Volume 1 • Issue 1 • July 2015 – JCE – Journal of Cardiovascular Emergencies https://www.jce.ro Cardiology, Emergency Medicine and Intensive-Care Medicine, Radiology Tue, 18 Oct 2016 10:55:30 +0000 en-US hourly 1 https://wordpress.org/?v=6.1.1 JCE – a New Perspective for Cardiovascular Emergencies https://www.jce.ro/article/jce-a-new-perspective-for-cardiovascular-emergencies/ Sun, 28 Jun 2015 23:00:55 +0000 http://www.jce.ro/?post_type=article&p=152

 

]]> The Role of Catheter Ablation of Ventricular Tachycardias in the Treatment of Patients with Electrical Storm https://www.jce.ro/article/the-role-of-catheter-ablation-of-ventricular-tachycardias-in-the-treatment-of-patients-with-electrical-storm/ Sun, 28 Jun 2015 22:55:29 +0000 http://www.jce.ro/?post_type=article&p=158 Read More ...]]>

ABSTRACT

Electrical storm due to the development of repetitive sustained ventricular tachycardias (VT) is a potentially life-threatening clinical entity. Acute catheter ablation can be lifesaving. Electrical storm (ES) can be characterized as a period of severe cardiac electrical instability manifested by recurrent ventricular arrhythmias. ES adversely affects short and long term prognosis. The highest mortality risk is in the first 3 months after the occurrence of the index event as shown by the AVID trial. The appearance of a ventricular tachycardia (VT) storm is associated with a rather high mortality despite the presence of an internal cardioverter defibrillator. Catheter ablation (CA) in VT storm is evolving as a standard of care therapy. The increased utilization of CA is partly driven by data suggesting that ICD shocks may be associated with increased mortality, partly due to the limited possibilities and adverse events of medical therapy. The aim of this review is to summarize recent advances in CA of VTs in emergency setting.

]]> Non-invasive, Complex Examination of Micro- and Macrovascular System of Patients with Type 1 Diabetes Mellitus with or Without Vascular Complications https://www.jce.ro/article/non-invasive-complex-examination-of-micro-and-macrovascular-system-of-patients-with-type-1-diabetes-mellitus-with-or-without-vascular-complications/ Sun, 28 Jun 2015 22:50:02 +0000 http://www.jce.ro/?post_type=article&p=163 Read More ...]]>

ABSTRACT

Objective: We examined the vascular system, from the microvasculature to the aorta, in diabetes mellitus, using non-invasive methods.
Methods: We enrolled patients with type 1 diabetes: 17 patients without complications (DMW) and 19 patients with clinically manifest complications (DMC). Control group was represented by 34 healthy volunteers (C). We examined microvascular function with laser-Doppler flowmetry, using post-occlusive reactive hyperemia test and local heating. Arterial stiffness was studied by arteriograph, determining augmentation index and pulse wave velocity. We measured serum levels of sE-selectin and sICAM-1, markers of endothelial dysfunction.
Results: Microvascular reactivity was significantly reduced in DMC-, and tendentiously in DMW groups. sE-selectin level was significantly higher in DMC group than in controls. Arterial stiffness was the highest in the DMC group and the lowest in the DMW group. Heart rate was significantly higher in both diabetic groups compared to controls. Time to maximum flow during PORH test tended to be the shortest in DMW group.
Conclusions: Our results confirm impairment of the microvascular system in diabetic patients, even in early, uncomplicated stage of the disease, and might demonstrate diffuse hyperkinesis in the vascular system, resulting from the insulin effect or refering to the “vasodilation phase” of diabetes mellitus.

 

]]> Impact of a Preexisting STEMI Network in Improving STEMI Diagnostic and Treatment in the Community after the Introduction of a National Program of Interventional Treatment in Acute Myocardial Infarction https://www.jce.ro/article/impact-of-a-preexisting-stemi-network-in-improving-stemi-diagnostic-and-treatment-in-the-community-after-the-introduction-of-a-national-program-of-interventional-treatment-in-acute-myocardial-infarcti/ Sun, 28 Jun 2015 22:40:31 +0000 http://www.jce.ro/?post_type=article&p=181 Read More ...]]>

ABSTRACT

Introduction: According to European guidelines, ST elevation acute myocardial infarction should be treated by immediate reperfusion, if diagnosed within 12 hours from the onset of symptoms. We aimed to show the impact of a well-functioning pre-existing STEMI network in improving the results of a national program dedicated to the invasive treatment of AMI.
Methods: We followed the comparison between primary PCI rates and STEMI-related mortality in two regions, after the introduction of a nationwide program for the interventional treatment of acute myocardial infarction: region A, where the territory has been appropriately prepared via previous organizational measures in the network, and region B, where the territory has not been previously prepared.
Results: In 2011, one year after the initiation of the national program, a primary PCI rate of 12.1%, a thrombolysis rate of 10.1% and a no-reperfusion treatment rate of 77.8% have been found in these new centers for patients arriving similar to the new centers) showed in 2011 a 73.85% primary PCI rate, 12.09% thrombolysis rate and a 14.07% conservative treatment rate, reflected in a mortality of 6.81% for “early presentations” in the registry centers.
Conclusions: The national strategy for reduction of STEMI related mortality via implementation of primary PCI, started in 2010, had a significant impact especially in that region where the territory was previously prepared with appropriate organizational efforts, including educational and logistic measures.

