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Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This research was funded by “Iuliu Haţieganu” University of Medicine and Pharmacy, Dept. of Cardiology, Cluj-Napoca, Romania, grant number 1529/66/18.01.2019. Introduction In addition to promoting coronary artery disease, obesity increases the risk of cardiovascular complications. The obesity paradox, however, refers to the observation that a high body mass index (BMI) may be protective of outcomes following an acute myocardial infarction (AMI). In patients with AMI, both NT-proBNP and novel echocardiographic markers (global longitudinal strain - GLS) provide additional information; nevertheless, there is limited research on the association between these parameters and obesity in this clinical setting. Material and methods This was a prospective study that included 55 patients admitted with AMI and preserved or mildly reduced LVEF (>40%), which all underwent successful percutaneous revascularization. At 48 hours after PCI, echocardiography was performed using a Vivid E95 scanner and the automated function-imaging (AFI) tool was used to determine GLS. NT-proBNP was measured using ELISA. All patients were divided into two groups according to their BMI (group 1 included 18 patients with normal BMI30 kg/m2). Results The mean age of the patients was of 66±14 years, 58% were male and 65.5% had STEMI. Other than obesity, there was no difference between groups in the other cardiovascular risk factors (smoking, dyslipidemia, arterial hypertension, diabetes, age, gender). In both groups, the anterior descending coronary artery was the most frequent culprit vessel (44% vs. 40%, p=0.9). The majority of the patients had single- or two- vessel coronary artery disease (72% vs. 73%), but there were no differences between groups (p=0.74). The values of NT-proBNP were significantly lower in the obese group (300 [117-713] vs. 756 [450-1800] pg/mL, p=0.02). However, regarding the echocardiographic evaluation of myocardial function, there was no difference between the values of GLS (-10.5% vs. -10.8%, p=0.77) or LVEF (56.7% vs. 49.2%, p=0.27) among groups. GLS showed a stronger correlation to NT-proBNP values in the normal weight group (r=0.63) than in the obese group (r=0.27). Conclusion Despite the fact that increased BMI is linked to lower values of NT-proBNP following AMI, non-obese patients do not demonstrate more impaired myocardial longitudinal function. These findings might offer more insights on the perspectives of obese AMI patients.

Funding Acknowledgements Type of funding sources: None. Introduction Obstructive sleep apnea (OSA) is a disorder frequently associated with clinical conditions and complications such as refractory hypertension, atrial fibrillation, nocturnal angina, dysrhythmias, congestive heart failure and stroke. Polysomnography is the gold standard test required to diagnose OSA, along with a targeted history and comprehensive examination of the patient. It involves the recording of various physiologic variables during sleep. Sleep related obstructive events may be measured using two indices: the apnea-hypopnea index (AHI) and the respiratory disturbance index, an AHI≥15 being diagnostic for OSA. The aim of this study was to determine the interaction between sleep apnea and demographic or echocardiographic markers. Material and methods This was a prospective study that included 33 patients with sleep apnea. Polysomnography was performed using a VitalNight cardiorespiratory polygraph to determine the apnea hypopnea index (AHI) and echocardiography was performed using a Vivid E95 scanner to determine the left ventricular ejection fraction (LVEF), the peak systolic right ventricular to right atrial pressure gradient (Gmax) and the right ventricular diameter and function (TAPSE and s’). Results The mean age of the patients was of 63±8 years and 14 patients (42%) had a Gmax>25mmHg. Regarding cardiovascular risk factors, 31 patients (94%) had arterial hypertension and 26 (79%) were smokers. Out of all patients, 25 (76%) had an appropriate echocardiographic acoustic window. The patients had mean values of AHI of 45±19. Mean values for the LVEF, Gmax, TAPSE and s’ were 53 ± 11%, 25± 14 m/s, 22 ± 4 mm, and 14 ± 3 cm/s, respectively. AHI showed moderate correlations to age (r=0.27), cervical perimeter (r=0.38) and BMI (r=0.30), but also to echocardiographic parameters as LVEF (r=0.29), Gmax (r=0.42), RV diameter (r=0.39), TAPSE (r=0.38) and s’ (r=0.34). ROC curves were determined to calculate the value of AHI to predict a Gmax >25 mmHg. A significant Gmax, as an indicator for increased right cardiac pressures, was predicted with a high sensitivity (86%) and specificity (84%) by a value of AHI > 45 (AUC=0.81, 95%CI = 0.64-0.927, p Conclusion In conclusion the study demonstrated that smoking and hypertension are important risk factors in patients with sleep apnea syndrome. There was a significant correlation between AHI and echocardiographic parameters of the right heart. AHI can be used as a predictor of increased right cardiac preassure when the value is above 45.

Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) represents the most common cardiac arrhythmia in adults worldwide. Catheter ablation (CA) of AF provides higher efficacy with comparable safety as antiarrhythmic drug therapy. Recently, high-power short-duration (HPSD) approach has emerged as an alternative to standard-power standard-duration settings, showing reduction in ablation times and increasing patient tolerability, with similar outcomes in terms of safety and efficacy. Although the advantages of general anesthesia (GA) are well established for standard-power standard-duration settings, there are currently no studies comparing GA to mild conscious sedation (MCS) for HPSD approach CA for AF. The aim of this study was to show whether GA improves procedural outcomes compared to MCS in AF CA using HPSD approach. Methods We included patients with paroxysmal or persistent AF who underwent HPSD CA using a contact-force sensing catheter (50W, ablation index 450 on the anterior wall and 320 on the posterior wall) either under GA or MCS. Procedural characteristics and success rates were compared between the two groups, as well as mid-term outcomes. Procedural safety was evaluated by intra- and post-procedural complications. Procedural efficiency was evaluated by total procedural time, number of radiofrequency applications, fluoroscopy time and dose. Acute success was defined as confirmation of entrance block in all pulmonary veins and mid-term success as freedom of AF at 6-months follow-up visits and re-do procedures. Results A total number of 131 patients were included in the study, 47 which underwent HPSD CA for AF under GA (group 1, mean age 60.2±10.2), and 84 under MCS (group 2, mean age 58.6±10.6). CA was performed for paroxysmal AF in 34 patients in group 1 (72.3 %) and 68 patients in group 2 (80.9 %), and for persistent AF in the remaining patients. We found lower mean total procedure time in the GA group (105.7±26.4 vs. 164.4± 41.9 min, p Conclusion This is the first study comparing GA to MCS for AF CA using HPSD approach. Our findings demonstrate that GA improves procedural efficiency and suggest lower AF mid-term recurrence when HPSD AF CA is performed under GA, compared to MCS.

