SAT0111 THE RELATIONSHIP BETWEEN THE ADMINISTRATION OF IL-6 INHIBITORS AND INSULIN RESISTANCE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) risk, due not only to the traditional risk factors (hypertension, insulin resistance/diabetes, obesity, smoking), but to the inflammatory status as well. The blockade of interleukin-6 (IL-6) can regulate the glucose metabolism, reducing the glucose level and insulin resistance (IR). This beneficial effect is seen more in patients with normal values of body mass index (BMI), compared to the obese population.

Objectives:

Given the mentioned existing data, we aim to demonstrate the positive effect of IL-6 inhibitors in active RA patients with normal or increased BMI.

Methods:

We recruited 56 consecutive patients with definite and active RA, non-responders/partial responders to conventional synthetic Drug Modifying Anti-Rheumatic Drugs (csDMARDs)/biological therapy. For a period of 52 weeks, patients received subcutaneous Tocilizumab (TCZ) in a dose of 162mg once a week, according to European League Anti Rheumatism (EULAR) recommendation and National Protocol. We assessed demographics, RA-related parameters (clinical, inflammatory and immune) and metabolic markers, as well as the peripheral response to insulin, quantified by Homeostasis Model Assessment for insulin resistance (HOMA-IR) and the Quantitative Insulin Sensitivity Check Index (QUICKI). We did not include in the study the patients known with diabetes mellitus (DM) and those undergoing glucocorticoids.

Results:

After 52 weeks of treatment, most of the patients showed a statistically significant reduction of HOMA-IR (3.61 ± 1.21 at the onset vs. 2.45 ± 1.46 at the end of the study, p<0.001), while QUICKI registered a slight increase (0.32 ± 0.01 at the onset vs. 0.33 ± 0.01 at the end of the study, p<0.001). Also, the decrease in insulin and glucose levels were more obvious in patients with normal BMI, strictly related to disease activity.

Conclusion:

Long-term administration of TCZ in active RA is associated with a significant reduction of disease activity and IR, especially in normal weight patients. This confirms that obesity, as a CV risk factor, represents one of the main causes of IR.

References:

[1]Castañeda S, Remuzgo-Martínez S, López-Mejías R et al. Rapid beneficial effect of the IL-6 receptor blockade on insulin resistance and insulin sensitivity in non-diabetic patients with rheumatoid arthritis.Clin Exp Rheumatol. 2019; 37(3):465-473.

[2]Lehrskov LL, Christensen RH. The role of interleukin-6 in glucose homeostasis and lipid metabolism.Semin Immunopathol. 2019; 41(4):491-499.

[3]Ursini F, Russo E, Ruscitti P, Giacomelli R, De Sarro G. The effect of non-TNF-targeted biologics and small molecules on insulin resistance in inflammatory arthritis.Autoimmun Rev. 2018 Apr;17(4):399-404.

Disclosure of Interests:

Alexandra Jitaru: None declared, Cristina Pomirleanu: None declared, Maria-Magdalena Leon-Constantin: None declared, Florin Mitu: None declared, CODRINA ANCUTA Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly

Unexpected Coronary Thrombosis Induced By Antiphospholipid Syndrome (Hughes Syndrome): Case Report

Antiphospholipid syndrome (APS), one of the most common states of acquired hypercoagulability, is diagnosed by the persistent presence of antiphospholipid antibodies and recurrent episodes of vascular thrombosis. We present the case of a 39-year-old man late-presenting for cardiac rehabilitation treatment after primary percutaneous coronary intervention (PCI) performed for anteroseptal myocardial infarction. He was a nonsmoker, with no prior personal history of other cardiovascular diseases (CVD) or cardiometabolic syndrome. The 60% thrombotic occlusion of the left anterior descending artery (LAD) leading to the acute cardiac event was the only abnormality that was found. The only etiological explanation was the late measurement and the positive tests for antiphospholipid antibodies. In young patients with no history of thrombotic disorder, such as cancer, cardiovascular or metabolic diseases, the unexpected onset of myocardial infarction by thrombotic coronary occlusion can be attributed to silent, undiagnosed autoimmune condition.

NEW CLASS OF DRUGS: THERAPEUTIC RNAi INHIBITION OF PCSK9 AS A SPECIFIC LDL-C LOWERING THERAPY

Hyperlipidemia is a well-known risk factor for coronary heart disease, the leading cause of death for both men and women. Current lipid-lowering treatment is not always efficient, therefore new pharmacological interventions that reduce LDL cholesterol (LDL-C) have been developed. This paper presents new class of specific LDL lipid-lowering drugs under investigation in phase II or III clinical trials. The inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9), a key enzyme in cholesterol homeostasis, improve the liver's ability to clear LDL from the plasma, reducing LDL-C levels. Currently, three monoclonal antibodies PCSK9 inhibitors (alirocumab, evolocumab and bococizumab) are evaluated in clinical outcome trials. ALN-PCSsc, the new first-in- class therapeutic RNA interference (RNAi) inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) is also the first-in-class investigational medicine that acts by turning off PCSK9 synthesis in the liver. The development leadership of ALN-PCSsc has now transferred from Alnylam Pharmaceuticals to The Medicines Company, who has initiated the ORION-1 Phase II study at the beginning of 2016. ALN-PCSsc has significant potential given its highly competitive profile as compared with monoclonal antibodies anti-PCSK9 MAbs, a recently approved class of LDL-C lowering drugs.

ST segment depression in asymptomatic male patient with normal coronary arteries

ST segment depression and T waves inversion are electrocardiographic (ECG) repolarization abnormalities often encountered in clinical medical practice that have been proved to predict future cardiovascular events. We present the case of a 62-year-old male patient, asymptomatic, with ST segment depression and inverted T waves discovered incidentally on resting ECG. Echocardiographic and laboratory examinations ruled out multiple causes of ECG abnormalities. Suspecting a silent myocardial ischemia, an ECG exercise stress test was performed; it revealed pseudo normalization of T waves during exercise and early recovery phase. Being inconclusive, a coronary CT was the final election test; it showed normal coronary arteries with no stenosis, the patient being scheduled for regular follow-up. The possible causes of ST segment depression are reviewed since it is important that early cardiovascular signs especially in asymptomatic patients to be prevented and detected.

The correlation between the ankle-brachial index and the metabolic syndrome

On a global scale, the cardiovascular diseases constitute the prime factor of death and invalidity. The premature mortality percentage caused by these varies from 4% in high developed countries to 40% in underdeveloped countries. Atherosclerosis is the most important etiological factor. The presence of various degrees of atherosclerosis in a certain vascular area (in our case, the lower limb arteries), increases the probability of affecting other areas as well (coronary, cerebral, renal, mesenteric arteries).

AIM

The evaluation and description of the correlations between the ankle-brachial index levels and the cardiovascular risk factors, taken individually or as part of the metabolic syndrome.

MATERIAL AND METHOD

The values of the ankle-brachial index were divided in normal and abnormal. The evaluated cardiovascular risk factors were: age, sex, arterial hypertension, obesity, smoking, high levels of cholesterol and basal glucose, low levels of HDL-cholesterol.

RESULTS

There were significant statistical differences between the normal ankle-brachial index lot and the one with abnormal values, specifically in patients with diabetes mellitus and metabolic syndrome. More so, the study demonstrates that the ankle-brachial index is considerably smaller in patients with metabolic syndrome.

