati-
ilor cardiovasculare. Indicele intima-media (IMT) si
rigiditatea arteriala carotidiana determinate ecografc
sunt markeri de ateroscleroza precoce. Scopul studiu-
lui este de a determina daca modifcarile structurale si
functionale carotidiene in ACM sunt corectate dupa
controlul ACM prin terapiile actuale in acromegalie.
Metode: 52 pacienti cu ACM internati consecutiv
(varsta medie 46+12 ani) au fost inclusi prospectiv
intre septembrie 2008-martie 2010. Toti pacientii au
fost evaluati prin factorii de risc cardiovascular clasici,
nivelul bazal al GH (sensibilitate 0,04 ng/ml) si IGF1,
ecografa arterei carotide comune drepte (2D si tehnici
de ecotracking) si comparati cu 21 pacienti control fara
ACM de aceeasi varsta si sex (40,7+11,8 ani).
Rezultate: 18 pacienti cu ACM au avut boala controlata
dupa tratament multimodal si 34 pacienti au avut boala
activa (6 pacienti netratati). Durata medie a ACM a fost
de 12+8 ani, cu intervalul de control al ACM de 0,6+1,4
ani. Nu au fost diferente intre numarul de factori de risc
cardiovascular si durata ACM intre grupurile de ACM
controlata si activa, dar pacientii cu ACM activa au
fost mai tineri decat cei cu ACM controlata (43+11 ani
versus 50,9+11 ani, p=0,02). Pacientii cu ACM au avut
carotida mai dilatata (6.3+0,6 mm) si indicele intima
medie (IMT) (0,7+0,1 mm) mai mare versus pacientii
control fara ACM (5,7+0,6 mm and 0,5+0,1 mm, re-
spectiv), p<0,001. La analiza de regresie multipla, IMT,
marker de ateroscleroza precoce, a depins de tensiunea
Echocardiographic evaluation
of Pulmonary artery pulsatility
in patients with pulmonary
hypertension associated with
left heart diseases
Aims: Lef heart diseases (LHD) are one of the most
common causes of pulmonary hypertension (PH),
associating a poor prognosis, especially in the presence
of right ventricular (RV) dysfunction. Recent studies
highlight the importance of morphologic and function
evaluation not only of RV but also of pulmonary ar-
tery and ventricular-arterial interaction, as new factors
for risk stratifcation in PH. Tis study was designed
to evaluate the relationship among pulmonary artery
pulsatility, severity of PH and RV function in patients
with PH associated with LHD.
Material and methods: We analyzed right branch
pulmonary artery pulsatility using M-mode echocar-
diography in the suprasternal window in 35 pts, aged
63+/- 9.66 years (15 women), with PH associated with
LHD (8 pts had severe mitral regurgitation, 9 pts had
severe aortic stenosis, 7pts had dilated cardiomiopathy,
7 pts hat severe mitral stenosis, 1 pacient had severe
aortic regurgitation, 2 pts had myocardial infarction
and one pacient had isolated lef ventricul diastolic dis-
function). Systolic pulmonary pressure (sPAP), accele-
ration time in the pulmonary artery (PAT), tricuspid
annulus plane systolic excursion (TAPSE) as well as
the end systolic (ESDmax) and maximum end diastolic
diameter (EDDmax) of right artery pulmonary branch
(RPAB) were measured with echocardiography. Arteri-
al pulsatility was calculated using the folowing formula:
[(ESDmax EDDmax)/EDDmax] * 100.
Results: One patient was in NYHA functional class I,
twelve were in class II, seventeen in class III and six
in class IV. In the study group, sPAP was 65,320,19
mmHg with an ATP of 84.625.1 ms and TAPSE of
194.77 mm. Te calculated mean pulsatility was
9.68+/- 5.64. Mean pulsatility correlated well with TAP-
SE (R=0.34, p=0.043), showing no correlation with the
hemodynamic parameters: sPAP and PAT and NYHA
functional class. TAPSE correlated with PAT (R=0.42,
p= 0.011), sPAP (R=0.51, p=0.002) and NYHA functi-
onal class (R=-0.4, p=0.01).
Conclusions: In patients with pulmonary hypertensi-
on associated with lef heart diseases, pulmonary ar-
tery pulsatility showed a positive relation with parame-
Suplimentul A, 2010
281
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ACM patients versus controls (6.3 +1.5 vs. 5.4+0.7 m/s,
p=0.005, with no diference between controlled and ac-
tive ACM, even afer age adjusting the 2 groups.
Conclusion: Patients with acromegaly present with
structural and functional alterations of carotid wall,
dependent on disease duration and not infuenced by
the disease status afer therapy.
210. Insuficienta cardiaca si
sindromul de apnee in somn
Magdalena Patriche, Andreea Stana, Ileana Tepes
Piser, C. Macarie
Scopul studiului a fost evaluarea efectelor stimularii
simpatice la pacientii cu sindrom de apnee in somn
(SAS) si insufcienta cardiaca, precum si a efectului
tratamentului cu CPAP/BiPAP - dupa o noapte, in
amelioarea valorilor hipertensiunii arteriale (HTA) si
frecventei cardiace (consecinte ale hiperstimularii sim-
patice), la aceasta categorie de pacienti (pts).
Material si metode: s-au luat in studiu 90 pts cu dis-
functie sistolica de ventricul stang (VS) (fractia de ejec-
tie VS 50%), la care s-a efectuat chestionarul Schram
(al Societatii Germane de Cercetare si Medicina a
Somnului) si examenul polisomnografc. Varsta medie
a pts. a fost de 59 10,4 ani, cu predominanta sexu-
lui masculin (80%). Au fost inclusi intro baza de date
urmatorii parametri: indicii antropometrici, obezitatea
(factor de risc pentru SAS), fractia de ejectie VS (me-
toda Simpson), tensiunea arteriala si frecventa cardiaca
inainte si dupa examenul polisomnografc si tratament
CPAP/BiPAP si rezultatele polisomnografce.
Rezultate: Pacientii au fost impartiti in doua loturi: lo-
tul 1 44 pts (48%) fara SAS la examenul polisomno-
grafc si lotul 2 46 pts. (52%) cu SAS. HTA sistemica a
fost evidentiata ca expresie a hiperactivitatii simpatice
la 41 pts (89%) in lotul 2, fata de 28 pts (64%) in lo-
tul 1,(p=0,005). Obezitatea a fost evidentiata la 33 pts
(72%) in lotul 2, cu predominenta obezitatii de grad II
(40%), comparativ cu 24 pts (55%) in lotul 1, cu predo-
minenta obezitatii de grad I (45%), (p=0,09). In urma
examenului polisomnografc s-a constatat ca din paci-
entii cu SAS, 22 pts (47%) au prezentat SAS forma cen-
trala (SAC), 18 pts (38%) SAS forma mixta (SAM) si 7
arteriala sistolica si de durata acromegaliei, p=0,01. Ve-
locitatea undei pulsului (PWV), un indice de rigiditate
arteriala, a fost mai mare la pacientii cu ACM versus
control (6,3+1,5 vs. 5,4+0,7 m/s, p=0,005, fara diferen-
te intre grupurile de ACM activa si controlata, chiar si
dupa eliminarea diferentei de varsta dintre grupuri.
Concluzie: Pacientii cu acromegalie au modifcari
structurale si functionale ale peretelui carotidei, depen-
dente de durata bolii si nu sunt infuentate de statusul
bolii dupa tratament.
Determinants of carotid
stiffness and early
atherosclerosis in acromegaly
Background. Patients with acromegaly (ACM) have a
reduced life expectancy, mainly due to cardiovascular
complications. Carotid intima-media thickness and sti-
fness as determined by ultrasonography are markers of
early atherosclerosis. Aim of the study. To determine if
structural and functional carotid alterations in patients
with acromegaly are dependent on disease status afer
current therapies for acromegaly.
Methods: 52 consecutive patients with ACM (mean
age 46+12 yrs) were prospectively included between
September 2008 - Mars 2010. For all pts we studied the
classical cardiovascular risk factors (CVF), basal GH
(sensitivity 0.04 ng/ml) and IGF1 levels, right common
carotid (RCC) ultrasonography (2D and echotracking
techniques) and compared with 21 age and sex mat-
ched controls without ACM (40.7+11.8 yrs).
Results: 18 ACM patients were controlled afer mul-
timodal therapy and 34 patients had active disease (6
nave patients). Te mean duration of ACM was 12+8
yrs, with disease free interval in patients with controlled
ACM of 0.6+1.4 yrs. Tere were no diferences between
the number of CVF and ACM duration between the
controlled and active ACM group, but patients with
active ACM were younger than in controlled ACM
