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Aortic stenosis is one of the leading causes of valvular disease requiring surgery or transcatheter intervention, with a rising prevalence due to the aging population. Current guidelines recommend transcatheter aortic valve implantation (TAVI) as the first-line treatment for patients with symptomatic severe aortic stenosis and high surgical risk. The indications for TAVI have expanded to low-surgical-risk patients due to increased operator experience and improved implanted devices with a dramatic reduction of complications. Considering the limited durability of bioprostheses, TAVI-in-TAVI procedures have been successfully performed as an alternative to surgery.

În prezent, insuficiența cardiacă (IC) reprezintă o provocare majoră în domeniul medical, afectând un număr semnificativ de persoane la nivel global. Cu toate că cercetările anterioare au adus contribuții valoroase, ultimele descoperiri și abordări aduc în prim-plan noi perspective asupra acestei afecțiuni complexe. Din cele analizate se evidențiază o creștere a incidenței IC, în special în rândul persoanelor mai tinere, cu perspective de creștere semnificativă a numărului de internări în viitor. Factorii de risc pentru IC sunt legați de stilul de viață nesănătos și de condiții medicale precum fibrilația atrială, boală arterială coronariană și hipertensiunea arterială. Pentru diagnostic, investigațiile paraclinice, alcătuit din electrocardiogramă și ecocardiografie, sunt esențiale, iar dozarea peptidelor natriuretice plasmatice poate oferi indicii valoroase suplimentare. Prognosticul pacienților cu IC variază în funcție de tipul de IC, fiind influențat de factori ca vârsta, sexul și comorbidități.

Obezitatea este un predictor independent al bolilor cardiovasculare, cu un risc crescut în prevenția primară, dar conform mai multor studii a fost demonstrat efectul potențial protector al obezității atunci când coexistă cu boala cardiovasculară, fenomen numit „paradoxul obezității”.În timp ce cercetările anterioare au demonstrat că mediatorii inflamatori au fost asociați cu o supraviețuire mai scurtă, efectul inflamației asupra asocierii dintre obezitate și insuficiența cardiacă nu a fost luat în considerare. Se cunoaște că țesutul adipos are un rol crucial în reglarea inflamației și homeostaziei metabolice, însă unele aspecte ale inflamației cronice au și efect adaptativ sau compensator în anumite condiții la persoanele obeze.În acest context, este important să investigăm mecanismele efectului protector a obezității în relație cu insuficiența cardiacă pentru a înțelege acest paradox și pentru a dezvolta strategii de tratament mai eficiente.

With advancements in screening, diagnosis, and treatment, cancer-related mortality is declining, and life expectancy for cancer patients is increasing by up to 30%. However, these patients often face increased cardiovascular risks due to hypertension, metabolic syndrome, and type 2 diabetes, as well as the cardiotoxic effects of cancer therapies. Chemotherapy drugs like anthracyclines, trastuzumab, and 5-fluorouracil can hurt the heart through oxidative stress, apoptosis, and mitochondrial dysfunction. This can cause heart failure, coronary heart disease, and arrhythmias, among other problems. Cardiovascular rehabilitation (CR) has emerged as a key strategy to mitigate these effects. Studies involving breast cancer patients and other cancer populations have demonstrated that CR programs, involving high-intensity interval training and moderate-intensity exercises, improve cardiorespiratory fitness and reduce cardiovascular risks in cancer patients. Despite challenges such as patient reluctance due to distance from specialized centers, telerehabilitation has proven to be a viable alternative. CR not only improves peak VO2 but also reduces systemic inflammation and promotes muscle mass gain while lowering mortality and healthcare costs associated with post-cancer therapy complications. Multidisciplinary involvement-integrating cardiologists, oncologists, psychologists, and nutritionists-enhances outcomes, improving both cardiac fitness and quality of life for cancer patients. Further research highlights the need for early intervention and customized CR programs to minimize cardiovascular toxicity and optimize pa tie nt reco very post-chemothera py. [ABSTRACT FROM AUTHOR]

Heart failure (HF) cannot be characterized as a condition/ disease in its own but is clinically described as a syndrome in which severe dysfunction leads to the inability of the cardiovascular system to maintain adequate blood circulation. From a clinical point of view, heart failure is the syndrome characterized by signs of stasis (pulmonary and/or systemic) and low cardiac output, occurring in most cases secondary to the evolution of a disease with cardiac involvement. There are limited and specific mechanisms by which heart disease can lead to cardiovascular failure. HF represents the onset of several phenomena that may be simultaneous or sequential and can be systematized into: circulatory failure, with decreased tissue perfusion; congestive manifestations by increased pulmonary and/ or systemic venous pressure; myocardial failure, specifically alteration of myocardial systolic and/or diastolic function. [ABSTRACT FROM AUTHOR]

Cardiac resynchronization therapy (CRT) has become part of the standard of care for symptomatic patients with heart failure, reduced ejection fraction (HRrEF), and wide QRS, despite optimal medical therapy. Device technology, operator experience, and post-implant optimization on follow-up have significantly improved CRT response during the last decade. In parallel, conduction system pacing (CSP) has emerged as a new and potentially better tool for maintaining physiological ventricular activation in patients with antibradycardia pacing, as well as an alternative for dyssynchrony correction in HFrEF patients. The current review focuses on cardiac dyssynchrony pathophysiology and correction methods, clinical evidence on CRT and CSP as therapies for cardiac dyssynchrony, and the role of each according to clinical evidence and current guidelines for HFrEF treatment.

Heart failure is one of the most complex pathologies and most prevalent diseases, with around 64 million people affected globally (2% of the total adult population). In the initial phase of heart failure, studies have shown that the autonomic nervous system is in a state of imbalance, with an increase in the influence of the sympathetic nervous system on the heart. Persistence of long-term activation of the autonomic nervous system produces a decrease in the levels of myocardial catecholamines and also promotes down-regulation of beta-1 receptors. This article is a systematic review of papers from four well-known and important scientific databases on the subject of power spectral analysis of ECG Holter monitoring in patients with heart failure. The PRISMA technique was used to identify the most relevant articles on this subject, and their results were presented based on importance of their use for the diagnosis of heart failure, for risk stratification of sudden death or arrhythmias, for the evaluation of certain treatments used, or for other possible pathophysiological mechanisms involved in the evolution of the disease. [ABSTRACT FROM AUTHOR]

Left ventricular hypertrabeculation is a recently described ventricular phenotype characterized by the alternation of excessive trabeculations with deep intertrabecular recesses that communicate with the left ventricular cavity but not with the coronary circulation.