CONCLUSIONS

The simple measurement of the afore mentioned index, as a atherosclerosis marker for the lower limb arteries, represents an independent prediction over the metabolic syndrome and the conventional risk factors, in the development of the cardiovascular diseases. The routine measurement of this parameter in medical practice might imply the early diagnosis of high risk manifested cardiovascular disease patients.

Differentiation of rheumatoid arthritis from hepatitis C-related arthropathy: case report

Chronic virus C hepatitis records high prevalence, almost 170 million people worldwide being infected. Systemic involvement is frequent and the implication of the osteoarticular system raises various problems in properly diagnosing and treating it. Rheumatoid arthritis is the most frequent type of inflammatory polyarthritis, with a prevalence of 0.8% in the general population. The rheumatoid factor recorded high values at virus C hepatitis patients (19-80%) even in the absence of articular manifestations, its sensitivity and specificity being reduced for the rheumatoid arthritis diagnosed simultaneous with virus C hepatitis. We report a case of chronic virus C hepatitis patient which, after 30 years of evolution, presents the onset of senile rheumatoid polyarthritis. The authors discuss the usefulness dosage of anti-cyclic citrullinated peptide antibodies for establishing the differential diagnosis between rheumatoid arthritis and hepatitis C-related arthropathy and the particularities of the specific treatment when there is a hepatitis C virus associated infection.

Therapeutical considerations in associated atrial fibrillation and heart failure

Atrial fibrillation is a supraventricular tachyarrhythmia very common in medical practice, often associated with heart failure. Pathophysiological relationship between atrial fibrillation and heart failure is in the attention of numerous case studies, being incomplete elucidated.

MATERIAL AND METHODS

We made a retrospective study on patients with both diseases, hospitalized in Cardiovascular Rehabilitation Hospital, Iasi, during 01.01.2013 - 31.12.2013. The obtained data allowed the classification of patients according to gender distribution, age groups, area of origin, clinical aspects, and association with other diseases, instituted treatment and appreciation of CHADS2 score. Data interpretation was performed with appropriate statistical methods.

RESULTS

We found a higher frequency of the disease among male patients, male: female ratio being 2:1; the most of the patients lived in urban area. The pick of diseases incidence was in patients over 65 years with a total percentage of 70.84% of cases. We noted that the most common symptoms were exertional dyspnea (in all patients), palpitations, dizziness, headache, fatigue, asthenia, dyspnea at rest and pain/chest pressure. In our study, the majority of patients received the beta-blocker--digoxin combination (46 patients, 40 patients respectively).

CONCLUSIONS

The coexistence of the two disorders could be explained by identifying common risk factors. Beta blockers should be the first therapeutic option in patients with chronic heart failure and atrial fibrillation because they have the effect of controlling heart rate and improve survival in patients with these disorders. Meanwhile, digoxin is a drug, only certain conditions of high accuracy monitoring; whose major clinical indications are heart failure and atrial rhythm disturbances.

Inflammatory markers in hypertensive patients and influence of some associated metabolic risk factor

Some epidemiological studies have begun to show a possible correlation between systemic and vascular inflammation and the presence of essential hypertension, especially if it is associated with metabolic risk factors (obesity, dyslipidemia, diabetes mellitus).

OBJECTIVES

The objective of this study was to evaluate the levels of C-reactive protein and fibrinogen as markers of inflammation in patients with essential hypertension, with or without associated metabolic risk factors.

MATERIAL AND METHODS

The retrospective study included 200 patients separated into five groups (control, hypertension, and respectively hypertension associated with obesity, or diabetes mellitus type II non-obese or obese type II diabetes). Anamnestic and anthropometric data, blood pressure and heart rate, blood glucose, lipid profile, fibrinogen, quantitative C-reactive protein and echocardiographic parameters have been reported and compared between groups.

RESULTS

Our study evaluated a total of 110 women and 90 men, each of the five groups comprising a total of 22 (55%) women and 18 (45%) males. Study of the inflammatory syndrome found the highest values of CRP in hypertensive and obese patients: 1.56 +/- 3.08 (p = 0.014) in group 3 and 0.92 +/- 1.11 (p = 0.001) in group 5 versus control group (0.30 +/- 0.36). Fibrinogen values were significantly elevated in all groups of hypertensive, demonstrating the existence of an inflammatory syndrome, even in the absence of obesity or diabetes.

CONCLUSIONS

All the patients showed a statistically significant relationship between elevated CRP and fibrinogen levels and the presence of hypertension, isolated, or in combination with obesity and diabetes mellitus.

Effects of two serotoninergic agents on the behavioral manifestations in rats

AIM

To investigate the effects of two serotonin receptor antagonists on spontaneous behavior in rats.

MATERIAL AND METHOD

The experiment was carried out on white male Wistar rats (150-200g) divided into 3 groups of 6 animals each, treated intraperitoneally with the same volume of solution as follows: Group I (Control): saline solution 0.1 ml/10 g weight; Group II (SB-269970): SB-269970 1 mg/kbw; Group III (NAN-190): NAN-190 1 mg/kbw. The effects of serotonin receptor antagonists on the spontaneous psychomotor skills of rats were tested in Actimeter LE-8811 (PanLab). The data were presented as mean +/- standard deviation and significance was tested by SPSS Statistics for Windows version 17.0 and ANOVA method. The experimental protocol was implemented according to the guidelines for handling and use of experimental animals of the Research Ethics Committee of the Iasi "Grigore T. Popa" University and ethical standards of the European Community.

RESULTS

The 5HT1 serotonin receptor antagonist NAN-190 determined a statistically significant reduction (p < 0.01) in both horizontal and vertical movements as compared with the control group, whereas the 5HT7 serotonin receptor antagonist SB269970 had no influence on rat behavioral manifestations.

CONCLUSIONS

In our experimental conditions 1 mg/kbw NAN-190 decreased the total escape attempts, corresponding to a significant diminution of exploratory and self-maintenance spontaneous behavior in this experimental animal model. These manifestations may be correlated with the anxiolytic effect of 5HT1 serotonin receptor antagonist NAN-190 in rats. The administration of 5HT7 serotonin receptor antagonist SB-269970 did not alter the spontaneous activity in this behavioral experimental model in rats.

Predictive value of a positive exercise stress testing and correlations with cardiovascular risk factors

Electrocardiogram exercise stress test (EST) is a widespread technique in assessment of coronary artery disease, stratifying cardiovascular risk and prognosis.

AIM

Evaluation of the impact of cardiovascular risk factors upon the results of EST.

METHODS

The 2-year retrospective study included 294 patients referred to an EST. All patients were assessed according to: presence of typical angina chest pain at admission, medical history of angina or myocardial infarction, resting electrocardiogram, global ejection fraction at echocardiographic exam and traditional cardiovascular risk factors. We compared the results between two groups: positive and negative EST.

RESULTS

The patients were age- and sex-matched. 160 patients (54.42%) had a positive EST. Positive EST was associated with typical angina chest pain at admission (88.12% vs. 76.11%, p = 0.008), coronary artery disease history (61.87% vs. 41.04%, p = 0.0003), resting ECG abnormalities (49.37% vs. 36.56%, p = 0.026), arterial hypertension (85.62% vs. 74.62%, p = 0.019). Ejection fraction was higher in the negative EST group (63.34 +/- 8.57% vs. 61.18 +/- 11.34%, p = 0.035). Type 2 diabetes mellitus, smoking, obesity, dyslipidemia and inflammatory syndrome did not significantly influence the results of the EST.

