THE ROLE OF NT PRO-BNP IN THE EVALUATION OF DIABETIC PATIENTS WITH HEART FAILURE.

CONTEXT: The prevalence of patients with concomitant heart failure (HF) and diabetes mellitus (DM) is high. OBJECTIVE: To analyze the role of NT-pro-BNP levels in the evaluation of diabetic patients with heart failure. DESIGN: Retrospective comparative cohort study. SUBJECTS AND METHODS: A total of 174 patients admitted to our Cardiology Department, previously diagnosed with HF, were enrolled. Among these patients, 47.7% had DM. HF was defined according to the 2016 ESC criteria. The NT-pro BNP levels above 126 pg/mL indicate a high probability of heart failure. RESULTS: In diabetic patients there were significant correlations between NT-pro-BNP values and the following parameters: hemoglobin (rho=-0.28, p=0.01), hematocrit (rho= -0.27, p=0.014), total cholesterol (rho= -0.21, p=0.048), triglycerides (rho= -0.283, p=0.01), ejection fraction (rho= -0.465, p<0.0001), end-diastolic volume (rho= 0.253, p= 0.026), end-systolic volume (rho= 0.29 p=0.01). Only the following 3 parameters: ejection fraction (p= 0.0009), hemoglobin (p= 0.0092) and triglycerides (p= 0.0380) were independent predictive factors for elevated NT-pro-BNP values. CONCLUSION: In diabetic heart failure patients, the value of NT-pro-BNP holds a pivotal role in the evaluation of their overall status, facilitating the establishment of correct management and follow-up.

Cardiovascular profiles of scleroderma patients with arrhythmias and conduction disorders.

Introduction Arrhythmias and conduction disorders are common among patients with scleroderma. Their early identification is important, since scleroderma patients with arrhythmias have a higher mortality risk compared with scleroderma patients without arrhythmias. The aim of this study was to characterize the cardiovascular profiles of scleroderma patients with different types of arrhythmias and conduction disorders. Methods One hundred and ten consecutive patients with a diagnosis of systemic sclerosis according to the ACR criteria were included in the study. Patients underwent a 12-lead ECG and a 24-hour Holter ECG monitoring for arrhythmias and conduction disorders identification. Blood sample testing, echocardiography, spirometry, chest X-ray and, when considered appropriate, high resolution chest CT were also performed. A subgroup of 21 patients underwent NT-pro BNP level measurements. Patients' clinical and para-clinical characteristics were compared according to the presence or absence of arrhythmias and conduction disorders. Results The prevalence of arrhythmia and conduction disturbances was 60.9%. Patients with such disorders were older (54.4 ± 13.3 vs. 49.7 ± 10.1 years, p=0.05), had a higher prevalence of pulmonary hypertension (p=0.008), valve disease (p < 0.001), especially mitral and tricuspid regurgitation, chamber enlargement on echocardiography (left atrial and right ventricular, p = 0.012 and 0.005, respectively) as well as higher NT-pro BNP levels: 265.5 ± 399.7 vs. 163 ± 264.3 pg/ml, p=0.04. Conclusion Arrhythmias and conduction disorders are common in patients with scleroderma. Patients with such disorders are older, have a higher prevalence of pulmonary hypertension, more severe mitral and tricuspid regurgitation, left atrial and right ventricular dilation on echocardiography.

Serum ghrelin level is associated with cardiovascular risk score.

UNLABELLED: Ghrelin, a newly discovered bioactive peptide, was originally reported to induce growth hormone release. Recent studies have shown beneficial hemodynamic effects of ghrelin in the cardiovascular system to support the wide distribution of its receptors in cardiovascular tissues. The aim of the study was to determine whether cardiovascular risk factors influence plasma ghrelin levels. METHODS: We evaluated in the Rehabilitation Hospital Cluj-Napoca, Cardiology-Department 88 consecutive subjects, 65 (73.86%) being women, with mean age 61.7 +/- 10.33 years. We assessed the presence of cardiovascular risk factors (obesity, arterial hypertension, diabetes mellitus, metabolic syndrome, smoking and lipid fractions). Plasma ghrelin levels were determined with a commercial ELISA kit (pg/ml). RESULTS: After the evaluation of cardiovascular risk factors, we found no statistically significant difference between ghrelin levels in the patients with vs those without cardiovascular risk factors (p>0.05). A negative correlation was found between ghrelin levels and age, r = -0.32 (p <0.05). Using the HeartScore Internet tool we calculated the cardiovascular risk for each patient according to the risk score system (SCORE) for high cardiovascular risk countries. Statistically, the risk of fatal cardiovascular events in the next 10 years was indirectly correlated with the ghrelin levels in each patient-correlation between ghrelin levels and SCORE system r = -0.25, p=0.015. In conclusion, low serum ghrelin concentrations are associated with an increased global cardiovascular risk, calculated based on the European SCORE scale. However, we could not demonstrate a direct relationship between any of the major risk factors and ghrelin.

