[Comparative evaluation of prognostic scores in pulmonary embolism ]. / Evaluarea comparativa a scorurilor prognostice in embolia pulmonara.

AIM: Pulmonary embolism is a life threatening disease and one of the main causes of in-hospital mortality. There are multiple risk stratification scoring systems for the forecast of the outcomes in patients with pulmonary embolism. MATERIAL AND METHODS: We conducted a prospective observational cohort study to evaluate the comparative validity of four prognostic models: pulmonary embolism severity index (PESI), simplified PESI score, PESI risk classes and shock index, for predicting short-term mortality in acute pulmonary embolism. The PESI and PESI--simplified scores and shock-index were calculated. PESI scores were segregated into risk class (I-V) obtaining PESI classes. Shock index was dichotomized into 0 (for value < 1) versus 1 (for value > 1) risk groups. We determined the area under Receiver Operating Characteristic curve, the sensitivity, specificity, likelihood ratio (LR+, LR-) for PESI score, simplified PESI score, PESI risk classes and shock index, to compare the ability of these scoring tools. RESULTS: The cohort consisted of 362 subjects. The mortality was 21.54%. The sensitivity, specificity and likelihood ratios were different between scores but the area under Receiver Operating Characteristic curve showed values in range 0.6-0.7. CONCLUSIONS: The assessed prognostic scores performed comparably for identifying pulmonary embolism patients at short-term risk of mortality, even for PESI score segregated in risk classes and dichotomized version of shock index.

Expression of extracellular markers as criteria for treatment of peripheral arterial occlusive disease.

UNLABELLED: During the last decade, mesenchymal stromal cells (MSC) have been used in medical therapeutics, especially for reperfusion in peripheral arterial disease, ischemic cardiomiopathy and myocardial infarction. Studies demonstrated that membrane proteins are important in MSC endothelial differentiation. AIM: To determine the expression of extracellular markers of MSC, in order to ascertain if some expressed proteins (MSC specific cluster of differentiation proteins, essential for MSC characterization and proteins which have a role in adhesion and migration) have capability to induce angiogenesis. MATERIAL AND METHODS: To detect the expression of these proteins and confirm the presence of MSC and other essential proteins with important role in adhesion and migration, cells from five donors were fully assessed by flow cytometry (surface expression), differentiation assays (MSC differentiation into osteocytes, adipocytes, and chondrocytes), and qRT-PCR (gene relative expression). RESULTS: Our results were in agreement with other reports, with small exceptions, related especially to donor dependent conditions. The surface expression of beta 1 subunits correlated with a high gene expression on RNA level. CONCLUSIONS: MSC had all specific characteristics. Surface marker expression was in agreement with previous findings. These cells can be used for endothelial progenitor cells further differentiation. Beta 1 expression suggests a high potential of the MSC to form capillary lumen, thus for further artery formation and efficient angiogenesis.

[Cardiorenal syndrome]. / Sindromul cardiorenal--o entitate incomplet definita.

Cardiac and renal disease are common and frequently coexist, resulting in increased risk of mortality, morbidity and cost of care. The interaction between heart and kidney is refered to as cardiorenal syndrome, but a consensus definition has not been established. Also, there are limited data about the true incidence, the pathophisiology is poorly understood and standardized diagnostic criteria are lacking. Because the process is complex, treatment can be a challenge despite the novel therapies. This paper addresses all the complex interactive aspects of the cardiorenal relationship, from pathophysiology to epidemiology, diagnosis and treatment, to have more clear perspectives on the future therapeutic approaches to this deadly association.

[Newly diagnosed peripheral arterial disease in patients with cardiovascular risk factor]. / Boala arteriala periferica nou diagnosticata la pacientul cu risc cardiovascular.

UNLABELLED: The goal of this study is to investigate the utility of ankle-brachial index (cut-off value < 0,90) as an indicator of peripheral arterial disease in a group of patients hospitalized in the Medical Clinic and to assess the prevalence of risk factor and associated comorbidities in patients with low index. MATERIAL AND METHODS: A total of 202 patients older than 50 years with established cardiovascular or cerebrovascular disease or at least one cardiovascular risk factor (smoking, diabetes, dyslipidemia and hypertension) underwent ankle-brachial index measurement for this study. Demographic data and cardiovascular risk factors were analyzed. We assessed medical history, symptoms and clinical examination. RESULTS: In this study, a number of 72 patients (35.64%) were diagnosed with peripheral arterial disease. Our results indicated that advanced age, greater number of total risk factors and presence of peripheral arterial disease related physical findings were associated with increased likelihood of low ankle-brachial index. CONCLUSIONS: We should recommend ankle-brachial index as screening test in patients older than 50 years, in the presence of at least one cardiovascular risk factor, for early detection of peripheral arterial disease and systemic atherosclerosis, to improve prevention and early aggressive treatment.