(43.2+11 vs. 50.9+11yrs, p=0.02). ACM patients had
higher RCC diameter (6.3+0.6 mm) and intima media
thickness (IMT) (0.7 +0.1 mm) versus controls witho-
ut ACM (5.7 +0.6 mm and 0.5+0.1 mm, respectively),
p<0.01. IMT, a marker of subclinical atherosclerosis,
was dependent at multiple regression analysis on systo-
lic blood pressure and disease duration (p=0.01). Pulse
wave velocity, an arterial stifness index was higher in
POSTER I I I
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Suplimentul A, 2010
282
with SAS. HT was highlighted as an expression of sym-
pathetic hyperactivity in 41 pts (89%) in group 2, in
regard of 28 pts (64%) in group 1(p= 0,005). Obesity
was present at 33 pts (72%) in group 2, with obesity
tip II predominance (40%), in regard of 24 pts (55%)
in group 1, with obesity tip I predominance (45%) (p=
0,09). Afer the polisomnografc exam, was ascertain
that in group 2, 22 pts (47%) presented central sleep ap-
nea (SAC), 18 pts (38%) mixed sleep apnea (SAM) and
7 pts (15%) obstructive sleep apnea (SAO). Among the-
se pts, only 11 pts (23%) was treated with CPAP/BiPAP
because of the ENT and neurologic diseases and non-
compliance of pts. In the wake of the statistical analysis,
was revealed a correlation between moderat and seve-
re lef ventricular systolic dysfunction and SAM (p=
0,05), but without a correlation between the severity of
SAS and the severity of systolic dysfunction. Afer the
CPAP/BiPAP treatement (during one night), the values
of blood pressure were signifcantly improved (especi-
ally the diastolic component) (134,4 vs. 120,1, p<0,05),
but without a signifcant decrease in heart rate values
(78,9 vs. 76,2, p= 0,3). Also, the treatement improved
the arterial oxygen saturation in these pts. (69,2% vs.
83%, p<0.05). Note that the results presented are pre-
liminary. Te data are part of ongoing study and will
assess the infuence of CPAP/BiPAP treatement in
heart failure.
Conclusions: Obesity and hypertension were correla-
ted with the presence of SAS in pts. with lef ventricular
systolic dysfunction and the CPAP/BiPAP treatement
proved efective in lowering blood pressure (especially
systolic component) and improve arterial oxygen satu-
ration.
211. Valoarea prognostic
a disfunctiei endoteliale la
pacientii hipertensivi cu sau
fr sindrom metabolic
A.Gavrila, C.Searpe, Maria Ciobanu, Anca Rosu, Sido-
nia Marinescu, Maria Chirion, V.Sbarcea
Spitalul Clinic C.F., Craiova
Scopul studiului a fost de a aprecia felul in care dis-
functia endoteliala se coreleaza cu evenimentele cardi-
ovasculare la pacientii cu sau fara sindrom metabolic
(SM).
pts (15%) SAS forma obstructiva (SAO). Dintre acestia,
la doar 11 pts (23%) s-a efectuat tratament cu CPAP/
BiPAP, datorita afectiunilor ORL, neurologice dar si a
necompliantei pts. In urma analizei statistice s-a evi-
dentiat o corelatie intre disfunctia sistolica moderata si
severa VS si SAM (p= 0,05), fara a se gasi o corelatie
intre severitatea SAS si severitatea disfunctiei sistolice.
Dupa tratamentul cu CPAP/BiPAP (in cursul unei nop-
ti), s-a evidentiat o ameliorare semnifcativ statistica a
valorilor tensiunii arteriale (in special a componentei
sistolice)(134,4 vs. 120,1, p<0,05), fara insa a se con-
stata o scadere semnifcativa a valorilor frecventei car-
diace (78,9 vs. 76,2, p= 0,3). De asemenea, tratamentul
a ameliorat si saturatia arteriala a oxigenului la acesti
pts (69,2% vs. 83%, p<0.05). Mentionam ca rezultatele
prezentate sunt preliminare. Studiul din care fac parte
este in curs de desfasurare, urmand a evalua infuenta
tratamentului CPAP/BiPAP in insufcienta cardiaca.
Concluzii: Obezitatea si HTA s-au corelat cu prezenta
SAS la pts. cu disfunctiei sistolica VS, iar tratamentul
cu CPAP/BiPAP s-a dovedit efcient in scaderea valori-
lor tensiunii arteriale (mai ales a componentei sistolice)
si ameliorarii saturatiei arteriale a oxigenului.
Heart failure and sleep apnea
syndrome
Te aim of the study was to assess the outcome of sym-
pathetic stimulation in patients (pts) with sleep apnea
syndrom (SAS) and heart failure, and also to evaluate
the results of CPAP/BiPAP treatment (during one ni-
ght), in improvement of hypertension (HT) and heart
rate - consequences of sympathetic hyperstimulation,
in this group of pts.
Design and methods: we studied 90 pts with lef ven-
tricular systolic dysfunction (lef ventricular ejection
fraction 50%), which we performed the Schram qu-
estionnaire (of German Society of Reserch and Medici-
ne of Sleep) and the polisomnografc exam. Te mean
age was 59 10,4yo, with male predominance (80%).
Te next data were added in a database: antropometric
index, obesity (SAS risk factor), lef ventricular ejection
fraction (Simpson method), and blood pressure, heart
rate before and afer the polisomnografc exam and
CPAP/BiPAP treatement and also the polisomnografc
results.
Results: Patients have been divide in two groups: group
1: 44 pts (48%) without SAS and group 2: 46 pts. (52%)
Suplimentul A, 2010
288
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The prognostic value of
endothelial dysfunction at
hypertensive patients with or
without metabolic syndrome
Te aim of the study was to estimate how the endothe-
lial dysfunction corellates with cardiovascular events
at hypertensive patients with or without metabolic
syndrome.
Material and methods: 30 hypertensive patients (mean
age = 58.2 7.6 years, 53.3 % males) - group 1 and 30
hypertensive patients with metabolic syndrome, mat-
ched for age and sex (mean age = 59.8 7.3 years, 56.6
% males) - group 2. Endothelial dysfunction was evalu-
ated using ultrasound assessment of fow-mediated va-
sodilatation of the brachial artery ( FMD). FMD smal-
ler than 10 % was considered abnormal. All patients
were evaluated during one year, in order to detect the
flowing complications: unstable angina (UA), non-ST-
segment elevation myocardial infarction (NSTEMI),
transient ischemic stroke (TIS), ischemic stroke (IS).
Results: In group 1, 14 patients (46.6 %) had redused
FMD (%): 7.4 1.7. In group 2, 17 patients (56.6 %) had
redused FMD (%): 6.8 2.5. Te diference is not signi-
fcantly statistic between the two groups (p = 0.08). In
group 1, UA was signifcantly associated with reduced
FMD (%) (7.2 1.6 vs 11.1 2.3, p = 0.03). In the same
group, TIS was found in a signifcantly higher proporti-
on at patients with reduced FMD (%) (7.1 1.8 vs 11.4
2.5, p=0.02). In group 2, UA was also signifcantly
associated with reduced FMD (%) (6.9 2.3 vs 10.8
2.9, p = 0.01). NSTEMI was signifcantly more frequent
at patients with reduced FMD (%) (6.3 1.9 vs 11.2
3.3, p = 0.01). In the same group, TIS was found in a
signifcantly higher proportion at patients with redu-
ced FMD (%) (6.7 2.9 vs 10.6 2.5, p = 0.02).
Conclusions: Hypertensive patients with metabolic
syndrome have endothelial dysfunction in a greater, but
not signifcant proportion than hypertensive patients
without metabolic syndrome. Endothelial dysfunction
seems to predict a worse mid term outcome (one year)
concerning cardovascular events at hypertensive pati-
ents, especially with metabolic syndrome. Moreover,
endothelilal dysfunction appears to have more power-
ful mid term prognostic value for incidence of acute
coronary syndromes without ST-segment elevation at
hypertensive patients with metabolic syndrome.
Material si metode: 30 pacienti hipertensivi (varsta
medie = 58.2 7.6 ani, 53.3 % barbati) grupul 1 si
30 pacienti hipertensivi cu SM , avand caracteristici si-
milare cu primul lot in ceea ce priveste distributia pe
varsta si sexe (varsta medie = 59.8 7.3 ani , 56.6 %
barbati) grupul 2. Disfunctia endoteliala a fost ana-
lizata folosind examinarea ecografca a vasodilatatiei
mediata de fux (FMD) la nivelul arterei brahiale. FMD
mai mica de 10 % a fost considerata anormala. Toti pa-
cientii au fost evaluati timp de 1 an in scopul depistarii