Role of Duke treadmill score in the diagnosis of ischemic heart disease in women.

UNLABELLED: Ischemic heart disease is underdiagnosed in women due to atypical symptomatology as well as to the lower specificity of several paraclinical tests, such as exercise stress testing. The aim of the study was to ascertain whether the Duke treadmill score (DTS) could be an efficient parameter in the diagnosis of ischemic heart disease in women. MATERIAL AND METHOD: 105 patients were enrolled in the study, 45.71% women with average age ranged between 20 and 70 years, investigated in the Rehabilitation Hospital, Cardiology-Departament, Cluj-Napoca, Romania. All the patients were clinically assessed as concerns the presence of cardiovascular risk factors, and they underwent electrocardiographic, echocardiographic and treadmill stress tests. DST was calculated according to the formula: exercise time--5 x (ST deviation expressed in mm-4 x Angina Index). RESULTS: DTS was lower in women as compared to men: 2.54 +/- 5.36 vs. 6 +/- 4.69, p=0.0006. 54.28% of the patients were ranged with a low DTS risk category, whereas 45.71% belonged to a moderate and high risk category. DTS was significantly lower in women than in men with high blood pressure (2.03 +/- 4.8 vs. 5.8 +/- 4.28), hypercholesterolemia (1.14 +/- 4.51 vs. 6.24 +/- 4.13), diabetes mellitus (1.83 +/- 3.73 vs. 6.13 +/- 4.8), and obesity (2.42 +/- 5.35 vs. 5.81 +/- 4.64). By analyzing the presence of cardiovascular risk factors only in women, we noticed that only those with high blood pressure (2.03 +/- 4.89 vs. 8.13 +/- 7.85) and hypercholesterolemia (2.31 +/- 4.76 vs. 3.89 +/- 5.95) had a statistically significant low DTS (p<0.05). In conclusion, our research, which showed differences in DTS between women and men, raises concerns about the early diagnosis of ischemic heart disease in women.

Renin Genetic Polymorphism in Heart Failure Patients.

BACKGROUND: Genetic polymorphism of renin-angiotensin-aldosterone system affects the pathogenesis of hypertension (HTN), ischemic heart disease (IHD) and heart failure (HF). The purpose of our study is to analyze A/G renin genetic polymorphism in heart failure patients. METHODS: We investigated renin polymorphism in 83 subjects hospitalized in the Cardiology Department of the Rehabilitation Hospital Cluj-Napoca, using the PCR amplification method. 43 patients were diagnosed with heart failure [NYHA III-IV class], and 40 subjects without cardiovascular disease (control group). The NT-proBNP and the presence of cardiovascular risk factors were assessed. RESULTS: Heart failure etiology was IHD in 60.46% of patients. The average value of NT-pro BNP was 2991.24 ± 2034.6 pg/ml. As it was expected, HF patients presented low lipid levels: total cholesterol = 162.36 ± 38.28 mg/dl, LDL-Cholesterol = 104.88 ± 27.60 mg/dl, triglycerides= 109.12 ± 55.84 mg/dl, HDL-Co = 35.68 ± 9.55 mg/dl. A/G renin genetic polymorphism [with pathogenic potential] in heart failure patients was of 60.46% (homozygote 4.65% and heterozygote 55.81%). Conversely, pathogenic mutations were found only in 38.46% of hypertensive patients, but also in 55.88% and 22.22% patients with obesity/overweight and diabetes. The heterozygote form was found in only 37.5% of control subjects. CONCLUSION: This study showed no involvement of A/G renin polymorphisms in the pathogenesis of HF.

Novel cardiovascular risk markers in women with ischaemic heart disease.

