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Cristina Vacarescu,1 Dragos Cozma,1,2 Lucian Petrescu,1,2 Simona Dragan,1,2 Cristian Mornos,1,2 Simina Crisan,1,2 Horea Feier,1,2 Mihai-Andrei Lazar,1 Ramona Alina Cozlac,1,2 Constantin Tudor Luca1,21Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania; 2Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, RomaniaPurpose: Left ventricle (LV)-only pacing is non-inferior to biventricular pacing but permanent fusion pacing is needed to ensure cardiac resynchronization therapy (CRT) responsiveness. The role of systematic exercise testing (ET) in these patients has not been established. This study was designed to assess clinical and therapeutic implications (device programming/drugs) of systematic ET in patients requiring fusion-pacing CRT without an right ventricle (RV) lead.Methods: Consecutive patients with a right atrium/LV-only dual-chamber (DDD) pacing system were included. Prospective data were obtained: device interrogation, ET, and echocardiography at every 6-month follow-up visit. CRT assessment during ET included maximal heart rate, beat-to-beat echocardiography analysis of LV fusion pacing, LV loss of capture, and improvement in exercise capacity. If LV loss of capture or unsatisfactory LV fusion pacing occurred, reprogramming was individualized for each patient and ET redone.Results: A total of 55 patients (29 male) aged 62±11 years were included. During follow-up (39±18 months), a total of 235 ETs were performed, with mean exercise load 6.4±1.3 metabolic equivalents of task (118±35 W, maximal heart rate 119±17 beats/min). Twenty patients (36%) had inadequate pacing or loss of LV capture during ET, due to exceeding the maximum tracking rate (11%), chronotropic incompetence (7%), and LV pacing outside the fusion-pacing band (18%), caused by physiological shortening of the PR interval or exagerated LV preexcitation during maximum exercise. Post-ET CRT-device optimization included reprogramming of rate-adaptive atrioventricular interval (total decrease 23±8 ms), individualized programming of maximum tracking rate, or rate-response function. Drug optimization was performed in 32% of patients, and ET redone in 36%.Conclusion: In one of three ETs, an intervention in device and medication optimization was done to ensure a better outcome. Routine ET should be a standard approach to maximize fusion-pacing CRT response during follow-up.Keywords: cardiac resynchronization therapy, LV-only pacing, exercise test, constant fusion pacing

ABSTRACT: An aneurysm is defined as a localized dilation of a blood vessel or heart. It may have either a congenital or an acquired origin and occurs in both humans and animals. Cardiac aneurysms are rare, and are characterized by sacculations of the cardiac wall. The present case report describes the macroscopic and microscopic findings of an aneurysm affecting both ventricles of the heart in a dog. A 7-year-old mixed-breed female dog with osteosarcoma on the left pelvic limb was euthanized and submitted to the veterinary pathology laboratory for necropsy. Macroscopically, besides the lesions in the link, the pericardial sac was adhered to the pericardial surface of the heart and there were two sacculations in both ventricles which communicated widely with the respective ventricle. Microscopically, fibrous tissue adhered to the pericardium, atrophy and necrosis of the cardiomyocytes with replacement by adipocytes were observed in addition to hyperplasia of the tunica media of arterioles and thrombosis. A diagnosis of acquired biventricular cardiac aneurysm was made based on the necropsy findings and microscopic lesions in the heart. We emphasize the importance of performing a necropsy and examining tissues histologically for the diagnosis of this rare condition. Ventricular aneurysms should be included in the differential diagnosis of cardiovascular disease in dogs.

O tumor venéreo transmissível canino é uma das neoplasias mais comuns principalmente em cães errantes, sendo classificado morfologicamente como uma neoplasia de células redondas. O presente trabalho tem por objetivo relatar um caso de tumor venéreo transmissível (TVT) metastático em uma cadela adulta sem raça definida (SRD). Na avaliação necroscópica, verificou-se a presença de neoformações na vulva/vagina, no baço e na pleura parietal, nas quais todas exibiam as mesmas características macroscópicas. Para elucidação do caso, realizaram-se exames citológicos e histológicos, com o intuito de observar padrões morfológicos semelhantes nos três tecidos analisados, sendo compatíveis com TVT. A metastização é uma complicação incomum nesse tipo de neoplasma, embora na literatura sejam encontrados relatos evidenciando a capacidade metastática do TVT, a ocorrência é com maior frequência em animais imunossuprimidos e os principais tecidos acometidos são os linfonodos regionais. Os órgãos cavitários, entretanto, também podem ser sítios de metástase, conforme averiguado no presente caso. Embora sejam raras, conclui-se que as metastizações podem ocorrer e realça-se a importância da inclusão do TVT como diagnóstico diferencial de neoplasias intracavitárias.