CONCLUSIONS

Typical angina, medical history of coronary artery disease, arterial hypertension, and reduced ejection fraction are strong predictors for a positive exercise stress test.

Annexins, calcium-dependent phospholipid binding proteins in irreducible heart failure

AIM

To analyze the expression and distribution of annexins V and VI in intact human hearts and in dilated cardiomyopathy (DCM) in patients with irreducible heart failure.

MATERIAL AND METHODS

The study included nine patients with DCM and irreducible heart failure. By immunoblotting and indirect immunofluorescence, the amount and location of annexins was determined using samples of left ventricular (LV) myocardium collected during orthotopic heart allotransplantation. Samples of LV myocardium from 9 individuals who died of craniocerebral trauma served as controls.

RESULTS

Quantitative analysis showed an increased level of both annexins in the myocardium of DCM patients compared with normal myocardium: 122 +/- 5% (p < 0.05) and 119 +/- 5% (p < 0.05) for annexins V and VI, respectively. In the intact heart annexin V was located at the sarcolemma and intercalated discs, while in the myocardium with heart failure mainly in the interstitium. In normal hearts, annexin VI was located at the sarcolema, including T-tubules, Z-lines and intercalated discs. In heart failure, annexin V1 was also located in the interstitium.

CONCLUSIONS

Redistribution of annexins V and VI in the cardiomyocytes in the interstitial space may have important functional consequences and indicates the role of myocardial protein expression disturbances in the etiology and/or pathogenesis of heart failure in pa-

The incidence of essential hypertension in elderly patients with metabolic syndrome

IASI, DURING OCTOBER 2010-JULY 201The arterial hypertension of the elderly represents an important public health issue, with an ever increasing tendency, due to the population ageing process.

AIM

The aim of this research is to contribute new data related to the incidence of essential hypertension in elderly patients with metabolic syndrome.

MATERIAL AND METHODS

The current study was conducted on a number of 1,832 patients hospitalized in the Cardiovascular Rehabilitation Clinic of Rehabilitation Hospital Iasi, in the period October 2010-July 2012. Of these patients we selected the ones who were 65 years of age or more and who fulfilled at least three of the five criteria that define the metabolic syndrome, using the criteria recommended by AHA/NHLBI.

RESULTS

The data obtained revealed an increased incidence of the cardiometabolic syndrome in patients over 65 years of age, in a percentage of 73%. The gender repartition revealed a higher frequency in the case of female patients (66%). Of the metabolic syndrome criteria, the highest incidence was registered for the essential hypertension. Most of the hypertensive patients were diagnosed with essential hypertension grade 3 (55%), while the rest had grade 2 (29%) and grade 1 respectively (16%).

CONCLUSION

EHT has a significant occurrence in elderly patients. It seems that hypertension of the elderly has a higher occurrence in the case of female patients, due to the lack of hormonal protection. The association with the other risk factors related to the metabolic syndrome makes the elderly more prone to the occurrence and development of cardiovascular diseases.

KEYWORDS

ESSENTIAL HYPERTENSION, ELDERLY PEOPLE,

Ebstein's anomaly

Ebstein's anomaly is a rare congenital heart disease, accounting for less than 1% of all congenital heart diseases, characterized by a wide clinical, electrocardiographic, echocardiographic, anatomic and prognostic polymorphism. The disease can be fatal since birth or may remain asymptomatic until adulthood, sometimes being associated with septal defects, transposition of great vessels, preexcitation syndromes, or left ventricular noncompaction. The genetic changes underlying this syndrome are not fully known, but in the cases associating left ventricular nonompaction a mutation in MYH7 gene encoding the beta-myosin heavy chain was recently detected. The authors present 2 cases of Ebstein's anomaly with different onset and course and discuss the current clinical, electrocardiographic and echocardiographic criteria used for prognostic stratification of Ebstein disease in relation to international literature.

Impact of metabolic syndrome on the development of cardiovascular disease

In recent years, the metabolic syndrome represents a major health problem worldwide, with a great impact in population, and also at individual level, by an increased prevalence of cardiovascular risk.

MATERIAL AND METHODS

We conducted a descriptive study on a lot of 131 patients hospitalized in Cardiovascular Clinic of Rehabilitation Hospital in Iasi, in the period April 2012 - April 2013.

RESULTS

In the analyzed group, the largest number of metabolic syndrome cases was recorded in the 50-59 years age group. There were no significant differences between the rural / urban areas (t = 0.113, p = 0.910). Frequency of ischemia was significantly higher in subjects with essential hypertension of IInd and IIIrd degree (Pearson Chi-square test = 3.955, df = 1, p <0.05). Significant differences were observed on females related to obesity and ischemia, meaning that women with higher obesity are predisposed to ischemic events. Regarding the degree of exercise testing and the origin area, no significant differences were registered (Pearson Chi-square test = 13.526, p = 0.004, df= 3).

CONCLUSIONS

Our study offers new information on metabolic syndrome, analyzing epidemiological and clinical criteria.

Heart rate variations in chronic obstructive pulmonary disease

Autonomic nervous system dysfunction proved in chronic obstructive pulmonary disease (COPD) patients might determine an elevated cardiovascular risk by heart rate alteration.

AIM

To assess the particularities of heart rate as a possible cardiovascular risk factor in COPD patients.

MATERIALS AND METHODS

This prospective, case-control study comparatively analyzed the pulse rate continuously recorded with a polygraph in 32 COPD patients and 29 healthy subjects during rest (supine and sitting position) and during submaximal exercise (6-minute walk test). The relation between pulse rate and respiratory, functional or clinical alterations was analyzed in COPD patients.

RESULTS

The mean pulse rate was significantly higher during rest and exercise in COPD patients compared with the controls. However, the chronotropic response determined by exercise was similar in COPD and control groups: 55.19 beats/minute and 57.21 beats/minute, respectively (p=0.686). The mean pulse rate during exercise correlated with hypoxemia (r=-0.354, p=0.47) and with resting pulse rate (r=0.871, p<0.001 for supine position).

CONCLUSIONS

COPD associates elevated pulse rates during both rest and exercise. Hypoxemia and resting pulse rate are determinatives of chronotropic response during submaximal exercise in COPD patients.

Influence of metabolic syndrome profile on cardiovascular risk

AIM

The trial was conducted on patients with metabolic syndrome hospitalized between 01.01.2012-31.12.2012 at Cardiovascular Rehabilitation Clinic of the Rehabilitation Hospital Iasi.

MATERIAL AND METHODS

Patients included in the study were analyzed according to age and sex, criteria for the clinical definition of the metabolic syndrome, known cardiovascular diseases, diabetes mellitus type 2 or type 1.

RESULTS

Metabolic syndrome components analysis showed statistical differences between the sexes, in case of certain cardiovascular risk factors. The frequency of cardiovascular risk factors (obesity, hypertriglyceridemia, hypertension, glycemic profile modification) was higher among women, the only risk factor most common in males was the decrease of HDL cholesterol. The statistically significant difference occurs in hypertriglyceridemia (p = 0.001) and HDL-Cholesterol (p = 0.000). Patients included in the study were studied depending on the frequency of the main cardiovascular diseases, secondary to the metabolic syndrome: ischemic heart disease, stroke, peripheral arterial disease of the lower extremities.