The incidence of coronary heart disease in premenopausal women is lower than in men because of their hormonal protection. Angina pectoris occurs in women about 10 years later than in men. However, mortality from ischaemic heart disease remains higher in women than in men. Current studies are focusing on novel cardiovascular risk biomarkers because it seems that traditional cardiovascular risk factors and their assessment scores underestimate the risk in females. Increased plasma levels of these newly established biomarkers of risk have been found to worsen endothelial dysfunction and inflammation, both of which play a key role in the pathogenesis of microvascular angina, which is very common in women. These novel cardiovascular risk markers can be classified into three categories: inflammatory markers, markers of haemostasis, and other biomarkers.

Novel Cardiovascular Risk Markers in Women with Ischaemic Heart Disease : Review Article

The incidence of coronary heart disease in premenopausal women is lower than in men because of their hormonal protection. Angina pectoris occurs in women about 10 years later than in men. However; mortality from ischaemic heart disease remains higher in women than in men. Current studies are focusing on novel cardiovascular risk biomarkers because it seems that traditional cardiovascular risk factors and their assessment scores underestimate the risk in females. Increased plasma levels of these newly established biomarkers of risk have been found to worsen endothelial dysfunction and inflammation; both of which play a key role in the pathogenesis of microvascular angina; which is very common in women. These novel cardiovascular risk markers can be classified into three categories: inflammatory markers; markers of haemostasis; and other biomarkers

Role of secretory phospholipase A2 in women with metabolic syndrome.

BACKGROUND & OBJECTIVES: Secretory phospholipase A2 (sPLA2), a member of the phospholipase A2 superfamily of enzymes that hydrolyses phospholipids, is a potentially useful plasma biomarker for atherosclerotic cardiovascular disease. Cardiovascular diseases are the leading cause of mortality in women. The purpose of this study was to investigate the correlation between cardiovascular risk factors and the sPLA2 levels in women with metabolic syndrome as compared to women without metabolic syndrome and men with metabolic syndrome. METHODS: Patients (n=100) with various cardiovascular risk factors consecutively evaluated at the Rehabilitation Hospital-Cardiology Department, Cluj-Napoca, Romania were enrolled during 2011, of whom 10 were excluded. The patients were divided in three groups: group 1 (37 women with metabolic syndrome), group 2 (27 men with metabolic syndrome), and group 3 (26 women without metabolic syndrome). Body weight, smoking habits, glycaemia, hypertension, and serum lipids fractions were analysed as cardiovascular factors. Serum sPLA2 activity was measured using the chromogenic method. RESULTS: There were no statistically significant correlations between sPLA2 levels and the investigated risk factors, irrespective of patient groups. However, there were significant positive correlations between sPLA2 and hsCRP in all three groups (P<0.05). In women with no metabolic syndrome an negative correlation was found between sPLA2 levels and HDL-C- r=-0.419, P=0.03. In men with metabolic syndrome there was a direct correlation between sPLA 2 levels and HOMA, r=0.43, P<0.05, 95% CI (-0.098; 1.15). INTERPRETATION & CONCLUSIONS: Women with metabolic syndrome did not display different sPLA2 levels as compared to men with metabolic syndrome and women without metabolic syndrome. However, women with metabolic syndrome demonstrated a low but positive correlation between sPLA2 and hsCRP levels.

Correlations between the surface ECG and the intracavitary electrocardiogram in typical atrial flutter.

