Beta-Blocker-Related Atrioventricular Conduction Disorders-A Single Tertiary Referral Center Experience.

Background and Objectives: Drug-related bradyarrhythmia is a well-documented major adverse event among beta-blocker users and a potential cause for hospitalization or additional interventions. Whether beta-blocker use is associated with specific bradyarrhythmia presentations, and how this relates to other predisposing factors, is not well known. We aim to evaluate the association between beta-blocker use and the type of atrioventricular (AV) conduction disorder in patients with symptomatic bradycardia. Materials and Methods: We conducted a retrospective cohort study on 596 patients with a primary diagnosis of symptomatic bradyarrhythmia admitted to a single tertiary referral center. Of the cases analyzed, 253 patients were on beta-blocker treatment at presentation and 343 had no bradycardic treatment. We analyzed demographics, clinical and paraclinical parameters in relation to the identified AV conduction disorder. A multivariate regression analysis was performed to explore factors associated with beta-blocker use. Results: Of the 596 patients (mean age 73.9 ± 8.8 years, 49.2% male), 261 (43.8%) had a third-degree AV block, 92 (15.4%) had a second-degree AV block, 128 (21.5%) had slow atrial fibrillation, 93 (15.6%) had sick sinus syndrome and 21 (3.5%) had sinus bradycardia/sinus pauses. Beta-blocker use was associated with the female gender (p < 0.001), emergency admission (p < 0.001), dilated cardiomyopathy (p = 0.003), the lower left ventricular ejection fraction (p = 0.02), mitral stenosis (p = 0.009), chronic kidney disease (p = 0.02), higher potassium levels (p = 0.04) and QRS duration > 120 ms (p = 0.02). Slow atrial fibrillation (OR = 4.2, p < 0.001), sick sinus syndrome (OR = 2.8, p = 0.001) and sinus bradycardia/pauses (OR = 32.9, p < 0.001) were more likely to be associated with beta-blocker use compared to the most common presentation (third-degree AV block), after adjusting for other patient characteristics. Conclusions: Beta-blocker use is more likely to be associated with slow atrial fibrillation, sick sinus syndrome and sinus bradycardia/pauses, compared to a second- or third-degree AV block, after adjusting for other patient factors such as gender, admission type, ECG, comorbidities, cardiac function and lab testing.

Evaluation of Laboratory Predictors for In-Hospital Mortality in Infective Endocarditis and Negative Blood Culture Pattern Characteristics.

OBJECTIVE: This study aimed to identify possible differences between blood culture-negative and blood culture-positive groups of infective endocarditis (IE), and explore the associations between biological parameters and in-hospital mortality. METHODS: This was a retrospective study of patients hospitalized for IE between 2007 and 2017. Epidemiological, clinical and paraclinical characteristics, by blood culture-negative and positive groups, were collected. The best predictors of in-hospital mortality based on the receiver-operating characteristic (ROC) analysis and AUC (area under the curve) results were identified. RESULTS: A total of 126 IE patients were included, 54% with negative blood cultures at admission. Overall, the in-hospital mortality was 28.6%, higher in the blood culture-negative than positive group (17.5% vs. 11.1%, p = 0.207). A significant increase in the Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score was observed in the blood culture-negative group (p = 0.004), but no baseline characteristics differed between the groups. The best laboratory predictors of in-hospital death in the total study group were the neutrophil count (AUC = 0.824), white blood cell count (AUC = 0.724) and MELD-XI score (AUC = 0.700). CONCLUSION: Classic laboratory parameters, such as the white blood cell count and neutrophil count, were associated with in-hospital mortality in infective endocarditis. In addition, MELD-XI was a good predictor of in-hospital death.

Heart rate variability analysis and cardiac dysautonomia in ischemic stroke patients.

