Introduction: The recent development of large networks dedicated to ST-segment elevation myocardial infarction (STEMI) led to a significant increase in the number of primary percutaneous interventions (p-PCI) parallel with mortality reduction in Acute Coronary Syndrome (ACS). The number of non ST segment elevation myocardial infarction (NSTEMI) is increasing and the highest mortality rates are encountered in patients with cardiogenic shock and/or out of hospital cardiac arrest associated to ACS. The aim of this study was to identify the factors associated with a higher mortality rate in a global population with acute coronary syndromes presented in the emergency department of a county clinical hospital which serves as a regional center for a STEMI network. Material and method: This is a retrospective study including 684 patients with acute coronary syndrome admitted in the Clinic of Cardiology from the County Clinical Emergency Hospital Tîrgu Mureș in 2014. In all the cases, the factors that correlated with in hospital mortality were identified and analyzed. Results: The incidence of arterial hypertension was significantly higher in patients admitted with unstable angina (75.0%) and STEMI cases with less than 12 hours onset of symptomatology (68.1%), while impaired renal function correlated with the presence of NSTEMI (66.6%). The presence of a multivessel disease was significantly correlated with cardiogenic shock. The localisation of the culprit lesion in the left anterior descending artery (LAD) significantly correlated with the development of cardiogenic shock, LAD culprit lesions being present in 44.4% of CS cases as compared with 21.7% of noCS cases in STEMI patients. In NSTEMI patients, the localisation of the culprit lesion in the left main artery (LM) significantly correlated with the development of cardiogenic shock, culprit lesions in the left main being present in 47.0% of CS cases as compared with 28.5% of noCS cases in STEMI patients. Conclusion: Patients presenting with out-of-hospital resuscitated cardiac arrest due to Acute Myocardial Infarction associate higher in-hospital mortality rates. In-hospital mortality seems to be highly correlated with the female gender, STEMI myocardial infarction and the presence of multivascular lesions.

Background: Little is known on the effect of epicardial fat in pulmonary arterial hypertension (PAH). Therefore, the present study sought to perform a comparative analysis on the influence of epicardial fat thickness (EFT) on the right and left ventricular function, between three different etiological varieties of pulmonary arterial hypertension: caused by congenital heart defects (atrial septum defects with left to right shunt), by systemic sclerosis, and by myocardial ischemia. Materials and Methods: This is a prospective observational study on 50 patients with documented PAH (systolic pulmonary artery pressure -PASP of >35 mmHg). The thickness of the epicardial adipose tissue was evaluated by 2D cardiac ultrasound, on the free wall of the right ventricle, during end-diastole, in the long parasternal axis view. The patients were divided into three study groups: Group 1 -PAH determined by congenital heart defects with left to right shunts (atrial septum defects, n = 25); Group 2 -PAH induced by systemic sclerosis (n = 12); Group 3 -PAH induced by myocardial ischemia (n = 13). Results: The average age was 54.48 ± 10.78 years, 30% (n = 15) of subjects were males, with a mean body mass index of 24.65 ± 4.40 kg/m 2 , EFT was 9.15 ± 2.24 mm, and the PASP was 41.33 ± 5.11 mmHg. Patients in Group 3 were more likely to smoke (p = 0.025) and presented a significantly lower LVEF, compared to the other groups (Group 1: 60% ± 6 vs. Group 2: 60% ± 7 vs. Group 3: 48% ± 7, p <0.0001). The largest EFT was found in Group 3 (11.08 ± 2.39 mm), followed by Group 2 (9.14 ± 2.03 mm), and Group 1 (8.16 ± 1.57 mm) (p = 0.0003). The linear regression analysis found no significant correlations between EFT and other echocardiographic parameters: PASP (r = -0.228, p = 0.118), LVEF (r = -0.265, p = 0.06), TAPSW (r = 0.015, p = 0.912), TEI (r = 0.085, p = 0.552), RVEDD (r = -0.195, p = 0.173), RA area (r = -178, p = 0.214), and LA diameter (r = 0.065, p = 0.650). Conclusions: Epicardial fat thickness was found to be significantly higher in patients with PAH induced by myocardial ischemia, followed by those with systemic sclerosis and congenital heart defects, respectively. EFT did not influence the echocardiographic parameters for left and right ventricular function in patients with pulmonary arterial hypertension of different etiologies.