UNLABELLED: Typical atrial flutter (cavo-tricuspid isthmus-dependent) has as an electrophysiological substrate a macro-reentry circuit localized in the right atrium. Depending on the right atrial depolarization sequence, the rotation of the macro-reentry circuit can be counterclockwise (with an inferior to superior activation of the right atrium free wall and superior to inferior activation of the interatrial septum), characterized by negative F waves in inferior leads (DII, DIII, aVF) and V6, and positive in V1 on the surface electrogram (ECG), or clockwise (with a superior to inferior activation of the right atrium free wall and inferior to superior activation of the interatrial septum) characterized by positive F waves in inferior leads (DII, DIII, aVF) and V6, and negative in V1. Nevertheless, it is considered that for the diagnosis of the typical or atypical nature of this arrhythmia, the surface ECG has limited value. The purpose of this study was to compare the relationship between the flutter rotation sequence determined by the intracavitary electrogram and the morphology of the F waves on the surface ECG. METHODS: The study included 387 patients admitted to the Cardiology - Rehabilitation Hospital from Cluj-Napoca between January 2007 and May 2010, diagnosed with typical atrial flutter during an electrophysiological study. Using the intracavitary electrograms the flutter rotation sequence was determined (clockwise or counterclockwise). The F waves' aspect on the surface ECG in leads DII, DIII, aVF, aVL, V1 and V6 was then analyzed. RESULTS: One hundred and fifty two patients (39.3%) were diagnosed with clockwise atrial flutter and 235 patients (60.7%) with counterclockwise atrial flutter. The positive predictive value (PPV) of negative F waves in inferior leads and positive in V1 was, in the case of counterclockwise atrial flutter 98%; the negative predictive value (NPV) was 79%; sensitivity (Se) was 83% and specificity (Sp) was 97%. For typical clockwise atrial flutter, the PPV of the positive F waves in the inferior leads and negative in V1 was 94% (p < 0.001); the NPV was 85%; Se was 73% and Sp was 97%. CONCLUSION: The surface ECG has a high value in determining the macroreentry circuit rotation sequence in the case of typical atrial flutter.

Assessment of the correlation between two defining criteria for bidirectional isthmic block in the ablation of typical atrial flutter.

BACKGROUND: A complete, bidirectional conduction block in the cavotricuspid isthmus (CTI) represents the end-point of the typical atrial flutter ablation. We investigated the correlation between two criteria for successful ablation, one based on the atrial bipolar electrogram morphology before and after complete CTI conduction block, compared to the standard criteria of differential pacing and reversal in the right atrial depolarization sequence during coronary sinus (CS) pacing. METHOD: We conducted a retrospective study in 111 patients (81 males, average age 62±10 years) who underwent an atrial flutter ablation during September 2007 - July 2009 in the Cardiology - Rehabilitation Hospital, UMF Cluj-Napoca. We assessed the presence of a bidirectional block at the end of the procedure using the standard criteria. We then analyzed the morphology of the bipolar atrial electrograms adjacent to the ablation line, before and after CTI conduction block. RESULTS: A change from a qRs morphology to a rSr' morphology when pacing from the coronary sinus and from a rsr' morphology to a QRS morphology when pacing from the low-lateral right atrium was associated with a CTI conduction block. Sensitivity (Se), specificity(Sp), positive predictive value (PPV), negative predictive value (NPV) were 96%, 89%, 99% and 67% respectively. CONCLUSION: Our study suggests that the analysis of the atrial bipolar electrogram next to the ablation line before and after CTI ablation may be used as a reliable criterion to validate CTI conduction block due to its high sensitivity, specificity and positive predictive value.

Four hundred meters walking test in the evaluation of heart failure patients.

UNLABELLED: The best evaluation of the severity and prognosis of heart failure patients is obtained by the maximal exercise stress testing, but for the very large number of HF patients and for evaluation of their daily effort capacity submaximal stress testing, mainly 6 minutes walking test are used. The limit of 6mWT is that during it the patients are not motivated to walk and also, the periphery, so important for heart failure patients, is not equally involved. OBJECTIVE: To compare a new fixed walking test-400m walking test with 6MWT and maximal exercise testing. METHODS: There were investigated 20 patients with dilated cardiomyopathy (DCM). The patients were included in the study after the relief of the congestive syndrome. Each patient was submitted in three consecutive days to a maximal symptom-limited exercise stress test on cycloergometer, a six minutes walking test, a 400 meters walking test. The last one consisted of walking on a corridor 40 meters long, at a speed chosen by the patient himself. The results were expressed in seconds representing the necessary time to cover the established 400 meters of distance. RESULTS: During cycloergometer exercise stress test the calculated mean peak VO2 was 15.2 +/- 1.4 mlO2/kg/min (4.32 METs). The mean distance walked during 6MWT was 350 +/- 34m and the mean time needed to walk 400m (400mWT) was 300 +/- 27 seconds. The correlation between peak VO2 and distance walked during 6MWT was -0.40, a similar but negative value (r = -0.42) being registered between peak VO2 and time registered during 400mWT. Only weak correlation was registered between LVEF and all the three tests. In turn the correlation between distance registered during 6MWT and time registered during 400mWT was excellent: r = -0.60. CONCLUSION: 400mWT is a useful tool for the evaluation of submaximal effort capacity of CHF patients. Its value to evaluate exercise capacity is similar with that of the 6 MWT, but 400mWT can assure a better evaluation of peripheral involvement.

