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Dregoesc MI, Bindea DI, Marc MC, Sasarman V, Iancu AC. Transcatheter aortic valve implantation in a patient with interventricular membranous septal aneurysm resulted in cardiac tamponade of unclear etiology. Med Ultrason 2023; 25:104-106. [PMID: 33220039 DOI: 10.11152/mu-2706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An 86-year-old lady with severe aortic stenosis and interventricular membranous septal aneurysm underwent transfemoral transcatheter aortic valve implantation (TAVI). A balloon-expandable valve was deployed after a difficult native valve crossing. Transesophageal echocardiography showed a rapidly accumulating pericardial effusion, with pericardial thrombus and subsequent cardiac tamponade. The angiographic views raised suspicion of aortic root perforation. Median sternotomy was performed because of sudden hemodynamic collapse.The report presents the uncommon association between severe aortic stenosis and interventricular membranous septal aneurysm in an octogenarian and discusses its impact on the development of a post-TAVI major complication.
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Affiliation(s)
- Mihaela Ioana Dregoesc
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.
| | - Dan Ion Bindea
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.
| | | | | | - Adrian Corneliu Iancu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.
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Abstract
Left main coronary artery disease is associated with an unfavorable prognosis. Evidence-based decision making regarding the optimal revascularization strategy in patients with left main disease has become a challenge, in view of the recently published data. An improvement in outcomes following left main percutaneous interventions could be achieved by reducing the rate of repeat target lesion revascularization through stent optimization techniques. In the setting of left main disease, procedural guidance by intravascular ultrasound or optical coherence tomography is essential for good long-term results, in such a way that intravascular imaging has gained more of a therapeutic connotation. Besides stent optimization, intracoronary imaging quantifies lesion severity, guides lesion preparation through morphological data, facilitates stent selection through accurate vessel sizing, identifies the landing zones, diagnoses acute vessel wall complications such as stent-related edge dissection or intramural hematoma, and defines procedural success.This review focuses on the two main intracoronary imaging techniques used for diagnostic evaluation and procedural guidance in left main coronary artery disease: intravascular ultrasound and optical coherence tomography. Based on the most recently published data, the review discusses each technique's advantages and pitfalls, and summarizes their indications.
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Affiliation(s)
- Mihaela Ioana Dregoesc
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.
| | - Adrian Corneliu Iancu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.
| | - Călin Homorodean
- "Iuliu Hatieganu" University of Medicine and Pharmacy, 1st Medical Department, Cluj-Napoca, Romania.
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Dregoesc MI, Ţigu AB, Bekkering S, van der Heijden CDCC, Bolboacǎ SD, Joosten LAB, Visseren FLJ, Netea MG, Riksen NP, Iancu AC. Relation Between Plasma Proteomics Analysis and Major Adverse Cardiovascular Events in Patients With Stable Coronary Artery Disease. Front Cardiovasc Med 2022; 9:731325. [PMID: 35211520 PMCID: PMC8861429 DOI: 10.3389/fcvm.2022.731325] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Despite the advances in the control of traditional risk factors, coronary artery disease (CAD) remains the greatest cause of morbidity and mortality. Our aim was to establish the relation between plasma proteomics analysis and the risk of cardiovascular events in patients with stable CAD. Materials and Methods Patients with stable CAD and documented coronary atherosclerosis were screened for inclusion. Using proximity extension assays, 177 plasma proteins were simultaneously measured. The endpoint consisted of the first major adverse cardiovascular event (MACE) and was the composite of cardiovascular death, acute coronary syndrome, stroke, transient ischemic attack, or acute limb ischemia at 18 months follow-up. Cox proportional-hazards regression with adjustment for multiple comparisons was used to identify biomarkers for the outcomes of interest. Results The cohort consisted of 229 patients. Six mediators were associated with MACE (p < 0.001). For these markers, the risk of MACE was calculated: tumor necrosis factor receptor superfamily member 13B (HR = 1.65; 95% CI: 1.30–2.10), C-C motif chemokine-3 (HR = 1.57; 95% CI: 1.23–1.98), decorin (HR = 1.65; 95% CI: 1.26–2.16), fibroblast growth factor-23 (HR = 1.56; 95% CI: 1.23–1.99), tumor necrosis factor-related apoptosis-inducing ligand-receptor 2 (TRAIL-R2) (HR = 1.61; 95% CI: 1.23–2.11), and tumor necrosis factor receptor superfamily member 10A (HR = 1.69; 95% CI: 1.25–2.29). Except for TRAIL-R2, the other proteins were associated with MACE independent of age, sex, diabetes mellitus, or estimated glomerular filtration rate. Conclusions In patients with stable CAD, five novel biomarkers were identified as independent risk factors for adverse outcomes. Novel biomarkers could represent pharmacological targets for the prevention of adverse cardiovascular events.