[Obesity paradox]. / Paradoxul obezitatii--realitate sau fictiune ?

Obesity has reached global epidemic proportions and is associated with major cardiovascular diseases and reduced overall survival. This paper reviews the metabolic and vascular consequences of dysfunctional adipocytokines in obesity as well as the pathological effects on blood pressure, cardiovascular structure and function. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese population with established cardiovascular disease have a better prognosis. There are potential explanations offered by literature for these puzzling data. For obese hypertensive patients the paradox is possibly linked to the lower systemic vascular resistance and plasma renin activity. In heart failure the excess body weight may confer some protective effects on mortality, due to a more metabolic reserve, higher levels of arterial pressure compatible with higher doses of cardioprotective medications, and a specific neuroendocrine profile with lower levels of circulating natriuretic atrial peptides, attenuated sympathetic nervous system and renin-angiotensin responses. For coronary heart disease and peripheral arterial disease the mechanisms are still uncertain. There are discussed a lesser severity of coronary lesions and left ventricular dysfunction, or a reduced prevalence of moderate-severe chronic obstructive pulmonary disease in patients selected for surgery. On the other hand, the constellation of data which supports purposeful weight reduction in the prevention and treatment of cardiovascular diseases, induces a controversial position regarding this new concept.

[A model for studying arterial stiffness in essential arterial hypertension]. / Model de studiu a rigiditatii arteriale in hipertensiunea arteriala esentialu.

UNLABELLED: Arterial stiffness (AS) is a complex parameter, which can be assessed by non-invasive methods. Our study demonstrates the usefulness of an integrative model for measuring the components of the AS. MATERIAL AND METHOD: The AS was prospectively studied before and after 6 and 12 months of antihypertensive treatment in 92 hypertensive patients and 50 matched normotensives. The studied parameters were pulse wave velocity (PWV), pulse pressure, indices of vascular compliance assessed by vascular ultrasound (b index and strain) and the systolic volume index/PP ratio (SVI/PP). RESULTS: All parameters of AS have a favourable evolution after 12 months of antihypertensive treatment and the normalization of the blood pressure. The central parameters have a different behavior compared with the peripheral AS, probably in relation with the arterial structure. The ratio SVI/PP is useful for studying the ventricular-arterial coupling. CONCLUSION: An integrative model for studying AS and a prospective follow-up is useful and necessary in essential arterial hypertension.

[The value of complior method for studying the endothelial dysfunction in hypertensive patients]. / Valoarea metodei complior in studiul disfunctiei endoteliale la pacientii hipertensivi.

OBJECTIVE: Non-invasive methods that measure the arterial stiffness and wave reflection have recently been used for assessing the endothelial dysfunction. Despite this fact, Complior method, which can study the relation between nitric oxide (NO) and pulse wave velocity as a measure of arterial stiffness, is not currently used. Our study evaluates the potential of Complior technique for a global assessing of the endothelial dysfunction. MATERIAL AND METHODS: Endothelial dysfunction was prospectively studied before and after 6 and 12 months of antihypertensive treatment in 92 hypertensive patients, strictly selected and 50 matched normotensives. The studied parameters were pulse wave velocity (PWV) and its variation under pharmacodynamic stimulation. NO-dependent/ independent vasodilatation were assessed with 400 microg Ventolin spray (deltaPWV% = BR) and 0.5 mg sublingual NTG (deltaPWV% = NR1), respectively. RESULTS: 1. The endothelial dysfunction has a large interindividual variability, irrespective the blood pressure values. 2. The endothelial dysfunction is a heterogenous condition, being more affected in peripheral arterial territory and in NO-dependent component. 3. Therapeutic effect depends on vascular structure and antihypertensive regimen. ACE inhibitors and calcium channel blockers have complementary intervention, so the combination can be useful for a better therapeutic control of the endothelial dysfunction. CONCLUSION: Complior is a very useful method for studying the complex profile of endothelial dysfunction and can complete the vascular ultrasound data for peripheral arterial site.

[Correlation between plasma level of endothelin-1 and heart remodeling in dilated cardiomyopathy]. / Interrelatii intre nivelele plasmaticeale endotelinei-1 si remodelarea cardiaca in cardiomiopatia dilatativa.