urmatoarelor complicatii: angina instabila (AI) , infarct
miocardic fara supra denivelare de segment ST (IMA-
FSD) , accident vascular cerebral ischemic tranzitor
(AIT) , accident vascular cerebral ischemic constituit
(AVC).
Rezultate: In grupul 1 , 14 pacienti (46.6 %) au avut
FMD (%) redusa: 7.4 1.7 . In grupul 2 , 17 pacienti
(56.6 %) au avut FMD (%) redusa: 6.8 2.5 . Diferenta
a fost nesemnifcativa statistic intre cele 2 grupuri (p
= 0.08). In grupul 1 , AI a fost asociata semnifcativ cu
FMD (%) redusa (7.2 1.6 vs 11.1 2.3 , p = 0.03). La
acelasi lot, AIT a fost gasit intr-o proportie semnifcativ
mai mare la pacientii cu FMD (%) redusa (7.1 1.8 vs
11.4 2.5 , p=0.02). In grupul 2 , AI a fost de asemenea
asociata semnifcativ cu FMD (%) redusa (6.9 2.3 vs
10.8 2.9 , p = 0.01). IMAFSD a fost semnifcativ mai
frecvent la pacientii cu FMD (%) redusa (6.3 1.9 vs
11.2 3.3 , p = 0.01). In acelasi grup , AIT a aparut intr-
o proportie semnifcativ mai mare la pacientii cu FMD
(%) redusa (6.7 2.9 vs 10.6 2.5 , p = 0.02).
Concluzii: Pacientii hipertensivi cu SM au disfunctie
endoteliala intr-o proportie mai mare dar nesemnif-
cativa fata de pacientii hipertensivi fara SM. Disfunctia
endoteliala pare sa prognozeze o evolutie mai nefavo-
rabila pe termen mediu (1 an), in ceea ce priveste eve-
nimentele cardiovasculare la pacientii hipertensivi, mai
ales la cei cu SM. In plus, disfunctia endoteliala pare sa
aiba o putere prognostica mai mare, pe termen mediu,
pentru incidenta sindroamelor coronariene acute fara
supradenivelare de segment ST, la pacientii hiperten-
sivi cu SM.
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Suplimentul A, 2010
281
Ectopic beats revealing
myocardial infarction with Q
wave
Purpose: Morphology of same ectopic beats with Q
wave allows a better assessment of known or unknown
of myocardial infarction (MI). Te MI with Q wave are
considered transmural or least in those MI, the necro-
sis would afect a larger of MI than in non Q MI.
Method: We have analysed ECGs in 12 cases with ven-
tricular extrasystols (VE), escape ventricular rhythms,
atrial fbrillation and atrial extrasystols with aberrant
conduction which could be revealing of Q wave MI.
Results: ECGs aspects witch confrm or unmask MI.
MI non Q, nontransmural possible, VE have recorded
MI with Q wave, transmural possible. Old inferior MI
and STEMI anterior without Q wave, VE with Q wave
unmask STEMI anterior with Q wave, concomitantly.
Old anteroapical MI with Q wave and lateral non Q
wave, VEs have recorded inferior and lateral MI with
Q wave; the lateral repolarization suspect of anevrism
has echocardiografc confrmed. Old inferior MI LBBB
with q wave in V4 VE confrms MI with Q wave in V3-
V5. Permanent atrial fbrillation without known MI and
brs with q wave, VEs have confrmed inferior MI with
Q wave, and a ventricular escape has unmasked antero-
septal MI with Q wave. Acute anterior MI with Q wave,
with rS in I and sinoatrial block, an episode of VTN
records extension in I with QR and lesion-ischemia.
Permanent atrial fbrillation without MI, afer a VE one
record two complexes with q and lesion-ischemia with
aspect of acute inferior MI, followed of complexes with
R wave and normal repolarization; post extrasystolic
ischemia have unmask MI; in precordials, an aberrant
ventricular conduction have unmask anterior MI with
Q wave. In two cases afer episodes of unstable angina
pectoris the aberrant atrial extrasystols have recorded
old inferior MI with Q wave. Discussion: Te VEs or
aberrant atrials extrasystoles are not accompanied by
Q wave only in aVR, aVL (V1). In VE, VT and idio-
ventricular rhythm the diagnosis of MI can be made on
predominant positive Q(q)RS complexes. Te VE with
Q(q) waves detects or confrms the MI until 50% of ca-
ses and is false positive in 8% of cases.
Conclusions: Te ectopic ventricular beats and ventri-
cular aberrant conductions can be of MI revealing with
Q wave, can unmask the extension of necrosis with Q
wave and can be suspect of ventricular anevrism. In
non Q MI, netransmural possible, VEs with Q wave
unmask MI with Q wave, transmural possible.
212. Batai ectopice revelatoare
de infarct miocardic cu unda Q
R.Grigore, Cristina Sutescu, Ileana Grigore
Spitalul Judetean, Galati
Scopul lucrarii: Morfologia unor batai ectopice cu
unda Q permite o evaluare mai corecta a cazurilor cu-
noscute sau necunoscute cu infarct miocardic (IM). IM
cu unda Q sunt considerate transmurale sau cel puin
in aceste IM necroza afecteaza o cantitate mai mare de
miocard.
Metoda: Am analizat ECG in 12 cazuri cu extrasisto-
le ventriculare (EV), ritmuri de evadare ventriculara,
fbrilaie atriala i extrasistole atriale aberante care pot
f revelatoare de IM cu unda Q.
Rezultate: Aspecte ECG care confrma sau demasca
IM. IM non Q, posibil netransmural, EV a inscris IM cu
unda Q posibil transmural. IM vechi inferior i STEMI
anterior fara unda Q, EV cu unda Q demasca STEMI
anterior cu unda Q, concomitent. IM vechi anteroapi-
cal cu unda Q i lateral non Q, EV au inscris IM inferior
i lateral cu unda Q; repolarizarea laterala suspecta de
anevrism s-a confrmat ecocardiografc. In IM vechi cu
BRS i unda q in V4, EV confrma IM cu unda Q in
V3-V5. Fibrilaie atriala permanenta fara IM cunoscut
i brs cu unda q, EV au confrmat IM inferior cu unda
Q, i o scapare ventriculara a demascat IM anteroseptal
cu unda Q. IM acut anterior cu unda Q, rS in I i bloc
sinoatrial; o secvena de TVN inscrie extindere in I cu
QR i leziune-ischemie. Fibrilaie atriala permanenta
fara IM, dupa o EV se inscriu doua complexe cu q i le-
ziune ischemie cu aspect de IM acut inferior, urmate de
complexe cu R i repolarizare normala; ischemia post
extrasistolica a demascat IM; in precordiale, o condu-
cere ventriculara aberanta a demascat IM anterior cu
unda Q. In doua cazuri, dupa episoade de angina pec-
torala instabila extrasistole atriale aberante au inscris
IM vechi inferior cu unda Q.
Discuii: EV sau extrasistole atriale aberante nu se
insoesc de Q decat in aVR, aVL (V1). In EV, TV i
ritmul idioventricular diagnosticul de IM poate f fa-
cut pe complexe Q (q)RS predominant pozitive. EV cu
unda Q (q) depisteaza sau confrma IM pana la 50%
din cazuri i este fals pozitiv in 8% din cazuri. In con-
cluzie bataile ectopice ventriculare i conducerile ven-
triculare aberante pot f revelatoare de IM cu unda Q,
pot demasca extinderea necrozei cu unda Q i pot f
suspecte de anevrism ventricular. In IM non Q, posibil
netransmural EV cu unda Q demasca IM cu unda Q,
posibil transmural.
Suplimentul A, 2010
285
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determinarile prin cateterism (r=0.9, p<0.01) si a sub-
estimat evaluarea prin metoda termodilutiei cu un bias
de 0,76 l/min.
Concluzii: Ecocardiografa ofera informatii sufcient
de precise in ceea ce priveste parametrii hemodinamici
caridiaci justifcand utilizarea metodei pe scara larga.
Totusi, metoda are un risc de subestimare a masurato-
riloe obtinute invaziv, in special in cazul determinarii
rezistentei vasculare pulmonare si a debitului cardiac.
Echocardiographic assessment
of hemodynamics comparison
with cardiac catheterization
Aims: Assessment of cardiac hemodynamics is most
important in clinical practice. We set out to evaluate
the accuracy of echocardiographic parameters in com-
parison with invasively-measured hemodynamic para-
meters.
Methods: Twelve patients (pts), aged 599 years,12
men, admitted in the intensive care unit with a clinical
indication for Swan Ganz catheterization had a simul-
taneous evaluation of hemodynamic parameters non-
invasively (by echocardiography) and invasively (by ca-
theterization). Systolic pulmonary pressure (sPAPcath),
pulmonary vascular resistance (PVRcath) and cardiac
output (COcath) were measured using the thermodi-
lution method. Using echocardiography, the following