 

]]> The Value of Angio CT Multislice for Pre- operative Assessment and Prediction of Post PCI Successful Intervention in Acute Coronary Syndromes Associated by Left Main Disease https://www.jce.ro/article/the-value-of-angio-ct-multislice-for-pre-operative-assessment-and-prediction-of-post-pci-successful-intervention-in-acute-coronary-syndromes-associated-by-left-main-disease/ Sun, 28 Jun 2015 22:35:19 +0000 http://www.jce.ro/?post_type=article&p=195 Read More ...]]>

ABSTRACT

Introduction: The location of culprit lesions on the left main is associated with an increased procedural risk in acute coronary syndromes. Our study aims to evaluate the utility of CT angiography determined Syntax score (CCTA) in comparison with the classical angiographic Syntax score for predicting the procedural success in percutaneous coronary interventions (PCI) of left main lesions.
Methods: We included 23 patients presenting to the Cardiology Clinic with an acute coronary syndrome. All patients underwent coronary angiography ± angio CT multisclice for assessment of the target lesion, defined as a significant (>50%) left main disease. Patient population consisted in: group 1 – 13 patients (56.52%), in whom revascularization indication was based on lesion severity assessment by CCTA score correlated with the angio Syntax score (SS), and group 2 – 10 patients (43.48%), in whom revascularization indication was based only on angio SS. According to the SS, the study population was divided into subgroup A – low SS (<22), subgroup B – intermediate SS (23–32) and subgroup C –high SS (>32). All patients were followed for 1 year.
Results: Despite similar SS in both groups (35.38 in group 1 vs. 32.4 in group 2), the use of Angio CT multislice increased the rate of PCI indication – 76.92% PCI in group 1 versus 50% PCI in group 2. In patients with high SS, PCI rate was 66.66% in group 1 compared with 50% in group 2 (p<0.05). High calcium score >100 was recorded in 50% of patients in the low SS subgroup (<22), 50% in the medium SS subgroup (23–32) and 22.22% in the high SS (>33) subgroup. One-year follow-up showed an overall mortality of 8.69%, slightly higher in group 2 (10%), as compared to group 1 (mortality of 7.69%).
Conclusions: Additional evaluation by angio CT of culprit left main stenoses in acute coronary syndromes provides more information about the complexity of atherosclerotic plaques in this location, and could be extremely useful in establishing the indication for PCI in high risk stenoses, showing a predictive significance for post-procedural 1 year follow up mortality.

 

]]> Correlation Between Acute Impairment of Regional Contractility and Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction https://www.jce.ro/article/correlation-between-acute-impairment-of-regional-contractility-and-left-ventricular-remodeling-after-revascularized-acute-myocardial-infarction/ Sun, 28 Jun 2015 22:27:48 +0000 http://www.jce.ro/?post_type=article&p=197 Read More ...]]>

ABSTRACT

Introduction: The present study aims to demonstrate the role of acute impairment of regional contractility, as assessed by 3D echocardiography, in predicting LV remodeling in post acute myocardial infarction (AMI) patients.
Methods: We enrolled in the study a number of 48 subjects with AMI who underwent primary PCI followed by optimum medical therapy. In all these cases we followed the correlation between the amplitude of ventricular remodeling at 6 months postinfarction and regional contractility in the immediate postinfarction period, as assessed by 3D echo parameters at baseline: regional index of contraction amplitude (RICA) and the index of contraction amplitude (ICA). Positive remodeling (PR) was defined as an increase in LV end-diastolic global volume with >15% compared with baseline.
Results: Patients with positive remodeling (PR) presented at baseline a significantly lower ejection fraction (44.75% versus 49.95%, p = 0.009), associated with a higher end-systolic volume (80.34 ml vs. 70.63 ml, p = 0.02) and lower values for index of contraction amplitude — ICA (3.05 vs. 3.53, p = 0.01) and for regional index of contraction amplitude — RICA (1.38 vs. 2.78, p <0.0001), in comparison with the patients who did not experience ventricular remodeling. RICA achieved the best statistical significance for predicting the development of LV remodeling during the evolution of the disease. For RICA, the ROC curve using logistic analysis showed an area under the curve (AUC) of 0.88, highly significant (p = 0.0001).
Conclusions: Impairment of regional contractility is associated with development of LV remodeling
to a more significant extent than the global impairment of ventricular contractility.

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