Introduction: The management of in stent restenosis represents a topic of great actuality and interest, especially since the interventional treatment with stent implantation became largely accepted as the metod of choice in patients with acute coronary syndromes. Identification of certain risk factors that could predict the development of an in stent restenosis and its severity could be extremely useful for the clinical management of these patients. Methods: We retrospectively analyzed a total of 60 stent restenoses encountered in 57 patients admitted and treated in the Cardiology Clinic of Tirgu Mures. The interval of occurrence of restenosis ranged between 2 months and 37 months postintervention. We monitored the demographic characteristics (age, gender, colesterol, presence of renal insufficiency) and we realized a descriptive qualitative analysis of the angiographic procedural aspects. The in stent restenosis occurred most frequently on left anterior descending artery (63%), followed by the circumflex artery (22.15%) and right coronary artery (14.8%), regardless of the degree of stenosis prior to revascularization. Results: Statistical analysis using Chi square test revealed no statistically significant differences in terms of the correlation between the incidence of restenosis and gender (p=0.14), treatment with ACE inhibitors (p=0.16), implanted stent diameter (p=0.22) or the type of procedure (ram crossing over a secondary branch being considered as a procedure involved in the genesis of severe restenosis) (p=0.2). We used the t-student test for comparative analysis of the correlation between the continuous variables related to initial native lesion diameter and the degree of restenosis, without finding any a statistically significant correlation between them (p=0.226). However, a statistically significant correlation was found between cholesterol levels and the degree of stenosis (p=0.039). Descriptive analysis of restenosis lesions did not find any statistically significant correlation with the type or degree of stenosis in the native vessel, but showed statistically significant differences when evaluating the geometric assumption of restenosis by intraluminal diameter or intraluminal area (p=0.0018), suggesting that assessment of the degree of restenosis should be performed only by planimetric area. Conclusions: We can conclude that in stent restenosis represents a plurifactorial phenomenon, that is not conditioned by the severity of the native lesion or by the administration of ACE inhibitors or Spironolactone, however it depends directly on the control of cholesterol values afther the coronary revascularization.

Aim:The aim of the study was to evaluate the correlation between renal function and heart function/echocardiographic parameters and epicardial adipose tissue thickness (EATT), respectively.Material and methods:Fifty patients with type 2 diabetes (T2D) were included in this study. Several laboratory parameters were obtained (HbA1c, fasting blood glucose, LDL-cholesterol, creatinine) and eGFR was calculated. Anthropometric measurements were performed (weight, waist and hip circumferences, 4 skinfolds, based on which % body fat was calculated). Patients underwent echocardiographic assessment to evaluate structural and functional parameters, including EATT. Left ventricular mass (LVM) was calculated and the geometric changes of the left ventricle were evaluated.Results:Forty-six per cent of the patients had a LV ejection fraction (EF) <55% and 34% had diastolic dysfunction. There were no significant differences between the three eGFR groups with regards to metabolic parameters, but LVEF was lower (53.0 ± 0.8%, 54.4 ± 2.4%, and 55.2 ± 1.5%, respectively) and EATT was higher (11.0 ± 1.0 mm, 8.58 ± 2.2 mm, and 7.63 ± 2.6 mm, respectively) with a lower eGFR (p = 0.04). More patients with eGFR <90 mL/min/1.73 m2had cardiac hypertrophy compared with those with eGFR ≥90 mL/min/1.73 m2(p = 0.04). EATT correlated positively with several anthropometric parameters, e.g. weight (r = 0.309, 95% CI: 0.022 to 0.549, p = 0.03), BMI (r = 0.398, 95% CI: 0.123 to 0.616, p = 0.004), and negatively with LVEF (r = −0.496, 95% CI: −0.687 to −0.242, p = 0.0003) and eGFR (r = −0.293, 95% CI: −0.531 to −0.013, p = 0.04). In patients with LVEF <55% vs. ≥55%, the EATT was significantly higher (9.5 ± 1.99 mm vs. 7.33 ± 2.37 mm, p = 0.013).Conclusion:In patients with T2D decreased renal function was associated with lower LVEF and higher EATT. EATT was also higher in patients with reduced LVEF.

Pyopericardium is an acquired disease associated with very high complication rates. Pyopericardium is a very rare form of pneumopericardium. The nontraumatic causes of pneumopericardium include gastro-pericardial fistula that can occur in refractory gastric ulcers, stomach or esophageal neoplasia, and in surgical interventions of the stomach, such as the Niessen fundoplication procedure. The case of life-threatening pneumopericardium associated with gastro-pericardial fistula resulting from the incarceration of a giant hiatal hernia is reported.

