2008_rrc_sup

1-5 Cardiopatie ischemic A7 6-10 Insufi cien cardiac A13 11-15 POSTER FORUM I A18 16-51 POSTER I A24

52-56 Aritmii I A65 57-61 Aritmii II A71 62-66 POSTER FORUM II A79 67-101 POSTER II A85

102-106 HTA Valvulopatii Cardiomiopatii A123 107-111 Cardiologie intervenional A131 112-116 POSTER FORUM III A138 117-151 POSTER III A144

152-156 Varia I A182 157-161 Varia II A189

Index autori A196 Index subiecte A201

Luni 22 septembrie 2008

Mari 23 septembrie 2008

Smbt 20 septembrie 2008

Duminic 21 septembrie 2008

Vol. XXIII,Suplimentul A, 2008

Vol. XXII, Nr. 1, 2008

1-5 Ischemic cardiopathy A7 6-10 Heart failure A13 11-15 POSTER FORUM I A18 16-51 POSTER I A24

52-56 Arrhythmias I A65 57-61 Arrhythmias II A71 62-66 POSTER FORUM II A79 67-101 POSTER II A85

102-106 Arterial hypertension - Valvulopathies - Cardiomyopathies A123 107-111 Interventional cardiology A131 112-116 POSTER FORUM III A138 117-151 POSTER III A144

152-156 Varia I A182 157-161 Varia II A189

Authors index A196 Topics index A201

Monday, September 22nd, 2008

Tuesday, September 23rd, 2008

Saturday, September 20th, 2008

Sunday, September 21st, 2008

Vol. XXIII,Suplimentul A, 2008

Preedinte: Radu CplneanuPreedinte ales: Dan DeleanuPreedinte anterior: Carmen GinghinVicepreedini: Marius Vintil Ioan Mircea ComanSecretar: Doina DimulescuTrezorier: Radu Ciudin

Membri: Eduard Apetrei erban Blnescu Carmen Bedeleanu Ovidiu Chioncel Mircea Cintez Gheorghe Andrei Dan Maria Dorobanu Dan Gai Bogdan Mut-Vitcu Tiberiu Nanea Mariana Rdoi Anca Sglimbea Gabriel Tatu-Chioiu Drago Vinereanu

CONSILIUL DE CONDUCERE ALSOCIETII ROMNE DE CARDIOLOGIE

ISSN: 1583-2996

Colegiul de redacie

Editura: Media Med PublicisPublicitate: offi [email protected]: Revista Romn deCardiologie se distribuie membrilor Societii Romne de CardiologieAbonamente: offi [email protected]

Caseta tehnicRspunderea pentru coninutul articolelor publicate revine n ntregime autorilor. Opi-niile, ideile, rezultatele studiilor publicate n Revista Romn de Cardiologie sunt cele ale autorilor i nu refl ect poziia i politica Societii Romne de Cardiologie. Nicio parte a acestei publicaii nu poate fi reprodus, stocat, transmis sub nicio form sau mijloc (elec-tronic, mecanic, fotocopie, nregistrare) fr permisiunea scris a edito rului. Toate drepturile rezervate Societii Romne de Cardiologie.Contact: Societatea Romn de Cardiologie Str. Avrig nr. 63, Sector 2, Bucureti Tel./Fax: +40.21.250 01 00, +40.21.250 50 86, +40.21.250 50 87; E-mail: [email protected]

Alexandru Cmpeanu - BucuretiMircea Cintez - BucuretiRadu Ciudin - BucuretiRadu Cristodorescu - TimioaraD. V. Cokkinos - GreciaG. Andrei Dan - BucuretiDan Deleanu - BucuretiGenevieve Derumeaux - FranaDoina Dimulescu - BucuretiMaria Dorobanu - Bucuretitefan Iosif Drgulescu - TimioaraGuy Fontaine - Frana

Bradu Fotiade - BucuretiAlan Fraser - AngliaMihai Gheorghiade - USALeonida Gherasim - BucuretiE. Grosu - Chiinu, R. MoldovaAssen R. Goudev - Bulgaria Alexandru Ioan - BucuretiDan Dominic Ionescu -CraiovaMatei Iliescu - BucuretiAndre Keren - IsraelIoan Maniiu - SibiuGerald A. Maurer - Austria

erban Mihileanu - FranaNour Olinic - Cluj-NapocaFausto Pinto - PortugaliaGian Luigi Nicolosi - ItaliaMariana Rdoi - BraovWillem J. Remme - OlandaDoina Rogozea - BucuretiMichal Tendera - PoloniaIon intoiu - BucuretiPanagiotis Vardas - GreciaDrago Vinereanu - BucuretiMarius Vintil - BucuretiDumitru Zdrenghea - Cluj-Napoca

Colectivul de redacie

Redactor efEduard Apetrei

Redactor ef adjunctCarmen Ginghin

RedactoriRadu CplneanuCezar Macarie

Redactor fondatorCostin Carp

Redactori asociaiMihaela RuginRuxandra JurcuBogdan A. PopescuCostel Matei

Revista Romn de Cardiologie | Vol. XXIII | Suplimentul A, 2008

ni mentelor cardiovasculare dup ajustarea pentru ali factori de risc cardiovasculari (OR 0.72; 95%CI 0.57-0.83, p=0.004) s-a dovedit de asemenea independent n analiza multivariant.Concluzie: Apolipoproteinele B i A-I pot fi considerate ca un mijloc de evaluare a riscului cardiovascular, va-loarea lor predictiv fi ind superioar celei obinute prin evaluarea profi lului lipidic convenional. Datele obi nute sugereaz determinarea apolipoproteinelor n prac tica clinic curent.

2. Expansiunea infarctului miocardic acut la bolnavii cuhipertrofie ventricular stng preexistent fa de cei fr hipertrofie ventricular Camelia Nicolae, Nicolae Pun, Gabriela Gheorghe, Irina Andrei, Sorin Vian, Conf. Adriana Ilieiu,Prof. Tiberiu NaneaSpitalul Clinic Caritas Acad. N. Cajal

Scop: Scopul studiului a fost de a evalua expansiunea produs dup infarctul miocardic (IMA) la bolnavii cu hipertrofi e ventricular stng (HVS) preexistent fa de cei fr hipertrofi e.Material i metod: Au fost inclui n studiu 88 bolnavi cu IMA cu localizare antero-septal i HVS preexistent i 84 bolnavi cu aceeai localizare a necrozei i fr HVS preexistent. Criteriile de includere n studiu au fost: primul infarct miocardic, infarct cu supradenivelare de segment ST i localizare antero-septal V1V4, dimensiuni normale a cavitii VS i prezena HVS. Criteriile de excludere au fost: infarct miocardic sechelar unul sau mai multe, insufi cien cardiac clasa III-IV NYHA, tulburri de ritm sau conducere, valvulopatii moderate i severe, localizare nonanterioar a necrozei. Au fost utilizai urmtorii parametrii: grosimea pereilor VS, wall-stressul sistolic, profi lul fl uxului mitral, masa ventriculului stng, viteza n tractul de ejecie al VS; de asemenea, a fost comparat efi ciena trombolizei la

1. Valoarea apolipoproteinelor A-I i B i a lipidelor plasmatice ca factori de risc cardiovascular Lucia Agoton-Coldea, Teodora Mocan, LD Rusu,R Pais, DL Dumitrascu Universitatea de Medicina si Farmacie Iuliu Hatieganu, Clinica Medicala II, Cluj-Napoca

Obiectivele studiului: Evidene recente arat c rapor-tul apolipoproteic (apo)B/apoA-I este un indicator mai bun pentru riscul coronarian dect profi lul lipidic con-venional. Plecnd de la aceste date ne-am propus s studiem dac apoB, apoA-I i raportul apoB/apoA-I sunt factori de risc independeni pentru cardiopatia ische mic i dac msurarea apolipoproteinelor este supe rioar determ inrii fraciunilor lipidice plasmatice n evaluarea riscului de evenimente coronariene.Material i metod: S-a realizat un studiu transversal n care au fost inclui 289 subieci, divizai n dou gru puri: 144 subieci cu infarct miocardic vechi i 145 subieci fr cardiopatie ischemic, dar cu factori de risc cardiovasculari. Au fost evaluai parametrii antro -po metrici i factorii de risc cardiovasculari. Dozarea frac iunilor lipidice s-a fcut prin metoda enzi ma tic, iar a apoA-I i apoB a fost realizat prin imuno turbi-dimetrie.Rezultate: Valorile medii ale fraciunilor lipidice au fost mai reduse la subiecii cu infarct miocardic dect la su biecii fr cardiopatie ischemic: colesterolul total (186.0648.11 vs. 206.9342.28 mg/dl, p=0.0001), LDL-coles terolul (118.5742.95 vs. 129.5339.75 mg/dl, p=0.023), HDL-colesterolul (43.6412.32 vs. 50.4821.09 mg/dl, p=0.0008) i ale trigliceridelor (145.3862.74 vs. 167.5682.11 mg/dl, p=0.01). Nivelul plas matic al apoB a fost mai mare la subiecii cu infarct mio cardic (1.120.57 vs. 0.860.27 g/l, p=0.0001), iar cel al apoA-I mai redus (1.310.47 vs. 1.400.39 g/l, p=0.101). Analiza multivariant indic faptul c nivelul plasmatic a apoproteinei B peste valoarea de 1.7 g/l este strns corelat cu prezena infarctului miocardic (OR 3.96; 95%CI 2.87-5.02, p=0.001) independent de alte cova riabile ca vrsta, fumatul, obezitatea, diabetul zaharat, hipertensiunea arterial, fraciunile lipidice. Efectul protectiv al apolipoproteinei A-I mpotriva eve-

CARDIOPATIE ISCHEMIC | ISCHEMIC CARDIOPATHY

CARDIOPATIE ISCHEMICISCHEMIC CARDIOPATHY

Revista Romn de Cardiologie, Vol. XXIIISuplimentul A, 2008

cele 2 grupuri de pacieni. Pentru obinerea propriu-zis a lungimii segmentului expansionat a fost utilizat o formul matematic original: L=2,68A, unde L a reprezentat lungimea segmentului expansionat i A=aria zonei anterioare a cavitii VS obinut pin seciunea sagital la nivelul pilierilor.Rezultate: Bolnavii cu HVS preexistent au fost repartizai n grupa I, iar cei fara HVS n grupa a II-a. ntre cele dou loturi de bolnavi nu au existat diferene semnifi cative privind caracteristicile generale cu excepia grosimii pereilor VS, a masei miocardice, prezenei semnelor de HVS pe electrocardiogram.Cel mai important parametru ecocardiografi c a constat n lungimea segmentului expansionat care la grupul I a prezentat valoarea de 13,881,31 mm, iar la grupul II a nscris 17,061,21 mm, iar diferena a fost semnifi cativ statistic.

Parametrii ecocardiografi ci utilizai n studiu pentru evaluarea tipului de hipertrofi e au prezentat valori diferite, semnifi cativ statistic pentru cele 2 grupuri. Profi lul fl uxului mitral a fost predominant de tip relaxare ntrziat pentru grupul I (82%) i ntr-un procent mult mai redus i pentru grupul II (60%) la care s-a nregistrat o pondere mai mare a profi lului mitral tip restrictiv (35%). Efi ciena trombolizei nu a infl uenat lungimea segmentului expansionat.Concluzii: HVS preexistent IMA cu supradenivelare de segment ST i dimensiuni normale a cavitii VS s-a asociat cu limitarea fenomenului de expansiune a infarctului. Rezultatele studiului demonstreaz o corelaie indirect ntre grosimea peretelui i lungimea segmentului expansionat.