OBJECTIVES: Autonomic nervous system dysfunction after ischemic stroke predisposes to cardiovascular complications. We aimed to investigate cardiac autonomic activity in ischemic stroke patients using heart rate variability analysis, illustrating the sympathovagal balance at different sympathetic and parasympathetic activation tests. PATIENTS AND METHODS: We studied the dynamics of the linear and non-linear heart rate variability parameters in 31 left and 40 right middle cerebral artery ischemic stroke patients in rest condition and during autonomic activation tests (handgrip, standing, deep breathing and Valsalva maneuver). Data were compared with 30 age- and sex-matched healthy controls. RESULTS: We found different responses after autonomic activation tests in stroke patients depending on the cortical lateralization of the ischemic lesion. In resting state, left hemisphere stroke patients presented enhanced parasympathetic modulation of the heart rate (higher values for RMSSD, pNN50, HF and SD1, p < 0.05), comparing to right hemisphere stroke patients. This second group displayed a reduced cardiac parasympathetic control in resting state and during autonomic activation tests (handgrip and standing tests) compared to the left hemisphere stroke group and controls. Non-linear parameters SD1 and DFA α1 showed a decrease of variability and complexity of the heart rate in right hemisphere stroke patients, ameliorated during vagal activation tests. CONCLUSION: To prevent possible complications with vital risk, assessment of cardiovascular autonomic activity becomes a necessary stage in stroke patient management, facilitating immediate implementation of preventive and therapeutic strategies. Heart rate variability analysis in resting state and during autonomic activation tests allows identifying patients prone to sympathetic hyperactivity. New therapeutic perspectives for stroke management may emerge founded on the modulation of the autonomic nervous system.

Romanian Registry of Hypertrophic Cardiomyopathy - overview of general characteristics and therapeutic choices at a national level.

INTRODUCTION: Hypertrophic cardiomyopathy (HCM) is a disease with increased left ventricular (LV) wall thickness not solely explained by abnormal loading conditions, with great heterogeneity regarding clinical expression and prognosis. The aim of the present study was to collect data on HCM patients from different centres across the country, in order to assess the general characteristics and therapeutic choices in this population. METHODS: Between December 2014 and April 2017, 210 patients from 11 Romanian Cardiology centres were enrolled in the National Registry of HCM. All patients had to fulfil the diagnosis criteria for HCM according to the European Society of Cardiology guidelines. Clinical, electrocardiographic, imaging and therapeutic characteristics were included in a predesigned online file. RESULTS: Median age at enrolment was 55 ± 15 years with male predominance (60%). 43.6% of the patients had obstructive HCM, 50% non-obstructive HCM, while 6.4% had an apical pattern. Maximal wall thickness was 20.3 ± 4.8 mm (limits 15-37 mm) while LV ejection fraction was 60 ± 8%. Heart failure symptoms dominated the clinical picture, mainly NYHA functional class II (51.4%). Most frequent arrhythmias were atrial fibrillation (28.1%) and non-sustained ventricular tachycardia (19.9%). Mean sudden cardiac death risk score (SCD-RS) was 3.0 ± 2.3%, with 10.4% of the patients with high risk of SCD. However, only 5.7% received an ICD. Patients were mainly treated with beta-blockers (72.9%), diuretics (28.1%) and oral anticoagulants (28.6%). Invasive treatment of LVOT obstruction was performed in a small number of patients: 22 received myomectomy and 13 septal ablation. Cardiac magnetic resonance was reported in only 14 patients (6.6%). CONCLUSIONS: The Romanian registry of HCM illustrates patient characteristics at a national level as well as the gaps in management which need improvement - accessibility to high-end diagnostic tests and invasive methods of treatment.

Perspectives on hypertension's prevalence, treatment and control in a high cardiovascular risk East European country: data from the SEPHAR III survey.