parameters were calculated: sPAPecho based on peak
velocity of the tricuspid regurgitation (PVTR) adding a
mean right atrial pressure of 10mmHg, PVRecho based
on the ratio between PVTR and velocity time integral
of pulmonary fow (VTIp) and COecho by multiplying
the cross sectional area of the lef ventricular outfow
tract with VTI of systemic fow.
Results: Nine pts were in postoperative status and three
pts were admitted in the intensive care unit for deterio-
rating clinical and hemodynamic status. Te sPAPcath
was 42.813 mmHg with a COcath of 5.11.6 l/min and
a calculated PVRcath of236.18107.4 dyne*sec/cm5
(2.93.4 Wood Units). sPAPecho was 43.815 mmHg
and correlated stronglywith the catheterization mea-
surement (r=0.89, p<0.01). Te bias between methods
was 1 mmHg with a standard error of estimation of 2%.
Te echo-estimated PVR was 2.010.84 Wood Units.
Tis correlated well with PVRcath (r=0.66,p=0.03),
and the correlation improved afer correcting for heart
213. Evaluarea ecocardiografica
a parametrilor hemodinamici
comparatie cu masuratorile
obtinute prin cateterismul
cardiac
S.Giusca, Ruxandra Jurcut, Oana Ghenu, B.A.Popescu,
Daniela Filipescu, Carmen Ginghina
Scop: Evaluarea statusului hemodinamic este foarte
importanta in practica clinica. Scopul studiului a con-
stat in evaluarea acuratetii determinarilor ecocardio-
grafce ale parametrilor hemodinamici comparativ cu
determinarile invazive prin cateterism.
Material si metoda: Douasprezece pacienti (pts)599
ani, 12 barbati, internati in sectia de terapie intensiva
cardiovasculara cu indicatie clinica de plasare de cate-
ter Swan Ganz au fost evaluati simultan din punct de
vedere hemodinamic utilizand ecocardiografa si cate-
terismul cardiac drept. Prin metoda termodilutiei au
fost determinati paramertii: presiunea sistolica in artera
pulmonara (PSAPcat), rezistenta vasculara pulmonara
(RVPcat) si debitul cardiac (DCcat). Din masuratorile
ecocardiografce au fost calculati paramertii: presiunea
sistolica in artera pulmonara (PSAPeco), rezistenta
vasculara pulmonara (RVPeco) pe baza raportului in-
tre velocitatea maxima a regurgitarii tricuspidiene si
integrala velocitate timp (IVT) a fuxului pulmonar si
debitul cardiac (DCeco) prin multiplicarea ariei trac-
tului de ejectie a ventricului stang cu IVT masurata la
acest nivel.
Rezultate: 9 pts se afau in status postoperator iar 3
pts au fost admisi in sectia de terapie intensiva pentru
agravarea statusului clinic si hemodinamic. PSAPca-
th a fost de 42.813 mmHg cu un DCcat de 5.11.6 l/
min si o RVPcat 236.18107.4 dyne*sec/cm5 (2.93.4
Unitati Wood). PSAPeco a fost de 43.815 mmHg cu
o corelatie stransa cu valorile determinate prin catete-
rism (r=0.89, p<0.01). Bias-ul masuratorii ecocardio-
grafce a PSAP a fost de 1 mmHg cu o eroare standard
de masurare de 2%. RVPeco a fost de 2.010.84 UW cu
o corelatie buna cu masuratorile obtinute la cateterism
(r=0.66, p=0.03), corelatie imbunatatita de corectia
pentru frecventa cardiaca (r=0.69, p=0.03). Determi-
nara ecocardiografca a subestimat constant RVPcat cu
un bias de 1.06 UW. DCeco a avut o corelatie stransa cu
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Suplimentul A, 2010
286
<60ml/min, iar SC a fost crescut (>1.2mg/dl) la 8
(33%) pacienti. QTmax a fost: 46053 ms, QTc: 55078
ms, Tpe: 15020 ms, Ta: 4.751.74 mm, potentiale ven-
triculare tardive si harti multipolare izointegrale QRST
au fost prezente la 15 (63%) pacienti, SC: 1.550.56 mg/
dl si GFR: 79.534 ml/min. Corelatii bune au fost gasite
intre parametrii ECG mentionati si GFR si SC; cea mai
buna corelatie a fost gasita intre QTc si GFR (r=-0.696).
Prevalente mari ale potentialelor ventriculare tardive
(74%), hartilor izointegrale QRST multipolare (53%),
QTmax (63%) si QTc (89%) alungite au fost gasite la
pacientii cu GFR redusa.
Concluzie: Riscul de aritmii ventriculare este crescut la
pacientii cu insufcienta cardiaca post-infarct si functie
renala afectata.
Renal function and ventricular
arrhythmia risk in post-
infarction heart failure patients
Introduction: Cardio-renal and reno-cardiac syndro-
mes signifcantly increase mortality.
Aim: We hypothesized that ventricular arrhythmia risk
is increased in post-infarction heart failure patients
with impaired renal function.
Material and methods: We included 24 post-infarcti-
on heart failure patients in our study. Tey underwent:
12-lead ECG, signal averaged ECG and 64-electrodes
body surface mapping. Te maximal duration of the
QT interval in the 12 ECG leads (QTmax), the heart
rate corrected QT interval (QTc), the Tpeak-Tend in-
terval (Tpe), T wave amplitude (Ta), signal-averaged
QRS duration (SA-QRS), RMS40 (the square root of
the last 40 ms of the late ventricular signal), LAS40 (the
duration of the signal at the end of the QRS complex
with an amplitude below 40 microV) and laboratory
parameters like: glomerular fltration rate (GFR) and
serum creatinine (SC) were assessed.
Results: GFR was impaired in 19 (79%) patients
(GFR<90ml/min), 7 (29%) patients had a GFR<60ml/
min, and SC was elevated (>1.2mg/dl) in 8 (33%) pa-
tients. QTmax was: 46053 ms, QTc: 55078 ms, Tpe:
15020 ms, Ta: 4.751.74 mm, late ventricular potenti-
als and multipolar isointegral QRST maps were present
in 15 (63%) patients, SC: 1.550.56 mg/dl and GFR:
79.534 ml/min. Good correlations were found betwe-
en the mentioned ECG parameters and GFR and SC;
rate(r=0.69, p=0.03). Te echo measurements con-
stantly underestimated PVR with a bias of 1.06 Wood
Units. Cardiac output measured with echocardiogra-
phy (4.41.1 l/min) correlated strongly with catheteri-
zation (r=0.9, p<0.01). As in the case of PVR, CO mea-
surements by echo underestimated cath-determined
values with a bias of 0.76 l/min.
Conclusion: Echocardiography provides a fairly accu-
rate description of cardiac hemodynamic parameters,
justifying its widespread use in clinical practice. Te
method has a risk of underestimating invasive-deter-
mined values especially when measuring pulmonary
resistance and cardiac output.
214. Functia renala si riscul de
aritmii ventriculare la pacientii
cu insuficienta cardiaca post-
infarct
Ioana Mozos, M.Hancu
Universitatea de Medicina si Farmacie Victor Babes
Timisoara
Introducere: Sindroamele cardio-renale si reno-cardi-
ace determina o crestere semnifcativa a mortalitatii.
Scop: Am pornit de la ipoteza ca riscul de aritmii ven-
triculare este crescut la pacientii cu insufcienta cardia-
ca post-infarct cu functie renala redusa.
Material si metoda: Am inclus 24 de pacienti cu in-
sufcienta cardiaca post-infarct in studiul nostru. Ei
au fost investigati cu ajutorul: ECG in 12 derivatii,
electrocardiografei de inalta rezolutie si mappingului
ECG de suprafata. S-au determinat: durata maxima
a intervalului QT in cele 12 derivatii ECG (QTmax),
intervalul QT corectat in functie de frecventa cardiaca
(QTc), intervalul cuprins intre varful si fnalul undei T
(Tpe), amplitudinea undei T (Ta), durata QRS determi-
nata cu ajutorul electrocardiografei de inalta rezolutie
(SA-QRS), RMS40 (radacina patratica a semnalului din
ultimele 40 ms ale complexului QRS), LAS40 (durata
semnalului de la fnalul complexului QRS cu o ampli-
tudine de sub 40 microV) precum si investigatii de la-
borator ca: rata fltrarii glomerulare (GFR) si creatinina
serica (SC).
Rezultate: GFR a fost redusa la 19 (79%) pacien-
ti (GFR<90ml/min), 7 (29%) pacieni au avut GFR
Suplimentul A, 2010
28I
POSTER I I I
POSTER I I I
the best correlation was found between QTc and GFR
(r=-0.696). High prevalence of late ventricular poten-
tials (74%), isointegral QRST multipolar maps (53%),
prolonged QTmax (63%) and QTc (89%) were found in
patients with a decreased GFR.
Conclusion: Ventricular arrhythmia risk is increased
in post-infarction heart failure patients with impaired
renal function.
I NDEX AUTORI | AUTHORS I NDEX*