În lucrare este prezentat sumarul literaturii, în care se aduc rezultatele cercetărilor referitor la parametrii ecocardio- grafici pentru detectarea precoce și monitoringul cardiotoxității tratamentului antitumoral. În timp ce fracția de ejecție a ventriculului stâng este în prezent cel mai utilizat indice pentru cuantificarea funcției cardiace în cardio-oncologie, există o serie de indici în curs de cerecetare pentru a se dovedi valoarea lor prognostică în apariția evenimetelor cardiace adverse în timpul terapiei cancerului, cum ar fi indicii derivați din metoda Doppler, parametrii speckle trancing, rata deformării cât și parametrii derivați de ecocardiografia tridimensională, ce pot oferi o sensibilitate suplimentară și o valoare prognostică substanțială pentru ulterioarele evenimente cardiovasculare adverse.

We present the case of a 61-year-old male patient, with no medical history, who was presenting for an anterior chest pain, which appeared suddenly during an effort, accompanied by palpitations, fatigue and dyspnea Physical examination revealed the presence of a 4/6 systolic murmur with maximal auscultation at the apex and radiation in the left axilla. Echocardiographic evaluation revealed diagnostically suggestive elements for severe posterior mitral valve prolapse without any rupture, color Doppler showing severe mitral regurgitation, a tricuspid valve prolapse, tricuspid regurgitation grade III and pulmonary hypertension. Coronary angiography revealed coronary arteries without hemodynamically significant lesions, and Holter ECG/24-hour monitoring detected atrial fibrillation in 44% of the monitoring time. In this context, the possible causes of the anterior chest pain were: microvascular angina, traction on the chordae or pulmonary hypertension. The patient had a surgical indication for mitral valve replacement or reconstruction. The department of cardiac surgery undergoes mitral valve replacement with a mechanical prosthesis with a favorable outcome. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a major public health problem characterised by a high rate of hospitalisation and death. The risk is maximal for patients admitted with acute heart failure (AHF). New therapies with solid proof of mortality reduction in both groups of patients with reduced and preserved ejection fraction (EF) are now available (valsartan/sacubitril and SGLT2 inhibitors).

Our goal was to characterize a cohort of heart failure patients with and without COVID-19 in terms of demographics, comorbid conditions, treatment regimens, lab test results and outcome.

Introduction. Diabetic cardiomyopathy is a distinct condition in diabetes and is independent of atherosclerotic coronary disease, having as an effect over time the onset of heart failure. Objective/Aims: This paper aims to analyze, based on the existing data in the specialized literature, the main myocardial structural changes in the diabetic patients as well as the specific electrophysiological changes and their clinical impact Materials and Methods: The study is based on articles published in MEDLINE/PubMed and Google Scholar. Results. Discussion. It has been shown that even from the pre-diabetic stage there is cardiometabolic damage followed by myocardial hypertrophy and progression to heart failure. However, in the early stage of diabetes, myocardial damage is discrete. As the metabolic disease progresses, the myocardial structural damage becomes irreversible Conclusion: The active self-monitoring of glycemic values as well as the imaging evaluation by cardiac ultrasonography of all patients with metabolic syndrome even in the presence of normal glycemic values, in order to initiate the early initiation of specific antidiabetic therapy in order to prevent the occurrence of cardiovascular complications specific to this metabolic pathology. [ABSTRACT FROM AUTHOR]

Insuficiența cardiacă atestă o prevalență de 26 milioane în populație, astfel constituind o prioritate globală pentru sănătate. Publicațiile actuale atestă că sindromul fragilității (SF) atinge 79% în insuficiența cardiacă și este un predictor independent al mortalității prin boli cardiovasculare. În studiu a fost evaluată fragilitatea prin scorul Edmonton auto-raportat de către pacienți și indexul comorbidităților Charlson la 36 pacienți spitalizați cu insuficiență cardiacă cronică cu vârsta medie 66,58±1,65(44-86) ani, inclusiv 20(55.6%) femei 16(44.4%) bărbați. Sindromul fragilității de diferit grad de severitate a fost constatat la 16(45,5%) vs 20(55.5%) pacienții non-fragili cu insuficiență cardiacă cronică cu vârsta medie 62,25±2,53 vs 70,05±1,87 ani în ambele grupuri, respectiv. Pacienții fragili au menționat mai frecvent scăderea activității fizice pe parcursul ultimii luni 14(87.5%), vs 12(60.0%) cazuri non-fragili. Calitatea somnului a fost diferită în grupuri, astfel că pacienții fragili au mai frecvent o durată a somnului ≤5 ore - 9(56.3%) cazuri, pe când în grupul non-fragili au predominat cei cu 7-8 ore de somn 8(40.0%) pacienți. Valoarea medie a Indicelui comorbidităților Charlson a constituit 5,3±0.5 puncte.

Introducere. Insuficiența cardiacă (IC) este un factor de risc bine determinat pentru mortalitate și morbiditate în perioada precoce după intervenție chirurgicală cardiacă. Ne-am propus să analizăm evoluția fenotipului clinic al IC la etapa precoce după suportarea unei operații pe cord. Materiale și metode. Studiul a inclus 126 pacienți consecutivi cu IC cronică stabilită, care au urmat programul de reabilitare cardiacă după suportarea unei intervenții chirurgicale pe cord (62,23±8,59 ani, 67,5% bărbați). Subiecții au fost divizați în 3 grupuri în funcție de fenotipul clinic de IC: grupul 1 - IC cu fracția de ejecție (FE) a ventriculului stâng (VS) redusă (IC-FErVS), grupul 2 - IC cu FE VS ușor redusă (IC-FEurVS) și grupul 3 - IC cu FE VS prezervată (IC-FEpVS). Toți pacienții au fost investigați complex prin electrocardiografie, ecocardiografie transtoracică, test de mers plat 6 minute și evaluarea nivelului seric al NT-proBNP. Rezultate. Preoperator, 23,9% de pacienți au avut IC-FErVS, 24,8% - IC-FEurVS și 51,3% - IC-FEpVS. Analizând evoluția fenotipului de IC în perioada postoperatorie precoce, s-a observat că majoritatea pacienților au rămas în cadrul aceluiași grup. Totuși, dintre pacienții cu IC-FEurVS preoperator, la 22,2% bolnavi s-a atestat IC-FEpVS la etapa postoperatorie precoce, iar la 22,2% dintre bolnavi s-a determinat IC-FErVS, p