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Affiliation(s)
- Mihaela Ioana Dregoesc
- Department of Cardiology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adrian Bogdan Ţigu
- Medfuture—The Research Center for Advanced Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Siroon Bekkering
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Internal Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
| | - Charlotte D. C. C. van der Heijden
- Department of Internal Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
| | - Sorana Daniela Bolboacǎ
- Department of Medical Informatics and Biostatistics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Leo A. B. Joosten
- Department of Internal Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
| | - Frank L. J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mihai G. Netea
- Department of Internal Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Niels P. Riksen
- Department of Internal Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Niels P. Riksen
| | - Adrian Corneliu Iancu
- Department of Cardiology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- *Correspondence: Adrian Corneliu Iancu
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Dregoesc MI, Istrate M, Sandu I, Iancu AC. OUP accepted manuscript. Eur Heart J 2022; 43:1599. [PMID: 36282779 DOI: 10.1093/eurheartj/ehac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mihaela Ioana Dregoesc
- Department of Cardiology, 'Iuliu Haţieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 'Niculae Stãncioiu' Heart Institute, Cluj-Napoca, Romania
| | - Mihnea Istrate
- Department of Cardiology, 'Iuliu Haţieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Irina Sandu
- 'Niculae Stãncioiu' Heart Institute, Cluj-Napoca, Romania
| | - Adrian Corneliu Iancu
- Department of Cardiology, 'Iuliu Haţieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 'Niculae Stãncioiu' Heart Institute, Cluj-Napoca, Romania
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Dregoesc MI, Bolboacă SD, Dorolțan PM, Istrate M, Marc MC, Iancu AC. Long-Term Mortality After Renal Artery Stenting in Patients With Severe Atherosclerotic Renal Artery Stenosis and High-Risk Clinical Manifestations. Am J Hypertens 2021; 34:880-887. [PMID: 33530094 DOI: 10.1093/ajh/hpab027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/19/2020] [Accepted: 01/27/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Atherosclerotic renal artery stenosis is a risk factor for cardiovascular death. Observational studies support the benefit of renal revascularization on outcomes in patients with high-risk clinical manifestations. In this context, we evaluated the factors associated with long-term mortality after renal artery stenting in patients with severe renal artery stenosis, impaired kidney function, and/or uncontrolled hypertension. METHODS The medical records of patients undergoing renal artery stenting between 2004 and 2014 were extracted. Blood pressure and creatinine were recorded at baseline, 24 hours poststenting and in the 1-month to 1-year interval that followed revascularization. Long-term follow-up was performed in March 2020. RESULTS The cohort consisted of 65 patients. Median follow-up was 120 months. In the first year after stenting, less patients had chronic kidney disease (CKD) class 3b-5 as compared with baseline (35.3% vs. 56.9%, P = 0.01). The number of patients with controlled blood pressure after revascularization increased with 69.2% (P < 0.001). Long-term all-cause mortality reached 44.6%. Age (odds ratio (OR) 1.1; 95% confidence interval (CI) 1.0-1.2; P = 0.01), male gender (OR 7.9; 95% CI 1.9-43.5; P = 0.008), poststenting CKD class 3b-5 (OR 5.8; 95% CI 1.5-27.9; P = 0.01), and postrevascularization uncontrolled hypertension (OR 8.9; 95% CI 1.7-63.5; P = 0.01) were associated with long-term mortality independent of diabetes mellitus and coronary artery disease. CONCLUSIONS Improved CKD class and blood pressure were recorded in the first year after renal artery stenting in patients with severe renal artery stenosis and high-risk clinical manifestations. The lack of improvement in kidney function and blood pressure was independently associated with long-term mortality.
