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Acute myocardial infarction (AMI) causes severe metabolic and electrophysiological changes that induce silent or symptomatic life-threatening arrhythmias. Ventricular arrhythmias and atrial fibrillation are common during the early phase of AMI and are also important prognostic factors. Rapid identification and treatment of these arrhythmias can be life-saving, since in-hospital mortality rises dramatically in patients who develop arrhythmias with a fast ventricular rate following an AMI. Along with myocardial revascularization, adequate pharmacological therapy of hemodynamically relevant arrhythmias is generally useful. Since there are no controlled randomized trials comparing different antiarrhythmic drugs (AADs) in AMI, optimal decision making is based on medical societies guidelines recommendations and clinical judgement.

Lately, RV dysfunction has emerged as a significant prognostic factor in heart failure with reduced ejection fraction (HFrEF). More so, recent data show a specific pattern of RV contraction in LBBB patients that is corrected by CRT, but not in patients with RV failure. The importance of RV evaluation in CRT patients is still under debate. Establishing the role of RV function in the setting of CRT may help identify patients with high risk of adverse events. Moreover, the changes induced by CRT upon RV may lead to a better understanding of the mechanisms behind CRT effects and may facilitate novel criteria for optimal selection of CRT candidates.

BACKGROUND Right ventricular - arterial (RV-PA) coupling can be estimated by echocardiography using the ratio between (TAPSE) and pulmonary arterial systolic pressure (PASP). TAPSE/PASP ratio proved to be a prognostic parameter in patients with heart failure and reduced ejection fraction (HFrEF). OBJECTIVE To evaluate the significance of RV-PA coupling in patients with HFrEF undergoing cardiac resynchronization therapy (CRT). METHODS Patients undergoing CRT in our center between January 2017 and November 2019 were eligible. Response to CRT was defined by a reduction of more than 15% of left ventricle systolic volume (LVESV) one year after CRT. Primary endpoint was a composite of HF hospitalizations and death during follow-up. RESULTS 54 patients (Age 64.0 ± 13.8 years; 58% male; left ventricular ejection fraction (LVEF) 28.4 ± 1.3%) were prospectively included. After a mean follow-up of 31 ± 12.9months, the primary endpoint had occurred in 18 (33.3%) patients. A lower TAPSE/PASP ratio was associated with baseline worse HF symptoms, lower LVEF and long-term less LV reverse remodeling (P

Optimal antithrombotic therapy in patients with AF who undergo coronary stenting for an ACS has been a subject of constant change, with the addition of numerous trials in recent years. Objectives: The aim of our study was to assess current antithrombotic treatment in patients with AF and ACS treated with PCI. Material and methods: We performed a observational retrospective study on patients with nonvalvular AF, ACS and PCI between January 2017 and May 2019. We assessed both ischemic risk (IR) and haemorrhagic risk (HR) according to the 2018 ESC guidelines strategies. Results: 184 patients with nonvalvular AF and ACS treated with PCI were eligible for inclusion. In the whole cohort the HR was significantly higher than the IR (3.66+/-1.15 respectively 2.84+/-1.15, p < 0.001). NSTEMI carries both the highest IR and HR (p

Objectives To provide preliminary data on practice of stress perfusion cardiovascular magnetic resonance (CMR) in a single center in Romania. Methods We retrospectively reviewed the clinical files and CMR reports of patients who underwent stress perfusion CMR in our institution between January 2018 and December 2020. Results A total of 1036 patients underwent CMR examinations during this period in our institution. Of these, 120 patients had stress perfusion CMR. The most common indication was the assessment of myocardial ischaemia in patients with established coronary artery disease (CAD) (77 patients, 64.16%), with either a history of myocardial infarction or previous coronary revascularization, or with intermediate lesions on invasive coronary angiography (ICA). The other indications consisted in detection of ischaemia in patients with suspected CAD (36 patients, 30%), characterization of the substrate of ventricular arrhythmia (5 patients, 4.16%) and assessment of the etiology of dilated cardiomyopathy (DCM) (4 patients, 3.33%). All patients had vasodilator stress with adenosine and an adequate stress response was obtained in 113 patients (94.16%). There were 21 patients (18.58%) with an abnormal stress test and patients with intermediate lesions on ICA had the highest prevalence of positive reports (24.32%). Sixty-three patients had myocardial fibrosis (52.5%): 49 patients (40.83%) had subendocardial (ischaemic) scars, while 14 patients (11.66%) had non-ischaemic scars. There were no serious adverse events related to the procedure. Conclusions This is the first report in Romania on the use of stress perfusion CMR in clinical practice. We report our experience on stress efficiency, acquisition protocol, artifacts, prevalence of positive tests and safety. Most stress CMRs were requested in patients with established CAD.