The expansion of myocardial infarction in patients with pre-existing left ventricular hypet-rophyCamelia Nicolae, Nicolae Pun, Gabriela Gheorghe, Irina Andrei, Sorin Vian, Conf. Adriana Ilieiu, Prof. Tiberiu NaneaAcad. N. Cajal Caritas Hospital, Bucharest, Romania

Objectives: Th e aim of the study was to assess the expansion aft er acute myocardial infarction in patients

with preexisting ventricular hypertrophy compared with patients without hypertrophyMethods: 88 patients with acute myocardial infarction, anterior V1-V4 location and preexisting ventricular hypertrophy and 84 patients with acute infarction, same location, but without hypertrophy were selected in the study. Th e inclusion criteria was: fi rst myocardial infarction with ST elevation, antero-septal location V1-V4, normal left ventricular cavity dimension and preexisting left ventricular hypertrophy . Patients were excluded if any of the following occured: previous myocardial infarction, class 3 or 4 NYHA heart failure, rhythm or impulse conduction disturbances, moderate or severe valvular heart disease, nonanterior infarct location. Th e following parameters were performed: left ventricular wall thickness, systolic wall-stress, mitral fl ow profi le, left ventricular outfl ow velocity. Also was compared the successfull of reperfusion. Th e length of infarct expansion was calculated with an original mathematical formula: L=2,68A, were L=length of infarct expansion, A=area of anterior ventricular cavity which is obtained in parasternal short axis section at papillary muscle level.Results: Patients were included in group I with hypertrophy and in group 2 without hypertrophy. Th ere was any diff erences between the groups compared, except for left ventricular wall thickness, myocardial mass and left ventricular hypertrophy on electrocardiogram. Th e most signifi cant echocardiographic parameter was infarct expansion length which in the fi rst group was 13,881,31 mm and in the second 17,061,21 mm and the diferences was signifi cant. Th e echocardiographic parameters used to analize left ventricular hypertrophy characteristics were diff erent within the groups. Th e mitral velocity profi le was mainly delayed relaxation type (82%) and 62% respectively with a more important distribution of restrictive pattern in the second group. Th e successful of reperfusion did not infl uence the length of infarct expansion.Conclusion: Preexisting left ventricular hypertrophy in acute myocardial infarction was associated with limitation of infarct expansion. Th e results of this study demostrate an indirect correlation between the thickness of ventricular wall and the length of infarct expansion.



3. Enoxaparin, heparin nefracionat sau ambele la pacienii cu infarct miocardic acut cu supradenivelare desegment ST? Date din Registrul RO-STEMIG.P. Tatu-Chioiu1, M. Dorobanu1, M. Cintez1,E. Craiu2, D.D.Ionescu3, C. Olariu4, C. Pop5,C. Arsenescu-Georgescu6, A. Diaconeasa1,R. Bugiardini71Bucureti2Constana3Craiova4Arad5Baia Mare6Iasi, Romania7Bologna, Italia, din partea investigatorilor Registrului Romn pentru infarct miocardic acut cu supradenive-lare de segment ST (RO-STEMI)

Introducere: 1. Studii recente au artat o mai bun evo-luie la pacienii cu infarct miocardic acut cu supra deni-velare de segment ST (STEMI), care au primit enoxa pa-rin (Enox) pentru 8 zile comparativ cu cei care au pri-mit heparin nefracionat (UH) timp de 48 ore. Aceas-t diferen a fost suspectat ca fi ind datorat efectului rebound indus de suspendarea UH dup 48 ore.

2. Efectele dublei anticoagulri (UH urmat de Enox) versus UH nu au fost nc evaluate.Obiectiv: Compararea mortalitii intraspitaliceti i a incidenei hemoragiilor cerebrale la pacienii nrolai n Registrul romn pentru STEMI (RO-STEMI) trata i fi e cu UH+Enox, fi e cu UH ca terapie asociat trombo-lizei.Metod: n perioada 1.01.2003-31.12.2007, un numr de 2477 pacieni consecutivi nrolai n RO-STEMI, n primele 6 ore de la debutul durerii toracice, au pri-mit terapie fi brinolitic (Streptokinaza, tPA, rPA, TNK+PA) asociat cu UH i Enox (UH 1000 UI/or, 48 ore urmat de Enox 1mg/Kgc pentru 8 zile, n=377), Enox (30-40mg iv bolus urmat de 1mg/kcg pentru 8 zile, n=470) sau UH (1000 U.I./or timp de 72-96 ore, n=1600). Toi pacienii au primit tratament aspirin i/sau clopidogrel n afara contraindicaiilor.Rezultate: Mortalitatea intraspitaliceasc a fost semni-fi cativ mai redus n subgrupul cu UH+Enox, compa-rativ cu subgrupul cu UH (3,4% vs. 9,0%, p=0,0001). O

tendi spre mortalitate mai redus a fost inregistrat i n subgrupul Enox (6,2%), comparativ cu subgrupul UH (p=0,054). Dup ajustarea n funcie de vrst i administrarea de aspirin i/sau clopidogrel, pacienii tratai cu UH+Enox au avut un risc de deces de 1,61 ori mai sczut comparativ cu pacienii tratai cu UH (95% CI, 0,21-0,72, p=0,003). Diferena ntre Enox i UH nu a fost semnifi cativ. Incidena hemoragiilor cerebrale non-fatale nu a fost diferit la pacienii care au primit terapie combinat cu UH+Enox (0,3%), sau Enox (0,4%) sau UH (0,8%).Concluzii: Datele din Registrul RO-STEMI sugereaz faptul c o combinaie ntre UH (48 ore) i Enox pn la 8 zile poate contribui pn la reducerea semnifi cativ a mortalitii intraspitaliceti la pacienii cu STEMI i terapie trombolitic comprativ cu pacienii tratai numai cu UH de 48 de ore.

Enoxaparin, unfractioned heparin or both in patients with ST-segment elevation myocardial infarction? Data from the RO-STEMI registryG.P. Tatu-Chioiu1, M. Dorobanu1, M. Cintez1,E. Craiu2, D.D.Ionescu3, C. Olariu4, C. Pop5,C. Arsenescu-Georgescu6, A. Diaconeasa11Bucharest2Constana3Craiova4Arad5Baia Mare6Iasi, Romania7Bologna, Italy, on behalf of the Romanian registry for ST-elevation myocardial infarction (RO-STEMI) inves-tigators.

Background: 1. Recent studies showed a better out-come in thrombolysed patients for ST-segment eleva-tion myocardial infarction (STEMI) who also received enoxaparin (Enox) for 8 days compared with pts receiving unfractionated heparin (UFH) for 48 hours. No study has investigated the eff ects of double anticoa -gulation (Enox and UFH) versus UFH as ancillary the-rapy for thrombolysis. Objective: To compare in-hospital mortality and incidence of non-fatal intracranial haemorrhage in



stresului oxidativ la pacientii cu sindroame coronariene acute (SCA) fara supradenivelare de seg ment ST si sindrom metabolic(SM) sau diabet zaharat (DZ) si la pacientii cu SCA fara SM (SCA non SM) si fara DZ (SCA non DZ). Material si metoda: 172 pacienti (p) cu SCA fara supra-denivelare de segment ST au fost inclusi intr-un studiu pros pectiv pe o perioada de urmarire de 3 ani, lotul fi ind impartit in 3 grupuri in relatie cu asocierea SM sau a DZ. Evaluarea bio-umorala s-a realizat initial, la 1 si 6 luni, evaluarea clinica, ecocardiografi ca s-a rea -li zat initial, la 1, 6, 12, 24 si 36 luni. Au fost eva lua ti ca markeri ai sindromului infl amator nivelul seric al proteinei C-reactive si nivelul plasmatic al fi bri no ge-nului iar ca markeri de stres oxidativ titrul de anti corpi Anti ox-LDL si nivelul seric al statusului anti oxidant total (TAS).

Rezultate:

SCA non MS non DZ

SCA MS SCA DZ

6 luniproteina C-reactiva >0,5mg/dl 6 (16.2%) 27 (35.5%)

p



Comparative evaluation of prognosis in patients with non st elevation acute coronary syndrome and metabolicsyndrome or diabetes mellitus E. Bobescu1,2, M. Radoi1,2, A. Burducea2, Bianca Dusa21Transilvania University - Faculty of Medicine2Clinic County Emergency Hospital- Clinic ofCardiology, Brasov, Romania

Aims: Evaluation of prognosis, left ventricular systolic function, infl ammatory syndrome and oxidative stress in patients with non ST elevation acute coronary syn-drome (ACS) associated with metabolic syndrome (MS) with diabetes mellitus(DM) in comparison with patients with ACS and with non MS non DM ACS patients.Methods: 172 patients (pts) with non ST elevation acute coronary syndrome were included in a prospective study for a period of 3 years and divided in three groups in relation with association of metabolic syndrome or diabetes mellitus. Biologic evaluation were performed initial and at 1, 6 months, clinical, electrocardiographic, echocardiographic evaluation were performed initial and at 1, 6, 12, 24 and 36 months. C-reactive protein serum level and fi brinogen plasma level were determi-nated as markers of infl ammatory syndrome. Anti ox-LDL antibody titers and total antioxidant status (TAS) serum level were measured for oxidative stress eva luation.

Results:

ACS non MS non DM

ACS MS ACS DM

6 monthsC-reactive protein>0,5mg/dl 6 (16.2%) 27 (35.5%)

p



Rezultate: S-a constatat c la majoritatea pacienilor ana lizai scorul TIMI s-a corelat cu nivelul seric al hs-CRP la internare i astfel prognosticul pe termen scurt al acestor pacieni poate fi infl uenat de nivelul seric al aces tei proteine de faz acut. Concluzii: Prognosticul pe termen scurt al pacienilor cu IMA cu supradenivelare de segment ST evaluat prin sco rul TIMI pare a fi infl uenat de nivelul seric al hs-CRP.

The prognosis of ST segment elevation acute myocardialinfarction patients in terms of the serum concentrations of hs-CRPTudorascu M Raul Petrior,Muetescu I Anca Emanuela,Tudoracu I Diana Rodica, Ionescu M Dan DominicUMF Craiova, Centrul de Cardiologie Craiova

It has been demonstrated that hs-CRP levels increase in patients with ST-segment elevation acute myocardial infarction, an increase witch has been proved to corre-late with long term mortality; however, very few studies have evaluated the short term prognosis for these pa-tients. We have undertaken to evaluate the short term prog nosis for ST-segment elevation MI patients based on the TIMI risk score and to establish its correlation with the serum level of hs-CRP.Th e study group consisted in 45 patients brought to the Cardiology Centre of Craiova and diagnosed with ST-segment elevation acute MI. For these patients all the necessary data for calculating the TIMI risk score were collected (age, angina history, diabetes mellitus, TA, heart rate, Killip class, weight, ST-segment elevation, left bundle branch block, time until treatment initiation). Th is score was calculated for each patient and the seru m hs-CRP level was measured.It was found that the TIMI score of most of the patients studied correlates with the hs-CRP serum level on ad-mi ssion and thus the short term prognosis of these pa-tients can be infl uenced by the serum level of this acu te phase protein.

Th e short term prognosis of ST segment elevation AMI patients assessed through the TIMI score appears to be infl uenced by hs-CRP serum levels.


INSUFICIEN CARDIAC | HEART FAILURE

dyne.sec.cm (-4), p

INSUFICIEN CARDIACHEART FAILURE


adverse). Difi cultatea tratamenului consta in inexis-tenta fl ecainidei pe piata farmaceutica din Romnia.