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Affiliation(s)
- Mihaela Ioana Dregoesc
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Sorana Daniela Bolboacă
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania
| | - Patricia Mirela Dorolțan
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Mihnea Istrate
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | | | - Adrian Corneliu Iancu
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
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Marc MC, Iancu AC, Bălănescu Ş, Dregoesc MI. Microvascular obstruction in acute myocardial infarction: an old and unsolved mystery. Med Pharm Rep 2019; 92:216-219. [PMID: 31460500 PMCID: PMC6709958 DOI: 10.15386/mpr-1261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/13/2019] [Accepted: 04/19/2019] [Indexed: 01/24/2023] Open
Abstract
In the setting of acute myocardial infarction, flow restoration in the culprit epicardial coronary artery is not synonymous with efficient reperfusion. Microvascular obstruction occurs in 50% of cases and represents a predictor of a long-term unfavorable outcome. Its prevalence has remained constant in recent years despite various treatment attempts. However, the success of targeted therapies could be mainly a problem of timing. Recent data bring evidence with regard to the role of pre-procedural distal embolization and highlight the relation between distal embolism, microvascular obstruction and intramyocardial inflammation. As a result, early detection of microvascular injury represents the first step in the development of targeted, individualized therapeutic approaches. In this context, the identification of new invasive surrogate parameters for the timely assessment and quantification of microvascular obstruction in the catheterization laboratory has become an important subject of current research. Among these, coronary wedge pressure is the most practical and revealing in the setting of primary percutaneous coronary intervention. It may offer comprehensive details on the mechanisms of microvascular injury and may therefore offer guidance for appropriate treatment selection.
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Affiliation(s)
- Mădălin Constantin Marc
- Department of Cardiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Adrian Corneliu Iancu
- Department of Cardiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Şerban Bălănescu
- "Carol Davila" University of Medicine and Pharmacy, Elias University Hospital, Bucharest, Romania
| | - Mihaela Ioana Dregoesc
- Department of Cardiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Cluj-Napoca, Romania
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Dregoesc MI, Iancu AC, Ober CD, Homorodean C, Bãlãnescu Ş, Bolboacã S. In ST-segment elevation myocardial infarction, the echocardiographic parameters of microvascular obstruction are not associated with left ventricular remodeling at five years of follow-up. Echocardiography 2019; 36:1103-1109. [PMID: 31116460 DOI: 10.1111/echo.14371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The correlation between the echocardiographic Doppler flow parameters of microvascular obstruction (MVO) and coronary wedge pressure (CWP) measured as a marker of severe compressive microvascular dysfunction and a predictor of adverse left ventricular remodeling was evaluated in a group of high-risk acute anterior myocardial infarction survivors. METHODS Twenty-four patients with mechanically reperfused anterior STEMI were divided into two groups based on the 38 mm Hg CWP cutoff for adverse left ventricular remodeling. Diastolic deceleration time (DDT), coronary flow reserve (CFR), systolic retrograde flow, peak systolic and peak diastolic velocities in the infarct-related artery were determined 3-5 days after revascularization. An echocardiographic 20% increase in left ventricular volumes defined adverse remodeling. RESULTS No significant differences were recorded between groups with regard to the echocardiographic parameters of MVO. No significant correlation was identified between CWP on one side and DDT (P = 0.30) and CFR (P = 0.39) on the other, irrespective of total ischemic time and extracted thrombus length. No difference in 5 years of follow-up left ventricular remodeling was detected in patients with DDT<900 msec as compared to those with DDT≥900 msec. The medium increase in left ventricular end-systolic volume in patients with low CWP was 24.78%, while it reached 127.27% (P = 0.03) in patients with CWP>38 mm Hg. CONCLUSIONS Coronary wedge pressure did not correlate with the surrogate parameters for MVO, but it was a predictor of left ventricular remodeling. None of the echocardiographic MVO parameters was associated with adverse remodeling at 5 years of follow-up.
