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Aims. Flow mediated vasodilatation (FMD) is impaired in chronic congestive heart failure (CHF). An inverse correlation exists between humeral artery diameter (HAD) and FMD, related to the shearing stress magnitude. Material and Methods. This study investigates the influence on HAD and FMD exerted by the presence and severity of congestive status in heart failure. The study included 16 p with ischemic cardiomiopathy (group A) and 20 p with hypertensive cardiomiopathy (group B), all in sinus rythm. Recordings were made before and after the correction of the congestive state and control of blood pressure. Data recorded at the beginning and the end of hospital stay, in each of the groups, were compared; data were also compared between the two groups. Results. In group A, a significant HAD decrease at rest was found, during correction of the congestive status (4.8±0.2 mm vs. 3.9±0.1 mm, p<0.001), as well as a significant FMD increase (5.4±0.9 mm vs. 7.8±0.8 mm, p<0.001). Similar data were found in group B, after congestive status correction and blood pressure control: significant rest HAD decrease (4.8±0,2 vs. 4.0±0.1 mm, p<0.001) and significant FMD increase (5.4±0.9 vs. 7.8±0.8 mm, p<0.001). The magnitude (%) of the HAD decrease after the congestive status correction in the two groups, was similar (17.3±5.3 vs. 17.3±3.4, NS). Conclusions. Congestive status in heart failure is associated not only with venous congestion, but also with arterial diameter increase. The congestion corection in CHF is associated with an arterial diameter decrease, which could in turn lead to an improvement of the impaired endothelial function. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Many recent clinical observation have revealed the presence of both pulmonary and tracheobronchial lymphadenopathy in patients with congestive heart failure. That lymphadenopathy is reversible and disappears after treatment for heart failure. In this paper we study the venous circulation of tracheobronchial and pulmonary lymph nodes in order to establish the role of vascularization in the reversible mediastinal lymphadenopathy in patients with congestive heart failure. MATERIAL AND METHODS: We studied cardiopulmonary blocks collected during necropsy of cases with a history of congestive heart failure. We have used microscope dissection coupled with colored gelatin injection and light microscopy to define the detailed anatomy of the tracheobronchial and pulmonary lymph nodes circulation. RESULTS AND DISCUSSIONS: We identified large anastomosis between the pulmonary venous circulation and the systemic venous circulation. These anastomoses had tortuos paths and were equipped with valves. In the medullary region of the pulmonary and traheobronchic lymph nodes, we noticed ectatic veins of variable sizes that increase the volume of the node and reduce the cortical region to a small peripheral band. CONCLUSIONS: The increase of volume of the traheobronchic and pulmonary lymph nodes in heart failure is caused by ectatic veins in the medullary region. The presence of ectatic veins can be explained by the increase of blood volume in the pulmonary venous system caused by the pulmonary-systemic anastomoses. This mechanism could explain appearance of the tracheobronchial lymphadenopaty in congestive heart failure. [ABSTRACT FROM AUTHOR]

Chronic heart failure is considered the most costly cardiovascular disease, which is also valid in Romania's case. One of the most frequent aggravation and death causes in the case of CHF is dilated cardiomyopathy (DCM) rhythm disorders. The aim of the present paper is to assess the prevalence of atrial fibrillation (AF) in DCM patients hospitalized in the Rehabilitation Hospital of Cluj-Napoca. Material and method: 164 patients diagnosed with DCM based on ESC criteria were included in the study, out of a total of 470 patients suffering from NYHA I-IV CHF functional class, hospitalized in the Rehabilitation Hospital between 2003 and 2004. They were divided in two study groups: group I- including 136 patients with cardiac rhythm disorders and group 1Iincluding 28 patients suffering from DCM, however with no rhythm disorders. CHF was defined based on European Society for Cardiology criteria set in 2008 (3). We analyzed the types of rhythm disorders in group 1, the recommended antiarrhythmic drugs, as well as the comparative characteristics of the two study groups from age, sex, cardiovascular risk factors, CHF aetiology, ECG and echocardiography parameters, ECG Holter/24 hours monitoring viewpoints. The statistic analysis was based on t-Student test. Results: The prevalence of the rhythm disorders in the 470 CHF patients was of 82.9%. The arrhythmia with the highest prevalence in group one was atrial fibrillation, in 45.6% (62 patients). The distribution of arrythmias in patients with sinus rhythm at rest (27.94%-38p) was paroxysmal AF episodes -57.89% (22 p) and different types of extra systolic arrhythmia -41.10% (16p). At the same time, 36 patients (26.4 %) exhibited atrioventricular blocks of various degrees, major LBBB, sinus tachycardia and paroxysmal supraventricular tachycardia. In conclusion, the arrhythmia with the highest prevalence in DCM patients is represented by ischemic and toxic AF. [ABSTRACT FROM AUTHOR]