Scop. Estimarea in vitro a efectelor IL-10 în diverse modele experimentale de insuficiență cardiacă. Material si metode. Insuficiența cardiacă (IC) a fost indusă la șobolani prin administrarea i/p a Dx în doză cumulată de 16 mg/kg sau prin administrarea de izoproterenol (i/p 2 ori la distanța de 24 ore) în doză de 150 mg/kg. IL-10 a fost administrată i/p zilnic timp de 7 zile după modelarea IC în doză unică de 50 mkg/kg. Efectele funcționale au fost testate utilizând modelul de perfuzie a cordului izolat în condiții de efort hemodinamic și neuroendocrin. Rezultate. IL-10 a îmbunătățit în ambele modele HF la cote similare capacitatea inimii privind adaptarea la efort prin volum și rezistență, cel mai important efect în acest context fiind creșterea vitezei de relaxare și contracție izovolumică a cordului cu până la 19%. De remarcat că, IL-10 a condus la apariția efectului inotrop pozitiv la acțiunea ET-1, reviriment asociată cu creșterea debitului cardiac. De asemenea, IL-10 a crescut toleranța miocardului la ischemie și reperfuzie, fapt atestat prin reducerea semnificativă a presiunii telediastolice a ventriculului stâng. Totodată, IL-10 a crescut rezerva func- țională coronariană inerentă acțiunii acetilcolinei, iar fluxul coronarian a crescut cu 25-33% în stimularea parasimpatică. Concluzie. IL-10 îmbunătățește în mod analog performanțele funcționale ale inimii în diferite modele de insuficiență cardiacă experimentală în timpul eforturilor hemodinamice și neuroendocrine, subliniind faptul că inflamația este un fac-tor patogen important al IC, indiferent de tipul leziunii miocardice.

Tromboembolismul pulmonar (TEP) rămâne o boală fatală subdiagnosticată la nivelul unității de urgență care sugerează necesitatea unor abordări alternative noninvazive de diagnostic rapid. Rolul ecocardiografiei transtoracale (ETT) în embolia pulmonară acută rămâne incomplet definit. Din 80 de pacienți incluși in studiu cu diagnosticului preventiv de TEP 68 (85 %) au fost supuși examinării ETT în primele 24-48 de ore de spitalizare. Analiza ETT a stabilit semne de HTP: severă ( PSAP ≥55mmHg ) la 39 pts ( 57,3 %), moderată (PSAP ≥35-35mm, ariei AD>18,0cm2, hipokinezia peretelui liber al VD, reducerea indexul TAPSE2,8m/sec, diminuarea indexului S’m tisular a VD

Multiple studii au evidențiat că programul de reabiltare cardiacă îmbunătățește rezultatele pacienților cu boli corona- riene și este asociat cu o reducere semnificativă a mortalității în perioada de după infarctul miocardic acut. Mecanismele care stau la bază sub aspectul funcției complexe cardiace, fie sistolică sau diastolică sunt încă nu pe deplin studiate. Sunt puține studii care au evaluat funcția diastolică la pacienții cu insuficiență cardiacă după programul de reabilitare cardiacă. Majoritatea studiilor pledează pentru o creștere a volumului bătaie și a fracției de ejecție a ventriculului stâng cât și o descreștere în frecvența contracțiilor cardiace și a presiuniii arteriale diastolice. În acest articol am studiat efectul pro- gramului de reabilitare cardiacă la pacienții care au suportat procedura de revascularizare coronariană prin angioplastie percutanată asupra funcției diastolice și a dimensiunilor ventricolului stâng.

Managementul tuturor pacienților cu insuficiență cardiacă (IC) și fracția de ejecție a ventricului stâng redusă este bazat pe tratamentul medicamentos optim - ”cei patru granzi” care reduc mortalitatea (1-inhibitorii enzimei de conversie a angiotenzinei sau inhibitorul neprilizinei și a receptorului de angiotensină; 2-beta-adrenoblocantele; 3-antagoniștii receptorilor mineralocorticoizi; 4-inhibitorii cotransportatorului sodiu-glucoză-2). Pentru categorii selecte de pacienți se impun tratamentele cu dispozitive cardiace implantabile (CRT-P/D sau ICD) și operatiile pe cord (by-pass aorto-corona- rian, operații reparative pe valva aortică sau pe valva mitrală) ce ameliorează prognoza vieții, iar pentru formele de IC avansată se pot lua în considerare metodele de suport circulator mecanic și transplantul cardiac.

Heart failure is one of the leading causes of morbidity globally, with an increasing incidence. Heart failure is a progressive, multi-causal syndrome with three phenotypic manifestations: heart failure with reduced ejection fraction, heart failure with mildly reduced ejection fraction, and heart failure with preserved ejection fraction. The aims of therapeutic interventions are to alleviate symptoms, limit disease progression, increase quality of life, decrease hospitalisations and prolong survival. Evidence-based treatment guidelines propose optimised individual strategies based on high-quality data collected from clinical trials. New therapeutic classes have emerged in recent years for different forms of heart failure. [ABSTRACT FROM AUTHOR]

Background and aim. Modern society is experiencing an accelerated increase in the number of elderly people, to the detriment of children and young adults, in the context of declining birth rates, high adult mortality and increasing life expectancy due to advances in medicine. Cardiovascular diseases are becoming more common in the general population, representing the leading cause of death, being responsible for a third of the total number of deaths worldwide, and heart failure is the most common cause of hospitalization in patients over 65 years. Depression is one of the most common mental illnesses, presents different clinical pictures, which vary from person to person and in relation to age, being shown that there are somatic disorders due to depression, including cardiovascular disease. Materials and method. We studied 127 patients hospitalized in the Geriatrics Department of the Calarasi County Emergency Hospital, diagnosed with heart failure (HF), being divided into 2 groups: the first group, which included 63 patients with heart failure with mildly reduced ejection fraction and the second, which included 64 patients with heart failure with preserved ejection fraction. Results. The main risk factor present in the studied patients was dyslipidemia, which is present in 90% of patients with a mildly ejection fraction and in 88% of patients with a preserved ejection fraction. Hypertension was also present in 75% of patients in the first group and in 63% of those in the second group. Depression was present in 67% of patients with mildly reduced ejection fraction and in 64% of those with preserved ejection fraction. The degree of depression was higher among women, 11% of those with HF with mildly reduced ejection fraction and 14% of those with preserved ejection fraction had major depression. The degree of depression increases with age, patients over 80 years presented predominantly moderate-severe depression (41% of patients in the first group, and 50% in the second). Patients with NYHA class III heart failure had predominantly moderate-to-severe depression: 50% of patients with mildly reduced ejection fraction and 67% of those with preserved ejection fraction. Conclusion. Depression is an important independent risk factor for heart failure in the elderly patients. Due to the fact that the symptoms of the two pathologies are often similar, the diagnosis of depression can be difficult to make, which is why it should be investigated in all patients with heart failure. It is important to understand the peculiarities of the polypathology of the elderly, which often poses problems for the diagnosis and treatment of the clinician. [ABSTRACT FROM AUTHOR]