The efficacy of antiarrhythmic treatment with flecainide in atrial fibrillationR.Bolohan, Veronica Moldovan, Mihaela Mihai, Mi-haela B.Leustean,V.Greere, G.Hila, I.Moscaliuc,D Nita, G.CristianArmys Emergency Clinical Center of Cardiovascular Diseases, Bucharest

We prospectively studied between January 2004 and May 2008 the effi cacy of antiarrhythmic treatment with fl ecainide in atrial fi brillation.Material and method: we evaluated 60 patients (42 men (70%) and 18 women (30%) with mean age 54 years old (45-75 years). 54 patients (90%) (Group A) were diagnosed with recurrent paroxysmal atrial fi brillation and 6 patients (10%) (Group B) had persistent atrial fi brillation and were treated with electrical or chemical conversion to sinus rhythm.

Our aim was signifi cant fewer or no more episodes of atrial fi brillation (Group A) and maintaining sinus rhythm in Group B.Results: - 51 patients from Group A (95%) showed a signifi cant favorable evolution (33 patients (61%) didnt present other episodes of atrial fi brillation, 18 patients (34%) showed signifi cant fewer episodes of atrial fi brillation)

- 5 patients from Group B maintained sinus rhythm.Conclusions: Flecainide is a very effi cient antiarrhyth-mic drug in prophylaxis of recurrences of atrial fi bri-lla tion (comparable with amiodarone, but with fewer ad ver se reactions). Th e diffi culty of the treatment is absen ce of fl ecainide on the Romanian market.

8. Diferene morfologice i funcionale vasculare n IC uman de etiologii diverse Ilinca Savulescu- Fiedler, Roxana Nicoleta Siliste,Mihaela Gherghiceanu, Ion I. Bruckner Spitalul Clinic Colea, Bucureti

Premisa teoretic: afectarea vascular, manifestat ca disfuncie endoteliala, este difuza in insufi cienta car-diaca (IC). Nu se cunoate dac afectarea endotelial este diferit n IC cu afectare diferita a functiei sistolice. Studiul isi propune aprecierea afectarii endoteliale in IC de etiologii diferite, ca si in IC prin disfunctie sistolica sau diastolica. Material si metoda: 15 pacienti cu diagnostic clinic de IC, de etiologii diferite (lot de studiu) si 11 pacienti fara diagnistic de IC (lot martor). Toti pacientii au suferit o interventie chirurgicala in sfera abdominala, prilej cu care s-a recoltat un frag-ment vascular din radacina mezenterului. n funcie de valoarea fractiei de ejectie pacienii au fost mprii n dou categorii: IC cu FE normal (ICFEN- 9 pacien-ti), sau IC cu FE sczut (ICFES- 6 pacienti). Tuturor pacientilor li s-au evaluat, funcia endotelial (ecogra-fi c) si aparenta morofologica endoteliala. Frag mentul vas cular recoltat a fost analizat morfologic prin micro-scopie optica i microscopie electronica.Re zul tate i discutii: Etiologia IC a fost divers: diabet zaha rat (DZ) 6 cazuri; boal coronarian 5 cazuri; val vu lopatii 3 cazuri; hipertensiune arterial izolata 1 caz. Valoarea medie a vasodilatatiei fl ux-mediate in artera brahiala (DFM) a fost net scazuta la pacientii cu IC (4,93%), comparativ cu cei din lotul control (6,65%). Cele mai mici valori ale DFM s-au inregistrat la pacientii cu DZ (3,56%). Valoarea DFM a fost net inferioara la cei cu ICFES (1,625%) comparativ cu pacientii cu ICFEN (6,55%). Examinarea in microscopie optica a structu rilor vasculare releva modifi cari morfologice doar la pacientii cu IC. Modifi carile de structura endo-teliala au fost diferite si au vizat celula endoteliala insasi (vacuole, elongare etc.), celulele musculare netede vas culare (modifi cari fenotipale, vacuolizari etc.), ma-tricea extracelulara, membrana bazala. Modifi carile electro no micro sco pice s-au semnalat doar la pacientii cu IC. La acestia, scorul mediu de a ctivare endoteliala (Masuda) a fost 2, iar valoarea medie a DFM a fost 1,53%, mult sub media lotului (4,93%). La pacientii cu IC fara activare endoteliala valoarea medie a DFM a fost 6,69% (superioar valorii medii a lotului). 44,44%



dintre pacieni cu diagnostic de ICFEN si 83,3% din cei cu ICEFS aveau activare endoteliala. Examinarea ultra-struc tu rala evidentiaza variate modifi cari endo teliale (nuclei eucro matici, vacuole endoteliale, contacte intre celulele endo teliale si celulele musculare netede, modi-fi cari matri ceale etc).Concluzii: Studiul desfurat arat c: DFM a fost mai mic la pacienii cu IC dect la lotul control; valoarea DFM a fost diferit n IC de etiologii diferite; valoarea DFM a variat n funcie de gradul de afectare a funciei sistolice. Prezena activrii endoteliale coreleaz cu valoarea DFM la nivelul arterei brahiale. Examinarea ultrastructurala relev anumite modifi cri endoteliale, cu relevanta necunoscuta, doar la pacienii afl ai n IC.

9. Practica medical nngrijirea pacienilor cu insuficien cardiac ntr-un centru teriar de urgen comparaie cu registruleuropean Euro Heart Survey Maria-Corina Bornoiu, Miruna Chiru, Ana Gabriela Fruntelat, Maria Dorobanu Spitalul Clinic de Urgen, Bucureti

Premize i obiective: Studiile privind insufi ciena car-diac sugereaz faptul c tratamentul standard, bazat pe dovezi nu este folosit n msura n care ar trebui. De aceea, am investigat felul n care sunt tratai i eva-luai pacienii cu insufi cien cardiac ntr-o clinic de cardiologie de urgen; totodat centru teriar, din Bucu-reti. Am plecat de la analiza unui grup de pacieni cu insufi cien cardiac internai n clinica noastra dup fi a de raportare a cazului folosit n EuroHeart Failure Survey II (EHS-HF II), n acelai mod n care au fost analizai pacienii din registrul european, pentru a vedea realitatea ngrijirii insufi cienei cardiace la noi com parativ cu media din Europa. Obiectivele au fost evaluarea caracteristicilor pacienilor, a etiologiei, trata-mentului i evoluiei insufi cienei cardiace la pacienii internai n Clinica de Cardiologie a Spitalului de Urgen- Bucureti n relaie cu rezultatele studiului EHS-HF II.

Metode: Un grup de 55 pacieni internai n Clinica de Cardiologie a Spitalului Clinic de Urgen Bucureti pentru insufi cien cardiac acut sau insufi cien car-diac cronic decompensat au fost nregistrai ntr-o baz de date construit pe baza fi ei de raportare a cazului din EHS-HF II. Au fost inclui pacieni con-secutivi care s-au internat prin camera de gard n secia de Cardiologie. Pacienii au fost clasifi cai n: insu-fi cien cardiac acut (ICA) i insufi cien cardiac cronic decompensat (ICCD). Rezultate: Dintre pa-cien tii studiai, 67.3% au avut ICCD i numai 32.7% ICA. Cele mai frecvente condiii subiacente la pacienii studiai au fost boala ischemic (80%), cu 36.4% seche-lari de infarct miocardic, hipertensiunea arterial (65.5%) i, pentru cei cu insufi cien cardiac acut, boala valvular (63.6%). Aderena la ghidurile actuale se men ine i n studiul nostru cu inhibitorii enzimei de con ver sie a angiotensin ei i spironolacton prescrise la peste 70% dintre pacieni la externare. Beta-blocantele ns sunt subutilizate n Romnia fi ind prescrise doar la 54.5% dintre pacieni. Digitala este extrem de utilizat n Romnia, cu aproape 70% dintre pacieni primind digoxin la externarea din spital.Concluzii: O treime dintre pacienii studiai au avut insufi cien cardiac acut (de novo), similar cu raportul European. O treime dintre pacieni au avut sindrom coro narian acut. Fracia de ejecie a ventriculului stng evaluat ecocardiografi c nu a fost diferit ntre clasele clinice de insufi cien cardiac, i a fost conservat la peste jumtate dintre pacieni, aspect raportat i de stu diul EHS-HF II i de alte studii similare. Jumtate dintre pacienii admii cu insufi cien cardiac decom-pensat se afl au sub tratam ent cu diuretice, beta-blo-cante i/sau inhibitori de enzim de conversie i o trei-me erau digitalizai. La externare, prescripia de inhi -bitori, diuretice i digoxin a crescut semnifi cativ, dar beta-blocantele au rmas sub-utilizate.



10. Anxietatea, depresia i calitatea vieii la pacienii cu insuficien cardiac ihipertensiune arterialRodica Avram, Simona Tman, Claudiu Popa,Dorina Jejeran, Tudor Ciocrlie, Florina Prv,Mihai Balint, Victor MogaClinica de Cardiologie, Spital Clinic Judeean de Urgen Timioara

Scopul lucrrii: Este de presupus ca la pacienii cardiaci s existe un grad de afectare psihic, n legtur cu simptomatologia clinic i limitarea funcional, posibil ns i cu o calitate a vieii alterat. Ne-am propus identifi carea anxietii, depresiei i evaluarea calitii vieii la pacienii (p) cu i fr insufi cien cardiac i corelarea cu parametrii clinici.Material i Metod: Am studiat un numr de 63 pacieni nediagnosticai cu boal psihiatric, internai de urgen i subclasifi cai n 2 loturi: insufi cien cardiac (IC) cu alterarea funciei sistolice (FE25) la 10p. (15,87%) i respectiv 42,86% prin HADS; depresia s-a confi rmat la 31,74% i respectiv la 28,7% din p. Gradul de severitate al HTA se coreleaz cu patologia psihiatric (p



Conclusions: Anxiety and depression are present in more than 1/3p., with a strong correlation with the hyper tensions severity. Subjective data regarding the quality of life and social support are in relation with clinical severity and the alteration of EF in heart failure p. Th e prevalence of psychiatric pathology, correlation with the quality of life, justifi es the research and action on psycho social factors.


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changes. Two months earlier the patient was inserted a VVI pacemaker (through the right subclavian vein) for low rhythm atrial fi brillation, with ought incidents. Present cardiac examination reveals: BP = 110/73 mm Hg, right heart failure decompensation signs, atrial fi bri llation with SVF 60 beats/min on EKG. Trans-thoracic and transesophagial echocardiographic exami-nation pinpoint a right intracavitary mass, 32/38 mm, extremely mobile, fl oating between right ventricle and atrium, through the tricuspid valve, attached to the distal extremity of the electrostimulation catheter (placed on the lateral wall of the right ventricle). Th e clinical hypothesis of pulmonary thromboembolism (originating in the catheter thrombosis) was confi rmed through pulmonary perfusion scintigraphy (lacunar images in both pulmonary area s, mainly in the left inferior lobe). Due to advanced patients age, therapeutic approach consisted in continuous heparin infusion, 800 IU/h, 14 days, followed by oral anticoagulation, resulting in complete thrombus dissolution. We note as favoring prothrombotic factors the presence of cardio-megaly, atrial fi brillation and congestive heart failure in this case.

