Volume 2 • Issue 1 • March 2016 – JCE – Journal of Cardiovascular Emergencies https://www.jce.ro Cardiology, Emergency Medicine and Intensive-Care Medicine, Radiology Tue, 18 Oct 2016 10:36:01 +0000 en-US hourly 1 https://wordpress.org/?v=6.1.1 Epicardial Adipose Tissue – A New Biomarker of Cardiovascular Risk https://www.jce.ro/article/epicardial-adipose-tissue-new-biomarker-cardiovascular-risk/ Wed, 25 May 2016 10:11:58 +0000 http://www.jce.ro/?post_type=article&p=660  

]]> Critical Congenital Heart Diseases as Lifethreatening Conditions in the Emergency Room https://www.jce.ro/article/critical-congenital-heart-diseases-lifethreatening-conditions-emergency-room/ Wed, 25 May 2016 10:09:51 +0000 http://www.jce.ro/?post_type=article&p=654 Read More ...]]>

ABSTRACT

Critical congenital heart disease (CHD) represents a special type of cardiovascular emergency due to the complexity of the associated pathology. In many cases, urgent surgery or catheterbased intervention is required as the condition might be life-threatening. In patients with ductal-dependent lesions, closure of the patent ductus arteriosus (PDA) within the first few days postpartum, can cause sudden clinical deterioration with potentially life-threatening consequences. The diagnostic challenges, clinical presentation and particularities related to the closure of PDA in life-threatening critical CHD are presented.

]]> Prognostic Value of Epicardial Fat Thickness as a Biomarker of Increased Inflammatory Status in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction https://www.jce.ro/article/prognostic-value-epicardial-fat-thickness-biomarker-increased-inflammatory-status-patients-type-2-diabetes-mellitus-acute-myocardial-infarction/ Wed, 25 May 2016 10:01:40 +0000 http://www.jce.ro/?post_type=article&p=651 Read More ...]]>

ABSTRACT

Introduction: The prognostic value of epicardial fat thickness (EFT) and inflammatory biomarkers such as hs-CRP have not been fully investigated in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM). The study aim was to assess the correlation between the EFT, the persistence of elevated circulating levels of hs-CRP at 7 ± 2 days after an AMI and the amplitude of the left ventricular (LV) remodeling, in patients with type 2 DM. Methods: The study included 98 patients (45 with type 2 DM and 43 with no DM): Group 1 included 22 low-to-intermediate risk patients (hsCRP <3 mg/l) and Group 2 had 23 high-risk, (hsCRP >3 mg/l) patients. EFT, LV function and remodeling were assessed at baseline and at six months after AMI in both groups. Results: In the diabetic population, the EFT was significantly higher in patients who developed ventricular remodeling as compared with those who did not (8.02 ± 1.80 mm vs. 6.65 ± 2.17 mm, p = 0.02) and significantly correlated with the circulating levels of hsCRP (r = 0.6251, p <0.0001). The levels of circulating hs-CRP, at baseline, significantly correlated with the RI at six months (r = 0.39, p <0.001). Also, in the diabetic population, the epicardial fat thickness was significantly higher in patients who developed ventricular remodeling as compared with those who did not (8.02 ± 1.80 mm vs. 6.65 ± 2.17 mm, p = 0.02). The epicardial adipose tissue thickness significantly correlated with the circulating levels of hsCRP (r = 0.6251, p <0.0001), while in the non-diabetic population, EFT was not significantly higher in patients who developed ventricular remodeling as compared with those who did not (71.38 ± 9.09 vs. 67.4 ± 10.17, p = 0.23). Multivariate analysis identified the hs-CRP values (OR: 4.09, p = 0.03) and the EFT (OR: 6.11, p = 0.01) as significant independent predictors for LV remodeling in diabetic population. Conclusions: A larger EFT is associated with a more severe remodeling and impairment of ventricular function in patients with type 2 DM and AMI.