Introduction: Heart failure (HF) patients have palliative care (PC) needs comparable to those of cancer patients, but few receive PC. Several palliative care needs assessment tools have been used among patients with HF to identify their needs, but it is not clear which tool is the most appropriate to use, for patients with HF. Method: literature searches were conducted on systematic review articles, mixed review articles, clinical trials collected from platforms: PubMed, Cochrane Library, Medline Complete, Medline, EMBASE, Medscape, Google Scholar and SCI-hub, the websites of the instruments identified, as well as in the references and citations of the included studies. Studies were considered for review if they presented tools to assess the needs of PC for patients with HF. Results: Of the 20,300 unique articles 40 reported the use or development of screening tools specific to people diagnosed with HF and with potential PC needs. The accuracy of 46 tools was assessed in ten studies, which studies are presented; these tools varied significantly in their ability to identify HF patients with significant PC needs and included general and specific indicators for HF disease. Discussion: Of the 46 tools listed and reviewed, seven were represented by NAT: PD-HF (Needs Assessment Tool: Progressive Disease-HF), achieving the highest percentage of appearance in the literature reviews. The middle percentage is represented by NECPAL (NECesidades Paliativas - Palliative Needs) and RADPAC (RADboud indicators for PAlliative Care Needs) tools which appear in equal numbers each. None of the instruments included in this analysis met all psychometric criteria. Conclusions: This paper provides preliminary evidence for NAT: PD-HF as a potential strategy for the identification and management of physical impairments and psychosocial problems experienced by people with HF. NAT: PD-HF has relatively wide applicability in HF populations and is used for both patient identification and identification of patient needs. Further research is needed to identify standardized screening processes that are based not only on predicting mortality and deterioration, but also on anticipating PC needs and predicting the rate and trajectory of functional decline. [ABSTRACT FROM AUTHOR]

Scopul acestui studiu a fost în identificarea parametrilor clinici și paraclinici, care determină mortalitatea pacienților cu insuficiență cardiacă (IC) cronică după revascularizare coronariană. În studiu au fost incluși 180 pacienți cu IC cronică, CF II și III NYHA, după revascularizare coronariană. Tot lotul de pacienți a fost divizat în 2 grupuri: grupul 1 – 166 pacienții, care au supraviețuit pe perioada de supraveghere și grupul 2 – 14 pacienți decedați. Durata medie de supraveghere a pacienților a constituit 28,8±0,6 luni. În urma analizei statistice discriminante s-a selectat asocierea a 13 parametri, care a demonstrat cea mai înaltă sensibilitate prognostică pentru pacienții cu insuficiență cardiacă cronică după revascularizare coronariană: rata pacienților cu insuficiență avansată (gr. III – IV) a valvei tricuspide și valvei mitrale, anemie, accident vascular cerebral în antecedente, bronhopneumopatie cronică obstructivă și hipertensiune arterială, diametrul atriului stâng, clasa funcțională NYHA, genul pacientului, rata pacienților fumători, numărul leucocitelor în ser și rata de pacienți, care au administrat spironolactonă și statine, cu puterea de prezicere pentru supraviețuire de 93,6% și pentru mortalitate de 78,6%.

Asocierea hipertrofiei VS este un factor de risc independent pentru mortalitate și morbiditate cardio-vasculară, fiind un biomarcher al leziunilor multiple de organe-țintă. Remodelarea miocardului VS este manifestarea cea mai frecventă a afectării de organ-țintă, iar denervarea arterelor renale reprezintă o metodă inovativă în tratamentul hipertensiunii arteriale rezistente care prezintă interes nu numai ca o metodă de reducere suplimentară a tensiunii arteriale la pacienții rezistenți la terapia standard cu antihipertensive, dar atestă impact şi asupra indicilor remodelării miocardului VS. Articolul este o sinteza a studiului desfăşurat in Departamentul Hipertensiuni arteriale ale IMSP Institutului de Cardiologie, scopul căreia a fost elucidarea modificărilor structural-geometrice a cordului în contextul manifestărilor clinice. Acest studiu a demonstrat că sub influența ambelor scheme de tratament farmacologic s-a atestat o dinamică statistic semnificativă începând cu 6 luni, neatingând însă valorile normale de referință în comparație cu tratamentul minim invaziv prin DASAR, care a indus o superioritate absolută în revers-remodelarea miocardului VS.

În articol sunt prezentate rezultatele studiului retrospectiv al fișelor de observație și al rapoartelor morfopatologice a 29 pacienți diagnosticați cu insuficiență cardiacă asociată tumorilor primare sau metastatice ale pericardului. Insuficiența cardiacă congestivă a fost cea mai frecventă manifestare a tumorilor primare și metastatice ale pericardului, fiind refractară la tratament și cu evoluție nefavorabilă. Tumorile metastatice ale pericardului au fost diagnosticate în 96,5% de cazuri. Dintre localizările primare au prevalat cancerul glandei mamare și cancerul pulmonar. Diagnosticul definitiv a necesitat o abordare multimodală care a inclus atât studii imagistice, cât și evaluarea histopatologică.

În pofida progresului în managementul insuficienței cardiace, prognosticul rămâne rezervat. Estimarea riscului este dificilă din cauza spectrului larg de comorbidități din această populație. Cea mai importantă co-morbiditate, asociată cu creșterea mortalității este afectarea funcției renale. În acest studiu, ne-am propus evaluarea performanței prognostice a markerilor de afectare renală la pacienții cu insuficiență cardiacă cronică.

În articol sunt prezentate datele unui studiu clinic original desfășurat în Departamentul Hipertensiuni arteriale al Institutului de Cardiologie. Scopul principal al studiului a fost analiza corelativă între valorile tensionale și gradul de insuficiență cardiacă, apreciat prin nivelul plasmatic al NTpro-BNP și distanța parcursă la test „mers 6 minute” la pacienți cu hipertensiune arterială rezistentă și insuficiență cardiacă cu fracția de ejecție păstrată.