Background: Recent data suggest that the mechanisms contributing to ischaemic mitral regurgitation (IMR) in the setting of acute myocardial infarction (MI) are different compared to chronic IMR. However, little is known about the dynamic changes over time of mitral valve (MV) geometry after acute MI. Methods and results:Comprehensive three-dimensional (3D) assessment of the MV geometry was performed in 30 patients in the first 7 days after a first ST elevation myocardial infarction (STEMI), and after 4 years of follow-up. The MV annulus diameters and area remained unchanged over time, however the MA became progressively flatter (mean difference of annular height 0.19±0.33 cm, p

Both supraventricular and ventricular arrhythmias may occur in patients without relevant epicardial coronary disease, significant structural heart disease or channelopathies. Their underlying mechanism is often unclear, and may sometimes be attributed to a preexistent coronary microvascular dysfunction which facilitates arrhythmias. Furthermore, arrhythmias may promote coronary microvascular dysfunction. We sought to clarify this relationship, starting from a clinical case of atrial fibrillation in a patient with coronary microvascular dysfunction and no epicardial coronary disease. We then explored various clinical scenarios which include ventricular arrhythmias, non-ischemic structural cardiac disease, cardiac pacing, bradyarrhythmias and conduction abnormalities.

Background: We aimed to evaluate whether right ventricle (RV) longitudinal strain indexed to pulmonary arterial systolic pressure (PASP) has prognostic significance in patients undergoing cardiac resynchronization therapy (CRT). Methods: Patients undergoing CRT were prospectively included. The primary endpoint was adverse cardiovascular events (death and HF-related hospitalizations). RV global longitudinal strain (RVGLS) and RV free wall strain (RVfwS) were measured by speckle tracking and indexed to echocardiographic estimated PASP. Results: A total of 54 patients (64.0 ± 13.8 years, 58% male) were included. After 33 ± 12.9 months, the primary endpoint occurred in 18 patients. Baseline RVGLS/PASP and RVfwS/PASP showed good discriminative ability for response to CRT (AUC = 0.88, 95% CI (0.74–1) and AUC = 0.87, 95% CI (0.77–1)). RVGLS/PASP and RVfwS/PASP were significantly associated with high risk of events at univariate analysis (HR 0.039, 95% CI (0.001–0.8) p &lt, 0.05, respectively HR = 0.049, 95% CI (0.0033–0.72), p &lt, 0.05). Upon multivariate Cox regression analysis, RVGLS/PASP and RVfwS/PASP remained associated with high risk of events (HR 0.018, 95% CI (0.0005–0.64), p = 0.02 and HR 0.015, 95% CI (0.0004–0.524), p = 0.01) after correction for gender, etiology, QRS duration and morphology. Conclusions: Indexing RV longitudinal strain (global and free wall) by PASP provides a parameter, which independently identifies patients with high risk of cardiovascular events and predicts non-response to CRT.

Objective: To study frequency and peculiarities of cardiovascular disorders in hypertensive pheochromocytoma (pheo) patients (pts). Design and methods: 250 hypertensive pheo pts (112 males and 138 females, mean age 41.7 11.8 y) were retrospectively studied. Tumors were located in adrenals in 232 (right 120, left 92, both 20) and were extraadrenal in 18 pts. 38 pts had recurrent pheo. All pts were operated and pheo was verified as benign (n1⁄4108), malignant (n1⁄4139) and borderline (n1⁄43) by histology. Tumor’s weight varied from 15 to 900 g and size from 1.5 to 12 cm. Results: In 41 of 250 pts (16.4%) hypertension was malignant (M), in 141 pts including 3M (56.4%, 2.1 %M) paroxysmal, in 70 pts including 31M (28.0%, 44.3 %M) sustain with crises, in 39 pts including 7M (15.6%, 17.9 %M) sustain without crises. Pulmonary edema was diagnosed in 8 of 250 pts (3.2%). Renal arteriography (n1⁄440) revealed renal artery stenosis (RAS) in 3 cases (7.5%), in 2 of them RAS was reversible. According to ECHOCG (n1⁄440) cardiac valve prolapse was registered in 19 pts (47.%), left ventricular hypertrophy 16 pts (40.0%). Myocardial infarction (MI) like changes were seen in 12 of 250 pts (4.8%), and postinfarction cardiosclerosis in 2 pts with recurrent pheo (0.8%). ECG 12 was normal in 20 pts (8%); different arrhythmias, conduction disorders were registered in 66 pts (26.4%). Holter ECG-monitoring (n1⁄440) revealed different arrhythmias in 19 pts (47.5%), dangerous ventricular arrhythmias (VA) in 7 pts (17.5%) and life-threatening VA in 2 pts (5%). Transient stroke was diagnosed in 14 (5.6%), both severe stroke and retinal detachment in 4 (1.6% each) of 250 pts. Conclusions: MI-like changes and reversible RAS were most likely caused by coronary or renal artery spasm, and were resolved after therapy with alpha-blockers and pheo removal. MI related to coronary atherosclerosis was observed in patients with recurrent pheo. Stroke, pulmonary edema and retinal detachment were related to high BP during hypertensive crises. Various arrhythmias were registered with Holter ECG-monitoring in 47.5% pheo pts, but dangerous and life-threatening ventricular arrhythmias in 17.5% and 5% respectively. Cardiac valve prolapse was revealed in nearly half of the pheo pts, most frequently mitral valve prolapse was seen. Most complications of high BP took place in pheo pts with malignant hypertension. In most cases (44.3%) malignant hypertension was observed in patients with sustain hypertension with crises.