OBJECTIVES: To estimate the trend in arterial hypertension's prevalence, awareness, treatment, and control in Romania, starting from the latest national survey Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania III that has a crucial importance for the development of prevention strategies at national level. METHODS: A representative sample of 1970 Romanian adults (mean age 48.38 years, age range 18-80 years, 52.5% women, 72.58% response rate), was enrolled. During the two study visits, three blood pressure (BP) measurements were performed at 1-min interval. Hypertension was defined as study SBP at least 140 mmHg and/or study DBP at least 90 mmHg at both study visits or previously diagnosed hypertension, regardless of BP values. BP control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg in hypertensive patients. RESULTS: General hypertension prevalence is 45.1% (19.1% newly diagnosed hypertension, 80.9% awareness of hypertension), increasing with age, regardless of sex and area of residence. Although the majority (72.2%) of hypertensive patients were treated (51.9% with two or more drugs), only 30.8% of them had controlled BP values. Following the evolution from the last 11 years, it is expected that in 2020 the prevalence of hypertension to be up to 44%, the awareness up to 96.2%, treatment of hypertension up to 83.7%, and BP control up to 36.6%. CONCLUSION: Hypertension's prevalence in Romania is on the rise despite the increase in awareness, treatment, and control. Possible explanations of this trend might be the increasing incidence of unhealthy lifestyle and diet, including high salt intake, and a general increase in the prevalence of obesity, diabetes mellitus, and dyslipidemia.

Midkine, a heparin-binding growth factor, and its roles in atherogenesis and inflammatory kidney diseases.

The heparin-binding protein midkine is a potent growth factor with emerging roles in numerous inflammatory diseases. Beyond its characterization in embryogenesis and organ development, ample insights into its function have been collected from experimental disease models using knockout animals or knockdown intervention strategies. Here a comprehensive overview on midkine and its functions in atherogenesis and kidney diseases is provided. Molecular clues to key signalling pathways (Akt, ERK, HIF1α) and key events in atherosclerotic vessels link midkine expression with vascular smooth muscle proliferation and (neo)angiogenesis. In acute and chronic kidney diseases, midkine expression is upregulated in tubular as well as endothelial cells. Experimental disease models that mimic diabetic nephropathy and/or immunologic glomerular damage indicate dichotomous midkine activities, with cytoprotective as well as injurious effects. This review also pinpoints the commonalities of the disease models. An understanding of the underlying molecular events will be required in order to design a targeted intervention into cardiovascular or renal diseases as well as inflammatory processes.

Inflammatory and Genetic Markers (APO B100 and Angiotensin-Converting Enzyme Gene) in the Coronary Artery Disease.

Aim: To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting enzyme (ACE) gene polymorphism and the severity of coronary artery disease (CAD). Material and Methods: We conducted a study in 58 patients with acute coronary syndromes (ACS) who underwent coronarography at the Iasi "Prof. Dr. George I.M. Georgescu' Institute of Cardiovascular Diseases. the patients included in the studies were selected from those who needed a coronarography for unstable angina or acute myocardial infarction. The data were uploaded and processed using the statistical functions in SPPS 18.0 at a 95% materiality threshold. Results: Elevated inflammation markers were found in all study patients, with small differences in distribution. None of the study patients presented ApoB100 gene mutations. As to ACE polymorphism, a predominance of genotype II in unicoronary patients and ID and DD genotypes in bicoronary and tricoronary patients was found. Conclusions: The results of our study confirm the role of genetic and epigenetic factors in the severity and progression of the coronary disease, leaving room for larger and more comprehensive studies and new research perspectives.

Chronic kidney disease: Prognostic marker of nonfatal pulmonary thromboembolism.

OBJECTIVE: Renal dysfunction is associated with increased cardiovascular morbidity and mortality. The alteration in renal function as a marker of mortality in pulmonary thromboembolism (PTE) has not been studied extensively. METHODS: Four hundred four consecutive patients diagnosed with non-high-risk PTE (without cardiogenic shock or blood pressure <90 mm Hg) were prospectively enrolled in the study between 2005-2010. Kidney function, based on glomerular filtration rate (GFR), calculated by the simplified modification in diet in renal disease (MDRD) equation (sMDRD); troponin I; B-type natriuretic peptide (BNP); and echocardiographic markers of right ventricular (RV) function were determined in survivors versus non-survivors after a 2-year follow-up. RESULTS: GFR was significantly lower in non-survivors than in survivors: 51.85±19.08 mL/min/1.73 m2 and 71.65±23.21 mL/min/1.73 m2, respectively (p=0.000). The highest 2-year mortality rate (20%) was recorded in patients with moderate renal dysfunction associated with RV dysfunction. Using multivariate analysis, we found that GFR is an independent predictor of 2-year mortality (OR 0.973, 95% CI: 0.959-0.987, p=0.000), besides troponin I, dyslipidemia, acceleration time of pulmonary ejection, pericardial effusion, and BNP. CONCLUSION: The association of renal dysfunction with right ventricular dysfunction in patients with non-fatal pulmonary thromboembolism resulted in high mortality. Renal dysfunction, assessed by glomerular filtration rate, may be used in the risk stratification of patients with non-high-risk pulmonary thromboembolism, besides troponin I, BNP, and right ventricle echocardiographic dysfunction markers.