Chronic heart failure is considered the most costly cardiovascular disease, which is also valid in Romania's case. One of the most frequent aggravation and death causes in the case of CHF is dilated cardiomyopathy (DCM) rhythm disorders. The aim of the present paper is to assess the prevalence of atrial fibrillation (AF) in DCM patients hospitalized in the Rehabilitation Hospital of Cluj-Napoca. Material and method 164 patients diagnosed with DCM based on ESC criteria were included in the study, out of a total of 470 patients suffering from NYHA I-IV CHF functional class, hospitalized in the Rehabilitation Hospital between 2003 and 2004. They were divided into two study groups: group I- including 136 patients with cardiac rhythm disorders and group 1Iincluding 28 patients suffering from DCM, however with no rhythm disorders. CHF was defined based on European Society for Cardiology criteria set in 2008 (3). We analyzed the types of rhythm disorders in group 1, the recommended antiarrhythmic drugs, as well as the comparative characteristics of the two study groups from age, sex, cardiovascular risk factors, CHF aetiology, ECG and echocardiography parameters, ECG Holter/24 hours monitoring viewpoints. The statistic analysis was based on t-Student test. Results: The prevalence of rhythm disorders in the 470 CHF patients was 82.9%. The arrhythmia with the highest prevalence in group one was atrial fibrillation, in 45.6% (62 patients). The distribution of arrythmias in patients with sinus rhythm at rest (27.94%-38p) was paroxysmal AF episodes -57.89% (22 p) and different types of extra systolic arrhythmia -41.10% (16p). At the same time, 36 patients (26.4 %) exhibited atrioventricular blocks of various degrees, major LBBB, sinus tachycardia and paroxysmal supraventricular tachycardia. In conclusion, the arrhythmia with the highest prevalence in DCM patients is represented by ischemic and toxic AF. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) had în many studies a reverse dependent relationship with prognosis at patients with heart failure, but it is not clear if this is an independent relation. Aim - To establish the correct relationship between body mass index and prognosis at patients with low ejection fraction heart failure, considering other confounding factor (clinical factors - age, NYHA class; parameters of ecocardiography - leftventricle ejection fraction, neurohormonal parameters - serum BNP and heart failure treatment). Methods - We includeed 296 patients with low ejection farction (LVEF <40%) heart failure admitted at Institutul de Urgenţă pentru Boli Cardiovasculare „Prof. Dr. C. C. Iliescu‟ between 1january 2005 and 31 december 2007. This group of patients was divided în three subgroups according to body mass index: with BMI between 20 and 24.9 kg/ m²; with BMI between 25 and 29.9 kg/m² and with BMI above 30 kg/m². There were no statistical significant differences according age, NYHA class, leftventricle ejection fraction and serum BNP between these three groups of patients. Follow-up period was of 24 ± 8 months; we analyzed total number of deaths, deaths by heart failure, admissions for aggravated heart failure. Also, we analyzed the relationship between these events and body mass index variation. Results - Among all 286 patients, 132 (44.59%) had a BMI between 20 and 24.9 kg/m²; 55 (18.58%) - BMI between 25 and 29.9 kg/m² and 109 (36.82%) - BMI above 30 kg/m². În follow-up period there were 41 deaths (13.85%), 38 deaths by heart failure (12.84%) and 85 (28.71%) admissions for aggravated heart failue; total number of events was of 105 (35.47%). Between analyzed groups there were statisticaly signifi cant differences only between composite end-point of total adverse events (39.39% at patients with BMI between 20 and 24.9 kg/m², 45.45% at patients with BMI between 25 and 29.9 kg/m² and 25.68% at patients with BMI > 30 kg/m²), but statistical power was low, and without a direct proporţional relationship between body mass index and adverse events. At patients with adverse events there were statistic significant differences regarding BMI variation (p = 0.0002 for any cause deaths, p = 0.0001 for deaths by heart failure, p =0.001 for admissions for heart failure aggravation and p = 0.0002 for adverse events), with most adverse events at patients with biggest weight decrease în the last year. Also, BMI variation was correlated with leftventricle ejection fraction (p = 0,004) and serum BNP value (p = 0.003), too. Conclusions - Reverse relationship between body mass index and heart failure prognosis did not persist after confounder factors removal. Unwanted weight decrease is an independent prognosis factor at patients with decresased leftventricle ejection fraction heart failure. [ABSTRACT FROM AUTHOR]