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Affiliation(s)
- Mihaela Ioana Dregoesc
- Department of Cardiology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Adrian Corneliu Iancu
- Department of Cardiology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Cluj-Napoca, Romania
| | | | - Cãlin Homorodean
- 1st Medical Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Şerban Bãlãnescu
- "Carol Davila", "Elias" University Hospital, University of Medicine and Pharmacy, Bucharest, Romania
| | - Sorana Bolboacã
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Homorodean C, Iancu AC, Dregoesc IM, Spînu M, Ober MC, Tãtaru D, Leucuţa D, Olinic M, Olinic DM. Renal Failure Impact on the Outcomes of ST-Segment Elevation Myocardial Infarction Patients Due to a Left Main Coronary Culprit Lesion Treated Using a Primary Percutaneous Coronary Intervention. J Clin Med 2019; 8:E565. [PMID: 31027307 PMCID: PMC6518004 DOI: 10.3390/jcm8040565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Patients with ST-segment elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (PPCI) on a left main culprit lesion have very high mortality rates. The interaction of chronic kidney disease (CKD) with such a catastrophic acute event on the background of their highly complex atherosclerotic lesions is not well established. Therefore, we sought to evaluate in these patients the influence of the estimated glomerular filtration rate (eGFR) on short- and long-term mortality. METHODS We retrospectively analyzed renal function in 81 patients with STEMI and PPCI on a left main culprit lesion from two tertiary centers. RESULTS Patients were divided in two groups according to an eGFR cut-off of 60 mL/min/1.73 m2: 40 patients with CKD and 41 without CKD. Patients with renal failure were older, had more diabetes, and had experienced more frequent myocardial infarction MIs. CKD patients had a higher baseline-SYNTAX score (p = 0.015), higher residual-SYNTAX score (p < 0.001), and lower SYNTAX revascularization index-SRI (p = 0.003). Mortality at 30-day, 1-year, and 3-year follow-ups were not significantly different between the two groups. However, when analyzed as a continuous variable, eGFR emerged as a predictor of 1-year mortality, both in univariate analysis (OR = 0.97, 95% CI: 0.95-0.99, p = 0.005) and in multivariate analysis, after adjusting for cardiogenic shock and Thrombolysis in Myocardial Infarction TIMI 0/1 flow (OR = 0.975, 95% CI: 0.95-0.99, p = 0.021). CONCLUSIONS In STEMI with PPCI on a left main culprit lesion, renal failure was associated with more complex coronary lesions and less complete revascularization, and turned out to be an independent predictor of mortality at 1-year follow-up.
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Affiliation(s)
- Cãlin Homorodean
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
- Emergency County Hospital, 400000 Cluj-Napoca, Romania.
| | - Adrian Corneliu Iancu
- Department of Cardiology, "Niculae Stãncioiu" Heart Institute, "Iuliu Hatieganu " University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania.
| | - Ioana Mihaela Dregoesc
- Department of Cardiology, "Niculae Stãncioiu" Heart Institute, "Iuliu Hatieganu " University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania.
| | - Mihai Spînu
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
| | | | - Dan Tãtaru
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
| | - Daniel Leucuţa
- Dept. of Medical Informatics and Biostatistics, "Iuliu Hatieganu " University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
| | - Maria Olinic
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
- Emergency County Hospital, 400000 Cluj-Napoca, Romania.
| | - Dan Mircea Olinic
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
- Emergency County Hospital, 400000 Cluj-Napoca, Romania.
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Duţu B, Pop D, Zdrenghea D, Comsa H, Iancu AC. The place and role of rehabilitation in patients undergoing endovascular revascularization for chronic critical ischemia. Balneo 2018. [DOI: 10.12680/balneo.2018.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dregoesc MI, Iancu AC, Lazar AA, Balanescu S. Hypereosinophilic syndrome with cardiac involvement in a patient with multiple malignancies. Med Ultrason 2018; 20:399-400. [PMID: 30167597 DOI: 10.11152/mu-1574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mihaela Ioana Dregoesc
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.
| | - Adrian Corneliu Iancu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.
| | - Alexandra Alina Lazar
- "Niculae Stancioiu" Heart Institute, Department of Cardiology, Cluj-Napoca, Romania.
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Marc MC, Iancu AC, Ober CD, Homorodean C, Bãlãnescu Ş, Sitar AV, Bolboacã S, Dregoesc IM. Pre-revascularization coronary wedge pressure as marker of adverse long-term left ventricular remodelling in patients with acute ST-segment elevation myocardial infarction. Sci Rep 2018; 8:1897. [PMID: 29382891 PMCID: PMC5789971 DOI: 10.1038/s41598-018-20276-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/16/2018] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to investigate the relationship between coronary wedge pressure (CWP), measured as a marker of pre-procedural microvascular obstruction, and left ventricular remodelling in high-risk ST-segment elevation myocardial infarction (STEMI) patients. Pre-revascularization CWP was measured in 25 patients with high-risk anterior STEMI. Left ventricular volumes and ejection fraction were echocardiographically measured at discharge and at follow-up. A 20% increase in left ventricular volumes was used to define remodelling. Patients with CWP ≤ 38 mmHg were characterized by late ventricular remodelling. Patients with CWP > 38 mmHg developed a progressive remodelling process which was associated with a significant 60 months increase in left ventricular volumes (P = 0.01 for end-systolic volume and 0.03 for end-diastolic volume) and a significant decrease in left ventricular ejection fraction (P = 0.05). A significant increase in both left ventricular end-systolic (P = 0.009) and end-diastolic volume (P = 0.02) from baseline to 60 months follow-up was recorded in patients with extracted thrombus length ≥2 mm. Pre-revascularization elevated CWP was associated with increased left ventricular volumes and decreased ejection fraction at long-term follow-up. CWP was a predictor of severe left ventricular enlargement, besides extracted thrombus quantity.