În lucrare este prezentat sumarul literaturii, în care se aduc rezultatele cercetărilor consacrate corelației hipertensiunii pulmonare și disfuncției de ventricul drept la pacienții cu insuficiență cardiacă cu fracție de ejecție prezervată. Mai mult de 80 % dintre pacienții cu insuficiență cardiacă cu fracție de ejecție prezervată dezvoltă hipertensiune pulmonară, această combinație fiind asociată cu agravarea simptomelor și majorarea mortalității. Dezvoltarea hipertensiunii pulmonare la bolnavii respectivi este mai frecvent întâlnită la femeile vârstnice cu comorbidități, precum: hipertensiune arterială cu hipertrofie de ventricul stâng, cardiopatie ischemică, fibrilație atrială, obezitate, diabet zaharat, boli renale și pulmonare. Totuși, există o discrepanță între necesitatea unui tratament specific, efectiv, sigur și lipsa unor evidențe științifice puternice în acest domeniu.

Circa 50% din pacienţii cu semne şi simptome de insuficiență cardiacă cronică au funcţie sistolică normală sau aproape normală. Sunt cunoscute riscurile sporite de evenimente cardiovasculare şi mortalitate crescută la pacienţii cu insuficiență cardiacă şi fracția de ejecție preservată. Interesul sporit pentru insuficiența cardiacă cu fracția de ejecție preservată a condus la o explozie de cercetări clinice şi iniţierea mai multor trialuri în ultimii 20 de ani. În acest articol au fost elucidate date epidemiologice, fiziopatologice, trialuri existente şi studii clinice de perspectivă.

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We report the case of a 77-year-old patient admitted for worsening dyspnea, palpitations and dizziness. The electrocardiogram (ECG) showed atrial fibrillation (AF) and left bundle branch block (LBBB). Clinical examination showed hypoxemia (SaO2 87% room air), jugular venous distension, pitting edema, arrhythmic heart sounds, a splitting of the second heart sound and systolic murmur (III-IV/VI) in the tricuspid area. Transthoracic echocardiography (TTE) showed right heart dilation, moderate tricuspid regurgitation, biventricular hypertrophy, and a dilated coronary sinus (CS). Agitated saline injection in the left basilar vein raised a suspicion of persistent left superior vena cava (PLSVC) to coronary sinus fistula. Transesophgaeal ecocardiography (TOE) showed a superior sinus venosus defect, with bidirectional shunt, and persistence of LSVC. CT angiography confirmed and detalied the malformation features. A low suspicion for congenital defects in older adults presents a significant diagnostic challenge. Multimodality cardiac imaging is critical in determining the etiology of right heart dilation, and knowledge of the anatomy and physiology of various shunt lesions is essential for clinicians. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to present the first Romanian case-series of patients with heart failure with reduced ejection fraction (HFrEF), supported with the newest generation of cardiac contractility modulation (CCM) device. Methods and results: 16 patients (15 men), aged 66.6±7.49 years, were supported with OPTIMIZER® smart IPG CCMX10 device and followed-up for an average duration of 385.75±326.32 days. The etiology of HF was ischemic in 13 patients (81%), 8 patients (50%) had atrial fibrillation, mean creatinine clearance value was 55.8±13.87 ml/min, and 5 patients (31,2%) had diabetes mellitus. All patients were supported with an implanted cardio verter-defibrillator (ICD), while 5 patients (31.2%) had cardiac resynchronization therapy (CRT) on top. The pharma cological treatment has been optimized in all patients. Six months after implantation, the LVEF has increased from 25.93%±6.21 to 35.5%±4.31 (p=0.00002), NYHA class improved from 3.18±0.4 to 1.83±0.38 (p<0.0001), and exercise tolerance evaluated with 6-minute walking test (6MWT) increased (from 321.87±70.63m to 521.41±86.43m; p<0,00001). Three patients (18,7%) died during the follow-up period after 48, 108 and 545 days (one non-cardiac death). Conclusions: Cardiac contractile therapy is a feasible, safe, and useful therapy for patients with HFrEF whose symptomatology is not improved with optimal standard therapy. [ABSTRACT FROM AUTHOR]

Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease, especially Heart failure (HF). Central sleep apnea (CSAS) share several pathophysiological features with obstructive sleep apnea, but each with a unique pathology and specific treatment. There are considerably fewer published patient profile reports in association with CSAS-HF. The treatment for association CSAS-HF varies and depends on the etiology of respiratory disorder and leaves considerable room for improvement for future investigations. Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates. At this time, it is also uncertain whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology. Therefore, this retrospective study highlights the interaction between CSA and HF, with particular attention to age differences, a frequent reported risk factor, in a Romanian large cohort. Were included adults >18 years old, with sleep apnea syndrome (apnea-hypopnea index-AHI>5 per hour of sleep with at least 50% of central on polygraphy-PG and after on polysomnographic-PSGsleep study) in the presence of sleep symptoms, with known HF with preserved LVEF (>40%) in a previous internal/cardiology department. Were excluded those < 18years old, with other sleep apneas (obstructive, mixed orcomplex), other sleep disorders (by PSG), inadequate PSG records, or patient refusal. Anthropometric data, clinical findings, vital parameters, comorbidities, treatments and investigations (see below) were analyzed in the population and also in subgroups. The majority of this study population (12 patients) were male, older, with normal weight, symptomatic and comorbidities. As many as 90% of the patients presented severe CSAS and 77.8% associated Cheyne-Stokes respiration (CSR). The comparative analysis of the subgroups in which according to the literature the associated pathologies manifest differently showed that there have not been noted major differences or statistically significant correlation between these two groups and cardiac outcomes. Still, in the group over 65 years we found that people were more predisposed to suffer from high BP, judging by the elevated level of the systolic blood pressure value, and another relevant comorbidities were atrial fibrillation, had more apneas and hypopneas during sleep and severe CSA were the most common. Following titration, AHI, central apnea index, desaturation index decreased with clinically significant. This study appeals to the importance of sleep health, an even more important aspect for Romania, where this associations underreported and even unrecognized, and thus the general condition of patients can worsen. Further research, based on other criteria of difference, is needed as the evidence is still lacking regarding the longterm consequences of CSA and long-term impact of current strategies in HF population. [ABSTRACT FROM AUTHOR]