Barsan S. 64, 128, 76, 175, 186
Bartos Daniela 42, 179
Bazac Mihaela 179
Beladan Cristiana Carmen 16, 68, 69, 81, 140, 149, 189,
205
Benea Loredana 119
Benedek Teodora 7, 9, 22, 77
Benedek I. 7, 9, 22, 28, 87, 77
Berceanu Vaduva Delia 112, 162
Bica Ramona 71
Bjerkestrand Andreea 12, 53, 172, 197
Blaj C. 182
Blajan D. 130
Blommaert Dominique 73
Bobescu Elena 8, 109, 160, 164
Bocicor Andreea 142
Bodizs G. 4 117
Boisteanu Daniela 74
Boldea Colcear Carmen Elena 113
Bolog Mihaela Ioana 185
Bologa Cristina 48
Bolohan R. 207
Borda Monica 88
Borza Alina 153
Botu E.G. 100
Branidou K. 14
Brnzan Livia 23, 61, 62, 188
Bruckner I. 39, 93, 138
Bucur Oana 7, 9, 77
Burducea A. 164
Burlacu A. 192, 195
Burlacu I. 21, 122, 132, 135
Burta O. 24
Buzogny J. 168
Buzogny Jzmin 103
C
Calangea Irina 60
Caldararu Cristina Ioana 41, 72, 191
Calin Andreea 16, 25, 68, 69, 81, 140, 149, 189, 205
Calin C. 68
Caloianu Geana Alina 97
Campeanu A. 91, 139
Capalneanu R. 161, 180
Caprariu Madalina 27
Caraba A. 29
Caraiola Simona 38
Carasca E. 103, 115, 137, 168
Carerj Simone 206
Carp A. 47
Catalin Gabriela 90
A
Adam F. 52, 63
Adrian V. 86
Aforii Raluca 118
Agoston Coldea Lucia 146
Albisoru Lavinia 75, 182
Aldulea Nicoleta 109
Alexandru R. 187
Alis Dema 23,188
Alistar Elena 133
Almarichi Simona, 4, 157
Ambarus V. 31, 45
Amzulescu Mihaela Silvia 150,151
Andrei Calin Catalina 52
Andrei Irina 34
Andor Minodora 51
Anghel Mariana 8, 160
Antal Annamria 103
Antal Ramona Alina 31
Antonini-Canterin F. 147, 189, 205, 206
Antoniu Flavia Catalina, 95
Arama Laura 64, 128, 76, 175, 186
Ardeleanu C. 49, 120, 136, 170
Ardeleanu Elena 163
Arhire D. 21, 49, 120, 122, 132, 135, 136, 170
Arhire Nicoleta 21, 49, 120, 122, 132, 135, 136, 170
Arhirii Raluca 45
Artenie R. 45
Aursulesei Viviana 37, 177
Avram Adina 27, 96, 112
Avram C. 86, 96
Avram Rodica 23, 61, 62, 188
Avram Simona 39, 93
B
Baciu Ionela 36, 209
Badano L.P. 25, 201
Badea Gabriela 185
Badescu Codruta 45
Bdescu Magda Mariana 113
Badila Elisabeta 42, 179
Baicus C. 14, 38
Balaceanu Alice 5
Balea I. 5
Balint M. 23, 61, 62, 188
Blint-Szentendrey Dalma 44
Banu Otilia 119
Brbulescu V. 21, 120, 122, 132, 135
Baroi Genoveva 177
*Cifra reprezint numrul rezumatului
Suplimentul A, 2010
I NDEX AUTORI
AUTHORS I NDEX
Catalina Arsenescu-Georgescu 6, 28, 46, 73, 74, 95,
108, 113, 134
Catau Gabriela 125
Cazacu Simona 8
Cebanu Mirela 15, 110, 117
Cenusa O. 176
Ceptureanu Daniela 115
Chetreanu Lucia 123
Chin D. 67, 79
Chioncel O. 47, 161, 180
Chiriac L. 28, 71, 207
Chirion Cristina 14
Chirion Maria 211
Chitkara K. 195
Chitu Monica 7, 9, 22, 77
Christodorescu Ruxandra 11, 29, 98, 143
Cimpoesu Diana 13
Cinteza M. 1, 66, 78, 106, 116, 141, 145, 148, 190,193,
195
Ciobanu Andrea 78, 80, 116, 141, 190, 200
Ciobanu Celia 160
Ciobanu L. 59, 199
Ciobanu Maria 211
Ciobanu N. 59, 199
Ciocarlie T. 23, 62, 188
Ciomag-Ianula Raluca 52, 63, 105, 155
Cioriaca, G. 86
Citu I. 51
Ciudin R. 114
Ciurea C. 54, 164,165
Ciutea Mirela Paraschiva 31
Coad Geanina 113
Cobe V. 59, 199
Cobzariu F.I. 40, 162
Coculescu M. 36, 209
Cojocaru Lucia 92
Coman I.M. 149,151
Constantin T. 163
Constantinescu Dana 72
Constantinescu Ileana 84
Copaci I. 38
Coriu D. 194
Corlan A. 1
Cornea B. 49, 120, 136, 170
Coroescu Mirela,21, 122, 132, 135
Costache Irina 13
Cote Ioana 178
Cotet Bianca 165
Cote Ioana 61
Cozlea L. 129
Cozma Angela 15, 37
Cozma D. 2, 17
Cozma Madalina 111
Craciun Laura 27, 96, 112
Craciunescu Ileana 85, 99, 185
Craiu Elvira 5, 28, 50, 87, 92, 156, 171
Crintea Simona 185
Cristea Ana 34, 157
Cristian G. 71, 207
Curea Fabiana 16
Cuzor Tatiana 176
D
Dan Anca 14
Dan Delia 18
Dan G.A. 14
Dan Loredana, 115
Dan P. 61
Daraban Ana Maria 194
Darabont Roxana 1
Dasoveanu Madalina 63, 105
Datcu Georgeta 8, 160, 164
Datcu M.D. 6, 37, 161, 177, 180
David Lilia 167, 176
Davide Ermacora 201
De Roy L. 73
DeKoninck P. 70, 202
Delcroix Marion 151
Dema Alis 23,188
Deprest J. 70, 202
Dicu Daniela 18
Dima Corina 19, 131
Dima Laura 194
Dimitriu A.G. 35,55,184
Dimitriu Lavinia 35, 55, 184
Dimulescu Doina 5, 41, 64, 76, 128, , 175, 186
Dinca V.G. 90
Dinu Melania 43
Dobie Lacramioara 146
Dobreanu D. 41
Dohotariu Liliana 13
Doka Bianca 8, 164
Domokos Edith 44
Donea Mirela 8, 54 , 160
Donoiu I. 180
Dormal F. 73
Dorobantu Maria 5, 28, 41, 42, 72, 87, 179, 191
Dsa Gza 44
Dragan Simona 11, 29, 40, 98, 143, 162
Draghici A. 196
Dragoi Ruxandra 141
Dragulescu ST. I. 2, 17, 75, 182
Droc I. 207
Duda-Seiman D.M. 40, 162
Dulgheru Raluca 78, 80, 83, 116, 141, 200
Dumitrache Lacramioara 42
Dumitrescu Mihaela 185
Dumitrescu S.I. 71, 207
Durbaca Adina 13
Dusceac D. 91, 139
I NDEX AUTORI
AUTHORS I NDEX
Suplimentul A, 2010
E
Edme Roxana Mustafa 107, 203
Emanoil Alina 196
Enache Roxana 16,69,81,140,149,205
Ene Elena 191
Enescu Oana 106,148, 190 ,193
F
Faggiano P. 25
Farcas Anca Daniela 3
Felea Doina 35
Filip Gabriela 61
Filipescu Daniela 213
Firastrau V. 87
Fit Raluca 164
Fleancu Alexandra 109
Florescu Maria 66, 78, 116, 148, 190, 193, 200
Florescu N. 192, 195, 198
Floria Mariana 31, 45, 46, 73
Florian Anca 36, 194, 209
Fraser A.G. 141
Frigy A.103, 115, 137, 168
Fruntelata Ana 65
Frunza Sabina Adriana 42
G
Gaita D. 27, 96, 112, 162
Galoiu Simona 36, 209
Garbea S 106
Gavrila A. 211
Germaine Savoiu 29, 98
German-Sallo Marta 44, 129
Ghenu Oana 213
Gheorghe Gabriela Silvia 34, 82
Gheorghiu A. 75,182
Gherghinescu Carmen-Lucia 141
Ghilencea L. 76, 128, 175, 186
Ghionea M. 149
Ghiorghiu Ioana 60, 85, 97, 99, 151, 173, 208
Gianfagna P. 201
Ginghin Carmen 5, 16, 25, 36, 38, 60, 68, 69, 70, 81,
84, 85, 97, 99, 104, 119, 140, 147, 149, 150, 151, 173,
189, 194, 201, 202, 205, 206, 208, 209, 213
Giuca Alina 180
Giusca S. 38, 70, 150,151, 202, 208, 213
Gligor Elena 144
Gojka Gabrijela 112
Gologanu Daniela 14
Gratian M.D. 56, 125, 126
Grecu Mihaela 74
Greere V. 28, 71, 207
Grigore Corina 93
Grigore Ileana 212
Grigore R. 212
Grigorica Lucica 161
Grosu A. 176
Grosu Cristina 49, 120, 136, 170
Gucciardo L. 70, 202
Gurghean Adriana 39
Gurgus Daniela 163
Gurzun Maria-Magdalena 114
H
Haba Danisia 123
Haiducu Lenuta 12, 53, 172, 197
Halici Florentina 102
Hancu M. 214
Hantulie Ileana 93
Hiastru Genoveva 184
Hodorogea Andreea 34, 157
Hodo-Vevecka Aneida 85, 99, 208
Homentcovschi Corina 39, 138
Horatiu R. 165
Horga Diana 22
Hubatsch Mihaela 44, 142
Huidu Simona 64, 76, 128, 175, 186
I
Iacob Nicoleta 56, 126
Iacobescu Alina 57, 101, 124, 153, 166
Iancu Madalina 85, 99, 173, 208
Ildik Kocsis 168
Iliescu V. 32
Iliesiu Adriana 82, 91, 139
Ilisei D. 19, 131
Ionac Adina 2, 17
Ionescu Luminita 64, 76, 128, 175, 186
Ionescu D.D. 10, 28, 107, 161, 180, 181, 203
Ionescu Luminita. 76, 186
Ionescu Ruxandra Maria 150,151
Ionescu Simona 45
Iordache C. 154, 158
Iorga S.I. 58
Iorga-Siman I. 130
Iorgulescu C.N. 41, 72, 155, 187
Isac Laura 150
Ispas V. 21, 49, 122, 132, 135, 136, 170
Istrate Adriana 194
Istratoaie O. 107, 203
Iurciuc M. 27, 86, 96, 112
Iurciuc Stela 27, 86, 96, 112
Ivanescu C. 51
Ivanica A. 75, 182
Ivanica G. 75, 182
Ivanov V. 59, 199
J
Jamart J. 73
Jinga D. 148
Suplimentul A, 2010
I NDEX AUTORI
AUTHORS I NDEX
Jitareanu Cristina 55