CONCLUSIONS

Association of impaired glucose tolerance/diabetes mellitus, arterial hypertension and hypertriglyceridemia recorded an additional risk of developing CIC or ischemic stroke, independent of sex.

The clinical-epidemological study of drugs used to treat arterial hypertension and associated comorbidities

AIM

The objective of this study was to investigate the drug treatment of AHT according to the grade and associated comorbidities: diabetes, chronic kidney disease, angina pectoris.

MATERIAL AND METHODS

This study is a retrospective one, comprising a total of 1064 patients admitted to the Clinical Rehabilitation Hospital lasi, Cardiovascular Rehabilitation Clinic between 01.01.2011 - 31.12.2012. We noted the epidemiological data on the distribution of AHT according to area of origin, sex, age, and the pharmacological treatment according to the AHT grade and related diseases.

RESULTS

The results obtained were statistically analyzed by comparing drugs used together, their number depending on the AHT grade and associated comorbidities in order to achieve target values of blood pressure and reduce cardiovascular risk. The strategies used to control blood pressure were the gradual increase of the dose of drug or its replacement, switching from monotherapy to combination therapy, starting treatment with two drugs or administration of fixed combinations.

CONCLUSIONS

The most used antihypertensive drugs were the angiotensin receptor blockers, ACE inhibitors, calcium blockers, diuretics and beta blockers. Some patients have even received triple therapy.

Body composition alterations in chronic obstructive pulmonary disease

Metabolic disorders are involved in the pathogenesis of some comorbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition.

AIM

To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients.

MATERIAL AND METHODS

A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used.

RESULTS

In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass.

CONCLUSIONS

Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

Body composition alterations in chronic obstructive pulmonary disease

Metabolic disorders are involved in the pathogenesis of some co morbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition.

AIM

To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients.

MATERIAL AND METHODS

A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used.

RESULTS

In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass.

CONCLUSIONS

Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

Significance of arterial stiffness and relationship with other noninvasive methods for the assessment of subclinical atherosclerosis inpatients with metabolic syndrome

Measurement of arterial stiffness is an accurate method of assessment of endothelial dysfunction, together with other noninvasive methods, in the diagnosis of atherosclerotic burden in patients with MetS.

MATERIAL AND METHODS

The study included 63 patients: MetS group (18 men, 20 women, mean age 58.86 +/- 8.86 years) and the control group (14 men, 11 women, mean age 59.68 +/- 10.0 years). They underwent the following examinations: assessment of arterial stiffness--pulse wave velocity (PWVao), augmentation index of brachial artery (Aixbr) and aorta (Aixao), central systolic blood pressure (SBPao); carotid ultrasound for detection of plaques and measurement of intima-media thickness (IMT); echocardiography--left ventricular hypertrophy (LVH); ankle-brachial index (ABI); biochemical parameters: C-reactive protein (CRP), fibrinogen (Fb), cholesterol (Col), HDLcol, LDLcol and triglycerides.

RESULTS

MetS patients had higher PWVao (10.06 +/- 2.12 m/s vs 8.29 +/- 1.33 m/s, p = 0.0001) and SBPao (135.06 +/- 19.80 mmHg vs. 121.76 +/- 18.62 mmHg, p = 0.009). Carotid IMT was higher in MetS group (0.92 +/- 0.11 vs. 0.83 +/- 0.10 mm, p = 0.003). Almost all MetS patients were hypertensive (94.7% vs. 52%, p = 0.01); LVH was present in 57.9% of MetS patients and 20% of the controls (p = 0.05). The MetS group presented higher Col (208.76 +/- 38.41 vs. 176.20 +/- 30.08 mg/dl, p = 0.0003) and CRP levels (0.872 +/- 0.852 mg/dl vs. 0.476 +/- 0.392 mg/dl, p = 0.01).

CONCLUSIONS

In MetS patients the most reliable marker of arterial stiffness was PWVao, followed by SBPao. Higher values of carotid IMT are also parameters of high atherosclerotic risk. CRP and Col can be considered biomarkers of high risk in MetS.

Chronic venous insufficiency stage v ceap secondary to hereditary thrombophilia at a young man

Hereditary thrombophilia is a rare disease of general population, which is responsible for debilitating consequences in severe cases. We present the case of a young male patient whose pathology and symptoms occurred since the age of two, which determined a venous insufficiency stage V with important limitation of the locomotors ability and plenty of complications. The aim of this paper is to draw attention to a disease that sometimes is not diagnosed on a first visit to the doctor.

The role of statins in deep vein thrombosis

Deep vein thrombosis (DVT) represents the formation of a blood clot in one of the deep veins of our body, predominantly occurring in the legs. According to international guidelines, the goal of the treatment in deep vein thrombosis is to prevent the progression and the recurrences of thrombotic process. The aim of this article is to explain the pathogenetic mechanism of deep vein thrombosis and the benefits of statins in such a disease. The vasoprotective effects of statins are related to their anti-thrombotic and anti-inflammatory properties. The administration of statins is associated with a lower incidence of venous thromboembolism (VTE) in the general population. It also helps in reducing the frequency of recurrences, being prescribed after an optimal 6 to 12 month anticoagulation. The study of these properties creates new opportunities for the use of statins in the prevention of post-thrombotic syndrome and recurrent venous thromboembolism (VTE).

[Prevalence of cardiovascular diseases in patients with hypothyroidism]

The cardiovascular risk in patients with hypothyroidism is related to an increased risk of functional cardiovascular abnormalities and atherosclerosis. AIMS--The purpose of the present study was to examine a possible association between subclinical and clinical hypothyroidism and cardiovascular disease (CVD). The retrospective study, which covered a 12 months period, had the purpose to establish the prevalence of various risk factors for CVD, within subclinical and clinical hypothyroidism.

MATERIAL AND METHODS

We have studied 64 subjects with subclinical and clinical hypothyroidism admitted to the Rehabilitation Hospital, in the Cardiovascular Clinic. They were divided by sex, age, living environment (urban, rural), value of cholesterol, heart rate, BMI, blood pressure. CONCLUSIONS--The study revealed an increased risk of cardiovascular abnormalities and an increased risk of atherosclerosis: 65,61% subjects were obese, 90,6% with high blood pressure, 62,5% had dyslipidaemia. Subclinical thyroid dysfunction is common in older people. The identification of subclinical and clinical hypothyroidism earlier, pursuit of markers for subclinical atherosclerosis and deployment of lifestyle changes, are elements that can also be the key in improving clinical and paraclinical parameters.

[Essential hypertension in young people--ambulatory versus hospital care]

Cardiovascular disease is the leading cause of death in our country. The number of young people with hypertension grow up quickly, so a good control of dyslipidemia and blood pressure (BP) is essential in prevention of cardiovascular disease.

AIM

To investigate the prevalence of HTA at young people and established the corelation with another risk factors like smoke, colesterol, obesity and heredity, few data are available on the blood pressure characteristics of young patients.

MATERIAL AND METHOD

It has been investigate 366 young people between 19-25 years old, in ambulatory system and 350 younger with the same age, in hospital. Blood pressure was measured according to standard procedures, and was considered well-controlled if it was < 140/90 mm Hg.

