Obstructive sleep apnea (OSA) causes recurrent apneas due to upper respiratory tract collapse, leading to sympathetic nervous system hyperactivation and increased cardiovascular risk. Moderate and severe forms of obstructive sleep apnea are associated with increased atrial volumes and affect left ventricular diastolic and then systolic function. Right ventricular ejection fraction can be accurately assessed via three-dimensional echocardiography, while bidimensional imaging can only provide a set of surrogate parameters to characterize systolic function (tricuspid annulus plane systolic excursion, right ventricular fractional area change, and lateral S'). Tissue Doppler imaging is a more sensitive tool in detecting functional ventricular impairment, but its use is limited by angle dependence and the unwanted influence of tethering forces. Two-dimensional speckle tracking echocardiography is considered more suitable for the assessment of ventricular function, as it is able to distinguish between active and passive wall motion. Abnormal strain values, a marker of subclinical myocardial dysfunction, can be detected even in patients with normal ejection fraction and chamber volumes. The left ventricular longitudinal strain is more affected by the presence of obstructive sleep apnea than circumferential strain values. Although the observed OSA-induced changes are subtle, the benefit of a detailed echocardiographic screening for subclinical heart failure in OSA patients on therapy adherence and outcome should be addressed by further studies.

Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.

Cardiopulmonary exercise testing (CPET) has become the golden standard in the assessment of exercise capacity and intensity of the patients who are performing cardiac rehabilitation. The purpose of our study was to objectify the relationships between the parameters of CPET and the lipid profile after the cardiovascular rehabilitation. We found a significant increase in oxygen consumption (VO2) values, anaerobic threshold, effort capacity and maximum heart rate and an improvement in the lipid profile, marking a reduced cardiovascular risk.

Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual's aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (∆ = 14.23 W, p = 0.0004), maximum oxygen uptake (∆ = 203.87 mL/min, p = 0.004), anaerobic threshold (∆ = 316.4 mL/min, p = 0.001), minute ventilation (∆ = 5.1 L/min, p = 0.01) and peak oxygen pulse (∆ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (∆ = −8.3 kCal/24 h, p = 0.04) and average Epworth score (∆ = −4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity.

Obstructive sleep apnea (OSA) is the most common type of sleep disordered breathing, with a signifi cant impact on health-related quality of life (HR-QoL). Continuous positive airway pressure (CPAP) is the gold-standard treatment for moderate-severe OSA, but is associated with poor patient compliance (due to fi nancial issues and frequent side eff ects). The purpose of this study is to evaluate HR-QoL among patients with moderate-severe OSA from NorthEastern Romania, at baseline and after 2 months of CPAP. 75 patients were initially included in our study but only 59 subjects returned for a second evaluation. HR-QoL was assessed using the European Quality of Life 5 Domain questionnaire (EQ-5D-5L). OSA has a signifi cant impact on quality of life in our group, with an average EQ-5D-5L index of 0.70±0.27 and an EQ-5D-5L Visual Analogue Scale (VAS) of 63.71±17.74%. Short-term CPAP use was associated with a statistically signifi cant improvement in Epworth Sleepiness Scale (Δ = 4.44, p <0.0000001), EQ-5D-5L index (Δ = 0.1, p=0.0008) and EQ-5D-5L VAS (Δ = 9.38%, p=0.00002). All patients with a high income (> 4000 lei/month) decided to continue using the device, while the decision not to continue CPAP was signifi cantly more frequent among patients with a low income (< 1000 lei /month-52.63% versus 21.21%, p=0.01). Our results suggest that income level signifi cantly infl uences CPAP compliance.

Brugada syndrome can induce malignant ventricular arrhythmias in the absence of structural heart disease. The hallmark of the condition is the ''coved'' (type I) or ''saddle-back'' (types II and III) ST segment elevation in the right precordial leads. The definite diagnosis requires the documentation of the type I morphology. The electrocardiographic pattern is often dynamic, but it can be unmasked by sodium channel blockers such as flecainide. We report the case of a 33-year old male, with family history significant for sudden cardiac death, who underwent successful cardio-pulmonary resuscitation for ventricular fibrillation-associated cardiac arrest. The 12 lead electrocardiogram performed after the resuscitation maneuvers showed intermittent type 1 Brugada pattern. General physical examination and routine laboratory evaluation were unremarkable. A repeated electrocardiogram revealed sinus tachycardia with right bundle branch block. We performed a flecainide challenge test which reproduced the initial coved-type ST segment elevation in V1 and V2. We decided to implant a ventricular single chamber cardioverter-defibrillator with one therapeutical window for ventricular fibrillation (at 300 ms), high energy shocks without antitachycardia pacing. The device was successful in preventing another episode of ventricular fibrillation just 2 days after the procedure. Implantable cardioverter-defibrillators are the most effective secondary prophylaxis therapeutic options for individuals with Brugada Syndrome, but they subject the patient to complications related to device implantation and inappropriate shocks.

Introduction. Hepatic steatosis represents a common pathological feature in patients with chronic viral C infection and can be independently associated with obesity, increased alcohol consumption, type 2 diabetes, and hyperlipidemia. These factors can contribute to the development of hepatic steatosis in patients with chronic HCV (Hepatitis C virus) infection. Materials and methods. 64 patients who underwent treatment with oral antivirals were included and evaluated through non-invasive methods for the degree of hepatic steatosis. Results. After at least 3 months of sustained viral response, all patients with advanced hepatic steatosis were categorized into lower classes in the Steatotest evaluation. Conclusion. This study highlights the importance of direct acting antiviral (DAA) treatment in the medical care of patients with chronic viral C infection and hepatic steatosis. Thirty years after the discovery of the hepatitis C virus, treatment with oral antivirals revolutionizes the medical care of patients with this chronic infection.

Type 2 diabetes mellitus (T2DM) is a very common disease, which is characterized by a prothrombotic status, very frequently leading to severe complications.The thrombophillic status results from chronic activation of the coagulation system, associated with a decrease in the endogenous fibrinolytic capacity. The objective of this study was to evaluate the thrombotic status in type 2 diabetic patients and to establish if the genomic polymorphisms of the haemostatic factors favor the increase of thrombosis in insulin resistance statuses. The research was done on a group of 60 patients with T2DM. Metabolic parameters such asserum glucose, total cholesterol, LDL, HDL, triglycerides, glycated hemoglobin and renal function indicators were assessed after 12 hours of fasting. The haemostasis was investigated through the levels of fibrinogen, thrombocytes count and morphology, the antithrombin III plasmatic concentration, the presence of different PAI-1 and coagulation factor XIII genotypes. The study revealed that PAI-14G/4G genotype was associated with high glycated hemoglobin levels and with increased total and LDL cholesterol, while the other PAI-1 genotypes had no such associations. Our research also showed that the mutant WT+MT factor XIII heterozygote was associated with high total and LDL cholesterol levels and with increased CRP concentrations.