UNLABELLED: The link between plasma level of endothelin-1 (ET-1) and heart failure has been established. This study demonstrate the role of endothelin-1 in progression of morphological and haemodynamic alteration of heart in patients with dilatative cardiomyopathy. MATERIALS AND METHODS: We included 71 patients with dilatative cardiomyopathy (ischemic and/or alcoholic)--36 men (50.7%) and 35 women (49.3%). We excluded patients who suffered from chronic renal failure, malignancies, systemic autoimmune disorders, liver cirrhosis. The echocardiography evaluated the chambers dimensions, valvular regurgitations, ejection and shortening fraction, systolic pulmonary artery pressure, cardiac output. All patients were assessed with endothelin-1 and usual hematological and biochemical tests, chest X-ray and electrocardiogram. RESULTS: The plasma level of endothelin-1 was increased of all patients (5.2775 +/- 2.65 fmol/ml). The value of ET-1 was associated with NYHA class of congestive heart failure (p < 0.000002). All patients were ejection fraction low (< 40%) and it was strongly associated with high level of plasma ET-1 (p < 0.001). The shortening fraction was very low at 87.32% of patients (value was between 5% and 15%) and the relation with ET-1 was significantly (r = - 0.3911, p = 0.001). The same relation was between ET-1 and tele-diastolic and telesystolic left ventricular volume (p = 0.026, respectively, p = 0.001), regional kinetics alteration (p = 0.023), systolic pulmonary arterial pressure (p = 0.0001, r = 0.71) and cardiac output (p = 0.0234). CONCLUSIONS: The plasma level of endothelin-1 is high at all patients with dilatative cardiomyopathy. Functional and morphological heart alterations are tightly connected to the changes of the endothelin system.

[Profile of endothelial dysfunction in arterial hypertension. Vascular ultrasound assessment]. / Profilul disfunctiei endoteliale în hipertensiunea arteriala. Evaluare prin ecografie vasculara.

UNLABELLED: Assessment of endothelial dysfunction in arterial hypertension using brachial ultrasound is a common method. Because of prognostic value of flow mediated dilation, vascular ultrasound is considered the standard noninvasive method. MATERIAL AND METHOD: In our study we assessed 92 hypertensive patients (very carefully selected) in a prospective and long term follow-up manner. We used the technical indications of actual guidelines. RESULTS: We confirmed the importance of a complete and complex assessment of endothelial dysfunction, using different parameters. Our study demonstrated that endothelial dysfunction exists in hypertensives, has a large interindividual variability and can be improved using adequate treatment. We also proposed a new parameter--the velocity ratio, and tested the value of normalized diameter ratio, as a nonconventional variable.

[Endothelial dysfunction assessment using vascular ultrasound in heart failure patients]. / Evaluarea disfunctiei endoteliale prin ecografie vasculara la pacientii cu insuficienta cardiaca cronica.

Endothelial dysfunction is an important factor leading to atherosclerosis, hypertension and heart failure. Flow mediated dilatation (endothelium dependent function) can be evaluated by vascular ultrasound. We investigated 71 heart failure patients (36 men-50.7%, 35 women-49.3%). The evaluation methods were: electrocardiogram, vascular ultrasound, echocardiography, chest X ray, hematological and biochemical tests. The statistical correlations were performed between clinical data, morphologic and hemodynamic parameters. Our results showed that endothelial dysfunction was present in all heart failure patients but it did not correlate with hemodynamic parameters. Elastic arterial parameters variation correlated with heart failure severity and flow mediated vasodilation.

[The cardiac manifestations in hyperthyroidism. The surgical implications]. / Manifestari cardiace în hipertiroidii. Implicatii chirurgicale.

In a statistics including 954 patients with hyperthyroidism [correction of Huprotoncoses] treated between 1966-1989, the authors found 522 cases (54) with various associated cardiac disorders. Of these cases, 199 presented rhythm disturbances: extrasystolic arrhythmia, auricular fibrillation and flutter to which 34 postoperative arrhythmias are added. Cardiac insufficiency present in 46 cases was the main complication and end point of the various myocardial conditions. Ischemic cardiopathy (181 cases), arterial hypertension (98 cases) and rheumatic valvulopathies (9 cases), either isolated or dominating the clinical picture, complete the nosological spectrum of these disturbances. The frequency of associated conditions and the absence of some specific morphologic lesions suggest that thyrotoxicosis is rather an aggravating factor although in many cases the presence of a previous cardiac disease is excluded. The two objectives in the management of thyrocardiac diseases are the amelioration of cardiac condition and an endocrine balance. In the conditions of a careful selection and preoperative preparation, surgery gave good results consisting, in this series, in over 70% cures and ameliorations.