RESULTS

From our ambulatory patients were 198 women (54.1%), 168 men (45.9%) and from hospital were 178 women (50.9%) and 172 men (41.9%). HTA was present at 37 patients (10.1%) in ambulatory system and 50 patients (14.3%) in hospital. Between the intensity of smoke, the number of cigarette and the prevalence of HTA is a direct relation. The heredity factor is very important, too. The prevalence grow more than 2.5 at this patients. The incidence of HTA is 1.9 bigger at women with big values of colesterol and 2.1 at men with big colesterol. The relation between HTA--obesity is proven in our study, the incidence of HTA is 2.6 bigger at the obeses patients. These arguments should also promote further research in primary care on the control and the therapeutic behavior of the physicians.

[Upper-extremity deep vein thrombosis: current concepts in diagnosis and treatment]

Upper-extremity deep vein thrombosis is a rare manifestation of venous thromboembolic disease. In the past few decades, the clinical importance of upper-extremity deep vein thrombosis has increased because of the wider use of central venous catheters and the development of ultrasonography as a simple and accurate objective diagnostic method. Primary upper-extremity deep vein thrombosis is a rare disorder (2 per 100,000 persons per year), which comprises (1) Paget-Schroetter Syndrome, also known as effort thrombosis, and (2) idiopathic upper-extremity deep vein thrombosis. Secundary upper-extremity deep vein thrombosis develops in patients with upper extremity central venous catheters, pacemakers or cancer and accounts for most cases of upper-extremity deep vein thrombosis. The imaging modes used for diagnosis are: duplex ultrasound, magnetic resonance. Contrast venogram is the standard diagnostic test for characterization of the anatomy. A staged, multimodal approach to Paget-Schroetter Syndrome can effectively restore venous patency, reduce the risk of rethrombosis, and return the patient to normal function. Primary care physicians should be aware of this condition and its atypical presentations, because delayed recognition in a high-functioning persons can be potentially disabling.

[Variability of cardiac rate in patients with obstructive sleep apnea/hypopnea]

BACKGROUND

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses caused by upper airway collapse during sleep, leading to intermittent hypoxemia, sleep fragmentation and autonomic dysfunction. The gold standard for the treatment of OSAHS is ventilation with continuous positive airway pressure (CPAP).

AIM

To study the effect of CPAP on autonomic dysfunction in patients OSAHS, by assessing the heart rate variability (HRV) parameters before the initiation of CPAP and under CPAP during the first week and at 3 months.

MATERIAL, METHODS

We have assessed HRV parametrs by 24 hours ECG Holter monitoring in 42 patients with moderate and severe OSAHS (apnea-hypopnea index AHI > or = 15/h) without other causes of autonomic neuropathy. The assessment was made at diagnosis, during the first week of CPAP use and at 3 months of CPAP use. RESULTS. Both time domain and frequency domain HRV parameters decreased significantly during the first week of CPAP use and increased back to normal values at 3 months. Initially and during the first week of treatment, HRV parameters correlated negatively with the severity of OSAHS expressed by AHI.

CONCLUSIONS

Patients with OSAHS present an alteration of HRV, proportionally with disease severity. The decrease in HRV is revealed by the absence of apneas during the initiation of CPAP. After 3 months of CPAP treatment, the HRV parmeters are normalized independently of the disease severity.

[Clinical and epidemiologic study of cardiovascular complications in patients with metabolic syndrome]

Our study aims to identify correlations between the metabolic syndrome and cardiovascular diseases determinism.

MATERIAL AND METHODS

A retrospective study was carried out on a sample of 1463 patients of which 734 patients met the diagnostic criteria of cardiometabolic syndrome, admitted in the Clinic of Cardiovascular Rehabilitation, Rehabilitation Hospital, Iasi, between 01.01.2009-31.12.2009.

RESULTS

The incidence of cardiometabolic syndrome has a soft predominance on the group 40-59 years (61.66%). The high level of hypertension was found in the patients group 48-69 years (53.70%) and lowest in the patients group 25-38 years (11.35%) (p = 0.001). The coronary heart diseases showed a significant difference between age groups: 48-69 years (41.80%), compared to 25-38 years (7.55%) (p = 0.003). Heart failure is part of the same age distribution curve (45%, 6.8%) (p = 0.02).

CONCLUSIONS

The metabolic syndrome is a predictor of the occurrence and development cardiovascular disease.

[Spinal tuberculosis or bone metastases? Case report]

Tuberculosis remains one of the most important infectious disease worldwide and skeletal form has an incidence between 3% and 10%, depending on geographic area. The thoracolumbar junction is the most commonly involved in vertebral tuberculosis; some radiologic features are specifics, but other could be indistinguishable from that of lymphoma or metastases. We discuss the case of a 80-year-old man presented with a 2-month history of thoracolumbar pain, fatigability and fever. The vertebral radiography showed narrowing of the intervertebral disc space between T1 and T12, adjacent irregularity, erosion and lisis of vertebres, features visibles also on computed tomography. After the exclusion of the other causes of osteolisis, we started a standard regimen of tuberculostatic treatment and after one month of treatment the symptoms of patient improved noticeably. Other problems of diagnostic and treatment modalities of spinal tuberculosis are discussed.

[Hyperuricemia and the metabolic syndrome]

Uric acid is the final product of purine metabolism in human beings. Despite the fact that uric acid was first identified approximately 2 centuries ago, certain pathophysiologic aspects of hyperuricemia are still not clearly understood. For years, hyperuricemia has been identified with or thought to be the same as gout, but uric acid has now been identified as a marker for a number of metabolic and hemodynamic abnormalities.The prevalence of the metabolic syndrome is very high in hyperuricemic patients. Recent epidemiologic studies support the view that asymptomatic hyperuricemia in patients at low cardiovascular risk is likely to result from diminished renal uric acid clearance and to be benign in outcome. In contrast, hyperuricemia in patients at high cardiovascular risk may promote or reflect alternative or additional pathogenetic factors promoting inflammatory, ischaemic or oxidative stresses to the heart and vessels. This hypothesis warrants testing, particularly in carefully designed randomized controlled urate-lowering interventional trials.

Correlations between C-reactive protein and metabolic syndrome or other associated diseases

The aim of the paper is to present few aspects about the implication of the C-reactive protein (CRP) in the metabolic syndrome. High-sensitivity (hs) CRP is a marker of subclinical inflammation and it is a mediator of atherosclerotic disease. A recent study indicates a possible dose-effect relationship between waist circumference and hs-CRP levels. Elevated level of hs-CRP was associated with risk of developing metabolic syndrome (MS). However, cross-sectional studies have reported increased concentration of these inflammatory markers in both MS and over type 2 diabetes mellitus (DM) and prospective studies have found strong, graded relations between hs-CRP and incident diabetes. A growing number of large-scale studies are finding positive correlations of CRP with cardiovascular disease and these correlations are independent of smoking. The studies show that it is an association between chronic inflammation and depressive symptoms.

[Angiotensin-converting enzyme inhibitors. Current indications]

Angiotensin-converting enzyme (ACE) inhibitors are a relatively homogenous drug class widely used today. They have been shown to reduce morbidity or mortality in congestive heart failure, myocardial infarction, chronic renal insufficiency, diabetes mellitus, and atherosclerotic cardiovascular disease. Pathologies underlying these conditions are partially attributable to the renin-angiotensin-aldosterone system. Angiotensin II contributes to endothelial dysfunction, altered renal hemodynamics, and vascular and cardiac hypertrophy. ACE inhibitors attenuate these effects. Clinical outcomes of ACE inhibition include lower incidence of fatal and nonfatal myocardial infarction, reinfarction, angina, stroke, end-stage renal disease, and morbidity and mortality associated with heart failure. ACE inhibitors are generally well tolerated and have few contraindications.