The effect of very short duration acute physical exercise upon adiponectin and leptin in overweight subjects.

BACKGROUND: Adiponectin is decreased and leptin increased in overweight subjects. In turn, exercise has controversial effect upon adiponectin and leptin plasmatic levels. PURPOSE: To study the effect of acute exercise upon plasmatic levels of adiponectin and leptin in normal and overweight subjects. METHOD: We studied 79 subjects, 42 males and 37 females, aged 56 +/- 9 years, divided into two groups. Group I consisted of 19 patients with body mass index (BMI) < 25 kg/(m)2 and group II consisted of 60 overweight subjects (BMI > 25 kg/(m)2). All subjects were submitted to a maximal symptom limited exercise stress testing on cycloergometer, upon classical protocols (mean effort 103 +/- 27 Ws). Venous blood samples were obtained before exercise (sample I) and at 30 minutes after the effort was stopped (sample II); adiponectin and leptin levels were determined, using ELISA method. RESULTS: At rest adiponectin is significantly decreased and leptin increased in overweight subjects. In turn, during exercise the values of the two adipokines were not significantly different from those registered at rest in both groups, even if the adiponectin remained at a low level and leptin decreased at the limit of significance in overweight subjects. Considering men and women, the data are similar for men but, after exercise, overweight women registered a significant reduction of the leptin values. Also at rest adiponectin levels are more increased in overweight women (p = 0.01). This suggests that overweight women can be protected in comparison with men and exercise could add a supplementary benefice. CONCLUSION: Acute exercise has little effect upon adiponectin and leptin levels, but rest adiponectin is increased and leptin significantly decreased during exercise in overweight women and could be beneficial to this category of subjects.

[Some cardiovascular effects of alcohol. Prospective study on 200 patients between 2006-2008]. / Consideratii privind unele efecte ale alcoolului asupra metabolismului lipidic. Studiu prospectiv pe 200 de pacienti în perioada 2006-2008.

UNLABELLED: Several studies have confirmed that drinking a moderate amount of alcohol (ethanol) decreases the risk of heart disease, heart attack, and stroke. There are several mechanisms of health benefits of alcohol, which include antiinflammatory, antioxidant and anti-blood clotting effects. The aim of the study is to underline the effects of alcohol consumption over cholesterol blood levels. MATERIAL AND METHODS: The study was conducted on 200 individuals from urban and rural areas of Iasi county (100 being alcohol consumers), during the 2006-2008. RESULTS: The cholesterol blood levels are greater than the normal accepted values, both in men and women (urban and rural), drinkers or nondrinkers. CONCLUSION: The cholesterol levels are higher in drinkers, women and rural population included in our study. We did not do a quantification of other factors which may increase the cholesterol blood levels, such as diet, body mass index and physical activities.

The role of radiofrequency ablation as a first line therapy in the treatment of atrial flutter.

UNLABELLED: Cavo-tricuspid isthmus radiofrequency (RF) ablation is an efficient option in the treatment of atrial flutter. In the case of a well-tolerated, first episode of atrial flutter, it has a class II indication, level of evidence B, the current first-line therapeutic option being electrical cardioversion, pharmacological cardioversion or atrial overdrive pacing followed by long-term antiarrhythmic therapy. The purpose of this study was to evaluate, in a prospective manner, the recurrence rate of these two different therapeutic options after the treatment of a first episode of atrial flutter. MATERIAL AND METHODS: Between January 2007 and May 2009, for 99 patients admitted to the hospital for a first episode of atrial flutter, cardioversion was attempted either by RF ablation (group 1-42 patients), or by electrical cardioversion, pharmacological cardioversion or atrial overdrive pacing followed by long-term Amiodarone therapy (group 21-57 patients). We compared the recurrence rate of atrial flutter in the 2 groups after a follow-up period of one year. RESULTS: In group 1, sinus rhythm was achieved in all patients, with bidirectional isthmic block being obtained for 37 patients (88.1%). In group 2, conversion to sinus rhythm was obtained in all cases. The recurrence rate was 6 times higher in group 2 vs group 1 (57.9% = 33 patients vs 9.5% = 4 patients) (p = 0.01). CONCLUSION: RF ablation should be considered as a therapeutic option in the treatment of the first episode of atrial flutter, due to its significant efficiency in maintaining sinus rhythm and to its low recurrence rate.