Ischemic heart disease morbidity and mortality are closely related to global and regional left ventricular function. The evaluation of left ventricular global function is a relevant part in the evolution of ischemic heart disease because it plays a significant role in prognosis prediction and patient management after revascularization. Regional function is also a critical part of the evolution, offering a possible and reliable mode for the assessment of myocardial disease. Currently several techniques for the evaluation of left ventricular parameters and function are in use. In this review we will discuss and compare currently available methods for the evaluation of global and regional left ventricular function such as 2D and 3D echocardiography, 3D speckle-tracking echocardiography, multi-slice computed tomography, and cardiac magnetic resonance imaging.Keywords: ischemic heart disease, echocardiography, 3D speckle-tracking echocardiography, multi-slice computed tomography, cardiac magnetic resonance imaging REVIEW DOI: 10.1515/jim-2017-0020 CARDIOLOGY // IMAGING Ischemic heart disease is the leading cause of death around the world. The morbidity and mortality rates are closely associated to regional and global left ventricular function in these patients. 1,2 The evaluation of global left ventricular (LV) function with noninvasive imaging tools has an important role in the therapeutic management and prognosis of patients with ischemic cardiac diseases. Several parameters have been proposed as illustrative for global left ventricular function such as volumes, ejection fraction, dimensions, end-diastolic pressure, contractility, and deformation parameters. Global systolic function is most often evaluated by measuring the difference in the end-diastolic and end-systolic volumes, determined in one, two and three dimensions, divided by the adequate end-diastolic volume. 3 Echocardiography is the most frequently used noninvasive technique for the analysis of LV parameters and function because of its accessibility, portability, and widely validated scale.

Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.Material and Method: We evaluated retrospectively 30 patients with angina and coronary luminal narrowing, who underwent 64-slice Coronary Computed Tomography Angiography. We measured the stenosis degree, intraluminal contrast density (Hounsfield units [HU]) at two levels, proximal and distal to stenosis, and the attenuation gradient was calculated on this basis.Results: The average contrast density was 77,96 UH proximal to the stenosis and 67,6 UH distal to the stenosis. The average transluminal gradient was 10,36. The average length of the coronary lesions was 16,93 mm. In those lesions with significant stenosis, expressed by >70% luminal narrowing, we recorded a significantly higher transluminal attenuation gradient as compared to those with <70% luminal narrowing (6.16 +/−3.7, 95%CI 4.3-80 vs 16.6 +/− 8.4, 95% CI 11.3 – 21.9). The degree of luminal narrowing significantly correlated with the contrast attenuation gradient (r=0.71, p<0.001).Conclusions: The assessment of intraluminal contrast density by Coronary Computed Tomography Angiography may represent a new noninvasive tool to obtain relevant information about the clinical significance of a coronary stenosis. Larger studies are requested to emphasize the benefits brought by CCTA in evaluating coronary lesions.

Funding Acknowledgements PlaqueImage Background The relationship between the degree of pulmonary hypertension (PH) and left ventricular performance in patients with systemic sclerosis is still a controversial issue in the literature. We aimed to conduct a comparative analysis of indexes characterizing left ventricular systolic and diastolic function, in two etiological types of pulmonary hypertension involving different pathophysiological mechanisms: PH caused by systemic sclerosis and PH caused by myocardial ischemia. Material and method We performed a prospective study on 83 patients (36 patients with documented PAH with a systolic pulmonary arterial pressure – sPAP of &gt;35 mmHg and 47 subjects with normal sPAP), out of which group 1 – with systemic sclerosis (n = 48); group 2 – significant coronary artery disease - CAD (n = 35). Patients of each group were divided in two subgroups based on the diagnosis of PH: group 1A - subjects with scleroderma and associated PH (n = 20), group 1B - subjects with scleroderma without PH (n = 28), group 2A - ischemic patients with associated PH (n = 16) and subgroup 2B - patients with ischemic disease without PH (n = 19). Results Patients in group 1 presented a significantly higher number of female subjects (p = 0.001) and a higher mean age (p = 0.009) compared to group 2. Patients with associated PH presented a significantly lower left ventricular ejection fraction (LVEF) compared to those without PH within the ischemic group (p = 0.023). There was a significant inverse correlation between the sPAP and LVEF in ischemic patients (r=-0.52, p = 0.001) as well as for scleroderma patients without PH (r=-0.51, p = 0.04). Tissue Doppler analysis of the left ventricular function indicated a significant negative correlation between the septal E’ value versus the sPAP and lateral E’ value versus the sPAP (r=-0.49, p = 0.002; r=-0.43, p = 0,008). Conclusions Intrinsic myocardial damage plays an important role in left ventricular systolic function even in the absence of PAH. Scleroderma patients present a less pronounced deterioration of the LVEF in response to pulmonary hypertension, indicating that in this group, additional compensatory mechanisms could be involved in the complex response of myocardium to elevated pulmonary pressures.