[The importance of carotid ultrasound in the risk stratification of patients with ischaemic heart disease]

The stratification of cardiovascular risk is important both in primary and secondary prevention. In the clinical evaluation, besides the well-known risk factors, the European Guide of Cardiovascular Prevention recommends the identification of additional markers of risk, one of them being the detection of atherosclerotic alterations by carotid ultrasound examination. The objectives of this study were: assessment of carotid ultrasound alterations in patients with known cardiovascular disease; their relation with the other risk factors, the clinical status and echocardiography.

METHOD

The study included 144 patients, aged 41-80 (84 males, 60 women) with cardiovascular disease (stable angina, myocardial infarction, peripheral arterial disease, arterial hypertension). Risk factors as smoking, hypercholesterolemia, diabetes mellitus, obesity have been determined, followed by a clinical assessment and echocardiographic examination. Ultrasound of the extracranial carotid arteries included measurement of IMT of the common carotid arteries, the identification of atherosclerotic plaques and the presence of stenoses. The plaques were considered if the IMT was more than 1.3 mm.

RESULTS

Patients with IMT > 0.8 are older (61.5 +/- 8.2 vs. 56.1 +/- 8.2 years, p = 0.001); the prevalence of arterial hypertension is greater (63.8% vs. 21.6%, p = 0.05), and at an IMT of more than 1.1 mm all were hypertensive; the association with peripheral arterial disease is significant at the IMT = 0.8 mm (23.6% vs. 4.8%, p = 0.01). The relationship with echocardiographic markers of left ventricular hypertrophy is present at an IMT of 0.8 mm and is evident at IMT = 1 mm (interventricular septum 13.2 +/- 3 vs. 12 +/- 2.3, p = 0.05; left ventricular wall 14 +/- 5.4 vs. 12 +/- 1.7, p = 0.01; left ventricular mass 323 +/- 94 vs. 282 +/- 68, p = 0.03), and also the relation with the degree of diastolic dysfunction expressed by E/A ratio (0.71 +/- 0.24 vs. 0.99 +/- 0.39, p = 0.001). The presence of atherosclerotic plaques correlates with gender (45.1% at male vs. 24.3%, p = 0.01) and older age (61.7 +/- 8.6 vs. 56.2 +/- 8.5 years, p = 0.001). IMT and carotid plaques are not significantly correlated either with such risk factors as smoking, hypercholesterolemia, diabetes mellitus or clinical conditions as myocardial infarction and angina.

CONCLUSION

IMT greater than 0.8 mm is a marker of increased cardiovascular risk, associated with age, presence of peripheral arterial disease, arterial hypertension, left ventricular hypertrophy, and diastolic dysfunction. IMT seems to be a more reliable index of cardiovascular risk than carotid plaques. Measurement of IMT is easy to be done in clinical practice, and is recommended for more accurate risk stratification in patients with atherosclerotic cardiovascular disease.

[Adult onset Still's disease with normal level of serum ferritin]

We present a case of an adult onset Still's disease: a 51 year old men presented with one month history of high spiking fever, asymmetric migratory polyarthritis and a previous history of pharyngitis. The diagnostic was based upon clinical criteria and laboratory findings, and necessitated the exclusion of infectious, neoplastic, and other "autoimmune" disease. The systemic involvement in our case induced us to comment therapy with corticosteroid. Patients with systemic disease have a favorable prognosis, with only rare serious complications from the disease (pericarditis, tamponade, diffuse intravascular coagulation, amyloidosis, hepatic disease, and respiratory failure) or the treatment (infections, gastrointestinal bleeding etc.).

[Role of the exercise test in the assessment of left ventricular performance in ischemic heart disease]

The exercise testing is indicated at patients with ischemic heart disease for multiple purposes: it reveals ischemic changes during the exercise and the severity of them; the ekg alterations correlate with the location and the extension of coronary stenoses. The exercise capacity is a strong predictor of survival. Exercise testing is indicated in the evaluation of patients with angina pectoris, after myocardial infarction and after revascularisation procedures and the results are useful in the risk stratification of the patients.

[Carotid atherosclerotic alterations revealed at ultrasonographic examination in patients with coronary heart disease]

Carotid ultrasound examination is a noninvasive method with large indications in the evaluation of atherosclerotic lesions at cardiac patients. The aims of the study were: the ultrasound assessment of extra cranial carotid system at patients with coronary heart disease; relationship with the cardiovascular risk factors, lipid profile and echocardiographic data.

METHODS

There were studied 47 patients with coronary heart disease (angina, myocardial infarction, ischemic cardiomyopathy, CABG). The evaluation included cardiovascular risk factors, clinical examination, serum lipids and glucose, echocardiographic data. The ultrasound examination of the carotid arteries included the measurement of the diameter and intima-media thickness (IMT) of the common carotid arteries, the presence and location of atherosclerotic plaques and the presence and severity of carotid stenosis.

RESULTS

There was a significant increase of the diameter and IMT with age (p=0.009 respectively p=0.05). Males had a greater medium diameter than women (7.8 +/- 0.9 mm vs. 7.3 +/- 0.8 mm, p=0.04). There was no significant relationship between the cardiovascular risk factors (smoking, arterial hypertension, diabetes mellitus, dyslipidemia) and IMT. The thickness of the interventricular septum (at the echocardiographic examination) correlated with the IMT (p=0.03). All the patients with myocardial infarction revealed carotid atherosclerotic plaques and most of the smokers had carotid plaques (88.9% vs. 44.8%, p=0.03). Patients with carotid plaques were older (60.9 +/- 10.1 vs. 54.8 +/- 6.1, p=0.02).

CONCLUSIONS

The incidence of carotid atherosclerosis increases with age; the carotid diameter is greater at males and older patients; IMT is influenced mainly by age; carotid plaques are present mainly at older patients, at smokers and those with myocardial infarction and can be considered an additional risk factor for vascular

[Chronic myocardial infarction. Clinical symptoms in elderly patients]

Although there is an increasing prevalence of coronary heart disease at the old age, the frequency of chronic myocardial infarction seems to be less in favour of other forms of manifestation. The objective of the study was the assessment of the clinical features of patients with chronic myocardial infarction at a population of coronary patients over 65, admitted in the Department of Cardiac Rehabilitation.

METHODS

There have been selected patients over 65 years with ischaemic heart disease: 29 with chronic myocardial infarction (Group A), and 31 with other forms of coronary heart disease (Group B). There were analysed cardiovascular risk factors, symptoms, lipidic profile, echocardiographic findings.

RESULTS

Mean age of the groups A and B are 69.9 +/- 4.7 and respectively 71.6 +/- 4.9. Arterial hypertension is more frequent at group B (28/31 vs 22/29, p=0.05); at group A there is a higher rate of smoking (13/29 vs 8/31, p=0.007) and diabetes mellitus (12/29 vs 3/31, p=0.001). Dyspnea is prevalent at group B (26/31 vs 21/29, p=0.01), and the resting heart rate is greater at the same group (89 +/- 19/min vs 74 +/- 14/min, p=0.02). Group A associates more frequent atherosclerotic neurologic and peripheric disease (7/29 vs 5/31 p=0.05 and respectively 6/29 vs 4/31, p=0.01). Although the ejection fraction has similar values (53.9 +/- 10% at group A and 53.8 +/- 14% at group B), the regional contractility abnormalities are more frequent at group A (17/29 vs 11/31, p=0.005).

