Predictors for the Development of Major Adverse Limb Events after Percutaneous Revascularization-Gender-Related Characteristics.

Background and Objectives: Revascularization has been proven to be superior to medication for symptom improvement in patients with peripheral arterial disease (PAD). There are well known gender differences in therapeutic strategies for PAD. The influence of gender on post-angioplasty prognosis is not fully understood though. The present study aims to identify potential peculiarities between men and women undergoing peripheral angioplasty, as well as factors responsible for those differences. Material and methods: 104 consecutive subjects (50 women and 54 men) who underwent percutaneous angioplasty (PTA) between January and October 2019 for symptomatic PAD were included. Demographics, PAD history, cardiovascular risk factors, comorbidities, the associated coronary or cerebrovascular diseases, biological parameters, drug-treatment and PTA type and technique were taken into account. The follow-up period was 2 years, during which major adverse limb events (MALE) were documented. Results: The mean age was 67 ± 10 years. Women were 4 years older than the men (69 ± 10 years vs. 65 ± 9.2 years-p = 0.04). Smoking was more prevalent in men (p = 0.0004), while other cardiovascular risk factors did not differ significantly. The mean follow-up of the two groups was 21 ± 2.4 months. Women had infra-inguinal involvement more frequently (78%), while men exhibited mixed disease, with supra + infra-inguinal (37%) or solely supra-inguinal (20.3%) involvement (p = 0.0012). Rates of MALE were similar in the two groups (p = 0.914). Gender did not influence the incidence of PAD-related adverse events. The only parameter that proved to have a significant influence on the occurrence of MALE was the ankle-brachial index (ABI). A value below 0.5 was found to be an independent predictor for MALE (p = 0.001). Conclusions: There was no significant difference in the incidence rates of MALE between the two genders over a 2-year follow-up period post-PTA. Regardless of sex, an ankle-brachial index value below 0.5 was the sole independent predictor for limb-related adverse events.

Major Left Bundle Branch Block and Coronary Heart Disease-Are There Any Differences between the Sexes?

Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = -0.52, p = 0.0012 vs. R = -0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women.

The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation.

AIMS: Intracardiac echocardiography (ICE) is a relatively young technique used during complex electrophysiology proce-dures, such as atrial fibrillation (AF) ablation. The aim of this study was to assess whether the use of ICE modifies the radia-tion exposure at the beginning of the learning curve in AF ablation. MATERIALS AND METHODS: In this retrospective study, 52 patients, in which catheter ablation for paroxysmal or persistent AF was performed, were included. For 26 patients we used ICE guidance together with fluoroscopy, whereas for the remaining 26 patients we used fluoroscopy alone, all supported by electroanatomical mapping. We compared total procedure time and radiation exposure, including fluoroscopy dose and time between the two groups and along the learning curve. RESULTS: Most of the patients included were suffering from paroxysmal AF (40, 76%), pulmonary vein isolation being performed in all patients, without secondary ablation sites. The use of ICE was associated with a lower fluoroscopy dose (11839.60±6100.6 vs. 16260.43±8264.5 mGy, p=0.041) and time (28.00±12.5 vs. 42.93±12.7 minutes, p=0.001), whereas the mean procedure time was similar between the two groups (181.54±50.3 vs 197.31±49.8 minutes, p=0.348). Radiation exposure was lower in the last 9 months compared to the first 9 months of the study (p<0.01), decreasing gradually along the learning curve. CONCLUSIONS: The use of ICE lowers radiation exposure in AF catheter ablation from the beginning of the learning curve, without any difference in terms of acute safety or efficacy. Aware-ness towards closest to zero radiation exposure during electrophysiology procedures should increase in order to achieve better protection for both patient and medical staff.

The role of multimodal imaging in the diagnosis of an asymptomatic patient with congenital anomaly.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary anomaly, which can cause potentially fatal complications, such as heart failure, myocardial infarction and sudden cardiac death. Only a few patients left untreated survive to adulthood. We highlight the importance of multimodal imaging in the diagnosis of ALCAPA syndrome in a young asymptomatic female patient with inducible ischemia on exercise. The patient was successfully treated with surgery.