Systemic or local thrombolysis in high-risk pulmonary embolism.

BACKGROUND AND AIM: High-risk pulmonary embolism (PE) represents an important health problem in emergency cardiology, being associated with a high rate of mortality. The aim of this study is to assess the efficacy and safety of pulmonary intra-arterial thrombolysis with streptokinase compared to systemic thrombolysis. METHODS AND RESULTS: In our study, 28 patients with acute high risk PE were treated by intra-arterial thrombolysis with clinical success rate of 96.4%, while in the group with systemic thrombolysis (24 patients) the rate of clinical success was significantly lower (70.8%). Also, pressure gradient between right ventricle (RV) and right atrial (RA) (PRV-RA) decreased significantly in patients treated by pulmonary intra-arterial thrombolysis instead of systemic thrombolysis. Mortality during the hospitalization was 0% in the group with local thrombolysis and 29.2% in the other group, with a significant statistical difference. Major bleeding complications appeared in 14.3% of the patients with local thrombolysis and in 20.8% of the ones treated by systemic thrombolysis, without statistical significance. Moreover, the proportion of minor bleeding was comparable in the two groups of patients. There was no intracranial bleeding. Disseminated intravascular coagulation occurred in 1 patient with systemic thrombolysis. CONCLUSIONS: The rate of clinical success and the regression of RV overload were significantly higher in patients treated by pulmonary intra-arterial thrombolysis. The results regarding the efficiency of the pulmonary intra-arterial thrombolysis in high-risk PE are encouraging, the mortality in these patients being significantly lower than the one for systemic administration of the thrombolytic agent.

Chemotherapy-related toxicity in childhood neoplasia.

PURPOSE: To evaluate the incidence and time of occurrence of chemotherapy-related toxic events in 100 children admitted to the Hematology-Oncology Ward of "Sfanta Maria" Children's Emergency Hospital in Iasi, Romania, over a 4-year period. METHODS: An analytical, descriptive and comparative, retrospective and prospective study covering a 4-year period on the incidence of chemotherapy side effects, was performed on 100 children admitted for solid tumors or hematologic malignancies. The probability of each adverse event to appear and the time period from chemotherapy initiation to the moment of side effect appearance were assessed. RESULTS: The most frequent toxicity was alopecia (79.5%), followed by medullary aplasia (71.1%), oral candidiasis (65.3%), diarrhea and emesis (64% each), toxic hepatitis (61%), and Cushing's syndrome (21.5%). Oral herpes and thrush were less frequent (13.2% and 12.2%, respectively). Remissions of the underlying disease were achieved in 69.9% of the cases. Alopecia, medullary aplasia and oral candidiasis developed during the first 14 months of treatment. Mucositis, emetic syndrome and toxic hepatitis were diagnosed within the first 12 months of treatment. Diarrhea and oral herpes or thrush appeared during the first 15 months, while Cushing's syndrome developed during the first 6 months. All remissions were obtained during the first 4 months of treatment. CONCLUSIONS: While alopecia and medullary aplasia were the most frequent side effects of chemotherapy in our study group, the earliest were Cushing's syndrome, emetic syndrome and toxic hepatitis.

Coronary stent entrapment.