CONCLUSIONS

Old patients with chronic myocardial infarction are especially male gender, associate smoking, diabetes mellitus, other atherosclerotic neurological and peripheric diseases; the regional contractility disturbances are more prevalent at this group.

[Is physical training useful for elderly patients with ischemic heart disease?]

The aim of the paper is the study of the effects of a supervised physical training at old patients with ischaemic heart disease.

METHODS

74 patients with ischaemic left ventricular dysfunction have been followed during a supervised physical training consisting of a daily programme of exercise over a period of 21 +/- 10 days. They were parted in Group A (n = 26) over 60 years old and Group B (n = 48) under this age. The heart rate (HR), systolic and diastolic heart pressure (SHP respectively DHP), the time-tension index (TTI) were registered during the rest, the peak intensity of exercise and the recovery. These parameters were compared in evolution at each group and also between the groups.

RESULTS

At Group A, at the end of the period, SHP at the peak intensity decreased (from 146 +/- 19 to 137 +/- 14 mmHg, p = 0.01), also SHP in the recovery period (from 119 +/- 10 to 116 +/- 10 mmHg, p = 0.01) and HR during the recovery time (from 77 +/- 8/min to 73 +/- 6/min, p = 0.03). The total length of the session time increased (from 12 +/- 4 min to 21 +/- 6 min, p = 0.01) and also the duration of the peak exercise time (from 3.6 +/- 1.0 min to 7.7 +/- 2.9 min, p = 0.03), in the condition of maintaining a HR at the peak exercise of about 75-76% of the maximum HR obtained at a previous exercise testing. The improvement of the training parameters was similar with Group B, except the duration of the session, longer at the last group (21 +/- 6 min at Group A vs. 25 +/- 7 min at Group B, p = 0.02) and the duration of the peak intensity (7.7 +/- 1.0 min at Group A vs. 9.1 +/- 2.9 min at Group B, p = 0.02).

CONCLUSIONS

Old patients with ischaemic left ventricular dysfunction improve their exercise capacity as well as the younger ones; the benefits of a supervised physical exercise are evident regardless of age.

[Physical exercise and vascular endothelium]

Physical exercise has positive effects at patients with atherosclerotic cardiovascular diseases. These benefits are explained not only by the action upon the cardiovascular risk factors, but also by the improvement of the endothelial dysfunction. Physical exercise has vasodilator, antiplatelet, antioxidative, antiadhesive, antiproliferative and antiapoptotic effects upon the vascular endothelium. It improves the endothelium-mediated vasodilation in coronarian and peripheral beds in coronary heart disease, arterial hypertension, heart failure, diabetes mellitus, and also at sedentary and smokers, thus exerting a vasculoprotective action against atherosclerotic disease.

[Clinico-functional particularities of cardiac dysfunction in the elderly]

Ischaemic left ventricular dysfunction is more frequent at the elderly and has a series of clinical and functional peculiarities. The aim of the paper is to define the clinical, biochemical, and echocardiograph features of the older patients with ischaemic heart disease.

METHODS

189 patients with ischaemic heart disease (old myocardial infarction, angina, ischaemic cardiomiopathy) have been parted, according to age, in Group A (n = 101) over 60 years old and Group B (n = 88) < 60 years old. Symptoms, cardiovascular risk factors, lipid profile, echocardiograph findings, and the exercise testing (at the bicycle) were analyzed.

RESULTS

Ischaemic heart dysfunction appears earlier at the male gender, who is dominant at Group B (83%) in comparison with Group A (48%, p = 0.009). Myocardial infarction is more frequent at Group B (61 vs 42%, p = 0.006), and ischaemic cardiomiopathy at Group A (34% vs. 2%, p = 0.004). At Group A, symptomatic heart failure (dyspnoea of III or IV NYHA class) is prevalent (20% vs. 1%, p = 0.002). Arterial hypertension was dominant at Group A (73% vs. 58%, p = 0.02). At the echocardiograph examination, regional and diffuse contractility abnormalities were dominant at Group A, and the ejection fraction was lower (49 +/- 10%) in comparison to Group B (53 +/- 9%, p = 0.005). Diastolic dysfunction was found in 63% at Group A and 36% at Group B (p = 0.001). At the exercise testing there were not reported significant differences concerning the mechanical load according to age (87% of maximum heart rate at Group A and 83% at Group B).

CONCLUSIONS

At the old patients with ischaemic left ventricular dysfunction the presence of a myocardial infarction is not so frequent. Systolic and diastolic dysfunction of the left ventricle is more severe, the ejection fraction is lower, but the exercise capacity did not differ significant.

[Osler--Rendu Disease: an example of a family clustering in a genetic disorder]

The case of a 75 years old woman with hereditary hemorrhagic telangiectasia (HHT) is presented. This condition is an autosomal dominant mucocutaneous and visceral fibrovascular dysplasia in which telangiectasia, arteriovenous malformations and aneurysms may be widely distributed throughout the cardiovascular system. It is usually recognized as a "triad" of telangiectasia, recurrent epistaxis and a family history of the disorder.

[Ischemic left ventricular diastolic dysfunction at females: clinical aspect]

The prevalence of the coronary heart disease at females becomes close to that of the male gender at older ages. However, studies of the assessment of ischemic cardiac disfunction include a few women. The objective of the paper is the analysis of the clinical profile of women with ischemic heart disfunction.

METHODS

There have been studied 189 patients with coronary heart disease (chronic myocardial infarction, stable angina, ischemic cardiomyopathy): 63 females and 126 males. The prevalence of the coronary diseases, risk factors, symptoms, lipidic profile, radiologic and echocardiographic alterations were analysed.

RESULTS

Mean age of the male group was 56.8 +/- 12.2, and of the female was 66.3 +/- 10.9 years, significantly older (p = 0.00001). Ischemic cardiomyopathy had a greater prevalence at women (33.3% vs 11.9%, p = 0.0004), while myocardial infarction dominated at the male gender (61.9% vs 28.6%, p = 0.0001); stable angina had similar rates (20.6%, respectively 19%). Episodes of cardiac decompensation were more often at women (20.6% vs 7.1%, p = 0.0003). Arterial hypertension prevailed at females (77.8% vs 60.3%, p = 0.01), and smoking at males (72.2% vs 7.5%, p = 0.00001). Women declared more often dyspnoea (p = 0.02) and the resting heart rate was higher (87 +/- 23/min vs 75 +/- 13/min, p = 0.0007). Mean values of cholesterol were higher at women, particularly LDL: 165 +/- 49 mg% vs 149 +/- 46 mg%, p = 0.04. At X-ray examination, cardiomegaly and pulmonary congestion were dominant at females. At echo examination, the ejection fraction had similar values (52.3 +/- 9.3% at women and 51.2 +/- 11.6% at men), but left ventricular hypertrophy and diastolic disfunction were prevalent at women (87.3% vs 69.1%, p = 0.01).