12. Corelaii ntre variabilitatea tensiunii arteriale i prezena sindromului metabolicC. Matei, Ioana Pop, Mihaela Rugin,Carmen Ginghin, E. Apetrei Clinica de Cardiologie, Institutul de Boli Cardiovascu-lare, Prof. Dr. C.C. Iliescu Bucureti

Obiective: Scopul principal al acestui studiu a fost evaluarea variabilitii tensiunii arteriale (TA) obinut prin nregistrarea ambulatorie continu la pacienii hipertensivi cu sau fr sindrom metabolic (SMet). Drept scop secundar am urmrit corelaiile ntre variabilitatea TA i indicele de rigiditate arterial AASI (ambulatory arterial stiff ness index).Metod: Un grup de 195 pacieni (pt.) hipertensivi (47% brbai, cu vrsta >21 ani, vrsta medie 57,9 ani)

11. Tromboza a cateterului de stimulare caz clinic M.D.Datcu, Viviana Aursulesei, Irina Costache,D. Iliescu, Georgeta Datcu Universitatea de Medicina si Farmacie Gr.T. Popa Iasi, Clinica I Medicala Cradiologica C.I.Negoita Iasi

Bolnavul S.Gh. 84 ani, se adreseaz pentru dureri tora-cice i dispnee, ambele la eforturi minime, nsoite de vertij n special la schimbrile brute ale poziiei. Este la dou luni de la implantarea unui pacemaker VVI pen tru fi brilaie atrial cu ritm lent (fr incidente).Bilan ul clinic i investigarea cordului arat: TA 110/73 mmHg, semne clinice de insufi cien cardiac dreap-t, RVS 60/min cu atriile n fi brilaie.Examenul eco-car diografi c (transtoracic i transesofagian) pune n eviden o imagine de mas intracavitar dreapt de 32/38 mm, extrem de mobil, fl otant ntre VD i AD prin valva tricuspid, ataat de extremitatea distal a cate terului de stimulare (plasat pe peretele lateral al VD). Suspiciunea clinic de tromboembolism pul mo-nar (sursa tromboza pe cateter) a fost confi r ma t de scintigram a pulmonar (imagini lacunare n am be le arii pulmonare, predominent n lobul infe rior stng) Dat fi ind vrsta bolnavului, se opiniaz pen tru hepa-rino terapie 800 UI/or, 14 zile, care a dus la dis pa riia ima ginii descrise.(continuat cu trata ment anti coagu-lant oral) Subliniem prezena facto rilor favo ri zani: car dio megalie, atriile n fi brilaie, insufi cien t car diac con ges tiv.

Electrostimulation catheter thrombosis case presentation M.D. Datcu, Viviana Aursulesei, Irina Costache,D. Iliescu, Georgeta Datcu Universitatea de Medicina si Farmecie Gr. T. Popa Iasi, Clinica I Medicala Cardiologica C. I. Negoita Iasi

Patient S. Gh., 84 years old, was admitted in the hospital for thoracic pain and exertion dyspneea, on minimal physic activities, with vertigo due to sudden positional


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evaluai prin monitorizare ambulatorie a tensiunii arteriale (MATA) timp de 24 ore au fost investigai clinic i biologic n privina existenei sindromului metabolic dup criteriile Federaiei Internaionale de Diabet (IDF). Pentru MATA am folosit un sistem BR-102 (Schiller AG, Elveia). Variabilitatea TA a fost calculat pentru fi ecare pacient, fi ind defi nit ca valoarea deviaiei standard fa de medie a valorilor TA nregistrate; a fost aleas o valoare cut-off de 17mmHg pentru a defi ni limita normalului (limita superioar a intervalului de confi den 95% a valorii medii a variabilitii TA msurate n ntreg lotul). n mod asemntor au fost defi nite valorile normale ale variabilitii diurne i nocturne de 17mmHg, respectiv 13,5mmHg. Analiza statistic a fost efectuat cu programul EpiInfo 2000 (CDC, Atlanta), versiunea 3.3.2.Rezultate: n lotul de studiu nu au existat diferene semnifi cative ntre cele 2 sexe n privina variabilitii TA. Pacienii au fost mprii n 2 grupuri n funcie de absena (grupul A, n= 131) sau prezena (grupul B, n= 64) sindromului metabolic. Nu au existat diferene semnifi cative statistic ntre cele dou grupuri n ceea ce privete vrsta, sexul, antecedentele cardiovasculare. Valoarea variabilitii TA nu a avut diferene semni-fi cative legate de prezena sindromului metabolic (16,2 5 n grupul A fa de 16,4 4,7 n grupul B); varia bi-litatea TA a fost comparabil indiferent de grupul de vrst n care s-a fcut analiza. De asemenea, nu au existat diferene semnifi cative ntre cele dou grupuri ntre variabilitatea diurn i respectiv cea nocturn. Am obinut o corelaie nalt semnifi cativ ntre indicele de rigiditate arterial (AASI) obinut la monitorizarea ambulatorie continu i variabilitatea TA (r= 0,98, p21years, medium age 57.9 years) underwent a 24-hour ambulatory blood pressure monitoring (ABPM) in our Cardiology Department were evaluated regarding medical history, renal function and presence of metabolic syndrome (International Diabetes Foundation criteria). Th e device used for ABPM was BR-102 (Schiller AG, Switzerland). Blood pressure variability was calculated for each patient and represents the standard deviation of the mean of BP values over the 24-hour recording; we choose as cut-off value for normal BP variability 17mmHg (upper limit of the 95% CI interval of BP variability of all pts. in our group). Th e same was done for diurnal and nocturnal BP variability; normal values were 17mmHg and 13,5mmHg, respectively. Statistical analysis was done with EpiInfo 2000 statistical soft ware package, version 3.3.2.Results: In our study group there was no signifi cant diff erence of BP variability between men and women. Th e patients were divided in two groups according to absence (group A, 131 pts.) or presence (group B, 64 pts.) of MetSyn. Th ere were no statistically signifi cant diff erences between this groups regarding age, sex, history of important cardiovascular diseases. Blood pressure variability has had no signifi cant diff erences between the two groups (16.2 5 in group A and 16.4 4.7 in group B); BP variability was comparable no matter the age group the analysis was done. In the mean time, there werent signifi cant diff erences between groups regarding nocturnal and diurnal BP variability. A highly signifi cant correlation index between AASI and BP variability was observed (r= 0.98, p< 0.001), also

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independent of the presence of metabolic syndrome.Conclusions: Th e presence of the metabolic syndrome associated to hypertension does not infl uence blood pressure variability. Instead, BP variability it is very well correlated to changes of arterial stiff ness refl ected by the ambulatory arterial stiff ness index, independent of metabolic syndrome presence.

13. Estimarea functiei sistolice si diastolice prin doppler tisu-lar la voluntari sanatosiOana Mihailescu, Cati Istrate, Ovidiu Chioncel,Cezar MacarieInstitutul de Boli Cardiovasculare Prof.Dr.C.C.Iliescu

Scop: Evaluarea velocitatilor miocardice sistolice si diastolice si a paternului specifi c al velocitatilor maxime sistolice (Vmx) si diastolice(E) prin Doppler tisular, la voluntarii sanatosi, pentru obtinerea unor scale ale normalului. In paralel evaluarea functiei diastolice prin metoda conventionala la nivelul fl uxului mitral.Metoda: S-au studiat 64 de voluntari sanatosi (fara afectare cardiovasculara, fara diabet zaharat, obezitate). S-au masurat: velocitatea maxima a umplerii diastolice precoce (E) si velocitatea maxima a umplerii diastolice tardive prin contractie atriala, cu Doppler pulsat pozitionat la varful cuspelor mitrale in sectiunea apical 4 camere (metoda conventionala) si velocitatile sistolice si diastolice prin Doppler tisular (V mx septal, Vmx lateral, Eseptal si E lateral, raport E/Es si E/E l) in sectiunea apical 4 si 2 camere, cu esantionul Doppler pulsat plasat in segmentul bazal, la 1 cm de inelul mitral.

Raportul E/Ea este folosit pentru estimarea presiunii de umplere a ventriculului stang, chiar si in conditii difi cile de evaluare (tahicardie sinusala), fi ind relativ independent de presarcina sau fractia de ejectie a ventriculului stang.Rezultate: din lotul studiat de 64 de voluntari, 43 sunt barbati si 21 sunt femei varsta medie este 35,89 8,1, media valorilor undei E este de 71,35 13,8 cm/s, media valorilor undei A de 68,4 11,5 cm/s, media valorilor undei Es de 7,5 1,3 cm/s, iar media undei El de 8,1 1,3 cm/s, media Vmx septal 6,8 1,3 cm/s, Vmx lat 7,6 1,7 cm/s, iar rapoartele E/Es cu media 8,62,8 si E/El de 7,9 2,5.

S-au constatat: coefi cient de corelatie Es cu El de 0,791 semnifi cativ statistic (p=0,001), coefi cient de corelatie VMS cu VML de 0,883 semnifi cativ statistic (p=0,001), coefi cient de corelatie El cu VML de 0,850 si El cu VMS de 0,789 semnifi cative statistic, (p=0,001), coefi cient de corelatie Es cu VMS de 0,635 si Es cu VML de 0,704, semnifi cative statistic (p=0,001) coefi cient de corelatie E/Es cu E/El de 0,857 semnifi cativ statistic (p=0,001).

Un procent de 13,9% din voluntari au raportul E/El mai mare decat valorile din literatura (care sunt considerate normale), iar 58,13% din voluntari au raportul E/Es mai mare decat valorile considerate normale. 18,6% din voluntari au raportul E/Es mai mare decat media + deviatia standard si 13,9% au raportul E/El mai mare decat media +deviatia standard. Concluzii: Media velocitatii maxime laterale este mai mare decat velocitatea maxime septale si media undei Elat este mai mare decat media Eseptal. Velocitatile diastolice ( El, Es) se coreleaza cu velocitatile sistolice (Vmx lat, Vmx septal), iar velocitatile maxime sistolice la nivelul peretelui lateral scad cu varsta, mai pregnant decat velocitatile maxime de la nivelul septului.

9,3% din voluntari au ambele rapoarte (E/El si E/Es) peste limita normala, aratand disfunctie diastolica, in timp ce valorile undelor E si A sunt in limite normale.

Din lotul studiat se poate afi rma importanta estimarii velocitatilor sistolice si diastolice prin Doppler tisular, fi ind net mai sensibile in detectarea disfunctiei diastolice fata de metoda clasica (undele E, A, raport E/A), precum si importanta estimarii velocitatilor atat la nivelul peretelui lateral cat si septal.

Assesment of diastolic and sys-tolic ventricular function by tissue doppler on healthy vol-untariesOana Mihailescu, Cati Istrate, Ovidiu Chioncel,Cezar MacarieInstitutul de Boli Cardiovasculare Prof.Dr.C.C.Iliescu

Aims: Th e aim of the study was to evaluate diastolic and systolic velocities, particular patterns of maximal systolic velocities (Vmx) and diastolic velocities (E) by Doppler tissue imaging (DTI) on healthy voluntaries


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for assessment of normal scales, comparative with con-ventional methods for assessment diastolic function.Methods: 64 healthy voluntaries (without any cardiovascular disease, diabetes mellitus, and obesity) were referred for an echocardiogram. It was measured early diastolic fi lling with maximal velocity (E), late diastolic fi lling by atrial contraction (A) on transmitral fl ow with Doppler pulsate, maximal systolic velocities (Vmx) and diastolic velocities (E) by tissue Doppler, on lateral wall and interventricular sept, in 4 chambers and 2 chambers view. E/E ratio was measured for assessment of left ventricular fi lling in diffi cult conditions such sinusal tachycardia, because of its relative independence with preload or ejection fraction.Results: In this lot, 64 healthy voluntaries, 43 men and 21 women, mean age was 35,89 8,1, the average for E velocity was 71,35 13,8 cm/s, the average for A velocity was 68,4 11,5 cm/s, average for Es 7,5 1,3 cm/s and for El 8,1 1,3 cm/s, the average for Vmx septal was 6,8 1,3 cm/s and mean for Vmx lat was 7,6 1,7 cm/s.

Th e E/Es ratio had the average 8,62,8 and E/El ratio had the average 7,9 2,5.

Th e correlation coeffi cient between Es and El was 0.791 statistical signifi cant (p=0,001), the correlation coeffi cient between systolic velocity Vmx septal and V mx lateral was 0.883 statistical signifi cant (p=0,001).