Background: Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure. Methods: AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This research was funded by “Iuliu Haţieganu” University of Medicine and Pharmacy, Dept. of Cardiology, Cluj-Napoca, Romania. This paper was published under the frame of European Social Found, Human Capital Operational Programme 2014-2020, project no. POCU/380/6/13/125171 Introduction Impaired longitudinal strain (GLS) is associated with increased wall stress following acute myocardial infarction (MI). However, little is known about the relationship between three-dimensional (3D)-GLS and two-dimensional (2D)-GLS. The aim of this study was to evaluate the relationship between 3D-GLS and 2D-GLS and also the association of 3D-GLS with specific biomarkers (NT-proBNP and Troponin) in patients with acute MI following percutaneous revascularization (PCI). Methods We included 100 patients with acute MI after successful PCI with a left ventricular ejection fraction (LVEF) >40%. 2D-GLS and 3D-GLS were assessed using speckle-tracking echocardiography and plasma concentrations of NT-proBNP and high sensitive troponin were analyzed. Results The patients had a mean age of 67.1 ± 13.1 years. 69 patients were diagnosed with ST-elevation MI (STEMI). Mean 3D-GLS was of -9.44 ± 4.35% and mean 2D-GLSwas of -10.1 ± 3.9%. 3D-GLS showed a strong correlation with 2D-GLS (r=-0.57, p Conclusion 3D-GLS showed small bias compared to 2D-GLS, but wide limits of agreement. The correlation between 3D-GLS and NT-proBNP was only moderate in acute MI. 3D-GLS might offer additional advantages in patients with complex geometry after acute MI due to faster data acquisition and lack of geometric assumption,but future studies are needed to confirm its role. Abstract Figure. Relationship between 3D and 2D GLS Abstract Figure. Corresponding Bland-Altman plots

Introduction Aortic stenosis has become the most common degenerative valvular heart disease, due to aging of the population. It represents 43% of degenerative valvular disease. Methods We prospectively followed 196 patients with degenerative aortic stenosis, for a period of 6 years. Of these, 106 had mild aortic stenosis, 28 had moderate aortic stenosis and 62 patients had severe aortic stenosis. Of the 196 patients, 54 had mild pulmonary hypertension (PH), 22 had moderate PH and 7 had severe PH. The survival data were estimated by the Kaplan - Meier method and the logrank test. The Cox proportional- hazards regression was performed to assess the differences between the groups. Results During the follow-up period, of a total of 196 patients, 61 patients died. We studied if the presence of PH has an influence on survival in patients with aortic stenosis and we found out that the patients who had PH had reduced survival rates, compared with those who hadn"t. The survival rate at 5 years was lower in the group with mild PH compared with the group with normal pulmonary pressure ( p = 0.045, HR 1.84, 95%CI 1.01-3.36). In the group with mild PH, 20 patients (37.03%) died at 5 years, compared with 23 in the group without PH (20.35%). The survival rate at 5 years was also lower in the group with moderate PH compared with the group with normal pulmonary pressure ( p = 0.001, HR 5.82, 95% CI 3.02-11.22). At 5 years, 15 patients with moderate PH died ( 68.18% compared with 20.35 in the group without PH). Comparing the group with severe PH with the group with normal pulmonary pressure the results showed a reduced survival rate in those with severe pulmonary hypertension ( p = 0.139, HR 2.48, 95% CI 0.74-8.27). At 5 years, 3 patients with severe PH died (42.85% compared with 20.35 in the group without PH). Conclusion The presence of PH in patients with degenerative aortic stenosis has a negative impact on survival, highly statistically significant (p

INTRODUCTION Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure. PURPOSE The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation. METHODS Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters. RESULTS Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded. CONCLUSIONS This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation. Abstract P338 Figure. ICE-guided transseptal puncture