The acute effect of Metoprolol upon NT-proBNP level in patients with congestive heart failure.

UNLABELLED: Brain natriuretic peptide (BNP) is a sensitive and specific marker of left ventricular (LV) function. The acute effect of beta blockers upon plasma BNP levels in CHF patients has been less studied but it is important because of the initial possible depressing effect upon LV function. PURPOSE: To investigate the acute effect of oral Metoprolol upon plasma proBNP levels in CHF patients. METHODS: There were included 56 patients with congestive heart failure, 38 with ischemic heart disease and 18 with idiopathic dilated cardiomyopathy, 40 males and 16 females, aged between 25 and 65 years, who were compared with 19 healthy individuals, 12 males and 7 females, of the same age. All patients were free of beta blockers treatment. Plasma Nt-proBNP was determined in fasting state using ELISA method (NV <250 fmol/mL). After this, every patient received 50 mg Metoprolol succinate and at three hours (considered as peak plasmatic concentration) venous blood samples were again obtained and Nt-proBNP determined. RESULTS: NT-pro BNP was increased (1400 +/- 130 fmol/mL) in heart failure patients and normal (187 +/- 17.2 fmol/mL) in healthy controls. After Metoprolol the plasmatic level of NT-proBNP was not significantly different in both healthy controls (162 +/- 13.3 fmol/mL) and heart failure patients (1419 +/- 133 fmol/ml) in comparison with baseline values. After Metoprolol NT-proBNP decreased (from 1266 +/- 121 to 1120 +/- 107, p>0.05) in III NYHA class patients and increased (from 1457 +/- 142 to 1530 +/- 150, p<0.05) in IV NYHA class patients. It remained unchanged in patients with LVEF >30% (1384 +/- 140 vs 1389 +/- 129 fmol/mL) and increased (from 1480 +/- 134 to 1690 +/- 161 fmol/mL, p<0.05) in patients with LVEF <30%; it was not significantly modified in patients with atrial fibrillation in comparison with those in sinus rhythm (1348 +/- 132 vs 1516 +/- 168 fmol/mL). CONCLUSION: Beta blockers do not have a severe depressant effect on left ventricular performance in all patients with systolic heart failure. A LVEF>30% suggests, but the lack of modification of NT-proBNP levels after administration of 50 mg Metoprolol confirm, that the beta blocking treatment can be initiated with higher doses than those recommended until now.

Drug secondary prevention in postmenopausal women with ischemic heart disease.

UNLABELLED: It is known that, in comparison with men, women with cardiovascular disease are undertreated, including drug treatment. This aspect was less studied with respect to drugs used for secondary prevention. METHODS: In an urban Romanian community there was studied a representative sample of 150 postmenopausal women with cardiovascular disease (62.7% of them with ischemic heart disease-IHD). We considered the secondary prevention by drugs. The results were compared with those registered in a similar sample of 160 men aged >55 years with cardiovascular disease (68.1% of them with IHD). The study was carried out using general practitioner's files. RESULTS: According to the literature, there were considered as preventive drugs: antiplatelet agents, statins, beta blockers and ACEI. Aspirin was used in 56.4% of the women and 72.5% of the men (p<0.05), ACEI in 69.1% and 79.8 % (p>0.05), beta blockers in 69.1% and 74.3 % (p>0.05) and statins in 48.9% and 48.6% (p>0.05). The results show that antiplatelet drugs are underused in ischemic patients, but especially in women. The maximum use of preventive drugs in women was registered after acute myocardial infarction (beta blockers 85.7%, statins 50%, aspirin 60.7%, ACEI 75%). In turn, the myocardial revascularization by CABG and PCI is low in both groups, but much less in women than in men: CABG 1.1% in women, 4.6% in men p>0.05, PCI 5.3% in women and 13.8% in men p<0.05. CONCLUSION: In postmenopausal women with ischemic heart disease the secondary prevention by drugs is similar with that applied in men, except aspirin and ACEI, which are underused.

Endothelial dysfunction in metabolic syndrome.