Th e correlation coeffi cient between El and Vmx lateral was 0.850 and El with Vmx septal 0.789, both stati stical signifi cant (p=0,001), the correlation coeffi -cient between Es with Vmx septal was 0.635 and Es with Vmx lateral 0.704 statistical signifi cant (p=0,001). Th e correlation coeffi cient between E/Es and E/El ratio was 0.857 statistical signifi cant (p=0,001).

13.9% form voluntaries had E/El ratio signifi cantly higher comparative with normal range from literature and 58.13% from voluntaries had E/Es ratio higher comparative with normal range from literature. 18.6% from voluntaries had E/Es ratio signifi cantly higher comparative with mean + standard deviation and 13.9% had E/El ratio signifi cantly higher comparative with mean + standard deviation.Conclusion: Th e average of the maximal systolic lateral velocities was higher comparative with the average of maximal systolic septal velocities and the average of Elateral was higher comparative with the average of Eseptal. Diastolic velocities ( El, Es) was signifi cantly correlated with systolic velocities (Vex lat, Vex septal) and maximal systolic lateral velocities decreased with age, signifi cantly higher comparative with maximal

systolic septal velocities. 9.3% from voluntaries had both E/El and E/Es ratio above normal range, revealed diastolic dysfunction, when the velocities E and A was normal. So, is important to asses the systolic and diastolic velocities by tissue Doppler, because of higher sensibility for diastolic dysfunction comparative with conventional methods for assessment diastolic function, as well the assessment of both lateral and septal velocities.

14. Potenialele atriale tardive i riscul de fibrilaie atrial la hipertensivii cu disfuncie diastolic Musetescu Rodica, Toader Despina, Popescu Monica, E. Belu, D.-D. Ionescu Centrul de Cardiologie Craiova

Disfuncia diastolic din hipertensiunea arterial este caracterizat printr-o presiune de umplere crescut. PHiRes este o metod care analizeaz potenialele atriale tardive de la fi nalul undei P, reprezentnd depolarizarea tardiv a miocardului atrial, locul n care i au originea aritmiile prin reintrare.Scop: folosirea potenialelor atriale tardive (PAT) ca marker al afectrii structurale a miocardului atrial la pacienii hipertensivi cu disfuncie diastolic i contrac-tilitate sistolic prezervat a ventriculului stng.Metode: 44 de pacieni hipertensivi cu vrste cuprinse ntre 48 i 80 de ani au fost evaluai prin: examinare clinic clasa funcional NYHA I-III; electrocardiograma cu 12 derivaii: criteriile Cornell pentru hipertrofi a ventricular stng (HVS) i suprasolicitarea atrial (SA), ecocardiografi a transtoracic: criterii pentru HVS septul interventricular >13 mm, peretele posterior al VS >12 mm ( msurate n modul M), indexul volumului atriului stng >20 ml/m2; criterii pentru disfuncia dias tolic folosind fl uxul Doppler transmitral, fl uxul venos pulmonar, tissue Doppler la nivelul lateral al inelului mitral n sectiunea 4 camere apical, velocitatea propagrii fl uxului (VPF) n modul M precum i cri-terii pentru potenialele atrial e tardive folosind electro-cardiograma de nalt rezoluie: durata undei P cu semnal mediat (SAPWD) >140 ms, rdcina ptrat medie (RMS 40) >3,5 V, integrala undei P >800 V,

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cu fi ltrele setate ntre 250-400 Mhz, nivelul zgomotului


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The effect of acute exercise upon adiponectin and leptin in overweight subjects D. Pop, D. Zdrenghea, G. Bodisz, D. Petrovai Universitatea de Medicina si Farmacie \Iuliu Hatie-ganu\, Spitalul Clinic de Recuperare- Cardiologie, Cluj-Napoca

Background: Adiponectin is decreased and leptin increased in overweight subjects. In turn, exercise has controversial eff ect upon adiponectin and leptin plasmatic levels.Purpose: To study the eff ect of acute exercise upon plasmatic levels of adiponectin and leptin in normal and overweight subjects.Method: We studied 79 subjects, 42 males and 37 females, aged 569 years, divided in two groups. Group I consisted of 19 patients with body mass index


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ventriculului stng n subgrupurile cu HRV sczut i, respectiv normal. HRV s-a modifi cat ntre cele dou nregistrri doar la 4 pacieni (la 3 de la sczut la normal), ambele nregistrri AECG fi ind efectuate n condiii de stabilitate clinic. Evaluarea HRV prin dou nregistrri AECG n comparaie cu doar o singur moni torizare AECG s-a corelat ceva mai bine cu sc-derea clasei NYHA (r= 0,28 vs. r= 0,18) i creterea frac-iei de ejecie (r= 0,25 vs. r= 0,19).Concluzii: Dei a fost efectuat pe un lot mic de pacieni, studiul de fa a artat faptul c mai multe nregistrri AECG la pacienii cu CMD, n special la cei fr aritmii simptomatice, cresc ansele pentru un tratament mai agresiv al aritmiilor. Variabilitatea ritmului sinusal nu s-a modifi cat semnifi cativ pe perioada de urmrire, dar valoarea prognostic a acesteia rmne crescut.

Use of multiple ambulatory ECG recordings in dilatedcardiomiopathy. Is it useful?C. Matei, Ioana Pop, Mihaela Rugin,Carmen Ginghin, E. Apetrei Clinica de Cardiologie, Institutul de Boli Cardiovascu-lare, Prof. Dr. C.C. Iliescu Bucureti

Purpose: Th e aim of the study was the evaluation of informations provided by serial 24-hours ambulatory ECG monitoring (AECG) in patients with dilated car-diomyopathy (DCM).Method: A subgroup of 30 patients (mean age 59.9 10.6 years, 83.3% men), diagnosed with DCM in our Department, with more than one 24-hours AECG recor-ding, were selected for the present study. Th e device used for 24 hours ECG monitoring was MT-100 and the soft ware used for ECG analysis was MT-200 (Schiller AG, Switzerland). For each patient, only fi rst and last recording during follow-up were analyzed. Th e mean time interval between recordings was 1411 months. Th e follow-up period (clinical events, pacemakers and/or ICD implantations, etc) was 1812 months. Heart rate variability (HRV) was assessed for both recordings

16. Este util monitorizarea ambulatorie ECG n dinamic la pacienii cu cardiomiopatie dilatativ?C. Matei, Ioana Pop, Mihaela Rugin,Carmen Ginghin, E. Apetrei Clinica de Cardiologie, Institutul de Boli Cardiovascu-lare, Prof. Dr. C.C. Iliescu Bucureti

Obiectiv: Scopul acestui studiu a fost evaluarea infor-ma iilor obinute prin monitorizare ambulatorie Holter ECG 24 ore (AECG) repetat la pacienii cu cardio mio-patie dilatativ (CMD).Metod: Pentru studiul de fa, a fost selectat un sub-grup de 30 pacieni (vrst medie 59,910,6 ani, 83,3% brbai), diagnosticai cu CMD n clinica noastr, la care s-a efectuat mai mult de o nregistrare ambulatorie ECG (AECG) pe 24 ore. Aparatul utilizat pentru moni-torizarea Holter ECG 24 ore a fost MT-100 i soft ul utilizat pentru analiz a fost MT-200 (Schiller AG, Elveia). Pentru fi ecare pacient au fost analizate doar pri ma i ultima nregistrare din perioada de urmrire. Intervalul mediu ntre nregistrri a fost de 1411 luni. Perioada de urmrire (evenimente clinice, implantul de stimulator cardiac i/sau defi brilator intracardiac etc.) a fost de 1812 luni. La 15 pacieni a fost evaluat varia-bilitatea ritmului cardiac (HRV) n ambele nre gis trri i a fost clasifi cat ca normal sau sczut utiliznd 2 parametrii: HRV index i pNN50. Analiza statistic a fost realizat cu EpiInfo 2000, versiunea 3.3.2.Rezultate: Prima monitorizare Holter ECG a artat arit mii ventriculare semnifi cative i a determinat nce-perea profi laxiei cu amiodaron la 5 dintre pacieni, 3 dintre acetia avnd indicaie IIb pentru AECG. La 15 din cei 30 pacieni indicaia pentru ambele AECG a fost evaluarea aritmiilor n insufi ciena cardiac (indi-caie de clas IIb). Implantarea de stimulator cardiac a fost efectuat dup prima monitorizare la 4 pacien-i i dup a doua monitorizare la 2 pacieni. n lotul studiat a fost necesar implantarea unui singur defi bri-lator intracardiac. Pe perioada de urmrire nu s-a nre gistrat nici un deces n lotul studiat. Nu a existat nici o diferen n ceea ce privete fracia de ejecie a


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in 15 patients and was classifi ed as normal or low HRV using 2 parameters: HRV index and pNN50. Statistical analysis was done using EpiInfo 2000 statistical package, version 3.3.2.Results: Th e fi rst AECG monitoring shows signifi cant ventricular arrhythmia and determined starting of amio darone prophylaxis in 5 patients, 3 of them with class IIb indication for AECG. In 15 of 30 patients the indication for both AECG was the evaluation of arrhythmia in heart failure (class IIb). Pace-maker implantation was considered aft er the fi rst AECG in 4 pa tients and aft er the second AECG in other 2 patients. Only one ICD implantation was necessary in our group of patients. None of the patients died during follow up. Th ere was no diff erence in the left ventricular ejection fraction between low and normal HRV subgroups. HRV did change between evaluations in 4 patients (3 from low to normal), both AECG exams in clinically stable condition. Evaluation of HRV by two AECG com pared to only one has a slightly better correlation to NYHA class decrease of (r= 0.28 vs. r= 0.18) and ejection fraction increase (r= 0.25 vs. r= 0.19).Conclusions: Despite the small series of patients in the present study, we showed that multiple AECG recor-dings in patients with DCM, especially without sympto-matic arrhythmias, increase the chance for a more aggre ssive attitude in treating arrhythmias. Heart rate variability does not change signifi cantly during follow-up, but its prognostic value is high.

17. Monitorizarea ambulatorie a tensiunii arteriale la pacientii diabetici hipertensiviE. Badila, D. Bartos, C. Tirziu, S. Ghiorghe,M. DorobantuSpitalul Clinic de Urgenta Bucuresti

Obiectiv: Aprecierea utilitatii monitorizarii ambulatorii automate a tensiunii arteriale (MAATA) in controlul valorilor tensionale la pacientii diabetici hipertensivi apparent bine controlati prin masurarea TA la cabinet. Metoda: In studiu au fost inclusi 62 pacienti hipertensivi diabetici. Fiecare subiect era tratat si aparent bine controlat (TA 125/80 mmHg. Rezultate: Din totalul pacientilor diabetici hipertensivi inclusi in studiul nostru, 67.7% au avut media valorilor presionale la MAATA peste limita (>125/80 mmHg). Media valorilor TA sistolice pe intreg lotul a fost de 141+/-10 mmHg iar media TA diastolice a fost 88+/-7 mmHg. Prevalenta pattern-ului non-dipping printre pacientii nostrii a fost de 64.5%. Din totalul subiectilor inclusi, 30.6% au prezentat un pattern cu risc inalt de tip riser (media TA nocturna mai mare decat media TA diurna). Concluzii: Pacientii diabetici cu hipertensiune arte ria-la trebuie evaluati prin monitorizare ambulatorie auto-mata a TA cu scopul stabilirii controlului optim al valo-rilor presionale. Doua treimi din pacientii inclusi in stu diul nostru au avut valorile TA peste limita, desi TA la cabinet era bine controlata. O treime dintre pacienti au asociat un pattern de tip riser, asociat cu un risc car-diovascular foarte inalt.