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Affiliation(s)
- Mãdãlin Constantin Marc
- "Iuliu Haţieganu'' University of Medicine and Pharmacy, 8 Victor Babeş, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Department of Cardiology, 19-21 Calea Moţilor, Cluj-Napoca, Romania
| | - Adrian Corneliu Iancu
- "Iuliu Haţieganu'' University of Medicine and Pharmacy, 8 Victor Babeş, Cluj-Napoca, Romania. .,"Niculae Stãncioiu" Heart Institute, Department of Cardiology, 19-21 Calea Moţilor, Cluj-Napoca, Romania.
| | - Camelia Diana Ober
- "Niculae Stãncioiu" Heart Institute, Department of Cardiology, 19-21 Calea Moţilor, Cluj-Napoca, Romania
| | - Cãlin Homorodean
- "Iuliu Haţieganu'' University of Medicine and Pharmacy, 8 Victor Babeş, Cluj-Napoca, Romania
| | - Şerban Bãlãnescu
- "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu, Bucharest, Romania
| | - Adela Viviana Sitar
- "Iuliu Haţieganu'' University of Medicine and Pharmacy, 8 Victor Babeş, Cluj-Napoca, Romania
| | - Sorana Bolboacã
- "Iuliu Haţieganu'' University of Medicine and Pharmacy, 8 Victor Babeş, Cluj-Napoca, Romania
| | - Ioana Mihaela Dregoesc
- "Iuliu Haţieganu'' University of Medicine and Pharmacy, 8 Victor Babeş, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Department of Cardiology, 19-21 Calea Moţilor, Cluj-Napoca, Romania
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Ober CD, Ober MC, Iancu AC. Serial transthoracic coronary Doppler shows complete reversibility of microvascular obstruction pattern at one month after reperfused acute myocardial infarction. Med Ultrason 2017; 19:45-50. [PMID: 28180196 DOI: 10.11152/mu-941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED "No reflow" phenomenon is a common complication with significant prognostic repercussions after reperfused acute myocardial infarction. Previous studies have shown the feasibility and prognostic significance of coronary microcirculation assessment by transthoracic Doppler of left anterior descending artery (LAD). The aim of the study was to evaluate the time course of the coronary microcirculation status after acute anterior myocardial infarction reperfused by primary angioplasty with stent on LAD. MATERIAL AND METHODS Twenty-three patients underwent transthoracic echocardiography at 3 days (M0) and one month (M1) after reperfusion, with LAD flow analysis (peak systolic and diastolic velocities, diastolic deceleration time and systolic flow reversal). The patients were divided into two groups, of good reperfusion and "no reflow", by a 600 ms cut-off of the M0 diastolic deceleration time, previously shown to best discriminate between the two microvascular reperfusion states. RESULTS Of all patients, 21 survived to M1 and were included in analysis. Microvascular obstruction, as defined, was present in 50% of patients at M0 and it was associated with significantly worse ejection fraction both at M0 and M1 (p=0.01 and 0.04, respectively). Killip class at admission was the only independent predictor of "no reflow". DDT increased from 661.9±339.3 at M0 to 948.2±201.8 at M1 (p=0.0003). In patients with initial "no reflow", DDT increased to normal values at M1 (876.2±167.7 vs. 346.3±133.9 at M0, p<0.0001). In these patients, the PDV/PSV ratio decreased at one month (1.91±0.37 vs. 2.70±1.22, p=0.06), by decrease of PDV (0.29±0.06 vs. 0.40±0.19, p=0.03). CONCLUSIONS The parameters of coronary microcirculatory impedance improve significantly at one month after infarction, suggesting delayed full reversibility of the microvascular obstruction.