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Heart failure is a disease with considerable socio-economic impact. Systolic dysfunction is most often defined as an ejection fraction below 35-40%. Two classes of agents have become the cornerstone of therapy to dealy or halt progression of cardiac dysfunction and improve mortality: angiotensin-converting enzyme inhibitors (ACE) and beta-blockers. Over time, new classes of agents that show an impact on mortality have been added, complicating decisions about optimal pharmacologic therapy. These include angiotensin receptor blockers, aldosterone antagonists and the combination of hydralazine and an oral nitrate. [ABSTRACT FROM AUTHOR]

Chronic heart failure is a common disease especially in the elderly. It affects 1-2% of the population and this proportion is expected to increase due to aging population and the better survival with different cardiac disease. If untreated chronic heart failure has a severe prognosis in line with many cancers, but the use of modern treatment can significantly reduce both mortality and morbidity. To initiate an optimal treatment is necessary early identification of chronic heart failure. Some patients are identified due to admission for acute heart failure, but most often the patient has to be identified by the general practitioner. The diagnosis is often difficult because symptoms of heart failure are rather nonspecific, are often present in other diseases and in patients who are physically unfit. Therefore there is a risk that patients are not properly investigated and diagnosed as having heart failure or to be over diagnosed and treated without having the diagnosis of heart failure confirmed. The most commonly accepted use of the B-type natriuretic peptides is screening for heart failure in order to select patients for echocardiographic evaluation. [ABSTRACT FROM AUTHOR]

Psychological adaptative reactions to disease can play a major part in the clinical course of heart failure patients. Objective. We studied the aditional effect of depression on the quality of life and clinical course of patients with acutely decompensated heart failure. Methods. We studied 150 patients admitted with acutely decompensated heart failure. The New York Heart Association (NYHA) functional class, ejection fraction (EF) assessed by echocardiography, 6-minute walk test (6MWT), depression score and quality of life (QOL) score were assessed at hospital admission, discharge and follow-up visits at 3, 6 and 12 months. Results. The EF in the 150 patients study group was low (30.8 ± 9,2 %) at admission, with an average increase of 5% (p=0,052 - marginally significant) at 6 months and of 10% (p < 0,01) at 12 months in 118 pts (78%). Depression was present in 52,6% of the 150 patients; 38% of them had moderate or severe depression. Moderate or severe depression was found in 87,2% of the 55 patients who had at least one decompensation of the heart failure. QOL of heart failure patients correlates negatively with the severity of depression (r=0,67 , p=0,009). Treatment improves QOL in all patients, with statistical significance in all except severe depression patients. Exercise tolerance assessed by 6MWT was significantly improved in patients with moderate (p < 0,01) and mild (p < 0,001) depression. Treatment didn't significantly improve exercise tolerance in patients with severe depression, although 73% of them were in NYHA II and III functional classes. Conclusion. Depression severity has a detrimental effect on the rehabilitation of heart failure patients. Patients with heart failure and severe depression have an unfavourable clinical course and multiple hospital admissions. The QOL and exercise tolerance are reduced in these patients and don't increase significantly under treatment. [ABSTRACT FROM AUTHOR]