Jitari Violeta 50, 171
Jurcut C. 38
Jurcut Ruxandra 36, 38, 60, 68, 70, 140, 149, 150, 151,
189, 194, 202, 208, 209, 213
K
Kikeli P.I. 142
Kosaka Tetsuya 89
Kovac J. 67, 79, 195
Kovacs I. 7, 9, 22, 77
Kozma Gabriela 7, 9, 77
Kulcsar Iulia 47
L
Lacatusu A. 26
Lacau Smaranda 76
Lacrosse M. 73
Laicu Simina 188
Lang L. 142
Laszlo M.I. 88,142
Lazar A. 24
Lazar L. 24
Lazar M., 89
Leiballi Elisa 205
Leica V. 21, 122, 132, 135
Lemeni Alina 150
Leon Maria 19, 131
Lerintiu O. 153
Lighezan D. 51
Lionte Catalina 48, 127
Luca Alina-Costina 154, 158
Luca C.T. 75, 182
Lucaci L. 134
Ludusan G. 5
Lupascu Luiza 68, 81
Lupu Silvia 146
M
Macarie C. 47, 87, 100, 161, 180, 201
Mafei Diana 138
Magda Stefania 78, 116, 141, 148, 190, 200
Magheru C. 57, 124, 166
Magheru Sorina 57, 101, 124, 153, 166
Maghiar F. 57, 101, 124, 153, 166
Malaescu I. 106
Mancas Silvia 27, 40, 86, 96, 112, 162
Manea Paloma 31, 45
Manoliu V. 14
Manta Olimpia 21, 49, 120, 122, 132, 135, 136, 170
Marcu Narcisa Paula 127
Marculescu Mihaela 157
Mrgrit Georgiana 138
Margulescu A. 66, 83, 145 193
Marinescu S. 130
Marinescu Sidonia 211
Marta Daciana Silvia 89, 90
Matei Claudia 7, 9, 22,77
Matei F.L. 16, 140
Mavrea Adelina 51
Maxim G.R. 156
Mehic Florentina 179
Melnic M. 64, 76, 128, 175, 186
Mezei Katalin 137
Miclaus G. 26
Mieghem T.Van 202
Mihaila M. 58, 130
Mihailescu Anca 39
Mihalcea Diana 148, 196
Mihaly Laszlo 88
Militaru A. 51
Mincu D. 155
Mincu Raluca 78,200
Minescu B. 5, 28
Mitrea Elena 45
Mitu F. 19, 131
Miu Violeta Nicoleta 50, 171
Moarcas Monica 164
Mocan Teodora 146
Moga V. 23, 188
Moisa Stefana-Maria 154, 158
Moise Ana 84
Moise Bianca 81, 140
Moldovan H. 32
Moldoveanu Elena 89, 90, 139
Molfea V. 12, 53, 172, 197
Moraru I. 59, 199
Mornos C. 2, 17
Moscaliuc B. 43
Moscaliuc I. 43
Motoc Adriana Crina 88
Motoc R.C.88
Mozos Ioana 29, 214, 98
Muraru Denisa 16, 25 , 68, 69, 81, 140, 149, 189, 201,
205
Muraru Minerva 93
Musetescu Rodica 10, 181
Mustafa Doriana 203
N
Nanea T. 34, 82, 91, 139, 157
Nastasa D. 74
Neagoe G. 71, 207
Neagu Oxana 165
Nechita Eugenia 87
Negru Alina 75, 182
Nicolae Camelia 82
Nicolosi GL 69, 147, 205, 206
Niculescu Natalia 141
Nistorescu D. 91, 139
Nitescu Doina 38
I NDEX AUTORI
AUTHORS I NDEX
Suplimentul A, 2010
O
Ochean V. 161
Oclei E. 21, 49, 120, 122, 132, 135, 136, 170
Olariu Ramona 26
Olinic N. 3
Opris Daniela, 150
Ouatu Anca 45
P
Pacurari Alina 29, 98
Pcuraru Elena 185
Pl Kinga 44
Palii Ina 33, 94
Pantaru Lacramioara 31
Parascan Liliana 32
Parepa Irinel Raluca 50, 171
Parv Florina 23, 61, 62, 188
Pascu Alina 164
Pascut D. 188
Patriche Magdalena 210
Patrut M. 49, 120, 136, 170
Ptrut M.E. 21, 122, 132, 135
Paun N. 82
Penciu Oana Maria 4, 117
Pescariu S. 2, 17, 75, 182
Petcu D.P. 20, 121, 204
Petrescu I. 6
Petrescu L 2, 6, 17
Petris A. 6, 13, 28, 87
Petris O.R. 48, 127
Petru I. 51
Piazza Rita 69, 205
Pinte Florina 71, 207
Pru Lucia 94
Pirvu O. 195, 198
Podoleanu C. 103, 137
Pop C. 5, 6
Pop C.F. 18
Pop Dana 4, 15, 110, 117, 144
Pop Lavinia 18
Pop V. 21, 49, 120, 122, 132, 135, 136, 170
Popa Anca 52, 63, 97, 104, 105
Popa Elena C 149,189
Popa R. 177
Popa V. 178
Popescu M. 57, 101, 124
Popescu A. 186
Popescu Andree 64, 76, 128, 175
Popescu B.A. 16, 25, 36, 38, 68, 69, 70, , 81, 85, 99, 140,
147, 149, 150, 151, 189, 201, 202, 205, 206, 208, 209,
213, 32
Popescu Irina 2, 17
Popescu Monica 10,181
Popescu Roxana, 64
Poplicean Brigitte 26
Popovici I. 59, 152, 199
Popovici M. 59, 199
Preg Z. 44, 142
Proclemer A. 25, 201
Procopciuc Lucia 4
Protopopescu Liliana 12, 53, 172 , 197
Protopopescu T. 12, 53, 172
Purcarea F. 104
Purice Mariana 209
Psk Katalin 44
R
Rachita E. 21, 49, 120, 122, 132, 135, 136, 170
Racila V. 176
Rada Maria 11, 40, 143, 162
Radoi Mariana 6, 8, 28, 54, 109, 111, 160, 164, 165
Radulescu Anca 156
Radulescu N. 90
Raduta Ioana 43
Ramazan D. 21, 122, 132, 135
Revenco N. 183
Rezus C. 45
Roman Mihaela 18
Romanciuc Lilia 183
Romanoschi Florentina 185
Roman-Pognuz A. 69, 205
Romosan I. 29, 98
Rosca Monica 16, 68, 81, 140, 149 189
Rou Anca 211
Rosu Doina 159, 169, 174
Rosu I.G. 31
Rudi M. 94
Rus H. 54, 160
Rus M. 24
Rusali A. 92, 97, 119
S
Salajan Adriana 178
Sandu C. 16, 68
Sarau C. 27, 96, 112
Sarbu P.I.A. 7, 9, 22,77, 149
Sascau R.A. 108
Savoiu G. 58,130
Savoiu Germaine 29, 98
Savu Oana, 36, 70, 202, 209
Sbarcea V. 211
Searpe C. 211
Serban Corina 11, 29, 30, 98, 143
Serban Irina 89, 90, 114
Serban Luminita 6
Serban M. 89, 90
Serban Marinela 60, 85, 97, 99, 119, 173, 208
Serboiu Sorina Crenguta 89
Sergiu D. 8
Siliste C. 83, 145
Siminonescu Oana 12, 53, 172, 197
Suplimentul A, 2010
I NDEX AUTORI
AUTHORS I NDEX
Tomescu M.C. 51
Toni O. 20, 121, 204
Topolnichi Lacramioara 87
Toringhibel M. 50, 171
Trache Cristina 58
Tudor C. 30
Tudor Simona 90
Tudoran Cristina 62
Tudoran Mariana 23, 61, 62, 188
Tudose M. 185
Turcanu Veronica 176
U
Udroiu C. 106, 192, 195, 198
Ursoniu S. 27, 112
Ursu Gina 185
Uscatescu Valeria 43
Uscoiu G. 91, 139
V
Vaduva Cristina 194
Valentina Uscatescu 100, 194
Van M.T. 70
Varlan Elena Ancuta 31
Vasa Nicotera Mariuca 67, 79
Vasile Alexandra 41, 72
Vasilescu R. 21, 49, 120, 122, 132, 135, 136, 170
Vasiluta L. 159, 169, 174
Vataman Eleonora 33
Vatasescu R.G. 41, 72, 155, 187, 191
Velimirovici Dana Emilia 11, 40, 143, 162
Velimirovici M. 40, 162
Venescu Eugenia 75, 182
Vernic Corina 112
Vinereanu D. 1, 6, 66, 67, 78, 79, 80, 83, 87, 106, 116,
141, 145, 148, 161, 180, 190, 192, 193, 195, 196, 198,
200
Vintila Ana-Maria 93, 193
Vintila M.M. 12, 53, 172, 197
Vintila V. 106, 192,193, 195, 198
Visan S. 82
Vittos Oana 102
Vladaia Aurora 36, 209
Vladoianu M. 161
Voicu V. 207
Voicu V.A. 71
Voigt J.U. 70, 151, 202
Voina Izabela-Roxana 111
Voinea Cristina 21, 49, 120, 122, 132, 135, 136, 170
Voinea Florina 81, 140
Vriz Olga 147, 189, 206
Z
Zanoschi A. 13
Zdrenghea D. 4, 15, 110, 117, 123, 144
Sinescu Crina Julieta 5, 52, 63, 87, 105
Sisu Roxana Cristina 66, 83, 145,193, 196
Sitar-Taut Adela-Viviana 4, 15, 110, 117, 144
Slovenski M. 51
Sorea Camelia 74
Soritau Olga 117
Sorodoc L. 48, 127
Sorodoc Victorita 48, 127
Sparacino Lina 147
Spiru B. 196
Stan C. 14
Stana Andreea 210
Stanca I. 64, 76 118, 128, , 175, 186,
Stancila Daniela 27, 96
Stanciu S. 71, 207
Stanciul V. 6
Stanciulescu Gabriela 58
Stanciulescu P. 106
Stanescu Cioranu Rodica 47
Stanescu Cristina Maria 14
Stanescu D.A. 14
Statescu C. 108
Stoica Adina Liliana 84
Stoica E. 47
Stoicescu C. 67, 79, 106, 192, 195,198
Strajean B. 91, 139
Stugren Carmen 117
Suceava Ioana 27
Suciu Zsuzsanna 7, 9, 22, 77
Suran Berenice 106
Susan Lelia 29, 30, 98
Susan Monica 30, 98, 163
Susan R. 30, 98, 163
Sutescu Cristina 212
Szabados C. 115, 137
Szab Mnika 44
Szakcs O. 168
Szke Szidnia 168
T
Tanase Daniela 45
Tanasescu C. 38
Tase A. 58, 130
Ttar Maria-Cristina 129
Tatu-Chitoiu G. 5, 6, 13, 28, 87, 155
Tautu Oana-Florentina 65
Teodorescu Andreea 71
Teodorescu Iulia 102
Tepes Piser Ileana 47, 100, 201
Tetiu O. 58, 130
Ticulescu C.R. 147, 206
Tilea Brndua 129
Tilea I. 129, 88
Tintoiu I. 71, 207
Tirziu Cristina 42, 179
Toader Despina Manuela 10, 181
Todira M. 199
I NDEX SUBI ECTE | TOPI CS I NDEX*