Ambulatory blood pressure monitoring in diabetichypertensive patientsE. Badila, D. Bartos, C. Tirziu, S. Ghiorghe,M. DorobantuEmergency Hospital Bucharest, Bucharest, Romania

Purpose: To assess the usefulness of ambulatory blood pressure monitoring (ABPM) in the control of blood pressure (BP) values in diabetic hypertensive patients with apparently well controled offi ce blood pressure. Methods: 62 hypertensive and diabetic patients were included in our study. Each subject was treated and the blood pressure was apparently well controlled (offi ce BP

POSTER I Revista Romn de Cardiologie, Vol. XXIIISuplimentul A, 2008

ded in our study, 67.7% had 24 h mean BP values over limits (>125/80 mmHg). Th e 24 h mean systolic BP in all groups was 141+/-10 mmHg and the diastolic BP was 88+/-7 mmHg. Th e prevalence of non-dipping pattern among our patients was 64.5%. 30.6% of the patients presented a high risk riser pattern (night time BP above daytime mean). Conclusions: Diabetic hypertensive patients should be evaluated by ambulatory blood pressure monitoring in order to estabilish the optimal control of BP values. Two third of our patients had BP over limits despite well controled offi ce BP. One third presented a riser pattern associated to a very high cardiovascular risk.

18. Este utila dozarea pro-BNP plasmatic pentru stratificarea riscului cardiovascular lapacientii hipertensivi?C. Tirziu1, E.Badila1, D. Bartos1, S. Ghiorghe1,R. Tirziu21Spitalul Clinic de Urgenta, Bucuresti2CMDTAAcad. St. Milcu, Bucuresti

Scopul studiului a fost de a testa utilitatea clinica a do-za rii plasmatice a proBNP-lui in vederea stratifi carii ris cului cardiovascular la pacientii cu hipertensiune arte riala.Metoda: Am evaluat un lot de 45 de pacienti cu hiper -tensiune arteriala esentiala fara insufi cienta car dia ca sau alte afectiuni concomitente dovedite a se core la cu cresterea valorilor plasmatice ale pro-BNP. Fie care pacient a fost evaluat astfel: a). clinic prin inre gis-trarea circumferintei taliei si indicelui de masa cor po-rala (IMC); b). biologic prin determinarea valo rilor plas matice ale glicemiei, colesterolului total, tri gli ce ri -delor, creatiniei (si clearenceul la creatinina), pro-BNP (ELECSYS 2010, Roche); si c). imagistic prin inre gis-trarea ECG, ecocardiografi e, determinarea eco grafi ca a indicelui intima-medie carotidian (IIM) si moni to-rizarea 24 ore a TA (ABPM Meditech).Rezultate: Valoarea proBNP-lui plasmatic s-a corelat liniar pozitiv (r= 0,523) cu valoarea colesterolului total si s-a corelat dupa o relatie patratica (r=0,517) cu nivelul trigliceridelor serice. Nu am identifi cat corelatie intre pro-BNP si circumferinta taliei sau IMC. De asemenea

nu s-a inregistrat legatura semnifi cativa statistic intre pro-BNP si prezenta ecocardiografi ca a HVS (coefi cient Pearson 0,23) sau a disfunctiei diastolice (coeffi cient Pearson 0,21), si nici cu valorile creatininei plasmatice sau a IIM. Am identifi cat o corelatie moderata pozitiva liniara intre pro-BNP si TAS medie (r=0,607) si TAD medie (r=0,596) dar fara concordanta intre valorile pro-BNP si variatia diurnal a TA.Concluzie: La pacientii cu HTA valoarea plasmatica a pro-BNP se coreleaza cu valorile colesterolului total si trigliceridelor dar nu am identifi cat corelatii semni-fi cative intre valorile acestuia si atingerea de organe tinta. Consideram ca dozarea pro-BNP plasmatic este utila in aprecierea controlului valorilor tensionale (corelatie cu valorile tensionale obtinute la monitorizarea in 24 de ore) dar nu isi dovedeste utilitatea privind stratifi carea riscului cardio-vascular la pacientii cu hipertensiune arteriala.

19. Tratamentul hipertensiunii rezistente prin adaugarea unei doze mici de spironolactonaE. Badila, C. Tirziu, S. Ghiorghe, D. Bartos,M. DorobantuSpitalul Clinic de Urgenta Bucuresti

Obiectiv: Aprecierea efi cientei clinice si hemodinamice a adaugarii unei doze mici de spironolactona, antagonist al aldosteronului, in tratamentul hipertensiunii arte-riale rezistente. Metoda: Studiul a inclus 26 pacienti cu HTA rezis-tenta. Efi cienta clinica a adaugarii unei doze mici de spironolactona (25 mg/zi) a fost apreciata prin masu-rarea TA la cabinet si prin monitorizarea ambulatorie auto mata a TA (ABPM-04, Meditech, Ungaria). Efi -cien ta hemodinamica a fost apreciata non-invaziv prin bioimpedanta electrica toracica (Hotman, Hemo Sapiens Inc). Pentru fi ecare pacient am determinat TA la cabinet, media TAS, media TAD, presiunea pulsului (PP), TA medie (TAM), stroke systemic vascular resis-tance index (SSVRI), total arterial compliance index (TACI), stroke index (SI). Rezultate: redate in tabel. Concluzii: Adaugarea unei doze mici de spironolactona este efi cienta in controlul hipertensiunii rezistente. Re-


POSTER I

ducerea rezistentei periferice reprezinta probabil un me canism important al efi cientei spironolactonei in HTA rezistenta. Utilizarea metodei bioimpedantei elec-trice toracice in managementul hipertensiunii rezis -tente permite identifi carea noninvaziva a ano ma liilor hemodinamice prezente la acesti pacienti.

Inainte de spironolactona Dupa

spironolactona p

Media TAS mmHg 164,612,5 129,56,3 0.01 Media TAD mmHg 92,310,4 76,45,3 0.01 TAM mmHg 116,49,6 94,25,3 0.01 PP mmHg 72,112,1 53,14,2 0.01 SI ml/m2 34,88,4 39,810,5 ns SSVRI dyn.sec.cm-5.m2 251,640,5 184,571,4 0.01 TACI 0,540,2 0,750,2 ns

Management of resistanthypertension by adding a low dose spironolactoneE. Badila, C. Tirziu, S. Ghiorghe, D. Bartos,M. DorobantuEmergency Hospital Bucharest

Objective: To assess the clinical and hemodynamical eff ectiveness of aldosterone antagonist spironolactone in the treatment of resistant hypertension. Method: 26 patients with resistant hypertension were included. Th e clinical eff ectiveness of adding a low dose spironolactone (25 mg/day) was assess by offi ce and ambulatory blood pressure monitoring (ABPM) (Meditech, Hungary). Th e hemodinamycal eff ectiveness was assess non-invasively by electric thoracic bioimpedance (ETB) (Hotman, HemoSapiens Inc). We measured offi ce blood pressure, mean systolic BP, mean diastolic BP, pulse pressure (PP), mean arterial pressure (MAP), stroke systemic vascular resistance index (SSVRI), total arterial compliance index (TACI), stroke index (SI).Results: see table. Conclusions: A low dose spironolactone is effi cacious in the control of resistant hypertension. Reduction of peripheral resistance is probably an important mecha-nism of eff ectiveness of spironolactone in resistant hy-pertension. Th e use of ETB in management of resistant hypertension allows non-invasive identifi cation of under lying hemodinamic abnormalities in these patien ts.

Before spironolactone Aft er

spironolactone p

SBP mmHg 164,612,5 129,56,3 0.01 DBP mmHg 92,310,4 76,45,3 0.01 MAP mmHg 116,49,6 94,25,3 0.01 PP mmHg 72,112,1 53,14,2 0.01 SI ml/m2 34,88,4 39,810,5 ns SSVRI dyn.sec.cm-5.m2 251,640,5 184,571,4 0.01 TACI 0,540,2 0,750,2 ns

20. Agregarea plachetar la pacienii cu infarct miocardic vechi i diabet zaharat tip 2 Silvia FilimonIMSP Institutul de Cardiologie, Chiinu, Republica Moldova

Scop: determinarea particularitilor agregrii plache-tare la pacienii cu infarct miocardic vechi i diabet za-harat tip 2. Material i metode: 100 pacieni, inclui n studiu, cu vrsta medie 58,880,92 ani, dintre care 51 brbai i 49 femei, au fost divizai n dou grupuri: Gru-pul I- de baz a inclus 50 pacieni cu infarct miocardic vechi (IMV) i diabet zaharat tip 2 (DZ tip 2), care pri-meau terapie standard pentru pacienii cu cardiopatie ischemic (CPI) (-adrenoblocante, inhibitori ai enzi-mei de conversie a angiotensinei-II, antiagregante, nitra i) i terapie hipoglicemic oral cu Glibenclamid i Grupul II- de referin a inclus 50 pacieni cu IMV fr DZ tip 2, care primeau terapie standard pentru CPI. Terapia antiagregant a fost suspendat cu 7 zile nainte de investigaie. Agregarea plachetar (AP) a fost studiat prin metoda fotometric Born/OBraen (1962), care permite aprecierea gradului i vitezei agregrii plachetare. n calitate de inductor al agregrii a fost utilizat adenozindifosfat (ADF (Germania) n con-centraie de 0,1 i 0,5 Mol. Paralel a fost apreciat AP prin metoda propus de Gabassov Z.A. i coaut.(1989), care permite nregistrarea razei medii a agregatelor. Protocolul explorrii a inclus determinarea timpului agregrii maximale prin dou metode (T%- metoda Born i TR- metoda Gabassov n secunde (s), gradului de agregare (H%) n procente (%), razei agregatelor (HR) n uniti optice (u.o) i indicelui de agregare (A)conform formulei: A= (Umax/Uo)2 - 1 unde A- indi cele de agregare; Umax- valoarea maximal a razei agregatelor; Uo- valoarea iniial a razei agregatelor.Rezultate: Analiza rezultatelor studiului a relevat unele particulariti ale agregrii plachetare la pacienii cu


IMV i DZ tip 2. La aceti pacieni s-a nregistrat o raz iniial a agregatelor mai mare la concentraia 0,1 Mol ADF- 4,840,19 u.o comparativ cu pacienii cu IMV fr DZ tip 2- 3,660,12 u.o (p


POSTER I

The utility of stabilizing sheath in the radiofrequency catheter ablation of the preexcitation syndrome in Ebsteins anomalyMihaela Grecu, Andrei Lozba, Tudor Georgescu, Ctlina Arsenescu GeorgescuCardiovascular Diseases Institute Prof. Dr. George I. M. Georgescu Iasi

Background: Th e anatomical malformation of the tricuspid valve apparatus makes diffi cult the radio-frequency ablation of the preexcitation syndrome in Ebsteins anomaly. Th ere are few data concerning the usefulness of the stabilizing sheath in maintaining the position of the ablation cathether.Method: A 50 year old patient, with an echocardiographic diagnosis of Ebsteins anomaly (apical displacement of the septal tricuspid valve leafl et of 35mm from the mitral annulus, 2nd degree tricuspid regurgitation and 50% atrialized right ventricle), with palpitations uncontrolled by class Ia, Ic and III antiarrhytmic drugs was referred to an electrophysiological study. Th e two-dimensional endocavitary mapping reveals the presence of an unique accessory pathway with fast bidirectional conduction, with an absolute refractory period of 220ms, located in the lateral side of the atrialized ventricular myocardium. Atrial stimulation induces the clinical orthodromic tachycardia, with right bundle branch block pattern, with a prolonged HV interval of 63ms and a VA interval of 274ms at the His bundle level and of 63ms at the right lateral level. Th e location of the ablation site was made solely on electrophysiologial criteria. Th e instability of the ablation catheter has imposed the use of a Preface stabilizing sheath that allowed the succesful maintaining of the catheter at the ablation site, where was recorded, in a bipolar lead, a low amplitude atrial potential, follo-w ed by a high amplitude ventricular potential with con ti nuous fusion in bipolar leads. Once identifi ed the atrial insertion of the accessory pathway during sinus rythm, orthodromic tachycardia was induced, during which the coincidence of the retrograde insertion of the accessory pathway with the anterograde one was proved, as located in the lateral side of the atria-lized ventricular myocardium. Postablation, the atrio-ventricular conduction was normal, but there was present an infra His conduction delay ( HV interval

of 63ms) with right bundle branch block pattern (QRS duration of 150ms), a common fi nding in Ebsteins anomaly. Th e fi nal ventricular stimulation evidentiated the disappearance of the retrograde conduction over the accessory pathway. Aft er 3 months of follow-up the patient is asymptomatic, doesnt require antiarrhytmic drugs, while maintaining the right bundle branch block pattern.Conclusions: Th e classical radiofrequency ablation of the preexcitation syndrome in Ebsteins anomaly could be diffi cult due to anatomical peculiarities. Th e use of the stabilizing sheath for the ablation catheter may contribute to the success of the procedure.