Background. Both ANP and BNP plasmatic levels increase in heart failure patients at rest and during exercise. Aim. To study the dynamics of cardiac peptides (NT-proANP and NT-proBNP) at rest and during exercise in patients with dilated cardiomyopathy (DCM) and heart failure (HF). Methods. 32 patients with DCM (of which 22 with ischemic etiology and 10 with non-ischemic one) and CHF (NYHA class I-IV) were studied. All patients performed a symptom-limited exercise testing on cycloergometer. Plasmatic values of NT-proANP and NT-proBNP were determined at rest and at peak effort by ELISA method, normal values (fmol/ml) were NT-proANP<1940 and NT-proBNP<250. Ejection fraction, diastolic diameter of the left ventricle and the left atrial diameter were measured using 2D echo. Results. At rest, NT-proANP was 3588.4±323 fmol/ml, 1.85 times greater than normal, while NT- proBNP was 788.8±73 fmol/ml, 3.19 times greater than normal. At peak effort, NT-proANP was 5241.9±423 fmol/ml (46% increase), while that of NT-proBNP was 983. 8 ±87 fmol/ml (24% increased). Rest and exercise value of NT-proANP correlated well with the NYHA I+II patients' effort capacity (r = 0.71) and even better with NYHA III+IV patients' effort capacity (r = 0.81, p<0.01). Also, rest and exercise value of NT-proBNP correlated well with the NYHA I+II patients' effort capacity (r = 0.92, p<0.01) and even better with NYHA III+IV patients' effort capacity (r = 0.98, p<0.01). On the other hand, there was no significant correlation between the plasmatic levels of cardiac peptides at rest and during exercise and left ventricle ejection fraction (r = 0.31), left ventricle telediastolic diameter, r = 0.32) and left atrial diameter (r = 0.37). [ABSTRACT FROM AUTHOR]

Dilated cardiomyopathy (DCM) is characterized by progressive left ventricular (LV) dilatation and greatly impaired LV systolic function, eventually culminating in end-stage congestive heart failure and death. Despite recent improvements in medical management, the overall prognosis of individuals with DCM is still poor. [ABSTRACT FROM AUTHOR]

Determining the ejection fraction of the left ventricle (LV) divides the patients with clinical and objective features of heart failure into two classes: patients with altered/reduced ejection fraction (HFREF) and patients with preserved ejection fraction (HFPEF). For a long period of time, the attention was focused on HF with reduced ejection fraction, but epidemiological studies have shown that 50% of the patients with signs and symptoms of heart failure have the ejection fraction in normal limits. In our study, we wish to make a characterization of the profile of the patients with heart failure as it appears in daily practice and not in the case of carefully selected population as it happens in trials. This study is useful for emphasizing the current reality existing in the case of patients with heart failure. [ABSTRACT FROM AUTHOR]

Elderly's cardiac insufficiency (CI) represents a public health issue. Within this context, the aim of the study is to assess cardiac stress test capacity of the patients with ischemic CI with a view to include them in cardiovascular rehabilitation programmes. Two groups of patients were studied: group 1-below 65 years old and group 2 - below 65 years old. All patients were submitted to the cardiac stress testing and echocardiography. IC forms with preserved ejection fraction were predominant. We noticed that the patients in group 1 have a cardiac stress test capacity greater than those in group 2 (WATTs: 86.11 ± 24.35 vs. 70.83 ± 21.7, p = 0.0051; METs: 4.6 ± 1.4 vs. 3.8 ± 1.1, p = 0.05). Most cardiac stress tests were stopped in both groups due to dyspnea. In conclusion, cardiac stress testing in its classical form can be useful for assessing exercise capacity in patients with CI who are to be included in cardiac rehabilitation programmes. [ABSTRACT FROM AUTHOR]

Determining the ejection fraction of the left ventricle (LV) divides the patients with clinical and objective features of heart failure into two classes: patients with altered/reduced ejection fraction (HFREF) and patients with preserved ejection fraction (HFPEF). For a long period of time, the attention was focused on HF with reduced ejection fraction, but epidemiological studies have shown that 50% of the patients with signs and symptoms of heart failure have the ejection fraction in normal limits. In our study, we wish to make a characterization of the profile of the patients with heart failure as it appears in daily practice and not in the case of carefully selected population as it happens in trials. This study is useful for emphasizing the current reality existing in the case ofpatients with heart failure. [ABSTRACT FROM AUTHOR]

