Acute coronary syndrome (ACS) induces a pro-inflammatory and pro-atherogenic state, increasing the risk of recurrent major adverse cardiovascular events (MACE). Rapid reduction of llow-density lipoprotein cholesterol (LDL-C) is an important therapeutic strategy for stabilizing vulnerable atherosclerotic plaques and reducing inflammation. Current clinical guidelines classify patients with a recent ACS as being at extremely high risk and recommend an LDL-C target of <55 mg/dl, together with a reduction of >50% from baseline. This paper evaluates lipid-lowering therapies, including statins, ezetimibe, PCSK9 monoclonal antibodies, inclisiran, and bempedoic acid. It examines their efficacy in lowering LDL-C, their effects on major adverse cardiovascular events (MACE), the management of statin intolerance, and their mechanisms of action. High-dose statin therapy has lipid-lowering and anti-inflammatory effects. Ezetimibe reduces LDL-C levels and cardiovascular events by selectively inhibiting the intestinal protein Niemann-Pick C1-Like 1. PCSK9 inhibitors, such as evolocumab and alirocumab, provide substantial additional reductions in LDL-C when used in combination with standard therapy, promoting plaque regression and reducing the rate of MACE. Inclisiran provides sustained hepatic inhibition of PCSK9 via small interfering RNA (siRNA), with a twice-yearly dosing regimen, helping to address issues related to treatment nonadherence. Patients with statin intolerance require alternative lipid-lowering strategies, such as bempedoic acid, which provides an option for achieving LDL-C targets. Early implementation of combination therapy during the acute phase optimizes vascular remodeling, reduces inflammation, and reduces the risk of recurrent ischemic events.

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide. When bleeding and the resulting hemodynamic instability become refractory to medical and conservative surgical measures, peripartum hysterectomy (PH) is performed as a last-resort, life-saving intervention and is recognized as a maternal near-miss criterion. Severe PPH has also been linked to long-term cardiovascular risk. Romanian data on PH are limited to single-center reports. Objective: To estimate the prevalence of PH in Romanian tertiary maternity units and to describe its indications, the management preceding hysterectomy, and short-term maternal and neonatal outcomes. Methods: Retrospective multicenter study in six level III university maternity units (Brașov, Bucharest, Cluj-Napoca, Craiova, Iași, and Târgu Mureș) between 1 January 2019 and 31 December 2023. All hysterectomies performed during pregnancy or within 42 days postpartum were identified. Prevalence was expressed per 10,000 births; individual-level data were analyzed descriptively. Results: A total of 231 PH were performed among 88,932 births, corresponding to 26.0 per 10,000 births (95% CI 22.7–29.6), with center-specific rates ranging from 14 to 46 per 10,000. Individual-level data were available for 108 women: 93 (86.1%) underwent hysterectomy after caesarean delivery and 42 (38.9%) had a previous caesarean section. Placenta accreta spectrum disorders (~50%) and uterine atony (~30%) accounted for about 80% of indications. In 49 women (45.4%), hysterectomy was performed without previous conservative measures. Blood transfusion was required in 79% of cases; no maternal deaths occurred, whereas neonatal mortality was 12%. Conclusions: PH prevalence in Romanian tertiary units is approximately five times the pooled European population-based estimate and is driven mainly by caesarean-associated PAS disorders and uterine atony. The high proportion of primary hysterectomy suggests rapid hemodynamic deterioration and/or limited access to conservative options. A national obstetric surveillance system and structured long-term cardiovascular follow-up of survivors are warranted.

Introduction: Ischemic heart disease remains a leading cause of morbidity and mortality worldwide. Coronary computed tomography angiography (CCTA) is recommended by current European guidelines as a first-line test for suspected obstructive coronary artery disease, but data on its economic impact in Romania remain limited. We evaluated a CCTA-first diagnostic strategy compared with a hypothetical strategy of invasive coronary angiography (ICA) in all patients with intermediate pretest probability. Material and methods: We conducted a retrospective cohort study of 248 patients with intermediate pretest probability (15–50%; RF-CL model) who underwent CCTA as a first-line test. CCTA findings were classified according to CAD-RADS 2.0, and patients with obstructive stenoses or non-diagnostic examinations were referred for ICA. Diagnostic performance, ICA avoidance, and costs were evaluated and compared with a hypothetical ICA-for-all strategy. Results: The mean age was 58.5 ± 9.1 years, 41.9% of patients were women, and the mean pretest probability was 31.0 ± 9.8%. Confirmed obstructive coronary artery disease was present in 63 patients (25.4%). CCTA had a sensitivity of 95.2%, specificity of 82.7%, negative predictive value of 98.1%, and overall accuracy of 85.9%. The CCTA-first strategy avoided ICA in 151 patients (60.9%) and reduced the average cost per patient from 4,249 to 2,525 RON, representing a 40.6% reduction and total savings of 427,600 RON. The cost per correct diagnosis was 2,940 RON with the CCTA-first strategy. Conclusions: In patients with intermediate pretest probability, a CCTA-first diagnostic strategy substantially reduced costs and the need for invasive testing while providing high sensitivity and negative predictive value. These findings support the use of CCTA as a diagnostic gatekeeper in cardiology practice in Romania.