Sudden death (SD) in athletes is a potential avoidable dramatic scenario. When done regularly, cardiological evaluation increases the chances of diagnosing ventricular pre-excitation. Consequently, the following question arises: what is the real incidence of SD risk in athletes with Wolff-Parkinson-White (WPW) syndrome/pattern? This study included 84 consecutive patients diagnosed with WPW and was designed as a retrospective analysis of data acquired between 2011 and 2021 to answer this question. The patients were evaluated using a 12-lead electrocardiogram (ECG), echocardiography, stress test, and electrophysiological study (EPS). The SD risk linked to WPW was defined as ≥ 1 of the following: the anterograde effective refractory period (AERP) of the accessory pathway (AP) ≤ 250 ms, atrial fibrillation (AF) with the shortest RR pre-excited interval ≤ 250 ms, syncope during AF or atrioventricular reentry tachycardia. The athletes with WPW pattern (n=25) or syndrome (n=59) at risk of SD were identified and treated with radiofrequency ablation (RFA). The mean age was 19.83 (10–29) years; 66.6% were men. Seventeen athletes (n=17; 20.23%) were found with SD risk: 15 (n=15; 17.85%) in the WPW syndrome group and 2 (n=2; 2.38%) in the WPW pattern group. During the EPS, n=4 developed syncope: 1 during antidromic tachycardia and 3 during pre-excited AF. RFA was curative in 96.42% of cases. The EPS is mandatory to identify athletes with short AERP APs linked to an increased risk of SD. RFA is the intervention that settles the patients into a risk-free area, allowing resumption of sports shortly afterward.

Diana Aurora Bordejevic,1 Tudor Pârvănescu,2 Lucian Petrescu,1 Cristian Mornoș,1 Ioan Olariu,1 Simina Crișan,1 Cristina Văcărescu,1 Mihai Lazăr,1 Vlad Ioan Morariu,2 Ioana Mihaela Citu,2 Mirela Cleopatra Tomescu,2 Dragoș Cozma1 1Cardiology Department, Institute of Cardiovascular Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 2Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Tudor Pârvănescu; Ioana Mihaela CituVictor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, Timișoara 300041, RomaniaTel +40 724 369729; +40 723 280 623Fax +40 256 220636Email tudorparvanescu@gmail.com; ioanamihaela2010@gmail.comBackground: Patients with acute myocardial infarction (AMI) are at high risk for left ventricular (LV) remodeling and heart failure. We aimed to study whether LV strains (S) and strain rates (SR) could predict cardiac remodeling in patients with AMI having a midrange or preserved LV ejection fraction (EF) following a percutaneous coronary intervention (PCI) within the first 12 hours from the onset of symptoms.Patients and Methods: This is a case-control observational study including patients admitted for their first AMI, either with ST-segment elevation (STEMI) or without ST elevation (NSTEMI), with an LVEF > 40% after a successful PCI. Echocardiography was repeated after 6 months, and the patients were divided into two groups, according to whether LV remodeling was determined on echocardiography.Results: Of the 253 AMI patients (mean 66 aged ± 13 years), including 185 males (73%), 61 (24%) presented signs of LV remodeling. In univariate logistic regression analysis, age, male sex, smoking history, hypertension, hypercholesterolemia, Killip class, renal function, peak creatine phosphokinase - MB level, 2- and 3-vessel coronary artery disease (CAD), and several echocardiographic parameters were significantly associated with LV remodeling (P< 0.05). In multivariate logistic regression analysis harmed (H) LS and SR, Killip class, 3-vessel CAD, and LV end-diastolic volume were outlined as independent predictors for LV remodeling. Receiver operating characteristic curve analyses showed that HLS and HLSR were the most powerful independent predictors for LV remodeling (P< 0.001), with an area under the curve (AUC) of 0.85 (sensitivity 83%; specificity 84%; p < 0.001) and 0.77 (sensitivity 93; specificity 61%; p < 0.001), respectively. The identified cut-off values for predictor variables were HLS< − 11%, and HLSR< − 0.65s− 1.Conclusion: We concluded that 2D-STE was the best method to evaluate LV remodeling in patients with AMI and midrange or preserved LVEF following myocardial revascularization by a PCI.Keywords: AMI, PCI, preserved LVEF, midrange LVEF, 2D speckle tracking echocardiography, LV remodeling

Introduction. Hypertrophic cardiomyopathy (HCM) is a disease with increased left ventricular (LV) wall thickness not solely explained by abnormal loading conditions, with great heterogeneity regarding clinical expression and prognosis. The aim of the present study was to collect data on HCM patients from different centres across the country, in order to assess the general characteristics and therapeutic choices in this population.