CONCLUSIONS

Ischemic heart disfunction at females appears at older ages, with the dominance of ischemic cardiomyopathy and angina. At similar levels of sistolic disfunction, the diastolic disfunction, the left ventricular hypertrophy and the cardiac decompensations are more frequently at female gender.

[Clinical aspects of the left ventricular diastolic dysfunction at patients with coronary heart disease]

Is is known that, besides the systolic disfunction, the presence of diastolic disfunction influences the prognosis of patients with coronary heart disease. The aim of the paper is to study the influence of the presence of diastolic disfunction upon the clinical profile and the functional capacity of the patients with coronary heart disease.

METHODS

189 patients with ischemic heart disease (chronic myocardial infarction, stable angina, ischemic cardiomiopathy) underwent an echocardiographic examination. The diastolic disfunction was assessed at the Doppler examination, by the the ratio of the E and A velocities. Consequently, 138 patients had a E/A ratio under 1 or above 2 and were considered with diastolic disfunction (group A); the other 47 with E/A ratio between 1-2 were included in group B. After the clinical evaluation, 80 patients underwent an exercise testing (47 of group A and 33 of group B).

RESULTS

Group A had a greater mean age (62.8 +/- 11.7 vs 51.5 +/- 11.6 years, p = 0.00006) and more females (72.5% vs 46.8%, p = 0.001); dyspnoea was more frequent and severe (NYHA II-IV), the arterial pressure higher (146/85 +/- 25/13 mmHg vs 136/79 +/- 26/15 mmHg, p = 0.004) and cardiac rate higher (82 +/- 18 vs 69 +/- 11/min, p = 0.0003). The echocardiographic assessment revealed a more severe systolic disfunction and a lower ejection fraction (50.3 +/- 10.6% vs 55.7 +/- 10.6%, p = 0.003). At the exercise testing, the maximum level and the duration of exercise were lower at group A than group B (5.41 +/- 2.07 MET vs 7.23 +/- 2.78 MET, p = 0.001 respectively 8.4 +/- 4.5 min vs 11.4 +/- 4.9 min, p = 0.01).

CONCLUSIONS

The presence of diastolic disfunction is higher at older patients and at those with associated arterial hypertension. Dyspnoea correlates with the presence and severity of diastolic disfunction and the exercise capacity is lower at these patients.

[The role of exercise testing in evaluation of functional capacity at patients with ischemic ventricular dysfunction]

The assessment of functional capacity represents an important parameter in the prognostic stratification of patients with heart failure. The objective of the paper is the testing of exercise capacity at patients with ischemic ventricular dysfunction.

METHODS

There have been selected 80 patients with coronary heart disease (old myocardial infarction, angina pectoris, ischemic cardiomiopathy) admitted in the Department of Internal Medicine, Rehabilitation Hospital, Iasi, during 1.01.1998-31.12.1999. They were divided into two groups: group A (46 patients) with proper ventricular function and ejection fraction (EF) above 50% and group B (34 patients) with EF under 50%. They underwent exercise testing at the ergometric bicycle.

RESULTS

Patients of group B had higher values of resting heart rate (74 +/- 9 vs 70 +/- 11, p = 0.04). There were registered similar levels at the maximal exercise at both groups (time-tension index, watt, MET). The evolution of the group with ventricular dysfunction is distinguished by a lower length of time of exercise (8.6 +/- 4.4 vs 9.8 +/- 5.2 min, p = 0.05) and by a significantly greater value of the ST depression (1.6 +/- 1.4 vs 0.9 +/- 1.1 mm, p = 0.01).

DISCUSSION AND CONCLUSIONS

The higher resting heart rate at patients with heart failure suggests the activation of neuroumoral mechanisms, especially the adrenergic activation. These patients reach maximal levels similar to those with good systolic function but in a shorter length of time, due to a physical deconditioning or to the same neuroumoral mechanisms. Ischemia is higher at these patients.

[Clinical characteristics of patients with ischemic heart failure]

A major cause of heart failure is coronary heart disease with an increasing prevalence and progression to heart failure. The objective of the study is the analysis of the clinical peculiarities, coronary risk factors and some resting hemodynamic parameters at patients with ischemic heart failure.

METHODS

There have been studied 189 patients with ischemic heart disease. The ejection fraction (EF) assessed by echocardiographic examination was used to divide them into three groups: group A of 106 with EF above 50%, group B of 55 with EF between 40-49% and group C of 28 with EF below 40%.

RESULTS

The mean age increased from group A (58 +/- 13 years) to group C (64 +/- 11 years, p = 0.05). Ischemic cardiomyopathy was higher at group C (32% vs 13% at group A and 24% at group B, p = 0.01) and old myocardial infarction was more frequent at group A (44% vs 45% at group B and 36% at group C, p = 0.009). Group C revealed a greater incidence of dyspnea (100%) and a greater resting heart rate (83 +/- 12/min, p = 0.03). The radiologic cardiomegaly was present at group C and at 42% at group A (p = 0.001). The echocardiographic findings show a greater prevalence of kinetic abnormalities and diastolic dysfunction at group C (p = 0.002 respectively 0.009).

CONCLUSION

Patients with myocardial dysfunction are older, with a lower prevalence of myocardial infarction in contrast with a higher prevalence of cardiomyopathy. Dyspnea is the dominant symptom and the resting heart rate is higher. Systolic dysfunction is present at all patients and diastolic dysfunction at the majority. There were not differences concerning the prevalence of the coronary risk factors.

[Is the age a limiting factor of functional capacity and cardiac performance in patients with chronic myocardial infarction ?]

Actually the old age is not considered a contra-indication of cardiac rehabilitation, although it influences the prognosis of patients with chronic myocardial infarction. The objective of the paper is the study of age as a limiting factor of the cardiac performance and exercise capacity at patients with myocardial infarction at the admission in rehabilitation programmes.

METHODS

Among the patients admitted in the Department of Internal Medicine of Rehabilitation Hospital of Iasi there were selected 132 with chronic myocardial infarction; they were divided into two groups: group A of 56 patients more than 55 years old and group B of 76 under 55. There were analysed the clinical features (risk factors, symptoms), the cardiac performance (by echographic study of the regional and global abnormalities of myocardial contractility) and the functional capacity (by exercise testing at the ergometric bicycle).

RESULTS

Both groups were similar by the point of view of the prevalence of the risk factors and location of the infarction. The ejection fraction, although smaller at the group A (45% vs 50%), did not reach the statistical significance. The exercise testing revealed a lower capacity of the group A, marked by higher levels of the cardiac rate and time-tension index at similar levels of exercise. The metabolic equivalent (MET) and VO2max were significantly lower (p = 0.001 respectively 0.002). There can be concluded that the age diminishes the exercise capacity of the patients with myocardial infarction without a marked influence of the cardiac performance. The last one depends on the infarction size and the myocardial status while the lowering of the functional capacity is influenced by noncardiac factors as well.

[Goldenhar syndrome in adults]

The paper presents the case of a 43 year old female patient with multi-malformations syndrome (facio-auriculo-vertebral syndrome), distinguished by alterations of the skeleton, face, sensorial organs and the heart. The syndrome is dominant at young ages and scarce at adults, and the explanation of the favorable evolution could be the lack of severe visceral or central nervous system involvement. The peculiar anomalies of this case are: asymmetric face, epibulbar dermoid, dysplastic ears, auricular tags, conductive and sensorineural deafness, fusion of vertebrae, hemivertebrae, ventricular septal defect.