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Affiliation(s)
| | | | - Adrian Corneliu Iancu
- "Niculae Stăncioiu" Heart Institute, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Kereiakes DJ, Yeh RW, Massaro JM, Driscoll-Shempp P, Cutlip DE, Steg PG, Gershlick AH, Darius H, Meredith IT, Ormiston J, Tanguay JF, Windecker S, Garratt KN, Kandzari DE, Lee DP, Simon DI, Iancu AC, Trebacz J, Mauri L. Stent Thrombosis in Drug-Eluting or Bare-Metal Stents in Patients Receiving Dual Antiplatelet Therapy. JACC Cardiovasc Interv 2015; 8:1552-62. [DOI: 10.1016/j.jcin.2015.05.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
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Kereiakes DJ, Yeh RW, Massaro JM, Driscoll-Shempp P, Cutlip DE, Steg PG, Gershlick AH, Darius H, Meredith IT, Ormiston J, Tanguay JF, Windecker S, Garratt KN, Kandzari DE, Lee DP, Simon DI, Iancu AC, Trebacz J, Mauri L. Antiplatelet therapy duration following bare metal or drug-eluting coronary stents: the dual antiplatelet therapy randomized clinical trial. JAMA 2015; 313:1113-21. [PMID: 25781440 PMCID: PMC4481320 DOI: 10.1001/jama.2015.1671] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Despite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown. OBJECTIVE To compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in patients treated with BMS taking aspirin and (2) treatment duration effect within the combined cohorts of randomized patients treated with DES or BMS as prespecified secondary analyses. DESIGN, SETTING, AND PARTICIPANTS International, multicenter, randomized, double-blinded, placebo-controlled trial comparing extended (30-months) thienopyridine vs placebo in patients taking aspirin who completed 12 months of DAPT without bleeding or ischemic events after receiving stents. The study was initiated in August 2009 with the last follow-up visit in May 2014. INTERVENTIONS Continued thienopyridine or placebo at months 12 through 30 after stent placement, in 11,648 randomized patients treated with aspirin, of whom 1687 received BMS and 9961 DES. MAIN OUTCOMES AND MEASURES Stent thrombosis, MACCE, and moderate or severe bleeding. RESULTS Among 1687 patients treated with BMS who were randomized to continued thienopyridine vs placebo, rates of stent thrombosis were 0.5% vs 1.11% (n = 4 vs 9; hazard ratio [HR], 0.49; 95% CI, 0.15-1.64; P = .24), rates of MACCE were 4.04% vs 4.69% (n = 33 vs 38; HR, 0.92; 95% CI, 0.57-1.47; P = .72), and rates of moderate/severe bleeding were 2.03% vs 0.90% (n = 16 vs 7; P = .07), respectively. Among all 11,648 randomized patients (both BMS and DES), stent thrombosis rates were 0.41% vs 1.32% (n = 23 vs 74; HR, 0.31; 95% CI, 0.19-0.50; P < .001), rates of MACCE were 4.29% vs 5.74% (n = 244 vs 323; HR, 0.73; 95% CI, 0.62-0.87; P < .001), and rates of moderate/severe bleeding were 2.45% vs 1.47% (n = 135 vs 80; P < .001). CONCLUSIONS AND RELEVANCE Among patients undergoing coronary stent placement with BMS and who tolerated 12 months of thienopyridine, continuing thienopyridine for an additional 18 months compared with placebo did not result in statistically significant differences in rates of stent thrombosis, MACCE, or moderate or severe bleeding. However, the BMS subset may have been underpowered to identify such differences, and further trials are suggested. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00977938.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio2Lindner Research Center, Cincinnati, Ohio
| | - Robert W Yeh
- Harvard Clinical Research Institute, Boston, Massachusetts4Massachusetts General Hospital, Boston
| | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts5Boston University, Boston, Massachusetts
| | | | - Donald E Cutlip
- Harvard Clinical Research Institute, Boston, Massachusetts6Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Gabriel Steg
- Université Paris-Diderot, Paris, France8Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France9National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Daniel I Simon
- University Hospitals Case Medical Center, Cleveland, Ohio
| | | | | | - Laura Mauri
- Harvard Clinical Research Institute, Boston, Massachusetts22Brigham and Women's Hospital, Boston, Massachusetts
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