The medical therapy of heart failure (HF) has been traditionally based on inhibiting the main pathophysiologic mechanisms: the adrenergic and renin-angiotensin-aldosterone systems. Introducing the therapeutical triad of beta-blockers, angiotensin converting enzyme inhibitors and mineralocorticoid receptor antagonists in the treatment of HF patients almost 40 years ago marked an important step since they were not only addressing the symptoms of HF, but also the prognosis and life-expectancy of these patients. Although many discoveries have been made in the past years, no other therapeutic class was able to increase survival among HF patients, until recently, when th SA e benefits of modulating the natriuretic peptide system were brought to the attention of the scientific community. Increasing the levels of natriuretic peptides with Sacubitril/Valsartan (SV) led to several benefits for the reduced ejection fraction HF population, including less long and short term complications, increased survival and a reduced symptom burden. As this article is being written, it is estimated that more than 2.8 million patients are being treated with SV(1). Therefore, SV is an important and validated therapy for HF patients and internists should be aware of its indications, benefits and management in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose. The present study aim to identify whether an unhealthy lifestyle, defined as active smoking and hypersodium diet, leads to a higher likelihood of readmission of patients with heart failure (HF) during the vulnerable period or to an increased risk of in-hospital mortality and one year mortality. The vulnerable period for patients with heart failure refers to the first 90 days after discharge. Material and methods. This was a retrospective study conducted in the Cardiology Clinic of the Emergency Clinical Hospital “Bagdasar Arseni” in Bucharest, between October 2018 and October 2019 and enrolled 500 patients with heart failure. After applying the inclusion and exclusion criteria, 198 patients remained eligible for inclusion in this study. Demographic data as well as those related to the presence of complications during hospitalization and in-hospital mortality were collected from the observation sheet and from the database of the “Bagdasar Arseni” hospital. Data on readmission in the first 90 days after the reference discharge and one year mortality were assessed by telephone and using the Hipocrate software. All data obtained were entered into the Microsoft Excel database and were statistically processed using the Python program. Results. An unhealthy lifestyle increase the probability of readmission by 12% and the risk of in-hospital mortality by 17%. Younger patients tends to have an unhealthy lifestyle compared to the elderly (p-value = 0.000). Men have an unhealthy lifestyle (p- value = 0.000). Professionally active people tend to have an unhealthy lifestyle (p-value = 0.02). No statistically significant differences were observed in terms of the unhealthy lifestyle of people from urban or rural areas. Conclusions. The present study highlights the fact that an unhealthy lifestyle increase the mortality rate and readmissions in patients with heart failure. From the analyzed data, our study is the first study that measured the cumulative impact of modifiable risk factors related to lifestyle on readmission in the vulnerable period. We believe that these results could be the basis of a future study that would include a larger number of a patients and more modifiable factors. [ABSTRACT FROM AUTHOR]

Diabetic cardiomyopathy (DCM) is a distinct condition with a pathogenesis that is independent from coronary artery disease and can lead to heart failure in diabetic patients. In some patients, diastolic dysfunction may progress to heart failure with reduced ejection fraction and results in systolic heart failure. Since DCM is highly prevalent in the asymptomatic diabetic patients, screening for its presence and the diagnosis of functional myocardial abnormalities (echocardiography and other cardiac imaging techniques) in diabetic populations can have a favorable impact on the progression to chronic heart failure.

Scopul studiului nostru constă în evaluarea comparativă a rezultatelor reabilitării cardiace în faza I (în staționar) la pacienții cu insuficiență cardiacă cronică după revascularizare coronariană în funcție de clasa funcțională NYHA. În studiu au fost incluși 263 pacienți cu insuficiență cardiacă cronică, internați pentru reabilitare cardiacă după revascularizare coronariană. Tot lotul de pacienți a fost divizat în 2 grupuri în funcție de clasa funcțională (CF) NYHA a insuficienței cardiace: grupul 1 – 155 pacienții cu clasa funcțională II NYHA și grupul 2 – 108 pacienți cu clasa funcțională III NYHA. Pacienții au fost supravegheați pe perioada aflării în staționar, unde s-a efectuat examenul clinic, ECG, Ecocardiografia, radiografia cutiei toracice, test cu efort fizic dozat mers plat 6 minute, investigații de laborator. Calitatea vieții pacienților incluși în studiu a fost determinată prin aplicarea chestionarului Minnesota LHF Q. Toleranța la efort fizic, determinată în test mers plat 6 minute, s-a majorat concludent la pacienții din ambele grupuri de studiu la sfârșitul perioadei de reabilitare în staționar, dar distanța parcursă în acest test a fost semnificativ mai mare la pacienții cu CF II NYHA comparativ cu cei cu CF III NYHA, iar scorul fizic al chestionarului Minnesota LHF a avut o valoare medie mai mică în grupul de pacienți cu CF II NYHA. Durata medie a fazei I (în staționar) de reabilitare cardiacă a fost semnificativ mai mare la pacienții cu CF III NYHA, comparativ cu cei cu CF II NYHA.

Introduction Heart failure (HF) with reduced ejection fraction is a complex condition requiring comprehensive diagnostic workup and management. Case presentation A 62-year-old male presented with resting HF and multiple syncopes. Medical history: former smoker, type 2 diabetes, advanced peripheral artery disease. Physical examination: congestive HF, obesity, discrete exophthalmia, grade 1 goitre, BP 110/70 mmHg, HR: 180 bpm. ECG: atrial fibrillation (AF), 180 bpm, RBBB, ST depression in anterolateral leads. CXR: pulmonary congestion, right pleural effusion. Blood analysis: D-dimer >5ng/ml, NTproBNP 12.900 pg/ml, hsTnI 550 ng/L, low TSH, fT3, fT4 4xULN. Cardiac echo: LVEF 20%, diffuse hypokinesis. HF symptom improvement with decongestion and rate control medication. Methimazole started on day 3. Intermittent conversion to sinus rhythm (SR) on day 7. ECG Holter (day 8-9): alternating moderate/high-rate AF and SR, 5-8 second sinus pauses and 1 syncope. LVEF 35% (day 9). Dual-chamber pacemaker implanted on day 10. Discharged on day 18. 2-months follow-up: LVEF 45%, NTproBNP 1.100 pg/ml, SR, HR 65-70 bpm, NYHA I HF. Conclusion Cardiac and non-cardiac aggravating factors can contribute to HF worsening. Unmasking these factors is essential, as specific treatments can markedly improve the patient's clinical status. [ABSTRACT FROM AUTHOR]

Cardiac amyloidosis is an underdiagnosed condition associated with a poor prognosis, likely leading to heart failure, malignant arrhythmias and death. A high index of suspicion should be maintained in regards to clinical, electrocardiographic and echocardiographic changes, as the "gold standard" for diagnosis, endomyocardial biopsy is often unavailable. Another challenge resides in the limited treatment options, with a relative contraindication to the use of betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and digoxin. We are presenting the case of a patient with heart failure, in whom echocardiography with speckle tracking and cardiac magnetic resonance played an important role in diagnosing cardiac amyloidosis and underlying multiple myeloma. Despite a poor prognosis based on biomarkers (troponin and NTproBNP) and global longitudinal strain, as well as ineligibility for stem cell transplant the patients survived for another 5 years. [ABSTRACT FROM AUTHOR]