Introduction Hypoplastic coronary artery disease (HCAD) refers to a congenital underdevelopment of one or more coronary arteries, which are greatly reduced in diameter or length. It is a rare congenital abnormality which has rarely been documented in living patients and which may lead to myocardial infarction (MI) and sudden cardiac death (SCD). This case describes an otherwise healthy young male, which was admitted in the emergency department (ED) for repeated sustained ventricular tachycardia (VT) and was thereby diagnosed with an isolated hypoplasia of the left circumflex coronary artery (CX). Investigations revealed scar-related tachycardia, due to a prior silent myocardial infarction caused by HCAD. These findings were suggested by echocardiography and coronary angiography and were later confirmed by magnetic resonance and 3D cardiac mapping. Case Report A 34-year-old male patient was admitted to the intensive care unit with recurrent sustained VT causing hemodynamic instability. After receiving two electric shocks and amiodarone in the ambulance, the patient became hemodynamically stable. There was no remarcable medical history besides a syncopal fall 5 years before and no symptoms prior to the current event. Initial physical examination, ECG and laboratory testing were normal. Echocardiography revealed a dilated left ventricle with akynesia of the lateral wall and a mildly reduced ejection fraction (EF = 45%), moderate mitral regurgitation due to restriction of the posterior mitral leaflet. A subsequent emergent coronary angiography was therefore performed, which showed no sign of atherosclerotic lesions, yet it revealed a hypoplastic CX, without compensatory collateral vessels supplying the lateral wall. Cardiac MR demonstrated delayed enhancement with transmural necrosis and no viability in the lateral wall of the LV, suggesting a long-standing MI. Therefore, the final diagnosis was scar-related VT, due to a prior silent MI caused by HCAD. The management of this patient included implantation of an ICD in the secondary prevention of SCD. Moreover, we performed an EPS, which identified a scar at the level of the lateral and inferolateral LV walls as a substrate for VT (electroanatomic 3D voltage mapping) and of the critical istmus (3D activation mapping). The next step was radiofrequency ablation of the critical isthmus, with no inducibility of the VT after the procedure. After 6-months follow-up, there was no recurrence of the VT. Conclusion Finding the cause of myocardial infarction in a young patient with VT can be very challenging. We emphasise the role of imaging for the diagnosis and management of these patients. HCAD is a rare congenital anomaly, which can lead to progressive fibrosis in the territory with poor blood supply, MI and SCD. Although it is a rare condition, it should be considered in young adults who present with MI and/or SCD. Abstract P1736 Figure. Investigations

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.

Background Even during remission, the systemic lupus erythematosus (SLE) patients have reduced exercise performance and this contributes to impairment of their quality of life 1 . Several causes as depression and deconditioning, arthritis, anemia, cardiovascular and respiratory involvement are widely accepted; however the weight of each factor is less known in particular individuals. Objectives Our study aimed to assess through cardiopulmonary exercise testing (CPX) the exercise performance of a SLE cohort and to establish its main determinants. Methods Thirty-one SLE patients with low disease activity underwent a CPX on cycle ergometer; the main metabolic parameters and standard 12-leads ECG were recorded; before exercise testing, a cardiac Doppler ultrasound was performed. The patient9s characteristics, cumulative organ damage and laboratory data were retrieved by medical chart review. The control group consisted of 25 age and sex-matched healthy, non-trained individuals. Results Within the study group, 28 (90.3%) were female, the mean age was 42.7±10.6 years and disease median duration 7.9 years. The aerobic performance was decreased by 16.2% (17.6 vs 21.36 ml/kg/min, p=0.022); the main disease characteristics which correlated with maximum oxygen uptake (VO2Mx) were anemia (p=0.035), renal involvement (p=0.05) and antiphospholipid syndrome (APS) (p=0.042) but not disease duration, cumulative damage or the immunological tests (hypocomplementemia, anti-Ro, anti-Sm, anti-dsDNA, AAN or APL antibodies). One quarter of patients did not reach the ventilatory anaerobic threshold (VAT, expressed as a percentage of calculated VO2Mx), mainly due to musculoskeletal pain (5 patients), dyspnea (2 patients with history of pulmonary embolism) and sudden rise in blood pressure (1 patient). Among the rest of them (23 patients, 74%), the VAT was at the lower limit of normal range (41.03% vs 54.0% for controls, p=0.014) corresponding to a “training reserve” of 31%. Of particular importance from this point of view were the criteria for test termination: dyspnea in 4 patients (1 with anemia, 1 with pulmonary fibrosis and 2 by hyperventilation proved by mean VE/VCO2 =41.5), fatigue (9 patients) and arthralgia (7 patients). Notably, among patients with established diagnosis of mild pulmonary fibrosis, COPD, ischemic or valvular heart disease, not dyspnea but arthralgia or fatigue was the reason for test termination, even if the VO2Mx was lower than recorded in the rest of the group (15.8 vs 19.2 ml/kg/min, p=0.037). Conclusions The exercise aerobic capacity of SLE patients is diminished and correlates with anemia, renal involvement and with hystory of pulmonary embolism. Surprisingly, even in patients with mild cardiovascular or respiratory involvement, the decreasing of exercise performance is limited mainly from musculoskeletal symptoms and from deconditioning. References Carvalho MR, Sato EI, Tebexreni AS, et al. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus. Arthritis Rheum 2005;53(6):838–44. Disclosure of Interest None declared

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

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.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.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% (p0.001); the NPV was 85%; Se was 73% and Sp was 97%.The surface ECG has a high value in determining the macroreentry circuit rotation sequence in the case of typical atrial flutter.

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.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.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).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.

There are many controversial concerning the role of alcohol in these diseases.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.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.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.

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.

Adiponectin is decreased and leptin increased in overweight subjects. In turn, exercise has controversial effect upon adiponectin and leptin plasmatic levels.To study the effect of acute exercise upon plasmatic levels of adiponectin and leptin in normal and overweight subjects.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 (BMI25 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.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.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.

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.To compare a new fixed walking test-400m walking test with 6MWT and maximal exercise testing.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.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 = -0.60.400mWT 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.

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.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.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.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.

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.

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.To investigate the acute effect of oral Metoprolol upon plasma proBNP levels in CHF patients.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 (NV250 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.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, p0.05) in III NYHA class patients and increased (from 1457 +/- 142 to 1530 +/- 150, p0.05) in IV NYHA class patients. It remained unchanged in patients with LVEF30% (1384 +/- 140 vs 1389 +/- 129 fmol/mL) and increased (from 1480 +/- 134 to 1690 +/- 161 fmol/mL, p0.05) in patients with LVEF30%; it was not significantly modified in patients with atrial fibrillation in comparison with those in sinus rhythm (1348 +/- 132 vs 1516 +/- 168 fmol/mL).Beta blockers do not have a severe depressant effect on left ventricular performance in all patients with systolic heart failure. A LVEF30% 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.