09.00 Circulatie pulmonara
09.01 Hipertensiune pulmonara 33, 54, 60, 95,
150, 151, 208
09.02 Embolism pulmonara 20, 43, 61, 159, 186,
188, 196
10.00 Computer in cardiologie 125, 126
11.00 Ecocardiografe 10, 36, 69, 70, 116, 127,
200, 201, 202, 213
11.01 Ecografe de stress 14
11.02 Ecografe transesofagiana 80
12.00 Electrocardiografe 16, 137, 184
13.00 Epidemiologie si preventie
13.01 Aterosceroza 23, 62, 78, 104, 209
13.02 Factori de risc 15, 19, 44, 102, 103, 124,
131, 147, 163, 168, 194, 206
13.03 Programe preventive 94, 112
14.00 Fiziologie, fziopatologie cardiovasculara
15.00 Functie cardiaca 134, 145
15.01 Functie sistolica 17, 147
15.02 Functie diastolica 81, 82, 93, 185, 193, 205
15.03 Insufcienta cardiaca cronica 4, 12, 45, 47,
66, 89, 90, 105, 111, 139, 161, 172, 197, 210
15.04 Insufcienta cardiaca acuta 2, 63, 180
15.05 Diagnostic, prognostic 52, 91
15.06 Tratament
16.00 Hipertensiune 29, 36, 37, 94, 146, 203, 211
16.01 Tratament 42, 130, 141, 143
16.02 Monitorizare ambulatorie 86, 133, 142
16.03 Fiziopatologie 1, 11, 98, 140
17.00 Reabilitare 3
18.00 Test de efort
19.00 Valvulopatii
19.01 Valvulopatii aortice 25, 67, 68, 79
19.02 Valvulopatii mitrale
19.03 Endocardita 119, 154
19.04 Proteze valvulare 40
19.05 Valvuloplastie
20.00 Altele 27, 30, 31, 38, 39, 55, 57, 85, 88, 97,
100, 117, 123, 132, 135, 144, 156, 165, 166,
170, 177, 190, 199, 207, 32, 214
01.00 Accidentul vascular cerebral 110
02.00 Aritmii 121, 204, 129
02.01 Mecanism
02.02 Electrocardiografe
02.03 SAECG, Monitorizare Holter
02.04 Variabilitate RR, QT 155, 183
02.05 Testare electrofziologica, ablatie 74, 75
02.06 Pacemaker, resincronizare 41, 83
02.07 Aritmii supraventriculare 46, 71, 73, 115,
187, 191
02.08 Aritmii ventriculare 182
02.09 Sindrom WPW 13
02.10 Moarte subita, resuscitare
02.11 Antiaritmice 58, 138
02.12 Cardioversie, defbrilare
03.00 Boli ale miocardului si pericardului
03.01 Cardiomiopatie hipertrofca 114, 149, 189
03.02 Cardiomiopatie dilatativa 74, 174
03.03 Miocardita
03.04 Tumori
04.00 Cardiologie interventionala 7, 9, 198
04.01 Coronarografe 59, 118
04.02 Angioplastie
04.03 Stenturi 192, 195
04.04 Restenoza 152
04.05 Alte proceduri
05.00 Cardiologie nucleara
06.00 Cardiopatii congenitale 26, 35, 56, 99, 158,
173
07.00 Cardiopatie ischemica 113
07.01 Angina pectorala stabile, instabila 48, 76
07.02 Infarct miocardic acut 5, 6, 22, 34, 50, 51,
87, 92, 106, 107, 128, 153, 157, 160, 167,
171, 175, 176, 178, 212
07.03 Perioada post infarct 181
07.04 Prognostic, stratifcarea riscului 8, 18, 65,
109, 169
07.05 Unitate coronariana, monitorizare
07.06 Tromboliza 24
07.07 Tratament 28, 53, 64, 101, 136, 164, 179
08.00 Chirurgie cardiovasculara 21, 49, 120
08.01 Cardiopatie ischemica
08.02 Valvulopatii 108, 162
08.03 Protectie miocardica
08.04 Aorta artere periferice 77, 84, 122
*Cifra reprezint numrul rezumatului