A 64-year-old woman with a history of coronary artery bypass and coronary angioplasty with unexpanded stent entrapment blocked in the circumflex coronary artery and left main is now presenting with crescendo angina pectoris. The Department of Cardiovascular Surgery established that a new surgical intervention presents a very high risk. In this condition, we decide for elective percutaneous coronary intervention for stent restenosis, which is a very difficult procedure in the particular condition of unexpanded stent blocked in the circumflex coronary artery and left main.

Thyroid dysfunction and ischemic heart disease--clinical correlations, progressive implications and impact on the prognosis.

UNLABELLED: Thyroid dysfunctions are associated with systolic and diastolic heart dysfunction, hypertension, rhythm disorders, etc. Clinically significant hyperthyroidism and hypothyroidism may have an impact on the patients with ischemic heart disease. OBJECTIVES: Investigation of the risk of developing ischemic heart disease, of the evolution and prognosis in relation to the entire spectrum of thyroid dysfunctions. MATERIALS AND METHODS: All participants included in the study were selected from among subjects with heart disorders who were controlled with concern to the thyroid hormonal condition and who hadn't been treated previously for thyroid functional disorders. Based on these criteria we defined a study group made out of 791 subjects, divided into five lots based on the level of thyroid hormones. Once the group was formed, we conducted evaluations of the cardiovascular and thyroid status at 6 and 12 months, respectively. RESULTS: In the witness lot, during monitoring 49% of the patients showed an ischemic heart disease. The main risk factors were: heart frequency of over 80 beats/min (RR = 1.83), age over 60 (RR = 1.47), female sex (RR = 1.21) and values of triglycerides over 160 mg/dl (RR = 1.23). In the group of patients with overt clinic hyperthyroidism, during monitoring 46.1% showed ischemic heart disease. The main risk factors were: heart frequency over 80 beats/min (RR = 2.41), age over 60 (RR = 1.67), high level of LDL-cholesterol (RR = 1.53) and female sex (RR = 1.31). Among the patients with overt clinical hyperthyroidism, during monitoring 53.3% showed ischemic heart disease. The main risk factors identified were: heart frequency over 80 beats/min (RR = 2.01), age over 60 (RR = 1.42), high levels of triglycerides (RR = 1.42) and LDL-cholesterol (RR = 1.32), as well as the presence of hypertension in the health records (RR = 1.31). CONCLUSIONS: Thyroid dysfunction is a common clinical condition with a key role in the regulation of the cardiovascular system and may contribute to the evolution of the ischemic heart disease and which should be taken into consideration when patients with heart disease are treated. In this light, thyroid function needs to be evaluated for all patients with a risk for ischemic heart disease.

Massive pericardial effusion associated with hypothyroidism.

The diagnosis of hypothyroidism is difficult because hypothyroidism in adults and especially the elderly, classic, has an insidious onset with a range of nonspecific symptoms which may delay diagnosis for months or even years. Old age seems to represent trigger factor for autoimmune diseases, including hypothyroidism. Clinical features in hypothyroidism, such as weight gain, fatigue, cold intolerance, constipation, dry skin, edema and muscle weakness, and decreased osteo-tendinous reflexes are usually subtle and can be overlooked. Thyroid dysfunction may be associated with a negative impact on the cardiovascular system. Pericardial, pleural and peritoneal effusions are common findings in hypothyroidism. This case report represents a typical primary hypothyroidism (autoimmune) and shows the clinical features of this disease. Basically we talked about a severe myxedema with the involvement of internal organs in an elderly woman and the euthyroidism restoration, under thyroid replacement therapy, was correlated with the clinical improvement and cardiovascular and neurological status, with radiographic remission and regression to extinction of pericardial effusion at repeated echocardiographic evaluations.

The importance of clinical prediction models in non-fatal pulmonary embolism: an analysis of the best known clinical scores.