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.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 aged55 years with cardiovascular disease (68.1% of them with IHD). The study was carried out using general practitioner's files.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 (p0.05), ACEI in 69.1% and 79.8 % (p0.05), beta blockers in 69.1% and 74.3 % (p0.05) and statins in 48.9% and 48.6% (p0.05). 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 p0.05, PCI 5.3% in women and 13.8% in men p0.05.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.

Several studies showed that elevated plasma levels of lipoprotein(a) [Lp(a)] represent a predictor for cardiovascular risk. Based on already existing literature data, we aim to study the relationship between Lp(a), lipids and other cardiovascular risk factors in individuals with or without coronary heart disease.We performed a cross-sectional transversal study on 208 patients (100 men and 108 women) aged between 37-75, with or without old myocardial infarction. In all the patients were evaluated the cardiovascular risk factors, the plasma level of the lipid fractions and Lp(a). The relationship between Lp(a) and the lipid and non-lipid risk factors were evaluated by the logistic regression method.The myocardial infarction group had higher values of plasma levels of Lp(a) (0.37 +/- 0.28 vs. 0.29 +/- 0.23 g/L, p0.05), and LDL-C (125.66 +/- 41.21 vs. 113.44 +/- 46.64 mg/dL, p0.05), than the group without coronary heart disease, as well as higher values of plasmatic TC/HDL-C ratio (4.31 +/- 1.55 vs. 4.08 +/- 1.29, p0.05), with significantly decreased plasmatic levels of HDL-C (45.88 +/- 12.04 vs. 53.22 +/- 23.12 mg/dL, p0.05). The association between the high Lp(a) plasma levels and the severity of coronary vessels number involved was significant. Multivariate analysis performed with adjustments for cardiovascular risk factors showed that the Lp(a), LDL-C and CT/HDL-C ratio levels are significant and independent predictive markers of coronary heart disease.The results show that the high Lp(a) plasma levels represent an independent cardiovascular risk factor, with superior risk prediction than the conventional lipid fractions. Our results confirm the Lp(a) as a marker for cardiovascular risk assessment in clinical practice.

Physical training has traditionally represented the main method used in cardiovascular rehabilitation of ischemic patients in the past years. Nowadays, cardiovascular rehabilitation has been extended to other cardiovascular diseases, such as heart failure. Also, cardiovascular rehabilitation included psychological, social and professional measures along with secondary prevention methods such as lifestyle changes. It has also been found that physical training has other additional effects which increased exercise tolerance. Effects on the risk factors regard beneficial effect on body weight, on the serum lipids levels, on psychosocial stress, on high blood pressure and on insulin resistance and diabetes mellitus. Physical exercise has also beneficial effects on the balance between sympathetic--vagal tone, inducing a vagal predominance, has anti-atherogenic and anti-ischemic effects, influencing the endothelial function, the inflammation (anti-inflammatory effect), both arteriogenesis and angiogenesis and thrombosis. Physical training could improve the symptoms of coronary patients by preconditioning, which has a protective effect for the myocardium. We may state that physical exercise has beneficial effects in cardiovascular patients because it increases exercise tolerance with positive consequences on the quality of life and professional reintegration, but also because it has positive effects beyond this. Thus, physical exercise should be practiced through cardiac rehabilitation programs, by all cardiovascular patients.

Cardiac peptides are increased at rest in heart failure patients representing a useful diagnostic tool for this condition. Recently it has been demonstrated that cardiac peptides increase also during myocardial ischemia. Cardiac peptides increase during exercise in heart failure patients, but it has not been established yet if the increase is the same in ischemic and nonischemic patients.There were studied 50 heart failure patients, 32 ischemic and 18 nonischemic, 35 males and 15 females aged 61.8 +/- 11.61 after the relief of congestive syndrome, which was submitted to a symptom-limited exercise stress test on a cycloergometer. Blood samples were obtained at rest and at a peak effort and the plasmatic values of NT-proBNP (NV250 fmoles/mL) and of NT-proANP (NV1950 fmoles/mL) were determined using the ELISA method.At rest, both NT-proBNP and NT-proANP were more increased in nonischemic (1104.33 +/- 730; 3275.55 +/- 3424) than in ischemic patients (685.68 +/- 452.01, 2265.0 +/- 2552.32) with significant differences only for NT-proBNP (p=0.016). During exercise NT-proBNP increase from 836.40 +/- 596.34 to 1403.92 +/- 2126.21 and NT-proANP from 2628.80 +/- 2903.41 to 3701.30 +/- 3237.76, the final values being again more increased in nonischemic patients (NT-proBNP-2945.44 +/- 3257.89; NT-proANP-3174 +/- 2905); for NT-proBNP p0.05. The results suggest that the stretching effect during exercise is more increased at the ventricular level in comparison with the atrial level (67% increase for NT-proBNP and only 40% for NT-proANP). Surprisingly, myocardial ischemia does not increase additionally cardiac peptides either at rest or during exercise. Our data suggest that the intracardiac pressure is more important than ischemia in determining the increase of cardiac peptides in heart failure patients because the left ventricular ejection fraction was lower in nonischemic patients (40.03 +/- 5.5 vs 38.11 +/- 4.07).Cardiac peptides are increased, both at rest and during exercise, in nonischemic heart failure patients in comparison with ischemic ones, probably in relationship with the lower left ventricular systolic function.