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Vol. 25, 2010, Suplim A

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ISSN: 1583-2996

Preedinte: Dan Deleanu

ratura (0.81). Totusi, adaugarea EPA la acest model de

RAS it was only 8%. Te association between APE and

I NSUFI CI ENA CARDI AC

plasmatice crescute ale angiotensinogenului la pacien-

I NSUFI CI ENA CARDI AC

tra-spitaliceasca semnifcativ mai redusa (1.63%) a

CARDI OPATI E I SCHEMI C

precoce post STEMI sau reocluzia precoce a fost semni-

CARDI OPATI E I SCHEMI C

coronariene acute Bobescu E. 1,2, Radoi M. 1,2, Dat-

CARDI OPATI E I SCHEMI C

Concluzii: TRC cu fuziune optima la pacientii cu po-

74. Exista remodelare

zare anterioara doar 12% au avut stenoza semnifcativa

Materials and methods: Tere were 144 patients in-

mmHg (26 pacienti), si IIb, cu sPAP>50 mmHg (16 pa-

mai multe detalii despre morfologia valvei prin evalu-

the end-diastolic (average bias = 7 ml; 7.8%, 95% CI)

Results: Te pattern of TMF was delayed relaxation

apicala maxima (r=-0,35, p=0,03), viteza maxima de

no coronary heart disease, randomized to either a nebi-

velul arterei carotide si determinarea markerilor in-

Matrix GLA protein is

Methods: Te study group included 42 patients with

statat o scadere semnifcativa a deformarii VS atat in

be treated with epirubicin-based chemotherapy, were

CARDI OMI OPATI I

tricuspid annular plane systolic excursion (TAPSE),

CARDI OMI OPATI I

I NDEX AUTORI | AUTHORS I NDEX*

I NDEX SUBI ECTE | TOPI CS I NDEX*

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