Background: Advanced heart failure (HF) represents a clinical entity encompassing severely symptomatic HF with severely dysfunctional left ventricles (LV). The single most important parameter for defining severe LV dysfunction and indicating the prescription of evidence-based therapies is LV ejection fraction (EF). We sought to investigate the hemodynamics by echocardiography in a cohort of advanced HF patients during a hospitalization for HF decompensation and assess the relevant differences when compared to a control cohort of asymptomatic patients with minor structural/functional cardiac abnormalities. Methods and results: In this prospective study we selected 18 advanced HF patients and 12 asymptomatic pre- HF patients with only minor structural/functional abnormalities. The 2 groups were clearly delineated by size parameters (end -systolic and -diastolic diameters and volumes respectively, with very low p values p<0.0001). Hemodynamic parameters were significantly different as well in the advanced HF group vs the 'pre-HF' group, including: ventricular-arterial coupling 1.745 vs. 0.895, p=0.0007; cardiac power output 0.762 vs. 0.932, p=0.044, systolic times ratio 0.406 vs. 0.200, p=0.0001. There were no significant differences for neither effective arterial elastance (Ea) and nor for cardiac index. Inside the advanced HF group, no correlation between LVEF and other parameters were found and none of these parameters could predict outcome. We observed a highly skewed variation of Ea in advanced HF patients. Conclusion: Among the most severe HF patients, the hemodynamic interaction between the dysfunctional LV and the compensatory response of the peripheral system is heterogenous and cannot predict outcome by single parameters. In these patients, assessment of cardiac performance should no longer rely on LEVF alone. [ABSTRACT FROM AUTHOR]

Cardiac amyloidosis (CA) still represents a frequently missed cause of heart failure with preserved ejection fraction (HFpEF). In the light of many new and effective therapies for immunoglobulin light chain amyloidosis (AL) and for transthyretin amyloidosis (ATTR), screening for amyloidosis as an important and potentially treatable diagnosis under the HFpEF becomes mandatory. A step-by-step algorithm for CA in HF patients was already provided by the guidelines. This review summarizes the role of all imaging modalities and biomarkers in the diagnosis and prognosis of both subtypes, the algorithm for diagnosis of CA, and new therapeutic options. It is the first Romanian publication which intends to bring altogether the current recommendations in the diagnosis and management of CA. [ABSTRACT FROM AUTHOR]

Objectives. We will review current concepts regarding bioenergetic decline in heart failure (HF). In the heart, the high energy demand must be met by continuous ATP generation. Cardiac energetic machinery orchestrates the ATP production by using oxidation of multiple energetic substrates including fatty acids (FA), glucose, amino acids and ketone bodies. The normal heart is metabolically flexible and able to use different energetic fuels during physiologic or pathologic circumstances to better match the energy demand. Mitochondria have critical role in maintaining cardiac metabolic flexibility. Methods. We analyzed the scientific literature pertinent to HF and mitochondrial dysfunction. Results. The general consent is that metabolic flexibility is lost in HF with either preserved or reduced ejection fraction (HFpEF and HFrEF, respectively). The prototype of HFpEF is the metabolic heart disease that is characterized by increased reliance on FA oxidation for ATP production and decreased glucose oxidation, while HFrEF presents a decreased FA oxidation. Both types of HF are associated with a decline in mitochondrial function leading to increased oxidative stress, abnormalities in the redox status and energy deficit. Conclusion. Current research is committed to find novel metabolically targeted therapeutic approaches to improve energetic metabolism and alleviate HF progression. [ABSTRACT FROM AUTHOR]

Purpose. NT proBNP is routinely used in the diagnosis and prognosis of HF. The study aimed to determine whether the value of NT proBNP can be used in hypertensive patients to detect patients at risk of developing HF and whether in these patients medical management guided by NT proBNP can prevent the development of HF. Material and methods. We included 275 hypertensive patients who presented to the Bagdasar-Arseni Emergency Hospital for cardiological consultation for a period of 3 years. Patients diagnosed with heart failure or left ventricular systolic dysfunction and patients with symptoms of heart failure at enrollment were excluded. We divided the patients into 2 groups, a control group and an intervention group. Patients in the intervention group were managed according to the NT proBNP value, and patients in the control group received standard treatment. Results. The objectives pursued at 3 years were: diagnosis of heart failure, systolic or diastolic dysfunction of the left ventricle and hospitalization for cardiovascular pathology. After 3 years, in the control group there were 34 patients (25.4%) who developed HF, compared to 24 patients (17.0%) in the intervention group. In the control group, 51 patients (38.1%) were diagnosed with LV systolic dysfunction compared to 37 patients (26.2%) in the intervention group. Regarding diastolic LV dysfunction, in the control group there were 83 patients (61.9%), and in the intervention group there were 73 patients (51.8%). Also, the rate of hospitalizations for cardiovascular pathology was higher in the control group 47 patients (35.1%) compared to 27 patients (19.1%) in the intervention group. Discussions. Hypertensive patients in the intervention group, who were managed according to the NT proBNP value, had a lower incidence rate of heart failure, LV systolic or diastolic dysfunction, or hospitalizations for cardiovascular events than in the control group. Conclusions. The value of NT proBNP may be useful for detecting hypertensive patients at risk of developing HF, and NT proBNP-guided medical management may prevent or delay the onset of HF. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a burden for the healthcare system. The incidence will increase significantly due to the aging of po pula tion, which is associated with multiple comorbidities. Anemia and iron deficiency are common in patients with HF, their etiology being often multifactorial. The screening for anemia and iron deficiency is recommended as soon as pos si ble. There are often no targeted investigations, therefore a significant proportion of cases are underdiagnosed. The ma nagement of patients may focus on identifying and correcting the cause. Anemia can occur due to nutritional deficiencies, infla mmation, renal failure, bone marrow dysfunction, neuro hormo nal activity, treatment and hemodilution. The appropriate the ra py for the patients with anemia and HF will contribute to the improvement of life quality. The only recommended iron product is ferric carboxymalose administered by intra venous infusion. Under the appropriate treatment, the pa tients showed an increase in effort tolerance, with an im prove ment in symptomatology and a lower number of hos pi ta li za tion days. The management of these cases is handled by a multidisciplinary team consisting of a general prac ti tio ner, a cardiologist and other specialists if the patient has other comorbidities. The role of the general practitioner is essential, as he can perform proper screening, prevention and management, developed by a multidisciplinary team, in order to reduce the cardiac morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background. Heart failure is a rare but serious diagnosis in pediatric patients. While in newborns and infants congenital heart disease is commonly the cause, in older children and in adolescents cardiomyopathies (primary or secondary) take the lead. The diagnosis may be difficult to establish, as the symptoms are nonspecific (especially in young ages). Case presentation. A previously healthy 16-year-old girl had been experiencing heart failure symptoms for the past 10 months, with gradual worsening of symptom severity. Upon evaluation, a diagnosis of class III Ross/NYHA heart failure due to dilated cardiomyopathy with severe left ventricular systolic dysfunction was established. Standard heart failure medication was initiated, alleviating congestion and partially controlling symptoms. There was no family or personal history of heart disease. The patient reported excellent exercise tolerance previously. No exposure to potentially toxic agents has been identified. The initial tests could not establish a definite cause, although a possible respiratory tract infection at the onset of symptoms and certain cardiac magnetic resonance imaging features could suggest previous eosinophilic myocarditis. Current literature to guide the diagnosis process and treatment options are discussed. Conclusions. Dilated cardiomyopathy is rare but severe in children. Even the typical symptoms may be downplayed or ignored for long periods, delaying the diagnosis; a high index of suspicion is therefore required when other more common disorders seem unlikely or have been ruled out. The possible underlying causes vary with age and differ from the adult population. An etiological diagnosis is frequently difficult to achieve, but must nonetheless be sought out, as it may allow for targeted therapy and improve prognosis. However, long-term outcome is usually grim. [ABSTRACT FROM AUTHOR]