The angiotensin converting enzyme (ACE) I/D polymorphism influences the plasmatic ACE levels, the highest being registered in the DD form. Similarly, the DD genotype is frequently associated with a CC homozygote genotype of the AT1 receptors. The polymorphism was studied mainly in hypertensive patients.To investigate the genetic polymorphism of renin angiotensin aldosterone system (RAAS) in patients with heart failure as a possible factor in determining the degree of the RAAS activation.The study included 36 NYHA III and IV class heart failure patients, 20 males and 16 females, aged 71.03 +/- 9.52 years. The distribution of ACE gene insertion, deletion (I/D) and AT1 receptors Al166C gene polymorphism were determined. Analyses of ACE and AT1 receptors genotypes were performed by polymerase chain reaction (PCR).The distribution of genetic ACE polymorphism was: D/D-47.22% (17 p); I/D-22.22% (8 p); I/I-30.55% (11 p). The identified AT1 receptors genotypes were as follows: AA-50% (18 p); AC-41.66% (15 p), CC-8.33% (3p). The two types of genetic polymorphism were associated in both the 20 hypertensive patients: DD+AA-35% (7 p); DD+AC -25% (5 p); DD+CC-10% (2 p) and the 16 patients without hypertension: DD+AA-6.25% (lp); DD + AC-18.75% (3p). LEVF was40% in 10 patients, 40% of them presenting pathogenetic polymorphism (DD+AC or DD+CC.Heart failure patients frequently present combinations of genetic polymorphism of RAAS probably involved in the development of neurohormonal pathogenic mechanism of the disease. This combination may be independent by the association with hypertension, and also in relationship with low ejection fraction.

The effects of dietary isoflavones on plasma cholesterol are discussed in order to find new diet therapies for hypercholesterolemia, which represents a cardiovascular risk factor. Isoflavones represent a class of biological substances with beneficial action in the reduction of cholesterol, LDL cholesterol, increase of HDL cholesterol and reduction of triglycerides as well as other risk factors of atherosclerotic cardiovascular diseases. The cholesterol-reducing effects of isoflavones have been demonstrated by numerous studies that started from the finding that the Japanese, consumers of more proteins of vegetal origin, present a lower incidence of ischemic heart disease, the mortality rate by cardiovascular disease being about half of that of the U.S.A. Subsequent studies were carried out in patient groups with high, average, small, or normal cholesterol levels, adults or children, all of them reporting that a diet containing vegetal isoflavones led to the reduction of cholesterol levels.

Tumor necrosis factor (TNF-alpha) and plasma levels of soluble tumor necrosis factor receptor I (sTNFR-I) are increased in patients with heart failure as an expression of chronic inflammation, representing a negative prognostic factor. Anemia and low serum lipid fraction are also negative prognostic factors, whose relationship with sTNFR-I has been less studied.The study investigated 54 patients with heart failure, 40 ischemic and 14 nonischemic, 35 males and 19 females, aged 65 +/- 10 years. Plasma sTNFR-I values (nv3 pg/ml) and serum lipid fractions were determined in each patient and the prevalence of anemia (Htor = 41% in men; Htor = 38% in women) was established. Left ventricular ejection fraction (LVEF) was determined by using 2D echo.sTNFR-I was increased in patients with heart failure--222.79 +/- 97.08 pg/ml. Anemia was found in 40.74% of the patients, sTNFR-I being significantly increased in patients with anemia (242.82 +/- 49.12 pg/ml) compared to patients without anemia (194.9 +/- 117.3); p0.05. TChol (152.63 +/- 55.4 vs 177.81 +/- 38.52 mg%), LDLChol (101.47 +/- 42.4 vs 113.59 +/- 28.3 mg%) and TG (96.22 +/- 59.12 vs 132.09 +/- 96.55 mg%) were insignificantly lower in patients with anemia. Patients with anemia and low LVEF did not present higher sTNFR-I values (236.548 +/- 47.2) compared to patients with LVEF40% (245.75 +/- 52.1). A weak negative correlation r = -0.31 was noted between sTNFR-I and Ht in anemic patients and also between sTNFR-I and TChol (r = -0.31), LDLchol (r = -0.28), TG(r = -0.22). No correlation could be established between TChol, LDLchol, TG and Ht.In patients with heart failure, increased sTNFR-I as an expression of chronic inflammation is correlated with both anemia and low serum lipid fractions even if the exact nature of the relationship has yet to be established. There is no direct correlation between anemia and low serum lipid fractions.

To investigate if apoB, apoA-I and apoB/apoA-I ratios are independent risk factors for coronary heart disease and to determine their value in relationship with serum lipid fractions in evaluating the risk of coronary events.We carried out a comparative observational study on 289 subjects divided into two groups: 144 subjects with old myocardial infarction, and 145 subjects without coronary heart disease, but with cardiovascular risk factors. None of the subjects received lipid-lowering drugs in the previous 3 months.The mean values of lipid fractions were lower in subjects with myocardial infarction than in subjects without coronary heart disease: total cholesterol (186.06 +/- 48.11 vs. 206.93 +/- 42.28 mg/dl, p = 0.0001), LDL-cholesterol (118.57 +/- 42.95 vs. 129.53 +/- 39.75 mg/dl, p = 0.023), HDL-cholesterol (43.64 +/- 12.32 vs. 50.48 +/- 21.09 mg/dl, p = 0.0008) and triglycerides (145.38 +/- 62.74 vs. 167.56 +/- 82.11 mg/dl, p = 0.01). The plasmatic levels of apoB were higher in subjects with myocardial infarction (1.12 +/- 0.57 vs. 0.86 +/- 0.27 g/l, p = 0.0001), but the apoA-I was lower (1.31 +/- 0.47 vs. 1.40 +/- 0.39 g/l, p = 0.101). The multivariate analysis indicated that plasmatic concentrations of apoB over 1.7 g/l are closely correlated with myocardial infarction (OR 3.96; 95% CI 2.87-5.02, p = 0.001) independent of other covariables such as age, smoking, diabetes, hypertension, lipid CT/HDL-C and the LDL-C/HDL-C ratio. The protective effect of apolipoprotein A1 against cardiovascular events after the adjustment for other cardiovascular risk factors (OR 0.72; 95% CI 0.57-0.83, p = 0.004) was also independent in multivariate analysis.These results highlight the significance of apoA-I and apoB in the evaluation of the cardiovascular risk. From this point of view, their predictive value is superior to that of serum lipid fractions. The data suggest that the determination of apoA-I and apoB is useful enough to be introduced in current clinical practice.