Simina Crişan,1,2 Lucian Petrescu,1,2 Mihai Andrei Lazăr,1,2 Cristina Văcărescu,1,2 Alina-Ramona Nicola,1 Dragoş Cozma,1,2 Cristian Mornoş,1,2 Constantin Tudor Luca1,2 1Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 2Institute of Cardiovascular Diseases, Timisoara, Romania Abstract: The evaluation of patients diagnosed with impaired systolic function heart failure represents a great challenge, in both the general and elderly population. We consider that elderly patients are the most severely affected by this disease that represents the final impact of cardiovascular disease continuum. Cardiovascular diseases are associated with serious morbidity and mortality, and considerable health care costs related to diagnosis and treatment. In this report we discuss some controversies regarding methods of heart failure evaluation as well as therapeutic steps and devices, including: reparatory therapeutic steps and initiation of therapy with loop diuretics, inconsistent dose titration for angiotensin-converting enzyme inhibitors/angiotensin receptor blocker and beta blockers, as well as novel therapies, such as angiotensin receptor neprilysin inhibitor and treatments that directly improve cardiomyocyte function. We conclude that, beyond technical progress, which is raising the cost of therapy for patients with heart failure, more careful monitoring of patient progress through clinical and paraclinical control visits, both at medical facilities and at home, would have greater impact and be more cost-effective. Physical therapy and promoting emotional and psychological wellbeing, to maintain a positive state of mind, contribute substantially to the quality of life and life expectancy, and are most important in elderly people who are most affected by dramatic reductions in wellbeing. Unfortunately, for many patients with severe impairment of left ventricular ejection fraction, these goals and therapeutic procedures are often lacking in current health care systems.Keywords: impaired left ventricular ejection fraction, heart failure, therapeutic controversies, elderly population

Background: Cardiac arrhythmias and conduction abnormalities are frequently identified by emergency medical service staff in patients requesting emergency services.

Scop: Această cercetare are drept scop stabilirea unei corelaţii genotip-fenotip la pacienţii trataţi cu acenocumarol şi studierea factoriilor genetici (polimorfismele VKORC1 şi CYP2C9), care ar putea influenţa valorile INR în timpul iniţierii terapiei anticoagulante orale cu acenocumarol. Material şi metode: Am inclus 131 de pacienţi care necesitau tratament cu acenocumarol, 70 (53,4%) femei şi 61 (46,6%) bărbaţi, internaţi în Clinica Medicala 5 din Cluj-Napoca, între 2009-2011. Am studiat influenţa vârstei, sexului, medicaţiei concomitente şi a genelor CYP2C9 şi VKORC1 asupra valorii INR măsurate în ziua a treia de tratament şi asupra diferenţei dintre această valoare şi valoarea INR măsurată la debutul tratamentului (INRDIF). Rezultate şi concluzii: Am demonstrat o diferenţă semnificativă statistic pentru INR3 şi valorile INRDIF la pacienţii cu genotip AA şi cei cu genotip GG ai polimorfismului c.- 1639G>A al genei VKORC1. Prezenţa genotipului AA al polimorfismului c.- 1639G>A al genei VKORC1 a determinat o creştere de 15,7 ori a riscului ca un pacient să prezinte INR supraterapeutic după 2 zile de tratament cu 4 mg de acenocumarol.

Asset revaluation can trigger different signals to investors depending upon company type, asset intensity and category and investors’ expectations. In the same time, motivations behind asset revaluation decisions are diverse, being influenced by management incentives, credit covenants, faithful representation and various other reasons. In many cases the revaluation decision is imposed upon the company by auditors or the need to reduce information asymmetry. In Romania, one of the main decision drivers is the Fiscal Code, due to buildings taxation provisions. For companies that revaluate their fixed assets for taxation purposes only (which is the case for most small companies in Romania), the primary concern is to reduce the fiscal impact – the preferred scenario in this case is most likely to be the one that reduces tax expenses. Our research aims to provide a full picture of the motivations behind the revaluation decision and point to the manipulation instruments made available to companies by the allowed alternatives in what regards (1) which assets to be revalued and (2) how to recalculate book values. By means of a case study we identify the options available to a revaluating company and show how each one can impact the financial statements and financial ratios, thus influencing financial statement users’ perception. Our analysis is limited to fixed assets revaluation, as these are the ones revaluated by most Romanian companies. The comparative analysis shows that the decision to not revaluate certain assets categories can lead to serious distortions of the faithful image. Financial ratios can be significantly impacted by the type of assets revalued, depending upon the revaluation direction (upward or downward) and the revaluation differences. In upward revaluation leverage ratios and solvency can improve, leading to a better position in relation to credit covenants. Equity is also positively affected. Alternatively, a decrease of assets’ value will be reflected in a negative manner upon these indicators, which might be a serious reason for a company to not revaluate, thus not preserving the true and fair value of assets in the financial statements. Companies can choose between two alternatives of recalculating book values and depreciation. The option taken can also influence the company’s financial position. Our study shows that impact over profitability is lower and that profit tax is not affected in a significant manner even if an influence can be identified.

Tangible assets revaluation has an impact over equity, profit and the financial indicators of the company, several being relevant for the decision making process of investor’s and company management. The revaluation process is usually done by valuation experts who have to start their mission departing from the accounting information regarding the revalued assets. A sound understanding of accounting rules and of the necessities of the revaluation process is essential for a reliable revaluation. Lack of specific accounting knowledge on the valuer’s side can lead to distorted representations of the valued assets which will affect faithful representation, have accounting and fiscal impacts and can also raise problems when auditing the company. The quality and valuation expertise of the called-in appraiser are also relevant for the outcome of the revaluation process, especially if market values evidence is scarce or the revaluated assets are highly specialised. We present the actions that the valuer and the entity have to pursue in order to ensure a reliable revaluation process, contributing thus to a better understanding of the practical approach to assets revaluation and its specific requirements.