CV RISK - A new relative cardiovascular risk score.

BACKGROUND AND AIMS: Nowadays it is recommended to use risk scores to evaluate the magnitude of cardiovascular risk in healthy people, most popular being SCORE (Europe) and Framingham and ASCVD (US). Unfortunately, they are not enough motivating in young and old population, don't consider protective factors and cannot be used in cardiovascular patients always included in very high risk category. To improve the evaluation everytime of individual cardiovascular risk we described a new score - CVRISK (cardiovascular relative individual risk). METHODS: It uses 15 items and can be used also in cardiovascular patients. The first seven items are clinical - age and gender, heredity, smoking, hypertension, obesity, psychosocial stress, previous cardiovascular disease. For items refer to laboratory data - LDL-C, HDL-C, TG, fasting plasma glucose (diabetes mellitus). The last two are protective factors - physical activity and healthy diet. RESULTS: Every item has a number of risk points and protective factors decrease with 25% and 15% the calculated risk. The risk can be automatically calculated after the introduction of the required data through an algorithm available at www.cvrisk.ro. Here, the calculated risk is compared with optimal and maximal risk. Thus the user is motivated to initiate or to continue preventive measures also suggested at www.cvrisk.ro, to improve cardiovascular health. CONCLUSION: CVRISK is not a substitute of current risk scores, but a complimentary tool to appreciate and modulate the individual cardiovascular risk. It can be useful to prevent CV disease or to improve its evolution. Individuals themselves can calculate it in order to maintain or improve their health.

The Association Between Six Surrogate Insulin Resistance Indexes and Hypertension: A Population-Based Study.

Background: The relationship between insulin resistance and hypertension is well established, but the association of different surrogate insulin resistance indexes with the presence of hypertension is still under debate. The aim of this study was to compare the strength of the association between the presence of hypertension and six indexes: triglyceride/HDL cholesterol ratio (TG/HDL-C), Triglyceride Glucose (TyG) Index, Visceral adiposity index (VAI), Lipid accumulation product (LAP), TyG-Body mass index (TyG-BMI), and TyG-Waist circumference (TyG-WC). Methods: Data from a cross-sectional epidemiological study enrolling a sample representative for the Romanian population aged 18-80 years, excluding those with diabetes or requiring treatment for hypertriglyceridemia, were used to calculate the six indexes. The association with the presence of hypertension was examined with binomial and multinomial logistic regression. Results: In multinomial logistic models, which included age, gender, smoking, drinking, sedentary lifestyle, estimated glomerular filtration rate, urinary sodium, urinary albumin creatinine ratio, and use of medications known to influence insulin resistance as covariates, all individual components and surrogate insulin resistance indexes were independently associated with the presence of hypertension. Values of pseudo R square ranged from 0.342 for the multivariate model including TG/HDL-C to 0.357 for the model including TyG-WC, but with no clear superiority of any of the tested indexes over all others. Models including BMI and WC had a similar ability to predict the presence of hypertension as most of the surrogate indexes and they were slightly superior to TG/HDL-C and TyG. Conclusions: Although TG/HDL-C, VAI, LAP, TyG, TyG-BMI, and TyG-WC were independently associated with the presence of hypertension, no superiority could be demonstrated over the use of BMI and WC as predictors of hypertension in this cross-sectional study.

Echocardiography as the first diagnostic clue to rapidly progressive systemic AL amyloidosis associated with multiple site thrombosis. A case report.

AL-amyloidosis is a rare, but complex disease, with a severe prognosis, cardiac involvement being found in half of the patients. The rapid increase of the LV wall thickness predicts an unfavorable evolution. We report the case of a 63-year-old man diagnosed with AL-amyloidosis, with cardiac involvement, associated with multiple site thrombosis.  Specific echocardiographic methods like tissue Doppler imaging and speckle tracking provided crucial diagnostic and prognostic information.