Both heart variability (HRV) and heart rate recovery (HRR) after exercise are considered to reflect the sympathetic-vagal balance and low values of them have negative prognostic significance, especially in ischemic patients. The main goal of the research was to establish if there is a correlation between HRR and HRV in ischemic patients and if interchangeability between them is possible. There were studied 63 patients with ischemic heart disease: old myocardial infarction, stable angina. unstable angina and silent ischemia. All patients performed exercise stress testing, the heart rate recovery being calculated as the difference between peak heart rate and the rate determined at one minute after the exercise was stopped. The "time-domain" HRV parameters SDANN, SDNN, RMSSD were automatically calculated during a 24 hours Holter ECG monitoring. The mean values were HRR: 39.24 +/- 17.47 beats/min (abnormal in 6% of the patients); HRV: SDNN-112.75 +/- 37.87 msec, SDANN-103.02 +/- 33.25 msec, RMSSD-50.21 +/- 48.15 msec (low HRV in 68.3% of the patients). There was no significant correlation between HRR and HRV's parameters (p0.05). There was no significant difference between HRR's mean in subjects with normal or abnormal values of HRV parameters (p0.05). Thus, in our study, the HRV values cannot be predicted by the determination of HRR, HRV parameters being more sensible than HRR to reveal increased sympathetic drive.

A significant relationship between autonomic nervous system function and cardiovascular mortality, including sudden death, has been reported. Loss of heart rate variability (HRV) is a strong predictor of mortality in patients postinfarction or with heart failure, but also in diabetes mellitus (DM) patients. The evaluation of the cardiovascular autonomic neuropathy in diabetes mellitus is done with the help of some non invasive tests, and lately with a 24 hour Holter monitoring. We aimed to analyze the parameters of HRV in 87 patients with established diagnosis of type II diabetes mellitus according to their fasting glucose levels over 120 mg/dl in at least two measurements. They were subjected to routine examination: ECG, 24-hour ECG, echocardiography, chest X ray and laboratory tests. HRV parameters were altered in 62 patients, despite the fact that echocardiography showed minor changes and normal ejection fraction in some cases. Overall HRV is markedly depressed in diabetes mellitus (DM). Diabetes patients had lower values for time-domain and frequency-domain parameters than controls (p

With the development of modern civilization and with continuous changing of job characteristics, occupational stress becomes increasingly important. Physicians are an exposed category and they are prone to develop stress-related disease and risk behaviors.We conduct a study among 118 physicians. The Romanian version of Job Content Questionnaire was mailed to all the subjects. We investigate the main scales of JCQ: decision latitude (DL), psychological job demands (PJD) and social support (SoS), along with the prevalence of risk behaviors, depression and sleeping problems.The final response rate was 112 (94.9%). The differences between women and men are significant for psychological demands (36.55 versus 32.9, P0.01), decision latitude (73.83 versus 67.05) and skill discretion (36.47 versus 34.6). Age positively correlated with SD (r = 0.40), DA (r = 0.40) and PJD (r = 0.29) in women and negatively with CoS (r = -0.39) in men. PJD negatively correlated with SS (r = -0.5) and CoS (r = -0.28) in women and with CoS (r = -0.54) in men. Smoking (32% women and 56% men) and sedentary behavior (over 60% women and men) positively correlated with PJD and negatively with social support in both men and women.The issue of professional stress is very important in modern medicine. Age and gender can be determinants of job strain, but also of job characteristics. Many studies have shown positive relations between job strain, and some harmful habits such as tobacco smoking and sedentary lifestyle; we have to outline again the importance of organizational factors in managing both stress and satisfaction at workplace.

The research considers the hypothesis that stressful professions, such as engine driver, influence the morbidity and mortality through cardiovascular diseases and favour some harmful habits with an impact upon cardiovascular morbidity.There were selected for study 496 engine drivers, males, and a control group of 305 males. They were questioned about: name, address, family history, pathological personal history, alcohol intake, smoking, diet habits, physical activity, sleeping hours and stress perception. There were measured: height, weight, blood pressure. There were determined: fasting plasma glucose, cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol.Hypertension was registered in 23.5% of the engine drivers and in only 9.5% the control group (P0.05). Dyslipidemia was noted in 57.4% of the engine drivers and 52.45% of the control group. Prevalence of smoking and overweight was higher in the control group. Unhealthy dietary patterns and physical inactivity were present in both groups, the circadian rhythms were altered only for engine drivers and questionnaires for stress perception showed higher irritability in the control group.The prevalence of some risk factors is higher for engine drivers, but for the others it is not. Also it seems that professional stress favours some harmful habits such as tobacco smoking, but the control group smokes more and they are inactive individuals with a great amount of irritability. The results do not totally sustain the idea we started from, that engine driver is a stressful profession; it seems that the effort/reward imbalance is more important than job-demand itself.