CRT represents the transition from the heart rhythm therapy, started more than 60 years ago with the first pacemakers, to the optimization therapy of myocardial contractility in heart failure. It is estimated that about a quarter of the population of patients with heart failure have electrical and mechanical criteria for cardiac asynchrony. They are the target of resynchronization therapy. The current indications for resynchronization therapy use basic selection criteria, without having high predictive power in terms of response to treatment. About one-third of patients undergoing resynchronization are found to be non-responsive to therapy. In this study we tested a new direction in our effort to increase the number of post-resynchronization beneficiaries, using markers of oxidative stress in patients with heart failure, assessed before and after intervention, with promising results. [ABSTRACT FROM AUTHOR]

Heart failure represents a progressive condition characterised by a decrease in the pump function of the heart. This disease affects 4.7% of the Romanian population with the age above 35 years old. The aim of this medical literature review is to identify the main objectives and the necessary interventions for an appropriate management of patients with advanced heart failure and palliative needs. Materials and method. The evaluation of 8 articles which brought information about the detection of the prognostic factors, the interventions for symptoms management, the evaluation of end-of-life state, the family support and the role of the multidisciplinary team. Results. The objectives of the caring process depend, on one hand, on the stage of the disease and, on the other hand, on the patient's life and living conditions. These items are in a continuous change, therefore the communication with the patient is essential for adapting the patient's expectations and the caring process objectives to the patient's condition. The initiation of palliative care and the detection of the prognostic factors are important elements for the care management of the patient with heart failure. The symptoms management has to combine both pharmacologic and nonpharmacologic interventions. The end-of-life stage of these patients is a period with a great psychoemotional strain that requires certain interventions in order to improve the quality of life and to reduce hospitalization. For achieving these goals, the professionals must involve and educate the family members on what caring for a palliative patient means, whether the patient is at home or in a palliative care bed unit. Conclusions. Taking care of a heart failure patient with palliative needs is a common situation for the general practitioner. In order to provide a proper care to this type of patients, the general practitioner needs a management plan based on specific and efficient interventions with positive results. [ABSTRACT FROM AUTHOR]

Objectives - The European Cardiac Resynchronization Therapy Survey II is the second CRT survey of the Heart Failure Association and European Heart Rhythm Association designed to observe implantation and follow-up practices across European countries. These data allow, for the first time, a valuable insight on CRT implantation strategies for Romanian patients. Methods - A total of 214 patients undergoing CRT-P/CRT-D implantations in 7 Romanian implantation centers were included in the survey. A one-time online case report form including data on implantation indication and procedure was completed for each implantation attempt. Results - Romanian patients were younger than the other European patients (p<0.001), had more severe symptoms of heart failure, lower ejection fraction and wider QRS complexes. More than half of the patients had non-ischemic cardiomyopathy. Most of the patients were in sinus rhythm, with a median intrinsic QRS duration of 163±24 ms. Echocardiography was the imaging method most often used and the median left ventricular ejection fraction was 24.9±8%. In comparison with other European countries, CRT-D devices and multipolar ventricular leads were more rarely implanted (p<0.001). Conclusions - In Romania indications regarding CRT implantation follow the most recent ESC guidelines, but the ratio of CRT-D devices in Romania is lower than in the other European countries and patients with more severe heart failure receive CRT. CRT should be considered earlier in heart failure patients in order to improve outcome. [ABSTRACT FROM AUTHOR]

Cardiac resynchronization therapy is a common option in adult patients with heart failure and conduction abnormalities. Specific selection criteria for pediatric population are lacking. We report the case of a 14-year-old boy with significant pulmonary regurgitation subsequent to corrected tetralogy of Fallot and single chamber permanent pacing which presented with heart failure symptoms. Careful management was planned by a Heart Team including pediatric cardiologist, cardiac surgeon, interventional cardiologist and anesthesiologist. After undergoing cardiac surgery with complete correction of the pulmonary regurgitation and upgrade to a triple chamber pacing, the patient was discharged in good clinical status. [ABSTRACT FROM AUTHOR]

Chronic heart failure and obesity are two conditions which despite all the advances made in the recent years, still represent two of the leading causes of morbidity and mortality worldwide. Moreover, a well-known fact is that the risk of sudden cardiac death, mostly related to malignant arrhythmias is higher in apparently healthy obese individuals in comparison with lean subjects. On the other hand, obese heart failure patients bring unique challenges in the diagnosis of heart failure, having a better prognosis than their normal or underweight counterparts. Taking into account the above-mentioned existing data, there are questions regarding whether cardiac arrhythmias such as atrial fibrillation or ventricular arrhythmias in this population have certain evolutive particularities. This paper describes various mechanisms of cardiac arrhythmias found in obese heart failure patients, such as myocardial architectural changes, neurohormonal and paracrine modifications. [ABSTRACT FROM AUTHOR]