The clinical evaluation in pulmonary embolism (PE) is the first instrument used by practitioners in the management of this potentially fatal pathology. The necessity of develop- ing certain valid and especially affordable practical instruments has led to the emergence of various clinical prediction models. The purpose of this paper is to analyze the main clinical scores, as a diagnostic or a prognostic tool, with their strengths and weaknesses. The PESI score, while relatively recent, remains the most investigated and validated prognostic score for the identification of the mortality risk and major adverse events, with economic implications of health services reduction costs through the accurate identification of patients with a low risk who are candidates of early hospital discharge. The simplified Geneva score (with a similar accuracy as the Geneva one) identifies a high or low PE probability, especially in combination with D-dimers, with a prognosis value as well. The Wells and simplified Wells scores identify the high or low probability, being improved by the level of D-dimers, having similar results with the Geneva score. The LR-PED score, conceived as an identification score for low risk, uses biochemical and electrocardiographic markers, but is less validated. The Vienna Prediction Model is another system for the evaluation of the recurrence in which the level of D-dimers is the main prediction factor. Other scores were evaluated with a statistically low significance. The Geneva and the PESI scores remain the most valuable instruments of diagnosis and clinical prognostic, respectively.

Hypertension prevalence and control in Romania at a seven-year interval. Comparison of SEPHAR I and II surveys.

OBJECTIVES: To present the current epidemiologic situation regarding hypertension's prevalence and control in Romania's adult population (revealed by SEPHAR II survey results) and to evaluate their tendency during the last 7 years (by comparing with the SEPHAR I survey results). METHODS: The two SEPHAR cross-sectional national surveys were conducted on a representative sample for the Romanian adult population (SEPHAR I: 2017 individuals aged 18-85 years, 45% response rate, SEPHAR II: 1975 individuals aged 18-80 years, 69% response rate), by means of questionnaire interview, blood pressure (BP) and anthropometric measurements during two study visits. Hypertension was defined as SBP at least 140  mmHg and/or DBP at least 90  mmHg at both study visits or previously diagnosed hypertension under current treatment. Controlled BP was defined as SBP less than 140  mmHg and DBP less than 90  mmHg in currently treated hypertensive individuals. RESULTS: Prevalence of hypertension in Romanian is 40.41%, awareness of hypertension is 69.55%, with 59.15% hypertensive individuals under current treatment with a control rate of 25%. In the last 7 years, there has been a 10.7% decrease in hypertension's prevalence together with an increase by 57% in awareness of hypertension and an increase by 52% in treatment of hypertension, leading to almost doubling of the hypertension's control rate in all hypertensive individuals. CONCLUSION: Although in the last 7 years, the tendency of hypertension's prevalence seems to be a descending one with an increasing trend in awareness, treatment and control of this condition, hypertension in Romania at this time still remains an 'unsolved equation'.

Particularities of coronary artery disease in hypertensive patients with left bundle branch block.

OBJECTIVE: We mean to investigate whether the presence of hypertension could be associated with a more severe atherosclerotic coronary artery disease in patients with left bundle branch block. MATERIAL AND METHODS: To assess the current incidence and meaning of hypertension associated with atherosclerotic coronary artery disease we performed a cross-sectional analysis that included 402 patients with left bundle branch block, admitted between January 2011 and June 2013 in the Cardiovascular Diseases Institute Iasi, Romania. Of these, 194 were hypertensive, especially grade 1 and 2; 272 patients had new or presumably new left bundle branch block on their presenting electrocardiograms. The median follow up was 7 days (hospitalization period). RESULTS: The results of our study show that hypertensive patients were more likely to have a prior history of cardiovascular events, including myocardial infarction, angina pectoris, diabetes and obesity, with statistically significant differences. On the other hand, the normotensive patients had higher rates of current and previous smoking and congestive heart failure. Conventional coronary angiography was performed in 130 (67.01%) hypertensive patients and demonstrated that almost half (41.76%) of them have coronary artery disease, one in five patients being diagnosed with acute coronary syndromes. The majority of hypertensive patients evaluated by coronary angiography had either one or two coronary lesions (28.86%); in contrast, from 110 normotensive patients evaluated by coronary angiography, 78.36% had no vessel disease (p = 0.001). When coronary artery disease was present it was frequently localized on the left descendent artery in both groups, but with statistically significant differences (16.82% in normotensives vs. 32.47% in hypertensives, p = 0.001). With regards to systolic left ventricular function, normotensive patients were more likely to have a decreased ejection fraction (EF) <50% (p <0.001), almost half of them having an EF <30%. CONCLUSIONS: We have found that hypertensive patients with left bundle branch block and a clinical context suggestive of acute coronary syndrome have an elevated risk of coronary artery disease, especially one and two coronary lesions. The association of hypertension with left bundle branch block is a high probability criterion for the diagnosis of coronary artery disease, even in asymptomatic patients.