Several studies suggested the role of the genes of the rennin-angiotensin system in the pathogenesis of essential arterial hypertension.We investigated 100 consecutive hypertensive patients (42 males and 58 females; mean +/- SD age, 55.14 +/- 9.49 years) for M235T and T174M polymorphisms. Seventy six normotensive patients (28 males and 48 females; mean +/- SD age, 54.94 +/- 9.56 years) formed the control group.M235T and T174M polymorphisms were analyzed using PCR-RFLP methods.The carrier frequency of M235T polymorphism in the AGT gene was 73% in hypertensive patients and 34.21% in normotensive patients (OR 5.2, 95%CI [2.72-9.93], p0.01, chi2 test). The carrier frequency of T174M polymorphism in the AGT gene was 42% in hypertensive patients and 11.84% in normotensive patients (OR 5.39, 95%CI [2.41-12.01], p0.01, chi2 test).Essential arterial hypertension is associated with polymorphisms in the AGT gene, M235T and T174M.

It is not well known what should be the benefits of a prolonged physical rehabilitation program after an acute myocardial infarction.Our study is an open, randomized comparison of a long-term versus a standard rehabilitation program. Sixty-seven patients with acute myocardial infarction were included in an outpatient physical rehabilitation program of 6-8 weeks. Of these, 22 randomly selected patients continued the program until the 36th month (Group A). Twenty-five of the others were rechecked after 36 months, and represented the controls (Group B). For both groups, at the end of this period, a cycloergometer exercise test evaluated the exercise capacity of subjects and an echocardiogram was performed to determine left ventricular systolic and diastolic function.The maximal exercise capacity increased from 147 +/- 13.8 W to 178 +/- 16.4 W in Group A (p0.01), but it decreased from 144 +/- 13.2 to 132 +/- 12.8 W in group B. Functional aerobic impairment decreased from 29 +/- 2.7% to 22 +/- 2.1% in Group A, but it increased from 26 +/- 2.5% to 37 +/- 3.8% in Group B. The ejection fraction and diastolic function parameters were not significantly modified during the 36 months, for both groups.Long-term physical rehabilitation is useful in patients after an acute myocardial infarction to increase effort capacity, but left ventricular performance is not significantly changed.

Ischemic preconditioning is generally a short duration phenomenon, but during acute myocardial infarction a better inhospital outcome of patients with previous angina suggests that the effect of ischemic preconditioning could be longer than it was considered until now. It was also demonstrated that during successive exercise stress testings (ET) ST depression became lesser as a consequence of ischemic preconditioning. We investigated the possible occurrence of ischemic preconditioning during rehabilitation of ischemic patients. There were studied 43p with old myocardial infarction or stable effort angina, 29 men and 14 women, aged 33-68 years, divided in two groups: group I (19p) was included in a cardiac rehabilitation programme (15-20 sessions) and group II (24p) was not. All the patients were submitted to two ET at a month interval, for group I before and after cardiac rehabilitation programme. The peak-effort level was significantly greater for group I (80.26 +/- 7.2w vs 93.42 +/- 8.3w p0.05) but not for group II (65.5 +/- 5.8w vs 72.91 +/- 6.5w p0.05) during the two ET. The double product (21.573 +/- 3122 vs 24.168 +/- 3423 for group I and 23.551 +/- 3100 vs 21.000 +/- 2752 for group II) was not significantly different (p0.05) during the two ET. The same unsignificant modification was noted for maximal ST depression for group II (1.458 +/- 0.32 vs 1.166 +/- 0.21 mm p0.05) but not for group I patients in which maximal ST depression during the second ET was significantly less than during the first ET (1.52 +/- 0.23 vs 0.736 +/- 0.12 mm p0.05). Because cardiac rehabilitation does not influence the ischemic threshold and because the lesser maximal ST depression during the second ET was noted at the same, or even greater, double product (MVO2), we consider that it can be attributed to ischemic preconditioning.

to compare the acute effect of ACEI and ARB's upon the plasmatic endothelin level in heart failure patients.There were studied 30 patients with congestive heart failure, III-IV functional NYHA class, that were not under ACEI or ARB's treatment. In all the patients the endothelinl-21 plasmatic level was determined. After this, 20 patients, representing group I, received a single dose of 1 mg trandolapril, and 10 patients, representing group II, received a single dose of 40 mg telmisartan. After 24 hours, the plasmatic endothelin 1-21 level was determined again.The mean endothelial plasmatic level was similar in both groups (group I: 0.358+/-0.04 fmol/ml; group II: 0.345+/-0.038). After 24 hours, the endothelin level decreased to 0.295+/-0.03 fmol/ml for group I (p0.05) and to 0.287+/-0.029 fmol/ml for group II (p0.05), suggesting that both ACEI and ARB's are equally efficient in decreasing endothelin. The initial endothelinl-21 level was inversely correlated with LVEF (r = -0.989), and the degree of the decrease of endothelinl-21 after both ACEI and ARB's is directly correlated with the initial endothelinl-21 level (r =0.64).The acute administration of ACEI and ARB's in heart failure patients decreases the endothelin level, both categories of drugs having the same effects.

We studied the relationship between Chlamydia pneumoniae antibodies, C-reactive protein (CRP) and interleukine 8 (IL-8) in 87 patients with ischemic heart disease: 29 patients with acute myocardial infarction, 18 patients with unstable angina pectoris and 40 patients with stable effort angina. We determined in all patients IgG and IgA antibodies to Chlamydia pneumoniae, CRP and IL-8. Species specific antibodies to Chlamydia pneumoniae (IgG and IgA) were detected by indirect ELISA technique (Savyon Diagnostics Ltd, Israel). Interleukine-8 measured by a commercially available ELISA kit (CLB, Amsterdam, The Netherlands). CRP was determined by radial immunodiffusion (Mancini). The IgG antibodies were present in 25 patients (29%), the greatest percentage being noted in patients with unstable angina pectoris (50%). The IgA antibodies were present, as a sign of chronic Chlamydia pneumoniae infection, in 56% of the patients with IgG antibodies. CRP was positive in 52% of the 25 patients with positive IgG antibodies, but in only 34% of the 62 patients without IgG antibodies (p0.01). IL-8 was positive in 12% of the patients with IgG antibodies, and in 21% of the patients without IgG antibodies but the difference is not significant (p0.05). It is concluded that there is a relationship between the presence of the Chlamydia pneumoniae infection and inflammatory reaction in patients with ischemic heart disease, but the neutrophils are not implied in this process.