Background: Congenital heart defects (CHDs) are the most prevalent birth anomalies and result from complex genetic and environmental factors. Beyond structural abnormalities, adverse intrauterine conditions may influence fetal development and contribute to long-term health outcomes. This study aimed to evaluate clinical and hematological markers of developmental vulnerability in a cohort of patients with CHD. Materials and Methods: A retrospective clinical analysis was conducted in 52 pediatric patients at the Institute of Cardiovascular Diseases (IBCV), Iași, Romania. Maternal clinical histories, hematological parameters (hemoglobin [Hb] and white blood cell [WBC] count), and neonatal parameters (birth weight, Apgar score, and birth Z-score) were analyzed. Results: Mean birth weight was 3,043.46 ± 642.34 g. Patients with cyanotic CHD had higher mean Hb concentrations than those with non-cyanotic CHD (13.82 vs. 12.82 g/dL), although the difference was not statistically significant (p = 0.170). Patients with identified genetic syndromes had significantly lower mean birth Z-scores than those without identified genetic syndromes (−1.26 vs. −0.57; p = 0.028). Conclusions: The lower birth Z-scores observed in patients with identified genetic syndromes suggest an association between genetic abnormalities and impaired fetal growth. The higher Hb concentrations observed in patients with cyanotic CHD, although not statistically significant, may reflect a compensatory response to chronic hypoxia. These readily available clinical parameters may provide additional information on developmental vulnerability in patients with CHD. Larger prospective studies are needed to clarify their potential role in long-term risk assessment and clinical follow-up.

Background: Major vascular trauma requires immediate restoration of perfusion, yet conduit options for large-vessel reconstruction are limited. Autologous veins are poorly matched to the caliber of the aorta and iliac arteries and may be unavailable in polytrauma, whereas synthetic grafts are biologically inert, prone to neointimal hyperplasia, and vulnerable to infection in contaminated fields. Decellularized xenogeneic scaffolds have been proposed as tissue-engineered vascular grafts (TEVGs) but remain underexplored for large-diameter applications. This study aimed to develop a rapid perfusion-based decellularization protocol for porcine aortic scaffolds, evaluate the effects of glutaraldehyde (GA) crosslinking, and characterize the resulting mechanical properties as a first step toward a large-diameter TEVG for emergency vascular reconstruction. Material and Methods: Twelve porcine thoracic aortic segments were processed into three paired groups: untreated, decellularized, and decellularized plus GA-crosslinked. Decellularization used recirculating perfusion with sequential 1% Triton X-100 and 1% sodium dodecyl sulfate and was confirmed by hematoxylin and eosin staining. Results: Decellularization significantly decreased the ultimate tensile stress compared to native tissue (4.09 ± 0.25 MPa vs. 5.34 ± 0.41 MPa, p < 0.0001) and also lowered Young’s modulus (p = 0.0024), but it did not affect failure strain (p = 0.7881). GA crosslinking brought the ultimate stress back to levels similar to native tissue (5.16 ± 0.71 MPa, p = 0.8352) and increased Young’s modulus beyond native values (5.93 ± 0.84 MPa, p = 0.0005), although it significantly reduced failure strain (p = 0.0006). Histological analysis confirmed complete nuclear removal with preserved fibrillar matrix structure. Conclusions: Rapid perfusion-based decellularization followed by GA crosslinking yielded large-diameter porcine aortic scaffolds with tensile strength restored to native levels and increased stiffness, at the cost of reduced extensibility. These findings establish a biomechanical basis for further development of decellularized porcine aortic conduits as off-the-shelf large-diameter TEVGs, pending in vivo evaluation of remodeling, patency, and infection resistance.

Introduction: SARS-CoV-2 infection is frequently associated with coagulation disorders and an increased risk of thromboembolic complications that may involve multiple vascular territories, with potentially fatal consequences. Case Series: We present six patients with confirmed COVID-19 who developed confirmed or suspected venous, arterial, or cardiac thromboembolic complications. Patients ranged in age from 54 to 79 years (mean, 64.4 years). All exhibited progressive increases in ferritin levels during hospitalization, while elevated inflammatory markers and dynamic D-dimer changes were observed in association with thromboembolic events. Despite prophylactic or therapeutic anticoagulation, severe complications still occurred. Three patients died from suspected intra-atrial mass, acute femoral and popliteal artery occlusion, and fulminant massive pulmonary thromboembolism, respectively. Conclusions: This case series highlights the systemic and heterogeneous nature of COVID-19-associated thromboembolism, which may occur despite anticoagulant prophylaxis, affect multiple vascular territories, and develop even in the absence of traditional thrombotic risk factors.

Introduction: Systemic amyloidosis (SA) comprises a heterogeneous group of disorders characterized by extracellular deposition of misfolded protein fibrils, leading to progressive organ dysfunction. Amyloid A (AA) amyloidosis is a systemic disorder that may involve multiple organs, including the gastrointestinal tract, heart, and serosal surfaces. Case presentation: We report a middle-aged man with long-standing ankylosing spondylitis who presented with progressive dyspnea and marked functional decline. Laboratory evaluation demonstrated severe hypoalbuminemia, chronic kidney disease with severe albuminuria, and markedly elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) despite only mild high- sensitivity troponin elevation. Electrocardiography showed low QRS voltage with a pseudoinfarction pattern. Transthoracic echocardiography revealed concentric left ventricular hypetrophy, mildly reduced ejection fraction, an infiltrative myocardial appearance, and severely impaired global longitudinal strain disproportionate to the degree of systolic dysfunction. Gastrointestinal biopsies demonstrated Congo red-positive amyloid deposits with positive amyloid A immunostaining, confirming systemic AA amyloidosis. Conclusions: This case illustrates systemic AA amyloidosis as a rare but devastating complication of long-standing, poorly controlled ankylosing spondylitis. The combination of dyspnea with large serosal effusions, markedly elevated NT-proBNP disproportionate to troponin elevation, low-voltage electrocardiography, and left ventricular hypertrophy with severely impaired global longitudinal strain should raise suspicion for cardiac amyloidosis in patients with chronic inflammatory diseases and prompt timely diagnostic evaluation.