Aim. An assessment of the quadruple combo eplerenone, ivabradine, clopidogrel, rosuvastatin behaviour in heart failure, in terms of clinical pharmacology, in order to use it, eventually, on a large scale in cardiovascular prevention vs. 288 controls. Method. 144 patients with heart failure documented by biomarkers, treated 6 months with the quadruple combo. Results. The combo proved high efficacy in clinical, haemodynamic, imaging, quality-of-life terms and safety. Conclusions. The combo could be used on larger scale in benefit of cardiovascular patients along the cardiovascular continuum. [ABSTRACT FROM AUTHOR]

A 27 year old woman was reffered to us for cardiac evaluation. She was diagnosed with juvenil hemochromatosis (genetic confirmation of G320V mutation) and she already had hypogonadism, skin pigmentation and liver damage. Initial Holter ECG monitoring for 24 hours was performed and several episodes of atrial fibrillation were recorded. Echocardiographic examination revealed an enlarged left ventricle with severe systolic and diastolic disfunction (EF~38%, restrictive filling pattern). After several months with theraphy (session of phlebotomy and oral medication for heart failure) ECG monitoring showed rare premature ventricular complexe and two episodes of nonsustained ventriculartahycardia. Which is the bestantiarrhythmic management forthis patient? Amiodarone, implantable cardioverter defibrillator or aggressive therapy for her underlying disease? [ABSTRACT FROM AUTHOR]

We assess the potential benefit of cardiac resynchronization therapy in the patients with normal sinus rhythm, drug refractory chronic heart failure related to dilated cardiomyopathy and prolonged QRS duration. 31 consecutive patients were included with NYHA class II (n=4), class III (n=12) or class IV (n=15) heart failure, LV ejection fraction <30%, and prolonged QRS = 150 ms received biventricular pacing therapy. The 6-minute walk distance was also increased early after the pacing therapy (3 months) and improved additionally by 9 months (all P<0.05). The LV fractional shortening and ejection fraction improved progressively during the resynchronization therapy and were significantly higher than the baseline values after 3 (p<0.05) and 9 months (p<0.01). Cardiac resynchronization therapy reverses LV remodelling and improves cardiac function. The patients with longer QRS duration and longer mitral regurgitation duration are more likely to benefit from atriobiventricular stimulation. [ABSTRACT FROM AUTHOR]

We assess the potential benefit of cardiac resynchronization therapy in the patients with normal sinus rhythm, drug refractory chronic heart failure related to dilated cardiomyopathy and prolonged QRS duration. 31 consecutive patients were included with NYHA class II (n=4), class III (n=12) or class IV (n=15) heart failure, LV ejection fraction <30%, and prolonged QRS = 150 ms received biventricular pacing therapy. The 6-minute walk distance was also increased early after the pacing therapy (3 months) and improved additionally by 9 months (all P<0.05). The LV fractional shortening and ejection fraction improved progressively during the resynchronization therapy and were significantly higher than the baseline values after 3 (p<0.05) and 9 months (p<0.01). Cardiac resynchronization therapy reverses LV remodelling and improves cardiac function. The patients with longer QRS duration and longer mitral regurgitation duration are more likely to benefit from atriobiventricular stimulation. [ABSTRACT FROM AUTHOR]

Autorii prezintă cazul unui sugar în vârstă se 2 luni, care se internează pentru semne clinice de insuficienţă cardiacă congestivă ce asociază hipotensiune arterială şi timp de recolorare prelungit, cu cardiomiopatie dilatativă la ecocardiografia Doppler şi modificări ischemice pe EKG. În ciuda tratamentului medicamentos, evoluţia a fost nefavorabilă, iar examenul anatomopatologic confirmă originea anormală a arterei coronare stângi (ACS) din artera pulmonară (AP), cardiomiopatia dilatativă a ventriculului stâng şi evidenţiază fibroelastoză şi necroză subendocardică secundare. [ABSTRACT FROM AUTHOR]