The statins have a moderate lowering effect upon triglycerides, one hypothesis suggesting an inhibitory effect upon liver VLDL synthesis. Because VLDL synthesis is related to other hepatic protein synthesis we studied the effect of Simvastatin upon serum cholinesterase activity and factor VII activity, which are also synthetized at hepatic level.39 patients with ischaemic heart disease, proved by coronarography and moderate hypercholesterolaemia received for two months 20 mg Simvastatin (Zocor). The value of total Co, LDLCo, HDLCo, triglycerides, serum cholinesterase activity and factor VII activity were determined before and after treatment, by standard methods.Triglycerides were, together with total Co, significantly lowered during the two months treatment with Simvastatin, but the values of serum cholinesterase and factor VII activity were not significantly modified. This suggests that moderate doses of Simvastatin do not depress liver protein synthesis.Simvastatin does not lower the triglycerides level through depression of liver protein syntesis, other mechanisms being probably involved.

Animal studies show that nitric oxide is involved in delayed ischaemic preconditioning.To determine whether plasma nitrates/nitrites (NOx-, as measure of nitric oxide) are modified by two consecutive effort tests and whether these changes translate into clinical improvement.There were studied 22 patients with ischemic heart disease, who performed two effort tests at 24-hour interval. Plasma NOx- level was determined and compared before and after both stress tests. Peak effort, double product at peak effort and maximal ST segment depression were considered clinical end-points and were compared between the two tests.Plasma NOx- increased slightly after the first exercise test compared to pre-test value (17.05 +/- 1.6 vs. 15.38 +/- 1.4 micromol/ml). In turn, after the second test a significant rise of NOx- level (23.65 +/- 2.2 vs. 15.10 +/- 1.3 micromol/ml, p0.03) was noticed. The pre-test value was practically identical between the two tests. Peak effort and double product at peak effort remained unchanged between the two tests. Although the ischaemic stress was the same, ST depression was significantly lower (p0.01) at the second test (0.85 +/- 0.06 vs. 1.73 +/- 0.16 mm).Our study shows an increase of plasma NOx- level after the second of two consecutive exercise stress tests at 24 hour interval, along with a decrease of electrocardiographic consequences of approximately the same ischemic stress. These findings are consistent with experimental data in animals, which point to nitric oxide as both trigger and effector of ischaemic preconditioning.

It was suggested recently that ischemic preconditioning can occur in clinical practice. We investigated this hypothesis in 26 patients with old myocardial infarction (MI) or stable angina pectoris, subjected to two successive exercise testings at 1 hour interval. The ST depression was significantly lesser during the second exercise testing (1.83 +/- 0.12 mm, vs 1.02 +/- 0.14 mm p0.01) at the same double product (DP) (24.877 +/- 1206 vs 24.711 +/- 1152 p0.05) and peak effort (76.92 +/- 6.63 w vs 75.96 +/- 6.27 w p0.05). The improvement was attributed to ischemic preconditioning.

Recent studies suggested an improving of left ventricular (LV) systolic function during exercise training in patients with old myocardial infarction. Twenty patients with old myocardial infarction (3-6 weeks) were included in an exercise training programme (mainly cycloergometer) for 2 to 8 weeks. Before and after the exercise training programme, the effort capacity and LV systolic function were determined through exercise testing on cycloergometer and echocardiography. The peak effort raised from 4.39 to 5.27 METs (p0.05) and the difference DAF-DAM was reduced from 25% to 12% (p0.05). The double product (DP) at peak effort raised nonsignificantly (4.91%, p0.05), but at submaximal effort levels DP decreased significantly on each effort step (12.16%, p0.05). In turn, LV systolic function calculated parameters were practically the same before and after the exercise training programme. (EDD 54.3 vs 5.3 mm, ESD 39.3 vs 38 mm, EDV 160 vs 169 ml, ESV 60.6 vs 54.8 ml, EF 54.1% vs 57.8%, SF 27.6% vs 31.2%). It is concluded that exercise training raised the effort capacity in patients with old myocardial infarction, mainly through peripheral mechanisms, LV systolic function being unchanged. It is also important that exercise training have not any detrimental effect upon LV systolic function and consequently exercise training programmes can be applied and can be useful also in patients with old myocardial infarction and impaired LV systolic function.

There is no correlation between left ventricular (LV) systolic function and effort capacity of the patients with acute or old myocardial infarction (MI). On the other hand, some recent studies suggest such a relationship for LV diastolic function. Twenty-five patients with old MI were submitted to a maximal symptoms limited exercise testing (ET) and to an echo Doppler examination; functional aerobic impairment (FAI), myocardial aerobic impairment (MAI), maximal exercise capacity (METs NYHA class), isovolumic relaxation time (IVRT), E and A wave velocity, E/A rate being calculated. There is a negative significant correlation between MAI and E velocity (r = -0.68), but not between MAI and A velocity or IVRT. The data sustained the correlation between LV diastolic dysfunction and myocardial ischemia, but not with effort capacity of the patients, the last one being determined mainly by other factors. The LV diastolic function indices were modified in anterior but not in inferior MI, in relation with the amount of myocardial necrosis. It is concluded that, like LV systolic function, LV diastolic function does not correlate with the effort capacity of the patients with MI, but it represents a good predictor of the severity of myocardial ischemia mainly in anterior MI.