22. Diabetul zaharat i insuficiena cardiac acut - elemente de epidemiologie descriptivMonica Bengu1, O. Chioncel2, C. Macarie21Secia de cardiologie, Spitalul Judeean Focani2Clinica de Cardiologie, Institutul de Boli Cardiovascu-lare C.C.Iliescu Bucureti

Introducere: Exist pn n prezent date limitate lega te de particularitile clinice i prevalena diabetului zaha-rat (DZ) n insufi ciena cardiac acut (ICA). Diabetul zaharat reprezint un factor cheie n fi ziopatolgia ICA alturi de congestie, injurie miocardic i sindrom cardio-renal. Evidenele epidemiologice legate de ICA pro vin din registre i trialuri mari (ADHERE, OPTI-MIZE HF, EHFS II, EFICA) i arat c prevalena DZ la pacienii spitalizai cu ICA este mare i variaz n func-ie de forma clinic a ICA.Obiective: Evaluarea prevalenei DZ i a tulburrilor de glicoreglare la pacienii cu insufi cien cardiac acut i evaluarea caracteristicilor clinice n cazul asocierii DZ-ICA.Material i metod: Studiul, observaional, de cohort prospectiv folosete date din Registrul Romn de Insu-fi cien cardic acut. Sunt nrolai consecutiv pacieni internai n secii de cardiologie din ar cu diagnosticul de ICA. Pacienii sunt ncadrai n 3 forme clinice de ICA: insufi cien cardiac decompensat, edem pul mo-nar acut i oc cardiogen. Sunt folosite criteriile ADA 1997 pentru clasifi carea glucometabolic (IFG, DZ). In cazul pacienilor diabetici este menionat tipul DZ


(cu noscut sau nou descoperit) i tratamentul folosit anterior internrii pentru controlul glicemiei. Rezultate: In intervalul noiembrie 2007-februarie 2008 au fost nrolai consecutiv 400 pacieni cu diagnosticul de ICA cu vrsta medie 67.1 ani (SD 12.6), 41.3% femei i 58.8% barbai. Din totalul pacienilor, 68.75% au fost spitalizai pentru insufi cien cardiac decompensat; 24.75% cu edem pulmonar acut i 6.5% cu diagnosticul de oc cardiogen.

Prevalena DZ la pacienii cu ICA a fost de 31.8% (21.3% DZ cunoscut i 10.5% DZ nou descoperit), ocupnd a treia poziie n ierarhia factorilor de risc cardio-vascular dup HTA (50.8%) si dislipidemie (33.3%). Prevalena tulburrilor de glicoreglare la internare la pa cienii nondiabetici (hiperglicemii tranzitorii peste 110 mg%) a fost de 25.75%. Astfel, prevalena DZ i a tulburrilor de glicoreglare n grupul pacienilor cu ICA a fost de 57.55%. Prevalena DZ a fost diferit n cele trei forme clinice de ICA. La pacienii cu ICA decompensat prevalena DZ a fost de 27.64% (18.55% DZ cunoscut i 9.09% DZ nou descoperit); la cei cu EPA prevalena DZ a fost de 40.40% (26.26% DZ cunoscut i 14.14% DZ nou descoperit). In cazul pacienilor cu oc cardiogen prevalena DZ a fost de 42.31% (30.77% DZ cunoscut i 11.54% DZ nou desoperit).Caracteristici clinice: In rndul pacienilor diabetici 48.82% erau fr tratament antidiabetic la internare, 26.77% aveau tratament cu insulin, 7.09% biguanide, 10.24% foloseau asocieri. Concluzii: Studiul aduce date legate de prevalena DZ la pacienii spitalizai cu ICA i prezint o serie de caracteristici clinice ale asocierii DZ-ICA, unele re zul tate fi ind comparabile cu cele din studiile mari. Nu m rul pacienilor inclui n acest studiu este mic, Regis trul Romn de Insufi cien cardic acut este n des f urare.

Diabetes mellitus and acute heart failure-descriptiveepidemiological dataMonica Bengu1, O. Chioncel2, C. Macarie21Secia de cardiologie, Spitalul Judeean Focani2Clinica de Cardiologie, Institutul de Boli Cardiovascu-lare C.C.Iliescu Bucureti

Background: Till now, there is limited data concerning clinical features and prevalence of diabetes mellitus

in acute heart failure. Diabetes mellitus represents a key factor in acute heart failure physiopathology, like congestion, myocardial injury and cardio-renal syndrome. Th ere is epidemiological data regarding acute heart failure from registries and clinical trials (ADHERE, OPTIMIZE HF, EHFS II, EFICA) showing that diabetes prevalence is increased in patients hospi-talized with acute heart failure, and prevalence is not the same in diff erent clinical form of acute heart failure. Objectives: Th is study, observational cohort study, used data from the Romanian Registry of Acute Heart Failure and its goals are prevalence evaluation of dia-betes mellitus and glucometabolic impairement in pa-tients with acute heart failure and clinical features eva-luation in these patients. Methods: Between November 2007-february 2008, 400 patients hospitalized with acute heart failure were enro-lled consecutively in three clinical forms of acute heart failure: decompensated heart failure, pulmonary oede-ma and cardiogenic shock. Criteria used for gluco meta-bolic classifi cation was made according to the ADA 1997 (for impaired fasting glucose, diabetes melli tus). Results: 400 patients were enrolled consecutively with diagnosis of acute heart failure, 41.3% women and 58.8% men, age 67.1 (SD 12.6). 68.75% patients were hos pitalized with decompensated heart failure, 24.75% with pulmonary oedema and 6.5% with cardio genic shock. Th e prevalence of diabetes mellitus in these patients was 31.8%, third position aft er arterial hyper-tension (50.8%) and dislipidemia, as cardiovascular risk factors. Prevalence of glucometabolic impairement in non diabetic patients (transitory increasing in plasma glu cose above 110 mg%) was 25.75%.

Th e prevalence of diabetes mellitus varied in diff erent clinical forms of acute heart failure. In patients with decompensated heart failure the prevalence of diabetes was 27.64%; in patients with pulmonary oedema 40.40% and in patients with cardiogenic shock the prevalence of diabetes mellitus was 42.31%. Regarding diabetic treatment, 57.55% of patients were without treatment, 26.77% used insulin, 7.09% biguanide and 10.24% used associations. Conclusions: Th is study brings new data concering romanian experience. Some of the results are similar with data recorded in large clinical trials and registries in the fi eld of acute heart failure.


POSTER I

23. Efectele hipertrofiei ven-triculare stngi induse de constricia de aort asupra fenomenelor electrice i meca-nice ale cordului de obolan Alina Scridon, R.C. Serban, M. Perian, Dan Dobreanu Disciplina de Fiziologie, UMF Targu Mures

Introducere: Ca rspuns la o larg varietate de stimuli - me canici, hemodinamici, hormonali, miocardul se adap teaz necesitilor crescute prin hipertrofi a mio ci-telor. Mecanismele implicate n hipertrofi a fi zio logi c, precum i n cea patologic sunt puin nelese. Rezul-tatele unor studii au sugerat posibilitatea ca cuplul exci-taie-contracie s fi e alterat n hipertrofi a car diac.Scopul studiului: A fost acela de a nelege bazele electro-mecanice implicate n hipertofi a cardiac.Material i metod: Treizeci de obolani Wistar au fost distribuii n dou grupuri: grupul control i grupul cu constricie aortic. Pentru grupul de studiu s-a efectuat intervenia chirurgical pentru realizarea constriciei aortei abdominale. Dup patru sptmni, obolanii din ambele grupuri au fost anesteziai i sacrifi cai. Au fost msurai o serie de parametrii electrici i respectiv mecanici. Pentru a investiga posibilul rol al alterrii cuplului excitaie-contracie, am comparat activitatea mecanic i electric, nregistrate simultan la muchii papilari normali i hipertrofi ai.Rezultate: Masele cardiace au fost mai mari pentru grupul de obolani cu constricie de aort cu 270,7% (p


sub forma unei brosuri. Majoritatea cunosteau valorile target ale factorilor de risc cardiovasculari:61% pentru circumferinta abdominala, 59% pentru tensiunea sistolica si diastolica, 57% pentru HDL colesterol si trigliceride. Toate femeiele din studiu aveau circum-ferinta abdominala mai mare decit normalul dar in rest valorile parametrilor masurati erau la tinta.Concluzii: O buna informare referitoare la factorii de risc cardiovasculari este necesara dar nu sufi cienta in clinica practica, masuri active din partea medicilor si pacientilor sunt necesare.

The awarenesslevel ofcardiovascular risk factorsvalues in women withmetabolic syndrom Nicoleta Calomfirescu, Marius Calomfirescu,Carmen GinghinaAsociatia Romana ptr. Dezvoltarea Educatiei in Sana-tate (ARDES), Medicover, UMF Carol Davila, Clinica de Cradiologie Fundeni

Purpose: It is accepted that the awareness of cardio-vascular risk factors and a good level of patient s infor-mation link with cardiovascular disease improve the adherence to treatment. Th e information quality and sources are very important criterion in this process. We want to establish the awareness level link with cardiovascular factors in a women group who came at a routine medical examination in an ambulatory care settings.Material and methods: 149 women randomly selected among a patient population who came in an ambulatory care setting between june - september 2006. In all women we measured sistolic and diastolic blood pressure and HDL cholesterol, glicemia and triglycerides were measured in the whole group. Obesity was assessed by abdominal circumference. All women answer to a questionnaire about the right values of cardiovascular risk factors and how are the major sources of medical information.Results: Th e mean age was 52,4 with standard devia-tion 10,26. Based on NCEP-ATPIII criterion, 91 (61,9%) had metabolic syndrom.Most of them have a me dium level of education(42,85%) and only 36,73%

had university degree. 55% received before the current visit a medical material link cardiovascular risk factors, and in 55% they received it in a medical setting as a written brochure (in 55%, too). Most of them know the right value of cardiovascular risk factors measured: 61% for abdominal circunference, 59%for sistolic and diastolic bloood pressure value, 57% for either HDL cholesterol and tryglicerides. All hypertensive women have the current value at target level, but whole group have an abdominal circumference higher than normal.Conclusions: A good information level about cardio-vascular disease factors is necessary but it is not enough in clinical practice, active measures from both parts doctors and patients are needed.