Annexins, calcium-dependent phospholipid binding proteins in irreducible heart failure.

AIM: To analyze the expression and distribution of annexins V and VI in intact human hearts and in dilated cardiomyopathy (DCM) in patients with irreducible heart failure. MATERIAL AND METHODS: The study included nine patients with DCM and irreducible heart failure. By immunoblotting and indirect immunofluorescence, the amount and location of annexins was determined using samples of left ventricular (LV) myocardium collected during orthotopic heart allotransplantation. Samples of LV myocardium from 9 individuals who died of craniocerebral trauma served as controls. RESULTS: Quantitative analysis showed an increased level of both annexins in the myocardium of DCM patients compared with normal myocardium: 122 +/- 5% (p < 0.05) and 119 +/- 5% (p < 0.05) for annexins V and VI, respectively. In the intact heart annexin V was located at the sarcolemma and intercalated discs, while in the myocardium with heart failure mainly in the interstitium. In normal hearts, annexin VI was located at the sarcolema, including T-tubules, Z-lines and intercalated discs. In heart failure, annexin V1 was also located in the interstitium. CONCLUSIONS: Redistribution of annexins V and VI in the cardiomyocytes in the interstitial space may have important functional consequences and indicates the role of myocardial protein expression disturbances in the etiology and/or pathogenesis of heart failure in pa-

Risk assessment in the development of atrial fibrillation at patients with associate thyroid dysfunctions.

UNLABELLED: Thyroid hormones are an important regulator of cardiac function and vascular system. Atrial fibrillation is a common cardiac arrhythmia and an important risk factor for the ischemic cerebral vascular accident and heart failure. OBJECTIVES: The examination of the risk to develop atrial fibrillation in relation to the whole spectrum of thyroid dysfunctions. MATERIAL AND METHODS: All participants to our study were selected from among subjects with cardiovascular disorders whose hormonal thyroid status had been controlled previously and who hadn't been treated for thyroid functional disorders. Based on these criteria we defined a study lot made up of 791 subjects, 700 women and 91 men, aged between 22 to 86, with a mean age of approximately 60 years old, divided into five groups, based on the level of thyroid hormones. Once the lot was constituted, evaluations were made of the cardiovascular and thyroid condition at 6 and 12 months. RESULTS: During monitoring, most patients who developed atrial fibrillation were registered in the groups with manifest clinical hyperthyroidism, 34,62% and respectively with subclinical hypothyroidism, 38,6%. The main risk factors at the patients with manifest clinical hyperthyroidism were: female gender (RR=1.97) and age above 60 (RR=1.33), as well as the presence of coronary disease in the personal pathological record (RR=3.31), HBP (RR=1.46) and cardiac frequency in excess of 80 beats/min (RR=1.38). The main risk factors that led to atrial fibrillation among the patients with subclinical hypothyroidism, were: obesity (RR=2.21), the presence in the personal record of heart disease (RR=2,0), age over 60 (RR=1.90) and female sex (RR=1.30). At the patients who had been administered beta blockers prior to admission (RR=0.99), ACEI (RR=0.85) and/or antiarrythmic drugs (RR=0.54), the medication represented a protective factor against developing atrial fibrillation. CONCLUSIONS: Thyroid dysfunctions are associated with an increased risk to develop atrial fibrillation, both in the case of clinically manifest and the subclinical manifest forms. These results support long term screening for thyroid dysfunctions for patients with atrial fibrillation.