Metabolic syndrome (MS) or insulin resistance syndrome is the result of multiple metabolic abnormalities associated with cardiovascular disease. Since 1988, when Reaven first described MS, many researches have been conducted in order to understand its pathophysiology, epidemiology, prognostic implications and therapeutic strategies. Numerous metabolic abnormalities found in the metabolic syndrome, including hyperglycemia, excessive fatty acids and insulin resistance, cause an endothelial cell dysfunction by affecting nitric oxide synthesis or degradation. Although the exact mechanism by which metabolic syndrome induces endothelial dysfunction remains to be clarified, there are many possibilities of vascular endothelial damage and increase in cardiovascular risk in these patients. The most frequent metabolic, hormonal, hemostatic abnormalities in patients with metabolic syndrome that may contribute to endothelial dysfunction are: hyperinsulinemia, hyperglycemia, increase in fatty acid levels, hypertriglyceridemia, decrease in HDL-cholesterol, increase in small dense LDL-cholesterol, increase in apolipoprotein B, increase in insulin-1 growth factor levels, increase in tissue angiotensin II levels, increase in plasminogen activator inhibitor-1, increase in C reactive protein, increase in oxidative stress.

[Prospective study about some of the cardiovascular effects of alcohol in 200 patients between 2006-2008]. / Studiu prospectiv privind unele din efectele alcoolului asupra sistemului cardiovascular la 200 de pacienti, in perioada 2006-2008.

UNLABELLED: There are many controversial concerning the role of alcohol in these diseases. MATERIAL AND METHODS: The aim of the study is to underline some of the risks and benefits of alcohol consumption in cardiovascular system, using Holtter ECG and measuring the levels of some blood constants. The study was conducted of 200 individuals of urban and rural areas of Iasi county (100 being alcohol consumers), during the 2006-2008. RESULTS: The cardiac arrhythmias are more frequent in rural alcoholic women, and the diastolic disturbances in drinkers. Prevalence of myocardial infarction is higher in urban non-alcoholic men. CONCLUSION: Even there are some benefits, the alcohol consumption still remain a risk factor for cardiovascular diseases. A clearer conclusion can be made if the daily alcohol intake is precisely evaluated, knowing that the patients' personal appreciation of alcohol dozes could be an error factor for the study.

Rehabilitation in diabetic patients.

Physical activity is very important for diabetic patients. In normal subjects physical activity postpones diabetes mellitus and in diabetic patients postpones the cardiovascular complications. In diabetic patients with cardiovascular disease, physical training increases exercise capacity, decreases complications and prolongs survival. Physical activity can be applied in diabetic patients as physical activity counseling or physical training, the second being recommended to be ambulatory and supervised but, sometimes, also home rehabilitation can be useful. Aerobic exercises, but also resistance exercises will be applied for a 30-60 min duration at least 3x/ week, recommended 5x/ week, and optimal every day. Some specific aspects of diabetic patients as hyper or hypoglycemia, autonomic or peripheral neuropathy, retinopathy, have to be considered during physical rehabilitation and sometimes physical training has to be modulated according to them. In conclusion, physical activity and training represent a real chance for every diabetic patient and has to be recommended and applied in all of them.

Drug treatment of heart failure patients in a general Romanian hospital.

OBJECTIVE: It is very well known that in clinical practice, according to the published guidelines, the heart failure patients are undertreated. There are striking differences in applying the guidelines in various countries and, up to the present, there are no consistent data for Romania. MATERIAL AND METHODS: There were studied 459 heart failure patients admitted in the Cardiology Department of a general hospital in Cluj-Napoca, Romania. They were evaluated from the point of view of the drugs used during hospitalization and recommended to be taken after discharge. RESULTS: The patients, 393 males and 66 females, aged 61+9 years (lower in comparison with other countries) were included in NYHA III and IV class, except 3%, in NYHA II class. The ischemic etiology was registered in 56% of the patients. Drug treatment was as follows: diuretics--86.98%, ACEI--77.77%, beta blockers--55.95, ARB's--7%, digoxin--51.63%, aldosterone antagonists--49%, nitrates--61.28%, statins--24%, antithrombotic therapy--60% (antiplatelet--45.75%, anticoagulants--28.5%), antiarrythmics--27.91% (mainly amiodarone). In comparison with other European countries, the use of RAAS antagonists is similar, there are more beta blockers and nitrates used, but there is less use of antithrombotic therapy (especially anticoagulation) and of statins. CONCLUSION: Even though Romania still belongs to the group of developing countries, the drug treatment of heart failure patients does not much differ from the treatment applied in developed countries.