The cardiorenal syndrome (SCR) is a complex syndrome which represents the interaction between the two organs when the dysfunction of one involves the dysfunction of the other. Imaging methods are necessary for the diagnosis and management of the patients with cardiorenal syndrome and they are useful in characterizing the dynamics of cardiac and renal performance, in order to define the interaction between the two systems and to characterize their progress in treatment. In the patients with cardiorenal syndrome, ultrasound provides valuable information on cardiac structure and function and on the acute or chronic nature of kidney disease. Modern imaging techniques are useful in characterizing the status of the two organs damage. These data are integrated with the results of the biological investigations to complete the pathophysiological profile and the evolution of this complex syndrome. [ABSTRACT FROM AUTHOR]

The cardiorenal syndrome (SCR) is a complex syndrome which represents the interaction between the two organs when the dysfunction of one involves the dysfunction of the other. Imaging methods are necessary for the diagnosis and management of the patients with cardiorenal syndrome and they are useful in characterizing the dynamics of cardiac and renal performance, in order to define the interaction between the two systems and to characterize their progress in treatment. In the patients with cardiorenal syndrome, ultrasound provides valuable information on cardiac structure and function and on the acute or chronic nature of kidney disease. Modern imaging techniques are useful in characterizing the status of the two organs damage. These data are integrated with the results of the biological investigations to complete the pathophysiological profile and the evolution of this complex syndrome. [ABSTRACT FROM AUTHOR]

Heart failure is one of the most common cardiac disease that affects people of all ages worldwide. Mechanisms that cause the disease began to be increasingly well understood. The most important are: Frank-Starling mechanism, myocardial hypertrophy and neurohormonal mechanisms. The most common cause of heart failure is the acute coronary syndrome. In fact, they say that almost any heart disease left untreated can lead to heart failure. The NYHA classification is used to determine the clinical evaluation of the disease. Echocardiography is the most frequently used imaging method to assess heart failure and B-type natriuretic peptide determination is becoming a routine laboratory examination used in this disease.Treatment of heart failure is trying to improve the patients' life, to slow disease progression and reduce mortality. [ABSTRACT FROM AUTHOR]

Heart failure is one of the most common cardiac disease that affects people of all ages worldwide. Mechanisms that cause the disease began to be increasingly well understood. Te most important are: Frank-Starling mechanism, myocardial hypertrophy and neurohormonal mechanisms. The most common cause of heart failure is the acute coronary syndrome. In fact, they say that almost any heart disease left untreated can lead to heart failure. The NYHA classification is used to determine the clinical evaluation of the disease. Echocardiography is the most frequently used imaging method to assess heart failure and B-type natriuretic peptide determination is becoming a routine laboratory examination used in this disease. Treatment of heart failure is trying to improve the patients' life, to slow disease progression and reduce mortality [ABSTRACT FROM AUTHOR]

An increasing prevalence of heart failure is seen in the general population and especially the aging population in the last years. Biggest challenge for the future is not only slowing disease progression, but even stopping the evolution of the heart failure, obtaining also an improvement in the patient's quality of life. Given the fact that heart failure is a progressive disease, the earlier the diagnosis is established, the more are reduced the risk of complications and the mortality. For this reason, it was felt the need to detect serum markers that correlate with a proper prognosis, NT-proBNP being one of those. [ABSTRACT FROM AUTHOR]

Cardiac resynchronization therapy (CRT) is a relatively new therapy for the patients with symptomatic heart failure resulting from the systolic dysfunction. CRT is achieved by simultaneously pacing both the left and right ventricles. Biventricular pacing resynchronizes the timing of global left ventricular depolarization and improves mechanical contractility and mitral regurgitation. [ABSTRACT FROM AUTHOR]

An increasing prevalence of heart failure is seen in the general population and especially the aging population in the last years. Biggest challenge for the future is not only slowing disease progression, but even halting the evolution of heart failure, with this being obtained also an improvement in patient quality of life. Given the fact that heart failure is a progressive disease, the earlier the diagnosis is established, the more it is reduced the risk of complications and mortality. For this reason, it was felt the need to detect serum markers that correlate with a proper prognosis, NT-proBNP being one of those. [ABSTRACT FROM AUTHOR]