25. Solutiile e-health:forta motrice a viitoarelor strategii de preventie Nicoleta Calomfirescu, Marius Calomfirescu,Carmen GinghinaAsociatia Romana ptr. Dezvoltarea Educatiei in Sana-tate (ARDES), Medicover, UMF Carol Davila, Clinica de Cradiologie Fundeni

Scop: In ultimii ani strategiile sistemelor de sanatate in domeniul cardiologiei au virat dinspre interventional spre preventie. Rezultatele programelor de preventie apar dupa multi ani, deci e nevoie de strategii efi ciente pentru aplicarea teoriei in practica. E-health este un concept dezvoltat in ultimii ani, dar cu o crestere importanta. Scopul studiului nostru epidemiologic, statistic si IT este de stabili daca e- helath pot reprezenta solutii pentru strategiile de preventie.Metode: Am analizat date din EuroStat, EuroHeart Survey despre distributia epidemiologica si consecintele fi nanciare ale afectiunilor cardiovasculare.Pe de alta parte am analizat oprtunitatile, costurile si bene fi ciile sistemelor de e-health.Rezultate: Solutiile e-health sunt un instrument important pentru: educatie, cercetare, CIS (sisteme cardio logice informatizate), networking, stabilind o legatura puternica intre furnizorii de servicii medicale si pacienti. Oamenii tineri cu virste intre 35-45 de ani sunt navigatori frecventi pe internet, deci segmentele de educatie si cercetare pot fi foarte folositoare din acest


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punct de vedere. Acuratetea si veridicitatea informatiei medicale sunt insa subiecte delicate. Tehnicile imagistice (ecografi a, MRI, angiografi a) sunt frecvent folosite in cardiologie, iar urmarirea pacientilor necesita stocarea multor informatii, respectiv imagini. La sfi rsit, dar nu pe ultimul loc, networking-ul insemna sa motivezi oame nii in directia potrivita. Concluzii: Coroborind datele din toate aceste perspective, solutiile e- health pot fi forta motrice a strategiilor preventive.

E-health solutions:the driving force for futurepreventions strategies Nicoleta Calomfirescu, Marius Calomfirescu,Carmen GinghinaAsociatia Romana ptr. Dezvoltarea Educatiei in Sana-tate (ARDES), Medicover, UMF Carol Davila, Clinica de Cradiologie Fundeni

Purpose: In the last few years health strategies in cardiology fi eld shift from interventional to prevention Preventions results will appear aft er a long period of time, so, good strategies to put theory in practice, are needed. E-health is a concept developed in the last few years but with an important growth. Th e purpose of our epidemiological, statistical and IT research is to establish if e-health can be a good solution for preventions strategi es.Methods: We analyzed statistical data from EuroStat, EuroHeartSurvey about fi nancial and epidemiological distribution of cardiovascular diseases across Europe. At the other side we analyze e-health opportunities, costs and benefi ts. Results E-health is a useful tool for: education, research, CIS (cardiology information system), networking, a strong link between healthcare providers and patients. Young people with age between 35-45 years old are frecquent fl yers on internet, so education and research can be very useful from this point of view. Informations accuracy and truth is a very delicate issue. Imagining (echo, MRI, angyogram) are used oft en in cardiology, and a patient follow-up need a lot of written and imaging information, so CIS is essen tial. At least but not the last, networking means to share and motivate people in the right direction as Heart Char ter does.

Conclusions: Th inkig from all this perspective e-health is the driving force for future preventions strategies.

26. Aplicaia n practic aghidurilor ESC n clasificarea clinic i identificareafactorilor de precipitare acazurilor de insuficien cardiac acut A. Frigy, Ildiko Kocsis, E. Caraca Clinica Medical IV, Tg. Mure

Clasifi carea clinic i identifi carea factorilor de preci-pitare a cazurilor de insufi cien cardiac acut (ICA) este important att pentru luarea unor deci zii tera-peutice corecte, ct i pentru prevenirea recuren elor. Pacieni i metod. ntr-un interval de 6 luni toi pacienii admii cu ICA (25 femei, 57 brbai, vrst medie 65.59 ani) au fost introdui ntr-o baz de date complex, n care am registrat conform ghidului ESC din 2005 clasifi carea clinic a cazurilor, respectiv facto rii precipitani ai decompensrii acute.Rezultate: Distribuia cazurilor conform claselor clini-ce a fost urmtoarea: decompensarea insufi cienei car-diace cronice - 39, ICA hipertensiv - 21, edem pulmo-nar acut - 6, oc cardiogen - 7, debit cardiac crescut - 3, ICA de ventricul drept - 6 cazuri. Distribuia pacien-ilor n funcie de severitate clinic a fost: cald i uscat - 4, cald i umed - 71, rece i uscat - 0, rece i umed - 7 pacieni. Cei mai frecveni factori de preci-pitare au fost (primii cinci): complian sczut - 27, criz hipertensiv - 12, tratament cronic suboptimal - 10, infecie -7, diagnostic greit - 6 cazuri.Concluzii: Majoritatea cazurilor intr in clasele clinice cu anse terapeutice mai bune (tensiune arterial ps-trat). Analiza factorilor de precipitare a decelat, c multe cazuri pot fi prevenite printr-o ngrijire mai aten t, respectiv prin ameliorarea cooperrii pacient-medic-familie.


Practical application of ESC guidelines in the clinicalclassification and theidentification of precipitating factors of acute heart failure cases A. Frigy, Ildiko Kocsis, E. CaracaClinica Medical IV, Tg. Mure

Classifi cation of acut heart failure (AHF) cases and the identifi cation of precipitating factors is important for early and adecvate therapeutic decisions and prevention of recurrences.Patients and methods: In a 6 month period, all patients (25 women, 57 men, mean age 69,59 yrs) admitted with AHF were introduced into a complex database, con-taining data about the classifi cation (clinical, clinical seve rity) and precipitating factors of the acute decom-pensation, according to the ESC guidelines from 2005.Results: Th e distribution of cases regarding clinical classifi cation was: acute decompensated heart failure - 39, hypertensive AHF 21, acute pulmonary oedema - 6, cardiogenic shock -7, high output AHF - 3, acute right heart failure - 6 patients. Classifi cation of patients according to clinical severity was: warm and dry: 4, warm and wet: 71, cold and dry: 0, cold and wet: 7 patients. Th e most frequent precipitating factors were (the fi rst fi ve): lack of compliance - 27, hypertensive crisis -12, suboptimal chronic treatment - 10, infection -7, missed diagnosis 6 patients.Conclusions: Th e majority of cases felt into categories with a better therapeutic chance (preserved blood pre-ssure). Analysis of precipitation factors revealed that a lot of cases can be prevented by a more careful patient mana gement and by enhancing the patient physician family cooperation.

27. Extinderea calcificarilorvalvulare aortice la pacientul cu hipertensiune arteriala corelata cu velocitatea fluxuluitransvalvular Aura Popa, Aurora-Maria Vladaia, Bogdan Popescu, Carmen Ginghina Institutul de Boli Cardiovasculare Prof. Dr. C.C. Ili-escu, Bucuresti

Rezumat: Rolul important al calcifi carilor valvulare aortice neobstructive (CVA) n morbiditatea si mor-talitatea cardiovasculara este cunoscut. Datele privind factorii care determina extinderea CVA, inter relatia lor cu velocitatea fl uxului transvalvular aortic sunt putine si discordante.Obiective: -analiza factorilor care determina extin-derea calcifi carilor valvulare aortice la pacientii cu hi-per tensiune arteriala; - analiza posibilei asocieri intre exten sia CVA si velocitatea fl uxului transvalvular aortic la pacientii fara stenoza aortica.Metoda: Esantionul de studiu a fost reprezentat din 66 pacienti (36 barbati si 30 feme), cu varsta intre 52-79 ani, media 65 6 ani, care au fost evaluai Eco-Doppler. Depozitul calcar este defi nit astfel: minim 5 mm. Criteriile de prezen a calcifi crilor valvulare aortice extinse: 1) cel puin o calcifi care semnifi cativ; 2) cel puin 2 calcifi cri medii. In lotul nostru au fost 8 pacieni (12%) cu calcifi cri semnifi cative i 36 de pacieni (55%) fr calcifi cri valvulare; restul de 22 de pacieni (33%) nu au criterii de CVA constituind grupul cu CVA nesemnifi cative.Rezultate: Un sfert din velocitile fl uxului transval-vular aortic s-au defi nit prin velociti crescute; velo-ci tatea maxima a fost semnifi cativ mai crescut la pa cienii cu calcifi cri valvulare semnifi cative (135 45 mm/sec) versus cei cu calcifi cri nesemnifi cative (116 23 mm/sec) sau cei fr calcifi cri valvulare (113 21 mm/sec). Fluxul aortic semnifi cativ crescut a fost la pacienii cu CVA semnifi cative fa de cei fr calcifi cri. Am identifi cat vrsta ca fi ind singura variabil independent asociat cu CVA avansate. CVA semnifi cative i genul feminin au fost identifi cate ca variabile independente pentru creterea fl uxului trans-valvular aortic.Concluzii: Prevalena CVA printre pacientii hiper ten-sivi este ridicat i n relaie clar cu vrsta. CVA sem-


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nifi cative se asociaz cu creterea velocitii fl uxului n ciuda deschiderii nerestrictive a cuspelor aortice.

28. Afectarea cardiaca inlimfoamele malignenon-hodgkin la copil diagnostic ecocardiografic Mandric Cristina, Dimitriu A.G, Miron IngrithUniversitatea de Medicina si Farmacie Iasi

Scopul lucrarii: obiectivarea rolului major al ecocardio-grafi ei in diagnosticul si monitorizarea afectarii car-diace in limfomul malign non-hodgkin (LMNH). Metoda: Pacienti: 38 copii, varsta cuprinsa intre 3 luni- 17ani cu LMNH, pe o perioada de 5 ani. Toti pacientii- evaluati clinic, electrocardiografi c, radiologic si ecocardiografi c.Rezultate: Afectarea cardiaca - 6 cazuri (15,8%); 5 cazuri limfom-T-, 1 caz limfom B; semne clinice de de but: astenie, dispnee, sindrom de vena cava supe rioa-ra. ECG: microvoltaj QRS si unda T. Rx. torace: afec-tare mediastinala(5cazuri) si efuziune pleu rala dreap-ta importanta(1). Eco aspecte: efuzie pericar dice(4), tamponada cardiaca(2); tumora pericardica (1). 2 cazuri mase intracardiace; caz1- masa tumorala ce umple atriul drept,cu baza de implantare spre VCS, caz2 masa tumorala ce se extinde de la peretele late ral AD spre valva septala tricuspida, la care se aso ciaza efuziune pericardica masiva; modifi carile eco din cazul 1 a fost confi rmat ulterior la necropsie. In cazul 2 si la toate cazurile cu efuziune pericardica la debut, modifi carile eco au revenit la normal dupa chimioterapie.Concluzie: Incidenta mare a afectarii car diace in LMNH determina necesitatea evaluarii eco in toate cazurile, chiar si in absenta simptomatologiei clinice, pentru a preveni aparitia tamponadei cardiace sau a altor urgente cardiace. Echo este o metoda cruciala de inves tigatie in diagnosticul si monitorizarea afectarii cardiace de LMNH.

29. Studiu privind incidenta si prevalenta sindromuluicoronarian acut la pacientii cu stenoza aortica degenerativa care prezinta asociat si stenoze carotidieneDan Delia, Calin PopSpitalul Judetean de Urgenta Baia Mare, Facultatea de Medicina. Universitatea de Vest Vasile Goldis- Arad

Introducere: Creterea grosimii intim-medie la nivel carotidian (IMT), stenozele carotidiene (CAS) i calci-fi erea inelului mitral (MAC) sunt legate de pato logia cardiovascular. Legtura ntre riscul de dezvol tare a sindromului coronarian acut (SCA) i IMT, CAS i MAC, la pacienii cu stenoz aortic dege nerativ nu este nc bine stabilit. Noi am evaluat rela ia dintre IMT, CAS, MAC i SCA la un grup de pacieni cu stenoz aortic degenerativ, pentru a vedea dac acetia sunt factori independe

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