]]> Characteristics of Neoatherosclerosis Within Implanted Coronary Stents in Patients with Acute Coronary Syndromes https://www.jce.ro/article/characteristics-neoatherosclerosis-within-implanted-coronary-stents-patients-acute-coronary-syndromes/ Wed, 25 May 2016 09:06:27 +0000 http://www.jce.ro/?post_type=article&p=647 Read More ...]]>

ABSTRACT

Introduction: In-stent restenosis (ISR) is traditionally associated with neointimal hyperplasia. However, recent studies have suggested that an underlying progression of the atherosclerotic process called neoatherosclerosis, different from intimal proliferation, could be involved in ISR development. In this study the aim was to compare the characteristics of the neoatheromatous plaque evidenced by Multislice Angio Computed Tomography, Optical Coherence Tomography (OCT) and Virtual Histology Intravascular Ultrasound (VH-IVUS) with the characteristics of de-novo lesions in native coronary vessels of patients with ISR. Material and methods: This is a prospective single-center pilot study in which patients presenting with acute chest pain and having at least one symptomatic bare-metal stent (BMS) restenosis at six months to one year after BMS implantation, were enrolled. The characteristics of the neointimal tissue developed within the implanted stents using Acio CT, OCT and VH-IVUS were studied. Results: In total, 27 patients with 38 coronary BMS were included in the study, in whom 27 ISR lesions and 43 lesions in native coronary vessels were identified. Angio CT examination revealed that atheromatous plaques responsible for ISR tend to have a larger volume compared with native lesions located in the same coronary vessel (plaque volume 91.2 mm3 for ISR vs. 60.4 mm3 for native vessels, p <0.0001). Additionally, they show more low density plaques compared to native coronary lesions located in the same coronary vessel (33.9 mm3 vs. 18.2 mm3 for the volume of the plaque with density <30 HU, p <0.0001). Plaques responsible for ISR exhibit a higher lipid content than native ones (41.1% vs. 22.9%, p = 0.05). OCT analysis indicated an irregular shaped vascular lumen in 44.4% of ISR lesions compared to 25.6% of de-novo lesions (p = 0.1). Conclusions: Neoatherosclerosis within the implanted coronary stents is associated with signs of plaque vulnerability to a significantly higher extent than the atheromatous plaques in native coronary arteries in patients with ISR presenting with an acute coronary syndrome.

]]> How To Treat Spontaneous Coronary Artery Dissection https://www.jce.ro/article/treat-spontaneous-coronary-artery-dissection/ Wed, 25 May 2016 09:02:17 +0000 http://www.jce.ro/?post_type=article&p=644 Read More ...]]>

ABSTRACT

Spontaneous coronary artery dissection (SCAD) is a rare disease, occurring most often in young women, around 40 years of age. Usually there is the presence of several predisposing factors. Diagnosis is made using coronary angiography, optical coherence tomography (OCT) or autopsy. Optical coherence tomography allows a precise diagnosis to be made, identifying as it can, a coronary artery intramural haematoma prior to the occurrence of a dissecting lesion. The case of a 52-year-old woman with SCAD of unknown etiology is reported.

]]> A Massive Aortic Intramural Haematoma – an Aortic Emergency https://www.jce.ro/article/massive-aortic-intramural-haematoma-aortic-emergency/ Wed, 25 May 2016 08:49:42 +0000 http://www.jce.ro/?post_type=article&p=640 Read More ...]]>

ABSTRACT

Aortic intramural haematoma (AIH) is a rarely recognized disease characterized by a sudden haemorrhage into aortic media in the absence of any intimal tear. The clinical evolution and mortality rates of AIH are similar to those of acute aortic dissection. However, in the acute clinical care of patients presenting with chest pain of aortic origin, it is important to differentiate intramural haematoma from aortic dissection. A case of an elderly patient with an intramural hematoma (IMH), which progressed to very large dimensions and involved the entire aortic wall, resulting in fatal complications is presented here.

]]> Treatment Difficulties in High Risk Pulmonary Embolism. A Case Report https://www.jce.ro/article/treatment-difficulties-high-risk-pulmonary-embolism-case-report/ Wed, 25 May 2016 07:51:19 +0000 http://www.jce.ro/?post_type=article&p=630 Read More ...]]>

ABSTRACT

Pulmonary embolism (PE) remains a common and potentially life-threatening cardiovascular emergency. Systemic thrombolysis with intravenous infusion of a thrombolytic agent is generally recommended for treatment of high risk PE. However, this method has known limitations in the presence of high bleeding risk. Catheter-directed thrombolysis has the potential to achieve the same benefits as systemic thrombolysis, with a lower risk of haemorrhage. The case presented is of a 67-year-old male patient with a high risk of pulmonary embolism and contraindications for systemic thrombolysis, in whom the presence of severe comorbidities presented an increased risk of surgical embolectomy, who was successfully treated by catheter-directed thrombolysis.

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